bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of Facial Pain After Internal Carotid Artery Stenting: The Role of External Carotid Artery Overstenting
Authors: Łyko-Morawska Dorota , Szkółka Łukasz , Serafin Michał , Senderek Emila , Kiczmer Paweł , Górska Magdalena , Kuczmik Wacław
Published: December 2024

Background: The external carotid artery (ECA) supplies blood to various facial and neck regions and may contribute to collateral cerebral perfusion. With the rise in carotid artery stenting (CAS) as a treatment for carotid stenosis, ECA overstenting has become a common procedure feature. This study aimed to assess the incidence, characteristics, and duration of facial pain following CAS, hypothesizing that ECA overstenting may contribute to facial pain. Materials and Methods: This prospective study included 55 patients treated with CAS for internal carotid artery (ICA) stenosis at a single center. Patients’ facial pain was evaluated using a numeric rating scale (NRS) before, immediately after, and 24 h post-CAS. Patient data, including demographics, comorbidities, and procedural details, were analyzed to assess the relationship between ICA stenosis degree, ECA diameter changes, and facial pain incidence. Results: CAS was associated with intraoperative facial pain in 27.27% of patients, with 7.28% reporting residual pain 24 h post-procedure. Pain occurrence was significantly higher in patients with lower ICA stenosis (p = 0.04). The median ECA diameter decreased from 4.11 mm to 3.16 mm (p < 0.001) after CAS, with ECA overstenting observed in 96.4% of cases. No significant relationship was found between pain severity and stent width or length. Conclusions: This study highlights that CAS significantly decreases the diameter of ECA. Additionally, ECA overstenting might be associated with perioperative and postoperative facial pain, emphasizing the need for careful monitoring of ECA patency following CAS.
Menstrual Disorders in Adolescence: Diagnostic and Therapeutic Challenges
Authors: Anthon Christiane , Steinmann Marcel , Vidal Angela , Dhakal Carolin
Published: December 2024

Background: Adolescence is the period of life between the ages of 10 and 19. This period is essentially dominated by puberty. The first menstruation, called menarche, occurs, on average, at the age of 12–13. The period after menarche, especially the first 2 years, is characterized by anovulatory cycles, which can be accompanied by menstrual irregularities. This review aims to describe the current status of the diagnostic and therapeutic challenges of the physiological and pathological causes of menstrual irregularities in adolescence and evaluates the benefits from interdisciplinary collaboration to ensure optimal care. Methods: A systematic literature search was conducted in the PubMed database in April 2024 using the following term: “menstrual disorder adolescence”. A total of 1724 abstracts were screened, and relevant articles from the last 10 years were included. In addition, a supplementary topic-relevant literature search of the guidelines of the European Society of Human Reproduction and Embryology (ESHRE) and the guidelines of the Arbeitsgemeinschaft der wissenschaftlichen medizinischen Fachgesellschaft (awmf) was carried out. Results: In addition to cycle irregularities that occur physiologically as a result of anovulatory cycles in the context of the immaturity of the hypothalamic–pituitary–gonadal axis, there are other cycle abnormalities that can be classified as pathological and need to be recognized and treated. Conclusions: Increasing awareness of the various specialist disciplines of physiological and pathological cycle abnormalities in adolescence and interdisciplinary cooperation between them can have a positive influence on the quality of life of adolescent women with cycle abnormalities.
Continuous Epidural Versus Non-Epidural Pain Management After Minimally Invasive Esophagectomy: A Real-Life, High-Case-Load Center Experience
Authors: Boehler Sebastian , Huber Markus , Wuethrich Patrick Y. , Beilstein Christian M. , Arigoni Stefano M. , Furrer Marc A. , Borbély Yves , Engel Dominique
Published: December 2024

Background/Objectives: Esophagectomy is a key component of esophageal cancer treatment, with minimally invasive esophagectomy (MIE) increasingly replacing open esophagectomy (OE). Effective postoperative pain management can be achieved through various analgesic modalities. This study compares the efficacy of thoracic epidural anesthesia (TEA) with non-TEA methods in managing postoperative pain following MIE. Methods: A retrospective review was conducted on 110 patients who underwent MIE between 2018 and 2023. 1. TEA vs. 2. intravenous patient-controlled analgesia (PCA) alone vs. 3. transversus abdominis plane (TAP) catheter with PCA vs. 4. single-shot TAP block with paravertebral catheter (PVB) in combination with PCA were compared. The primary outcome was postoperative pain within the first 72 h, assessed using the numeric rating scale. Secondary outcomes included postoperative surgical complications (Clavien–Dindo classification (CDC)), patient satisfaction, and duration of induction and emergence, among others. Results: The incidence of an NRS > 3 during movement was 47.1%, 51%, 60.1%, and 48.3% for TEA, PCA alone, TAP + PCA, and PVB + PCA, respectively. For pain at rest, the rates were 8.3%, 4.3%, 11.2%, and 5%, respectively. High surgical complication rates were observed across all groups (CDC IIIa-V 31.6% overall), with patient satisfaction similarly high, regardless of the analgesic modality used (85% satisfied or very satisfied). No differences in the other secondary outcomes were observed. Conclusions: PVB combined with PCA offered analgesic efficacy and patient satisfaction comparable to TEA in managing postoperative pain following MIE.
Exploring the Role of Perfusion in Skin Graft Viability on the Scalp and Lower Limb: An Analysis of Graft Bed, Margin, and Donor Skin Using Laser Speckle
Authors: Pinho André , Brinca Ana , Vieira Ricardo
Published: December 2024

Background/Objectives: Reperfusion is a major determinant of skin graft viability. The contributions of the perfusion status of the wound bed, wound margin, and donor skin to the success of the skin graft are unclear. We aimed to evaluate the relationship between perfusion variables and graft necrosis extension on the scalp and lower limb. Methods: A prospective study was conducted on adults undergoing skin graft closure after skin cancer excision on the scalp (n = 22) and lower limb (n = 20). Perfusion was measured intraoperatively and non-invasively with laser speckle contrast imaging on the graft bed, margin, and donor skin. By day 28, graft necrosis extension was quantified. Results: On the scalp and lower limb, graft bed perfusion very strongly correlated with necrosis extension (r = −0.82, p < 0.001 and r = −0.94, p < 0.001, respectively). A significant correlation (r = −0.57, p = 0.01) between margin perfusion and necrosis extension was only observed on the lower limb. The donor skin perfusion and necrosis extension did not correlate in either location (p > 0.05). The graft bed perfusion explained 68% and 89% of the variation in necrosis extension on the scalp and lower limb, respectively. Regression models of necrosis extension based on graft bed perfusion were obtained. For each unit increase in the perfusion of the graft bed, a similar decrease in necrosis extension was observed on the scalp and lower limb (40 and 48 percentage points, respectively). Conclusions: Unlike the perfusion of the wound margin and donor skin, wound bed perfusion plays a significant role in skin graft viability and can predict necrosis extension.
Is Whole-Body Cryostimulation Useful in Modulating Spasticity in Adults with Cerebral Palsy? A Case Study
Authors: Piterà Paolo , Bigoni Matteo , Prina Elisa , Barrera Boris , Yavuz Duru Ceren , Verme Federica , Fontana Jacopo Maria , Priano Lorenzo , Mauro Alessandro , Capodaglio Paolo
Published: December 2024

Background: This case study investigates the effect of a five-session whole-body cryostimulation (WBC) cycle on a 55-year-old female patient with cerebral palsy (CP) and lower limb spasticity (LLS) with a typical diplegic gait pattern. CP is a common physical disability characterized by motor impairments, including spasticity, which significantly impacts mobility and quality of life. The current treatments for spasticity often have limited efficacy and considerable side effects, making alternative therapies like WBC an area of interest. Methods: The patient underwent a 10-day inpatient rehabilitation program integrated with five WBC sessions at −110 °C for 2 min. The treatment effects were assessed immediately before and after the five WBC sessions using the Ashworth Scale, Fugl-Meyer Assessment, H-reflex test, and gait analysis. Psychosocial outcomes were measured with the SF-36, WHO-5, PSQI, ESS, and BDI questionnaires. Results: Immediately after the WBC cycle, gait analysis showed increased walking speed (0.48 to 0.61 m/s left; 0.49 to 0.57 m/s right) and step length (0.30 to 0.38 m left; 0.30 to 0.35 m right). The H/M ratio in the H-reflex test improved, indicating a better neuromuscular efficiency. Psychosocial assessments revealed a 42.5% reduction in pain and a 24% improvement in overall quality of life and well-being. Discussion and Conclusions: The objective improvements in gait parameters and neuromuscular modulation, along with the subjectively reported enhancements in functional abilities, highlight the potential of WBC as a valuable addition to rehabilitation strategies for this population. Further research is needed to confirm these findings and assess long-term outcomes.
Neutropenia and Felty Syndrome in the Twenty-First Century: Redefining Ancient Concepts in Rheumatoid Arthritis Patients
Authors: Rodas Flores Jorge Luis , Hernández-Cruz Blanca , Sánchez-Margalet Víctor , Fernández-Reboul Fernández Ana , Fernández Panadero Esther , Moral García Gracia , Pérez Venegas José Javier
Published: December 2024

Objectives: To describe the frequency of neutropenia and Felty syndrome in patients with rheumatoid arthritis (RA) attended in routine clinical practice. Methods: We selected by randomization a sample of 270 RA patients attended from January 2014 to November 2022. Demographic, clinical, and neutropenia-related variables were collected from the electronic medical records. Neutropenia was defined as having an absolute neutrophil count (ANC) of less than 1500/mm3 once, and acute if it persisted for <3 months. Felty syndrome was defined as RA-related neutropenia, rheumatoid factor (RF) and/or anti citrullinated protein antibody (ACPA) positivity. Results: We found 50 patients who had at least one neutropenia episode, with an incidence of 18.5% (14.0–25.6%). Most were women, with age (mean, p25–p75) at the time of neutropenia of 61.5 (57.4–69.3) years, 85% RF+ and 76% ACPA+. The demographic and RA characteristics of patients with and without neutropenia were very similar, except for sex: most patients with neutropenia were women. The 50 patients had 99 episodes of neutropenia; 59% were acute. The lower ANC was 1240 (1000–1395) mm3, and most of the episodes were mild (74%). In 32% of cases, there was other cytopenia. The RA activity measured by DAS28 in patients with neutropenia was low, at 2.18 (1.75–2.97). A total of 82 of 99 neutropenia episodes were related to DMARDs, 60% to Anti-IL6 drugs in monotherapy, 13% to RA activity, 3% to infectious diseases and 1% to hematologic malignancy. There were five (1.8%) cases with Felty syndrome, but only one woman with the classic combination of RA, positivity of autoantibodies (RF and ACPA), neutropenia and splenomegaly. Conclusions: In the 21st century, neutropenia in RA patients is most commonly related to biologics, mostly IL6 inhibitors and methotrexate. Episodes are mild, acute, with low RA activity, and associated with severe infections in few cases. Felty syndrome is rare.
Project Initiate: A Clinical Feasibility Trial of Equitable Access to Early Neurodevelopmental Therapy
Authors: Trenkle Jessica , Liddle Alison , Boswell Lynn , Drumm Dawn , Barnes Denise , Jedraszko Aneta M. , Andrews Bree , Murphy Shannon , Msall Michael E. , Gaebler-Spira Deborah , deRegnier Raye-Ann
Published: December 2024

Background/Objectives: Despite evidence of the effectiveness of early intervention (EI) programs, eligible infants often experience delays in initiation of services or fail to receive services entirely. Disparities have been documented, including lower enrollment rates for infants with public insurance. The objective of this pilot study was to evaluate the feasibility of initiating home physical therapy (PT) services promptly after neonatal or cardiac intensive care unit (NICU/CICU) discharge for infants with public insurance and to assess early motor outcomes for children who received study therapy compared with a standard of care group. Methods: Infants were recruited if discharged from a study NICU/CICU, had public insurance, and were eligible for Illinois EI services. Infants living in Chicago (n = 46) received weekly home-based PT from a study therapist until 3–4 months corrected age (CA). Infants living outside Chicago received standard of care services and served as a control group (n = 14). At discharge, infants were referred to EI and underwent the Test of Infant Motor Performance (TIMP). Outcomes at 3–4 months CA included initiation rates for study PT and EI and follow-up TIMP testing. Results: By 3–4 months CA, 78% of the intervention group had received ≥1 PT session. In contrast, just 13% of the entire cohort had received any EI therapy. Infants who had 8–10 PT sessions in the first 3–4 months after discharge were more likely to have a change in the TIMP Z-score of >0.5 SD. Conclusions: Prompt transition to home therapy was feasible for infants with public insurance in an urban setting who may benefit most due to the potential for neuroplastic change. Addressing barriers identified in this study may assist in improving access to EI for young infants.
Wearable Cardioverter Defibrillator as a Treatment in Patients with Heart Failure of Various Aetiologies—A Series of Ten Cases Within the BIA-VEST Registry
Authors: Kazberuk Małgorzata , Pogorzelski Piotr , Kuźma Łukasz , Kurasz Anna , Róg-Makal Magdalena , Matys Urszula , Tokarewicz Justyna , Kralisz Paweł , Dobrzycki Sławomir
Published: December 2024

Background/Objectives: Sudden cardiac death (SCD) remains a major global health concern and represents one of the most common causes of mortality due to cardiovascular diseases. The wearable cardioverter–defibrillator (WCD) is an innovative, non-invasive medical device designed to provide continuous heart monitoring and immediate defibrillation in patients at risk for SCD. The study aimed to assess the efficacy of WCD usage in patients awaiting decision on therapy with implantable cardioverter–defibrillators (ICDs). Methods: We explored the clinical applications, benefits, and limitations of WCD usage within the BIA-VEST registry in Poland over the years 2021–2023. The study included 10 patients with a mean age of 49.1 ± 12.02 years. Results: All patients demonstrated good tolerance and compliance with the LifeVest WCD, wearing it for an average of 93.1 days, about 22.8 h per day (95.7% of the time). No interventions from LifeVests were recorded, and there were no effective, ineffective, or inadequate discharges. After the first follow-up echocardiography, five patients still required ICDs. Due to improved LVEF and overall condition in six out of ten patients undergoing WCD bridge therapy, ICD implantation was finally waived. Conclusions: The WCD acts as a bridge to therapy, such as ICD implantation or cardiac surgery, and may be particularly beneficial for patients with transient or evolving conditions, such as structural heart diseases and life-threatening ventricular arrhythmias.
Endovascular Repair of Spontaneous Rupture of Stent Graft Branch in Thoracoabdominal Aortic Aneurysm—Management, Case Study, and Review
Authors: Płoński Adam , Płoński Adam Filip , Chlabicz Michał , Głowiński Jerzy
Published: December 2024

Background: Stent-graft implantation is a widely recognized method for endovascular treatment of aortic aneurysms. In cases where the aneurysm involves the thoracic and abdominal aorta, repair including fenestrated and branched stent grafts provides a viable alternative. This approach, initially reserved for patients unsuitable for open surgery, has become preferred for anatomically appropriate thoracoabdominal aortic aneurysms. The Zenith t-Branch system has been extensively studied, demonstrating high technical success rates and acceptable mortality and morbidity. However, complications such as endoleaks, kinking, and stent-graft branch rupture remain significant challenges. Methods: We present the case of an 82-year-old male with a thoracoabdominal aortic aneurysm treated with endovascular aneurysm repair using the Zenith t-Branch. Four years post-implantation, he developed a spontaneous rupture of the stent-graft branch, leading to dangerous leakage and aneurysm sac enlargement. An urgent surgical intervention was performed, implanting additional Be-Graft into the damaged branch, restoring stent-graft continuity and revascularizing the superior mesenteric artery. Results: The procedure was completed successfully. We conducted a review of the latest literature on endovascular treatment of thoracoabdominal aortic aneurysms with particular emphasis on the possibility of repairing postoperative complications, especially endoleaks. Conclusions: While modern technologies have significantly improved outcomes, serious complications persist. Studies emphasize the importance of regular imaging follow-up for early complication detection and management. Continuous advancements in stent-graft technology aim to reduce complications further and improve outcomes. This case underscores the necessity of experienced operators in managing complex and rare complications and highlights the promising future of endovascular techniques in treating thoracoabdominal aortic aneurysms.
Reintervention for Acute Aortic Prosthesis Endocarditis: Early and Mid-Term Outcomes
Authors: D’Alonzo Michele , Chabry Yuthiline , Melica Giovanna , Gallien Sébastien , Lim Pascal , Aouate David , Huguet Raphaëlle , Galy Adrien , Lepeule Raphaël , Fihman Vincent , Pressiat Claire , Folliguet Thierry , Fiore Antonio
Published: December 2024

Objective: This study aimed to analyze the outcomes and challenges associated with surgical redo procedures following aortic valve replacement for acute infective endocarditis. While transcatheter aortic valve implantation is growing in terms of its utilization for degenerative bioprostheses failure, valve-in-valve procedures are limited in acute aortic endocarditis. Surgical interventions for aortic prosthesis endocarditis carry a significant risk, with a higher mortality and morbidity, often requiring concomitant complex procedures. Methods: This was a retrospective, monocentric, observational study. We identified 352 patients with infective endocarditis from the institutional database. After applying the inclusion and exclusion criteria, 54 patients who underwent surgical re-operation between 2016 and 2023 were included. Endpoints included early and late mortality, complications, and major adverse cardiac and cerebrovascular events (MACCEs). Results: From the cohort, predominantly male and with an average age of 71.9 ± 12.1 years old (79.6%), the following notable findings were derived: isolated aortic valve replacement was feasible only in 34 patients (63%) while more complex procedures were demanded in the other cases; the overall 30-day mortality rate was 18.5%, post-operative ECMO occurred in 9.3% of cases, and post-operative new stroke in 2.7%; the 5-year overall survival rate was 58.3 ± 18.6%, while freedom from MACCEs was 41.7 ± 19.7%. Another re-intervention was required in three patients during follow-up, with one case attributed to re-endocarditis. Conclusions: Despite advancements in surgical and perioperative care, redo procedures for acute infective endocarditis pose significant risks, as evidenced by the high 30-day mortality rate. However, the 5-year survival suggests a relatively acceptable outcome, underscoring the complexities and challenges inherent in managing this condition surgically.
Comparison of CytoSorb and Jafron HA330 Hemoadsorption Devices in Pediatric Oncological Patients with Sepsis: Retrospective Observational Study
Authors: Ryazanova Diana , Tobylbayeva Zaure , Mironova Olga , Kakenov Erken , Sazonov Vitaliy
Published: December 2024

Background: Pediatric sepsis presents a severe risk to immunocompromised children, especially those with cancer or pre-existing conditions, posing a significant threat to their lives. Cytokine hemadsorption has emerged as a promising therapeutic approach for managing sepsis and severe inflammatory conditions in critically ill patients. This innovative method involves eliminating pro-inflammatory cytokines from the bloodstream, targeting the underlying hyper-inflammatory response often seen in critical illnesses. Study aim: The study aim is to examine and compare the efficacy of HA330 and CytoSorb for extracorporeal blood purification in septic children with oncology. Methods: In this retrospective observational study, we examine 20 cases to assess the effectiveness of hemoperfusion therapy using hemoadsorption devices in pediatric septic patients with oncology. Our focus is on the use of HA330 and Cytosorb hemoadsorption devices, both designed to remove bacterial toxins and inflammatory agents from the bloodstream. Results: Our study reveals that hemoadsorption with HA330 and CytoSorb effectively treats septic children with oncological conditions. Conclusions: The presented findings suggest no statistically significant difference between the two devices in reducing the levels of the assessed parameters for extracorporeal blood purification in this patient population.
Associations Between Clinical Manifestations of SARS-CoV-2 Infection and HLA Alleles in a Caucasian Population: A Molecular HLA Typing Study
Authors: Tymoniuk Bogusław , Borowiec Maciej , Makowska Joanna , Holwek Emilia , Sarnik Joanna , Styrzyński Filip , Dróżdż Izabela , Lewiński Andrzej , Stasiak Magdalena
Published: December 2024

Background and Objectives: Severe COVID-19 still constitutes an important health problem. Taking into account the crucial role of HLA in immune reactions, evaluation of the impact of HLA on COVID-19 risk and clinical course seemed necessary, as the already available data are inconsistent. The aim of the present study was to compare the HLA profiles of patients with symptomatic SARS-CoV-2 infection and a healthy control group, as well as to compare HLA allele frequencies in patients with severe and non-severe courses of COVID-19. Materials and Methods: HLA classes were genotyped using a next-generation sequencing method in 2322 persons, including 2217 healthy hematopoietic stem cell potential donors and 105 patients with symptomatic COVID-19. Results: Symptomatic course of SARS-CoV-2 infection appeared to be associated with the presence of HLA-A*30:01, B*44:02, B*52:01, C*05:01, C*17:01, and DRB1*11:02, while HLA-C*07:04 and DQB1*03:03 seem to play a protective role. Moreover, we demonstrated that the severe symptomatic course of COVID-19 can be associated with the presence of HLA-B*08:01, C*04:01, DRB1*03:01, and DQB1*03:01, while HLA-DRB1*08:01 appeared to be protective against severe COVID-19 disease. Conclusions: Identification of alleles that are potentially associated with symptomatic SARS-CoV-2 infection as well as the severe course of COVID-19 broadens the knowledge on the genetic background of COVID-19 course and can constitute an important step in the development of personalized medicine.
Skeletal Muscle Measurements Based on Abdominal Computerized Tomography (CT) Predict Risk of Osteoporosis in Incident Hemodialysis Patients
Authors: Park Hwajin , Han Suyeon , Hwang Yunkyeong , Choi Wonjung , Hong Yu Ah , Chang Yoon-Kyung
Published: December 2024

Objective: Osteoporosis is prevalent in patients with chronic kidney disease (CKD), with risk increasing as CKD progresses, subsequently elevating fracture risk. While previous studies have shown a link between low skeletal muscle mass and osteoporosis in the general population, there is limited research exploring this relationship in patients with advanced CKD (stages 3-5D). This study aimed to evaluate whether skeletal muscle area (SMA), as measured by abdominal CT, is correlated with bone mineral density (BMD) in advanced CKD patients beginning hemodialysis. Methods: This single-center, retrospective cohort study included patients who started maintenance hemodialysis at Daejeon St. Mary’s Hospital from January 2018 to September 2021. Patients who underwent abdominal CT and BMD assessments within three months of dialysis initiation were enrolled, resulting in a sample of 87 individuals. Baseline characteristics were analyzed, with patients stratified by sex and SMA quartiles. Pearson’s correlation and multivariate regression analyses were conducted to the relationship between SMA and BMD T-scores. Results: The study cohort had an average age of 65.4 years, with 52.9% of participants being male. Male patients exhibited significantly higher SMA and BMD T-scores in both the lumbar spine and femur compared to female patients. SMA showed the strongest positive correlation with BMD at both sites (lumbar spine, r = 0.424; femur, r = 0.514; p < 0.001). Multivariate analysis identified SMA as an independent positive predictor of BMD, while alkaline phosphatase (ALP) was independently associated with lower femur BMD. In the SMA-based subgroup analysis, patients with lower SMA had significantly lower BMD T-scores and a higher risk of osteoporosis. Logistic regression indicated that patients in the lowest SMA quartile had substantially increased odds of osteoporosis compared to those in the highest quartile, with an adjusted odds ratio of 30.59 (p = 0.008). Conclusions: Lower skeletal muscle mass is significantly associated with lower bone density and a higher risk of osteoporosis in advanced CKD patients initiating hemodialysis. SMA, as measured by abdominal CT, may serve as a useful marker for identifying patients at elevated osteoporosis risk in this population.
Safety and Accuracy of Guided Interradicular Miniscrew Insertion: A Systematic Review and Meta-Analysis
Authors: Santmartí-Oliver Margalida , Jorba-García Adrià , Moya-Martínez Tania , de-la-Rosa-Gay Cristina , Camps-Font Octavi
Published: December 2024

Background: Achieving ideal anchorage is crucial in orthodontics for controlled tooth movement. Miniscrews (MSs) have improved skeletal anchorage, but freehand placement poses risks like root damage and limited precision. Guided techniques, including radiographic guides and computer-assisted methods (static [sCAS] and dynamic [dCAS]), were developed to enhance accuracy and safety. Objective: This systematic review and meta-analysis aimed to evaluate the safety and accuracy of MS placement using different guidance approaches. Materials: A systematic search up to March 2024 identified studies on guided MS insertion, assessing safety (root contact/damage) and accuracy (angular, coronal, and apical deviations) of guided vs. freehand placement. Two reviewers assessed the risk of bias and study quality using RoB 2 for RCTs, NOS for cohort studies, and an adapted tool for pre-clinical studies. Random-effects meta-analysis was performed for studies with common parameters, and safety outcomes were pooled using logit-transformed proportions. Heterogeneity was evaluated with I² and χ² tests. Results: Eleven studies (652 MSs) were included, though no dCAS studies were analyzed. The only RCT had “some concerns” regarding risk of bias, cohort studies ranged from medium to low quality, and most pre-clinical studies had high bias risk. sCAS significantly reduced root damage compared to freehand methods (OR = 0.11; 95% CI: 0.04–0.36; p < 0.001; I² = 1%) and reduced angular and linear deviations. Due to heterogeneity, no quantitative synthesis of accuracy outcomes was performed. Conclusions: sCAS improves the safety and accuracy of MS insertion compared to freehand and radiographic guide methods. These results highlight the clinical benefits of sCAS in orthodontics. Future studies should refine protocols and explore dCAS for further accuracy improvements.
Prevalence of Antiphospholipid Antibody Syndrome Among Patients with Recurrent Pregnancy Loss: Impact of the Revised 2023 ACR/EULAR Antiphospholipid Syndrome Criteria
Authors: Mercier Marion , Lescoat Alain , Pierre-Jean Morgane , Dumontet Erwan , Le Lous Maela , Belhomme Nicolas
Published: December 2024

Objectives: Current guidelines recommend systematic screening for rheumatic diseases (RDs), including antiphospholipid syndrome (APS), in patients with recurrent pregnancy loss (RPL). However, these recommendations are based on limited evidence, as data on the prevalence of RD in this specific population remain scarce. In particular, the impact of the recent update to the ACR/EULAR classification criteria for APS on the prevalence of RD among RPL patients has yet to be clarified. To address these gaps, this study aims to (i) assess the impact of the 2023 ACR/EULAR APS classification criteria in patients with recurrent pregnancy loss (RPL); and (ii) analyze the prevalence of RD in these patients. Methods: We conducted a retrospective cohort study at Rennes University Hospital. From January 2010 to December 2021, all patients referred to the Clinical Immunology Department for RPL were included. Patients were eligible if they had undergone a full RPL evaluation, according to guidelines. Results: We included 165 women with RPL. APS according to the Sydney criteria was found in 24 (14.5%) patients. No significant differences in obstetric history or clinical signs were observed between APS-positive and APS-negative individuals. Only two patients fulfilled the updated 2023 APS criteria, resulting in 163 (98.8%) patients being classified as having unexplained recurrent pregnancy loss (uRPL). Among them, 108 had a new pregnancy following uRPL, resulting in 87 (81%) live births and 21 (19%) recurrent miscarriages. We did not identify any prognostic factor associated with subsequent pregnancy outcomes, including the patients’ antiphospholipid biological profile. We found a prevalence of non-APS RD of only 2.4% in the study population, including systemic lupus erythematosus, rheumatoid arthritis, and Behçet’s disease. Conclusions: APS was identified in 14.5% of the patients based on the former Sydney criteria and 1.2% according to the revised criteria. The lack of clinical differences between APS and non-APS patients aligns with previously reported limitations of the Sydney criteria in accurately identifying aPLA-related RPL. According to the rarity of APS as per the updated criteria, future large collaborative trials will be needed to further characterize APS-related RPL patients and to determine the best treatment strategy for future pregnancies.
Invasive Cardiopulmonary Exercise Testing in Chronic Thromboembolic Pulmonary Disease; Obesity and the VE/VCO2 Relationship
Authors: Oliveros Estefania , Mauri Madeline , Pietrowicz Rylie , Sadek Ahmed , Lakhter Vladimir , Bashir Riyaz , Auger William R. , Vaidya Anjali , Forfia Paul R.
Published: December 2024

Background: Invasive cardiopulmonary exercise testing (iCPET) provides valuable insight into dyspnea in patients with chronic thromboembolic pulmonary disease, in part through an increased relationship of minute ventilation to CO2 production (VE/VCO2). Obesity lowers the VE/VCO2 in patients without cardiopulmonary disease; however, whether this holds true in obese subjects with chronic thromboembolic pulmonary hypertension (CTEPH) and chronic thromboembolic pulmonary disease (CTEPD) is unknown. Objective: Report on the iCPET findings of patients with CTEPH and CTEPD and investigate the relationship between obesity and gas exchange parameters, especially VE/VCO2 in these patients. Methods: Retrospective analysis of CTEPH and CTEPD patients undergoing iCPET. Results: We studied 60 patients; 34 (56.7%) had CTEPH and 26 (43.3%) had CTEPD. The mean age was 61.2 ± 14 years and the mean BMI was 31.8 ± 8.3 mg/kg2. A higher VE/VCO2 (41.9 ± 10.2 vs. 36.8 ± 8.9; p = 0.045) was observed in CTEPH vs. CTEPD. There was an inverse relationship between the VE/VCO2 slope and BMI. For an increase of 1 point in BMI, the VE/VCO2 slope fell by 0.6 in CTEPD and 0.35 in CTEPH (p < 0.001). The mean VE/VCO2 slope in CTEPH and CTEPD groups was 48.6 ± 10.4 in BMI < 25 and 31.3 ± 6.5 in BMI > 35 (p < 0.001). The lower VE/VCO2 slope in obesity relates to an increased VCO2/work rate relationship; there was no difference in the VE/work relationship. Conclusions: The VE/VCO2 slope is markedly reduced by obesity, independent of the level of pulmonary vascular obstruction in CTEPH or CTEPD. Thus, obesity masks key physiologic evidence of pulmonary vascular obstruction on the gas exchange assessment of obese individuals.
Urinary Output as a Predictor of Mortality in Cardiogenic Shock: An Explorative Retrospective Analysis
Authors: Markart Sebastian , Hermann Alexander , Chiari Florian , Heinz Gottfried , Speidl Walter S. , Lenz Max , Hengstenberg Christian , Schellongowski Peter , Staudinger Thomas , Zilberszac Robert
Published: December 2024

Background/Objectives: Cardiogenic shock (CS) remains a critical condition with high mortality rates despite advances in treatment. This study aimed to evaluate the prognostic significance of urinary output at various time intervals during CS and its effectiveness as a predictor of 30-day mortality, particularly in comparison to the Simplified Acute Physiology Score 3 (SAPS 3). Methods: We conducted a retrospective analysis of 96 patients diagnosed with CS, assessing urinary output at different intervals (0–6 h, 6–12 h, 12–24 h, and 0–24 h) as potential predictors of 30-day mortality. SAPS 3 was calculated for all patients, and its predictive value was compared to that of urinary output using both univariate and multivariate analyses. Additional analyses included ROC curve assessment and Kaplan–Meier survival analysis. Results: Urinary output at 6–12 h was significantly associated with 30-day mortality in univariate analysis. Area under the receiver operating characteristic curves (AUROCs) for urinary output at 0–6 h, 6–12 h, and 12–24 h was 0.61 (p = 0.07), 0.63 (p = 0.04), and 0.61 (p = 0.08), respectively. These AUROCs did not differ significantly between the three urinary output parameters. Regarding the cumulative urinary output of 0–24 h, the most pronounced impact was observed in patients producing less than 0.5 mL/kg/h. In multivariate analysis, when combined with SAPS 3, the predictive power of urinary output diminished. SAPS 3 alone demonstrated significant predictive value with an AUROC of 0.77 (p < 0.001). Conclusions: While early urinary output is a valuable predictor of 30-day mortality in patients with CS, its prognostic strength is limited when considered alongside comprehensive risk assessments like SAPS 3. These findings suggest that a multifaceted approach, incorporating both early and comprehensive indicators, is essential for accurately predicting outcomes in CS patients.
Can Quality of Life Tests Be Useful in Patients Affected by Alpha-1 Antitrypsin Deficiency?
Authors: Hernández-Pérez José María , Khadour-Khadour Hassan , Romero-Romero Gema , García-Bello Miguel Ángel
Published: December 2024

Alpha-1 antitrypsin deficiency (AATD) is a genetic condition that predisposes a person to certain diseases over their lifetime, mainly including lung disease (in the form of emphysema) and liver disease (liver cirrhosis). Quality of life questionnaires are instruments designed to quantify the deterioration of a patient’s health. Background/Objectives: This study aimed to assess whether certain quality of life tests that are routinely used in clinical practice can be useful for patients with AATD. Methods: A sample of AATD patients, with various genotypes, but with the common characteristic that they must have both altered alleles (Pi* ≠ M), participated in the study. Different quality of life tests were used, including the COPD Assessment Test (CAT), COPD and Asthma Sleep Impact Scale, the short form of the Short Form Health Survey, and EuroQol 5 dimensions, and were related to differing clinical and functional characteristics. Results: The sample was composed of 54 patients, and slightly more than half of the participants were women (57.4%), with a mean age of 51.5 ± 13.7. The main genotypes were Pi*SZ (43.4%) and Pi*ZZ (34%). In patients under 65 years of age (n = 47), those who were actively working could walk a greater distance in the walking test, namely, 573 m (511–629), compared to those who were not actively working, namely, 415.5 m (392–469; p < 0.001). Active non-workers had a worse CAT (13.6 ± 7.8 vs. 4.6 ± 4.3; p < 0.001). In total, 80% of non-working patients had exacerbations, but only 46. 9% of those who were active, although the association did not reach statistical significance (p = 0.068). Having a lower score in the physical component of SF-12 was related to suffering from lung disease (46.0 ± 11.4 vs. 38.4 ± 11.1 (p = 0.026)). Conclusions: Quality of life tests were able to detect differences and relate them to functional factors such as the distance covered in the walking test, being sensitive and specific in this regard.
Effective Multi-Layered Structure Design with Carbon-Based Hybrid Polymer Nanocomposites Using Evolutionary Algorithms
Authors: Syed Javed
Published: December 2024

Electromagnetic wave-absorbing materials (EMAMs) and structures are crucial in aerospace and electronic communications due to their ability to absorb electromagnetic waves. The development of materials that are lightweight, sustainable, and cost-effective, exhibiting high-performance absorption across a broad frequency spectrum, is therefore important. However, homogeneous electromagnetic absorbing materials require assistance to meet all these criteria. Therefore, developing multi-layer absorbing coatings is essential for enhancing performance. The present study uses 21 different composites of varying weight fractions of polypropylene, graphene nanoplatelets, and multiwall carbon nanotubes nanocomposites to develop multi-layer absorbing materials and optimize their performance. These multi-layer carbon polymer nanocomposites were meticulously constructed using evolutionary algorithms like Non-sorted Genetic Algorithm-II and Particle Swarm Optimization to achieve ultra-broadband electromagnetic wave absorption capabilities. Among the designed electromagnetic absorbing materials, a two-layer model, i.e., 1.5 wt% MWCNT/PP/epoxy with a thickness of 1.052 mm and 2.7% GNP/PP/epoxy with a thickness of 4.456 mm totaling 5.506 mm, was identified as optimal using NSGA-II. The structure has exhibited exceptional absorption performance with a minimum reflection loss of −21 dB and a qualified bandwidth extending to 4.2 GHz. PSO validated and optimized this structure, confirming NSGA-II’s efficiency and effectiveness in quickly obtaining optimal solutions. This broadband absorber design combines the structure design and material functioning through additive manufacturing, allowing it to absorb well over a wide frequency range.
Effect of Fluoride Varnishes on Demineralization and Acid Resistance in Subsurface Demineralized Lesion Models
Authors: Iwawaki Rika , Horie Taku , Alhotan Abdulaziz , Nagatsuka Yuka , Sakuma Keiko , Yoshihara Kumiko , Tsujimoto Akimasa
Published: December 2024

This study aimed to clarify the effects of high-concentration fluoride varnish application on the inhibition of the progression of initial enamel caries. Remineralization capacity and acid resistance following high-concentration fluoride varnish application were compared with untreated models and models treated with fluoride mouthwash. Bovine enamel was used to create a model of initial enamel caries. The high-concentration fluoride varnishes Enamelast and Clinpro White Varnish and the fluoride mouthwash Miranol were used. Specimens were evaluated using Contact Microradiography (CMR) and an Electron Probe Micro-Analyzer (EPMA). While a single application of high-concentration fluoride varnish and short-term fluoride mouthwash use did not appear to cause remineralization in the subsurface demineralized layer, improvements in acid resistance were observed, leading to reduced demineralization under subsequent acidic challenges.
Analysis of Microstructure and Mechanical Properties of CoCrMo Alloys Processed by Metal Binder Jetting Multi-Step Technique
Authors: Pellegrini Alessandro , Lavecchia Fulvio , Guerra Maria Grazia , Galantucci Luigi Maria
Published: December 2024

Metal Binder Jetting (BJT/M) has emerged as a promising additive manufacturing (AM) technology for the realization of complex parts using a wide range of metal alloys. This technology offers several advantages, such as design flexibility, reduced lead times, a high building rate, and the ability to fabricate intricate geometries that are difficult or impossible to achieve with conventional manufacturing methods. Cobalt Chromium Molybdenum (CoCrMo) alloys are particularly suitable for demanding applications in the aerospace, biomedical, and industrial sectors that require high strength and hardness, corrosion resistance, and biocompatibility. In this work, ten cubic and ten tensile samples were printed with a layer height of 50 µm using the shell printing method, debound and sintered at 1325 °C for 4 h, with the aim of investigating the properties of CoCrMo parts made using BJT technology. A density of 7.88 g/cc was obtained from the Archimede’s test. According to the printing and sintering parameters, an average hardness of 18.5 ± 1.8 HRC and an ultimate tensile strength of 520.5 ± 44.6 MPa were obtained. Finally, through a microstructure analysis, an average grain size of 182 ± 14.7 µm was measured and the presence of an intergranular Cr-rich phase and Mo-rich carbides was detected.
Impacts of Marine Plastic Pollution on Seagrass Meadows and Ecosystem Services in Southeast Asia
Authors: Douglas Janine , Niner Holly , Garrard Samantha
Published: December 2024

Seagrass meadows provide ecosystem services (ES) that are critical for humanity. Southeast Asia (SEA) is a hotspot of seagrass diversity, and the region’s seagrass-derived ES have been valued at over $100 billion annually; however, the health and extent of seagrass meadows are in decline. Marine plastic pollution (MPP) is an escalating problem and a concern for vulnerable marine habitats such as seagrass meadows. To understand the impacts that MPP has on seagrass ecosystems and their provision of ES, we conducted a mixed methodology study that involved a systematic search of the literature and the synthesis of the results with a risk assessment. The results indicated that MPP negatively impacts seagrass through factors such as spatial competition, chemical leaching, and reduced rates of photosynthesis and rhizome growth. This can lead to a reduction in seagrass biomass, triggering the degradation of all seagrass-derived ES. A risk assessment of the microplastic impact results indicated that seagrass-derived ES are at high risk of decline from the current microplastic concentrations, which in turn indicates a potential threat to the well-being of those dependent on them.
Porifera Associated with Deep-Water Stylasterids (Cnidaria, Hydrozoa): New Species and Records from the Ross Sea (Antarctica)
Authors: Calcinai Barbara , Marrocco Teo , Roveta Camilla , Puce Stefania , Montagna Paolo , Mazzoli Claudio , Canese Simonepietro , Vultaggio Carlo , Bertolino Marco
Published: December 2024

Stylasterid corals are known to be fundamental habitat-formers in both deep and shallow waters. Their tridimensional structure enhances habitat complexity by creating refuges for a variety of organisms and by acting as basibionts for many other invertebrates, including sponges. Porifera represent crucial components of marine benthic assemblages and, in Antarctica, they often dominate benthic communities. Here, we explore the sponge community associated with thanatocoenosis, mostly composed of dead stylasterid skeletons, collected along the Western and Northern edges of the Ross Sea continental shelf. Overall, 37 sponge species were identified from 278 fragments of the stylasterid Inferiolabiata labiata, of which 7 are first records for the Ross Sea, 1 is first record for Antarctic waters and 2 are proposed as new species. Despite the high biodiversity recorded in this and previous studies on Antarctic deep-sea communities, we are still far from capturing the true richness of Antarctic benthic assemblages. Long-term research programs designed to improve the knowledge of the deep-sea fauna inhabiting Antarctic waters are needed to support successful management and conservation plans, especially in this area, considered one of the main marine diversity hotspots worldwide.
Influence of Fungal Colonization on Exacerbations in Patients with Cystic Fibrosis
Authors: Madrid-Carbajal Claudia Janeth , de la Rasilla Teresa Peláez-García , Iscar-Urrutia Marta , Solís-García Marta , Fernández-Álvarez Ramón , Pérez-Martínez Liliana , Zapico-González María Soledad , Garcia-Clemente Marta
Published: December 2024

The importance of fungal pathogens in cystic fibrosis (CF) patients and their diagnosis remains a challenge, so our aim was to analyze the influence of the detection of fungi in sputum by using conventional culture and molecular techniques, polymerase chain reaction (PCR), lateral flow devices (LFDs), and galactomannan (GM) on exacerbations in patients with cystic fibrosis. A prospective study was conducted in patients via follow-up in the CF Unit of the Central University Hospital of Asturias from January 2021 to April 2022. Adult patients with at least one documented exacerbation were included. A complete fungal analysis of sputum samples was performed both in a period of clinical stability and in the exacerbation period. The microbiological study included conventional cultures for fungi, qPCR (polymerase chain reaction), LFDs (lateral flow devices), and galactomannan (GM) in sputum. We found that there were changes in their detection according to whether the patient is in a period of clinical stability or exacerbation; the positivity of the molecular tests and biomarkers in the period of exacerbation increased by 14%, 25%, and 21% for the analysis by qPCR, GM, and LFDs for Aspergillus and by 15% for the sputum culture for Aspergillus, which may mean that fungal isolates may play a role in the exacerbations of these patients.
Real-World Antifungal Therapy Patterns Across the Continuum of Care in United States Adults with Invasive Aspergillosis
Authors: Alexander Barbara D. , Johnson Melissa , Bresnik Mark , Anupindi Vamshi Ruthwik , Pizzicato Lia , DeKoven Mitchell , Lovelace Belinda , Coleman Craig I.
Published: December 2024

Changes to antifungal therapy (AFT) in invasive aspergillosis (IA) may occur due to intolerance, side effects, drug interactions, or lack of response. We describe AFT change patterns in IA patients. This was a US claims data study. IA patients were identified during the index hospitalization from October 2015 to November 2022. Patients were stratified by whether they ‘changed’ or ‘did not change’ AFT during or after the index hospitalization. AFT patterns were assessed for four lines of therapy or until loss of follow-up. First-line AFT began during the index hospitalization. Discontinuation with restart, modification, or switch in AFT ended the current line and initiated a subsequent line. Inverse probability-of-treatment weighting was utilized. Among 1192 adults with IA, 59.3% changed their AFT (60.0% modified AFT, 22.1% stopped first-line AFT and later initiated a new AFT for second line, and 18% immediately switched to a different AFT). Among those who changed AFT, triazole use predominated, with voriconazole (37.3–49.3%) and isavuconazole (19.3–26.7%) the most used across all AFT lines. Echinocandin use varied between 25.3 and 33.6% over all lines, and amphotericin B use increased over lines 1–4 (13.4–20.7%). Among the 40.7% of patients that completed AFT without changes, most received triazole monotherapy (62.8% voriconazole; 15.2% isavuconazole). Most patients required changes to their AFT.