bluuebunny/crossref_metadata_2025 huggingface dataset:
Prediction of Temperature and Humidity in Footwear Warehouses Based on Improved Arithmetic Optimization Twin Support Vector Machine for Regression
Authors: zhang Xin , Shi Chunyang , Bai Yinuo , Chen Jida
Published: February 2025

Temperature and humidity fluctuations in storage environments significantly impact the material properties and quality of footwear. Temperature and humidity fluctuations in storage environments significantly impact the material properties and quality of footwear. Traditional warehouse management approaches typically rely on fixed environmental control systems, which struggle to adapt to real-time dynamic changes, leading to high energy consumption, Inefficient management, and potential impacts on footwear quality. To address the aforementioned issues, the study employed an improved arithmetic optimization algorithm (AOA) to optimize the twin support vector machine for regression algorithm (LAOA-TSVR) and develop the corresponding prediction model. First, SPSS was used for correlation analysis to identify the primary factors influencing temperature and humidity in the warehouse. Second, to validate the model's prediction accuracy, the algorithm was compared with three common models: backpropagation neural network (BP), radial basis function neural network (RBF), and twin support vector regression (TSVR). The results demonstrate that the LAOA-TSVR exhibits fast convergence, high prediction accuracy, and robust generalization ability. Finally, the model was applied in a real warehouse environment. The results indicate that when the temperature and humidity errors in the warehouse remain within ±10% and ±5%, the endpoint hit rates for warehouse temperature reach 96.8% and 88.1%. while those for warehouse humidity reach 93.6% and 86.3%, respectively. For ±10% errors, the dual hit rate for warehouse temperature and humidity is 92.7%. The model establishes a theoretical foundation for accurately predicting temperature and humidity in warehouse environments, thereby facilitating the optimization of control strategies and improving warehouse management efficiency.
Compact Ultra-Wideband Microstrip MIMO Antenna with Triple Notch-Based Characteristic
Authors: ÖZTÜRK Cennet , ÇİMEN SİBEL
Published: February 2025

This paper presents the design of a novel ultra-wideband (UWB) Multiple Input Multiple Output (MIMO) antenna with triple-band notches. In the proposed design, two antenna elements are positioned within a 38 × 29 mm² area, using a common ground plane. I-, C-, and U-shaped slots are incorporated to reject frequencies in the WiMAX, WLAN, and X bands, respectively. Good isolation between the radiator elements is achieved through the implementation of the Defective Ground Structures (DGS) technique and the addition of L-stubs to the ground plane. The proposed MIMO antenna exhibits low isolation, below -20 dB, across its operating band. Moreover, the envelope correlation coefficient (ECC) and diversity gain (DG) values of the designed antenna are less than 0.025 and greater than 9.98 dB, respectively. The scattering parameters and radiation characteristics of the proposed MIMO antenna were tested through a fabricated prototype. The MIMO antenna shows promise for UWB applications due to its compact structure and notch-band features.
Machine Learning-Powered Data Cleaning for LEGEND: A Semi-Supervised Approach Using Affinity Propagation and Support Vector Machines
Authors: León Esteban , Li Aobo , Bahena Schott Miguel Angel , Bos Brady , Busch Matthew , Chapman Jason Robert , Duran Guadalupe Lourdes , Gruszko Julieta , Henning Reyco , Martin Eric Larue , Wilkerson John
Published: February 2025

Neutrinoless double-beta decay (0νββ) is a rare nuclear process that, if observed, will provide insight into the nature of neutrinos and help explain the matter-antimatter asymmetry in the universe. The Large Enriched Germanium Experiment for Neutrinoless Double-Beta Decay (LEGEND) will operate in two phases to search for 0νββ. The first (second) stage will employ 200 (1000) kg of High-Purity Germanium (HPGe) enriched in 76Ge to achieve a half-life sensitivity of 1027 (1028) years. In this study, we present a semi-supervised data-driven approach to remove non-physical events captured by HPGe detectors powered by a novel artificial intelligence model. We utilize Affinity Propagation to cluster waveform signals based on their shape and a Support Vector Machine to classify them into different categories. We train, optimize, test our model on data taken from a natural abundance HPGe detector installed in the Full Chain Test experimental stand at the University of North Carolina at Chapel Hill. We demonstrate that our model yields a maximum sacrifice of physics events of 0.024 + 0.004 - 0.003 % after data cleaning. Our model is being used to accelerate data cleaning development for LEGEND-200 and will serve to improve data cleaning procedures for LEGEND-1000.
Saturated Fusion Systems on 𝑝-Groups of Maximal Class
Authors: Grazian Valentina , Parker Chris
Published: February 2025

For a prime number

p
p

, a finite

p
p

-group of order

p
n

p^n

has maximal class if and only if it has nilpotency class

n
−
1

n-1

. Here we examine saturated fusion systems

F

\mathcal F

on maximal class

p
p

-groups

S
S

of order at least

p
4

p^4

. The Alperin-Goldschmidt Theorem for saturated fusion systems yields that

F

\mathcal F

is entirely determined by the

F

\mathcal F

-automorphisms of its

F

\mathcal F

-essential subgroups and of

S
S

itself. If an

F

\mathcal F

-essential subgroup either has order

p
2

p^2

or is non-abelian of order

p
3

p^3

, then it is called an

F

\mathcal F

-pearl. The facilitating and technical theorem in this work shows that an

F

\mathcal F

-essential subgroup is either an

F

\mathcal F

-pearl, or one of two explicitly determined maximal subgroups of

S
S

. This result is easy to prove if

S
S

is a

2
2

-group and can be read from the work of Díaz, Ruiz, and Viruel together with that of Parker and Semeraro when

p
=
3

p=3

. The main contribution is for

p
≥
5

p \ge 5

as in this case there is no classification of the maximal class

p
p

-groups. The main theorem describes all the reduced saturated fusion systems on a maximal class

p
p

-group of order at least

p
4

p^4

and follows from two more extensive theorems. These two theorems describe all saturated fusion systems, not restricting to the reduced ones for example, on exceptional and non-exceptional maximal class

p
p

-groups respectively. As a corollary we have the easy to remember result that states that, if

O
p

(

F

)
=
1

O_p(\mathcal F)=1

, then either

F

\mathcal F

has

F

\mathcal F

-pearls or

S
S

is isomorphic to a Sylow

p
p

-subgroup of

G

2

(
p
)

\mathrm G_2(p)

with

p
≥
5

p\ge 5

and the fusion systems are explicitly described.
Long-Term Changes to Cardiovascular Biomarkers After Hormone Therapy in the Women's Health Initiative Hormone Therapy Clinical Trials
Authors: Nudy Matthew , Aragaki Aaron K. , Jiang Xuezhi , Manson JoAnn E. , Shadyab Aladdin H. , Jung Su Yon , Martin Lisa W. , Wild Robert A. , Womack Catherine , Mouton Charles P. , Rossouw Jacques E. , Schnatz Peter F.
Published: February 2025

OBJECTIVE:

To assess the long-term changes in cardiovascular biomarkers during the WHI (Women's Health Initiative) hormone therapy (HT) clinical trials of conjugated equine estrogens (CEE) alone and CEE plus medroxyprogesterone acetate (MPA).

METHODS:

HT trial participants from the CEE alone (n=1,188, 0.625 mg/d CEE or placebo) and the CEE+MPA (n=1,508, 0.625 mg/d CEE plus continuous 2.5 mg/d MPA or placebo) trials provided blood samples at baseline and after 1, 3, and 6 years. Low-density lipoprotein cholesterol (LDL-C; primary endpoint), high-density lipoprotein cholesterol (HDL-C), triglycerides, total cholesterol, lipoprotein(a), glucose, insulin, and homeostatic model assessment for insulin resistance were measured. Repeated-measures regression models estimated the geometric means of each log-transformed biomarker by restricted maximum likelihood. A constant treatment effect across visits was used to estimate the overall effect, expressed as a ratio of geometric means, and was complemented with geometric means (95% CIs) by randomization group and corresponding ratios of geometric means (95% CI; HT vs placebo) at each visit.

RESULTS:

During the intervention phase of the CEE-alone trial, randomization to CEE reduced LDL-C by 11% over 6 years (ratio of geometric means 0.89, 95% CI, 0.88–0.91, P<.001). The overall reduction in LDL-C was similar for CEE+MPA relative to placebo (ratio of geometric means 0.88, 95% CI, 0.86–0.89, P<.001). Relative to placebo, HDL-C and triglycerides were 13.0% and 7.0% higher with CEE and CEE+MPA, respectively. The homeostatic model assessment for insulin resistance decreased by 14.0% and 8.0% for CEE-alone and CEE+MPA trial participants, respectively. Relative to placebo, lipoprotein(a) decreased by 15.0% and 20.0% for participants randomized to CEE alone and CEE+MPA, respectively.

CONCLUSION:

Lipoprotein(a), LDL-C, and homeostatic model assessment for insulin resistance were lower and HDL-C levels were higher for HT compared with placebo. Triglycerides increased in both the CEE and CEE+MPA trials, however. Future research should assess whether other progestogens attenuate the effect of estrogen on HDL-C. These results may be used to counsel younger menopausal women with bothersome symptoms who are deciding whether to initiate oral HT within the context of published effects of oral HT on rates of cardiovascular events.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT00000611.
Diffuse large B-cell lymphoma mimicking metastatic melanoma: the importance of biopsies in the era of immune checkpoint inhibitors
Authors: Janßen Sarah , Moufarrej Andrew , Springer Robin , Häberle Lena , Jäger Paul , Antke Christina , Homey Bernhard , Lindhof Harm-Henning
Published: February 2025

Positron emission tomography (PET)/computed tomography (CT) imaging is an established tool in diagnosing and staging for various malignancies, however, during immune checkpoint inhibitor (ICI) therapy not only inflammatory changes may mimic disease progression, but also secondary malignancies should be considered in the setting of unusual clinical and radiographic findings. Here, we present the case of a 64-year-old man with a lymphogenic metastatic malignant melanoma treated with ipilimumab/nivolumab, in whom PET/CT indicated tumor progression of an intra-abdominal mass. Biopsy revealed an unusual reactive T-cell expansion without clonal expansion, pathologically consistent with ICI-induced immune response. As the patient’s general condition worsened, we switched to targeted therapy, which had to be discontinued due to increasing fatigue. Follow-up PET/CT at 6 months showed further intra-abdominal progression. Subsequent histopathology of the extirpated mesenteric lymph node conglomerate now revealed diffuse large B-cell lymphoma. Our case highlights the importance of repeated histologic examinations of radiologic pathologies to distinguish secondary malignancies from ICI-induced inflammatory reactions or progressive disease.
Hypertensive Disorders of Pregnancy: A Review of the Current Literature and Future Directions
Authors: Ramchandani Juhi , Garg Jasmine , Rajendran Geetha , Aronow Wilbert S. , Frishman William H. , Gupta Chhaya Aggarwal
Published: February 2025

Hypertensive disorders in pregnancy (HDPs) are a leading cause of maternal and fetal morbidity and mortality worldwide. The pathophysiology is complex and still poorly understood but thought to involve a combination of maternal modifiable and nonmodifiable risk factors and placental changes with resultant end-organ dysfunction. Treatment of HDP involves a combination of lifestyle modification and pharmacotherapy, with differing treatment thresholds across organizations. HDP can increase maternal risk for future cardiovascular disease and has shown disparities in racial prevalence and outcomes. Additional efforts are needed to minimize the risk for future cardiovascular disease and improve racial disparities in patients facing HDP.
Updated Review of Transcatheter Strategies and Intervention for Mitral Regurgitation
Authors: Passey Siddhant , Patail Haris , Spevack Daniel , Ahmad Hasan , Ohira Suguru , Shimamura Junichi , Frishman William H. , Aronow Wilbert S. , Haidry Syed Abbas
Published: February 2025

Mitral regurgitation (MR) is a prevalent valvular heart disease with significant morbidity, particularly in aging populations. Management strategies for MR have evolved from traditional open-heart surgery to innovative transcatheter approaches, addressing the limitations of surgical repair in high-risk patients. Transcatheter edge-to-edge repair, exemplified by devices such as MitraClip and PASCAL, has shown efficacy in reducing MR severity, improving functional capacity, and decreasing heart failure hospitalizations in selected patients. Advances in annuloplasty and chordal repair offer minimally invasive options with promising early outcomes. Transcatheter mitral valve replacement represents the frontier of MR treatment, addressing anatomical complexities unsuitable for repair, though complications such as left ventricular outflow tract obstruction persist. Emerging data from clinical trials underscore the importance of patient selection and a multidisciplinary heart team approach. In this review, each modality is discussed concerning its indications, procedural techniques, outcomes, and associated challenges. It highlights the transformative potential of transcatheter mitral valve interventions while emphasizing the need for ongoing innovation and research to optimize outcomes and expand therapeutic options for patients with severe MR.
Psychometric Testing of the Kansas City Cardiomyopathy Questionnaire 12 in A European Population
Authors: Iovino Paolo , Dollaku Hamilton , Rasero Laura , Uchmanowicz Izabella , Alvaro Rosaria , Pucciarelli Gianluca , Vellone Ercole
Published: February 2025

Introduction

The Kansas City Cardiomyopathy Questionnaire (KCCQ) is one of the most widely used instruments for measuring health-related quality of life of patients with heart failure (HF). However, its 12-item version (KCCQ-12) was not sufficiently tested in European populations, and its invariance in patients with reduced, midrange, and preserved ejection fraction has never been assessed.

Aims

The purpose of this study is to examine the validity and reliability of the KCCQ-12 in a large cohort of Italian patients with HF and assess its measurement invariance across levels of ejection fraction.

Methods

A total of 510 patients (mean age = 72 years, 58% males) completed the KCCQ-12 alongside other measures of depression, anxiety, quality of life, and HF symptom burden. Construct validity was assessed by means of a confirmatory factor analysis and by testing the association of the KCCQ-12 scores with clinical parameters (ie, ejection fraction and mortality at 12 months) as well as measures of anxiety, depression, symptom burden, and general quality of life. Multigroup confirmatory factor analysis was implemented to investigate invariance properties across those with reduced, midrange, and preserved ejection fraction. Omega and model-based internal consistency coefficients were computed to investigate internal consistency reliability.

Results

The confirmatory factor analysis specified according to the original 4-factor model (ie, physical and social limitations, symptom frequency, and quality of life) yielded satisfactory fit indices (root mean square error of approximation = 0.053, comparative fit index = 0.98). Moderate-to-high correlations were found between the KCCQ-12 and the mental and physical component scores of the Short Form 12, as well as other conceptually related constructs, indicating adequate facets of construct validity. Multigroup confirmatory factor analysis tested across patients with different ejection fraction groups, established that the KCCQ-12 was invariant at the partial scalar level. Omega and model-based internal consistency coefficients were adequate, ranging from 0.75 to 0.90 for the subscales, and 0.94 for the whole scale, confirming strong internal consistency reliability.

Conclusions

The KCCQ-12 demonstrated satisfactory psychometric properties in our European sample of patients with HF, providing evidence to support its use in practice and further research.
Should Patients Hospitalized for Community-Acquired Pneumonia Be Treated With Additional Antimicrobial Agents Directed Against Anaerobes?
Authors: Smith Miriam A. , Varghese Shawn , Kluger Courtney , Doan Thien-Ly
Published: February 2025

BACKGROUND:

The revised 2019 American Thoracic Society (ATS)/Infectious Disease Society of America (IDSA) clinical practice guidelines for treatment of community-acquired pneumonia (CAP) in newly hospitalized patients with no immunocompromising condition do not recommend addition of focused anaerobic coverage in the absence of lung abscess or empyema. However, many clinicians still prescribe antimicrobial treatment of anaerobes. Our article reviews the basis for the ATS/IDSA guidelines and provides recommendations based on more recent evidence.

AREAS OF UNCERTAINTY:

Despite the ATS/IDSA 2019 guidelines for treatment of newly hospitalized patients with CAP, clinicians still prescribe directed anaerobic treatment. We include newer data since the publication of the CAP guidelines to determine if the recommendations should be revised.

DATA SOURCES:

The databases searched for this review included PubMed/MEDLINE, Google Scholar, CINAHL, Embase, and Cochrane Library, using controlled vocabulary including the following medical subject headings keywords: aspiration, pneumonia, anaerobe, and anaerobic coverage. Studies and reviews from January 2019 to June 2024 were evaluated. Articles were selected if the content involved treatment, including clinical outcomes and microbiology.

THERAPEUTIC ADVANCES:

We found 4 articles between 2019 and 2024 addressing the 2019 ATS/IDSA CAP guidelines. One Canadian study comparing patients receiving limited or extended anaerobic coverage found no significant mortality benefit and a significantly higher rate of Clostridioides difficile colitis with extended coverage. Another study demonstrated a longer intensive care unit length of stay in patients receiving additional anaerobic coverage. A systematic review and meta-analysis also demonstrated no mortality benefit in patients with aspiration pneumonia who received directed anaerobic coverage versus those who did not. In another study, the prevalence of anaerobic bacteria isolated from respiratory samples was similar in patients with aspiration community–acquired pneumonia versus patients with CAP with or without aspiration risk factors.

CONCLUSIONS:

Based on review of newer evidence, we continue to support the 2019 ATS/IDSA treatment guidelines for CAP.
Abnormal Glucose Metabolism and Body Composition Changes in Childhood Acute Lymphoblastic Leukemia Survivors During Their Adolescence
Authors: Supho Warittha , Anurathapan Usanarat , Mahachoklertwattana Pat , Khlairit Patcharin , Pongratanakul Sarunyu , Wongdaeng Aree , Poomthavorn Preamrudee
Published: February 2025

Childhood acute lymphoblastic leukemia survivors (ALL-S) face an increased risk of abnormal glucose metabolism (AGM). This study aimed to assess glucose metabolism in 141 ALL-S. All underwent an oral glucose tolerance test (OGTT) and were classified into AGM and normal glucose tolerance (NGT) groups. Insulin sensitivity and secretion indices were calculated from plasma glucose and serum insulin derived from the OGTT. Fat mass index (FMI) was derived from body composition analysis. Sixty-seven of 141 (48%) ALL-S had AGM. AGM was demonstrated in 33 of 98 nonobese ALL-S. ALL-S with AGM had a greater waist circumference percentile and FMI SD score than those with NGT. In addition, ALL-S with AGM had lower insulin sensitivity (greater homeostasis model assessment of insulin resistance: 2.3 [1.4, 3.3] vs. 1.0 [0.5, 1.4], P<0.001 and lower whole-body insulin sensitivity index: 3.5 [2.3, 4.1] vs. 7.9 [5.3, 10.9], P<0.001) and lower insulin secretion relative to insulin sensitivity (disposition index: 5.8 [4.2, 10.2] vs. 10.0 [6.1, 14.6], P<0.001) than those with NGT. Therefore, ALL-S could develop AGM regardless of their body mass index status. AGM in ALL-S stemmed from both insulin resistance and impaired insulin secretion.
Urinary tract infections and other associated factors in two Syrian hospitals: a cross-sectional study
Authors: Alkailani Ali , Soqia Jameel , Kakaje Ameer , Daher Nizar
Published: February 2025

Introduction:

Urinary tract infections (UTIs) cause a major burden in hospitals, mainly among the elderly, where they can increase morbidity and mortality and are a common cause of delirium. We aim to study UTIs, their inflammatory markers, and microbiology cultures in Syria.

Methods:

This is a cross-sectional study conducted in two major hospitals in Damascus, Syria, on patients admitted for UTIs and urosepsis who had positive urine cultures. Our study included comorbidities such as diabetes and high blood pressure. Urine culture, symptoms, and presentation were used to determine the diagnosis of UTI/urosepsis. Having an indwelling catheter or other abnormalities was also included.

Results:

This study included 120 patients, 66 (55%) being females. The mean age of the sample was 59.5 years (SD = 11.4), with 52.2% being above 60 years of age. Urine cultures yielded 64 (53.3%) Escherichia coli, of which extended-spectrum beta-lactamases (ESBL) 16 (13.3%), and 23 (19.2%) yielded Klebsiella pneumoniae. Diabetes was significantly associated with having sepsis with the UTI (P < 0.049). Older ages, higher C-reactive protein and neutrophils ratio were significantly associated with urosepsis compared to having just a UTI. However, having an indwelling catheter, urological anatomical abnormalities and recurrent UTIs were not associated with a higher chance of urosepsis.

Conclusion:

UTIs are a major problem and the ESBL burden is high. We need better early indicators to face this growing resistance and to improve outcomes.
Uncommon manifestation of MRSA-related deep vein thrombosis and lung abscesses in a young child: a case report
Authors: Roumi Jamal Bakri , Tarsha Kurdi Hala , Kalaji Rawan , Fustuk Mohamad Omar , Tarsha Kurdi Khalil , Awad Hebatullah
Published: February 2025

Introduction and importance:

Cellulitis, a common skin and soft tissue infection, can lead to complications such as deep vein thrombosis (DVT), presenting with unilateral limb swelling, erythema, and pain. Methicillin-resistant Staphylococcus aureus (MRSA) is a notable causative pathogen for severe cases and complications.

Case presentation:

We report a rare case of MRSA-induced DVT and lung abscesses in a 5-year-old male following a knee injury. The child initially presented with fever, vomiting, abdominal pain, and restricted movement in the right leg. Laboratory tests confirmed DVT, and chest imaging subsequently revealed multiple lung abscesses. Septic arthritis was ruled out based on a knee synovial fluid test showing no growth of pathogenic bacteria. The patient received initial treatment with intravenous (IV) fluids, subcutaneous enoxaparin sodium (clexane), and IV antibiotics (teicoplanin and ceftazidime). Treatment was later modified to include vancomycin, metronidazole, and finally, linezolid due to its superior lung penetration and clinical response. Endocarditis was ruled out via transthoracic echocardiography. The patient showed marked improvement and was successfully discharged after 2 months.

Clinical discussion:

This case underscores the importance of considering DVT as a potential complication of cellulitis in pediatric patients, particularly with MRSA involvement. The pathophysiology of MRSA-induced DVT involves bacterial toxins that promote platelet aggregation, thrombin activation, and endothelial dysfunction, creating a procoagulant milieu. This case adds to the limited literature on pediatric MRSA infections leading to such severe complications and emphasizes the need for early recognition and targeted therapy.

Conclusion:

MRSA-related infections can lead to rare but severe complications in pediatric patients. Clinicians should maintain a high index of suspicion for DVT and lung abscesses in cases of MRSA cellulitis, particularly following trauma. Early diagnosis and aggressive treatment are essential for better outcomes.
Comparative evaluation of modified frenectomy with papilla preservation flap versus conventional technique in upper labial frenectomy: a randomized controlled trial
Authors: Sayegh Wadie , Khalil Ali , Sleman Nadim
Published: February 2025

Introduction:

Cosmetic concerns among patients have led to an increased demand for dental treatments aimed at achieving a perfect smile. One of the main cosmetic issues in adults is the gap between the upper incisors, known as diastema, and the upper lip frenulum is often a contributing factor to this condition. Therefore, it is imaportant to focus on this aspect.

Objective:

To explore a new technique for cutting the upper lip frenulum in patients with a gap between the central incisors while avoiding the negative effects of the traditional technique.

Materials and methods:

This randomized controlled clinical trial included 20 patients diagnosed with abnormal upper lip frenal attachment and diastema between the central incisors. The study compared the modified frenectomy technique with a papilla preservation flap against the traditional “Archer” technique. Each technique was performed on 10 patients, and outcomes such as scar formation, gingival inflammation, and post-surgical pain were evaluated.

Results:

The “modified frenectomy with papilla preservation flap” technique prevented scar formation in the papilla area between the upper incisors in nine cases, while scar formation occurred in seven cases using the traditional technique. There were no statistically significant differences in gingival inflammation post-surgery. Pain levels were lower with the modified technique: on the first day, the average pain score was 1.5 for the modified technique and 2.8 for the traditional technique. By the third day, the average pain was 4.3 for the modified technique and 6.9 for the traditional technique, with pain decreasing by the seventh day to an average of 0.7 for the modified technique and 1.6 for the traditional technique.

Conclusion:

The modified frenectomy with a papilla protection flap effectively reduces scarring, enhances healing, and minimizes postoperative pain, offering a more comfortable and aesthetically better result than conventional methods.
Bardet–Biedl syndrome in a Syrian adolescent: a rare case report
Authors: Alabed Ammer , Alhallak Shaghaf , Dakkak Tala , Alhaj Ali Ahmad Jamal , Beiruty Noel , Alwannous Kamal
Published: February 2025

Introduction:

Bardet–Biedl Syndrome (BBS) is a rare genetic disorder that affects multiple organs and presents with a variety of characteristics. It was found that a dysfunction in the cilia causes it, in addition to mutations in the genes involved in the composition of these cilia. We present a unique case of BBS in a 13-year-old male from Syria, characterized by a significant family history of scleroderma and a distinct clinical presentation.

Case presentation:

The patient presented with intellectual disabilities, post-axial polydactyly, and a history of delayed developmental milestones. The patient’s BMI was within the normal range. Laboratory investigations revealed increased TSH and positive calcium oxalate, without evidence of central obesity or blindness. The diagnosis of BBS was made with a moderate level of confidence. The patient was undergoing treatment with thyroxine, showing improvement in thyroid function and communication skills.

Clinical discussion:

This case highlights the manifestations of BBS and the importance of recognizing atypical presentations. Diagnostic criteria traditionally emphasize a combination of primary and secondary features. We discuss the challenges of diagnosing BBS without genetic testing and the implications for treatment in resource-limited settings. Additionally, we explore therapeutics in managing the patient’s condition.

Conclusion:

This case represents a unique presentation of BBS, expanding the understanding of its clinical variability in different populations. The findings underscore the necessity for individualized diagnostic approaches and comprehensive management strategies in patients with limited access to genetic testing. By documenting this case, we contribute to the growing body of literature on BBS, particularly in the Syrian context, highlighting the need for increased awareness and research into this challenging disorder.
A Goal-Concordant Prescribing Conceptual Framework
Authors: DeSanto-Madeya Susan , Clayton Margaret F. , Fromme Erik , Troiani Francesca , Tjia Jennifer
Published: February 2025

Optimizing medication benefit and minimizing harm through effective and appropriate medication management is emerging as an important strategy in hospice and palliative care. This approach, however, often fails to align patient and family goals for remaining life with clinician priorities. Ascertaining patient and caregiver values and goals and aligning these goals with clinicians' priorities for care is a complex and iterative process. This process requires effective communication between all participants as a patient's illness trajectory moves toward death. The purpose of this article was to present a beginning conceptual framework for clinical consideration and use, as well as an example of a potential measurement framework envisioned from the conceptual framework for future research application. Both frameworks focus on goal-concordant prescribing among seriously ill older adults in home hospice. An environmental scan of existing deprescribing frameworks and approaches to goal ascertainment that inform hospice deprescribing was conducted. Feedback from practicing hospice clinicians engaged in a pilot project implementing a novel goal-concordant prescribing approach, as well as interprofessional clinicians and family caregivers from previous projects, were also used to identify theoretical and clinically relevant gaps in care as well as future research opportunities. The environmental scan and multiproject feedback served as the foundation for the development of the conceptual framework. The suggested communication frameworks for goal-concordant prescribing seek to bridge the gap between the preferences and priorities of the patient and family caregiver, and the risk-benefit considerations brought forth by clinicians.
Impact of Lymphedema Duration on Lymphatic Vessel Quality and Outcomes After Supermicrosurgical Lymphaticovenous Anastomosis
Authors: Taliat George , Ou Yu-Che , Wang Yu-Ming , Chang Chad , Wu Shao-Chun , Lin Wei-Che , Chien Peng-Chen , Hsieh Ching-Hua , Yang Johnson Chia-Shen
Published: February 2025

Background:

Inferior lymphatic vessel (LV) quality was thought to be associated with prolonged lymphedema duration (LD), which can lead to unfavorable lymphaticovenous anastomosis (LVA) outcomes. However, increasing evidence supports the use of LVA in the treatment of advanced lymphedema. Hence, this study aimed to determine the impact of LD on LV quality and outcomes after LVA in patients with secondary lower limb lymphedema.

Patients and Methods:

A total of 189 patients who underwent supermicrosurgical LVA were retrospectively reviewed and enrolled. The study group (LD>3.6 years) and the control group (LD≤3.6 years) consisted of 94 and 95 patients, respectively. Patients with previous LVA, liposuction, or excisional therapy were excluded. Patient characteristics, intraoperative findings, functional parameters and volume changes were recorded and the parameters except LD were matched using propensity-score-matching. The primary endpoint was volume change at 6 and 12 months after LVA.

Results:

Before matching, the study group had significantly higher ratios of indocyanine green-enhanced, lymph flow-positive, and Normal+Ectatic LVs (p=0.016, 0.035, and 0.002, respectively) than the control group. After all parameters except LD were matched, 64 patients were included in each group, with higher median LD in the study group (7.8 vs. 1.1 years, p<0.001) than the control group. However, no significant intergroup differences were found in postoperative percentage volume reduction at the 6- and 12-month follow-up (p=0.813 and 0.627, respectively).

Conclusion:

Contrary to common beliefs, longer LD did not negatively affect LV quality and outcomes after LVA. Therefore, LVA remains a viable treatment option for patients with long-standing lymphedema.
Photon-Counting Detector CT Iodine Maps Versus SPECT/CT
Authors: Kerber Bjarne , Hüllner Martin , Maurer Alexander , Flohr Thomas , Ulrich Silvia , Lichtblau Mona , Frauenfelder Thomas , Franckenberg Sabine
Published: February 2025

Objectives

The aim of this study was to compare the accuracy of photon-counting detector computed tomography (PCD-CT) iodine maps of the lung parenchyma with perfusion scintigraphy for detection and extent estimation of pulmonary perfusion defects.

Materials and Methods

This institutional review board–approved retrospective study included 26 subjects (11 male, aged 57.2 ± 15.8 years; 15 female, aged 55.2 ± 15.7 years) who underwent clinically indicated PCD-CT and perfusion SPECT/CT to assess for chronic thromboembolic pulmonary hypertension (CTEPH). Two blinded radiologists used CT iodine maps and corresponding sharp-kernel CT reconstructions in lung window to evaluate presence and extent of lobar perfusion defects and detect patients with CTEPH (or CTEPH overlap with other causes of PH). Accordingly, 2 blinded nuclear medicine physicians/radiologists evaluated perfusion SPECT/CT scans. The clinical diagnosis was reviewed in an interdisciplinary clinical setting. Quantitative analyses were calculated for both modalities. Perfusion defect estimation was compared with right heart catheter measurements.

Results

Of the 26 subjects included, 10 were diagnosed with CTEPH or CTEPH overlap, 12 were diagnosed with PH associated with other pathologic mechanisms, 3 had no PH, and 1 had previous acute pulmonary embolism, which resolved. Radiation dose was greatly reduced for PCD-CT compared with SPECT/CT (1.19 [±0.33] mSv; 6.34 [±1.68] mSv, respectively, P < 0.001). Both PCD-CT readers (R1, R2) showed a trend toward higher accuracy, sensitivity, and specificity for CTEPH diagnosis compared with the scintigraphy consensus (SC) (accuracy: R1 0.85, R2 0.88, SC 0.73; sensitivity: R1 0.90, R2 0.90, SC 0.80; specificity: R1 0.81, R2 0.88, SC 0.69), although there was no significant difference observed (P > 0.688). There was good to excellent agreement between both PCD-CT readers for perfusion defect estimation. Moderate intermodality agreement was observed for CTEPH diagnosis certainty and perfusion defect estimation. The quantitative evaluation showed strong to excellent correlation between PCD-CT and SPECT/CT relative perfusion. There was a significant moderate correlation between PCD-CT perfusion defect estimations and mean pulmonary artery pressure (R1: r = 0.49, P = 0.020; R2: r = 0.49, P = 0.021), pulmonary vascular resistance (R1: r = 0.60, P = 0.003; R2: r = 0.52, P = 0.013), and cardiac index (R1: r = −0.45, P = 0.042).

Conclusions

PCD-CT iodine maps allow for accurate CTEPH detection and are comparable to perfusion SPECT/CT with good quantitative correlation, but only moderate qualitative agreement, at greatly reduced radiation dose. Furthermore, visual PCD-CT perfusion defect extent was associated with prognostic right heart catheter measurements.
Pros and Cons of High-Performance Gradient Enabled Short-TE Prostate DWI
Authors: Bachl Maximilian , Skwierawska Dominika , Hadler Dominique , Schreiter Hannes , Uder Michael , Janka Rolf , Laun Frederik B. , Bickelhaupt Sebastian
Published: February 2025

Objectives

Recent advances in high-performance gradient technology have enabled shorter echo times (TEs) for diffusion-weighted prostate MRI. Short TE may improve the conspicuity of the usually T2 hypointense lesions but may also influence the diagnostic performance of the apparent diffusion coefficient (ADC) due to a changed weighting of subcompartments, including prostate fluid and tissues. The purpose of this study was to evaluate the influence of TE on prostate diffusion-weighted images with respect to lesion conspicuity and diagnostic performance of the ADC.

Materials and Methods

This institutional review board–approved prospective monocentric study included n = 55 (mean age 69 ± 9 years) patients undergoing clinically indicated prostate MRI on two 3 T MRI scanners with high-performance gradients. Diffusion-weighted imaging (DWI) was performed with an echo-planar sequence at 2 different TEs, 41 ms and 70 ms, with b-values of 50 s/mm2 and 800 s/mm2. Computed DWI was generated for a b-value of 1400 s/mm2. The lesion conspicuity and image quality were rated by 3 independent readers with a 5-point Likert scale and tested with the Wilcoxon rank sum test. Lesion ADCs were recorded, and their ability to detect significant lesions (Gleason score >6) was assessed with a receiver operator curve analysis.

Results

Among the participants, n = 24 had clinically significant prostate cancer. The image quality at b = 1400 s/mm2 was rated significantly higher at TE = 41 ms than at TE = 70 ms (mean Likert score ± standard deviation for TE = 41 ms vs TE = 70 ms: R1: 4.06 ± 0.68 vs 3.02 ± 0.59; R2: 4.09 ± 0.82 vs 3.26 ± 0.67; R3: 4.16 ± 0.71 vs 3.18 ± 0.70; for all P’s < 0.001). The lesion conspicuity at b = 1400 s/mm2 was rated higher at TE = 41 ms than at TE = 70 ms (mean Likert score ± standard deviation for TE = 41 ms vs TE = 70 ms: R1: 4.55 ± 0.66 vs 4.46 ± 0.72, P = 0.17; R2: 4.64 ± 0.59 vs 4.53 ± 0.63, P = 0.03; R3: 4.53 ± 0.66 vs 4.28 ± 0.80, P = 0.01). However, the ADC-based area under the curve for lesion characterization decreased from 0.80 at TE = 70 ms to 0.70 at TE = 41 ms (P = 0.07).

Conclusions

Shortening TE to 41 ms in prostate DWI increases lesion conspicuity on high b-value images; however, it negatively impacts the diagnostic performance of the ADC.
Artificial Intelligence Iterative Reconstruction for Dose Reduction in Pediatric Chest CT
Authors: Zhang Feifei , Peng Liying , Zhang Guozhi , Xie Ruigang , Sun Minghua , Su Tao , Ge Yinghui
Published: February 2025

Purpose:

To assess the performance of a newly introduced deep learning-based reconstruction algorithm, namely the artificial intelligence iterative reconstruction (AIIR), in reducing the dose of pediatric chest CT by using the image data of below 3-year-old patients with congenital heart disease (CHD).

Materials and Methods:

The lung image available from routine-dose cardiac CT angiography (CTA) on below 3 years patients with CHD was employed as a reference for evaluating the paired low-dose chest CT. A total of 191 subjects were prospectively enrolled, where the dose for chest CT was reduced to ~0.1 mSv while the cardiac CTA protocol was kept unchanged. The low-dose chest CT images, obtained with the AIIR and the hybrid iterative reconstruction (HIR), were compared in image quality, ie, overall image quality and lung structure depiction, and in diagnostic performance, ie, severity assessment of pneumonia and airway stenosis.

Results:

Compared with the reference, lung image quality was not found significantly different on low-dose AIIR images (all P>0.05) but obviously inferior with the HIR (all P<0.05). Compared with the HIR, low-dose AIIR images also achieved a closer pneumonia severity index (AIIR 4.32±3.82 vs. Ref 4.37±3.84, P>0.05; HIR 5.12±4.06 vs. Ref 4.37±3.84, P<0.05) and airway stenosis grading (consistently graded: AIIR 88.5% vs. HIR 56.5% ) to the reference.

Conclusions:

AIIR has the potential for large dose reduction in chest CT of patients below 3 years of age while preserving image quality and achieving diagnostic results nearly equivalent to routine dose scans.
Submental Osteocutaneous Flap for Reconstruction of Maxillary and Mandibular Defects After Tumor Resections
Authors: Pérez Salazar F. , Cariati P. , Marín Fernandez AB. , Martínez Lara I
Published: February 2025

Reconstructing facial structures after tumor removal is a complex challenge in maxillofacial surgery. The submental osteocutaneous flap offers a reliable and versatile solution for patients requiring reconstruction of the jaw and surrounding areas. This technique is particularly beneficial for individuals with underlying health conditions or advanced age, who may not tolerate more complex procedures such as free microvascular flaps. In our study, we describe the successful use of this flap in one patient with maxillofacial tumor. Our patient had part of the mandible reconstructed after cancer resection. The flap provided excellent outcomes, restoring both function and facial aesthetics. This approach leverages the submental artery’s robust blood supply to transfer skin, soft tissue, and a segment of jawbone to the defect site. Additionally, a reverse blood flow variant of this technique expands its applications, allowing reconstruction in more distant facial regions. Our results demonstrate that the submental flap is an effective, safe, and practical alternative for patients who are not candidates for more invasive procedures. It ensures quick recovery and minimal complications, helping patients regain their appearance and quality of life after cancer surgery.
Occultation constraints on solar system formation models
Authors: Buie Marc W. , Keller John M. , Nesvorný David , Porter Simon B.
Published: February 2025

The process by which a system of non-luminous bodies form around a star is fundamental to understanding the origins of our own solar system and how it fits into the context of other systems we have begun to study around other stars. Some basics of solar system formation have emerged to describe the process by which dust and gas around a newly formed star evolve into what we see today. The combination of occultation observations and the flyby observations by New Horizons of the Cold-Classical Kuiper Belt Object (CCKBO), (498958) Arrokoth, has provided essential new constraints on formation models through its three-dimensional shape. We present a case that an occultation-driven survey of CCKBOs would provide fundamental new insight into solar system formation processes by measuring population-wide distributions of shape, binarity, and spin-pole orientation as a function of size in this primordial and undisturbed reservoir.

This article is part of the theme issue ‘Major advances in planetary sciences thanks to stellar occultations’.
The lungs of the finch: three-dimensional pulmonary anatomy of the zebra finch (
Taeniopygia castanotis
)
Authors: Martinez Aracely , Diaz Jr Raul E. , Grand Pre Clinton A. , Hedrick Brandon P. , Schachner Emma R.
Published: February 2025

The avian respiratory system has been an area of biological interest for centuries, with zebra finches (
Taeniopygia castanotis
) emerging in recent decades as a primary avian model organism popularized across numerous disciplines. The pulmonary system of birds is unique in that air moves unidirectionally through the gas-exchanging lung, and previous works have suggested anatomical constraints within the bronchial network that may be coupled to the inspiratory valving mechanism in Aves. We used µCT-based segmented models to visualize and describe the morphology of the zebra finch lower respiratory system and to examine intra- and interspecific differences of the bronchial tree with the phylogenetically and ecologically different African grey parrot (
Psittacus erithacus
). Here, we show that zebra finches have highly variable lung and air sac morphology within individuals but generally do not diverge from the anatomical
bauplan
previously described for passerines. Additionally the parabronchi in the zebra finch lung are arranged into isolated segments between secondary bronchi, which has not been described and may be coupled with airflow patterns in this species. Both zebra finches and African grey parrots show constrained interostial distances and robust, caudally directed third ventrobronchi that may play an unexplored role in the unidirectional airflow patterns of birds.

This article is part of the theme issue ‘Biology of the avian respiratory system: development, evolutionary morphology, function and clinical considerations’.
Avian air sacs and neopulmo: their evolution, form and function
Authors: Klein Wilfried , Pereira Ribeiro Vinícius , Bueno de Souza Ray Brasil
Published: February 2025

The avian respiratory system is composed of an exchange structure (parabronchi) and a pump (air sacs) to perform gas exchange. While there are many studies dealing with the morphology and function of the palaeopulmonic parabronchi, the air sacs and the neopulmo have been somewhat neglected from a comparative and functional point of view, not always receiving a closer examination that they deserve. While a decent amount of data are available regarding air sac and neopulmo morphology on a family level or for domestic species, several orders of birds have yet to be investigated. Owing to the lack of detailed specific data, we did not perform a comparative phylogenetic analysis but compiled data regarding air sac and neopulmo morphology and analysed them from the viewpoint of current phylogenetic relations while also discussing aspects of these structures regarding avian physiology.

This article is part of the theme issue ‘The biology of the avian respiratory system’.
A morphometric and stereological study of the chorioallantoic membrane of the developing ostrich (
Struthio camelus australis
) embryo: a light and transmission electron microscopy investigation
Authors: Mthombeni Dzunani , Makanya Andrew N. , Jimoh Sikiru , Maina John
Published: February 2025

The developing chorioallantoic membrane (CAM) of the ostrich (
Struthio camelus
) was studied between embryonic days 16 (E16) and E37. Egg masses and volumes were estimated prior to harvesting of the CAM. CAM volumes were obtained before the CAM was sampled for histology and transmission electron microscopy analysis. Stereological methods were used to estimate volume densities and absolute volumes of CAM structural components. Growth rate estimates of the CAM and its major components were obtained. At E16, the three layers of the CAM were clearly delineated, but large parts still had not developed the blood–gas barrier (BGB) portions. By E37, chorionic blood capillaries had assumed a superficial position with thin BGB portions covering most of the chorionic surface. On regression analyses, the CAM had two growth phases, namely phase I that occurred between E16 and E25, when the CAM grew rapidly from a volume of 5.55 ± 1.27 to 28.82 ± 5.62 cm
3
to then decrease to 25.18 ± 4.79 cm
3
during phase II (E25−E37). The latter decline was attributed to changes in the chorionic and allantoic layers, while regression in the mesoderm mainly characterized blood and lymphatic vessels.

This article is part of the theme issue ‘The biology of the avian respiratory system’.