bluuebunny/crossref_metadata_2025 huggingface dataset:
The Financial Impact of an Employee Wellness Program Focused on Cardiovascular Disease Risk Reduction
Authors: Boyce Irena , DeVoe Jason , Norsen Lisa , Smith Joyce A. , Anson Elizabeth , McGregor Holly A. , Singh Renu
Published: November 2024

Background. Evidence for the effectiveness and cost-savings of workplace wellness programs (WWPs) is varied, likely due to the variability in program design, as not all WWPs meet the five-point criteria of a “comprehensive WWP” set by the U.S. Centers for Disease Control and Prevention. A 2019 study of changes in cardiovascular disease (CVD) risk for those enrolled in a comprehensive WWP found that nearly half of enrolled employees with moderate to high CVD risk improved their risk compared to the initial predictions. This study extends those findings by evaluating the cost-savings and return on investment (ROI) resulting from participants’ CVD risk reduction from the employer’s perspective. Method. Cost-savings related to CVD risk were extrapolated using two studies that provided associated cost-savings for individuals participating in a WWP. Utilizing reference groups used in previous studies, we calculated cost-savings per 1% reduction in CVD risk using our population’s specific CVD risk and our program-specific costs. The cost-savings were annualized per person within each risk category. Results. Across all risk categories, cost-savings were USD 1224 per individual or USD 4.90 ROI for every USD 1 spent. Those at risk had a higher ROI per USD 1.00 spent (USD 35.4 and USD 19.2 for males and females, respectively) than those with minimal risk. However, even those with minimal risk showed a positive ROI (USD 0.3 and USD 5.0 for males and females, respectively). Conclusions/Application to Practice. Investment in WWPs should prioritize programs that include all five elements of the standards established by the U.S Centers for Disease Control and Prevention. Well-designed and comprehensive WWPs can effectively impact employee health and lead to a positive ROI and cost-savings for employers.
The Silent Burden: Investigating Post-Traumatic Stress Disorder and Social Isolation Among Healthcare Workers During COVID-19
Authors: Goniewicz Mariusz , Włoszczak-Szubzda Anna , Al-Wathinani Ahmed M. , Goniewicz Krzysztof
Published: November 2024

Background: The COVID-19 pandemic has significantly impacted the mental health of healthcare professionals, particularly nurses and paramedics. This study investigates the prevalence of Post-Traumatic Stress Disorder (PTSD) and the impact of social ostracism on psychological distress among healthcare workers (HCWs) in Poland, with a focus on exploring the interplay between professional and social factors contributing to their stress. Methods: A cross-sectional survey was conducted between March 2021 and February 2022 with 852 HCWs from four Polish provinces. PTSD symptoms were measured using the PTSD Checklist—Civilian Version (PCL-C), and social ostracism was assessed through a custom-designed questionnaire. Results: Of the participants, 14.1% reported experiencing social ostracism, and 4.9% observed such experiences among colleagues. Those who experienced or witnessed ostracism reported significantly higher PTSD symptoms (p < 0.001). Concerns about personal health and the well-being of older individuals were strongly associated with increased PTSD severity, while concerns for household members were not. Conclusions: Social ostracism exacerbates the psychological burden on healthcare workers, contributing to higher levels of PTSD. This study highlights the need for targeted mental health interventions and support systems, including resilience training and stigma reduction initiatives, to address these challenges. Future research should explore cross-national comparisons and long-term psychological effects among diverse healthcare populations.
Promoting Influenza Vaccination Uptake Among Chinese Older Adults Based on Information–Motivation–Behavioral Skills Model and Conditional Economic Incentive: Protocol for Randomized Controlled Trial
Authors: Lin Hao , Xu Jiannan , Abuduwayiti Refukaitijiang , Ji Ying , Shi Yuhui , Zhang Lanchao , Shi Zhengli , Ni Mojun , Tao Sihong , Yang Bohao , Liu Shuhan , Galárraga Omar , Chang Chun , Cao Wangnan , Mo Phoenix Kit-Han
Published: November 2024

Background: Influenza poses a substantial health burden, especially among older adults in China. While vaccination is one of the most effective preventions, influenza vaccine uptake rates among Chinese older adults remain low. This study examines the individual and combined effects of behavioral interventions based on the Information–Motivation–Behavioral Skills (IMB) model and economic incentives in promoting influenza vaccine uptake among older adults living in China. Methods: The study will recruit 640 older adults living in eight communities that have not been covered by the free influenza vaccination policy. These eight communities (as clusters), stratified by urban and rural, will be randomized to four parallel arms, including a usual care arm, an IMB-based behavioral intervention arm, a conditional economic incentive arm, and a combined behavioral-economic arm. The interventions will start from the beginning of the flu season and last for about one month. Specifically, the IMB-based behavioral intervention encompasses health education brochures, healthcare provider-led lectures, interactive quizzes, and personalized consultations. The exact number of economic incentives is conditional on the timing of vaccination (a higher amount for early immunization) and the number of people within a household to be vaccinated at the same appointment (a higher amount for more people). The primary outcome is the influenza vaccination rate. Data will be gathered through vaccination records and questionnaires covering IMB-based vaccination cognitions. Mixed-effects models will be used to analyze the outcome of vaccination rate, reporting difference-in-differences estimates with 95% confidence intervals. Conclusions: The results of this study have the potential to inform influenza vaccination program scaleup among older adults who are not yet covered by the free influenza vaccination policy. Ethics and dissemination: Ethics approval has been granted by the ethics commission of Peking University Health Science Centre (IRB00001052-24090). Participants will be required to sign a written consent form. Findings will be reported in conferences and peer-reviewed publications in accordance with the recommendations of the Consolidated Standards of Reporting Trials. Registration number: This study was registered at the Chinese Clinical Trial Registry (ChiCTR2400090229).
Closing Editorial for Smart Healthcare: Technologies and Applications
Authors: Kou Gang , Ding Shuai , Luo Li , Lu Tian , Kanagasingam Yogesan
Published: November 2024

It is our honor to present this editorial to close the Special Issue “Smart Healthcare: Technologies and Applications”, which we are coordinating [...]
The Promise and Limitations of Student Belonging as a Predictor of Retention
Authors: Gilani David , McArthur Daniel , Thomas Liz
Published: November 2024

Efforts to improve student retention are regularly explored within higher education literature and practice due to their status as a noble aim shared by governments, universities, and students themselves. To this end, students’ sense of belonging has become an increasingly popular topic of study due to its comprehensive links to student success. However, while student retention is understood as a binary, externally defined metric, student belonging is subjective, messy, and dynamic. This study utilises a longitudinal design to explore the changing relationship between student belonging, intention to persist, and eventual continuation with 101 first-year undergraduate students at two English universities. Regression analyses were utilised to build on previous research showing the near-perfect correlation between belonging and students’ intention to persist. Sense of belonging was also a strong predictor of eventual continuation status for all time-point measures of belonging except at the start of the first academic year. These findings provide further evidence for the promise of student belonging as a tool for practitioners to pre-empt risks of withdrawal. However, the findings also suggest that early measurements of a sense of belonging could be less reliable.
CRISPR/Cas9-Mediated BocPDSs Gene Editing in Chinese Kale Using the Endogenous tRNA-Processing System
Authors: Wang Yudan , Sharif Rahat , Li Guangguang , Chen Guoju , Chen Changming
Published: November 2024

Chinese kale is a native vegetable from the Brassicaceae family that is grown extensively in Southeast Asia and Southern China. Its low genetic transformation and gene editing efficiency hinder gene function research and molecular biology in Chinese kale. CRISPR/Cas9 is a useful tool for plant genome research due to its rapid development and optimization. This study targeted BocPDSs, (BocPDS1, BocPDS2) to establish an effective CRISPR/Cas9 system in Chinese kale. A tandemly arranged tRNA-sgRNA construct was used to express numerous sgRNAs to induce BocPDS1 and BocPDS2 double and single mutations, with a mutation rate of 61.11%. As predicted, several mutant plants showed an albino phenotype with a harbored mutation in an exon and intron region, highlighting the relevance of the intron. The presence of mutations in the intron region suggests that the cleavage process in Chinese kale, utilizing CRISPR/Cas9 shows a preference for AT-rich regions. The distinct and somewhat redundant functions of BocPDS1 and BocPDS2 are demonstrated by the complete albino phenotype of the double mutants and the mosaic albino phenotype of the individual BocPDS1 and BocPDS2 mutants. Specific gene editing modes, including base deletion, base substitution, and base insertion, were identified in the sequence of the target gene. Among them, short nucleotide insertions were the most common type of insertion, with base insertions having the highest frequency (61.54%). Furthermore, no instances of off-target gene editing were detected. The current work demonstrated that the CRISPR/Cas9 gene editing system, which relies on endogenous tRNA processing, can effectively induce mutagenesis in Chinese kale. This finding establishes a theoretical basis and technical backbone for the more effective implementation of CRISPR/Cas9 gene-editing technology in Chinese kale and Brassica plants.
Enhancing Fruit Retention and Juice Quality in ‘Kinnow’ (Citrus reticulata) Through the Combined Foliar Application of Potassium, Zinc, and Plant Growth Regulators
Authors: Arshad Iqra , Saleem Muhammad , Akhtar Muhammad , Shani Muhammad Yousaf , Farid Ghulam , Jarecki Wacław , Ashraf Muhammad Yasin
Published: November 2024

Improving fruit quality and reducing pre-harvest fruit drop are critical goals for Citrus reticulata production in Pakistan, where climatic and nutritional challenges affect yield and juice quality. This study evaluated the combined effects of plant growth regulators (salicylic acid and indole acetic acid) and nutrients (potassium and zinc) on fruit drop and juice volume in Citrus reticulata L. Field trials were conducted at three locations in Punjab, Pakistan (Layyah, Faisalabad, and Sargodha) using a randomized complete block design (RCBD) with five replications per treatment. Nutrients (K and Zn at 100 mg/L each) and growth regulators (SA at 100 mg/L and IAA at 5 mg/L) were applied individually or in combination at three growth stages. Statistical analyses, including PCA, ANOVA, and GGE biplot, were used to identify the most effective treatments for improving fruit juice quality and reducing fruit drop. The combined foliar application of SA + K + Zn was the most effective across all parameters, except fruit drop, juice citric acid contents, and juice pH, which were negatively affected. The highest juice potassium content was observed with K application. The PCA and GGE biplot analysis indicated that the Sargodha orchard performed best, with the SA + K treatment being the most effective there, while SA + K + Zn showed the best results at Layyah and Faisalabad for reducing fruit drop, enhancing juice volume, and improving fruit quality. However, individual fruit, juice, and juice nutrient contents traits analyses revealed that the most significant improvements in fruit and juice quality were observed at the Sargodha site instead of Layyah and Faisalabad. The treatment SA + K + Zn proved to be the most stable and consistent in enhancing citrus fruit and juice quality across all three selected locations. The findings suggest that adopting the SA + K + Zn treatment could be a practical approach for citrus farmers aiming to enhance crop yield and fruit quality, thereby supporting agricultural productivity and export potential in Pakistan.
Groundwater Response to Snowmelt Infiltration in Seasonal Frozen Soil Areas: Site Monitoring and Numerical Simulation
Authors: Fang Yongjun , Du Xinqiang , Ye Xueyan , Wang Enbo
Published: November 2024

Spring snowmelt has a significant impact on the hydrological cycle in seasonally frozen soil areas. However, scholars hold differing, and even opposing, views on the role of snowmelt during the thawing period in groundwater recharge. To explore the potential recharge effects of spring snowmelt on groundwater in seasonal frozen soil areas, this study investigated the vadose zone dynamics controlled by soil freeze–thaw processes and snowmelt infiltration in the Northeast of China for 194 days from 31 October 2020 to 12 May 2021. Responses of groundwater level and soil moisture to snowmelt infiltration show that most snowmelt was infiltrated under the site despite the ground being frozen. During the unstable thawing period, surface snow had already melted, and preferential flow in frozen soil enabled the recharge groundwater by snowmelt (rainfall), resulting in a significant rise in groundwater levels within a short time. The calculated and simulated snowmelt (rainfall) infiltration coefficient revealed that during the spring snowmelt period, the recharge capacity of snowmelt or rainfall to groundwater at the site is 3.2 times during the stable thawing period and 4.5 times during the non-freezing period.
Analyzing Hydrodynamic Changes in Dubai Creek, UAE: A Pre- and Post-Extension Study
Authors: Elkersh Khaled , Atabay Serter , Ali Tarig , Yilmaz Abdullah G. , Mortula Maruf Md. , Cavalcante Geórgenes H.
Published: November 2024

This paper presents a comparative study that examines the effects of the Dubai Creek extension on its hydrodynamics and water flushing dynamics. Dubai Creek (Khor Dubai) is a 24 km long artificial seawater stream located in the emirate of Dubai. The creek has experienced the impact of the rapid urbanization of Dubai and a major 13 km extension project, which connected the creek to the Arabian Gulf from the other side. In this paper, two-dimensional hydrodynamic and flushing models were created using Delft3D Flexible Mesh (2021.03) to investigate the water circulation and water quality of the creek before and after the extension. The hydrodynamic models were calibrated and validated to accurately simulate water levels and currents with correlation values close to 1 and very small RMSE and bias. Flushing models were created to simulate water renewal along the creek. The results of the flushing models showed a significant improvement in the flushing characteristics of pollutants in terms of the residence times of the extended creek (Existing Creek) model compared to the old one (Old Creek). This improvement emphasized the positive impact of the creek extension project on the local aquatic ecosystem and its overall water quality.
Combining Network Pharmacology and Transcriptomic Strategies to Explore the Pharmacological Mechanism of Total Ginsenoside Ginseng Root and Its Impact on Antidepressant Effects
Authors: Chen Weijia , Guo Pengli , Su Lili , Guo Xiangjuan , Shi Meiling , Geng Jianan , Zong Ying , Zhao Yan , Du Rui , He Zhongmei
Published: November 2024

Depression is one of the most common neurological diseases, which imposes a substantial social and economic burden on modern society. The purpose of this study was to explore the mechanism of total ginsenoside ginseng root (TGGR) in the treatment of depression through a comprehensive strategy combining network pharmacology, transcriptomics, and in vivo experimental validation. The Traditional Chinese Medicine Systematic Pharmacology (TCMSP) database and literature were used to collect the main components and targets of TGGR. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were applied to explore the underlying mechanisms. In addition, the chronic unpredictable mild stress (CUMS)-induced C57BL/6 mouse model was used to evaluate the antidepressant activity of TGGR. The results showed that TGGR improved depression-like behavior in mice and increased the decrease in serum 5-hydroxytryptamine (5-HT) and brain-derived neurotrophic factor (BDNF) levels caused by CUMS. Combined network pharmacology and transcriptomic analysis showed that the AMP-activated kinase (AMPK) signaling pathway mainly enriched the core target. Immunohistochemistry, Western blotting, and reverse transcription quantitative polymerase chain reaction (RT-qPCR) were used to confirm whether TGGR exerts antidepressant effects by regulating this pathway. The results showed that TGGR has a regulatory impact on related proteins in the AMPK pathway, and the regulatory effect of TGGR on proteins was inhibited after the administration of related pathway inhibitors. In summary, total ginsenosides may regulate the AMPK signaling pathway and activate the sirtuin 1 (SIRT1) peroxisome proliferator-activated receptor-gamma coactivator 1-alpha (PGC-1α) pathway to have therapeutic effects on depression.
Advances and Challenges in Low-Resource-Environment Software Systems: A Survey
Authors: Agbeyangi Abayomi , Suleman Hussein
Published: November 2024

A low-resource environment has limitations in terms of resources, such as limited network availability and low-powered computing devices. In such environments, it is arguably more difficult to set up new software systems, maintain existing software, and migrate between software systems. This paper presents a survey of software systems for low-resource environments to highlight the challenges (social and technical) and concepts. A qualitative methodology is employed, consisting of an extensive literature review and comparative analysis of selected software systems. The literature covers academic and non-academic sources, focusing on identifying software solutions that address specific challenges in low-resource environments. The selected software systems are categorized based on their ability to overcome challenges such as limited technical skills, device constraints, and socio-cultural issues. The study reveals that despite noteworthy progress, unresolved challenges persist, necessitating further attention to enable the optimal performance of software systems in low-resource environments.
The Flight Pattern of Navel Orangeworm (Amyelois transitella Walker) 2008–2023 in California Pistachio
Authors: Siegel Joel Philip
Published: November 2024

The navel orangeworm, Amyelois transitella, is the principal pest of pistachio and almond in California. The timing of the insecticide application is challenging because there is no model that predicts when pistachio is vulnerable to infestation. Sixteen years of pistachio flight data from Madera and Fresno counties (541,892 adults) were analyzed to determine if there was a consistent starting point each year for flights that overlap pistachio vulnerability. This effort was complicated by changes in trap lures over this period, as unmated females were replaced by a combination lure consisting of the synthetic pheromone and phenyl propionate, which is needed because mating disruption suppresses pheromone lure trap capture. There were two additional complications: the increased degree day accumulation during the growing season and the three-fold hectarage expansion of pistachio. A biofix at 944.4 degree days °C from the beginning of the year was identified from the dataset, which was consistent across all years in both counties. Using the biofix, subsequent flight peaks occurred at 277.78 degree day °C intervals (generation time on new crop pistachios), corresponding to three weeks in the field. This biofix can be used to improve the timing of field scouting, which in turn will improve the timing of insecticide application.
Seasonal Dynamics of Non-Biting Midges (Diptera: Chironomidae) and Relevant Environmental Factors
Authors: Lei Teng , Gu Jingjing , Zhao Mengyao , Chen Yuqiu , Song Chao , Qi Xin
Published: November 2024

The family Chironomidae is speciose and is present in almost all freshwater habitats. Adult non-biting midges emerge from waterbodies and swarm in high numbers, occasionally disrupting people’s outdoor activities. In order to understand the seasonal dynamics of species composition, a continuous observation of non-biting midge diversity was performed. Adult non-biting midges were collected using light traps from the autumn of 2022 to the summer of 2023 in an urban wetland park. Species were identified based on morphological characteristics and DNA barcodes. Alpha diversity was evaluated using Margalef, Pielou, and Shannon–Wiener indexes. Beta diversity was evaluated using unconstrained NMDS analysis and constrained CCA. The impacts of environmental factors, including barometric pressure, temperature, relative humidity, and wind speed, on the variation in species composition were estimated in the constrained analyses. A total of 42 species were identified, with 29 species belonging to Chironominae, 9 species belonging to Orthocladiinae, and 4 species belonging to Tanypodinae. The species composition varied across different seasons. Summer sites and autumn sites shared the highest similarity in diversity, and spring sites presented the lowest diversity. The variation was significantly correlated with environmental conditions. The results showed that seasonality is a factor influencing the diversity of adult non-biting midges.
Multiple Arterial Grafting During Coronary Artery Bypass Graft Surgery in Diabetic and Non-Diabetic Patients: A Short- and Long-Term Analysis at a Single Center
Authors: Jasarevic Miralem , Krueger Oskar , Strathmann Jan , Jasarevic Marinela , Shehada Sharaf-Eldin , Piotrowski Jarowit Adam , Massoudy Parwis , Jakob Heinz , Kamler Markus , Akhyari Payam , Thielmann Matthias
Published: November 2024

Background/Objectives: Coronary artery bypass surgery (CABG) with multiple arterial grafting (MAG) has shown potential to improve patient survival compared to single arterial bypass grafting. Whether this superiority in survival also exists in diabetics is uncertain. We therefore aimed to compare short and long-term outcomes of MAG in diabetic versus non-diabetic patients. Methods: In this retrospective study, we investigated short- and long-term clinical outcomes of diabetic (n = 256) and non-diabetic (n = 800) patients undergoing CABG with MAG between January 1999 and December 2019 at our institution. Results: Diabetics had a significantly higher EuroScore II (1.37 ± 2.4 vs. 0.88 ± 1.58, p < 0.0001) and underwent significantly less bilateral internal thoracic artery (BITA) grafting (51.95% vs. 67.75%; p < 0.0001) compared to non-diabetics. The incidence of postoperative adverse events, such as pneumonia, stroke, and sepsis, did not differ between the two groups. However, diabetics suffered significantly more often from post-cardiotomy cardiogenic shock, renal failure requiring dialysis, and sternal wound infections over the entire follow-up period. Non-diabetics had a significantly higher median survival time of 19.6 years compared to 14.54 years found in diabetic patients (p < 0.0001). Conclusions: Among patients undergoing MAG, diabetic individuals were found to have a significantly lower overall median survival. This emphasizes the importance of diabetes as a risk factor in choosing individual surgical strategies.
Management of Abnormal Uterine Bleeding Among Reproductive Age Group Women: A Cross-Sectional Study
Authors: Almuhaitb Rina Abdullah , Alenazi Rinad Hamad , Almebki Rauof Ahmad , Alshehri Raghad Awadh , Alemad Monya Mohammed , AlHarbi Joud Mohammed , AlAmro Shahad Abdullah , Alshahrani Renad Mohammed , Bakhsh Hanadi
Published: November 2024

Background: Abnormal uterine bleeding (AUB) is a common gynecological complaint affecting women of reproductive age. This study aimed to explore the management of AUB using the FIGO PALM-COEIN classification system. Methods: A cross-sectional study was conducted at King Abdullah bin Abdulaziz University Hospital, reviewing 500 medical records of women aged 20–50 years with AUB. Data on demographics, clinical characteristics, PALM-COEIN classification, and treatment modalities were collected and analyzed. Results: The majority of participants were aged 20–29 years (43%) and overweight or obese (64.2%). Ovulatory dysfunction (31.6%) was the most common identifiable cause of AUB, followed by leiomyoma (16.8%). Hormonal treatments, particularly combined oral contraceptive pills, were associated with improved outcomes (OR = 2.15, p < 0.001) and reduced anemia prevalence (p = 0.042). Age (OR = 0.95, p = 0.015) and BMI (OR = 1.10, p = 0.005) were significant predictors of treatment response. The presence of leiomyoma decreased the odds of treatment success (OR = 0.55, p = 0.007), while ovulatory dysfunction increased the likelihood of response (OR = 1.75, p = 0.003). Conclusions: The study highlights the complex nature of AUB and the effectiveness of hormonal treatments in its management. Findings emphasize the need for individualized treatment approaches based on the underlying etiology and patient characteristics. Future research should focus on long-term outcomes and optimizing management strategies for complex cases.
The Association Between Time in Range %, Measured by Continuous Glucose Monitoring (CGM) and Physical Health Agility Status Indices Amongst Older People with T2D: A Cross-Sectional Study
Authors: Basson-Shleymovich Yamit , Yahalom-Peri Tal , Azmon Michal , Cukierman-Yaffe Tali
Published: November 2024

Background: Individuals with diabetes face a higher risk of mobility disabilities, frailty, and sarcopenia (physical health agility). Studies have shown an association between HbA1C levels and physical health agility status. There is less information available about the relationship with time in range (%) (TIR). The aim of this study was to evaluate the cross-sectional relationship between time in range % (TIR %) and physical health agility status among older adults with type 2 diabetes (aerobic capacity, gait speed, strength, balance, and frailty). Methods: A cross-sectional study was conducted among individuals with diabetes over the age of 60. Participants were equipped with a blinded continuous glucose monitor (CGM) system (Medtronic iPro™2 and CareLink™, Medtronic, Northridge, CA, USA)) for 1 week and underwent an elaborate physical functional assessment (physical health agility) at the beginning and end of that week. The relationship between various physical health agility indices and both TIR (%) and HbA1c was evaluated using linear regression, with adjustments made for age and sex. Results: This analysis pertains to 139 individuals over the age of 60 with type 2 diabetes. After adjustment for age and sex, a 1% higher TIR (70–180 mg/dL) was associated with a 0.169 better score on aerobic capacity and endurance (p-value = 0.023), 0.119 better score on muscle strength of the upper limb (p-value = 0.039), 0.164 better score on dynamic balance (p-value = 0.039), and 0.165 better score on the evaluation of fall risk and balance (p-value = 0.037). Conclusions: In older individuals with diabetes, a higher percentage of time in range (TIR) is linked to better physical agility status indices. Future research is needed to determine whether glucose levels are simply a marker of disease severity or if there is a potential causal relationship.
Sex Differences in Clinical Features in Gout: A Nationwide Retrospective Cohort Study
Authors: Do Hyunsue , Choe Kwanyoung , Kim Min Jung , Shin Kichul , Moon Ki Won
Published: November 2024

Background: Patients with gout have several coexisting conditions that impact mortality. We analyzed the differences in clinical manifestations among Korean patients with gout and compared the causes of death based on sex using data from the Korean National Health Insurance Service-National Sample Cohort database. Methods: We included adults with gout receiving urate-lowering therapy (ULT) from 2002 until 2019. The clinical features and causes of death were compared between male and female patients. Multivariate Cox regression was performed to identify the risk factors contributing to all-cause mortality. Results: The results showed that female patients were older at the start of ULT and had more comorbidities. The most common cause of death among all patients with gout was chronic kidney disease (CKD). When observed separately by sex, lung cancer is the leading cause in males, versus CKD in females. Multivariate Cox analysis showed that old age at ULT start, low body mass index (BMI), current smoking, diabetes, CKD, cerebrovascular disease, malignancy, and low hemoglobin were significant risk factors for all-cause mortality in males; however, old age at ULT start, low BMI, CKD, malignancy, and low hemoglobin were significant risk factors in females. Conclusions: The clinical features and cause of death were different between male and female patients with gout, suggesting that treatment strategies for gout should be established differently depending on sex.
Surgical or Transcatheter Mitral Valve Replacement After Prior Bioprosthesis or Ring Implantation: A Landmark Analysis of Early and Long-Term Outcomes
Authors: Pollari Francesco , Liang Huan , Vogt Ferdinand , Ledwon Miroslaw , Weber Lucia , Sirch Joachim , Bagaev Erik , Fittkau Matthias , Fischlein Theodor
Published: November 2024

Background: In recent years, the use of transcatheter valve-in-valve implantation in the mitral position (TMVI) for the treatment of mitral valve pathology following ring or bioprosthetic implantation has emerged as a less invasive option in comparison to repeated mitral valve surgery (RMVS). We aimed to compare the early and mid-term results of these two strategies. Method: We retrospectively analyzed all patients who underwent a mitral intervention in our institution between 2005 and 2022. Applying the exclusion criteria, 41 subjects were analyzed: 23 underwent RMVS, while 18 underwent a TMVI. The time-dependency treatment effect was approached using a landmark analysis, applying the Kaplan–Meier analysis at different time points. Results: The two study groups were comparable in terms of age (p = 0.18), gender (p = 0.78), body surface area (p = 0.33), and EuroSCORE II (p = 0.06). No patients died perioperatively or had a stroke. Two patients in each group died within the first 30 days following the procedure (RMVS 8.3% vs. TMVI 11.1%; p = 0.75). Eighteen patients had died at follow-up; two underwent re-intervention on their mitral valve (one in each group). The mean survival was not statistically different between groups (RMVS 8 ± 1.1 years, 95% CI 5.8–10.2, vs. TMVI 4.79 ± 0.82 years, 95% CI 3.1–6.4; log-rank = 0.087). A landmark analysis of survival after four years showed significantly worse survival for patients in the TMVI group in comparison with those treated surgically (log-rank = 0.047). Conclusions: TMVI and RMVS are both effective strategies with similar short-term outcomes. However, patients in the TMVI group showed a significantly lower survival rate after four years.
Sports Activity with Ankle Osteoarthritis and Total Ankle Arthroplasty
Authors: Santini Simone , Marinozzi Andrea , Talia Adrian J. , Herrera-Rodríguez Alejandro , Herrera-Pérez Mario , Valderrabano Victor
Published: November 2024

Background/Objectives: The interest in performing total ankle arthroplasty (TAA) to address end-stage ankle osteoarthritis (OA) is continuously growing. Sports activity plays an important role in our world. The literature is sparse regarding return-to-sports activity following TAA. The levels and types of sports in TAA are rarely reported. The purpose of this prospective case series study is to investigate sports activity in ankle osteoarthritis (OA) and TAA in terms of rate, frequency, type, and clinical outcomes with a minimum 2 years of follow-up after surgery. Methods: A total of 103 patients (105 implants, 52 female, and 51 male), mean age 60.5 years (range, 23–84 years) with end-stage ankle OA were treated using a three-component, uncemented, mobile-bearing VANTAGE Total Ankle System. The mean follow-up was 2.9 years (range, 2–5 years). Visual Analogic Scale Pain Score (VAS, 0–10 points), Ankle Dorsiflexion/Plantarflexion (DF/PF) range of motion (ROM; degrees), functional American Orthopaedic Foot and Ankle Society (AOFAS) Ankle/Hindfoot Score (0–100 points), Subjective Patients’ Satisfaction Score (0–10 points), Sports Activity Rate, Sports Frequency Score, and sports type were assessed. Results: The mean preoperative VAS Pain Score was 6.7 points (range, 3–10 points) and 0.2 points for postoperative (range, 0–3 points) (p < 0.001). The mean DF/PF ROM was 24.9° preoperative (range, 0–60°) and 52.9° postoperative (range, 15–85°) (p < 0.001). The mean preoperative functional AOFAS Ankle/Hindfoot Score was 39.5 points (range, 4–57 points) and 97.8 points for postoperative (range, 75–100 points) (p < 0.001). The mean postoperative Subjective Patients’ Satisfaction Score was 9.7 points (range, 7–10 points). The preoperative Sports Activity Rate was 31.1%, with 85.4% for postoperative (p < 0.001). All the groups exhibited substantial Sports Frequency Score increases (p < 0.001). The most practised sports were hiking, biking, fitness, and swimming. Conclusions: total ankle arthroplasty (TAA) is an effective treatment for end-stage ankle OA. TAA facilitates a noteworthy increase in sports activity. This research offers important sports insights to patients with ankle OA and TAA.
Temperamental and Character Traits as Risk Factors for Binge Eating Disorder in Women with Polycystic Ovary Syndrome
Authors: Suchta Katarzyna , Smolarczyk Roman , Hajbos Marta , Kokoszka Andrzej
Published: November 2024

Background/Objectives: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age. It is associated with an increased risk of somatic and mental health problems. The prevalence of binge eating disorder (BED) in women with PCOS is higher than in the healthy population. The co-occurrence of PCOS and BED increases the risk of negative health outcomes and may worsen patient compliance. For both groups of disorders, specific personality traits have been described in the literature. The aim of this study was to assess temperament and character in PCOS women with and without BED, in search of specific personality traits that may distinguish PCOS patients with a higher predisposition to BED. Methods: 128 women diagnosed with PCOS according to the modified Rotterdam criteria were included in the study. All completed the Temperament and Character Inventory by R.C. Cloninger (TCI). The collected data were statistically analyzed. Results: The PCOS–BED subgroup was characterized by specific personality traits in comparison with PCOS subgroup: statistically significantly higher scores of harm-avoidance dimensions (in anticipatory worry, shyness, and fatigability subscales) and statistically significantly lower scores of persistence and self-directedness dimensions (in purposeful, resourcefulness, self-acceptance, and enlightened second nature subscales). Conclusions: PCOS–BED women have certain personality traits. Screening PCOS patients for the presence of certain personality traits could identify those at risk. PCOS–BED women may be at higher risk of health problems and treatment failure and may require a different therapeutic approach to treatment, including psychotherapeutic interventions.
The Role of Psychological Variables in Predicting Rehabilitation Outcomes After Spinal Cord Injury: An Artificial Neural Networks Study
Authors: Mascanzoni Marta , Luciani Alessia , Tamburella Federica , Iosa Marco , Lena Emanuela , Di Fonzo Sergio , Pisani Valerio , Di Lucente Maria Carmela , Caretti Vincenzo , Sideli Lucia , Cuzzocrea Gaia , Scivoletto Giorgio
Published: November 2024

Background: Accurate prediction of neurorehabilitation outcomes following Spinal Cord Injury (SCI) is crucial for optimizing healthcare resource allocation and improving rehabilitation strategies. Artificial Neural Networks (ANNs) may identify complex prognostic factors in patients with SCI. However, the influence of psychological variables on rehabilitation outcomes remains underexplored despite their potential impact on recovery success. Methods: A cohort of 303 patients with SCI was analyzed with an ANN model that employed 17 input variables, structured into two hidden layers and a single output node. Clinical and psychological data were integrated to predict functional outcomes, which were measured by the Spinal Cord Independence Measure (SCIM) at discharge. Paired Wilcoxon tests were used to evaluate pre–post differences and linear regression was used to assess correlations, with Pearson’s coefficient and the Root Mean Square Error calculated. Results: Significant improvements in SCIM scores were observed (21.8 ± 15.8 at admission vs. 57.4 ± 22.5 at discharge, p < 0.001). The model assigned the highest predictive weight to SCIM at admission (10.3%), while psychological factors accounted for 36.3%, increasing to 40.9% in traumatic SCI cases. Anxiety and depression were the most influential psychological predictors. The correlation between the predicted and actual SCIM scores was R = 0.794 for the entire sample and R = 0.940 for traumatic cases. Conclusions: The ANN model demonstrated the strong impact, especially for traumatic SCI, of psychological factors on functional outcomes. Anxiety and depression emerged as dominant negative predictors. Conversely, self-esteem and emotional regulation functioned as protective factors increasing functional outcomes. These findings support the integration of psychological assessments into predictive models to enhance accuracy in SCI rehabilitation outcomes.
The Effects of Syphilis Infection on Total Knee Arthroplasty Outcomes: A Retrospective Cohort Study
Authors: Gudmundsson Paul , Gadda Marc , Areti Aruni , Sambandam Senthil
Published: November 2024

Objective: This study investigated the impact of recent syphilis infection on postoperative outcomes following total knee arthroplasty (TKA). We hypothesized that patients with a documented history of syphilis infection would experience a higher rate of postoperative complications compared to those without such a history. Methods: We conducted a retrospective cohort analysis using a national insurance claims database. Our study population included 237,360 patients who underwent primary TKA between 2005 and 2024. Patients were classified into two groups based on the presence (+Syph) or absence (−Syph) of a syphilis diagnosis within one year prior to the TKA. We evaluated the rates of several postoperative complications at 30 days postsurgery, including infection, hematologic issues, and cardiac events. Statistical analyses between groups was performed using chi-squared tests and Fisher’s exact tests. Routine demographic data such as age, sex, race, and comorbidities were also analyzed. Results: Among the 237,360 TKA patients, we identified 71 with a history of syphilis within one year of their surgery. The +Syph group exhibited significantly higher rates of periprosthetic infection (4.23% vs. 0.81%, p = 0.001), need for manipulation under anesthesia (MUA) at four months (7.04% vs. 2.82%, p = 0.032), deep venous thrombosis (4.23% vs. 1.27%, p = 0.026), periprosthetic fracture (2.82% vs. 0.23%, p < 0.001), and pneumonia (2.82% vs. 0.62%, p = 0.019) within 30 days postTKA. No significant differences were observed in 30-day mortality, deep or superficial surgical site infections, wound dehiscence, blood loss anemia, or transfusion requirements. Additionally, rates of acute renal failure, pulmonary embolism, and cardiac events did not differ significantly between groups. Demographically, patients in the syphilis cohort had a higher prevalence of smoking and diabetes preoperatively within one year of their surgical date. Conclusions: A documented syphilis diagnosis within one year of TKA significantly affects postoperative outcomes, increasing the rates of prosthetic joint infection, MUA, deep venous thrombosis, periprosthetic fracture, and pneumonia. These findings underscore the need for heightened vigilance in the pre- and postoperative management of patients with a history of syphilis infection undergoing TKA. Further research is warranted to explore the relationship between prior syphilis infection and TKA outcomes, as well as to develop strategies to mitigate this increased risk.
AM-PAC 6-Clicks Basic Mobility and Daily Activities Scores Predict 90-Day Modified Rankin Score in Patients with Acute Ischemic Stroke Secondary to Large Vessel Occlusion
Authors: Cho Andrew , Lakhani Dhairya A. , Balar Aneri B. , Salim Hamza , Koneru Manisha , Hillis Argye , Gonzalez Fernández Marlis , Vagal Vaibhav , Urrutia Victor , Faizy Tobias D. , Heit Jeremy J. , Albers Greg W. , Mazumdar Ishan , Chen Kevin , Sepehri Sadra , Kim Minsoo , Luna Licia , Mei Janet , Yedavalli Vivek S. , Hyson Nathan
Published: November 2024

Background: The relative level of functional impairment in stroke patients is a significant determinant of post-acute care. The Activity Measure for Post Acute Care 6-Clicks (AM-PAC) scores for basic mobility and daily activity are rapid standardized assessments whose utilities in predicting long-term stroke outcomes have not yet been studied. Methods: We performed a retrospective analysis of acute ischemic stroke patients and their outcomes. We evaluated the distribution of outcomes using the chi-square test. We then compared the proportions of patients with good stroke outcomes for different combinations of favorable scores. We performed two-proportion z-tests to determine the significance, and p < 0.05 was considered significant. Results: 282 patients met all of the inclusion criteria between 12 January 2017 and 19 March 2023 (M age = 66.4, 59.9% female). After dichotomizing the scores as “favorable” vs. “unfavorable”, we found that 128/155 (82.6%) patients with favorable basic mobility had good stroke outcomes vs. 20/127 (15.7%) with unfavorable basic mobility (p < 0.0001). Similarly, for favorable daily activity, it was 103/113 (91.2%) vs. 45/169 (26.6%), for both favorable, it was 100/109 (91.7%) vs. 48/173 (27.7%), and for neither favorable, it was 17/123 (13.8%) vs. 131/159 (82.4%), all with p < 0.0001. When comparing among groups, both favorable patients differed significantly from those with favorable basic mobility alone (p = 0.033) but not those with favorable daily activity alone (p = 0.875). Even after adjusting for age, the odds ratios of favorable scores were greater than 20 for any combination (p < 0.001). Conclusions: Basic mobility and daily activity AM-PAC scores at discharge are independent predictors of anterior circulation acute ischemic stroke outcomes at 90 days.
Assessing Cardiovascular Risk in Geriatric Patients Without Atherosclerotic Cardiovascular Disease
Authors: Żurański Witold , Nowak Justyna , Danikiewicz Aleksander , Zubelewicz-Szkodzińska Barbara , Hudzik Bartosz
Published: November 2024

Introduction: Age is a major risk factor that affects the likelihood of developing atherosclerotic cardiovascular disease (ASCVD). The anticipated 10-year ASCVD risk for nearly all individuals aged 70 years and older surpasses conventional risk thresholds. When considering treatment for risk factors, it is important to take into account ASCVD risk modifiers, such as malnutrition, polypharmacy, and comorbidities. Objectives: The aim of this study was to estimate ASCVD risk in apparently healthy (without established ASCVD) elderly persons. We also evaluated several biochemical and clinical indicators to better characterize the studied population. Patients and methods: A total of 253 elderly individuals aged 70 years and older, who were apparently healthy and did not have established atherosclerotic cardiovascular disease (ASCVD), were enrolled in the study. The Systemic Coronary Risk Estimation 2-Older Persons (SCORE2-OP) model was utilized to assess their 10-year risk of developing ASCVD. Results: Among the 253 participants, 41 (16.2%) were classified as high risk, while 212 (83.8%) were categorized as very high risk. No individuals had a low ASCVD risk (defined as less than 7.5%). The median 10-year risk of developing ASCVD for the study group was 23% (ranging from 17% to 32%). The number of individuals identified as very high risk increased significantly with age, with nearly all participants aged 75 years and older being considered very high risk. An age of 75 years or older is associated with a very high risk for ASCVD, supported by a C-statistic of 0.92, which reflects a positive predictive value (PPV) of 99% and a negative predictive value (NPV) of 52% (p < 0.001). Conclusions: Elderly individuals without established ASCVD constitute a varied group. The majority were identified as being at very high risk for ASCVD. Age and hypertension were the primary factors contributing to this risk. Furthermore, modifiers of ASCVD risk, including malnutrition, polypharmacy, and multimorbidity, were commonly observed.
Fibrinogen and Prothrombin Complex Concentrate: The Importance of the Temporal Sequence—A Post-Hoc Analysis of Two Randomized Controlled Trials
Authors: Ranucci Marco , Aloisio Tommaso , Di Dedda Umberto , Anguissola Martina , Barbaria Alessandro , Baryshnikova Ekaterina
Published: November 2024

Background/Objectives: A low level of soluble coagulation factors after cardiac surgery may cause excessive bleeding and trigger clinical correction using prothrombin complex concentrate (PCC). According to the current guidelines, the trigger values for PCC administration are not defined. In the published algorithms, when driven by ROTEM®, the triggers vary from 80 s to >100 s of coagulation time (CT) during an EXTEM test. Two randomized controlled trials on fibrinogen (FC) supplementation after cardiac surgery previously pointed out that the patients receiving FC supplementation had a significant decrease in their EXTEM CT. This study investigates the hypothesis that after increasing the availability of a substrate (fibrinogen), thrombin generation induces fibrin network formation faster, and that, before considering PCC administration, the normalization of fibrinogen levels should be sought. Methods: A retrospective study based on a post-hoc analysis of the data collected in two previous RCTs involving 85 patients, all of whom received FC supplementation. Results: The results of this post-hoc analysis demonstrate that there is a significant negative association between FIBTEM maximum clot firmness (MCF) and the EXTEM CTs before and after FC supplementation; FC supplementation decreases the EXTEM CTs both in patients with a low FIBTEM MCF and a normal FIBTEM MCF. After FC supplementation, 45 (53%) of the patients had an EXTEM CT of >80 s, 22 (26%) had an EXTEM CT of >90 s, and 8 (9%) had an EXTEM CT of >100 s. Conclusions: Our study confirms and quantifies the effects of reducing EXTEM CTs through FC supplementation. A stepwise strategy of factors correction with FC supplementation should be used before considering PCC administration as it might reduce the need for PCC.