bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of and Variables Associated with Syncope-Related Injuries and Fractures in Germany: A Cross-Sectional Study in General Practices
Authors: Gümbel Danilo Christian , Konrad Marcel , Krieg Sarah , Krieg Andreas , Kostev Karel
Published: March 2024

Background: There is a lack of studies investigating the prevalence of syncope-related injuries in a large representative cohort. The aim of this cross-sectional study is to investigate the prevalence of, and variables associated with syncope-related injuries and fractures in a large outpatient population in Germany. Methods: The present study used data from the Disease Analyzer database (IQVIA) and included adults with first-time diagnoses of syncope in 1 of 1284 general practices in Germany between 2005 and 2022 (index date). The prevalence of injuries and separate fractures documented on the index date was examined, and the association of demographic and clinical variables with the risk of syncope-related injuries and fractures was studied using multivariable logistic regression. Results: A total of 143,226 patients (mean age: 57.1 years, 56.9% female) were included in this study. The proportion of injuries was 10.4% and increased from 6.4% in the age group 18–30 to 15.0% in the age group >80 years. Female sex was associated with a slightly higher risk of injury (OR: 1.09; 95% CI: 1.05–1.13) and fractures (OR: 1.17; 95% CI: 1.07–1.28). Osteoporosis was associated with a higher risk of injury (OR: 1.25; 95% CI: 1.16–1.34) and fracture (OR: 1.53; 95% CI: 1.33–1.76), while obesity was only associated with a slightly increased risk of injury. Conclusions: Syncope-related injuries are common among syncope patients. Factors associated with a higher risk of syncope-related injuries, such as female sex, older age, and osteoporosis, can be incorporated into an effective risk stratification and help to improve the outcome of syncope patients.
Osseodensification vs. Conventional Osteotomy: A Case Series with Cone Beam Computed Tomography
Authors: Costa José Adriano , Mendes José Manuel , Salazar Filomena , Pacheco José Júlio , Rompante Paulo , Moreira Joaquim Ferreira , Mesquita José Diogo , Adubeiro Nuno , da Câmara Marco Infante
Published: March 2024

Introduction: Osseodensification is a non-extraction technique using specially designed drills to increase bone density while extending an osteotomy, allowing bone to be preserved and condensed by compacting autograft during osteotomy preparation, increasing bone density around implants, and improving mechanical stability. Aim: The objective of this study is to compare conventional osteotomy and osseodensification protocols in implant placement and analyze whether there are differences in bone density. Materials and Methods: Study variables were defined, namely, osseodensification technique, conventional osteotomy technique, bone density, sex, area of location, implant dimensions, implant dimensions, and implant stability. Eligibility and exclusion criteria were defined. A step-by-step surgical protocol was developed. The surgeon and radiologist underwent intra-examiner calibration. A total of 15 patients were selected according to the eligibility criteria, and a total of 41 implants were inserted, 20 implants by conventional osteotomy and 21 by osseodensification. A cone beam computed tomography was performed one year after prosthetic rehabilitation to estimate bone density. Data were collected and recorded, and in the analysis of the association of variables, non-parametric tests were applied. Results: Significant statistical results were found in bone density values, with higher values being obtained with the osseodensification technique, that is, median density values of 1020, and median density values of 732 for the bone drilling technique. The results of the correlation between bone density in both techniques and sex, primary implant stability, implant dimensions and location area were statistically non-significant. Conclusions: Within the limitations of this study, there are differences in bone density between conventional osteotomy and osseodensification protocols. Bone density is increased with osseodensification over a study period of one year.
The Road to Sepsis in Geriatric Polytrauma Patients—Can We Forecast Sepsis in Trauma Patients?
Authors: Niggli Cédric , Vetter Philipp , Hambrecht Jan , Pape Hans-Christoph , Mica Ladislav
Published: March 2024

Background: Sepsis is a leading cause of mortality in polytrauma patients, especially beyond the first week, and its management is vital for reducing multiorgan failure and improving survival rates. This is particularly critical in geriatric polytrauma patients due to factors such as age-related physiological alterations and weakened immune systems. This study aimed to investigate various clinical and laboratory parameters associated with sepsis in polytrauma patients aged < 65 years and ≥65 years, with the secondary objective of comparing sources of infection in these patient groups. Methods: A retrospective cohort study was conducted at the University Hospital Zurich from August 1996 to December 2012. Participants included trauma patients aged ≥16 years with an Injury Severity Score (ISS) ≥ 16 who were diagnosed with sepsis within 31 days of admission. Patients in the age groups < 65 and ≥65 years were compared in terms of sepsis development. The parameters examined included patient and clinical data as well as laboratory values. The statistical methods encompassed group comparisons with Welch’s t-test and logistic regression. Results: A total of 3059 polytrauma patients were included in the final study. The median age in the group < 65 years was 37 years, with a median ISS of 28. In the patient group ≥ 65 years, the median age was 75 years, with a median ISS of 27. Blunt trauma mechanism, ISS, leucocytosis at admission, and anaemia at admission were associated with sepsis in younger patients but not in geriatric patients, whereas sex, pH at admission, lactate at admission, and Quick values at admission were not significantly linked with sepsis in either age group. Pneumonia was the most common cause of sepsis in both age groups. Conclusions: Various parameters linked to sepsis in younger polytrauma patients do not necessarily correlate with sepsis in geriatric individuals with polytrauma. Hence, it becomes critical to recognize imminent danger, particularly in geriatric patients. In this context, the principle of “HIT HARD and HIT EARLY” is highly important as a proactive approach to effectively address sepsis in the geriatric trauma population, including the preclinical setting.
The Correlation of Body Mass Index with Risk of Recurrence in Post-Menopausal Women with Breast Cancer Undergoing Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography
Authors: Quartuccio Natale , Ialuna Salvatore , Pulizzi Sabina , D’Oppido Dante , Antoni Mauro , Moreci Antonino Maria
Published: March 2024

Background: The aim of this study was to investigate whether high body mass index (BMI) increases the risk of recurrence and correlates with higher glucose uptake in recurrent lesions in post-menopausal female patients with breast cancer. Methods: A hospital database was searched to retrieve breast cancer patients who had undergone an [18F]FDG PET/CT scan before neoadjuvant chemotherapy and curative-intent surgery. BMI was calculated at the baseline [18F]FDG PET/CT scan. There was a median follow-up of 5 years after the baseline PET/CT scan to identify recurrence in the breast (T_rec); lymph nodes (N_rec); and distant locations (M_rec). Furthermore, SUVmax was measured at the sites of recurrence. A chi-square test was used to investigate any difference in the frequency of any recurrence, T_rec, N_rec, and M_rec, between overweight women (BMI ≥ 25 kg/m2) and women with a BMI < 25 kg/m2 (p < 0.05). SUVmax was compared using a t-test (p < 0.05) between the two groups. Results: A total of 142 post-menopausal patients (BMI: 26.84 ± 5.59; 84 overweight and 58 with normal weight) were retrieved from the database. There were 48 recurrences at the follow-up. The chi-square test demonstrated in overweight women an increased frequency of any recurrence (35 vs. 13; p = 0.025) and T_rec (15 vs. 2; p = 0.018) and a higher T_rec SUVmax (4.74 ± 2.90 vs. 1.85 ± 0.63; p = 0.09) compared to women with a BMI < 25 kg/m2. Conclusions: BMI seems to correlate with an increased rate of recurrence, especially in the breast, and a higher glucose uptake in post-menopausal patients with recurrent breast cancer.
Multicomponent Exercise Intervention for Preventing Falls and Improving Physical Functioning in Older Nursing Home Residents: A Single-Blinded Pilot Randomised Controlled Trial
Authors: Sadaqa Munseef , Debes Wesam A. , Németh Zsanett , Bera-Baka Zsófia , Vachtler-Szepesi Marianna , Nácziné Földes Loretta , Prémusz Viktória , Hock Márta
Published: March 2024

Background: Older nursing home residents are at a greater risk of falling due to frailty. Exercise is effective at hampering frailty and related adverse events, including falls. Objectives: Our purpose was to evaluate the effect of a 12-week moderate-intensity multicomponent exercise programme on the number of falls and physical functioning among older nursing home residents. Also, we examined the association between the number of falls and demographics as well as physical and cognitive baseline data. Methods: The study protocol was registered on clinicaltrials.gov with the following identifier: NCT05835297. Older adults aged 65 years and over were recruited from a nursing home, and eligible and consenting residents were randomly allocated to two parallel groups: the intervention group, which performed a multicomponent exercise programme composed of strength, balance, and aerobic training (n = 12), and the control group, which received usual care (n = 12). Outcomes included falls, and measures of strength, balance, and mobility. Results: We had high adherence to exercise sessions, and no adverse events were recorded. We observed a non-significant reduction in falls (p = 0.34) and a significant improvement in Short Physical Performance Battery (p = 0.003) after the exercise programme. Falls were associated with being female and having diminished physical or cognitive function. Conclusions: Multicomponent exercise programmes should be implemented regularly in nursing homes for their effectiveness. Future studies with bigger samples, including participants with worse physical and cognitive impairments, as well as follow-up periods are required.
Efficacy of a Novel Tapered Contrast Catheter for Endoscopic Ultrasound-Guided Hepaticogastrostomy: A Multicenter Study
Authors: Niiya Fumitaka , Sato Tatsunori , Kaneko Junichi , Ishikawa Kazuma , Tamai Naoki , Yamawaki Masataka , Noda Jun , Azami Tetsushi , Nishimoto Fumiya , Takano Yuichi , Nagahama Masatsugu
Published: March 2024

Background: Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is an alternative for failed endoscopic retrograde cholangiopancreatography (ERCP), with current success rates of 65–84% considered suboptimal. A novel ERCP catheter (SHOREN, Kaneka Corporation, Osaka, Japan) with a tapered 3.3-French tip may facilitate smoother insertion, potentially improving outcomes. Methods: This retrospective analysis encompassed EUS-HGS procedures conducted from January 2021 to August 2023 at four institutions. The aim of this study was to compare the performance of conventional and novel ERCP contrast catheters regarding the success rate of single-attempt catheter insertion, failure rates, technical success rates, and incidence of adverse events. Results: The study included 48 patients; 26 underwent EUS-HGS using conventional catheters and 22 with the novel catheter. The novel catheter achieved higher success rates in single-attempt insertions (96.5% vs. 80.8%) and lower failure rates (4.6% vs. 7.7%). The occurrence of bile peritonitis was comparable between the two groups. Conclusions: The novel ERCP contrast catheter with a tapered tip appears to contribute to successful catheter insertion and is useful for EUS-HGS.
Non-Invasive Recording of Ocular-Following Responses in Children: A Promising Tool for Stereo Deficiency Evaluation
Authors: Miladinović Aleksandar , Quaia Christian , Ajčević Miloš , Diplotti Laura , Michieletto Paola , Accardo Agostino , Pensiero Stefano
Published: March 2024

Background: The ability to merge the two retinal images to perceive depth (stereopsis) plays an important role in human vision. Its proper development requires binocular alignment and good visual acuity in both eyes during childhood. Because treatments are more effective when applied early, early diagnosis is important. Unfortunately, assessing stereo deficiencies in infants and young children remains challenging. Recently, it has been shown that ocular-following responses (OFRs; reflexive, short-latency eye movements induced by the sudden motion of a large textured pattern) are sensitive to changes in interocular correlation, making them potentially useful for stereo deficiency assessments. To test this hypothesis, we measured OFRs elicited by dichoptic stimulation in children with normal and compromised stereopsis (due to amblyopia). Methods: Two groups of six children (age- and sex-matched: 3M/3F aged 7–12 yo), one with compromised stereopsis and one with normal stereopsis, were included. OFRs were recorded using a custom high-resolution video eye-tracking system. The relative differences between eye displacement induced by correlated stimuli (up-correlated–down-correlated) and anticorrelated (up-anticorrelated–down-anticorrelated) were compared. Results: We found significant differences between OFRs induced by two dichoptic conditions (correlated and anticorrelated stimuli) in most children with normal stereopsis, whereas no differences were observed in children with compromised stereopsis, indicating a lack of disparity detectors. Conclusions: OFRs might thus be exploited as a diagnostic tool for the objective identification of stereo deficiencies in children. This might lead to improved early diagnosis and treatment outcomes for conditions like amblyopia and strabismus.
Thrombotic Microangiopathy as a Life-Threatening Complication of Long-Term Interferon Beta Therapy for Multiple Sclerosis: Clinical Phenotype and Response to Treatment—A Literature Review
Authors: Allinovi Marco , Mazzierli Tommaso , Laudicina Selene , Pastò Luisa , Portaccio Emilio , Amato Maria Pia , Trivioli Giorgio
Published: March 2024

Thrombotic microangiopathy (TMA) has been observed in some patients receiving interferon beta (IFNβ) therapy for relapsing-remitting multiple sclerosis, but little is known about its clinical features and outcomes. We searched the literature to identify cases with IFNβ-related TMA and assessed their pattern of organ involvement, the presence of prodromal manifestations, the treatments used, and the outcomes. Thirty-five articles met the inclusion criteria, and data of 67 patients were collected. The median duration of IFNβ therapy before the diagnosis of TMA was 8 years, and 56/67 (84%) presented with acute kidney injury (AKI), of which 33 required acute dialysis. All but three patients had manifestations during the four weeks before TMA onset, including flu-like symptoms, headache, and worsening blood pressure control. In only two patients, ADAMTS13 activity was reduced, while 27% had low C3 levels. However, none showed causative genetic mutations associated with development of atypical hemolytic uremic syndrome. All patients discontinued IFNβ, 34 (55%) also received plasma exchange, and 12 (18%) received eculizumab. Complete renal recovery was achieved by 20 patients (30%), while 13 (20%) developed end-stage renal disease. Among those with AKI requiring dialysis, eculizumab therapy was associated with a significantly reduced risk of ESRD compared with plasma exchange. Therefore, TMA with features of aHUS mainly occurs after prolonged treatment with IFNβ and is preceded by prodromes, which may lead to an early diagnosis before life-threatening complications occur. Eculizumab appears beneficial in cases with severe kidney involvement, which supports a role of the complement system in the pathogenesis of these forms.
Characteristics of Homebound and Patients with Disability Who Use Home-Based Primary Care in Korea: A Retrospective Study for 2018–2022
Authors: Lee Sun Young , Chu Hyein , Kim Yu-Mi
Published: March 2024

(1) Background and Methods: This study evaluated characteristics of South Korean patients necessitating home-based primary care (HBPC) from 2018 to 2022, distinguishing between homebound individuals with chronic conditions and those with registered disabilities. (2) Result: Among 171 HBPC recipients, 56.1% were homebound, predominantly older with a median age of 81 years (interquartile range (IQR 68.5–86.0)), while 43.9% were disabled, generally younger with a median age of 39 years (IQR, 28–64). Activities of daily living were assessed, revealing a median score of 14 (IQR, 10–19), indicative of high care dependency. The most common conditions among homebound patients were dementia (27.1%) and physical mobility difficulties (21.9%), whereas mental disabilities (53.3%) and mobility issues (36.0%) prevailed in disabled patients. The primary HBPC needs for homebound patients included management of acute medical conditions (27.1%) and sores (17.7%). Conversely, regular health check-ups (46.7%) and management of neuropsychiatric symptoms (26.7%) were prevalent among the disabled group. (3) Conclusion: Notably, over 90% of HBPC patients required assistance with daily activities, highlighting significant differences in the needs and characteristics between older, homebound individuals with multiple comorbidities and younger, disabled patients receiving medical aid. These insights emphasize the necessity to develop customized HBPC programs to adequately cater to the diverse patient needs within South Korea.
Remote Physiotherapy for Children with ASD during the COVID-19 Pandemic: A Thematic Analysis of Physical Therapists’ Perspectives
Authors: Harel Yael , Romano Alberto , Lotan Meir
Published: March 2024

Background: Physical therapy plays a crucial role in addressing the physical challenges faced by individuals with autism spectrum disorder (ASD). Amidst the COVID-19 pandemic lockdown, physical therapists (PTs) working in special education centers for ASD children were tasked with deploying remote telehealth interventions (RTIs), an uncommon approach in physical therapy until then. The present article aims to describe and discuss the PTs’ perspective of using RTI with children with ASD during the national Israeli COVID-19 lockdown. Methods: Reports from 13 experienced PTs who treated and supported 244 children with ASD using RTIs over six weeks were analyzed. The study employed quantitative research methods, including freely written reports and discussions addressing the question “what were your experiences as a PT treating ASD children remotely during the nationwide COVID-19 lockdown?” Results: the reports were categorized into four main themes: (a) the implications of RTIs on the children; (b) the implications of RTIs on the PTs; (c) modifications for applying RTI; and (d) PTs’ family rapport as a necessary basis for RTI. Noteworthy findings include the unaffected implementation of RTIs by ASD severity level and the dependence of RTI’s success on parental availability and the ability of parents to tailor activities for their child. Conclusions: The findings of the current research suggest that PT services through RTIs are well-suited for individuals with ASD and their families.
The Recent Management of Vestibular Schwannoma Radiotherapy: A Narrative Review of the Literature
Authors: Brun Lucie , Mom Thierry , Guillemin Florent , Puechmaille Mathilde , Khalil Toufic , Biau Julian
Published: March 2024

Background: Radiotherapy (RT) plays an important role in the therapeutic management of vestibular schwannoma (VS). Fractionated stereotactic radiotherapy (FSRT) or radiosurgery (SRS) are the two modalities available. The purpose of this article is to review the results of VS RT studies carried out over the last ten years. Materials and Methods: A literature search was performed with PubMed and Medline by using the words vestibular schwannoma, acoustic neuroma, radiotherapy, and radiosurgery. Results: In small (<3 cm) VS, SRS offers a local control rate of >90%, which seems similar to microsurgery, with a favorable tolerance profile. Hypofractionated FSRT (three to five fractions) is a relatively recent modality and has shown similar outcomes to normofractionated FSRT. Hearing preservation may highly differ between studies, but it is around 65% at 5 years. Conclusions: SRS and FRST are non-invasive treatment options for VS. SRS is often preferred for small lesions less than 3 cm, and FSRT for larger lesions. However, no randomized study has compared these modalities.
Explanatory Cognitive Diagnosis Models Incorporating Item Features
Authors: Liao Manqian , Jiao Hong , He Qiwei
Published: March 2024

Item quality is crucial to psychometric analyses for cognitive diagnosis. In cognitive diagnosis models (CDMs), item quality is often quantified in terms of item parameters (e.g., guessing and slipping parameters). Calibrating the item parameters with only item response data, as a common practice, could result in challenges in identifying the cause of low-quality items (e.g., the correct answer is easy to be guessed) or devising an effective plan to improve the item quality. To resolve these challenges, we propose the item explanatory CDMs where the CDM item parameters are explained with item features such that item features can serve as an additional source of information for item parameters. The utility of the proposed models is demonstrated with the Trends in International Mathematics and Science Study (TIMSS)-released items and response data: around 20 item linguistic features were extracted from the item stem with natural language processing techniques, and the item feature engineering process is elaborated in the paper. The proposed models are used to examine the relationships between the guessing/slipping item parameters of the higher-order DINA model and eight of the item features. The findings from a follow-up simulation study are presented, which corroborate the validity of the inferences drawn from the empirical data analysis. Finally, future research directions are discussed.
Centrifuge Modelling of Composite Bucket Foundation Breakwater in Clay under Monotonic and Cyclic Loads
Authors: Jiang Minmin , Lu Zhao , Cai Zhengyin , Xu Guangming
Published: March 2024

This study investigates the monotonic and cyclic performance of composite bucket foundation breakwater in clay through centrifuge modeling. The application of monotonic loads simulates extreme wave conditions, and cyclic load corresponds to long-term serviceability conditions. In centrifuge tests, three typical soil strengths were tested, and two load eccentricities were simulated to check the influence of wave force height. Multiple measurements were conducted, including rotation angle, horizontal displacement, vertical settlement, and pore pressure variation. When soil strength increases in monotonic centrifuge tests, the ultimate bearing capacity of the bucket foundation experiences significant growth, and the foundation failure pattern varies. In responding to the monotonic test, the foundation’s rotation center constantly moved downward during the loading process, indicating that the deeper soil would be activated to resist the horizontal loading. In contrast, the rotation center movement in the symmetric centrifuge test was opposed to the non-symmetric test because the deeper soil was required to provide resistance to balance the more severe load under the non-symmetric loading condition. It should be noted that non-symmetric loading does not impact the bucket foundation as seriously as symmetric loading. The utilization of deep-soil resistance in non-symmetric tests is beneficial in controlling deformation.
Changes in Serum IL-12 Levels following the Administration of H1-Antihistamines in Patients with Chronic Spontaneous Urticaria
Authors: Ene Corina Daniela , Tocut Milena , Tampa Mircea , Georgescu Simona Roxana , Matei Clara , Leulescu Iulia Maria Teodora , Nicolae Ilinca , Ene Cosmin
Published: March 2024

Introduction. Research regarding the role of the IL-12 cytokine family in modulating immune and inflammatory responses is continuously evolving. In this study, the contribution of the p35 and p40 subunits as monomers (noted as IL-12p35 and IL-12p40) and heterodimers (noted as IL-12p70 or IL-12p35/p40) was analysed in the pathophysiology and progression of chronic spontaneous urticaria (CSU). Materials and methods. We conducted a longitudinal, case–control study involving 42 CSU cases and 40 control cases comprising adults without associated conditions. Serial measurements were performed to assess the serum levels of IL-12p70, IL-12p35, and IL-12p40 at the onset of the disease (pre-therapy phase) and 6 weeks after the initiation of the treatment (post-therapy phase). Results. During the pre-therapeutic phase of CSU, elevated serum levels of IL-12 cytokine subtypes were detected compared to the control group. The relationship between IL-12 profiles and the course of CSU highlighted the pro-inflammatory role of IL-12p70 and the anti-inflammatory role of IL-12p35. Significant correlations were observed between IL-12p70 levels and the duration of the disease, as well as between IL-12 and the effectiveness of H1-antihistamines. Conclusions. The molecular background for the pleiotropic activities mediated by IL-12-derived cytokines in patients with CSU lies in the strict regulation of the production, signalling pathways, and cytokine-specific influences on the same pathophysiological events. The results of the present study suggest that the superficial layers of the skin serve as a cellular source of IL-12, a cytokine produced through antigenic stimulation. In patients with CSU, we identified independent, additive, or divergent functions of IL-12p70, IL-12p35, and IL-12p40, all relevant to systemic inflammation. These findings prove that the prototype programming of IL-12 is abnormal in CSU.
Chronic Obstructive Pulmonary Disease Mortality and Hospitalization during the COVID-19 Pandemic Compared with before the Pandemic: A Systematic Review and Meta-Analysis
Authors: Ahn Chiwon , Park Yeonkyung
Published: March 2024

This study aimed to assess the impact of the pandemic on hospitalization and mortality rates among patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). We conducted a systematic search across three medical databases for studies comparing the AECOPD mortality and hospitalization rates during the COVID-19 pandemic with those before the pandemic, up until December 2023. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analysis of Observational Studies in Epidemiology guidelines, we performed a meta-analysis with a random-effects model to pool odds ratios (ORs), 95% confidence intervals (CIs), and heterogeneity (I2). From 4689 records, 21 studies met our inclusion criteria. Our analysis revealed a significant increase in in-hospital mortality during the pandemic (pooled OR = 1.27, 95% CI = 1.17–1.39, I2 = 50%). Subgroup analysis highlighted a more pronounced mortality risk in single-center studies and smaller populations. Conversely, hospitalization rates for AECOPD significantly declined during the pandemic (pooled OR = 0.39, 95% CI = 0.18–0.85, I2 = 99%). The study demonstrates that during the COVID-19 pandemic, there was a substantial decrease in hospital admissions for AECOPD and an increase in in-hospital deaths. This shows that better healthcare plans and pandemic preparedness are needed to help people with chronic conditions.
Long-Term Perspectives on Chronic Rhinosinusitis with Nasal Polyps: Evaluating Recurrence Rates after Functional Endoscopic Sinus Surgery in the Biologics Era—A 5-Year Follow-Up Study
Authors: Cavaliere Carlo , Masieri Simonetta , Begvarfaj Elona , Loperfido Antonella , Baroncelli Silvia , Cascone Francesca , Ciofalo Andrea
Published: March 2024

Introduction: Chronic rhinosinusitis with nasal polyps (CRSwNP) is an inflammatory disease with multifactorial etiopathogenesis. This study investigated the recurrence rate and risk factors predicting recurrence in patients subjected to Functional Endoscopic Sinus Surgery (FESS) for CRSwNP. Methods: Patients affected by CRSwNP who underwent FESS between January 2015 and March 2020 were enrolled. The recurrence rate and the influence of risk factors were assessed. Results: A total of 154 patients were included, 100 males and 54 females, aged 14–82 years (mean age 51.96 ± 16.27; median 52 years). Of 154 patients, 28 presented CRSwNP recurrence in a follow-up period ranging from 6 months to 69 months, with a recurrence rate of 18.2%. The recurrence rate was higher in patients aged between 31 and 50 years and between 51 and 70 years at the time of surgery than in those aged between 14 and 30 years and over 70 years. Furthermore, most patients with recurrence were men (61%), while 39% were women. A higher recurrence rate was observed between non-smokers (50%) and ex-smokers (36%), while only 14% declared themselves habitual smokers. Only four subjects (14%) had a positive family history of CRSwNP. Conclusion: To date, no specific biomarkers have been identified in order to determine the appropriate therapy for the patients affected by CRSwNP. Based on our results, we suggest that it is necessary for an accurate assessment of the CRSwNP patients to identify which phenotype/endotype each subject manifests based on medical history, endoscopy, computed tomography, and a laboratory evaluation.
Fog Computing-Based Smart Consumer Recommender Systems
Authors: Hornik Jacob , Ofir Chezy , Rachamim Matti , Graguer Sergei
Published: March 2024

The latest effort in delivering computing resources as a service to managers and consumers represents a shift away from computing as a product that is purchased, to computing as a service that is delivered to users over the internet from large-scale data centers. However, with the advent of the cloud-based IoT and artificial intelligence (AI), which are advancing customer experience automations in many application areas, such as recommender systems (RS), a need has arisen for various modifications to support the IoT devices that are at the center of the automation world, including recent language models like ChatGPT and Bard and technologies like nanotechnology. This paper introduces the marketing community to a recent computing development: IoT-driven fog computing (FC). Although numerous research studies have been published on FC “smart” applications, none hitherto have been conducted on fog-based smart marketing domains such as recommender systems. FC is considered a novel computational system, which can mitigate latency and improve bandwidth utilization for autonomous consumer behavior applications requiring real-time data-driven decision making. This paper provides a conceptual framework for studying the effects of fog computing on consumer behavior, with the goal of stimulating future research by using, as an example, the intersection of FC and RS. Indeed, our conceptualization of the “fog-based recommender systems” opens many novel and challenging avenues for academic research, some of which are highlighted in the later part of this paper.
Prevalence and Clinical Management of Adrenal Tumour-Related Hyperandrogenism: A Narrative Review
Authors: Medenica Sanja , Zivanovic Dusan , Milardi Domenico , Bruno Carmine , Batkoska Ljubica , Traini Emanuela , Pontecorvi Alfredo
Published: March 2024

Hyperandrogenism is a condition in which the levels of androgen hormones in the blood are significantly increased and could be of an adrenal or ovarian origin. The adrenal androgens, normally secreted by the zona reticularis, are steroid hormones with weak androgen activity. The causes of hyperandrogenism are diverse and could be endogenous and exogenous. Androgen excess affecting different tissues and organs results in clinical features such as acne, hirsutism, virilization, and reproductive dysfunction such as oligomenorrhoea/amenorrhoea. Although androgen excess is rarely associated with adrenal tumours, it is important as it could be predictive of malignancy. A careful evaluation of the androgen pattern, also in patients with clear signs of hyperandrogenism, could be useful. Laboratory evaluation should focus on measuring total testosterone levels, followed by the estimation of other androgens such as dehydroepiandrosterone and androstenedione, and using visualisation procedures in the further management. The treatment of adrenal hyperandrogenism is eminently surgical, in consideration of the frequent malignant origin. The aim of this review is to elaborate and summarize the prevalence and clinical management of hyperandrogenism of an adrenal origin by describing the physiological mechanisms of adrenal androgen steroidogenesis, the clinical manifestations of hyperandrogenism with a special reference to hyperandrogenism in adrenal adenomas and carcinomas, and the diagnostic methods that will lead us to establishing the correct diagnosis and different treatment options to manage this condition according to the clinical presentation of the patient.
Vernal Keratoconjunctivitis: Immunopathological Insights and Therapeutic Applications of Immunomodulators
Authors: Hehar Navpreet K. , Chigbu DeGaulle I.
Published: March 2024

Vernal keratoconjunctivitis (VKC) is a complex and multifactorial disease process that employs Th2 cell-mediated immunologic processes, which involves the overexpression of interleukin 4 (IL-4), IL-5, IL-9, IL-13, and IL-31, and the activation of mast cells that release IL-5 and CCL-11, recruiting eosinophils to the site of inflammation. The disease primarily affects young males and is more common in regions with warm climates. VKC is characterized by persistent and recurrent conjunctival inflammation that can adversely affect the patient’s quality of life, and, when inadequately treated, may lead to a host of ocular complications, such as corneal shield ulcers and scarring. The major distinct forms of VKC include limbal or palpebral, which may occur in combination. The clinicopathological features of VKC include the presence of pseudogerontoxon, limbal gelatinous hyperplasia, and perilimbal hyperpigmentation. Topical immunomodulators are effective anti-steroidal options for controlling severe and chronic cases of VKC. This review will provide a brief overview of topical immunomodulators, including cyclosporin and tacrolimus, and will highlight the clinical manifestations, pathological mechanisms, and fibroproliferative changes in the conjunctiva that can result from recurrent disease.
Sympathetic Nervous Influences Are Negative Prognostic Factors in Stomach Cancer
Authors: Petrescu Mihai , Târtea Georgică , Udriștoiu Ion , Militaru Felicia , Petrescu Alexandra-Roxana , Ciurea Ana-Maria , Petrescu Ana-Maria , Obleagă Cosmin , Vere Cristin Constantin
Published: March 2024

(1) Background: The aim of our study was to assess the involvement of the sympathetic nervous system in the progression of patients with gastric carcinoma by analyzing the sympathetic neuronal fibers and beta 2 adrenoreceptors. (2) Methods: We performed a retrospective study in which we analyzed the clinical, biological, and histological data from a total of 104 patients diagnosed with stomach cancer. (3) Results: After analyzing the immunoreactivity of beta 2 adrenoreceptors, we observed increased values in patients with tumors larger than 5 cm in diameter (p = 0.0371), with a deeper degree of tumor invasion T3–4 (p = 0.0159), invasion in more than two lymph nodes (p = 0.0462), or a TNM stage III–IV. Regarding the survival analysis, better survival rates (65%) were observed for patients with a low value of beta 2 adrenoreceptors (B2A−), compared to B2A (+) patients, in which survival at 3 years of follow-up was only 43%. In addition, the analysis of intra-tumoral sympathetic fibers showed a better survival rate (83%) for patients with a low value of density compared to patients with increased density, in whom the survival rate was only 24%. (4) Conclusions: The findings of this study indicate that patients with stomach cancer have a more unfavorable prognosis when they have a higher density of sympathetic nerve fibers and an increased expression of beta 2 adrenergic receptors inside the tumor.
1-(2,4-Dinitrophenyl)-2-((Z)-2-((E)-4-fluorobenzylidene)-3,4-dihydronaphthalen-1(2H)-ylidene)hydrazine
Authors: Abdel-Wahab Bakr F. , Mohamed Hanan A. , Kariuki Benson M. , El-Hiti Gamal A.
Published: March 2024

The reaction of (E)-2-(4-fluorobenzylidene)-3,4-dihydronaphthalen-1(2H)-one and (2,4-dinitrophenyl)hydrazine in boiling ethanol containing hydrochloric acid (0.2 mL; 37%) for 1.5 h gave 1-(2,4-dinitrophenyl)-2-(2-(4-fluorobenzylidene)-3,4-dihydronaphthalen-1(2H)-ylidene)hydrazine in a 90% yield. Various spectral analyses, including NMR, and X-ray crystallography established the structure of the newly synthesized hydrazone.
Nonlinear Ultrasonic C-Scan Imaging for Contact-Type Defects in Diffusion-Bonded Joints—A Case Study
Authors: Zhang Chi , Pan Qianghua , Liu Taili , Zhang Lin , Gang Tie
Published: March 2024

Diffusion bonding technology is widely used in the connection of precision components, yet accurately and reliably detecting contact-type defects on the bond interface still remains a significant problem. Nonlinear ultrasonic methods have been proven to be sensitive to contact-type defects; however, the use of continuous wave or tone burst wave excitation limits its wider application. In this paper, dual-probe nonlinear ultrasonic testing with pulse wave excitation is proposed to detect contact-type defects in diffusion-bonded joints. A titanium alloy diffusion-bonded specimen with artificial defects was fabricated, and the corresponding detection device was designed based on the existing ultrasonic C-scan testing system. A C-scan imaging program based on nonlinear parameters was developed by extracting the fundamental and second harmonic waves of the reflection echo on the bond interface. The results demonstrated that the proposed detection scheme can obtain the nonlinear parameters of diffusion-bonded interfaces, and the nonlinear ultrasonic C-scan image of the bond interface is also obtained. The nonlinear parameter in the contact-type defects areas calculated from the bond interface echo is about 10 times (20 dB) higher than that in macro defects areas, whose gap is about 10 μm. The results indicate that the nonlinear ultrasonic methods seem to be more sensitive to contact-type defects and have a great potential to complement the insufficient detection capability of linear ultrasound for diffusion-bonded joints.
Augmenting Deep Neural Networks with Symbolic Educational Knowledge: Towards Trustworthy and Interpretable AI for Education
Authors: Hooshyar Danial , Azevedo Roger , Yang Yeongwook
Published: March 2024

Artificial neural networks (ANNs) have proven to be among the most important artificial intelligence (AI) techniques in educational applications, providing adaptive educational services. However, their educational potential is limited in practice due to challenges such as the following: (i) the difficulties in incorporating symbolic educational knowledge (e.g., causal relationships and practitioners’ knowledge) in their development, (ii) a propensity to learn and reflect biases, and (iii) a lack of interpretability. As education is classified as a ‘high-risk’ domain under recent regulatory frameworks like the EU AI Act—highlighting its influence on individual futures and discrimination risks—integrating educational insights into ANNs is essential. This ensures that AI applications adhere to essential educational restrictions and provide interpretable predictions. This research introduces NSAI, a neural-symbolic AI approach that integrates neural networks with knowledge representation and symbolic reasoning. It injects and extracts educational knowledge into and from deep neural networks to model learners’ computational thinking, aiming to enhance personalized learning and develop computational thinking skills. Our findings revealed that the NSAI approach demonstrates better generalizability compared to deep neural networks trained on both original training data and data enriched by SMOTE and autoencoder methods. More importantly, we found that, unlike traditional deep neural networks, which mainly relied on spurious correlations in their predictions, the NSAI approach prioritizes the development of robust representations that accurately capture causal relationships between inputs and outputs. This focus significantly reduces the reinforcement of biases and prevents misleading correlations in the models. Furthermore, our research showed that the NSAI approach enables the extraction of rules from the trained network, facilitating interpretation and reasoning during the path to predictions, as well as refining the initial educational knowledge. These findings imply that neural-symbolic AI not only overcomes the limitations of ANNs in education but also holds broader potential for transforming educational practices and outcomes through trustworthy and interpretable applications.
Optimizing the Economic Order Quantity Using Fuzzy Theory and Machine Learning Applied to a Pharmaceutical Framework
Authors: Kalaichelvan Kalaiarasi , Ramalingam Soundaria , Dhandapani Prasantha Bharathi , Leiva Víctor , Castro Cecilia
Published: March 2024

In this article, we present a novel methodology for inventory management in the pharmaceutical industry, considering the nature of its supply chain. Traditional inventory models often fail to capture the particularities of the pharmaceutical sector, characterized by limited storage space, product degradation, and trade credits. To address these particularities, using fuzzy logic, we propose models that are adaptable to real-world scenarios. The proposed models are designed to reduce total costs for both vendors and clients, a gap not explored in the existing literature. Our methodology employs pentagonal fuzzy number (PFN) arithmetic and Kuhn–Tucker optimization. Additionally, the integration of the naive Bayes (NB) classifier and the use of the Weka artificial intelligence suite increase the effectiveness of our model in complex decision-making environments. A key finding is the high classification accuracy of the model, with the NB classifier correctly categorizing approximately 95.9% of the scenarios, indicating an operational efficiency. This finding is complemented by the model capability to determine the optimal production quantity, considering cost factors related to manufacturing and transportation, which is essential in minimizing overall inventory costs. Our methodology, based on machine learning and fuzzy logic, enhances the inventory management in dynamic sectors like the pharmaceutical industry. While our focus is on a single-product scenario between suppliers and buyers, future research hopes to extend this focus to wider contexts, as epidemic conditions and other applications.
Transforaminal Epidural Block and Erector Spinae Plane Block to Manage Acute Zoster-Associated Pain: A Retrospective Case–Control Study
Authors: Soh Hyojung , Ko Yeona , Shin Jungwon , Kim Eung Don
Published: March 2024

Background and Objectives: Achieving adequate pain reduction in the acute phase of herpes zoster is essential for preventing postherpetic neuralgia (PHN). For this purpose, appropriate antiviral medications, oral analgesic medications, and various nerve block methods could be applied. Erector spinae plane block (ESPB) is a simple, novel ultrasound-guided block technique, and its use has increased because the procedure is convenient and relatively safe. Although several cases have reported the zoster-associated pain (ZAP) control effect of ESPB, the efficacy of ESPB has not been compared with that of other types of nerve blocks for managing ZAP. This study aimed to compare the efficacy of ESPB with that of other types of nerve blocks for managing ZAP. Study Design: Retrospective case–control study. Materials and Methods: Medical records of 53 patients with acute thoracic herpes zoster were reviewed. We divided the participants into two groups: patients who received transforaminal epidural injection (TFEI) (n = 32) and those who received ESPB (n = 21). The efficacy of the procedure was assessed by a numerical rating scale (NRS) and by recording patient medication doses before the procedure and at 1 week, 1 month, 2 months, and 3 months after the procedure. Results: The time required for pain intensity to decrease to NRS ≤ 2 was not significantly different between the groups. The rate of medication discontinuation also was not different between the groups. There was no significant difference between the two groups in the proportion of clinically significant PHN (NRS ≥ 3) at any time point. Limitations: The relatively small sample size from a single center and the retrospective nature of the study served as limitations. Conclusions: The clinical effects of ESPB and TFEI were similar in patients with acute thoracic herpes zoster. ESPB could be considered an interventional option for ZAP management.
The Association of Acetabulum Fracture and Mechanism of Injury with BMI, Days Spent in Hospital, Blood Loss, and Surgery Time: A Retrospective Analysis of 67 Patients
Authors: Wójcicki Rafał , Pielak Tomasz , Walus Piotr Marcin , Jaworski Łukasz , Małkowski Bartłomiej , Jasiewicz Przemysław , Gagat Maciej , Łapaj Łukasz , Zabrzyński Jan
Published: March 2024

Background and Objectives: The objective of this retrospective study was to investigate the association between acetabulum fractures; the mechanism of injury; and variables such as BMI, duration of hospital stay, blood loss, and surgery time. By exploring these factors, we aim to enhance our understanding of them and their impact on the healing process and the subsequent management of pelvic fractures. Materials and Methods: This study included 67 of 136 consecutive patients who were admitted for pelvic ring fracture surgery between 2017 and 2022. The data were collected prospectively at a single trauma center. The inclusion criteria were acetabulum fractures and indications for operative treatment. The exclusion criteria were non-operative treatment for acetabular and pelvic ring fractures, fractures requiring primary total hip arthroplasty (THA), and periprosthetic acetabular fractures. Upon admission, all patients underwent evaluation using X-ray and computed tomography (CT) scans of the pelvis. Results: The present study found no statistically significant differences between the examined groups of patients with pelvic fractures in terms of BMI, surgery duration, length of hospital stay, and blood transfusion. However, two notable findings approached statistical significance. Firstly, patients who experienced a fall from height while sustaining a pelvic fracture required a higher number of blood transfusions (2.3 units) than those with other mechanisms of injury which was close to achieving statistical significance (p = 0.07). Secondly, patients undergoing posterior wall stabilization required a significantly lower number of blood transfusions than those with other specific pelvic injuries (0.33 units per patient), approaching statistical significance (p = 0.056). Conclusions: The findings indicated that factors such as BMI, time of surgery, blood loss, and the duration of hospital stay were not directly correlated with the morphology of acetabular fractures, the presence of additional trauma, or the mechanism of injury. However, in the studied group, the patients whose mechanism of trauma involved falling from height had an increased number of blood transfusions compared to other groups. Moreover, the patients who had surgery due to posterior wall acetabulum fracture had decreased blood transfusions compared to those with other Judet and Letournel types of fractures. Additionally, they had the shortest duration of surgery.