bluuebunny/crossref_metadata_2025 huggingface dataset:
Potential impacts of reduced winter Kara Sea ice on the dipole pattern of cold surge frequency over the tropical western Pacific
Authors: Zhang Shiyue , Zeng Gang , Yang Xiaoye , Lin Zhaohui
Published: May 2024

The impact of Arctic Sea ice melting on weather and climate extremes in the Northern Hemisphere has garnered widespread attention. Existing research has convincingly demonstrated the importance of this impact in mid-high latitudes, while its influence in areas beyond remains controversial. This study reveals the indirect influence of Kara Sea ice reduction on cold surge (CS) over the tropical western Pacific (TWP), with the East Asian jet stream serving as the connecting link. The leading mode of CSs over the TWP exhibits a zonal dipole characteristic, which is associated with cyclonic anomaly over the Philippine Sea. The enhanced cyclonic anomaly is caused by strengthened and northward-moved subtropical East Asian jet stream and weakened polar jet stream, which can lead to more CSs over the South China Sea and fewer CSs over the Philippine Sea. Such variations in the jet stream are contributed by the facilitated atmospheric blockings west of the Ural Mountains, which suppressed the circumpolar westerly winds and increased meridional temperature gradient in Northeast Asia. The connection between atmospheric blockings and Kara Sea ice can be confirmed through local vertical energy exchange. Simulations of the atmospheric response to the forcing of decreased Kara Sea ice support the proposed connection. Although there is no statistically significant correlation between tropical CSs and Kara Sea ice, this study highlights the potential impacts of Arctic climate change signal on weather and climate extremes over tropical regions.
Numerical Simulation of Eco Sustainable Construction and Demolition Waste (CDW) based Geopolymer Concrete Blocks as Coarse Aggregates by using ANSYS Software
Authors: Bhavana K Y , Usha S , Mallesh T V , Shiva Raju G D
Published: May 2024

Recycled Aggregate (RA) reduces the carbon footprint and disposal problem associated with construction and demolition debris. As India is a lower middle country, demolition of existing buildings and constructions is taking place at a rapid pace. According to the Building Materials Promotion Board, India generates 150 million tons of construction and demolition waste annually. A study commissioned by the BBMP estimated CDW generation in Bengaluru 2,500 to 3,000 tons per day in 2022, leading to the problem of CDW disposal. The biggest environmental problem is the rapid manufacture of cement for construction activities, which generates millions of tons of carbon dioxide annually, the greatest environmental concern. Coarse aggregate was made from demolished buildings and other construction debris. The construction and demolition were collected from C&D Waste Traders, sirjala Bengaluru of 10 mm size recycled aggregate using. As the crushed aggregate is porous in nature due to residual slurry, these aggregates were treated in two stages: abrasion to remove residual loose slurry, and then again by immersing the aggregate in fly ash solution of concentration 1:6. Additionally, these cured aggregates are mixed with a strong geopolymer precursor in a mix ratio of 1:4:5 to form 400X200X150 mm block. To evaluate the masonry behavior of concrete blocks the tests are conducted as per the ASTM codes. The Prism Test on Masonry was conducted as per the code ASTM C 1314 and Diagonal Tension (Shear) in Masonry Assemblages as per the code ASTM E519 and this experimental study is compared with the ANSYS Software.
Assessment of Health and Safety Performance in Construction Industry
Authors: Maheshwary Aman , Singh Sabhilesh
Published: May 2024

The management of health and safety is crucial for anyone working in Construction industry. The Indian economy has suffered both financial and human losses as a result of poor health and safety management in the building industry. This study’s main goal is to analyse the health and safety management in the construction industry and identify the variables that influence it. A questionnaire was created for the survey while taking into account the past research for this topic. Collected and analysed survey data to identify the main elements influencing safety and health. This study offers a number of suggestions and tactics to enhance workers and employees health and safety management.
A Study of Flexible Pavement with Replacement of Bitumen with Melted Tyres& Recycled Aggregates using ANN Technique
Authors: Raina Prateeksha , Gupta Sushindra Kumar
Published: May 2024

Artificial neural network is a data processing mathematical model based on biological neurons. It is a complex structure composed of interconnected neurons that can be used to solve problems and perform tasks. Two essential construction materials in the industry are crumb rubber and destroyed aggregates. For accurate Marshall Stability mix proportioning, this work establishes the usage of ANNtechniques. Five of the most widely used statistical metrics are Pearson correlation coefficient, mean absolute error, and root mean square errors. When compared to other applied models, ANN produces better results. Proposed models should save money in terms of materials, labour, and time while also improving accuracy. The recommended concrete should be more cost-effective and long-lasting.The recommended values such as CC= 0.9484, Mean Absolute error=0.7988, RMSE=0.9478 represents that the result should be more cost-effective and long-lasting.
Groundwater Modelling of Jamwa Ramgarh using Visual MODFlow Flex
Authors: Sharma Yogendra , Gupta Mohit , Ravanan Mr. Arivumani , Mehra Isha , Singh Lavish Kumar , Kumar Monu , Duran Sandeep Kumar , Patel Utkarsh
Published: May 2024

A steady state finite difference model, MODFLOW, is developed to quantify groundwater in Jamwa Ramgarh, Jaipur (Dt) Rajasthan, using Groundwater data from 06 observation wells. ArcGIS was used to generate various shapefiles required as input files in Visual MODFlow Flex. The findings indicate that the calculated contours of groundwater levels closely correspond to the observed contours. The sustainable utilization and management of groundwater resources pose significant challenges for many countries worldwide. In recent years, groundwater modelling has emerged as an effective approach to tackle these challenges. Various modelling software tools are available to simulate groundwater flow, with MODFLOW being widely used to investigate the interactions between surface water and groundwater and to develop models for specific study areas. MODFLOW, a renowned groundwater modelling software, enables researchers and water resource professionals to understand and analyze the complex dynamics of groundwater systems. By utilizing MODFLOW, it becomes possible to assess the interactions between surface water and groundwater, evaluate the impacts of pumping or recharge activities, and make informed decisions regarding the sustainable management of groundwater resources. The utilization of MODFLOW and similar modelling software plays a crucial role in advancing our understanding of groundwater systems and supporting effective groundwater resource management practices.
Influence of square jets in Oxygen transfer in an Open Channel
Authors: Puri Diksha , Sihag Parveen , Thakur M.S
Published: May 2024

Plunging jets are popular for aeration in wastewater treatment plants due to low energy needs. In the present study, square jets were evaluated to determine their effectiveness in providing aeration efficiency by plunging jets in an open channel flow. The study seeks to add to the existing knowledge and provide insight into the performance of single and multiple square plunging jets in wastewater treatment plants. Passing a water sample from the pool through an open channel, via square water jet(s), has shown that variables such as a higher number of jets, and discharge have a significant impact on aeration efficiency (E20). The findings demonstrate that the increase in E20 was found to be 85.22% to 117.6% with Nj=64 over the single jet when discharge was varied from 3.41L/s to 4.75L/s, further affirming the remarkable effectiveness of plunging jets in promoting aeration in open channel flows. Furthermore, it was observed that Fr. No. is the parameter that has the most impact on calculating E20 with correlation of 0.95311.
Polycystic ovary syndrome and endometrial cancer risk: results from a nationwide cohort study
Authors: Frandsen C L B , Gottschau M , Nøhr B , Viuff J H , Maltesen T , Kjær S K , Jensen A , Svendsen P F
Published: May 2024

Most previous studies found an elevated risk of endometrial cancer among women with polycystic ovary syndrome (PCOS). However, these had highly varying methods for ascertainment of PCOS diagnoses and limitations such as few exposed women and short follow-up. In this cohort study, we investigated the association between PCOS and endometrial cancer among women born in Denmark between January 1, 1940, and December 31, 1993 (n = 1 719 121). Data in this study, including PCOS and endometrial cancer diagnoses and covariates, were derived from nationwide registers. We used Cox proportional hazards regression models to calculate hazard ratios (HRs) and 95% CIs. A total of 7862 endometrial cancer cases were identified during 23.7 years of follow-up (IQR, 37.7-61.9). We found an increased risk of endometrial cancer among women with PCOS compared with women without PCOS (HR = 3.02; 95% CI, 2.03-4.49). The risk was increased for premenopausal women (HR = 5.82; 95% CI, 3.64-9.30), whereas no marked association was seen for postmenopausal women. However, for postmenopausal women, results were limited by few cases and young age at the end of follow-up. Mounting evidence of an increased risk for endometrial cancer among women with PCOS reinforces the need for prevention and early detection.

This article is part of a Special Collection on Gynecological Cancers.
The associations of oxaliplatin-induced peripheral neuropathy, sociodemographic characteristics, and clinical characteristics with time to fall in older adults with colorectal cancer
Authors: Hines Robert B , Schoborg Christopher , Sumner Timothy , Thiesfeldt Dana-Leigh , Zhang Shunpu
Published: May 2024

Our purpose was to investigate the associations between falls and oxaliplatin-induced peripheral neuropathy (OIPN), sociodemographic characteristics, and clinical characteristics of older patients with colorectal cancer. The study population consisted of older adults diagnosed with colorectal cancer whose data were obtained from the Surveillance, Epidemiology, and End Results database combined with Medicare claims. We defined OIPN using specific (OIPN 1) and broader (OIPN 2) definitions of OIPN, based on diagnosis codes. Extensions of the Cox regression model to accommodate repeated events were used to obtain overall hazard ratios (HRs) with 95% CIs and the cumulative hazard of fall. The unadjusted risk of fall for colorectal cancer survivors with versus without OIPN 1 at 36 months of follow-up was 19.6% versus 14.3%, respectively. The association of OIPN with time to fall was moderate (for OIPN 1, HR = 1.37; 95% CI, 1.04-1.79) to small (for OIPN 2, HR = 1.24; 95% CI, 1.01-1.53). Memantine, opioids, cannabinoids, prior history of fall, female sex, advanced age and disease stage, chronic liver disease, diabetes, and chronic obstructive pulmonary disease all increased the hazard rate of falling. Incorporating fall prevention in cancer care is essential to minimize morbidity and mortality of this serious event in older survivors of colorectal cancer.
Downregulation of lysine 2-hydroxyisobutyrylation of ErbB3 binding protein 1 at amino acid 210 promotes keratinocyte proliferation via induction of transcription initiation factor IA-mediated rRNA synthesis
Authors: Li Junqin , Wang Ying , Niu Xuping , Xing Jianxiao , Dou Yu , Yao Yuanjun , Liang Yanyang , Wang Zehong , Wang Qiang , Feng Haiyan , Peng Aihong , Guo Yi , Liang Huifang , Guo Yaxin , Li Juan , Hou Ruixia , Cheng Yueai , Qu Tong , Li Xinhua , Yin Guohua , Zhang Kaiming
Published: May 2024

Background

Psoriasis is a prevalent chronic inflammatory dermatosis characterized by the excessive proliferation of keratinocytes (KCs). Lysine 2-hydroxyisobutyrylation (Khib) is a newly identified post-translational modification that regulates various biological processes. Abnormal Khib modification has been associated with the development of autoimmune diseases.

Objectives

To investigate the abnormal Khib modification profile and its pathogenic role in psoriasis.

Methods

Liquid chromatography–tandem mass spectrometry was used to analyse Khib-modified proteins in the epidermis of psoriasis lesions and healthy control skin. Mutated cells and mice with downregulated Khib modification of ErbB3 binding protein 1 (EBP1) at amino acid 210 (EBP1Khib210) were generated, to investigate the functional effects of EBP1Khib210 in psoriasis.

Results

Omics analysis revealed dysregulation of Khib modification in psoriatic lesions, exhibiting a distinct profile compared with controls. We found downregulation of EBP1Khib210 in psoriatic lesions and mice with imiquimod-induced psoriasis. Notably, expression of EBP1Khib210 was upregulated in patients with psoriasis following effective treatment. Decreased EBP1Khib210 enhanced KC viability, proliferation and survival but inhibited apoptosis in vitro. Additionally, Pa2g4K210A mice with downregulated Ebp1Khib210 exhibited more severe psoriatic lesions and enhanced KC proliferation. Moreover, we found that the EBP1K210A mutation increased the interaction between EBP1 and nuclear protein kinase B (Akt), thereby inhibiting mouse double minute 2-mediated transcription initiation factor IA (TIF-IA) ubiquitination and resulting in increased rRNA synthesis and KC proliferation. Downregulation of EBP1Khib210 was attributed to an inflammation-induced increase in histone deacetylase 2 expression.

Conclusions

Downregulation of EBP1Khib210 promoted KC proliferation by modulating Akt signalling and TIF-IA-mediated rRNA synthesis. These insights into Khib modification provide better understanding of the pathogenesis of psoriasis and suggest potential therapeutic targets.
Fibroblasts with high matrix metalloproteinase 2 expression regulate CD8+ T-cell residency and inflammation via CD100 in psoriasis
Authors: Dong Canbin , Lin Jui-Ming , Lu Xiaonian , Zhu Junhao , Lin Lanmei , Xu Jinhua , Du Juan
Published: May 2024

Background

Psoriasis is a T cell-mediated chronic inflammatory skin condition characterized by the interaction of T cells with various cell types, forming an inflammatory microenvironment that sustains psoriatic inflammation. Homeostasis of these tissue-resident T cells is supported by fibroblasts, the primary structural cells in the dermis. In psoriasis, there is increased expression of matrix metalloproteinase 2 (MMP2), mediating structural alterations in skin tissues and modulating inflammation. Additionally, the CD100–plexin-B2 (PLXNB2) axis is known to enhance psoriasis inflammation via keratinocytes, and CD103 levels are associated with the severity of psoriasis upon relapse.

Objectives

To elucidate the role of fibroblasts and the MMP2–CD100 axis in modulating psoriasis inflammation.

Methods

CD100 expression and function in psoriasis were assessed using immunofluorescence, enzyme-linked immunosorbent assay, single-cell transcriptome sequencing, cellular interaction analyses and quantitative reverse transcriptase polymerase chain reaction. CD8+ T cells from people with psoriasis were isolated using magnetic beads, to investigate the regulatory effect of MMP2 on CD100 expression on their membranes. Single-cell transcriptome sequencing, spatial transcriptome sequencing, mimetic timing analysis, immunofluorescence and flow cytometry were used to determine the origin of MMP2 and its impact on CD103+ CD8+ T cells. The hypotheses were further validated in vivo using MMP2 and CD100 inhibitors.

Results

Soluble CD100 (sCD100) was significantly upregulated in both psoriatic lesions and peripheral blood, amplifying psoriasis inflammation by promoting the production of inflammatory cytokines by keratinocytes, fibroblasts and endothelial cells via the sCD100–PLXNB2 axis. Fibroblasts that highly expressed MMP2 (MMP2hi) exacerbated psoriasis symptoms by facilitating CD100 shedding from CD8+ T-cell membranes. Additionally, it was shown that fibroblasts enhance the upregulation of the CD8+ T-cell residency factor CD103 in co-cultures with CD8+ T cells. Inhibitors targeting MMP2 and CD100 were effective in reducing inflammation in an imiquimod-induced psoriasis model.

Conclusions

Our findings underscore the pivotal role of MMP2hi fibroblasts in the amplification and recurrence of inflammatory responses in psoriasis. These fibroblasts augment psoriasis inflammation through the CD100–PLXNB2 axis by facilitating CD100 shedding on CD8+ T-cell membranes and by upregulating CD103, thereby enhancing CD8+ T-cell residency.
Laparoscopic Versus Robotic Revisional Bariatric Surgery
Authors: Burgard M , Iranmanesh P , Toso C , Mönig S , Egger B , Pugin F , Jung M
Published: May 2024

Background

Revisional bariatric surgery (RBS) represents up to 15% of all bariatric procedures. The most performed conversion procedures are Roux-en-Y-Gastric Bypass (RYGB) and Vertical Sleeve Gastrectomy (VSG) after adjustable gastric banding (AGB), VSG or vertical banded gastroplasty (VBG). While the overall complication rate is known to be higher compared to primary surgery, the optimal surgical approach, laparoscopic or robotic, remains controversial.

Aims

We aimed to compare laparoscopic and robotic RBS in terms of peri and post-operative complications, ICU admission, operative time, and the length of hospital stay.

Methods

We conducted a retrospective multi-center case control study of patients who underwent RBS from 2013 to 2023 in two centers. Cases and controls were matched by the index procedure, - AGB or a stapled procedure and the revisional procedure, - RYGB or VSG.

Results

59 revisional procedures were performed (36 and 23 per center). After matching according to index and revisional procedures, 46 patients were included, 23 in the robotic and 23 in the laparoscopic group. There were no statistically significant differences in demographics, BMI, or comorbidities between the groups. The overall peri- and early post-operative complication rate was similar while patients in the laparoscopic group had a higher rate of severe complications and reoperations (13% versus 0%), however, without reaching a statistically significant difference (p = 0,07). The operative time was shorter in the laparoscopic group (161 +/- 55 versus 232 +/- 63 minutes, p < 0,05).

Conclusion

Our retrospective study showed a tendency towards more severe perioperative complications and reoperations in laparoscopic compared to robotic revisional surgery in patients with similar index and conversion procedures. Patients with complex revisional RYGB could benefit from robotic surgery. As the literature provides contrasting results, further studies should be performed to address this question.
Evaluation of Tolerance Towards Ureteral Double-J-Stents in Children: An Unmet Need
Authors: Frech M , Planta D , Vuille-Dit-Bille R , Holland-Cunz S
Published: May 2024

Background

Ureteric double-J-stents (DJS) are commonly applied devices in urology that often cause irritative symptoms in adults, leading to decreased quality of life. Little is known about how they are tolerated by children. Furthermore, standardized patient-centered care for children has not yet been established.

Aims

The aim of this study was to assess the tolerance of children towards DJS by evaluating their irritative symptom rate and to raise awareness of the need for a standardized evaluation method.

Methods

A prospective observational single-center study was conducted over a period of 14 months on children with indwelling DJS. A questionnaire addressing 5 categories (voiding symptoms, general symptoms, social activities and/or sexual health, catheter removal, and medication) was developed for different age groups and employed after stent removal.

Results

Twenty patients requiring DJS with a mean age of 5.8 years (ranging from 3 months to 15 years) were enrolled in the study. During the indwelling time (mean 6 weeks), 65% (n=13) of the patients suffered from irritative symptoms (intermittent pain and/or voiding problems). There was a positive association between age and the reported pain score (Spearman's ρ = 0.54, p = 0.04).

Conclusion

Irritative symptoms caused by DJS were systematically assessed in children for the first time. To guarantee patient-centered care, our study's high rate of irritative symptoms must be accounted for when employing DJS. With the questionnaire, we provide an example of a sensitive tool to evaluate the management of children with DJS and treatment options to reduce stent-related symptoms.
Clinical Presentation and Risk Factors of Acalculous Cholecystitis in Outpatients, a Literature Review and Retrospective Study
Authors: Dogny C , Fournier I , Sgardello S
Published: May 2024

Background

Acute acalculous cholecystitis in healthy patients is relatively understudied. It is usually described in patients within the intensive care unit, where it is associated with high mortality rates reaching 30%-50% in the literature.

Aims

To review patients who have developed AAC in outpatient or non-ICU settings, identify risk factors and clinical presentation, and compare these data with those in the literature.

Methods

We first performed a literature review. We then determined the inclusion criteria: acalculous cholecystitis confirmed by either an ultrasound, or CT scan, at pathology and intraoperatively. We excluded all patients hospitalized within the ICU or who developed AAC because of multiorgan failure or patients without histopathological evidence. We performed a 5-year search in our institution’s database with the terms “cholecystitis” and “acalculous cholecystitis.

Results

23 patients were included in our study based on histopathology. The most frequent co-morbidities were cardiovascular and metabolic syndrome. The most common complaint was abdominal pain, ten patients (50%) presented to the emergency department with an increase of at least two of three biological markers (CRP, bilirubine and leucocytosis). We had no mortality reported at 30 days.

Conclusion

Epidemiologically, our population’s characteristics correspond to those of other studies, with most patients being male. The majority of patients were ASA III suggesting that this disease concerns more polymorbid patients despite a high percentage of healthy patients. Right upper quadrant pain, whether associated with leukocytosis or not, seems to be the main factor leading to further investigation. Abdominal US is considered the diagnostic technique of choice. However, most patients in our study underwent US and CT. We found that acalculous cholecystitis in outpatients, does not have the high mortality rate that was previously attributed to it, but is more frequent in polymorbid patients with cardiovascular risk factors.
Recurrence and Survival after Robotic vs. Laparoscopic Liver Resection in Very-Early to Early Stage (BCLC 0-A) Hepatocellular Carcinoma: A Retrospective Cohort Study with Propensity Score Matching
Authors: Bernardi L , Bernardi L , Balzano E , Roesel R , Vacca P , Senatore A , Garo M L , Majno-Hurst P , Cristaudi A , Ghinolfi D
Published: May 2024

Background

Robotic (RLR) and laparoscopic liver resection (LLR) provide similar short-term outcomes in hepatocellular carcinoma (HCC) of stage BCLC 0-A, but data on recurrence and survival are still lacking in populations with high prevalence of cirrhosis.

Aims

We investigated the outcomes of RLR vs. LLR for HCC in a cohort with high rate of cirrhosis. The primary endpoint was recurrence-free (RFS) and overall survival (OS); incidence, pattern, and treatment of recurrence were the secondary ones.

Methods

RLRs and LLRs for HCC of stage BCLC 0-A from two tertiary centers for liver surgery were retrospectively reviewed. Propensity score matching (PSM) was used to mitigate selection bias. Survival was estimated with Kaplan Meier method with Log rank.

Results

One-hundred-ninety-six patients underwent RLR (n=68) or LLR (n=128) for BCLC 0-A HCC.

After 1:1 PSM, two groups (RLR=68; LLR=68) of patients with similar characteristics, liver function and HCC features were obtained: age (median) 71-year-old, males 73.5%, underlying cirrhosis 91.2% (Child A 96.8%, MELD <9 96%), portal hypertension 22.1%, single-HCC 90.4%.

At a median follow-up of 29.0 months, 2- and 5-year RFS were 78.0 vs. 59.0% and 54.0 vs. 53.0% (p=0.107), while OS was 97.0 vs. 90.0% and 87.0 vs. 90.0% (p=0.951) for RLR vs. LLR respectively. Incidence of recurrence was similar (35.3 vs. 39.7%; p=0.723) and was mostly within the liver (29.4 vs. 30.9%; p=1.000) or within 2 years after hepatectomy (54.2 vs. 81.5%, p=0.116) in RLR vs. LLRs. Curative-intent treatment of recurrences did not differ (liver transplantation 19.6%, redo-resection 15.7%) except for a tendency to more redo-resections of recurrences after RLR (29.2 vs. 3.7%; p=0.062).

Conclusion

Oncologic outcomes of RLR were not inferior to those of LLR in selected HCC patients of stage BCLC 0-A with underlying cirrhosis. Both techniques guaranteed similar salvageability at HCC recurrence in our experience.
Which Surgical Technique for Liver Resection is Favourable in Patients with Colorectal Liver Metastases?
Authors: Zeindler J , Hess G F , von Heesen M , Muenst S , Bolli M , Soysal S D , Kollmar O , Schmitt A M
Published: May 2024

Background

The liver is the most common metastatic site after curative treatment for colorectal cancer (CRC). Around 50% of all patients with CRC will develop colorectal liver metastases (CRLM). Liver resection (LR) represents a curative treatment option. Benefits of anatomic (ALR) versus non-anatomic liver resection (NALR) show a lack of consistent evidence. While ALR seems to be associated with a higher postoperative complication rate, NALR could lead to more recurrences.

Aims

We investigated complication and survival rates of patients with CRLM after both resection types.

Methods

This is a multicentre cohort study using retrospectively and prospectively collected data. All patients undergoing LR for CRLM between 2009 and 2020 from 3 specialised centres in Switzerland and Germany were included. Complication and survival rates after ALR versus NALR were analysed using uni- and multivariate Cox regression models.

Results

624 patients were included. Median follow-up time was 25.49 months. In 292/624 patients (47%) ALR was performed, while 53% underwent NALR. Complications according to the Clavien-Dindo classification have been observed significantly more often in the ALR group (p=0.001). Especially severe complications grade III and IV have been more present after ALR (36/292 vs. 26/332 and 13/292 vs. 11/332, respectively). Both, length of ICU and postoperative hospital stay have been significantly longer in the ALR group (p<0.001 each). The uni- and multivariate models have shown no significant differences in overall survival (OS) and recurrence free survival rates (RFS) between both groups (for OS adjusted HR of 0.84 (95% CI 0.59 - 1.21; p=0.35) and for RFS adjusted HR 0.92 (95% CI 0.69 - 1.22, p=0.56)).

Conclusion

This multicentre prospective study investigating ALR versus NALR for CRLM has shown no significant differences in OS and RFS. However, postoperative complications have been reported significantly more often after ALR. NALR seems to be the better choice for patients with CRLM undergoing LR.
The Incidence of Incisional Hernia after Colorectal Surgery Depends on the Extraction Site: A Cohort Analysis
Authors: Burgard M , Liot E , Meurette G , Toso C , Ris F , Meyer J
Published: May 2024

Background

Although minimally invasive surgery has reduced the incidence of incisional hernia in colorectal surgery, specimen extraction site still constitutes a risk for incisional hernia.

Aims

We aimed to analyse the incidence of incisional hernia according to the specimen extraction site.

Methods

We conducted a retrospective observational cohort study of consecutive patients who underwent elective laparoscopic colorectal surgery for colorectal cancer between 01.2013 and 12.2021. The primary outcome was the CT-proven incidence of incisional hernia at the level of the extraction site until the end of follow-up (12.2023). Patients with open surgery, previous hernia repair, reoperations during the study period or without imaging follow-up were excluded.

Results

One hundred and fifty-eight patients were included. One hundred and four patients (65,8 %) had an extraction site located on the midline, and 54 patients (34,2 %) had an extraction site which was off midline. The midline was preferably used as extraction site during right and transverse colectomy (96,5% and 100% respectively), and off midline was used in left hemicolectomy, sigmoid colectomy and anterior resection (60%, 88%, 93,8% respectively). The overall incidence of incisional hernia at the level of the extraction site was of 29,8 % (31 patients) when midline was chosen as the extraction site, and of 1,9% (1 patient) when the extraction site was off-midline (p-value<0,001). Seven patients (6,7%) required hernia repair in the midline group and no patient (0%) in the off-midline group (p-value=0.051). The mean follow-up was of 3.1+/-2.1 years. Uni-and multivariate logistic regression identified the choice of extraction site as a risk factor for incisional hernia (odds ratio: 22,5, 95%CI: 2,3-27,1, p-value: 0,03).

Conclusion

Choosing the midline as an extraction site exposes patients to the risk of incisional hernia. Fully minimally invasive colorectal resection using off-midline incision as extraction site should be encouraged.
Risk Factors for Prolonged Air Leakage after Uniportal Anatomical Segmentectomy
Authors: Rieder O , Gioutsos K , Galanis M , Nguyen T L , Senbaklavaci Ö , Dorn P
Published: May 2024

Background

As the population ages and comorbidities increase, minimal invasive anatomical segmentectomies are increasingly being performed. Complications are to be considered in this vulnerable population.

Aims

Our aim was to investigate the incidence and risk factors for prolonged air leak in patients undergoing minimally invasive single-port pulmonary segmentectomy at our institution.

Methods

Retrospective analysis of all patients undergoing uniportal segmentectomy in our department from March 2015 to August 2023. Prolonged air leak (PAL) was defined as an air leak that lasted longer than 5 days.

Results

575 segmentectomies were performed using uniportal video-assisted thoracoscopic surgery (uVATS). 374 complex segmentectomies (65.0%) and 405 (70.4%) single segmentectomies were performed. Prolonged air leak occurred in 88 patients (15.3%). Length of stay and duration of drainage were 8.6 (±4.86) and 10.6 (±8.12) days in the PAL subgroup, whereas they wer 3.6 (±2.25) and 2.0 (±1.3) days in the non-PAL group, both statistically significant. Patients with COPD GOLD II/III were significantly more common in the PAL group.

Using machine learning, two models were developed that predicted the occurrence of PAL with an accuracy of 70 %. The first model detected the following parameters as significant: removal of segment 2 or 8, diabetes, inhalers, squamous cell carcinoma. The second model recognized DLCO (%), pack-years, FEV1 (%) and operation time as parameters.

Furthermore, we used recursive partitioning to develop a decision tree that stratified PAL risk by answering 1-3 yes/no questions. Patients with >28 pack-years and DLCO < 71% had a 77% probability of developing prolonged air leak.

Conclusion

Severe COPD, low DLCO and FEV1, increased pack-years, inhalers, diabetes, and segment 2 or 8 surgery were identified as risk factors for prolonged air leak. These findings may help in the planning of surgery and the use of sealants at the end of surgery in high-risk patients.
Gaining exposure on perceptions of sunscreen: a national survey of patients with melanoma
Authors: Raza Sami A , Cannon Diane , Ali Faisal R
Published: May 2024

The incidence of melanoma is increasing. We ascertained perceptions regarding sunscreen and factors influencing choice in patients with melanoma. A survey was distributed to all members of a support group for people with melanoma. In total, 571 responses were received across 6 weeks. Most respondents (n = 452/571; 79.2%) indicated that they knew how much sunscreen to apply; the most popular frequency of application was once daily (n = 180/571; 31.5%). The most popular cosmetic benefit respondents indicated was reduced redness on sun-exposed areas of the skin (n = 418/571; 73.2%). Most respondents (n = 552/571; 96.7%) agreed that more education is needed regarding the importance of wearing sunscreen. The three most popular factors influencing sunscreen choice were a sun protection factor (SPF) > 50 (n = 299/571; 52.4%), dermatologist recommendation (n = 267/571; 46.8%) and price (n = 262/571; 45.9). Sustainable packaging (n = 45/571; 7.9%) and ethical sourcing of ingredients (n = 65/571; 11.4%) were not ranked highly. Given that 42.0% (n = 240/571) only applied sunscreen on sunny days, an education campaign is required. Industry should consider public education regarding sustainability. A further study ascertaining the views and perceptions of sunscreen in a cohort of people without melanoma is strongly encouraged.
CardioHotspots: a database of mutational hotspots for cardiac disorders
Authors: García S Alberto , Costa Mireia , García-Zarzoso Alba , Pastor Oscar
Published: May 2024

Mutational hotspots are DNA regions with an abnormally high frequency of genetic variants. Identifying whether a variant is located in a mutational hotspot is critical for determining the variant’s role in disorder predisposition, development, and treatment response. Despite their significance, current databases on mutational hotspots are limited to the oncology domain. However, identifying mutational hotspots is critical for any disorder in which genetics plays a role. This is true for the world’s leading cause of death: cardiac disorders. In this work, we present CardioHotspots, a literature-based database of manually curated hotspots for cardiac diseases. This is the only database we know of that provides high-quality and easily accessible information about hotspots associated with cardiac disorders. CardioHotspots is publicly accessible via a web-based platform ( https://genomics-hub.pros.dsic.upv.es:3099/).

Database URL: https://genomics-hub.pros.dsic.upv.es:3099/.
Mixing properties of coronary infusion catheters assessed by in vitro experiments and computational fluid dynamics
Authors: de Vos Annemiek , Troost Sophie , Waterschoot Anke , Pijls Nico , van ‘t Veer Marcel
Published: May 2024

Aims

Continuous infusion thermodilution is an established technique for the assessment of absolute coronary blood flow and microvascular resistance due to its proven accuracy and reproducibility. However, for this technique to yield reliable measurements, direct and homogenous mixing of injected saline and blood is mandatory. This study aimed to assess and compare the mixing properties of two different microcatheters, namely the Rayflow® (with sideholes for infusion) and the Finecross® catheter (single end-hole for infusion), which are commonly used in the catheterization laboratory.

Methods and results

The study employed three different methods to evaluate the mixing properties of the catheters. Firstly, a qualitative assessment of mixing was performed using ink injections in an in vitro bench model of a coronary artery. Secondly, in analogy to the human catheterization laboratory, mixing properties over the length of the coronary artery were assessed semi-quantitatively by temperature measurements in the bench model. Lastly, a quantitative assessment was performed by 3D computational fluid dynamics, where the standard deviation and entropy ratio of the temperature over the cross-section in the coronary artery model were calculated for both catheters.

Conclusion

All three evaluation methods demonstrated that the Rayflow catheter’s specific design leads to a more optimal, homogeneous mixture of blood and saline over both the cross-section and length of a coronary vessel, as compared with the standard end-hole catheter.
Ticagrelor monotherapy for acute coronary syndrome: an individual patient data meta-analysis of TICO and T-PASS trials
Authors: Lee Yong-Joon , Shin Sanghoon , Kwon Sung Woo , Suh Yongsung , Yun Kyeong Ho , Kang Tae Soo , Lee Jun-Won , Cho Deok-Kyu , Park Jong-Kwan , Bae Jang-Whan , Kang Woong Cheol , Kim Seunghwan , Lee Seung-Jun , Hong Sung-Jin , Ahn Chul-Min , Kim Jung-Sun , Kim Byeong-Keuk , Ko Young-Guk , Choi Donghoon , Jang Yangsoo , Hong Myeong-Ki
Published: May 2024

Background and Aims

In patients with acute coronary syndrome (ACS), dual antiplatelet therapy (DAPT) with aspirin and a potent P2Y12 inhibitor is recommended for 12 months after drug-eluting stent (DES) implantation. Monotherapy with a potent P2Y12 inhibitor after short-term DAPT is an attractive option to better balance the risks of ischaemia and bleeding. Therefore, this study evaluated the efficacy and safety of ticagrelor monotherapy after short-term DAPT, especially in patients with ACS.

Methods

Electronic databases were searched from inception to 11 November 2023, and for the primary analysis, individual patient data were pooled from the relevant randomized clinical trials comparing ticagrelor monotherapy after short-term (≤3 months) DAPT with ticagrelor-based 12-month DAPT, exclusively in ACS patients undergoing DES implantation. The co-primary endpoints were ischaemic endpoint (composite of all-cause death, myocardial infarction, or stroke) and bleeding endpoint [Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding] at 1 year.

Results

Individual patient data from two randomized clinical trials including 5906 ACS patients were analysed. At 1 year, the primary ischaemic endpoint did not differ between the ticagrelor monotherapy and ticagrelor-based DAPT groups [1.9% vs. 2.5%; adjusted hazard ratio (HR) 0.79; 95% confidence interval (CI) 0.56–1.13; P = .194]. The incidence of the primary bleeding endpoint was lower in the ticagrelor monotherapy group (2.4% vs. 4.5%; adjusted HR 0.54; 95% CI 0.40–0.72; P < .001). The results were consistent in a secondary aggregate data meta-analysis including the ACS subgroup of additional randomized clinical trials which enrolled patients with ACS as well as chronic coronary syndrome.

Conclusions

In ACS patients undergoing DES implantation, ticagrelor monotherapy after short-term DAPT was associated with less major bleeding without a concomitant increase in ischaemic events compared with ticagrelor-based 12-month DAPT.

Study registration

PROSPERO (ID: CRD42023476470).
Long QT syndrome: importance of reassessing arrhythmic risk after treatment initiation
Authors: Dusi Veronica , Dagradi Federica , Spazzolini Carla , Crotti Lia , Cerea Paolo , Giovenzana Fulvio L F , Musu Giulia , Pedrazzini Matteo , Torchio Margherita , Schwartz Peter J
Published: May 2024

Background and Aims

Risk scores are proposed for genetic arrhythmias. Having proposed in 2010 one such score (M-FACT) for the long QT syndrome (LQTS), this study aims to test whether adherence to its suggestions would be appropriate.

Methods

LQT1/2/3 and genotype-negative patients without aborted cardiac arrest (ACA) before diagnosis or cardiac events (CEs) below age 1 were included in the study, focusing on an M-FACT score ≥2 (intermediate/high risk), either at presentation (static) or during follow-up (dynamic), previously associated with 40% risk of implantable cardioverter defibrillator (ICD) shocks within 4 years.

Results

Overall, 946 patients (26 ± 19 years at diagnosis, 51% female) were included. Beta-blocker (βB) therapy in 94% of them reduced the rate of those with a QTc ≥500 ms from 18% to 12% (P < .001). During 7 ± 6 years of follow-up, none died; 4% had CEs, including 0.4% with ACA. A static M-FACT ≥2 was present in 110 patients, of whom 106 received βBs. In 49/106 patients with persistent dynamic M-FACT ≥2, further therapeutic optimization (left cardiac sympathetic denervation in 55%, mexiletine in 31%, and ICD at 27%) resulted in just 7 (14%) patients with CEs (no ACA), with no CEs in the remaining 57. Additionally, 32 patients developed a dynamic M-FACT ≥2 but, after therapeutic optimization, only 3 (9%) had CEs. According to an M-FACT score ≥2, a total of 142 patients should have received an ICD, but only 22/142 (15%) were implanted, with shocks reported in 3.

Conclusions

Beta-blockers often shorten QTc, thus changing risk scores and ICD indications for primary prevention. Yearly risk reassessment with therapy optimization leads to fewer ICD implants (3%) without increasing life-threatening events.
PERCUTANEOUS CORONARY INTERVENTION FOR LEFT MAIN DISEASE IN HIGH BLEEDING RISK: OUTCOMES FROM A SUBANALYSIS OF THE DELTA 2 REGISTRY
Authors: Federico F , Botti G , Meliga E , Daemen J , D‘Ascenzo F , Capodanno D , Tchetche D , Van Mieghem N , Nakamura S , Tamburino C , Mehran R , Montorfano M , Chieffo A
Published: May 2024

Introduction

High bleeding risk (HBR) can represent a challenge, especially in patients with complex coronary lesions undergoing PCI. This study aims at investigating the prevalence of HBR in a wide and comprehensive cohort of patients undergoing left main (LM) PCI, describing their clinical phenotype, and reporting their procedural outcomes.

Methods

The analysis was performed on data from the DELTA 2 Registry, which prospectively included patients who underwent LM PCI at 19 centers worldwide. The patients were defined to be at HBR if ≥1 Major Criteria or ≥2 Minor Criteria from the Academic Research Consortium (ARC) were met. The primary endpoint was a composite of all–cause death, myocardial infarction (MI) or stroke at median follow–up.

Results

A total of 1531 patients were included, the rate of HBR was 65.8%. Besides the different clinical characteristics embedded in the ARC definition, HBR had higher prevalence of ACS at presentation (49.2% vs 26.8%, p<0.001), and experienced higher in hospital mortality (1.8% vs 0.2%; p=0.029) and MI (5.0% vs 2.1%, p=0.009) (Figure, Panel A). The median follow–up was 473 days. The rate of the primary endpoint was more than three times higher in HBR patients (20.8% vs 6.1%; HR 3.3; 95% CI: 2.2–4.8) (Figure, Panel B), and significantly driven by all cause death (16.2% vs 4.6%; HR: 3.3; 95% CI:2.2–5.1) and MI (5.8% vs 1.9%; HR 2.9; 95% CI: 1.5–5.7). Conversely no significant difference was reported in terms of target lesion revascularization (TLR) probable or defined stent thrombosis.

Conclusions

HBR patients undergoing LM PCI experienced higher rates of all cause death and MI at follow–up; similar outcomes were also reported in–hospital.
THE COPRESENCE OF HYPOVITAMINOSIS D AND DIABETES MELLITUS TRIPLES THE OCCURRENCE OF SEVERE CAD IN WOMEN
Authors: Aleksova A , Fluca A , Zandonà L , Stenner E , Chicco A , Pani B , Derin A , Marketou M , D‘Errico S , Sinagra G , Janjusevic M
Published: May 2024

Background

Suboptimal levels of vitamin D have been associated with imbalanced calcium homeostasis, impaired glucose and lipid metabolism, increased oxidative stress, inflammatory state and endothelial dysfunction. Despite a growing prevalence of hypovitaminosis D affecting all age groups and mostly female gender (defined as vitamin D levels ≤ 20 ng/ml), our knowledge about the relationship between vitamin D levels and the severity of coronary artery disease (CAD) between genders remains limited.

Aim and Methods

In order to study the gender variations in hypovitaminosis D levels and the severity of CAD in individuals suffering from acute myocardial infarction (AMI), blood samples were obtained on hospital admission from patients with AMI enrolled from 2014 to 2022. CAD was defined as the presence of at least one coronary vessel stenosis greater than 50%, while severe CAD was defined as left main disease and/or three–vessel disease.

Results

1484 patients were enrolled in the study. The mean age within the cohort was 66.25 (11.47) years, with a predominant male representation (71.8%). Overall, 86.2% of patients exhibited CAD, while 32.9% had severe CAD. The median concentration of serum vitamin D was 17.25 [10.3 – 24.7] ng/ml, and hypovitaminosis D was observed in 59.7% of patients. The prevalence of hypovitaminosis D was significantly higher in women with severe CAD (74.1% vs 58.1%, p=0.002), whereas no statistically significant difference was noted among men with this clinical presentation (61.3% vs 57.1%, p=0.193). In female patients, hypovitaminosis D (OR: 1.85, p=0.013), alongside diabetes mellitus (DM) and advanced age, emerged as a predictive factor for severe CAD after adjusting for confounding variables such as glomerular filtration rate <60 mL/min/1.73 m², elevated cholesterol levels, and body mass index. However, hypovitaminosis D did not demonstrate independent predictive significance for severe CAD in male patients. Among female patients, those who had both hypovitaminosis D and DM exhibited a risk of more than three times higher for a severe CAD diagnosis compared to those who did not have hypovitaminosis D or DM (OR: 3.56 [1.8–7.03], p=0.021).

Conclusion

The identification of hypovitaminosis D as a predictor for severe CAD specifically in women represents the original aspect of our research. Moreover, our findings highlight that the risk of the incidence of severe CAD is more than tripled for women having both vitamin D deficiency and DM.
A LONG QT SYNDROME WITHOUT MANIFESTATION
Authors: Magnano R , Rossi D , Pezzi L , Scollo D , Civitarese T , Odoardi A , Carnesale R , Vitulli P , D‘Alleva A , Forlani D , Genovesi E , Gallina S , Paloscia L , Di Marco M
Published: May 2024

A 66–year–old Caucasian woman presented for outpatient evaluation due to elevated blood pressure levels at home (approximately 220/120 mmHg) and a significant family history of long QT syndrome. The index case in the family appeared to be her sister, investigated following an ECG showing markedly prolonged QT interval and a family history of sudden cardiac death. The patient underwent genetic analysis, revealing a positive mutation in KCNQ1. She was currently on treatment with Levotiroxina for recently discovered hypothyroidism.The ECG showed sinus rhythm with a heart rate of 85 bpm, signs of left ventricular hypertrophy, particularly Sokolow (SV1 + RV6 70 mm) and Peguero Lo Presti (SD + SV4 50 mm). The QTc interval was 515 ms (Bazett). Echocardiography revealed severe left ventricular hypertrophy (SIVd 14 mm; PWd 12 mm; LVMi 128 g/m2; RWT 0.5) with normal overall systolic function (EF 60%). No significant valvular pathologies were observed, and the right ventricle appeared normal in size and function.The hypertrophy was attributed to uncontrolled severe arterial hypertension. However, the identification of a prolonged QT interval in a patient with a strong family component (Schwartz score 4, high probability) led to genetic testing, confirming a mutation in KCNQ1. As the patient was asymptomatic with a low risk of major arrhythmias over the next 5 years (1–2–3–LQTS–risk score 2.77%), she entered follow–up and received beta–blocker therapy, specifically nadolol, combined with other antihypertensive medications.This clinical case describes an entire family with LQTS1 (type 1) positive for KCNQ1 mutation, exhibiting phenotypic manifestations distinct from those reported in the literature. Notably, there was a prevalence in females, and the condition was incidentally discovered during a routine checkup conducted for unrelated reasons, without any history of major arrhythmias.Long QT syndrome (LQTS) is characterized by a prolonged QT interval, predisposing individuals to life–threatening arrhythmias leading to syncope and sudden death. Mutations in genes encoding ion channels account for 75% of LQTS cases. LQTS1, associated with a "loss–of–function" mutation in the KCNQ1 gene, represents one of the three genetic subtypes. LQTS1 typically manifests with arrhythmias in childhood, with a male predominance. Adrenergic triggers are crucial precipitants for arrhythmic events