bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of phase centre variation on tropospheric delay in PPP‐AR with low‐cost global navigation satellite systems receiver and antenna
Authors: Wu Jizhong , Wang Xiaoying , Ma Hongyang
Published: November 2024

As low‐cost global navigation satellite systems receiver and antenna become increasingly prevalent for water vapour monitoring, precise millimetre‐level characterisation of instrument biases is crucial for maintaining measurement accuracy and reliability. This study examines the impact of phase centre variation (PCV) corrections on zenith wet delay (ZWD) accuracy in precise point positioning (PPP) solutions using low‐cost systems. The results show that PCV corrections significantly improve ZWD estimation, reducing bias and RMS by 66% and 31% in ambiguity float PPP, and by 71% and 38% in ambiguity fixed PPP. In addition, integer ambiguity resolution offers no significant improvement in ZWD accuracy without PCV correction. When PCV corrections and ambiguity fixing are applied, low‐cost receivers demonstrate ZWD estimates comparable to those of high‐precision geodetic receivers, with a deviation of 0.2 mm and an RMS of 2 mm. However, variations in signal tracking and multipath suppression can still influence ambiguity fixing rates, resulting in slightly lower performance for low‐cost receivers compared to their high‐precision counterparts. The study concludes that deploying low‐cost receivers with calibrated antennas offers a cost‐effective approach to increasing the spatial resolution of atmospheric water vapour measurements, thereby enhancing weather monitoring and early warning systems, particularly for localised extreme weather events.
Antibiotikaanwendung 2012/13 bis 2021/22 in deutschen Akutkrankenhäusern
Authors: Kern Winfried V. , Steib-Bauert Michaela , Fellhauer Matthias , Baumann Jürgen , Först Gesche , Kramme Evelyn , Dörje Frank , de With Katja
Published: November 2024

Eine wichtige Voraussetzung für die Sicherung einer rationalen Antibiotika-Verordnung ist die Verfügbarkeit und Prüfung von Verbrauchsdaten. Wir haben erstmals vor 10 Jahren solche Daten für Akutkrankenhäuser in Deutschland vorgestellt und möchten die Entwicklungen seither beschreiben.

Die jährlichen Antibiotika-Verordnungsmengen aus Akutkrankenhäusern wurden für den Zeitraum 2012/13 bis 2021/22 analysiert, dargestellt als Tagesdosen pro 100 Pflegetage, wobei die Tagesdosis-Definition speziell für den Krankenhausbereich adaptiert wurde („recommended daily dose“, RDD). Zusätzlich wurde eine Hochrechnung auf die Gesamtbevölkerung unter Verwendung der seitens der WHO definierten Tagesdosen („defined daily doses“, DDD) vorgenommen.

Die Antibiotika-Verbrauchsdichte in deutschen Akutkrankenhäusern ist im betrachteten 10-Jahres-Zeitraum nicht angestiegen. Sie betrug im Median im Jahre 2012/13 insgesamt 41,9 RDD/100 Pflegetage (n=169, Interquartilbereich 35–48 RDD/100) im Vergleich zu 42,1 RDD/100 im Jahre 2021/22 (n=329, Interquartilbereich 35–48 RDD/100). Auf die Bevölkerung bezogen lag der Verbrauch 2021/22 bei 1,85 DDD pro 1000 Bewohner und Tag. Die Verbrauchsdichte war in Universitätskliniken (54,0 RDD/100) signifikant höher als in den nicht universitären Krankenhäusern unterschiedlicher Größe, deren Verbrauchswerte sich nur wenig unterschieden (Mediane 39,8–44,0 RDD/100). Penicilline wurden zunehmend häufiger (Anstieg des Anteils an allen Wirkstoffen +63%), Fluorchinolone (– 54%) und Cephalosporine der ersten und zweiten Generation (– 41%) seltener eingesetzt. Auf Intensivstationen war die Verordnungsdichte rund doppelt so hoch wie auf den Normalstationen. Hohe Verordnungsdichten wurden
auch in universitären hämatologisch-onkologischen Abteilungen (Median 96,8 RDD/100) und in Fachabteilungen für Urologie (Mediane 65,1–70,5 RDD/100) und HNO-Heilkunde (Mediane 49,1–60,9 RDD/100) beobachtet.

Bei gleichbleibender Antibiotika-Verordnungsdichte im Krankenhaus insgesamt gab es Verschiebungen im Spektrum der Wirkstoffgruppen, mit einer zunehmenden Bevorzugung von Penicillin-Derivaten. Auf die Bevölkerung hochgerechnet lag der Verbrauch leicht oberhalb des europäischen Durchschnitts.
One Size Does Not Fit All: Prediction of Nerve Length in Implant-based Nipple–Areola Complex Neurotization
Authors: Zhang Casey , Moroni Elizabeth A. , Moreira Andrea A.
Published: November 2024

Background Breast reconstruction with sensory restoration is gaining recognition as an important goal. Successful reinnervation has been shown in autologous reconstruction but not widely studied in implant-based reconstruction (IBR). This article describes our technique for nipple–areola complex (NAC) neurotization to predict maximal nerve length. We also propose a novel equation that can be utilized preoperatively to estimate the total nerve length required for NAC neurotization.

Methods This is a retrospective study of patients who underwent nerve reconstruction with IBR between April 2021 and May 2022. An equation based on the arc length of a circle was utilized to predict the total nerve length required. Postoperative assessment of sensation was performed at 3, 6, and 12 months using Semmes–Weinstein monofilament testing in all four breast quadrants and the NAC. Patients completed the Breast-Q Sensation Module preoperatively and at 3, 6, and 12 months.

Results NAC neurotization was performed in 58 patients undergoing IBR. The average length of intercostal nerve (ICN) harvested was 5.3 cm for staged reconstructions and 5.6 cm for direct-to-implant reconstruction. The average total nerve length (allograft + mobilized ICN) was 12.3 cm. On average, 6.9 cm of nerve allograft was used. The mean difference between total nerve length and predicted nerve length was 0.47 cm (range −3.5 to 4.6 cm). There was a significant improvement in sensory monofilament values measured in all four breast quadrants and the NAC between 3 to 6 and 6 to 12 months postoperatively.

Conclusion A thorough understanding of sensory anatomy and precise surgical techniques are essential to perform NAC neurotization successfully. Our early results suggest the positive impact of breast sensation on patient quality of life.
Social Determinants of Health Associated with Intimate Partner Violence in an Urban Obstetric Population
Authors: Kuhrau Christina R. , Kelly Elizabeth , DeFranco Emily A.
Published: November 2024

Objective Intimate partner violence (IPV) is pervasive and can lead to severe health consequences. In the United States, 25% of women have experienced sexual violence, physical violence, and/or stalking by an intimate partner. However, less is known about the frequency and risk factors for IPV in the obstetric population.

Study Design Nested case–control study from a prospective cohort study of 606 parturients at a single academic medical center from 2011 to 2022. Structured questionnaires were administered to randomly chosen, consented patients during their postpartum hospital stay to gather information on social determinants of health (SDoH) and birth outcomes. The case group included participants who reported forced sex causing pregnancy, verbal abuse before or during pregnancy, or physical abuse during pregnancy. The control group reported none of these. Odds ratios were used to quantify the relationship between IPV and maternal sociodemographic characteristics, pregnancy factors, and levels of perceived support and discrimination.

Results Of 606 study participants, 568 (94%) provided data on IPV. Of those, 20.4% reported IPV (case) and 80.6% reported no IPV (control). In total, 74.6% of the study population was enrolled prepandemic. Unmarried status, low income, food insecurity, housing insecurity, substance use during pregnancy, higher gravidity, unintended pregnancy, low social support, and racial and gender discrimination were all significantly associated with IPV; maternal race and pregnancy during the COVID-19 pandemic were not.

Conclusion IPV is common, reported by one in five parturients in our population. Although maternal race was not associated with IPV in this perinatal cohort, experiencing racism was. Initiatives aimed to address SDoH such as substance use, family planning, and access to food and housing remain key opportunities to support pregnant patients experiencing IPV. The connection between perceived discrimination and IPV found here highlights the importance of addressing the influence of racism and gender-based discrimination on adverse birth outcomes in the United States.

Key Points
Neutrophil Extracellular Traps, Platelets and Endothelial Cells Cooperatively Contribute to Hypercoagulability in Non-Small Cell Lung Cancer
Authors: Tong Dongxia , Gao Yuan , Sun Weihua , Yang Jie , Liu Yang , Li Jihe , Zhang Yan
Published: November 2024

Background Thromboembolism is the second leading cause of death among patients with non-small cell lung cancer (NSCLC), but the precise mechanisms of thrombogenesis in NSCLC remain largely unknown. Our objectives were to evaluate the definitive role of neutrophil extracellular traps (NETs) in the hypercoagulability in NSCLC and to explore its interactions with platelets and endothelial cells (ECs).

Methods The levels of NET markers in samples from 100 NSCLC patients and 30 healthy controls were measured by ELISA. NET formation was detected using immunofluorescence. Procoagulant activity was assessed based on purified coagulation complex, thrombin, clotting time, and fibrin formation assays.

Results The plasma levels of NETs were increased in a stage-dependent manner in NSCLC patients and were markedly higher than those in controls. Neutrophils from NSCLC patients were more prone to form NETs, resulting in shortened coagulation time, significantly increased thrombin–antithrombin complexes and fibrin compared to controls. Moreover, NETs generation was mediated by High Mobility Group Box 1 from activated platelets in NSCLC patients. Conversely, NETs from NSCLC patients also induce phosphatidylserine exposure on platelets, leading to markedly enhanced procoagulant activity (PCA). Furthermore, NETs can damage endothelial cells and convert them to a procoagulant phenotype. The administration of NETs inhibitors (DNase I/activated protein C) could markedly diminish the PCA of NETs, activated platelets, and ECs.

Conclusion Our results suggest that NETs contribute to hypercoagulability and may represent a potential therapeutic target to prevent cancer-associated thrombosis in NSCLC patients.
Consecutive Sonogashira–Suzuki–Michael Cyclization: Three-Component Synthesis of Phenanthridines and Benzo[c]chromenes
Authors: Müller Thomas J. J. , Schmitz G. Hendrik , Karl Leonard , Ganter Christian
Published: November 2024

The equistoichiometric three-component reaction of an acid chloride, an alkyne, and an ortho-amino- or ortho-hydroxyphenylboronic ester proceeds smoothly to give phenanthridines or benzo[c]chromenes, respectively, with good to quantitative yields in the sense of a Sonogashira–Suzuki–Michael cyclization sequence. In the coupling of ortho-amidophenylboronates, interestingly, after ring closure a subsequent an acyl migration occurs to give 6-(2-(acyloxy)vinyl)phenanthridines.
Scandium(III) Triflate Catalyzed Reductive Etherification of Carbonyl Compounds with Alcohols Using 1,1,3,3-Tetramethyldisiloxane as the Reducing Agent
Authors: Nobuta Tomoya , Mineno Tomoko , Yamagiwa Noriyuki
Published: November 2024

In this study, we present a straightforward protocol for the reductive etherification of carbonyl compounds with alcohols using a catalytic amount of scandium(III) triflate [Sc(OTf)3] and 1,1,3,3-tetramethyldisiloxane to produce nonsymmetrical ethers. The reaction proceeds under mild room-temperature conditions and accommodates a broad range of substrates, including α,β-unsaturated aldehydes, yielding the desired products in good to excellent yields. Notably, the catalyst loading of Sc(OTf)3 could be reduced to 0.1 mol%.
Direct One-Pot Synthesis of Tetrazole Derivatives from Aldehydes under Metal-Free Conditions
Authors: Ahmed Naseem , Singh Rajeev
Published: November 2024

A simple and efficient one-pot protocol has been developed for the synthesis of 1H-tetrazole and 1-methyltetrazole derivatives from aldehydes under mild and metal-free conditions using ammonium azide or methyl azide, respectively. A number of tetrazole derivatives were obtained in moderate to high yields (75–92%) in green solvents at a moderate temperature. These reactions presumably proceed through the formation of a nitrile in situ. The mild conditions and the easy workup and purification make this method highly valuable.
Synthesis of Chiral Cyclopentadienyl Rhodium Complexes and Their Application in Enantioselective C–H Functionalization Reactions
Authors: You Shu-Li , Gou Bo-Bo , Shen Wen-Jie , Gu Qing
Published: November 2024

In recent years, rhodium catalysis has evolved as a powerful tool for chemo- and stereocontrolled syntheses of chiral molecules through C–H functionalization. In particular, chiral cyclopentadienyl rhodium (CpRh) complex-catalyzed asymmetric C–H functionalization reactions have gained ever-increasing attention in organic synthesis. However, the design and synthesis of novel chiral Cp ligands remain challenging due to the difficulty of imparting chiral elements into the Cp moiety. In this account, we introduce our research progress in the syntheses of chiral cyclopentadienyl ligands and their applications in rhodium-catalyzed asymmetric C–H functionalization reactions.

1 Introduction

2 SCpRh-Catalyzed Enantioselective C–H Functionalization Reactions

3 CpmRh-Catalyzed Enantioselective C–H Functionalization Reactions

4 BOCpRh-Catalyzed Enantioselective C–H Functionalization Reactions

5 BCSCpRh-Catalyzed Enantioselective C–H Functionalization Reactions

6 Conclusion
Ureterolithiasis with Hydroureteronephrosis Treated by Individualized Homoeopathy: A Case Report
Authors: Parui Patranu , Dey Neelavna , Sarkar Abdul Wahab , Bhattacharjee Baidurjya
Published: November 2024

Ureteric stones are a common surgical condition in the modern world. Ureteric stones are associated with severe pain, hematuria, hydronephrosis, urinary infections, nausea, and vomiting. A plethora of causes are responsible for the formation of such stones, with modern lifestyle and poor eating habits as some leading risk factors. Conventional treatment mostly relies on surgical means, whereas homoeopathy can successfully expel the stone without any invasive methods and can be a safer and acceptable alternative to surgery. In this case a 25-year-old male presented with a complaint of pain in the right flank and lower abdomen associated with a burning sensation after urination. Pain aggravated from the afternoon up to midnight. He was taking analgesic medicines without any significant relief. After failure to relieve pain from conventional therapies, the patient resorted to homoeopathic treatment. After a thorough case-taking, analysis, and repertorization, Lycopodium clavatum was prescribed. The patient was better within a few days and reported that the stone was expelled through the urethra which was confirmed by ultrasound examination. The pain visual analog scale, measuring 8 at baseline, was improved to “no pain” at the end of the treatment. The Modified Naranjo Criteria for Homoeopathy with a +8 score demonstrated positive causality of homoeopathic treatment. This case study reveals a certain role of homoeopathic treatment in ureterolithiasis and demonstrates the potential of homoeopathy in surgical conditions.
A Survey on Hearing Loss, Dizziness, and Balance Problems as Fall Risk Factors: Responses of Older Adults Seen by Audiologists
Authors: Criter Robin E.
Published: November 2024

Background Falls are a significant health care concern for older adults in the United States. Audiologists are health care providers who are experts in hearing and vestibular dysfunctions, two areas known to be risk factors for falls. It is not known whether audiology patients consider audiology services to be related to falls or whether they consider audiologists to be a viable resource related to fall-related health care.

Purpose The purpose of this study was to investigate whether audiology patients consider (1) hearing, dizziness, and balance difficulties as risk factors for falls, and (2) audiologists as health care providers who can address fall risk, assessment, and prevention.

Research Design This was a cross-sectional survey study.

Study Sample In total, 78 community-dwelling audiology patients aged 60 years or older were included in the study.

Intervention Not applicable

Data Collection and Analysis To reach a broad group of participants, online surveys (Qualtrics) and paper-and-pencil surveys (at the university clinic) were used. The analysis included descriptive statistics and independent-samples t-tests.

Results Nearly half of participants (48.7%) fell within the preceding year, and almost three-quarters (72.4%) felt falls were an important health care concern for them. Fewer than half (43.4%) considered hearing loss to be a fall risk factor, compared to dizziness (92.2%) and balance problems (97.3%). Slightly over half (53.3%) agreed that audiologists can address falls, fall risk, and prevention. However, only 39.5% would discuss falls with their audiologist, compared to 57.9% for dizziness and balance concerns and 90.5% for hearing concerns. No significant differences were found between participants who reported a recent fall and those who did not.

Conclusions Targeted patient education regarding the audiology scope of practice as it pertains to fall risk and prevention may be warranted, particularly if hearing loss is a modifiable fall risk factor which can be addressed through seeking audiologic services.
Assessing the Current Landscape and Future Directions of Digital Denture Technology
Authors: Saini Ravinder S. , Zafar Muhammad Sohail , Adanir Necdet , Alarcón-Sánchez Mario Alberto , Heboyan Artak
Published: November 2024

Digital dentures are removable dental prostheses fabricated using computer-aided design/computer-aided manufacturing (CAD/CAM) technology. This study aimed to explore the trends in digital dentures. A comprehensive four-phase search and selection strategy was framed.

Dimensions and Lens.org databases were used. Boolean operators were used to combine keywords.

The most significant growth occurred by 2021, with 71 publications and 984 citations. Egypt had the highest publication rankings, with 46 total publications (TP) and 45 total citations (TC). The University of Geneva played a significant role in contributing to 16 TP and 491 TC. Egyptian Dental Journal ranked at the top. The group with four authors had an even higher number of authorships, with a total of 60. The top four keywords were CAD/CAM, 3D printing, CAD-CAM, complete denture, and digital dentistry. The Glossary of Prosthodontic Terms, Ninth Edition, was referenced 614 times and had the highest average number of citations (75.2). The top three writers had strong relationships with the three sources and preferred to publish using four keywords. The 11-author group, cluster 6, had the highest level of network cooperation.

In conclusion, research on digital dentures has grown in terms of number of articles and citations.
Second Opinion in Medical Oncology in the Age of Artificial Intelligence and Telemedicine
Authors: Giglio Auro del , Serrano Sergio Vicente , Costa Mateus Uerlei Pereira da
Published: November 2024

The present review explores the role and impact of second opinions in medical oncology, particularly considering the recent advancements in artificial intelligence (AI) and telemedicine. A comprehensive literature search was conducted, and data from various studies were analyzed, highlighting why patients seek a second opinion, the rates of disagreement between the first and second opinions, and the potential barriers to obtaining a second opinion. The results showed that seeking a second opinion is common, with patients often seeking reassurance and a better understanding of their diagnosis and treatment options. However, there is limited evidence on the impact of second opinions on patient outcomes and the cost of care. Additionally, the introduction of Multidisciplinary Molecular Tumor Boards, AI, and telemedicine may improve decision-making and treatment strategies in the context of second opinions. Further research is needed to fully understand the role and implications of second opinions in medical oncology and how these recent technologies impact the second opinion process.
Knowledge and Practice of Dental Health among Pregnant Women in a Selected Hospital Mangaluru
Authors: Jojo Ann Maria , D'Souza Pramila , Abraham Anju , Korah Ann Mary , Anvita Anvita
Published: November 2024

Introduction Oral health is a significant part of prenatal care: health of the mouth, teeth, and gums. Pregnant mothers are more prone to cavities due to hormone surges and a change in eating habits. Although dental health is a crucial component of general health, midwives and obstetricians tend to ignore these aspects unless women complain about dental pain. This study aims to assess pregnant women's dental health knowledge and practices.

Materials and Methods A descriptive correlational research design was adopted for the study. A total of 256 women were selected by using a purposive sampling technique from the antenatal wards and outpatient departments of a tertiary hospital in Mangaluru. The data were collected using the demographic proforma, structured knowledge questionnaire, and self-reported practice checklist on dental health.

Result The mean age of the women was 27.93 ± 4.72 years. Out of the total number of women selected for the study, 56.6% were housewives, 61.7% were women from below the poverty line, and 57.8% were from rural areas. Regarding knowledge and practice, 66.4% of pregnant women had poor knowledge of dental care and 97.7% of them had an unfavorable practice of dental care during pregnancy. There was a moderate correlation between knowledge and practice of dental health during pregnancy (r = 0.038; p = 0.03).

Conclusion The study findings show that dental care or oral health care is neglected during pregnancy.
Knowledge About Genetics in Congenital Hearing Loss: A Survey Among Audiologists
Authors: Kaur Navleen , Deshpande Shweta
Published: November 2024

Introduction According to the World Health Organization, there are more than 63 million people in India who have disabling hearing loss. Hearing loss at birth can be caused due to genetic factors. Referral for genetic testing and counseling can be directly influenced by the knowledge among the audiologists. Specific guidelines and recommendations have been provided by experts in the field for competency in genetics among professionals to ensure early and appropriate management in young children with hearing loss. In India, there is limited research done on assessing audiologists' knowledge concerning the importance of genetic testing and counseling. Thus, the present study aimed to explore the knowledge about the role of genetics in congenital hearing loss among audiologists.

Method The study was conducted in two phases. Phase I included the development and validation of the questionnaire. Phase II included the administration of the questionnaire to the professionals from the field of audiology and speech-language pathology through Google Forms.

Results The study findings revealed that the knowledge level about general genetics was adequate; however, aspects related to genetic testing and syndromic and nonsyndromic congenital hearing loss were moderate. There was a statistically significant difference observed in the scores obtained by professionals who had completed Master of Science in Audiology as compared to those who had completed Bachelors in Audiology and Speech Language Pathology and Masters in Audiology and Speech Language Pathology.

Conclusion The study has highlighted the current knowledge of audiologists with respect to domains of genetic testing and syndromic and nonsyndromic congenital hearing loss. There is a need to educate audiologists working in the area of early identification and intervention about the genetic basis of hearing loss.
Level of Competency among Palestinian Nurses Regarding Electrocardiogram Interpretation and Arrhythmias Management: A Cross-Sectional Study
Authors: Qaddumi Jamal , Omar Sewar , Alsadi Ahmad , Kanan Huthaifah , Mahmoud Manar , Dwikat Mohammed
Published: November 2024

Background Electrocardiographic (ECG) interpretation skills are key in providing fast attention to patients with cardiovascular diseases, enabling prevention or early detection of life-threatening situations. The main aim of the study is to determine the current competency level in ECG interpretation and arrhythmias management of nurses in critical and noncritical departments.

Method A cross-sectional design using a convenience sample of 251 nurses working in critical and noncritical departments of Northern West Bank hospitals was used. A valid and reliable structured questionnaire was used to collect data that were designed to measure the competency level in ECG interpretation and arrhythmias management.

Result About half of the participants were females (50.2%), with a mean age of 29.2 ± 5.68 years, and 50.2% of them reported they received ECG courses. Unfortunately, low competency levels in ECG interpretation and arrhythmias management of nurses in critical and noncritical departments were found as only 17.1% of the participants were competent (≥7.5 out of 10). Nurses working in critical care units, males, and those with higher education levels scored significantly higher than those working in noncritical units, females, and those with a bachelor's degree or diploma. Unfortunately, nurses had low competency levels not only in ECG rhythm interpretation but also in the management of arrhythmia cases.

Conclusion The level of competency in ECG interpretation and arrhythmias management among Palestinian nurses is low as only 17.1% of participants were competent in ECG interpretation and arrhythmia management. Thus, this can be considered a serious and alarming situation especially when dealing with a malignant lethal arrhythmia. Therefore, improving nurses' knowledge of ECG interpretation and management of cardiac arrhythmias is essential and warranted.
Comparison of Efficacy and Safety of Talc to Povidone-Iodine Pleurodesis in Malignant Pleural Effusion: A Systematic Review and Meta-Analysis
Authors: Balan Divya , Baral Tejaswini , Manu Mohan K. , Mohapatra Aswini Kumar , Miraj Sonal Sekhar
Published: November 2024

Malignant pleural effusion (MPE) poses a substantial clinical challenge, necessitating effective interventions. Pleurodesis, commonly employed in MPE management, involves inducing pleural symphysis to prevent fluid accumulation. Talc and povidone-iodine have emerged as prominent agents for pleurodesis, each with its unique characteristics and considerations. This systematic review and meta-analysis aimed to compare the efficacy and safety of talc powder pleurodesis (TPP) and povidone-iodine pleurodesis (PIP) in the management of MPE. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a systematic review registered in PROSPERO (CRD42023470930). Randomized controlled trials (RCTs) with TPP and PIP arms for MPE were included. The information sources included electronic bibliographic databases such as PubMed, Scopus, Web of Science, Cochrane, and Embase from inception to November 2023. The Cochrane risk of bias tool was used for the critical appraisal. A meta-analysis using RevMan 5.3 compared outcomes. Out of 105 identified records, 3 RCTs were included in our review. Our review findings revealed a higher success rate for TPP. However, variability existed, with one study indicating better success rates in PIP groups. Adverse events were reported less frequently in the PIP group, suggesting a potentially superior safety profile. TPP showed higher overall success in comparison to PIP, emphasizing the need for cautious clinical decision-making given variability. The potential superior safety profile of povidone-iodine underscores the importance of context-specific choices, considering patient preferences and resource constraints in selecting pleurodesis interventions for MPE management.
Factor XIII Deficiency: Laboratory, Molecular, and Clinical Aspects
Authors: Dorgalaleh Akbar , Jozdani Sina , Zadeh Masoumeh Kiani
Published: November 2024

Factor XIII-A (FXIII-A) deficiency is an ultra-rare bleeding disorder characterized by high rates of morbidity and mortality, primarily resulting from intracranial hemorrhage, umbilical cord bleeding, and miscarriage, whereas patients with severe FXIII-B deficiency present with a milder phenotype. Although the estimated incidence of severe FXIII-A deficiency is one per 2 million, a high prevalence ranging from 0.8 to 3.5% has been observed for heterozygous FXIII-A deficiency. Unlike most bleeding disorders, individuals with heterozygous FXIII-A deficiency, particularly women, are more likely to experience hemorrhagic complications during hemostatic challenges. About 200 Mutations have been observed in F13A and F13B genes, with most being missense mutations, while large deletions are the rarest. There is no correlation between genotype and phenotype and a moderate to strong correlation between factor activity and clinical severity in FXIII-A deficiency, making it difficult to predict bleeding patterns based on genotype and FXIII activity levels. Primary prophylaxis is mandatory for all patients with severe FXIII-A deficiency, while those with heterozygous deficiency are generally asymptomatic and may require on-demand therapy during hemostatic challenges, most commonly in women. On the other hand, patients with severe FXIII-B deficiency may only require on-demand therapy, while heterozygotes are generally asymptomatic. Although there are general recommended therapeutic regimens for prophylaxis or on-demand therapy in different situations, personalized pharmacokinetic-based replacement therapy represents the optimal approach that can optimize intervention efficacy. In such an approach, several factors may affect the effectiveness of treatment and determine the dose and type of intervention, including the classification of FXIII deficiency, residual plasma levels of FXIII, clinical situation requiring intervention, age, weight, and also gender.
Global Burden of Testicular Cancer and Its Risk Factors
Authors: Mhamane Sharyu , Bagal Sonali , Shivshankar Samyukta , Kadam Prithviraj , Prakash Gagan , Budukh Atul
Published: November 2024

Testicular cancer (TC) is a rare cancer accounting for 5% of total urologic tumors. It occurs in distinct age groups of adolescents and young adults unlike other cancers peaking in the older age groups. About 95% of TC arises from germ cells. The histological classification of TC consists mainly of seminomas and nonseminomas. Based on GLOBOCAN 2022, the continent with the highest incidence rate was Europe (Age-adjusted rate-6.4), while Africa (0.59) had the lowest incidence. The highest mortality rates were estimated for Latin America and the Caribbean (0.58) followed by Europe (0.35) while the lowest was for the Asian continent (0.14). The highest prevalence of TC was in Europe followed by Oceania and Northern America, while Africa had the least prevalence of TC cases among all. A myriad of risk factors is associated with TC; Cryptorchidism is the strongest associated risk factor of TC increasing the risk by fivefold. Other risk factors identified include family history increasing the risk by four- to eightfold, increased adult height, infertility (1.6- to 2.8-fold), pesticide exposure (threefold), and gr/gr deletion (threefold). Clinically, TC generally presents as a painless scrotal swelling often mistaken as a hydrocele and the bulk of disease growing in the retroperitoneum can be asymptomatic even after growing to a huge size. This article aims to present the global burden of TC and also discusses its etiological risk factors.
Increased Platelet Adhesiveness in Patients with Venous Thromboembolic Disease
Authors: Diaz-Ricart Maribel , Souto Juan Carlos , Martinez-Sanchez Julia , Torramade-Moix Sergi , Moreno-Castaño Ana Belén , Llobet Dolors , Jerez-Dolz Didac , Sanchez Pablo , Carrasco Marina , Mojal Sergi , Moret Carla , Camacho Mercedes , Soria José Manuel , Palomo Marta , Martin-Fernandez Laura , Vidal Francisco , Escolar Gines
Published: November 2024

Background Association between global platelet function and the risk of venous thromboembolic disease (VTE) has been proposed, though the mechanisms do not involve increased platelet aggregation. However, platelet adhesiveness has not been systematically explored in VTE patients.

Objectives To evaluate platelet adhesive functions in VTE patients.

Methods Platelet adhesion was evaluated by using whole blood samples from VTE patients, selected based on short closure times on the PFA-100 (n = 54), and matched healthy individuals (n = 57) in: (i) the PFA-100, (ii) a cone plate analyzer (CPA), on a plastic surface, (iii) microfluidic devices, with two- and three-dimensional evaluation, and (iv) membrane glycoprotein analysis. Intraplatelet signaling was evaluated in isolated collagen type I (Col-I) activated platelets and platelets adhered on Col-I or von Willebrand factor (VWF) coated coverslips under flow. VWF antigen and ADAMTS-13 activity were measured in plasma samples.

Results PFA-100 closure times remained significantly shorter in patients. The CPA test showed a significant increase in the platelet aggregates size when using blood from VTE patients. Platelet adhesion on Col-I revealed a higher area covered by platelets and increased aggregate volume when exposed to samples from VTE patients. Protein P-ZAP70/SYK72 showed a phosphorylation level significantly increased in patients' platelets. Plasma VWF was significantly elevated in VTE patients.

Conclusions Platelets from VTE patients exhibit a proadhesive phenotype under flow conditions potentially related to the shortened occlusion times with the PFA-100. This enhanced adhesiveness may be explained by higher intraplatelet ZAP70/SYK72 phosphorylation and increased plasma VWF in patients. Therefore, primary hemostasis plays a significant role in the pathophysiology of VTE.
Recombination landscape and karyotypic variations revealed by linkage mapping in the grapevine downy mildew pathogen Plasmopara viticola
Authors: Dvorak Etienne , Mazet Isabelle D , Couture Carole , Delmotte François , Foulongne-Oriol Marie
Published: November 2024

Plasmopara viticola, the causal agent of grapevine downy mildew, is a biotrophic oomycete engaged in a tight coevolutionary relationship with its host. Rapid adaptation of the pathogen is favored by annual sexual reproduction that generates genotypic diversity. With the aim of studying the recombination landscape across the P. viticola genome, we generated 2 half-sibling F1 progenies (N = 189 and 162). Using targeted SNP sequencing, between 1,405 and 1,894 markers were included in parental linkage maps, and a consensus map was obtained by integrating 4,509 markers. The reference genome could be assembled into 17 pseudochromosomes, anchoring 88% of its physical length. We observed a strong collinearity between parental genomes and extensive synteny with the downy mildew Peronospora effusa. In the consensus map, the median recombination rate was 13.8 cM/Mb. The local recombination rate was highly variable along chromosomes, and recombination was suppressed in putative centromeric regions. Recombination rate was found negatively correlated with repeats’ coverage and positively correlated with gene coverage. However, genes encoding secreted proteins and putative effectors were underrepresented in highly recombining regions. In both progenies, about 5% of the individuals presented karyotypic anomalies. Aneuploidies and triploidies almost exclusively originated from the male-transmitted chromosomes. Triploids resulted from fertilization by diploid gametes, but also from dispermy. Obligatory sexual reproduction each year may explain the lower level of karyotypic variation in P. viticola compared to other oomycetes. The linkage maps will be useful to guide future de novo chromosome-scale assemblies of P. viticola genomes and to perform forward genetics.
Scale-up of HIV Services for Key Population in Mozambique, 2020–2023
Authors: Malimane Inácio , Seleme Jéssica , Maibaze Gonçalves , Matsimbe Lúcio , Benech Irene , Simbine Ana Paula , Gaspar Núno , Maposse Stélio , Mazive Josefa , Sathane Isabel , Timbana António , Langa António , Couto Aleny
Published: November 2024

Introduction

Mozambique provides targeted services to reduce HIV incidence and improve clinical outcomes among key populations (KP), including female sex workers (FSW), men who have sex with men (MSM), prisoners, and people who inject drugs (PWID). KP program data were analyzed to understand achievements since 2020 and remaining gaps.

Methods

We analyzed PEPFAR Monitoring, Evaluation, and Reporting routine aggregate data available for 2020–2023. KPs on antiretroviral therapy (ART) were defined as clients with ≤28 days since the last missed visit. The test positivity rate was calculated as positive tests over tests conducted. The viral load suppression (VLS) rate was calculated as KP with VLS (<1,000 copies/mL) among those tested in the past 12 months. Data were analyzed by fiscal year (October–September) and KP sub-group.

Results

During 2020–2023, tests conducted increased by 176% (43,834 to 121,184), positive tests increased by 33% (10,412 to 13,883) and test positivity was 17% (56,494/333,194); KP newly initiated on ART increased by 198% (3,979 to 11,875); and KP on ART increased by 370% (8,042 to 37,779). Among KP on ART in September 2023, 25,900 (69%) were FSW, 6,601 (17%) were MSM, 4,078 (11%) were prisoners, and 1,200 (3%) were PWID; VLS rate was 94% (23,224/24,723); 94% among FSW (16,451/17,551), 95% among MSM (4,195/4,419), 94% among prisoners (1,837/1,956), and 93% among PWID (741/797).

Conclusion

The successful scale-up of KP services in Mozambique since 2020 has increased the number of KP tested, initiated, and sustained on treatment, with high VLS rates. This indicates the positive impact of services among KP, contributing to reaching HIV epidemic control nationally.
A simple tool for Visualizing Time Sections of Transesophageal Echocardiography with Python
Authors: Fiammante Marc , Dellamonica Pierre , Mertens Emilie , De La Chapelle Arnaud , Leveille Laury , Labbaoui Mohamed
Published: November 2024

Background

Transesophageal echocardiography (TEE) is a critical tool in diagnosing and managing infectious endocarditis, providing detailed images of cardiac structures. However, identifying vegetations on valves and their dynamic behavior in ultrasound videos can be challenging. TEEs metadata often does not include scale enabling computation of speed.

Objectives

To address this, we developed a simple Python-based tool that enhances the visualization of these dynamic characteristics. This tool reconstructs an optical flow from TEE images, capturing the motion of cardiac structures and offering deeper insights into their behavior. The tool also recovers scale from visual information on the TEES.

Methods

By leveraging the Marching Cubes algorithm and 2D Fast Fourier Transform (FFT) to recover scale from images, the tool efficiently processes video frames to create a 3D representation where time is the third dimension. Wit his mouse the user can select temporal slices and a view of the dynamic evolution in that slice is created together with the speeds.

Results

This approach allows for measurement of thicknesses and speeds, aiding in the evaluation of valvular and vegetation dynamics.

Conclusions

The tool’s user-friendly interface, built with Dash and Plotly, enables interactive analysis and visualization, making it a valuable asset for cardiologists in clinical settings to further analyze valvular behavior.
The reciprocal relationship between short- and long-term motor learning and neurometabolites
Authors: Hehl Melina , Van Malderen Shanti , Blashchuk Svitlana , Sunaert Stefan , Edden Richard A. E. , Swinnen Stephan P. , Cuypers Koen
Published: November 2024

Introduction

Skill acquisition requires practice to stimulate neuroplasticity. Changes in inhibitory and excitatory neurotransmitters, such as respectively gamma-aminobutyric acid (GABA) and glutamate, are believed to play a crucial role in promoting neuroplasticity.

Methods

Magnetic resonance spectroscopy (MRS) at 3T, using the MEGA-PRESS sequence, and behavioral data were collected from 62 volunteers. Participants completed a four-week protocol, practicing either complex (n = 32) or simple (n = 30) bimanual tracking tasks (BTT). Neurotransmitter levels and skill levels at baseline, after two, and four weeks of motor training were compared for left and right primary sensorimotor cortex (SM1) and left dorsal premotor cortex (PMd). Furthermore, task-related modulations of neurotransmitter levels in left PMd were assessed.

Results

Baseline neurotransmitter levels in motor-related brain regions predicted training success. While lower GABA+ (p=0.0347) and higher Glx (glutamate+glutamine compound) levels (p=0.0234) in left PMd correlated with better long-term learning of simple and complex tasks, respectively, higher GABA+ in right SM1 correlated with complex task learning (p=0.0064). Resting neurometabolite levels changed during the intervention: left SM1 Glx decreased with complex training towards week 4 (p=0.0135), while right SM1 Glx was increased at week 2 (p=0.0043), regardless of training type. Group-level analysis showed no task-related neurometabolite modulation in the left PMd. However, individual baseline GABA+ and Glx modulation influenced short-term motor learning (interaction: p=0.0213).

Conclusion

These findings underscore the importance of an interplay between inhibitory and excitatory neurotransmitters during motor learning and suggest potential for future personalized approaches to optimize motor learning.

Key points

-Neurotransmitter dynamics predict training success:Baseline levels of GABA+ and Glx in motor-related brain regions (left PMd and right SM1) were found to predict long-term learning success, with specific patterns correlating with better performance in both simple and complex motor tasks.

-Training-induced changes in neurometabolites:Resting levels of Glx in SM1 changed significantly during the motor training, with a decrease in left SM1 Glx after four weeks of complex training, and an increase in right SM1 Glx after two weeks for both the simple and complex training group, indicating dynamic adaptations in response to motor training.

-Personalized motor learning potential:The interaction between baseline levels and task-related modulation of GABA+ and Glx influenced short-term motor learning outcomes.
Inconsistency of AI in Intracranial Aneurysm Detection with Varying Dose and Image Reconstruction
Authors: Goelz Leonie , Laudani Angelo , Genske Ulrich , Scheel Michael , Bohner Georg , Bauknecht Hans-Christian , Mutze Sven , Hamm Bernd , Jahnke Paul
Published: November 2024

Background

Scanner-related changes in data quality are common in medical imaging, yet monitoring their impact on diagnostic AI performance remains challenging.

Purpose

To assess the consistency of an FDA-approved AI solution for intracranial aneurysm detection across changes in image data quality caused by dose and image reconstruction.

Methods

Consistency testing was performed using a head CT phantom designed for AI evaluation, replicating a patient with three intracranial aneurysms in the anterior communicating artery (ACoA), middle cerebral artery (MCA), and basilar artery (BA). The phantom was examined three times at 21 doses ranging from 0.47 to 20.09 mGy using iterative reconstruction (IR) and filtered back projection (FBP). Aneurysm labeling by an AI solution approved for triage and notification of intracranial aneurysms was analyzed. Five neuroradiologists evaluated all examinations for aneurysm visibility.

Results

The AI solution labeled 74.6% of ACoA, 92.9% of MCA, and 2.4% of BA aneurysms, while reader experiments yielded aneurysm visibility rates of 98.6%, 99.8%, and 95.4%, respectively. The AI demonstrated stable performance within the medium dose range but produced inconsistent results at doses below 8 mGy with IR, 7 mGy with FBP, and also above 14 mGy with FBP. Doses below 1 mGy with IR and 2 mGy with FBP led to a complete lack of AI response to any aneurysm. Readers noted at least one visible aneurysm in every case and reported 100% visibility for all aneurysms at doses above 2 mGy.

Conclusions

Diagnostic AI shows inconsistent performance when image data quality is not optimal and requires more stringent quality standards than radiologists. Standardized consistency testing reveals AI performance issues when these quality requirements are not achieved.
Systematic differences in TB treatment outcomes across in Brazil by patient- and area-related factors: an analysis of national disease registry data
Authors: Ryuk Do Kyung , Pelissari Daniele M , Alves Kleydson , Harada Luiza Ohana , Oliveira Patricia Bartholomay , Johansen Fernanda D C , Maciel Ethel L N , Castro Marcia C , Cohen Ted , Sanchez Mauro , Menzies Nicolas A
Published: November 2024

Background

A substantial fraction of individuals initiating tuberculosis (TB) treatment do not successfully complete the regimen. Understanding variation in TB treatment outcomes could reveal opportunities to improve the effectiveness of TB treatment services.

Methods

We extracted data on TB treatment outcomes, patient covariates, and location of residence from Brazil’s National Disease Notification Information System, for all new TB patients diagnosed during 2015-2018. We analyzed whether or not patients experienced an unsuccessful treatment outcome (any death on treatment, loss to follow-up, or treatment failure). We constructed a statistical model predicting treatment outcome as a function of patient-level covariates, including socio-demographic factors, co-prevalent health conditions, health behaviors, membership of vulnerable populations, and diagnosed form of TB disease. We used this model to decompose state- and municipality-level variation in treatment outcomes into differences attributable to patient-level factors and area-level factors, respectively.

Results

Treatment outcomes data for 259,449 individuals were used for the analysis. Across Brazilian states, variation in unsuccessful treatment due to patient-level factors was substantially less that variation due to area-level factors, with the difference between best and worst performing states 7.1 and 13.3 percentage points for patient-level and area-level factors, respectively. Similar results were estimated at the municipality-level, with 9.3 percentage points separating best and worst performing municipalities according to patient-level factors, and 20.5 percentage points separating best and worst performing municipalities according to area-level factors. Results were similar when we analyzed loss to follow-up as an outcome.

Conclusions

The results of this analysis revealed substantial variation in TB treatment outcomes across states and municipalities in Brazil, which could not be explained by differences in patient-level factors. This area-level variation likely reflects the consequences of differences in health system organization, clinical practices, and other socio-environmental factors not reflected in patient-level data. Further research to reveal the reasons for these differences is urgently needed to identify effective approaches to TB care, reduce geographic disparities in treatment effectiveness across Brazil, and increase the fraction of patients who successfully complete TB treatment.