bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of Anomalous Coronary Arteries—Surgical Revascularisation Using the Pure Internal Thoracic Artery Technique
Authors: James Ramon L. , Das De Sudeep , Singh Avtaar Singh Sanjeet , Dreisbach John , Watkins Stuart , Al-Attar Nawwar
Published: April 2023

OBJECTIVES: To evaluate the use of CABG utilising an isolated pedicled Right Internal Thoracic Artery (RITA) or Left Internal Thoracic Artery (LITA) or the Pure Internal Thoracic Artery (PITA) technique to treat anomalous aortic origin of coronary artery (AAOCA). METHODS: A retrospective review of all patients at our institution over an 8-year period (2013–2021) who underwent surgery for AAOCA was performed. Data assessed included patient demographics, initial presentation, morphology of coronary anomaly, surgical procedure, cross-clamp time, cardiopulmonary bypass time, and long-term outcome. RESULTS: A total of 14 patients underwent surgery, including 11 males (78.5%) with a median logistic EuroSCORE of 1.605 (IQR 1.34). The median age was 62.5 years (IQR 48.75). Presentation was angina (7 patients), acute coronary syndrome (5 patients), incidental findings in aortic valve pathology (2 patients). AAOCA morphology varied: RCA from left coronary sinus (6), RCA from left main stem (3), left coronary artery from the right coronary sinus (1), left main stem arising from right coronary sinus (2) and circumflex artery arising from the right coronary sinus (2). Overall, 7 patients had co-existing flow-limiting coronary artery disease. CABG was performed using either a pedicled skeletonized RITA, LITA or PITA technique. There was no perioperative mortality. Overall median follow-up time was 43 months. One patient presented with recurrent angina secondary to graft failure at 2 years and there were two non-cardiac-related deaths at 4 and 35 months. CONCLUSION: The use of internal thoracic artery grafts can provide a durable treatment option in patients with anomalous coronary arteries. The potential risk of graft failure in patients with no flow-limiting disease should be very carefully considered. However, a proposed benefit of this technique is the use of a pedicle flow to increase the long-term patency. More consistent results are obtained when ischaemia can be demonstrated preoperatively.
Assessment of Pain in Glaucoma Patients Undergoing Micropulse Transscleral Laser Therapy
Authors: Sukkee Janrapee , Taechajongjintana Natnaree , Ratanawongphaibul Kitiya , Itthipanichpong Rath , Manassakorn Anita , Tantisevi Visanee , Rojanapongpun Prin , Chansangpetch Sunee
Published: April 2023

Background: This study aimed to assess the pain experienced during micropulse transscleral laser therapy (MPTLT) and overnight thereafter and explore the factors associated with the pain. Methods: This prospective study included 100 eyes of 81 glaucoma patients undergoing MPTLT under retrobulbar anesthesia. All patients were asked to rate both types of pain using a numerical rating scale (NRS). The risk factors were explored using multivariable mixed-effects ordinal logistic regression. Results: The mean (SD) NRS pain score during the procedure was 3.57 (3.41) (range 0–10), which included no, mild, moderate, and severe pain in 30 (30%), 33 (33%), 17 (17%), and 20 (20%) eyes, respectively. The mean (SD) NRS score of overnight pain was 2.99 (2.28) (range 0–9), which included no, mild, moderate, and severe pain in 17 (17%), 59 (59%), 17 (17%), and 7 (7%) eyes, respectively. Twenty-seven (27%) eyes reported worse pain overnight than during the procedure. Increased age, initial intraocular pressure, and pain during the procedure were significantly associated with increased overnight pain (p < 0.05). Conclusions: Up to a fourth of eyes had worse pain after discharge. Older age, initial intraocular pressure, and pain during the procedure were risk factors for higher levels of overnight pain.
Identifying Residual Psychological Symptoms after Nasal Reconstruction Surgery in Patients with Empty Nose Syndrome
Authors: Huang Chien-Chia , Wu Pei-Wen , Huang Chi-Che , Chang Po-Hung , Fu Chia-Hsiang , Lee Ta-Jen
Published: April 2023

Background: Empty nose syndrome (ENS) is a syndrome of paradoxical nasal obstruction that is thought to be mostly caused by inappropriate turbinate procedures. This study aimed to investigate depression- and anxiety-associated psychological symptoms in patients with ENS before and after surgical reconstruction, and to compare them with those of control subjects. Methods: Patients with ENS were prospectively enrolled. The Sino-Nasal Outcome Test-25 (SNOT-25), Empty Nose Syndrome 6-item questionnaire (ENS6Q), Beck Depression Inventory-II (BDI-II), and Beck Anxiety Inventory (BAI) were used to evaluate the participants before and after reconstruction surgery with submucosal Medpor implantation (Stryker, Kalamazoo, MI), as well as control subjects at enrollment. Results: Forty patients with ENS and forty age- and sex-matched controls were recruited. Patients with ENS experienced significant improvement in SNOT-25, ENS6Q, BDI-II, and BAI scores after surgery, but all were significantly greater than those in the control group. Nine patients with ENS (22.5%) had postoperative residual psychological symptoms. Preoperative BDI-II and BAI scores were significant predictors of postoperative residual psychological symptoms. The optimal cut-off value was BDI-II > 28.5 (sensitivity, 77.8%; specificity, 77.4%) in receiver operating characteristic curve analysis. Conclusions: The nasal and psychological evaluations in patients with ENS significantly improved after nasal reconstruction surgery, but both were significantly greater than those in the control group. Identifying individuals who may experience postoperative residual symptoms and providing a multimodal approach, including surgical reconstruction and psychiatric treatment, are suggested.
Updated Immunotherapy for Gastric Cancer
Authors: Narita Yukiya , Muro Kei
Published: April 2023

Gastric cancer treatments are evolving rapidly. For example, immune checkpoint inhibitors, especially those that target PD-1 or PD-L1, have long-term efficacy in a subset of gastric cancer patients, and are currently the first-line therapy. Immunotherapies approved for use in untreated gastric cancer patients include monotherapy and chemotherapy-immunotherapy combinations. Major clinical trials have reported efficacy and safety data suggesting that PD-L1 expression is important for regimen selection, although other biomarkers, clinicopathologic factors, and patient preference might also be relevant in other situations. Currently, several novel biomarkers and therapeutic strategies are being assessed, which might refine the current treatment paradigm. In this review, we describe the current treatment regimens for patients with gastric cancer and detail the approach we use for the selection of first-line immunotherapy regimens.
Effect of Functional Electrical Stimulation in Convalescent Stroke Patients: A Multicenter, Randomized Controlled Trial
Authors: Matsumoto Shuji , Shimodozono Megumi , Noma Tomokazu , Miyara Kodai , Onoda Tetsuya , Ijichi Rina , Shigematsu Takashi , Satone Akira , Okuma Hidenobu , Seto Makiko , Taketsuna Masanori , Kaneda Hideaki , Matsuo Miyuki , Kojima Shinsuke ,   the RALLY Trial Investigators
Published: April 2023

Background: We evaluated whether the Walkaide® device could effectively improve walking ability and lower extremity function in post-stroke patients with foot drop. Patients aged 20–85 years with an initial stroke within ≤6 months and a functional ambulation classification score of 3 or 4 were eligible. Materials and Methods: Patients were randomly allocated to the functional electrical stimulation (FES) or control group at a 1:1 ratio. A 40 min training program using Walkaide was additionally performed by the FES group five times per week for 8 weeks. The control group received the 40 min training program without FES. Results: A total of 203 patients were allocated to the FES (n = 102) or control (n = 101) groups. Patients who did not receive the intervention or whose data were unavailable were excluded. Finally, the primary outcome data of 184 patients (n = 92 in each group) were analyzed. The mean change in the maximum distance during the 6-MWT (primary outcome) was 68.37 ± 62.42 m and 57.50 ± 68.17 m in the FES and control groups (difference: 10.86 m; 95% confidence interval: −8.26 to 29.98, p = 0.26), respectively. Conclusions: In Japanese post-stroke patients with foot drop, FES did not significantly improve the 6 min walk distance during the convalescent phase. The trial was registered at UMIN000020604.
Comparative Transcriptomic Analysis of Archival Human Vestibular Schwannoma Tissue from Patients with and without Tinnitus
Authors: Bommakanti Krishna , Seist Richard , Kukutla Phanidhar , Cetinbas Murat , Batts Shelley , Sadreyev Ruslan I. , Stemmer-Rachamimov Anat , Brenner Gary J. , Stankovic Konstantina M.
Published: April 2023

Vestibular schwannoma (VS) is an intracranial tumor that commonly presents with tinnitus and hearing loss. To uncover the molecular mechanisms underlying VS-associated tinnitus, we applied next-generation sequencing (Illumina HiSeq) to formalin-fixed paraffin-embedded archival VS samples from nine patients with tinnitus (VS-Tin) and seven patients without tinnitus (VS-NoTin). Bioinformatic analysis was used to detect differentially expressed genes (DEG; i.e., ≥two-fold change [FC]) while correcting for multiple comparisons. Using RNA-seq analysis, VS-Tin had significantly lower expression of GFAP (logFC = −3.04), APLNR (logFC = −2.95), PREX2 (logFC = −1.44), and PLVAP (logFC = −1.04; all p < 0.01) vs. VS-NoTin. These trends were validated by using real-time RT-qPCR. At the protein level, immunohistochemistry revealed a trend for less PREX2 and apelin expression and greater expression of NLRP3 inflammasome and CD68-positive macrophages in VS-Tin than in VS-NoTin, suggesting the activation of inflammatory processes in VS-Tin. Functional enrichment analysis revealed that the top three protein categories—glycoproteins, signal peptides, and secreted proteins—were significantly enriched in VS-Tin in comparison with VS-NoTin. In a gene set enrichment analysis, the top pathway was allograft rejection, an inflammatory pathway that includes the MMP9, CXCL9, IL16, PF4, ITK, and ACVR2A genes. Future studies are needed to examine the importance of these candidates and of inflammation in VS-associated tinnitus.
Automatic Planning Tools for Lumbar Pedicle Screws: Comparison and Validation of Planning Accuracy for Self-Derived Deep-Learning-Based and Commercial Atlas-Based Approaches
Authors: Scherer Moritz , Kausch Lisa , Bajwa Akbar , Neumann Jan-Oliver , Ishak Basem , Naser Paul , Vollmuth Philipp , Kiening Karl , Maier-Hein Klaus , Unterberg Andreas
Published: April 2023

Background: This ex vivo experimental study sought to compare screw planning accuracy of a self-derived deep-learning-based (DL) and a commercial atlas-based (ATL) tool and to assess robustness towards pathologic spinal anatomy. Methods: From a consecutive registry, 50 cases (256 screws in L1-L5) were randomly selected for experimental planning. Reference screws were manually planned by two independent raters. Additional planning sets were created using the automatic DL and ATL tools. Using Python, automatic planning was compared to the reference in 3D space by calculating minimal absolute distances (MAD) for screw head and tip points (mm) and angular deviation (degree). Results were evaluated for interrater variability of reference screws. Robustness was evaluated in subgroups stratified for alteration of spinal anatomy. Results: Planning was successful in all 256 screws using DL and in 208/256 (81%) using ATL. MAD to the reference for head and tip points and angular deviation was 3.93 ± 2.08 mm, 3.49 ± 1.80 mm and 4.46 ± 2.86° for DL and 7.77 ± 3.65 mm, 7.81 ± 4.75 mm and 6.70 ± 3.53° for ATL, respectively. Corresponding interrater variance for reference screws was 4.89 ± 2.04 mm, 4.36 ± 2.25 mm and 5.27 ± 3.20°, respectively. Planning accuracy was comparable to the manual reference for DL, while ATL produced significantly inferior results (p < 0.0001). DL was robust to altered spinal anatomy while planning failure was pronounced for ATL in 28/82 screws (34%) in the subgroup with severely altered spinal anatomy and alignment (p < 0.0001). Conclusions: Deep learning appears to be a promising approach to reliable automated screw planning, coping well with anatomic variations of the spine that severely limit the accuracy of ATL systems.
Organic Nanodelivery Systems as a New Platform in the Management of Breast Cancer: A Comprehensive Review from Preclinical to Clinical Studies
Authors: Rafik Salma T. , Vaidya Jayant S. , MacRobert Alexander J. , Yaghini Elnaz
Published: April 2023

Breast cancer accounts for approximately 25% of cancer cases and 16.5% of cancer deaths in women, and the World Health Organization predicts that the number of new cases will increase by almost 70% over the next two decades, mainly due to an ageing population. Effective diagnostic and treatment strategies are, therefore, urgently required for improving cure rates among patients since current therapeutic modalities have many limitations and side effects. Nanomedicine is evolving as a promising approach for cancer management, including breast cancer, and various types of organic and inorganic nanomaterials have been investigated for their role in breast cancer diagnosis and treatment. Following an overview on breast cancer characteristics and pathogenesis and challenges of the current treatment strategies, the therapeutic potential of biocompatible organic-based nanoparticles such as liposomes and polymeric micelles that have been tested in breast cancer models are reviewed. The efficacies of different drug delivery and targeting strategies are documented, ranging from synthetic to cell-derived nanoformulations together with a summary of the interaction of nanoparticles with externally applied energy such as radiotherapy. The clinical translation of nanoformulations for breast cancer treatment is summarized including those undergoing clinical trials.
Women Have More Recurrences of Atrial Fibrillation than Men after Thoracoscopic Ablation and Suffer More from Established Risk Factors
Authors: Wesselink Robin , Mossink Bente , Meulendijks Eva , van den Berg Nicoline , Neefs Jolien , Kawasaki Makiri , Fabrizi Benedetta , Piersma Femke , Al-Shama Rushd , de Vries Tim , de Jong Jonas , van Boven Wim , Driessen Antoine , de Groot Joris
Published: April 2023

Introduction. Atrial fibrillation (AF) is more prevalent in men than in women. However, women with AF are more symptomatic, have a worse quality of life, a higher stroke risk and may therefore benefit most from ablation. In this study we aim to identify the risk of recurrent AF after thoracoscopic ablation, and assess the differential impact of the risk factors for recurrence between women and men. Method. This is a single center cohort study, including patients undergoing thoracoscopic ablation for advanced AF between 2008 and 2019. All patients were clinically followed up for two years with quarterly 24 h Holter monitoring and ECGs for the detection of recurrent AF. Left atrial appendage (LAA) tissue was collected for collagen analysis. Results. We included 571 patients, of whom 143 (25%) were women. Women were older than men (63 ± 8.3 y vs. 59 ± 8.5, p < 0.001), but had fewer cardiovascular risk factors, myocardial infarctions (1.4% vs. 6.5%, p = 0.03) and, in particular, vascular disease (7.0% vs. 16.1%, p = 0.01). Women suffered more from AF recurrence, driven by more atrial tachycardias, and sex was an independent risk factor for recurrence (HR1.41 [1.04–1.91], p = 0.028]). The presence of vascular disease was associated with an increased risk for AF recurrence in women, but not in men. In LAA histology, women had more collagen than men, as had patients with persistent compared to paroxysmal AF. Conclusion. Women had 15% more recurrences, driven by more atrial tachycardias, which may be explained by a more fibrotic atrial substrate. What’s new? Women undergoing thoracoscopic AF ablation have a higher risk of recurrent AF, driven by more atrial tachycardias. Among patients with left atrial enlargement or persistent AF, women have worse outcomes than men. Vascular disease was a risk factor for recurrence in women, but not in men. In a histopathologic analysis of the left atrial appendage, women had more collagen than men, as had patients with persistent compared to paroxysmal AF.
Mortality, Intensive Care Unit Admission, and Intubation among Hospitalized Patients with COVID-19: A One-Year Retrospective Study in Jordan
Authors: Al Oweidat Khaled , Al-Amer Rasmieh , Saleh Mohammad Y. , Albtoosh Asma S. , Toubasi Ahmad A. , Ribie Mona Khaled , Hasuneh Manar M. , Alfaqheri Daniah L. , Alshurafa Abdullah H. , Ribie Mohammad , Ali Amira Mohammed , Obeidat Nathir
Published: April 2023

COVID-19 is a public health crisis that has caused numerous deaths, necessitated an increased number of hospital admissions, and led to extended inpatient stays. This study aimed to identify the factors associated with COVID-19 mortality, intensive care unit admission, intubation, and length of hospital stay among Jordanian patients. This was a one-year retrospective study of 745 COVID-19 patients admitted to Jordan University Hospital. Data regarding the patients’ demographics, clinical and co-morbid conditions, imaging, laboratory parameters, mortality, intensive care unit admission (ICU), and intubation were collected from their medical records using a coding manual. The data revealed that the overall rates of COVID-19-related mortality, ICU admission, and invasive intubation were 23.0%, 28.3%, and 10.8%, respectively. Chronic kidney disease (CKD), troponin, lactate dehydrogenase (LDH), and O2 saturation <90% were significantly associated with the mortality rate. The variables that were significantly associated with ICU admission were heart failure and the use of remdesivir. However, O2 saturation <90% and gastrointestinal (GI) symptoms were the only variables associated with invasive intubation. The findings of this study suggest that study-related health outcomes can be used to predict the severity of COVID-19, and they can inform future research aiming to identify specific populations who are at a higher risk of COVID-19 complications.
Omega-3 Polyunsaturated Fatty Acids in Managing Comorbid Mood Disorders in Chronic Obstructive Pulmonary Disease (COPD): A Review
Authors: Zailani Halliru , Satyanarayanan Senthil , Liao Wei-Chih , Liao Hsien-Feng , Huang Shih-Yi , Gałecki Piotr , Su Kuan-Pin , Chang Jane
Published: April 2023

Chronic obstructive pulmonary disease (COPD) is the third-leading cause of mortality globally, significantly affecting people over 40 years old. COPD is often comorbid with mood disorders; however, they are frequently neglected or undiagnosed in COPD management, thus resulting in unintended treatment outcomes and higher mortality associated with the disease. Although the exact link between COPD and mood disorders remains to be ascertained, there is a broader opinion that inflammatory reactions in the lungs, blood, and inflammation-induced changes in the brain could orchestrate the onset of mood disorders in COPD. Although the current management of mood disorders such as depression in COPD involves using antidepressants, their use has been limited due to tolerability issues. On the other hand, as omega-3 polyunsaturated fatty acids (n-3 PUFAs) play a vital role in regulating inflammatory responses, they could be promising alternatives in managing mood disorders in COPD. This review discusses comorbid mood disorders in COPD as well as their influence on the progression and management of COPD. The underlying mechanisms of comorbid mood disorders in COPD will also be discussed, along with the potential role of n-3 PUFAs in managing these conditions.
The Modulation of Adipokines, Adipomyokines, and Sleep Disorders on Carcinogenesis
Authors: Brzecka Anna , Martynowicz Helena , Daroszewski Cyryl , Majchrzak Maciej , Ejma Maria , Misiuk-Hojło Marta , Somasundaram Siva G. , Kirkland Cecil E. , Kosacka Monika
Published: April 2023

Obesity and sarcopenia, i.e., decreased skeletal muscle mass and function, are global health challenges. Moreover, people with obesity and sedentary lifestyles often have sleep disorders. Despite the potential associations, metabolic disturbances linking obesity, sarcopenia, and sleep disorders with cancer are neither well-defined nor understood fully. Abnormal levels of adipokines and adipomyokines originating from both adipose tissue and skeletal muscles are observed in some patients with obesity, sarcopenia and sleep disorders, as well as in cancer patients. This warrants investigation with respect to carcinogenesis. Adipokines and adipomyokines may exert either pro-carcinogenic or anti-carcinogenic effects. These factors, acting independently or together, may significantly modulate the incidence and progression of cancer. This review indicates that one of the possible pathways influencing the development of cancer may be the mutual relationship between obesity and/or sarcopenia, sleep quantity and quality, and adipokines/adipomyokines excretion. Taking into account the high proportion of persons with obesity and sedentary lifestyles, as well as the associations of these conditions with sleep disturbances, more attention should be paid to the individual and combined effects on cancer pathophysiology.
Reversibility of Frail Phenotype in Patients with Inflammatory Bowel Diseases
Authors: Salvatori Silvia , Marafini Irene , Franchin Martina , Lavigna Diletta , Brigida Mattia , Venuto Chiara , Biancone Livia , Calabrese Emma , Giannarelli Diana , Monteleone Giovanni
Published: April 2023

It was recently reported that frailty status can negatively influence the clinical course of patients with inflammatory bowel diseases (IBDs). Our recent study demonstrated that 20% of patients with an IBD are frail, and disease activity increases the risk of frailty. In the present study, we prospectively monitored this subgroup of frail patients, assessed whether the frailty status was reversible, and analyzed factors associated with frailty reversibility. Of the sixty-four frail patients with IBD enrolled, five (8%) were lost during the follow-up period and one (2%) underwent a colectomy. Eleven out of the fifty-eight (19%) patients maintained a frail phenotype during a median follow-up of 8 months (range 6–19 months), and thirty-five (60%) and twelve (21%) became pre-frail or fit, respectively. A comparison of the 58 patients at baseline and at the end of the study showed that frail phenotype reversibility occurred more frequently in patients who achieved clinical remission. A multivariate analysis showed that the improvement of the frail phenotype was inversely correlated with the persistence of clinically active disease (OR:0.1; 95% CI: 0.02–0.8) and a history of extra-intestinal manifestations (OR:0.1; 95% CI: 0.01–0.6) and positively correlated with the use of biologics (OR: 21.7; 95% CI: 3.4–263). Data indicate that the frail phenotype is a reversible condition in most IBD patients, and such a change relies on the improvement in disease activity.
Long-Term Effects of Sacubitril-Valsartan on Cardiac Remodeling: A Parallel Echocardiographic Study of Left and Right Heart Adaptive Response
Authors: Valli Federica , Bursi Francesca , Santangelo Gloria , Toriello Filippo , Faggiano Andrea , Rusconi Irene , Vella Anna Maria , Carugo Stefano , Guazzi Marco
Published: April 2023

Sacubitril/Valsartan (S/V) carries potential anti-remodeling properties, however long-term effects and biventricular adaptive response are poorly described. 76 HFrEF patients who underwent progressive uptitration of S/V, completed the annual scheduled follow-up. After a median follow-up of 11 (8–13) months, left ventricular (LV) reverse remodeling (RR) is defined as (1) absolute increase in LV ejection fraction (EF) ≥ 10% or LVEF ≥ 50% at follow-up and (2) decrease in indexed LV end-diastolic diameter (LVEDDi) of at least 10% or indexed LVEDDi ≤ 33 mm/m2, occurred in 27.6%. Non-ischemic etiology, shorter duration of HF, and absence of a history of AF were independently associated with LVRR (p < 0.05). TAPSE and TAPSE/PASP, a non-invasive index of right ventricular (RV) coupling to the pulmonary circulation, significantly improved at follow-up (0.45 vs. 0.56, p = 0.02). 41% of patients with baseline RV dysfunction obtained favorable RV remodeling despite only a moderate correlation between RV and LV function was observed (r = 0.478, p = 0.002). Our data point to a potential long-term reverse global remodeling effect by S/V, especially in patients who start S/V at an early stage of the disease, and focus our attention on a possible direct effect of the drug in synergistic hemodynamics between RV and pulmonary circulation.
Desmoplakin Cardiomyopathy: Comprehensive Review of an Increasingly Recognized Entity
Authors: Brandão Mariana , Bariani Riccardo , Rigato Ilaria , Bauce Barbara
Published: April 2023

Desmoplakin (DSP) is a desmosomal protein that plays an essential role for cell-to-cell adhesion within the cardiomyocytes. The first association between DSP genetic variants and the presence of a myocardial disease referred to patients with Carvajal syndrome. Since then, several reports have linked the DSP gene to familial forms of arrhythmogenic (ACM) and dilated cardiomyopathies. Left-dominant ACM is the most common phenotype in individuals carrying DSP variants. More recently, a new entity—“Desmoplakin cardiomyopathy”—was described as a distinct form of cardiomyopathy characterized by frequent left ventricular involvement with extensive fibrosis, high arrhythmic risk, and episodes of acute myocardial injury. The purpose of this review was to summarize the available evidence on DSP cardiomyopathy and to identify existing gaps in knowledge that need clarification from upcoming research.
The Impact of Partial Splenic Embolization on Portal Hypertensive Gastropathy in Cirrhotic Patients with Portal Hypertension
Authors: Saeki Michio , Okubo Hironao , Takasaki Yusuke , Nakadera Eisuke , Fukuo Yuka , Fukada Hiroo , Hotchi Yuta , Maruyama Hitoshi , Kokubu Shigehiro , Shiina Shuichiro , Nagahara Akihito , Ikejima Kenichi
Published: April 2023

This study investigated the impact of partial splenic embolization (PSE) on portal hypertensive gastropathy (PHG). We retrospectively analyzed endoscopic findings and the portal venous system of 31 cirrhotic patients with PHG. The improved group was defined as the amelioration of PHG findings using the McCormack classification. Child–Pugh scores of the improved group (18 of 31 patients) were significantly lower compared with those of the non-improved group (p = 0.018). The changes in the diameters of the portal trunk and those of the spleno-portal junction and spleen hilum in the splenic vein of the improved group were significantly larger than those of the non-improved group (p = 0.007, p = 0.025, and p = 0.003, respectively). The changes in the diameters of the portal vein and splenic hilum of the splenic vein showed significant correlations with Child–Pugh score (r = 0.386, p = 0.039; r = 0.510, p = 0.004). In a multivariate analysis of baseline factors related to the improved group, Child–Pugh grade A was significantly associated with the improvement of PHG (odds ratio 6.875, p = 0.033). PSE could be useful for PHG, especially in patients with Child–Pugh grade A, at least in the short term.
Home High-Flow Therapy in Patients with Chronic Respiratory Diseases: Physiological Rationale and Clinical Results
Authors: Vega Pittao Maria Laura , Schifino Gioacchino , Pisani Lara , Nava Stefano
Published: April 2023

High-flow therapy (HFT) is the administration of gas flows above 15 L/min. It is a non-invasive respiratory support that delivers heated (up to 38 °C), humidified (100% Relative Humidity, RH; 44 mg H2O/L Absolute Humidity, AH), oxygen-enriched air when necessary, through a nasal cannula or a tracheostomy interface. Over the last few years, the use of HFT in critically ill hypoxemic adults has increased. Although the clinical benefit of home high-flow therapy (HHFT) remains unclear, some research findings would support the use of HHFT in chronic respiratory diseases. The aim of this review is to describe the HFT physiological principles and summarize the published clinical findings. Finally, we will discuss the differences between hospital and home implementation, as well as the various devices available for HHFT application.
Assessment of Cytological Changes in the Oral Mucosa in Young Hematological Patients Treated with Systemic Chemotherapy
Authors: Fiwek Paula , Irga-Jaworska Ninela , Wojtylak Szymon , Biernat Wojciech , Emerich Katarzyna , Pomiecko Dagmara
Published: April 2023

Background and Objectives: The primary objective of the undertaken study was to determine the morphological changes that occur within the oral epithelium in children undergoing chemotherapy following a diagnosis of hematological malignancies. Materials and Methods: The study group consisted of 18 patients diagnosed with leukemia or lymphoma undergoing treatment with chemotherapy. Swabs (liquid-based cytology) were collected from the oral cavity for microscopic evaluation at baseline, during the chemotherapy cycle with oral mucositis symptoms present, and upon completion of the cycle. Both the neutrophil count and oral mucositis (OM) were registered using the WHO (World Health Organization) scale. The control group included 41 children who were generally healthy. All samples underwent microscopical analyses at the Department of Pathology, Medical University of Gdansk, Poland. Results: A total of 190 cytological preparations were evaluated. The baseline preparations revealed similar cytological images, and the superficial cells of the epithelial layers were seen. A significant (p < 0.01) increase in the number of cells in the intermediate layer of the oral epithelium, as well as a decrease (p < 0.01) in the volume of cells in the superficial layers, was observed in further stages of cytostatic treatment. Conclusions: A decrease in the percentage of superficial epithelial cells with a corresponding increase in the number of intermediate epithelial cells is considered to be a result of toxic damage to the oral mucosa during chemotherapy.
Impact of Temperature and Radiation Factors on Special Concretes Used for NPP Construction
Authors: Fiskov Anton A. , Magola Igor A. , Ditts Alexander A. , Mitina Natalia A. , Vinokurov Sergey E.
Published: April 2023

The core catcher is arranged in an unattended, unventilated sub-reactor space. It is designed to receive molten corium in emergencies, and thus the concrete used in the core catcher must be resistant to high temperatures without significant loss of strength. During nuclear power plant (NPP) operation, these concretes are subjected to considerable radiation exposure, which may also affect their physical–chemical properties. Concrete mixes based on Portland cement and alumina cement with iron and corundum aggregate were investigated. Model samples of concrete were subjected to temperature exposure in the temperature range of 100 to 1000 °C and to radiation exposure in the field of mixed and neutron irradiation in the reactor cell at a load of at least 1 × 107 Gy. Concrete heating over 200 °C leads to a decrease in strength characteristics from 25.1 MPa to 2.6 MPa in Portland cement-based concretes and from 40 MPa to 12 MPa in alumina cement-based concretes. The decrease in concrete strength at high temperatures is due to dehydration of hardening phases, polymorphic transitions of aggregate and chemical interaction between concrete components. Radiation exposure of Portland cement-based concrete samples leads to an increase in their strength. Alumina cement-based concretes are less resistant to radiation exposure, and their strength decreases as a result of radiation exposure-induced processes.
Current Status and Future Outlook of Additive Manufacturing Technologies for the Reconstruction of the Trachea
Authors: Lee Hwa-Yong , Lee Jin Woo
Published: April 2023

Tracheal stenosis and defects occur congenitally and in patients who have undergone tracheal intubation and tracheostomy due to long-term intensive care. Such issues may also be observed during tracheal removal during malignant head and neck tumor resection. However, to date, no treatment method has been identified that can simultaneously restore the appearance of the tracheal skeleton while maintaining respiratory function in patients with tracheal defects. Therefore, there is an urgent need to develop a method that can maintain tracheal function while simultaneously reconstructing the skeletal structure of the trachea. Under such circumstances, the advent of additive manufacturing technology that can create customized structures using patient medical image data provides new possibilities for tracheal reconstruction surgery. In this study, the three-dimensional (3D) printing and bioprinting technologies used in tracheal reconstruction are summarized, and various research results related to the reconstruction of mucous membranes, cartilage, blood vessels, and muscle tissue, which are tissues required for tracheal reconstruction, are classified. The prospects for 3D-printed tracheas in clinical studies are also described. This review serves as a guide for the development of artificial tracheas and clinical trials using 3D printing and bioprinting.
Theoretical Study of Supercavitation Bubble Formation Based on Gillespie’s Algorithm
Authors: Arad Ludar Lotan , Gany Alon
Published: April 2023

Understanding the creation and development of a supercavitation bubble is essential for the design of supercavitational underwater vehicles and applications. The pressure field of the supercavitation bubble is one of the most significant factors in these processes, and it should be taken into account in the analysis. The underwater vessel is surrounded by a supercavitation bubble which is, in fact, an inhomogeneous fluid containing cavities (also described as microbubbles). The distribution of the cavities in the supercavitation volume dictates the pressure field and thus determines the stresses and forces that act on the vessel and affect its motion and stability. In this research, we suggest a new approach to studying the bubbles’ formation and learning about the cavities’ distribution in the low-pressure volume that envelops the underwater vehicle. We used Logvinovich’s principle to describe a two-dimensional ring of fluid that is created at the front edge of the supercavitation body and moves downstream along the vessel. To describe the distribution of the cavities we used Gillespie’s algorithm, which is usually used to describe biological and chemical systems. The algorithm succeeded in describing the random movement of the cavities in the cross-section under various conditions and also in describing their distribution and effects on the macroscopic system. A few factors of the physical characteristics of the fluid and the flow conditions were examined (the initial bubble supply, and the rate coefficients of creation and collapse). The results led to the conclusion that with an examination of those factors and using Gillespie’s algorithm, predictions of the distribution and thus the development of supercavitation could be achieved. The main finding of the analysis was that asymmetric development of the bubbles took place, in spite of the symmetry of the physical problem, as observed in high-resolution experiments.
Application of a Deep Neural Network for Acoustic Source Localization Inside a Cavitation Tunnel
Authors: Lin Bo-Jie , Guan Pai-Chen , Chang Hung-Tang , Hsiao Hong-Wun , Lin Jung-Hsiang
Published: April 2023

Navigating with low noise is the key capability in the submarine design considerations, and noise reduction is also one of the most critical issues in the related fields. Therefore, it is necessary to identify the source of noise during design stage to improve the survivability of the submarines. The main objective of this research is using the supervised neural network to construct the system of noise localization to identify noise source in the large acoustic tunnel. Firstly, we started our proposed method by improving the Yangzhou’s method and Shunsuke’s method. In the test results, we find that the errors of the both can be reduced by using the min-max normalization to highlight the data characteristics of the low amplitude in some frequency. And Yangzhou’s method has higher accuracy than Shunsuke’s method. Then, we reset the diagonal numbers of the cross spectral matrix in Yangzhou’s method to zero and replace mean absolute error to be the loss function for improving the stability of training, and get the most suitable neural network construction for our research. After our optimization, the error decreases from 0.315 m to 0.008 m in cuboid model test. Finally, we apply our method to the cavitation tunnel model. A total of 100 data sets were used for training, 10 sets for verification, and 5 for testing. The average error of the test result is 0.13 m. For the model test in cavitation tunnel in National Taiwan Ocean University, the length of ship model is around 7 m. And the average error is sufficient to determine the noise source position.
Experiment and Simulation of the Shape and Stored Gas Characteristics of the Flexible Spherical Airbag for Underwater Compressed Air Energy Storage
Authors: Liu Mingyao , Sun Ke , Wang Xudong , Lu Changbo , Ma Gang , Long Kai
Published: April 2023

Underwater compressed air energy storage (UCAES) is an advanced technology used in marine energy systems. Most components, such as turbines, compressors, and thermal energy storage (TES), can be deployed on offshore platforms or on land. However, underwater gas-storage devices, which are deployed in deep water, have specific characteristics. Flexible inflatables have become a viable alternative for underwater compressed air energy storage (UCAES) as air storage devices. Few studies have been conducted on the characteristics of partially inflated structures during the inflating and deflating processes. A tank experiment of a 1 m model of an underwater spherical airbag was performed to investigate the characteristics of the deformed shape, pressure, and volume of the stored compressed air. A finite element (FE) simulation of an airbag model with the same dimensions was established in Abaqus/Explicit. The simulation under shallow testing conditions was in good agreement with the experimental results. Furthermore, studies on the performance of a 4 m airbag prototype with different water depths are presented. The results indicated that the shape variation was only related to the volume (inflation ratio). The pressure varied approximately linearly with the inflation ratio during the quasi-static process from an empty shape to a zero-pressure shape. The operating depth had a slight effect on the deformation. Because the scaling factor influences the pressure difference of the surface at the same height proportion, the larger the dimensions of the airbag, the higher the pressure difference will be.
A Repertoire of Clinical Non-Dermatophytes Moulds
Authors: Menu Estelle , Filori Quentin , Dufour Jean-Charles , Ranque Stéphane , L’Ollivier Coralie
Published: April 2023

Humans are constantly exposed to micromycetes, especially filamentous fungi that are ubiquitous in the environment. In the presence of risk factors, mostly related to an alteration of immunity, the non-dermatophyte fungi can then become opportunistic pathogens, causing superficial, deep or disseminated infections. With new molecular tools applied to medical mycology and revisions in taxonomy, the number of fungi described in humans is rising. Some rare species are emerging, and others more frequent are increasing. The aim of this review is to (i) inventory the filamentous fungi found in humans and (ii) provide details on the anatomical sites where they have been identified and the semiology of infections. Among the 239,890 fungi taxa and corresponding synonyms, if any, retrieved from the Mycobank and NCBI Taxonomy databases, we were able to identify 565 moulds in humans. These filamentous fungi were identified in one or more anatomical sites. From a clinical point of view, this review allows us to realize that some uncommon fungi isolated in non-sterile sites may be involved in invasive infections. It may present a first step in the understanding of the pathogenicity of filamentous fungi and the interpretation of the results obtained with the new molecular diagnostic tools.
Invasive Mechanical Ventilation and Death Was More Likely in Patients with Lower LDL Cholesterol Levels during COVID-19 Hospitalization: A Retrospective Propensity-Matched Cohort Study
Authors: Mehta Adhya , Kharawala Amrin , Nagraj Sanjana , Apple Samuel J. , Barzallo Diego , Al Deen Alhuarrat Majd , Moya Cesar Joel Benites , Vikash Sindhu , Zoumpourlis Panagiotis , Xesfingi Sophia , Varrias Dimitrios , Demirhan Yunus Emre , Palaiodimos Leonidas , Karamanis Dimitrios
Published: April 2023

Hyperlipidemia has been associated with worse outcomes in patients with Coronavirus disease 2019 (COVID-19). However, lower LDL-C (low-density lipoprotein cholesterol) levels have been associated with increased COVID-19 severity and mortality. We conducted a retrospective observational study of patients with COVID-19 admitted to New York City Health and Hospitals from 1 March 2020 to 31 October 2020, comparing pre-COVID-19 LDL-C levels or LDL-C levels obtained during COVID-19 hospitalization, with the need for invasive mechanical ventilation and death. Propensity score matching was performed using logistic regression models, and standardized mean differences were calculated. A total of 3020 patients (median age 61 years; 36% women) were included. In the matched cohort, on multivariate logistic regression analysis, LDL was inversely associated with in-hospital death (OR: 0.99, 95% CI: 0.986–0.999, p = 0.036). As a categorical variable, LDL > 70 mg/dL was associated with 47% lower likelihood of invasive mechanical ventilation (OR: 0.53, 95% CI: 0.29–0.95, p = 0.034). No significant association between pre-COVID-19 LDL and death or invasive mechanical ventilation was found (OR: 1.00, 95% CI 0.99–1.01, p = 0.833). Low LDL-C level measured during COVID-19 was associated with a higher likelihood of invasive mechanical ventilation and in-hospital death. A similar association was not found between pre-COVID-19 LDL-C and these outcomes. LDL-C levels obtained during COVID-19 are likely not reflective of the baseline lipid profile.
Management of Patients Affected by Giant Cell Arteritis during the COVID-19 Pandemic: Telemedicine Protocol TELEMACOV
Authors: Parisi Simone , Ditto Maria Chiara , Talotta Rossella , Laganà Angela , Peroni Clara Lisa , Fusaro Enrico
Published: April 2023

Giant cell arteritis (GCA) is the most common primary systemic vasculitis in western countries, prevalently affecting elderly people. Both early diagnosis and regular monitoring are necessary for the correct management of GCA. Following the outbreak of the COVID-19 pandemic, government decisions aiming at reducing the contagion led to reductions in health activities, limiting them to urgent cases. At the same time, remote monitoring activities have been implemented through telephone contacts or video calls carried out by specialists. In line with these deep changes affecting the worldwide healthcare system and in consideration of the high risk of GCA morbidity, we activated the TELEMACOV protocol (TELEmedicine and Management of the patient affected by GCA during the COVID-19 pandemic) in order to remotely monitor patients affected by GCA. The aim of this study was to evaluate the effectiveness of telemedicine in the follow-up of patients already diagnosed with GCA. This was a monocenter observational study. Patients with a previous diagnosis of GCA admitted to the Rheumatology Unit of the University Hospital “Città della Salute e della Scienza” in Turin were monitored every 6–7 weeks by means of video/phone calls from 9 March to 9 June 2020. All patients were asked questions concerning the onset of new symptoms or their recurrence, exams carried out, changes in current therapy, and satisfaction with video/phone calls. We performed 74 remote monitoring visits in 37 GCA patients. Patients were mostly women (77.8%) and had a mean age of 71.85 ± 9.25 years old. The mean disease duration was 5.3 ± 2.3 months. A total of 19 patients received oral glucocorticoids (GC) alone at the time of diagnosis with a daily dose of 0.8–1 mg/kg (52.7 ± 18.3 mg) of prednisone, while 18 patients were treated with a combination of oral steroids (at the time of diagnosis, the prednisone mean dose was 51.7 ± 18.8 mg) and subcutaneous injections of tocilizumab (TCZ). During the follow-up, patients additionally treated with TCZ reduced their GC dose more than patients treated with GC alone (p = 0.03). Only one patient, who was treated with GC alone, had a cranial flare and needed to increase the dosage of GC, which led to rapid improvement. Furthermore, all patients proved very adherent to the therapies (assessed by Medication Adherence Rating Scale (MARS)) and considered this type of monitoring very satisfactory according to a Likert scale (mean score 4.4 ± 0.2 on a 1–5 range). Our study shows that telemedicine can be safely and effectively used in patients with GCA under control as a possible alternative, at least for a limited period of time, to traditional visits.
Family Communication about Diagnostic Genetic Testing for Younger-Onset Dementia
Authors: Poulton Alice , Curnow Lisette , Eratne Dhamidhu , Sexton Adrienne
Published: April 2023

Younger-onset dementia (YOD) refers to onset before 65 years of age and may be associated with a genetic cause. Family communication surrounding any genetic risk is complex, and this process may be further complicated in a YOD context due to its effects on cognition, behaviour, and associated psychosocial consequences. This study aimed to investigate how individuals experience family communication about potential genetic risk and testing for YOD. Thematic analysis was performed on verbatim transcripts of nine semi-structured interviews undertaken with family members who attended a neurogenetics clinic due to a relative diagnosed with YOD. The interviews explored the participants’ experiences of learning that YOD might be inherited and the ensuing family communication about genetic testing. Four key themes emerged: (1) a clinical diagnostic odyssey was common and could be a motivator for genomic testing, (2) pre-existing family tension and/or disconnection was a common barrier, (3) family members’ autonomy was considered, and (4) avoidant coping strategies influenced communication. Communication regarding potential YOD genetic risk is a complicated process and may be influenced by pre-existing family dynamics, individual coping mechanisms, and a desire to promote autonomy in relatives. To promote effective risk communication, genetic counsellors should pre-emptively address family tensions that may be exacerbated in the context of genetic testing for YOD, with awareness that family strain during a preceding period of diagnostic odyssey is common. Genetic counsellors can offer psychosocial support to facilitate coping with this tension in an adaptive way. The findings also indicated the importance of extending genetic counselling support to relatives.