bluuebunny/crossref_metadata_2025 huggingface dataset:
Acromegaly: The Relationship between Hemodynamic Profiles Assessed via Impedance Cardiography and Left Ventricular Systolic Function Assessed via Echocardiography
Authors: Włochacz Agnieszka , Krzesiński Paweł , Uziębło-Życzkowska Beata , Witek Przemysław , Zieliński Grzegorz , Kazimierczak Anna , Wierzbowski Robert , Banak Małgorzata , Gielerak Grzegorz
Published: September 2024

Background/Objectives: Acromegaly-induced prolonged exposure to growth hormone and insulin-like growth factor 1 may have significant cardiovascular effects. The purpose of this study was to assess the relationship between hemodynamic parameters measured via impedance cardiography (ICG) and parameters of systolic left ventricular function measured via echocardiography in patients with acromegaly. Methods: The observational cohort study included 33 patients with newly diagnosed acromegaly, with a mean age of 47 years and without significant comorbidities. Correlation analysis (Spearman’s rank correlation coefficient R) was performed on parameters obtained by ICG and left ventricular systolic function parameters obtained by echocardiography. ICG assessment included indices of (1) cardiac function as a pump: stroke volume index (SI), cardiac index (CI), Heather index (HI), velocity index (VI), and acceleration index (ACI); (2) afterload: systemic vascular resistance index (SVRI) and total arterial compliance index (TACI); and (3) thoracic fluid content (TFC). Echocardiographic examinations evaluated left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS). Results: A lower LVEF was associated with a lower SI (R = 0.38; p = 0.03) and a higher SVRI (R = −0.35; p = 0.046), whereas lower GLS was associated with lower SI (R = 0.43; p = 0.02), CI (R = 0.62; p < 0.001), VI (R = 0.59; p < 0.001), ACI (R = 0.38; p = 0.048), HI (R = 0.59; p < 0.001), and TACI (R = 0.50; p = 0.006) and a higher SVRI (R = −0.59; p < 0.001). No significant correlation was observed between either LVEF or GLS and TFC. Conclusions: In patients with acromegaly, poorer echocardiographic parameters of left ventricular systolic function are associated with impaired function of the heart as a pump and higher afterload as assessed via ICG.
Parental Knowledge and Its Impact on Nutrition and Oral Health Habits in Children: A Cognitive Investigation
Authors: Guerra Fabrizio , Zumbo Giulia , Straccamore Lucia , Sansotta Laura , Stamegna Claudio , Iacono Roberta , Corridore Denise , Vozza Iole
Published: September 2024

Background: The correlation between the intake of certain nutrients and the development of oral pathologies has been demonstrated by several studies. The objective of this epidemiological investigation was to evaluate parents’ knowledge and awareness of children’s nutrition starting from the early stages of childhood. Methods: A questionnaire with 35 questions was handed over to 120 parents of infants aged 4 to 24 months. Among these, 20 questionnaires were excluded because they were incomplete; hence, the final sample analyzed consisted of 100 questionnaires. The outcome of this study revealed that the parents are well aware of many common topics, but their knowledge regarding specific prevention measures, i.e., the use of systemic fluoride as per the international guidelines, needs proper attention. Results: and Conclusions: After analyzing all the collected data, it is possible to conclude that prevention is the best investment to avoid the onset of the carious pathology, which can be possible through parental education, for example, by raising awareness among expectant mothers, through different actions in the territory. However, further research is needed as this study has some limitations and the convenience sample is hospital-based and not effectively representative of the whole population.
Metformin Treatment Is Not Associated with Altered PD-L1 Expression in Diabetic Patients with Oral Squamous Cell Carcinoma
Authors: Mamilos Andreas , Winter Lina , Lein Alexander , Spoerl Steffen , Ludwig Nils , Ettl Tobias , Künzel Julian , Reichert Torsten , Spanier Gerrit , Brochhausen Christoph
Published: September 2024

Background: The anti-neoplastic activity of metformin is a subject of current debate. Preclinical data have suggested that metformin enhances PD-L1 anti-tumor effects in various cancer entities by decreasing insulin levels and inducing energetic stress. However, its impact on PD-L1 expression remains unclear in a clinical setting. Therefore, we aim to investigate the impact of metformin treatment in type 2 diabetes mellitus (DM) patients on PD-L1 expression in patients with oral squamous cell carcinoma (OSCC). Methods: We performed a retrospective analysis of patients with DM and OSCC treated at our tertiary referral center over a period of 12 years. The tumor proportion score (TPS), immune cell score (IC), and combined positive score (CPS) were used to quantify PD-L1 expression. PD-L1 expression of patients receiving metformin was compared to a control group without metformin prescription. Results: A total of 68 patients diagnosed with OSCC and DM were analyzed, with 24 receiving and 44 not receiving metformin therapy. No statistically significant differences were identified between the metformin and non-metformin groups for any of the scores (TPS: p = 0.818; IC: p = 0.748; CPS: p = 0.387). Conclusions: In contrast to previous studies, we could not find significant differences in PD-L1 expression between patients with and without metformin intake. Further research needs to shed light on the exact mechanism of metformin in different tumor entities. A comprehensive understanding of metformin’s role in cancer therapy could provide valuable insights for potential use of metformin as an adjuvant treatment to immune checkpoint therapy.
Flap-Free Tendon Coverage Using Autologous Fat Grafts Enhanced with Platelet-Rich Plasma and Growth Factors at a Secondary Level Hospital: A Case Report
Authors: Santamaría Salvador Guadalupe , Acosta Muñoz Esteban , Samaniego Rojas Juan , Hidalgo Quishpe Charles , Izquierdo-Condoy Juan S. , Vasconez-Gonzalez Jorge , Ortiz-Prado Esteban
Published: September 2024

Background: Autologous fat grafting, enriched with platelet-rich plasma (PRP), has been established as an effective and affordable treatment for various types of wound healing. However, its efficacy in managing wounds with tendon exposure has not been thoroughly investigated. Methods: We report the case of a 40-year-old male who sustained a severe friction burn on his hand and forearm from a car accident, resulting in significant tissue loss and exposed extensor tendons. Results: Traditional wound treatment strategies were not implemented due to specific patient circumstances. After initial surgical management failed to prevent necrosis and maintain coverage of the exposed tendons, the patient underwent a novel treatment involving autologous fat grafting combined with PRP and growth factors. The procedure was repeated twice within a month to promote granular tissue formation over that area and facilitate subsequent coverage with an epidermoreticular graft. By day 21 post-initial graft, the exposed tendons were 98% covered with granular tissue. Complete wound coverage was achieved by day 60, and by day 130 the patient had regained 90% functionality of the affected limbs. Conclusions: This case illustrates the potential of autologous fat grafting combined with PRP and growth factors as a viable, flap-free alternative for covering tendon exposures. This approach not only enhances wound healing but also supports functional recovery, underscoring the need for further research into its broader applicative potentials.
Association of Diagonal Earlobe Crease with Risk of Atrial Fibrillation in Stable Patients with Coronary Artery Disease
Authors: Jin Moo-Nyun , Song Changho , Kim Young Ju
Published: September 2024

Background: Diagonal earlobe crease (DELC) is a proposed visible predictor of coronary artery disease (CAD). However, studies on the association between atrial fibrillation (AF) and DELC are lacking. This study evaluated the association between DELC and the incidence of AF in patients with CAD. Methods: A total of 669 participants aged <65 years (mean, 53.8 ± 7.5 years) diagnosed with CAD and without AF were evaluated for the presence of DELC. The study outcome was the incidence of AF based on the presence of DELC. The study period was planned for 60 months with a minimum follow-up period of 12 months. Results: Herein, the incidence of DELC was 10.8%. During the follow-up period (44.6 ± 14.9 months), the incidences of AF development were 16.4% and 8.4% in DELC and non-DELC groups, respectively. Kaplan–Meier analysis revealed that the occurrence of AF was significantly higher in the DELC group than in the non-DELC group (log-rank test, p = 0.02). Compared with patients without DELC, patients with DELC had a high risk of AF development (adjusted hazard ratio = 1.88, 95% confidence interval = 1.01–3.53). Conclusions: DELC is associated with an increased risk of AF in patients with CAD. These findings may aid in the detection of AF in patients with CAD.
Evaluation of Serum Calprotectin as an Alternative Diagnostic Marker for Intrahepatic Cholestasis of Pregnancy
Authors: Katiyar Harshita , Yadav Sangeeta , Singh Surender , Mishra Ajay Kumar , Pradhan Mandakini , Lingaiah Raghavendra , Goel Amit
Published: September 2024

Background/Objectives: Intrahepatic cholestasis of pregnancy (ICP) is characterised by unexplained intense pruritus during pregnancy. While serum bile acid (BA) is the standard diagnostic marker for ICP, we explored the potential of serum calprotectin as an alternative diagnostic marker for ICP. Methods: Leftover serum specimens with known serum BA levels, collected from non-pregnant women and pregnant women with an ICP, were used to measure serum calprotectin levels using the Human calprotectin L1/S100-A8/A9 ELISA kit. Results: Serum calprotectin levels were measured in 79 pregnant women with ICP (median [interquartile range] 28 year; serum BA 20 [13.7–35.7] μMol/L; calprotectin159 pg/mL [122.2–212.3]); 43 pregnant women without ICP (age 28 years; serum BA 3.6 [2.1–5.8] μMol/L; calprotectin 146.5 pg/mL [75.8–194.8]), and 59 non-pregnant women (age 28 years; serum BA 3.5 [1.6–5.1 μMol/L; calprotectin 82.4 pg/mL [48.8–137.2]). Compared to non-pregnant women, calprotectin levels were significantly elevated among pregnant women with (p < 0.001) or without ICP (p = 0.01). Calprotectin levels were comparable between pregnant women with and without ICP (p = 0.15). The areas under the ROC curve, to differentiate the presence and absence of ICP, were 0.940 (0.903–0.977; p < 0.001) and 0.681 (0.604–0.759; p < 0.001) for BA and calprotectin, respectively. Conclusions: Serum calprotectin is raised in pregnant women regardless of the presence or absence of ICP and had an inferior diagnostic performance for ICP compared to BA. This information is crucial for understanding the challenges in ICP diagnosis and the limitations of serum calprotectin as an alternative marker.
The Influence of Obstructive Sleep Apnea on Post-Stroke Complications: A Systematic Review and Meta-Analysis
Authors: Kurra Nithin , Gandrakota Nikhila , Ramakrishnan Manju , Sudireddy Kavya , Boorle Naga Vijaya Lakshmi Divya , Jillella Dinesh
Published: September 2024

Objectives: Evidence shows that obstructive sleep apnea (OSA) is associated with the development of stroke. This study investigates the relationship between OSA and post-stroke complications, addressing the limited data on how OSA influences the severity and development of these complications through a systematic review of existing literature. Methods: Data was collected from PubMed, Web of Science, and Scopus databases up to December 2023. Studies meeting the inclusion criteria were selected, and statistical analyses were performed using Review Manager 5.4.1. A random-effects model was used for pooling data with heterogeneity, and findings were presented using standard ratios with 95% confidence intervals. Results: The analysis included nine studies. Stroke patients with OSA did not show a significantly higher risk of post-stroke complications, which include mild cognitive impairment, dementia, insomnia, fatigue, reduced sleep quality, depression, anxiety, recurrent strokes, and death, compared with those without OSA (RR = 1.05, 95% CI 0.97 to 1.13). However, patients with high stroke severity and OSA had a slightly higher risk of post-stroke complications (RR = 1.06, 95% CI 1.01 to 1.12). Conclusions: This systematic review and meta-analysis suggests that OSA confers a higher risk of post-stroke complications in patients with high stroke severity. Further studies are required to explore the impact of OSA on post-stroke complications.
Placental Gene Therapy for Fetal Growth Restriction and Preeclampsia: Preclinical Studies and Prospects for Clinical Application
Authors: Majumder Sanjukta , Moriarty Kristen Lee , Lee Youngmok , Crombleholme Timothy M.
Published: September 2024

In the last three decades, gene therapy has demonstrated significant progress. Over 700 active investigational new drug (IND) applications have been reported. Research on in utero gene therapy has advanced, but ethical and safety concerns persist. A novel approach under investigation is placental gene therapy, which holds promise for targeting diseases associated with placental dysfunction, such as fetal growth restriction (FGR) and preeclampsia. One of the underlying causes of placental insufficiency in these conditions is reduced placental growth factor-driven angiogenesis and endothelial cell dysfunction during fetal development. Studies have explored the overexpression of growth factor transgenes like IGF-1 to address FGR, yielding promising outcomes in animal models. Furthermore, intra-placental gene transfer, instead of systemic delivery of gene therapy vectors, has the potential to treat and cure these disorders. However, challenges and limitations akin to in utero gene therapy persist, including the risk of in utero infection, potential impairment of the mother’s future fertility, the risk of germline integration, and possible off-target effects of gene transfer in the fetus or the mother. Consequently, additional research and deliberation within the scientific and medical communities are warranted to fully comprehend the potential benefits and risks of placental gene therapy.
A French Preoperative Cholesteatoma Management: Current Preoperative Consultation and Tendencies
Authors: Reliquet Benjamin , Folia Mireille , Elhomsy Paul , Aho-Ludwig Serge , Guigou Caroline
Published: September 2024

Objectives: This study aimed to characterize the information delivery during preoperative consultations for cholesteatoma removal surgery in 2024. The secondary objective was to identify any factors influencing the information delivered. Methods: This study was a practice survey which included 33 closed-ended questions and 1 open-ended question. Seven questions concerned the participants’ characteristics and 2 questions concerned the physiopathology of cholesteatoma. Nine questions focused on surgical information, six questions focused on the procedure modalities and ten questions focused on the risks of complications from the intervention. Results: Eighty-two surgeons answered the survey. In 75% of the cases, an information form written by a professional society was provided. The risk of recurrence or residual post-operative cholesteatoma was systematically stated in 78% of cases (n = 64), while the risk of aesthetic sequelae was only stated in 1% (n = 1). Participants working in a university hospital were more likely to inform patients about the risks of vertigo (p = 0.04), aesthetic risks (p = 0.04), poor functional outcomes (p = 0.04), surgical revision (p = 0.05) and the risk of peripheral facial paralysis (p = 0.05). Surgeons who mainly practiced otology were more likely to inform patients about the risks of recurrence and/or residual cholesteatoma (p = 0.02) and taste disturbances (p = 0.02). Conclusions: Cholesteatoma surgery was well explained to patients during the preoperative consultation, mostly with written support, even if the information given was not the same for all complication risks. It could be useful to create an information form dedicated to cholesteatoma surgery to improve comprehensive information and maintain a trustworthy relationship with patients.
Diabetes-Related Changes in Carotid Wall Properties: Role of Triglycerides
Authors: Kozakova Michaela , Morizzo Carmela , Penno Giuseppe , Chiappino Dante , Palombo Carlo
Published: September 2024

Background/Objectives: This study compares the power of the radiofrequency (RF) signal reflected from the media layer (media power) of the common carotid artery (CCA) and the CCA stiffness between individuals with and without type 2 diabetes mellitus (T2DM). It also evaluates the associations of CCA media power with plasma glucose and lipid levels, as well as carotid stiffness. Methods: A total of 540 individuals, 115 with and 425 without T2DM (273 males, mean age = 64 ± 8 years) were studied using RF-based tracking of the right CCA. The following parameters were measured: CCA media thickness, luminal diameter, wall tensile stress (WTS), local pulse wave velocity (PWV), and media power. Results: Compared to the non-diabetic individuals, the T2DM patients had significantly higher CCA media thickness (652 ± 122 vs. 721 ± 138 microns, p < 0.005), luminal diameter (6.12 ± 0.78 vs. 6.86 ± 0.96 mm, p < 0.0005), media power (36.1 ± 4.8 vs. 39.3 ± 4.6, p < 0.0001), and PWV (7.65 ± 1.32 vs. 8.40 ± 1.89 m/s; p < 0.01), but comparable WTS (32.7 ± 10.4 vs. 33.1 ± 10.7 kPa; p = 0.25). In the entire population, CCA media power was independently associated with male sex, pulse pressure, current smoking, and T2DM; when T2DM was not included in the model, triglycerides emerged as an independent determinant of media power. The CCA PWV was independently associated with age, pulse pressure, media power, and T2DM. Conclusions: Our findings suggest the presence of structural changes in the arterial media of T2DM patients, leading to carotid stiffening and remodeling, aiming to preserve WTS. T2DM-related changes in arterial wall composition may be driven by high plasma triglyceride levels, which have previously been associated with both arterial stiffening and the incidence of CV events.
Severe Bacterial Superinfection of Influenza Pneumonia in Immunocompetent Young Patients: Case Reports
Authors: Białka Szymon , Zieliński Michał , Latos Magdalena , Skurzyńska Marlena , Żak Michał , Palaczyński Piotr , Skoczyński Szymon
Published: September 2024

Influenza can lead to or coexist with severe bacterial pneumonia, with the potential to permanently damage lung tissue, refractory to conservative treatment in the post-COVID-19 period. It can lead to serious complications; therefore, annual vaccinations are recommended. This case series with a literature review pertains to two young female patients with an insignificant past medical history, who required emergency lobectomy due to bacterial complications after influenza infection. Urgent lobectomy proves to be a feasible therapeutic option for selected patients with pleural complications.
Effects of Switching FSH Preparations on Sperm Parameters and Pregnancy: A Prospective Controlled Study
Authors: Cannarella Rossella , Leanza Claudia , Crafa Andrea , Aversa Antonio , Condorelli Rosita A. , Calogero Aldo E. , La Vignera Sandro
Published: September 2024

Objective: To study the effect of switching to a follicle-stimulating hormone (FSH) preparation other than that to which infertile male patients have not had an effective response. Patients and methods: Seventy-four normogonadotropinemic, non-obstructive, oligozoospermic patients who were poor responders to the administration of highly purified FSH (hpFSH) (Group 1 (n = 22) and Group 3 (n = 15)) or to recombinant human FSH (rhFSH) (Group 2 (n = 22) and Group 4 (n = 15)) were selected for this prospective study. After 3 months of washout from treatment with the first FSH preparation of choice, rhFSH was administered to patients in Groups 1 and 4 and hpFSH to those in Groups 2 and 3. Serum luteinizing hormone, FSH, total testosterone levels, conventional sperm parameters, testicular volume, and the number of pregnancies were evaluated at study entry and after the first and second treatment cycles. Results: Comparing treatment groups, the greatest improvement in sperm parameters was recorded in the groups of patients prescribed the switch in FSH preparation. Group 1 had the greatest benefit from therapy, with the highest pregnancy rate after the second treatment cycle. Indeed, eight couples achieved pregnancy (36.4%), compared to Groups 2 (n = 4; 18.2%), 3 (n = 1; 6.7%), and 4 (n = 2; 13.3%) (p = 0.04). Conclusions: The results of this study suggest that a therapeutic scheme involving the “switching” of the FSH preparation yields better results than a protocol using the same FSH preparation for six months. These findings, if confirmed by further studies, will help us better design a treatment strategy with FSH for infertile patients with oligozoospermia.
Barriers to Type 1 Diabetes Adherence in Adolescents
Authors: Azar Sarah , Maroun Abou Jaoude Noa , Kędzia Andrzej , Niechciał Elżbieta
Published: September 2024

Background: Adolescence is a particularly crucial period of physical, emotional, and social development and adaptation, rendering these formative years rather challenging for individuals with chronic conditions like type 1 diabetes (T1D). Despite rapid improvement in diabetes therapies, adolescents with T1D are characterized by poorer adherence to treatment regimens compared with other pediatric age groups. Insufficient adherence is strongly related to low diabetes control, increasing morbidity, and risk for premature mortality. This study aimed to provide a comprehensive overview of adolescents’ most common barriers to T1D adherence, stressing the need for a deep and comprehensive understanding of these barriers. The complexity of these barriers is underscored by the diverse factors contributing to poor T1D adherence in adolescents. Methods: A narrative review was conducted, surveying four databases (PubMed, Scopus, EMBASE, and Web of Science) for full-text articles in the English language published up to June 2024. All studies related to barriers to T1D adherence in adolescents were considered. The literature was selected using selection and exclusion criteria and extracted and organized using Mendeley. Exclusion criteria included studies with insufficient data and non-peer-reviewed articles. This review revealed that adolescents face numerous obstacles to T1D adherence related to psychological factors, flux in family dynamics, perceived social pressures, therapy-related factors, transitioning responsibility, risk-taking behaviors, and pubertal changes. Conclusions: Navigating the adaptations to the different aspects of T1D, from treatment to complications and adolescents’ personal growth, effectively requires a thorough understanding of the barriers of a treatment regimen that patients at this critical age face.
Lenvatinib Plus Pembrolizumab versus Doxorubicin for Advanced or Recurrent Endometrial Cancer with Short Treatment-Free Intervals Following First-Line Carboplatin Plus Paclitaxel
Authors: Wang Shao-Jing , Chen Hsin-Hua , Sun Lou , Shih Yu-Hsiang , Lu Ting-Fang , Chen Yen-Fu , Fan Chun-Ting , Hsu Shih-Tien , Liu Chin-Ku , Hwang Sheau-Feng , Lu Chien-Hsing
Published: September 2024

Background: The treatment-free interval is a significant predictor of worse prognosis and poor response rates of the second-line treatment in patients with carboplatin and paclitaxel (PT)-pretreated, advanced, or recurrent endometrial cancer (EC). Whether lenvatinib plus pembrolizumab still confers a survival benefit compared with doxorubicin in patients with platinum-free intervals of <6 months remains unclear. Methods: This multi-institutional retrospective analysis was performed using de-identified electronic health records from the TriNetX Research Network. Patients with advanced or recurrent ECs who received lenvatinib plus pembrolizumab or doxorubicin within six months of first-line PT were identified. A 1:1 propensity score matching (PSM) was conducted to control for potential confounding variables. Overall survival (OS) and adverse event profile were the primary and secondary outcomes. Results: Between January 2018 and February 2024, 130 patients with PT-treated, advanced, or recurrent ECs who received lenvatinib plus pembrolizumab and 122 patients who received doxorubicin at a platinum-free interval of <6 months were identified across 31 healthcare organizations. In the balanced cohort following PSM with 117 patients in each group, treatment with lenvatinib plus pembrolizumab was associated with improved OS compared with treatment with doxorubicin (12.8 vs. 8.2 months, p = 0.012, hazard ratio: 0.65, 95% confidence interval: 0.46–0.91). Regarding adverse event analysis, a higher incidence of hypothyroidism and proteinuria was observed with lenvatinib plus pembrolizumab, and more hematological toxicities were observed with doxorubicin. Conclusions: in patients with treatment-free intervals of <6 months, lenvatinib plus pembrolizumab still confers improved survival compared with doxorubicin in PT-treated, advanced, or recurrent ECs.
Left Ventricular Non-Compaction: Evolving Concepts
Authors: Pittorru Raimondo , De Lazzari Manuel , Migliore Federico , Frasson Enrica , Zorzi Alessandro , Cipriani Alberto , Brunetti Giulia , De Conti Giorgio , Motta Raffaella , Perazzolo Marra Martina , Corrado Domenico
Published: September 2024

Left ventricular non-compaction (LVNC) is a rare heart muscle disease defined by the presence of prominent left ventricular trabeculation, deep intertrabecular recesses, and a thin compact layer. Several hypotheses have been proposed regarding its pathogenesis, with the most recently accepted one being that compact layer and trabeculated layers develop independently according to an “allometric growth”. The current gold-standard diagnostic criteria (in particular, the Petersen index non-compaction/compaction ratio > 2.3) reflect an excess of myocardial trabeculation, which is not a specific morpho-functional feature of LVNC cardiomyopathy but merely a “phenotypic trait”, even described in association with other myocardial disease and over-loading conditions. Accordingly, the European Society of Cardiology (ESC) guidelines have definitively abolished the term ‘LVNC cardiomyopathy’. Recently, evolving perspectives led to the restoration of LVNC cardiomyopathy by distinguishing “hypertrabeculation phenotype” and “non-compaction phenotype”. It has been proposed that the disease-specific pathophysiologic mechanism is a congenitally underdevelopment of the compact layer accounting for an impairment of the left ventricular systolic function. Future prospective research should focus on the clinical and prognostic relevance of compact layer thinning rather than excessive trabeculation, which could significantly influence the management of patients with LVNC. The review aims to update current knowledge on the pathogenesis, genetics, and diagnostic criteria of LVNC, offering modern insights for future perspectives.
CPAP Treatment at Home after Acute Decompensated Heart Failure in Patients with Obstructive Sleep Apnea
Authors: Kalaydzhiev Petar , Borizanova Angelina , Georgieva Neli , Voynova Gergana , Yakov Slavi , Kocev Tsvetan , Tomova-Lyutakova Galya , Krastev Bozhidar , Spasova Natalia , Ilieva Radostina , Kinova Elena , Goudev Assen
Published: September 2024

Background: Acute decompensated heart failure (ADHF) is a condition with a high frequency of hospitalizations and mortality, and obstructive sleep apnea (OSA) is a common comorbidity. Continuous positive airway pressure (CPAP) therapy at home can be a good adjunctive non-drug therapy for these patients. Methods: We conducted a single-center, prospective cohort study from 150 consecutive patients hospitalized for heart failure exacerbation in the cardiology department. Of these, 57 patients had obstructive sleep apnea. After discharge, CPAP therapy at home was offered. We divided them into two groups and followed them for 1 year. All patients received optimal medical treatment. At the end of the period, patients underwent a follow-up physical examination, a follow-up echocardiography, and a follow-up evaluation of the Epworth Sleepiness Scale (ESS). Results: From 81 patients with sleep apnea, 72.8% (n = 59) had obstructive sleep apnea (OSA) and 27.2% (n = 22) had central sleep apnea (CSA). There was a statistically significant difference in body mass index (BMI), ESS, systolic blood pressure (SBP), diastolic blood pressure (DBP), and left ventricular ejection fraction (LVEF%) in the group with CPAP therapy compared to the no-CPAP group. The CPAP group had a median survival of 11.7 months vs. 10.1 months in the no-CPAP group (log-rank (Mantel–Cox) p = 0.044). Conclusions: This study suggests that obstructive sleep apnea is a common comorbidity in patients with acute decompensated heart failure. The addition of CPAP therapy in these patients improves the symptoms and the prognosis.
A Systematic Review of Ureteral Reimplantation Techniques in Endometriosis: Laparoscopic Versus Robotic-Assisted Approach
Authors: Di Michele Stefano , Bramante Silvia , Rosati Maurizio
Published: September 2024

Introduction: Endometriosis, characterized by the presence of endometrial tissue outside the uterus, includes deep endometriosis (DE), which can affect the urinary tract. Ureteral endometriosis (UE) is a rare but significant manifestation that can lead to ureteral obstruction, hydronephrosis, and potential kidney loss. This systematic review evaluates the effectiveness and outcomes of laparoscopic versus robotic-assisted ureteral reimplantation techniques in patients with UE. Materials and Methods: A systematic literature search was conducted following PRISMA guidelines across PubMed, MEDLINE, Embase, Web of Science, and the Cochrane Library, from inception to July 2024. Studies included patients with UE who underwent ureteral reimplantation using laparoscopic or robotic-assisted techniques. Data on patient demographics, surgical technique, duration of surgery, complications, follow-up duration, and clinical outcomes were extracted and analyzed. Results: Twelve studies met the inclusion criteria, comprising 225 patients in the laparoscopic group and 24 in the robotic-assisted group. Lich–Gregoir ureteral reimplantation, with or without a psoas hitch, was the predominant technique used. The average surgery duration was 271.1 min for the laparoscopic group and 310.4 min for the robotic-assisted group. Recurrence rates for UE were 2.95% for laparoscopic and 5.9% for robotic-assisted procedures. The robotic-assisted group had a significantly shorter hospital stay (6.7 days vs. 9.1 days, p < 0.01). Postoperative complication rates were comparable between the two techniques (p = 0.422). Conclusions: Both laparoscopic and robotic-assisted techniques for ureteral reimplantation in UE are safe and effective, with the choice of technique guided by surgeon expertise and specific clinical scenarios. However, the limited number of robotic cases introduces a bias, despite statistical significance.
Immunologic and Targeted Molecular Therapies for Chordomas: A Narrative Review
Authors: Golding Regina , Abuqubo Rami , Pansa Christopher J. , Bhatta Manish , Shankar Vishal , Mani Kyle , Kleinbart Emily , Gelfand Yaroslav , Murthy Saikiran , De la Garza Ramos Rafael , Krystal Jonathan , Eleswarapu Ananth , Yassari Reza , Mostafa Evan , Fourman Mitchell S. , Schlumprecht Anne
Published: September 2024

Chordomas are rare sarcomas arising from notochordal tissue and occur most commonly in the spine. The standard of care for chordomas without evidence of metastatic disease generally consists of en bloc resection followed by adjuvant radiotherapy. However, long-term (20-year) survival rates are approximately 30%. Chordomas are generally considered as chemo resistant. Therefore, systemic therapies have rarely been employed. Novel immunotherapies, including antibody therapy and tumor vaccines, have shown promise in early trials, leading to extended progression-free survival and symptom relief. However, the outcomes of larger trials using these vectors are heterogeneous. The aim of this review is to summarize novel chordoma treatments in immune-targeted therapies. The current merits, trial outcomes, and toxicities of these novel immune and targeted therapies, including those targeting vascular endothelial growth factor receptor (VEGFR) targets and the epidermal growth factor receptor (EGFR), will be discussed.
Transjugular Intrahepatic Portosystemic Shunt (TIPS) for Treatment of Bleeding from Cardiofundal and Ectopic Varices in Cirrhosis
Authors: Shalaby Sarah , Nicoară-Farcău Oana , Perez-Campuzano Valeria , Olivas Pol , Torres Sonia , García-Pagán Juan Carlos , Hernández-Gea Virginia
Published: September 2024

Acute variceal bleeding in cirrhosis represents a critical clinical event that significantly impacts patient prognosis, with mortality rates increasing further after a second episode. This underscores the need for immediate intervention and optimal prophylaxis. The creation of a transjugular intrahepatic portosystemic shunt (TIPS) has been proven to be highly effective for managing esophageal variceal bleeding. However, the use of TIPS for managing cardiofundal gastric varices and ectopic varices remains debated due to their unique vascular anatomy and the limited data available. These varices, although less prevalent than esophageal varices, are complex and heterogeneous vascular shunts between the splanchnic venous system and the systemic veins. Indeed, while endoscopic therapy with tissue adhesives is widely endorsed for achieving hemostasis in active hemorrhage, there is no consensus regarding the optimal approach for secondary prophylaxis. Recent research emphasizes the efficacy of endovascular techniques over endoscopic treatments, such as TIPS and endovascular variceal embolization techniques. This review examines the use of TIPS in managing acute variceal bleeding in patients with cirrhosis, focusing specifically on cardiofundal gastric varices and ectopic varices, discussing optimal patient care based on the latest evidence, aiming to improve outcomes for this challenging subset of patients.
Assessing Gender Differences in Neuropathic Pain Management: Findings from a Real-Life Clinical Cross-Sectional Observational Study
Authors: Marcianò Gianmarco , Siniscalchi Antonio , Di Gennaro Gianfranco , Rania Vincenzo , Vocca Cristina , Palleria Caterina , Catarisano Luca , Muraca Lucia , Citraro Rita , Evangelista Maurizio , De Sarro Giovambattista , D’Agostino Bruno , Abrego-Guandique Diana Marisol , Cione Erika , Morlion Bart , Gallelli Luca
Published: September 2024

Introduction: Neuropathic pain is defined as pain induced by a lesion or disease of the somatosensory nervous system. Pharmacological and non-pharmacological treatments are frequently employed. In the current clinical investigation, we assessed the effects of sex on the safety and effectiveness of medications used to treat neuropathic pain. Methods: We conducted a prospective analysis between 1 February 2021 and 20 April 2024, involving patients with neuropathic pain referred to the Ambulatory of Pain Medicine of “Renato Dulbecco” University Hospital in Catanzaro (Calabria, Italy). Patients over 18 years old with signs of neuropathic pain (Douleur Neuropathique en 4 questionnaire ≥ 4) were included. Exclusion criteria comprised patients with Alzheimer’s disease; patients with nociplastic or nociceptive pain; and patients with neoplasms. Patients with fewer than two accesses to ambulatory care were excluded, as were those who did not sign the informed consent. Clinical data were collected from each enrolled patient and subsequently analyzed, considering clinical outcomes. Sex and gender differences in efficacy were estimated using multivariate linear modeling and propensity-score matching. Results: During the study, 531 patients were screened, and 174 were enrolled (33.5%, mean age 61.5 ± 13.1; 64 males and 110 females, mean age 60.6 ± 13.4 and 61.96 ± 13.0) in accordance with the inclusion and exclusion criteria. Only minor differences in treatment prescription were observed based on age, body mass index, and comorbidities. Smoking, sex, educational level, and body mass index did not induce a significant change in pain perception. Males required slightly higher, though not significantly, doses of drugs for pain control than females. The treatment was not significantly more effective for females than for males. Females did not exhibit a significantly lower number of adverse drug reactions compared to males. Conclusions: The current study found that there are no appreciable differences between the sexes when it comes to the treatment of neuropathic pain.
Polymer Boron-Containing Composite for Protecting Astronauts of Manned Orbital Stations from Secondary Neutron Radiation
Authors: Yastrebinsky Roman Nikolaevich , Yastrebinskaya Anna Viktorovna , Gorodov Andrey Ivanovich , Akimenko Anastasia Vladislavovna
Published: September 2024

This article considers the prospects of using heat-resistant polyimide boron-containing composites to protect astronauts of manned orbital stations from secondary neutron radiation. Variant calculations are performed regarding neutron and gamma-quanta flux distributions in a polyimide composite material with different boron content used to reduce capture radiation. The dependences of spatial distributions of thermal neutron flux density and the gamma-quanta dose rate in a polyimide composite layer with a boron content of 0 to 5% are obtained. An experimental assessment of the energy distribution of neutron and gamma radiation behind the protective polyimide composite is carried out. The introduction of boron atoms in an amount of 3.0 wt.% shows the absence of bursts of secondary gamma radiation energy in the composite, which is due to the high cross-section of thermal neutron absorption by boron atoms. As a result, with a material layer thickness of 3–10 cm, the gamma-quanta dose rate decreases by 2–3 times. The differential thermal analysis method showed that the upper limit of the working temperature of the polyimide composite is 500 °C. The polyimide matrix filled with boron atoms can find effective application in the development of new radiation-protective polymer materials used in manned orbital stations.
Evaluating the Hybridization and Treatment Effects on the Mechanical Properties of Enset and Sisal Hybrid Composites
Authors: Bekele Abera Endesha , Lemu Hirpa G.
Published: September 2024

Natural fibers are among the most employed reinforcements in the manufacturing process of innovative fiber-based composite materials. As with any composite materials, the properties of composites depend on the type and properties of the fiber, fiber structure, composition (hybridization), and treatment. In this study, the composite was fabricated by using hand lay-up with 100/0, 75/25, 50/50, 25/75, and 0/100 Enset/Sisal (E/S) hybridization ratio. Three cases, i.e., untreated, 5%, and 10% NaOH treatment were considered. The effects of hybridization and treatment on the mechanical and water absorption properties of woven and unidirectional orientation of E/S hybrid composite were evaluated by using a two-factors analysis of variance. The fiber–matrix interfacial fractured surface was characterized by scanning electron microscopy. The treated (5% NaOH) and woven fiber orientation exhibited better mechanical properties than untreated and unidirectional hybrid composites. The flexural and tensile strength of the woven composite was improved by 5% and 9%, respectively, when compared with woven untreated 50/50 volume ratio of composites. In both samples and orientations, the hybridization effects show a higher percentage contribution to the mechanical properties. But, in both orientations of composite samples, the treatment effects show a higher percentage contribution for water absorption properties.
Evaluation of Different ZX Tensile Coupon Designs in Additive Manufacturing of Amorphous and Semi-Crystalline Polymer Composites
Authors: Rayaprolu Raviteja , Kadiyala Ajay Kumar , Lawrence Joseph G.
Published: September 2024

The layer-by-layer deposition of molten polymer filament in fused deposition modeling (FDM) has evolved as a disruptive technology for building complex parts. This technology has drawbacks such as the anisotropic property of the printed parts resulting in lower strength for parts printed in the vertical Z direction compared with the other two planes. In this manuscript, we attempt to address these challenges as well as the lack of standardization in sample preparation and mechanical testing of the printed parts. The paper focuses on process parameters and design optimization of the ZX build orientation. Type I tensile bars in ZX orientation were printed as per the ASTM D638 standard using two (2B) and four (4B) tensile bar designs. The proposed design reduces material loss and post-processing to extract the test coupons. Printing a type I tensile bar in the ZX orientation is more challenging than type IV and type V due to the increased length of the specimen and changes in additional heat buildup during layer-by-layer deposition. Three different polymer composite systems were studied: fast-crystallizing nanofiller-based high-temperature nylon (HTN), slow-crystallizing nanofiller-based polycyclohexylene diethylene terephthalate glycol-modified (PCTG), and amorphous carbon fiber-filled polyetherimide (PEI-CF). For all the polymer composite systems, the 2B showed the highest strength properties due to the shorter layer time aiding the diffusion in the interlayers. Further, rheological studies and SEM imaging were carried out to understand the influence of the two designs on fracture mechanics and interlayer bonding, providing valuable insights for the field of additive manufacturing and material science.
Design of an Overhead Crane in Steel, Aluminium and Composite Material Using the Prestress Method
Authors: Solazzi Luigi , Tomasi Ivan
Published: September 2024

The present research describes a design of an overhead crane using different materials with a prestress method, which corresponds to an external compression force with the aim of reducing the displacement of the beam due to the external load. This study concerns a bridge crane with a span length of 10 m, with a payload equal to 20,000 N and an estimated fatigue life of 50,000 cycles. Three different materials are studied: steel S355JR, aluminium alloy 6061-T6 and carbon fibre-reinforced polymer (CFRP). These materials are analysed with and without the contribution of the prestress method. In reference to the prestressed steel solution (which has a weight equal to 79% of the non-prestressed configuration), this study designed an aluminium solution that is 50.7% of the weight of the steel one and a composite solution that is always 20.3% of the steel configuration. In combining the methods, i.e., the materials and prestress, compared to the non-prestressed steel solution with a weight evaluated to be 758 kg, the weight of the aluminium configuration is equal to 40% of the traditional one, and the composite value is reduced to 16%, with a weight of 121 kg.
Optimization of Al6061 Nanocomposites Production Reinforced with Multiwalled Carbon Nanotubes
Authors: Monteiro Beatriz , Simões Sónia
Published: September 2024

This study investigates the impact of multi-walled carbon nanotubes (MWCNTs) on the microstructure and mechanical properties of Al6061 nanocomposites. The MWCNTs were uniformly dispersed in the aluminum alloy matrix using ultrasonication following cold pressing and sintering in a vacuum. The effect of the sintered temperature on the microstructure and mechanical properties of the nanocomposites was evaluated. The addition of MWCNTs resulted in grain refinement, with the nanocomposites exhibiting smaller and more uniformly distributed grains than the pure Al6061 matrix, particularly at lower sintering temperatures of 580 and 600 °C. The nanocomposites also demonstrated an increase in hardness, with peak values observed at 580 °C, primarily due to the effective dispersion of MWCNTs, which restrict dislocation movement and reinforce grain boundaries. While higher sintering temperatures led to significant grain growth and less uniform hardness distribution, lower temperatures favored finer grain structures and more homogeneous hardness profiles. The results suggest that the optimal sintering temperature for achieving the best balance between microstructure and mechanical properties is 580 °C. However, the study also highlights the need for optimized dispersion techniques to achieve a more uniform distribution of MWCNTs.
Mechanical and Thermal Properties of Polypropylene, Polyoxymethylene and Poly (Methyl Methacrylate) Modified with Adhesive Resins
Authors: Czakaj Jakub , Pakuła Daria , Głowacka Julia , Sztorch Bogna , Przekop Robert E.
Published: September 2024

Polyoxymethylene (POM), polypropylene (PP), and poly(methyl methacrylate) (PMMA) have been blended with adhesive-grade ethylene vinyl acetate (EVA), propylene elastomer (VMX), isobutylene–isoprene rubber (IIR) and an acrylic block copolymer (MMA-nBA-MMA). The blends were prepared using a two-roll mill and injection molding. The mechanical properties of the blends, such as tensile strength, tensile modulus, elongation at maximum load, and impact resistance, were investigated. The water contact angle, melt flow rate (MFR), and differential scanning calorimetry were ascertained to evaluate the blends. The blend samples exhibited the following properties: all POM/EVA blends showed reduced crystallinity compared to neat POM; the 80% PMMA/20% MMA-nBA-MMA blend showed improved impact resistance by 243% compared to the neat PMMA. An antiplasticization effect was observed for POM/EVA 1% blends and PMMA/EVA 1% blends, with MFR reduced by 1% and 3%, respectively. The MFR of the PP/IIR 1% blend increased by 5%, then decreased below the MFR near the polymer for the remaining IIR concentrations.
Numerical Simulation of Subaerial Granular Landslide Impulse Waves and Their Behaviour on a Slope Using a Coupled Smoothed Particle Hydrodynamics–Discrete Element Method
Authors: Zheng Feidong , Liu Qiang , Xu Jinchao , Ming Aqiang , Dong Jia
Published: September 2024

Numerical simulations were conducted to investigate the wave features of subaerial granular landslide-generated impulse waves and their impact on slopes. A numerical solution was obtained by coupling smoothed particle hydrodynamics (SPH) and the discrete element method (DEM). Several predictive equations were tested for their applicability in predicting the maximum crest amplitude of impulse waves generated by slides of different shapes. The results indicated that the predictive model developed by Heller and Hager, utilising slide centroid impact velocity, showed favourable prediction accuracy for the maximum crest amplitude, almost independent of the slide shape at impact. Regarding the leading wave, although the wave profile and velocity distribution deviated significantly from a solitary wave of the same wave amplitude, the maximum run-up could be satisfactorily estimated using solitary wave theory. In addition, the increase in the maximum dynamic forces exerted by the impulse waves on the slope followed a power law with the incident wave amplitude.