bluuebunny/crossref_metadata_2025 huggingface dataset:
The Impact of a Randomized Community-Based Intervention on the Awareness of Women Residing in Lebanon Toward Breast Cancer, Cervical Cancer, and Intimate Hygiene
Authors: Chehab Rim , Abboud Rimla , Bou Zeidan Mariane , Eid Chelsy , Gerges Giovanni , Attieh Cecile Z. , Btadini Said , Kazma Dana O. , Bou Chahine El Chalouhi Sophia M. , Abi Haidar Mohammad , Abdulaal Maram M. , Maatouk Ralph , Maatouk Karen , El Khoury Sarah , Nassar Malek N. , El Asmar Béchara , Chahine Mirna N.
Published: December 2024

Background/Objectives: Women’s health represents an integral component of public health. With breast cancer being the first worldwide and cervical cancer the fourth most common cancer among women, and while habits of intimate hygiene remain mediocre, it is crucial to address these issues. We aimed to evaluate the efficacy of a community-based intervention on the knowledge and preventive measures (K&P) of women toward breast cancer, cervical cancer, and intimate hygiene. Methods: This longitudinal multicentric prospective interventional study was conducted on women residing in Lebanon aged 18–83 years old. The awareness sessions took place either in person or online to address these three topics, covering the eight governorates of Lebanon. Our sample included women both from the general population and from Order of Malta Lebanon (OML)’s centers and mobile medical units. A stratified randomized sampling method was implemented using age and governorates. Women were interviewed before (pre-test) and after (post-test) the awareness session. The K&P score and the improvement post-intervention were represented in a function of all the study variables. A p ˂ 0.05 was found statistically significant. Results: A total of 657 women, with the majority being nonsmokers and having a bachelor’s degree as their highest level of education, completed surveys before and after the intervention, showcasing a significant overall K&P mean score improvement of 50.48% in the pre- vs. post-test (an average score of 22.01 ± 5.95 over 38 (57.93% of correct answers) vs. 33.12 ± 3.41 over 38 (89.58% of correct answers), respectively, p < 0.001). A significant difference was also noted between pre- and post-test (p < 0.001) in each of the three topics individually, with improvements of 52.39% for breast cancer, 60.00% for cervical cancer, and 22.27% for intimate hygiene. Conclusions: National awareness campaigns are key to shedding light on breast and cervical cancer matters and improving women’s reproductive health and intimate hygiene in Lebanon. Addressing the knowledge gaps and promoting early screening and healthy habits through national public health policies can empower women to protect their health and well-being.
Prevalence of Glaucoma and Its Bayesian Risk Estimation Model Using Common Determinants in the Adult Population of Hail Region, Saudi Arabia
Authors: Ali Abrar , Alshammari Zaki Aqeel , Alshomer Fahad Mohammed , Alanezi Njoud Saleh , Alassaf Othman Mohammad , Albarrak Sarah Khalid , Alzabni Sami Ibrahim , Almozaini Khaled Homod , Alamer Solaiman Ismail , Shalaby Nabeel , Saleem Mohd , Syed Khaja Azharuddin Sajid
Published: December 2024

Background/Objectives: Glaucoma is a global health concern, with an anticipated rise from 64.5 million cases in 2014 to 112 million by 2040. In Saudi Arabia, it contributes to 5.7% of visual impairment cases. Early detection through routine eye exams is crucial, as glaucoma often progresses asymptomatically, leading to irreversible vision loss if left untreated. The present study aims to determine the prevalence of glaucoma in the Hail region of Saudi Arabia. Methods: For this cross-sectional study, a sample of 200 participants underwent demographic assessment, and a Bayesian Risk Estimation Model was employed to analyze determinants such as age, gender, education, and comorbidities. Results: The cross-sectional study in the Hail region of Saudi Arabia involving 9407 outpatients revealed a glaucoma prevalence of 2.1%, with key factors influencing glaucoma risk identified, including age (60–69 years with a 43.38% chance), illiteracy (22.58% chance), and comorbidities such as diabetes mellitus (16.10% chance) and cataract (15.40% chance). Conclusions: In conclusion, the study in the Hail region highlights a 2.1% prevalence of glaucoma, emphasizing the significant impact of age, education, and comorbidities on glaucoma risk. These findings underscore the importance of targeted interventions for at-risk populations to enhance glaucoma management and prevention efforts.
Predicting Severe COVID-19 Outcomes in the Elderly: The Role of Systemic Immune Inflammation, Liver Function Tests, and Neutrophil-to-Lymphocyte Ratio
Authors: Bota Adrian Vasile , Marc Felicia , Adelina Mavrea , Nicolescu Laura , Tudora Adelina Georgiana , Cotoraci Coralia
Published: December 2024

Background: Patients aged 80 years and above are at increased risk for severe COVID-19 outcomes. This study aimed to evaluate the prognostic utility of the derived neutrophil-to-lymphocyte ratio (dNLR), aspartate-aminotransferase-to-lymphocyte ratio index (ALRI), aspartate-aminotransferase-to-platelet ratio index (APRI), and systemic immune inflammation index (SII) in predicting severe disease, intensive care unit (ICU) admission, and mortality among COVID-19 patients aged 80 years and older. Methods: In this retrospective cohort study, 138 elderly patients (≥80 years) and 215 younger controls (<65 years) with confirmed COVID-19 were included. Laboratory data at admission were collected, and the dNLR, ALRI, APRI, and SII scores were calculated. Receiver operating characteristic (ROC) curve analysis was performed to assess the predictive performance of these indices. Results: The SII had the highest area under the ROC curve (AUC) for predicting severe disease in elderly patients (AUC = 0.857, 95% CI: 0.795–0.919, p < 0.001), with an optimal cutoff value of 920 × 10⁹/L (sensitivity 86%, specificity 78%). Elevated SII was significantly associated with increased risk of ICU admission (hazard ratio (HR): 2.9, 95% CI: 1.8–4.6, p < 0.001) and mortality (HR: 3.2, 95% CI: 1.9–5.2, p < 0.001). Similarly, dNLR showed good predictive value (AUC = 0.792, 95% CI: 0.722–0.862, p < 0.001). Conclusions: SII and dNLR are valuable prognostic biomarkers for predicting severe outcomes in COVID-19 patients aged 80 years and above. Early identification using these indices can assist clinicians in risk stratification and management decisions to improve patient outcomes.
Challenges and Strategies for Continuous Cropping of Morchella spp.: A Review
Authors: Xu Lingling , Zhang Yan , Li Haijuan , Li Jing , Xu Jing
Published: December 2024

Continuous cropping obstacles (CCOs) have increasingly become an important phenomenon affecting morel mushroom yield and quality. In this review, we summarize the current knowledge about the driving factors behind morel mushroom continuous cropping, including the increase in soil nutrients, disorder of the soil microbial structure, aggravation of diseases, and accumulation of allelochemicals and autotoxins. Furthermore, we analyze the interrelationships among these driving factors. To mitigate these adverse effects, we propose five potential strategic approaches aimed at optimizing existing interventions. This overview not only delineates the causative agents and their intricate interactions under continuous cropping scenarios but also consolidates prospective solutions to alleviate these constraints, thereby advancing our understanding and management of morel production sustainability.
Temporal Stages of Burnout: How to Design Prevention?
Authors: Leclercq Céline , Hansez Isabelle
Published: December 2024

Burnout, a major concern defined most commonly in the literature with a symptoms-based classification, can also be described as a temporal process with various stages experienced by workers, each composed of unique characteristics and challenges. This intricate process of burnout emphasizes pivotal moments, such as engagement and enthusiasm with a high job ideal (Stage 0), weakening of the ideal (Stage 1), protective withdrawal (Stage 2) and confirmed burnout (Stage 3). Through an opinion review, the objective of this article is to examine which prevention level, and more specifically which prevention actions, can be developed at each stage of this temporal process of burnout. The review criteria allow for the integration of both individual- and organization-focused interventions, ranging from early organizational-level strategies (primary prevention) to clinical consultations addressing the erosion of professional ideals (secondary prevention), as well as psychoeducational sessions aimed at promoting worker well-being. In conclusion, the article underscores the need for a holistic approach, combining organization-focused interventions with individual-focused interventions. Through a comprehensive review, this research provides insights into evidence-based practices, identifies gaps in current research, and offers guidance for future interventions for better support of workers facing burnout.
Perceptions of the Harm of Cigarettes, Mental Health, and Quality of Life Among Transgender Adults Who Smoke Menthol Cigarettes: Results from Wave 5 of the Population Assessment for Tobacco and Health (PATH) Study
Authors: Brown Nichelle , Shin Heesung , Smiley Sabrina L.
Published: December 2024

Sexual and gender minority (SGM) individuals in the United States are at greater risk for combustible tobacco use and mental health problems compared to heterosexual and cisgender individuals. National data comparing associations of menthol cigarette use and mental health among transgender and cisgender individuals in the United States are lacking. The goals of the current study were to (1) characterize transgender and cisgender individuals who smoke menthol cigarettes, and (2) investigate cross-sectional associations between gender identity, harm perceptions of cigarettes, mental health experiences, and quality of life. Data were drawn from Wave 5 of the Population Assessment of Tobacco and Health (PATH) Study (2018–2019). A total of 3989 cisgender (mean [SD] age, 40.47 [0.32] years) and transgender (mean [SD] age, 38.36 [0.09] years) participants who reported current (past 30-day) menthol cigarette use were included in the analysis. Comparing transgender to cisgender groups, significant differences were found in associations between harm perceptions of cigarettes (adjusted odds ratio [AOR] 0.07; 95% CI: 0.02–0.28) and reported depression (AOR 4.57; 95% CI: 1.36–15.33). Collectively, these findings provide evidence that transgender adults who smoke menthol cigarettes are less likely than cisgender adults who smoke menthol cigarettes to perceive smoking as harmful to health and more likely to report recent experiences of depression.
Gender, Mental Health Stigma, and Help-Seeking in Arabic- and Swahili-Speaking Communities in Australia
Authors: Slewa-Younan Shameran , Narchal Renu , Das Ruth , Krstanoska-Blazeska Klimentina , Blignault Ilse , Li Bingqin , Reavley Nicola , Renzaho Andre
Published: December 2024

Australia is an ethnically diverse nation with large numbers of migrants and refugees entering the country yearly. Despite research demonstrating that individuals from culturally and linguistically diverse (CaLD) communities experience an elevated risk of developing a mental illness, mental health services uptake is consistently low. To improve the mental health outcomes of these CaLD individuals in Australia, there is an urgent need to understand barriers to treatment, such as stigma. Research has noted that gender may play a role in mental health stigma and help-seeking. Using a qualitative approach as part of the Embrace Multicultural Mental Health Project, the aim of this study was to explore gender perspectives in mental health stigma and help-seeking among Arabic-speaking and Swahili-speaking individuals in Sydney. A total of five focus group discussions and 18 interviews were undertaken online using Zoom, digitally recorded, transcribed, and thematically analysed. Three major themes were identified. The first theme related to stigma and the fears regarding mental illness being discovered by others. The second theme related to the different approaches to confronting stigma. The last theme related to the various issues considered when identifying sources of help. Our findings suggest that a nuanced approach using the ‘what matters most’ framework can explain how men and women within each community may experience stigma and emphasise different aspects of help-seeking. These findings can help to guide clinical practitioners in delivering gender-specific and culturally sensitive and effective treatment sessions with these CaLD individuals, in addition to offering directions for stigma-reduction initiatives.
Food Financialization: Impact of Derivatives and Index Funds on Agri-Food Market Volatility
Authors: Venegas María del Rosario , Feregrino Jorge , Lay Nelson , Espinosa-Cristia Juan Felipe
Published: December 2024

This study explores the financialization of agricultural commodities, focusing on how financial derivatives and index funds impact the volatility of agro-food markets. Using a Dynamic Conditional Correlation (DCC) GARCH model, we analyze volatility spillovers among key agricultural commodities, particularly maize, and related financial assets over a sample period from 2007 to 2020. Our analysis includes major financial assets like Exchange-Traded Funds (ETFs), the S&P 500 index, and agribusiness corporations such as ADM and Bunge and the largest corn flour producer, GRUMA. The results indicate that financial speculation, especially via passive investments such as ETFs, has intensified price volatility in commodity futures, leading to a systemic risk increase within the sector. This study provides empirical evidence of increased market integration between the agro-food sector and financial markets, underscoring risks to food security and economic stability. We conclude with recommendations for regulatory actions to mitigate systemic risks posed by the growing financial influence in agricultural markets.
Research and Modeling of Commercial Location Selection Based on Geographic Big Data and Mobile Signaling Data—A Case Study of the Central Urban Area of Beijing
Authors: Zou Jin , Zhang Xun , Cong Yangxiao , Gao Zhentong , Shi Jinlian
Published: December 2024

The layout and site selection strategy of commercial facilities are crucial for both enterprise performance and market image, while also significantly impacting the overall planning of urban commercial environments. However, conventional methods of choosing sites sometimes depend on outdated management information systems or static statistical models, which may not take into account all relevant factors and have poor data quality. By utilizing geographical big data and geographical artificial intelligence, this study improves the viability of commercial layout and site selection methods. This study utilizes mobile phone signaling data from Beijing combined with point-of-interest (POI) data from within the Sixth Ring Road of Beijing to identify user behaviors using algorithms. Through a combination of BiLSTM-RF and reinforcement learning algorithms, a population location prediction algorithm is constructed to address the issues of inaccurate and outdated population flow data in commercial site selection. The forecast distribution has a high level of accuracy, with a prediction accuracy rate of 73.2%. Additionally, based on geographical big data, the urban landscape is reconstructed to create a 3D model of Beijing. An immersive interactive commercial site selection system is implemented using the Unreal Engine.
Morphometric Similarity Patterning of Amyloid-β and Tau Proteins Correlates with Transcriptomics in the Alzheimer’s Disease Continuum
Authors: Brusini Lorenza , Dolci Giorgio , Pini Lorenzo , Cruciani Federica , Pizzagalli Fabrizio , Provero Paolo , Menegaz Gloria , Boscolo Galazzo Ilaria
Published: December 2024

Bridging the gap between cortical morphometric remodeling and gene expression can help to clarify the effects of the selective brain accumulation of Amyloid-β (Aβ) and tau proteins occurring in the Alzheimer’s disease (AD). To this aim, we derived morphometric similarity (MS) networks from 126 Aβ- and tau-positive (Aβ+/tau+) and 172 Aβ−/tau− subjects, and we investigated the association between group-wise regional MS differences and transcriptional correlates thanks to an imaging transcriptomics approach grounded in the Allen Human Brain Atlas (AHBA). The expressed gene with the highest correlation with MS alterations was BCHE, a gene related to Aβ homeostasis. In addition, notably, among the most promising results derived from the enrichment analysis, we found the immune response to be a biological process and astrocytes, microglia, and oligodendrocyte precursors for the cell types. In summary, by relating cortical MS and AHBA-derived transcriptomics, we were able to retrieve findings suggesting the biological mechanisms underlying the Aβ- and tau- induced cortical MS alterations in the AD continuum.
Navigating Therapeutic Challenges in BRAF-Mutated NSCLC: Non-V600 Mutations, Immunotherapy, and Overcoming Resistance
Authors: Bortolot Martina , Torresan Sara , De Carlo Elisa , Bertoli Elisa , Stanzione Brigida , Del Conte Alessandro , Spina Michele , Bearz Alessandra
Published: December 2024

Although rare in non-small cell lung cancer (NSCLC), BRAF mutations present considerable therapeutic challenges. While the use of BRAF and MEK inhibitor combinations has significantly improved survival outcomes in patients with BRAF V600E mutations, no targeted therapies are currently available for class II and III mutations, leaving the optimal treatment strategy and prognosis for these patients uncertain. Additionally, despite immunotherapy typically showing limited benefit in patients with other activating genomic alterations, it appears to deliver comparable efficacy in BRAF-mutated NSCLC, emerging as a potentially viable treatment option, particularly in patients with a history of smoking. However, resistance to BRAF pathway inhibitors is inevitable, leading to disease progression, and a well-defined strategy to overcome these resistance mechanisms is lacking. This review aims to explore the critical challenges in the management of BRAF-mutated NSCLC, providing a comprehensive summary of the current evidence and highlighting ongoing clinical trials that aim to address these critical gaps.
Expression of Neurotrophins and Its Receptors During Fetal Development in the Human Cochlea
Authors: Steinacher Claudia , Nishio Shin-ya , Usami Shin-ichi , Dudas Jozsef , Rieder Dietmar , Rask-Andersen Helge , Crespo Berta , Moreno Nadjeda , Konschake Marko , Seifarth Christof , Glueckert Rudolf
Published: December 2024

We determined the relative expression levels of the receptors TrkA, TrkB, TrkC, and p75NTR and ligands BDNF, NT-3, NGF, and NT-4 with RNAseq analysis on fetal human inner ear samples, located TrkB and TrkC proteins, and quantified BDNF with in situ hybridization on histological sections between gestational weeks (GW) 9 to 19. Spiral ganglion neurons (SGNs) and satellite glia appear to be the main source of BDNF and synthesis peaks twice at GW10 and GW15–GW17. Tonotopical gradients of BDNF revert between GW8 and GW15 and follow a maturation and innervation density gradient in SGNs. NT-3/TrkC follows the same time course of expression as BDNF/TrkB. Immunostaining reveals that TrkB signaling may act mainly through satellite glia, Schwann cells, and supporting cells of Kölliker’s organ, while TrkC signaling targets SGNs and pillar cells in humans. The NT-4 expression is upregulated when BDNF/NT-3 is downregulated, suggesting a balancing effect for sustained TrkB activation during fetal development. The mission of neurotrophins expects nerve fiber guidance, innervation, maturation, and trophic effects. The data shall serve to provide a better understanding of neurotrophic regulation and action in human development and to assess the transferability of neurotrophic regenerative therapy from animal models.
Transcriptomic Study of Nicotiana tabacum Treated with the Bacterial Protein CspD Reveals Some Specific Abiotic Stress Responses
Authors: Erokhin Denis , Baranova Diana , Sergeeva Ksenia , Pasechnik Tatiana , Shcherbakova Larisa , Statsyuk Natalia , Dzhavakhiya Vitaly
Published: December 2024

The ability of a cold-shock protein CspD from Bacillus thuringiensis to protect both dicots and monocots against various pathogens is well confirmed under both greenhouse and field conditions; however, the molecular basis of this phenomenon at the transcriptomic level still remains unexplored. Expression profiles of some marker genes associated with SAR/ISR nonspecific resistance pathways and ROS scavengers were examined in CspD-treated Nicotiana tabacum plants, and the RNA-seq analysis of CspD-treated plants was first carried out. The ISR markers PDF1.2 and PR4 were overexpressed locally in treated tobacco leaves with the maximum 2.4- and 5.7-fold change, respectively, reached 12 h after the leaf treatment with CspD; PDF1.2 was also up-regulated 4.8-fold four days after the inoculation of treated plants with TMV. The ROS scavenger analysis demonstrated overexpression of Cu-Zn superoxide dismutase in both treated (with the maximum 5.4-fold change observed 6 h after the treatment) leaves and leaves from the upper tier (“system” leaves, 6.5-fold change observed 4 days after the treatment). The ROS assay confirmed endogenous accumulation of superoxide in CspD-treated leaves 6 and 24 h after the treatment. An in silico comparative study of Arabidopsis orthologs of highly up-regulated tobacco genes induced by CspD with Arabidopsis genes activated by some other molecular patterns revealed the specific CspD-induced expression of Cu-Zn superoxide dismutase and some other genes associated with light and cold responses. This study may contribute to a better understanding of cross-talking between abiotic stress and nonspecific immunity in plants.
What Hinders Adoption of Artificial Intelligence for Cybersecurity in the Banking Sector
Authors: Ali Adeel , Shah Mahmood
Published: December 2024

AI-enabled cybersecurity systems are becoming common, but their effectiveness is reported to be mixed at best due to some barriers. The primary objective of this systematic literature review is to find barriers associated with the use of AI-enabled cybersecurity systems. A comprehensive systematic literature review approach was implemented in this study. Literature sampled from different databases (Scopus and WOS) was synthesised to synthesise barriers associated with using an AI-enabled cybersecurity system, and a total of 41 papers were selected using systematic inclusion criteria. The study identified several barriers, such as the complexity of systems, lack of top management support, lack of AI-proficient employees, and lack of regulatory support for AI. These barriers are classified into technological, organisational, and environmental. This paper is unique as it focuses on the barriers associated with using advanced technologies such as AI-enabled expert systems for cybersecurity. Thus, the current research makes a novel contribution, arguing that attention is required toward organisational-level issues to protect the system from cyberattacks. This will establish the way for researchers to evaluate these barriers, opening new avenues for empirical research and for practitioners to utilise these systems more effectively.
An Open-Frame Loading Stage for High-Resolution X-Ray CT
Authors: Plappert David , Schütz Michael , Ganzenmüller Georg C. , Fischer Frank , Campos Mario , Procz Simon , Fiederle Michael , Hiermaier Stefan
Published: December 2024

The utilisation of high-resolution in situ computed tomography (CT) in the (sub-)μm range is typically only viable in synchrotron facilities, as the deployment of a conventional loading stage in laboratory CTs with a cone beam source does not facilitate a corresponding geometric magnification. This publication presents a CT system with a novel in situ concept that allows spatial resolutions down to 0.5 μm, enabling the analysis of weakly absorbing materials capable of applying loads of up to 5 kN in both the compression and tension directions to the sample during the measurement. The necessity for a highly precise mechanical design to ensure successful measurements at magnifications approaching the theoretical limit makes the system’s development particularly demanding. The components employed are presented, along with the requisite considerations and methodologies. It can be demonstrated that the intended specifications with regard to precision and quality are met. The experimental results of a fibre-reinforced polymer demonstrate the system’s ability to detect matrix damage features below a single fibre diameter, thereby highlighting its potential for applications in materials science where traditional laboratory CTs are insufficient and synchrotron access is limited.
Retrospective Study on Short-Term Reverse Cardiac Remodeling in Obese Patients Undergoing Sleeve Gastrectomy
Authors: Izzo Carmine , Visco Valeria , Cirillo Alessandra , Bonadies Davide , Caliendo Giuseppe , Rusciano Maria Rosaria , Virtuoso Nicola , Loria Francesco , Bramanti Alessia , Venturini Eleonora , Di Pietro Paola , Pilone Vincenzo , Schiavo Luigi , Carrizzo Albino , Vecchione Carmine , Ciccarelli Michele
Published: December 2024

Severe obesity is closely associated with an increased risk of comorbidities and alterations in cardiac structure and function. The primary objective of this study was to investigate cardiovascular (CV) risk factors and ventricular remodeling in individuals from an obese population eligible for bariatric surgery. The secondary objective was to evaluate changes in anthropometric, clinical laboratory, and echocardiographic measurements 12 weeks after surgery compared to baseline values. This retrospective observational cohort study involved patients from a single specialized bariatric surgery center. A total of 35 patients were included (mean age 41.5 ± 10.3 years; BMI 43.4 ± 6.6 kg/m2), of whom 34.2% had a family history of coronary artery disease (CAD), 5.7% had a prior history of CAD, 8 had essential hypertension, 11.4% had dyslipidemia, 20% were smokers, and 8.6% were former smokers. Approximately 57% of the patients exhibited concentric left ventricular remodeling, and 14% had grade I diastolic dysfunction. At 12 weeks post-surgery, with an average weight loss of 25 kg and a mean BMI reduction of 8.5 kg/m2, 14% of the patients still exhibited concentric left ventricular remodeling, and about 11% had grade I diastolic dysfunction. Bariatric surgery contributes to the improvement of cardiac function and structure over time as a result of significant weight loss.
Prevalence of Oral Diseases and the Influence of the Presence of Overweight/Obesity in Schoolchildren Population in Mallorca
Authors: Coll Irene , Vallejos Daniela , Cuesta Raúl , Domínguez Jorge , Tomás Pilar , López-Safont Nora
Published: December 2024

Background: The pediatric population is one of the social groups most affected by oral pathology, and overweight and/or obesity is increasingly frequently observed. This work presents a study of the prevalence of oral disease in the school population in Mallorca and its relationship with overweight/obesity. Methods: A cross-sectional study was carried out with a sample of 718 students aged 5–6 (n = 255), 12 (n = 230) and 15 years (n = 233). The WHO criteria for diagnosing and coding examined teeth and overweight/obesity prevalence values. To explore the differences in data, the mean was analyzed using the Student’s t-test or a one-way analysis of variance followed by the Bonferroni post hoc analysis. Results: Results found that students aged 15 years have a caries prevalence rate of 45.49%, higher than those aged 12 (27.39%). The presence of dental calculus in 15-year-old students is 52.8%, even higher than in 12-year-olds (30%). Students aged 6 and 12 with lower weight percentiles have fewer healthy teeth than those with higher percentiles. Conclusions: The schoolchildren have experienced a decrease in caries and an increase in periodontitis, with weight percentile potentially influencing the number of healthy teeth.
The Prevalence and Characteristics of Anemia in Romanian Patients with Type 2 Diabetes: A Cross-Sectional Study
Authors: Gaita Laura , Timar Bogdan , Lazar Sandra , Popescu Simona , Albai Oana , Braha Adina , Timar Romulus
Published: December 2024

Background/Objectives: Anemia is a prevalent comorbidity of diabetes, and although various mechanisms have been shown to link these two conditions, their interaction has not been sufficiently explored. Our cross-sectional, non-interventional study aimed to evaluate the prevalence of anemia and its subtypes, as well as their interactions, in patients with type 2 diabetes (T2D). Methods: A total of 227 patients previously diagnosed with T2D were enrolled. These patients were assessed regarding their medical history and the evolution of their diabetes, and were screened for anemia. Results: Anemia was encountered in 32.6% of the 227 hospitalized patients previously diagnosed with T2D enrolled in this study. Its presence was associated with a higher prevalence of complications and comorbidities, such as chronic kidney disease (CKD), retinopathy, and atrial fibrillation. The most common types of anemia observed were those associated with CKD, other chronic conditions, and iron deficiency. A moderate, positive correlation (r = 0.307; p < 0.0001) has been observed between estimated glomerular filtration rate (eGFR) and hemoglobin, and a moderate, negative correlation has been observed between age and hemoglobin (r = −0.351; p < 0.0001), with the results also analyzed using multiple regression and ROC curve analysis. Additionally, a weak, positive, yet statistically significant correlation was observed between glycemic values and hemoglobin levels, which requires further research. Conclusions: Anemia is frequently encountered in patients with T2D, especially in those with increased age, decreased eGFR, and additional chronic degenerative complications or other comorbidities; thus, a systematic screening for an early diagnosis and interdisciplinary management is recommended for improved outcomes related to morbidity, mortality, and quality of life.
Beyond Anticoagulation: Limitations of Oral Anticoagulants in Preventing Stroke Recurrence in Atrial Fibrillation
Authors: Seetge Jessica , Cséke Balázs , Karádi Zsófia Nozomi , Bosnyák Edit , Szapáry László
Published: December 2024

Background/Objectives: Despite the widespread use of oral anticoagulants (OACs), acute ischemic stroke (AIS) remains a significant risk for patients with atrial fibrillation (AF). The real-world effectiveness of OACs in preventing recurrent strokes, particularly following an initial stroke of cardioembolic (CE) origin, continues to be a major challenge for clinicians managing AF patients. This study evaluated the efficacy of OACs in secondary stroke prevention and investigated the influence of anticoagulation type and quality on recurrence risk. Methods: We analyzed data from 128 AF patients in the prospective Transzlációs Idegtudományi Nemzeti Laboratórium (TINL) STROKE-registry, admitted with CE stroke between February 2023 and September 2024. Patients were categorized by anticoagulation status at admission (OAC-users, n = 89; anticoagulation-naïve, n = 39). Recurrence rates were assessed using logistic regression models, adjusted for age, sex, hypertension, diabetes, and pre-stroke disability. Subgroup analyses explored the effects of anticoagulation type and quality. Results: Recurrence rates were similar between the OAC-treated and anticoagulation-naïve patients after adjusting for confounders (19.10% vs. 17.95%, p = 0.870). Among the anticoagulated patients, neither anticoagulation type nor quality alone significantly influenced the recurrence risk. However, their interaction was statistically significant (p = 0.049), suggesting that the effectiveness of anticoagulation in preventing strokes is strongly affected by treatment quality. Conclusions: Although OACs are a cornerstone of stroke prevention in patients with AF, their efficacy in reducing recurrence depends on optimal management. These findings highlight that adequate anticoagulation, not just its use, is critical to minimize recurrence risk. To effectively prevent strokes in high-risk AF patients, future strategies must focus on standardized protocols, tailored monitoring, and individualized dosing regimens.
Screening for Hypophosphatasia in Adult Patients at a Maximum Care Provider—Retrospective Analyses over Fifteen Years
Authors: Hennings Robert , Le Duc Diana , Bundalian Linnaeus , Tönjes Anke , Lemke Johannes R. , Thiery Joachim , Kratzsch Jürgen , Roth Andreas
Published: December 2024

Background/Objectives: Hypophosphatasemia (HPE) may be temporary (tHPE) in the context of severe diseases, such as sepsis or trauma, or it may persist (pHPE), indicating an adult form of hypophosphatasia (HPP; OMIM 171760), a rare metabolic bone disorder caused by pathogenic nucleotide variants (PNVs) in the ALPL gene. The aim of this study was to analyze the role of auxiliary general biomarkers in verifying low alkaline phosphatase (ALP) serum activity level as an alert parameter for PNVs in the ALPL gene, which are indicative of HPP. In this retrospective analysis, we examined adult patients with an ALP serum activity level below 21 U/L. The cohort comprised 88 patients with temporary HPE (tHPE group) and 20 patients with persistent HPE who underwent re-examination. Genetic analysis performed on 12 pHPE patients identified PNV in the ALPL gene in 11 cases (ALPL group). Hemoglobin [HB], aspartate aminotransferase [AST], gamma-glutamyl transferase [GGT], calcium, phosphate, thyrotropin [TSH], albumin, total protein, and C-reactive protein [CRP] levels represented basic biomarkers. A comparative analysis between groups employed a Student’s t-test, and a Student’s t-test with bootstrap sampling (n = 10.000) was performed. Results: The mean HB, ALP, calcium, albumin, and total protein levels were lower in the tHPE group compared with the ALPL group (p < 0.01). AST and CRP were increased in the tHPE group (p < 0.01). The model showed an accuracy of 90% and an AUC of 0.94, which means that it can discern the two groups ~94% of the time. Conclusions: Basic biomarker evaluation effectively supports the interpretation of a decreased ALP serum activity level in the context of suspected HPP. In patients with laboratory HPE and biomarkers within reference, a PNV in the ALPL gene is highly suspected.
Specificities of Myocardial Infarction and Heart Failure in Women
Authors: Dekleva Milica , Djordjevic Ana , Zivkovic Stefan , Lazic Jelena Suzic
Published: December 2024

Substantial evidence from previous clinical studies, randomized trials, and patient registries confirms the existence of significant differences in cardiac morphology, pathophysiology, prevalence of specific coronary artery disease (CAD), and clinical course of myocardial infarction (MI) between men and women. The aim of this review is to investigate the impact of sex or gender on the development and clinical course of MI, the mechanisms and features of left ventricular (LV) remodeling, and heart failure (HF). The main sex-related difference in post-MI LV remodeling is adverse LV dilatation in males versus concentric LV remodeling or concentric LV hypertrophy in females. In addition, women have a higher incidence of microvascular dysfunction, which manifests as impaired coronary flow reserve, distal embolism, and a higher prevalence of the no-reflow phenomenon. Consequently, impaired myocardial perfusion after MI is more common in women than in men. Regardless of age or other comorbidities, the incidence of reinfarction, hospitalization for HF, and mortality is significantly higher in females. There is therefore a “sex paradox”: despite the lower prevalence of obstructive CAD and HF with reduced ejection fraction (HFrEF), women have a higher mortality rate after MI. Different characteristics of the coronary network, such as plaque formation, microvascular dysfunction, and endothelial inflammation, as well as the prolonged time to optimal coronary flow restoration, secondary mitral regurgitation, and pulmonary vascular dysfunction, lead to a worse outcome in females. A better understanding of the mechanisms responsible for MI occurrence, LV remodeling, and HF in men and women would contribute to optimized patient therapy that would benefit both sexes.
Comment on Foti et al. Identification of Achille’s Tendon Tears: Diagnostic Accuracy of Dual-Energy CT with Respect to MRI. J. Clin. Med. 2024, 13, 4426
Authors: Maffulli Nicola , Spiezia Filippo
Published: December 2024

We read with great attention, and fully enjoyed, the work by Foti G [...]
Immune Response to an Adjuvanted Recombinant Zoster Vaccine in Japanese Patients with Rheumatoid Arthritis Receiving Upadacitinib (End Zoster-J Study): Study Protocol for an Exploratory Parallel Triple-Arm Prospective Trial
Authors: Watanabe Ryu , Fujii Hisako , Imai Takumi , Furusawa Yuki , Katsushima Masao , Fukumoto Kazuo , Yamada Yutaro , Mamoto Kenji , Okano Tadashi , Yamada Shinsuke , Hashimoto Motomu
Published: December 2024

Background: Janus kinase (JAK) inhibitors have emerged as a new class of disease-modifying anti-rheumatic drugs in the treatment of rheumatoid arthritis (RA). However, herpes zoster is one of the common adverse events of JAK inhibitors, including upadacitinib, which is especially high in Japanese patients with RA compared to those from Western countries. Recombinant zoster vaccine (Shingrix®) is an adjuvanted subunit vaccine containing varicella-zoster virus (VZV) glycoprotein E (gE) that is effective in adults over 50 years of age. Despite this, no studies have examined its immunogenicity in Japanese patients receiving upadacitinib. Therefore, this study aims to examine the effectiveness of the recombinant zoster vaccine in Japanese patients with RA receiving upadacitinib. Methods: This is a single-center, exploratory, interventional, open-label, parallel triple-arm, prospective study. A total of 69 patients (23 in each group) aged 50 years or over and treated with a stable dose of methotrexate (MTX) monotherapy (6–12 mg/week), upadacitinib monotherapy (15 mg/day), or MTX (6–12 mg/week) + upadacitinib 15 mg/day (combination) for at least 1 month prior to study entry will be included. Moreover, all three groups will receive two intramuscular injections of the recombinant zoster vaccine at 8-week intervals. The primary endpoint is the proportion of positive anti-gE antibodies 4 weeks after the second injection. Secondary endpoints include RA disease activity, positive gE-specific CD4+ T-cells, and VZV-specific antibodies at indicated time points. Data on outcome measures will be collected at baseline and at 4, 8, 12, and 20 weeks. Endpoints will be summarized using descriptive statistics from baseline therapy, and results will be compared in an exploratory manner. Discussion: Despite the limited generalizability due to its design as a single-center, single-ethnic study, small sample size, and short observation period, this study provides evidence on the effectiveness and tolerability of recombinant zoster vaccine in Japanese patients with RA receiving upadacitinib.
Resuscitation and Initial Management After Moderate-to-Severe Traumatic Brain Injury: Questions for the On-Call Shift
Authors: Barea-Mendoza Jesús Abelardo , Chico-Fernández Mario , Ballesteros Maria Angeles , Caballo Manuel Alejandro , Castaño-Leon Ana M. , Egea-Guerrero J. J. , Lagares Alfonso , Morales-Varas Guillermo , Pérez-Bárcena Jon , Serviá Goixart Luis , Llompart-Pou Juan Antonio
Published: December 2024

Traumatic brain injury (TBI) is a leading cause of disability and mortality globally, stemming from both primary mechanical injuries and subsequent secondary responses. Effective early management of moderate-to-severe TBI is essential to prevent secondary damage and improve patient outcomes. This review provides a comprehensive guide for the resuscitation and stabilization of TBI patients, combining clinical experience with current evidence-based guidelines. Key areas addressed in this study include the identification and classification of severe TBI, intubation strategies, and optimized resuscitation targets to maintain cerebral perfusion. The management of coagulopathy and special considerations for patients with concomitant hemorrhagic shock are discussed in depth, along with recommendations for neurosurgical interventions. This article further explores the role of multimodal neuromonitoring and targeted temperature management to mitigate secondary brain injury. Finally, it discusses end-of-life care in cases of devastating brain injury (DBI). This practical review integrates foundational and recent advances in TBI management to aid in reducing secondary injuries and enhancing long-term recovery, presenting a multidisciplinary approach to support acute care decisions in TBI patients.
Impact of Maternal Smoking on Obstetric and Neonatal Outcomes in Twin Pregnancies: A Narrative Review
Authors: Juliá-Burchés Cristina , Martínez-Varea Alicia , Morales-Roselló José , Diago-Almela Vicente
Published: December 2024

Maternal smoking, including both traditional cigarettes and electronic ones, is a significant modifiable risk factor associated with adverse perinatal outcomes, especially in twin pregnancies. This narrative review aims to explore the impact of maternal smoking on obstetric and neonatal outcomes in twin pregnancies, which inherently carry a higher risk of complications. A literature search was conducted using the PubMed and EMBASE databases, selecting studies published between January 1994 and October 2024. The findings demonstrate a clear association between smoking and increased risks of preterm birth and fetal growth restriction (FGR) in twin pregnancies. These risks are exacerbated when smoking is combined with other factors, such as preeclampsia and elevated body mass index (BMI). Smoking was also associated with long-term post-natal complications, including respiratory problems like asthma, as well as cognitive and behavioral disorders. However, an association with preeclampsia was not found, and further studies are needed to clarify the relationship in the fields of preterm premature rupture of membranes (PPROM) and fetal death. The adverse effects of smoking are primarily due to reduced oxygen supply to the fetus, caused by nicotine-induced vasoconstriction and carbon monoxide exposure, leading to placental insufficiency and fetal hypoxia. These effects are amplified in twin pregnancies due to the increased physiological demands. The review highlights that smoking cessation interventions during pregnancy are crucial to mitigate these risks and improve maternal and neonatal health outcomes.
Assessment of the Mandibular Osseous Architecture in Cleft Lip and Palate Using Fractal Dimension Analysis: A Pilot Study
Authors: Özden Samet , Cicek Orhan
Published: December 2024

Background/Objectives: Although there has been extensive research on the orofacial morphologic effects of cleft lip and palate (CLP), the effects of CLP on mandibular structures remain largely unknown. The aim of this study was to investigate the trabeculation differences in the mandibular osseous architecture of patients with bilateral CLP (BCLP) and left-sided unilateral CLP (UCLP) using fractal dimension (FD) analysis and to compare these findings with healthy controls without CLP. Methods: A total of 63 patients (27 females, 36 males) with a mean age of 9.69 ± 1.5 years in the pre-peak growth stage were divided into three groups (n = 21 per group): the control group (CG), the BCLP group, and the UCLP group. The FD analysis was conducted on selected regions of interest (ROIs) from the mandibular condyle, angulus, corpus, and coronoid areas in TIFF-formatted panoramic radiographs. Statistical analyses were performed using the paired t-test and ANOVA for parametric data, and the Wilcoxon and Kruskal–Wallis tests for nonparametric data. Statistical significance was set at p < 0.05. Results: The FD values obtained from the ROIs of the right condyle were found to be significantly lower in the BCLP group compared to the CG and UCLP groups (p < 0.05). Conversely, the FD values for the left condyle were significantly higher in the CG group (p < 0.05), while no significant differences were observed between the BCLP and UCLP groups (p > 0.05). The FD value of the left condyle in the UCLP group was found to be significantly lower than that of the right condyle (p < 0.05). In the CG group, the FD values for both the right and left mandibular condyle and corpus were significantly higher than those for the angulus and coronoid regions; in the UCLP group, only the FD values of the right mandibular condyle and corpus were significantly higher than those for the same regions (p < 0.05). Conclusions: The reduced FD values in the mandibular condyle of CLP patients during the pre-peak growth stage suggest a loss of trabeculation and lower metabolic activity, while similarly, reduced FD values in the corpus region contribute to delayed tooth eruption timing, likely due to decreased masticatory forces during the intercuspal position and altered occlusal relationships. Clinical Relevance: In treating CLP patients, particularly with orthopedic face masks, the reduction in metabolic activities in these areas should be considered to achieve the optimal mandibular growth and development, and dental eruptions during the distribution of force from the chin to the corpus and condyle.
Correlates of Premenstrual Syndrome in Polish Adolescents—Results from POLKA 18 Youth-Led Cross-Sectional Study
Authors: Rylewicz Katarzyna , Drejza Michalina Anna , Łopiński Grzegorz , Majcherek Ewa , Barwińska Joanna , Mizgier Małgorzata , Plagens-Rotman Katarzyna , Pisarska-Krawczyk Magdalena , Kędzia Witold , Jarząbek-Bielecka Grażyna
Published: December 2024

Objectives: This study aims to evaluate the prevalence of premenstrual syndrome (PMS) among Polish adolescents and explore its associations with mental health outcomes, lifestyle factors, and risk behaviours. Additionally, it seeks to examine the impact of PMS on quality of life, contributing to the foundation for initiatives that enhance adolescent menstrual health. Methods: This research is part of the POLKA 18 study, a youth-led cross-sectional survey conducted between April and December 2019. Final-year high school students were surveyed using paper-based, self-reported questionnaires. Statistical analysis was performed using the R programming language in RStudio, with a significance threshold of p-value < 0.05. Results: A total of 1545 valid responses were analysed. PMS was reported by 33.9% of respondents, with over 80% experiencing premenstrual symptoms. Adolescents with negative mental health outcomes, such as self-harm or suicidal ideation, were significantly more likely to report PMS (p ≤ 0.001). PMS was also strongly associated with anxiety and panic attacks (p < 0.001). Risk behaviours, including smoking (p = 0.006), illicit substance use (p < 0.01), and increased alcohol consumption in the past 30 days (p < 0.001), were more prevalent among adolescents with PMS. Furthermore, respondents with PMS reported poorer school performance (p = 0.002), higher stress levels (p < 0.001), and a more negative perception of their overall health (p < 0.001) compared to peers without PMS. Conclusions: PMS is significantly associated with mental health issues, engagement in risky behaviours, higher stress, and diminished self-perceived health and academic performance. These findings highlight the need for further research and the development of targeted interventions to improve adolescent menstrual health.