bluuebunny/crossref_metadata_2025 huggingface dataset:
Intelligent Vision System with Pruning and Web Interface for Real-Time Defect Detection on African Plum Surfaces
Authors: Fadja Arnaud Nguembang , Che Sain Rigobert , Atemkemg Marcellin
Published: October 2024

Agriculture stands as the cornerstone of Africa’s economy, supporting over 60% of the continent’s labor force. Despite its significance, the quality assessment of agricultural products remains a challenging task, particularly at a large scale, consuming valuable time and resources. The African plum is an agricultural fruit that is widely consumed across West and Central Africa but remains underrepresented in AI research. In this paper, we collected a dataset of 2892 African plum samples from fields in Cameroon representing the first dataset of its kind for training AI models. The dataset contains images of plums annotated with quality grades. We then trained and evaluated various state-of-the-art object detection and image classification models, including YOLOv5, YOLOv8, YOLOv9, Fast R-CNN, Mask R-CNN, VGG-16, DenseNet-121, MobileNet, and ResNet, on this African plum dataset. Our experimentation resulted in mean average precision scores ranging from 88.2% to 89.9% and accuracies between 86% and 91% for the object detection models and the classification models, respectively. We then performed model pruning to reduce model sizes while preserving performance, achieving up to 93.6% mean average precision and 99.09% accuracy after pruning YOLOv5, YOLOv8 and ResNet by 10–30%. We deployed the high-performing YOLOv8 system in a web application, offering an accessible AI-based quality assessment tool tailored for African plums. To the best of our knowledge, this represents the first such solution for assessing this underrepresented fruit, empowering farmers with efficient tools. Our approach integrates agriculture and AI to fill a key gap.
Electronic Health (eHealth) Literacy and Self-Care Behaviors—Results from a Survey of University Students in a Developing Country
Authors: Bin Naeem Salman , Faiola Anthony , Ur-Rehman Aziz , Kamel Boulos Maged N.
Published: October 2024

eHealth literacy (eHL) is directly linked to disease prevention, health promotion, and improved healthcare outcomes. The objectives of this study are to assess undergraduate university students’ knowledge and perceived skills of finding, appraising, and applying electronic health information to health-related problems, as well as to assess the association of eHL with physical, psychological, and emotional self-care. Methods: The measurement model, comprising four correlated factors based on the 28 valid items from two reliable and valid tests, the ‘eHealth literacy scale (eHEALS)’ and ‘the self-care assessment tool (SCAT)’, was estimated using confirmatory factor analysis (CFA) among a sample of 1557 undergraduate university students in Pakistan. Results: The mean value of the eHEALS ranges between 2.90 and 3.33, indicating that the majority of the respondents had moderate levels of eHL skills. Female respondents and respondents from urban areas have greater levels of perceived eHL skills compared with their male and rural counterparts. The CFA model fit indices show that the goodness of fit values are acceptable: x2 = 7.727, p = 0.000; RMSEA = 0.065; TLI = 0.930, CFI = 0.936, IFI = 0.936, GFI = 0.890, NFI = 0.928, RFI = 0.920, PGFI = 0.754. Conclusion: Electronic health (eHealth) literacy has a strong positive association with physical, psychological, and emotional self-care. However, perceived eHL skills among undergraduate university students are moderate, making them potentially susceptible to health risks. Implications: Our study has several practical implications. Its findings can be used to devise eHealth literacy programs for developing relevant skills among undergraduate university students based on their identified needs.
Neurophysiological Approach for Psychological Safety: Enhancing Mental Health in Human–Robot Collaboration in Smart Manufacturing Setups Using Neuroimaging
Authors: Arif Arshia , Zakeri Zohreh , Omurtag Ahmet , Breedon Philip , Khalid Azfar
Published: October 2024

Human–robot collaboration (HRC) has become increasingly prevalent due to innovative advancements in the automation industry, especially in manufacturing setups. Although HRC increases productivity and efficacy, it exposes human workers to psychological stress while interfacing with collaborative robotic systems as robots may not provide visual or auditory cues. It is crucial to comprehend how HRC impacts mental stress in order to enhance occupational safety and well-being. Though academics and industrial interest in HRC is expanding, safety and mental stress problems are still not adequately studied. In particular, human coworkers’ cognitive strain during HRC has not been explored well, although being fundamental to sustaining a secure and constructive workplace environment. This study, therefore, aims to monitor the mental stress of factory workers during HRC using behavioural, physiological and subjective measures. Physiological measures, being objective and more authentic, have the potential to replace conventional measures i.e., behavioural and subjective measures, if they demonstrate a good correlation with traditional measures. Two neuroimaging modalities including electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS) have been used as physiological measures to track neuronal and hemodynamic activity of the brain, respectively. Here, the correlation between physiological data and behavioural and subjective measurements has been ascertained through the implementation of seven different machine learning algorithms. The results imply that the EEG and fNIRS features combined produced the best results for most of the targets. For subjective measures being the target, linear regression has outperformed all other models, whereas tree and ensemble performed the best for predicting the behavioural measures. The outcomes indicate that physiological measures have the potential to be more informative and often substitute other skewed metrics.
Preliminary Studies to Bridge the Gap: Leveraging Informal Software Architecture Artifacts for Structured Model Creation
Authors: Kaplan Joshua , Rabelo Luis
Published: October 2024

This study addresses the prevalent gap between structured models and informal architectural methodologies in software engineering. Recognizing the potential of informal architecture artifacts in analytical processes, we introduce a methodology that efficiently transforms these informal components into structured models. This method facilitates understanding and utilizing informal diagrams and enhances analytical capabilities through graph analysis techniques. By leveraging user-friendly tools such as Draw.io, the methodology democratizes the modeling process, making sophisticated architectural analyses accessible to a broader spectrum of professionals without requiring deep expertise in formal methods. The innovative aspects of this methodology lie in its ability to streamline the transformation process, significantly improving both the efficiency and effectiveness of model creation and analysis. These enhancements are demonstrated through a practical application involving a sample architecture diagram, where the resulting model is thoroughly analyzed using advanced graph analysis tools. This approach bridges the theoretical and practical divides in software architecture.
Fuzzy Logic Concepts, Developments and Implementation
Authors: Saatchi Reza
Published: October 2024

Over the past few decades, the field of fuzzy logic has evolved significantly, leading to the development of diverse techniques and applications. Fuzzy logic has been successfully combined with other artificial intelligence techniques such as artificial neural networks, deep learning, robotics, and genetic algorithms, creating powerful tools for complex problem-solving applications. This article provides an informative description of some of the main concepts in the field of fuzzy logic. These include the types and roles of membership functions, fuzzy inference system (FIS), adaptive neuro-fuzzy inference system and fuzzy c-means clustering. The processes of fuzzification, defuzzification, implication, and determining fuzzy rules’ firing strengths are described. The article outlines some recent developments in the field of fuzzy logic, including its applications for decision support, industrial processes and control, data and telecommunication, and image and signal processing. Approaches to implementing fuzzy logic models are explained and, as an illustration, Matlab (version R2024b) is used to demonstrate implementation of a FIS. The prospects for future fuzzy logic developments are explored and example applications of hybrid fuzzy logic systems are provided. There remain extensive opportunities in further developing fuzzy logic-based techniques, including their further integration with various machine learning algorithms, and their adaptation into consumer products and industrial processes.
An Intelligent Approach to Automated Operating Systems Log Analysis for Enhanced Security
Authors: Johnphill Obinna , Sadiq Ali Safaa , Kaiwartya Omprakash , Aljaidi Mohammad
Published: October 2024

Self-healing systems have become essential in modern computing for ensuring continuous and secure operations while minimising downtime and maintenance costs. These systems autonomously detect, diagnose, and correct anomalies, with effective self-healing relying on accurate interpretation of system logs generated by operating systems (OSs). Manual analysis of these logs in complex environments is often cumbersome, time-consuming, and error-prone, highlighting the need for automated, reliable log analysis methods. Our research introduces an intelligent methodology for creating self-healing systems for multiple OSs, focusing on log classification using CountVectorizer and the Multinomial Naive Bayes algorithm. This approach involves preprocessing OS logs to ensure quality, converting them into a numerical format with CountVectorizer, and then classifying them using the Naive Bayes algorithm. The system classifies multiple OS logs into distinct categories, identifying errors and warnings. We tested our model on logs from four major OSs; Mac, Android, Linux, and Windows; sourced from Zenodo to simulate real-world scenarios. The model’s accuracy, precision, and reliability were evaluated, demonstrating its potential for deployment in practical self-healing systems.
Spatial Aggregations of the Grey Field Slug Deroceras reticulatum Are Unstable Under Abnormally High Soil Moisture Conditions
Authors: Price Claire S. V. , Harris W. Edwin , Forbes Emily , Walters Keith F. A.
Published: October 2024

Deroceras reticulatum in arable fields display spatio-temporally stable slug patches that have been well documented under typical soil moisture conditions. The effect of abnormally high soil moisture on slug patch stability, however, is unknown. In this study, stepped gradient choice tests comparing soil moisture levels of 50–125% soil capacity showed slug preferences for levels in a range near to 125%. Activity became erratic, however, when given a choice of high moisture levels (125–370%), potentially because slugs searched for preferred conditions. Slug spatial aggregation was investigated in 21 commercial fields in 2023/24, a season of extreme rainfall, and then compared to years exhibiting typical rainfall (2015–2018). Slug patches occurred in 27.2% of assessment visits to fields during 2023/24 compared to 96.4% in typical years, suggesting weather conditions leading to abnormally high soil moisture are significantly associated with the breakdown of slug spatial aggregation behaviour. Random forest models identified the weather predictors (precipitation, relative humidity, temperature) with the highest impact on slug distribution and relative abundance, with the assessment date and region also related to relative abundance. However, a complex of environmental parameters affects soil moisture content, and no statistically significant effects of individual weather predictors emerged. The results are discussed in relation to slug behaviour in the context of their impact on targeted slug treatments.
Hand Warmer-Induced Hypoxia Accelerates Pest Control in Hermetic Storage
Authors: Li Wenbo , Yaninek John Stephen , Baributsa Dieudonne
Published: October 2024

Accelerating oxygen depletion during hermetic storage can minimize pest damage and preserve product quality. This study evaluated the effectiveness of hand warmers in accelerating hypoxia to control insect pests inside hermetic containers. We used one, two, or four hand warmers to deplete oxygen in a 4-gallon hermetic jar with 4 kg of cowpea and cowpea bruchids, alongside a non-hermetic control with cowpea bruchids and no hand warmers. Oxygen levels, insect mortality, egg counts, seed moisture content, and germination rates were monitored over 2, 5, or 8 days of storage. Only the four hand warmers treatment reduced oxygen levels below 1% within 12 h and maintained them for up to 168 h. The other treatments did not achieve this level. Insect mortality was higher with more hand warmers and extended storage duration, reaching 100% after 5 and 8 days with four and two hand warmers, respectively. Similarly, increased hand warmers and extended storage durations reduced egg counts and adult emergence. The treatments did not affect the moisture content or germination rates of the stored cowpea seeds. Hand warmers proved effective in accelerating hypoxia during hermetic storage, resulting in high insect mortality and reduced reproduction, without compromising grain quality.
Body Weight’s Role in Infective Endocarditis Surgery
Authors: Elderia Ahmed , Woll Gerold , Wallau Anna-Maria , Bennour Walid , Gerfer Stephen , Djordjevic Ilija , Wahlers Thorsten , Weber Carolyn
Published: October 2024

Objective: to investigate how body mass index (BMI) affects the outcome in patients treated surgically for infective endocarditis (IE). Methods: This is a single-center observational analysis of consecutive patients treated surgically for IE. We divided the cohort into six groups, according to the WHO classification of BMI, and performed subsequent outcome analysis. Results: The patient population consisted of 17 (2.6%) underweight, 249 (38.3%) normal weight, 252 (38.8%) overweight, 83 (12.8%) class I obese, 28 (4.3%) class II obese, and 21 (3.8%) class III, or morbidly obese, patients. The median age of the entire cohort was 64.5 [52.5–73.6] years. While only 168 (25.9%) patients were female, women significantly more often exhibited extremes in regards to BMI, including underweight (47.1%) and morbid obesity (52.4%), p = 0.026. Class II and III obese patients displayed more postoperative acute kidney injury (47.9%), p = 0.003, more sternal wound infection (12.9%), p < 0.001, worse 30-day survival (20.4%), p = 0.031, and worse long-term survival, p = 0.026, compared to the results for the other groups. However, the multivariable analysis did not identify obesity as an independent risk factor for 30-day mortality, with an odds ratio of 1.257 [0.613–2.579], p = 0.533. Rather, age > 60, reduced LVEF < 30%, staphylococcal infection, and prosthetic valve endocarditis correlated with mortality. While BMI showed poor discrimination in predicting 30-day mortality on the ROC curve (AUC = 0.609), it showed a fair degree of discrimination in predicting sternal wound infection (AUC = 0.723). Conclusions: Obesity was associated with increased comorbidities, complications, and higher postoperative mortality in IE patients, but it is not an independent mortality risk factor. While BMI is a poor predictor of death, it is a good predictor of sternal wound infections.
Multivariate Analysis of the Determinants of Total Mortality in the European Union with Focus on Fat Intake, Diabetes, Myocardial Infarction, Life Expectancy, and Preventable Mortality: A Panel Data Fixed-Effects Panel Data Model Approach
Authors: Stanciu Silviu Marcel , Rusu Emilia , Jinga Mariana , Ursu Cosmin Gabriel , Stanciu Rares Ioan , Miricescu Daniela , Antohi Valentin Marian , Barbu Elena
Published: October 2024

Cardiovascular disease is the leading cause of death in the European Union (EU), and while the mortality rates of diabetes, myocardial infarction, and the total fat intake have been extensively studied, we believe that understanding the interaction between such closely correlated determinants is crucial to the development of effective health policies in the EU. Our paper’s novelty is represented by the econometric modelling, and its ability to capture both temporal and unit variations. The research methodology consists of using a panel data model with fixed effects for the 27 EU member states over the period 2010–2021. The results of the study show that the standardized mortality rate for deaths preventable by prevention and treatment and diabetes-related mortality are significant predictors of total mortality in the EU. The standardized mortality rate for deaths preventable by prevention and treatment had a significant positive impact, suggesting that improved preventive and therapeutic interventions can significantly reduce total mortality. Diabetes-associated mortality also showed a strong positive correlation with total mortality, emphasizing the need for effective diabetes management and prevention strategies. These results are useful for the formulation of public health strategies aimed at improving life expectancy and reducing the burden of chronic diseases.
Indirect-Oscillation Sign Suggesting Infective Endocarditis on the Routine Chest CT
Authors: Son Min Ji , Yoo Seung Min , Lee Hwa Yeon , White Charles S.
Published: October 2024

Routine chest CT is not essential for the diagnostic workup for infective endocarditis (IE), but this type of study may be the initial imaging modality in the evaluation of patients ultimately proven to have IE who present to the emergency department with nonspecific clinical symptoms. Although routine chest CT cannot directly assess valvular oscillating motion due to the lack of cine images, we hypothesized that a combination of elongated nodular valve thickening and abnormal orientation to the normal valve with a blind end on routine CT (indirect-oscillation sign) might suggest movable vegetation indirectly. To evaluate this possibility, we studied 27 patients with IE and 35 controls who underwent both routine chest CT and echocardiography. CT scanning was initiated following a delay of 60–80 s after the administration of the contrast medium. Two cardiothoracic radiologists retrospectively analyzed the CT images to assess the indirect-oscillation sign with consensus. The sensitivity, specificity, positive predictive value, and negative predictive value of the indirect-oscillation sign on routine chest CT were 29.6% (8/27), 100% (35/35), 100% (8/8), and 64.8% (35/54), respectively. Although uncommon, the presence of the indirect-oscillation sign involving the aortic or mitral valve on routine chest CT is a suggestive finding for IE.
Criteria for PAVM Reintervention
Authors: Fish Adam , Knight Elizabeth , Henderson Katharine , Pollak Jeffrey , Schlachter Todd
Published: October 2024

Background/Objectives: To propose criteria for retreating previously embolized PAVMs and determining the effectiveness of the criteria to prevent paradoxical embolization. Methods: A retrospective review of patients with PAVMs treated at a single HHT center of excellence between 1 January 2013, and 10 September 2023, was performed. Patients with PAVM recurrence were either retreated or observed based on the following criteria for PAVM reintervention: 1. Embolic device(s) not creating a sufficiently dense matrix, such that a channel through them may be >/ 2 mm; 2. Accessory feeding artery or pulmonary collateral >/ 2 mm; 3. Hemoptysis in a patient with no other explanation. Results: A total of 438 PAVMs were treated in 151 patients, including 106 patients with definite, 14 possible, and 31 doubtful HHT. Post-embolization PAVM recurrence occurred in 36 patients (36/151, 23.8%), including 15 patients (15/151, 9.9%) with 22 PAVMs (22/438, 5.0%) meeting criteria for reintervention. A total of 21 patients (21/151, 13.9%) with recurrence did not meet reintervention criteria and were therefore observed. Pre-treatment paradoxical embolization occurred in 36 patients (36/151) for a lifetime prevalence rate of 23.7%. Post-treatment paradoxical embolization did not occur in any patients following PAVM embolization (0/151). There was one case of iatrogenic paradoxical embolization in a patient being treated for systemic collateral reperfusion and hemoptysis. However, this was not included given that it was not a spontaneous event. Conclusions: Utilizing modern embolization techniques and devices, the proposed reintervention criteria, and screening intervals, paradoxical embolizations can be effectively prevented in patients with PAVMs.
Prognostic Relevance of Gradient and Flow Status in Severe Aortic Stenosis
Authors: Pozo Osinalde Eduardo , Bravo Domínguez Juan Ramón , De Lara Fuentes Lina , Marcos-Alberca Pedro , Gómez de Diego José Juan , Olmos Blanco Carmen , Mahia Casado Patricia , Luaces Mendez María , Collado Yurrita Luis , Carnero-Alcázar Manuel , Jiménez-Quevedo Pilar , Nombela-Franco Luis , Pérez-Villacastín Julián
Published: October 2024

Background: Severe aortic stenosis (AS) may present with different flow, gradient and left ventricular ejection fraction (LVEF) patterns. Paradoxical low-flow low-gradient (PLF-LG) severe AS has a specific clinical profile, but its prognosis and management remain controversial. Our aim is to evaluate the impact of different AS patterns in the incidence of major clinical events. Methods: A retrospective observational study was carried out on all the consecutive patients diagnosed with severe AS at our tertiary hospital centre in 2021. Echocardiographic measurements were carefully reviewed, and patients were classified following current guidelines into four categories: high gradient (HG), concordant low-flow low-gradient (CLF-LG), paradoxical low-flow low-gradient (PLF-LG) and normal-flow low-gradient (NF-LG). The baseline characteristics and clinical events (heart failure admission, intervention and death) at 1-year follow-up were collected from medical records. The association between categories and events was established using Student’s t test or ANOVA as required. Results: 205 patients with severe AS were included in the study (81 ± 10 years old, 52.7% female). Category distribution was as follows: HG (138, 67.3%), PLF-LG (34, 19.8%), CLF-LG (21, 10.2%) and NF-LG (12, 5.9%). During the follow-up, 24.8% were admitted due to heart failure, 68.3% received valve replacement (51.7% TAVR) and 22% died. Severe tricuspid regurgitation was more frequent in patients with PLF-LG than in HG AS (14.7% vs. 2.2%; p < 0.01). Despite no differences in intervention rate, more patients with PLF-LG (32.4% vs. 15.9%; p = 0.049) died during the evolution. Conclusions: The PLF-LG pattern was the second most common pattern of severe AS in our cohort, and it was related to a higher mortality with no differences in intervention rate. Thus, this controversial category, rather than being underestimated, should be followed closely and considered for early intervention.
Prehabilitation in Frail Octogenarian and Nonagenarian Patients in Colorectal Cancer Surgery: Short- and Medium-Term Outcomes
Authors: Ramírez-Martín Raquel , Mauleón Ladrero Coro , Gazo Martínez Jose Antonio , Déniz-González Victoria , Martín Maestre Isabel , Corral-Sastre Lucía , Villajos-Guijarro María , Menéndez-Colino Rocío , Pascual Miguelañez Isabel , González-Montalvo Juan Ignacio
Published: October 2024

Background: There is still limited evidence on the results of prehabilitation in very old frail patients. The aim of this study is to analyze the outcomes and course of octogenarian and nonagenarian patients undergoing prehabilitation before surgery for colorectal cancer (CRC). Methods: a prospective study was conducted in a tertiary hospital from 2018 to 2022. All patients diagnosed with CRC over 80 years old and proposed for surgery were included. A comprehensive geriatric assessment (CGA) for frailty detection was performed, and the therapeutic decision was taken by the multidisciplinary tumor committee. Prehabilitation led by the geriatric team was performed. The rate of medical and surgical complications, hospital stay, in-hospital mortality, and first-year mortality were recorded. Results: CRC surgery was proposed in 184 patients >80 years. After a multidisciplinary decision, surgery was performed on 126 (68.5%) patients, of whom 12 (0.5%) were nonagenarians. Fifty percent of octogenarians and 86% of nonagenarians were frail. Prehabilitation consisted of the following: adapted physical exercise (100%); oral nutritional supplementation (73.8%); anemia treatment (59.5%); delirium prevention (5.6%); antidepressant treatment (15.9%); vitamin D supplementation (21.4%); and pharmacological deprescription (38.1%). The post-surgical complication rate was low (4.3% surgical and 29.4% medical complications), and in-hospital mortality was very low (3.2%). Nonagenarian patients had a higher rate of complications compared to octogenarians (OR 4.0 (95% CI 1.13–14.12))—mainly heart failure (OR 4.68 (95% CI 1.21–18.09))—but there were no differences in hospital stay or first-year mortality. Conclusions: prehabilitation in very old patients with CRC surgery is possible and provides good results.
Updates in Structural Cardiovascular Interventions: Key Insights from Recent Studies
Authors: Tagliari Ana Paula , Taramasso Maurizio
Published: October 2024

The year 2024 brought remarkable advancements and high-quality evidence to the field of cardiovascular interventions [...]
Validating the Definition of Lumbar Instability—A Cross-Sectional Study with 420 Healthy Volunteers
Authors: Suzuki Manabu , Tanaka Yasuhisa , Hashimoto Ko , Tsubakino Takumi , Hoshikawa Takeshi , Takahashi Kohei , Latt Myo Min , Aizawa Toshimi
Published: October 2024

Background/Objectives: Low back pain is thought to be caused by lumbar instability. To date, multiple definitions of radiological lumbar instability have been used without verifying the “normal range” of the lumbar segmental mobility. Ideally, normative data for lumbar mobility in healthy individuals are required to establish an acceptable threshold for lumbar instability. This study aims to elucidate (i) the prevalence of so-called radiological lumbar instability at each lumbar spine level in conventional criteria and (ii) a practical radiological threshold for lumbar instability in healthy individuals. Methods: Participants completed a questionnaire and underwent standard active dynamic radiography of the lumbar spine in the standing position. Intervertebral range of motion (IROM) and sagittal translation distance (ΔST) were measured at each intervertebral level. Nachemson’s criteria of radiological lumbar instability were applied. Results: This study involved four hundred and twenty participants (249 males and 171 females); 76% (320/420) met the criteria for radiological lumbar instability. The definition of lumbar instability based on IROM and ΔST was achieved by 0.2% and 1.7% of participants at the L5–sacrum (L5–S) level, respectively. Conclusions: The normative data of lumbar mobility were obtained from a large number of participants who had less LBP-related ADL disability. The widely accepted criteria for lumbar instability were not applicable except for the L5–S level. Further studies of lumbar mobility, including patients with severe LBP, might prove the relationship between hypermobility of the lumbar spine and LBP.
Pre-Operative Gastroesophageal Reflux Does Not Affect 30-Day Outcomes in Patients Undergoing Revisional Bariatric Surgery to Single Anastomosis Duodeno-Ileal Bypass (SADI): An Analysis of 933 Metabolic and Bariatric Accreditation and Quality Improvement Program Patients
Authors: Meyer Daniel , Mocanu Valentin , Switzer Noah J. , Birch Daniel W. , Karmali Shahzeer
Published: October 2024

Background: The use of a single anastomosis duodeno-ileal bypass (SADI) as a revisional procedure in patients with pre-operative GERD is not well understood. Thirty-day outcomes in patients with pre-existing GERD undergoing revision with an SADI have not been previously reported. Methods: The Metabolic and Bariatric Accreditation and Quality Improvement Program registry was consulted to identify patients undergoing revisional bariatric surgery with an SADI between 2020 and 2021. Our analysis sought to determine if preoperative GERD had significant impact on thirty-day outcomes. Bivariate and multivariable logistic regression analyses were used to identify independent predictors of 30-day morbidity. Results: Preoperative GERD was seen in 342 patients (36.7%). Preoperative GERD was not associated with anastomotic leak (2.5% non-GERD cohort vs. 1.2% GERD cohort; p = 0.2) nor bleeding (1% non-GERD cohort vs. 1.8% GERD cohort; p = 0.33). There was no difference in thirty-day readmission (5.6% vs. 5.9%, p = 0.9), reintervention (2.4% vs. 1.2%, p = 0.2), or reoperation (3.6% vs. 2.05%; p = 0.19) rates. The multivariable regression analysis revealed that a history of myocardial infarction was associated with a significantly elevated risk of serious complication (OR 12.2; 95% CI 2.79–53.23; p = 0.001), as was dyslipidemia (OR 2.2; 95% CI 1.04–4.56; p = 0.04). Conclusions: Pre-operative GERD does not have any association with anastomotic leak, bleeding, thirty-day readmission, reintervention, or reoperation in patients undergoing revisional bariatric surgery to SADI. A history of myocardial infarction and dyslipidemia are independent predictors of post-operative thirty-day morbidity, irrespective of the presence of preoperative GERD.
Aggressive Types of Malignant Thyroid Neoplasms
Authors: Boudina Maria , Zisimopoulou Eleana , Xirou Persefoni , Chrisoulidou Alexandra
Published: October 2024

Differentiated thyroid cancer (DTC) includes many subtypes, which demonstrate favorable to aggressive behavior. During the past decades, efforts have been made to describe aggressive thyroid cancers. Within DTC, aggressive variants constitute rare entities with unique histopathological features and compromised survival, as local and distant metastatic disease is frequent. In recent years, the distinct category of poorly differentiated thyroid cancer was introduced in 2004 and the type of differentiated high-grade thyroid carcinoma was recently added in the 2022 WHO classification of thyroid neoplasms. Finally, anaplastic thyroid cancer exhibits a rapid, resistant to therapy, progression and confers the shortest survival. In this review, we will present the characteristics of these thyroid cancer types and also discuss the treatment, management, and follow-up of these difficult cases. Emphasis was given to recent bibliography of the last decade.
Who Lives Longer, the Valve or the Patient? The Dilemma of TAVI Durability and How to Optimize Patient Outcomes
Authors: Cesario Vincenzo , Oliva Omar , De Biase Chiara , Beneduce Alessandro , Boiago Mauro , Dumonteil Nicolas , Tchetche Didier
Published: October 2024

Over the past few years, transcatheter aortic valve implantation (TAVI) imposed itself as the first-choice therapy for symptomatic aortic stenosis (AS) in elderly patients at surgical risk. There have been continuous technological advancements in the latest iterations of TAVI devices and implantation techniques, which have bolstered their adoption. Moreover, the favorable outcomes coming out from clinical trials represent an indisputable point of strength for TAVI. As indications for transcatheter therapies now include a low surgical risk and younger individuals, new challenges are emerging. In this context, the matter of prosthesis durability is noteworthy. Initial evidence is beginning to emerge from the studies in the field, but they are still limited and compromised by multiple biases. Additionally, the physiopathological mechanisms behind the valve’s deterioration are nowadays somewhat clearer and classified. So, who outlasts who—the valve or the patient? This review aims to explore the available evidence surrounding this intriguing question, examining the various factors affecting prosthesis durability and discussing its potential implications for clinical management and current interventional practice.
Reanimation Techniques of Peripheral Facial Paralysis: A Comprehensive Review Focusing on Surgical and Bioengineering Approaches
Authors: Saraniti Carmelo , Verro Barbara
Published: October 2024

Peripheral facial paralysis represents a disabling condition with serious psychological and social impact. Patients with peripheral facial paralysis have a disfigurement of the face with loss of harmony and symmetry and difficulties in everyday facial functions such as speaking, drinking, laughing, and closing their eyes, with impairment of their quality of life. This paralysis leads to impairment of facial expression, which represents one of the first means of communication, an important aspect of human interaction. This review aims to explore the reanimation techniques for managing peripheral facial paralysis. An analysis of static and dynamic techniques for facial reanimation is provided, including muscle flaps, nerve grafting techniques, and bioengineering solutions. Each technique showed its benefits and drawbacks; despite several options for facial reanimation, no technique has been detected as the gold standard. Therefore, each patient must be evaluated on an individual basis, considering their medical history, age, expectations, and treatment goals, to find the best and most fitting treatment.
Fracture Mapping in High-Energy Chest Trauma
Authors: Li Shuhuan , Sun Duo , Wang Chu , Hu Pan , Jin Feifei , Huang Wei
Published: October 2024

Background: High-energy chest trauma often results in rib fractures and associated chest injuries. This study explored fracture distribution patterns in high-energy chest trauma, using three-dimensional (3D) fracture mapping technology. Methods: This retrospective study analyzed cases of high-energy chest trauma with rib fractures treated at a Level 1 Trauma Center, from February 2012 to January 2023. Specifically, 3D computed tomography (CT) was used to reconstruct rib fractures and create fracture-frequency heat maps, analyzing the influence of other thoracic fractures on rib fracture distribution. Results: Rib fractures were frequently found in the anterior and posterior thoracic areas. On average, patients sustained 7 ± 3.87 rib fractures, with clavicle fractures in 25.5% and scapular fractures in 19.6% of cases. Scapular fractures led to more posterior rib fractures, while sternal fractures were associated with more anterior rib fractures. Clavicle fractures were linked to fractures of the first to third ribs. Conclusions: Rib fractures in high-energy chest trauma occurred most often in the anterior and posterior regions. Fractures of the scapula and sternum influence the positioning of the fracture lines. Clavicular fractures are associated with a higher incidence of upper rib fractures. These findings can help inform surgical decisions and complication management.
Heart Rate Variability and Interoception in Periodic Limb Movements in Sleep: Interference with Psychiatric Disorders?
Authors: Małkiewicz Marta A. , Malinowski Krzysztof S. , Grzywińska Małgorzata , Partinen Eemil , Partinen Markku , Pyrzowski Jan , Wszędybył-Winklewska Magdalena
Published: October 2024

Periodic limb movements in sleep (PLMS) are a prevalent disorder characterized by rhythmic, involuntary movements of the lower limbs, such as dorsiflexion of the ankle and extension of the big toe, occurring in periodic intervals during sleep. These movements are often linked to disrupted autonomic nervous system (ANS) activity and altered interoception. Interoception involves perceiving internal bodily states, like heartbeat, breathing, hunger, and temperature, and plays a crucial role in maintaining homeostasis and the mind–body connection. This review explores the complex relationships between PLMS, heart rate variability (HRV), ANS dysregulation, and their impact on psychiatric disorders. By synthesizing the existing literature, it provides insights into how ANS dysregulation and altered interoceptive processes, alongside PLMS, contribute to psychiatric conditions. The review highlights the potential for integrated diagnostic and therapeutic approaches and presents a cause-and-effect model illustrating the mutual influence of psychiatric disorders, ANS dysregulation, PLMS, and interoception.
A Gender Perspective on Coloproctological Diseases: A Narrative Review on Female Disorders
Authors: De Nardi Paola , Giacomel Greta , Orlandi Simone , Poli Giulia , Pozzo Mauro , Rinaldi Marcella , Veglia Antonella , Pietroletti Renato
Published: October 2024

Coloproctological diseases, including both benign and malignant conditions, are among the most common diagnoses in clinical practice. Several disorders affect both men and women, while others are unique to women, or women are at a greater risk of developing them. This is due to anatomical, biological, and social conditions and also due to females’ exclusive capabilities of reproduction and pregnancy. In this context, the same proctological disease could differ between men and women, who can experience different perceptions of health and sickness. There is a raised awareness about the impact of different diseases in women and a growing need for a personalized approach to women’s health. In this review, we aim to summarize the specific features of the main coloproctological diseases, specifically in the female population. This includes common complaints during pregnancy, conditions linked to vaginal delivery, functional consequences after colorectal resections, and conditions presenting a gender disposition.
Music-Based Therapy for the Treatment of Perioperative Anxiety and Pain—A Randomized, Prospective Clinical Trial
Authors: Goel Shiv K. , Kim Valdemir , Kearns Jeremy , Sabo Daniel , Zoeller Lynsie , Conboy Coleen , Kelm Nicole , Jackovich Ann E. , Chelly Jacques E.
Published: October 2024

Background: Music-based intervention has been advocated as a nonpharmacologic approach for the perioperative control of pain and anxiety in surgical patients. However, its impact on patients with preoperative anxiety has not been clearly established. Our study aimed to examine the impact of music-based intervention administered before, during, and after surgery on postoperative opioid consumption and pain levels, as well as preoperative anxiety, depression, and pain catastrophizing. We hypothesized that, compared to a control group, music-based intervention would be effective in reducing opioid requirements and mood disorders. Methods: This study was a single-center, prospective, single-blinded, randomized controlled trial. Inclusion criteria isame-day or observation surgery. Exclusion criteria included American Society of Anesthesiologists physical status IV, use of spinal anesthesia, PROMIS Anxiety T-scores ≤ 57.4 and ≥74.1, preoperative chronic opioid use, transgender surgery, and history of drug or alcohol abuse. Music-based intervention was developed by a certified music therapist. Each patient was randomized to receive standard of care (SC) or SC plus music-based intervention before, during, and after surgery. The primary end point was postoperative oral morphine equivalents (OMEs) over 5 days following surgery using the area under the curve (AUC)Secondary end points were PROMIS Anxiety, PROMIS Depression scores Pain Catastrophizing Scale scores, postoperative nausea and vomiting, time of hospital discharge, and patient satisfaction (0 = totally unsatisfied to 10 = completely satisfied). Results: A total of 75 patients were randomized to a music-based intervention (n = 33) or control (n = 42) group. Patients in the music-based intervention group consumed 56.7% less opioids than those in the control group (AUC was 2.8 in the music-based intervention group vs. 6.4 in the control group, absolute standardized mean difference (aSMD) = 0.34 (−0.17, 0.85)). No difference in pain scores was recorded between groups. Music-based intervention also reduced anxiety on postoperative day (POD)2 (aSMD = 0.38 (−0.16, 0.91)), depression on POD2 (aSMD = 0.31 (−0.23, 0.84)) and POD4 (aSMD = 0.24 (−0.29, 0.77)), and pain catastrophizing on POD1 (aSMD = 0.24 (−0.3, 0.77)). Conclusions: Our data support the use of music-based intervention to reduce postoperative opioid requirements. Music-based intervention may also reduce anxiety, depression, and pain catastrophizing.
Anterior Cruciate Ligament Tear: Individualized Indications for Non-Operative Management
Authors: Komnos George A. , Hantes Michael H. , Kalifis Georgios , Gkekas Nifon K. , Hante Artemis , Menetrey Jacques
Published: October 2024

Anterior cruciate ligament (ACL) rupture represents a common sports injury that is mostly managed operatively. However, non-operative treatment can also play a role, despite the limited high-quality published data on ACL tear management. Both methods have shown favorable outcomes, but clear guidelines based on high-quality research are lacking. Several factors should be considered and discussed with the patient before deciding on the best treatment method. These include patient characteristics and expectations, concomitant injuries, and clinical evaluation, with laxity or/and instability being one of the most essential parameters examined. This should eventually lead to an individualized approach for each patient to ensure the best possible outcome. This review aims to delve into all parameters that are related to ACL rupture and guide physicians in choosing the most appropriate treatment method for each patient.
Impact of Frailty on Early Readmissions of Endoscopic Retrograde Cholangiopancreatography in the United States: Where Do We Stand?
Authors: Pinnam Bhanu Siva Mohan , Dahiya Dushyant Singh , Chandan Saurabh , Gangwani Manesh Kumar , Ali Hassam , Singh Sahib , Hayat Umar , Iqbal Amna , Alsakarneh Saqr , Jaber Fouad , Mohamed Islam , Sohail Amir Humza , Sharma Neil
Published: October 2024

Background/Objectives: We assessed the impact of frailty on outcomes of endoscopic retrograde cholangiopancreatography (ERCP) in the United States. Methods: The National Readmission Database (2016–2020) was used to identify index and 30-day ERCP readmissions, which were categorized into low-frailty, intermediate-frailty, and high-frailty groups based on the Hospital Frailty Risk Score (HFRS). Outcomes were then compared. Results: Of 885,416 index admissions, 9.9% were readmitted within 30 days of ERCP. The odds of 30-day readmission were higher in the intermediate-frailty group (12.59% vs. 8.2%, odds ratio [OR] 1.67, 95% confidence interval [CI] 1.64–1.71, p < 0.001) and the high-frailty group (10.57% vs. 8.2%, OR 1.62, 95% CI 1.52–1.73, p < 0.001) compared to the low-frailty group. On readmission, a higher HFRS also increased mean length of stay (intermediate-frailty vs. low-frailty: 8.49 vs. 4.22 days, mean difference (MD) 4.26, 95% CI 4.19–4.34, p < 0.001; high-frailty vs. low-frailty: 10.9 vs. 4.22 days, MD 10.9 days, 95% CI 10.52–11.28, p < 0.001) and mean total hospitalization charges (intermediate-frailty vs. low-frailty: $118,996 vs. $68,034, MD $50,962, 95% CI 48, 854–53,069, p < 0.001; high-frailty vs. low-frailty: $195,584 vs. $68,034, MD $127,550, 95% CI 120,581–134,519, p < 0.001). The odds of inpatient mortality were also higher for the intermediate-frailty and high-frailty compared to the low-frailty subgroup. Conclusions: Frailty was associated with worse clinical outcomes after ERCP.
Contemporary Use of Drug-Coated Balloons for Coronary Angioplasty: A Comprehensive Review
Authors: Verde Nicola , Ciliberti Giuseppe , Pittorino Luca , Ferrone Marco , Franzese Michele , Russo Massimo , Cioppa Angelo , Popusoi Grigore , Salemme Luigi , Tesorio Tullio , Di Gioia Giuseppe
Published: October 2024

The interventional treatment of coronary artery disease (CAD) has undergone significant improvements thanks to technological innovations. Nowadays, percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation is the standard of care for the treatment of CAD. Nevertheless, the non-negligible incidence of in-stent restenosis (ISR) and suboptimal results in various anatomical settings has led to the development of drug-coated balloons (DCBs). DCBs are catheter-based balloons whose surface is coated with an anti-proliferative drug (mainly Paclitaxel or Sirolimus) loaded onto the balloon surface with different technologies and dose concentrations. In the beginning, these devices were used for the treatment of ISR showing an excellent efficacy profile in the inhibition of intimal hyperplasia. Subsequently, several studies evaluated their use in other angiographical and clinical contexts such as de novo lesions, small vessel disease, diffuse coronary disease, bifurcation lesions, acute coronary syndromes, high-bleeding risk and diabetic patients. This comprehensive review aims to describe the main DCB platforms on the market, their fields of application with the main supporting studies and their future perspectives.
Breast Cancer Adjuvant Radiotherapy and Chemotherapy Sequencing: Sequential, Concomitant, or What Else? A Comprehensive Review of the Adjuvant Combinations Journey
Authors: Lazzari Grazia , Montagna Antonietta , D’Andrea Barbara , Bianculli Antonella , Calice Giovanni , Tucciariello Raffaele , Castaldo Giovanni , Metallo Vito , De Marco Giuseppina , Benevento Ilaria
Published: October 2024

Background: To date, in breast cancer (BC) treatment, adjuvant chemotherapy (A-CT) has preceded adjuvant radiotherapy (A-RT). In the last twenty years, the adjuvant treatment of BC has quickly evolved due to better knowledge of its molecular biology, genetic profile, and α/β ratio of 3/4 Gy for tumor and normal tissue radiosensitivity. Thus, new schedules with hypofractionated radiotherapy have been tested, and a third generation of A-CT has been introduced, raising the question of whether it is time to rethink the sequencing between these two approaches. Methods: In the last 20 years, many attempts have been made worldwide to optimize the best sequencing strategy between these two approaches in terms of sequential CT-RT and RT-CT and concomitant and sandwich modalities using drugs and schedules. This paper presents a comprehensive review of the state of the art, analyzing all the available studies to assess the sequencing between A-CT and A-RT with different generations of chemotherapy schedules. Results: More than 8000 patients from 30 studies treated with adjuvant chemotherapy and whole breast radiotherapy who were enrolled in randomized, retrospective, and prospective studies were analyzed. Sequential, concomitant, and sandwich modalities of chemotherapy with conventional or hypofractionated RT schedules from the most important studies were included. The most used sequence was adjuvant chemotherapy followed by conventional or hypofractionated radiotherapy. In the concomitant approach, i.v. CMF has been the most important adopted schedule, while the concomitant use of anthracyclines and taxanes with conventional or hypofractionated radiotherapy has been found to be more toxic. One study analyzed the benefit in terms of reducing adjuvant treatment time with upfront hypofractionated radiotherapy and third-generation chemotherapy. Conclusions: At present, the best sequencing strategy has not yet been defined. This comprehensive review is a journey among the most important randomized, retrospective, and prospective studies that highlights the past, current, and novel time sequencing proposals between A-CT and A-RT to assess the state of the art and provide useful information for future adjuvant approaches in breast cancer treatment.