bluuebunny/crossref_metadata_2025 huggingface dataset:
Phylogenetical Position versus Pollination Syndromes: Floral Trichomes of Central American and Mexican Pinguicula
Authors: Lustofin Krzysztof , Świątek Piotr , Miranda Vitor F. O. , Płachno Bartosz J.
Published: May 2023

Central American and Mexican Pinguicula species are characterized by enormous divergence in size and color of flowers and are pollinated by butterflies, flies, bees, and hummingbirds. It is known that floral trichomes are key characters in plant–pollinator interaction. The main aim of our study was to verify our hypothesis that the distribution and diversity of non-glandular and glandular trichomes are related to the pollinator syndromes rather than the phylogenetic relationships. The studied sample consisted of Central American and Mexican species. In our study, we relied on light microscopy and scanning electron microscopy with a phylogenetic perspective based on ITS DNA sequences. The flower morphology of species pollinated by butterflies and hummingbirds was similar in contrast to species pollinated by flies and bees. Species pollinated by butterflies and hummingbirds contained low diversity of non-glandular trichomes, which occurred mostly in the tube and basal part of the spur. Surprisingly, in P. esseriana and P. mesophytica, non-glandular trichomes also occurred at the base of lower lip petals. In the case of species pollinated by flies/bees, we observed a high variety of non-glandular trichomes, which occurred on the surface of corolla petals, in the tube, and at the entrance to the spur. Furthermore, we did not identify any non-glandular trichomes in the spur. The capitate glandular trichomes were of similar morphology in all examined species. There were minor differences in the shape of the trichome head, as well as the length and the number of stalk cells. The distribution and the diversity of non-glandular and glandular trichomes and pollinator syndromes were mapped onto a phylogenetic reconstruction of the genus. Most micromorphological characters appear to be associated more with floral adaptation to pollinators and less with phylogeny.
Oriented Crossover in Genetic Algorithms for Computer Networks Optimization
Authors: Rabee Furkan , Hussain Zahir M.
Published: May 2023

Optimization using genetic algorithms (GA) is a well-known strategy in several scientific disciplines. The crossover is an essential operator of the genetic algorithm. It has been an active area of research to develop sustainable forms for this operand. In this work, a new crossover operand is proposed. This operand depends on giving an elicited description for the chromosome with a new structure for alleles of the parents. It is suggested that each allele has two attitudes, one attitude differs contrastingly with the other, and both of them complement the allele. Thus, in case where one attitude is good, the other should be bad. This is suitable for many systems which contain admired parameters and unadmired parameters. The proposed crossover would improve the desired attitudes and dampen the undesired attitudes. The proposed crossover can be achieved in two stages: The first stage is a mating method for both attitudes in one parent to improving one attitude at the expense of the other. The second stage comes after the first improvement stage for mating between different parents. Hence, two concurrent steps for improvement would be applied. Simulation experiments for the system show improvement in the fitness function. The proposed crossover could be helpful in different fields, especially to optimize routing algorithms and network protocols, an application that has been tested as a case study in this work.
The Phasor Diagram of a Superconducting Synchronous Electrical Machine
Authors: Ilyasov Roman Ildusovich
Published: May 2023

This paper describes a universal method proposed by the author for the evaluative analytical calculation of the main parameters of synchronous electrical machines, including superconducting ones. Traditional methods for analytical calculation of parameters to build a phasor diagram of electrical machines require a calculation of all dimensions of the active zone, tooth-slot zone and frontal parts of armature windings. All sizes and local states of magnetic circuit saturation are necessary for the calculation of magnetic conductivities. Traditional analytical methods use, among other things, empirical formulas and non-physical coefficients and allow one to calculate only standard machines with classic tooth-slot zones and armature winding types. As a result of drawing a phasor diagram using traditional methods, the angle between the electromotive force and voltage is calculated, which is the machine’s internal parameter and has no major significance for users. The application of modern computer programs for simulation requires a preliminary analytical calculation in order to obtain all dimensions of the three-dimensional model. FEM simulation programs are expensive, require expensive high-performance computers and highly paid skilled personnel. Fast analytical techniques are also required to assess the correctness of the obtained automatic computer simulation results. The proposed analytical method makes it possible to quickly obtain all the main parameters of a newly designed machine (including superconducting ones and those of non-traditional design) without a detailed calculation of the dimensions of the tooth-slot zone and armature end-windings. The characteristic values of load angles are set according to the results of simple calculations, and the desired values, obtained via plotting, represent the inductive resistances of armature winding and inductive voltage drop across it. Results of practical significance, calculated from the voltage diagram, are as follows: the inductor’s magnetomotive force necessary to maintain the nominal load voltage value, regardless of the magnitude (including double overload) and type of the connected load, or the main dimensions of the active zone.
Development and Temporal Validation of an Electronic Medical Record-Based Insomnia Prediction Model Using Data from a Statewide Health Information Exchange
Authors: Holler Emma , Chekani Farid , Ai Jizhou , Meng Weilin , Khandker Rezaul Karim , Ben Miled Zina , Owora Arthur , Dexter Paul , Campbell Noll , Solid Craig , Boustani Malaz
Published: May 2023

This study aimed to develop and temporally validate an electronic medical record (EMR)-based insomnia prediction model. In this nested case-control study, we analyzed EMR data from 2011–2018 obtained from a statewide health information exchange. The study sample included 19,843 insomnia cases and 19,843 controls matched by age, sex, and race. Models using different ML techniques were trained to predict insomnia using demographics, diagnosis, and medication order data from two surveillance periods: −1 to −365 days and −180 to −365 days before the first documentation of insomnia. Separate models were also trained with patient data from three time periods (2011–2013, 2011–2015, and 2011–2017). After selecting the best model, predictive performance was evaluated on holdout patients as well as patients from subsequent years to assess the temporal validity of the models. An extreme gradient boosting (XGBoost) model outperformed all other classifiers. XGboost models trained on 2011–2017 data from −1 to −365 and −180 to −365 days before index had AUCs of 0.80 (SD 0.005) and 0.70 (SD 0.006), respectively, on the holdout set. On patients with data from subsequent years, a drop of at most 4% in AUC is observed for all models, even when there is a five-year difference between the collection period of the training and the temporal validation data. The proposed EMR-based prediction models can be used to identify insomnia up to six months before clinical detection. These models may provide an inexpensive, scalable, and longitudinally viable method to screen for individuals at high risk of insomnia.
Zygomatic Implant Insertion in MRONJ: A Case Report with a Follow-Up of 3 Years
Authors: Goker Funda , Grecchi Emma , Del Fabbro Massimo , Longoni Salvatore , Stefanelli Luigi Vito , Grecchi Francesco
Published: May 2023

The oral rehabilitation of MRONJ patients represents a challenging situation. Conventional dental implant insertion is not indicated because of the risk of creating a new necrotic area. This case study describes the oral rehabilitation of a 78-year-old female patient, who developed an osteonecrotic lesion in the fourth year of bisphosphonate treatment. The patient underwent a series of surgeries, including resection of the necrotic tissue on the right maxillary region and removal of conventional implants. The patient had a large maxillary defect, and no other treatment modalities such as conventional prosthetic appliances and traditional dental implant insertions were applicable. The patient had a very poor quality of life and as a rehabilitation option, two zygomatic implant insertions were planned and performed as an anchorage for maxillary fixed prosthesis. Radiographic and clinical examination after three years of follow-up indicated that healing was achieved, and healthy tissues formed around zygomatic implants. The patient did not suffer from any additional necrotic tissues or other complications in the oral cavity. According to the results of this case report, zygomatic implantation after resective surgery might be considered as a promising alternative for MRONJ patients with large defects when other treatment alternatives fail or are not applicable.
Association between Red Blood Cell Distribution Width and Obstructive Sleep Apnea Syndrome: A Systematic Review and Meta-Analysis
Authors: Di Lorenzo Biagio , Pau Maria Carmina , Zinellu Elisabetta , Mangoni Arduino A. , Paliogiannis Panagiotis , Pirina Pietro , Fois Alessandro G. , Carru Ciriaco , Zinellu Angelo
Published: May 2023

Although polysomnography is the gold standard method to diagnose obstructive sleep apnea syndrome (OSAS), there is an ongoing quest for simpler and relatively inexpensive biomarkers of disease presence and severity. To address this issue, we conducted a systematic review of the potential diagnostic role of the red blood cell distribution width (RDW), a routine hematological parameter of red blood cell volume variability, in OSAS. A total of 1478 articles were initially identified in the databases PubMed, Web of Science, Scopus, Embase, and Google Scholar, from their inception to February 2023, and 20 were selected for final analysis. The RDW was significantly higher in OSAS than in non-OSAS subjects (SMD = 0.44, 95% CI 0.20 to 0.67, p < 0.001; low certainty of evidence). In univariate meta-regression, the mean oxygen saturation (SpO2) was significantly associated with the effect size. No significant between-group differences were observed in subgroup analyses. Notably, in OSAS subjects, the RDW SMD progressively increased with disease severity. In conclusion, these results suggest that the RDW is a promising biomarker of OSAS (PROSPERO registration number: CRD42023398047).
Definition of the Clinical Characteristics of Patients with Moderate and Severe Atopic Dermatitis for Whom Narrow-Band UVB (NB-UVB) and Medium-Dose UVA1 Phototherapies Are Still Valuable Treatment Options at the Age of Biologics
Authors: Rossi Mariateresa , Damiani Caterina , Arisi Mariachiara , Tomasi Cesare , Tonon Francesco , Venturini Marina , Calzavara-Pinton Piergiacomo
Published: May 2023

Narrow-band (NB) UVB and UVA1 have been successfully used for the treatment of atopic dermatitis (AD) since the 1980s, but the clinical indications for their use “at the age of biologics” remain to be assessed. From 2013 to 2017, 145 patients underwent a first treatment cycle with phototherapy. They achieved a median final EASI score of 9.90 with UVA1 and 13.70 with NB-UVB. The rates of patients achieving an IGA score of 0/1 persistent for at least 6 months were 33% with UVA1 and 28% with NB-UVB, and the rates with an EASI90 improvement were 10.9% with UVA1 and 11.0% with NB-UVB. The cut-off baseline EASI values for a good probability to achieve a 0/1 IGA were 24.4 with UVA1 and 24.7 with NB-UVB. A 0/1 IGA persistent for at least 6 months was more likely to be achieved by patients with a history of flares interspersed with periods of mild or no disease. From 2018, we only enrolled patients with the above-mentioned characteristics. The number of treated patients was lower, but the final EASI score, the rate of patients achieving IGA 0/1 persistent for at least 6 months, and EASI90 were significantly higher. Medium-dose UVA1 and NB-UVB phototherapies remain useful for the treatment of AD patients with a baseline EASI score lower than 24.4 and 24.7, respectively, and a medical history of flares followed by prolonged periods of complete or near-complete remission.
In Vitro Gametogenesis in Oncofertility: A Review of Its Potential Use and Present-Day Challenges in Moving toward Fertility Preservation and Restoration
Authors: Wesevich Victoria , Arkfeld Christopher , Seifer David
Published: May 2023

Current fertility preservation options are limited for cancer survivor patients who wish to have their own biological children. Human in vitro gametogenesis (IVG) has the hypothetical ability to offer a unique solution to individuals receiving treatment for cancer which subsequently shortens their reproductive lifespan. Through a simple skin punch biopsy, a patient’s fertility could be restored via reprogramming of dermal fibroblast cells to induced pluripotent stem cells, then from primordial germ cell-like cells into viable oocytes and spermatocytes which could be used for embryogenesis. Induced pluripotent stem cells could also be used to form in vitro environments, similar to the ovary or testes, necessary for the maturation of oogonia. This would allow for the entire creation of embryos outside the body, ex vivo. While this area in stem cell biology research offers the potential to revolutionize reproduction as we know it, there are many critical barriers, both scientific and ethical, that need to be overcome to one day see this technology utilized clinically.
The Accuracy of Sonographically Estimated Fetal Weight and Prediction of Small for Gestational Age in Twin Pregnancy—Comparison of the First and Second Twins
Authors: Gawie-Rotman Moran , Menashe Shoval , Haggiag Noa , Shrim Alon , Hallak Mordechai , Gabbay-Benziv Rinat
Published: May 2023

Accurate sonographic estimation of fetal weight is essential for every pregnancy, especially in twin gestation. We conducted a retrospective analysis of the sonographically estimated fetal weight (sEFW) of all twin gestations performed within 14 days of delivery in a single center that aimed to evaluate the accuracy of sEFW in predicting neonatal weight and small for gestational age (SGA) by comparing the first fetus to the second. A total of 190 twin gestations were evaluated for the study. There was no statistically significant difference in the sEFW between the first and the second twins, but the second twin had a statistically significant lower birth weight (2434 vs. 2351 g, p = 0.028). No difference was found in median absolute systematic error (p = 0.450), random error, or sEFW evaluations that were within 10% of the birth weight between the fetuses (65.3% vs. 67.9%, p = 0.587). Reliability analysis demonstrated an excellent correlation between the sEFW and the birth weight for both twins; however, the Euclidean distance was slightly higher for the first twin (12.21%). For SGA prediction, overall, there was a low sensitivity and a high specificity for all fetuses, with almost no difference between the first and second twins. We found that sEFW overestimated the birth weight for the second twin, with almost no other difference in accuracy measures or SGA prediction.
Ventilatory Effects of Isoflurane Sedation via the Sedaconda ACD-S versus ACD-L: A Substudy of a Randomized Trial
Authors: Müller-Wirtz Lukas , Becher Tobias , Günther Ulf , Bellgardt Martin , Sackey Peter , Volk Thomas , Meiser Andreas
Published: May 2023

Devices used to deliver inhaled sedation increase dead space ventilation. We therefore compared ventilatory effects among isoflurane sedation via the Sedaconda ACD-S (internal volume: 50 mL), isoflurane sedation via the Sedaconda ACD-L (100 mL), and propofol sedation with standard mechanical ventilation with heat and moisture exchangers (HME). This is a substudy of a randomized trial that compared inhaled isoflurane sedation via the ACD-S or ACD-L to intravenous propofol sedation in 301 intensive care patients. Data from the first 24 h after study inclusion were analyzed using linear mixed models. Primary outcome was minute ventilation. Secondary outcomes were tidal volume, respiratory rate, arterial carbon dioxide pressure, and isoflurane consumption. In total, 151 patients were randomized to propofol and 150 to isoflurane sedation; 64 patients received isoflurane via the ACD-S and 86 patients via the ACD-L. While use of the ACD-L was associated with higher minute ventilation (average difference (95% confidence interval): 1.3 (0.7, 1.8) L/min, p < 0.001), higher tidal volumes (44 (16, 72) mL, p = 0.002), higher respiratory rates (1.2 (0.1, 2.2) breaths/min, p = 0.025), and higher arterial carbon dioxide pressures (3.4 (1.2, 5.6) mmHg, p = 0.002), use of the ACD-S did not significantly affect ventilation compared to standard mechanical ventilation and sedation. Isoflurane consumption was slightly less with the ACD-L compared to the ACD-S (−0.7 (−1.3, 0.1) mL/h, p = 0.022). The Sedaconda ACD-S compared to the ACD-L is associated with reduced minute ventilation and does not significantly affect ventilation compared to a standard mechanical ventilation and sedation setting. The smaller ACD-S is therefore the device of choice to minimize impact on ventilation, especially in patients with a limited ability to compensate (e.g., COPD patients). Volatile anesthetic consumption is slightly higher with the ACD-S compared to the ACD-L.
Single Center, Propensity Score Matching Analysis of Different Reconstruction Techniques following Pancreatoduodenectomy
Authors: Bellotti Ruben , Cardini Benno , Strolz Carola J. , Stättner Stefan , Oberhuber Rupert , Braunwarth Eva , Resch Thomas , Scheidl Stefan , Margreiter Christian , Schneeberger Stefan , Öfner Dietmar , Maglione Manuel
Published: May 2023

Background: Pancreatoduodenectomy is still hampered by significant morbidity. So far, there is no universally accepted technique aimed at minimizing postoperative complications. Herein, we compare three different reconstruction techniques. Methods: This is a retrospective study of a prospectively maintained database including 283 patients operated between January 2010 and December 2020. Three reconstruction techniques were compared: (1) the Neuhaus-style telescope pancreatojejunostomy, (2) the pancreatogastrostomy, and (3) the modified Blumgart-style, duct-to-mucosa pancreatojejunostomy. The primary endpoint consisted in determining the rates of clinically relevant postoperative pancreatic fistulas (CR-POPF); the secondary endpoints included 90 days morbidity and mortality rates. A propensity score matching analysis was used. Results: Rates of CR-POPF did not differ significantly between the groups (Neuhaus-style pancreatojejunostomy 16%, pancreatogastrostomy 17%, modified Blumgart-style pancreatojejunostomy 15%), neither in the unmatched nor in the matched analysis (p = 0.993 and p = 0.901, respectively). Similarly, no significant differences could be observed with regard to major morbidity (unmatched p = 0.596, matched p = 0.188) and mortality rates (unmatched p = 0.371, matched p = 0.209) within the first 90 days following surgery. Propensity-score matching analyses revealed, however, a higher occurrence of post-pancreatectomy hemorrhage after pancreatogastrostomy (p = 0.015). Conclusion: Similar CR-POPF rates suggest no crucial role of the applied reconstruction technique. Increased incidence of intraluminal post-pancreatectomy hemorrhages following pancreatogastrostomy demands awareness for meticulous hemostasis.
Metabolic Outcomes in Pediatric Patients One-Year Post-Total Pancreatectomy with Islet Autotransplantation after Early Pump Initiation
Authors: Tellez Siobhan , Hornung Lindsey , Abu-El-Haija Maisam , Elder Deborah
Published: May 2023

We previously published that insulin pump initiation immediately after IV insulin therapy was associated with improved post-surgical glycemic outcomes compared to multiple daily injections (MDI) in pediatric patients following a total pancreatectomy with islet autotransplantation (TPIAT). We investigated metabolic outcomes of this population at one-year post-TPIAT to assess if the improved outcomes in the early pump group were sustained over time. We retrospectively reviewed 40 patients post-TPIAT previously studied at 10-days post-surgery (15 used MDI and 25 used pump therapy immediately post-ICU, and all were discharged on pump therapy). Data analyzed included: demographics, islet equivalents per kilogram (IEQ/kg) transplanted, exogenous insulin use, and baseline vs. one-year (via mixed meal testing) HbA1c, fasting glucose, insulinogenic index, and the area under the curve (AUC) for insulin and c-peptide. More patients were off insulin at one year in the early pump group compared to the MDI group (45% vs. 13%, p = 0.07). Of all patients off insulin, 100% of the early pump users weaned off by six months post-TPIAT compared to 30% of the MDI users. Two known variables associated with favorable insulin outcomes, lower age and higher IEQ/kg, were not significantly different between groups. Fasting glucose was lower in the early pump group compared to the MDI group (median 97 vs. 122 mg/dL, p = 0.003), while AUC c-peptide was greater in early pump users at one-year post-TPIAT but did not reach significance (median 57.0 vs. 50.3 ng/mL × minutes, p = 0.14). Other metabolic outcomes did not differ between groups. Despite lower median age and higher IEQ/kg in the MDI group, the early pump group had a lower fasting glucose. Younger TPIAT age (p = 0.02) and early pump users (p = 0.04) were significantly associated with insulin independence at one year. This study was limited by sample size. Early pump use may have long-term benefits in post-TPIAT endogenous insulin secretion.
Tinnitus Is Marginally Associated with Body Mass Index, Heart Rate and Arterial Blood Pressure: Results from a Large Clinical Sample
Authors: Langguth Berthold , Bulla Jan , Fischer Beate , Baurecht Hansjoerg , Schecklmann Martin , Marcrum Steven C. , Vielsmeier Veronika
Published: May 2023

Introduction: This study aimed to explore whether body mass index (BMI), systolic blood pressure (RR syst), diastolic blood pressure (RR diast) or heart rate (HR) are associated with tinnitus status and/or severity. Methods: To that end, we evaluated the influence of tinnitus status and Tinnitus Handicap Inventory (THI) score on BMI, RR syst, RR diast and HR by comparing data from a large sample of patients presenting to a specialized tertiary referral clinic (N = 1066) with data from a population-based control group (N = 9885) by means of linear models. Results: Tinnitus patients had a significantly lower BMI and higher RR syst, RR diast and HR than non-tinnitus patients; however, the contribution of the case–control status to R2 was very small (0.1%, 0.7%, 1.4% and 0.4%, respectively). BMI had little predictive power for the THI score (higher BMI scores were related to higher THI scores; R2 = 0.5%) and neither RR syst, RR diast, nor HR showed a statistically significant association with THI. Discussion: Our findings suggest that HR, RR and BMI are at most marginally associated with tinnitus status and severity.
Evolution of Concepts: Can Personalized Hip Arthroplasty Improve Joint Stability?
Authors: Sivaloganathan Sivan , Blakeney William , Rivière Charles , Vendittoli Pascal-André
Published: May 2023

Hip arthroplasty procedures are successful and reproducible. However, within the first two post-operative years, hip dislocations are the most common cause for revisions. This is despite the majority of the dislocations having the acetabular component within what is described as the ‘safe zone’. The limitations of such boundaries do not take into account the variability of individual hip anatomy and functional pelvic orientation that exist. An alternative concept to address hip instability and improve overall outcomes is functional acetabular orientation. In this review article, we discuss the evolution of concepts, particularly the kinematic alignment technique for hip arthroplasty and the use of large-diameter heads to understand why total hip arthroplasty dislocations occur and how to prevent them.
Endoscopic Ultrasound-Guided Local Ablative Therapies for the Treatment of Pancreatic Neuroendocrine Tumors and Cystic Lesions: A Review of the Current Literature
Authors: Prete Alexander M. , Gonda Tamas A.
Published: May 2023

Since its emergence as a diagnostic modality in the 1980s, endoscopic ultrasound (EUS) has provided the clinician profound access to gastrointestinal organs to aid in the direct visualization, sampling, and subsequent identification of pancreatic pathology. In recent years, advancements in EUS as an interventional technique have promoted the use of local ablative therapies as a minimally invasive alternative to the surgical management of pancreatic neuroendocrine tumors (pNETs) and pancreatic cystic neoplasms (PCNs), especially for those deemed to be poor operative candidates. EUS-guided local therapies have demonstrated promising efficacy in addressing a spectrum of pancreatic neoplasms, while also balancing local adverse effects on healthy parenchyma. This article serves as a review of the current literature detailing the mechanisms, outcomes, complications, and limitations of EUS-guided local ablative therapies such as chemical ablation and radiofrequency ablation (RFA) for the treatment of pNETs and PCNs, as well as a discussion of future applications of EUS-guided techniques to address a broader scope of pancreatic pathology.
Injectable Platelet-Rich Fibrin (I-PRF) Administered to Temporomandibular Joint Cavities: A Scoping Review
Authors: Sielski Marcin , Chęcińska Kamila , Chęciński Maciej , Sikora Maciej
Published: May 2023

The aim of this review was to systematically map the research on the intra-articular administration of injectable platelet-rich fibrin (I-PRF) to the temporomandibular joints (TMJs). Medical databases covered by the ACM, BASE, Google, NLM, and ResearchGate were searched on 23 February 2023. The assessment of the level of evidence was based on the Oxford Center for Evidence-Based Medicine 2011 scale. The risk of bias was assessed for randomized controlled trials with the RoB2 tool. Extracted data were tabulated, and the changes in effect values were calculated. A total of eight studies qualified, of which five trials on 213 patients were randomized and controlled (RCTs). In each of the RTC study groups, arthrocentesis was performed, and 1–2 mL per joint of I-PRF (700 rpm/3 min/60 g centrifugation) was administered. Articular pain in three months decreased to 0–25% of the initial pre-interventional values in the study and 38–50% in the control groups. Mandible mobility increased to 121–153% and 115–120% in the I-PRF groups and controls, respectively. The main limitations of the evidence were the small number of RCTs and the lack of any RCT study groups receiving I-PRF without prior arthrocentesis. In conclusion, supplementing the temporomandibular joint rinsing with I-PRF administration further relieves pain and improves mandible mobility. The lack of RCTs on the intra-articular administration of I-PRF as a stand-alone procedure encourages further research. This research received no external funding. The review protocol has not been previously published.
Early Re-Exploration versus Conservative Management for Postoperative Bleeding in Stable Patients after Coronary Artery Bypass Grafting: A Propensity Matched Study
Authors: Spadaccio Cristiano , Rose David , Nenna Antonio , Taylor Rebecca , Bittar Mohamad Nidal
Published: May 2023

Background: Postoperative bleeding requiring re-exploration in cardiac surgery has been associated with complications impacting short-term outcomes and perioperative survival. Many aspects of decision-making for re-exploration still remain controversial, especially in hemodynamically stable patients with significant but not acutely cumulating chest drain output. We investigated the impact of re-exploratory surgery on short-term outcomes in a “borderline population” of CABG patients who experienced significant non-acute bleeding, but that were not in critically hemodynamic unstable conditions. Methods: A prospectively collected database of 8287 patients undergoing primary isolated elective CABG was retrospectively interrogated. A population of hemodynamically stable patients experiencing significant non-acute or rapidly cumulating bleeding (>1000 mL of blood loss in 12 h, <200 mL per hour in the first 5 h) with normal platelet and coagulation tests was identified (N = 1642). Patients belonging to this group were re-explored (N = 252) or treated conservatively (N = 1390) based on the decision of the consultant surgeon. Clinical outcomes according to the decision-making strategy were compared using a propensity score matching (PSM) approach. Results: After PSM, reoperated patients exhibited significantly higher overall blood product consumption (88.4% vs. 52.6% for red packed cells, p = 0.001). The reoperated group experienced higher rates of respiratory complications (odds ratio 5.8 [4.29–7.86] with p = 0.001 for prolonged ventilation), prolonged stay in intensive care unit (coefficient 1.66 [0.64–2.67] with p = 0.001) and overall length of stay in hospital (coefficient 2.16 [0.42–3.91] with p = 0.015) when compared to conservative management. Reoperated patients had significantly increased risk of multiorgan failure (odds ratio 4.59 [1.37–15.42] with p = 0.014) and a trend towards increased perioperative mortality (odds ratio 3.12 [1.08–8.99] with p = 0.035). Conclusions: Conservative management in hemodynamically stable patients experiencing significant but non-critical or emergency bleeding might be a safe and viable option and might be advantageous in terms of reduction of postoperative morbidities and hospital stay.
Intrapartum Maternal Fever and Long-Term Infectious Morbidity of the Offspring
Authors: Zamstein Omri , Wainstock Tamar , Sheiner Eyal
Published: May 2023

Maternal intrapartum fever can lead to various maternal and neonatal complications and is attributed to various etiologies including infectious and non-infectious processes. In this study, we evaluated whether intrapartum fever affects the offspring’s tendency to long-term infectious morbidity. A population-based cohort analysis including deliveries between 1991 and 2021 was conducted. The incidence of hospitalizations of the offspring up to the age of 18 years, due to various infectious conditions, was compared between pregnancies complicated by intrapartum fever and those that were not. A Kaplan–Meier survival curve was used to assess cumulative hospitalization incidence. A Cox proportional hazards model was used to control for confounders. Overall, 538 of the 356,356 included pregnancies were complicated with fever. A higher rate of pediatric hospitalizations due to various infectious conditions was found among the exposed group, which was significant for viral, fungal and ENT infections (p < 0.05 for all). The total number of infectious-related hospitalizations was significantly higher (30.1% vs. 24.1%; OR = 1.36; p = 0.001), as was the cumulative incidence of hospitalizations. This association remained significant after controlling for confounders using a Cox proportional hazards model (adjusted HR = 1.21; 95% CI 1.04–1.41, p = 0.016). To conclude, fever diagnosed close to delivery may influence offspring susceptibility to pediatric infections.
The Presence of Myosteatosis Is Associated with Age, Severity of Liver Disease and Poor Outcome and May Represent a Prodromal Phase of Sarcopenia in Patients with Liver Cirrhosis
Authors: Geladari Eleni , Alexopoulos Theodoros , Kontogianni Meropi D. , Vasilieva Larisa , Mani Iliana , Tenta Roxane , Sevastianos Vasilios , Vlachogiannakos Ioannis , Alexopoulou Alexandra
Published: May 2023

Background/Aims: Myosteatosis implies impaired muscle quality. The aim of the study was to investigate the association of myosteatosis with other muscle abnormalities and its role in the prognosis of liver cirrhosis (LC). Method: Skeletal muscle index (SMI) and myosteatosis were measured by computed tomography. Myosteatosis was defined as muscle radiodensity and evaluated according to dry body mass index (BMI). Median values and interquartile range were used for continuous and count (percentage) for categorical variables. Results: A total of 197 consecutive patients were included (age 61 (IQR 52–68); 67% male; MELD score 11 (interquartile range 7.5–16)). Myosteatosis was identified in 73.6% and sarcopenia in 44.6% of patients. Myosteatosis was positively associated with age (p = 0.024) and Child–Pugh (p = 0.017) and inversely associated with SMI (p = 0.026). Patients with myosteatosis exhibited lower 360-day survival (log-rank p = 0.001) compared to those without it. MELD (p < 0.001) and myosteatosis (p = 0.048) emerged as negative prognostic factors of survival in multivariate model. Individuals combining low muscle strength and impaired muscle quality and quantity displayed more advanced LC, impaired muscle performance, lower BMI (p < 0.001 each) and a three times higher mortality rate compared to those with low muscle quality alone. Conclusions: The presence of myosteatosis was associated with advanced age, low skeletal mass and more severe LC. Myosteatosis was associated with poor prognosis and may represent a prodromal phase of muscle degeneration before the development of sarcopenia.
Quantitative Assessment of Upper Limb Movement in Post-Stroke Adults for Identification of Sensitive Measures in Reaching and Lifting Activities
Authors: Błaszczyszyn Monika , Szczęsna Agnieszka , Konieczny Mariusz , Pakosz Paweł , Balko Stefan , Borysiuk Zbigniew
Published: May 2023

Background: The assumption of this work is the achievement of objective results of the movement structure, which forms the basis for in-depth analysis and, consequently, for determining the upper limb movements that are most affected by stroke compared to healthy people. Methods: An analysis of relevant and systematically identified features of upper limb movement in post-stroke adults is presented based on scalable hypothesis tests. The basic features were calculated using movements defined by the x, y, and z coordinates (i.e., 3D trajectory time series) and compared to the results of post-stroke patients with healthy controls of similar age. Results: After automatic feature selection, out of the 1004 common features of upper limb movement, the most differentiated were the upper arm movements in reaching kinematics. In terms of movement type, movements in the frontal plane (shoulder abduction and adduction) were the most sensitive to changes. The largest number of discriminating features was determined on the basis of acceleration time series. Conclusions: In the 3D assessment of functional activities of the upper limb, the upper arm turned out to be the most differentiated body segment, especially during abduction and adduction movements. The results indicate a special need to pay attention to abduction and adduction movements to improve the activities of daily living of the upper limbs after a stroke.
Smoking Increases the Risk of Hepatocellular Carcinoma and Cardiovascular Disease in Patients with Metabolic-Associated Fatty Liver Disease
Authors: Yoo Jeong-Ju , Park Man Young , Cho Eun Ju , Yu Su Jong , Kim Sang Gyune , Kim Yoon Jun , Kim Young Seok , Yoon Jung-Hwan
Published: May 2023

The association of smoking with hepatocellular carcinoma (HCC) or cardiovascular disease (CVD) has been reported, but the study of its relationship with metabolic-associated fatty liver disease (MAFLD) is limited. We aimed to investigate the effect of smoking on the incidence of HCC or CVD in MAFLD patients. Using the Korean nationwide health screening database, we analyzed subjects between 2001 and 2015. A total of 283,088 subjects including 110,863 MAFLD patients and 172,225 controls were analyzed. Smoking status was divided by non-smoker, ex-smoker, or current smoker. In the follow-up period, a total of 2903 (1.0%) subjects developed HCC, and the MAFLD group (1723, 1.6%) had a significantly higher incidence than the control group (1180, 0.7%). In the MAFLD group, current smokers showed significantly higher risk of HCC compared to non-smokers (adjusted HR 1.24, 95% CI 1.08–1.41), whereas the control group did not (adjusted HR 1.07, 95% CI 0.89–1.30). A total of 18,984 (6.7%) patients developed CVD, and the incidence was significantly higher in the MAFLD group (8688, 7.8%) than in the control group (10,296, 6.0%), similar to HCC. The risk of CVD in current smokers increased by 22% compared to non-smokers in the MAFLD group (adjusted HR 1.22, 95% CI 1.15–1.30) and by 21% (adjusted HR 1.21, 95% CI 1.13–1.29) in the control group. Based on sex stratification, men showed increased incidence of both HCC and CVD by smoking, whereas women had only increased risk of CVD. Smoking significantly increases the incidence of HCC and CVD in MAFLD patients; thus, it is highly recommended to quit smoking completely in the population with MAFLD.
Effects of Surface Preparation Methods on the Color Stability of 3D-Printed Dental Restorations
Authors: Raszewski Zbigniew , Chojnacka Katarzyna , Mikulewicz Marcin
Published: May 2023

Background: Color stability is a crucial performance parameter for dental restorations, and limited research exists on how surface preparation methods affect it. The purpose of this study was to test the color stability of three resins intended for 3D printing, which can be used to make dentures or crowns in A2 and A3 colors. Materials and Methods: Samples were prepared in the form of incisors; the first group was not subjected to any treatment after curing and washing with alcohol, the second was covered with light-curing varnish, and the third was polished in a standard way. Then, the samples were placed in solutions of coffee, red wine, and distilled water and stored in the laboratory. After 14, 30, and 60 days, color changes were measured (presented as Delta E) compared to material stored in the dark. Results: The greatest changes were observed for samples that were not polished, then were placed in red wine dilutions (ΔE = 18.19 ± 0.16). Regarding the samples covered with varnish, during storage, some parts detached, and the dyes penetrated inside. Conclusions: 3D-printed material should be polished as thoroughly as possible to limit the adhesion of dyes from food to their surface. Applying varnish may be a temporary solution.
CrossFit Motivates a 41-Year-Old Obese Man to Change His Lifestyle and Achieve Long-Term Health Improvements: A Case Report
Authors: Brandt Tom , Schinköthe Timo , Schmidt Annette
Published: May 2023

The purpose of this case report was to demonstrate how CrossFit (CF) as a workplace health intervention (WHI) led to long-term lifestyle changes and health improvements in an inactive, sedentary individual. Therefore, we analysed the case of a 41-year-old obese man (BMI: 41.3 kg/m2) with elevated blood pressure and poor fitness. To evaluate the factors that facilitated his behavioural change, we collected quantitative and qualitative data (from 2015 to 2022) and analysed it based on the COM-B framework. Given the already great training opportunities at his workplace, we assumed that improvements in capability and motivation led to behavioural change and maintenance. Essential for this behavioural change was the fact that CF combined health-promoting training with intrinsically motivating aspects which are typical for classic sports such as challenge, a feeling of competence, and social interaction. In conjunction with rapid fitness improvements (capability), a positive feedback cycle between capability, motivation, and behaviour developed which enabled physical activity to become habitual. As a result, blood pressure was normalized, BMI (32.9 kg/m2) and resting heart rate decreased (−20 bpm), and mobility (FMS score: +89%), strength (+14 to 71%), and well-being (WHO-5 score: +12%) increased. In conclusion, CF should be considered an effective, efficient, and safe WHI with great potential for behavioural changes and maintenance.
A Network Model for Identifying Key Causal Factors of Ship Collision
Authors: Liu Jianzhou , Zhu Huaiwei , Yang Chaoxu , Chai Tian
Published: May 2023

In the analysis of the causes of ship collisions, the identification of key causal factors can help maritime authorities to provide targeted safety management solutions, which is of great significance to the prevention of ship collisions. In order to identify the key causal factors leading to ship collisions, we first construct a network model of ship collisions, in which the nodes represent the causal factors, and the edges represent the interrelationship between the causal factors. Second, based on the constructed network model, we propose a successive safety analysis method. This method can quantify the importance of each causal factor, and the quantified results allow us to identify the key causal factors of ship collisions. Finally, we verify the validity of the model using numerical cases.
Influence of Beach Erosion during Wave Action in Designed Artificial Sandy Beach Using XBeach Model: Profiles and Shoreline
Authors: Zhou Yingtao , Feng Xi , Liu Maoyuan , Wang Weiqun
Published: May 2023

Beach width is an important factor for tourists’ comfort, and the backshore is a swash zone where sediment moves quickly. Artificial sandy beaches focus on beach width stability and evolution. This paper is based on an artificial beach project in Haikou Bay, where, in view of the existing conditions, a new type of beach profile that can protect beach berm and width without being eroded by large wave action. Numerical simulation based on XBeach model were conducted to predict the morphodynamical responses of the beach, including a diagnosis of the erosion spots under storm and normal wave events, respectively. Sediment fluxes along and across the shoreline under varied scenarios, dependent on profile width and backshore slope, were discussed. It was found that normal waves with lower heights and longer periods can induce stronger erosion than storm waves due to the landform of the inner-bay in Haikou Bay. Engineering and biological methods to reduce beach erosion during wave action were discussed. Biological methods such as green-plants-root-system can retain berm surface sediment without allowing it to be transported offshore by wave action. The design concept of this artificial beach project may inspire more beach design and protection projects in coastal zones.
Experimental Study on the Efficiency of Dynamic Marine Thermal Energy Generator Based on Phase Change Compensation
Authors: Dong Ruichun , Lin Xu , Liu Jie , Hu Mengqi , Liu Zezheng , Yang Jingze , Du Libin
Published: May 2023

Miniaturized detection devices in the ocean generally experience problems such as short endurance and unreliable power supplies. This article aimed to develop a dynamic ocean temperature difference energy collection device to capture ocean temperature difference energy and provide objective electricity for stable detection devices. The main focus was to conduct experimental research on the effectiveness of a dynamic ocean temperature difference energy power generation device. During the research process, the fact that ammonia gas in a working fluid is easy to liquefy and vaporize was utilized. By utilizing the increase in seawater temperature during the floating process of the device, it vaporized and drove the turbine to rotate for power generation. In the structural design, multiple sets of small air chambers were creatively proposed, which could effectively control the air pressure and improve the stability of the airflow. By charging the airflow to impact the turbine, multiple sets of power generation fans were used to form a stable current. Further, the buoyancy of the device could be changed by adding phase change materials between the air chamber and the device shell, and the temperature difference between the two ends of the phase change materials could be used to change the electron density of the material to form a weak current. In this experimental study, concepts such as the structural design of multiple small gas chambers, miniaturization of energy collection devices, compensation power generation of phase change materials, and application scenarios of devices combined with Argo buoys were all proposed for the first time. The results of this experimental study indicate that the overall power generation of the device is about 2A, and its maximum output power amplitude is about 22 W. The cyclic thermal efficiency of the power generation device can be increased from +0.19% to +0.88%. The development of this thermoelectric power generation device can provide a considerable stable power supply for ocean observation devices, especially the buoy device represented by Argo, which can extend the endurance of deep-sea exploration devices.
Path Planning Method for Underwater Gravity-Aided Inertial Navigation Based on PCRB
Authors: Wang Bo , Cai Tijing
Published: May 2023

Gravity-aided inertial navigation system (GAINS) is an important development in autonomous underwater vehicle (AUV) navigation. An effective path planning algorithm plays an important role in the performance of navigation in long-term underwater missions. By combining the gravity information obtained at each position with the error information from the INS, the posterior Cramér-Rao bound (PCRB) of GAINS is derived in this paper. The PCRB is the estimated lower bound of position variance for navigation along the planned trajectory. And the sum of PCRB is used as the minimum cost from the initial state to the current state in the state space, and the position error prediction variance of inertial navigation system (INS) is used as the minimum estimated cost of the path from the current state to the goal state in the A* algorithm. Thus, a path planning method with optimal navigation accuracy is proposed. According to simulation results, traveling along the path planned by the proposed method can rapidly improve the positioning accuracy while consuming just slightly more distance. Even when measuring noise changes, the planned path can still maintain optimal positioning accuracy, and high positioning accuracy is possible for any trajectory located within a certain range of the planned path.
Underwater-YCC: Underwater Target Detection Optimization Algorithm Based on YOLOv7
Authors: Chen Xiao , Yuan Mujiahui , Yang Qi , Yao Haiyang , Wang Haiyan
Published: May 2023

Underwater target detection using optical images is a challenging yet promising area that has witnessed significant progress. However, fuzzy distortions and irregular light absorption in the underwater environment often lead to image blur and color bias, particularly for small targets. Consequently, existing methods have yet to yield satisfactory results. To address this issue, we propose the Underwater-YCC optimization algorithm based on You Only Look Once (YOLO) v7 to enhance the accuracy of detecting small targets underwater. Our algorithm utilizes the Convolutional Block Attention Module (CBAM) to obtain fine-grained semantic information by selecting an optimal position through multiple experiments. Furthermore, we employ the Conv2Former as the Neck component of the network for underwater blurred images. Finally, we apply the Wise-IoU, which is effective in improving detection accuracy by assigning multiple weights between high- and low-quality images. Our experiments on the URPC2020 dataset demonstrate that the Underwater-YCC algorithm achieves a mean Average Precision (mAP) of up to 87.16% in complex underwater environments.