bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role of Digital Technologies in Enhancing Cognitive Extension
Authors:   National Research Centre “Kurchatov Institute”, Backsanskiy Oleg Ye. , Sorokina Svetlana G. ,   Sechenov First Moscow State Medical University
Published: December 2024

In the contemporary landscape, digital technologies reshape human cognition by influencing core cognitive functions such as memory, perception, and decision-making. This article examines major theories of cognitive extension, including E. Clark and D. Chalmers’ Extended Mind Theory and R. Hirsmink’s Multidimensional Theory of Cognitive Extension, in order to assess how these technologies integrate with and expand human cognitive abilities. These concepts suggest that technologies and devices such as smartphones, the Internet, and GPS systems function as external cognitive elements that augment or replace memory, analysis, and spatial awareness. Such technologies become “extensions” of the mind, transforming traditional cognitive processes and providing immediate access to vast amounts of data, which reduces reliance on biological memory and alters methods of knowledge organization. However, these enhancements result in significant challenges in maintaining epistemic responsibility. Algorithmic filters in digital platforms like social media and search engines lead to cognitive biases, narrowing individuals’ perception of reality and hindering critical thinking. To mitigate these effects, the article emphasizes the need for digital literacy, defined as an understanding of algorithms, content management practices, and privacy safeguards. Developing this literacy is essential for users to maintain cognitive autonomy, enabling them to engage with information critically and independently. Furthermore, the article highlights the role of educators in fostering critical assessment skills and epistemic responsibility. By training students to evaluate digital content critically, educators support the development of intellectual virtues, which are essential in an age where technology profoundly shapes cognitive and decision-making processes. Overall, this article underscores the importance of conscious technology use, advocating for a balanced approach that leverages digital tools to enhance cognitive capabilities while safeguarding against the risks of algorithmic manipulation.
"A New Approach for Identification and Analysis of Urban Heat Island Hotspots "
Authors:   Babeș-Bolyai University, Faculty of Geography, Department of Extensions, Gheorgheni Branch, Cluj-Napoca, ROMANIA, MAGYARI-SÁSKA Zsolt , HORVÁTH Csaba ,   Babeș-Bolyai University, Faculty of Geography, Department of Physical and Technical Geography, Research Centre for Sustainable Development, Cluj-Napoca, ROMANIA, CROITORU Adina-Eliza ,   Babeș-Bolyai University, Faculty of Geography, Department of Physical and Technical Geography, Research Centre for Sustainable Development, Cluj-Napoca, ROMANIA, POP Sorin ,   Creative Space SRL, Baia Mare, ROMANIA
Published: December 2024

Cities are heating up faster than their rural counterparts due to the urban heat island phenomenon, with severe heat accumulation in various areas – hotspots. This study proposes a new approach to analysing urban heat islands by detecting and hierarchising their associated hotspots based on their severity derived from the combination of intensity and frequency. The new method, implemented in R, uses Landsat thermal band data, study area boundaries, and an imperviousness layer to pinpoint critical areas. It consists of a three-step process: i. identifying and prioritising hotspots for each usable satellite image; ii. computing the intensity and frequency, and iii. calculating severity and generating the maps. Combining reclassified multi-image intensity and persistence data, we derived nine classes representing the range from the most frequent and intense areas to the least. Incorporating the imperviousness layer, the hotspot extension is dramatically reduced. The resulting hotspot maps provide valuable insights for urban planners and policymakers, highlighting the most vulnerable regions within the urban area and signalling the need for targeted administrative interventions. This comprehensive analysis was also applied to cold spots, ensuring a thorough understanding of the most and least critical regions.
The role of the will in community development between Sharīʿah and secular law: From establishment to revival
Authors: ALSAIED MOHAMAD , Abdeddayem Sellami , Omar Yousif Ahmed
Published: December 2024

This study aims to explore the precise characteristics of the issue of bequests, not solely from a jurisprudential perspective as is common among researchers, but also by linking it to its role in community development and progress. Bequests serve multiple functions that represent the ethical and cultural objectives of Sharīʿah [the ‘Divine Legislation’], which manifest in the process of uniting members of a single society. This is achieved through their contribution to building bonds of affection and compassion among individuals. Additionally, bequests have economic dimensions that consider the interests of the needy and provide them with resources to elevate their living standards. The study also presents a comparison between the contract of bequest an inheritance contract in Islamic Sharīʿah and secular laws, particularly Western ones. This is done by examining the mechanisms employed in enforcing bequests and understanding the interests sought in each, highlighting the distinct features of Islamic Sharīʿah in its consideration of kinship and both private and public interests, aiming to clear religious liability and via promoting community development while prioritizing moral and societal values. Accordingly, this study, in its examination of the subject, seeks to investigate the essence and objectives of bequests and extract the meanings endorsed by the majority of scholars who permitted bequests to heirs, conditional upon the consent of the remaining heirs. This approach considers both the significance of maintaining harmonious familial ties, and the positive impact this has on individual and community development. This will then be compared to some methods that strictly define inheritance in certain Western societies. The researcher employed both analytical and comparative methodologies, in line with the study’s requirements, noting that the nature of the research opens horizons for understanding the approaches of non-Islamic countries regarding the issue of wills, the importance of exploring the culture of the other and its foundational references, the impact of Islamic laws on others, and how the laws upon which Islamic legislations were established have benefited from Western legal obligations. This represents an extension that goes beyond legislative codification to a cultural exchange that allows us to build intellectual communication with the other, placing this research before a fundamental problem embodied in the following question: To what extent do bequests contribute to community development? And what are the communicative dimensions that comparative legislation on bequests with the other offers us?
Measurement of the degree of connection between cities on the east and west banks of the Pearl River Estuary—Based on urban gravity model
Authors: Xie Zhanxi , Loi Hoi Ngan , Liu Xiwen
Published: December 2024

Since the Reform and Opening up, GDP of the cities on eastern bank of the Pearl River Estuary in Guangdong Province were higher than the eastern bank cities. Therefore, this article aims to modify the urban gravity model combines it with the entropy weight method to calculate urban quality and applies it to measure the degree of connectivity between cities over the past decades. The research aims to explore whether cities with higher economic output have a greater attraction for surrounding cities, and whether the eastern bank cities can also promote the development of the west. Through detailed data collection and analysis, this essay reveals the dynamic changes of the gravity among cities and its influence factors such as economic, transportation and urban development. The research results indicate that the strongest gravitational force between cities on the east and west banks is between Dongguan and Zhongshan, rather than between Shenzhen and cities on the west bank. This demonstrates that the connection between cities on the east and west banks is primarily constrained by geographical factors, and the geographical location of a city influences on surrounding cities significantly. In particular, Dongguan and Zhongshan play a key role in connecting the eastern and western bank of the Pearl River Estuary, rather than Shenzhen, which is traditionally considered to have the highest economic aggregate. In addition, the study also found that the COVID-19 epidemic has had a significant impact on inter-city communication, resulting in a decline in inter-city gravity in recent years.
Development of an instructional system design as a guideline for Nursepreneur mastery learning policy: Elevating healthcare through design thinking and InnoTVET approach
Authors: Manowaluilou Nongluck
Published: December 2024

This research presents an innovative perspective on vocational education by merging the Instructional System Design (ISD) model with Innovation in Thailand Vocational Education and Training (InnoTVET) principles. Targeted at nursing students, the course aims to cultivate entrepreneurial skills while connecting vocational training with healthcare policy development. It aligns with global movements in Education for Sustainable Development (ESD), addressing the increasing demand for nurse entrepreneurs who can devise creative healthcare solutions within established policy frameworks. By employing mastery learning techniques alongside design thinking, the course effectively bridges theoretical concepts with practical applications. The mixed-methods study underlines relevant contribution in students’ entrepreneurial mindsets. Results from t-tests reveal the students’ ability to identify opportunities, engage in innovative thinking, and work within policy frameworks. Findings are supported by qualitative data, which demonstrate enhanced confidence, improved problem-solving capacities, and a deeper understanding of healthcare market dynamics. Although expert evaluation of student projects is scheduled for future iterations, the initial outcomes reinforce the course’s success. The course is structured into seven modules spanning 45 hours, featuring active learning components, five business-oriented assignments, and a final innovation project that integrates the curriculum’s core elements. This design ensures students develop both practical expertise and interdisciplinary insights critical to healthcare innovation. The integration of InnoTVET and ISD principles in nursing education sets a precedent for vocational education reform. This example of a successful nursepreneurship initiative provides a scalable model for enhancing vocational programs in diverse fields, fostering innovation and sustainability.
Bridging digital bank and e-commerce: A study on customer experience and reuse intention in integrated digital payment system
Authors: Fitri Alya Muthia , Haq Arinil , Febrianny Raissa Adlina , Handayani Putu Wuri , Fitriani Hana
Published: December 2024

The emerging growth digital application has driven ecosystems integrating digital banks and e-commerce platforms, enabling seamless, efficient transactions. This study examines the impact of user experience and satisfaction on reuse intention in this integrated environment. Using a mixed-method approach, data were collected through surveys of 471 respondents and interviews with 30 participants. Quantitative data were analyzed using structural equation modeling, while qualitative data were processed through content analysis. Results show that perceived ease of use, usefulness, reliability, value, and risk significantly affect user experience, while perceived security does not. These findings aim to help digital banks and e-commerce platforms design effective CRM strategies to enhance satisfaction and reuse intention.
Development of a global management model and verification of the connotation of “Guanxi” in contemporary Chinese marketing channels
Authors: Wu Xiaoqin , Panyasiri Chaiyanant , Zhang Li
Published: December 2024

This study aims to explore the connotation of “Guanxi” within contemporary Chinese marketing channels and to construct and verify a global management model. The objective is to examine how instrumental and emotional dimensions of Guanxi influence enterprise operations and management processes. A hybrid research methodology combining qualitative and quantitative approaches was employed. In-depth interviews with 30 dealer executives provided qualitative insights, while a large-scale survey with 305 valid responses facilitated quantitative analysis. SPSS22.0 and LISREL8.8 were utilized for data analysis, including reliability, validity, hypothesis testing, and structural equation modeling (SEM). The findings reveal that Guanxi is multi-dimensional, comprising both instrumental and emotional components. Instrumental Guanxi includes factors such as status, prestige, credibility, and decision-making power, while emotional Guanxi encompasses trust, emotional connection, and mutual respect. Both dimensions significantly affect professionalism, shared values, contact frequency, and popularity within marketing channels. Hypothesis testing confirmed the significant relationships between these variables, except for the non-significant impact of popularity on instrumental Guanxi. The mediating effects of flexibility and supervision on the relationship between Guanxi and corporate performance were also significant, highlighting the mechanisms through which Guanxi influences organizational outcomes. Moderating effects of perceived internal incentive fairness and digital collaboration capabilities further amplify these relationships. Finaly, the study underscores the dual importance of strategic utility and emotional resonance in Guanxi, providing a robust model for understanding its impact on business management. These insights are valuable for both researchers and practitioners aiming to leverage Guanxi in enhancing organizational performance and relational strategies.
The paradox explained: The advancement of LGBTQ rights in the context of growing illiberalism
Authors: Lo Noble Po Kan
Published: December 2024

The article undertakes an exploration into the rather unexpected progressiveness exhibited by courts across the globe in bestowing protection upon LGBTQ rights. A three-pronged study, which encompasses an examination of the theoretical rationales, empirical investigations, and doctrinal underpinnings of the augmentation of LGBTQ rights in diverse locales, is executed. It is hypothesized that a prima facie paradox emerges, whereby LGBTQ rights have been safeguarded and advanced in an extraordinary fashion, while concurrently, a discernible general trend of deviation from liberal constitutionalism, rights safeguarding mechanisms, and the rule of law is observable in other arenas. This article scrutinizes this contention and discovers that it is substantiated by case law from various regions. Critical theory and Butler’s theory of performativity potentially offer the most cogent explanations for this paradox. They have led to the social embrace of LGBTQ rights, while simultaneously, the enactment or amplification of these rights even in illiberal states furnishes an effortless ‘triumph’ for illiberal political actors, which can be employed as a countermeasure against assaults on their liberal and democratic reputations.
Empowerment of rural women through microfinance in Bangladesh: Empirical evidence from the Grameen Bank of Bangladesh
Authors: Bitan Khanam , Lee Sung-Kyu
Published: December 2024

The study’s goal is to evaluate how microfinance initiatives affect women’s empowerment in Bangladesh. For this study, we analyzed data on a variety of women’s empowerment-related issues, including both beneficial and detrimental elements that stand in the way of women’s empowerment. Therefore, in order to accomplish the specified goal, we choose a suitable and intentional methodology. We employ diverse data gathering approaches to examine the gathered data and achieve the primary goal of the research project. It presents the positive effects of microfinance on women, such as (1) the enhancement of women’s authority in financial affairs; and (2) the augmentation of their ability to make decisions in household; and (3) community matters following their participation in the microfinance program. This also provides an analysis of the data pertaining to the adverse effects of microfinance on women. It examines how women encounter various challenges and engage in unethical behaviors after obtaining a loan, leading to heightened levels of stress following their participation in the microfinance program. This study looks into the advantages and disadvantages of Grameen Bank’s microcredit program for women. A questionnaire gathered primary data for this study from women participating in the microfinance program in Gopalgonj. To collect information and comprehend respondent behavior, I used case study, analytical and descriptive study design. Regression analysis, correlation, and percentage are used to examine the data. The findings indicate that women’s decision-making skills have improved due to their financial stability, but they have also experienced increased life challenges and high levels of stress.
Determinants of adoption process with lifestyle applications: Findings from an exploratory study
Authors: Ercsey Ida , Keller Veronika
Published: December 2024

This study examines the adoption and usability of lifestyle (LS) apps, considering demographic factors like age and education that influence adoption decisions. The study employed a mixed-methods design, combining an experiment (spanning 14 weeks of app use) with semi-structured interviews and periodic measurements. The researchers employed the Mobile Application Usability Questionnaire (MAUQ) to identify pivotal aspects of standalone app usability, interface satisfaction, and usefulness at various stages of use, with a particular emphasis on the experiences of Hungarian students (n = 36). The results demonstrate that health-related factors have a significant impact on students’ behavior and evaluation of lifestyle apps over the 14-week period. Overall, the analyzed LS apps demonstrated positive outcomes in terms of supporting subject health and significantly improving the perceived health state. The findings highlight both practical and theoretical contributions to the field of mobile health applications, suggesting avenues for further research to either confirm or challenge existing theories.
Understanding consumer behavior and strategies for adopting reusable packaging in food delivery
Authors: Hong Jungyeon , Kim Jaewan , Dusadenoad Supasini , Han Yeji
Published: December 2024

This study explores the factors that affect consumer adoption of reusable packaging in South Korea’s food delivery market. Adopting a mixed-method that includes interviews and an online survey of 137 consumers aged 18 to 30, the analysis, using an ordered probit model, reveals key drivers of the likelihood of switching to food delivery services using reusable packaging. Positive influences include environmental concerns, intention to take action on disposable packaging, willingness to pay extra, and awareness that reusable packaging does not require washing. However, challenges such as hygiene concerns and higher delivery fees deter consumers from switching to reusable package option. Demographic factors like living arrangements and gender show minimal impact. In response to the findings, the study suggests strategic solutions, including a pilot program, to overcome barriers and effectively demonstrate the benefits of reusable containers.
Tratamento e ressocialização dos inimputáveis: reflexos do retorno à convivência em sociedade após o internamento
Authors: Oleskovicz Maria Eduarda , Toporoski Elizeu Luiz
Published: December 2024

Este artigo tem como finalidade demonstrar a efetividade das internações de infratores considerados inimputáveis em razão de doença psiquiátrica em Hospital de Custódia e Tratamento Psiquiátrico. Questiona-se o grau de eficácia da medida de segurança consistente na internação e se há a devida ressocialização e acompanhamento ambulatorial após o fim do tratamento. O objetivo geral busca analisar os reflexos do retorno à convivência em sociedade e a importância da ressocialização após o internamento para tratamento dos inimputáveis no HCTP e, ainda, como ocorre a ressocialização. Os objetivos têm como intuito: abordar o instituto da inimputabilidade; analisar a importância da ressocialização e da continuidade do tratamento ambulatorial; observar como funciona o tratamento dos indivíduos internados no HCTP e os reflexos do retorno à convivência em sociedade após a saída. A metodologia é qualitativa com método de abordagem dedutivo, baseada em obras literárias e artigos científicos, bem como de documentos normativos e jurisprudenciais. Pode-se concluir que o tratamento e a ressocialização por meio do internamento em Hospital de Custódia e Tratamento Psiquiátrico era falha e não causava efeitos positivos para os internados e consequentemente para a sociedade em geral, fazendo com que o Conselho Nacional de Justiça, por meio da Resolução n. 487/2023 determinasse o fim das internações nos HCTP e a partir de 2023, a internação se tornou medida excepcionalíssima e será cumprida em Hospital Geral, com a garantia de manter o convívio social com familiares, por meio de auxílio de Rede de Atenção Psicossocial e do judiciário.
Development and application of a model for the automatic evaluation and classification of onions (Allium cepa L.) using a Deep Neural Network (DNN)
Authors: Rybacki Piotr , Przygodziński Przemysław , Kowalczewski Przemysław Łukasz , Sawinska Zuzanna , Kowalik Ireneusz , Osuch Andrzej , Osuch Ewa
Published: December 2024

Evaluating onions for size, shape, damage, colour and discolouration is the first and most important step in classifying them for raw material quality, processing and the horticultural and agri-food sectors. Current methods of geometric evaluation and grading of onions involve mechanical and extremely invasive sorting, which causes additional damage, reduces the quality of the raw material and is also labour and time-consuming. As a result, non-invasive evaluation and classification methods that are both fast and accurate are being sought. One such method is digital image analysis, which, when combined with instrumentation and deep neural networks, can fully automate the process. The main aim of this study was the development of a model for the automatic evaluation and classification of onions using a deep convolutional neural network (CNN) model. A fixed-architecture network was built, for which a computational algorithm was developed in Python 3.9 and published at https://github.com/piotrrybacki/onion-CNN.git (accessed on 4 October 2024). The Hyduro F1 onion variety, a hybrid all-purpose variety of the Rijnsburger type, was used to build, teach and test the model. The developed algorithm classified the onion images qualitatively with an accuracy of 91.85%. This classification was based on the geometric parameters of the onion, i.e. diameter, height, transversal and longitudinal circumference, and the estimated area of damage or discolouration of the skin. The root mean square error (MSE) in RGB space varied between 87.99 and 91.24, and the maximum image classification time was 28.98 ms/image. The developed algorithm has a very high utility, as it automates the classification process, reducing its time and labour intensity.
Redescription of Homeopronematus anconai (Baker) (Acari, Iolinidae) and description of Quasihomeopronematus nordestinus n. gen. n. sp.
Authors: De Vis Raf M. J. , Vervaet Lore , Reybroeck Eva , Vanlommel Wendy , Van Havermaet Robin , Foqué Dieter , Marcossi Ítalo , Pallini Angelo , Binda de Assis Caio Henrique , Van Leeuwen Thomas , Ueckermann Edward A.
Published: December 2024

In a survey of natural enemies of Aculops lycopersici (Tryon, 1917), we collected specimens of Homepronematus anconai (Baker, 1943) in different European countries and redescribed the species based on specimens collected in Belgium. The newly collected specimens were measured and morphologically compared with USA specimens available from museum collections. We also measured collections' specimens previously identified as H. staercki from Hungary, and others, previously identified (but undescribed) as Homeopronematus cf. staercki sp. nov. from Serbia. Quasihomeopronematus n. gen., with its type species Quasihomeopronematus nordestinus n. gen. n. sp., are described based on specimens from Brazil. As the name suggests, this genus is similar to the genus Homepronematus. Single female expansion lines were set-up with H. anconai specimens from Belgium, France, Germany and Hungary, and Q. nordestinus specimens from Brazil. With specimens of these lines, molecular analysis was performed to construct a phylogenetic tree including the results of previous studies with Pronematus ubiquitus (McGregor, 1932) and P. duffelensis De Vis and Ueckermann, 2024. The tree showed differences between origins of H. anconai, with one French line standing out. In a PCA analysis on morphological characters, the same French line separated from all other geographical origins albeit with some overlap. The molecular and morphological differences were assigned to intraspecific variation, and we consider all specimens studied as H. anconai. Homepronematus anconai is morphologically different from Q. nordestinus but the latter separated similarly as that one French line from all other H. anconai lines. We conclude that the CO1-gene is not sufficient to separate genera in the family of the pronematinae. The specimens previously identified as H. staercki or Homeopronematus cf. staercki sp. nov. overlap in the PCA analysis with the specimens of H. anconai. Therefore, we synonymise H. staercki with H. anconai. The results are discussed and additionally both species' distribution, habitat, and feeding habits are presented.
PROGRESSION OF THE ASCENDING AORTA DIAMETER AFTER SURGICAL OR TRANSCATHETER BICUSPID AORTIC VALVE REPLACEMENT
Authors: Chiariello G. A. , Di Mauro M. , Villa E. , Bruno P. , Mazza A. , Marcolini A. , Conserva A. , Fabiani L. , Pasquini A. , Massetti M.
Published: December 2024

Objectives:

Ascending aorta (AA) dilatation in patients with bicuspid aortic valve (AV) is related both to genetic and haemodynamic factors. The aim of this study is to compare late progression of AA dilatation in bicuspid AV patients undergoing surgical aortic valve replacement (SAVR) versus transcatheter aortic valve implantation (TAVI).

Methods:

Data of 189 consecutive patients who underwent AV replacement for severe bicuspid AV stenosis were prospectively collected. Patients who underwent SAVR were compared to patients who underwent TAVI. Indication to the procedure was validated by the institutional Heart Team. Aortic diameters were evaluated by transthoracic echocardiogram. Differences between preoperative and long-term follow-up AA diameters were compared in the 2 groups.

Results:

Between January 2015 and December 2021, 143 (76%) patients underwent SAVR and 46 (24%) patients underwent TAVI. At 4.6 (standard deviation 1.7) years follow-up, patients in the TAVI group showed significantly lower survival (P = 0.00013) and event-free survival (P<0.0001). AA diameter progression was lower in surgical compared to transcatheter patients, 0.95 (0.60, 1.30) vs 1.65 (0.67, 2.63) mm, P=0.02. AA diameter progression indexed for body surface area and height was lower in the surgical group: 0.72 (0.38, 1.05) vs 1.05 (0.39, 1.71) mm/m2, P = 0.02, and 0.59 (0.36, 0.81) vs 1.11 (0.44, 1.78) mm/m, P = 0.001, respectively. At multivariable linear regression analysis transcatheter procedure, baseline aortic diameter and paravalvular leak were significantly associated with increased postoperative AA dilatation.

Conclusions:

Bicuspid AV patients who underwent SAVR, showed significantly less long-term AA diameter progression than patients who underwent transcatheter procedure.
IMPACT OF AORTIC ROOT REPLACEMENT VS CONSERVATIVE REPAIR ON OUTCOMES OF SURGICALLY TREATED ACUTE TYPE A AORTIC DISSECTION
Authors: Nocera C. , Murana G. , Votano D. , Rucci P. , Nania R. , Fiaschini C. , Campanini F. , Rosa S. , Di Marco L. , Pacini D.
Published: December 2024

Objective:

Optimal treatment of the aortic root in acute type A aortic dissection (ATAAD) is debated, partially due to the difficulty in producing randomized clinical trials. In this study we compared outcomes of root-conservative repair (RCR) vs aortic root replacement (ARR) and performed a counterfactual analysis of causation to estimate their impact on long-term outcomes.

Methods:

From January 2000 to July 2021 494 ATAAD were surgically treated at our institution. Among these, 296 received RCR, 198 ARR. Pre-operative characteristics, short- and long-term outcomes were compared. Counterfactual analysis estimated the causal treatment effect of ARR vs RCR on time to death and time to reintervention.

Results:

In the ARR group patients were younger (61.7±11.2 vs 67.8±11.5 years, p<0.01) and showed higher rates of moderate to severe AR (47.5% vs 18.2%, p<0.01). Short-term outcomes did not differ except for bleeding requiring reopening, which occurred more in the ARR group (18.2 vs 10.2%, p=0.01). There was no statistically significant difference in terms of 10-year survival and freedom from reintervention. The results of causal effect analysis, however, showed that time-to-death was increased by 7 months and time-to-reintervention by 17 months in the ARR group, though this didn’t reach statistical significance.

Conclusions:

ARR and RCR showed comparable outcomes. Survival and freedom from reintervention, however, might be increased by root replacement.
BEATING HEART TRANSPLANTATION: FIRST EXPERIENCE IN ITALY
Authors: Vendramin I. , Lechiancole A. , Nalon S. , Benedetti G. , Di Lorenzo A. , Guzzi G. , Piani D. , Sponga S.
Published: December 2024

Background and Aim:

Prolonged donor graft ischemia during harvesting and transportation may be responsible of allograft dysfunction after heart transplantation (HTx). Our Center firstly adopted the Organ Care System (OCS) in 2007, being one of the enrolling Centers in the PROCEED-II trial. Since then, we have preserved a total of 87 donor hearts with OCS.

Methods:

In 2024, we modified the implantation surgical phase in 2 patients. The grafts employed were from donation after brainstem death (DBD) donors, and preserved with the OCS.

The cardiopulmonary bypass (CPB) was modified so that the grafts could be perfused through an additional arterial perfusion line. The donor aorta was cannulated and connected to the additional CPB arterial line. The perfusion from the OCS was stopped, the aorta cross-clamped immediately distal to the CBP perfusion line and antegrade flow was initiated.

Graft implantation started with the left atrial anastomosis. The aortic anastomosis was then carried out between the two clamps which were released upon completion of the suture. The remainder of operation was concluded as in a standard HTx.

Results:

At the end of HTx, recipients were weaned from CPB without difficulty. Recipient 1 presented, after 2 days, moderate rejection which resolved after treatment. In Recipient 2 the postoperative course was uncomplicated.

Conclusions:

This preliminary experience has demonstrated that HTx with a beating heart obtained by DBD is feasible. By eliminating the second period of ischemia could be particularly beneficial, especially when using marginal donors, DCD grafts or long-distance procurements.
RIGHT VENTRICULAR ASSIST DEVICE SUPPORT AS TREATMENT FOR ADVANCED RIGHT HEART FAILURE: TREATMENT STRATEGIES AND ANALYSIS OF OUTCOMES
Authors: Loforte A. , Abbà P. , Spitaleri A. , Parrella B. , Aloi V. , De Laurentis A. , Maraschioni G. , Costamagna A. , Trompeo A. C. , La Torre M. W. , Boffini M. , Rinaldi M.
Published: December 2024

Background and Aim:

RotaFlow (Getinge) system, used as temporary right ventricular assist device (t-RVAD), has been investigated as treatment for refractory right heart failure (RHF).

Methods:

We retrospectively analysed 42 consecutive adult patients who underwent t-RVAD implantation at our institution, between 2009 and 2024 (male 67%; age 60.1±11.6 years). Indications for support were: failure to wean from cardiopulmonary bypass in the setting of post-cardiotomy cardiogenic shock (45%) and primary donor graft failure (33%), post-durable LVAD (19%), and post-acute myocardial infarction (3%).

Results:

Mean duration of support was 9 ± 8 days (range: 1-29 days) with a mean flow of 3.2±0.8 lpm. Femoral vein to pulmonary artery setting was established in 67% of cases, with interposition of a Dacron graft and tunnelling of the outflow cannula through the left 3rd intercostal space in 79% of them; direct right atrium inflow was used in 24% and a ProtekDuo cannula was adopted in 7% of cases.

An oxy-RVAD was set in 43% of overall population. Rethoracotomy for bleeding was necessary in 15.4% of patients; no pulmonary embolism occurred. Mean intensive care unit (ICU) stay was 26.3±28.1 days. The success rate, in terms of survival on t-RVAD was 57.1%. Mean hospital stay was 39.1±41.8 days. Preoperative APACHE II, SOFA, SAPS II scorings were associated with increased 30-days mortality (16.3 vs. 12.5, p=0.05; 9 vs. 6.5, p=0.02; 41.6 vs. 34.7; p=0.03).

Conclusions:

t-RVAD support is still a valid option to treat advanced RHF. A pre-operative risk scoring may guide a proper timing for t-RVAD insertion.
IMPACT OF HEMOLYSIS DURING MICRO-AXIAL FLOW PUMP SUPPORT ON EARLY OUTCOMES AFTER DURABLE LVAD IMPLANTATION: INSIGHTS FROM AN INTERNATIONAL REGISTRY
Authors: Loforte A. , Spitaleri A. , Gallone G. , Lewin D. , Rojas Hernandez S. , Bernhardt A. , Billion M. , Meyer A. , Netuka I. , Kooij J. , Pieri M. , Szymanski M. , Moeller C. , Akhyari P. , Jawad K. , Krasivskyi I. , Schmack B. , Färber G. , Medina M. , Haneya A. , Zimpfer D. , Nersesian G. , Lanmüller P. , Monteleone G. , Oezkur M. , Djordjevic I. , Saeed D. , Boffini M. , Stein J. , Gustafsson F. , Scandroglio M. , Meyns B. , Hofmann S. , Belohlavek J. , Gummert J. , Potapov E. , Rinaldi M.
Published: December 2024

Aim and Background:

The impact of hemolysis during micro-axial flow pump (mAFP, Impella, Abiomed) support on early outcomes after durable left ventricular assist device (d-LVAD) implantation is unknown.

Methods:

Among 341 patients undergoing d-LVAD implantation after mAFP support, between January 2017 and December 2022, at 19 international Institutions, 311 were retrospectively included (male gender 82.6%, median age 58 years, Impella 5.0/5.5 72.3%, HeartMate III 57.7%). The incidence and predictors of hemolysis, as well as its impact on early post-d-LVAD outcomes were assessed. The primary outcome was a composite of hemocompatibility-related adverse events (HRAEs: stroke, gastrointestinal bleeding, pump thrombosis).

Results:

Hemolysis occurred in 40.8% of the patients. Impella 2.5/CP vs. 5.0/5.5 was the single independent predictor of hemolysis (adj-HR 2.68, 95%CI 1.04-6.94, p=0.031). Post- d-LVAD HRAEs occurred more frequently among patients with hemolysis (31.9% vs. 20.6%, p=0.041), mainly driven by hemorrhagic stroke and gastro-intestinal bleeding. At multivariate analysis, hemolysis remained independently associated with HRAEs (adj-HR 1.62, 95%CI 1.02-2.58, p=0.041), together with higher body surface area (p<0.001) and female sex (p=0.004). Patients with hemolysis were more likely to need a temporary right ventricular assist device following d-LVAD implantation (28.3% vs. 16.8%, p=0.012) and to undergo early heart transplantation (17.4% vs. 8.6%, p=0.031), while no difference in mortality was observed (23.6% vs 21.2%, p=0.355).

Conclusions:

Among patients undergoing d-LVAD implantation with mAFP bridge, hemolysis during mAFP support is common, occurs more frequently among patients supported with Impella 2.5/CP, and is an independent predictor of post- d-LVAD early HRAEs, mainly driven by bleeding events
POST-IMPLANT TRANSCATHETER AORTIC PROSTHESIS DEFORMATION: TRICUSPID VERSUS BICUSPID VALVE.
Authors: Zaccone G. , Moscarelli M. , Pernice V. , Trizzino F. , Milo S. , Speziale G. , Fattouch K.
Published: December 2024

Objective:

There is conflicting evidence supporting the widespread use of transcatheter aortic prostheses for bicuspid valves. In these patients, prosthesis deformation, also known as non- uniform expansion, may frequently occur. Little information is available regarding post- implant prosthesis behaviour in the context of native tricuspid versus bicuspid aortic valve stenosis, particularly following self-expandable valves.

Methods:

We analysed 100 consecutive post-implant multi detector computed tomography scans to assess prosthesis non-uniform expansion at six pre-specified valvular levels, and other specific parameters, including valvular and perivalvular thrombosis at six months follow-up. Echocardiographic prosthesis performance and clinical outcome was also evaluated.

Results:

Mean eccentricity was significantly higher in the bicuspid group (0.43 ± 0.09 vs 0.37± 0.08, p=0.005, bicuspid vs tricuspid); valvular and perivalvular thrombosis were also significantly more frequent in the bicuspid than in the tricuspid group (81% vs. 36.9%, p=0.031); there was no significant difference in terms of mean prosthetic gradient at follow-up between groups (7.31 ± 5.53 mmHg vs 7.09 ± 3.05 mmHg, p= 0.825); EOAi was also similar between bicuspid and tricuspid (1.08 ± 0.12 cm2 vs 1.03 ± 0.13 cm2, p=0.101), with no significant changes compared to discharge. However, the bicuspid valve was associated with a significantly higher risk of adverse events (HR:3.72, 95%CI: 1.07-13.4, p= 0.027).

Conclusions:

Higher levels of eccentricity, which indicates prosthesis deformation, is often detected in bicuspid valves. Although echocardiographic performance was not affected, this might have led to an increased incidence of thrombosis at valvular and perivalvular levels and worse outcomes
COMBINED ENDOSCOPIC VALVE SURGERY AND CORONARY ARTERY BYPASS VIA MINI-THORACOTOMY
Authors: Margari V. , Squiccimarro E. , Visicchio G. , Kounakis G. , Pascarella C. , Carbone C. , Paparella D.
Published: December 2024

Background:

Consistent evidence favors of endoscopic valve surgery (eVS) exists. Yet, the adoption of minimally invasive coronary surgery (MICS) remains low, particularly for combined procedures. We aim to describe our experience with combined eVS and MICS.

Methods:

We reviewed patients who underwent eVS+MICS at Santa Maria Hospital, Bari, from 2021-2024. The primary outcome was follow-up mortality. Patients received MICS and either endoscopic mitral repair (eMVr) or aortic valve replacement (eAVR). After double- lumen endotracheal intubation, right internal jugular vein cannulation, right groin incision for echo-guided cannulation, cardiopulmonary bypass establishment, Chitwood clamp insertion at the second interspace (IS-2), eMVr was performed via right-MT above the nipple at IS-4 while eAVR via anterior MT at IS-3. MICS consisted of a left internal thoracic artery (LITA) to left anterior descending off-pump graft via an additional left-MT at IS-5 in eMVr cases, and a saphenous vein (SVG) to posterior descending artery (PDA) graft via the same right-MT, in eAVR cases.

Results:

Thirteen patients underwent eVS+MICS: age was 67±4 years, 8 were male, and EuroSCORE II was 2.6±1.1. Nine patients had eMVr: 6 posterior leaflet resections, and 4 neochordal repairs. All eMVr included ring annuloplasty; four had monopolar ablation and left atrial appendage closure. Four patients had eAVR with bioprosthesis and SVG-to-PDA. Mechanical ventilation averaged 4±2 hours, with ICU discharge after 2±1 days. All patients were discharged healthy, with no deaths at 2-year follow-up.

Conclusion:

Combined eVS+MICS is safe, with satisfactory outcomes. Minimally invasive techniques should be adopted in specialized centers, even in complex cases.
TAVI, VALVE IN MAC AND CLOSURE OF PARAVALVULAR LEAK IN AN INOPERABLE PATIENT
Authors: Di Carlo M. , Cavalli G. G. , Vallabini A. , Spatuzza P. , Braccio M. , Palladino M. , Gallo N. , Alemanni R. , Leone A. , Di Marco L. , Pacini D. , Cassese M.
Published: December 2024

Particularity of the video:

Multivalvular disease (MVD) still represents a challenging scenario. The first-choice treatment is usually open surgery, given the possibility of simultaneously treating all the involved valves. Nonetheless, patients’ clinical conditions are getting far worse, dramatically increasing the surgical risk and operative mortality. Therefore, a transcatheter approach may represent a safe alternative, though considering the burden of a high technical complexity.

Brief description:

We report the case of a 76-year-old female affected by severe aortic and mitral valve stenosis, presenting with acute heart failure (NYHA IV). Surgery was denied due to chronic myeloid leukemia, determining severe pancytopenia (platelet count 12000/mm3) and unfavorable anatomical characteristics, related to the extremely calcified mitral valve ring (MAC). A transcatheter approach was chosen, performing in a single-step procedure a TAVI, a TVMI-in- MAC and a subsequent paravalvular leak closure. The patient was eventually discharged and in good clinical conditions at 1 month follow-up.
HEART TRANSPLANTATION IN ADULT WITH CONGENITAL HEART DEFECTS: HOW FAR IS TOO FAR IN WAITING LIST? SIEVING RESULTS THROUGH A RISK SCORE
Authors: Berardi M. , careddu L. , orioli V. , mangerini V. F. , petridis F. D. , ragni L. , assenza G. E. , agulli M. , gargiulo D. G. , angeli E.
Published: December 2024

Background:

Adult with congenital heart defects (ACHD) constitute a heterogeneous and expanding group of patients. ACHD are characterized by complex cardiac anatomical features, precarious hemodynamic stability and associated multiorgan dysfunction, with higher risk for advanced heart failure requiring orthotopic heart transplantation (OHT). To stratify this risk, Seese et al. proposed an ACHD-OHT-Risk Score for 1-year mortality including age, comorbidities and laboratory values. This study evaluated early and long-term survival of ACHD underwent OHT in our unit and the adherence of the ACHD-OHT-Risk Score for our population.

Methods:

ACHD (age>16 years) underwent OHT between January 1997 and August 2024 were analyzed in the study. Kaplan-Meier analysis was performed to report the early and long-term survival. In addition, population was divided in two groups according to the ACHD-OHT-Risk Score: Low-risk (<2 points)-High-risk(≥2points). Groups’ survival at 1year was compared.

Results:

From 1997 to 2024, 33 ACHD underwent OHT. Mean age at transplant was 33,32 ± 12,60 years. Parameters used to determine the risk score are reported in fig.1. The overall survival at 1, 10,20 years was 84.8%, 77.7% and 64.8% respectively. Low-risk group included 13 patients (39,4%), High-risk group 20 patients (60,6%). One-year survival in low-risk group at 1,6,12 months was 100%,92%,92%, while in high risk group 95%,80% and 80%, respectively (log- rank=0.33).

Conclusion:

OHT in ACHD remains challenging and affected by high risk mortality in the first year of follow-up. The ACHD-OHT-Risk Score derived some risk factors of early mortality and could suggest a more aggressive approach to waiting list enrolment and progression to achieve OHT in optimal multiorgan conditions.
Topical Helichrysum italicum Essential Oil-Based Ointment Hastens Excisional Wound Healing by Alleviating Inflammation and Oxidative Stress in Diabetic Rats
Authors: Andjic Marijana , Kocovic Aleksandar , Vucicevic Ksenija , Jakovljevic Vladimir , Simanic Igor , Vukasinovic Vesic Milica , Bradic Jovana
Published: December 2024

This study aimed to develop novel topical semi-solid formulation based on Helichrysum italicum (H. italicum) essential oil and to assess its wound-healing capacity through macroscopic and biochemical examination of markers of inflammation and oxidative stress. Methods: The wound-healing effect was evaluated on an excision wound model. The study was carried out on male Wistar albino rats with induced diabetes type 1. Diabetic rats were randomly divided into four groups: control (CTRL), 1% silver sulfadiazine (SSD), ointment base (OINT), and HIEO OINT (H. italicum essential oil-based ointment). The investigated formulations were applied once daily, for three weeks. The formulation containing H. italicum essential oil has shown no changes in color, smell, consistency, or homogeneity during the storage period at room temperature for six months. Three-week administration of HIEO ointment led to a significant reduction in wound size and the percentage of wound contraction was the highest in HIOE point group. A significant increase in wound contraction percentage was observed from day 7. The treatment with HIEO ointment significantly reduced tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6), and enhanced IL-10 levels. Additionally, a three-week administration of HIEO ointment elevated antioxidative enzymes detected in wound tissue. Our findings showed that topical application of HIEO ointment showed immense potential in augmenting skin wound regeneration in diabetes rats by upregulating the antioxidant status as well as modulating cytokines.
Diabetic Kidney Disease Position Paper of the Macedonian Society of Nephrology, Dialysis, Transplantation and Artificial Organs (MSNDTAO), Macedonian Society of Cardiology (MSC), and Scientific Association of Endocrinologists and Diabetologists of Macedonia (SAEDM)
Authors: Spasovski Goce , Markovska Zaklina Sterjova , Gjorgjievski Nikola , Poposka Lidija , Kostov Jorgo , Bosevski Marijan , Ahmeti Irfan , Jovanovska-Mishevska Sasha , Milenkovic Tatjana
Published: December 2024

Diabetic kidney disease (DKD) is a significant and growing global health concern, affecting a substantial proportion of individuals with diabetes mellitus. This position paper of Scientific societies of endocrinologists, nephrologists and cardiologists has been consensually brought at a couple of mutual meetings, aiming to synthesize current knowledge on screening, diagnosis and staging of DKD, emphasizing the need for an early detection and intervention in order to prevent progression to end-stage renal disease (ESRD). The role of glycemic control, blood pressure management, lipid management and the use of reno and cardioprotective agents, including angiotensin-converting enzyme inhibitors, sodium-glucose co-transporter 2 inhibitors and non-steroidal mineralocorticisteroid receptor antagonist has been entirely considered. Furthermore, we highlight the importance of a multidisciplinary approach in the care of patients with DKD, integrating lifestyle modifications and patient education into the clinical practice. This paper advocates for the implementation of standardized screening protocols and the development of personalized treatment strategies to optimize patient outcomes. By addressing the complexities of DKD, we aim to provide a comprehensive framework for healthcare professionals to enhance the quality of care for individuals at risk of or living with this condition.