bluuebunny/crossref_metadata_2025 huggingface dataset:
Detection of Volatile Compounds and Their Contribution to the Nutritional Quality of Chinese and Japanese Welsh Onions (Allium fistulosum L.)
Authors: Liu Xuena , Guo Jinghua , Chen Zijing , Xu Kun , Xu Kang
Published: April 2024

Allium vegetables attract attention for their flavor and aroma in Asia, especially in China and Japan. The aim of this experiment was to uncover the differences in the unique flavor compounds of two Welsh onions that are typical cultivars in China and Japan (‘Zhangqiu’ and ‘Tenko’). Chemical methods and solid-phase microextraction–gas chromatography-mass spectrometry were performed to determine the nutritional quality and quantity of volatile compounds of various organs of Welsh onions. The results show that a total of 30, 37, and 28 compounds were detected in the roots, pseudostem, and leaves of ‘Zhangqiu’, respectively, while 21, 27, and 20 compounds were detected in the corresponding organs of ‘Tenko’. The distribution of sulfur compounds in the roots, pseudostem, and leaves of ‘Zhangqiu’ accounted for 72%, 83%, and 26% of the total content, while those of ‘Tenko’ accounted for 55%, 84%, and 57%, respectively. Aldehydes are the second largest class of volatiles in Welsh onions. The distribution of aldehydes in the leaves was notably different: 52% and 27% in ‘Zhangqiu’ and ‘Tenko’, respectively. The contribution of S to the volatile substances was outstanding, and through forward selection, it was found that P, Ca, and Mg contribute to the volatile substances of Welsh onions. The above results indicate that the different genotypes of Welsh onions have various flavors, and mineral elements contribute variously to these flavors. Calcium could be a new topic of interest for our subsequent research on elements and volatiles.
Optimizing Apricot Yield and Quality with Biostimulant Interventions: A Comprehensive Analysis
Authors: Cirillo Aurora , Izzo Luana , Ciervo Andrea , Ledenko Ivana , Cepparulo Marco , Piscitelli Alfonso , Di Vaio Claudio
Published: April 2024

Biostimulant products are recognized for their ability to improve the agronomic parameters of plants and the qualitative and nutraceutical parameters of fruits and confer greater resistance to plants under abiotic and biotic stress conditions. In our study, we tested three different biostimulants on cultivar “Lady Cot” apricot plants: animal-derived protein hydrolysate, plant-derived protein hydrolysate, and one based on algae to evaluate their effects on improving the agronomic parameters of plants and fruit quality. The product that stood out for providing positive effects was the protein hydrolysate-based product, which increased plant production by 53.80% and yield efficiency by 56.38%. At the same time, it also increased the fruit’s diameter growth by approximately 8.3%, showing positive effects on fruit weight as well. The animal-derived protein hydrolysate also reduced acidity by 13.8% and showed a significant increase compared to the control in terms of total polyphenols. Additional research is scheduled to validate these results and ascertain which categories of biostimulant products are most effective in enhancing the agronomic, qualitative, and sensory characteristics of other apricot cultivars.
Saffron In Vitro Propagation: An Innovative Method by Temporary Immersion System (TIS), Integrated with Machine Learning Analysis
Authors: Tarraf Waed , İzgü Tolga , Şimşek Özhan , Cicco Nunzia , Benelli Carla
Published: April 2024

The propagation of Crocus sativus L. relies exclusively on corm multiplication. As underground storage organs, corms are susceptible to a wide range of pathogens, environmental stresses, and diseases, making traditional propagation methods often ineffective with the loss of valuable material. In vitro propagation offers an alternative for the saffron culture under controlled conditions. In particular, the innovative application of the Temporary Immersion System (TIS) represents a technological advancement for enhancing biomass production with a reduction in operational costs. The current study utilized the Plantform™ bioreactor to propagate in vitro saffron corms from the ‘Abruzzo’ region (Italy), integrating machine learning models to assess its performance. The evaluation of saffron explants after 30, 60, and 90 days of culture showed a marked improvement in growth and microcorm production compared to conventional in vitro culture on semisolid medium, supported by the machine learning analysis. Indeed, the Random Forest algorithm revealed a predictive accuracy with an R2 value of 0.81 for microcorm number, showcasing the capability of machine learning models to forecast propagation outcomes effectively. These results confirm that applying TIS in saffron culture could lead to economically viable, large biomass production within a controlled environment, irrespective of seasonality. This study represents the first endeavor to use TIS technology to enhance the in vitro propagation of saffron in conjunction with machine learning, suggesting an innovative approach for cultivating high-value crops like saffron.
A Review of Emerging Technologies for the Extraction of Bioactive Compounds from Berries (Phalsa Berries)
Authors: Shams Rafeeya , Kaur Simrat , Dash Kshirod Kumar , Czipa Nikolett , Kovács Béla , Shaikh Ayaz Mukarram
Published: April 2024

Berries have been gaining in popularity among consumers and producers due to their natural bioactive compounds that have beneficial effects on human health. This review aimed to identify effective techniques for the extraction of bioactive compounds from berries, consolidate the findings of recent studies using various extraction technologies, and provide a global perspective on the research trends in this field. These extraction techniques include pulsed electric field, ultrasound-assisted extraction, pressurized liquid extraction, microwave-assisted extraction, and supercritical CO2 extraction. The solid waste generated during the industrial berry juice production process is assumed to be a less expensive source of raw materials for the natural extraction of bioactive compounds. The main aim of modern techniques is to produce more of the desired compound and find a method to extract bioactive compounds from berries without the use of hazardous solvents. These include flavonoids, phenols, anthocyanins, and antioxidants. Regarding the characterization of the bioactive compounds that are isolated from berries, aspects such as scanning electron microscopy, X-ray powder diffraction, Fourier transform infrared spectroscopy, and nuclear magnetic resonance were reviewed.
Predicting the Conversion from Mild Cognitive Impairment to Alzheimer’s Disease Using an Explainable AI Approach
Authors: Grammenos Gerasimos , Vrahatis Aristidis G. , Vlamos Panagiotis , Palejev Dean , Exarchos Themis ,   for the Alzheimer’s Disease Neuroimaging Initiative
Published: April 2024

Mild Cognitive Impairment (MCI) is a cognitive state frequently observed in older adults, characterized by significant alterations in memory, thinking, and reasoning abilities that extend beyond typical cognitive decline. It is worth noting that around 10–15% of individuals with MCI are projected to develop Alzheimer’s disease, effectively positioning MCI as an early stage of Alzheimer’s. In this study, a novel approach is presented involving the utilization of eXtreme Gradient Boosting to predict the onset of Alzheimer’s disease during the MCI stage. The methodology entails utilizing data from the Alzheimer’s Disease Neuroimaging Initiative (ADNI). Through the analysis of longitudinal data, spanning from the baseline visit to the 12-month follow-up, a predictive model was constructed. The proposed model calculates, over a 36-month period, the likelihood of progression from MCI to Alzheimer’s disease, achieving an accuracy rate of 85%. To further enhance the precision of the model, this study implements feature selection using the Recursive Feature Elimination technique. Additionally, the Shapley method is employed to provide insights into the model’s decision-making process, thereby augmenting the transparency and interpretability of the predictions.
CRISPR/Cas9-Based Functional Characterization of SfUGT50A15 Reveals Its Roles in the Resistance of Spodoptera frugiperda to Chlorantraniliprole, Emamectin Benzoate, and Benzoxazinoids
Authors: Shi Zhan , Luo Mei , Yuan Jinxi , Gao Bin , Yang Minghuan , Wang Guirong
Published: April 2024

UDP-glycosyltransferases (UGTs) are a diverse superfamily of enzymes. Insects utilize uridine diphosphate-glucose (UDP-glucose) as a glycosyl donor for glycosylation in vivo, involved in the glycosylation of lipophilic endosymbionts and xenobiotics, including phytotoxins. UGTs act as second-stage detoxification metabolizing enzymes, which are essential for the detoxification metabolism of insecticides and benzoxazine compounds. However, the UGT genes responsible for specific glycosylation functions in S. frugiperda are unclear at present. In this study, we utilized CRISPR/Cas9 to produce a SfUGT50A15-KO strain to explore its possible function in governing sensitivity to chemical insecticides or benzoxazinoids. The bioassay results suggested that the SfUGT50A15-KO strain was significantly more sensitive to chlorantraniliprole, emamectin benzoate, and benzoxazinoids than the wild-type strains. This finding suggests that the overexpression of the SfUGT50A15 gene may be linked to S. frugiperda resistance to pesticides (chlorantraniliprole and emamectin benzoate) as well as benzoxazinoids (BXDs).
Evaluation of Cotton Fleahopper (Pseudatomoscelis seriatus (Reuter)) Feeding on Mpp51Aa2-Traited Cotton Utilizing Electrical Penetration Graph (EPG) Waveforms
Authors: Arthur Brady P. , Suh Charles P.-C. , McKnight Benjamin M. , Parajulee Megha N. , Yang Fei , Chappell Thomas M. , Kerns David L.
Published: April 2024

Prior to the recent implementation of the Mpp51Aa2 pesticidal protein (ThryvOn), transgenic cotton cultivars have historically offered no control of the cotton fleahopper (Pseudatomocelis seriatus (Reuter)). To evaluate the feeding behavior of cotton fleahoppers on ThryvOn cotton, electropenetrography (EPG) using a Giga-8 DC instrument was used to monitor the probing activity of fourth- and fifth-instar cotton fleahopper nymphs on both ThryvOn and non-ThryvOn cotton squares. Nymphs were individually placed on an excised cotton square for 8 h of EPG recording, after which resulting waveforms were classified as non-probing, cell rupturing, or ingestion. Although there were significantly more cell rupturing events per insect on ThryvOn (mean ± SEM, 14.8 ± 1.7) than on non-ThryvOn squares (mean ± SEM, 10.3 ± 1.6), there was no difference attributable to ThryvOn in the average number of ingestion events per insect. However, the average duration of ingestion events was significantly shorter on squares with ThryvOn (mean ± SEM, 509 ± 148 s) than on squares without (mean ± SEM, 914 ± 135 s). This suggests that cotton fleahoppers continued to probe despite their inability to sustain ingestion. These results provide conclusive evidence that the Mpp51Aa2 pesticidal protein affects the feeding behavior of cotton fleahopper nymphs.
Clinical Features and Patient Outcomes in Infective Endocarditis with Surgical Indication: A Single-Centre Experience
Authors: Pizzino Fausto , Paradossi Umberto , Trimarchi Giancarlo , Benedetti Giovanni , Marchi Federica , Chiappino Sara , Conti Mattia , Di Bella Gianluca , Murzi Michele , Di Sibio Silvia , Concistrè Giovanni , Bianchi Giacomo , Solinas Marco
Published: April 2024

Background: Infective endocarditis (IE) is marked by a heightened risk of embolic events (EEs), uncontrolled infection, or heart failure (HF). Methods: Patients with IE and surgical indication were enrolled from October 2015 to December 2018. The primary endpoint consisted of a composite of major adverse events (MAEs) including all-cause death, hospitalizations, and IE relapses. The secondary endpoint was all-cause death. Results: A total of 102 patients (66 ± 14 years) were enrolled: 50% with IE on prosthesis, 33% with IE-associated heart failure (IE-aHF), and 38.2% with EEs. IE-aHF and EEs were independently associated with MAEs (HR 1.9, 95% CI 1.1–3.4, p = 0.03 and HR 2.1, 95% CI 1.2–3.6, p = 0.01, respectively) and Kaplan–Meier survival curves confirmed a strong difference in MAE-free survival of patients with EEs and IE-aHF (p < 0.01 for both). IE-aHF (HR 4.3, 95% CI 1.4–13, p < 0.01), CRP at admission (HR 5.6, 95% CI 1.4–22.2, p = 0.01), LVEF (HR 0.9, 95% CI 0.9–1, p < 0.05), abscess (HR 3.5, 95% CI 1.2–10.6, p < 0.05), and prosthetic detachment (HR 4.6, 95% CI 1.5–14.1, p < 0.01) were independently associated with the all-cause death endpoint. Conclusions: IE-aHF and EEs were independently associated with MAEs. IE-aHF was also independently associated with the secondary endpoint.
The Effect of a Cognitive Dual Task on Gait Parameters among Healthy Young Adults with Good and Poor Sleep Quality: A Cross-Sectional Analysis
Authors: Dalbah Jood , Zadeh Shima A. Mohammad , Kim Meeyoung
Published: April 2024

Background: Sleep quality is known to affect automatic and executive brain functions such as gait control and cognitive processing. This study aimed to investigate the effect of dual tasks on gait spatiotemporal parameters among young adults with good and poor sleep quality. Methods: In total, 65 young adults with a mean age of 21.1 ± 2.5 were assessed for gait analysis during single-task and dual-task conditions. The participants’ sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and gait was assessed using the BTS Gaitlab System. The participants were asked to walk at natural speed as a single-task condition, followed by walking while performing a cognitive task as a dual-task condition. The parameters assessed included the gait velocity (m/s), cadence (steps/min), step width (m), and stride length (m). The dual-task cost (DTC) on each gait parameter was calculated. The Mann–Whitney U test was used to compare the differences in the DTC on gait variables between the good and poor sleep quality groups and the Spearman correlation test was used to assess the correlation between total PSQI scores and the DTC. Results: At a significance level of p < 0.05, a significant difference in cadence between the two sleep quality groups was observed, in addition to a positive correlation between sleep quality and the DTC effect on gait mean velocity, cadence, and stride length. Our findings also revealed a greater DTC in participants with poorer sleep quality. Conclusions: These findings contribute to our perception of the significance of sleep quality in gait performance while multitasking in younger populations.
Contemporary Prevalence of Oral Clefts in the US: Geographic and Socioeconomic Considerations
Authors: Brydges Hilliard T. , Laspro Matteo , Verzella Alexandra N. , Alcon Andre , Schechter Jill , Cassidy Michael F. , Chaya Bachar F. , Iturrate Eduardo , Flores Roberto L.
Published: April 2024

Background: Socio-economic status, living environments, and race have been implicated in the development of different congenital abnormalities. As orofacial clefting is the most common anomaly affecting the face, an understanding of its prevalence in the United States and its relationship with different determinants of health is paramount. Therefore, the purpose of this study is to determine the modern prevalence of oral–facial clefting in the United States and its association with different social determinants of health. Methods: Utilizing Epic Cosmos, data from approximately 180 US institutions were queried. Patients born between November 2012 and November 2022 were included. Eight orofacial clefting (OC) cohorts were identified. The Social Vulnerability Index (SVI) was used to assess social determinants of health. Results: Of the 15,697,366 patients identified, 31,216 were diagnosed with OC, resulting in a prevalence of 19.9 (95% CI: 19.7–20.1) per 10,000 live births. OC prevalence was highest among Asian (27.5 CI: 26.2–28.8) and Native American (32.8 CI: 30.4–35.2) patients and lowest among Black patients (12.96 CI: 12.5–13.4). Male and Hispanic patients exhibited higher OC prevalence than female and non-Hispanic patients. No significant differences were found among metropolitan (20.23/10,000), micropolitan (20.18/10,000), and rural populations (20.02/10,000). SVI data demonstrated that OC prevalence was positively associated with the percentage of the population below the poverty line and negatively associated with the proportion of minority language speakers. Conclusions: This study examined the largest US cohort of OC patients to date to define contemporary US prevalence, reporting a marginally higher rate than previous estimates. Multiple social determinants of health were found to be associated with OC prevalence, underscoring the importance of holistic prenatal care. These data may inform clinicians about screening and counseling of expectant families based on socio-economic factors and direct future research as it identifies potential risk factors and provides prevalence data, both of which are useful in addressing common questions related to screening and counseling.
Sex Disparity in the Association of Metabolic Syndrome with Cognitive Impairment
Authors: Chang Yi-Min , Lee Chia-Lin , Wang Jun-Sing
Published: April 2024

Background/Objectives: Metabolic syndrome (MS) is a constellation of several cardiometabolic risk factors. We investigated sex disparity in the associations between MS and cognitive impairment using cross-sectional data from Taiwan Biobank. Methods: We determined the associations of MS and its five components with cognitive impairment (mini-mental state examination, MMSE < 24) and the five domains of MMSE using logistic regression analyses. Results: A total of 7399 men and 11,546 women were included, and MS was significantly associated with cognitive impairment only in women (adjusted OR 1.48, 95% CI 1.29–1.71, p = 0.001) (p for interaction 0.005). In women, the association with MS was significant in orientation (adjusted OR 1.21, 95% CI 1.07–1.37, p = 0.003), memory (adjusted OR 1.12, 95% CI 1.01–1.25, p = 0.034) and design copying (adjusted OR 1.41, 95% CI 1.23–1.62, p = 0.001) (p value for interaction 0.039, 0.023, and 0.093, respectively). Among the components of MS, a large waist circumference (adjusted OR 1.25, 95% CI 1.08–1.46, p = 0.003), high fasting glucose (adjusted OR 1.16, 95% CI 1.00–1.34, p = 0.046), and low HDL cholesterol (adjusted OR 1.16, 95% CI 1.00–1.34, p = 0.049) were significantly associated with cognitive impairment in women. Conclusions: Our findings suggest that sex has a significant influence on the association between MS and cognitive dysfunction, especially in orientation and memory.
Intra-Examiner Reliability and Validity of Sagittal Cervical Spine Mensuration Methods Using Deep Convolutional Neural Networks
Authors: Hosseini Mohammad Mehdi , Mahoor Mohammad H. , Haas Jason W. , Ferrantelli Joseph R. , Dupuis Anne-Lise , Jaeger Jason O. , Harrison Deed E.
Published: April 2024

Background: The biomechanical analysis of spine and postural misalignments is important for surgical and non-surgical treatment of spinal pain. We investigated the examiner reliability of sagittal cervical alignment variables compared to the reliability and concurrent validity of computer vision algorithms used in the PostureRay® software 2024. Methods: A retrospective database of 254 lateral cervical radiographs of patients between the ages of 11 and 86 is studied. The radiographs include clearly visualized C1–C7 vertebrae that were evaluated by a human using the software. To evaluate examiner reliability and the concurrent validity of the trained CNN performance, two blinded trials of radiographic digitization were performed by an extensively trained expert user (US) clinician with a two-week interval between trials. Then, the same clinician used the trained CNN twice to reproduce the same measures within a 2-week interval on the same 254 radiographs. Measured variables included segmental angles as relative rotation angles (RRA) C1–C7, Cobb angles C2–C7, relative segmental translations (RT) C1–C7, anterior translation C2–C7, and absolute rotation angle (ARA) C2–C7. Data were remotely extracted from the examiner’s PostureRay® system for data collection and sorted based on gender and stratification of degenerative changes. Reliability was assessed via intra-class correlations (ICC), root mean squared error (RMSE), and R2 values. Results: In comparing repeated measures of the CNN network to itself, perfect reliability was found for the ICC (1.0), RMSE (0), and R2 (1). The reliability of the trained expert US was in the excellent range for all variables, where 12/18 variables had ICCs ≥ 0.9 and 6/18 variables were 0.84 ≤ ICCs ≤ 0.89. Similarly, for the expert US, all R2 values were in the excellent range (R2 ≥ 0.7), and all RMSEs were small, being 0.42 ≤ RMSEs ≤ 3.27. Construct validity between the expert US and the CNN network was found to be in the excellent range with 18/18 ICCs in the excellent range (ICCs ≥ 0.8), 16/18 R2 values in the strong to excellent range (R2 ≥ 0.7), and 2/18 in the good to moderate range (R2 RT C6/C7 = 0.57 and R2 Cobb C6/C7 = 0.64. The RMSEs for expert US vs. the CNN network were small, being 0.37 ≤ RMSEs ≤ 2.89. Conclusions: A comparison of repeated measures within the computer vision CNN network and expert human found exceptional reliability and excellent construct validity when comparing the computer vision to the human observer.
The Short-Term Efficacy of a Three-Week Pulmonary Rehabilitation Program among Patients with Obstructive Lung Diseases
Authors: Klimczak Magdalena K. , Krzepkowski Hubert A. , Piotrowski Wojciech J. , Białas Adam J.
Published: April 2024

Introduction: The recommended duration for pulmonary rehabilitation stands at a minimum of six weeks; however, this stipulation may pose constraints in various countries due to financial limitations imposed by insurance companies and/or national health funds, as is the case in Poland. Consequently, our study endeavors to analyze the short-term outcomes stemming from a condensed three-week PR regimen administered to patients diagnosed with chronic obstructive pulmonary disease (COPD), asthma, and the concomitance of these conditions (COPD-A)—this is an approach that is standard in the rehabilitation protocols endorsed by our national health fund. Methods: Patients diagnosed with COPD, asthma, and COPD-A, referred to the PR program, underwent retrospective analysis to evaluate the short-term efficacy of a three-week PR program. Patients underwent comprehensive assessment by respiratory physicians and rehabilitation consultants, leading to individualized PR programs. Clinical evaluations occurred at program onset and completion. Results: 125 patients participated: 37 COPD, 61 asthma, and 27 COPD-A. Significant improvements were observed in the COPD Assessment Test (CAT), the consensus-based GINA symptom control tool (GINA-SCT), the Modified Medical Research Council (mMRC) scale, forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), and the 6-min walk test (6 MWT) distance, as well as in the St. George’s Respiratory Questionnaire (SGRQ) scores. All groups experienced reduced dyspnea severity and improved exercise tolerance. FEV1 and FVC improved in asthma and COPD-A, but not significantly in COPD. Multivariable logistic regression identified predictive factors for PR response. Conclusions: The study supports the short-term efficacy of the three-week PR program in improving clinical outcomes, exercise tolerance, and quality of life in COPD and asthma patients. Tailoring interventions based on predictors of PR response can optimize outcomes. Further research, particularly of the COPD-A group, is needed for individualized approaches. Larger sample sizes are necessary to confirm our findings.
Vitamin D and Albumin Deficiency in a Swiss Orthopaedic Surgery In-Patient Cohort
Authors: Kingston Craig David , Santini Simone , Hauke Dorian , Valderrabano Victor
Published: April 2024

Background: Vitamin D and protein deficiencies are common conditions in the general population. In Orthopaedic surgery, they can result in wound complications or poor bone healing. The goal of this study was, therefore, to determine the prevalence of vitamin D and albumin deficiencies in patients scheduled for elective Orthopaedic procedures. Methods: We performed an observational, noninterventional study using the demographic characteristics via means chart analysis of in-patients with an elective surgery in a single Swiss Orthopaedic centre. The following variables were collected and analysed: age, gender, BMI, ASA score, rate of vitamin D supplementation before surgery, and serum preoperative levels of vitamin D, albumin, Haemoglobin, calcium, and phosphate. Results: A total of 336 patients were analysed; there were 218 women (64.9%) and 118 men (35.1%). The average age was 59.4 years (17–89 years). The average BMI was 26.8 kg/m2 (17.8–37.6) and the average ASA score was II (I–III). The overall prevalence of vitamin D deficiency was 82.1%, being more common in the male (89.8%) than female patients (77.9%). Patients who received vitamin D supplements before surgery had an average vitamin D level in the normal range. Of the subgroup of 170 patients who were over 60 years of age, 78.8% of the patients were Vitamin D deficient, with deficiency once again being more common in men (93.3%) than in women (92%). Albumin deficiency was documented in 58.9% of the cases. A total of 62.8% of all the female patients were albumin deficient, and 51.7% of all male patients were. Of the subgroup of 170 patients who were over 60 years of age, 71.8% of the patients were albumin deficient, with the deficiency being practically identical in men (71.1%) and women (72%). Conclusions: Despite increased awareness in the medical community, vitamin D and albumin deficiencies remain highly prevalent in elective Orthopaedic patients. Pre/perioperative screening and addressing possible vitamin D and albumin deficiencies are of great importance for good outcomes in Orthopaedic surgery.
Clival Metastases: Single-Center Retrospective Case Series and Literature Review
Authors: Carretta Alessandro , Sollini Giacomo , Guaraldi Federica , Rustici Arianna , Magnani Marcello , Asioli Sofia , Faustini-Fustini Marco , Pasquini Ernesto , Zoli Matteo , Mazzatenta Diego
Published: April 2024

Background/Objectives: Clivus metastases from distant neoplasms are uncommon occurrences both in clinical practice and the neurosurgical literature. Surgical management is debated, particularly about the role of surgery and the preferable approach. The aim of this study was to report our surgical experience and review the concerning literature. Methods: Our institutional registry was retrospectively reviewed, and patients who underwent surgical treatment for clival metastasis from 1998 to 2023 were included. A PRISMA systematic review of the literature was performed. Results: Four patients were enrolled, and all of them underwent an endoscopic endonasal approach (EEA). Three presented with cranial nerve (CN) VI palsy. The aim of surgery was biopsy in all cases. No complications were reported. Mean overall survival (OS) was 6 ± 1 months. The systematic review retrieved 27 papers reporting 39 patients who underwent the surgical treatment of clivus metastases. Most of them (79.5%) presented with CN palsies, and EEA was the preferred approach in 92.3% of the cases, to perform a biopsy in most patients (59%). Two hemorrhagic complications (5.1%) were reported, and the mean OS was 9.4 ± 5.6 months. Conclusions: Clival metastases are uncommonly observed, in most cases, during advanced stages of oncological disease. The aim of surgery should be the confirmation of diagnosis and symptomatic relief, balancing the risk–benefit ratio in a multidisciplinary context. EEA is the approach of choice, and it should be carried out in experienced tertiary skull base centers.
Biochemical Changes in Anterior Chamber of the Eye in Diabetic Patients—A Review
Authors: Dolar-Szczasny Joanna , Drab Agnieszka , Rejdak Robert
Published: April 2024

This article aims to provide a comprehensive review of the biochemical changes observed in the anterior chamber of the eye in diabetic patients. The increased levels of inflammatory markers, alterations in antioxidant defense mechanisms, and elevated levels of advanced glycation end products (AGEs) in the aqueous humor (AH) are explored. Additionally, the impact of these biochemical changes on diabetic retinopathy progression, increased intraocular pressure, and cataract formation is discussed. Furthermore, the diagnostic and therapeutic implications of these findings are presented. This study explores potential biomarkers for detecting diabetic eye disease at an early stage and monitoring its progression. An investigation of the targeting of inflammatory and angiogenic pathways as a potential treatment approach and the role of antioxidant agents in managing these biochemical changes is performed.
Systemic Inflammatory Response Index (SIRI) as a Predictive Marker for Adverse Outcomes in Children with New-Onset Type 1 Diabetes Mellitus
Authors: Scutca Alexandra-Cristina , Jugănaru Iulius , Nicoară Delia-Maria , Brad Giorgiana-Flavia , Bugi Meda-Ada , Asproniu Raluca , Cristun Lucian-Ioan , Mărginean Otilia
Published: April 2024

(1) Background: Although most cases of new-onset type 1 diabetes mellitus (T1DM) are managed without serious events, life-threatening complications do arise in a subset of patients. Our objective was to assess the correlation between elevated SIRI values and adverse events related to the onset of T1DM. (2) Methods: This retrospective study, spanning ten years, included 187 patients with new-onset T1DM divided into three groups based on SIRI tertiles. The primary outcome was the occurrence of acute complications during hospital admission, while the secondary outcome was prolonged Intensive Care Unit (ICU) admission. (3) Results: Patients with high SIRI values were more likely to experience higher disease activity, leading to longer ICU admission times and more frequent complications. Multivariate logistic regression analysis revealed that the SIRI was independently associated with acute complications (p = 0.003) and prolonged ICU length of stay (p = 0.003). Furthermore, receiver operating characteristic analysis demonstrated the SIRI’s superior predictive accuracy compared to venous pH (AUC = 0.837 and AUC = 0.811, respectively) and to the individual component cell lineages of the SIRI. (4) Conclusions: These findings emphasize the potential utility of the SIRI as a prognostic marker in identifying patients at increased risk during T1DM hospital admissions.
A Review of Key Regulators of Steady-State and Ineffective Erythropoiesis
Authors: Țichil Ioana , Mitre Ileana , Zdrenghea Mihnea Tudor , Bojan Anca Simona , Tomuleasa Ciprian Ionuț , Cenariu Diana
Published: April 2024

Erythropoiesis is initiated with the transformation of multipotent hematopoietic stem cells into committed erythroid progenitor cells in the erythroblastic islands of the bone marrow in adults. These cells undergo several stages of differentiation, including erythroblast formation, normoblast formation, and finally, the expulsion of the nucleus to form mature red blood cells. The erythropoietin (EPO) pathway, which is activated by hypoxia, induces stimulation of the erythroid progenitor cells and the promotion of their proliferation and survival as well as maturation and hemoglobin synthesis. The regulation of erythropoiesis is a complex and dynamic interaction of a myriad of factors, such as transcription factors (GATA-1, STAT5), cytokines (IL-3, IL-6, IL-11), iron metabolism and cell cycle regulators. Multiple microRNAs are involved in erythropoiesis, mediating cell growth and development, regulating oxidative stress, erythrocyte maturation and differentiation, hemoglobin synthesis, transferrin function and iron homeostasis. This review aims to explore the physiology of steady-state erythropoiesis and to outline key mechanisms involved in ineffective erythropoiesis linked to anemia, chronic inflammation, stress, and hematological malignancies. Studying aberrations in erythropoiesis in various diseases allows a more in-depth understanding of the heterogeneity within erythroid populations and the development of gene therapies to treat hematological disorders.
Awareness of Pregnant Patients about Congenital Cytomegalovirus Infection—A Semi-Systematic Review
Authors: Bartnik Paweł , Bender Aleksandra , Kacperczyk-Bartnik Joanna , Ciebiera Michał , Urban Aleksandra , Sienko Anna , Bilir Esra , Romejko-Wolniewicz Ewa , Sieńko Jacek
Published: April 2024

Background: Cytomegalovirus (CMV) infection represents a major issue worldwide, since it constitutes the most common viral congenital infection, with a prevalence of 0.58% and 1–5% in developed and developing countries, respectively. According to recent studies, prenatal treatment significantly decreases the risk of vertical CMV transmission, and early intervention may even prevent the termination of pregnancy. This study aimed to investigate the level of awareness of CMV among pregnant patients through a semi-systematic review. Methods: We included all of the original articles investigating knowledge and awareness about CMV infection among pregnant women. Our research included the PubMed database. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement, the Covidence system automatically guided us to screen the titles and/or abstracts, and then full-texts, followed by data extraction from the eligible studies. Results: We screened 764 studies altogether, with 13 studies included in this analysis. Knowledge about the existence of CMV infection risk varied between the articles, ranging from 11.4% in a study performed in Ireland to 60% reported in a study on the French population. Studies analyzing the impact of educational interventions on patients’ knowledge about preventive measures reported significant improvement compared to their level of awareness before the intervention. Conclusions: Patients’ awareness and knowledge about CMV seemed to be generally low or very low during the last decade before the development of effective secondary prevention methods. Educational interventions seem to be effective, and therefore their wide use could be of potential benefit. In the era of available secondary prevention of vertical transmission, it is crucial to concentrate the efforts of different stakeholders to increase the awareness of cCMV among pregnant women.
Massive Transfusion Protocol and Outcome of Patients with Acute Variceal Bleeding
Authors: Kim Aryoung , Sinn Dong Hyun , Song Byeong Geun , Goh Myung Ji , Hwang Sung Yeon , Ko Ryoung-Eun , Chung Chi Ryang , Park Chi-Min
Published: April 2024

Background/Aims: The massive transfusion protocol (MTP) can improve the outcomes of trauma patients with hemorrhagic shock and some patients with non-traumatic hemorrhagic shock. However, no information is available regarding whether MTP can improve the outcomes of acute variceal bleeding (AVB). This study aimed to determine the effects of MTP on the outcomes of patients with AVB. Methods: Consecutive patients (n = 218) with AVB who did not have current malignancy and visited the emergency room between July 2014 and June 2022 were analyzed. 42-day mortality and failure to control the bleeding were compared between patients with and without MTP activation. Additionally, propensity-score matching was conducted. Results: The amount of blood product transfused was higher in the MTP group. The 42-day mortality rate (42.1% vs. 1.5%, p < 0.001) and the rate of failure to control bleeding (36.8% vs. 0.5%, p < 0.001) were significantly higher in those who received blood transfusions by MTP. MTP was an independent factor associated with 42-day mortality in the multivariable-adjusted analysis (HR 21.05; 95% CI 3.07–144.21, p = 0.002, HR 24.04; 95% CI 3.41–169.31, p = 0.001). The MTP group showed consistently higher 42-day mortality and failure to control bleeding in all subgroup analyses, stratified by systolic blood pressure, hemoglobin level, and the model for end-stage liver disease score. The MTP group also showed higher 42-day mortality (42.9% vs. 0%, p = 0.001) and failure to control bleeding (42.9% vs. 0%, p = 0.001) in a propensity score-matched analysis (n = 52). Conclusions: MTP was associated with poor outcomes in patients with AVB. Further studies are needed to see whether MTP can be an option for patients with massive AVB.
The Clinical Efficacy of Different Relaxation Exercises on Intraocular Pressure Reduction: A Meta-Analysis
Authors: Wu Bing-Qi , Kuo Hou-Ting , Hsu Alan Y. , Lin Chun-Ju , Lai Chun-Ting , Tsai Yi-Yu
Published: April 2024

Objective: The aim of this study was to synthesize the available evidence on the clinical efficacy of different relaxation exercises on intraocular pressure (IOP) reduction. Methods: A systemic search of PubMed, Embase, Cochrane CENTRAL, and Web of Science was undertaken from the earliest record to 10 April 2024. Peer-reviewed studies that reported on healthy individuals and glaucoma patients engaging in relaxation exercises for at least three weeks were included. The primary outcome was changes in IOP levels from baseline, before the commencement of relaxation exercises, to post-exercise. Our statistical analysis employed a random-effects model, with effect sizes reported using Hedges’ g. Results: Twelve studies were included, totaling 764 eyes (mean participant age ranging from 21.07 to 69.50 years). Relaxation exercises significantly reduced IOP, with Hedges’ g being −1.276 (95% CI: −1.674 to −0.879) and I2 = 84.4%. Separate subgroup analyses showed that breathing exercises (Hedges’ g = −0.860, p < 0.0001), mindfulness-based stress reduction (MBSR) (Hedges’ g = −1.79, p < 0.0001), and ocular exercises (Hedges’ g = −0.974, p < 0.0001) were associated with reduced IOP levels. The reduction in IOP following the relaxation exercises was found to be associated with baseline IOP either greater than (Hedges’ g = −1.473, p < 0.0001) or less than 21 mmHg (Hedges’ g = −1.22, p < 0.0001). Furthermore, this effect persisted with follow-up durations of less than (Hedges’ g = −1.161, p < 0.0001) and more than one month (Hedges’ g = −1.324, p < 0.0001). Conclusions: The current meta-analysis indicates that relaxation exercises can significantly reduce IOP levels. Relaxation exercises are a potential class of novel treatments for glaucoma patients that deserve further evaluation.
Heart Failure Management through Telehealth: Expanding Care and Connecting Hearts
Authors: Tedeschi Andrea , Palazzini Matteo , Trimarchi Giancarlo , Conti Nicolina , Di Spigno Francesco , Gentile Piero , D’Angelo Luciana , Garascia Andrea , Ammirati Enrico , Morici Nuccia , Aschieri Daniela
Published: April 2024

Heart failure (HF) is a leading cause of morbidity worldwide, imposing a significant burden on deaths, hospitalizations, and health costs. Anticipating patients’ deterioration is a cornerstone of HF treatment: preventing congestion and end organ damage while titrating HF therapies is the aim of the majority of clinical trials. Anyway, real-life medicine struggles with resource optimization, often reducing the chances of providing a patient-tailored follow-up. Telehealth holds the potential to drive substantial qualitative improvement in clinical practice through the development of patient-centered care, facilitating resource optimization, leading to decreased outpatient visits, hospitalizations, and lengths of hospital stays. Different technologies are rising to offer the best possible care to many subsets of patients, facing any stage of HF, and challenging extreme scenarios such as heart transplantation and ventricular assist devices. This article aims to thoroughly examine the potential advantages and obstacles presented by both existing and emerging telehealth technologies, including artificial intelligence.
The Ascyrus Medical Dissection Stent: A One-Fits-All Strategy for the Treatment of Acute Type A Aortic Dissection?
Authors: Pitts Leonard , Moon Michael C. , Luehr Maximilian , Kofler Markus , Montagner Matteo , Sündermann Simon , Buz Semih , Starck Christoph , Falk Volkmar , Kempfert Jörg
Published: April 2024

The treatment of DeBakey type I aortic dissection remains a major challenge in the field of aortic surgery. To upgrade the standard of care hemiarch replacement, a novel device called an “Ascyrus Medical Dissection Stent” (AMDS) is now available. This hybrid device composed of a proximal polytetrafluoroethylene cuff and a distal non-covered nitinol stent is inserted into the aortic arch and the descending thoracic aorta during hypothermic circulatory arrest in addition to hemiarch replacement. Due to its specific design, it may result in a reduced risk for distal anastomotic new entries, the effective restoration of branch vessel malperfusion and positive aortic remodeling. In this narrative review, we provide an overview about the indications and the technical use of the AMDS. Additionally, we summarize the current available literature and discuss potential pitfalls in the application of the AMDS regarding device failure and aortic re-intervention.
Basic Principles and Role of Endoscopic Ultrasound in Diagnosis and Differentiation of Pancreatic Cancer from Other Pancreatic Lesions: A Comprehensive Review of Endoscopic Ultrasound for Pancreatic Cancer
Authors: Dahiya Dushyant Singh , Shah Yash R. , Ali Hassam , Chandan Saurabh , Gangwani Manesh Kumar , Canakis Andrew , Ramai Daryl , Hayat Umar , Pinnam Bhanu Siva Mohan , Iqbal Amna , Malik Sheza , Singh Sahib , Jaber Fouad , Alsakarneh Saqr , Mohamed Islam , Ali Meer Akbar , Al-Haddad Mohammad , Inamdar Sumant
Published: April 2024

Pancreatic cancer is one of the leading causes of cancer-related deaths worldwide. Pancreatic lesions consist of both neoplastic and non-neoplastic lesions and often pose a diagnostic and therapeutic challenge due to similar clinical and radiological features. In recent years, pancreatic lesions have been discovered more frequently as incidental findings due to the increased utilization and widespread availability of abdominal cross-sectional imaging. Therefore, it becomes imperative to establish an early and appropriate diagnosis with meticulous differentiation in an attempt to balance unnecessary treatment of benign pancreatic lesions and missing the opportunity for early intervention in malignant lesions. Endoscopic ultrasound (EUS) has become an important diagnostic modality for the identification and risk stratification of pancreatic lesions due to its ability to provide detailed imaging and acquisition of tissue samples for analysis with the help of fine-needle aspiration/biopsy. The recent development of EUS-based technology, including contrast-enhanced endoscopic ultrasound, real-time elastography–endoscopic ultrasound, miniature probe ultrasound, confocal laser endomicroscopy, and the application of artificial intelligence has significantly augmented the diagnostic accuracy of EUS as it enables better evaluation of the number, location, dimension, wall thickness, and contents of these lesions. This article provides a comprehensive overview of the role of the different types of EUS available for the diagnosis and differentiation of pancreatic cancer from other pancreatic lesions while discussing their key strengths and important limitations.
Telemedical Intervention and Its Effect on Quality of Life in Chronic Heart Failure Patients: The Results from the Telemedicine and e-Health Solution Pilot Program
Authors: Wańczura Piotr , Aebisher David , Wiśniowski Mateusz , Kos Marek , Bukowski Hubert , Hołownia-Voloskova Malwina , Przybylski Andrzej
Published: April 2024

(1) Background: Heart failure (HF) is not only a common cardiovascular disease with a poor prognosis. Its prevalence in developed countries equals 1–2% of the general population of adults, while in Poland HF, patients constitute 3.2% of the total population. Modern heart failure treatment should be focused not only on reducing the risk of death and the number of readmissions due to HF exacerbation but quality of life as well. Telemedicine has been suggested as a viable tool for enhancing HRQL. Therefore, we present the results of telemedical intervention in a group of HF patients and its effect on quality of life in chronic heart failure patients from a pilot study dedicated to reducing social inequalities in health through the use of telemedicine and e-health solutions. (2) Method: The project was a multicenter, open, non-controlled trial conducted by the University of Rzeszów, Poland. The data points were collected in the June 2023–December 2023 period from fourteen primary care units from five voivodeships, mostly considered social exclusion areas. A total of 52.7% of the patients recruited were Podkarpackie Voivodeship inhabitants. The result and discussion are presented based on the Chronic Heart Failure Questionnaire (CHFQ) and the EuroQol Visual Analogue Scale (EQVAS). (3) Results: During the program, a total of over 100,000 telemedicine examinations were conducted in the form of body weight measurement, heart rate, blood pressure tests, and 7-day Holter or 14-day event Holter assessment. Over the course of this study, coordinating the pilot program medical staff has ordered 570 changes in the patient’s pharmacotherapy, confirming the positive impact on quality of life in the study group. (4) Conclusions: A comprehensive telemedical intervention can contribute to an improvement in the quality of life of patients with HF beyond what was achieved with the basic standard of care in the group of HF patients from the social exclusion region. It is now unclear if the result of the basic telemedical intervention would be constant after discontinuation of the mentioned pilot program.
Use of Fluorescence Imaging in Liver Transplant Surgery
Authors: Ducas Alvaro , Martinino Alessandro , Evans Lorna Astrid , Manueli Laos Emiliano G. , Giovinazzo Francesco ,   on behalf of the SMAGEICS Group
Published: April 2024

Liver transplant surgery is a complex procedure that demands high knowledge of surgical anatomy and the precise recognition and preservation of structures. To address this, the use of fluorescence imaging has facilitated the identification of anatomical structures such as biliary ducts, arteries, and liver segmentation. Indocyanine green is among the most commonly utilized fluorescent agents, not just during surgery but also in the pre- and postoperative phases, where it is used to assess graft failure by measuring the plasma disappearance rate. New advancements such as artificial intelligence paired with fluorescence imaging have the potential to enhance patient outcomes. Additionally, technologies such as augmented reality and mixed reality could be integrated into surgical procedures, broadening the scope of possibilities for improving patient safety.