bluuebunny/crossref_metadata_2025 huggingface dataset:
Fractal Strategy for Improving Characterization of N2 Adsorption–Desorption in Mesopores
Authors: Feng Kunpeng , Liu Gaofeng , Zhang Zhen , Liu Huan , Lv Runsheng , Wang Xiaoming , Chang Ping , Lin Jia , Barakos George
Published: October 2024

The current studies primarily analyze the heterogeneity and complexity of mesopore structures based on low-temperature nitrogen (N2) adsorption curves and the Frenkel–Halsey–Hill (FHH) fractal model. However, these studies ignore the fact that the low-temperature N2 desorption curve can also reflect the desorption performance of the mesopore structure. In this research, novel fractal indicators for characterizing the adsorption–desorption performance of mesopores based on the fractal dimension from the N2 adsorption curves and N2 desorption curves are proposed. The novel fractal indicators I1 and I2 are applied to evaluate the adsorption–desorption performance of mesopores with pore size 2–5 nm and pore size 5–50 nm, respectively. The fractal indicator I1 shows an increasing trend with coalification, reflecting that the gas adsorption performance of 2–5 nm mesopores is enhanced with coalification. The fractal indicator I2 exhibits a trend of first increasing and then decreasing with coalification, indicating the gas desorption performance of mesopores with pore size 5–50 nm decreases first and then increases. The proposed indicators provide novel analytical parameters for further understanding the gas adsorption–desorption mechanism of porous coal-based or carbon-based materials.
A Novel Approach to the Fractional Laplacian via Generalized Spherical Means
Authors: Bouzeffour Fethi
Published: October 2024

Although at least ten equivalent definitions of the fractional Laplacian exist in unbounded domains, we introduce an additional equivalent definition based on the generalized spherical mean-value operator—a Fourier multiplier operator involving the normalized Bessel function. Specifically, we demonstrate that this new definition allows us to reduce any n-dimensional fractional Laplacian to a one-dimensional operator, which simplifies computation and enhances efficiency. We propose two methods for computing the generalized spherical means of a given function: one by solving standard wave equations and the other by solving Darboux’s equations.
Finite-Time Synchronization Criteria for Caputo Fractional-Order Uncertain Memristive Neural Networks with Fuzzy Operators and Transmission Delay Under Communication Feedback
Authors: Fan Hongguang , Shi Kaibo , Guo Zizhao , Zhou Anran
Published: October 2024

Unlike existing memristive neural networks or fuzzy neural networks, this article investigates a class of Caputo fractional-order uncertain memristive neural networks (CFUMNNs) with fuzzy operators and transmission delay to realistically model complex environments. Especially, the fuzzy symbol AND and the fuzzy symbol OR as well as nonlinear activation behaviors are all concerned in the generalized master-slave networks. Based on the characteristics of the neural networks being studied, we have designed distinctive information feedback control protocols including three different functional sub-modules. Combining comparative theorems, inequality techniques, and stability theory, novel delay-independent conditions can be derived to ensure the finite-time synchronization (FTS) of fuzzy CFUMNNs. Besides, the upper bound of the settling time can be effectively evaluated based on feedback coefficients and control parameters, which makes the achievements of this study more practical for engineering applications such as signal encryption and secure communications. Ultimately, simulation experiments show the feasibility of the derived results.
Transnational Cyber Governance for Risk Management in the Gas Sector: Exploring the Potential of G7 Cooperation
Authors: Pengili Megghi , Raszewski Slawomir
Published: October 2024

At the Group of Seven (G7) summit held on 13–15 June in 2024, the Group’s leaders committed to establishing a collective cyber security framework and reinforcing the work of the cyber security working group to manage the risks targeting energy systems. Likewise, oil and electricity, and natural gas rely on complex and interdependent technologies and communication networks from production to consumption. The preparedness to handle cyber security threats in the energy infrastructures among decision makers, planners, and the industry in a concerted manner signifies that cyber security is becoming more appreciated. Therefore, considering the ambition and achievement of the G7 countries towards energy and cyber sovereignty, this paper’s focus and research question aims to explore the potential existence of the cyber governance alliance in the gas subsector within the G7. The objective of this paper is twofold. First, it explores the potential of the G7, the world’s seven largest advanced economies, to lead on a nascent cyber governance for risk management in the gas sector. The qualitative analysis conducted through the institutional analysis and design method examines up-to-date data involving mainly state actors. Second, by drawing on LNG, one of the world’s fastest growing energy types in the coming decades, the paper points out the need for further research on the transnational governance operating through public–private engagement to address the cyber risks to gas systems. While the paper makes an empirical contribution to the field of security governance and a practical contribution to security consulting, its limitations rely on the necessity to also conduct a quantitative enquiry, which would necessitate, among others, a review of the literature in the G7 countries, and a group of researchers from academia and practitioners to obtain a sense of the cyberspace in the energy reality.
Bungen—An East Asian Philosophy of Culture in Terms of Intercultural Interactions and a Reinterpretation of Watsuji’s Concept of Aidagara
Authors: Tam Andrew Ka Pok
Published: October 2024

Influenced by Hegel, modern Chinese philosophers (e.g., Mou Zong-San, Lao Sze-Kwang, etc.) and Japanese philosophers (e.g., Nishida Kitaro) were inclined to narrate Chinese or Japanese culture in terms of the Hegelian concept of ‘spirit’. Nevertheless, the Hegelian philosophy of culture assumes the existence of an unchangeable cultural spirit and was therefore criticised by Watsuji Tetsuro. Watsuji denies the existence of an unchangeable cultural spirit and argues that cultures arise from the aidagara (interactions) between Ningen (human society) and Fudo (nature). Yet Watsuji’s narration of culture overemphasised the aidagara between Ningen and Fudo but disregarded that culture may also arise from the aidagara among cultures. Therefore, by reinterpreting Watsuji’s concept of aidagara, this paper proposes the concept of Bungen to explain the formation of cultures in terms of intercultural interactions and therefore highlight the diversity of East Asian cultures.
Outcomes of COVID-19 in Pregnant Women: A Retrospective Analysis of 300 Cases in Jordan
Authors: Al-Amoosh Hamza Hasan Suliman , Al-Amer Rasmieh , Alamoush Aysheh Hasan , Alquran Fatima , Atallah Aldajeh Taghreed Mohammad , Al Rahamneh Taysier Ahmad , Gharaibeh Amer , Ali Amira Mohammed , Maaita Maher , Darwish Tamara
Published: October 2024

Background: The impact of COVID-19 on pregnancy remains a critical area of research, with growing evidence suggesting that maternal infection, particularly in the third trimester, may lead to significant complications Aims: The primary aim was to investigate the maternal and neonatal outcome of pregnant Jordanian women with COVID-19. The secondary aim included exploring demographics, obstetrics characteristics, and comorbidities among these women. Methods: A retrospective comprehensive review of the records of 300 cases of pregnant women with COVID-19, who were treated between November 2020 and April 2021 at Queen Alia Military Hospital (a main referral center for patients with COVID-19) in Jordan. All cases were confirmed by the rapid antigen test (RAT) + long polymerase chain reaction (PCR) test used to detect SARS-CoV-2 by amplifying viral RNA from patient samples. Women infected with COVID-19 were categorized into four groups according to the RCOG guidelines for COVID-19 infection in pregnancy: asymptomatic, mild, moderate, and severe cases. All cases were managed following the Royal College of Obstetricians and Gynecologists protocol for COVID-19 in pregnancy. Data extracted from patient’s records included demographic information, COVID-19 clinical manifestations, obstetric history, diagnostic findings, treatment plans, comorbidities, gestational age at diagnosis, treatment protocols, and maternal and neonatal outcomes. Results: The mean age was 29.7 years; 98.3% were nonsmokers; 8% had previous miscarriages, and 67.3% had the infection in the third trimester. Iron deficiency anemia affected 30.3%, while 18.3% had comorbidities, mainly hypothyroidism. Most women were asymptomatic 61.7%, but 33% had respiratory symptoms, 4.7% needed intensive care unit (ICU) admission, and 2.7% resulted in maternal deaths. First-trimester and second-trimester miscarriages were recorded in 2.67% and 3.67% of cases, respectively, while preterm labor occurred in 3.0% of pregnancies. Additionally, age and hospitalization duration had a positive correlation with the neonatal outcomes (r = 0.349, p < 0.01), (r = 0.376, p < 0.01), respectively. Furthermore, COVID-19 presentation and treatment options demonstrated a strong positive correlation (p-value <0.01). On the other hand, maternal death had a strong negative correlation with poor neonatal outcomes (r = −0.776, p < 0.01). Conclusion: The study showed that COVID-19 in pregnant women, particularly in the third trimester, is associated with significant neonatal complications, with age, hospitalization duration, and COVID-19 severity strongly impacting outcomes.
Unusual Composition of the Sarezzano Reliquary Busts
Authors: Labate Maria , Sirello Carmela , Aceto Maurizio , Cervini Fulvio , Castronovo Simonetta , Operti Lorenza , Agostino Angelo
Published: October 2024

The interdisciplinary study of two reliquary busts from Sarezzano (Piedmont, Italy) is a perfect example of the necessity to provide for material characterisation as a recurring common practice in historical studies and a mandatory step in conservation assessment. Furthermore, the diagnostics of cultural heritage play a crucial role in art historical research, providing relevant information on artefacts’ genesis, production technology, and conservation history. The study of the materials of the reliquary busts was performed by non-invasive (portable X-ray fluorescence spectrometry) and micro-invasive (stereomicroscope, attenuated total reflection Fourier transform infrared spectroscopy and powder X-ray diffraction analysis) methods. According to the results, the busts were found to be made of a tin–lead alloy, a rather unusual material for mediaeval reliquary busts. Moreover, the outcome suggests that the busts were originally silvered, except for the hair and beard which are still gilded. The analysis reveals the use of colophony as an adhesive buffer layer on the busts’ alloy, as well as inside them, to favour the metal working process, since it is found as degraded residue. Finally, even the typology of alloy decay is defined. All this information has enabled us to determine the artistic technique and estimate the value and quality of the material employed. In addition, it has led to the correct choice of materials and methods to be adopted during the restoration, and therefore the usage of more suitable solvents and tools.
Blockchain Tokens, Price Volatility, and Active User Base: An Empirical Analysis Based on Tokenomics
Authors: Moncada Roberto , Ferro Enrico , Fiaschetti Maurizio , Medda Francesca
Published: October 2024

Blockchain tokens have accumulated tremendous market value but remain highly controversial, given their price volatility and seemingly speculative nature. Ironically, this very characteristic can foster token retention as users wait for occasions of appreciation. In this paper, we conduct an empirical analysis with 58 tokens in two steps: first, an investigation of the drivers of user activity and token price volatility using a new blockchain token classification framework, searching for possible tokenomics links. Our findings suggest that there is an intrinsic relationship between the way tokens are used as a means of exchange and how token usage dynamics influence user engagement oppositely to market stability. Only some features, such as earning potential and voting rights, foster token-holding strategies, while only Ethereum ecosystem membership has positive effects on price volatility. Second, we analyze the direct relationship between price volatility and active users. Results show that, on average, a 10% increase in volatility is related to a decrease in active addresses ranging between 3.96% and 5.88%. The finding is supportive of the hypothesis that token price volatility may be treated as an opportunity to increase token retention.
Enhanced Chaotic Pseudorandom Number Generation Using Multiple Bernoulli Maps with Field Programmable Gate Array Optimizations
Authors: Palacios-Luengas Leonardo , Medina-Ramírez Reyna Carolina , Marcelín-Jiménez Ricardo , Rodriguez-Colina Enrique , Castillo-Soria Francisco R. , Vázquez-Medina Rubén
Published: October 2024

Certain methods for implementing chaotic maps can lead to dynamic degradation of the generated number sequences. To solve such a problem, we develop a method for generating pseudorandom number sequences based on multiple one-dimensional chaotic maps. In particular, we introduce a Bernoulli chaotic map that utilizes function transformations and constraints on its control parameter, covering complementary regions of the phase space. This approach allows the generation of chaotic number sequences with a wide coverage of phase space, thereby increasing the uncertainty in the number sequence generation process. Moreover, by incorporating a scaling factor and a sine function, we develop a robust chaotic map, called the Sine-Multiple Modified Bernoulli Chaotic Map (SM-MBCM), which ensures a high degree of randomness, validated through statistical mechanics analysis tools. Using the SM-MBCM, we propose a chaotic PRNG (CPRNG) and evaluate its quality through correlation coefficient analysis, key sensitivity tests, statistical and entropy analysis, key space evaluation, linear complexity analysis, and performance tests. Furthermore, we present an FPGA-based implementation scheme that leverages equivalent MBCM variants to optimize the electronic implementation process. Finally, we compare the proposed system with existing designs in terms of throughput and key space.
Experimental Evaluation of an Innovative Connection for the Reinforcement of Existing Infilled RC Buildings
Authors: Mehdipour Zabih , Poletti Elisa , Fontes André C. , Branco Jorge M.
Published: October 2024

The retrofitting of existing reinforced concrete (RC) buildings with cross-laminated timber (CLT) panels presents a promising approach for enhancing seismic performance and overall structural resilience. However, effective integration of CLT with existing RC structures poses significant challenges, particularly concerning the design of connections between CLT panels and the RC structure. This paper introduces a novel connection that addresses these challenges by focusing on both structural and architectural considerations. Structurally, the connection is engineered to provide optimal stiffness, strength, and deformation capacity, ensuring robust performance under seismic and dynamic loads. Architecturally, the design incorporates a predefined weak component that facilitates easy access and rapid replacement of damaged parts, thereby reducing downtime and maintenance efforts. The proposed connection was evaluated through a series of monotonic and cyclic loading tests, demonstrating its structural efficiency and reliability. The results indicate that the new connection system not only meets the necessary structural requirements but also offers practical benefits for maintenance and repair, contributing to the overall sustainability and resilience of retrofitted RC buildings. This innovative approach represents a significant advancement in the field of structural retrofitting, providing a viable solution for integrating CLT panels into existing RC frameworks.
Risks of Cervical Cancer Recurrence After Fertility-Sparing Surgery and the Role of Human Papillomavirus Infection Types
Authors: Aimagambetova Gulzhanat , Bapayeva Gauri , Ukybassova Talshyn , Kamzayeva Nazira , Sakhipova Gulnara , Shanazarov Nasrulla , Terzic Milan
Published: October 2024

Cervical cancer is a largely preventable malignancy of the uterine cervix. The tendencies in cervical cancer morbidity and mortality have remained similar for the past decade, albeit with increasing frequency in low- and middle-income countries (LMICs). Moreover, in the majority of LMICs, cervical cancer is the second most prevalent cancer and the second most common cause of cancer-related death among reproductive-age women. High-risk human papillomavirus (HR-HPV) infections have been proven to be associated with up to 95% of cervical cancer cases, with HPV-16 and HPV-18 types being responsible for approximately 70% of all cervical cancers, with the other high-risk HPV types accounting for up to a further 25%. More recently, the latest data appear to confirm there is a change in the frequency of HR-HPV occurrence, especially HPV-16 and HPV-18, as a reflection of the implementation of preventive vaccination programs. Owing to the growing incidence of cervical cancer among reproductive-age women and with the development of cancer management approaches, fertility-sparing options have been proposed for early-stage cervical cancer management as an option for young women, especially those with unaccomplished reproductive desires. However, methods applied for this purpose (cold-knife conization, loop electrosurgical excision, trachelectomy) have variable outcomes and do not prevent risks of relapse. Multiple factors are involved in cervical cancer recurrence, even in cases treated at the early stage of the disease. In this review, the authors unveil whether HPV infection and virus type could be one of the key factors associated with cervical cancer recurrence after fertility-sparing surgery. Reviews of the literature reveal that recurrent and persistent HR-HPV infection is a strong predictor of cervical lesions’ relapse. In particular, HPV-16 and HPV-18 infections and their persistence have been reported to be associated with cervical cancer recurrence. HR-HPV genotyping before and after fertility-sparing surgery for cervical cancer could facilitate a personalized approach and improve the overall survival rate. Screening for HR-HPV is essential during the follow-up of cervical cancer-treated women and will help to predict possible cancer recurrence.
Impact of Home Mobile Phone-Based Telemonitoring in Preventing Exacerbations and Hospitalizations Among Patients with Chronic Obstructive Pulmonary Disease: An IMTEC Study
Authors: Kaddoussi Rania , Bel Haj Ali Khaoula , Hajji Ekram , Ben Soltane Houda , Chamtouri Ikram , Dhaoui Randa , Younes Salma , Fahem Nesrine , Khalifa Meriem , Dhouib Wafa , Msolly Mohamed Amine , Sekma Adel , Boubaker Hamdi , Bouida Wahid , Nouira Semir
Published: October 2024

COPD is a major public health problem due to its high morbidity and mortality. The evolution of COPD is marked by the occurrence of acute exacerbations (AECOPD). One of the major causes of AECOPD is non-adherence treatment. Telemedicine is an accessible educational tool that can help physicians to provide continuous, accessible educational support and monitoring for patients with COPD. Objectives: This study aimed to determine the impact of therapeutic education via phone-based telemedicine on ED visits and/or hospitalizations for AECOPD. Methods: This is a randomized controlled trial carried out in the emergency department (ED) of Fattouma Bourguiba Monastir over a period of 7 consecutive months, including patients admitted with a final diagnosis of AECOPD. Patients were randomly assigned to receive standard care (STD) or weekly phone-based telemonitoring (TLM). Outcomes (exacerbation and the need for hospitalization for AECOPD) were assessed at a 1-, 3-, and 6-month follow-up after being discharged from the hospital. Results: We included 163 patients (57 patients in the TLM group and 106 patients in the STD group). The mean age of the study population was 66.5 ± 12.5 years. The TLM group exhibited a significantly lower risk of ED visits for AECOPD compared to the STD group, with an odds ratio of 0.13 (95% CI: 0.04–0.40) and a p-value ≤ 0.001. Additionally, the TLM group had a notably lower hospitalization rate for AECOPD compared to the control group (15.8% vs. 44.3%, respectively), with an odds ratio of 0.23 (95% CI: 0.10–0.52) and a p-value < 0.001. The all-cause death rate was also lower in the TLM group at the 6-month follow-up. Conclusions: Telemedicine represents an innovative approach that could improve the management of patients with COPD.
The Double-Edged Sword of Immunotherapy—Durvalumab-Induced Polyendocrinopathy—Case Report
Authors: Błażowska Olga , Stróżna Katarzyna , Dancewicz Hanna , Zygmunciak Przemysław , Zgliczyński Wojciech , Mrozikiewicz-Rakowska Beata
Published: October 2024

Introduction: Immunotherapy is one of the greatest advancements in oncological patient care. The broader the treatment application, the more common the adverse events associated with the therapy. Immune checkpoint inhibitors (ICI) are currently used in numerous malignancies. These drugs influence the immune cells’ interactions, which translates to interruption of immune evasion and increased anti-tumor activity. However, the disruption of immunological signaling pathways often leads to adverse events, such as endocrinological insufficiencies, among which thyroid is the most common. Moreover, the co-appearance of several insufficiencies has been previously described. Case report: A 73-year-old female treated with durvalumab due to non-small cell lung carcinoma was admitted to the emergency unit due to symptoms of ketoacidosis. She had a history of well-controlled type 2 diabetes mellitus and autoimmune thyroiditis. Laboratory results showed increased anti-GAD antibodies, while the low C-peptide level indicated type 1 diabetes mellitus. Moreover, over the course of longer observation, the patient presented with abrupt aggravation of her autoimmune thyroiditis. Conclusions: The new onset of endocrinological insufficiencies is a rare adverse event of immunotherapy. Clinicians must pay particular attention to any signs indicating these life-threatening conditions. In case of the appearance of any endocrinological adverse event, the close cooperation of oncologists and endocrinologists is required to enhance patients’ quality of life.
The Association Between the Perception of Exercise Benefits and Barriers and Exercise Self-Efficacy During the Induction Phase of Dialysis in Patients with End-Stage Kidney Disease: A Cross-Sectional Study
Authors: Hirano Yuma , Fujikura Tomoyuki , Yamaguchi Tomoya , Kato Akihiko , Kono Kenichi , Ohashi Naro , Yasuda Hideo , Yamauchi Katsuya
Published: October 2024

Background/Objectives: The physical function of patients with chronic kidney disease gradually declines as kidney function deteriorates, and this decline becomes more pronounced after the initiation of dialysis. Encouraging the development of exercise habits from the initiation phase of dialysis is crucial. Increased exercise self-efficacy is essential for establishing these habits. However, the related factors at this stage are unclear. This study hypothesized that perceptions of exercise benefits and barriers are related to exercise self-efficacy and aimed to investigate this association. Methods: This single-center, cross-sectional study included 72 patients and assessed the stages of exercise behavior change, perceptions of exercise benefits and barriers, and exercise self-efficacy. Multiple regression analysis was used to examine the association between exercise self-efficacy and perceptions of the benefits and barriers of exercise. Results: Perceptions of exercise benefits were still significantly associated with self-efficacy for exercise after adjustment for age, gender, history of cardiovascular disease, diabetic kidney disease, living alone, employment, and physical function (β = 0.474, p < 0.001). Similarly, perceptions of exercise barriers were also significantly associated with self-efficacy for exercise (β = −0.410, p = 0.001). A subgroup analysis that only examined participants without exercise habits revealed a similar association. Conclusions: Perceptions of exercise benefits and barriers may be associated with exercise self-efficacy in patients with end-stage kidney disease during the initiation phase of dialysis. As patients are temporarily hospitalized during this phase, it provides an opportunity for intervention. Exercise education and supportive environments during hospitalization may enhance perceptions of exercise benefits, reduce perceptions of exercise barriers, and improve exercise self-efficacy.
The Geriatric Nutrition Risk Index Is Not a Prognostic Predictor for Postoperative Morbidity in Extremely Elderly Patients Undergoing Surgery for Proximal Femur Fractures
Authors: Choi Jung Ju , Park Chun Gon , Kim Ji Woong , Jo Youn Yi
Published: October 2024

Background/Objectives: The geriatric nutrition risk index (GnRI) has been regarded as a useful predictor of morbidity and mortality in elderly patients. This study aimed to determine the use of the GnRI as a prognostic predictor in extremely elderly patients undergoing proximal femur fracture surgery and the usefulness of evaluation tools related to a patient’s underlying disease and functional capacity in predicting the prognosis of extremely elderly patients. Methods: We analyzed 548 patients who had undergone surgery for proximal femur fracture caused by trauma, with an age of ≥80 years, without other accompanying trauma. Results: Body mass index (BMI) (OR, 1.077; 95% CI, 1.010–1.149; p = 0.023), serum albumin levels (0.389; 0.223–0.678; p = 0.001), and Charlson comorbidity index (CCI) (1.170; 1.014–1.349; p = 0.031) were determined to be predictors of morbidity in a multivariable regression analysis. The area under the curve (AUC) in the receiver operating characteristic curve of BMI was 0.565 (95% CI, 0.493–0.637; p = 0.065), and the optimal cut-off value could not be determined. The AUC of serum albumin was 0.647 (0.576–0.717; p < 0.001), and the optimal cut-off value was 3.65 g/dL (sensitivity, 72.2%; specificity, 52.7%). The AUC of the CCI was 0.648 (0.580–0.715; p < 0.001), and the optimal cut-off value was 6.5 (sensitivity, 63.3%; specificity, 61.4%). Conclusions: The GnRI was not a predictive factor for patient prognosis after proximal femur fractures in extreme elderly patients. Rather, serum albumin level and CCI, which reflect the patient’s underlying comorbid conditions, were more useful in predicting in-hospital morbidity after proximal femur surgery in extremely elderly patients.
The 36-Item Yoni Task: Normative Data for the Clinical Assessment of Theory of Mind
Authors: Isernia Sara , Rossetto Federica , Marchetti Antonella , Baglio Francesca
Published: October 2024

Background: The evaluation of Theory of Mind (ToM) in the clinical setting remains limited due to the lack of valid instruments for a quick and reliable assessment. In this study, the psychometric properties of the Yoni-36 task were tested, and correction grids, equivalence scores, and normative data were computed. Methods: In total, 318 healthy subjects (169 females; mean age = 42.22 ± 18.11 years; mean education = 15.01 ± 3.43 years) were enrolled and administered the Yoni-36 task. Results: Statistical analysis showed good-to-high internal consistency, split-half reliability, and discrimination ability (especially for the second-order items) of the Yoni-36 task. Regression models highlighted the predictive role of age and education on second-order, affective, cognitive accuracy, and response time scores. Education influenced the first-order ToM response time score as well. Based on β values of the regressions, raw scores of the Yoni task were adjusted for sex, age, and education, and correction grids were computed. The equivalent scores indicated an accuracy index score < 0.69 and a response time index score < 0.83 as cut-off points for ToM competence. Normative data reported a mean accuracy and response time index score of 0.90 ± 0.11 and 0.91 ± 0.05 in the Italian population, respectively. Conclusions: The Yoni-36 proved to be a valid instrument for a quick and reliable ToM assessment, suitable to be included in neuropsychological batteries and to be used in routine clinical practice.
The Predictive Value of Perioperative Inflammatory Indexes in Major Arterial Surgical Revascularization from Leriche Syndrome
Authors: Drăgan Anca , Drăgan Adrian Ştefan , Ştiru Ovidiu
Published: October 2024

Objectives: The role of inflammation in the pathophysiology of atherosclerosis is extensive. Our study aims to assess the predictive role of inflammatory indexes regarding in-hospital mortality in major vascular surgery of Leriche syndrome as a convenient, low-cost, and noninvasive prognostic marker to optimize the patient’s perioperative course. Methods: Our retrospective single-center study enrolled consecutive patients diagnosed with aortoiliac occlusive disease, Leriche syndrome, who underwent elective major vascular surgery between 2017 and 2023 in a tertiary cardiovascular center. Preoperative, postoperative, and day-one after-surgery data, including systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), aggregate index of systemic inflammation (AISI), neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio, and monocyte–lymphocyte ratio, were studied to the endpoint, in-hospital death. We also tested the delta values of the indexes to the endpoint. The indexes were compared to the Revised Cardiac Risk Index (RCRI) and Vascular Surgery Group Cardiac Risk Index (VSG-CRI) for outcome prediction. Results: The tested inflammatory indexes significantly increased from the preoperative to postoperative and, further, to the day-one settings. Preoperative AISI (p = 0.040) emerged as the only independent risk factor regarding in-hospital death occurrence in Leriche patients who underwent major revascularization surgery. While RCRI did not significantly predict the endpoint (AUC = 0.698, p = 0.057), VSG-CRI (AUC = 0.864, p = 0.001) presented the best result in ROC analysis. Postoperative NLR (AUC = 0.758, p = 0.006) was next, followed by NLR postoperative–preoperative (_Preop-_Postop) delta value (AUC = 0.725, p = 0.004), postoperative SIRI (AUC = 0.716, p = 0.016), SIRI_Preop-_Postop delta value (AUC = 0.712, p = 0.016), postoperative SII (AUC = 0.692, p = 0.032), and SII_Preop-_Postop delta value (AUC = 0.631, p = 0.030). Conclusions: Inflammatory indexes are valuable tools for assessing perioperative risk in major vascular surgery, enhancing the value of the already validated risk scores.
Intensive Multiprofessional Rehabilitation Is Superior to Standard Orthogeriatric Care in Patients with Proximal Femur Fractures—A Matched Pair Study of 9580 Patients from the Registry for Geriatric Trauma (ATR-DGU)
Authors: Bökeler Ulf , Liener Ulrich , Schmidt Hannah , Vogeley Nils , Ketter Vanessa , Ruchholtz Steffen , Pass Bastian
Published: October 2024

Background: Orthogeriatric treatment, which involves a collaborative approach between orthopedic surgeons and geriatricians, is generally considered to be superior to standard care following hip fractures. The aim of this study was to investigate additional effects of a geriatrician-led multidisciplinary rehabilitation program. Methods: In this matched paired observational cohort study, patients aged 70 years and older with a proximal femur fracture requiring surgery were included. Between 1 January 2016 and 31 December 2022 data were recorded from hospital admission to 120-day follow-up in the Registry for Geriatric Trauma (ATR-DGU), a registry of older adults with hip fractures. Out of 60,254 patients, 9580 patients met the inclusion criteria, 4669 patients received early multiprofessional rehabilitation (EMR) and 4911 patients were treated by standard orthogeriatric co-management (OGC). Results: Compared to standard orthogeriatric treatment, multiprofessional therapy significantly lowered the 7-day mortality rate (2.89% vs. 5.11%) and had a significant impact on walking ability seven days after surgery (86.44% vs. 77.78%). Conclusions: In summary, a geriatrician-led multiprofessional rehabilitation program resulted in lower mortality and improved walking ability than standard orthogeriatric care.
Prediction of a Cephalometric Parameter and Skeletal Patterns from Lateral Profile Photographs: A Retrospective Comparative Analysis of Regression Convolutional Neural Networks
Authors: Ito Shota , Mine Yuichi , Urabe Shiho , Yoshimi Yuki , Okazaki Shota , Sano Mizuho , Koizumi Yuma , Peng Tzu-Yu , Kakimoto Naoya , Murayama Takeshi , Tanimoto Kotaro
Published: October 2024

Background/Objectives: Cephalometric analysis has a pivotal role in the quantification of the craniofacial skeletal complex, facilitating the diagnosis and management of dental malocclusions and underlying skeletal discrepancies. This study aimed to develop a deep learning system that predicts a cephalometric skeletal parameter directly from lateral profile photographs, potentially serving as a preliminary resource to motivate patients towards orthodontic treatment. Methods: ANB angle values and corresponding lateral profile photographs were obtained from the medical records of 1600 subjects (1039 female and 561 male, age range 3 years 8 months to 69 years 1 month). The lateral profile photographs were randomly divided into a training dataset (1250 images) and a test dataset (350 images). Seven regression convolutional neural network (CNN) models were trained on the lateral profile photographs and measured ANB angles. The performance of the models was assessed using the coefficient of determination (R2) and mean absolute error (MAE). Results: The R2 values of the seven CNN models ranged from 0.69 to 0.73, and the MAE values ranged from 1.46 to 1.53. Among the seven models, InceptionResNetV2 showed the highest success rate for predictions of ANB angle within 1° of range and the highest performance in skeletal class prediction, with macro-averaged accuracy, precision, recall, and F1 scores of 73.1%, 78.5%, 71.1%, and 73.0%, respectively. Conclusions: The proposed deep CNN models demonstrated the ability to predict a cephalometric skeletal parameter directly from lateral profile photographs, with 71% of predictions being within 2° of accuracy. This level of accuracy suggests potential clinical utility, particularly as a non-invasive preliminary screening tool. The system’s ability to provide reasonably accurate predictions without radiation exposure could be especially beneficial for initial patient assessments and may enhance efficiency in orthodontic workflows.
Fluid Overload in Children Following Hematopoietic Cell Transplant: A Comprehensive Review
Authors: Elbahlawan Lama , Qudeimat Amr , Morrison Ray , Schaller Alexandra
Published: October 2024

Fluid overload significantly increases morbidity and mortality in critically ill children. Following hematopoietic cell transplant (HCT), children are at a high risk of fluid accumulation due to essential increased fluid intake for nutrition, blood products, and antimicrobials. In addition, many complications predispose these children to capillary leak and fluid overload (FO), such as sinusoidal obstruction syndrome, engraftment syndrome, sepsis, and acute kidney injury (AKI). FO > 10% occurs in nearly half of children following HCT and is associated with a lower PICU survival rate. In addition, in children with acute respiratory failure post HCT, each 1% increase in cumulative fluid balance on d 3 increases the odds of PICU mortality by 3%. Furthermore, FO worsens AKI. Tools such as the renal angina index and urinary biomarkers such as neutrophil gelatinase-associated lipocalin can help identify patients at risk of AKI and FO. Early detection, prevention, and intervention are crucial to improving outcomes in this population. Management strategies include fluid restriction, diuretics, and continuous kidney replacement therapy (CKRT) when FO exceeds 10% and other measures have failed.
From Cells to Plaques: The Molecular Pathways of Coronary Artery Calcification and Disease
Authors: Mitsis Andreas , Khattab Elina , Christodoulou Evi , Myrianthopoulos Kimon , Myrianthefs Michael , Tzikas Stergios , Ziakas Antonios , Fragakis Nikolaos , Kassimis George
Published: October 2024

Coronary artery calcification (CAC) is a hallmark of atherosclerosis and a critical factor in the development and progression of coronary artery disease (CAD). This review aims to address the complex pathophysiological mechanisms underlying CAC and its relationship with CAD. We examine the cellular and molecular processes that drive the formation of calcified plaques, highlighting the roles of inflammation, lipid accumulation, and smooth muscle cell proliferation. Additionally, we explore the genetic and environmental factors that contribute to the heterogeneity in CAC and CAD presentation among individuals. Understanding these intricate mechanisms is essential for developing targeted therapeutic strategies and improving diagnostic accuracy. By integrating current research findings, this review provides a comprehensive overview of the pathways linking CAC to CAD, offering insights into potential interventions to mitigate the burden of these interrelated conditions.
Comparative Analysis of Concurrent Chemoradiotherapy Versus Chemotherapy Alone as First-Line Palliative Treatments for Advanced Esophageal Squamous Cell Carcinoma
Authors: Wonglhow Jirapat , Wetwittayakhlang Panu , Sunpaweravong Patrapim , Sathitruangsak Chirawadee , Dechaphunkul Arunee
Published: October 2024

Background: In advanced-stage esophageal squamous cell carcinoma (ESCC), treatment of both the primary tumor and metastatic sites is imperatively required. Consequently, an optimal treatment modality should effectively control both aspects. Therefore, the benefits of concurrent chemoradiotherapy (CCRT) in cases of advanced-stage ESCC should be evaluated. Methods: This retrospective study compared the efficacy and safety of CCRT versus chemotherapy alone for advanced-stage ESCC patients from January 2012 to December 2023 at a university hospital in Southern Thailand. Survival was assessed using the Kaplan–Meier approach, with comparisons being made by the log-rank test. A p-value of <0.05 indicated statistical significance. Results: From a total of 196 patients with stage IV ESCC, 117 (59.7%) received CCRT, while 79 (40.3%) received chemotherapy alone. The median overall survival (OS) time was 9.04 months for CCRT and 5.79 months for chemotherapy (hazard ratio, HR: 0.58 [0.43–0.78]). CCRT significantly improved OS time in stage IVA patients (HR: 0.52 [0.29–0.93]), but not in stage IVB patients (HR: 0.76 [0.51–1.11]). The median progression-free survival (PFS) time was 6.04 months for CCRT and 3.50 months for chemotherapy (HR 0.48 [0.35–0.65]). The objective response rates (ORRs) were 43.6% and 22.8%, respectively (p = 0.003). Hematological toxicities were more common with CCRT, along with mild cases of treatment-associated pneumonitis and dermatitis. Conclusions: Although palliative chemotherapy is the standard treatment for advanced-stage ESCC, CCRT provides significant benefits for patients with stage IVA ESCC, improving OS, PFS, and ORRs, despite there being a higher incidence of adverse events. Thus, CCRT should be considered for patients with stage IVA ESCC with a good performance status.
Comparative Effectiveness of Devices for Interventional Patent Foramen Ovale Closure: Insights from a 23-Year Monocentric Analysis
Authors: Kayvanpour Elham , Matzeit Elena , Kaya Ziya , Pleger Sven , Bahrmann Anke , Reichardt Christine , Ringleb Peter Arthur , Frey Norbert , Meder Benjamin , Sedaghat-Hamedani Farbod
Published: October 2024

Background/Objectives: Patent foramen ovale (PFO) is a congenital heart defect affecting up to 25% of the population, associated with an increased risk of cryptogenic stroke. Percutaneous PFO closure is a minimally invasive procedure aimed at reducing stroke risk by eliminating the right-to-left shunt. Methods: This monocentric, retrospective study analyzed 716 patients who underwent PFO closure between January 2000 and February 2023. Data collected included demographics, indications for closure, procedural details, and outcomes. Key endpoints were complications at the puncture site, pericardial effusion, recurrent stroke or transient ischemic attack (TIA), thrombi on the device, new-onset atrial fibrillation, and death. Results: The cohort had a mean age of 50.6 ± 12.6 years, with 60.8% female. Four devices were used: Occlutech PFO occluder (n = 106), Amplatzer PFO occluder (n = 227), Gore septal occluder (n = 296), and Cardia PFO-Star (n = 87). The initial procedural success rate was 98.9%, with no significant differences between devices. Complication rates were low across all devices. Residual shunt incidence decreased from 17.9% in 1 month to 3.4% in 12 months. Device-specific complications included late-onset pericardial effusion (p = 0.01), erosions (Cardia PFO-Star), and device thrombus formation (Gore septal occluder). Conclusions: PFO closure is a safe and effective method for preventing recurrent strokes, with high success rates and varying specific complication profiles, depending on the device. Further long-term studies are needed to evaluate newer devices and optimize patient outcomes.
Experimental Study on the Classification and Evolution of the Tip Cavitation Morphology in Axial Waterjet Pumps with Two Different Blade Numbers
Authors: Shen Xi , Wu Haoran , Yang Gang , Tang Rui , Chang Chenxin , Xu Bin , Lin Suben , Zhang Desheng
Published: October 2024

Tip leakage flow and induced unstable cavitation can significantly damage the performance of axial waterjet pumps. This study investigated the impact of blade numbers on cavitating conditions in an axial waterjet pump by conducting tests of performance characteristics and high-speed photography experiments on three-blade and four-blade impellers. The results showed that the critical cavitation number σc of the three-blade impeller was larger, while the four-blade impeller flow pattern deteriorated more rapidly after σc. Various cavitation structures in the tip region were observed under different conditions, including clearance cavitation, shear layer cavitation, tip leakage vortex cavitation, and suction-side-perpendicular cavitating vortices (SSPCVs). Tip cavitation maps of the test impellers were drawn based on the flow rate coefficient and cavitation number variation. The three-blade impeller exhibited a wider range of severe cavitation, particularly with an increased occurrence of SSPCVs. With the cavitation number and flow rate coefficient decreased, the SSPCV generated from triangular cavitation cloud shedding presented an increased trend in scale and quantity. Conversely, in the case of the four-blade impeller, SSPCVs were often disrupted by the adjacent blade during migration and interfered with the tip cavitation in the neighboring flow passage.
An Improved Framework of Major Function-Oriented Zoning Based on Carrying Capacity: A Case Study of the Yangtze River Delta Region
Authors: Zhang Qun , Wang Lili , Wang Hanmei , Chen Yang , Tian Chunhua , Shao Yixi , Liu Tiange
Published: October 2024

Major function-oriented zoning, a key spatial planning strategy in China, aims to coordinate resource endowments, socio-economic development, and subsequent planning initiatives. However, the existing framework for major function-oriented zoning relies predominantly on socio-economic statistical indicators at the regional level, often neglecting the critical role of carrying capacity. To address this limitation, we assessed both the current state and dynamic trends of the carrying capacity to identify risk and advantageous zones for major functions, with the objective of optimizing major function-oriented zoning in the Yangtze River Delta region, China. Our findings indicate that 47 counties are experiencing significant pressure under the current carrying capacity, while 57 counties exhibit a deteriorating trend in their capacity. Over half of the counties are categorized as having an overloaded carrying capacity. Based on this analysis, 66 counties have been designated as risk zones for major functions. Consequently, the optimization of major function-oriented zoning requires adjustments in 10 counties, incorporating the identified risk and advantageous zones to enhance spatial planning efficacy. This study proposes an enhanced methodological framework for major function-oriented zoning by fully integrating carrying capacity assessments, offering substantial support for territorial spatial planning in China. We believe that these improvements contribute significantly to more resilient and sustainable regional development strategies.
Spatial–Temporal Evolution and Driving Force Analysis of Blue–Green Space in the Chengdu–Chongqing Economic Circle, China
Authors: Zhang Guangshun , Su Yi , Wang Ziming , Chen Ying , Wan Jiangjun , Bai Haichao
Published: October 2024

In the rapid process of urbanization, revealing the patterns and driving forces behind the evolution of blue–green spaces holds significant value for optimizing urban blue–green environments. This study systematically investigates the spatial–temporal evolution characteristics and driving forces of blue–green space in the Chengdu–Chongqing Economic Circle from 1990 to 2020, utilizing GIS technology, landscape pattern analysis, and geographic detectors. The research findings indicate the following: (1) The area of blue–green space in the study area exhibits a general trend of initial growth followed by decline, with significant changes occurring between 2010 and 2020. (2) The fragmentation degree of blue–green space is gradually increasing, while connectivity among landscapes is decreasing; however, there has been an increase in landscape distribution uniformity. More than 90% of blue–green spaces expanded mainly through adjacency patterns. (3) In examining driving forces, it was found that temperature, topographic relief, elevation, population density, and construction intensity are the primary driving factors. Notably, the influence of natural factors has diminished over time while human social factors have significantly intensified. This study offers solutions for optimizing the configuration of blue–green spaces within the Chengdu–Chongqing Economic Circle. It also serves as a reference case for promoting high-quality urbanization in developing countries undergoing rapid urbanization.