bluuebunny/crossref_metadata_2025 huggingface dataset:
Hematological Side Effects of 177Lu-DOTA-TATE Therapy in Patients with NENs
Authors: Carideo Luciano , Meucci Rosaria , Campagna Giuseppe , Russo Vincenzo Marcello , D’Ippolito Enrico , Rinzivillo Maria , Panzuto Francesco , Prosperi Daniela
Published: December 2024

Background/Objectives: Lutathera® ([177Lu]Lu-DOTA-TATE) is the first radiolabelled somatostatin (SST) analog approved for the treatment of patients with well-differentiated (G1 and G2) unresectable or metastatic gastro-entero-pancreatic neuro-endocrine-neoplasms (GEP-NENs). The bone marrow and kidneys are critical organs for RLT with [177Lu]Lu-DOTA-TATE. Our purpose was to evaluate hematological and renal toxicity in 29 patients (18 males, 11 females) treated with Lutathera®. Methods: According to standard protocols, four cycles of (177Lu)Lu-DOTA-TATE were administered every eight/nine weeks. Patients received pre-medication with anti-emetic and anti-acid drugs and a slow amino acid infusion for renal protection. Blood count and serum creatinine data were collected at three time points: before the first cycle, after the second cycle, and at the end of treatment. Results: We found that almost all hematological parameters significantly decreased between the baseline and/or interim and post-therapy evaluation, although without a clinical impact. The presence of total tumor load or bone metastases had no influence on these findings, while male patients showed less hematological toxicity than females. Conversely, creatinine levels did not vary during treatment. Conclusions: Our study confirms that [177Lu]Lu-DOTATATE RLT is safe and well tolerated despite some minor (grade 1) hematological toxicity.
Extracting Regular Building Footprints Using Projection Histogram Method from UAV-Based 3D Models
Authors: Ren Yaoyao , Li Xing , Jin Fangyuqing , Li Chunmei , Liu Wei , Li Erzhu , Zhang Lianpeng
Published: December 2024

Extracting building outlines from 3D models poses significant challenges stemming from the intricate diversity of structures and the complexity of urban scenes. Current techniques heavily rely on human expertise and involve repetitive, labor-intensive manual operations. To address these limitations, this paper presents an innovative automatic technique for accurately extracting building footprints, particularly those with gable and hip roofs, directly from 3D data. Our methodology encompasses several key steps: firstly, we construct a triangulated irregular network (TIN) to capture the intricate geometry of the buildings. Subsequently, we employ 2D indexing and counting grids for efficient data processing and utilize a sophisticated connected component labeling algorithm to precisely identify the extents of the roofs. A single seed point is manually specified to initiate the process, from which we select the triangular facets representing the outer walls of the buildings. Utilizing the projection histogram method, these facets are grouped and processed to extract regular building footprints. Extensive experiments conducted on datasets from Nanjing and Wuhan demonstrate the remarkable accuracy of our approach. With mean intersection over union (mIOU) values of 99.2% and 99.4%, respectively, and F1 scores of 94.3% and 96.7%, our method proves to be both effective and robust in mapping building footprints from 3D real-scene data. This work represents a significant advancement in automating the extraction of building footprints from complex 3D scenes, with potential applications in urban planning, disaster response, and environmental monitoring.
The Significance of the Response: Beyond the Mechanics of DNA Damage and Repair—Physiological, Genetic, and Systemic Aspects of Radiosensitivity in Higher Organisms
Authors: Ostoich Peter V.
Published: December 2024

Classical radiation biology as we understand it clearly identifies genomic DNA as the primary target of ionizing radiation. The evidence appears rock-solid: ionizing radiation typically induces DSBs with a yield of ~30 per cell per Gy, and unrepaired DSBs are a very cytotoxic lesion. We know very well the kinetics of induction and repair of different types of DNA damage in different organisms and cell lines. And yet, higher organisms differ in their radiation sensitivity—humans can be unpredictably radiosensitive during radiotherapy; this can be due to genetic defects (e.g., ataxia telangiectasia (AT), Fanconi anemia, Nijmegen breakage syndrome (NBS), and the xeroderma pigmentosum spectrum, among others) but most often is unexplained. Among other mammals, goats (Capra hircus) appear to be very radiosensitive (LD50 = 2.4 Gy), while Mongolian gerbils (Meriones unguiculatus) are radioresistant and withstand quadruple that dose (LD50 = 10 Gy). Primary radiation lethality in mammals is due most often to hematopoietic insufficiency, which is, in the words of Dr. Theodor Fliedner, one of the pioneers of radiation hematology, “a disturbance in cellular kinetics”. And yet, what makes one cell type, or one particular organism, more sensitive to ionizing radiation? The origins of radiosensitivity go above and beyond the empirical evidence and models of DNA damage and repair—as scientists, we must consider other phenomena: the radiation-induced bystander effect (RIBE), abscopal effects, and, of course, genomic instability and immunomodulation. It seems that radiosensitivity is not entirely determined by the mathematics of DNA damage and repair, and it is conceivable that radiation biology may benefit from an informed enquiry into physiology and organism-level signaling affecting radiation responses. The current article is a review of several key aspects of radiosensitivity beyond DNA damage induction and repair; it presents evidence supporting new potential venues of research for radiation biologists.
A Multi-Player Framework for Sustainable Traffic Optimization in the Era of Digital Transportation
Authors: Kotsi Areti , Politis Ioannis , Chaniotakis Emmanouil , Mitsakis Evangelos
Published: December 2024

Nowadays, traffic management challenges in the era of digital transport are rising, as the interactions of various stakeholders providing such technologies play a pivotal role in shaping traffic dynamics. The objective of this paper was to present a game-theory-based framework for modeling and optimizing urban traffic in road networks, considering the co-existence and interactions of different players composed of drivers of conventional vehicles, central governing authorities with traffic management capabilities, and competitive or cooperative connected mobility private service providers. The scope of this work was to explore and present the outcomes of diverse mixed equilibrium conditions in the road network of the city of Thessaloniki (Greece), integrating the principles of user equilibrium, system optimum, and Cournot oligopoly. The impacts of varying network attributes were systematically analyzed to provide quantitative indicators representing the overall network performance. Analysis of the results provided insights into the sensitivity and the resilience of the road network under various prevalence schemes of drivers of conventional vehicles, representing the user equilibrium characteristics, or drivers relying on traffic guidance provided by a central governing authority, representing the system optimum principles as well as the cooperation and competition schemes of private connected mobility providers with certain market shares in the network.
Contemporary Trends in Pulsed Field Ablation for Cardiac Arrhythmias
Authors: Yavin Hagai , Prasad Mark , Gordon Jonathan , Aksu Tolga , Huang Henry D.
Published: December 2024

Pulsed field ablation (PFA) is a catheter-based procedure that utilizes short high voltage and short-duration electrical field pulses to induce tissue injury. The last decade has yielded significant scientific progress and quickened interest in PFA as an energy modality leading to the emergence of the clinical use of PFA technologies for the treatment of atrial fibrillation. It is generally agreed that more research is needed to improve our biophysical understanding of PFA for clinical cardiac applications as well as its potential as a potential alternative energy source to thermal ablation modalities for the treatment of other arrhythmias. In this review, we discuss the available preclinical and clinical evidence for PFA for atrial fibrillation, developments for ventricular arrhythmia (VA) ablation, and future perspectives.
ECMO in the Cardiac Catheterization Lab—Patient Selection Is Key
Authors: Tracy William , Ferrell Brandon E. , Skendelas John P. , Uehara Mayuko , Sugiura Tadahisa
Published: December 2024

The use of extracorporeal membrane oxygenation (ECMO) has emerged as a rescue intervention for hemodynamically unstable patients and prophylactic intraprocedural hemodynamic support in the cardiac catheterization laboratory. The prompt initiation of ECMO provides immediate hemodynamic support and allows for the completion of bridging and/or life-saving interventions. However, there are no clinical practice guidelines for the use of extracorporeal support in this area. This review examines the role of patient selection and therapeutic intervention for extracorporeal support in the cardiac catheterization laboratory.
The Role of Incentive Spirometry in Enhanced Recovery After Lung Cancer Resection: A Propensity Score-Matched Study
Authors: Casiraghi Monica , Orlandi Riccardo , Bertolaccini Luca , Mazzella Antonio , Girelli Lara , Diotti Cristina , Caffarena Giovanni , Zanardi Silvia , Baggi Federica , Petrella Francesco , Maisonneuve Patrick , Spaggiari Lorenzo
Published: December 2024

Background: Postoperative physiotherapy is a cornerstone of Enhanced Recovery After Surgery (ERAS) programs, especially following lung resection. Despite its importance, the literature lacks clear recommendations and guidelines, particularly regarding the role of incentive spirometry (IS). This study aims to determine whether incentive spirometry offers additional benefits over early ambulation alone in patients undergoing lung resection for primary lung cancer. Methods: We conducted a retrospective case–control study at the European Institute of Oncology (IEO) involving patients who underwent lung resection from June 2020 to June 2022. Patients were divided into two cohorts: early ambulation alone (control group) and early ambulation with IS (IS group). The primary endpoint was the rate of postoperative pulmonary complications. Secondary endpoints included length of hospital stay and time to chest drain removal. A propensity score-matched analysis was performed based on age, sex, and BMI. Data were compared using Chi-squared and Student’s t-tests as appropriate. Results: A total of 304 patients were included, with 153 in the intervention group and 151 in the control group. After propensity-score matching, 52 patients from each cohort were compared. No significant differences were found between the groups regarding postoperative oxygen requirement, fever, atelectasis, residual pleural space, need for bronchoscopy toilette, and re-hospitalization rate. IS group showed trends toward shorter hospital stays and lower time to chest drain removal, though without reaching statistical significance. Conclusions: IS did not significantly improve postoperative outcomes compared to early ambulation alone in patients undergoing lung resection for primary lung cancer. More extensive, prospective, randomized trials are needed to confirm these findings.
Tidal Volume Challenge to Assess Volume Responsiveness with Dynamic Preload Indices During Non-Cardiac Surgery: A Prospective Study
Authors: Griva Panagiota , Kapetanakis Emmanouil I. , Milionis Orestis , Panagouli Konstantina , Fountoulaki Maria , Sidiropoulou Tatiana
Published: December 2024

Background/Objectives: The aim of this study is to assess whether changes in Pulse Pressure Variation (PPV) and Stroke Volume Variation (SVV) following a VtC can predict the response to fluid administration in patients undergoing surgery under general anesthesia with protective mechanical ventilation. Methods: A total of 40 patients undergoing general surgery or vascular surgery without clamping the aorta were enrolled. Protective mechanical ventilation was applied, and the radial artery was catheterized in all patients. The protocol began one hour after the induction of general anesthesia and the stabilization of hemodynamic parameters. The parameters PPV6 and SVV6 were recorded during ventilation with a Vt of 6 mL/kg Ideal Body Weight (IBW) (T1). Then, the Vt was increased to 8 mL/kg IBW for 3 min without changing other respiratory parameters. After the VtC, the parameters PPV8 and SVV8 (T2) were recorded. After the stabilization of hemodynamic parameters, volume expansion (VE) was administered with colloid fluid of 6 mL/kg IBW. Parameters before (T3) and 5 min after fluid challenge (T4) were recorded. The change in the Stroke Volume Index (SVI) before and after VE was used to indicate fluid responsiveness. Patients were classified as fluid responders (SVI ≥ 10%) or non-responders (SVI < 10%). Results: The parameter ΔPPV(6–8) demonstrated good predictive ability to predict fluid responsiveness, evidenced by an Area Under the Curve (AUC) of 0.86 [95% Confidence Interval (CI) 0.74 to 0.95, p < 0.0001]. The threshold of ΔPPV(6–8) exceeding 2% identified responders with a sensitivity of 83% (95% CI 0.45 to 1.0, p < 0.0001) and a specificity of 73% (95% CI 0.48 to 1.0, p < 0.0001). The parameter ΔSVV(6–8) also revealed good predictive ability, reflected by an AUC of 0.82 (95% CI 0.67 to 0.94, p < 0.0001). The criterion ΔSVV(6–8) greater than 2% pinpointed responders with a sensitivity of 83% (95% CI 0.71 to 1.0, p < 0.001) and a specificity of 77% (95% CI 0.44 to 1.0, p < 0.001). Conclusions: This study demonstrates that VtC possesses good predictive ability for fluid responsiveness in patients undergoing general surgery.
The Relationship Between Health Parameters, Body Size, Elements of Lifestyle, and Hand Grip Strength in a Group of Patients with Type 2 Diabetes, Aged 40–98, from Ulaanbaatar, Mongolia
Authors: Jaalkhorol Myadagmaa , Cieślik Agata , Dashtseren Myagmartseren , Khairat Anya , Damdinbazar Otgonbayar , Ochirdorj Gerelmaa , Khurelbaatar Tsetsegsuren , Batmunkh Ganbayar , Ganzorig Ulemjjargal , Kozieł Sławomir
Published: December 2024

Background/Objectives: Decreased muscle strength and lower hand grip strength (HGS) values are observed in patients with type 2 diabetes (T2D). This study aimed to present the values of hand grip strength as a valuable tool in T2D treatment monitoring in the context of body size and lifestyle elements in 347 patients with type 2 diabetes from Ulaanbaatar, Mongolia. Methods: A retrospective cross-sectional study was performed at hospitals in Ulaanbaatar, Mongolia. The maximum grip strengths of the right and left hands were measured three times, alternatively, using a digital hand dynamometer. The maximum grip strength of the dominant hand was used for the analysis. Results: The values of HGS in both hands dropped with increased age, systolic blood pressure (SBP), the duration of diabetes, and low glucose blood levels, whereas they increased with height. Patients who smoked had the lowest three values of HGS (the average value for each hand), whereas patients who quit smoking had the highest values. Second-order interactions between diastolic blood pressure (DBP) and sex showed a significant effect on the average HGS of both hands and for the left hand in particular (where HGS decreased only in females, whereas it increased in males). Conclusions: HGS is influenced by important socioeconomic and anthropometric factors in patients with type 2 diabetes, making it a valuable indicator of general health.
Double-Stranded RNA-Based Method for Diagnosing Severe Fever with Thrombocytopenia
Authors: Park Jung Wan , Jeon Jaemin , Kim Yoosik , Jeon Min Hyok
Published: December 2024

Background/Objectives: This study explores the potential of using elevated levels of blood double-stranded RNA (dsRNA) as a diagnostic tool for severe fever with thrombocytopenia syndrome (SFTS) infection. Methods: Blood samples from SFTS patients were collected, dsRNA was purified, and total dsRNA expression was quantitatively analyzed using a spiropyran-based method. Comparative analysis was performed using blood samples from healthy individuals and scrub typhus patients with similar symptoms. Results: The results revealed that individuals infected with SFTS had significantly higher total blood dsRNA levels compared to healthy or scrub typhus controls. The dsRNA-based method also has potential for assessing infection severity based on dsRNA levels. Conclusions: These findings suggest that total dsRNA expression can serve as a quick and convenient method to differentiate SFTS from other non-viral conditions with similar clinical presentations. This method shows promise as a novel diagnostic tool.
Parental Compliance with Preschool Vision Screening Test
Authors: Kerner Lavi Hilit , Koval Tal , Trifonov Ilanit , Reitblat Olga , Spierer Oriel
Published: December 2024

Objective: To assess the barriers to parental compliance with preschool vision screening tests and the recommended follow-up eye care. Methods: This prospective study included children aged 3–6 years attending 46 preschools. Parents were asked for consent for their children to participate in a vision screening test. Parents whose child did not participate due to lack of parental consent and parents whose child failed the screening test were contacted by telephone and given a standardized questionnaire to identify potential barriers to compliance. Results: A total of 1511 children (mean age 4.76 years ± 0.76, 51.3% boys) were eligible for vision screening. Consent was given by the parents of 1295 children (85.7%). Lack of consent in children who had never been examined by an ophthalmologist was primarily due to unawareness of the screening test or other logistical reasons (117 cases, 92.1%). Of the children screened, 140 (11.1%) failed the test and 80.0% of their parents adhered to the recommended follow-up eye care. Parents who followed the screening vision test recommendations were more likely to be native language speakers (82.8% vs. 58.8% mothers and 88.9% vs. 60.0% fathers; p = 0.049 and 0.015, respectively). There was a higher chance of at least one parent being native-born if recommendations were followed (90.6% vs. 58.8%, p = 0.004). All other factors tested were insignificant. Conclusions: Parental consent and cooperation with vision screening test and its recommendations were high. Migrant families are more likely to face challenges in following vision screening test recommendations, underscoring the need for tailored approaches for specific populations.
Strategies in Diagnosis and Therapy of External Outflow Graft Obstruction in Patients with a Fully Magnetically Levitated Left Ventricular Assist Device: A Meta-Analysis and Systematic Review
Authors: Huang Anna , von Mackensen Johanna K. R. , Zwaans Vanessa I. T. , Schuering Carla L. , Iske Jasper , Stein Julia , Ott Sascha , Heck Roland , Starck Christoph T. , Kempfert Joerg , Jacobs Stephan , Falk Volkmar , Potapov Evgenij V. , Wert Leonhard
Published: December 2024

Background: The HeartMate 3 (HM3, Abbott) left ventricular assist device (LVAD) is the only commercially available option considered suitable for long-term circulatory support. External compression of the outflow graft causing obstruction (eOGO) is a serious adverse event affecting patients on long-term support. The obstruction occurs due to the accumulation of gelatinous substance between the bend relief and outflow graft. This systematic review evaluated all available studies with regard to the diagnosis and therapy of eOGOs. Methods: A systematic literature review and analysis of individual patient data was performed using MEDLINE/PubMed following PRISMA guidelines. Original works dating up to 31 October 2024 were considered. Results: Twenty-four publications that met the inclusion criteria were identified, providing individual data from 113 patients with a median support time to eOGO diagnosis of 809 days [588, 1095] and follow-up after treatment of 365 days [33, 605]. eOGO severity classification was performed on 108 patients according to our grading system. For treatment, most patients underwent surgery (n = 38) or stenting (n = 29). A hazard ratio of 0.75 [0.28, 2.03] was calculated for the surgical group versus the stenting group (p = 0.570). Conclusions: Concerning 30-day mortality, we did not find a significant difference between the eOGO severity of survivors and non-survivors. We found no significant differences in outcome between patients with differing eOGO severity and treatment strategy, namely stenting and surgery. Due to an increase in eOGO incidence after one year of support, we propose that clinicians monitor their patients for this complication when support time surpasses one year.
Active Helicobacter pylori Infection Does Not Influence Outcomes After Sleeve Gastrectomy—Observational Cohort Study
Authors: Łukasiewicz Martyna , Lisovski Patryk , Proczko-Stepaniak Monika , Wilczyński Maciej , Szarafińska Marzena , Świetlik Dariusz , Szymański Michał
Published: December 2024

Background: Helicobacter pylori (HP) is under investigation for its potential role in postoperative complications. While some studies indicate no impact, they often cite short or incomplete follow-up. This study aims to compare 1-year outcomes in groups with and without active HP infection after bariatric surgery, also assessing HP prevalence in postoperative specimens of sleeve gastrectomy (SG) patients. Methods: Conducted between May 2020 and May 2021, this study involves both retrospective and prospective data collection from 93 eligible SG patients. Demographics, surgical outcomes and follow-up results (including complications; weight and BMI at 3, 6 and 12 months post-SG) were extracted. Results: No statistically significant differences in body weight were observed at 3 (p = 0.3757), 6 (p = 0.1422) or 12 (p = 0.2737) months post-surgery between the HP-positive (Group A) and non-infected (Group B) groups. Group A experienced significant reductions in body weight at 6 and 12 months (p < 0.0001), while group B showed significant reductions at 3, 6 and 12 months (p < 0.0001), with additional decreases at 6 and 12 months post-surgery compared to 3 months. No significant differences in overall surgery-related side effects were observed between the groups. Conclusions: Patients with active HP infections undergoing SG displayed comparable rates of short- and long-term complications to the non-infected group. Active HP infection did not impact body weight loss outcomes at 12 months, but it may potentially slow it down in the initial three-month post-surgery period. This underscores the need to consider eradication while maintaining awareness of the potential side effects associated with the process.
Endothelial Glycocalyx Damage and Arterial Thickness in Patients with Retinal Vein Occlusion (RVO)
Authors: Korakas Emmanouil , Pavlidis George , Lampsas Stamatios , Agapitou Chrysa , Risi-Koziona Alexia , Kountouri Aikaterini , Pliouta Loukia , Katogiannis Konstantinos , Pililis Sotirios , Thymis John , Oikonomou Evangelos , Siasos Gerasimos , Ikonomidis Ignatios , Lambadiari Vaia , Chatziralli Irini
Published: December 2024

Background: Retinal vein occlusion (RVO) is a relatively uncommon condition with a complex pathophysiology. However, its association with traditional cardiovascular risk factors is well established. In this study, we compared arterial stiffness and endothelial function between patients with RVO and healthy controls. Methods: We enrolled 28 consecutive patients with RVO, either central (CRVO) or branch (BRVO), and 30 healthy controls. We measured: (i) perfused boundary region of the sublingual arterial microvessels (a marker of endothelial glycocalyx thickness), (ii) pulse wave velocity (PWV), augmentation index (AIx), and central systolic blood pressure (cSBP). Results: No statistically significant differences regarding age, gender, and major cardiovascular risk factors were noted between patients and controls. Compared to controls, patients with RVO had higher PBR, PWV, AIx, and cSBP values (p < 0.05). For each of these indices, no statistically significant differences were noted between patients with CRVO and BRVO (p > 0.05). Conclusions: Patients with RVO demonstrated reduced endothelial glycocalyx thickness and increased arterial stiffness compared to healthy controls. These findings further elucidate the role of atherosclerosis and endothelial dysfunction in the pathophysiology of the disease and indicate the need for the evaluation of subclinical cardiovascular disease in such patients.
Skin Physiological Parameters and Their Association with Severe Atopic Dermatitis in Mongolian Children
Authors: Batbileg Lkhamdari , Baasanjav Sevjidmaa , Tulgaa Khosbayar , Byambasukh Oyuntugs , Naymdavaa Khurelbaatar , Yadamsuren Enkhtur , Biziya Baasanjargal
Published: December 2024

Background: Atopic dermatitis (AD) is a chronic skin condition that weakens the skin barrier, leading to increased trans-epidermal water loss and reduced skin moisture. Understanding how these changes in the skin barrier relate to AD severity in Mongolian children may offer insights that could apply to other regions facing similar environmental challenges. Methods: A cross-sectional study was conducted at the National Dermatology Center of Mongolia, involving 103 children with AD. Severity was assessed using the SCORAD index, and skin barrier function was measured through TEWL, skin moisture, and pH. Linear regression analyses were conducted, adjusting for age, skin physiological parameters, AD severity characteristics, and total IgE levels. Results: Among the participants, 48.54% were classified as having moderate AD, while 34.95% had severe AD. The mean SCORAD index was 43.19 ± 17.11. In the final adjusted regression analysis, higher TEWL was significantly associated with greater AD severity (non-lesional: B = 0.328, p = 0.004; lesional: B = 0.272, p = 0.007), while skin moisture showed an inverse association (non-lesional: B = −0.771, p < 0.001; lesional: B = −0.218, p < 0.001). The total IgE level was significantly higher in the severe AD group (p = 0.013). Although skin pH initially correlated with AD severity, it did not remain significant in multivariate analysis. Conclusions: This study emphasizes the role of skin barrier function, particularly increased TEWL and reduced moisture, in AD severity among Mongolian children.
The Clinical Characteristics and Treatment Outcomes of Mesonephric Tumours of the Uterine Cervix: A Systematic Review and Proposal of Embryologically-Oriented Surgical Resection
Authors: Daas Mohammad , Pappa Christina , Shibli Dana , Al-Ani Abdallah , Dhar Sunanda , Manek Sanjiv , Sayasneh Ahmad , Alazzam Moiad
Published: December 2024

Background/Objectives: Cervical mesonephric adenocarcinomas (MNACs) are among the rarest neoplasms of the female genital tract. Unlike the majority of cervical cancers, which are predominantly squamous in origin and strongly associated with HPV seropositivity, MNACs are distinct in both histology and pathophysiology. Despite their unique characteristics, MNACs have historically been managed in parallel with squamous cell carcinomas, resulting in a lack of optimised, evidence-based treatment protocols. In this systematic review, we aim to evaluate the current management strategies for MNACs and their associated clinical outcomes. Additionally, we critically appraise existing surgical and adjuvant therapies and propose embryologically oriented surgical techniques to achieve optimal tumour resection. Methods: We performed a systematic search across the MEDLINE, CENTRAL, EMBASE, and ClinicalTrials.gov databases from 1960 to June 2024. The search strategy employed a combination of keywords and MeSH terms, including “Uterine Cervical Neoplasms” [MeSH], “mesonephric tumour”, “mesonephric neoplasm”, and “mesonephric cancer”. All relevant publications, including case reports and case series, were considered. Results: A total of 49 publications were finally included in the analysis, involving a thorough description of 91 MNAC cases. Most patients had stage I disease (70.8%) (n = 51). Hysterectomy was performed in 77 patients. The median follow-up was 29 months (range 1–199 months). Disease recurrence was observed in 35.2% (n = 25) of the cases, with the median disease-free survival (DFS) being 24 months (range 1–199). At the follow-up, 64.8% (n = 46) of patients remained in remission irrespective of the treatment modality, while 27.4% (n = 20) died due to disease progression. Conclusions: Mesonephric neoplasms of the uterine cervix are rare and clinically aggressive cancers that signify poor prognosis. Accurate identification and effective management can be challenging due to their particular anatomic and immunohistochemical characteristics. Therefore, a more tailored embryological-based approach should be considered for an optimal oncologic outcome.
Kenny–Caffey Syndrome Type 2 (KCS2): A New Case Report and Patient Follow-Up Optimization
Authors: Hatziagapiou Kyriaki , Sertedaki Amalia , Dermentzoglou Vasiliki , Popović Nataša Čurović , Lambrou George I. , Papageorgiou Louis , Thireou Trias , Kanaka-Gantenbein Christina , Sakka Sophia D.
Published: December 2024

Background/Objectives: Kenny–Caffey syndrome 2 (KCS2) is a rare cause of hypoparathyroidism, inherited in an autosomal dominant mode, resulting from pathogenic variants of the FAM111A gene, which is implicated in intracellular pathways regulating parathormone (PTH) synthesis and skeletal and parathyroid gland development. Methods: The case of a boy is reported, presenting with the characteristic and newly identified clinical, biochemical, radiological, and genetic abnormalities of KCS2. Results: The proband had noticeable dysmorphic features, and the closure of the anterior fontanel was delayed until the age of 4 years. Biochemical evaluation at several ages revealed persistent hypocalcemia, high normal phosphorous, and inappropriately low normal PTH. To exclude other causes of short stature, the diagnostic approach revealed low levels of IGF-1, and on CNS MRI, small pituitary gland and empty sella. Nocturnal levels of growth hormone were normal. MRI also revealed bilateral symmetrical microphthalmia and torturous optic nerves. Skeletal survey was compatible with cortical thickening and medullary stenosis of the long bones. Genomic data analysis revealed a well-known pathogenic variant of the FAM111A gene (c.1706G>A, p. R569H), which is linked with KCS2 or nanophthalmos. Conclusions: KCS2, although a rare disease, should be included in the differential diagnosis of hypoparathyroidism and short stature. Understanding the association of pathogenic variants with KCS2 phenotypic variability will allow the advancement of clinical genetics and personalized long-term follow-up and will offer insights into the role of the FAM111A gene in the disease pathogenesis and normal embryogenesis of implicated tissues and organs.
Adverse Pregnancy Outcomes in Patients with Polycystic Ovary Syndrome with Pre-Conceptional Hyperandrogenism: A Multi-Institutional Registry-Based Retrospective Cohort Study
Authors: Chang Yi-Ting , Chen Ming-Jer , Lin Wei-Szu , Lin Ching-Heng , Chang Jui-Chun
Published: December 2024

Background/Objectives: Women with polycystic ovarian syndrome (PCOS) are at higher risk for pregnancy complications. The PCOS population is heterogeneous, with different phenotypes linked to varying risks of adverse outcomes. However, literature on pre-conceptional hyperandrogenism is limited and based on small sample sizes. Methods: This multi-institutional registry-based retrospective cohort study included pregnant patients diagnosed with PCOS with or without pre-conceptional hyperandrogenism. Utilizing the TriNetX platform, one-to-one propensity score matching was conducted to adjust for confounding factors. Exclusion criteria included multiple pregnancies and patients who received assisted reproductive technology, oral contraceptives, or spironolactone. 571 patients with PCOS and pre-conceptional hyperandrogenism and 13,465 patients with PCOS without hyperandrogenism were identified. Post-propensity matching, each cohort consisted of 564 patients. Results: Pregnant women diagnosed with PCOS and pre-conceptional hyperandrogenism showed a higher risk of large for gestational age (6.6% vs. 3.9%, OR = 1.73, 95% CI [1.007–2.972], p-value = 0.045) and preterm birth (10.3% vs. 5.9%, OR = 1.844, 95% CI [1.183–2.876], p-value = 0.006), but had no significant increase in the risk of gestational hypertension, preeclampsia/eclampsia, gestational diabetes, missed abortion, intrauterine growth restriction, placenta abruption, or cesarean section. Conclusions: Women with PCOS and pre-conceptional hyperandrogenism have an increased risk of pregnancy complications, especially large for gestational age and preterm birth. Further research is needed to clarify the underlying mechanisms, and whether treatment can improve outcomes.
Surgical Emergencies in Rectal Cancer: A Narrative Review
Authors: Pajola Maria , Fugazzola Paola , Cobianchi Lorenzo , Frassini Simone , Ghaly Ahmed , Bianchi Carlo , Ansaloni Luca
Published: December 2024

Colorectal cancer (CRC) is the third most diagnosed cancer worldwide and the second most common cause of cancer death. About 20% of patients diagnosed with rectal cancer present with emergency symptoms. Typical symptoms include acute bleeding, obstruction, and perforation. These emergency situations can be life-threatening and may lead to decreased life expectancy and quality of life. Bowel perforation is the most common cause of emergency presentation, followed by obstruction and acute bleeding. This narrative review analyzes the existing literature regarding the acute presentation of rectal cancer, producing three flow charts for the management of the main rectal emergencies. The treatment of acute bleeding differs based on the hemodynamic status. Treatment for bowel perforation or occlusion differs depending on whether the lesion is intraperitoneal or extraperitoneal. Emergency presentations seem to be strongly associated with several poor prognostic factors, including lymphovascular invasion, perineural invasion, and high-grade or poorly differentiated tumors. An association between emergency presentation and larger tumor size, advanced tumor stage, node-positive disease, and metastatic disease is reported in the literature. The difference between colon and rectal cancer, both in terms of treatment and prognosis, has been widely acknowledged. Thus, comprehensive studies and dedicated guidelines are needed, considering the lack of literature published about rectal cancer in an emergency setting.
Biomarkers of Importance in Monitoring Heart Condition After Acute Myocardial Infarction
Authors: Aleksova Aneta , Fluca Alessandra Lucia , Beltrami Antonio Paolo , Dozio Elena , Sinagra Gianfranco , Marketou Maria , Janjusevic Milijana
Published: December 2024

Despite notable advancements in cardiovascular medicine, morbidity and mortality rates associated with myocardial infarction (MI) remain high. The unfavourable prognosis and absence of robust post-MI protocols necessitate further intervention. In this comprehensive review, we will focus on well-established and novel biomarkers that can provide insight into the processes that occur after an ischemic event. More precisely, during the follow-up, it is of particular importance to monitor biomarkers that indicate an increase in myocardial stretch and stress, damage and death of cardiomyocytes, remodelling of the extracellular matrix, oxidative stress, and inflammation. This enables the identification of abnormalities in a timely manner, as well as the capacity to respond promptly to any changes. Therefore, we would like to highlight the importance of well-known markers, such as natriuretic peptides, high-sensitivity troponins, soluble suppression of tumorigenicity 2, galactin-3, C-reactive protein, and interleukins in post-MI settings, as well as biomarkers such as adrenomedullin, growth differentiation factor-15, insulin-like growth factor binding protein 7, amyloid beta, vitamin D, trimethylamine N-oxide, and advanced glycation end-products that recently emerged in the cardiovascular filed. The implementation of novel post-MI protocols, which encompass the monitoring of the aforementioned biomarkers deemed pertinent, in conjunction with adherence to established cardiac rehabilitation programmes, along with the already well-established therapeutic strategies and control of cardiovascular risk factors, has the potential to markedly enhance patient outcomes and reduce the elevated level of morbidity and mortality.
Comparative Evaluation of Treatment Outcomes of Revision Anterior Cruciate Ligament Reconstruction Using Allograft and Semitendinosus Autograft
Authors: Kentel Maciej , Kentel Monika , Korolczuk Krzysztof , Witkowski Jarosław
Published: December 2024

Introduction: The number of revision anterior cruciate ligament reconstruction (RACLR) procedures is increasing in proportion to the increase in the number of anterior cruciate ligament reconstruction (ACLR) procedures. Although approximately 50–75% of these procedures can be performed in a single-stage procedure, not all of them can. The choice of graft may influence the results of RACLR. The most commonly mentioned graft materials for RACLR are allografts and autografts. Background/Objectives: The aim of the study was to evaluate the results of single-stage RACLR using a semitendinosus (ST) autograft or allograft and to follow-up and compare the results of both groups after 2 years. Methods: The retrospective cohort study was carried out between 2008 and 2021, during which time 2327 ACLRs were performed. Graft rupture occurred in 198 (8.5%) patients, and 98 (4.2%) patients underwent RACLR. RACLR was performed as a single-stage procedure using a semitendinosus autograft or allograft in 56 patients. The KT-2000, Lachman and axis shift, range of motion, Tegner, Lysholm, KSS, KOOS, and IKDC tests were used to assess outcomes. Results: There were no differences between the groups in terms of age, time of revision after procedure, parameters for the graft (screw diameter, endobutton length, femoral tunnel length) or for the procedure and revision, BMI, or in the time needed for returning to dynamics and training. The groups did not differ in quality of life in any measurements, stiffness, pain function, or sport. Analysis showed higher Lysholm results on the day of treatment in the autograft group than in the allograft group (p = 0.11). The allograft group had higher KSS scores on the day of treatment (p = 0.11) and after 60 months or at the moment of breakup than the autograft group (p = 0.025). Conclusions: Single-stage revision anterior cruciate ligament reconstruction with an autograft and ST provides good knee stability. The results of single-stage revision anterior cruciate ligament treatment using an ST autograft or an ST allograft are similar.
Transfemoral Compared to Transapical Transcatheter Aortic Valve Implantation in Chronic Dialysis-Dependent Patients
Authors: Mangner Norman , Schrader Manuela , Haussig Stephan , Kiefer Philipp , Leontyev Sergey , Kappert Utz , Alexiou Konstantin , Crusius Lisa , Erbs Sandra , Gasior Tomasz , Steul Jean-Honoré , Goto Keita , Trausch Anne , Hommel Jennifer , Abdel-Wahab Mohamed , Borger Michael A. , Holzhey David , Linke Axel , Woitek Felix J.
Published: December 2024

Introduction: Patients with end-stage kidney disease (ESRD) represent a high-risk population in terms of both development of and death by cardiovascular diseases. Outcome data of ESRD patients with severe aortic valve stenosis (AS) treated by transcatheter aortic valve implantation (AVI) are scarce. We aim to compare the outcome of ESRD patients undergoing transfemoral (TF) or transapical (TA) AVI. Methods: From June 2006 to December 2019, 176 consecutive patients with ESRD receiving chronic hemodialysis underwent TF- or TA-AVI at two German heart centers. The primary outcome measure was 1-year all-cause mortality. Other outcomes included VARC-3 defined device success and early safety. Results: The cohort comprised 61 (34.7%) patients receiving TA-AVI and 115 (65.3%) patients receiving TF-AVI. Perioperative risk, assessed using the EuroScore II, was not different between groups. VARC-3 defined device success (52.5% vs. 80.0%, p < 0.001) and early safety (27.9% vs. 45.2%, p = 0.025) were lower in TA-AVI patients compared to the TF-AVI group. The 30-day mortality was 4.7-fold higher in TA- compared TF-AVI patients (24.6% vs. 5.2%, p < 0.001). The 1-year mortality was higher in TA- compared with TF-AVI patients (57.3% vs. 27.8%, p < 0.001). By applying a Cox regression analysis, it was found that TA-AVI was the only independent factor associated with 1-year all-cause mortality (HRadj 2.65 (95%-CI 1.63-4.30), p < 0.001). Conclusions: In ESRD patients, TA-AVI was associated with worse early outcomes and increased mortality up to 1 year compared to the TF-AVI. Transfemoral access is recommended, when feasible, in ESRD patients undergoing TAVI.
Evaluation of Ocular Irritation Sensitivity: Implications of Clinical Parameters, Pain Sensitivity, and Tear Neuromediator Profiles
Authors: Yoon Hyeon-Jeong , Moon Ja Young , Kim Hyun Jee , Park Sodam , Choi Ji Suk , Choi Hoon-In , Kim Seoyoung , Yoon Kyung Chul
Published: December 2024

Background/Objectives: Sensitivity to ocular irritation varies among individuals, being influenced by clinical, subjective, and biochemical factors. This study aimed to evaluate individual variability in ocular irritation sensitivity, focusing on clinical parameters, pain perception, and tear neuromediator profiles. Methods: Sixty female participants aged 20–40 were classified into high-sensitivity and low-sensitivity groups based on their response to an irritant (Tween20). Clinical assessments included the ocular surface disease index (OSDI), tear break-up time (TBUT), Schirmer test, and corneal touch threshold measured with the Cochet–Bonnet esthesiometer. Pain sensitivity was assessed using the pain sensitivity questionnaire (PSQ), and tear neuromediators were quantified in tear samples before and after stimulation. The concentrations of calcitonin gene-related peptide (CGRP), nerve growth factor, neuropeptide Y, vasoactive intestinal peptide (VIP), and substance P were measured using an enzyme-linked immune sorbent assay (ELISA). Results: The high-sensitivity group exhibited significantly higher OSDI scores (p = 0.038). No significant differences were observed in TBUT, corneal staining scores, or Schirmer’s test results. The PSQ results revealed that the high-sensitivity group had lower total and moderate pain scores (p = 0.037 and p = 0.040, respectively). An analysis of the tear neuromediator showed elevated baseline CGRP levels (p = 0.017) and a significant post-stimulation increase in substance P (p = 0.021) in the high-sensitivity group. Conclusions: These findings emphasize the value of combining clinical, subjective, and biochemical measures to understand sensitivity to ocular irritation. This comprehensive approach may guide the development of safer cosmetic formulations and improve safety assessment protocols.
Predictive Potential of ECMO Blood Flow for Hemolysis and Outcome of Patients with Severe ARDS
Authors: Bünger Victoria , Russ Martin , Kuebler Wolfgang M , Menk Mario , Weber-Carstens Steffen , Graw Jan A
Published: December 2024

Background: Treatment with veno-venous extracorporeal membrane oxygenation (VV ECMO) has become a frequently considered rescue therapy in patients with severe acute respiratory distress syndrome (ARDS). Hemolysis is a common complication in patients treated with ECMO. Currently, it is unclear whether increased ECMO blood flow (Q̇EC) contributes to mortality and might be associated with increased hemolysis. Methods: A total of 441 patients with ARDS and VV ECMO, treated in a tertiary ARDS center, were included. The Q̇EC value for a significant increase in ICU mortality was determined by binary recursive partitioning. Linear regression analysis was performed to analyze a correlation between mean Q̇EC and mean plasma concentrations of cell-free hemoglobin (CFH). Results: A Q̇EC of 4 L/min divided the cohort into two groups with significantly different ICU mortality (Q̇EC ≤ 4 L/min: 39.3% (n = 300) versus Q̇EC > 4 L/min: 71.6% (n = 141), p < 0.001). Patients with Q̇EC > 4 L/min had a higher 28-day mortality. Furthermore, a higher mean Q̇EC was associated with increased CFH and decreased haptoglobin plasma concentrations. Conclusion: In patients with ARDS and VV ECMO, a mean Q̇EC > 4 L/min is associated with increased mortality, increased CFH and decreased haptoglobin plasma concentrations. Whether increased hemolysis determines the poorer outcome associated with higher Q̇EC should be the subject of future research.
Are Ki-67 and Procalcitonin Expression Levels Useful in Predicting the Biological Behavior of Hepatocellular Carcinoma After Liver Transplantation?
Authors: Karabulut Ertugrul , Akbulut Sami , Samdanci Emine Turkmen , Akatli Ayse Nur , Elsarawy Ahmed , Kucukakcali Zeynep , Ogut Zeki , Tuncer Adem , Ince Volkan , Yilmaz Sezai
Published: December 2024

Background: Examinations of procalcitonin (PCT) and Ki-67 expression levels in hepatocellular carcinoma (HCC) patients who have undergone liver transplantation (LT) through immunohistochemical analyses of tumor tissue may reveal the biological characteristics of the tumor, thus informing the selection of HCC patients for LT. Methods: Hepatectomy specimens from 86 HCC patients who underwent LT were obtained and analyzed immunohistochemically for the expression of PCT and Ki-67. The percentage and intensity of PCT staining, as well as the percentage of Ki-67 expression, were assessed for each patient. The impacts of PCT and Ki-67 expression on disease-free survival, overall survival, and the recurrence rate were studied, as well as their correlations with other clinicopathological features. Results: The recurrent HCC group showed a higher Ki-67 level (p < 0.001), larger maximum dominant tumor diameter (p < 0.001), and higher rate of vascular invasion (p = 0.001). The pre-transplant AFP (p = 0.001), maximum dominant tumor diameter (p < 0.001), number of tumor nodules (p < 0.001), rate of vascular invasion (p = 0.001), and Ki-67 level (p = 0.044) were higher in patients beyond the Milan criteria. Similarly, the pre-transplant AFP (p < 0.001); maximum dominant tumor diameter (p < 0.001); number of tumor nodules (p < 0.001); rates of portal vein tumor thrombus (p = 0.002), poor differentiation (p = 0.021), and vascular invasion (p < 0.001); and Ki-67 level (p = 0.010) were higher in patients beyond the expanded Malatya criteria. The maximum dominant tumor diameter (p = 0.006); Ki-67 level (p = 0.003); rates of vascular invasion (p < 0.001), cases beyond the Milan criteria (p = 0.042) and the expanded Malatya criteria (p = 0.027), and portal vein tumor thrombus (p = 0.020); and presence of recurrence (p < 0.001) were higher in HCC patients with mortality. The Kaplan–Meier estimates indicated that Ki-67 levels exceeding 5% significantly affected DFS and OS. Although the Kaplan–Meier estimates indicated that a PCT staining percentage of ≥25% did not have a statistically significant effect on DFS or OS, the outcomes may be considered clinically significant. Conclusions: This study demonstrated that the Ki-67 proliferation index can be used as a predictive biomarker of the biological behavior of HCC. Furthermore, we claim that PCT expression over a particular threshold might impact recurrence and survival, and we believe that further multicenter prospective studies focused on standardized PCT antibody staining are crucial in order to determine its potential as a biomarker for HCC.