bluuebunny/crossref_metadata_2025 huggingface dataset:
A Comprehensive Study of Governance Issues in Decentralized Finance Applications
Authors: Ma Wei , Zhu Chenguang , Liu Ye , Xie Xiaofei , Li Yi
Published: February 2025

Decentralized Finance (DeFi) is a prominent application of smart contracts, representing a novel financial paradigm in contrast to centralized finance. While DeFi applications are rapidly emerging on mainstream blockchain platforms, their quality varies greatly, presenting numerous challenges, particularly in terms of their governance mechanisms. In this paper, we present a comprehensive study of governance issues in DeFi applications. Initially, we collected 3,165 academic papers and numerous industry reports. After thorough screening, we selected 44 academic papers and 11 industry reports for detailed analysis. Drawing upon insights from industry reports and academic research articles, we develop a taxonomy to categorize these governance issues. We collect and build a dataset of 4,446 audit reports from seventeen Web3 security companies, categorizing their governance issues according to our constructed taxonomy. We conducted a thorough analysis of governance issues and identified vulnerabilities in the governance design and implementation, e.g., voting sybil attack and proposal front-running. Our statistical analysis indicates that a significant portion (35.48%) of governance-related issues is classified as severe. Within these, ownership-related problems constitute the largest share (65.38%). Despite DeFi governance being essential for the long-term success of DeFi projects, our data shows that both auditors and development teams have not fully grasped its significance. Based on audit reports, we also analyzed common vulnerabilities and issues in the governance domain. Our research identifies two primary categories of DeFi governance issues: technology-centric and human-centric. Technology-centric issues can be addressed through technology updates and iterations, whereas human-centric issues are influenced not only by the development team's technical skills but also by their understanding of DeFi governance. Data analysis reveals that design and implementation issues are frequently overlooked; although not directly associated with vulnerabilities, these issues can impact the equitable distribution of project benefits. Furthermore, our analysis of 104 projects’ tokenomics configurations, including 15 collected from DeFi platforms, uncovered 27 inconsistent configurations, with only two projects exhibiting no issues. This suggests that such issues are relatively common. We therefore advise project teams to ensure consistency between their tokenomics design and the actual code. Our study culminates in providing several key practical implications for various DeFi stakeholders, including developers, users, researchers, and regulators, aiming to deepen the understanding of DeFi governance issues and contribute to the robust growth of DeFi systems.
Towards Robust Cyber Attack Taxonomies: A Survey with Requirements, Structures, and Assessment
Authors: Santos Paulo Roberto da Paz Ferraz , Resende Paulo Angelo Alves , Gondim João José Costa , Drummond André Costa
Published: February 2025

Cyber attacks have become a growing threat in today’s interconnected society, and taxonomies play a crucial role in understanding and preventing these attacks. However, the lack of comprehensive assessment methods for evaluating attack taxonomies represents a significant gap in the literature, hindering their development and applicability. This paper aims to address this gap by conducting a survey of 20 attack taxonomies published between 2011 and 2022 and evaluating them with a novel set of qualitative and quantitative assessment criteria, grounded in fundamental taxonomy requirements and key structural attributes. In pursuit of clear and objective assessment criteria, the authors investigated the main taxonomy properties in the literature, identifying dependencies and relationships. This investigation extracted the fundamental requirements for a relevant and widely accepted attack taxonomy in the cybersecurity community. Noteworthy structural aspects, such as organization, scheme, labeling, and approach, are also addressed, considering their impact on taxonomy effectiveness and applicability constraints. Finally, the paper poses some open questions and challenges, along with suggestions for future research directions.
Table 4 from Variant of Uncertain Significance Patterns among Patients with Early-Onset Colorectal Cancer
Authors: Francis Rachel A. , Tavtigian Sean , Horton Carolyn , Holowatyj Andreana N.
Published: February 2025

Characteristics of five individuals with early-onset colorectal cancer who identified as Asian and had a VUS detected in MSH2
Detecting atrial fibrillation by artificial intelligence enabled neuroimaging examination.
Authors: Sharobeam Angelos , Shokri Mohammad Javad , Desai Nandakishor , Rao Aravinda S. , Kusuma Yohanna , Palaniswami Marimuthu , Davis Stephen M. , Yan Bernard
Published: February 2025

Background

Diagnosis of occult atrial fibrillation (AF) is difficult as it is often asymptomatic, leading to under detection. Current diagnostic tests have variable limitations in feasibility and accuracy. Machine learning is gaining greater traction for clinical decision making and may help facilitate the detection of undiagnosed AF when applied to magnetic resonance imaging (MRI). We hypothesise that machine learning algorithm increases the accurate classification of MRIs of stroke patients into those due to AF vs large artery atherosclerosis.

Methods

Stroke aetiology for each patient was determined by a review of medical records and investigations. Patients with either AF or large artery atherosclerosis were included.
Patients were randomly divided into the training and validation groups (4:1). A 3D convolutional neural network (ConvNeXt) was developed to train and validate the algorithm. After training, the models were evaluated using common metrics for binary classification.

Results

A total of 235 patients were analysed (97 with AF, 138 without AF). The mean age of the sample was 71.1 (SD 14.2) and 35% percent were female. The best discriminative performance was obtained in the 5th fold of cross-validation (AUC-ROC 0.88) and the overall model performance was 0.81. The best performing metrics were precision (0.84) and the F1-score (0.77).

Conclusion

Our machine learning algorithm has reasonable classification power in categorizing stroke patients into those with and without underlying AF. Testing in external validation data sets are critical to confirm these results.
Impact of acute or chronic post-void retention after midurethral sling surgery for women with stress urinary incontinence: a systematic review and retrospective analysis of our data
Authors: Skuk Eva , Lukanović David , Lebar Vojka , Matjašič Miha , Lasič Mateja , Barbič Matija
Published: February 2025

Objectives: The aim of our study was to analyze the percentage of acute urinary retention after midurethral sling (MUS) surgery for stress urinary incontinence (SUI). The results of our study directed us to conduct a systemic review (SR) because of the need to consolidate existing knowledge on the incidence and management of postoperative urinary retention.
Design: The first part of the article presents the SR, which was conducted after the retrospective analyses of our data.
Participants/Materials: This article presents a retrospective study conducted on a sample of 55 patients who underwent three different types of MUS surgery: TVT-Abbrevo, TVT-O, and single-incision Ophira Mini Sling.
Setting: The study analyzes outcomes at a median 8-year follow-up, focusing on the significance of acute urinary retention after MUS surgery.
Methods: SR was conducted using Medline, Cochrane, and Clinical Trials databases, following PRISMA guidelines. The retrospective study involved 55 patients who underwent three types of MUS surgery (TVT-Abbrevo, TVT-O, and Ophira) at our clinic, with a median follow-up of 8 years. Postoperative outcomes, including acute urinary retention and residual urine, were assessed using ultrasound, and success was evaluated through the Patient Global Impression of Improvement (PGI-I) and International Consultation on Incontinence Questionnaire–Short Form (ICIQ-SF).
Results: The SR has shown that the reported percentage of patients with acute postoperative urinary retention after MUS procedures varies between 1.5% and 6.6%. In our retrospective analyses, five patients had acute urinary retention after the procedure (9.1%) and required the use of a Foley catheter for several days. All three surgical procedures resulted in similar levels of patient satisfaction at follow-up, as indicated by the PGI-I scores and patients’ ICIQ-SF scores. The type of procedure and the patients’ ICIQ-SF or PGI-I scores do not significantly correlate with the post-void residual volume.
Limitations: One of the major limitations in our analyses is the lack of any possibility to compare all TVT approaches, including retropubic. A larger sample size would be necessary to draw more definitive conclusions from these observations.
Conclusions: Our SR provides a comprehensive synthesis of previous research on urinary retention after MUS surgery. We noted that many studies fail to consider the possibility of preexisting urinary retention. Clinically significant long-term urinary retention in our cohort of patients was below 100 ml, was not specifically correlated with any type of procedure, and was not statistically correlated with acute urinary retention after operation.
A case report: Metastatic Gestational Trophoblastic Neoplasia leading to acute respiratory failure and death.

About a particularly challenging management in the intensive care unit, and exploring the potential of Pembrolizumab in treating frail pretreated Gestational Trophoblastic Neoplasia
Authors: Meyers Michel , Awada Ahmad , Najmaoui Marine , Ilzkovitz Maxime , Pezzullo Martina , Chaves Julia , Deviere Jacques , Halenarova Katarina , Georgala Aspasia , Fastrez Maxime , Goffin Frédéric , Polastro Laura
Published: February 2025

:

Case presentation:

We present the case of a 37-year-old female patient who developed an acute respiratory failure requiring mechanical ventilation, two months after term delivery by cesarian section. The diagnosis of gestational trophoblastic neoplasia was suspected due to high level of HCG in post-partum period and thoracic imaging suggesting multiple pulmonary metastases. No biopsy was available. She subsequently developed severe ARDS requiring veno-venous extracorporeal membrane oxygenation (VV-ECMO) support alongside concurrent polychemotherapy.
After spending 61 days in the intensive care unit (ICU), and achieving biological complete remission based on HCG monitoring, the patient was transferred to the oncology ward. Due to prolonged hypoperfusion and hypoxemia the patient developed ischemic cholangiopathy, severely constraining further therapeutic options. After 4 months of biological remission, the patient experienced a recurrence based on HCG rising and reappearing of pulmonary lesions on thoracic imaging in the lungs.

In second-line, the patient was treated with carboplatin, with no significant response. In third-line, Pembrolizumab was used, and the patient experienced a significant decrease in HCG. However, due to hematologic toxicity, we discontinued the treatment. Subsequently, HCG level raised and the patient rapidly developed hemorrhagic cerebral metastasis and succumbed shortly thereafter.

Conclusion:

This case underscores the importance of prompt recognition and timely intervention in the management of patients with ARDS during the early postpartum period. GTN with lung involvement should be considered after excluding the other more frequent causes of ARDS. It also highlights how ECMO support enables the continuation of chemotherapy and the achievement of remission in choriocarcinoma.
Furthermore, due to the inability to initiate the desired chemotherapy, immunotherapy was introduced as a possible treatment modality. Therefore, this case underscores the importance of adaptability in treatment plans based on patient-specific clinical conditions and collaborative decision-making with specialized centers.
Finally, it emphasizes the efficacy of Pembrolizumab, even as a monotherapy, in pre-treated choriocarcinoma cases.
Management of Refractory Esophageal Variceal Bleeding when TIPSS Is Not Possible: Review of a Challenging Case
Authors: Qatomah Abdulrahman , Bessissow Ali , Chen Yen-I , Bessissow Talat , Benmassaoud Amine
Published: February 2025

Introduction: Esophageal variceal bleeding (EVB) is a common complication of portal hypertension. Guidelines recommend initiation of vasoactive agents in combination with antimicrobial therapy prior to endoscopic variceal ligation. In cases of refractory EVB, trans-jugular intrahepatic portosystemic shunt (TIPSS) is recommended; however, it is contraindicated in up to 35% of cases. Case Presentation: We report a case of a 61-year-old male newly diagnosed with hepatocellular carcinoma and extensive portal vein thrombosis. The patient developed a refractory EVB failing medical and endoscopic therapies which was successfully treated with transcutaneous left gastric vein embolization (LGVE). Conclusion: LGVE could be contemplated in instances where anatomical complexities or contraindications to TIPSS arise.
Preoperative Systemic Chemotherapy Including Immune Checkpoint Inhibitors for Patients with Tumor-Associated Dermatomyositis
Authors: Kawamura Yukino , Shimomura Akihiko , Taniyama Tomoko , Hirai Hoshie , Hashimoto Kazuki , Honda Yayoi , Kitagawa Dai , Kaneko Hiroshi , Shimizu Chikako
Published: February 2025

Introduction: Immune checkpoint inhibitors (ICIs), used in cancer immunotherapy, enhance the immune system’s ability to attack cancer cells. However, this activation can lead to severe immune-associated adverse events due to overactivation. In autoimmune diseases, the immune system mistakenly targets the body’s tissues, producing autoantibodies that cause inflammation and tissue damage. Despite the increasing use of ICIs, limited information exists on their effects and potential harms in patients with active autoimmune diseases, making it challenging to predict outcomes and manage risks for these patients. Case Presentation: We report a case of a patient with breast cancer presenting with a rash and muscle weakness. The simultaneous onset of these symptoms, along with the rapid growth of the breast tumor, led to a diagnosis of tumor-associated dermatomyositis (DM). The patient presented with locally advanced triple-negative breast cancer and received preoperative chemotherapy, including ICIs. Conclusion: The administration of preoperative chemotherapy, including ICIs, to a patient with breast cancer and tumor-associated DM was found to be a safe and effective treatment approach. There is a need to better understand the interplay between ICIs and autoimmune diseases and to develop safe and effective treatment strategies for this unique patient population.
Late prenatal development of hindbrain herniation in open spina bifida
Authors: Lapa Denise Araujo , Rangwala Shivani , Zebian Bassel , Brown Matthew , Chu Jason , Chmait Ramen H.
Published: February 2025

Introduction: We describe four cases of open spina bifida initially presumed to be “closed” defects in which serial prenatal ultrasound examinations documented the occurrence of sac rupture and development of Chiari II malformation later in the pregnancy.
Case presentation: In each case, the ultrasound examinations starting from 19-24 weeks’ gestation, showed spinal cystic lesions containing neural elements, but no evidence of Chiari II malformation. The lack of hindbrain herniation rendered them ineligible for prenatal surgical repair; but follow-up imaging at 24-32 weeks’ gestation, demonstrated the cystic lesions no longer visible or visible but decompressed, with the additional development of de novo hindbrain herniation.
Conclusion: We conclude by recommending serial ultrasound surveillance of presumed “closed” spina bifida as these may be in fact open defects, with confirmatory diagnosis only possible later in pregnancy. This detection is important because it may change counseling since prenatal repair or planned delivery may be warranted
Diversity in United States dementia prevention trials: An updated systematic review of eligibility criteria and recruitment strategies
Authors: Lazaar Najoua , Van Beek Sabine E. , Rirash Awaale F. , Papma Janne M. , Perales-Puchalt Jaime , Shaw Ashley R. , Vidoni Eric D. , Franzen Sanne
Published: February 2025

Introduction: Given the elevated dementia risk in underrepresented demographic groups in the US—particularly in Latino and Non-Latino Black individuals compared to Non-Latino White individuals—it is vital that these groups are well-represented in dementia prevention research. Eligibility criteria and recruitment strategies may play a key role in promoting participant diversity. The aim of this review was to examine eligibility criteria and recruitment strategies in US dementia prevention trials in light of participant diversity.

Methods: A systematic review was conducted using Medline (including PubMed), Embase, Cochrane Library and CINAHL. We explored the percent White participants for trials using vs. not using a specific eligibility criterion or recruitment strategy using Hodges-Lehmann median difference estimation.

Results: Of forty-four studies meeting the inclusion criteria, twenty-seven reported on racial/ethnic diversity. Analyses demonstrated that criteria regarding cardiovascular disease, pulmonary disease, hearing impairment, and sedentary lifestyle were associated with relatively high participant diversity, while gastro-intestinal/liver disease, motivation to participate, and language proficiency criteria were associated with relatively little diversity. Information on recruitment strategies was often lacking. Three studies described recruitment efforts explicitly aimed at increasing diversity. Recruitment strategies associated with relatively high racial/ethnic diversity included recruitment via referral/word-of-mouth, television/radio advertising, and recruitment at church.

Conclusion: Eligibility criteria could be improved by revisiting and revising how they are defined (e.g. motivation to participate). Regarding recruitment, several recommendations are provided, including 1) lifting barriers to study participation (e.g. through reimbursement), 2) collaborating with community partners, and 3) formally studying the effectiveness of recruitment strategies.
Artificial intelligence in colonoscopy – where are we now in 2024?
Authors: Lai Wan Ying , Lin Kenneth Weicong , Ling Loi Pooi , Li James W. , Lau Louis H.S. , Chiu Philip W.Y.
Published: February 2025

Introduction: Colonoscopy has a crucial role in reducing colorectal cancer incidence and mortality. Different artificial intelligence (AI) systems were developed to further improve its quality assurance (computer-aided quality improvement, CAQ), lesion detection (computer-aided detection, CADe) and lesion characterization (computer-aided characterization, CADx). There were studies investigating the roles of these AI systems in different domains of standard colonoscopies.

Methods: In this state-of-the-art narrative review, we summarize the current evidence, discuss existing limitations, as well as explore the future directions of AI in colonoscopy.

Results: CAQ enhances colonoscopy quality through real-time feedback and quality monitoring systems, but the studies have inconsistent results due to small training datasets and varied methodologies. CADe increases adenoma detection rate and reduces adenoma missed rates but there are concerns about false positives, unnecessary polypectomies, potential de-skilling of endoscopists, and cost-effectiveness. CADx systems have mixed results and accuracies in differentiating polyp types, its use is further hindered by inadequate representation of sessile serrated lesions and a lack of rigorous trials comparing it with standard colonoscopy.

Conclusion: Despite the emerging evidence of AI-assisted colonoscopy, its potential drawbacks and limitations may hinder the further implementation in real-world clinical practice. Long-term data on clinical efficacy, cost effectiveness, liability and data sharing are the key areas to be addressed.
Microsurgical Treatment versus Endovascular Treatment for Ruptured Intracranial Aneurysms in Elderly Patients: A Multicenter Study in Northern China
Authors: Gao Yikuan , An Xiuhu , Wang Bangyue , Liu Shunde , Jiang Wuqiang , Zhong Xiangping , He Lijin , Yang Xinyu
Published: February 2025

Background: Management of ruptured intracranial aneurysms (RIAs) in elderly patients remains a major challenge in the treatment of cerebrovascular diseases. This study aims to provide a comprehensive analysis of the impact of microsurgical treatment (MST) and endovascular treatment (EVT) on the outcomes of elderly patients with RIAs in northern China.
Methods: We consecutively enrolled elderly patients with RIAs who underwent surgery in the Chinese Multicenter Cerebral Aneurysm Database (CMAD) from January 2017 to December 2020. In this study, in-hospital complications, survival, and functional outcomes were compared between MST and EVT after 1:1 propensity score matching (PSM). Kaplan-Meier survival analyses and Cox proportional hazards modeling identified factors associated with mortality in both groups. Logistic regression analyses identified 2-year survival-dependent risk factors, and subgroup analyses were conducted for key strata.
Results: 744 elderly patients with RIAs were enrolled in the study. 219 patients with MST after PSM were matched with 219 patients with EVT. Compared to EVT, MST had a higher 2-year mortality rate (32.8% vs. 20.5%, p=0.002), higher incidence of adverse discharge outcomes (48.4% vs. 32.4%, p=0.001), longer length of stay (LOS) (16 (12-24) vs. 15 (10-23), p=0.049), pneumonia (MST: 31.1%; EVT: 21.9%, p=0.030), and intracranial infection (9.6% vs. 2.7%, p=0.005). However, there was no difference in the 2-year survival-dependent outcome (22.7% vs 23.2%, p=0.924). Differences in risk factors for mortality and 2-year survival-dependent outcomes were observed between the MST and EVT groups in the elderly population. The negative association of EVT with risk of mortality was consistent across specific subgroups.
Conclusion: Elderly patients with RIAs who underwent EVT were significantly better than the MST group in terms of short-term functional outcomes, in-hospital complications, long-term survival, and LOS. However, there were no differences in the 2-year survival-dependent outcomes.
Single-tube multiplex PCR-SSP for the detection of RHD variant alleles commonly found in serologically D– phenotype individuals in a Thai population
Authors: Pittayabumrung Ornuma , Leelayuwat Chanvit , Romphruk Amornrat V. , Simtong Piyapong
Published: February 2025

Background: The molecular basis of the RHD gene found in serologically D– phenotype individuals differs with race/ethnicity. Therefore, we aimed to develop a single-tube multiplex PCR-sequence specific primer (multiplex PCR-SSP) to detect RHD variant alleles commonly found in serologically D– phenotype individuals in a Thai population.
Study design and methods: In total, 205 blood samples with a serologically D– phenotype were tested using a single-tube multiplex PCR-SSP targeted RHD exons 1, 4, 7, 10, and c.1227G>A in RHD exon 9 in combination with a hybrid Rhesus box, and results were confirmed by direct DNA sequencing.
Results: In a single-tube multiplex PCR-SSP, three patterns of amplified RHD exons were observed: total deletion of the RHD gene, Asian-type DEL, and RHD-CE-D hybrid. The allele frequencies of RHD*01N.01, RHD*01EL.01, and RHD-CE-D hybrid were 83.4%, 12.9%, and 2%, respectively. All of the Asian-type DEL samples present the RHCE*C/E allele (predicted RhCE phenotype: C/E+).
Conclusion: This study successfully established a simple and reliable molecular diagnostic platform for analyzing RHD variant alleles commonly found in serologically D– phenotype individuals in a Thai population. This technique could enable broader RHD*01EL.01 (Asian-type DEL) analyses in high-prevalence areas such as Thailand and other countries in East and Southeast Asia, serving as an example for blood bank routine settings.
Exploring Trends and Challenges in Global Health Dental Education: Scoping Review
Authors: Wolpe Beatriz Helena , Rodacoski Isabela , Danelle Victor Augusto , Prado Maria Rosa Machado , Bellani lliam Augusto Gomes de Oliveira
Published: February 2025

Oral health is vital to overall well-being but faces significant global challenges, necessitating reform in dental education. Global oral health education empowers professionals to address these issues, promoting global competencies and preventive approaches. The objective is to map scientific articles that approach global oral health education, its practical reality, and curricular inclusion in undergraduate dental programs. This study is a scoping review following the Joanna Briggs Institute's approach, with searches in databases such as PubMed and SciELO using the keywords "global health" and "education, dental," along with the boolean operator AND. After excluding studies outside of the scope of the research and duplicate articles, 26 articles were selected for analysis. Among the analyzed articles, the need to further discuss the following topics was observed: trends and challenges in global dental education, oral health inequalities and the need for global approaches, and the integrating global health into the dental curriculum. The reviewed studies highlight the importance of adapting curricula to global needs, emphasizing the integration of oral health into global health policies and the promotion of interprofessional competencies. The review underscores the need to internationalize dental education and prepare future dentists to address oral health inequalities, with global partnerships and interprofessional collaboration being essential for the success of these initiatives. The conclusion shows that global oral health education should include preventive and interdisciplinary approaches, preparing professionals for global challenges. This requires integrating global health competencies into curricula and promoting international collaborations in dental education.
Pulmonary hypertension in the field of hematological and oncological diseases
Authors: Lichtblau Mona , Lador Frédéric , Lechartier Benoit , Ellegast Jana Maria , Pohle Susanne , Preiss Helga , Genecand Leon , Wick Carmen , Ulrich Silvia , Reimann Lena
Published: February 2025

Hematological and oncological diseases collectively affect a substantial number of patients. Pulmonary hypertension (PH) is recognized as a potential complication associated with these conditions, manifesting in various forms of PH and presenting with a range of symptoms. The complexity of PH in this context arises from its multifactorial etiology, which can include direct effects of malignancies, treatment-related effects and the impact of disease progression. The variability in how PH presents and progresses in patients with hematological diseases and neoplasms complicates its diagnosis and management. Accurate identification of PH alongside the underlying condition is crucial for enabling optimal treatment and improving overall survival. A multidisciplinary approach involving pulmonologists, hematologists, and oncologists is essential to address these challenges effectively. This review aims to summarize recent research findings and enhance the understanding of the complex interactions between PH and hemato-oncological diseases.
A Case Report of Intravitreal Aflibercept for Iris Metastasis from Small Cell Lung Carcinoma with Neovascular Glaucoma
Authors: Goto Hitoshi , Hirakata Kyrie , Nakamoto Kenji , Okamoto Fumiki , Hori Junko
Published: February 2025

Introduction
Metastatic iris tumors from lung cancer are uncommon and challenging to diagnose. As lung cancer treatments improve, life expectancy increases, potentially leading to more cases of metastasis. These tumors often cause neovascular glaucoma, making intraocular pressure (IOP) management crucial, especially in terminal-stage patients.

Case Presentation
A 65-year-old man with small cell lung carcinoma (SCLC) presented with right ocular pain and blurred vision. His right IOP was 55 mmHg, and examination revealed anterior chamber cells, multiple greyish-white iris masses, and right iris neovascularization. Anterior chamber fluid cytology confirmed the diagnosis of metastatic iris tumors from SCLC. Despite treatment with topical eye drops, oral acetazolamide, and intravenous hypertonic mannitol, the IOP remained poorly controlled. Intravitreal aflibercept was subsequently administered into his right eye for neovascular glaucoma. Neovascular glaucoma disappeared rapidly, but IOP did not improve. However, intravenous infusion of hypertonic mannitol was no longer required, and the complaints of nausea associated with intraocular pressure decreased. Although this patient died four months after the initial visit due to multiple metastases of SCLC, the intravitreal aflibercept was effective in shrinking the iris tumor size and lowering intraocular pressure in the terminal phase of the disease.

Conclusion
This is the first reported use of intravitreal aflibercept for SCLC metastases to the iris. While the prognosis of patients with metastatic iris tumors remains poor, intravitreal aflibercept injections show potential in reducing iris tumor size and lowering IOP. Although not curative, this therapeutic approach may play a significant role in the symptom management of these patients.
Distress & Care Utilization in Patients with Myeloproliferative Neoplasms
Authors: Patel Rushil Virendra , Boselli Danielle , Meadors Patrick L. , Begley Stephanie , Bose Rupali , Ai Jing , Ragon Brittany Knick , Sanikommu Srinivasa , Shah Nilay , Knight Thomas , Symanowski James T. , Walsh Declan , Mesa Ruben A. , Grunwald Michael R. , Chojecki Aleksander
Published: February 2025

INTRODUCTION
Distress negatively affects cancer outcomes. The National Comprehensive Cancer Network (NCCN) recommends screening patients for distress by a self-reported scale (0-10) and to refer those with scores ≥ 4 to supportive services (SS). Little is known about the prevalence of distress and healthcare utilization in classical Philadelphia chromosome-negative myeloproliferative neoplasms (MPNs): polycythemia vera (PV), essential thrombocythemia (ET), myelofibrosis (MF).

METHODS
We retrospectively identified MPN patients at our center to measure the proportions of patients with distress ≥ 4 evaluated by a SS [chaplaincy, integrative oncology, palliative medicine, psychiatry, psychology, and social work (SW)] or had acute care utilization (ACU; ≥ 1 ED visit or hospitalization) within six months of electronic distress screening (EDS). We also obtained sociodemographic, disease characteristics, and symptom score data to stratify variables associated with distress.

RESULTS
Among 141 patients (44 PV, 49 ET, 48 MF), the median age was 63 years (range, 25-89). Most patients identified as female (62%), White (77%), and completed EDS within three months of diagnosis (55%). Of 75/141 (53%) who reported distress ≥ 4, only 25/75 (33%) were evaluated by SS, and 23/75 (31%) had ACU within six months of EDS. Patients with distress ≥ 4 evaluated by SS had significantly higher ACU (48% vs. 14%; p=0.009). Distress was associated with higher symptom scores and more ED visits but not gender, race, ethnicity, diagnosis, relationship status, or insurance.

CONCLUSION
Despite consensus recommendations, most patients with distress ≥ 4 were not evaluated by SS. Future work should identify ways to better use patient-reported outcomes to promote early intervention.
Deep learning and radiomics for gastric cancer lymph node metastasis: Automated segmentation and multi-machine learning study from two centers
Authors: Shang Hui , Fang Yue , Zhao Yuyang , Mi Nan , Cao Zhendong , Zheng Yi
Published: February 2025

Objective: The objective of this study is to develop an automated method for segmenting spleen computed tomography (CT) images using a deep learning model. This approach is intended to address the limitations of manual segmentation, which is known to be susceptible to inter-observer variability. Subsequently, a prediction model of gastric cancer (GC) lymph node metastasis was constructed in conjunction with radiomics and deep learning features, and a nomogram was generated to explore the clinical guiding significance.
Methods: This study enrolled 284 patients with pathologically confirmed GC from two centers. we employed a deep learning model, U-Mamba, to obtain fully automatic segmentation of the spleen CT images. Subsequently, radiomics features and deep learning features were extracted from the entire spleen CT images, and significant features were identified through dimensionality reduction. The clinical features, radiomic features, and deep learning features were organized and integrated, and five machine learning methods were employed to develop 15 predictive models. Ultimately, the model exhibiting superior performance was presented in the form of a nomogram.
Results: A total of 12 radiomics features, 17 deep learning features, and 2 clinical features were deemed valuable. The DRC model demonstrated superior discriminative capacity relative to other models. A nomogram was constructed based on the logistic clinical model to facilitate the usage and verification of the clinical model.
Conclusion: Radiomics and deep learning features derived from automated spleen segmentation to construct a nomogram demonstrate efficacy in predicting LNM in GC. Concurrently, fully automated segmentation provides a novel and reproducible approach for radiomics research.
Hypothyroidism in infants after enteral administration of iodinated contrast media: a rare but serious complication
Authors: Pijpers Adinda G.H. , Zwaveling-Soonawala Nitash , van Schuppen Joost , Onland Wes , van Trotsenburg A.S. Paul , van Heurn L.W. Ernest , Derikx Joep P.M. , Mooij Christiaan F.
Published: February 2025

Introduction: Excessive exposure to iodine early in life can cause primary hypothyroidism by failure to escape the Wolff-Chaikoff effect. Although reported for intravenous iodinated contrast medium (ICM) and topical iodine, prospective studies on thyroid function after enterally administered ICM are lacking. This study aimed to determine the occurrence of hypothyroidism after enteral ICM administration in young infants.
Methods: Prospective cohort study between November 1st 2022 and July 1st 2024 in infants <6 months of age, who underwent radiological examination (mostly abdominal X-ray, AXR) with enteral ICM administration. Stasis of contrast was evaluated by AXR on day two after ICM administration. Serum thyroid-stimulating hormone (TSH) and free thyroxine (fT4) levels were measured around days 5 and 10 after ICM administration and, if abnormal, repeated on day 15.
Results: Thirty-three patients were included. Seventeen patients (51.5%) were born preterm. Stasis of ICM after two days was present in 12 of 28 patients (42.9%). In five male patients (15.2%) abnormal TSH or fT4 levels were observed during follow-up. One of these five patients developed ICM-induced hypothyroidism requiring treatment. In two cases physiological escape of the Wolff-Chaikoff effect was seen. In two cases non-thyroidal illness/hypothyroxinemia of prematurity was observed. Four of the five patients with abnormal TSH or fT4 levels were born preterm.
Conclusion: In this study, one patient developed primary hypothyroidism requiring levothyroxine treatment after enteral ICM administration. We recommend monitoring of thyroid function in infants younger than six months after enteral ICM administration, especially in preterm born infants.
Evolution of plasticity in brain morphology
Authors: Axelrod Caleb J. , Stec Helen , Tran Stephanie M. , Donacik Dora C. , Francis Nathan M. , Gautam Nimisha , Rhodes Madelyn , Viswanathan Neha , Gordon Swanne P.
Published: February 2025

Brain morphology is a critical trait influencing animal performance that has been shown to demonstrate phenotypic plasticity in response to a variety of environmental cues. Further, plasticity itself has consistently been recognized as a trait that can be selected upon and evolve. There has been limited research examining how evolution and selection act on plasticity in brain morphology. Here, we review the environmental factors that have been shown to cause plasticity in brain morphology across animal taxa. We further propose a framework for examining the evolution of brain morphology plasticity, including four hypothesized patterns of selection that may cause evolution of plasticity in this critical trait. Finally, we outline potential ways these hypotheses can be tested to build our understanding of the evolution of brain morphology plasticity.
Integration of Complementary Medicine in Geriatric Nursing Homes: A Prospective Comparative Observational Study
Authors: Ortiz Miriam , Schnabel Katharina , Binting Sylvia , Lezius Susanne , Wegscheider Karl , Teut Michael , Suhr Ralf , Brinkhaus Benno
Published: February 2025

Introduction
A healthy lifestyle is considered to be an important factor for healthy aging. Kneipp therapy (KT) includes a combination of hydrotherapy, herbal medicine, mind-body medicine, physical activities and healthy nutrition. In this study, we investigated the effectiveness of KT care on activities of daily living, health and quality of life in residents of nursing homes.
Methods
We conducted a prospective, two-armed comparative observational study to compare matched nursing homes with KT (Kneipp group) vs. nursing homes with common preventive interventions (control group) over a 12-month period.. Outcome measures included activities of daily living (Barthel Index), cognition (Mini-Mental State Examination (MMSE)) and quality of life (QUALIDEM; Short-Form 12 (SF-12)).
Results
We included 7 nursing homes (n=105 residents) for the Kneipp group and 6 nursing homes (n=69) as control. Except for Barthel Index, there were no time point dependent differences between the groups. The Barthel Index showed a smaller difference from baseline in the control group (mean diff. 0.94, 95%CI [-1.94; 3.82]) compared to Kneipp group (- 4.08, 95%CI [-6.46; -1.69]; p=0.009) after 6 months.
Pooled over the timepoints the SF-12 mental health sum scale exhibited a smaller difference from baseline in the Kneipp group (-1.3, 95%CI [-3.6; 0.9]) compared to the control group (-3.8, 95%CI [-6.3; -1.4]; p=0.027). Furthermore, the MMSE sumscore, decreased less in the Kneipp group compared to control (-1.1, 95%CI [-2.2, -0.1]; p=0.033) after 12 months.
A post hoc comparison of residents from both groups who received at least 30 preventive interventions monthly exhibited better values for QUALIDEM items “social relations”, “social isolation” and “feeling at home”.
Conclusion
This comparative observational study showed only small differences in outcome measures between the groups. The frequency of treatments may positively influence social components of behavior and well-being in residents. High-quality pragmatic randomized trials are needed for further investigations.
Decontesting Corporate Responsibility for Collaboration: A Case Study of a Cross-Sector Coalition Lobbying for Human Rights Regulation
Authors: Penttilä Visa , den Hond Frank , Fougère Martin , Solitander Nikodemus
Published: February 2025

This article examines how non-governmental organizations (NGOs) and firms can collaborate on a contested corporate social responsibility (CSR) issue in lobbying the government to regulate businesses. Previous research has established how various contextual, organizational, and interactional factors affect cross-sector collaboration. However, there is little research on specific strategies that organizations can use to collaborate on contested and divisive issues. While research on CSR has introduced decontestation as a way of establishing dominant interpretations or depoliticization of CSR, through an empirical study, we suggest that decontestation can be used as a means of constituting cross-sector collaboration around contested issues and as a strategy for lobbying politicians and the public. We identified different mechanisms of decontestation employed by a Finnish cross-sector coalition in lobbying for human rights due diligence regulation. Our findings expand the literature on CSR decontestation and contribute to a better understanding of how NGOs and firms can form and collaborate in a cross-sector coalition to advance a contested issue.
Interaction between intubation and stress regarding hemodynamic and hormonal changes
Authors: Abd Elhafez Nashwa Farouk , Oriquat Ghaleb Ali , Nsairat Hamdi , Jaber Bahaa , Abdelraouf Abdelraouf Ms , Fahmy Marina Kamal , Saleem Tahia H. , Abdelall Alshimaa Hafez
Published: February 2025

Objective

To compare the efficacy of dexmedetomidine and fentanyl to reduce hemodynamic and biochemical stress markers associated with endotracheal intubation under general anesthesia.

Methods

We performed a prospective randomized controlled study of 80 patients and 20 healthy controls at Assiut University from January to June 2024. The patients were allocated to two groups: Group D received dexmedetomidine and Group F received fentanyl. Blood samples were collected at four time points: T0 (baseline), T1 (2 minutes after induction of anesthesia), T2 (1 minute after intubation), and T3 (10 minutes post-intubation), for stress marker analysis.

Results

Intubation significantly increased stress markers in both groups compared to baseline. Group D showed significantly lower cortisol, norepinephrine, and lactate concentrations at T1, T2, and T3; and hemodynamic parameters at T2; whereas Group F demonstrated earlier post-operative recovery.

Conclusions

Both drugs increased stress markers, but dexmedetomidine more effectively reduced biochemical marker concentrations, suggesting better stress control, whereas fentanyl use led to quicker recovery. Dexmedetomidine is more effective at reducing intubation-induced stress, whereas fentanyl facilitates faster post-operative recovery.
A Rare Presentation of Chronic Exfoliative Cheilitis: Case Report
Authors: Eltoureini Abdelrahman , Alharbi Hamad , Saleh Wafaa
Published: February 2025

Background:

Chronic exfoliative cheilitis is an inflammatory condition of the lips that involves exfoliation of the superficial layers of the lip with continuous peeling, ulceration, and exfoliation. Chronic exfoliative cheilitis can lead to social and psychosocial problems.

Case presentation:

A 73-year-old diabetic male presented with a lip lesion showing continuous ulceration, crusting, and peeling of the lower lip. It was a spontaneous complaint that had its onset 6 months ago and has constantly evolved. The medical history revealed controlled diabetes mellitus while the social and family histories showed no marked findings. After a careful history, clinical examination, and laboratory investigations with the exclusion of the possible etiologic factors of cheilitis, the patient was diagnosed with chronic exfoliative cheilitis with unknown etiology. Then, the patient was prescribed topical steroids, and he was advised for continuous follow-up visits.

Conclusion:

Diagnosing chronic cheilitis is challenging and requires careful history, clinical examination, and laboratory investigation, with continuous follow-up to improve the patient’s quality of life. Further research is needed to better understand and treat these cases.
Effect of different incisions on dry eye symptoms after cataract surgery in diabetic patients
Authors: Yang Xiao , Li Lijuan , Shen Huiping , Bai Xue
Published: February 2025

Aim

Diabetic patients suffer from severe dry eye after cataract surgery, and the aim of this study was to investigate the effect of 2.2 mm and 3.0 mm clear corneal incisions on dry eye after phacoemulsification in patients with type 2 diabetes mellitus (T2DM).

Methods

Clinical data of 104 patients with T2DM who underwent phacoemulsification in the Department of Ophthalmology of The People’s Hospital of Yingshang from January 2022 to November 2023 were retrospectively collected. The patients were categorized into 2.2 mm and 3.0 mm groups according to the surgical incision, and their preoperative and postoperative Ocular surface disease index (OSDI), Schirmer I test (SIt), and Fluorescein breakup time (FBUT), as well as anxiety and depression levels, were analyzed.

Results

Before surgery, mild anxiety and depression were present in both groups. At 7 days and 1 month postoperatively, OSDI was significantly higher and SIt and FBUT were substantially lower in both groups, but the above indexes were milder in the 2.2 mm group. Meanwhile, the psychological status of both groups significantly improved at 1 month after surgery, and the improvement was more significant in the 2.2 mm group. At 3 months postoperatively, the dry eye of the two groups was relieved, and the psychological status was also improved.

Conclusion

Compared with 3.0 mm, a 2.2 mm clear corneal incision effectively reduced dry eye after phacoemulsification in T2DM patients.
Scaling up hepatitis C testing and linkage-to-care among people who use drugs: lessons learned from a pilot project implemented at a supervised consumption site
Authors: Hannigan Alannah , Krishnan Nandini , Singh Kirti , Bytelaar Shannon , Schmitz Deb , Bartlett Sofia , Hall David , Barrios Rolando , Montaner Julio S. G. , Harris Marianne , Hull Mark W. , Salters Kate A.
Published: February 2025

Background

Despite rolling out publicly-funded hepatitis C virus (HCV) treatment across the province of British Columbia (BC), Canada, 35% of people returning positive HCV RNA results in 2020 did not initiate treatment. The HCV epidemic in Canada continues to disproportionately impact people who use drugs and yet, this population has the lowest proportional uptake of HCV treatment. Evidence suggests linkages to healthcare after diagnosis is one of the key factors that impacts uptake of HCV treatment among this priority population. The Hep C Connect pilot project was implemented to characterize HCV testing outcomes and linkage-to-care rates within a low-barrier supervised consumption site (SCS) in Vancouver, BC.

Methods

All clients (aged ≥ 19 years) attending the Hope to Health SCS in Vancouver, Canada were invited to participate in the pilot study between November 2021 and December 2022. Interviewer-led surveys were conducted and participants were offered same-day HCV point-of-care (POC) antibody (Ab) testing. Participants received a cash honorarium for sharing their time and experiences. Descriptive statistics are shared in order to describe the reach and impact of this pilot project.

Results

The study enrolled 186 participants including 123(66.1%) men and 59(31.7%) women, with a median age of 42 (Q1,Q3- 34,49). Forty-seven (25.3%) participants stated that they use an SCS regularly and 123(66.1%) stated that they get new rigs every day. Notably, 64(34.4%) participants reported not having a primary care provider yet more than three-quarters of the participants (144, 77.4%) reported having been ever tested for HCV. All 186 participants agreed to HCV POC Ab testing with 59.7% returning a positive HCV POC Ab result. Despite good HCV POC Ab uptake and high rates of HCV knowledge, 49(44.1%) of the HCV Ab positive participants chose not to engage in confirmatory ribonucleic acid (RNA) testing.

Conclusions

The Hep C Connect pilot explored the gaps evident in the HCV cascade-of-care as it pertains to people who use drugs. Findings suggest that, despite high levels of HCV knowledge, the employment of blood draw RNA testing deterred people from engaging in confirmatory testing. Improving the HCV cascade-of-care will require alternative strategies that are more acceptable to this population.