bluuebunny/crossref_metadata_2025 huggingface dataset:
Parental Perspectives on Communication from Health Care Providers following a Newborn Diagnosis of Congenital Cytomegalovirus Infection: A Secondary Analysis of a Qualitative Study
Authors: Lanzieri Tatiana M. , Hall Mary Ann K. , Rau Ashrita , McBride Holly , Watson Danie , Rheaume Carol , Demmler-Harrison Gail
Published: August 2023

The study objective was to identify communication messages that parents of children diagnosed with congenital cytomegalovirus (cCMV) infection reported as essential and helpful. We performed a secondary analysis of focus groups and interviews conducted with 41 parents of children with cCMV who had enrolled in a long-term follow-up cCMV study at an academic medical center. Three groups of parents who had children with cCMV participated in the study: parents with children symptomatic at birth, parents with children asymptomatic at birth who later developed sensorineural hearing loss, and parents with children asymptomatic at birth who remained asymptomatic into adulthood. Using a health marketing approach, we identified six general themes from the focus group sessions: initial diagnosis, likely health outcome(s), comfort and coping, symptom watch, resources, and prevention. Receiving the initial diagnosis was shocking for many parents, and they wanted to know how their child would or could be affected. They valued access to the information, follow-up visits for early detection of hearing loss and other developmental delays, and support from other parents. Parents wished to obtain this information from their pediatrician but felt that experts offered more up-to-date knowledge about prognosis, monitoring, and treatment. With more U.S. states implementing cCMV screening strategies which would lead to more infant diagnoses, it will be necessary for providers to meet parents’ expectations and communication needs.
Synthesis of Copper/Sulfur Co-Doped TiO2-Carbon Nanofibers as Catalysts for H2 Production via NaBH4 Hydrolysis
Authors: Abutaleb Ahmed
Published: August 2023

Copper/sulfur co-doped titanium dioxide-carbon nanofibers (Cu,S-codoped TiO2 NPs, decorated-CNFs) catalysts were synthesized using the electrospinning process to produce composite nanofibers (NFs). These composite NFs were utilized for the hydrolysis of sodium borohydride (SBH) to generate hydrogen gas (H2), taking advantage of their catalytic properties. The experimental results demonstrated that using 100 mg of composite NFs yielded the highest catalytic activity for H2 production, generating 79 mL of H2 gas within 6 min at 25 °C and 1000 revolutions per minute (rpm) using 1 mmol of SBH. As the catalyst dosage was reduced from 100 mg to 75, 50, and 25 mg, the reaction time increased by 9, 13, and 18 min, respectively. Kinetic studies revealed that the reaction rate followed a first-order reaction, indicating a direct proportionality between the rate of reaction and the catalyst amount. Additionally, it was observed that the concentration of SBH had no influence on the reaction rate, suggesting a zero-order reaction. Increasing the reaction temperature resulted in a reduced reaction time. The activation energy was determined to be 26.16 kJ mol−1. The composite NFs maintained their superior performance over five iterations. These findings suggest that composite nanofibers have the potential to serve as a cost-effective alternative to expensive catalysts in hydrogen production.
Hemoadsorption Using CytoSorb® in Patients with Infective Endocarditis: A German-Based Budget Impact Analysis
Authors: Rao Cristina , Preissing Franziska , Thielmann Matthias , Wendt Daniel , Haidari Zaki , Kalisnik Jurij Matija , Daake Lothar , Traeger Karl
Published: August 2023

A considerable number of infective endocarditis (IE) patients require cardiac surgery with an increased risk for postoperative sepsis. Intraoperative hemoadsorption may diminish the risk of postoperative hyperinflammation with potential economic implications for intensive care unit (ICU) occupation. The present study aimed to theoretically investigate the budget impact of a reduced length of ICU stay in IE patients treated with intraoperative hemoadsorption in the German healthcare system. Data on ICU occupation were extrapolated from a retrospective study on IE patients treated with hemoadsorption. An Excel-based budget impact model was developed to simulate the patient course over the ICU stay. A base-case scenario without therapy reimbursement and a scenario with full therapy reimbursement were explored. The annual eligible German IE patient population was derived from official German Diagnostic-Related Group (DRG) volume data. One-way deterministic sensitivity analysis and multivariate analysis were performed to evaluate the uncertainty over the model results. The use of intraoperative hemoadsorption resulted in EUR 2298 being saved per patient in the base-case scenario without therapy reimbursement. The savings increased to EUR 3804 per patient in the case of full device-specific reimbursement. Deterministic and probabilistic sensitivity analyses confirmed the robustness of savings, with a probability of savings of 87% and 99% in the base-case and full reimbursement scenario, respectively. Intraoperative hemoadsorption in IE patients might have relevant economic benefits related to reduced ICU stays, resulting in improved resource use. Further evaluations in larger prospective cohorts are warranted.
Prevalence, Risk Factors, Prognosis, and Management of Pericardial Effusion in COVID-19
Authors: Saraç İbrahim , Aydın Sidar Şiyar , Özmen Murat , Doru Halil İbrahim , Tonkaz Gökhan , Çırçır Melike Nur , Akpınar Furkan , Zengin Onur , Delice Orhan , Aydınyılmaz Faruk
Published: August 2023

Background: There is limited data in the literature about the clinical importance and prognosis of pericardial effusion (PE) in patients discharged after recovering from COVID-19, but large-scale studies have yet to be available. This study investigated the prevalence, risk factors, prognosis, late clinical outcomes, and management of PE in COVID-19. Materials and Methods: Between August 2020 and March 2021, 15,689 patients were followed up in our pandemic hospital due to COVID-19. Patients with positive polymerase chain reaction (PCR) test results and PE associated with COVID-19 in computed tomography (CT) were included in the study. The patients were divided into three groups according to PE size (mild, moderate, and large). Transthoracic echocardiography (TTE) records, laboratory data, clinical outcomes, and medical treatments of patients discharged from the hospital were retrospectively reviewed. Results: According to the PE size (mild, moderate, large) of 256 patients with PE at admission or discharge, the mean age was 62.17 ± 16.34, 69.12 ± 12.52, and 72.44 ± 15.26, respectively. The mean follow-up period of the patients was 25.2 ± 5.12 months. Of the patients in the study population, 53.5% were in the mild group, 30.4% in the moderate group, and 16.1% in the large group. PE became chronic in a total of 178 (69.6%) patients at the end of the mean three months, and chronicity increased as PE size increased. Despite the different anti-inflammatory treatments for PE in the acute phase, similar chronicity was observed. In addition, as the PE size increased, the patients’ frequency of hospitalization, complications, and mortality rates showed statistical significance between the groups. Conclusions: The clinical prognosis of patients presenting with PE was quite poor; as PE in size increased, cardiac and noncardiac events and mortality rates were significantly higher. Patients with large PE associated with COVID-19 at discharge should be monitored at close intervals due to the chronicity of PE and the increased risk of tamponade.
Ultrasound-Guided Injections of HYADD4 for Knee Osteoarthritis Improves Pain and Functional Outcomes at 3, 6, and 12 Months without Changes in Measured Synovial Fluid, Serum Collagen Biomarkers, or Most Synovial Fluid Biomarker Proteins at 3 Months
Authors: Meehan Richard T. , Gill Mary T. , Hoffman Eric D. , Coeshott Claire M. , Galvan Manuel D. , Wolf Molly L. , Amigues Isabelle A. , Kastsianok Liudmila M. , Regan Elizabeth A. , Crooks James L. , Czuczman Gregory J. , Knight Vijaya
Published: August 2023

Background: Prior studies have demonstrated improved efficacy when intra-articular (IA) therapeutics are injected using ultrasound (US) guidance. The aim of this study was to determine if clinical improvement in pain and function after IA hyaluronic acid injections using US is associated with changes in SF volumes and biomarker proteins at 3 months. Methods: 49 subjects with symptomatic knee OA, BMI < 40, and KL radiographic grade II or III participated. Subjects with adequate aspirated synovial fluid (SF) volumes received two US-guided IA-HA injections of HYADD4 (24 mg/3 mL) 7 days apart. Clinical evaluations at 3, 6, and 12 months included WOMAC, VAS, PCS scores, 6 MWD, and US-measured SF depth. SF and blood were collected at 3 months and analyzed for four serum OA biomarkers and fifteen SF proteins. Results: Statistical differences were observed at 3, 6, and 12 months compared to baseline values, with improvements at 12 months for WOMAC scores (50%), VAS (54%), and PCS scores (24%). MMP10 levels were lower at 3 months without changes in SF volumes, serum levels of C2C, COMP, HA, CPII, or SF levels of IL-1 ra, IL-4, 6, 7, 8, 15, 18, ILGFBP-1, 3, and MMP 1, 2, 3, 8, 9. Baseline clinical features or SF biomarker protein levels did not predict responsiveness at 3 months. Conclusions: Clinical improvements were observed at 12 months using US needle guidance for IA HA, whereas only one SF protein biomarker protein was different at 3 months. Larger studies are needed to identify which SF biomarkers will predict which individual OA patients will receive the greatest benefit from IA therapeutics.
Speech and Burden of Secondary Surgical Interventions Following One-Stage Repair of Unilateral Cleft Lip and Palate and Alveolar Bone Grafting Performed at Different Timings
Authors: Brudnicki Andrzej , Radkowska Elżbieta , Sawicka Ewa , Fudalej Piotr Stanisław
Published: August 2023

A comprehensive assessment of the treatment outcome in cleft lip and palate involves evaluating speech and the impact of speech-correcting surgical interventions. This retrospective case–control study compared the speech outcomes of 37 boys and 19 girls with unilateral cleft lip and palate (UCLP) who underwent one-stage cleft repair at an average age of 8.1 months and alveolar bone grafting either before or after 6 years of age, with a non-cleft control group at an average age of 10 years. Two experienced speech and language pathologists conducted perceptual speech assessments using a specialized test of 27 sentences designed for Polish-speaking cleft patients. The results revealed that 5.3% had severe hypernasality, 1.8% had severely impaired speech intelligibility, 10.7% exhibited retracted compensatory articulations, and 7.1% displayed facial grimacing. Mild hyponasality was observed in 12.3% of patients, while 16.1% exhibited voice abnormalities. Additionally, 12.5% of patients required orofacial fistula repairs, 3.6% underwent pharyngoplasties, and 28.6% received ear ventilation tube insertions. The study indicates that speech abnormalities in UCLP patients were relatively infrequent and not highly severe, suggesting that the primary UCLP repair method presented effectively reduced the need for further surgical interventions, leading to positive speech outcomes.
Vacuolar ATPase Is a Possible Therapeutic Target in Acute Myeloid Leukemia: Focus on Patient Heterogeneity and Treatment Toxicity
Authors: Bartaula-Brevik Sushma , Leitch Calum , Hernandez-Valladares Maria , Aasebø Elise , Berven Frode S. , Selheim Frode , Brenner Annette K. , Rye Kristin Paulsen , Hagen Marie , Reikvam Håkon , McCormack Emmet , Bruserud Øystein , Tvedt Tor Henrik Anderson
Published: August 2023

Vacuolar ATPase (V-ATPase) is regarded as a possible target in cancer treatment. It is expressed in primary acute myeloid leukemia cells (AML), but the expression varies between patients and is highest for patients with a favorable prognosis after intensive chemotherapy. We therefore investigated the functional effects of two V-ATPase inhibitors (bafilomycin A1, concanamycin A) for primary AML cells derived from 80 consecutive patients. The V-ATPase inhibitors showed dose-dependent antiproliferative and proapoptotic effects that varied considerably between patients. A proteomic comparison of primary AML cells showing weak versus strong antiproliferative effects of V-ATPase inhibition showed a differential expression of proteins involved in intracellular transport/cytoskeleton functions, and an equivalent phosphoproteomic comparison showed a differential expression of proteins that regulate RNA processing/function together with increased activity of casein kinase 2. Patients with secondary AML, i.e., a heterogeneous subset with generally adverse prognosis and previous cytotoxic therapy, myeloproliferative neoplasia or myelodysplastic syndrome, were characterized by a strong antiproliferative effect of V-ATPase inhibition and also by a specific mRNA expression profile of V-ATPase interactome proteins. Furthermore, the V-ATPase inhibition altered the constitutive extracellular release of several soluble mediators (e.g., chemokines, interleukins, proteases, protease inhibitors), and increased mediator levels in the presence of AML-supporting bone marrow mesenchymal stem cells was then observed, especially for patients with secondary AML. Finally, animal studies suggested that the V-ATPase inhibitor bafilomycin had limited toxicity, even when combined with cytarabine. To conclude, V-ATPase inhibition has antileukemic effects in AML, but this effect varies between patients.
Clinical Significance of Surgical Intervention to Restore Swallowing Function for Sustained Severe Dysphagia
Authors: Ito Hiroaki , Nagao Asuka , Maeda Suguru , Nakahira Maya , Hyodo Masamitsu
Published: August 2023

Owing to rapid population aging, patients with dysphagia are significantly increasing in society. Dysphagia treatment is aimed at the restoration of the swallowing function and the prevention of recurrent aspiration-induced pulmonary infection. However, despite intensive rehabilitation, oral food intake remains inadequate in many patients with severe dysphagia, which results in the deterioration of patients’ quality of life and joy of living. Surgical intervention may serve as a useful therapeutic strategy to restore swallowing function in these patients. The study included 25 patients (mean, 70.4 years; male/female ratio, 20:5) with chronic dysphagia. Dysphagia was associated with cerebrovascular diseases in sixteen patients; with age-induced physiological deterioration in five patients; and with miscellaneous etiologies in four cases. Cricopharyngeal and infrahyoid myotomies were performed in all patients. Laryngeal elevation and the medialization of the paralyzed vocal fold were performed in 15 and 3 patients, respectively. The Food Intake Level Scale (FILS) and videoendoscopic examination score (VEES) were used to evaluate swallowing function. The FILS showed a restoration of oral food intake alone in 72% of patients, and 64% of patients maintained this improvement at their last follow-up visit. We observed significantly improved VEES scores postoperatively. However, patients with cognitive impairment or advanced age showed poor outcomes. In conclusion, surgical intervention may be an effective therapeutic option to restore swallowing function in cases of sustained severe dysphagia; however, surgical indications require careful consideration.
Completion of the Emergency Department “Big 6” in Patients with an Acute Hip Fracture Is Associated with a Lower Mortality Risk and Shorter Length of Hospital Stay
Authors: Clement Nick D. , Penfold Rose S. , Duffy Andrew , Murthy Krishna , MacLullich Alasdair M. J. , Duckworth Andrew D.
Published: August 2023

The aims of this study were to assess whether completion of the emergency department (ED) Big 6 interventions (provision of pain relief, screening for delirium, early warning score (EWS) system, full blood investigation and electrocardiogram, intravenous fluids therapy, and pressure area care) in those presenting with an acute hip fracture were associated with mortality risk and length of acute hospital stay. A retrospective cohort study was undertaken. All patients aged ≥50 years that were admitted with a hip fracture via the ED at a single centre during a 42-month period were included. A total of 3613 patients (mean age 80.9; 71% female) were included. The mean follow up was 607 (range 240 to 1542) days. A total of 1180 (32.7%) patients had all six components completed. Pain relief (90.8%) was the most frequently completed component and pressure area assessment (57.6%) was the least. Completion of each of the individual Big 6 components, except for pressure areas assessment, were associated with a significantly (p ≤ 0.041) lower mortality risk at the 90-days, one-year and final follow-up. The completion of all components of the Big 6 was associated with a significantly (2.4 hours, p = 0.002) shorter time to theatre. Increasing number of Big 6 components completed were independently associated with a lower mortality risk: when all six were completed, the hazard ratio was 0.64 (95% CI 0.52 to 0.78, p < 0.001). Completion of an increasing number of Big 6 components was independently associated with shorter length of hospital stay and completion of all six was associated with a 2.3 (95% CI 0.9 to 3.8)-day shorter acute stay. The findings provide an evidence base to support the ongoing use of the Big 6 in the ED.
Salivary Complaints in Burning Mouth Syndrome: A Cross Sectional Study on 500 Patients
Authors: Canfora Federica , Calabria Elena , Spagnuolo Gianrico , Coppola Noemi , Armogida Niccolò Giuseppe , Mazzaccara Cristina , Solari Domenico , D’Aniello Luca , Aria Massimo , Pecoraro Giuseppe , Mignogna Michele Davide , Leuci Stefania , Adamo Daniela
Published: August 2023

Background: Xerostomia and sialorrhea often accompany Burning Mouth Syndrome (BMS) despite no change in saliva quantity. This study analyzed BMS patients with different symptom combinations: burning only (B), burning and xerostomia (BX), burning and sialorrhea (BS), and burning with xerostomia and sialorrhea (BXS), using a large sample of 500 patients from the University of Naples Federico II. Methods: After a medical evaluation, patients were divided into four groups based on their reported symptoms: B (140), BX (253), BS (49), and BXS (58). Patient data on education, BMI, smoking/alcohol habits, comorbidities, medication use, pain intensity, quality, and psychological profile were collected. Results: The BX group showed a higher prevalence of patients taking blood thinners. Additional symptoms varied among groups, with the BX group experiencing more dysgeusia and globus, and the BS group reporting more tingling. Multivariate analysis identified BMI, dysgeusia, globus, and blood thinner use as significant factors in the B and BX groups, while male gender, tingling, alcohol use, and pain quality were significant in the BS and BXS groups. Conclusions: Overall, BMS patients display a complex range of symptoms, with xerostomia being the most frequent additional symptom. Sociodemographic, psychological, and medical factors cannot fully explain the variations in symptomatology among different patient subgroups. Further research is needed to understand the underlying causes and develop tailored treatment approaches.
Role of Cardiovascular Imaging in Risk Assessment: Recent Advances, Gaps in Evidence, and Future Directions
Authors: Perone Francesco , Bernardi Marco , Redheuil Alban , Mafrica Dario , Conte Edoardo , Spadafora Luigi , Ecarnot Fiona , Tokgozoglu Lale , Santos-Gallego Carlos G. , Kaiser Sergio Emanuel , Fogacci Federica , Sabouret Annabelle , Bhatt Deepak L. , Paneni Francesco , Banach Maciej , Santos Raul , Biondi Zoccai Giuseppe , Ray Kausik K. , Sabouret Pierre
Published: August 2023

Optimal risk assessment for primary prevention remains highly challenging. Recent registries have highlighted major discrepancies between guidelines and daily practice. Although guidelines have improved over time and provide updated risk scores, they still fail to identify a significant proportion of at-risk individuals, who then miss out on effective prevention measures until their initial ischemic events. Cardiovascular imaging is progressively assuming an increasingly pivotal role, playing a crucial part in enhancing the meticulous categorization of individuals according to their risk profiles, thus enabling the customization of precise therapeutic strategies for patients with increased cardiovascular risks. For the most part, the current approach to patients with atherosclerotic cardiovascular disease (ASCVD) is homogeneous. However, data from registries (e.g., REACH, CORONOR) and randomized clinical trials (e.g., COMPASS, FOURIER, and ODYSSEY outcomes) highlight heterogeneity in the risks of recurrent ischemic events, which are especially higher in patients with poly-vascular disease and/or multivessel coronary disease. This indicates the need for a more individualized strategy and further research to improve definitions of individual residual risk, with a view of intensifying treatments in the subgroups with very high residual risk. In this narrative review, we discuss advances in cardiovascular imaging, its current place in the guidelines, the gaps in evidence, and perspectives for primary and secondary prevention to improve risk assessment and therapeutic strategies using cardiovascular imaging.
Effects of Transcranial Direct Current Stimulation on Social Attention Patterns and Emotion Recognition Ability in Male Adolescents with Autism Spectrum Disorder
Authors: Prillinger Karin , Radev Stefan T. , Amador de Lara Gabriel , Werneck-Rohrer Sonja , Plener Paul L. , Poustka Luise , Konicar Lilian
Published: August 2023

Autism Spectrum Disorder (ASD) is characterized by impairments in social cognition including emotion recognition (ER) abilities. Common symptoms include unusual patterns of visual social attention, which are investigated as early developmental biomarkers for ASD. Transcranial Direct Current Stimulation (tDCS) has shown promising results in influencing social functioning in individuals with ASD. However, the effects of tDCS on social attention patterns and ER ability in adolescents with ASD remain unclear. This double-blind, sham-controlled, randomized clinical trial examined the effects of repeated sessions of tDCS on gaze behavior and ER ability in 22 male adolescents diagnosed with ASD. Participants received either 20 min of 2 mA active tDCS or sham stimulation for 10 days and an intra-stimulation training. Social allocation patterns were assessed using eye-tracking paradigms, including ER tasks. Our results indicated no tDCS-specific effects. Both groups showed improvements in ER and more frequent, faster, and longer fixations on the eyes than the mouth, and on social than nonsocial areas. In tasks with low social content, fixating the mouth seemed to increase ER accuracy. Understanding the effects of tDCS on social functioning in adolescents with ASD holds promise for the development of targeted interventions to improve their social cognition abilities.
Change in the Clinical Picture of Hospitalized Patients with COVID-19 between the Early and Late Period of Dominance of the Omicron SARS-CoV-2 Variant
Authors: Flisiak Robert , Zarębska-Michaluk Dorota , Dobrowolska Krystyna , Rorat Marta , Rogalska Magdalena , Kryńska Justyna Anna , Moniuszko-Malinowska Anna , Czupryna Piotr , Kozielewicz Dorota , Jaroszewicz Jerzy , Sikorska Katarzyna , Bednarska Agnieszka , Piekarska Anna , Rzymski Piotr
Published: August 2023

This study aimed to compare the clinical picture of COVID-19 in the initial and later period of Omicron dominance and to identify populations still at risk. A retrospective comparison of the clinical data of 965 patients hospitalized during the early period of Omicron’s dominance (EO, January–June 2022) with 897 patients from a later period (LO, July 2022–April 2023) from the SARSTer database was performed. Patients hospitalized during LO, compared to EO, were older, had a better clinical condition on admission, had a lower need for oxygen and mechanical ventilation, had less frequent lung involvement in imaging, and showed much faster clinical improvement. Moreover, the overall mortality during EO was 14%, higher than that in LO—9%. Despite the milder course of the disease, mortality exceeding 15% was similar in both groups among patients with lung involvement. The accumulation of risk factors such as an age of 60+, comorbidities, lung involvement, and oxygen saturation <90% resulted in a constant need for oxygen in 98% of patients, an 8% risk of mechanical ventilation, and a 30% mortality rate in the LO period. Multiple logistic regression revealed lower odds of death during the LO phase. Despite the milder course of infections caused by the currently dominant subvariants, COVID-19 prophylaxis is necessary in people over 60 years of age, especially those with comorbidities, and in the case of pneumonia and respiratory failure.
Long-Acting Buprenorphine Formulations as a New Strategy for the Treatment of Opioid Use Disorder
Authors: Maremmani Icro , Dematteis Maurice , Gorzelanczyk Edward J. , Mugelli Alessandro , Walcher Stephan , Torrens Marta
Published: August 2023

Long-acting buprenorphine formulations have been recently marketed for the Opioid Agonist Treatment (OAT) of opioid use disorder (OUD) associated with medical, social, and psychological support. Their duration of action ranges from one week up to 6 months. The non-medical use of opioids is increasing with a parallel rise in lethal overdoses. Methadone and buprenorphine are the standard treatment for opioid dependence. Methadone Maintenance Treatment (MMT) is widely recognized as one of the most effective ways of reducing the risks of overdose, crime, and transmission of HIV (Human Immunodeficiency Virus) in people who use opioids; however, its effectiveness has been hindered by low rates of uptake and retention in treatment. Furthermore, both methadone and buprenorphine are widely diverted and misused. Thus, a crucial aspect of treating OUD is facilitating patients’ access to treatment while minimizing substance-related harm and improving quality of life. The newly developed long-acting buprenorphine formulations represent a significant change in the paradigm of OUD treatment, allowing an approach individualized to patients’ needs. Strengths of this individualized approach are improved adherence (lack of peaks and troughs in blood concentrations) and a reduced stigma since the patient doesn’t need to attend their clinic daily or nearly daily, thus facilitating social and occupational integrations as the quality of life. However, less frequent attendance at the clinic should not affect the patient–physician relationship. Therefore, teleconsulting or digital therapeutic services should be developed in parallel. In addition, diversion and intravenous misuse of buprenorphine are unlikely due to the characteristics of these formulations. These features make this approach of interest for treating OUD in particular settings, such as subjects staying or when released from prison or those receiving long-term residential treatment for OUD in the therapeutic communities. The long-lasting formulations of buprenorphine can positively impact the OUD treatment and suggest future medical and logistic developments to maximize their personalized management and impact.
High Prevalence of Persistent Measurable Postoperative Knee Joint Laxity in Patients with Tibial Plateau Fractures Treated by Open Reduction and Internal Fixation (ORIF)
Authors: Bormann Markus , Neidlein Claas , Neidlein Niels , Ehrl Dennis , Jörgens Maximilian , Berthold Daniel P. , Böcker Wolfgang , Holzapfel Boris Michael , Fürmetz Julian
Published: August 2023

The development of post-traumatic osteoarthrosis after tibial plateau fracture (TPF) is multifactorial and can only be partially influenced by surgical treatment. There is no standardized method for assessing pre- and postoperative knee joint laxity. Data on the incidence of postoperative laxity after TPF are limited. The purpose of this study was to quantify postoperative laxity of the knee joint after TPF. Fifty-four patients (mean age 51 ± 11.9 years) were included in this study. There was a significant increase in anterior–posterior translation in 78.0% and internal rotation in 78.9% in the injured knee when compared to the healthy knee. Simple fractures showed no significant difference in laxity compared to complex fractures. When preoperative ligament damage and/or meniscal lesions were present and surgically treated by refixation and/or bracing, patients showed higher instability when compared to patients without preoperative ligament and/or meniscal damage. Patients with surgically treated TPF demonstrate measurable knee joint laxity at a minimum of 1 year postoperatively. Fracture types have no influence on postoperative laxity. This emphasizes the importance of recognizing TPF as a multifaceted injury involving both complex fractures and damage to multiple ligaments and soft tissue structures, which may require further surgical intervention after osteosynthesis.
Electroanatomical Conduction Characteristics of Pig Myocardial Tissue Derived from High-Density Mapping
Authors: Wilhelm Theresa Isabelle , Lewalter Thorsten , Fischer Johannes , Reiser Judith , Werner Julia , Baumgartner Christine , Gleirscher Lukas , Hoppmann Petra , Kupatt Christian , Tiemann Klaus , Jilek Clemens
Published: August 2023

Background: Ultra-high-density mapping systems allow more precise measurement of the heart chambers at corresponding conduction velocities (CVs) and voltage amplitudes (VAs). Our aim for this study was to define and compare a basic value set for unipolar CV and VA in all four heart chambers and their separate walls in healthy, juvenile porcine hearts using ultra-high-density mapping. Methods: We used the Rhythmia Mapping System to create electroanatomical maps of four pig hearts in sinus rhythm. CVs and VAs were calculated for chambers and wall segments with overlapping circular areas (radius of 5 mm). Results: We analysed 21 maps with a resolution of 1.4 points/mm2. CVs were highest in the left atrium (LA), followed by the left ventricle (LV), right ventricle (RV), and right atrium (RA). As for VA, LV was highest, followed by RV, LA, and RA. The left chambers had a higher overall CV and VA than the right. Within the chambers, CV varied more in the right than in the left chambers, and VA varied in the ventricles but not in the atria. There was a slightly positive correlation between CVs and VAs at velocity values of <1.5 m/s. Conclusions: In healthy porcine hearts, the left chambers showed higher VAs and CVs than the right. CV differs mainly within the right chambers and VA differs only within the ventricles. A slightly positive linear correlation was found between slow CVs and low VAs.
Impact of Diabetic Foot Multidisciplinary Unit on Incidence of Lower-Extremity Amputations by Diabetic Foot
Authors: Ortiz-Zúñiga Ángel , Samaniego Jordi , Biagetti Betina , Allegue Nicolás , Gené Anna , Sallent Andrea , Crespo Almudena , Serracanta Jordi , Torrents Carme , Issa Daniela , Rivas Danilo , Veintemillas Maria Teresa , Fernández-Hidalgo Núria , Busquets Rosa , Royo Josep , Hernández Cristina
Published: August 2023

Background: One of the most devastating complications of diabetes is diabetes-related foot disease (DFD), which is a priority for public health systems. The 2016–2020 Catalonia Health Plan aimed to reduce the incidence of total and major lower-extremity amputations (LEAs) due to DFD by 10% in the population aged 45–74 years. The aim of the present study was to compare the incidence of LEA-DFD 5 years before and after the creation of the Diabetic Foot Multidisciplinary Unit at our Hospital. Methods: We prospectively collected all cases of LEA-DFD performed at Vall d’Hebron University Hospital from 1 January 2016 to 31 December 2020. Cases of LEA-DFD performed from 1 January 2011 to 31 December 2015 were retrospectively reviewed. The incidence of LEA-DFD between these periods was compared. Results: A total of 457 LEAs due to DFD were performed in 316 patients. We observed a reduction of 27.9% [CI: 23.7–32.1%] in the incidence of total LEA in the 2016–2020 period in comparison with the period 2011–2016 (0.8 ± 0.1 vs. 1.1 ± 0.3 per 10.000 inhabitants/year, p < 0.001), as well as a reduction of 49.3% [CI: 44.6–53.9%] in the incidence of major LEA-DFD (0.15 ± 0.1 vs. 0.30 ± 0.1 per 10.000 inhabitants/year, p < 0.001). Conclusions: The implementation of a Diabetic Foot Multidisciplinary Unit resulted in a significant reduction in the rate of amputations due to DFD in the population with diabetes in North Barcelona.
A Framework for Detecting Thyroid Cancer from Ultrasound and Histopathological Images Using Deep Learning, Meta-Heuristics, and MCDM Algorithms
Authors: Sharma Rohit , Mahanti Gautam Kumar , Panda Ganapati , Rath Adyasha , Dash Sujata , Mallik Saurav , Hu Ruifeng
Published: August 2023

Computer-assisted diagnostic systems have been developed to aid doctors in diagnosing thyroid-related abnormalities. The aim of this research is to improve the diagnosis accuracy of thyroid abnormality detection models that can be utilized to alleviate undue pressure on healthcare professionals. In this research, we proposed deep learning, metaheuristics, and a MCDM algorithms-based framework to detect thyroid-related abnormalities from ultrasound and histopathological images. The proposed method uses three recently developed deep learning techniques (DeiT, Swin Transformer, and Mixer-MLP) to extract features from the thyroid image datasets. The feature extraction techniques are based on the Image Transformer and MLP models. There is a large number of redundant features that can overfit the classifiers and reduce the generalization capabilities of the classifiers. In order to avoid the overfitting problem, six feature transformation techniques (PCA, TSVD, FastICA, ISOMAP, LLE, and UMP) are analyzed to reduce the dimensionality of the data. There are five different classifiers (LR, NB, SVC, KNN, and RF) evaluated using the 5-fold stratified cross-validation technique on the transformed dataset. Both datasets exhibit large class imbalances and hence, the stratified cross-validation technique is used to evaluate the performance. The MEREC-TOPSIS MCDM technique is used for ranking the evaluated models at different analysis stages. In the first stage, the best feature extraction and classification techniques are chosen, whereas, in the second stage, the best dimensionality reduction method is evaluated in wrapper feature selection mode. Two best-ranked models are further selected for the weighted average ensemble learning and features selection using the recently proposed meta-heuristics FOX-optimization algorithm. The PCA+FOX optimization-based feature selection + random forest model achieved the highest TOPSIS score and performed exceptionally well with an accuracy of 99.13%, F2-score of 98.82%, and AUC-ROC score of 99.13% on the ultrasound dataset. Similarly, the model achieved an accuracy score of 90.65%, an F2-score of 92.01%, and an AUC-ROC score of 95.48% on the histopathological dataset. This study exploits the combination novelty of different algorithms in order to improve the thyroid cancer diagnosis capabilities. This proposed framework outperforms the current state-of-the-art diagnostic methods for thyroid-related abnormalities in ultrasound and histopathological datasets and can significantly aid medical professionals by reducing the excessive burden on the medical fraternity.
A High-Precision Detection Model of Small Objects in Maritime UAV Perspective Based on Improved YOLOv5
Authors: Yang Zhilin , Yin Yong , Jing Qianfeng , Shao Zeyuan
Published: August 2023

Object detection by shipborne unmanned aerial vehicles (UAVs) equipped with electro-optical (EO) sensors plays an important role in maritime rescue and ocean monitoring. However, high-precision and low-latency maritime environment small-object-detection algorithms remain a major challenge. To address this problem, this paper proposes the YOLO-BEV (“you only look once”–“bird’s-eye view”) model. First, we constructed a bidirectional feature fusion module—that is, PAN+ (Path Aggregation Network+)—adding an extremely-small-object-prediction head to deal with the large-scale variance of targets at different heights. Second, we propose a C2fSESA (Squeeze-and-Excitation Spatial Attention Based on C2f) module based on the attention mechanism to obtain richer feature information by aggregating features of different depth layers. Finally, we describe a lightweight spatial pyramid pooling structure called RGSPP (Random and Group Convolution Spatial Pyramid Pooling), which uses group convolution and random channel rearrangement to reduce the model’s computational overhead and improve its generalization ability. The article compares the YOLO-BEV model with other object-detection algorithms on the publicly available MOBDrone dataset. The research results show that the mAP0.5 value of YOLO-BEV reached 97.1%, which is 4.3% higher than that of YOLOv5, and the average precision for small objects increased by 22.2%. Additionally, the YOLO-BEV model maintained a detection speed of 48 frames per second (FPS). Consequently, the proposed method effectively balances the accuracy and efficiency of object-detection in shipborne UAV scenarios, outperforming other related techniques in shipboard UAV maritime object detection.
Wave Resistance Caused by a Point Load Steadily Moving on the Surface of a Floating Viscoelastic Plate
Authors: Wang Zi Qi , Lu Dong Qiang
Published: August 2023

The wave resistance caused by a point load steadily moving on an infinitely extended viscoelastic plate floating on an inviscid fluid is analytically studied, which can be used to describe the response due to the motion of amphibious air-cushion vehicles on the continuous ice sheet on the ocean. The action of concentrated and distributed point loads are both considered. Under the assumptions that the fluid is incompressible and homogeneous and the motion of the fluid is irrotational, the Laplace equation is taken as the governing equation. For the floating plate, the Kelvin–Voigt viscoelastic model is employed. At the plate–fluid interface, linearized boundary conditions are used when the wave amplitude generated is less than its wavelength. The Fourier integral transform is performed to achieve the formal solution. The residue theorem is applied to derive the response of flexural–gravity wave resistance. It is indicated that for a point load with a uniform rectilinear motion, the wave resistance shows a sharp decrease with the increase in the moving speed when the load velocity is greater than the minimum phase velocity. There is no steady wave resistance when the load velocity is smaller than the minimum phase velocity. The effects of different parameters are obtained. Wave resistance decreases with the increasing plate thickness, viscoelastic parameter, and Poisson’s ratio, especially for a small value of viscoelastic parameter.
A Study on Mechanical Properties of Modified Soil–Cement Mixed with Ferronickel Slag Powder under Dry–Wet Cycles in Marine Environments
Authors: Chen Sanshan , Chen Feng , Chen Weizhen , Wang Hao , Yang Jianxue
Published: August 2023

Soft soil foundations in marine environments are under coupling actions of seawater erosion and dry–wet cycles due to tides. Ferronickel slag is a solid waste produced in the smelting of ferronickel alloys. To recycle industrial solid waste and conserve energy, ferronickel slag is partially substituted for cement to solidify the soft soil foundations in marine environments. Unconfined compression tests were conducted for soil–cement mixed with ferronickel slag of various proportions to investigate its apparent erosion characteristics and mechanical characteristics under dry–wet cycles. In the tests, the corresponding numbers of cycles were set to 0, 6, 12, and 18. To further investigate the microscopic action mechanism of ferronickel slag on soil–cement, a nuclear magnetic resonance (NMR) device was utilized to analyze the microstructure of the soil–cement. According to the testing results, the unconfined compressive strength of soil–cement first increased and then decreased when the number of cycles of seawater erosion increased. With other conditions being the same, the addition of ferronickel slag can improve soil–cement strength, and changes in soil–cement strength were more significant than that with no ferronickel slag mixed. Moreover, the optimal amount of admixture was proved to be 45%. As the number of dry–wet cycles increased, the mass of soil–cement first increased and then decreased. With the same number of dry–wet cycles, soil–cement mixed with ferronickel slag had a smaller mass loss rate than that with no ferronickel slag added. After six dry–wet cycles, apparent erosion of soil–cement becomes increasingly serious, including the absence of edges and corners, deformation of surfaces, and even spalling and cracking. The NMR analysis revealed that dry–wet cycles can promote the evolution of small pores into larger ones within the soil–cement, thereby increasing the number of larger pores, leading to an increase in porosity, a decrease in the compactness of the soil–cement, and a reduction in strength.
Multiple Feature Extraction Long Short-Term Memory Using Skip Connections for Ship Electricity Forecasting
Authors: Kim Ji-Yoon , Oh Jin-Seok
Published: August 2023

The power load data of electric-powered ships vary with the ships’ operational status and external environmental factors such as sea conditions. Therefore, a model is required to accurately predict a ship’s power load, which depends on changes in the marine environment, weather environment, and the ship’s situation. This study used the power data of an actual ship to predict the power load of the ship. The research on forecasting a ship’s power load fluctuations has been quite limited, and the existing models have inherent limitations in predicting these fluctuations accurately. In this paper, A multiple feature extraction (MFE)-long short-term memory (LSTM) model with skip connections is introduced to address the limitations of existing deep learning models. This novel approach enables the analysis and forecasting of the intricate load variations in ships, thereby facilitating the prediction of complex load fluctuations. The performance of the model was compared with that of a previous convolutional neural network-LSTM network with a squeeze and excitation (SE) model and deep feed-forward (DFF) model. The metrics used for comparison were the mean absolute error, root mean squared error, mean absolute percentage error, and R-squared, wherein the best, average, and worst performances were evaluated for both models. The proposed model exhibited a superior predictive performance for the ship’s power load compared to that of existing models, as evidenced by the performance metrics: mean absolute error (MAE) of 55.52, root mean squared error of (RMSE) 125.62, mean absolute percentage error (MAPE) of 3.56, and R-squared (R2) of 0.86. Therefore, the proposed model is expected to be used for power load prediction during electric-powered ship operations.
Mechanical Behavior and Sealing Performance Study of Subsea Connector Core-Sealing Components under the Combined Action of Internal Pressure, Bending Moment, and Axial Load
Authors: Hao Xiaoquan , Yun Feihong , Jiao Kefeng , Chen Xi , Jia Peng , Wang Xiangyu , Wang Liquan
Published: August 2023

A complete subsea production system (SPS) is assembled by interconnecting subsea manufacturing facilities through subsea connectors. To ensure the reliability and longevity of the SPS, it is imperative to thoroughly investigate the mechanical behavior and sealing performance of the subsea connector’s core-sealing components. In this study, the loading conditions of the subsea clamp connector are examined to analyze the load transfer relationship between its components under different modes. A mathematical model for the load transfer between locking torque and sealing contact pressure is developed for the preloading mode, and the concept of mechanical transfer efficiency is introduced. Another mathematical model for the load transfer between the locking torque and the design pressure is developed for the operation mode. Furthermore, a three-dimensional full-size finite element model of the subsea clamp connector is established to analyze the effects of complex loads on the mechanical behavior and sealing performance of its core-sealing components. The simulation results indicate that internal pressure loading positively affects the sealing of the subsea connector, and that the stress distribution in the core-sealing components under bending moment loading exhibits significant asymmetric characteristics. Additionally, the superposition of axial tensile loads reduces the effect of the bending moment on the strength of the core seal member but further weakens the seal. Finally, an experimental system is designed to validate the simulation results.
The Ascidian–Amphipod Association between Phallusia mammillata (Cuvier, 1815) and Leucothoe richiardii (Lessona, 1865) in the Mar Grande of Taranto (Mediterranean Sea, Italy)
Authors: Arduini Daniele , Doria Lorenzo , Borghese Jacopo , Gravina Maria Flavia , Giangrande Adriana
Published: August 2023

Amphipods are widespread in the marine environment, and some have adopted a symbiotic lifestyle, such as numerous species of the genus Leucothoe (Leach, 1814). Unfortunately, few examples of such a relationship are known for the Mediterranean Sea. In the present study, we report for the first time the symbiotic relationship between Leucothoe richiardii (Lessona, 1865) and the ascidian Phallusia mammillata (Cuvier, 1815) from the Mar Grande of Taranto. Two samplings were carried out in November 2021 and May 2022, and the population structure of L. richiardii was also analyzed in relation to host weight. L. richiardii was found to live its entire cycle in P. mammillata. The amphipod population was dominated by females, and in most cases, juveniles of various sizes were found together with adults, indicating prolonged parental care. The host selection by the amphipods proved to be random and was determined by the abundance/availability of ascidians rather than their weight. The ascidians showed no signs of disturbance by the inhabiting amphipods, although they were present in large numbers, and we assumed that the relationship between L. richiardii and P. mammillata was commensal.