bluuebunny/crossref_metadata_2025 huggingface dataset:
Simultaneous high-speed schlieren and chemiluminescence imaging on the propagation characteristics of continuous rotating detonation wave in an optically accessible combustor
Authors: Fan Weijie , Peng Haoyang , Yue Xiaofei , Liu Shijie , Zhang Hailong , Liu Weidong , Zhong Shenghui
Published: February 2025

In this short letter, simultaneous high-speed schlieren and chemiluminescence imaging is demonstrated in a rounded-rectangle continuous rotating detonation combustor for the first time. Typical flowfield structures of the continuous rotating detonation (CRD), such as the fuel injection structure, fresh combustible mixture layer, detonation wave, and the downstream oblique shock wave, are clearly identified by the schlieren images. Integral of chemiluminescence intensity (ICI) of the simultaneous schlieren and chemiluminescence images fluctuates periodically, indicating the rotation motion of the shock wave and reaction zone, and the propagation frequency of CRD wave can be obtained by the fast Fourier transform on the ICI results. The induced shock wave and the front of the reaction zone are highly coincident in the simultaneous schlieren and chemiluminescence images. Furthermore, the frequencies of the local ICI in a monitor area at the same circumferential position of schlieren and chemiluminescence images well coincide with each other, which quantitatively verified that the non-premixed CRD wave is an interacted structure of induced shock wave coupled with the following reaction zone. Simultaneous high-speed schlieren and chemiluminescence imaging demonstrates great potential for characterizing detailed flowfield structures and propagation characteristics of CRD wave.
Fission dynamics and post-slope evolution of nonlinear internal waves over gentle continental shelves
Authors: Zhi Changhong , Xu Shuangdong , Cong Shuai
Published: February 2025

This study explores the fission and evolution of internal solitary waves (ISWs) propagating over gentle continental shelves, with particular focus on the shelf region beyond the slope–an area often overlooked in prior studies. High-resolution numerical simulations based on the improved variable coefficient adjusted high-order unidirectional model, a simplified two-layer fluid framework validated against laboratory experiments, reveal critical thresholds for wave splitting, where significant fission occurs for wave amplitudes |a|/h1≥0.5 and bottom slopes S≥0.4. A novel nonlinear saturation model is developed to quantitatively describe the relationship between the number of fissioned waves, wave amplitude, and slope steepness, capturing the observed stabilization of Nmax due to energy redistribution constraints. These findings bridge a critical gap in understanding ISW dynamics in post-slope shelf regions and offer a predictive framework applicable to natural oceanic conditions. The validated model enhances insight into energy redistribution, sediment transport, and ecological processes in stratified coastal environments.
The vibrational wavepackage dynamics and phase modulation via the resonant Rydberg states in molecules
Authors: Cao Ling , Wang Yanmei , Wei Jie , Song Xinli , Zhang Song
Published: February 2025

The observation of vibrational coherence has become significant because it reflects the spatial and temporal localization of a nucleus in a specific mode and characterizes energy flow and multiple kinetic relaxations in chemical dynamics. Vibrational coherence in the S1 state of 2,4-difluoroanisole has been investigated in real time by femtosecond time-resolved photoelectron spectroscopy and time-of-flight mass spectroscopy. Quantum beats of superpositions exhibit temporal oscillations with a frequency of 78 cm−1. Combining the structure computations, oscillations derive from the structure change from planar to nonplanar geometry, which correspond the coherence wavepackets moving from the Franck–Condon region toward the minimum point of the potential energy surface, elucidating the energy flows following the excitation of 2,4-difluoroanisole in the S1 state. The phases of the quantum beat via the resonant Rydberg states exhibit a shift of π rad. The vibrational coherent phase modulation via the resonant Rydberg states will facilitate the chemical coherence control in complex molecular systems.
A multi-modal approach to enhance Toxoplasma gondii detection in the Australian landscape
Authors: Breidahl Amanda Jane , Lynch Michael , Sutherland Duncan R. , Traub Rebecca , Hufschmid Jasmin
Published: February 2025

Context The disease toxoplasmosis, caused by infection with the intra-cellular protozoan parasite Toxoplasma gondii, is a potential threat to the conservation of some endothermic vertebrates. Toxoplasmosis has been reported to cause disease and acute death in many marsupials, including endangered bandicoots. Methods are required to quantify the environmental contamination with T. gondii and, hence, assess the relative threat it poses to resident species. A multi-modal approach to assess an environment for the presence of pathogens increases the likelihood of a more accurate estimate of the level of contamination and inferred risk of infection to target species. Aim This project aimed to use a multi-modal approach to estimate the environmental contamination with T. gondii across two separate landscapes with differing cat populations in the northern hinterland of Western Port, Victoria, Australia. Methods The following four parameters were used: the presence of IgG antibodies to T. gondii in free-ranging southern brown bandicoots (Isoodon obesulus) using the modified agglutination test (MAT); the presence of T. gondii DNA in the tissues of free-ranging rabbits (Oryctolagus cuniculus) and mice (Mus musculus) by real-time quantitative polymerase chain reaction (qPCR); and the presence of T. gondii oocysts in the soil using filtration methods and real-time qPCR. Key results Toxoplasma gondii was not identified in any of the soil samples (n = 594), southern brown bandicoots (n = 24) or mice (n = 267). Only one rabbit tested positive for T. gondii (n = 118). Conclusions The tests across soils and three different mammalian species all delivered similar results, leading to the conclusion that the landscapes measured had low T. gondii contamination at the time of assessment. Implications This Australian study is the first to show that the use of pathogen detection in target and two sentinel species, combined with soil analysis, may be a useful approach to assess the environmental risk of T. gondii infection in endangered and vulnerable species. Further research is recommended across sites with a gradient of T. gondii contamination and into the use of other sentinel species. Further refining of techniques for direct soil analysis in Australian conditions is recommended.
Thermal Conductivity Analysis of Laminated Composite Plates using Finite Element Method
Authors: Dash Dibyajyoti , Bano Alfia , N. V. Swamy Naidu
Published: February 2025

Thermal conductivity in composite materials refers to their heat conduction capability, influenced by the contribution of fibers and matrix. Analyzing this property is essential for predicting temperature distribution and ensuring structural integrity under thermal loads on laminated composite plates. This study investigates steady-state heat conduction in laminated composite plates using finite element analysis based on the Galerkin method, implemented in MATLAB. The analysis considers two boundary conditions: specified temperature and mixed boundary conditions, with the latter involving convection and insulation to replicate real-world scenarios. The study evaluates isotropic, orthotropic, and MMC plates, focusing on the effects of thermal conductivity, aspect ratio, and ply orientation on heat flow and temperature distribution. The results demonstrate that higher thermal conductivity improves heat distribution and reduces peak temperatures while increasing aspect ratios enhance temperature uniformity. The study also examines the influence of varying ply orientations in MMC laminates, highlighting their role in directional and uniform heat flow. Validation of the finite element code against analytical solutions ensures reliable results. The findings provide practical insights for optimizing thermal performance and designing efficient composite materials, with applications in fields like aerospace and electronics where effective heat management is critical.
Statistical aspects of weighted balls in boxes problems with an emphasis on population models
Authors: Huillet Thierry , Martinez Servet
Published: February 2025

We investigate the following problems, including the classical integer partitioning question: In how many ways can a population of size n be split into k parts when the parts consist of different kinds of trees under various labelling schemes of their constitutive atoms (nodes)? What are the sizes of the parts or clusters? The answers strongly depend on whether the particles (balls) and the parts (boxes) are distinguishable or not. This weighted partitioning setup has weights that are independent of the box numbers, either in a combinatorial or probabilistic sense. This class of problems also possibly shows, for specific alternative choices of power-law cluster weights, a ‘Bose–Einstein-like’ phase transition from a condensed to a dilute phase. When weights depend on the box numbers, we run into classical Bose–Einstein versus Maxwell–Boltzmann occupancy problems, which we briefly revisit for comparison and completeness. Our contribution reveals how sensitive occupancy issues are to the notion of distinguishability.
Fluctuation theorem for time-averaged work
Authors: Nazé Pierre
Published: February 2025

There is evidence that taking the time average of the work performed by a thermally isolated system effectively ‘transforms’ the adiabatic process into an isothermal one. This approach allows inherent quantities of adiabatic processes to be accessed through the definitions of isothermal processes. A fluctuation theorem is then established, linking the time-averaged work to the quasistatic work. Numerical evidence supporting this equality is provided for a classical harmonic oscillator with a driven linear equilibrium position parameter. Furthermore, the strong inequality for the average work is derived from the deduced fluctuation theorem using optimality arguments.
Objective and Subjective Financial Knowledge among Emerging Adults
Authors: Lee Sunwoo T , Kim Kyoung Tae
Published: February 2025

There is a growing emphasis on financial knowledge as a crucial factor in making successful financial decisions. Two aspects of financial knowledge have been identified: (1) objective financial knowledge, which measures one’s actual ability to understand financial topics, and (2) subjective financial knowledge, which measures one’s self-assessed level of knowledge. Objective and subjective financial knowledge levels do not always align, and this misalignment (when subjective exceeds objective) has been referred to as overconfidence in financial knowledge. Individuals face a variety of financial decisions for the first time in emerging adulthood, and their level of financial knowledge, along with the gap between objective and subjective assessments of that knowledge, will significantly impact their financial situation throughout their lives. This chapter examines the objective, subjective, and the disparity between these two indicators of financial knowledge among emerging adults and provides important insights for researchers, practitioners, policymakers, and educators.
Emerging Adults’ Financial Skills
Authors: Rollins-Koons Ashlyn , McCoy Megan , Lininger Favian Ray
Published: February 2025

The term “financial skills” refers to the qualities, characteristics, or abilities in an individual that influence their ability to apply their financial knowledge in decision-making and behaviors. In other words, these skills play a significant role in determining whether individuals are predisposed toward adopting sound financial practices in emerging adulthood. This chapter describes how three identified financial skills—numeracy, reading comprehension, and executive functioning—influence financial behaviors, opportunities, and well-being. Strategies and suggestions for improving these financial skills are also discussed. Additionally, the chapter features an interview with an emerging adult who shared his reflections on the content of the chapter. He provides valuable insights into financial skills by discussing the development of financial skills in himself and those around him.
Emerging Adults’ Financial Decisions: A Neurocognitive Perspective
Authors: Robba Matteo , Colautti Laura , Iannello Paola
Published: February 2025

Emerging adults are required to assume more and more responsibility over their financial situation by making decisions that will affect their future financial well-being. However, at the same time, younger individuals are more likely to exhibit impulsive decisions, risk- and sensation-seeking behaviors, and an overestimation of their knowledge and capabilities in financial domains. This can be due to changes in neural development that occur until early adulthood and to psychological characteristics that can negatively affect their decision-making process. The present chapter investigates individual differences involved in financial decision-making by exploring cognitive and neural correlates. Understanding the main neural and cognitive mechanisms that affect emerging adults’ financial decision-making may have various practical implications, including the development of financial education initiatives specifically for emerging adults.
Career Considerations in Emerging Adulthood
Authors: Nuckols Julia A , Ranta Mette
Published: February 2025

In this chapter, we will explore the landscape of opportunities for flourishing and risks for floundering among young professionals today. The evolution of emerging adults’ career culture is examined, highlighting aspects such as increased flexibility, career development, as well as growing uncertainties in the modern information society. We will delve into the pressures to succeed, post-graduation plans, financial concerns, and exploration of self-esteem of emerging adults navigating their career trajectories. Professionally, the demands of globalization and digitalization are ubiquitous, emphasizing the significance of targeted skills like digital literacy. We will widen the scope to address amplified uncertainty in emerging adults’ career development and financial stability, accentuated by global disruptions such as the COVID-19 pandemic. The chapter equips emerging adults, their parents, and educators with strategies for thriving in a rapidly evolving world, while providing quotes from emerging adults today, offering comprehensive insights into the modern career landscape.
Emerging Adults’ Financial Identity
Authors: Serido Joyce , Ranta Mette , Shim Soyeon
Published: February 2025

To answer the question “Who am I from a financial point of view?,” in this chapter, we review the literature on identity formation, building on seminal work of Erik Erikson’s (1950, 1968), to focus on identity development within the domain of finances. More precisely, we review previous studies that contributed to the conceptualization, the structure, and the measurement of financial identity and its role in contributing to emerging adults’ financial decision-making style and journey to financial independence and well-being. Throughout the chapter, we provide comments from emerging adults to connect research insights to their lived experiences. In some cases, we offer actionable advice for parents and practitioners who support emerging adult development. We conclude the chapter with suggestions for advancing our understanding of the processes that promote financial independence and well-being among emerging adults.
The European Commission’s Toleration of Noncompliance with EU Law
Authors: Zhang Yaning
Published: February 2025

This book explores the reasons why the European Commission, as the guardian of the EU treaties, purposely tolerates noncompliance with EU law by member states. To uncover this sensitive and invisible phenomenon, this research first develops an effective conceptualization strategy that defines, illustrates, and captures toleration of noncompliance (ToN). The existing compliance literature mainly looks for explanations from peculiarities of member states, policy sectors, and legal rules. Surprisingly, little attention has been paid to the supranational prosecutor. To close this theoretical gap, this study shifts the focus to the institutional nature of the Commission. Viewing the Commission as an institutional hybrid of a political agent and a judicial trustee, this book theorizes that enforcement incentives derived from the dual institutional facets jointly lead to a typology of enforcement forbearance. Based on four in-depth case studies covering diverse policy areas (public health, defence, migration and asylum, transport) and different member states (Slovakia, the Czech Republic, Italy, and Germany), this book demonstrates that enforcement forbearance can be used by the Commission to suppress the inherent deficiencies of EU law (altruistic ToN) or as a quid pro quo to advance the Commission’s policy agenda (egocentric ToN). When both types of logic are at play, ToN works simultaneously as a ‘painkiller’ and a policy ‘catalyst’ (active ToN). Lastly, ToN can also be exploited to deal with domestic political crises of member states. Drawing on the findings of the case studies, this book concludes that the legitimacy of ToN is very diverse concerning different types of ToN.
Introduction
Authors: Zhang Yaning
Published: February 2025

This chapter introduces a widely recognized but under-researched puzzle—why does the European Commission, as the guardian of EU treaties, purposefully tolerate noncompliance with EU law by member states? While the Commission has long been known as a strategic and selective enforcer of EU law, enforcement forbearance remains a ‘black box’ of compliance research due to the political sensitivity of the matter. To unpack the secrecy surrounding this phenomenon, this chapter lays out the main conceptual contribution, which consists of a novel definition and diverse manifestations of toleration of noncompliance (ToN). Furthermore, drawing on the theoretical lens of agency and trusteeship, it sketches the analytical typology of ToN based on divergent enforcement incentives of the Commission. The chapter concludes with a brief on the research design and the structure of the book.
Active ToN
Authors: Zhang Yaning
Published: February 2025

This chapter focuses on the third ideal type of ToN—active ToN. By integrating the logic of altruistic and egocentric ToN, active ToN theorizes enforcement forbearance simultaneously as a ‘painkiller’ to suppress the deficiencies of the EU legal order and a ‘catalyst’ to advance the Commission’s policy agenda. This chapter traces the Commission’s benevolent enforcement of the Italian government’s degrading asylum practices and finds that the Commission’s forbearance in the present case was a viable exit route for the Italian government overburdened by the imbalanced Common European Asylum System (CEAS). Additionally, it is a political gesture of goodwill to secure Rome’s critical support for the Commission’s legislative plan to overhaul CEAS. The stalled legislative process in the following years also indicates that the function of ToN as a legislative catalyst is not guaranteed success.
Passive ToN
Authors: Zhang Yaning
Published: February 2025

This chapter illustrates the last ideal type of enforcement forbearance—passive ToN. Though unrelated to the institutional characteristics of the Commission, passive ToN draws scholarly attention to an under-investigated argument that enforcement flexibility is to cope with the domestic political crisis of the recalcitrant member state. Focusing on the discriminative road charge scheme introduced by the German government in 2015, this chapter traces how a populist campaign slogan evolved into a controversial policy of the German coalition government and eventually forced the Commission to give its enforcement blessing to defuse a potentially explosive coalition crisis. As the only case of this research for which ToN was overridden by the CJEU, this chapter demonstrates that the enforcement discretion of the Commission is not unlimited and reveals the dark side of the legitimacy of ToN.
The Commandment
Authors: Kubátová Hana
Published: February 2025

The chapter explores why and how Christian nationalism became the new commandment of the state. It examines Christian nationalism as a manifestation of Christianism, as the defense of the majority nation against anything foreign, specifically targeting Jews and other minorities, as well as other perceived threats to the Christian nation, including liberalism and modernity. This chapter also explores the meaning of Christian nationalism in the processes and mechanisms employed to turn a political claim made at the center into a social reality, especially at the multicultural eastern edges. This includes dissecting how different ideas were utilized to alter individuals’ perceptions of themselves, their communities, and the world. Within Slovakia, this chapter shows, two concepts emerged as influential driving forces in determining action: self-love and racialized notions of work and productivity. The ousting of Jews, as well as Roma, from the villages and towns of eastern Slovakia was not only justified based on biblical references but also portrayed as an act carried out in the name of the nation. Local clergy played a significant role in propagating and amplifying these concepts at the edges of the state, leading to the establishment and enforcement of social hierarchies that facilitated mounting processes of genocide.
The Demand
Authors: Kubátová Hana
Published: February 2025

The fourth chapter examines the interconnectedness that developed between individuals residing in eastern Slovakia and the central authorities in Bratislava as a system of intelligence gathering and information exchange took root. It explores how rural residents skillfully maneuvered through shifting social norms to gain access to coercion and power that often emanated from the center but did not merely remain there. The analysis focuses on how seemingly mundane choices, daily routines, and social patterns contributed to the making of complicity in and through everyday life. It explores the utilization of party membership and sheds light on how individuals perceived as politically ignorant successfully navigated bureaucratic obstacles to achieve access to authority and its spoils. The chapter examines how these individuals pursued their own interests, with particular emphasis on intercessions and denunciations around Aryanization—an important turning point where the aspirations of those in power aligned with the demands of those living on the margins of society. Notably, Aryanization was not merely a bureaucratic procedure of turning Jewish possessions Slovak; it was a complex social process characterized by power distribution and contestation within the fascist state and its multidirectional communications apparatuses. Social mobility coexisted with social atomization, revealing the intricate dynamics at play in the development and practice of Christian nationalism in the context of Aryanization. The communication and collaboration between the central authority and the periphery, as well as between the elites and the masses, shaped this unfolding phenomenon in ways that turned neighbors against neighbors while providing forms of enrichment and empowerment to those who successfully aligned their actions with the racial project of the state.
The Collapse
Authors: Kubátová Hana
Published: February 2025

The chapter focuses on the collapse of the fascist regime, a collapse that was triggered by the advancing German-Soviet front line in the eastern edges of the country. It examines the impact of the failed 1944 anti-fascist rebellion and the subsequent German occupation on the Christian national order in the country. Focusing on the perspectives of individuals situated on the periphery of the national community who unexpectedly found themselves at the forefront of monumental military conflicts waged by transnational forces, the chapter provides insights into the complex motivations people had for participating in (or fighting to quash) the Slovak National Uprising—complexities that have since been simplified in celebratory accounts of the uprising as the manifestation of popular resistance to the state. Emphasizing the voices of those marginalized groups such as Jews and Roma, the chapter argues for the importance of not only listening to their stories but also integrating them into the national narrative that unfolds during the wartime period. This lens exposes the fractures and contradictions that have plagued the regime since its inception, illustrating how these led to physical, communal, and material devastation, contributing to the downfall of the central structures of the regime but not necessarily to the disintegration of the Christian national project it constructed in negotiation with the people and places of the periphery.
Efficacy, Immunogenicity, and Safety of the Bivalent RSV Prefusion F (RSVpreF) Vaccine in Older Adults Over 2 RSV Seasons
Authors: Walsh Edward E , Eiras Daniel , Woodside John , Jiang Qin , Patton Michael , Marc Gonzalo Pérez , Llapur Conrado , Rämet Mika , Fukushima Yasushi , Hussen Nazreen , Cardona Jose , Mikati Tarek , Zareba Agnieszka , Ilangovan Kumar , Lino Maria Maddalena , Kalinina Elena V , Swanson Kena A , Gurtman Alejandra , Munjal Iona
Published: February 2025

Background

RSV is an important cause of lower respiratory tract illness (LRTI) in older adults. RSVpreF is a bivalent stabilized prefusion F vaccine containing antigens against RSV-A and RSV-B. In this phase 3 trial in ≥60-year-olds, RSVpreF demonstrated vaccine efficacy (VE) of 88.9% and 77.8% against RSV-associated LRTI with ≥3 symptoms at the end of RSV seasons 1 and 2, respectively. Here we describe final safety and efficacy results and present immunogenicity data.

Methods

This study was conducted over 2 RSV seasons. Participants were randomized (1:1) to 1 dose of RSVpreF 120-µg or placebo. A secondary objective was to describe RSVpreF immunogenicity 1-month postvaccination and before season 2 visits in a participant subset from the USA and Japan.

Results

One-month postvaccination neutralization titer geometric mean fold rise (GMFR) was 12.1 for combined RSV-A/RSV-B. Geometric mean titers decreased at the preseason 2 visit, but remained substantially higher than baseline (RSV-A/RSV-B GMFR=4.7). One month postvaccination, GMFRs for RSV-A/RSV-B neutralizing responses ranged from 12.0−13.0 for subgroups stratified by age (60−69, 70−79, ≥80 years). RSV-A/RSV-B GMFRs in participants with prespecified chronic conditions were generally similar to those without (range, 11.4−14.4). A consistent favorable safety profile and durable VE was seen through 2 RSV seasons.

Conclusion

High RSV neutralizing titers were observed 1 month after RSVpreF vaccination in ≥60-year-olds, with similarly robust responses across age subgroups and baseline chronic conditions. These robust immune responses corresponded with high RSVpreF VE against RSV-associated LRTI. RSVpreF had a favorable safety profile over 2 seasons.

NCT05035212; EudraCT, 2021-003693-31
Skull joints assessed via CT for age estimation—a systematic review
Authors: Macedo Fernanda , Stefanel Maria Eduarda , Sakurada Adriano , Moreira Débora , Junqueira José Luiz Cintra , Franco Ademir
Published: February 2025

Objectives

To screen the existing scientific literature and to evaluate the reliability of skull joints as biological markers for age estimation when analyzed via computed tomography (CT).

Methods

The study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered in Open Science Framework (DOI: 10.17605/OSF.IO/PCVEF). Eligible studies included observational cross-sectional research that assessed skull joints for age estimation through CT. Data from five databases were screened: Medline/PubMed, Scopus, LILACS, SciELO and Open Grey. The risk of bias was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Tools for Systematic Reviews.

Results

A total of 15 studies out of 4633 initially screened were eligible. The studies tested age estimation based on the spheno-occipital joint (53.33%) and cranial sutures, namely coronal, sagittal and lambdoid (46.66%). Multi-slice CT was the most commonly used imaging modality (66.66%), with a slice thickness of < 1mm in 93.33% of studies. All the studies that assessed the spheno-occipital joint endorsed its application for age estimation, but some (37.5%) stressed limitations. Four (57.14%) out of the seven studies that assessed the cranial sutures raised concerns about their use for age estimation (three advised against it). Most of the studies had a low risk of bias (86.66%).

Conclusion

Findings supported the forensic application of the spheno-occipital joint for age estimation in adolescents and young adults, despite variability in fusion age. Cranial sutures were largely discouraged as sole markers because of unsatisfactory accuracy and high error risks.
Mortality and morbidity after transcatheter aortic valve implantation compared to an age- and sex-matched control population: a population-based study from the SWEDEHEART registry
Authors: Lachonius Maria , Nielsen Susanne J , Giang Kok Wai , Backes Jenny , Bjursten Henrik , Hagström Henrik , James Stefan , Settergren Magnus , Skoglund Kristofer , Jeppsson Anders , Pétursson Pétur
Published: February 2025

Introduction

Data are lacking about the risk for death and major adverse cardiovascular events (MACE) after transcatheter aortic valve implantation (TAVI), compared to the general population. Therefore, we assessed the risk for all-cause death and MACE after TAVI in patients aged 65 years and older, in comparison to an age- and sex-matched control population.

Methods

In total, 5 924 TAVI patients and 10 928 matched controls (mean age 82.1, SD 6.0, and 81.9, SD 6.1, respectively) were included from 2014 to 2020. The SWEDEHEART registry and four mandatory national registers were used to collect data. Cox regression models were used to assess the association with all-cause mortality and MACE risk.

Results

In total, 1 410 (23.8%) of the TAVI patients and 2 115 (19.4%) controls died during the follow-up period. Median follow-up was 1.9 years (IQR 0.9–3.3) respectively. The crude mortality and MACE risks were higher in TAVI patients than in controls (hazard ratios (HR) 1.27 [95% Confidence interval (CI): 1.19–1.36] and HR 1.44 [95% CI: 1.35–1.53], respectively). After adjustment, there was a lower risk for both mortality and MACE in TAVI patients (adjusted hazard ratio (aHR) 0.77 [95% CI: 0.71–0.84] and aHR 0.90 [95% CI: 0.83–0.98], respectively).

Conclusion

After adjustments for comorbidities, the mortality risk was lower in TAVI patients, compared with an age- and sex-matched control population. These findings suggest that the high burden of comorbidities in TAVI patients has a strong impact on the risk for mortality and MACE after TAVI.
A111 EVALUATION OF REFERRAL COMPLETENESS FOR LARGE NON-PEDUNCULATED POLYPS IN LIGHT OF RECENT INTERNATIONAL CONSENSUS: A SINGLE-CENTER STUDY
Authors: Alabdulkarim B , Khalaf K , May G , Mosko J , Teshima C
Published: February 2025

Background

Endoscopic mucosal resection (EMR) is standard-of-care for treating large non-pedunculated colorectal polyps yet often requires referral to expert centers. Hence, inclusion of important information to the therapeutic endoscopist is essential for pre-procedure planning. A recent international consensus statement, comprised of 19 components, aims to improve triage and planning of endoscopic resection for large non-pedunculated colorectal polyps. We sought to determine the current status of inclusion of these reporting elements in referrals to our tertiary center.

Aims

1- Report the rate of complete referrals in light of the international expert consensus statement

2- Investigate the degree of correlation of polyp adjudication between referring endoscopist and local advance therapeutic endoscopiest assessment

3- Explore factors predicting comprehensive reporting

Methods

Single-center review of prospectively collected colorectal polyp referrals for large non-pedunculated polyps from March 2021 to March 2023.

Results

411 referrals for large polyps were received; median size 3 cm; 58% located in ascending colon. 89 % of referrals included the initial assessment date, and only 38% incorporated video or photo documentation, of which 44% were deemed sufficient to demonstrate polyp features. Anatomical location was reported in 96% of referrals, while polyp size was mentioned in only half of the referrals (50%). Polyp morphology was described in 91% as either sessile (n=360) or pedunculated (n=35). Paris classification was reported in 53% of referrals, and LST classification in 90%. 12% of referrals reported four elements of less, while 18% of referrals reported all elements. Correlations with our own endoscopic assessments were diverse, ranging from a robust correlation for anatomical location (r=0.82, 95%CI 0.78-0.86, p < 0.001) to a more modest correlation for Paris classification (r=0.44, 95%CI 0.35-0.52 p < 0.001).

Conclusions

Our study reveals deficiencies in current referral practices and emphasizes the consensus statement’s role in improving the process. Consequences of low-quality referrals may include compromised patient care, leading to delayed diagnoses, inappropriate treatments, and potentially compromised patient outcomes. Thus, we have identified a likely knowledge gap in polyp characterization among referring physicians that will be a focus of a subsequent QI initiative.

Funding Agencies

None
A117 EXPECT THE UNEXPECTED. UNUSUAL PATHOLOGY FINDINGS FROM ROUTINE POLYPECTOMY. A REVIEW OF SUBMUCOSAL GI LESIONS
Authors: Adesina O
Published: February 2025

Background

Granular cell tumours (GCTs) are rare benign submucosal neoplasms. They most commonly arise from neural or Schwann cells. While GCTs are frequently encountered in the oral cavity, skin, and breast, gastrointestinal involvement remains a clinical rarity. This case series highlights the incidental detection of GCTs during routine colonoscopy. In this setting, we provide insights into the diagnostic challenges and management approaches for such submucosal lesions.

Aims

To present a case series of two patients with incidentally discovered GCTs during routine colonoscopy, discuss the diagnostic and management strategies for GCTs, and offer a review of current literature with implications for clinical practice.

Methods

We present two cases of GCTs identified during routine colonoscopic polypectomy. The clinical presentations, diagnostic processes, and management strategies were analyzed using the existing literature. Particular focus was given to the challenges of identifying submucosal lesions in the gastrointestinal tract and determining appropriate follow-up care based on histopathological findings.

Results

The first case is a 75-year-old man who underwent a colonoscopy after a positive fecal immunochemical test (FIT), with normal physical and laboratory findings. Multiple polyps were identified, and histopathology confirmed a GCT in the cecum. The patient was asymptomatic, and a surveillance colonoscopy was scheduled.

The second case is a 74-year-old woman who was referred to gastroenterology after a positive FIT. She was asymptomatic, with normal physical and laboratory findings. Initial colonoscopy revealed two resected polyps. A follow-up colonoscopy a year later identified three additional polyps, one of which was a GCT. Surveillance colonoscopy was advised in four years.

GCTs of the gastrointestinal tract are rare, most commonly found in the distal esophagus (about 60%). Typically submucosal, they rarely invade the mucosa or muscularis propria. Other notable subepithelial lesions include gastrointestinal stromal tumours (GISTs), leiomyomas, lipomas, ectopic pancreatic tissue, and neuroendocrine tumours. Unlike GCTs, GISTs and leiomyosarcomas are more often malignant. Endoscopic, radiologic, and endosonographic assessments assist in the risk stratification of subepithelial lesions, with one study demonstrating these features having a 92.9% specificity for detecting GISTs. Histology remains crucial for confirmation of diagnosis. Management of benign GCTs may involve endoscopic resection or surveillance, whereas malignant cases may require more extensive treatment, including adjuvant chemotherapy or radiotherapy.

Conclusions

GCTs are rare findings in gastrointestinal pathology. Treatment involves resection or close surveillance. Further research is needed to refine optimal diagnostic and therapeutic approaches for these uncommon neoplasms.

Funding Agencies

None
A118 DE NOVO CROHN’S DISEASE FOLLOWING ORTHOTOPIC LIVER TRANSPLANTATION IN A PATIENT WITH PRIMARY SCLEROSING CHOLANGITIS: A CASE REPORT
Authors: Bello A , Samad N
Published: February 2025

Background

Primary sclerosing cholangitis (PSC) is strongly associated with inflammatory bowel disease (IBD), most commonly ulcerative colitis, with up to 80% of PSC patients developing IBD during their lifetime. However, the development of de novo Crohn’s disease following orthotopic liver transplantation (OLT) is rare, complicating both immunosuppressive management and long-term patient outcomes.

Aims

The aim of this study is to report a rare case of de novo Crohn’s disease post-OLT in a PSC patient, exploring their presentation, the role of tacrolimus in its development and highlighting successful management with vedolizumab.

Methods

We conducted a retrospective case analysis of a 44-year-old female patient who underwent OLT in 2021 for PSC-related decompensated cirrhosis. Prior to the transplant, the patient had no history of IBD, and a screening colonoscopy revealed normal colonic mucosa, although histological analysis indicated proctitis. Approximately two years post-OLT, while on the immunosuppresive agent tacrolimus, the patient developed new gastrointestinal symptoms, including abdominal pain, diarrhea, tenesmus, and nocturnal bowel movements. Diagnostic evaluation included endoscopic assessment and histopathological analysis of biopsy samples.

Results

Endoscopic examination revealed inflammation characterized by ileitis and left-sided colitis. Histopathology confirmed a diagnosis of de novo Crohn’s disease. The patient’s clinical course was complicated by the need to balance her immunosuppressive therapy with treatment for Crohn’s disease. Vedolizumab, a gut-selective biologic agent targeting the α4β7 integrin, was initiated alongside her existing immunosuppressive regimen. Over the course of treatment, the patient demonstrated significant clinical improvement, with a marked reduction in abdominal pain and diarrhea, as well as an overall improvement in quality of life.

Conclusions

The development of de novo Crohn’s disease in patients with PSC following OLT, though rare, presents a complex clinical challenge. Immunosuppressive agents, particularly tacrolimus, may play a contributory role in the pathogenesis of de novo IBD, though the precise mechanisms remain unclear. Early diagnosis and intervention with targeted therapies, such as vedolizumab, are critical in managing IBD in this population, as they allow for effective control of gastrointestinal inflammation while maintaining necessary immunosuppression. This case underscores the importance of vigilant surveillance in post-OLT patients to ensure timely intervention. Further research is warranted to elucidate the underlying risk factors and optimize therapeutic strategies for de novo IBD in the post-transplant setting, particularly in PSC patients who may be at increased risk.

Funding Agencies

None
A122 CHARACTERIZATION OF COLORECTAL NEOPLASIA IN PEOPLE WITH LYNCH SYNDROME
Authors: Al-Bayati K , Brar K , Rothenmund H , Chordiker B , Stone J , Kim C , Singh H
Published: February 2025

Background

Lynch syndrome (LS) is an autosomal dominant condition that is associated with germline variants in the MLH1, MSH2, MSH6, or PMS2 genes or a deletion in the EpCAM gene which inactivates MSH2. LS is the most common cause of hereditary colorectal cancer (CRC), accounting for 3% of all new diagnoses. In 2017, Manitoba implemented an initiative where all CRC biopsy and surgical specimens for patients ≤ 70 years of age are screened for LS through mismatch repair immunochemistry. If confirmed to have LS, cascade testing is offered, and systematic evidence-based screening is recommended. Recent hypotheses suggest alternative pathways of development of CRC in LS, with variation by affected gene. Guidelines recommend delaying onset of screening colonoscopy to age 30-35 for those with MSH6 and PMS2 mutations. However, there are limited contemporary data on pre-CRC lesions in LS, including any differences according to impacted gene. Lower rate of CRC in young persons with MSH6/PMS2 may be related to removal of pre-CRC lesions

Aims

The objective of this study is to characterize colorectal lesions among a population-based cohort of LS individuals

Methods

The database of individuals with pathogenic/likely pathogenic (P/LP) LS gene variants in Manitoba is augmented with colonoscopy data and pathological findings. We report descriptive statistics to describe the neoplastic lesions (pre-CRC lesions and CRC) in those with LS with data stratified by gene type. Prevalence estimates among individuals with LS without CRC amongst those with advanced CRC precursor lesions was reported. Advanced CRC precursor lesions are defined as either ≥1 cm in size, villous/tubulovillous histology, high grade dysplasia, or serrated polyps with dysplasia

Results

A total of 482 people with LS were analysed (33.9% males). 198 individuals with LS had documented CRC, of which 28.3% were in the cecum. Prevalence of advanced CRC precursors was 9/81 in people with MSH6 mutation, 18/102 with MLH1 mutation, 16/112 with PMS2 mutation, and 30/136 with MSH2 mutation. Median age at diagnosis of advanced CRC precursors was 56-years with average polyp size of 16.5 mm. 1/8 individuals under the age of 35 years old at the time of the colonoscopy in the MSH6 group had advanced CRC precursors, compared to 1/25 of individuals in the PMS2 mutation group. There were no CRC diagnosed below the age of 35 in the PMS2 and MSH6 groups

Conclusions

This population-based study is characterizing neoplastic lesions in individuals with LS highlighting the distribution of these lesions according to gene variants. The data analysis thus far raises concerns on the recent guidelines recommendations to increase the age of onset of colonoscopy surveillance to 35 years old in those with PMS2/MSH6 mutation; those recommendations did not consider the effect of removal of CRC precursors on CRC occurrence

Funding Agencies

None
A140 DUPILUMAB IMPROVED HISTOLOGY, CLINICAL SYMPTOMS, AND ENDOSCOPIC FEATURES IN ADULTS AND ADOLESCENTS WITH EOSINOPHILIC ESOPHAGITIS THROUGH 52 WEEKS REGARDLESS OF BASELINE DISEASE DURATION: POST-HOC SUBGROUP ANALYSIS OF THE PHASE 3 LIBERTY EOE TREET STUDY
Authors: Gonsalves N , Schlag C , Santander C , Peterson K , Alkhouri R , Xia C , Raphael B P , Radwan A
Published: February 2025

Background

Limited literature is available on EoE disease duration and response to therapy. Dupilumab is approved for EoE in patients aged ≥12 years, weighing ≥40 kg, in the EU, and in patients aged ≥1 year, weighing ≥15 kg, in the USA and Canada.

Aims

To assess the long-term efficacy of dupilumab in patients with EoE stratified by baseline disease duration.

Methods

In Part B of LIBERTY EoE TREET (NCT03633617), patients received 24 weeks of dupilumab 300 mg or placebo weekly (qw). Eligible patients who completed Part B received dupilumab through 52 weeks (Part C). Co-primary endpoints were the proportion achieving peak esophageal intraepithelial eosinophil count (PEC) ≤6 eosinophils/high-power field (eos/hpf) and absolute change in Dysphagia Symptom Questionnaire (DSQ) total score. Secondary endpoints included proportion achieving PEC <15 eos/hpf, percent change in PEC, and mean change in Endoscopic Reference Score (EREFS) total score and Histologic Scoring System (HSS) grade/stage scores. Data were stratified by baseline disease duration defined as time since diagnosis (≤5 years, >5-≤10 years, >10 years).

Results

At Part B baseline in the dupilumab and placebo groups, respectively, 43 and 48 patients had EoE for ≤5 years, 22 and 13 patients had EoE for >5-≤10 years, and 15 and 18 patients had EoE for >10 years. At Week 24, PEC ≤6 eos/hpf and DSQ total score favored dupilumab over placebo, regardless of disease duration. Dupilumab also improved percent change in PEC and change in EREFS and HSS grade/stage scores across all disease duration subgroups vs placebo (Table). At Week 52, improvements were maintained in patients who received continued dupilumab; patients who switched from placebo to dupilumab at Week 24 also showed improvement in all outcomes. Overall safety was consistent with the known dupilumab safety profile.

Conclusions

These results show that dupilumab 300 mg qw is an effective long-term treatment for patients with EoE, including a subset of patients with longstanding disease potentially inadequately addressed by alternative therapies.

Funding Agencies

Research sponsored by Sanofi and Regeneron Pharmaceuticals Inc.
A143 PREDICTIVE SCORES AND CLINICAL FAILURE AFTER PER-ORAL ENDOSCOPIC MYOTOMY
Authors: Parvizian M K , Rai M , Bechara R
Published: February 2025

Background

Achalasia is a rare esophageal motility disorder characterized by incomplete lower esophageal sphincter relaxation and absent peristalsis. Increasingly, per-oral endoscopic myotomy (POEM) has been used as a first-line therapy for achalasia. However, a small proportion of patients will experience clinical failure after POEM (Eckhardt Score>3). Several small studies have attempted to predict which patients will experience failure after POEM; however, none have been validated outside their original centers.

Aims

To compare the performance of the Zhongshan, JAMS, and Urakami scores to predict key outcomes post-POEM.

Methods

A single centre retrospective cohort study from March 2016 to January 2024 including all adult patients undergoing POEM for achalasia with at least 3 months of follow-up was conducted. The performance of the different scores in predicting clinical failure and the presence of minimal symptoms (Ekhardt Score <=1) was analyzed. Scores were calculated and patients categorized as high-risk for failure (>=5% risk) or low risk based on score cutoffs from the original validation studies.

Results

156 patients were included in our study. The median age of participants was 57.5 (IQR 36-68), and 70 were female (44.9%). 6 patients experienced clinical failure (3.8%) and 115 had minimal symptoms post-POEM (73.7%). The Urakami score demonstrated the highest sensitivity for predicting clinical failure (1.00; 95% CI 0.54-1.00) and presence of more than minimal symptoms (1.00; 95% CI 0.91-1.00), while the Zhongshan score exhibited the highest specificity for clinical failure (0.82; 95% CI 0.74-0.88) and more than minimal symptoms (0.84; 95% CI 0.76-0.90). (Table 1)

Conclusions

This study reports the first validation of predictive scores in POEM patients outside of their centres of origin. The Urakami score may play a role in identifying patients at low risk of clinical failure, while the Zhongshan score may help identify patients at high risk of clinical failure. Using these scores can aid in counseling patients pre-POEM about their expected outcomes.

Test characteristics of various scores to predict outcomes after POEM

Funding Agencies

None