bluuebunny/crossref_metadata_2025 huggingface dataset:
A Self-Sovereign Identity–Blockchain-Based Model Proposal for Deep Digital Transformation in the Healthcare Sector
Authors: Cocco Luisanna , Tonelli Roberto
Published: December 2024

The acceleration of the digital transformation process imposed by the pandemic in all the countries of the European Union, and in all sectors, has given way to a revolution that up until a couple of years ago would have been impossible even to imagine. Digital innovation has become a factor of competitiveness in all sectors. In this new scenario that has come to be, the Blockchain technology, the Self-Sovereign Identity paradigm, Internet of Things, and, in general, the new technologies that will emerge, will constitute enhancers of competitiveness and will have to aim for interoperability. In this context, this article develops and presents a model proposal in the healthcare field that aims to highlight how the combination of the Blockchain technology and the Self-Sovereign Identity paradigm restores full control over a person’s identity and information, while ensuring the integrity of all medical reports, enabling secure communications between personal medical devices and patient/doctor applications on devices exploiting peer Decentralized Identifiers and ensuring data privacy, exploiting Zero Knowledge Proofs. The proposal relies on the Veramo platform, treating all medical reports as verifiable credentials and storing them in digital wallets owned by the patient. The article concludes by presenting a prototype designed and implemented for managing medication prescriptions, their issuance, and their exchange.
Generalized Sampling Theory in the Quaternion Domain: A Fractional Fourier Approach
Authors: Samad Muhammad Adnan , Xia Yuanqing , Al-Rashidi Nader , Siddiqui Saima , Bhat Muhammad Younus , Alshanbari Huda M.
Published: December 2024

The field of quaternions has made a substantial impact on signal processing research, with numerous studies exploring their applications. Building on this foundation, this article extends the study of sampling theory using the quaternion fractional Fourier Transform (QFRFT). We first propose a generalized sampling expansion (GSE) for fractional bandlimited signals via the QFRFT, extending the classical Papoulis expansion. Next, we design fractional quaternion Fourier filters to reconstruct both the signals and their derivatives, based on the GSE and QFRFT properties. We illustrate the practical utility of the QFRFT-based GSE framework with a case study on signal denoising, demonstrating its effectiveness in noise reduction with the Mean Squared Error (MSE), highlighting the improvement in signal restoration.
Drug-Induced Liver Injury: Role of Circulating Liver-Specific microRNAs and Keratin-18
Authors: Cardin Romilda , Bizzaro Debora , Russo Francesco Paolo , D’Arcangelo Francesca , Ideo Francesco , Pelizzaro Filippo , Carlotto Chiara , Minotto Milena , Farinati Fabio , Burra Patrizia , Germani Giacomo
Published: December 2024

Background and Objective: Drug-induced liver injury (DILI) is increasingly becoming a cause of acute hepatitis. The study evaluated the role of liver-specific microRNAs (miRNAs) and keratin-18 (K-18) markers M30 (apoptosis) and M65 (necrosis) as biomarkers of acute hepatitis. Methods: Sixty-eight patients were sub-grouped as DILI, HBV- and alcohol-related acute hepatitis. Five healthy controls were included. The expression of plasma miR-21-5p, miR-34a-5p and miR-122-5p was evaluated by RT-qPCR analysis using healthy volunteers as reference. M30 and M65 were determined with ELISA kits. Results: All markers were significantly higher in the acute liver disease patients compared to controls. In DILI, miRNA levels positively correlated with M30, M65 and ALT. miR-122-5p had the highest AUC of 0.73, sensitivity of 76.2 and specificity of 72.2 in identifying DILI from other groups. Patients with hepatocellular-pattern DILI showed higher miR-122-5p and miR-21-5p compared to patients with cholestatic or mixed pattern. A new score to discriminate DILI versus other causes of acute hepatitis was developed using the identified risk factors as follows: 0.012 × miR-34a-5p + 0.012 × miR-122-5p − 0.001 × M30 + 2.642 × 1 (if mixed pattern) + 0.014 × 1 (if hepatocellular pattern) + 1.887. The AUC of the score was 0.86, with a sensitivity and specificity of 81%, better than the values of the single markers. Conclusions: Liver-specific miRNAs and K-18 could be promising serum biomarkers of DILI, especially when used in combination.
MicroRNA Screening Reveals Upregulation of FoxO-Signaling in Relapsed Acute Myeloid Leukemia Patients
Authors: Reichelt Paula , Bernhart Stephan , Platzbecker Uwe , Cross Michael
Published: December 2024

Background/Objectives: AML is an aggressive malignant disease characterized by aberrant proliferation and accumulation of immature blast cells in the patient’s bone marrow. Chemotherapeutic treatment can effectively induce remission and re-establish functional hematopoiesis. However, many patients experience chemoresistance-associated relapse and disease progression with a poor prognosis. The identification of molecular determinants of chemoresistance that could serve as potential targets for the therapeutic restoration of chemosensitivity has proven to be challenging. Methods: To address this, we have analyzed longitudinal changes in the expression of microRNAs during disease progression in a small set of four AML patients, combined with gene ontology (GO) pathway analysis and evaluation of gene expression data in patient databases. Results: MicroRNA profiling of bone marrow samples at diagnosis and after relapse revealed significant differential expression of a large number of microRNAs between the two time points. Subsequent GO pathway analysis identified 11 signal transduction pathways likely to be affected by the differential miRNA signatures. Exemplary validation of the FoxO signaling pathway by gene expression analysis confirmed significant upregulation of FOXO1 and the target genes GADD45 and SOD2. Conclusions: Here, we show how a microRNA-based pathway prediction strategy can be used to identify differentially regulated signaling pathways that represent potential targets for therapeutic intervention.
Transcriptomic Changes in Human Tonsil-Derived Mesenchymal Stem Cells Across Culture Passages
Authors: Oh Moon Sik , Hong Heesun , Lee Ok Joo , Yi Su Hyeon , Park Hae Sang , Lee Jae-Jun , Park Chan Hum , Im Sun-Wha
Published: December 2024

Background/Objectives: Tonsil-derived mesenchymal stem cells (TMSCs) are in the limelight in regenerative medicine due to their high proliferation and differentiation potential. It is important to conduct studies to determine the optimal conditions for achieving the maximum yield while maintaining the optimal differentiation capacity of TMSCs. Methods: This study explores the impact of serial subculture on TMSCs by analyzing gene expression at passages 2, 4, 6, and 8. For each culture passage, genes with significant differences in RNA expression from previous passages were selected and their characteristics were observed performing enrichment analysis including KEGG (Kyoto Encyclopedia of Genes and Genomes) and Reactome pathway. Results: At each passage, a “cell cycle” term was ranked high with statistical significance in the KEGG and Reactome pathway. Cell cycle gene expression, including Cyclin-dependent kinases (CDKs) and cyclins, increased until passage 6, then decreased by passage 8. The cell cycle is known to be important not only for proliferation but also for determining whether stem cells maintain pluripotency or differentiate into various lineages. Conclusions: The results suggest that cell cycle gene expression can guide the timing for differentiation induction, with passage 6 potentially being a critical point for initiating differentiation.
Association Among MCT1 rs1049434 Polymorphism, Athlete Status, and Physiological Parameters in Japanese Long-Distance Runners
Authors: Seki Shotaro , Kobayashi Tetsuro , Beppu Kenji , Nojo Manabu , Hoshina Kosaku , Kikuchi Naoki , Okamoto Takanobu , Nakazato Koichi , Hwang Inkwan
Published: December 2024

Background/Objectives: Monocarboxylate transporters (MCTs) comprise 14 known isoforms, with MCT1 being particularly important for lactate transport. Variations in lactate metabolism capacity and aerobic performance are associated with the T1470A polymorphism in MCT1. We aimed to investigate the frequency of the T1470A polymorphism and compare relevant physiological parameters among long-distance runners, wherein these parameters are fundamental to athletic performance. Methods: We included 158 Japanese long-distance runners (LD) and 649 individuals from the general Japanese population (CON). The frequency of the T1470A polymorphism was compared between these groups and across athletic levels using the chi-square test. Additionally, physiological data were collected from 57 long-distance runners, and respiratory gas measurements were obtained using the mixing-chamber method during a graded incremental exercise test. Results: We observed a significant difference between the LD and CON groups in the dominant model and between the sub-28 min group and 28 min or above group in the recessive model. As the competitive level increased, the frequency of the AA genotype also increased. When comparing physiological parameters between the AA genotype and T allele, subjects with the AA genotype showed significantly higher values for oxygen uptake at lactate threshold (p = 0.001), oxygen uptake at onset of blood lactate accumulation (p = 0.01), maximal oxygen uptake (p = 0.005), and maximal blood lactate concentration (p = 0.038). Conclusions: These results suggest that the AA genotype of the T1470A polymorphism of MCT1 is an effective genotype associated with athletic status and aerobic capacity in Japanese long-distance runners.
Prospects of Creating a Geopark in the Ulytau Region of Kazakhstan: Geoheritage and Geotourism Potential
Authors: Nigmatova Saida , Pirogova Tatyana , Madiyarova Ilnura , Bekbotaeva Alma , Seydali Arman , Kozhakhmet Bakhtyar , Kalibek Balzhan
Published: December 2024

This article is devoted to the study of geoheritage objects and the scientific justification for the creation of a geopark in the Ulytau region of Central Kazakhstan. This region is the largest copper-bearing province in the world and has a unique natural and cultural heritage. The purpose of this article is to show the scientific and tourist significance of geoheritage objects of the potential Ulytau Geopark. The geological history of this area tells about no less than 500 million years of the planet’s development. Geological, historical and sacred objects make this area extremely interesting for the development of geotourism and the creation of geoparks as a basis for the sustainable development of the area. The research methods included a bibliographic method, which made it possible to collect information on the geoheritage of the territory; field survey techniques; and methods based on the evaluation of the criteria for eligibility for UNESCO Geoparks. The methodology included five main blocks of assessment (geology and landscape, structure and management model, interpretation and environmental education, geotourism and sustainable development at the regional level) and represents an integrated interdisciplinary approach to present regional features in the context of the geological heritage of the world. Despite the length of time geology has been studied and the resources actively used, geoheritage sites have not been previously studied and characterised. Geoparks in Kazakhstan are at an early stage of development and this article aims to show the potential for establishing geoparks in the Ulytau region.
Emotional Health of Immigrant Adolescents by a Cross-Lagged Panel Network Analysis: Self-Esteem and Depression
Authors: Sui Tiange , Yeung Jerf W. K.
Published: December 2024

Background/Objectives: The study investigated the dynamic interrelations of both positive and negative self-esteem with depression among immigrant adolescents. Methods: Longitudinal data from the Children of Immigrants Longitudinal Study (CILS) were analyzed using a Cross-Lagged Panel Network (CLPN) model. Results: The results showed strong autoregressive effects; both the positive and negative dimensions of self-esteem and symptoms of depression were fairly stable across the two measurement times. Cross-lagged effects indicated that higher levels of positive self-esteem predicted reduced depressive symptoms; for example, higher self-worth at Time 1 was associated with a lower lack of motivation at Time 2. However, some components, for instance, positive self-attitude, predicted in greater sadness from Time 1 to Time 2. On the other hand, certain dimensions of negative self-esteem, such as feeling useless at Time 1, were related to decreases in depressive symptoms at Time 2, which points to complex and bidirectional effects that challenge traditional hypotheses on how self-esteem may affect mental health. Conclusions: The current study teases apart sub-components of self-esteem and, in doing so, demonstrates how different facets uniquely predict depression over time and inform nuanced mental health trajectories among immigrant youth. The findings indicate that selective self-esteem interventions should be carried out to enhance resilience and mental well-being in adolescents from diverse backgrounds.
The New Iberian Macho in Democratic Spain: Modern Men in the Men’s Magazines?
Authors: Velasco Molpeceres Ana , Gómez Cuesta Cristina , Prieto Muñiz María
Published: December 2024

The evolution of men’s fashion and lifestyle magazines in Spain since the 1970s reflects shifts in male identity, influenced by the country’s transition from dictatorship to democracy and the liberalizing period of el Destape. This study examines how these magazines capture the adaptations of the “modern man”, emphasizing his pursuit of freedom and alignment with global trends. By analyzing the content of men’s magazines and contrasting them with women’s publications, this study identifies gendered consumption patterns and the role of magazines as both historical records and consumer products. Comparisons reveal how men and women were positioned as both subjects and objects. Results show that men’s magazines initially centered on lifestyle and erotic themes, with successful titles like MAN outlasting less defined publications. Over time, male-targeted magazines broadened their content, increasingly presenting men as consumers of lifestyle topics. This shift parallels the growth of new male-focused magazines since the 2000s, which now leverage social media-driven trends to attract audiences. The study concludes that these magazines have not only shaped male identity but have also reflected capitalist consumer strategies, adapting to digital contexts. Modern male lifestyle magazines, while diversifying themes, remain influenced by traditional gender dynamics that underscore male dominance in cultural narratives.
Sociodemographic and Population Exposure to Upstream Oil and Gas Operations in Canada
Authors: Lavoie Martin , Risk David , Rainham Daniel
Published: December 2024

Canada, as one of the largest oil and gas producer in the world, is responsible for large emissions of methane, a powerful greenhouse gas. At low levels, methane is not a direct threat to human health; however, human health is affected by exposure to pollutants co-emitted with methane. The objectives of this research were to estimate and map pollutants emitted by the oil and gas industry, to assess the demographic of the population exposed to oil and gas activities, and to characterize the impact of well density on cardiovascular- and respiratory-related outcomes with a focus on Alberta. We estimated that ~13% and 3% people in Alberta reside, respectively, within 1.5 km of an active well and 1.5 km of a flare. Our analysis suggests that racial and socioeconomic disparities exist in residential proximity to active wells, with people of Aboriginal identity and people with less education being more exposed to active wells than the general population. We found increased odds of cardiovascular-related (1.13–1.29 for low active well density) and respiratory-related (1.07–1.19 for low active well density) outcomes with exposure to wells. Close to 100 countries produce oil and gas, making this a global issue. There is an important need for additional studies from other producing jurisdictions outside the United States.
Evaluating Exoskeletons for WMSD Prevention: A Systematic Review of Applications and Ergonomic Approach in Occupational Settings
Authors: Cardoso André , Ribeiro Andreia , Carneiro Paula , Colim Ana
Published: December 2024

This review provides a comprehensive analysis of studies investigating the impact of occupational exoskeletons on work-related musculoskeletal disorder (WMSD) risk factors. The primary objective is to examine the methodologies used to assess the effectiveness of these devices across various occupational tasks. A systematic review was conducted following the PRISMA guidelines, covering studies published between 2014 and 2024. A total of 49 studies were included, identified through searches conducted in Scopus and Web of Science databases, with the search string launched in August 2024. The review identifies a growing body of research on passive and active exoskeletons, with a notable focus on laboratory-based evaluations. The results indicate that direct measurement and self-report methods are the preferred approaches in these domains. Ergonomic limitations and user discomfort remain concerns in some cases. The findings of this review may influence stakeholders by providing insights into the potential benefits of adopting exoskeletons and improving workplace ergonomics to reduce WMSD risks. Additionally, the identification of WMSD assessment methods will be valuable for validating the use of these technologies in the workplace. The review concludes with recommendations for future research, emphasizing the need for more real-world assessments and improved exoskeleton designs to enhance user comfort and efficacy.
Encapsulating Spatially Varying Relationships with a Generalized Additive Model
Authors: Comber Alexis , Harris Paul , Murakami Daisuke , Nakaya Tomoki , Tsutsumida Narumasa , Yoshida Takahiro , Brunsdon Chris
Published: December 2024

This paper describes the use of Generalized Additive Models (GAMs) to create regression models whose coefficient estimates vary with geographic location—spatially varying coefficient (SVC) models. The approach uses Gaussian Process (GP) splines (smooths) for each predictor variable, which are parameterised with observation location in order to generate SVC estimates. These describe the spatially varying relationships between predictor and response variables. The proposed GAM approach was compared with Multiscale Geographically Weighted Regression (MGWR) using simulated data with complex spatial heterogeneities. The geographical GP GAM (GGP-GAM) was found to out-perform MGWR across a range of fit metrics and resulted in more accurate coefficient estimates and lower residual errors. One of the GGP-GAM models was investigated in detail to illustrate model diagnostics, checks of spline/smooth convergence and basis evaluations. A larger simulated case study was investigated to explore the trade-offs between GGP-GAM complexity (via the number of knots), performance and computational efficiency. Finally, the GGP-GAM and MGWR approaches were applied to an empirical case study. The resulting models had very similar accuracies and fits and generated subtly different spatially varying coefficient estimates. A number of areas of further work are identified.
Building an Indoor Digital Twin—A Use-Case for a Hospital Digital Twin to Analyze COVID-19 Transmission
Authors: Lee Youngin , Choi Min Hyeok , Song Yong-Soo , Lee Jun-Gi , Park Jin Young , Li Ki-Joune
Published: December 2024

As indoor space becomes more important in our daily life, the demand to build digital twins for indoor spaces is increasing accordingly. The properties of indoor spaces, however, differ from those of outdoor spaces, and we need to apply different approaches to build indoor digital twins. In our work, we propose a framework for building an indoor digital twin with a use case for hospitals in general and large hospitals in particular, which may be considered as one of the most complicated types of digital twin. One of our goals is to establish a framework for building indoor digital twins based on standards and our framework starts from OGC IndoorGML, which is a standard for indoor data models and encoding schemes for indoor spatial data. In this paper, each step of the framework is presented for the construction of an indoor hospital digital twin focusing on a use case of epidemic analysis of COVID-19 transmission in a hospital. The use case study covers the entire life cycle of the indoor spatial application from requirement analysis, data modeling, and building indoor spatial data to the development of a COVID-19 transmission analysis. Our work represents a use case for indoor digital twins based on the OGC IndoorGML standard and eventually may serve as a framework and reference for building indoor digital twins. As our work is mainly focused on the construction of hospital digital twins, the study on COVID-19 infection model itself is limited in this paper. Improvement of the infection models and validations will be the next step of our work. As HVAC (heat, ventilation, and air conditioning) was not fully considered in our use case, we also expect that it is possible to strengthen our use case by including HVAC for the analysis of airflow dynamics.
Correction: Hong et al. Anti-Proliferative and Pro-Apoptotic Effects of Licochalcone A through ROS-Mediated Cell Cycle Arrest and Apoptosis in Human Bladder Cancer Cells. Int. J. Mol. Sci. 2019, 20, 3820
Authors: Hong Su Hyun , Cha Hee-Jae , Hwang-Bo Hyun , Kim Min Yeong , Kim So Young , Ji Seon Yeong , Cheong JaeHun , Park Cheol , Lee Hyesook , Kim Gi-Young , Moon Sung-Kwon , Yun Seok Joong , Chang Young-Chae , Kim Wun-Jae , Choi Yung Hyun
Published: December 2024

In the original publication [...]
Growth Differentiation Factor 15 as a Marker for Chronic Ventricular Pacing
Authors: Edlinger Christoph , Bannehr Marwin , Lichtenauer Michael , Paar Vera , Jankowska Paulina , Hauptmann Laurenz , Hoppe Uta C. , Butter Christian , Schernthaner Christiana
Published: December 2024

Background/Objectives: Right ventricular pacing is an effective and safe treatment option for patients experiencing symptomatic bradycardia. However, some individuals may develop left ventricular dysfunction as a consequence. Growth differentiation factor 15 (GDF-15), which is not present in a healthy adult heart, is upregulated in cardiomyocytes in response to various stress stimuli. This study aimed to explore the potential of GDF-15 as a biomarker for chronic right ventricular pacing. Methods: This single-center cross-sectional cohort study analyzed data from 265 consecutive patients (60.4% male) with either single- or dual-chamber pacemakers, all lacking pre-existing heart failure, who attended the outpatient department for routine follow-up. Chronic right ventricular (RV) pacing was defined as pacing exceeding 40% over the past year. Serum samples were collected, and GDF-15 levels were measured using a commercially available immunoassay (R&D Systems Inc., Minneapolis, MN, USA). Student’s t-test was utilized to assess group differences, and receiver operating characteristic (ROC) analysis was employed to evaluate diagnostic performance. Results: When stratifying patients by pacing burden, GDF-15 levels were significantly higher in those with pacing over 40% compared to those with 40% or less (789 ± 293 pg/mL vs. 1186 ± 592 pg/mL; p < 0.001). The ROC analysis indicated that GDF-15 serves as a marker for chronic RV pacing, yielding an area under the curve of 0.713 (95% confidence interval 0.650–0.776; p < 0.001). Conclusions: This study suggests that GDF-15 may be a valuable biomarker for chronic right ventricular pacing.
The Influence of Anti-ETAR and Anti-CXCR3 Antibody Levels on the Course of Specific Glomerulonephritis Types
Authors: Szymczak Maciej , Heidecke Harald , Żabińska Marcelina , Janek Łucja , Wronowicz Jakub , Kujawa Krzysztof , Bukowiec-Marek Karolina , Gołębiowski Tomasz , Skalec Karolina , Schulze-Forster Kai , Konieczny Andrzej , Banasik Mirosław
Published: December 2024

Background: Anti-ETAR (endothelin A receptor) antibodies and anti-CXCR3 (C-X-C motif chemokine receptor 3) antibodies are types of non-HLA (human leukocyte antigens) antibodies that could have some influence on the course of glomerulonephritis. The authors aimed to study the influence of these antibodies’ levels on the course of specific glomerulonephritis types. Methods: We evaluated the anti-ETAR and anti-CXCR3 antibody levels in the serum of patients with membranous nephropathy (n = 18), focal and segmental glomerulosclerosis (FSGS) (n = 25), systemic lupus erythematosus (n = 17), IgA nephropathy (n = 14), mesangiocapillary glomerulonephritis (n = 6), anti-neutrophil cytoplasmic antibodies (c-ANCA) vasculitis (n = 40), and perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA) vasculitis (n = 16), and we compared their levels with the control group (n = 22). Next, we observed the patients’ clinical parameters (serum creatinine, albumin, total protein) for 2 years and checked the correlation of the clinical course markers with basic receptor antibody level. Results: Our results indicate lower anti-ETAR antibody levels in patients with FSGS and IgA nephropathy compared to the control group. Both types of antibodies correlated with creatinine levels after 2 years of observation in IgA nephropathy. Both types of antibodies seemed to negatively influence the total protein and albumin levels in systemic lupus erythematosus. Conclusions: This prospective observation showed that anti-ETAR and anti-CXCR 3 antibody levels are connected with the course of IgA nephropathy and lupus nephritis.
Deep Brain Stimulation Combined with NMDA Antagonist Therapy in the Treatment of Alzheimer’s Disease: In Silico Trials
Authors: Świetlik Dariusz
Published: December 2024

Background: Deep brain stimulation (DBS) is employed to adjust the activity of impaired brain circuits. The variability in clinical trial outcomes for treating Alzheimer’s disease with memantine is not yet fully understood. We conducted a randomized in silico study comparing virtual DBS therapies with treatment involving an NMDA antagonist combined with DBS in patients with Alzheimer’s disease. Methods: Neural network models representing Alzheimer’s disease (AD) patients were randomly assigned to four groups: AD, memantine treatment, DBS, and DBS and memantine. Out of 100 unique neural networks created to model moderate and severe AD with varying hippocampal synaptic loss, 20 were randomly selected to represent AD patients. Virtual treatments—memantine, DBS, and DBS and memantine—were applied, resulting in a total of 80 simulations. Results: The normalized mean number of spikes in the CA1 region among the virtual AD hippocampi treated with memantine, DBS therapy, and DBS and memantine differed significantly (p < 0.0001). The normalized mean number of spikes in the virtual AD hippocampi was 0.33 (95% CI, 0.29–0.36) and was significantly lower compared to the number of spikes in the virtual AD hippocampi treated with memantine, which was 0.53 (95% CI, 0.48–0.59) (p = 0.0162), and in the DBS and memantine group, which was 0.67 (95% CI, 0.57–0.78) (p = 0.0001). Conclusions: Our simulation results indicate the effectiveness of virtual memantine and DBS therapy compared to memantine monotherapy for Alzheimer’s disease.
Infectious Risk in Pediatric Emergency Departments in Italy: A Survey by the Italian Society for Pediatric Emergency and Urgent Medicine (SIMEUP) on Available Preventive and Diagnostic Tools
Authors: Bianchini Sonia , Formicola Stefania , Decembrino Lidia , Ladetto Laura , Pullano Maria Novella , Neglia Cosimo , Buonsenso Danilo , Zampogna Stefania , Esposito Susanna
Published: December 2024

Background/Objectives: The COVID-19 pandemic has emphasized the importance of preparedness in preventing the spread of infectious diseases, especially in Emergency Departments (EDs), where initial patient assessments and triage occur. This study aims to evaluate the current practices and available tools for infection control in Pediatric EDs across Italy, focusing on the differences between various hospital types and regional settings. Methods: A cross-sectional national survey was conducted in February 2022, targeting healthcare workers in Pediatric EDs across Italy. The survey, distributed via the Italian Society for Pediatric Emergency and Urgent Medicine (SIMEUP) mailing list, collected data on infection control measures, including the availability of hand hygiene stations, personal protective equipment, disinfection protocols, and the use of rapid diagnostic tests. Results: A total of 80 questionnaires were completed from 119 (67.2%) different ERs. The majority of respondents were from Northern Italy (47.5%) and worked in hospitals with 24 h pediatric assistance (48.8%). Less than half of non-pediatric hospitals had separate access for children, potentially exposing them to adult pathogens. Across all settings, basic infection control measures, such as providing masks and hand gel, were widely implemented. However, significant differences were observed in the availability of social distancing, informational materials, and dedicated pediatric pathways, with I level assistance hospitals less likely to have these resources. Rapid diagnostic tests were available in most settings, but the focus was predominantly on SARS-CoV-2, despite other respiratory pathogens’ relevance in pediatric care. Conclusions: Strengthening preparations for future pandemics will be crucial in enhancing the resilience of healthcare systems and ensuring the safety of both patients and healthcare workers in the face of emerging infectious threats.
Actions Taken by Bystanders During Sudden Cardiac Arrest: Analysis of Emergency Medical Service Documentation in Poland
Authors: Milewski Rafał , Lewko Jolanta , Milewska Gabriela , Baranowska Anna , Lankau Agnieszka , Orzechowska Magda , Krajewska-Kułak Elżbieta
Published: December 2024

Background/Objectives: Sudden cardiac arrest (SCA) is a severe medical condition involving the cessation of the heart’s mechanical activity. Following the chain of survival, which includes early recognition and calling for help, early initiation of cardiopulmonary resuscitation (CPR), early defibrillation, and post-resuscitation care, offers the greatest chances of saving a person who has experienced SCA. The aim of this study was to analyze cases of out-of-hospital cardiac arrest (OHCA) and assess the actions taken by bystanders. Methods: The input for analysis consisted of 49,649 dispatch records from the emergency medical team (EMT) at the Voivodeship Emergency Medical Station in Bialystok in 2018–2019. Results: Among the patients where bystanders performed CPR, the return of spontaneous circulation (ROSC) occurred in 30.53% of cases, whereas in the cases where the bystander did not perform CPR, ROSC occurred in 2.35% of cases. When cardiac arrest rhythm was ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT), ROSC occurred in 58.62% of cases, while there was asystole or pulseless electrical activity (PEA) present, ROSC occurred in 26.56% of cases. In patients who experienced OHCA in a VF/pVT rhythm and who underwent intubation, ROSC occurred in 58.73% of cases, whereas in patients who underwent alternative procedures for airway management, ROSC occurred in 83.33% of cases. Conclusions: The most significant factor influencing the occurrence of ROSC in patients is CPR initiation by bystanders. The presence of a rhythm that requires defibrillation increases the likelihood of achieving ROSC in the patient. Alternative methods for airway management appear to be more beneficial in VF/pVT rhythms.
Toe Separators as a Therapeutic Tool in Physiotherapy—A Systematic Review
Authors: Krześniak Hanna , Truszczyńska-Baszak Aleksandra
Published: December 2024

Background: Deformities of the foot represent a significant clinical problem. Toe separators constitute an available tool used in various forms of conservative treatment, primarily used for the correction of hallux valgus, but also for improvement in the condition of neurological patients, e.g., after a stroke, or to treat dermatological problems. The goal of this systematic review is to critically assess the current scientific literature on the application of toe separators as a therapeutic intervention in physiotherapy. Methods: A systematic search was conducted across several electronic databases, such as PubMed, Science Direct, and Web of Science. The review included randomized controlled trials, quasi-experimental studies, and observational studies that explored the use of toe separators in physiotherapeutic interventions. Two independent reviewers evaluated all search results to determine eligible studies and assess their methodological quality. Results: A total of 1020 studies were found through the database search. Out of these, 10 studies met the inclusion criteria and were incorporated into the review. The sample sizes of the selected studies varied from 9 to 90 participants. In the majority of the studies, the methodological quality was not mentioned, and a frequent lack of information was noted. Based on a literature analysis, separators were primarily used as a tool for the correction of hallux valgus, but there are also promising results for use in neurology and dermatology as well as affecting the lower leg muscles during gait. Conclusions: The use of toe separators can be a valuable tool for the conservative treatment of hallux valgus and the associated deformities. The research so far varies in describing the type, material, and method of the application of the separators. Studies showed a variety of applications as well as variation in the use of materials. Further research is needed to establish the effectiveness of toe separators in foot disorders more precisely.
Skeletal Muscle Mass Loss Leads to Prolonged Mechanical Ventilation and Higher Tracheotomy Rates in Critically Ill Patients
Authors: Allgayer Gabriel M. , Ulm Bernhard , Sauter Andreas P. , Schaller Stefan J. , Blobner Manfred , Fuest Kristina E.
Published: December 2024

Background: Skeletal muscle mass depletion adversely affects critically ill patient outcomes. Standardized methods for assessing muscle mass in this population are limited, particularly regarding changes during ICU stays and their implications for risk stratification. Methods: In this secondary analysis of our prospective data registry of surgical ICU patients, we used a single slice extracted from a computed tomography scan to determine the patient’s direction of absolute change in skeletal muscle mass between two different time points (−14 d to +0 d and +5 d to +21 d) during his or her critical illness. Results: In total, 98 surgical patients were included in the final analysis. A decrease in a patient’s skeletal muscle mass is associated with prolonged mechanical ventilation compared to patients whose skeletal muscle mass remained the same or increased (415 vs. 42 h, p = 0.003). Patients losing skeletal muscle mass also needed to be ventilated more frequently (88.3% vs. 60.5%, p = 0.002), had a higher rate of tracheotomy (50.0% vs. 23.7%, p = 0.011), and had an increased ICU length of stay (22 vs. 13 days, p = 0.045). Conclusions: A decreased skeletal muscle index in early critical illness negatively impacts ventilation parameters, highlighting the importance of monitoring and managing muscle mass changes to optimize outcomes in ICU patients.
Near-Infrared Spectroscopy Allows for Monitoring of Bone Fracture Healing via Changes in Oxygenation
Authors: Nowicki Cedric , Ganse Bergita
Published: December 2024

Bone fractures are associated with hypoxia, but no longitudinal studies of perfusion measurements in human patients have been reported despite the clinical and research potential. In this longitudinal observational cohort study, the near-infrared spectroscopy (NIRS) device PortaMon was used to assess oxy-(O2Hb), deoxy-(HHb) and total (tHb) haemoglobin, as well as the differences between O2Hb and HHb (HbDiff) and the tissue saturation index (TSI) at three different depths in the fracture gap. Linear mixed effect models were fitted to analyse time effects. One-way ANOVAs were conducted to compare groups. The time points corresponding to minima were calculated via linear regression. In this study, 11 patients with tibial shaft fractures underwent longitudinal measurements. Additionally, 9 patients with diagnosed tibial shaft nonunion and 23 age-matched controls were measured once. In the longitudinal group, all fractures healed, and decreases in O2Hb and HbDiff (all p < 0.05) were observed, with minima occurring 19–21 days after fracture. O2Hb values in nonunion patients did not differ from the minima in longitudinally measured union patients, whereas differences in HHb and tHb were significant (all p < 0.05). Previously, the onset of hypoxia has been assumed to be much faster. The characteristic trajectories of the NIRS parameters O2Hb and HbDiff can be used to fulfil the need for a non-invasive method to monitor fracture healing. These results suggest that NIRS could supplement radiographs and clinical impressions in daily clinical practice and may enable earlier diagnosis of nonunion.
Expanding IMO Compendium with NAVTEX Messages for Maritime Single Window
Authors: Lee Changui , Lee Seojeong
Published: December 2024

The International Maritime Organization (IMO) introduced the Maritime Service Portfolio (MSP) and Maritime Single Window (MSW) to enhance the digitalization and efficiency of maritime transportation. While the MSP defines 16 maritime services focused on safety, security, efficiency, and environmental protection, the MSW provides a unified digital platform for submitting and processing information related to a ship’s operations. To support the implementation of MSW, the IMO Compendium provides standardized data sets and reference models to enable seamless information exchange across maritime systems. This paper proposes an expansion of the IMO Compendium to integrate the MSP’s maritime safety information service into the MSW environment. The study focuses on the integration of NAVTEX messages, a key source of navigational safety information, by identifying their key attributes and structuring them according to the IHO S-124 standard. A case study demonstrates the feasibility of the proposed data structure by transforming a sample NAVTEX message into the expanded IMO Compendium format and testing its transmission using an open-source MQTT library. This paper provides a structured methodology for integrating NAVTEX messages, effectively bridging legacy systems with modern digital infrastructures and facilitating enhanced interoperability in maritime operations. The proposed data structure will be presented to standardization bodies for further consideration, contributing to ongoing efforts to improve maritime operational efficiency and support digital transformation.
Uric Acid Correlates with Serum Levels of Mineral Bone Metabolism and Inflammation Biomarkers in Patients with Stage 3a–5 Chronic Kidney Disease
Authors: Mendoza Carrera Francisco , Vázquez Rivera Gloria Elizabeth , Leal Cortés Caridad A. , Rizo De la Torre Lourdes del Carmen , Parra Michel Renato , Orozco Sandoval Rosalba , Pérez Coria Mariana
Published: December 2024

Background and Objectives: Uric acid (UA) and the markers of mineral bone metabolism and inflammation are commonly altered in patients with chronic kidney disease (CKD) and are associated with the risk of cardiovascular complications and death. Studies point to a link between high serum UA and mineral bone homeostasis and inflammation, but controversy remains. The aim of this study was to evaluate the relationship between UA levels and mineral bone metabolism and inflammation biomarkers in a sample of Mexican patients with CKD 3a–5. Materials and Methods: This cross-sectional study included 146 Mexican patients with CKD 3a–5. In addition, 25 healthy subjects were included in the study with the aim of generating reference data for comparisons. Metabolic parameters including UA serum concentrations, mineral bone metabolism (parathormone (PTH), fibroblast growth factor 23 (FGF23), calcium, and phosphate), and inflammation (interleukin (IL)-1β, IL-6, and tumor necrosis factor-alpha (TNF-α)) biomarkers were measured in all of the samples and compared as a function of the estimated glomerular function rate (eGFR) or UA levels. Results: Intact PTH, FGF23, and cytokines were higher in advanced CKD stages. Patients with hyperuricemia had significantly higher values of FGF23 and TNF-α compared with those without hyperuricemia. The eGFR was found to be significantly and negatively correlated with all markers. Uric acid was significantly correlated with phosphate, iPTH, FGF23, and TNF-α, whereas iPTH was significantly correlated with FGF23, TNF-α, and FGF23. Finally, a multivariate analysis confirmed the relationship of eGFR with all the tested biomarkers, as well as other relationships of iPTH with UA and TNF-α and of FGF23 with UA and TNF-α. Conclusions: This study supports the relationship between uric acid and levels of mineral bone metabolism and inflammation biomarkers in patients with CKD at middle to advanced stages. In the follow-up of patients with CKD, monitoring and controlling UA levels through nutritional or pharmacological interventions could help in the prevention of alterations related to mineral bone metabolism.
A Novel Reconstruction Approach After Skin Cancer Ablation Using Lateral Arm Free Flap: A Serial Case Report
Authors: Jung Soyeon , Lee Seungjun , Eun Seokchan
Published: December 2024

Background and Objectives: The lateral arm flap has been a very useful choice for the reconstruction of small to medium-sized defects, such as in the hands, extremities, and oral head and neck area. Its versatile characteristics and surgical feasibility allow this flap to be widely applied, but its reconstructive potential in the facial subunit after tumor ablation procedures has never been reported. In this study, we aimed to utilize the advantages of this flap to carry out facial temple subunit defect reconstruction. Materials and Methods: Between 2020 and 2023, 12 patients underwent temple reconstruction with lateral arm free flaps after wide malignant tumor excisions. There were seven women and five men, and the mean patient age was 60.6 years. Among the patients with cancer, six had squamous cell carcinoma, five had basal cell carcinoma, and one had myxofibrosarcoma. All flaps were elevated under general anesthesia. Alprostadil (PGE1, Eglandin®, Mitsubishi Tanabe Korea, Seoul, Republic of Korea) was administered postoperatively. Results: All flaps were the fasciocutaneous type, with sizes that varied from 3 cm × 4 cm to 5 cm × 7 cm (average size: 22.7 cm2). The average pedicle length was 6.1 cm. The versatility of the lateral arm flap enabled successful coverage in all cases, with no specific complications. Good functional outcomes and good ranges of motion in the donor arms were observed after surgery. Conclusions: The authors successfully verified the advantages of lateral arm flaps in the treatment of medium-sized facial temple subunit defects.
Temporal Trends and Identification of Suicide Mortality Risk Areas in Brazil (2000–2022): Are We Dealing with an Underestimated Epidemic?
Authors: Souza Danilo de Gois , Andrade Lucas Almeida , Góes José Augusto Passos , Melo Luís Ricardo Santos de , Melo Matheus Santos , Ribeiro Caíque Jordan Nunes , Santos José Marcos de Jesus , Camargo Emerson Lucas Silva , de Sousa Álvaro Francisco Lopes , Carneiro Liliane Moretti , Souza Regina Claudia da Silva , Santos Márcio Bezerra , Lima Shirley Veronica Melo Almeida , Ventura Carla Aparecida Arena , dos Santos Allan Dantas
Published: December 2024

Background and Objectives: Suicide is a pressing public health issue globally, including in Brazil, where it ranks among the leading causes of mortality. This study aimed to analyze the spatial, temporal, and spatiotemporal distribution of suicide mortality in Brazil from 2000 to 2022. Materials and Methods: Using secondary data from the Mortality Information System of Brazil’s 5570 municipalities, an ecological study of time series was conducted. Segmented linear regression (Joinpoint 4.6 version) was used to calculate temporal trends, while Moran’s indices were employed to analyze spatial autocorrelations. Retrospective scanning was utilized to investigate spatiotemporal clusters, and choropleth maps were developed to visualize high-risk areas. Results: The analysis revealed the occurrence of 240,843 suicides in Brazil, with higher percentages in the southeast, south, and northeast regions. The south, central–west, and southeast regions exhibited the highest mortality rates, predominantly among white, single men, aged 20 to 59, with 1 to 11 years of schooling. Intentional self-harm by hanging, strangulation, and suffocation was the main cause. The general trend of mortality due to suicide in Brazil was increasing (AAPC: 2.9; CI 95%: 2.6 to 3.0), with emphasis on the age groups from 10 to 19 years (AAPC: 3.7; CI 95%: 2.9 to 4.5) and 20–39 years old (AAPC: 2.9; CI 95%: 2.3 to 3.5). The brutal and smoothed rates revealed areas of high mortality in the south, north, and central–west regions. Conclusions: The findings of this study highlight the need to direct resources and efforts to the south and midwest regions of Brazil, where suicide rates are the highest. Additionally, implementing targeted prevention programs for young men, who are the most affected, is essential to reduce suicide mortality in these areas.
Prognostic Value of Neutrophil, Monocyte, Lymphocyte, and Platelet/High-Density Lipoprotein Ratios in Ischemic Heart Disease: An NHANES Analysis
Authors: Wu Chia-Chen , Wu Chia-Hui , Lee Chien-Ho , Chen Tien-Yu , Cheng Cheng-I
Published: December 2024

The prognostic value of easily accessible hematologic biomarkers, such as the neutrophil-to-HDL ratio, as well as the monocyte-to-HDL, lymphocyte-to-HDL, and platelet-to-HDL ratios, remains underexplored in patients with established ischemic heart disease (IHD). Community-dwelling adults aged ≥ 20 with established IHD from the National Health and Nutrition Examination Survey (NHANES) 1999–2018 were eligible. Mortality was tracked through linkage to the National Death Index (NDI) until the end of 2019. Cox regressions examined the associations between these hematologic ratios and all-cause mortality. Receiver operating characteristic (ROC) curve analysis assessed the predictive accuracy of these ratios for mortality. A total of 2265 patients were analyzed, with a median follow-up period of 80 months. After adjusting for demographic factors, lifestyle variables, and comorbidities, patients in the highest quartile of the neutrophil/HDL had a significantly increased all-cause mortality risk (aHR = 1.41, 95% CI: 1.13–1.77) compared to those in the lowest quartile. No significant associations were found between the other ratios and mortality. In conclusion, this study found that among the hematologic ratios analyzed, an elevated neutrophil-to-HDL ratio has the strongest potential for mortality risk stratification in community-dwelling patients with ischemic heart disease in the US, offering important guidance for both patients and clinicians.