bluuebunny/crossref_metadata_2025 huggingface dataset:
Immunometabolic Profiling of Chronic Subdural Hematoma through Untargeted Mass Spectrometry Analysis: Preliminary Findings of a Novel Approach
Authors: Kipele Maria , Buchfelder Michael , Taudte R. Verena , Stadlbauer Andreas , Kinfe Thomas , Bozhkov Yavor
Published: October 2023

Objective: Metabolomics has growing importance in the research of inflammatory processes. Chronic subdural hematoma (cSDH) is considered to be, at least in part, of inflammatory nature, but no metabolic analyses yet exist. Therefore, a mass spectrometry untargeted metabolic analysis was performed on hematoma samples from patients with cSDH. Methods: A prospective analytical cross-sectional study on the efficacy of subperiosteal drains in cSDH was performed. Newly diagnosed patients had the option of granting permission for the collection of a hematoma sample upon its removal. The samples were analyzed using liquid chromatography–mass spectrometry to obtain different types of metabolites from diverse biochemical classes. The statistical analysis included data cleaning, imputation, and log transformation, followed by PCA, PLS-DA, HCA, and ANOVA. The postoperative course of the disease was followed for 3 months. The metabolite concentrations in the hematoma fluid were compared based on whether a recurrence of the disease was recorded within this time frame. Results: Fifty-nine samples from patients who were operated on because of a cSDH were gathered. Among those, 8 samples were eliminated because of missing metabolites, and only 51 samples were analyzed further. Additionally, 39 samples were from patients who showed no recurrence over the course of a 3-month follow-up, and 12 samples were from a group with later recurrence. We recorded a noticeable drop (35%) in the concentration of acylcarnitines in the ”recurrence group“, where 10 of the 22 tested metabolites showed a significant reduction (p < 0.05). Furthermore, a noticeable reduction in different Acyl-CoA-dehydrogenases was detected (VLCAD-deficiency p < 0.05, MCAD-deficiency p = 0.07). No further changes were detected between both populations. Conclusions: The current study presents a new approach to the research of cSDH. The measurements presented us with new data, which, to date, are without any reference values. Therefore, it is difficult to interpret the information, and our conclusions should be considered to be only speculative. The results do, however, point in the direction of impaired fatty acid oxidation for cases with later recurrence. As fatty acid oxidation plays an important role in inflammatory energy metabolism, the results suggest that inflammatory processes could be aggravated in cases with recurrence. Because our findings are neither proven through further analyses nor offer an obvious therapy option, their implications would not change everyday practice in the management of cSDH. They do, however, present a further possibility of research that might, in the future, be relevant to the therapy.
Can Perfusion-Based Brain Tissue Oxygenation MRI Support the Understanding of Cerebral Abscesses In Vivo?
Authors: Knott Michael , Hoelter Philip , Soder Liam , Schlaffer Sven , Hoffmanns Sophia , Lang Roland , Doerfler Arnd , Schmidt Manuel Alexander
Published: October 2023

Purpose: The clinical condition of a brain abscess is a potentially life-threatening disease. The combination of MRI-based imaging, surgical therapy and microbiological analysis is critical for the treatment and convalescence of the individual patient. The aim of this study was to evaluate brain tissue oxygenation measured with dynamic susceptibility contrast perfusion weighted imaging (DSC-PWI) in patients with brain abscess and its potential benefit for a better understanding of the environment in and around brain abscesses. Methods: Using a local database, 34 patients (with 45 abscesses) with brain abscesses treated between January 2013 and March 2021 were retrospectively included in this study. DSC-PWI imaging and microbiological work-up were key inclusion criteria. These data were analysed regarding a correlation between DSC-PWI and microbiological result by quantifying brain tissue oxygenation in the abscess itself, the abscess capsula and the surrounding oedema and by using six different parameters (CBF, CBV, CMRO2, COV, CTH and OEF). Results: Relative cerebral blood flow (0.335 [0.18–0.613] vs. 0.81 [0.49–1.08], p = 0.015), relative cerebral blood volume (0.44 [0.203–0.72] vs. 0.87 [0.67–1.2], p = 0.018) and regional cerebral metabolic rate for oxygen (0.37 [0.208–0.695] vs. 0.82 [0.55–1.19], p = 0.022) were significantly lower in the oedema around abscesses without microbiological evidence of a specific bacteria in comparison with microbiological positive lesions. Conclusions: The results of this study indicate a relationship between brain tissue oxygenation status in DSC-PWI and microbiological/inflammatory status. These results may help to better understand the in vivo environment of brain abscesses and support future therapeutic decisions.
Digitalized Control Algorithm of Bridgeless Totem-Pole PFC with a Simple Control Structure Based on the Phase Angle
Authors: Lee Gi-Young , Park Hae-Chan , Ji Min-Woo , Kim Rae-Young
Published: October 2023

Compared to the conventional boost power factor correction (PFC) converter, a totem-pole bridgeless PFC has high efficiency because it does not have an input diode rectifier stage, but a current spike may occur when the polarity of the grid voltage changes. This paper proposes a digital control algorithm for bridgeless totem-pole PFC with a simple control structure based on the phase angle of grid voltage. The proposed algorithm has a PI-based double-loop control structure and performs DC-link voltage and input inductor current control. Rectifying switches operate based on the proposed rectification algorithm using phase angle information calculated through a single-phase phase-locked loop (PLL) to prevent current spikes. The feed-forward duty ratio value is calculated according to the polarity of the grid voltage and added to the double-loop controller to perform appropriate power factor control. The performance and feasibility of the proposed control algorithm are verified through a 3 kW hardware prototype.
General Overview and Proof of Concept of a Smart Home Energy Management System Architecture
Authors: Motta Lucas L. , Ferreira Luiz C. B. C. , Cabral Thales W. , Lemes Dimas A. M. , Cardoso Gustavo dos S. , Borchardt Andreza , Cardieri Paulo , Fraidenraich Gustavo , de Lima Eduardo R. , Neto Fernando B. , Meloni Luís G. P.
Published: October 2023

This paper proposes and implements a smart architecture for Home Energy Management Systems (HEMS) that enables interoperability among devices from different manufacturers. This is achieved through the use of standardized elements and the design of an innovative middleware. The system comprises a control unit that communicates with smart outlets using the Wireless Smart Ubiquitous Network (WI-SUN) Home Area Network (HAN) specification, while smart metering is achieved using the WI-SUN Field Area Network (FAN) specification. To manage important data, a web platform and mobile app were created. Additionally, machine learning techniques are utilized to identify energy consumption of individual appliances when only the aggregate energy consumption of the house is available. The architecture presented here supports real-time control of energy use and generation through HEMS, and new devices can be added transparently. Finally, a comparison of the proposed system with similar systems in literature highlights its many advantages in terms of functionality.
Efficient Difficulty Level Balancing in Match-3 Puzzle Games: A Comparative Study of Proximal Policy Optimization and Soft Actor-Critic Algorithms
Authors: Kim Byounggwon , Kim Jungyoon
Published: October 2023

Match-3 puzzle games have garnered significant popularity across all age groups due to their simplicity, non-violent nature, and concise gameplay. However, the development of captivating and well-balanced stages in match-3 puzzle games remains a challenging task for game developers. This study aims to identify the optimal algorithm for reinforcement learning to streamline the level balancing verification process in match-3 games by comparison with Soft Actor-Critic (SAC) and Proximal Policy Optimization (PPO) algorithms. By training the agent with these two algorithms, the paper investigated which approach yields more efficient and effective difficulty level balancing test results. After the comparative analysis of cumulative rewards and entropy, the findings illustrate that the SAC algorithm is the optimal choice for creating an efficient agent capable of handling difficulty level balancing for stages in a match-3 puzzle game. This is because the superior learning performance and higher stability demonstrated by the SAC algorithm are more important in terms of stage difficulty balancing in match-3 gameplay. This study expects to contribute to the development of improved level balancing techniques in match-3 puzzle games besides enhancing the overall gaming experience for players.
Enhancing Swarm Intelligence for Obstacle Avoidance with Multi-Strategy and Improved Dung Beetle Optimization Algorithm in Mobile Robot Navigation
Authors: Li Longhai , Liu Lili , Shao Yuxuan , Zhang Xu , Chen Yue , Guo Ce , Nian Heng
Published: October 2023

The Dung Beetle Optimization (DBO) algorithm is a powerful metaheuristic algorithm that is widely used for optimization problems. However, the DBO algorithm has limitations in balancing global exploration and local exploitation capabilities, often leading to getting stuck in local optima. To overcome these limitations and address global optimization problems, this study introduces the Multi-Strategy and Improved DBO (MSIDBO) Algorithm. The MSIDBO algorithm incorporates several advanced computational techniques to enhance its performance. Firstly, it introduces a random reverse learning strategy to improve population diversity and mitigate early convergence or local stagnation issues present in the DBO algorithm. Additionally, a fitness-distance balancing strategy is employed to better manage the trade-off between diversity and convergence within the population. Furthermore, the algorithm utilizes a spiral foraging strategy to enhance precision, promote strong exploratory capabilities, and prevent being trapped in local optima. To further enhance the global search ability and particle utilization of the MSIDBO algorithm, it combines the Optimal Dimension-Wise Gaussian Mutation strategy. By minimizing premature convergence, population diversity is increased, and the convergence of the algorithm is accelerated. This expansion of the search space reduces the likelihood of being trapped in local optima during the evolutionary process. To demonstrate the effectiveness of the MSIDBO algorithm, extensive experiments are conducted using benchmark test functions, comparing its performance against other well-known metaheuristic algorithms. The results highlight the feasibility and superiority of MSIDBO in solving optimization problems. Moreover, the MSIDBO algorithm is applied to path planning simulation experiments to showcase its practical application potential. A comparison with the DBO algorithm shows that MSIDBO generates shorter and faster paths, effectively addressing real-world application problems.
Unsupervised Multiview Fuzzy C-Means Clustering Algorithm
Authors: Hussain Ishtiaq , Sinaga Kristina P. , Yang Miin-Shen
Published: October 2023

The rapid development in information technology makes it easier to collect vast numbers of data through the cloud, internet and other sources of information. Multiview clustering is a significant way for clustering multiview data that may come from multiple ways. The fuzzy c-means (FCM) algorithm for clustering (single-view) datasets was extended to process multiview datasets in the literature, called the multiview FCM (MV-FCM). However, most of the MV-FCM clustering algorithms and their extensions in the literature need prior information about the number of clusters and are also highly influenced by initializations. In this paper, we propose a novel MV-FCM clustering algorithm with an unsupervised learning framework, called the unsupervised MV-FCM (U-MV-FCM), such that it can search an optimal number of clusters during the iteration process of the algorithm without giving the number of clusters a priori. It is also free of initializations and parameter selection. We then use three synthetic and six benchmark datasets to make comparisons between the proposed U-MV-FCM and other existing algorithms and to highlight its practical implications. The experimental results show that our proposed U-MV-FCM algorithm is superior and more useful for clustering multiview datasets.
Effects of Chemical Soil Characteristics, Air Temperature and Precipitation on Pinus pinea Growth in Southern Inland Portugal
Authors: Gonçalves Ana Cristina , Alexandre Carlos , Andrade José , Pires Rita
Published: October 2023

Pinus pinea is widely distributed in the Mediterranean basin. In Portugal, it is predominantly located in the southwestern coastal area. Yet, there are also forest areas of Pinus pinea in inland southern Portugal. Four plots were settled to study the effects of soil chemical characteristics, air temperature and precipitation on Pinus pinea growth. In these plots, stand structure, soil texture, soil organic matter, soil content on macronutrients and micronutrients, air temperature and precipitation were analysed. The results indicate that the greatest growth was achieved in the plots with good availability of nutrients and the highest precipitation, whereas the lowest growth was observed in the plots with the lowest precipitation. There seems to be a trend toward the main limiting factor to Pinus pinea growth being the availability of water.
Individual Tree Height Increment Model for Quercus mongolica Secondary Forest in the Northeastern China Using Generalized Nonlinear Two-Level Mixed-Effects Model
Authors: Hu Xuefan , Jin Yingshan , Zhang Xiaohong , Zhang Huiru
Published: October 2023

(1) Background: Mongolian oak secondary forest is widely distributed in the northeast of China, and most of these forests are formed after the overcutting of broad-leaved Pinus koraiensis mixed forest. Most of the forest productivity is low and the ecological function is degraded, due to insufficient understanding of Mongolian oak and lack of scientific management. Deepening the research on exploring reasonable management measures of Mongolian oak secondary forest to an improved stand status is the basis for improving its quality and promoting its forward succession process. (2) Methods: Twelve permanent plots with an area of 1 ha were established in the Mongolian oak secondary forest on Tazigou forest farm in Wangqing, Jilin Province of northeastern China. The response of tree height increment of Mongolian oak secondary forest is studied based on the survey data of 2013 and 2018. Two-level nonlinear mixed-effects models were constructed to predict the height of a single tree using sample plots and tree species as random effects, combined with a variety of tree size factors, site factors, and competitive factors as independent variables. (3) Results: The significant factors related to the height increment of Mongolian oak secondary forest are the initial diameter at breast height as the size of the tree itself (DBH), height (H), crown height ratio (CR), and site productivity index reflecting site quality (SPI). The distance-dependent and distance-independent competition indexes have no significant effect on tree height increment. The fitting accuracy of the two-level mixed-effects model that introduces plots and tree species as random effects has been greatly improved (coefficient of determination R2 increased by 51.8%). The prediction results show that the two trees with the largest DBH have the strongest prediction ability. (4) Conclusions: The generalized nonlinear two-level mixed-effects model constructed in this study can describe the height increment of an individual tree in the Mongolian oak secondary forest. Two sample trees, namely the two largest trees in each sub-plot, were applied for estimating the random effects when both measurement cost and potential errors of prediction were balanced.
Divergent Responses of Temperature Sensitivity to Rising Incubation Temperature in Warmed and Un-Warmed Soil: A Mesocosm Experiment from a Subtropical Plantation
Authors: Zheng Yong , Yang Zhijie , Zhou Jiacong , Zheng Wei , Chen Shidong , Lin Weisheng , Xiong Decheng , Xu Chao , Liu Xiaofei , Yang Yusheng
Published: October 2023

We conducted a short-term laboratory soil warming incubation experiment, sampling both warmed and un-warmed soils from a subtropical plantation in southeastern China, incubating them at 20 °C, 30 °C, and 40 °C. Our aim was to study the SOC mineralization response to increasing temperatures. Our findings revealed that the temperature sensitivity (Q10) of SOC mineralization to short-term experimental warming varied between the warmed soil and the un-warmed soil. The Q10 of the un-warmed soil escalated with the temperature treatment (20–30 °C: 1.31, 30–40 °C: 1.63). Conversely, the Q10 of the warmed soil decreased (20–30 °C: 1.57, 30–40 °C: 1.41). Increasing temperature treatments decreased soil substrate availability (dissolved organic C) in both un-warmed and warmed soil. The C-degrading enzyme in un-warmed soil and warmed soil had different trends at different temperatures. In addition, warming decreased soil microbial biomass, resulting in a decrease in the total amount of phospholipid fatty acids (PLFAs) and a decrease in the abundance of fungi and Gram-negative bacteria (GN) in both un-warmed and warmed soil. The ratio of fungal to bacterial biomass (F:B) in un-warming soil was significantly higher than that in warmed soil. A drop in the microbial quotient (qMBC) coupled with a rise in the metabolic quotient (qCO2) indicated that warming amplified microbial respiration over microbial growth. The differential Q10 of SOC mineralization in un-warmed and warmed soil, in response to temperature across varying soil, can primarily be attributed to shifts in soil dissolved organic C (DOC), alterations in C-degrading enzyme activities, and modifications in microbial communities (F:B).
The Relationship between Complement Components C1R and C5 Gene Polymorphism and the Values of Blood Indices in Suckling Piglets
Authors: Szymańska Hanna , Dzika Ewa , Zabolewicz Tadeusz Jarosław , Życzko Krystyna
Published: October 2023

The main mechanism of innate immunity is the complement system. Its components include the protein products of the C1R and C5 genes, which are involved in the classical activation pathway as well as the inflammatory and cytolytic immune responses, respectively. The aim of this study was to determine the relationship between PCR-restriction fragment length polymorphism in C1R (726T > C) and C5 (1044A > C) genes, and the values of hematological and biochemical blood indices in suckling crossbred (Polish Large White × Polish Landrace × Duroc × Pietrain) piglets (n = 473), considering their age (younger, 21 ± 3 days, n = 274; older, 35 ± 3 days, n = 199) and health status. The frequencies of the C5 genotypes deviated from the Hardy–Weinberg expectations. Younger piglets, healthy piglets, piglets that deviated from physiological norms and older piglets with the C1R TT genotype all had lower white and red blood cell indices. In piglets with the C5 CC genotype, younger piglets, piglets that deviated from physiological norms and older piglets, a greater number and/or percentage of monocytes were recorded in the blood. Older piglets also showed an increase in the number of leukocytes and granulocytes, along with a tendency for a decrease in the percentage of lymphocytes in their blood. We concluded that a polymorphism in the C1R gene may exhibit a functional association or genetic linkage with other genes involved in the process of erythropoiesis. Furthermore the relationship between the C5 gene polymorphism and the number and/or percentage of monocytes in the blood may modify the body’s defense abilities. Piglets with the CC genotype, having an increased number/proportion of these cells in their blood, probably display a weakened immune response to pathogens or a chronic stimulation of the immune system.
Geodetic Applications and Improvement of the X- and L-Method of Deformation Analysis
Authors: Ambrožič Tomaž , Turk Goran , Marjetič Aleš
Published: October 2023

Monitoring displacements of the object can be performed using geodetic methods by selecting reference points on the surrounding terrain and points on the object that discretely describe the object’s behavior. The measurements are repeated in several epochs. By analyzing the geodetic network we can determine the status of a single point, i.e., whether the point has moved or not. The article discusses the testing of congruence, the testing of transformation of a single triangle, and the calculation of other deformation parameters in 2D networks resulting from the changes of points coordinates between two epochs. This is essentially the content of the Munich deformation method presented by W.M. Welsch, which includes the X- and L-method. The article also proposes some corrections to the original Munich approach. Finally, the applicability of the method is shown on a well-known practical example.
Is the Mesochori Fault a Key Structure for Understanding the Earthquake Activity during the 2021 Damasi Earthquakes in Northern Thessaly, Greece?
Authors: Koukouvelas Ioannis K. , Caputo Riccardo , Nikolakopoulos Konstantinos G. , Kyriou Aggeliki , Famiglietti Nicola Angelo
Published: October 2023

On 3 March 2021, an important seismic sequence started in northern Thessaly, Greece. The Damasi Seismic Sequence (DSS) deformed the western sector of the Tyrnavos Graben, which includes a major blind normal fault and the Titarisios River Graben (TRG). In this contribution, we provide fieldwork observations across the TRG and satellite radar interferometry of the faults controlling the graben. In addition, we provide a map of the active faults exposed in the TRG and palaeoseismological analyses of the Mesochori Fault, which together contribute to unravelling the seismic history of the area. DInSAR provides clear evidence of the Mesochori Fault surface rupture during the main shocks, while our palaeoseismological analyses document a long seismic history of the fault, with a mean recurrence interval of 1.0–1.5 ka and a mean slip per event of ~15 cm for the last four events reactivating the scarp. Quantitative geomorphological analyses based on real-time kinematic (RTK) measurements with global navigation satellite system (GNSS) receivers and data from UAV flight campaigns also provide evidence of postseismic activity across the Mesochori Fault. Based on these results showing that (at least) the Mesochori Fault has been reactivated several times in the latest Quaternary the seismotectonics of the TRG are discussed.
A Portrait of the Rights of Children with Disabilities in Nigeria: A Policy Review
Authors: Elekanachi Rose Uzoma , Shikako Keiko , Snider Laurie , Dahan-Oliel Noemi
Published: October 2023

Worldwide, 200 million children experience disability, with the vast majority living in low- and middle-income countries. The United Nations Convention on the Rights of the Child (CRC) places great importance on the rights of all children for the opportunities for survival, growth, health, and development. A subsequent document, the UN Convention on the Rights of Persons with Disabilities (CRPD), identifies children with disabilities as rights bearers who should be considered in all policies and programming worldwide. Nigeria, in 1991 and 2010, ratified the CRC and the CRPD, respectively. Nonetheless, knowledge of the extent to which their disability and child-directed policies considers these two key conventions, in ensuring that children and children with disabilities have access to care within their right remains limited. This study examined the extent to which Nigeria’s current disability and childhood policies have integrated the two child and disability related conventions from the UN. Using a structured search of databases and Nigerian federal and state government websites, we conducted a policy review to identify their disability and child-related disability policies. We also included the CRC and CRPD reports submitted by the Nigerian government to the United Nations Office of the High Commissioner for Human Rights (OHCHR) (2008 and 2010 cyclical year). A thematic analysis, based on the CRC and CRPD report, identified the following six themes: participation, support systems, awareness raising, factors associated with adherence to the CRC, laws and rights, and services. The review showed that the available Nigerian disability policies were federal, with some state policies which aligned with the CRC and CRPD. Also identified was the lack of disability policies specific to children and their families. We concluded that, to ensure proper inclusion of the rights of all children, including those with disabilities, in Nigeria there is a need for a more optimal uptake of recommendations of the CRC and CRPD as laid out by the UN.
Understanding HPV Vaccination Policymaking in Rwanda: A Case of Health Prioritization and Public-Private-Partnership in a Low-Resource Setting
Authors: Asempah Eric , Wiktorowicz Mary E.
Published: October 2023

Rwanda is the first African country to implement a national HPV vaccination program in 2011. This study sought to clarify the HPV vaccination policymaking process in Rwanda through the lens of Kingdon’s multiple stream framework and Foucault’s concept of governmentality. Perspectives of policymakers engaged in HPV vaccination policy were gathered from published sources, along with key informant interviews. Rwanda’s track record of successful vaccination programs enabled by a culture of local accountability created public and private sector incentives. Effective stakeholder engagement, health priority setting, and resource mobilization garnered locally and through international development aid, reflect indicators of policy success. The national HPV policymaking process in Rwanda unfolded in a relatively cohesive and stable policy network. Although peripheral stakeholder resistance and a constrained national budget can present a threat to policy survival, the study shows that such factors as the engagement of policy entrepreneurs within a policy network, private sector incentives, and international aid were effective in ensuring policy resolution.
Comparison of Physical Activity Patterns among Three Major Chronic Respiratory Diseases
Authors: Mantoani Leandro Cruz , Furlanetto Karina Couto , Camillo Carlos Augusto , de Oliveira Joice Mara , Polastri Cláudia , Schneider Lorena Paltanin , Zamboti Camile Ludovico , Hernandes Nidia Aparecida , Pitta Fabio
Published: October 2023

Although the level of physical activity in daily life (PADL) plays a vital role concerning the health of subjects with chronic lung diseases, it remains uncertain how PADL patterns compare among different conditions. This study’s objective was to compare the PADL levels of subjects with COPD, asthma and idiopathic pulmonary fibrosis (IPF); and to investigate PADL behaviour in different diseases’ severity. Stable subjects who had not undergone pulmonary rehabilitation in the previous year were included. Subjects were divided into two subgroups according to disease severity: mild/moderate and severe/very severe. The primary outcome was time spent in moderate-to-vigorous physical activities (MVPA) (Actigraph GT3x) measured during one week over 12 h/day; other assessments included pulmonary function, peripheral muscle strength and exercise capacity. Comparisons among subgroups were corrected for age, BMI and sex. The analysis involved 119 subjects (47 asthma, 48 COPD and 24 IPF). Subjects with asthma had higher PADL levels than those with COPD and IPF (MVPA 18(14–22) vs. 8(4–12) vs. 7(1–12) min/day, respectively; p ancova = 0.002). Subjects with severe/very severe IPF had the lowest PADL level among all subgroups. Adult subjects with asthma have higher PADL levels than those with COPD and IPF, whereas patients with severe and very severe IPF are the most physically inactive subjects.
Evolving the Era of 5D Ultrasound? A Systematic Literature Review on the Applications for Artificial Intelligence Ultrasound Imaging in Obstetrics and Gynecology
Authors: Jost Elena , Kosian Philipp , Jimenez Cruz Jorge , Albarqouni Shadi , Gembruch Ulrich , Strizek Brigitte , Recker Florian
Published: October 2023

Artificial intelligence (AI) has gained prominence in medical imaging, particularly in obstetrics and gynecology (OB/GYN), where ultrasound (US) is the preferred method. It is considered cost effective and easily accessible but is time consuming and hindered by the need for specialized training. To overcome these limitations, AI models have been proposed for automated plane acquisition, anatomical measurements, and pathology detection. This study aims to overview recent literature on AI applications in OB/GYN US imaging, highlighting their benefits and limitations. For the methodology, a systematic literature search was performed in the PubMed and Cochrane Library databases. Matching abstracts were screened based on the PICOS (Participants, Intervention or Exposure, Comparison, Outcome, Study type) scheme. Articles with full text copies were distributed to the sections of OB/GYN and their research topics. As a result, this review includes 189 articles published from 1994 to 2023. Among these, 148 focus on obstetrics and 41 on gynecology. AI-assisted US applications span fetal biometry, echocardiography, or neurosonography, as well as the identification of adnexal and breast masses, and assessment of the endometrium and pelvic floor. To conclude, the applications for AI-assisted US in OB/GYN are abundant, especially in the subspecialty of obstetrics. However, while most studies focus on common application fields such as fetal biometry, this review outlines emerging and still experimental fields to promote further research.
Electrophysiological and Imaging Biomarkers to Evaluate Exercise Training in Patients with Neuromuscular Disease: A Systematic Review
Authors: Pomp Lisa , Jeneson Jeroen Antonius Lodewijk , van der Pol W. Ludo , Bartels Bart
Published: October 2023

Exercise therapy as part of the clinical management of patients with neuromuscular diseases (NMDs) is complicated by the limited insights into its efficacy. There is an urgent need for sensitive and non-invasive quantitative muscle biomarkers to monitor the effects of exercise training. Therefore, the objective of this systematic review was to critically appraise and summarize the current evidence for the sensitivity of quantitative, non-invasive biomarkers, based on imaging and electrophysiological techniques, for measuring the effects of physical exercise training. We identified a wide variety of biomarkers, including imaging techniques, i.e., magnetic resonance imaging (MRI) and ultrasound, surface electromyography (sEMG), magnetic resonance spectroscopy (MRS), and near-infrared spectroscopy (NIRS). Imaging biomarkers, such as muscle maximum area and muscle thickness, and EMG biomarkers, such as compound muscle action potential (CMAP) amplitude, detected significant changes in muscle morphology and neural adaptations following resistance training. MRS and NIRS biomarkers, such as initial phosphocreatine recovery rate (V), mitochondrial capacity (Qmax), adenosine phosphate recovery half-time (ADP t1/2), and micromolar changes in deoxygenated hemoglobin and myoglobin concentrations (Δ[deoxy(Hb + Mb)]), detected significant adaptations in oxidative metabolism after endurance training. We also identified biomarkers whose clinical relevance has not yet been assessed due to lack of sufficient study.
Sizing the Frozen Elephant Trunk Based on Aortic Pathology and the Importance of Pre-Operative Imaging
Authors: Koulouroudias Marinos , Velissarios Konstantinos , Kokotsakis John , Magouliotis Dimitrios E. , Tsipas Pantelis , Arjomandi Rad Arian , Viviano Alessandro , Kourliouros Antonios , Athanasiou Thanos
Published: October 2023

The frozen elephant trunk is a formidable tool for the aortovascular surgeon. An appreciation of how to size the graft in different pathologies is key in achieving optimal results. Herein, we demonstrate worked examples of how imaging can be used to plan for a frozen elephant trunk and discuss the nuisances and uncertainties of sizing using three index cases: Type A aortic dissection, distal thoracic aortic aneurysm and chronic dissection.
Early Detection of Alzheimer’s Disease in Postmenopausal Women Using Thalamic Subnuclear Volumetry
Authors: Kim Gwang-Won , Park Kwangsung , Jeong Gwang-Woo
Published: October 2023

Alzheimer’s disease (AD) and aging are intrinsically interconnected with each other and are mediated by molecular, cellular, and biological systems. In particular, a specific pattern of brain volume atrophy is the most profound risk factor for cognitive impairment, including AD, that is directly linked to aging. Thus, this study aimed to investigate knowledge on the early detection of AD in postmenopausal women, focusing on the volume changes of the subcortical regions, including the thalamic subnuclei, in women with AD vs. postmenopausal women. Twenty-one women with AD and twenty-one postmenopausal women without AD underwent magnetic resonance imaging (MRI). Women with AD showed significantly reduced volumes in the hippocampus, thalamus, and amygdala compared with postmenopausal women (p < 0.05, FWE-corrected). After adjustments for age, the right hippocampal volume was found to be significantly lower in the women with AD, but the volumes of the thalamus and amygdala were relatively unaffected. The women with AD exhibited significantly reduced volume in the right laterodorsal nucleus of the thalamus compared with the postmenopausal women (p < 0.05, Bonferroni-corrected). Our findings suggest that the reduced volume of both the right laterodorsal thalamic nucleus and right hippocampus may serve as a potential biomarker for the early detection of AD in postmenopausal women.
Evidence-Based Analysis of the Critical Steps of Radical Cystectomy for Bladder Cancer
Authors: D’Andrea Vincent D. , Melnick Kevin , Yim Kendrick , Ernandez John , Onochie Nnamdi , Clinton Timothy N. , Steele Graeme S. , Preston Mark A. , Kibel Adam S. , Mossanen Matthew
Published: October 2023

Radical cystectomy (RC) is an integral part of the management of patients with advanced-stage bladder cancer. This major oncologic operation is prone to complications resulting in morbidity and mortality. We analyzed the critical steps of open RC, performed an evidence-based review of these steps, and discussed our experience and approach. We conducted a literature review of the open RC technique, identified the critical steps that consistently appeared across different sources, and organized these steps into a framework. PubMed was queried with the critical steps as keywords for relevant articles published from 1 January 2013 to 1 August 2023. We utilized this query to conduct a systematic review of the literature using the outcomes of overall survival and 90-day complication rate. We developed the “Summary for the 10 Critical Operative Steps of Radical Cystectomy”, a concise guide to the approach to open RC. When available, an evidence-based analysis of each critical step was performed. We also included additional components of cystectomy optimization such as pre-habilitation in the preoperative phase, standard versus extended lymphadenectomy, the vaginal-sparing approach to female radical cystectomy, patient-reported outcomes following urinary diversion, the use of a mesh for stoma formation, and the use of the ERAS protocol for postoperative care. An evidence-based assessment of RC may help provide valuable information to optimize surgical techniques and patient outcomes.
The Significance of Histopathological Findings on Clinical Outcomes in Endoscopic Papillectomy with Endocut
Authors: Miyamoto Sayaka , Serikawa Masahiro , Ishii Yasutaka , Tatsukawa Yumiko , Nakamura Shinya , Ikemoto Juri , Tamura Yosuke , Nakamura Kazuki , Furukawa Masaru , Yamashita Yumiko , Iijima Noriaki , Arihiro Koji , Oka Shiro
Published: October 2023

This study aimed to evaluate primary clinical outcomes in patients who underwent endoscopic papillectomy (EP) using the Endocut mode while examining the pathological characteristics of the margin of the resected specimen. To this end, 70 patients who underwent Endocut EP were included. Resection margins were classified according to pathological findings as “negative”, “positive”, or “uncertain (difficult pathological evaluation)”. The effect of pathological resection margins on residual tumor recurrence rates was evaluated. The median follow-up was 47 months (range, 22–84). Eleven patients (15.7%) were diagnosed with residual tumors, ten of whom were diagnosed within 6 months after EP. The resection margins were pathologically negative in 27 patients, positive in 15, and uncertain in 28; residual tumors occurred in 5 patients (33.3%) in the positive group, 5 (17.9%) in the uncertain group, and 1 (3.7%) in the negative group. The patient in the negative group had familial adenomatous polyposis (FAP). Female sex, FAP, and uncertain or positive resection margins were significantly more common in residual patients (p = 0.009, 0.044, and 0.041, respectively). Pathological resection margins can be used to infer the residual tumor incidence, leading to early post-treatment of residual tumors.
Myocardial, Valvular, and Vascular Structural and Functional Properties in Acromegaly
Authors: Nemes Attila , Kormányos Árpád , Ambrus Nóra , Lengyel Csaba , Valkusz Zsuzsanna
Published: October 2023

Acromegaly is an uncommon systematic endocrine disease caused by the hypersecretion of human growth hormone and, consequently, of insulin-like growth factor-1 during adulthood. Acromegaly could cause a typical cardiomyopathy characterized by left ventricular hypertrophy associated with diastolic dysfunction, which later could progress to systolic dysfunction. Moreover, some valvular and vascular abnormalities are also associated with acromegaly. This present review aims to summarize available information regarding acromegaly-associated abnormalities in myocardial, valvular, and vascular structural and functional properties and their relationship to disease activity and treatment options.
Pandemic Stressors and Adaptive Responses: A Longitudinal Analysis of the Quality of Life and Psychosocial Dynamics among Urothelial Cancer Patients
Authors: Barbos Vlad , Feciche Bogdan , Bratosin Felix , Tummala Durganjali , Shetty Uday Shree Akkala , Latcu Silviu , Croitor Alexei , Dema Vlad , Bardan Razvan , Cumpanas Alin Adrian
Published: October 2023

The 2019 coronavirus disease (COVID-19) pandemic has had a profound influence on different sectors of society, including health. This study hypothesized a significant impact of the pandemic on the quality of life and psychosocial well-being of urothelial cancer patients, specifically anticipating a decrease in anxiety and depression scores as the pandemic progressed. The primary objectives were to assess longitudinal changes in quality of life indexes, evaluate Healthcare Anxiety and Depression Scale (HADS) score trends over three years (2020–2022), and identify any correlational patterns between the progression of the pandemic and anxiety, depression, and stress levels among this cohort. A cross-sectional analysis was conducted on Eastern Cooperative Oncology Group (ECOG) 1 and Tumor Node Metastasis (TNM) stage 1 bladder cancer patients from the Timis County Emergency Clinical Hospital in Romania. Sixty patients were evaluated each year from 2020 to 2022, utilizing a detailed selection process involving the review of both the hospital database and paper records. Key data included demographic information, medical history, and responses to the Patient Health Questionnaire (PHQ-9), Short Form (SF-36), HADS, and Generalized Anxiety Disorder (GAD-7) questionnaires. A total of 163 completed questionnaires were analyzed, providing insight into various aspects of patients’ experiences during the pandemic. Notably, the mean hospitalization days ranged from 3.6 ± 2.1 days in 2020 to 4.0 ± 2.4 days in 2022 (p = 0.663). Concerns that current symptoms might be pandemic-related spiked to 63.5% in 2021, but reduced to 50.9% in 2022, with this fluctuation being significant (p = 0.026). The perception of decreased quality of or accessibility to medical care was significant over the years, with a decline to 52.7% in 2022 (p = 0.033). Quality of life assessments demonstrated an upward trend, from an average score of 55.9 ± 8.9 in 2020 to 59.3 ± 8.8 in 2022 (p = 0.049). Interestingly, anxiety levels, as indicated by the HADS survey, revealed a significant decline from a score of 7.8 in 2020 to 6.5 in 2022 (p = 0.008). On the other hand, GAD-7 scores displayed a downward trend over the years, potentially indicative of developed coping strategies (p = 0.034). This study provides a comprehensive insight into the fluctuating dynamics of psychosocial factors and quality of life among urothelial cancer patients during the pandemic years. It underscores a potential adaptive response, as evidenced by the decrease in anxiety levels and an upward trend in the quality of life scores over the period. These findings highlight the resilience and adaptability of this patient cohort amidst the challenges posed by the pandemic, potentially guiding future interventions and supports in similar health crises.
Network-Based In Silico Analysis of New Combinations of Modern Drug Targets with Methotrexate for Response-Based Treatment of Rheumatoid Arthritis
Authors: Assefi Marjan , Lewandrowski Kai-Uwe , Lorio Morgan , Fiorelli Rossano Kepler Alvim , Landgraeber Stefan , Sharafshah Alireza
Published: October 2023

Background: Methotrexate (MTX), sulfonamides, hydroxychloroquine, and leflunomide have consistently resulted in remission with relatively mild to moderate adverse effects in patients with rheumatoid arthritis (RA). Modern medications outperform traditional treatments in that they target the pathological processes that underlie the development of RA. Methods: Following PRISMA guidelines, the authors accomplished a systematic review of the clinical efficacy of RA drugs, including the biologics such as Tumor Necrosis Factor-alpha inhibitors (TNF-α i) like Etanercept, Infliximab, Golimumab, and Adalimumab, kinase inhibitors (JAK inhibitors including Baricitinib and Tofacitanib), SyK inhibitors like Fos-tamatinib, MAPK inhibitors such as Talmapimod, T-cell inhibitors (Abatacept), IL6 blockers (Tocilizumab), and B cells depleters (Rituximab). These drugs have been found to increase remission rates when combined with MTX. A bioinformatics-based network was designed applying STRING-MODEL and the DrugBank database for the aforementioned drugs and MTX and, finally, employed for this systematic review. Results: Current research demonstrates that non-TNF-α inhibitor biologicals are particularly helpful in treating patients who did not respond well to conventional medications and TNF-α inhibitors. Despite being effective, these innovative drugs have a higher chance of producing hazardous side effects. The in silico investigations suggested an uncovered molecular interaction in combining MTX with other biological drugs. The STRING-MODEL showed that DHFR, TYMS, and ATIC, as the receptors of MTX, interact with each other but are not connected to the major interacted receptors. Conclusions: New game-changing drugs including Mavrilimumab, Iguratimod, Upadacitinib, Fenebrutinib, and nanoparticles may be crucial in controlling symptoms in poorly managed RA patients. Emerging therapeutic targets like Toll-like 4 receptors, NLRP3 inflammasome complexes, and mesenchymal stem cells can further transform RA therapy.
Cerebral Venous Thrombosis during Thyrotoxicosis: Case Report and Literature Update
Authors: Raho Emanuela Maria , Antonioni Annibale , Cotta Ramusino Niccolò , Jubea Dina , Gragnaniello Daniela , Franceschetti Paola , Penitenti Francesco , Daniele Andrea , Zatelli Maria Chiara , Naccarato Maurizio , Traluci Ilaria , Pugliatti Maura , Padroni Marina
Published: October 2023

Cerebral venous thrombosis (CVT) is a rare cause of stroke, particularly in young adults. Several known thrombophilic conditions may lead to an increased CVT risk. Interestingly, few cases in the literature have reported an association between CVT and thyrotoxicosis. Here, we describe the case of a young woman with CVT and concomitant thyrotoxicosis, without any other known prothrombotic conditions. We also performed a literature review of CVT cases and hyperthyroidism, searching for all articles published in peer-reviewed journals. We identified 39 case reports/case series concerning patients with CVT associated with thyrotoxicosis, highlighting, in most cases, the association with additional known prothrombotic factors. We then discussed the possible mechanisms by which hyperthyroidism could underlie a pro-coagulative state resulting in CVT. Thyroid disease might be a more common prothrombotic risk factor than expected in determining CVT. However, in most cases, a coexistence of multiple risk factors was observed, suggesting a multifactorial genesis of the disorder. We hope that this work may alert clinicians to consider thyrotoxicosis as a potential risk factor for CVT, even in patients who apparently have no other pro-coagulative conditions.
Baseline Corticosterone, Stress Responses, and Leukocyte Profiles in Chicks of Precocial Birds in Rural and Urban Environments
Authors: Quirici Verónica , Valeris-Chacín Carlos E. , Parada Pablo , Cuevas Elfego , Wingfield John C.
Published: October 2023

The urban environment produces complex relationship among urban stressors that could change the levels of the steroid hormone, glucocorticoid (GCs). Studies that have evaluated baseline corticosterone (Cort) levels (the main GC in birds) and stress responses during development in urban and rural environments have obtained contrasting results. This ambiguity could partially be because the studies were carried out in altricial species, where parental care and sibling competition can affect Cort levels. Therefore, in this study, we compared levels of circulating baseline levels of CORT (blood sample obtained within 3 min of capture) and stress responses (blood sample obtained 30 min after capture) and the H/L ratio (an alternative method to measure stress) in chicks of a precocial bird, southern lapwings (Vanellus chilensis), from one rural (6 chicks), one urban low-polluted (13 chicks), and one urban high-polluted (10 chicks) site of Metropolitan Region of Santiago de Chile. We observed higher baseline Cort (2.41 ± 1.78 ng/mL) in the urban high-polluted site, a higher H/L ratio (0.51 ± 0.20) in the urban low-polluted site, and similar stress response across the three sites. We propose that the difference in stress physiology we observed within Santiago de Chile is because the two zones are at extremes in terms of stressors (noise, light, chemical, and human presence). It is unusual to find a precocious bird that lives in both urban and rural areas; therefore, the results of this study will advance our knowledge of the effect of the urban environment during the development of wildlife, which is relevant in terms of management and conservation.