bluuebunny/crossref_metadata_2025 huggingface dataset:
Multivariate analysis of prognostic factors in patients with lip squamous cell carcinoma after surgery
Authors: Cheng Hao , Xu Jin-Hong , He Jia-Qi , Yang Xi-Yang , Shen Xu-Ning , Xu Xue-Lian
Published: January 2024

Background

Lip squamous cell carcinoma (LSCC) was one of the most common cancer types of head and neck tumors. This study aimed to find more predictors of the prognosis in postoperative LSCC patients.

Methods

A total of 147 LSCC patients between June 2012 and June 2018 were collected from two tertiary care institutions. There were 21 clinicopathological factors included and analyzed in our study. The univariate and multivariate Cox regression analyses were performed to find the independent prognostic factors for predicting progression-free survival (PFS) and overall survival (OS) in postoperative LSCC patients. The role of adjuvant radiotherapy in various subgroups was displayed by Kaplan–Meier plots.

Results

The 1-, 3-, and 5-year PFS of postoperative LSCC patients were 88.4%, 70.1%, and 57.8%, respectively. Similarly, the 1-, 3-, and 5-year OS of postoperative LSCC patients were 94.6%, 76.9%, and 69.4%, respectively. The results suggested that postoperative LSCC patients with age at diagnosis ≥ 70 years, grade with moderate or poor differentiate, the American Joint Committee on Cancer (AJCC) stage IV, higher systemic immune-inflammation index (SII), surgical margin < 5, and age-adjusted Charlson Comorbidity Index (ACCI) ≥ 5 tend to have a poorer PFS (all P < 0.05). Besides, postoperative LSCC patients with age at diagnosis ≥ 70 years, AJCC stage IV, higher GPS, higher SII, and ACCI ≥ 5 tend to have a worse OS (all P < 0.05). Additionally, postoperative patients with LSCC in the subgroup of ACCI < 5 and AJCC III–IV stage was more likely to benefit from adjuvant radiotherapy, but not for the other subgroups.

Conclusion

We identified a series of significant immune-inflammation-related and comorbidity-related clinicopathological factors associated with the prognosis of postoperative LSCC patients by local data from two tertiary care institutions in China, which can be helpful for patients and surgeons to pay more attention to nutrition, inflammation, and complications and finally obtained a better prognosis.
Investigating the citing communities around three leading health-system frameworks
Authors: Weisz George , Harper Jonathan
Published: January 2024

Of numerous proposed frameworks for analyzing and impacting health systems, three stand out for the large number of publications that cite them and for their links to influential international institutions: Murray and Frenk (Bull World Health Organ 78:717–31, 2000) connected initially to the World Health Organization (WHO) and then to the Global Burden of Disease Project; Roberts et al. (Getting health reform right: a guide to improving performance and equity, Oxford University Press, Oxford, 2004) sponsored by the World Bank/Harvard Flagship Program; and de Savigny and Adam (Systems thinking for health systems strengthening, WHO, 2009) linked to the WHO and the Alliance for Health Policy and Systems Research. In this paper, we examine the citation communities that form around these works to better understand the underlying logic of these citation grouping as well as the dynamics of Global Health research on health systems. We conclude that these groupings are largely independent of one another, reflecting a range of factors including the goals of each framework and the problems that it was meant to explore, the prestige and authority of institutions and individuals associated with these frameworks, and the intellectual and geographic proximity of the citing researchers to each other and to the framework authors.
Screening for juvenile idiopathic arthritis associated uveitis with laser flare photometry in the pediatric rheumatology office: a prospective observational study
Authors: Ede Kaleo , Shishov Michael , Wershba Elisa , Goswami Nikita , Gorry Sabrina , Joseph Malin , Mirea Lucia , O’Neil James
Published: January 2024

Background

Juvenile Idiopathic Arthritis (JIA) Associated Uveitis (JIA-U) remains one of the most serious complications of JIA in children. Historically, pediatric JIA is diagnosed by an Optometrist or Ophthalmologist; however, barriers to scheduling increase wait times that may delay diagnosis and treatment. The purpose of this study was to evaluate laser flare photometry (LFP) use to diagnose JIA-U in the Pediatric Rheumatology clinic for patients with JIA.

Methods

This prospective, observational study assessed pediatric patients diagnosed with JIA without a previous history of uveitis between January 2020 and September 2022. All patients underwent at least one evaluation of both eyes using a Kowa FM-600 laser flare photometer during a routine Rheumatology appointment, as well as a standard slit lamp examination (SLE) by optometry or ophthalmology during routine clinical care. Data collected at patient visits included demographics, JIA characteristics, treatment, LFP readings, and anterior chamber (AC) cell grade score utilizing the SUN grading system. Data were summarized using descriptive analyses and the uveitis false positive rate was calculated.

Results

The study cohort included 58 pediatric patients diagnosed with JIA. The mean age was 8.4 years (1.2–16.3 years) at diagnosis and 11.9 (4.8–16.5 years) at enrollment. The mean duration of disease at time of enrollment was 42 months (range; 0-157 months). Participants were predominantly female (n = 43, 74.1%) and white/Caucasian race (n = 37, 63.8%). The most common JIA subtypes included persistent oligoarticular JIA (n = 19, 32.8%), and RF negative polyarticular JIA (n = 12, 20.7%). There were 12 ANA positive patients (20.7%). At enrollment, 16 patients (27.6%) were not on medications, with 20 (34.5%) on methotrexate, 20 (34.5%) on adalimumab, 6 (10.3%) on tocilizumab, and 5 (8.6%) on etanercept. During the study period, no eye exams detected active uveitis based on SLE with a SUN grade over 0. However, of the 135 LFP readings, 131 (97.0%) were normal, yielding a false positive rate of 3% (95% CI: 0.8%, 7.4%).

Conclusions

LFP is a non-invasive tool that can be utilized in the pediatric rheumatology clinic to evaluate for JIA-U. There is a low false positive rate of LFP when compared with standard slit lamp exam.
Association of gestational metabolic syndrome with the Chinese Healthy Eating Index in mid-pregnancy: a cross-sectional study
Authors: Wu Hui , Yi Min-hui , Liu Bing-gang , Xu Yan , Wu Qin , Liu Yu-hong , Lu Ling-peng
Published: January 2024

Background

This study aims to investigate the relationship between gestational metabolic syndrome (GMS) and the Chinese Healthy Eating Index (CHEI) in mid-pregnancy, and to identify potentially beneficial or high-risk dietary habits. We have developed a mid-pregnancy version of CHEI-2022, adapting the Chinese Healthy Eating Index to align with the food quantity recommendations outlined in the 2022 Dietary Guidelines for Chinese Residents for mid-pregnancy.

Methods

Using the inclusion and exclusion criteria, data from 2411 mid-pregnant individuals were collected through interviews. The Total CHEI score and its component scores were determined through analysis of responses from the food frequency questionnaire. GMS diagnosis involved conducting physical examinations and performing blood biochemical tests. A logistic regression model was employed to analyze the relationship between GMS or related indices and both the total CHEI score and its component scores.

Results

The study identified an overall GMS prevalence of 21.65% (522 out of 2411 participants). During mid-pregnancy, participants diagnosed with GMS exhibited higher BMI, FBG, 1hPBG, 2hPBG, TC, TG, HDL, SBP, as well as higher educational levels and daily activity, compared to those without GMS (P < 0.001). After adjusting for potential confounders, participants with higher total CHEI scores (≥ 80) were found to have lower odds of GMS or related indices (P < 0.05). Increasing dietary intake of potatoes, whole grains, beans, dark green vegetables, and fruits, as per the CHEI recommendations, was associated with reduced odds of GMS or related indices (P < 0.05).

Conclusion

A high-quality diet, as indicated by a total CHEI score of 80 or higher, and increased consumption of specific dietary components, namely potatoes, beans, dark green vegetables, and fruits, were found to effectively reduce the odds of GMS or related indices during mid-pregnancy.
Marketing claims, promotional strategies, and product information on Malaysian e-cigarette retailer websites-a content analysis
Authors: Shroff Sameeha Misriya , Sreeramareddy Chandrashekhar T
Published: January 2024

Background

Marketing and sales of e-cigarettes are unregulated in Malaysia. We analyzed content displayed on e-cigarette retailer websites to identify marketing claims, promotional strategies, and product details in the year 2022.

Methods

We analyzed 30 Malaysia-based retailer websites using a mixed methods approach. Data were extracted as the frequency of occurrences of marketing claims, presence of regulatory information, product types, and flavors of e-juice as per a predefined codebook based on published literature. We also extracted textual details published on the websites about marketing claims, and slogans.

Results

Most retailer websites provided contact information and physical store addresses (83%) but only half had ‘click through’ age verification (57%) that seldom needed any identification proof for age (3%). Marketing claims were related to health (47%), smoking cessation (37%), and modernity/trend (37%) and none had health warnings. Promotional strategies were discounts (80%). starter kits (57%) and email subscriptions (53%). Product types displayed were rechargeable (97%) and disposable (87%) devices and e-liquids (90%) of an array of flavors (> 100). Nicotine presence, its concentration, and “nicotine is an addictive chemical” were displayed in 93%, 53%, and 23% of websites respectively.

Conclusion

Surveillance of content displayed online on e-cigarette retailer websites and regulation of online marketing and sales should be implemented by the Ministry of Health, Malaysia. Such measures are needed to prevent access to, and initiation of e-cigarette use among the youth and adults who do not smoke.
Myocardial involvement characteristics by cardiac MR imaging in neurological and non-neurological Wilson disease patients
Authors: Deng Wei , Zhang Jie , Jia Zhuoran , Pan Zixiang , Wang Zhen , Xu Huimin , Zhong Liang , Yu Yongqiang , Zhao Ren , Li Xiaohu
Published: January 2024

Objectives

To explore the characteristics of myocardial involvement in Wilson Disease (WD) patients by cardiac magnetic resonance (CMR).

Methods

We prospectively included WD patients and age- and sex-matched healthy population. We applied CMR to analyze cardiac function, strain, T1 maps, T2 maps, extracellular volume fraction (ECV) maps, and LGE images. Subgroup analyzes were performed for patients with WD with predominantly neurologic manifestations (WD‐neuro +) or only hepatic manifestations (WD‐neuro −).

Results

Forty-one WD patients (age 27.9 ± 8.0 years) and 40 healthy controls (age 25.4 ± 2.9 years) were included in this study. Compared to controls, the T1, T2, and ECV values were significantly increased in the WD group (T1 1085.1 ± 39.1 vs. 1046.5 ± 33.1 ms, T2 54.2 ± 3.3 ms vs. 51.5 ± 2.6 ms, ECV 31.8 ± 3.6% vs. 24.3 ± 3.7%) (all p < 0.001). LGE analysis revealed that LGE in WD patients was predominantly localized to the right ventricular insertion point and interventricular septum. Furthermore, the WD‐neuro + group showed more severe myocardial damage compared to WD‐neuro − group. The Unified Wilson Disease Rating Scale score was significantly correlated with ECV (Pearson’s r = 0.64, p < 0.001).

Conclusions

CMR could detect early myocardial involvement in WD patients without overt cardiac function dysfunction. Furthermore, characteristics of myocardial involvement were different between WD‐neuro + and WD‐neuro − , and myocardial involvement might be more severe in WD‐neuro + patients.

Critical relevance statement

Cardiac magnetic resonance enables early detection of myocardial involvement in Wilson disease patients, contributing to the understanding of distinct myocardial characteristics in different subgroups and potentially aiding in the assessment of disease severity.

Key points

• CMR detects WD myocardial involvement with increased T1, T2, ECV.

• WD‐neuro + patients show more severe myocardial damage and correlation with ECV.

• Differences of myocardial characteristics exist between WD‐neuro + and WD‐neuro − patients.

Graphical Abstract
Intratumoral and peritumoral radiomics predict pathological response after neoadjuvant chemotherapy against advanced gastric cancer
Authors: Liu Chenchen , Li Liming , Chen Xingzhi , Huang Chencui , Wang Rui , Liu Yiyang , Gao Jianbo
Published: January 2024

Background

To investigate whether intratumoral and peritumoral radiomics may predict pathological responses after neoadjuvant chemotherapy against advanced gastric cancer.

Methods

Clinical, pathological, and CT data from 231 patients with advanced gastric cancer who underwent neoadjuvant chemotherapy at our hospital between July 2014 and February 2022 were retrospectively collected. Patients were randomly divided into a training group (n = 161) and a validation group (n = 70). The support vector machine classifier was used to establish radiomics models. A clinical model was established based on the selected clinical indicators. Finally, the radiomics and clinical models were combined to generate a radiomics–clinical model. ROC analyses were used to evaluate the prediction efficiency for each model. Calibration curves and decision curves were used to evaluate the optimal model.

Results

A total of 91 cases were recorded with good response and 140 with poor response. The radiomics model demonstrated that the AUC was higher in the combined model than in the intratumoral and peritumoral models (training group: 0.949, 0.943, and 0.846, respectively; validation group: 0.815, 0.778, and 0.701, respectively). Age, Borrmann classification, and Lauren classification were used to construct the clinical model. Among the radiomics–clinical models, the combined-clinical model showed the highest AUC (training group: 0.960; validation group: 0.843), which significantly improved prediction efficiency.

Conclusion

The peritumoral model provided additional value in the evaluation of pathological response after neoadjuvant chemotherapy against advanced gastric cancer, and the combined-clinical model showed the highest predictive efficiency.

Critical relevance statement

Intratumoral and peritumoral radiomics can noninvasively predict the pathological response against advanced gastric cancer after neoadjuvant chemotherapy to guide early treatment decision and provide individual treatment for patients.

Key points

1. Radiomics can predict pathological responses after neoadjuvant chemotherapy against advanced gastric cancer.

2. Peritumoral radiomics has additional predictive value.

3. Radiomics–clinical models can guide early treatment decisions and improve patient prognosis.

Graphical Abstract
A renal aplasia case mimicking radiologically as unilateral renal agenesis in a child with spina bifida, atresia ani and unilateral undescended testis: a case report
Authors: Yuri Prahara , Irzan Muhammad Anwar , Ghinorawa Tanaya , Solichin Muchamad Ridotu , Dwianingsih Ery Kus
Published: January 2024

Background

As a result of the failure of embryogenic kidney formation, a condition can occur where not a single kidney appears and this phenomenon is known as unilateral renal agenesis (URA). Both aplastic and dysplastic kidney are different from renal agenesis, atrophy and renal hypoplasia. However, from this case report it can be seen that there are similarities, both radiologically and macroscopically, between cases of unilateral renal aplasia and renal agenesis.

Case presentation

A 2 year old Javanese boy came to the health facility with complaints of recurrent fever and urinary tract symptoms such as dysuria and straining. Computerized Tomography (CT) scan of the abdomen and urography showed agenesis of the left kidney and a probable spina bifida. Cystourethrography examination was done and showed grade 5 voiding, then retrograde pyelography was performed with the diagnosis of unilateral renal agenesis was made because there was no visible left side collecting system even though there was a duplication in the left ureter. The next examination was carried out by histopathology and immunohistochemistry after resection of the left side of the ureter and the diagnosis increasingly pointed towards renal aplasia after primitive renal structures were found.

Conclusions

Renal agenesis and aplastic kidney are difficult to differentiate macroscopically and radiologically. Nevertheless, from this case report, we try to provide some interesting points to differentiate cases of unilateral renal agenesis from Renal Dysplasia which presents as unilateral renal aplasia.
Therapeutic potential of berberine in attenuating cholestatic liver injury: insights from a PSC mouse model
Authors: Wang Yanyan , Zhao Derrick , Su Lianyong , Tai Yun-Ling , Way Grayson W. , Zeng Jing , Yan Qianhua , Xu Ying , Wang Xuan , Gurley Emily C. , Zhou Xi-Qiao , Liu Jinze , Liu Jinpeng , Chen Weidong , Hylemon Phillip B. , Zhou Huiping
Published: January 2024

Background and aims

Primary sclerosing cholangitis (PSC) is a chronic liver disease characterized by progressive biliary inflammation and bile duct injury. Berberine (BBR) is a bioactive isoquinoline alkaloid found in various herbs and has multiple beneficial effects on metabolic and inflammatory diseases, including liver diseases. This study aimed to examine the therapeutic effect of BBR on cholestatic liver injury in a PSC mouse model (Mdr2−/− mice) and elucidate the underlying mechanisms.

Methods

Mdr2−/−mice (12–14 weeks old, both sexes) received either BBR (50 mg/kg) or control solution daily for eight weeks via oral gavage. Histological and serum biochemical analyses were used to assess fibrotic liver injury severity. Total RNAseq and pathway analyses were used to identify the potential signaling pathways modulated by BBR in the liver. The expression levels of key genes involved in regulating hepatic fibrosis, bile duct proliferation, inflammation, and bile acid metabolism were validated by qRT-PCR or Western blot analysis. The bile acid composition and levels in the serum, liver, small intestine, and feces and tissue distribution of BBR were measured by LC–MS/MS. Intestinal inflammation and injury were assessed by gene expression profiling and histological analysis. The impact on the gut microbiome was assessed using 16S rRNA gene sequencing.

Results

BBR treatment significantly ameliorated cholestatic liver injury, evidenced by decreased serum levels of AST, ALT, and ALP, and reduced bile duct proliferation and hepatic fibrosis, as shown by H&E, Picro-Sirius Red, and CK19 IHC staining. RNAseq and qRT-PCR analyses indicated a substantial inhibition of fibrotic and inflammatory gene expression. BBR also mitigated ER stress by downregulating Chop, Atf4 and Xbp-1 expression. In addition, BBR modulated bile acid metabolism by altering key gene expressions in the liver and small intestine, resulting in restored bile acid homeostasis characterized by reduced total bile acids in serum, liver, and small intestine and increased fecal excretion. Furthermore, BBR significantly improved intestinal barrier function and reduced bacterial translocation by modulating the gut microbiota.

Conclusion

BBR effectively attenuates cholestatic liver injury, suggesting its potential as a therapeutic agent for PSC and other cholestatic liver diseases.
Systemic inflammation and insulin resistance-related indicator predicts poor outcome in patients with cancer cachexia
Authors: Ruan Guo-Tian , Deng Li , Xie Hai-Lun , Shi Jin-Yu , Liu Xiao-Yue , Zheng Xin , Chen Yue , Lin Shi-Qi , Zhang He-Yang , Liu Chen-An , Ge Yi-Zhong , Song Meng-Meng , Hu Chun-Lei , Zhang Xiao-Wei , Yang Ming , Hu Wen , Cong Ming-Hua , Zhu Li-Chen , Wang Kun-Hua , Shi Han-Ping
Published: January 2024

Background

The C-reactive protein (CRP)-triglyceride-glucose (TyG) index (CTI), which is a measure representing the level of inflammation and insulin resistance (IR), is related to poor cancer prognosis; however, the CTI has not been validated in patients with cancer cachexia. Thus, this study aimed to explore the potential clinical value of the CTI in patients with cancer cachexia.

Methods

In this study, our prospective multicenter cohort included 1411 patients with cancer cachexia (mean age 59.45 ± 11.38, 63.3% male), which was a combined analysis of multiple cancer types. We randomly selected 30% of the patients for the internal test cohort (mean age 58.90 ± 11.22% 61.4% male). Additionally, we included 307 patients with cancer cachexia in the external validation cohort (mean age 61.16 ± 11, 58.5% male). Receiver operating characteristic (ROC) and calibration curves were performed to investigate the prognostic value of CTI. The prognostic value of the CTI was also investigated performing univariate and multivariate survival analyses.

Results

The survival curve indicated that the CTI showed a significant prognostic value in the total, internal, and external validation cohorts. Prognostic ROC curves and calibration curves revealed that the CTI showed good consistency in predicting the survival of patients with cancer cachexia. Multivariate survival analysis showed that an elevated CTI increased the risk of death by 22% (total cohort, 95% confidence interval [CI] = 1.13–1.33), 34% (internal test cohort, 95%CI = 1.11–1.62), and 35% (external validation cohort, 95%CI = 1.14–1.59) for each increase in the standard deviation of CTI. High CTI reliably predicted shorter survival (total cohort, hazard ratio [HR] = 1.45, 95%CI = 1.22–1.71; internal test cohort, HR = 1.62, 95%CI = 1.12–2.36; external validation cohort, HR = 1.61, 95%CI = 1.15–2.26). High CTI significantly predicted shorter survival in different tumor subgroups, such as esophageal [HR = 2.11, 95%CI = 1.05–4.21] and colorectal cancer [HR = 2.29, 95%CI = 1.42–3.71]. The mediating effects analysis found that the mediating proportions of PGSGA, ECOG PS, and EORTC QLQ-C30 on the direct effects of CTI were 21.72%, 19.63%, and 11.61%, respectively We found that there was a significant positive correlation between the CTI and 90-day [HR = 2.48, 95%CI = 1.52–4.14] and 180-day mortality [HR = 1.77,95%CI = 1.24–2.55] in patients with cancer cachexia.

Conclusion

The CTI can predict the short- and long-term survival of patients with cancer cachexia and provide a useful prognostic tool for clinical practice.
Estimation of normal lung weight index in healthy female domestic pigs
Authors: Fioccola Antonio , Nicolardi Rosmery Valentina , Pozzi Tommaso , Fratti Isabella , Romitti Federica , Collino Francesca , Reupke Verena , Bassi Gianluigi Li , Protti Alessandro , Santini Alessandro , Cressoni Massimo , Busana Mattia , Moerer Onnen , Camporota Luigi , Gattinoni Luciano
Published: January 2024

Introduction

Lung weight is an important study endpoint to assess lung edema in porcine experiments on acute respiratory distress syndrome and ventilatory induced lung injury. Evidence on the relationship between lung–body weight relationship is lacking in the literature. The aim of this work is to provide a reference equation between normal lung and body weight in female domestic piglets.

Materials and methods

177 healthy female domestic piglets from previous studies were included in the analysis. Lung weight was assessed either via a CT-scan before any experimental injury or with a scale after autopsy. The animals were randomly divided in a training (n = 141) and a validation population (n = 36). The relation between body weight and lung weight index (lung weight/body weight, g/kg) was described by an exponential function on the training population. The equation was tested on the validation population. A Bland–Altman analysis was performed to compare the lung weight index in the validation population and its theoretical value calculated with the reference equation.

Results

A good fit was found between the validation population and the exponential equation extracted from the training population (RMSE = 0.060). The equation to determine lung weight index from body weight was: $${\text{Lung}} {\text{Weight}} {\text{Index}} \left(\frac{{\text{g}}}{{\text{kg}}}\right)=26.26*{10}^{-0.011*{\text{Body}} {\text{Weight}} \left({\text{kg}}\right)}.$$

LungWeightIndex

g
kg

=
26.26

∗

10

-
0.011

∗
BodyWeight

kg

.

At the Bland and Altman analyses, the mean bias between the real and the expected lung weight index was − 0.26 g/kg (95% CI − 0.96–0.43), upper LOA 3.80 g/kg [95% CI 2.59–5.01], lower LOA − 4.33 g/kg [95% CI = − 5.54–(− 3.12)].

Conclusions

This exponential function might be a valuable tool to assess lung edema in experiments involving 16–50 kg female domestic piglets. The error that can be made due to the 95% confidence intervals of the formula is smaller than the one made considering the lung to body weight as a linear relationship.
How to govern greenwashing behaviors in green finance products: a tripartite evolutionary game approach
Authors: Liu Changyu , Li Wei , Chang Le , Ji Qiang
Published: January 2024

Greenwashing behaviors (GWBs) in green finance products (GFPs) by enterprises seriously hinder the realization of environmental protection goals. However, methods for effectively regulating GWBs in GFPs are unclear. This study constructed a tripartite evolutionary game model to analyze the formation and governance mechanisms of GWBs in GFPs among regulatory authorities, enterprises, and investors. Subsequently, the stability equilibrium strategy and key factors influencing the system equilibrium were discussed. Several interesting conclusions were drawn. First, we demonstrated that an interdependence mechanism exists among three game agents who mutually influence each other. The larger the probability of regulatory authorities choosing active supervision and investors adopting feedback, the more enterprises are willing to carry out green projects. Second, three corresponding governance modes for GWBs were put forward following the developmental stages of GFPs. Among these, the collaboration mode is the most effective in incentivizing enterprises to implement green projects. Third, based on sensitivity simulations, the initial willingness of the tripartite stakeholders, investor feedback cost, investor compensation, the penalty for greenwashing enterprises, and the reputational benefit of enterprises are critical factors that influence evolutionary results. Finally, targeted countermeasures were provided for regulatory authorities to prevent enterprises from engaging in GWBs.
Time and frequency dynamics between NFT coins and economic uncertainty
Authors: Sadorsky Perry , Henriques Irene
Published: January 2024

Non-fungible tokens (NFTs) are one-of-a-kind digital assets that are stored on a blockchain. Examples of NFTs include art (e.g., image, video, animation), collectables (e.g., autographs), and objects from games (e.g., weapons and poisons). NFTs provide content creators and artists a way to promote and sell their unique digital material online. NFT coins underpin the ecosystems that support NFTs and are a new and emerging asset class and, as a new and emerging asset class, NFT coins are not immune to economic uncertainty. This research seeks to address the following questions. What is the time and frequency relationship between economic uncertainty and NFT coins? Is the relationship similar across different NFT coins? As an emerging asset, do NFT coins exhibit explosive behavior and if so, what role does economic uncertainty play in their formation? Using a new Twitter-based economic uncertainty index and a related equity market uncertainty index it is found that wavelet coherence between NFT coin prices (ENJ, MANA, THETA, XTZ) and economic uncertainty or market uncertainty is strongest during the periods January 2020 to July 2020 and January 2022 to July 2022. Periods of high significance are centered around the 64-day scale. During periods of high coherence, economic and market uncertainty exhibit an out of phase relationship with NFT coin prices. Network connectedness shows that the highest connectedness occurred during 2020 and 2022 which is consistent with the findings from wavelet analysis. Infectious disease outbreaks (COVID-19), NFT coin price volatility, and Twitter-based economic uncertainty determine bubbles in NFT coin prices.
Traumatic spinal cord and peripheral nerve injuries: correlation of trauma type with subsequent disability
Authors: Kaya Ahsen , Senol Ender , Bayrakci Engin , Altindag Hayrettin
Published: January 2024

Background

Traumatic spinal cord and peripheral nerve injuries may lead to neurological deficits and fatal consequences. This study aimed to evaluate the characteristics of traumatic spinal cord and peripheral nerve injuries, examine the relationship between the type of injury and the affected nerves, and discuss appropriate prevention measures.

Results

Of these, 236 were males and 63 were females, and the mean age was 35.56 ± 15.10 years. Traffic accidents (56.9%) were the most common etiological factor. This study included 288 peripheral nerve injuries and 82 spinal cord injuries. The fibular nerve (n = 49) and cervical spinal cord (n = 35) were the most frequently injured areas. Permanent functional and sensorial losses associated with traumatic nerve injuries were observed in 239 (79.9%) cases, of which 171 exhibited loss of muscle strength, 114 presented with neuro-sensorial symptoms, 37 had urinary/faecal incontinence, and 1 demonstrated erectile dysfunction. And, the incidence of permanent loss of function was significantly higher following traffic accidents ($$\chi$$
χ
2 = 50.095, Adj. p < 0.001).

Conclusions

Peripheral and spinal nerve injuries play a crucial role in forensic investigations, providing valuable insights into the circumstances surrounding a crime or injury. Their significance extends to both criminal and civil proceedings, influencing legal strategies, determinations of liability, and the quantification of damages. In this study, especially traffic accidents were significantly associated with nerve injuries leading to permanent loss of function, and the type of trauma was associated with the nerves injured. Therefore, this study will contribute to criminal and civil proceedings.
Never too young for a salivary gland carcinoma ex-pleomorphic adenoma
Authors: Fuad Ahmad Muizzuddin Ahmad , Guan Lum Sai , Yunus Mohd Razif Mohamad
Published: January 2024

Background

Carcinoma ex-pleomorphic adenoma (CXPA) can either arise primarily as a de novo or from the malignant transformation of a benign pleomorphic adenoma (PA). CXPA mostly occurs in adults aged 50 to 70 years; hence, the occurrence of CXPA in younger ages is not common.

Case presentation

We report a 27-year-old female who had a history of submandibulectomy for pleomorphic adenoma, and presented with recurrent left submandibular swelling for 4 months. The mass was rapidly increasing in size and was associated with occasional throbbing pain. Examination showed a multilobulated, firm left submandibular swelling with no overlying skin changes. FNAC was performed twice, by conventional and ultrasound-guided techniques, and both concluded as benign salivary gland tumours. CT scan and MRI revealed a well-demarcated tumour with an area of necrosis within, with no obvious invasion into surrounding soft tissue and no significant lymphadenopathy. Having high suspicion of a malignant transformation, the tumour was resected with a concurrent modified radical neck dissection. The histopathological examination confirmed a carcinoma ex-pleomorphic adenoma with the myoepithelial malignant component. The patient subsequently received adjuvant radiotherapy. This case demonstrated that CXPA, although rare, can occur in young adults. Pre-operative FNAC and radiological imaging may mimic a pleomorphic adenoma.

Conclusion

The presence of recurrent tumours with rapid growth should alarm the clinician about a possible malignant transformation of a benign parotid tumour.
Cryoglobulinemia: the “cold” problem in cardiac surgery, a single-center experience and a literature review
Authors: Raimondo Pasquale , Intini Gianmarco , Lauletta Gianfranco , Teora Valentina , Lenoci Sergio Domenico , Rubino Giovanni , Villani Maria Arcangela , Armenise Agnese , Stripoli Antonia , Colantuono Giuseppe , Di Bari Nicola , Fiore Giuseppe , Paternoster Gianluca , Grasso Salvatore
Published: January 2024

Cardiac surgery with cardiopulmonary bypass (CBP) is essential for different cardiac procedures in order to perform surgery with a clear sight field.

To safely perform surgery with CPB and preserve brain, kidney, and patient tissue from ischemic damage, cold cardioplegia, and mild to deep hypothermia are induced during the operation.

Cryoglobulinemia is a hematological/infective-related disease (in certain cases idiopathic) in which temperature-dependent antibodies tend to aggregate and form emboli in the vascular system causing tissue damage if exposed to low temperature.

The patient with cryoglobulinemia (known and unknown) can be at risk of a major ischemic event during CPB and induced hypothermia.

This article’s aim is to evaluate the present scientific literature in order to understand how, in years, the therapeutic or preventive approach, is evolving, and to analyze and make improvements to the management of a cryoglobulinemic patient who must undergo elective or emergency cardiac surgery.

In the last part of our article, we expose our single-center experience during a 32-month-long period of survey.

In all cases, our medical team (anesthesiologists, perfusionists, and cardiac surgeons) opted for a normothermic cardiopulmonary bypass to lower the risk of cryoglobulin-associated complications.

In our experience, along with therapeutic intervention to lower the cryoglobulin titer, normothermic management of cardiopulmonary bypass is as safe as hypothermic management.

Notwithstanding our results, further studies with a larger population are needed to confirm this perioperative management in a cardiac surgery setting.
Characterization of cannabis withdrawal symptoms and serum levels of neurotransmitters
among cannabis-dependent smokers during sustained abstinence within a controlled residential
environment
Authors: Sharma R. , Tikka S. K. , Bhute A. R. , Dhamija P. , Bastia B. K.
Published: January 2024

Introduction

Cannabis (aka marijuana) is the most frequently consumed illicit substance worldwide,
and a subset of frequent cannabis smokers (up to 30%) develop dependence. A less well-known
consequence of cannabis dependence is withdrawal syndrome, characterized by a time-dependent
constellation of symptoms (Lafaye et al. Dialogues Clin Neurosci 2017;19(3),
309-316).

Objectives

This study aims to prospectively assess the course of cannabis withdrawal symptoms
within a controlled inpatient detoxification setting and to correlate the severity of
withdrawal symptoms with the serum levels of neurotransmitters (NT).

Methods

N=45 treatment-seeking chronic cannabis dependents (assessed by ICD-10) were enrolled,
and their withdrawal symptoms were assessed prospectively from admission (Day-0) to 28 days
using Marijuana withdrawal checklist (MWC). Sociodemographic characteristics and
self-reported drug use histories were reported. Serum levels of dopamine, serotonin,
norepinephrine, epinephrine, and cortisol were measured. Cannabis abstinence symptoms were
assessed daily using MWC for 4 weeks, and serum neurotransmitter levels were analyzed at
admission (Day 0), 7, 14, 21, and 28. Comparison between groups was done using Friedman’s
test. Correlation between NT level and MWC scores was performed using linear regression
spearman correlation analysis

Results

The follow-up NT levels from Day 0 to 28 showed a significant (p<0.05) decrease in
serotonin and dopamine, whereas epinephrine levels showed a significant increase (Fig 1) with
the course of withdrawal. Withdrawal symptoms like decreased appetite, sweating, and craving
were significantly and positively correlated with serotonin, dopamine, and epinephrine NT
levels (Fig 2).

Image:

Image 2:

Conclusions

Findings support the presence of clinically significant cannabis withdrawal symptoms
with NT levels in subjects with cannabis dependence seeking substance abuse treatment. The
data of this study determine the relationship between observed withdrawal symptoms and
changes in brain chemistry and evaluate its possible utility as a predictor of
relapse.

Disclosure of Interest

None Declared
A case of Pathological Laughter in a patient with recurrent stroke
Authors: Lakhotia S. , Parikh M. N.
Published: January 2024

Introduction

Stroke survivors frequently deal with neuropsychiatric sequelae - depression, anxiety
and apathy being the most common ones. Pathological laughing and crying (PLC) is a post
stroke condition characterized by brief, intense uncontrollable crying and/or laughing due to
a neurological disorder. Prevalence of PLC post stroke has been reported to be 15-20%.
Pathological laughter (PL) is commonly associated with bilateral or diffuse cerebral lesions.
Ischemic injury involving the internal capsule and basal ganglia seems to be associated with
emotional disorders.

Objectives

To discuss an uncommon case of pathological laughter developing after recurrent
infarct.

Methods

A 32-year-old male patient presented to the medical emergency for complaints of
slurring of speech since 7 hours. On examination, patient was alert, oriented, with blood
pressure 150/90 mmHg. He had a history of similar stroke 2 years prior to current complaints
and was on treatment for hypertension since then.

Baseline investigations were done. MRI brain revealed acute lacunar
infarcts in bilateral ganglio-capsular region, chronic small vessel ischaemic
changes in B/L periventricular white matter (Fazeka grade 2) and micro-haemorrhages in
various brain regions. Patient was managed conservatively (antiplatelets, statins,
antihypertensives).

Patient was then referred to Psychiatry department for uncontrollable laughing spells,
which started few hours after onset of above complaints. These occurred without any
provocation, every 1-2 hours, lasting for several seconds to a minute, and relieved
spontaneously. Patient was aware of episodes and found them embarrassing socially. Mental
status examination revealed no mood features or other abnormalities.

Patient was prescribed Escitalopram, but shifted to homeopathic medicine and was lost
to follow up. Telephonic interview one year later revealed that while other complaints have
remitted, patient still has laughing spells of similar quality and frequency.

Results

Discussion: In post stroke PLC, pathological crying represents about 80% cases, while
Pure Pathological Laughing, as in the present case, is uncommon. It is generally seen in
diffuse CNS pathologies (eg. multiple sclerosis) or bilateral – ischaemic or
degenerative.

In case of strokes, PL may herald symptom onset, or may immediately follow focal
deficits. The aetiology of PLC is unknown; monoaminergic neurotransmission may be altered in
post stroke PLC. SSRIs are regarded as first choice treatment agents, given their greater
tolerability overall.

Conclusions

Pathological laughter is a comparatively uncommon but recognisable and treatable post
stroke sequela, more commonly seen in bilateral lesions. Patients often describe PL as
distressing and socially disabling, but awareness about this condition and available
treatments is lacking.

Disclosure of Interest

None Declared
Microsatellite Instability Is Insufficiently Used as a Biomarker for Lynch Syndrome Testing in Clinical Practice
Authors: Papadopoulou Eirini , Rigas George , Fountzilas Elena , Boutis Anastasios , Giassas Stylianos , Mitsimponas Nikolaos , Daliani Danai , Ziogas Dimitrios C , Liontos Michalis , Ramfidis Vasileios , Christophilakis Charalampos , Matthaios Dimitris , Floros Theofanis , Florou-Chatzigiannidou Chrysiida , Agiannitopoulos Konstantinos , Meintani Angeliki , Tsantikidi Aikaterini , Katseli Anastasia , Potska Kevisa , Tsaousis Georgios , Metaxa-Mariatou Vasiliki , Nasioulas George
Published: January 2024

PURPOSE

The pan-cancer presence of microsatellite instability (MSI)–positive tumors demonstrates its clinical utility as an agnostic biomarker for identifying immunotherapy-eligible patients. Additionally, MSI is a hallmark of Lynch syndrome (LS), the most prevalent cancer susceptibility syndrome among patients with colorectal and endometrial cancer. Therefore, MSI-high results should inform germline genetic testing for cancer-predisposing genes. However, in clinical practice, such analysis is frequently disregarded.

METHODS

A next-generation sequencing (NGS)–based technique was used for MSI analysis in 4,553 patients with various tumor types. Upon request, somatic BRAF gene analysis was conducted. In addition, hereditary testing of cancer-associated genes was performed in MSI-high cases using a capture-based NGS protocol. MLH1 promoter methylation analysis was conducted retrospectively in patients with colorectal and endometrial cancer to further investigate the origin of MSI at the tumor level.

RESULTS

The MSI positivity rate for the entire cohort was 5.27%. Endometrial, gastric, colorectal, urinary tract, and prostate cancers showed the highest proportion of MSI-high cases (15.69%, 8.54%, 7.40%, 4.55%, and 3.19%, respectively). A minority of 45 patients (22.73%) among the MSI-high cases underwent germline testing to determine whether the mismatch repair pathway deficiency was inherited. 24.44% of those who performed the genetic test carried a pathogenic variant in an LS-associated gene. Three MSI-high individuals had non-LS gene alterations, including BRCA1, BRCA2, and CDKN2A pathogenic variants, indicating the presence of non–LS-associated gene alterations among MSI-high patients.

CONCLUSION

Although MSI analysis is routinely performed in clinical practice, as many as 77% of MSI-high patients do not undergo LS genetic testing, despite international guidelines strongly recommending it. BRAF and MLH1 methylation analysis could shed light on the somatic origin of MSI in 42.50% of the MSI-high patients; however, MLH1 analysis is barely ever requested in clinical practice.
Effect of a 6-Week Carbohydrate-Reduced High-Protein Diet on Levels of FGF21 and GDF15 in People With Type 2 Diabetes
Authors: Richter Michael M , Thomsen Mads N , Skytte Mads J , Kjeldsen Sasha A S , Samkani Amirsalar , Frystyk Jan , Magkos Faidon , Holst Jens J , Madsbad Sten , Krarup Thure , Haugaard Steen B , Wewer Albrechtsen Nicolai J
Published: January 2024

Context

Fibroblast growth factor 21 (FGF21) and growth differentiation factor 15 (GDF15) are increased in type 2 diabetes and are potential regulators of metabolism. The effect of changes in caloric intake and macronutrient composition on their circulating levels in patients with type 2 diabetes are unknown.

Objective

To explore the effects of a carbohydrate-reduced high-protein diet with and without a clinically significant weight loss on circulating levels of FGF21 and GDF15 in patients with type 2 diabetes.

Methods

We measured circulating FGF21 and GDF15 in patients with type 2 diabetes who completed 2 previously published diet interventions. Study 1 randomized 28 subjects to an isocaloric diet in a 6 + 6-week crossover trial consisting of, in random order, a carbohydrate-reduced high-protein (CRHP) or a conventional diabetes (CD) diet. Study 2 randomized 72 subjects to a 6-week hypocaloric diet aiming at a ∼6% weight loss induced by either a CRHP or a CD diet. Fasting plasma FGF21 and GDF15 were measured before and after the interventions in a subset of samples (n = 24 in study 1, n = 66 in study 2).

Results

Plasma levels of FGF21 were reduced by 54% in the isocaloric study (P < .05) and 18% in the hypocaloric study (P < .05) in CRHP-treated individuals only. Circulating GDF15 levels increased by 18% (P < .05) following weight loss in combination with a CRHP diet but only in those treated with metformin.

Conclusion

The CRHP diet significantly reduced FGF21 in people with type 2 diabetes independent of weight loss, supporting the role of FGF21 as a “nutrient sensor.” Combining metformin treatment with carbohydrate restriction and weight loss may provide additional metabolic improvements due to the rise in circulating GDF15.
Βιβλιοκρισία: Δ. ΚΑΚΛΑΜΑΝΟΣ, Ο Άγιος Θεόδωρος ο Στουδίτης και το αγιολογικό του έργο. Συμβολή στη μελέτη της εκκλησιαστικής γραμματείας της μεσοβυζαντινής περιόδου, [Ανάλεκτα Βλατάδων 70], Πατριαρχικόν Ίδρυμα Πατερικών Μελετών, Θεσσαλονίκη 2018
Authors: ΠΕΤΡΟΥΓΑΚΗ-ΚΑΛΑΪΤΖΑΝΤΩΝΑΚΗ Δέσποινα
Published: January 2024

Βιβλιοκρισία: Δ. Κακλαμάνος, Ο Άγιος Θεόδωρος ο Στουδίτης και το    αγιολογικό του έργο. Συμβολή στη μελέτη της εκκλησιαστικής γραμματείας της μεσοβυζαντινήςπεριόδου, [Ανάλεκτα Βλατάδων 70], Πατριαρχικόν Ίδρυμα Πατερικών Μελετών, Θεσσαλονίκη 2018
Ναυτική διαιτησία, το δικαίωμα στην παροχή δικαστικής προστασίας των απασχολούμενων στο ιδιόμορφο φαινόμενο των ναυτιλιακών συναλλαγών, η νέα αναδυόμενη διεθνής τάξη και οι προοπτικές της διεθνούς θεσμικής ναυτικής διαιτησίας στον Πειραιά
Authors: Δούκας Παναγιώτης
Published: January 2024

Η θεσμική διεθνής ναυτική διαιτησία, είναι αρχέγονος και αυτοφυής suigeneris θεσμός, που λειτουργεί στα πλαίσια της αυτορυθμιστικής λειτουργίας της διεθνούς επιχειρηματικής κοινότητας του θαλασσίου εμπορίου, προορισμένος να συμβάλει, αποτελεσματικά, στην επίλυση διαφορών μεταξύ των μελών της, συνάδουσα με την ελληνική συνταγματική τάξη, συμπέρασμα το οποίο συνάγεται με την επισκόπηση του συγκεκριμένου θεσμού υπό το πρίσμα της συμβατότητας με τις γενικές αρχές, οι οποίες απορρέουν από την έννοια του κράτους δικαίου και οι οποίες συγκροτούν την εγχώρια έννομη τάξη. Με την προσφυγή στην θεσμική ναυτική διαιτησία, υλοποιείται το συνταγματικό δικαίωμα στην παροχή δικαστικής προστασίας των συναλλασσομένων στο ιδιόμορφο φαινόμενο των διεθνών ναυτιλιακών συναλλαγών, κυρίως, όμως, η άσκηση του δικαιώματος αυτού, αποτελεί αυτόθροη συνέπεια της σύμφυτης, με την εγγενή ελευθερία και της αυτονομίας της βούλησής των, πρόθεσής τους να αποφύγουν το εξαναγκαστικό, αυτοσυντηρούμενο και ανεπαρκές κρατικό μονοπώλιο απονομής δικαιοσύνης, μέσω της παράλληλης μακρόχρονης δημιουργίας εξωκρατικών δικαστικών μηχανισμών επίλυσης διαφορών, αλλά και της αποτελεσματικότητας της λειτουργίας του θεσμού στην διεθνή ναυτιλιακή επιχειρηματική δραστηριότητα, η οποία προκύπτει μετά από αξιολόγησή του σύμφωνα με τις γενικές αρχές της θεωρίας της οικονομικής ανάλυσης του δικαίου. Έτσι ο θεσμός αυτός, ως αποκύημα της διαχρονικής εξέλιξης του ναυτικού εθίμου, εκφεύγει της επιρροής κάθε εθνικού δικαίου για να υποβληθεί στο υπερεθνικό δίκαιο της Lex Maritima, διαρθρωμένος σε ένα αυτόνομο διεθνές δικαιοδοτικό σύστημα, παράλληλο προς τις εθνικές δικαιοδοτικές τάξεις, με την έννοια της δημόσιας τάξης να συνιστά το μέτρο που καθορίζει την έκταση του ελέγχου της διαιτητικής απόφασης, όταν συμπλέκονται η θεσμική διεθνής ναυτική δικαιοδοτική και η εθνική έννομη τάξη. Η δημιουργία ενός ελκυστικού θεσμικού περιφερειακού ναυτικού διαιτητικού κέντρου στον Πειραιά, με τα λειτουργικά εργαλεία του Fast Track Arbitration και Med-Arb,μετά απόαναλογική εφαρμογή των μεθόδων της ναυτικής διαμεσολάβησης στη ναυτική διαιτησία, θα συντελέσει, ούτως ώστε, παράλληλα με την ελληνική παντοκρατορία στο διεθνές θαλάσσιο εμπόριο και με εκμετάλλευση της προέχουσας γεωοικονομικής θέσης της Ελλάδας στην ανατολική Μεσόγειο και τα Βαλκάνια και με την ταυτόχρονη δημιουργία ενός πλέγματος παροχής υψηλού επιπέδου υπηρεσιών στη ναυτιλία, κυρίων και άλλων βοηθητικών για την ναυτιλία υπηρεσιών, να δημιουργηθεί προέχουσα, παγκοσμίως, δομή θεσμικής ναυτικής διαιτησίας ανταγωνιστικής της αντίστοιχης Αγγλικής, η οποία αν και κατέχει τα σκήπτρα τυγχάνει εξαιρετικά χρονοβόρα και δαπανηρή, για να υπερκεραστεί η παραδοσιακή επιφυλακτικότητα των Ελλήνων εφοπλιστών στους ελληνικούς σχετικούς θεσμούς.