bluuebunny/crossref_metadata_2025 huggingface dataset:
A Curriculum Batching Strategy for Automatic ICD Coding with Deep Multi-Label Classification Models
Authors: Wang Yaqiang , Han Xu , Hao Xuechao , Zhu Tao , Shu Hongping
Published: November 2022

The International Classification of Diseases (ICD) has an important role in building applications for clinical medicine. Extremely large ICD coding label sets and imbalanced label distribution bring the problem of inconsistency between the local batch data distribution and the global training data distribution into the minibatch gradient descent (MBGD)-based training procedure for deep multi-label classification models for automatic ICD coding. The problem further leads to an overfitting issue. In order to improve the performance and generalization ability of the deep learning automatic ICD coding model, we proposed a simple and effective curriculum batching strategy in this paper for improving the MBGD-based training procedure. This strategy generates three batch sets offline through applying three predefined sampling algorithms. These batch sets satisfy a uniform data distribution, a shuffling data distribution and the original training data distribution, respectively, and the learning tasks corresponding to these batch sets range from simple to complex. Experiments show that, after replacing the original shuffling algorithm-based batching strategy with the proposed curriculum batching strategy, the performance of the three investigated deep multi-label classification models for automatic ICD coding all have dramatic improvements. At the same time, the models avoid the overfitting issue and all show better ability to learn the long-tailed label information. The performance is also better than a SOTA label set reconstruction model.
The Social Legitimacy of Pain: Protocol for a Systematic Literature Review
Authors: Serrano-Gemes Gema , Vizcaíno-Cuenca Rocío , Serrano-del-Rosal Rafael
Published: November 2022

Introduction: Pain is a perception conditioned both by the subjective experience of the sufferer and their social context. A preliminary literature search suggests that, today, information about the social legitimacy of pain is scarce, although it is known that this phenomenon is an element that is closely linked to the type of pain and contributes to the sufferer’s experience. Thus, our objective is to explore how the social legitimacy of pain is tackled in the scientific literature. Methods: This study is a protocol for a systematic literature review where six databases were reviewed: Pubmed, Web of Science, Scielo, Scopus, PsycInfo, and CINAHL, were searched for papers dealing with the social legitimacy of pain from any discipline/study design. The obtained papers will be exported to Zotero, where the duplicates will be deleted. Later, the studies of interest will be selected, first on the basis of their titles/abstracts, and, later, on the complete text. This process will be carried out in pairs. Finally, the data of interest will be extracted, analyzing their quality, to finally make a qualitative analysis of the results. Discussion: This will be the first review to systematically explore the available evidence on the social legitimacy of pain. Therefore, it will be able, not only to extend the theoretical knowledge on this phenomenon, but also to extend its visibility, which will make it possible for the social legitimacy of pain to be studied from different disciplines and fields, thus improving the way it is approached.
Effectiveness of Blood Flow Restriction in Neurological Disorders: A Systematic Review
Authors: Vinolo-Gil Maria Jesus , Rodríguez-Huguet Manuel , Martin-Vega Francisco Javier , Garcia-Munoz Cristina , Lagares-Franco Carolina , Garcia-Campanario Ismael
Published: November 2022

There is scientific evidence that Blood Flow Restriction (BFR) is beneficial in healthy people, the elderly and patients with musculoskeletal disorders. A systematic review was conducted to evaluate the effectiveness of BFR in patients with neurological disorders. The literature search was conducted up until July 2022 in the following databases: PubMed, Web of Science (WOS), Physiotherapy Evidence Database (PEDro), LILACS, Scopus, Cumulative Index of Nursing and Allied Literature Complete (CINAHL), the Cochrane Library and Scientific Electronic Library Online (SciELO). The PEDro scale was used to analyze the methodological quality of the studies, and the Cochrane Collaboration’s tool was employed to evaluate the risk of bias. A total of seven articles were included. BFR seems to be beneficial in neurological disorders. Improvements have been found in sensorimotor function, frequency and step length symmetry, perceived exertion, heart rate and gait speed, walking endurance, fatigue, quality of life, muscles thickness, gluteus density and muscle edema. No improvements were found in lower limb strength or balance. However, results must be taken with caution due to the small number of articles and to the large heterogeneity. More clinical trials are needed. These studies should homogenize the protocols used in larger samples, as well as improve their methodological quality.
Unveiling the Predisposing Factors for the Development of Branch Canker and Dieback in Avocado: A Case of Study in Chilean Orchards
Authors: Valencia Ana L. , Saavedra-Torrico Jorge , Rosales Inés Marlene , Mártiz Johanna , Retamales Alonso , Link Andrés , Gil Pilar M.
Published: November 2022

Chilean avocado orchards have been affected by branch canker and dieback, mainly associated with pathogens species of the family Botryosphaeriaceae. Producers often relate water stress to these phenomena; however, predisposing factors for these diseases in Chilean orchards have not been reported. Therefore, the objective of this study was to identify the main climate, planting, and management variables associated with branch canker and dieback in Chilean avocado orchards. Multivariable statistical analyses (PCA and PLS-DA) were performed to analyze 76 variables possibly associated with the incidence of these diseases during two consecutive growing seasons. Our findings indicated that branch canker and dieback are mainly conditioned by orchard variables such as plant age, canopy volume, trunk diameter, leaf area index, and planting density. Variables associated with aged orchards, such as high age, high canopy volume, and high trunk diameter, appeared to be more associated with high incidence levels than were younger orchards with higher planting densities and high tree vigor levels. In addition, abiotic stresses, such as frost and overirrigation, were associated as secondary factors affecting these diseases’ development in avocado orchards. Moreover, this study allowed us to determine that branch canker and dieback can develop indistinctly in the different Chilean agroclimatic zones.
Growth Analysis of Plant Factory-Grown Lettuce by Deep Neural Networks Based on Automated Feature Extraction
Authors: Moon Taewon , Choi Woo-Joo , Jang Se-Hun , Choi Da-Seul , Oh Myung-Min
Published: November 2022

The mechanisms of lettuce growth in plant factories under artificial light (PFALs) are well known, whereby the crop is generally used as a model in horticultural science. Deep learning has also been tested several times using PFALs. Despite their numerous advantages, the performance of deep learning models is commonly evaluated based only on their accuracy. Therefore, the objective of this study was to train deep neural networks and analyze the deeper abstraction of the trained models. In total, 443 images of three lettuce cultivars were used for model training, and several deep learning algorithms were compared using multivariate linear regression. Except for linear regression, all models showed adequate accuracies for the given task, and the convolutional neural network (ConvNet) model showed the highest accuracy. Based on color mapping and the distribution of the two-dimensional t-distributed stochastic neighbor embedding (t-SNE) results, ConvNet effectively perceived the differences among the lettuce cultivars under analysis. The extension of the target domain knowledge with complex models and sufficient data, similar to ConvNet with multitask learning, is possible. Therefore, deep learning algorithms should be investigated from the perspective of feature extraction.
Using Mixed Methods to Understand Spatio-Cultural Process in the Informal Settlements: Case Studies from Islamabad, Pakistan
Authors: Shafqat Ramisa , Marinova Dora
Published: November 2022

A mixed-methods approach is used to understand the human factors defining cultural heritage in two informal settlements in Islamabad, Pakistan, namely France Colony and Mehr Abadi. The methodology applied is based on spatial investigation within a placemaking framework to create a visual representation of the neighborhoods, and grounded theory to explore the experiences and memories of their inhabitants through verbal communication. A combination of techniques, including transect walks, photography, and on-site interviews, allows us to map the tangible and intangible elements of the informal settlements. Cultural characteristics are identified as essential in the spatio-cultural processes occurring in the informal settlements. The study concludes that cultural dilapidation happens because of obstructions in the processes translating intangible heritage into tangible space. Appropriate policy interventions are suggested to minimize the loss of rural heritage transfer to informal settlements within the urban fabric of Islamabad.
Assessment of Atmospheric Correction Processors and Spectral Bands for Satellite-Derived Bathymetry Using Sentinel-2 Data in the Middle Adriatic
Authors: Vrdoljak Ljerka , Kilić Pamuković Jelena
Published: November 2022

Satellite-derived bathymetry (SDB) based on multispectral satellite images (MSI) from the satellite’s optical sensors is a recent technique for surveying shallow waters. Sentinel-2 satellite mission with an open access policy and high spatial, radiometric, and temporal resolution of MSI-s started a new era in the mapping of coastal bathymetry. More than 90 percent of the electromagnetic (EM) signal received by satellites is due to the atmospheric path of the EM signal. While Sentinel-2 MSI Level 1C provides top-of-atmosphere reflectance, Level 2A provides bottom-of-atmosphere reflectance. The European Space Agency applies the Sen2Cor algorithm for atmospheric correction (AC) to model the atmospheric path of the signal and reduce the MSI reflectance from L1C to L2A over the land area. This research evaluated the performance of different image-based AC processors, namely: Sen2Cor, Acolite, C2RCC, and iCOR for SDB modelling. The empirical log band ratio algorithm was applied to a time series of Sentinel-2 MSI in the middle Adriatic. All AC processors outperformed Sentinel-L2A MSI for SDB. Acolite and iCOR demonstrated accurate performance with a correlation coefficient higher than 90 percent and the RMSE under 2 m for depths up to 20 m. C2RCC produced more robust bathymetry models and was able to retrieve the depth information from more scenes than any other correction. Furthermore, a switch model combining different spectral bands improved mapping in shallow waters, demonstrating the potential of SDB technology for the effective mapping of shallow waters.
The Association between the Respiratory System and Upper Limb Strength in Males with Duchenne Muscular Dystrophy: A New Field for Intervention?
Authors: Sobierajska-Rek Agnieszka , Wasilewska Eliza , Śledzińska Karolina , Jabłońska-Brudło Joanna , Małgorzewicz Sylwia , Wasilewski Andrzej , Szalewska Dominika
Published: November 2022

Progressive, irreversible muscle weakness is the leading symptom of Duchenne muscular dystrophy (DMD), often resulting in death from respiratory muscle failure. Little is known about the relationship between the functioning of the respiratory system and the hand grip—a function which remains long preserved. This study aimed to investigate the interdependence between muscle strength and the function of both hand grip and the respiratory system in patients with DMD. Materials and Method: The study included cohort patients, aged 6–17, with DMD, recruited from the Rare Disease Centre, Gdansk, Poland. Clinical status (Vignos scale, Brook scale), pulmonary function (respiratory muscle strength—MIP, MEP); spirometry (FEV1; FVC), as well as upper limb function (performance of the upper limb—PUL 2.0) and hand grip strength (HGS) (hand-held dynamometer) were evaluated in all participants. Results: Finally, 53 boys (mean age 11.41 ± 3.70 years, 25 non-ambulant) were included. Each of the participants presented a lower %pv of MIP (48.11 ± 27), MEP (38.11 ± 22), PUL (75.64 ± 27), and HGS (33.28 ± 18). There were differences between the ambulatory and non-ambulatory groups in values of MIP, MEP, FVC, PUL, HGS (p < 0.001 for all), and FEV1 (p < 0.013). There were correlations between PUL, HGS, and MIP (R = 0.56; R = 0.61, p < 0.001 both), MEP (R = 0.59; R = 0.62, p < 0.001), FVC (R = 0.77; R = 0.77, p < 0.001), and FEV1 (R = 0.77; R = 0.79; p < 0.001). These correlations were found for all participants, but non-ambulatory patients presented stronger relationships. Conclusions: 1. The pulmonary and upper limb functions were within the normal range in ambulatory and low in non-ambulatory patients with DMD, but the muscle strength of both systems was low, regardless of the stage of the disease. 2. There seems to be an interdependence between the respiratory system and upper limb strength in terms of muscle strength and function in DMD patients, which is stronger in non-ambulatory patients. This may be the basis for the creation of a new personalized plan in rehabilitation—the simultaneous rehabilitation of the respiratory and upper limb muscles. Further studies on this theory should be conducted.
Assessing the Content Quality of Online Parental Resources about Newborn Metabolic Disease Screening: A Content Analysis
Authors: Ngan Olivia M. Y. , Wong Wing Ki , Tam Janice Ching , Li Chi Kong
Published: November 2022

Parents increasingly utilise the internet to obtain information on health practices, but the quality of online information about screening for inherited metabolic diseases (IMD) needs to be improved. A content analysis examined how IMD blood and urine tests were described online in local healthcare sectors between May and June 2021. Among the nine resources, four were blood test providers and five were urine test providers. All mentioned the test benefits and procedures. Other information, such as false-positive/negative or risk of pain, was infrequently mentioned. The descriptions of urine tests are advertised as outperforming blood tests and can be purchased from commercial laboratory sites without medical guidance. Two urine test providers claimed no false results were reported. A few commercial advertisements highlighted the simplicity of the urine test and potentially overstated the invasiveness of the blood test. We found that some advertisements described IMD as “silent killers” and emphasised the advantage of getting “reassurance” in controlling the child’s developmental health and well-being. To better protect the parents, or broadly, the public interest, regulatory and oversight measures on the urine tests should be implemented to promote the proper use of genetic tests. Without timely regulation and oversight, the incorrect descriptions might create a public misconception about utilising these commercial laboratory tests to inform health decisions.
Generalized Zero-Shot Learning for Image Classification—Comparing Performance of Popular Approaches
Authors: Saad Elie , Paprzycki Marcin , Ganzha Maria , Bădică Amelia , Bădică Costin , Fidanova Stefka , Lirkov Ivan , Ivanović Mirjana
Published: November 2022

There are many areas where conventional supervised machine learning does not work well, for instance, in cases with a large, or systematically increasing, number of countably infinite classes. Zero-shot learning has been proposed to address this. In generalized settings, the zero-shot learning problem represents real-world applications where test instances are present during inference. Separately, recently, there has been increasing interest in meta-classifiers, which combine the results from individual classifications to improve the overall classification quality. In this context, the purpose of the present paper is two-fold: First, the performance of five state-of-the-art, generalized zero-shot learning methods is compared for five popular benchmark datasets. Second, six standard meta-classification approaches are tested by experiment. In the experiments undertaken, all meta-classifiers were applied to the same datasets; their performance was compared to each other and to the original classifiers.
Nonstoichiometric Strontium Ferromolybdate as an Electrode Material for Solid Oxide Fuel Cells
Authors: Suchaneck Gunnar , Artiukh Evgenii
Published: November 2022

This review is devoted to the application of Sr2FeMoO6−δ (SFM) and Sr2F1.5Mo0.5O6−δ (SF1.5M) in La1−xSrxGa1−yMgyO3−δ (LSGM)-based SOFCs. We consider the most relevant physical properties (crystal structure, thermodynamic stability, iron and molybdenum valence states, oxygen vacancy formation and oxygen non-stoichiometry, electrical conductivity), A- and B-site ion substitution, and the performance of SF1+xM SOFCs (polarization resistance, operation with hydrogen, operation with hydrocarbons and methanol). Their properties can be tailored to a particular application by the substitution of different metal cations into their lattices. SF1+xM materials are excellent catalysts in hydrocarbon oxidation and can prevent carbon deposition due to the ability to exchange lattice oxygen with the gaseous phase. Moreover, they are sulfur tolerant. This opens the way to direct hydrocarbon-fueled SOFCs, eliminating the need for external fuel reforming and sulfur removal components. Such SOFCs can be greatly simplified and operate with much higher overall efficiency, thus contributing to the solution to the lack of energy problem in our modern world.
Composites Based on Polylactide Doped with Amorphous Europium(III) Complex as Perspective Thermosensitive Luminescent Materials
Authors: Knyazev Andrey A. , Krupin Aleksandr S. , Galyametdinov Yuriy G.
Published: November 2022

This work reports fabrication of polylactide (PLA) films doped with various additives of an amorphous Eu(III) complex. We study the temperature behavior of the luminescence intensity and lifetime of the PLA-Eu(III) composites in the range of 298–353 K and investigate the mechanism of luminescence temperature quenching. The peak relative sensitivity of the films reaches 20.1 %×K−1 and exceeds the respective characteristics of all known lanthanide-containing thermosensors designed for the range of physiological temperatures. The produced films can be potential novel materials for luminescent thermosensors.
The Gut Bacterial Community of Chlaenius pallipes (Coleoptera: Carabidae) Associates with Their Habitat and Morphology
Authors: Do Yuno , Park Jun-Kyu , Park Woong-Bae , Kim Min-Seob
Published: November 2022

We investigated whether the gut bacterial community of Chlaenius pallipes could represent the health conditions of individuals or populations based on where these beetles inhabit. Considering the ecological traits of the species, the gut bacterial communities of carabid populations inhabiting stable or unstable habitats were compared. Food resource quality (δ15N) and morphological shape, especially body and wing size, may be significant factors that directly or indirectly affect the gut bacterial community of carabid beetles. Firmicutes (51.7%) and Proteobacteria (36.3%) were the predominant phyla in the gut bacterial community of C. pallipes. A significant difference in the gut bacterial community structure was observed between organisms inhabiting unstable and stable habitats in this study. Wing size, as estimated by centroid size, was correlated with differences in the gut bacterial community composition of the species. Even if a factor is not strong enough to determine the survival of carabid beetles, the composition of the gut bacterial community can change. We found that although each individual has a large variation in the gut bacterial community composition, the gut bacterial community can be used to evaluate the condition of each habitat through consistent investigation. Habitat assessment based on changes in the number of carabid beetle species and their composition requires relatively long-term research; however, the gut bacterial community of carabid beetles can help identify short-term environmental changes.
Trunk Injection with Insecticides Manages Xylotrechus chinensis (Chevrolat) (Coleoptera: Cerambycidae)
Authors: Kavallieratos Nickolas G. , Boukouvala Maria C. , Skourti Anna , Nika Erifili P. , Papadoulis Georgios Th.
Published: November 2022

Xylotrechus chinensis (Chevrolat) (Coleoptera: Cerambycidae) is a serious wood-boring insect of mulberry trees (Morus spp.). Larvae of this species enter the trunk of the tree and feed on woody tissues. Xylotrechus chinensis is endemic in several Asian countries, while, in the last decade, it invaded Europe. In the present work, we evaluated trunk injection against this pest. The systemic insecticides fipronil, imidacloprid, and spirotetramat were used in the trials. Abamectin was used as a positive control since it has been found to be effective for the management of X. chinensis. Imidacloprid and fipronil proved to be highly effective against this species in both years (9.5 and 12.1 exit holes/tree in 2021, 5.0 and 8.8 exit holes/tree in 2022, respectively), while spirotetramat was the least effective. The lowest mean number of exit holes was recorded when abamectin was applied in both years (4.7 exit holes/tree in 2021 and 3.3 exit holes/tree in 2022). The percentage of exit holes was reduced by 76.1, 71.8, and 85.6% in trees treated with imidacloprid, fipronil, and abamectin, respectively, after two years of application, while spirotetramat caused a 37.4% reduction. Trunk injection with imidacloprid, fipronil, and abamectin could be used against X. chinensis for long-term control of mulberry trees.
Measuring the Beam Energy in Proton Therapy Facilities Using ATLAS IBL Pixel Detectors
Authors: Schilling Isabelle , Bäcker Claus Maximilian , Bäumer Christian , Behrends Carina , Hötting Marius , Hohmann Jana , Kröninger Kevin , Timmermann Beate , Weingarten Jens
Published: November 2022

The accurate measurement of the beam range in the frame of quality assurance (QA) is a requirement for clinical use of a proton therapy machine. Conventionally used detectors mostly estimate the range by measuring the depth dose distribution of the protons. In this paper, we use pixel detectors designed for individual particle tracking in the high-radiation environment of the ATLAS experiment at LHC. The detector measures the deposited energy in the sensor for individual protons. Due to the limited dynamic energy range of the readout chip, several ways to measure the proton energy or range are examined. A staircase phantom is placed on the detector to perform an energy calibration relative to the NIST PSTAR stopping power database. In addition, track length measurements are performed using the detector aligned parallel with the beam axis to investigate the Linear Energy Transfer (LET) per pixel along the trajectory of individual protons. In this proof-of-principle study, we show that this radiation hardness detector can successfully be used to determine the initial proton energy for protons impinging on the sensor with an energy below 44 MeV after the range shifters. It becomes clear that an improvement of the energy resolution of the readout chip is required for clinical use.
Incarcerated Brazilian Elderly: Memories about Family
Authors: Lima Pollyanna , Oliveira Alessandra , Reis Luana , Lopes Arianna , Santana Elaine , Nobre Thaiza , Reis Luciana
Published: November 2022

This article aims to analyze the memories of incarcerated elderly people about family. This is an exploratory and analytical study, with a qualitative approach, carried out in three prison units in Bahia, with 31 incarcerated elderly people, through semi-structured interview. Most are male (30), between 60 to 65-years-old (21), married (12) and with three to four children (10). The results show that the 10 most evoked words were: family; sons; mom; father; women; life; cry; today; brothers; and longing. The study showed that the family constitution is maintained because the experiences that are symbolized in it have socially crystallized definitions as references. Anchored by social frames of memories that remain, since they remain alive in the groups and are permanently maintained. It was also found that the family plays an extremely important role in their lives and that the mother is the central point of this family.
Maternal Inherited Thrombophilia in Monochorionic Twin Pregnancy with Twin-Twin Transfusion Syndrome
Authors: Giannubilo Stefano R. , Fiorelli Alessia , Marzioni Daniela , Tossetta Giovanni , Capogrosso Giulia , Ciavattini Andrea
Published: November 2022

Background: To study the frequency of inherited thrombophilia in monochorionic twin pregnancies with twin-twin transfusion syndrome (TTTS). Methods: At the Department of Obstetrics of the Polytechnic University of Marche (Ancona, Italy) a population of monochorionic diamniotic pregnant women was selected retrospectively. After termination of the pregnancy, genotyping for Factor I, Factor V Leiden, Factor II and Methylenetetrahydrofolate Reductase (MTHFR), as well as activities of the plasma proteins C and S, was performed. Results: Regarding the 32 patients with TTTS, from a cohort of 104 monochorionic pregnancies recruited, at least one thrombophilic defect was more frequent (OR: 3.24), and the allele polymorphism frequency was higher for Factor I (OR: 4.4) and for Factor V Leiden (OR: 11.66). Conclusions: Maternal inherited thrombophilia, possibly also inherited from monochorial fetuses, may result in impaired development of the placental vascular architecture. This inheritance hypothesis may explain why only a fraction of monochorionic diamniotic twins develop TTTS.
Post-Transplant Lymphoproliferative Disorder: A Rare Case of CNS Involvement following Renal Transplant
Authors: Feindt Austin , Lara-Velazquez Montserrat , Alkhasawneh Ahmad , Rao Dinesh , Makary Raafat , Dombrowski Keith , Tavanaiepour Daryoush , Rahmathulla Gazanfar
Published: November 2022

Background: Post-transplant lymphoproliferative disorders (PTLD) are rare immunosuppression complications affecting 5% of transplant patients. Isolated central nervous system (CNS)-PTLD without nodal or extra-nodal organ involvement is rarely reported and is difficult to diagnose due to the non-specific clinical manifestations and imaging features overlapping with other common CNS lesions. Case presentation: We present a case of a 72-year-old female subjected to a renal transplant 11 years ago with progressively worsening headaches and confusion. Imaging revealed vasogenic edema in the left frontal and bilateral temporal lobes. She was subjected to a craniotomy and excisional biopsy to obtain tissue for diagnostic and therapeutic interventions. Pathology examination showed atypical EBV-positive lymphoplasmacytic infiltrate, consistent with Polymorphic type PTLD. Conclusions: Patients diagnosed with PTLD need to have close monitoring of immunosuppressive medications while in the hospital. Early diagnosis is essential for patient survival with PTLD, as their health can deteriorate fast.
Pharmacological Interventions for Opioid-Induced Hyperalgesia: A Scoping Review of Preclinical Trials
Authors: Koponen Mia Elena , Forget Patrice
Published: November 2022

Background: Opioid analgesics are the most effective pharmacological agents for moderate and severe pain. However, opioid use has several limitations such as opioid-induced hyperalgesia (OIH), which refers to the increased pain sensitivity that occurs once analgesia wears off after opioid administration. Several pharmacological interventions have been suggested for OIH, but the current literature does not provide guidelines on which interventions are the most effective and whether they differ depending on the opioid that induces hyperalgesia. This scoping review aimed to identify and describe all the preclinical trials investigating pharmacological interventions for OIH caused by remifentanil, fentanyl, or morphine as the first step towards evaluating whether the most effective OIH interventions are different for different opioids. Methods: Electronic database searches were carried out in Embase, PubMed, and Web of Science. Detailed data extraction was conducted on the eligible trials. Results: 72 trials were eligible for the review. Of these, 27 trials investigated remifentanil, 14 trials investigated fentanyl, and 31 trials investigated morphine. A total of 82 interventions were identified. The most studied interventions were ketamine (eight trials) and gabapentin (four trials). The majority of the interventions were studied in only one trial. The most common mechanism suggested for the interventions was inhibition of N-methyl-D-aspartate (NMDA) receptors. Conclusion: This scoping review identified plenty of preclinical trials investigating pharmacological interventions for OIH. Using the current literature, it is not possible to directly compare the effectiveness of the interventions. Hence, to identify the most effective interventions for each opioid, the interventions must be indirectly compared in a meta-analysis.
Is the Pandemic Wearing Us Out? A Cross-Sectional Study of the Prevalence of Fatigue in Adult Twins without Previous SARS-CoV-2 Infection
Authors: Rupp Sophia Kristina , Weimer Katja , Goebel-Stengel Miriam , Enck Paul , Zipfel Stephan , Stengel Andreas
Published: November 2022

During the pandemic, mental health was not only impaired in people after a SARS-CoV-2 infection, but also in people without previous infection. This is the first study on twins without prior SARS-CoV-2 infection to estimate the influence of genetic components and shared as well as individual environments on pandemic-associated fatigue. The study sample included 55 monozygotic and 45 dizygotic twin pairs. A total of 34.5% reported an increase in fatigue since the pandemic. A significant correlation was shown between the responses within monozygotic (χ2[1] = 11.14, p = 0.001) and dizygotic pairs (χ2[1] = 18.72, p < 0.001). In all pandemic-associated fatigue dimensions, individual environment (ranging from e2 = 0.64 to e2 = 0.84) and heritability (ranging from h2 = 0.32 to h2 = 1.04) seem to have the highest impact. The number of comorbidities significantly correlated with physical fatigue (Spearman’s ρ = 0.232, p < 0.001) and psychological impairment due to pandemic measures with the total fatigue score (Spearman’s ρ = 0.243, p < 0.001). However, calculated ANCOVAs with these significant correlations as covariates showed no significant influence on the mean values of the respective fatigue dimensions. Susceptibility to pandemic-associated fatigue may be genetically and environmentally determined, while intensity is also influenced by individual components. The prevalence of fatigue is high even in individuals without prior SARS-CoV-2 infection. Future mental health prevention and intervention programs should be implemented to alleviate the impact of the pandemic on the global population.
Association between COVID-19 Burden, Population Vaccination Status, and Urologic Oncology Surgery Volume: A National Multicenter Cross-Sectional Study
Authors: Amir Ido , Golan Shay , Frumer Michael , Sternberg Itay A. , Gildor Omri Schwarztuch , Hoffman Azik , Shashar Reut , Mano Roy , Savin Ziv , Haifler Miki , Zilberman Dorit E. , Dotan Zohar A. , Rosenzweig Barak
Published: November 2022

Initial deleterious effects of the COVID-19 pandemic on urologic oncology surgeries are well described, but the possible influence of vaccination efforts and those of pandemic conditions on surgical volumes is unclear. Our aim was to examine the association between changing vaccination status and COVID-19 burden throughout the pandemic and the volume of urologic oncology surgeries in Israel. This multi-center cross-sectional study included data collected from five tertiary centers between January 2019 and December 2021. All 7327 urologic oncology surgeries were included. Epidemiological data were obtained from the Israeli Ministry of Health database. A rising trend in total urologic oncology surgery volumes was observed with ensuing COVID-19 wave peaks over time (X2 = 13.184, df = 3, p = 0.004). Total monthly surgical volumes correlated with total monthly hospitalizations due to COVID-19 (R = −0.36, p = 0.015), as well as with the monthly average Oxford Stringency Index (R = −0.31, p = 0.035). The cumulative percent of vaccinations and of new COVID-19 cases per month did not correlate with total monthly urologic surgery volumes. Our study demonstrates the gradual acclimation of the Israeli healthcare system to the COVID-19 pandemic. However, hospitalizations due to COVID-19, as well as restriction stringency, correlate with lower volumes of urologic oncological surgeries, regardless of the population’s vaccination status.
Artificial Intelligence in Pediatric Cardiology: A Scoping Review
Authors: Sethi Yashendra , Patel Neil , Kaka Nirja , Desai Ami , Kaiwan Oroshay , Sheth Mili , Sharma Rupal , Huang Helen , Chopra Hitesh , Khandaker Mayeen Uddin , Lashin Maha M. A. , Hamd Zuhal Y. , Emran Talha Bin
Published: November 2022

The evolution of AI and data science has aided in mechanizing several aspects of medical care requiring critical thinking: diagnosis, risk stratification, and management, thus mitigating the burden of physicians and reducing the likelihood of human error. AI modalities have expanded feet to the specialty of pediatric cardiology as well. We conducted a scoping review searching the Scopus, Embase, and PubMed databases covering the recent literature between 2002–2022. We found that the use of neural networks and machine learning has significantly improved the diagnostic value of cardiac magnetic resonance imaging, echocardiograms, computer tomography scans, and electrocardiographs, thus augmenting the clinicians’ diagnostic accuracy of pediatric heart diseases. The use of AI-based prediction algorithms in pediatric cardiac surgeries improves postoperative outcomes and prognosis to a great extent. Risk stratification and the prediction of treatment outcomes are feasible using the key clinical findings of each CHD with appropriate computational algorithms. Notably, AI can revolutionize prenatal prediction as well as the diagnosis of CHD using the EMR (electronic medical records) data on maternal risk factors. The use of AI in the diagnostics, risk stratification, and management of CHD in the near future is a promising possibility with current advancements in machine learning and neural networks. However, the challenges posed by the dearth of appropriate algorithms and their nascent nature, limited physician training, fear of over-mechanization, and apprehension of missing the ‘human touch’ limit the acceptability. Still, AI proposes to aid the clinician tomorrow with precision cardiology, paving a way for extremely efficient human-error-free health care.
The Impact of Cardiac Chamber Volumes on Permanent His Bundle Pacing Procedural Outcomes—A Single Center Experience
Authors: Pestrea Catalin , Cicala Ecaterina , Ivascu Madalina , Gherghina Alexandra , Pintilie Irina , Ortan Florin , Pop Dana
Published: November 2022

His bundle pacing (HBP) has several pitfalls, such as the inability to identify the His bundle and lack of capture at acceptable thresholds. The majority of data regarding HBP were obtained using a dedicated non-deflectable delivery system. This study aimed to evaluate the impact of cardiac chamber dimensions on permanent HBP procedural outcomes when using this type of fixed-curve catheter. Seventy-two patients subjected to HBP from the 1st of January to the 31st of December 2021 at our institution were retrospectively reviewed. The baseline clinical characteristics and echocardiographic measurements of all the cardiac chambers were recorded, as well as procedural outcomes (HB electrogram identification and overall procedural success). During the procedure, the HB electrogram was recorded in 59 patients (81.9%) and successful permanent HBP was achieved in 33 patients, representing 45.8% of all the studied patients. Left atrial (LA) and right atrial (RA) volumes were significantly higher in patients without HB electrogram identification. Only LA and RA volumes were statistically associated with HB electrogram localization, while there was no significant association between the echocardiographic parameters and procedural success. LA volumes above 93 mL and RA volumes above 60 mL had an 8.81 times higher chance of failure to localize the HB electrogram compared with patients with lower volumes (p < 0.001). When considering non-deflectable delivery catheters for HBP, careful preprocedural echocardiographic analysis of the atrial volumes could help in the proper selection of implanting tools, thus optimizing the procedural outcomes and costs.
Relevance of Routine Postoperative CT Scans Following Aneurysm Clipping—A Retrospective Multicenter Analysis of 423 Cases
Authors: Krakowiak Michał , Fercho Justyna Małgorzata , Szmuda Tomasz , Piwowska Kaja , Och Aleksander , Sawicki Karol , Krystkiewicz Kamil , Modliborska Dorota , Kierońska Sara , Och Waldemar , Mariak Zenon Dionizy , Furtak Jacek , Gałązka Stanisław , Sokal Paweł , Słoniewski Paweł
Published: November 2022

Aim: Postoperative head computed tomography (POCT) is routinely performed in numerous medical institutions, mainly to identify possible postsurgical complications. This study sought to assess the clinical appropriateness of POCT in asymptomatic and symptomatic patients after ruptured or unruptured aneurysm clipping. Methods: This is a retrospective multicenter study involving microsurgical procedures of ruptured (RA) and unruptured intracranial aneurysm (UA) surgeries performed in the Centers associated with the Pomeranian Department of the Polish Society of Neurosurgeons. A database of surgical procedures of intracranial aneurysms from 2017 to 2020 was created. Only patients after a CT scan within 24 h were included. Results: A total of 423 cases met the inclusion criteria for the analysis. Age was the only significant factor associated with postoperative blood occurrence on POCT. A total of 37 (8.75%) cases of deterioration within 24 h with urgent POCT were noted, 3 (8.1%) required recraniotomy. The highest number necessary to predict (NNP) one recraniotomy based on patient deterioration was 50 in the RA group. Conclusion: We do not recommend POCTs in asymptomatic patients after planned clipping. New symptom onset requires radiological evaluation. Simultaneous practice of POCT after ruptured aneurysm treatment within 24 h is recommended.
External Validation of the American College of Surgeons Surgical Risk Calculator in Elderly Patients Undergoing General Surgery Operations
Authors: Kokkinakis Stamatios , Andreou Alexandros , Venianaki Maria , Chatzinikolaou Charito , Chrysos Emmanuel , Lasithiotakis Konstantinos
Published: November 2022

Preoperative risk stratification in the elderly surgical patient is an essential part of contemporary perioperative care and can be done with the use of the American College of Surgeons Surgical Risk Calculator (ACS-SRC). However, data on the generalizability of the ACS-SRC in the elderly is scarce. In this study, we report an external validation of the ACS-RC in a geriatric cohort. A retrospective analysis of a prospectively maintained database was performed including patients aged > 65 who underwent general surgery procedures during 2012–2017 in a Greek academic centre. The predictive ability of the ACS-SRC for post-operative outcomes was tested with the use of Brier scores, discrimination, and calibration metrics. 471 patients were included in the analysis. 30-day postoperative mortality was 3.2%. Overall, Brier scores were lower than cut-off values for almost all outcomes. Discrimination was good for serious complications (c-statistic: 0.816; 95% CI: 0.762–0.869) and death (c-statistic: 0.824; 95% CI: 0.719–0.929). The Hosmer-Lemeshow test showed good calibration for all outcomes examined. Predicted and observed length of stay (LOS) presented significant differences for emergency and for elective cases. The ACS-SRC demonstrated good predictive performance in our sample and can aid preoperative estimation of multiple outcomes except for the prediction of post-operative LOS.
Comparison of COVID-19 and RSV Infection Courses in Infants and Children under 36 Months Hospitalized in Paediatric Department in Fall and Winter Season 2021/2022
Authors: Fedorczak Anna , Zielińska Natalia , Nosek-Wasilewska Paulina , Mikołajczyk Katarzyna , Lisiak Joanna , Zeman Krzysztof , Tkaczyk Marcin
Published: November 2022

Background: The study aimed to determine the differences between COVID-19 and Respiratory syncytial virus (RSV) infections in young children hospitalized in the pediatric department. Methods: This retrospective study included 52 children with COVID-19 and 43 children with RSV infection younger than 36 months hospitalized in a pediatric department between September 2021 and March 2022. Clinical and laboratory findings, methods of treatment and hospitalization length were compared. Results: In the RSV group, significantly higher rates of cough (93.2% vs. 38.5%), rhinitis (83.7% vs. 50%), dyspnea (83.7% vs. 21.1%), crackles (69.8% vs. 5.8%) and wheezes (72.1% vs. 9.6%) were observed. The COVID-19 group had significantly higher rates of fever (80.8% vs. 37.2%) and seizures (13.5% vs. 0%). Patients with RSV infection had significantly higher rates of bronchodilator therapy (88.37% vs. 5.77%) and oxygen therapy (48.8% vs. 7.7%) and required a longer hospital stay (8 vs. 3 days). In admission, the majority of the patients from both groups were not treated with antibiotics, but because of clinical deterioration and suspected bacterial co-infections, antibiotics were administered significantly more frequently in the RSV group (30.2% vs. 9.6%). Conclusions: RSV infection in infants and small children had a more severe course than COVID-19 infection. RSV infection was associated with a longer hospitalization period and required more elaborate treatment.
Association of CHA2DS2-VASc Score with Long-Term Incidence of New-Onset Atrial Fibrillation and Ischemic Stroke after Myocardial Infarction
Authors: Jaakkola Samuli , Paana Tuomas , Airaksinen Juhani , Sipilä Jussi , Kytö Ville
Published: November 2022

The CHA2DS2-VASc score is a reliable tool used to estimate the risk of ischemic stroke (IS) in patients with atrial fibrillation (AF). Few tools exist for the prediction of new-onset AF (NOAF) after myocardial infarction (MI) and its relation to IS. We studied the usefulness of CHA2DS2-VASc in predicting NOAF and IS in a long-term follow-up after MI. Consecutive MI patients without baseline AF (n = 70,922; mean age: 68.2 years), discharged from 20 hospitals in Finland during 2005–2018, were retrospectively studied using national registries. The outcomes of interest after discharge were NOAF- and IS-assessed with competing risk analyses at one and ten years. The median follow-up was 4.2 years. The median baseline CHA2DS2-VASc score was 3 (IQR 2–5). The likelihood of both NOAF and NOAF-related IS increased stepwise with this score at one and ten years (all p < 0.0001). The one-year-adjusted subdistribution hazard ratio (sHR) was 4.03 (CI 3.68–4.42) for NOAF in patients with CHA2DS2-VASc scores ≥6 points. The cumulative incidence of IS was 15.2% in patients with NOAF vs. 6.2% in patients without AF at 10 years after MI (adj. sHR 2.12; CI 1.98–2.28; p < 0.0001). Coronary artery bypass surgery was associated with a higher NOAF incidence compared to percutaneous coronary intervention (adj. sHR 1.87; CI 1.65–2.13; p < 0.0001 one year after MI). The CHA2DS2-VASc score is a simple tool used to estimate the long-term risk of NOAF and IS after MI in patients without baseline AF. Coronary bypass surgery is associated with an increased NOAF incidence after MI.
Evaluation of a Post-Operative Therapy Protocol after Epithelium-Off Corneal Cross-Linking in Patients Affected by Keratoconus
Authors: Knutsson Karl Anders , Genovese Paola Noemi , Paganoni Giorgio , Ambrosio Oriella , Ferrari Giulio , Zennato Arianna , Cataldo Madeleine , Caccia Michela , Rama Paolo
Published: November 2022

A large retrospective study evaluated the safety of a post-operative therapy protocol after epithelium-off corneal collagen cross-linking (CXL). In total, 1703 eyes of the 1190 patients with progressive keratoconus were enrolled in a retrospective cohort study in a tertiary care university hospital. CXL was performed using a standardized technique (Dresden protocol: 0.1% riboflavin solution containing dextran 20% for 30 min during the soaking phase followed by 30-min ultraviolet A irradiation (3 mW/cm2)). Postoperatively, a bandage contact lens was applied, and therapy included a topical fluoroquinolone antibiotic until the epithelium healed, followed by topical fluorometholone treatment for three weeks. Post-operative complications were recorded and analyzed. No cases of infectious keratitis occurred, whereas peripheral sterile infiltrates were observed in 1.17% of cases. Trace haze was typically present but did not have an impact on visual acuity. In fifteen cases (0.88%), visually significant anterior stromal opacity developed. Mild signs of dry eye were observed in 22 eyes (1.29%). The present study demonstrates that a post-operative treatment protocol including fluoroquinolone antibiotics and a BCL in the first phase until complete epithelial healing, followed by a three-week period of topical steroid treatment is safe and not associated with the development of microbial keratitis.
The Changing Complementary Role of Multimodality Imaging in Clinical Cardiology
Authors: Nicolosi Gian Luigi
Published: November 2022

Over the past two decades, major technological developments and progress have been reached for all imaging modalities applied to clinical cardiology, from echocardiography to magnetic resonance, computed tomography, nuclear imaging, etc [...]
MCP1 Could Mediate FGF23 and Omega 6/Omega 3 Correlation Inversion in CKD
Authors: Mattinzoli Deborah , Turolo Stefano , Alfieri Carlo Maria , Ikehata Masami , Caldiroli Lara , Armelloni Silvia , Montini Giovanni , Agostoni Carlo , Messa Piergiorgio , Vettoretti Simone , Castellano Giuseppe
Published: November 2022

Fibroblast growth factor 23 (FGF23) concentrations rise after the early stages of chronic kidney disease (CKD). FGF23 is involved in inflammatory reactions closely associated with an incremented risk of cardiovascular disease (CVD). There is growing evidence that omega-6 (n-6) and n-3 polyunsaturated fatty acids (PUFA) can modulate inflammation through several mediators producing an opposite effect on cardiovascular (CV) risks. In this study, we explore whether there is any correlation between PUFA, FGF23, and inflammation in CKD patients. We evaluated, cross-sectionally, 56 patients at different stages of CKD. Monocyte chemoattractant protein 1 (MCP1), and intact and c-terminal FGF23 (iFGF23, cFGF23) were quantified by the ELISA, and the fatty acids (FA) profile was analyzed by gas chromatography. Concurrently with an eGFR decrease (p < 0.01) and an MCP1 increase (p = 0.031), we observed an inversion of the correlation between FGF23 and the n-6/n-3 ratio. This last correlation was inversed in CKD stage 3 (r2 (−) 0.502 p = 0.029) and direct in stage 5 (r2 0.657 p = 0.020). The increase in MCP1 seems to trigger events in the inversion of the correlation between FGF23 and the n-6/n-3 PUFA ratio. This result strongly encourages future studies on basal pathways, on possible pharmacological interventions, and on managing kidney transplant patients treated with immunosuppressive therapy.