bluuebunny/crossref_metadata_2025 huggingface dataset:
Machine Learning Insights into the Last 400 Years of Etna Lateral Eruptions from Historical Volcanological Data
Authors: Malaguti Arianna Beatrice , Corradino Claudia , La Spina Alessandro , Branca Stefano , Del Negro Ciro
Published: November 2024

Volcanic hazard assessment is generally based on past eruptive behavior, assuming that previous activity is representative of future activity. Hazard assessment can be supported by Artificial Intelligence (AI) techniques, such as machine learning, which are used for data exploration to identify features of interest in the data. Here, we applied a machine learning technique to automate the analysis of these datasets, handling intricate patterns that are not easily captured by explicit commands. Using the k-means clustering algorithm, we classified effusive eruptions of Mount Etna over the past 400 years based on key parameters, including lava volume, Mean Output Rate (MOR), and eruption duration. Our analysis identified six distinct eruption clusters, each characterized by unique eruption dynamics. Furthermore, spatial analysis revealed significant sectoral variations in eruption activity across Etna’s flanks. These findings, derived through unsupervised learning, offer new insights into Etna’s eruptive behavior and contribute to the development of hazard maps that are essential for long-term spatial planning and risk mitigation.
Natural H2 Transfer in Soil: Insights from Soil Gas Measurements at Varying Depths
Authors: Patino Cesar , Piedrahita Dora , Colorado Elkin , Aristizabal Katherine , Moretti Isabelle
Published: November 2024

The exploration of natural H2 is beginning in several countries. One of the most widely used methods for detecting promising areas is to measure the H2 percentage of the air contained in soils. All data show temporal and spatial variabilities. The gradient versus depth is not usually measured since the standard procedure is to drill and quickly install a tube in the soil to pump out the air. Drill bits used do not exceed one meter in length. These limitations have been overcome thanks to the development of a new tool that enables percussion drilling and gas measurements to be carried out with the same tool until 21 feet deep. This article shows the results obtained with this method in the foreland of the Colombian Andes. The variation of the gradient as a function of depth provides a better understanding of H2 leakage in soils. Contrary to widespread belief, this gradient is also highly variable, and, therefore, often negative. The signal is compatible with random and discontinuous H2 bubbles rising, but not with a permanent diffusive flow. Near-surface bacterial consumption should result in a H2 increase with depth; it may be true for the first tens of centimeters, but it is not observed between 1 and 5 m. The results show that, at least in this basin, it is not necessary to measure the H2 content at depths greater than the conventional one-meter depth to obtain a higher signal. However, the distance between the measured H2 peaks versus depth may provide information about the H2 leakage characteristics and, therefore, help quantify the near-surface H2 flow.
Joint Toxicity and Interaction of Carbon-Based Nanomaterials with Co-Existing Pollutants in Aquatic Environments: A Review
Authors: Pikula Konstantin , Johari Seyed Ali , Santos-Oliveira Ralph , Golokhvast Kirill
Published: November 2024

This review paper focuses on the joint toxicity and interaction of carbon-based nanomaterials (CNMs) with co-existing pollutants in aquatic environments. It explores the potential harmful effects of chemical mixtures with CNMs on aquatic organisms, emphasizing the importance of scientific modeling to predict mixed toxic effects. The study involved a systematic literature review to gather information on the joint toxicity and interaction between CNMs and various co-contaminants in aquatic settings. A total of 53 publications were chosen and analyzed, categorizing the studies based on the tested CNMs, types of co-contaminants, and the used species. Common test models included fish and microalgae, with zebrafish being the most studied species. The review underscores the necessity of conducting mixture toxicity testing to assess whether the combined effects of CNMs and co-existing pollutants are additive, synergistic, or antagonistic. The development of in silico models based on the solid foundation of research data represents the best opportunity for joint toxicity prediction, eliminating the need for a great quantity of experimental studies.
Origin, Evolution, and Diversification of the Expansin Family in Plants
Authors: Wang Zhizhan , Cao Jinbiao , Lin Nan , Li Jiaming , Wang Yazhou , Liu Weibin , Yao Wen , Li Yang
Published: November 2024

The cell wall is a crucial feature that allows ancestral streptophyte green algae to colonize land. Expansin, an extracellular protein that mediates cell wall loosening in a pH-dependent manner, could be a powerful tool for studying cell wall evolution. However, the evolutionary trajectory of the expansin family remains largely unknown. Here, we conducted a comprehensive identification of 2461 expansins across 64 sequenced species, ranging from aquatic algae to terrestrial plants. Expansins originated in chlorophyte algae and may have conferred the ability to loosen cell walls. The four expansin subfamilies originated independently: α-expansin appeared first, followed by β-expansin, and then expansin-like A and expansin-like B, reflecting the evolutionary complexity of plant expansins. Whole genome duplication/segmental duplication and tandem duplication events greatly contributed to expanding the expansin family. Despite notable changes in sequence characteristics, the intron distribution pattern remained relatively conserved among different subfamilies. Phylogenetic analysis divided all the expansins into five clades, with genes from the same subfamily tending to cluster together. Transcriptome data from 16 species across ten lineages and qRT-PCR analysis revealed varying expression patterns of expansin genes, suggesting functional conservation and diversification during evolution. This study enhances our understanding of the evolutionary conservation and dynamics of the expansin family in plants, providing insight into their roles as cell wall-loosening factors.
Genome-Wide Analysis of the Serine Carboxypeptidase-like (SCPL) Protein Family of Bitter Gourd and Functional Validation of McSCPL22 in Fusarium oxysporum f. sp. Momordicae (FOM) Resistance
Authors: Guan Feng , Yang Xuetong , Shi Bo , Wang Kai , Zhang Jingyun , Xie Yuanyuan , Wan Xinjian
Published: November 2024

Bitter gourd is increasingly being recognized for its value as a vegetable and medicinal use, but the molecular mechanisms of pathogen resistance remain relatively poorly understood. The serine carboxypeptidase-like (SCPL) protein family plays a key role in plant growth, pathogen defense, and so on. However, a comprehensive identification and functional characterization of the SCPL gene family has yet to be conducted in bitter melon. In this study, 32 SCPL genes were identified in bitter gourd and divided into three classes. The number of SCPL genes contained in the three clusters was 7, 7, and 18, respectively. Most SCPL gene promoters contain cis-acting elements with light, hormone, and stress responses. The RNA sequencing data showed that the expression of several SCPL genes changed significantly after pathogen infection. In particular, expression of the McSCPL4, 10, 17, 22, and 25 genes increased substantially in the resistant varieties after infection, and their expression levels were higher than those in the susceptible varieties. These results suggested that genes such as McSCPL4, 10, 17, 22, and 25 may play a significant role in conferring resistance to fungal infections. Moreover, the expression levels of the McSCPL10, 17, 22, 23, and 25 genes were likewise significantly changed after being induced by salicylic acid (SA) and jasmonic acid (JA). In situ hybridization showed that McSCPL22 was expressed in the vascular tissues of infected plants, which largely overlapped with the location of Fusarium oxysporum f. sp. Momordicae (FOM) infection and the site of hydrogen peroxide production. Our results showed that McSCPL22 may be involved in the regulation of the SA and JA pathways and enhance resistance to FOM in bitter gourd plants. This is the first study to perform SCPL gene family analysis in bitter gourd. McSCPL22 may have the potential to enhance FOM resistance in bitter gourd, and further investigation into its function is warranted. The results of this study may enhance the yield and molecular breeding of bitter gourd.
The Dual Role of B Cells in the Tumor Microenvironment: Implications for Cancer Immunology and Therapy
Authors: Yang Hao , Zhang Zhiru , Li Jijun , Wang Kun , Zhu Wanting , Zeng Yingyue
Published: November 2024

The tumor microenvironment (TME) is a complex and heterogeneous tissue composed of various cell types, including tumor cells, stromal cells, and immune cells, as well as non-cellular elements. Given their pivotal role in humoral immunity, B cells have emerged as promising targets for anti-tumor therapies. The dual nature of B cells, exhibiting both tumor-suppressive and tumor-promoting functions, has garnered significant attention. Understanding the distinct effects of various B cell subsets on different tumors could pave the way for novel targeted tumor therapies. This review provides a comprehensive overview of the heterogeneous B cell subsets and their multifaceted roles in tumorigenesis, as well as the therapeutic potential of targeting B cells in cancer treatment. To develop more effective cancer immunotherapies, it is essential to decipher the heterogeneity of B cells and their roles in shaping the TME.
Cardioimmunology in Health and Diseases: Impairment of the Cardio-Spleno-Bone Marrow Axis Following Myocardial Infarction in Diabetes Mellitus
Authors: Salybekov Amankeldi A. , Tashov Kanat , Sheng Yin , Salybekova Ainur , Shinozaki Yoshiko , Asahara Takayuki , Kobayashi Shuzo
Published: November 2024

A comprehensive understanding of the cardio-spleen-bone marrow immune cell axis is essential for elucidating the alterations occurring during the pathogenesis of diabetes mellitus (DM). This study investigates the dynamics of immune cell kinetics in DM after myocardial infarction (MI) over time. MI was induced in diabetic and healthy control groups using C57BL/N6 mice, with sacrifices occurring at days 1, 3, 7, and 28 post-MI to collect heart, peripheral blood (PB), spleen, and bone marrow (BM) samples. Cell suspensions from each organ were isolated and analyzed via flow cytometry. Additionally, the endothelial progenitor cell-colony-forming assay (EPC-CFA) was performed using mononuclear cells derived from BM, PB, and the spleen. The results indicated that, despite normal production in BM and the spleen, CD45+ cells were lower in the PB of DM mice at days 1 to 3. Further analysis revealed a reduction in total and pro-inflammatory neutrophils (N1s) in PB at days 1 to 3 and in the spleen at days 3 to 7 in DM mice, suggesting that DM-induced alterations in splenic neutrophils fail to meet the demand in PB and ischemic tissues. Infiltrating macrophages (total, M1, M2) were reduced at day 3 in the DM-ischemic heart, with total and M1 (days 1–3) and M2 (days 3–7) macrophages being significantly decreased in DM-PB compared to controls, indicating impaired macrophage recruitment and polarization in DM. Myeloid dendritic cells (mDCs) in the heart were higher from days 1 to 7, which corresponded with the enhanced recruitment of CD8+ cells from days 1 to 28 in the DM-infarcted myocardium. Total CD4+ cells decreased in DM-PB at days 1 to 3, suggesting a delayed adaptive immune response to MI. B cells were reduced in PB at days 1 to 3, in myocardium at day 3, and in the spleen at day 7, indicating compromised mobilization from BM. EPC-CFA results showed a marked decrease in definitive EPC colonies in the spleen and BM from days 1 to 28 in DM mice compared to controls in vitro, highlighting that DM severely impairs EPC colony-forming activity by limiting the differentiation of EPCs from primitive to definitive forms. Taking together, this study underscores significant disruptions in the cardio-spleen-bone marrow immune cell axis following MI in DM, revealing delayed innate and adaptive immune responses along with impaired EPC differentiation.
AI-Assisted Identification of Primary and Secondary Metabolomic Markers for Postoperative Delirium
Authors: Ivanisenko Vladimir A. , Rogachev Artem D. , Makarova Aelita-Luiza A. , Basov Nikita V. , Gaisler Evgeniy V. , Kuzmicheva Irina N. , Demenkov Pavel S. , Venzel Artur S. , Ivanisenko Timofey V. , Antropova Evgenia A. , Kolchanov Nikolay A. , Plesko Victoria V. , Moroz Gleb B. , Lomivorotov Vladimir V. , Pokrovsky Andrey G.
Published: November 2024

Despite considerable investigative efforts, the molecular mechanisms of postoperative delirium (POD) remain unresolved. The present investigation employs innovative methodologies for identifying potential primary and secondary metabolic markers of POD by analyzing serum metabolomic profiles utilizing the genetic algorithm and artificial neural networks. The primary metabolomic markers constitute a combination of metabolites that optimally distinguish between POD and non-POD groups of patients. Our analysis revealed L-lactic acid, inositol, and methylcysteine as the most salient primary markers upon which the prediction accuracy of POD manifestation achieved AUC = 99%. The secondary metabolomic markers represent metabolites that exhibit perturbed correlational patterns within the POD group. We identified 54 metabolites as the secondary markers of POD, incorporating neurotransmitters such as gamma-aminobutyric acid (GABA) and serotonin. These findings imply a systemic disruption in metabolic processes in patients with POD. The deployment of gene network reconstruction techniques facilitated the postulation of hypotheses describing the role of established genomic POD markers in the molecular-genetic mechanisms of metabolic pathways dysregulation, and involving the identified primary and secondary metabolomic markers. This study not only expands the understanding of POD pathogenesis but also introduces a novel technology for the bioinformatic analysis of metabolomic data that could aid in uncovering potential primary and secondary markers in diverse research domains.
Leveraging Social Media for Stakeholder Engagement: A Case on the Ship Management Industry
Authors: Yuen Kum Fai , Lee Jun Da , Nguyen Cam Tu , Wang Xueqin
Published: November 2024

Social media is an important driver of firm success by providing an avenue for stakeholder engagement. Operating in a highly complex and competitive environment, firms in the ship management industry can utilise social media platforms to engage with their stakeholders, which can enhance stakeholder satisfaction and loyalty. However, stakeholder engagement rates can vary, with some posts generating more engagement than others. Drawing on the perceived value and word-of-mouth psychological motivation theories, this study introduces a theoretical model to identify and examine factors influencing stakeholder engagement on LinkedIn in the ship management industry. A hierarchical regression analysis is conducted on the posts of ten ship management firms to study the influence of content type and message characteristics variables on engagement rates. The results revealed nine variables that can significantly influence stakeholder engagement. They are links, corporate brand names, call-to-actions, message length, tangible resources, social content, emotional content, first-person texts, and emojis. The findings provide recommendations for firms in the ship management industry in terms of the message strategies to incorporate into their posts to encourage higher engagement rates. This study also enriches literature for stakeholder engagement on social media.
Improving Consumer Health Search with Field-Level Learning-to-Rank Techniques
Authors: Yang Hua , Gonçalves Teresa
Published: November 2024

In the area of consumer health search (CHS), there is an increasing concern about returning topically relevant and understandable health information to the user. Besides being used to rank topically relevant documents, Learning to Rank (LTR) has also been used to promote understandability ranking. Traditionally, features coming from different document fields are joined together, limiting the performance of standard LTR, since field information plays an important role in promoting understandability ranking. In this paper, a novel field-level Learning-to-Rank (f-LTR) approach is proposed, and its application in CHS is investigated by developing thorough experiments on CLEF’ 2016–2018 eHealth IR data collections. An in-depth analysis of the effects of using f-LTR is provided, with experimental results suggesting that in LTR, title features are more effective than other field features in promoting understandability ranking. Moreover, the fused f-LTR model is compared to existing work, confirming the effectiveness of the methodology.
Correlations and Fractality in Sentence-Level Sentiment Analysis Based on VADER for Literary Texts
Authors: Hernández-Pérez Ricardo , Lara-Martínez Pablo , Obregón-Quintana Bibiana , Liebovitch Larry S. , Guzmán-Vargas Lev
Published: November 2024

We perform a sentence-level sentiment analysis study of different literary texts in English language. Each text is converted into a series in which the data points are the sentiment value of each sentence obtained using the sentiment analysis tool (VADER). By applying the Detrended Fluctuation Analysis (DFA) and the Higuchi Fractal Dimension (HFD) methods to these sentiment series, we find that they are monofractal with long-term correlations, which can be explained by the fact that the writing process has memory by construction, with a sentiment evolution that is self-similar. Furthermore, we discretize these series by applying a classification approach which transforms the series into a one on which each data point has only three possible values, corresponding to positive, neutral or negative sentiments. We map these three-states series to a Markov chain and investigate the transitions of sentiment from one sentence to the next, obtaining a state transition matrix for each book that provides information on the probability of transitioning between sentiments from one sentence to the next. This approach shows that there are biases towards increasing the probability of switching to neutral or positive sentences. The two approaches supplement each other, since the long-term correlation approach allows a global assessment of the sentiment of the book, while the state transition matrix approach provides local information about the sentiment evolution along the text.
Fitness Costs in Diamondback Moth Plutella xylostella (L.) (Lepidoptera: Plutellidae) Resistant to Lufenuron, A Chitin-Synthesis Inhibitor Insecticide
Authors: Bermúdez Natalia C. , Pava Nataly de la , Nascimento Deividy V. , Ribeiro Lilian M. S. , Siqueira Herbert A. A. , Torres Jorge B.
Published: November 2024

The diamondback moth (DBM), Plutella xylostella, is the main pest of Brassicas crops worldwide, and its recorded resistance to 101 active ingredients indicates it is difficult to control. The purpose of this study was to investigate the hypothesis that P. xylostella has fitness costs associated with its resistance to lufenuron, a chitin-synthesis inhibitor insecticide. Thus, concentration–mortality bioassays were performed for susceptible (REC-S), resistant (BZR-R) populations, their progenies F1 and F1′, and one established population without selection pressure (BZR-Rns) after four generations. A fertility life table was used to assess the biological performance of the REC-S and BZR-R. BZR-Rns of P. xylostella. The larval stage, longevity, and survival differed between populations. The reproductive rate (R0) was significantly lower in the F1 (♀R × ♂S) (28.19) and F1′ (♀S × ♂R) (34.06) progenies compared with their parents, but not with the relaxed BZR-Rns (39.39). The mean generation time (T), intrinsic rate of population growth (rm), and doubling time (DT) differed between REC-S and progenies, with fitness of 0.52 and 0.64 for F1 and F1′, respectively. Overall, the results suggest that the resistance of P. xylostella to lufenuron is stable and that low fitness costs appear to be associated with resistance to lufenuron, although heterozygotes showed lower fitness than their parents. Strategies such as preserving refuge areas, rotation of modes of action, etc., are essential for resistance management and prolonging the efficacy of control agents; this highlights the importance of integrated insecticide resistance management.
An In Vivo Model of Estrogen Supplementation Concerning the Expression of Ca2+-Dependent Exchangers and Mortality, Vitality and Survival After Myocardial Infarction in Ovariectomized Rats
Authors: Toporcer Tomáš , Grendel Tomáš , Špaková Ivana , Blichárová Alžbeta , Verbóová Ľudmila , Benetinová Zuzana , Čižmárová Beata , Rabajdová Miroslava , Toporcerová Silvia
Published: November 2024

Background: Ischemic-reperfusion damage of cardiomyocytes due to myocardial infarction (MI) often leads to the death of an individual. Premenopausal women have been observed to have a significantly lower risk of cardiovascular disease (CVD) than men of the same age. In menopausal women, this trend is significantly reversed, and the risk of CVD increases up to 10-fold. Estrogens affect the development and function of the heart muscle, and as they decrease, the risk and poor prognosis of CVD increase. This study is focused on the effects of estrogen supplementation on morbidity, vitality, and NCX1 expression after MI on a model system. Methods: In this study, female Sprague Dawley rats (n = 58), which were divided into three experimental groups (NN—control group, non-supplemented; OVX-N—ovariectomized, non-supplemented; OVX-S—ovariectomized, supplemented), received left thoracotomy in the fourth intercostal space. The left anterior descendent coronary artery was ligated 2 mm from its origin with an 8.0 suture. An immunohistological analysis as well as an RT-PCR analysis of NCX1 expression were performed. Results: A higher survival rate was recorded in the OVX-N group (86%) in comparison with the OVX-S group (53%) (p < 0.05). In addition, higher NCX1 expression 7 days/14 days after MI in the OVX-S group in comparison with the NN and OVX-N (p < 0.001 and p < 0.05) groups was recorded. Seven days after MI, a significantly higher expression (p < 0.005) of mRNA NCX1 in the OVX-N group was also recorded in comparison with the NN group. Conclusions: This study provides a comprehensive description of the effect of estrogen supplementation on NCX1 expression and overall vitality in ovariectomized rats that survived MI.
Long-Term Follow-Up After Non-Curative Endoscopic Submucosal Dissection for Early Gastrointestinal Cancer—A Retrospective Multicenter Analysis
Authors: Pimingstorfer Philipp , Gregus Matus , Ziachehabi Alexander , Függer Reinhold , Moschen Alexander R. , Schöfl Rainer
Published: November 2024

Background: Endoscopic Submucosal Dissection (ESD) has become the standard therapy for early malignant lesions in the gastrointestinal tract and has shown as good oncological surgery results. Approximately 30% of ESDs do not meet the criteria for oncological curability, and upfront surgery is indicated. Hence, about 40% of patients with an indication for surgery are advised against surgery because of comorbidities and an advanced age. Methods: We performed a multicenter retrospective cohort study on the long-term outcomes of non-curative ESDs, performed between 2009 and May 2024, without additional tumor therapy. The primary outcome was the recurrence of malignancy, either local malignancy or lymph node metastasis during follow-up, or death. We compared the outcomes between two cohorts: after non-curative ESD (ncESD) and after curative ESD (cESD). Results: A total of 374 ESDs were analyzed in this study. Overall, the technical success rate was 91%, and the oncological curative resection criteria were met in 70.9% of patients. Severe complications occurred in 5% of cases without procedure-associated mortality. In the ncESD group, 20% (7/35) of patients had a recurrence of malignancy primarily due to positive horizontal margins in the resection specimens, and 3 out of 35 died due to a non-oncological reason during the follow-up (mean length 36.6 months). In the cESD group, 3% (1/33) of patients had tumor recurrence, and 1 patient died because of a non-oncological reason. The tumor recurrence rate between the cohorts was significant (p = 0.017), and overall mortality did not show significance (p = 0.33). Conclusions: Especially in the elderly and multimorbid patients, the recommendation to perform rescue surgery after non-curative ESD remains challenging. Residual malignancy rates in surgical resection specimens are low, recurrence rates of malignancy are low, and mortality rates for non-oncological reasons are high in this population. There is a need for more data for the individualization of patient management after non-curative ESD.
Endosaccular Coil Embolization of Ruptured Anterior Inferior Cerebellar Artery Pseudoaneurysm After Gamma Knife Surgery for Vestibular Schwannoma: A Case Report and Literature Review
Authors: Baek Byung Hyun , Kim Seul Kee , Lee Yun Young , Kim Hyoung Ook , Kim You Sub , Joo Sung Pil , Yoon Woong
Published: November 2024

Background: Ruptured pseudoaneurysm of the distal anterior inferior cerebellar artery (AICA) in patients with a history of gamma knife surgery (GKS) for vestibular schwannoma (VS) is rare. Several previous reports have described treatment strategies for radiation-induced pseudoaneurysm in the AICA: either surgical trapping or endovascular parent artery occlusion of the AICA. Methods: We present the first case of endosaccular coil embolization for a ruptured pseudoaneurysm in a large-diameter AICA after GKS for VS, successfully preserving the parent AICA. Results: Major recanalization of the coiled pseudoaneurysm was observed on follow-up imaging 3 months after the initial endovascular treatment. The patient subsequently underwent additional endosaccular coil embolizations for regrowth of the treated pseudoaneurysm buried in the VS. Two years later, another major recanalization was detected, prompting further retreatment. Subsequently, the patient has remained in a stable condition for 4 years. Conclusions: We suggest that endosaccular coil embolization of the distal AICA aneurysm with parent artery preservation might be a safe and feasible treatment option for radiation-induced saccular pseudoaneurysm arising from a large parent artery. However, close and regular follow-up imaging and preparation for potential retreatment are necessary, as pseudoaneurysms coiled within VSs are prone to recanalization.
Enhancing ICU Outcomes Through Intelligent Monitoring Systems: A Comparative Study on Ventilator-Associated Events
Authors: Liu Jui-Fang , Kang Mei-Ying , Lin Hui-Ling , Liu Shih-Feng
Published: November 2024

Background: Using intelligent monitoring systems can potentially improve the identification and management of ventilator-associated events (VAEs). This single-center retrospective observational study evaluated the impact of implementing intelligent monitoring systems on the clinical outcomes of patients with VAEs in an ICU setting. Method: An intelligent VAE monitoring system was integrated into electronic medical records to continuously collect patient data and alert attending physicians when a ventilated patient met the criteria for a ventilator-associated condition, which was defined as an increase of at least three cm H2O in positive end expiratory pressure (PEEP), an increase of at least 0.20 in the fraction of inspired oxygen (FiO2), or the FiO2 being over baseline for at least two consecutive days. This study covered two phases, consisting of before using the intelligent monitoring system (2021–2022) and during its use (2023–2024). Results: The results showed that patients monitored with the intelligent system experienced earlier VAE detection (4.96 ± 1.86 vs. 7.77 ± 3.35 days, p < 0.001), fewer ventilator-associated condition (VAC) occurrences, and a shorter total duration of VACs. Additionally, the system significantly reduced ventilator days, antibiotic use, and 14-day mortality. Conclusions: Intelligent monitoring systems enhance VAE management, improve clinical outcomes, and provide valuable insights into the future of critical care medicine.
An MRI-Based Method for the Morphologic Assessment of the Anterior Tibial Tuberosity
Authors: Preda Emi Marinela , Constantin Nicolae , Dragosloveanu Serban , Cergan Romica , Scheau Cristian
Published: November 2024

Background: A prominent anterior tibial tuberosity (or tibial tubercle) can be seen in ongoing Osgood–Schlatter disease (OSD) in teenagers or as a sequela of OSD in adults. Current radiological methods do not provide a true anatomical assessment of the tibial tuberosity; therefore, we proposed and developed a Magnetic Resonance Imaging (MRI)-based method for measuring the anterior tibial tuberosity index, aiming to deal with the current lack of effective techniques for accurately assessing these particular morphologic features. Methods: A retrospective study included 47 knees with tibial tuberosity measurements on both true sagittal MPR images of 3D proton density (PD)-weighted MRI sequences and lateral knee radiographs. The same landmarks were followed and the anterior tibial tuberosity index (ATTI) was measured. Results: The comparison of the results obtained by the two methods demonstrates that our method is reliable and reproducible with substantial inter- and intra-observer agreement. The intraclass correlation coefficient was 0.9250 (95% CI: 0.8654 to 0.9582), indicating excellent reliability between the two methods. A strong positive correlation was also identified, with a correlation coefficient of r = 0.8746 (95% CI: 0.7845 to 0.9286, p < 0.0001) between the two methods. No significant deviation from linearity was observed by analyzing the linear model validity using the cusum test (p = 0.62). Conclusions: Based on these results, we encourage the use of 3D PD-weighted MRI sequences for the measurement of the anterior tibial tuberosity on MRI in order to avoid unnecessary exposure to ionizing radiation and potentially obtain a more accurate measurement. Future larger studies should also explore the benefit of utilizing 3D sequences over 2D lateral projections to minimize measuring bias.
Association Between Laboratory Coagulation Parameters and Postpartum Hemorrhage in Preterm and Term Caesarean Section: A Retrospective Analysis
Authors: Dibiasi Christoph , Jecel Emilia , Falcone Veronica , Schaden Eva , Gratz Johannes
Published: November 2024

Background: Deranged antepartum laboratory parameters may be risk factors for postpartum hemorrhage (PPH). However, whether this is also valid in women who give birth prematurely is currently unknown. Methods: We performed a retrospective single-center study to assess the role of antepartum hemoglobin, platelet count, fibrinogen, activated partial thromboplastin time, and prothrombin time as risk factors for PPH following caesarean section. We defined PPH as documented blood loss of at least 1 L and/or transfusion of red blood cell concentrates. We stratified the included patients according to gestational age: extremely preterm (gestational age < 28 weeks), very preterm (gestational age between 28 and 32 weeks), late and moderate preterm (gestational age between 32 and 37 weeks), and term (gestational age ≥ 37 weeks). Results: We included 1734 patients, 112 (6%) of whom had PPH. In total, 19 patients (10%) were in the extremely preterm group, 13 patients (10%) were in the very preterm group, 44 patients (9%) were in the late and moderate preterm group, and 36 patients (4%) were in the term group. Hemoglobin predicted PPH in all gestational age groups. Platelet count was associated with PPH in term, but not in preterm patients. Fibrinogen was associated with PPH in late prematurity but not in term patients and not in patients with early or extreme prematurity. Conclusions: Antepartum hemoglobin was the only factor predicting PPH in preterm and term caesarean sections. Platelet count and fibrinogen concentration were associated with PPH in term and late prematurity, respectively, but not in earlier stages of prematurity.
Prothrombotic Rebound After Discontinuation of Direct Oral Anticoagulants Therapy: A Systematic Review
Authors: Frydrych Marta , Janeczek Maciej , Małyszek Agata , Nelke Kamil , Dobrzyński Maciej , Lukaszewski Marceli
Published: November 2024

Background/Objectives: The practice of holding anticoagulation is a relatively common approach, with the aim of either preventing excessive bleeding in preparation for surgical procedures or managing acute bleeding episodes. Methods: To assess the relationship between the discontinuation of direct oral anticoagulants (DOACs) therapy and the condition of hypercoagulability, a systematic review of the literature was conducted, following PRISMA guidelines, in PubMed/MEDLINE, Cochrane, and Google Scholar. These databases were searched for all publications that described a rebound phenomenon or hypercoagulability state after DOACs discontinuation. Results: A total of 1494 articles were selected from searched databases, and 29 were eligible. A final total of 16 case reports and 14 original research articles were subjected to analysis. Conclusions: The results of this study indicate that the cessation of DOAC therapy may be associated with an increased risk of thrombotic events. More studies are required to ascertain whether DOACs treatment cessation can be linked to rebound phenomena associated with thromboembolic events. This will provide the data needed to determine the incidence and risk of this phenomenon.
Dual-Fluoroscopy vs. Single-Fluoroscopy in Balloon Kyphoplasty: A Study of Efficiency and Safety
Authors: Romem Roy , Engel Itzhak , Segal David , Behrbalk Refael , Schleifer David , Koch Jonathan EJ , Ohana Nissim , Baruch Yuval
Published: November 2024

Background: Vertebral compression fractures (VCFs) are the most prevalent type of osteoporotic fractures, often causing significant pain, morbidity, and mortality. Vertebral augmentation procedures like balloon kyphoplasty (BK) are effective in treating VCFs. These procedures are typically performed using a single fluoroscopy machine (SF) for anteroposterior (AP) and lateral views. We have implemented a dual-fluoroscopy (DF) technique to reduce procedure time and radiation exposure. The goal of this study was to determine whether dual-fluoroscopy could optimize surgical efficiency without compromising safety, offering a more effective alternative to traditional single-fluoroscopy methods. Methods: This retrospective study included 126 patients who underwent BK with either SF (n = 74, 58.7%) or DF (n = 52, 41.3%) between 2020 and 2024. We collected data on procedure duration per pedicle (PDPP), radiation exposure (reference air kerma and dose-area product [DAP]), and radiation duration. A sub-analysis of post-learning phase cases was performed. Results: A learning curve was identified for the first 24 cases and 15 cases using the SF technique and DF technique, respectively, which was followed by a stabilization in procedure duration per pedicle (Levene’s statistic = 10.623, p = 0.002 for SD difference, p < 0.001 for mean PDPP difference). After the completion of the learning phase for both techniques, the DF group demonstrated a significantly shorter PDPP (11.83 ± 4.3 vs. 14.03 ± 5.57 min, p = 0.049). No significant differences were found in radiation exposure, including radiation duration (p = 0.577), reference air kerma, or DAP. Conclusions: Dual-fluoroscopy significantly reduces procedure time after the learning curve is overcome, improving efficiency without increasing radiation exposure. This technique holds promise for optimizing kyphoplasty workflow and safety, supporting broader clinical adoption.
Flow-Adjusted Trabeculectomy
Authors: Kratz Assaf , Goldberg Ivan , Koren Tal , Hadad Aviel , Knyazer Boris , Lim Ridia
Published: November 2024

Background/Objectives: As one of the most efficacious glaucoma surgical techniques, trabeculectomy is considered by many surgeons to be the “gold standard” intra-ocular pressure (IOP)-reducing intervention. The purpose of this study is to present our intra-operative flow-adjusted surgical method, which aims to provide safety and efficacy more simply than previous methods. Methods: Retrospectively, we evaluated outcomes for trabeculectomy or phacotrabeculectomy in surgery-naïve eyes over three years for patients with glaucoma not associated with other ocular co-morbidities. We defined complete success as an IOP between 5 and 18 mmHg plus at least a 20% reduction from baseline, without concomitant medications. Relative success was the same result, with glaucoma medication(s). Failure was regarded as an IOP less than 5 or higher than 18 mmHg, or by the need for a subsequent glaucoma operation. Results: We assessed the results from 186 eyes of 186 patients. After exclusion, a group of 45 trabeculectomies and 35 phacotrabeculectomies were analyzed. In eyes undergoing a trabeculectomy, over a mean follow-up of 16.0 months, IOP fell from 28.1 ± 8.0 mmHg with 3.6 ± 1.1 medications to 9.7 ± 3.6 mmHg (66% reduction) with 0.4 ± 1.0 medications (each p < 0.00001). The success rate was 88.9% (75.6% complete success). In eyes undergoing a phacotrabeculectomy, over a mean of 19.1 months, IOP fell from 26.1 ± 10.2 mmHg with 3.5 ± 1.3 medications to 10.0 ± 3.6 mmHg (62% reduction) on 0.9 ± 1.4 medications (each p < 0.00001). The success rate was 91.4% (57.1% complete success). Complication rates were low, with no major complications in either group. Conclusion: To lower IOP, our intra-operative flow-adjusted trabeculectomy and phacotrabeculectomy techniques appear to be safe and effective.
Hemodialysis Experience After Kahramanmaraş Earthquake
Authors: Kaya Bulent , Balal Mustafa , Seyrek Neslihan , Mete Burak , Karayaylali Ibrahim
Published: November 2024

Background: Hemodialysis treatment for acute kidney injury associated with crush syndrome is very complex. In our study, we summarized the problems and complications experienced by our hemodialysis center after the Kahramanmaraş earthquake. Methods: After the earthquake, our hospital treated 1396 victims. We evaluated the initial indications for dialysis, hemodialysis complications and the mortality of patients undergoing hemodialysis, including crush-related acute kidney injury (n = 82), during the earthquake period. We also compared them with patients who were undergoing hemodialysis (n = 76) in the same period but had end-stage renal failure and acute kidney injury due to other causes (n = 15). Results: After the earthquake, 173 adult patients, 91 (52.6%) of whom were male, with a mean age of 49.5 + 19.7 years, underwent hemodialysis between 6 and 22 February 2023. Patients with crush-related acute kidney injury experienced more complications during hemodialysis, and the increase in creatine kinase activity increased the risk of hemodialysis complications. The most common complications were blood clots in the dialyzer membrane, intradialytic hypotension, and intradialytic insufficient flow. The most frequent indication for initial hemodialysis was hyperkalemia (61, 74.4%). The major problems in the hemodialysis center included inadequate equipment and an insufficient number of experienced health personnel. Conclusions: Hyperkalemia is the most important initial indication for hemodialysis in patients with crush-related acute kidney injury. Crush-related acute kidney injury patients require hemodialysis more frequently, and hemodialysis complications are higher in patients with crush-related AKI, so the hemodialysis treatment of these patients should be more cautious. In an earthquake, hemodialysis centers may face significant challenges, such as damage, transportation issues, power outages, and water outages, which can hinder hemodialysis treatment.
IgA Vasculitis (Henoch–Schönlein Purpura): An Update on Treatment
Authors: Castañeda Santos , Quiroga-Colina Patricia , Floranes Paz , Uriarte-Ecenarro Miren , Valero-Martínez Cristina , Vicente-Rabaneda Esther F. , González-Gay Miguel A.
Published: November 2024

Objective: IgA vasculitis (IgAV), previously named as Henoch–Schönlein purpura, is the most frequent systemic vasculitis in children. In adults, IgAV is less common although it is associated with more severe disease. In fact, the frequency of glomerulonephritis (referred to as IgAV nephritis) in adults is higher than in children and tends to present more severely, with around 10–30% of those affected eventually progressing to end-stage renal disease. In this review, we describe the pathophysiology, main clinical features, diagnosis of the disease, and latest clinical data regarding IgAV therapy. Methods: A narrative literature review, primarily based on articles published in PubMed, was conducted. In addition to discussing the main aspects of glucocorticoids and conventional disease-modifying drugs used in the management of IgAV, this review focuses on the latest information reported regarding biologics and potential future therapies. Results: Glucocorticoids are the first-line therapy for IgAV, especially in adults with severe manifestations. Colchicine, dapsone, and methotrexate can be useful for controlling minor manifestations. Several immunomodulatory agents, such as cyclosporine A, tacrolimus, and mycophenolate mofetil, have shown favorable results as glucocorticoid-sparing agents. Leflunomide has shown promising results but requires further study. The use of rituximab has demonstrated efficacy in reducing relapse frequency, lowering the cumulative glucocorticoid burden, and achieving long-term remission of the disease in children and adults with IgAV. Immunoglobulins and plasma exchange therapy can also be useful in difficult and life-threatening situations. Other potential therapies with encouraging results include TRF-budesonide, B-cell-directed therapy, B-cell-depleting agents, sodium–glucose cotransporter-2 inhibitors, endothelin receptor antagonists, and complement pathway inhibitors. Conclusions: Glucocorticoids are the first-line therapy for IgAV, especially in adults with severe manifestations. The role of various immunomodulatory therapies, such as calcineurin inhibitors and mycophenolate mofetil, remains promising, while rituximab reduces the long-term side effects of glucocorticoids and can help achieve disease remission. Other potential therapies with encouraging results require further research.
Assessment of Professional Practices in the Care Pathway of Patients with Upper Aerodigestive Tract Cancer in a University Hospital
Authors: Chbihi Dounia , Corda Morgane , Thibault Thomas , Baude Jérémy , Guigou Caroline , Folia Mireille
Published: November 2024

Objectives: The main objective of this study was to evaluate the alignment between treatment decisions made during multidisciplinary team meetings (MTMs) and the treatments received by patients with upper aerodigestive tract cancers. The secondary objective was to identify factors influencing potential discrepancies. Methods: This retrospective, single-center study was conducted at a tertiary referral center and included 147 patients diagnosed with squamous cell carcinoma of the upper aerodigestive tract. Patients were divided into two groups based on the match between MTM-decided and actual treatments. Multivariate analysis was performed to assess factors independently associated with discrepancies. Results: Out of 147 patients, 28 (19%) received treatment that did not align with MTM decisions. Among these, eight died before treatment, one patient refused care, five received supportive care, five patients underwent surgery, three received radiotherapy alone, one patient underwent surgery and adjuvant radiochemotherapy, one patient underwent surgery and adjuvant radiotherapy alone, three patients received radiochemotherapy, and one patient received palliative chemotherapy. Independent significant factors associated with non-concordance included poor performance status (PS) and treatment not received at a tertiary reference center. Treatment shifts mainly involved downgrading from curative to palliative care. Conclusions: This study highlights the importance of patient health status in determining deviations from MTM decisions. Further efforts should focus on improving the integration of patient comorbidities and health status into MTM decision-making to optimize care delivery.
Effective Treatment of Basal Cell Carcinoma with a Topical Enzymatic Mixture Enriched in Bromelain: Summary of Proof-Of Concept Clinical Studies on the First 22 Tumors
Authors: Rosenberg Lior , Shoham Yaron , Berman Brian , Tyring Stephen K. , Tharp Michael D. , Singer Adam J.
Published: November 2024

Background/Objectives: Basal cell carcinoma (BCC), the most prevalent form of human cancer, is traditionally treated by surgical and alternative destructive or topical chemical means, each with its advantages, challenges, and drawbacks. We describe our experience treating BCCs with a topical concentrate of proteolytic enzymes enriched in bromelain (CPEEB) sourced from pineapple stems. CPEEB has strong proteolytic, antitumor–proapoptotic, and inflammation modulation activities, and is approved for debridement of deep burns and starting phase 3 trials for chronic wounds. Methods: In the first proof-of-concept (POC) study, six BCCs on three individuals were treated with five to six daily CPEEB 10% topical applications under a zinc oxide-based occlusive dressing for 9–12 h each during a period of up to 10 days. These patients were followed for up to 4 years. In an additional two POC studies, 16 patients with one BCC each were treated every other day for a total of seven applications of topical CPEEB 5% under a variety of occlusive dressings. The wounds were followed for up to 2 months before undergoing diagnostic excisional biopsy. Results: In the first study, clinical assessment of the BCCs and two excisional biopsies after 6 months suggested that all lesions were eradicated with spontaneous healing within ~2 weeks without clinical or histological recurrence for over 4 years. In the two subsequent studies, 16 histologically diagnosed superficial and nodular BCCs were treated using four application techniques. Excisional histology after 2 months confirmed BCC eradication in seven of the patients. In nine patients, with compromised occlusive dressings, histological eradication was incomplete. Treatment was well tolerated by all patients with the expected local skin reactions, which completely healed within 2–3 weeks. Conclusions: These are POC preliminary studies aimed at indicating the potential efficacy and feasibility of topical CPEEB in eradicating BCC. In these studies, topical CPEEB 10% and 5% resulted in complete eradication of the BCC when appropriately applied. CPEEB was well tolerated in all patients, and all treated sites’ erosions healed without scars in <3 weeks. Further research is necessary to corroborate the results, refine the application technique, and complete the regulatory process.