bluuebunny/crossref_metadata_2025 huggingface dataset:
AED Inequity among Social Groups in Guangzhou
Authors: Gao Feng , Lu Siyi , Liao Shunyi , Chen Wangyang , Chen Xin , Wu Jiemin , Wu Yunjing , Li Guanyao , Han Xu
Published: April 2024

Automated external defibrillators (AEDs) are regarded as the most important public facility after fire extinguishers due to their importance to out-of-hospital cardiac arrest (OHCA) victims. Previous studies focused on the location optimization of the AED, with little attention to inequity among different social groups. To comprehensively investigate the spatial heterogeneity of the AED inequity, we first collected AED data from a WeChat applet. Then, we used the geographically weighted regression (GWR) model to quantify the inequity level and identify the socio-economic status group that faced the worst inequity in each neighborhood. Results showed that immigrants of all ages suffer a more severe AED inequity than residents after controlling population and road density. Immigrants face more severe inequity in downtown, while residents face more severe inequity in the peripheral and outer suburbs. AED inequity among youngsters tends to be concentrated in the center of each district, while inequity among the elderly tends to be distributed at the edge of each district. This study provides a new perspective for investigating the inequity in public facilities, puts forward scientific suggestions for future AED allocation planning, and emphasizes the importance of the equitable access to AED.
A Scalable and Automated Framework for Tracking the Likely Adoption of Emerging Technologies
Authors: Williams Lowri , Anthi Eirini , Burnap Pete
Published: April 2024

While new technologies are expected to revolutionise and become game-changers in improving the efficiency and practices of our daily lives, it is also critical to investigate and understand the barriers and opportunities faced by their adopters. Such findings can serve as an additional feature in the decisionmaking process when analysing the risks, costs, and benefits of adopting an emerging technology in a particular setting. Although several studies have attempted to perform such investigations, these approaches adopt a qualitative data collection methodology, which is limited in terms of the size of the targeted participant group and is associated with a significant manual overhead when transcribing and inferring results. This paper presents a scalable and automated framework for tracking the likely adoption and/or rejection of new technologies from a large landscape of adopters. In particular, a large corpus of social media texts containing references to emerging technologies was compiled. Text mining techniques were applied to extract the sentiments expressed towards technology aspects. In the context of the problem definition herein, we hypothesise that the expression of positive sentiment implies an increase in the likelihood of impacting a technology user’s acceptance to adopt, integrate, and/or use the technology, and negative sentiment implies an increase in the likelihood of impacting the rejection of emerging technologies by adopters. To quantitatively test our hypothesis, a ground truth analysis was performed to validate that the sentiments captured by the text mining approach were comparable to the results provided by human annotators when asked to label whether such texts positively or negatively impact their outlook towards adopting an emerging technology. The collected annotations demonstrated comparable results to those of the text mining approach, illustrating that the automatically extracted sentiments expressed towards technologies are useful features in understanding the landscape faced by technology adopters, as well as serving as an important decisionmaking component when, for example, recognising shifts in user behaviours, new demands, and emerging uncertainties.
Automated Trace Clustering Pipeline Synthesis in Process Mining
Authors: Grigore Iuliana Malina , Tavares Gabriel Marques , Silva Matheus Camilo da , Ceravolo Paolo , Barbon Junior Sylvio
Published: April 2024

Business processes have undergone a significant transformation with the advent of the process-oriented view in organizations. The increasing complexity of business processes and the abundance of event data have driven the development and widespread adoption of process mining techniques. However, the size and noise of event logs pose challenges that require careful analysis. The inclusion of different sets of behaviors within the same business process further complicates data representation, highlighting the continued need for innovative solutions in the evolving field of process mining. Trace clustering is emerging as a solution to improve the interpretation of underlying business processes. Trace clustering offers benefits such as mitigating the impact of outliers, providing valuable insights, reducing data dimensionality, and serving as a preprocessing step in robust pipelines. However, designing an appropriate clustering pipeline can be challenging for non-experts due to the complexity of the process and the number of steps involved. For experts, it can be time-consuming and costly, requiring careful consideration of trade-offs. To address the challenge of pipeline creation, the paper proposes a genetic programming solution for trace clustering pipeline synthesis that optimizes a multi-objective function matching clustering and process quality metrics. The solution is applied to real event logs, and the results demonstrate improved performance in downstream tasks through the identification of sub-logs.
An Old Material for a New World: Prussian Blue and Its Analogues as Catalysts for Modern Needs
Authors: Concina Isabella
Published: April 2024

Prussian blue analogues (PBAs) have recently emerged as effective materials in different functional applications, ranging from energy storage to electrochemical water splitting, thence to more “traditional” heterogeneous catalysis. Their versatility is due to their open framework, compositional variety, and fast and efficient internal charge exchange, coupled with a self-healing ability that makes them unique. This review paper presents and discusses the findings of the last decade in the field of the catalytic and photocatalytic application of PBAs in water remediation (via the degradation of organic pollutants and heavy metal removal) and the catalytic oxidation of organics and production or organic intermediates for industrial synthesis. Analysis of the catalytic processes is approached from a critical perspective, highlighting both the achievements of the research community and the limits still affecting this field.
Electrochemical Investigation of Lithium Perchlorate-Doped Polypyrrole Growing on Titanium Substrate
Authors: Xie Yibing , Xu Jing , Lu Lu , Xia Chi
Published: April 2024

Lithium perchlorate-doped polypyrrole growing on titanium substrate (LiClO4-PPy/Ti) has been fabricated to act as electroactive electrode material for feasible electrochemical energy storage. A theoretical and experimental investigation is adopted to disclose the conductivity, electroactivity properties and interfacial interaction-dependent capacitance of LiClO4-PPy/Ti electrode. The experimental measurement results disclose that LiClO4-PPy/Ti reveals lower ohmic resistance (0.2226 Ω cm−2) and charge transfer resistance (2116 Ω cm−2) to exhibit higher electrochemical conductivity, a more reactive surface, and feasible ion diffusion to present higher double-layer capacitance (0.1930 mF cm−2) rather than LiClO4/Ti (0.3660 Ω cm−2, 65,250 Ω cm−2, 0.0334 mF cm−2). LiClO4-PPy/Ti reveals higher Faradaic capacitance caused by the reversible doping and dedoping process of perchlorate ion on PPy than the electrical double-layer capacitance of LiClO4/Ti caused by the reversible adsorption and desorption process of the LiClO4 electrolyte on Ti. Theoretical simulation calculation results prove that a more intensive electrostatic interaction of pyrrole N···Ti (2.450 Å) in LiClO4-PPy/Ti rather than perchlorate O···Ti (3.537 Å) in LiClO4/Ti. LiClO4-PPy/Ti exhibits higher density of states (57.321 electrons/eV) at Fermi energy and lower HOMO-LUMO molecule orbital energy gap (0.032 eV) than LiClO4/Ti (9.652 electrons/eV, 0.340 eV) to present the enhanced electronic conductivity. LiClO4-PPy/Ti also exhibits a more declined interface energy (−1.461 × 104) than LiClO4/Ti (−5.202 × 103 eV) to present the intensified interfacial interaction. LiClO4-PPy/Ti accordingly exhibits much higher specific capacitances of 0.123~0.0122 mF cm−2 at current densities of 0.01~0.10 mA cm−2 rather than LiClO4/Ti (0.010~0.0095 mF cm−2, presenting superior electroactivity and electrochemical capacitance properties. LiClO4-PPy/Ti could well act as the electroactive supercapacitor electrode for feasible energy storage.
Insecticide Resistance in Aedes aegypti Mosquitoes: Possible Detection of kdr F1534C, S989P, and V1016G Triple Mutation in Benin, West Africa
Authors: Tokponnon Tatchémè Filémon , Ossè Razaki , Zoulkifilou Sare Dabou , Amos Gbenouga , Festus Houessinon , Idayath Gounou , Sidick Aboubakar , Messenger Louisa A. , Akogbeto Martin
Published: April 2024

Epidemics of arboviruses in general, and dengue fever in particular, are an increasing threat in areas where Aedes (Ae.) aegypti is present. The effectiveness of chemical control of Ae. aegypti is jeopardized by the increasing frequency of insecticide resistance. The aim of this study was to determine the susceptibility status of Ae. aegypti to public health insecticides and assess the underlying mechanisms driving insecticide resistance. Ae. aegypti eggs were collected in two study sites in the vicinity of houses for two weeks using gravid Aedes traps (GATs). After rearing the mosquitoes to adulthood, female Ae. aegypti were exposed to diagnostic doses of permethrin, deltamethrin and bendiocarb, using Centers for Disease Control and Prevention (CDC) bottle bioassays. Unexposed, un-engorged female Ae. aegypti were tested individually for mixed-function oxidase (MFO), glutathione-S-transferase (GST) and α and β esterase activities. Finally, allele-specific PCR (AS-PCR) was used to detect possible kdr mutations (F1534C, S989P, and V1016G) in the voltage-gated sodium channel gene in insecticide-exposed Ae. aegypti. Most traps were oviposition positive; 93.2% and 97% of traps contained Ae. aegypti eggs in the 10ème arrondissement of Cotonou and in Godomey-Togoudo, respectively. Insecticide bioassays detected resistance to permethrin and deltamethrin in both study sites and complete susceptibility to bendiocarb. By comparison to the insecticide-susceptible Rockefeller strain, field Ae. aegypti populations had significantly higher levels of GSTs and significantly lower levels of α and β esterases; there was no significant difference between levels of MFOs. AS-PCR genotyping revealed the possible presence of 3 kdr mutations (F1534C, S989P, and V1016G) at high frequencies; 80.9% (228/282) of the Ae. aegypti tested had at least 1 mutation, while the simultaneous presence of all 3 kdr mutations was identified in 13 resistant individuals. Study findings demonstrated phenotypic pyrethroid resistance, the over-expression of key detoxification enzymes, and the possible presence of several kdr mutations in Ae. aegypti populations, emphasizing the urgent need to implement vector control strategies targeting arbovirus vector species in Benin.
South American Validation of a Survey to Assess Eco-Anxiety in Adults (ECO-ANS-LATAM)
Authors: Mejia Christian R. , Alvarez-Risco Aldo , Vizcardo David A. , Sedano-Ochoa Luzmila , Medina Rivera Maria Fe , Shimabukuro Jaramillo Claudia , Cedillo-Balcázar Jamil , Mamani-Benito Oscar , Carranza Esteban Renzo Felipe , Armada Jose , Ubillus Milward , Del-Aguila-Arcentales Shyla , Davies Neal M. , Yáñez Jaime A.
Published: April 2024

Background: climate change is a reality, and more and more people are becoming aware of this global problem, which has generated anxiety in some populations. To validate a short survey to assess eco-anxiety in adults in South America. Methods: It is an instrumental study, and the validation was based on a previous survey, which had six questions and was generated by 217 respondents in the USA in 2021. These questions were subjected to a validation process with expert judgment, pilot and application, and then statistics were obtained. It was validated with 1907 people in six countries in South America, where the mean, standard deviation, skewness and kurtosis were adequate. Results: The initial confirmatory factorial model obtained unsatisfactory goodness-of-fit indices, so the indices were modified through a re-specification, where two items were eliminated, after which adequate values were obtained (χ2 = 22.34, df = 2, p = 0.00; RMR = 0.020; GFI = 0.990; CFI = 0.990; TLI = 0.990; and RMSEA = 0.070). Finally, the overall Cronbach’s α was calculated to be 0.88 (95% CI = 0.86–0.89). Conclusions: The test was validated in a large South American population and found that only four questions can efficiently measure anxiety about the effects of climate change. The instrument can be used with other tests to screen different age groups, ethnicities and realities.
Visceral Leishmaniasis in a Twin Pregnancy: A Case Report and Review of the Literature
Authors: Karampas Grigorios , Koulouraki Sevasti , Daikos George L. , Nanou Christina , Aravantinos Leon , Eleftheriades Makarios , Metallinou Dimitra , Christopoulos Panagiotis
Published: April 2024

Visceral leishmaniasis (VL), often referred to as kala-azar, is quite rare in developed countries during pregnancy. Only few studies have evaluated its impact on perinatal outcome. It is caused primarily by Leishmania donovani or Leishmania infantum and presents with a wide spectrum of clinical manifestations from cutaneous ulcers to multisystem disease. Differential diagnosis is challenging as symptoms and signs are insidious, mimicking other diseases. Misdiagnosis can result in severe adverse perinatal outcomes, even maternal/neonatal death. Early treatment with liposomal amphotericin-B (LAmB) is currently the first choice with adequate effectiveness. We report a rare case of VL in a twin pregnancy with onset at the second trimester, presenting with periodic fever with rigors, right flank pain, and gradual dysregulation of all three cell lines. The positive rK39 enzyme-linked immunosorbent assay test confirmed the diagnosis. Treatment with LAmB resulted in clinical improvement within 48 h and in the delivery of two late-preterm healthy neonates with no symptoms or signs of vertical transmission. The one-year follow-up, of the mother and the neonates, was negative for recurrence. To our knowledge, this is the first reported case of VL in a twin pregnancy, and consequently treatment and perinatal outcome are of great importance.
Athlete Fear Avoidance, Depression, and Anxiety Are Associated with Acute Concussion Symptoms in Athletes
Authors: Patlan Ilana , Gamelin Gabrielle , Khalaj Kosar , Castonguay Tristan , Dover Geoffrey
Published: April 2024

Background: Assessing sport-related concussions in athletes presents challenges due to symptom variability. This study aimed to explore the relationship between acute concussion symptoms and athlete fear avoidance, pain catastrophizing, depression, and anxiety. Anxiety and depression have previously been associated with the number of symptoms after a concussion, but no prior research has examined the possible link between athlete fear avoidance and acute concussion symptoms. Methods: Thirty-four collegiate athletes (mean age = 20.9 ± 1.8 years) were assessed within 48 h of a concussion using the Sport Concussion Assessment Tool 5, Athlete Fear Avoidance Questionnaire (AFAQ), Pain Catastrophizing Scale, and Hospital Anxiety and Depression Scale. Results: Results showed a significant association between the athlete fear avoidance and the number of concussion symptoms (r = 0.493, p = 0.003), as well as depression and anxiety measured by HADS (r = 0.686, p < 0.001). Athlete fear avoidance and HADS scores were predictors of symptom severity, explaining 41% of the variance (p = 0.001). Athletes with higher fear avoidance tended to report more symptoms post concussion. Conclusions: This study underscores the link between athlete fear avoidance, anxiety, depression, and the severity of concussion symptoms. Administering the AFAQ to assess athlete fear avoidance at the initial assessment of a concussion may be helpful in interpreting the symptoms of an acute concussion.
The Appropriateness of Footwear in Diabetic Patients Observed during a Podiatric Examination: A Prospective Observational Study
Authors: Hazbiu Anisa , Teobaldi Ilaria , Sepe Mario , Federici Giovanni , Meloni Marco , Uccioli Luigi
Published: April 2024

Background: Adequate compliance with wearing therapeutic footwear (TF) to prevent diabetic foot ulcers is known to be low. The primary aim of this study was to identify population awareness about the ulceration and/or recurrence risk according to footwear choice. The secondary aim was to evaluate the compliance level in footwear choice based on a patient’s own risk. Methods: Forty podiatrists participated from 1 September 2017 to 31 August 2018, providing six-section forms which included personal data, risk classification, footwear characteristics and a knowledge questionnaire. Results: This study included 1507 patients. Those with active ulcers were excluded. A total of 43% of patients belonged to risk class 0, 19% to risk class 1, 19% to risk class 2 and 19% to risk class 3. A total of 58% had foot deformities. Conclusions: Nearly half of patients with a high risk of ulceration had knowledge of their own risk but the majority of them did not follow the recommendations. Only a small percentage (36%) of risk class 3 patients wore footwear suitable for their risk class. There was poor consideration of footwear choice among patients. We highlight critical issues in patient education and compliance with wearing footwear appropriate to their risk class.
Family-Centric Applied Behavior Analysis Facilitates Improved Treatment Utilization and Outcomes
Authors: Adelson Robert P. , Ciobanu Madalina , Garikipati Anurag , Castell Natalie J. , Singh Navan Preet , Barnes Gina , Rumph Jodi Kim , Mao Qingqing , Roane Henry S. , Vaish Anshu , Das Ritankar
Published: April 2024

Background/Objective: Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by lifelong impacts on functional social and daily living skills, and restricted, repetitive behaviors (RRBs). Applied behavior analysis (ABA), the gold-standard treatment for ASD, has been extensively validated. ABA access is hindered by limited availability of qualified professionals and logistical and financial barriers. Scientifically validated, parent-led ABA can fill the accessibility gap by overcoming treatment barriers. This retrospective cohort study examines how our ABA treatment model, utilizing parent behavior technicians (pBTs) to deliver ABA, impacts adaptive behaviors and interfering behaviors (IBs) in a cohort of children on the autism spectrum with varying ASD severity levels, and with or without clinically significant IBs. Methods: Clinical outcomes of 36 patients ages 3–15 years were assessed using longitudinal changes in Vineland-3 after 3+ months of pBT-delivered ABA treatment. Results: Within the pBT model, our patients demonstrated clinically significant improvements in Vineland-3 Composite, domain, and subdomain scores, and utilization was higher in severe ASD. pBTs utilized more prescribed ABA when children initiated treatment with clinically significant IBs, and these children also showed greater gains in their Composite scores. Study limitations include sample size, inter-rater reliability, potential assessment metric bias and schedule variability, and confounding intrinsic or extrinsic factors. Conclusion: Overall, our pBT model facilitated high treatment utilization and showed robust effectiveness, achieving improved adaptive behaviors and reduced IBs when compared to conventional ABA delivery. The pBT model is a strong contender to fill the widening treatment accessibility gap and represents a powerful tool for addressing systemic problems in ABA treatment delivery.
Pushing the Limits of Minimally Invasive Spine Surgery—From Preoperative to Intraoperative to Postoperative Management
Authors: Drossopoulos Peter N. , Sharma Arnav , Ononogbu-Uche Favour C. , Tabarestani Troy Q. , Bartlett Alyssa M. , Wang Timothy Y. , Huie David , Gottfried Oren , Blitz Jeanna , Erickson Melissa , Lad Shivanand P. , Bullock W. Michael , Shaffrey Christopher I. , Abd-El-Barr Muhammad M.
Published: April 2024

The introduction of minimally invasive surgery ushered in a new era of spine surgery by minimizing the undue iatrogenic injury, recovery time, and blood loss, among other complications, of traditional open procedures. Over time, technological advancements have further refined the care of the operative minimally invasive spine patient. Moreover, pre-, and postoperative care have also undergone significant change by way of artificial intelligence risk stratification, advanced imaging for surgical planning and patient selection, postoperative recovery pathways, and digital health solutions. Despite these advancements, challenges persist necessitating ongoing research and collaboration to further optimize patient care in minimally invasive spine surgery.
Feasibility of Combining Functional Mobilisation with Resistance and Endurance Training for Mechanically Ventilated Patients in Intensive Care Unit Setting—A Pilot Study
Authors: Jayachandran Balachandran , Venkatesan Kumaresh , Tan Sunny Boon Chai , Yeo Lynn Soo Hoon , Venkatacham Jonathen , Selvakumar Mohena Priyaa , Tan Bryan Yijia
Published: April 2024

Background: Intensive-care-acquired weakness resulting in functional impairment is common in critical care survivors. This study aims to evaluate the feasibility of a combined early functional training with endurance and resistance training and its effect on the functional outcome. Methods: It is a pilot study performed in a 39-bed Medical and Surgical Intensive Care Unit (ICU). Patients who were premorbidly independent and were mechanically ventilated for ≥24 h were recruited to receive functional mobilisation (sit out of bed, ambulation), endurance (bed cycling), and resistance training (selected upper and lower limb muscle training using weights). The primary outcomes were feasibility of training, muscle strength, handgrip strength, quadricep strength, and Functional Status Score-Intensive Care Unit (FSS-ICU) collected at the first assessment in the ICU, at the ICU discharge, and at hospital discharge. Secondary outcomes were functional capacity (6-Minute Walk Distance) and quality of life measures, EQ-5D, at hospital discharge and at 3 months. Results: Out of the 11 patients, 6 (54.54%) patients achieved level 2 functional mobilisation, 2 (18.18%) patients achieved level 2 resistance training, and 1 (9.09%) patient achieved level 2 endurance training. There were no significant differences in the medical research council (MRC) score, quadricep strength, and handgrip strength between the first assessment in the ICU, at the ICU discharge, and at hospital discharge. However, there was a significant difference in FSS_ICU (p < 0.008) from the first assessment in the ICU up to hospital discharge. EQ-5D visual analogue scale also showed a change of 8.5% at 3-month follow-up. 6MWD showed significant difference (p < 0.043) at 3-month follow-up compared to that at hospital discharge. Conclusions: The study found low compliance to resistance and endurance training in patients with mechanical ventilation. However, functional mobilisation in terms of sit out of bed was possible in more than half of the recruited patients.
Aerobic Microbiological Spectrum and Antibiotic Resistance in Children Operated for Anorectal Abscesses
Authors: Chakarov Dzhevdet , Hadzhieva Elena , Kalchev Yordan , Hadzhiev Dimitar
Published: April 2024

(1) Background: Anorectal abscesses are a relatively rare pathology in childhood. Most often, male children under 1 year of age are affected. The importance of microbiological examination for the diagnosis and treatment of such patients remains debatable among surgeons, resulting in scarce data being available in the literature. We aimed to identify the aerobic microbiological spectrum and antibiotic resistance of isolates in children undergoing operation to treat anorectal abscesses. (2) Methods: We performed a case series of 102 children diagnosed and operated for anorectal abscesses over a period of 10 years (2010–2019). Purulent wound exudate was used for microbiological evaluation, which was subsequently cultured on 5% sheep-blood agar and eosin–methylene blue agar. For microbiological identification, conventional biochemical tests and semi-automated (API 20, bioMerieux, Marcy-l’Étoile, France) tests were used, as well as automated systems (Vitek-2 Compact, bioMerieux, France). Antimicrobial susceptibility testing was performed by the disk diffusion method of Bauer–Kirby and by determining the minimal inhibitory concentrations for glycopeptides. The results were interpreted according to the EUCAST standard for the corresponding year. (3) Results: Microbiological testing in children operated for anorectal abscesses mainly identified the gut commensals that normally reside in the rectal mucosa. Monocultures were found in just over half of the cases. Escherichia coli, Klebsiella pneumoniae complex, and Proteus mirabilis were the most frequently isolated. In addition, Staphylococcus aureus was found in 7% of patients. In Gram-negative bacteria, antibiotic resistance was most often observed in penicillins, cephalosporins, sulfonamides, and fluoroquinolones. (4) Conclusions: The increasing rates of antimicrobial resistance impose the need for the local monitoring of circulating commensal bacteria associated with anorectal abscesses in children to guide antibiotic therapy when indicated.
The Prognostic Value of Positron Emission Tomography/Computed Tomography in Clinical Stage I Lung Cancer Patients: A Propensity-Match Analysis
Authors: Cheng Ya-Fu , Huang Jing-Yang , Lin Ching-Hsiung , Lin Sheng-Hao , Wang Bing-Yen
Published: April 2024

Background: The application of positron emission tomography/computed tomography (PET/CT) helps provide accurate clinical staging for lung cancer patients. However, the effects and trends in early-stage lung cancer remain unclear. The aim of this study was to compare differences between clinical stage I lung cancer patients who received PET/CT for staging and those who did not. Methods: Data were obtained from the Taiwan Society of Cancer Registry. There were 6587 clinical stage I lung cancer patients between 2009 and 2014 analyzed in this study. We compared the characteristics of the PET/CT and no PET/CT groups. After propensity score matching, it resulted in both groups having 2649 patients. We measured the overall survival rates of all clinical stage I lung cancer patients and the overall survival rates of patients with PET/CT and without PET/CT. Results: The 1-, 3-, and 5-year survival rates of all clinical stage I lung cancer patients were 97.2%, 88.2%, and 79.0%, respectively. Patients with a larger tumor size tended to receive PET/CT for staging (stage Ib: 38.25% vs. 27.82%, p < 0.0001) and a larger resection (lobectomy: 74.62% vs. 66.61%, p < 0.0001). The 5-year survival rates were 79.8% in the PET/CT group and 78.2% in the no PET/CT group after propensity score matching (p = 0.6528). Conclusions: For clinical stage I lung cancer in Taiwan, patients with larger tumor sizes tend to have PET/CT for staging. Although PET/CT provided more precise clinical staging, these patients still received larger resections and had more pathological migration. However, there was no overall survival rate benefit after PET/CT.
The Spectrum of Cutaneous Manifestations in Lupus Erythematosus: A Comprehensive Review
Authors: Fijałkowska Aleksandra , Kądziela Marcelina , Żebrowska Agnieszka
Published: April 2024

Lupus erythematosus (LE) is an autoimmune inflammatory disease with complex etiology. LE may present as a systemic disorder affecting multiple organs or be limited solely to the skin. Cutaneous LE (CLE) manifests with a wide range of skin lesions divided into acute, subacute and chronic subtypes. Despite classic forms of CLE, such as malar rash or discoid LE, little-known variants may occur, for instance hypertrophic LE, chilblain LE and lupus panniculitis. There are also numerous non-specific manifestations including vascular abnormalities, alopecia, pigmentation and nail abnormalities or rheumatoid nodules. Particular cutaneous manifestations correlate with disease activity and thus have great diagnostic value. However, diversity of the clinical picture and resemblance to certain entities delay making an accurate diagnosis The aim of this review is to discuss the variety of cutaneous manifestations and indicate the clinical features of particular CLE types which facilitate differential diagnosis with other dermatoses. Although in diagnostically difficult cases histopathological examination plays a key role in the differential diagnosis of LE, quick and accurate diagnosis ensures adequate therapy implementation and high quality of life for patients. Cooperation between physicians of various specialties is therefore crucial in the management of patients with uncommon and photosensitive skin lesions.
Advancing the Clinical and Molecular Understanding of Cornelia de Lange Syndrome: A Multidisciplinary Pediatric Case Series and Review of the Literature
Authors: Gruca-Stryjak Karolina , Doda-Nowak Emilia , Dzierla Julia , Wróbel Karolina , Szymankiewicz-Bręborowicz Marta , Mazela Jan
Published: April 2024

Cornelia de Lange syndrome (CdLS) is a complex genetic disorder with distinct facial features, growth limitations, and limb anomalies. Its broad clinical spectrum presents significant challenges in pediatric diagnosis and management. Due to cohesin complex mutations, the disorder’s variable presentation requires extensive research to refine care and improve outcomes. This article provides a case series review of pediatric CdLS patients alongside a comprehensive literature review, exploring clinical variability and the relationship between genotypic changes and phenotypic outcomes. It also discusses the evolution of diagnostic and therapeutic techniques, emphasizing innovations in genetic testing, including detecting mosaicism and novel genetic variations. The aim is to synthesize case studies with current research to advance our understanding of CdLS and the effectiveness of management strategies in pediatric healthcare. This work highlights the need for an integrated, evidence-based approach to diagnosis and treatment. It aims to fill existing research gaps and advocate for holistic care protocols and tailored treatment plans for CdLS patients, ultimately improving their quality of life.
The Relationship between Body Mass Index, Body Dissatisfaction and Mood Symptoms in Pregnant Women
Authors: Grano Caterina , Vacca Mariacarolina , Lombardo Caterina
Published: April 2024

Background: High body mass and adiposity during pregnancy can contribute to psychological distress, and body dissatisfaction may be a potential underlying mechanism of this association. Objective. This study aimed to evaluate the mediational role of body dissatisfaction in the relationship between body mass index (BMI) and depressive and anxious symptoms, respectively. Methods: Given the cross-sectional design of this study, two alternative models were investigated, positing that BMI was related to depressive (Model 1a) and anxious symptoms (Model 2a), which, in turn, predicted body dissatisfaction. Seventy-two pregnant women in the third trimester of pregnancy completed the Body Image Disturbance Questionnaire, the Beck Depression Inventory-II and the State-Trait Anxiety Inventory, as well as a demographic form assessing their BMI. Results: As hypothesized, body dissatisfaction mediated the relationship between BMI and psychopathological symptoms. Moreover, the alternative models of reverse mediation were also significant, suggesting that psychopathological symptoms mediated the relationship between BMI and body dissatisfaction. Findings from both the hypothesized and alternative models suggested that, on the one hand, higher distress symptoms associated with body dissatisfaction would result from high BMI and, on the other hand, that body dissatisfaction may result from the effect of BMI on distress symptoms. Conclusions: The present study suggests that body image theory and practice should be implemented by the inclusion of evidence-based clinical interventions for promoting psychological well-being during the antenatal period.
Alterations in Corneal Sensitivity, Staining and Biomechanics of Alopecia Areata Patients: Novel Findings in a Case-Control Study
Authors: Burgos-Blasco Barbara , Burgos-Blasco Patricia , Rodriguez-Quet Olivia , Arriola-Villalobos Pedro , Fernandez-Vigo Jose Ignacio , Saceda-Corralo David , Vaño-Galvan Sergio , García-Feijóo Julián
Published: April 2024

Background: A higher prevalence of ophthalmological alterations in systemic inflammatory diseases has been demonstrated. Objectives: Our objectives were to determine anterior segment findings and corneal properties in alopecia areata (AA). Methods: This is a case-control study. Severe AA patients (Severity of Alopecia Tool > 50%) and non-AA subjects underwent a general ophthalmological examination, a Pentacam and Corvis scheimpflug technology examination (Oculus Optikgeräte GmbH, Wetzlar, Germany). Visual acuity, refractive error, corneal aesthesiometry, and biomechanical and topographic variables were registered. Results: In total, 25 AA patients (50 eyes; 50.6 ± 8.1 years) and 29 controls (58 eyes; 49.4 ± 8.6 years) were included. AA patients had decreased corneal sensitivity, more corneal staining, and a more advanced cataract (p ≤ 0.004). The anterior topographic flat meridian, mean anterior keratometry, and maximum keratometric point were increased in AA (p ≤ 0.040), while pachymetry values were thinner (p ≤ 0.001). Keratoconus index and Belin/Ambrosio-enhanced ectasia total deviation display were increased (p ≤ 0.007). Two eyes with a topographic diagnosis of keratoconus and four eyes with subclinical keratoconus were detected in AA. Applanation lengths were smaller in AA (p ≤ 0.029). The Corvis Biomechanical Index was increased in AA (p = 0.022). Conclusions: AA patients have reduced corneal sensitivity and increased corneal staining. Topographic and biomechanical parameters are altered, and there could be a higher risk of keratoconus, thus possibly requiring routine ophthalmological examination.
Usefulness of Combined Measurement of Surfactant Protein D, Thrombin–Antithrombin III Complex, D-Dimer, and Plasmin–α2 Plasmin Inhibitor Complex in Acute Exacerbation of Interstitial Lung Disease: A Retrospective Cohort Study
Authors: Takeshita Yuichiro , To Masako , Kurosawa Yusuke , Furusho Naho , Kinouchi Toru , Tsushima Kenji , Tada Yuji , To Yasuo , Sakao Seiichiro
Published: April 2024

Background/Objectives: The coagulation cascade due to tissue damage is considered to be one of the causes of poor prognostic outcomes in patients with acute exacerbations of interstitial lung disease (AE-ILD). This study aimed to confirm coagulopathy in AE-ILD by evaluating the differences in the clinical characteristics of coagulation/fibrinolysis markers between stable ILD and AE-ILD. Methods: Overall, 81 patients were enrolled in this retrospective study and categorized into the following two groups: a chronic ILD group comprising 63 outpatients and an acute ILD group comprising 18 inpatients diagnosed with AE-ILD. Serum markers, including thrombin–antithrombin III complex (TAT), D-dimer, plasmin–α2 plasmin inhibitor complex (PIC), and surfactant protein D (SP-D), were compared between the groups. Results: Among the 18 patients with acute ILD, 17 did not meet the International Society of Thrombosis and Hemostasis scoring system for disseminated intravascular coagulation. In acute ILD, the SP-D levels were statistically significantly positively correlated with TAT, D-dimer, and PIC levels, while the Krebs von den Lungen 6 (KL-6) levels showed no correlation with any of these coagulation/fibrinolytic markers. A positive correlation was observed between SP-D levels and TAT, D-dimer, and PIC levels in acute ILD. Serum TAT, D-dimer, and PIC all showed good area under the receiver operating characteristic (ROC) curve (AUC) values in ROC analysis for the diagnosis of acute ILD. Conclusions: In the clinical setting of AE-ILD, it may be important to focus not only on alveolar damage markers such as SP-D but also on coagulation/fibrinolytic markers including TAT, D-dimer, and PIC.
Predisposition and Working Conditions for the Occurrence of Lumbar Syndrome in Medical Workers of the Clinical Center of Montenegro during the COVID-19 Pandemic
Authors: Jovanović Dragana , Backović Dragana , Tomas Ana , Bukumirić Zoran , Koprivica Bojan
Published: April 2024

Background: Lumbar pain is a condition of discomfort in the lower back caused by numerous factors, lasting for short or longer periods of time. Healthcare professionals, regardless of the type of care they are engaged in, are at risk of lumbar pain. This is the first study that deals with the problem of lumbar syndrome in health workers in Montenegro. Methods: This cross-sectional study included full-time health workers employed in the Clinical Center of Montenegro who were involved in the treatment of COVID-19 patients during 2020 and 2021. The survey consisted of general questions for collecting socio-demographic and COVID-19 engagement data; the Modified Nordic questionnaire was used for the analysis of musculoskeletal symptoms, and the EQ-5D—questionnaire was used to measure the quality of life associated with health. Results: The one-year prevalence of lumbar pain was 68.1%. Factors associated with lumbar pain were as follows: a higher degree of physical inactivity (each subject with a higher degree of physical inactivity had a 24% higher chance of occurrence of lumbar pain); a higher degree of load and over-engagement during the COVID-19 pandemic (each subject with a higher degree of workload had a nearly 50% higher chance of occurrence of lumbar pain); duration of engagement during the COVID-19 pandemic (subjects engaged up to a month were 4 times more likely to develop lumbar pain, and subjects engaged for 1–3 months were 3.5 times more likely to develop lumbar pain compared to those who were not engaged in COVID-19 treatment). This study also confirms that lumbar syndrome affects the quality of life of health workers. Conclusions: Lumbar syndrome is highly prevalent among healthcare professionals in the Clinical Center of Montenegro, especially in the population of nurses, where evidence-based preventive measures are needed.
The Outcome after Laser Therapy of Monochorionic Twin Pregnancies Complicated by Twin-Twin Transfusion Syndrome with Coexistent Selective Fetal Growth Restriction
Authors: Ortiz Javier U. , Guggenberger Johanna , Graupner Oliver , Ostermayer Eva , Kuschel Bettina , Lobmaier Silvia M.
Published: April 2024

Background: Most previous studies evaluated outcomes of twin–twin transfusion syndrome (TTTS) without considering the coexistence of selective fetal growth restriction (sFGR). The objectives of this study were to compare twin survival and pregnancy complications after laser therapy of TTTS with and without sFGR. Methods: For this purpose, a retrospective cohort study including 98 monochorionic diamniotic twins and three dichorionic triamniotic triplets treated in a single tertiary center was conducted. Results: Overall, 46 twins had selective fetal growth restriction (26 type I, 13 type II, 7 type III). At birth, donor survival (61% vs. 91%), double survival (57% vs. 82%), and overall survival (75% vs. 88%) were significantly lower in the group with coexistent sFGR. Recipient survival (89% vs. 86%), miscarriage (7% vs. 2%), PPROM < 32 weeks (48% vs. 29%), and preterm delivery < 32 weeks (52% vs. 45%) were not significantly higher in the group with coexistent sFGR. Donor twins with sFGR type I (69% vs. 91%) and types II–III (50% vs. 91%) showed significantly lower survival than those without sFGR. Multivariate regression analysis identified sFGR and its subtypes as independent predictors of donor demise. Conclusions: the coexistence of sFGR in TTTS pregnancies was associated with poor donor outcomes and is probably the most important predictor of donor survival.
Impact of the COVID-19 Pandemic on Head and Neck Cancer Management: The Experience of the Maxillo-Facial Surgery Department of a French Regional Referral Center in a High-Incidence Area
Authors: Colin Emilien , Paasche Agnès , Destrez Alban , Devauchelle Bernard , Bettoni Jérémie , Bouquet Julien , Dakpé Stéphanie , Testelin Sylvie
Published: April 2024

Background: Cancer patients are at a high risk of complications in cases of infection, and head and neck cancers (HNC) are no exception. Since late 2019, SARS-CoV-2 has caused a global health crisis, with high rates and severe forms of the disease in cancer patients. Hospitalization, surgery and radiotherapy were rapidly described as increasing the risk of infection. Since March 2020, the Amiens University Hospital (France) has been taking care of COVID-19 patients while its maxillofacial surgery department managed HNC patients without interruption, even during lockdown periods. However, many questions concerning the impact on patient care were still pending. The aim of this study is to describe HNC management in our center during the first epidemic peak and to evaluate the impact of containment measures on patient treatment. Methods: We retrospectively included 44 HNC patients treated in our department between 1 March and 31 August 2020. Two groups were defined according to the period of care: lockdown (March to May) and lighter restrictions (June to August). Results: The results show typical epidemiological characteristics, maintained management times and non-downgraded procedures. Conclusions: Thus, during the first epidemic peak, continuity of care and patients’ safety could be ensured thanks to adequate means, adapted procedures and an experienced surgical team.
The Impact of Shared Assistance between Dermatology and Internal Medicine on Patients with Psoriasis
Authors: García-Malinis Ana Julia , Pérez-Gilaberte Juan Blas , Gracia-Cazaña Tamara , González García Maria Pilar , Planas Linares Dolores , Gilaberte Yolanda
Published: April 2024

Background: The care of psoriatic patients requires a multidisciplinary approach that addresses not only skin involvement but also cardiovascular risk factors. Coordination between dermatology and internal medicine departments, with a specific focus on treatment and long-term follow-up, can substantially improve the course of a disease and its associated complications. Objective: to evaluate the effects of the holistic management of patients with psoriasis by a multidisciplinary team consisting of dermatology and internal medicine specialists. Methods: We conducted an observational, prospective, single-center case–control study between October 2016 and December 2019 in San Jorge University Hospital (Huesca, Spain). Cases included patients undergoing follow-up in the combined dermatology and internal medicine clinic. The control group consisted of an equivalent number of randomly selected, age- and sex-matched patients with moderate-to-severe psoriasis who were seen in the general dermatology department of the same hospital during the same time period. Main outcomes and measures: The primary outcome was the control of psoriatic disease and cardiovascular risk factors such as weight, blood pressure, waist circumference, body mass index (BMI), SCORE index (Systematic Coronary Risk Evaluation), and blood test parameters, as well as diet, physical exercise, and habits such as tobacco and alcohol consumption. To compare data collected over time, data were grouped into three time periods: baseline (t1), intermediate (t2), and final (t3). Results: The case group consisted of 27 patients, and the control group consisted of 25 patients. Multivariate analysis was used to evaluate the relationship between the 10-year risk of experiencing a cardiovascular event (SCORE) and the clinical characteristics and analytical variables of patients with psoriasis and controls (n = 52). The variables that were significantly associated with a higher 10-year risk of experiencing a cardiovascular event were age (OR, 1.33; CI95% 1.21–1.50; p < 0.001); smoking (OR, 5.05, CI95% 1.07–27.37; p = 0.047); PASI (OR, 7.98, CI95% 2.32–35.86; p = 0.003); BSA (OR, 1.22, CI95% 1.01–1.49; p = 0.044); and being a control patient (OR, 3.26; CI95% 0.84–13.56; p = 0.029). Conclusions: Pharmacological and behavioral interventions carried out as part of the procedure of the multidisciplinary clinic resulted in improvements in the following variables relative to the control group: PASI, BSA, DLQI, PSOLIFE, lipid profile, insulin and HOMA-IR GGT levels, vitamin D levels, and SCORE. These findings indicate the beneficial effect of the multidisciplinary clinic, which reduced the risk of cardiovascular events in psoriatic patients with metabolic comorbidities.
Changes in Maternal Heart Rate Variability and Photoplethysmography Morphology after Corticosteroid Administration: A Prospective, Observational Study
Authors: Bester Maretha , Nichting Thomas J. , Joshi Rohan , Aissati Lamyae , Oei Guid S. , Mischi Massimo , van Laar Judith O. E. H. , Vullings Rik
Published: April 2024

Background: Owing to the association between dysfunctional maternal autonomic regulation and pregnancy complications, assessing non-invasive features reflecting autonomic activity—e.g., heart rate variability (HRV) and the morphology of the photoplethysmography (PPG) pulse wave—may aid in tracking maternal health. However, women with early pregnancy complications typically receive medication, such as corticosteroids, and the effect of corticosteroids on maternal HRV and PPG pulse wave morphology is not well-researched. Methods: We performed a prospective, observational study assessing the effect of betamethasone (a commonly used corticosteroid) on non-invasively assessed features of autonomic regulation. Sixty-one women with an indication for betamethasone were enrolled and wore a wrist-worn PPG device for at least four days, from which five-minute measurements were selected for analysis. A baseline measurement was selected either before betamethasone administration or sufficiently thereafter (i.e., three days after the last injection). Furthermore, measurements were selected 24, 48, and 72 h after betamethasone administration. HRV features in the time domain and frequency domain and describing heart rate (HR) complexity were calculated, along with PPG morphology features. These features were compared between the different days. Results: Maternal HR was significantly higher and HRV features linked to parasympathetic activity were significantly lower 24 h after betamethasone administration. Features linked to sympathetic activity remained stable. Furthermore, based on the PPG morphology features, betamethasone appears to have a vasoconstrictive effect. Conclusions: Our results suggest that administering betamethasone affects maternal autonomic regulation and cardiovasculature. Researchers assessing maternal HRV in complicated pregnancies should schedule measurements before or sufficiently after corticosteroid administration.