bluuebunny/crossref_metadata_2025 huggingface dataset:
Arbeitsbedingungen in der Chirurgie und deren Auswirkungen
Authors: Gumpp J. , Fritze-Büttner F. , Blank B. , Axt S.
Published: October 2024

Hintergrund

In chirurgischen Disziplinen werden schlechte Arbeitsbedingungen und eine hohe Unzufriedenheit der Chirurginnen und Chirurgen der verschiedenen Disziplinen aufgezeigt. Die psychischen Folgen dieser Bedingungen auf die Chirurginnen und Chirurgen selbst sowie Auswirkungen auf deren Familien sind bisher unzureichend beachtet worden.

Ziel der Arbeit

Ziel dieser nationalen Umfrage des Berufsverbandes der Deutschen Chirurgie e. V. (BDC) war es, einen aktuellen Status der Arbeitsbedingungen in chirurgischen Abteilungen deutscher Kliniken zu erheben und die psychischen und familiären Auswirkungen dieser aufzuzeigen.

Material und Methoden

Im Zeitraum 01–02/2024 wurde eine Umfrage mit 26 Fragen mit den Schwerpunkten psychische Belastung, beruflich bedingte partnerschaftliche und familiäre Probleme sowie Suchtverhalten an alle Mitglieder des BDC sowie an alle deutschen chirurgischen Fachgesellschaften geschickt.

Ergebnisse

Es konnten 2221 Umfragen ausgewertet werden. Unter den Umfrageteilnehmern wurden Bürokratie (84,4 %) und ein unangemessener Ausgleich von Überstunden (68,1 %) als Hauptbelastung angesehen. Zur Bewältigung der Arbeitsbelastung wurden Alkohol (20,3 %), Nikotin (8,9 %) und Medikamente (8,3 %) angegeben; 60 % der Chirurginnen/Chirurgen gaben einen negativen Einfluss auf ihre Beziehung mit dem Partner/der Partnerin und 40 % auf die Beziehung mit den Kindern an.

Diskussion

Von Chirurginnen/Chirurgen werden schlechte Arbeitsbedingungen angegeben. Diese haben massive Auswirkungen auf die Psyche der Chirurginnen/Chirurgen sowie auf deren familiäre Beziehungen. Konsekutiv denken viele Chirurginnen/Chirurgen daran, den chirurgischen Beruf aufzugeben. Um diese Umstände zu verbessern und den chirurgischen Beruf wieder attraktiver zu machen, muss ein drastisches Umdenken erfolgen.
Are the grandparents alright? The health consequences of grandparental childcare provision
Authors: Eibich Peter , Zai Xianhua
Published: October 2024

This paper examines the causal effect of childcare provision on grandparents’ health in the United States. We use the sex ratio among older adults’ children as an instrument for grandparental childcare provision. Our instrument exploits that parents of daughters transition to grandparenthood earlier and invest more in their grandchildren than parents of sons. We estimate 2SLS regressions using data from the Health and Retirement Study. The results suggest that providing childcare is detrimental to grandparents’ physical functioning and subjective health. We show that these effects increase with the intensity of grandchild care provision, and the effects are driven primarily by grandmothers.
A mass spectrometry database for the identification of marine animal saponin-related metabolites
Authors: Smith Stuart J. , Cummins Scott F. , Motti Cherie A. , Wang Tianfang
Published: October 2024

Saponins encompass a diverse group of naturally occurring glycoside molecules exhibiting amphiphilic properties and a broad range of biological activities. There is a resurgence of interest in those saponins produced by marine organisms based on their potential therapeutic benefits, application in food products and most recently their potential involvement in intra- and inter-species chemical communication. The continual advancements in liquid chromatography techniques and mass spectrometry technologies have allowed for greater detection rates, as well as improved isolation and elucidation of saponins. These factors have significantly contributed to the expansion in the catalogue of known saponin structures isolated from marine invertebrates; however, there currently exists no specific chemical library resource to accelerate the discovery process. In this study, a Marine Animal Saponin Database (MASD v1.0) has been developed to serve as a valuable chemical repository for known marine saponin-related data, including chemical formula, molecular mass and biological origin of nearly 1000 secondary metabolites associated with saponins produced by marine invertebrates. We demonstrate its application with an exemplar asteroid extract (Acanthaster cf. solaris, also known as crown-of-thorns starfish; COTS), identifying saponins from the MASD v1.0 that have been previously reported from COTS, as well as 21 saponins isolated from multiple other related asteroid species. This database will help facilitate future research endeavours, aiding researchers in exploring the vast chemical diversity of saponins produced by marine organisms and providing ecological insights, and the realisation of their potential for various applications, including as pharmaceuticals.

Graphical Abstract
Languages Generated by Conjunctive Query Fragments of FC[REG]
Authors: Thompson Sam M. , Freydenberger Dominik D.
Published: October 2024

$${\textsf{FC}}$$
FC
is a finite model variant on the theory of concatenation, $${\textsf{FC}[\textsf{REG}]}$$

FC
[
REG
]

extends $${\textsf{FC}}$$
FC
with regular constraints. This paper considers the languages generated by their conjunctive query fragments, and . We compare the expressive power of $${\textsf {FC[REG]-CQ}}$$

FC
[
REG
]
-
CQ

to that of various related language generators, such as regular expressions, patterns, and typed patterns. We then consider decision problems for $${\textsf {FC-CQ}}$$

FC
-
CQ

and $${\textsf {FC[REG]-CQ}}$$

FC
[
REG
]
-
CQ

, and show that certain static analysis problems (such as equivalence and regularity) are undecidable. While this paper defines $${\textsf {FC-CQ}}$$

FC
-
CQ

based on the logic $${\textsf{FC}}$$
FC
, it can equally be understood as synchronized intersections of pattern languages, or as systems of restricted word equations.
CT Perfusion imaging as prognostic factor for outcome of lacunar stroke
Authors: Mausbach Stefan , Abdallah Lamya Ahmad , Ben-David Eliel , Teitcher Michael , Bornstein Natan M. , Eichel Roni
Published: October 2024

Background

Early neurological deterioration (END) affects 20–30% of patients with lacunar stroke within 48 h despite optimal treatment. Previously established markers included infection and infarct location on imaging. We studied the utility of measuring global cerebral blood flow (gCBF) measured by CT-Perfusion (CTP) as an early predictor of END in patients with lacunar strokes.

Methods

162 patients with lacunar stroke were measured for gCBF including both cerebral hemispheres and cerebellum. We stratified patients by normal gCBF (> 40 ml/100 mg/min) vs. low gCBF (< 40 ml/100 mg/min). Stroke location, vascular risk factors, age and gender were assessed. The primary outcome was the change in the NIHSS score after 48 h from index stroke.

Results

Mean gCBF of the overall cohort was 37.72 ml/100 mg/min. Both groups had a baseline NIHSS score of 4.2 with similar standard deviations. The NIHSS score decreased by 1.3 points in normal gCBF group and increased by 1.1 points in the low gCBF group. All stroke sites deteriorated in the low gCBF group, particularly the capsula interna, corona radiata, and lateral pontine area. END occurred in 37.8% in low gCBF compared to 3.1% in the normal gCBF patients. In contrast, clinical improvement after 48 h occurred in 64.2% of patients with normal gCBF but only 6.1% with low gCBF.

Conclusion

Our study supports measurement of gCBF by CTP as a potential imaging biomarker for END. Additionally, it adds evidence to the body of supporting the vulnerability of capsula interna and pontine infarctions to END.
TFIIS is required for reproductive development and thermal adaptation in barley
Authors: Ahmad Imtiaz , Kis András , Verma Radhika , Szádeczky-Kardoss István , Szaker Henrik Mihály , Pettkó-Szandtner Aladár , Silhavy Dániel , Havelda Zoltán , Csorba Tibor
Published: October 2024

Key message

Barley reproductive fitness and efficient heat stress adaptation requires the activity of TFIIS, the elongation cofactor of RNAPII.

Regulation of transcriptional machinery and its adaptive role under different stress conditions are studied extensively in the dicot model plant Arabidopsis, but our knowledge on monocot species remains elusive. TFIIS is an RNA polymerase II-associated transcription elongation cofactor. Previously, it was shown that TFIIS ensures efficient transcription elongation that is necessary for heat stress survival in A. thaliana. However, the function of TFIIS has not been analysed in monocots. In the present work, we have generated and studied independent tfIIs-crispr-mutant barley lines. We show that TFIIS is needed for reproductive development and heat stress survival in barley. The molecular basis of HS-sensitivity of tfIIs mutants is the retarded expression of heat stress protein transcripts, which leads to late accumulation of HSP chaperones, enhanced proteotoxicity and ultimately to lethality. We also show that TFIIS is transcriptionally regulated in response to heat, supporting a conserved adaptive function of these control elements for plant thermal adaptation. In sum, our results are a step forward for the better understanding of transcriptional machinery regulation in monocot crops.
Computed tomography referral guidelines adherence in Europe: insights from a seven-country audit
Authors: Singer Clara , Saban Mor , Luxenburg Osnat , Yellin Lucia Bergovoy , Hierath Monika , Sosna Jacob , Karoussou-Schreiner Alexandra , Brkljačić Boris
Published: October 2024

Background

Ensuring appropriate computed tomography (CT) utilization optimizes patient care while minimizing radiation exposure. Decision support tools show promise for standardizing appropriateness.

Objectives

In the current study, we aimed to assess CT appropriateness rates using the European Society of Radiology (ESR) iGuide criteria across seven European countries. Additional objectives were to identify factors associated with appropriateness variability and examine recommended alternative exams.

Methods

As part of the European Commission-funded EU-JUST-CT project, 6734 anonymized CT referrals were audited across 125 centers in Belgium, Denmark, Estonia, Finland, Greece, Hungary, and Slovenia. In each country, two blinded radiologists independently scored each exam’s appropriateness using the ESR iGuide and noted any recommended alternatives based on presented indications. Arbitration was used in case auditors disagreed. Associations between appropriateness rate and institution type, patient’s age and sex, inpatient/outpatient patient status, anatomical area, and referring physician’s specialty were statistically examined within each country.

Results

The average appropriateness rate was 75%, ranging from 58% in Greece to 86% in Denmark. Higher rates were associated with public hospitals, inpatient settings, and referrals from specialists. Variability in appropriateness existed by country and anatomical area, patient age, and gender. Common alternative exam recommendations included magnetic resonance imaging, X-ray, and ultrasound.

Conclusion

This multi-country evaluation found that even when using a standardized imaging guideline, significant variations in CT appropriateness persist, ranging from 58% to 86% across the participating countries. The study provided valuable insights into real-world utilization patterns and identified opportunities to optimize practices and reduce clinical and demographic disparities in CT use.

Key Points

Question

Largest multinational study (7 EU countries, 6734 CT referrals) assessed real-world CT appropriateness using ESR iGuide, enabling cross-system comparisons.

Findings

Significant variability in appropriateness rates across institution type, patient status, age, gender, exam area, and physician specialty, highlighted the opportunities to optimize practices based on local factors.

Clinical relevance

International collaboration on imaging guidelines and decision support can maximize CT benefits while optimizing radiation exposure; ongoing research is crucial for refining evidence-based guidelines globally.
ESR Essentials: role of PET/CT in neuroendocrine tumors—practice recommendations by the European Society for Hybrid, Molecular and Translational Imaging
Authors: Ebner Ricarda , Sheikh Gabriel T. , Brendel Matthias , Ricke Jens , Cyran Clemens C.
Published: October 2024

Neuroendocrine neoplasms (NEN) originate from the secretory cells of the neuroendocrine system, with the majority arising in the gastrointestinal tract and pancreas. Given the heterogeneity in the biological behavior and morphological differentiation of these tumors, advanced imaging techniques are crucial for supporting the suspected diagnosis, accurate staging, and monitoring therapy. As most well-differentiated NEN demonstrate overexpression of somatostatin receptors (SSR) on the cell surface, SSR-directed PET/CT is considered the reference standard for imaging of this particular entity. SSR-PET/CT should be the imaging method of choice in every NEN G1 or G2 and considered for re-staging after both potentially curative and non-curative surgeries. The extent of SSR expression is also crucial for determining a patient’s eligibility for peptide receptor radionuclide therapy (PRRT). PRRT utilizes [177Lu]Lu-DOTA-TATE to target the SSR receptor and can significantly prolong progression-free survival in patients with advanced, progressive neuroendocrine tumor of the gastroenteropancreatic system (GEP-NET). PET/CT is a central component of the multidisciplinary management of NEN. Variable follow-up intervals are recommended, considering that tumors with higher proliferation rates or advanced metastatic disease require more frequent assessments. The combination with other imaging modalities, like MRI, complements SSR-PET/CT, further enhancing overall diagnostic accuracy.

Key Points

Somatostatin receptor-PET/CT (SSR-PET/CT) is the guideline-recommended reference standard for imaging well-differentiated neuroendocrine tumors (NET).

SSR-PET/CT should be the diagnostic imaging of choice for staging and post-therapy re-staging of grade 1 or 2 NET (G1 or G2).

Variable follow-up intervals are recommended for NET G1 and G2. Tumors with higher proliferation rates or advanced metastatic disease necessitate more frequent assessments.
Differential fatty acids utilization across life stages in a Vespa species
Authors: Bouchebti Sofia , Levin Eran
Published: October 2024

Dietary fatty acids (FAs) are essential macronutrients affecting animal fitness, growth, and development. While the degree of saturation of FAs usually determines the level of absorption and allocation within the body, the utilization of dietary FAs across the life stages of individuals remains unknown. We used three different 13 C labeled FAs, with a different saturation level (linoleic acid (18:2), oleic acid (18:1), and palmitic acid (16:0)), to investigate the absorption and allocation of dietary FAs across the life stages of the Oriental hornet. Our results show that only larvae utilized all tested FAs as metabolic fuel, with palmitic acid being oxidized at the highest rate. Oleic and palmitic acids were predominantly incorporated into larval tissues, while oleic acid dominated pupal tissues. In contrast, linoleic and oleic acids were predominantly incorporated into adult tissues. These findings highlight a life stage-dependent shift in certain FAs utilization, with palmitic acid mostly utilized in early stages and linoleic acid in adulthood, while oleic acid remained consistently utilized across all life stages. This study emphasizes the importance of considering FA saturation and life stage dynamics in understanding FA utilization patterns.
Effect of postpartum pessary use on pelvic floor function: a prospective multicenter study
Authors: Beer Franziska , Kuppinger Madeleine , Schwab Frank , Hübner Markus , Kiefner Brenda , Nacke Anna , Kelkenberg Ute , Schütze Sabine , Lindner Anna , Hellmeyer Lars , Janni Wolfgang , Metz Melanie , Deniz Miriam
Published: October 2024

Purpose

This study evaluates the restitution of pelvic floor function in postpartum women using the Restifem® pessary in a preventive and therapeutic approach.

Methods

In this multicentre study all postpartum women independently of their parity, mode of delivery and existing pelvic floor symptoms were offered to use the Restifem® pessary from 6 weeks postpartum for 3 to 6 months. They completed the validated German pelvic floor questionnaire (GPFQpp) via online survey at 6 weeks, 6 months and 12 months postpartum and were divided, by their own choice, into users and non-users of the pessary.

Results

Initially 857 women were enrolled. After 6 weeks 137 pessary users and 133 non-users, after 12 months 53 pessary users and 45 non-users submitted a completed questionnaire. Pessary users had significantly higher (worse) scores in all domains of the GPFQpp at 6 weeks postpartum. At 12 months postpartum pessary users still had a significantly higher bladder score, compared to non-users. There was a greater improvement in the bladder score (p = 0.005) and the pelvic organ prolapse score (p < 0.001) from 6 weeks to 12 months postpartum, among pessary users compared to non-users.

Conclusion

Pessary users had a significantly greater improvement in pelvic floor function from 6 weeks to 12 months postpartum, compared to non-users. This effect might be in part due to wearing the pessary but also due to greater scope for recovery, given the higher level of pelvic floor dysfunction in the pessary user group.

Trial registration.

The trial was registered in the German Clinical Trials Register (DRKS00024733) on 19 of April 2021.
S100 and CD34 positive spindle cell tumors of the uterine cervix with EGFR mutation: a hitherto unrecognized neoplasm phenotypically and epigenetically overlapping with “NTRK-rearranged spindle cell neoplasms” of the uterus
Authors: Michal Michael , Kuruc Josef , Hájková Veronika , Michalová Květoslava , Klubíčková Natálie
Published: October 2024

NTRK-rearranged spindle cell neoplasm represents an emerging entity included in the latest 5th edition of WHO classification of both soft tissue and female genital tumors. By immunohistochemistry, they are commonly positive for CD34, S100 protein, and CD30 and typically harbor fusions of kinase genes such as NTRK1/2/3, RET, and BRAF. In the gynecological tract, they typically affect the uterine cervix or uterine body. Most of the reported cases had fibrosarcoma-like morphology, occasionally showing perivascular and stromal hyalinization with only a few cases showing a less cellular spindle cell proliferation. Except for one case with RET fusion, all other gynecological cases harbored exclusively NTRK1/2/3 fusions. Besides kinase gene fusions, the analogous tumors in soft tissues may also harbor activating EGFR or BRAF point mutations, but no such case has been described in the uterus. Herein we are reporting two cases from the uterine cervix showing morphology and molecular features previously unreported at this anatomic site. The patients were 46 and 34 years old and clinically presented with unremarkable cervical polyps each measuring 8 mm in diameter. Histologically, both cases had a rounded polypoid outline and were composed of hypocellular proliferation of bland spindle cells lacking mitotic activity and growing in a fibrotic stroma which was punctuated by prominent small vessels with thick hyalinized walls. Immunohistochemically, both showed a diffuse expression of CD34, CD30, and S100 protein, whereas SOX10 was negative. Both cases harbored exon 20 EGFR mutation and did not reveal any fusions or significant copy number changes. The patient in case 1 was treated by hysterectomy with salpingectomy with no other residual tumor detected, and she was alive and well 27 months after the diagnosis. The patient in case 2 had no other known tumors at the time of diagnosis, but no follow-up is available. We believe the reported cases represent a hitherto unrecognized variant of “NTRK-rearranged spindle cell neoplasms” of the uterine cervix with novel EGFR mutations.
FGFR3::TACC3 fusions in head and neck carcinomas: a study of nine cases highlighting phenotypic heterogeneity, frequent HPV association, and a morphologically distinct subset in favor of a putative entity
Authors: Agaimy Abbas , Antonescu Cristina R. , Bell Diana , Breimer Gerben E. , Dermawan Josephine K. , Kester Lennart A. , Laco Jan , Rijken Johannes A. , Whaley Rumeal D. , Stoehr Robert , Cramer Thomas , Bishop Justin A.
Published: October 2024

The FGFR3::TACC3 fusion has been reported in subsets of diverse cancers including urothelial and squamous cell carcinomas (SCC). However, the morphology of FGFR3::TACC3-positive head and neck carcinomas has not been well studied and it is unclear if this fusion represents a random event, or if it might characterize a morphologically distinct tumor type. We describe nine FGFR3::TACC3 fusion–positive head and neck carcinomas affecting six males and three females aged 38 to 89 years (median, 59). The tumors originated in the sinonasal tract (n = 4), parotid gland (n = 2), and one case each in the oropharynx, submandibular gland, and larynx. At last follow-up (9–21 months; median, 11), four patients developed local recurrence and/or distant metastases, two died of disease at 11 and 12 months, one died of other cause, one was alive with disease, and two were disease-free. Three of six tumors harbored high risk oncogenic HPV infection (HPV33, HPV18, one unspecified). Histologically, three tumors revealed non-keratinizing transitional cell-like or non-descript morphology with variable mixed inflammatory infiltrate reminiscent of mucoepidermoid or DEK::AFF2 carcinoma (all were HPV-negative), and three were HPV-associated (all sinonasal) with multiphenotypic (1) and non-intestinal adenocarcinoma (2) pattern, respectively. One salivary gland tumor showed poorly cohesive large epithelioid cells with prominent background inflammation and expressed AR and GATA3, in line with a possible salivary duct carcinoma variant. Two tumors were conventional SCC. Targeted RNA sequencing revealed an in-frame FGFR3::TACC3 fusion in all cases. This series highlights heterogeneity of head and neck carcinomas harboring FGFR3::TACC3 fusions, which segregates into three categories: (1) unclassified HPV-negative category, morphologically distinct from SCC and other entities; (2) heterogeneous group of HPV-associated carcinomas; and (3) conventional SCC. A driver role of the FGFR3::TACC3 fusion in the first category (as a potential distinct entity) remains to be further studied. In the light of available FGFR-targeting therapies, delineation of these tumors and enhanced recognition is recommended.
Psychometric properties of the preschool strengths and difficulties questionnaire (SDQ) in UK 1-to-2-year-olds
Authors: Byrne Elizabeth M. , Eneberi Annette , Barker Beth , Grimas Ellen , Iles Jane , Pote Helen , Ramchandani Paul G. , O’Farrelly Christine M.
Published: October 2024

Early identification of emotional and behavioural difficulties in very young children is crucial for intervention and prevention. The Strengths and Difficulties Questionnaire (SDQ) is a widely used measure of child and adolescent mental health that is brief, cost-effective, and easy to administer. The aims of this study were to establish the validity and reliability of the preschool SDQ in UK 1-2-year-olds. This study investigated the psychometric properties of the Preschool SDQ in a large UK sample (N = 2040; female = 46.86%; male = 50.83%, sex not recorded = 2.30%) of infants and toddlers (1-2-year-olds). Analyses were performed at item-level (internal consistency, internal structure, measurement invariance) and scale-level (test–retest reliability, convergent validity). Similar to previous research, confirmatory factor analysis supported a slightly modified five-factor model, including the addition of a positive construal method factor, resulting in satisfactory data fit and a moderately good fitting model. Internal consistency (Cronbach’s alpha) for the SDQ total difficulties score was satisfactory, and higher for externalising over internalising problems. Moderate to strong correlations indicated good test–retest reliability, and moderate correlations indicated convergent validity between the SDQ and Child Behavior Checklist (CBCL), but associations were weaker than those found in studies with older children.

Conclusions: The SDQ demonstrated satisfactory psychometric properties, suggesting that it may be a useful tool for the detection of early mental health difficulties, particularly externalising symptoms, even in very young toddlers. Further research is needed to validate the SDQ in younger populations and to establish cut-off scores for clinical interpretation. The implications of these findings are discussed.

What is known:• Clinically significant emotional and behavioural problems can and do emerge in early toddlerhood.• Parenting interventions can reduce mental health problems.• Valid, reliable, brief, and affordable tools are needed to identify very young children who may benefit from such support.What is new:• The Strengths and Difficulties Questionnaire was found to have acceptable factor structure and psychometric properties for use with young children aged 1-2 years old in the UK.• The externalising subscale in particular shows promise as an early screening tool.
Palpable signs of skull fractures on physical examination and depressed skull fractures or traumatic brain injuries on CT in children
Authors: Bressan Silvia , Tancredi Daniel , Casper Charles T. , Da Dalt Liviana , Kuppermann Nathan
Published: October 2024

To assess the actual presence of underlying depressed skull fractures and traumatic brain injuries (TBI) on computed tomography (CT) in children with and without palpable skull fractures on physical examination following minor head trauma. This was a secondary analysis of a prospective, observational multicenter study enrolling 42,412 children < 18 years old with Glasgow Coma Scale scores ≥ 14 following blunt head trauma. A palpable skull fracture was defined per the treating clinician documentation on the case report form. Skull fractures and TBIs were determined on CT scan by site radiologists. Palpable skull fractures were reported in 368/10,698 (3.4%) children < 2 years old, and in 676/31,613 (2.1%) of older children. Depressed skull fractures on CT were observed in 56/273 (20.5%) of younger children with palpable skull fractures and in 34/3047 (1.1%) of those without (rate difference 19.4%; 95%CI 14.6–24.2%), and in 30/486 (6.2%) vs 63/11,130 (0.6%) of older children (rate difference 5.6%; 95%CI 3.5–7.8%). TBIs on CT were found in 73/273 (26.7%) and 189/3047 (6.2%) of younger children with and without palpable skull fractures (rate difference 20.5%; 95%CI 15.2–25.9), and in 61/486 (12.6%) vs 424/11,130 (3.8%) of older children (rate difference 8.7%; 95%CI 6.1–12.0).

Conclusions: Although depressed skull fractures and TBIs on CT are more common in children with palpable fractures than those without, most of these children do not have underlying depressed fractures. The discriminatory ability of the scalp examination could be enhanced by direct bedside visualization of the skull, such as through ultrasound.

What is Known:

• “Palpable skull fractures” are a high-risk predictor in the PECARN traumatic brain injury (TBI) rule for children younger than 2 years.

• The reliability of physical exam findings suggestive of underlying skull fractures is unclear.

What is New:

• In children younger than 2 years of age, approximately one in five of those with “palpable skull fractures” will actually have a depressed skull fracture on CT, while 60% will have any skull fracture.

• The discriminatory ability of the scalp examination could be enhanced by direct bedside visualization of the skull, such as through ultrasound.
Splanchnic and cerebral oxygenation during cyclic phototherapy in preterm infants with hyperbilirubinemia
Authors: Dani Carlo , Remaschi Giulia , Rossi Federica , Fusco Monica , Poggi Chiara , Corsini Iuri , Pratesi Simone
Published: October 2024

Cyclic phototherapy (cPT) can achieve a reduction in total serum bilirubin comparable to that achieved with standard continuous PT in preterm infants. Our aim was to assess the effect of cPT on splanchnic (rSO2S) and cerebral (rSO2C) oxygenation measured by near-infrared spectroscopy (NIRS). We prospectively studied 16 infants with a gestational age of 25–34 weeks with hyperbilirubinemia requiring PT. Splanchnic regional oxygenation (rSO2S), oxygen extraction fraction (FOES), and cerebro-splanchnic oxygenation ratio (CSOR) were recorded before, during, and after cPT discontinuation. We found that rSO2S, FOES, and CSOR did not change during the study period. The overall duration of single or multiple courses of PT was 6.5 (6.0–13.5) h, but by cycling PT, the actual exposure was 3.0 (1.5–4.9) h. Twelve patients (75%) required 15 min/h cPT, and four (25%) required prolonging cPT to 30 min/h. None of the patients developed enteral feeding intolerance.

Conclusions: cPT treatment of hyperbilirubinemia in preterm infants does not affect splanchnic oxygenation or intestinal oxygen blood extraction, likely due to the short exposure to PT light, and it could contribute to decreasing the risk of feeding intolerance.

What is Known:• The assumption that phototherapy (PT) is innocuous with no serious adverse effects has been questioned.• Cyclic phototherapy (cPT) can achieve a reduction in total serum bilirubin comparable to that achieved with standard continuous PT in preterm infants.

What is New:• Splanchnic and cerebral oxygenation measured by near-infrared spectroscopy did not change during KMC.• cPT can contribute to decrease the risk of feeding intolerance likely due to the short exposure to PT light.
The role of institutional ethics committees in Austria
Authors: Schober Sophie , Klee Sascha , Trautinger Franz
Published: October 2024

Research involving human subjects or identifiable human material and data must be assessed by an ethics committee. The Karl Landsteiner University of Health Sciences has established a Commission on Ethics and Scientific Integrity to evaluate medical research conducted by its faculty and students and at its affiliated hospitals.

All projects submitted to the Commission on Ethics and Scientific Integrity between 2018 and 2023 were analyzed regarding their major characteristics, the duration of the evaluation process, and votes issued.

A total of 520 applications were electronically submitted during the observation period. Most of the studies were retrospective data analyses in the field of oncology, psychology and surgery. Most studies included less than 100 volunteers. Of the applications 50% received a final vote within 5 months, during which several revision rounds took place. Overall, about 77% of votes issued during the observation period were positive and 2% were rejections. In 11% files were closed due to withdrawal. In 11% final votes were pending at the end of the observation period due to requests for revisions.

Our results emphasize the importance of institutional ethics committees using the example of the Commission on Ethics and Scientific Integrity at the Karl Landsteiner University. Such committees fill a gap in evaluating research not covered by Austrian legal regulations. Continuous development of standards, operating procedures, and national and international collaborations are required to assess and minimize risks to trial subjects and to provide a safe and productive environment for research in human medicine and related fields.
Healthcare use among cancer survivors during the COVID-19 pandemic: results from the SHARE COVID-19 Survey
Authors: Pimentel Ana Sofia , Costa Ana Rute
Published: October 2024

Purpose

To estimate the association between a previous cancer diagnosis and healthcare use during the COVID-19 pandemic among Europeans and Israelis individuals.

Methods

This cross-sectional study was based on data from the Survey of Health, Ageing and Retirement in Europe (SHARE), including the SHARE COVID-19 Survey, which was conducted in the summer of 2020, in 27 countries. Cancer survivors (CS, n = 6409) were country-, sex-, age-, and education-matched (1:2) to non-cancer individuals (NC). Adjusted odds ratios (OR) and 95% confidence intervals (95%CI) were computed using logistic regression.

Results

Overall, CS were more likely to refer that they forwent medical appointments due to fear of COVID-19 (OR = 1.29, 95%CI 1.19–1.41) than NC, particularly those who lived with their partner and other relatives (OR = 1.79, 95%CI 1.39–2.30). Likewise, CS had their medical appointments postponed more often (OR = 1.54, 95%CI 1.44–1.64); this association was stronger among CS who lived with their partner and other relatives (OR = 1.96, 95%CI 1.63–2.36) who reported higher economic difficulties (OR = 1.73, 95%CI 1.50–2.00) and those with no multimorbidity (OR = 1.85, 95%CI 1.62–2.11). CS were also more likely to refer that they were unable to book an appointment (OR = 1.43, 95%CI 1.26–1.63), particularly those who reported that a person close to them died due to COVID-19 (OR = 2.72, 95%CI 1.47–5.01).

Conclusion

CS were more likely to forgo medical treatment, report healthcare postponements, and be unable to book an appointment than NC, which highlights the importance of closely monitoring the long-term impact of the COVID-19 pandemic along the cancer care continuum.
Surgical treatment of meningiomas improves neurocognitive functioning and quality of life – a prospective single-center study
Authors: Ueberschaer Moritz , Hackstock Rene , Rainer Lucas , Breitkopf Katharina , Rezai Arwin , Kaiser Andreas , Griessenauer Christoph J. , Schwartz Christoph
Published: October 2024

Background and purpose

Early diagnosis and the refinement of treatment of patients with intracranial meningiomas have brought quality of life (QoL) and neurocognitive functioning as outcome measures into focus. The aim of this study is a comprehensive assessment of neurocognitive function, quality of life and the presence of depression in meningioma patients before and after surgery.

Methods

Patients with MRI diagnosis of intracranial meningioma and indication for surgery were prospectively included. A clinical neuropsychologist performed neurocognitive assessments within 3 months before and 12 months after surgery. The test battery included investigation of selective and divided attention, verbal and figural memory, executive functioning, and word fluency. Self-report questionnaires to assess depressive symptoms, QoL, and disease coping were administered. Raw values and t-values were compared pre-and postoperatively. Outcome was stratified by tumor- and peritumoral brain edema (PTBE) volumes, postoperative resolution of PTBE and WHO grade. The study included 18 predominantly female patients (83%) with a median age of 59 years and mostly CNS WHO grade 1 meningiomas (83%).

Results

There was a significant postoperative improvement in the ability to selectively react under stress, in working memory and improved delayed reproduction of verbal and visual memory content. QoL improved regarding a reduction in physical problems, an improvement in energy, and social functioning. There was a trend towards worse preoperative scores in all tests, and greater postoperative improvement in patients with PTBE. Tumor volume had no effect on the measured outcome. The patients did not suffer from depressive symptoms before the surgery but improved postoperatively and most patients had an active, problem-oriented coping strategy.

Conclusion

Resection of intracranial meningiomas leads to an improvement in multiple neurocognitive domains and QoL. There is a trend towards poorer preoperative neurocognitive functioning and greater postoperative improvement in patients with PTBE. Depression appears to play a minor role in the context of neurocognitive functioning and disease coping.
Temporomandibular joint space variation and masticatory muscle activation during clenching with full versus partial covering occlusal splints
Authors: Seiler Annika , Lukic Nenad , Özcan Mutlu , Kazimi Marina , Kaldas Moody , Gallo Luigi M. , Colombo Vera
Published: October 2024

Objectives

Occlusal splints are the main therapeutic choice in the treatment of temporomandibular disorders (TMD). However, their precise working mechanism is unclear. This study aimed to compare the biomechanical effect of three commercially available splint designs (full covering splint, anterior bite splint and posterior bite splint) during biting in a sample of healthy subjects.

Materials and methods

Magnetic resonance imaging (MRI) was combined with jaw tracking to measure the minimal intraarticular distance (MID) of 20 human temporomandibular joints (TMJ) whilst simultaneously recording the electromyogram (EMG) of the masticatory muscles. The changes caused by clenching with a bite force of 100 N without splint (baseline) and on each splint were calculated. Repeated measures ANOVA was performed on the means of the MID variations and EMG amplitudes.

Results

Clenching on the anterior bite splint resulted in two times less activation of the anterior temporalis muscle than baseline (p = 0.003), full covering (p = 0.011) and posterior bite splint (p = 0.011). MID was reduced by clenching in all conditions, but the reduction was almost three times larger with the anterior bite splint compared to no splint (p = 0.011). The full covering splint and the posterior bite splint did not differ significantly in EMG activation of both masseter and temporalis muscles and MID variation.

Conclusions

This study showed that splint designs have a different impact on the MID and EMG activation while clenching. The anterior bite splint had a greater impact on the reduction of the muscle activation, whereas clenching on the anterior bite splint led to bigger reduction of MID and thus had the greatest influence on alteration in the condylar position.

Clinical relevance

The design of the splint can affect MID and muscle activation and is a variable to consider in the treatment of patients with TMD according to their symptoms.
Exploring the role of plasmapheresis prior to thyroidectomy in managing thyrotoxicosis: a comprehensive scoping review
Authors: Koziak Weronika , Dudek Stanisław , Putowski Zbigniew , Sanfilippo Filippo , Zawadka Mateusz
Published: October 2024

A thyroid storm is the most extreme and life-threatening presentation of thyrotoxicosis. Thyroidectomy can be used for definitive treatment. It should be performed after euthyroidism is accomplished. The use of therapeutic plasma exchange (TPE) is a last resort option in cases where standard pharmacological therapy proves to be ineffective. Due to its rare prevalence, there are limited data evaluating the usefulness and efficacy of TPE as a bridging therapy to thyroidectomy. The absence of relevant literature prompted us to conduct a scoping review. The following bibliographic databases were searched for articles dated 30 November 2023: Medline, EMBASE, Web of Science and Google Scholar. The search identified 1047 records, of which 42 articles were accepted with a total of 234 patients. The dominant indications for TPE were side effects due to conventional treatment. The mean fT4 level decreased 51.9% of baseline after TPE, while the mean fT3 level decreased 66.6% of baseline. The main side effects observed with FFP were allergic reactions, while the use of an albumin solution was associated with perioperative bleeding. Based on the limited data available in the literature, we recognize plasmapheresis as an effective treatment option for reducing thyroid hormone levels prior to thyroidectomy in patients with thyrotoxicosis. Available data suggest that it might be reasonable to limit the number of sessions in favor of an earlier surgical intervention. To reduce the risk of bleeding, FFP may be a better option as a replacement fluid, especially in the session prior to thyroidectomy.
Diagnostic delay in patients with sporadic hereditary transthyretin-mediated amyloidosis
Authors: Antunes Bernardo , Conceição Isabel , Falcão de Campos Catarina , de Carvalho Mamede
Published: October 2024

Background

Hereditary transthyretin-mediated amyloidosis (ATTRv amyloidosis) is a rare progressively incapacitating condition with a wide range of genotype/phenotype presentations. It is frequently diagnosed late in its course, particularly in sporadic cases.

Objectives

Analysing predictors of diagnostic delay in this subpopulation should be, therefore, a priority.

Methods

109 apparently sporadic ATTRv amyloidosis patients followed in a reference centre in Hospital de Santa Maria (ULS Santa Maria-CAML), in Lisbon, were studied. Time from symptom onset to diagnosis, age, sex, municipality of origin and initial symptoms were obtained. Diagnostic delay was compared between different decades with a Kruskal–Wallis test, and its predictors were evaluated in a univariate model followed by a binary logistic regression analysis to calculate the adjusted odds ratio.

Results

The median diagnostic delay was 1262 days. There was a non-significant difference in diagnostic delay between the 80 s, 90 s, 2000s and 2010s decades. There was a non-significant trend for a longer diagnostic delay in woman and in patients having no neurologic symptoms at onset.

Conclusion

There is an important diagnostic delay in sporadic cases of ATTRv amyloidosis. Awareness should be spread among clinicians regarding the various manifestations of this disease, stressing the importance of family history and epidemiological data.
Real-world effectiveness and safety of trastuzumab-deruxtecan in Japanese patients with HER2-positive advanced gastric cancer (EN-DEAVOR study)
Authors: Kawakami Hisato , Nakanishi Koki , Makiyama Akitaka , Konishi Hirotaka , Morita Satoshi , Narita Yukiya , Sugimoto Naotoshi , Minashi Keiko , Imano Motohiro , Inamoto Rin , Kodera Yasuhiro , Kume Hiroki , Yamaguchi Keita , Hashimoto Wataru , Muro Kei ,   EN-DEAVOR Study Group
Published: October 2024

Background

Trastuzumab-deruxtecan (T-DXd) was approved for the treatment of HER2-positive patients with advanced gastric cancer in Japan based on the results of the DESTINY-Gastric01 trial. This study aimed to collect real-world data and evaluate the effectiveness and safety of T-DXd.

Methods

Patients aged ≥ 20 years at the start of T-DXd administration with a histopathologically confirmed diagnosis of HER2-positive unresectable advanced or recurrent gastric or gastroesophageal junction (GEJ) adenocarcinoma that had worsened after chemotherapy were enrolled in this retrospective cohort study. Key outcomes included T-DXd treatment status, overall survival (OS), real-world progression-free survival (rwPFS), time to treatment failure (TTF), objective response rate and frequency of grade ≥ 3 adverse events (AEs).

Results

Of the 312 patients included in the analysis, 75.3% were male, the median (range) age was 70.0 (27.0–89.0) years, 12.2% had an ECOG PS ≥ 2, 43.3% had ascites and the initial T-DXd dose was > 5.4– ≤ 6.4 mg/kg in 78.2% of patients. The median (95% confidence interval) OS, rwPFS and TTF (months) was 8.9 (8.0–11.0), 4.6 (4.0–5.1) and 3.9 (3.4–4.2), respectively. The response rate was 42.9% in patients with a target lesion. In total, 48.4% of patients experienced a grade ≥ 3 AE, 2.6% experienced grade 5 AEs and 60.9% experienced AEs leading to T-DXd dose adjustments (reduction: 36.9%, interruption: 34.0% or discontinuation: 23.7%). No new safety signals were detected.

Conclusions

T-DXd was effective and had a manageable safety profile as a third- or later-line treatment for patients with HER2-positive gastric or GEJ cancer in Japanese clinical practice. Clinical trial registration: UMIN000049032
Recovery of samarium and cobalt/iron oxide from SmCo magnets through acid baking and water leaching
Authors: Emil-Kaya Elif , Lu Xi , Friedrich Bernd
Published: October 2024

Rare earth elements (REEs) and cobalt (Co) are listed as critical raw materials because of their importance in global industrial production growth, high supply risk, and economic significance. The recovery of Co and REEs from secondary resources is therefore proposed as a key countermeasure to address this concern. In this study, a straightforward process that integrates acid baking and water leaching is proposed for the recovery of samarium (Sm) and Co from scrap SmCo magnets. Firstly, the chemical composition of SmCo magnets is revealed by ICP-OES and XRF. The Taguchi experimental design technique is employed to optimize nitric acid baking and water leaching. Based on the thermal decomposition behavior of Co, Fe, and Sm, the acid baking temperature is studied for the conversion of metal nitrates, excluding REEs nitrates, into metal oxides. The optimal conditions for acid baking and water leaching are identified, and a reactor for the pilot-scale acid baking process is proposed. The optimum parameters are tested with the proposed reactor.
Optimization problems with uncertain objective coefficients using capacities
Authors: Vu Tuan-Anh , Afifi Sohaib , Lefèvre Eric , Pichon Frédéric
Published: October 2024

We study a general optimization problem in which coefficients in the objective are uncertain. We use capacities (lower probabilities) to model such uncertainty. Two popular criteria in imprecise probability, namely maximality and E-admissibility, are employed to compare solutions. We characterize non-dominated solutions with respect to these criteria in terms of well-known notions in multi-objective optimization. These characterizations are novel and make it possible to derive several interesting results. Specially, for convex problems, maximality and E-admissibility are equivalent for any capacities even though the set of associated acts is not convex, and in case of 2-monotone capacities, finding an arbitrary non-dominated solution and checking if a given solution is non-dominated are both tractable. For combinatorial problems, we show a general result: in case of 2-monotone capacities, if the deterministic version of the problem can be solved in polynomial time, checking E-admissibility can also be done in polynomial time. Lastly, for the matroid optimization problem, more refined results are also obtained thanks to these characterizations, namely the connectedness of E-admissible solutions and an outer approximation based on the greedy algorithm for non-dominated solutions with respect to maximality.
Multi-armed bandit games
Authors: Gürsoy Kemal
Published: October 2024

A sequential optimization model, known as the multi-armed bandit problem, is concerned with optimal allocation of resources between competing activities, in order to generate the most likely benefits, for a given period of time. In this work, following the objective of a multi-armed bandit problem, we consider a mean-field game model to approach to a large number of multi-armed bandit problems, and propose some connections between dynamic games and sequential optimization problems.