bluuebunny/crossref_metadata_2025 huggingface dataset:
Langzeitverläufe bipolarer Störungen
Authors: Czempiel Tabea , Mikolas Pavol , Bauer Michael , Vogel Sabrina , Ritter Philipp
Published: December 2024

Hintergrund

Die bipolare Störung (englisch: „bipolar disorder“, kurz: BD) ist eine schwerwiegende Erkrankung mit sehr heterogenen Verlaufsformen. Während ein Teil der Patienten keine oder kaum langfristige Beeinträchtigungen aufweist, zeigt ein anderer Teil der Betroffenen erhebliche neurokognitive Einschränkungen mit deutlichem psychosozialen Funktionsabbau. Welche Faktoren den Krankheitsverlauf beeinflussen, ist Gegenstand aktueller Forschungsbestrebungen.

Ziel der Arbeit

In dieser Übersichtsarbeit werden der Langzeitverlauf der bipolaren Erkrankung und die ihn beeinflussenden Faktoren dargestellt. Insbesondere wird auf differenzielle Verlaufstypen eingegangen. Das kognitive und psychosoziale Funktionsniveau sowie die psychopathologischen Besonderheiten der Erkrankung werden beleuchtet. Zudem werden biologische Faktoren und Therapieansätze herausgearbeitet, welche den Verlauf und die Prognose beeinflussen.

Material und Methoden

Literaturrecherche mittels PubMed mit Fokus auf longitudinalen Studien (siehe Onlinezusatzmaterial).

Ergebnisse

Bis zum aktuellen Zeitpunkt gibt es wenige Prädiktoren und Biomarker, die eine Voraussage über den Langzeitverlauf erlauben. Keiner ist ausreichend untersucht, um den klinischen Einsatz zu ermöglichen. Eine geeignete pharmakologische und psychotherapeutische Behandlung Betroffener ist unerlässlich, um erneute Krankheitsepisoden zu vermeiden.

Diskussion

Der Langzeitverlauf der bipolaren Störung ist stark heterogen und facettenreich. Trotz intensiver Forschungsbemühungen sind noch keine Prädiktoren identifiziert, welche verlässlich den klinischen Verlauf vorhersagen. Umso wichtiger ist die weitere Erforschung, um individualisierte Therapieangebote zu unterbreiten, neuartige Therapien zu entwickeln und frühzeitig den Verlauf positiv zu beeinflussen.
Vulvovaginalcandidose
Authors: Fößleitner Philipp
Published: December 2024

Die Vulvovaginalcandidose (VVC) ist eine der häufigsten Infektionen des weiblichen Genitaltrakts und die Hauptursache für Konsultationen in gynäkologischen Praxen. Sie wird meist durch Candida albicans ausgelöst. Etwa 70–75 % der Frauen erleben mindestens eine Episode im Laufe ihres Lebens. Die Pathogenese der VVC ist komplex und basiert auf einem Ungleichgewicht zwischen Candida als Erreger und fehlenden Abwehrmechanismen der Patientin. Risikofaktoren, die eine Kolonisation bzw. eine Umwandlung von einer asymptomatischen Kolonisation in eine symptomatische Infektion begünstigen, umfassen hormonelle Veränderungen, genetische Prädispositionen, die Einnahme von Antibiotika, Hyperglykämie und einige bestimmte Lebensstilfaktoren. Zu den häufigsten Symptomen einer VVC zählen Juckreiz, vaginaler Ausfluss, Dyspareunie und Dysurie, wobei die Symptomatik oft unspezifisch ist und andere Erkrankungen des Genitaltrakts imitieren kann. Die Diagnostik erfordert eine sorgfältige Anamnese, eine klinische Untersuchung sowie die mikroskopische Untersuchung des Vaginalsekrets. Bei rezidivierenden Infektionen ist eine Kultur sinnvoll, um die spezifische Candida-Art zu identifizieren. Die Therapie der akuten VVC erfolgt durch lokale Antimykotika wie Imidazole oder alternativ Nystatin, während die Behandlung rezidivierender VVC eine langfristige Therapie mit Fluconazol erfordert. In der Schwangerschaft sind topische Imidazole die bevorzugte Behandlungsoption. Alternative Behandlungsmethoden wie Dequaliniumchlorid zeigen ebenfalls vielversprechende Ergebnisse. Ergänzende Maßnahmen, wie der Einsatz von Probiotika, könnten zur Reduktion der Rückfallrate beitragen. Der Beitrag gibt einen umfassenden Überblick über die Pathogenese, Risikofaktoren, Symptomatik, Diagnostik und Therapie der VVC.
Glutathione alterations in depression: a meta-analysis and systematic review of proton magnetic resonance spectroscopy studies
Authors: Bell Charles J. M. , Mehta Mitul , Mirza Luwaiza , Young Allan H. , Beck Katherine
Published: December 2024

Background

Major depressive disorder (MDD) is a common and serious psychiatric disorder associated with significant morbidity. There is mounting evidence for the role of oxidative stress in the pathophysiology of depression.

Objective

To investigate alterations in the brain antioxidant glutathione in depression by undertaking a meta-analysis of proton magnetic resonance spectroscopy (1H-MRS).

Methods

MEDLINE, EMBASE and Psych Info databases were searched for case–control studies that reported brain glutathione levels in patients with depression and healthy controls. Means and variances (SDS) were extracted for each measure to calculate effect sizes. Hedges g was used to quantify mean differences. The Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed.

Results

8 studies that reported measurements for 230 patients with depression and 216 controls were included. Three studies included data for the occipital cortex and five studies for the medial frontal cortex. In the occipital cortex, GSH was lower in the patient group as compared to controls (g = -0.98, 95% [CI, -1.45—-0.50], P = < 0.001). In both the medial frontal cortex and in the combined all areas analysis there was no significant difference in GSH levels between cases and controls.

Conclusions

This study found reduced levels of GSH specifically in the occipital region of patients with MDD. This provides some support for the role of oxidative stress in depression and suggests that targeting this system may provide future therapeutic opportunities. However, the meta-analysis was limited by the small number and quality of the included studies. More studies using high quality MRS methods in a variety of brain regions are needed in the future to test this putative hypothesis.
Subtypes of cognitive impairment in cerebellar disease identified by cross-diagnostic cluster-analysis: results from a German multicenter study
Authors: Liu Qi , Rubarth Kerstin , Faber Jennifer , Sulzer Patricia , Dogan Imis , Barkhoff Miriam , Minnerop Martina , Berlijn Adam M. , Elben Saskia , Jacobi Heike , Aktories Julia-Elisabeth , Huvermann Dana M. , Erdlenbruch Friedrich , Van der Veen Raquel , Müller Johanna , Nio Enzo , Frank Benedikt , Köhrmann Martin , Wondzinski Elke , Siebler Mario , Reetz Kathrin , Konczak Jürgen , Konietschke Frank , Klockgether Thomas , Synofzik Matthis , Röske Sandra , Timmann Dagmar , Thieme Andreas
Published: December 2024

Background

Cognitive and neuropsychiatric impairment, known as cerebellar cognitive affective syndrome (CCAS), may be present in cerebellar disorders. This study identified distinct CCAS subtypes in cerebellar patients using cluster analysis.

Methods

The German CCAS-Scale (G-CCAS-S), a brief screening test for CCAS, was assessed in 205 cerebellar patients and 200 healthy controls. K-means cluster analysis was applied to G-CCAS-S data to identify cognitive clusters in patients. Demographic and clinical variables were used to characterize the clusters. Multiple linear regression quantified their relative contribution to cognitive performance. The ability of the G-CCAS-S to correctly distinguish between patients and controls was compared across the clusters.

Results

Two clusters explained the variance of cognitive performance in patients’ best. Cluster 1 (30%) exhibited severe impairment. Cluster 2 (70%) displayed milder dysfunction and overlapped substantially with that of healthy controls. Cluster 1 patients were on average older, less educated, showed more severe ataxia and more extracerebellar involvement than cluster 2 patients. The cluster assignment predicted cognitive performance even after adjusting for all other covariates. The G-CCAS-S demonstrated good discriminative ability for cluster 1, but not for cluster 2.

Conclusions

The variance of cognitive impairment in cerebellar disorders is best explained by one severely affected and one mildly affected cluster. Cognitive performance is not only predicted by demographic/clinical characteristics, but also by cluster assignment itself. This indicates that factors that have not been captured in this study likely have effects on cognitive cerebellar functions. Moreover, the CCAS-S appears to have a relative weakness in identifying patients with only mild cognitive deficits.

Study registration

The study has prospectively been registered at the German Clinical Study Register (https://www.drks.de; DRKS-ID: DRKS00016854).
Intravenous thrombolysis and mechanical thrombectomy in acute stroke patients on direct oral anticoagulants
Authors: Kristoffersen Espen Saxhaug , Seiffge David Julian , Meinel Thomas Raphael
Published: December 2024

Intravenous thrombolysis and mechanical thrombectomy reduce morbidity and improve functional outcome in ischemic stroke. However, acute recanalization therapies may increase the risk of symptomatic intracranial hemorrhage due to its effects on the brain tissue. An increasing proportion of patients with ischemic stroke are using direct oral anticoagulants (DOACs). While current international guidelines recommend against intravenous thrombolysis in patients with intake of DOACs within the last 48 h, they also highlight lack of evidence in the area. Based on these guidelines, a significant proportion of patients are consequently disqualified from intravenous thrombolysis. Measuring anticoagulant activity before intravenous thrombolysis has been suggested as a way to select patients with low risk of symptomatic intracranial hemorrhage, but uncertainty exists about feasibility, validity, availability and costs. Reversal agents have demonstrated potential in facilitating safer intravenous thrombolysis administration, though their efficacy is not established in randomized controlled trials, and logistical and cost-related barriers limit their widespread use. During the last couple of years several large cohort studies reported no significant increase in symptomatic intracranial hemorrhage among selected patients on DOACs receiving intravenous thrombolysis compared to those not on anticoagulants, even without the use of DOAC plasma levels or reversal agents. Mechanical thrombectomy appears to be generally safe in patients with recent DOAC intake. The aim of this review is to discuss the uncertainty around the safety and efficacy of intravenous thrombolysis and thrombectomy in patients with a recent intake of DOAC, summarize existing knowledge, and outline potential approaches.
Brain MRI volumetry and atrophy rating scales as predictors of amyloid status and eligibility for anti-amyloid treatment in a real-world memory clinic setting
Authors: Zilioli A. , Rosenberg A. , Mohanty R. , Matton A. , Granberg T. , Hagman G. , Lötjönen J. , Kivipelto M. , Westman E.
Published: December 2024

Predicting amyloid status is crucial in light of upcoming disease-modifying therapies and the need to identify treatment-eligible patients with Alzheimer’s disease. In our study, we aimed to predict CSF-amyloid status and eligibility for anti-amyloid treatment in a memory clinic by (I) comparing the performance of visual/automated rating scales and MRI volumetric analysis and (II) combining MRI volumetric data with neuropsychological tests and APOE4 status. Two hundred ninety patients underwent a comprehensive assessment. The cNeuro cMRI software (Combinostics Oy) provided automated computed rating scales and volumetric analysis. Amyloid status was determined using data-driven CSF biomarker cutoffs (Aβ42/Aβ40 ratio), and eligibility for anti-Aβ treatment was assessed according to recent recommendations published after the FDA approval of the anti-Aβ drug aducanumab. The automated rating scales and volumetric analysis demonstrated higher performance compared to visual assessment in predicting Aβ status, especially for parietal-GCA (AUC = 0.70), MTA (AUC = 0.66) scores, hippocampal (AUC = 0.68), and angular gyrus (AUC = 0.69) volumes, despite low global accuracy. When we combined hippocampal and angular gyrus volumes with RAVLT immediate recall and APOE4 status, we achieved the highest accuracy (AUC = 0.82), which remained high even in predicting anti-Aβ treatment eligibility (AUC = 0.81). Our study suggests that automated analysis of atrophy rating scales and brain volumetry outperforms operator-dependent visual rating scales. When combined with neuropsychological and genetic information, this computerized approach may play a crucial role not only in a research context but also in a real-world memory clinic. This integration results in a high level of accuracy for predicting amyloid-CSF status and anti-Aβ treatment eligibility.
Further evidence of biallelic NAV3 variants associated with recessive neurodevelopmental disorder with dysmorphism, developmental delay, intellectual disability, and behavioral abnormalities
Authors: Kakar Naseebullah , Mascarenhas Selinda , Ali Asmat , Azmatullah  , Ijlal Haider Syed M. , Badiger Vaishnavi Ashok , Ghofrani Mobina Shadman , Kruse Nathalie , Hashmi Sohana Nadeem , Pozojevic Jelena , Balachandran Saranya , Toft Mathias , Malik Sajid , Händler Kristian , Fatima Ambrin , Iqbal Zafar , Shukla Anju , Spielmann Malte , Radhakrishnan Periyasamy
Published: December 2024

Neuron navigators (NAVs) are cytoskeleton-associated proteins well known for their role in axonal guidance, neuronal migration, and neurite growth necessary for neurodevelopment. Neuron navigator 3 (NAV3) is one of the three NAV proteins highly expressed in the embryonic and adult brain. However, the role of the NAV3 gene in human disease is not well-studied. Recently, five bi-allelic and three mono-allelic variants in NAV3 were reported in 12 individuals from eight unrelated families with neurodevelopmental disorder (NDD). Here, we report five patients from three unrelated consanguineous families segregating autosomal recessive NDD. Patients have symptoms of dysmorphism, intellectual disability, developmental delay, and behavioral abnormalities. Exome sequencing (ES) was performed on two affected individuals from one large family, and one affected individual from each of the other two families. ES revealed two homozygous nonsense c.6325C > T; p.(Gln2109Ter) and c.6577C > T; p.(Arg2193Ter) and a homozygous splice site (c.243 + 1G > T) variants in the NAV3 (NM_001024383.2). Analysis of single-cell sequencing datasets from embryonic and young adult human brains revealed that NAV3 is highly expressed in the excitatory neurons, inhibitory neurons, and microglia, consistent with its role in neurodevelopment. In conclusion, in this study, we further validate biallelic protein truncating variants in NAV3 as a cause of NDD, expanding the spectrum of pathogenic variants in this newly discovered NDD gene.
Day surgery in children: 15-year analysis of unplanned admissions at a Japanese tertiary children’s hospital
Authors: Sueda Aya , Kagawa Tetsuro , Kojima Taiki
Published: December 2024

Purpose

Unplanned hospital admission following pediatric day surgery is a crucial quality indicator. This study examined the incidence, related risks, interventions, and outcomes of unplanned hospital admission following pediatric day surgery among children in Japan.

Methods

This single-center, retrospective study analyzed data of 14,529 pediatric patients under the age of 18 years who underwent day surgery between August 2007 and December 2022. Unplanned hospital admission was defined as an overnight hospital stay that was not planned preoperatively, including patients who returned to the emergency department and required admission within 24 h of discharge. Reasons for unplanned hospital admission and interventions were categorized, and risk factors were identified using logistic regression.

Results

The incidence of unplanned hospital admission was 0.19%. The most common reasons for unplanned hospital admission were anesthetic-related, particularly postoperative nausea and vomiting (36%), which was managed primarily with intravenous fluids (36%) and antiemetic medications (21%). Medical and surgical factors were next most common. Logistic regression identified longer operation time (adjusted Odds ratio 1.03; 95% confidence interval [1.01, 1.04]; P < 0.001) and exit from the operating room after 15:00 (adjusted Odds ratio 29.3; 95% confidence interval [7.09, 121]; P < 0.001) as significant risk factors for unplanned hospital admission.

Conclusion

Unplanned hospital admission was most commonly anesthetic-related and was managed with intravenous fluids and antiemetic medications. Longer operation time and later exit from the operating room were significant risk factors. These findings can guide targeted strategies to further reduce unplanned hospital admission and improve pediatric day surgery quality.
Comparison of software-assisted and freehand methods of rotational assessment for diaphyseal femur fractures
Authors: Blough Christian , Huang Kevin , Garlich John , Little Milton , Moon Charles , Marecek Geoffrey
Published: December 2024

Objective

Accurate rotational reduction following femoral shaft fracture fixation is absent in up to 28% of cases yet is critical for lower extremity biomechanics. The objective of this cadaveric study was to compare the results of freehand methods of rotational reduction with software-assisted rotational reduction.

Methods

Four fellowship-trained orthopedic trauma surgeons attempted rotational correction in a cadaveric model with fluoroscopic assistance using (1) their method of choice (MoC) and (2) software assistance (SA). After correction, deviation from baseline rotation was calculated.

Results

The mean difference between the two methods (MoC–SA) was 1.1 which was not significant when comparing all raters and between raters individually. SA had significantly less variability compared to MoC. The rate of clinically relevant rotational deformity (> 15°) was 28% using MoC and 11% using SA.

Conclusion

Rotational assessment of diaphyseal femur fractures in this cadaveric model was not significantly different when compared between method of choice and software augmentation.
Mid-term survival and complications of double-crown-retained removable dental prostheses placed in the dental practice – a retrospective study
Authors: Klotz Anna-Luisa , Hagspiel Stefanie , Büsch Christopher , Zenthöfer Stephanie , Rammelsberg Peter , Zenthöfer Andreas
Published: December 2024

Objectives

Clinical data on the performance of double-crown-retained removable dental prostheses (dcRDPs), especially beyond university studies, are rare. The objective of this retrospective clinical study was to evaluate the survival and complication-freeness probabilities of dcRDPs and to identify risk factors for failure and complications in a dental practice setting.

Materials and methods

Anonymized practice data of 174 patients (56.9% female) fitted with a total of 213 dcRDPs (mean of 3.3 abutment teeth per dcRDP) were evaluated up to 11 years after prothesis placement (mean observation time of 3.9 years). Probabilities of survival and complication freeness were calculated on the prosthesis- and abutment level and visualized using the Kaplan–Meier method. Factors influencing failure and complications were computed using Cox regression analyses (R Ver. 7; alpha < 0.05).

Results

During our observation period, 39 (18%) of the dcRDPs failed. The mean (95% CI) overall survival was 94% (90–97%) after 2 years and 86% (80–92%) after 5 years. DcRDP survival correlated with lower patient age and more abutment teeth (P < 0.05), while other analyzed factors did not. The probability of absence of prosthesis-related complications was 92% after 2 years and 80% after 5 years. The probability of no technical complications of abutments (teeth/implants) was 85% after 2 years and 78% after 5 years, and the probability of no biological complications was 87% after 2 years and 72% after 5 years. In total, 141 dcRDPs (66.2%) faced at least one complication during the observation period.

Conclusions

Double-crown-retained prostheses fitted in a dental practice had acceptable mid-term survival rates and common technical and biological complications that were frequently easily manageable. However, prosthesis performance depended on the quality and number of abutment teeth/implants. Within the limitations of this retrospective analysis, the outcomes we observed in a dental practice are comparable to, albeit slightly worse than, those found in university studies.

Clinical relevance.

Evaluation of the clinical performance of dcRDPs fitted in a dental practice is important to estimate durability and complication patterns in order to weigh treatment decisions.
Intermittent theta burst stimulation vs. high-frequency repetitive transcranial magnetic stimulation for post-stroke dysfunction: a Bayesian model-based network meta-analysis of RCTs
Authors: Huang Yanbing , Li Caihui , Cai Rongda , Lin Tianlai , Chen Weiwen
Published: December 2024

Objective

This research aims to comprehensively assess the efficacy of intermittent theta-burst stimulation (iTBS) vs. high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) in post-stroke dysfunction.

Materials and methods

Until January 2024, extensive electronic database searches were conducted (PubMed, Embase, Cochrane Library, Web of Science, etc.). Fugl-Meyer Assessment for Upper Extremities (FMA-UE) was used to assess upper limb (UL) dysfunction; post-stroke dysphagia (PSD) was identified by Standardized Swallowing Assessment (SSA), Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS), and Penetration/Aspiration Scale (PAS). Results were analyzed by network meta-analysis (NMA), and the mean difference (MD) and 95% confidence intervals (95% CI) were also reported. We conducted a descriptive analysis due to the inability to synthesize data on post-stroke cognitive impairment (PSCI).

Results

19 studies were included for NMA analysis. For UL disorder, the efficacy of treatments was ranked as HF-rTMS [MD (95%CI):3.00 (1.69,4.31)], iTBS [MD (95%CI): 2.16 (0.84, 3.50)], and sham stimulation (reference). For PSD, the efficacy of treatment to reduce scores of FEDSS or SSA were iTBS [FEDSS, MD (95%CI): -0.80 (-1.13, -0.47); SSA, MD (95%CI): -3.37 (-4.36, -2.38)], HF-rTMS [FEDSS, MD (95%CI): -0.43 (-0.76, -0.10); SSA, MD (95%CI): -2.62 (-3.91, -1.35)], and sham stimulation(reference). Descriptive analysis of PSCI found that both iTBS and HF-rTMS were effective in improving PSCI.

Conclusions

HF-rTMS demonstrates superior efficacy in UL dysfunction, while iTBS is more effective in PSD. Clinicians should carefully evaluate the type and severity of post-stroke dysfunction in each patient to select the most appropriate treatment.
Robotic dual-docking surgery for para-aortic lymphadenectomy in endometrial cancer: a prospective feasibility study
Authors: Yanazume Shintaro , Kobayashi Hiroaki , Ushiwaka Takashi , Togami Shinichi , Kamio Masaki
Published: December 2024

Background

The standard for robotic para-aortic lymphadenectomy has not been fully established. Para-aortic lymphadenectomy performed by sharing the same ports with pelvic procedures, a procedure known as dual-docking surgery, can be performed using the latest robotic system. We prospectively examined the ability of standardized dual-docking robotic surgery in endometrial cancer patients.

Methods

This study prospectively verified the feasibility and safety of dual-docking robotic surgeries performed between March 2017 and December 2021. The laterally placed ports were aligned with the umbilicus. Primary outcome was the surgical completion rate; secondary outcomes were blood loss, operative time, unexpected port placement, conversion, complications, length of hospital stay, and survival.

Results

Most patients (14/15, 93%) underwent surgery using our methods without additional port placements, and one patient was converted to laparotomy. Median blood loss was 162 mL (range: 20–685 mL). Median operative time was 183 and 206 min in the upper and lower abdomen. Median number of resected para-aortic lymph nodes was 19 (range: 6–29), and pelvic lymph nodes was 28 (range: 15–42). Although there was no difficulty in moving the forceps intraoperatively, major complications including vessel injury, and pelvic abscesses were observed. The lateral ports could be placed 6–10 cm apart in patients with any range of body type.

Conclusion

Dual-docking surgery for endometrial cancer has the potential to be a standard procedure for robotic endometrial cancer surgery, although a greater number of cases are needed to acquire proficiency.
Impact of hyperkalaemia on renin–angiotensin–aldosterone (RAAS) inhibitor reduction or withdrawal following hospitalisation
Authors: Ellis Hugh Logan , Al-Agil Mohammad , Kelly Philip A. , Teo James , Sharpe Claire , Whyte Martin B.
Published: December 2024

Background

Inhibitors of the renin–angiotensin–aldosterone system (RAAS), such as ACE inhibitors (ACEi), angiotensin-II receptor blockers and mineralocorticoid receptor antagonists, reduce morbidity and mortality in hypertension, congestive heart failure and chronic kidney disease. However, their use can lead to hyperkalaemia. We examined the proportions of RAAS inhibitor (RAASi) reduction or withdrawal, across GFR strata, following hospitalisation and the effect on patient mortality.

Methods

This was a retrospective cohort study of adult patients hospitalised from 1 January2017 to 31 December2020. Biochemistry data, clinical notes and medicines use were extracted using the CogStack platform, from electronic health records. Patients were identified by creatinine measurement during hospitalisation. Hyperkalaemia was defined as potassium > 5.0 mmol/L, with severity categorisation. RAASi discontinuation defined as ≥ 48 h without administration. Mortality risk associated with RAASi cessation was assessed using Cox proportional hazards models.

Results

Among 129,172 patients with potassium measurements, 49,011 were hospitalised. Hyperkalaemia prevalence was 8.57% in the emergency department and 16.79% among hospitalised patients. Higher hyperkalaemia levels correlated with increased CKD and heart failure. RAASi use was more common in hyperkalaemic patients, with higher discontinuation rates during hospitalisation (36% with potassium 5–5.5 mmol/L; 61% with potassium > 6.5 mmol/L). By discharge, 32% of patients had RAASi stopped, and 2% doses reduced. Discontinuation of RAASi was associated with 37% worse survival probability.

Conclusion

RAASi cessation was greater with hyperkalaemia and associated with increased mortality in hospitalised patients. Reinstitution of RAASi after hospital discharge, or alternative management of hyperkalaemia if maintained on RAASi therapy, may improve clinical outcomes.
Besonderheiten der Pharmakotherapie Jugendlicher mit Epilepsie
Authors: Feucht M. , Pimpel B.
Published: December 2024

Epilepsien gehören zu den häufigsten chronischen neurologischen Erkrankungen des Jugendalters. Umfassende hormonelle Veränderungen führen zu Änderungen der klinischen Repräsentanz (inklusive assoziierter komorbider Störungen) bei seit der Kindheit bestehenden sowie zur Erstmanifestation einer Reihe neuer Epilepsiesyndrome, während altersgebundene Syndrome in dieser Zeit meist spontan remittieren. Geschlechtsspezifische Hormonveränderungen beeinflussen die Pharmakodynamik und -kinetik der zur Behandlung verfügbaren anfallssupprimierenden Substanzen und damit deren Wirk- und Nebenwirkungsspektren. Schließlich muss sich die Arzt-Patienten-Beziehung – soweit möglich – schrittweise vom familien- in Richtung eines patientenzentrierten Zugangs mit Unterstützung zunehmender Eigenverantwortung der jungen PatientInnen für ihre Erkrankung entwickeln. Die vorliegende Übersicht behandelt die Besonderheiten der Pharmakotherapie der Epilepsien im Jugendalter sowie Unterschiede zu den rezent publizierten Leitlinien für Erwachsene.
Field verification of single leak detection method based on transient pressures using optimization technique in in-situ irrigation pipeline system including branch junctions and diameter changes
Authors: Asada Yohei , Hagiwara Taiki , Tsubota Toma , Suzuki Tetsuya , Kurasawa Kanae , Kimura Masaomi , Azechi Issaku , Iida Toshiaki
Published: December 2024

For decades, leak detection methods utilizing pressure variations (transient test-based technique: TTBT) have been recognized as convenient and accurate for pipeline leak detection. However, their effectiveness in long-distance complex structured field pipelines has not been fully demonstrated, presenting significant challenges for practical implementation. This study, for the first time, tested the effectiveness of inverse transient analysis (ITA), a type of TTBT, on detecting a single-point leak in the Ogura irrigation pipeline system in Sado, Niigata, Japan. The system spans approximately 18 km and features several branches and diameter changes. We proposed a new ITA method using the transient model and the comprehensive learning particle swarm optimization (CLPSO) as the optimization technique. In the verification experiments, pressure variations were induced by closing the downstream valve under two different initial downstream flow rates (approximately 0.032 and 0.093 m3/s) in scenarios without a leak, with a leak near the downstream end of the main pipeline, and with a leak on the branch pipeline. The calibration of the transient model with the wave speed distribution as parameters was conducted prior to leak detection, demonstrating pre-estimation of this wave speed distribution is essential for accurate leak detection. The application of the proposed ITA for measured pressure variations resulted in averaged estimated leak location errors along the total length of the pipeline system with the standard deviations as follows: 0.217 ± 0.038% near the downstream end of the main pipeline for a 0.032 m3/s downstream flow, 0.978 ± 0.456% for a 0.093 m3/s flow, 1.843 ± 1.815% on the branch pipeline for a 0.032 m3/s flow, and 0.880 ± 0.560% for a 0.093 m3/s flow. In cases of the leak near the downstream end of the main pipeline, smaller steady flow rate resulted in smaller variability and higher accuracy in the estimated leak location. Conversely, for the leak in the branch pipeline, larger steady flow rate was better for the estimated leak position. This suggests that the optimal steady flow rate for accurate leak detection varies depending on the leak location. The leak sizes can be expressed as ratios of the estimated leakage discharges to the actual average irrigation water flow rate, resulting in values ranging from 4.86% to 8.58%. From these results, the proposed leak detection method is expected to contribute to reducing the effort and cost for irrigation engineers to narrow down potential leak areas in pipeline systems.
Negative trends in Rabbit populations in ‘Pest’ and ‘Non-Pest’ areas of central Spain after the outbreak of rabbit hemorrhagic disease virus 2
Authors: Marin-Sáez Cristina , Delibes-Mateos Miguel , Cooke Brian , Santoro Simone , Castro Francisca , Villafuerte Rafael
Published: December 2024

Despite increased conservation efforts, the European rabbit (Oryctolagus cuniculus), a keystone species in the Iberian Peninsula, continues declining due to habitat degradation and viral diseases. Following the 2011 outbreak of Rabbit Hemorrhagic Disease virus GI.2, the species was listed as Endangered by the International Union for Conservation of Nature (IUCN). While rabbit declines in natural habitats are well documented, no research has separately analyzed population trends between areas where rabbits are managed as agricultural pests (rabbit emergency hunting areas: REHAs) and other areas, mostly natural (non-REHAs). Additionally, recent findings suggest divergent trends between the two rabbit subspecies, O. c. cuniculus and O. c. algirus, which coexist only in a limited area where their ranges overlap, with the latter possibly experiencing a more widespread decline. Here, we analyzed hunting yield data from ~ 6,000 hunting estates in Castilla-La Mancha (central Spain), spanning 2009 to 2022. Using linear mixed models (GLMMs), we found significant differences in rabbit hunting yields and trends between REHAs and non-REHAs, as well as between the subspecies’ distribution areas. Densities of hunted rabbits were higher in REHAs, while the lowest hunting yields were observed in O. c. algirus areas, consistent with studies suggesting its lower abundance. Population trends in non-REHAs showed declines for both subspecies, with a less pronounced decrease in O. c. cuniculus areas and near stability in REHAs inhabited by this subspecies. These findings reveal contrasting trends between subspecies and management areas, emphasizing the need for targeted management strategies tailored to agricultural and natural habitats and the specific ecological requirements of each subspecies.
Models of symbol emergence in communication: a conceptual review and a guide for avoiding local minima
Authors: Zubek Julian , Korbak Tomasz , Rączaszek-Leonardi Joanna
Published: December 2024

Computational simulations are a popular method for testing hypotheses about the emergence of symbolic communication. This kind of research is performed in a variety of traditions including language evolution, developmental psychology, cognitive science, artificial intelligence, and robotics. The motivations for the models are different, but the operationalisations and methods used are often similar. We identify the assumptions and explanatory targets of the most representative models and summarise the known results. We claim that some of the assumptions—such as portraying meaning in terms of mapping, focusing on the descriptive function of communication, and modelling signals with amodal tokens—may hinder the success of modelling. Relaxing these assumptions and foregrounding the interactions of embodied and situated agents allows one to systematise the multiplicity of pressures under which symbolic systems evolve. In line with this perspective, we sketch the road towards modelling the emergence of meaningful symbolic communication, where symbols are simultaneously grounded in action and perception and form an abstract system.
Artificial intelligence for geometry-based feature extraction, analysis and synthesis in artistic images: a survey
Authors: Vijendran Mridula , Deng Jingjing , Chen Shuang , Ho Edmond S. L. , Shum Hubert P. H.
Published: December 2024

Artificial Intelligence significantly enhances the visual art industry by analyzing, identifying and generating digitized artistic images. This review highlights the substantial benefits of integrating geometric data into AI models, addressing challenges such as high inter-class variations, domain gaps, and the separation of style from content by incorporating geometric information. Models not only improve AI-generated graphics synthesis quality, but also effectively distinguish between style and content, utilizing inherent model biases and shared data traits. We explore methods like geometric data extraction from artistic images, the impact on human perception, and its use in discriminative tasks. The review also discusses the potential for improving data quality through innovative annotation techniques and the use of geometric data to enhance model adaptability and output refinement. Overall, incorporating geometric guidance boosts model performance in classification and synthesis tasks, providing crucial insights for future AI applications in the visual arts domain.
Climate displaces deposition as dominant driver of dissolved organic carbon concentrations in historically acidified lakes
Authors: Herreid Allison M. , Fazekas Hannah M. , Nelson Sarah J. , Wymore Adam S. , Murray Desneiges , Varner Ruth K. , McDowell William H.
Published: December 2024

Climate and atmospheric deposition interact with watershed properties to drive dissolved organic carbon (DOC) concentrations in lakes. Because drivers of DOC concentration are inter-related and interact, it is challenging to assign a single dominant driver to changes in lake DOC concentration across spatiotemporal scales. Leveraging forty years of data across sixteen lakes, we used structural equation modeling to show that the impact of climate, as moderated by watershed characteristics, has become more dominant in recent decades, superseding the influence of sulfate deposition that was observed in the 1980s. An increased percentage of winter precipitation falling as rain was associated with elevated spring DOC concentrations, suggesting a mechanistic coupling between climate and DOC increases that will persist in coming decades as northern latitudes continue to warm. Drainage lakes situated in watersheds with fine-textured, deep soils and larger watershed areas exhibit greater variability in lake DOC concentrations compared to both seepage and drainage lakes with coarser, shallower soils, and smaller watershed areas. Capturing the spatial variability in interactions between climatic impacts and localized watershed characteristics is crucial for forecasting lentic carbon and nutrient dynamics, with implications for lake ecology and drinking water quality.
Remarks on the Safety of Lithium -Ion Batteries for Large-Scale Battery Energy Storage Systems (BESS) in the UK
Authors: Edwards Peter P. , Dobson Peter J.
Published: December 2024

Large grid-scale Battery Energy Storage Systems (BESS) are becoming an essential part of the UK energy supply chain and infrastructure as the transition from electricity generation moves from fossil-based towards renewable energy. The deployment of BESS is increasing rapidly with the growing realisation that renewable energy is not always instantly available and hence dispatchable when consumers need it. This paper is a brief overview of the fundamental battery chemistry and some of the important safety issues of these large, energy—dense facilities. Our aim is to examine the potential causes of major BESS “battery fires” and explosions and the essential mitigation procedures that must be in place before their further deployment. It is strongly recommended that there is a pause to the widespread ongoing deployment of BESS installations in the UK and indeed in all countries until the necessary health and safety (H&S) standards and practice are adopted through established appropriate regulatory conditions for BESS hazards.
Modernity Versus Tradition: Beyond the Ideological Dispute
Authors: Martin-Echebarria Gorka
Published: December 2024

The process of implementing the liberal-bourgeois revolution was a transcendental event in Western history. The liberal revolutions of the eighteenth and, especially, nineteenth century, gave birth to a new world that sought to impose itself upon the traditional world, that of the Ancien Régime. The arrival of liberalism was not without conflicts, controversies, and dichotomies, which, on more than one occasion, were resolved on bloody battlefields and wars, both international and civil. The conflict between liberals and reactionaries generated a distinct material culture that amply illustrates the clash between these two worlds. This article delves into the effects this process had on the material culture of the time. To this end, several case studies of the Spanish nineteenth-century civil wars are presented, known as the Carlist Wars. We analyze the material culture of various archaeological sites comparatively with similar cases. The article concludes with a discussion of several of the aspects addressed: the conflict’s material expression, the dialectics between modernity and tradition, and its inherent contradictions.
High-Isolation Array Antenna Design for 5G mm-Wave MIMO Applications
Authors: Abbasi Nisar Ahmad , Virdee Bal , Din Iftikhar Ud , Ullah Sadiq , Althuwayb Ayman A. , Rashid Nasr , Soruri Mohammad , See Chan Hwang , Alibakhshikenari Mohammad
Published: December 2024

A low form-factor design of an eight-element antenna array is presented for 5G mm-wave MIMO applications. The design features modified circular patch radiators that achieve an impedance bandwidth of 2.6 GHz, covering frequencies from 37.7 to 40.3 GHz. The radiating elements are strategically arranged on opposite sides of a common substrate and interleaved to significantly reduce mutual coupling between adjacent elements. This innovative technique effectively minimizes coupling between the array’s radiators without the need of a decoupling structure. The MIMO antenna is fabricated on a low-loss Rogers-5880 substrate, with a thickness of 0.8 mm, a dielectric constant of 2.2, and a loss tangent of 0.0009, ensuring minimal signal loss and confirming the accuracy of simulation results. The inter-element isolation exceeds 25 dB, and the array provides a gain greater than 6 dBi, with a peak gain of 7.5 dBi at 39 GHz. This high gain enhances the antenna’s ability to mitigate atmospheric attenuation at higher frequencies, making it highly suitable for 5G mm-wave applications.
The potential for spatial ability development through the Swedish technology and craft compulsory curricula
Authors: Lin Ting Jun , Buckley Jeffrey , Gumaelius Lena , Ampadu Ernest
Published: December 2024

Spatial ability has been demonstrated to be a significant predictor of students’ achievement in science, technology, engineering, and mathematics education. While several studies have focused on offering supplementary or isolated spatial training interventions, this study focuses on spatial ability development through embedded interventions within technology curricula. Specifically, document analysis is adopted in this study to identify the potential areas for spatial ability development within the Swedish compulsory Technology and Craft curricula. A framework consisting of two dimensions has been established by a qualitative coding approach. The first dimension, termed the “visual dimension”, encompasses graphical, property, and manufactured components, reflecting the spatial nature of the information that students engage with. The second dimension, termed the “epistemic dimension”, comprises conceptual and procedural knowledge, representing the types of knowledge students acquire. The framework allows educators to identify potential areas for developing spatial ability within technology curricula. Additionally, it is envisioned that this framework could increase awareness of how to spatialise curriculum and pedagogies among various stakeholders, including policymakers and teacher trainers.
The Knowledge and Preferences of Parents/Carers of Autistic Children and Young People about Technology Devices
Authors: Kouroupa Athanasia , Irvine Karen , Mengoni Silvana E. , Sharma Shivani
Published: December 2024

This study explored parents’/carers’ knowledge, interest, and preferences towards technology devices as support mediums for autistic children, the reasoning behind any choice and the factors associated with the most preferred technology device. Technology devices were conceptualised as smartphones, iPods, tablets, virtual reality, robots, and ‘other’ for participants to list their own further interpretations of technology devices. Survey data were collected from 267 parents/carers of autistic children aged 2–18 years internationally between May to October 2020. Parents/carers of autistic children and young people were aware of, interested in and mostly preferred the use of tablets because of their convenience and ease of use. They least preferred virtual reality followed by robots due to both being overwhelming, cold, inconvenient to transport and expensive. Robots, in particular, were unknown to respondents. The data suggested that some technology devices as a support medium are not widely known to families of autistic children and young people in support programmes. Technology devices need to be financially approachable and achieve a high standard of design to engage users. Future research should focus on gathering evidence from the autistic community about their preferences and views of technology devices as a medium in autism support programmes.
The Effect of Plant Food Treatment on Stable Isotopes and Their Relevance for Archaeological Studies: A Methodological Pilot Study
Authors: Baumann Chris , Larbey Cynthia , Ebner Martin , Bocherens Hervé , Hardy Karen
Published: December 2024

Plants are a crucial part of the human diet, serving as a primary source of micronutrients, fiber, and carbohydrates, providing readily available energy. Beyond the consumption of cooked and raw edible plants, early humans also developed methods for plant processing for delayed consumption, to de-toxify/improve bioavailability, and perhaps for flavor. In later prehistory delayed consumption includes preservation processes for storage. The processing of plants through sprouting, fermentation, cooking, and roasting has not only expanded the variety of consumable plant species but also enhanced their nutritional value. There are few methods for detecting fermented foods in the early prehistoric diet. Based on the hypothesis that the microbes active in fermentation change the nitrogen and carbon isotope ratios of plant foods, our pilot study lays the groundwork for further research, offering a promising direction for understanding the complexities of human-plant interactions throughout history. This study focuses on these four plant treatment methods, which have both contemporary relevance and archaeobotanical evidence of use. We aimed to explore how these treatments might affect stable isotope values, such as carbon (δ13C) and nitrogen (δ15N), which are crucial for reconstructing ancient diets. Through an experimental approach involving 12 plant species, our findings suggest that while sprouting and roasting had minimal impact on isotopic values, fermentation and cooking showed more variable effects depending on the plant species. These preliminary results provide new insights into the influence of plant processing on isotopic compositions and underscore the importance of considering these factors in dietary reconstructions.
Marine heatwave off Tokai, Japan, attributed to the Kuroshio Large Meander Path, and an associated increase in summer rainfall over Japan
Authors: Sugimoto Shusaku
Published: December 2024

The Tokai and Kanto districts in Japan have 50 million inhabitants and its summer climate is characterized by large rainfall. The Kuroshio, which flows off the southern coast of the Tokai–Kanto districts, took a large meander (LM) path since the summer of 2017 for the first time since the 2004/2005 event and is still ongoing. Satellite observations reveal that sea surface temperature (SST) in a coastal region off the Tokai–Kanto districts were about 3 °C higher than the climatology during the present LM event (August 2017–December 2023), with maximum anomalies of + 5 °C. This warming signal constitutes a coastal marine heatwave attributable to the LM path. Regional atmospheric model experiments present that the coastal SST warming (3 °C above climatology) in summer, under prevailing monsoonal southerly winds, enhances surface-level southerly winds and water vapor in the lower atmosphere, leading to water vapor transport toward the Tokai district. This results in atmospheric instability and rainfall increase (as much as 150%) over the Tokai district. The coastal area off the Tokai–Kanto districts exhibits no significant long-term SST increase under present climate from 1982 to 2016, before the beginning of the present LM event. However, the high-resolution ocean model projects considerable warming of this coastal region under a high CO2 emission scenario, with SST increase by about 2 °C as early as 2050. Our experiments reveal that a 5 °C SST increase doubles rainfall in the Tokai district. This study will improve weather and seasonal forecasting and advances the prevention and mitigation of rainfall-related risks.