bluuebunny/crossref_metadata_2025 huggingface dataset:
A Study on Countermeasures against Neutralizing Technology: Encoding Algorithm-Based Ransomware Detection Methods Using Machine Learning
Authors: Lee Jaehyuk , Yun Jinseo , Lee Kyungroul
Published: March 2024

Ransomware, which emerged in 1989, has evolved to the present in numerous variants and new forms. For this reason, serious damage caused by ransomware has occurred not only within our country but around the world, and, according to the analysis of ransomware trends, ransomware poses an ongoing and significant threat, with major damage expected to continue to occur in the future. To address this problem, various approaches to detect ransomware have been explored, with a recent focus on file entropy estimation methods. These methods exploit the characteristic increase in file entropy that is caused by ransomware encryption. In response, a method was developed to neutralize entropy-based ransomware detection technology by manipulating entropy using encoding methods from the attacker’s perspective. Consequently, from the defender’s standpoint, countermeasures are essential to minimize the damage caused by ransomware. Therefore, this article proposes a methodology that utilizes diverse machine learning models such as K-Nearest Neighbors (KNN), logistic regression, decision tree, random forest, gradient boosting, support vector machine (SVM), and multi-layer perception (MLP) to detect files infected with ransomware. The experimental results demonstrate empirically that files infected with ransomware can be detected with approximately 98% accuracy, and the results of this research are expected to provide valuable information for developing countermeasures against various ransomware detection technologies.
Detection of DoS Attacks for IoT in Information-Centric Networks Using Machine Learning: Opportunities, Challenges, and Future Research Directions
Authors: Bukhowah Rawan , Aljughaiman Ahmed , Rahman M. M. Hafizur
Published: March 2024

The Internet of Things (IoT) is a rapidly growing network that shares information over the Internet via interconnected devices. In addition, this network has led to new security challenges in recent years. One of the biggest challenges is the impact of denial-of-service (DoS) attacks on the IoT. The Information-Centric Network (ICN) infrastructure is a critical component of the IoT. The ICN has gained recognition as a promising networking solution for the IoT by supporting IoT devices to be able to communicate and exchange data with each other over the Internet. Moreover, the ICN provides easy access and straightforward security to IoT content. However, the integration of IoT devices into the ICN introduces new security challenges, particularly in the form of DoS attacks. These attacks aim to disrupt or disable the normal operation of the ICN, potentially leading to severe consequences for IoT applications. Machine learning (ML) is a powerful technology. This paper proposes a new approach for developing a robust and efficient solution for detecting DoS attacks in ICN-IoT networks using ML technology. ML is a subset of artificial intelligence (AI) that focuses on the development of algorithms. While several ML algorithms have been explored in the literature, including neural networks, decision trees (DTs), clustering algorithms, XGBoost, J48, multilayer perceptron (MLP) with backpropagation (BP), deep neural networks (DNNs), MLP-BP, RBF-PSO, RBF-JAYA, and RBF-TLBO, researchers compare these detection approaches using classification metrics such as accuracy. This classification metric indicates that SVM, RF, and KNN demonstrate superior performance compared to other alternatives. The proposed approach was carried out on the NDN architecture because, based on our findings, it is the most used one and has a high percentage of various types of cyberattacks. The proposed approach can be evaluated using an ndnSIM simulation and a synthetic dataset for detecting DoS attacks in ICN-IoT networks using ML algorithms.
Enhancing Motor Imagery Electroencephalography Classification with a Correlation-Optimized Weighted Stacking Ensemble Model
Authors: Ahmadi Hossein , Mesin Luca
Published: March 2024

In the evolving field of Brain–Computer Interfaces (BCIs), accurately classifying Electroencephalography (EEG) signals for Motor Imagery (MI) tasks is challenging. We introduce the Correlation-Optimized Weighted Stacking Ensemble (COWSE) model, an innovative ensemble learning framework designed to improve MI EEG signal classification. The COWSE model integrates sixteen machine learning classifiers through a weighted stacking approach, optimizing performance by balancing the strengths and weaknesses of each classifier based on error correlation analysis and performance metrics evaluation across benchmark datasets. The COWSE model’s development involves selecting base classifiers, dynamically assigning weights according to performance, and employing a meta-classifier trained on these weighted predictions. Testing on the BNCI2014-002 dataset, the COWSE model achieved classification accuracy exceeding 98.16%, marking a significant advancement in MI EEG classification. This study highlights the potential of integrating multiple machine learning classifiers to address the complex challenges of EEG signal classification. By achieving new benchmarks and showcasing enhanced classification capabilities, the COWSE model contributes significantly to BCI research, encouraging further exploration into advanced ensemble learning strategies.
The Effects of SARS-CoV-2 on the Angiopoietin/Tie Axis and the Vascular Endothelium
Authors: Janchivlamdan Dolgormaa , Shivkumar Maitreyi , Singh Harprit
Published: March 2024

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can cause potentially life-threatening coronavirus disease (COVID-19). COVID-19 is a multisystem disease and is associated with significant respiratory distress, systemic hyperinflammation, vasculitis, and multi-organ failure. SARS-CoV-2 causes the deterioration of numerous systems, with increasing evidence implying that COVID-19 affects the endothelium and vascular function. The endothelium is important for preserving vascular tone and homeostasis. The overactivation and dysfunction of endothelial cells are significant outcomes of severity in patients with COVID-19. The Angiopoietin 1/Tie 2 pathway plays an important role in endothelium quiescence and vessel stability. The disruption of Angiopoietin/Tie balance affects the vessel contact barrier and leads to vessel leakage, and this in turn causes endothelial dysfunction. Although vascular instability through SARS-CoV-2 is associated with endothelial dysfunction, it is still not understood if the virus affects the Angiopoietin/Tie axis directly or via other mechanisms such as cytokine storm and/or immune response associated with the infection. This review provides an overview of the impact SARS-CoV-2 has on endothelial function and more specifically on the Angiopoietin/Tie pathway.
Influence of Recycled High-Density Polyethylene Fibers on the Mechanical and Electrochemical Properties of Reinforced Concrete
Authors: Flores Nicolás Alejandro , Menchaca Campos Elsa C. , Flores Nicolás Mario , Martínez González José J. , González Noriega Omar A. , Uruchurtu Chavarín Jorge
Published: March 2024

The quantity of different plastics generated after consumption is an impact factor affecting the environment, and the lack of recycling generates solid waste. The purpose of this work is to incorporate high-density recycled polyethylene fibers (HDPE) for possible use as concrete reinforcement. Physical and mechanical properties from recycled fibers were analyzed, such as density, absorption, and stress resistance, as well as workability, air content, porosity, concrete compression, and flexural strength properties. Samples were prepared with a low fiber content of 0.2% and 0.4%, as a substitution for sand weight, and lengths of 10 and 30 mm. To study corrosion phenomena, the specimens were exposed to a saline environment containing 3% sodium chloride for 365 days, and the electrochemical techniques including half-cell potential (HCP), electrochemical noise (EN), linear polarization resistance (LPR), and electrochemical impedance spectroscopy (EIS) were applied. The results showed a 4.8% increase in compressive strength with a low fiber percentage and short geometries, while flexural strength increased marginally by 2.3% with small quantities of HDPE fibers. All these factors contribute to greater material durability, less permeability, and crack control. A positive effect of fibers with short dimensions on the corrosion processes of a steel bar was observed, with the fibers acting as a physical barrier against the diffusion of chloride ions.
Wheat Protein Hydrolysates Improving the Stability of Purple Sweet Potato Anthocyanins under Neutral pH after Commercial Sterilization at 121 °C
Authors: Feng Yaping , Qiao Bingqian , Lu Xue , Xiao Jianhui , Yu Lili , Niu Liya
Published: March 2024

Anthocyanins are prone to degradation and color fading after sterilization. This work examined the potential of wheat protein hydrolysates (WPHs, 40 g/L) in improving the stability of purple sweet potato anthocyanins (PSPAs) under a pH of 6.8 after sterilization at 121 °C followed by storage. Results showed that WPHs increased the thermal degradation half-life of PSPAs 1.65 times after sterilization. Compared to PSPAs alone, after being stored at 37 °C and 45 °C for 7 days, the retention concentration of PSPAs with WPHs was 5.4 and 32.2 times higher, and the color change of PSPAs with WPHs decreased from 6.19 and 10.46 to 0.29 and 0.77, respectively. AFM data, fluorescence and UV spectrograms indicated the formation of complexes between PSPAs and WPHs by hydrophobic attraction confirmed by zeta-potential data. PSPAs with WPHs had stable particle size and zeta potential, which may also significantly increase the concentrations after digestion and antioxidant power of PSPAs. This work indicated that the assembled PSPAs composite structure by WPHs significantly reduced the degradation of PSPAs at a pH of 6.8 after sterilization at 121 °C followed by long-term storage.
The Use of Waste Products from the Food Industry to Obtain High Value-Added Products
Authors: Kowalski Stanisław , Gumul Dorota
Published: March 2024

Globalization and population expansion are driving the evolution of the food industry, offering an expanded array of food choices to cater to increasingly discerning consumers [...]
Polysaccharides as Protective Agents against Heavy Metal Toxicity
Authors: Iddrisu Lukman , Danso Felix , Cheong Kit-Leong , Fang Zhijia , Zhong Saiyi
Published: March 2024

Polysaccharides are functional foods or drugs that can be used to alleviate heavy metal poisoning by cadmium, lead, mercury, and arsenic. Industries generate substantial quantities of toxic heavy metal wastes, such as wastewater discharges, paints, electronic waste, batteries, pigments, and plastics, into the environment that pose a risk to human health. Therefore, it is imperative to eliminate accumulated heavy metal ions from the body and the environment. Heavy metal toxicity can lead to decreased energy levels and impair the functioning of vital organs, such as the brain, lungs, kidneys, liver, and blood. Prolonged exposure can result in progressive physical, muscular, and neurological degeneration that resembles conditions such as multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, and muscular dystrophy. Polysaccharides operate through mechanisms such as chelation, antioxidant defense, immunomodulation, and tissue repair. Polysaccharides involved in heavy metal removal include methionine and cysteine, together with N-acetylcysteine, an acetylated form of cysteine, S-adenosylmethionine, a metabolite of methionine, α-lipoic acid, and the tripeptide glutathione (GSH). These compounds effectively bind with harmful heavy metals to create a stable complex and defend biological targets from metal ions, thus decreasing their harmful effects and causing them to be excreted from the body. This review also highlights the importance of polysaccharides’ ability to mitigate oxidative stress, enhance immune responses, and support tissue repair processes. Polysaccharides are ubiquitous in nature and take part in diverse processes, making them potential natural therapies for heavy metal-related diseases. This review discusses the effectiveness of natural polysaccharides and the mechanisms that allow them to bind with heavy metals to alleviate their effects from the body and the environment. Polysaccharides have inherent features that enable them to function as pharmacological agents and regulate the immune response.
Identity Complexity’s Influence on Multicultural Families’ Ethnic Identity Development and Acculturation Outcomes: A Qualitative Study among Binational (Estonian–Foreign) Parents in Estonia
Authors: Ceballos Rodriguez Gabriel Alberto
Published: March 2024

For multicultural family members who live in cosmopolitan environments, concepts such as ethnic identity and integration have different significance. Some individuals can report, for example, that ethnic identity and integration have never played an important role in their lives and even feel that they represent old-fashioned notions from which modern societies should rather move on. For others, these concepts are much more relevant and are experienced in more challenging and complex ways. This article explores the influence that identity complexity—a cognitive disposition to perceive overlaps between different social identities, plays in this process. Forty parents of Estonian–foreign children (a traditionally cosmopolitan segment) were interviewed in Estonia and prompted to talk about topics such as their own ethnic identity(ies), their (and their family’s) feelings of integration into the Estonian society, and the way in which they represent their children’s ethnic identities, e.g., mostly Estonian/foreign, fifty–fifty, global citizen, etc. Thematic analysis combined with intersectionality suggests that there are associations between the identity complexity of interviewees and their attitudes towards these topics. Furthermore, results show that beyond the traditional dichotomy of high vs. low identity complexity, some interviewed parents have transitioned from higher to lower levels of identity complexity and vice versa at different times in their lives for different reasons. This study sheds light on identity complexity as a relevant predictor of acculturation and ethnic identity development outcomes among multicultural family members. It also contributes to the literature on cosmopolitan populations as a diverse group.
Thermal Anomalies Observed during the Crete Earthquake on 27 September 2021
Authors: Ghosh Soujan , Sasmal Sudipta , Maity Sovan K. , Potirakis Stelios M. , Hayakawa Masashi
Published: March 2024

This study examines the response of the thermal channel within the Lithosphere–Atmosphere–Ionosphere Coupling (LAIC) mechanism during the notable earthquake in Crete, Greece, on 27 September 2021. We analyze spatio-temporal profiles of Surface Latent Heat Flux (SLHF), Outgoing Longwave Radiation (OLR), and Atmospheric Chemical Potential (ACP) using reanalysis data from the National Oceanic and Atmospheric Administration (NOAA) satellite. Anomalies in these parameters are computed by removing the background profile for a non-seismic condition. Our findings reveal a substantial anomalous increase in these parameters near the earthquake’s epicenter 3 to 7 days before the main shock. The implications of these observations contribute to a deeper understanding of the LAIC mechanism’s thermal channel in seismic events.
Evaluating Machine Learning Stability in Predicting Depression and Anxiety Amidst Subjective Response Errors
Authors: Ku Wai Lim , Min Hua
Published: March 2024

Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) pose significant burdens on individuals and society, necessitating accurate prediction methods. Machine learning (ML) algorithms utilizing electronic health records and survey data offer promising tools for forecasting these conditions. However, potential bias and inaccuracies inherent in subjective survey responses can undermine the precision of such predictions. This research investigates the reliability of five prominent ML algorithms—a Convolutional Neural Network (CNN), Random Forest, XGBoost, Logistic Regression, and Naive Bayes—in predicting MDD and GAD. A dataset rich in biomedical, demographic, and self-reported survey information is used to assess the algorithms’ performance under different levels of subjective response inaccuracies. These inaccuracies simulate scenarios with potential memory recall bias and subjective interpretations. While all algorithms demonstrate commendable accuracy with high-quality survey data, their performance diverges significantly when encountering erroneous or biased responses. Notably, the CNN exhibits superior resilience in this context, maintaining performance and even achieving enhanced accuracy, Cohen’s kappa score, and positive precision for both MDD and GAD. This highlights the CNN’s superior ability to handle data unreliability, making it a potentially advantageous choice for predicting mental health conditions based on self-reported data. These findings underscore the critical importance of algorithmic resilience in mental health prediction, particularly when relying on subjective data. They emphasize the need for careful algorithm selection in such contexts, with the CNN emerging as a promising candidate due to its robustness and improved performance under data uncertainties.
Assessment of the Clinical and Functional Health Status of Patients with Amyotrophic Lateral Sclerosis during the COVID-19 Pandemic in Brazil Using Telemedicine
Authors: Brito Ozana , Fregonezi Guilherme , Pondofe Karen , Vieira Rayane Grayce da Silva , Ribeiro Tatiana , Dourado Júnior Mário Emílio , Fidelix Emanuela Coriolano , Nagem Danilo , Valentim Ricardo , Sarmento Antonio , Resqueti Vanessa
Published: March 2024

This study aimed to monitor the clinical and functional progression of patients with amyotrophic lateral sclerosis (ALS) and adjust ventilatory support during the COVID-19 pandemic in Brazil using telemedicine. This longitudinal case series included five evaluations from January 2019 to June 2021. The first and second assessments were performed in person and consisted of pulmonary function, respiratory muscle strength, functionality (ALS Functional Rating Scale—Revised [ALSFRS-R]) and disease staging (King’s College criteria). The use of non-invasive ventilation (NIV), ALSFRS-R, and disease staging were assessed in the third, fourth, and fifth assessments during the COVID-19 pandemic, using telemedicine. The rate of functional decline was calculated by the difference in the total score of ALSFRS-R between evaluations. A cutoff of 0.77 in the ALSFRS-R was used to characterize the speed of functional decline. Eleven patients (mean age of 51 years, eight males) were assessed. The total score of the ALSFRS-R (p < 0.01) and its motor domain (p < 0.01) reduced significantly during the pandemic. NIV prescription increased from 54.4% to 83.3%. Telemedicine helped with the clinical and functional follow-up of patients with ALS.
Components of Mid-Nineteenth- and Mid-Twentieth-Century Cudbears
Authors: Maccarelli Laura , Schaeffer Terry T. , Smith Gregory D. , Chen Victor J.
Published: March 2024

Analysis of purple dyestuff from a tin labeled “1 oz. Cudbear, No. 1 N. F. Powdered”, marketed by the American business S. B. Penick & Company, “Manufacturers of fine drugs and chemicals”, confirmed that the material was indeed a lichen dyestuff. It contains the same major orcein components identified in several other lichen dyes and dyed samples dating from the mid-19th century to today. These dyestuffs were analyzed using several analytical techniques. Fluorescence and fiber optic reflectance spectroscopic data for all the samples were similar. High performance liquid chromatography with diode array detection coupled to mass spectrometry confirmed that this commercial American cudbear was very similar to the samples from the United Kingdom but rather different from the archil-dyed reference yarns from Europe. The significance of the observations is discussed, and chemical structures are proposed for several of the unknown dye components detected in this study.
Will Artificial Intelligence Affect How Cultural Heritage Will Be Managed in the Future? Responses Generated by Four genAI Models
Authors: Spennemann Dirk H. R.
Published: March 2024

Generative artificial intelligence (genAI) language models have become firmly embedded in public consciousness. Their abilities to extract and summarise information from a wide range of sources in their training data have attracted the attention of many scholars. This paper examines how four genAI large language models (ChatGPT, GPT4, DeepAI, and Google Bard) responded to prompts, asking (i) whether artificial intelligence would affect how cultural heritage will be managed in the future (with examples requested) and (ii) what dangers might emerge when relying heavily on genAI to guide cultural heritage professionals in their actions. The genAI systems provided a range of examples, commonly drawing on and extending the status quo. Without a doubt, AI tools will revolutionise the execution of repetitive and mundane tasks, such as the classification of some classes of artifacts, or allow for the predictive modelling of the decay of objects. Important examples were used to assess the purported power of genAI tools to extract, aggregate, and synthesize large volumes of data from multiple sources, as well as their ability to recognise patterns and connections that people may miss. An inherent risk in the ‘results’ presented by genAI systems is that the presented connections are ‘artifacts’ of the system rather than being genuine. Since present genAI tools are unable to purposively generate creative or innovative thoughts, it is left to the reader to determine whether any text that is provided by genAI that is out of the ordinary is meaningful or nonsensical. Additional risks identified by the genAI systems were that some cultural heritage professionals might use AI systems without the required level of AI literacy and that overreliance on genAI systems might lead to a deskilling of general heritage practitioners.
Simulation Model Construction of Plant Height and Leaf Area Index Based on the Overground Weight of Greenhouse Tomato: Device Development and Application
Authors: Guo Shenbo , Wu Letian , Cao Xinwei , Sun Xiaoli , Cao Yanfei , Li Yuhan , Shi Huifeng
Published: March 2024

Plant height and leaf area index (LAI) are crucial growth indicators that reflect the growth status of tomatoes in greenhouses, enabling accurate determinations to effectively estimate crop transpiration and formulate irrigation strategies for reducing agricultural water waste. There is a need for the increased application of related models to simulate tomato growth indices in the traditional greenhouse production in China. This study proposes a nondestructive, real-time monitoring and simulation device for measuring tomato plant height and leaf area index. The weight of aboveground tomatoes was obtained by suspending tomato plants on dynamometers, while the total weight of stem and leaf organs was determined using a distribution coefficient simulation model. The R2 value between the measurements from the electronic scale and those from the aboveground fresh weight device for tomatoes was 0.937, with an RMSE value of 0.05 kg. The monitoring device did not affect the average tomato growth during operation. The device will not affect the growth of tomatoes during monitoring. A multiple linear regression was used to compare the measured and simulated values of the plant height and leaf area index of various types of greenhouse tomatoes cultivated in different greenhouse types. The average R2 value for simulating plant height was 0.817 with an RMSE of 10.81 cm. The average R2 value for the leaf area index was 0.854, with an RMSE of 0.55 m2·m−2. The simulated values for plant height and leaf area index closely matched the measured values, indicating that the model has high accuracy and applicability in traditional Chinese greenhouses (solar greenhouses and insulated plastic greenhouses). However, further optimization is required for commercially produced, continuous plastic greenhouses equipped with greenhouse environmental control equipment.
Knowledge Graph Representation of Multi-Source Urban Storm Surge Hazard Information Based on Spatio-Temporal Coding and the Hazard Events Ontology Model
Authors: Lei Xinya , Wang Yuewei , Han Wei , Song Weijing
Published: March 2024

Coastal cities are increasingly vulnerable to urban storm surge hazards and the secondary hazards they cause (e.g., coastal flooding). Accurate representation of the spatio-temporal process of hazard event development is essential for effective emergency response. However, current knowledge graph representations face the challenge of integrating multi-source information with various spatial and temporal scales. To address this challenge, we propose a new information model for storm surge hazard events, involving a two-step process. First, a hazard event ontology is designed to model the components and hierarchical relationships of hazard event information. Second, we utilize multi-scale time segment integer coding and geographical coordinate subdividing grid coding to create a spatio-temporal framework, for modeling spatio-temporal features and spatio-temporal relationships. Using the 2018 typhoon Mangkhut storm surge event in Shenzhen as a case study and the hazard event information model as a schema layer, a storm surge event knowledge graph is constructed, demonstrating the integration and formal representation of heterogeneous hazard event information and enabling the fast retrieval of disasters in a given spatial or temporal range.
Evaluating Different Track Sub-Ballast Solutions Considering Traffic Loads and Sustainability
Authors: Castro Guilherme , Saico Jonathan , de Moura Edson , Motta Rosangela , Bernucci Liedi , Paixão André , Fortunato Eduardo , Oliveira Luciano
Published: March 2024

The railway industry is seeking high-performance and sustainable solutions for sub-ballast materials, particularly in light of increasing cargo transport demands and climate events. The meticulous design and construction of track bed geomaterials play a crucial role in ensuring an extended track service life. The global push for sustainability has prompted the evaluation of recycling ballast waste within the railway sector, aiming to mitigate environmental contamination, reduce the consumption of natural resources, and lower costs. This study explores materials for application and compaction using a formation rehabilitation machine equipped with an integrated ballast recycling system designed for heavy haul railways. Two recycled ballast-stabilised soil materials underwent investigation, meeting the necessary grain size distribution for the proper compaction and structural conditions. One utilised a low-bearing-capacity silty sand soil stabilised with recycled ballast fouled waste (RFBW) with iron ore at a 3:7 weight ratio, while the second was stabilised with 3% cement. Laboratory tests were conducted to assess their physical, chemical, and mechanical properties, and a non-linear elastic finite element numerical model was developed to evaluate the potential of these alternative solutions for railway sub-ballast. The findings indicate the significant potential of using soils stabilised with recycled fouled ballast as sub-ballast for heavy haul tracks, underscoring the advantages of adopting sustainable sub-ballast solutions through the reuse of crushed deteriorated ballast material.
Association between PET/CT Scan Findings, Treatment, and Cancer Incidence in a Cohort of AAA Patients
Authors: Sakalihasan Natzi , Bruls Samuel , Hustinx Roland , Tchana-Sato Vincent , Sakalihasan Sarah , Hultgren Rebecka , Labropoulos Nicos , Colige Alain , Durieux Rodolphe , Drion Pierre , Albert Adelin , Defraigne Jean-Olivier , Musumeci Lucia
Published: March 2024

Background: Abdominal aortic aneurysm (AAA) is a chronic inflammatory disease that poses several challenges. Given the increasing evidence that AAA patients are more likely to develop cancer and the importance of its early detection, we strived to develop a non-invasive tool based on serial FDG-PET/CT scan examinations to identify, among AAA patients, those at risk of cancer. Methods: Between 2006 and 2011 we recruited 149 AAA patients, free of cancer at baseline, and followed them until the end of 2021. All patients underwent an FDG-PET/CT scan at inclusion and possibly more scans during follow-up. At each medical imaging examination, the aneurysmal FDG uptake was recorded. Patients were stratified based on their aortic wall PET status (negative/positive). Any occurrence of cancer was reported. A Cox regression analysis and competing-risk modeling were applied to the data. Results: The proportion of AAA patients who developed cancer was 31.5% (mean time to diagnosis was 5.7 ± 3.4 years) and the death rate was 59%. A difference in cancer incidence between PET+ and PET− patients was detected (46.8% vs. 27.3%; HR = 1.96, 95%CI: 1.07–3.57, p = 0.028). Moreover, AAA patients undergoing surgical treatment had a lower risk of cancer than unoperated patients (28% vs. 50%; HR = 0.41, 95%CI: 0.21–0.80, p = 0.009). Conclusions: In AAA patients, diagnostic imaging with an FDG-PET/CT scan can help identify those patients at a higher risk of developing cancer. Moreover, the higher cancer risk in non-surgically treated patients calls for further analysis of associations between aneurysm growth and malignant disease.
The Efficacy and Safety of Sacubitril/Valsartan Compared to Valsartan in Patients with Heart Failure and Mildly Reduced and Preserved Ejection Fractions: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Kommu Sharath , Berg Richard L.
Published: March 2024

Background: Sacubitril/valsartan improves heart failure (HF) outcomes in patients with heart failure with reduced ejection fraction (HFrEF). However, randomized controlled trials (RCTs) in patients with heart failure and mildly reduced ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF) have shown inconsistent results. We conducted this meta-analysis to comprehensively evaluate the efficacy and safety of sacubitril/valsartan compared to valsartan within this specific patient population. Methods: We searched the MEDLINE database and ClinicalTrials.gov and identified four RCTs that could be included in our analysis, with 3375 patients in the sacubitril/valsartan group and 3362 in the valsartan group. Results: Our study shows that, in patients with HFmrEF and HFpEF, sacubitril/valsartan was superior to valsartan in some of the key HF outcomes, such as the Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ CSS), with a small but significant mean difference of 1.13 (95% confidence interval or CI of 0.15 to 2.11, p-value 0.024), an improvement in the New York Heart Association (NYHA) class (odds ratio or OR of 1.32, 95% CI 1.11 to 1.58, p-value 0.002), and the composite outcome of hospitalizations for HF and cardiovascular death, with a relative risk (RR) of 0.86 (95% CI 0.75 to 0.99, p-value 0.04). However, there was no additional benefit with sacubitril/valsartan compared to valsartan for the outcomes of cardiovascular death and all-cause mortality. In terms of side effects, sacubitril/valsartan was associated with a higher risk of hypotension when compared to valsartan (OR 1.67, 95% CI 1.27 to 2.19, p-value < 0.0001), but did not show an increased risk of hyperkalemia or worsening renal function. Conclusions: In individuals with HFmrEF or HFpEF, sacubitril/valsartan can result in improvements in the HF outcomes of the KCCQ CSS, the NYHA class, and the composite outcome of hospitalization for HF and cardiovascular death when compared to valsartan. While there was a higher risk of hypotension with sacubitril/valsartan compared to valsartan, there was no corresponding increase in the risk of hyperkalemia or worsening renal function.
Unlocking Diagnostic Precision: FATE Protocol Integration with BLUE and eFAST Protocols for Enhanced Pre-Hospital Differential Diagnosis of Pleural Effusion Manifested as Dyspnea in Adults—A Pilot Study
Authors: Kowalczyk Damian , Turkowiak Miłosz , Piotrowski Wojciech Jerzy , Rosiak Oskar , Białas Adam Jerzy
Published: March 2024

Background: Dyspnea commonly stems from combined myocardial and pulmonary dysfunction, posing challenges for accurate pre-hospital diagnosis. Limited diagnostic capabilities hinder the differentiation of cardiac and pulmonary issues. This study assesses the efficacy of combined cardiac and pulmonary ultrasound using the BLUE, eFAST, and FATE protocols. Methods: Participants were consecutively enrolled from dyspnea-related emergency calls in Warsaw, Poland, from 4 April 2022, to 15 June 2023. Patients with pleural effusion were identified through pre-hospital and in-hospital radiological assessments. Pre-hospital thoracic ultrasonography followed the BLUE, eFAST, and FATE protocols, alongside comprehensive clinical assessments. The pre-hospital diagnoses were juxtaposed with the with hospital discharge diagnoses. Results: Sixteen patients (8 men, 8 women; median age: 76 years) were enrolled. Inter-rater agreement for the BLUE protocol was substantial (κ = 0.78), as was agreement for eFAST (κ = 0.75), with almost perfect agreement for combined protocol assessment (κ = 0.83). Left ventricle hypokinesis, identified via the FATE protocol, significantly correlated with hospital-diagnosed decompensated heart failure as the primary cause of dyspnea. Sensitivity and specificity were 1.0 (95%CI: 0.62–1.0) and 0.6 (95%CI: 0.15–0.95), respectively. Positive predictive value was 0.85 (95%CI: 0.55–0.98), and diagnostic accuracy was 0.86 (95%CI: 0.62–0.98). Conclusions: Integrating the FATE protocol into BLUE and eFAST enhances pre-hospital differential diagnosis accuracy of pleural effusion in adults. This synergistic approach streamlines diagnostic processes and facilitates informed clinical decision-making. Larger-scale validation studies are needed for broader applicability.
Cardiovascular Toxicity of Antineoplastic Treatments in Hematological Diseases: Focus on Molecular Mechanisms to Improve Therapeutic Management
Authors: Barachini Serena , Buda Gabriele , Petrini Iacopo
Published: March 2024

In recent years, advancements in the treatment of hematologic neoplasms have led to more effective and less toxic therapeutic schemes, resulting in prolonged patient life expectancy. However, the success of these treatments has also brought about an increased prevalence of cardiovascular adverse events, becoming a significant concern for the growing population of cancer survivors. Antineoplastic therapies, targeting both tumor and organ vessels, contribute to vascular toxicity, influenced by genetic factors and pre-existing vascular diseases. Chemotherapeutic agents and targeted treatments can induce cardiovascular toxicity by affecting endothelial cells and cardiomyocytes through various mechanisms, including hypoxia, vasculature abnormalities, and direct effects on cardiomyocytes. Cardiovascular adverse events encompass a wide range, from cardiac dysfunction to an elevated risk of arrhythmias. While early cardiac events are well-described in clinical trials, delayed toxicities are gaining relevance due to prolonged patient survival. The review focuses on the cardiac and vascular toxicity of antineoplastic drugs in hematological disorders, providing insights into the molecular physiopathology of cancer therapy-associated cardiotoxicity. Understanding how these drugs interact with the heart and blood vessels is essential for predicting, detecting, and managing chemotherapy-related heart issues.
Predictors of Outcome after Direct Aspiration of Basilar Artery Occlusion
Authors: Mako Miroslav , Krastev Georgi , Nosáľ Vladimír , Haring Jozef , Jakubcová Denisa , Daniš Martin , Klepanec Andrej , Haršány Ján , Sivák Štefan , Kurča Egon
Published: March 2024

Background: Basilar artery occlusion (BAO) is a serious disease with a poor prognosis if left untreated. Endovascular therapy (EVT) is the most effective treatment that is able to reduce mortality and disability. Treatment results are influenced by a wide range of factors that have not been clearly identified. In the present study, direct aspiration was chosen as a first-line treatment. The safety and effectiveness of direct aspiration in BAO were determined, and factors affecting patient outcomes were identified. Methodology: Data for patients with BAO treated between November 2013 and December 2021 were evaluated using a database. The association between clinical and procedural parameters and functional outcome was assessed. Results: A total of 89 patients with BAO were identified. Full recanalization was achieved in 69.7% of cases and partial recanalization in 19.1%. Intracranial hemorrhage was detected in 11 (12.4%) patients, of which, eight (9.0%) patients experienced symptomatic intracranial hemorrhage. Patients with good outcomes presented with milder strokes (mean NIHSS score of 12.58 vs. 24.00, p < 0.001), had higher collateral scores (6.79 vs. 5.88, p = 0.016), more often achieved complete recanalization (87.9% vs. 58.9%, p = 0.009), and more often experienced early neurological improvement (66.7% vs. 26.8%, p < 0.001). On the contrary, patients with worse outcomes had higher serum glucose levels (p = 0.05), occlusion of the middle portion of the basilar artery (MAB) (30.3% vs. 53.6%, p = 0.033), longer thrombus lengths (10.51 vs. 16.48 mm, p = 0.046), and intracranial hemorrhage (p = 0.035). Conclusions: The present study results suggest that direct aspiration is a safe and effective treatment for patients with BAO. We identified several factors affecting the patients’ outcome.
The Impact of High BMI on Pregnancy Outcomes and Complications in Women with PCOS Undergoing IVF—A Systematic Review and Meta-Analysis
Authors: Alenezi Salih Atalah , Khan Raheela , Amer Saad
Published: March 2024

(1) Background: Current evidence indicates that women with polycystic ovarian syndrome (PCOS) undergoing in vitro fertilization (IVF) have an increased likelihood of adverse pregnancy outcomes. The objective of this systematic review was to clarify the role of a PCOS-related high body mass index (BMI) in these unfavourable pregnancy outcomes. (2) Methods: A comprehensive search of electronic databases was conducted to identify studies investigating the impact of high BMI on pregnancy outcomes in women with PCOS undergoing IVF. RevMan software (v5.4) was used to calculate the odds ratio (OR) and 95% confidence interval (CI). (3) Results: Nineteen eligible studies (n = 7680) were identified, including 16 retrospective cohort studies (n = 6934), two prospective cohort studies (n = 525), and one cross-sectional study (n = 221). Pooled analysis showed significantly higher odds of clinical pregnancy (OR, 1.16 [95% CI, 1.04–1.29]; z = 2.73; p = 0.006; I2 = 30%) and livebirths (OR, 1.88 [95% CI, 1.56–2.27]; z = 6.54; p < 0.0001; I2 = 55%) in women with PCOS with a normal versus a high BMI. Meta-analysis showed significantly increased odds of miscarriages in women with PCOS with a high versus a normal BMI (OR, 0.76 [95% CI, 0.60–0.95]; z = 2.42; p = 0.02; I2 = 53%). Pooled analysis of three studies (n = 993) showed significantly higher ORs of gestational diabetes mellitus (OR 3.96 [95% CI 1.62–9.68]; z = 3.01; p = 0.003; I2 = 58%) and gestational hypertension (OR 2.16 [95% CI 1.32–3.54]; z = 3.05; p = 0.002; I2 = 68%) in women with PCOS with a high versus a normal BMI. Meta-analysis of three studies reported significantly greater odds of a caesarean section for women with PCOS with a high versus a normal BMI (OR 0.45 [95% CI 0.29–0.69]; z = 3.66; p = 0.0003; I2 = 0%). (4) Conclusions: The increased likelihood of adverse pregnancy outcomes observed in women with PCOS undergoing IVF seems to be attributable to a PCOS-related high BMI.
Association between Blood Lead Levels and Silent Myocardial Infarction in the General Population
Authors: Mostafa Mohamed A. , Abueissa Mohammed A. , Soliman Mai Z. , Ahmad Muhammad Imtiaz , Soliman Elsayed Z.
Published: March 2024

Background: Although the link between lead exposure and patterns of cardiovascular disease (CVD) has been reported, its association with silent myocardial infarction (SMI) remains unexplored. We aimed to assess the association between blood lead levels (BLLs) and SMI risk. Methods: We included 7283 (mean age 56.1 ± 2.52 years, 52.5% women) participants free of CVD from the Third National Health and Nutrition Examination Survey. BLL was measured using graphite-furnace atomic absorption spectrophotometry. SMI was defined as ECG evidence of myocardial infarction (MI) without history of MI. The association between SMI and BLLs was examined using multivariable logistic regression. Results: SMI was detected in 120 participants with an unweighted prevalence of 1.65%. Higher BLL correlated with higher SMI prevalence across BLL tertiles. In multivariable-adjusted models, participants in the third BLL tertile had more than double the odds of SMI (OR: 3.42, 95%CI: 1.76–6.63) compared to the first tertile. Each 1 µg/dL increase in BLL was linked to a 9% increase in SMI risk. This association was consistent across age, sex, and race subgroups. Conclusions: Higher BLLs are associated with higher odds of SMI in the general population. These results underscore the significance of the ongoing efforts to mitigate lead exposure and implement screening strategies for SMI in high-risk populations.
Nimesulide-Induced Fixed Drug Eruption Followed by Etoricoxib-Induced Fixed Drug Eruption: An Unusual Case Report and Review of the Literature
Authors: Makris Michael , Papapostolou Niki , Koumprentziotis Ioannis-Alexios , Pappa Georgia , Katoulis Alexander C.
Published: March 2024

Fixed drug eruption (FDE) is a well-recognized, non-immediate, drug hypersensitivity reaction, often attributed to the use of various medications, most commonly non-steroidal anti-inflammatory drugs (NSAIDs) and antibiotics. Cross-reactivity between related NSAIDs in FDE has been reported, but among chemically unrelated NSAIDs, is rare. Herein, we present a rare well-documented case where a patient initially displayed tolerance to etoricoxib after experiencing a nimesulide-induced FDE. Subsequently, the patient developed an etoricoxib-induced FDE, accompanied by the development of bullous lesions. This case report and the literature review on comparable FDE occurrences shed light on the intricate nature of FDEs, suggesting the possibility of cross-reactivity between chemically related and unrelated NSAIDs or the emergence of new drug-specific T cells without cross-reactivity after multiple exposures to a drug in a susceptible patient. Our case underscores the importance of increased awareness and vigilance among both physicians and patients in the realm of personalized medicine. Further research is needed to unravel the intricate mechanisms behind these drug eruptions, improve diagnostic approaches, and enhance patient care.
Donor Characteristics in Graft Detachment after Posterior Lamellar Keratoplasty for Fuchs Endothelial Dystrophy and Bullous Keratopathy
Authors: Cardascia Nicola , Cassano Flavio , Pastore Valentina , La Tegola Maria Gabriella , Sborgia Alessandra , Boscia Francesco , Alessio Giovanni
Published: March 2024

Background: Descemet Membrane Endothelial Keratoplasty (DMEK) has been widely adopted to treat Fuchs endothelial dystrophy (FED) and Bullous keratopathy (BK). Graft detachment (GD) is one of the common earliest post-operatory complications, and it is usually recovered by Air Rebubbling (ARB). Methods: Retrospectively, we investigated predictive factors related to GD between January 2016 and March 2020, a pre-COVID era, in 72 patients, 72 eyes, and their donors’ lamellar characteristics, focusing on donor’s cause of death. The patients were divided according to the posterior lamellar keratoplasty technique adopted. Results: GD and consequent ARB were most common but not significantly prevalent in DMEK (p = 0.11). It was more common in FED for both surgical approaches. Only in BK treated with DSAEK were host steeper mean astigmatism (p = 0.03) and donors with smaller graft pre-cut diameters (p = 0.02) less likely to be related to GD. Regarding donor’s cause of death, only cardiovascular accident could be related to GD in BK treated with DMEK (p = 0.04). Conclusions: Our study shows that the conventional match between pathology and corneal lenticule is not sufficient to prevent ARB. Donor’s cause of death can impair graft and host attachment. In particular, cardiovascular death may impair the efficiency of donors’ endothelial cells, inducing GD after DMEK in BK.
The Effect of Severe Varus Deformity on Clinical and Radiographic Outcomes in Mechanical Aligned Total Knee Arthroplasty with Medial Stabilizing Technique
Authors: Lee Sung-Sahn , Jung Jewon , Kim Hanbit , Kim Jinwoo , Jung In Geol , Kim Jiin , Moon Young-Wan
Published: March 2024

Background: The purpose was to compare the clinical and radiographic outcomes between preoperative mild and severe varus deformity after total knee arthroplasty (TKA) with medial stabilizing technique (MST). Methods: We retrospectively analyzed 158 knees of 125 female patients with a 2-year follow-up who underwent mechanically aligned TKA with MST between April 2018 and February 2021. Patients were divided into two groups; the severe varus group was defined as one with preoperative hip-knee ankle (HKA) angle ≥ 15° and the mild varus group with HKA angle < 15°. Pre- and post-operative clinical outcomes (Western Ontario and McMaster University Osteoarthritis Index, Knee Society Knee Score) and radiographic outcomes (medial proximal tibial angle (MPTA), HKA angle, lateral distal femoral angle (LDFA), joint line distance, and femoral component rotation angle) were compared between the groups. Results: Among the 158 knees analyzed, 131 and 27 were allocated to the mild and severe varus groups, respectively. Preoperative data showed that the MPTA (84.7° ± 2.8° vs. 80.7° ± 3.2°, p < 0.001) was significantly less in the severe varus group. In postoperative data, clinical outcomes were not different between the groups. Joint line distance (18.4 mm ± 2.8 mm vs. 18.6 mm ± 2.7 mm, p = 0.676) was also not significantly different. Femoral component rotation angle (−1.7° ± 1.0° vs. −1.0° ± 1.3°, p = 0.018) was more externally rotated in the severe varus group. Conclusions: Severe varus group showed comparable clinical and radiographic outcomes to that of mild varus group after mechanically aligned TKA with MST.
Improved Oral Health Is Associated with a Lower Risk of Late Onset Ankylosing Spondylitis: A Nationwide Cohort Study
Authors: Chung Min Kyung , Chang Yoonkyung , Park Jung-Hyun , Leem Gwang Hyun , Song Tae-Jin
Published: March 2024

Background: The aim of this study was to evaluate the association of oral health status and habits with the occurrence of ankylosing spondylitis (AS) in a nationwide population-based cohort in a longitudinal setting. Methods: A total of 2,415,963 individuals aged 40–79 years who underwent oral health examinations were included from the National Health Insurance Service-National Health Screening (NHIS-HEALS) cohort of Korea between 2003 and 2004. The occurrence of AS was analyzed according to the oral health status and oral hygiene habits. Results: Among 2,271,221 of the participants, AS occurred in 6366 (0.3%) participants over 16.7 years. The likelihood of AS was higher in participants who had periodontitis (hazard ratio [HR]: 1.33, 95% confidence interval [CI]: 1.20–1.46, p < 0.0001) and more missing teeth (HR: 1.68, 95% CI: 1.42–1.99, p < 0.0001). However, better oral hygiene habits such as frequent tooth brushing (HR: 0.77, 95% CI: 0.71–0.83, p < 0.0001) and a history of dental scaling within the last year (HR 0.88, 95% CI 0.82–0.95, p = 0.001) were associated with a lower occurrence of AS. Conclusions: Periodontitis and an increased number of missing teeth could be related to the occurrence of late-onset AS. Improved oral hygiene care may attenuate the likelihood of late-onset AS.