bluuebunny/crossref_metadata_2025 huggingface dataset:
Are Serious Games an Effective Teaching Tool in Anatomy Education? A Systematic Review
Authors: Al Habsi Tariq , Alibrahim Hashim , Zaabi Adhari Al , Mogali Sreenivasulu Reddy , Wen Tan Jun , Joseph Mickael , Al-Ajmi Eiman , Sirasanagandla Srinivasa Rao
Published: February 2025

Background: Human anatomy is a crucial component of medical curricula, requiring innovative methods to enhance students’ learning outcomes. Recently, various technology-based methods have emerged to address the limitations of traditional anatomy teaching methods. Among these, serious games have emerged as a promising tool demonstrating effectiveness in achieving various learning outcomes. This systematic review aims to evaluate the effectiveness of serious games in anatomy education and identify gaps in literature. Methods: Following PRISMA guidelines, a comprehensive search of databases including PubMed, Scopus, and Google Scholar was performed. Of 900 records identified, 24 records were eligible for the full text review. Of these, 14 studies were included eventually for detailed analysis. Study quality was assessed using the Newcastle–Ottawa Scale. Results: The results showed that the key learning domains assessed were knowledge acquisition, engagement, perception, and skills development. Most studies reported positive outcomes in terms of students’ performance and satisfaction. Despite these findings, variations in study design, sample size, and assessment methods were noted, limiting the generalizability of results. Conclusions: Serious games represent a novel supplement to anatomy education, fostering improved learning outcomes and engagement. However, future work should focus on well-crafted randomized controlled trials to effectively evaluate the impact of using serious games in anatomy teaching with combined qualitative and quantitative evaluation approaches.
Shape Effect and Accuracy Analysis of Rock Tensile Strength Test
Authors: Pei Junjie , Zhao Jinchang , Niu Shaoqing
Published: February 2025

To investigate the influence of shape effects on the tensile strength of rocks, splitting tests were conducted on disc specimens with the same thickness-to-diameter ratio but different diameters using physical similarity simulation and numerical simulation experiments. Additionally, finite element analysis software was employed to perform numerical simulation tests on two types of dumbbell-shaped specimens involved in direct tensile tests of rocks. This study revealed that when the thickness-to-diameter ratio is fixed at 0.5, the splitting tensile strength decreases gradually as the specimen diameter increases from 30 mm to 110 mm. This trend can be well fitted using a power function. The tensile strength measured from direct tensile tests on the two types of dumbbell-shaped specimens shows a slight decreasing trend as the diameter of the central effective test area decreases. Moreover, the measured tensile strength is lower than the actual tensile strength. The test results for disc specimens are the closest to the actual tensile strength, followed by arc-transition dumbbell-shaped specimens, and lastly, straight-transition dumbbell-shaped specimens. The correlation coefficients between the test results and the actual tensile strength for the three types of specimens are also provided.
Measurement Uncertainty and Compliance Evaluation Applied to Natural Gas Moisture
Authors: Moreira Rosana Medeiros , Biazon Cesar Luís , de Oliveira Elcio Cruz
Published: February 2025

The reliability of natural gas moisture measurements is crucial in preventing corrosion in pipelines and equipment, ensuring burning efficiency and mitigating operational risks, and is often mandated by standards and regulations. An important quality parameter that aids in conformity assessment, particularly in risk assessment, is measurement uncertainty. The assessment of measurement uncertainty, based on the Law of Uncertainty Propagation, depends on the mathematical model used to calculate this physicochemical property. This study aimed to compare different algorithms for calculating moisture content in natural gas, estimate and validate the measurement uncertainty based on the algorithms implemented in the Portable Moisture Analyzer (PM880) equipment, a portable hygrometer manufactured by Panametrics in Wilmington, NC, USA, and evaluate compliance with Brazilian legislation using guard bands as a decision rule. The moisture results in natural gas varied by a maximum of 1% among the three approaches presented. Furthermore, based on the dew point and pressure results, the expanded uncertainties of moisture were about 20%, which did not compromise the risk assessment for the consumer, as the moisture results were well below the specification value. Consequently, the upper tolerance limit of 58.4 ppmv H2O was established.
Vestibulo-Oculomotor Reflex Dysfunction in Children with Cerebral Palsy Correlates with Gross Motor Function Classification System
Authors: Casagrande Conti Laura , Ferri Nicola , Manzari Leonardo , Lelli Tommaso , Mangeruga Maria , Dal Piaz Margherita , Manzotti Andrea , Verrecchia Luca , Tramontano Marco
Published: February 2025

Background/Objectives: This study aims to evaluate the feasibility of the angular vestibulo-ocular reflex (aVOR) function assessment in children with cerebral palsy (CP) using the video Head Impulse Test (vHIT) and to investigate how vestibular impairments correlate with functional motor ability. Methods: This cross-sectional study included children diagnosed with CP who attempted a vestibular function assessment with the vHIT. Descriptive statistics and a subgroup analysis based on clinical expression were performed. Finally, the correlation between aVOR gain and functional motor ability was investigated. Results: Thirteen children underwent assessments of the horizontal semicircular canals. Six out of thirteen children presented at least one dysfunctional canal; overall, eight out of twenty-six horizontal semicircular canals were dysfunctional in the HIMP paradigm. A subgroup analysis revealed a dysfunctional aVOR gain in all the children presenting ataxia. The correlation analysis demonstrated a strong negative association between aVOR gain and the Gross Motor Function Classification System (−0.73 and −0.68 for the left and right horizontal canal, respectively; p < 0.05). Conclusions: Vestibular dysfunctions are prevalent in children with CP and strongly correlate with motor function. An instrumental vestibular assessment in children with cognitive-motor disability seems feasible, in particular for horizontal canals and the HIMP paradigm. This could be important for better framing a child’s function and enhancing the management of balance and motor impairments with more specific strategies for children with CP.
Dia-B-Ties: B Cells in the Islet–Immune-Cell Interface in T1D
Authors: Hilliard Brandon K. , Prendergast Jessica E. , Smith Mia J.
Published: February 2025

Type 1 diabetes (T1D) is an autoimmune disease that affects an estimated 30 million people worldwide and results in a lifelong dependency of exogenous insulin treatments. While T1D is characterized by T-cell driven-destruction of the insulin-secreting β cells, B lymphocytes play a key role in the islet–immune interface. B cells are an essential intermediary between islet cells and other immune-cell populations. Through antigen presentation, cytokine secretion, and antibody production, B cells play a role in activating autoreactive islet-specific T cells, thus potentiating pancreatic inflammation in the early stages of T1D. Despite this, their role in disease development remains an understudied feature of T1D with significant therapeutic potential. Herein, we will discuss the current knowledge of the islet–immune-cell interface within T1D through the lens of B lymphocytes. We will also consider knowledge gaps that may be limiting further therapeutic opportunities.
Smith–Lemli–Opitz Syndrome: Oral Characteristics and Risk Factors for Caries Development
Authors: Olczak-Kowalczyk Dorota , Witt-Porczyk Aneta , Piekoszewska-Ziętek Paula , Krajewska-Walasek Małgorzata
Published: February 2025

Background/Objectives: Smith–Lemli–Opitz syndrome is a metabolic autosomal recessive disease, characterized by congenital defects, with concomitant psychomotor developmental delay. The symptoms are variable and depend on the clinical form of the disease. The aim of this study was to assess the prevalence and types of oral abnormalities in children and adolescents with Smith–Lemli–Opitz syndrome. Methods: The study enrolled 30 patients, including 15 subjects with Smith–Lemli–Opitz syndrome, confirmed by a genetic examination. We performed an extra- and intraoral examination, paying attention to the presence of dysmorphic features, including the shape and symmetry of the face; the condition of the skin and lips; the gingival and hygienic status; dental caries; lesions of non-carious origin; abnormalities of size, shape, and number; and alignment of teeth in the dental arch. Results: Patients in the study group presented with micrognathia, a short neck, ptosis, and an upturned nose. More frequently than in the control group, we observed occlusal abnormalities and dental crowding, anatomical abnormalities or gingivitis. The prevalence of dental caries in both groups was similar; however, the study group recorded higher dmft and DMFT values. Conclusions: The phenotypic features of patients with Smith–Lemli–Opitz syndrome increase their risk of developing dental caries and gingivitis.
The Effect of Stress on Depression in Postgraduate Students: Mediating Role of Research Self-Efficacy and Moderating Role of Growth Mindset
Authors: Li Tongji , Guan Jun , Huang Yishu , Jin Xinglin
Published: February 2025

This study investigates the relationship between stress and depression among postgraduate students, with a focus on the mediating role of research self-efficacy and the moderating role of growth mindset. A questionnaire survey was conducted among 2278 graduate students nationwide, utilizing the Mindset Scale, Depression–Anxiety–Stress Scale, and Research Self-Efficacy Scale. Data were analyzed using SPSS 27.0 and AMOS 24.0. The results indicate the following: (1) Stress has a significant positive relationship with depression, while stress is negatively related to research self-efficacy, and research self-efficacy is negatively related to depression. (2) Research self-efficacy partially mediates the relationship between stress and depression, accounting for 35.6% of the total effect. (3) Growth mindset moderates both the relationship between stress and research self-efficacy and the relationship between research self-efficacy and depression. These findings reveal the mechanisms through which stress affects depression among graduate students, underscore the importance of mental health education, and provide scientific evidence for universities and educational institutions to design targeted prevention and intervention measures.
From Development to Validation: Exploring the Efficiency of Numetrive, a Computerized Adaptive Assessment of Numerical Reasoning
Authors: Karagianni Marianna , Tsaousis Ioannis
Published: February 2025

The goal of the present study is to describe the methods used to assess the effectiveness and psychometric properties of Numetrive, a newly developed computerized adaptive testing system that measures numerical reasoning. For this purpose, an item bank was developed consisting of 174 items concurrently equated and calibrated using the two-parameter logistic model (2PLM), with item difficulties ranging between −3.4 and 2.7 and discriminations spanning from 0.51 up to 1.6. Numetrive constitutes an algorithmic combination that includes maximum likelihood estimation with fences (MLEF) for θ estimation, progressive restricted standard error (PRSE) for item selection and exposure control, and standard error of estimation as the termination rule. The newly developed CAT was evaluated in a Monte Carlo simulation study and was found to perform highly efficiently. The study demonstrated that on average 13.6 items were administered to 5000 simulees while the exposure rates remained significantly low. Additionally, the accuracy in determining the ability scores of the participants was exceptionally high as indicated by various statistical indices, including the bias statistic, mean absolute error (MAE), and root mean square error (RMSE). Finally, a validity study was performed, aimed at evaluating concurrent, convergent, and divergent validity of the newly developed CAT system. Findings verified Numertive’s robustness and applicability in the evaluation of numerical reasoning.
Parents of Children with Congenital Heart Disease (CHD): A Narrative Study of the Social and Clinical Impact of CHD Diagnosis on Their Role and Health
Authors: Moro Christian , Iudici Antonio , Turchi Gian Piero
Published: February 2025

Congenital heart diseases (CHDs) lead to psychological and social repercussions for parents of affected children: the diagnosis, screenings, surgeries, and hospitalization, as well as ongoing difficulties bring with them stress, anxiety, fear, stigmatization, and isolation. Studies investigating parents’ direct perspective on these issues lack in the field literature. Our research aims to leverage parents’ narratives in order to explore how they describe their role as parents of a child with CHD and the impact of its social and clinical repercussions on their lives. We recruited 45 parents and analyzed their narratives through the MADIT approach, focusing on the discursive modalities and content cores employed. Parents describe and judge their role as ‘worried-protective’, ‘heroic’, ‘normal-untroubled’, and ‘unfortunate’, in a way that strongly characterizes the person, leaving limited possibilities for assuming different features. The clusters ‘state of ordeal’, ‘state of alert-overprotection’, and ‘personal identity changes’ are connoted as inevitable and established component of parents’ lives, while ‘limitation of life experiences’ is less monolithic and more open to change. Current narratives assume a totalizing form in the life of these parents, that can lead to stigma and exacerbate the already present difficulties and challenges, that need targeted psychological intervention by field professionals.
Analysis of Development Trends and Associations in Intelligent Construction of Chinese Corporations
Authors: Wang Yuhao , Zhao Xuefeng , Yu Xueyao , Liu Siyu , Feng Miao , Tao Yibing , Yang Qiantai
Published: February 2025

Intelligent construction, as a crucial driving force for the transformation and upgrading of the construction industry, is currently reshaping the production processes and management models throughout the entire life cycle of buildings. Nevertheless, construction enterprises are confronted with issues, such as great difficulties in system integration, complexity in multi-field collaboration, mismatch of technological requirements, and disharmony between standards and management processes during the process of promoting intelligent construction, which have restricted its in-depth application. This paper adopts a combination of questionnaire surveys and text mining methods to accurately gain insights into the actual situation of the application of intelligent construction in Chinese corporations. Cite Space is utilized to conduct keyword co-occurrence and clustering analyses and to construct the correlation atlas of the intelligent construction system, which are used to conduct in-depth analyses of its development trends and internal correlations. The research results demonstrate that aspects, such as building information modeling (BIM), smart construction sites, intelligent equipment, and prefabricated construction, exhibit significant development trends in the field of intelligent construction. Moreover, the precise matching between technology and the business needs of enterprises is of vital importance for the efficient implementation of intelligent construction. This research provides clear technological and management paths for intelligent construction in Chinese corporations, aiming to promote the standardization process of intelligent construction for enterprises and the industry and to facilitate the digital transformation and upgrading of the construction industry.
Experimental and Finite Element Analysis of Bending Performance of Web-Embedded Double Inverted T-Shaped Steel–Concrete Composite Beams
Authors: Shen Jie , Zhang Xiantong , Wu Peng , Yue Kong , Chen Jianbing
Published: February 2025

This study investigates the bending performance of web-embedded double inverted T-shaped steel–concrete composite beams (WDTSCBs) through experimental testing and finite element analysis (FEA). A novel composite beam structure was developed, where double inverted T-shaped steel beams are interconnected by slotted web plates and embedded in concrete flanges, aiming to enhance load-bearing capacity and ductility. Four WDTSCB specimens, utilizing C40 concrete and Q345qB steel, were tested under static loading to analyze failure modes, load-deflection behavior, and crack development. The experimental results were validated by FEA in ABAQUS, achieving an error margin of less than 5%. The findings indicate that WDTSCBs exhibit superior flexural performance compared to traditional composite beams, with higher bending resistance and reduced steel consumption. These results provide valuable insights into the design and optimization of steel–concrete composite structures, promoting their application in civil engineering.
Vulnerability Assessment of the Prefabricated Building Supply Chain Based on Set Pair Analysis
Authors: Li Jinjin , Luo Lan , Liu Zhangsheng
Published: February 2025

In recent years, the disruption of the prefabricated building supply chain has led to increased construction period delays and cost overruns, limiting the development and popularization of prefabricated buildings in China. Therefore, this study established a vulnerability evaluation index system for the prefabricated building supply chain using the driving force–pressure–state–impact–response (DPSIR) framework. We employed the intuitionistic fuzzy analytic hierarchy process (IFAHP), the projection pursuit (PP) model, and variable weight theory to determine the indicator weights. The IFAHP was utilized to reduce the subjectivity in weight assignment and to obtain the degree of membership, non-membership, and hesitation of experts in evaluating the importance of indicators. The PP model was used to determine objective weights based on the structure of the evaluation data, and variable weight theory was applied to integrate subjective and objective weights according to management needs. We utilized Set Pair Analysis (SPA) to establish a vulnerability evaluation model for the building supply chain, treating evaluation data and evaluation levels as a set pair. By analyzing the degree of identity, difference, and opposition of the set pair, we assessed and predicted the vulnerability of the building supply chain. Taking the Taohua Shantytown project in Nanchang as a case study, the results showed that the primary index with the greatest influence on the vulnerability of the prefabricated building supply chain was the driving force, with a weight of 0.2692, followed by the secondary indices of market demand and policy support, with weights of 0.0753 and 0.0719, respectively. The project’s average vulnerability rating was moderate (Level III), and it showed an improvement trend. During the project’s implementation, the total cost overrun of the prefabricated building supply chain was controlled within 5% of the budget, the construction period delay did not exceed 7% of the plan, and the rate of production safety accidents was below the industry average. The results demonstrated that the vulnerability assessment method for the prefabricated building supply chain based on SPA comprehensively and objectively reflected the vulnerability of the supply chain. It is suggested to improve the transparency and flexibility of the supply chain, strengthen daily management within the supply chain, and enhance collaboration with supply chain partners to reduce vulnerability.
Chemical Mechanisms of Cement Stabilization and Durability Enhancement in High-Content Modified Phosphogypsum
Authors: Xu Bin , Zhou Yingxin , Wu Zijing , Lu Kaiji , Wang Hongbing , Gao Aodong
Published: February 2025

Phosphogypsum, a byproduct of phosphate fertilizer production, accumulates in large quantities annually, posing significant environmental challenges due to harmful components such as fluorine, heavy metals, and acidic salts. To mitigate these issues, phosphogypsum is often combined with cement and single modifiers such as sodium silicate, hydrated lime, and defluorinating agents for use in pavement applications. However, concerns about the durability of unmodified or singly modified high-content phosphogypsum have hindered its widespread adoption. To address this issue, this study explored the use of sodium silicate, hydrated lime, and defluorinating agents as composite modifiers to enhance the durability of cement-stabilized phosphogypsum. The mechanisms of modification by individual and composite additives were investigated using X-ray diffraction (XRD) and scanning electron microscopy (SEM). Durability was evaluated through three-point bending fatigue, freeze–thaw, and drying shrinkage tests on both unmodified and modified cement-stabilized phosphogypsum. The results demonstrated that the composite modification of sodium silicate, hydrated lime, and defluorinating agents significantly improved the material’s density, strength, and stability by enhancing hydration products and stabilizing fluoride ions. The modified material exhibited superior fatigue and freeze–thaw resistance, with reduced mass loss and slower strength decline compared to unmodified phosphogypsum. Additionally, the modified material showed improved drying shrinkage performance due to enhanced hydration. However, caution is recommended when using these materials in regions with high moisture content and significant temperature fluctuations.
A Review of the Thermal and Mechanical Characteristics of Alkali-Activated Composites at Elevated Temperatures
Authors: Wu Ting , Tang Si , Dong Yao-Rong , Luo Jiang-Hua
Published: February 2025

Alkali-activated materials (AAMs) are promoted as a sustainable alternative to ordinary Portland cement (OPC). They not only have excellent resistance to high temperatures and chemical corrosion, but they can also help to reduce greenhouse gas emissions and reduce energy consumption. Despite their superior resistance to high temperatures compared to conventional cement-based concretes, studies have indicated that AAMs still face challenges related to performance degradation under elevated temperatures. This paper systematically reviews and summarizes the thermal properties (i.e., thermal expansion, thermal stability, and thermal conductivity), mechanical performance, and deterioration mechanisms of various alkali-activated composite systems. The findings reveal significant variability in resistance to high temperatures among different AAM systems, originating from the diversity of precursor materials used. Generally, the strength deterioration of various AAMs below 400 °C is minimal or even slightly increased, while between 600 °C and 800 °C, the strength degradation is significantly accelerated. Upon reaching 800 °C, the rate of the strength deterioration of AAMs tends to stabilize, with some alkali-activated composites even exhibiting signs of strength recovery. After exposure to high temperatures of 800 °C, the retentions of the compressive strength and flexural strength of alkali-activated composites are in the ranges of about 20–60% and 20–40%, respectively. The degradation mechanisms at elevated temperatures primarily include crystalline-phase transformation, microstructural changes, and thermal incompatibility arising from the differing coefficients of thermal expansion between the matrix and the aggregates. Finally, this paper discusses effective strategies to enhance the resistance of AAMs to high temperatures and highlights both the opportunities and challenges for future research in this field.
Color Preference and Color Supportive Behavior: The After Effects of Color Perception of Rural Housing Among the Indigenous Residents in Gutian District, Fujian Province, China
Authors: Kong Deyi , Li Ziyi , Fei Xinhui , Chen Zujian
Published: February 2025

The colors of traditional dwellings are an extremely intuitive manifestation of regional culture and an important reference for guiding rural housing. This study takes the Gutian district as the research region and explores the internal influence mechanism of the “color perception–preference–supportive behavior” of the indigenous residents towards traditional dwellings, specifically rammed earth dwellings. After constructing a structural equation model, the results were as follows: (1) The color perception of the indigenous residents towards traditional dwellings has two dimensions: distinctiveness and rootedness. (2) The color perception of the indigenous residents towards traditional dwellings can significantly enhance their color preference, but the two dimensions of color perception have different effects on color preference. (3) Color perception has a direct impact on color supportive behavior, mainly reflected in the dimension of the perception of distinctiveness. On the other hand, the mediating role of color preference has a positive impact on color—supportive behavior, mainly reflected in the dimension of the perception of rootedness. This study constructs a positive—cycle model that goes from the strengthening of color perception to the promotion of color preference and finally to the enhancement of color supportive behavior. The aim is to deeply analyze the multiple values contained in the colors of traditional dwellings, which not only demonstrate regional characteristics but also closely meet the emotional needs of the indigenous residents and have broad application potential in rural housing and cultural inheritance significance.
Assessment of Damage Progression in Corner Buildings with Infill Walls During an Intraplate Earthquake in Mexico
Authors: Martínez Abel , Jara José M. , López Juan I. , Olmos Bertha A. , Varum Humberto , Lampropoulos Andreas
Published: February 2025

On 19 September 2017, an intraplate earthquake with a magnitude of Mw = 7.1 occurred in Mexico. Visual inspection reports following the earthquake indicated that 11% of high-risk structures and 35% of collapsed buildings were situated at block corners in Mexico City. This study analyzes the statistics on corner buildings damaged by the 2017 earthquake. Three numerical models of reinforced concrete buildings were developed, featuring four, six, and eight floors with a waffle flat slab floor system. The study focuses on collapsed corner buildings and examines their seismic responses using a series of real unscaled accelerograms from the 19 September 2017 earthquake recorded at seismic stations near these buildings. The nonlinear dynamic analysis showed that seismic demands are concentrated at the more flexible corners of buildings with plan stiffness irregularity, which may result in a collapse at drift ratios lower than those required for more regular structures, indicating low seismic resilience. The study analyzed the progression of seismic demands and damage to corner buildings throughout the 19 September 2017 earthquake, allowing for a numerical verification of the observed damages. Damage indices and the distribution of seismic demands on the buildings clearly correlated with the observed partial and total collapses during the earthquake.
A Study on the Thermal Conductivity of Graphite Composite Insulation Material for Building Insulation
Authors: Wang Ruhua , Yuan Qianbin , Zhang Ze , Zhang Fei , Zhao Kecheng , Xu Jian , Zhao Tengfei
Published: February 2025

Global climate change has placed a heavy burden on the environment, with building energy consumption gradually emerging as a major environmental stressor. Therefore, energy conservation and emission reduction in buildings have increasingly become key issues of great concern. In regions with hot summers and cold winters, building envelope structures often use insulation materials to facilitate energy efficiency in buildings. Graphite composite insulation material (GCIM), a high-performance building insulation composite material, is composed primarily of graphite polystyrene particles (GPPs), glass microspheres (GMs), cement, and silica fume (SF). The thermal conductivity (TC) is an important parameter that affects its insulation performance. The volume ratios (VRs) of the material components will have a significant impact on its TC. However, there is currently a relative lack of theoretical research on the influencing factors of its TC, and its TC mechanism is not very clear. Therefore, a novel series-parallel alternate heat conduction theoretical model (SPAM) was established in this paper. The theoretical calculation expression for the TC of GCIM was derived using Fourier’s law of heat conduction. Through numerical simulation, three models comprising a total of 60 finite element (FE) models were constructed. The results of the numerical simulation were compared with theoretical calculations to further determine the influence of material component VRs on the TC of GCIM. The research results indicate that in the three established conventional models, the TC of GCIM decreases rapidly in the early stages and then stabilizes later, with a critical point at Ψ1Ψ2=Ψ1Ψ4=5. Within the specified range of VR variations, the value of Ψ1Ψ2 has the greatest impact on the TC performance of GCIM, followed by Ψ1Ψ4, while Ψ1Ψ3 has the smallest impact. The research findings will guide the material composition of the GCIM, reduce their TC, enhance their insulation performance, decrease building energy consumption, and hold high theoretical and practical value. This research will provide a theoretical reference basis for the widespread application of the GCIM in the field of building insulation.
Advances in CDK4 and 6 Inhibitors: Transforming Breast Cancer Treatment
Authors: Santander Ballestín Sonia , Abadía Labena María , Avedillo-Salas Ana , Marco Continente Cristina , Arribas Blázquez Marina , Luesma Bartolomé María José
Published: February 2025

Background and Objectives: Breast cancer is the most common malignant neoplasm worldwide and the most prevalent one among women. It represents the leading cause of cancer-related death among females. Cyclin-dependent kinase 4 and 6 inhibitors disrupt the cell cycle, inducing cellular senescence and, ultimately, apoptosis. Consequently, they have become a novel type of adjuvant therapy for the treatment of advanced or metastatic breast cancer characterised by positive hormone receptors and human epidermal growth factor receptor 2 (HER-2) negative. Methods: A systematic review was conducted, analysing the available literature on cyclin-dependent kinase 4 and 6 inhibitors published over the last five years. The aim was to evaluate the efficacy and safety of adding these drugs to the standard endocrine therapy for this pathology. Results: The combination of cyclin-dependent kinase 4 and 6 inhibitors with endocrine therapy was shown to improve progression-free survival, overall survival, and chemotherapy-free intervals in patients who received this combination therapy. Conclusions: The addition of CDK4/6 inhibitors to endocrine therapy in the treatment of advanced or metastatic breast cancer with positive hormone receptors and HER-2 negative significantly improved PFS, median survival, and chemotherapy-free intervals compared with the use of hormonal treatments alone or in combination with a placebo. Currently, CDK4/6 inhibitors are becoming established as a new standard treatment for this pathology, offering lower toxicity than chemotherapy. However, it is necessary to deeply investigate the mechanisms of treatment resistance and develop effective therapies to overcome them.
The Impact of Radiotherapy and Attenuated Chemotherapy Regimens in Older Patients with Classic Hodgkin Lymphoma: A Real-Life Study from the ReLLi Network
Authors: Cox Maria Christina , Caridi Matteo , Patirelis Alexandro , Del Giudice Ilaria , Pulsoni Alessandro , Renzi Daniela , Pelliccia Sabrina , Battistini Roberta , Anticoli Borza Paola , Annibali Ombretta , Rapisarda Vito , Alma Eleonora , Messina Nadia , D’Elia Gianna Maria , Marchesi Francesco , Cenfra Natalia , Bianchi Maria Paola , Natalino Fiammetta , Carpaneto Andrea , Assanto Giovanni Manfredi , Zizzari Anna Giulia , Maiolo Elena , De Sanctis Vitaliana , Hohaus Stefan , Rigacci Luigi
Published: February 2025

Background/Objectives: The treatment of older patients with classic Hodgkin lymphoma (eHL) remains a challenge. Methods: This study reports the first real-life survey of eHL treated with contemporary therapies in Italy. One hundred and fifty eHL patients were treated between 2013 and 2018: seventy-one were aged 60–69 years and seventy-nine ≥70 years (median age 70.5 years; range = 60–89). Curative treatments included ABVD-like regimens and attenuated approaches alternating ABVD-like regimens with non-anthracycline-containing cycles. Results: After a median follow-up of 81 months, the 5-year overall survival (OS) was 87% for patients aged 60–69 and 62% for those aged ≥70. Among 132 patients (88%) treated with curative intent, the 5-year cancer-specific survival (CSS) was 93% for the 60–69 group and 70% for the ≥70 group, while event-free survival (EFS) was 78% and 58%, respectively (p < 0.001). Multivariate analysis showed that age ≥ 70, omission of radiotherapy (RT), and failure to achieve complete remission (CR) after chemotherapy were significant predictors of OS, CSS, and EFS. Synthetic data analysis confirmed that omitting RT worsens outcomes at all stages, while reduced-dose anthracycline regimens are non-inferior to full-dose schedules. Conclusions: This survey highlights key prognostic factors and supports the optimization of future treatment strategies including targeted drugs.
Superior Survival and Lower Recurrence Outcomes with Breast-Conserving Surgery Compared to Mastectomy Following Neoadjuvant Therapy in 607 Breast Cancer Patients
Authors: Gentile Damiano , Canzian Jacopo , Barbieri Erika , Di Maria Grimaldi Simone , De Sanctis Rita , Tinterri Corrado
Published: February 2025

Backgrounds: Neoadjuvant therapy (NAT) is a cornerstone in the management of breast cancer (BC), enabling tumor downstaging and improved surgical options. Methods: This study retrospectively analyzed 607 BC patients treated with NAT and surgery at IRCCS Humanitas Research Hospital, Milan, Italy, to compare long-term oncologic outcomes of breast-conserving surgery (BCS) versus mastectomy. Patient demographics, tumor characteristics, and treatment details were analyzed using descriptive statistics, logistic regression, and Cox proportional hazards models. Results: Of the 607 patients, 54.7% underwent BCS, and 45.3% had mastectomy. BCS was associated with significantly superior 10-year outcomes compared to mastectomy, including disease-free survival (DFS, 75.2% vs. 71.1%, p = 0.001), distant DFS (75.2% vs. 71.1%, p = 0.001), overall survival (OS, 82.9% vs. 78.1%, p = 0.002), and BC-specific survival (BCSS, 87.7% vs. 83.1%, p = 0.001). Pathologic complete response (pCR) emerged as a protective factor across all endpoints, while mastectomy was independently associated with worse BCSS (HR: 2.068, 95% CI: 1.016–4.210, p = 0.045). Conclusions: Our findings demonstrate the oncologic safety and potential superiority of BCS over mastectomy in NAT-treated BC patients, highlighting the importance of individualized surgical decision-making to optimize survival outcomes.
MRI-Guided Multi-Catheter High-Dose-Rate Interstitial Brachytherapy for Uterine Cervical Cancer
Authors: Yamazaki Hideya , Masui Koji , Yoshida Ken , Suzuki Gen , Takenaka Tadashi , Yamada Kei , Kotsuma Tadayuki , Takaoka Yuji , Fujiwara Kei , Tanaka Yutaka , Tanaka Eiichi
Published: February 2025

Background/Objectives To evaluate the efficacy and safety of unique magnetic resonance imaging (MRI)-guided interstitial brachytherapy (ISBT) for locally advanced cervical cancer that is unsuitable for intracavitary brachytherapy (ICBT) or intracavitary/interstitial brachytherapy (ICISBT). Methods: We analyzed the clinical outcomes, including toxicity, of 68 previously untreated patients with cervical cancer treated between 2014 and 2024. Results: The median high-risk clinical target volume (HR-CTV) was 53.20 cc (range, 16.34–147.03 cc) with ISBT. With a median follow-up time of 37.5 months (7–115 months), the three-year local control, progression-free survival, and overall survival rates were 89.8%, 52.4%, and 70.9%, respectively. Multivariate analyses showed significant associations of histology with local control, overall treatment times, HR-CTV volume with overall survival rate, over all treatment times, and HR-CTV volume and M category with progression-free survival. Toxicity grade 3 occurred in 12 patients (17.6%) and consisted of four genitourinary (5.8%) and seven gastrointestinal (10.2%) toxicities. Conclusions: MRI-guided ISBT is an effective treatment strategy for obtaining a favorable local control rate for selected advanced diseases with an acceptable complication rate. Future research is warranted to elucidate who would be good candidates for MRI-guided ISBT.
Sentinel Lymph Node in Endometrial Hyperplasia: State of the Art and Future Perspectives
Authors: Billone Valentina , De Paola Lina , Conti Eleonora , Borsellino Letizia , Kozinszky Zoltan , Giampaolino Pierluigi , Suranyi Andrea , Della Corte Luigi , Andrisani Alessandra , Cucinella Gaspare , Marinelli Susanna , Gullo Giuseppe
Published: February 2025

Background/Objectives: Endometrial hyperplasia is a uterine pathology characterized by the abnormal proliferation of endometrial glands, resulting in an increased gland-to-stroma ratio. Complex atypical hyperplasia represents the primary precursor to endometrial cancer. Given the high risk of progression to endometrial adenocarcinoma, the accurate diagnosis and classification of endometrial hyperplasia are crucial. Since the treatment for atypical endometrial hyperplasia is the same as that for early-stage endometrial cancer (i.e., total hysterectomy and bilateral salpingo-oophorectomy), researchers have questioned whether sentinel lymph node mapping could also have a prognostic role in atypical endometrial hyperplasia. Methods: A literature search was conducted in PubMed and Scopus from 2014 to 2025. Of the 65 papers found, 31 relevant articles were selected based on inclusion criteria, focusing on sentinel lymph node staging in patients with atypical endometrial hyperplasia. This review aims to assess whether sentinel lymph node mapping can be routinely used for prognostic and therapeutic purposes in clinical practice. Results: Sentinel lymph node biopsy represents a promising diagnostic technique for patients with atypical endometrial hyperplasia, reducing the need for invasive procedures and postoperative risks. However, its application requires advanced surgical skills and access to specific technologies, raising ethical and financial concerns, while future studies could improve patient selection and the reliability of the procedure through technological innovations. Conclusions: Sentinel lymph node biopsy is a safe and effective method for staging early-stage endometrial cancer and atypical hyperplasia, with low metastasis rates, but future research should focus on identifying patients who would benefit most from this procedure, considering its costs and required expertise.
H2AJ Is a Direct Androgen Receptor Target Gene That Regulates Androgen-Induced Cellular Senescence and Inhibits Mesenchymal Markers in Prostate Cancer Cells
Authors: Heidari Horestani Mehdi , Atri Roozbahani Golnaz , Baniahmad Aria
Published: February 2025

Background: Prostate cancer (PCa) is a significant public health issue, particularly in developed countries. The androgen receptor (AR) plays a key role in regulating both the normal development and the proliferation of PCa. Bipolar androgen therapy, which involves treatment with supraphysiological androgen levels (SALs), has been shown to inhibit PCa growth. SAL induces cellular senescence in AR-positive PCa cell lines, human tumor samples, and xenografted mouse models. Methods: Transcriptome and chromatin immunoprecipitation (ChIP)-seq analysis, ChIP-qPCR, knockdown (KD), overexpression (OE), qRT-PCR, immunodetection, in situ histochemistry. Results: Here, we show using ChIP-seq and RNA-seq that H2AJ, a variant of the canonical histone H2A, is a direct target gene of AR that regulates cellular senescence and the formation of senescence-associated heterochromatin foci (SAHF). Accordingly, bioinformatic analyses reveal a large overlap of the H2AJ transcriptome with the cellular senescence score of PCa. Analyzing a large cohort of patient samples, the expression of H2AJ is higher in tumor samples compared to normal samples suggesting growth-promoting activity. Interestingly, however, the expression is diminished in metastatic tumor samples, indicating that H2AJ inhibits the mesenchymal transition in PCa cells. Functionally, the KD of H2AJ inhibits growth, whereas the H2AJ overexpression promotes cell growth. Furthermore, these data suggest that H2AJ inhibits the expression of mesenchymal markers, in agreement with the low expression of H2AJ in metastatic forms of tumors from patient cohorts. Conclusion:H2AJ is a direct positively AR-regulated target gene induced by SALs that regulates cellular senescence, promotes growth, and inhibits the expression of mesenchymal markers.
The Feasibility and Validity of Home Spirometry for People with Cystic Fibrosis: Is It Comparable to Spirometry in the Clinic?
Authors: Sopiadou Athina , Gioulvanidou Maria , Kogias Christos , Chrysochoou Elissavet-Anna , Kalaitzopoulou Ioustini , Hatziagorou Elpis
Published: February 2025

Background/Objectives: Home spirometry allows people with cystic fibrosis (CF) to monitor their lung function from home. However, there are concerns about its feasibility and validity compared to traditional clinic spirometry. The aim of this study was to evaluate the feasibility and validity of telehealth spirometry for patients with CF living in a regional setting. Methods: This retrospective study included forty-eight people with cystic fibrosis (pwCF) aged 6–33 years. Participants performed home spirometry using a portable flow sensor spirometer over a one-year period, without supervision. Spirometry readings from portable spirometers were compared with the nearest in-clinic spirometry using the intra-correlation coefficient (ICC) and Bland–Altman plots. Data were collected over a period of one year, with regular intervals of measurements. Results: In 427 of the 877 (48.6%) attempted sessions, successful spirometry at home was recorded. Although we showed good reliability between at-home and in-clinic measurements using the Bland–Altman plots and intraclass correlation co-efficient (ICC) (values ranged from 0.76 to 0.88), analysis of the 117 pairs of at-home and in-clinic spirometries showed that mean differences of forced expiratory volume in the 1st sec (FEV1) and forced vital capacity (FVC) obtained at home (both in liter and z-score) had, on average, lower values than the corresponding values at the clinic. Conclusions: Home-based telehealth spirometry is feasible among pwCF and provides advantages, especially for those from remote or secluded areas. However, lower values in FVC and FEV1 obtained through home spirometry should not be used interchangeably with clinic values.
Visual Cortical Processing in Children with Early Bilateral Cochlear Implants: A VEP Analysis
Authors: Badarni-Zahalka Ola , Dakwar-Kawar Ornella , Adelman Cahtia , Khoury-Shoufani Salma , Attias Josef
Published: February 2025

Background/Objectives: Cochlear implantation is the primary treatment for severe-to-profound hearing loss, yet outcomes vary significantly among recipients. While visual–auditory cross-modal reorganization has been identified as a contributing factor to this variability, its impact in early-implanted children remains unclear. To address this knowledge gap, we investigated visual processing and its relationship with auditory outcomes in children who received early bilateral cochlear implants. Methods: To examine potential cross-modal reorganization, we recorded visual evoked potentials (VEPs) in response to pattern-reversal stimuli in 25 children with cochlear implants (CIs) (mean implantation age: 1.44 years) and 28 age-matched normal-hearing (NH) controls. Analysis focused on both the occipital region of interest (ROI: O1, OZ, and O2 electrode sites) and right temporal ROI, examining VEP components and their correlation with speech perception outcomes. Results: Unlike previous studies in later-implanted children, the overall occipital ROI showed no significant differences between groups. However, the left occipital electrode (O1) revealed reduced P1 amplitudes and delayed N1 latencies in CI users. Importantly, O1 N1 latency negatively correlated with speech-in-noise performance (r = −0.318; p = 0.02). The right temporal region showed no significant differences in VEP N1 between groups and no correlation with speech performance in CI users. Conclusions: Early bilateral cochlear implantation appears to preserve global visual processing, suggesting minimal maladaptive reorganization. However, subtle alterations in left occipital visual processing may influence auditory outcomes, highlighting the importance of early intervention and the complex nature of sensory integration in this population.
Theory of Mind, Self-Perceptions, and Peer Popularity in Middle Childhood and Early Adolescence
Authors: Osterhaus Christopher , D’Urso Giulio , Koerber Susanne , Bosacki Sandra L.
Published: February 2025

Background/Objectives: Peer popularity is often associated with children’s and adolescents’ Theory of Mind (ToM), as well as with self-perceptions. This paper describes two cross-sectional studies that investigate the individual differences and associations among peer popularity, ToM, and self-perceptions (i.e., several dimensions of self-esteem, including global, academic, or physical self-esteem). Methods: Study 1 involved 229 German children aged 5 to 8 years. Study 2 involved 127 Canadian adolescents aged 10 to 12 years. Participants in both studies completed measures of ToM, self-perceptions, and peer popularity. Results: Study 1 found significant associations among children’s ToM and self-perceptions (their global self-esteem) but found no associations with children’s peer popularity. Study 2 revealed significant positive associations between adolescents’ ToM and their peer popularity, as well as between ToM and self-perceptions (in particular, adolescents’ academic self-esteem). Conclusions: Our findings support the view that ToM matters for children’s and young adolescents’ self-perceptions and plays an increasingly important role in their everyday social life. Curricular implications for ToM, identity formation (self-perceptions), and peer relations are discussed.