bluuebunny/crossref_metadata_2025 huggingface dataset:
Personal Characteristics of Students with Different Indicators Based on the Results of Psychological Measurement of Lies and Mendacity
Authors:   Ufa University of Science and Technology, Gainullina Svetlana M. , Bashkatov Sergey A. ,   Ufa University of Science and Technology
Published: December 2024

The article discusses the concepts of lies and mendacity, focusing on their negative social meaning, and paying attention to socially approved and disapproved types of lies. A lie is understood as a fact of conscious, deliberate distortion of the truth, expressed in words or actions, and mendacity is a personality trait that tends to emotionally charged acts of silence and distortion of relevant information. The article discusses the contradiction between the insufficient study of the phenomenon of lies among students, which manifests itself as a personal trait, and the demand for adequately educated specialists in society in accordance with the Federal Law “On Education in the Russian Federation”. It follows from this that there is a socially significant problem of diagnosing mendacity with determining the scale of its spread in society. The work puts forward a hypothesis about the existence of differences in the severity of the characteristics of personal traits in students with high and low rates according to the results of psychodiagnostics of lies and mendacity. Therefore, the aim of the study was a comparative study of the personal characteristics of university students with high and low rates of lying and mendacity, which made it possible to describe these characteristics in the form of corresponding generalized personality portraits.
Human actions and the philosophy of pluralism in Islam
Authors: Jemal Bassem , Smida Nizar , Zaghloul Sabrin , Ebead Said Aly
Published: December 2024

This paper aims to explore the issue of human actions in Islamic thought, focusing on the various stances regarding determinism, free will, and the intermediate position between them. This topic is linked to an ontological question: What are the limits of human responsibility for their actions? Our view is that the different positions on human actions reflect the presence of pluralism within Islamic thought, specifically through the discipline of Islamic theology (kalām). The difference in positions about the human actions within the science of theology expresses the vitality of Islamic thought and its appreciation of the right to differ between theological schools such as the Mu’tazila, Shi’a, and Sunnis, especially in an era dominated by the rationalism of Mu’tazila thought influenced by the methodology of Greek philosophical thought. This difference was recognized, especially in the third and fourth centuries AH/ninth and tenth centuries AD. We consider this difference in discussing the subject of the human actions as evidence of the principle of pluralism in Islam, which allows us to speak of the existence of a significant degree of intellectual tolerance, a subject that has not been studied to date. The prevailing view in studies today on this subject is that the theological groups accuse each other of unbelief, which is a mistaken position, because the saying of unbelief did not appear until after the fourth century AH/tenth century AD when transmission, reliability, and conservatism prevailed in Islamic thought. In addressing this issue, we examine three major stances on human actions as represented by three theological schools: The Mu’tazila (who advocated free will in human actions), the Jabriya (who advocated determinism in human actions), and the Ash’ariyya (who upheld the theory of acquisition). Once this is accomplished, we will explore the philosophy of pluralism in Islam through the lens of kalām. The most important conclusion we reached is that the debate on human actions opened, by the mid-4th century AH/10th century CE, an intellectual horizon that laid the foundations for pluralism in Islamic theological discussions. However, this horizon was soon closed due to various factors, which we have discussed throughout the paper.
Empowering environmental sustainability: Islamic values and their synergy with the SDGs
Authors: Aboukhousa Heba Ahmed , Hassan Mohamed Abdelgalil , Badran Mohamed Abouelfadl
Published: December 2024

This research delves into the connection between Islamic beliefs and sustainability by showcasing how values drawn from the Quran and Sunnah offer a distinctive and long-lasting structure for sustainable progress. The teachings of Islam promote equilibrium, fairness and environmental guardianship showcasing their harmony with the Sustainable Development Goals (SDGs) set by the United Nations. Through combining spiritual aspects this study examines how Islamic values—, like taking care of the environment ensuring fair resource allocation and practicing moderation—can tackle present day global issues. The study uses an approach to examine important Islamic texts and their interpretations in order to gain understanding of how these values can be applied in various aspects such as social issues and the environment or economy department effectively. The results show that Islamic principles not work well with contemporary sustainability methods but also provide a unique ethical and spiritual viewpoint that boosts sustainability efforts in the long run. In contrast to systems of thought Islamic teachings stress the need for balance between advancement and ethical responsibility resulting in advantages, for current and future generations alike. This research adds to the conversation about sustainability by showing how Islamic principles offer a holistic framework, for promoting a harmonious and moral way of progress while underscoring their significance in addressing urgent worldwide challenges.
Driving marketing performance through market-based innovation capability: Resource advantage theory of competition
Authors: Situmorang Tumpal P. , Tarigan Miska Irani , Margery Errie , Lusiah Lusiah , Ardyan Elia
Published: December 2024

Using the Resource Advantage Theory approach, this research aims to examine the gap between entrepreneurial opportunities and marketing performance, with market-based innovation capability acting as a mediating variable. The data collection method used non-probability sampling with a purposive sampling technique. The data that was eligible to be processed were 250 respondents. Hypothesis testing was used using the AMOS application. The research results show that market-based innovation capability can improve marketing performance as a mediating variable. In addition, market penetration strength can also improve marketing performance. As a strategic variable, market-based innovation capability (MBIC) converts entrepreneurial opportunities into competitive advantages relevant to market needs. In addition, business actors become more adaptive and responsive to market dynamics, increasing competitiveness sustainably. MBIC, rooted in the Resource Advantage Theory of competition, contributes to developing market-based innovation strategies in the UMKM sector.
New entrants joining the industry, what skill do they need?
Authors: Dwidienawati Diena , Istiani Cornelia , Rahman Rizqi
Published: December 2024

This study investigates the critical skills required for new entrants to succeed in today’s workforce, focusing on both soft and hard skills. Through a comprehensive systematic review of existing literature using the PRISMA method, we analyzed 12 selected journals from an initial pool of 870, sourced from major databases such as Scopus, Science Direct, and Emerald Insight. Our research uncovers four key insights. First, we provide a clear and precise definition of employability skills, establishing the foundation for what competencies are essential for workforce readiness. Second, our analysis identifies a distinct separation between soft and hard skills, with soft skills such as communication, problem-solving, teamwork, ethics, and leadership being universally critical across all industries. Third, while soft skills have broad applicability, hard skills are highly specialized, varying significantly depending on industry and job role. To simplify their understanding and application, we categorized these hard skills into specific groups. Finally, the study highlights the urgent need for further empirical research to validate these findings in real-world settings, as the current conclusions are drawn solely from literature. This potential gap between academic preparation and industry expectations underscores the necessity for ongoing collaboration between educational institutions and employers, which will be a primary focus of our future research.
Patient safety culture and hospital performance: Patient safety outcomes in the traditional Chinese medicine public hospitals in Sichuan, China
Authors: Zhang Na , Ali Anees Janee , Gao Peiyang
Published: December 2024

Hospital performance possesses strategic significance in achieving an essential completive advantage for the public hospitals. This study aimed to examine the relationship between patient safety culture (PSC) and the performance of traditional Chinese medicine (TCM) public hospitals in Sichuan, China. To address the research purpose, this study analyses the hospital performance and Patient safety culture in traditional Chinese medicine public hospital in China. We examine the propose model by analyzing cross-sectional survey data from 194 clinical directors at 194 public traditional Chinese medicine hospitals using the Partial least squares structural equation model in Smart PLS 4.0. This study provides predictive evidence that PSC in unit management and management support can lead to better patient safety outcomes. The results revealed patient safety outcomes significantly and positively effects of patient safety related to unit management and management support on overall hospital performance (p-value: 0.000–0.003).
Deep learning-based intraoperative guidance system for anatomical identification in laparoscopic surgery: A review
Authors: Khojah Balsam , Enani Ghada , Malibari Areej , Alhalabi Wadee , Sabbagh Abdulrahman
Published: December 2024

The power of Artificial Intelligence (AI) combined with the surgeons’ expertise leads to breakthroughs in surgical care, bringing new hope to patients. Utilizing deep learning-based computer vision techniques in surgical procedures will enhance the healthcare industry. Laparoscopic surgery holds excellent potential for computer vision due to the abundance of real-time laparoscopic recordings captured by digital cameras containing significant unexplored information. Furthermore, with computing power resources becoming increasingly accessible and Machine Learning methods expanding across various industries, the potential for AI in healthcare is vast. There are several objectives of AI’s contribution to laparoscopic surgery; one is an image guidance system to identify anatomical structures in real-time. However, few studies are concerned with intraoperative anatomy recognition in laparoscopic surgery. This study provides a comprehensive review of the current state-of-the-art semantic segmentation techniques, which can guide surgeons during laparoscopic procedures by identifying specific anatomical structures for dissection or avoiding hazardous areas. This review aims to enhance research in AI for surgery to guide innovations towards more successful experiments that can be applied in real-world clinical settings. This AI contribution could revolutionize the field of laparoscopic surgery and improve patient outcomes.
Regional head leadership model in mitigating climate change in Papua
Authors: Fitriani Fitriani , Tjilen Alexander Phuk , Betaubun Martha , Suhendra Fajar A.
Published: December 2024

This research aims to build an appropriate leadership model for regional heads in mitigating disasters due to climate change that is occurring in Papua. Papua Island is one of the islands that is included in disaster-prone areas, namely earthquakes, flash floods, tidal floods and landslides. This disaster occurred due to Papua’s geological conditions in the form of activity on the Indo-Australian plate (southern part) and the Pacific plate (north-eastern part). Exploitation of nature carried out by companies and communities themselves in a particular area has an impact on the balance of the natural ecosystem. So far, disaster management has only focused on emergency response. Aid movements coordinated by ordinary people also focus more on raising aid for emergency situations. In fact, comprehensive disaster management includes before, during and after a disaster occurs. So a combination of leadership styles is needed that must be carried out at each phase of a disaster so that the right model can be produced. The results of this research found that the leadership model of regional heads in mitigating climate change in Papua is in accordance with the disaster management cycle with leadership styles, and traditional Papuan leadership styles. This combination is called a collaborative leadership model for disaster management in Papua. It is hoped that by implementing this model, climate change disaster mitigation can be effective.
A systematic literature review of personification communication of AI anchor
Authors: Liu Xingyu , Zawawi Julia Wirza Mohd , Ghazali Akmar Hayati Ahmad
Published: December 2024

As a product of the integration of AI technology and media, the debate surrounding the potential replacement of human anchors by AI anchors has persisted since their inception. This paper conducts a systematic literature review of research on AI anchors in China from 2000 to 2023, grounded in theories of personalization within the field of communication studies. The analysis aims to compare the differences in personalized representation between AI anchors and human anchors, summarizing the advancements, challenges, and future directions of AI anchor communication based on personality. This contribution seeks to enhance the existing knowledge base surrounding AI anchor research.
The role of education and life expectancy in improving the quality of human resources in Indonesia, Malaysia, and Thailand
Authors: Tantowi Ahmad
Published: December 2024

In the human and economic development context, this study examines the relationship between human capital, life expectancy, labor force participation rate, and education level in Indonesia, Malaysia, and Thailand. The World Bank’s 2001–2021 data are examined using a panel vector autoregressive model. The findings demonstrate the substantial influence of health expenditure from the prior period on present health expenditure. Though not significantly different, life expectancy and education levels from earlier periods also impact present health spending. A slight positive correlation exists between prior labor force involvement and present healthcare costs. An increase in current health expenditure supports an increase in life expectancy. Health expenditure in the previous period had a significant positive effect on education, although insignificant. Life expectancy in the previous period harms current education but is also insignificant. Education in the previous period significantly positively affects current education, indicating a sustained impact of education investment. Labor force participation in the previous period also positively affected education, although not significantly. The prior period’s health spending, life expectancy, and educational attainment impact the current labor force participation rate. The length of life has a significant favorable impact on entering the labor sector. Currently being in the job field has a good correlation with prior education as well. These findings support that higher education levels lead to higher labor force participation rates. Life expectancy, health care costs, education level, and prior work experience all influence current life expectancy. While prior life expectancy significantly influences current life expectancy, health expenditures have a negligible negative impact. Prior education positively impacts life expectancy but negatively impacts prior labor force engagement. These results reject the hypothesis that increasing life expectancy causes current health expenditure to increase.
A automutilação induzida pelas redes sociais levanta questão crucial: pode ser considerada crime contra à vida?
Authors: Daroz Guilherme , Serafini Lucas
Published: December 2024

A Constituição Federal estabelece que somente os crimes contra à vida (homicídio, infanticídio, aborto e induzimento, instigação ou auxílio ao suicídio) serão julgados pelo Tribunal do Júri, ficando os demais sob o crivo de juízes togados. Todavia, o Pacote Anticrime inseriu, no artigo 122 do Código Penal, além do induzimento, instigação e auxílio ao suicídio, à automutilação. Logo, o objetivo geral do presente trabalho é, justamente, esclarecer se a inclusão da automutilação como conduta criminosa pode ser legitimamente considerada um crime contra a vida mesmo que a morte da vítima não seja o objetivo do agente. Os objetivos específicos incluem a síntese do desenvolvimento da legislação penal em relação aos crimes contra à vida, o exame do incentivo à automutilação em ambientes virtuais e, por fim, as controvérsias do artigo 122 do Código Penal com o advento da Lei n. 13.968/2019. O problema central abordado é se a adequação da inclusão da automutilação como conduta criminosa no artigo 122 do Código Penal é acertada. Metodologicamente, a pesquisa utiliza uma abordagem qualitativa, com análise documental e revisão bibliográfica sobre a legislação penal e casos concretos. Os resultados indicam que a nova redação do artigo 122 do Código Penal, na verdade, constitui uma extensão excessiva dos crimes contra a vida.
Effects of hydropriming, halopriming, and hormopriming seed treatments on the subsequent salt stress tolerance of quinoa (Chenopodium quinoa Willd.) in Algeria
Authors: Lallouche Bahia , Hadj Kouider Boubakr
Published: December 2024

Quinoa, a valuable halophyte, plays a crucial role in ensuring food and nutritional security under climate change. However, high salinity levels can hinder seed germination and subsequent plant growth. The current study aimed to enhance the salinity tolerance of pre-optimized quinoa seeds through various priming techniques: hydropriming (distilled water, 25 °C, 12 hours), halopriming (75 mM CaCl₂, KNO₃, and MgSO₄ at 25 °C for 12 hours), and hormopriming with gibberellic acid (GA₃ 25 mM, 25 °C, 12 hours). The seed germination parameters: germination percentage, relative salt tolerance and salt tolerance index, as well as growth parameters of seedlings as plant height, leaf number, plant fresh weight, root length, root fresh weight, plant height/root length ratio, plant height stress tolerance index, root length stress tolerance index, and chlorophyll content, were evaluated in Giza 02 and Q102 Chenopodium quinoa varieties. Halopriming with KNO₃, hormopriming with GA₃, followed by halopriming with MgSO₄, effectively mitigated the negative impacts of salinity. This priming approach shows promise for enhancing quinoa crop resilience in saline soils and could serve as a model for other salt-sensitive crops.
FIRST YEAR EXPERIENCE IN TOTAL ENDOSCOPIC MITRAL VALVE REPAIR WITH THREE-DIMENSIONAL VIDEO-ASSISTED TECHNOLOGY
Authors: Fiorentino M. , Mikus E. , Costantino A. , Sangiorgi D. , Tenti E. , Tremoli E. , Savini C.
Published: December 2024

Background:

The minimally invasive approach is the gold standard for mitral valve surgery. Advancements in technology are crucial for enhancing surgical outcomes and reducing invasiveness. We present our experience with total endoscopic mitral valve repair.

Methods:

From July 2023 to June 2024, 61 patients underwent total endoscopic mitral valve repair with three-dimensional video-assisted technology (EinsteinVision® 3.0, B. Braun, Aesculap AG, Tuttlingen, Germany). Median age was 61 years (53-68) and 62.3% were males. Median EuroSCORE II was 0.76 (0.56-1.14).

Results:

The majority of patients were in NYHA class II and 42.6% had pulmonary hypertension. Seven (11.5%) patients underwent associate procedures. No conversion to full sternotomy was necessary. In six (9.84%) patients with left coronary dominance we used indocyanine green fluorescence for a real-time analysis of the course of the circumflex artery during surgery. No perioperative acute myocardial infarction or stroke was observed. No 30- day mortality was reported, while one patient (1.6%) suffered from sepsis and multi-organ failure leading to in-hospital death. Atrial fibrillation was observed in 14 patients (23%) and 1 patient (1.6%) required Pace-maker implantation. We observed 2 (3.3%) re-thoracotomies for bleeding and 41% of patients required blood transfusions. Median ventilation time was 5 hours (4-6). Median intensive care unit and in-hospital stay were 2 (2-2) and 7 (7-9) days.

Conclusions:

Total endoscopic mitral valve surgery is safe and feasible with good postoperative outcomes. Moreover, the possibility to use indocyanine green fluorescence to detect the course of the circumflex artery assist surgeons, reducing the risk of perioperative myocardial infarction.
IS THE SURGICAL OPTION TOO CHALLENGING IN CASE OF MULTIVALVULAR INFECTIVE ENDOCARDITIS?
Authors: Kushta E. , Seminari E. , Amoroso F. , Laerta S. , Sangaletti G. , De Gregori D. , Villano V. A. , Pucci F. , Pelenghi S. , Totaro P.
Published: December 2024

Background:

Double-valve infective endocarditis (DVIE) accounts for 15–20% of all endocarditis. The mechanisms of extension of the infection differ as in left-sided DVIE, there is often a primary focus in aortic valve which then involves the mitral valve. On other hands bilateral endocarditis is often the consequence of the infection’s haematogenous spread. Therapeutical strategies and managements of DVIE are still debated being the surgical option somewhat challenging. Here we report our single center experience in managements of DVIE.

Methods and Materials:

Our Endocarditis Registry STEADY, include patients admitted with a diagnosis of IE from 2009 to 2024. Data were retrospectively analyzed focusing on DVIE. All cases were independently evaluated by an infectious disease specialist, a cardiologist and a cardiac surgeon. Variables associated with in-hospital and 1-year mortality were compared between two groups: patients with surgical treatment (STG) and patients with conservative treatment (MTG).

Results:

Out of 398 patients enrolled in STEADY, 63 (15.8%) had a diagnosis of DVIE. 51 (81%) pts had left side endocarditis, 12 (19%) bilateral endocarditis. 39 (62%) were included in STG group; 24(38%) in MTG. Out of 39 patients of the STG, 18(46%) received urgent surgery. The most frequent pathogen was Streptococcus spp. in both groups (38% in MTG and 31% in STG), followed by Staphylococcus spp. (21% and 23%). Overall 1-year mortality was 19% in STG and 46% on MTG (p=0,047).

Conclusions:

Patients with DVIE still carry high risk of poor outcomes. To improve the prognosis, patients at higher risk for complications need to be identified and an aggressive therapeutic approach could probably be beneficial.
TWO DECADES OF MITRAL VALVE REPAIR IN PATIENTS WITH SMALL CALCIFICATIONS: LONG-TERM OUTCOMES AND PROGNOSTIC FACTORS
Authors: Giambuzzi I. , Bonalumi G. , Maccarana A. , Naliato M. , Alamanni F. , Zanobini M.
Published: December 2024

Introduction:

Mitral valve calcifications increase the complexity of valvular repair. Major calcifications have a known impact on the outcomes, while minor calcifications are less studied. We aim to define the role of minor mitral valve calcification on long term results of valvular repair.

Methods:

Retrospective study on patients who underwent mitral valve repair between 2001 and 2010. Patients who had a degenerative mitral valve disease, minor calcification at pre-operative echocardiogram confirmed at surgical inspection and no employment of decalcification techniques were included. A control group was selected using a 1:2 match using propensity score. Kaplan-Meier curves estimated long term survival and mitral valve events (recurrent mitral regurgitation>2+, mitral valve reintervention, endocarditis and cardiac death. Cox- model estimated the unadjusted and adjusted hazard ratio.

Results:

A total of 1052 patients underwent mitral valve repair and 42(3.99%) met the inclusion criteria. 76 patients were selected to form the Control Group. The only significant preoperative difference among the two groups was the presence of coronaropathy, which was more common in the group with mitral calcification (p-value 0.0283). At follow-up, 30 patients developed the study endpoint (Control Group: n=13, 17.1%; Group with mitral calcification: n=17, 40.5%; p=0.0053). The 19-year survival by Kaplan–Meier analysis showed that mitral valve calcification is associated with a worse survival (HR: 2.538 [1.520-4.238], p=0.0004), even after adjusting for preoperative coronary disease.

Conclusions:

Minor mitral calcifications are associated with a worse outcome, even after adjusting for preoperative coronary disease. Minor calcification should be taken into account when planning surgery and follow up.
FU.T.U.RE. STUDY (FUNCTIONAL TRICUSPID UPDATE STUDY ON RECURRENCE)
Authors: Mazzenga G. , Grandinetti M. , Chiariello G. A. , Nesta M. , Cammertoni F. , Calabrese M. , Testa N. , Montesano M. , Pavone N. , Bruno P. , Massetti M.
Published: December 2024

Background and Aim:

In current clinical practice, tricuspid valve surgery is often overlooked and lacks adequate standardization. This leads to a considerable risk of tricuspid regurgitation recurrence after mitral-tricuspid surgery, significantly affecting patient outcomes. Our study investigates the predictive role of demographic, clinical, echocardiographic, and surgical factors in tricuspid regurgitation recurrence to help address this critical prognostic challenge.

Methods:

This single-center, ambispective, observational study included 178 patients who underwent mitral-tricuspid surgery at our institution between January 2012 and June 2019. Follow-up data were collected at an average of 6 years post-intervention. We conducted a univariable analysis of major demographic, clinical, echocardiographic, and surgical factors. Significant and suggestive predictors were integrated into a multivariable model, from which we developed a nomogram as a predictive tool.

Results:

Univariable analysis revealed several parameters significantly associated with an increased risk of recurrent tricuspid regurgitation. Following multivariable analysis, suture ring-less repair emerged as an independent predictor of recurrence, linked with a 3.7-fold increased recurrence risk. All factors included in the multivariable model were subsequently incorporated into a scoring system designed to predict 5-year recurrence-free survival before surgery.

Conclusions:

Our innovative scoring system’s aim is to contribute to building in the “real world” a uniform and patient-tailored perspective for functional tricuspid valve regurgitation surgery. This knowledge could help improving patient care as well as contributing to the advancement of surgical strategies in this critical area of surgery.
ENDOCARDITIS TEAM? DESIGNING AN ORIGINAL AND TAILORED CLINICAL PATHWAY
Authors: Pavone N. , Cammertoni F. , Bruno P. , Calabrese M. , Grandinetti M. , D’acierno E. M. , Cutrone G. , Lombardo A. , Scoppettuolo G. , Massetti M.
Published: December 2024

Background and Aim:

Incidence of infective endocarditis (IE) is worryingly increasing. Clinical care of IE is often fragmented resulting in delayed diagnosis and suboptimal management. According to recent guidelines, in 2023 we created the Endocarditis Team (ET), providing the most appropriate diagnostic tests and treatment options through a dedicated clinical pathway (CP). In this study we compare clinical and management outcomes of patients treated before and after the CP.

Methods:

We prospectively collected data from surgically treated patients, at our institution, after the CP implementation (post-CP group) and compared them with data from the previous 3 years (pre- CP group). We analyzed baseline characteristics such as clinical presentation, disease complexity, in-hospital mortality and management outcomes such as ICU stay and post- operative and total in-hospital length of stay.

Results:

Fifty-six patients underwent surgery for IE during the Post-CP group (2023-2024), compared to 82 patients in the Pre-CP group (2020-2022). Clinical presentation was similar in the two groups even though patients in the Post-CP group had higher numbers of pseudoaneurysms, abscesses and redo procedures. STS-PROMM was higher in the Post-CP group (33.4 ± 7.5 vs 29.3 ± 8.7, p<0.01). No difference for in-hospital mortality was found (7.3% vs 8.9%). Length of ICU (4 vs 6 days) and post-operative in-hospital stay (30.5 vs 32 days) increased in the post-CP group. Total in-hospital stay showed a two-day reduction in the post-CP group (43 vs 41 days).

Conclusions:

Although some controversies still exist, we believe that our ET had a positive impact on healthcare of patients with IE.
MEDICAL THERAPY IN TYPE B AORTIC INTRAMURAL HEMATOMA: A VERY RECENT SINGLE-CENTER EXPERIENCE
Authors: Calanni Macchio C. , Damiano A. , Milione A. , Mileo E. , Lonardo E. , Hamameh S. H. B. , Pisapia G. , Di Tommaso L.
Published: December 2024

Background and Aim:

Type B intramural hematoma (TBIMH) management is unclear. Recent guidelines recommend optimal medical therapy (OMT) for stable cases without high-risk signs, closely monitoring evolution with regular imaging follow-ups. OMT and elective TEVAR are suggested for high-risk patients and emergent TEVAR for complicated IMH. In this single-center retrospective series, we report our experience of OMT failure.

Methods:

From January to June 2024, 4 patients were admitted at our department diagnosed with TBIMH. All of them, without high-risk features or complications, received OMT until unexpected complications occurred, meeting criteria for endovascular repair.

Results:

One patient underwent surgical treatment after 12 days of OMT due to worsening neurological status and CT evidence of focal contrast enhancements. The remaining patients, initially discharged on medical treatment, developed Type B dissection progression with new symptoms or CT scan worsening after one month. We performed TEVAR for all of them. Post-operative period was uneventful and early follow-up outcomes are good, except for the requiring of rehabilitation for the patient with neurological complications.

Conclusions:

OMT and observation remains the treatment main-stay for patients with TBIMH. Nevertheless, delayed endovascular repair, subsequent to OMT failure, cannot solve the following complications or sequelae or even death. The question remains: is medical approach safe? Which is the ideal frequency of CT scan control? Further studies, long-term follow-up and adequate sample size may answer.
MELD AND MELD-BASED SCORE AS POTENTIAL EARLY MARKER OF VISCERAL MALPERFUSION IN PATIENTS WITH ACUTE AORTIC DISSECTION
Authors: Totaro P. , Kushta E. , Musto M. , Amoroso F. , Pelenghi S.
Published: December 2024

Introduction:

Acute aortic dissection of the ascending aorta carries a very high early mortality up to 1%-2% /h in untreated symptomatic patients. Immediate surgical treatment, therefore, has been considered so far the gold standard in such conditions. The relevance of preoperative peripheral malperfusion in postoperative outcome, however has been recently pointed out suggesting the option for a primary stabilization of peripheral (especially visceral) malperfusion. The diagnosis of clinically significant visceral malperfusion, however, is still unclear and often underdiagnosed. Here we evaluate the potential of using MELD and MELD- based scores, as marker of significant malperfusion, in preoperative prediction of postoperative in-hospital mortality

Materials and Methods:

160 patients undergoing surgical repair of acute aortic dissection over a 10-year period with a complete preoperative blood analysis recorded in our system were retrospectively enrolled in this study. Preoperative MELD (Model for End stage Liver Disease) a simple preoperative score, calculated from 3 biochemical variable, and MELD-based scores were calculated and a potential correlation with postoperative mortality was analysed.

Results:

Overall In-hospital Mortality was 16,8%. MELD Score ranged between 3 and 26. Overall MELD score was significantly higher in patients who died postoperatively, especially in male patients. Furthermore Meld >8 was predictive risk factor for in-hospital postoperative mortality. MELD-based scores were higher in death patients without statistical significance.

Discussion:

In conclusion MELD score could represent a simple method to predict postoperative mortality in case of acute aortic syndrome, detecting early signs of visceral malperfusion, potentially amenable of an “abdomen first” treatment.
EXTENSIVE VERSUS CONVENTIONAL TREATMENT FOR TYPE A AORTIC DISSECTION: PRELIMINARY RESULTS OF ASCYRUS MEDICAL DISSECTION STENT
Authors: Segreto A. , Pisano C. , Torre S. , Castrovinci S. , Amoncelli E. , Territo S. , Argano V.
Published: December 2024

Background and Aim:

Acute type A aortic dissection (ATAAD) is a critical condition typically managed with high risks extensive surgical interventions, such as open aortic repair, especially for patients with complex anatomies or comorbidities. AMDS offers a less invasive, hybrid approach that stabilizes the true lumen and promotes aortic remodeling, potentially reducing the need for more complex surgery and rate of reintervention. This study compares preliminary outcomes between patients treated with AMDS in Zone 0 and those undergoing conventional surgical treatment such as Ascending aortic replacement ± hemiarch.

Methods:

Between August 2019 and August 2024 we treated 70 patients for ATAAD. Excluding 54 patients treated with arch replacement and reimplantation of epiaortic vessels, this retrospective analysis compares 8 patients treated with AMDS (AMDS group) and 8 patients treated with ascending aortic replacement ± hemiarch (control group). We collected data on demographics, clinical characteristics, procedural details, and postoperative outcomes.

Results:

The median age was 57 years for the AMDS group and 66.5 years for the control group. Although there was no significant difference in procedural times and in-hospital mortality between the groups we found a significant difference in aortic remodeling in the AMDS group on follow-up CT scans with complete or partial false lumen thrombosis.

Conclusions:

AMDS appears to be a promising alternative to conventional surgery for ATAAD, showing improved aortic remodeling despite similar in-hospital mortality rates. However, further studies with larger sample sizes and longer follow-up are needed to confirm the long-term safety and efficacy of AMDS in ATAAD management.
NON-ANATOMICAL DEBRANCH OF THE SUPRA-AORTIC VESSELS DURING COMPLEX AORTIC SURGERY: EARLY AND MID-TERM RESULTS
Authors: Faggi A. , Del Forno B. , Rinaldi E. , Pallotta R. , Azzola Guicciardi N. , Verzini A. , De Bonis M. , Alfieri O. , Castiglioni A. , Maisano F.
Published: December 2024

Background:

Several surgical techniques have been proposed over the years to treat aortic arch pathology, confirming the complexity of this disease. Our conventional approach is the «debranch-first technique» combined to frozen elephant trunk procedure (FET). In addition, an extra- anatomical bypass between the left common carotid artery and subclavian artery (CSB) is performed prior the main surgery. The aim of this study was to investigate the early and midterm results of this two-step-based procedure.

Methods:

Between 2012 and 2024, 87 patients underwent FET. The main indications were degenerative aortic aneurysm (26%), chronic aortic dissection (66.6%) and acute aortic syndrome (7%). REDO Aortic Surgery was performed in 61 patients (70%). EuroSCORE II and STS score were 5.85% and 1.93%, respectively. 78 patients (90%) were submitted CSB, prior to FET procedure. Both axillary arteries were cannulated; debranching first technique was performed during the cooling of the patient and - after the aortic arch replacement by a custom-made graft – at last sutured to the aortic graft.

Results:

30-Days Mortality occurred in 12 patients (14%). 10 patients had a stroke (fatal for 2 patients). 5.8% suffered from a temporary spinal cord ischemia. The estimated 5-year overall survival was 64%. 23 patients were submitted to a second-step endovascular procedures (41%).

Conclusions:

The debranch – first technique with non- anatomical sovraortic vessels reimplantation and previous CSB represents a safe and effective method to address this complex pathology. A longer follow up is needed to confirm the goodness of this approach.
DOES ZONE 2 OR ZONE 3 PRODUCE BETTER OUTCOMES FOR TOTAL AORTIC REPLACEMENT WITH THE FROZEN ELEPHANT TRUNK TECHNIQUE? A METANALYSIS
Authors: Ahmadi-Hadad A. , Milione A. , Moldon H. J. , Soltaniardestani S. , Damiano A. , Calanni C. , Pacciolla A. , Lonardo E. , Comentale G. , Pilato E.
Published: December 2024

Backgroung:

Frozen elephant trunk (FET) technique is a treatment for various pathologies of the thoracic aorta. The distal aortic anastomosis may be made at various points along the aortic arch, most often zone 3 but it is hypothesized that zone 2 may be safer. This meta-analysis aimed to compare short-term mortality and incidence of various adverse effects for FET procedures which used aortic zone 2 or aortic zone 3 as a starting point.

Methods:

Pubmed, Medline, and Embase were searched on the 6th March 2024 producing 253 results. Abstracts and then full texts were screened to identify 4 studies which met all criteria. Our protocol was registered in PROSPERO on the 25th May 2024 with registration number CRD42024550403. Data were extracted via custom computer code and analyzed with Revman.

Results:

Acute kidney injury (AKI) was significantly less likely to occur in procedures using zone 2 (RR: 0.66; p=0.003). Choice of zone 2 or zone 3 confers no statistically significant effects on risk of bleeding events (RR: 0.53; p=0.42); parapesis (RR: 0.97; p=0.96); paraplegia (RR: 0.52; p=0.25); 30-day mortality (RR: 0.48; p=0.31); stroke (RR: 0.51; p=0.10).

Conclusions:

AKI appears to be less likely in when distal anastomosis is made in zone 2. Otherwise, carrying out a distal anastomosis in aortic zone 2 or aortic zone 3 may be equally safe in terms of the outcomes analyzed. With neither option appearing to any statistically significant effect on short-term mortality, or incidence of stroke, paraplegia, or parapesaris.
IS THERE A ROLE FOR HEMOADSORPTION DURING CARDIOPULMONARY BYPASS AND CIRCULATORY ARREST IN ACUTE AORTIC DISSECTION SURGERY?
Authors: Gigliotti G. , Franzese I. , Fierro N. , Gripshi F. , Tassone M. R. , Sasso F. , Grassi P. , Mazzaro E.
Published: December 2024

Background:

This retrospective single-center study evaluates the effects of hemadsorption with CytoSorb ® on the vasoactive and inotropic support in patients undergoing surgery for acute aortic dissection (AAD) with circulatory arrest.

Methods:

We enrolled 29 consecutive patients undergoing AAD surgery with Cytosorb®, between May 2022 and June 2024, and 33 consecutive patients previously treated without Cytosorb® (January 2018 – May 2022). The primary endpoint was the changes in vasoactive- inotropic score (VIS), which quantifies the degree of hemodynamic support. VIS and drugs’ doses were collected at 8 time-points from preoperative to 72 hours after surgery. Nonparametric tests were applied and p<0.05 was settled for statistical significance.

Results:

Baseline characteristics did not differ between the two groups, except for the cardiopulmonary bypass temperature and circulatory arrest time, which are not significant related to drug request at linear regression. The median VIS showed a trend with two peaks, one early after cardiopulmonary bypass discontinuation and one 6 hours after surgery. The drugs’ doses and VIS were lower in Cytosorb® group at any time-points, with significant lower value of VIS from the ICU admission (p=0.026) to 24 hours after surgery (p=0.029). Nevertheless, there were no differences in clinical outcome (in-hospital mortality, p=1; hospital lengths of stay, p=0.1; postoperative highest creatinine value, p=0.05).

Conclusions:

Evidence on CytoSorb® during AAD surgery is poor. In this scenario, our results suggest an improved hemodynamic stability using CytoSorb®. However, many factors may compete to vasoactive request and further examination in large sample sizes are needed.
TRANSCATHETER AORTIC VALVE IN VALVE IMPLANTATION IN SEVERE BIOPROSTHETIC AORTIC VALVE DISFUNCTION AFTER BIOPROSTHETIC BENTALL OPERATION: THE VALVE TO CORONARY PROBLEM
Authors: Pisano C.
Published: December 2024

A 85- year-old man presented with shortness of breath. He had a Bio-Bentall operation (Sorin Mitroflow 23 mm + Intervascular Woven tube graft 26 mm) and coronary implantation 11 years ago. TTE demonstrated severe aortic valve prosthesis regurgitation. The TC scan showed a distance between the anulus of the aortic valve and the left coronary (VTC) of 1.7 mm with a high risk of coronary obstruction. The TEE showed a VTC > 6 mm. The patient underwent TAVI VIV via transfemoral approach. There was marked movement of valve marker in relation to sewing ring during systole and diastole, but this was stabilized using rapid pacing, allowing safe and slow deployment of a size 23 mm Evolut PRO self-expanding transcatheter aortic valve. Good valve positioning and no coronary obstruction were confirmed with contrast fluoroscopy. The patient was well post-procedure and discharged 48 h later.
CARDIOROOT VS VALSALVA: A COMPARATIVE STUDY IN PATIENTS UNDERGOING DAVID WITH 4D FLOW METHOD
Authors: Tassi S. , Mariani C. , Azzini F. , Nania R. , Castagnini S. , Niro F. , Pulvirenti B. , Pacini D.
Published: December 2024

Introduction:

This study compares the fluid dynamics of two vascular prostheses used in Tirone-David procedures, aiming to evaluate their performance in terms of blood flow patterns and hemodynamic parameters within the aortic root.

Matherial and Results:

This study compared twelve patients underwent valve-sparing surgery using either Valsalva Graft Terumo or CardioRoot Gentinge. The procedural success rate was 100%. All patients successfully underwent 4D magnetic resonance imaging. The bulk flow parameters evaluated were: peak velocity, Wall share stress, Volume of blood. Each parameter was evaluated on three sections: mid neo-sinus of Valsalva (P1), mid ascending aorta (P2), distal native ascending aorta (P3). No significant statistical difference was found in peak velocity, wall shear stress and blood volume at P1 P2 between the prostheses. The volume at P3 was statistically different (p-value=0.04), probably influenced by anatomical variability. Simulation of engineered models confirmed the presence of vorticity at level of the neo-sinuses of Valsalva without significant differences between the two different prostheses

Conclusion:

4D flow MRI and computational fluid dynamics simulations revealed similar flow patterns and hemodynamic characteristics within the aortic root, suggesting that both grafts offer comparable performance in terms of fluid dynamics. The statistical analysis data revealed no significant differences in flow, wall shear stress, or velocity between the two vascular grafts. Streamline observations showed similar turbulence patterns. These findings suggest that the choice of graft may have minimal impact on postoperative outcomes in valve- sparing surgery.
RELATIONSHIP BETWEEN DIABETES AND LONG-TERM OUTCOMES IN PATIENTS UNDERGOING ISOLATED CORONARY ARTERY BYPASS GRAFTING.
Authors: Vitale N. , barili F. , d’errigo P. , baglio G. , daprati A. , badoni G. , duranti G. , donatelli F. , parolari A. , rosato S.
Published: December 2024

Background and Aim:

Diabetes is a known risk factor for coronary artery disease, but its impact after coronary artery bypass grafting (CABG) remains uncertain, with limited data on long-term outcomes. This study aims to assess how diabetes affects 10-year outcomes following CABG.

Methods:

The PRedictIng long term Outcomes afteR Isolated coronary arTery bypass surgery (PRIORITY) project is an observational cohort study that combines two prospective multicenter studies from 2002-2004 and 2007-2008 on isolated CABG. Follow-up data were gathered from administrative databases and extended up to 10 years post-surgery. Primary outcome was a composite of Major Adverse Cardiac and Cerebrovascular Events (MACCE). Baseline differences between patients with and without diabetes were adjusted using propensity score inverse probability of treatment. Time-to-event data were analyzed through Cox- regression and competing risk analysis.

Results:

The study included 10989 patients with complete follow-up information who had isolated CABG, with 32.3% having diabetes. Diabetic patients exhibited a higher 10-year risk for MACCE (weighted HR 1.22, 95% CI 1.17 - 1.27, p<0.001), mortality (HR 1.39, 95% CI 1.32 - 1.47, p<0.001), stroke (HR 1.33, 95% CI 1.21 - 1.47), and myocardial infarction (MI) (HR 1.16, 95% CI 1.07 - 1.25, p<0.001). However, diabetes was not linked to higher incidence of repeat revascularization (HR 1.03, 95% CI 0.95 - 1.12, p=0.41).

Conclusions:

Diabetic patients faced poorer outcomes, with a higher 10-year incidence of myocardial infarction and a lower rate of repeat revascularization, suggesting that diabetes may have a more detrimental effect on microvascular health rather than on the grafts.
THE IMPACT OF FEMALE GENDER ON EARLY AND LONG-TERM OUTCOMES AFTER CORONARY ARTERY BYPASS GRAFTING SURGERY
Authors: Nardi P. , Altieri C. , Labriola V. , Latini E. , Cipullo F. , Salvati A. C. , Scognamiglio M. , Bassano C. , D’Onofrio A.
Published: December 2024

Aim:

Data on female gender differences on clinical prognosis after coronary artery bypass grafting (CABG) are still controversial. We retrospectively evaluated the impact of women patients in comparison with men undergoing CABG on long-term outcome.

Methods:

Between December 2014 and March 2022, 1044 consecutive patients (162 females, 15.5%, 882 males, 84.5%) underwent isolated CABG. The mean follow-up was 40±27 (median 38) months. Logistic and Cox model analysis regressions were used to assess the risk of female gender and other variables, Kaplan-Meier estimates to assess survival rates.

Results:

Baseline characteristics were similar, Euroscore-2 was higher in women (3.23% vs 2.63%; P=0.04). There was no difference in the use of left internal mammary artery (95.5% vs 94.9%; P>0.80). Women did not have a significant higher operative mortality than men (n=5, 3.08% vs n=17, 1.93%; P=0.37). Independent predictors of early mortality were emergency CABG (P<0.0001), PCI within 30 days (P=0.002), and the higher Euroscore-2 (P=0.016). At 7.5 years, actuarial survival was 87%±3.6% for female gender vs 88%±1.9% for male gender, freedom from cardiac death 97%±1.8% vs 96.6%±1.0%, from MACE 87%±6.2% vs 90%±2.5% (P-values>0.5). Independent predictor of all-causes death and cardiac death was the advanced age (74 years in dead patients vs 64 years in survivors; P<0.0001). Female gender was not a predictor of neither operative mortality (P=0.34) nor worse long-term outcome (P=0.41).

Conclusions:

Women undergoing CABG do not appear to be associated with worse early prognosis. Freedom from late all-causes mortality, cardiac death and cardiac events are equally satisfactory, highlighting the positive protective effect of CABG over time also in women.