bluuebunny/crossref_metadata_2025 huggingface dataset:
Real-World Implementation and Performance Analysis of Distributed Learning Frameworks for 6G IoT Applications
Authors: Naseh David , Abdollahpour Mahdi , Tarchi Daniele
Published: March 2024

This paper explores the practical implementation and performance analysis of distributed learning (DL) frameworks on various client platforms, responding to the dynamic landscape of 6G technology and the pressing need for a fully connected distributed intelligence network for Internet of Things (IoT) devices. The heterogeneous nature of clients and data presents challenges for effective federated learning (FL) techniques, prompting our exploration of federated transfer learning (FTL) on Raspberry Pi, Odroid, and virtual machine platforms. Our study provides a detailed examination of the design, implementation, and evaluation of the FTL framework, specifically adapted to the unique constraints of various IoT platforms. By measuring the accuracy of FTL across diverse clients, we reveal its superior performance over traditional FL, particularly in terms of faster training and higher accuracy, due to the use of transfer learning (TL). Real-world measurements further demonstrate improved resource efficiency with lower average load, memory usage, temperature, power, and energy consumption when FTL is implemented compared to FL. Our experiments also showcase FTL’s robustness in scenarios where users leave the server’s communication coverage, resulting in fewer clients and less data for training. This adaptability underscores the effectiveness of FTL in environments with limited data, clients, and resources, contributing valuable information to the intersection of edge computing and DL for the 6G IoT.
Erlang-U: Blocking Probability of UAV-Assisted Cellular Systems
Authors: Rivero-Angeles Mario E. , Villordo-Jimenez Iclia , Orea-Flores Izlian Y. , Torres-Cruz Noé , Pretelín Ricárdez Angel
Published: March 2024

In modern and future communication systems, we expect peaks of traffic that largely exceed the capacity of the system, since they are originally designed to support normal traffic loads. Such peaks can be caused by emergency events and cultural or sporting gatherings, among others. Indeed, implementing more channels than the ones required in normal traffic conditions would entail higher costs and energy consumption. As such, when a traffic peak arrives, the system performance is greatly affected. To this end, we propose the use of mobile channels that assist cellular systems to increase the capacity of the network for a certain period. In this paper, we derive the blocking probability of a UAV (Unmanned Aerial Vehicle)-assisted cellular system to temporarily increase the capacity of the communication network in case of a traffic overload. The analysis presented in this work allows a careful design of future communication systems requiring fewer channels, that can serve users in normal traffic load conditions while using UAVs to maintain an adequate blocking probability when the traffic load increases. To this end, we develop the ErlangU formula, similar to the ErlangB formula for a conventional voice service cellular system.
Toward Generating a New Cloud-Based Distributed Denial of Service (DDoS) Dataset and Cloud Intrusion Traffic Characterization
Authors: Shafi MohammadMoein , Lashkari Arash Habibi , Rodriguez Vicente , Nevo Ron
Published: March 2024

The distributed denial of service attack poses a significant threat to network security. Despite the availability of various methods for detecting DDoS attacks, the challenge remains in creating real-time detectors with minimal computational overhead. Additionally, the effectiveness of new detection methods depends heavily on well-constructed datasets. This paper addresses the critical DDoS dataset creation and evaluation domain, focusing on the cloud network. After conducting an in-depth analysis of 16 publicly available datasets, this research identifies 15 shortcomings across various dimensions, emphasizing the need for a new approach to dataset creation. Building upon this understanding, this paper introduces a new public DDoS dataset named BCCC-cPacket-Cloud-DDoS-2024. This dataset is meticulously crafted, addressing challenges identified in previous datasets through a cloud infrastructure featuring over eight benign user activities and 17 DDoS attack scenarios. Also, a Benign User Profiler (BUP) tool has been designed and developed to generate benign user network traffic based on a normal user behavior profile. We manually label the dataset and extract over 300 features from the network and transport layers of the traffic flows using NTLFlowLyzer. The experimental phase involves identifying an optimal feature set using three distinct algorithms: ANOVA, information gain, and extra tree. Finally, this paper proposes a multi-layered DDoS detection model and evaluates its performance using the generated dataset to cover the main issues of the traditional approaches.
Composition-Dependent Phonon and Thermodynamic Characteristics of C-Based XxY1−xC (X, Y ≡ Si, Ge, Sn) Alloys
Authors: Talwar Devki N.
Published: March 2024

Novel zinc-blende (zb) group-IV binary XC and ternary XxY1−xC alloys (X, Y ≡ Si, Ge, and Sn) have recently gained scientific and technological interest as promising alternatives to silicon for high-temperature, high-power optoelectronics, gas sensing and photovoltaic applications. Despite numerous efforts made to simulate the structural, electronic, and dynamical properties of binary materials, no vibrational and/or thermodynamic studies exist for the ternary alloys. By adopting a realistic rigid-ion-model (RIM), we have reported methodical calculations to comprehend the lattice dynamics and thermodynamic traits of both binary and ternary compounds. With appropriate interatomic force constants (IFCs) of XC at ambient pressure, the study of phonon dispersions ωjq→ offered positive values of acoustic modes in the entire Brillouin zone (BZ)—implying their structural stability. For XxY1−xC, we have used Green’s function (GF) theory in the virtual crystal approximation to calculate composition x, dependent ωjq→ and one phonon density of states gω. With no additional IFCs, the RIM GF approach has provided complete ωjq→ in the crystallographic directions for both optical and acoustical phonon branches. In quasi-harmonic approximation, the theory predicted thermodynamic characteristics (e.g., Debye temperature ΘD(T) and specific heat Cv(T)) for XxY1−xC alloys. Unlike SiC, the GeC, SnC and GexSn1−xC materials have exhibited weak IFCs with low [high] values of ΘD(T) [Cv(T)]. We feel that the latter materials may not be suitable as fuel-cladding layers in nuclear reactors and high-temperature applications. However, the XC and XxY1−xC can still be used to design multi-quantum well or superlattice-based micro-/nano devices for different strategic and civilian application needs.
Regulatory and Sensing Iron–Sulfur Clusters: New Insights and Unanswered Questions
Authors: SantaMaria Anna M. , Rouault Tracey A.
Published: March 2024

Iron is an essential nutrient and necessary for biological functions from DNA replication and repair to transcriptional regulation, mitochondrial respiration, electron transfer, oxygen transport, photosynthesis, enzymatic catalysis, and nitrogen fixation. However, due to iron’s propensity to generate toxic radicals which can cause damage to DNA, proteins, and lipids, multiple processes regulate the uptake and distribution of iron in living systems. Understanding how intracellular iron metabolism is optimized and how iron is utilized to regulate other intracellular processes is important to our overall understanding of a multitude of biological processes. One of the tools that the cell utilizes to regulate a multitude of functions is the ligation of the iron–sulfur (Fe-S) cluster cofactor. Fe-S clusters comprised of iron and inorganic sulfur are ancient components of living matter on earth that are integral for physiological function in all domains of life. FeS clusters that function as biological sensors have been implicated in a diverse group of life from mammals to bacteria, fungi, plants, and archaea. Here, we will explore the ways in which cells and organisms utilize Fe-S clusters to sense changes in their intracellular environment and restore equilibrium.
Nuclear Receptor FTZ-F1 Controls Locust Molt by Regulating the Molting Process of Locusta migratoria
Authors: Zhang Yichao , Li Hongjing , Liu Xiaoman , Li Hongli , Lan Qiuyan , Wu Haihua , Wang Yanli , Zhang Jianzhen , Zhao Xiaoming
Published: March 2024

Fushi-tarazu factor 1 (FTZ-F1) is a class of transcription factors belonging to the nuclear receptor superfamily and an important molting regulator in insects; however, its detailed function in the molting process of Locusta migratoria is still unclear. This study identified two FTZ-F1 transcripts (LmFTZ-F1-X1 and LmFTZ-F1-X2) in L. migratoria. The classical domains of FTZ-F1 were present in their protein sequences and distinguished based on their variable N-terminal domains. Reverse-transcription quantitative polymerase chain reaction analysis revealed that LmFTZ-F1-X1 and LmFTZ-F1-X2 were highly expressed in the integument. RNA interference (RNAi) was used to explore the function of LmFTZ-F1s in the molting of the third-instar nymph. Separate LmFTZ-F1-X1 or LmFTZ-F1-X2 silencing did not affect the normal development of third-instar nymphs; however, the simultaneous RNAi of LmFTZ-F1-X1 and LmFTZ-F1-X2 caused the nymphs to be trapped in the third instar stage and finally die. Furthermore, the hematoxylin-eosin and chitin staining of the cuticle showed that the new cuticles were thickened after silencing the LmFTZ-F1s compared to the controls. RNA-seq analysis showed that genes encoding four cuticle proteins, two chitin synthesis enzymes, and cytochrome P450 303a1 were differentially expressed between dsGFP- and dsLmFTZ-F1s-injected groups. Taken together, LmFTZ-F1-X1 and LmFTZ-F1-X2 are involved in the ecdysis of locusts, possibly by regulating the expression of genes involved in cuticle formation, chitin synthesis, and other key molting processes.
Unveiling the Mainland vs. Insular Variability of the Eumerus barbarus Species Group (Diptera: Syrphidae) in the Western Mediterranean Basin
Authors: Aguado-Aranda Pablo , Ricarte Antonio , Nedeljković Zorica , Hauser Martin , Kelso Scott , Sainz-Escudero Lucía , Skevington Jeffrey H. , Marcos-García María Ángeles
Published: March 2024

Comprising nearly 300 described species, Eumerus Meigen, 1822, is one of the most speciose syrphid genera worldwide, and its taxonomic diversity is remarkable in the Mediterranean basin. The Eumerus barbarus (Coquebert, 1804) group consists of four species in the western Mediterranean. Although the phenotypic variability of this species group has been commented on in previous studies, it has never been contrasted with molecular data. In the present work, the morphological variation found in 300+ specimens of this species group from the western Mediterranean is explored and tested against the COI mitochondrial DNA (mtDNA). The highest phenotypic disparity was found in E. barbarus and Eumerus sulcitibius Rondani 1868. The integrative approach has not revealed cryptic diversity within the species E. barbarus but in E. sulcitibius. As a result, a new species close to E. sulcitibius was discovered, Eumerus sardus Aguado-Aranda, Ricarte & Hauser sp. n., from Sardinia, Italy. The new insular species is here described, illustrated, and discussed. A total of twenty-three haplotypes of COI mtDNA were identified amongst the analyzed Mediterranean specimens of E. barbarus, whereas two and five haplotypes were distinguished in the Iberian specimens of E. sulcitibius and Eumerus gibbosus van Steenis, Hauser & van Zuijen, 2017, respectively. Moreover, the first known barcodes of E. gibbosus and Eumerus schmideggeri van Steenis, Hauser & van Zuijen, 2017 were obtained, and the distribution ranges of all species are mapped. An updated dichotomous key to the males of the E. barbarus group from the western Mediterranean is provided.
High-Throughput Screening of PAM-Flexible Cas9 Variants for Expanded Genome Editing in the Silkworm (Bombyx mori)
Authors: Sun Le , Zhang Tong , Lan Xinhui , Zhang Na , Wang Ruolin , Ma Sanyuan , Zhao Ping , Xia Qingyou
Published: March 2024

Genome editing provides novel opportunities for the precise genome engineering of diverse organisms. Significant progress has been made in the development of genome-editing tools for Bombyx mori (B. mori) in recent years. Among these, CRISPR/Cas9, which is currently the most commonly used system in lepidopteran insects, recognizes NGG protospacer adjacent motif (PAM) sequences within the target locus. However, Cas9 lacks the ability to target all gene loci in B. mori, indicating the need for Cas9 variants with a larger editing range. In this study, we developed a high-throughput screening platform to validate Cas9 variants at all possible recognizable and editable PAM sites for target sequences in B. mori. This platform enabled us to identify PAM sites that can be recognized by both xCas9 3.7 and SpCas9-NG variants in B. mori and to assess their editing efficiency. Cas9 shows PAM sites every 13 base pairs in the genome, whereas xCas9 3.7 and SpCas9-NG have an average distance of 3.4 and 3.6 base pairs, respectively, between two specific targeting sites. Combining the two Cas9 variants could significantly expand the targeting range of the genome, accelerate research on the B. mori genome, and extend the high-throughput rapid screening platform to other insects, particularly those lacking suitable NGG PAM sequences.
Upward and Poleward (but Not Phenological) Shifts in a Forest Tenebrionid Beetle in Response to Global Change in a Mediterranean Area
Authors: Fattorini Simone
Published: March 2024

There is an increasing volume of literature on the impact of climate change on insects. However, there is an urgent need for more empirical research on underrepresented groups in key areas, including species for which the effects of climatic change may seem less evident. The present paper illustrates the results of a study on a common forest tenebrionid beetle, Accanthopus velikensis (Piller and Mitterpacher, 1783), at a regional scale within the Mediterranean basin. Using a large set of records from Latium (central Italy), changes in the median values of elevation, latitude, longitude, and phenology between two periods (1900–1980 vs. 1981–2022) were tested. Records of A. velikensis in the period 1981–2022 showed median values of elevation and latitude higher than those recorded in the first period. Thus, in response to rising temperatures, the species became more frequent at higher elevation and in northern places. By contrast, A. velikensis does not seem to have changed its activity pattern in response to increased temperatures, but this might be an artifact due to the inclusion of likely overwintering individuals. The results obtained for A. velikensis indicate that even thermally euryoecious species can show changes in their elevational and latitudinal distribution, and that poleward shifts can be apparent even within a small latitudinal gradient.
Modeling and Experimental Validation of Broad Input-Output Range Three-Voltage-Level Rectifier
Authors: Oren Yarden , Dahan Eliav , Shmaryahu Aaron , Kellerman Yishai , Sitbon Moshe , Gadelovits Shlomo Yaakov , Baimel Dmitry , Aharon Ilan
Published: March 2024

A new type of single–conversion–step wide–input–range versatile step–up/down three–voltage–level power–factor correction stage is presented in this manuscript. The rectifier can operate both in continuous–conduction mode and discontinuous–conduction mode. First, the rectifier’s principle of operation is described, and then the innovative rectifier is analyzed in continuous and discontinuous–conduction modes. After, an average model for the innovative rectifier is developed. Lastly, the proposed theory is experimentally validated using a multiplier–less dual–control–loop mode at discontinuous–conduction modes. It is shown that although no multiplier is used in the control circuitry, the power factor is near unity. It is revealed that the rectifier can swing the output voltage from 50 V to 900 V while the input voltage is 230 Vrms. Although the rectifier output has a split DC bus with three voltage levels, the required control effort is low, and the output voltage is balanced. The innovative topology suits any standard power–factor correction rectifier application, dual–stage low–voltage power supply, and three–level voltage supplement for low–harmonic inverters. Since the rectifier’s output–voltage swing is extremely wide, energy storage systems and electric vehicle batteries are suitable applications.
Thrombus Imaging Characteristics to Predict Early Recanalization in Anterior Circulation Large Vessel Occlusion Stroke
Authors: Arrarte Terreros Nerea , Stolp Jeffrey , Bruggeman Agnetha A. E. , Swijnenburg Isabella S. J. , Lopes Ricardo R. , van Meenen Laura C. C. , Groot Adrien E. D. , Kappelhof Manon , Coutinho Jonathan M. , Roos Yvo B. W. E. M. , Emmer Bart J. , Beenen Ludo F. M. , Dippel Diederik W. J. , van Zwam Wim H. , van Bavel Ed , Marquering Henk A. , Majoie Charles B. L. M.
Published: March 2024

The early management of transferred patients with a large vessel occlusion (LVO) stroke could be improved by identifying patients who are likely to recanalize early. We aim to predict early recanalization based on patient clinical and thrombus imaging characteristics. We included 81 transferred anterior-circulation LVO patients with an early recanalization, defined as the resolution of the LVO or the migration to a distal location not reachable with endovascular treatment upon repeated radiological imaging. We compared their clinical and imaging characteristics with all (322) transferred patients with a persistent LVO in the MR CLEAN Registry. We measured distance from carotid terminus to thrombus (DT), thrombus length, density, and perviousness on baseline CT images. We built logistic regression models to predict early recanalization. We validated the predictive ability by computing the median area-under-the-curve (AUC) of the receiver operating characteristics curve for 100 5-fold cross-validations. The administration of intravenous thrombolysis (IVT), longer transfer times, more distal occlusions, and shorter, pervious, less dense thrombi were characteristic of early recanalization. After backward elimination, IVT administration, DT and thrombus density remained in the multivariable model, with an AUC of 0.77 (IQR 0.72–0.83). Baseline thrombus imaging characteristics are valuable in predicting early recanalization and can potentially be used to optimize repeated imaging workflow.
Prenatal Diagnosis of Congenital Heart Disease: The Crucial Role of Perinatal and Delivery Planning
Authors: Patel Sheetal R. , Michelfelder Erik
Published: March 2024

Although most congenital heart defects (CHDs) are asymptomatic at birth, certain CHD lesions are at significant risk of severe hemodynamic instability and death if emergent cardiac interventions are not performed in a timely fashion. Therefore, accurate identification of at-risk fetuses and appropriate delivery resource planning according to the degree of anticipated hemodynamic instability is crucial. Fetal echocardiography has increased prenatal CHD detection in recent years due to advancements in ultrasound techniques and improved obstetrical cardiac screening protocols, enabling the prediction of newborns’ hemodynamic status. This assessment can guide multidisciplinary resource planning for postnatal care, including selection of delivery site, delivery room management, and transport to a cardiac center based on CHD risk severity. This review will discuss fetal cardiovascular physiology and the circulatory changes that occur at the time of and immediately following birth, outline fetal echocardiographic findings used to risk-stratify newborns with CHDs, and outline principles for neonatal resuscitation and initial transitional care in neonates with these complex CHD lesions.
Aggressive Rhythm Control Strategy in Atrial Fibrillation Patients Presenting at the Emergency Department: The HEROMEDICUS Study Design and Initial Results
Authors: Tsiachris Dimitrios , Argyriou Nikos , Tsioufis Panagiotis , Antoniou Christos Konstantinos , Laina Aggeliki , Oikonomou George , Doundoulakis Ioannis , Kordalis Athanasios , Dimitriadis Kyriakos , Gatzoulis Konstantinos , Tsioufis Konstantinos
Published: March 2024

Atrial fibrillation has progressively become a more common reason for emergency department visits, representing 0.5% of presenting reasons. Registry data have indicated that about 60% of atrial fibrillation patients who present to the emergency department are admitted, emphasizing the need for more efficient management of atrial fibrillation in the acute phase. Management of atrial fibrillation in the setting of the emergency department varies between countries and healthcare systems. The most plausible reason to justify a conservative rather than an aggressive strategy in the management of atrial fibrillation is the absence of specific guidelines from diverse societies. Several trials of atrial fibrillation treatment strategies, including cardioversion, have demonstrated that atrial fibrillation in the emergency department can be treated safely and effectively, avoiding admission. In the present study, we present the epidemiology and characteristics of atrial fibrillation patients presenting to the emergency department, as well as the impact of diverse management strategies on atrial-fibrillation-related hospital admissions. Lastly, the design and initial data of the HEROMEDICUS protocol will be presented, which constitutes an electrophysiology-based aggressive rhythm control strategy in patients with atrial fibrillation in the emergency department setting.
Assessment of Esophageal Shifts during Catheter Ablation of Atrial Fibrillation Using Intracardiac Ultrasound Integrated with 3-Dimensional Electroanatomical Mapping System
Authors: Pernat Andrej , Zavrtanik Mark , Robles Antonio Gianluca , Romano Silvio , Sciarra Luigi , Antolič Bor
Published: March 2024

Purpose: Atrioesophageal fistula is one of the most feared complications of radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) as it is associated with high mortality. Determining the esophagus location during RFCA might reduce the risk of esophageal injury. The present study aims to evaluate the feasibility of using intracardiac echocardiography integrated into a 3-dimensional electroanatomical mapping system (ICE/3D EAM) for the assessment of esophageal position and shifts in response to ablation. Methods: We prospectively enrolled 20 patients that underwent RFCA of AF under conscious analgosedation. The virtual anatomy of the left atrium, the pulmonary vein (PV) ostia, and the esophagus was created with ICE/3D EAM. The esophageal positions were obtained at the beginning of the procedure and then after left and right PV isolation (PVI). Esophageal shifts were measured offline after the procedure using the tools available in the 3D EAM system. Results: Most esophagi moved away from the ablated PV ostia. After the left PVI, the median of the shifts was 2.8 mm (IQR 1.0–6.3). In 25% of patients, the esophagus shifted by >5.0 mm (max. 13.4 mm). After right PVI, the median of shifts was 2.0 mm (IQR 0.7–4.9). In 10% of patients, the esophageal shift was >5.0 mm (max. 7.8 mm). Conclusions: ICE/3D EAM enables the intraprocedural visualization of baseline esophageal position and its shifts after PVI. The shifts are variable, but they tend to be small and directed away from the ablation site. Repeated intraprocedural visualization of the esophagus may be needed to reduce the risk of esophageal injury.
Association between Preoperative C-Reactive Protein-to-Albumin Ratio and Mortality after Plastic and Reconstructive Surgery
Authors: Oh Ah Ran , Sung Ha Min , Park Jungchan , Jin Gayoung , Kong So Myung , Jung Minsu , Lee Sangmin Maria
Published: March 2024

Background: Prognostic markers have not been extensively studied in plastic and reconstructive surgery. Objective: We aimed to evaluate the prognostic value of preoperative C-reactive protein (CRP)-to-albumin ratio (CAR) in plastic and reconstructive surgery and to compare it with the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and modified Glasgow prognostic score (mGPS). Methods: From January 2011 to July 2019, we identified 2519 consecutive adult patients who were undergoing plastic and reconstructive surgery with available preoperative CRP and albumin levels. The receiver operating characteristic (ROC) curve was generated to evaluate predictability and estimate the threshold. The patients were divided according to this threshold, and the risk was compared. The primary outcome was one-year mortality, and the overall mortality was also analyzed. Results: The one-year mortality was 4.9%. The CAR showed an area under the ROC curve of 0.803, which was higher than those of NLR, PLR, and mGPS. According to the estimated threshold of 1.05, the patients were divided into two groups; 1585 (62.9%) were placed in the low group, and 934 (37.1%) were placed in the high group. After inverse probability weighting, the mortality rate during the first year after plastic and reconstructive surgery was significantly increased in the high group (1.3% vs. 10.9%; hazard ratio, 2.88; 95% confidence interval, 2.17–3.83; p < 0.001). Conclusions: In this study, high CAR was significantly associated with one-year mortality of patients after plastic and reconstructive surgery. Further studies are needed on prognostic markers in plastic and reconstructive surgery.
Radiological Parameters for the Detection of Pulmonary Hypertension in Severe Aortic Valve Stenosis and Their Influence on Mortality: Does Sex Matter?
Authors: Kletzer Joseph , Scharinger Bernhard , Demirel Ozan , Kaufmann Reinhard , Medved Michaela , Reiter Christian , Hammerer Matthias , Steinwender Clemens , Hecht Stefan , Kopp Kristen , Hoppe Uta C. , Hergan Klaus , Boxhammer Elke
Published: March 2024

Background: Echocardiography has long been established as the primary noninvasive method for diagnosing pulmonary hypertension (PH) prior to transcatheter aortic valve replacement (TAVR) in patients with severe aortic valve stenosis (AS). In recent years, radiological methods for diagnosing PH have been investigated. Measurements such as the computed tomography angiography (CTA)-derived pulmonary artery (PA) diameter and PA diameter/body surface area (PA/BSA) have shown promising results regarding their diagnostic strength. However, it has yet to be determined if a patient’s sex has any impact on the effectiveness of these diagnostic measurements. Methods: In all, 271 patients (51.3% male, mean age 82.6 ± 4.8 years) with severe AS undergoing TAVR were separated into male and female groups. The cut-off values for the diagnosis of PH were calculated for the CTA-derived PA diameter and PA/BSA based on different systolic pulmonal artery pressure values (40–45–50 mmHg). Patients were then subclassified according to measurements above or below these PA diameters and PA/BSA cut-off values. A PA diameter ≥29.5 mm and PA/BSA ≥ 15.7 mm/m2 qualified for PH. The 1–5 year survival rate in these cohorts was further analyzed. Results: Patients with a PA diameter ≥29.5 mm showed a significantly higher 1 year mortality rate (p = 0.014). This observation could only be confirmed for the male sex (p = 0.018) and not for the female sex (p = 0.492). As for the PA/BSA, in patients over the cut-off value, no significant increase in mortality was noted in the overall cohort. However, the male patients showed increased 3 year (p = 0.048) and 5 year mortality rates (p = 0.033). Conclusions: The CTA-obtained PA diameter and PA/BSA are both useful in the diagnosis of PH and mortality risk stratification in patients with severe AS undergoing TAVR, especially in males. Male patients with PA ≥ 29.5 mm or PA/BSA ≥ 15.7 mm/m2 seem to be at a higher risk of death during follow-up after undergoing TAVR. In females, no such correlation was observed.
Robotic Vascular Resection in Pancreatic Ductal Adenocarcinoma: A Systematic Review
Authors: Zecchin Ferrara Victoria , Martinino Alessandro , Toti Francesco , Schilirò Davide , Pinto Federico , Giovinazzo Francesco ,   on behalf of the SMAGEICS Group
Published: March 2024

(1) Background: This study comprehensively compared robotic pancreatic surgery with vascular resection (RPS-VR) to other surgical procedures in the treatment of pancreatic ductal adenocarcinoma (PDAC). (2) Methods: A systematic review of relevant literature was conducted to assess a range of crucial surgical and oncological outcomes. (3) Results: Findings indicate that robotic surgery with vascular resections (VRs) significantly prolongs the duration of surgery compared to other surgical procedures, and they notably demonstrate an equal hospital stay. While some studies reported a lower conversion rate and a higher rate of blood loss and blood transfusion in the RPS-VR group, others found no significant disparity. Furthermore, RPS-VR consistently correlated with comparable recurrence rates, free margins R0, postoperative mortality, and complication rates. Concerning the last one, certain reviews reported a higher rate of major complications. Overall survival and disease-free survival remained comparable between the RPS-VR and other surgical techniques in treating PDAC. (4) Conclusions: The analysis emphasizes how RPS-VR is a resembling approach in terms of surgical outcomes and aligns with existing literature findings in this field.
Characterization of Vestibular Phenotypes in Patients with Genetic Hearing Loss
Authors: Han Ji Hyuk , Bae Seong Hoon , Joo Sun Young , Kim Jung Ah , Kim Se Jin , Jang Seung Hyun , Won Dongju , Gee Heon Yung , Choi Jae Young , Jung Jinsei , Kim Sung Huhn
Published: March 2024

Background: The vestibular phenotypes of patients with genetic hearing loss are poorly understood. Methods: we performed genetic testing including exome sequencing and vestibular function tests to investigate vestibular phenotypes and functions in patients with genetic hearing loss. Results: Among 627 patients, 143 (22.8%) had vestibular symptoms. Genetic variations were confirmed in 45 (31.5%) of the 143 patients. Nineteen deafness genes were linked with vestibular symptoms; the most frequent genes in autosomal dominant and recessive individuals were COCH and SLC26A4, respectively. Vestibular symptoms were mostly of the vertigo type, recurrent, and persisted for hours in the genetically confirmed and unconfirmed groups. Decreased vestibular function in the caloric test, video head impulse test, cervical vestibular-evoked myogenic potential, and ocular vestibular-evoked myogenic potential was observed in 42.0%, 16.3%, 57.8%, and 85.0% of the patients, respectively. The caloric test revealed a significantly higher incidence of abnormal results in autosomal recessive individuals than in autosomal dominant individuals (p = 0.011). The genes, including SLC26A4, COCH, KCNQ4, MYH9, NLRP3, EYA4, MYO7A, MYO15A, and MYH9, were heterogeneously associated with abnormalities in the vestibular function test. Conclusions: In conclusion, diverse vestibular symptoms are commonly concomitant with genetic hearing loss and are easily overlooked.
Whole-Body Cryostimulation in Multiple Sclerosis: A Scoping Review
Authors: Alito Angelo , Fontana Jacopo Maria , Franzini Tibaldeo Eleonora , Verme Federica , Piterà Paolo , Miller Elzbieta , Cremascoli Riccardo , Brioschi Andrea , Capodaglio Paolo
Published: March 2024

Multiple sclerosis (MS) is the most common cause of non-traumatic long-term disability in young adults. Whole-body cryostimulation (WBC) is a cold-based physical therapy known to induce physiological exercise-mimicking changes in the cardiovascular, neuromuscular, immune, and endocrine systems and to influence functional and psychological parameters by exposing the human body to cryogenic temperatures (≤−110 °C) for 2–3 min. The purpose of this scoping review is to present an overall view on the potential role of WBC as an adjuvant therapy in the treatment of MS. PubMed, ScienceDirect, Embase, and Web of Science were searched up to 30 November 2023, and a total of 13 articles were included. WBC may have beneficial antioxidant effects as a short-term adjuvant treatment in MS. There were no significant changes in antioxidant enzymes, nitric oxide levels, metalloproteinase levels, blood counts, rheology, and biochemistry. WBC can lead to a reduction in fatigue and an improvement in functional status, with a significant effect on both mental and physical well-being. There were no reported adverse effects. The results suggest that WBC may complement therapeutic options for patients with MS, as the effects of cryogenic cold stimulation have been shown to activate antioxidant processes and improve functional status, mood, anxiety, and fatigue.
Physical Therapies for Delayed Onset Muscle Soreness: A Protocol for an Umbrella and Mapping Systematic Review with Meta-Meta-Analysis
Authors: Wiecha Szczepan , Posadzki Paweł , Prill Robert , Płaszewski Maciej
Published: March 2024

Background: Delayed onset muscle soreness (DOMS), also known as exercise-induced muscle damage (EIMD), is typically caused by strenuous and/or unaccustomed physical exercise. DOMS/EIMD manifests itself in reduced muscle strength and performance levels, increased muscle soreness, swelling, and elevated levels of inflammatory biomarkers. Numerous randomised controlled trials (RCTs) and systematic reviews (SRs) of a wide variety of physiotherapy interventions for reducing the signs and symptoms of DOMS/EIMD have been published. However, these SRs often arrive at contradictory conclusions, impeding decision-making processes. Objective: We will systematically review the current evidence on clinical outcomes (efficacy, safety) of physiotherapy interventions for the treatment of DOMS/EIMD in healthy adults. We will also assess the quality of the evidence and identify, map, and summarise data from the available SRs. Method: Umbrella review with evidence map and meta-meta-analyses. MEDLINE, Embase, Cochrane Database of Systematic Reviews, Epistemonikos and PEDro will be searched from January 1998 until February 2024. SRs of RCTs of any treatment used by physiotherapists (e.g., low-level laser therapy, electrical stimulation, heat/cold therapy, ultrasound, magnets, massage, manual therapies) to treat DOMS/EIMD in healthy adults will be eligible. Narrative/non-systematic reviews, studies of adolescents/children and medically compromised individuals, of complementary therapies, dietary, nutritional, or pharmacological interventions, as well as self-administered interventions, or those published before 1998, will be excluded. AMSTAR 2 will be used to evaluate the methodological quality of the included SRs. Corrected covered area, will be computed for assessing overlaps among included SRs, and an evidence map will be prepared to describe the credibility of evidence for interventions analysed in the relevant SRs. Discussion: DOMS/EIMD is a complex condition, and there is no consensus regarding the standard of clinical/physiotherapeutic care. By critically evaluating the existing evidence, we aim to inform clinicians about the most promising therapies for DOMS/EIMD. This umbrella review has the potential to identify gaps in the existing evidence base that would inform future research. The protocol has been registered at PROSPERO (CRD42024485501].
Endoscopic Management of Post-Sleeve Gastrectomy Complications
Authors: Masood Muaaz , Low Donald E. , Deal Shanley B. , Kozarek Richard A.
Published: March 2024

Obesity is associated with several chronic conditions including diabetes, cardiovascular disease, and metabolic dysfunction-associated steatotic liver disease and malignancy. Bariatric surgery, most commonly Roux-en-Y gastric bypass and sleeve gastrectomy, is an effective treatment modality for obesity and can improve associated comorbidities. Over the last 20 years, there has been an increase in the rate of bariatric surgeries associated with the growing obesity epidemic. Sleeve gastrectomy is the most widely performed bariatric surgery currently, and while it serves as a durable option for some patients, it is important to note that several complications, including sleeve leak, stenosis, chronic fistula, gastrointestinal hemorrhage, and gastroesophageal reflux disease, may occur. Endoscopic methods to manage post-sleeve gastrectomy complications are often considered due to the risks associated with a reoperation, and endoscopy plays a significant role in the diagnosis and management of post-sleeve gastrectomy complications. We perform a detailed review of the current endoscopic management of post-sleeve gastrectomy complications.
The Impact of Implementation of Palliative, Non-Operative Management on Mortality of Operatively Treated Geriatric Hip Fracture Patients: A Retrospective Cohort Study
Authors: Nijdam Thomas , Schiepers Tim , Laane Duco , Schuijt Henk Jan , van der Velde Detlef , Smeeing Diederik
Published: March 2024

(1) Background: Hip fracture patients with very limited life expectancy can opt for non-operative management (NOM) within a palliative care context. The implementation of NOM in the palliative context may affect the mortality of the operatively treated population. This retrospective cohort study aimed to determine whether the operatively treated geriatric hip fracture population would have a lower in-hospital mortality rate and fewer postoperative complications after the introduction of NOM within a palliative care context for patients with very limited life expectancy. (2) Methods: Data from 1 February 2019 to 1 February 2022 of patients aged 70 years or older were analyzed to give a comparison between patients before and after implementation of NOM within a palliative care context. (3) Results: Comparison between 550 patients before and 485 patients after implementation showed no significant difference in in-hospital or 1-year mortality rates (2.9% vs. 1.4%, p = 0.139; 22.4% vs. 20.2%, p = 0.404, respectively). Notably, post-implementation, fewer patients had prior dementia diagnoses (15% vs. 21%, p = 0.010), and intensive care unit admissions decreased (3.5% vs. 1.2%, p = 0.025). (4) Conclusions: The implementation of NOM within a palliative care context did not significantly reduce mortality or complications. However, NOM within palliative care is deemed a more patient-centered approach for geriatric hip fracture patients with very limited life expectancy.
Minimally Invasive Surgery for Adolescent Idiopathic Scoliosis: A Systematic Review
Authors: Tsirikos Athanasios I. , Ahuja Kaustubh , Khan Mohsin
Published: March 2024

Background: Minimally invasive surgical (MIS) techniques have gained popularity as a safe and effective alternative to open surgery for degenerative, traumatic, and metastatic spinal pathologies. In adolescent idiopathic scoliosis, MIS techniques comprise anterior thoracoscopic surgery (ATS), posterior minimally invasive surgery (PMIS), and vertebral body tethering (VBT). In the current systematic review, the authors collected and analyzed data from the available literature on MIS techniques in AIS. Methods: The articles were shortlisted after a thorough electronic and manual database search through PubMed, EMBASE, and Google Scholar. Results: The authors included 43 studies for the review; 14 described the outcomes with ATS, 13 with PMIS, and 16 with VBT. Conclusions: While the efficacy of the ATS approach is well-established in terms of comparable coronal and sagittal correction to posterior spinal fusion, the current use of ATS for instrumented fusion has become less popular due to a steep learning curve, high pulmonary and vascular complication rates, implant failures, and increased non-union rates. PMIS is an effective alternative to the standard open posterior spinal fusion, with a steep learning curve and longer surgical time being potential disadvantages. The current evidence, albeit limited, suggests that VBT is an attractive procedure that merits consideration in terms of radiological correction and clinical outcomes, but it has a high complication and re-operation rate, while the most appropriate indications and long-term outcomes of this technique remain unclear.
Effectiveness of High-Power Laser Therapy via Shear Wave Speed Analysis on Pain and Functioning in Patients with Lateral Epicondylitis: A Proof-of-Concept Study
Authors: Marotta Nicola , de Sire Alessandro , Lippi Lorenzo , Moggio Lucrezia , Mondardini Paolo , Sgro Maria , Bartalotta Isabella , Zito Roberta , Giroldini Teobaldo , Invernizzi Marco , Longo Umile Giuseppe , Ammendolia Antonio
Published: March 2024

Background: Lateral epicondylitis (LE) causes lateral elbow pain due to the overuse of the common extensor tendon. Several therapies have been proposed for pain relief and functional recovery, including physical therapy, minimally invasive injection approaches, and physical agent modalities such as laser therapy. Methods: Our study evaluates the impact of high-power laser therapy (HPLT) on pain and functioning. The HPLT protocol consists of 10 daily sessions using a LASERIX PRO device. The healthy elbow of each participant was also considered as a control group. The outcomes assessed were the Numerical Rating Scale (NRS) for pain, QuickDASH questionnaire for functionality, and shear wave velocity (SWS) through ultrasonography. Assessments were conducted at baseline (T0), post-treatment (T1), and 2-week follow-up (T2). Results: Sixteen participants (81.2% male, mean age 40.4 ± 5.53 years) completed the study. Post-treatment, pain significantly decreased (NRS: T0 6.13 ± 0.96; T1 2.75 ± 1.69; p <  0.001), functionality improved (QuickDASH: T0 69.88 ± 10.75; T1 41.20 ± 3.78; p < 0.001), and shear wave velocity increased (SWS (m/s): T0 1.69 ± 0.35; T1 2.56 ± 0.36; p <  0.001). Conclusions: At the 2-week follow-up, pain relief was maintained, and shear wave velocity showed no further significant change. Shear wave velocity assessments might be considered a useful diagnostic tool. However, further research is needed to support the role of HPLT and shear wave velocity in the rehabilitation management of LE.
Effectiveness of Copeptin, MR-proADM and MR-proANP in Predicting Adverse Outcomes, Alone and in Combination with Traditional Severity Scores, a Secondary Analysis in COVID-19 Patients Requiring Intensive Care Admission
Authors: Varaldo Emanuele , Rumbolo Francesca , Prencipe Nunzia , Bioletto Fabio , Settanni Fabio , Mengozzi Giulio , Grottoli Silvia , Ghigo Ezio , Brazzi Luca , Montrucchio Giorgia , Berton Alessandro Maria
Published: March 2024

Objective: To investigate whether copeptin, MR-proADM and MR-proANP, alone or integrated with the SOFA, MuLBSTA and SAPS II scores, are capable of early recognition of COVID-19 ICU patients at increased risk of adverse outcomes. Methods: For this predefined secondary analysis of a larger cohort previously described, all consecutive COVID-19 adult patients admitted between March and December 2020 to the ICU of a referral, university hospital in Northern Italy were screened, and clinical severity scores were calculated upon admission. A blood sample for copeptin, MR-proADM and MR-proANP was collected within 48 h (T1), on day 3 (T3) and 7 (T7). Outcomes considered were ICU and in-hospital mortality, bacterial superinfection, recourse to renal replacement therapy (RRT) or veno-venous extracorporeal membrane oxygenation, need for invasive mechanical ventilation (IMV) and pronation. Results: Sixty-eight patients were enrolled, and in-hospital mortality was 69.1%. ICU mortality was predicted by MR-proANP measured at T1 (HR 1.005, 95% CI 1.001–1.010, p = 0.049), although significance was lost if the analysis was adjusted for procalcitonin and steroid treatment (p = 0.056). Non-survivors showed higher MR-proADM levels than survivors at all time points, and an increase in the ratio between values at baseline and at T7 > 4.9% resulted in a more than four-fold greater risk of in-hospital mortality (HR 4.417, p < 0.001). Finally, when considering patients with any reduction in glomerular filtration, an early copeptin level > 23.4 pmol/L correlated with a more than five-fold higher risk of requiring RRT during hospitalization (HR 5.305, p = 0.044). Conclusion: Timely evaluation of MR-proADM, MR-proANP and copeptin, as well as changes in the former over time, might predict mortality and other adverse outcomes in ICU patients suffering from severe COVID-19.
Placental Cortisol Dysregulation in Mothers with Experiences of Childhood Adversity: Potential Mechanisms and Clinical Implications
Authors: George Joshua , Muzik Maria , Townsel Courtney
Published: March 2024

Adverse childhood experiences (ACEs) are extremely prevalent in the United States population. Although ACEs occurs in childhood, exposure to them has been associated with adverse future pregnancy outcomes and an increased risk of poorer social determinants of health, which further drive the risk of negative pregnancy outcomes. In addition, maternal ACE exposure has been linked to poor infant and child outcomes, highlighting the intergenerational transmission of risk from mother to child. While alterations along the Maternal–Placental–Fetal Hypothalamic–pituitary–adrenal (HPA) axis is hypothesized to be involved, the exact biological pathway underlying this intergenerational passage of risk is mostly unknown. This present work will highlight what is known about pregnancy-related stress hormone physiology, discuss the potential mechanisms of action of ACEs on cortisol regulation, and suggest opportunities for further clinical and translational studies.
Peripheral Blood Eosinophilia in Patients with Diabetic Foot Infection Receiving Long-Term Antibiotic Therapy
Authors: Kadosh Freund Reut , Rozenberg Elimelech , Shafat Tali , Saidel-Odes Lisa
Published: March 2024

Background: The eosinophil level in peripheral blood increases in response to various conditions, the most common being medication use. Since the outcome of increased levels of eosinophils can range from a benign finding to extensive damage to host organs and systemic consequences, this finding raises concern among clinicians. We aimed to assess the prevalence of prolonged antibiotic-therapy-induced eosinophilia and possible outcomes. Methods: We conducted a retrospective cohort study of diabetic patients admitted to the orthopedic department from December 2016 through December 2020 due to a moderate to severe diabetic foot infection and who received at least 14 days of antibiotic therapy. Patients were identified retrospectively through the orthopedic department registry, and their files were reviewed, extracting demographics, laboratory test results, antibiotic treatment, and outcomes. Results: The cohort included 347 patients; a total of 114 (32.8%) developed eosinophilia during the follow-up period. Patients who developed eosinophilia had a significantly longer duration of antibiotic treatment (p < 0.001) and a significantly longer hospitalization (p = 0.001). For multivariable analysis, the independent risk factors predicting drug-induced eosinophilia included older age, higher eosinophil count on admission (per quantile) and higher platelet count on admission (per quantile) (p = 0.012, p < 0.001, p = 0.009, respectively). There was no evidence of complications in patients who developed eosinophilia compared to patients who did not. No significant association with a specific type of antibiotic was found. Conclusions: We found a higher incidence of drug-induced eosinophilia than expected or previously described. The factors associated with eosinophilia included age and higher baseline eosinophil and platelet levels but not antibiotic type.