bluuebunny/crossref_metadata_2025 huggingface dataset:
Mapping the Environmental Co-Benefits of Reducing Low-Value Care: A Scoping Review and Bibliometric Analysis
Authors: Parker Gillian , Hunter Sarah , Born Karen , Miller Fiona A.
Published: June 2024

Reducing low-value care (LVC) and improving healthcare’s climate readiness are critical factors for improving the sustainability of health systems. Care practices that have been deemed low or no-value generate carbon emissions, waste and pollution without improving patient or population health. There is nascent, but growing, research and evaluation to inform practice change focused on the environmental co-benefits of reducing LVC. The objective of this study was to develop foundational knowledge of this field through a scoping review and bibliometric analysis. We searched four databases, Medline, Embase, Scopus and CINAHL, and followed established scoping review and bibliometric analysis methodology to collect and analyze the data. A total of 145 publications met the inclusion criteria and were published between 2013 and July 2023, with over 80% published since 2020. Empirical studies comprised 21%, while commentary or opinions comprised 51% of publications. The majority focused on healthcare generally (27%), laboratory testing (14%), and medications (14%). Empirical publications covered a broad range of environmental issues with general and practice-specific ‘Greenhouse gas (GHG) emissions’, ‘waste management’ and ‘resource use’ as most common topics. Reducing practice-specific ‘GHG emissions’ was the most commonly reported environmental outcome. The bibliometric analysis revealed nine international collaboration networks producing work on eight key healthcare areas. The nineteen ‘top’ authors were primarily from the US, Australia and Canada.
Poor Health Behaviour in Medical Students at a South African University: A Cross-Sectional Survey Study
Authors: Celie Bert , Laubscher Ria , Bac Martin , Schwellnus Marianne , Nolte Kim , Wood Paola , Camacho Tanya , Basu Debashis , Borresen Jill
Published: June 2024

Background: Personal health behaviours and lifestyle habits of health professionals influence their counselling practices related to non-communicable diseases (NCDs). There are limited data on the prevalence of unhealthy lifestyle habits among medical students and the impact of acquired health knowledge throughout the curriculum. The aim of this study was to determine and compare the prevalence of modifiable behavioural NCD risk factors of medical students in different academic years at a South African tertiary institution. Methods: A cross-sectional observational study of 532 consenting medical students was conducted. Participants completed five online questionnaires regarding lifestyle behaviours (physical activity, dietary habits, smoking, alcohol consumption and sleep). Results: Lifestyle-related risk factors with the highest prevalence were poor sleep quality (66.0%), low levels of habitual physical activity (55.8%) and low-to-moderate diet quality (54.5%). There were no differences between academic years for all risk factors measured. Over 60% of the cohort had two or more NCD risk factors and this prevalence did not differ across the degree program with the acquisition of more health knowledge. Conclusion: Medical students have a high prevalence of poor sleep quality, low levels of physical activity and low-to-moderate diet quality, which does not appear to change over the course of their academic career. Sleep hygiene, regular physical activity and healthy nutrition should be targeted in intervention programmes and be more prevalent in the medical curriculum.
Study on Multiscale Virtual Environment Construction and Spatial Navigation Based on Hierarchical Structure
Authors: Chen Chao , Li Chaoyang , Lu Kai , Chen Hao , Xiao Xin , Fang Chaoyang
Published: June 2024

Multiscale virtual environments (MSVEs) allow the integration of elements and environments at different scale levels into a unified space, which facilitates researchers’ perception, understanding, and experimental research of complex geospatial spaces. Although there have been several methods for achieving multiscale effects in virtual environments (VEs), they cannot assist users in constructing more complete spatial cognitive maps and presenting multiscale information efficiently. This study proposes a hierarchical-structure-based MSVE construction method, which can effectively integrate multiscale information and ensure that the richness of details of information is gradually enhanced with the progression of the hierarchical structure. In addition, a spatial navigation study is conducted, considering the relationship between users’ perspective changes and spatial cognition, and the effects of users’ perspective changes on their spatial cognition in an MSVE are explored. A multiscale virtual wetland environment covering four levels is constructed to conduct a case study of a virtual environment of a wetland of Poyang Lake. The research results show that the proposed method is feasible. Moreover, the spatial navigation based on the change in the hierarchical perspective is in line with the spatial cognitive habits of users, which can satisfy the cognitive needs of users from the macro-region to specific wetland landscapes.
Stability Engineering of Recombinant Secretory IgA
Authors: Göritzer Kathrin , Strasser Richard , Ma Julian K.-C.
Published: June 2024

Secretory IgA (SIgA) presents a promising avenue for mucosal immunotherapy yet faces challenges in expression, purification, and stability. IgA exists in two primary isotypes, IgA1 and IgA2, with IgA2 further subdivided into two common allotypes: IgA2m(1) and IgA2m(2). The major differences between IgA1 and IgA2 are located in the hinge region, with IgA1 featuring a 13-amino acid elongation that includes up to six O-glycosylation sites. Furthermore, the IgA2m(1) allotype lacks a covalent disulfide bond between heavy and light chains, which is present in IgA1 and IgA2m(2). While IgA1 demonstrates superior epitope binding and pathogen neutralization, IgA2 exhibits enhanced effector functions and stability against mucosal bacterial degradation. However, the noncovalent linkage in the IgA2m(1) allotype raises production and stability challenges. The introduction of distinct single mutations aims to facilitate an alternate disulfide bond formation to mitigate these challenges. We compare four different IgA2 versions with IgA1 to further develop secretory IgA antibodies against SARS-CoV-2 for topical delivery to mucosal surfaces. Our results indicate significantly improved expression levels and assembly efficacy of SIgA2 (P221R) in Nicotiana benthamiana. Moreover, engineered SIgA2 displays heightened thermal stability under physiological as well as acidic conditions and can be aerosolized using a mesh nebulizer. In summary, our study elucidates the benefits of stability-enhancing mutations in overcoming hurdles associated with SIgA expression and stability.
Association between Disgust Sensitivity during Pregnancy and Endogenous Steroids: A Longitudinal Study
Authors: Kaňková Šárka , Dlouhá Daniela , Ullmann Jana , Velíková Marta , Včelák Josef , Hill Martin
Published: June 2024

The emotion of disgust protects individuals against pathogens, and it has been found to be elevated during pregnancy. Physiological mechanisms discussed in relation to these changes include immune markers and progesterone levels. This study aimed to assess the association between steroids and disgust sensitivity in pregnancy. Using a prospective longitudinal design, we analyzed blood serum steroid concentrations and measured disgust sensitivity via text-based questionnaires in a sample of 179 pregnant women during their first and third trimesters. We found positive correlations between disgust sensitivity and the levels of C19 steroids (including testosterone) and its precursors in the Δ5 pathway (androstenediol, DHEA, and their sulfates) and the Δ4 pathway (androstenedione). Additionally, positive correlations were observed with 5α/β-reduced C19 steroid metabolites in both trimesters. In the first trimester, disgust sensitivity was positively associated with 17-hydroxypregnanolone and with some estrogens. In the third trimester, positive associations were observed with cortisol and immunoprotective Δ5 C19 7α/β-hydroxy-steroids. Our findings show that disgust sensitivity is positively correlated with immunomodulatory steroids, and in the third trimester, with steroids which may be related to potential maternal-anxiety-related symptoms. This study highlights the complex relationship between hormonal changes and disgust sensitivity during pregnancy.
Elicitor-Mediated Enhancement of α-Tocopherol in Cell Suspension Cultures of Nicotiana tabacum
Authors: Harish Mani Chandra , Balamurugan Shanmugaraj , Sathishkumar Ramalingam
Published: June 2024

Plant cell and tissue culture have been used as the alternative and potential renewable source for the production of valuable phytochemicals. Elicitation offers a reliable in vitro approach to produce or enhance potential phytochemicals. α-tocopherol, which is an isoform of vitamin E, is a potent fat-soluble phytochemical known in nature. The present study focused on enhancing the production of α-tocopherol in the cell suspension culture through an elicitation approach. Suspension cultures of Nicotiana tabacum were established from the leaf disk-derived callus. The cell suspension cultures were treated with different elicitors (methyl jasmonate, salicylic acid, and yeast extract) at the lag phase of the cell growth cycle. The effects of elicitors on cell cultures were determined in terms of biomass, and α-tocopherol enhancement was determined using high-performance liquid chromatography (HPLC). Different elicitors depending on the concentration exerted different effects on cell growth and α-tocopherol production. Methyl jasmonate treatment showed the significantly highest increase in α-tocopherol on the 6th day of treatment in tobacco suspension cultures. Methyl jasmonate at the concentration of 150 μM enhanced α-tocopherol content to 24-fold over the control. This study clearly shows that the elicitors had the potential to increase the accumulation of α-tocopherol considerably in tobacco cell cultures. The outcomes of this study could be of considerable importance to the nutraceutical and pharmaceutical industries.
Applying Machine Learning in Marketing: An Analysis Using the NMF and k-Means Algorithms
Authors: Gallego Victor , Lingan Jessica , Freixes Alfons , Juan Angel A. , Osorio Celia
Published: June 2024

The integration of machine learning (ML) techniques into marketing strategies has become increasingly relevant in modern business. Utilizing scientific manuscripts indexed in the Scopus database, this article explores how this integration is being carried out. Initially, a focused search is undertaken for academic articles containing both the terms “machine learning” and “marketing” in their titles, which yields a pool of papers. These papers have been processed using the Supabase platform. The process has included steps like text refinement and feature extraction. In addition, our study uses two key ML methodologies: topic modeling through NMF and a comparative analysis utilizing the k-means clustering algorithm. Through this analysis, three distinct clusters emerged, thus clarifying how ML techniques are influencing marketing strategies, from enhancing customer segmentation practices to optimizing the effectiveness of advertising campaigns.
Unveiling the Microbiome Diversity in Telenomus (Hymenoptera: Scelionidae) Parasitoid Wasps
Authors: Gómez-Govea Mayra A. , Peña-Carillo Kenzy I. , Ruiz-Ayma Gabriel , Guzmán-Velasco Antonio , Flores Adriana E. , Ramírez-Ahuja María de Lourdes , Rodríguez-Sánchez Iram Pablo
Published: June 2024

Bacterial symbionts in insects constitute a key factor for the survival of the host due to the benefits they provide. Parasitoid wasps are closely associated with viruses, bacteria, and fungi. However, the primary symbionts and their functions are not yet known. This study was undertaken to determine the gut microbiota of six species of the Telenomus genus: T. alecto (Crawford), T. sulculus Johnson, T. fariai Costa Lima, T. remus Nixon, T. podisi Ashmead, and T. lobatus Johnson & Bin. Wasp parasitoids were collected from their hosts in different locations in Mexico. DNA was extracted from gut collection, and sequencing of bacterial 16S rRNA was carried out in Illumina® MiSeq™. Among the six species of wasps, results showed that the most abundant phylum were Proteobacteria (82.3%), Actinobacteria (8.1%), and Firmicutes (7.8%). The most important genera were Delftia and Enterobacter. Seventeen bacteria species were found to be shared among the six species of wasps. The associate microbiota will help to understand the physiology of Telenomus to promote the use of these wasp parasitoids in the management of insect pests and as potential biomarkers to target new strategies to control pests.
Temporal Trends in Mental Disorder Rates among Patients with Colorectal Cancer: A Comprehensive Analysis
Authors: Roderburg Christoph , Loosen Sven H. , Leyh Catherine , Krieg Andreas , Krieg Sarah , Jördens Markus , Luedde Tom , Kostev Karel
Published: June 2024

Background: Colorectal cancer (CRC) stands as one of the most prevalent and burdensome malignancies worldwide. Similar to other cancers, CRC has been associated with the development of psychiatric diseases, including anxiety and depression. However, temporal trends in psychiatric disorders rates within CRC patients have not been investigated so far. Methods: The present study included 15,619 individuals with colorectal cancer and 78,095 propensity score-matched individuals without cancer, who were identified within the Disease Analyzer (IQVIA) database in Germany between 2005 and 2022. Cox regression analysis was conducted to assess the association between CHC and subsequent psychiatric diseases, including depression, anxiety disorders, and adjustment disorder, by period (2005–2010, 2011–2016, 2017–2022). Results: The 12-month cumulative incidence of any psychiatric disorder diagnosis in the CRC cohort increased from 6.3% in 2005–2010 to 8.2% in 2017–2022. The strongest increase was observed for reaction to severe stress and adjustment disorder (1.0% in 2005–2010 to 2.6% in 2017–2022). Notably, the strong increase in psychiatric disorders was not specific for cancer patients since a slight increase in psychiatric disorders was also observed in the non-cancer cohort. Regression analyses revealed that CRC was strongly and significantly associated with an increased risk of depression, anxiety disorders, reaction to severe stress and adjustment disorders, as well as any psychiatric disorder. Of note, the extent of the association was stronger in 2017–2022 compared to 2005–2010, clearly proving a “real” increase in the rates of psychiatric disorders over time. Conclusions: This study presents novel data from a large cohort of outpatients in Germany, providing strong evidence for an increase in psychiatric disorders in the recent years. These findings contribute to the existing body of literature and should trigger the recognition of psychiatric problems in cancer survivors.
Nutritional Trends in Cystic Fibrosis: Insights from the Italian Cystic Fibrosis Patient Registry
Authors: Salvatore Donatello , Padoan Rita , Amato Annalisa , Salvatore Marco , Campagna Giuseppe ,   on behalf of the Italian CF Registry Working Group
Published: June 2024

Background: Over the past decades, efforts have been made to improve the nutritional well-being of people with cystic fibrosis (pwCF). Due to the correlation observed between nutritional indices and lung function, prevailing recommendations consistently advocate for BMI percentile goals at or above the 50th percentile in pwCF. Recent global trends show a notable increase in overweight and obese statuses among pwCF. This study aims to explore the nutritional status of Italian pwCF. Methods: Data from the Italian CF Patient’s Registry were analysed to assess the proportion of individuals categorized as underweight, target weight, overweight, and obese from 2010 to 2021. Patient-level comparison data from 2021 were also examined to identify the potential determinants of overweight and obesity. Results: Analysis spanning 2010 to 2021 reveals a decrease of approximately 40% in underweight status among adults, while the proportion of malnourished patients younger than 18 years remained stable. Conversely, there was a substantial increase of over 70% in overweight status and over 85% in obesity among adults, with minor fluctuations observed among children and adolescents. Patient factors associated with increased obesity incidence included age older than 45 years, male gender, pancreatic sufficiency, possession of at least one CFTR variant conferring residual function, ppFEV1 > 90, and lower prevalence of Pseudomonas aeruginosa colonization. Conclusions: Our study confirms the evolving nutritional status landscape among Italian adult pwCF, with a significant shift towards overweight and obesity over the past decade. These trends highlight the need for proactive measures within CF standards of care to adapt and address the changing needs of patients.
Primary Tumor Sidedness Associated with Clinical Characteristics and Postoperative Outcomes in Colon Cancer Patients: A Propensity Score Matching Analysis
Authors: Hu Wan-Hsiang , Eisenstein Samuel , Parry Lisa , Ramamoorthy Sonia
Published: June 2024

Background: Recent investigations have suggested that-sidedness is associated with the prognosis of colon cancer patients. However, the role of sidedness in surgical outcome is unclear. In this study, we tried to demonstrate the real role of sidedness in postoperative results for colon cancer patients receiving surgical intervention. Methods: This is a propensity score matching study using the database of the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) from 2009 to 2013. Sidedness groups including right-sided and left-sided colon cancer were created according to the associated diagnosis and procedure codes. Postoperative 30-day mortality, morbidity, overall complications, and total length of hospital stay were analyzed after performing propensity score matching. Results: Out of a total of 24,436 colon cancer patients who received associated operations, 15,945 patients had right-sided cancer and 8941 patients had left-sided cancer. Right-sided colon cancer patients were accompanied by more preoperative comorbidities including old age, female sex, hypertension, dyspnea, anemia, hypoalbuminemia, and a high American Society of Anesthesiologists grade (SMD > 0.1). Postoperative mortality, morbidities including re-intubation, bleeding, urinary tract infection and deep vein thrombosis, postoperative overall complications, and total length of hospital stay were significantly associated with right-sided cancer (p < 0.05). After 1:1 propensity score matching, postoperative mortality was not significantly different between right-sided cancer (2.3%) and left-sided cancer (2.4%) patients. The patients with left-sided colon cancer had significantly more postoperative morbidities, more overall complications, and longer total length of hospital stay. Conclusions: Poor clinical characteristics and postoperative outcomes were noted in right-sided cancer patients. After propensity score matching, left-sided cancer patients had worse postoperative outcomes than those with right-sided cancer.
Sleep Disorders in Connective Tissue Diseases—Coexisting Diseases or Disease Components?
Authors: Cholerzyńska Hanna , Zasada Wiktoria , Tselios Konstantinos , Grygiel-Górniak Bogna
Published: June 2024

This comprehensive review examines the complex relationship between sleep disorders and rheumatic diseases, supported by findings from the latest research articles. It encompasses various rheumatic conditions, including rheumatoid arthritis, systemic lupus erythematosus, and systemic sclerosis. The review reveals the bidirectional relationship between sleep disorders and these diseases, emphasizing their impact on disease progression and quality of life. Conventional and alternative therapeutic interventions for connective tissue diseases are presented, focusing on improving sleep quality and alleviating rheumatic symptoms. The role of pro-inflammatory cytokines and their potential modulation through pharmacological agents is also discussed. In the treatment of sleep disorders, various options are proposed, such as cognitive behavioral therapy for insomnia, physical activity, dietary modifications, and alternative approaches like reflexology and acupuncture. Thus, this review offers a nuanced understanding of the connection between sleep disorders and rheumatic diseases, supported by evidence from diverse studies. Such an approach is particularly important because it enhances sleep quality for overall patient well-being in the holistic management of rheumatic conditions.
Exploring Headaches in Pediatric Behçet Disease: Prevalence, Clinical Impact, and Management
Authors: Santangelo Andrea , Corsello Antonio , Gizzi Gilda , Lancieri Maddalena , Diana Maria Cristina , Trucco Federica , Orsini Alessandro , Bonuccelli Alice , Peroni Diego Giampietro , Perilli Lorenzo , Correnti Edvige , Santangelo Giuseppe , Striano Pasquale , Raieli Vincenzo
Published: June 2024

Behçet’s Disease (BD), also recognized as Behçet Syndrome, manifests uniquely in pediatric populations as Pediatric Behçet’s Disease (PBD), characterized by multisystemic inflammatory symptoms including recurrent oral and genital aphthae, and diverse ocular, vascular, and neurological involvements. This review elucidates the prevalence, burden, and management strategies of headaches in children with PBD, focusing on both primary headaches, such as migraine and tension-type headaches, and secondary headaches linked to systemic disease manifestations. It explores the pathophysiological underpinnings specific to PBD-related headaches and discusses the intricate relationship between systemic inflammatory processes and neurological symptoms. By examining the literature from 2004 to 2024, this study highlights the high frequency of headache in PBD patients, underscoring its diagnostic and clinical significance. We aim to provide a detailed understanding of headache management in PBD, emphasizing tailored therapeutic strategies that address the unique challenges faced by this patient population. This review also underscores the importance of comprehensive clinical evaluations to optimize outcomes and mitigate long-term sequelae, proposing that awareness and understanding of headache in PBD can significantly enhance both diagnosis and management.
Long-Term Safety of Level II Oncoplastic Surgery after Neoadjuvant Treatment for Locally Advanced Breast Cancer: A 20-Year Experience
Authors: Sanchez Alejandro M. , De Lauretis Flavia , Bucaro Angela , Borghesan Niccolo , Pirrottina Chiara V. , Franco Antonio , Scardina Lorenzo , Giannarelli Diana , Millochau Jenny C. , Parapini Marina L. , Di Leone Alba , Marazzi Fabio , Orlandi Armando , Palazzo Antonella , Fabi Alessandra , Masetti Riccardo , Franceschini Gianluca
Published: June 2024

Background: Oncoplastic surgery (OPS) reliability in the post-neoadjuvant chemotherapy (NACT) setting is still debated due to weak scientific evidences in such scenarios. Methods: Our analysis aims to report results obtained in a retrospective series of 111 patients consecutively treated with level II OPS after NACT at the Multidisciplinary Breast Center of the Fondazione Policlinico Universitario Agostino Gemelli IRCCS between 1998 and 2018. The surgical endpoints were the mean specimen volume, rates of positive margins (PMR), re-excision (RR), conversion to mastectomy (CMR), and complications (CR). The oncological endpoints were overall survival (OS), disease-free survival (DFS), and local recurrence (LR). To evaluate the impact of NACT on surgical and oncological outcomes at 302 months, we conducted a propensity score matching, pairing patients in post-NACT and upfront surgery groups. Results: The mean sample volume was 390,796 mm3. We registered a 3.6% of PMR, 1.8% RR, 0.9% CMR, 5% CR. The 10-year OS and 10-year DFS with a median follow-up of 88 months (6–302) were 79% and 76%, respectively, with an LR recurrence rate of 5%. The post-NACT group received significantly larger excised volumes and lower PMR. NACT did not affect surgical and oncological outcomes. Conclusions: Level II OPS can be considered a reliable alternative to mastectomy even in the post-NACT setting.
Neurovascular Issues in Antiphospholipid Syndrome: Arterial Vasculopathy from Small to Large Vessels in a Neuroradiological Perspective
Authors: Zedde Marialuisa , Grisendi Ilaria , Assenza Federica , Napoli Manuela , Moratti Claudio , Lara Bonacini , Di Cecco Giovanna , D’Aniello Serena , Pavone Claudio , Pezzella Francesca Romana , Candelaresi Paolo , Andreone Vincenzo , Valzania Franco , Pascarella Rosario
Published: June 2024

Antiphospholipid syndrome (APS) is an autoimmune prothrombotic condition characterized by venous thromboembolism, arterial thrombosis, and pregnancy morbidity. Among neurological manifestations, arterial thrombosis is only one of the possible associated clinical and neuroradiological features. The aim of this review is to address from a neurovascular point of view the multifaceted range of the arterial side of APS. A modern neurovascular approach was proposed, dividing the CNS involvement on the basis of the size of affected arteries, from large to small arteries, and corresponding clinical and neuroradiological issues. Both large-vessel and small-vessel involvement in APS were detailed, highlighting the limitations of the available literature in the attempt to derive some pathomechanisms. APS is a complex disease, and its neurological involvement appears multifaceted and not yet fully characterized, within and outside the diagnostic criteria. The involvement of intracranial large and small vessels appears poorly characterized, and the overlapping with the previously proposed inflammatory manifestations is consistent.
Predicting Outcome in Clear Aligner Treatment: A Machine Learning Analysis
Authors: Wolf Daniel , Farrag Gasser , Flügge Tabea , Timm Lan Huong
Published: June 2024

Background/Objectives: Machine learning (ML) models predicting the risk of refinement (i.e., a subsequent course of treatment being necessary) in clear aligner therapy (CAT) were developed and evaluated. Methods: An anonymized sample of 9942 CAT patients (70.6% females, 29.4% males, age range 18–64 years, median 30.5 years), as provided by DrSmile, a large European CAT provider based in Berlin, Germany, was used. Three different ML methods were employed: (1) logistic regression with L1 regularization, (2) extreme gradient boosting (XGBoost), and (3) support vector classification with a radial basis function kernel. In total, 74 factors were selected as predictors for these methods and are consistent with clinical reasoning. Results: On a held-out test set with a true-positive rate of 0.58, the logistic regression model has an area under the ROC curve (AUC) of 0.67, an average precision (AP) of 0.73, and Brier loss of 0.22; the XGBoost model has an AUC of 0.67, an AP of 0.74, and Brier loss of 0.22; and the support vector model has a recall of 0.61 and a precision of 0.64. The logistic regression and XGBoost models identify predictors influencing refinement risk, including patient compliance, interproximal enamel reduction (IPR) and certain planned tooth movements, for example, lingual translation of maxillary incisors being associated with the lowest risk of refinement and rotation of mandibular incisors with the highest risk. Conclusions: These findings suggest moderate, well-calibrated predictive accuracy with both regularized logistic regression and XGBoost and underscore the influence the identified factors have on the risk of refinement in CAT, emphasizing their importance in the careful planning of orthodontic treatment and the potential for shorter treatment times, less patient discomfort, and fewer clinic visits. Identification of at-risk individuals could support tailored clinical decision-making and enable targeted interventions
Robotic-Assisted Pelvic Exenteration for Cervical Cancer: A Systematic Review and Novel Insights into Compartment-Based Imaging
Authors: Van Trappen Philippe , Walgraeve Marie-Sofie , Roels Sarah , Claes Nele , De Cuypere Eveline , Baekelandt Frederic , Arentsen Harm
Published: June 2024

Background: Patients with persistent or recurrent cervical cancer, following primary treatment with concurrent chemoradiation, represent a subgroup eligible for pelvic exenteration. In light of the substantial morbidity associated with open pelvic exenterations, minimally invasive surgical techniques have been introduced. This systematic review aims to analyze and discuss the current literature on robotic-assisted pelvic exenterations in cervical cancer. In addition, novel aspects of compartment-based magnetic resonance imaging (MRI) are highlighted. Methods: This systematic review followed the PRISMA guidelines, and a comprehensive literature search on robotic-assisted pelvic exenterations in cervical cancer was conducted to assess, as main objectives, early and late postoperative complications as well as oncological outcomes. Inclusion and exclusion criteria were applied to select eligible studies. Results: Among the reported cases of robotic-assisted pelvic exenterations in cervical cancer, 79.4% are anterior pelvic exenterations. Intraoperative complications are minimal and early/late major complications averaged between 30–35%, which is lower compared to open pelvic exenterations. Oncological outcomes are similar between robotic and open pelvic exenterations. Sensitivity for locoregional invasion increases up to 93% for compartment-based MRI in colorectal cancer. A refined delineation of the seven pelvic compartments for cervical cancer is proposed here. Conclusions: Robotic-assisted pelvic exenterations have demonstrated feasibility and safety, with reduced rates of major complications compared to open surgery, while maintaining surgical efficiency and oncological outcomes. Compartment-based MRI holds promise for standardizing the selection and categorization of pelvic exenteration procedures.
Diagnostic and Prognostic Value of Right Ventricular Fat Quantification from Computed Tomography in Arrhythmogenic Right Ventricular Cardiomyopathy
Authors: Faga Valentina , Ruiz Cueto María , Viladés Medel David , Moreno-Weidmann Zoraida , Dallaglio Paolo D. , Diez Lopez Carles , Roura Gerard , Guerra Jose M. , Leta Petracca Rubén , Gomez-Hospital Joan Antoni , Comin Colet Josep , Anguera Ignasi , Di Marco Andrea
Published: June 2024

Background: In arrhythmogenic right ventricular cardiomyopathy (ARVC) non-invasive scar evaluation is not included among the diagnostic criteria or the predictors of ventricular arrhythmias (VA) and sudden death (SD). Computed tomography (CT) has excellent spatial resolution and allows a clear distinction between myocardium and fat; thus, it has great potential for the evaluation of myocardial scar in ARVC. Objective: The objective of this study is to evaluate the feasibility, and the diagnostic and prognostic value of semi-automated quantification of right ventricular (RV) fat replacement from CT images. Methods: An observational case–control study was carried out including 23 patients with a definite (19) or borderline (4) ARVC diagnosis and 23 age- and sex-matched controls without structural heart disease. All patients underwent contrast-enhanced cardiac CT. RV images were semi-automatically reconstructed with the ADAS-3D software (ADAS3D Medical, Barcelona, Spain). A fibrofatty scar was defined as values of Hounsfield Units (HU) <−10. Within the scar, a border zone (between −10 HU and −50 HU) and dense scar (<−50 HU) were distinguished. Results: All ARVC patients had an RV scar and all scar-related measurements were significantly higher in ARVC cases than in controls (p < 0.001). The total scar area and dense scar area showed no overlapping values between cases and controls, achieving perfect diagnostic performance (sensitivity and specificity of 100%). Among ARVC patients, 16 (70%) had experienced sustained VA or aborted SD. Among all clinical, ECG and imaging parameters, the dense scar area was the only one with a statistically significant association with VA and SD (p = 0.003). Conclusions: In ARVC, RV myocardial fat quantification from CT is feasible and may have considerable diagnostic and prognostic value.
Proposed Clinical Algorithm for Pleuroparenchymal Fibroelastosis (PPFE)
Authors: Yamakawa Hideaki , Oda Tsuneyuki , Sugino Keishi , Hirama Takashi , Komatsu Masamichi , Katano Takuma , Fukuda Taiki , Takemura Tamiko , Kubota Yoshiaki , Kishaba Tomoo , Norisue Yasuhiro , Araya Jun , Ogura Takashi
Published: June 2024

Pleuroparenchymal fibroelastosis (PPFE) is characterized by fibrosis involving the pleura and subpleural lung parenchyma, predominantly in the upper lobes. As PPFE appears to occur in patients with heterogeneous etiologies, the disease course is thus also heterogenous, with some patients showing rapid progression while others have slow progression. Therefore, it is very difficult to predict prognosis with PPFE. Needless to say, this problematic matter has influenced the treatment strategy of PPFE patients. In fact, until now no evidence has been shown for use in creating an appropriate management algorithm for PPFE. We speculate that “uncoordinated breathing” is the most important reason for dyspnea in PPFE patients. Because monitoring of physique and not just pulmonary function and radiological evaluation is also very important, particularly in PPFE patients, this review focused on the characteristics of PPFE through an overview of previous studies in this field, and we proposed an algorithm as precision medicine based on the current evidence. Multiple views by the pulmonologist are needed to standardize a clinical algorithm that is necessary to correctly assess PPFE patients under the premise of maintenance of physique by providing appropriate nutritional care and pulmonary rehabilitation.
Health-Related Quality of Life Using the KIDSCREEN-27 Questionnaire among Adolescents with High Myopia
Authors: Zawistowska Joanna , Powierza Katarzyna , Sawicka-Powierza Jolanta , Macdonald Justyna , Czerniawska Mirosława , Macdonald Alexandra , Przystupa Zuzanna , Bakunowicz-Łazarczyk Alina
Published: June 2024

Background/Objectives: The aim of the study was to explore Health-Related Quality of Life (HRQoL) using the KIDSCREEN-27 questionnaire among adolescents with high myopia (HM). Methods: Sixty-nine adolescents with HM and 71 healthy participants aged 12–17 years and their parents or legal guardians were enrolled in the study. Results: Adolescents with HM showed significantly lower scores on the Physical Well-Being dimension in comparison with controls (p = 0.003), particularly girls with HM in comparison with girls from the control group (p = 0.008), and 15–17-year-old adolescents in comparison with same-aged controls (p = 0.020). Girls with HM were characterised by significantly worse scores on the Psychological Well-Being dimension compared with boys with HM (p < 0.042). Sociodemographic factors and refractive error, its duration, and acceptance of disease had no impact on HRQoL. Conclusions: HM may have a negative impact on the HRQoL of children, affecting particularly the physical and psychological well-being of girls. It is important that a holistic approach to the treatment of HM in adolescents is taken by measuring their HRQoL as part of the routine diagnostic process. Use of the KIDSCREEN-27 questionnaire seems justified as it allows for determination of the type of intervention required to improve the HRQoL of individuals affected by the disease.
Use of HugoTM RAS in General Surgery: The First 70 Cases at a German Centre and a Systematic Review of the Literature
Authors: Belyaev Orlin , Fahlbusch Tim , Slobodkin Illya , Uhl Waldemar
Published: June 2024

Introduction: The versatile open modular design of the newly introduced robotic platform HugoTM RAS is expected to allow its rapid spread in general surgery. However, the system is not yet approved for use in oesophageal and HPB-surgery and is not licensed worldwide. The aim of this work was to review the current spectrum of general surgical procedures that may be feasibly and safely performed with Hugo. Methods: We retrospectively reviewed our own series and performed a systematic review of all the published reports of general surgical procedures performed with this system in the literature. Results: Seventy patients underwent general surgery with Hugo at our institution, and another 99 patients were reported in the literature. The most common procedures were colorectal (n = 55); cholecystectomy (n = 44); repair of groin, ventral and hiatal hernias (n = 34); upper GI (n = 28); adrenalectomy (n = 6); and spleen cyst deroofing (n = 2). No device-related complications were reported. Arm collisions and technical problems were rare. The docking and console times improved in all series. The port positions and robotic arm configurations varied among authors and depended on the surgical indication, patient characteristics and surgeon’s preference. Conclusions: A wide spectrum of general surgical procedures has been safely and effectively performed with the Hugo RAS, even by robotically inexperienced teams with a limited choice of instruments. Technical improvements to the system and the introduction of robotic energy devices may help Hugo evolve to a vital alternative to established robotic systems.
Pregnancy and Childbirth Fear of Women from Poland, Greece, Turkey, Belarus, and Russia
Authors: Kułak Bejda Agnieszka , Kourkouta Lambrini , Tsaloglidou Areti , Koukourikos Konstantinos , Aydin Avci Ilknur , Çelik Eren Dilek , Shpakou Andrei , Khvoryk Natallia , Hutsikava Liudmila , Waszkiewicz Napoleon
Published: June 2024

Background/Objectives: Pregnancy and childbirth in many women cause various situations, from physical to emotional. The analysis of selected factors affecting pregnancy and childbirth in a group of women from Poland, Greece, Turkey, Belarus, and Russia and self-assessment of their impact on fear of pregnancy and childbirth. Material and Methods: A total of 2017 women were surveyed, including 584 pregnant women, 528 postpartum women, and 906 non-pregnant and never-pregnant women. The study used an original questionnaire, including questions on socio-demographics and the history of pregnancy and childbirth. The material status of the respondents was assessed using the Family Affluence Scale. Results: The age range of respondents was 19–50. The surveyed women most often reported (p < 0.001) fear (n = 928) and excitement (n = 901). A positive correlation was found between anemia, infections, and fear in women from Belarus. No correlation was found between low, average, or high material status and the perception of pregnancy in women from the studied countries. Significantly (p < 0.001), women from Turkey had more children (p < 0.001) than women from other countries. With the exception of Russia, statistical correlations were shown between the feeling of fear of pregnancy and childbirth and the way the previous/current pregnancy was delivered and the experience of an artificial/natural miscarriage in the past. In general, 630 women had given birth vaginally, and 283 women had given birth by cesarean section. In the group of currently pregnant women, 22 women had had natural miscarriages in Belarus, 37 in Poland, 27 in Greece, 29 in Turkey, and 9 in Russia. Conclusions: When thinking about pregnancy, respondents in all groups most often felt joy and excitement, as well as fear and excitement, about childbirth. Natural miscarriage was experienced most frequently by women in Poland and Greece and induced in Belarus. The largest number of women who had cesarean section were from Poland and Belarus.
Clinical Significance of the Inferomedial Orbital Strut in Orbital Blowout Fractures: Incidence of Symptomatic Diplopia in a Fractured vs. Intact Strut
Authors: Someda Steffani Krista , Miyazaki Hidetaka , Kakizaki Hirohiko , Takahashi Yasuhiro
Published: June 2024

Background/Objectives: This study aims to compare the clinical findings, particularly symptomatic diplopia, associated with an inferomedial orbital strut fracture versus intact strut and to determine the clinical significance of the inferomedial orbital strut in patients with orbital floor and medial orbital wall fractures. Methods: A 10-year retrospective observational study involving orbital blowout fracture cases was conducted in our institution. Patients with fractures of the orbital floor medial to the infraorbital groove and medial orbital wall, as seen on computed tomography (CT) scans, were included in this study. Patients with concomitant orbital rim fracture and those with old orbital fractures were excluded. Fracture of the inferomedial orbital strut was diagnosed via coronal CT images and patients were classified into those with an inferomedial orbital strut fracture and those without. Results: A total of 231 orbits from 230 patients was included in the study (fractured strut on 78 sides and intact strut on 153 sides). Approximately 2/3 of patients in both groups had the field of binocular single vision in primary position upon first examination (p = 0.717). Patients with strut fractures demonstrated only comminuted or open fractures, while those without strut fractures showed diverse fracture patterns (p < 0.001). Conclusions: Inferomedial orbital strut fracture does not automatically result in diplopia in patients with orbital blowout fractures. The integrity of the orbital periosteum plays a more essential role in hampering extraocular muscle displacement, thereby preventing symptomatic diplopia in these patients.
The Tri-Steps Model of Critical Conditions in Intensive Care: Introducing a New Paradigm for Chronic Critical Illness
Authors: Likhvantsev Valery V. , Berikashvili Levan B. , Yadgarov Mikhail Ya. , Yakovlev Alexey A. , Kuzovlev Artem N.
Published: June 2024

Background: The prevailing model for understanding chronic critical illness is a biphasic model, suggesting phases of acute and chronic critical conditions. A major challenge within this model is the difficulty in determining the timing of the process chronicity. It is likely that the triad of symptoms (inflammation, catabolism, and immunosuppression [ICIS]) could be associated with this particular point. We aimed to explore the impact of the symptom triad (inflammation, catabolism, immunosuppression) on the outcomes of patients hospitalized in intensive care units (ICUs). Methods: The eICU-CRD database with 200,859 ICU admissions was analyzed. Adult patients with the ICIS triad, identified by elevated CRP (>20 mg/L), reduced albumin (<30 g/L), and low lymphocyte counts (<0.8 × 109/L), were included. The cumulative risk of developing ICIS was assessed using the Nelson–Aalen estimator. Results: This retrospective cohort study included 894 patients (485 males, 54%), with 60 (6.7%) developing ICIS. The cumulative risk of ICIS by day 21 was 22.5%, with incidence peaks on days 2–3 and 10–12 after ICU admission. Patients with the ICIS triad had a 2.5-fold higher mortality risk (p = 0.009) and double the likelihood of using vasopressors (p = 0.008). The triad onset day did not significantly affect mortality (p = 0.104). Patients with ICIS also experienced extended hospital (p = 0.041) and ICU stays (p < 0.001). Conclusions: The symptom triad (inflammation, catabolism, immunosuppression) during hospitalization increases mortality risk by 2.5 times (p = 0.009) and reflects the chronicity of the critical condition. Identifying two incidence peaks allows the proposal of a new Tri-steps model of chronic critical illness with acute, extended, and chronic phases.
Acoustic Emission during Non-Uniform Progression of Processes in Composite Failure According to the Von Mises Criterion
Authors: Filonenko Sergii , Stakhova Anzhelika , Bekö Adrián , Grmanova Alzbeta
Published: June 2024

In the study, based on the model of acoustic emission during the destruction of a composite material by shear force according to the Von Mises criterion, the effect of non-uniformity of the destruction process on the generated acoustic emission signal is simulated. The study under the accepted modeling conditions allows us to determine the patterns of changes in the amplitude envelope of acoustic emission signals at various stages of developing processes. In theoretical and experimental studies of acoustic emission signals when searching for patterns in their parameter changes and developing methods for monitoring or diagnosing the state of composite materials, the problem lies in the interpretation of recorded information. This issue arises from the complexity and diversity of processes occurring in the material structure at micro and macro levels, and the high sensitivity of the acoustic emission method to these processes, wherein structural changes lead to observable alterations in the characteristics of acoustic emissions. Solving this problem requires both theoretical and experimental studies to understand the influence of various factors on the characteristics of the generated acoustic emission. The results of the presented study can be used to assess the condition of composite materials and structures, such as bridges, e.g., in terms of defectiveness, property dispersion, damage during operation, and other characteristics.
A Critical Review of Cold-Formed Steel Built-Up Composite Columns with Geopolymer Concrete Infill
Authors: Sara Simon Serene , Kafle Bidur , Al-Ameri Riyadh
Published: June 2024

Concrete-filled built-up cold-formed steel (CFS) columns offer enhanced load-carrying capacity, improved strength-to-weight ratios, and delayed buckling through providing internal resistance and stiffness due to the concrete infill. Integrating sustainable alternatives like self-compacting geopolymer concrete (SCGC) with low carbon emissions is increasingly favoured for addressing environmental concerns in construction. This review aims to explore the current knowledge regarding CFS built-up composite columns and the performance of SCGC within them. While research on geopolymer concrete-filled steel tubes (GPCFSTs) under various loads has demonstrated high strength and ductility, investigations into built-up sections remain limited. The literature suggests that geopolymer concrete’s superior compressive strength, fire resistance, and minimal shrinkage render it highly compatible with steel tubular columns, providing robust load-bearing capacity and gradual post-ultimate strength, attributed to the confinement effect of the outer steel tubes, thereby preventing brittle failure. Additionally, in built-up sections, connector penetration depth and spacing, particularly at the ends, enhances structural performance through composite action in CFS structures. Consequently, understanding the importance of using a sustainable and superior infill like SCGC, the cross-sectional efficiency of CFS sections, and optimal shear connections in built-up CFS columns is crucial. Moreover, there is a potential for developing environmentally sustainable built-up CFS composite columns using SCGC cured at ambient temperatures as infill.