bluuebunny/crossref_metadata_2025 huggingface dataset:
Oxidation of DJ-1 Cysteines in Retinal Pigment Epithelium Function
Authors: Bhattacharyya Sanghamitra , Sturgis Johnathon , Maminishkis Arvydas , Miller Sheldon S. , Bonilha Vera L.
Published: September 2022

The retina and RPE cells are regularly exposed to chronic oxidative stress as a tissue with high metabolic demand and ROS generation. DJ-1 is a multifunctional protein in the retina and RPE that has been shown to protect cells from oxidative stress in several cell types robustly. Oxidation of DJ-1 cysteine (C) residues is important for its function under oxidative conditions. The present study was conducted to analyze the impact of DJ-1 expression changes and oxidation of its C residues on RPE function. Monolayers of the ARPE-19 cell line and primary human fetal RPE (hfRPE) cultures were infected with replication-deficient adenoviruses to investigate the effects of increased levels of DJ-1 in these monolayers. Adenoviruses carried the full-length human DJ-1 cDNA (hDJ) and mutant constructs of DJ-1, which had all or each of its three C residues individually mutated to serine (S). Alternatively, endogenous DJ-1 levels were decreased by transfection and transduction with shPARK7 lentivirus. These monolayers were then assayed under baseline and low oxidative stress conditions. The results were analyzed by immunofluorescence, Western blot, RT-PCR, mitochondrial membrane potential, and viability assays. We determined that decreased levels of endogenous DJ-1 levels resulted in increased levels of ROS. Furthermore, we observed morphological changes in the mitochondria structure of all the RPE monolayers transduced with all the DJ-1 constructs. The mitochondrial membrane potential of ARPE-19 monolayers overexpressing all DJ-1 constructs displayed a significant decrease, while hfRPE monolayers only displayed a significant decrease in their ΔΨm when overexpressing the C2S mutation. Viability significantly decreased in ARPE-19 cells transduced with the C53S construct. Our data suggest that the oxidation of C53 is crucial for regulating endogenous levels of ROS and viability in RPE cells.
Virtual CT Myelography: A Patch-Based Machine Learning Model to Improve Intraspinal Soft Tissue Visualization on Unenhanced Dual-Energy Lumbar Spine CT
Authors: Nguyen Xuan V. , Nelakurti Devi D. , Dikici Engin , Candemir Sema , Boulter Daniel J. , Prevedello Luciano M.
Published: September 2022

Background: Distinguishing between the spinal cord and cerebrospinal fluid (CSF) non-invasively on CT is challenging due to their similar mass densities. We hypothesize that patch-based machine learning applied to dual-energy CT can accurately distinguish CSF from neural or other tissues based on the center voxel and neighboring voxels. Methods: 88 regions of interest (ROIs) from 12 patients’ dual-energy (100 and 140 kVp) lumbar spine CT exams were manually labeled by a neuroradiologist as one of 4 major tissue types (water, fat, bone, and nonspecific soft tissue). Four-class classifier convolutional neural networks were trained, validated, and tested on thousands of nonoverlapping patches extracted from 82 ROIs among 11 CT exams, with each patch representing pixel values (at low and high energies) of small, rectangular, 3D CT volumes. Different patch sizes were evaluated, ranging from 3 × 3 × 3 × 2 to 7 × 7 × 7 × 2. A final ensemble model incorporating all patch sizes was tested on patches extracted from six ROIs in a holdout patient. Results: Individual models showed overall test accuracies ranging from 99.8% for 3 × 3 × 3 × 2 patches (N = 19,423) to 98.1% for 7 × 7 × 7 × 2 patches (N = 1298). The final ensemble model showed 99.4% test classification accuracy, with sensitivities and specificities of 90% and 99.6%, respectively, for the water class and 98.6% and 100% for the soft tissue class. Conclusions: Convolutional neural networks utilizing local low-level features on dual-energy spine CT can yield accurate tissue classification and enhance the visualization of intraspinal neural tissue.
Wolbachia in Black Spiny Whiteflies and Their New Parasitoid Wasp in Japan: Evidence of the Distinct Infection Status on Aleurocanthus camelliae Cryptic Species Complex
Authors: Andrianto Eko , Kasai Atsushi
Published: September 2022

Wolbachia, an alphaproteobacterial reproductive parasite, can cause profound mitochondrial divergence in insects, which might eventually be a part of cryptic speciation. Aleurocanthus camelliae is a cryptic species complex consisting of several morphospecies and/or haplotypes that are genetically different but morphologically indistinctive. However, little is known about the Wolbachia infection status in these tea and Citrus pests. Thus, this study aimed to profile the diversity and phenotypic characteristics of Wolbachia natural infections in the A. camelliae cryptic species complex. A monophyletic strain of Wolbachia that infected the A. camelliae cryptic species complex (wAlec) with different patterns was discovered. Whiteflies that are morphologically identical to Aleurocanthus spiniferus (Aleurocanthus cf. A. spiniferus in Eurya japonica and A. spiniferus in Citrus) were grouped into uninfected populations, whereas the fixed infection was detected in A. camelliae B1 from Theaceae. The rapid evolution of wAlec was also found to occur through a high recombination event, which produced subgroups A and B in wAlec. It may also be associated with the non-cytoplasmic incompatibility (CI) phenotype of wAlec due to undetectable CI-related genes from phage WO (WOAlec). The current discovery of a novel cryptic species of A. camelliae led to a discussion about the oscillation hypothesis, which may provide insights on cryptic speciation, particularly on how specialization and host expansion have been recorded among these species. This study also identified a parasitoid wasp belonging to the genus Eretmocerus in A. camelliae, for the first time in Japan.
Obesity Surgery Improves Hypogonadism and Sexual Function in Men without Effects in Sperm Quality
Authors: Miñambres Inka , Sardà Helena , Urgell Eulalia , Genua Idoia , Ramos Analía , Fernández-Ananin Sonia , Balagué Carmen , Sánchez-Quesada Jose Luis , Bassas Lluís , Pérez Antonio
Published: September 2022

(1) Background: Obesity is associated with hypogonadism, sexual dysfunction, and impaired fertility in men. However, its effects on semen parameters or sexual function remain debatable. (2) Methods: This paper involves a longitudinal study in men submitted for obesity surgery at a university tertiary hospital. Patients were studied at baseline and at 6, 12, and 18 months after obesity surgery. At each visit, anthropometry measures were collected and hormonal and semen parameters were studied. Sexual function was evaluated with the International Index of Erectile Function (IIEF). (3) Results: A total of 12 patients were included. The average body mass index of patients decreased from 42.37 ± 4.44 to 29.6 ± 3.77 kg/m2 at 18 months after surgery (p < 0.05). Hormonal parameters improved after obesity surgery. The proportion of sperm cells with normal morphology tended to decrease from baseline and became most significant at 18 months (5.83 ± 4.50 vs. 2.82 ± 2.08). No significant changes were found in the remaining semen parameters. Erectile function improved significantly at six months after surgery. (4) Conclusions: The authors believe that, in general, the effects of obesity surgery on fertility may be limited or even deleterious (at least in the short and midterm follow-up).
Intravenous Corticosteroid Therapy for Acute Lumbar Radicular Pain
Authors: Hershkovich Oded , Mor Yaakov , Lotan Raphael
Published: September 2022

Introduction: The efficacy of pharmacological interventions for acute lumbar radicular pain (ALRP) is limited, and systemic steroid use remains controversial. We evaluated the effectiveness and tolerance of systemic steroid use in a cohort of patients with ALRP. Methods: A retrospective cohort of 56 patients (including 24 females) were admitted with intractable ALRP resistance to conservative treatment of NSAIDs and opiates between the years 2016 and 2018. Medical records were studied for demographics, physical examination findings, Visual Analogue Score (VAS), IV steroids side effects, and recent imaging findings. All patients received a daily dose of IV 24 mg Dexamethasone until discharge, SNRB, or surgery. Results: The average IV steroid treatment was 3.9 (±2.8) days, with most patients showing significant pain relief allowing discharge (69.7%). SNRB was required in 19.6% and surgical intervention in 10.7% within the same admission. Multivariate analysis did not find any parameter to predict treatment failure (age, gender, motor/sensory deficit, CT/MRI findings). The motor deficit, positive straight leg raising (SLR), and dural sac compression on CT were higher in the intervention group but did not reach statistical significance. One patient required discontinuation of IV steroids due to elevated blood pressure. Conclusions: Despite the insufficient evidence in the literature, IV steroid treatment is still a viable option in ALRP treatment, with pain relief allowing discharge in 70% of patients and a low complication rate. Our study found daily 24 mg IV dexamethasone for ALRP to be an effective treatment and helpful in most patients admitted. This study supports the common practice used by spine units.
The Genomic Environment of BRAF Mutated and BRAF/PIK3CA Double Mutated Colorectal Cancers
Authors: Voutsadakis Ioannis A.
Published: September 2022

Background: Colorectal cancer represents the most prevalent gastrointestinal malignancy. Prognosis of metastatic disease has improved in recent years with the introduction of effective systemic therapies, but mean survival remains in the range of two to three years. Targeted therapies based on specific molecular alterations in sub-sets of colorectal cancers have the potential of contributing to therapeutic progress. BRAF and PIK3CA are oncogenic kinases commonly mutated in colorectal cancers and can be targeted through small molecule kinase inhibitors. Methods: Clinical and genomic data from two extensive series of colorectal cancers were interrogated to define the molecular characteristics of cancers with BRAF mutations with and without concomitant mutations in PIK3CA. Results: Colorectal cancers that are BRAF and PIK3CA double mutants represent a small minority of about 5% of colorectal cancers in the two examined series of mostly localized disease. They also represent about one third of all BRAF mutated colorectal cancers. Most mutations in BRAF are classic V600E mutations. A high prevalence of MSI and CIMP is observed in BRAF mutated colorectal cancers with or without PIK3CA mutations. Mutations in tumor suppressors FBXW7 and ATM display a higher prevalence in BRAF mutated cancers. The prognosis of BRAF mutated colorectal cancers with or without PIK3CA mutations is not significantly different than counterparts with wild type BRAF. This contrasts with the known adverse prognostic effect of BRAF in metastatic disease and relates to the different prevalence of MSI in mutant BRAF localized versus metastatic colorectal cancers. Conclusions: BRAF mutations are the defining molecular alterations in double mutant BRAF and PIK3CA colorectal cancers as determined by increased MSI and CIMP in BRAF subsets with and without PIK3CA mutations. Moreover, BRAF mutated cancers with and without PIK3CA mutations are characterized by the absence of KRAS mutations and a lower prevalence of APC mutations than BRAF wild type counterparts. Mismatch-repair-associated gene mutations display higher frequencies in BRAF mutated colorectal cancers. Despite the absence of prognosis implications of BRAF mutations in the studied cohorts of mostly localized cancers, such mutations could be prognostic in certain subsets. The presence of mutations in other genes, such as ATM and high MSI status present opportunities for combination therapies.
Structure-Function Relationship in Patients with Retinitis Pigmentosa and Hyperautofluorescent Rings
Authors: Kim Soung Jun , Song Chae Hyun , Bae Kun Ho , Yoon Chang Ki , Park Un Chul , Lee Eun Kyoung
Published: September 2022

This study aimed to investigate the association between retinal sensitivity and retinal microstructures in fundus autofluorescence (FAF) and optical coherence tomography (OCT) in patients with retinitis pigmentosa (RP) and hyperautofluorescent (hyperAF) rings. This cross-sectional study included 44 eyes from 26 consecutive patients with RP. The morphological geometry of the hyperAF ring, such as three distinct FAF regions, hyperAF ring area, and longest diameter of the hyperAF ring on FAF, and the retinal microstructure, such as total retinal thickness (TRT) and outer retinal thickness (ORT), on OCT, were evaluated. A strong correlation of mean retinal sensitivity with hyperAF ring area (R = 0.8013, p < 0.001) and longest diameter of the hyperAF ring (R = 0.9072, p < 0.001) was observed. Segmented linear regression (SLR) analysis revealed breakpoints of 12.83 mm2 and 5.21 mm, respectively. ORT (R = 0.6551, p < 0.001) was more strongly correlated with retinal sensitivity than TRT (R = 0.2732, p < 0.001). SLR analysis revealed a breakpoint between the ORT and retinal sensitivity of 145.12 μm. In patients with RP and hyperAF rings, retinal sensitivity was strongly associated with the morphological geometry of the hyperAF ring. ORT, rather than TRT, strongly correlated with retinal sensitivity.
Advances in Optical Coherence Tomography Imaging Technology and Techniques for Choroidal and Retinal Disorders
Authors: Ong Joshua , Zarnegar Arman , Corradetti Giulia , Singh Sumit Randhir , Chhablani Jay
Published: September 2022

Optical coherence tomography (OCT) imaging has played a pivotal role in the field of retina. This light-based, non-invasive imaging modality provides high-quality, cross-sectional analysis of the retina and has revolutionized the diagnosis and management of retinal and choroidal diseases. Since its introduction in the early 1990s, OCT technology has continued to advance to provide quicker acquisition times and higher resolution. In this manuscript, we discuss some of the most recent advances in OCT technology and techniques for choroidal and retinal diseases. The emerging innovations discussed include wide-field OCT, adaptive optics OCT, polarization sensitive OCT, full-field OCT, hand-held OCT, intraoperative OCT, at-home OCT, and more. The applications of these rising OCT systems and techniques will allow for a closer monitoring of chorioretinal diseases and treatment response, more robust analysis in basic science research, and further insights into surgical management. In addition, these innovations to optimize visualization of the choroid and retina offer a promising future for advancing our understanding of the pathophysiology of chorioretinal diseases.
Hepatic Fibrosis Is a Risk Factor for Greater Severity and Worse Outcome of Acute Ischemic Stroke
Authors: Ztriva Eleftheria , Protopapas Adonis , Mentizis Pavlos , Papadopoulos Anastasios , Gogou Christiana , Kiosi Maria , Kyziroglou Maria , Minopoulou Ioanna , Gkounta Anastasia , Papathanasiou Erofili , Cholongitas Evangelos , Savopoulos Christos , Tziomalos Konstantinos
Published: September 2022

Background: Nonalcoholic fatty liver disease, particularly in the presence of hepatic fibrosis, is associated with an increased risk of cardiovascular events, including ischemic stroke. However, it is unclear whether hepatic fibrosis is associated with the severity and outcome of acute ischemic stroke. Aim: To evaluate the relationship between hepatic fibrosis and the severity at admission and in-hospital outcome of acute ischemic stroke. Patients and methods: We prospectively studied all patients who were admitted to our department with acute ischemic stroke between September 2010 and February 2018 (n = 1107; 42.1% males, age 79.8 ± 7.2 years). The severity of stroke was assessed at admission with the National Institutes of Health Stroke Scale (NIHSS). Severe stroke was defined as NIHSS ≥ 21. The presence of hepatic fibrosis was evaluated with the Fibrosis-4 index (FIB-4). The outcome was assessed with dependency at discharge (modified Rankin Scale between 2 and 5) and with in-hospital mortality. Results: Patients with severe stroke had a higher FIB-4 index than patients with non-severe stroke (2.7 ± 1.7 and 2.3 ± 1.4, respectively; p < 0.05). Independent risk factors for severe IS were age (relative risk (RR) 1.064, 95% confidence interval (CI) 1.030–1.100, p < 0.001), female sex (RR 1.723, 95% CI 1.100–2.698, p = 0.012), atrial fibrillation (RR 1.869, 95% CI 1.234–2.831, p = 0.002), diastolic blood pressure (DBP) (RR 1.019, 95% CI 1.006–1.033, p = 0.001), and the FIB-4 index (RR 1.130, 95% CI 1.007–1.268, p = 0.022). At discharge, 64.2% of patients were dependent. The FIB-4 index did not differ between patients who were dependent and those who were independent at the time of discharge (2.3 ± 1.5 and 2.1 ± 1.2, respectively; p = 0.061). During hospitalization, 9.8% of patients died. Patients who died during hospitalization had a higher FIB-4 index than those who were discharged (2.9 ± 1.8 and 2.3 ± 1.4, respectively; p < 0.005). Independent risk factors for in-hospital mortality were DBP (RR 1.022, 95% CI 1.010–1.034, p < 0.001), serum glucose levels (RR 1.004, 95% CI 1.001–1.007, p = 0.007), serum triglyceride levels (RR 0.993, 95% CI 0.987–0.999, p = 0.023), NIHSS (RR 1.120, 95% CI 1.092–1.149, p < 0.001), and the FIB-4 index (RR 1.169, 95% CI 1.060–1.289, p = 0.002). Conclusions: Hepatic fibrosis, evaluated with the FIB-4 index, appears to be associated with more severe ischemic stroke and might also represent an independent risk factor for in-hospital mortality in patients admitted with acute ischemic stroke.
The Association between Acute Myocardial Infarction-Related Outcomes and the Ramadan Period: A Retrospective Population-Based Study
Authors: Betesh-Abay Batya , Shiyovich Arthur , Davidian Shani , Gilutz Harel , Shalata Walid , Plakht Ygal
Published: September 2022

Fasting throughout the Muslim month of Ramadan may impact cardiovascular health. This study examines the association between the Ramadan period and acute myocardial infarction (AMI)-related outcomes among a Muslim population. The data were retrospectively extracted from a tertiary hospital (Beer-Sheva, Israel) database from 2002–2017, evaluating Muslim patients who endured AMI. The study periods for each year were: one month preceding Ramadan (reference period (RP)), the month of Ramadan, and two months thereafter (1840 days in total). A comparison of adjusted incidence rates between the study periods was performed using generalized linear models; one-month post-AMI mortality data were compared using a generalized estimating equation. Out of 5848 AMI hospitalizations, 877 of the patients were Muslims. No difference in AMI incidence between the Ramadan and RP was found (p = 0.893). However, in the one-month post-Ramadan period, AMI incidence demonstrably increased (AdjIRR = 3.068, p = 0.018) compared to the RP. Additionally, the highest risk of mortality was observed among the patients that underwent AMI in the one-month post-Ramadan period (AdjOR = 1.977, p = 0.004) compared to the RP. The subgroup analyses found Ramadan to differentially correlate with AMI mortality with respect to smoking, age, sex, diabetes mellitus, and hypertension, suggesting the Ramadan period is a risk factor for adverse AMI-related outcomes among select Muslim patients.
Effect of High-Intensity Strength and Endurance Training in the Form of Small Circuits on Changes in Lipid Levels in Men Aged 35–40 Years
Authors: Ambroży Tadeusz , Rydzik Łukasz , Obmiński Zbigniew , Spieszny Michał , Szczepanik Antoni , Ambroży Dorota , Basiaga-Pasternak Joanna , Spieszny Jakub , Niewczas Marta , Jaszczur-Nowicki Jarosław
Published: September 2022

Background: Blood lipid profiles consist of total cholesterol (TC) and its fractions, high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), non-high-density lipoprotein cholesterol (non-HDL), and triglycerides (TG). For several decades, studies have examined the effects of various factors on lipid status and its association with the risk of developing arteriosclerosis and cardiovascular disease. The beneficial effects of increased physical activity on cardiovascular health have been demonstrated by appropriate modulation of lipid profiles. For individuals with low physical activity, the literature recommends engaging in various forms of training that can improve physical fitness and resting lipid status. The aim of the study was to examine whether a specific original training program improves lipid profiles to the levels recommended for the male population. Methods: The study involved two equal (n = 15) groups of men (experimental and control groups, aged 35–40 years). The experimental group performed 60-min training sessions for 8 weeks (3 times a week) including a set of strength and endurance exercises. Before and after the training program, blood was drawn from both groups for serum determination of TC, HDL, LDL non-HDL, and TG, and a battery of four field physical performance tests was administered. Results: Statistically significant decreases (TC by 19.3%, TG by 23.7%, LDL by 15%), a non-significant decrease (10% for non-HDL), and no change for HDL were found in the experimental group. Control group showed a statistically significant decrease, by 7.4% for TC. The results confirm the effectiveness of the proposed training in improving health indices. Conclusions: The 8-week training program met the health-related fitness paradigm recommended for physical activity in men aged 35–40 years. After the completion of the program, all the participants expressed their satisfaction from participating in a health-promoting experiment.
Anticoagulation Strategies during Extracorporeal Membrane Oxygenation: A Narrative Review
Authors: Rajsic Sasa , Breitkopf Robert , Jadzic Dragana , Popovic Krneta Marina , Tauber Helmuth , Treml Benedikt
Published: September 2022

The development of extracorporeal life support technology has added a new dimension to the care of critically ill patients who fail conventional treatment options. Extracorporeal membrane oxygenation (ECMO)—specialized temporary life support for patients with severe cardiac or pulmonary failure—plays a role in bridging the time for organ recovery, transplant, or permanent assistance. The overall patient outcome is dependent on the underlying disease, comorbidities, patient reaction to critical illness, and potential adverse events during ECMO. Moreover, the contact of the blood with the large artificial surface of an extracorporeal system circuit triggers complex inflammatory and coagulation responses. These processes may further lead to endothelial injury and disrupted microcirculation with consequent end-organ dysfunction and the development of adverse events like thromboembolism. Therefore, systemic anticoagulation is considered crucial to alleviate the risk of thrombosis and failure of ECMO circuit components. The gold standard and most used anticoagulant during extracorporeal life support is unfractionated heparin, with all its benefits and disadvantages. However, therapeutic anticoagulation of a critically ill patient carries the risk of clinically relevant bleeding with the potential for permanent injury or death. Similarly, thrombotic events may occur. Therefore, different anticoagulation strategies are employed, while the monitoring and the balance of procoagulant and anticoagulatory factors is of immense importance. This narrative review summarizes the most recent considerations on anticoagulation during ECMO support, with a special focus on anticoagulation monitoring and future directions.
Radiomics in Urolithiasis: Systematic Review of Current Applications, Limitations, and Future Directions
Authors: Lim Ee Jean , Castellani Daniele , So Wei Zheng , Fong Khi Yung , Li Jing Qiu , Tiong Ho Yee , Gadzhiev Nariman , Heng Chin Tiong , Teoh Jeremy Yuen-Chun , Naik Nithesh , Ghani Khurshid , Sarica Kemal , De La Rosette Jean , Somani Bhaskar , Gauhar Vineet
Published: September 2022

Radiomics is increasingly applied to the diagnosis, management, and outcome prediction of various urological conditions. Urolithiasis is a common benign condition with a high incidence and recurrence rate. The purpose of this scoping review is to evaluate the current evidence of the application of radiomics in urolithiasis, especially its utility in diagnostics and therapeutics. An electronic literature search on radiomics in the setting of urolithiasis was conducted on PubMed, EMBASE, and Scopus from inception to 21 March 2022. A total of 7 studies were included. Radiomics has been successfully applied in the field of urolithiasis to differentiate phleboliths from calculi and classify stone types and composition pre-operatively. More importantly, it has also been utilized to predict outcomes and complications after endourological procedures. Although radiomics in urolithiasis is still in its infancy, it has the potential for large-scale implementation. Its greatest potential lies in the correlation with conventional established diagnostic and therapeutic factors.
(R)Evolution in Allergic Rhinitis Add-On Therapy: From Probiotics to Postbiotics and Parabiotics
Authors: Capponi Martina , Gori Alessandra , De Castro Giovanna , Ciprandi Giorgio , Anania Caterina , Brindisi Giulia , Tosca Mariangela , Cinicola Bianca , Salvatori Alessandra , Loffredo Lorenzo , Spalice Alberto , Zicari Anna
Published: September 2022

Starting from the “Hygiene Hypothesis” to the “Microflora hypothesis” we provided an overview of the symbiotic and dynamic equilibrium between microbiota and the immune system, focusing on the role of dysbiosis in atopic march, particularly on allergic rhinitis. The advent of deep sequencing technologies and metabolomics allowed us to better characterize the microbiota diversity between individuals and body sites. Each body site, with its own specific environmental niches, shapes the microbiota conditioning colonization and its metabolic functionalities. The analysis of the metabolic pathways provides a mechanistic explanation of the remote mode of communication with systems, organs, and microflora of other body sites, including the ecosystem of the upper respiratory tract. This axis may have a role in the development of respiratory allergic disease. Notably, the microbiota is significant in the development and maintenance of barrier function; influences hematopoiesis and innate immunity; and shows its critical roles in Th1, Th2, and Treg production, which are necessary to maintain immunological balance and promote tolerance, taking part in every single step of the inflammatory cascade. These are microbial biotherapy foundations, starting from probiotics up to postbiotics and parabiotics, in a still-ongoing process. When considering the various determinants that can shape microbiota, there are several factors to consider: genetic factors, environment, mode of delivery, exposure to antibiotics, and other allergy-unrelated diseases. These factors hinder the engraftment of probiotic strains but may be upgradable with postbiotic and parabiotic administration directly on molecular targets. Supplementation with postbiotics and parabiotics could represent a very exciting perspective of treatment, bypassing probiotic limitations. At present, this avenue remains theoretical and to be explored, but it will certainly be a fascinating path to follow.
Efficacy of Robot-Assisted Gait Training Combined with Robotic Balance Training in Subacute Stroke Patients: A Randomized Clinical Trial
Authors: Aprile Irene , Conte Carmela , Cruciani Arianna , Pecchioli Cristiano , Castelli Letizia , Insalaco Sabina , Germanotta Marco , Iacovelli Chiara
Published: September 2022

Recently, the use of robotic technology in gait and balance rehabilitation of stroke patients has been introduced, with positive results. The purpose of this study was to evaluate the effectiveness of robotic gait and trunk rehabilitation compared to robotic gait training alone on balance, activities, and participation measures in patients with subacute stroke. The study was a randomized, controlled, single blind, parallel group clinical trial. Thirty-six patients with first ischemic or hemorrhagic stroke event were enrolled, and they were randomized in two groups: Gait Group (GG), where they received only robotic treatment for gait rehabilitation through an end-effector system, and Gait/Trunk Group (GTG) where they performed end-effector gait rehabilitation and balance with a robotic platform, 3 times/week for 12 sessions/month. At the end of the study, there was an improvement in balance ability in both groups. Instead, the lower limb muscle strength and muscle tone significantly improved only in the GTG group, where we found a significant reduction in the trunk oscillations and displacement during dynamic exercises more than the GG group. The robotic platform which was added to the gait robotic treatment offers more intense and controlled training of the trunk that positively influences the tone and strength of lower limb muscles.
Does Smoking Affect OSA? What about Smoking Cessation?
Authors: Pataka Athanasia , Kotoulas Seraphim , Kalamaras George , Tzinas Asterios , Grigoriou Ioanna , Kasnaki Nectaria , Argyropoulou Paraskevi
Published: September 2022

The connection between smoking and Obstructive sleep apnea (OSA) is not yet clear. There are studies that have confirmed the effect of smoking on sleep disordered breathing, whereas others did not. Nicotine affects sleep, as smokers have prolonged total sleep and REM latency, reduced sleep efficiency, total sleep time, and slow wave sleep. Smoking cessation has been related with impaired sleep. The health consequences of cigarette smoking are well documented, but the effect of smoking cessation on OSA has not been extensively studied. Smoking cessation should improve OSA as upper airway oedema may reduce, but there is limited data to support this hypothesis. The impact of smoking cessation pharmacotherapy on OSA has been studied, especially for nicotine replacement therapy (NRT). However, there are limited data on other smoking cessation medications as bupropion, varenicline, nortriptyline, clonidine, and cytisine. The aim of this review was to explore the current evidence on the association between smoking and OSA, to evaluate if smoking cessation affects OSA, and to investigate the possible effects of different pharmacologic strategies offered for smoking cessation on OSA.
Severe Complications after General Anesthesia versus Sedation during Pediatric Diagnostic Cardiac Catheterization for Ventricular Septal Defect
Authors: Ogawa Yuki , Yamana Hayato , Noda Tatsuya , Kishimoto Miwa , Yoshihara Shingo , Kanaoka Koshiro , Matsui Hiroki , Fushimi Kiyohide , Yasunaga Hideo , Kawaguchi Masahiko , Imamura Tomoaki
Published: September 2022

Pediatric cardiac catheterization requires unconsciousness and immobilization through general anesthesia or sedation. This study aimed to compare the occurrence of severe complications in pediatric diagnostic cardiac catheterization for ventricular septal defect between general anesthesia and sedation performed under similar institutional environments. Using the Japanese Diagnosis Procedure Combination database, we retrospectively identified pediatric patients (aged <2 years) who underwent diagnostic cardiac catheterization for ventricular septal defect between July 2010 and March 2019. The composite outcome was the occurrence of severe complications, including catecholamine use and intensive care unit admission, within seven days after catheterization. Overlap weighting based on propensity scores was used to adjust for patient- and hospital-level confounding factors. We identified 3159 patients from 87 hospitals, including 930 under general anesthesia and 2229 under sedation. The patient- and hospital-level baseline characteristics differed between the groups. After adjustment, the proportion of patients with severe complications was significantly higher in the general anesthesia group than in the sedation group (2.4% vs. 0.6%; risk difference, 1.8% [95% confidence interval, 0.93–2.6%]). Severe complications occurred more frequently in the general anesthesia group than in the sedation group. Further research on anesthetic methods is necessary to assess the safety and accuracy of pediatric diagnostic cardiac catheterization.
Snail Track Lesion with Flat Keratometry in Anterior Segment Dysgenesis Caused by a Novel FOXC1 Variant
Authors: Skalicka Pavlina , Jedlickova Jana , Horinek Ales , Trkova Marie , Davidson Alice E. , Tuft Stephen J. , Dudakova Lubica , Liskova Petra
Published: September 2022

We report the phenotype of a 15-year-old female patient with anterior segment dysgenesis (ASD) caused by a novel heterozygous loss-of-function FOXC1 variant. The proband underwent an ophthalmic examination as well as a molecular genetic investigation comprising exome sequencing, a single nucleotide polymorphism array to access copy number and Sanger sequencing to exclude non-coding causal variants. There was bilateral mild iris hypoplasia with pupil deformation and iridocorneal adhesions. In addition to these features of ASD, the corneas were flat, with mean keratometry readings of 38.8 diopters in the right eye and 39.5 diopters in the left eye. There was a snail track lesion of the left cornea at the level of the Descemet membrane. The central corneal endothelial cell density was reduced bilaterally at 1964 and 1373 cells/mm2 in the right and left eyes, respectively. Molecular genetic analysis revealed that the proband was a carrier of a novel heterozygous frameshifting variant in FOXC1, c.605del p.(Pro202Argfs*113). Neither parent had this change, suggesting a de novo origin which was supported by paternity testing. We found no possibly pathogenic variants in the other genes associated with posterior corneal dystrophies or ASD. Further studies are warranted to verify whether there is a true association between snail track lesions, corneal flattening, and pathogenic variants in FOXC1.
Advances in Perioperative Nutrition
Authors: Kokkinakis Stamatios , Lasithiotakis Konstantinos
Published: September 2022

In the modern era of prehabilitation, identifying malnourished surgical patients and optimising their nutritional status is crucial [...]
Late Presenters with ST-Elevation Myocardial Infarction: A Call to Action
Authors: De Luca Leonardo , Veneziano Francesco , Karaboue Michele
Published: September 2022

The emphasis on timely coronary reperfusion in the setting of ST-segment elevation Myocardial Infarction (STEMI) comes from older studies suggesting a significant reduction in mortality among patients treated with fibrinolytic therapy during the first hours after onset of symptoms and a progressive increase in fatal events in those presenting later [...]
Exploiting Online Services to Enable Anonymous and Confidential Messaging
Authors: Sousa Pedro , Pinto António , Pinto Pedro
Published: September 2022

Messaging services are usually provided within social network platforms and allow these platforms to collect additional information about users, such as what time, for how long, with whom, and where a user communicates. This information allows the identification of users and is available to the messaging service provider even when communication is encrypted end-to-end. Thus, a gap still exists for alternative messaging services that enable anonymous and confidential communication and that are independent of a specific online service. Online services can still be used to support this messaging service, but in a way that enables users to communicate anonymously and without the knowledge and scrutiny of the online services. In this paper, we propose messaging using steganography and online services to support anonymous and confidential communication. In the proposed messaging service, only the sender and the receiver are aware of the existence of the exchanged data, even if the online services used or other third parties have access to the exchanged secret data containers. This work reviews the viability of using existing online services to support the proposed messaging service. Moreover, a proof-of-concept of the proposed message service is implemented and tested using two online services acting as proxies in the exchange of encrypted information disguised within images and links to those images. The obtained results confirm the viability of such a messaging service.
The Developmental Trajectory of Motor Competence of Children That Lived the COVID-19 Confinement Period: A Four-Year Follow-Up Study in Portuguese Children
Authors: Carballo-Fazanes Aida , Rodrigues Luis Paulo , Silva Rui , Lopes Vitor P. , Abelairas-Gómez Cristian
Published: September 2022

Children’s motor competence (MC) was negatively affected by the COVID-19 pandemic; however, possible chronic effects have not been studied. Therefore, the aim of this study was to examine the possible impact of the forced lack of physical activity (PA) during the COVID-19 lockdown on children’s MC two years later. The motor competence of sixty-seven healthy children (7.4–12.2 years old) was assessed using the Motor Competence Assessment (MCA). All participants completed the MCA tests at two different moments (before and after the COVID-19 lockdown), four years apart. The mean values after the COVID-19 lockdown for all participants on the subscales and on the Total MCA are lower, but no significant changes were found when controlling for gender and age (p > 0.05 in all analyses). However, a significant decrease was found in the Locomotor subscale in boys (p = 0.003). After dividing the participants into three age groups, the youngest also suffered a decrease in the Locomotor subscale (p < 0.001) and their Total MCA (p = 0.04). In addition, those participants who had a higher MC at baseline decreased their scores for the Locomotor (p < 0.001) and Manipulative (p < 0.001) subscales, and for the Total MCA (p < 0.001). In conclusion, the younger children and the more motor proficient did not fully recover from the negative effects of the pandemic lockdown after two years.
Invasive Fungal Disease in Patients with Myeloid Malignancies: A Retrospective Cohort Study of a Diagnostic-Driven Care Pathway Withholding Mould-Active Prophylaxis
Authors: De Kort Elizabeth A. , Buil Jochem B. , Schalekamp Steven , Schaefer-Prokop Cornelia , Verweij Paul E. , Schaap Nicolaas P. M. , Blijlevens Nicole M. A. , Van der Velden Walter J. F. M.
Published: September 2022

Objectives: Patients receiving remission induction therapy for acute myeloid leukaemia (AML) are at high risk of developing invasive fungal disease (IFD). Newer therapies with targeted antileukemic agents and the emergence of azole resistance pose a challenge to the strategy of primary antifungal prophylaxis. We report the experience of a diagnostic-driven care pathway (DCP) for the management of IFD in these patients, using only culture-directed mould inactive prophylaxis. Methods: Retrospectively, we used a single-centre study of consecutive patients receiving intensive chemotherapy for myeloid malignancies between 2014 and 2021. DCP consisted of serial cultures and serum galactomannan (sGM) screening, CT imaging, and bronchoscopy to direct targeted antifungal treatment. IFD was classified according to the 2020 EORTC/MSGERC criteria. Results: A total of 192 patients with myeloid malignancies received 300 courses of intensive chemotherapy. There were 14 cases of invasive yeast infections and 18 of probable/proven invasive mould disease (IMD). The incidence of probable/proven IMD during the first cycle of remission-induction chemotherapy was 4.6% (n = 9). sGM remained negative in all cases of invasive aspergillosis (IA), with positive mycology findings in bronchoalveolar lavage. All-cause mortality was 9.4% (n = 18) 100 days after starting chemotherapy and was comparable between patients with or without IFD. The fungal-related mortality was 1% (n = 2). Conclusion: Diagnostic-driven based management without universal mould active prophylaxis is a feasible strategy in the management of IFD and limits unnecessary antimould treatment during intensive chemotherapy. The poor performance of serial serum galactomannan screening in detecting IA warrants further investigation.
Stereochemical and Biosynthetic Rationalisation of the Tropolone Sesquiterpenoids
Authors: Li Lei , Cox Russell J.
Published: September 2022

This review summarises the known structures, biological activities, and biosynthetic pathways of the tropolone sesquiterpenoid family of fungal secondary metabolites. Synthesis of this knowledge allows likely structural and stereochemical misassignments to be revised and shows how the compounds can be divided into three main biosynthetic classes based on the stereochemistry of key biosynthetic steps.
The Effect of SARS-CoV-2 Vaccination on B-Cell Phenotype in Systemic Sclerosis Patients
Authors: Pellicano Chiara , Colalillo Amalia , Basile Valerio , Marino Mariapaola , Basile Umberto , La Gualana Francesca , Mezzaroma Ivano , Visentini Marcella , Rosato Edoardo
Published: September 2022

Objective: to assess the influence of SARS-CoV-2 mRNA vaccine on B-cell phenotypes in systemic sclerosis (SSc). Methods: peripheral blood B-cell subpopulations were evaluated before (t1) and 3 months (t3) after the second dose of vaccine in 28 SSc patients. Peripheral blood B-cell subpopulations were evaluated in 21 healthy controls (HCs) only at t1. Anti-spike IgG levels were evaluated at t3 in both cohorts. Results: SSc patients presented higher naive, double-negative, and CD21low B cells compared to HCs. IgM-memory and switched-memory B cells were lower in SSc patients than HCs. No differences in anti-spike IgG levels after vaccination were observed between SSc patients and HCs. Anti-spike IgG levels after vaccination were lower in SSc patients with increased CD21low B cells at baseline compared to SSc patients with normal CD21low B cells. A positive correlation was found between IgG levels and naive B cells. A negative linear correlation was shown between IgG levels and IgM-memory, switched-memory, double-negative, and CD21low B cells. Conclusions: SARS-CoV-2 mRNA vaccine response is normal in SSc patients not undergoing immunosuppressive therapy. The normal number of naive B cells is a positive marker of antibody response. The increased percentage of CD21low B cells represents a negative marker of antibody response.
IRO/Shift Test Is Comparable to the Jobe Test for Detection of Supraspinatus Lesions
Authors: Fieseler George , Schwesig René , Sendler Julia , Cornelius Jakob , Schulze Stephan , Lehmann Wolfgang , Hermassi Souhail , Delank Karl-Stefan , Laudner Kevin
Published: September 2022

To determine how the internal rotation and shift (IRO/shift) test compares to the gold standard of clinical tests (Jobe test) for diagnosing supraspinatus lesions and to confirm these clinical results with surgical findings, 100 symptomatic patients were clinically examined between October 2018 and November 2019. All 100 patients were evaluated using both the IRO/shift test and Jobe test. A total of 48 of these patients received surgical intervention. Based on these data, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for both the IRO/shift test and Jobe test were calculated. The IRO/shift test had a sensitivity of 96% (95% CI: 82–100%), specificity of 50% (95% CI: 27–73%), PPV of 73% (95% CI: 56–86%), NPV of 91% (95% CI: 59–100%), and an accuracy of 77% (95% CI: 63–88%). The Jobe test had a sensitivity of 89% (95% CI: 72–98%), specificity of 60% (95% CI: 36–81%), PPV of 76% (95% CI: 58–89%), NPV of 80% (95% CI: 52–96%), and an accuracy of 77% (95% CI: 54–81%). These results suggest that the IRO/shift test is comparable to the Jobe test, which is often viewed as the gold standard clinical examination for assessing supraspinatus lesions. This study was approved by the Ethics Commission of the Martin Luther University Halle-Wittenberg (reference number: 2018-05).
COVID-19 Severity and Mortality after Vaccination against SARS-CoV-2 in Central Greece
Authors: Samara Athina A. , Boutlas Stylianos , Janho Michel B. , Gourgoulianis Konstantinos I. , Sotiriou Sotirios
Published: September 2022

Background: Vaccination against SARS-CoV-2 (COVID-19) has become crucial for limiting disease transmission and reducing its severity, hospitalizations and mortality; however, despite universal acceptance, vaccine hesitancy is still significant. In the present manuscript, we aim to assess COVID-19-attributed mortality after the prevalence of new variants of the virus (Delta and Omicron viral strains) and to evaluate the vaccination effect. Methods: All patients that were hospitalized due to COVID-19 infection in the Respiratory Department of a tertiary referral center in central Greece between 1st of June 2021 and 1st of February 2022 were included in the present study. Results: 760 consecutive patients were included in the study; 89 (11.7%) were diagnosed with severe COVID-19 and 220 (38.7%) patients were fully vaccinated. In logistic regression, increased age (aOR = 1.12, p < 0.001), male gender (aOR = 2.29, p = 0.013) and vaccination against SARS-CoV-2 virus (aOR = 0.2, p < 0.001) were associated with mortality attributed to COVID-19 with a statistically significant association. Moreover, increased age (aOR = 1.09, p < 0.001), male gender (aOR = 1.92, p = 0.025) and vaccination against SARS-CoV-2 virus (aOR = 0.25, p < 0.001) were statistically significantly associated with clinical severity of COVID-19 infection. However, when comparing the length of hospitalization between vaccinated and unvaccinated patients, the difference was not statistically significant between the two groups (p = 0.138). Conclusions: Vaccination against SARS-CoV-2 virus had a protective effect in terms of mortality and clinical severity of COVID-19 during the fourth wave of the pandemic in Central Greece. The national vaccination policy has to focus on vulnerable populations that are expected to benefit the most from the vaccine’s protection.
Measurement of Tibial Orientation Helps Select the Optimal Insert Thickness to Personalize PCL Tension in a Medial Ball-in-Socket TKA
Authors: Nedopil Alexander J. , Howell Stephen M. , Hull Maury L.
Published: September 2022

As the conformity of a medial ball-in-socket total knee arthroplasty (TKA) provides intrinsic anterior-posterior (A-P) stability, surgeons cannot rely on the manual examination of sagittal laxity to identify the optimal insert thickness. Instead, the present study determined whether measuring tibial axial orientation in extension and 90° flexion with an insert goniometer could identify the optimal thickness that, when implanted, provides high postoperative function. In twenty-two patients that underwent unrestricted caliper-verified kinematic alignment (KA) with a PCL retaining implant, two surgeons measured tibial orientation in extension and 90° flexion with 10, 11, 12, and 13 mm thick insert goniometers. Each TKA had one insert thickness that restored either the maximum external tibial orientation in extension, the maximum internal tibial orientation at 90° flexion, or both relative to 1 mm thinner and thicker inserts. In addition, the 6-month median [interquartile range] Forgotten Joint Score of 73 (54–87) and Oxford Knee Score of 42 (38–45) indicated high satisfaction and function. In conclusion, surgeons using a medial ball-in-socket TKA design can measure external tibial orientation in extension and internal tibial orientation at 90° flexion with an insert goniometer. Furthermore, implanting an insert with the thickness that provided the maximum orientation values resulted in high postoperative function, thereby personalizing PCL tension.