bluuebunny/crossref_metadata_2025 huggingface dataset:
Religious Affiliation, Internalized Homonegativity and Depressive Symptoms: Unveiling Mental Health Inequalities among Brazilian Gay Men
Authors: Alckmin-Carvalho Felipe , Oliveira António , Silva Patricia , Cruz Madalena , Nichiata Lúcia , Pereira Henrique
Published: September 2024

Introduction: Different religious narratives associate same-sex sexuality, in its various manifestations, with moral deviation or sin. Gay men who are socialized in more religious communities appear to experience and internalize greater levels of homonegativity, as well as to present greater indicators of depressive symptoms. The purpose of this study was to evaluate indicators of perceived homonegativity in the community and internalized, and signs/symptoms of depression reported by Brazilian gay men with a nominal religion and compare them to those reported by Atheists or Agnostics. Method: Our sample comprised 194 Brazilian gay men, distributed into three groups: Christians (Protestants and Catholics, n = 71; 36.6%); Spiritualists (Kardecists or religions of African origin, n = 52; 26.8%) and Atheists or Agnostics (n = 71; 36.6%). The following measurement instruments were used: sociodemographic questionnaire, Internalized Homophobia Scale and Beck Depression Scale. Results: High mean scores of depression were verified in all groups, and 60% of the sample presented some level of depression. There was a higher level of self-reported homonegativity among Christians and Spiritualists compared to that reported by Atheists or Agnostics, with the differences between the groups being significant. The regression analysis indicated a significant effect of religion on homonegativity, but not on depression. Conclusion: Our results suggest that gay men’s chronic exposure to non-affirming religious affiliation contexts may harm the construction of a positive gay identity and should be taken into consideration when addressing mental health inequalities of sexual minorities.
The Relationship between Cyberchondria and Health Anxiety and the Moderating Role of Health Literacy among the Pakistani Public
Authors: Sansakorn Preeda , Mushtaque Iqra , Awais-E-Yazdan Muhammad , Dost Muhammad Khyzer Bin
Published: September 2024

Following the COVID-19 pandemic, the current study examines the association between cyberchondria and health anxiety in the Pakistani population, with health literacy as a moderator. This study utilized a cross-sectional research approach, with data gathered through simple random sampling. The study enlisted 1295 participants from Pakistan aged between 18 and 70, 63% of whom were male and 36% of whom were female. The researchers found a statistically significant positive link between cyberchondria and health anxiety (β = 0.215; t = 1.052; p 0.000). The moderating influence of health literacy suggests that health anxiety has a significantly negative effect on the relationship between cyberchondria and health anxiety (β = −0.769; t = 2.097; p 0.037). Moreover, females had higher cyberchondria scores than males. Health-related anxiety did not differ between the sexes, and males had greater health literacy than females. These results emphasize the critical role of health literacy in the moderating effects of cyberchondria on health anxiety. Furthermore, they reveal significant gender differences in both cyberchondria and health literacy.
Universal Snow Avalanche Modeling Index Based on SAFI–Flow-R Approach in Poorly-Gauged Regions
Authors: Durlević Uroš , Valjarević Aleksandar , Novković Ivan , Vujović Filip , Josifov Nemanja , Krušić Jelka , Komac Blaž , Djekić Tatjana , Singh Sudhir Kumar , Jović Goran , Radojković Milan , Ivanović Marko
Published: September 2024

Most high-mountain regions worldwide are susceptible to snow avalanches during the winter or all year round. In this study, a Universal Snow Avalanche Modeling Index is developed, suitable for determining avalanche hazard in mountain regions. The first step in the research is the collection of data in the field and their processing in geographic information systems and remote sensing. In the period 2023–2024, avalanches were mapped in the field, and later, avalanches as points in geographic information systems (GIS) were overlapped with the dominant natural conditions in the study area. The second step involves determining the main criteria (snow cover, terrain slope, and land use) and evaluating the values to obtain the Snow Avalanche Formation Index (SAFI). Thresholds obtained through field research and the formation of avalanche inventory were used to develop the SAFI index. The index is applied with the aim of identifying locations susceptible to avalanche formation (source areas). The values used for the calculation include Normalized Difference Snow Index (NDSI > 0.6), terrain slope (20–60°) and land use (pastures, meadows). The third step presents the analysis of SAFI locations with meteorological conditions (winter precipitation and winter air temperature). The fourth step is the modeling of the propagation (simulation) of other parts of the snow avalanche in the Flow-R software 2.0. The results show that 282.9 km2 of the study area (Šar Mountains, Serbia) is susceptible to snow avalanches, with the thickness of the potentially triggered layer being 50 cm. With a 5 m thick snowpack, 299.9 km2 would be susceptible. The validation using the ROC-AUC method confirms a very high predictive power (0.94). The SAFI–Flow-R approach offers snow avalanche modeling for which no avalanche inventory is available, representing an advance for all mountain areas where historical data do not exist. The results of the study can be used for land use planning, zoning vulnerable areas, and adopting adequate environmental protection measures.
Clinical, Biochemical, and Molecular Characteristics of Filipino Patients with Tyrosinemia Type 1
Authors: Cavan Barbra Charina V. , de Castro-Hamoy Leniza G. , Abarquez Conchita G. , Maceda Ebner Bon G. , Alcausin Maria Melanie Liberty B.
Published: September 2024

Hereditary tyrosinemia type I (HT1), or hepatorenal tyrosinemia, is an amino acid disorder which may cause hepatic failure as well as renal and neurologic comorbidities. Early detection of this disorder is possible with newborn screening (NBS). The objective of this study is to describe the clinical, biochemical, and molecular characteristics of Filipino patients diagnosed with HT1 through the expansion of the Philippine NBS program in 2014. There were a total of 16 patients with confirmed HT1 from then until September 2022. Clinical and biochemical data during confirmation and initial evaluation, as well as molecular data, were obtained from the patients’ medical records. The cohort included children between the ages of 18 and 54 months at the time of data collection. The mean age at treatment initiation was 26.8 days. The mean succinylacetone level from dried blood spot sampling using tandem mass spectrometry (MS) was 11.1 µmol/L. Biochemical confirmatory tests via plasma amino acid analysis showed mean levels of tyrosine, phenylalanine, and methionine of 506.1 µmol/L, 111.5 µmol/L, and 125.4 µmol/L, respectively. Upon urine organic acid (UOA) analysis, succinylacetone was detected in all except for one patient, who was managed prior to UOA analysis. The most common clinical characteristics were abnormal clotting times (62.5%), elevated alpha fetoprotein (37.5%), anemia (31.3%), and metabolic acidosis (31.3%). The most common genotype was homozygous c.122T>C p.Leu41Pro in 64.3% of patients. The allelic frequency of this pathogenic variant is 71.4%. The inclusion of HT1 in the Philippine NBS program allowed early diagnosis and management of HT1 patients.
Classification of Histamine Content in Fish Using Near-Infrared Spectroscopy and Machine Learning Techniques
Authors: Ninh Duy Khanh , Phan Kha Duy , Vo Cong Tuan , Dang Minh Nhat , Le Thanh Nhan
Published: September 2024

Near-infrared (NIR) spectroscopy has emerged as a popular technique for assessing food quality due to its advantages over complex chemical analysis methods. However, the application of NIR spectroscopy for evaluating fish quality based on histamine content has not been extensively explored. This study investigates the use of NIR spectroscopy in combination with machine learning (ML) techniques to classify fish samples into two safety classes, Safe and Unsafe, based on their histamine content. A comprehensive NIR dataset comprising 11,360 spectra collected at eight distinct positions within the fish body was obtained from 284 fish samples of mackerel, tuna, and pompano species. ML experiments were conducted to classify fish samples based on whether their histamine content exceeded the permissible limit of 100 ppm. To address class imbalance and optimize ML models, various data pre-processing and feature extraction techniques as well as ML algorithms were explored. The results demonstrated that utilizing NIR data specifically obtained from the tail’s flesh, a specific location within the fish, yielded superior models for fish safety classification. A feature extraction method employing pre-processed NIR spectra and their second derivatives, combined with an optimized convolutional neural network architecture, outperformed traditional ML classifiers with an accuracy of approximately 93%.
A New Integer Model for Selecting Students at Higher Education Institutions: Preparatory Classes of Engineers as Case Study
Authors: Majdoub Soufyane , Loqman Chakir , Boumhidi Jaouad
Published: September 2024

This study addresses the challenge of selecting outstanding students at higher education institutions under multiple constraints. We propose a novel integer programming solution to manage this process, formulating it as a constrained assignment problem with a maximization objective function. This function prioritizes the fair selection of students while respecting criteria such as academic qualifications, required skills, and student preferences. The goal is to develop a decision support system that efficiently selects qualified students at higher education institutions within a reasonable time. The model was tested using real data from Moroccan preparatory classes, achieving important assignment rates across all student categories. Results demonstrate significance in execution time, fulfillment of student choices, and prioritization of outstanding students. This approach offers a flexible, efficient solution for managing academic merit-based selections, optimizing resource utilization, and enhancing fairness in the selection process.
Human versus Neural Machine Translation Creativity: A Study on Manipulated MWEs in Literature
Authors: Corpas Pastor Gloria , Noriega-Santiáñez Laura
Published: September 2024

In the digital era, the (r)evolution of neural machine translation (NMT) has reshaped both the market and translators’ workflow. However, the adoption of this technology has not fully reached the creative field of literary translation. Against this background, this study aims to explore to what extent NMT systems can be used to translate the creative challenges posed by idioms, specifically manipulated multiword expressions (MWEs) found in literary texts. To carry out this pilot study, five manipulated MWEs were selected from a fantasy novel and machine-translated (English > Spanish) by four NMT systems (DeepL, Google Translate, Bing Translator, and Reverso). Then, each NMT output as well as a human translation are assessed by six professional literary translators by using a human evaluation sheet. Based on these results, the creativity obtained in each translation method was calculated. Despite the satisfactory performance of both DeepL and Google Translate, HT creativity was highly superior in almost all manipulated MWEs. To the best of our knowledge, this paper not only contributes to the ongoing study of NMT applied to literature, but it is also one of the few studies that delve into the almost unexplored field of assessing creativity in neural machine-translated MWEs.
Assessment of Environmental Risks during the Implementation of Infrastructure Projects in the Arctic Region
Authors: Makarova Irina , Makarov Dmitriy , Gubacheva Larisa , Mukhametdinov Eduard , Mavrin Gennadiy , Barinov Aleksandr , Mavrin Vadim , Gabsalikhova Larisa , Boyko Aleksey , Buyvol Polina
Published: September 2024

The Arctic Zone of Russia (AZR), due to its significant potential, for the implementation of which infrastructure projects and strategic plans are envisaged, is of great importance for the country. Particular attention is paid to the transport and related infrastructure development. The implementation of such projects requires the creation and implementation of modern integrated solutions based on new technical and technological solutions. The development of new territories is accompanied by problems such as urbanization and the disruption of ecosystems, which will have a particularly negative impact on the Arctic zone. The situation is complicated by the fact that the work must be carried out in difficult conditions, which are associated with a large number of risks, including environmental ones. Currently, many types of businesses are characterized by a transition to the implementation of the concepts of green and blue economy, as well as ESG principles when building strategic development plans that include risk reduction. Achieving this goal is possible through an environmental risk management system. To create a suchlike system, it is necessary to identify the most significant risk characteristics of each type of activity, taking into account their negative impact on the environment, after which it will be possible to plan measures to either prevent risks or minimize their consequences. Taking into account the above, we plan to develop the concept of an environmental risk management system (ERMS) as part of the region’s development strategy implementation. To reach this purpose, identifying the main groups of environmental risks depending on the danger source based on the scientific article review results, systematizing concepts aimed at improving the environmental situation under different types of anthropogenic impacts on the environment, developing an algorithm for implementing an environmental risk management system depending on the risk type, and proposing a concept for building an environmental risk management system are needed. The scientific novelty of the work lies in the fact that the main directions of negative anthropogenic impact on the environment are systematized, and possible ways to reduce environmental risks are outlined. The practical significance of the work lies in the fact that when implementing such a system, it will be possible to manage not only risks of a certain category, but also monitor the situation as a whole, identifying the consequences for related areas.
Predicting the Potential Global Distribution of the Plum Fruit Moth Grapholita funebrana Treitscheke Using Ensemble Models
Authors: Yang Mingsheng , Huo Yiqi , Wang Lei , Wang Jialu , Zuo Shichao , Pang Chaoyun , Wang Zhengbing , Zhang Hongfei , Xu Kedong , Ma Keshi
Published: September 2024

The plum fruit moth, Grapholita funebrana Treitschke, is one of the most significant borer pests, often causing huge economic losses in fruit production. However, the potential distribution range of this economically important pest is still poorly understood. For this study, we simulated an ensemble species distribution model to predict the spatiotemporal distribution pattern of G. funebrana at a global scale. The results show that the suitable habitats for this moth, under current environmental conditions, are mainly distributed in Europe; East Asia, including China and Japan; Central Asia; and some parts of America. In future projections, the suitable habitats are predicted to generally expand northward, while the suitable area will remain unchanged overall. However, the area of highly suitable habitat will decrease to only 17.49% of that found under current conditions. None of the nine factors used were revealed to be predominant predictors in terms of contributing to the model, suggesting that the integrated effects of these variables shape G. funebrana’s distribution. In this study, the distribution range that has been predicted, especially for the regions with a highly suitable habitat, poses a high risk of G. funebrana outbreaks, highlighting the urgency of pest management. Moreover, in the United States of America (USA) and Japan (for which G. funebrana distributions were not previously recorded), especially in areas highly suitable for this moth, monitoring and quarantine measures should be strengthened to prevent the colonization and further dispersal of this pest, as seen with its close relative G. molesta, which has become a cosmopolitan pest species, migrating from its native region (East Asia) to other continents, including the Americas.
Assessing the Potential of Tortistilus (Hemiptera: Membracidae) from Northern California Vineyards as Vector Candidates of Grapevine Red Blotch Virus
Authors: Hoyle Victoria J. , McGinnity Schneider Elliot J. , McLane Heather L. , Wunsch Anna O. , Fendell-Hummel Hannah G. , Cooper Monica L. , Fuchs Marc F.
Published: September 2024

Ceresini treehoppers are present in northern California vineyard ecosystems, including the closely related Spissistilus and Tortistilus (Hemiptera: Membracidae). These membracids are not direct pests of wine grapes, but S. festinus is a vector of grapevine red blotch virus (GRBV). No information is available on the ability of Tortistilus spp. to transmit GRBV. In this study, Tortistilus were collected on yellow panel cards across 102 vineyard sites and surrounding areas in Napa Valley, California, USA in 2021–2023. Specimens were morphotyped, sexed and tested for GRBV ingestion and acquisition by multiplex PCR or qPCR. Phylogenetic analysis of the partial sequence of mt-COI and ITS gene fragments of a subset of 40 Tortistilus specimens revealed clustering in a monophyletic clade with T. wickhami with the former barcode sequence. Only 6% (48/758) of the T. wickhami tested positive for GRBV, but none of the heads with salivary glands (0%, 0/50) of the dissected specimens tested positive for GRBV, indicating no virus acquisition. In contrast, half of the dissected heads with salivary glands of S. festinus (52%, 12/23), from the same collection vineyard sites, tested positive for GRBV. Together, our findings confirmed the presence of T. wickhami in northern California vineyards and suggested a dubious role of this treehopper as a vector of GRBV.
Enhancing Biological Control Efficacy: Insights into the Feeding Behavior and Fitness of the Omnivorous Pest Lygus lineolaris
Authors: Solà Cassi Mireia , Dumont François , Provost Caroline , Lucas Eric
Published: September 2024

Lygus lineolaris (Palisot de Beauvois) (Hemiptera: Miridae), a true omnivorous insect, poses a significant threat to agriculture in the Neartic region. Understanding the feeding behavior of L. lineolaris is crucial for developing integrated pest management strategies. This study aimed to evaluate the effects of different diets on the fitness of L. lineolaris, with a focus on the diet source, feeding regime (phytophagy, zoophagy, and phytozoophagy), and number of diet items. The experimental design in the laboratory investigated the impacts of strawberry, canola and buckwheat flowers, as well as spider mites and aphids to explore relationships found in a conventional strawberry field. Results reveal that diet source, feeding regime, and the number of diet items influence L. lineolaris performance (i.e., survivorship rate, developmental time, and adult weight and length). Improvements in fitness are indicated by higher nymphal survival, shorter developmental time, and larger adults. Immature stages of L. lineolaris show improved fitness when provided with diets rich in canola compared to strawberry flowers and spider mites. Furthermore, the inclusion of multiple diet items in phytozoophagous regimes enhances insect performance. The findings emphasize the significance of understanding L. lineolaris’ nutritional requirements and the biodiversity of target ecosystems for modeling energy flows and designing effective IPM strategies against this pest. This research contributes to the knowledge base for biological control programs targeting L. lineolaris in agricultural systems.
SpemNet: A Cotton Disease and Pest Identification Method Based on Efficient Multi-Scale Attention and Stacking Patch Embedding
Authors: Qiu Keyuan , Zhang Yingjie , Ren Zekai , Li Meng , Wang Qian , Feng Yiqiang , Chen Feng
Published: September 2024

We propose a cotton pest and disease recognition method, SpemNet, based on efficient multi-scale attention and stacking patch embedding. By introducing the SPE module and the EMA module, we successfully solve the problems of local feature learning difficulty and insufficient multi-scale feature integration in the traditional Vision Transformer model, which significantly improve the performance and efficiency of the model. In our experiments, we comprehensively validate the SpemNet model on the CottonInsect dataset, and the results show that SpemNet performs well in the cotton pest recognition task, with significant effectiveness and superiority. The SpemNet model excels in key metrics such as precision and F1 score, demonstrating significant potential and superiority in the cotton pest and disease recognition task. This study provides an efficient and reliable solution in the field of cotton pest and disease identification, which is of great theoretical and applied significance.
Risk Factors for Postoperative Atrial Fibrillation in Myocardial Revascularization Surgery: A 15-Year Experience
Authors: Bonilla-Bonilla Diana Marcela , Osorio-Toro Luis Miguel , Daza-Arana Jorge Enrique , Quintana-Ospina Jhon H. , Ávila-Valencia Juan Carlos , Lozada-Ramos Heiler
Published: September 2024

Background: Myocardial revascularization surgery (MRV) is a revascularization therapy for coronary artery disease aimed at improving survival conditions. Elderly patients with increased comorbidities undergoing MRV face challenges in preventing postoperative complications, including atrial fibrillation (AF), a common arrhythmia occurring in 40% of cases or even in 80% of cases if the procedure is combined with valve surgery. This study aimed to determine the risk factors associated with the appearance of postoperative AF (POAF) in patients undergoing isolated MRV. Methods: This is an epidemiological, retrospective, and analytical case–control study (90 cases and 360 controls). Results: Mortality within the group of patients who presented with POAF in the study population was 15.5%, and 9.44% in the control group. Logistic regression showed an association of AF with the presurgical variables age >60 years and urgent/emergency surgery and the postsurgical variables cardiogenic shock, blood transfusion, pulmonary edema, pleural effusion, orotracheal reintubation, and mechanical ventilation time. Conclusions: Strategies should be proposed for the timely identification of risk factors and postoperative complications related to AF onset to avoid the increased morbidity and mortality associated with this type of arrhythmia during the postoperative period.
Clinical, Radiographic, and Biomechanical Evaluation of the Upper Extremity in Patients with Osteogenesis Imperfecta
Authors: Oder Katharina , Unglaube Fabian , Farr Sebastian , Kranzl Andreas , Stauffer Alexandra , Ganger Rudolf , Raimann Adalbert , Mindler Gabriel T.
Published: September 2024

Introduction: Osteogenesis imperfecta (OI) is a hereditary disorder primarily caused by mutations in type I collagen genes, resulting in bone fragility, deformities, and functional limitations. Studies on upper extremity deformities and associated functional impairments in OI are limited. This cross-sectional study aimed to evaluate upper extremity deformities and functional outcomes in OI. Methods: We included patients regardless of their OI subtypes with a minimum age of 7 years. Radiographic analysis of radial head dislocation, ossification of the interosseous membrane, and/or radioulnar synostosis of the forearm were performed, and deformity was categorized as mild, moderate, or severe. Clinical evaluation was performed using the Quick Disabilities of Arm, Shoulder, and Hand (qDASH) questionnaire and shoulder-elbow-wrist range of motion (ROM). Three-dimensional motion analysis of the upper limb was conducted using the Southampton Hand Assessment Procedure (SHAP). The SHAP quantifies execution time through the Linear Index of Function (LIF) and assesses the underlying joint kinematics using the Arm Profile Score (APS). Additionally, the maximum active Range of Motion (aRoM) was measured. Results: Fourteen patients aged 8 to 73 were included. Radiographic findings revealed diverse deformities, including radial head dislocation, interosseous membrane ossification, and radioulnar synostosis. Six patients had mild, six moderate, and two severe deformities of the upper extremity. Severe deformities and radial head dislocation correlated with compromised ROM and worse qDASH scores. The qDASH score ranged from 0 to 37.5 (mean 11.7). APS was increased, and LIF was reduced in OI-affected persons compared with non-affected peers. APS and LIF also varied depending on the severity of bony deformities. aRoM was remarkably reduced for pro-supination. Conclusion: Patients with OI showed variable functional impairment from almost none to severe during daily life activities, mainly depending on the magnitude of deformity in the upper extremity. Larger multicenter studies are needed to confirm the results of this heterogeneous cohort. Level of evidence: Retrospective clinical study; Level IV.
Outcome-Orientated Organ Allocation—A Composite Risk Model for Pancreas Graft Evaluation and Acceptance
Authors: Reichelt Sophie , Öllinger Robert , Halleck Fabian , Kahl Andreas , Raschzok Nathanael , Winter Axel , Maurer Max Magnus , Lehner Lukas Johannes , Pratschke Johann , Globke Brigitta
Published: September 2024

Background: Pancreas transplantation (PTX) remains the most effective treatment to prevent long-term complications and provide consistent euglycemia in patients with endocrine pancreatic insufficiency, mainly in type I diabetic patients. Considering early graft loss (EGL) and the perioperative complication rate, an optimal risk stratification based on donor risk factors is paramount. Methods: In our single-center study, we retrospectively assessed the risk factors for EGL and reduced graft survival in 97 PTXs (82 simultaneous pancreas and kidney [SPK], 11 pancreases transplanted after kidney [PAK] and 4 pancreases transplanted alone [PTA]) between 2010 and 2021. By statistically analyzing the incorporation of different donor risk factors using the Kaplan–Meier method and a log-rank test, we introduced a composite risk model for the evaluation of offered pancreas grafts. Results: The overall EGL rate was 6.5%. In the univariate analysis of donor characteristics, age > 45 years, BMI > 25 kg/m2, lipase > 60 U/L, cerebrovascular accident (CVA) as the cause of death, mechanical cardiopulmonary resuscitation (mCPR), cold ischemia time (CIT) > 600 min and retrieval by another center were identified as potential risk factors; however, they lacked statistical significance. In a multivariate model, age > 45 years (HR 2.05, p = 0.355), BMI > 25 kg/m2 (HR 3.18, p = 0.051), lipase > 60 U/L (HR 2.32, p = 0.148), mCPR (HR 8.62, p < 0.0001) and CIT > 600 min (HR 1.89, p = 0.142) had the greatest impact on pancreas graft survival. We subsumed these factors in a composite risk model. The combination of three risk factors increased the rate of EGL significantly (p = 0.003). Comparing the pancreas graft survival curves for ≥3 risk factors to <3 risk factors in a Kaplan–Meier model revealed significant inferiority in the pancreas graft survival rate (p = 0.029). Conclusions: When evaluating a potential donor organ, grafts with a combination of three or more risk factors should only be accepted after careful consideration to reduce the risk of EGL and to significantly improve outcomes after PTX.
Accuracy of Implant Guided Surgery in Fully Edentulous Patients: Prediction vs. Actual Outcome—Systematic Review
Authors: Azevedo Mafalda , Correia Francisco , Faria Almeida Ricardo
Published: September 2024

Objectives: Examine deviations between the digitally planned and actual implant positions in clinical studies using static fully guided surgical guides. Identify potential associated factors and strategies to minimize their likelihood. Materials and Methods: This systematic review was conducted following the PRISMA checklist. The literature search was conducted in the PubMed® and Scopus® databases up to February 2024 following the PICOS search strategy. Clinical trials conducted between 2013 and 2024, evaluating the accuracy of static fully guided surgical guides placed in fully edentulous patients, were included. The studies had to assess at least two of the following parameters: angular deviation, cervical deviation, apical deviation, and depth deviation. Results: Out of the 298 articles initially searched, six randomized clinical trials and three clinical trials were included. All but one article used mucosa-supported guides; the remaining one used bone-supported guides. Apical deviations were more significant than cervical deviations, and implants tended to be placed too superficially. The greatest mean deviations were 2.01 ± 0.77 mm for cervical and 2.41 ± 1.45 mm for apical deviations, with the largest angular deviation recorded at 4.98 ± 2.16°. Conclusions: The accuracy of the surgical guide is influenced by various factors, including the technique of image acquisition and subsequent planning, guide support methods, and the adopted surgical protocol. Apical deviations are influenced by cervical and angular deviations. Additionally, deviations were more pronounced in the mandible. Further studies with similar methodologies are necessary for a more precise assessment of the different factors and for establishing safety margins.
Machine Learning Prediction Model to Predict Length of Stay of Patients Undergoing Hip or Knee Arthroplasties: Results from a High-Volume Single-Center Multivariate Analysis
Authors: Di Matteo Vincenzo , Tommasini Tobia , Morandini Pierandrea , Savevski Victor , Grappiolo Guido , Loppini Mattia
Published: September 2024

Background: The growth of arthroplasty procedures requires innovative strategies to reduce inpatients’ hospital length of stay (LOS). This study aims to develop a machine learning prediction model that may aid in predicting LOS after hip or knee arthroplasties. Methods: A collection of all the clinical notes of patients who underwent elective primary or revision arthroplasty from 1 January 2019 to 31 December 2019 was performed. The hospitalization was classified as “short LOS” if it was less than or equal to 6 days and “long LOS” if it was greater than 7 days. Clinical data from pre-operative laboratory analysis, vital parameters, and demographic characteristics of patients were screened. Final data were used to train a logistic regression model with the aim of predicting short or long LOS. Results: The final dataset was composed of 1517 patients (795 “long LOS”, 722 “short LOS”, p = 0.3196) with a total of 1541 hospital admissions (729 “long LOS”, 812 “short LOS”, p < 0.001). The complete model had a prediction efficacy of 78.99% (AUC 0.7899). Conclusions: Machine learning may facilitate day-by-day clinical practice determination of which patients are suitable for a shorter LOS and which for a longer LOS, in which a cautious approach could be recommended.
Morbidity and Mortality after Cytoreductive Surgery and HIPEC in a National Reference Center: A Six-Year Experience under Independent Evaluation
Authors: Alberto Vilchez Miguel Enrique , Halskov Sebastian , Winter Axel , Pratschke Johann , Rau Beate , Gül Safak
Published: September 2024

Introduction: Cytoreductive surgery (CRS) coupled with hyperthermic intraperitoneal chemotherapy (HIPEC) is a potentially curative approach to peritoneal disease (PD) and corresponds to the needs of patients with dire survival rates. However, the oncological community remains cautious toward this procedure because of its significant morbidity and mortality rates. This evolving evidence around CRS and HIPEC and its impact suggests a need for more standardized procedures in existing centers. Because of its complexity and potential for high morbidity and mortality, critical observation of our center’s complication rates using complication management documentation tools were crucial to further develop our standard operating procedures (SOP) and maximize patient safety. Methods: Our prospectively maintained institutional database was queried to identify all patients who underwent CRS and HIPEC and had a filled-out quality management (QM) and complication management documentation tool at discharge at the surgical department of the Charité—Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany, between January 2018 and December 2023. Results: A total of 155 patients had a surgical and/or medical complication recorded. In total, 305 surgeries were surveyed. Some patients had more than one postoperative complication; hence, 344 events in 50 categories were recorded, of which 267 were graded 3a or higher in 92 patients. The most common medical complications were of pulmonary and renal origin. On the surgical side, surgical site infections (SSI) were most common. The incidence of anastomotic leakage (AL) was 5% (n = 8), with no events between 2021 and the present. Patients with longer surgery duration times were at higher risk for developing postoperative complications. Conclusions: Major abdominal surgeries like CRS and HIPEC are associated with significant patient morbidity despite achieving optimal oncological outcomes. Postoperative complications are managed through strict surveillance and transparency, particularly in our large reference centers, to minimize patient risk. Quality management programs in our department have successfully maintained high standards of care without compromising patient safety.
Cardiac Magnetic Resonance for Structural Aortic Valve Stenosis Procedures
Authors: Ferrández-Escarabajal Marcos , Hadley Michael , Sanz Javier
Published: September 2024

The number of structural aortic valve procedures has increased significantly in recent years. Pre-procedural planning and follow-up with noninvasive testing are essential. Although cardiac magnetic resonance (CMR) is the gold standard for assessing left ventricular mass, volume, and function, it is not performed routinely in patients undergoing structural interventions. CMR can provide useful information for pre- and post-procedural assessment, including quantification of cardiac function, myocardial assessment, grading of the severity of valvular heart disease, and evaluation of extracardiac anatomy while avoiding the limitations of other non-invasive modalities. Here, we review the use cases, future perspectives, and limitations of CMR for patients undergoing structural aortic valve procedures.
Lens Factor Choice in IOL Power Calculation after Laser Refractive Surgery: The Right Constant for Advanced Lens Measurement Approach (ALMA)
Authors: Cione Ferdinando , De Bernardo Maddalena , Di Stasi Margherita , De Luca Martina , Albano Rosa , Rosa Nicola
Published: September 2024

Background/Objectives: To evaluate the advanced lens measurement approach (ALMA) formula accuracy using different lens constants available on the user group for laser interference biometry (ULIB) and IOL Con platforms. Methods: In this retrospective, comparative, case-series study, 150 eyes of 160 patients with previous myopic Photorefractive Keratectomy (PRK) or laser-assisted in situ keratomileusis (LASIK), who underwent uneventful cataract surgery and IOL implantation, were examined. The ALMA formula was evaluated to calculate the refractive prediction error (PE), analysing four different categories of lens constants: both nominal and optimized A-Constant for SRKT, which are available on the ULIB and IOL Con platforms. An additional analysis was carried out in this study, evaluating if a decreased ULIB optimized constant (DUOC) with different fixed factors (−1.2 −1.3 −1.4 −1.5) could improve refractive outcomes. Median absolute error (MedAE) and percentage of eyes within ±0.50 and ±1.00 diopters (D) of prediction error were measured as the main outcomes. Results: Comparing the lens factors available on ULIB and IOL Con platforms, the ALMA formula reported a lower MedAE and higher percentages of eyes with a refractive PE within 1.0 D using ULIB nominal constants (all p < 0.05). Using DUOC (−1.3), and there was a statistically significant improvement of both MedAE and of the percentages of eyes with PE within ±0.50 D with the ALMA method compared to nominal ULIB constants (all p < 0.05). Conclusions: The impact of different lens factors in the IOL power calculation after myopic LRS should be carefully evaluated. The ALMA formula, in the absence of optimized constants by zeroing the mean error, should be used by subtracting 1.3 from the optimized ULIB constants available on the IOL Con website. This finding suggests further studies to test which of these constants could work better with the other post-refractive surgery formulas.
Pulsed Field Ablation: A Comprehensive Update
Authors: Ezzeddine Fatima M. , Asirvatham Samuel J. , Nguyen Duy T.
Published: September 2024

One of the recent advancements in the field of cardiac electrophysiology is pulsed field ablation (PFA). PFA is a novel energy modality that does not rely on thermal processes to achieve ablation which, in turn, results in limited collateral damage to surrounding structures. In this review, we discuss the mechanisms, safety, efficacy, and clinical applications of PFA for the management of atrial and ventricular arrhythmias. We also summarize the published pre-clinical and clinical studies regarding this new technology.
Extracorporeal Photopheresis in Pediatric and Adult Patients with Graft-Versus-Host Disease
Authors: Ionete Alexandra , Surleac Marius , Uta Mihaela , Varady Zsofia , Bica Ana Maria , Jercan Cristina Georgiana , Colita Anca , Coriu Daniel
Published: September 2024

Background/Objectives: Graft-versus-host disease (GVHD) is a severe complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT) resulting from histocompatibility differences between donor and host cells leading to inflammation, tissue damage, and compromised patient outcome. Extracorporeal photopheresis (ECP) is considered as a second-line treatment administered to patients with GVHD who do not respond to corticosteroid treatment or who experience a relapse after an initial response and are therefore classified as steroid refractory (SR). The aim of this study is to evaluate the clinical response rates in both pediatric and adult patients with acute (a) or chronic (c) GVHD and to assess the effectiveness of ECP using the real-world data from a single center. Methods: We performed a retrospective study on 30 patients, including 11 pediatric and 19 adult patients who were treated with ECP as a second-, third-, or fourth-line therapy for (a) and (c) GVHD, alongside corticosteroids and other immunomodulatory medications. The median time from aGVHD onset to ECP was 11.5 days (range: 3 days–9 months), while for cGVHD, the median time was 90 days (range: 2 days–9 months). Results: The overall response rate (ORR) in the aGVHD patient population was 60% with a median of 9 procedures (range: 2–20). For cGVHD patients, the ORR was 70% after a median of 23.5 ECP procedures (range: 8–43). Most patients had skin involvement, with ECP achieving an ORR of 81.8% in aGVHD and 77.7% in cGVHD cases. Conclusions: ECP is a beneficial therapy for patients with (a) and (c) GVHD who have not responded to corticosteroids and other forms of immunosuppressive therapy. Specifically, ECP demonstrated efficacy in improving skin and oral symptoms and permitted reductions in or the elimination of their corticosteroid usage. The study found that extending the duration of ECP treatment was associated with better outcomes, and no detectable complications were observed over a 38-week period.
Comparative Accuracy and Reliability of Three Electronic Apex Locators in Determining the Apical Constriction of Molar Canals: A Micro-CT Evaluation
Authors: Barakat Reem M. , Almohareb Rahaf A. , Alharbi Arwa O. , Alhazmi Asma , Alomar Reem
Published: September 2024

Background: Determining the correct apical limit for root canal treatment is essential for its success. This study evaluates the accuracy of three electronic apex locators (EALs) in locating the apical constriction (AC) in molar canals. Methods: Forty extracted human mandibular molars were scanned using micro-CT, and endodontic access cavities were created. Teeth were mounted in alginate, and three EALs—Root ZX-mini, Root ZX-II, and Sirona integrated apex locator—were used to measure the canal working length in dry canals and with EDTA gel. Micro-CT scans were performed with files in place, and the distance from the AC was calculated. Measurements within 0.1–0.5 mm were categorized as ‘close’. Those extending beyond towards the major foramen were categorized as ‘beyond’, otherwise they were classified as ‘far’. Data analysis was conducted with a level of significance set at 5%. Results: Most readings for all EALs were in the ‘close’ category, with significant differences between devices (p < 0.0001). Root ZX-mini and Root ZX-II had 74.4% and 72.5% ‘close’ readings, respectively, versus 51% for Sirona integrated. Accuracy did not differ significantly between dry and EDTA-treated canals (p = 0.306). All EALs demonstrated excellent operator reliability (ICC 0.996–1.00). Conclusions: All EALs accurately determined AC, unaffected by lubricants. However, Root ZX-mini and Root ZX-II outperformed Sirona integrated. All EALs showed consistent reliability.
Clinical Risk Factors and First Gestational 75 g OGTT May Predict Recurrent and New-Onset Gestational Diabetes in Multiparous Women
Authors: Mirabelli Maria , Tocci Vera , Chiefari Eusebio , Iuliano Stefano , Brunetti Francesco S. , Misiti Roberta , Giuliano Stefania , Greco Marta , Foti Daniela P. , Brunetti Antonio
Published: September 2024

Background: Women who experience gestational diabetes mellitus (GDM) during their first pregnancy are at a high risk of developing GDM again in subsequent pregnancies. Even mothers with no previous history of GDM may develop the condition in a new pregnancy. Methods: In this retrospective cross-sectional observational study, 759 multiparous women tested for GDM in two successive pregnancies using the 75 g OGTT (IADPSG criteria) were enrolled. The OGTT was performed at 24–28 weeks’ gestation or earlier if there was a history of GDM. Participants were categorized into four groups: women with normal glucose tolerance (NGT) in both pregnancies (n = 493), women with a first occurrence of GDM in their second pregnancy (n = 74), women with non-recurrent GDM in their second pregnancy (n = 92), and women with recurrent GDM in their second pregnancy (n = 100). Results: Intergroup comparisons revealed clinical predictors of GDM in the first pregnancy (family history of type 2 diabetes, PCOS, advanced maternal age, pregravid obesity) and in the second pregnancy (interpregnancy BMI gain), as well as predictors of recurrent GDM (pregravid obesity, PCOS). A positive correlation was observed between the OGTT glucose levels of consecutive pregnancies. Adjusted logistic regression indicated that a higher 1-h post-load glucose level (≥130 mg/dL) during the first pregnancy significantly increased the likelihood of new-onset GDM in the second pregnancy (OR: 2.496), whereas a higher 2-h post-load glucose level (≥153 mg/dL) at the first diagnostic OGTT increased the likelihood of recurrent GDM (OR: 2.214). Conclusions: Clinical risk factors and post-load glucose levels during the first gestational 75 g OGTT can help predict new-onset or recurrent GDM in multiparous women.
The Relationship between Treatment Response and Overall Survival in Borderline, Non-Resectable and Resectable Pancreatic Cancer Patients Treated with Neoadjuvant FOLFIRINOX
Authors: Barenboim Alex , Mercer Diego , Sahnan Kapil , Gaffan Alex , Goren Or , Halperin Sharon , Brazowski Eli , Pelles Avraham Sharon , Klausner Joseph M. , Lubezky Nir
Published: September 2024

Background: The National Comprehensive Cancer Network (NCCN)-recommended treatment for patients with borderline-resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC) involves a combination of neoadjuvant FOLFIRINOX chemotherapy and the curative surgical resection of the tumor. This study seeks to identify the clinical, radiological, laboratory, and pathologic predictors that can anticipate the oncological outcomes of patients. Methods: In this study, we conducted a retrospective analysis of patients who had undergone curative surgical resection for BRPC, LAPC, or resectable disease with high-risk features after receiving neoadjuvant FOLFIRINOX at two institutions. We evaluated by means of multivariate analysis whether clinical and laboratory response, tumor markers, radiological response, and pathologic tumor response grade correlated with overall survival (OS) and disease-free survival (DFS). Results: The study enrolled a total of 70 patients with BRPC, LAPC, and resectable disease with high-risk features who underwent resection after neoadjuvant FOLFIRINOX. Age above 65 years and fewer than nine cycles of chemotherapy (OR 4.2; 95% CI 1.4–12.0; p-value 0.007); locally advanced tumors after neoadjuvant treatment (NAT) (OR 7.0; 95% CI 1.9–25.7; p-value 0.003); and lymph node disease and histological tumor regression grade 2 and 3 (OR 4.3; 95% CI 0.9–19.2; p-value 0.05) were risk factors linked to adverse OS and DFS. The median OS and DFS were 33 (22–43.9) months and 16.5 (11.3–21.6) months, respectively. Conclusions: Classification as a LA tumor after NAT was the only preoperative radiological factor that predicted adverse survival in patients undergoing curative surgery after NAT. Other clinical, biochemical, and radiological measures of response were not found to predict OS. Patient age, the cumulative administration of more than eight cycles of chemotherapy, and a significant pathological response were associated with better OS. The results of this study are important for treatment decision-making and prognostication in patients with BRPC and LAPC.
Perspectives on Creating a Chronic Pain Support Line in Portugal: Results of a Focus Group Study among Patients and Healthcare Professionals
Authors: Cruz Mariana , Durães Maria Inês , Azevedo Patrícia , Carvalhal Célia , Pinho Simão , Sampaio Rute
Published: September 2024

Background: Chronic pain (CP) patients frequently feel misunderstood and experience a lack of support. This led to the creation of support telephone lines in some countries. However, there is no scientific data grounding their development or evaluating their performance. Almost 37% of the Portuguese adult population suffers from CP, with great costs for patients and the healthcare system. Methods: To determine the viability of a support line for CP in Portugal, a qualitative study was designed, and online focus group meetings, with patients and healthcare professionals, were conducted. Their perspectives, beliefs, and expectations were evaluated and described. Results: This study revealed that a CP support line is a feasible project from the participants’ perspective if its interventions are limited to active listening, emotional support, and tailored suggestions. Conclusions: It has the potential to generate a positive impact on healthcare services, while also contributing to greater equity of access to support.