bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigating the Feasibility of Assessing Depression Severity and Valence-Arousal with Wearable Sensors Using Discrete Wavelet Transforms and Machine Learning
Authors: Ahmed Abdullah , Ramesh Jayroop , Ganguly Sandipan , Aburukba Raafat , Sagahyroon Assim , Aloul Fadi
Published: August 2022

Depression is one of the most common mental health disorders, affecting approximately 280 million people worldwide. This condition is defined as emotional dysregulation resulting in persistent feelings of sadness, loss of interest and inability to experience pleasure. Early detection can facilitate timely intervention in the form of psychological therapy and/or medication. With the widespread public adoption of wearable devices such as smartwatches and fitness trackers, it is becoming increasingly possible to gain insights relating the mental states of individuals in an unobtrusive manner within free-living conditions. This work presents a machine learning (ML) approach that utilizes retrospectively collected data-derived consumer-grade wearables for passive detection of depression severity. The experiments conducted in this work reveal that multimodal analysis of physiological signals in terms of their discrete wavelet transform (DWT) features exhibit considerably better performance than unimodal scenarios. Additionally, we conduct experiments to view the impact of severity on emotional valence-arousal detection. We believe that our work has implications towards guiding development in the domain of multimodal wearable-based screening of mental health disorders and necessitates appropriate treatment interventions.
Barriers Affecting Higher Education Institutions’ Adoption of Blockchain Technology: A Qualitative Study
Authors: Mohammad Abdulghafour , Vargas Sergio
Published: August 2022

Despite the many benefits of blockchain technology in higher education, this technology is not widely adopted by Higher Education Institutions (HEIs). Therefore, instead of providing additional motives for adopting blockchain technology, this research tries to understand what factors discourage HEIs from merging blockchain with their procedures. The methodology used for this research is based upon qualitative research using 14 interviews with administrative and academic staff from the European Union (EU) and Canada. Our findings based on our empirical data revealed 15 key challenges to blockchain adoption by HEIs that are classified based on the technology, organization, and environment (TOE) framework. Theoretically, this study contributes to the body of knowledge relating to blockchain technology adoption. Practically, this research is expected to aid HEIs to assess the applicability of blockchain technology and pave the way for the widespread adoption of this technology in the educational field.
Improved Cementitious Tile Adhesives’ Workability and Mechanical Performance with the Use of Recycled Materials
Authors: Lourenço Ana , Silva Luís , Fernandes Vera , Sequeira Pedro
Published: August 2022

The impact that construction has on sustainability as a relevant consumer of materials is well known, especially with regard to cement, which contributes to high CO2 emissions. It is well known that in tile adhesives, cement add positive technical contributes, supporting tensile adhesion, especially after water immersion and freeze–thaw cycles. On the other hand, it is also known that that it is possible to replace Portland cement with alternative sources, such as blast furnace slag, fly and bottom ashes, or other pozzolanic materials. Even so, other materials can be also used to contribute to additional performance. This work intends to prove that using recycled materials or by-products is not just a potential way to replace existing materials, improving environmental sustainability, but also contributes additional value to mortars, such as cement-based tile adhesives. Different recycled waste materials are introduced to a cement-based tile adhesive and the evaluation of properties according to EN 12004 is conducted. The results show how the introduction of recycled rubber can contribute to improve the workability of a tile adhesive, acting as a lightweight aggregate. Moreover, it can contribute to reducing the dynamic elasticity modulus; thus, it has a potential contribution to reduce global tensions in tiling systems, and the adhesion results are maintained by the introduction of slag, another recycled material. The weight reduction reduces mortar consumption, one of the main targets to support indicated strategy and justify a more sustainable performance. The results indicate that the introduction of rubber and slag provide good technical and mechanical performance for the mortars, as well as excellent workability.
Mountain Roads’ Geometric Design: Methodological Proposal for Hairpin Bend Design/Retrofitting
Authors: Ciampa Donato , Olita Saverio
Published: August 2022

Mountainous roads often have to overcome considerable differences in height, which is why hairpin bends find a valid and common use. Despite this, there is a lack of specific international standards. Given the absence of a national standard governing the mountain roads’ design, in Italy, as in many other countries, the Swiss standard SNV 640198a is generally applied. This standard does not guarantee the correct geometric design of hairpin bends for Italian vehicle fleets and fleets according to the Directive 2002/7/EC. In this paper, the authors have developed a new methodology based on the Swiss standard upgrade, which is applicable internationally. Starting from hairpin bends’ geometric layouts provided by SNV 640198a and from related considerations, respectively, to the gyration formulae use and to swept path analysis’ simulations, they developed new planimetric layouts compatible with the vehicle fleet and with the cross-sectional dimensions of Italian roads. In this way, a generally valid methodology applicable to any international context was defined. In particular, the study allowed the definition of new geometric layouts to be used in hairpin bend design/retrofitting when it is necessary to guarantee the simultaneous entry into the bend of a 12 m long bus, and a car travelling in the opposite direction. Finally, the proposed methodology was applied to a mountain road case study in the Lucanian Dolomites area; an area of great tourist, cultural and environmental interest in southern Italy.
Research on the Hydration and Mechanical Properties of NAC-Hardened Cement under Various Activation Methods
Authors: Zhang Shiyi , Fan Yingfang , Shah Surendra P.
Published: August 2022

Adding mineral admixture is one of the leading technical ways to improve the durability of cement-based materials. Nano attapulgite clay (NAC) is a unique fiber rod crystal structure that can change the physical and mechanical properties of cement-based materials, and opens up a new idea for exploring the durability of high-performance cement-based materials. This paper studied the effects of NAC on the hydration process, pore structure, and mechanical properties of a cement substrate under different activation methods. The results show that the pH value of the pore solution of cement mixed with 5% NAC high-viscosity ore (calcined) was 8.8% higher than that of the cement without NAC. The chemically bound water contents in the 1% and 3% NAC raw (calcined) cement were 14.11% and 14.04%; when the content of calcined NAC raw ore was 1%, the improvement effect on the cement hydration process is the best. The content of calcined NAC was 1%, 3%, and 5%, and the porosity of hardened cement paste was 19%, 19.04%, and 22.27% lower than that of the cement without NAC. Calcining NAC raw ore can improve cement’s hydration process, promote cement’s hydration reaction, and increase the compactness of hardened cement paste. The fluidity of the cement mortar mixed with calcined high-viscosity ore (D and E) at a mixing amount of 5% was reduced by 32.66% and 26.13%, respectively, compared to the ordinary specimens. The flexural strength of the cement paste mixed with calcined raw ore and high-viscosity ore at a mixing amount of 1% was generally improved by 28.40% and 17.28% compared to the cement without NAC paste. After calcination, the NAC raw ore is better than the high-clay ore in improving the mechanical properties of cement.
Synergistic Correlation in the Colloidal Properties of TiO2 Nanoparticles and Its Impact on the Photocatalytic Activity
Authors: Ceballos-Chuc María Concepción , Ramos-Castillo Carlos Manuel , Rodríguez-Pérez Manuel , Ruiz-Gómez Miguel Ángel , Rodríguez-Gattorno Geonel , Villanueva-Cab Julio
Published: August 2022

In this work, the relationship between the photodegradation rate of methylene blue (MB) and the effective surface charge of titania nanoparticles (TiO2 NPs) in an aqueous solution is addressed. Colloidal dispersions were prepared from TiO2 NPs (4–10 nm) for the heterogenous photocatalysis test. The dispersion properties such as pH, hydrodynamic diameter, zeta potential, and isoelectric point were studied. Acidic TiO2 dispersions (pH = 3.6–4.0) with a positive zeta potential and smaller hydrodynamic diameter exhibit larger colloidal stability and pseudo-first-order kinetics for the degradation of MB. The largest rate constant (5 × 10−2 min−1) corresponded to a conversion of 98% within 75 min under UV light. This enhanced rate is a synergic effect between the surface area, charge, and optimal hydrodynamic diameter of TiO2 NPs. A linear correlation between the calculated values for the absorption cross-section and normalized rate constant was found for the systems under study. It was observed that an eventual increase in the pH (4–5.5) reduces the effective surface charge and dispersion stability, causing a decrease in the rate constants of one order of magnitude (10−3 min−1) for TiO2 agglomerates with a larger hydrodynamic diameter (300–850 nm).
In-Clinic Measurements of Vascular Risk and Brain Activity
Authors: Boone Jeffrey , Davids Anna H. , Joffe David , Arese Lucini Francesca , Oakley David S. , Oakley Madeleine J. , Peterson Matthew
Published: August 2022

Background: Cardiovascular disease and dementia represent two health problems that may be causally connected. Studies have shown patients with dementia to have reduced cardiovascular health measures, where patients with dementia also have reduced electrophysiological brain activity as measured by event-related potentials (ERP’s). Few studies have attempted to correlate the two: cardiovascular health and ERP brain activity. The objective of this study is to determine if there are ERP differences between patients with lower versus higher measures of cardiovascular risk. Methods: For 180 patients ages 53 (16) years, Audio P300 ERP amplitudes and latencies (speeds) were measured upon initial patient visit alongside other clinical evaluations. Cardiovascular risk was categorized into good versus poor levels for blood pressure resting and stressed, E/A Ratio, atherosclerosis, and carotid intima-media thickness. Results: Groups with good levels had lower latencies (faster P300′s) and higher amplitudes than those with poor levels across all cardiovascular risk measures, significant to p < 0.05 for most parameters. While both cardiovascular health and P300 metrics decline with age, poor blood pressure and plaque was seen to affect P300 performance across all age groups in this study. Conclusion: These data suggest correlation between brain activity, as measured by the P300, and five standard measures of cardiovascular health and this correlation may begin at an early age. While further explorations are warranted, these results could have implications on the management of preventative medicine by bringing preventative cardiology and brain health together.
Current Advances in Lung Ultrasound in COVID-19 Critically Ill Patients: A Narrative Review
Authors: Lê Minh Pierre , Jozwiak Mathieu , Laghlam Driss
Published: August 2022

Lung ultrasound (LUS) has a relatively recent democratization due to the better availability and training of physicians, especially in intensive care units. LUS is a relatively cheap and easy-to-learn and -use bedside technique that evaluates pulmonary morphology when using simple algorithms. During the global COVID-19 pandemic, LUS was found to be an accurate tool to quickly diagnose, triage and monitor patients with COVID-19 pneumonia. This paper aims to provide a comprehensive review of LUS use during the COVID-19 pandemic. The first section of our work defines the technique, the practical approach and the semeiotic signs of LUS examination. The second section exposed the COVID-19 pattern in LUS examination and the difference between the differential diagnosis patterns and the well-correlation found with computer tomography scan findings. In the third section, we described the utility of LUS in the management of COVID-19 patients, allowing an early diagnosis and triage in the emergency department, as the monitoring of pneumonia course (pneumonia progression, alveolar recruitment, mechanical ventilation weaning) and detection of secondary complications (pneumothorax, superinfection). Moreover, we describe the usefulness of LUS as a marker of the prognosis of COVID-19 pneumonia in the fourth section. Finally, the 5th part is focused on describing the interest of the LUS, as a non-ionized technique, in the management of pregnant COVID-19 women.
Association of Acute Headache of COVID-19 and Anxiety/Depression Symptoms in Adults Undergoing Post-COVID-19 Rehabilitation
Authors: Mazurek Justyna , Cieślik Błażej , Szary Patryk , Rutkowski Sebastian , Szczegielniak Jan , Szczepańska-Gieracha Joanna , Gajda Robert
Published: August 2022

As a common non-respiratory symptom of COVID-19, headache should not be overlooked, and its characteristics should be recorded with scrutiny. Identifying risk factors associated with post-COVID headache will ensure immediate action and counseling for this population of patients. Therefore, the study aimed to investigate the relationship between headache and psychological state (stress level, depression, and anxiety symptoms) in adults undergoing post-COVID-19 rehabilitation. In addition, we used mediation analysis to evaluate the mediation effect of psychological variables in the relationship between headache and quality of life. This cross-sectional study included 147 patients undergoing post-COVID-19 rehabilitation at the Public Hospital in Poland (64 males, 83 females, with mean age of 56.97 years). Psychological parameters were evaluated using the Hospital Anxiety and Depression Scale (HADS), the Perceived Stress Scale (PSS-10), and the brief World Health Organization Quality of Life Scale (WHOQOL-BRIEF). Additionally, all participants completed a questionnaire related to COVID-19 symptoms and their severity, the place of COVID-19 treatment, and the need for oxygen therapy during hospitalization. Of all participants, 65% experienced headache during COVID-19. Of the participants with headache, there were significantly more females in this group (69% vs. 31%), and they were significantly younger (mean age 55.47 vs. 59.78 years). Participants with headache had a 27% higher HADS-D score, a 21% higher HADS-A score, and a 13% higher PSS-10 score. Moreover, gender and headache were found to be important predictor variables for total HADS and HADS-D, accounting for 11% and 7%, respectively. Mediation analysis has shown that the tested psychological variables mediated 39–68% of the total effect of headache influence on WHOQOL domains. In conclusion, our study demonstrated several relationships between headache that occurred during COVID-19 and symptoms of depression, anxiety, and perceived stress level during post-COVID rehabilitation also in the context of quality of life. Our results show that patients who experienced headaches during COVID-19 are at high risk of developing anxiety-depressive symptoms later. Female gender is associated with a higher prevalence of headache during COVID-19.
Analysis of Mortality in Unvaccinated Patients with COVID-19 and Cardiovascular Risk
Authors: Sarzyńska Kathie , Świątkowski Filip , Janc Jarosław , Zabierowski Jan , Jankowska-Polańska Beata , Chabowski Mariusz
Published: August 2022

COVID-19 is a contagious disease that has spread globally, killing millions of people around the world. In order to reduce the likelihood of in-hospital death due to COVID-19, it is reasonable to select a group of patients with a low probability of survival and to implement measures in advance to minimize the risk of death. One way to do this is to establish cut-off values for the most commonly performed blood laboratory tests, above or below which the likelihood of death increases significantly. The aim of the study was to determine the basic laboratory parameters among unvaccinated patients hospitalized for COVID-19 with concomitant cardiovascular disease, which are the predictors of in-hospital death. Out of 1234 patients, 446 people who met the specific inclusion criteria were enrolled in the study. The multivariate regression analysis has shown that the independent predictors of death are: troponin levels of at least 0.033 μg/L (OR = 2.04 [1.10; 3.79]), creatinine of at least 1.88 mg/dL (OR = 2.88 [1.57; 5.30]), D-dimers of at least 0.97 g/L (OR = 2.04 [1.02; 4.07]), and C-reactive protein minimum of 0.89 mg/L (OR = 2.28 [1.24; 4.18]).
Decrease in Bone Formation and Bone Resorption during Intravenous Methylprednisolone Pulse Therapy in Patients with Graves’ Orbitopathy
Authors: Rymuza Joanna , Gutowska Klaudia , Kurpios-Piec Dagmara , Struga Marta , Miśkiewicz Piotr
Published: August 2022

Background: Treatment with glucocorticoids (GCs) is associated with side effects. In contrast to the well-known negative impact on bone tissue exerted by oral GCs, few data are available regarding intravenous GCs. We investigated the influence of intravenous methylprednisolone (IVMP) on bone turnover markers (BTM): amino-terminal propeptide of type I procollagen (P1NP) and the C-terminal telopeptide of type I collagen (CTX), and on calcium metabolism parameters: 1,25-dihydroxyvitamin D (1,25(OH)2D), 25-hydroxyvitamin D (25(OH)D), calcium (Ca), phosphate (P), and intact parathormone (iPTH). Methods: In a prospective study, 23 consecutive subjects with Graves’ orbitopathy were included and treated with IVMP according to the European Group on Graves’ Orbitopathy recommendations. We evaluated effects on BTM occurring during the first 7 days after 0.5 g IVMP, and after the therapy with 12 IVMP pulses with a cumulative dose of 4.5 g. Results: We observed prompt but transient decrease of P1NP (p < 0.001) and the reduction of CTX (p = 0.02) after the first IVMP pulse. Following the full course of IVMP therapy, both P1NP and CTX were found decreased (p < 0.05 and p < 0.01, respectively). Conclusions: A single pulse of 0.5 g IVMP already decreases bone formation and resorption; however, this change is transient. The full therapy is associated with suppression of bone turnover.
Smoking Is Positively Related and Alcohol Consumption Is Negatively Related to an Increased Risk of Meniere’s Disease
Authors: Kim So Young , Chung Juyong , Yoo Dae Myoung , Kwon Mi Jung , Kim Ji Hee , Kim Joo-Hee , Kim Heejin , Choi Hyo Geun
Published: August 2022

A few prior researchers presumed the impacts of smoking and alcohol on the risk of Meniere’s disease (MD). This study investigated the relationship between smoking, alcohol consumption, and obesity with Meniere’s disease in an adult population. The ≥40-year-old population in the Korean National Health Insurance Service-Health Screening Cohort 2002–2019 was analyzed. A total of 15,208 patients with MD were matched with 499,658 comparison participants. The current smoking, alcohol consumption, and past medical histories were collected. Body mass index (BMI) was grouped into underweight, normal, overweight, obese I, and obese II. The odds of histories of smoking and alcohol consumption and the BMI group for MD were analyzed using conditional logistic regression analysis. These associations were further analyzed in subgroups of age, sex, smoking, alcohol consumption, and BMI. In the overall adult population, smoking and alcohol consumption did not show an association with MD. Being underweight was linked with lower odds for MD (adjusted OR [aOR] = 0.80, 95% CI = 0.68–0.93, p = 0.004). In the male group, smoking was positively associated with MD (aOR = 1.08, 95% CI = 1.00–1.17, p = 0.043), while alcohol consumption was negatively related to MD (aOR = 0.87, 95% CI = 0.81–0.94, p < 0.001). Being underweight was related to a lower risk of MD. In adult men, smoking was predicted to increase, while alcohol consumption was predicted to decrease the risk of MD.
Increased Carcinoembryonic Antigen (CEA) Level Is Highly Associated with Low Skeletal Muscle Mass in Asymptomatic Adults: A Population-Based Study
Authors: Park Chul-Hyun , Lizarraga Antonio Diaz , Lee Yong-Taek , Yoon Kyung-Jae , Yoo Tae-Kyung
Published: August 2022

We investigated the relationship between high carcinoembryonic antigen (CEA) levels and low skeletal muscle mass (LMM) in asymptomatic adults in a population-based study. A total of 202,602 adults (mean age 41.7 years) without malignancy, stroke, cardiovascular disease, or chronic lung/liver disease were included. A high CEA level was defined as ≥5 ng/mL. Skeletal muscle mass index (SMI) was calculated based on appendicular muscle mass (kg)/height (m)2. Participants were classified into three groups based on SMI: “normal”, “mild LMM”, and “severe LMM.” The prevalence of elevated CEA levels was the highest in subjects with severe LMM (4.2%), followed by those with mild LMM (1.6%) and normal muscle mass (1.1%) (p for trend < 0.001). In multivariate logistic regression analysis, high CEA was independently associated with having mild LMM (adjusted odds ratio, 1.139 [95% confidence interval, 1.092–1.188]) and severe LMM (2.611 [2.055–3.319]) compared to normal muscle mass. Furthermore, the association between high CEA and severe LMM was stronger in women than that in men (women, 5.373 [2.705–10.669]; men, 2.273 [1.762–2.933]). Elevated CEA levels were significantly associated with a higher prevalence of LMM. Therefore, increased CEA could be used as a biomarker for detecting LMM in adults without cancer.
Real-Life Value of the Odysight® Application in At-Home Screening for Exudative Recurrence of Macular Edema
Authors: Kielwasser Gauthier , Kodjikian Laurent , Dot Corinne , Burillon Carole , Denis Philippe , Mathis Thibaud
Published: August 2022

Background: The aim of this study was to describe the value of the Odysight® application in addition to a classical follow-up regimen in the detection of exudative recurrences in patients with macular edema. Methods: We conducted an observational, multicenter, retrospective study. The Odysight® application includes a visual acuity (VA) test that can lead to alerts in case of a drop of >5 VA letters on two successive tests. The efficacy of the alerts in detecting exudative recurrence was studied. Results: A total of 149 eyes of 123 patients were included. The sensitivity of alerts for the detection of recurrence was 30.8% (95% CI [17.6; 44.0]) and its specificity was 83.7% (95% CI [73.2; 94.3]. A better baseline VA was found to be significantly associated with a better retention of the application (OR = 0.05, 95% CI [0.002; 0.62]; p = 0.045). Of the 12/39 alerts that detected a recurrence, eight (20.5% of all alerts) resulted in the scheduling or advancement of an intravitreal injection. Conclusions: In the present study, the sensitivity and positive predictive value of the Odysight® application seems low but its use in addition to the usual follow-up of the patient can detect, in certain cases, an early recurrence and thus allow an anticipated readjustment of the treatment.
Evaluation of Glycosylated Ferritin in Adult-Onset Still’s Disease and Differential Diagnoses
Authors: Guerber Arthur , Garneret Etienne , El Jammal Thomas , Zaepfel Sabine , Gerfaud-Valentin Mathieu , Sève Pascal , Jamilloux Yvan
Published: August 2022

Glycosylated ferritin (GF) has been reported as a good diagnostic biomarker for adult-onset Still’s disease (AOSD), but only a few studies have validated its performance. We performed a retrospective study of all adult patients with at least one GF measurement over a 2-year period in one hospital laboratory. The diagnosis of AOSD was based on the expert opinion of the treating physician and validated by two independent investigators. Patients’ characteristics, disease activity, and outcome were recorded and compared. Twenty-eight AOSD and 203 controls were identified. Compared to controls, the mean GF was significantly lower (22.3% vs. 39.3, p < 0.001) in AOSD patients. GF had a high diagnostic accuracy for AOSD, independent of disease activity or total serum ferritin (AUC: 0.674 to 0.915). The GF optimal cut-off value for AOSD diagnosis was 16%, yielding a specificity of 89% and a sensitivity of 63%. We propose a modified diagnostic score for AOSD, based on Fautrel’s criteria but with a GF threshold of 16% that provides greater specificity and increases the positive predictive value by nearly 5 points. GF is useful for ruling out differential diagnoses and as an appropriate classification criterion for use in AOSD clinical trials.
Anemia Is an Indicator for Worse Organ Damage Trajectories in Patients with Systemic Sclerosis: A Retrospective Study
Authors: Li Zhaohua , Xu Dan , Jiang Xintong , Li Ting , Su Yin , Mu Rong
Published: August 2022

It is important for clinicians to determine the risk of worsening trajectories in SSc patients. The Scleroderma Clinical Trials Consortium (SCTC) Damage Index (DI) has been developed to quantify organ damage and shows good capability for mortality and morbidity prediction in patients with SSc. This retrospective study aimed to describe the SCTC-DI in Chinese SSc patients and to find features predicting worse organ damage trajectories based on SCTC-DI. A total of 433 SSc patients who met the inclusion criteria in the Peking University Third Hospital (PKUTH-SSc) and People’s Hospital SSc cohort (PKUPH-SSc) were recruited for our study. Organ damage was relatively mild in our Chinese SSc cohort compared to other cohorts, with a mean SCTC-DI of 5.21 ± 4.60. We used both SCTC-DI ≥ 6 and ≥4 to define the high burden of organ damage and established two risk models by the LASSO algorithm, which revealed good identification of high organ damage burden (AUC = 0.689, 95% CI 0.636 to 0.742, p < 0.001 in SCTC-DI ≥ 6 model; AUC = 0.694, 95% CI 0.641 to 0.746, p < 0.001 in modified SCTC-DI ≥ 4 model). The anemia index at the baseline was included in these two models and was also independently related to organ damage progression (HR = 1.75, 95% CI 1.16 to 2.66, p = 0.008). In addition, the presence of an anti-Scl-70 autoantibody was also a predictor of progression (HR = 1.91, 95% CI 1.22 to 2.99, p = 0.005). In conclusion, anemia at the baseline was an important indicator for worse organ damage trajectories in SSc patients. We recommend using hemoglobin as a potential biomarker to evaluate organ damage in SSc patients.
The Efficacy of Exercise Training for Cutaneous Microvascular Reactivity in the Foot in People with Diabetes and Obesity: Secondary Analyses from a Randomized Controlled Trial
Authors: Lanting Sean , Way Kimberley , Sabag Angelo , Sultana Rachelle , Gerofi James , Johnson Nathan , Baker Michael , Keating Shelley , Caterson Ian , Twigg Stephen , Chuter Vivienne
Published: August 2022

It is unclear if cutaneous microvascular dysfunction associated with diabetes and obesity can be ameliorated with exercise. We investigated the effect of 12-weeks of exercise training on cutaneous microvascular reactivity in the foot. Thirty-three inactive adults with type 2 diabetes and obesity (55% male, 56.1 ± 7.9 years, BMI: 35.8 ± 5, diabetes duration: 7.9 ± 6.3 years) were randomly allocated to 12-weeks of either (i) moderate-intensity continuous training [50–60% peak oxygen consumption (VO2peak), 30–45 min, 3 d/week], (ii) low-volume high-intensity interval training (90% VO2peak, 1–4 min, 3 d/week) or (iii) sham exercise placebo. Post-occlusive reactive hyperaemia at the hallux was determined by laser-Doppler fluxmetry. Though time to peak flux post-occlusion almost halved following moderate intensity exercise, no outcome measure reached statistical significance (p > 0.05). These secondary findings from a randomised controlled trial are the first data reporting the effect of exercise interventions on cutaneous microvascular reactivity in the foot in people with diabetes. A period of 12 weeks of moderate-intensity or low-volume high-intensity exercise may not be enough to elicit functional improvements in foot microvascular reactivity in adults with type 2 diabetes and obesity. Larger, sufficiently powered, prospective studies are necessary to determine if additional weight loss and/or higher exercise volume is required.
Pancreatic Adeno-MiNEN, a Rare Newly Defined Entity with Challenging Diagnosis and Treatment: A Case Report with Systematic Literature Review and Pooled Analysis
Authors: Angelico Roberta , Siragusa Leandro , Pathirannehalage Don Cristine Brooke , Sensi Bruno , Billeci Federica , Vattermoli Leonardo , Padial Belen , Palmieri Giampiero , Anselmo Alessandro , Coppola Alessandro , Tisone Giuseppe , Manzia Tommaso Maria
Published: August 2022

Mixed neuroendocrine non-neuroendocrine neoplasms (MiNEN) are a peculiar entity that can occur throughout the whole gastrointestinal trait, and pancreatic localization is rare. Their main characteristic is the presence of at least a neuroendocrine and an epithelial component, each accounting for at least 30% of the tumour mass. The presence of epithelial ductal component defines adeno-MiNEN. We report a case of a 59-year-old woman affected by pancreatic adeno-MiNEN with challenging diagnosis and successfully treated. A systematic literature review and pooled analysis was also performed, aiming to define the management and outcomes of pancreatic adeno-MiNEN. Out of 190 identified records, 15 studies including 28 patients affected by pancreatic-adeno-MiNEN were included in the analysis. Pancreatic adeno-MiNEN occurred mainly in males (82.8%) and at a mean age of 61.7 (range: 24–82) years. Pre-operative diagnosis was possible only in 14.2% of cases. At presentation, the majority had already advanced disease (TNM stage III (53.8%) and stage IV 19.3%). Adjuvant therapy was performed in 55% of patients, and the tumour recurrence rate was in 30% of cases. Median disease-free survival (DFS) was 12 months (range: 0–216 months) with a 5-year DFS of 16.6%, while the median overall survival (OS) was 12 months (range: 0–288 months) with a 5-year OS of 23.5%. Pancreatic adeno-MiNENs are rare; as they have very heterogenous behaviour, they are rarely diagnosed preoperatively and have poor prognosis. Treatment of localised MiNEN still relies on radical surgical resection, which seems essential to achieve a good oncological prognosis. International registry on MiNEN is necessary to improve the knowledge on this rare tumour and to improve its outcomes.
OCT Analysis of Retinal Pigment Epithelium in Myopic Choroidal Neovascularization: Correlation Analysis with Different Treatments
Authors: Allegrini Davide , Vezzola Diego , Borgia Alfredo , Raimondi Raffaele , Sorrentino Tania , Tripepi Domenico , Stradiotto Elisa , Alì Marco , Montesano Giovanni , Romano Mario R.
Published: August 2022

Objective: The objective of this study was to analyze the status of the retinal pigment epithelium (RPE) by means of the spectral domain optical coherence tomography (SD-OCT) overlying the myopic neovascular lesions in the involutive phase, looking for any correlations between the status of the RPE and the size of the lesions and the type and duration of the treatment. Methods: SD-OCT examinations of 83 consecutive patients with myopic choroidal neovascularization (CNV) were reviewed and divided into two groups: group A, patients with CNV characterized by uniformity of the overlying RPE, and group B, patients with CNV characterized by non-uniformity of the overlying RPE. Results: The median lesion area, major diameter, and minimum diameter were, respectively, 0.42 mm2 (0.30–1.01 mm2), 0.76 mm2 (0.54–1.28 mm2), and 0.47 mm2 (0.63–0.77 mm2) in group A, and 1.60 mm2 (0.72–2.67 mm2), 1.76 mm2 (1.13–2.23 mm2), and 0.98 mm2 (0.65–1.33 mm2) in group B. These values were lower in group A than in group B (p < 0.001). The number of treatments with a period free of disease recurrence for at least 6 months was greater (p < 0.010) in group B (6.54 ± 2.82) than in group A (3.67 ± 2.08), and treatments include intravitreal anti-vascular endothelial growth factor injection, photodynamic therapy, or both. Conclusions: Our results showed that the size of myopic neovascular lesion influences the development of a uniform RPE above the lesion and therefore the disease prognosis. The presence of uniform RPE was found to be extremely important in the follow-up of patients with myopic CNV, as it influences the duration of the disease and the number of treatments required.
Application of the Extracts of Uncaria tomentosa in Endodontics and Oral Medicine: Scoping Review
Authors: Dioguardi Mario , Spirito Francesca , Sovereto Diego , Ballini Andrea , Alovisi Mario , Lo Muzio Lorenzo
Published: August 2022

Background: The main purpose of endodontic treatment is to eliminate the bacteria that are responsible for the contamination and infection of the internal surfaces in order to resolve any pulp or periapical pathology. In fact, some bacteria, such as Enterococcus faecalis, can escape the action of root canal irrigants by aggregating into a biofilm and penetrating deeply into the dentinal tubules. Uncaria tomentosa is a plant belonging to the Rubiaceae family and also commonly known as cat’s claw due to the shape and position of the spines; it is a traditional Peruvian medicinal plant of Amazonian origin. Applications in the dental field have been described both in the prevention and treatment of stomatitis and as an antibacterial and anti-inflammatory agent; it has also been investigated as an additive in irrigants and specifically as gels in endodontic cements. The aim of this scoping review is to summarize all the scientific evidence on the possible applications of Uncaria tomentosa extracts in endodontics and, more generally, in oral medicine, in order to understand whether the active ingredients extracted from Uncaria tomentosa can bring a real advantage in endodontics, in the reduction of endodontic failures and in the onset of recurrent endodontic lesions. Methods: The scoping review was carried out strictly following the PRISMA-ScR checklist; the search was carried out on five databases (PubMed, Scopus, Science Direct, EBSCO and Web of Science) and a register (Cochrane library). Results: The research produced a number of bibliographic sources totaling 2104. With the removal of duplicates, 670 were obtained; potentially eligible articles amounted to 23, of which only seven in vitro studies (four microbiological studies), five clinical studies (three randomized trials) and a case report were included. Conclusions: From the data in the literature, it can be stated that the active ingredients present in Uncaria tomentosa could represent an interesting product to be used in the endodontic field, both in endocanalary cements and as a gel.
A Comparison of Different Types of Esophageal Reconstructions: A Systematic Review and Network Meta-Analysis
Authors: Hung Pang-Chieh , Chen Hsuan-Yu , Tu Yu-Kang , Kao Yung-Shuo
Published: August 2022

Background: A total esophagectomy with gastric tube reconstruction is the mainstream procedure for esophageal cancer. Colon interposition and free jejunal flap for esophageal reconstruction are the alternative choices when the gastric tube is not available. However, to date, a solution for the high anastomosis leakage rates among these three types of conduits has not been reported. The aim of this network meta-analysis was to investigate the rate of anastomotic leakage (AL) among the three procedures to determine the best esophageal substitute or the future direction for improving the conventional gastric pull-up (GPU). Methods: We searched PubMed, Cochrane, and Embase databases. We included esophageal cancer patients receiving esophagectomy and excluded patients with other cancer. The random effect model was used in this network meta-analysis. The Newcastle–Ottawa Scale (NOS) was used for the quality assessment of studies in the network meta-analysis, and funnel plots were used to evaluate publication bias. The primary outcome is anastomosis leakage; the secondary outcomes are stricture formation, length of hospital stays, and mortality rate. Results: Nine studies involving 1613 patients were included in this network meta-analysis. The trend results indicated the following. Regarding anastomosis leakage, free jejunal flap was the better procedure; regarding stricture formation, colon interposition was the better procedure; regarding mortality rate, free jejunal flap was the better procedure; regarding length of hospital stay, gastric pull-up was the better treatment. Discussion: Overall, if technically accessible, free jejunal flap is a better choice than colon interposition when gastric conduit cannot be used, but further study should be conducted to compare groups with equal supercharged patients. In addition, jejunal flap (JF) cannot replace traditional gastric pull-up (GPU) due to technical complexities, more anastomotic sites, and longer operation times. However, the GPU method with the supercharged procedure would be a possible solution to lower postoperative AL. The limitation of this meta-analysis is that the number of articles included was low; we aim to update the result when new data are available. Funding: None. Registration: N/A.
Silent Hypoxemia in the Emergency Department: A Retrospective Cohort of Two Clinical Phenotypes in Critical COVID-19
Authors: Alamé Karine , Lemaitre Elena Laura , Abensur Vuillaume Laure , Noizet Marc , Gottwalles Yannick , Chouihed Tahar , Lavoignet Charles-Eric , Bérard Lise , Molter Lise , Gennai Stéphane , Ugé Sarah , Lefebvre François , Bilbault Pascal , Le Borgne Pierrick
Published: August 2022

Introduction: Understanding hypoxemia, with and without the clinical signs of acute respiratory failure (ARF) in COVID-19, is key for management. Hence, from a population of critical patients admitted to the emergency department (ED), we aimed to study silent hypoxemia (Phenotype I) in comparison to symptomatic hypoxemia with clinical signs of ARF (Phenotype II). Methods: This multicenter study was conducted between 1 March and 30 April 2020. Adult patients who were presented to the EDs of nine Great-Eastern French hospitals for confirmed severe or critical COVID-19, who were then directly admitted to the intensive care unit (ICU), were retrospectively included. Results: A total of 423 critical COVID-19 patients were included, out of whom 56.1% presented symptomatic hypoxemia with clinical signs of ARF, whereas 43.9% presented silent hypoxemia. Patients with clinical phenotype II were primarily intubated, initially, in the ED (46%, p < 0.001), whereas those with silent hypoxemia (56.5%, p < 0.001) were primarily intubated in the ICU. Initial univariate analysis revealed higher ICU mortality (29.2% versus 18.8%, p < 0.014) and in-hospital mortality (32.5% versus 18.8%, p < 0.002) in phenotype II. However, multivariate analysis showed no significant differences between the two phenotypes regarding mortality and hospital or ICU length of stay. Conclusions: Silent hypoxemia is explained by various mechanisms, most physiological and unspecific to COVID-19. Survival was found to be comparable in both phenotypes, with decreased survival in favor of Phenotype II. However, the spectrum of silent to symptomatic hypoxemia appears to include a continuum of disease progression, which can brutally evolve into fatal ARF.
Association between Outpatient Visits and Initiating Medication among Elderly Patients after an Osteoporotic Vertebral Fracture
Authors: Wu Ya-Chi , Chen Chuan-Yu , Chang Chin-Sung , Li Chia-Chun , Wang Ru-Hsueh , Sun Zih-Jie , Wu Chih-Hsing , Chang Yin-Fan
Published: August 2022

Purpose: A treatment gap exists in vertebral fracture (VF) patients. An outpatient visit is a necessary step to initiate treatment. The study aimed to evaluate factors associated with an outpatient visit following a VF diagnosis, and the association between the interval of an outpatient visit after VF diagnosis and its impact on prescribing of anti-osteoporosis medications (AOMs). Methods: Subjects 65 years and older from Tianliao Township in Taiwan with newly diagnosed VF between 2009 and 2010 were included. Information about outpatient visits and AOMs prescriptions were derived from the National Health Insurance Research database and followed up for 2 years. Factors associated with outpatient visits and the initiation of AOMs were assessed using the multivariable Cox proportional regression model analysis. The receiver operating characteristic curve (ROC curve) was analyzed to determine the predictive effects of the interval between an outpatient visit following the diagnosis of a new VF on initiating AOMs and the potential optimal cutoff point. Results: Of 393 participants, 42.2% had outpatient visits within 2 years after a new VF diagnosis, for which the mean interval was 4.8 ± 4.8 months. Patients who were female and reported a current use of supplements were positively associated with visits after a new VF diagnosis, but the bone mineral density (BMD) T-score was negatively associated with visits. Furthermore, 140 (35.6%) patients had initiated AOMs within 2 years after the diagnosis of a new VF. It was found that a higher BMD T-score and a longer interval between an outpatient visit following diagnosis was negatively associated with initiation of AOMs. The ROC curve analysis showed outpatient visits within 3 months after a VF diagnosis had the highest Youden index and maximum area under the curve. Conclusions: Patients who were female, were currently taking supplements, and those who had a lower BMD T-score were more likely to visit doctors after being diagnosed with a new VF. Furthermore, a lower BMD T-score and a shorter interval, within 3 months and not more than 8 months, between an outpatient visit following the diagnosis of VF increased the likelihood of being prescribed AOMs.
Infective Endocarditis by Pasteurella Species: A Systematic Review
Authors: Alifragki Angeliki , Kontogianni Argyro , Protopapa Ioanna , Baliou Stella , Ioannou Petros
Published: August 2022

Pasteurella spp. are non-motile, facultative anaerobic, Gram-negative coccobacilli that are commonly found in the oral cavity and the gastrointestinal tract of some animals and are known to be the cause of infections. Usually, infections by Pasteurella spp. in humans is more common in the context of an animal bite leading to a skin and soft tissue infection (SSTI). Infective endocarditis (IE) is rarely caused by Pasteurella spp.; however, it can pose diagnostic and therapeutic dilemmas due to its rarity. The aim of the present study was to systematically review all cases of IE by Pasteurella spp. in the literature. A systematic review was performed of PubMed, Scopus and the Cochrane Library (through 20 December 2021) for studies providing data on epidemiology and clinical and microbiological characteristics as well as data on treatment and outcomes of IE by Pasteurella spp. A total of 28 studies containing data for 28 patients were included. Prosthetic valve was present in 21.4% of patients. The aorta was the most commonly involved intracardiac site. Fever, sepsis, septic shock and heart failure were the most common clinical presentations. Cephalosporins, aminopenicillins and penicillin were the antimicrobials used most commonly. Overall mortality was 17.9%.
The Jaws Brachioplasty: An Original Technique: Improving Aesthetic Outcomes in Arm Lift Procedures
Authors: Nisi Giuseppe , Giardino Francesco , Giudice Martino , Fasano Giorgio , Cuomo Roberto , Grimaldi Luca
Published: August 2022

(1) Background: The increase in the number of bariatric surgery procedures has led plastic surgeons to look for new approaches to improve outcomes of body-contouring surgeries. A major concern in brachioplasty is the scarring process. Here, we propose a novel technique to minimize the incidence of pathological or unsatisfactory scars from brachioplasty. A video of the entire procedure is provided. (2) Methods: From January 2016 to August 2020, we performed the “Jaws” brachioplasty on 16 post-bariatric patients. We evaluated the effectiveness of the technique through pre- and postoperative assessments by patients and surgeons, the Vancouver Scar Scale, and the detection of major and minor complications within 12 months of follow-up. (3) Results: Thirteen patients were female and three were male, with a mean age of 32.5 ± 6.8 years (range: 22–47 years). The BODY-Q© Arms Section scores improved significantly, with no incidence of major or minor complications over 1 year of follow-up, and favorable aesthetic outcomes. (4) Conclusions: We believe that the “Jaws” technique is a valid contribution to post-bariatric surgery, as it aims to solve specific aesthetic problems of scarring from brachioplasty. The small number of patients does not allow the comparison of our original technique to others previously described in the literature.
Influence of Radiotherapy on Ossification of Vascularized Osseous Reconstruction of the Jaw: A Radiological Retrospective Cohort Study Based on Panoramic Radiographs
Authors: Gottsauner Maximilian , Fehrer Clara , Spoerl Steffen , Schuderer Johannes , Zeman Florian , Fiedler Mathias , Maurer Michael , Reichert Torsten E. , Ettl Tobias
Published: August 2022

Background: The aim of this study was to evaluate the impact of irradiation and time of irradiation on the ossification of jaws reconstructed with free bone grafts. Methods: In total, 100 reconstructions of the jaw were retrospectively evaluated for ossification between bone segments by two raters based on postoperative panoramic radiographs (immediate postOP, approximately 6, 12 and 24 months follow-up). Three subgroups were divided according to the time of irradiation: preoperative radiation therapy (n = 41), postoperative radiation therapy (n = 26) and patients without any radiation therapy (n = 33) as the control group. Ossification time and influencing factors were documented. Results: The fastest ossification with a median of 304 ± 37 days was observed (p < 0.001) in the nonirradiated control group. No significant difference (p = 0.087) in ossification was found between the pre- (447 ± 136 days) and postoperative (510 ± 112 days) radiation groups. Ossification between two graft segments (336 ± 38 days) showed significantly (p < 0.001) faster ossification than between the original and grafted bone (448 ± 85 days). Moreover, closer initial contact between the segments resulted in faster ossification (p < 0.001). When analyzing cofactors, tobacco consumption was the only negative factor aggravating ossification (p = 0.006). Conclusion: Head and neck radiation corresponded with the impaired and prolonged ossification of jaw reconstructions with free bone grafts. There was no difference in ossification if radiotherapy was performed before or after reconstructive surgery. A close bony contact was particularly important for ossification between the original and grafted bone.