bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring the Critical Risk Factors of Public–Private Partnership City Hospital Projects in Turkey
Authors: Dogan Erdem Tugba , Birgonul Zeynep , Bilgin Gozde , Akcay Emre Caner
Published: February 2024

Governments face challenges in delivering essential public services due to their limited funds. This has led to an increasing reliance on the Public–Private Partnership (PPP) model, an alternative financing model involving a long-term collaboration between the private and public sectors to provide public services. Turkey, as a developing country facing financial limitations, has embraced the PPP model to address urgent public needs. Over the past decade, the Turkish Government has extensively utilized the PPP model, particularly in executing city hospital projects. However, investors have faced challenges in project execution due to various risk factors. Therefore, the main objective of this study is to explore the critical risk factors associated with PPP city hospital projects in Turkey. In this context, a comprehensive literature review was conducted to identify potential risks related to PPP city hospital projects. A questionnaire survey was implemented to assess the probability of occurrence and the severity of the impact of these risk factors. The collected data underwent analysis to determine the priority of these risk factors. The findings revealed that the top five most critical risk factors in PPP city hospital projects in Turkey are “foreign exchange rate fluctuations”, “inflation rate volatility”, “high finance costs”, “fiscal issues”, and “economic crises”. Conversely, “unavailability of equipment” was identified as the least significant risk factor. The insights gained from this research can offer valuable guidance for prospective investors interested in participating in PPP city hospital projects in Turkey and other developing countries with similar conditions.
Energy Benefits of Tourist Accommodation Using Geodesic Domes
Authors: González-Avilés Ángel Benigno , Pérez-Carramiñana Carlos , Galiano-Garrigós Antonio , Pérez-Millán María Isabel
Published: February 2024

Over the last decade there has been a proliferation of glamping architecture. This study analyses the energy performance of geodesic domes for use in tourist glamping compared to more conventional prismatic architectural solutions. The energy analysis of geodesic domes applied to this type of singular construction project currently lacks detailed studies that provide conclusions about their relevance and suitability with respect to other types of architecture. The main objective of this research is to demonstrate the energy benefits of tourist accommodations that use geodesic structures compared to those with a simple geometry. A comparative study of a traditional and a geodesic geometry accommodation is carried out, considering that they share the same characteristics and they are built with the same construction solution. An energy simulation of both architectures is carried out by using DesignBuilder software. The most influential strategies, such as Direct Passive Solar Gain, Heating, Natural Ventilation Cooling, Fan-Forced Ventilation Cooling and Window Solar Shading are considered. After demonstrating the greater efficiency of geodesic domes, this study analyses the relevance of subdividing the accommodations into several geodesic dome spaces. The results quantify an energy benefit of 52% for cooling consumption using the geodesic dome solution compared to a traditional prismatic solution.
Urine-Based Biomarker Test Uromonitor® in the Detection and Disease Monitoring of Non-Muscle-Invasive Bladder Cancer—A Systematic Review and Meta-Analysis of Diagnostic Test Performance
Authors: Kravchuk Anton P. , Wolff Ingmar , Gilfrich Christian , Wirtz Ralph M. , Soares Paula , Braun Kay-Patrick , Brookman-May Sabine D. , Kollitsch Lisa , Hauner Katharina , Burchardt Martin , Bründl Johannes , Burger Maximilian , May Matthias
Published: February 2024

Optimal urine-based diagnostic tests (UBDT) minimize unnecessary follow-up cystoscopies in patients with non-muscle-invasive bladder-cancer (NMIBC), while accurately detecting high-grade bladder-cancer without false-negative results. Such UBDTs have not been comprehensively described upon a broad, validated dataset, resulting in cautious guideline recommendations. Uromonitor®, a urine-based DNA-assay detecting hotspot alterations in TERT, FGFR3, and KRAS, shows promising initial results. However, a systematic review merging all available data is lacking. Studies investigating the diagnostic performance of Uromonitor® in NMIBC until November 2023 were identified in PubMed, Embase, Web-of-Science, Cochrane, Scopus, and medRxiv databases. Within aggregated analyses, test performance and area under the curve/AUC were calculated. This project fully implemented the PRISMA statement. Four qualifying studies comprised a total of 1190 urinary tests (bladder-cancer prevalence: 14.9%). Based on comprehensive analyses, sensitivity, specificity, positive-predictive value/PPV, negative-predictive value/NPV, and test accuracy of Uromonitor® were 80.2%, 96.9%, 82.1%, 96.6%, and 94.5%, respectively, with an AUC of 0.886 (95%-CI: 0.851–0.921). In a meta-analysis of two studies comparing test performance with urinary cytology, Uromonitor® significantly outperformed urinary cytology in sensitivity, PPV, and test accuracy, while no significant differences were observed for specificity and NPV. This systematic review supports the use of Uromonitor® considering its favorable diagnostic performance. In a cohort of 1000 patients with a bladder-cancer prevalence of ~15%, this UBDT would avert 825 unnecessary cystoscopies (true-negatives) while missing 30 bladder-cancer cases (false-negatives). Due to currently limited aggregated data from only four studies with heterogeneous quality, confirmatory studies are needed.
The Regeneration of Dolomite as a Heterogeneous Catalyst for Biodiesel Production
Authors: Šlinkšienė Rasa , Paleckienė Rasa , Gaidė Ieva , Makarevičienė Violeta , Sendžikienė Eglė
Published: February 2024

Dolomite as a heterogeneous catalyst can be used in biodiesel synthesis. Process material costs can be reduced by regenerating and reusing the catalyst. Two methods of regeneration of dolomite were studied: (1) washing for 30 min with methanol, filtration, and washing for 30 min with hexane and (2) calcination at high temperature. Catalytic efficiency and catalyst changes after 1–6 cycles were evaluated. X-ray, FTIR, and SEM studies were performed. Calcination has been found to be a more effective method of catalyst regeneration than washing with solvents. The catalytic effectiveness of dolomite only slightly decreased over six application cycles. The results of the instrumental analysis showed that the structure and composition of the dolomite do not change during calcination after three cycles, while obvious changes in the structure of dolomite during catalyst washing were observed.
Gold, Silver and Copper Catalysis
Authors: Carabineiro Sónia Alexandra Correia
Published: February 2024

In terms of catalysis, the exploration of novel materials and innovative methodologies continues to drive the field forward, offering solutions to pressing challenges in various industrial applications [...]
The Relationship between p-tau217, p-tau231, and p-tau205 in the Human Brain Is Affected by the Cellular Environment and Alzheimer’s Disease Pathology
Authors: Wennström Malin , Schultz Nina , Gallardo Paula Mille ,   The Netherlands Brain Bank, Serrano Geidy E. , Beach Thomas G. , Bose Suchira , Hansson Oskar
Published: February 2024

The levels of p-tau217 and p-tau231 in cerebrospinal fluid (CSF) are associated with early amyloid beta (Aß) changes in the brain, while the CSF levels of p-tau205 are foremost related to tau pathology in the later stages of the disease. To investigate if the three p-tau variants are found to the same degree in different tau structures and if their co-localization is affected by the diagnosis and presence of Aß plaques, we immunostained sections of the entorhinal cortex (EC) and inferior temporal gyrus (ITG) from non-demented controls (NC), patients with Alzheimer’s disease (AD), and primary age-related tauopathy (PART) against p-tau217, p-tau231, and p-tau205 together with Methoxi-X04. An analysis using confocal microscopy showed that the co-localization variable, the Pearson correlation coefficient (PCC), was significantly higher between p-tau231 and p-tau205 in neurofibrillary tangles compared to neuropil threads and dystrophic neurites in plaques. The PCC value between all three p-tau variants in the neuropil threads was significantly lower in the ECs of patients with AD compared to the NC and in the ITGs of patients with AD, with a high Aß load compared to PART. The lowered value was associated with proportionally higher amounts of non-colocalized p-tau231 and p-tau217 compared to p-tau205, and the PCC values were negatively correlated with Aß and the tangle loads in patients with AD, but positively correlated with tangles in PART. These results suggest that the proportion of and co-localization between p-tau217, p-tau231, and p-tau205 are dependent on cellular localization and are altered in response to AD pathology in a spatial–temporal manner.
Regulation of the Activity of the Dual Leucine Zipper Kinase by Distinct Mechanisms
Authors: Köster Kyra-Alexandra , Dethlefs Marten , Duque Escobar Jorge , Oetjen Elke
Published: February 2024

The dual leucine zipper kinase (DLK) alias mitogen-activated protein 3 kinase 12 (MAP3K12) has gained much attention in recent years. DLK belongs to the mixed lineage kinases, characterized by homology to serine/threonine and tyrosine kinase, but exerts serine/threonine kinase activity. DLK has been implicated in many diseases, including several neurodegenerative diseases, glaucoma, and diabetes mellitus. As a MAP3K, it is generally assumed that DLK becomes phosphorylated and activated by upstream signals and phosphorylates and activates itself, the downstream serine/threonine MAP2K, and, ultimately, MAPK. In addition, other mechanisms such as protein–protein interactions, proteasomal degradation, dephosphorylation by various phosphatases, palmitoylation, and subcellular localization have been shown to be involved in the regulation of DLK activity or its fine-tuning. In the present review, the diverse mechanisms regulating DLK activity will be summarized to provide better insights into DLK action and, possibly, new targets to modulate DLK function.
The Role of Skin-to-Skin Contact and Breastfeeding in the First Hour Post Delivery in Reducing Excessive Weight Loss
Authors: Jurgelėnė Valentina , Kuzmickienė Vilma , Stonienė Dalia
Published: February 2024

Background and aims: An excessive weight loss (EWL) of >10% after birth is associated with serious health outcomes. The aim of this study was to determine factors that can reduce weight loss in full-term, exclusively breastfed infants after birth. Methods: This is a retrospective, observational, single-center study. We included 642 healthy, full-term, exclusively breastfed neonates born in 2019 in a baby-friendly hospital, and their healthy mothers. The exclusion criteria were as follows: supplementation with formula, multiple pregnancies, and neonates or mothers with health issues. Results: The mean percentage of neonatal weight loss after 24 h of life was 5.13%, and that after 48 h was 6.34%. Neonates delivered via a caesarean section lost more weight after 24 and 48 h of life than those delivered via vaginal delivery (p < 0.01). There is a noticeable pattern that neonates tend to lose more weight if they do not get skin-to-skin contact (SSC) and breastfeeding within the first hour after birth (p > 0.05). Conclusions: Neonates born via a CS tend to lose more weight after 24 and 48 h of life. Immediate SSC and breastfeeding in the first hour after delivery may decrease the excessive weight loss.
The Effect of Breastfeeding Practices of Undernourished Mothers in Rural Sierra Leone on Infant Growth and Mortality
Authors: Koroma Aminata Shamit , Stephenson Kevin B. , Iversen Per O. , Manary Mark J. , Hendrixson David Taylor
Published: February 2024

Breastfeeding provides optimal infant nutrition; however, <50% of infants are exclusively breastfed (EBF) for 6 months. We aimed to describe breastfeeding practices and their effects on growth and mortality among a high-risk mother-infant cohort in rural Sierra Leone. This was a secondary analysis of data from a randomized nutrition intervention trial among undernourished pregnant women. The study’s primary outcomes were infant weight and length gains at 6 weeks of age. We included 1270 singleton infants in the analysis, with 1092 (85.6%) having 24-week outcome data. At 6 weeks, 88% were EBF, but the rate of EBF decreased to 17% at 24 weeks. The EBF infants at 6 weeks had improved length (difference of 0.9 mm/week; 95% CI 0.4 to 1.3; p < 0.001) and weight (difference of 40 g/week; 95% CI 24 to 53; p < 0.001) gains compared to the non-EBF infants. At 12 weeks, the EBF infants had improved weight (difference of 12 g/week; 95% CI 2 to 22; p = 0.024) gain. The EBF infants had lower mortality than the infants who were not EBF (hazard ratio of 0.39; 95% CI 0.18 to 0.84; p = 0.017). In summary, the infants who were EBF had greater weight and length gain and reduced mortality than those who were not EBF. Efforts to improve breastfeeding should thus be prioritized to improve infant health.
Prevalence of TERT Promoter Mutations in Orbital Solitary Fibrous Tumors
Authors: Koca David Sinan , Kolpakov Vladimir , Ihlow Jana , von Laffert Maximilian , Erb-Eigner Katharina , Herbst Hermann , Kriese Karen , Schweizer Leonille , Bertelmann Eckart
Published: February 2024

The orbital manifestation of a solitary fibrous tumor (SFT) is exceptionally rare and poses specific challenges in diagnosis and treatment. Its rather exceptional behavior among all SFTs comprises a high tendency towards local recurrence, but it rarely culminates in metastatic disease. This raises the question of prognostic factors in orbital SFTs (oSFTs). Telomerase reverse transcriptase (TERT)-promoter mutations have previously been linked to an unfavorable prognosis in SFTs of other locations. We analyzed the prevalence of TERT promoter mutations of SFTs in the orbital compartment. We performed a retrospective, descriptive clinico-histopathological analysis of nine cases of oSFTs between the years of 2017 and 2021. A TERT promoter mutation was present in one case, which was classified with intermediate metastatic risk. Local recurrence or progress occurred in six cases after primary resection; no distant metastases were reported. Multimodal imaging repeatedly showed particular morphologic patterns, including tubular vascular structures and ADC reduction. The prevalence of the TERT promoter mutation in oSFT was 11%, which is similar to the prevalence of extra-meningeal SFTs of the head and neck and lower than that in other extra-meningeal compartments. In the present study, the TERT promoter mutation in oSFT manifested in a case with an unfavorable prognosis, comprising aggressive local tumor growth, local recurrence, and eye loss.
Optimizing Atrial Fibrillation Care: Comparative Assessment of Anticoagulant Therapies and Risk Factors
Authors: Rus Marius , Ardelean Adriana Ioana , Crisan Simina , Marian Paula , Pobirci Oana Lilliana , Huplea Veronica , Judea Pusta Claudia , Osiceanu Gheorghe Adrian , Stanis Claudia Elena , Andronie-Cioara Felicia Liana
Published: February 2024

Background and objectives: Atrial fibrillation (AF) is a common arrhythmia associated with various risk factors and significant morbidity and mortality. Materials and methods: This article presents findings from a study involving 345 patients with permanent AF. This study examined demographics, risk factors, associated pathologies, complications, and anticoagulant therapy over the course of a year. Results: The results showed a slight predominance of AF in males (55%), with the highest incidence in individuals aged 75 and older (49%). Common risk factors included arterial hypertension (54%), dyslipidemia, diabetes mellitus type 2 (19.13%), and obesity (15.65%). Comorbidities such as congestive heart failure (35.6%), mitral valve regurgitation (60%), and dilated cardiomyopathy (32%) were prevalent among the patients. Major complications included congestive heart failure (32%), stroke (17%), and myocardial infarction (5%). Thromboembolic and bleeding risk assessment using CHA2DS2-VASc and HAS-BLED scores demonstrated a high thromboembolic risk in all patients. The majority of patients were receiving novel oral anticoagulants (NOACs) before admission (73%), while NOACs were also the most prescribed antithrombotic therapy at discharge (61%). Conclusions: This study highlights the importance of risk factor management and appropriate anticoagulant therapy in patients with AF, to reduce complications and improve outcomes. The results support the importance of tailored therapeutic schemes, for optimal care of patients with AF.
Modeling and Simulating an Epidemic in Two Dimensions with an Application Regarding COVID-19
Authors: Alanazi Khalaf M.
Published: February 2024

We derive a reaction–diffusion model with time-delayed nonlocal effects to study an epidemic’s spatial spread numerically. The model describes infected individuals in the latent period using a structured model with diffusion. The epidemic model assumes that infectious individuals are subject to containment measures. To simulate the model in two-dimensional space, we use the continuous Runge–Kutta method of the fourth order and the discrete Runge–Kutta method of the third order with six stages. The numerical results admit the existence of traveling wave solutions for the proposed model. We use the COVID-19 epidemic to conduct numerical experiments and investigate the minimal speed of spread of the traveling wave front. The minimal spreading speeds of COVID-19 are found and discussed. Also, we assess the power of containment measures to contain the epidemic. The results depict a clear drop in the spreading speed of the traveling wave front after applying containment measures to at-risk populations.
Nanoemulsions Containing Mucuna pruriens (L.) DC. Seed Extract for Cosmetic Applications
Authors: Chookiat Suwaporn , Theansungnoen Tinnakorn , Kiattisin Kanokwan , Intharuksa Aekkhaluck
Published: February 2024

Mucuna pruriens is a medicinal plant whose seeds have various types of pharmacological activities and are used in many traditional medicines. The aim of this study was to evaluate the phytochemicals as well as the anti-aging, antioxidant, and moisturizing properties of seed extracts of M. pruriens var. pruriens and M. pruriens var. utilis. In addition, the best extract was selected for the development of nanoemulsions. M. pruriens var. utilis had the highest total phenolic and total flavonoid contents. It had good antioxidant activity (the IC50 of DPPH was 4.87 µg/mL, the FRAP value was 1.63 mg of FeSO4/mg of extract, and the percentage of lipid peroxidation was 80.19%) and anti-aging activity (the percentages of inhibition of hyaluronidase, collagenase, and elastase were 26.41%, 51.16%, and 22.78%, respectively). The occlusive factor was 46.12 ± 1.72. Therefore, M. pruriens var. utilis seed extract was selected for the preparation of nanoemulsions. The results showed that the size, PDI, and zeta potential of nanoemulsions containing M. pruriens var. utilis seed extract at day 30 did not significantly differ from those at day 0. In addition, the %EE was 63.46%. A study of skin permeation showed that the retention in the membrane after six hours of skin permeation study was 44.19%. Therefore, nanoemulsions containing M. pruriens var. utilis seed extract have good potential for further use in cosmetic applications.
Investigating Influential Parameters for High-Purity Germanium Crystal Growth
Authors: Bhattarai Sanjay , Mei Dongming , Budhathoki Narayan , Dong Kunming , Warren Austin
Published: February 2024

This paper focuses on the research and development of high-purity germanium (HPGe) crystals for detector fabrication, specifically targeting applications in rare-event physics searches. The primary objective was to produce large-scale germanium crystals weighing >1 kg with a controlled diameter of ∼10 cm and an impurity range of approximately 1010/cm 3. Ensuring structural integrity and excellent crystalline quality requires a thorough assessment of dislocation density, a critical aspect of the crystal development process. Dislocation density measurements play a crucial role in maximizing the sensitivity of HPGe detectors, and our findings confirmed that the dislocation density fell within acceptable ranges for detector fabrication. Additionally, this paper examines the segregation coefficient of various contaminants during the crystal development process. Comprehensive analysis of impurity segregation is essential for reducing contaminant quantities in the crystal lattice and customizing purification processes. This, in turn, minimizes undesired background noise, enhancing signal-to-noise ratios for rare-event physics searches and overall detector performance. The investigation included the segregation coefficients of three major acceptors and one donor in crystals grown at the University of South Dakota, providing valuable insights for optimizing crystal purity and detector efficiency.
Explaining Color Change in Gem-Quality Andradite Garnet
Authors: Xu Jia-Hong , Yu Xiao-Yan , Shen Mei , Yan Ying , Wang Guang-Ya
Published: February 2024

The homomorphic substitution of the garnet group is common in nature. Two rare color-changing andradite garnets are studied in this paper. One color changes from yellowish-green in the presence of daylight to maroon under incandescent light; the other color changes from brownish yellow to brownish red. In this study, conventional gemological instruments, infrared (IR) spectroscopy, ultraviolet–visible–near infrared (UV–Vis–NIR) spectroscopy, Raman spectroscopy, and electron probe microanalysis (EPMA) were used to explore the gemology and coloration mechanisms of color-changing garnets. Experiments revealed that the color-changing gemstones in the study are andradite garnets. There are two transmission windows in the UV–Vis spectrum: the red region (above 650 nm) and the green region (centered at 525 nm). The chemical compositional analysis indicates that the samples are very low in Cr (<1 ppm) and high in Fe2+ (from 2.31 wt.% to 4.66 wt.%). The combined spectra and chemical compositional analysis show that Fe2+ is the main cause of the color change. Based on the IR spectrum (complex water peaks), UV–Vis–NIR spectrum (similar to that of Namibian andradite garnet), and chemical compositional analysis (low Cr content), it is concluded that color-changing andradite may be related to skarn rock genesis.
Personalizing the Treatment of Women with Ductal Carcinoma In Situ (DCIS) Using the DCIS Score: A Qualitative Study on Score Use
Authors: O’Brien Mary Ann , Paszat Lawrence , Makuwaza Tutsirai , Fong Cindy , Rakovitch Eileen
Published: February 2024

Background: A twelve-gene molecular expression assay (DCIS score) may help guide radiation oncology treatment under specific circumstances. We undertook a study to examine radiation oncologist (RO), surgeon, and decision maker views on implementing the DCIS score in practice for women with low-risk DCIS. Methods: We conducted a qualitative study involving telephone interviews that were audio-recorded and transcribed. Two researchers conducted a thematic analysis of transcripts. Results: Twenty-eight individuals (ROs, breast cancer surgeons, and cancer policy decision makers) were invited to participate; 22 out of the 28 people (79%) agreed. The final sample included 20 participants: 11 of 13 (85%) ROs, 5 of 7 (71%) surgeons, and 4 of 8 (50%) decision makers. Most ROs expressed concerns about overtreatment but could not predict with certainty which low-risk patients could safely avoid radiation. The DCIS score was viewed as contributing valuable personalized risk information as part of treatment decision making that included clinicopathological factors and women’s preferences. Future implementation would require guidelines with input from the oncology team. Conclusions: ROs had concerns about the overtreatment of women with DCIS, but lacked the tools to reliably predict which women could safely avoid radiation. By providing oncologists and women with personalized tumor information, the DCIS score was an important component of treatment decision making.
Ferritin: A Biomarker Requiring Caution in Clinical Decision
Authors: Lemaire Baptiste , Frias Miguel A. , Golaz Olivier , Magnin Jean-Luc , Viette Véronique , Vuilleumier Nicolas , Waldvogel Abramowski Sophie
Published: February 2024

Objectives. To determine the ferritin inter-assay differences between three “Conformité Européenne” (CE) marked tests, the impact on reference intervals (RI), and the proportion of individuals with iron deficiency (ID), we used plasma and serum from healthy blood donors (HBD) recruited in three different Switzerland regions. Design and Methods. Heparinized plasma and serum from HBD were obtained from three different transfusion centers in Switzerland (Fribourg, Geneva, and Neuchatel). One hundred forty samples were recruited per center and per matrix, with a gender ratio of 50%, for a total of 420 HBD samples available per matrix. On both matrices, ferritin concentrations were quantified by three different laboratories using electrochemiluminescence (ECL), latex immunoturbidimetric assay (LIA), and luminescent oxygen channeling immunoassay (LOCI) assays, respectively. The degree of agreement between matrices and between the three sites/methods was assessed by Passing–Bablok and we evaluated the proportion of individuals deemed to have ID per method. Results. Overall, no difference between serum and heparinized plasma ferritin values was observed according to Passing–Bablok analyses (proportional bias range: 1.0–3.0%; maximum constant bias: 1.84 µg/L). Significant median ferritin differences (p < 0.001 according to Kruskal–Wallis test) were observed between the three methods (i.e., 83.6 µg/L, 103.5 µg/L, and 62.1 µg/L for ECL, LIA, and LOCI in heparinized plasma, respectively), with proportional bias varying significantly between ±16% and ±32% on serum and from ±14% to ±35% on plasma with no sign of gender-related differences. Affecting the lower end of RI, the proportion of ID per method substantially varied between 4.76% (20/420) for ECL, 2.86% (12/420) for LIA, and 9.05% (38/420) for LOCI. Conclusions. Serum and heparinized plasma are exchangeable for ferritin assessment. However, the order of magnitude of ferritin differences across methods and HBD recruitment sites could lead to diagnostic errors if uniform RI were considered. Challenging the recently proposed use of uniform ferritin thresholds, our results highlight the importance of method- and region-specific RI for ferritin due to insufficient inter-assay harmonization. Failing to do so significantly impacts ID diagnosis.
The Use of Artificial Intelligence in the Liver Histopathology Field: A Systematic Review
Authors: Grignaffini Flavia , Barbuto Francesco , Troiano Maurizio , Piazzo Lorenzo , Simeoni Patrizio , Mangini Fabio , De Stefanis Cristiano , Onetti Muda Andrea , Frezza Fabrizio , Alisi Anna
Published: February 2024

Digital pathology (DP) has begun to play a key role in the evaluation of liver specimens. Recent studies have shown that a workflow that combines DP and artificial intelligence (AI) applied to histopathology has potential value in supporting the diagnosis, treatment evaluation, and prognosis prediction of liver diseases. Here, we provide a systematic review of the use of this workflow in the field of hepatology. Based on the PRISMA 2020 criteria, a search of the PubMed, SCOPUS, and Embase electronic databases was conducted, applying inclusion/exclusion filters. The articles were evaluated by two independent reviewers, who extracted the specifications and objectives of each study, the AI tools used, and the results obtained. From the 266 initial records identified, 25 eligible studies were selected, mainly conducted on human liver tissues. Most of the studies were performed using whole-slide imaging systems for imaging acquisition and applying different machine learning and deep learning methods for image pre-processing, segmentation, feature extractions, and classification. Of note, most of the studies selected demonstrated good performance as classifiers of liver histological images compared to pathologist annotations. Promising results to date bode well for the not-too-distant inclusion of these techniques in clinical practice.
Innovative Neuroimaging Biomarker Distinction of Major Depressive Disorder and Bipolar Disorder through Structural Connectome Analysis and Machine Learning Models
Authors: Huang Yang , Zhang Jingbo , He Kewei , Mo Xue , Yu Renqiang , Min Jing , Zhu Tong , Ma Yunfeng , He Xiangqian , Lv Fajin , Lei Du , Liu Mengqi
Published: February 2024

Major depressive disorder (MDD) and bipolar disorder (BD) share clinical features, which complicates their differentiation in clinical settings. This study proposes an innovative approach that integrates structural connectome analysis with machine learning models to discern individuals with MDD from individuals with BD. High-resolution MRI images were obtained from individuals diagnosed with MDD or BD and from HCs. Structural connectomes were constructed to represent the complex interplay of brain regions using advanced graph theory techniques. Machine learning models were employed to discern unique connectivity patterns associated with MDD and BD. At the global level, both BD and MDD patients exhibited increased small-worldness compared to the HC group. At the nodal level, patients with BD and MDD showed common differences in nodal parameters primarily in the right amygdala and the right parahippocampal gyrus when compared with HCs. Distinctive differences were found mainly in prefrontal regions for BD, whereas MDD was characterized by abnormalities in the left thalamus and default mode network. Additionally, the BD group demonstrated altered nodal parameters predominantly in the fronto-limbic network when compared with the MDD group. Moreover, the application of machine learning models utilizing structural brain parameters demonstrated an impressive 90.3% accuracy in distinguishing individuals with BD from individuals with MDD. These findings demonstrate that combined structural connectome and machine learning enhance diagnostic accuracy and may contribute valuable insights to the understanding of the distinctive neurobiological signatures of these psychiatric disorders.
A Deep Convolutional Neural Network for Pneumonia Detection in X-ray Images with Attention Ensemble
Authors: An Qiuyu , Chen Wei , Shao Wei
Published: February 2024

In the domain of AI-driven healthcare, deep learning models have markedly advanced pneumonia diagnosis through X-ray image analysis, thus indicating a significant stride in the efficacy of medical decision systems. This paper presents a novel approach utilizing a deep convolutional neural network that effectively amalgamates the strengths of EfficientNetB0 and DenseNet121, and it is enhanced by a suite of attention mechanisms for refined pneumonia image classification. Leveraging pre-trained models, our network employs multi-head, self-attention modules for meticulous feature extraction from X-ray images. The model’s integration and processing efficiency are further augmented by a channel-attention-based feature fusion strategy, one that is complemented by a residual block and an attention-augmented feature enhancement and dynamic pooling strategy. Our used dataset, which comprises a comprehensive collection of chest X-ray images, represents both healthy individuals and those affected by pneumonia, and it serves as the foundation for this research. This study delves deep into the algorithms, architectural details, and operational intricacies of the proposed model. The empirical outcomes of our model are noteworthy, with an exceptional performance marked by an accuracy of 95.19%, a precision of 98.38%, a recall of 93.84%, an F1 score of 96.06%, a specificity of 97.43%, and an AUC of 0.9564 on the test dataset. These results not only affirm the model’s high diagnostic accuracy, but also highlight its promising potential for real-world clinical deployment.
Diagnostic and Management Challenges of Esophageal Rupture with Concomitant Cervical Abscess in Chronic High Cervical Tetraplegia
Authors: Park Junghwan , Lee Dong Gyu
Published: February 2024

A 65-year-old with a history of spinal cord injury and previous cervical surgery presented with persistent fever despite antibiotic treatment. MRI scans revealed an abscess in the neck extending from C3 to C6, with associated osteomyelitis. After an initial discharge following antibiotic therapy, the patient was readmitted due to recurrent systemic infection symptoms and another abscess. A subsequent endoscopy showed esophageal rupture with protruding cervical fusion metal. Due to operative risks, a percutaneous endoscopic gastrostomy was performed without further infection recurrence. The absence of typical imaging signs of esophageal rupture made diagnosis difficult. The infection spread through the cervical fascia from superficial to deep cervical areas. Esophageal rupture, a rare complication of cervical surgery, presents with varying symptoms depending on its location and was particularly challenging to diagnose in this patient due to high cervical tetraplegia, which masked typical pain responses. Therefore, this case highlights the need to consider esophageal rupture in differential diagnoses for chronic ACDF patients, even when typical symptoms are absent.
Agreement between Handheld and Standard Echocardiography for Diagnosis of Latent Rheumatic Heart Disease in Brazilian Schoolchildren from High-Prevalence Settings (Agreement between Screening and Standard Echo for RHD)
Authors: Diniz Marina , Fraga Lucas , Nunes Maria , Oliveira Kaciane , Amaral Ingred , Chavez Luz , de Paula Luiza , Haiashi Beatriz , Ferreira Alexandre , Silva Mauro , Veloso Jéssica , Silva Cássia , Gelape Fernanda , Santos Luiza , Amaral Arthur , Coelho Cecília , Diamante Lucas , Correia Juliane , Meira Zilda , Ribeiro Antonio , Spaziani Alison , Sable Craig , Nascimento Bruno
Published: February 2024

Introduction: Handheld echocardiography (echo) is the tool of choice for rheumatic heart disease (RHD) screening. We aimed to assess the agreement between screening and standard echo for latent RHD diagnosis in schoolchildren from an endemic setting. Methods: Over 14 months, 3 nonphysicians used handheld machines and the 2012 WHF Criteria to determine RHD prevalence in consented schoolchildren from Brazilian low-income public schools. Studies were interpreted by telemedicine by 3 experts (Brazil, US). RHD-positive children (borderline/definite) and those with congenital heart disease (CHD) were referred for standard echo, acquired and interpreted by a cardiologist. Agreement between screening and standard echo, by WHF subgroups, was assessed. Results: 1390 students were screened in 6 schools, with 110 (7.9%, 95% CI 6.5–9.5) being screen positive (14 ± 2 years, 72% women). Among 16 cases initially diagnosed as definite RHD, 11 (69%) were confirmed, 4 (25%) reclassified to borderline, and 1 to normal. Among 79 cases flagged as borderline RHD, 19 (24%) were confirmed, 50 (63%) reclassified to normal, 8 (10%) reclassified as definite RHD, and 2 had mild CHD. Considering the 4 diagnostic categories, kappa was 0.18. In patients with borderline RHD reclassified to non-RHD, the most frequent WHF criterion was B (isolated mitral regurgitation, 64%), followed by A (2 mitral valve morphological features, 31%). In 1 patient with definite RHD reclassified to normal, the WHF criterion was D (borderline RHD in aortic and mitral valves). After standard echo, RHD prevalence was 3.2% (95% CI 2.3–4.2). Conclusions: Although practical, RHD screening with handheld devices tends to overestimate prevalence.
The Portal Venous Pulsatility Index and Main Portal Vein Diameter as Surrogate Markers for Liver Fibrosis in Nonalcoholic Fatty Liver Disease and Metabolic-Dysfunction-Associated Steatotic Liver Disease
Authors: Lee Jaejun , Choi Seungmyeon , Cho Seong-Hyun , Yang Hyun , Sung Pil-Soo , Bae Si-Hyun
Published: February 2024

(1) Background: Despite numerous noninvasive methods for assessing liver fibrosis, effective ultrasound parameters remain limited. We aimed to identify easily measurable ultrasound parameters capable of predicting liver fibrosis in patients with nonalcoholic fatty liver disease (NAFLD) and metabolic-dysfunction-associated steatotic liver disease (MASLD); (2) Methods: The data of 994 patients diagnosed with NAFLD via ultrasound at the Armed Forces Goyang Hospital were retrospectively collected from June 2022 to July 2023. A liver stiffness measurement (LSM) ≥ 8.2 kPa was classified as significant fibrosis. Liver steatosis with cardiometabolic risk factors was defined as MASLD. Two ultrasound variables, the portal venous pulsatility index (VPI) and main portal vein diameter (MPVD), were measured; (3) Results: Of 994 patients, 68 had significant fibrosis. Significant differences in VPI (0.27 vs. 0.34, p < 0.001) and MPVD (10.16 mm vs. 8.98 mm, p < 0.001) were observed between the fibrotic and non-fibrotic groups. A logistic analysis adjusted for age and body mass index (BMI) revealed that only VPI (OR of 0.955, p = 0.022, VPI on a 0.01 scale) and MPVD (OR of 1.501, p < 0.001) were significantly associated with significant liver fibrosis. In the MASLD cohort (n = 939), VPI and MPVD were associated with significant fibrosis. To achieve better accuracy in predicting liver fibrosis, we established a nomogram that incorporated MPVD and VPI. The established nomogram was validated in the test cohort, yielding an area under the receiver operating characteristic curve of 0.821 for detecting significant liver fibrosis; (4) Conclusions: VPI and MPVD, as possible surrogate markers, are useful in predicting significant fibrosis in patients with NAFLD and MASLD.
A Preliminary Diagnostic Model for Forward Head Posture among Adolescents Using Forward Neck Tilt Angle and Radiographic Sagittal Alignment Parameters
Authors: Moon Young Jae , Ahn Tae Young , Suh Seung Woo , Park Kun-Bo , Chang Sam Yeol , Yoon Do-Kun , Kim Moo-Sub , Kim Hyeonjoo , Jeon Yong Dae , Yang Jae Hyuk
Published: February 2024

Despite numerous attempts to correct forward head posture (FHP), definitive evidence-based screening and diagnostic methods remain elusive. This study proposes a preliminary diagnostic methodology for FHP, utilizing a noninvasive body angle measurement system as a screening test for FHP and incorporating radiological parameters for sagittal alignment. We enrolled 145 adolescents for FHP screening. The forward neck tilt angle (FNTA), defined as the angle between the vertical line and the line connecting the participant’s acromion and tragus, was measured using the POM-Checker (a noninvasive depth sensor-based body angle measurement system). A whole-spine standing lateral radiograph was obtained, and eight sagittal alignment parameters were measured. Statistical analyses of the association between the FNTA and eight sagittal alignment parameters were conducted. We used 70% of the participant data to establish a preliminary diagnostic model for FHP based on FNTA and each sagittal alignment parameter. The accuracy of the model was evaluated using the remaining 30% of the participant data. All radiological parameters of sagittal alignment showed weak statistical significance with respect to FNTA (best case: r = 0.16, p = 0.0500; cranial tilt). The proposed preliminary diagnostic model for FHP demonstrated 95.35% agreement. Notably, the model using FNTA without radiological parameters accurately identified (100%) participants who required radiographic scanning for FHP diagnosis. Owing to the weak statistical significance of the association between radiological parameters and external body angle, both factors must be considered for accurate FHP diagnosis. When a clear and severe angle variation is observed in an external body angle check, medical professionals should perform radiographic scanning for an accurate FHP diagnosis. In conclusion, FNTA assessment of FNTA through the proposed preliminary diagnostic model is a significant screening factor for selecting participants who must undergo radiographic scanning so that a diagnosis of FHP can be obtained.
High-Risk Sarcoidosis: A Focus on Pulmonary, Cardiac, Hepatic and Renal Advanced Diseases, as Well as on Calcium Metabolism Abnormalities
Authors: Israël-Biet Dominique , Bernardinello Nicol , Pastré Jean , Tana Claudio , Spagnolo Paolo
Published: February 2024

Although sarcoidosis is generally regarded as a benign condition, approximately 20–30% of patients will develop a chronic and progressive disease. Advanced pulmonary fibrotic sarcoidosis and cardiac involvement are the main contributors to sarcoidosis morbidity and mortality, with failure of the liver and/or kidneys representing additional life-threatening situations. In this review, we discuss diagnosis and treatment of each of these complications and highlight how the integration of clinical, pathological and radiological features may help predict the development of such high-risk situations in sarcoid patients.
Validation of a New Digital and Automated Color Perception Test
Authors: Fanlo-Zarazaga Alvaro , Echevarría José Ignacio , Pinilla Juan , Alejandre Adrián , Pérez-Roche Teresa , Gutiérrez Diego , Ortín Marta , Pueyo Victoria
Published: February 2024

Although color vision deficiencies are very prevalent, there are no ideal methods for assessing color vision in all environments. We compared a new digital and automated method that quantifies color perception for the three protan, deutan, and tritan axes with two of the most commonly used color tests in daily practice: the Ishihara 38 plates test and the Farnsworth–Munsell 100-Hue test. One hundred patients underwent a triple examination composed of the new DIVE Color Test, the Ishihara test, and the Farnsworth–Munsell 100-Hue test. The DIVE Color Test was performed twice in forty participants to assess its repeatability. In the trichromatic group, the mean age stood at 20.57 ± 9.22 years compared with 25.99 ± 15.86 years in the dyschromatic group. The DIVE and Ishihara tests exhibited excellent agreement in identifying participants with color deficiency (Cohen’s kappa = 1.00), while it was 0.81 when comparing DIVE and Farnsworth. The correlation between the global perception values of Farnsworth (TES) and DIVE (GCS) was 0.80. The repeatability of the DIVE Color Test was high according to Bland–Altman analysis with an intraclass correlation coefficient of 0.83. According to Ishihara, the DIVE Color Test proved to be an effective and reproducible tool for red–green color vision deficiency detection, capable of determining the severity of the defect in each of the three axes faster and more accurately than both Ishihara and Farnsworth.
Robotic-Assisted Bronchoscopy: A Comprehensive Review of System Functions and Analysis of Outcome Data
Authors: Prado Renan Martins Gomes , Cicenia Joseph , Almeida Francisco Aécio
Published: February 2024

The past two decades have witnessed a revolutionary era for peripheral bronchoscopy. Though the initial description of radial endobronchial ultrasound can be traced back to 1992, it was not until the mid-2000s that its utilization became commonplace, primarily due to the introduction of electromagnetic navigation (EMN) bronchoscopy. While the diagnostic yield of EMN-assisted sampling has shown substantial improvement over historical fluoroscopy-assisted bronchoscopic biopsy, its diagnostic yield plateaued at around 70%. Factors contributing to this relatively low diagnostic yield include discrepancies in computed tomography to body divergence, which led to unsuccessful lesion localization and resultant unsuccessful sampling of the lesion. Furthermore, much of peripheral bronchoscopy utilized a plastic extended working channel whose tips were difficult to finely aim at potential targets. However, the recent introduction of robotic-assisted bronchoscopy, and its associated stability within the peripheral lung, has ignited optimism for its potential to significantly enhance the diagnostic performance for peripheral lesions. Moreover, some envision this technology eventually playing a pivotal role in the therapeutic delivery to lung tumors. This review aims to describe the currently available robotic-assisted bronchoscopy technologies and to discuss the existing scientific evidence supporting these.
Mesenchymal Stem Cell Transplantation Has a Regenerative Effect in Ischemic Myocardium: An Experimental Rat Model Evaluated by SPECT-CT Assessment
Authors: Koutela Antonella , Loudos George , Rouchota Maritina , Kletsas Dimitrios , Karameris Andreas , Vilaras George , Zografos George C. , Myoteri Despoina , Dougenis Dimitrios , Papalois Apostolos E.
Published: February 2024

Translational perspective: Ischemic heart disease remains a major medical problem with high mortality rates. Beside the great efforts devoted to research worldwide and the use of numerous experimental models, an absolute understanding of myocardial infarction and tissue loss has not yet been achieved. Furthermore, the regeneration of myocardial tissue and the improvement of myocardial activity after ischemia is one of the major areas of interest in the medical (and especially cardiovascular) community. In a novel experimental rat model, the beneficial effect of mesenchymal stem cell transplantation (MSCT) in a surgically induced ischemic myocardium was documented. From a clinical perspective, this work supports the surgical administration of MSCT in the infarcted area during coronary artery bypass surgery. Aims: The regeneration of myocardial tissue and the improvement of myocardial activity after ischemia is one of the major areas of interest in cardiovascular research. We developed a novel experimental rat model and used it to examine the effect of mesenchymal stem cell transplantation (MSCT) on myocardial ischemia evaluated by SPECT-CT and immunohistochemistry. Methods and results: An open thoracotomy took place for forty adult female Wistar rats with (n = 30) or without (n = 10) surgical ligation of the left anterior descending coronary artery (LAD) in order to cause myocardial ischemia. Myocardial viability was evaluated via SPECT/CT 7 days before surgery, as well as at 7 and 14 days post-surgery. At day 0, 15 animals received homologous stem cells injected at the ischemic myocardium area. A SPECT/CT evaluation showed decreased activity of the myocardial cells in the left ventricle one week post-infarction. Regeneration of the ischemic myocardium fifteen days post-infarction was recorded only in animals subjected to stem cell transplantation. These findings were also confirmed by histology and immunohistochemical analysis, with the significantly higher expression of GATA4 and Nkx2.5. Conclusions: The positive effect of mesenchymal stem cell transplantation in the ischemic myocardium was recorded. The application of SPECT-CT allowed a clear evaluation of both the quality and quantity of the living myocardium post-infarction, leading to a new approach in the research of cardiovascular diseases. From a clinical perspective, MSCT may be beneficial when accompanied by myocardial revascularization procedures.