bluuebunny/crossref_metadata_2025 huggingface dataset:
Rationale and Design of the Impact of Air Pollution Due to DESERT Dust in Patients with HEART Failure (DESERT HEART)
Authors: Domínguez-Rodríguez Alberto , Avanzas Pablo , Báez-Ferrer Néstor , Abreu-González Pedro , Rodríguez Sergio , Matos-Castro Sebastian , Hernández-Vaquero Daniel
Published: July 2023

Aims: The main objective of this study is to determine whether exposure to Saharan dust causes airway inflammation and oxidative stress in patients with stable chronic heart failure (HF) and a left ventricular ejection fraction of less than 40%. Methods: A longitudinal study design is used, involving the inclusion of 40 patients with stable chronic HF and a left ventricular ejection fraction of less than 40%. Four sputum samplings will be taken from each patient, with one sampling taken each week over four consecutive weeks. The sputum samples will be used to analyze the degree of inflammation and oxidative stress. Air quality monitoring stations will be used to analyze the particulate matter (PM) exposure of each patient. The intrusion of desert dust will be identified using meteorological models. There will be 160 scheduled samplings in 40 patients with chronic HF. Mixed regression models will be used to assess the influence of the concentrations of PM (from the episodes of desert dust) upon the airway inflammation and oxidative stress markers. Conclusion: The results of this study will test the hypothesis that exposure to high concentrations of Saharan dust affects the normal function of the respiratory epithelium due to the imbalance between the production of free radicals and antioxidant enzymes, thus causing increased pulmonary inflammation and oxidative stress in patients with HF that in turn may facilitate decompensations of their background disease condition.
Characterizing Foveal Hypoplasia Using Optical Coherence Tomography Angiography: Evaluation of Microvascular Abnormalities and Clinical Significance
Authors: Storp Jens Julian , Zimmermann Julian Alexander , Danzer Moritz Fabian , Alnawaiseh Maged , Eter Nicole , Al-Nawaiseh Sami
Published: July 2023

This study aimed to evaluate foveal avascular zone (FAZ) features and macular flow density (FD) in various retinal layers in a cohort of patients with foveal hypoplasia (FH) using optical coherence tomography angiography (OCTA), in order to characterize microvascular abnormalities and explore their potential clinical significance. FAZ parameters and FD, as well as retinal thickness and volume values were analyzed and compared between patients with FH and an age- and gender-matched control cohort. Correlations between disease severity and visual acuity (VA), as well as between disease severity and FAZ features were evaluated. A total of 19 eyes with FH and 19 control eyes were included. The study group showed significantly higher FD values in the foveal sectors of the superficial and deep capillary plexus compared to controls. FAZ area, perimeter, and acircularity index (ACI) were noticeably altered in eyes with FH; however, they did not correlate with disease severity. Visual acuity was negatively correlated with disease severity. The results of this study provide evidence of altered microvasculature architecture specifically in the foveal sectors of patients with FH. The higher FD values in the foveal sectors of FH patients suggest a potential compensatory response of the retinal microvasculature. FAZ parameters and FD values of the foveal sectors could be used as part of an OCTA-based grading system in FH patients.
The Present and Future of Artificial Intelligence in Urological Cancer
Authors: Liu Xun , Shi Jianxi , Li Zhaopeng , Huang Yue , Zhang Zhihong , Zhang Changwen
Published: July 2023

Artificial intelligence has drawn more and more attention for both research and application in the field of medicine. It has considerable potential for urological cancer detection, therapy, and prognosis prediction due to its ability to choose features in data to complete a particular task autonomously. Although the clinical application of AI is still immature and faces drawbacks such as insufficient data and a lack of prospective clinical trials, AI will play an essential role in individualization and the whole management of cancers as research progresses. In this review, we summarize the applications and studies of AI in major urological cancers, including tumor diagnosis, treatment, and prognosis prediction. Moreover, we discuss the current challenges and future applications of AI.
Impact of ILD-Specific Therapies on Perioperative Course in Patients with Progressive Interstitial Lung Disease Undergoing Lung Transplantation
Authors: Munker Dieter , Arnold Paola , Leuschner Gabriela , Irlbeck Michael , Michel Sebastian , Kauke Teresa , Meiser Bruno , Behr Jürgen , Kneidinger Nikolaus , Veit Tobias
Published: July 2023

Immunosuppressants and antifibrotics are currently used to treat patients with various interstitial lung diseases, which may undergo lung transplantation (LTx). The retrospective study aimed to evaluate the potential effects of therapeutic regimen on the perioperative course in patients with idiopathic pulmonary fibrosis (IPF) or progressive pulmonary fibrosis (PPF) undergoing LTx. All patients with IPF and PPF undergoing LTx between January 2014 and December 2021 were included. We retrospectively screened for previous use of immunosuppressants and antifibrotic therapy. We analyzed perioperative courses, short-term outcomes, and safety retrospectively. In total, 286 patients with diagnosis of IPF or PPF were analyzed. According to the treatment regimen before LTx, the study cohort was divided into four groups and compared. No differences between antifibrotic monotherapy, combined antifibrotic and immunosuppressive therapy with regard to postoperative complications were observed. Length of mechanical ventilation was shorter in patients with antifibrotics prior to LTx. Pretreatment with antifibrotic monotherapy and a combination of antifibrotic drugs with immunosuppressive therapy, lower body mass index (BMI) and lower blood loss, were independently associated with primary graft dysfunction grades 0–3 72 hours after LTx (p < 0.001). Finally, patients with antifibrotic monotherapy developed significantly less de novo donor-specific antibodies (DSA) (p = 0.009). Higher intraoperative blood loss, etiology of interstitial lung disease (ILD) and older age were independently associated with shorter survival after LTx. Use of antifibrotic monotherapy and a combination of antifibrotic drugs with immunosuppressive therapy in IPF/PPF patients undergoing LTx, proved to be safe and might lead to beneficial effects after LTx.
Clostridioides difficile and Enterococci’s Interplay in the Human Gut: Bacterial Alliance or Competition? A Systematic Literature Review
Authors: Granata Guido , Schiavone Francesco , Taglietti Fabrizio , Petrosillo Nicola
Published: July 2023

Clostridioides difficile and Enterococcus spp. are two common bacterial pathogens populating the human microbiota. We possess scant data on how Clostridioides difficile interacts with Enterococcus spp. in the gut microbiota in subjects colonized with Clostridioides difficile or during a Clostridioides difficile infection. We carried out a systematic review of studies on Enterococcus spp. and Clostridioides difficile’s interaction in the gut microbiota and on the effect of Enterococcus spp. gut colonization on CDI development. Studies on Enterococcus spp. and Clostridioides difficile’s interaction in the gut microbiota and on the effect of Enterococcus spp. gut colonization on CDI were searched using the search terms “clostridium”, “clostridioides”, “difficile” and “enterococcus” on the MEDLINE and SCOPUS databases. PubMed was searched until 1 May 2023. An English language restriction was applied. The risk of bias in the included studies was not assessed. Quantitative and qualitative information was summarized in textual descriptions. Fourteen studies, published from August 2012 to November 2022, on Clostridioides difficile and Enterococcus spp.’s interaction in the gut microbiota met the inclusion criteria. The studies included in our systematic review reported evidence that the Enterococcus spp. intestinal burden represents a risk factor for the occurrence of CDI. There is supporting evidence that Enterococcus spp. play a role in CDI development and clinical outcomes.
The Efficacy of Platelet-Rich Plasma Augmentation in Microfracture Surgery Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis
Authors: Woo Inha , Park Jeong Jin , Seok Hyun-Gyu
Published: July 2023

The appropriate surgical management of osteochondral lesions of the talus (OLT) remains a challenge for foot and ankle surgeons. Currently, microfracture (MF) is the first-line operative treatment for small osteochondral lesions. However, the fibrous cartilage regenerated after MF is mechanically inferior to hyaline cartilage regeneration and is susceptible to deterioration over time. Thus, this meta-analysis aimed to elucidate the efficacy of platelet-rich plasma (PRP) augmentation compared with MF only or other adjuvant supplementations combined with the PRP + MF group (others) for the management of OLT. We searched the PubMed, Embase, Web of Science, and Cochrane Library databases for studies that compared the clinical outcomes of patients who underwent MF only and those who underwent PRP or other adjuvant materials such as hyaluronic acid or BST-CarGel. After the screening, four randomized controlled trials and one quasi-randomized controlled trial were included in this review. We used the following tools for clinical evaluation: the American Orthopedic Foot and Ankle Society (AOFAS) score, Ankle–Hindfoot Scale score, Visual Analog Scale (VAS) score for pain, and the Foot and Ankle Ability Measure (FAAM) score. The standardized mean difference (SMD) was used to analyze the differences in outcomes between groups. Patients in the PRP + MF group had superior final VAS and AOFAS scores to the MF only group. (both p < 0.01) However, no significant improvements between baseline and final follow-up were noted in either score. In addition, there was no remarkable difference in the overall FAAM pain measures between the two groups. The PRP + MF and others groups revealed no significant effect differences in the clinical scores. The results of this analysis suggest that PRP + MF would be more favorable and effective than MF only or additional adjuvant supplementation.
Comparative Analysis of Morbidity and Mortality Outcomes in Elderly and Nonelderly Patients Undergoing Elective TEVAR: A Systematic Review and Meta-Analysis
Authors: Frisiras Angelos , Giannas Emmanuel , Bobotis Stergios , Kanella Ilektra , Arjomandi Rad Arian , Viviano Alessandro , Spiliopoulos Kyriakos , Magouliotis Dimitrios E. , Athanasiou Thanos
Published: July 2023

Objective: Due to an ever-increasing ageing population and limited available data around the use of thoracic endovascular aortic repair (TEVAR) in elderly patients, investigating its efficacy and safety in this age cohort is of vital importance. We thus reviewed the existing literature on this topic to assess the feasibility of TEVAR in elderly patients with severe thoracic aortic pathologies. Methods: We identified all original research studies that assessed TEVAR in elderly patients published up to 2023. Morbidity, as assessed by neurological and respiratory complications, endoleaks, and length of stay, was the primary endpoint. Short-term mortality and long-term survival were the secondary endpoints. The Mantel–Haenszel random and fixed effects methods were used to calculate the odds ratios for each outcome. Further sensitivity and subgroup analyses were performed to validate the outcomes. Results: Twelve original studies that evaluated elective TEVAR outcomes in elderly patients were identified. Seven studies directly compared the use of TEVAR between an older and a younger patient group. Apart from a shorter hospital stay in older patients, no statistically significant difference between the morbidity outcomes of the two different cohorts was found. Short-term mortality and long-term survival results favoured the younger population. Conclusions: The present meta-analysis indicates that, due to a safe perioperative morbidity profile, TEVAR should not be contraindicated in patients based purely on old age. Further research using large patient registries to validate our findings in elderly patients with specific aortic pathologies and both elective and emergency procedures is necessary.
Computational and Experimental Analyses for Pathogenicity Prediction of ACVRL1 Missense Variants in Hereditary Hemorrhagic Telangiectasia
Authors: Iwasa Toru , Urasaki Akihiro , Kakihana Yuki , Nagata-Akaho Nami , Harada Yukihiro , Takeda Soichi , Kawamura Teruhisa , Shiraishi Isao , Kurosaki Kenichi , Morisaki Hiroko , Yamada Osamu , Nakagawa Osamu
Published: July 2023

Hereditary hemorrhagic telangiectasia (HHT) is a vascular disease caused by the defects of ALK1/ACVRL1 receptor signaling. In this study, we evaluated 25 recently identified ACVRL1 missense variants using multiple computational pathogenicity classifiers and experimentally characterized their signal transduction capacity. Three extracellular residue variants showed no detectable cell surface expression and impairment of bone morphogenetic protein 9 (BMP9) responsiveness of SMAD-dependent transcription in luciferase assays. Four variants with amino acid replacement in the motifs essential for the intracellular kinase function lost SMAD-dependent signaling. Most of other variations in the kinase domain also caused marked downregulation of signaling; however, two variants behaved as the wild-type ACVRL1 did, while computational classifiers predicted their functional abnormalities. Three-dimensional structure prediction using the ColabFold program supported the significance of the L45 loop and NANDOR domain of ACVRL1 for its association with SMAD1 and BMPR2, respectively, and the variations in these motifs resulted in the reduction of SMAD signaling. On the other hand, two of the GS domain variants maintained high signal transduction capacity, which did not accord with their computational pathogenicity prediction. These results affirm the requirement of a combinatory approach using computational and experimental analyses to accurately predict the pathogenicity of ACVRL1 missense variants in the HHT patients.
Genotypic Findings in Noonan and Non-Noonan RASopathies and Patient Eligibility for Growth Hormone Treatment
Authors: Carcavilla Atilano , Cambra Ana , Santomé José , Seidel Verónica , Cruz Jaime , Alonso Milagros , Pozo Jesús , Valenzuela Irene , Guillén-Navarro Encarna , Santos-Simarro Fernando , González-Casado Isabel , Rodríguez Amparo , Medrano Constancio , López-Siguero Juan , Ezquieta Begoña
Published: July 2023

Molecular study has become an invaluable tool in the field of RASopathies. Treatment with recombinant human growth hormone is approved in Noonan syndrome but not in the other RASopathies. The aim of this study was to learn about the molecular base of a large cohort of patients with RASopathies, with particular emphasis on patients with pathogenic variants in genes other than PTPN11, and its potential impact on rGH treatment indication. We reviewed the clinical diagnosis and molecular findings in 451 patients with a genetically confirmed RASopathy. HRAS alterations were detected in only 2 out of 19 patients referred with a Costello syndrome suspicion, whereas pathogenic variants in RAF1 and SHOC2 were detected in 3 and 2, respectively. In 22 patients referred with a generic suspicion of RASopathy, including cardiofaciocutaneous syndrome, pathogenic alterations in classic Noonan syndrome genes (PTPN11, SOS1, RAF1, LZTR1, and RIT1) were found in 7 patients and pathogenic variants in genes associated with other RASopathies (HRAS, SHOC2, and PPPCB1) in 4. The correct nosological classification of patients with RASopathies is critical to decide whether they are candidates for treatment with rhGH. Our data illustrate the complexity of differential diagnosis in RASopathies, as well as the importance of genetic testing to guide the diagnostic orientation in these patients.
Cross-Training and Resistance Training in Adults with Type B Acute Lymphoblastic Leukemia during the Induction Phase: A Randomized Blind Pilot Study
Authors: Gallardo-Rodríguez Adán Germán , Fuchs-Tarlovsky Vanessa , Ocharán-Hernández María Esther , Ramos-Peñafiel Christian Omar
Published: July 2023

Patients with acute lymphoblastic leukemia (ALL) undergoing induction decrease their physical capacity, lose muscle mass, and decrease their quality of life (QOL). The safety, feasibility, and benefits of exercise during chemotherapy have been proven, but the effects of cross-training activities have yet to be analyzed. To measure the effects of cross-training on body composition, physical performance, and QOL, a blind randomized clinical trial was carried out. A total of 33 patients were included and randomized into a cross-training exercise group (CEG), a resistance exercise group (REG), and a control group (CG). During induction, patients received an exercise routine three to five days a week for 30 to 50 min each. Body composition, QOL, and physical performance were measured at baseline, up to discharge, and at a follow-up of two months. Body composition improved in the REG and CEG. In the CG, muscle mass decreased and fat mass increased (p = 0.020 and 0.020, respectively). The REG and CEG had significant positive improvements in physical performance compared to the CG. QOL showed no differences in any group (p = 0.340). Cross-training and resistance exercise are essential to improve body composition and physical performance during induction. Considering the prognostic value of physical performance, we propose integrated training exercises as adjuvant therapy in adult patients with ALL.
Enhancing Intermediate Vision in Patients Affected by Epiretinal Membrane Treated by Phaco-Vitrectomy
Authors: Giansanti Fabrizio , Dragotto Francesco , Nicolosi Cristina , Alonzo Ludovica , Cifarelli Lorenzo , Franco Fabrizio Gaetano Saverio , Vannozzi Lorenzo , Abbruzzese Giacomo , Bacherini Daniela , Virgili Gianni
Published: July 2023

Background: The aim of this research was to see if a refractive enhanced monofocal IOL (Eyhance IOL, IOL Abbott Medical Optics, Inc., Santa Ana, CA, USA) can provide better intermediate vision in patients undergoing phaco-vitrectomy due to cataract and epiretinal macular membrane (ERM). Methods: A nonrandomized prospective observational comparative study enrolled patients affected by cataract and ERM undergoing phaco-vitrectomy. A follow up of 6 months was established. Corrected and uncorrected visual acuity of both monocular and binocular types were assessed regarding intermediate and far distances. The CATQUEST 9-SF questionnaire was administered preoperatively and at the last follow-up. Results: Twenty-three eyes of twenty-three patients were enrolled, with 11 in the enhanced monofocal group. The uncorrected and corrected distance visual acuity after 6 months was not statistically different. Both monocular and binocular uncorrected intermediate visual acuity after 6 months were higher in the enhanced monofocal group (p < 0.001). The corrected intermediate visual acuity after 6 months was higher in the enhanced monofocal group (p = 0.01). The CATQUEST-9SF questionnaire showed significant differences in the variation between the preoperative condition and six-month postoperative results (p < 0.001). Conclusions: This refractive enhanced monofocal IOL can provide better intermediate vision compared to a standard monofocal IOL in patients undergoing phaco-vitrectomy due to cataracts and ERM. Further studies are necessary to confirm these results.
Changes in Antibiotic Resistance of Acinetobacter baumannii and Pseudomonas aeruginosa Clinical Isolates in a Multi-Profile Hospital in Years 2017–2022 in Wroclaw, Poland
Authors: Mączyńska Beata , Jama-Kmiecik Agnieszka , Sarowska Jolanta , Woronowicz Krystyna , Choroszy-Król Irena , Piątek Daniel , Frej-Mądrzak Magdalena
Published: July 2023

In recent years, we have witnessed increasing drug resistance among bacteria, which is associated with the use and availability of an increasing number of broad-spectrum antimicrobials, as well as with their irrational and excessive use. The present study aims to analyze changes in the drug resistance of Gram-negative Pseudomonas aeruginosa and Acinetobacter baumannii, isolated from infections in a multi-profile hospital over a five-year period (from 2017 to 2022). Among the practical results of the evaluation of these data will be the possibility to determine changes in susceptibility to the antibiotics used in the hospital. This, in turn, will help propose new therapeutic options, especially for empirical therapy, which is essential in severe infections. Analysis of the use of different antibiotic groups has made it possible to identify the causes of increasing resistance in the analyzed Gram-negative bacilli. The highest antibiotic use was observed in the hospital between 2020 and 2022, most probably due to the COVID-19 pandemic and the higher number of patients in severe condition requiring hospitalization. Unfortunately, during the period analyzed, the number of multi-resistant strains of A. baumannii was successively increasing; this seems to be related to the increased use, especially during the pandemic period, of broad-spectrum antibiotics, mainly penicillins with inhibitors, third-generation cephalosporins and carbapenems.
Medical Treatment of Obstructive Sleep Apnea in Children
Authors: Ergenekon Almala Pinar , Gokdemir Yasemin , Ersu Refika
Published: July 2023

Obstructive sleep apnea (OSA) is characterized by recurrent complete or partial obstruction of the upper airway. The prevalence is 1–4% in children aged between 2 and 8 years and rising due to the increase in obesity rates in children. Although persistent OSA following adenotonsillectomy is usually associated with obesity and underlying complex disorders, it can also affect otherwise healthy children. Medical treatment strategies are frequently required when adenotonsillectomy is not indicated in children with OSA or if OSA is persistent following adenotonsillectomy. Positive airway pressure treatment is a very effective modality for persistent OSA in childhood; however, adherence rates are low. The aim of this review article is to summarize medical treatment options for OSA in children.
CBCT-Based Design of Patient-Specific 3D Bone Grafts for Periodontal Regeneration
Authors: Verykokou Styliani , Ioannidis Charalabos , Angelopoulos Christos
Published: July 2023

The purpose of this article is to define and implement a methodology for the 3D design of customized patient-specific scaffolds (bone grafts) for the regeneration of periodontal tissues. The prerequisite of the proposed workflow is the three-dimensional (3D) structure of the periodontal defect, i.e., the 3D model of the hard tissues (alveolar bone and teeth) around the periodontal damage, which is proposed to be generated via a segmentation and 3D editing methodology using cone beam computed tomography (CBCT) data. Two types of methodologies for 3D periodontal scaffold (graft) design are described: (i) The methodology of designing periodontal defect customized block grafts and (ii) the methodology of designing extraction socket preservation customized grafts. The application of the proposed methodology for the generation of a 3D model of the hard tissues around periodontal defects of a patient using a CBCT scan and the 3D design of the two aforementioned types of scaffolds for personalized periodontal regenerative treatment shows promising results. The outputs of this work will be used as the basis for the 3D printing of bioabsorbable scaffolds of personalized treatment against periodontitis, which will simultaneously be used as sustained-release drug carriers.
Evidence for Hypoxia-Induced Shift in ATP Production from Glycolysis to Mitochondrial Respiration in Pulmonary Artery Smooth Muscle Cells in Pulmonary Arterial Hypertension
Authors: Akagi Satoshi , Nakamura Kazufumi , Kondo Megumi , Hirohata Satoshi , Udono Heiichiro , Nishida Mikako , Saito Yukihiro , Yoshida Masashi , Miyoshi Toru , Ito Hiroshi
Published: July 2023

Background: The metabolic state of pulmonary artery smooth muscle cells (PASMCs) from patients with pulmonary arterial hypertension (PAH) is not well understood. In this study, we examined the balance between glycolysis and mitochondrial respiration in non-PAH-PASMCs and PAH-PASMCs under normoxia and hypoxia. Methods: We investigated the enzymes involved in glycolysis and mitochondrial respiration, and studied the two major energy-yielding pathways (glycolysis and mitochondrial respiration) by measuring extracellular acidification rate (ECAR) and cellular oxygen consumption rate (OCR) using the Seahorse extracellular flux technology. Results: Under both normoxia and hypoxia, the mRNA and protein levels of pyruvate dehydrogenase kinase 1 and pyruvate dehydrogenase were increased in PAH-PASMCs compared with non-PAH-PASMCs. The mRNA and protein levels of lactate dehydrogenase, as well as the intracellular lactate concentration, were also increased in PAH-PASMCs compared with non-PAH-PASMCs under normoxia. However, these were not significantly increased in PAH-PASMCs compared with non-PAH-PASMCs under hypoxia. Under normoxia, ATP production was significantly lower in PAH-PASMCs (59 ± 5 pmol/min) than in non-PAH-PASMCs (70 ± 10 pmol/min). On the other hand, ATP production was significantly higher in PAH-PASMCs (31 ± 5 pmol/min) than in non-PAH-PASMCs (14 ± 3 pmol/min) under hypoxia. Conclusions: There is an underlying change in the metabolic strategy to generate ATP production under the challenge of hypoxia.
Prevention of Early Sudden Cardiac Death after Myocardial Infarction Using the Wearable Cardioverter Defibrillator—Results from a Real-World Cohort
Authors: Rohrer Ursula , Manninger Martin , Fiedler Lukas , Steinwender Clemens , Binder Ronald K. , Stühlinger Markus , Zirngast Birgit , Zweiker David , Zirlik Andreas , Scherr Daniel
Published: July 2023

Background: After acute myocardial infarction (AMI), patients are at risk of sudden cardiac death. The VEST trial failed to show a reduction in arrhythmic mortality in AMI patients with an LVEF ≤ 35% prescribed with a WCD, having a lower-than-expected WCD wearing compliance. Objectives: The aim was to investigate on outcomes of patients in a real-world Austrian cohort with good compliance. Methods: A retrospective analysis of all eligible Austrian WCD patients according to the VEST trial inclusion and exclusion criteria between 2010 and 2020 was performed. Results: In total, 105 Austrian patients (64 ± 11 years, 12% female; LVEF 28 ± 6%) received a WCD for a median of 69 (1; 277) days after AMI (wearing duration 23.5 (0; 24) hours/day). Within the first 90 days, 4/105 (3.8%) patients received 9 appropriate shocks (2 (1; 5) shocks). No inappropriate shocks were delivered, and 3/105 (2.9%) patients died during follow-up. Arrhythmic mortality (1.9% Austria vs. 1.6% VEST, p = 0.52), as well as all-cause mortality (2.9% vs. 3.1%, p = 0.42) was comparable in both cohorts. Conclusions: The WCD is a safe treatment option in a highly selected cohort of patients with LVEF ≤ 35% after AMI. However, despite excellent WCD wearing duration in our cohort, the arrhythmic mortality rate was not significantly different.
Primary Adrenal Lymphomas with Cushing’s Syndrome: Two Cases with Evidence of Endogeneous Cortisol Production by the Neoplastic Lymphoid Cells
Authors: Papageorgiou Sotirios G. , Mavroeidi Ioanna , Kostakis Marios , Spathis Aris , Leventakou Danai , Kritikou Evangelia , Oikonomopoulos Nikolaos , Kourkouti Chrysoula , Krania Maria , Bouchla Anthi , Thomopoulos Thomas , Tsakiraki Zoi , Markakis Konstantinos , Panayiotides Ioannis G. , Thomaidis Nikolaos , Pappa Vasiliki , Foukas Periklis G. , Peppa Melpomeni
Published: July 2023

Primary adrenal lymphoma (PAL) is a rare entity that presents as unilateral or bilateral rapidly growing adrenal masses, with signs and symptoms most commonly related to adrenal insufficiency due to the mass effect on the surrounding tissues. Although steroeidogenesis has not been previously described in PAL, we herein report two cases of PAL presenting as adrenal incidentalomas (AIs) that demonstrated autonomous cortisol production. A 52-year-old woman presented with lumbar pain; a computed tomography (CT) scan demonstrated a left AI measuring 8.5 × 15 × 10 cm. Similarly, an 80-year-old woman presented with lumbar pain, demonstrating in a CT scan a bilateral AI (right: 9 × 6.5 cm, left: 3.6 × 3.2 cm). Both cases underwent a full hormonal evaluation according to the algorithm for the investigation of AIs, demonstrating increased 24-h cortisol excretion, suppressed fasting adrenocorticotropic hormone (ACTH) levels, and non-suppressed serum cortisol levels in both the overnight and the low-dose dexamethasone suppression tests, indicating autonomous cortisol secretion and Cushing’s syndrome. In a relatively short time, both patients developed night sweats, and their clinical picture deteriorated, while the CT scans showed increased dimensions of the masses with radiological characteristics compatible to lymphoma. Both patients underwent ultrasound-guided biopsies (FNBs), revealing infiltration of the left adrenal by diffuse large B-cell lymphoma in the first case, whereas bilateral adrenal infiltration from the same histological type was noted in the second case. Subsequently, they were treated with immunochemotherapy, but the second patient died from an infection shortly after the initiation of the treatment. To our knowledge, this is the first report of PAL presenting with Cushing’s syndrome due to autonomous cortisol production, indicating that neoplastic lymphoid cells in PAL might acquire the potential for steroidogenesis; therefore, more cases of PAL should be analyzed so as to further elucidate the complex pathogenesis and the natural course of this entity.
Norwegian Version of the Chelsea Critical Care Physical Assessment Tool (CPAx-NOR): Translation, Face Validity, Cross-Cultural Adaptation and Inter-Rater Reliability
Authors: Schanke Charlotte Marie , Brekka Anne Kristine , Rimehaug Stein Arne , Klokkerud Mari , Andersen Tiina Maarit
Published: July 2023

Background: Assessment of physical and respiratory function in the intensive care unit (ICU) is useful for developing an individualized treatment plan and evaluating patient progress. There is a need for measurement tools that are culturally adapted, reliable and easy to use. The Chelsea Critical Care Physical Assessment Tool (CPAx) is a valid measurement tool with strong psychometric properties for the intensive care population. This study aims to translate, adapt and test face validity and inter-rater reliability of the Norwegian version of CPAx (CPAx-NOR) for use in critically ill adult patients receiving prolonged mechanical ventilation. Method: CPAx-NOR was forward backward translated, culturally adapted and tested by experts and patients for face validity. Thereafter tested by 10 physiotherapists in five hospitals for inter-rater reliability. Results: The experts and pilot testers reached consensus on the translation and face validity. Patients were tested at time point A (n = 57) and at time point B (n = 53). The reliability of CPAx-NOR at “A” was 0.990 (0.983–0.994) and at “B” 0.994 (0.990–0.997). Based on A+B combined and adjusted, the ICC was 0.990 (95% CI 0.996–0.998). Standard error of measurement (SEM) was 0.68 and the minimal detectable change (MDC) was 1.89. The Bland–Altman plot showed low bias and no sign of heteroscedasticity. CPAx-NOR changed with a mean score of 14.9, and showed a moderate floor effect at the start of physiotherapy and low ceiling effects at discharge. Conclusion: CPAx-NOR demonstrated good face validity and excellent inter-rater reliability. It can be used as an assessment tool for physical function in critically ill adults receiving prolonged mechanical ventilation in Norway.
The Relationship between Hyperuricemia and Echocardiographic Parameters in Patients with Chronic Atrial Fibrillation
Authors: Jordhani Mikel , Cafka Majlinda , Seiti Joana , Barrios Vivencio
Published: July 2023

Purpose Uric acid serves as a marker for cardiovascular risk and is often linked to inflammation and oxidative stress. There is evidence suggesting an association between uric acid and atrial fibrillation (AF), including its severity and occurrence of crises, as well as its involvement in cardiovascular mechanisms. The objective of this study was to assess the correlation between hyperuricemia and echocardiographic features in patients with chronic AF lasting for more than 5 years. Methods This case-control study involved 107 patients diagnosed with chronic non-valvular AF. Uric acid levels were measured in all patients, and they were divided into two groups: the first group consisted of 66 patients with hyperuricemia (>7.2 mg/dL), while the second group included 41 patients with normal uric acid levels. Echocardiography (TTE) was performed to evaluate each patient. Various clinical and echocardiographic parameters, such as left ventricle telediastolic (LVTDD) and telesystolic (LVTSD) diameters, left atrial diameter (LAD), aortic diameter (AoD), ejection fraction (EF), and pulmonary artery pressure (PAP), were analyzed. Results Binary logistic regression analysis revealed a statistically significant relationship between uric acid levels (>7.2 mg/dL) and LAD. For each unit increase in LAD, the probability of having hyperuricemia increased by 9% [odds ratio (OD): 0.91, 95% confidence interval (CI): 0.84—0.99]. A significant relationship was found between uric acid levels (>8 mg/dL) and LVESD (p = 0.045) as well as PAP (p = 0.006). For every unit increase in LVESD, the likelihood of having uric acid levels greater than 8 mg/dL increased by 22% [OD: 0.82, 95% CI: 0.67—0.99, b = −0.2]. Likewise, for each unit increase in PAP, the probability of having uric acid levels greater than 8 mg/dL was 9.4% [OD: 0.91, 95% CI: 0.86—0.97, b = −0.09]. Conclusions This study demonstrates that hyperuricemia has a significant relationship with the development of atrial remodeling, with an important association observed between hyperuricemia and an increase in left atrial diameter. Hyperuricemia is also correlated with an enlargement of the left ventricle end-systolic diameter and pulmonary artery pressure, showing a possible influence that hyperuricemia might have also left ventricle morphology and right ventricle function.
Saline versus Plasma Solution-A in Initial Resuscitation of Patients with Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial
Authors: Woo Jae-Hyug , Lim Yong Su , Cho Jin Seong , Yang Hyuk Jun , Jang Jae Ho , Choi Jea Yeon , Choi Woo Sung
Published: July 2023

Background: Although saline is commonly used during cardiopulmonary resuscitation (CPR) or post-cardiac arrest care, it has detrimental effects. This trial aimed to evaluate the efficacy of a balanced crystalloid solution (Plasma Solution-A [PS]) in out-of-hospital cardiac arrest (OHCA) patients and compare it with the efficacy of saline. Methods: A randomized, unblinded clinical trial was conducted using PS and saline for intravenous fluid administration during CPR and post-cardiac arrest care of non-traumatic OHCA patients admitted to the emergency department of a tertiary university hospital. Patients received saline (saline group) or PS (PS group) within 24 h of hospital arrival. The primary outcomes were changes in arterial pH, bicarbonate, base excess (BE), and chloride levels within 24 h. The secondary outcomes were clinical outcomes including mortality. Results: Of the 364 patients, data from 27 and 26 patients in the saline and PS groups, respectively, were analyzed. Analysis using a linear mixed model revealed a significant difference in BE change over time between the groups (treatment-by-time p = 0.044). Increase in BE and bicarbonate levels from 30 min to 2 h was significantly greater (p = 0.044 and p = 0.024, respectively) and the incidence of hyperchloremia was lower (p < 0.001) in the PS group than in the saline group. However, there was no difference in clinical outcomes. Conclusion: Use of PS for resuscitation resulted in a faster improvement in BE and bicarbonate, especially in the early phase of post-cardiac arrest care, and lower hyperchloremia incidence than the use of saline, without differences in clinical outcomes, in OHCA patients.
XEN®-63 Compared to XEN®-45 Gel Stents to Reduce Intraocular Pressure in Glaucoma
Authors: Evers Charlotte , Böhringer Daniel , Kallee Sara , Keye Philip , Philippin Heiko , Piotrowski Timothy , Reinhard Thomas , Lübke Jan
Published: July 2023

The XEN® gel stent reduces intraocular pressure (IOP) in glaucoma. XEN®-45 is widely used; the newer XEN®-63 has a larger lumen targeting potentially lower IOP outcomes. We retrospectively compared the first 15 XEN®-63 cases to 15 matched XEN®-45 controls. With a preoperative IOP of 18.1 ± 3.9 mmHg (mean ± SD) and a final IOP of 9.1 ± 2.0 mmHg, XEN®-63 implantation resulted in an IOP reduction of 44.6 ± 16.5%. Similarly, with a preoperative IOP of 18.3 ± 4.5 mmHg and a final IOP of 10.3 ± 2.1 mmHg, XEN®-45 implantation resulted in an IOP reduction of 40.1 ± 17.2%. The median follow-up period was 204 days (range 78–338 days) for the XEN®-63 group and 386 days (range 99–1688 days) for the XEN®-45 group. In total, 5/15 eyes of each group underwent open conjunctival bleb revision within the period of observation. Three eyes of the XEN®-63 group had secondary glaucoma surgery. One eye in the XEN®-63 group and three eyes in the XEN®-45 group required a restart of antiglaucomatous medication. In conclusion, both stents effectively lower IOP and medication. XEN®-63 achieved a slightly lower IOP over a short follow-up. Complication and revision rates were similar.
Validation of the German Version of the P4 Suicidality Tool
Authors: Schluessel Sabine , Halfter Kathrin , Haas Carolin , Kroenke Kurt , Lukaschek Karoline , Gensichen Jochen
Published: July 2023

For general practitioners (GPs), it may be challenging to assess suicidal ideation (SI) in patients. Although promising instruments exist for the use in primary care, only a few have been validated in German. The objectives of this study were to examine the validity of the brief P4 screener for assessing SI in a cross-sectional study including outpatients. Inclusion criteria were a PHQ-9 score ≥ 10 or an affirmative answer to its SI item. Construct validity of the P4 was examined by comparison with the four-item Suicide Behaviors Questionnaire-Revised (SBQ-R), the PHQ-9 (convergent), and the positive mental health (PMH) scale (divergent). The study sample included 223 patients (mean age 47.61 ± 15 years; 61.9% women) from 20 primary care practices (104 patients) and 10 psychiatric/psychotherapeutic clinics (119 patients). The first three items of the P4 correlate positively with most of the four items of the reference standard SBQ-R (convergent validity); the fourth item of the P4 (preventive factors) correlates significantly with the PMH scale. The most common preventive factor (67%) is family or friends. The German P4 screener can be used to assess SI in outpatient care. It explores preventive or protective factors of suicide, which may support the GP’s decision on treatment. We recommend a further clinical interview for patients flagged by P4 assessment in order to more formally assess suicidal risk.
Mechanical Properties of Uncured Thermoset Tow Prepreg: Experiment and Finite Element Analysis
Authors: Derakhshani Dastjerdi Mina , Carboni Massimo , Hojjati Mehdi
Published: July 2023

This paper presents an experimental analysis of the tensile behavior of unidirectional carbon/epoxy prepreg, focusing on the nonlinearity observed at the beginning of the stress–strain curve. Due to the material’s high viscosity, securely holding specimens during testing was challenging, prompting modifications in the gripping method to ensure reliable data. By using a longer gauge length, the slippage impact on elastic modulus measurement was minimized, resulting in good repeatability among the test samples. Experimental findings highlighted the significant interaction between fiber waviness and the viscous matrix, leading to stiffness reduction. The linear stiffness of the samples closely matched that of the fibers and remained unaffected by temperature variations. However, at higher temperatures, the epoxy matrix’s decreased viscosity caused an upward shift in the stiffness plot within the non-linear region. To support the experimental findings, a micromechanical model of prepreg tow with fiber waviness was proposed. An RVE model of periodically distributed unidirectional waved cylindrical fibers embedded within the matrix was developed to predict effective material stiffness parameters. The simulation outcomes aligned well with the uniaxial tensile test of the prepreg tow, demonstrating the proposed RVE model’s capability to accurately predict elastic properties, considering factors like fiber arrangement, waviness, and temperature.
Manufacturing of High Conductivity, High Strength Pure Copper with Ultrafine Grain Structure
Authors: Ladani Leila , Razmi Jafar , Lowe Terry C.
Published: July 2023

Applications of Copper (Cu) range from small scale applications such as microelectronics interconnects to very large high-powered applications such as railguns. In all these applications, Cu conductivity and ampacity play vital roles. In some applications such as railguns, where Cu also plays a structural role, not only is high conductivity needed, but high strength, high ductility, and high wear resistance are also critical. Current technologies have achieved their full potential for producing better materials. New approaches and technologies are needed to develop superior properties. This research examines a new fabrication approach that is expected to produce Cu with superior mechanical strength, enhanced wear resistance, and increased electrical conductivity. Materials with refined grain structures were obtained by breaking down the coarse-grained Cu particles via cryogenic ball milling, followed by the consolidation of powders using cold isostatic pressing (CIP) and subsequent Continuous Equal Channel Angular Pressing (C-ECAP). The mixture of fine and ultrafine grains, with sizes between 200 nm to 2.5 µm and an average of 500 nm, was formed after ball milling at cryogenic temperatures. Further processing via C-ECAP produced nanostructured Cu with average grain sizes below 50 nm and excellent homogenous equiaxed grain shapes and random orientations. The hardness and tensile strength of the final Cu were approximately 158% and 95% higher than the traditional coarse-grained Cu bar, respectively. This material also displayed a good electrical conductivity rate of 74% International Annealed Copper Standard (IACS), which is comparable to the current Cu materials used in railgun applications.
Safety First—A Critical Examination of the Lights and Shapes in COLREGs
Authors: Dong Wenhai , Zhang Pengfei , Li Jie
Published: July 2023

According to The International Regulations for Preventing Collisions at Sea, 1972, ships can only determine their collision avoidance responsibilities in accordance with the rules of “Conduct of Vessels in Sight of One Another” if the dynamic and category of the target ship is identified to be using lights and/or shapes during encounters at sea. Then, appropriate actions can be taken, and the effectiveness of the collision avoidance actions can be checked during the subsequent maneuvering process. In order to analyze and solve the problems related to lights and shapes and to adapt to the development of ship size, speed, and intelligence, this paper firstly reviews the development history and revision process of lights and shapes. Furthermore, it explains the collision avoidance responsibility of ships in sight of one another, analyzes the role of lights and shapes in the collision avoidance process, and summarizes the lights and shapes displayed by different categories of ships. Next, through qualitative and quantitative analysis, the relationship between the visibility distance of lights and shapes and the timing of ship avoidance actions is examined. Finally, the paper points out current problems related to lights and shapes, including: (1) non-uniform visibility distance of lights, (2) insufficient visibility distance of lights, and (3) small size of shapes, and proposes solutions to these problems from theoretical and practical perspectives, including: (1) unifying the visibility distance of masthead light, sidelights, and sternlight to 6 nautical miles, (2) unifying the visibility distance of the sternlight to 3 nautical miles, and (3) unifying the diameter size of shapes and the vertical distance between shapes to 1.8 m.
Sea Level Rise and Future Projections in the Baltic Sea
Authors: Kapsi Ivar , Kall Tarmo , Liibusk Aive
Published: July 2023

This article aimed to provide an overview of relative and absolute sea level rise in the Baltic Sea based on different studies, where researchers have used data from tide gauges, satellite altimetry, sea level rise, and land uplift models. These results provide an opportunity to get an overview of the sea level rise in the Baltic Sea. However, to better understand the impact of sea level rise on the coastal area of the Baltic Sea, and especially in Estonia, two post-glacial land uplift models, the latest land uplift model NKG2016LU of the Nordic Commission of Geodesy (NKG) and Estonian land uplift model EST2020VEL, were used. These models enabled to eliminate post-glacial land uplift from absolute sea level rise. To determine the relative sea level rise in the coastal area of the Baltic Sea, the rates from land uplift models were compared to ESA’s BalticSEAL absolute sea level rise model. It was found that the relative sea level rise between 1995–2019 was −5 to 4.5 mm/yr (based on NKG2016LU) in the Baltic Sea. In addition, the southern area is more affected by relative sea level rise than the northern part. During the research, it was also found that the IPCC AR5 sea level projections predict a maximum relative sea level rise in the Baltic Sea by the year 2100 of between 0.3 to 0.7 m. As coastal areas in the southern part of the Baltic Sea are predominantly flat, the sea level may reach the real estate properties by the end of the 21st century. In the coastal area of Estonia, the relative sea level rise in the period 1995–2019 was −1.1 to 3.1 mm/yr (based on NKG2016LU) and −0.3 to 3.4 mm/yr (based on EST2020VEL), the difference between the land uplift models is −0.9 to 0.1 mm/y. In Estonia, the west and southwest area are most threatened by sea level rise, where the coast is quite flat. One of the largest cities in Estonia, Pärnu, is also located there. Using the ESA’s sea level and EST2020VEL land uplift models, it was found that the relative sea level rise will be 0.28 m by the year 2100. Based on the large spatial resolution IPCC AR5 sea level projections, the relative sea level rise will be on the same scale: 0.2–0.4 m.
Solar Energy-Powered Boats: State of the Art and Perspectives
Authors: Minak Giangiacomo
Published: July 2023

This paper presents an examination of the primary applications of solar energy as the main power source in the maritime sector, focusing on recent developments. A comprehensive review of the existing literature, including journal articles, proceedings, and patents, is conducted to identify three prominent areas for advancing solar energy-powered boats: maritime drones, sporting boats, and short-range touristic vessels. Maritime drones primarily serve as small autonomous boats for research, conservation, or military operations. On the other hand, sporting boats include nautical and energy design competitions involving students and enthusiasts. In terms of commercial interest, there is a growing demand for environmentally friendly and low-noise boats suitable for tourist activities, particularly in protected areas. Furthermore, specific and illustrative cases are explored in a dedicated section. Lastly, potential future perspectives are discussed and elucidated.