bluuebunny/crossref_metadata_2025 huggingface dataset:
DNA Barcoding of German Cuckoo Wasps (Hymenoptera: Chrysididae) Suggests Cryptic Species in Several Widely Distributed Species
Authors: Schmid-Egger Christian , Schmidt Stefan , Rosa Paolo , Niehuis Oliver
Published: November 2024

Germany is home to a rich cuckoo wasp fauna (Hymenoptera: Chrysididae) with about 108 species. However, several nomenclatural changes, the lack of identification keys, and the discovery of cryptic species difficult to identify based on external morphology have made the identification of several species a challenge. COI barcoding has been instrumental in the identification of some cuckoo wasp species and could help alleviate some of the above problems, but a reliable large reference database containing the cuckoo wasp barcodes is lacking. We present the COI barcodes of more than 800 specimens of 101 cuckoo wasp species native to Germany to lay the foundation for the barcode-based identification of German species. An analysis of the COI barcode sequences suggested groups that are largely consistent with the current taxonomy of the group. We found a few cases of over- or undersplitting of taxa. In some common species, the high degree of barcode divergence suggests the presence of cryptic species that need to be further assessed by integrative approaches. Our library of cuckoo wasp reference barcodes will enhance researchers’ ability to reliably identify species within this fascinating group of insects, in particular for identifying life stages that offer few or no morphological features for species-level identification.
Toxicity and Sublethal Effect of Chlorantraniliprole on Multiple Generations of Aedes aegypti L. (Diptera: Culicidae)
Authors: Batool Nimra , Abubakar Muhammad , Noureldeen Ahmed , Naqqash Muhammad Nadir , Alghamdi Akram , Al Dhafar Zamzam M. , Baakdah Fadi , Mozūratis Raimondas
Published: November 2024

Due to the quick development of insecticide resistance, it is crucial to optimize management programs by understanding the sublethal effects of effective insecticides like chlorantraniliprole on Aedes aegypti L. populations. Using age-stage and two-sex life tables, we investigated the sublethal impacts of chlorantraniliprole on Ae. aegypti. Larval duration in the progeny of exposed parents was reduced by 0.33–0.42 days, whereas, the longevity of male and female adults was decreased by 1.43–3.05 days. Similarly, the egg-laying capacity of F1 and F2 progeny of the exposed parents was significantly reduced from 27.3% to 41.2%. The mean generation time (T) increased up to 11.8% in exposed populations, and the net reproduction rate (Ro) decreased by 51.50–55.60%. After 24 h of chlorantraniliprole treatment, there was a significant increase in cytochrome P450 activity. Contrarily, the activity of glutathione S-transferase (GST) initially declined but started increasing after 48 h of treatment. This research highlights the importance of chlorantraniliprole in mosquito management, as well as the importance of considering sublethal effects when developing strategies to handle them. Having a thorough understanding of the harmful effects of insecticides on mosquito populations can greatly enhance the effectiveness of insecticide-based interventions, while also minimizing the risk of pest resurgence.
Morphology of the Mouthparts of Ladybeetle Vibidia duodecimguttata (Coleoptera: Coccinellidae), with Emphasis on Their Sensilla
Authors: Chen Long , Shi Yaping , Wang Ke , Sun Yuanxing , Hao Yanan
Published: November 2024

Mouthparts are the feeding organs of insects, which play vital roles in the feeding process. The morphology of insect mouthparts has greatly evolved according to different foods and feeding habits. Therefore, studying the structure of the mouthparts is the key to understanding their feeding mechanisms. Vibidia duodecimguttata is an important biological control agent for powdery fungus. In this study, the fine morphology of the mouthpart of V. duodecimguttata was studied by scanning electron microscopy. The basic components of mouthpart of V. duodecimguttata are similar to those of other ladybeetles, while the specific morphology of each part is different. In total, six kinds of sensilla were identified on mouthpart, and twelve types of sensilla were divided according to their morphology, length and distribution. In addition, two kinds of glandular structures were also found, namely perforated plates and cuticular pores. Finally, the morphological differences between mycetophagous and other feeding habits ladybeetles were compared, and the function of each kind of sensilla was discussed, which may establish a solid foundation for further understanding of the feeding mechanism of ladybirds.
The Ontogeny and Dietary Differences in Queen and Worker Castes of Honey Bee (Apis cerana cerana)
Authors: Yang Chunyu , Lei Li , Wang Ying , Xu Baohua , Liu Zhenguo
Published: November 2024

The honey bee Apis cerana cerana (A. c. cerana), a subspecies of Apis cerana, is endemic in China and possesses a valuable ecological niche. Understanding the ways to protect this honey bee’s populations is crucial, but this topic has been understudied. For the efficient utilization of beekeeping and pollination, there is a need to explore its biology and management practices. In light of this, the current study was carried out to investigate the ontogeny and dietary differences in the queen and worker castes of the A. c. cerana honey bee. This article presents, supplemented by reference images, a detailed description of the life history of A. c. cerana queens and workers. Additionally, this study investigated the nutritional differences between royal jelly (RJ) and worker jelly (WJ) at various larval ages. The contents of the moisture, crude protein, and amino acids in RJ and WJ were determined via freeze drying, Kjeldahl nitrogen determination, and ultra-high performance liquid chromatography. The results highlight significant variations in the moisture content, crude protein concentration, and amino acid concentration between RJ and WJ. The results offer theoretical support for ex situ artificial rearing practices of A. c. cerana.
cpt1b Regulates Cardiomyocyte Proliferation Through Modulation of Glutamine Synthetase in Zebrafish
Authors: Cheng Xiaohan , Ju Jingyi , Huang Wenping , Duan Zongyi , Han Yanchao
Published: November 2024

Carnitine palmitoyltransferase 1b (Cpt1b) is a crucial rate-limiting enzyme in fatty acid metabolism, but its role and mechanism in early cardiac development remains unclear. Here, we show that cpt1b regulates cardiomyocyte proliferation during zebrafish development. Knocking out entire cpt1b coding sequences leads to impaired cardiomyocyte proliferation, while cardiomyocyte-specific overexpression of cpt1b promotes cardiomyocyte proliferation. RNA sequencing analysis and pharmacological studies identified glutamine synthetase as a key downstream effector of cpt1b in regulating cardiomyocyte proliferation. Our study elucidates a novel mechanism whereby cpt1b promotes zebrafish cardiomyocyte proliferation through glutamine synthetase, which provides new perspectives on the significance of fatty acid metabolism in heart development and the interplay between fatty acid and amino acid metabolic pathways.
A Retrospective Analysis of Emergency Versus Elective Surgical Outcomes in Colon Cancer Patients: A Single-Center Study
Authors: Negruț Roxana Loriana , Coțe Adrian , Maghiar Adrian Marius
Published: November 2024

Introduction: Emergency surgical interventions for colon cancer are often associated with poorer outcomes compared to elective surgeries due to the advanced state of the disease and the urgency of intervention. This retrospective study aimed to evaluate the management of emergency management of colon cancer and to evaluate differences in patient outcomes. Conducted at a single surgical emergency center, the study analyzed 182 cases, focusing on demographics, tumor characteristics, surgical methods and patient outcomes. Material and Methods: A retrospective observational study was conducted, involving 182 cases who underwent surgery for colon cancer in a single surgical emergency center. Data was collected from hospital records, encompassing demographic details, tumor characteristics, surgical intervention detail and outcomes, alongside with inflammatory profiles. Statistical analyses included descriptive statistics and t-tests with standard significance at p < 0.05. Results: The study showed that emergency cases had significantly poorer in-hospital survival rates (75.42%) compared to elective surgeries. Inflammatory markers such as Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio were higher in emergency cases, suggesting heightened systemic stress. Emergency surgery was also associated with a higher incidence of ostomy and postoperative complications. Conclusions: Emergency surgery for colon cancer is linked to more advanced tumors, increased physiological stress and lesser clinical outcomes. Early detection strategies and active targeted screening could reduce the need for emergency interventions. Future research should focus on early diagnosis protocols and enhancing public health strategies to minimize emergency presentations, thereby leading to better outcomes for colon cancer patients.
Antibody Response After a Fifth Dose (Third Booster) of BNT162b2 mRNA COVID-19 Vaccine in Healthcare Workers
Authors: Saiag Esther , Gamzu Ronni , Padova Hagit , Paran Yael , Goldiner Ilana , Cohen Neta , Bomze David
Published: November 2024

Although a fourth dose of SARS-CoV-2 vaccine was shown to be effective, the immunogenicity of a fifth dose in immunocompetent individuals had not been well described. This was a prospective observational cohort study of previously vaccinated healthcare workers at a single tertiary hospital in Israel. Individuals were administered up to three booster doses of the BNT162b2 mRNA vaccine (i.e., up to five overall doses), during the period between July 2021 and January 2023. Immunogenicity was assessed using the SARS-CoV-2 IgG (sCOVG) semi-quantitative assay, performed at several time points. The cohort consisted of 162 individuals (median age 69 years, 62% female). Of these, 104 (64%) received four doses and 58 (36%) received five doses. Anti-SARS-CoV-2 antibody levels increased in all cases, regardless of the baseline levels. The fold-change increase in the mean sCOVG index was 29.2 (SD 2.6) after the third vaccine, 3.8 (SD 2.4) after the fourth vaccine, and 3.6 (SD 3.0) after the fifth vaccine. A waning effect over time was seen in 78% and 43% of participants for the third and fourth doses, respectively. Adverse events following the fifth dose were limited and mild. Similar to previous booster vaccines, a fifth dose of BNT162b2 is immunogenic and safe in healthy individuals, although the clinical implications remain unclear.
Characteristics and Therapy of Jersey Finger Type V Injuries at a Middle-European Level 1 Trauma Center—A Retrospective Data Analysis
Authors: Hoppe Paul Lennart , Frenzel Stephan , Krusche-Mandl Irena , Thalhammer Gerhild , Hajdu Stefan , Halát Gabriel
Published: November 2024

Background/Objectives: Reports on type V FDP tendon avulsions and their treatment are rare. Furthermore, they are not always classified in a consistent manner in the literature. The purpose of our retrospective data analysis was to evaluate and present jersey finger type V injury characteristics, primary radiological findings, treatment options and subsequent patient outcomes, as well as potential complications. Methods: We reviewed all patients treated for a fracture of the distal phalanx at an academic Level 1 trauma center over a period of 19 years. By reviewing the patients’ charts and their initial X-rays, we identified 44 patients with injuries matching the criteria for classification as jersey finger type Va and type Vb. All clinical records and radiologic images were reviewed to gather data on the mechanism of trauma, injury characteristics, type of treatment and subsequent outcomes in both subtypes. Results: Direct blows represented the most common mechanism of trauma, accounting for 23 cases. Among 44 jersey finger type V injuries, 31 showed minor displacement and were treated conservatively with a good outcome. Six patients undergoing surgery showed a poor outcome, except for one. Conclusions: Jersey finger type V differs considerably from the remaining types of jersey finger injuries regarding the predominant trauma mechanism. Therefore, its inclusion in this classification should be reevaluated. Established surgical techniques for refixation did not show a satisfying outcome, thus the implementation of alternative surgical techniques seems advisable when better therapeutic results are sought.
Unlocking the Potential of the Elderly Population in Serbia: A Modeling Study on Musculoskeletal Disorders and Associated Factors
Authors: Radovic Diana , Santric-Milicevic Milena , Nikolic Dejan , Filipovic Tamara , Ducic Jovan , Nikcevic Ljubica , Jovicic Milica , Tulic Ivan , Tulic Goran
Published: November 2024

Background/Objectives: A properly functioning musculoskeletal system is imperative for human well-being at every stage of life, including at an older age. This study’s aim was to assess the relationship between sociodemographic and physical functioning variables and the presence of individual musculoskeletal disorders (MSDs), MSD comorbidity, and multimorbidity, as well as to determine factors that are independent predictors of the presence of MSDs in people over 65 years old. Methods: This population-based study included 3701 participants aged 65 years and older. Data on individual MSDs addressed cervical and lumbosacral spine regions and degenerative joint disease (arthrosis). The subjects were categorized into four groups: those without any diseases; those with one MSD; those with two MSDs (comorbidities); and those with three MSDs (multimorbidities). The sociodemographic and physical functioning variables were analyzed. Results: Females were more likely to have MSDs (two: OR 1.95 and three: OR 2.25) than men. Elderly people aged 75 and above were 1.49 times more likely to have three MSDs. Elderly people with elementary school education were more likely to have MSDs (two: OR 1.34 and three: OR 2.06) than those with high school/university education. The low-income population was 2.47 times more likely to have three MSDs. Individuals with partial activity limitations because of health problems had greater chances of having one, two, or three MSDs (OR 1.60, 1.59, and 1.94, respectively), and elderly individuals with severe limitations had an OR of 1.43, 2.17, and 4.12, respectively. Individuals with some/many difficulties in walking up or down 12 steps were more likely to have MSDs (two: OR 2.26 and three: OR 2.28). Conclusions: The significant predictors of experiencing a single MSD, MSD comorbidity, or MSD multimorbidity include residing in the Serbian capital city and having limitations in activities due to health problems. A significant predictor of having a single MSD or MSD comorbidity is residing in the northern region of Serbia. A significant predictor of MSD comorbidity is residing in the southeastern region of Serbia. Significant predictors of MSD comorbidity or MSD multimorbidity include female gender, an elementary school educational level, and experiencing difficulty in walking up or down 12 steps. Significant predictors of MSD multimorbidity are being 75 years of age and above and having a lower income.
Impact of Alcohol Consumption on Cardiovascular Events in Patients Undergoing Percutaneous Coronary Intervention
Authors: Yun Junpil , Han Kyungdo , Ki You-Jeong , Hwang Doyeon , Kang Jeehoon , Yang Han-Mo , Park Kyung Woo , Kang Hyun-Jae , Koo Bon-Kwon , Kim Hyo-Soo , Han Jung-Kyu
Published: November 2024

Background/Objectives: The impact of alcohol consumption and its restriction on clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) remains elusive. We aimed to investigate the clinical outcomes in drinkers undergoing PCI. Methods: We included 77,409 patients who underwent PCI and a health check-up within one year of the PCI using a nationwide prospective database from the Korean National Health Insurance System. Primary outcomes were major adverse cardiovascular and cerebrovascular events (MACCE), a composite of all-cause mortality, myocardial infarction, coronary revascularization, and stroke. Patients were classified as non-drinkers, within-the-guideline (≤1 standard drink in women and ≤2 in men), and above-the-guideline drinkers based on drinking status at the first health check-up after PCI. Results: During a 4.0-year follow-up duration, MACCE incidence was 19.7% (n = 15,214) (4689 [6.1%] deaths, 1916 [2.5%] MI, 2033 [2.6%] strokes, and 10,086 [13.0%] revascularizations). Both within-the-guideline- (aHR [95%CI], 0.843 [0.773–0.919]) and above-the-guideline drinkers (0.829 [0.784–0.876]) had a lower MACCE risk than the non-drinkers. A characteristic J-curve relationship was observed between the frequency or body weight-adjusted alcohol consumption and MACCE risk, with the lowest risk in the once-per-week and a mild amount per body weight (≤0.33 g/kg/week) group. Drinking habits after PCI were associated with a lower risk of adverse cardiovascular outcomes; those who continued to drink before and after PCI had the lowest risk. Conclusions: Alcohol consumption was associated with a lower risk of adverse outcomes in patients undergoing PCI. Further studies with longer-term follow-up are warranted.
Breast Implants: Low Rate of Annual Check-Ups Results in Delayed Presentation of Ruptured Implants
Authors: Flores Tonatiuh , Kerschbaumer Celina , Glisic Christina , Weber Michael , Schrögendorfer Klaus F. , Bergmeister Konstantin D.
Published: November 2024

Background: Breast-implant-based reconstruction is one of the most performed procedures in plastic surgery. Despite the high durability of breast implants, various complications are accompanied with prolonged inlay duration, particularly implant rupture. Many aftereffects can be associated with implant rupture, especially siliconoma and BIA-ALCL. Without regular implant check-ups, implant-related issues may remain underrecognized. Here, we analyzed the number of breast implant carriers needing revisions and if patients adhered to annual implant follow-up recommendations. Methods: We reviewed 1128 breast procedures at the department of plastic surgery at the University Clinic of St. Poelten between August 1st 2018 and December 31st 2023. Patients were analyzed to see whether regular check-ups of their breast implants were performed. Additionally, implant-related complications were investigated, as well as if they were noticed by implant carriers. Results: Only 15.46% of breasts implants were regularly checked at least once a year in our cohort. The remaining 84.54% of patients consulted our department due to pain or aesthetic discomfort without periodical follow-ups. Most implant ruptures (73.8%) were diagnosed in patients consulting acutely due to pain or capsular contraction after an average of 17.36 ± 10.57 years. Routine examination uncovered 26.2% of silent implant ruptures without patients yet complaining of clinical symptoms as early as 15.44 ± 11.17 years. Conclusions: Most implant ruptures develop clinical symptoms as an indicator that removal is warranted. However, only regular follow-ups can identify implant complications several years earlier and possibly reduce severe sequalae such as BIA-ALCL. This highlights the significance and necessity of annual breast implant controls by surgeons and radiologic imaging to prevent devastating implant-associated aftereffects.
Assessing the Pharmacotherapy and Clinical Outcomes After Deep Brain Stimulation for Treatment-Refractory Obsessive–Compulsive Disorder: A Case–Cohort Study
Authors: Knebel Joshua , McClure Robert K. , Kennedy M. Lindsey Hedgepeth
Published: November 2024

Background: In the search for effective treatments for refractive obsessive–compulsive disorder (OCD), deep brain stimulation (DBS) serves as an alternative option for those with minimal response to pharmacotherapy. The rarity of reports regarding DBS use for OCD is attributed to the invasive nature of the procedure: placement of electrodes within targeted areas of the brain to provide neuromodulation. This treatment of last resort may decrease functional impairment and pharmacologic complications for a debilitating mental illness. This study compares the pharmacotherapy utilization and treatment outcomes of five treatment-refractory OCD patients after the placement of DBS with those of a matched cohort. Methods: This retrospective, single-center, case–cohort study reviewed the electronic medical records of five subjects treated with DBS for treatment-refractory OCD and compared them to a similar treatment-refractory cohort whose OCD was treated without the use of DBS. Control subjects were matched by age, sex, years since diagnosis, number of previous medication class trials, and additional clinical factors. Inclusion criteria were defined as those that are at least eighteen years of age, assigned a primary diagnosis of OCD per the ICD-10 classification, and received DBS treatment for refractory OCD. Exclusion criteria included comorbid psychotic disorders, unstable neurological or coagulation disorder(s), and/or an eating disorder diagnosis. The primary endpoint was the change in the number of psychotropic medications two years after implantation for the DBS cohort and two years after psychiatric decompensation for the comparator cohort. Secondary endpoints included: Y-BOCS (the Yale–Brown Obsessive–Compulsive Scale) changes over time, duration quantity of psychotropic medication classes prescribed, and additional symptomology scale changes. Results: Patients receiving DBS were more likely to be on fewer medications and trialed fewer medications after treatment. One out of the five patients was found to be a responder in Y-BOCS scoring after DBS treatment. A reduction in anxiety and depression symptoms was also seen in the HAM-A and HAM-D scales for those that received DBS. Conclusions: A reduction in psychiatric medications trialed during therapy was observed, as well as varying reductions in OCD, anxiety, and depression symptomology following DBS. Results from this study indicate that DBS implantation may contribute to a reduction in polypharmacy while displaying DBS’s potential impact on comorbid anxiety and depression symptoms. Given that the small sample size limits generalizability, additional prospective, randomized trials comparing the efficacy of DBS for OCD-specific symptomology and its overall impact on pharmacotherapy are needed in order to further establish the role of DBS as an accepted treatment option for OCD.
Surgery or Comorbidities: What Is the Primum Movens of Kidney Dysfunction After Nephrectomy? A Multicenter Study in Living Donors and Cancer Patients
Authors: Trevisani Francesco , Floris Matteo , Trepiccione Francesco , Rosiello Giuseppe , Capasso Giovambattista , Pani Antonello , Maculan Marco , Mascia Giacomo , Silvestre Cristina , Bettiga Arianna , Cinque Alessandra , Capitanio Umberto , Larcher Alessandro , Briganti Alberto , Salonia Andrea , Rigotti Paolo , Montorsi Francesco , Angioi Andrea , Furian Lucrezia
Published: November 2024

Background and Hypothesis: Acute Kidney Injury (AKI) and Chronic Kidney Disease (CKD) are significant risks for kidney cancer (KC) patients undergoing partial (PN) or radical nephrectomy (RN) and for living kidney donors (LKD). This study compares AKI and CKD incidence in these groups with a pre-operative glomerular filtration rate (GFR) over 60 mL/min/1.73 m2. Methods: This study included 465 KC patients with cT1-2N0M0 kidney mass and 256 LKD who underwent nephrectomy at four Italian institutions from 2014 to 2021. Data on demographics, comorbidities, and therapies were analyzed. Serum creatinine and estimated GFR (eGFR) were measured before and after surgery. Outcomes were AKI (per KDIGO guidelines) and CKD stage progression. Analyses included descriptive statistics, ANOVA, logistic regression, and Kaplan–Meier survival. Results: Among 721 patients, significant age and gender differences were noted. Hypertension (41%) and diabetes (7.1%) were prevalent in RN and PN groups. Post-surgery AKI was more common in donors (84%), while CKD stage progression varied by surgery type (CKD stage G3 after 60 months: RN 48.91%, PN 18.22%, LKD 26.56%). Age, pre-surgery CKD, and surgery type predicted CKD progression. Limitations include retrospective design and bias. Conclusions: Both LKD and KC patients face similar AKI and CKD risks. Surgery type significantly influences AKI and CKD incidence, highlighting the importance of approach.
An Evaluation of the Estimated Aligners Needed to Correct Malocclusion Traits Using Invisalign ClinCheck™ Pro Software: A Retrospective Study
Authors: Rincon-Gregor Ileana Rosa , Bautista-Rojas Cielo Ivette , Trejo-Aké Elsy Abigail , Zúñiga-Herrera Iván Daniel , Herrera-Atoche José Rubén
Published: November 2024

Background: This study evaluated the number of aligners that Invisalign ClinCheck™ Pro Software estimates for correcting different malocclusion traits. Methods: This retrospective study included 157 non-extraction patients over the age of 12 years old with easy to mild malocclusions who were treated with Invisalign aligners. The Index of Complexity, Outcome, and Need (ICON) was used to evaluate the malocclusion complexity level. The number of aligners (upper, lower, and total) required to correct the malocclusion was compared based on sex, ICON level, molar and canine class, occlusal asymmetry, overbite, overjet, crowding, incisor inclination, and Bolton discrepancy. A Mann–Whitney U test (for comparisons between two groups) or a Kruskal–Wallis test (for comparisons between three or more groups) (p < 0.05) was used to evaluate differences in the number of aligners across variable categories. Results: ICON, molar class, overbite, and overjet presented significant differences (p < 0.05) in the number of aligners (upper, lower, and total) required to correct a malocclusion. Canine class and lower dental crowding showed significant differences in the lower and total number of aligners (p < 0.05). Conclusions: The number of aligners increases when the malocclusion presents any of the following elements: the absence of molar or canine class I, an altered overjet or overbite, severe lower crowding, or a higher complexity level. The clinician should consider these malocclusion traits when estimating the number of aligners needed for correction.
Yield of Echocardiography with Bubble Studies Among Acute Ischemic Stroke Patients
Authors: Hu Jonathan , Lee Anson Yoong-Chee , Nakagawa Kazuma , Vu Kimberly , Khan Zia Rehman , Tanoue Michael
Published: November 2024

Background: Transthoracic (TTE) and transesophageal (TEE) echocardiographic studies with agitated saline, also known as “bubble studies” (BSs), are used to diagnose patent foramen ovales (PFOs) in cryptogenic strokes (CSs). Guidelines limit PFO closure recommendations to CS patients ≤ 60 but BSs are often performed as part of standard order sets, leading to inappropriate studies in older patients with already-established stroke etiologies. Methods: This retrospective single-center study included acute ischemic stroke patients between January 2021 and June 2022 and assessed the stroke etiology and number of the echocardiographic studies performed. Results: A total of 663 patients were admitted during this period with 413 (62.3%) classified as non-CS. Overall, 390 (58.8%) TTE and 40 (6.0%) TEE with BSs were conducted. Of that, non-CS patients received 252 TTE and 17 TEE with BSs. PFOs were diagnosed in 36 CS and 18 non-CS patients and 14 of the 15 PFO closures were performed in the CS patients for primary stroke prevention. The one closure in the non-CS patient was performed in conjunction with the open excision of a mitral valve mass. Conclusions: Therefore, the majority of the BSs performed in non-CS patients yielded no change in management. Our study identifies a large volume of diagnostic studies that are not supported by current clinical guidelines and instead, may contribute to healthcare waste. A new institutional protocol should be established to improve operational efficiency and reduce the downstream implications of diagnostic overuse in ischemic stroke care.
Biliary Reconstruction with Hepaticoduodenostomy Versus Hepaticojejunostomy After Choledochal Cyst Resection: A Narrative Review
Authors: Iglesias Nicholas , Huerta Carlos Theodore , Lynn Royi , Perez Eduardo A.
Published: November 2024

Choledochal cysts (CCs), a congenital anomaly resulting in the abnormal dilation of the biliary ductal system, are most often identified in patients younger than 10 years of age. Regardless of clinical presentation, the cornerstone of therapy for CCs is complete surgical excision with reconstruction with either hepaticoduodenostomy or hepaticojejunostomy. Although both procedures are used by surgeons for the correction of CCs, evidence on clinical outcomes following both approaches is inconclusive as to which may offer superior reconstruction. This narrative review aims to compare the current literature regarding both approaches by evaluating their anatomic and operative considerations, as well as their perioperative, postoperative, and long-term outcomes. Future studies should closely focus on long-term, comparative outcomes, including the risk of biliary malignancy, and refine techniques to minimize complications, such as biliary reflux and bowel obstruction, in order to improve care for pediatric patients undergoing treatment for CCs.
NEWS-2 Accuracy in Predicting Mortality and Severe Morbidity Among Hospitalized COVID-19 Patients: A Prospective Cohort Study
Authors: Tarabeih Mahdi , Qaddumi Jamal , Mohammad Tukhi Islam , Na'amnih Wasef
Published: November 2024

Background: Early risk stratification tools for COVID-19 patients have been indicated yet there are few data about their ability to effectively detect clinical deterioration among COVID-19 patients. Objectives: To evaluate the NEWS-2 to predict severe morbidity and mortality for COVID-19 patients admitted to hospitals. Methods: We conducted a prospective cohort study among adult COVID-19 patients with a confirmed diagnosis who were admitted to the inpatient units at COVID-19 Martyrs Medical Military Complex Hospital, from 1 March 2022, until 29 February 2023. NEWS-2 scores were measured at admission and 6, 12, 24, and 48 h after their admission to the hospital using receiver operating characteristic (ROC) curves. Results: Overall, 192 adult COVID-19 patients aged 25–94 years (mean = 62.1, SD = 13.9) were enrolled. Of those, 49.0% were males, 47.4% were vaccinated, and 53.6% had diabetes. The 192 enrolled patients were classified into NEWS-2 score categories, with almost 13% (12.5%) falling into the high-risk category already upon admission. The mean NEWS-2 scores were excellent predictors of mechanical ventilation, admission to the ICU, and mortality, as indicated by an AUROC of 0.94 (95% CI: 0.88–1.00, p < 0.001), 0.91 (95% CI: 0.87–0.96, p < 0.001), and 0.96 (95% CI: 0.92–1.00, p < 0.001), respectively. Significant differences in mean NEWS-2 scores were found between the participating patients, both with and without comorbidity in the course of the patient’s stay in the ICU, and mortality (p = 0.004, p = 0.043, respectively). Positive correlations of the high NEWS-2 scores were revealed using a multiple linear regression model, indicating the necessity of administering non-invasive ventilatory assistance (p = 0.013), hospitalization for a minimum of six days (p = 0.013), and admission to the ICU (p = 0.006). Nonetheless, there was a negative association between mortality and the NEWS-2 score (p < 0.001). Conclusions: The NEWS-2 had moderate sensitivity and specificity in predicting the deterioration of patients with COVID-19 whereas there was high sensitivity and specificity in predicting the mortality for patients with COVID-19, both with and without comorbidity. Our findings support the utility of NEWS-2 monitoring as a sensitive approach for initially assessing COVID-19 patients. It could be helpful to enhance the accuracy of predictive performance by supplementing the score parameters by adding biological parameters in addition to clinical judgment.
Unveiling Artificial Intelligence’s Power: Precision, Personalization, and Progress in Rheumatology
Authors: Mondillo Gianluca , Colosimo Simone , Perrotta Alessandra , Frattolillo Vittoria , Gicchino Maria Francesca
Published: November 2024

This review examines the increasing use of artificial intelligence (AI) in rheumatology, focusing on its potential impact in key areas. AI, including machine learning (ML) and deep learning (DL), is revolutionizing diagnosis, treatment personalization, and prognosis prediction in rheumatologic diseases. Specifically, AI models based on convolutional neural networks (CNNs) demonstrate significant efficacy in analyzing medical images for disease classification and severity assessment. Predictive AI models also have the ability to forecast disease trajectories and treatment responses, enabling more informed clinical decisions. The role of wearable devices and mobile applications in continuous disease monitoring is discussed, although their effectiveness varies across studies. Despite existing challenges, such as data privacy concerns and issues of model generalizability, the compelling results highlight the transformative potential of AI in rheumatologic disease management. As AI technologies continue to evolve, further research will be essential to address these challenges and fully harness the potential of AI to improve patient outcomes in rheumatology.
A Nation-Wide Evaluation of Suboptimal Lipid-Lowering Treatment Patterns Among Patients Undergoing Intervention for Acute Coronary Syndrome in Hungary
Authors: Nagy Gergely Gyorgy , Mark Laszlo , Gerencser Andrea , Reiber Istvan , Kiss Norbert , Rokszin Gyorgy , Fabian Ibolya , Csanadi Zoltan , Karadi Istvan , Aradi Daniel , Bajnok Laszlo , Paragh Gyorgy
Published: November 2024

Background/Objectives: A significant gap exists between guideline recommendations and everyday practice. Stringent treatment is needed for vulnerable patients with acute coronary syndrome (ACS). Methods: Data on the lipid-lowering therapy (LLT), including the adherence, persistence, and mortality of patients undergoing percutaneous coronary intervention or bypass surgery in Hungary in 2018 were followed up and analyzed based on the National Health Insurance Fund database until the end of 2020. Results: A total of 12,997 patients underwent revascularization for ACS in 2018, whose discharge therapy included any LLT, a high- or moderate-intensity statin, or ezetimibe at a proportion of 91%, 75%, 12%, and 4%, respectively. By the end of the observation period, the frequency of ezetimibe administration increased to 11%. Persistence decreased, reaching 50% for all therapeutic regimens by month 16. Patients on moderate statin doses had a significantly higher mortality rate at the end of follow-up than those receiving high-intensity statin with (20% vs. 9%, p < 0.0001) or without (20% vs. 14%, p = 0.00029) ezetimibe. Those taking less potent statin doses had higher rates of comorbidities; for example, a minimum of three comorbidities were present in 39% of patients taking medium statin doses and 23% among those on high-intensity statin therapy (p < 0.0001). Conclusions: LLT persistence decreased during follow-up. The administration of a higher-intensity lipid-lowering regimen was associated with better persistence and adherence, along with more favorable mortality rates. Multimorbidity was associated with the use of lower statin doses. The results suggest that more attention is needed in terms of lipid control of females, elderly people, and individuals with several comorbidities, and emphasis should be placed on improving persistence and increasing the frequency of combined LLT prescriptions.
Hospital Admission Trends in Alpha-1-Antitrypsin Deficiency: A Sex-Based Analysis from the Spanish National Discharge Database, 2016–2022
Authors: de-Miguel-Diez Javier , Lopez-de-Andres Ana , Zamorano-Leon José J. , Hernández-Barrera Valentín , Cuadrado-Corrales Natividad , Jimenez-Sierra Ana , Carabantes-Alarcon David , Jimenez-Garcia Rodrigo
Published: November 2024

Objectives: To analyze the number and clinical characteristics of hospital admissions in Spain between 2016 and 2022 in which alpha-1-antitrypsin deficiency (AATD) was coded; to describe and analyze differences in these parameters between men and women; and to identify variables associated with a worse prognosis. Methods: We used a nationwide discharge database to select all admissions featuring an AATD diagnostic code (ICD-10 code E88.01) in any position. Results: We found 5142 hospital admissions with a diagnosis of AATD and detected a significant increase in their number from 2016 to 2022 (p = 0.034 for trend). Males accounted for 58.21% of the hospitalizations and had a higher Charlson Comorbidity Index than women (1.86 vs. 1.33; p < 0.001), were hospitalized more frequently (21.18% of men were hospitalized more than once vs. 17.76% of women, p < 0.001), and had a higher probability of severe disease (OR 1.39; 95%CI 1.10–1.75). Crude in-hospital mortality (IHM) was 6.85% in men and 4.8% in women (p = 0.007). The variables associated with IHM in both sexes were older age, more hospital admissions, and liver disease or lung cancer. Invasive and non-invasive mechanical ventilation and admission to the ICU were also associated with IHM in men and women. Multivariable adjustment revealed no association between sex and IHM. Conclusions: The number of hospitalizations for AATD increased in Spain from 2016 to 2022. Men represented almost 60% of hospitalizations, were admitted more frequently and with more comorbidities, and had a higher probability of severe disease than women. There was no association between sex and IHM.
Planning Accuracy and Stem Offset Assessment in Digital Two-Dimensional Versus Three-Dimensional Planning in Cementless Hip Arthroplasty: A Systematic Review and Meta-Analysis
Authors: Parisi Francesco Rosario , Zampogna Biagio , Zampoli Andrea , Ferrini Augusto , Albimonti Giorgio , Del Monaco Alessandro , Za Pierangelo , Papalia Giuseppe Francesco , Papalia Rocco
Published: November 2024

Background/Objectives: Total hip arthroplasty (THA) planning is crucial for restoring hip function and minimizing complications. The present systematic review and meta-analysis aimed to assess and compare the accuracy of 2D versus 3D preoperative planning in THA. Methods: The inclusion criteria were randomized controlled trials (RCTs) and observational studies (ROSs) published in English comparing the accuracy of 2D and 3D preoperative planning for total hip arthroplasty. We excluded review articles, registers, studies not written in English, studies that did not report the cup sizing accuracy or stem sizing accuracy or give a description of the preoperative planning method used, and non-comparative studies. In June 2024, following the PRISMA 2020 statement, a systematic review and a meta-analysis of the literature were conducted in PubMed, Scopus, and the Cochrane Library. The statistical analysis software Review Manager (RevMan) version 5.4 was used to perform the meta-analysis to compare the accuracy of 2D and 3D planning, and to assess the risk of bias, the ROBINS-I tool was used. Results: The analysis included 777 patients from six studies. The analysis showed that 3D planning offers superior precision compared to 2D planning, both for the cup (96.92% vs. 87.14%) and the stem (94.72% vs. 86.28%). The forest plots assessed a better trend for 3D planning in terms of exact size prediction and accuracy within ±1 size. Conclusions: The three-dimensional method was more precise and accurate than two-dimensional planning, both for the stem and the cup. It offered a detailed three-dimensional view of the patient’s anatomy. The main limitation was the challenge in finding homogeneous data regarding biomechanical parameters, surgical approaches, and different planning systems for both three-dimensional and two-dimensional methods.
Real-World Clinical Outcomes of Neoadjuvant Platinum-Based Chemotherapy with Nivolumab in Non-Small Cell Lung Cancer
Authors: Shalata Walid , Daher Sameh , Maimon Rabinovitch Natali , Shamai Sivan , Kian Waleed , Turgeman Ilit , Dudnik Yulia , Kazareen Olga , Rovitsky Yulia , Sabo Edmond , Faber Dan Levy , Galili Ronen , Wiesel Ory , Baranovsky Konstantin , Agbarya Abed
Published: November 2024

Background: Lung cancer is among the most prevalent and serious forms of cancer, characterized by an allogenic phenotype that presents significant therapeutic challenges. Materials and Methods: We analyzed medical records from January 2022 to August 2023, focusing on individuals aged 18 and older diagnosed with resectable NSCLC who received neoadjuvant chemo-immunotherapy prior to surgical intervention. Results: The cohort comprised 56 patients, predominantly smokers (95%) and male (74%), with 80% presenting the disease at stage III. Of the participants, 44 underwent surgery, with 95% receiving lobar resection. Clinical assessments via PET-CT imaging revealed an 86% rate of response or disease stabilization, while pathological evaluations showed complete and major pathological responses in 61% of cases. Conclusions: This real-world data supports the safety and efficacy of incorporating immune checkpoint inhibitors in the neoadjuvant treatment of NSCLC, followed by surgical resection.
The Effect of Exercise Program Interventions on Frailty, Clinical Outcomes, and Biomarkers in Older Adults: A Systematic Review
Authors: Prommaban Adchara , Moonkayaow Sasiwimon , Phinyo Phichayut , Siviroj Penprapa , Sirikul Wachiranun , Lerttrakarnnon Peerasak
Published: November 2024

Background: Frailty is characterized by the decreased ability in older adults to handle daily or acute stressors due to age-related declines in physiological reserve and organ system performance. This condition results from the interaction of multiple physiological pathways and changes in biomarkers. Exercise programs are currently recommended to promote “healthy aging” in frail older adults. Objective: This systematic review aimed to evaluate the effectiveness of exercise program interventions in improving outcomes related to frailty, physical function, cognitive performance, and biomarkers in frail older adults. Methods: This study was designed according to the PRISMA guidelines. A systematic search was conducted in PubMed, Embase, and Scopus for studies published between 2014 and 2024. Two independent reviewers extracted data, with disagreements resolved by a third reviewer. Randomized controlled trials involving pre-frail or frail older adults aged 60 and above in all settings were included. The focus was on the impact of exercise programs, especially multicomponent interventions, on frailty outcomes and biomarkers. Results: Nine studies involving a total of 2083 participants met the inclusion criteria. The age range of participants was 65.35 ± 5.15 to 86.7 ± 4.00 years, with 64.7% being female. The results demonstrated that multicomponent exercise programs significantly improved frailty status, enhanced physical and cognitive function, and improved emotional well-being. Additionally, these programs led to significant reductions in inflammatory biomarkers, such as IL-6 and TNF-α, which are associated with frailty. Conclusion: This review highlights the beneficial effects of multicomponent exercise programs on pre-frail and frail older adults, providing evidence that these interventions improve physical and cognitive functions and emotional well-being, and reduce inflammation. These findings offer valuable insights into developing targeted interventions to manage frailty in clinical practice.
Brainstem Anesthesia and Cardiac Arrest Following Peribulbar Block: A Case Report and Systematic Review of the Literature
Authors: Ripa Matteo , Schipa Chiara , Aceto Paola , Kanikaram Goutham , Shah Neeraj Apoorva
Published: November 2024

Background: We report a case of brainstem anesthesia (BSA) and subsequent cardiac arrest following a routinary peribulbar block (PB) in a patient scheduled for cataract extraction and intraocular lens (IOL) implantation, thus providing a reference for further analysis of this potentially catastrophic life-threatening complication and to evaluate the current knowledge in terms of incidence, physiopathology management, and treatment of the BSA following PB. Methods: Three databases (PubMed, Embase, and Scopus) were checked to perform a systematic review of all available studies in the English Language following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to evaluate relevant studies that clearly described BSA following BSA. Results: Our literature search identified 15 cases. All the patients experienced BSA-related symptoms, including respiratory arrest, seizure, heart rate, and blood pressure abnormalities. All the patients with respiratory arrest required assisted ventilation with intubation, whereas patients with seizures were administered intravenous midazolam. Only one patient experienced cardiac arrest and underwent cardiac resuscitation. Surgery was aborted and deferred in 5 out of 15 patients, whereas 4 out of 15 underwent surgery after extubation. Conclusions: Despite the BSA incidence after the PB being very low, this possible life-threatening rare event should be considered in patients losing their consciousness and becoming apneic after the block. Therefore, prompt recognition and immediate treatment are paramount to cope with this potentially catastrophic scenario and save the patient’s life.
A Patient Case of Malan Syndrome Involving 19p13.2 Deletion of NFIX with Longitudinal Follow-Up and Future Prospectives
Authors: Makker Simran , Gagnon Bernadine R. , Trew Isabella , Mougios Vivian , Hanna Anne , Cale Jessica M. , McIntosh Craig S.
Published: November 2024

Background and Objectives: Malan syndrome is a rare overgrowth syndrome resulting from NFIX haploinsufficiency due to heterozygous loss-of-function mutations or microdeletions of NFIX on chromosome 19 at p13.2. Phenotypic presentation can vary but is characterized by macrocephaly, long and slender body habitus, skeletal abnormalities, and intellectual disability. Methods: Here, we report on the presentation, management, and development of a patient with Malan syndrome, highlighting the clinical and behavioral aspects of this syndrome, therapeutic interventions employed, and the course of disease over a 15-year period. We review medical records, cytogenetic analysis and neuropsychologic testing results, as well as speech pathology, optometric, and medical reports. In addition, we discuss personalized therapeutic strategies that could potentially be exploited in the future for such overgrowth syndromes. Results: To our knowledge, this is the first longitudinal follow-up report of a case of Malan syndrome to highlight the clinical course, interventions employed, and resulting improvements in neurocognitive function over time. Conclusions: This case highlights the importance of early diagnosis, intervention, and preventative care in overgrowth syndromes, as well as the potential for therapeutic intervention in the future.