bluuebunny/crossref_metadata_2025 huggingface dataset:
Aerodynamic modeling and performance analysis of model predictive controller for fixed wing vertical takeoff and landing unmanned aerial vehicle
Authors: Getachew Melkamu Tadesse , Zeleke Dinku Seyoum
Published: May 2024

This research focuses mainly on the aerodynamic modelling and performance analysis of a model predictive controller for a hybrid fixed-wing vertical takeoff and landing of unmanned aerial vehicle. The aerodynamics, which comprises several aerodynamic characteristics including the lift, drag, and thrust coefficients, is modelled using Newton’s second law of motion. The force and moment equations were obtained, and they were then converted into matrix and state equation form, together with the transformation matrices. The essential equations with six degrees of freedom (6 DoF) and 12 state matrices including the control input and manipulating variables were obtained. The proposed model predictive controller (MPC) was designed using the optimal model predictive controller design parameters, such as a sampling time of 0.1, a prediction horizon of 15, a control horizon of 3 and additional controller settings. With a settling period of 3 s, an overshoot of 0.5865, and a steady state inaccuracy of 0.00785, the MATLAB simulation demonstrates that the system variables, including roll, pitch, and yaw, are stabilized. This MPC control is more effective in anticipating and optimizing the UAV than other control strategies. Eventually, the controller’s simulation on MATLAB Simulink demonstrates the controller’s ability to stabilize and control the system in a real-time application. Autonomous vertical takeoff and landing operations depend heavily on the mathematical model and architecture of the flight controller. Among the uses are inspection, monitoring, and rescue.
Microstructural characterization and analysis of nitinol-based self-healing metals matrix composite of A356 alloy produced by high-pressure die casting
Authors: Sharma Sumit , Nandan Gopal , Tyagi R K
Published: May 2024

A self-healing non-ferrous metal-matrix composite is prepared by the high-pressure die-casting process. It includes casting set-up, sample preparation of metal matrix composite (MMC), microstructural characterization, and analysis of its ability to close the crack. Aluminum alloy (A356) is deployed as a matrix material in the MMC. Nitinol is a smart alloy produced by a combination of Nickel and Titanium in equal mass proportion. Apart from excellent mechanical properties it also exhibits super-elasticity and shape-memory effect. The wire of the Nitinol is integrated as reinforcement within the matrix of A356 alloy through a high-pressure die-casting process. The recovery percentage of the metal matrix composite and microstructural evaluation are reported. The deployment of shape memory wire provides the ability to recover the matrix material even from plastic strain by just heating the sample slightly above the activation temperature of the Nitinol wire. Microstructural evaluation indicates fair integration of the reinforcement within the matrix material. Gaining the ability for 30.27% angular restoration and 19.37% crack closer is a very positive sign for designing self-healing metallic materials.
Leakage detection of an acoustic emission pipeline based on an improved transformer network
Authors: Lang Xianming , Wang Chunyu
Published: May 2024

Pipeline leakage detection is an integral part of pipeline integrity management. Combining AE (Acoustic Emission) with deep learning is currently the most commonly used method for pipeline leakage detection. However, this approach is usually applicable only to specific situations and requires powerful signal analysis and computational capabilities. To address these issues, this paper proposes an improved Transformer network model for diagnosing faults associated with abnormal working conditions in acoustic emission pipelines. First, the method utilizes the temporal properties of the GRU and the positional coding of the Transformer to capture and feature extract the data point sequence position information to suppress redundant information, and introduces the largest pooling layer into the Transformer model to alleviate the overfitting phenomenon. Second, while retaining the original attention learning mechanism and identity path in the original DRSN, a new soft threshold function is introduced to replace the ReLU activation function with a new threshold function, and a new soft threshold module and adaptive slope module are designed to construct the improved residual shrinkage unit (ASB-STRSBU), which is used to adaptively set the optimal threshold. Finally, pipeline leakage is classified. The experimental results show that the NDRSN model is able to make full use of global and local information when considering leakage signals and can automatically learn and acquire the important parameters of the input features in the spatial and channel domains. By optimizing the GRU improved Transformer network recognition model, the method significantly reduces the model training time and computational resource consumption while maintaining high leakage recognition accuracy. The average accuracy reached 93.97%. This indicates that the method has good robustness in acoustic emission pipeline leakage detection.
Prediction on partial replacement of cement and coarse aggregate by zeolite powder and steel slag in high-performance concrete
Authors: R Arvind Saravan , Annadurai R
Published: May 2024

High performance concrete is obtained by the inclusion of mineral admixtures like silica fume and fly ash in the concrete. The research explores the viability and performance of sustainable concrete by introducing zeolite powder as a partial substitute for cement and steel slag as a partial replacement for coarse aggregate in M-70 grade concrete. Zeolite powder, possessing pozzolanic properties, is a natural or synthetic aluminosilicate material, while steel slag is an industrial byproduct with potential as an alternative aggregate source. The main objective is to investigate the impact of zeolite powder and steel slag on the development of High-Performance Concrete (M-70) in accordance with Bureau of Indian standards. The formulation of high-performance concrete involved replacing 12.5%, 15%, and 17.5% of the cement with zeolite powder and varying the proportion of steel slag as a replacement for coarse aggregate (ranging from 30% to 55%). A comprehensive mechanical test was conducted on these specimens and compared with conventional concrete. Among the 19 mixes, the optimal combination was identified, incorporating 15% zeolite powder as a cement replacement and 45% steel slag as a coarse aggregate replacement, resulting in superior performance compared to conventional concrete. This mix was further studied for non-destructive testing, and microstructural analysis. Subsequently, the experimental results were compared with predicted outcomes using the Taguchi method. The close alignment between the values obtained experimentally and those predicted further validates the effectiveness of the optimized mix.
A multifidelity approach to continual learning for physical systems
Authors: Howard Amanda , Fu Yucheng , Stinis Panos
Published: May 2024

We introduce a novel continual learning method based on multifidelity deep neural networks. This method learns the correlation between the output of previously trained models and the desired output of the model on the current training dataset, limiting catastrophic forgetting. On its own the multifidelity continual learning method shows robust results that limit forgetting across several datasets. Additionally, we show that the multifidelity method can be combined with existing continual learning methods, including replay and memory aware synapses, to further limit catastrophic forgetting. The proposed continual learning method is especially suited for physical problems where the data satisfy the same physical laws on each domain, or for physics-informed neural networks, because in these cases we expect there to be a strong correlation between the output of the previous model and the model on the current training domain.
From discrete to continuous: Monochromatic 3-term arithmetic progressions
Authors: Greenwood Torin , Kariv Jonathan , Williams Noah
Published: May 2024

We prove a known 2-coloring of the integers

[
N
]
≔
{
1
,
2
,
3
,
…
,
N
}

[N] ≔\{1,2,3,\dots ,N\}

minimizes the number of monochromatic arithmetic 3-progressions under certain restrictions. A monochromatic arithmetic progression is a set of equally-spaced integers that are all the same color. Previous work by Parrilo, Robertson and Saracino conjectured an optimal coloring for large

N
N

that involves

12
12

colored blocks. Here, we prove that the conjectured coloring minimizes monochromatic arithmetic

3
3

-progressions among anti-symmetric colorings with

12
12

or fewer colored blocks. We leverage a connection to the coloring of the continuous interval

[
0
,
1
]

[0,1]

used by Parrilo, Robertson, and Saracino as well as by Butler, Costello and Graham. Our proof identifies classes of colorings with permutations, then counts the permutations using mixed integer linear programming.
The brain insulin receptor gene network and associations with frailty index
Authors: Selenius Jannica S , Silveira Patricia P , Haapanen Markus J , von Bonsdorff Mikaela , Lahti Jari , Eriksson Johan G , Wasenius Niko S
Published: May 2024

Objective

To investigate longitudinal associations between variations in the co-expression-based brain insulin receptor polygenic risk score and frailty, as well as change in frailty across follow-up.

Methods

This longitudinal study included 1605 participants from the Helsinki Birth Cohort Study. Biologically informed expression-based polygenic risk scores for the insulin receptor gene network, which measure genetic variation in the function of the insulin receptor, were calculated for the hippocampal (hePRS-IR) and the mesocorticolimbic (mePRS-IR) regions. Frailty was assessed in at baseline in 2001–2004, 2011–2013 and 2017–2018 by applying a deficit accumulation-based frailty index. Analyses were carried out by applying linear mixed models and logistical regression models adjusted for adult socioeconomic status, birthweight, smoking and their interactions with age.

Results

The FI levels of women were 1.19%-points (95% CI 0.12–2.26, P = 0.029) higher than in men. Both categorical and continuous hePRS-IR in women were associated with higher FI levels than in men at baseline (P < 0.05). In women with high hePRS-IR, the rate of change was steeper with increasing age compared to those with low or moderate hePRS-IR (P < 0.05). No associations were detected between mePRS-IR and frailty at baseline, nor between mePRS-IR and the increase in mean FI levels per year in either sex (P > 0.43).

Conclusions

Higher variation in the function of the insulin receptor gene network in the hippocampus is associated with increasing frailty in women. This could potentially offer novel targets for future drug development aimed at frailty and ageing.
A Comparative Analysis of Secreted miRNAs Reveals Candidate Biomarkers for Pleural Mesothelioma Detection
Authors: Kraft A , Meerang M , Kirschner M B , Boeva V , Opitz I
Published: May 2024

Background

MicroRNAs secreted by tumour cells through exosomes or in non-encapsulated form, were shown to promote tumour growth and treatment resistance, underscoring their potential as cancer biomarkers.

Aims

Here, we compare miRNAs secreted by pleural mesothelioma (PM) primary cells with miRNAs secreted by non-PM cells, in order to identify diagnostic biomarkers of this devastating disease.

Methods

We established primary cell cultures from pleural effusion of 12 PM and 7 non-PM patients. Secreted miRNAs were profiled as: (1) total secreted miRNA in cell culture supernatant (Sup), and (2) exosomal (Exo) miRNAs. Exosomes were extracted using iZON qEV columns. RNA was extracted with mirVana PARIS kit. Sequencing libraries were prepared using the QIAseq miRNA Library Kit (Qiagen). Reads were mapped on the mature miRNA sequences (MirBaseDB), followed by DESeq2 differential expression analysis. MiRNA target genes were selected using MirDB and functionally annotated using DAVID.

Results

We identified 309 and 84 deregulated miRNAs in PM-Exo and PM-Sup samples, respectively (p-value <0.05, Fig. 1A). Among the up-regulated miRNAs, we found let-7c-3p and miR-16-5p, which are known tumour suppressors, and miR-23a-3p and miR-30a-5p (Fig. 1B). Interestingly, miR-30a-5p belongs to the same family as miR-30e-5p, which together with miR-23a-3p was previously identified as part of the long survival signature in PM. Additionally, we identified 11 miRNAs that showed up-regulation in both PM-Exo and PM-Sup. Further analysis of these candidate miRNAs revealed that exosomal expression of miR-30a-5p was a significant predictor of patient survival (Fig. 1C). Finally, we identified potential target genes of the 11 up-regulated miRNAs - the target genes were significantly associated with transcriptional regulation and cell division (p-value <0.05).

Conclusion

Our comparative analysis of secreted miRNAs identified 11 candidate biomarkers for PM. Our findings emphasise the importance of the PM secretome in advancing our understanding of mesothelioma biology and discovering novel cell-free biomarkers. Further in-depth analyses are currently underway.
Investigating the Effect of Liver Regeneration on Tumor Growth: Development of a Mouse Model with Orthotopic Implantation of Patient-derived HCC Organoids
Authors: Sedlaczek P , Haak F , Aegerter N L E , Müller P , Piscuoglio S , Coto-Llerena M , Soysal S D , Hess G F , Kollmar O
Published: May 2024

Background

Recurrence after hepatocellular carcinoma (HCC) treatment is a significant problem. It affects more than 70% of patients undergoing liver resection. Recurrence can arise from undetected micro metastasis or de novo cancer. Clinical and experimental studies suggest that liver regeneration ensuing surgical resection may activate occult micro-metastasis leading to regeneration induced tumor recurrence. However, in vivo patient-derived organoid (PDO) HCC models that are translatable to patient tumors are sparse.

Aims

Here, we aim to establish a new in vivo model to understand the impact of liver regeneration on HCC tumor growth.

Methods

PDOs were generated from HCC tissue obtained from patients undergoing liver resection at the Clarunis University Digestive Health and Care Center and transduced with firefly luciferase. Implantation was performed via laparotomy and orthotopic injection of the organoids in the right superior liver lobe. Tumor growth is monitored by in vivo bioluminescence imaging until the endpoint of the experiment. As a primary endpoint tumor growth two weeks after liver resection was defined. Experimental groups underwent either minor (30%) or major (65%) hepatectomy of tumor-free liver, whereas the control group received a re-laparotomy with subsequent closure of the abdomen. Normal liver and tumor tissue were characterized using immunohistochemistry.

Results

Two HCC-PDO lines were successfully implanted. Compared to the control, after minor and major liver resection the mean weight increased significantly to 0.82% (p < 0.0001) respectively 0.99% (p < 0.0001). Preliminary data about the tumor volume have yet to be concluded. Histology and immunohistochemistry staining for HCC confirmed the origin of the PDOs from the original patient tumor.

Conclusion

The establishment of an orthotopic xenograft mouse model for HCC PDO was successful. Through liver resection, a regenerative environment could be achieved, to investigate the molecular behavior of HCC recurrence after surgery. This offers the basis to study potential new targets and mechanisms to improve HCC-treatment.
Spatial Transcriptomics Reveals Interaction of Injury-Derived Osteopontin with Mesothelial Cells in Serosal Scarring
Authors: Bayer J , Slade B , Yarahmadov T , Sanchez-Taltavull D , Purvanov V , Borbély Y , Candinas D , Legler D , Kubes P , Stroka D , Zindel J
Published: May 2024

Background

Abdominal surgeries are often live-saving procedures. However, surgical interventions in the peritoneal cavity can cause the formation of post-surgical adhesions. These irreversible scar bands can trigger severe complications, such as chronic pelvic pain, small bowel obstruction, and infertility in women. Unfortunately, no effective treatment options for adhesion patients exist. On a cellular level, mesothelium-derived mesenchymal myofibroblasts have been identified as key pro-fibrotic players in adhesion formation.

Aims

Our aim is to study the molecular mechanisms of mesothelial cell recruitment in serosal repair and scarring, and thereby to identify potential targets for specific pharmacological anti-adhesion treatments.

Methods

We used a mesothelial cell reporter mouse system (Wt1CreERT2xRosa26tdTomato) and experimental injury models to study the differences of mesothelial cell recruitment to sites of adhesion formation in comparison to wound sites healing scar-free. To answer how injury zones affect the accumulation of mesothelial cells, we used untargeted spatial transcriptomics, identifying candidate molecules that were i) upregulated in adhesion formation sites, ii) not highly expressed in scar-free wound sites, and iii) had the potential to interact with mesothelial cells.

Results

We observed strong spatiotemporal correlation between accumulation of tdTomato+ cells and consecutive scarring. Spatial deconstruction of scar-specific signaling identified the candidate molecule Secreted phosphoprotein 1; an inflammatory zone-specific gene that encodes Osteopontin (OPN). After confirming increased OPN protein levels 7d post-surgery, we investigated its effect on adhesion formation using Spp1-/- mice. Indeed, Spp1-deficient mice showed significantly lower adhesion scores compared to control mice. Mechanistically, recombinant OPN had no chemotactic effect on primary human mesothelial cells, however triggered the upregulation of transcription factors associated with mesothelial-to-mesenchymal transition.

Conclusion

Together, these findings suggest a pivotal role for OPN in linking inflammation at injury sites with mesothelial cell recruitment in post-surgical serosal scarring. Therefore, OPN represents a potential target for novel pharmacological strategies to specifically inhibit scarring without affecting normal wound repair.
Long-Term Follow-Up after Ureteral Reimplantation in Children: A 12-Year Analysis
Authors: Gerwinn T , Zellner M , Prouza A , Kennedy U , Horst M , Mazzone L
Published: May 2024

Background

Ureteral reimplantation (UR) is a well-established procedure, yet there exists a notable absence of evidence-based guidelines for postoperative follow-up. Existing literature suggests that routine follow-up extending beyond one year may not yield significant advantages, particularly for asymptomatic children. However, it is crucial to acknowledge that many studies supporting this assertion rely on relatively short observation periods.

Aims

This study seeks to address the potential emergence of late-presenting complications post UR. Our objective is to comprehensively evaluate our patient cohort for the incidence of conditions warranting the establishment of standardized, long-term follow-up practices after UR.

Methods

Retrospective review of 137 medical records from children who underwent UR at our institution between January 2006 and June 2013. Inclusion criteria required a minimum 10-year postoperative follow-up.

Results

Fifty-three renal units in 34 children met inclusion criteria. Ureterovesical junction (UVJ) obstruction occurred in 7.5% of the units and was diagnosed within eight months after UR. Obstruction occurred exclusively after Politano-Leadbetter reimplantation and was silent in all cases. Postoperative UTIs occurred in 9 children. Notably, these were all singular events without signs for recurrent reflux. A decade after surgery, one child developed chronic kidney disease (CKD) due to preexisting reflux nephropathy (RN), while one child was newly diagnosed with RN during follow-up despite the timely surgical correction of vesicoureteral reflux (VUR). or hypertension linked to RN were recorded.

Conclusion

Children with uncomplicated postoperative recoveries within the first-year, devoid of evident UVJ obstruction, exhibit a low subsequent risk, suggesting limited benefit from repeated scheduled long-term follow-up. Nevertheless, we recommend that general practitioners conduct regular monitoring, considering individual risk factors, to enhance the detection of late-onset hypertension or proteinuria as potential indicators of RN during adolescence.
Retroperitoneoscopic Renal Surgery in Infants <10kg, Description of First 50 Patients
Authors: Sanchez O , Birraux J , Andrieu Vidal I , Broennimann E , Stathopoulos E , Alam M , Sommer C
Published: May 2024

Background

Most paediatric urologists have adopted minimally invasive surgery when approaching the kidney for reconstructive or ablative surgery. Although small weight has previously been described as a limiting factor for retroperitoneoscopic surgery, as of 2017, we have approached all non-oncological initial renal surgery by retroperitoneoscopy regardless of patient weight, with a standardised technique for port placement and initial dissection.

Aims

The aim is to present our current experience and short-term results with a minimally invasive approach to renal surgery in small patients.

Methods

We present a description of the cohort and performed operations with conversion and intra-operative complication rate.

Results

The median age of our patients is 4,7 months (26days-12months), mean weight is 5,8Kg (3,5 Kg-9,6 Kg) F:M 16:34, we performed 12 nephrectomies, 5 hemi-nephrectomies, 3 uretero-ureterostomies, 30 pyeloplasties, with 3 patients presenting with crossing vessels. No patient needed transfusion; 1 patient presented with nephrostomy catheter migration needing a second anaesthesia on day 1. We had to perform 1 conversion to open surgery because of unclear anatomy following percutaneous drainage. No patients showed significant loss of function on the remaining pole after hemi-nephrectomy.

Conclusion

The retroperitoneoscopic approach and its advantages in terms of minimal post-operative pain, quick recovery and reliable results can safely be offered to all our paediatric patients for routine and complex non-oncological renal surgery.
Music Therapy in Patients Undergoing Ambulatory Surgery: A Single-Blind Randomized Trial
Authors: Mongelli F , Doria T , la Regina G , Cammalleri C A , Sabbatini F , la Regina D
Published: May 2024

Background

Day surgery procedures constitute an essential part of surgical practices in hospitals worldwide. However, outpatients may experience anxiety, fear, and stress negatively impacting patients' ability to follow the established ambulatory surgery pathway. While medications are generally administered to reduce perioperative stress, there are several measures to avoid their use. Music therapy (MT) can be used as a complementary, drug-free, safe, and cost-effective intervention.

Aims

The purpose of our study was to evaluate the impact of MT on perioperative stress and patient satisfaction in patients undergoing ambulatory surgery.

Methods

We conducted a randomized study in patients undergoing ambulatory surgery. The MT group listened to relaxing music for the whole hospital stay, while the control group received the standard treatment. Both groups were managed in the pre- and postoperative periods according to current clinical practice and ultimately received the Leiden Perioperative care Patient Satisfaction (LPPS) questionnaire before hospital discharge.

Results

During the study period, 33 patients were included, 16 randomized to the MT arm and 17 to the control arm. The average age of the patients was 51.1±16.2 years, and 10 (31.2%) patients were women. The postoperative period was uneventful for almost all patients (95.8%), and we observed a high level of satisfaction. No patient required medication for anxiety treatment in the postoperative period. Pre- and postoperative vital signs were similar in both arms. A slightly higher LPPS score was noted in the MT group (179±8 vs. 171±20 pts, p=0.174).

Conclusion

Despite limitations, our study demonstrated that MT in patients undergoing ambulatory surgery might be advantageous in reducing perioperative stress, potentially increasing satisfaction, and enhancing patients' perception of being cared for in a multidisciplinary manner, without neglecting the emotional aspect.
Frailty Assessment for Risk Stratification in Pancreatic Surgery – Results of a Single-Center Cohort Study
Authors: Frey M , Krombholz E , Patalong S , Wirsching A , Nocito A
Published: May 2024

Background

Large cohort studies found an increase in frailty with age. Age is a known risk factor for pancreatic cancer. Seventy percent of new diagnoses are made in patients aged more than 65 years. Pancreatic resections represent the only hope for cure but are associated with high morbidity. The definition “fit for pancreatic surgery”, currently mainly based on age and comorbidities, is continuously challenged.

Aims

The aim of this study is to analyze the impact of frailty on postoperative outcomes after pancreatic resections.

Methods

Data of consecutive patients undergoing pancreatic resections between January 2015 and July 2022 were retrospectively analyzed. Postoperative complications were graded by the Clavien-Dindo Classification, Comprehensive Complication Index (CCI) and complications specific to pancreatic resections as recommended and published by the International Study Group of Pancreatic Surgery. The modified frailty index (mFI) was defined by 11 variables. An mFI score above 0.27 was set to define frailty.

Results

A pancreatic resection was performed in 159 patients, of which 23 (15%) were classified as frail. Pancreatoduodenectomies were similarly distributed in both groups. Frail patients were older (median of 74 vs. 69 years). Male gender was associated with frailty (83%, p=0.001)., Moreover, frailty was associated with an increased rate of preoperative biliary drainage. Although intensive care stay was increased in the frail group (median 3 vs. 0 days; p=0.01), total length of hospital stay was not affected. Frailty was associated with severe complications as defined by a comprehensive complication index >50 (35% vs. 10%; p=0.003), an increased rate of severe type C pancreatic fistula (13% vs. 2%, p=0.04), and a higher 90-day mortality (13% vs. 2%, p=0.04).

Conclusion

Assessment of frailty should be used for preoperative risk stratification since frailty is associated with a higher morbidity and mortality after pancreatic resections.
The PAncreatic Surgery Composite Endpoint PACE – Development and Validation of a Clinically Relevant Endpoint Requiring Lower Sample Sizes
Authors: Kümmerli C , Nickel F , Müller P C , Schmidt M W , Schmidt L P , Wise P , Klotz R , Tjaden C , Diener M , Probst P , Hackert T , Büchler M W
Published: May 2024

Background

Single endpoints in prospective and randomized studies have become impractical due to their low frequency and the marginal benefit of new interventions.

Aims

To provide a composite endpoint in pancreatic surgery.

Methods

Data from prospective studies were used to develop (n=1273) and validate (n=544) a composite endpoint based on postoperative pancreatic fistula, post-pancreatectomy hemorrhage as well as reoperation and reinterventions. All patients had pancreatectomies of different extents. The association of the developed PAncreatic surgery Composite Endpoint (PACE) with prolonged length of hospital stay (LOS) >75th percentile and mortality were assessed. A single-institution database was used for external validation (n = 2666). Sample size calculations were made for single outcomes and the composite endpoint.

Results

In the internal validation cohort, the PACE demonstrated an AUC of 78.0%, a sensitivity of 90.4% and a specificity of 67.6% in predicting a prolonged LOS. In the external cohort, the AUC was 76.9%, the sensitivity 73.8% and the specificity 80.1%. The 90-day mortality rate was significantly different for patients with a positive versus a negative PACE both in the development and internal validation cohort (5.1% vs 0.9%; P< 0.001), as well as in the external validation cohort (8.5% vs 1.2%, P< 0.001). The PACE enabled sample size reductions of up to 80.5% compared to single outcomes.

Conclusion

The PACE performed well in predicting prolonged hospital stays and can be used as a standardized and clinically relevant endpoint for future prospective trials enabling lower sample sizes and therefore improved feasibility compared to single outcome parameters.
Concomitant Cervical and Anal Screening for Human Papillomavirus (HPV) – Worth the effort or waste of time?
Authors: Espirito Santo I , Kefleyesus A , Pache B , Chilou C , Hübner M , Hahnloser D , Grass F
Published: May 2024

Background

Human papilloma virus (HPV) infection represents the most common sexually transmitted disease and a major risk factor for disease progression to anal cancer.

Aims

This study aimed to analyze the rate of concomitant anal dysplasia in a prospectively surveilled cohort of sexually active women.

Methods

This study represents a follow-up analysis of the AnusGynecology (ANGY) study (doi.org/10.3390/cancers14205096). This prospective, cross-sectional single-center study recruited women for concomitant cervical and anal screening of HPV genotypes and cytology during a single appointment. Cervical / anal smears +/- biopsies if deemed necessary were performed by board-certified specialists during a single outpatient visit. All women with findings of either HPV or any type of dysplastic lesions on anal smears were offered follow-up in a specialized high-resolution anoscopy (HRA) outpatient clinic.

Results

Overall, 275 patients (mean age 42±12) were included. Among them, 102 (37%) had cervical high risk (HR)-HPV. Anal smear cytology was performed in 255 patients (93%), while 19 patients (7%) underwent anal biopsy during the combined visit. In total, HPV was (incidentally) revealed in 91 patients (33%) on anal smears, while any degree of anal dysplasia was found in 30 patients (11%), 6 if which were high-grade squamous intraepithelial lesions (H-SIL). Furthermore, 10 out of 19 biopsies were positive (3 H-SIL lesions).

Only half (48/93, 52%) of women agreed to undergo the recommended specialized follow-up evaluation. Of them, 18 (38%) were diagnosed with dysplastic lesions (9 L-SIL and H-SIL, respectively) on biopsies, while the remaining visits revealed no abnormalities.

Conclusion

The present study revealed a significant number of dysplastic lesions in women willing to undergo specialized proctologic evaluation after abnormal findings on initial screening. Close follow-up of these women is hence strongly recommended.
Snapshot Audit Early Onset Colorectal Cancer (EOCC) – What is the Current Situation in Switzerland?
Authors: Gros H , Taha-Mehlitz S , Erdem-Sanchez S , Klasen J M , Friedrich U , Steinemann D , Huber A K , Gass M , Rodjakovic D , Galli R , Nebiker C , Hartel M , Müller A , Viehl C , Di Pietro Martinelli C , Holzgang M , Happ S , Simon T , Stimpfle D , Zingg U , Teixeira Da Cunha S , Eisner L , Studer P , Worni M , von Strauss Und Torney M
Published: May 2024

Background

Early onset colorectal cancer (EOCC), defined as colorectal cancer (CRC) ≤ 50 years, has seen an alarming rising incidence in western countries.

Aims

This research aims to determine the current state of incidence, symptoms, diagnostic methods, and treatment approach in EOCC compared to late onset CRC (LOCRC) in the extended Northwestern Switzerland.

Methods

Patients seeking care for CRC between April-November 2023 were enrolled in a prospective multicenter (11 hospitals within extended Northwestern Switzerland) observational cohort study. Information was collected using questionnaires and patient charts.

Results

We included 315 patients, thereof 38 (10.8%) EOCC. In total 211 (58.9%) patients were male, mean age was 42.5 and 71.2 years, respectively. Rectal bleeding was the main symptom in both groups (60.5% vs 37.0%), followed by change in bowel habits in EOCC and fatigue in LOCRC without reaching significance. Rectal bleeding and mucous, abdominal pain, change of bowel habits and bloating were significantly more often in EOCC. Significantly more LOCRC patients stated that their physical condition affected sexual erection and social interaction, whereas in EOCC, family life was significantly affected. For both groups, endoscopy was the leading diagnostic tool. EOCC had a diagnostic delay of 6.5 weeks compared to their counterparts. No difference in frequency of neoadjuvant treatment, surgical approach or need for emergency surgery was observed. In EOCC, a trend to more lymph node retrieval was observed and significantly more EOCC received an ostomy. Postoperatively, significantly more EOCC than LOCRC patients received adjuvant chemotherapy (55.6 % vs 28.6 %).

Conclusion

Our analysis illustrates the current standard-of-care of EOCC in the extended Northwestern Switzerland. EOCC compared to LOCRC patients present themselves differently to the medical community, leading to a different approach to their symptoms, which eventually results in a delayed diagnosis. Based on these results, it is time to foster awareness and start redefining national screening criteria.
Analysis of Eligibility of the S1 Corridor for the Trans-Sacral Screw Placement in Geriatric Patients
Authors: Polt M , Zindel-Geisseler C , Sommer C , Stillhard P , Müller D A , Acklin Y P , Michelitsch C
Published: May 2024

Background

Minimal-invasive placement of a trans-sacral screw represents an increasingly popular method of fixation for Fragility Fractures of the Pelvis (FFP), with variable upper sacral anatomy representing the main challenge. Little is known about the variability of sacral anatomy in the geriatric population and the potential effect of osteoporosis on the upper sacral anatomy and thus S1 corridor morphology.

Aims

To examine the eligibility (>12 mm) of the S1 corridor for the trans-sacral screw placement in a geriatric population and to analyse what pelvic dysmorphism signs might serve as predictors for an ineligible S1 corridor.

Methods

We analysed S1 corridor in pelvic CT scans of 107 geriatric patients without history of fracture or other pelvic pathology. First, the eligibility for the trans-sacral screw placement was determined by measuring the width and the height of the central portion of the S1 corridor. Then, pelvises were examined for signs of dysmorphism. The correlation of these signs with the ineligible S1 corridor was analysed.

Results

In our geriatric population with average age of 79,55 ± 8.79 years (male : female 0.88) 44% of S1 corridors were not eligible for a trans-sacral screw. In this ineligible group the height was shown to be a more significant limiting dimension (90,9%), compared to the width in 68,2% (p<0.05). Mamillary processes, not recessed sacrum and dysmorphic sacral foramina were present in 38,3%, 34,6%, and 26,2% respectively, with not recessed sacrum demonstrating a significant correlation with a too narrow S1 corridor (p<0.05).

Conclusion

The analysed geriatric population demonstrates a high prevalence of a too narrow S1 corridor, which makes a placement of a trans-sacral screw risky or even impossible. The height of the S1 corridor represents the main limiting factor with a dysmorphism sign of a not recessed sacrum being a significant predictor for the ineligible S1 corridor.
Cement Augmentation for Proximal Humerus Fractures: A Meta-Analysis of Randomized Trials and Observational Studies
Authors: Lecoultre Y , Beeres F , van de Wall B , Link B C , Tillmann F , Pretz F , Babst R
Published: May 2024

Background

It is unclear if elderly patients treated with plate osteosynthesis for proximal humerus fractures benefit from cement augmentation.

Aims

This meta-analysis aims to compare cement augmentation to no augmentation regarding healing, complications, and functional results.

Methods

PubMed, Embase and Cochrane Central Register of Controlled Trials were searched for randomized clinical trials and observational studies. Effect estimates were pooled across studies using random effects models. The primary outcome is overall complication rate. Stratified analyses were performed for types of complication (implant related or systemic). Secondary outcomes include re-interventions, hospital stay, operation time, functional scores, and general quality of life.

Results

Five observational studies and one randomized controlled trial with a total of 541 patients were included. The overall complication rate was significantly lower in the augmented group (15.6% versus 25.4%, OR 0.54 (95%CI 0.33–0.87)). This was caused by a reduction of implant related complications (10.4% vs 19.9%, OR 0.49 (95%CI 0.28, 0.88)). No difference in humeral head necrosis was found. Data on re-intervention, hospital stay, and operation time was limited but did not show significant differences. No impact on functional scores and general quality of life was detected.

Conclusion

This meta-analysis shows that cement augmentation may reduce overall complications, mainly by preventing implant related complications. No difference was detected regarding need for reintervention, functional scores, general quality of life and hospital stay. This is the first meta-analysis on this topic. It remains to be seen whether conclusions will hold when more and better-quality data becomes available.
Bridging Stent-Graft Implantation in the Renal Artery During Complex Endovascular Aortic Procedures does not alter the Renal Sonographic Resistance Index
Authors: Reitnauer D , Stadlbauer T H W , Zimmermann A
Published: May 2024

Background

Ultrasound examination of the resistance index (RI) of both kidneys can provide evidence of renal artery stenosis. The extent to which the RI is changed after bridging stent-graft implantation due to altered flow characteristics is not known.

Aims

The aim of the study was to investigate the influence of renal bridging stent-grafts on the RI of the kidneys after fenestrated endovascular aortic repair (FEVAR).

Methods

Ultrasound examinations of the kidneys were conducted using a GE LOGIQ S7 XDclear ultrasound system (GE Medical Systems AG, Glattburg, Switzerland). The evaluation was performed according to SGUM 2D standard criteria. The RI was determined in all consecutive patients on the day before and after renal bridging stent-graft implantation. For this purpose, the kidneys were divided into 3 areas according to the standard protocol and 2 RI values were recorded per area by evaluating intrarenal arterial Doppler signals. Mean values were calculated and compared for each kidney.

Results

For 64 kidneys in 32 consecutive patients (73.9±7.8 years, 4 female, 28 male) treated with FEVAR and renal bridging stent–graft implantation pre- and postinterventional examinations were carried out. Sono-morphologically, the kidneys examined were inconspicuous (pre: size at least 107.1x52.4 mm, parenchymal margin 18.3 mm versus post: size at least 107.9x52.9 mm, parenchymal margin 18.6 mm, p>0.4). The arborization of the renal perfusion was preserved pre and post implantation. The RI did not differ before and after implantation (0.66±0.06 versus 0.67±0.07; p=0.10). None of the patients experienced severe impairment of renal function.

Conclusion

After successful implantation of a bridging stent-graft in a non-stenosed renal artery, there is no relevant change in the RI of the kidney. The RI seems therefore to be suitable for assessing renal perfusion after complex endovascular aortic therapy.
Perioperative and Mid-Term Outcomes of Bovine Xenografts in Infected Aortic/Iliac Surgery
Authors: Celi de la Torre J A , Hakimi M
Published: May 2024

Background

Various methods of open-surgical treatment of infected aortic and iliac pathologies are available. The use of surgeon-made bovine pericardium grafts in infected aortic/iliac context has been associated with a low re-infection rate as well as high feasibility. Prefabricated (factory pre-sewn) bovine pericardium prostheses have been available for a few years. Studies reporting clinical results are rare.

Aims

Present the perioperative and mid-term outcomes of a bifurcated and straight bovine pericardium prostheses (BioModiVasc®) in infected aortic and iliac pathologies.

Methods

Retrospective database analysis of all vascular surgery operations between 2021 and 2023 at our centre.

Results

28 BioModiVasc® grafts were implanted in 27 patients due to INAA (40,7%), VGEI (51,9%), trauma (3,7%) or Leriche-Syndrome (3,7%). Patients were predominantly male (85,2%) and often presented arterial hypertension (88,9%). Significant risk factors were infection in a remote site (29,6%), emergency/urgent operations in the past 12 months (22,2%) and previous vascular procedures (44,4%). Elevated CRP (88,9%) and soreness at site (81,5%) were the most common findings at presentation. CT-scan showed infection-typical findings in 96,3%. Pathogen was isolated in 77,8% of the cases. Median operation time was 300 minutes. 88,9% of the operations were emergency/urgent ones. 96,3% of the reconstructions were orthotopic, access was mostly transperitoneal (59,3%). Median hospital/ICU days were 19 and 2 respectively. Infection a/o operation-associated 30-day mortality was 11,1%. 3-deaths occurred at follow-up (median 12 months), non-infection a/o operation related. 1 patient required a re-do due to a duodenal erosion caused by the prosthetic anastomosis.

Conclusion

Open surgical treatment of aortic/iliac septic pathologies with the BioModiVasc® prosthesis yields good results, which are similar to the reported results of the use of surgeon-made bovine pericardial reconstructions.
Italian Association of Hospital Cardiologists position paper—obesity in adults: a clinical primer
Authors: Di Fusco Stefania Angela , Mocini Edoardo , Gori Mauro , Iacoviello Massimo , Bilato Claudio , Corda Marco , De Luca Leonardo , Di Marco Massimo , Geraci Giovanna , Iacovoni Attilio , Milli Massimo , Navazio Alessandro , Pascale Vittorio , Riccio Carmine , Scicchitano Pietro , Tizzani Emanuele , Gabrielli Domenico , Grimaldi Massimo , Colivicchi Furio , Oliva Fabrizio
Published: May 2024

Obesity is a chronic and relapsing disease characterized by the interaction between individual predispositions and an obesogenic environment. Recent advances in understanding the mechanisms of energetic homoeostasis paved the way to more effective therapeutic approaches compared with traditional treatments. Since obesity is a complex disease, it necessitates a multi-disciplinary approach whose implementation remains challenging. Nonetheless, emerging pharmacological interventions appear promising. Currently, therapeutic success is discreet in the short term but often fails to maintain long-term weight loss due to a high likelihood of weight regain. Cardiologists play a key role in managing patients with obesity, yet often lack familiarity with its comprehensive management. The aim of this document is to summarize knowledge to consolidate essential knowledge for clinicians to effectively treat patients living with obesity. The paper emphasizes the pivotal role of a strong patient–clinician relationship in navigating successful treatment. We analyse the criteria commonly used to diagnose obesity and point out the strengths and limitations of different criteria. Furthermore, we discuss the role of obesiologists and the contributions of cardiologists. In addition, we detail key components of effective therapeutic strategies, including educational aspects and pharmacological options.
Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO) scientific statement on the simplification of the drug regimen for secondary cardiovascular prevention
Authors: De Luca Leonardo , Di Fusco Stefania Angela , Iannopollo Gianmarco , Mistrulli Raffaella , Rizzello Vittoria , Aimo Alberto , Navazio Alessandro , Bilato Claudio , Corda Marco , Di Marco Massimo , Geraci Giovanna , Iacovoni Attilio , Milli Massimo , Pascale Vittorio , Riccio Carmine , Scicchitano Pietro , Tizzani Emanuele , Gabrielli Domenico , Grimaldi Massimo , Colivicchi Furio , Oliva Fabrizio
Published: May 2024

The issue of suboptimal drug regimen adherence in secondary cardiovascular prevention presents a significant barrier to improving patient outcomes. To address this, the utilization of drug combinations, specifically single pill combinations (SPCs) and polypills, was proposed as a strategy to simplify treatment regimens. This approach aims to enhance treatment accessibility, affordability, and adherence, thereby reducing healthcare costs and improving patient health. The document is an Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO) scientific statement on simplifying drug regimens for secondary cardiovascular prevention. It discusses the underuse of treatments despite available, effective, and accessible options, highlighting a significant gap in secondary prevention across different socio-economic statuses and countries. The statement explores barriers to implementing evidence-based treatments, including patient, healthcare provider, and system-related challenges. The paper also reviews international guidelines, the role of SPCs and polypills in clinical practice, and their economic impact, advocating for their use in secondary prevention to improve patient outcomes and adherence.
CARDIAC AMYLOIDOSIS IN ELDERLY WITH POSITIVE SCINTIGRAPHY AND MONOCLONALITY: A DIAGNOSTIC DILEMMA
Authors: Alfarano M , Giordano C , Marchionni G , Berni S , Ballatore F , Costantino J , Tocci M , Lavalle C , Vizza C , D‘Amati G , Chimenti C
Published: May 2024

Background and Aims

Clinical identification of elderly patients with both wild–type transthyretin amyloidosis (ATTR) and monoclonal gammopathy of unknown significance (MGUS) is increasing. For this reason, accurate amyloid histologic subtyping is crucial in case of concomitant positivity of bisphosphonate scintigraphy and monoclonal protein testing. We report the diagnostic work–up of cardiac amyloidosis in this specific patient subtype in our tertiary referral center.

Methods

Among 133 patients who received the diagnosis of cardiac amyloidosis from March 2021 to March 2023, 21 (16%) presented with an abnormality of both bisphosphonate scintigraphy and at least one of the serum monoclonal protein tests. Patients underwent abdominal fat biopsy/needle aspiration as the first diagnostic procedure. In case of negative results, an endomyocardial biopsy (EMB) was planned. Amyloid was identified at histology by Congo Red staining. Amyloid typing was obtained by immunohistochemistry using a recently developed amyloid antibody panel AmYkit (Amimed) applicable on fixed paraffin–embedded tissues in an automated platform. The results were compared with those obtained with standard immunohistochemistry.

Results

Sixteen of the 21 patients were older than 75 years (76%, 81±10 ys) with a grade 3 (62%) or 2 (33%) scintigraphy. A grade 1 positive scintigraphy was detected in one patient. Serum immunofixation revealed a previously unknown monoclonal protein peak in 78%, while 22% had a history of MGUS. None of the patients had hematologic disorders. TTR pathogenic mutation was detected in one patient. On pathologic examination, abdominal fat was negative for amyloid in all cases, while Congo Red staining was positive in all examined EMBs. Immunohistochemistry performed with standard antibodies was not able to discriminate between AL and ATTR, due to signal overlapping of variable intensity. Conversely, our preliminary results with AmYkit panel of antibodies demonstrate absence of signal overlapping in over 90% of cases, allowing accurate histologic discrimination between AL and TTR.

Conclusion

Based on our clinical and histologic observations, in elderly patients with concomitant positivity of both bisphosphonate scintigraphy and monoclonal protein testing, TTR is the most frequent type of cardiac amyloid. EMB is a useful diagnostic tool to confirm the clinical suspicion of amyloidosis. Accurate amyloid subtyping is granted by a more sensitive panel of antibodies.