bluuebunny/crossref_metadata_2025 huggingface dataset:
Contrapasso, Violence, and Madness in Dante’s The Divine Comedy and Westworld
Authors: Schmid Alexander Eliot
Published: August 2024

The medieval epic poem, The Divine Comedy, and Jonathan Nolan and Lisa Joy’s prestige drama, Westworld, have more in common than at first meets the eye. Both represent hellish and purgatorial geographies, both physical and psychological. And both share the view that what is regularly considered “perfect liberty”, or the liberty to indulge in any and every desire one wishes to with impunity, is in fact a form of slavery, as argued by Aristotle. Both the denizens in Dante’s Inferno and the guests in Westworld’s park, therefore, are ensnared by their own desires. This article will consider the structure of Dante Alighieri’s The Divine Comedy and Jonathan Nolan and Lisa Joy’s hit HBO show Westworld, which I will argue takes parts of its structure consciously from Dante’s The Divine Comedy. And though at the outset, the two works of art appear dissimilar, the theologically and philosophically infused medieval Catholic-Italian poetry of Dante and the sensuous, nihilistic, and provocative story-telling of Jonathan Nolan’s recent work on the generation and expression of consciousness, ultimately what they share is similarity in structure and an agreement on the connection between activity, suffering, madness, perfection, consciousness, and freedom of the will from sin.
How Expectations and Trust in Telemedicine Contribute to Older Adults’ Sense of Control: An Empirical Study
Authors: Niu Siyu , Hong Wenjia , Ma Yiming
Published: August 2024

As numerous nations transition into digital and aging societies, the digital divide has emerged as a significant impediment to older adults’ autonomous engagement in the digital society. Enhancing the well-being of elderly individuals through remote medical technology represents a prevailing and prospective trend. Nevertheless, remote medical technology extends beyond the realm of healthcare, offering promise for narrowing the digital divide through the deployment of digital devices and provision of intergenerational support. Therefore, this study investigates the role of trust and expectations in the use of telemedicine, indicating potential pathways for how these products can improve older adults’ daily living abilities. Through the construction of a theoretical model, we collected the relevant data of 661 elderly people who use telemedicine technology in China and analyzed the data with SmartPLS4 to obtain the research results. The study discovered that, among older people using telemedicine technology, (1) healthcare expectations promote the breadth of telemedicine product use; (2) trust in product safety increases the depth of telemedicine product use; (3) trust in the service provider promotes the breadth of telemedicine product use; and (4) when compared to the depth of product use, the breadth of telemedicine product use increases older adults’ sense of control over their digital lives. The findings provide new empirical data to support growing beliefs about how expectations and trust can increase a sense of control over one’s life. They also provide practical contributions on how to boost older adults’ usage of telemedicine products, promote their digital literacy and competency, and enhance their sense of control over their digital lives.
Water Level Temporal Variability of Lake Mégantic during the Period 1920–2020 and Its Impacts on the Frequency of Heavy Flooding of the Chaudière River (Quebec, Canada)
Authors: Goulet Samuel , Assani Ali Arkamose , Roy Alexandre
Published: August 2024

The objective of this study is to analyze the temporal variability in water levels of Lake Mégantic (27.4 km2) during the period 1920–2020 in relation to anthropogenic and natural factors on the one hand, and its impact on the intensity and frequency of heavy flooding (recurring floods ≥ 10 years) of the Chaudière River of which it is the source, on the other hand. The application of four different Mann–Kendall tests showed a significant decrease in lake water levels during this period. The Lombard test revealed two breaks in the average daily maximum and average water levels, but only one break in the average daily minimum water levels. The first shift, which was smoothed, occurred between 1957 and 1963. It was caused by the demolition in 1956 of the first dam built in 1893 and the significant storage of water in the dams built upstream of the lake between 1956 and 1975. The second shift, which was rather abrupt, occurred between 1990 and 1993. It was caused by the voluntary and controlled lowering of the lake’s water levels in 1993 to increase the surface area of the beaches for recreational purposes. However, despite this influence of anthropogenic factors on this drop in water levels, they are negatively correlated with the global warming climate index. It is therefore a covariation, due to anthropogenic factors whose impacts are exerted at different spatial scales, without a physical causal link. However, the winter daily minimum water levels, whose temporal variability has not been influenced by anthropogenic activities, are positively correlated with the NAO and AO indices, but negatively with PDO. Finally, since the transformation of Lake Mégantic into a reservoir following the construction of the Mégantic dam in 1893 and 1973 to control heavy flooding in the Chaudière River, all recurrent floods ≥ 10 years have completely disappeared in the section of this river located downstream of Lake Mégantic. However, the disappearance of these floods and the drop in water levels of Lake Mégantic have not significantly impacted the stationarity in the flow series of the Chaudière River since 1920.
An Experimental Investigation of Tsunami Bore Impact on Coastal Structures
Authors: Erduran Kutsi S. , Akansu Yahya E. , Ünal Uğur , Adekoya Olusola O.
Published: August 2024

This experimental study focused on the measurement and analysis of the impact force caused by a tsunami bore on a coastal structure. The bore wave was produced by a dam break mechanism. The water depth in the reservoir and the location of the coastal structures were varied to simulate different impact scenarios. The time history of the force resulting from the impact of the bore wave on the coastal structure was measured. The propagation of the bore wave along the flume was recorded and the video recordings were converted into digital data using an image-processing technique in order to determine the flow depth variations with time. The hydrostatic forces and the corresponding depth and time-averaged hydrodynamic forces as well as the maximum hydrodynamic forces were acquired for each scenario. The ratio of hydrodynamic to hydrostatic forces were obtained, and it was observed that the calculated averaged ratio was within the recommended design ratio. The results indicate that an increase in the reservoir level caused an increase in the magnitude and intensity of the impact forces, however, the relationship was non-linear. Moreover, it was found that the location of the structure did not play a significant role on the intensity of the impact forces.
A Hybrid Hierarchical Mathematical Heuristic Solution of Sparse Algebraic Equations in Sentiment Analysis
Authors: Jalali Maryam , Zahedi Morteza , Gharahbagh Abdorreza Alavi , Hajihashemi Vahid , Machado José J. M. , Tavares João Manuel R. S.
Published: August 2024

Many text mining methods use statistical information as a text- and language-independent approach for sentiment analysis. However, text mining methods based on stochastic patterns and rules require many samples for training. On the other hand, deterministic and non-probabilistic methods are easier and faster to solve than other methods, but they are inefficient when dealing with Natural Language Processing (NLP) data. This research presents a novel hybrid solution based on two mathematical approaches combined with a heuristic approach to solve unbalanced pseudo-linear algebraic equation systems that can be used as a sentiment word scoring system. In its first step, the proposed solution uses two mathematical approaches to find two initial populations for a heuristic method. The heuristic solution solves a pseudo-linear NLP scoring scheme in a polarity detection method and determines the final scores. The proposed solution was validated using three scenarios on the SemEval-2013 competition, the ESWC dataset, and the Taboada dataset. The simulation results revealed that the proposed solution is comparable to the best state-of-the-art methods in polarity detection.
Virtual and Augmented Reality in Science, Technology, Engineering, and Mathematics (STEM) Education: An Umbrella Review
Authors: Zhang Yiqun , Feijoo-Garcia Miguel A. , Gu Yiyin , Popescu Voicu , Benes Bedrich , Magana Alejandra J.
Published: August 2024

The application of extended reality (XR) technology in education has been growing for the last two decades. XR offers immersive and interactive visualization experiences that can enhance learning by making it engaging. Recent technological advances have led to the availability of high-quality and affordable XR headsets. These advancements have spurred a wave of research focused on designing, implementing, and validating XR educational interventions. Limited literature focuses on the recent trends of XR within science, technology, engineering, and mathematics (STEM) education. Thus, this paper presents an umbrella review that explores the exploding field of XR and its transformative potential in STEM education. Using six online databases, the review zoomed in on 17 out of 1972 papers on XR for STEM education, published between 2020 and 2023, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The results highlighted the types of XR technology applied (i.e., virtual reality and augmented reality), the specific STEM disciplines involved, the focus of each study reviewed, and the major findings from recent reviews. Overall, the educational benefits of using XR technology in STEM education are apparent: XR boosts student motivation, facilitates learning engagement, and improves skills, for example. However, using XR in education still has challenges that must be addressed, such as the physical discomfort of the learner wearing the XR headset and technical glitches. Besides revealing trends of using XR in STEM education, this umbrella review encourages reflection on current practices and suggests ways to apply XR to STEM education effectively.
A Multi-Biomarker Approach to Increase the Accuracy of Diagnosis and Management of Coronary Artery Disease
Authors: Hostačná Lenka , Mašlanková Jana , Pella Dominik , Hubková Beáta , Mareková Mária , Pella Daniel
Published: August 2024

Non-invasive possibilities of predicting cardiovascular risk and monitoring the treatment and progression of coronary artery disease (CAD) are important subjects of cardiovascular research. Various inflammatory markers have been identified as potential biomarkers of CAD, including interleukin-6 (IL-6), lipocalin-2 (LCN-2), growth differentiation factor 15 (GDF-15), and T cell immunoglobulin and mucin domain-3 (TIM-3). This research aims to identify their utility in the investigation of CAD severity and progression. The basic anthropometric parameters, as well as the levels of urea, creatinine, CRP, leukocytes, fibrinogen, and biomarkers of inflammation, were measured in 130 patients who underwent coronary angiography. In male patients, divided according to findings on coronary angiography, we observed an increasing expression of GDF-15 with increasing stenosis (with worsening findings). In females, we observed increasing fibrinogen expression with increasing stenosis, i.e., findings on coronary angiography. Correlation analysis did not confirm the relationship between TIM-3, LCN and 2, IL-6 and the severity of findings obtained by coronary angiography; however, the correlation of TIM-3 and LCN-2 expression was positive with the finding, and the correlation of IL-6 with the finding was surprisingly negative. Understanding the role of these inflammatory markers in CAD can be helpful in risk stratification, guiding therapeutic strategies, and monitoring treatment responses in patients with CAD.
P1 and N1 Characteristics in Individuals with Normal Hearing and Hearing Loss, and Cochlear Implant Users: A Pilot Study
Authors: Seol Hye Yoon , Kang Soojin , Kim Sungkean , Kim Jihoo , Kim Euijin , Hong Sung Hwa , Moon Il Joon
Published: August 2024

Background: It has been reported in many previous studies that the lack of auditory input due to hearing loss (HL) can induce changes in the brain. However, most of these studies have focused on individuals with pre-lingual HL and have predominantly compared the characteristics of those with normal hearing (NH) to cochlear implant (CI) users in children. This study examined the visual and auditory evoked potential characteristics in NH listeners, individuals with bilateral HL, and CI users, including those with single-sided deafness. Methods: A total of sixteen participants (seven NH listeners, four individuals with bilateral sensorineural HL, and five CI users) completed speech testing in quiet and noise and evoked potential testing. For speech testing, the Korean version of the Hearing in Noise Test was used to assess individuals’ speech understanding ability in quiet and in noise (noise from the front, +90 degrees, and −90 degrees). For evoked potential testing, visual and auditory (1000 Hz, /ba/, and /da/) evoked potentials were measured. Results: The results showed that CI users understood speech better than those with HL in all conditions except for the noise from +90 and −90 degrees. In the CI group, a decrease in P1 amplitudes was noted across all channels after implantation. The NH group exhibited the highest amplitudes, followed by the HL group, with the CI group (post-CI) showing the lowest amplitudes. In terms of auditory evoked potentials, the smallest amplitude was observed in the pre-CI condition regardless of the type of stimulus. Conclusions: To the best of our knowledge, this is the first study that examined visual and auditory evoked potentials based on various hearing profiles. The characteristics of evoked potentials varied across participant groups, and further studies with CI users are necessary, as there are significant challenges in collecting and analyzing evoked potentials due to artifact issues on the CI side.
Self-Efficacy and Perceived Stress in Women Experiencing Preterm Birth
Authors: Białas Agata , Nowak Anna , Kamecka Karolina , Rasmus Paweł , Timler Dariusz , Marczak Michał , Kozłowski Remigiusz , Lipert Anna
Published: August 2024

Background: Being an unexpected, undesired and life-threatening situation, preterm birth (PTB) is a stress-, anxiety- and depression-generating factor for women delivering prematurely. The aim of this study was to assess the relationship between self-efficacy, coping strategies and perceived stress in mothers who experienced preterm birth and full-term birth, to determine the needs for personalized emotional support. Methods: The study was conducted among 251 women divided into the preterm birth group (PBG) and the full-term birth group (FBG). Data were collected using the following: (1) The State-Trait Anxiety Inventory (STAI) Questionnaire, (2) Generalized Self-Efficacy Scale (GSES) and (3) Coping Inventory for Stressful Situations Questionnaire (CISS), which were distributed online from January 2021 to June 2021. Results: Lower STAI scores were recorded in the preterm birth group (PBG) with high self-efficacy (HSE) when compared to the full-term birth group with HSE. CISS test scores were higher in PBG women with low self-efficacy (LSE) in comparison to women with LSE in FBG (p < 0.001). A positive and strong relationship (0.83; p < 0.05) was found between avoidance-oriented style and strategy of avoidance by engaging in surrogate activities and a positive moderate relationship (0.58; p < 0.05) with the style of looking for social contacts in PBG with LSE. Conclusions: The task-oriented coping style seems to be the most beneficial strategy for mothers, regardless of their preterm or term delivery, as focusing on specific activities increases the sense of self-efficacy and the anxiety level can decrease. Awareness of different styles of coping with stress and a sense of self-efficacy are necessary to plan personalized interventions for premature infants’ mothers.
Association between Atherogenic Dyslipidemia and Subclinical Myocardial Injury in the General Population
Authors: Elbadawi Nada S. , Sobih Moaze H. , Soliman Mai Z. , Mostafa Mohamed A. , Kazibwe Richard , Soliman Elsayed Z.
Published: August 2024

Background: Subclinical myocardial injury (SCMI) is associated with an increased risk of poor cardiovascular disease (CVD) outcomes. Understanding the underlying risk factors for SCMI is crucial for the prevention and management of CVD. We hypothesized that atherogenic dyslipidemia, a combination of high triglycerides (TG) and low high-density lipoprotein cholesterol (HDL-C), is associated with an increased risk of SCMI. Methods: This analysis from the third National Health and Nutrition Examination Survey (NHANES-III) included 7093 participants (age 59.3 ± 13.4 years, 52.8% women, and 49.4% White) free of CVD. Atherogenic dyslipidemia was defined as TG ≥ 150 mg/dL and HDL-C < 40 mg/dL in men or <50 mg/dL in women. A validated electrocardiographic-based cardiac infarction injury score (CIIS) ≥ 10 was considered positive for SCMI. Multivariable logistic regression analysis was used to examine the association of different combinations of TG and HDL-C groups, including atherogenic dyslipidemia with SCMI. Results: About 22.5% (n = 1594) of participants had atherogenic dyslipidemia, and 26.3% (n = 1862) had SCMI. Compared to participants with normal TG and normal HDL-C, those with atherogenic dyslipidemia had a higher prevalence of SCMI (31.2% vs. 23.9%, p-value < 0.001). In a multivariable logistic regression model, atherogenic dyslipidemia was associated with the highest odds of SCMI followed by high TG/normal HDL-C, then low HDL-C/normal TG [OR (95% CI): 131 (1.14, 1.52), 1.13 (0.97, 1.33), and 1.01 (0.86, 1.20), respectively). Conclusions: Atherogenic dyslipidemia is associated with a higher risk of SCMI, which highlights the role of nontraditional risk factors in the development of subclinical CVD.
Treatment of Lichen Planopilaris and Frontal Fibrosing Alopecia: A Retrospective, Real-Life Analysis in a Tertiary Center in Germany
Authors: Stege Henner , Haist Maximilian , Schultheis Michael , Pawlowski Johannes , Wittmann Miriam , Grabbe Stephan , Butsch Florian
Published: August 2024

Background: Lichen planopilaris (LPP) is an inflammatory cicatricial alopecia characterized by an irreversible destruction of the hair follicle resulting in its permeant destruction. The clinical presentation of LPP is a progressive patchy scarring alopecia. A variety of systemic agents is used to treat LPP with varying success. The aim of this retrospective, real-life analysis was to evaluate the treatment of hydroxychloroquine for LPP. Method: In this retrospective, single-center study, we analyzed 110 patients with LPP and frontal fibrosing alopecia (FFA) who received treatment over a 12-month period from March 2014 to March 2021 at the Department of Dermatology, University of Mainz Medical Center. Patient records were analyzed for response to treatment, co-morbidities, disease progression-free survival (DPFS), and safety. Clinical parameters associated with treatment response were determined with Cox regression modelling and logistic regression. Results: Overall, 77 of 110 patients were treated with a systemic agent. There was a clear association between LPP and the occurrence of Hashimoto thyroiditis. Topical treatment with corticosteroids did not improve clinical symptoms in the majority of patients (15 out of 101). In 71% of patients treated with systemic cyclosporine A and 62% of patients treated with hydroxychloroquine, we observed a significant resolution of the inflammatory process, which correlated with a robust durable clinical response (p < 0.001). Toxicity was observed in 17% (n = 9) of patients receiving systemic treatment with hydroxychloroquine and correlated with the duration of systemic treatment (p < 0.001). Treatment discontinuation was associated with a flare-up of clinical symptoms (29%), which required the re-initiation of second-line therapy in 13 out of 51 patients. Overall, the initiation of second-line treatment, either hydroxychloroquine or Cyclosporine A (CsA), yielded positive results, especially in the patient cohort treated with hydroxychloroquine (overall response rate, ORR = 100%), who showed disease progression during CsA or retinoids. Conclusions: Our results from this contemporary cohort of patients with LPP and FFA indicate that hydroxychloroquine and cyclosporine are effective systemic agents in decreasing clinical symptoms. However, our data also show that the discontinuation of treatment is often associated with the exacerbation of clinical symptoms. Response rates to second-line treatment were especially favorable in the patient cohort with hydroxychloroquine.
A Systematic Review of Ongoing Registered Research Studies on Post-Operative Atrial Fibrillation after Cardiac Surgery
Authors: Quan Ivy , Belley-Côté Emilie P. , Spence Jessica , Wang Austine , Sidhom Karen , Wang Michael Ke , Conen David , Sun Bryan , Shankar Aadithya Udaya , Whitlock Richard P. , Devereaux P. J. , Healey Jeff S. , McIntyre William F.
Published: August 2024

Background/Objectives: New-onset atrial fibrillation (AF) after cardiac surgery is associated with patient-important outcomes. Uncertainty persists regarding its prevention, detection, and management. This review seeks to identify, compile, and describe ongoing registered research studies involving patients with or at risk for post-operative AF (POAF) after cardiac surgery. Methods: We searched clinical trial registries in January 2023 for studies focusing on POAF prediction, prevention, detection, or management. We extracted data from each record and performed descriptive analyses. Results: In total, 121 studies met the eligibility criteria, including 82 randomized trials. Prevention studies are the most common (n = 77, 63.6%), followed by prediction (n = 21, 17.4%), management (n = 16, 13.2%), and detection studies (n = 7, 5.8%). POAF after cardiac surgery is an area of active research. Conclusions: There are many ongoing randomized prevention studies. However, two major clinical gaps persist; future randomized trials should compare rate and rhythm control in patients who develop POAF, and long-term follow-up studies should investigate strategies to monitor for AF recurrence in patients with POAF.
A Modified Triangular Arthroscopic Suture-Based Fixation for Tibial Eminence Fractures: Technique, Outcome and Literature Review
Authors: Morag Guy , Rachevski Gil , Dolkart Oleg , Rath Ehud , Dubin Jeremy , Chechik Ofir , Drexler Michael , Atzmon Ran
Published: August 2024

Objectives: Tibial eminence fractures account for 2% to 5% of all knee injuries. Low-grade fractures, such as Type I, are typically treated conservatively, whereas high-grade fractures, such as Types III and IV, usually require surgical intervention. This paper describes a modified surgical arthroscopic technique, which employs pull-through triangle suture fixation for Type II and Type III arthroscopic intercondylar eminence avulsion fractures. In addition, we examined the efficacy and complication rate compared to the existing literature. Methods: Data were prospectively collected for knee arthroscopy surgeries and retrospectively analyzed with a minimum two-year follow-up. Twenty-three consecutive adults underwent arthroscopic treatment of displaced intercondylar Type II and Type III eminence fractures, as evidenced by clinical examination and imaging studies between May/2008 and May/2021. The patient’s knee evaluation was performed using clinical symptoms and physical examination, along with International Knee Documentation Committee (IKDC) questionnaire and Tegner Activity Score. Compared to the literature, post-hoc power was calculated based on the mean Tegner Activity Score in our analysis. Results: fifteen females and eight males (mean age 33.9 years, range 19–56 years) were enrolled. The average postoperative follow-up was 35.4 months (27–53). The post-hoc power was 95% confidence in terms of the Tegner Activity Score. The mean ± standard deviation postoperative Tegner Activity Score was 8.2 ± 1.7 (6.8–10.0). Fifteen patients were classified as IKDC A (normal), six as IKDC B (nearly normal), and two as IKDC C (abnormal). The mean IKDC subjective score was 72.7 ± 23 (23–100). Twenty-four patients achieved normal flexion degrees compared with the unaffected side, while one patient achieved a flexion of only 0–90°. The group’s mean flexion range of motion was 123 ± 16° (90–150°). Conclusion: This study presents a modified surgical arthroscopic suture fixation technique for tibial eminence fractures. The procedure is relatively simple and requires no more than basic arthroscopy equipment. The clinical and radiographic results indicate that this technique is safe, efficient, enables early initiation of rehabilitation, and has a lower complication rate in a variety of aspects compared with other fixation techniques used for tibial eminence fractures.
Occult Serologically Confirmed Cases of SARS-CoV-2 Coronavirus among the General Population in the Era of the Fourth Vaccination
Authors: Hay Levy Mori , Cohen Neta , Marom Rotem , Goldshmidt Hanoch , Zeltser David , Mizrahi Michal , Simhon Yanay , Gamzu Ronni , Arber Nadir , Lev-Ari Shahar , Capua Tali , Saiag Esther
Published: August 2024

Background: Asymptomatic SARS-CoV-2 infection can significantly increase the spread of the COVID-19 pandemic. We aimed to investigate the epidemiological and clinical predictors of occult serologically confirmed SARS-CoV-2 cases among the general population during the fourth vaccination era in Israel. Methods: We conducted a cross-sectional study among individuals aged ≥18 years who had not been tested for COVID-19 in the preceding 5 months. Occult serologically confirmed cases were based on the presence of anti-N IgG antibodies. Potential risk factors were examined. Multivariable regression analysis identified independent predictors of subclinical SARS-CoV-2 infection. Results: This study included 504 participants. The prevalence of occult serologically confirmed SARS-CoV-2 was 12.5%. Chronic disease was found to be an independent predictor for the absence of occult disease (aOR) 0.4 [95% (CI): 0.18–0.87], p-value = 0.02). No significant differences were observed in age, sex, marital status, number of children, vaccination status, or exposure to COVID-19 infection between participants with and without SARS-CoV-2 sub-infection. Conclusions: We found a lower prevalence of occult serologically confirmed SARS-CoV-2 cases, compared to previous reports, and a negative correlation between chronic disease and occult SARS-CoV-2. Continued research, surveillance, and intervention strategies are needed to optimize long-term health outcomes and provide valuable insights for public health policymakers and clinicians.
Skin Microvascular Dysfunction in Type 2 Diabetes Mellitus Using Laser Speckle Contrast Analysis and Association with Carotid Intima-Media Thickness
Authors: Lamprou Stamatina , Koletsos Nikolaos , Zografou Ioanna , Lazaridis Antonios , Mintziori Gesthimani , Trakatelli Christina Maria , Kotsis Vasilios , Gkaliagkousi Eugenia , Doumas Michael , Triantafyllou Areti
Published: August 2024

Background: It is established that diabetes mellitus (DM) is characterized by increased cardiovascular risk associated with subclinical atherosclerosis as well as microvascular alterations. Laser speckle contrast analysis (LASCA) is an innovative, non-invasive method for assessing skin microvascular function. Objectives: We sought to assess skin microvascular function in patients with type 2 DM and matched controls. Methods: Consecutive patients with DM and individuals matched for age, sex and BMI were included in the study. Skin microvascular perfusion was assessed, using LASCA, during baseline, a 5 min occlusion period and a 5 min reperfusion period. Carotid intima-media thickness (cIMT) was measured as a surrogate marker of macrocirculation. Results: In total, 18 patients with DM and 22 in the control group were enrolled. No statistically significant differences were observed in baseline flux, peak flux and percentage decrease during arterial occlusion. During reperfusion, individuals with DM exhibited a smaller peak magnitude compared to controls (147.0 ± 64.7% vs. 189.4 ± 46.0%, respectively; p < 0.05). Moreover, cIMT was higher in patients with DM compared to controls (0.68 ± 0.09 mm vs. 0.60 ± 0.08 mm, respectively, p < 0.01) and was negatively correlated with skin microvascular reactivity in the univariate analysis. In the multivariate analysis, glucose and office systolic blood pressure levels remained significant predictors of microvascular reactivity. Conclusions: Our study shows that patients with type 2 DM exhibit impaired skin microvascular function compared to controls. Furthermore, glucose levels and blood pressure play a key role in microvascular dysfunction. However, additional studies are needed to address the clinical significance of early microvascular changes in DM.
Primary Cauda Equina Lymphoma Mimicking Meningioma
Authors: Lapolla Pierfrancesco , Maiola Vincenza , Familiari Pietro , Tomei Gabriella , Gangemi Dominella , Ienzi Sara , Arcese Roberto , Palmieri Mauro , Relucenti Michela , Mingoli Andrea , Brachini Gioia , Nottola Stefania Annarita , D’Andrea Giancarlo , La Pira Biagia , Bruzzaniti Placido
Published: August 2024

Background: Spinal cord lymphomas represent a minority of extranodal lymphomas and often pose diagnostic challenges by imitating primary spinal tumors or inflammatory/infective lesions. This paper presents a unique case of primary cauda equina lymphoma (PCEL) and conducts a comprehensive review to delineate the clinical and radiological characteristics of this rare entity. Case Report: A 74-year-old male presented with progressive paresthesia, motor weakness, and symptoms indicative of cauda equina syndrome. Neurological examination revealed paraparesis and sphincter dysfunction. Imaging studies initially suggested an intradural meningioma. However, surgical intervention revealed a diffuse large B-cell lymphoma infiltrating the cauda equina. Findings: A systematic review of the pertinent literature identified 18 primary cauda equina lymphoma cases. These cases exhibited diverse clinical presentations, treatments, and outcomes. The mean age at diagnosis was 61.25 years for women and 50 years for men, with an average follow-up of 16.2 months. Notably, 35% of patients were alive at 18 months, highlighting the challenging prognosis associated with PCEL. Discussion: Primary spinal cord lymphomas, especially within the cauda equina, remain rare and diagnostically complex due to their nonspecific clinical manifestations. The review highlights the need to consider spinal cord lymphoma in patients with neurological symptoms, even without a history of systemic lymphoma. Diagnostic Approaches: Magnetic resonance imaging (MRI) serves as the primary diagnostic tool but lacks specificity. Histopathological examination remains the gold standard for definitive diagnosis. The review underscores the importance of timely biopsy in suspected cases to facilitate accurate diagnosis and appropriate management. Management and Prognosis: Current management involves biopsy and chemotherapy; however, optimal treatment strategies remain ambiguous due to the rarity of PCEL. Despite aggressive therapeutic interventions, prognosis remains poor, emphasizing the urgency for enhanced diagnostic and treatment modalities. Conclusions: Primary cauda equina lymphoma poses diagnostic and therapeutic challenges, necessitating a high index of suspicion in patients with atypical spinal cord symptoms. Collaborative efforts between neurosurgical, oncological, and infectious diseases teams are imperative for timely diagnosis and management. Advancements in diagnostic precision and therapeutic options are crucial for improving patient outcomes.
Somatic Structure and Ultrasound Parameters of the Calcaneus Bone in Combat Sports Athletes in Relation to Vitamin D3 Levels
Authors: Brudecki Janusz , Rydzik Łukasz , Wąsacz Wojciech , Ruzbarsky Pavel , Czarny Wojciech , Warowna Marlena , Ambroży Tadeusz
Published: August 2024

Background/Objectives: Physical activity is widely recognized for its beneficial effects on bone density during adolescence, which could lead to enhanced bone density in later life, thus acting as a health-promoting activity with long-lasting implications. However, not all studies are conclusive regarding the type, intensity, duration, and frequency of the most effective physical activities. This study focuses on combat sports athletes and examines the relationship between their somatic build and heel bone parameters using ultrasound (USG) and their vitamin D3 levels. Methods: The study included 40 male athletes specializing in various combat sports. The measurements of body height, body mass, skinfold thickness, and bone widths at multiple sites were performed to estimate the somatic build. The USG parameters of the heel bone and the blood levels of vitamin D3 were also recorded. Statistical significance was determined using one-way ANOVA, with differences among sports disciplines also examined. Results: The study found significant differences in the body composition and USG bone parameters among athletes from different combat sports (p ≤ 0.05). The calcaneus stiffness index (SI) and speed of sound (SOS) were significantly higher in athletes with normal vitamin D3 levels compared to those with below-normal levels (p = 0.0015 and p = 0.001, respectively). These findings suggest that vitamin D3 may influence bone stiffness and density. Conclusions: The study underscores the importance of maintaining adequate vitamin D3 levels to support bone mineralization in athletes, particularly those training indoors with limited exposure to sunlight. It also highlights the potential of using USG as a non-invasive method to assess bone health, aiding in the optimization of training programs to prevent injuries and improve performance.
Interstitial Lung Disease Phenotypes and Predictive Risk Factors in Primary Sjögren’s Syndrome
Authors: La Rocca Gaetano , Ferro Francesco , Sambataro Gianluca , Elefante Elena , Fulvio Giovanni , Navarro Inmaculada Concepción , Moretti Michele , Romei Chiara , Mosca Marta , Baldini Chiara
Published: August 2024

Background/Objectives: The prevalence of Interstitial Lung Disease (ILD) and risk factors for its development in patients with primary Sjögren’s syndrome (pSS) are still debated, possibly due to the existence of heterogeneous pSS-related ILD phenotypes. The aims of this study were: 1. To investigate the prevalence and predictive factors for ILD development in a single-center pSS cohort; 2. To characterize different pSS-ILD phenotypes. Methods: Clinical, laboratory and imaging data of pSS patients attending our center from January 2019 to September 2023 were retrospectively analyzed. ILD presence was confirmed on HRCT. Results: Forty-three out of 474 enrolled pSS patients presented ILD (M:F = 6:37), accounting for an overall ILD prevalence of 9.1%. In 19 cases, ILD was the first manifestation of pSS (ILD-onset), while in 24 ILD was diagnosed after pSS (ILD-incident). Compared to ILD-onset, ILD-incident patients more often presented pSS-related hematologic abnormalities (p = 0.012), cutaneous involvement (p = 0.027), inflammatory arthralgias (p = 0.026), C4 hypocomplementemia (p = 0.012) and positive RF (p = 0.031). On the other hand, ILD-onset patients were significantly older at pSS diagnosis (p = 0.008) and presented more severe fibrosis on HRCT (p = 0.008). On the univariate analysis, higher ESSDAI (p = 0.011), Raynaud’s phenomenon (p = 0.009), anti-Ro52 (p = 0.031), hypergammaglobulinemia (p = 0.011), Rheumatoid Factor (RF) (p = 0.038) and C4 hypocomplementemia (p = 0.044) at baseline were associated to ILD development during follow-up. On the multivariate analysis, the ESSDAI at baseline (p = 0.05) and Raynaud’s phenomenon (p = 0.013) at baseline were the only independent predictors of ILD development. Conclusions: ILD is a relatively common and clinically heterogenous pSS manifestation. Elevated disease activity at pSS onset is a risk factor for ILD development, prompting careful follow-up and intriguingly suggesting that immunomodulatory therapies may prevent ILD.
The Role of Vitamin D Metabolism Genes and Their Genomic Background in Shaping Cyclosporine A Dosage Parameters after Kidney Transplantation
Authors: Kotowska Katarzyna , Wojciuk Bartosz , Sieńko Jerzy , Bogacz Anna , Stukan Iga , Drożdżal Sylwester , Czerny Bogusław , Tejchman Karol , Trybek Grzegorz , Machaliński Bogusław , Kotowski Maciej
Published: August 2024

Background: Kidney transplantation is followed by immunosuppressive therapy involving calcineurin inhibitors (CNIs) such as cyclosporin A. However, long-term high CNIs doses can lead to vitamin D deficiency, and genetic variations influencing vitamin D levels can indirectly impact the necessary CNIs dosage. This study investigates the impact of genetic variations of vitamin D binding protein (DBP) rs2282679 and CYP2R1 hydroxylase rs10741657 polymorphisms on the cyclosporin A dosage in kidney transplant recipients. Additional polymorphisims of genes that are predicted to influence the pharmacogenetic profile were included. Methods: Gene polymorphisms in 177 kidney transplant recipients were analyzed using data mining techniques, including the Random Forest algorithm and Classification and Regression Trees (C&RT). The relationship between the concentration/dose (C/D) ratio of cyclosporin A and genetic profiles was assessed to determine the predictive value of DBP rs2282679 and CYP2R1 rs10741657 polymorphisms. Results: Polymorphic variants of the DBP (rs2282679) demonstrated a strong predictive value for the cyclosporin A C/D ratio in post-kidney transplantation patients. By contrast, the CYP2R1 polymorphism (rs10741657) did not show predictive significance. Additionally, the immune response genes rs231775 CTLA4 and rs1800896 IL10 were identified as predictors of cyclosporin A response, though these did not result in statistically significant differences. Conclusions:DBP rs2282679 polymorphisms can significantly predict the cyclosporin A C/D ratio, potentially enhancing the accuracy of CNI dosing. This can help identify patient groups at risk of vitamin D deficiency, ultimately improving the management of kidney transplant recipients. Understanding these genetic influences allows for more personalized and effective treatment strategies, contributing to better long-term outcomes for patients.
Automated Quality Control Solution for Radiographic Imaging of Lung Diseases
Authors: Kleefeld Christoph , Castillo Lopez Jorge Patricio , Costa Paulo R. , Fitton Isabelle , Mohamed Ahmed , Pesznyak Csilla , Ruggeri Ricardo , Tsalafoutas Ioannis , Tsougos Ioannis , Wong Jeannie Hsiu Ding , Zdesar Urban , Ciraj-Bjelac Olivera , Tsapaki Virginia
Published: August 2024

Background/Objectives: Radiography is an essential and low-cost diagnostic method in pulmonary medicine that is used for the early detection and monitoring of lung diseases. An adequate and consistent image quality (IQ) is crucial to ensure accurate diagnosis and effective patient management. This pilot study evaluates the feasibility and effectiveness of the International Atomic Energy Agency (IAEA)’s remote and automated quality control (QC) methodology, which has been tested in multiple imaging centers. Methods: The data, collected between April and December 2022, included 47 longitudinal data sets from 22 digital radiographic units. Participants submitted metadata on the radiography setup, exposure parameters, and imaging modes. The database comprised 968 exposures, each representing multiple image quality parameters and metadata of image acquisition parameters. Python scripts were developed to collate, analyze, and visualize image quality data. Results: The pilot survey identified several critical issues affecting the future implementation of the IAEA method, as follows: (1) difficulty in accessing raw images due to manufacturer restrictions, (2) variability in IQ parameters even among identical X-ray systems and image acquisitions, (3) inconsistencies in phantom construction affecting IQ values, (4) vendor-dependent DICOM tag reporting, and (5) large variability in SNR values compared to other IQ metrics, making SNR less reliable for image quality assessment. Conclusions: Cross-comparisons among radiography systems must be taken with cautious because of the dependence on phantom construction and acquisition mode variations. Awareness of these factors will generate reliable and standardized quality control programs, which are crucial for accurate and fair evaluations, especially in high-frequency chest imaging.
Exoscope and Supermicrosurgery: Pros and Cons of 3D Innovation in Lymphatic Surgery
Authors: Frosolini Andrea , Benedetti Simone , Catarzi Lisa , Massarelli Olindo , Gennaro Paolo , Gabriele Guido
Published: August 2024

Background: The surgical treatment of lymphedema has seen advancements in recent years, with supramicrosurgical lymphaticovenular anastomosis (sLVA) gaining global acceptance. The integration of 3D exoscopes into microsurgery offers potential ergonomic and educational benefits. However, systematic evaluation of their efficacy in sLVA remains limited. Methods: A retrospective cross-sectional study was conducted comparing the use of 3D exoscopes to conventional operating microscopes (OM) in sLVA surgeries. Patient data from January 2019 to January 2024 were reviewed, with demographic, clinical, and surgical outcome variables analyzed. Ergonomic assessments were performed using Rapid Entire Body Assessment (REBA) and Rapid Upper Limb Assessment (RULA), while surgeon satisfaction was evaluated through the Microsurgical Intraoperative Satisfaction and Comfort questionnaire (MISCq). Results: An analysis of 25 patients (OM group: n = 14; exoscope group: n = 11) revealed no significant differences in age, sex, etiology, or surgical site between the two groups. Surgical time, number of incisions, and number of anastomoses showed nonsignificant variations between the OM and exoscope groups. Ergonomic assessments indicated potential benefits with exoscope use, particularly for the assistant surgeon. Survey results demonstrated comparable levels of surgeon satisfaction with both instruments, with no significant differences in image quality, contrast, illumination, magnification, visual field, ergonomic maintenance, or stereoscopic orientation. Conclusions: The study suggests that 3D exoscopes are a valuable tool for sLVA supermicrosurgery, offering comparable outcomes to traditional microscopes with potential ergonomic advantages. Their integration into microsurgical practice may contribute to improved surgical comfort and team performance. Further research is warranted to confirm these findings and explore additional factors such as cost-effectiveness and long-term patient outcomes.
Clinical and Hemodynamic Outcomes with Enalapril Orodispersible Minitablets in Young Children with Heart Failure Due to Congenital Heart Disease
Authors: Bijelic Maja , Djukic Milan , Vukomanovic Vladislav , Parezanovic Vojislav , Lazic Milica , Pavlovic Andrija , Popovic Sasa , Parezanovic Miro , Stefanovic Igor , Djordjevic Stefan , Ninic Sanja , Prijic Sergej , Bozic Cvijan Bojana , Jovanovic Ida , Bajcetic Milica ,   LENA Study
Published: August 2024

Background: The angiotensin-converting enzyme inhibitor (ACEI) enalapril is often administered to infants and young children with heart failure (HF) in various dosing regimens and formulations not adapted for their age. Methods: This prospective, two-center, open-label 8-week study evaluated an age-appropriate formulation of orodispersible minitablets (ODMTs) of enalapril (0.25 mg and 1 mg) in children aged 0 to 6 years with HF due to congenital heart disease. An age/weight-based dosing schedule was followed. Measures of echocardiographic parameters, blood pressure, heart rate, modified Ross score, and biochemistry were obtained over the 8-week period. The following two groups were assessed: ACEI-naïve and ACEI-pretreated patients. Results: In total, 53 children (age range of 0.05 to 4.8 years) were enrolled and 29 were ACEI-naïve. The average enalapril dose was 0.098 mg/kg (0.06–0.17 mg/kg) in the naïve group and 0.15 mg/kg (0.07–0.3 mg/kg) in pretreated patients. After 8 weeks, the modified Ross score and left ventricular diastolic dimension (LVD) z-score showed a significant decrease in both groups (p < 0.005). During 8 weeks follow-up, there were no difference in the z-scores for the systolic blood pressure (p = 0.071) or heart rate (p = 0.146). Conclusions: Pediatric patients treated with ODMTs of enalapril for 8 weeks had favorable improvements in LVD and HF symptoms.
Exploration of Choroidal Thinning Located Temporal to the Fovea: A Pilot Study
Authors: Ehongo Adèle , Jawdat De Togme Georgina , De Maertelaer Viviane
Published: August 2024

Background/Objectives: Posterior staphyloma (PS) is a hallmark of pathological myopia, corresponding to a circumscribed outpouching of the eyeball with choroidal thinning and inward scleral deformation at its edges. Its pathogenesis is still unclear, thus constituting a research priority as the prevalence of myopia is increasing worldwide. Recently, it has been suggested that the optic nerve sheaths or oblique muscles are potential promoters of PS through the traction or compression effect that they apply to the eye wall. The inferior oblique muscle (IOM) inserts 1–2 mm from the macula. The projection of its insertion is accessible using Optical Coherence Tomography (OCT). Before launching prospective studies, we sought to detect any choroidal thinning (ChT) in the temporal vicinity of the macula and to measure the distance between it and the fovea (FT-distance). Methods: This retrospective cross-sectional pilot study included 120 eyes. Using Spectralis®-OCT, the area centered by the Bruch’s membrane opening–fovea axis was analyzed for ChT and FT-distance. Results: Of the 112 defined eyes, 70% (78 eyes) had ChT. Pachymetry was significantly thinner (p = 0.018) in eyes with than without ChT. The mean FT-distance was 3601.9 ± 93.6 µm. Conclusions: The location of ChT coincided with the insertion distance of the IOM, suggesting a link between them. The association between the presence of ChT and a thinner pachymetry suggests a reduced scleral resistance, as a thinner pachymetry is related to a thinner sclera. Our results suggest a link between ocular deformation and the IOM, which may be relevant for the pathogenesis of PS, warranting further investigation.