bluuebunny/crossref_metadata_2025 huggingface dataset:
A New SDM-Based Approach for Assessing Climate Change Effects on Plant–Pollinator Networks
Authors: Rahimi Ehsan , Jung Chuleui
Published: October 2024

Current methods for studying the effects of climate change on plants and pollinators can be grouped into two main categories. The first category involves using species distribution models (SDMs) to generate habitat suitability maps, followed by applying climate change scenarios to predict the future distribution of plants and pollinators separately. The second category involves constructing interaction matrices between plants and pollinators and then either randomly removing species or selectively removing generalist or specialist species, as a way to estimate how climate change might affect the plant–pollinator network. The primary limitation of the first approach is that it examines plant and pollinator distributions separately, without considering their interactions within the context of a pollination network. The main weakness of the second approach is that it does not accurately predict climate change impacts, as it arbitrarily selects species to remove without knowing which species will truly shift, decline, or increase in distribution due to climate change. Therefore, a new approach is needed to bridge the gap between these two methods while avoiding their specific limitations. In this context, we introduced an innovative approach that first requires the creation of binary climate suitability maps for plants and pollinators, based on SDMs, for both the current and future periods. This step aligns with the first category of methods mentioned earlier. To assess the effects of climate change within a network framework, we consider species co-overlapping in a geographic matrix. For this purpose, we developed a Python program that overlays the binary distribution maps of plants and pollinators, generating interaction matrices. These matrices represent potential plant–pollinator interactions, with a ‘0’ indicating no overlap and a ‘1’ where both species coincide in the same cell. As a result, for each cell within the study area, we can construct interaction matrices for both the present and future periods. This means that for each cell, we can analyze at least two pollination networks based on species co-overlap. By comparing the topology of these matrices over time, we can infer how climate change might affect plant–pollinator interactions at a fine spatial scale. We applied our methodology to Chile as a case study, generating climate suitability maps for 187 plant species and 171 pollinator species, resulting in 2906 pollination networks. We then evaluated how climate change could affect the network topology across Chile on a cell-by-cell basis. Our findings indicated that the primary effect of climate change on pollination networks is likely to manifest more significantly through network extinctions, rather than major changes in network topology.
Outcomes of Elongated Styloid Process Syndrome Treated with Minimally Invasive Cervical Styloidectomy (MICS)—A Single-Center Retrospective Study
Authors: Bargiel Jakub , Gontarz Michał , Gąsiorowski Krzysztof , Marecik Tomasz , Wyszyńska-Pawelec Grażyna
Published: October 2024

Background: Stylohyoid syndrome, also known as classical Eagle syndrome (ES), is a rare condition characterized by elongation of the styloid process (SP) or calcification of the stylohyoid chain, presenting numerous non-specific symptoms. Most papers concerning this rare condition are case reports, case studies, or retrospective studies. This retrospective study delves into the intricacies of Eagle syndrome and evaluates surgical outcomes in patients treated with minimally invasive cervical styloidectomy (MICS). Methods: We conducted a retrospective study of patients treated due to ES between September 2021 and August 2023. Ninety-seven patients were qualified for MICS. Evaluation before and after surgical treatment was conducted during follow-up visits and by a questionnaire that included various data, such as symptoms, pain intensity, evaluation of healing period, and overall patient satisfaction. The minimum follow-up period was six months. Results: After applying inclusion and exclusion criteria, eighty-four patients were qualified for further assessment. The most common symptoms that subsided completely after treatment were pharyngeal foreign body sensation and pain with dysphagia or odynophagia. The MICS procedure proved to be highly effective, with 94.2% of patients experiencing a significant reduction in pain intensity and 97.1% reporting overall success. All patients were satisfied with the aesthetic outcome of the scar. The length of SP and time onset from the first symptoms to treatment positively correlated with the number, intensity, and time required for symptoms to subside. Conclusions: Eagle syndrome should be considered in diagnosing patients with orofacial and cervical pain symptoms, as the time from occurrence of the first symptoms to treatment is crucial. MICS is highly effective and has a low rate of complications in treating ES. Potential scar formation should not be a significant factor when deciding between the intraoral and external approaches.
Effect of Glucagon-like Peptide-1 Receptor Agonism on Aortic Valve Stenosis Risk: A Mendelian Randomization Analysis
Authors: Karakasis Paschalis , Patoulias Dimitrios , Giannakoulas George , Sagris Marios , Theofilis Panagiotis , Fragakis Nikolaos , Biondi-Zoccai Giuseppe
Published: October 2024

Background: Aortic valve repair is currently the only effective treatment for calcific aortic valve stenosis (CAVS), as no pharmacological therapies exist to prevent or slow its progression. Recent promising results showed that glucagon-like peptide-1 (GLP-1) attenuates the calcification of aortic valve interstitial cells. Therefore, we conducted a two-sample Mendelian randomization analysis to investigate the effect of GLP-1 receptor agonism (GLP-1Ra) on the risk of CAVS. Methods: The inverse variance weighted (IVW) method was used to obtain the primary causal inference, and several sensitivity analyses, including MR-Egger, were performed to assess the robustness of the results. Results: Based on the IVW estimates, the GLP-1Ra showed a neutral effect on the risk of CAVS (odds ratio [OR] per 1 mmol/mol decrease in glycated hemoglobin = 0.87, 95% CI = [0.69, 1.11], p = 0.259; I2 = 4.5%, Cohran’s Q = 2.09, heterogeneity p = 0.35; F statistic = 16.8). A non-significant effect was also derived by the sensitivity analyses. No evidence of horizontal pleiotropy was identified. Conclusions: GLP-1Ra was not significantly associated with the risk of CAVS. Furthermore, pragmatically designed studies are required to evaluate the effect of GLP-1Ra on the clinical course of CAVS in different patient subgroups.
Monocyte Count as a Predictor of Major Adverse Limb Events in Aortoiliac Revascularization
Authors: Pereira-Neves António , Dias Lara , Fragão-Marques Mariana , Vidoedo José , Ribeiro Hugo , Andrade José Paulo , Rocha-Neves João
Published: October 2024

Background/Objectives: Atherosclerosis is a leading cause of death, especially in the developed world, and is marked by chronic arterial inflammation and lipid accumulation. As key players in its progression, monocytes contribute to plaque formation, inflammation, and tissue repair. Understanding monocyte involvement is crucial for developing better therapeutic approaches. The objective of this study is to assess the prognostic value of monocytes for limb-related outcomes following revascularization for complex aortoiliac lesions, thereby emphasizing the central role of monocytes in atherosclerosis. Methods: This prospective cohort study-enrolled patients who had undergone elective aortoiliac revascularization at two hospitals between January 2013 and December 2023. Patients with TASC II type D lesions were included, excluding those with aneurysmal disease. Demographic, clinical, and procedural data were gathered, and patients were monitored for limb-related outcomes. Preoperative complete blood counts were analyzed, and statistical analyses, including multivariable Cox regression, were conducted to identify predictors of major adverse limb events (MALE). Results: The study included 135 patients with a mean age of 62.4 ± 9.20 years and predominantly male (93%). Patients were followed for a median of 61 IQR [55.4–66.6] months. Smoking history (91%) was the most prevalent cardiovascular risk factor. Preoperative monocyte count >0.720 × 109/L was associated with worse 30-day limb-related outcomes (MALE: OR 7.138 95% CI: 1.509–33.764, p = 0.013) and long-term outcomes, including secondary patency (p = 0.03), major amputation (p = 0.04), and MALE (p = 0.039). Cox regression analysis confirmed an elevated monocyte count as an independent predictor of MALE (adjusted hazard ratio 2.149, 95% CI: 1.115–4.144, p = 0.022). Conclusions: This study demonstrated that patients with a higher absolute monocyte count may be more exposed to the risk of MALE in patients with aortoiliac TASC II type D lesions undergoing revascularization, with predictive accuracy in both the short and long term. Additionally, it was an independent predictor of major amputation. This new marker has the potential to serve as a cost-effective and easily available tool for risk stratification, helping identify patients at higher risk of MALE.
Association of High-Risk Obstructive Sleep Apnea with Artificial Intelligence-Guided, CT-Based Severity Scores in Patients with COVID-19 Pneumonia
Authors: Atceken Zeynep , Celik Yeliz , Atasoy Cetin , Peker Yüksel
Published: October 2024

Background: We have previously demonstrated that high-risk obstructive sleep apnea (HR-OSA), based on a modified Berlin Questionnaire (mBQ), is linked to worse clinical outcomes. Chest computed tomography (CT) imaging with the implementation of an artificial intelligence (AI) analysis program has been a valuable tool for the speedy assessment of huge numbers of patients during the COVID-19 epidemic. In the current study, we addressed how the severity of AI-guided, CT-based total opacity ratio (TOR) scores are associated with high-risk OSA and short-term outcomes in the same cohort. Methods: The ratio of the volume of high opacity areas to that of the total lung volume constituted the TOR. We arbitrarily applied thresholds of <5 (no or mild TOR), ≥5 and <15 (moderate TOR), and ≥15 (severe TOR). Results: In total, 221 patients were included. HR-OSA was observed among 11.0% of the no or mild TOR group, 22.2% of the moderate TOR group, and 38.7% of the severe TOR group (p < 0.001). In a logistic regression analysis, HR-OSA was associated with a severe TOR with an adjusted odds ratio of 3.06 (95% confidence interval [CI] 1.27–7.44; p = 0.01). A moderate TOR predicted clinical worsening with an adjusted hazard ratio (HR) of 1.93 (95% CI 1.00–3.72; p = 0.05) and a severe TOR predicted worsening with an HR of 3.06 (95% CI 1.56–5.99; p = 0.001). Conclusions: Our results offer additional radiological proof of the relationship between HR-OSA and worse outcomes in patients with COVID-19 pneumonia. A TOR may also potentially indicate the individuals that are at higher risk of HR-OSA, enabling early intervention and management strategies. The clinical significance of TOR thresholds needs further evaluation in larger samples.
Assessing the Efficacy of Lokomat Training in Pediatric Physiotherapy for Cerebral Palsy: A Progress Evaluation
Authors: Błażkiewicz Michalina , Hadamus Anna
Published: October 2024

Background: Gait disturbances in children with cerebral palsy can increase the hindrance caused by loss of independence and social engagement. The Lokomat, developed by Hocoma, shows promise as a supplementary tool for gait rehabilitation. This study investigates the impact of Lokomat training on gait parameters and trends observed during training. Methods: A total of 26 children (13 male individuals) with a diagnosis of cerebral palsy (CP), aged 4 to 23 years, were enrolled in the study. Patients participated in a standard comprehensive rehabilitation program with additional Lokomat training sessions. Gait function was assessed using the Timed Up and Go Test (TUG) and the 10 m walking test (10mWT) at the beginning and end of the rehabilitation period. Changes in Lokomat parameters (step number, session duration, speed, body weight support, and guidance force) were also analysed. Results: The median duration of the 10mWT and TUG significantly decreased across the groups after the treatment program. The highest increases were observed for the number of steps taken. Across the entire cohort, the linear trend curves for distance and number of steps exhibited near-perpendicular alignment with the horizontal axis, suggesting significant improvement in these parameters. A consistent trend was noted for speed, with the trend line aligned parallel with the horizontal axis. Decreasing trends were observed for body weight support and guidance force. Conclusions: Therapy with the Lokomat functioning as the active gait orthosis can be used as a form of support to the standard rehabilitation protocol for patients with CP.
Outcome of Centenarians with Hip Fracture: An Analysis of the Registry for Geriatric Trauma (ATR-DGU)
Authors: Pass Bastian , Knobe Matthias , Schmidt Hannah , Bliemel Christopher , Aigner Rene , Liener Ulrich , Lendemans Sven , Schoeneberg Carsten , Boekeler Ulf ,   Registry for Geriatric Trauma (ATR-DGU)
Published: October 2024

Background/Objectives: Outcomes for hip fracture patients have improved over the years, yet the population of older patients (≥80 years) continues to grow. By 2100, the global centenarian population is projected to exceed 25 million, but data on hip fracture outcomes in this group are rare and often derived from small samples. This study aimed to analyze outcomes for centenarian hip fracture patients in specialized geriatric trauma centers and compare them with those of patients under 80. Methods: We conducted a retrospective analysis of the AltersTraumaRegister DGU® from 2016 to 2022, including all proximal femur fracture data. Patients were categorized into two groups: under 80 years and centenarians. The primary outcome was in-hospital mortality, with secondary outcomes including quality of life, walking ability on postoperative day seven, length of hospital stay, readmission rates, and changes in living situations. Results: Among 14,521 patients, 316 were over 99 years old. In-house mortality was significantly higher in centenarians (15.44% vs. 3.58%; p < 0.001), with more discharged to nursing homes. After matching by the Geriatrics at Risk (GeRi) score, mortality differences diminished. Conclusions: While age is a risk factor for mortality, centenarian hip fracture patients’ outcomes do not significantly differ from those aged ≤80 when considering other risk factors.
Clinical and Sociodemographic Profile, Self-Care, Adherence and Motivation for Treatment, and Satisfaction with Social Support in Portuguese Patients with Type 2 Diabetes
Authors: Regufe Virginia M. G. , Lobão Manuel A. , Cruz-Martins Natália , Luís Carla , von Hafe Pedro , Pinto Cristina B.
Published: October 2024

Objective: This study aimed to characterize the sociodemographic and clinical profiles of Portuguese patients with type 2 diabetes mellitus (T2DM) and to assess their self-care practices, treatment adherence, motivation, and satisfaction with social support. Methods: A cross-sectional observational study was conducted at an endocrinology unit in northern Portugal from January 2021 to December 2022. The sample included 303 adult patients with T2DM who provided informed consent. Data were collected using a structured questionnaire addressing sociodemographic, clinical, and self-care aspects. Validated scales were used to assess diabetes knowledge, self-care activities, treatment adherence, motivation, and social support. Results: Of the 303 patients enrolled, with a median age of 67 years, 51.2% were female and 68.2% retired. Clinical measures showed a median systolic blood pressure of 135 mmHg, abdominal circumference of 104.6 cm, and BMI of 29.3 kg/m2. Self-care practices were suboptimal, with only 25.1% of patients consistently following a healthy diet, and 31% engaged in weekly physical activity. Although treatment adherence was generally high, issues like forgetfulness were reported. Satisfaction with social support varied, with 30% of patients feeling isolated. Conclusions: The study identifies significant gaps in diet and physical activity adherence among T2DM patients. There is a need for targeted educational interventions and enhanced support systems to improve self-care and treatment outcomes. Personalized care strategies addressing educational, motivational, and social support factors are crucial to better managing T2DM and improving patient well-being.
Dyadic Effects of Attachment on Illness Acceptance in Patients with Breast Cancer and Spousal Caregivers: Sense of Coherence as a Mediator
Authors: Krok Dariusz , Telka Ewa , Moroń Marcin
Published: October 2024

Background: Attachment styles have been found to play a significant role in adjustment to cancer. Couples often cope with breast cancer through an interdependent approach to the disease rather than just acting as individuals, and a sense of coherence is an important factor that influences these relationships. This study examined how attachment styles and sense of coherence impact illness acceptance in couples facing breast cancer within a dyadic perspective. Methods: Data were analyzed from 145 women with recently diagnosed breast cancer and their 145 partners, who attended clinic appointments related to medical treatment. They completed self-report measures of attachment, sense of coherence, and illness acceptance. Results: Higher secure attachment and low insecure attachment scores were associated with a higher sense of coherence and better illness acceptance both in women and partners. Results of actor–partner interdependence mediation models indicated that most associations between attachment styles and illness acceptance were mediated by sense of coherence within both intrapersonal (actor–actor) and interpersonal (actor–partner) effects. Conclusions: The interdependence in attachment and sense of coherence brought noticeable benefits to couples’ illness acceptance when facing breast cancer. In line with the salutogenic model, these relationships predominantly depended on the mediational function of comprehensibility, manageability, and meaningfulness, which determined cognitive and emotional reactions that influenced both patients’ and spouses’ acceptance of the disease.
Impact of Remote Dielectric Sensing on Predicting Worsening Heart Failure During Hospitalization for Heart Failure
Authors: Imamura Teruhiko , Nomoto Yu , Izumida Toshihide , Narang Nikhil , Kinugawa Koichiro
Published: October 2024

Background: A remote dielectric sensing (ReDS) system quickly quantifies pulmonary congestion. Nonetheless, its efficacy in predicting an in-hospital increase in plasma B-type natriuretic peptide levels, the potential surrogate of worsening heart failure, remains undetermined. Methods: Patients who underwent ReDS measurement on admission during their hospitalization in the general wards for heart failure between 2021 and 2022 were eligible. The impact of the baseline ReDS value, completely blinded to the attending clinicians, on the in-hospital increase in plasma B-type natriuretic peptide levels of >100 pg/mL from index admission was evaluated. Results: A total of 147 patients admitted with acute-on-chronic heart failure (median age: 79 years; 76 men) were included. The median ReDS value on admission was 28% (25%, 34%). Eighteen patients experienced the primary outcome: plasma B-type natriuretic peptide levels increasing from 461 (207, 790) pg/mL (baseline) to 958 (584, 1290) pg/mL (maximum) (p < 0.001). The ReDS value on admission was an independent predictor of the primary outcome, with an adjusted odds ratio of 1.07 (95% confidence interval: 1.01–1.14; p = 0.028) with an optimal cutoff of 32%. Conclusions: The ReDS system could be a promising tool for predicting in-hospital worsening heart failure in patients hospitalized for heart failure when measured upon admission. The clinical implication of ReDS-guided management of heart failure during index hospitalization requires further studies.
A Decade-Long Retrospective Study of Factors Influencing Survival in Ruptured Abdominal Aortic Aneurysm
Authors: Kalender Günay , Weissmann Thomas , Dinç Ugur
Published: October 2024

Background: Ruptured abdominal aortic aneurysm (rAAA) carries a high mortality risk, requiring rapid diagnosis and intervention. This study assesses various clinical factors influencing rAAA management outcomes in alignment with evolving guidelines from 2011 to 2024. Methods: A retrospective analysis of 62 rAAA patients treated at Vivantes Clinic, Berlin, from July 2014 to May 2024 was conducted. Data were obtained from medical records, focusing on vital parameters at admission and during treatment. Both numerical and categorical variables were analyzed to identify survival determinants. Results: The overall survival rate was 55%. Significant differences in systolic and diastolic blood pressures during surgery were noted between survivors and non-survivors, with lower pressures observed in non-survivors at critical surgical stages. Other vital signs showed no significant variations. Survival was significantly associated with gender, fluid therapy, and aneurysm location. Conclusions: Effective blood pressure management during surgery is crucial for improving survival in rAAA cases. This study emphasizes adherence to current clinical guidelines and highlights the need for ongoing research to fill existing knowledge gaps. Further investigations are essential to enhance patient care and outcomes in rAAA.
Harnessing Virtual Reality: Improving Social Skills in Adults with Autism Spectrum Disorder
Authors: Calderone Andrea , Militi Angela , Latella Desirèe , De Luca Rosaria , Corallo Francesco , De Pasquale Paolo , Quartarone Angelo , Maggio Maria Grazia , Calabrò Rocco Salvatore
Published: October 2024

Background and Objectives: Autism Spectrum Disorder (ASD) involves challenges in social communication and daily functioning. Emerging research highlights that virtual reality (VR) interventions can significantly improve social skills in adults with ASD by providing immersive, controlled practice environments. This systematic review will assess the effectiveness of VR-based interventions for improving social skills in adults with ASD. Materials and Methods: Studies were identified from an online search of PubMed, Web of Science, Cochrane Library, and Embase databases without any search time range. This review was registered on Open OSF (n) P4SM5. Results: Recent studies show that VR interventions significantly enhance job interview skills, social abilities, and practical tasks in adults with ASD, with improvements in confidence, social understanding, and everyday skills. VR has been shown to be user-friendly and effective in providing immersive, adaptable training experiences. Conclusions: The review highlights VR’s promising role in improving social skills, job interview abilities, and daily functioning in adults with ASD. It emphasizes the need for broader studies, standardized interventions, and exploration of VR’s integration with other therapies to enhance long-term effectiveness and address comorbidities like anxiety and depression.
The Controversial Role of Glucocorticoids in Atheroembolic Renal Disease: A Narrative Review
Authors: Pacchiarini Maria Chiara , Di Mario Francesca , Greco Paolo , Fiaccadori Enrico , Rossi Giovanni Maria
Published: October 2024

Cholesterol crystal embolism (CCE) is an underrecognized multisystemic disease caused by the displacement of cholesterol crystals from atheromatous aortic plaques to distal vascular beds, leading to ischemic injury of target organs, particularly the kidneys, i.e., atheroembolic renal disease (ARD). According to recent research, cellular necrosis, induced by crystal-induced cytotoxicity, enhances the autoinflammatory cascade of the NLPR3 inflammasome, leading in turn to the so-called “necroinflammation”. The purported involvement of the latter in CCE offers a rationale for the therapeutic approach with anti-inflammatory drugs such as glucocorticoids, the use of which has long been a matter of debate in CCE. Diagnostic delay and no consistent evidence regarding efficacious treatment, leading to inconsistency in clinical practice, may worsen the already poor prognosis of ARD. The possible role of glucocorticoids in the treatment of ARD is thereby herein explored in a narrative fashion, analyzing the limited data from case reports and clinical trials.
Investigation of Radiation Exposure of Medical Staff During Lateral Fluoroscopy for Posterior Spinal Fusion Surgery
Authors: Watanabe Seiya , Nakanishi Kazuo , Mura Masakatsu , Yutori Ato , Hitomi Go , Uchino Kazuya , Iba Hideaki , Sugimoto Yoshihisa , Mitani Shigeru
Published: October 2024

Background/Objectives: In spinal surgery, it is especially crucial to insert implants in the correct location. Intraoperative fluoroscopy is often necessary to safely perform spinal surgery because of serious complications that can occur if the screw deviates. However, the use of intraoperative fluoroscopy comes at the cost of radiation exposure to the surgeons and operating room staff. Therefore, it is desirable for spinal surgeons to understand the characteristics of radiation in order to minimize patient and medical staff exposure. This study aimed to create an aerial radiation dose distribution map for lateral fluoroscopy, a commonly used technique for posterior spinal fusion. Methods: A human body-equivalent phantom was placed in a prone position on the Jackson Table. The measurement method used was a lateral fluoroscopic evaluation, assuming posterior spinal fusion. Measurements were taken at three levels: 80 (gonadal), 100 (thoracoabdominal), and 150 cm (lens and thyroid). Results: The highest radiation doses were received by primary surgeons. The scrub nurse was the next most exposed. Conclusions: We developed an aerial dose distribution map for lateral fluoroscopy in posterior spinal fusion. Radiation exposure was the highest among primary surgeons.
Melanoma in Adolescents and Young Adults (AYAs): An Italian Multi-Centric Retrospective Experience
Authors: Valenti Mario , D’Arino Andrea , Melis Enrico , Carugno Andrea , Sena Paolo , Frascione Pasquale , Cota Carlo , Piscazzi Francesco , Mercuri Santo Raffaele , Russo Vincenzo , Damiano Giuseppe , Bulotta Alessandra , Marzano Angelo Valerio , Mattioli Maria Alessandra , Borroni Riccardo G , Narcisi Alessandra , Costanzo Antonio , Ardigò Marco , Paolino Giovanni
Published: October 2024

Background: Melanoma is currently the most prevalent malignant neoplasm among adults and represents the second most common cancer in both sexes among individuals aged 0 to 39 years. This retrospective multicenter study delves into the distinctive clinical, anamnestic, histopathologic, and prognostic attributes of melanoma in Adolescent and Young Adults (AYA), defined as patients diagnosed at ≤40 years, across four Italian centers. Methods: Through a computer-based review of clinical records from 1 January 2010 to 30 September 2023, AYA melanomas were contrasted with non-AYA melanomas (>40 years) among 1452 patients. Data on demographics, melanoma localization, histological type, Breslow thickness, ulceration, and sentinel lymph node (SLN) biopsy status were meticulously collected and analyzed. Results: Our analysis revealed a female predominance in the AYA group and a male predominance in the non-AYA group, with significant differences in anatomical localization and histological types between the two. AYA melanomas showed nearly equal trunk and limb involvement, contrasting with the trunk predominance in non-AYA melanomas. While Breslow thickness was similar across both groups, the presence of ulceration and total number of nevi showed no significant difference. Survival analysis indicated a marginally higher Disease-Free Survival (DFS) in AYA patients compared to non-AYA patients, without a significant difference in Overall Survival (OS). Conclusions: This study highlights demographic and clinical distinctions between AYA and non-AYA melanoma patients, underscoring the need for tailored follow-up and treatment strategies. Despite these insights, the heterogeneity of melanoma among young adults calls for further research, including genetic analyses, to fully understand this unique melanoma subgroup. Indeed, AYA melanoma patients could represent a different and specific target for both follow-up and treatments.
Mini-Invasive Thoracic Surgery for Early-Stage Lung Cancer: Which Is the Surgeon’s Best Approach for Video-Assisted Thoracic Surgery?
Authors: Trabalza Marinucci Beatrice , Siciliani Alessandra , Andreetti Claudio , Tiracorrendo Matteo , Messa Fabiana , Piccioni Giorgia , Maurizi Giulio , D’Andrilli Antonio , Menna Cecilia , Ciccone Anna Maria , Vanni Camilla , Argento Giacomo , Rendina Erino Angelo , Ibrahim Mohsen
Published: October 2024

Objectives: The choice of the best Video-Assisted Thoracic Surgery (VATS) surgical approach is still debated. Surgeons are often faced with the choice between innovation and self-confidence. The present study reports the experience of a high-volume single institute, comparing data of uni-portal, bi-portal and tri-portal VATS, to find out the safest and most effective mini-invasive approach, leading surgeon’s choice. Methods: Between 2015 and 2022, a total of 210 matched patients underwent VATS lobectomy for early-stage cancer, using uni-portal (fifth intercostal space), bi-portal (seventh space for optic and the fifth), and tri-portal (seventh and the fifth/four) access. Patients were matched for age, BPCO, smoke, comorbidities, lesions (size and staging) to obtain three homogenous groups (A: uni-portal; B: bi-portal; C: tri-portal). The surgeons had comparable expertise. Data were retrospectively collected from institutional database and analyzed. Results: No differences were detected considering time of surgery, length of hospital stay, complications, conversion rate, specific survival, and days of chest tube length of stay. Better results on chest tube removal were described in group A (mean 1.1 days) compared to B (mean 2.6 days) and C (mean 4.7 days); nevertheless, they not statistically significant (p = 0.106). Conclusions: No significant differences among the groups were described, except for the reduction in chest tube permanence in group A. This allows to hypothesize an enhanced recovery after surgery in this group but the different approaches in this series seem to guarantee comparable safety and effectiveness. Considering no superiority of one method above the others, the best suggested approach should be the one for which the surgeon feels more confident.
Thoughts on Self-Harm in Polish Pregnant and Postpartum Women During the Pandemic Period
Authors: Sioma-Markowska Urszula , Motyka Róża , Krawczyk Patrycja , Waligóra Karolina , Brzęk Anna
Published: October 2024

Background: The risk of depression during pregnancy and postpartum is high and has intensified during the COVID-19 pandemic. The aim of this study was to estimate the risk of depressive disorders and self-harm thoughts in the third trimester of pregnancy and the first week postpartum in the pandemic period. Methods: This study involved a total of 317 pregnant and postpartum women. The risk and severity of depressive disorders and the prevalence of self-harm thoughts in women during the perinatal period were assessed using EPDS. Results: Pregnant women were significantly more likely to have higher EPDS scores compared to postpartum women. Mild depressive symptoms were reported by 22.08% of pregnant women and 17.18% of postpartum women, and severe symptoms were observed in 25.97% of pregnant women and 16.56% of postpartum women. Thoughts of self-harm were reported by 11.69% of pregnant women and 17.79% of postpartum women. Self-harm thoughts were significantly more common among pregnant women: multiparous women, pregnant women who received psychiatric treatment before pregnancy, those diagnosed with depressive disorders, those who suffered from prolonged periods of anxiety and sadness, and those lacking a supportive person. Among postpartum women, there were statistically significant differences in the prevalence of self-harm thoughts for place of residence, education, type of occupation, number of pregnancies, course of pregnancy, and presence of a supportive person. Conclusions: The increased prevalence of depressive symptoms and self-harm thoughts related to the COVID-19 pandemic highlights the urgent need for screening among pregnant women and the implementation of clinical interventions.
Initial Experience with the 4D Mini-TEE Probe in the Adult Population
Authors: Papadopoulos Konstantinos , Ikonomidis Ignatios , Coisne Augustin , Özden Kayhan Özge , Tzikas Apostolos , Fragakis Nikolaos , Antoniadis Antonios P. , Vannan Mani A , Donal Erwan
Published: October 2024

Background: Transesophageal echocardiography (TEE) is a vital diagnostic tool in clinical practice, particularly in transcatheter interventions where it aids in both pre-operative planning and intra-operative guidance. Traditional TEE probes often require general anesthesia due to patient discomfort. However, the development of miniaturized TEE probes presents a promising alternative, enabling routine examinations and interventions with minimal sedation. This study evaluates the feasibility of performing a complete 2D/4D TEE protocol with the new 4D mini-TEE probe in the echocardiography department and its application in transcatheter interventions. Methods: This is a retrospective study that included 30 consecutive patients from two high-volume European hospitals (Interbalkan Medical Center, Thessaloniki, Greece, and Rennes University, France) that underwent TEE or transcatheter interventions. The new 4D mini-TEE 9VT-D probe (GE Healthcare) was utilized. The quality of the images and the tolerance of the probe were assessed in the cath lab during interventions and in the echocardiography department during routine TEE examinations. Results: Direct comparison of the 4D mini-TEE probe with the standard 6VT-D probe confirmed the excellent image quality of this new pediatric probe. Most of the patients required minimal sedation or local oropharyngeal anesthesia, with satisfactory tolerance reported. Most of the transcatheter procedures did not require general anesthesia and intubation, resulting in shorter procedural time. Both 2D and 4D imaging modalities offered adequate intra-operative guidance for transcatheter procedures. Conclusions: The 4D mini-TEE probe delivers exceptional imaging capabilities for routine examinations and transcatheter interventions without needing sedation. Its use reduces esophageal trauma and the need for general anesthesia, enhancing patient comfort and safety.
Diagnostic Accuracy Performance of Fluorescence In Situ Hybridization (FISH) for Biliary Strictures: A Systematic Review and Meta-Analysis
Authors: Aggarwal Manik , Simadibrata Daniel M. , Kipp Benjamin R. , Prokop Larry J. , Barr Fritcher Emily G. , Schneider Amber , Cooley Matthew A. , Gores Gregory J. , Eaton John , Roberts Lewis R. , Chandrasekhara Vinay
Published: October 2024

Background and Aims: This systematic review and meta-analysis aims to compare the performance of UroVysion® FISH based on the different definitions of a positive result used in published literature with the goal of determining the optimal FISH definition for detecting pancreaticobiliary malignancy. Methods: A systematic literature search identified studies from database inception to Sept 2024 that evaluated the diagnostic performance of FISH in determining malignancy among patients with biliary strictures. All thresholds for positive FISH, as defined by the individual study, were included in this review. Subgroup analysis was performed based on the definitions of positive FISH as follows: (1) polysomy only; (2) polysomy, tetrasomy, or trisomy; and (3) polysomy or 9p deletion. Results: Eighteen studies comprising 2516 FISH specimens were analyzed, including 1133 (45.0%) with malignancy. Using a threshold for positivity as defined in individual studies, the overall sensitivity of FISH was 57.6% (95% confidence interval [CI], 49.4–65.4%), and the overall specificity was 87.8% (95% CI, 79.2–93.2%). Subgroup analysis showed that polysomy as the threshold for positive FISH yielded a sensitivity of 49.4% (95% CI, 43.2–55.5%), with an increased specificity of 96.2% (95% CI, 92.7–98.1%), while polysomy + tetrasomy/trisomy as positive FISH resulted in an increased sensitivity of 64.3% (95% CI 55.4–72.2%) but a decreased specificity of 78.9% (95% CI 64.4–88.5%). The addition of 9p deletion to polysomy as the criteria for a positive test resulted in a non-significant increase in sensitivity (54.7% (95% CI 42.4–66.5%) while maintaining specificity (95.1% (95% CI 84.0–98.6%). Conclusions: Based on these findings, polysomy only or polysomy/9p deletion should be considered as the criterion for defining a positive FISH test to improve diagnostic sensitivity while maintaining high specificity.
Trabecular Bone Score as a Complementary Tool for the Assessment of Bone Mineral Density in Patients with Asymptomatic Monoclonal Gammopathies
Authors: Drakoulidou Styliani , Ntanasis-Stathopoulos Ioannis , Kyritsi Aikaterini , Koutoulidis Vassilis , Malandrakis Panagiotis , Kanellias Nikolaos , Kastritis Efstathios , Dimopoulos Meletios A. , Gavriatopoulou Maria , Chalazonitis Athanasios , Terpos Evangelos
Published: October 2024

Background/Objectives: Monoclonal gammopathies, such as Monoclonal Gammopathy of Undetermined Significance (MGUS) and Smoldering Multiple Myeloma (SMM), are conditions marked by the overproduction of specific monoclonal proteins. Patients with these conditions are known to have a higher risk of fractures compared to the general population, yet there are no established guidelines for assessing or managing their skeletal health. The Trabecular Bone Score (TBS), which can be calculated from DXA images of the lumbar spine, provides additional insights into bone microarchitecture. Methods: This study aimed to determine whether TBS can serve as a supplementary tool in assessing bone loss in MGUS and SMM patients. Conducted from 2020 to 2023, the study involved 148 participants—74 diagnosed with a myeloma precursor state and 74 healthy controls—who underwent simultaneous DXA and TBS measurements. Results: The results indicated a weak positive correlation (R = 0.405) between DXA and TBS T-scores, suggesting that other factors may influence the measurements. When analyzed separately, the correlations remained weak for both MGUS (R = 0.250) and SMM (R = 0.485). Interestingly, discrepancies were noted in T-score classifications; for instance, a patient classified as normal via DXA could be deemed osteopenic or osteoporotic with TBS. Conclusions: Overall, the findings suggest that incorporating TBS alongside DXA can enhance the accuracy of bone density assessments, facilitating earlier diagnosis and treatment initiation for osteoporosis in asymptomatic patients with monoclonal gammopathies.
Comparison of Short-Term Outcomes of DSA and ALMIS Approach for Bipolar Cemented Hemiarthroplasty in Patients with Neck of Femur Fracture
Authors: Moussaoui Juliane , Hallbauer Jakob , Wilharm Arne , Marintschev Ivan , Hofmann Gunther Olaf , Weschenfelder Wolfram
Published: October 2024

Background/Objectives: A neck of femur (NOF) fracture is one of the most common fractures, and its treatment in the geriatric population using cemented bipolar hemiarthroplasty (HA) is a standard procedure worldwide. Various surgical approaches have been described for this operation, aiming to reduce complications and improve early mobilization. The present study compares two minimally invasive approaches, the anterolateral minimally invasive approach (ALMIS) and the direct superior approach (DSA), with respect to their intraoperative and early postoperative complications in cemented bipolar HA. Methods: The medical records of all patients undergoing cemented bipolar HA for a NOF fracture between January 2017 and December 2023 were analyzed. The aim of the study was to compare the two surgical approaches. The evaluation focused on intraoperative parameters and early complications. Results: A total of 226 patients were included in the analysis, with 62 undergoing DSA and 164 ALMIS, with an average age of 83.5 years. The two approaches did not differ significantly in terms of stem implantation quality, length of hospital or intensive care unit stay, postoperative mobilization, or the need for transfusions. However, the ALMIS was associated with a significantly shorter operative time (DSA: 89.7 min vs. ALMIS: 77.2 min; p < 0.01). On the other hand, the DSA had a significantly lower complication rate (DSA: 0/61 vs. ALMIS: 11/163; p = 0.04). Conclusions: In a comparison of the two minimally invasive approaches, DSA and ALMIS, for treating a NOF fracture with cemented bipolar HA, the DSA demonstrated a lower complication rate, though it had a slightly longer operating time.
The Significance of the Myocardial Performance Index and Fetal Doppler Abnormalities in Growth-Restricted Fetuses: A Systematic Review of the Literature
Authors: Czapska Agnieszka Helena , Kosińska-Kaczyńska Katarzyna
Published: October 2024

Introduction: This review aims to investigate the clinical implications of using the myocardial performance index (MPI), obtained through tissue Doppler imaging (TDI) and spectral Doppler, in assessing fetal cardiac function in growth-restricted fetuses. It explores the MPI’s potential in predicting adverse perinatal outcomes and its utility when combined with conventional pulsed-wave Doppler assessments for enhanced fetal well-being evaluations. Material and Methods: A systematic search of PubMed and Google Scholar databases spanning from 2004 to 2023 was conducted to identify pertinent articles on the MPI’s clinical application in managing growth-restricted fetuses. Inclusion criteria followed the Fetal Medicine Barcelona definition of fetal growth restriction (FGR) to mitigate study group heterogeneity. The research sources were PubMed and Google Scholar databases, and the review was conducted without any specific clinical or laboratory setting. Only articles meeting the inclusion criteria for FGR, as per the Fetal Medicine Barcelona definition, were considered. Six studies meeting these criteria were included in the review. The review analyzed the correlation between MPI values and conventional Doppler parameters, investigating the progression of myocardial function impairment and its association with the risk of fetal demise. The primary outcome measures included the relationship between MPI values, fetal well-being, and the potential for prenatal cardiac dysfunction in growth-restricted fetuses. Results: The findings indicate that as conventional Doppler parameters deteriorate, MPI values increase, suggesting progressive myocardial dysfunction. The MPI may cross the 95th percentile before abnormal flow in the ductus venosus and aortic isthmus, highlighting the potential for diastolic dysfunction preceding hypoxia in growth-restricted fetuses. Elevated MPI levels were observed in both growth-restricted and small-for-gestational-age (SGA) fetuses, indicating prenatal cardiac impairment. The strong association between an abnormal MPI and perinatal mortality has been shown for early FGR. Conclusions: MPI alterations appear to precede abnormal Doppler parameters in early- and late- onset FGR, potentially indicating diastolic dysfunction preceding hypoxia. Additionally, the MPI correlates with the risk of fetal demise. However, larger studies are needed to establish its sensitivity and specificity. Furthermore, the significance of prenatal cardiac impairment in some SGA fetuses raises questions about its potential impact on perinatal outcomes and cardiovascular programming.
Multi-Scale Characterization of Conventional and Immediate Dental Implant Systems
Authors: Mok Seeun , Naftulin Mori E. , Meirelles Luiz , Kim Minji , Liu Jie , Lee Christine H. , Emam Hany A. , Jatana Courtney A. , Chien Hua-Hong , Ko Ching-Chang , Kim Do-Gyoon
Published: October 2024

We hypothesized that the different post-implantation healing stages between the conventional and immediate implantations produce different amounts and tissue composition of the peri-implant bone. Thus, the objective of the current study was to examine whether the stability of dental implant systems is associated with characteristics of the interfacial bone area at different post-implanation healing periods. Mandibular molars were extracted from each beagle dog. After 10 weeks post-extraction, a screw-type titanium dental implant was placed in the molar location following a conventional dental implant (Con) procedure. Simultaneously, mandibular premolars were extracted and the same type of dental implant was placed in the distal site of the extracted premolar root following an immediate dental implant (Imm) procedure. The implant stability quotient (ISQ) values were not significantly different between Con and Imm groups at 0-, 3-, and 6-weeks post-implantation. However, 3D micro-computed tomography and 2D histological images confirmed that the Imm system had more gaps between the bone and implant than the Con system. On the other hand, the nanoindentation modulus value at the bone–implant interface was significantly higher for the Imm group than the Con group at both 3 weeks and 6 weeks post-implantation. The current results from multi-scale characterization suggest that the higher interfacial bone quality of the Imm system, despite its earlier post-implantation stage, plays a crucial role in maintaining stability comparable to that of the Con system.
Advancing Ton-Bag Detection in Seaport Logistics with an Enhanced YOLOv8 Algorithm
Authors: Qiu Xiulin , Zhang Haozhi , Yuan Chang , Liu Qinghua , Yao Hongzhi
Published: October 2024

Intelligent logistics and freight transportation is an important part of realizing the intelligence of port terminals. Due to the problems of inaccurate ton bag identification, high costs, large model sizes, and long computation times in traditional freight transportation—issues that hinder meeting real-time requirements on resource-constrained operational equipment—this paper proposes an improved lightweight ton bag detection algorithm, YOLOv8-TB (YOLOv8-Ton Bag), which is optimized based on YOLOv8. Firstly, the improved LZKAC module is introduced to combine with SPPF to form a new SPPFLKZ module, which improves the feature expression performance. Then, with reference to spatial and channel reconstruction convolution and deformable convolution, the C2f-SCTT block is designed for the backbone network, which reduces the spatial and channel redundancy between features in the network. Finally, the C2f-ORECZ block based on a linear scaling layer is designed for the neck, which reduces the training overhead and strengthens the feature learning of the feature extraction network for the targets in the complex background of the harbor and adds the 160 × 160 scale detection head to strengthen small target detection abilities. On the logistics ton bag operation dataset provided by shipping port enterprises, the improved algorithm improves by 3.7% and 5% compared with the original algorithm in mAP50 and mAP50-95, respectively, the model size is reduced by 4.42 MB and the amount of model computation is only 8 G, which is capable of accurately detecting logistics ton bags in real time. The superiority of the method is verified by comparing it with other classical target detection algorithms.