bluuebunny/crossref_metadata_2025 huggingface dataset:
Oral Function and Eating Habit Problems in People with Down Syndrome
Authors: Cañizares-Prado Sonia , Molina-López Jorge , Moya María Trinidad , Planells Elena
Published: February 2022

Background: Down syndrome (DS) is a genetic disorder in which there is an increased risk of developing clinical comorbidities that require regular attention: health problems, alterations in maxillomandibular development, chewing and swallowing problems, as well as dietary habits that may influence diet and nutritional status. This study will analyze the frequency of occurrence of these factors with increasing age in this population. Methods: A descriptive cross-sectional study was conducted with 18 participants aged 30–45 years. The condition of orofacial structures, chewing and swallowing function and oral and eating habits were assessed to observe the frequency of occurrence of these problems with increasing age. Results: A high frequency of digestive problems was observed. There was also a presence of problems in the introduction of new tastes and consistencies. In addition, unilateral chewing was reported in 100% of the participants, severe anatomical dysfunction of the mandible/maxilla and high hypotonicity reflected in tongue movements. Conclusions: it is necessary to educate, through specific intervention protocols, the younger generations with DS, as well as their environment, as harmful habits are developed in childhood and consolidated throughout life.
Relationships between Violence Experience, Resilience, and the Nursing Performance of Emergency Room Nurses in South Korea
Authors: Kim Sarang , Gu Minkyung , Sok Sohyune
Published: February 2022

In urgent situations where tensions and conflicts are amplified, emergency room nurses are vulnerable to violence and are exposed to dangerous situations because they are confronted by patients or caregivers. This study sought to examine the relationship between violence experience, resilience, and nursing performance among emergency room nurses in South Korea. A cross-sectional descriptive design was used. The study participants included 130 nurses working in the emergency room of a general hospital. Measures included the general characteristics list, the violence experience tool, the resilience tool, and the nursing performance tool. Data were collected from February to March 2021. In this study, among the forms of violence experienced by emergency room nurses, verbal violence was most prevalent. The violence experiences showed significant differences according to age, clinical experience, work experience in the emergency room, position, and job satisfaction. Resilience displayed significant differences according to marital status, clinical experience, position, average monthly salary, and job satisfaction. Nursing performance showed significant differences based on gender, age, marital status, clinical experience, work experience in the emergency room, position, average monthly salary, and job satisfaction. There was a positive correlation between resilience and nursing performance. This study suggests that emergency room nurses in Korea experienced more verbal violence than other types of violence. The violence experiences, resilience, and nursing performance showed significant differences according to the general and job-related characteristics of the study participants. Concrete strategies and interventions to reduce the frequency of experiences of verbal violence among emergency room nurses, increase their resilience, and improve the nursing performance of emergency room nurses are needed.
High-Risk Clone of Klebsiella pneumoniae Co-Harbouring Class A and D Carbapenemases in Italy
Authors: Del Rio Arcadia , Muresu Narcisa , Sotgiu Giovanni , Saderi Laura , Sechi Illari , Cossu Andrea , Usai Manuela , Palmieri Alessandra , Are Bianca Maria , Deiana Giovanna , Cocuzza Clementina , Martinelli Marianna , Calaresu Enrico , Piana Andrea Fausto
Published: February 2022

Background: Carbapenem-resistant Klebsiella pneumoniae (CR-Kp) is endemic globally, causing severe infections in hospitalized patients. Surveillance programs help monitor and promptly identify the emergence of new clones. We reported the rapid spread of a novel clone of K. pneumoniae co-harbouring class A and D carbapenemases in colonized patients, and the potential risk factors involved in the development of infections. Methods: Rectal swabs were used for microbiological analyses and detection of the most common carbapenemase encoding genes by real-time PCR (i.e., blaKPC, blaOXA-48, blaNDM, blaVIM, and blaIMP). All strains co-harbouring KPC and OXA-48 genes were evaluated. For each patient, the following variables were collected: age, sex, length and ward of stay, device use, and outcome. Clonality of CR-Kp was assessed by preliminary pulsed field gel electrophoresis (PFGE), followed by multi-locus sequence typing (MLST) analyses. Results: A total of 127 isolates of K. pneumoniae co-harbouring KPC and OXA-48 were collected between September 2019 and December 2020. The median age (IQR) of patients was 70 (61–77). More than 40% of patients were admitted to intensive care unit (ICU). Around 25% of patients developed an invasive infection, the majority of which were respiratory tract infections (17/31; 54.8%). ICU stay and invasive infection increased the risk of mortality (OR: 5.39, 95% CI: 2.42–12.00; OR 6.12, 95% CI: 2.55–14.69, respectively; p-value ≤ 0.001). The antibiotic susceptibility test showed a resistance profile for almost all antibiotics considered. Monoclonal origin was confirmed by PFGE and MLST showing a similar restriction pattern and belonging to ST-512. Conclusions: We report the spread and the marked antibiotic resistance profiles of K. pneumoniae strains co-producing KPC and OXA-48. Further study could clarify the roles of clinical and microbiological variables in the development of invasive infection and increasing risk of mortality, in colonized patients.
Long-Term Risk of Breast Cancer after Diagnosis of Benign Breast Disease by Screening Mammography
Authors: Román Marta , Louro Javier , Posso Margarita , Vidal Carmen , Bargalló Xavier , Vázquez Ivonne , Quintana María Jesús , Alcántara Rodrigo , Saladié Francina , del Riego Javier , Peñalva Lupe , Sala Maria , Castells Xavier ,   on behalf of the BELE and IRIS Study Groups
Published: February 2022

Assessing the long-term risk of breast cancer after diagnosis of benign breast disease by mammography is of utmost importance to design personalised screening strategies. We analysed individual-level data from 778,306 women aged 50–69 years with at least one mammographic screening participation in any of ten breast cancer screening centers in Spain from 1996 to 2015, and followed-up until 2017. We used Poisson regression to compare the rates of incident breast cancer among women with and without benign breast disease. During a median follow-up of 7.6 years, 11,708 (1.5%) women had an incident of breast cancer and 17,827 (2.3%) had a benign breast disease. The risk of breast cancer was 1.77 times higher among women with benign breast disease than among those without (95% CI: 1.61 to 1.95). The relative risk increased to 1.99 among women followed for less than four years, and remained elevated for two decades, with relative risk 1.96 (95% CI: 1.32 to 2.92) for those followed from 12 to 20 years. Benign breast disease is a long-term risk factor for breast cancer. Women with benign breast disease could benefit from closer surveillance and personalized screening strategies.
Using Illicit Drugs to Lose Weight among Recovering Female Drug Users in China: An Exploratory Qualitative Study
Authors: Liu Liu , Wang Xiaotao , Xie Yang , Chui Wing-Hong
Published: February 2022

The population of female drug users has been growing in China, and these women have been found to care deeply about their weight. Against this backdrop, this study examines the relationship between Chinese women’s illicit drug use and their intentions to lose weight, keep fit, and maintain a slim body shape. The participants of this study were 29 women who all had experience with illicit drug use for weight control. These women were drawn from a female compulsory drug treatment center located in eastern China. Semi-structured interviews with these 29 participants were conducted between 2013 and 2016. Expectations of losing weight and pursuing their ideal slim body shape were found to be an important reason for the study participants’ initiation of drug use, its maintenance, and failures to achieve abstinence. These Chinese female drug users were generally satisfied with weight loss outcomes subsequent to drug consumption. A fuller appreciation of Chinese women’s weight-loss-related illicit drug use patterns is much needed to help devise strategies and policies to deal with this growing problem. These include changing the dominant aesthetic cultural preference for thinness, paying particular attention to the functional use of illicit drugs in drug treatment programs, and having special interventions for women who interact with drug users within their social networks.
Using Distributed Lag Non-Linear Models to Estimate Exposure Lag-Response Associations between Long-Term Air Pollution Exposure and Incidence of Cardiovascular Disease
Authors: Kriit Hedi Katre , Andersson Eva M. , Carlsen Hanne K. , Andersson Niklas , Ljungman Petter L. S. , Pershagen Göran , Segersson David , Eneroth Kristina , Gidhagen Lars , Spanne Mårten , Molnar Peter , Wennberg Patrik , Rosengren Annika , Rizzuto Debora , Leander Karin , Yacamán-Méndez Diego , Magnusson Patrik K. E. , Forsberg Bertil , Stockfelt Leo , Sommar Johan N.
Published: February 2022

Long-term air pollution exposure increases the risk for cardiovascular disease, but little is known about the temporal relationships between exposure and health outcomes. This study aims to estimate the exposure-lag response between air pollution exposure and risk for ischemic heart disease (IHD) and stroke incidence by applying distributed lag non-linear models (DLNMs). Annual mean concentrations of particles with aerodynamic diameter less than 2.5 µm (PM2.5) and black carbon (BC) were estimated for participants in five Swedish cohorts using dispersion models. Simultaneous estimates of exposure lags 1–10 years using DLNMs were compared with separate year specific (single lag) estimates and estimates for lag 1–5- and 6–10-years using moving average exposure. The DLNM estimated no exposure lag-response between PM2.5 total, BC, and IHD. However, for PM2.5 from local sources, a 20% risk increase per 1 µg/m3 for 1-year lag was estimated. A risk increase for stroke was suggested in relation to lags 2–4-year PM2.5 and BC, and also lags 8–9-years BC. No associations were shown in single lag models. Increased risk estimates for stroke in relation to lag 1–5- and 6–10-years BC moving averages were observed. Estimates generally supported a greater contribution to increased risk from exposure windows closer in time to incident IHD and incident stroke.
Time for Re-Evaluating the Human Carcinogenicity of Ethylenedithiocarbamate Fungicides? A Systematic Review
Authors: Cocco Pierluigi
Published: February 2022

Background. In January 2021, the European Union ended the license of Mancozeb, the bestselling ethylenedithiocarbamate (EBDC) fungicide, because of some properties typical of human carcinogens. This decision contrasts the IARC classification of EBDC fungicides (Group 3, not classifiable as to human carcinogenicity). A systematic review of the scientific literature was conducted to explore the current evidence. Methods. Human and experimental studies of cancer and exposure to EBDC fungicides (Mancozeb, Maneb, Zineb, and others) and ethylene thiourea (ETU), their major metabolite, published in English as of December 2021, were retrieved using PubMed, the list of references of the relevant reports, and grey literature. Results. The epidemiological evidence of EBDC carcinogenicity is inadequate, with two studies each suggesting an association with melanoma and brain cancer and inconsistent findings for thyroid cancer. Experimental animal studies point at thyroid cancer in rats and liver cancer in mice, while multiple organs were affected following the long-term oral administration of Mancozeb. The mechanism of thyroid carcinogenesis in rats has also been shown to occur in humans. Genotoxic effects have been reported. Conclusions. The results of this systematic review suggest inadequate evidence for the carcinogenicity of EBDC fungicides from human studies and sufficient evidence from animal studies, with positive results on three out of ten key characteristics of carcinogens applying to humans as well. An IARC re-evaluation of the human carcinogenicity of EBDC fungicides is warranted.
Microbiology-Based Instruction during Prenatal Dental Visits Improves Perinatal Oral Health Literacy
Authors: Thomson Joshua J. , Relich Erin E. , Girdwood John R. , Byrappagari Divesh
Published: February 2022

To improve oral hygiene education, we evaluated the perception and potential impact of microbiology-focused oral hygiene instructions (OHI) given to pregnant patients. Dental hygienists provided this supplemental education and administered Saliva-Check Mutans (SCM) tests to pregnant patients (n = 188) in Obstetrics and Gynecology (OB/GYN) settings. Patients reported their self-perceived understanding of the relationship between oral bacteria and dental disease and returned postdelivery to receive a second SCM test and follow-up questionnaire (n = 47). Prior to the hygienist instruction, 84% of participants understood that bacteria caused tooth decay, while only 36% understood they could transfer these bacteria to their children. After instruction, patient understanding increased to 97% and 95%, respectively. Participants attributed these increases to the hygienist’s explanation and SCM test. In postdelivery participants, >80% reported adherence to routine oral hygiene practices, and a significant decrease in patients with high-risk levels of salivary Streptococcus mutans was determined by SCM test (p = 0.0253). Participants agreed that the SCM test (89%) and microbiology explanation (95%) should be provided to every pregnant patient. Evaluation of patient perception of this intervention highlights how focused instruction on the infectious nature of dental disease can increase perinatal oral health literacy. Microbiology-focused education should be given to pregnant patients to reduce oral health disparities.
A Three-Step Procedure for Emergency Cerclage: Gestational and Neonatal Outcomes
Authors: Gómez-Castellano Manuel , Sabonet-Morente Lorena , González-Mesa Ernesto , Jiménez-López Jesús S.
Published: February 2022

(1) Background: The objective of our prospective observational study was to evaluate a new technique for emergency cerclage, which was performed on a cohort of patients with cervical incompetence in the second trimester. (2) Methods: 26 pregnant women presented at 15 to 24 weeks of gestation with cervical dilatation and bursa prolapse. A new emergency cerclage was performed using a technique consisting of the first cerclage in a tobacco bag and a second occlusive cerclage located inferiorly to the first. The technique is concluded with the performance of a cervical cleisis when vaginal bag prolapse is present, and this overall procedure is called the three-step procedure for emergency cerclage (TSEC). (3) Results: To assess its effectiveness, we measured the latency from procedure to delivery, pregnancy duration, infant birth weight, and rate of premature amniorrhexis. The mean latency from procedure to delivery was 14 weeks + 6 days, the mean weight of newborns was 2550 g and the mean gestational age at delivery was 35 weeks. The neonatal survival rate was 95.8%. The rate of premature amniorrhexis (<34 weeks gestational age) was 8.3% (two cases) with successful perinatal outcomes. There were significant differences (p < 0.05) between groups. A multivariate regression model showed that the best variables for predicting the latency to delivery were the cervical dilatation at diagnosis, use of the three-step cerclage, cervical length after the procedure, and gestational age at diagnosis. (4) Conclusions: The excellent results obtained with the TSEC procedure in terms of the latency from the procedure to delivery, gestational age at delivery, birth weight, and having few reported complications highlight the importance of collecting new data on this promising novel procedure.
The Prevalence of Polypharmacy and Potentially Inappropriate Medications and Its Relationship with Cognitive Status in Portuguese Institutionalized Older Adults: A Cross-Sectional Study
Authors: Caçador Catarina , Teixeira-Lemos Edite , Oliveira Jorge , Pinheiro João , Teixeira-Lemos Luís , Ramos Fernando
Published: February 2022

The aim of this study was to evaluate the prevalence of polypharmacy and potentially inappropriate medications (PIMs) in a population of older adults living in nursing homes. Furthermore, we also intended to assess the possible association between polypharmacy, potentially inappropriate medications and cognitive impairment in institutionalized older adults. A cross-sectional study analyzed data from 193 nursing home residents in the district of Viseu, Portugal, between September 2018 and June 2019, with a mean age of 82.4 ± 6.2 years (ranging from 65 to 95 years old); 72.5% (n = 140) were female participants. Major polypharmacy was presented in 80.8% of the study population, who took 7.6 ± 3.3 drugs per day. Using the Beers Criteria, we found that 79.3% took PIMs. There was a positive association between polypharmacy and PIM (p < 0.001), showing that higher medicines intake increased the number of PIMs. Polypharmacy was not associated with the functionality of the older adults to perform activities of daily living, but was associated with cognitive impairment. The older adults with lower scores on the Mini Mental State Examination (MMSE) took more drugs (p = 0.039) and used more PIM (p < 0.001). Moreover, patients taking five or more prescription drugs per day (major polypharmacy) consuming any psychiatric, gastrointestinal or oral antidiabetic agents (regardless of whether they were considered potentially inappropriate or not) had higher odds of displaying cognitive impairment than those who did not (p < 0.05). Older adult residents of the studied nursing homes were potentially affected by polypharmacy and inappropriate polypharmacy. This observation reveals the need to adopt and implement strategies that make drug therapy more adequate and safer for older adults.
Land Use/Land Cover Change and Their Driving Factors in the Yellow River Basin of Shandong Province Based on Google Earth Engine from 2000 to 2020
Authors: Cui Jian , Zhu Mingshui , Liang Yong , Qin Guangjiu , Li Jian , Liu Yaohui
Published: February 2022

As the convenient outlet to the Bo Sea and the major region of economic development in the Yellow River Basin, Shandong Province in China has undergone large changes in land use/land cover (LULC) in the past two decades with rapid urbanization and population growth. The analysis of the LULC change patterns and its driving factors in the Shandong section of the Yellow River Basin can provide a scientific basis for rational planning and ecological protection of land resources in the Shandong section of the Yellow River Basin. In this manuscript, we analyzed the spatial pattern of LULC and its spatial and temporal changes in the Shandong section of the Yellow River Basin in 2000, 2010, and 2020 by using the random forest classification algorithm with the Google Earth Engine platform and multi-temporal Landsat TM/OLI data. The driving factors of LULC changes were also quantified by the factor detector and interaction detector in the geodetector. Results show that in the past two decades, the LULC types in the study area are mainly farmland and construction land, among which the proportion of farmland area has decreased and the proportion of construction land area has increased from 19.4% to 29.7%. Based on the results of factor detector, it can be concluded that elevation, slope, and soil type are the key factors affecting LULC change in the study area. The interaction between elevation and slope, slope and soil type, and temperature and precipitation has strong explanatory power for the spatial variation of LULC change in the study area. The research results can provide data support for ecological environmental protection, sustainable, and high-quality development of the Shandong section of the Yellow River Basin, and help local governments take corresponding measures to achieve coordinated and sustainable socioeconomic and environmental development.
Neural Vocoding for Singing and Speaking Voices with the Multi-Band Excited WaveNet
Authors: Roebel Axel , Bous Frederik
Published: February 2022

The use of the mel spectrogram as a signal parameterization for voice generation is quite recent and linked to the development of neural vocoders. These are deep neural networks that allow reconstructing high-quality speech from a given mel spectrogram. While initially developed for speech synthesis, now neural vocoders have also been studied in the context of voice attribute manipulation, opening new means for voice processing in audio production. However, to be able to apply neural vocoders in real-world applications, two problems need to be addressed: (1) To support use in professional audio workstations, the computational complexity should be small, (2) the vocoder needs to support a large variety of speakers, differences in voice qualities, and a wide range of intensities potentially encountered during audio production. In this context, the present study will provide a detailed description of the Multi-band Excited WaveNet, a fully convolutional neural vocoder built around signal processing blocks. It will evaluate the performance of the vocoder when trained on a variety of multi-speaker and multi-singer databases, including an experimental evaluation of the neural vocoder trained on speech and singing voices. Addressing the problem of intensity variation, the study will introduce a new adaptive signal normalization scheme that allows for robust compensation for dynamic and static gain variations. Evaluations are performed using objective measures and a number of perceptual tests including different neural vocoder algorithms known from the literature. The results confirm that the proposed vocoder compares favorably to the state-of-the-art in its capacity to generalize to unseen voices and voice qualities. The remaining challenges will be discussed.
Navigation Data Anomaly Analysis and Detection
Authors: Amro Ahmed , Oruc Aybars , Gkioulos Vasileios , Katsikas Sokratis
Published: February 2022

Several disruptive attacks against companies in the maritime industry have led experts to consider the increased risk imposed by cyber threats as a major obstacle to undergoing digitization. The industry is heading toward increased automation and connectivity, leading to reduced human involvement in the different navigational functions and increased reliance on sensor data and software for more autonomous modes of operations. To meet the objectives of increased automation under the threat of cyber attacks, the different software modules that are expected to be involved in different navigational functions need to be prepared to detect such attacks utilizing suitable detection techniques. Therefore, we propose a systematic approach for analyzing the navigational NMEA messages carrying the data of the different sensors, their possible anomalies, malicious causes of such anomalies as well as the appropriate detection algorithms. The proposed approach is evaluated through two use cases, traditional Integrated Navigation System (INS) and Autonomous Passenger Ship (APS). The results reflect the utility of specification and frequency-based detection in detecting the identified anomalies with high confidence. Furthermore, the analysis is found to facilitate the communication of threats through indicating the possible impact of the identified anomalies against the navigational operations. Moreover, we have developed a testing environment that facilitates conducting the analysis. The environment includes a developed tool, NMEA-Manipulator that enables the invocation of the identified anomalies through a group of cyber attacks on sensor data. Our work paves the way for future work in the analysis of NMEA anomalies toward the development of an NMEA intrusion detection system.
Secure Z-MAC Protocol as a Proposed Solution for Improving Security in WSNs
Authors: Almansoori Mona Nasser , Elshamy Ahmad Ahmad , Mustafa Ahmad Abdel Muttalib
Published: February 2022

Security is one of the major issues in Wireless Sensor Networks (WSNs), as poor security disrupts the entire network and can have a significant effect on data transmission. WSNs need safe data transmission at a high rate while maintaining data integrity. By modifying the Z-MAC protocol and merging it with IHOP and elliptic-curve encryption techniques, the present research produced a novel protocol that enables safe data transfer. Additionally, the paper examined the IHOP technique for secure data transfer based on the Z-MAC protocol, which offers a simple and efficient key generation mechanism based on a hierarchical key management architecture. Additionally, the Z-MAC protocol offered low contention, high throughput, reduced latency, low power consumption, and increased efficiency. One of the most major applications of the Secure Z-MAC protocol may be the Vehicle Area Network, which would help in increasing highway automobile traffic while simultaneously enhancing individual safety and minimizing accidents.
Reminiscence Therapy in the Treatment of Depression in the Elderly: Current Perspectives
Authors: Khan Arshia , Bleth Alex , Bakpayev Marat , Imtiaz Nabiha
Published: February 2022

Reminiscence therapy has been known to provide relief against depression and behavioral and psychological symptoms of dementia. This therapy has been used for decades as a nonpharmacological treatment or tool that has produced both positive and negative results. This paper explores the current trends in reminiscence therapy in the treatment of depression in the elderly. Some of these trends involve the use of technology such as mobile apps and robotics while others follow more traditional and proven methods. A comparison of the variations in the interpretations of reminiscence therapy treatment mechanisms and their impacts will also be discussed. The ultimate goal of this paper is to highlight the current trends in the use of reminiscence therapy in treatment of depression in the elderly.
Cardiotoxicity of Non-Anthracycline Cancer Chemotherapy Agents
Authors: Briasoulis Alexandros , Chasouraki Angeliki , Sianis Alexandros , Panagiotou Nikolaos , Kourek Christos , Ntalianis Argyrios , Paraskevaidis Ioannis
Published: February 2022

Throughout the last decades, newly developed chemotherapeutic agents and immunotherapies that target signaling pathways have provided patients with better prognoses, improved their quality of life and increased survival rates, thus converting cancer to a stable chronic disease. However, non-anthracycline cancer chemotherapy agents and immunotherapies including human epidermal growth factor receptor 2 (HER2) inhibitors, vascular endothelial growth factor (VEGF) inhibitors, Bcr-Abl tyrosine-kinase inhibitors (TKI), proteasome inhibitors, immune checkpoint inhibitors and chimeric antigen receptor T cells (CAR-T cells) may cause cardiovascular toxicity events and complications that usually interrupt the continuation of an appropriate treatment regimen, which induces life-threatening risks or leads to long-term morbidity. Heart failure, cardiac arrythmias and cardiomyopathies are the most common cardiovascular events related to cardiotoxicity due to chemotherapy. Each patient should be carefully assessed and monitored before, during and after the administration of chemotherapy, to address any predisposing risk factors and the new onset of cardiotoxicity manifestations early and treat them appropriately. The development of novel anticancer agents that cause minimal cardiovascular toxicity events or novel agents that ameliorate the adverse effects of the existing anticancer agents could drastically change the field of cardio-oncology. The aim of this narrative review is to demonstrate new knowledge regarding the screening and diagnosis of non-anthracycline-induced cardiotoxicity and to propose protective measures that could be performed in order to achieve the delivery of optimal care.
Acute Kidney Injury Following Transcatheter Aortic Valve Implantation: Association with Contrast Media Dosage and Contrast Media Based Risk Predication Models
Authors: Sudarsky Doron , Drutin Yarden , Kusniec Fabio , Grosman-Rimon Liza , Lubovich Ala , Kinany Wadia , Hazanov Evgeni , Gelbstein Michael , Birati Edo Y. , Marai Ibrahim
Published: February 2022

The effect of contrast media (CM), delivered prior to- and during transcatheter aortic valve implantation (TAVI), on kidney function, following the procedure, is debatable. Consequently, the performance of CM-based, acute kidney injury (AKI) risk prediction models is also questionable. We retrospectively studied 210 patients that underwent TAVI. We recorded the dose of CM used prior and during TAVI, calculated the results of different AKI risk assessment models containing a CM module, and tested their association with AKI after the procedure. AKI was diagnosed in 38 patients (18.1%). The baseline estimated glomerular filtration rate (eGFR) was lower in the AKI+ group compared to AKI− group (51 ± 19.3 versus 64.5 ± 19 mL/min/1.73 mr2, respectively). While the dose of CM delivered prior to TAVI, during TAVI or the cumulative amount of both did not differ between the groups, the results of all tested risk models were higher in AKI+ patients. However, by multivariable analysis, only eGFR had a consistent independent association with AKI. We suggest that the dose of CM delivered prior or during TAVI is not associated with AKI and that the predictive power of CM based AKI risk models is, in all probability, limited to eGFR alone.
Association of IL-10 and CRP with Pulse Wave Velocity in Patients with Abdominal Aortic Aneurysm
Authors: Åström Malm Ida , De Basso Rachel , Blomstrand Peter , Wågsäter Dick
Published: February 2022

Background: Markers of inflammation and arterial stiffness are predictors of cardiovascular morbidity and events, but their roles in the mechanisms and progression of abdominal aortic aneurysm (AAA) in males have not been fully investigated. This study explored possible associations between inflammatory marker levels and arterial stiffness in males with AAA. Methods: A total of 270 males (191 AAA and 79 controls) were included in the study. Arterial stiffness was assessed using non-invasive applanation tonometry to measure the regional pulse wave velocity between the carotid and femoral arteries and the carotid and radial arteries. Blood samples were obtained, and interleukin-10 (IL-10) and CRP levels were analysed. Results: Subjects with an AAA had higher levels of IL-10 (21.5 ± 14.0 ng/mL versus 16.6 ± 9.3 ng/mL) compared to controls (p = 0.007). In the AAA cohort, subjects with T2DM showed higher levels of IL-10 (26.4 ± 17.3 versus 20.4 ± 13.0, p = 0.036). We observed a positive correlation between PWVcf and CRP in the control group (r = 0.332) but not the AAA group. PWVcf and CRP were negatively correlated (r = 0.571) in the T2DM subjects treated with metformin in the AAA group. Conclusion: Arterial stiffness is related to the degree of inflammation reflected by CRP and IL-10 levels in males with an AAA. IL-10 is negatively correlated with arterial stiffness in these subjects. This finding suggests that IL-10 may decrease arterial stiffness in males with AAA. The negative correlation between CRP and PWVcf in males with T2DM treated with metformin may indicate that metformin influences the arterial wall to decrease stiffness in subjects with AAA.
Thromboprophylaxis Reduced Venous Thromboembolism in Sickle Cell Patients with Central Venous Access Devices: A Retrospective Cohort Study
Authors: Forté Stéphanie , De Luna Gonzalo , Abdulrehman Jameel , Fadiga Nafanta , Pestrin Olivia , Pham Hung d’Alexandry d’Orengiani Anne-Laure , Aneke John Chinawaeze , Guillet Henri , Budhram Dalton , Habibi Anoosha , Ward Richard , Bartolucci Pablo , Kuo Kevin H. M.
Published: February 2022

Sickle cell disease (SCD) induces a chronic prothrombotic state. Central venous access devices (CVADs) are commonly used for chronic transfusions and iron chelation in this population. CVADs are an additional venous thromboembolism (VTE) risk factor. The role of thromboprophylaxis in this setting is uncertain. The objectives are: (1) to determine whether thromboprophylaxis reduces VTE risk in SCD patients with CVAD and (2) to explore characteristics associated with VTE risk. We identified adults with SCD and CVAD intended for chronic use (≥3 months) at two comprehensive SCD centers. Thromboprophylaxis presence; type; intensity; and patient-, catheter-, and treatment-related VTE risk factors were recorded. Among 949 patients, 49 had a CVAD (25 without and 24 with VTE prophylaxis). Thromboprophylaxis type and intensity varied widely. Patients without thromboprophylaxis had higher VTE rates (rate ratio (RR) = 4.0 (95% confidence interval: 1.2–12.6), p = 0.02). Hydroxyurea was associated with lower VTE rates (RR = 20.5 (6.4–65.3), p < 0.001). PICC lines and Vortex and Xcela Power implantable devices were associated with higher rates compared with Port-a-Cath (RR = 5.8 (1.3–25.9), p = 0.02, and RR = 58.2 (15.0–225.0), p < 0.001, respectively). Thromboprophylaxis, hydroxyurea, and CVAD subtype were independently associated with VTE. The potentially protective role of thromboprophylaxis and hydroxyurea for VTE prevention in patients with SCD and CVAD merits further exploration.
Psychological Interventions for Children with Autism during the COVID-19 Pandemic through a Remote Behavioral Skills Training Program
Authors: Marino Flavia , Chilà Paola , Failla Chiara , Minutoli Roberta , Vetrano Noemi , Luraschi Claudia , Carrozza Cristina , Leonardi Elisa , Busà Mario , Genovese Sara , Musotto Rosa , Puglisi Alfio , Arnao Antonino Andrea , Cardella Giuliana , Famà Francesca Isabella , Cusimano Gaspare , Vagni David , Martines Pio , Mendolia Giovanna , Tartarisco Gennaro , Cerasa Antonio , Ruta Liliana , Pioggia Giovanni
Published: February 2022

COVID-19 has impacted negatively on the mental health of children with autism spectrum disorder (ASD), as well as on their parents. Remote health services are a sustainable approach to behavior management interventions and to giving caregivers emotional support in several clinical domains. During the COVID-19 pandemic, we investigated the feasibility of a web-based behavioral skills training (BST) program for 16 parents and their children with ASD at home. The BST parent training package was tailored to each different specific behavioral disorder that characterizes children with ASD. After training, we found a significant reduction in the frequency of all the targeted behavioral disorders, as well as an improvement in psychological distress and the perception of the severity of ASD-related symptoms in parents. Our data confirm the efficacy of remote health care systems in the management of behavioral disorders of children with ASD, as well as of their parents during the COVID-19 pandemic.
Sexual and Emotional Health after Allogeneic Hematopoietic Cell Transplantation: A Comprehensive Review and Guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)
Authors: Alsuliman Tamim , Jondreville Ludovic , Baylet Caroline , Dann Marie-Pierre , De Bentzmann Natacha , Fontoura Marie-Laure , Genty Carole , Huynh Anne , Ibled Diane , Yakoub-Agha Ibrahim , Mercier Lara , Poirot Catherine , Porcheron Sophie , Tourette-Turgis Catherine , Vernant Jean-Paul , Vexiau-Robert Dominique , Nguyen Stéphanie
Published: February 2022

A person’s sexual and emotional life is greatly impacted after allogeneic hematopoietic stem cell transplantation (allo-HSCT). This topic is not addressed very much by patients and caregivers. Physical, endocrine and genital chronic graft versus host disease (cGVHD)-related disorders are multiple and intertwined with psychological disorders. The Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) has issued recommendations for a better gynecological monitoring of female recipients after allo-HCT. A patient booklet was also offered to patients in the form of questions and answers to facilitate discussions between patients and caregivers and to improve the management of sexual and emotional life after transplant.
The Utility and Diagnostic Accuracy of Transient Elastography in Adults with Morbid Obesity: A Prospective Study
Authors: Ali Ahmad Hassan , Al Juboori Alhareth , Petroski Gregory F. , Diaz-Arias Alberto A. , Syed-Abdul Majid M. , Wheeler Andrew A. , Ganga Rama R. , Pitt James B. , Spencer Nicole M. , Hammoud Ghassan M. , Rector R. Scott , Parks Elizabeth J. , Ibdah Jamal A.
Published: February 2022

Patients with morbid obesity are at high risk for nonalcoholic fatty liver disease (NAFLD) complicated by liver fibrosis. The clinical utility of transient elastography (TE) by Fibroscan in patients with morbid obesity (body mass index (BMI) ≥ 40 kg/m2) is not well-defined. We examined the diagnostic accuracy of Fibroscan in predicting significant liver fibrosis (fibrosis stage ≥2) in morbidly obese patients (BMI ≥ 40 kg/m2). Patients scheduled for bariatric surgery were prospectively enrolled. Intraoperative liver biopsy, liver-stiffness measurement (LSM) by Fibroscan (XL probe), and biochemical evaluation were all performed on the same day. The endpoint was significant liver fibrosis defined as fibrosis stage ≥2 based on the Nonalcoholic Steatohepatitis Clinical Research Network. The optimal LSM cutoff value for detecting significant fibrosis was determined by using the Youden Index method. Routine clinical, laboratory, and elastography data were analyzed by stepwise logistic regression analysis to identify predictors of significant liver fibrosis and build a predictive model. An optimal cutoff point of the new model’s regression formula for predicting significant fibrosis was determined by using the Youden index method. One hundred sixty-seven patients (mean age, 46.4 years) were included, of whom 83.2% were female. Histological assessment revealed the prevalence of steatohepatitis and significant fibrosis of 40.7% and 11.4%, respectively. The median LSM was found to be significantly higher in the significant fibrosis group compared to those in the no or non-significant fibrosis group (18.2 vs. 7.7 kPa, respectively; p = 0.0004). The optimal LSM cutoff for predicting significant fibrosis was 12.8 kPa, with an accuracy of 71.3%, sensitivity of 73.7%, specificity of 70.9%, positive predictive value of 24.6%, negative predictive value of 95.5%, and ROC area of 0.723 (95% CI: 0.62–0.83). Logistic regression analysis identified three independent predictors of significant fibrosis: LSM, hemoglobin A1c, and alkaline phosphatase. A risk score was developed by using these three variables. At an optimal cutoff value of the regression formula, the risk score had an accuracy of 79.6% for predicting significant fibrosis, sensitivity of 89.5%, specificity of 78.4%, positive predictive value of 34.7%, negative predictive value of 98.3%, and ROC area of 0.855 (95% CI: 0.76–0.95). Fibroscan utility in predicting significant liver fibrosis in morbidly obese subjects is limited with accuracy of 71.3%. A model incorporating hemoglobin A1c and alkaline phosphatase with LSM improves accuracy in detecting significant fibrosis in this patient population.
Supra- and Infra-Renal Aortic Neck Diameter Increase after Endovascular Repair of a Ruptured Abdominal Aortic Aneurysm
Authors: van der Riet Claire , Schuurmann Richte C. L. , Karelis Angelos , Suludere Mehmet A. , van Harten Meike J. , Sonesson Björn , Dias Nuno V. , de Vries Jean-Paul P. M. , Dijkstra Martijn L.
Published: February 2022

Hypovolemia-induced hypotension may lead to an aortic diameter decrease in patients with a ruptured abdominal aortic aneurysm (rAAA). This study investigates the changes in supra- and infra-renal aortic neck diameters before and after endovascular aortic aneurysm repair (EVAR) for rAAA and the possible association with endograft apposition. A retrospective cohort study was conducted including 74 patients treated between 2010 and 2019 in two large European vascular centers. Outer-to-outer wall diameters were measured at +40, +10, 0, −10, and −20 mm relative to the lowest renal artery baseline on the last pre- and first post-EVAR computed tomography angiography (CTA) scan in a vascular workstation. Endograft apposition was determined on the first post-EVAR CTA scan. The post-operative diameter was significantly (p < 0.001) larger than the preoperative diameter at all aortic levels. The aortic diameter at +40 mm (supra-renal) and −10 mm (infra-renal) increased by 6.2 ± 7.3% and 12.6 ± 9.8%, respectively. The aortic diameter at +40 mm increased significantly more in patients with low preoperative systolic blood pressure (<90 mmHg; p = 0.005). A shorter apposition length was associated with a higher aortic diameter increase (R = −0.255; p = 0.032). Hypovolemic-induced hypotension results in a significant decrease in the aortic diameter in patients with an rAAA, which should be taken into account when oversizing the endograft.
Higher-Level Executive Functions in Healthy Elderly and Mild Cognitive Impairment: A Systematic Review
Authors: Corbo Ilaria , Casagrande Maria
Published: February 2022

Mild Cognitive Impairment (MCI) is a clinical syndrome characterized by a moderate decline in one or more cognitive functions with a preserved autonomy in daily life activities. MCI exhibits cognitive, behavioral, psychological symptoms. The executive functions (EFs) are key functions for everyday life and physical and mental health and allow for the behavior to adapt to external changes. Higher-level executive functions develop from basic EFs (inhibition, working memory, attentional control, and cognitive flexibility). They are planning, reasoning, problem solving, and fluid intelligence (Gf). This systematic review investigates the relationship between higher-level executive functions and healthy and pathological aging, assuming the role of executive functions deficits as a predictor of cognitive decline. The systematic review was conducted according to the PRISMA Statement. A total of 73 studies were identified. The results indicate that 65.8% of the studies confirm significant EFs alterations in MCI (56.8% planning, 50% reasoning, 100% problem solving, 71.4% fluid intelligence). These results seem to highlight a strong prevalence of higher-level executive functions deficits in MCI elderly than in healthy elderly.
The COORDINATE Pilot Study: Impact of a Transcatheter Aortic Valve Coordinator Program on Hospital and Patient Outcomes
Authors: Bohmann Katja , Burgdorf Christof , Zeus Tobias , Joner Michael , Alvarez Héctor , Berning Kira Lisanne , Schikowski Maren , Kasel Albert Markus , van Mark Gesine , Deutsch Cornelia , Kurucova Jana , Thoenes Martin , Frank Derk , Wundram Steffen , Bramlage Peter , Miller Barbara , Veulemans Verena
Published: February 2022

The transcatheter aortic valve implantation (TAVI) treatment pathway is complex, leading to procedure-related delays. Dedicated TAVI coordinators can improve pathway efficiency. COORDINATE was a pilot observational prospective registry at three German centers that enrolled consecutive elective patients with severe aortic stenosis undergoing TAVI to investigate the impact a TAVI coordinator program. Pathway parameters and clinical outcomes were assessed before (control group) and after TAVI coordinator program implementation (intervention phase). The number of repeated diagnostics remained unchanged after implementation. Patients with separate hospitalizations for screening and TAVI had long delays, which increased after implementation (65 days pre- vs. 103 days post-implementation); hospitalizations combining these were more efficient. The mean time between TAVI and hospital discharge remained constant. Nurse (p = 0.001) and medical technician (p = 0.008) working hours decreased. Patient satisfaction increased, and more consistent/intensive contact between patients and staff was reported. TAVI coordinators provided more post-TAVI support, including discharge management. No adverse effects on post-procedure or 30-day outcomes were seen. This pilot suggests that TAVI coordinator programs may improve aspects of the TAVI pathway, including post-TAVI care and patient satisfaction, without compromising safety. These findings will be further investigated in the BENCHMARK registry.
Association between Lung Fluid Levels Estimated by Remote Dielectric Sensing Values and Invasive Hemodynamic Measurements
Authors: Imamura Teruhiko , Hori Masakazu , Ueno Yohei , Narang Nikhil , Onoda Hiroshi , Tanaka Shuhei , Nakamura Makiko , Kataoka Naoya , Sobajima Mitsuo , Fukuda Nobuyuki , Ueno Hiroshi , Kinugawa Koichiro
Published: February 2022

Background: Remote dielectric sensing (ReDS™) is an electromagnetic-based technology used to noninvasively measure lung fluid levels. The association between ReDS values and invasively measured hemodynamics, particularly among those with small physics, remains unknown. Methods: Consecutive patients with chronic heart failure who were admitted to our institute and underwent invasive right heart catheterization as well as simultaneous ReDS measurement at clinically stable conditions between September and November 2021 were prospectively included. The colinearity between ReDS values and pulmonary capillary wedge pressure was studied. Results: In total, 30 patients (median 79 (73, 84) years old, 13 men) were included. Median ReDS value was 26% (22%, 28%). ReDS values had a moderate collinearity with pulmonary capillary wedge pressure (r = 0.698, p < 0.001), even among those with a body height < 155 cm. ReDS values with a cutoff of 28% predicted a pulmonary capillary wedge pressure > 15 mmHg with sensitivity 0.70 and specificity 0.75. Conclusions: An electromagnetic-based engineering ReDS might be a potential tool to estimate cardiac pressure in patients with heart failure, including those with small physics.
Prognostic Role of Pre-Treatment Metabolic Parameters and Sarcopenia Derived by 2-[18F]-FDG PET/CT in Elderly Mantle Cell Lymphoma
Authors: Albano Domenico , Pasinetti Nadia , Dondi Francesco , Giubbini Raffaele , Tucci Alessandra , Bertagna Francesco
Published: February 2022

The goal of this retrospective study was to analyze and compare the prognostic role of fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (2-[18F]-FDG PET/CT) features and sarcopenia, estimated by CT of PET in elderly (≥65 years) Mantle Cell Lymphoma (MCL). We recruited 53 patients, who underwent pre-treatment 2-[18F]-FDG PET/CT and end-of-treatment PET/CT, and the main semiquantitative parameters were calculated. Sarcopenia was measured as skeletal muscle index (SMI, cm2/m2) and derived by low-dose PET/CT images at the L3 level. Specific cut-offs for SMI were calculated by receiver operator curve and divided by gender. Metabolic response was evaluated at end-of-treatment PET/CT, applying the Deauville score. Progression Free Survival (PFS) and Overall Survival (OS) were calculated for the whole population and for different subgroups, defined as per different sarcopenia cut-off levels. The specific cut-offs to define sarcopenia were 53 cm2/m2 for male and 45.6 cm2/m2 for female. Thirty-two (60%) patients were defined as sarcopenic. The 3-year and 5-year PFS rates were 29% and 23%, while the 3-year and 5-year OS rates were 43% and 33%. Metabolic response, total metabolic tumor volume (tMTV), total lesion glycolysis (tTLG) and sarcopenia were independent prognostic factors for PFS. Considering OS, no variable was significantly associated. Combination between PET features and sarcopenia may help to predict PFS.