bluuebunny/crossref_metadata_2025 huggingface dataset:
Reliability of Kaiser Score in Assessing Additional Breast Lesions Identified on Staging MRI in Patients with Breast Cancer
Authors: Hijazi Madiha , Chahine Reve , Berjawi Ghina , Jabbour Yara , El Annan Tamara , Ibrahim Roy , Nassar Lara
Published: August 2024

(1) Background: The Kaiser score is a user-friendly tool that evaluates lesions on breast MRI and has been studied in the general population and a few specific clinical scenarios. We aim to evaluate the performance of the Kaiser score in the characterization of additional lesions identified on staging breast MRI. (2) Methods: The Kaiser score of the biopsied additional lesions identified on staging MRI in recently diagnosed breast cancer patients was retrospectively determined. Statistical analysis was performed to evaluate the diagnostic capability of the Kaiser score and whether it is affected by different imaging and pathological parameters of the additional and the index lesion. (3) Results: Seventy-six patients with ninety-two MRI-detected lesions constitute the studied population. There was a statistically significant difference in the Kaiser score between benign and malignant lesions, irrespective of the pathology of the index cancer (p = 0.221) or the size and the imaging features of the additional lesion. Using a cutoff of 5 and above for suspicious lesions, biopsy could have been avoided in 34/92 lesions. (4) Conclusions: The Kaiser score can assist radiologists in the evaluation of additional MRI lesions identified in recently diagnosed breast cancer patients, thus decreasing the number of unneeded biopsies and delays in definitive surgical management.
Exploring the Interplay of Dataset Size and Imbalance on CNN Performance in Healthcare: Using X-rays to Identify COVID-19 Patients
Authors: Davidian Moshe , Lahav Adi , Joshua Ben-Zion , Wand Ori , Lurie Yotam , Mark Shlomo
Published: August 2024

Introduction: Convolutional Neural Network (CNN) systems in healthcare are influenced by unbalanced datasets and varying sizes. This article delves into the impact of dataset size, class imbalance, and their interplay on CNN systems, focusing on the size of the training set versus imbalance—a unique perspective compared to the prevailing literature. Furthermore, it addresses scenarios with more than two classification groups, often overlooked but prevalent in practical settings. Methods: Initially, a CNN was developed to classify lung diseases using X-ray images, distinguishing between healthy individuals and COVID-19 patients. Later, the model was expanded to include pneumonia patients. To evaluate performance, numerous experiments were conducted with varied data sizes and imbalance ratios for both binary and ternary classifications, measuring various indices to validate the model’s efficacy. Results: The study revealed that increasing dataset size positively impacts CNN performance, but this improvement saturates beyond a certain size. A novel finding is that the data balance ratio influences performance more significantly than dataset size. The behavior of three-class classification mirrored that of binary classification, underscoring the importance of balanced datasets for accurate classification. Conclusions: This study emphasizes the fact that achieving balanced representation in datasets is crucial for optimal CNN performance in healthcare, challenging the conventional focus on dataset size. Balanced datasets improve classification accuracy, both in two-class and three-class scenarios, highlighting the need for data-balancing techniques to improve model reliability and effectiveness. Motivation: Our study is motivated by a scenario with 100 patient samples, offering two options: a balanced dataset with 200 samples and an unbalanced dataset with 500 samples (400 healthy individuals). We aim to provide insights into the optimal choice based on the interplay between dataset size and imbalance, enriching the discourse for stakeholders interested in achieving optimal model performance. Limitations: Recognizing a single model’s generalizability limitations, we assert that further studies on diverse datasets are needed.
Reproducibility and Repeatability in Focus: Evaluating LVEF Measurements with 3D Echocardiography by Medical Technologists
Authors: Nielsen Marc Østergaard , Ljoki Arlinda , Zerahn Bo , Jensen Lars Thorbjørn , Kristensen Bent
Published: August 2024

Three-dimensional echocardiography (3DE) is currently the preferred method for monitoring left ventricular ejection fraction (LVEF) in cancer patients receiving potentially cardiotoxic anti-neoplastic therapy. In Denmark, however, the traditional standard for LVEF monitoring has been rooted in nuclear medicine departments utilizing equilibrium radionuclide angiography (ERNA). Although ERNA remains a principal modality, there is an emerging trend towards the adoption of echocardiography for this purpose. Given this context, assessing the reproducibility of 3DE among non-specialized medical personnel is crucial for its clinical adoption in such departments. To assess the feasibility of 3DE for LVEF measurements by technologists, we evaluated the repeatability and reproducibility of two moderately experienced technologists. They performed 3DE on 12 volunteers over two sessions, with a collaborative review of the results from the first session before the second session. Two-way intraclass correlation values increased from 0.03 to 0.77 across the sessions. This increase in agreement was mainly due to the recognition of false low measurements. Our findings underscore the importance of incorporating reproducibility exercises in the context of 3DE, especially when operated by technologists. Additionally, routine control of the acquisitions by physicians is deemed necessary. Ensuring these hurdles are adequately managed enables the adoption of 3DE for LVEF measurements by technologists.
Intelligent Fault Diagnosis Method for Rotating Machinery Based on Recurrence Binary Plot and DSD-CNN
Authors: Shi Yuxin , Wang Hongwei , Sun Wenlei , Bai Ruoyang
Published: August 2024

To tackle the issue of the traditional intelligent diagnostic algorithm’s insufficient utilization of correlation characteristics within the time series of fault signals and to meet the challenges of accuracy and computational complexity in rotating machinery fault diagnosis, a novel approach based on a recurrence binary plot (RBP) and a lightweight, deep, separable, dilated convolutional neural network (DSD-CNN) is proposed. Firstly, a recursive encoding method is used to convert the fault vibration signals of rotating machinery into two-dimensional texture images, extracting feature information from the internal structure of the fault signals as the input for the model. Subsequently, leveraging the excellent feature extraction capabilities of a lightweight convolutional neural network embedded with attention modules, the fault diagnosis of rotating machinery is carried out. The experimental results using different datasets demonstrate that the proposed model achieves excellent diagnostic accuracy and computational efficiency. Additionally, compared with other representative fault diagnosis methods, this model shows better anti-noise performance under different noise test data, and it provides a reliable and efficient reference solution for rotating machinery fault-classification tasks.
The Use of TheraBracelet Upper Extremity Vibrotactile Stimulation in a Child with Cerebral Palsy—A Case Report
Authors: Seo Na Jin , Brinkhoff Molly , Fredendall Savannah , Coker-Bolt Patricia , McGloon Kelly , Humanitzki Elizabeth
Published: August 2024

TheraBracelet is a peripheral vibrotactile stimulation applied to affected upper extremities via a wristwatch-like wearable device during daily activities and therapy to improve upper limb function. The objective of this study was to examine the feasibility of using TheraBracelet for a child with hemiplegic cerebral palsy. Methods: A nine-year-old male with cerebral palsy was provided with TheraBracelet to use during daily activities in the home and community settings for 1.5 years while receiving standard care physical/occupational therapy. Results: The child used TheraBracelet independently and consistently, except during summer vacations and elbow-to-wrist orthotic use from growth spurt-related contracture. The use of TheraBracelet did not impede or prevent participation in daily activities. No study-related adverse events were reported by the therapist, child, or parent. Future research is warranted to investigate TheraBracelet as a propitious therapeutic device with a focus on the potential impact of use to improve the affected upper limb function in daily activities in children with hemiplegic cerebral palsy.
PH-CBAM: A Parallel Hybrid CBAM Network with Multi-Feature Extraction for Facial Expression Recognition
Authors: Liao Liefa , Wu Shouluan , Song Chao , Fu Jianglong
Published: August 2024

Convolutional neural networks have made significant progress in human Facial Expression Recognition (FER). However, they still face challenges in effectively focusing on and extracting facial features. Recent research has turned to attention mechanisms to address this issue, focusing primarily on local feature details rather than overall facial features. Building upon the classical Convolutional Block Attention Module (CBAM), this paper introduces a novel Parallel Hybrid Attention Model, termed PH-CBAM. This model employs split-channel attention to enhance the extraction of key features while maintaining a minimal parameter count. The proposed model enables the network to emphasize relevant details during expression classification. Heatmap analysis demonstrates that PH-CBAM effectively highlights key facial information. By employing a multimodal extraction approach in the initial image feature extraction phase, the network structure captures various facial features. The algorithm integrates a residual network and the MISH activation function to create a multi-feature extraction network, addressing issues such as gradient vanishing and negative gradient zero point in residual transmission. This enhances the retention of valuable information and facilitates information flow between key image details and target images. Evaluation on benchmark datasets FER2013, CK+, and Bigfer2013 yielded accuracies of 68.82%, 97.13%, and 72.31%, respectively. Comparison with mainstream network models on FER2013 and CK+ datasets demonstrates the efficiency of the PH-CBAM model, with comparable accuracy to current advanced models, showcasing its effectiveness in emotion detection.
Underreporting of Cases in the COVID-19 Outbreak of Borriana (Spain) during Mass Gathering Events in March 2020: A Cross-Sectional Study
Authors: Domènech-Montoliu Salvador , Pac-Sa Maria Rosario , Sala-Trull Diego , Del Rio-González Alba , Sanchéz-Urbano Manuel , Satorres-Martinez Paloma , Blasco-Gari Roser , Casanova-Suarez Juan , Gil-Fortuño Maria , López-Diago Laura , Notari-Rodríguez Cristina , Pérez-Olaso Óscar , Romeu-Garcia Maria Angeles , Ruiz-Puig Raquel , Aleixandre-Gorriz Isabel , Domènech-León Carmen , Arnedo-Pena Alberto
Published: August 2024

Determining the number of cases of an epidemic is the first function of epidemiological surveillance. An important underreporting of cases was observed in many locations during the first wave of the COVID-19 pandemic. To estimate this underreporting in the COVID-19 outbreak of Borriana (Valencia Community, Spain) in March 2020, a cross-sectional study was performed in June 2020 querying the public health register. Logistic regression models were used. Of a total of 468 symptomatic COVID-19 cases diagnosed in the outbreak through anti-SARS-CoV-2 serology, 36 cases were reported (7.7%), resulting in an underreporting proportion of 92.3% (95% confidence interval [CI], 89.5–94.6%), with 13 unreported cases for every reported case. Only positive SARS-CoV-2 polymerase chain reaction cases were predominantly reported due to a limited testing capacity and following a national protocol. Significant factors associated with underreporting included no medical assistance for COVID-19 disease, with an adjusted odds ratio [aOR] of 10.83 (95% CI 2.49–47.11); no chronic illness, aOR = 2.81 (95% CI 1.28–6.17); middle and lower social classes, aOR = 3.12 (95% CI 1.42–6.85); younger age, aOR = 0.97 (95% CI 0.94–0.99); and a shorter duration of illness, aOR = 0.98 (95% CI 0.97–0.99). To improve the surveillance of future epidemics, new approaches are recommended.
Impacts of Fire Frequency on Net CO2 Emissions in the Cerrado Savanna Vegetation
Authors: Gomes Letícia , Schüler Jéssica , Silva Camila , Alencar Ane , Zimbres Bárbara , Arruda Vera , Silva Wallace Vieira da , Souza Edriano , Shimbo Julia , Marimon Beatriz Schwantes , Lenza Eddie , Fagg Christopher William , Miranda Sabrina , Morandi Paulo Sérgio , Marimon-Junior Ben Hur , Bustamante Mercedes
Published: August 2024

Savannas play a key role in estimating emissions. Climate change has impacted the Cerrado savanna carbon balance. We used the burned area product and long-term field inventories on post-fire vegetation regrowth to estimate the impact of the fire on greenhouse gas emissions and net carbon dioxide (CO2) emissions in the Cerrado savanna between 1985 and 2020. We estimated the immediate emissions from fires, CO2 emissions by plant mortality, and CO2 removal from vegetation regrowth. The burned area was 29,433 km2; savanna fires emitted approximately 2,227,964 Gg of CO2, 85,057 Gg of CO, 3010 Gg of CH4, 5,103 Gg of NOx, and 275 Gg of N2O. We simulated vegetation regrowth according to three fire regime scenarios: extreme (high fire frequency and short fire interval), intermediate (medium fire frequency and medium fire interval), and moderate (low fire frequency and long fire interval). Under the extreme and intermediate scenarios, the vegetation biomass decreased by 2.0 and 0.4% (ton/ha-year), while the biomass increased by 2.1% under a moderate scenario. We converted this biomass into CO2 and showed that the vegetation regrowth removed 63.5% of the total CO2 emitted (2,355,426 Gg), indicating that the Cerrado savanna has been a source of CO2 to the atmosphere.
The Impact of Lighting Treatments on the Biosynthesis of Phenolic Acids in Black Wheat Seedlings
Authors: Lan Hongjie , Wang Chunping , Yang Zhengfei , Zhu Jiangyu , Fang Weiming , Yin Yongqi
Published: August 2024

Light, as a crucial environmental determinant, profoundly influences the synthesis of secondary metabolites in plant metabolism. This study investigated the impacts of the red light combined with ultraviolet-A (UV-A) and ultraviolet-B (UV-B) treatments on phenolic acid biosynthesis in black wheat seedlings. The results demonstrate that the red light combined with UV-A and UV-B treatments significantly enhanced the levels of phenolic acids in black wheat seedlings, at 220.4 μg/seedling and 241.5 μg/seedling, respectively. The content of bound phenolic acids in black wheat seedlings increased by 36.0% under the UV-B treatment. The application of the UV-A/UV-B treatments markedly enhanced the activities of phenylalanine ammonia-lyase, 4-coumarate CoA ligase, and cinnamate 4-hydroxylase in black wheat seedlings while also promoting the expression levels of genes related to phenolic acid synthesis. The expression levels of fructose-1,6-bisphosphate aldolase and NADP-malic enzyme related to photosynthesis were significantly upregulated. This resulted in an augmentation in the chlorophyll content, thereby enhancing photosynthesis in black wheat seedlings. Nevertheless, the UV-A and UV-B treatments also had a significant constraining effect on the growth and development of black wheat seedlings. In addition, the UV-A and UV-B treatments increased the activity and gene expression levels of antioxidant enzymes while significantly increasing the contents of total flavonoids and anthocyanins, activating the antioxidant system. The findings reveal that light-source radiation serves as an effective method for promoting the biosynthesis of phenolic acids in black wheat seedlings.
Membrane Damage and Metabolic Disruption as the Mechanisms of Linalool against Pseudomonas fragi: An Amino Acid Metabolomics Study
Authors: Cai Jiaxin , Chen Haiming , Wang Runqiu , Zhong Qiuping , Chen Weijun , Zhang Ming , He Rongrong , Chen Wenxue
Published: August 2024

Pseudomonas fragi (P. fragi) is usually detected in low-temperature meat products, and seriously threatens food safety and human health. Therefore, the study investigated the antibacterial mechanism of linalool against P. fragi from membrane damage and metabolic disruption. Results from field-emission transmission electron microscopy (FETEM) and atomic force microscopy (AFM) showed that linalool damage membrane integrity increases surface shrinkage and roughness. According to Fourier transform infrared (FTIR) spectra results, the components in the membrane underwent significant changes, including nucleic acid leakage, carbohydrate production, protein denaturation and modification, and fatty acid content reduction. The data obtained from amino acid metabolomics indicated that linalool caused excessive synthesis and metabolism of specific amino acids, particularly tryptophan metabolism and arginine biosynthesis. The reduced activities of glucose 6-phosphate dehydrogenase (G6PDH), malate dehydrogenase (MDH), and phosphofructokinase (PFK) suggested that linalool impair the respiratory chain and energy metabolism. Meanwhile, genes encoding the above enzymes were differentially expressed, with pfkB overexpression and zwf and mqo downregulation. Furthermore, molecular docking revealed that linalool can interact with the amino acid residues of G6DPH, MDH and PFK through hydrogen bonds. Therefore, it is hypothesized that the mechanism of linalool against P. fragi may involve cell membrane damage (structure and morphology), disturbance of energy metabolism (TCA cycle, EMP and HMP pathway) and amino acid metabolism (cysteine, glutamic acid and citrulline). These findings contribute to the development of linalool as a promising antibacterial agent in response to the food security challenge.
Conditional Feature Selection: Evaluating Model Averaging When Selecting Features with Shapley Values
Authors: Huber Florian , Steinhage Volker
Published: August 2024

In the field of geomatics, artificial intelligence (AI) and especially machine learning (ML) are rapidly transforming the field of geomatics with respect to collecting, managing, and analyzing spatial data. Feature selection as a building block in ML is crucial because it directly impacts the performance and predictive power of a model by selecting the most critical variables and eliminating the redundant and irrelevant ones. Random forests have now been used for decades and allow for building models with high accuracy. However, finding the most expressive features from the dataset by selecting the most important features within random forests is still a challenging question. The often-used internal Gini importances of random forests are based on the amount of training examples that are divided by a feature but fail to acknowledge the magnitude of change in the target variable, leading to suboptimal selections. Shapley values are an established and unified framework for feature attribution, i.e., specifying how much each feature in a trained ML model contributes to the predictions for a given instance. Previous studies highlight the effectiveness of Shapley values for feature selection in real-world applications, while other research emphasizes certain theoretical limitations. This study provides an application-driven discussion of Shapley values for feature selection by first proposing four necessary conditions for a successful feature selection with Shapley values that are extracted from a multitude of critical research in the field. Given these valuable conditions, Shapley value feature selection is nevertheless a model averaging procedure by definition, where unimportant features can alter the final selection. Therefore, we additionally present Conditional Feature Selection (CFS) as a novel algorithm for performing feature selection that mitigates this problem and use it to evaluate the impact of model averaging in several real-world examples, covering the use of ML in geomatics. The results of this study show Shapley values as a good measure for feature selection when compared with Gini feature importances on four real-world examples, improving the RMSE by 5% when averaged over selections of all possible subset sizes. An even better selection can be achieved by CFS, improving on the Gini selection by approximately 7.5% in terms of RMSE. For random forests, Shapley value calculation can be performed in polynomial time, offering an advantage over the exponential runtime of CFS, building a trade-off to the lost accuracy in feature selection due to model averaging.
Facial and Emotion Recognition Deficits in Myasthenia Gravis
Authors: García-Sanchoyerto Maddalen , Salgueiro Monika , Ortega Javiera , Rodríguez Alicia Aurora , Parada-Fernández Pamela , Amayra Imanol
Published: August 2024

Myasthenia gravis (MG) is a neuromuscular disease of autoimmune etiology and chronic evolution. In addition to the muscle weakness and fatigue that characterize MG, in some studies patients show an inferior performance in cognitive tasks and difficulties in recognizing basic emotions from facial expressions. However, it remains unclear if these difficulties are due to anxious–depressive symptoms that these patients present or related to cognitive abilities, such as facial recognition. This study had a descriptive cross-sectional design with a sample of 92 participants, 52 patients with MG and 40 healthy controls. The data collection protocol included measures to assess recognition of facial expressions (BRFT), facial emotional expression (FEEL), and levels of anxiety and depression (HADS). The MG group had worse performance than the control group in recognizing “fear” (p = 0.001; r = 0.344), “happiness” (p = 0.000; r = 0.580), “disgust” (p = 0.000; r = 0.399), “surprise” (p = 0.000; r = 0.602), and “anger” (p = 0.007; r = 0.284). Likewise, the MG group also underperformed in facial recognition (p = 0.001; r = 0.338). These difficulties were not related to their levels of anxiety and depression. Alterations were observed both in the recognition of facial emotions and in facial recognition, without being mediated by emotional variables. These difficulties can influence the interpersonal interaction of patients with MG.
Remote Patient Monitoring Is Associated with Improved Outcomes in Hypertension: A Large, Retrospective, Cohort Analysis
Authors: Smith Wesley , Colbert Brett M. , Namouz Tariq , Caven Dean , Ewing Joseph A. , Albano Andrew W.
Published: August 2024

Hypertension (HTN) is a chronic condition that requires careful monitoring and management. Blood pressure readings in the clinic and self-reported blood pressure readings are often too intermittent to allow for careful management. Remote patient monitoring is a solution that may have positive impacts on HTN management. Individuals at cardiac and primary care clinics were prescribed a remote patient-monitoring (RPM) program. Patients were sent blood pressure monitors that were enabled to transmit data over cellular networks. We reviewed trends in HTN management retrospectively in patients who had previously been on conventional therapy for a year and participated in RPM for a minimum of 90 days. There were 6595 patients enrolled, and the mean duration on RPM was 289 days. A total of 4370 participants (66.3%) had uncontrolled HTN, and 2476 (37.5%) had stage 2 HTN. After at least 90 days on the RPM program, the number of patients with uncontrolled HTN reduced to 2648 (40.2%, p < 0.01), and the number of patients with stage 2 HTN reduced to 1261 (19.1%, p < 0.01). Systolic blood pressure improved by 7.3 mmHg for all patients and 16.7 mmHg for stage 2 HTN. There was improvement in mean arterial pressure (MAP) in all patients with uncontrolled HTN by 8.5 mmHg (p < 0.0001). RPM is associated with improved HTN control and provides further evidence supporting telehealth programs which can aid in chronic disease management.
Physiological Responses of Hollyhock (Alcea rosea L.) to Drought Stress
Authors: Sadeghi Arezoo , Karimmojeni Hassan , Razmjoo Jamshid , Baldwin Timothy C.
Published: August 2024

Hollyhock (Alcea rosea L.) is an aromatic, ornamental/medicinal plant species for which the selection of drought-tolerant varieties based on physio-chemical traits is desirable. The data presented resulted from a field experiment. This experiment was designed as a split-plot, based on a randomized complete block design, in which the main plots consisted of the three irrigation regimes (30, 60 and 80% permissible discharge moisture available in the soil), and the subplots consisted of nine hollyhock varieties. Photosynthetic pigments, Fv/Fm, proline content and selected antioxidant enzymes were measured throughout the period of induced drought stress. The data obtained illustrate the nature of the physiological response of hollyhock to drought stress. Based on the measured traits the varieties Isfahan 1, Shiraz 1 and Tabriz were shown to display the highest degree of resistance to drought stress. These data suggest that the effect of drought stress is dependent upon the drought level, variety and the trait in question. In this regard, future plant breeders for this species may find it useful to utilize ascorbate peroxidase (APX), catalase (CAT) and guayacol peroxidase (POX) activities as biochemical markers to select for drought-tolerant genotypes. As such, hollyhock can be considered a promising ornamental/medicinal species for cultivation in semi-arid environments.
Comparison of Short Uncemented Metaphyseal Stem and Long-Stem Reverse Shoulder Arthroplasty in Proximal Humerus Fractures: Preliminary Study at 2-Year Follow-Up
Authors: Ippolito Giorgio , Lanzetti Riccardo Maria , Ferraro Sergio , Pace Valerio , Damo Marco , Surace Michele Francesco , Giai Via Alessio Davide Enrico , Crivellaro Michele , De Marinis Giancarlo , Spoliti Marco
Published: August 2024

Introduction: In the last few years, short metaphyseal-socket prosthetic humeral stems have been introduced for reverse shoulder arthroplasty (RSA). A short stem may have advantages in humeral force distribution, reducing shear stress and preserving bone stock, keeping in mind the need for possible future revision surgery. The main objective of our study was to validate the use of a short stem prosthesis in the surgical treatment of humeral fractures by comparing clinical and radiological outcomes of our studied implant with those obtained with the use of traditional long-stem implants. Methods: In this multicentric, controlled prospective study, 125 patients with proximal three- or four-fragment humerus fractures were selected and treated with RSA. A short stem was used in group A (n = 53, mean age: 75.6 ± 5.6 years old), and a long stem was used in group B (n = 72, mean age: 71.76 ± 3). Active range of motion (ROM), Constant score (CS), Quick DASH, American Shoulder and Elbow Surgeons Shoulder (ASES) score, and Visual Analog Scale (VAS) scores were collected and analyzed at 2 years mean follow-up, as well as humeral and glenoid bone resorption (sum Inoue scores and Sirveaux scores were used). Results: No statistically significant differences were observed between group A and B in ROM, Constant score (51.69 ± 15.8 vs. 53.46 ± 15.96, p > 0.05), Quick DASH (31.5 ± 21.81 vs. 28.79 ± 13.72, p = 0.85), ASES (82.53 ± 17.79 vs. 84.34 ± 15.24, p = 0.57), or the VAS (0.53 ± 1 vs. 0.56 ± 1.07, p = 0.14) at the final follow-up. No statistically significant differences were found in the radiographic parameters between the two groups. No statistically significant differences were found for the average degree of humeral and glenoid bone resorption either. Conclusions: The use of a short metaphyseal-socket stem can be considered a safe, effective, and feasible option in reverse shoulder arthroplasty for treating proximal humerus fractures. Our results are encouraging, with no statistically significant differences identified between the proposed treatment and traditional long stems.
Reduced Incidence of Pneumothorax and Chest Tube Placement following Transthoracic CT-Guided Lung Biopsy with Gelatin Sponge Torpedo Track Embolization: A Propensity Score–Matched Study
Authors: Feinggumloon Sasikorn , Radchauppanone Panupong , Panpikoon Tanapong , Buangam Chinnarat , Pichitpichatkul Kaewpitcha , Treesit Tharintorn
Published: August 2024

Objectives: To evaluate the effectiveness of track embolization using gelatin sponge torpedo in reducing the incidence of pneumothorax and chest tube placement after percutaneous CT-guided lung biopsy. Methods: A retrospective single-center analysis of percutaneous computed tomography (CT)-guided transthoracic lung biopsies was performed between 2017 and 2022. After excluding the patients who received an ultrasound-guided biopsy, combined lung biopsy with ablation, fiducial placement, unsuccessful procedure due to uncooperative patient, and age under 18 years, 884 patients’ clinical information was collected (667 without track embolization and 217 with track embolization). The incidence of early and late pneumothorax and chest tube placement were compared between the two groups. Propensity score matching (PSM) was applied to minimize selection bias. Univariable and multivariable analyses were performed to determine risk factors for pneumothorax. Results: After PSM, the baseline differences and all factors that could affect the incidence of pneumothorax were balanced between the track embolization group (217 patients) and the non-track embolization group (217 patients). The incidence rates of early pneumothorax (13.4% vs. 24.0% p = 0.005), late pneumothorax (11.0% vs. 18.0% p = 0.021), and chest tube placement (0.9% vs. 4.6% p = 0.036) were significantly decreased in the track embolization group. However, the success rate of tissue diagnosis yield and length of hospital stay were not significantly different between the two groups. In multivariate analysis, the risk of pneumothorax increased as the fissure was passed (OR = 3.719, p = 0.027). Conclusions: Using track embolization with a gelatin sponge torpedo significantly decreased the incidence of pneumothorax and chest tube placement following percutaneous CT-guided lung biopsy.
The Association between Cardiovascular Risk Factors and Lichen Sclerosus: A Systematic Review and Meta-Analysis
Authors: Untaaveesup Suvijak , Kantagowit Piyawat , Leelakanok Nattawut , Chansate Petcharpa , Eiumtrakul Wongsathorn , Pratchyapruit Walaiorn , Sriphrapradang Chutintorn
Published: August 2024

Background/Objective: Lichen sclerosus is a chronic inflammatory skin disease that affects people of all ages and sexes. Evidence of cardiovascular risk factors in lichen sclerosus has been continuously reported; however, the definitive association remains inconclusive. This meta-analysis aimed to summarize the association between cardiovascular risk factors and lichen sclerosus. Methods: Electronic databases, including MEDLINE and EMBASE, were systematically searched from inception to May 2024 to identify the literature reporting the association between cardiovascular risk factors and lichen sclerosus. A random-effects model was used for the meta-analysis. Results: We included 16 eligible studies: nine case–control studies, six retrospective cohort studies, and one cross-sectional study. A total of 432,457 participants were included. Lichen sclerosus was significantly associated with type 2 diabetes mellitus with an odds ratio of 2.07 (95% CI: 1.21–3.52). Although not statistically significant, a trend of increasing risk in hypertension, dyslipidemia, obesity, and metabolic syndrome was observed among lichen sclerosus patients, with odds ratios of 1.56 (95% CI: 0.90–2.70), 1.44 (95% CI: 0.94–2.23), 5.84 (95% CI: 0.37–92.27), and 1.36 (95% CI: 0.52–3.54), respectively. Conclusions: Lichen sclerosus was associated with diabetes mellitus and potentially correlated with hypertension, dyslipidemia, obesity, and metabolic syndrome. Population-based prospective observational studies are required to further elucidate these findings and assess the impact of these associations.
Urgent or Emergent Endovascular Aortic Repair of Infective Aortitis
Authors: Orellana Davila Bernardo , Mancusi Carlotta , Coscarella Carlo , Spataro Claudio , Carfagna Paolo , Ippoliti Arnaldo , Giudice Rocco , Ferrer Ciro
Published: August 2024

Background: Aortitis is a rare inflammation of the aorta. It can be classified as infective, non-infective, or idiopathic. Infective aortitis can debut as an acute aortic syndrome that needs urgent or emergent treatment. Historically, these kinds of patients have been preferably treated by open surgery, with subsequent lack of information about the endovascular repair. The aim of the present study is to report the results of our experience with the urgent or emergent endovascular repair of infective aortitis with acute presentation. Methods: All consecutive urgent or emergent endovascular repairs, performed between January 2019 and January 2024 for the treatment of infective aortitis, were included. The inclusion criteria were clinical, laboratory, and radiological findings recognized as aortitis risk factors. Patients with graft or endograft infection, aortic fistulae, and mycotic aneurysm were excluded. Primary endpoints were technical success and 30-day and follow-up survival. Early and late major adverse events, any changes in lesion morphology over time, and need for re-intervention were also assessed. Results: A total of 15 patients (14 males and 1 female) with a mean age of 74.2 ± 8.3 were included. All the subjects were treated by endovascular means in an urgent or emergent setting because of a rapidly growing aneurysm, symptomatic lesion, or contained or free aortic rupture. The diagnosis of infective aortitis was confirmed postoperatively by positive blood cultures in all the patients. A rapidly growing or symptomatic lesion was noted in all 15 subjects. Among these there were six (40%) contained and two (13%) free aneurysm ruptures. The endovascular techniques performed were as follows: four thoracic-EVAR (TEVAR), three off-the-shelf branched-EVAR (BEVAR), one Chimney-EVAR (Ch-EVAR), six EVAR with bifurcated graft, and one EVAR with straight tube graft. Technical success was achieved in 100% of the patients. Two patients (13%) died within 30 days after the index procedure. No case of early aortic-related mortality was registered. During a mean follow-up of 31.6 ± 23.1 months (range 1–71), no further death or major adverse event was registered among the remaining 13 alive patients. Re-interventions were performed in three cases (20%). Aneurysm’s shrinkage > 5 mm or stability was noted in 10 of the 13 patients who survived the early period after repair. Conclusions: Despite the relative reluctance to use an endograft in an infected area, in our experience the endovascular approach resulted to be feasible, safe, and effective in the treatment of infective aortitis with acute presentation, with acceptable peri-operative and mid-term follow-up outcomes. Further studies are needed to confirm our results.
Dental Hygiene Challenges in Children with Autism: Correlation with Parental Stress: A Scoping Review
Authors: Alegría Pablo López , Landim Síbila Floriano , Branco Braulio Henrique Magnani , Carmine Florencia , Birditt Katherine , Sandoval Cristian , González Manuel Martín
Published: August 2024

Background: Children diagnosed with autism spectrum disorders are shown to have poor periodontal health and dental hygiene habits. Extensive research has revealed that parents of children with autism spectrum disorder (ASD) frequently encounter heightened levels of stress, despair, and anxiety in comparison to parents of neurotypical children. The aim was to understand the relationship between the dental hygiene of children with ASD and the stress generated in their parents. Methods: A scoping review was carried out to identify any gaps or research opportunities for clinical practice concerning oral care and stress levels in parents in the PubMed, Medline, ScienceDirect, and Scopus databases. Results: A total of 139 articles were reviewed. Of these, only 10 met the selection criteria for inclusion. Our results reveal a lack of studies presenting evidence on the topic of poor dental hygiene in children with ASD and high stress levels in their parents. Discussion: There is ample evidence that children with ASD have poor dental hygiene, as well as higher levels of stress in their parents. However, little or no evidence links these two variables. Future studies should focus on this link, which could have practical implications for improving dental care for children with ASD.
PEBAX® 5533D Formulation for Enhancement of Mechanical and Thermal Properties of Material Used in Medical Device Manufacturing
Authors: Guillén-Espinoza Mildred , Sancho Fabián Vásquez , Starbird-Perez Ricardo , Zamora-Sequeira Roy
Published: August 2024

The medical device industry is constantly innovating in the search for materials that demonstrate superior performance, better intrinsic characteristics, profitability, and a positive impact on potential patients. The thermoplastic polymer resin Pebax® 5533D is one of the most widely used commercial materials for manufacturing medical device parts due to its easy processability. However, its mechanical and thermal properties require improvements to mitigate identified manufacturing defects, such as a decrease in material flexibility, high susceptibility to moisture, and thermal degradation during processing. Therefore, this study integrated different materials, such as plasticizers and filler additives, to produce a polymer compound prototype formula as a solution technique to enhance the current material’s performance. Modifying mechanical and rheological properties allows to evaluate the impacts on the polymeric material’s flexibility and thermal behavior. This was achieved by processing mixed additives using injector-molding equipment to obtain equal-molded samples of every formula. In addition, material characterization was performed to determine the variations in the samples’ crystallization, flexural strength, and moisture content. Calcium stearate was determined to be the most significant component serving as a mechanical resistance modifier and thermal stabilizer alongside calcium chloride as a moisture content reducer combined with Pebax® 5533D.
Innovative Implementation Strategies for Familial Hypercholesterolemia Cascade Testing: The Impact of Genetic Counseling
Authors: Morgan Kelly M. , Campbell-Salome Gemme , Walters Nicole L. , Betts Megan N. , Brangan Andrew , Johns Alicia , Kirchner H. Lester , Lindsey-Mills Zoe , McGowan Mary P. , Tricou Eric P. , Rahm Alanna Kulchak , Sturm Amy C. , Jones Laney K.
Published: August 2024

The IMPACT-FH study implemented strategies (packet, chatbot, direct contact) to promote family member cascade testing for familial hypercholesterolemia (FH). We evaluated the impact of genetic counseling (GC) on medical outcomes, strategy selection, and cascade testing. Probands (i.e., patients with FH) were recommended to complete GC and select sharing strategies. Comparisons were performed for both medical outcomes and strategy selection between probands with or without GC. GEE models for Poisson regression were used to examine the relationship between proband GC completion and first-degree relative (FDR) cascade testing. Overall, 46.3% (81/175) of probands completed GC. Probands with GC had a median LDL-C reduction of −13.0 mg/dL (−61.0, 4.0) versus −1.0 mg/dL (−16.0, 17.0) in probands without GC (p = 0.0054). Probands with and without GC selected sharing strategies for 65.3% and 40.3% of FDRs, respectively (p < 0.0001). Similarly, 27.1% of FDRs of probands with GC completed cascade testing, while 12.0% of FDRs of probands without GC completed testing (p = 0.0043). Direct contact was selected for 47 relatives in total and completed for 39, leading to the detection of 18 relatives with FH. Proband GC was associated with improved medical outcomes and increased FDR cascade testing. Direct contact effectively identified FH cases for the subset who participated.
The Utility of Radiomorphometric Mandibular Indices on Cone Beam Computer Tomography in the Assessment of Bone Mass in Postmenopausal Women: A Cross-Sectional Study
Authors: Poiană Ioana Ruxandra , Dobre Ramona , Pițuru Silviu-Mirel , Bucur Alexandru
Published: August 2024

Background: The present study examined the potential use of computed tomography radiomorphometric mandibular indices on cone beam CT (CBCT) for the assessment of bone density in postmenopausal women with low bone mass. Methods: We included 104 postmenopausal women who received dual-energy X-ray absorptiometry (DXA) using a DXA scanner and mental foramen (MF) region CBCT using a NewTom VGi EVO Cone Beam 3D system. We assessed the relationships between the following DXA parameters: lumbar, femoral neck, and total hip T-scores, bone mineral density (BMD), lumbar trabecular bone score (TBS), and mandibular inferior cortical bone thickness at 4 sites. The cross-sectional images were obtained, as follows: anterior (A)—10 mm anterior from the MF; molar (M)—10 mm posterior from the MF; posterior (P)—25 mm posterior from the MF; symphysis (S)—equidistant from the centers of the right and left MF. Results: We found that A and M indices showed statistically significant moderate positive correlations with lumbar spine, femoral neck, and total hip BMD, as well as TBS. The P index demonstrated moderate positive correlations with these measurements, while the S index did not show significant correlations with BMD or TBS in postmenopausal women. Conclusions: These findings support the potential usefulness of CBCT-derived radiomorphometric mandibular indices for non-invasive bone health assessment in clinical practice.
Effects of Dance-Based Aerobic Training on Mental Health and Quality of Life in Older Adults with Mild Cognitive Impairment
Authors: Sánchez-Alcalá Marcelina , Aibar-Almazán Agustín , Hita-Contreras Fidel , Castellote-Caballero Yolanda , Carcelén-Fraile María del Carmen , Infante-Guedes Aday , González-Martín Ana María
Published: August 2024

(1) Background: Mild cognitive impairment in older adults is a condition characterized by a decrease in mental abilities that affects their quality of life. The aim of this study is to evaluate the effects of an aerobic training program based on dance on depression, sleep quality, and quality of life in older adults with mild cognitive impairment. (2) Methods: This study employed a randomized controlled trial design with a total of 92 older adults with cognitive impairment, randomly assigned to an experimental group (n = 47) undergoing dance-based aerobic training and a control group (n = 45) who did not receive any intervention. Depression was assessed using the Yesavage Geriatric Depression Scale, sleep quality through the Pittsburgh Sleep Quality Index (PSQI), and quality of life through the SF-36 questionnaire. (3) Results: Statistically significant improvements were observed in depression (t(46) = 4.783, p = 0.000) and in the PSQI domains: subjective sleep quality (t(46) = 3.333, p = 0.002, and Cohen’s d = 0.35), sleep duration (t(46) = 5.511, p = 0.000, and Cohen’s d = 0.73) and PSQI total score (t(46) = 2.116, p = 0.040, and Cohen’s d = 0.20). Regarding quality of life, improvements were observed in all domains of the questionnaire: the general health (t(46) = −9.374, p = 0.000, and Cohen’s d = 0.03), physical function (t(46) = −9.374, p = 0.000, and Cohen’s d = 0.03), the physical role (t(46) = −5.954, p = 0.000, and Cohen’s d = 1.06), the emotional role (t(46) = −6.200, p = 0.000, and Cohen’s d = 0.80), social function (t(46) = −5.585, p = 0.000, and Cohen’s d = 0.53), physical pain, (t(46) = −9.224, p = 0.000, and Cohen’s d = 1.04), vitality (t(46) = 2.289, p = 0.027, and Cohen’s d = 1.27), mental health, (t(46) = −7.985, p = 0.000, and Cohen’s d = 1.33), the physical summary component, (t(46) = −13.532, p = 0.000, and Cohen’s d = 1.81), and in the mental summary component (t(46) = −10.6 81, p = 0.000, and Cohen’s d = 0.06); (4) Conclusions: The results of the present study showed that they suggest that a dance-based aerobic training program improves mental health and quality of life in older people with mild cognitive impairment, providing a non-pharmacological approach to improve general well-being in this population.
Emergency Awake Laparotomy Using Neuraxial Anaesthesia: A Case Series and Literature Review
Authors: Leoni Matteo Luigi Giuseppe , Rossi Tommaso , Mercieri Marco , Cerati Giorgia , Abbott David Michael , Varrassi Giustino , Cattaneo Gaetano , Capelli Patrizio , Mazzoni Manuela , Corso Ruggero Massimo
Published: August 2024

Emergency laparotomy is a surgical procedure associated with significantly higher mortality rates compared to elective surgeries. Awake laparotomy under neuraxial anaesthesia has recently emerged as a promising approach in abdominal surgery to improve patient outcomes. This study aims to evaluate the feasibility and potential benefits of using neuraxial anaesthesia as the primary anaesthetic technique in emergency laparotomies. We conducted a case series involving 16 patients who underwent emergency laparotomy for bowel ischemia, perforation, or occlusion. Neuraxial anaesthesia was employed as the main anaesthetic technique. We analysed patient demographics, clinical characteristics, intraoperative details, and postoperative outcomes. The primary outcome measures included the adequacy of postoperative pain control, the incidence of postoperative complications, and mortality rates. Among the 16 patients, adequate postoperative pain control was achieved, with only 2 patients requiring additional analgesia. Postoperative complications, including sepsis, wound dehiscence, and pneumonia, were observed in seven patients (44%). The observed mortality rate was relatively low at 6% (one patient). Notably, conversion to general anaesthesia was not necessary in any of the cases, and no early readmissions were reported. Our findings highlight the feasibility and potential benefits of using neuraxial anaesthesia in emergency laparotomies. The observed low mortality rate and the avoidance of conversion to general anaesthesia suggest that neuraxial anaesthesia may be a useful alternative in emergency settings. However, the occurrence of postoperative complications in 44% of patients indicates the need for cautious patient selection and close monitoring. Further research with larger sample sizes is warranted to fully elucidate the efficacy, safety, and potential impact of this technique on patient outcomes in emergency laparotomies.