bluuebunny/crossref_metadata_2025 huggingface dataset:
Virtual minimum potential queuing
Authors: Lee Chul Ki , Jeong Deog Kyoon , Shim Yong Chul
Published: January 2025

We propose Virtual Minimum Potential Queuing (VMPQ) which provides a simple virtual time update function with O(1) complexity. While Weighted Fair Queuing (WFQ) provides low latency and good fairness, the virtual time update function has O(V) complexity for serving V busy flows. Start Potential Fair Queuing (SPFQ), which updates virtual time with a reduced complexity of O(log V), provides a fairness index very close to WFQ. Some other algorithms reduce virtual time update complexity further, but they degrade the fairness index significantly. VMPQ recalibrates virtual time using a virtual minimum potential, which is calculated with only a pre-computed constant and the finish time of the packet selected for transmission. This method requires O(1) complexity for the recalibration. Additionally, it does not affect the maximum latency and keeps fairness index to be almost identical to SPFQ.
Network profit optimization for traffic grooming in WDM networks with wavelength converters
Authors: Zhang James Yiming , Wu Jing , Yang Oliver , Savoie Michel
Published: January 2025

The traffic grooming technique provides a two-layer traffic engineering capability by aggregating and routing up-layer low-bandwidth traffic flows over low-layer re-configurable routed high-bandwidth connections. In this paper, we optimize traffic grooming for static traffic in mesh Wavelength Division Multiplexing (WDM) networks with wavelength converters. The optimization objective is to maximize network profit, which is the difference between resource cost and the revenue generated (by selecting profitable traffic flows). A constrained integer linear programming formulation is given, and a decomposition using Lagrangian relaxation is proposed. We then present a systematic approach to solve this problem and to obtain a performance bound for an arbitrary topology mesh network. Our approach can select traffic flows based on their profit, while obtaining their data path routing, lightpath routing and wavelength assignment at the same time. Our performance evaluation also reveals the impact of various cost parameters on the profit objective.
A Pathway Finding System for the Cell Signaling Networks	Database
Authors: Takai-Igarashi Takako , Kaminuma Tsuguchika
Published: January 2025

We report on a knowledge-based pathway-finding system that builds on the cell-signaling networks database, CSNDB, which we developed previously. This new system, PaF-CSNDB, uses a general inference engine to apply rules for finding and coupling pathways between or around specific biomolecules from the CSNDB database. We show how PaF-CSNDB finds relationships in a large but fragmented collection of cell-signaling knowledge by filtering out and composing together those sections of pathways specified from an extensive and complex set of binary or pair-wise cell-signaling reactions. The system can be accessed over the World Wide Web (http://goc.nihs.go.jp/csndb.html).
Threading Analysis of Prospero-Type Homeodomains
Authors: Banerjee-Basu Sharmila , Landsman David , Baxevanis Andreas D.
Published: January 2025

The homeodomain is a common structural motif found in many transcription factors involved in cell fate determination during development. We have used threading analysis techniques to predict whether the atypical homeodomain of prospero (pros) family members could form the three-helical homeodomain structural motif, even though these proteins are not statistically similar to canonical homeodomains as assessed by BLAST searches. Amino acid sequences of these divergent homeodomain proteins were threaded through the X-ray coordinates of the Drosophila engrailed homeodomain protein [23]. The analysis confirms that the prospero class of homeodomain proteins is indeed capable of forming the homeodomain structure despite its low degree of sequence identity to the canonical homeodomain. Energy calculations indicate that the homeodomain structure is stabilized primarily by hydrophobic interactions between residues at the helical interfaces. Although the atypical prospero-type homeodomain shows very little sequence similarity when compared to other homeodomain proteins, the critical amino acids responsible for maintaining the three-dimensional structure are highly conserved. A number of other homeodomain proteins, such as PHO2p from Saccharomyces and Pax6 from human, were also included in the threading analysis and were shown to be able to form the engrailed structure, indicating that there are no rigid overall sequence requirements for the formation of the homeodomain structural motif. Based on the threading experiments and the subsequent structural alignment, a new amino acid signature that unambiguously identifies the prospero-type proteins was deduced.
Control parameters and mutation based variants of differential evolution algorithm
Authors: Pooja  , Chaturvedi Praveena , Kumar Pravesh
Published: January 2025

Differential Evolution (DE) is considered as a simple yet influential search engine used for optimization of real-valued, multimodal and nonlinear functions. Here two new variants of the parent DE are presented with self-tuned control parameters and a modified mutation scheme. The First variant, designed by applying self-adaptive control parameters to the parent DE, is named as CPDE and the second one, the enhanced version of CPDE in which CPDE is embedded with a modified mutation scheme, is named as CPMDE. The crucial role of the self-adaptive control parameters can't be abandoned, which is used to improve the quality of the solution. The next application of self-adapted control parameters is drawn with a modified mutation operation in which the whole search space is divided into three equal parts for the sake of maximum exploration of the search space. A set of 14 traditional and 12 non-traditional (6 shifted and 6 hybrid) test problems is chosen for validation of the performance of the proposed algorithms which is then compared with the parent DE and some other variants of DE in terms of number of function evaluations, CPU time, error and standard deviation. Numerical and statistical results show that the proposed algorithm helps in providing a better trade-off between convergence rate and efficiency.
A Low-Risk vs. Market-Based Portfolio in Equity Market: Evidence from Global Financial Crisis and Global Pandemic Crisis in Pakistan
Authors: Raza Muhammad Wajid , Said Bahrawar , Hassan Ijaz
Published: January 2025

The study tests the characteristics of a low-risk-based portfolio compared with a broader market-capitalization weighted portfolio (benchmark portfolio) in Pakistan Stock Exchange (PSX). This study considers all listed stocks at PSX as an investment universe. Low-risk stocks were assessed by measuring the idiosyncratic risk. Extensive back-tests were performed to compare the financial performance for 2005-2022. Results show that the market-capitalization-based portfolio outperforms the low-risk-based portfolio in terms of annualized returns. However, the latter significantly reduces the risk and leads to superior risk-adjusted performance. The low-risk portfolio indicates resilience to market turmoil and reduces the downside risk of the market portfolio. The risk-return relationship appears to be stronger in the case of idiosyncrasies. The effect of the GFC-2008 and the GPC-2020 are also investigated; the results indicate that a low-risk-based portfolio carries higher returns while the market capitalization portfolio carries relatively higher risk. Both individuals and institutional investors can enhance the risk-adjusted performance of their portfolios by adopting a low-risk-based strategy.
Mitigating Tax Avoidance through Corporate Governance: The Mediating Role of Financial Distress
Authors: Maqbool Zahid , Rasheed Muhammad Haroon , Sadiq Salma
Published: January 2025

The post-pandemic era has brought Pakistan into a spiral of economic instability and downturn, making taxation a vital avenue for the economic survival of country. One of the key avenues of revenue collection for an economy is its manufacturing sector. Therefore, the current study analyzed the facilitating role of financial distress to examine the relationship amongst governance mechanisms and tax avoidance. The sample comprised data collected from 167 firms for 13 years, from the time period of 2011-2023. Panel data Generalized Method of Moment (GMM) regression model is utilized for analysis. Findings indicate that the firms in Pakistan tend to get involved in tax avoidance during economic distress and effective corporate governance may significantly reduce this behavior. The mediation analysis established that the association of board structure and tax avoidance is channeled through financial distress. This association highlighted those weak corporate mechanisms in a firm leading to financial distress which, in turn, leads to tax avoidance behavior. Hence, addressing corporate governance issues in the firm may also indirectly influence the tax avoidance behavior in the corporate sector of Pakistan. Furthermore, the control variables including firm size (FS), market-to-book ratio, return on assets (ROA), and leverage (LEV) have non-significant influence on tax avoidance. The study provided some unique implications related to tax avoidance, particularly with context to a struggling economy, such as Pakistan. These findings may also help tax officials to be more cautious of the firms that have weak indicators of corporate governance. Furthermore, in weak economic scenarios, such as Pakistan, tax avoidance practices tend to increase across the business sectors. Lastly, this association between tax management and financial distress would enable the investors' needs to assess premium cash flow and the risk of capital costs.
A mathematical model of the dynamic viscosity dependence of motor oils on temperature, soot concentration, and its morphology
Authors: Lesin A. V. , Isaev A. V. , Tonkonogov B. P. , Dunaev S. V. , Kulikov A. B.
Published: January 2025

Objectives. A quick cold start of emergency and auxiliary power units based on diesel engines should be possible at any time without problems and in the shortest possible time. The condition of the engine oil is one of the most important factors influencing the smooth start-up of power plants. During diesel engine operation, engine oil accumulates soot in its composition, negatively affecting its rheological properties. The aim of this research is to develop a mathematical model to describe changes in the dynamic viscosity of motor oils as a function of temperature. This model will account for the concentration of soot and its morphology, based on the results of experimental studies.Methods. Standardly used motor oils for diesel engines M-14D2SE and M-5z/14D2SE were used as oil samples in the preparation of model mixtures. The dispersed phase of the suspensions comprised carbon black of the N110, N220, N330, and N220 grades, characterized by a dusty (nongranular) texture. The rheological properties of the samples were determined using a TA Instruments DHR-2 rotational rheometer. The experimental data was subjected to mathematical statistical processing, in order to obtain approximating dependencies.Results. The paper presents an analysis of the various approaches to the description of the rheology of suspensions and the results of experimental studies of the viscosity-temperature characteristics (VTCs) of model samples of oils containing soot. The extant models of the dependence of the dynamic viscosity of suspensions on temperature, volume concentration of the dispersed phase, particle size and shape are demonstrated to be inadequate for the description of the VTCs of motor oils containing soot. A model of the rheological properties of soot-oil suspensions is proposed in the form of a mathematical dependence of their dynamic viscosity on temperature, mass concentration of soot, material density and size of soot particles, characteristics of the shape and structure of primary aggregates and the ratio of the sizes of aggregates and molecules of the dispersion medium.Conclusions. It was demonstrated that a comprehensive description of the VTCs of engine oils containing soot necessitates the consideration of the structural characteristics of the primary aggregates of soot particles. A mathematical model of the VTCs of oils was developed. This model is based on the dependence of the dynamic viscosity of oils on temperature, mass concentration of soot, density of the particle material, degree of non-sphericity of aggregates, the ratio of the particle sizes of the dispersed phase (either aggregates orsingle particles of non-aggregated soot) and oil molecules, and on the structure ofsoot, characterized by adsorption of dibutyl phthalate.
Increasing the efficiency of bioreactor operation for cultivation of methane-oxidizing bacteria under conditions of decreasing carbon dioxide concentration in the cultural liquid
Authors: Kochetkov V. M. , Gaganov I. S. , Tolkin D. V. , Kochetkov V. V. , Nynkov P. A.
Published: January 2025

Objectives. The work set out to develop a bioreactor that incorporates a carbon dioxide removal unit within the apparatus gas phase, which is capable of operating without the need for supplementary compression apparatus. As part of testing the developed equipment in order to ascertain its capacity for enhanced biomass production, the principal fermentation system parameters that facilitate the optimal bioreactor productivity in conditions of carbon dioxide removal from the apparatus gas phase were identified.Methods. A series of tests were conducted on the fermentation unit with the objective of controlling the oxygen and carbon dioxide content in the gas phase of the bioreactor. This was achieved using an in-line gas analyzer fitted with electrochemical sensors. The oxygen and carbon dioxide content in the gas phase was determined by means of gas chromatography. The oxygen and natural gas flow rates were determined using a thermal electronic flow controller equipped with thermoresistive elements. The oxygen content of the cultural liquid was determined by means of an optical oxygen sensor with integrated transducer. The pH level in the bioreactor was monitored and maintained using an electrochemical pH sensor.Results. The efficacy of the newly devised jet-type bioreactor design, which permits the incorporation of a carbon dioxide removal unit into the fermentation system without requiring supplementary compression apparatus, was evaluated through experimentation. The system was tested with the carbon dioxide removal unit included in the design, resulting in a 64% increase in bioreactor productivity and a 18% reduction in oxygen consumption as a component of the gas supply.Conclusions. The operational parameters of a technological bioreactor that facilitate a stable continuous process of bacterial cultivation were identified.
Influence of modifying additives on the structure and properties of biodegradable mixtures based on poly-3-hydroxybutyrate and nitrile butadiene rubber
Authors: Povernov P. A. , Shibryaeva L. S. , Anshin S. M.
Published: January 2025

Objectives. To investigate polymer composite materials based on poly-3-hydroxybutyrate (PHB) of microbiological origin and the synthetic nitrile butadiene rubber NBR-28. The biodegradability of PHB implies the possibility of its use for invasive medical purposes; however, this is significantly limited by its brittleness. The aim of this work was to search for approaches to altering the molecular structure of PHB-based composites, in order to impart them with sufficient physical and mechanical characteristics and increase their compatibility without violating biodegradability.Methods. Reaction mixtures contained the elastic material NBR-28, various modifiers (sorbitan oleate, epoxidized soybean oil, siloxane rubber), and additional polymer components (ethylene–vinyl acetate copolymer and polybutylene adipate terephthalate). The mixtures were prepared in a PL 2200-3 plasticorder (Brabender, Russia) by pressing, holding the material at 180°C under pressure for 3 min followed by quenching in cold water. The surfaces of the films and plates of the mixtures were studied using an Axio Imager Z2m optical microscope (Carl Zeiss, Germany) with the Axio Vision software at 50× and 200× magnification in reflected light. The mechanical properties of materials under tension were measured using an Instron 3365 universal tensile testing machine (Instron, United Kingdom).Results. The role of modifiers and polymer additives in the PHB–NBR-28 composites and their influence on the morphology of mixtures, crystallinity, and mechanical characteristics were established. The introduction of modifiers made it possible to reduce the average particle size of the NBR-28 phase in the PHB matrix by 30–50%, additionally changing their morphology. In this case, the uniformity of particle distribution increased, having a positive effect on the mechanical characteristics of the systems.Conclusions. It was shown that the modifiers change the morphology of mixtures, reduce the average particle size of the NBR phase by 30–50%, and positively affect the strength of the systems. Owing to changes in the structure of their interfacial layers and, as a consequence, physical and mechanical characteristics, the resulting composites render suitable for use in reparative bone and dental surgery, as well as for creating wound healing materials.
Oscillation rheometry of curing process of epoxy binders modified with polyetherimide
Authors: Polunin S. V. , Atamas K. A. , Gorbunova I. Yu. , Morozova P. A. , Marakhovsky K. M.
Published: January 2025

Objectives. The aim of this study is to ascertain the influence of polyetherimide on the curing process of epoxy binders.Methods. The storage modulus and loss modulus of epoxyamine systems were measured as a function of curing time on the Anton Paar MCR 302 rheometer. The experiments were carried out at an oscillation frequency of 1 Hz, with an amplitude aligned with the linear viscoelasticity region, and across a range of temperatures (160, 170, and 180°C). The crossover point was determined when the components of the complex modulus of elasticity are equal according to the obtained dependencies.Results. The influence of polyetherimide on the curing process of epoxyamine binders was investigated at a thermoplastic content of 5 to 20 pts. wt at three temperatures. In a system modified with 20 pts. wt of polyetherimide, phase separation was observed during the curing process. In systems modified with 10 and 20 pts. wt of polyetherimide, the limiting value of the modulus of elasticity was observed to be higher at 170°C than at 180°C.Conclusions. The modification of epoxyamine binders with thermoplastic in an amount of 5–20 pts. wt has been observed to extend the time required to reach the crossover point. Furthermore, the curing process markedly slows down in the system comprising 10 pts. wt of thermoplastic content, in which it takes the longest time to reach the crossover point at all three experimental temperatures.
A retrospective Study on Intestinal Injury from Blunt Abdominal Trauma
Authors: Kannaian Muralidharan , Bezawada Bhaskara Rao , K Vinod , Bose Subash Chandra
Published: January 2025

Introduction: Blunt abdominal trauma is the primary cause of morbidity and mortality. Suppose there are no indications of external trauma or changes in the patient's vital signs; blunt abdominal injuries might be complicated to identify at first. It is possible to lose a significant amount of blood without the abdomen appearing significantly different. A direct blow from blunt trauma can result in visceral damage and solid organ rupture, which can cause hemorrhage, peritonitis, and related pelvic injuries. The liver, small bowel, and spleen are the most frequently injured organs.
Objectives: To find out the etiology, manifestation, anatomical distribution, diagnostic method, management, and outcome of intestinal injuries from blunt abdominal trauma.
Material and Methods: About 59 individuals who had laparotomies during a 3-year period to treat intestine damage from traumatic abdominal trauma were included in the research. In a retrospective analysis, the patients' causes, presentations, anatomical distributions, diagnostic techniques, related injuries, courses of therapy, and deaths were all examined.
Results: About 59 individuals with 60 significant bowel and mesentery lesions from blunt abdominal trauma were conducted. The average age was 36.78 years, and the male-to-female ratio was 5.5: 1. About 60 people sustained severe injuries. Furthermore, there were 50 minor intestinal injuries, which included 48 perforations, 12 major seromuscular injuries, and seven mesenteric, eleven colonic, and one duodenal injury. Thirty-three individuals suffered injuries from automobile incidents. The most frequent damage was a perforation at the small bowel's antimesenteric boundary. For colonic perforations, treatment included protective colostomy after resection, anastomosis, and perforation repair. There were 2 (3.38%) documented fatalities, and 10 (16.9%) individuals experienced significant problems.
Conclusion: Due to its enormous infectious potential, early detection of intestinal injuries following severe abdominal trauma is crucial, even if it might be challenging. Severe injuries are frequently linked to intestinal perforations and are likely the deciding factors in survival.
Aortic Valve Surgery in Patients Over 75 Years Old: Early Results and Predictors of Hospital Mortality
Authors: Dumani Selman , Dibra Laureta , Likaj Ermal , Kuci Saimir , Rruci Edlira , Veseli Aferdita , Krakulli Klodian , Kacani Andi , Prifti Edvin , Tanku Ilir , Pellumbi Devis , Mehmeti Alessia , Musliu Adelina , Refatllari Ali , Veshti Altin
Published: January 2025

Background: Aortic valve surgery is the most essential part of worldwide heart valve surgery. In recent decades, the patient profile has changed even in our country, with the age of patients undergoing aortic valve surgery increasing significantly.
The primary objectives of this study are the early results of aortic valve replacement surgery in patients over 75 years old and the negative predictors that affect hospital mortality.
Materials and Methods: This is a retrospective study of 73 patients over 75 who underwent aortic valve surgery in 2014-2021 in our Cardiac Surgery Service, University Hospital Center “Mother Theresa” in Tirana. The patients' data regarding demographic, preoperative, operative, and postoperative variables were collected from the hospital's medical records. The data are presented in mean values and standard deviation. T-test and chi-squared test are also used.
Results: This study involved 73 patients, 50 males and 23 females. The age range was 75-85, averaging 77.12±2.31 years. Hospital mortality was 4.1%. The incidence of major perioperative complications such as low cardiac output, stroke, respiratory problems, bleeding, atrial fibrillation, wound infection, and conduction disturbances was 6.8%, 2.7 %, 4.1%, 2.7 %, 21.9 %, 2.6%, and 4.2 %.
Conclusions: Aortic valve surgery for elderly patients over 75 can be performed well. Concomitant procedures, prolonged extracorporeal circulation, and emergency intervention expose the patient to a high operative risk.
Selection of Prosthesis in Aortic Valve Surgery: Short Review and Trend in our Practice in 10 Years
Authors: Dumani Selman , Likaj Ermal , Dibra Laureta , Pellumbi Devis , Musliu Adelina , Qejvani Fjoralba , Veshti Altin
Published: January 2025

Introduction: In our country, the predominant condition treated in aortic valve surgery in its early stages was aortic valve disease of rheumatic origin, primarily in patients under the age of 60. In recent decades, due to lifestyle changes, increased average lifespan, and a shift in surgical treatment concepts among the elderly, there has been a noticeable trend towards atherosclerotic aortic valve disease treated surgically. This condition poses challenges in selecting the type of prosthesis for surgical replacement—either bioprosthetic or mechanical. The replacement of the aortic valve, aside from its undeniable benefits for patients, also introduces various complications, such as bleeding related to anticoagulation, thromboembolism, prosthetic endocarditis, and structural degeneration of the prosthesis. These complications vary between the two main groups of prostheses: bioprosthetic and mechanical. In this context, we are confronted with the challenge of selecting the type of prosthesis suitable for each patient.
This paper presents current issues regarding selecting aortic valve prostheses, considering factors related to the prosthesis and the patient. We will also discuss the trends in prosthesis usage in our country over the past decade.
Materials and Methods: We reviewed the types of mechanical and bioprosthetic valves used over the past ten years at our clinic, the Cardiac Surgery Service of the University Hospital Center "Mother Teresa.” We consulted articles, studies, and guidelines for managing heart valve diseases from European and American cardiology associations.
Conclusion: The choice of prosthesis for aortic valve replacement remains a current issue, involving considerations of patient-related and prosthesis-related factors. The decision is based on guidelines recommendations, surgical team judgment, and patient preference, following a detailed explanation of the benefits and risks associated with each type of prosthesis.
Challenges in Burns Management in a Tertiary Care Center in Albania
Authors: Filaj Vladimir , Tabaku Ester , Kola Ina , Gjonaj Ferdiola , Tafilaj Vilma , Drinjak Henri
Published: January 2025

Introduction: Burn injuries represent a significant public health concern globally, with a substantial impact on morbidity and mortality rates, particularly in low- and middle-income countries.
This study provides valuable insights into the epidemiology of burn injuries in Albania. It highlights the critical need for targeted interventions to reduce the incidence and severity of burns in the population.
Materials and Methods: This retrospective cohort study examined burn patients at the Department of Burns and Plastic Surgery at Mother Teresa University Hospital Center in Tirana from January 2022 to January 2024. Data were collected from medical records in Tirana, Albania. Formal approval was obtained from the Ethics Committee of Mother Teresa Hospital. The data were recorded in Excel and analyzed using the SPSS statistics program.
Results: This retrospective cohort study included 303 burn patients admitted between January 2022 and January 2024. Data on patient demographics, burn causes, total body surface area (TBSA), and burn severity were collected and analyzed using SPSS software.
The mean patient age was 36.1 years, with children aged 0-10 most affected, especially 2-year-olds. The youngest patient was seven months old, and the oldest was 89. Male patients comprised 60.7% of the cohort. The leading cause of burns was scalding from hot liquids (39.9%), followed by flames (20.4%) and electrical burns (8.2%). The average TBSA affected was 23.06%. The mortality rate was 7.3%.
Conclusion: Burn injuries present significant physical and psychological challenges. Despite advancements in burn care, the importance of preventive measures and public awareness campaigns must be addressed. These remain the most effective strategies to reduce burn incidence and severity. These findings underscore Albania's need for improved burn prevention and public safety initiatives.
Current Situation and Management of Pleural Effusion in PHI Clinical Hospital Tetovo
Authors: Rexhepi Ruzhdi , Arifi Selma , Rexhepi Merita , Dokic Dejan , Ruskovska Tatjana
Published: January 2025

Introduction: Pleural effusion is a disturbance in the balance between fluid production and elimination in the pleural space, resulting in abnormal fluid accumulation. It can result from various medical conditions related to the lungs and pleura or systemic diseases. Identifying the etiology of pleural effusion is essential for effective treatment. According to Light's criteria, pleural effusions are transudative and exudative.
Material and Methods: For this research, we collected data from the existing documentation in the Department of Pulmonology and Respiratory Allergology at PHI Clinical Hospital Tetovo from June 2022 to June 2023. This study included 133 patients with dyspnea, persistent chest pain, fatigue, hemoptysis, cough, a history of past illnesses, and other comorbid conditions. The data collection process was rigorous, and we followed ethical guidelines to ensure the reliability of our findings.
Results: The patients included in our study were between 36 to 84 years old. Of them, 72,9% were males, and 27,1% were females. 85,7% were smokers, and 14,3% were non-smokers. 75,0% of patients complained of dyspnea, and 24,8% had hemoptysis. From the ultrasonography findings, 15,0% had an alteration in the left lung, 11,3% in the right lung, 20,3% of patients were punctuated to the left side, and 24,8% were punctuated to the right lung. In comparison, 1,5% were punctuated to both sides. In 2,3% of the subjects, computed tomography described an effusion in the left lung.
Conclusion: The results suggest that pleural effusion is associated with various diseases, especially heart failure and malignant diseases. Our study underscores the importance of early detection of the cause of pleural effusion and the underlying disease for successfully managing and treating the disease. The insights from our research can guide healthcare professionals in developing effective treatment strategies and improving patient outcomes.
Damage Control Laparotomy in Trauma Patients: A Level I Trauma Center Experience
Authors: Duncan Anthony J. , Hopper Wade A. , Ahmeti Mentor
Published: January 2025

Introduction: The surgical management of traumatic injury is an evolving and controversial topic. We present outcomes of laparotomy performed for blunt and penetrating trauma at a level I trauma center over a nearly 10-year period.
Material and Methods: Retrospective single-center cohort study of patients who received either damage control laparotomy or definitive laparotomy with fascial closure at the time of index procedure. The primary outcome was in-hospital mortality. Secondary outcomes were length of stay, complications, intensive care requirements, and vasopressor use.
Results: Out of 125 included patients, 69 received damage control laparotomy, and 56 received definitive laparotomy.  Damage control laparotomy was associated with significantly higher mortality (20.9% vs 1.8%, p=.0015) and length of stay (16.1 vs. 9.3 days, p=.0005) than definitive laparotomy. Complications occurred significantly more frequently among damage control laparotomy patients (53.6% vs. 14.3%, p<.0001). Damage control laparotomy patients were substantially more likely to require intensive care unit admission, mechanical ventilation, and vasopressor support.
Conclusion: Patients undergoing damage control laparotomy are at significantly increased risk for adverse outcomes, including increased in-hospital mortality, prolonged length of stay, more significant complication burden, and increased need for mechanical ventilation and pressure support as compared to patients undergoing definitive laparotomy.
Surgical Approaches for Aortic Root Aneurysm: A Comparative Analysis of the David and Yacoub Techniques
Authors: Likaj Ermal , Mehmeti Alessia , Dumani Selman , Mana Fjorba , Kuci Saimir , Bejko Ervin , Veseli Aferdita
Published: January 2025

Introduction: This paper compares the David and Yacoub procedures for valve-sparing aortic root replacement, two leading techniques for treating aortic root aneurysms while preserving the native aortic valve. Both methods aim to avoid prosthetic valve replacement and the need for lifelong anticoagulation.
Material and Methods: We reviewed the technical nuances, clinical outcomes, and long-term durability of each technique, incorporating findings from recent and historical studies. Also, we'd like to present two case reports from our clinic showing the application of the David procedure.
Results: The David procedure involves complete excision of the aortic root and reimplantation of the native aortic valve within a Dacron graft. It offers superior long-term durability and lower reoperation rates, particularly in younger patients and those with connective tissue disorders. In contrast, the Yacoub procedure entails partial root resection and remodeling with preservation of the sinuses of Valsalva, making it a viable option for older patients or those with isolated root dilation.
Conclusions: Both the David and Yacoub procedures are advanced techniques for aortic root replacement, each with unique advantages and challenges. The David procedure, with its excellent durability,  has consistently delivered successful outcomes. It is especially beneficial for younger patients and those with connective tissue disorders, supporting its role as a preferred approach for long-term outcomes in this population.
Thymus Hyperplasia and Thymoma Type B in Patients with Myasthenia Gravis: Two case reports and Literature Review
Authors: Dumani Selman , Kuqo Altin , Likaj Ermal , Kuci Saimir , Ikonomi Majlinda , Dibra Laureta , Mehmeti Alessia , Celiku Ejona , Veshti Altin
Published: January 2025

Introduction: The thymus gland plays a pivotal role in immune system regulation, but conditions such as thymic hyperplasia (TH) and thymoma pose distinct clinical challenges due to their rarity and complex presentation in surgical practice. Both conditions can mimic similar symptoms, particularly in patients with Myasthenia Gravis (MG), where surgery serves as both a diagnostic and therapeutic intervention. This report presents the surgical management and outcomes of two MG patients with distinct thymic pathologies: TH and Type B thymoma, alongside a review of the relevant literature.
Two MG patients were referred to our clinic for surgical intervention. The first patient underwent a standard sternotomy for the resection of TH, while the second patient underwent a mini-sternotomy for thymectomy targeting a Type B thymoma. Both procedures were completed successfully with uneventful postoperative courses. Surgical resection remains the gold standard for the treatment and definitive diagnosis of thymic gland abnormalities. Advances in surgical techniques, including minimally invasive approaches, offer excellent outcomes with reduced morbidity, providing a viable alternative to traditional methods.
Conclusion: The cases underscore the critical role of surgical intervention in managing thymic pathologies in MG patients. Both traditional and minimally invasive techniques yield excellent clinical outcomes, reinforcing their importance in the treatment paradigm for thymic hyperplasia and thymoma. Further studies are needed to refine surgical approaches and optimize patient outcomes.
Noninvasive Polypoid Malignant Mixed Mullerian Tumor of the Uterus: A Case Report and Literature Review
Authors: Kaza Leon , Berdica Leart , Teona Teona , Ndoja Albina
Published: January 2025

Introduction: Malignant mixed Müllerian tumors (MMMT), also known as carcinosarcomas, are rare and highly aggressive neoplasms of the uterus, accounting for less than 5% of all uterine malignancies. These tumors are biphasic, comprising both carcinomatous (epithelial) and sarcomatous (mesenchymal) components, and are typically associated with poor prognoses due to their rapid progression and high metastatic potential.
In this report, we present a unique case of noninvasive polypoid MMMT of the uterus, highlighting its clinical presentation, diagnostic challenges, and management. We also provide a comprehensive literature review, which enriches our understanding of this case within the broader context of uterine carcinosarcomas.
Results: This is the first documented case in English literature of a polypoid uterine carcinosarcoma without endometrial infiltration. It is significant because it adds to the limited literature on noninvasive polypoid MMMTs, typically aggressive and diagnosed at advanced stages. Uterine carcinosarcomas are generally aggressive, with most cases diagnosed at advanced stages.
Conclusion: Uterine carcinosarcomas are indeed rare, aggressive, and rapidly progressing neoplasms with poor prognoses. It is crucial to include carcinosarcomas in the differential diagnosis of high-grade uterine neoplasms, especially for polypoid tumors. This inclusion is not just essential, but it is the key to ensuring accurate and timely diagnosis, underscoring the significant role of medical professionals in this process.
Types of Road Traffic Accidents and Emergency Medical Care
Authors: Lenjani Basri , Dogjani Agron , Abdullahu Luljeta , Zeqiri Arlind , Lenjani Dardan , Imeri Bujar
Published: January 2025

Introduction: A traffic accident is when only material damage is caused to the vehicle and track environment, and there are no casualties. RTA represents a significant risk for morbidity and mortality in Kosovo, of which head injury and multiple-site injury increase injury severity.
The anatomical site, mechanism of injury, time to reach an initial health facility, time of the day, patient condition at ED, type of treatment given, GCS at admission, and days spent in the hospital were among independent predictors of management outcome. Targeted approaches to improving the care of the injured victims may improve outcomes.
Thus, the clinician should consider the clinical presentation of RTA and give due attention to the identified contributing factors in managing it. Law enforcers should also emphasize the identified types and mechanisms of accidents. The PubMed database was utilized for article selection, and papers were obtained and reviewed. The ATLS protocol has been developed to manage trauma patients systematically so as not to miss any condition that may kill the patient.
Conclusions: Triage is essential in managing accidental situations and strengthening the primary, secondary, and tertiary health systems. To design clinical guidelines, algorithms, and triage protocols at the three levels of health care, all healthcare professionals should be educated and trained with continuing courses in triage, communication, and Basic Life Support -AED, ACLS, PHTLS, BTLS, and ATLS.
Basic Medical Emergency Treatment for Maxillofacial Injuries
Authors: Lenjani Ilirian , Lenjani Fatime , Mustafa Mentor , Dogjani Agron , Lenjani Basri
Published: January 2025

Introduction: Maxillofacial trauma presents unique challenges due to the complex anatomy of the face, encompassing vital structures. Beyond physical injuries, these cases significantly impact a patient's appearance and function, necessitating a multidisciplinary approach.
Challenges: Maxillofacial trauma often co-occurs with other injuries, particularly head, chest, and extremity trauma. This increases complexity, with head injuries observed in 7.6-8.9% of facial fracture cases, frequently associated with lower Glasgow Coma Scores. Cervical spine injuries and airway obstruction are significant concerns.
Management: While trauma management has significantly improved mortality rates, maxillofacial injuries in polytrauma patients remain a challenge. Their proximity to the brain, spine, and airway necessitates modifications to standard ABC assessments. These modifications often incorporate DRSABCDE, a comprehensive evaluation that includes airway clearance with C-spine control, breathing, ventilation, oxygenation, circulation, disability-neurologic status, exposure-environment, and body temperature. Each component of DRSABCDE is crucial in the initial management of maxillofacial trauma.
Conclusion: Continuous education and training in triage, communication, and advanced life support (e.g., BLS-AED, ACLS, PHTLS, BTLS, ATLS) are crucial and empowering for healthcare professionals managing maxillofacial trauma in polytrauma patients. This ongoing learning equips them with the necessary skills and knowledge to handle these complex cases effectively.
Gastric MALT Lymphoma with Giant Ulcer from Untreated H. pylori: Role of Endoscopic Biopsy – A Case Report.
Authors: Dede Hysni , Roshi Rovena , Cekodhima Gentiana , Tahiraj Manjola , Orlandi Augusto
Published: January 2025

Introduction: Gastric mucosa-associated lymphoid tissue (MALT) lymphoma is a rare extranodal non-Hodgkin lymphoma strongly linked to Helicobacter pylori infection. It often presents with nonspecific symptoms like dyspepsia, nausea, and epigastric pain and can mimic other gastric pathologies, such as peptic ulcers or gastric cancer.
This case report is significant as it highlights the importance of thorough biopsy procedures in diagnosing gastric MALT lymphoma. The patient presented with complaints of dyspepsia, nausea, and epigastralgia and had a giant ulcer on endoscopy. Only after biopsies with a large number of samples (over 10) from both normal and abnormal mucosa the diagnosis of MALT lymphoma was established and reconfirmed after immunohistochemistry. The presence of Helicobacter pylori was detected, and after its eradication treatment, the ulcer was more minor and improved from Forrest II-c to III. This case underscores the potential for a wrong diagnosis (undiagnosed MALT-Lymphoma) if biopsy samples are not comprehensive. It also emphasizes the need for suspicion of gastric MALT-Lymphoma and the necessity of more invasive tissue biopsy, such as EUS-FNA, EMR, and ESD, when suspicion persists.
Conclusion: Early diagnosis of gastric MALT lymphoma requires multiple biopsy samples during the initial endoscopy to prevent false negatives. Immunohistochemistry is essential for confirmation, and advanced techniques like EUS-FNA, EMR, or ESD play a significant role when suspicion persists. Timely H. pylori eradication can lead to ulcer healing and better outcomes. Proper endoscopist training is critical to reduce diagnostic delays.
New Pathogens in Blood Donors and Patients in Albania
Authors: Seferi Irena , Shano Viola , Dakavelli Brunilda , Duro Vjollca , Qyra Shpetim , Bulo Anyla
Published: January 2025

Introduction: The emergence of novel pathogens poses a significant and immediate threat to global blood safety, particularly in regions experiencing epidemiological shifts. This study urgently examines the prevalence and impact of newly identified pathogens among blood donors and recipients in Albania, focusing on assessing their implications for public health and transfusion medicine.
Results revealed a prevalence of new pathogens among donors and patients, highlighting the potential risk of transmission through blood transfusion. Travel history, socioeconomic status, and urban-rural disparities significantly influenced pathogen prevalence. This study underscores the urgent need for enhanced screening protocols and public health interventions to mitigate the risks associated with emerging pathogens. Our findings contribute to a growing body of evidence emphasizing the crucial role of continuous surveillance and adaptive strategies in transfusion medicine to ensure blood safety and protect vulnerable populations in Albania and beyond.
Conclusion: The study highlights the presence of emerging pathogens in blood donors and patients in Albania, underscoring their potential to significantly impact blood safety and public health. The findings emphasize the necessity for improved screening protocols, continuous epidemiological surveillance, and targeted public health interventions to address the risks associated with these pathogens. Adopting adaptive strategies in transfusion medicine is critical to safeguarding the health of donors and recipients in the region.
Redo Aortic Valve Replacement After Prior Transcatheter versus Surgical Aortic Valve Replacement: Insights from Western Experience
Authors: Aliu Arber , Durici Klodiana , Lazo Ira , Veshti Altin
Published: January 2025

Introduction: The demand for reoperation on the aortic valve in Albania is rising, mirroring the increasing average age of the population and the subsequent rise in patients requiring aortic valve surgery. This trend underscores the need for this informative article, which aims to provide insights into the risks and outcomes of aortic valve reoperations, particularly in light of efforts by interventional cardiologists to expand the indications for TAVR to younger and lower-risk patients. Data from the Society of Thoracic Surgeons (STS) National Database reveal results that warrant attention, with concerns over reoperations after TAVR growing, mainly due to the uncertain feasibility of repeat TAVR. 
This article presents a novel perspective on the risks associated with surgical aortic valve replacement (SAVR) after prior TAVR or SAVR. It underscores the urgent need to develop an optimal strategy for managing these patients and offers fresh insight. 
Material and Methods: Our research, based on a comprehensive analysis of data from the Society of Thoracic Surgeons in the USA's 10-year database, included individuals who underwent bioprosthetic SAVR following prior TAVR and/or SAVR. Our analyses, which included total and isolated SAVR groups, focused on the primary outcome of operative mortality, ensuring the reliability and thoroughness of our study. 
Results: The study included 31,106 patients who underwent SAVR. Among them, 1,126 had prior TAVR (TAVR-SAVR), 674 had undergone SAVR followed by TAVR and SAVR (SAVR-TAVR-SAVR), and 29,306 had undergone prior SAVR (SAVR-SAVR). Matched analysis for isolated SAVR cases showed a 1.74-fold higher operative mortality for TAVR-SAVR than SAVR-SAVR (P = 0.020). In our center, 5 cases have been performed in the last two years with excellent results, no losses, and operating times close to the first-time interventions.
Conclusions: This study's findings significantly contribute to the field. They could influence clinical practice, particularly for patients with longer life expectancies and anatomy unsuitable for TAVR. They suggest an initial SAVR approach may provide better results even in necessary surgical re-interventions on the aortic valve.
Diagnosis and Treatment of Postoperative Myocardial Infarction: A Retrospective Cohort Study on 600 Cardiac Surgery Patients
Authors: Kuci Saimir , Goga Marsela , Ibrahimi Alfred , Bejko Ervin , Llazo Stavri , Burimi Jonela , Bulku Esmerilda , Kacani Andi , Likaj Ermal , Refatllari Ali , Dumani Selman , Krakulli Klodian , Aliu Arber , Mana Fjorba , Pellumbi Devis , Veseli Aferdita , Rruci Edlira , Dibra Laureta , Baboci Arben , Prifti Edvin , Veshti Altin
Published: January 2025

Introduction: Postoperative myocardial infarction (PMI) is a severe complication after cardiac surgery, significantly impacting patient outcomes. Acute PMI after cardiac surgery is an infrequent event that can evolve rapidly and become a potentially life-threatening complication. Multiple factors are associated with acute PMI after cardiac surgery and may vary by the type of surgical procedure performed. Although the criteria defining nonprocedural myocardial ischemia are well established, there are no universally accepted criteria for diagnosing acute PMI. This retrospective study analyzed 600 patients who underwent cardiac surgery at a single center over one year. The incidence, diagnosis, and management of PMI were evaluated, focusing on diagnostic methods, therapeutic interventions, and the role of intra-aortic balloon pumps (IABPs). Our findings provide insights into the anesthesiologist’s role in identifying and managing PMI, highlighting strategies to reduce morbidity and mortality in this high-risk population.
Conclusions: Early detection and tailored management of PMI are vital to reducing complications. Anesthesiologists and intensive care teams are key in optimizing outcomes through advanced support measures like intra-aortic balloon pumps. These findings, which provide practical insights to enhance perioperative care, empower us to manage this high-risk population better.