bluuebunny/crossref_metadata_2025 huggingface dataset:
Novel Approach for the Immobilization of Cellobiose Dehydrogenase in PEDOT:PSS Conductive Layer on Planar Gold Electrodes
Authors: Cihan Esra , Melnik Eva , Kurzhals Steffen , Plata Paulina , Mutinati Giorgio C. , Hainberger Rainer , Felice Alfons K.G. , Schulz Christopher , Lieberzeit Peter
Published: February 2024

Third-generation biosensors use enzymes capable of direct electron transfer (DET) to the sensor surface. They are of interest for continuous glucose monitoring in blood or interstitial fluid, but they are rarely investigated. One reason is the hindered DET of the enzymes to the metallic electrodes. In this publication, a novel method for the immobilization of cellobiose dehydrogenase (CDH) DET enzymes employing conductive poly(3,4-ethylenedioxythiophene)-poly (styrene sulfonate) (PEDOT:PSS) inks and a protective polyethylene glycol dimethacrylate (PEG-DMA) hydrogel layer on gold electrodes is reported. This layer stack showed a glucose-specific current response for voltages between −0.2 and 0.4 V in physiological PBS buffer, and enabled interference-less sensing in a solution of acetaminophen, ascorbic acid, dopamine, and uric acid at 0 V. A Michaelis–Menten fit led to a maximum current density (Imax) of 257 ± 7.9 nA/mm2 and a Michaelis–Menten constant (Km) of 28.4 ± 2.2 mM, with a dynamic range of 0.1–20 mM glucose and a limit of detection of 0.1 mM. After 16 h of continuous measurement of 20 mM glucose, the signal decreased to 60% of its initial value. Storage stability was successfully verified until up to 10 days. In summary, this paper shows a simplified approach for the fabrication of third-generation biosensors using CDH-PEDOT:PSS and PEG-DMA hydrogel inks.
Effect of Nano-Silver Solution Microcapsules Mixed with Rosin-Modified Shellac Microcapsules on the Performance of Water-Based Coating on Andoung Wood (Monopetalanthus spp.)
Authors: Zou Yuming , Pan Pan , Zhang Nana , Yan Xiaoxing
Published: February 2024

To obtain dual functions of antibacterial and self-healing of a coating, nano-silver solution microcapsules coated with urea formaldehyde resin were selected for antibacterial agents, and rosin-modified shellac microcapsules coated with melamine formaldehyde resin were selected for repairing agents. The optical, mechanical, antibacterial, self-healing, and other physicochemical properties of the coatings were analyzed. The method of adding two microcapsules independently did not affect the coating’s hardness. When the primer was prepared by self-healing microcapsules and the topcoats were prepared by antibacterial microcapsules, the hardness of the prepared coatings was maintained at 3 H, with the adhesion up to class 2, the impact strength up to 18 kg·cm, and the roughness as low as 1.144 µm. The elongation at fracture of the coatings prepared by adding microcapsules independently was improved by 2.2%. The self-healing microcapsules release the repair agents to improve the mechanical properties of the coatings. In terms of the antibacterial properties of the coatings, the method that involves adding the microcapsules independently is better than mixed adding. Against Escherichia coli, the antibacterial rate of coatings prepared by adding microcapsules independently reached 82%. Against Staphylococcus aureus, the antibacterial rate of coatings reached 83.3%. At the same time, the self-healing rate was up to 41.1%. The two microcapsules were added to the water-based coating independently to obtain antibacterial and self-healing functions with good comprehensive properties. By modifying coatings on the Andoung wood (Monopetalanthus spp.) with antibacterial microcapsules and self-healing microcapsules, it is possible to obtain good antibacterial properties, further protect the wood substrate, and broaden the application range of functional coatings.
Surface Characteristics of Vacuum-Plasma-Sprayed Reinforced Stainless Steel Coatings with TiC Particles
Authors: Anghel (Petculescu) Iasmina-Mădălina , Uțu Diana , Mitelea Ion , Constantin Albert Titus , Uțu Ion-Dragoș
Published: February 2024

Fe-based coatings reinforced with TiC particles exhibit outstanding properties and are widely recognized as highly promising coatings or components with superior performance. In the present study, composite materials using a powder mixture of AISI 316 stainless steel and TiC particles were deposited by vacuum plasma spraying onto a S235 low alloyed steel substrate. The coating and the base material were characterized in terms of microstructure and surface properties. The metallographic analysis of the deposited coating revealed the uniform distribution of the TiC into the stainless steel matrix. The results show that the presence of tungsten carbide particles improved the hardness and tribological properties of the composite coating compared with the S235 base material. The wear resistance of the coating was approximately seven times higher than that of the low alloyed steel substrate. The electrochemical corrosion resistance of the coating in chloride media was much higher than that of the base material.
Sleep Research in the Era of AI
Authors: Göktepe-Kavis Pinar , Aellen Florence M. , Alnes Sigurd L. , Tzovara Athina
Published: February 2024

The field of sleep research is both broad and rapidly evolving. It spans from the diagnosis of sleep-related disorders to investigations of how sleep supports memory consolidation. The study of sleep includes a variety of approaches, starting with the sole focus on the visual interpretation of polysomnography characteristics and extending to the emergent use of advanced signal processing tools. Insights gained using artificial intelligence (AI) are rapidly reshaping the understanding of sleep-related disorders, enabling new approaches to basic neuroscientific studies. In this opinion article, we explore the emergent role of AI in sleep research, along two different axes: one clinical and one fundamental. In clinical research, we emphasize the use of AI for automated sleep scoring, diagnosing sleep-wake disorders and assessing measurements from wearable devices. In fundamental research, we highlight the use of AI to better understand the functional role of sleep in consolidating memories. While AI is likely to facilitate new advances in the field of sleep research, we also address challenges, such as bridging the gap between AI innovation and the clinic and mitigating inherent biases in AI models. AI has already contributed to major advances in the field of sleep research, and mindful deployment has the potential to enable further progress in the understanding of the neuropsychological benefits and functions of sleep.
Ruptured Recurrent Interstitial Ectopic Pregnancy Successfully Managed by Laparoscopy
Authors: Ungureanu Claudiu Octavian , Stanculea Floris Cristian , Iordache Niculae , Georgescu Teodor Florin , Ginghina Octav , Mihailov Raul , Vacaroiu Ileana Adela , Georgescu Dragos Eugen
Published: February 2024

Ectopic pregnancies are a frequently encountered cause of first-trimester metrorrhagia. They occur when an embryo is implanted and grows outside the normal uterine space. Uncommonly, the embryo can be implanted in the intramural portion of the uterine tube, a condition referred to as interstitial localization. This specific type of ectopic pregnancy may have an unpredictable course, potentially leading to severe uterine rupture and catastrophic bleeding if not promptly diagnosed and managed. We present a rare case of a multiparous 36-year-old female patient who underwent pelvic ultrasonography in the emergency department for intense pelvic pain associated with hypotension and moderate anemia. A history of right salpingectomy for a ruptured tubal ectopic pregnancy 10 years previously was noted. High beta-HCG levels were also detected. A pelvic ultrasound allowed us to suspect a ruptured ectopic interstitial pregnancy at 8 weeks of amenorrhea. An association with hemoperitoneum was suspected, and an emergency laparoscopy was performed. The condition was confirmed intraoperatively, and the patient underwent a right corneal wedge resection with suture of the uterine myometrium. The postoperative course was uneventful, and the patient was discharged on the fourth day postoperatively. Interstitial ectopic pregnancy is a rare yet extremely perilous situation. Timely ultrasound-based diagnosis is crucial as it can enable conservative management with Methotrexate. Delayed diagnosis can lead to uterine rupture with consecutive surgery based on a transection of the pregnancy and cornual uterine resection.
Multiple-Target Matching Algorithm for SAR and Visible Light Image Data Captured by Multiple Unmanned Aerial Vehicles
Authors: Zhang Hang , Zheng Jiangbin , Song Chuang
Published: February 2024

Unmanned aerial vehicle (UAV) technology has witnessed widespread utilization in target surveillance activities. However, cooperative multiple UAVs for the identification of multiple targets poses a significant challenge due to the susceptibility of individual UAVs to false positive (FP) and false negative (FN) target detections. Specifically, the primary challenge addressed in this study stems from the weak discriminability of features in Synthetic Aperture Radar (SAR) imaging targets, leading to a high false alarm rate in SAR target detection. Additionally, the uncontrollable false alarm rate during electro-optical proximity detection results in an elevated false alarm rate as well. Consequently, a cumulative error propagation problem arises when SAR and electro-optical observations of the same target from different perspectives occur at different times. This paper delves into the target association problem within the realm of collaborative detection involving multiple unmanned aerial vehicles. We first propose an improved triplet loss function to effectively assess the similarity of targets detected by multiple UAVs, mitigating false positives and negatives. Then, a consistent discrimination algorithm is described for targets in multi-perspective scenarios using distributed computing. We established a multi-UAV multi-target detection database to alleviate training and validation issues for algorithms in this complex scenario. Our proposed method demonstrates a superior correlation performance compared to state-of-the-art networks.
Quasi-Equilibrium States and Phase Transitions in Biological Evolution
Authors: Romanenko Artem , Vanchurin Vitaly
Published: February 2024

We developed a macroscopic description of the evolutionary dynamics by following the temporal dynamics of the total Shannon entropy of sequences, denoted by S, and the average Hamming distance between them, denoted by H. We argue that a biological system can persist in the so-called quasi-equilibrium state for an extended period, characterized by strong correlations between S and H, before undergoing a phase transition to another quasi-equilibrium state. To demonstrate the results, we conducted a statistical analysis of SARS-CoV-2 data from the United Kingdom during the period between March 2020 and December 2023. From a purely theoretical perspective, this allowed us to systematically study various types of phase transitions described by a discontinuous change in the thermodynamic parameters. From a more-practical point of view, the analysis can be used, for example, as an early warning system for pandemics.
Assessment of Student and Teacher Perceptions on the Use of Virtual Simulation in Cell Biology Laboratory Education
Authors: Navarro Cristina , Arias-Calderón Manuel , Henríquez Carolina A. , Riquelme Paula
Published: February 2024

Virtual laboratory simulations (VLs), particularly in Biology education, are gaining popularity. This study focused on assessing students’ and teachers’ perceptions of VLs, developed by Labster, in a first-year undergraduate cell biology course. The evaluation involved surveys and interviews with 352 respondents. Findings indicate that over 90% of students found VLs user-friendly and visually engaging. However, around 60% noted the need for significant technical resources, which could limit accessibility. Over 80% of students reported that VLs increased their motivation, autonomy, interest, and confidence. While only 72% viewed them as potential replacements for traditional labs, more than 90% preferred using VLs as preparatory material for practical sessions. Teachers generally agreed with these perceptions, emphasizing the need for technical support for effective use. They suggested that VLs are better as pre-lab activities rather than full replacements. Both students and teachers recognized VLs as beneficial for academic performance and learning attitude but noted limitations in technical support for home use. The consensus was that VLs are most effective as complementary material before in-person lab sessions.
Adaptive Dynamic Boundary Sliding Mode Control for Robotic Manipulators under Varying Disturbances
Authors: Song Zhendong , Bao Danyang , Wang Wenbin , Zhao Wei
Published: February 2024

This paper introduces an Adaptive Dynamic Bounded Sliding Mode Control (ADBSMC) method that incorporates a disturbance observer to enhance the response characteristics of the robot manipulator while eliminating the reliance on a priori knowledge. The proposed method utilizes nonlinear sliding mode manifolds and fast-terminal-type convergence laws to address errors and parameter uncertainties inherent in the nonlinear system models. The adaptive law is designed to cover all boundary conditions based on the model’s state. It can dynamically determine upper and lower bounds without requiring prior knowledge. Consequently, the ADBSMC control method amalgamates the benefits of adaptive law and fast terminal sliding mode, leading to significant enhancements in control performance compared with traditional sliding mode control (SMC), exhibiting robustness against uncertain disturbances. To mitigate external disturbances, a system-adapted disturbance observer is devised, facilitating real-time monitoring and compensation for system disturbances. The stability of ADBSMC is demonstrated through the Lyapunov method. Simulation and experimental results validate the effectiveness and superiority of the ADBSMC control scheme, showcasing its potential for practical applications.
Control Performance Requirements for Automated Driving Systems
Authors: Vidano Trevor , Assadian Francis
Published: February 2024

This research investigates the development of risk-based performance requirements for the control of an automated driving system (ADS). The proposed method begins by determining the target level of safety for the virtual driver of an ADS. The underlying assumptions are informed by existing data. Next, geometric models of the road and vehicle are used to derive deterministic performance levels of the virtual driver. To integrate the risk and performance requirements seamlessly, we propose new definitions for errors associated with the planner, pose, and control modules. These definitions facilitate the derivation of stochastic performance requirements for each module, thus ensuring an overall target level of safety. Notably, these definitions enable real-time controller performance monitoring, thus potentially enabling fault detection linked to the system’s overall safety target. At a high level, this approach argues that the requirements for the virtual driver’s modules should be designed simultaneously. To illustrate this approach, this technique is applied to a research project available in the literature that developed an automated steering system for an articulated bus. This example shows that the method generates achievable performance requirements that are verifiable through experimental testing and highlights the importance in validating the underlying assumptions for effective risk management.
The Application of Cyanobacteria as a Biofertilizer for Okra (Abelmoschus esculentus) Production with a Focus on Environmental and Ecological Sustainability
Authors: Chanda Saoli , Dattamudi Sanku , Jayachandran Krishnaswamy , Scinto Leonard J. , Bhat Mahadev
Published: February 2024

Cyanobacteria, an important addition to biofertilizers, are gaining popularity for their multifaceted benefits in sustainable agriculture and ecosystem restoration. However, harmful algal blooms (HABs) in freshwater, predominantly caused by cyanobacteria, prevent sunlight penetration into the water and develop hypoxic and anoxic conditions. We collected cyanobacteria slurry from Lake Jesup (Central Florida, USA), repurposed it as a biofertilizer, and incorporated it in a typical South Florida calcite soil for high-value okra (Abelmoschus esculentus; var: Clemson spineless) production. Experiments were conducted at the Organic Garden Shade House and Greenhouse located inside the main campus of the Florida International University (FIU), FL, USA. A two-year experiment with four different treatments was conducted, namely, (a) control (C; no fertilizer applied), (b) total synthetic (TS), (c) total biofertilizer (TB; only cyanobacteria biofertilizer was applied), and (d) half and half (HH; 50% biofertilizer + 50% synthetic fertilizer), which were arranged in a randomized complete block design (RCBD) with six replications for each treatment. Our results indicate that TB and TS produced about 29 to 33% higher SPAD (soil plant analytical development) readings than the control. The absence of interveinal chlorosis (yellowing of leaves) in the TB and HH treatments suggests that the cyanobacteria-based biofertilizer had a role in supplying one of the critical micronutrients, iron (Fe). Analysis of the biofertilizer indicated 2000 ppm Fe content, which directly supports our observation. Similarly, average plant height (61 cm), yield (130 gm per pot), and crop biomass (67 gm) productions were significantly higher in TB than in the control. Overall, this study documents the potential of cyanobacteria biofertilizers as a viable option compared to synthetic fertilizers for sustainable crop production and soil health improvement.
A Multi-Head LSTM Architecture for Bankruptcy Prediction with Time Series Accounting Data
Authors: Pellegrino Mattia , Lombardo Gianfranco , Adosoglou George , Cagnoni Stefano , Pardalos Panos M. , Poggi Agostino
Published: February 2024

With the recent advances in machine learning (ML), several models have been successfully applied to financial and accounting data to predict the likelihood of companies’ bankruptcy. However, time series have received little attention in the literature, with a lack of studies on the application of deep learning sequence models such as Recurrent Neural Networks (RNNs) and the recent Attention-based models in general. In this research work, we investigated the application of Long Short-Term Memory (LSTM) networks to exploit time series of accounting data for bankruptcy prediction. The main contributions of our work are the following: (a) We proposed a multi-head LSTM that models each financial variable in a time window independently and compared it with a single-input LSTM and other traditional ML models. The multi-head LSTM outperformed all the other models. (b) We identified the optimal time series length for bankruptcy prediction to be equal to 4 years of accounting data. (c) We made public the dataset we used for the experiments which includes data from 8262 different public companies in the American stock market generated in the period between 1999 and 2018. Furthermore, we proved the efficacy of the multi-head LSTM model in terms of fewer false positives and the better division of the two classes.
Application of Deep Learning in Predicting Particle Concentration of Gas–Solid Two-Phase Flow
Authors: Wang Zhiyong , Yan Bing , Wang Haoquan
Published: February 2024

Particle concentration is an important parameter for describing the state of gas–solid two-phase flow. This study compares the performance of three methods, namely, Back-Propagation Neural Networks (BPNNs), Recurrent Neural Networks (RNNs), and Long Short-Term Memory (LSTM), in handling gas–solid two-phase flow data. The experiment utilized seven parameters, including temperature, humidity, upstream and downstream sensor signals, delay, pressure difference, and particle concentration, as the dataset. The evaluation metrics, such as prediction accuracy, were used for comparative analysis by the experimenters. The experiment results indicate that the prediction accuracies of the RNN, LSTM, and BPNN experiments were 92.4%, 92.7%, and 92.5%, respectively. Future research can focus on further optimizing the performance of the BPNN, RNN, and LSTM to enhance the accuracy and efficiency of gas–solid two-phase flow data processing.
Quantitative NMR Spectrometry of Phenylpropanoids, including Isoeugenol in Herbs, Spices, and Essential Oils
Authors: Fabry Pascal , Weber Sandra , Teipel Jan , Richling Elke , Walch Stephan G. , Lachenmeier Dirk W.
Published: February 2024

Isoeugenol (2-methoxy-4-(1-propenyl)phenol) has been recently classified as possibly carcinogenic to humans (Group 2B) by the International Agency for Research on Cancer (IARC). This study conducted an analysis of isoeugenol in common herbs and spices, including basil, cinnamon, ginger, and nutmeg, using 1H nuclear magnetic resonance (NMR) spectrometry. Additionally, over 1300 coffee samples were analysed by 1H-NMR for isoeugenol, but it was not detected in any of the analysed samples. Various essential oils, including nutmeg, basil, clove, sweet flag, and ylang-ylang oils, were examined for isoeugenol content. Out of the twelve nutmeg oils tested, four contained isoeugenol, with concentrations ranging from 3.68 ± 0.09 g/kg to 11.2 ± 0.10 g/kg. However, isoeugenol was not detected in the essential oils of calamus, basil, ylang-ylang, and clove using NMR spectrometry. These findings warrant critical evaluation of the previous literature, given reports of high isoeugenol levels in some of these matrices. A toxicological assessment has determined that there is no risk to human health by exposure to isoeugenol via nutmeg essential oils.
Lecithin’s Roles in Oleogelation
Authors: Harasym Joanna , Banaś Karol
Published: February 2024

This manuscript analyzes the research considering the exploitation of lecithin in oleogelation. The main objective of the work was to gather, analyze, and extract from the existing research data the information that enables us to identify lecithin-dependent roles. Oleogelation is still under research, while using various oleogelators and structurants provides changes on different physico-chemical levels. Multivariable formulations do not facilitate the elucidation of the specific role of any of them. Lecithin, due to its complex structure, big molecule, and amphiphilic nature, can provide different functionalities in complex matrices like oleogels. Therefore, this review identifies and categorizes the functionality of lecithin in oleogelation into four main roles: 1. oleogelation facilitator; 2. structure-forming impact; 3. texturing agent; and 4. functionality provider. Also, the origin and structure-forming characteristics of lecithin, as well as a short summary of the oleogelation process itself, are presented. Our critical analysis allowed us to identify the roles of lecithin in the oleogelation process and categorized them as follows: oleogelator, emulsifier, structural organization facilitator, structural modifier, crystal characteristics modifier, self-assembly promoter, thermal behavior changer, hydrogen-bonded networks promoter, hydrogel structure modifier, texture and structural modifier, gel-like state promoter, oil capacity enhancer, functionality provider, shelf life extender, and bioavailability and bioaccessibility enhancer. Lecithin came out as an important and multifunctional compound whose applications in oleogelation need to be thoroughly pre-considered. It is crucial to grasp all the possible roles of used compounds to be able to predict the final functionality and characteristics of formed oleogel matrices.
Using Auschwitz Prisoner Numbers to Correct Deportation Lists
Authors: Stroweis Jean-Pierre
Published: February 2024

A list of the first Jews deported from Compiègne, France on 27 March 1942 to Auschwitz-Birkenau was never found. Similarly, there is no known arrival list for this convoy. All the 1112 men entered the camp, were assigned prisoner numbers, and were then tattooed. In 1978, Serge Klarsfeld created a list by assembling sub-lists from WWII and immediate post-war sources. Despite significant ongoing research by Klarsfeld and others, no definitive list was ever compiled. Material recorded and maintained by the Nazis (daily count book, death registers, entry cards) pertaining to this early period does exist. This paper demonstrates how systematic use of Auschwitz prisoner numbers combined with French censuses and metrical records enabled us to significantly revise our records of who was deported in this transport, by eliminating dozens of names, amending many more, and adding several others.
Translation, Cross-Cultural Adaptation, and Feasibility of the NHPT-E of Manual Dexterity for the Spanish Population
Authors: Moreno-Morente Gema , Hurtado-Pomares Miriam , Sánchez-Pérez Alicia , Terol-Cantero M. Carmen
Published: February 2024

The Nine-Hole Peg Test (NHPT) is considered a “gold standard” for the measurement of manual dexterity. The aim of this study was the translation and culturally adapting the original version of the NHPT. Materials and Methods: The adaptation was carried out following the standardized translation–retrotranslation guidelines and procedures referred to in the literature and in the International Test Commission (CIT). The final Spanish version of the NHPT (NHPT-E) was administered to 40 healthy adults. We evaluated its feasibility by means of a questionnaire elaborated according to Iraossi’s checklist proposal for the pilot test process. Results: Modifications of expression in the grammatical mode of the verbs were performed, as well as the adaptation of some terms used in the three sections of the original version of the test (General Information, Installation, and Application Instructions). In the pilot study, for 95% of the participants, the NHPT-E is a comfortable test to take, and, for 100% of the evaluators, the test includes all the necessary information, with clear instructions and interpretation of the results. Conclusions: The cross-cultural adaptation and pilot study enabled the development of a suitable and viable version of the NHPT-E for use in the Spanish population.
Predictors of Depression in Elderly According to Gender during COVID-19: Using the Data of 2020 Community Health Survey
Authors: Jun Hye-Jung , Kim Kyoung-Mi
Published: February 2024

Background: This study aimed to examine factors influencing depression according to gender in people during COVID-19. Methods: This study was conducted on 61,147 elderly individuals over the age of 65 who participated in the 2020 Community Health Survey (CHS). Data analysis was conducted using SAS 9.4. Results: Elderly females had a higher perceived fear of COVID-19 than males. The common factors affecting depression in elderly individuals were age, monthly income, economic activity, stress, subjective health status, and social support. Among elderly women, changes in residential areas and daily life due to COVID-19 were identified as factors affecting depression. Conclusions: Therefore, during COVID-19, it was necessary to provide customized depression relief programs for the elderly, and it was necessary to find ways for them to positively perceive their health status and increase healthcare efficacy. In the future, it is necessary to pay attention to elderly women living in rural areas and make efforts to ensure that their daily lives are not interrupted by infectious diseases.
Comparison of Health Behaviors of Healthcare Workers and the General Public in Israel: A Cross-Sectional Survey
Authors: Ramot Shira , Tal Orna , Rosenbloom Tova
Published: February 2024

Healthcare workers (HCWs) are role models and advisors for promoting health behaviors among their patients. We conducted a cross-sectional survey to identify and compare the health behaviors of 105 HCWs and 82 members of the Israeli public. Of 13 health behaviors examined, undergoing screening tests, getting influenza vaccines and smoking were significantly different between the HCWs and the public. Further comparison between physicians and other HCWs (e.g., nurses, physiotherapists, dieticians) showed that the physicians reported the least favorable health behaviors: having less than 7 h of sleep, being less likely to eat breakfast, having greater alcohol consumption and being least likely to undergo regular screening tests. Analysis of a composite healthy lifestyle score (which included 11 health behaviors) showed statistically significant differences among the three groups (p = 0.034): only 10.6% of the physicians had a high healthy lifestyle score compared to the other HCWs (34.5%). In conclusion, the HCWs and the public report suboptimal health behaviors. Beyond the concern for HCWs’ personal health, their health behaviors have implications for the health of patients and the general public, as they play an important role in health promotion and counseling. HCWs’ suboptimal “health profile” mandates implementing policies to improve their knowledge of recommended health behaviors, primarily targeting physicians, even at an early phase of their professional journey.
Updated Clinical Classification and Hemodynamic Definitions of Pulmonary Hypertension and Its Clinical Implications
Authors: Kularatne Mithum , Gerges Christian , Jevnikar Mitja , Humbert Marc , Montani David
Published: February 2024

Pulmonary hypertension (PH) refers to a pathologic elevation of the mean pulmonary artery pressure (mPAP) and is associated with increased morbidity and mortality in a wide range of medical conditions. These conditions are classified according to similarities in pathophysiology and management in addition to their invasive hemodynamic profiles. The 2022 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension present the newest clinical classification system and includes significant updates to the hemodynamic definitions. Pulmonary hypertension is now hemodynamically defined as an mPAP > 20 mmHg, reduced from the previous threshold of ≥25 mmHg, due to important insights from both normative and prognostic data. Pulmonary vascular resistance has been extended into the definition of pre-capillary pulmonary hypertension, with an updated threshold of >2 Wood Units (WU), to help differentiate pulmonary vascular disease from other causes of increased mPAP. Exercise pulmonary hypertension has been reintroduced into the hemodynamic definitions and is defined by an mPAP/cardiac output slope of >3 mmHg/L/min between rest and exercise. While these new hemodynamic thresholds will have a significant impact on the diagnosis of pulmonary hypertension, no evidence-based treatments are available for patients with mPAP between 21–24 mmHg and/or PVR between 2–3 WU or with exercise PH. This review highlights the evidence underlying these major changes and their implications on the diagnosis and management of patients with pulmonary hypertension.
Deterioration of Kidney Function Is Affected by Central Arterial Stiffness in Late Life
Authors: Tap Lisanne , Borsboom Kim , Corsonello Andrea , Lattanzio Fabrizia , Mattace-Raso Francesco
Published: February 2024

Cardiovascular diseases affect kidney function. The aim of this study was to investigate the possible associations between hemodynamic parameters and change in kidney function in individuals aged 75 years and older. Data on hemodynamics and blood and urine samples were collected at baseline and during one-year visits. Hemodynamics were split into two groups based on median values. Changes in the estimated glomerular filtration rate (eGFR) were investigated between low and high groups for each hemodynamic parameter using analysis of variance. Changes in the albumin–creatinine ratio (ACR) were examined as binary outcomes (large increase vs. stable) using logistic regression. The population consisted of 252 participants. Participants in the high central systolic blood pressure (cSBP) group had a greater decline in eGFR than participants in the low cSBP group (−6.3% vs. −2.7%, p = 0.006). Participants in the high aortic pulse wave velocity (aPWV) group had a greater decline in eGFR than those in the low aPWV group (−6.8% vs. −2.5%, p = 0.001). Other hemodynamic parameters were not associated with eGFR changes. Hemodynamics were not associated with changes in the ACR; aPWV and cSBP appear to be predictors for eGFR decline in older age; monitoring and treatment of elevated stiffness might be helpful in order to prevent kidney function decline.
Anti-Anginal Efficacy of Zibotentan in the Coronary Slow-Flow Phenomenon
Authors: Pasupathy Sivabaskari , Tavella Rosanna , Zeitz Christopher , Edwards Suzanne , Worthley Matthew , Arstall Margaret , Beltrame John F.
Published: February 2024

Background: Patients with coronary microvascular disorders often experience recurrent angina for which there are limited evidence-based therapies. These patients have been found to exhibit increased plasma levels of endothelin; thus, selective endothelin–A (Et-A) receptor blockers such as zibotentan may be an effective anti-anginal therapy in these patients. The study evaluated the impact of a 10 mg daily dose of zibotentan on spontaneous angina episodes in patients with the coronary slow-flow phenomenon who had refractory angina (i.e., experiencing angina at least three times/week despite current anti-anginal therapy). Methods: Using a randomized, double-blind, placebo-controlled, crossover trial design with 4-week treatment periods, 18 patients (63.2 ± 9.9 years, 33% females) were recruited. The primary endpoint was angina frequency as measured by an angina diary, with secondary endpoints including nitrate consumption, angina duration/severity and the Seattle Angina Questionnaire (SAQ) domains. Results: During the 4 weeks of therapy, angina frequency significantly improved with zibotentan therapy (placebo 41.4 (58.5) vs. zibotentan 29.2 (31.6), p < 0.05), and sublingual nitrate consumption significantly reduced (placebo 11.8 (15.2) vs. zibotentan 8.8 (12.9), p < 0.05. Conclusions: Zibotentan improved the frequency of spontaneous angina episodes and reduced sublingual nitrate consumption in patients unresponsive to standard anti-anginal therapy.
Isolated Depo-Medrol Administration under Tenon’s Capsule for Post-COVID-19 Uveitis in a Child: A Case Report and Literature Review
Authors: Modrzejewska Monika , Cyrankiewicz Joanna , Zdanowska Oliwia , Bosy-Gąsior Wiktoria
Published: February 2024

Coronavirus disease 2019 (COVID-19) can manifest with ocular symptoms. These symptoms can be divided into isolated events attributed to COVID-19, and those occurring in multisystem inflammatory syndrome in children (MIS-C), a newly diagnosed disease entity associated with COVID-19 infection. Currently, the literature lacks specific guidelines and treatment regimens for COVID-19 ocular symptoms, especially in children. The authors present the case of a 14-and-a-half-year-old boy with bilateral uveitis of the anterior and posterior segments along with vasculitis and optic neuritis associated with SARS-CoV-2 infection. The authors also perform an up-to-date review of all available publications on the treatment of post-COVID-19 uveitis in children described in the literature between 2020 and 2023. In the case described by the authors, the treatment involved a Depo-Medrol 40 mg/mL injection uder the Tenon capsule, with two subconjunctival injections of epinephrine, topical steroid therapy and non-steroidal anti-inflammatory drugs: dexamethasone 0.1%; diclofenac eye drops. In addition, acetylsalicylic acid (150 mg) and pentoxifylline (100 mg, orally) were administered throughout the course of the disease as well as up to 12 months after its termination, until a complete improvement in visual acuity and the withdrawal of ocular lesions were achieved. It can be assumed that this type of treatment is far more beneficial for pediatric patients, with an effect comparable to systemic steroid administration with a preserved improvement in retinal-vascular circulation, without exposing the child to systemic post-steroid complications.
Peak Slope Ratio of the Recruitment Curves Compared to Muscle Evoked Potentials to Optimize Standing Configurations with Percutaneous Epidural Stimulation after Spinal Cord Injury
Authors: Alazzam Ahmad M. , Ballance William B. , Smith Andrew C. , Rejc Enrico , Weber Kenneth A. , Trainer Robert , Gorgey Ashraf S.
Published: February 2024

Background: Percutaneous spinal cord epidural stimulation (pSCES) has effectively restored varying levels of motor control in persons with motor complete spinal cord injury (SCI). Studying and standardizing the pSCES configurations may yield specific motor improvements. Previously, reliance on the amplitude of the SCES-evoked potentials (EPs) was used to determine the correct stimulation configurations. Methods: We, hereby, retrospectively examined the effects of wide and narrow-field configurations on establishing the motor recruitment curves of motor units of three different agonist–antagonist muscle groups. Magnetic resonance imaging was also used to individualize SCI participants (n = 4) according to their lesion characteristics. The slope of the recruitment curves using a six-degree polynomial function was calculated to derive the slope ratio for the agonist–antagonist muscle groups responsible for standing. Results: Axial damage ratios of the spinal cord ranged from 0.80 to 0.92, indicating at least some level of supraspinal connectivity for all participants. Despite the close range of these ratios, standing motor performance was enhanced using different stimulation configurations in the four persons with SCI. A slope ratio of ≥1 was considered for the recommended configurations necessary to achieve standing. The retrospectively identified configurations using the supine slope ratio of the recruitment curves of the motor units agreed with that visually inspected muscle EPs amplitude of the extensor relative to the flexor muscles in two of the four participants. Two participants managed to advance the selected configurations into independent standing performance after using tonic stimulation. The other two participants required different levels of assistance to attain standing performance. Conclusions: The findings suggest that the peak slope ratio of the muscle agonists–antagonists recruitment curves may potentially identify the pSCES configurations necessary to achieve standing in persons with SCI.
The Safety and Effectiveness of Apixaban in Patients with End-Stage Kidney Disease on Dialysis: A Retrospective Observational Study
Authors: El Nekidy Wasim , Abidi Emna , Nabil Said , Kendakji Saba , Ali Moatasem , Aburuz Salahdein , Atallah Bassam , Hijazi Fadi , Mallat Jihad , Akour Amal
Published: February 2024

Background: Apixaban has been increasingly utilized for various FDA-approved indications, including stroke prevention and venous thromboembolism (VTE) treatment in patients with end stage kidney disease (ESKD) on hemodialysis. However, the safety and efficacy of its use in this population is not well established. Hence, the purpose of this study is to evaluate the safety and effectiveness of apixaban by examining outcomes in this population. Methods: This was a retrospective observational study that involved adults with ESKD who were on hemodialysis and prescribed apixaban from our hospital’s outpatient pharmacy between 1 May 2015, and 31 March 2022. Demographics, apixaban indications, dose appropriateness, concomitant antiplatelet use, and comorbidities data were collected. Bleeding and thromboembolic events were also collected. Results: Sixty-six patients fulfilled the inclusion criteria, 50% of them males. Median age was 71 (63.5–82) years, and the median BMI 28.2 (59.5–86.25) kg/m2. The median follow-up time was 5 (1.9–12.3) months. Concomitant antiplatelet use (39.4%) and high medication adherence (84.8%) were observed. During follow-up, major bleeding events occurred in 15.2% of cases, with minor bleeding being more common (36.4%), and VTE and stroke events occurred in 4.5% of cases; appropriate dosing was prevalent (62.1%), and there was an overall all-cause mortality rate of 34.8%. Most patients received a 2.5 mg BID apixaban dose (56.1%), including both NVAF and VTE groups. Notably, the multivariate logistic regression analysis indicated that weight, and daily dose were insignificant predictors of bleeding events (p = 0.104, 0.591), however, the BMI was the main independent risk factor for bleeding in this population [OR = 0.9, 95% CI: 0.8–0.99; p = 0.023]. Conclusions: Our analysis of apixaban-treated ESKD patients highlights that the risk of bleeding is significant, and BMI was the main independent risk factor. A larger prospective study is needed to confirm our findings.
The Effect of War on STEMI Incidence: Insights from Intensive Cardiovascular Care Unit Admissions
Authors: Loutati Ranel , Bruoha Sharon , Taha Louay , Karmi Mohammad , Perel Nimrod , Maller Tomer , Amsalem Itshak , Hitter Rafael , Levi Nir , Zacks Netanel , Shrem Maayan , Amro Motaz , Shuvy Mony , Glikson Michael , Asher Elad
Published: February 2024

(1) Background: The impact of armed conflicts on public health is undeniable, with psychological stress emerging as a significant risk factor for cardiovascular disease (CVD). Nevertheless, contemporary data regarding the influence of war on CVD, and especially on acute coronary syndrome (ACS), are scarce. Hence, the aim of the current study was to assess the repercussions of war on the admission and prognosis of patients admitted to a tertiary care center intensive cardiovascular care unit (ICCU). (2) Methods: All patients admitted to the ICCU during the first three months of the Israel–Hamas war (2023) were included and compared with all patients admitted during the same period in 2022. The primary outcome was in-hospital mortality. (3) Results: A total of 556 patients (184 females [33.1%]) with a median age of 70 (IQR 59–80) were included. Of them, 295 (53%) were admitted to the ICCU during the first three months of the war. Fewer Arab patients and more patients with ST-segment elevation myocardial infraction (STEMI) were admitted during the war period (21.8% vs. 13.2%, p < 0.001, and 31.9% vs. 24.1%, p = 0.04, respectively), whereas non-STEMI (NSTEMI) patients were admitted more frequently in the pre-war year (19.3% vs. 25.7%, p = 0.09). In-hospital mortality was similar in both groups (4.4% vs. 3.4%, p = 0.71; HR 1.42; 95% CI 0.6–3.32, p = 0.4). (4) Conclusions: During the first three months of the war, fewer Arab patients and more STEMI patients were admitted to the ICCU. Nevertheless, in-hospital mortality was similar in both groups.
Switching from Intravenous to Subcutaneous Biological Therapy for Inflammatory Bowel Disease Patients Remains a Challenge
Authors: Richter Vered , Cohen Daniel L. , Kriger-Sharabi Ofra , Zelnik Yovel Dana , Kochen Nadav , Broide Efrat , Shirin Haim
Published: February 2024

Biological inflammatory bowel disease (IBD) medications, once limited to intravenous (IV) administration, can now be administered both via IV and subcutaneously (SC). This study investigates patient preferences, willingness to switch from IV to SC, and associated factors. A questionnaire covering demographics, disease-related inquiries, quality of life, and IBD medication preferences was distributed via email, the Israeli Crohn’s Disease and Ulcerative Colitis Foundation, infusion centers, and clinics. From 454 IBD patients (median age: 42 years; 55.7% female), responses revealed a preference for SC every 8 weeks, which is comparable to daily oral dosing. Both options were significantly favored over IV every 8 weeks and SC every 2 weeks, with no statistically significant differences between the latter two. However, among patients who were experienced with both SC and IV administration, a clear preference for SC administration every 2 weeks over IV every 8 weeks surfaced. Among IV-treated patients, 54.5% resisted switching to SC. Key reasons for this included medical staff presence (57.7%), a fear of needles (46.4%), belief in infusion efficacy (37.1%), and longer intervals between infusions (36.1%). Findings suggest that transitioning from IV to SC treatment is challenging due to patient resistance, which is influenced by specific factors. Identifying and addressing these obstacles is crucial for optimizing IBD management.
Current Trends in Gait Rehabilitation for Stroke Survivors: A Scoping Review of Randomized Controlled Trials
Authors: Teodoro Joana , Fernandes Sónia , Castro Cidália , Fernandes Júlio Belo
Published: February 2024

Background: Stroke stands as a significant global health concern, constituting a leading cause of disability worldwide. Rehabilitation interventions are crucial in aiding the recovery of stroke patients, contributing to an overall enhancement in their quality of life. This scoping review seeks to identify current trends in gait rehabilitation for stroke survivors. Methods: The review followed the methodological framework suggested by Arksey and O’Malley. Electronic databases, such as CINAHL Complete, MEDLINE Complete, and Nursing & Allied Health Collection, were systematically searched in November 2023. Inclusion criteria comprised papers published in either English or Portuguese from 2013 to 2023. Results: From the initial search, a total of 837 papers were identified; twenty-one papers were incorporated into this review. Thirteen distinct categories of gait rehabilitation interventions were identified, encompassing diverse approaches. These categories comprise conventional rehabilitation exercises, traditional gait training with integrated technology, and gait training supported by modern technologies. Conclusions: Although traditional rehabilitation exercises have historically proven effective in aiding stroke survivors, a recent trend has emerged, emphasizing the development and integration of innovative therapeutic approaches that harness modern technologies.
Exploiting the Features of Clinical Judgment to Improve Assessment of Disease Severity in the Emergency Department: An Acutelines Study
Authors: Visser Martje , Rossi Daniel , Bouma Hjalmar R. , ter Maaten Jan C.
Published: February 2024

Background: Clinical judgment, also known as gestalt or gut feeling, can predict deterioration and can be easily and rapidly obtained. To date, it is unknown what clinical judgement precisely entails. The aim of this study was to elucidate which features define the clinical impression of health care professionals in the ED. Method: A nominal group technique (NGT) was used to develop a consensus-based instrument to measure the clinical impression score (CIS, scale 1–10) and to identify features associated with either a more severe or less severe estimated disease severity. This single-center observational cohort study included 517 medical patients visiting the ED. The instrument was prospectively validated.. The predictive value of each feature for the clinical impression was assessed using multivariate linear regression analyses to adjust for potential confounders and validated in the infection group. Results: The CIS at the ED was associated with ICU admission (OR 1.67 [1.37–2.03], p < 0.001), in-hospital mortality (OR 2.25 [1.33–3.81], p < 0.001), and 28-day mortality (OR 1.33 [1.07–1.65], <0.001). Dry mucous membranes, eye glance, red flags during physical examination, results of arterial blood gas analysis, heart and respiratory rate, oxygen modality, triage urgency, and increased age were associated with a higher estimated disease severity (CIS). On the other hand, behavior of family, self-estimation of the patient, systolic blood pressure, and Glascow Coma Scale were associated with a lower estimated disease severity (CIS). Conclusion: We identified several features that were associated with the clinical impression of health care professionals in the ED. Translating the subjective features and objective measurements into quantifiable parameters may aid the development of a novel triage tool to identify patients at risk of deterioration in the ED.