bluuebunny/crossref_metadata_2025 huggingface dataset:
Support of Migrant Reception, Integration, and Social Inclusion by Intelligent Technologies
Authors: Wanner Leo , Bowen Daniel , Burgos Marta , Carrasco Ester , Černocký Jan , Codina Toni , Danilins Jevgenijs , Davey Steffi , de Lara Joan , Dimopoulou Eleni , Egorova Ekaterina , Gebhard Christine , Grivolla Jens , Jaramillo-Rojas Elena , Klusch Matthias , Mavropoulos Athanasios , Moudatsou Maria , Nikolaidou Artemisia , Ntioudis Dimos , Rodríguez Irene , Rosgova Mirela , Shekhawat Yash , Shvets Alexander , Sobko Oleksandr , Tzionis Grigoris , Vrochidis Stefanos
Published: November 2024

Apart from being an economic struggle, migration is first of all a societal challenge; most migrants come from different cultural and social contexts, do not speak the language of the host country, and are not familiar with its societal, administrative, and labour market infrastructure. This leaves them in need of dedicated personal assistance during their reception and integration. However, due to the continuously high number of people in need of attendance, public administrations and non-governmental organizations are often overstrained by this task. The objective of the Welcome Platform is to address the most pressing needs of migrants. The Platform incorporates advanced Embodied Conversational Agent and Virtual Reality technologies to support migrants in the context of reception, integration, and social inclusion in the host country. It has been successfully evaluated in trials with migrants in three European countries in view of potentially deviating needs at the municipal, regional, and national levels, respectively: the City of Hamm in Germany, Catalonia in Spain, and Greece. The results show that intelligent technologies can be a valuable supplementary tool for reducing the workload of personnel involved in migrant reception, integration, and inclusion.
Mitigating Bias Due to Race and Gender in Machine Learning Predictions of Traffic Stop Outcomes
Authors: Saville Kevin , Berger Derek , Levman Jacob
Published: November 2024

Traffic stops represent a crucial point of interaction between citizens and law enforcement, with potential implications for bias and discrimination. This study performs a rigorously validated comparative machine learning model analysis, creating artificial intelligence (AI) technologies to predict the results of traffic stops using a dataset sourced from the Montgomery County Maryland Data Centre, focusing on variables such as driver demographics, violation types, and stop outcomes. We repeated our rigorous validation of AI for the creation of models that predict outcomes with and without race and with and without gender informing the model. Feature selection employed regularly selects for gender and race as a predictor variable. We also observed correlations between model performance and both race and gender. While these findings imply the existence of discrimination based on race and gender, our large-scale analysis (>600,000 samples) demonstrates the ability to produce top performing models that are gender and race agnostic, implying the potential to create technology that can help mitigate bias in traffic stops. The findings encourage the need for unbiased data and robust algorithms to address biases in law enforcement practices and enhance public trust in AI technologies deployed in this domain.
Crossbreeding and Backcrossing in the Pyrethroid-Resistant Ladybird Beetle Eriopis connexa (Germar) Determines Resistance in Offspring
Authors: Rodrigues Alice S. , Barbosa Paulo R. R. , Nascimento Deividy V. , Torres Jorge B.
Published: November 2024

The conservation of the predatory ladybird beetle, Eriopis connexa (Germar) after its release also relies on its resistance and the performance of its progenies. When resistant individuals are released or evolve in the field through mating with susceptible pairs, we anticipate that they will generate a resistant progeny, inheriting the resistance to lambda-cyhalothrin through an autosomal mechanism. The susceptibility of a field-collected population (EcGA) was characterized and determined by the performance of their progenies generated through mating with a resistant parent (EcViR). We paired virgin adults from the EcGA and EcViR populations, observing how their progenies developed, reproduced, and survived when exposed to dried lambda-cyhalothrin residues applied at field rates. Adults from the EcGA population were ~200-fold more susceptible than those of the EcViR population. Developmental times from larva to adult emergence for EcGA individuals were delayed by approximately 6 days and generated smaller adults compared to EcViR and their progenies. The egg production did not differ across parents and progenies, but females from EcGA and EcGA × EcViR progenies produced 130 more eggs in comparison to EcViR females during the 35-day evaluation period. Exposure to lambda-cyhalothrin resulted in 77.4 to 100% survival for adults from EcViR × EcGA progenies and EcViR parents, while EcGA and the population standard for susceptibility maintained in the laboratory (EcFM) did not survive the insecticide exposure. These findings indicate that field crosses between EcViR and EcGA will improve their progenies’ biological performance compared to the EcViR parents and will maintain a high lambda-cyhalothrin survival rate.
Distinct Patterns of Smooth Muscle Phenotypic Modulation in Thoracic and Abdominal Aortic Aneurysms
Authors: Lin Chien-Jung , Keating Campbell , Roth Robyn , Caliskan Yasar , Nazzal Mustafa , Exil Vernat , DiPaolo Richard , Verma Divya Ratan , Harjai Kishore , Zayed Mohamed , Lin Chieh-Yu , Mecham Robert P. , Jain Ajay K.
Published: November 2024

Thoracic and abdominal aortic aneurysms (TAAs and AAAs, respectively) share morphological features but have distinct clinical and hereditary characteristics. Studies using bulk RNA comparisons revealed distinct patterns of gene expression in human TAA and AAA tissues. However, given the summative nature of bulk RNA studies, these findings represent the totality of gene expression without regards to the differences in cellular composition. Single-cell RNA sequencing provides an opportunity to interrogate cell-type-specific transcriptomes. Single cell RNA sequencing datasets from mouse TAA (GSE153534) and AAA (GSE164678 and GSE152583) with respective controls were obtained from the Gene Expression Omnibus. Bioinformatic analysis was performed with the Seurat 4, clusterProfiler, and Connectome software packages (V1.0.1). Immunostaining was performed with standard protocols. Within normal and aneurysmal aortae, three unique populations of cells that express smooth muscle cell (SMC) markers were identified (SMC1, SMC2, and SMCmod). A greater proportion of TAA SMCs clustered as a unique population, SMCmod, relative to the AAA SMCs (38% vs. 10–12%). These cells exhibited transcriptional features distinct from other SMCs, which were characterized by Igfbp2 and Tnfrsf11b expression. Genes upregulated in TAA SMCs were enriched for the Reactome terms “extracellular matrix organization” and “insulin-like growth factor (IGF) transport and uptake by IGF binding proteins (IGFBPs)”, indicating a role for Igfbp2 in TAA pathogenesis. Regulon analysis revealed transcription factors enriched in TAAs and AAAs. Validating these mouse bioinformatic findings, immunostaining demonstrated that both IGFBP2 and TNFRSF11B proteins increased in human TAAs compared to AAAs. These results highlight the unique cellular composition and transcriptional signature of SMCs in TAAs and AAAs. Future studies are needed to reveal the pathogenetic pathways of IGFBP2 and TNFRSF11B.
Transcatheter Repair of Tricuspid Valve Regurgitation: A Systematic Review
Authors: Srinivasan Aswin , Brown Jonathan , Rhodes Alexander , Khan Sobia , Chinta Viswanath , Loyalka Pranav , Kumar Arnav
Published: November 2024

Introduction: Clinically significant severe tricuspid regurgitation (TR) is a common untreated pathology associated with increased mortality. Even though surgical valve replacement has been the mainstay option, transcatheter intervention is a novel and potentially effective tool. To the best of our knowledge, this is the first systematic review that assessed and compared clinical and echocardiographic outcomes of coaptation and annuloplasty devices in patients with clinically significant TR. Methods: PubMed, the Cochrane Central Register of Controlled Trials, and EMBASE were searched for articles published from August 2016 until February 2023. Primary endpoints were technical and procedural successes. Secondary endpoints were TR grade, NYHA, change in 6 min walk distance (6MWD), and echocardiographic parameters at 30-day follow-up. Results: We included thirty-eight studies consisting of 2273 patients with severe symptomatic TR (NYHA III-IV 77% and severe/massive/torrential TR 83.3%) and high surgical risk (mean EUROSCORE of 7.54). The technical success for the annuloplasty devices was 96.7% and for the coaptation device was 94.8%. The procedural success for the annuloplasty devices was 64.6% and for the coaptation device was 81.4%. The 6MWD increased by 17 m for the coaptation devices and increased by 44 m after 30 days for the annuloplasty devices. A reduction in TR grade to <2 was seen in 70% of patients with coaptation and 59% of patients with annuloplasty devices. Conclusions: Transcatheter tricuspid valve intervention appears to be feasible and is associated with favorable outcomes.
Staging Accuracy and Prognostic Value of Prostate-Specific Membrane Antigen PET/CT Strongly Depends on Lymph Node Tumor Burden
Authors: Özman Oktay , Veerman Hans , Contieri Roberto , Droghetti Matteo , Donswijk Maarten L. , Hagens Marinus J. , Van Leeuwen Pim J. , Vis André N. , van der Poel Henk G.
Published: November 2024

Objectives: To explore the factors affecting the lymph node metastasis (LNM) detection performance of prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) and to evaluate its prognostic value for biochemical recurrence after radical prostatectomy (RP). Methods: Patients who had intermediate- or high-risk prostate cancer and underwent robot-assisted (RA)RP between 2017 and 2021 were included. Initial lymph node staging was carried out using PSMA PET/CT. Sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values were calculated. A cut-off value for LNM tumor deposit size that maximizes specificity was investigated and a post hoc specificity analysis was carried out. In survival analysis for biochemical progression-free survival (bPFS) after RP, Kaplan–Meier curves of molecular imaging (mi)N0 and miN1 patients were compared using the log-rank test and separate Cox regression models were developed to reveal the significance of PSMA PET/CT staging in pre- and post-surgery settings. Results: In 583 patients with a prevalence of pathology-proven LNM of 27.4%, overall sensitivity, specificity, PPV, and NPV of PSMA PET/CT per patient were 26.3% [95%CI 18.9–35.5], 93.9% [95%CI 84.9–100], 61.8% [95%CI 44.5–83.5], and 77.1% [95%CI 69.7–85.1], respectively. PSMA PET/CT showed a better sensitivity as LNM tumor deposit size increased (p = 0.003 OR 2.4 [95%CI 1.3–4.4]) and a better specificity in pT3-4 tumors (96.1%) versus pT2 (91.1%, p = 0.024 OR 2.7 [95%CI 1.1–6.3]). After adjustment according to 5.5 mm LNM tumor deposit size, which showed the best discriminative performance (AUC: 0.905 [95%CI 0.804–1.000, p < 0.001]), overall sensitivity tripled (90.2%, p < 0.001). The 1-year bPFS was 56.0% and 83.3% for miN1 and miN0 patients, respectively (p < 0.001). Whereas miN0pN1 was not, miN1pN1 disease was independently associated with decreased bPFS (HR:2.1 95%CI 1.3–3.4, p < 0.001). Conclusions: PSMA PET/CT has a lymph node tumor burden-dependent and cohort-driven diagnostic ability but consequently a strong independent prognostic value for predicting biochemical recurrence after RARP.
Clinical Outcomes of Tube Feeding vs. Hand Feeding in Advanced Dementia
Authors: Chua Wei Yu , Tan Eng-King
Published: November 2024

Dementia is a growing public health issue, with the number of cases projected to triple by 2050 as society ages. Although the American Geriatrics Society recommends careful hand feeding over tube feeding for patients with advanced dementia, an increasing proportion of patients are receiving tube feeding. Although decisions regarding tube feeding are often based on the physician, recent studies have shown that tube feeding has significant implications for clinical outcomes and quality of life. Tube feeding is associated with an increased risk of mortality, pneumonia and the use of restraints. Although tube feeding may reduce caregiver burden, it does not improve survival or nutritional status and incurs significant financial costs. Caregivers that hand feed patients often experience stress, particularly in regions where support services are limited. However, there are various strategies available to promote hand feeding which include environmental interventions, mealtime assistance and caregiver training. Although hand feeding is the most comfortable option for patients, the frequency of mealtimes and financial and mental health impact on caregivers requires the physician to conduct a holistic assessment of the patient when deciding on the mode of feeding for patients with advanced dementia.
Harnessing the Power of ChatGPT in Cardiovascular Medicine: Innovations, Challenges, and Future Directions
Authors: Leon Marc , Ruaengsri Chawannuch , Pelletier Glenn , Bethencourt Daniel , Shibata Masafumi , Flores Manuel Quiroz , Shudo Yasuhiro
Published: November 2024

Cardiovascular diseases remain the leading cause of morbidity and mortality globally, posing significant challenges to public health. The rapid evolution of artificial intelligence (AI), particularly with large language models such as ChatGPT, has introduced transformative possibilities in cardiovascular medicine. This review examines ChatGPT’s broad applications in enhancing clinical decision-making—covering symptom analysis, risk assessment, and differential diagnosis; advancing medical education for both healthcare professionals and patients; and supporting research and academic communication. Key challenges associated with ChatGPT, including potential inaccuracies, ethical considerations, data privacy concerns, and inherent biases, are discussed. Future directions emphasize improving training data quality, developing specialized models, refining AI technology, and establishing regulatory frameworks to enhance ChatGPT’s clinical utility and mitigate associated risks. As cardiovascular medicine embraces AI, ChatGPT stands out as a powerful tool with substantial potential to improve therapeutic outcomes, elevate care quality, and advance research innovation. Fully understanding and harnessing this potential is essential for the future of cardiovascular health.
Association Between Thyrotoxicosis and Cerebral Venous Thrombosis
Authors: Paccagnella Margherita , Pizzo Anna , Calabrò Veronica , Velardi Valerio , Fabris Bruno , Bernardi Stella
Published: November 2024

Thyrotoxicosis appears to be a predisposing factor for cerebral venous thrombosis (CVT), which is a rare but important cause of stroke in young adults. The presentation of CVT is highly variable, ranging from a history of headaches (in the majority of cases) to deep coma, with the latter requiring invasive neurosurgical decompression. Although the long-term outcomes of CVT are favorable, multicenter cohort studies have shown that death may occur in up to 4% of cases in the acute phase and 8–10% of cases in the long term. It has been argued that the substantial decrease in mortality in patients with CVT that has been observed during the past few decades may be the result of an increased awareness of CVT among clinicians. Given that thyrotoxicosis is a risk factor for CVT, clinicians (and endocrinologists) should be alert to the possibility of CVT in patients with thyroid disease in order to prevent it whenever possible or treat it promptly. In this review, we provide an updated overview of the characteristics of patients with thyrotoxicosis who presented with CVT, the underlying mechanisms, and a few tips for clinicians.
Impact of Hyperuricemia on Clinical Outcomes in Sepsis Patients: A Retrospective Cohort Study
Authors: Alshehri Abdulmajeed M. , Alrashed Mohammed , Shawaqfeh Mohammad , Almutairi Fahad , Alanazi Abdulsalam , Alfaifi Mohammed , Albekairy Nataleen A. , Alshaya Abdulrahman , Al Yami Majed S. , Almohammed Omar A. , Al Harbi Shmeylan
Published: November 2024

Background: Hyperuricemia has been linked to various adverse clinical outcomes. Data on the clinical outcomes and the relationship between hyperuricemia and sepsis remain limited. The aim of this study was to evaluate the impact of hyperuricemia on clinical outcomes in sepsis patients and to identify whether it can predict the mortality in this patient population. Methods: This was a retrospective cohort study of adult patients with sepsis admitted to the intensive care unit (ICU) from 1 January 2021 to 31 December 2023. The patients were divided into hyperuricemia and non-hyperuricemia groups. Hyperuricemia was defined as a serum uric acid level > 416.4 µmol/L (7.0 mg/dL) in males or >357.0 µmol/L (6.0 mg/dL) in females based on the first serum uric acid reading within 24 h of ICU admission. The primary outcome of this study was ICU mortality. Secondary outcomes included in-hospital mortality, progression to septic shock, and ICU and hospital lengths of stay (LOSs). Results: A total of 599 patients were included in the study. Among these, 303 were in hyperuricemia group, while 296 were in the non-hyperuricemia group. The incidence of ICU and in-hospital mortality was higher in the hyperuricemia group compared to the non-hyperuricemia group (26.7% vs. 18.9% (p < 0.001) and 34.7% vs. 19.3% (p < 0.001), respectively). After adjusting for cofounders, hyperuricemia was not a predictor of ICU mortality (OR 1.52, 95% CI 0.95–2.43, p = 0.083). Most secondary outcomes were similar between the groups. However, the hyperuricemia group had a higher incidence of progression to septic shock (67.3% vs. 50.7%, p < 0.001), and hospital LOS was significantly longer in the hyperuricemia group (384 vs. 264 h, p = 0.004). Conclusions: Our findings demonstrated that hyperuricemia in sepsis patients was associated with worse clinical outcomes such as higher ICU and hospital mortality. Moreover, there was a higher incidence of septic shock progression and longer hospital LOS. The other outcomes were not statistically significantly different. Further prospective research is warranted to confirm these findings.
Midterm Outcome of Balloon-Expandable Covered Stenting of Femoral Access Site Complications
Authors: Szentiványi András , Borzsák Sarolta , Süvegh András , Bérczi Ákos , Szűcsborús Tamás , Ruzsa Zoltán , Fontos Géza , Szalay Csaba Imre , Papp Roland , Molnár Levente , Csobay-Novák Csaba
Published: November 2024

Background: Vascular access site complications (VASCs) after endovascular interventions requiring a large-bore access are frequent and known to be associated with increased morbidity and mortality. Although balloon-expandable covered stents (BECSs) are increasingly used in such indications, their performance in this rather hostile territory is currently unknown. We aimed to evaluate the safety and efficacy of BECSs in common femoral artery (CFA) VASCs management. Methods: This is a national multicenter retrospective study of all patients who underwent BECS implantation of the CFA due to a VASCs after an endovascular procedure between January 2020 and May 2023 in major tertiary referral centers in Hungary. Operative data were collected and follow-up ultrasound examinations were performed. Our study is registered on ClinicalTrials.gov (NCT05220540) and followed the STROBE guidelines. Results: Of the 23 patients enrolled (13 females, mean age: 74.2 ± 8.6), technical success was achieved in 21 (91.3%) cases, with one perioperative death. After an average follow-up of 18.0 ± 11.4 months, another nine (39.1%) deaths occurred, and one was VASCs-associated. BECS occlusion was detected in one (4.3%) patient, being the only reintervention (4.3%) where revascularization was also achieved. Conclusions: Although BECS implantation for CFA VASCs is feasible with a relatively high technical success rate, the mortality rate is non-negligible. Until adequately evaluated, BECS implantation in such indications is to be used with caution, ideally only within the framework of a trial.
The Intra-Meatal Application of Tadalafil Cream Versus Oral Administration Efficacy and Safety: Results from a Randomized, Two-Administration Route, Cross-Over Clinical Trial
Authors: Trifu Dragoș-Mihail , Leucuța Daniel-Corneliu , Pintea-Trifu Martina-Luciana , Elec Florin , Crișan Nicolae , Eniu Dan , Coman Ioan
Published: November 2024

Background: Tadalafil cream, a topically administered phosphodiesterase-5 inhibitor (PDE5), presents a potential alternative to oral PDE5 inhibitors like tadalafil for the treatment of erectile dysfunction (ED). This study evaluates the non-inferiority and potential superiority of tadalafil cream compared to oral tadalafil. Methods: This randomized controlled trial employed a cross-over design with two treatment periods of two weeks each, separated by a one-week washout phase. Thirty-five male participants aged 18–75 with diagnosed ED (International Index of Erectile Function–Erectile function: IIEF-EF score < 26) were randomized to receive either tadalafil cream or oral tadalafil. Tadalafil cream was applied topically, while tadalafil was taken orally. The primary endpoint was IIEF-EF, and secondary endpoints were measured using the International Index of Erectile Function (IIEF) domain scores. Adverse events and treatment preferences were also assessed. Results: Tadalafil cream showed a higher increase in sexual function across all IIEF domains compared to oral tadalafil. The lower bounds of the confidence interval [improvement: final−baseline scores between tadalafil cream and oral tadalafil 0.72 (95% CI −2.72–4.15)] were above the non-inferiority margin of −3.22, confirming tadalafil cream’s non-inferiority in the erectile function domain. In the intercourse satisfaction domain, tadalafil cream was superior to oral tadalafil. At the end of the trial, 88.57% of participants preferred tadalafil cream (95% CI 73.26%–96.79%), a result significantly above the non-inferiority margin that indicated superiority (p < 0.001). No systemic adverse events were reported for tadalafil cream, and significant differences in dizziness, headache, nasal congestion, and erythema were observed between the two treatments. Conclusions: Tadalafil cream is a safe and effective treatment for erectile dysfunction, demonstrating non-inferiority and potential superiority over oral tadalafil, with a high patient preference. Its topical administration offers a promising alternative for patients, particularly those with cardiovascular diseases where oral PDE5 inhibitors are contraindicated or less well tolerated.
Opinions of Psychologists in Poland Regarding the Possibility of Prescribing Psychotropic Drugs—A Cross-Sectional Study
Authors: Banasiewicz Jolanta , Rozenek Hanna , Kos y Gonzales Monika , Wójtowicz Stanisław , Zaręba Kornelia
Published: November 2024

Background/Objectives: Discussions about the possibility of psychologists prescribing medications have been ongoing for several years. The study aims to ascertain the opinion of the Polish professional community of psychologists on the right of psychologists to prescribe psychotropic drugs. Methods: The study was conducted on online forums (Porozumienie Psychologów) associated with psychologists from all over the world from 15 April 2023 to 30 September 2023. The participants were asked to fill out a Google survey consisting of 26 questions. Results: A total of 677 psychologists participated in the study, including 580 (85.7%) women and 97 (14.3%) men. The majority of the respondents were at the peak of their life activity, between 30 and 50 years of age. A large group of respondents believed that a psychologist should have the right to prescribe psychotropic drugs (46.5%) and declared their participation in activities to promote these rights (52.9%). The vast majority of respondents reported that psychologists authorized to prescribe drugs should complete additional courses as part of the pharmacology specialization (74.8%) and should pass an exam in this field (73.4%) or should complete additional courses in the field of pharmacology (74.8%). Such opinions were much more common in the group with psychological specializations. In this group, more people allowed for such a privilege for those who have completed studies, have documented five years of experience, or have a psychotherapist certificate (p < 0.0001). Conclusions: There may be many societal needs that could be successfully met by psychologists obtaining prescriptive privileges. However, psychologists ought to understand that our obligations need to transcend guild concerns and appropriate qualifications.
Real-World Data on Effectiveness and Safety of First-Line Use of Caplacizumab in Italian Centers for the Treatment of Thrombotic Thrombocytopenic Purpura: The Roscapli Study
Authors: Fianchi Luana , Bonanni Matteo , Borchiellini Alessandra , Valeri Federica , Giuffrida Gaetano , Grasso Stephanie , Fozza Claudio , Ponta Michele , Tiscia Giovanni L. , Grandone Elvira , Vianelli Nicola , Dedola Alessandra , Pirozzi Teresa , Sacco Monica , Lancellotti Stefano , De Cristofaro Raimondo
Published: November 2024

Background/Objectives: Immune thrombotic thrombocytopenic purpura (iTTP) is a thrombotic microangiopathy caused by the formation of anti-ADAMTS13 antibodies. Caplacizumab is approved for the treatment of acute episodes of iTTP in conjunction with plasma exchange (PEX) and immunosuppression. Real-world data for the use of caplacizumab in Italy have been recently published by a limited number of centers located in the northern and middle regions of the country only. Methods: A total of 38 patients with iTTP were enrolled in the study in six Italian centers spread over the entire territory of the country. The patients’ data were registered in eCRF. Results: All patients achieved normalization of platelet count (median 2.0 days, IQR: 2–4), within a time significantly shorter than in the absence of caplacizumab, as previously reported in other studies. As to the secondary aims, patients treated with caplacizumab had a few exacerbations (4/38 (10.5%)) and relapses (2/38, 5.3%). No deaths or refractoriness were observed in these patients. The total length of hospitalization was 12 days (IQR: 9–18) and only one patient required 2 days of stay in the intensive care unit. Interestingly, when caplacizumab was initiated within the first 3 days, the plasma exchange (PEX) duration was 9 days (IQR: 8–10), which was significantly lower than those reported in previous studies conducted in the absence of caplacizumab. No severe adverse event was described in the caplacizumab-treated patients. Conclusions: Caplacizumab reduced exacerbations and refractoriness compared with previously reported standard-of-care regimens. When administered in association with PEX and immunosuppressive therapy, caplacizumab provided rapid normalization of platelet count, which was responsible for lower overall hospitalization time, ICU stay, lower exacerbations and relapses compared to previously reported outcomes of studies carried out without caplacizumab.
Transcatheter Aortic Valve Replacement Versus Surgical Aortic Valve Replacement in Bicuspid Aortic Valve Stenosis—We Need a Well-Designed Randomized Control Trial
Authors: Grubb Kendra J. , Tom Stephanie K. , Xie Joe , Kalra Kanika , Camaj Anton
Published: November 2024

Bicuspid aortic stenosis is a common pathology, typically seen in patients a decade younger than those with tricuspid valves. Surgical aortic valve replacement has been the mainstay treatment for bicuspid disease, especially considering the prevalence of concomitant aortic aneurysmal pathology. Transcatheter aortic valve replacement has shown equivalent results in bicuspid compared to tricuspid pathology in highly selected patient populations in single-arm registries and observational studies. For older patients with favorable bicuspid pathology, TAVR is reasonable. However, as younger patients with longer life expectancy are now being treated with TAVR, what is “best” is a question only answered by a well-designed randomized controlled trial. Herein, we describe the current evidence for treating bicuspid aortic stenosis and provide a framework for future trials. Yet, the question of equipoise remains, and who will we enroll?
Editorial to Advances in Minimally Invasive Spine Surgery
Authors: Tender Gabriel C. , Crabill George A.
Published: November 2024

Degenerative spinal pathology is a leading cause of morbidity in the United States with a predicted increase in prevalence as the population ages [...]
Bridging Gaps and Charting Future Directions in Vasculitis
Authors: Watanabe Ryu
Published: November 2024

The field of vasculitis continues to evolve rapidly, driven by breakthroughs in both basic and clinical research [...]
Current Milestones and Future Horizons in Minimally Invasive Urologic Surgery
Authors: Becker Benedikt , Rosenbaum Clemens M.
Published: November 2024

Minimally invasive surgery (MIS) has emerged as one of the most significant advancements in the field of urology over the past few decades [...]
Conservative Management of Bowel Endometriosis: Cross-Sectional Analysis for Assessing Clinical Outcomes and Quality-of-Life
Authors: Ceccaroni Marcello , Baggio Silvia , Capezzuoli Tommaso , Albanese Mara , Mainardi Paride , Zorzi Carlotta , Foti Giovanni , Barra Fabio
Published: November 2024

Background/Objectives: Bowel endometriosis (BE) is characterized by the presence of endometrial-like tissue within the muscular layer of the bowel wall. When BE does not result in the severe obstruction to fecal transit and in the absence of (sub)occlusive symptoms, the decision to perform surgery can be challenging, as intestinal procedures are associated with higher complication rates and long-term bowel dysfunction. This cross-sectional study aims to evaluate the quality of life (QoL) in patients with BE who avoided surgery, as well as to investigate the impact of the characteristics of BE nodules on the QoL and intestinal function. Methods: A retrospective cross-sectional analysis was conducted involving 580 patients with BE who did not undergo surgery but were treated conservatively with medical therapy or expectant management between January 2017 and August 2022. The diagnosis of BE was established through transvaginal ultrasound and confirmed via double contrast barium enema. After at least one year of follow-up, the QoL and intestinal function were assessed using the Endometriosis Health Profile-5 (EHP-5) questionnaire and the Bowel Endometriosis Symptom (BENS) score, while pain symptoms were quantified with the Visual Analog Scale (VAS 0–10). Statistical analyses were performed to explore potential associations between the QoL and the characteristics of BE nodules (size, location, and evidence of stenosis), as well as the type and duration of medical therapy. Results: Patients with BE reported a satisfactory overall QoL, with a mean EHP-5 score of 105.42 ± 99.98 points and a VAS score below three across all pain domains. They did not demonstrate significant impairment in bowel function, as indicated by a mean BENS score of 4.89 ± 5.28 points. Notably, patients receiving medical therapy exhibited a better QoL compared to those not receiving treatment (p < 0.05), with the exception of postmenopausal patients, who reported the highest QoL overall (p < 0.05). Among the characteristics of BE, nodule location significantly impacted the QoL and symptom intensity, with low (rectal or rectosigmoid) nodules less tolerated compared to sigmoid nodules, particularly regarding non-menstrual pelvic pain (NMPP), dyschezia, and psychological impact on daily life (p < 0.05). Conclusions: Women can effectively manage BE conservatively in the absence of (sub)occlusive symptoms, even when large nodules are present, causing significant radiological stenosis. The characteristics of BE nodules do not significantly affect the QoL or symptom intensity; however, the location of BE nodules is a crucial factor negatively influencing these outcomes. Medical therapy may confer a beneficial impact on patients of reproductive age with BE, but its use should be carefully considered for those approaching menopause, weighing the risks and benefits.
The Impact of Previously Diagnosed Depression on Early and One-Year Mortality in Patients with Acute Ischemic Stroke in Opole Province, Poland
Authors: Łabuz-Roszak Beata , Starostka-Tatar Anna , Górniak Maja , Wójcicki Kacper , Nalewajko Krzysztof , Zieliński Robert , Roszak Mateusz , Gierlotka Marek
Published: November 2024

Background: Depression is a known stroke risk factor, but its influence on stroke course depending on gender and age is not clearly defined. The purpose of this study was to determine the impact of previously diagnosed depression on early and one-year mortality in patients with acute ischemic stroke (IS) in relation to gender, age, and concomitant diseases. Methods: This study was based on the registry created from the public health insurer in Poland (2009–2020). Two groups were distinguished: IS-D—patients with IS and a diagnosis of depression within preceding 5 years (n = 520); IS-nD—patients with IS who had never been diagnosed with depression (n = 11,505). Results: In-hospital, 30-day, and 1-year mortality did not differ between groups (3.8% vs. 5.1%, 13.1% vs. 12.9%, and 27.1% vs. 26.8%, respectively). However, when statistical analysis was performed stratified by gender and age, we found a significantly higher 30-day and 1-year mortality in men under the age of 65 with previously diagnosed depression in comparison to those without depression (13.6% vs. 3.8%, p < 0.001; and 20.3% vs. 10.8, p < 0.021, respectively). Conclusions: The incidence of post-stroke depression was higher in IS-D group, regardless of gender and age. Early and one-year mortality was higher in younger men with IS and previously diagnosed depression.
Orthobiologic Products: Preservation Options for Orthopedic Research and Clinical Applications
Authors: Fang William H. , Vangsness C. Thomas
Published: November 2024

The biological products used in orthopedics include musculoskeletal allografts—such as bones, tendons, ligaments, and cartilage—as well as biological therapies. Musculoskeletal allografts support the body’s healing process by utilizing preserved and sterilized donor tissue. These allografts are becoming increasingly common in surgical practice, allowing patients to avoid more invasive procedures and the risks associated with donor site morbidity. Bone grafting is one of the most frequently used procedures in orthopedics and traumatology. Biologic approaches aim to improve clinical outcomes by enhancing the body’s natural healing capacity and reducing inflammation. They serve as an alternative to surgical interventions. While preliminary results from animal studies and small-scale clinical trials have been promising, the field of biologics still lacks robust clinical evidence supporting their efficacy. Biological therapies include PRP (platelet-rich plasma), mesenchymal stem cells (MSCs)/stromal cells/progenitor cells, bone marrow stem/stromal cells (BMSCs), adipose stem/stromal cells/progenitor cells (ASCs), cord blood (CB), and extracellular vesicles (EVs), including exosomes. The proper preservation and storage of these cellular therapies are essential for future use. Preservation techniques include cryopreservation, vitrification, lyophilization, and the use of cryoprotective agents (CPAs). The most commonly used CPA is DMSO (dimethyl sulfoxide). The highest success rates and post-thaw viability have been achieved by preserving PRP with a rate-controlled freezer using 6% DMSO and storing other cellular treatments using a rate-controlled freezer with 5% or 10% DMSO as the CPA. Extracellular vesicles (EVs) have shown the best results when lyophilized with 50 mM or 4% trehalose to prevent aggregation and stored at room temperature.
Can Artificial Intelligence Help Us in the Evaluation of Coronary Artery Calcification Scores by Acting as a Prognosticator in Patients That Are Operated on Due to Non-Small Cell Lung Cancer? A Pivotal Study
Authors: Marjanski Tomasz , Chmielecki Michal , Klein-Awerjanow Kaja , Cytawa Wojciech , Ciepialowska Patrycja , Bilyk Andrii , Peksa Rafal , Dudek Magdalena
Published: November 2024

Background: Non-small cell lung cancer (NSCLC) is the leading cause of death from malignancies, and surgical resection is the most effective form of treatment. Coronary artery disease (CAD) is a common comorbidity in patients with NSCLC. A coronary artery calcium (CAC) score correlates with the extent of CAD. We aimed to test whether an automated assessment of CAC scores helps to identify the population of patients with a higher risk of postoperative complications and worse overall survival (OS) after the surgical treatment of NSCLC. Methods: In this retrospective cohort study, the data of the patients who were surgically treated for NSCLC were matched with the reassessed preoperative CT images. The postoperative complication rates and overall survival were analyzed. The CAC score was evaluated automatically using the Syngo.via Siemens Healthcare software. Cardiac age was assessed according to Hoff et al. 2001. The prognosticators of postoperative complications and of OS were tested. Results: The data of 193 patients with complete data, an adherence to the inclusion and exclusion criteria, and that were operated between 2018 and 2019, were included. Cardiac age was a predictor of the cardiovascular and pulmonary complications rate (95%CI −0.007–0.203, p = 0.066, beta coefficient 0.098). In a multivariable stepwise regression analysis, operative access was a predictor of cardiovascular and pulmonary complications (95%CI −0.290–−0.111, p < 0.001, beta coefficient −0.200), cardiovascular complications (95%CI −0.161–−0.022, p = 0.011, beta coefficient −0.036), and the general complication rate (95%CI −0.370–−0.194, p < 0.001, beta coefficient −0.286). Kaplan–Meier curves were separated in the survival analysis of groups of patients with a cardiac age 0–69 years vs. an age of 70+ (92 vs. 92 patients) (in Cox regression analysis, HR = 1.678, 95%CI 0.847–3.292 p = 0.138). Conclusions: An automated CAC score assessment may be a potential and clinically meaningful prognosticator of both postoperative complications and OS in patients that are operated on due to NSCLC. Further studies are required.
Optical Coherence Tomography Study of Choroidal Response to Exercise-Induced Hypertension in Chronic Central Serous Chorioretinopathy
Authors: Samanta Anindya , Gregori Giulia , Muzi Alessio , Gujar Ramkailash , Mariotti Cesare , Fruttini Daniela , Vupparaboina Kiran K. , Chhablani Jay , Nicolò Massimo , Eandi Chiara M. , Cardillo Piccolino Felice , Lupidi Marco
Published: November 2024

Background/Objectives: The aim of this study was to evaluate the choroidal vascular response using optical coherence tomography (OCT) in patients with chronic central serous chorioretinopathy (CSCR) during transient increases in blood pressure. Methods: This observational, case–control study enrolled chronic CSCR patients and age-matched healthy controls. OCT scans of the macula were performed at rest and during hand-grip (HG) isometric exercise. Mean ocular perfusion pressure (MOPP) and subfoveal choroidal thickness (SCT) were measured at baseline and during stress. Quantitative OCT assessment included the bright area (BA, stroma), dark area (DA, vascular lumen), and total choroidal area (CA). The choroidal vascularity index (CVI) was calculated as DA/CA to assess vascular response to stress. A comparative analysis between CSCR patients and controls was conducted. Conclusions: MOPP was significantly higher (p = 0.008) at baseline in CSCR patients and further increased under stress compared to controls. SCT and CA were both significantly higher in CSCR patients than in healthy subjects at rest and under stress (p < 0.001), but no change occurred after HG. A significant decrease in CVI (p = 0.005) was noted in controls under stress, but not in CSCR patients. Additionally, a negative correlation between CVI and MOPP was found in healthy subjects (−0.648; p = 0.043). The study demonstrated a choroidal vasoconstrictive response to stress in healthy subjects, as evidenced by a decrease in CVI, but not in CSCR patients. This suggests that CSCR patients may experience impaired choroidal blood flow regulation, resulting in potentially higher perfusion pressures during stress without compensatory vasoconstriction, potentially affecting the choriocapillaris.
Beyond the Surgery: The Impact of Coping Strategies on Persistent Pain After Rotator Cuff Repair
Authors: Brune Daniela , Endell David , George Steven Z. , Edwards Robert , Scheibel Markus , Lazaridou Asimina
Published: November 2024

Background: Rotator cuff repair is widely recognized as one of the most painful orthopedic surgeries, yet postoperative pain management in these patients is often underexplored. This study aimed to explore the relationship between pain outcomes and functional recovery six months after arthroscopic rotator cuff repair (ARCR), with a focus on the role of different pain coping mechanisms as mediators. Methods: This study included 83 patients that underwent rotator cuff repair. Pain levels were assessed using the Brief Pain Inventory (BPI-SF), while shoulder function was evaluated using the Oxford Shoulder Score (OSS). Coping strategies, including self-statements, ignoring pain, distraction, and praying, were examined in relation to pain severity and interference and were assessed with the Coping Strategies Questionnaire-Revised (CSQ-R). Simple and parallel mediation analyses were performed using the PROCESS macro to assess the mediating effects of coping mechanisms on the relationship between pain intensity, pain interference, and postoperative OSS. Results: Post-surgery, patients showed a significant improvement in OSS (from 29 ± 9 to 42 ± 6). At six months, 24% of patients reported chronic postsurgical pain (CPSP), defined as a pain severity score of 3 or higher. Correlation analyses revealed that OSS was negatively associated with pain catastrophizing (r = −0.35, p < 0.01) and praying (r = −0.28, p < 0.01). OSS was significantly negatively associated with pain severity (r = −0.54; p < 0.01) and pain interference (r = −0.51, p < 0.01). Mediation analysis demonstrated that coping self-statements significantly mediated the relationship between pain interference and shoulder function (a*b = 0.5266 (BootSE = 0.2691, 95% CI [0.1010, 1.1470]), emphasizing the important role of cognitive strategies in supporting recovery outcomes. Conclusion: Patients engaging in adaptive coping strategies, particularly coping self-statements, reported better functional outcomes. The findings underscore the importance of targeted interventions focusing on effective pain coping mechanisms to improve recovery post-ARCR.
Safety of Obstetric Ultrasound: Mechanical and Thermal Indexes—A Systematic Review
Authors: Varthaliti Antonia , Fasoulakis Zacharias , Lygizos Vasilios , Zolota Vasiliki , Chatziioannou Maria Ioanna , Daskalaki Maria Anastasia , Daskalakis George , Antsaklis Panos
Published: November 2024

Background/Objectives: Obstetric ultrasound is one of the most commonly used imaging modalities during pregnancy to detect any fetal abnormalities. The aim of this systematic review was to appraise all available scientific literature and summarize current evidence regarding the safety of fetal ultrasound by using the thermal index (TI) and mechanical index (MI). Methods: We applied the PRISMA guidelines in order to prepare the review, and a 2-step process was performed in order to evaluate the available literature and decide which studies to be included. A thorough search of the Medline, Scopus, and Google Scholar databases was performed. Randomized and non-randomized studies were considered for review. The MI and TI were available in ultrasound machines after 1993; thus, studies before that year would not provide data on these two indexes. Results: A total of 21 studies were included in this review, including prospective, retrospective, cross-sectional, and survey-type studies. A common theme of the majority of the studies is the increased acoustic output available to the machines with time and the limited awareness of where the MI/TI indexes are from the operators. Conclusions: This review indicates that, while obstetric ultrasound is predominantly safe, there is a need for operators to consistently observe MI/TI indexes and adhere to the ALARA principle to minimize potential risks.
Clinical and Structural Results Following Arthroscopic and Open Repair of Isolated Subscapularis Tears
Authors: Bartl Christoph , Dolde Janna , Gebhard Florian , Eichhorn Stefan , Hainzer Lisa , Pauly Stephan
Published: November 2024

Objective: With advances in techniques, arthroscopic repair of isolated subscapularis tendon tears has become increasingly popular in recent years. The aim of this study was to analyze the clinical and structural results of arthroscopic repair versus the gold standard of open repair. It is a prospective cohort study with a control group; evidence level III. Methods: In a prospective study performed at two centers, 18 patients with an isolated subscapularis tear were treated with arthroscopic repair (ARG) and 16 patients with open repair (ORG) using a uniform single-row suture anchor repair technique in both groups. The subscapularis function was assessed using specific clinical tests (belly-press and lift-off tests), strength testing and shoulder function with the use of the Constant–Murley score (CMS). Standardized magnetic resonance imaging (MRI) was used to evaluate the postoperative subscapularis muscle-tendon status. Results: At a minimum follow-up of 48 months, the CMS increased from a mean of 54 points preoperatively to a mean of 86 points postoperatively in the ARG (p < 0.01) and from 50 points to 85 points postoperatively in the ORG (p < 0.01). Specific subscapularis tests (belly-press test and lift-off test) were significantly improved from the preoperative to the postoperative status in both repair groups (p < 0.05). Despite a subscapularis tendon healing rate of over 90% on MRI scans in both repair groups, the incomplete correction of specific muscle tests was a frequent postoperative finding. Conclusions: Arthroscopic repair of isolated subscapularis tears achieved equivalent clinical and structural results compared to the gold standard of open repair.