bluuebunny/crossref_metadata_2025 huggingface dataset:
The US4ABL Strategy: A Systematic Ultrasound-Guided Approach for Left Atrial and Ventricular Ablation Procedures
Authors: Bejinariu Alexandru Gabriel , Augustin Nora , Spieker Maximilian , auf der Heiden Carsten , Angendohr Stephan , Höckmann Moritz , Clasen Lukas , Hartl Stefan , Makimoto Hisaki , Busch Lucas , Kelm Malte , Rana Obaida
Published: December 2024

Background: The safety and efficacy of electrophysiological (EP) procedures using ultrasound (US) guidance are being increasingly studied. We investigated if a systematic workflow with ultrasound guidance (the US4ABL), comprising four steps (transesophageal echocardiography (TEE) for left atrial thrombus exclusion, US of the groin vessels to guide femoral access, TEE-aided transseptal puncture, and transthoracic echocardiography (TTE) for exclusion of pericardial tamponade after the procedure), reduces the number of complications and fluoroscopy duration and dose. Methods: A total of 212 consecutive patients underwent left-sided ablations using the US4ABL workflow and were compared to a group of 299 patients who underwent the same type of ablations using post-procedural TTE to exclude tamponade (standard group: venous and/or arterial access by palpation and fluoroscopy, and pressure guided transseptal puncture). Complications, procedural duration, fluoroscopy duration, and dose were compared. Results: The cohort included 511 patients (42% female); 43.8% of patients suffered from paroxysmal atrial fibrillation (AF), 35.4% presented with persistent AF, 10.7% underwent the procedure was for atrial tachycardia, and 10% of patients had premature ventricular contractions. The complication rate in the US4ABL group was lower compared to the standard group: 0 complications vs. 11 complications (3.7%, mainly vascular and pericardial), respectively (p = 0.005). The procedure times were lower in the US4ABL group (p < 0.01), whereas the fluoroscopy time and dose did not differ significantly. Conclusions: A fully ultrasound-guided (US4ABL) workflow for left atrial and ventricular electrophysiology procedures reduces the complication rate and the procedure time.
Stress Analysis in Conversion Total Hip Arthroplasty: A Finite Element Analysis on Stem Length and Distal Screw Hole
Authors: Shimasaki Koshiro , Nishino Tomofumi , Yoshizawa Tomohiro , Watanabe Ryunosuke , Hirose Fumi , Yasunaga Shota , Mishima Hajime
Published: December 2024

Background/Objectives: Proximal femoral fractures are particularly common in older adults, and cases requiring conversion to total hip arthroplasty may arise because of treatment failure or osteoarthritis. Fractures around the distal screw removal holes can be problematic. This study aimed to analyze the relationship between stem length and femoral stress distribution to determine the optimal stem length. Methods: A finite element analysis simulation was conducted using pre-existing femoral computed tomography data, an intramedullary nail, and three types of stems of varying lengths. Loads simulating normal walking and stair climbing were applied, and the average and maximum equivalent stresses were measured on both the medial and lateral sides of the distal screw removal hole for each stem length. Statistical analysis was then performed to evaluate the stress distributions. Results: The average stress around the distal screw removal hole tended to decrease as stem length increased. The maximum stress was significantly lower with the 160-mm stem, which provides a 40-mm bridging length, compared to the 120-mm and 130-mm stems, where the stem tip aligned with or only slightly extended past the distal screw removal hole (bridging lengths of 0 mm and 10 mm, respectively). Conclusions: In conversion hip total arthroplasty following proximal femoral fractures, using a sufficiently long stem can help avoid stress concentration around the distal screw removal hole, thereby potentially reducing the risk of periprosthetic fractures.
Transcatheter Embolization of Systemic-to-Pulmonary Collaterals: A New Approach Using Concerto™ Helix Nylon-Fibered Microcoils
Authors: Pfeifer Jochen , Poryo Martin , Gheibeh Anas , Rentzsch Axel , Abdul-Khaliq Hashim
Published: December 2024

Background: Systemic-to-pulmonary collaterals (SPCs) are common in congenital heart disease (CHD). Particularly in single ventricle anatomy and Fontan circulation, SPC can both complicate the postoperative course and lead to clinical deterioration in the long term. The treatment of SPC is controversial. The aim of our study was (1) to retrospectively analyse patients who underwent SPC embolization using Concerto™ Helix nylon-fibred microcoils (CHMs) and (2) to describe the interventional technique. Methods: In this single-centre retrospective observational cohort study, we analysed clinical and imaging data of all patients who underwent transcatheter embolization of SPCs using CHMs from January 2016 to December 2023. Results: In 38 consecutive patients (65.8% male, median age 41 months, range 2–490), a total number of 141 CHMs had been implanted into 64 SPCs in 49 procedures. The majority were arterial SPCs (n = 59/64) originating from the thoracic aorta or its branches; 5/64 were veno-venous SPCs. Primary closure succeeded in all procedures. The CHM diameters ranged from 3 to 8 mm, with 5 mm being the most commonly used diameter. The mean coil/SPC ratio was 2.6 (range 1.3–5.3). CHM implantation was performed via four French sheaths. Both detachment and stable positioning were simple and safe. Neither non-target embolization nor coil migration occurred. One complication was a vascular injury with resulting extravasation of contrast medium. In 18/49 procedures (36.7%), coils other than CHMs or vascular plugs were additionally inserted into separate SPCs. Conclusions: CHMs are appropriate for SPC embolization in all age groups, including infants, with a low complication rate. The coils are particularly suitable for the closure of collaterals with a small diameter or tortuous course. They can be used in combination with other embolization devices to achieve comprehensive collateral closure.
Evaluating Anesthesia Guidance for Rescue Analgesia in Awake Patients Undergoing Carotid Endarterectomy with Cervical Plexus Blocks: Preliminary Findings from a Randomized Controlled Trial
Authors: Stasiowski Michał Jan , Zmarzły Nikola , Grabarek Beniamin Oskar
Published: December 2024

Background/Objectives: Eversion carotid endarterectomy (CEA) in awake patients is performed using cervical plexus blocks (CPBs) with or without carotid artery sheath infiltration (CASI) under ultrasound guidance. Although adequacy of anesthesia (AoA) guidance monitors nociception/antinociception balance, its impact on intraoperative analgesia quality and perioperative outcomes in awake CEA remains unexplored. Existing literature lacks evidence on whether AoA-guided anesthesia enhances clinical outcomes over standard techniques. This study aimed to assess the role of AoA guidance in improving intraoperative analgesia and perioperative outcomes in patients undergoing CEA with CPBs alone or with CASI compared to standard practice. Methods: A randomized controlled trial included 184 patients divided into three groups: CPBs with intravenous rescue fentanyl (IRF) and lidocaine (LID) guided by hemodynamic observation (C group), AoA-guided IRF and LID (AoA group), and AoA-guided IRF, LID, and CASI (AoA-CASI group). Primary outcomes included perioperative adverse events, and secondary outcomes assessed rescue medication demand and hemodynamic stability. Results: Analysis of 172 patients revealed no significant differences between groups in perioperative adverse events or hemodynamic parameters (p > 0.05). However, the AoA-CASI group demonstrated significantly reduced IRF and LID usage compared to the C and AoA groups (p < 0.001). No significant advantage was observed between the AoA and C groups regarding adverse events (p = 0.1). Conclusions: AoA-guided anesthesia with or without CASI does not significantly reduce perioperative adverse events or improve hemodynamic stability in awake CEA. Clinical implications suggest that focusing on surgical technique optimization may yield greater benefits in reducing adverse events compared to advanced anesthetic monitoring. Further studies are warranted to explore alternative approaches to enhance clinical outcomes.
The Therapeutic Potential of Different Surgical Approaches in the Management of Cardiac Myxoma: A Systematic Review
Authors: Mendyka Dominik , Płonek Tomasz , Jędrasek Tomasz , Korman Adrian , Złotowska Aleksandra , Jędrasek Aleksandra , Skalik Robert , Kustrzycki Wojciech
Published: December 2024

Background: Cardiac myxomas are benign tumors of the heart. They occur mostly in the left atrium. The preferred treatment is surgical resection, which can be performed via conventional median sternotomy, minimally invasive, or robotic-assisted approaches. This study aimed to evaluate the outcomes, advantages, and limitations of these surgical methods, with a focus on their safety, efficacy, and impact on patient recovery. Methods: This systemic review was conducted according to PRISMA guidelines. The chosen databases were systematically searched using the keywords “cardiac myxoma”, “resection”, “approach”, “minimally invasive”, and “robotic surgery”. The comparison between the surgical strategies was based on thirteen articles, which met the inclusion criteria. Results: Median sternotomy remains the standard technique, providing excellent surgical access but is associated with longer hospital stays, higher blood loss, and increased risk of complications such as stroke. Minimally invasive approaches demonstrated comparable safety with shorter ICU stays, reduced blood loss, and lower postoperative pain but presented challenges, including limited exposure and longer procedure times. Robotic-assisted surgery showed potential as a safe alternative but was limited by high costs and technical demands. However, the data on minimally invasive and robotic methods are limited due to the rarity of cardiac myxomas. Conclusions: The choice of surgical technique should be individualised by considering the tumour size, location, patient condition, and surgeon expertise. Routine postoperative echocardiographic monitoring is essential to detect residual or recurrent tumours. Further studies are needed to validate the long-term efficacy of minimally invasive and robotic approaches.
3-Step Combined Technique for Correction of Involutional Lower Eyelid Ectropion: A Case Series
Authors: Rubino Corrado , Trignano Emilio , Dore Stefano , Pinna Antonio , Tsatsaris Nicola , Ziani Federico , Sangalli Lucia , Tettamanzi Matilde , Rampazzo Silvia
Published: December 2024

Background: Involutional lower eyelid ectropion is a common disorder of the elderly population. Several surgical approaches have been described in the literature to address the multifactorial nature of this condition, each targeting different factors contributing to its development. Nevertheless, no single procedure has proven to be superior to the others. This study aims to assess the safety and effectiveness of a new 3-step combined technique in treating involutional ectropion. Methods: The surgical technique consists of a combination of lateral lid-shortening with removal of a base-up triangle (modified Bick procedure), lower eyelid skin release, and transposition of a laterally based myocutaneous flap from the upper eyelid. A retrospective chart review was conducted for all patients treated with this procedure at our institution between 2012 and 2023 was performed. Self-reported patient satisfaction with functional and esthetic outcomes was evaluated three months after surgery. Results: A total of thirty-six patients (forty-five eyelids) were included in the study, with a mean follow-up period of 22 months (range 3–144). Minor surgical revision was performed in one case for early wound dehiscence following premature stitches removal. The overall success rate was 93.2%, with one case of undercorrection and two cases of recurrence recorded at three years postoperatively. No additional complications or recurrences were observed during the follow-up period. Conclusions: The 3-step combined procedure demonstrated high efficacy and safety, offering excellent functional and esthetic outcomes. This approach provides a reliable solution for treating involutional ectropion, making it a valuable addition to the surgical options for this condition.
Correlation Between Voltage and Impedance Mapping in Patients with Atrial Fibrillation
Authors: Taormina Antonio , Grossi Benedetta , Ragaini Elisa Maria , Falasconi Giulio , Penela Diego , Ceriotti Carlo , Poggio Luca , Galimberti Paola , Latini Alessia Chiara , Carli Sebastiano , Del Monaco Guido , Chiarito Mauro , Sticchi Alessandro , Giunti Filippo , Antonelli Giulia , Preda Alberto , Guarracini Fabrizio , Mazzone Patrizio , Condorelli Gianluigi
Published: December 2024

Background. Pulmonary vein isolation (PVI) represents the cornerstone of paroxysmal (PAF) and persistent atrial fibrillation (PsAF) ablation. Impedance values provide insights on tissue conductive properties. Methods. Consecutive patients undergoing PAF and PsAF ablation were prospectively enrolled. All the patients underwent a preprocedural multidetector computed tomography (MDCT) to evaluate left atrial wall thickness (LAWT). Electroanatomic maps were acquired with the ablation catheter, and impedance values (Ω) and voltage amplitude (mV) of bipolar electrograms were collected. Results. A total of 60 patients (40 with PAF and 20 with PsAF) were included in the study. In all PAF cases, no voltage value lower than 0.5 mV was found at LA mapping; the corresponding mean impedance value was 151.5 ± 5.4 Ω. In PsAF cases, voltage values inferior to 0.05 mV have been reported in 19/20 patients. PsAF patients showed a mean impedance value of 129.1 ± 3.8 Ω. The correlation analysis between bipolar voltage and impedance reported an rs value of 0.4166 (p < 0.001), showing a positive correlation between the two variables. On the contrary, no direct correlation was found between voltage and LAWT and between impedance and LAWT (rsv-t = 0.1838; rsi-t = 0.1133, respectively). Conclusions. This research study suggests a correlation between voltage amplitude and impedance values, so that impedance might be used for arrhythmogenic substrate characterization.
In the Twilight of Evidence: Is Bypass Surgery Still on the Table for Cardiac Allograft Vasculopathy?
Authors: Alyaydin Emyal , Flammer Andreas J.
Published: December 2024

Background: Cardiac allograft vasculopathy (CAV) is a major prognosis-limiting factor in patients undergoing orthotopic heart transplantation (HT). Due to the diffuse involvement of the coronary tree, CAV lesions are often not amenable to percutaneous coronary intervention (PCI), leaving coronary artery bypass grafting (CABG) and retransplantation as primary revascularization options. Aim and Results: The latest guidelines from the International Society for Heart and Lung Transplantation (ISHLT) recognize CABG as a viable option but with a downgraded strength of recommendation. The 2023 ISHLT guidelines now categorize CABG as a Class IIb recommendation (Level of Evidence: C) for highly selected CAV patients with anatomically suitable lesions, a downgrade from the Class IIa recommendation in the 2010 guidelines. This adjustment underscores the persisting reliance on limited, retrospective studies and the lack of substantial new data supporting CABG in CAV management. Our article examines the evidence collected since 2010 on this topic, highlighting key findings and assessing the role of CABG in contemporary transplant practice. This article calls for targeted investigations to better define the role of CABG as a therapeutic option, addressing the gaps in evidence for surgical revascularization in HT patients.
Beta-Blockers in Patients with Myocardial Infarction and Preserved Left Ventricular Ejection: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Sabina Michael , Shah Shrinand , Grimm Mason , Daher Jean Carlo , Campillo Paola , Boozo Mohammed Baraa , Al-Abdouh Ahmad , Abusnina Waiel , D’ Ascenzo Fabrizio , Bizanti Anas
Published: December 2024

Background: The benefit of beta-blockers (BBs) for myocardial infarction (MI) patients with a preserved left ventricular ejection fraction (LVEF) is uncertain. While beneficial for a reduced LVEF, their efficacy with a preserved LVEF, especially with modern revascularization, is unclear. Methods: A PRISMA-guided systematic review and meta-analysis utilized PubMed and EMBASE. Three randomized controlled trials comparing outcomes in MI patients with a preserved LVEF treated with BBs versus no treatment were included. The primary outcome was composite all-cause mortality and MI; secondary outcomes were all-cause mortality, cardiovascular mortality, MI, and stroke. Results: Three studies, including a total of 9512 participants, were analyzed. Beta-blockers did not demonstrate a statistically significant benefit in reducing the composite endpoint of all-cause mortality and myocardial infarction (RR 0.97, 95% CI: 0.84–1.12, p = 0.671, I2 = 0%). Similarly, no significant effect was observed for secondary outcomes: all-cause mortality (RR 0.96, 95% CI: 0.79–1.17, p = 0.708), cardiovascular mortality (RR 1.22, 95% CI: 0.87–1.72, p = 0.247), myocardial infarction (RR 0.97, 95% CI: 0.78–1.19, p = 0.759), and stroke (RR 0.96, 95% CI: 0.66–1.38, p = 0.819). Conclusions: In patients with myocardial infarction and a preserved LVEF, beta-blockers did not significantly reduce mortality, recurrent myocardial infarction, or stroke, suggesting a limited benefit in this population under contemporary management protocols.
Endocrine Hormones and Their Impact on Pubertal Gynecomastia
Authors: Shi Zi’ang , Xin Minqiang
Published: December 2024

Pubertal gynecomastia (PG) is a common condition characterized by the abnormal development and hyperplasia of unilateral or bilateral breast tissue in adolescent males, affecting up to 50% of appropriately aged adolescents and exhibiting rising prevalence over recent years. The etiology of PG is multifaceted, encompassing physiological, pharmacological, and pathological factors. This narrative review synthesizes evidence from a comprehensive selection of peer-reviewed literature, including observational studies, clinical trials, systematic reviews, and case reports, to explore the pivotal role of endocrine hormones in the pathogenesis of PG. Specifically, it examines the effects of follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T), estradiol (E2), progesterone (P), prolactin (PRL), growth hormone (GH), insulin-like growth factor-1 (IGF-1), thyroid hormones (T3, T4), parathyroid hormone (PTH), anti-Müllerian hormone (AMH), human chorionic gonadotropin (hCG), and leptin. By synthesizing current insights, this review underscores the intricate hormonal dynamics underlying PG and their implications for diagnosis and treatment. Conclusively, the findings advocate for a personalized approach in the clinical management of PG, with particular emphasis on the hormonal milieu as a cornerstone of therapeutic strategy.
The Impact of Pelvic Organ Prolapse on the Long-Term Outcomes of Transobturator Tape (TOT) Procedures—A Retrospective Study
Authors: Hillmeyer Alessia , Kennes Lieven N. , Strauss Mila , Lube Katharina , Stickeler Elmar , Najjari Laila
Published: December 2024

Objectives: Transobturator tape (TOT) procedures are a widely used and effective treatment for stress urinary incontinence (SUI), but there is limited research on mesh-related complications and revision surgeries. This study aimed to evaluate the incidence of revision surgeries and mesh-related complications following TOT procedures and identify potential risk factors influencing these outcomes. Methods: This retrospective study analyzed data from patients who underwent TOT procedures at the specialized incontinence center of University Hospital Aachen (UHA), Germany, between January 2010 and May 2023. Patients were divided into three groups: initial surgery without revision, initial surgery with revision, and external referrals requiring revision. Statistical analyses included multivariate logistic regression and predictive cross-validation to identify risk factors for revision and mesh-related complications. Results: Out of 265 TOT procedures performed, the revision rate was 8.7%, and the mesh-related complication rate was 2.6%. Mesh complications, including erosion and wound dehiscence, accounted for 30% of revisions, while 70% of revisions were caused by recurrent stress urinary incontinence (SUI). External referrals showed longer revision intervals compared to UHA patients (53 months vs. 5 months; p = 0.003). Multivariate analysis identified rectoceles as a protective factor against revisions (p = 0.0414), while pre-existing conditions significantly increased revision risk (p = 0.0100). Conclusions: The revision rate following TOT procedures was 8.7%, with mesh-related complications accounting for 2.6%. Pre-existing conditions significantly increased the risk of revision, while rectoceles were associated with improved outcomes. These findings emphasize the importance of identifying patient-specific risk factors to enhance the safety and success of TOT procedures.
Effects of Aging on Orbicularis Oculi Muscle Strength and Ultrastructure in Dermatochalasis: A Pilot Study
Authors: Krajewska-Węglewicz Larysa , Felczak Paulina , Dorobek Małgorzata
Published: December 2024

Background: Age-related changes to the orbicularis oculi muscle include impaired eyelid function, such as lagophthalmos, alterations in tear film dynamics, and aesthetic changes like wrinkles, festoons, and the descent of soft tissue. To date, the structural and functional changes that would comprehensively increase our understanding of orbicularis aging have not been analyzed. This study aims to investigate functional outcomes using surface electromyography and correlate them with ultrastructural changes in orbicularis during aging. Methods: This study enrolled 26 patients aged 37 to 78 years with a clinical diagnosis of dermatochalasis. Patients were divided into two age groups (<60 years; ≥60 years). Ultrastructural and electromyographical examinations were performed, and the electromyographical signals were correlated with the ultrastructural damage in the orbicularis. Results: This study revealed significantly lower values of average voluntary contraction and RMS of the surface electromyography signals in the older age group compared to the younger age group (p = 0.029 and p = 0.045, respectively). There was no statistically significant association between age and muscle damage (χ2(2) = 2.86, p > 0.05). There was no correlation between average voluntary contraction and the degree of ultrastructural damage in both groups (Spearman’s coefficient equaled 0.06923 and 0.64366, respectively). Conclusions: sEMG measurements are valuable for monitoring age-related functional changes in the orbicularis. Aging diminishes the functional capacity of the orbicularis, as evidenced by reduced contraction strength. This study, the first to compare ultrastructural and electromyographical changes in the orbicularis among dermatochalasis patients of different ages, finds that ultrastructural damage to muscle fibers is not directly responsible for the contraction strength decline.
Mitigating the Risk of QTc Prolongation When Using Haloperidol for Acute Treatment of Cannabinoid Hyperemesis Syndrome in Adolescents and Young Adults
Authors: Merino Sandra , Tordera Lissette , Jun Allison , Yang Sun
Published: December 2024

Background/Objectives: Cannabinoid Hyperemesis Syndrome (CHS), associated with long-term cannabinoid use, has been increasingly observed in emergency room visits as more states in the U.S. have legislatively permitted medical and recreational marijuana use. The acute management of CHS primarily focuses on antiemetic treatment and supportive care. However, both the condition itself and the antiemetic drugs, such as haloperidol, may cause QTc prolongation. Methods: We reported two adolescent cases admitted to the emergency department for acute antiemesis management of CHS who received haloperidol treatment. A literature review was performed through October 2024 for previously published cases of QTc prolongation and/or Torsades de Pointes (TdP) in adolescents and young adults. Results: A 15-year-old female presented with hypokalemia and hypomagnesemia upon admission. She complained of chest pain and tachycardia, and the electrocardiogram (EKG) showed prolonged QTc (528 msec). The haloperidol infusion was discontinued. She recovered well post-discharge without complaints. A 17-year-old female had a borderline prolonged QT interval (476 msec). Her nausea and vomiting improved with a three-dose course of intravenous fosaprepitant before discharge. Our literature search identified five severe cases with life-threatening episodes of QTc prolongation and/or TdP in adolescents and young adults. Conclusions: Patients with CHS are at higher risk of QTc prolongation due to cannabis use, electrolyte imbalance, and antiemetic medications. We recommend vigilant EKG monitoring, particularly before initiating and throughout haloperidol treatment. If the patient presents with an increased risk of QTc prolongation, consider using topical capsaicin, lorazepam, aprepitant/fosaprepitant, and olanzapine as alternatives.
Evaluation of Early Maladaptive Schemas and Adult Attachment Profiles in Patients Diagnosed with Major Depressive Disorder and Examination of Their Relationship with Disease Variables
Authors: Özaslan Emre , Türkili Seda , Acar Şenel
Published: December 2024

Background/Objectives: The study aimed to compare the early maladaptive schemas and adult attachment profiles of patients diagnosed with major depressive disorder with those of healthy controls. Another objective of our study was to investigate the potential relationships between disease-related variables—such as the type of depression, number of depressive episodes, history of hospitalization, and suicidal ideation or attempts—and schema and attachment characteristics in the group of patients with major depressive disorder. Methods: The study included 118 patients who presented to the Psychiatry outpatient clinic at Mersin University Faculty of Medicine Hospital between 1 April 2021 and 1 September 2021 and were diagnosed with major depressive disorder according to DSM-5 diagnostic criteria based on mental state examinations conducted by researchers, as well as 92 healthy volunteers with no history of mental disorders. A sociodemographic data form prepared by the researchers was used to inquire about characteristics such as gender, age, and educational status. Additionally, a clinical data form was designed and implemented by the researchers to gather information regarding DSM-5 specifiers and the patients’ clinical histories. The Young Schema Questionnaire Short Form-3 was used to evaluate early maladaptive schemas, while adult attachment profiles were assessed using the Experiences in Close Relationships Inventory II. The severity of depression in the patient group was measured with the Beck Depression Inventory. Statistical analysis of the data was conducted using SPSS 21, with a p-value less than 0.05 considered statistically significant. Results: The study included 118 patients, 84 (71.2%) of whom were women and 34 (28.8%) men, along with 92 healthy volunteers, 60 (65.2%) of whom were women and 32 (34.8%) men. The mean age was 41.9 (±13.2) in the patient group and 40.8 (±11.9) in the control group (p > 0.05). The patient group had higher scores than the control group across all schema subtypes and attachment dimensions. Significant differences in certain schemas were observed between patients with chronic depression and those with recurrent depressive episodes, as well as between patients with a single hospitalization history and those with multiple hospitalizations, and between patients with a history of suicide attempts and those without any suicidal ideation or attempts. Positive significant correlations were found between the attachment and schema scores and the severity of depression in both patients and controls. Conclusions: Further research is needed to determine the role of schemas and attachment styles in the development of depression in more detail and to focus on schema and attachment-based therapies in treatment.
Effects of Intensive Impairment-Oriented Arm Rehabilitation for Chronic Stroke Survivors: An Observational Cohort Study
Authors: Platz Thomas , Kaiser Katharina , Laborn Tina , Laborn Michael
Published: December 2024

Objective: To assess the effects of a two-week course of intensive impairment-oriented arm rehabilitation for chronic stroke survivors on motor function. Methods: An observational cohort study that enrolled chronic stroke survivors (≥6 months after stroke) with mild to severe arm paresis, who received a two-week course of impairment-oriented and technology-supported arm rehabilitation (1:1 participant–therapist setting), which was carried out daily (five days a week) for four hours. The outcome measures were as follows: the primary outcome was the arm motor function of the affected arm (mild paresis: BBT, NHPT; severe paresis: Fugl-Meyer arm motor score). The secondary outcomes were measures of finger strength, active ROM, spasticity, joint mobility/pain, somatosensation, emotional distress, quality of life, acceptability, and adverse events. Results: One hundred chronic stroke survivors (≥6 months after stroke) with mild to severe arm paresis were recruited. The training was acceptable (drop-out rate 3%; 3/100). The clinical assessment indicated improved motor function (SMD 0.42, 95% CI 0.36–0.49; n = 97), reduced spasticity/resistance to passive movement, and slightly improved joint mobility/pain and somatosensation. The technology-based objective measures corroborated the improved active range of motion for arm and finger joints, reduced finger spasticity/resistance to passive movement, and the increased amount of use in daily life, but there was no effect on finger strength. The patient’s emotional well-being and quality of life were positively influenced. Adverse events were reported by the majority of participants (51%, 49/97) and were mild. Conclusions: Structured intensive impairment-oriented and technology-supported arm rehabilitation can promote motor function among chronic stroke survivors with mild to severe arm paresis and is an acceptable and tolerable form of treatment when supervised and adjusted by therapists.
A Large Study About Reproductive Factors That Predict Hysterosalpingography-Identified Tubal Pathology: An Insight into the Necessity of Preconception Screening
Authors: Nako Yurie , Ota Kuniaki , Sujino Toshio , Mitsui Junichiro , Kamo Hisae , Katsumata Shoko , Takayanagi Yuko , Tajima Makiko , Ishikawa Tomonori , Komiya Akira , Kawai Kiyotaka
Published: December 2024

Background/Objectives: Hysterosalpingography (HSG) is pivotal in delineating tubal pathology, but is associated with pain and exposure to ionizing radiation. This study investigated which reproductive factors predict HSG-identified tubal pathology. Methods: From May 2016 to August 2023, 3322 infertile females with HSG (mean age 33.9 ± 4.3 years) were assessed for fallopian tube status. Results: HSG indicated that 2764 had patent tubes while 558 (16.8%) had non-patent tubes. Unilateral and bilateral absence of free contrast spillage occurred in 377 (11.3%) and 181 (5.4%) cases, respectively. Non-spillage, denoted as non-patency, was seen in 148 (4.5%) and 153 (4.6%) right and left cases, respectively. Tubal occlusion was observed in 181 (5.4%) and 159 (5.4%) right and left cases, respectively. Hydrosalpinx was found in 37 (1.2%) right and 58 (1.7%) left cases. Multivariate logistic regression revealed CT-IgG positivity (odds ratio [OR]: 1.57), endometrioma (OR: 1.64), and fibroids (OR: 1.58) as independent factors for increased non-patency. CT-IgG positivity (OR: 1.92) and fibroids (OR: 1.88) were significant risk factors for occlusion. Painful defecation (OR: 2.79), CT-IgA positivity (OR: 2.09), CT-IgG positivity (OR: 2.07), and endometrioma (OR: 3.11) were significant risk factors for hydrosalpinx. Conclusions: In females with painful defecation, CT-IgG positivity, endometrioma, and fibroids, HSG may be used as a second-line investigation, with laparoscopy as the preferred assessment tool.
Baseline and Follow-Up Cardiac Magnetic Resonance Imaging Findings in Children with Acute Myocarditis and Factors Associated with Late Gadolinium Enhancement
Authors: Yukcu Bekir , Aydemir Merve Maze , Balci Mehmet , Kanyilmaz Mehmet , Turkvatan Aysel , Gokalp Selman , Guzeltas Alper , Atik Sezen Ugan
Published: December 2024

Objectives: Cardiac magnetic resonance (CMR) plays a central role in the diagnosis and follow-up of acute myocarditis (AM). In this study, we aimed to evaluate baseline and follow-up CMR findings and associated factors in children with AM. Methods: A retrospective analysis of CMR in pediatric patients with clinical presentations suggestive of myocarditis was performed. Patients’ demographic characteristics, clinical data, and diagnostic test results, as well as CMR imaging results, were evaluated. Results: All 28 pediatric patients with acute myocarditis included in this study had late gadolinium enhancement (LGE) on initial CMR imaging. Additionally, 14 (50%) patients had increased extracellular volume (ECV), 4 (50%) patients had focal high-intensity areas on T2 STIR images, 15 (53.6%) patients had increased T1 relaxation time, and 17 (60.7%) patients had increased T2 relaxation time. At a median follow-up CMR of 6 months, 24 (85.7%) patients had LGE, 5 (17.9%) patients had increased ECV, and 7 (25%) patients had increased T1 relaxation time, while other parameters showed complete recovery. Baseline troponin and CRP levels, T1 relaxation time, T2 relaxation time, and increased ECV were found to be factors associated with the resolution of LGE. Conclusions: Baseline troponin and CRP levels, as well as T1 relaxation time, T2 relaxation time, and increased ECV, were effective parameters that seemed to predict the resolution of LGE. Larger and multicenter experiences would confirm these hypotheses.
Long-Term Eosinophil Depletion: A Real-World Perspective on the Safety and Durability of Benralizumab Treatment in Severe Eosinophilic Asthma
Authors: Menzella Francesco , Marchi Mariarita , Caminati Marco , Romagnoli Micaela , Micheletto Claudio , Bonato Matteo , Idotta Giuseppe , Nizzetto Manuele , D’Alba Giuseppina , Cavenaghi Massimiliano , Bortoli Michela , Beghè Bianca , Pini Laura , Benoni Roberto , Casoni Gianluca , Muzzolon Rodolfo , Michieletto Lucio , Bosi Annamaria , Mastrototaro Andrea , Diamandi Adela , Nalin Mara , Senna Gianenrico
Published: December 2024

Background/Objectives: Benralizumab is an anti-IL-5 receptor alpha monoclonal antibody that induces the near-complete depletion of eosinophils. This study aimed to evaluate the long-term safety and effectiveness of benralizumab in patients with severe eosinophilic asthma (SEA) over an extended 48-month follow-up period, offering one of the longest real-world perspectives available. Methods: This was a single-arm, retrospective, observational, multicenter study involving 123 SEA patients treated with benralizumab at a dosage of 30 mg every 4 weeks for the first 3 doses and then every 8 weeks. The safety endpoints focused on the frequency and nature of adverse events and the likelihood that they were induced by benralizumab. The efficacy endpoints focused on lung function, asthma exacerbations and control, and oral corticosteroid use. Results: Benralizumab, consistent with its mechanism of action, led to the rapid and nearly complete depletion of eosinophils. In total, 26 adverse events (21.1%) were observed, with 1.6% related to the treatment and 0.8% categorized as serious (vagal hypotension). Bronchitis was the most common unrelated adverse event (15.4%), occurring between months 36 and 38. Importantly, benralizumab effectiveness and safety were maintained consistently across the 48-month duration, resulting in significant improvements in lung function and reductions in oral corticosteroid use and exacerbation frequency. Conclusions: Benralizumab demonstrated a favorable safety profile, comparable to previously published studies, with perdurable effectiveness in controlling SEA and reducing oral corticosteroid use. Finally, this study provides evidence that near-complete eosinophil depletion does not increase long-term safety risks and supports benralizumab as a reliable treatment option for SEA patients.
Analysis of Azure Zero Trust Architecture Implementation for Mid-Size Organizations
Authors: Dakić Vedran , Morić Zlatan , Kapulica Ana , Regvart Damir
Published: December 2024

The Zero Trust Architecture (ZTA) security system follows the “never trust, always verify” principle. The process constantly verifies users and devices trying to access resources. This paper describes how Microsoft Azure uses ZTA to enforce strict identity verification and access rules across the cloud environment to improve security. Implementation takes time and effort. Azure’s extensive services and customizations require careful design and implementation. Azure administrators need help navigating and changing configurations due to its complex user interface (UI). Each Azure ecosystem component must meet ZTA criteria. ZTAs comprehensive policy definitions, multi-factor and passwordless authentication, and other advanced features are tested in a mid-size business scenario. The document delineates several principal findings concerning the execution of Azure’s ZTA within mid-sized enterprises. Azure ZTA significantly improves security by reducing attack surfaces via ongoing identity verification, stringent access controls, and micro-segmentation. Nonetheless, its execution is resource-demanding and intricate, necessitating considerable expertise and meticulous planning. A notable disparity exists between theoretical ZTA frameworks and their practical implementation, characterized by disjointed management interfaces and user fatigue resulting from incessant authentication requests. The case studies indicate that although Zero Trust Architecture enhances organizational security and mitigates risks, it may disrupt operations and adversely affect user experience, particularly in hybrid and fully cloud-based settings. The study underscores the necessity for customized configurations and the equilibrium between security and usability to ensure effective ZTA implementation.
Development of a Video-Test of Emotional Intelligence for Teachers (ViTIED)
Authors: Berrios-Martos María-Pilar , Palomera Raquel
Published: December 2024

Emotional Intelligence (EI) in teaching is associated with various educational outcomes and processes. However, it has typically been measured through self-reports and general EI assessments, lacking a specific performance test with greater ecological validity in relation to the demands of the professional educational context. This study describes the development and validation results of the Video-Test of Emotional Intelligence for Teachers (ViTIED), a new performance-based measure to assess the EI of secondary education teachers based on ability EI model and the situational judgment test paradigm. The test comprises 12 video scenes designed to elicit intra- and interpersonal processes, as well as both positive and negative emotions. A total of 163 Spanish teachers (36% male, 64% female; mean age = 40.32 years) completed the ViTIED, along with personality, perceived EI, and burnout assessments. Test scores provide initial evidence of adequate reliability, as well as content, convergent, and divergent validity. Continued validation of this measure will benefit evaluation and intervention processes with teachers, as well as research on the impact of teachers’ EI on the teaching–learning processes and the well-being of the educational community.
Numerical Analysis of the Influence of Rectangular Deflectors and Geometry of L-Shaped Channel over the Performance of a Savonius Turbine
Authors: Santos Andrei Luís Garcia , Martins Jaifer Corrêa , Isoldi Liércio André , Dias Gustavo da Cunha , Rocha Luiz Alberto Oliveira , Souza Jeferson Avila , dos Santos Elizaldo Domingues
Published: December 2024

The present work investigates the influence of rectangular deflectors on the performance of a Savonius turbine mounted in an L-shaped channel, which represents a geometry like that found in one oscillating water column (OWC) device. It also performs a geometric investigation of the entrance region of the channel. More precisely, it investigates the effect of the height/length ratio (H1/L1) of the entering region of the channel on the system performance for three different configurations: (1) without the use of deflectors, (2) with just one deflector upstream the turbine, and (3) with one deflector upstream and another downstream the turbine. The geometric investigation is performed based on the constructal design method, and the entering channel area (A1) is the problem constraint. The performance indicators are the mechanical power in the Savonius turbine and the available power in the device. For all cases, it is considered turbulent airflow in the domain, being solved by the unsteady Reynolds Averaged Navier–Stokes mass and momentum equations. The numerical solution was obtained with the finite-volume method using the Ansys FLUENT software (version 2021 R1). The k-ω shear stress transport turbulence closure model is used. The results demonstrated that the mechanical and available powers depend on the H1/L1 ratio, regardless of the usage of deflectors. For instance, differences of up to 16.35% in mechanical power and 7.25% in available power were observed between the best and worst performance configurations in the case without deflectors. The use of deflectors resulted in increases of two and three times in available and mechanical powers, respectively, when the cases with one and two deflectors are compared with those without deflectors. This demonstrates that the enclosed domain and the insertion of the deflectors can enhance the performance of the Savonius turbine.
Adaptive Positioning Control of Multi-Point Moorings with Disturbance Observation Under Input Constraints
Authors: Lu Run , Zhang Guichen , Liu Ru , Gao Chaojian , Chen Wei , Fu Huanglong
Published: December 2024

In the presence of dynamic uncertainties, external time-varying disturbances, and limited inputs to the multi-point mooring system (MPMS) of a floating offshore platform (FOP), this paper proposes a robust adaptive dynamic surface (RADS) control method incorporating a disturbance observer. A disturbance observer is designed to estimate the unknown time-varying disturbance and apply feedforward compensation to the control variable. Simultaneously, the adaptive law of the σ-corrected leakage term is employed to estimate the bound of the disturbance observation error, thereby enhancing positioning accuracy. An auxiliary dynamic system (ADS) is then introduced to address input constraints, while the differential explosion problem associated with the traditional inversion method is resolved through the integration of the dynamic surface control (DSC) algorithm. The Lyapunov function is utilized to demonstrate that the controller ensures the consistent ultimate boundedness of all signals within the closed-loop system. Finally, a simulation experiment was conducted based on the eight-point mooring platform of the “Kantan3”, and the positioning accuracy reached 3%, which is higher than the specification requirements of the classification society. The results indicate that the designed controller achieves higher positioning accuracy and improved anti-interference performance and has been put into practical application on “Kantan3”.
System-Level Digital Twin Modeling for Underwater Wireless IoT Networks
Authors: Wang Lei , Yan Lei , Li Xinbin , Han Song
Published: December 2024

Digital Twin (DT) technology is pivotal in advancing smart underwater wireless IoT networks and effectively enhancing capabilities for monitoring and managing aquatic environments. For complex system-level DT models in these networks, assembling multiple unit-level DT models becomes crucial. Federated Learning (FL) presents a distributed machine learning paradigm that enables devices within underwater wireless IoT networks to collaboratively refine a DT model. Employing FL for DT modeling (FLDTM) is particularly valuable, as it allows for the enhancement of model accuracy without explicitly sharing local data, thereby preserving data privacy under challenging aquatic conditions. In this article, we propose a secure and efficient multi-server FL framework tailored for underwater wireless systems. We introduce a voting-based security prediction model to significantly bolster security in underwater wireless communication. Moreover, we introduce the network flow problem and employ a minimum-cost flow algorithm to enable FL servers’ cooperation. These strategies are integrated into a smart contract, namely, the UCB-based Smart Contract with a Security Prediction model and Minimum-Cost Flow (UCB-SCPF) policy. Experimental results show that the UCB-SCPF policy-based FLDTM framework achieves model accuracy comparable to ideal conditions while demonstrating excellent performance in terms of training efficiency and security. Additionally, the framework maintains stability as the network scale increases. These findings underscore the potential of the UCB-SCPF policy-based FLDTM framework in advancing DT technology for underwater wireless IoT networks.
A State-of-the-Art Review on Storm Events, Overtopping and Morphological Changes in Front of Coastal Structures
Authors: Romão Frederico , Lima Márcia , Coelho Carlos
Published: December 2024

Overtopping phenomena and consequent floods cause significant damage to coastal communities. Morphological changes in front of structures during storms can influence their functionality, affecting their stability and leading to failures, impacting the population that are depending on those coastal interventions for their protection. The effect of climate changes, such as sea level rise and increase of the frequency and intensity of storms, can raise the number of overtopping events over defense structures, also increasing coastal morphological changes, challenging future managers, engineers and the scientific coastal communities. A review of morphological changes in front of coastal defense structures and in natural barriers due to overtopping, wave run-down and reflux was conducted. The objective of this review was to find and gather relevant information, sometimes dispersing, reflecting and grouping the concepts found in the literature. Additionally, the gaps in scientific research are addressed, focusing on topics that may be enhanced. Several keywords used in the research were presented, emphasizing the relationship between overtopping and models (physical and numerical), storms, defense structures and morphological changes, also related to wave run-down during storms. The results show that there is limited information available that is mainly related to morphological changes in front of coastal defense structures during storm events, showing an opportunity to develop knowledge.