bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring Physician and Patient Perspectives on Expectations and Role Models Towards Chronic Pain Treatment in General Practice: A Qualitative Cross-Sectional Study
Authors: Dupont Dominik , Brinkmöller Sabrina , Carter Sarina , Wensing Michel , Straßner Cornelia , Engeser Peter , Poß-Doering Regina
Published: January 2025

Background and Objective: Approximately 7.4% of the German population matched the criteria of impeding, chronic non-cancer-related pain in 2014. Guidelines emphasize the importance of a holistic treatment approach. The project RELIEF aims to develop and evaluate a multifaceted case-management intervention to foster the holistic management of chronic pain in general practice. To inform intervention development, this study explored expectations and perceived role models of general practitioners (GP) and patients regarding chronic non-cancer-related pain management in general practice with a focus on patient expectations of GPs and themselves, as well as GP expectations of patients and their anticipation of patient’s expectations. Methods: Data were collected via semi-structured guide-based interviews with general practitioners and patients. Pseudonymized verbatim transcripts were analyzed using an inductive–deductive approach with a structuring qualitative content analysis. The Theoretical Domains Framework served as an analytical framework to explore behavioral aspects associated with expectations and role perceptions. Results:n = 25 interviews were analyzed (GP: n = 10, patient: n = 15). Findings indicate that patients considered themselves as the main actor in the therapy process yet expected guidance and care coordination from their GP. The essential role GPs play in pain management was emphasized. Role models indicated by GPs and some patients represent a care ideal, which was also reflected in discussed expectations. GPs anticipated that patients would place high relevance on pharmacological options. Patients highlighted their preference of non-pharmacological and alternative treatment options. Conclusions: Our findings demonstrate the importance of holistic, individually tailored chronic pain management in general practice. Systematic, multifaceted case management, as planned in the RELIEF project, may contribute to high-quality primary care for affected individuals.
The Role of Personality in Explaining Burnout, Work Addiction, and Stress-Related Growth in Prehospital Emergency Personnel
Authors: Butoi Mihai Alexandru , Vancu Gabriela , Marcu Radiana-Carmen , Hermenean Andrei , Puticiu Monica , Rotaru Luciana Teodora
Published: January 2025

Background/Objectives: This is a cross-sectional study designed to explore the contribution of personality factors (the Alternative Five Factor Model) and lower order characteristics (responsive distress and self-discipline) to burnout, work addiction, and stress-related growth among Romanian prehospital emergency healthcare workers. Methods: A total of 266 prehospital professionals (41 physicians, 74 nurses, and 151 paramedics) participated in the study out of the 728 invited (36.5% response rate). The age of participants ranged between 20 and 57 years and 67.3% were men. The participants completed the Oldenburg Burnout Inventory, the Dutch Work Addiction Scale (the short version), the Stress-Related Growth Scale, the Zuckerman–Kuhlman Personality Inventory, the Responsive Distress Scale, and the Self-Discipline Scale. Results: The results show that burnout was predicted by age, gender, impulsive sensation seeking, responsive distress, and self-discipline; work addiction was predicted by aggression–hostility, sociability, and responsive distress, while stress-related growth was predicted by age, activity, and self-discipline. Additionally, we found that emergency healthcare workers displayed lower impulsive sensation seeking, neuroticism–anxiety, and aggression–hostility, but displayed higher levels of activity and sociability in comparison with the general Romanian population, although these differences must be interpreted with caution as the general Romanian population tend to be significantly younger. Conclusions: This study provides new insights into the role of personality traits as risk factors for burnout and work addiction, and as protective factors for stress-related growth in prehospital emergency personnel. It is also among the few studies in this field to employ the Alternative Five Factor Model of personality.
Knowledge, Attitude, and Practice in Dental Trauma Management Among Schoolteachers in Taif, Saudi Arabia
Authors: Alzahrani Muaath H. , Alghoraibi Muwffak , Alzubaidi Mohammed A. , Basha Sakeenabi , Althomali Yousef , Mohamed Roshan Noor , Altalhi Faisal K. , Alzahrani Yazeed A. , Albalooshy Amal , Alharbi Abdulaziz , Alqarni Ali
Published: January 2025

Background: In Saudi Arabia, dental trauma is regarded as one of the most important issues affecting schoolchildren. This study evaluated Saudi Arabian schoolteachers’ knowledge, attitude, and practice regarding emergency dental trauma management. Methods: A cross-sectional study was conducted on 263 schoolteachers from 25 schools; 50.9% were females. A questionnaire was used to collect respondents’ personal and professional data and information on managing dental injury scenarios and the respondents’ attitudes toward dental injuries. A multivariate logistic regression analysis was carried out for the independent and outcome variable of inadequate knowledge regarding dental trauma management. Results: Male teachers had better knowledge than female teachers regarding emergency management of avulsed teeth. Compared to female teachers, male teachers would scrub a tooth with a toothbrush to replant it back into its socket if it fell onto the ground and was covered with dirt. Males had a significantly higher percentage of believing it is not teachers’ responsibility to care for tooth injuries in schools. Teachers with teaching experience of 5–10 years had a significantly higher percentage of training in dental emergencies. Teachers with bachelor’s degrees agreed on the need for teacher involvement to save the tooth in a timely manner. Compared to general teachers, physical education teachers would put the tooth back in the mouth and send the child to the dentist immediately if they were hit in the face and the upper front tooth fell out of their mouth. Teachers with a diploma level of education and teachers with a general type of teaching qualification were 2.15 times (CI = 0.98–3.11, p = 0.002) and 3.19 times (CI = 1.71–4.22, p = 0.0001) more likely to have a higher level of inadequate knowledge regarding dental trauma management. Conclusions: There is a need to raise teachers’ awareness and improve their dental trauma emergency management training.
COVID-19-Related Discontinuation Impact on Patient-Reported Outcomes in Long-Term Thermal Therapy: A Single-Center Observational Study at Saturnia Thermal Springs
Authors: Ferrara Elisabetta , Scaramuzzino Manela , Murmura Giovanna , D’Addazio Gianmaria , Sinjari Bruna
Published: January 2025

Background: Thermal therapy represents a well-established therapeutic approach for chronic musculoskeletal and respiratory conditions. To date, no studies have investigated the clinical effects of treatment interruption in thermal medicine. We aimed to evaluate the clinical impact of COVID-19 lockdown-induced thermal therapy discontinuation through validated patient-reported outcomes. Methods: This single-center observational, retrospective study (March 2020–June 2024) evaluated 97 patients receiving standardized thermal therapy at Saturnia Thermal Springs. Treatment protocols included balneotherapy, mud therapy, and inhalation treatments in cycles of 12–15 sessions, with maintenance protocols every 4–6 months. Primary outcomes were assessed through VAS and SF-36 PCS, with EQ-5D and PSQI as secondary outcomes. Results: Significant clinical deterioration occurred during treatment interruption (p < 0.001) in 77.7% of patients. Recovery patterns were duration-dependent, with the 6–7-year cohort showing faster recovery (mean time to baseline: 2.8 months) compared to the 3–5-year cohort (4.6 months). Effect sizes were substantial across all outcomes (Cohen’s d > 1.0), with EQ-5D scores showing duration-dependent improvement (mean improvement in 6–7-year cohort: 0.27). Conclusions: Thermal therapy interruption precipitates quantifiable clinical deterioration, with recovery patterns significantly influenced by pre-existing treatment duration. These findings support the essential nature of treatment continuity in thermal therapy protocols.
Hygiene Status of Over-the-Row Blueberry Machine Harvesters Cleaned and Sanitized Using Various Approaches
Authors: Dai Yaxi , Holland Renee , Doane Sarah , Yang Weiqiang , Chen Jinru
Published: January 2025

Contamination of fresh blueberries via contact with an equipment surface is an important food hygiene/safety issue. In this study, four and six over-the-row blueberry machine harvesters in Georgia or Oregon were each sampled twice on two different harvest days in the 2022 harvest season. Nine sites on the top loaders (n = 8) and seven sites on the bottom loaders (n = 2) were sampled before and after cleaning/sanitation. Populations of total aerobes (TA), total yeasts and molds (YM), total coliforms (TC), and the presence of fecal coliforms (FC) and enterococci (EC) in collected samples were determined. Data collected was analyzed using the split-plot ANOVA of SAS. On average, cleaned/sanitized surfaces had about one log lower (p ≤ 0.05) TA and YM counts than the uncleaned surfaces, while no difference in TC counts was observed. The vertical and horizontal conveyors and fruit-catch plates had significantly higher TA, YM, and TC counts than other sampled sites. FC and EC were detected in 7.8% or 14.1% of the Georgia samples and 5.6% or 10.2% of the Oregon samples. The type and concentration of sanitizers and frequency and approach of cleaning/sanitation treatments all impacted the hygiene status of berry-contact surfaces of machine harvesters.
The Genetic Diversity, Population Structure, and Historical Dynamics of Wild Pyrus Species on the Yunnan–Kweichow Plateau
Authors: Yang Xiang , Dong Xingguang , Li Kunming , Zhang Ying , Xu Chenxi , Huo Hongliang , Tian Luming , Xu Jiayu , Liu Chao , Qi Dan , Cao Yufen
Published: January 2025

Located in the southwestern region of China, the Yunnan–Kweichow Plateau, is closely related to the origins of Pyrus L. Despite this important status, there has been relatively little population genetics research focused on the wild Pyrus species in this area. To address this gap in knowledge, the present study was conducted investigating wild Pyrus species distributions in the Yunnan–Kweichow Plateau region. These analyses entailed the collection of 80 accessions, whole-genome resequencing, and the detection of variants including SNPs, InDels, SVs, and CNVs. Genetic structure analyses revealed clear differences between P. pashia and P. calleryana, where the former was additionally subdivided into five groups. The genetic structure of these accessions was closely aligned with their geographic distribution, highlighting the fragmented nature of wild Pyrus populations on the Yunnan–Kweichow Plateau. Analyses of genetic diversity suggested that the central and easter portions of Yunnan Province are key centers of Pyrus diversity on the Yunnan–Kweichow Plateau, whereas the highest degree of differentiation was observed for wild Pyrus in the southwest and northwest regions. Demographic analyses indicated that wild Pyrus populations on the Yunnan–Kweichow Plateau are currently in a state of population contraction, with evidence of migration events between these populations.
Snorkelling and Breath-Hold Diving Fatalities in Australia—A Review of 317 Deaths
Authors: Lippmann John M.
Published: January 2025

As snorkelling and breath-hold diving are conducted in a potentially hostile environment by participants with varying skills and health, fatalities occur. In this study, snorkelling and breath-hold diving fatalities were investigated in Australia from 2000 to 2021 to identify causes and countermeasures. The Australasian Diving Safety Foundation database and the National Coronial Information System were searched to identify snorkelling/breath-hold diving deaths from 2000 to 2021. Relevant data were extracted, recorded, and analysed. The median age of the 317 victims was 48 years, two-thirds were overweight or obese, and almost half had health conditions, including ischaemic heart disease (IHD) and left ventricular hypertrophy (LVH), predisposing them to an arrhythmia-related snorkelling incident. One-third of victims were likely disabled by cardiac arrhythmias and at least 137 deaths were from primary drowning, with 34 following apnoeic hypoxia. Pre-existing health conditions, particularly IHD and LVH, predispose to many snorkelling deaths in older participants and may be somewhat mitigated by targeted health screening. Drownings from apnoeic hypoxia persist in younger breath-hold divers who should avoid pushing their limits without close monitoring. Skills practice in a controlled environment, increased focus on the importance of an effective buddy, and improved supervision are necessary to mitigate risk in the inexperienced.
“My Husband Is a ‘Mama’s Boy’”: Women’s Views on Male Engagement in Maternal, Newborn, and Child Health in Western Kenya
Authors: Tura Robsan , Aluku Nema C. M. , Ashida Sato , Story William T.
Published: January 2025

There is an increasing global acknowledgment of the critical role that men have as key partners in maternal, newborn, and child health (MNCH). Most male-engagement initiatives do not address the perceived benefits and risks that women may experience because of increased male participation in MNCH, especially in Kenya. The aim of this study, therefore, is to qualitatively assess how women perceive and experience increased male engagement in MNCH in western Kenya. Using a phenomenological approach, 53 women (35 mothers and 18 mothers-in-law) were purposively selected from seven communities in Kakamega County and participated in seven focus group discussions (FGD) in November and December 2020. Our findings suggest that the level of support for increased male involvement in MNCH varies depending on the type of participant. While mothers-in-law were less supportive of increased male involvement, mothers were more supportive of male involvement that fosters gender equity, such as joint decision making. Most mothers-in-law argued that women are ‘naturally’ closer to children, that men cannot care for children and their involvement may harm children, and men’s involvement may give men more control over women’s spaces. These findings show that programmatic initiatives to enhance male engagement in MNCH must consider mothers-in-law’s concerns and leverage mothers’ desire to engage men in a gender-equitable way.
Absenteeism Among Healthcare Workers: Job Grade and Other Factors That Matter in Sickness Absence
Authors: Sakr Carine J. , Fakih Lina M. , Musharrafieh Umayya M. , Khairallah Ghassan M. , Makki Maha H. , Doudakian Rita M. , Tamim Hani , Redlich Carrie A. , Slade Martin D. , Rahme Diana V.
Published: January 2025

Background: Absenteeism among healthcare workers (HCWs) disrupts workflows and hampers the delivery of adequate patient care. The aim of the study was to examine predictors of sick leaves among HCWs in a tertiary medical center in Lebanon. Methods: A retrospective analysis of sick leaves linked to health records of 2850 HCWs between 2015 and 2018 was performed. Sick leave episodes were stratified by diagnosis. Bivariate and negative binomial regression analyses were performed to investigate predictors. Results: The mean number of sick leave episodes was 10.6 per person over 4 years. The strongest predictor of higher sickness absenteeism was low job grade (IR = 1.52; 95% CI = 1.39, 1.67). Female sex (IR = 1.24; 95% CI = 1.14, 1.36), older age (IR = 1.19; 95% CI = 1.08, 1.30), being married (IR = 1.21; 95% CI = 1.11, 1.33), being a current smoker (IR = 1.21; 95% CI = 1.11, 1.32), and having a history of selected medical conditions were all significant sick leave predictors. Conclusion: Demographic, work-related, and health-related predictors are associated with the number of sick leave episodes. To address the health inequity, additional research should evaluate how some socio-economic factors determine poorer health outcomes and should guide approaches to address this crucial issue to protect the health and well-being of this key workforce.
Mapping the Dream: Designing Optimal E-Bike Routes in Valparaíso, Chile, Using a Multicriteria Analysis and an Experimental Study
Authors: Aprigliano Vicente , Toro Catalina , Rojas Gonzalo , Bastías Iván , Cardoso Marcus , Santos Tálita , da Silva Marcelino Aurélio Vieira , Bustos Emilio , de Oliveira Ualison Rébula , Seriani Sebastian
Published: January 2025

The city of Valparaíso, Chile, faces significant mobility challenges due to its steep slopes, complex urban infrastructure, and socioeconomic conditions. In this direction, this study explores the potential promotion of E-bike uses by identifying the optimal routes that connect metro stations to strategic hilltop streets in the city. A hybrid methodology combining a multicriteria GIS-based analysis and an experimental study was used to evaluate potential routes and the possibility of increasing the power limitations for non-motorized mobility in Chile. Fifteen routes were assessed based on criteria including the slope, traffic safety, directionality, intersections, and travel distance. The results indicate that routes such as Cumming from Puerto and Bellavista stand out as the most viable for e-bike use given their favorable characteristics. The experimental study revealed that higher-powered E-bikes (500 W and 750 W) would be more able to overcome the steep slopes of Valparaíso, with an average speed of 5.36 km/h and 9.52 km/h on routes with a 10.88% average slope. These findings challenge the current regulatory limit of 250 W for non-motorized vehicles in Chile, highlighting the potential benefits of increasing their power limits to enhance sustainable mobility in the hilly urban contexts of this country. This study highlights the need to adapt urban mobility policies to the unique topographical conditions of each city. Future research should build upon more experimental studies, develop specific street-scale analyses using audit methods, incorporate climate-related variables, and evaluate the economic viability of e-bike infrastructure. Addressing these aspects could position Valparaíso as a leading example of sustainable urban mobility for cities facing comparable challenges.
Idiopathic Abdominal Wall Endometrioma: Case Report with Investigation of the Pathological, Molecular Cytogenetic and Cell Growth Features In Vitro
Authors: Gogusev Jean , Lepelletier Yves , Cohen Henri , Ami Olivier , Validire Pierre
Published: January 2025

Abdominal wall endometriosis (AWE) is a clinical disorder with unknown pathogenesis with an incidence between 0.03% and 1% in women affected by cutaneous/scar endometriosis. We investigated the pathological, molecular cytogenetic and cell proliferation features of a primary AWE developed in rectus abdominis muscle in a patient without co-existing pelvic endometriosis. An investigational model of cultured stromal cells was additionally established. Histologically, the lesion revealed areas of endometrial-like glands surrounded by a thick stromal layer in addition to numerous disseminated foci composed exclusively of stromal cells. Beyond the strong expression of Estrogen (ER) and Progesterone receptors (PRs), consistent immunolabeling for several mesenchymal stromal/stem cell antigens and oncoproteins was revealed in both the endometrioma as well as in the cultured stromal cells. The Fluorescence in situ hybridization (FISH) analysis of the endometrioma demonstrated a structural alteration of the c-MYC protooncogene, with a mean of three gene copies in 3% to 5% of both glandular and stromal cells. The FISH assay applied on the cultured cells showed c-MYC gene amplification, with an average number of more than six gene copies in 18% to 25% of the cellular nuclei. Altogether, these results markedly highlight the pathological and molecular features of idiopathic AWE essential for histo-pathogenetic categorization.
Impact of Honey Soil Supplementation on Growth and Antioxidant Activity in Basil (Ocimum basilicum L.) Plants
Authors: Sadou Dyhia , Fedeli Riccardo , Celletti Silvia , Amessis-Ouchemoukh Nadia , Ayad Rabha , Loppi Stefano , Ouchemoukh Salim
Published: January 2025

This study explores the potential of honey as a natural soil amendment to enhance plant growth and biochemical resilience in Ocimum basilicum L. Honey solutions at varying concentrations (2.5%, 5%, and 10%) were applied to evaluate their effects on growth parameters, biomass accumulation, and antioxidant activity. The results revealed that lower honey concentrations (2.5%) had a minimal impact on plant height, while higher concentrations (5% and 10%; −42% and −43%, respectively) exhibited inhibitory effects, suggesting a dose-dependent response. The leaf count remained stable across treatments, indicating a consistent morphological outcome. The biomass analysis highlighted variability in the plant biomasses, reflecting the influence of honey concentrations on plant energy allocation. Despite unchanged chlorophyll and ascorbic acid levels, significant enhancements in antioxidant compounds and activity were observed, particularly at lower concentrations (antioxidant activity at 2.5% and 5%; +26% and +30%, respectively), underlining the role of honey in bolstering the antioxidant defense system. These findings demonstrate honey’s dual role as a growth modulator and antioxidant enhancer, emphasizing its relevance in sustainable agricultural practices. This research contributes to the development of eco-friendly strategies for improving crop performance and resilience through the application of naturally derived biostimulants.
An Integrated Approach of Video Game Therapy®: A Case Study
Authors: Crepaldi Maura , Bocci Francesco , Sarini Marcello , Greco Andrea
Published: January 2025

International literature in the field of rehabilitation and psychological support is increasingly characterized by the inclusion and use of video games and virtual media, even if the results are controversial. The theoretical basis on which the study presented is based is Video Game Therapy®. This approach uses commercial video games, which are generally free or available at a relatively low cost. These games possess many essential functions that make them practical as preventive tools or support for integration into traditional therapies. Video Game Therapy® allows the patient to reflect on emotional containment and cognitive self-regulation to establish a state of mental balance and well-being. It encourages insight and leads the player to reflect on some salient aspects of their character and lifestyle and their emotions and thoughts linked to specific life episodes relived in the game setting. Starting from these premises, the study shows promising results, presenting a single case of a boy with social isolation problems and relational difficulties, in which significant changes were highlighted in the perception, expression, and management of emotions, as well as in metacognition and self-efficacy.
Comparison of Fecundity and Gall-Forming of the Horned-Gall Aphid, Schlechtendalia chinensis (Hemiptera: Aphididae) from Different Populations
Authors: Xu Xin , Shi Zhaohui , Tong Chang , Shao Shuxia , Wei Hongyuan , Yang Zixiang
Published: January 2025

The horned-gall aphid, Schlechtendalia chinensis, is the most economically valuable Chinese gallnut aphid species, playing a decisive role in the production of Chinese gallnuts. The method of cultivating the gallnut species with artificial moss and increasing the yield of gallnuts after inoculation has been applied in the main producing areas of Chinese gallnuts. However, it is still unclear whether artificial cultivation affects the fecundity and gall-forming effect of S. chinensis. In this study, autumn migrant aphids of S. chinensis from wild, artificial and introduced populations were used as materials to cultivate and inoculate under the same environment. The number of male and female sexuales, fundatrices, the galls per tree, and the total weight of galls per tree in subsequent generations were analyzed, and differences in the fecundity and gall-forming effects of different populations were analyzed. The results showed that the fecundity of the wild population was stronger than that of the artificial population, and the number of aphids produced by a single spring migrant and the number of fundatrices increased by 75.86% and 81.62%, respectively. Compared with the introduced population, the survival rate of female sexuales in the local population was higher. Compared with the artificial population, the gall-forming effect of the wild population was better; the number of galls per tree, the weight of single gall, and the total weight of galls per tree increased by 68.33%, 50.77%, and 153.78%, respectively; and the gall preservation rate increased significantly. Artificial cultivation of S. chinensis will lead to a decrease in fecundity and gall-forming effect in subsequent generations, showing the degradation of the vitality of S. chinensis. Therefore, it is necessary to improve the effect of artificial cultivation of S. chinensis by adopting technical measures such as wild population or introduction.
Spinal Cord Stimulation for Refractory Angina Pectoris: Current Status and Future Perspectives, a Narrative Review
Authors: Gazzeri Roberto , Mosca Jacopo , Occhigrossi Felice , Mercieri Marco , Galarza Marcelo , Leoni Matteo Luigi Giuseppe
Published: January 2025

Refractory angina pectoris (RAP) is a clinical syndrome characterized by persistent chest pain caused by myocardial ischemia that is unresponsive to optimal pharmacological therapy and revascularization procedures. Spinal cord stimulation (SCS) has emerged as a promising therapeutic option for managing RAP, offering significant symptom relief and improved quality of life. A systematic literature review was conducted to evaluate the clinical effectiveness, mechanisms of action, and safety profile of SCS in treating RAP. Comprehensive searches were performed in PubMed, Scopus, and Web of Science for studies published between 1990 and 2023. Of 328 articles identified, 6 met the inclusion and exclusion criteria for final analysis. The included studies consistently demonstrated that SCS significantly reduces the frequency of anginal episodes and nitroglycerin use while improving exercise capacity and quality of life. Proposed mechanisms include modulation of pain signals via the gate control theory, enhancement of autonomic balance, and redistribution of myocardial perfusion. Novel stimulation modalities, including high-frequency, Burst, and Differential Target Multiplexed (DTM), show potential advantages in enhancing patient comfort and clinical outcomes. Nevertheless, long-term studies are necessary to validate these findings and establish the comparative efficacy of these advanced technologies. SCS is a safe and effective therapy for patients with RAP who are unsuitable for surgical interventions. Innovations in neurostimulation, including closed-loop systems and personalized treatment strategies have the potential to further optimize outcomes. Rigorous clinical trials are needed to consolidate the role of SCS as a cornerstone therapy for the management of RAP.
Regional Anesthesia with Spontaneous Breathing for Trans-Axillary Surgery in Thoracic Outlet Syndrome: A Retrospective Comparative Study
Authors: Stilo Francesco , Strumia Alessandro , Catanese Vincenzo , Montelione Nunzio , Tomaselli Eleonora , Pascarella Giuseppe , Costa Fabio , Ciolli Alessandro , Longo Ferdinando , Mattei Alessia , Schiavoni Lorenzo , Ruggiero Alessandro , Codispoti Francesco Alberto , Paolini Julia , Agrò Felice Eugenio , Spinelli Francesco , Carassiti Massimiliano , Cataldo Rita
Published: January 2025

Background: Thoracic outlet syndrome (TOS) is an uncommon condition defined by the compression of neurovascular structures within the thoracic outlet. When conservative management strategies fail to alleviate symptoms, surgical decompression becomes necessary. The purpose of this study is to evaluate and compare the efficacy and safety of regional anesthesia (RA) using spontaneous breathing in contrast to general anesthesia (GA) for patients undergoing surgical intervention for TOS. Methods: We conducted a retrospective comparative study involving 68 patients who underwent trans-axillary first rib resection for TOS. The patient cohort was divided into two groups: 29 patients in the GA group and 39 patients in the RA group. The RA technique employed consisted of supraclavicular brachial plexus (SBP) and pectoral nerve (PECS II) blocks, accompanied by deep sedation. Key outcome measures such as pain scores, opioid consumption, and various perioperative parameters were systematically analyzed. Results: Postoperative pain levels recorded in the recovery room were significantly lower in the RA group, with a median numerical rating scale (NRS) score of zero compared to two in the GA group (p = 0.0443). Additionally, both intraoperative and postoperative opioid consumption showed a marked reduction in the RA group, with p-values of less than 0.001 and 0.0418, respectively. The RA approach was associated with shorter surgical durations (p = 0.0008), a decrease in the incidence of postoperative nausea and vomiting (PONV) (p = 0.0312), and a lower occurrence of intraoperative lung injuries (p < 0.0001). Furthermore, the length of hospital stay was significantly reduced for patients in the RA group. Conclusions: Although both groups reported low postoperative pain scores, the regional anesthesia approach exhibited distinct advantages in terms of opioid consumption, surgical duration, and overall perioperative outcomes. The utilization of SBP and PECS II blocks facilitated surgical procedures and mitigated complications, thereby positively influencing the postoperative recovery trajectory. Future prospective studies are essential to validate these findings further and to investigate long-term outcomes associated with the use of regional anesthesia in TOS surgery.
Avoiding Chest Wall Morbidity in Outpatient Microvascular Free-Flap Breast Reconstruction
Authors: Martinez Carlos A. , Boutros Sean G.
Published: January 2025

Background. Removal of the rib and adjacent cartilage is a common step for exposure of the recipient chest vessels in free-flap breast reconstructions. However, this adds both short- and long-term morbidity to the procedure. We describe our experience in avoiding rib removal in microvascular breast reconstruction. Patients and Methods. We retrospectively reviewed recipient vessel preparation in free-flap breast reconstructions performed by a single surgeon (SGB). Results. A total of 556 consecutive patients, totaling 1106 flaps over 5 years, were assessed. Recipient vessels included IMA in 1068 flaps and internal mammary perforator in 38 DIEP flaps. Nine patients underwent bilateral DIEP flap breast reconstruction with a cross-chest anastomosis, where the IMA was the recipient. Also, the IMA was used in 171 patients who underwent breast reconstruction with stacked flaps. No instances of complete rib resection were reported. However, in two cases of delayed DIEP flap reconstruction without a history of radiation, resection of 20% of the rib was required for safe vessel preparation. No intraoperative complications were observed, and three flaps from different patients were lost (one PAP and two DIEPs). Conclusions. Microsurgery in free-flap breast reconstructions has greatly evolved in the past two decades. Exposure of the IMA recipient vessels typically involves the removal of a portion of the intercostal cartilage and the rib, allowing comfortable and safe management of the vasculature during dissection and anastomosis. Nonetheless, excessive removal often leads to short-term increased pain and long-term cosmetic and functional complications, such as a noticeable depression of the chest wall especially noted in thin patients with small flaps. Our approach can be safely employed to preserve the anatomy and decrease pain, allowing for outpatient performance of these procedures.
Long-Term Clinical Impact of Paravalvular Leak Following Transcatheter Aortic Valve Implantation
Authors: Aurigemma Cristina , Trani Carlo , D’Errigo Paola , Barbanti Marco , Biancari Fausto , Tarantini Giuseppe , Ussia Gian Paolo , Ranucci Marco , Badoni Gabriella , Baglio Giovanni , Rosato Stefano
Published: January 2025

Background: Paravalvular leak (PVL) was initially recognized as one of the most common complications after transcatheter aortic valve implantation (TAVI) and has been linked to adverse clinical outcomes, including mortality. This study aims to assess the long-term clinical effects of PVL in patients undergoing TAVI with the latest generation of transcatheter aortic valves, as part of the national observational prospective multicenter study OBSERVANT II. Methods: OBSERVANT II included all consecutive patients with severe aortic stenosis who underwent TAVI across 28 Italian centers from December 2016 to September 2018. A total of 2125 patients were included in this analysis and stratified according to the presence of moderate-to-severe PVL (significant PVL, n = 155) versus no/trace-to-mild PVL (no significant PVL, n = 1970). The primary endpoint was 5-year major adverse cardiac and cerebrovascular events (MACCE), including all-cause death, stroke, myocardial infarction, and coronary revascularization. Five-year all cause death and re-hospitalization for heart failure (HF) were the secondary endpoints. Results: In our cohort, the incidence of moderate-to-severe PVL was 7%. Age, aortic anulus perimeter, and self-expandable valves were determinants of PVL. The risk of MACCE, all-cause death, and re-hospitalization for HF at the 5-year follow-up were not different between the study groups [HR = 1.07 (95% CI: 0.85–1.34) p = 0.571; HR = 1.10 (95% CI: 0.87–1.39) p = 0.435; HR = 1.20 (95% CI: 0.88–1.62) p = 0.245, respectively]. Conclusions: In this analysis of the OBSERVANT II study, moderate/severe PVL was not associated with a higher incidence of MACCE and re-hospitalization for heart failure at the 5-year follow-up.
Investigating Tumor-Infiltrating Lymphocytes in the Microenvironment of Oral Squamous Cell Carcinoma (OSCC) and Oral Potentially Malignant Disorders (OPMDs): Can They Shift Our Perspective? A Scoping Review
Authors: Sutera Samuele , Furchì Olga Anna , Pentenero Monica
Published: January 2025

Background/Objectives: Tumor-infiltrating lymphocytes (TILs) play a crucial role in the tumor microenvironment (TME), influencing the progression, prognosis, and response to treatment in oral squamous cell carcinoma (OSCC) and its precursors, oral potentially malignant disorders (OPMDs). This scoping review assesses the current literature on TILs in the TME of OSCC and OPMDs, aiming to identify trends and gaps in the research. Methods: A comprehensive search was performed in PubMed, using the following query terms: “Tumor Microenvironment AND (mouth neoplasms OR oral lichen OR leukoplakia OR oral lichenoid OR dysplasia OR GVHD OR lupus)”. Based on the inclusion criteria, we selected in vivo human original research and clinical observational studies that focused on TILs within the TME of OSCC and OPMDs. Results: Out of 1152 results in PubMed, 58 studies were selected and analyzed. These studies investigated various TILs, including T cells, B cells, and natural killer (NK) cells. Of these, 47 studies focused on the OSCC TME, 4 examined the OPMDs ME, and 7 compared OSCC TME and OPMDs ME. Discussion: While TILs in OSCC have been extensively studied, research on infiltrating lymphocytes in OPMDs is still limited. In OSCC, CD8+ T cells, T helper 1 cells, and NK cells are associated with strong antitumor activity, whereas CD4+ T cells, including T helper 2 and regulatory T cells, are linked to protumoral effects. B cells remain less explored due to their low frequency in the TME. In OPMDs, trends suggest an increase in activated CD8+ T cells in OLP and lower NK cell numbers compared to OSCC, which may contribute to malignant transformation. Understanding the spatial distribution and activation status of TILs within the TME is essential for deciphering their role. The variability in TIL composition highlights the complexity of the TME. Conclusions: Current knowledge remains preliminary, though it highlights the crucial role of TILs in carcinogenesis and OSCC. A more in-depth understanding could improve diagnostic and therapeutic strategies, including the assessment of the risk of malignant transformation in OPMDs.
Posterior Fossa Stereotactic Biopsy with Leksell Vantage Frame—Case Series and Review of Literature
Authors: Rowbottom Hojka , Končnik Rok , Ravnik Janez , Šmigoc Tomaž
Published: January 2025

Background: Stereotactic biopsy of posterior fossa lesions, which are often inoperable, enables a safe trajectory and provides tissue samples for accurate diagnosis, which is crucial for correct treatment since the latest World Health Organization Classification of Tumors of the Central Nervous System from 2021 places immense emphasis on molecular diagnostics. Stereotactic biopsy using the Leksell Vantage headframe is, due to its rigid design, extremely accurate, but stiffer, making the procedure more challenging and the learning curve steeper. Methods: This retrospective analysis demonstrates the introduction of the new Leksell Vantage headframe in day-to-day practice at the University Medical Center in Maribor, Slovenia, in demanding procedures of posterior fossa biopsies, and also provides a review of the literature available on the topic with emphasis on the technical aspect of posterior fossa biopsy using the Leksell Vantage headframe in adults. Results: In the observed series of three patients with posterior fossa lesions, all biopsies were representative, despite tissue samples being small, providing conclusive histopathologic reports (glioblastoma, rosette-forming glioneuronal tumor and metastasis of melanoma) with additional molecular diagnostics. After the initial biopsy case, the preoperative planning times and procedure times were shortened as we learnt about the importance of a tailored approach from the first case. In all cases, the biopsy was performed under local anesthesia with patients being awake throughout surgery. Conclusions: The rigid Leksell Vantage headframe makes access to the posterior fossa tougher when compared to its predecessors. However, the procedure is very accurate but requires precise preoperative planning and a customized approach when placing the headframe.
Comparison of COVID-19 and Non-COVID-19 Tracheostomised Patients: Complications, Survival, and Mortality Risk Factors
Authors: Mesalles-Ruiz Marta , Alonso Maitane , Cruellas Marc , Plana Martí , Penella Anna , Portillo Alejandro , Gumucio Víctor Daniel , González-Compta Xavier , Mañós Manel , Nogués Julio
Published: January 2025

Objectives: To compare the outcomes of tracheostomised COVID-19 patients with non-COVID-19 tracheostomised patients to identify factors influencing severity and mortality. Methods: A retrospective, single-centre cohort study was conducted on COVID-19 tracheostomised patients admitted from May 2020 to February 2022, compared with a cohort of non-COVID-19 tracheostomised patients. Results: COVID-19 tracheostomised patients had a higher mortality rate (50% vs. 27.3% in non-COVID-19 patients). Mortality risk factors in COVID-19 tracheostomised patients included female sex (HR 1.99, CI 1.09–3.61, p = 0.025), ischemic heart disease (HR 5.71, CI 1.59–20.53, p = 0.008), elevated pre-tracheostomy values of PEEP (HR 1.06, CI 1.01–1.11, p = 0.017) and INR (HR 1.04, CI 1.01–1.07, p = 0.004), and ventilatory complications (HR 8.63, CI 1.09–68.26, p = 0.041). No significant differences in complication rates were found based on Sars-CoV-2 infection or tracheostomy type. Conclusions: Tracheostomy technique did not impact complications, discharge circumstances, or mortality, supporting the safety of bedside percutaneous tracheostomies for COVID-19 patients. COVID-19 tracheostomised patients exhibited a higher mortality rate.
Endoscopic Resection of Large Non-Pedunculated Colonic Polyps Without Submucosal Injection Is Safe and Effective with Adequate Technique
Authors: Celdir Melis Gokce , Hoilat Gilles Jadd , Kahveci Alp Serhat , El Abiad Rami , Gerke Henning
Published: January 2025

Background/Objectives: Endoscopic resection with lift polypectomy using submucosal injection (SI) for large non-pedunculated colorectal polyps is recommended to facilitate complete mucosal resection and decrease the risk of perforation; however, there are no studies comparing the safety and efficacy of large polypectomies with and without lift polypectomy. We aimed to evaluate the feasibility and safety of the polypectomy technique without SI compared to the routine use of SI. Methods: We performed a single tertiary center retrospective study evaluating all consecutive large non-pedunculated colorectal polyps (≥20 mm) referred to expert endoscopists in polypectomy from 2018 through 2021. We collected and analyzed data on demographics, polyp characteristics, resection technique, complications, and polyp recurrence in 6–12 months. Results: In 200 large non-pedunculated colonic polyp resections, 110 (55%) were performed with SI. The median polyp size was slightly larger in SI (30 mm IQR [20, 40] vs. 25 mm IQR [20, 30] in no-SI, p < 0.05), with a range of 20 to 130 mm. There were no differences in delayed bleeding rates. No perforation was noted in the no-SI group, and five perforations occurred in the SI group, without a statistically significant difference between groups. There was no statistically significant difference in the polyp recurrence rate at 6–12 months between the no-SI and SI groups (12% vs. 8% in no-SI vs. SI, respectively, p = 0.48). Conclusions: Complete removal of large non-pedunculated polyps without SI is feasible and safe in this large series. This approach had similar rates of clinically significant post-polypectomy bleeding and a non-significant difference in perforation rate compared to polyp resection with routine use of SI. Randomized trials are warranted to further assess the safety and efficacy of this approach.
Prediction Model for POstoperative atriaL fibrillAtion in caRdIac Surgery: The POLARIS Score
Authors: Rosati Fabrizio , Baudo Massimo , Tomasi Cesare , Scotti Giacomo , Pirola Sergio , Mastroiacovo Giorgio , Polvani Gianluca , Bisleri Gianluigi , Benussi Stefano , Di Bacco Lorenzo , Muneretto Claudio
Published: January 2025

Background: New-onset postoperative atrial fibrillation (POAF) is the most common complication after cardiac surgery, occurring approximately in one-third of the patients. This study considered all-comer patients who underwent cardiac surgery to build a predictive model for POAF. Methods: A total of 3467 (Center 1) consecutive patients were used as a derivation cohort to build the model. The POLARIS score was then derived proportionally from the odds ratios obtained following multivariable logistic regression (MLR). The Brier Score, the area under the receiver operating characteristic curve, and the Hosmer–Lemeshow goodness-of-fit test were used to validate the model. Then, 2272 (Center 2) consecutive patients were used as an external validation cohort. Results: In the overall population (n = 5739), POAF occurred in 32.7% of patients. MLR performed in the derivation cohort showed that age, obesity, chronic renal failure, pulmonary hypertension, minimally invasive surgery, and aortic and mitral valve surgery were predictors of POAF. The derived POLARIS score was used to further stratify the population into four risk clusters: low (1.5–3), intermediate (3.5–5), high (5.5–7), and very high (7.5–9), each progressively showing an increase in POAF incidence. This was confirmed in a correlation analysis (Spearman’s rho: 0.636). Conclusions: The POLARIS score is a simple-to-use tool to stratify patients at higher risk of POAF. Precise identification of such patients might be used to implement clinical practice with the introduction of preoperative antiarrhythmic prophylaxis, further reducing the incidence of POAF and, potentially, its clinical sequelae, despite further investigations being warranted to test this model in prospective studies.
Effects of Spinal Cord Stimulation in Patients with Small Fiber and Associated Comorbidities from Neuropathy After Multiple Etiologies
Authors: Canós-Verdecho Ángeles , Bermejo Ara , Castel Beatriz , Izquierdo Rosa , Robledo Ruth , Gallach Elisa , Sevilla Teresa , Argente Pilar , Huertas Ismael , Peraita-Costa Isabel , Morales-Suarez-Varela María
Published: January 2025

Objectives: The aim of this study was to evaluate the effects of spinal cord stimulation (SCS) on pain, neuropathic symptoms, and other health-related metrics in patients with chronic painful peripheral neuropathy (PN) from multiple etiologies. Methods: A prospective single center observational longitudinal cohort study assessed SCS efficacy from April 2023 to May 2024, with follow-ups at 2, 4, 6, and 12 months in 19 patients suffering from the painful polyneuropathy of diverse etiologies: diabetic (DPN), idiopathic (CIAP), chemotherapy-induced (CIPN), and others. Patients were implanted with a neurostimulator (WaveWriter AlphaTM, Boston Scientific Corporation, Valencia, CA, USA) and percutaneous leads targeting the lower limbs (T10–T11) and, if necessary, the upper limbs (C4–C7). Stimulation programming was individualized based on patient preference and best response. Assessments were performed before and after implantation and included pain intensity (VAS and DN4), neuropathic pain symptoms (NPSI and SF-MPQ-2), autonomic symptoms (SFN-SIQ and SAS), sensory and small fiber nerve injury (UENS), functionality (GAF), sleep (CPSI), global impression of change (CGI and PGI), and quality of life (EQ-VAS and EQ-5D). Intra-epidermal nerve fiber density (IENFD) via skin biopsy was also performed at baseline (diagnostic) and after 12 months to assess potential small fiber re-growth. Statistical analyses were conducted to determine the evolution of treatment success. Results: To date, 19 patients have undergone implantation and completed follow-up. SCS produced a significant consistent and sustained improvement in pain intensity by 49% in DN4 and 76% in VAS, in neuropathic pain symptoms by 73%, in autonomic symptoms by 26–30%, in the sensorimotor physical exam by 8%, in functionality by 44%, in sleep by 74%, and in quality of life (69% for EQ-VAS and 134% EQ-5D). Both clinicians and patients had a meaningful global impression of change, at 1.1 and 1.3, respectively. Distal intra-epidermal nerve fiber density improved by 22% at 12 months while proximal intra-epidermal nerve fiber density decreased by 18%. Conclusions: SCS is an effective therapy for managing various types of PN.