bluuebunny/crossref_metadata_2025 huggingface dataset:
VAC-Stent in the Treatment of Post-Esophagectomy Anastomotic Leaks: A New “Kid on the Block” Who Marries the Best of Old Techniques—A Review
Authors: Dell’Anna Giuseppe , Fanti Lorella , Fanizza Jacopo , Barà Rukaia , Barchi Alberto , Fasulo Ernesto , Elmore Ugo , Rosati Riccardo , Annese Vito , Laterza Liboria , Fuccio Lorenzo , Azzolini Francesco , Danese Silvio , Mandarino Francesco Vito
Published: July 2024

Esophagectomy, while a pivotal treatment for esophageal cancer, is not without adverse events. Among these, anastomotic leak (AL) is the most feared complication, threatening patient lives and incurring significant healthcare costs. The management of AL is complex and lacks standardization. Given the high morbidity and mortality rates associated with redo-surgery, which poses risks for already fragile patients, various endoscopic treatments have been developed over time. Self-expandable metallic stents (SEMSs) were the most widely used treatment until the early 2000s. The mechanism of action of SEMSs includes covering the wall defect, protecting it from secretions, and promoting healing. In 2010, endoscopic vacuum therapy (EVT) emerged as a viable alternative for treating ALs, quickly gaining acceptance in clinical practice. EVT involves placing a dedicated sponge under negative pressure inside or adjacent to the wall defect, aiming to clear the leak and promote granulation tissue formation. More recently, the VAC-Stent entered the scenario of endoscopic treatment of post-esophagectomy ALs. This device combines a fully covered SEMS with an integrated EVT sponge, blending the ability of SEMSs to exclude defects and maintain the patency of the esophageal lumen with the capacity of EVT to aspirate secretions and promote the formation of granulation tissue. Although the literature on this new device is not extensive, early results from the application of VAC-Stent have shown promising outcomes. This review aims to synthesize the preliminary efficacy and safety data on the device, thoroughly analyze its advantages over traditional techniques and disadvantages, explore areas for improvement, and propose future directions.
Hypoglycemia in Oral Glucose Tolerance Test during Pregnancy and Risk for Type 2 Diabetes—A Five-Year Cohort Study
Authors: Haggiag Noa , Rotman Moran , Hallak Mordechai , Toledano Yoel , Gabbay-Benziv Rinat , Maor-Sagie Esther
Published: July 2024

Objective: To evaluate the risk of progression to type 2 diabetes (T2D) following reactive hypoglycemia in 100 g oral glucose tolerance test (oGTT). Methods: A retrospective analysis of parturients with up to 5-year follow-up postpartum. Data were extracted from the computerized laboratory system of Meuhedet, an Israeli HMO and cross-linked with the Israeli National Registry of Diabetes. Included were parturients with no prior diabetesand available oGTT values during pregnancy. Reactive hypoglycemia was defined as glucose levels lower than 60 mg/dL in at least one of 3 post-glucose load values in oGTT. The cohort was divided into 3 groups: normal glucose status, reactive hypoglycemia, and GDM. Maternal characteristics, laboratory data, and progression to T2D over 5 years were compared. Univariate and survival analyses assessed the adjusted hazard ratio for T2D, stratified by obesity Results: Among 14,122 parturients, 16.8% had reactive hypoglycemia, 71% had normal glucose status, and 12.2% had GDM. Adjusted for age, obesity, and hypertension, Parturients with reactive hypoglycemia had similar T2D risk compared to normal glucose status and a lower risk compared to GDM patients, regardless of obesity status. Conclusions: Reactive hypoglycemia during oGTT does not increase the risk of progressing to T2D.
Assessment of the Relationship between Antero-Posterior Dental Malocclusions, Body Posture Abnormalities and Selected Static Foot Parameters in Adults
Authors: Nowak Monika , Golec Joanna , Golec Piotr , Wieczorek Aneta
Published: July 2024

Objectives: This study aimed to find if a relationship exists between antero-posterior malocclusions and the level of musculoskeletal disorders in adults, including body posture and static foot analysis. Methods: In all, 420 participants were recruited through convenience sampling (Kraków University students and patients of a local dentist’s practice). Following general medical interviews, dental examinations and consideration of inclusion and exclusion criteria, 90 healthy volunteers (ages 19–35) were enrolled and assigned to three groups (n = 30) based on occlusion type (Angle’s molar Class I, II or III). The research procedure involved occlusion and temporomandibular disorder assessment conducted by a dental specialist. Comprehensive morphological measurements of body asymmetry were performed using the Videography 2D package and FreeSTEP software, which calculated the parameters determined from anterior, posterior and lateral projection photos. Foot loading distribution was analyzed using the FreeMED baropodometric platform. Results: Significant differences were demonstrated in the positioning of the head, cervical and lumbar spine in the sagittal plane among individuals with the analyzed occlusal classes (p < 0.05). Individuals with Angle’s Class II exhibited significantly greater forward head positions and greater depths of cervical and lumbar lordosis compared with individuals with Class III or Class I. Those with overbites had higher forefoot loading. The Class III individuals exhibited greater L-R displacement, indicating a larger angle of displacement of the centers of the right and left feet relative to the lower edge of the measurement platform, suggesting pelvic rotation. Conclusions: An inclination for concurrent occurrences of malocclusions and posture deviations in the sagittal plane was observed. An interdisciplinary approach involving dentistry and physiotherapy specialists which utilizes tools for comprehensive posture assessment is crucial for diagnosing and treating such conditions.
Evolution of Stemless Reverse Shoulder Arthroplasty: Current Indications, Outcomes, and Future Prospects
Authors: Hatta Taku , Mashiko Ryosuke , Kawakami Jun , Matsuzawa Gaku , Ogata Yohei , Hatta Waku
Published: July 2024

Reverse total shoulder arthroplasty (rTSA) is increasingly being used as a reliable option for various shoulder disorders with deteriorated rotator cuff and glenohumeral joints. The stemless humerus component for shoulder arthroplasties is evolving with theoretical advantages, such as preservation of the humeral bone stock and decreased risk of periprosthetic fractures, as well as clinical research demonstrating less intraoperative blood loss, reduced surgical time, a lower rate of intraoperative fractures, and improved center of rotation restoration. In particular, for anatomical total shoulder arthroplasty (aTSA), the utilization of stemless humeral implants is gaining consensus in younger patients. The current systematic review of 14 clinical studies (637 shoulders) demonstrated the clinical outcomes of stemless rTSA. Regarding shoulder function, the mean Constant-Murley Score (CS) improved from 28.3 preoperatively to 62.8 postoperatively. The pooled overall complication and revision rates were 14.3% and 6.3%, respectively. In addition, recent studies have shown satisfactory outcomes with stemless rTSA relative to stemmed rTSA. Therefore, shoulder surgeons may consider adopting stemless rTSA, especially in patients with sufficient bone quality. However, further long-term studies comparing survivorship between stemless and stemmed rTSA are required to determine the gold standard for selecting stemless rTSA.
Respiratory Symptoms and Changes of Oxidative Stress Markers among Motorbike Drivers Chronically Exposed to Fine and Ultrafine Air Particles: A Case Study of Douala and Dschang, Cameroon
Authors: Tiekwe Joseph Eloge , Ongbayokolak Nadine , Dabou Solange , Natheu Cerge Kamhoua , Goka Marie Stéphanie , Nya Biapa Prosper Cabral , Annesi-Maesano Isabella , Telefo Phélix Bruno
Published: July 2024

Recent studies revealed that the high production of reactive oxidative species due to exposure to fine or ultrafine particles are involved in many chronic respiratory disorders. However, the poor standard of clinical data in sub-Saharan countries makes the assessment of our knowledge on the health impacts of air pollution in urban cities very difficult. Objective: The aim of this study was to evaluate the distribution of respiratory disorders associated with exposure to fine and ultrafine air particles through the changes of some oxidative stress biomarkers among motorbike drivers from two cities of Cameroon. Methods: A cross-sectional survey using a standardized questionnaire was conducted in 2019 on 191 motorcycle drivers (MDs) working in Douala and Dschang. Then, the activities of superoxide dismutase (SOD) and the level of malondialdehyde (MDA) were measured using colorimetric methods. The data of participants, after being clustered in Microsoft Excel, were analyzed and statistically compared using SPSS 20 software. Results: The motorbike drivers recruited from both cities were from 21 to 40 years old, with a mean age of 29.93 (±0.82). The distribution of respiratory disorders, such as a runny nose, cold, dry cough, chest discomfort, and breathlessness, was significantly increased among MDs in Douala. According to the results of biological assays, SOD and MDA were significantly greater among the MDs recruited in Douala compared to those of Dschang. The change in these oxidative stress markers was significantly positively correlated with the mobilization of monocytes and negatively correlated with neutrophils, showing the onset and progression of subjacent inflammatory reactions, and it seemed to be significantly influenced by the location MDs lived in. Conclusions: Through this study, we have confirmed the evidence supporting that the onset and progression of oxidative stress is caused by the long-term exposure to fine or ultrafine air particles among working people living in urban cities. Further studies should be conducted to provide evidence for the cellular damage and dysfunction related to the chronic exposure to fine particulate matter (PM) in the air among working people in the metropolitan sub-Saharan Africa context.
Impact of Upadacitinib on Atopic Keratoconjunctivitis Exacerbated by Dupilumab Treatment in Atopic Dermatitis Patients: A Prospective Dermatological and Ophthalmological Clinical Evaluation in Common Clinical Practice
Authors: Paganini Claudia , Spelta Sara , Tofani Lorenzo , Talamonti Marina , Bianchi Luca , Coassin Marco , Di Zazzo Antonio , Galluzzo Marco
Published: July 2024

Introduction: Atopic dermatitis (AD) is a prevalent chronic inflammatory skin condition with a substantial impact on patients, particularly due to ocular involvement known as atopic keratoconjunctivitis (AKC). Current therapeutic approaches, such as dupilumab, often lead to conjunctivitis, prompting exploration of alternative treatments like upadacitinib. Methods: We collected dermatological and ophthalmological prospective clinical evaluations of six adults with moderate-to-severe AD, undergoing treatment with upadacitinib after discontinuation of dupilumab due to the onset of AKC during therapy and the worsening of dermatitis in particular in the head and neck region. Clinical evaluations, including EASI scores, itch and sleep NRS, DLQI, and ocular parameters, were performed at baseline (during screening assessment before switching to upadacitinib) and then at week 12 and week 24. Clinical evaluation of AKC was performed by a team of ophthalmologists. Results: Upadacitinib not only improved atopic dermatitis in terms of EASI, itching, and sleep NRS, but also demonstrated a notable reduction in ocular signs and symptoms, as indicated by the Visual Analogue Scale (VAS), the Efron scale, and the Ocular Surface Disease Index Symptom Severity (OSDISS) scores. Discussion: Our observation of common clinical practice underscores the substantial impact of biological and small-molecule therapies on AD, emphasizing the limitation posed by dupilumab-associated conjunctivitis. Switching to upadacitinib significantly improved both clinical and functional ocular outcomes, suggesting its potential as an alternative therapeutic option for AD patients with ocular involvement. Conclusion: The presented data provides insights into the complex interplay between systemic therapies and ocular manifestations in AD. Upadacitinib emerges as a promising option to address dupilumab-associated conjunctivitis, offering improved quality of life for patients.
The Rendezvous Technique: A Minimally Invasive Non-Surgical Approach for the Management of Iatrogenic Ureteral Injuries
Authors: Faiella Eliodoro , Pacella Giuseppina , Vergantino Elva , Santucci Domiziana , De Cicco Nardone Carlo , Terranova Corrado , Plotti Francesco , Angioli Roberto , Beomonte Zobel Bruno , Grasso Rosario Francesco
Published: July 2024

Background/Objectives: The aim of our study is to evaluate the feasibility and efficacy of the rendezvous technique for the treatment of iatrogenic ureteral injuries. Methods: From 2014 to 2019, 29 patients treated with the rendezvous technique for mono- or bilateral iatrogenic ureteral injuries were enrolled in this retrospective study. All the leaks were previously assessed by CT-urography and antegrade pyelography. Ureteral continuity was restored by performing the rendezvous technique, combining antegrade trans-nephrostomic access and a retrograde trans-cystostomic approach. A double J stent was antegradely inserted, and a nephrostomy tube was kept in place at the end of the procedure. A post-procedure CT-urography and a 30-day nephrostogram follow-up were performed. In the absence of a contrast leak, the nephrostomy tube was removed. Patient follow-up was set with CT-urography at 3, 6, and 12 months and stent substitution every 4 months. The CT-urography was performed to confirm the restored integrity of the ureter before stent removal. Results: The rendezvous technique was successful in all cases with the resolution of the ureteral leak. No major complications were observed. In all the patients, the nephrostomy tube was removed after 30 days. After performing CT-urography, the stent was removed permanently after 12 months. Only three cases showed local post-treatment stenosis treated with surgical ureteral reimplantation. Conclusions: The rendezvous technique is a safe and effective minimally invasive procedure that can be used to restore the continuity of the ureter, avoiding open surgery and providing valuable support for the management of complications after gynecological surgery.
Review of Role of Surgery with Electroporation in Melanoma: Chemotherapy, Immunotherapy, and Gene Delivery
Authors: Ahmad M. Usman , Walsh Allyson , Kirane Amanda
Published: July 2024

Electroporation with chemotherapy (ECT) is currently offered as a treatment in Europe for locoregional or metastatic melanoma with cutaneous lesions. However, the role of surgery and other forms of electroporation in melanoma requires further evaluation. Two reviewers used two databases to conduct a literature search and review, and 51 publications related to electroporation with chemotherapy, immunotherapy, or gene delivery were found. ECT appears to be effective in reducing tumor burden for surgical resection, replacing surgical intervention with evidence of complete regression in some lesions, and inducing both local and systemic immune effects. These immune effects are pronounced when ECT is combined with immunotherapy, with a statistically significant improvement in overall survival (OS). Other forms of electroporation, such as those using calcium chloride, an IL-12 plasmid, and vaccination, require further study. However, IL-12 plasmid electroporation may be inferior to ECT based on the evidence available. Furthermore, irradiation of the tumor prior to ECT treatment is negatively correlated with local response. Access to ECT is restricted in the US and requires further evaluation. More randomized controlled trials of ECT and electroporation treatment in locoregional melanoma are recommended.
Rapid and Precise Computation of Fractional Flow Reserve from Routine Two-Dimensional Coronary Angiograms Based on Fluid Mechanics: The Pilot FFR2D Study
Authors: Tsigkas Grigorios G. , Bourantas George C. , Moulias Athanasios , Karamasis Grigorios V. , Bekiris Fivos V. , Davlouros Periklis , Katsanos Konstantinos
Published: July 2024

Objective: To present a novel pipeline for rapid and precise computation of fractional flow reserve from an analysis of routine two-dimensional coronary angiograms based on fluid mechanics equations (FFR2D). Material and methods: This was a pilot analytical study that was designed to assess the diagnostic performance of FFR2D versus the gold standard of FFR (threshold ≤ 0.80) measured with a pressure wire for the physiological assessment of intermediate coronary artery stenoses. In a single academic center, consecutive patients referred for diagnostic coronary angiography and potential revascularization between 1 September 2020 and 1 September 2022 were screened for eligibility. Routine two-dimensional angiograms at optimal viewing angles with minimal overlap and/or foreshortening were segmented semi-automatically to derive the vascular geometry of intermediate coronary lesions, and nonlinear pressure–flow mathematical relationships were applied to compute FFR2D. Results: Some 88 consecutive patients with a single intermediate coronary artery lesion were analyzed (LAD n = 74, RCA n = 9 and LCX n = 5; percent diameter stenosis of 45.7 ± 11.0%). The computed FFR2D was on average 0.821 ± 0.048 and correlated well with invasive FFR (r = 0.68, p < 0.001). There was very good agreement between FFR2D and invasive-wire FFR with minimal measurement bias (mean difference: 0.000 ± 0.048). The overall accuracy of FFR2D for diagnosing a critical epicardial artery stenosis was 90.9% (80 cases classified correctly out of 88 in total). FFR2D identified 24 true positives, 56 true negatives, 4 false positives, and 4 false negatives and predicted FFR ≤ 0.80 with a sensitivity of 85.7%, specificity of 93.3%, positive likelihood ratio of 13.0, and negative likelihood ratio of 0.15. FFR2D had a significantly better discriminatory capacity (area under the ROC curve: 0.95 [95% CI: 0.91–0.99]) compared to 50%DS on 2D-QCA (area under the ROC curve: 0.70 [95% CI: 0.59–0.82]; p = 0.0001) in predicting wire FFR ≤ 0.80. The median time of image analysis was 2 min and the median time of computation of the FFR2D results was 0.1 s. Conclusion: FFR2D may rapidly derive a precise image-based metric of fractional flow reserve with high diagnostic accuracy based on a single two-dimensional coronary angiogram.
Postural and Lumbopelvic Control: Crucial Factors in the Functionality of Patients with Low Back Pain—A Descriptive Cross-Sectional Study
Authors: Stöwhas Katherine , Droppelmann Guillermo , Jorquera Carlos , Feijoo Felipe
Published: July 2024

Background: Low back pain (LBP) is one of the most prevalent musculoskeletal disorders in adults worldwide. Alterations in postural and lumbopelvic control and functionality appear to be determining factors in its resolution. Methods: A cross-sectional study was performed. Patients with LBP were enrolled. Lumbar pain; postural control (PC), total area of the center of pressure (TACOP), and the velocity of the center of pressure (VCOP); lumbopelvic control (LPC); and functionality were evaluated. Statistical tests were implemented to determine differences between sex and age and correlation models among the variables. Results: Thirty adult patients with LBP were analyzed. A strong relationship was found between pain and functionality [r = 0.64; p < 0.001]. A moderate relationship was found between pain and TACOP [r = 0.395; p = 0.031]. A moderate relationship was observed between TACOP and functionality [0.413; p = 0.023] and between LPC and TACOP [r = 0.416; p = 0.001]. Conclusions: This study demonstrates the significant impact of LBP on postural control, lumbopelvic control, and functionality. These results highlight the importance of addressing postural and lumbopelvic control in LBP treatment. No significant differences based on gender and age were found, but all clinical variables differed significantly between the LBP and control groups, underscoring the unique impairments associated with LBP.
Neonatal Outcome following External Cephalic Version (ECV)—Comparison between Vaginal Birth after Successful ECV and Elective Caesarean Section after Unsuccessful ECV
Authors: Borgmeier Felix , Horst de Cuestas Sophia , Pruss Maximilian , Fath Noa , Hagenbeck Carsten
Published: July 2024

Introduction: In 3–6% of pregnancies, foetuses can be expected to be in a breech presentation near term. Consultation concerning further management of the pregnancy, including the option of an external cephalic version (ECV), is recommended by international guidelines (RCOG, ACOG, and DGGG). With regards to an ECV, there need to be two assumptions. Firstly, the procedure is safe, which has been shown adequately. Secondly, a vaginal birth after a successful ECV needs to prove to be non-inferior to the alternative of an elective caesarean section. The aim of this study is to assess the non-inferiority assumption. Methods: Overall, 142 singleton pregnancies were analysed that presented a foetus in a non-cephalic presentation and underwent an ECV near term between 2011 and 2020. The ECV was performed at 36 weeks of gestation for primiparous women and at 37/38 weeks of gestation for multiparous women. To assess neonatal outcome, the following parameters were recorded: arterial and venous umbilical cord blood pH, APGAR scores and admission to the neonatal intensive care unit (NICU). Data were analysed under the assumption that neonatal outcome does not differ between elective caesarean sections with or without an ECV in advance. Results: The success rate of an ECV was 56.3% (80/142). In the case of a successful ECV, there was a 77.5% (62/80) chance for a vaginal delivery. The mean arterial pH for neonates born vaginally after successful ECV was 7.262 (SD 0.089), compared to 7.316 (SD 0.051) for those born via elective caesarean section (p < 0.001). APGAR scores at 1, 5, and 10 min were similar between the groups, with a slightly higher proportion of neonates scoring below the median in the caesarean section group. Specifically, 13.7% (7/51) at 1 min, 15.7% (8/51) at 5 min, and 9.8% (5/51) at 10 min in the caesarean section group were below the median, compared to 4.92% (3/61), 4.92% (3/61), and 3.28% (2/61) in the vaginal birth group. NICU admission rates were 3.28% for vaginal births and 3.92% for elective caesarean sections (p > 0.05). Conclusions: Women with a successful ECV can expect a neonatal birth outcome after a vaginal birth that is non-inferior to an alternative elective caesarean section.
Attention-Deficit Hyperactivity Disorder Symptoms in Adults Diagnosed with Multiple Sclerosis: Prevalence and Correlates
Authors: Al-Ameri Mariam , Abu-Shaikh Hanan , Mansour Mohammad , Al-Habahbeh Suha , Weshah Feras , Ennab Wail , Binsaleh Ammena Y. , Shilbayeh Sireen Abdul Rahim , Gammoh Omar
Published: July 2024

Background: The relationship between adult ADHD symptoms in People with Multiple Sclerosis (PwMS) is understudied. This study aimed to answer two questions: are PwMS more likely to experience higher ADHD symptoms versus healthy subjects? And what are the correlates of severe ADHD symptoms in PwMS? Methods: This study followed a cross-sectional design with predefined inclusion criteria. The Adult ADHD Self-Report Scale-V1.1 (ASRS) was used to assess the ADHD symptoms severity. Results: Data were analyzed from 171 PwMS and 200 controls. Regression analysis revealed that PwMS were at a significantly (B = 3.05, t = 2.24, 95% CI = 0.37–5.73, p = 0.02) higher risk to report higher ADHD scores versus controls. In addition, PwMS with relapses in the last 6 months and PwMS reporting smartphone addiction were at a significantly higher risk for severe ADHD (B = 7.19, t = 269, 95% CI = 1.91–12.48, p = 0.008) and (B = 9.18, t = 3.47, 95% CI = 3.97–14.41, p = 0.001), respectively. In conclusion, diagnosis with MS in our study was identified as a risk for higher ADHD symptoms. Conclusions: Further research is required to establish this relationship, and holistic medical and psychological interventions are required to improve the cognitive status of PwMS.
Pelvic Fixation for Non-Ambulatory Patients with Neuromuscular Scoliosis Treated with Magnetically Controlled Growing Rods—A 4-Year Comparison of Two Different Fixation Methods
Authors: Heuer Annika , Stuecker Sebastian , Stuecker Ralf , Mladenov Kiril
Published: July 2024

Background/Objectives: This study aims to analyze the efficacy and safety of the two pelvic fixation systems, S-hooks (SH) and lumbar-sacral-alar-iliac (SAI) screws, when used in association with magnetically controlled growing rods (MCGRs) in non-ambulatory children with severe neuromuscular scoliosis (NMS). Methods: Forty-one patients were retrospectively examined and subdivided corresponding to ilium hook fixation or SAI screws. The major curve correction (%) and pelvic obliquity (PO) correction (%) were assessed utilizing scoliosis plain film radiographs over time. Complications and unplanned return to the operating room (UPROR) were recorded. Patient-specific pre- and postoperative values were included in a backward stepwise regression model to assess UPROR. Results: Mean age at index intervention was 9.4 years. Preoperative main curve was 81° and PO was 22°. 21 and 20 patients were categorized into the SH and SAI subgroups, respectively. Initial curve correction was significantly better in the SAI subgroup (63 vs. 42% in the SH, p = 0.045), while PO correction was equally good. Curve and PO correction were maintained throughout the follow-up period of 55 months. UPROR rate was 38% in the SH subgroup, and 5% in the SAI subgroup (p = 0.010). Regression analysis identified postoperative curve correction as predictive value for UPROR (p = 0.006). Conclusions: SAI screw fixation has a low UPROR rate and achieves superior curve correction. S-hooks are a viable option to correct PO and NMS in children with high operative risk to reduce operative time, but revision surgery is not uncommon.
Developing the Benchmark: Establishing a Gold Standard for the Evaluation of AI Caries Diagnostics
Authors: Boldt Julian , Schuster Matthias , Krastl Gabriel , Schmitter Marc , Pfundt Jonas , Stellzig-Eisenhauer Angelika , Kunz Felix
Published: July 2024

Background/Objectives: The aim of this study was to establish a histology-based gold standard for the evaluation of artificial intelligence (AI)-based caries detection systems on proximal surfaces in bitewing images. Methods: Extracted human teeth were used to simulate intraoral situations, including caries-free teeth, teeth with artificially created defects and teeth with natural proximal caries. All 153 simulations were radiographed from seven angles, resulting in 1071 in vitro bitewing images. Histological examination of the carious lesion depth was performed twice by an expert. A total of thirty examiners analyzed all the radiographs for caries. Results: We generated in vitro bitewing images to evaluate the performance of AI-based carious lesion detection against a histological gold standard. All examiners achieved a sensitivity of 0.565, a Matthews correlation coefficient (MCC) of 0.578 and an area under the curve (AUC) of 76.1. The histology receiver operating characteristic (ROC) curve significantly outperformed the examiners’ ROC curve (p < 0.001). All examiners distinguished induced defects from true caries in 54.6% of cases and correctly classified 99.8% of all teeth. Expert caries classification of the histological images showed a high level of agreement (intraclass correlation coefficient (ICC) = 0.993). Examiner performance varied with caries depth (p ≤ 0.008), except between E2 and E1 lesions (p = 1), while central beam eccentricity, gender, occupation and experience had no significant influence (all p ≥ 0.411). Conclusions: This study successfully established an unbiased dataset to evaluate AI-based caries detection on bitewing surfaces and compare it to human judgement, providing a standardized assessment for fair comparison between AI technologies and helping dental professionals to select reliable diagnostic tools.
Brown Tumors: The Hidden Face of Primary and Renal Hyperparathyroidism Amid Real-Life Settings
Authors: Carsote Mara , Ciobica Mihai-Lucian , Sima Oana-Claudia , Valea Ana , Bondor Cosmina Ioana , Geleriu Andreea , Ticolea Madalina , Nistor Claudiu , Rusu Crina Claudia
Published: July 2024

Brown tumors, an exceptional bone complication of severe primary (PHP) or renal (secondary) hyperparathyroidism (RHP), are caused by long-standing, elevated parathormone (PTH)-induced osteoclast activation causing multinucleated giant cell conglomerates with hemosiderin deposits in addition to the local production of cytokines and growth factors. We aim to present an adult case series including two females displaying this complication as part of a multidisciplinary complex panel in high PTH-related ailments. The approach was different since they had distinct medical backgrounds and posed a wide area of challenges amid real-life settings, namely, a 38-year-old lady with PHP and long-term uncontrolled hypercalcemia (with a history of pregnancy-associated PHP, the removal of a cystic jaw tumor, as well as a family and personal positive diagnosis of polycystic kidney disease, probably a PHP-jaw tumor syndrome), as well as, a 26-year-old woman with congenital single kidney and chronic renal disease-associated RHP who was poorly controlled under dialysis and developed severe anemia and episodes of metabolic acidosis (including one presentation that required emergency hemodialysis and was complicated with convulsive seizures, followed by resuscitated respiratory arrest). Both subjects displayed a severe picture of PHP/RHP with PTH levels of >1000 pg/mL and >2000 pg/mL and elevated serum bone turnover markers. Additionally, they had multiple brown tumors at the level of the ribs and pelvis (asymptomatically) and the spine, skull, and pelvis (complicated with a spontaneous cervical fracture). As an endocrine approach, the control of the underlying parathyroid disease was provided via surgery in PHP (for the postparathyroidectomy hungry bone syndrome) via medical intervention (with vitamin D analogs) in RHP. Additionally, in this case, since the diagnosis was not clear, a multidisciplinary decision to perform a biopsy was taken (which proved inconclusive), and the resection of the skull tumor to confirm the histological traits. This series highlights the importance of addressing the entire multidisciplinary panel of co-morbidities for a better outcome in patients with PHP/RHP-related brown tumors. However, in the instance of real-life medicine, poor compliance and reduced adherence to recommendations might impair the overall health status. Thus, sometimes, a direct approach at the level of cystic lesion is taken into consideration; this stands for a narrow frame of decision, and it is a matter of personalized decision. As seen here, brown tumors represent the hidden face of PHP/RHP, primarily the complex and severe forms, and awareness is essential even in the modern era.
Development and Validation of an Artificial Intelligence Model for Detecting Rib Fractures on Chest Radiographs
Authors: Lee Kaehong , Lee Sunhee , Kwak Ji Soo , Park Heechan , Oh Hoonji , Koh Jae Chul
Published: July 2024

Background: Chest radiography is the standard method for detecting rib fractures. Our study aims to develop an artificial intelligence (AI) model that, with only a relatively small amount of training data, can identify rib fractures on chest radiographs and accurately mark their precise locations, thereby achieving a diagnostic accuracy comparable to that of medical professionals. Methods: For this retrospective study, we developed an AI model using 540 chest radiographs (270 normal and 270 with rib fractures) labeled for use with Detectron2 which incorporates a faster region-based convolutional neural network (R-CNN) enhanced with a feature pyramid network (FPN). The model’s ability to classify radiographs and detect rib fractures was assessed. Furthermore, we compared the model’s performance to that of 12 physicians, including six board-certified anesthesiologists and six residents, through an observer performance test. Results: Regarding the radiographic classification performance of the AI model, the sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) were 0.87, 0.83, and 0.89, respectively. In terms of rib fracture detection performance, the sensitivity, false-positive rate, and free-response receiver operating characteristic (JAFROC) figure of merit (FOM) were 0.62, 0.3, and 0.76, respectively. The AI model showed no statistically significant difference in the observer performance test compared to 11 of 12 and 10 of 12 physicians, respectively. Conclusions: We developed an AI model trained on a limited dataset that demonstrated a rib fracture classification and detection performance comparable to that of an experienced physician.
Echocardiography-Derived Hemodynamic Forces Are Associated with Clinical Outcomes in Patients with Non-Ischemic Dilated Cardiomyopathy
Authors: Cesareo Marco , Ródenas-Alesina Eduard , Guala Andrea , Lozano-Torres Jordi , Casas Guillem , Vallelonga Fabrizio , Airale Lorenzo , Ferreira-González Ignacio , Milan Alberto , Rodriguez-Palomares Jose F.
Published: July 2024

Introduction: Non-ischemic dilated cardiomyopathy (NIDCM) is characterized by a reduced left ventricular (LV) ejection fraction (LVEF, <50%) and a high risk for heart failure (HF) and death. Echocardiography-derived hemodynamic forces (HDFs) may provide important information on LV mechanics, but their prognostic value is unknown. Aim: To explore the features of echocardiography-derived HDFs in NIDCM and their association with clinical endpoints. Methods: Asymptomatic, non-hospitalized NIDCM patients free from coronary artery disease and moderate or severe valvular heart disease were included in this single-center observational retrospective longitudinal study. Those with atrial fibrillation and a follow-up <12 months were excluded. Major adverse cardiovascular events (MACE) were defined as a composite of all-cause death, HF hospitalization, and ambulatory intravenous diuretics administration. LV HDFs were analyzed with a prototype software. Apex-base (HDFs-ab), lateral-septal (HDFs-ls), and HDFs-angle were computed. Results: Ninety-seven patients were included, sixty-seven (69%) were males, mean age was 62 ± 14 years, and mean LVEF was 39.2 ± 8.6%. During a median follow-up of 4.2 (3.1–5.1) years, 19 (20%) patients experienced MACE. These patients had a higher HDFs-angle (71.0 (67.0–75.0) vs. 68.0 (63.0–71.0)°, p = 0.005), lower HDFs-ls (1.36 (1.01–1.85) vs. 1.66 ([1.28–2.04])%, p = 0.015), but similar HDFs-ab (5.02 (4.39–6.34) vs. 5.66 (4.53–6.78)%, p = 0.375) compared to those without MACE. in a Cox regression analysis, HDFs-angle (HR 1.16 (95%-CI 1.04–1.30), p = 0.007) was associated with MACE, while other conventional echocardiography parameters, including LVEF and LV longitudinal strain, were not. Conclusions: HDFs-angle is associated with clinical endpoints in NIDCM. A higher HDFs-angle may be a marker of impaired myocardial performance in patients with reduced LVEF.
Ionizing Radiation-Induced Oxidative Stress in Computed Tomography—Effect of Vitamin C on Prevention of DNA Damage: PREVIR-C Randomized Controlled Trial Study Protocol
Authors: Sotomayor Camilo G. , González Camila , Soto Miki , Moreno-Bertero Nicolás , Opazo Claudina , Ramos Baltasar , Espinoza Gonzalo , Sanhueza Álvaro , Cárdenas Gonzalo , Yévenes Sebastián , Díaz-Jara Jorge , de Grazia José , Manterola Marcia , Castro Daniel , Gajardo Abraham A. I. J. , Rodrigo Ramón
Published: July 2024

Exposure to ionizing radiation (IR) is inevitable in various X-ray imaging examinations, with computed tomography (CT) being a major contributor to increased human radiation exposure. Ionizing radiation may cause structural damage to macromolecules, particularly DNA, mostly through an indirect pathway in diagnostic imaging. The indirect pathway primarily involves the generation of reactive oxygen species (ROS) due to water radiolysis induced by IR, leading to DNA damage, including double-strand breaks (DSB), which are highly cytotoxic. Antioxidants, substances that prevent oxidative damage, are proposed as potential radioprotective agents. This Study Protocol article presents the rationale for selecting vitamin C as a preventive measure against CT-associated IR-induced DNA damage, to be investigated in a randomized placebo-controlled trial, with a full in vivo design, using an oral easy-to-use schedule administration in the outpatient setting, for the single CT examination with the highest total global IR dose burden (contrast-enhanced abdomen and pelvis CT). The study also aims to explore the mediating role of oxidative stress, and it has been written in adherence to the Standard Protocol Items recommendations.
Clinical and Physiological Variables in Patients with Post-COVID-19 Condition and Persistent Fatigue
Authors: Santos Maércio , Dorna Mariana , Franco Estefânia , Geronutti Jéssica , Brizola Luís , Ishimoto Letícia , Barros Yasmin , Costa Adriele , Breda Carolina , Marin Caroline , Suetake Fernanda , Azevedo Paula , Paiva Sergio de , Tanni Suzana , Prudente Robson
Published: July 2024

Background/Objectives: Post-COVID-19 condition can manifest through various symptoms such as dyspnea, cognitive disturbances, and fatigue, with mechanisms related to these symptoms, particularly those related to fatigue, still requiring further clarification. Therefore, our aim was to assess the clinical and physiological variables in patients with post-COVID-19 condition and persistent fatigue. Methods: After one year post-COVID-19 infection, the patients underwent a comprehensive evaluation, including a complete blood count, a metabolic panel, complete spirometry, and assessments of dyspnea, quality of life, anxiety and depression, physical capacity, body composition, muscle strength, comorbidities, and medications. The participants were categorized into two groups: G1—fatigue and G2—non-fatigue. Results: Seventy-seven patients (53% female; 55 ± 11.8 years) were included, 37 in G1 and 40 in G2. As for clinical markers and symptoms of illness, in those with persistent fatigue symptoms, a greater sensation of dyspnea [BDI score: 7.5 (6–9) vs. 12 (9–12), p < 0.001; mMRC score: 1 (1–2) vs. 0 (0–1), p = 0.002], worse quality of life [SGRQ total score: 1404 (1007–1897) vs. 497 (274–985); p < 0.001], higher levels of anxiety [HADS-A score: 8 (5–9) vs. 3 (0.5–4); p < 0.001], and a reduction in peripheral and inspiratory muscle strength [handgrip strength: 34 (28–40) vs. 40 (30–46.5) kgf, p = 0.044; MIP: −81 ± 31 vs. −111 ± 33 mmHg, p < 0.001)] were observed. Conclusions: Those with persistent fatigue exhibited a greater sensation of dyspnea, higher levels of anxiety, reduced peripheral and inspiratory muscle strength, and a greater impairment of quality of life. The severity of fatigue was influenced by the worsening quality of life, heightened anxiety levels, and decreased peripheral muscle strength. Additionally, the worse quality of life was associated with a higher sensation of dyspnea, lower muscle strength, and reduced physical capacity.
Effect of Ion-Exchanger Monoporosity in the Kinetics of Oxygen Sorption by Silver-Containing Nanocomposites
Authors: Krysanov Vyacheslav , Gadebskaya Maria , Krysanova Tatyana , Kravchenko Tamara , Kozaderov Oleg
Published: July 2024

The results of a study of the kinetics of oxygen sorption from water by silver-containing nanocomposites synthesized on the base of macroporous ion exchangers with different pore sizes are presented. In the case of the Lewatit K 2620 ion exchanger, the pore size was fixed (41 nm), and for KU-23, it varied in the range from 10 to 100 nm. The nanocomposite materials Ag0⸱KU-23 and Ag0⸱Lewatit K 2620 were prepared by chemical precipitation. Using the different physicochemical methods, it was found that due to the monoporosity of the ion exchanger, the average size of the silver particles in the Ag0⸱Lewatit K 2620 nanocomposite is smaller than for KU-23. This effect contributes to the intensification of oxygen absorption and is proved by the results of studying the rate and degree of oxygen sorption by nanocomposites in the entire studied range of their capacity on metal. On the other hand, the polyporosity of the KU-23 ion exchanger, due to its better diffusion permeability, contributes to the more uniform distribution of silver over the volume of nanocomposite grains and ensures the steady state of the sorption process. Based on the presented experimental results, the synthesized silver-containing nanocomposites can be recommended as multifunctional materials with bactericidal action and catalytic effect for different industrial applications, including the deep removal of dissolved oxygen in the production of ultrapure water for energetics and microelectronics.
Processing and Mechanics of Aromatic Vitrimeric Composites at Elevated Temperatures and Healing Performance
Authors: Mandal Tanaya , Ozten Unal , Vaught Louis , Meyer Jacob L. , Amiri Ahmad , Polycarpou Andreas , Naraghi Mohammad
Published: July 2024

Carbon fiber reinforced polymer (CFRP) composites are renowned for their exceptional mechanical properties, with applications in industries such as automotive, aerospace, medical, civil, and beyond. Despite these merits, a significant challenge in CFRPs lies in their repairability and maintenance. This study, for the first time, delves into the processing and self-healing capability of aromatic thermosetting co-polyester vitrimer-based carbon fiber composites through mechanical testing. Vitrimers are an emerging class of thermosetting polymers, which, owing to their exchangeable covalent bonds, enable the re-formation of bonds across cracks. The specific vitrimer chosen for this study is an aromatic thermosetting co-polyester (ATSP). The mechanical properties of samples were analyzed initially through three-point bending (3PB) testing at room temperature before and after healing (by curing samples for 2 h at 280 °C). Samples were also 3PB tested at 100 °C to analyze their mechanical properties at an elevated temperature for comparison to the samples tested at room temperature. To investigate the fracture properties, optical microscopy images of samples were taken after 3PB tests, which were analyzed to observe crack initiation and crack growth behavior. Through load–displacement curves from double cantilever beam (DCB) mechanical testing, the Mode I crack initiation fracture toughness values of self-healed composites and control composites were calculated to evaluate healing efficiency in ATSP CFRP composites cured at 280 °C for 2 h. Scanning electron microscopy (SEM) showed a similar surface morphology of cracks before and after self-healing. Micro-computed tomography (CT) X-ray imaging confirmed that the healed samples closely resembled the as-fabricated ones, with the exception of some manufacturing voids, caused by outgassing in the initial healing cycle. This research demonstrated the ability for the in situ repair of ATSP CFRPs by restoring the fracture toughness to values comparable to the pristine composite (~289 J/m2).
Pollen Grain Classification Using Some Convolutional Neural Network Architectures
Authors: Garga Benjamin , Abboubakar Hamadjam , Sourpele Rodrigue Saoungoumi , Gwet David Libouga Li , Bitjoka Laurent
Published: July 2024

The main objective of this work is to use convolutional neural networks (CNN) to improve the performance in previous works on their baseline for pollen grain classification, by improving the performance of the following eight popular architectures: InceptionV3, VGG16, VGG19, ResNet50, NASNet, Xception, DenseNet201 and InceptionResNetV2, which are benchmarks on several classification tasks, like on the ImageNet dataset. We use a well-known annotated public image dataset for the Brazilian savanna, called POLLEN73S, composed of 2523 images. Holdout cross-validation is the name of the method used in this work. The experiments carried out showed that DenseNet201 and ResNet50 outperform the other CNNs tested, achieving results of 97.217% and 94.257%, respectively, in terms of accuracy, higher than the existing results, with a difference of 1.517% and 0.257%, respectively. VGG19 is the architecture with the lowest performance, achieving a result of 89.463%.
Imaging Based Techniques Combined with Color Measurements for the Enhancement of Medieval Wall Paintings in the Framework of EHEM Project
Authors: Pogliani Paola , Pelosi Claudia , Lanteri Luca , Bordi Giulia
Published: July 2024

(1) Background: This paper illustrates an innovative methodological approach chosen to study and map the colors of the medieval wall painting of Santa Maria Antiqua in the Roman Forum, one of the pilot sites of the EHEM project (Enhancement of Heritage Experiences: The Middle Ages). Digital Layered Models of Architecture and Mural Paintings over Time). (2) Methods: Two methods were employed to gather information about colors and mapping. Specifically, colorimetry was utilized for spot measurements, and hypercolorimetric multispectral imaging (HMI) was employed to map the same colors sampled through colorimetry. (3) Results: Chromatic data for all colors in the wall paintings were obtained in the CIELAB color space. Additionally, chromatic similarity maps were generated using the innovative HMI system, a multispectral imaging technique capable of obtaining color data information through advanced calibration software named SpectraPick® (Version 1.1). This comprehensive approach facilitates a thorough understanding of color characteristics and distribution. (4) Conclusions: The color measurements and mapping represent significant advancements in the interpretation of medieval wall paintings, which are often fragmentary and stratigraphically complex. This research sheds new light on the colors used and enhances our understanding of the original appearance of the iconographic patterns. Furthermore, it enables the reconstruction of colors that closely resemble the originals.
Ensuring Melt Track Width Consistency and Crack-Free Conditions Using Interpass-Temperature-Dependent Process Parameters for Wire-Arc-Directed Energy-Deposited Inconel 718
Authors: Jimenez Xavier A. , Song Jie , Fu Yao , To Albert C.
Published: July 2024

Melt track width can vary in a wire-arc-directed energy-deposited material (DED) using a constant set of process parameters, leading to a lower-quality build. In this work, a novel framework is proposed that uses the data from the process parameter development stage to create optimized process parameters for a target layer width at different interpass temperatures without hot cracking. Inconel 718 is used as the model material since it is known to suffer from hot cracking during DED processing. In the proposed framework, a process window containing a few sets of process parameters (torch travel speed and wire feed rate) is established for crack-free deposition of Inconel 718, and these parameters are used to create a small database. A linear regression model is then employed to generate interpass-temperature-specific optimized process parameters for a target melt track width. The results demonstrate that the proposed approach can reduce the melt track width variation in the deposited walls from 12% to 3% error on average under different printing conditions. It also demonstrates that interpass temperature (IPT) can be used as a controlled variable and the optimized process parameters as initial values when applying control techniques to the process.