bluuebunny/crossref_metadata_2025 huggingface dataset:
Expression of Endometrial Receptivity Markers throughout the Menstrual Cycle in Women with and without Uterine Adenomyosis
Authors: Stratopoulou Christina Anna , El Grari Ines , Camboni Alessandra , Donnez Jacques , Dolmans Marie-Madeleine
Published: August 2024

Background/Objectives: While it is known that adenomyosis is associated with poor reproductive outcomes, the underlying mechanisms are unclear, and to date, there is no standard treatment protocol for these patients. Endometrium from adenomyosis patients is characterized by several abnormalities, potentially resulting in impaired receptivity and subsequent implantation failure. Methods: Endometrial biopsies were collected from 26 women with adenomyosis and 26 control subjects. Immunohistochemistry was performed to evaluate the expression of markers of endometrial receptivity, namely the progesterone receptor (PR), glycodelin, leukemia inhibitory factor (LIF), homeobox A10 (HOXA10), integrin beta chain beta 3 (integrin β3) and osteopontin. Scanning electron microscopy was used to observe pinopodes on the surface of mid-secretory endometrial epithelium. Results: PR, LIF and osteopontin expression were all found to be weaker in secretory-phase stroma from adenomyosis patients than in healthy controls. HOXA10 expression was decreased in adenomyosis during the secretory phase, and also the proliferative phase, where it reached statistical significance in both epithelial and stromal compartments. Glycodelin and integrin β3 levels did not differ between diseased and healthy tissues in any of the cycle phases. Pinopodes were fewer and at later developmental stages in adenomyosis compared to those on the surface of healthy endometrium from the same time period of the menstrual cycle. Conclusions: Endometrium from adenomyosis patients is characterized by abnormal expression of various receptivity markers. The stromal compartment appears to be affected most, showing reduced expression of PR, LIF and osteopontin in the secretory phase and lower levels of HOXA10 during both proliferative and secretory phases. Decreased receptivity due to impaired stromal decidualization may contribute to poor reproductive outcomes in adenomyosis patients.
Symptoms, Course, and Factors Related to Long-Term Morbidity, Including Differences between Infection Strains, in Patients with Long COVID in a Primary Care Clinic in Japan: An Observational Study
Authors: Baba Kenji , Kawai Seiko , Iwase Satoshi , Ushida Takahiro , Tamura Yasuhiro , Arimoto Mariko , Nojiri Makiko , Watanabe Daisuke , Ban Nobutaro
Published: August 2024

Objectives: The objectives were to investigate the clinical characteristics and course of long COVID, defined as the persistence of symptoms at least one month after the onset of COVID-19, in outpatients and to clarify differences in symptoms between SARS CoV-2 mutant strains. Methods: Our observational study in a primary care institution in Japan included 1053 patients with long COVID who visited our outpatient clinic between April 2021 and March 2023. Symptom distribution, performance status, and patient background at the time of the first outpatient visit were compared between infectious strains (Delta and before group and Omicron group). Background factors and symptoms related to time to remission were also analyzed. Results: The severity of COVID-19 in the acute phase was mild, moderate, and severe in 82.2%, 14.9%, and 2.9% in the Delta and before group; and in 97.6%, 1.7%, and 0.4% in the Omicron group, respectively. Vaccination coverage was significantly different between the Delta and before (37.1%) and Omicron groups (73.1%) (p < 0.001), probably due to the period of vaccine unavailability in the former group. Symptoms of fatigue and headache occurred most frequently, irrespective of infectious strain. The mean number of symptoms per patient was significantly higher in the Delta and before group than the Omicron group (3.4 vs. 2.7, p < 0.0001). The median time overall to remission of long COVID was 169 days. Cox hazard model analysis identified female sex, high body mass index, and dyspnea (but not infectious strain) as significant factors prolonging the time to remission (p < 0.05). Conclusions: Differences in the number of symptoms between infectious strains may be related to differences in viral virulence and/or vaccination coverage. However, the clinical course was found to be minimally influenced by the infectious strain. The present results should improve the understanding of prognosis in patients with long COVID from both the clinical and social perspectives.
Maternal–Fetal Transfer of Anti-SARS-CoV-2 Antibodies in Amniotic Fluid: Insights from Maternal Vaccination and COVID-19 Infection
Authors: Sgayer Inshirah , Odeh Marwan , Gal-Tanamy Meital , Shehadeh Mona , Rechnitzer Hagai , Haddad Yousef , Hamoudi Rudi , Mousa Nisreen Kinaani , Dakwar Vivian Abu Uksa , Wolf Maya Frank , Falik Zaccai Tzipora C. , Lowenstein Lior
Published: August 2024

Objectives: As the COVID-19 pandemic wanes, understanding maternal–fetal antibody transfer remains crucial for optimizing vaccination strategies. This study evaluates anti-SARS-CoV-2 antibody levels in amniotic fluid following maternal BNT162b2 mRNA vaccination and/or COVID-19 infection during early pregnancy, focusing on the first and second trimesters. Methods: A retrospective cohort study was conducted at a tertiary university-affiliated hospital, involving 149 pregnant women who underwent amniocentesis. Anti-SARS-CoV-2 spike IgG levels were measured in amniotic fluid samples. Participants were categorized based on vaccination and infection status: vaccine-only, infection-only, vaccine + infection, and no vaccine/infection. Correlations between antibody levels and the time since vaccination or infection were analyzed. Results: The vaccine + infection group had a higher proportion of positive antibody levels compared to the vaccine-only group (63.6% vs. 35.9%, p = 0.029). Median SARS-CoV-2 IgG levels were significantly higher in the vaccine + infection group (283.0 AU/mL) than in the vaccine-only group (64.1 AU/mL, p = 0.006). Women who received three vaccine doses had higher antibody levels and more positive antibody rates compared to those with one or two doses. A significant negative correlation was found between antibody levels and the interval since the last vaccine dose or infection. Conclusions: Our results indicate the presence of anti-SARS-CoV-2 antibodies in the amniotic fluid, reflecting antibody transfer during early pregnancy. However, a noticeable decrease in immunity was observed, as indicated by declining amniotic fluid antibody levels over time. Further studies are needed to determine the optimal timing and number of boosters required to protect against new variants of SARS-CoV-2.
Task-Specific Perceived Harmfulness Predicts Protective Movement Behaviour in Chronic Low Back Pain
Authors: Matheve Thomas , Timmermans Annick , Danneels Lieven , De Baets Liesbet
Published: August 2024

Background/Objectives: There is emerging evidence that task-specific pain-related psychological measures may better predict movement behaviour in chronic low back pain (CLBP) than general pain-related psychological measures. Currently, little is known regarding the prediction of movement duration and movement velocity. Methods: Baseline data from a previously published randomized controlled trial were used (clinicaltrials.gov NCT02773160). Fifty-five patients with CLBP and 54 pain-free persons performed a lifting task while kinematic measurements were obtained to calculate movement velocity of the L1 vertebra, S1 vertebra, and the lumbar spine, as well as the time to complete the lifting task. Scores on the Photograph Daily Activities Series-Short Electronic Version (PHODA-SeV), Tampa Scale for Kinesiophobia (TSK), and its Activity Avoidance and Somatic Focus subscales were used as general pain-related psychological measures. The score on a picture of the PHODA-SeV, showing a person lifting an object with a bent back (PHODA-Lift), was used as task-specific measure of perceived harmfulness. Results: The task-specific measure best predicted movement duration and movement velocity of L1 and the lumbar spine, and explained 35%, 19%, and 25% of the respective movement parameters. Although general perceived harmfulness predicted S1 velocity and movement duration, it only explained 6% and 8% of the respective movement parameters. General measures of pain-related fear were not predictive for any of the movement parameters. It took patients with CLBP significantly longer to complete the lifting task when compared to the pain-free participants (ES = 1.01, p < 0.0001), and patients with CLBP also moved significantly slower at L1 (ES = 0.85, p < 0.0001) and the lumbar spine (ES = 1.01, p < 0.0001). These between-groups differences were larger for CLBP subgroups with higher scores on the PHODA-Lift, and to some extent for subgroups with higher total scores on the PHODA-SeV. Conclusions: Task-specific perceived harmfulness best predicts movement velocity. General pain-related fear measures (i.e., TSK and its subscales) do not predict these movement parameters.
Ablation Strategies for Persistent Atrial Fibrillation: Beyond the Pulmonary Veins
Authors: Baqal Omar , Shafqat Areez , Kulthamrongsri Narathorn , Sanghavi Neysa , Iyengar Shruti K. , Vemulapalli Hema S. , El Masry Hicham Z.
Published: August 2024

Despite advances in ablative therapies, outcomes remain less favorable for persistent atrial fibrillation often due to presence of non-pulmonary vein triggers and abnormal atrial substrates. This review highlights advances in ablation technologies and notable scientific literature on clinical outcomes associated with pursuing adjunctive ablation targets and substrate modification during persistent atrial fibrillation ablation, while also highlighting notable future directions.
FAST4D—A New Score to Reduce Missed Strokes in Emergency Medical Service: A Prospective, Multicentric Observational Proof-of-Concept Trial
Authors: Claudi Christian , Worm André , Schmohl Donata , Juenemann Martin , Alhaj Omar Omar , Loesche Hendrik , Huttner Hagen B. , Schramm Patrick
Published: August 2024

Background: Undoubtedly, overlooking a stroke can result in severe disability or even death. However, identifying stroke patients in the prehospital setting poses a significant challenge. While the Face–Arm–Speech–Time (FAST) score is widely used, its effectiveness has been questioned because of its focus on symptoms primarily associated with anterior circulation strokes. In response to this limitation, we developed the innovative FAST4D score and conducted a comparative analysis of stroke detection rates between the novel FAST4D score and the FAST score. Methods: This prospective, multicenter proof-of-concept study aimed to assess stroke detection rates using both the FAST score and the new FAST4D score, which incorporates additional items such as the acute onset of diplopic images, deficit in the field of vision, dizziness/vertigo, and dysmetria/ataxia. Following their presentation to emergency medical services, all patients suspected of having a stroke and those diagnosed with a stroke upon discharge were included in this study. The diagnostic performance of the novel FAST4D score was evaluated and compared with that of the FAST score. Results: Between May 2019 and June 2021, a total of 1469 patients (749 female) were enrolled, with 1035 patients discharged with the diagnosis of stroke. Notably, 259 patients were identified solely through the FAST4D score. This resulted in a significantly higher rate of correctly identified as having had a stroke (stroke detection rate, sensitivity) with the new FAST4D score (93%) compared with the established FAST score (78%) (p < 0.001). This resulted in a reduction in false negative diagnoses by 65%. Conclusions: The novel FAST4D score demonstrated a 15-percentage increase in the stroke detection rate. This heightened detection rate holds the potential for more accurate patient allocation to stroke units, consequently reducing the time to revascularization.
Long-Term Survival in Metastatic Pancreatic Adenocarcinoma of Intestinal Type
Authors: Rahnea-Nita Gabriela , Rebegea Laura-Florentina , Grigorean Valentin Titus , Coman Ionuţ Simion , Coman Violeta Elena , Pleşea Iancu Emil , Erchid Anwar , Florea Costin George , Liţescu Mircea , Rahnea-Nita Roxana-Andreea
Published: August 2024

Introduction and Literature Review: Pancreatic cancer is often diagnosed in an advanced/metastatic stage, as it is a very aggressive type of cancer. The prognosis of pancreatic cancer is extremely unfavorable. The mean survival rate for patients with metastatic pancreatic adenocarcinoma is 3–6 months. Stage IV pancreatic cancer has a five-year survival rate of 1.3% to 13%. This article presents recent data regarding the oncologic management of metastatic pancreatic cancer. Case presentation: We present the case of a female patient who was 49 years old at the time of diagnosis, in June 2021. The patient was diagnosed with stage IV pancreatic neoplasm (due to liver metastases). The diagnosis was made by histopathological and immunohistochemical examination, which corroborated imaging investigations. The patient underwent four lines of chemotherapy between July 2021 and July 2024, undergoing partial response to the disease. The patient is a long-term survivor of metastatic pancreatic cancer (3 years in July 2024). Discussions: the peculiarity of this case is long-term survival (3 years and a month at the date when this article is being written) in a patient with pancreatic cancer and liver metastases. Conclusions: histopathological type, good performance status, CEA, and CA tumor markers 19.9 within normal limits may be favorable prognostic factors for long-term survival in metastatic pancreatic carcinoma.
Limits of Stability during a Therapeutic Exercise Intervention for Instability: Progression, Responders’ and Non-Responders’ Analysis and Predictors
Authors: Flix-Díez Laura , Blanco-Pareja Melissa , Pérez-Fernández Nicolás
Published: August 2024

Background/Objectives: Instability is one of the main symptoms in patients with vestibular and neurological disorders and therapeutic exercise interventions are increasing in popularity as a form of treatment. Additionally, the limits of stability measurement are known to be a good tool for balance evaluation and monitoring of these interventions. The aim of this work is to better understand how a specific protocol provokes changes on this variable and to study the characteristics of those who do and do not respond to it. Methods: A retrospective study was developed with the data of 40 patients treated in the Otorhinolaryngology department in Clínica Universidad de Navarra (Madrid, Spain). They had an initial reduction in limits of stability, completed the proposed protocol with home-based and hospital-based exercises and with frequent limits of stability remeasurement, and were assisted to a follow-up retest after 1–2 months. Results: A progressive improvement in limits of stability measure was developed through the intervention and was partially retained at follow-up visit. Several differences were found between those patients who improved with the treatment (responders) and those who did not improve (non-responders). More specifically an initial measure of the limits of stability was able to differentiate those groups with a cut-off data of 56 cm2. Conclusions: The proposed protocol was able to induce motor learning in patients included in this study with good retention after 1–2 months. Furthermore, there is some variability in how patients respond to the treatment. Age and diagnosis should be considered and an interesting cut-off data for clinal decision making was found.
Correlation between Epsilon Wave and Late Potentials in Arrhythmogenic Right Ventricular Cardiomyopathy—Do Late Potentials Define the Epsilon Wave?
Authors: Skrzypczyńska-Banasik Urszula , Woźniak Olgierd , Kowalik Ilona , Fronczak-Jakubczyk Aneta , Borowiec Karolina , Hoffman Piotr , Biernacka Elżbieta Katarzyna
Published: August 2024

Introduction: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic disorder characterised by progressive fibrosis predominantly of the right ventricular (RV) myocardium, resulting in life-threatening arrhythmias and heart failure. The diagnosis is challenging due to a wide spectrum of clinical symptoms. The important role of ECG was covered in the current diagnostic criteria. The role of the epsilon wave (EW) is still under discussion. Aim: The aim of the study was to examine a potential association between the EW and late ventricular potentials (LPs) in ARVC patients (pts). The correlation between RV dilatation or dysfunction and LPs/EW was also analysed. Methods: The ARVC group consisted of 81 pts (53 men, aged 20–78 years) fulfilling 2010 International Task Force Criteria. 12-lead ECG, LPs, Holter, and ECHO were performed in all pts. The presence of EW was analysed in ECG by 3 investigators. LPs were detected by signal-averaged ECG (SAECG). SAECG was considered positive for LPs when at least two of the three following criteria were met: (1) the filtered QRS duration (fQRS) ≥ 114 msec; (2) the duration of the final QRS fragment in which low-amplitude signals lower than 40 μV are recorded (LAS-40 > 38 msec); and (3) the root mean square amplitude of the last 40 milliseconds of the fQRS complex (RMS-40 < 20 μV). The results were compared with a reference group consisting of 53 patients with RV damage in the course of atrial septum defect (ASD) or Ebstein’s Anomaly (EA). Results: In the ARVC group, a significant relationship was observed between the occurrence of EW and the presence of LPs. EW was more common in the LP+ than in the LP- patients (48.1% vs. 6.9%, p < 0001; OR 12.5; 95% CI [2.691–58.063]). In ARVC pts, RVOT > 36 mm, RVIT > 41 mm, and RV S’ < 9 cm/s were observed significantly more often in the LPs+ than in the LPs− group (OR [95% CI]: 8.3 [2.9–1.5], 6.4 [2.2–19.0] and 3.6 [1.1–12.2], respectively). In the ARVC group, any of fQRS > 114 ms, LAS > 38 ms, and RMS < 20 μV were significantly more frequent in EW+ pts. In multivariate analysis, the independent factors of the EW were LAS-40 and RV S’. In the LPs− subgroup, RVOT > 36 mm was more frequent in ASD/EA than in ARVC (70.4% vs. 25%, p = 0.002). Similarly, in the LPs− subgroup, RVIT > 41 mm was encountered more frequently in ASD/EA than in ARVC (85.2% vs. 48.3%, p = 0.004). Conclusions: In ARVC, there is an association between EW and LPs, with both probably resulting from the same process of fibrofatty substitution of the RV myocardium. Although RV dilatation is common in ASD and EA, it does not correlate with LPs.
Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors in Patients Following Acute Coronary Syndromes: From Lipid Lowering and Plaque Stabilization to Improved Outcomes
Authors: Dimitriadis Kyriakos , Pyrpyris Nikolaos , Iliakis Panagiotis , Beneki Eirini , Adamopoulou Eleni , Papanikolaou Aggelos , Konstantinidis Dimitrios , Fragkoulis Christos , Kollias Anastasios , Aznaouridis Konstantinos , Tsioufis Konstantinos
Published: August 2024

Lipid lowering, with the use of statins after an acute coronary syndrome (ACS), is a cornerstone, well-established strategy for the secondary prevention of ischemic events in this high-risk cohort. In addition to the positive effect on lipid levels, statins have also been linked to improved atherosclerotic plaque characteristics, such as plaque regression and inflammation reduction, associated with the extent of reduction in LDL-C. The recent emergence of PCSK9 inhibitors for the management of dyslipidemia and the more extensive lipid lowering provided by these agents may provide better prevention for ACS patients when initiated after the ACS event. Several trials have evaluated the immediate post-ACS initiation of PCSK9 inhibitors, which has shown, to date, beneficial results. Furthermore, PCSK9 inhibitors have been linked with positive plaque remodeling and associated mortality benefits, which makes their use in the initial management strategy of such patients appealing. Therefore, in this review, we will analyze the rationale behind immediate lipid lowering after an ACS, report the evidence of PCSK9 inhibition immediately after the ACS event and the available data on plaque stabilization, and discuss treatment algorithms and clinical perspectives for the use of these agents in this clinical setting.
Overview of the Use of Optical Coherence Tomography Angiography in Neovascular Age-Related Macular Degeneration
Authors: Faatz Henrik , Lommatzsch Albrecht
Published: August 2024

The aim of this review is to present and discuss the use of optical coherence tomography angiography (OCTA) in age-related macular degeneration (AMD). OCTA is a non-invasive imaging procedure that gives a detailed indirect view of physiological and pathological vessels in the retina and choroid membrane. Compared with dye-based imaging, OCTA provides a segmented presentation of the individual vascular layers and plexuses, thus enabling previously unattainable differentiation and classification of pathological vascular changes within or underneath the retina. In particular, OCTA facilitates early detection of exudative macular neovascularizations (MNV) so that treatment with anti-VEGF medication can be initiated. Moreover, in the context of both screening and therapy monitoring, it is hoped that OCTA can provide more detailed data to enable greater personalization of treatment and follow-up. The image quality of OCTA is, however, susceptible to artifacts, and validation of the results by studies is required. Recent developments have shown constant improvement both in the algorithms for image calculation and avoidance of artifacts and in image quality, so the scope of OCTA will certainly expand with time.
Comparative Retrospective Cohort Study of Carotid-Subclavian Bypass versus In Situ Fenestration for Left Subclavian Artery Revascularization during Zone 2 Thoracic Endovascular Aortic Repair: A Single-Center Experience
Authors: Ozcinar Evren , Dikmen Nur , Baran Cagdas , Buyukcakir Onur , Kandemir Melisa , Yazicioglu Levent
Published: August 2024

Background: Thoracic endovascular aortic repair (TEVAR) has become the first-line therapy for descending aortic disease. Recent studies have demonstrated that preventive revascularization of the left subclavian artery (LSA) in zone 2 TEVAR cases reduces the risk of neurological complications. However, there is no uniform consensus on the choice of revascularization techniques. Although carotid-subclavian bypass is considered the gold standard method, in situ fenestration techniques have also shown encouraging results. This study aims to compare the carotid-LSA bypass with in situ fenestration (ISF) for LSA revascularization and to discuss our treatment approach. Methods: We conducted a retrospective review of all patients undergoing zone 2 TEVAR with in situ fenestration (ISF) or carotid-subclavian artery bypasses for LSA revascularization at our institution between February 2011 and February 2024. Preoperative patient characteristics and primary outcomes, such as operative mortality, transient ischemic attack, stroke, and spinal cord ischemia, were analyzed between the groups. Results: During the 13-year study period, 185 patients underwent TEVAR procedures. Of these, 51 patients had LSA revascularization with zone 2 TEVAR; 32 patients underwent carotid-subclavian artery bypasses, and 19 underwent in situ fenestration. The technical success rate was 100%. Statistically, there was no significant difference between the groups in terms of primary outcomes such as stroke, transient ischemic attack, spinal cord ischemia, and death (p > 0.05). Conclusions: In situ fenestration (ISF) may be an effective and feasible method for LSA revascularization. With precise patient selection and in experienced hands, ISF appears to be associated with similar perioperative outcomes and mortality rates to the carotid-subclavian bypass.
Utility of Contrast-Enhanced Ultrasound in Optimizing Hepatic Abscess Treatment and Monitoring
Authors: Dobek Adam , Kobierecki Mateusz , Kosztowny Konrad , Grząsiak Oliwia , Fabisiak Adam , Falenta Krzysztof , Stefańczyk Ludomir
Published: August 2024

Background/Objectives: Untreated hepatic abscesses (HAs) have an 80% mortality rate and can be caused by bacteria and fungi. Previously managed with surgery, current treatments now utilize interventional radiology and antibiotics, reducing complications to 2.5%. This study evaluates contrast-enhanced ultrasound (CEUS) for better drainage placement and monitoring, overcoming conventional ultrasound’s limitations in detecting the HA liquefied portion. Methods: We conducted a retrospective study of 50 patients with HAs confirmed via computed tomography (CT) scans. Inclusion criteria comprised specific clinical symptoms and laboratory parameters. Both B-mode and CEUS were utilized for initial and follow-up imaging. Results: In the CEUS studies, the mean size of HAs was 6.26 cm, with pus displaying significantly lower echogenicity compared to the HA pouch and liver parenchyma in all phases. Classification by size (>6 cm, <6 cm) and volume (>113 mL, <113 mL) revealed differences in the assessment of fluid volume between CEUS and B-mode. Conclusions: CEUS is valuable for diagnosing, performing therapeutic procedures, and monitoring HA. It provides precise real-time assessment of HA morphology, including dimensions and volume. If the liquefied volume of an HA exceeds 113 mL, it may qualify for drainage placement. CEUS can replace CT as an effective, less harmful, and cheaper method, eliminating the need for multiple radiological departments. While CEUS is a safer, cost-effective alternative to CT for HA evaluation and monitoring, comprehensive clinical evaluation remains essential. Therefore, CEUS should be part of a broader diagnostic and monitoring strategy, not a stand-alone solution.
Myocardial Fibrosis Quantification Methods by Cardiovascular Magnetic Resonance Imaging in Patients with Fabry Disease
Authors: Sokolska Justyna M. , Károlyi Mihály , Hiestand Dana R. , Gastl Mareike , Weber Lucas , Sokolski Mateusz , Kosmala Wojciech , Alkadhi Hatem , Gruner Christiane , Manka Robert
Published: August 2024

Background/Objectives: The presence of late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) in patients with Fabry disease (FD) is a predictor of adverse cardiac events. The aim of this study was to establish the most reliable and reproducible technique for quantifying LGE in patients with FD. Methods: Twenty FD patients with LGE who underwent CMR on the same scanner and LGE sequence were included. LGE quantifications were done using gray-scale thresholds of 2, 3, 4, 5 and 6 standard deviations (SD) above the mean signal intensity of the remote myocardium, the full width at half maximum method (FWHM), visual assessment with threshold (VAT) and the fully manual method (MM). Results: The mean amount of fibrosis varied between quantification techniques from 36 ± 19 at 2SD to 2 ± 2 g using the FWHM (p < 0.0001). Intraobserver reliability was excellent for most methods, except for the FWHM which was good (ICC 0.84; all p < 0.05). Interobserver reliability was excellent for VAT (ICC 0.94) and good for other techniques (all p < 0.05). Intraobserver reproducibility showed the lowest coefficient of variation (CV, 6%) at 5SD and at 2SD and VAT (35% and 38%) for interobserver reproducibility. The FWHM revealed the highest CV (63% and 94%) for both intra- and interobserver reproducibility. Conclusions: The available methods for LGE quantification demonstrate good to excellent intra- and interobserver reproducibility in patients with FD. The most reliable and reproducible techniques were VAT and 5SD, whereas the FWHM was the least reliable in the setting of our study. The total amount of LGE varies strongly with the quantification technique used.
Efficacy of Percutaneous Laser Disc Decompression (PLDD) Combined with an Oral Food Supplement for Lumbar Disc Herniation
Authors: Gazzeri Roberto , Leoni Matteo Luigi Giuseppe , Occhigrossi Felice
Published: August 2024

Background: In recent years, minimally invasive treatment options for lumbar disc herniation, such as percutaneous laser disc decompression (PLDD), have been introduced to avoid more invasive surgical methods. Combining these minimally invasive approaches with nutraceuticals that are effective in neuroprotection and pain management may lead to better long-term outcomes. Methods: The present study evaluated the beneficial effects of a new oral food supplement composed of acetyl-L-carnitine, α-lipoic acid, quercetin, bromelain, pantothenic acid, and vitamins C, B1, B2, B6, and B12 in patients with neuropathic pain due to herniated lumbar discs treated with PLDD. Patients were divided into two groups of 26 patients each: group A underwent PLDD alone, while group B underwent PLDD followed by a dietary supplement for two months after surgery. Preoperative VAS scores for leg pain were recorded for both groups and no significant difference was observed (8.7 for Group A and 8.6 for Group B). Results: In Group A, the mean postoperative VAS score for leg pain at a 1-month follow-up was 2.5, which remained stable at 3 months. In Group B, the mean postoperative VAS score was 2.0 at 1-month and improved to 1.6 at the 3-month follow-up. According to self-reported leg pain assessments, 66.5% of the patients using the dietary supplement reported a significantly better pain condition, and 43.5% reported a somewhat better situation. In contrast, 7.7% of the patients who underwent PLDD alone reported no changes in leg pain at the final follow-up. Conclusions: The results of our study indicate that the oral food supplement could provide a safe and effective treatment in patients with painful radiculopathy, enhancing the recovery of sensory fiber function in lumbar nerve roots after surgical lumbar disc decompression.
Not Every Size Fits All: Surgical Corridors for Clival and Cervical Chordomas—A Systematic Review of the Literature and Illustrative Cases
Authors: Maugeri Rosario , Bonosi Lapo , Brunasso Lara , Costanzo Roberta , Santi Samuele , Signorelli Francesco , Iacopino Domenico Gerardo , Visocchi Massimiliano
Published: August 2024

Introduction. Clival chordomas represent a rare but clinically significant subset of skull base tumors, characterized by a locally aggressive nature and a location in proximity to vital neurovascular structures. Surgical resection, often combined with adjuvant therapies, remains the cornerstone of clival chordoma treatment, and various approaches and techniques have evolved to maximize tumor removal while preserving neurological function. Recent advancements in skull base surgery, imaging, and adjuvant therapies have improved outcomes by reducing morbidity and thus enhancing long-term survival. Methods and Results. We have conducted a systematic review on PubMed/Medline following PRISMA guidelines regarding indications, the extent of resection (EOR), and complication rates. Then, we present three illustrative cases from our personal experience, which started 25 years ago with CVJ instrumentation procedures and 15 years ago with anterior decompressive transmucosal procedures performed with the aid of an operative microscope, an endoscope, and neuroradiological monitoring. Conclusions. Traditionally, the transoral approach (TOA) is the most frequently used corridor for accessing the lower clivus and the anterior craniovertebral junction (CVJ), without the need to mobilize or retract neural structures; however, it is associated with a high rate of complications. The endonasal approach (EEA) provides access to the anterior CVJ as well as to the lower, middle, and superior clivus, decreasing airway and swallowing morbidity, preserving palatal function, decreasing postoperative pain, and reducing the incidence of tracheostomy. The submandibular retropharyngeal approach (SRA) allows unique access to certain cervical chordomas, which is better suited when the lesion is located below the clivus and in the midline.
May Patients with Recurrent Venous Disease Benefit from Sequential Treatment More than Those without Previous Intervention? A Single-Center Retrospective Study on the Safety and Efficacy of Abdominal and Pelvic Veins Embolization in Sequential Approach
Authors: Szary Cezary , Wilczko-Kucharska Justyna , Celejewski Krzysztof , Łodyga Małgorzata , Napierala Marcin , Plucinska Dominika , Swieczkowski-Feiz Siavash , Leszczynski Jerzy , Zawadzki Michal , Grzela Tomasz
Published: August 2024

Background/Objective: The endovenous embolization of insufficient abdominal/pelvic veins is the preferred method of treatment. Also, it seems to be crucial in the treatment of lower limb vein insufficiency, particularly in recurrent disease. This study aimed to evaluate of pelvic vein embolization safety and its impact on the short-term outcome in the sequential treatment of venous disease. Methods: A retrospective analysis involved data from 506 female patients with venous disease involving abdominal and pelvic veins. All records were extracted from the medical database and included patient history, imaging reports as well as pre- and post-operative surveys. Results: Among the patients analyzed, 37.2% underwent some venous intervention in the past, with significant differences in symptom severity between groups. The embolization procedure revealed a high safety profile, with no serious complications. Pain during and after the procedure was generally low, with significantly lower pain scores in patients with recurrence. In patients who required left renal vein venoplasty a 1.7-fold increased risk of lumbar pain after embolization and venoplasty procedure was observed. Overall, 66.6% of patients reported improvement in pelvic symptoms and 72.1% experienced improvement in leg symptoms. The full sequential treatment protocol (abdominal, pelvic, and leg compartment) demonstrated superior outcomes in leg symptom improvement compared to embolization alone. Conclusions: Pelvic vein embolization is a safe and effective method of treatment, significantly improving both pelvic and leg symptoms, particularly in patients with a history of previous interventions in lower limb veins. Further studies are warranted to validate our findings and further refine treatment protocols.
Unexpected Infective Endocarditis: Towards a New Alert for Clinicians
Authors: La Canna Giovanni , Torracca Lucia , Barbone Alessandro , Scarfò Iside
Published: August 2024

Despite the clear indications and worldwide application of specific guidelines, the recognition of Infective Endocarditis (IE) may be challenging in day-to-day clinical practice. Significant changes in the epidemiological and clinical profile of IE have been observed, including variations in the populations at risk and an increased incidence in subjects without at-risk cardiac disease. Emergent at-risk populations for IE particularly include immunocompromised patients with a comorbidity burden (e.g., cancer, diabetes, dialysis), requiring long-term central venous catheters or recurrent healthcare interventions. In addition, healthy subjects, such as skin-contact athletes or those with piercing implants, may be exposed to the transmission of highly virulent bacteria (through the skin or mucous), determining endothelial lesions and subsequent IE, despite the absence of pre-existing at-risk cardiac disease. Emergent at-risk populations and clinical presentation changes may subvert the conventional paradigm of IE toward an unexpected clinical scenario. Owing to its unusual clinical context, IE might be overlooked, resulting in a challenging diagnosis and delayed treatment. This review, supported by a series of clinical cases, analyzed the subtle and deceptive phenotypes subtending the complex syndrome of unexpected IE. The awareness of an unexpected clinical course should alert clinicians to also consider IE diagnosis in patients with atypical features, enhancing vigilance for preventive measures in an emergent at-risk population untargeted by conventional workflows.
Transformation of Biomass Power Plant Ash into Composite Fertilizers: A Perspective to Prepare a Rain-Controlled Ammonium Ion–Releasing Composite Fertilizer
Authors: Kótai László , Windisch Márk , Béres Kende Attila
Published: August 2024

We have developed a convenient route to transform biomass power plant ashes (BPPA) into porous sponge-like fertilizer composites. The absence of water prevents the chemical reaction and carbon dioxide formation when concentrated sulfuric acid is mixed with BPPA and CaCO3. Adding water, however, initiates the protonation reaction of carbonate ion content and starts CO2 evolution. The key element of the method was that the BPPA and, optionally, CaCO3 and/or CaSO4·0.5H2O were mixed with concentrated sulfuric acid to make a paste-like consistency. No gas evolution occurred at this stage; however, with the subsequent and controlled addition of water, CO2 gas evolved and was released through the channels developed in the pastry-like material due to the internal gas pressure, but without foaming. Using a screw-containing tube reactor, the water can be introduced under pressure. Due to the pressure, the pores in the pastry-like material became smaller, and consequently, the mechanical strength of the granulated and solidified mixture became higher than that of the reaction products prepared under atmospheric pressure. The main reaction products were syngenite (K2Ca(SO4)2·H2O) and polyhalite (K2Ca2Mg(SO4)4·2H2O). These compounds are valuable fertilizer components in themselves, but the material’s porous nature helps absorb solutions of microelement fertilizers. Surprisingly, concentrated ammonium nitrate solutions transform the syngenite content of the porous fertilizer into ammonium calcium sulfate ((NH4)2Ca(SO4)2·2H2O, koktaite). Koktaite is slightly soluble in water, thus the amount of ammonium ion released on the dissolution of koktaite depends on the amount of available water. Accordingly, ammonium ion release for plants can be increased with rain or irrigation, and koktaite is undissolved and does not decompose in drought situations. The pores (holes) of this sponge-like fertilizer product can be filled with different solutions containing other fertilizer components (phosphates, zinc, etc.) to adjust the composition of the requested fertilizer compositions for particular soils and plant production. The method allows the preparation of ammonium nitrate composite fertilizers containing metallic microelements, and various solid sponge-like composite materials with adjusted amounts of slowly releasing fertilizer components like syngenite and koktaite.
Surface Analysis of Orthodontic Mini-Implants after Their Clinical Use
Authors: Ioana Tamara Rahela , Boeru Filip George , Antoniac Iulian , Mitruț Ioana , Staicu Ionela Elisabeta , Rauten Anne Marie , Uriciuc Willi Andrei , Manolea Horia Octavian
Published: August 2024

Temporary anchorage devices (TADs) are orthodontic mini-implants with remarkable characteristics that, once inserted, present mechanical retention (primary stability) without the process of bone osseointegration. However, interaction with the biological environment may cause changes in the morphology of the external surface of dental TADs. In this study, we used 17 TADs made of aluminum–vanadium titanium alloy, produced by two companies, which were analyzed through optical microscopy after being removed from the patients during orthodontic treatment. We evaluated the changes that appeared on the TADs’ surfaces after their use in the biological environment, depending on the morphological area in which they were inserted. In our study, we found changes in the morphology of the implant surface, and especially deposits of biological material in all study groups. On all samples examined after clinical use, regardless of the period of use, corrosion surfaces in different locations were observed. Our obtained results support the idea that the biological environment is aggressive for mini-implant structures, always producing changes to their surface during their clinical use.
Ex Vivo Simultaneous H215O Positron Emission Tomography and Magnetic Resonance Imaging of Porcine Kidneys—A Feasibility Study
Authors: Arildsen Maibritt Meldgaard , Mariager Christian Østergaard , Overgaard Christoffer Vase , Vorre Thomas , Bøjesen Martin , Moeslund Niels , Alstrup Aage Kristian Olsen , Tolbod Lars Poulsen , Vendelbo Mikkel Holm , Ringgaard Steffen , Pedersen Michael , Buus Niels Henrik
Published: August 2024

The aim was to establish combined H215O PET/MRI during ex vivo normothermic machine perfusion (NMP) of isolated porcine kidneys. We examined whether changes in renal arterial blood flow (RABF) are accompanied by changes of a similar magnitude in renal blood perfusion (RBP) as well as the relation between RBP and renal parenchymal oxygenation (RPO). Methods: Pig kidneys (n = 7) were connected to a NMP circuit. PET/MRI was performed at two different pump flow levels: a blood-oxygenation-level-dependent (BOLD) MRI sequence performed simultaneously with a H215O PET sequence for determination of RBP. Results: RBP was measured using H215O PET in all kidneys (flow 1: 0.42–0.76 mL/min/g, flow 2: 0.7–1.6 mL/min/g). We found a linear correlation between changes in delivered blood flow from the perfusion pump and changes in the measured RBP using PET imaging (r2 = 0.87). Conclusion: Our study demonstrated the feasibility of combined H215O PET/MRI during NMP of isolated porcine kidneys with tissue oxygenation being stable over time. The introduction of H215O PET/MRI in nephrological research could be highly relevant for future pre-transplant kidney evaluation and as a tool for studying renal physiology in healthy and diseased kidneys.
Review Regarding the Influence of Cryogenic Milling on Materials Used in the Aerospace Industry
Authors: Nita Bogdan , Tampu Raluca Ioana , Tampu Catalin , Chirita Bogdan Alexandru , Herghelegiu Eugen , Schnakovszky Carol
Published: August 2024

In the aerospace industry, an important number of machined parts are submitted for high-performance requirements regarding surface integrity. Key components are made of materials selected for their unique properties and they are obtained by milling processes. In most situations, the milling process uses cooling methods because, in their absence, the material surface could be affected by the generated heat (temperatures could reach up to 850 °C), the residual stress, the cutting forces, and other factors that can lead to bad integrity. Cryogenic cooling has emerged as a pivotal technology in the manufacturing of aeronautical materials, offering enhanced properties and efficiency in the production process. By utilizing extremely low temperatures, typically involving liquid nitrogen or carbon dioxide, cryogenic cooling can significantly enhance the material’s properties and machining processes. Cryogenic gases are tasteless, odorless, colorless, and nontoxic, and they evaporate without affecting the workers’ health or producing residues. Thus, cryogenic cooling is also considered an environmentally friendly method. This paper presents the advantages of cryogenic cooling compared with the classic cooling systems used industrially. Improvements in terms of surface finishing, tool life, and cutting force are highlighted.
Application of Pattern Search and Genetic Algorithms to Optimize HDPE Pipe Joint Profiles and Strength in the Butt Fusion Welding Process
Authors: Mathkoor Mahdi Saleh , Jassim Raad Jamal , Al-Sabur Raheem
Published: August 2024

The rapid spread of the use of high-density polyethylene (HDPE) pipes is due to the wide variety of methods for connecting them. This study keeps pace with the developments of butt fusion welding of HDPE pipes by exploring the relationship between the performance of the weld joints by studying ultimate tensile strength and exploring the joint welding profiles by studying the shape of the joint at the outer surface of the pipe (height and width of the joint cap) and the shape of the joint at the internal surface (height and width of the joint root). Welding pressure, heater temperature, stocking time, and cooling time were the parameters for the welding process. Regression was analyzed using ANOVA, and an ANN was used to analyze the experimental results and predict the outputs. Two optimization techniques (pattern search and genetic algorithm) were applied to obtain the ideal operating conditions and compare their performance. The results showed that pattern search and genetic algorithms can determine the optimal output results and corresponding welding parameters. In comparison between the two methods, pattern search has a limited relative advantage. The optimal values for the obtained outputs revolved around a tensile strength of 35 MPa (3.45 and 4.5 mm for the cap and root heights, and 8 and 6.98 mm for the cap and root widths, respectively). When comparing the effects of welding parameters on the results, welding pressure had the best effect on tensile strength, and plate surface temperature had the most significant effect on the welding profile geometries.
Study of Structure Formation in Multilayer Composite Material AA1070-AlMg6-AA1070-Titanium (VT1-0)-08Cr18Ni10Ti Steel after Explosive Welding and Heat Treatment
Authors: Malakhov Andrey , Niyozbekov Nemat , Denisov Igor , Saikov Ivan , Shakhray Denis , Volchenko Evgenii
Published: August 2024

Multilayer composite materials, consisting of layers of aluminum alloy and steel, are used in the manufacturing of large engineering structures, including in the shipbuilding and railcar industries. Due to the different properties of aluminum alloys and steels, it is difficult to achieve high-strength joints by conventional welding. Therefore, these joints are produced by explosive welding. In the present work, the structure of a multilayer material, AA1070-AlMg6-AA1070 (aluminum alloys)-VT1-0-08Cr18Ni10Ti (steel), was investigated after explosive welding and heat treatments were performed under different conditions. The microstructure of the AlMg6 layer at the AlMg6-AA1070 interface consists of shaped anisotropic grains extending along the weld interface. The AA1070 layer is enriched with magnesium due to its diffusive influx from AlMg6. In the AlMg6 and VT1-0 layers, adiabatic shear bands are found that start at the weld interface and propagate deep into the material. The optimal temperature for the heat treatment is 450–500 °C, as internal stresses are reduced at this temperature and the grain structure of the AlMg6 layer is not coarse. Tear strength testing revealed that the tear strength of the composite material after explosive welding was 130 ± 10 MPa, which exceeded the strength of the AA1070 alloy.
Metagenomic Profiling of Bacterial Communities and Functional Genes in Penaeus monodon
Authors: Chen Juan , Li Yundong , Jiang Song , Yang Qibin , Huang Jianhua , Yang Lishi , Shi Jianzhi , Lu Zhibin , Zhang Yan , Jiang Shigui , Zhou Falin
Published: August 2024

Penaeus monodon is one of the world’s most important aquaculture species, with its host-associated microbial community playing a crucial role in its growth, metabolism, immune response, and adaptation. In our study, we utilized Illumina high-throughput sequencing to investigate the composition, structure, and function of the intestinal microbial communities of P. monodon from two different regions in Guangdong. Our results identified 176 phyla across both populations, with Proteobacteria and Firmicutes being predominant. Furthermore, we identified 3095 genera, with Photobacterium, Vibrio, and Aliiroseovarius being the most dominant. Functional gene analysis based on KEGG data indicated that the carbohydrate metabolism and amino acid metabolism were significant at the secondary metabolic pathway level. The eggNOG functional annotation revealed that the genes involved in replication, recombination, and repair are of paramount importance. The CAZy annotation results indicated that Glycoside Hydrolases (GH) have the highest abundance. The Pfam annotation analysis showed that the two most prevalent domains are P-loop NTPase and NADP Rossmann. Our investigation provides a reference for species-level and functional-level analyses of the intestinal microbiota of P. monodon, contributing valuable insights into its microbial ecology.