bluuebunny/crossref_metadata_2025 huggingface dataset:
Recognition of Strokes in the ICU: A Narrative Review
Authors: Noda Kotaro , Koga Masatoshi , Toyoda Kazunori
Published: April 2023

Despite the remarkable progress in acute treatment for stroke, in-hospital stroke is still devastating. The mortality and neurological sequelae are worse in patients with in-hospital stroke than in those with community-onset stroke. The leading cause of this tragic situation is the delay in emergent treatment. To achieve better outcomes, early stroke recognition and immediate treatment are crucial. In general, in-hospital stroke is initially witnessed by non-neurologists, but it is sometimes challenging for non-neurologists to diagnose a patient’s state as a stroke and respond quickly. Therefore, understanding the risk and characteristics of in-hospital stroke would be helpful for early recognition. First, we need to know “the epicenter of in-hospital stroke”. Critically ill patients and patients who undergo surgery or procedures are admitted to the intensive care unit, and they are potentially at high risk for stroke. Moreover, since they are often sedated and intubated, evaluating their neurological status concisely is difficult. The limited evidence demonstrated that the intensive care unit is the most common place for in-hospital strokes. This paper presents a review of the literature and clarifies the causes and risks of stroke in the intensive care unit.
Neurological Complications in Pregnancy and the Puerperium: Methodology for a Clinical Diagnosis
Authors: Merlino Lucia , Matys Viviana , Crognale Alba , D’Ovidio Giulia , Della Rocca Carlo , Porpora Maria , Titi Luca , Viscardi Maria , Volpicelli Agnese , Piccioni Maria
Published: April 2023

Neurological complications in pregnancy and the puerperium deserve particular attention from specialists due to the worsening of the clinical picture for both the mother and the fetus. This narrative review of existing data in the literature aims to analyze the most common “red flag symptoms” attributable to neurological complications such as pre-eclampsia (PE), eclampsia, HELLP syndrome, posterior reversible encephalopathy syndrome (PRES), cerebral vasoconstriction syndrome (RCVS), stroke, CVS thrombosis, pituitary apoplexy, amniotic fluid embolism and cerebral aneurysm rupture, with the aim of providing a rapid diagnostic algorithm useful for the early diagnosis and treatment of these complications. The data were derived through the use of PubMed. The results and conclusions of our review are that neurological complications of a vascular nature in pregnancy and the puerperium are conditions that are often difficult to diagnose and manage clinically. For the obstetrics specialist who is faced with these situations, it is always important to have a guide in mind in order to be able to unravel the difficulties of clinical reasoning and promptly arrive at a diagnostic hypothesis.
Clinical Relevance of Vaginal Cuff Dehiscence after Minimally Invasive versus Open Hysterectomy
Authors: Eoh Kyung Jin , Lee Young Joo , Nam Eun Ji , Jung Hye In , Kim Young Tae
Published: April 2023

This study aimed to evaluate the clinical relevance of vaginal cuff dehiscence following a hysterectomy. Data were prospectively collected from all patients who underwent hysterectomies at a tertiary academic medical center between 2014 and 2018. The incidence and clinical factors of vaginal cuff dehiscence after minimally invasive versus open hysterectomy were compared. Vaginal cuff dehiscence occurred in 1.0% (95% confidence interval [95% CI], 0.7–1.3%) of women who underwent either form of hysterectomy. Among those who underwent open (n = 1458), laparoscopic (n = 3191), and robot-assisted (n = 423) hysterectomies, vaginal cuff dehiscence occurred in 15 (1.0%), 33 (1.0%), and 3 (0.7%) cases, respectively. No significant differences in cuff dehiscence occurrence were identified in patients who underwent various modes of hysterectomies. A multivariate logistic regression model was created using the variables indication for surgery and body mass index. Both variables were identified as independent risk factors for vaginal cuff dehiscence (odds ratio [OR]: 2.74; 95% CI, 1.51–4.98 and OR: 2.20; 95% CI, 1.09–4.41, respectively). The incidence of vaginal cuff dehiscence was exceedingly low in patients who underwent various modes of hysterectomies. The risk of cuff dehiscence was predominantly influenced by surgical indications and obesity. Thus, the different modes of hysterectomy do not influence the risk of vaginal cuff dehiscence.
Diagnostic Value of Serum Lactate Dehydrogenase Level Measured in the Emergency Department in Predicting Clinical Outcome in Out-of-Hospital Cardiac Arrest: A Multicenter, Observational Study
Authors: Kim Jihyun , Kim Yong Won , Kim Tae-Youn
Published: April 2023

Introduction: Out-of-hospital cardiac arrest (OHCA) is complex, and risk stratification tools have the potential to include components other than clinical risk indicators, thus requiring extensive studies. Simple and accurate biomarkers for OHCA patients with poor prognoses are still needed. Serum lactate dehydrogenase (LDH) has been identified as a risk factor in patients with various diseases, such as cancer, liver disease, severe infections, and sepsis. The primary aim of this study was to assess the accuracy of LDH values at initial presentation in the emergency department (ED) in predicting the clinical outcome in OHCA. Methods: This retrospective multicenter observational study was performed in the ED of two tertiary university hospitals and one general hospital between January 2015 and December 2021. All patients with OHCA who visited the ED were included. The primary outcome was the sustained return of spontaneous circulation (ROSC; >20 min) after advanced cardiac life support (ACLS). The secondary outcome was survival to discharge (including home care and nursing care discharge) among patients with ROSC. The neurological prognosis was considered a tertiary outcome in patients who survived to discharge. Results: In total, 759 patients were enrolled in the final analysis. The median LDH level in the ROSC group was 448 U/L (range: 112–4500), which was significantly lower than that in the no-ROSC group (p < 0.001). The median LDH level in the survival-to-discharge group was 376 U/L (range: 171–1620), which was significantly lower than that in the death group (p < 0.001). Using the adjusted model, the odds ratio of the LDH value (≤634 U/L) for primary outcomes was 2.418 (1.665–3.513) and the odds ratio of LDH value (≤553 U/L) for secondary outcomes was 4.961 (2.184–11.269). Conclusions: In conclusion, the serum LDH levels of patients with OHCA measured in the ED can potentially serve as a predictive marker for clinical outcomes such as ROSC and survival to discharge, although it may be difficult to predict neurological outcomes.
Transoral Robotic Surgery in the Management of Submandibular Gland Sialoliths: A Systematic Review
Authors: Rogalska Marta , Antkowiak Lukasz , Kasperczuk Anna , Scierski Wojciech , Misiolek Maciej
Published: April 2023

This study aimed to systematically review the literature to determine the efficacy and safety of transoral robotic surgery (TORS) in the management of submandibular gland (SMG) sialolithiasis. PubMed, Embase, and Cochrane were searched for English-language articles evaluating TORS in the management of SMG stones published up to 12 September 2022. Nine studies with a total of 99 patients were included. Eight patients underwent TORS followed by sialendoscopy (TS); 11 patients underwent sialendoscopy followed by TORS and sialendoscopy (STS); 4 patients underwent sialendoscopy followed by TORS only (ST); and 4 patients underwent TORS without sialendoscopy (T). The mean operative time amounted to 90.97 min. The mean procedure success rate reached 94.97%, with the highest for ST (100%) and T (100%), followed by the TS (95.04%) and STS (90.91%) variants. The mean follow-up time was 6.81 months. Transient lingual nerve injury occurred in 28 patients (28.3%) and was resolved in all of them within the mean of 1.25 months. No permanent lingual nerve injury was reported. TORS is a safe and effective management modality for hilar and intraparenchymal SMG sialoliths, with high procedural success in terms of successful sialolith removal, SMG preservation, and reduced risk of permanent postoperative lingual nerve damage.
Baseline Predictors of the Long-Term Insufficient Biochemical Response in Patients with Autoimmune Hepatitis: A Single Center Experience
Authors: Toniutto Pierluigi , Zorzi Michela , D’Alì Lorenzo , Cussigh Annarosa , Cmet Sara , Bitetto Davide , Fornasiere Ezio , Fumolo Elisa , Di Loreto Carla , Falleti Edmondo
Published: April 2023

The treatment response criteria in autoimmune hepatitis (AIH) have been recently updated. This study aimed to assess treatment responses in 39 (16 males) patients with AIH confirmed by histology. Prednisone added to azathioprine or mycophenolate was the most frequent first-line treatment. Serum alanine aminotransferase (ALT) levels were periodically checked for a median of 45 months. Eight (20.5%) patients presented 4 weeks non-response (NR). Baseline lower multiples of ALT above the upper normal limit (UNL) (p = 0.005), Ishak liver fibrosis score > 3 (p = 0.029), and less frequent confluent necrosis > 2 (p < 0.001) were independent predictors of NR. 24 (61.5%) patients achieved complete biochemical response (CBR) at six months. Ishak liver fibrosis score ≤ 3 (p < 0.001), lobular eosinophilic infiltrate (p < 0.001), and ≥50% decrease in serum ALT levels at week 4 (p < 0.001) were independent predictors of CBR. In addition, the GLUCRE score, derived from the multiplication of serum creatinine (mg/dL) and glucose (mg/dL) levels, were identified. A baseline GLUCRE value > 100 strongly predicted CBR failure (p = 0.003) at a follow-up greater than 12 months. In conclusion, the absence of cirrhosis and a ≥50% UNL decrease in serum ALT levels were independent predictors for CBR. A baseline GLUCRE score may help identify patients maintaining longer CBR.
Effect of Exercise on Liver Function and Insulin Resistance Markers in Patients with Non-Alcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Hejazi Keyvan , Hackett Daniel
Published: April 2023

Background: Structured exercise as part of lifestyle modification plays an important role in the improvement of non-alcoholic fatty liver disease (NAFLD); however, its effectiveness has been shown to vary. This systematic review with meta-analysis investigated the effects of exercise on liver function and insulin resistance markers in patients with NAFLD. Methods: Six electronic databases were searched using terms related to exercise and NAFLD up to March 2022. Data were analyzed using a random-effects model to estimate the standardized mean difference (SMD) and 95% confidence interval. Results: The systematic search identified 2583 articles, of which a total of 26 studies met the inclusion criteria and were eligible. Exercise training had a moderate effect on reducing ALT (SMD: −0.59, p = 0.01) and small effects on reducing AST (SMD: −0.40, p = 0.01) and insulin (SMD: −0.43, p = 0.02). Significant reductions in ALT were found following aerobic training (SMD: −0.63, p < 0.01) and resistance training (SMD: −0.45, p < 0.001). Moreover, reductions in AST were found following resistance training (SMD: −0.54, p = 0.001), but not after aerobic training and combined training. However, reductions in insulin were found following aerobic training (SMD: −0.55, p = 0.03). Exercise interventions for <12 weeks compared to ≥12 weeks were more effective in reducing FBG and HOMA-IR, while interventions for ≥12 weeks compared to <12 weeks were more effective in reducing ALT and AST levels. Conclusions: Our findings support the effectiveness of exercise in improving liver function markers but not in blood glucose control in NAFLD patients. Additional studies are needed to determine the exercise prescription to maximize health in these patients.
A Multi-Modal AI-Driven Cohort Selection Tool to Predict Suboptimal Non-Responders to Aflibercept Loading-Phase for Neovascular Age-Related Macular Degeneration: PRECISE Study Report 1
Authors: Chorev Michal , Haderlein Jonas , Chandra Shruti , Menon Geeta , Burton Benjamin , Pearce Ian , McKibbin Martin , Thottarath Sridevi , Karatsai Eleni , Chandak Swati , Kotagiri Ajay , Talks James , Grabowska Anna , Ghanchi Faruque , Gale Richard , Hamilton Robin , Antony Bhavna , Garnavi Rahil , Mareels Iven , Giani Andrea , Chong Victor , Sivaprasad Sobha
Published: April 2023

Patients diagnosed with exudative neovascular age-related macular degeneration are commonly treated with anti-vascular endothelial growth factor (anti-VEGF) agents. However, response to treatment is heterogeneous, without a clinical explanation. Predicting suboptimal response at baseline will enable more efficient clinical trial designs for novel, future interventions and facilitate individualised therapies. In this multicentre study, we trained a multi-modal artificial intelligence (AI) system to identify suboptimal responders to the loading-phase of the anti-VEGF agent aflibercept from baseline characteristics. We collected clinical features and optical coherence tomography scans from 1720 eyes of 1612 patients between 2019 and 2021. We evaluated our AI system as a patient selection method by emulating hypothetical clinical trials of different sizes based on our test set. Our method detected up to 57.6% more suboptimal responders than random selection, and up to 24.2% more than any alternative selection criteria tested. Applying this method to the entry process of candidates into randomised controlled trials may contribute to the success of such trials and further inform personalised care.
Could Inhibiting the DNA Damage Repair Checkpoint Rescue Immune-Checkpoint-Inhibitor-Resistant Endometrial Cancer?
Authors: Li Yinuo , Wang Xiangyu , Hou Xin , Ma Xiangyi
Published: April 2023

Endometrial cancer (EC) is increasingly undermining female health worldwide, with poor survival rates for advanced or recurrent/metastatic diseases. The application of immune checkpoint inhibitors (ICIs) has opened a window of opportunity for patients with first-line therapy failure. However, there is a subset of patients with endometrial cancer who remain insensitive to immunotherapy alone. Therefore, it is necessary to develop new therapeutic agents and further explore reliable combinational strategies to optimize the efficacy of immunotherapy. DNA damage repair (DDR) inhibitors as novel targeted drugs are able to generate genomic toxicity and induce cell death in solid tumors, including EC. Recently, growing evidence has demonstrated the DDR pathway modulates innate and adaptive immunity in tumors. In this review, we concentrate on the exploration of the intrinsic correlation between DDR pathways, especially the ATM-CHK2-P53 pathway and the ATR-CHK1-WEE1 pathway, and oncologic immune response, as well as the feasibility of adding DDR inhibitors to ICIs for the treatment of patients with advanced or recurrent/metastatic EC. We hope that this review will offer some beneficial references to the investigation of immunotherapy and provide a reasonable basis for “double-checkpoint inhibition” in EC.
Effect of Hemolysis Regarding the Characterization and Prognostic Relevance of Neuron Specific Enolase (NSE) after Cardiopulmonary Resuscitation with Extracorporeal Circulation (eCPR)
Authors: Haertel Franz , Babst Josephine , Bruening Christiane , Bogoviku Jurgen , Otto Sylvia , Fritzenwanger Michael , Gecks Thomas , Ebelt Henning , Moebius-Winkler Sven , Schulze P. Christian , Pfeifer Ruediger
Published: April 2023

Background: Hemolysis, a common adverse event associated with veno-arterial extracorporeal membrane oxygenation (VA-ECMO), may affect neuron-specific enolase (NSE) levels and potentially confound its prognostic value in predicting neurological outcomes in resuscitated patients without return of spontaneous circulation (ROSC) that require extracorporeal cardiopulmonary resuscitation (eCPR). Therefore, a better understanding of the relationship between hemolysis and NSE levels could help to improve the accuracy of NSE as a prognostic marker in this patient population. Methods: We retrospectively analyzed the records of patients who received a VA-ECMO for eCPR between 2004 and 2021 and were treated in the medical intensive care unit (ICU) of the University Hospital Jena. The outcome was measured clinically by using the Cerebral Performance Category Scale (CPC) four weeks after eCPR. The serum concentration of NSE (baseline until 96 h) was analyzed by enzyme-linked immunosorbent assay (ELISA). To evaluate the ability of individual NSE measurements to discriminate, receiver operating characteristic (ROC) curves were calculated. Serum-free hemoglobin (fHb, baseline until 96 h) served as a marker for identifying a confounding effect of parallel hemolysis. Results: 190 patients were included in our study. A total of 86.8% died within 4 weeks after ICU admission or remained unconscious (CPC 3–5), and 13.2% survived with a residual mild to moderate neurological deficit (CPC 1–2). Starting 24h after CPR, NSE was significantly lower and continued to decrease in patients with CPC 1–2 compared to the group with an unfavorable outcome of CPC 3–5. In addition, when evaluating on the basis of receiver operating characteristic curves (ROC), relevant and stable area under the curve (AUC) values for NSE could be calculated (48 h: 0.85 // 72 h: 0.84 // 96 h: 0.80; p < 0.01), and on the basis of a binary logistic regression model, relevant odds ratios for the NSE values were found even after adjusting for fHb regarding the prediction of an unfavorable outcome of CPC 3–5. The respective adjusted AUCs of the combined predictive probabilities were significant (48 h: 0.79 // 72 h: 0.76 // 96 h: 0.72; p ≤ 0.05). Conclusions: Our study confirms NSE as a reliable prognostic marker for poor neurological outcomes in resuscitated patients receiving VA-ECMO therapy. Furthermore, our results demonstrate that potential hemolysis during VA-ECMO does not significantly impact NSE’s prognostic value. These findings are crucial for clinical decision making and prognostic assessment in this patient population.
Coronary Artery Disease and Prognosis of Heart Failure with Reduced Ejection Fraction
Authors: Vicent Lourdes , Álvarez-García Jesús , Vazquez-Garcia Rafael , González-Juanatey José R. , Rivera Miguel , Segovia Javier , Pascual-Figal Domingo , Bover Ramón , Worner Fernando , Fernández-Avilés Francisco , Ariza-Sole Albert , Martínez-Sellés Manuel
Published: April 2023

Our aim was to determine the prognostic impact of coronary artery disease (CAD) on heart failure with reduced ejection fraction (HFrEF) mortality and readmissions. From a prospective multicenter registry that included 1831 patients hospitalized due to heart failure, 583 had a left ventricular ejection fraction of <40%. In total, 266 patients (45.6%) had coronary artery disease as main etiology and 137 (23.5%) had idiopathic dilated cardiomyopathy (DCM), and they are the focus of this study. Significant differences were found in Charlson index (CAD 4.4 ± 2.8, idiopathic DCM 2.9 ± 2.4, p < 0.001), and in the number of previous hospitalizations (1.1 ± 1, 0.8 ± 1.2, respectively, p = 0.015). One-year mortality was similar in the two groups: idiopathic DCM (hazard ratio [HR] = 1), CAD (HR 1.50; 95% CI 0.83–2.70, p = 0.182). Mortality/readmissions were also comparable: CAD (HR 0.96; 95% CI 0.64–1.41, p = 0.81). Patients with idiopathic DCM had a higher probability of receiving a heart transplant than those with CAD (HR 4.6; 95% CI 1.4–13.4, p = 0.012). The prognosis of HFrEF is similar in patients with CAD etiology and in those with idiopathic DCM. Patients with idiopathic DCM were more prone to receive heart transplant.
Deprescribing Strategies: A Prospective Study on Proton Pump Inhibitors
Authors: Calvini Giulia , Baiardi Giammarco , Mattioli Francesca , Milano Giulia , Calautti Francesca , Zunino Alessia , Fraguglia Carla , Caccavale Fabio , Lantieri Francesca , Antonucci Giancarlo
Published: April 2023

Proton pump inhibitors (PPIs) are among the most controversially prescribed drugs in polypharmacy. This observational prospective study assessed the PPI prescriptive trend during hospitalization before and after implementation of a prescribing/deprescribing algorithm in a real-life hospital setting and the related clinical–economic benefit at discharge. PPI prescriptive trends were compared between three quarters of 2019 (9 months) and the same period of 2018 by a chi-square test with a Yate’s correction. The proportions of treated patients in the two years (1120 discharged patients in 2018 and 1107 in 2019) were compared by the Cochran–Armitage trend test. DDDs (defined daily doses) were compared between 2018 and 2019 by the non-parametric Mann–Whitney test and normalizing DDD/DOT (days of therapy) and DDD/100 bd (bed days) for each patient. Multivariate logistic regression was performed on PPI prescriptions at discharge. The distribution of patients with PPIs at discharge was significantly different in the two years (p = 0.0121). There was a downward trend in the number of PPI prescriptions (29.9%) in the third trimester of 2019 compared to the others of the same year (first trimester: 34.1%, second trimester: 36.0%) and by contrast with the same periods of 2018 (29.4, 36.0, and 34.7%) (p = 0.0124). DDDs/patient did not differ between 2018 and 2019 nor across the three trimesters. However, both DDD/DOT and DDD/100 bd showed a decrease in the third trimester of 2019, with a marked difference for DDD/DOT (p = 0.0107). The reduction in consumption detected in the last phase of 2019 in terms of DDD/DOT was 0.09 with a consequent containment of pharmaceutical spending. The development and implementation of multidisciplinary prescribing/deprescribing protocols in both hospital and community settings could lead to a reduction in the misuse of PPIs, with significant savings in healthcare resources.
Determination of Correlated Color Temperature in Ex Vivo Porcine Eyes during Intraocular Illumination
Authors: Fehler Nicole , Hessling Martin
Published: April 2023

(1) Background: In ophthalmic surgery, white light is mostly applied to illuminate the intraocular space, and ophthalmologists are comfortable working with it. Diaphanoscopic illumination changes the spectral composition of light, resulting in a change in the correlated color temperature (CCT) of the intraocular illumination. This color change makes it difficult for surgeons to recognize the structures in the eye. CCT during intraocular illumination has not yet been measured before, and it is the aim of this study to perform such measurement. (2) Methods: CCT was measured inside ex vivo porcine eyes during diaphanoscopic illumination and endoillumination using a current ophthalmic illumination system with a detection fiber inside the eye. By applying pressure on the eye with a diaphanoscopic fiber, the dependency of CCT on pressure was examined. (3) Results: The intraocular CCT values during endoillumination were 3923 K and 5407 K for the halogen and xenon lamps, respectively. During diaphanoscopic illumination, a strong unwanted red shift was observed, resulting in 2199 K and 2675 K for the xenon and the halogen lamps, respectively. Regarding different applied pressures, the CCT did not differ considerably. (4) Conclusions: This red shift should be compensated for in the development of new illumination systems since surgeons are used to white light illumination, which also simplifies the identification of retinal structures.
Multidimensional Interventions on Supporting Disease Management for Hospitalized Patients with Heart Failure: The Role of Clinical and Community Pharmacists
Authors: Jasińska-Stroschein Magdalena , Waszyk-Nowaczyk Magdalena
Published: April 2023

Background: existing trials on the role of clinical pharmacists in managing chronic disease patients have focused on variety of interventions, including preparing patients for the transition from hospital to home. However, little quantitative evidence is available regarding the effect of multidimensional interventions on supporting disease management for hospitalized patients with heart failure (HF). The present paper reviews the effects of inpatient, discharge and/or after-discharge interventions performed on hospitalized HF patients by multidisciplinary teams, including pharmacists. Methods: articles were identified through search engines in three electronic databases following the PRISMA Protocol. Randomized controlled trials (RCTs) or non-randomized intervention studies conducted in the period 1992–2022 were included. In all studies, baseline characteristics of patients as well as study end-points were described in relation to a control group i.e., usual care and a group of subjects that received care from a clinical and/or community pharmacist, as well as other health professionals (Intervention). Study outcomes included all-cause hospital 30-day re-admission or emergency room (ER) visits, all-cause hospitalization within >30 days after discharge, specific-cause hospitalization rates, medication adherence and mortality. The secondary outcomes included adverse events and quality of life. Quality assessment was carried out using RoB 2 Risk of Bias Tool. Publication bias across studies was determined using the funnel plot and Egger’s regression test. Results: a total of 34 protocols were included in the review, while the data from 33 trials were included in further quantitative analyses. The heterogeneity between studies was high. Pharmacist-led interventions, usually performed within interprofessional care teams, reduced the rates of 30-day all-cause hospital re-admission (odds ratio, OR = 0.78; 95% CI 0.62–0.98; p = 0.03) and all-cause hospitalization >30 days after discharge (OR = 0.73; 95% CI 0.63–0.86; p = 0.0001). Subjects hospitalized primarily due to heart failure demonstrated reduced risk of hospital admission within longer periods, i.e., from 60 to 365 days after discharge (OR = 0.64; 95% CI 0.51–0.81; p = 0.0002). The rate of all-cause hospitalization was reduced by multidimensional interventions taken by pharmacists: reviews of medicine lists and/or their reconciliation at discharge (OR = 0.63; 95% CI 0.43–0.91; p = 0.014), as well as interventions that were based mainly on patient education and counseling (OR = 0.65; 95% CI 0.49–0.88; p = 0.0047). In conclusion, given that HF patients often have complex treatment regimens and multiple comorbid conditions, our findings highlight the need for greater involvement from skilled clinical and community pharmacists in disease management.
Intense Pulsed Light Therapy in the Treatment of Dry Eye Diseases: A Systematic Review and Meta-Analysis
Authors: Demolin Lilian , Es-Safi Majda , Soyfoo Muhammad Shahnawaz , Motulsky Elie
Published: April 2023

Background: Intense pulsed light therapy (IPL) is a recently developed way of treating dry eye disease (DED). During the last decade, there was a multiplication of trials studying IPL efficacy. The goal of this review is to summarize the most important and significant results of these trials estimating effect sizes. Methods: The PubMed and sciencedirect databases were searched using a PICO model-based approach. Randomized controlled trials including at least 20 patients with DED and no other eye condition, with a control group and break-up time or symptom scores data available for extraction were included in this review. Statistical analysis evaluated the tear break-up time (TBUT), non-invasive break-up time (NIBUT), ocular surface disease index (OSDI), and standard patient evaluation of eye dryness (SPEED). Three comparisons were carried on for each outcome: longest follow-up values vs. baseline in the treatment group, longest follow-up values in the treatment group vs. control group, and changes from baseline in the treatment group vs. control group. A subgroup analysis was carried on. Results: Eleven randomized controlled trials, published between 2015 and 2021 were included in this systematic review with 759 patients in total. The longest follow-up values vs. baseline in the treatment group analyses were significantly in favor of IPL for all the parameters studied for instance: NIBUT (effect size (ES), 2.02; 95% confidence interval (CI), (1.43; 2.62)), TBUT (ES, 1.83; 95% CI, (0.96; 2.69)), OSDI (ES, −1.38; 95% CI, (−2.12; −0.64)) and SPEED (ES, −1.15; 95% CI, (−1.72; −0.57)). The longest follow-up values in the treatment group vs. control group analyses, and, the change from baseline in the treatment group vs. control group analyses, were both significantly in favor of IPL for NIBUT, TBUT, and SPEED but not for OSDI. Conclusions: IPL seems to have a positive effect on tear stability evaluated by the break-up times. However, the effect on DED symptoms is less clear. Some confounding factors such as the age and the IPL device used influence the results indicating that the ideal settings still need to be found and personalized for the patient.
Comparative Thermoelectric Properties of Polypropylene Composites Melt-Processed Using Pyrograf® III Carbon Nanofibers
Authors: Paleo Antonio J. , Krause Beate , Mendes Ana R. , Tavares Carlos J. , Cerqueira Maria F. , Muñoz Enrique , Pötschke Petra
Published: April 2023

The electrical conductivity (σ) and Seebeck coefficient (S) at temperatures from 40 °C to 100 °C of melt-processed polypropylene (PP) composites filled with 5 wt.% of industrial-grade carbon nanofibers (CNFs) is investigated. Transmission Electron Microscopy (TEM) of the two Pyrograf® III CNFs (PR 19 LHT XT and PR 24 LHT XT), used in the fabrication of the PP/CNF composites (PP/CNF 19 and PP/CNF 24), reveals that CNFs PR 24 LHT XT show smaller diameters than CNFs PR 19 LHT XT. In addition, this grade (PR 24 LHT XT) presents higher levels of graphitization as deduced by Raman spectroscopy. Despite these structural differences, both Pyrograf® III grades present similar σ (T) and S (T) dependencies, whereby the S shows negative values (n-type character). However, the σ (T) and S (T) of their derivative PP/CNF19 and PP/CNF24 composites are not analogous. In particular, the PP/CNF24 composite shows higher σ at the same content of CNFs. Thus, with an additionally slightly more negative S value, the PP/CNF24 composites present a higher power factor (PF) and figure of merit (zT) than PP/CNF19 composites at 40 °C. Moreover, while the σ (T) and S (T) of CNFs PR 19 LHT XT clearly drive the σ (T) and S (T) of its corresponding PP/CNF19 composite, the S (T) of CNFs PR 24 LHT XT does not drive the S (T) observed in their corresponding PP/CNF24 composite. Thus, it is inferred in PP/CNF24 composites an unexpected electron donation (n-type doping) from the PP to the CNFs PR 24 LHT XT, which could be activated when PP/CNF24 composites are subjected to that increase in temperature from 40 °C to 100 °C. All these findings are supported by theoretical modeling of σ (T) and S (T) with the ultimate aim of understanding the role of this particular type of commercial CNFs on the thermoelectrical properties of their PP/CNF composites.
Plasma Synthesis and Characterization of PANI + WO3 Nanocomposites and their Supercapacitor Applications
Authors: Sirotkin Nikolay , Khlyustova Anna
Published: April 2023

In this work, an underwater impulse discharge initiated in polyaniline (PANI) aqueous dispersion between tungsten rods is applied to produce metal oxide nanoparticles and create polymer nanocomposites. The prepared materials were analyzed by X-ray diffraction (XRD), ultraviolet-visible spectroscopy (UV-Vis), Fourier transform infrared spectroscopy (FTIR), transmission electron microscopy (TEM), and scanning electron microscopy (SEM). XRD, FTIR, and TEM confirmed the presence of tungsten oxide particles in the final composite, while spectroscopic characterization revealed the interaction between the metal oxide and PANI. The results showed that the incorporation of WO3 into the PANI matrix could improve the optical bandgap of the nanocomposites. In addition, the electrochemical performance of the hybrid nanocomposites was tested by cyclic voltammetry (CV) and galvanostatic charge-discharge (GCD). The results obtained indicated that the PANI + WO3 nanocomposite could be a promising candidate as an electrode material for high-power supercapacitor applications.
Differences between Elite and Professional Male Handball Players in Kinematic Parameters of Single Fake Movement
Authors: Burger Ante , Vrdoljak Dario , Foretić Nikola , Spasić Miodrag , Pavlinović Vladimir
Published: April 2023

Feint movement is an important factor for offensive players to outplay their guard, and score. So far, there is no evidence of feint biomechanical analysis on a sample of elite players in handball or other team sports. Therefore, this study aimed to investigate kinematic parameters of single side fake movement between elite and professional level handball players. The sample of participants consisted of 10 handball players divided into two subsamples: elite handball players (100.00 ± 8.00 kg; 196.00 ± 4.64 cm) and professional handball players (91.20 ± 3.42 kg; 192.4 ± 7.30 cm). The kinematic analysis was conducted using a GAIT—LaBACS software system. Variables consisted of two phases (fake phase and actual phase) of feint single change of direction. Both phases included seven kinematic parameters that were observed. Statistical analysis included descriptive statistic parameters. The differences between elite and professional handball players were analyzed by multivariate and univariate variance analysis. Results showed significant differences between elite and professional players (λ = 0.44, p = 0.00), in fake phase (i.e., 1. Phase). The results also indicate that in there is no statistically significant difference between both groups (λ = 0.64, p = 0.22). Two variables had significant differences between elite and professional players (i.e., step length of the stride leg (p = 0.02) and moving the leg opposite the throwing arm in space (p = 0.00)). To conclude, the article examines specific movement patterns of single side fake movement in elite players and the confirmed importance of efficient skill execution in top level handball. On the contrary, less skilled players use more space for the same technical element.
Eye Gaze Patterns during Reasoning Provide Insights Regarding Individual Differences in Underlying Cognitive Abilities
Authors: Laurence Paulo Guirro , Jana Tatiana Abrão , Bunge Silvia A. , Macedo Elizeu C.
Published: April 2023

Sequences of eye movements during performance of a reasoning task has provided insights into the strategies individuals use to solve that specific task; however, prior studies have not examined whether eye gaze metrics reflect cognitive abilities in a way that transcends a specific task. Thus, our study aimed to explore the relationship between eye movement sequences and other behavioral measures. Here, we present two studies that related different eye gaze metrics in a matrix reasoning task with performance on a different test of fluid reasoning and tests of planning, working memory, and cognitive flexibility. Additionally, we related gaze metrics to self-reported executive functioning in daily life, as measured by BRIEF-A. To perform this, we classified the participants’ eye gaze in each item of the matrices test using an algorithm and then used LASSO regression models with the cognitive abilities as the dependent variable to select eye-tracking metrics to predict it. Overall, specific and distinct eye gaze metrics predicted 57% variance in the fluid reasoning scores; 17% variance in the planning scores; and 18% variance in the working memory scores. Taken together, these results support the hypothesis that the selected eye-tracking metrics reflect cognitive abilities that transcend specific tasks.
Numerical Simulation of Hydrodynamic Performance of Podded Propulsion under Maneuvering Condition
Authors: Chen Weimin , Ma Jiachen , Hu Jian , Zhang Li
Published: April 2023

Podded propulsion offers excellent maneuverability without the need for mechanically complex transmission systems. However, the hydrodynamic performance of podded propulsion under maneuvering conditions has not yet been adequately investigated. This study proposes a Reynolds-averaged Navier–Stokes (RANS)-based method to investigate the hydrodynamic performance of pod thrusters under maneuvering conditions. The accuracy of the numerical method is verified based on a comprehensive convergence analysis and experimental comparison. A comparative analysis of the difference in thrust, moment and their coefficients between maneuvering and steady-state conditions is performed. Additionally, the impact of the advance number on the propeller hydrodynamic performance under maneuvering conditions is examined. The results demonstrate that the thrust coefficient and the torque coefficient of the propeller at positive and negative oblique flow angles exhibit asymmetry owing to the influence of the incoming flow velocity. Furthermore, the thrust and torque under maneuvering conditions increase significantly compared with those under the steady-state condition.
Influence of Topographic and Geological Features on the Seismic Response of the Reef Site in the South China Sea
Authors: Bao Xin , Liu Jingbo , Wang Fei
Published: April 2023

Insufficient comprehension of the seismic impact of the reef terrain, geology, and material properties of the reefs in the South China Sea still presents considerable impediments in studying the seismic response of reef engineering sites and assessing their seismic safety. To surmount this challenge, a seismic response analysis model of the reef-seawater system is established. This model takes into account the fluid-solid interaction effect, the wave radiation effect of the infinite seawater layer and the semi-infinite seabed, as well as the seismic wave input process of the reef-seawater system. Through targeted parameter analyses, the impact of various factors, including the shear wave velocity, thickness, and slope of distinct reef layers, the width of the reef flat, and the dynamic coupling effect of seawater on the seismic response of reef sites, is thoroughly examined. It has been determined that the seismic response of the reef site is markedly amplified as the shear wave velocity decreases and the thickness of the uppermost reef layer increases. While the effects of the slope gradient of the topmost reef layer and the width of the reef flat on the seismic response of the reef site are chiefly observed in the edge area and the central area, respectively. The layer of seawater plays a crucial role in radiation damping, serving as a medium for the dissipation of seismic energy and thereby weakening the overall seismic response of the reef site.
An Approach for Shipping Emissions Estimation in Ports: The Case of Ro–Ro Vessels in Port of Vigo
Authors: Albo-López Ana B. , Carrillo Camilo , Díaz-Dorado Eloy
Published: April 2023

Despite most atmospheric emissions being produced by vessels when navigating at sea, they are also important when in port because of their proximity to urban areas and their harmful effects on climate change and health. First, we carried out a bibliographical review of the nine most relevant methods to estimate the emission of ships in ports. These methods have been used to estimate the emissions of the sixteen most representatives Ro–Ro (roll-on–roll-off) ships calling at the Port of Vigo. From the results obtained, a new simplified method for estimation is proposed, which is based on linear regression curves and takes into account the number of ships and the average number of hours they remain in port annually. This simplification could be a useful tool when making preliminary assessments of the emissions from ships in port, which can also be extrapolated to other ports or types of ships.
Hydrodynamic Shape Design and Self-Propulsion Analysis of a Hybrid-Driven AUG
Authors: Chen Chen-Wei , Zhou Zhao-Ye , Chen Xu-Peng , Zhou Xiao-Jing
Published: April 2023

Due to the lack of a powerful propulsion device in conventional autonomous underwater gliders (AUGs), their mobility and flexibility are insufficient, thus not being capable of also ensuring the stability of the motion route. Thus, it is necessary to further develop hybrid-driven AUGs. This paper applied CFD simulation and experimental analysis methods to study and design a hybrid-driven AUG with a propeller optimized from a type of AUG with swept-forward and swept-back wings. Through parameter adjustment, the hydrodynamic configuration was optimized, and the optimal hull design and hydrofoil type selection were proposed. The lift–drag ratio could be improved by up to 22.5% at an angle of attack of 8 degrees. The optimized AUG was combined with a single propeller for self-propulsion simulation. Aiming at the problem caused by the propeller torque on the AUG, the strategy of a contra-rotating propeller (CRP) was conducted to self-eliminate the propeller torque. The simulation results show that in the self-propulsion state, the torque of the contra-rotating propeller could be reduced by more than 92% compared with that of a single propeller, greatly reducing the impact on the hybrid-driven AUG and raising the navigation stability.
First Description of Non-Enzymatic Radical-Generating Mechanisms Adopted by Fomitiporia mediterranea: An Unexplored Pathway of the White Rot Agent of the Esca Complex of Diseases
Authors: Moretti Samuele , Goddard Mary-Lorène , Puca Alessandro , Lalevée Jacques , Di Marco Stefano , Mugnai Laura , Gelhaye Eric , Goodell Barry , Bertsch Christophe , Farine Sibylle
Published: April 2023

Fomitiporia mediterranea (Fmed) is the primary Basidiomycota species causing white rot in European vineyards affected by the Esca complex of diseases (ECD). In the last few years, an increasing number of studies have highlighted the importance of reconsidering the role of Fmed in ECD etiology, justifying an increase in research interest related to Fmed’s biomolecular pathogenetic mechanisms. In the context of the current re-evaluation of the binary distinction (brown vs. white rot) between biomolecular decay pathways induced by Basidiomycota species, our research aims to investigate the potential for non-enzymatic mechanisms adopted by Fmed, which is typically described as a white rot fungus. Our results demonstrate how, in liquid culture reproducing nutrient restriction conditions often found in wood, Fmed can produce low molecular weight compounds, the hallmark of the non-enzymatic “chelator-mediated Fenton” (CMF) reaction, originally described for brown rot fungi. CMF reactions can redox cycle with ferric iron, generating hydrogen peroxide and ferrous iron, necessary reactants leading to hydroxyl radical (•OH) production. These observations led to the conclusion that a non-enzymatic radical-generating CMF-like mechanism may be utilized by Fmed, potentially together with an enzymatic pool, to contribute to degrading wood constituents; moreover, indicating significant variability between strains.
Immune Response and Transplacental Antibody Transfer in Pregnant Women after COVID-19 Vaccination
Authors: Lubrano Chiara , Mancon Alessandro , Anelli Gaia Maria , Gagliardi Gloria , Corneo Roberta , Bianchi Micol , Coco Chiara , Dal Molin Giulia , Vignali Michele , Schirripa Irene , Di Simone Nicoletta , Pavone Giulia , Pellegrino Antonio , Gismondo Maria Rita , Savasi Valeria Maria , Cetin Irene
Published: April 2023

COVID-19 infection is associated with increased risk of pregnancy complications, making vaccination during pregnancy critical for mother-neonate dyads. Few data, often with an unrepresentative sample size, are available on SARS-CoV-2 vaccine-induced humoral and cell-mediated response. Here, we evaluated anti-S antibody and interferon-gamma (IFN-γ) production elicited by SARS-CoV-2 immunization in maternal and neonatal plasma. Pregnant women (n = 230) were prospectively enrolled and classified as unvaccinated (n = 103) and vaccinated (n = 127); after serological screening for previous infections, assays were performed on 126 dyads, 15 mothers and 17 newborns. Positive anti-S antibodies were found in most of the vaccinated subjects, regardless of timespan between immunization and delivery (range: 7–391 days). A total of 89 of 92 vaccinated women showed a broad response to COVID-19 immunization and highly effective placental transfer, as attested by anti-S positive rates (maternal = 96.7%, cord = 96.6%). Most of our subjects had indeterminate results in an IGRA assay, preventing a conclusive evaluation of IFN-γ production. Indeed, pregnancy-related hormonal changes may influence T-cell response with an impact on IFN-γ production. Positive pregnancy and perinatal outcomes reinforce the evidence that the anti-SARS-CoV-2 immunization is effective and well-tolerated in pregnant women and also protective for the fetus/neonate, even though it was not possible to define the related IFN-γ production and role.
Investigating the Role of Maintenance TMS Protocols for Major Depression: Systematic Review and Future Perspectives for Personalized Interventions
Authors: d’Andrea Giacomo , Mancusi Gianluca , Santovito Maria Chiara , Marrangone Carlotta , Martino Fabrizio , Santorelli Mario , Miuli Andrea , Di Carlo Francesco , Signorelli Maria Salvina , Clerici Massimo , Pettorruso Mauro , Martinotti Giovanni
Published: April 2023

Repetitive Transcranial Magnetic Stimulation (rTMS) has been approved by the FDA as an effective intervention for Treatment-Resistant Depression (TRD). However, there is little evidence about maintenance protocol necessity. The aim of this systematic review is to identify, characterize, and evaluate the current maintenance TMS protocols for MDD and TRD patients who have received acute treatment. A literature search was conducted following the PRISMA guidelines of 2015 on PubMed, Scopus, and Web of Science databases for publications up to March 2022. Fourteen articles were included. High protocol heterogeneity was observed. Most studies highlighted significant efficacy of maintenance protocols in decreasing relapse risk, suggesting that administering two or fewer stimulations per month is ineffective in sustaining an antidepressant effect or in reducing the risk of relapse in responder patients. The risk of relapse was most pronounced after five months from the acute treatment. Maintenance TMS appears to be a resourceful strategy to maintain acute antidepressant treatment effects, significantly reducing relapse risk. The ease of administering and the ability to monitor treatment adherence should be considered when evaluating the future use of maintenance TMS protocols. Further studies are needed to clarify the clinical relevance of overlapping acute TMS effects with maintenance protocols and to evaluate their long-term effectiveness.
Weed Seed Banks in Intensive Farmland and the Influence of Tillage, Field Position, and Sown Flower Strips
Authors: Schnee Liesa , Sutcliffe Laura M. E. , Leuschner Christoph , Donath Tobias W.
Published: April 2023

Agricultural intensification has caused once diverse arable fields to become species-poor. Their seed banks, which are fundamental for re-establishment and maintenance of plant communities in such repeatedly disturbed environments, are now largely depleted. In order to advise farmers on the successful implementation of agri-environmental measures, as well as reduce potential subsequent costs of continued weed control, understanding seed bank dynamics in relation to aboveground vegetation is essential. We (1) investigated the change in seed bank composition in the field edge and the interior, and (2) analyzed the seed bank in flower strips and adjacent fields in relation to the aboveground vegetation on intensively managed arable farms across Germany. Low-tillage systems contained more plant species and higher seed densities in the seed bank than regularly ploughed fields. Species diversity at the field edge was higher than in the field interior, with a continuous decrease in the number of species and seed density within the first 2 m from the edge. Flower strips can lead to an enrichment of the seed bank, but it is driven by the strong rise in a few common species such as Chenopodium album. To cultivate successful flower strips, we recommend close onsite monitoring, as well as rapid intervention in the case of weed infestation.