bluuebunny/crossref_metadata_2025 huggingface dataset:
Functional Food Nutrients, Redox Resilience Signaling and Neurosteroids for Brain Health
Authors: Scuto Maria , Majzúnová Miroslava , Torcitto Gessica , Antonuzzo Silvia , Rampulla Francesco , Di Fatta Eleonora , Trovato Salinaro Angela
Published: November 2024

The interplay between functional food nutrients and neurosteroids has garnered significant attention for its potential to enhance stress resilience in health and/or disease. Several bioactive nutrients, including medicinal herbs, flavonoids, and bioavailable polyphenol-combined nanoparticles, as well as probiotics, vitamin D and omega-3 fatty acids, have been shown to improve blood–brain barrier (BBB) dysfunction, endogenous neurosteroid homeostasis and brain function. These nutrients can inhibit oxidative stress and neuroinflammation, which are linked to the pathogenesis of various neurological disorders. Interestingly, flavonoids exhibit dose-dependent effects, activating the nuclear factor erythroid 2–related factor 2 (Nrf2) pathway at the physiological/low dose (neurohormesis). This leads to the upregulation of antioxidant phase II genes and proteins such as heme oxygenase-1 (HO-1) and sirtuin-1 (Sirt1), which are activated by curcumin and resveratrol, respectively. These adaptive neuronal response mechanisms help protect against reactive oxygen species (ROS) and neurotoxicity. Impaired Nrf2 and neurosteroid hormone signaling in the brain can exacerbate selective vulnerability to neuroinflammatory conditions, contributing to the onset and progression of neurodegenerative and psychiatric disorders, including Alzheimer’s disease, anxiety and depression and other neurological disorders, due to the vulnerability of neurons to stress. This review focuses on functional food nutrients targeting Nrf2 antioxidant pathway and redox resilience genes to regulate the neurosteroid homeostasis and BBB damage associated with altered GABAergic neurotransmission. By exploring the underlying molecular mechanisms using innovative technologies, we aim to develop promising neuroprotective strategies and personalized nutritional and neuroregenerative therapies to prevent or attenuate oxidative stress and neuroinflammation, ultimately promoting brain health.
Novelty Seeking in Parkinson’s Disease: A Candidate Biomarker for Cognitive Changes
Authors: Paulk Kyle , Neilson Lee E.
Published: November 2024

Background: Parkinson’s disease (PD) is a common neurodegenerative disorder characterized by motor impairments, cognitive decline, and affective changes. Beyond the well-described motor symptoms, neuropsychiatric symptoms play a crucial role in PD disability burden. Novelty seeking, a trait extensively studied within various models of personality, may influence the manifestation of these non-motor symptoms. Methods: A narrative review of articles determined relevant by the author(s) was undertaken. Results: The literature indicates that PD patients typically exhibit low novelty seeking initially. However, dopaminergic therapies can increase novelty-seeking behaviors, sometimes leading to impulse control disorders (ICD). Studies using the Temperament and Character Inventory (TCI) suggest a complex interplay between disease state, medication, and baseline personality, which is not fully elucidated. High novelty seeking scores predict a higher risk of ICDs, yet they also correlate with a more benign clinical phenotype and improved quality of life post-DBS surgery. Conclusions: Novelty seeking is a significant trait in PD, influencing non-motor symptoms and treatment responses. Understanding its neurobiological basis and clinical implications could lead to better diagnostic and therapeutic strategies through the use of objective, practical tools for disease monitoring, individualized therapy, and pharmacological development.
From Data to Diagnosis: Machine Learning Revolutionizes Epidemiological Predictions
Authors: Abdul Rahman Abdul Aziz , Rajasekaran Gowri , Ramalingam Rathipriya , Meero Abdelrhman , Seetharaman Dhamodharavadhani
Published: November 2024

The outbreak of epidemiological diseases creates a major impact on humanity as well as on the world’s economy. The consequence of such infectious diseases affects the survival of mankind. The government has to stand up to the negative influence of these epidemiological diseases and facilitate society with medical resources and economical support. In recent times, COVID-19 has been one of the epidemiological diseases that created lethal effects and a greater slump in the economy. Therefore, the prediction of outbreaks is essential for epidemiological diseases. It may be either frequent or sudden infections in society. The unexpected raise in the application of prediction models in recent years is outstanding. A study on these epidemiological prediction models and their usage from the year 2018 onwards is highlighted in this article. The popularity of various prediction approaches is emphasized and summarized in this article.
Modeling Zika Virus Disease Dynamics with Control Strategies
Authors: Helikumi Mlyashimbi , Lolika Paride O. , Makau Kimulu Ancent , Ndambuki Muli Charles , Mhlanga Adquate
Published: November 2024

In this research, we formulated a fractional-order model for the transmission dynamics of Zika virus, incorporating three control strategies: health education campaigns, the use of insecticides, and preventive measures. We conducted a theoretical analysis of the model, obtaining the disease-free equilibrium and the basic reproduction number, and analyzing the existence and uniqueness of the model. Additionally, we performed model parameter estimation using real data on Zika virus cases reported in Colombia. We found that the fractional-order model provided a better fit to the real data compared to the classical integer-order model. A sensitivity analysis of the basic reproduction number was conducted using computed partial rank correlation coefficients to assess the impact of each parameter on Zika virus transmission. Furthermore, we performed numerical simulations to determine the effect of memory on the spread of Zika virus. The simulation results showed that the order of derivatives significantly impacts the dynamics of the disease. We also assessed the effect of the control strategies through simulations, concluding that the proposed interventions have the potential to significantly reduce the spread of Zika virus in the population.
Non-Random Distribution of Boreus hyemalis Among Bryophyte Hosts: Evidence from Field and Laboratory Tests
Authors: Pyszko Petr , Drgová Michaela , Plášek Vítězslav , Drozd Pavel
Published: November 2024

Our understanding of herbivorous insect’s host selection is often based on observed associations with host plants, which can be biased by relative plant abundance, leading to inaccurate assumptions of preference. These biases may be particularly pronounced for insects associated with bryophytes, where dominance patterns are less evident. Estimating selection tendencies is also challenging for rare species with unique ecologies. Boreus hyemalis, a winter-active insect, associates with a range of bryophyte species, yet its specificity in moss-host selection remains unclear. This study investigates whether B. hyemalis shows non-random distribution among bryophyte species in natural habitats and laboratory settings. Field surveys revealed associations with 21 moss species, with significant selection tendencies toward Dicranella heteromalla and Hypnum cupressiforme, with moss species richness being a key factor for boreid inhabitance. Laboratory tests assessed selection among 14 moss species, including H. cupressiforme morphotypes, under controlled conditions. Results indicated Polytrichum formosum was the most frequently selected in the lab. Despite some discrepancies between field and lab findings, B. hyemalis shows specific selection tendencies for particular moss species. These results provide new insights into the ecological interactions between bryophytes and this winter-active insect, emphasizing the importance of moss structure and species richness in shaping B. hyemalis distribution.
Predicting Potential Distribution of Teinopalpus aureus Integrated Multiple Factors and Its Threatened Status Assessment
Authors: Du Congcong , Feng Xueyu , Chen Zhilin , Qiao Gexia
Published: November 2024

The accurate prediction of the niche and the potential distribution of a species is a fundamental and key content for biodiversity related research in ecology and biogeography, especially for protected species. Biotic interactions have a significant impact on species distribution but are often overlooked by SDMs. Therefore, it is crucial to incorporate biotic interaction factors into SDMs to improve their predictive performance. The Teinopalpus aureus Mell, 1923 is endemic to high altitudes in southern East Asia, renowned for its exceptional beauty and rarity. Despite the significant conservation value, its spatial distribution remains unclear. This study integrated climate data, host plants, and empirical expert maps to predict its potential distribution. The results indicated that utilizing the species richness of host plants as a surrogate for biotic interactions was a simple and effective way to significantly improve the predictive performance of the SDMs. The current suitable distribution of T. aureus and its host plants is highly fragmented, primarily concentrated in the Nanling and Wuyi Mountains, and consisting of numerous isolated small populations. Given climate change, their distribution is significantly shrinking, increasing the threatened level in the future. Especially for the population of T. aureus hainani Lee, the likelihood of extinction is extremely high. Abiotic factors not only directly affect the distribution of T. aureus but also indirectly impact it through the host plants. This was evident in the delayed response of T. aureus to climate change compared to its host plants, which is called the “hysteresis effect” caused by biotic interactions. Overall, we tentatively suggest regarding T. aureus as a vulnerable species. In the future, multiple measures could be taken to indirectly protect the feeding and habitat resources of T. aureus by conserving host plants, thereby enhancing its survival prospects.
Exploring the Biology of Quasi-Social Idiobiont Parasitoids in the Genus Sclerodermus (Hymenoptera: Bethylidae)
Authors: Malabusini Serena , Lupi Daniela
Published: November 2024

Species in the genus Sclerodermus are among the most socially complex parasitoids, unlike most parasitoids, which are solitary and do not provide care after laying eggs. In Sclerodermus, groups of females paralyse their host, lay eggs on it, and work together to care for the brood (a quasi-social form of reproduction). This research, through database analysis and meta-analysis, covers the biology of the genus, which has 80 species, though only 24 have been studied in detail. It describes their morphology and behaviour, focusing on offspring production, developmental time, and the factors influencing these, such as kinship and the number of females tending the brood. The materials and methods used provide a comprehensive approach to data collection and analysis, drawing on diverse sources, rigorous classification, and advanced statistical techniques. This approach revealed that Sclerodermus species display a high degree of consistency in their responses to temperature, host size, and foundress number.
Immunomodulation and Protective Effects of Cordyceps militaris Extract Against Candida albicans Infection in Galleria mellonella Larvae
Authors: Eiamthaworn Kiratiya , Holthaus David , Suriyaprom Sureeporn , Rickerts Volker , Tragoolpua Yingmanee
Published: November 2024

Cordyceps militaris-derived formulations are currently used for multiple purposes because of their medical properties, especially immune system modulation. This study analyzes the inhibitory effects of C. militaris aqueous extract on Candida albicans infections and the immune response in larvae of the greater wax moth Galleria mellonella (Lepidoptera: Pyralidae). Larvae exhibited melanization within 1 h of being infected with C. albicans inoculum at a concentration of 106 cells/larvae, and died within 24 h from a lethal dose. Aqueous extract of C. militaris proved to be nontoxic at concentrations of 0.25 and 0.125 mg/larvae, and had the greatest ability to prolong the survival of larvae infected with a sublethal dose of C. albicans at a concentration of 105 cells/larvae. Moreover, the number of hemocytes in the hemolymph of G. mellonella increased after infection with C. albicans and treatment with the aqueous extract of C. militaris at 1, 24, and 48 h by 1.21 × 107, 1.23 × 107, and 1.4 × 107 cells/100 µL, respectively. The highest number of hemocytes was recorded after treatment of infected G. mellonella with the extract for 48 h. Transcriptional upregulation of the immune system was observed in certain antimicrobial peptides (AMPs), showing that the relative expression of galiomicin, gallerimycin, and lysozyme genes were upregulated as early as 1 h after infection. Therefore, we conclude that C. militaris aqueous extract can modulate the immune system of G. mellonella and protect against infection from C. albicans.
A Detailed Inspection of Machine Learning Based Intrusion Detection Systems for Software Defined Networks
Authors: AlSharman Saif AlDeen , Al-Khaleel Osama , Al-Ayyoub Mahmoud
Published: November 2024

The growing use of the Internet of Things (IoT) across a vast number of sectors in our daily life noticeably exposes IoT internet-connected devices, which generate, share, and store sensitive data, to a wide range of cyber threats. Software Defined Networks (SDNs) can play a significant role in enhancing the security of IoT networks against any potential attacks. The goal of the SDN approach to network administration is to enhance network performance and monitoring. This is achieved by allowing more dynamic and programmatically efficient network configuration; hence, simplifying networks through centralized management and control. There are many difficulties for manufacturers to manage the risks associated with evolving technology as the technology itself introduces a variety of vulnerabilities and dangers. Therefore, Intrusion Detection Systems (IDSs) are an essential component for keeping tabs on suspicious behaviors. While IDSs can be implemented with more simplicity due to the centralized view of an SDN, the effectiveness of modern detection methods, which are mainly based on machine learning (ML) or deep learning (DL), is dependent on the quality of the data used in their modeling. Anomaly-based detection systems employed in SDNs have a hard time getting started due to the lack of publicly available data, especially on the data layer. The large majority of existing literature relies on data from conventional networks. This study aims to generate multiple types of Distributed Denial of Service (DDoS) and Denial of Service (DoS) attacks over the data plane (Southbound) portion of an SDN implementation. The cutting-edge virtualization technology is used to simulate a real-world environment of Docker Orchestration as a distributed system. The collected dataset contains examples of both benign and suspicious forms of attacks on the data plane of an SDN infrastructure. We also conduct an experimental evaluation of our collected dataset with well-known machine learning-based techniques and statistical measures to prove their usefulness. Both resources we build in this work (the dataset we create and the baseline models we train on it) can be useful for researchers and practitioners working on improving the security of IoT networks by using SDN technologies.
Exposure to Gas Flaring Among Residents of Oil-Producing Communities in Bayelsa State, Niger Delta Region of Nigeria: A Cross-Sectional Study of Haematological Indices
Authors: Jato Domotimi James , Onyije Felix M. , Mgbere Osaro O. , Avwioro Godwin Ovie
Published: November 2024

Air pollution contributes significantly to morbidity and mortality globally. The Niger Delta Region of Nigeria flares the second largest amount of natural gas in the world, with residents of oil-producing communities bearing the burden of outdoor pollution that may have adverse effects on their health and well-being. Our study aimed to investigate the haematological indices of residents of a selected gas-flaring site. We conducted a cross-sectional study, wherein a total of eighty adults aged 24 to 73 years were recruited from communities located within a radius of approximately 5 to 10 km from the gas-flaring facility. Blood specimens were collected from consenting participants and analysed for various haematological parameters, including Red Blood Cell (RBC) count, Packed Cell Volume (PCV), Haemoglobin (HB), Mean Cell Haemoglobin (MCH), platelet count (PLT), White Blood Cell (WBC) count, neutrophil (NEU), lymphocytes (LYMs), and Monocyte + Basophil + Eosinophil (MXD). The analysis was performed using an automated Sysmex KX21N haematological analyser. Overall, there was a significant decrease in RBC counts (p < 0.001) and a significant elevation in WBCs (p < 0.001) among people residing within a 5 km radius compared to those residing within a 10 km radius. About 42.5% of males residing within a 5 Km radius exhibited low RBC counts in contrast to only 15% of males residing within a 10 km radius. The WBC levels were found to be significantly higher (p < 0.001) than the reference range among both males and females residing within a 5 km radius compared to those residing at a distance of 10 km. In the female population, 15% of individuals residing within a 5 km and 10 Km radius exhibited RBC levels below the reference category, while 7.5% showed RBC levels above the reference range. Exposure to gas flaring may alter haematological indices. It is, therefore, recommended that a comprehensive longitudinal study be conducted among residents of oil-producing communities and workers at gas-flaring facilities in the Niger Delta region of Nigeria to assess the potential environmental and health implications of their exposure to chemical pollutants.
The Development and Validation of a Glaucoma Health Score for Glaucoma Screening Based on Clinical Parameters and Optical Coherence Tomography Metrics
Authors: Chaglasian Michael , Nishida Takashi , Moghimi Sasan , Speilburg Ashley , Durbin Mary K. , Hou Huiyuan , El-Nimri Nevin W. , Lee Christopher K. , Guzman Anya , Arias Juan D. , Bossie Timothy , Yong Yu Xuan , Zangwill Linda M. , Weinreb Robert N.
Published: November 2024

Background/Objectives: This study aims to develop and validate a Glaucoma Health Score (GHS) that incorporates multiple individual glaucoma risk factors to enhance glaucoma detection in screening environments. Methods: The GHS was developed using a retrospective dataset from two clinical sites, including both eyes of glaucoma patients and controls. The model incorporated age, central corneal thickness, intraocular pressure, pattern standard deviation from a visual field threshold 24-2 test, and two parameters from an optical coherence tomography (OCT) test: the average circumpapillary retinal nerve fiber layer thickness and the minimum thickness of the six sectors of the macular ganglion cell plus the inner plexiform layer. The GHS was then validated in two independent datasets: one from primary care sites using Maestro OCT data (test dataset 1) and another from an academic center using DRI OCT Triton (test dataset 2). Results: Both eyes of 51 glaucoma patients and 67 controls were included in the development dataset. Setting the GHS cutoff at 75 points out of 100, test dataset 1, which comprised 41 subjects with glaucoma and 41 healthy controls, achieved an area under the receiver operating characteristic curve (AUROC) of 0.98, with a sensitivity of 71% and specificity of 98%; test dataset 2, which included 53 patients with glaucoma and 53 healthy controls, resulted in an AUROC of 0.95, with a sensitivity of 75% and specificity of 96%. A decision curve analysis across all datasets demonstrated a higher net benefit for the GHS model compared to individual OCT parameters. Conclusions: The GHS offers a feasible, standardized approach for early detection of glaucoma, providing strong specificity and acceptable sensitivity, with clear decision-making benefits in screening settings.
Roxadustat Efficacy and Safety in Patients Receiving Peritoneal Dialysis: Pooled Analysis of Four Phase 3 Studies
Authors: Fliser Danilo , Bhandari Sunil , Ortiz Alberto , Santos Vicki , Khalife Najib , Jiletcovici Alina , Akizawa Tadao
Published: November 2024

Background/Objectives: Roxadustat is an oral hypoxia-inducible factor prolyl hydroxylase inhibitor approved to treat anemia of chronic kidney disease (CKD). The efficacy and safety of roxadustat compared with parenteral erythropoiesis-stimulating agents (ESAs) were evaluated in patients with anemia of CKD receiving peritoneal dialysis (PD). Methods: This analysis pooled data from four phase 3, multicenter, randomized, open-label, active-comparator studies (PYRENEES, SIERRAS, HIMALAYAS, ROCKIES). The primary endpoints evaluated were hemoglobin change from baseline (CFB) to Weeks 28–36 without rescue therapy and hemoglobin CFB to Weeks 28–52 regardless of rescue therapy use. Safety data were reported. Results: This analysis included 422 patients (215 roxadustat, 207 ESA). Hemoglobin CFB to Weeks 28–36 without rescue therapy and hemoglobin CFB to Weeks 28–52 regardless of rescue therapy achieved non-inferiority for roxadustat vs. ESAs. The mean weekly dose of roxadustat was maintained over time (Weeks 1–4, 3.86 mg/kg/week; Weeks 101–104, 3.27 mg/kg/week), whereas the mean weekly ESA dose increased by 24% (Weeks 1–4, 115.70 IU/kg/week; Weeks 101–104, 143.40 IU/kg/week). Fewer patients treated with roxadustat received intravenous iron supplementation and rescue therapy, and patients treated with an ESA required blood transfusions sooner. Roxadustat-treated patients experienced a greater decrease in low-density lipoprotein cholesterol levels relative to baseline vs. ESA-treated patients. Treatment-emergent adverse events were similar in both treatment groups. Major adverse cardiovascular event (MACE), MACE plus unstable angina or congestive heart failure, and all-cause mortality hazard ratios were <1; the lower limit of the 95% CIs was <0.6, and the upper limit was >1.3. Conclusions: Roxadustat was non-inferior to ESAs in correcting and maintaining hemoglobin levels, with stable dosing and a comparable safety profile, in anemic patients receiving PD.
Prevalence and Center Variability of Catheter-Based Hemodialysis in Vienna: Insights from the Vienna ACTS NOW Study
Authors: Plimon Markus , Leinweber Maria-Elisabeth , Hofmann Amun G. , Ksiazek Sara H. , Taher Fadi , Werzowa Johannes , Säemann Marcus , Assadian Afshin
Published: November 2024

Objectives: The choice of vascular access continues to be a critical component in the management of hemodialysis patients. Despite the international consensus favoring arteriovenous (AV) fistulas, the use of central venous catheters (CVCs) remains prevalent, with substantial variations across countries and even among dialysis centers within the same region. This study examines the prevalence of CVC use among chronic hemodialysis (CHD) patients in Vienna, Austria, and explores inter-center differences. Methods: A cross-sectional analysis was conducted on patients receiving CVC-based CHD in Vienna as of March 2023. Patient demographics, comorbidities and their hemodialysis history were collected. Additionally, a subset of the population underwent vascular access (VA) mapping to assess eligibility for AV fistula (AVF) or AV graft (AVG) creation. Results: A total of 335 patients received CVC-based hemodialysis, equaling a CVC proportion of 42.5%. 191 (57.0%) patients on CVC-based CHD gave their consent to record their clinical data and vascular access history. Of the 191 included patients, 61 gave their consent to receive VA mapping. Of the 61 patients who received VA mapping, 60 (98.4%) were eligible for an upper extremity AVF or AVG. There was no significant difference regarding patient demographics, dialysis vintage, history of previous AVF or AVG or Charlson Comorbidity Index between the mapping and non-mapping group. The odds ratio of having a CVC in the absence of in-house vascular surgery was 3.41 (95% CI: 2.31–5.02, p-value < 0.001) compared to patients with in-house vascular surgery. Conclusions: The majority of patients that consented to ultrasound VA mapping fulfilled vascular requirements for AVF or AVG creation. Our study highlights the potential to decrease the prevalence of CVC-based CHD in Vienna that could translate to a reduction in CVC-associated complications.
Methodological Considerations for Studies Evaluating Bleeding Prediction Using Hemostatic Point-of-Care Tests in Cardiac Surgery
Authors: Petricevic Mirna , Goerlinger Klaus , Milojevic Milan , Petricevic Mate
Published: November 2024

A certain proportion of patients undergoing cardiac surgery may experience bleeding complications that worsen outcomes. Numerous studies have investigated bleeding in cardiac surgery and some evaluate the role of hemostatic point-of-care tests in cardiac surgery patients. The prevalence of excessive bleeding varies in the literature, and such variability stems from the lack of a standardized definition of excessive bleeding. Herein, we report numerous definitions of excessive bleeding and methodological considerations for studies evaluating bleeding using hemostatic point-of-care tests in cardiac surgery patients. We evaluated the role of hemostatic point-of-care devices in contemporary research on bleeding complications and hemostatic management in cardiac surgery. The type of studies (prospective vs. retrospective, interventional vs. observational), patient selection (less complex vs. complex cases), as well as data analysis with comprehensive statistical considerations have also been provided. This article provides a comprehensive insight into the research field of bleeding complications in cardiac surgery and may help readers to better understand methodological flaws and how they influence current evidence.
The Many Faces of Immune Thrombocytopenia: Mechanisms, Therapies, and Clinical Challenges in Oncological Patients
Authors: Kos Marek , Tomaka Piotr , Mertowska Paulina , Mertowski Sebastian , Wojnicka Julia , Błażewicz Anna , Grywalska Ewelina , Bojarski Krzysztof
Published: November 2024

The pathogenesis of immune thrombocytopenia (ITP) is complex and involves the dysregulation of immune cells, such as T and B lymphocytes, and several cytokines that promote the production of autoantibodies. In the context of cancer patients, ITP can occur in both primary and secondary forms related to anticancer therapies or the disease itself. Objective: In light of these data, we decided to prepare a literature review that will explain the classification and immunological determinants of the pathogenesis of ITP and present the clinical implications of this condition, especially in patients with cancer. Materials and methods: We reviewed the literature on immunological mechanisms, therapies, and challenges in treating ITP, particularly on cancer patients. Results: The results of the literature review show that ITP in cancer patients can be both primary and secondary, with secondary ITP being more often associated with anticancer therapies such as chemotherapy and immunotherapy. Innovative therapies such as TPO-RA, rituximab, Bruton’s kinase inhibitors, and FcRn receptor inhibitors have shown promising results in treating refractory ITP, especially in patients with chronic disease. Conclusions: ITP is a significant clinical challenge, especially in the context of oncology patients, where both the disease and treatment can worsen thrombocytopenia and increase the risk of bleeding complications. Treatment of oncology patients with ITP requires an individualized approach, and new therapies offer effective tools for managing this condition. Future research into immunological mechanisms may bring further advances in treating ITP and improve outcomes in cancer patients.
Time from Final Oncologist Visit to Death and Palliative Systemic Treatment Use Near the End of Life in Heavily Pretreated Patients with Luminal Breast Cancer
Authors: Püsküllüoğlu Mirosława , Ziobro Marek , Pieniążek Małgorzata , Pacholczak-Madej Renata , Ochenduszko Sebastian , Godek Iwona , Adamkiewicz-Piejko Agata , Grela-Wojewoda Aleksandra
Published: November 2024

Background: Palliative care must be tailored for patients with extended disease trajectories, such as those with hormone receptor-positive, Human Epidermal Growth Factor Receptor 2 (HER2)-negative advanced breast cancer (ABC), including the appropriate timing of discontinuing treatment. This study aimed to assess the interval between the last oncologist visit and death and the application of systemic treatment near the end of life in this patient population. Methods: This retrospective study included patients with luminal ABC who received at least two lines of palliative systemic treatment at the National Research Institute of Oncology in Poland, and died between November 2020 and March 2024. Results: Seventy-six women, with a median age 62.8 years (range: 35.3–91.5), were included. The median number of prior palliative systemic treatment lines was three (range: 2–6). At their last recorded oncologist visit, 75% of the patients were receiving active treatment (53% with hormonal therapy and 22% with chemotherapy). Only 25% were under continuous palliative care at this visit. Treatment was administered within the last month of life to 53% of the patients. The median duration from the last oncologist visit to death was 23 days (range: 0–408). The duration of this time interval was only associated with the performance status at the last visit (p < 0.05). Conclusions: Oncologists frequently delay the recognition of the need to discontinue systemic therapy. Patients with luminal HER2-negative ABC may be offered numerous effective lines of systemic treatment, complicating this decision further. Implementing clearer guidelines for end-of-life care for this group and providing proper training for healthcare providers is essential.
Illuminating Hypomania in Early Adolescence: Associations Between Dark-Side and Bright-Side Hypomania, Insomnia, and Health-Related Quality of Life
Authors: Eisenhut Larina , Sadeghi-Bahmani Dena , Dürsteler Kenneth M. , Mikoteit Thorsten , Fichter Christian , Brühl Annette Beatrix , Stanga Zeno , Brand Serge
Published: November 2024

Background: Adolescence is a period of significant psychological, physical, and social changes. During this time, adolescents face increasing responsibilities, such as making educational and career decisions, managing peer relationships, and becoming more independent from their families. These changes are often accompanied by mood fluctuations and altered sleep patterns. This study aimed to explore the relationships between bright- and dark-side hypomania, insomnia, and various dimensions of health-related quality of life (HRQOL), such as self-esteem, family and peer relationships, social acceptance, and autonomy. Methods: A total of 1475 participants in mid-adolescence (mean age: 13.4 years; range: 11–16 years; 48.8% males) completed a series of self-reported questionnaires covering sociodemographic information, hypomania, including dark and bright-side hypomania, insomnia, and HRQOL. Results: Compared to participants with no or dark-side hypomania, participants with bright-side hypomania reported better HRQOL. Bright-side hypomania was significantly associated with favorable relationships with parents and home, peer relationships, and the school environment and with less insomnia. In contrast, dark-side hypomania showed significant associations with lower scores for self-esteem, moods and emotional states, peer relationships, social acceptance, the school environment, and more insomnia. Conclusions: Among a larger sample of adolescents, bright- and dark-side hypomania were associated with a broad, though specific variety of aspects of HRQOL and insomnia. Given that standardized programs are available to improve insomnia and resilience as a proxy of psychological well-being, such interventions may have the potential to improve adolescents’ psychological well-being and sleep quality concomitantly.
Assessing the Efficacy and Safety of Extubation Protocols in the Intensive Care Unit Following Transoral Robotic Surgery for Obstructive Sleep Apnea Syndrome: A Retrospective Cohort Study
Authors: Recchia Andreaserena , Cascella Marco , Copetti Massimiliano , Barile Alessio , Bignami Elena Giovanna , D’Ecclesia Aurelio , Izzi Antonio , Manuali Aldo , Marchello Vincenzo , Mincolelli Giuseppe , Del Gaudio Alfredo
Published: November 2024

Background: There is a notable lack of protocols addressing extubation techniques in transoral robotic surgery (TORS) for obstructive sleep apnea (OSA). Methods: This retrospective cohort study enrolled patients who underwent TORS for OSA between March 2015 and December 2021 and were managed with different extubation approaches. The patients were divided into two groups: high-flow nasal cannula (HFNC) therapy and conventional oxygen therapy. The use of an airway exchange catheter (AEC) was investigated. Results: The application of HFNC use versus conventional oxygen therapy led only to a statistical reduction in extubation time (p = 0.024); length of stay in the intensive care unit (ICU) and the episodes of desaturation below 95% were reduced, but data are non-statistically significant. Similarly, the application of an AEC led to a reduction in extubation time in hours (p = 0.008) and length of stay in the ICU (p = 0.024). Conclusions: In patients with OSA who underwent TORS, the use of an HFNC, with or without an AEC, resulted in a significant reduction in extubation time without major adverse events. Additionally, HFNC utilization may decrease desaturation episodes during extubation. Despite limitations, based on the findings of this preliminary investigation, the combination of an HFNC and an AEC emerges as a promising strategy for enhancing the safety and efficacy of extubation protocols in this patient population.
Imaging Techniques for Meniscal Vasculature: A Systematic Review of Clinical and Translational Applications
Authors: Orellana Federica , Barna Raluca-Ana-Maria , Calastra Camilla Giulia , Parrilli Annapaola
Published: November 2024

Purpose: The focus of this review is on the imaging techniques used to visualize the meniscal vascular network and arteries in clinical, human ex vivo, and animal model applications. For this purpose, research articles from the past decade that have imaged the vascular network of the meniscus and/or the genicular and popliteal arteries were identified according to established PRISMA statement standards. Methods: Various imaging modalities, including magnetic resonance imaging, micro-computed tomography, and optical and fluorescence microscopy, were included and compared based on the type of visualization, imaging resolution, and range of vessel size detection. These imaging modalities were evaluated based on the outcomes of interest, including diagnostic accuracy in identifying the meniscal vasculature and associated pathologies, clinical applications to guide surgical decisions, and translational applications contributing to the research and development of new therapies and the understanding of meniscal physiology and pathology. Results: The analysis conducted in this study highlights the importance of imaging resolution and visualization type in accurately depicting the complex microvasculature of the meniscus with high precision and detail. Conclusions: This review underscores the necessity for high-resolution 3D imaging techniques to comprehensively understand the meniscal vascular network and enhance surgical approaches and treatment options for meniscal lesions and pathologies.
Artificial Ex Utero Systems to Treat Severe Periviable Fetal Growth Restriction—A Possible Future Indication?
Authors: Okpaise Oluwateniayo O. , Fils Aaron J. , Tonni Gabriele , Ruano Rodrigo
Published: November 2024

Fetal growth restriction, or intrauterine growth restriction, is a common gestational condition characterized by reduced intrauterine growth. However, severe periviable fetal growth restriction is still associated with elevated perinatal mortality and morbidity. The current literature advises delivery once it is deemed that fetal compromise is evident. As uteroplacental insufficiency is the most common etiology of this condition, we hypothesize that the use of artificial ex utero systems to provide adequate nutrition and recreate the uterine environment may be a viable treatment option in this situation, even with the possibility of treating severe fetal growth restriction and prevent sequelae. There are promising experimental studies in sheep models investigating the artificial ex utero system for potential prenatal conditions, but future additional investigation is needed before translating to clinical trials in humans.
The Co-Existence of Hypovitaminosis D and Diabetes Mellitus Triples the Incidence of Severe Coronary Artery Disease in Women
Authors: Aleksova Aneta , Janjusevic Milijana , Pani Beatrice , Hiche Cristina , Chicco Andrea , Derin Agnese , Zandonà Lorenzo , Stenner Elisabetta , Beltrame Daria , Gabrielli Marco , Lovadina Stefano , Corgosinho Flávia Campos , D’Errico Stefano , Marketou Maria , Zwas Donna R. , Sinagra Gianfranco , Fluca Alessandra Lucia
Published: November 2024

Background and Aims: Hypovitaminosis D is involved in the development and progression of atherosclerosis, and it is more prevalent in women. The differential impact of hypovitaminosis D on the severity of coronary artery disease (CAD) between genders remains poorly understood. This study aims to address this literature gap. Methods: A total of 1484 consecutive patients with acute myocardial infarction (AMI) were enrolled in the study. Hypovitaminosis D was defined as vitamin D ≤ 20 ng/mL. CAD was defined as the presence of at least one coronary vessel stenosis > 50%, while severe CAD was defined as left main disease and/or three-vessel disease > 50%. Results: The mean age of the cohort was 66.3 (11.5) years, with a predominance of the male gender (71.8%). Vitamin D values were significantly lower in women than in men (15.7 [8.4–25.4] ng/mL vs. 17.9 [11–24.3] ng/mL, p = 0.01). A higher prevalence of severe CAD was observed in female patients with hypovitaminosis D compared to those without (33% vs. 19%, p < 0.01). This finding was not observed in men. Among women, hypovitaminosis D significantly increased the risk of severe CAD (OR: 1.85, p = 0.01), together with diabetes mellitus (DM) and older age, adjusted for GFR < 60 mL/min/1.73 m2, cholesterol and body mass index. Furthermore, women with both hypovitaminosis D and DM had more than three times the risk of severe CAD compared with women who lacked both (OR: 3.56, p = 0.02). Conclusions: In women, hypovitaminosis D increases the risk of severe CAD, and the co-existence of hypovitaminosis D and DM triples the incidence of severe CAD.
Diagnosis and Treatment of Renal ANCA Vasculitis: A Summary of the Consensus Document of the Catalan Group for the Study of Glomerular Diseases (GLOMCAT)
Authors: Draibe Juliana Bordignon , Marco Helena , Ibernon Meritxell , Agraz Irene , Arcal Carola , Barros Xoana , Cabrera Victoria , Da Silva Iara , Díaz Montserrat , Fulladosa Xavier , Guillén Elena , Lescano Patricia , Valenzuela Laura Martínez , Márquez Eva , Martín Nadia , Merino Ana , Navarro Maru , Rodríguez Eva , Soler Mª José , Torras Joan , Quintana Luís F. ,   on behalf of the Catalan Society of Nephrology
Published: November 2024

The document provides a comprehensive overview of the diagnosis, monitoring, and treatment of anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) with renal involvement, focusing on granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA). It outlines the definitions, clinical presentation, histopathological classification, monitoring strategies, induction and maintenance treatments, as well as special considerations for relapsing, refractory, and frail patients with renal AAV. The document was prepared by the Catalan Group for the Study of Glomerular Diseases (GLOMCAT), which comprises nephrologists with extensive experience in the diagnosis and treatment of AAV patients. Several virtual and face-to-face meetings were held for coordination, section assignments, and content discussion. An exhaustive and systematic search of the literature was carried out, which included, among others, the following databases: PubMed, EMBASE, Cochrane Library, Google Scholar, and ClinicalTrials.gov, as well as the abstract books of national and international congresses. Overall, the document provides a comprehensive guide for clinicians managing patients with renal AAV, offering evidence-based recommendations for diagnosis, monitoring, and treatment across various clinical scenarios.
The Potential Health Risks and Benefits of Progesterone in the Transgender Woman Population—A Narrative Review
Authors: Szymczyk Simone , Mączka Katarzyna , Mądrzak Lidia , Grymowicz Monika , Smolarczyk Roman
Published: November 2024

Introduction: Currently, progesterone is notably absent from conventional feminizing hormone therapies for transgender women. Anecdotal reports indicate the potential for health advantages following the incorporation of progesterone into treatment regimens. The primarily female hormone, progesterone naturally surges in women during the menstrual luteal phase. When administered exogenously, it may expedite bodily changes that are pivotal for gender transition. Progesterone holds promise as a potential remedy for various health conditions prevalent in the transgender woman population. Methods: This narrative review synthesizes existing literature and presents a comprehensive account of the administration of exogenous progesterone in transgender women. A literature search was conducted using the PubMed, Embase, ScienceDirect, and ResearchGate databases. The following keywords were used in the search: progesterone, transgender, breast neoplasms, lactation, prostate, testicular neoplasms, and thrombosis. These terms were combined using Boolean operators. The results of the initial search were screened by three independent reviewers based on their relevance to the topic under study. Results: A total of 104 studies were initially identified as meeting the criteria for inclusion. Following an assessment based on the contents of the title, abstract, and full text, 39 studies were deemed eligible for inclusion. A critical examination of health outcomes was conducted across key sections, including breast development, mental health, lactation, cancer risk (breast and prostate), thrombosis, and nervous and other systems. Discussion: The use of progesterone in the transgender woman population is a topic that has yet to be sufficiently researched. The limited sample size, short follow-up periods, and lack of randomization restrict the potential for achieving a robust scientific evidence base. In order to gain a fuller understanding of this topic, findings from studies on contraception, hormone replacement therapy, and animal models were considered. Conclusions: Progesterone may have a beneficial effect on the bodies of transgender women without significant adverse health effects. Further investigation through well-designed studies is recommended. Randomized controlled trials that include various dosages, broad and long-term effects, and precise demographics are needed. There is an immediate need for more knowledge to create appropriate patent and clinical practice guidelines.
Post-Operative Urinary Tract Infections After Radical Cystectomy: Incidence, Pathogens, and Risk Factors
Authors: Sandberg Maxwell , Vancavage Rachel , Refugia Justin M. , Underwood Gavin , Ye Emily , Marie-Costa Claudia , Rodriguez Rainer , Prokopiou Nicos , Bissette Randall , Davis III Ronald , Hemal Ashok , Rodriguez Alejandro R.
Published: November 2024

Background: The incidence of urinary tract infections (UTIs) after radical cystectomy (RC) with urinary diversion (UD), the typical pathogens, and associated patient risk factors have not been well documented. In this study, we examined the incidence of post-op UTIs after RC to identify associated risk factors. Methods: Single-center, retrospective case series of 386 patients with bladder cancer who underwent RC with UD between 2012 and 2024. The primary objective was UTI incidence, defined by the frequency of patients with urine culture with >105 colony-forming units per high-powered field, spanning from post-op day 0 (POD0) to 90 days after discharge. Isolated pathogens were reported. Risk factors for UTIs were assessed. Results: The average age was 69 years old at surgery, and patients were predominantly male (80%). The cumulative incidence of post-op UTIs was 14%, among which 12 patients had more than one UTI. The UTI incidence was 2%, 8%, and 7% during the immediate post-op period, within 30 days, and within 31–90 days, respectively. Isolated pathogens included Escherichia coli (26%), Enterococcus faecalis (24%), Klebsiella pneumoniae (21%), and Pseudomonas species (21%). In the immediate post-op period, female sex was the only significant risk factor. At 31 to 90 days, cutaneous ureterostomy UD was the predominant risk factor for UTIs. For ileal conduit patients, those with a Wallace ureteral anastomosis were associated with UTI 31–90 days from discharge for RC. Conclusions: Our retrospective data suggests the incidence of UTIs and their causative pathogens after RC differ based on post-operative time points and vary according to different patient risk factors.
Clinical and Radiographic Results in Thoracic Hyperkyphosis Surgical Treatment Considering the Optimal Distal Fusion Area
Authors: Scaramuzzo Laura , Giudici Fabrizio , Velluto Calogero , Barone Giuseppe , Meluzio Maria Concetta , Zagra Antonino , Proietti Luca
Published: November 2024

Introduction: The aim of this retrospective study was to evaluate the clinical and radiographic outcomes of patients who underwent posterior correction and fusion for thoracic hyperkyphosis, with a focus on determining the optimal distal fusion level. Methods: From 2006 to 2012, 26 patients with a median age of 16.8 years (range 14–25), diagnosed with either idiopathic hyperkyphosis or Scheuermann’s kyphosis, underwent posterior fusion and Ponte osteotomies at two medical centers. Radiographic evaluations were performed preoperatively, immediately postoperatively, and at the final follow-up and included assessments of fusion extension, Cobb angle, sagittal balance, and the presence of junctional kyphosis or discopathy. Results: The median follow-up period was 12.3 years (range 11–17). Good clinical outcomes were observed in 24 patients, with no cases of hardware failure. The distal fusion area included the first lordotic vertebra in 17 patients, the sagittal stable vertebra in four patients, and both in five patients. Cobb angle correction was maintained at 50% at the final follow-up (p > 0.05). Significant sagittal balance correction was achieved in 87% of patients immediately postoperatively and was maintained at the final follow-up (p > 0.05). Junctional kyphosis occurred in two patients whose fusion area included only the first lordotic vertebra. Conclusions: Including at least the first lordotic vertebra in the fusion area is crucial for preventing junctional kyphosis. Extending the fusion to the stable vertebra can reduce the incidence of distal junctional kyphosis, especially in symptomatic young adult patients, potentially avoiding the need for revision surgery.