Search Results (12,745)

Background/Objectives: Appendiceal neuroendocrine neoplasms (ANENs) are usually found incidentally during histology examination after appendectomy for appendicitis. Due to their rarity in pediatric populations, there is no consensus on treatment or follow-up. The analysis of patients with ANENs of our and other studies will increase the understanding of this tumor. Methods: Pediatric patients with ANENs were uniformly managed at our center between 1998 and 2023. Patients’ presenting symptoms, surgery, tumor histology, post-surgical work-up, follow-up and outcome were analyzed. Results: Our report describes 17 patients with a diagnosis of ANEN after appendectomy. The median age was 14 years (range of 4–17 years). Tumors were located at the tip of the appendix in 58.8% of cases and only one had a diameter >1 cm. All were well-differentiated tumors with free resection margins. The submucosa was invaded in five cases, muscularis propria in eight and subserosa in four. Post-appendectomy work-up included tumor marker measurement, abdominal ultrasound and computed tomography or magnetic resonance imaging, chest X-ray and octreotide scintigraphy. No residual tumors or metastases were detected. Additional surgery was not necessary. Follow-up was carried out for a median duration of 6 years (range of 1–10 years). Only one patient was lost to follow-up and all other patients are alive without tumor recurrence. Conclusions: The tumor characteristics of our patients confirmed data from the literature. With the lack of a sufficient number of large prospective trials, it is important to add more information to confirm the benign nature and excellent outcome of this tumor, even without additional surgery. Consensus guidelines are needed for ANENs in pediatric populations. Full article

Background: Multimorbidity, polypharmacy, and inappropriate prescribing are significant challenges in the geriatric population. Tools such as the Beers List, FORTA, and STOPP/START criteria have been developed to identify potentially inappropriate prescribing (PIP). STOPP/START criteria detect both potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs). The latest, third version of STOPP/START criteria expands the tool, based on the growing literature. The study aimed to evaluate the prevalence of PIP and the number of PIP per person identified by STOPP/START version 3 and to compare it to the previous version. Methods: This retrospective, cross-sectional study enrolled one hundred geriatric patients with polypharmacy from two day-care centers for partially dependent people in Poland. Collected data included demographic and medical data. STOPP/START version 3 was used to identify potentially inappropriate prescribing, whereas the previous version served as a reference. Results: STOPP version 3 detected at least one PIM in 73% of the study group, a significantly higher result than that for version 2 (56%). STOPP version 3 identified more PIMs per person than the previous version. Similarly, START version 3 had a significantly higher prevalence of PPOs (74% vs. 57%) and a higher number of PPOs per person than the previous version. The newly formed STOPP criteria with high prevalence were those regarding NSAIDs, including aspirin in cardiovascular indications. Frequent PPOs regarding newly formed START criteria were the lack of osmotic laxatives for chronic constipation, the lack of mineralocorticoid receptor antagonists, and SGLT-2 inhibitors in heart failure. Conclusions: This study showed the high effectiveness of the STOPP/START version 3 criteria in identifying potentially inappropriate prescribing, with a higher detection rate than version 2. Full article

Background and Objectives: Understanding the underlying causes of implantable cardioverter-defibrillator (ICD) discharges is vital for effective management. This study aimed to evaluate the characteristics of patients admitted following ICD discharge, focusing on myocardial ischemia as a potential exacerbating factor and potential risk factors for VT recurrence. Materials and Methods: This retrospective, single-center study included 81 patients with high energy discharge from cardiac implantable electronic device admitted urgently to the cardiology department from 2015 to 2022. The exclusion criterion was ST-segment elevation acute coronary syndrome. Data were collected anonymously from electronic medical records. Patients were categorized based on coronary angiography, percutaneous angioplasty, presence of significant stenosis, recurrent ventricular tachycardia (VT), and catheter ablation. Clinical variables, including demographic data, echocardiographic parameters, and pharmacotherapy, were analyzed. The primary endpoint was the recurrence of VT during in-hospital stay. Results: Among 81 patients, predominantly male (86.4%), with a mean age of 63.6 years, 55 (67.9%) had coronary artery disease (CAD) as the primary etiology for ICD implantation. Coronary angiography was performed in 34 patients (42.0%) and showed significant stenosis (>50%) in 18 (41.8%) patients, while 8 (26.0%) individuals underwent percutaneous coronary intervention (PCI). Recurrent VT occurred in 21 subjects (26.3%), while ventricular catheter ablation was performed in 36 patients (44.0%). Referral for urgent coronary angiography was associated with presence of diabetes (p = 0.028) and hyperlipidemia (p = 0.022). Logistic regression analysis confirmed NYHA symptomatic class (OR 4.63, p = 0.04) and LVH (OR 10.59, p = 0.049) were independently associated with relapse of VT. CAD patients underwent catheter ablation more frequently (p = 0.001) than those with dilated cardiomyopathy. Conclusions: The study showed a low referral rate for coronary angiography among patients with ICD discharge. Presence of LVH and preexisting symptomatic class influence arrhythmia recurrence. Understanding these associations can guide personalized management strategies for ICD recipients. Full article

Chemokines are integral components of the immune system and deeply involved in the pathogenesis and progression of inflammatory bowel disease (IBD) and colorectal cancer (CRC). Although a considerable amount of transcriptome data has been accumulated on these diseases, most of them are limited to a specific stage of the disease. The purpose of this study is to visually demonstrate the dynamic changes in chemokines across various stages of bowel diseases by integrating relevant datasets. Integrating the existing datasets for IBD and CRC, we compare the expression changes of chemokines across different pathological stages. This study collected 11 clinical databases from various medical centers around the world. Patients: Data of patient tissue types were classified into IBD, colorectal adenoma, primary carcinoma, metastasis, and healthy control according to the publisher’s annotation. The expression changes in chemokines in various pathological stages are statistically analyzed. The chemokines were clustered by different expression patterns. The chemokine family was clustered into four distinct expression patterns, which correspond to varying expression changes in different stages of colitis and tumor development. Certain chemokines and receptors associated with inflammation and tumorigenesis have been identified. Furthermore, it was confirmed that the 2,4,6-trinitrobenzenesulfonic acid (TNBS)-induced colitis model and the azoxymethane (AOM)/ dextran sulfate sodium (DSS)-induced colon cancer model shows stronger correlations with the clinical data in terms of chemokine expression levels. This study paints a panoramic picture of the expression profiles of chemokine families at multiple stages from IBD to advanced colon cancer, facilitating a comprehensive understanding of the regulation patterns of chemokines and guiding the direction of drug development. This study provides researchers with a clear atlas of chemokine expression in the pathological processes of inflammatory bowel disease and colon cancer. Full article

Background: Ischemic stroke is a leading cause of mortality worldwide, and intravenous thrombolysis, while improving functional outcomes, still leaves a significant mortality rate. This study aimed to investigate the clinical and pathological data of thrombolysed stroke patients who subsequently died and underwent autopsy, focusing on hemorrhagic transformation (HT). Methods: Over a 10-year period, 1426 acute ischemic stroke patients received thrombolysis at our center, with an in-hospital mortality rate of 11.7%. Autopsies were performed on 98 of the 167 deceased patients. Results: HT was found in 47% of these cases, only less than half occurring within a day of thrombolysis. Significant independent predictors of HT included higher lactate dehydrogenase (LD) levels and higher INR values at admission. HT directly caused death in 30% of cases, often through herniation, while other complications (pulmonary embolism, pneumonia) were also common. Conclusions: These findings highlight the importance of postmortem investigations to accurately determine the incidence of HT and contributing factors. Our data indicate that in the vast majority of HT cases, the role of contributing factors other than rt-PA may be important. Of the routinely assessed clinical and laboratory parameters at admission, only LD and INR were found to be independent predictors of HT in the autopsied studied cohort. Full article

This research employs the maximum entropy (MaxEnt) model alongside game theory, integrated with an extensive framework of natural disaster risk management theory, to conduct a thorough analysis of the indicator factors related to urban flooding. This study conducts an assessment of the risks associated with urban flooding disasters using Changchun city as a case study. The validation outcomes pertaining to urban flooding hotspots reveal that 88.66% of the identified flooding sites are situated within areas classified as high-risk and very high-risk. This finding is considered to be more reliable and justifiable when contrasted with the 77.73% assessment results derived from the MaxEnt model. Utilizing the methodology of exploratory spatial data analysis (ESDA), this study applies both global and local spatial autocorrelation to investigate the disparities in the spatial patterns of flood risk within Changchun. This study concludes that urban flooding occurs primarily in the city center of Changchun and shows a significant agglomeration effect. The region is economically developed, with a high concentration of buildings and a high percentage of impervious surfaces. The Receiver Operating Characteristic (ROC) curve demonstrates that the MaxEnt model achieves an accuracy of 90.3%. On this basis, the contribution of each indicator is analyzed and ranked using the MaxEnt model. The primary determinants affecting urban flooding in Changchun are identified as impervious surfaces, population density, drainage density, maximum daily precipitation, and the Normalized Difference Vegetation Index (NDVI), with respective contributions of 20.6%, 18.1%, 13.1%, 9.6%, and 8.5%. This research offers a scientific basis for solving the urban flooding problem in Changchun city, as well as a theoretical reference for early warnings for urban disaster, and is conducive to the realization of sustainable urban development. Full article

Despite the potential benefits of generative artificial intelligence (genAI), concerns about its psychological impact on medical students, especially about job displacement, are apparent. This pilot study, conducted in Jordan during July–August 2024, aimed to examine the specific fears, anxieties, mistrust, and ethical concerns medical students harbor towards genAI. Using a cross-sectional survey design, data were collected from 164 medical students studying in Jordan across various academic years, employing a structured self-administered questionnaire with an internally consistent FAME scale—representing Fear, Anxiety, Mistrust, and Ethics—comprising 12 items, with 3 items for each construct. Exploratory and confirmatory factors analyses were conducted to assess the construct validity of the FAME scale. The results indicated variable levels of anxiety towards genAI among the participating medical students: 34.1% reported no anxiety about genAI‘s role in their future careers (n = 56), while 41.5% were slightly anxious (n = 61), 22.0% were somewhat anxious (n = 36), and 2.4% were extremely anxious (n = 4). Among the FAME constructs, Mistrust was the most agreed upon (mean: 12.35 ± 2.78), followed by the Ethics construct (mean: 10.86 ± 2.90), Fear (mean: 9.49 ± 3.53), and Anxiety (mean: 8.91 ± 3.68). Their sex, academic level, and Grade Point Average (GPA) did not significantly affect the students’ perceptions of genAI. However, there was a notable direct association between the students’ general anxiety about genAI and elevated scores on the Fear, Anxiety, and Ethics constructs of the FAME scale. Prior exposure to genAI and its previous use did not significantly modify the scores on the FAME scale. These findings highlight the critical need for refined educational strategies to address the integration of genAI into medical training. The results demonstrate notable anxiety, fear, mistrust, and ethical concerns among medical students regarding the deployment of genAI in healthcare, indicating the necessity of curriculum modifications that focus specifically on these areas. Interventions should be tailored to increase familiarity and competency with genAI, which would alleviate apprehensions and equip future physicians to engage with this inevitable technology effectively. This study also highlights the importance of incorporating ethical discussions into medical courses to address mistrust and concerns about the human-centered aspects of genAI. In conclusion, this study calls for the proactive evolution of medical education to prepare students for new AI-driven healthcare practices to ensure that physicians are well prepared, confident, and ethically informed in their professional interactions with genAI technologies. Full article

Background: Recent data from European studies (EUROASPIRE V, DA VINCI, SANTORINI) indicate that achieving the LDL cholesterol (LDL-C) target in patients at very high cardiovascular risk is uncommon. Additionally, using a combination therapy involving statins and ezetimibe remains infrequent. Methods: A single-center assessment of a pre-defined lipid lowering treatment algorithm’s effectiveness at achieving the LDL-C target in patients at very high cardiovascular risk one month and one year after hospitalization. Results: 81 patients were included, all in secondary prevention. The average age of the patient was 66.9 years, and the main cardiovascular risk factors included hypertension, diabetes mellitus, and smoking history. Following the predefined lipid-lowering algorithm specific to our study, which involves initiating high-intensity statin therapy or a combination of statin and ezetimibe depending on initial LDL-C levels and patient history; 30 (37%) patients initiated high-intensity statin therapy (Atorvastatin (40 mg, 80 mg) or Rosuvastatin (20 mg, 40 mg)), while 51 (63%) started combination therapy with high-intensity statin and ezetimibe 10 mg. After one year, 57 (70.4%) remained adherent to their initial treatment, achieving a mean LDL-C of 49.5 ± 16.9 mg/dL, with 36 (63.2%) of them reaching the LDL-C target of <55 mg/dL. A total of 13 patients discontinued treatment, and 9 were lost to follow-up, withdrew from the study, or died. Conclusion: Initiating dual statin and ezetimibe therapy or high-intensity statin therapy early, based on the expected treatment efficacy, holds the potential to more rapidly and effectively achieve LDL-C targets in a larger proportion of very high-risk cardiovascular patients. Full article

Background/Objectives: The aim of this study was to examine sex-related differences in the outcomes of polytraumatized patients admitted to a level I trauma center. Methods: This was a retrospective data analysis of 980 consecutive polytraumatized patients admitted to a single level I trauma center between January 1995 and December 2020. Results: Among all patients, about 30% were female, with a significantly higher age and significantly higher rates of suicidal attempts. No sex-related differences regarding injury severity or trauma mechanisms could be seen, but female patients had significantly higher overall in-hospital mortality rates compared to male patients. Even in the elderly group of patients, elderly female patients were significantly older compared to elderly male patients, with significantly increased lengths of hospital stay. In the elderly group of patients, no sex-related differences regarding injury severity, trauma mechanisms or mortality could be detected. Multivariate analysis revealed suicidal attempt, severe head injury and age > 54 years as independent prognostic factors in the survival of polytraumatized patients. Conclusions: Distinctive sex-related differences can be found, with female polytraumatized patients being significantly older and having higher overall mortality rates with significantly increased LOS. Our study suggests a strong sex-independent influence of age, suicidal attempt and severe head injury on the outcomes of polytraumatized patients. Full article

Background: In response to the COVID-19 pandemic, the European Association of Urology (EAU) Guidelines defined priority groups to guide the prioritization of surgery for urological malignancies. The objective of this study was to evaluate the impact of the COVID-19 prioritization recommendations on tumor pathological characteristics in a real-world setting at our academic referral institution. Methods: We compared baseline and pathological tumor features of all patients with urological malignancies treated during the pandemic period (2020–2021) versus in the post-pandemic period (2022–2023). Our institution adhered to the international recommendations and prioritized those cases defined as “high-risk”. Results: Data from 9196 patients treated for urological malignancies were reviewed and grouped according to period of surgery (4401 in the pandemic period vs. 4785 in the post-pandemic period). The overall number of surgical procedures was comparable for all diseases except for the number of radical prostatectomies (1117 vs. 1405; p = 0.03) and partial nephrectomies (609 vs. 759; p = 0.02), which were significantly lower in the pandemic period. Regarding tumor pathological features, none of the recorded variables were found to differ according to period of surgery, including disease stage, tumor grading, presence of necrosis, lymphovascular invasion, and histological variants. Conclusions: A correct policy of prioritization of oncological pathologies during emergency periods and a centralization of oncological cases in reference centers reduce the possible risk of worsening cancer disease features related to the reorganization of healthcare resources. Full article

This study has systematically investigated and compared the geographical distribution patterns and population density of G. menyuanensis (Gm) and G. qinghaiensis (Gq), which are endemic to the QTP region and inflict severe damage. Using a method combining the BIOMOD2 integration model (incorporating nine ecological niche models) and current species distribution data, this study has compared changes in potential habitats and distribution centers of these two species during ancient, present, and future climate periods and conducted a correlation test on the prediction results with land use types. The study results indicate that there are differences in geographical distribution patterns, distribution elevations, and population density of these two species. Compared with single models, the integration model exhibits prominent accuracy and stability with higher KAPPA, TSS, and AUC values. The distribution of suitable habitats for these two species is significantly affected by climatic temperature and precipitation. There is a significant difference between the potential habitats of these two species. Gm and Gq are distributed in the northeastern boundary area and the central and eastern areas of the QTP, respectively. The areas of their suitable habitats are significantly and positively correlated with the area of grassland among all land use types of QTP, with no correlations with the areas of other land use types of QTP. The potential habitats of both species during the paleoclimate period were located in the eastern and southeastern boundary areas of the QTP. During the paleoclimate period, their potential habitats expanded towards the Hengduan Mountains (low-latitude regions) in the south compared with their current suitable habitats. With the subsequent temperature rising, their distribution centers shifted towards the northeast (high-latitude) regions, which could validate the hypothesis that the Hengduan Mountains were refuges for these species during the glacial period. In the future, there will be more potential suitable habitats for these two species in the QTP. This study elucidates the ecological factors affecting the current distribution of these grass caterpillars, provides an important reference for designating the prevention and control areas for Gm and Gq, and helps protect the alpine meadow ecosystem in the region. Full article

Catch crops are intermediate crops sown between two main crop cycles. Their adoption into the cropping system has increased considerably in the last years due to its numerous benefits, in particular its potential in carbon fixation and preventing nitrogen leaching during winter. The growth period of catch crops in Germany is often marked by dense cloud cover, which limits land surface monitoring through optical remote sensing. In such conditions, synthetic aperture radar (SAR) emerges as a viable option. Despite the known advantages of SAR, the understanding of temporal behavior of radar parameters in relation to catch crops remains largely unexplored. Hence, in this study, we exploited the dense time series of Sentinel-1 data within the Copernicus Space Component to study the temporal characteristics of catch crops over a test site in the center of Germany. Radar parameters such as VV, VH, VH/VV backscatter, dpRVI (dual-pol Radar Vegetation Index) and VV coherence were extracted, and temporal profiles were interpreted for catch crops and preceding main crops along with in situ, temperature, and precipitation data. Additionally, we examined the temporal profiles of winter main crops (winter oilseed rape and winter cereals), that are grown parallel to the catch crop growing cycle. Based on the analyzed temporal patterns, we defined 22 descriptive features from VV, VH, VH/VV and dpRVI, which are specific to catch crop identification. Then, we conducted a Kruskal–Wallis test on the extracted parameters, both crop-wise and group-wise, to assess the significance of statistical differences among different catch crop groups. Our results reveal that there exists a unique temporal pattern for catch crops compared to main crops, and each of these extracted parameters possess a different sensitivity to catch crops. Parameters VV and VH are sensitive to phenological stages and crop structure. On the other hand, VH/VV and dpRVI were found to be highly sensitive to crop biomass. Coherence can be used to detect the sowing and harvest events. The preceding main crop analysis reveals that winter wheat and winter barley are the two dominant main crops grown before catch crops. Moreover, winter main crops (winter oilseed rape, winter cereals) cultivated during the catch crop cycle can be distinguished by exploiting the observed sowing window differences. The extracted descriptive features provide information about sowing, harvest, vigor, biomass, and early/late die-off nature specific to catch crop types. In the Kruskal–Wallis test, the observed high H-statistic and low p-value in several predictors indicates significant variability at 0.001 level. Furthermore, Dunn’s post hoc test among catch crop group pairs highlights the substantial differences between cold-sensitive and legume groups (p < 0.001). Full article

Background: Balloon aortic valvuloplasty (BAV) is currently used as pre-treatment for patients undergoing trans-catheter aortic valve replacement (TAVR) as well as a stand-alone option for subjects with significant contraindications to TAVR. Mammoth is a newly available non-compliant balloon catheter (BC) included in the balloon-expandable Myval THV system (Meril Life Sciences Pvt. Ltd., India). As limited data on the performance of this BC are available, we here report the results following its use for BAV as pre-dilatation during TAVR or as a stand-alone procedure. Methods: A retrospective, single-center cohort analysis was performed on patients with severe aortic valve stenosis (AS) treated with the Mammoth BC at IRCCS Ospedale Galeazzi Sant’Ambrogio, Milan, Italy. The primary endpoint was technical success defined as successful Mammoth BC advancement across the AS followed by its full and homogeneous inflation without major complications such as aortic root/left ventricular outflow tract injury and/or stroke. Results: A total of 121 patients were treated by BAV with Mammoth BC during the study period. Among these, 105 patients underwent BAV pre-dilatation before TAVR while 16 patients underwent a stand-alone BAV procedure. Mammoth BC was delivered and successfully inflated at the target site in all of the 121 cases without BC-related complications (100% technical success). However, in the BAV “stand-alone group”, three patients required two different balloon sizes while in nine patients multiple rounds (two to three) of balloon inflation were needed to significantly lower the transvalvular gradient. No cases of aortic root injury or massive aortic regurgitation due to Mammoth BC-related aortic leaflet injury were reported while one major stroke occurred late after TAVR. No intra-procedural deaths occurred nor bleeding (BARC 3-4) or major vascular complication. Conclusions: Mammoth BC use in patients with severe AS proved safe and effective, either before TAVR or as a stand-alone procedure, expanding the range of available tools for structural operators. Full article

Accurate monitoring of lithium-ion battery temperature is essential to ensure these batteries’ efficient and safe operation. This paper proposes a relevance-based reconstruction-oriented EMD-Informer machine learning model, which combines empirical mode decomposition (EMD) and the Informer framework to estimate the surface temperature of 18,650 lithium-ion batteries during charging and discharging processes under complex operating conditions. Initially, based on 9000 data points from the U.S. NASA Prognostics Center of Excellence’s random battery-usage dataset, where each data point includes three features: temperature, voltage, and current, EMD is used to decompose the temperature data into intrinsic mode functions (IMFs). Subsequently, the IMFs are reconstructed into low-, medium-, and high-correlation components based on their correlation with the original data. These components, along with voltage and current data, are fed into sub-models. Finally, the model captures the long-term dependencies among temperature, voltage, and current. The experimental results show that, in single-step prediction, the mean squared error, mean absolute error, and maximum absolute error of the model’s predictions are 0.00095, 0.02114, and 0.32164 °C; these metrics indicate the accurate prediction of the surface temperature of lithium-ion batteries. In multi-step predictions, when the prediction horizon is set to 12 steps, the model achieves a hit rate of 93.57% where the maximum absolute error is within 0.5 °C; under these conditions, the model combines high predictive accuracy with a broad predictive range, which is conducive to the effective prevention of thermal runaway in lithium-ion batteries. Full article

The WuShen counties in the hinterland of the Maowusu Sandland are located in the “ecological stress zone” of the forest–steppe desert, with low vegetation cover, a strong ecosystem sensitivity, and poor stability under the influence of human activities. Therefore, it is important to study and analyze the changes in vegetation growth in this region for the purpose of objectively evaluating the effectiveness of desertification control in China’s agricultural and pastoral intertwined zones, and formulating corresponding measures in a timely manner. In this paper, the spatial and temporal variations in the vegetation NDVI in the WuShen counties of the Maowusu Sandland and their response relationships with driving factors were investigated by using a trend test, center of gravity transfer model, partial correlation calculation, and residual analysis, and by using the MOD13A3 vegetation NDVI time series data from 2000 to 2020, as well as the precipitation, temperature, and potential evapotranspiration data from the same period. The results showed the following: ① The regional vegetation NDVI did not fluctuate significantly with latitude and longitude, and the NDVI varied between 0.227 and 0.375 over the 21-year period, with a mean increase of 0.13 for the region as a whole and an increase of 0.61 for the region of greatest change. Of the area, 86.83% experienced a highly significant increase, and the trend in increase around rivers and towns was higher than that in the northwestern inland flow area, with the overall performance of “low in the west and high in the east”. ② Only 2.07% of the vegetation NDVI center of gravity did not shift, and the response with climate factors was mainly characterized by having consistent or opposite center of gravity changes with precipitation and potential evapotranspiration. ③ Human activities have been the dominant factor in the vegetation NDVI change, with 75.89 percent of the area positively impacted by human activities, and human activities in the southwest inhibiting the improvement of vegetation in the area. The impact of human activities on the unchanged land type area is increasing, most obviously in the farmland area, and the impact of human activities on the changed land type area is gradually decreasing in the area where the farmland becomes impervious. The vegetation in the area above 1300 m above sea level is degraded by the environment and human activities. The research results can provide scientific support for the implementation of ecological fine management and the formulation of corresponding ecological restoration and desertification control measures in the Maowusu Sandland. At the same time, it is expected to serve as a baseline for other studies on the evolution of vegetation in agro-pastoral zones. Full article