Search Results (23)

Background/Objectives: Hemorrhage remains a leading cause of early mortality in trauma patients, and timely transfusion guided by a structured massive transfusion protocol (MTP) is critical for improving outcomes. Although regional trauma centers have been established, standardized MTPs remain insufficiently developed in many settings. This study aimed to evaluate current MTP practices across five major trauma centers within a national trauma care system. Methods: Participating institutions provided written protocols and completed a structured survey addressing key domains, including activation criteria, transfusion strategies, laboratory monitoring, adjunct therapies, termination processes, and performance improvement measures. Findings were analyzed and compared against established international recommendations. Results: All centers had implemented MTPs and were capable of delivering initial blood products within 15 min. However, considerable variation was observed in activation triggers, transfusion ratios, and laboratory monitoring protocols. None of these centers maintained thawed plasma or whole blood in immediate readiness. Only one of five centers had a formal performance improvement monitoring system. Tranexamic acid was included in all institutional protocols. Conclusions: This review highlights significant variability and critical gaps in MTP implementation across trauma centers. Inconsistent activation criteria, the absence of essential components, and limited quality monitoring may compromise the efficacy of current practices. To improve patient outcomes, a standardized, evidence-based MTP framework should be developed and implemented nationwide. Full article

This research assessed 42 lentil genotypes developed by ICARDA along with a local variety over three growing seasons (2019–2022) in Southeastern Türkiye. Phenological, morphological, and yield attributes were determined to observe earliness, yield stability, and adaptation properties. Genotype G3771 showed outstanding performance in grain yield (2579 kg ha⁻¹), 1000-seed weight (54.9 g), and harvest index (37.3%), although it had lower stability under more severe drought conditions. Early-maturing genotypes like G3744, G3715, and G3716 consistently flowered and matured sooner, making them better suited for escaping terminal drought stress areas. The highest yields were recorded during the 2019–2020 season, which experienced favorable rainfall and soil nutrient levels, while the lowest yields occurred due to changing climatic conditions in the 2020–2021 season, highlighting the crop’s sensitivity to climate. Principal component analysis, hierarchical clustering, the Modified Multi-Trait Stability Index (MTSI), and the Multi-Trait Genotype-Ideotype Distance Index (MGIDI) aided in effective genotype classification. Although G3771 was the most productive, genotypes G3687, G3715, and G3689 proved to be the most stable and early maturing based on MGIDI scores. Strong relationships between grain yield, biological yield, and seed size identified these as key selection criteria. This study underscores the value of multi-trait selection tools like MGIDI and MTSI in consistently pinpointing lentil genotypes that balance earliness, productivity, and adaptability, laying a strong foundation for developing climate-resilient varieties suited to semi-arid climates. Full article

Background and Objectives: As a leading European country in terms of cervical cancer incidence and mortality, there has been a pressing need for Romania to upgrade its cervical cancer management. The criteria set by the International Federation of Gynecology and Obstetrics indicate that different treatments should have a similar trend concerning progression-free survival and overall survival at all the various stages of cervical cancer. This study aimed to assess the cost-effectiveness (CE) of the primary treatment plans related to the survival rate for cervical cancer screening in the western part of Romania and provide some recommendations. Materials and Methods: Descriptive statistics and a correlation model were used to examine costs. AI models have been developed to forecast the CE of different treatments using the above-mentioned studies on overall survival rates and treatment-related toxicity rates for five years. The costs of cervical cancer treatment were sourced from the public health department, the oncology clinic in the western region of Romania, and the County Hospital available for each stage. Results: Treatment expenses vary by cancer stage, with a significant increase from stages IA/IB to IIA, stabilizing between IIA and IIIC (about €7800–€8300), followed by a steep decline in IVA and a more pronounced decrease in IVB and in situ. The results highlight certain treatment combinations and their costs, indicating that the highest costs (exceeding €8000) are linked to multimodal treatments, which encompass surgery, chemotherapy, radiotherapy, and brachytherapy. Conclusions: Advanced cancer stages (IIA–IIIC) entail the highest treatment costs due to intricate, multimodal therapy, whereas early stages (IA, IB, in situ) and late terminal stages (IVB) are linked to considerably reduced treatment costs. Full article

Background: Cardiopulmonary exercise testing (CPET) is a valuable diagnostic and prognostic tool for assessing the integrated function of the cardiopulmonary and muscular systems during exercise. The initiation of a CPET program is complex, and data on early implementation in academic centers remain relatively limited. Objective: to evaluate the initial integration of CPET within a pulmonary department, focusing on patient demographics, referral indications, test performance, and factors associated with anaerobic threshold achievement. Methods: A retrospective cohort study was conducted at a single tertiary care center, including all patients who underwent their first CPET between February 2016 and December 2022. Demographic, clinical, and functional parameters were extracted. Multivariable logistic regression was used to identify variables associated with anaerobic threshold achievement, defined as a respiratory exchange ratio (RER) ≥ 1.1. Results: The cohort included 434 patients (mean age 60.3 ± 14.1 years; 54% male; mean BMI 29.2 ± 5.6 kg/m²). The most common indication for testing was dyspnea (50%). Tests were most frequently terminated due to leg discomfort (39%) and dyspnea (38.8%). Achievement of RER ≥ 1.1 was independently associated with lower BMI (aOR = 0.91; 95% CI: 0.88–0.95; p < 0.001), higher FVC % predicted (aOR = 1.02; 95% CI: 1.00–1.03; p = 0.028), and greater minute ventilation volume (aOR = 1.02; 95% CI: 1.01–1.03; p < 0.001), and it was less likely in patients referred for cardiovascular disease (aOR = 0.37; 95% CI: 0.21–0.64; p < 0.001). No consistent temporal trend in RER achievement was observed across the study period. Conclusions: CPET was most commonly utilized in response to patient-reported dyspnea, with test termination frequently driven by subjective symptoms rather than objective clinical criteria. Anaerobic threshold achievement was more strongly associated with individual physiological characteristics than with institutional experience. These findings underscore the importance of patient preparation and pulmonary functional capacity in optimizing CPET performance. Full article

This paper proposes a modified polar coding-based selected mapping (PC-SLM) scheme to reduce the peak-to-average power ratio (PAPR) in orthogonal frequency-division multiplexing (OFDM) systems. In the proposed transmitter, modulated signal vector for a subset of frozen bits, termed PAPR bits, are precomputed, enabling a single polar encoder and modulator to generate multiple modulation symbols, thereby significantly reducing the hardware complexity compared to existing PC-SLM schemes. To achieve side information (SI)-free transmission, a novel belief propagation (BP)-based receiver is introduced, incorporating a G-matrix-based early termination criterion and a frozen bit check (BP-GF) for joint detection and decoding. Simulation results show that the proposed scheme significantly reduces PAPR across various code lengths, with greater gains as the number of PAPR bits increases. Furthermore, for PC-SLM schemes employing the partially frozen bit method, the BP-GF-based receiver achieves a PAPR reduction and error correction performance comparable to that of the successive cancellation (SC)-based receiver. Additionally, the BP-GF-based receiver exhibits lower decoding latency than the successive cancellation list (SCL)-based receiver. Full article

A protocol for detecting the potential occurrence of spontaneous combustion (SC) in stored cottonseeds and peanuts using a micro-incubator is described. The protocol indicates how to quantify CO₂ production rates and final CO₂ levels in wet versus dry cottonseed and peanut samples, which can provide crucial data for the early detection of SC risk in storage facilities. The experimental design utilizes a micro-incubator to simulate conditions found in large bulk crop storage. Parameters monitored include CO₂ concentration, temperature, and relative humidity. The protocol includes preparation methods, experimental procedures for both control (dry) and wet seed tests, and test termination criteria that allow for safe experimentation of likely pathogenic fungi. The protocol has three replicates for wet and dry conditions. The protocol is intended to facilitate future experimental studies and ultimately contribute to the development of a consistently reliable early warning fire detection system for SC in cottonseed and peanut warehouse facilities. A consistently reliable fire detection system would address a critical need in the cotton and peanut industry for improved fire risk management and insurability of storage facilities. Full article

Background/Objectives: Children and adolescents with psoriasis can have severe and long-lasting disease requiring early and effective therapy. The range of associated comorbidities is comparable to adult patients with additional problems deriving from their growth and maturation. Therefore, tailored information and interdisciplinary teamwork is necessary to effectively manage pediatric psoriasis. Methods: We reflected on our experience with therapy management of children and adolescents with psoriasis coming to our university outpatient clinic and summarized the challenges and special features of these patients together with approved medications and recommendations for treatment. We present our algorithm for managing these patients in an interdisciplinary setting. Results: Children can develop psoriasis very early in their life, and they show specific patterns of skin involvement depending on age. Scores such as the cDLQI and the PASI help to quantify the clinical severity and burden of the disease, and the upgraded criteria should reflect that children’s needs are different from adults’. The choice of medication is limited to a few, but increasing approvals for children and the close exchange of information and preparations with pediatricians and other specialties before initiating systemic therapies are crucial for children to support compliance. We emphasize the focus on vaccinations and the treatment of chronic infections, e.g., the management of TBI, which is different from adults. Conclusions: With the increased options for the systemic treatment of children with psoriasis, clear and adapted information for the child, guardian and pediatrician is essential to assure a well-managed environment and to prevent the unnecessary termination of effective therapy. Full article

Background: Understanding the potential risk factors for failure of pregnancy termination is crucial for informed clinical decision making. Such insights can assist clinicians in adjusting the dosage or route of various regimens, as well as in counseling patients and predicting the likelihood of successful outcomes. However, research on these risk factors has been limited, and existing studies have yielded inconsistent results. To address this gap, we conducted a study with a large sample size, focusing on identifying the potential risk factors for failure of second-trimester termination using misoprostol as a single agent, specifically between 14 and 28 weeks of gestation. Methods: A secondary analysis based on a database of second-trimester terminations was conducted. The inclusion criteria were a singleton pregnancy, gestational age between 14 and 28 weeks, an unfavorable cervix, no spontaneous labor pain, intact membranes, and termination with misoprostol alone. Potential risk factors for failure of termination, defined as no abortion within 48 h, were analyzed using univariate and multivariate analyses. Results: A total of 1094 cases were included in the analysis, consisting of 991 successful cases and 103 (9.4%) cases of failure. The significant risk factors for failure of termination included early gestational age, live fetuses, sublingual regimen of 400 mcg every 6 h, and high maternal pre-pregnancy BMI. Previous cesarean sections and lower Bishop scores tended to increase the risk but did not reach a significant level. Conclusions: Second-trimester termination with misoprostol as a single agent was highly effective, with a failure rate of 9.4%. The risk factors for failure included gestational age, fetal viability, misoprostol regimen, and maternal pre-pregnancy BMI, suggesting that these factors should be taken into consideration for second-trimester terminations with misoprostol. Full article

In several applications of text classification, training document labels are provided by human evaluators, and therefore, gathering sufficient data for model creation is time consuming and costly. The labeling time and effort may be reduced by active learning, in which classification models are created based on relatively small training sets, which are obtained by collecting class labels provided in response to labeling requests or queries. This is an iterative process with a sequence of models being fitted, and each of them is used to select query articles to be added to the training set for the next one. Such a learning scenario may pose different challenges for machine learning algorithms and text representation methods used for text classification than ordinary passive learning, since they have to deal with very small, often imbalanced data, and the computational expense of both model creation and prediction has to remain low. This work examines how classification algorithms and text representation methods that have been found particularly useful by prior work handle these challenges. The random forest and support vector machines algorithms are coupled with the bag of words and FastText word embedding representations and applied to datasets consisting of scientific article abstracts from systematic literature review studies in the biomedical domain. Several strategies are used to select articles for active learning queries, including uncertainty sampling, diversity sampling, and strategies favoring the minority class. Confidence-based and stability-based early stopping criteria are used to generate active learning termination signals. The results confirm that active learning is a useful approach to creating text classification models with limited access to labeled data, making it possible to save at least half of the human effort needed to assign relevant or irrelevant class labels to training articles. Two of the four examined combinations of classification algorithms and text representation methods were the most successful: the SVM algorithm with the FastText representation and the random forest algorithm with the bag of words representation. Uncertainty sampling turned out to be the most useful query selection strategy, and confidence-based stopping was found more universal and easier to configure than stability-based stopping. Full article

The purpose of the study is to elucidate whether irisin is a promising predictive biomarker for kidney-related events in patients with T2DM and concomitant asymptomatic HF. We prospectively enrolled 146 T2DM patients who had either evidence of structural cardiac abnormality or elevated levels of N-terminal brain natriuretic pro-peptide (NT-proBNP) > 125 pmol/mL and followed them for 52 weeks. Structural cardiac abnormalities were used as the minimum from the following criteria: abnormal left ventricular (LV) global longitudinal strain (GLS) < −16%, LV hypertrophy, left atrial volume index > 34 mL/m², abnormal ratio of early transmitral diastolic filling velocity/early mitral annular velocity ≥ 13 units. All the patients underwent echocardiographic and Doppler examinations by two blinded, highly experienced echocardiographers. NT-proBNP, irisin, TNF-alpha, and hs-CRP were quantified in the serum at baseline, at 26 weeks, and at the end of the study. The kidney-related outcomes consisted of an eGFR reduction by 40% from baseline, or end-stage kidney disease, or kidney replacement therapy. We found that levels of irisin at baseline < 4.15 ng/mL and/or its decrease > 20% from baseline in T2DM patients predicted kidney-related events better than baseline levels/dynamic NT-proBNP and the use of SGLT2 inhibitors. In conclusion, we established that a low baseline level of irisin and its 20% decrease correlated with newly kidney-related events in T2DM patients with asymptomatic HFpEF/HFmrEF. Full article

The diagnosis of early acute myocardial infarction is of particular importance in forensic practice considering the frequency of sudden cardiac death and the difficulty of positively identifying it through classical histological methods if survival is less than 6 h. This article aims to analyze potential immunohistochemical markers that could be useful in diagnosing acute myocardial infarction within the first 6 h of its onset. We conducted an extensive evaluation of the literature according to the PRISMA guidelines for reporting systematic literature reviews. We searched the Web of Science and PubMed databases from their inception to 2023 using the following keywords: “myocardial infarction” and “immunohistochemistry”. Fifteen studies met the inclusion criteria. Immunohistochemical markers as complement factors and CD59, myoglobin, fibrinogen, desmin, tumor necrosis factor alpha (TNF-α), P-38, JNK (Jun N Terminal Kinase), transforming growth factor β1 (TGF-β1), cardiac troponins, fibronectin, H-FABP (heart fatty acid binding protein), dityrosine, fibronectin, CD15, IL-1β, IL-6, IL-15, IL-8, MCP-1, ICAM-1, CD18, and tryptase can be used to identify the first six hours of acute myocardial infarction. These markers are mostly studied in experimental animal models. It is necessary to conduct extensive studies on human myocardial tissue fragments, which will involve the analysis of several immunohistochemical markers and careful analysis of the available data on perimortem events, resuscitation, and postmortem intervals in the context of a uniform laboratory methodology. Full article

Background: Functional gastrointestinal disorders are very common condition. The aim of this study is to evaluate the implications of the mode of pregnancy termination and early infant feeding on the incidence of gastrointestinal disorders and atopic dermatitis at birth and 3, 6, and 12 months of age. Methods: This study included 82 pregnant women and their newborns born at term. All newborns were examined at birth and 3, 6, and 12 months of age according to the ROME IV criteria. Results: In children born after cesarean section, the incidence of regurgitation was significantly higher. In children fed mostly or exclusively with formula, dry skin with allergic features was observed more often compared to breastfed children, but this relation was statistically significant only at the age of 12 months. The use of antibiotic therapy increased the risk of allergic skin lesions by almost seven times at 3 months of life. Gastrointestinal disorders in the form of regurgitation, colic, and constipation occur within the period of up to 12 months of the child’s life and may be related to the mode of the termination of pregnancy via cesarean section and the use of artificial feeding or antibiotic therapy. The occurrence of atopic dermatitis in infants at 12 months of life is correlated with the mode of the termination of pregnancy after cesarean section. Conclusions: One of the risk factors for the occurrence of atopic dermatitis and gastrointestinal disorders in the period up to 12 months of the child’s life may be a cesarean section and the use of formula feeding or antibiotic therapy. Full article

Background: The aim of this case series report is to evaluate the characteristics of multisystem inflammatory syndrome (MIS) in neonates following prenatal maternal COVID-19 infection. Methods: We present a case series of three newborns (≤28 days of age) diagnosed with MIS due to the vertical transmission of SARS-CoV2 infection and admitted from 1 January 2021 to 1 June 2023. The inclusion criteria were negative RT-PCR-SARS-CoV-2 test in infants, initial negative IgM-SARS-CoV-2 in infants followed by the emergence of positive IgG-SARS-CoV-2 antibodies in infants and maternal COVID-19 infection in the third trimester of pregnancy. Patients enrolled in this case series were admitted due to acute febrile illnesses. Results: All three cases occurred in patients born at a mean gestational age of 39 weeks and who were appropriate for gestational age. The mean age at admission was 18.3 days. Fibrinogen (>400 mg/dL) and ferritin (>120 mg/dL) were elevated above the upper normal limit. Elevated levels of myocardial biomarkers (D-dimers, N-terminal pro b-type natriuretic peptide troponin T and creatine phosphokinase myocardial band) were recorded, with normal heart function evaluated using echocardiography. All three patients were treated with antibiotics; one received intravenous immunoglobulin. A 4-week follow-up was completed in two patients when their myocardial biomarkers and ferritin were still elevated but lower compared with previous examinations. D-dimers levels were normalized in 2/3 patients. Conclusions: Subclinical myocarditis was diagnosed as an early outcome in infants with MIS diagnosed postnatally due to the vertical transmission of SARS-CoV2 infection and may represent a new challenge for pediatricians in the pandemic era. Full article

Sudden cardiac death is a sudden and highly fatal condition. Implementing high-quality emergency cardiopulmonary resuscitation (CPR) early on is an effective rescue method for this disease. However, the rescue steps of CPR are complicated and difficult to remember, and the quantitative indicators are difficult to control, which leads to a poor quality of CPR emergency actions outside the hospital setting. Therefore, we have developed CPR emergency equipment with a multisensory feedback function, aiming to guide rescuers in performing CPR through visual, auditory, and tactile interaction. This equipment consists of three components: first aid clothing, an audio-visual integrated terminal, and a vital sign detector. These three components are based on a micro-power WiFi-Mesh network, enabling the long-term wireless transmission of the multisensor data. To evaluate the impact of the multisensory feedback CPR emergency equipment on nonprofessionals, we conducted a controlled experiment involving 32 nonmedical subjects. Each subject was assigned to either the experimental group, which used the equipment, or the control group, which did not. The main evaluation criteria were the chest compression (CC) depth, the CC rate, the precise depth of the CC ratio (5–6 cm), and the precise rate of the CC ratio -(100–120 times/min). The results indicated that the average CC depth in the experimental group was 51.5 ± 1.3 mm, which was significantly better than that of the control group (50.2 ± 2.2 mm, p = 0.012). Moreover, the average CC rate in the experimental group (110.1 ± 6.2 times/min) was significantly higher than that of the control group (100.4 ± 6.6 times/min) (p < 0.001). Compared to the control group (66.37%), the experimental group showed a higher proportion of precise CC depth (82.11%), which is closer to the standard CPR rate of 100%. In addition, the CC ratio of the precise rate was 93.75% in the experimental group, which was significantly better than that of 56.52% in the control group (p = 0.024). Following the experiment, the revised System Availability Scale (SUS) was utilized to evaluate the equipment’s usability. The average total SUS score was 78.594, indicating that the equipment’s acceptability range was evaluated as ‘acceptable’, and the overall adjective rating was ‘good’. In conclusion, the multisensory feedback CPR emergency equipment significantly enhances the CC performance (CC depth, CC rate, the precise depth of CC ratio, the precise rate of CC ratio) of nonprofessionals during CPR, and the majority of participants perceive the equipment as being easy to use. Full article

We aimed to investigate the role of [¹⁸F]FDG positron emission tomography/computed tomography (PET/CT) in the early detection of arterial wall inflammation (AWI) in melanoma patients receiving immune checkpoint inhibitors (ICIs). Our retrospective study enrolled 95 melanoma patients who had received ICIs. Inclusion criteria were ICI therapy for at least six months and at least three [¹⁸F]FDG PET/CTs, including one pretreatment session plus two scans three and six months after treatment initiation. AWI was assessed using quantitative and qualitative methods in the subclavian artery, thoracic aorta, and abdominal aorta. We found three patients with AWI visual suspicion in the baseline scan, which increased to five in the second and twelve in the third session. Most of these patients’ treatments were terminated due to either immune-related adverse events (irAEs) or disease progression. In the overall population, the ratio of arterial-wall maximum standardized uptake value (SUVmax)/liver-SUVmax was significantly higher three months after treatment than the pretreatment scan in the thoracic aorta (0.83 ± 0.12 vs. 0.79 ± 0.10; p-value = 0.01) and subclavian artery (0.67 ± 0.13 vs. 0.63 ± 0.12; p-value = 0.01), and it remained steady in the six-month follow-up. None of our patients were diagnosed with definite clinical vasculitis on the dermatology follow-up reports. To conclude, our study showed [¹⁸F]FDG PET/CT’s potential to visualise immunotherapy-induced subclinical inflammation in large vessels. This may lead to more accurate prediction of irAEs and better patient management. Full article