Carotid CT angiography (CTA) can precede CTP in the stroke protocol. Temporal information of the bolus tracking series of CTA could allow for better timing and a decreased number of scans in CTP, resulting in less radiation exposure, if the shortening of CTP does not alter the calculated infarct core and penumbra or the resulting perfusion maps, which are essential for further treatment decisions. (2) Methods: 66 consecutive patients with ischemic stroke proven by follow-up imaging or endovascular intervention were included in this retrospective study approved by the local ethics committee. In each case, six simulated, stepwise shortened CTP examinations were compared with the original data regarding the perfusion maps, infarct core, penumbra and endovascular treatment decision. (3) Results: In simulated CTPs with 26, 28 and 30 scans, the infarct core, penumbra and PRR values were equivalent, and the resulting clinical decision was identical to the original CTP. (4) Conclusions: The temporal information of the bolus tracking series of the carotid CTA can allow for better timing and a lower radiation exposure by eliminating unnecessary scans in CTP. Especially in the early phase, reliable and fast diagnosis is crucial to improve the outcome of thrombolysis in the new era of advanced stroke treatment. Although magnetic resonance imaging (MRI) is the most sensitive method to detect the tissue at risk, CT perfusion (CTP) imaging, a fast and widely available imaging modality, is also able to differentiate the infarct core from the penumbra in patients with suspected stroke. The current CTP acquisition, which covers almost the whole brain, operates in cine mode and scans the first pass, peak and wash-out of the intravenous administered contrast agent in brain tissue. CTP maps depicting cerebral blood volume, cerebral blood flow, mean transit time, time to drain and time to maximum can be generated to differentiate the ischemic core from penumbra, and even automated volume calculations are available ,2,3,4,5.For patients who otherwise meet the criteria for endovascular therapy, a noninvasive intracranial vascular study is recommended during the initial imaging evaluation of the acute stroke patient, and it is reasonable to proceed with CTA, if indicated, in patients with suspected intracranial large vessel occlusion, as well as to apply CT perfusion to determinate collateral flow status and to determine the eligibility for mechanical thrombectomy .Carotid CT angiography can precede CTP in the diagnostic CT algorithm in stroke patients, and the order of CT angiography and CTP does not significantly affect the quantitative parameters of CTP . The timIn our study, we used the temporal information of the bolus tracking series of a preceding CT angiography to investigate whether optimal timing of the CTP has the potential to reduce the number of scans applied and whether shortening the CTP affects the automatically calculated infarct core and penumbra. In addition, we investigated whether altering the number of CTP scans in this manner significantly affects the resulting maps as well as influences the resulting clinical decision pathway. These are critical to the decision to choose interventional or conventional lysis therapy.In the current literature, there is no comparable study using the bolus tracking series of the carotid CT angiography to assess the optimal timing for CT perfusion of the brain.Our study was conducted in accordance with the Declaration of Helsinki, approved by the local ethical committee and registered with the following ID: DRKS00023941 in the German Clinical Trials Register. The imaging data of all included patients were retrospectively collected and anonymized.Patients with a suspected diagnosis of ischemic stroke who received CTP from 1 January to 31 December 2020 were searched for in our institutional Picture Archiving and Communicating System. Patients with a perfusion deficit had to meet the following inclusion criteria: age over 18 years, institutional standard imaging protocol including non-enhanced cranial CT, CT angiography of the carotid arteries and CTP, follow-up imaging or subsequent intervention and archived scans of the bolus tracking in the ascending aorta. Patients with perfusion disturbances in the initial CTP imaging but without any evidence of an ischemic event in the follow-up imaging were not included in the study group. A total of 395 patients with suspected ischemic stroke received the institutional standard protocol during this period. A total of 76 patients with available bolus tracking records and perfusion deficits who had infarct demarcation in the follow-up imaging or underwent mechanical intravascular procedures because of cerebral artery occlusion were included in our study. A total of 10 patients were excluded: 2 due to the inconsistency of the perfusion deficit with the infarct lesion in the follow-up imaging, 2 due to an invalid bolus tracking dataset  and 6 due to an invalid CTP dataset (motion artifacts). The total of 66 patients  constituted our study group. Patient recruitment is shown as a flow chart in Imaging was performed on a 192-detector-row dual-source-CT scanner  according to the vendor’s recommendations. The following optimized scan parameters were applied for CTP in each patient: whole brain coverage with a scan length of 294 mm, applying a tube voltage of 70 kV, a fixed tube current of 250 mAs and a rotation time of 0.25 s and acquiring 32 scans with a time interval of 1.5 s between two scans. The contrast agent was administered in the antecubital vein as a bolus of 40 mL, with 300 mg iodine per mL  at a flow rate of 6 mL per second, followed by a saline bolus of 50 mL. The scan phase began 8 s after the start of the contrast agent injection. For the CT angiography of the carotid arteries, the contrast agent was administered as a bolus of 40 mL at a flow of 5 mL per second, and the first bolus tracking scan began 7 s after injection. The tracking scans were performed at the level of the ascending aorta, with a frequency of 1 per second. The scanning period of the CT angiography began as the intraluminal enhancement of the aorta reached the threshold CT attenuation value of 100 HU.After image acquisition, all CTP datasets: 32 scans—each of them operating with 116 slices of 1.5 mm—were reconstructed, anonymized and transferred to a dedicated image processing software. For all datasets, we performed perfusion analysis with the vendor-given Syngo Volume Perfusion CT Neuro software . The infarct core and penumbra were automatically calculated by applying the same software using the vendor-given fixed specification for cerebral blood volume and cerebral blood flow threshold values: cerebral blood volume < 1.2 mL/100 mL and cerebral blood flow < 35.1 mL/100 mL ,13,14. T30), 28 scans (sCTP28), 26 scans (sCTP26), 24 scans (sCTP24), 22 scans (sCTP22) and 20 scans (sCTP20), resulting in six additional sCTP datasets in each patient.In each patient, simulated and gradually shortened CTP datasets were generated using the temporal information of the contrast agent arrival in the ascending aorta. The temporal information was extracted from the corresponding bolus tracking scans. In a preliminary study of 50 patients receiving a valid CTP, enhancement curves and aortic bolus arrival were analyzed to compare the delay of the contrast agent arrival in the ascending aorta and in the intracranial arteries. Considering these results, an exact time interval was identified to define the first scan of the CTP dataset in the simulated CTP (sCTP) examinations of our patient study group. This interval was constant for each patient and was considered in each patient. It was added to the personalized time information we retrieved from the corresponding data of the aortal bolus tracking series in each patient, and it was respected in all simulated datasets to identify the first scan. After the first scan of the sCTPs was selected and tagged, we generated shortened scan series: the 32 scans of the oCTPs were gradually decreased to 30 scans  datasets were reloaded into Syngo.Via, and the infarct core, penumbra and PRR  were automatically calculated for each patient of the study group.PRR values of the simulated datasets (sCTPs) were compared to PRR values of the original imaging data (oCTPs) and analyzed regarding discrepancy.In all perfusion CT examinations including original imaging data and simulated datasets, the clinical decision pathway concerning the differentiation between the “target mismatch profile”  and the “malignant profile” was examined according to previous studies investigating stroke evolution and the effect of intravenous thrombolysis with or without mechanical thrombectomy ,17,18,19The data of radiation exposure were extracted from the clinical dose-monitoring software .The relationship between the delay of the aortal bolus arrival and the chronological data of the wash-in and wash-out phases was analyzed.p-value of 0.05. With the aid of Bonferroni correction, the confidence interval was adjusted because of multiple comparisons, and the significance level was set at 0.003 (0.05/18 = 0.00278).A paired sample t-test was used to investigate the equivalence of the calculated values for the infarct and penumbra and the PRR values between oCTP and the six sCTPs. The level of significance was set at a The linear relationship between the aortal bolus arrival, the arterial inflow peak, the venous inflow peak, the end point of the wash-out phase and the duration of the complete perfusion curve covering both the wash-in and the wash-out phase was investigated by calculating the Pearson product–moment correlation coefficient.The statistical calculations were performed with a statistical software .The mean value and the standard deviation for the infarct core volume and penumbra in the standard CTP protocol were 35.71 ± 34.83 mL (ranged from 6.4 mL to 218.59 mL) and 131.37 ± 59.71 mL (ranged from 45.45 mL to 338.61 mL), respectively. The radiation exposure of the standard protocol operating with 32 scans was 196.13 mGy (computed tomography dose index) and 2908.3 mGycm (dose length product).p-values and radiation exposure, are shown in The results of the volumetric calculations of the shortened simulated CTPs, including In the comparative analysis of the PRR values of standard and simulated CTPs, the percentages of the simulated examinations, which present a deviation not exceeding 1%, 3%, 5% and 10%, are given in 20), 19 (sCTP22) and 15 (sCTP24). In the simulated CTPs with 26, 28 and 30 scans, the patients with a “target mismatch” profile were identical.In standard CTP, a “target mismatch” profile was identified in 55 of the 66 patients. We detected a “malignant” profile in nine patients because of a large infarct core (>50 mL) and in two patients because of an insufficient mismatch (ratio < 1.8). The number of patients with a “malignant” profile was higher in some of the simulated CTPs: 21 .The correlation analysis showed a strong positive correlation of the aortal bolus arrival with all evaluated parameters of the perfusion curve  principle ,24,25,26Given that CT angiography of the carotid artery, which precedes CTP in the diagnostic CT algorithm, has no influence on CTP results , the bolUsing this method, we were able to generate personalized shortened CTPs with the same diagnostic quality, allowing for a dose reduction of at least 18.75% in all patients without a loss of image information and without changing the clinical decision based on the imaging results in our study. The calculated CTP maps were also visually identical in all cases with comparable volumetric results. An example is presented in 24 (50 patients) and 62.1% of sCTP22 (41 patients) compared with the oCTP series. These results suggest that, in certain cases, a further dose reduction could be achieved by lowering the number of scans to 24 or even to 20. Underlying this, 10.6% of the sCTP20 (7 patients) had PRR values that were more than 99% identical to oCTP series. These results indicate that, in these cases, the number of scans could be decreased to 20 without any impairment of the diagnostic quality, which corresponded to a 28.5 s-long scanning window and a dose reduction of 37.5%. The duration of the wash-in and wash-out phase took less than 24 s in these patients, and they also had a very fast aortal bolus arrival as well as an early arterial and venous inflow peak. The flow curves of a corresponding patient are visualized in Furthermore, PRR values showed no more than 5% deviation in 75.8% of sCTPOur correlation analysis indicates a strong relationship between a fast aortal bolus arrival and a fast wash-in phase and an early arterial inflow peak and a fast wash-out phase.Considering this information, personalized CTP protocols with an optimized number of perfusion scans as well as dose-optimized CT examinations could be easily available and should be applied in all suitable patients.On the other hand, bolus tracking in 4 patients (6.1%) revealed a very early contrast arrival (enhancement well above 100 HU in the first bolus tracking scan) in the ascending aorta, resulting in a shift in the ascending arterial inflow curve closer to the venous inflow curve in the original CTP and indicating an unwelcome delay of the original CTP, suggesting a probable loss of information. The flow curves of a corresponding patient are visualized in The classic CTP protocol recommended by Wintermark et al., applying a 40 s scanning window starting 7 s after the contrast injection, has similar characteristics to the protocol we used, with a delay of 8 s, a scanning window of 46.5 s and a scan interval of 1.5 s ,26.Corcuera-Solano et al. advocated for the use of adapted variable and extended sampling  to improve quality and to reduce radiation exposure to 1588 mGycm at 70 kVp. However, Kasasbeh et al. found that an acquisition duration of 65 s or longer is required ,28.The lack of optimal timing can significantly impede the efficiency of this scanning technique. Due to the variation in cardiac output among patients , the overall duration of the entire contrast circle, including the arterial arrival and venous return, might not be appropriately captured if it does not fit within the scan window. In this case, patients with a delayed bolus arrival may have a truncated descending slope of the venous wash-out curve; we observed this phenomenon in seven patients (10.6%) in our study. The flow curves of a corresponding patient are visualized in These findings indicate the urgent need for proper and personally adapted timing of CTP imaging instead of the use of a fixed delay to receive high-quality perfusion data in all patients. Moreover, in patients with a very slow bolus arrival, a prolonged scanning interval instead of 1 or 2 s could be considered to improve the quality of the data acquisition.However, the manual adjustment of the timing of the imaging or the imaging parameter can be highly operator-dependent. The integration of the temporal information of the bolus tracking series of the carotid CT angiography into the CT perfusion protocol by the vendor might reduce the operator-dependent character of this method.We acknowledge the limitations of our study. The injection rates of contrast agents were similar for CT angiography (5 mL/s) and CTP (6 mL/s) but not completely identical. Because of the automated software-based calculation method, our results are quite reproducible within our study but not comparable to the results of other software that use different parameters for infarct core and penumbra identification .In conclusion, the timing information of the bolus tracking of previous carotid CT angiography can be used in the stroke protocol to reduce radiation exposure by avoiding unnecessary scans. In addition, the information from bolus tracking allows for the better timing of CTP, which could lead to better outcomes in certain cases by adjusted timing.


The boron deposited at Mo(110) via electron-beam deposition at a substrate temperature of 300 K grows as a 2D layer, at least in submonolayer coverage. Such a film is bound to the Mo(110) via polarized chemisorption bonds, dramatically changing the charge density at the substrate surface manifested by the Mo(110) surface plasmon damping. Upon annealing of the B-Mo(110) system, the boron diffuses into the Mo(110) bulk following a two-mode regime: (1) quite easy dissolution, starting at a temperature of about 450 K with an activation energy of 0.4 eV; and (2) formation of molybdenum boride at a temperature higher than 700 K with M-B interatomic bonding energy of 3.8 eV. The feature of the formed molybdenum boride is that there is quite notable carbon monoxide oxidation activity on its surface. A further dramatic increase of such an activity is achieved when the molybdenum boride is oxidized. The latter is attributed to more activated states of molecular orbitals of coadsorbed carbon monoxide and oxygen due to their enhanced interaction with both boron and oxygen species for Mo Acharya and Turner [For a long time, boron-doped materials have attracted much attention in finding wide application in different fields of science and technology, such as material science, mechanical engineering, electronics, optics and others ,2,3. Quid Turner  investig2→CO2) at the borided Mo(110). It is concluded that this is due to d-band filling of Mo upon alloying with boron via d←p hybridization on one hand, and reconstruction of the surface with exposing the newly formed active adsorption/reaction sites to the gas phase on the other. Apart from being a modifier enhancing the catalytic activity of the corresponding template, the bare boron can also serve as a catalyst, for instance, such as for a nitrogen reduction reaction [3 orbitals of boron form bonds by charge backdonation from boron to nitrogen. As a result, the p*-antibonding orbital of N2 becomes populated, which causes weakening of the N-N bond. This situation differs from the case of transition metal substrates, when empty d-orbitals, as acceptors of lone-pair electrons of nitrogen, determine the activity of the adsorption/reaction site. Remarkable enhancement of dehydrogenation of hydrocarbons is observed by Ha et al. [nB clusters acquire when Pt is alloyed with boron.In line with the trend of modification of metals with boron, Tvauri et al.  by Surfareaction . By DFT reaction  have shoa et al.  during cDespite quite extensive studies of catalytic behavior of boron-doped materials, the subject of the oxides of corresponding boron-containing materials remains almost totally unexplored. At the same time, the general trend in catalytic activity of materials is that their efficiency increases when shifting from unoxidized materials to the oxides . Taking −10 mbar. For excitation of photoelectrons, a monochromatized Al Ka irradiation with photon energy of 1486.6 eV was used, while registering the photoelectrons by conventional 150°-hemispherical electron energy analyzer. The latter was set to a constant pass energy of 15 eV, providing an energy resolution of 0.8 eV, given the used slit width of the analyzer of 6 mm [7/2 level (84.0 eV) detected from ca. 4 nm thick Au film in-situ deposited onto Mo(110) substrate by thermal evaporation. For very precise determination of the value of the binding energy, a number of parameters, such as the sample work function and its possible variation during measurements, and the alignment of energy levels between the analyzer and the sample, are to be taken into account [2 (m/z = 28 and 44 a.u.m.). No background processing procedure of the TPD spectra was applied. The work function was measured by the Anderson method, utilizing a low-energy electron beam via detection of shift of the retarding curves, determined by the contact potential difference between the cathode of the corresponding low-energy electron gun and the sample. The value of the work function of Mo(110) was assumed to be 5.0 eV, taken as a reference point, since the Anderson method allows detection of only the relative change of the work function, not the absolute value. Fourier-transform infrared (FTIR) spectra in RAIRS mode were registered with the aid of conventional IR-spectrometer (Nicolet-870). To detect the vibrational modes of the molecules adsorbed on surface of the sample, the IR-source and the detector (MCT) were aligned across the sample in a way to ensure grazing incidence of the beam (incidence angle is 80 degrees). For the p-polarized light, using such a geometry provides maximal sensitivity to the molecular vibrations aligned along the surface normal. Such configuration is used because the diatomic molecules, like CO, NO, etc, usually adsorb in an upright, sometimes tilted geometry [Experimental measurements have been done in an ultra-high vacuum by a set of surface sensitive techniques: X-ray photoelectron  and Auger electron spectroscopy  , angle-integrated electron energy loss spectroscopy (EELS) , work function measurements, temperature programmed desorption spectroscopy (TPD) , reflection-absorption infrared spectroscopy (RAIRS)  and low-energy ion scattering (LEIS) . All these techniques were implemented in the VGS Escalab MkII system  with a base pressure of around 3 × 10 of 6 mm . To dete account ,13. In t15 cm−2. For preparation of the B-Mo(110) compound and its oxide, the initial coverage of deposited boron was 2 ML. This film is quite unstable, and its annealing leads to dramatic diffusion of the boron from the surface into the bulk of the Mo(110) substrate. The amount of boron atoms remaining at the surface and subsurface region of few atomic layers is such that the mean B to Mo atomic concentration ratio is 1 to 3.To prepare the B-Mo(110), the boron film was initially deposited onto Mo(110) by electron bombardment. The system was then annealed at a temperature of 1200 K, resulting in a quite stable compound with an amorphous surface structure. The amount of deposited boron atoms on Mo(110) has been in-situ determined by quartz microbalance installed coaxially to the Mo(110) at a sample holder in UHV. The coverage of boron atoms defined as 1 monolayer (1 ML) corresponds to surface concentration of atoms of 2.75 × 10−6 mbar × 1 s. The sample was mounted on the manipulator, enabling movement in UHV in -directions, tilting and 360°-rotation. The sample could be cooled down to about 90 K via a liquid nitrogen reservoir, and heated up to 2700 K by electron bombardment with temperature control by the calibrated W-Re thermocouple.To realize the adsorption of gaseous species on such prepared samples, the UHV chamber was controllably backfilled by the carbon monoxide and molecular oxygen of research-grade quality via the high-sensitive leak valves. As a measure of the amount of adsorbed molecules, the value of exposure defined as multiplication of the partial pressure and the time during which this partial pressure is kept is used. An exposure unit (1 L) was defined as: 1 L = 10xy, and pz orbitals, leading to damping of the surface plasmon intensity [Before alloying of B with the Mo(110), it is informative to verify the growth mode of the B submonolayer to multilayer film and the electronic state of adsorbed boron atoms on Mo(110) surface held at room temperature. The growth mode of B on Mo(110) in the submonolayer region was determined by the well-known procedure of plotting the Auger uptake curves of the substrate (Mo(110)) and the deposited layer (B) . The corntensity .The tendency of quite strong interaction between B and Mo(110), seen by the above transformation of the surface plasmon mode, is further manifested when the system is annealed. As seen in Given the different rates of boron interdiffusion in the Mo(110) (+ ion scattering features at 807 eV for Mo and 348 eV for B. The latter corresponds to the situation when the entire Mo(110) surface area is covered by the B. After annealing of such a boron film at a coverage of 2 ML at a temperature of 1200 K for 3 min, the observed LEIS spectrum is shown in In order to probe the outermost surface layer of B-Mo(110) system, the LEIS spectroscopy, which is well suited for this purpose, was used. For more unambiguous interpretation of the spectra, initially the spectra of bare Mo(110) and the thick boron film were recorded. The corresponding spectra are shown in −6 mbar while keeping the substrate temperature at 900 K for 10 min. The corresponding LEIS spectrum is shown in 5/2 photoelectron lines shift upon oxidation from 190 to 191 eV, and from 228 to 229.5 eV, respectively  to the more tilted adsorption geometry of CO molecule on the boride oxide compared to an unoxidized substrate; and (2) to the enhanced backdonation of electron charge from the substrate to the anti-bonding 2p* molecular orbital of CO , while the wavenumber shifts to blue by 20 cm−1 (spectrum 3). The observed drop of IR intensity is due to the situation when the CO molecules acquire more tilted adsorption geometry on the oxygen pre-dosed surface, compared to bare MoxByOz. The indicated blue shift of CO frequency results from the partial transfer of the electronic charge from the 2p* antibonding orbital of CO to more electronegative adsorbed oxygen. This in turn leads to somewhat strengthening of the intramolecular CO bond, and thus to stretch frequency blue-shift. In this regard, it is noteworthy that the behavior of adsorbed CO on the molybdenum boride oxide surface is considerably different from that occurring on the surface of molybdenum boride with the adsorbed oxygen, as was reported earlier [−1, which is 142 cm−1 higher than the value corresponding to the MoxByOz surface (The adsorption properties of the molybdenum boride and its oxide (borate) are dramatically different. This is seen from the comparison of vibrational spectra of adsorbed carbon monoxide molecules (sorption ). Accordsorption , the six earlier . In the 2), resulting in CO2 formation and its desorption into the gas phase, on the surface of unoxidized molybdenum boride (spectrum 1′) and the molybdenum boride oxide MoxByOz (spectrum 2′), are shown in an inlay of 2 formation efficiency is as twice as high than in the former case. Moreover, in the latter case, the desorption temperature of the formed CO2 by the (CO + O2) reaction via Langmuir-Hinshelwood mechanism on the surface of ternary oxide is 21 degrees lower, also pointing at its higher catalytic activity. According to DFT studies of Stampfl and Scheffler [2 intensity is higher for the molybdenum boride oxide (inlay). Another reason for the inverse proportionality between the intensities of the vibrational lines of CO and the TPD spectra can be the fact that, unlike the MoxByOz, a smaller part of CO molecules is converted into CO2 on the surface of molybdenum boride. Moreover, the efficiency of oxidation of CO by coadsorbed oxygen is higher for the lower energy of chemisorption of oxygen with the substrate [This difference is also manifested in the case of temperature variation for these substrates, revealed by TPD measurements. The corresponding spectra for  was modified by boron as one of the recently discovered promising additives. To form such a mixed B-Mo(110) compound, first the boron submonolayer to multilayer films, in-situ deposited onto Mo(110) substrate and held at room temperature, were studied by a set of surface characterization techniques in an ultra-high vacuum. The chemisorption bond formed at the B-Mo(110) interface dramatically changes the electron state of the outermost layer of the substrate, leading to the total dampening of its surface plasmon excitation. The latter, along with the quite small dipole moment of single adsorbed boron atoms (0.2 D), points at the formation of preferentially covalent chemisorption bonds. This can be viewed as a precursor state for B intermixing in the Mo bulk, and the formation of a borided molybdenum upon the annealing of the boron overlayer. Such a double compound is completely different from the bare Mo(110), in that in the latter case, the only reaction of CO on the surface is dissociation, while in the former the dissociation shifts to an oxidation reaction pathway with quite notable activity. The CO oxidation activity considerably grows further when the borided molybdenum is oxidized.


A promising method of obtaining mineral fiber fillers for dry building mixtures is the processing of waste that comes from the production of technogenic fibrous materials (TFM). The novelty of the work lies in the fact that, for the first time, basalt production wastes were studied not only as reinforcing components, but also as binder ones involved in concrete structure formation. The purpose of the article is to study the physical and mechanical properties of waste technogenic fibrous materials as additives for optimizing the composition of raw concrete mixes. To assess the possibility of using wastes from the complex processing of TFM that were ground for 5 and 10 min as an active mineral additive to concrete, their chemical, mineralogical, and granulometric compositions, as well as the microstructure and physical and mechanical characteristics of the created concretes, were studied. It is established that the grinding of TFM for 10 min leads to the grinding of not only fibers, but also pellets, the fragments of which are noticeable in the total mass of the substance. The presence of quartz in the amorphous phase of TFM makes it possible to synthesize low-basic calcium silicate hydrates in a targeted manner. At 90 days age, at 10–20% of the content of TFM, the strength indicators increase (above 40 MPa), and at 30% of the additive content, they approach the values of the control composition without additives (above 35 MPa). For all ages, the ratio of flexural and compressive strengths is at the level of 0.2, which characterizes a high reinforcing effect. Analysis of the results suggests the possibility of using waste milled for 10 min as an active mineral additive, as well as to give better formability to the mixture and its micro-reinforcement to obtain fiber-reinforced concrete. An important direction in the development of concrete science is to minimize the use of cement as a result of its partial replacement with various fillers, including those obtained from production waste ,2,3. ManA promising direction for obtaining mineral fiber fillers for dry building mixtures is the processing of waste from the production of technogenic fibrous materials (TFM) ,5,6.The most studied type of TFM is pulp and paper waste, consisting mainly of fibers with a length of 0.1 to 5 mm, of plant origin, isolated from coniferous and hardwood , the stems and bast of annual plants, and seed pods and leaves of some plants or mineral (asbestos) origin  7,8,9].,8,9.7,8,In the world, about 15 million tons of pulp and paper waste are generated annually, of which 12 million tons are suitable for processing ,11,12,13Cellulose fiber has an amorphous structure, is insoluble in water, is resistant to acids and alkalis, and has a pH value in the range of 4 to 12 ,15. Cell3), storage areas occupy a large share of the area in factory warehouses and landfills  ;−providing various sizes of fibers for their use in composite mixtures for various technological purposes, incl. for 3D technologies in construction ,32.It is advisable to use a step-by-step process for the complex processing of basalt fibrous waste:Obtaining agglomerated, highly concentrated microfiber fillers has a number of technological advantages: increased flowability and better transport ability, which ensures a more uniform distribution of fibers in macro and micro volumes of a composite mixture with heterogeneous components, and expands the scope of the use of basalt waste (fibers) in an agglomerated form for various technological purposes  .−increase in the crack resistance of the product ;−imparting thixotropic properties of the mortars;−improving the fixing ability on a vertical surface, preventing tiles from slipping (if in tile adhesive);−reduction in shrinkage that occurs during the maturation of mortar or concrete;−increase in frost-resistant properties of products;−improving the rheological properties of the mortar and increasing the time of work with them.The effects of using technogenic fiber in mortar or concrete ,34,35:−iThe use of various industrial fibers for reinforcing concrete is sufficiently studied, for example, basalt and polypropylene , steel, The novelty of the work lies in the fact that, for the first time, basalt production wastes are studied not only as reinforcing components, but also as binder components, involved in concrete structure formation.The purpose of the article is to study the physical and mechanical properties of waste technogenic fibrous materials for use as additives for optimizing the composition of raw concrete mixes.Portland cement CEM I 42.5 N  according to EN-197 was used as a binder. As an active mineral additive to concrete, wastes from the complex processing of TFM  were used. Microsilica, which is a technogenic waste from metallurgy, was used to provide the pozzolanic reaction.2, CaO, MgO, Al2O3, Fe2O3, Na2O, TiO2, and K2O impurities represent mineral wool. The amount of SiO2 is 44.11%, the specific surface area is 200 m2/kg, the bulk density is 1366 kg/m3; and true density is 2884 kg/m3.The superplasticizer “PFM-NLK”  was used in the mixes. For the developed mortars, sand with a particle size of 1.5–2.5 mm was used.In the work, samples of 70 × 70 × 70 mm in size (according to Russian standard GOST 310) were molded with different waste content (10–40% by weight of cement) and the corresponding replacement of part of the cement. The water to cement ratio (W/C) was 0.4 and the sand/binder ratio was kept constant at 2.75. The compositions of concrete mixes are given in All mixes were designed based on the conditions of equal workability, providing a slump of 19 cm and a slump flow of 43 cm.To assess the possibility of using wastes ground for 5 and 10 min for the complex processing of TFM as an active mineral additive to concrete, their chemical and mineralogical compositions were studied using an X-ray fluorescence spectrometer. Using a scanning electron microscope, the shape and size of the particles were visually assessed before and after grinding.The specific surface area was determined by two complementary methods using the PSH-2 device  and the Sorbi-M device (4-point BET method), . The volume of pores with a radius <19.4 nm was also calculated.The microstructure of the materials was studied using a Mira 3 scanning electron microscope .Compressive and flexural strength tests were carried out after 7, 28 and 90 days according to the Russian standard GOST 310.Silica in this type of technogenic raw material is in an amorphous highly dispersed state, as evidenced by the maximum peak in the region of 31–33° .2O6 and anorthite CaAl2Si2O8, which is characteristic of crystalline basalt. These phases begin to crystallize at temperatures above 900 °C during the melting of basalt in the production of mineral fiber.The main crystalline phases of TFM that belong to plagioclases are augite CaSi2 released as a result of the hydration of clinker minerals. These processes allow the targeted synthesis of low-basic calcium silicate hydrates during hydration, which are responsible for the strength properties of the finished building product.The presence of crystalline phases of quartz in the β-modification is evidenced by characteristic diffraction reflections. There is a high-temperature polymorphic modification of quartz β-crystobalite. The presence of quartz in the amorphous phase causes high solubility in saturated alkaline solutions of the hydrated binder and active interaction with the Ca(OH)The results obtained are confirmed by the energy dispersive microanalysis (EDM) of waste performed with the construction of a map of the distribution of chemical elements over the surface. Results also indicate the absence of additional inclusions in the material due to preliminary screening .SEM images obtained using a scanning electron microscope a show thWhen grinding using a ball mill for 5 min, the size of the fibers is significantly reduced. First, there is the most intensive grinding of thin and long fibers; as a result, the ratio of length to diameter decreases. The beadlets themselves remain largely unchanged b, but soFurther grinding for 10 min leads to grinding not only the fibers, but also the beadlets, the fragments of which are noticeable in the total mass of the substance. There is a large number of the smallest nanosized crushed fractions, however, there is also a significant amount of larger particles of a fibrous form c.This is consistent with the obtained granulometric composition of the powders .3/g  made it possible to maintain the slump within 20 cm for almost all compositions .Only at a dosage of TFM in the amount of 40 wt. % value of the slump decreased to 16 cm. At the same time, the parameter of the slump flow was kept at the level of 48–51 cm, allowing its decrease in the amount of TFM 30–40 wt. % up to 46 cm.The density of the fresh mixture modified with FMT reduced when the dosage increasing. The decrease in the density of the hardened concrete samples is justified by the fact that the average density of cement hydration products is lower than the average density of the initial mixture.Compositions with 40% TFM in all periods of hardening have the lowest strengths, with a 50% drop compared to the control composition. For all the mixtures only at the age of 7 and 28 days, the compressive strength decreased (by about 20–40% compared to the control samples) as the content of mineral wool waste increased . CorrelaHowever, at the age of 90 days, at 10–20% of the content of TFM, the strength indicators increase, and at 30% of the content of the additive they approach the values of the control composition without additives. The decrease in compressive strength of samples with the replacement of cement by 30 and 40% of TFM is explained by supersaturation and weakening of the hardening system, confirming the optimal content of this component at the level of 20%.Good early compressive strength results (7 days) are noted; even at 40% replacement of cement by TFM, the early compressive strength reaches 15 MPa. This allows you to speed up the production of concreting. The increase in strength may be associated with the pozzolanic reaction, the completeness of which increases most at a later age ,52,53,54The decrease in strength at 28 days of age may be due to the high water demand of the finely ground filler, which intensively absorbs water, slowing down the rate of hydration. However, in the future, the filler can release stored water, providing long-term hydration. Based on the test results mentioned above, the inclusion of 10–20% mineral wool waste is optimal.Good results were obtained in the study of flexural strength . The opt2 released as a result of the hydration of clinker minerals.Thus, the analysis of the results suggests the possibility of using waste milled for 10 min as an active mineral additive, as well as to give better formability to the mixture and its micro-reinforcement to obtain fiber-reinforced concrete ,63,64,65−The processing of TFM for 10 min leads to the grinding of not only fibers, but also granules, fragments of which are noticeable in the total mass of the substance. There is a large amount of the smallest nanosized crushed fractions, however, there is also a significant amount of larger particles of a fibrous form. This is the reason for the effective use of the material to control the structure formation of the cement composite, both at the macro level (fiber) and at the micro level (cement substitute).−2 released as a result of the hydration of clinker minerals. These processes make it possible to purposefully synthesize low-basic calcium silicate hydrates during hydration, which are responsible for the strength properties of the finished building product.The reactive activity of TFM is confirmed by the high solubility in saturated alkaline solutions of the hydrated binder and active interaction with the Ca(OH)−At 90 days of age, at 10–20% of the content of TFM, the strength indicators increase (above 40 MPa), and at 30% of the additive content, they approach the values of the control composition without additives (above 35 MPa). For all ages, the ratio of flexural and compressive strengths is at the level of 0.2, which characterizes a high reinforcing effect. The increase in strength may be associated with the pozzolanic reaction, the completeness of which increases most at a later age. In addition, the microsize of the grains of TFM waste used in this study increases the compressive strength of the mortar by acting as a compactor.−Analysis of the results suggests the possibility of using waste milled for 10 min as an active mineral additive, as well as to give better moldability to the mixture and its micro-reinforcement to obtain fiber-reinforced concrete.The physico-mechanical properties of waste technogenic fibrous materials (TFM) used as additives for optimizing the composition of raw concrete mixtures were studied. The following results were obtained:


The possibility of reactive printability on protective flame—resistant fabrics, varied in composition of weft threads and weave was investigated. In addition, the wash fastness of printed samples was analyzed. The functional properties of fabrics were assessed by measuring of the Limiting Oxygen Index (LOI). Printing was performed with two printing pastes varied in thickeners and two dyestuff concentrations. The samples were analyzed by microscopic imaging using digital microscope and spectrophotometric measurement before and after the five washing cycles. The results confirmed the printability of FR inherent fabrics specified through fine colored effects and optimal wash fastness. Non-flammability of textiles has been the subject of intensive research since the 1940s, although there are also studies published as early as 1735 and 1821 on finishing of cellulosic textiles using alum, ferrous sulphate and borax, which laid the foundation for a modern approach to the research and development of non-flammable textiles ,11,12,132, various clay compounds, and polycarboxylic acids for application to cotton : 9.564 mm [+/−0.192 mm]; one pixel increment (one keyboard arrow press): ~7.4 μm).The scanning of the fabrics was performed with resolution of 1200 dpi.FR properties of fabrics before printing in warp and weft direction by LOI-Limiting Oxygen Index were examined according to a standard protocol are presented in The results of LOI in MCC as a method for evaluation of the fire retardancy of materials using only a few milligrams of sample showed small differences between samples, −1] for fabric 2 to 51.00 [J(g·K)−1] for fabric 5. Other fabrics are specified between these values. Fabric 1, Fabric 2 and Fabric 4 possessed more optimal values than Fabric 3 and 5. Peak heat release rates (Qmax) for selected fabrics 1, 2 and 4 fully follow the values of the heat release capacity. Specific heat release of samples (hc) fabric 1 and fabric 3 is less than 7.00 [kJ·g−1], while to fabric 2 and fabric 5 possessed the same value, 7.20 [kJ·g−1], and finally the fabric 5 to which belongs the highest value of 8.00 [kJ·g−1]. Pyrolysis residues of all tested fabrics are higher than 40%. Finally, according to MCC criteria small differences were found between tested fabrics, which can be attributed to structural features, primarily in the fabric embroidery. Nevertheless, all fabrics can be specified as fire retardant.Tested fabrics can be grouped according to values of MCC parameters as follows. The heat release capacity (ηc) of fabrics ranges from 39.00 [J(g·K)The surface of fabrics was characterized by pH value, which may indicate on character of residual substances, The values obtained indicate acidity of the surface which may be caused by yarn preparations. The acidic surrounding can affect the reduced bonding of the reactive dye with the fiber, since it requires alkaline conditions to induce the reaction of the dye with the fiber. So samples were before printing washed in a mild detergent composed from anionic and non-ionic surfactants. After the analyses of FR properties of the fabrics along with the characterization of the surface pH, the process of printing with reactive dye was approached.For Fabric 1, for samples printed with Paste 2a, 4a and 4b, satisfactory print sharpness was obtained .The result indicates that a thickener with a higher dry matter content is suitable for this type of fabric with a hydrophobic fiber content (aramids and PA), as in the case of the indicated pastes, regardless of the type of thickener. The microscopic images clearly show the component of aramid yarn that remained uncolored, and the proportion of the same is visible due to the characteristic of the weaving. Since the appearance of the color depends on the interaction of simultaneous remission from the dyed and undyed components of the fabric, an influence of the uncolored component on obtained color appearance can be expected.Fabric 2  differs a, regardless of the type of thickener and the amount of dry matter, satisfactory print sharpness was obtained, but for Paste b where a higher amount of dye is present , regardless of the type of thickener.For fabric 4 , printedb with a higher dye content, again a satisfactory print sharpness is obtained for printing pastes 3 and 4 with a starch-based thickener . Microscopic images clearly show the difference in weaving structure, which results in a difference in the ratio of dyed and undyed components in the fabric content, and the impact of such yarn ratio on the subjective color appearance as well as on the objective measurements that follow, is expected.As for Pastes a, with a lower content of dye, satisfactory, given the sharpness of the print contour, proved to be pastes with a thickener of higher viscosity, ie a higher proportion of dry matter , regardless of the type of thickener. When printing with pastes with a higher proportion of dye, capillary spillage occurs, with the exception of the sample printed with Paste 4b .For Fabric 5 , for PasPaste 1a showed the stability in viscosity and homogeneity of the structure and sharp, equal prints were achieved without spillage and capillary migration. The same effects were achieved for pastes 2a, 3b and 4b. Pastes 1b, 3a and 4a did not gave satisfactory print sharpness, although the coverage of surface with printing paste is of optimal uniformity. In addition, during printing and fixing, capillary spreading of the paste occurred, although there were no changes in the viscosity and homogeneity of the paste during the process. Paste 2b also did not achieve satisfactory print sharpness, although the coverage of the surface with printing paste was optimal here as well.Comparative analysis is given of the objective values of color strength (K/S) and the ratio of lightness (L*) and chroma (C*) as a definition of color intensity. The results of K/S are shown graphically in Objective K/S values show a relatively low achieved color strength. As expected,. slightly higher values were obtained for printing pastes “b” with a higher concentration of dyestuff. Such lower K/S values were to be expected, given that only a partial ratio of components contained in the yarn composition is capable of bonding with dyestuff (the cellulosic part contained in the viscose yarn component).The Kubelka-Munk coefficient, which objectively evaluates the color strength (K/S), is defined by the amount of dye that binds to the fiber in the printing process. The higher the color strength coefficient K/S, the greater the color depth itself, which estimates the coverage of the surface with color in the printing process. The printing process in which dyes are applied is actually a dyeing process from small, concentrated baths that takes place in the fixing phase. In this process, a certain amount of dye binds to the fiber, which depends on the conditions created by the thickener and other components in the printing paste during the fixing phase.However, the K/S color intensity data alone does not provide information on the appearance of the achieved color. The K/S value needs to be analyzed in the context of the ratio of lightness (L*) and chroma (C*) for a given tone (h°). Namely, the same values of color strength will not have the same interpretation for different color hues and will depend on the understanding of the nature of color. According to its nature, blue belongs to naturally darker colors, which means that maximum chroma is achieved at lower lightness, expressed in objective CIE values, at lightness levels below 50. Therefore, the results indicated a lower color intensity, given the obtained lightness values above 50 (except for fabric 4) and relatively low saturation values. Such ratio of lightness (L*) and chroma (C*) is in accordance with the K/S values. The specific ratio of lightness and chroma, in general, is the definition of color intensity and depends, in addition to the parameters of the dyestuff and the textile material, also on the color itself.In print characterization, color reproduction quality control is performed by evaluating the spectrophotometric parameters. In dye printing, achieving a satisfactory intensity and brilliance of coloration of printed parts of the fabric is very complex. Precisely due to the chemical bonding of the dye with the fiber, the obtained coloration becomes an integral part of the fabric structure, which provides more satisfactory properties of fastness, but lower brilliance of the dye. It is the color intensity as well as the brilliance of the print coloration that can be defined by the specific ratio of lightness (L*) and chroma (C*). In the samples tested in this paper, the lower intensity of the obtained coloration is contributed by the specific composition of the fabric in which more than half of the content are fibers that cannot be dyed by the process of dye-fiber chemical bonding.The spectrophotometrically measured values of samples after the 5th wash cycle were compared with the values of unwashed samples and the analysis of the change in the value of K/S (color strength) and the specific relationship of lightness (L*) and chroma (C*) was performed. The results for K/S are shown graphically on For K/S values, a minimal change was obtained, after the washing cycles, which indicate that there were no evident release of dye. Slightly higher differences in K/S values after washing were obtained for Fabric 4 printed with Paste b, regardless of the type and viscosity of the thickener. It can be said that, in this sample, the amount of bound dye was lower and there was a higher release of dye from during washing.For the ratio of lightness (L*) and chroma (C*), in general for all samples (Fabrics 1 to 5), it was observed that there was an increase in lightness (L*) and a decrease in chroma (C*). This result of the lightness-chroma (L*-C*) ratio is in line with the K/S values and the indication of a slight dye release. An increase in lightness and a decrease in chroma indicates a shift in coloration towards a lighter, more pastel color shade, indicating albeit slight but still fading coloration in the wash.In further analysis, the color differences are calculated based on objective spectrophotometric measurement of samples before and after the 5 washing cycles, taking the values of printed unwashed samples as the standard (reference) values. The results are shown in terms of color parameters differences  as well as in terms of total color difference value (dE), presented graphically in For the parameters of lightness (L*) and hue (h°), the differences (dL* and dh) were for all samples within the ranges of tolerances . The differences obtained for chroma parameter (dC*) were higher and outside the tolerances. However, although the individual differences in chroma (dC*) were out of the tolerances, the values of the total color difference (dE), taking into account the obtained minimum differences in lightness and hue, were also mostly within the tolerance limits. More pronounced values of the total color difference (dE), outside the range of tolerance (dE < 1.5), were obtained only for Fabric 1, Paste 3b. The results of the differences are acceptable and indicate a satisfactory color wash fastness.Based on the analysis, it can be confirmed that it is possible to achieve a certain level of coloration in fabrics that contain a high proportion of aramid fibers (95% in warp and 40% in weft yarn composition), if a certain ratio of cellulose component is contained (30–40% in weft yarn). The weft yarn contained a component of viscose (38–40%) that has the ability to bond reactive dye, and coloration was achieved even in samples that had a certain basic color i.e., were not completely uncolored . Although, by objective evaluation of the color strength, lower K/S values were obtained (1.1 to 2.6), by analyzing the relationship between the color lightness parameters (L*) and chroma (C*), a satisfactory color intensity was achieved .CIE = 0.32–0.91).The results confirmed the optimal wash fastness in the process of five washing cycles, more emphasized for Fabric 5, where for all printing conditions (sort and viscosity of the thickener as well as dyestuff content) the lowest differences values have been obtained (dEThis research is part of the comprehensive research of the characteristics of FR fabrics and the possibility of their finishing in the processes of dyeing and printing.


Water is a scarce resource with a close and intricate nexus with energy. Water contamination has been reported in almost every region of the world, with a significant impact on human health ,2. Therei) application of innovative materials in water decontamination, (ii) the synthesis and characterization of engineered nanocomposites, (iii) water decontamination by photocatalysis, adsorption and other techniques, and (iv) computational and theoretical studies of the reaction mechanisms, kinetics and thermodynamics of water depollution processes.This Special Issue focuses on the  nanoparticles are of high interest to researchers in the fields of materials science and nanotechnology Cl molar flux, and the electric current efficiency increase with a rising concentration of [C4C4IM]Cl in the feed solution was reported [4C4IM]Cl content and increases linearly with the increase in the [C4C4IM]Cl concentration in the initial solution. The ionic liquids concentration in the feed solution influences the solution conductivity, electrical resistance, and concentration polarization, as well as the electrodialysis efficiency [This Special Issue also includes the study of Babilas et al.  on the rreported . The eneficiency  by a redficiency .In this Special Issue, Zheng et al. reported water tree characteristics and its mechanism of crosslinking polyethylene grafted with polar group molecules. . The res2PO4 and Na2HPO4 due to the coupled effects of increased electrostatic repulsion, the competition for retention sites, and the double layer compression [This Special Issue also includes the study of Liu et al.  on the spression . Hydrogepression . High pHpression . The prepression . This stpression .4−) is considered to be a promising water treatment technology: the process is based on the ability of a specific mixed microbial culture to use perchlorate as an electron acceptor in the absence of oxygen. Both fixed optimal hydraulic retention times and the effect of nitrate on perchlorate reduction were investigated with various concentrations of the electron donor [In this Special Issue, Yu et al. reported the impact of acetate on the reduction of perchlorate by mixed microbial culture under the influence of nitrate and sulfate, the kinetic parameters of the Monod equation and the optimal ratio of acetate to perchlorate for the perchlorate-reducing bacterial consortium. . The bioon donor . The preon donor .4/g-C3N4 mesoporous nanosheets via coupling adsorption and photocatalysis. The ultrathin and porous structure of the EuVO4/g-C3N4 increased the specific surface area and active reaction sites, and the formation of the heterostructure extended visible light absorption and accelerated the separation of charge carriers [4/g-C3N4 followed the pseudo second-order kinetics model, and the adsorption isotherm data complied with the Langmuir isotherm model [4/g-C3N4 obeyed the zero-order kinetics equation for 0–10 min and the first-order kinetics equation for 10–30 min [4/g-C3N4 heterojunctions, with superior synergetic effects of adsorption and photocatalysis, for potential application in wastewater treatment [This Special Issue also includes the study of Ran et al.  on the rcarriers . These tcarriers . The metrm model . The pho0–30 min . This streatment .The study of Iosif et al.  is focusI am grateful to all the authors for their contributions, covering the most recent progress and new developments in the field of metal–ferrite nanocomposites. I hope that the published studies will pave the way for novel real-world synthesis, characterization, and applications of innovative materials.


There are more and more basketball competitions, to propose a classification method of thoracolumbar fractures to assist in the diagnosis of basketball injuries, to analyze the feasibility of its clinical application, and to improve the recovery rate.  From February 2015 to May 2022, 1130 CT images of thoracolumbar fractures admitted to our hospital and affiliated hospital units due to basketball injuries were collected, and the image labeling system uniformly labeled them. All CT images were classified according to the AO spine classification of thoracolumbar injuries. In the ABC-type classification, 935 CT images were used for training and validation to optimize the deep learning system, including 815 training sets and 120 validation sets; the remaining 198 CT images were used as test sets for comparing the deep learning system and clinician's diagnosis. In the classification of subtype A, a total of 523 CT scans can be performed for training and validation to optimize the deep learning system, including 500 training sets and 23 validation sets; the remaining 94 CT images are used as test sets for comparing depth learning systems and clinicians' diagnostic results. P < 0.001); the correct rate of subtype A was 85.3%, with a kappa coefficient of 0.815 (P < 0.001).  The deep learning system had a correct rate of ABC classification of fractures in 86.4%, with a kappa coefficient of 0.850 ( The classification accuracy of thoracolumbar fractures based on deep learning is high. The method can assist in diagnosing CT images of thoracolumbar fractures and improve the current manual and complex diagnosis process. From the analysis of the status quo of clinical treatment of basketball injuries, basketball is a ball sport with strong collective antagonism. Offense and defense alternate instantaneously, sudden start and stop, jumping and squatting, body position changes, etc.; players constantly change. Action is a characteristic of basketball, so basketball is very prone to various sports injuries, and the incidence of fractures continues to rise. The incidence of medical disputes in fracture diagnosis remains high. Improving the timeliness, accuracy, and comprehensiveness of fracture diagnosis is necessary. Conventional radiographic diagnosis is difficult for occult or minor fractures in fracture diagnosis. Once missed or misdiagnosed, it may lead to complications such as compression plate fracture, deep infection, delayed fracture union, or nonunion. Improve fracture diagnosis techniques.The current fracture diagnostic typing is based on simple typing of fracture morphology or neurological function score, which can only distinguish the general location, morphology, and degree of fracture. The diagnostic typing of the same patient varies greatly among clinicians. The current fracture diagnostic typing system is less intelligent and less consistent and lacks guidance on personalized treatment modalities, which is not conducive to forming and applying standardized treatment plans for spinal fractures. Therefore, a classification method is urgently needed to unify the typing and diagnose fracture types.Deep learning technology is applied in the clinical medical field mainly for reading and diagnosing medical images. The deep learning technology can quickly mark abnormal structures or areas in the medical images of patients, providing important references for doctors' judgment and diagnosis. Current research on medical image processing based on deep learning technology is mainly focused on large –3, liverThe CT images of all cases this time include 1130 fracture CT images collected in our hospital and affiliated hospitals from February 2015 to May 2022, which were injured in basketball and collected in our hospital and affiliated hospitals. Images of fractures were observed. As sample data, exclude unique samples with special bone structures such as severe shadow shading, hidden fractures, and osteoporosis.This study establishes a fracture classification method based on the Faster RCNN deep learning network. For the problem of various types of fractures, the Faster RCNN is applied to iteratively learn a large number of prelabeled CT sample data of fracture types, extract the different features of various types of fracture sample data as the input of the classifier, and achieve the classification of the corresponding fracture test sample data.To fit the input to the Faster RCNN, the CT images are first preprocessed. To standardize the images, including graying out the images, uniform size, and resolution, ① CT images are mainly in black and white tones and need to be grayed out. After the grayscale operation, the number of image channels is reduced, which can effectively improve the efficiency of image processing. This study uses the PIL library method that comes with Python to implement image grayscale. ② When the scale difference between images is significant, the image features will also vary greatly, which will significantly impact the training model's speed and results. This study also uses the self-contained PIL library in Python to process the size and resolution of the images so that they match the input size of the iterative learning network.Based on data preprocessing, doctors who have been practicing clinical work for more than ten years at our hospital applied the Imaging Labeling system to classify and confirm CT images and label them to build the training and validation sets for deep learning networks.According to the AO spine classification 2015, vertebral fractures are classified as type A , type B (anterior-posterior distraction injury), type C , A2 , A3 , and A4 .For the selected sample, the classification method proposed in this study can also deal with the presence of multiple fractures in the thoracolumbar spine, considering the practical situation where multiple different types of fractures may exist simultaneously on a single CT image.Of the three basic types of ABC, a total of 935 thoracolumbar fracture images were selected for training and validation in this study, including 815 in the training set and 120 in the validation set, including 160 for type C, 319 for lumbar A, 48 for lumbar B, 350 for thoracic A, and 58 for thoracic B; 711 for males and 224for females; and 15 to 35 years of age, with an average of 20 years. A total of 198 thoracolumbar fracture images were selected as the test sample, of which 32 were C type, 70 were lumbar A type, 12 were lumbar B type, 80 were thoracic A type, and 15 were thoracic B type; 148 were male, and 47 were female; and the ages ranged from 17 to 36 years, with a mean of 25 years.In the subtype classification study of type A fractures, a total of 523 images of thoracolumbar fractures were selected for training and validation, including 5489 images in the training set and 34 images in the validation set, including 46 images of type A1, 28 images of type A2, and 240 images of type A2. A3 type and A4 type were 175; 371 males and 151 females, aged 15 to 35 years old, with an average of 20 years old. 113 sheets were selected as test samples, including 15 sheets of type A1, 17 sheets of type A2, 34 sheets of type A3, and 47 sheets of type A4; 74 sheets for men and 20 sheets for women; aged 17 to 36 years old, with an average of 25 years old.M × N blocks . The pooling layer divides each candidate region into M × N blocks (M denotes the pool height and N denotes the pool width). The maximum pooling operation is performed for each block so that the candidate regions of different sizes are transformed into feature vectors of uniform size during the feature mapping process and then fed to the next layer. The pooling layer makes the output feature map consistent with the dimensionality of the fully connected layer after it. Finally, Softmax Loss (detecting classification probability) and Smooth L1 Loss (detecting edge regression) are used for classification and regression, as shown in Faster RCNN consists of 2 modules: region proposal network (RPN) candidate frame extraction module + Fast RCNN detection module. In Faster RCNN, the training image is input to the VGG16 convolutional neural network to extract the features of the image; the RPN layer generates the candidate frames, and then, each “candidate frame” is mapped to the feature map to obtain the feature map of the region of interest; the pooling layer of the region of interest divides each candidate region into The convolution layer is also known as the feature extraction layer. The convolutional layer contains 3 layers of convolution, pooling, and activation. To accommodate fracture image classification, this study's Faster RCNN learning model has 13 convolutional and activation layers and 4 pooling layers, as shown in The RPN operates as follows: a sliding scan is performed on the final convolutional feature map using a small network, and sliding window processing ensures that the regression and classification layers are associated with the entire feature space of the convolutional layer. This is then mapped to a low-dimensional vector, and finally, this low-dimensional vector is sent to the regression and classification layers to output classification diagnostics, as shown in In this study, according to the classification results of the test set, the overall correct rate and kappa coefficient are used as the evaluation indexes of the overall classification effect, where the correct overall rate is the proportion of all correctly classified samples to the total samples, which is an assessment of the overall accuracy; the kappa coefficient reflects the consistency between the classification results of the classifier and the actual results. The Faster RCNN is a multiclassification network, for each class. For each category, we split it into multiple binary categories for calculation, such as for ABC-type fracture typing; when calculating the evaluation index, the problem of five categories is split into five binary categories, and the single category correct rate, sensitivity, specificity, positive predictive value, negative predictive value, and Jorden index are used as the evaluation index for the classification effect of a category, where the single category correct rate is the proportion of samples to the total samples for whether the classification is correct for a specific type. The sensitivity is the proportion of all positive cases that are correctly classified, which measures the capability of the classifier to identify positive cases; the specificity is the probability of correctly predicting the “true negative” case, which measures the ability of the model to identify negative cases; the positive predictive value is the proportion of the samples classified as positive cases that are actually positive cases. The loss value is a measure of the difference between the output of the trained model and the actual result and is related to the choice of the loss function and the number of iterations.α = 0.05.SPSS 24.0 software was used to analyze the data statistically. Correctness, sensitivity, specificity, positive predictive value, negative predictive value, Youden index, and kappa coefficient were selected for statistical analysis according to data characteristics. The test level was P 0.001). The results of the classification of the ABC type are shown in P < 0.001). The results of the classification of type A subtypes are shown in In this study, deep learning technology was applied to the classification of human thoracolumbar fractures, and a large number of CT images were screened, preprocessed, renamed, and sample annotated; after which Faster RCNN was used to learn and train the sample data of thoracolumbar fractures, establish the classification model and method of thoracolumbar fractures, and apply the CT images of human thoracolumbar fractures to test experiments.For the classification of type ABC fractures, the overall correct classification rate of the classification model was 86.4%, with a kappa coefficient of 0.850. The sensitivity and specificity of the classification of type A fractures were higher, above 90%, for both thoracic and lumbar spine. Also, there were more unmarked samples for type A compared with type B and C. This may be caused by the bias of irregular shading in the type A dataset. Moreover, the unmarked cases are rarely found in the coronal plane and are mainly concentrated in the sagittal plane. This is because types A3 and A4 are both burst fractures with a richer fracture pattern, leading to increased difficulty in classification.Type C ranked 2nd in the Jorden index. Of the 904 training and 35 validation images, 160 were type C, a smaller percentage than type A. The main reason for type C being misidentified is that in the coronal plane type C is so similar to type A that features characterizing type C osteochondral misalignment are only available when in the sagittal plane. Type C and type B can have similar problems in the coronal plane. In the case of similarity, the misidentification as type A is mainly due to the higher proportion of type A pictures, which obtains a more comprehensive characterization of the characterized type A fracture caused by the uneven proportion of data set types. Type C can have a higher correct rate because it is a displaced fracture morphologically more different from A and B and can be easily distinguished.Type B fractures had the lowest Jorden index in the test, between 0.7 and 0.8, with a specificity of 100%, mainly because too few type B samples were used to train the network, even less than type C. There was an imbalance between the sample proportions, and the learning network model learned the features of type A and C fractures better; secondly, type B tends to be a fracture of the bone joint extending into the spinous portion when the fracture of the spinous is not apparent; it is easy to misidentify type B as type A.For subtype A fracture classification, the overall correctness of the model was 85.3%, with a kappa coefficient of 0.815. The sensitivity was relatively high for types A3 and A4, exceeding 90%. The main problem with A3 and A4 identification was mutual misidentification. Type A3 fractures had only one endplate fracture, while A4 had both upper and lower endplates fractured. The distinction between A3 and A4 can only be made by whether 2 endplates are involved, and the difference between the two is slight, which is the main reason for their confusion. In addition, both A3 and A4 are burst fractures with diverse and variable fracture patterns. In a way, the amount of data in the training sample of 500 cases was insufficient, leading to unmarked A3 and A4 types.The sensitivity of both A1 and A2 recognition is low, mainly due to the small training set of A1 and A2. Except for the unmarked cases, the false identifications are all types A3 and A4 due to the relatively large proportion of A3 and A4 in this dataset. In this study, the type ratio has been artificially balanced in the selection of images so that the number of A1 and A2 is similar and the number of A3 and A4 is similar, which will ensure a specific recognition correct rate with insufficient samples in the dataset.This study's results show that the sensitivity of type B, type C, and two subtypes, A1 and A2, is lower than that of type A and types A3 and A4, respectively. Due to the small number of cases of these fracture types, the amount of data for these types is not enough compared to the amount of data for other types, and the learning network cannot fully extract the features of these fracture types, resulting in poorer recognition of these types. Deep learning has high requirements for dataset quality, and the acquisition of medical images is heavily dependent on clinical cases, making it difficult to establish a universal image dataset. This study found that the proportion of different types in the dataset also impacts the experimental results. Based on clinical experience, patients with A1 and A2 fracture types are themselves fewer, and some fracture cases are less distinctive, resulting in less easy identification by the machine; A3 and A4 types are more concentrated but have more fracture manifestations, resulting in the learning network not learning enough comprehensive features for correct identification. The imbalance in the proportion of dataset types can lead to the misidentification of the less represented categories as the more represented ones. The uneven distribution of the dataset due to insufficient clinical imaging data will impact the experimental results and require an increase in sample size to reduce bias in further studies.The next issue is the number of training datasets and iterations. The ABC typing in this study used 935 training and validation sets and 10,000 iterations of learning. Before the final training, 10,000, 3,000, and 6,000 iterations were used successively, whose recognition results had a significant loss to achieve the expected results, and the number of iterations of 10,000 obtained better results. Therefore, it can be concluded that the size of the training set directly affects the classification and recognition results, which could be solved using other advanced machine learning techniques .In summary, this study starts from the current problems faced by diagnosing spinal fractures caused by basketball injuries and introduces the latest deep learning methods for fracture diagnosis classification. The advanced thoracolumbar fracture classification method can realize the machine's autonomous fracture detection and fracture classification, which helps to shorten the time required for manual diagnosis, effectively promote high-quality medical resources, and improve the accuracy and consistency of early diagnosis of spinal fractures, thereby improving the early diagnosis of spinal fractures, efficacy of treatment of fractures.There are still some limitations in this study: with a small sample data size, the classification accuracy of the method proposed in this research is not high, and it is easy to miss and misidentify. Future research will focus on solving the above small sample problem and achieving accurate learning for fracture patterns by changing the network structure and algorithm.


Objective: To assess the impact of the COVID-19 pandemic and lockdown measures on the presenting characteristics  of newly diagnosed type 1 diabetes in Spanish children. Research Design and Methods: An ambispective observational multicenter study was conducted in nine Spanish tertiary-level hospitals between January 2015 and March 2021. Inclusion criteria: new cases of type 1 diabetes in children (0–14 years) recording age, sex, date of diagnosis, presence of diabetic ketoacidosis (DKA) at onset, and severity of DKA. Data were compared before and during the pandemic. Results: We registered 1444 new cases of type 1 diabetes in children: 1085 in the pre-pandemic period (2015–2019) and 359 during the pandemic (2020–March 2021). There was a significant increase in the group aged ≤4 years in the pandemic period . In 2020–2021, cases of DKA increased significantly by 12% (95% CI: 7.2–20.4%), with a higher percentage of moderate and severe DKA, although this increase was not significant. In 2020, there was a sharp decrease in the number of cases in March, with a progressive increase from May through November, higher than in the same months of the period 2015–2019, highlighting the increase in the number of cases in June, September, and November. The first three months of 2021 showed a different trend to that observed both in the years 2015–2019 and in 2020, with a marked increase in the number of cases. Conclusions: A change in monthly distribution was described, with an increase in DKA at onset of type 1 diabetes. No differences were found in severity, although there were differences in the age distribution, with an increase in the number of cases in children under 4 years of age. Epidemiological studies have an important role in type 1 diabetes, since they enable estimation of the necessary resources for its management, as well as providing insight into its etiology and risk factors.The estimated incidence of type 1 diabetes in the Spanish population under 15 years of age is 17.69 cases/100,000 inhabitants/year .On 31 January 2020, the first case of coronavirus disease 2019 (COVID-19) was diagnosed in Spain . AngioteA number of studies examining the presentation of new cases of type 1 diabetes in children and adolescents after the declaration of the pandemic, reported an increase in the frequency severity of diabetes ketoacidosis (DKA) presentation ,10,11,12The change in the frequency and severity in type 1 diabetes forms presentation after the emergence of the pandemic, raises the hypothesis that variations in the circulation of seasonal viruses, which could have been acting as triggers for onset or the delay in diagnosis due to individuals postponing consultation because of the fear of infection, may have contributed to this new scenario .The aim of the present study was to assess the impact of the COVID-19 pandemic and the resulting lockdown measures on the presenting characteristics of newly diagnosed type 1 diabetes in Spanish children with respect to age at diagnosis, severity, and monthly distribution.This was a multicenter, observational, ambispective study conducted in nine Spanish tertiary-level hospitals between January 2015 and February 2021. We included all new diagnoses of type 1 diabetes in the pediatric population (0–14 years) in each of the participating centers. Age, sex, date of diagnosis, presence of DKA at onset, and severity of DKA  were recorded. Data were collected in two periods and compared before the pandemic (2015–2019) and during the pandemic (2020–2021).The study was undertaken with the approval of the Ethics Committee of the Regional Hospital of Malaga. The diagnostic criteria for type 1 diabetes were those established by the American Diabetes Association . The crip < 0.05 being considered statistically significant. The resulting data are presented in tables and figures to illustrate the distribution of the data.The statistical analysis was performed using R Commander Version 2.7-1 software . To evaluate the differences between the different study years, the chi-squared test was used, with p-value of 0.0041 (We collected data from 1444 new cases of type 1 diabetes in the pediatric age group during the period 2015–2021: 1085 in the pre-pandemic period (2015–2019) and 359 during the pandemic (2020–March 2021). Regarding the distribution of cases by age, an increase in the group aged ≤4 years was evident in the pandemic period, with a chi-squared value of 10.986 with 2 degrees of freedom and a f 0.0041 , indicatDuring 2020–2021, the number of DKA cases increased significantly by 12% (95% CI: 7.2 to 20.4%) . In thisThe monthly distribution of new type 1 diabetes cases, as well as cases with DKA as a form of presentation, are shown in The COVID-19 pandemic has had a major impact on our society, generating changes that may have influenced the epidemiological situation of other diseases such as the onset of type 1 diabetes. Our study describes an increase in cases of new-onset type 1 diabetes with DKA presentation in children and adolescents under 14 years of age in the period 2020–2021, following the declaration of the COVID-19 pandemic by the WHO, compared to previous years. No differences in severity were found over the entire 2020–2021 period. This differs from observations made by other authors from Germany, Italy, Australia, and Canada during the first months after the start of the pandemic ,11,12,13We also found significant differences in the distribution by age group, with an increase in 2020–2021 of children diagnosed under 4 years of age. A study carried out in Germany showed a significant increase in both the incidence of type 1 diabetes and severe forms of DKA, with these results being more striking in children under 6 years of age . The latA study conducted by the Italian Society of Pediatric Endocrinology and Diabetes assessing the epidemiological change during the Italian lockdown (20 February to 14 April 2020), in comparison with the same period in 2019, observed a decrease in the incidence of type 1 diabetes in the confinement period, with the overall incidence being similar in both years , which iFor the first quarter of 2021, our data show an increase in the expected number of cases in this period with respect to previous years. We cannot determine whether this increase in the actual number of cases in the first quarter of 2021 is the result of an increase in incidence or whether it is due to a change in monthly distribution as observed in previous months. We can speculate that impact that different COVID waves and associated protective measures may be having in terms of altering other seasonal infections such as flu, respiratory syncytial virus, rhinovirus, or coxsackie, would play a role in these epidemiological abnormalities observed for new diabetes cases. It is still unclear the involvement of COVID in the genesis or progression of type 1 diabetes. A recent report by the. Centers for Disease Control and Prevention (CDC) of the US reported that persons under 18 y with COVID-19 were more likely to receive a new diabetes diagnosis >30 days after the infection than were those without COVID-19 and those with pre-pandemic acute respiratory infections .A limitation of our study is that we cannot provide incidence rates. The representative sample limited to nine tertiary-level hospitals in Spain showed an increase in DKA as a form of presentation, with a higher presentation in children under 4 years of age and changes in the monthly distribution. In addition, our study collects cases only under the age of 14 years old as the majority of pediatric diabetes centers in Spain take care of patients up to this age group. This might be responsible for the differences observed in the findings of other European countries such as Italy or Germany. Further studies are needed to determine whether these epidemiological changes are directly related to SARS-CoV-2, with the modification of hygiene measures, or other factors that are not being considered at the present time.In conclusion, a change in monthly distribution was noted, as well as an increase in DKA at onset of type 1 diabetes without differences in DKA severity during the first year after the pandemic commencement. Differences in age distribution were observed with an increase in the number of cases in children under 4 years of age. The final causes of these epidemiological changes remain unknown.


Conclusions: Ototoxicity caused by platinum compounds can occur even after the conclusion of the treatments, and the factors affecting its progression are radiotherapy and the aminoglycosides therapy.Background: Platinum compounds are a group of fundamental chemotherapeutics used in the treatment of solid tumors, but they are burdened by side effects, such as ototoxicity. The objective of this study was to evaluate the incidence of ototoxicity caused by platinum compounds and the risk factors affecting its appearance/progression. Methods: Data from 53 patients who received platinum compounds and who had been off therapy for at least 5 years were analyzed. We collected data relating to audiometry conducted annually from the end of treatment and for at least 5 subsequent years, as well as information concerning the oncological history and comorbidities. Results: At the end of the treatment, 17 patients (32.08%) presented ototoxicity, according to the Boston SIOP Ototoxicity Scale; the risk factors included a higher serum creatinine value at diagnosis, having undergone cranial radiotherapy, and needing magnesium supplementation. After 5 years from the end of the treatment, the number of patients with exhibiting ototoxicity was 31 (58.5%); the factors that influenced the onset/progression of the damage were having undergone radiotherapy (HR 1.23;  In recent decades, the use of international cooperative protocols of treatment for pediatric cancer patients has resulted in a marked improvement in their survival . The impPlatinum compounds are among the pivotal drugs used in the treatment of pediatric cancer patients . They arNumerous factors can affect the appearance of ototoxicity, including genetic predisposition, the primary site of the tumor, concomitant radiotherapy, exposure to other ototoxic drugs, the presence of kidney damage, and electrolyte disturbances . AlthougIn this study, we analyzed the prevalence of early- and late-onset ototoxicity and the risk factors for its onset/progression in pediatric patients undergoing treatment with platinum compounds.to describe the prevalence of early- and late-onset ototoxicity in pediatric cancer survivors treated with platinum compounds.The primary endpoint was:to evaluate the severity of ototoxicity according to the SIOP Boston Ototoxicity Scale;to analyze the clinical characteristics of patients with early- and late-onset hearing loss from platinum compounds;to analyze the potential risk factors for progression of hearing damage from platinum compounds after the end of treatment.The secondary endpoints were:In this observational study, data from 90 pediatric patients treated with cisplatin and/or carboplatin, consecutively admitted at the Pediatric Oncology Unit of the Fondazione Policlinico Universitario Agostino Gemelli IRCCS from January 2007 to December 2017, were retrospectively analyzed. The audiological evaluation was performed in the Service of Audiology of the Fondazione Policlinico Universitario Agostino Gemelli IRCCS. Informed consent was obtained from the parents or the legal guardians of the enrolled patients. The study was carried out fin accordance with the Declaration of Helsinki, and it was approved by our ethical committee (protocol ID: 0019971/20-ID 3074). cancer diagnosis at age <18 years;having undergone therapy with cisplatin and/or carboplatin;age at the first platinum course ≤18 years;availability of audiological baseline evaluation before the beginning of treatment, audiological re-evaluation prior to each chemotherapy cycle, and a yearly audiological long-term follow-up for at least 5 years after the end of chemotherapy.Inclusion criteria were: age at first platinum course >18 years;diagnosis of hearing loss at the baseline evaluation before chemotherapy;having received the last administration of platinum compounds less than 5 years previously;absence of audiological evaluation at one or more time-points.Exclusion criteria were:demographic characteristics (age and sex);data related to the neoplastic disease ;type and duration of the treatment ;data related to comorbidity .For each patient, the following data were collected:www.asha.organization/politics, accessed on 17 December 2022). The audiological recordings were reviewed and classified according to the SIOP  Boston Ototoxicity Scale (grade 0–4). Consequently, with our protocol ), while cisplatin was administered to 29 (54.7%) patients (cumulative dose of 367 [SD 218.9]). The number of patients who received both platinum compounds was 18 (33.9%). During treatment with platinum compounds, hypomagnesaemia was found in 8 (15.1%) patients, for which intravenous supplementation was administered. A total of 23 (43.4%) patients underwent aminoglycoside therapy due to febrile neutropenia during treatment with platinum compounds. A diuretic was used in only one patient. No patient presented anomalies in renal function at the start of treatment, and in no case was there any evidence of alteration in renal function during treatment with platinum compounds or during follow-up.At the end of treatment, 17 (32.1%) patients had developed ototoxicity: 5 (29.4%) had class 1 ototoxicity according to the SIOP Boston Ototoxicity Scale, 3 (17.7%) had class 2 ototoxicity, 1 (5.9%) had class 3 ototoxicity, and 8 (47%) had class 4 ototoxicity. In 6 patients, it was necessary to replace cisplatin with carboplatin during treatment due to the appearance of SIOP grade >2 ototoxicity (1 patient with class 2 ototoxicity at the end of treatment and 5 patients with class 4 ototoxicity at the end of treatment).Five years after the end of treatment, 31 (58.5%) patients exhibited hearing damage; 8 (25.8%) had class 1 ototoxicity, 2 (6.5%) had class 2 ototoxicity, 1 (3.2%) had class 3 ototoxicity, and 20 (64.5%) had class 4 ototoxicity, according to the SIOP Boston Ototoxicity Scale. Thus, 5 years after the end of treatment, only 22 patients had normal hearing.At the end of the treatment, 17 patients (32.1%) showed ototoxicity, while 36 patients (67.9%) had normal hearing. No statistically significant differences were observed between patients with ototoxicity and patients with normal hearing at the end of treatment in relation to the age at diagnosis, the age at the beginning of treatment and at the end of treatment, nor to the dose of cisplatin and/or carboplatin.A statistically significant difference was instead observed in relation to the creatinine value at the beginning of the treatment. In fact, patients who showed ototoxicity at the end of treatment had, on average, higher creatinine values  before starting chemotherapy than patients with normal hearing  (p 0.04).The use of other ototoxic drugs, such as aminoglycosides, does not seem to have affected the onset of ototoxicity at the end of treatment in our group of patients, while the presence of alterations in the blood concentration of magnesium and the consequent need for its intravenous integration influenced the onset of hearing impairment. In fact, of the 17 patients with ototoxicity, 29.4% needed magnesium supplementation, while in patients with normal hearing only 8.3% needed magnesium (p 0.04).Most of the patients with ototoxicity at the end of treatment had undergone cranial radiotherapy (76.5%). Of the 21 patients who underwent radiotherapy, 13 exhibited ototoxicity and only 8 did not. On the other hand, the dose of radiotherapy administered does not seem to influence the onset of ototoxicity.A total of 5 years after treatment, the number of patients with hearing loss was 31 (58.5%), while the number of patients with normal hearing was 22 (41.5%). Of the 31 patients with hearing impairment 5 years after the end of treatment, 14 showed the condition of late onset hearing loss. Progressive hearing loss was observed in 7 patients who presented with ototoxicity at the end of treatment. Therefore, 21 (39.6%) patients showed a worsening of hearing abilities in the 5 years following the end of the treatment, 14 passed from class 0 to a class >1 on the SIOP Boston Ototoxicity Scale, , and 7 presented a progression of the damage which was already present at the end of the treatment  see .We compared the characteristics of the patients who experienced a worsening of hearing condition over the 5-year follow-up period with those who maintained stable hearing, and we observed that no statistically significant differences were present between the two groups in relation to the age at diagnosis, the age at the beginning of treatment and the end of treatment, or the dose of cisplatin and/or carboplatin.p = 0.02).In contrast to what was observed at the end of the treatment, the average value of serum creatinine before the beginning of the treatment and the need for Mg intravenous integration were not found to be different between the two groups of patients. However, the percentage of patients who received aminoglycosides during chemotherapy was higher among patients with a progression of the damage (61.9%) than among those with stable hearing (37.5%) (p = 0.007).Five years after the end of the therapy, the number of patients with late-onset hearing loss/progressive hearing loss who had undergone radiotherapy was 13, statistically different from those with stable hearing (The median time to progression of hearing damage was 25.4 months (SD 16.6). p < 0.01) and having received aminoglycosides .As shown in 2, while in our population, the mean dose of cisplatin was 367 mg/m2. Furthermore, 54.7% of our patients received cisplatin during treatment, while 83% received carboplatin; previous studies have shown that cisplatin is burdened by greater ototoxicity than carboplatin [The prevalence of early-onset hearing loss, which was defined as ototoxicity registered at the end of treatment, in our sample of patients was 32.1%. This prevalence is lower than those observed in previous studies , and thiboplatin . The lowAs evidenced by previous studies , a lowerAs previously noted, even in our study population, most patients with ototoxicity had undergone cranial radiotherapy. In fact, this is an important risk factor for the onset of hearing damage from platinum compounds .In the population with early-onset hearing loss, we also observed a higher percentage of patients undergoing neurosurgical surgery than in the population with normal hearing at the end of treatment. This was probably due to the primary location of the tumor and damage to the nerve structures necessary to achieve tumor removal.Five years after the end of treatment, the prevalence of ototoxicity increased to 58.5%. This data demonstrates that the damage caused by platinum compounds can occur and worsen, even after the end of the treatment. In fact, 14 patients who did not have hearing loss at the end of treatment experienced late-onset hearing loss in the following 5 years, and 7 patients experienced a worsening of their conditions. In analyzing the characteristics of these 21 patients, which made up 39.6% of the population, we observed that having received aminoglycosides and having undergone cranial radiotherapy were the only distinguishing features with respect to patients with stable hearing. These two factors have also demonstrated statistical significance in the risk analysis, further highlighting their ability to facilitate the continuation over time of hearing damage from platinum compounds.As previously supposed, the damage to the outer hair cells by aminoglycosides, which are the major target of cisplatin ototoxicity ,28, causRadiotherapy, on the other hand, in addition to facilitating the early-onset of damage from platinum compounds, has shown to be a risk factor for the worsening of hearing loss over time, even after the end of treatment .On the other hand, unlike early-onset hearing loss, in patients with late-onset hearing loss/progressive hearing loss, we did not observe differences in relation to the value of plasma creatinine or in the need for magnesium supplementation. These two elements are probably implicated in the early hearing damage from platinum compounds, but do not act in favoring the continuation of the damage after the end of the treatment.These data demonstrate that the damage from platinum compounds is perpetuated over time and can manifest itself/progress even after the conclusion of the treatment. Therefore, surveillance cannot end with the conclusion of the treatment, but must continue over time to allow for the early identification of the onset of hearing damage. Furthermore, for patients undergoing cranial radiotherapy and aminoglycoside therapy, monitoring must be even more accurate, since these patients are at risk for the progression of ototoxicity after the end of treatment. In our study, we evaluated a 5-year follow-up; however, especially in patients undergoing cranial radiotherapy and those who receive aminoglycosides, the follow-up should be continued even beyond 5 years, given the possibility of late ototoxicity and the worsening of the damage auditory system.The prevalence of early ototoxicity in our population was 32.1%, and the factors influencing its appearance included having undergone radiotherapy, having had a higher serum creatinine value at the beginning of treatment, and having needed magnesium supplementation.A total of 5 years after the end of the treatment, the prevalence of ototoxicity increased up to 58.5%, and 39.6%. of the patients experienced a worsening of hearing in the 5 years after the end of treatment. The factors that influenced the worsening of the damage in the 5 years after the conclusion of the therapy were radiotherapy and aminoglycoside therapy.Therefore, the audiological follow-up of childhood cancer survivors cannot be concluded at the end of the treatment, but must continue over time, with particular attention paid to subjects undergoing radiotherapy and aminoglycoside therapy who could undergo a worsening condition and require medical interventions aimed at the recovery of lost function before further progression.