European University Cyprus

The integration of smart contracts, blockchain, and AI is revolutionizing insurance by boosting efficiency, transparency, and automation, but also introduces legal and regulatory challenges under English common law and the EU AI Act. This chapter explores how smart contracts can be effectively adopted in insurance while addressing trust, transparency, and compliance, focusing on their legal enforceability, use in parametric and marine insurance, and the EU AI Act's stringent demands for fairness, accountability, and transparency in AI-driven processes. It contrasts the UK's flexible, principles-based approach—rooted in good faith and fairness—with the EU's rigid, risk-based framework, assessing their impact on innovation, consumer protection, and cross-border operations. By analyzing algorithmic bias, explainability, liability, and fraud detection, the study provides a holistic legal and regulatory analysis and proposes a balanced framework to harmonize innovation with legal compliance, ensuring a fair, transparent, and resilient insurance market in the digital age.

Abstract Introduction Minimally invasive techniques have transformed early rectal cancer treatment; yet the optimal approach is unclear. ESD, EMR, and TAMIS are increasingly being used, however, most studies only compare two of these techniques. This meta-analysis directly compares all three in efficacy, safety, and oncological performance. Methods PubMed, Scopus, and Medline were searched to identify relevant studies as of September 2024. Criteria included studies in adults with early rectal cancer treated by ESD, EMR, or TAMIS, reporting at least one outcome and specifying treatment type and cancer stage. Comprehensive Meta-Analysis v4 was used for analysis with heterogeneity assessed via I². Results A total of 127 studies encompassing 8915 patients were included (EMR = 3979, ESD = 4470, and TAMIS = 466). Mean procedural times were: overall 8.3 min (7.7–8.8), I² = 99%; EMR 7.5 (6.9–8.1), I² = 98%; ESD 32.6 (29.3–36), I² = 99%; TAMIS 101.6 (83.9–119.9), I² = 95%. En bloc resection: overall 87.1% (85.6–88.5), I² = 81%; EMR 86.5% (84.4–88.4), I² = 82%; ESD 87.2% (84.4–89.5), I² = 80%; TAMIS 94.1% (88.9–97), I² = 0%. R0 resection: overall 79.7% (78.6–80.8), I² = 80%—EMR 79.9% (78.3–81.5), I² = 85%; ESD 78.7% (77.1–80.3), I² = 76%; TAMIS 87.1% (82.8–90.4), I² = 42%. Conclusions Although EMR appears efficient, it demonstrated less favourable outcomes regarding en bloc resection. ESD showed favourable oncological outcomes while maintaining moderate procedural time. TAMIS is most time-intensive but yields the highest resection quality.

Tebipenem is a new carbapenem antibiotic that binds to penicillin-binding proteins (PBPs). Given the need for effective antibiotics against multidrug-resistant (MDR) bacteria, this review evaluated the in vitro antimicrobial activity of tebipenem against Gram-negative and Gram-positive bacteria, focusing on uropathogens. Five resources (Google Scholar, Web of Science, Embase, Scopus, and PubMed) were used to identify relevant articles. Of the 1322 articles identified, 9 relevant studies were included, which evaluated 12,501 Gram-negative and 122 Gram-positive pathogens. All nine studies (100%) assessed the activity of tebipenem against Escherichia coli, with an MIC90 value range of 0.015->4 mg/L. Seven studies (77.8%) included Klebsiella pneumoniae, with an MIC90 value range of 0.015-0.5 mg/L. Six studies (66.7%) reported data on Proteus mirabilis, with an MIC90 value range of ≤0.125-0.5 mg/L. Two studies (22.2%) evaluated the activity of tebipenem against Enterococcus faecalis, with MIC90 of 1 mg/L among vancomycin-susceptible isolates and 32 mg/L in isolates with not-reported mechanisms of resistance. Two studies (22.2%) evaluated the activity of tebipenem against Enterococcus faecium, with MIC90 of >4 mg/L among both vancomycin-susceptible and vancomycin-resistant isolates and MIC90 of 128 mg/L among isolates with no resistance mechanism reported. Tebipenem demonstrated good activity against Enterobacterales, such as E. coli and K. pneumoniae. The antimicrobial agent exhibited higher MICs and a higher proportion of resistance among P. mirabilis isolates. Tebipenem could be effective for outpatient treatment of infections caused by MDR Gram-negative pathogens. However, given its potential to exert selective pressure for the development of antimicrobial resistance, it should be considered for patients with cUTIs when none of the first-line treatment options demonstrate in vitro antimicrobial activity.

Background and Objectives: De Quervain tenosynovitis (DQT) is a stenosing overuse condition of the synovial sheath of the first extensor compartment of the wrist. Open surgical release of the first dorsal compartment remains a standard intervention for DQT when conservative treatments fail. This systematic review evaluated the comparative efficacy of transverse versus longitudinal skin incisions for open release of the first dorsal compartment in DQT. Materials and Methods: Four studies with 259 patients were included in the review. Data from 17 patients were unavailable due to loss to follow-up; therefore, 243 wrists (242 patients) were included in the quantitative analysis. The transverse incision group consisted of 114 cases, and the longitudinal incision group of 129 cases. The primary outcome of the review was the incision-related incidence of injuries to adjacent anatomical structures, including injuries to the superficial branch of the radial nerve (SBRN), tendon injuries, and vein injuries. Secondary outcomes included hypertrophic scar formation, wound infection, and postoperative changes in pain severity measured using a visual analog scale (VAS). Results: Although there was a lower rate of SBRN injury in the longitudinal group (5.4% vs. 7% in the transverse group), the difference did not meet statistical significance (OR = 2.17; 95% CI, 0.39-11.99; p = 0.37; I2 = 30%). Similarly, there was no significant difference in the risk of vein injury (RD = 0.06; 95% CI, -0.03 to 0.14; p = 0.21; I2 = 61%), hypertrophic scar formation (OR = 1.39; 95% CI, 0.32 to 6.04; p = 0.66; I2 = 35%), and wound infection (RD = 0.00; 95% CI, -0.03 to 0.03; p = 0.93; I2 = 0%). Although both approaches resulted in significant pain improvement, no statistically significant difference in postoperative pain was observed between incision types, as assessed by the VAS for pain (mean difference = 0.30; 95% CI, -0.70 to 1.30; p = 0.56; I2 = 43%). Conclusions: No significant differences were identified between incision techniques for DQT in terms of complication rates and postoperative pain outcomes. However, the available evidence is limited, and future high-quality trials are necessary to determine any clinically meaningful difference. Therefore, incision selection should be individualized based on surgeon preference, patient-specific anatomy, and procedural complexity. Despite the technique used, meticulous surgical technique is essential to prevent postoperative complications.

The Cyprus Genome Project characterizes the genetic landscape of the Cypriot population to address the lack of population-specific data in global repositories. We employed a serial independent pool-sequencing (pool-seq) strategy to sequence DNA from 10,000 healthy bone marrow donors, randomized into 10 independent biological replicates. This study design was selected to leverage specific operational and statistical advantages. Operationally, the method enables the processing of a large cohort that would be cost-prohibitive using individual sequencing. Statistically, the use of 10 independent biological replicates allowed for the differentiation of true low-frequency variants from sequencing artifacts. Furthermore, this design enabled the calculation of empirical confidence intervals for variant frequencies. We utilized both Whole Exome Sequencing and a targeted gene panel (813 genes) to maximize read depth and sensitivity. The study identified over 4 million variants, including > 100,000 variants absent from the gnomAD v4.1 and ClinVar databases. Validation against published clinical cohorts confirmed high concordance (r > 0.92). The results highlight significant differences between local and global allele frequencies, including pathogenic variants that are common in Cyprus but rare globally. The results, including an interactive genome map with full annotations from gnomAD v4.1 and ClinVar, are publicly accessible at www.cyprusgenome.org, with the aim of advancing healthcare and facilitating future clinical research.

This qualitative study explores how primary and secondary educators perceive the integration of Artificial Intelligence (AI) in gifted STEAM education within mixed-ability classrooms. This study examines how AI is framed as a pedagogical tool for creativity, differentiation, and inclusion. Educators recognized AI's potential to inspire imaginative engagement and support individualized learning but voiced concerns about student dependency, weakened collaboration, and reduced critical inquiry. Findings reveal ambivalence: AI is seen both as a creative ally and a pedagogical risk. Meaningful integration depends less on technology itself and more on socio-pedagogical frameworks, teacher expertise, curricular fit, and ethical awareness. The study calls for reflective, critically literate approaches to AI in gifted education, challenging techno-optimistic narratives and emphasizing the relational dimensions of teaching and learning.

Suzuki–Miyaura coupling of 3-chloro-5-[(2-ethylhexyl)amino]-4H-1,2,6-thiadiazin-4-one with phenylboronic acid, at ca. 100 °C, gave 3-[(2-ethylhexyl)amino]-5-phenyl-4H-1,2,6-thiadiazin-4-one in 69% yield. Another nucleophilic substitution reaction of 3-chloro-5-[(4-oxo-5-phenyl-4H-1,2,6-thiadiazin-3-yl)amino]-4H-1,2,6-thiadiazin-4-one with 2-ethylhexan-1-amine at ca. 100 °C gave 3-[(2-ethylhexyl)amino]-5-[(4-oxo-5-phenyl-4H-1,2,6-thiadiazin-3-yl)amino]-4H-1,2,6-thiadiazin-4-one in 93% yield.

Solitary median maxillary central incisor (SMMCI) syndrome is a rare developmental disorder in which a patient presents with only one upper central incisor located in the midline, along with some other features -such as deviant sella turcica and pituitary gland morphology, panhypopituitarism, hypothyroidism, and hypoplasia of the inner genitals- that may or may not be present. Although some authors consider it a mild manifestation of holoprosencephaly, others classify it as a distinct entity. The aim of this case report is to describe the orthodontic treatment of an 11-year-old female patient with SMMCI. The patient presented with early permanent dentition, Class II, division 2, subdivision (left) malocclusion on a Class I skeletal pattern, a solitary median maxillary central incisor, and moderate crowding in the lower dental arch. Orthodontic treatment was carried out using fixed appliances, involving the creation of space for an additional maxillary central incisor and the correction of Class II malocclusion through the application of intermaxillary elastics. By the end of treatment, Class I canine and molar relationships had been achieved, the overjet and overbite became optimal, and a one-wing Maryland bridge was placed in the area of the left maxillary central incisor. Regarding retention, a lower fixed retainer from canine to canine and upper and lower vacuum-formed appliances were used. In conclusion, this case report highlights the importance of coordinated care among dental specialists for effectively treating solitary median maxillary central incisor cases.

Current VMAT planning workflows for prostate cancer primarily depend on conventional dose-volume criteria specified at discrete dose or volume points. These point-based objectives, however, do not necessarily lead to globally optimal, patient-specific treatment plans. While radiobiological models such as Tumor Control Probability (TCP) and Normal Tissue Complication Probability (NTCP) can provide more meaningful, individualized targets, previous implementations have either employed these for plan evaluation or integrated biological objectives without providing a comprehensive set of deliverable trade-off plans. To date, no prescription-free, automated VMAT planning method has been introduced that generates clinically deliverable, patient-specific Pareto fronts that are biologically interpretable and useful for radiobiological trade-off analysis. The purpose of this study was to develop and clinically evaluate a fully automated, prescription-free VMAT planning framework for primary prostate cancer that generates Pareto-optimal, clinically deliverable treatment plans in radiobiological objective space, constrained by predefined TCP and NTCP levels. The proposed framework was implemented within a commercial treatment planning system (TPS). 17 patients with unfavorable intermediate-risk prostate cancer were retrospectively selected for evaluation. For each patient, TCP and NTCP levels were predefined for three target volumes and seven organs at risk (OARs), restricting the optimization to clinically meaningful regions of the solution space. Plan optimization was performed using Particle Swarm Optimization (PSO) to iteratively adjust VMAT parameters, with the complication-free tumor control probability (P+) serving as the sole objective function. All resulting, clinically deliverable plans were generated in the TPS and subsequently analyzed in the bi-objective radiobiological space defined by injury probability (PI) versus one minus the benefit probability (1 - PB). The plan yielding the highest P+ and the corresponding individualized pseudo-Pareto front were identified for each patient. The proposed method was benchmarked against clinical moderately hypofractionated simultaneous integrated boost (SIB) plans. The proposed prescription-independent planning approach successfully generated individualized pseudo-Pareto fronts for all 17 patients in the radiobiological space of PI versus (1 - PB). This enabled clinicians to visualize and interpret trade-offs between tumor control and normal tissue complication risk within the predefined TCP and NTCP levels. For each patient, the plan with highest P+ achieved superior predicted tumor control and reduced normal tissue toxicity compared to manually optimized clinical plans. The method effectively individualized dose distributions according to patient-specific anatomy and tumor biology, without reliance on fixed dose prescriptions or conventional constraints. All highest P+ treatment plans fulfilled the clinical dose requirements. Sensitivity analyses demonstrated robustness of the framework with respect to variations in TCP model parameters. This study demonstrated the feasibility of a fully automated, prescription-free VMAT planning framework for primary prostate cancer, indicating its potential for future clinical implementation. The proposed framework directly optimized treatment plans in radiobiological objective space, producing Pareto-optimal, clinically deliverable solutions using predefined TCP and NTCP levels. It enables patient-specific trade-off analysis taking into account tumor control and normal tissue complication risk. The work provides a foundation for further development, including the incorporation of geometric uncertainties, acceleration through parallel or GPU-based computation, and application to additional tumor sites.