Search Results (78)

Background: Breast and hematological cancer treatments, especially with anthracyclines, have been shown to be associated with an increased risk of cardiotoxicity (CTX). An accurate prediction of cardiotoxicity risk and early detection of myocardial injury may allow for effective cardioprotection to be instituted and tailored to reverse cardiac dysfunction and prevent the discontinuation of essential cancer treatments. Objectives: The PRoactive Evaluation of Function to Evade Cardio Toxicity (PREFECT) study sought to evaluate the ability of fast-strain-encoded (F-SENC) cardiac magnetic resonance imaging (CMR) and 2D echocardiography (2D Echo) to stratify patients at risk of CTX prior to initiating cancer treatment, detect early signs of cardiac dysfunction, including subclinical CTX (sub-CTX) and CTX, and monitor for recovery (REC) during cardioprotective therapy. Methods: Fifty-nine patients with breast cancer or lymphoma were prospectively monitored for CTX with F-SENC CMR and 2D Echo over at least 1 year for evidence of cardiac dysfunction during anthracycline based chemotherapy. F-SENC CMR also monitored myocardial deformation in 37 left ventricular (LV) segments to obtain a MyoHealth risk score based on both longitudinal and circumferential strain. Sub-CTX and CTX were classified based on pre-specified cardiotoxicity definitions. Results: CTX was observed in 9/59 (15%) and sub-CTX in 24/59 (41%) patients undergoing chemotherapy. F-SENC CMR parameters at baseline predicted CTX with a lower LVEF (57 ± 5% vs. 61 ± 5% for all, p = 0.05), as well as a lower MyoHealth (70 ± 9 vs. 79 ± 11 for all, p = 0.004) and a worse global circumferential strain (GCS) (−18 ± 1 vs. −20 ± 1 for all, p < 0.001). Pre-chemotherapy MyoHealth had a higher accuracy in predicting the development of CTX compared to CMR LVEF and 2D Echo LVEF (AUC = 0.85, 0.69, and 0.57, respectively). The 2D Echo parameters on baseline imaging did not stratify CTX risk. F-SENC CMR obtained good or excellent images in 320/322 (99.4%) scans. During cancer treatment, MyoHealth had a high accuracy of detecting sub-CTX or CTX (AUC = 0.950), and the highest log likelihood ratio (indicating a higher probability of detecting CTX) followed by F-SENC GLS and F-SENC GCS. CMR LVEF and CMR LV stroke volume index (LVSVI) also significantly worsened in patients developing CTX during cancer treatment. Conclusions: F-SENC CMR provided a reliable and accurate assessment of myocardial function during anthracycline-based chemotherapy, and demonstrated accurate early detection of CTX. In addition, MyoHealth allows for the robust identification of patients at risk for CTX prior to treatment with higher accuracy than LVEF. Full article

Leaves (LV), stems (STs), and inflorescences (IFs) of Pfaffia glomerata are usually discarded despite containing various bioactive compounds, especially β-ecdysone saponin. The objective was to optimize by desirability (DI) the ultrasound-assisted extraction (UAE) of bioactive compounds (total phenolics (TPCs), antioxidant activity (AA), and total saponins) from the aerial parts (LV, ST, and IF) of P. glomerata. Ideal drying conditions were determined and the drying kinetics were evaluated. LV, STs, and IFs were dried and extracted (0.06 g/mL 80% EtOH) in a USS (6 cm × 12 mm, pulse 3/6 s) by Central Composite Design (CCD), varying sonication power (140–560 W) and time (11–139 min), with TPC, AA by DPPH, and total saponin content as responses. The DI indicated that the higher TPC, AA, and saponin levels were obtained at 136.5 min and 137.87 W (STs), and 138.6 min and 562.32 W (LV and IFs). IF extracts contained higher saponin, TPCs, and AA. Higher β-ecdysone levels (3.90 mg g⁻¹) were present in the leaves. Several phenolics were detected in area parts of P. glomerata, the most abundant being p-coumaric acid (LV) and nicotinic acid (STs and IFs). These compounds provide potential health benefits. Phytol was found in all extracts. Extracts by UAE from leaves have antibacterial potential, with demonstrated inhibitory effects against S. aureus, E. coli, L. monocytogenes, S. Typhi, and P. aeruginosa, and presented bactericidal effects against E. coli, L. monocytogenes, and S. Typhi. Aerial parts of P. glomerata can be used to obtain extracts by UAE rich in bioactive compounds, providing complete utilization of the plant and sustainability to cultivation. This work represents the first report on the application of ecofriendly UAE techniques to extract bioactive compounds from the aerial parts of Brazilian ginseng. Full article

This paper introduces a novel structural health monitoring (SHM) approach based on guided electromagnetic waves propagating in a dielectric waveguide in the frequency range from 23.5 to 26 GHz. This approach enables the detection of structural damage based on the analysis of radar signals. This paper presents the performance of the methodology through an experimental case study considering an autonomous heavy lift drone where the whole SHM system is integrated onboard. The whole data acquisition pipeline is described, and damage detection results based on a damage indicator approach are presented and discussed. Finally, this work proves the ability of guided electromagnetic wave technology to be used in flying aerial vehicles. The methodology can be applied to other aircraft structures and application cases in the future. Full article

Background/Objectives: Bleomycin electrosclerotherapy (BEST), which combines intralesional bleomycin administration with electroporation, enhances drug uptake and has shown efficacy in treating vascular malformations resistant to conventional therapies. While BEST is increasingly used in various anatomical sites, its application in the upper aerodigestive tract remains underexplored. This study evaluates the safety and effectiveness of BEST in managing slow-flow vascular malformations of the oral cavity, tongue, larynx, and hypopharynx. Methods: In this retrospective, multicenter study, 20 patients with symptomatic slow-flow vascular malformations of the upper aerodigestive tract were treated with BEST. Clinical and radiological assessments were used to evaluate the treatment response, categorized as “significantly reduced”, “reduced”, “stable disease”, or “lesion growth”. Postprocedural complications and functional outcomes were systematically recorded. Results: A total of 29 BEST sessions were performed. Lesions of the tongue (n = 8) and combined oral cavity and tongue (n = 6) showed the highest response rates, with significant symptom reduction in five out of eight and five out of six patients, respectively. Among isolated oral cavity lesions (n = 4), one out of four demonstrated a significant reduction. In contrast, laryngeal and hypopharyngeal lesions (n = 2) had limited response, with one case showing partial reduction and the other remaining stable. Severe complications, including bleeding and dyspnea requiring tracheostomy, limited further treatment in these locations. No systemic adverse events, such as pulmonary toxicity, were observed. Conclusions: BEST is effective for treating vascular malformations of the upper aerodigestive tract, particularly in the tongue and oral cavity, but presents significant risks in laryngeal and hypopharyngeal lesions. A multidisciplinary approach is required to optimize treatment protocols for these challenging locations. Full article

Ovarian carcinoma is a gynecological cancer with poor long-term survival rates when detected at advanced disease stages. Early symptoms are non-specific, and currently, there are no adequate strategies to identify this disease at an early stage when much higher survival rates can be expected. Ovarian carcinoma is a heterogeneous disease, with various histotypes originating from different cells and tissues, and is characterized by distinct somatic mutations, progression profiles, and treatment responses. Our study presents a targeted metabolomics approach, characterizing seven different ovarian (cancer-) cell lines according to their extracellular, intracellular, and RNA-derived modified nucleoside profiles. Moreover, these data were correlated with transcriptomics data to elucidate the underlying mechanisms. Modified nucleosides are excreted in higher amounts in cancer cell lines due to their altered DNA/RNA metabolism. This study shows that seven different ovarian cancer cell lines, representing different molecular subtypes, can be discriminated according to their specific nucleoside pattern. We suggest modified nucleosides as strong biomarker candidates for ovarian cancer with the potential for subtype-specific discrimination. Extracellular modified nucleosides have the highest potential in the distinguishing of cell lines between control cell lines and themselves, and represent the closest to a desirable, non-invasive biomarker, since they accumulate in blood and urine. Full article

Background/Objective: Tibial eminence avulsion fracture (TEAF) is a traumatic injury of the anterior cruciate ligament that occurs in children with an immature skeletal system. It has an incidence of 3 per 100,000 children, with an increasing prevalence over time. The objective of this study was to evaluate the long-term clinical and subjective outcomes of displaced TEAF requiring surgical intervention and to assess the return to sport. Methods: A retrospective cohort study was conducted, identifying all patients who underwent arthroscopic-assisted TEAF refixation at HFR-Fribourg between 2012 and 2020, performed by a single surgeon. A total of fifteen patients were included for descriptive analysis, while twelve patients underwent clinical assessment of knee joint stability and functional outcomes using patient-reported outcome measures (PROMs): Pedi-IKDC, Lysholm, Tegner, and Marx. Results: Of the fifteen patients, fourteen had type III and one had type II TEAF according to the McKeever classification. The mean age at the time of injury was 11.5 years, and the average time between surgery and long-term follow-up was 5.1 years (range: 0.9–8.9 years). For the primary outcomes of the operated knee, no significant differences were observed in muscle mass or range of motion between the operated and non-operated limbs (p > 0.05). Anterior knee stability, as assessed by the Lachman test and Rolimeter, showed no significant difference between the operated and non-operated knee (p > 0.05). Regarding secondary outcomes, the Pedi-IKDC and Lysholm scores were 98 out of 100, the Tegner score was 5.5 out of 10, and the Marx score was 14.5 out of 20 at the final follow-up. There were no significant differences in the number of hours per week or frequency of sport activity (mean three times per week) before and after surgery. Conclusions: The surgical treatment for displaced TEAF, specifically the pull-out suture technique with arthroscopic assistance, demonstrates excellent clinical and functional outcomes, with high recovery rates and restored knee stability. This technique allows patients to return to sports without significant impairment. Although no comparative analysis was performed, these findings provide a foundation for future studies to further validate and compare the effectiveness of this surgical approach. Full article

Background/Objectives: To develop a decision framework integrating computed tomography (CT) radiomics and clinical factors to guide the selection of transarterial chemoembolization (TACE) technique for optimizing treatment response in non-resectable hepatocellular carcinoma (HCC). Methods: A retrospective analysis was performed on 151 patients [33 conventional TACE (cTACE), 69 drug-eluting bead TACE (DEB-TACE), 49 degradable starch microsphere TACE (DSM-TACE)] who underwent TACE for HCC at a single tertiary center. Pre-TACE contrast-enhanced CT images were used to extract radiomic features of the TACE-treated liver tumor volume. Patient clinical and laboratory data were combined with radiomics-derived predictors in an elastic net regularized logistic regression model to identify independent factors associated with early response at 4–6 weeks post-TACE. Predicted response probabilities under each TACE technique were compared with the actual techniques performed. Results: Elastic net modeling identified three independent predictors of response: radiomic feature “Contrast” (OR = 5.80), BCLC stage B (OR = 0.92), and viral hepatitis etiology (OR = 0.74). Interaction models indicated that the relative benefit of each TACE technique depended on the identified patient-specific predictors. Model-based recommendations differed from the actual treatment selected in 66.2% of cases, suggesting potential for improved patient–technique matching. Conclusions: Integrating CT radiomics with clinical variables may help identify the optimal TACE technique for individual HCC patients. This approach holds promise for a more personalized therapy selection and improved response rates beyond standard clinical decision-making. Full article

Lithium-ion batteries are a key technology in supply chains for modern electric vehicles. Their production is complex and can be prone to defects. As such, the detection of defective batteries is critical to ensure performance and consumer safety. Existing end-of-line testing relies heavily on electrical measurements for identifying defective cells. However, it is possible that not all pertinent information is encoded within the electrical measurements alone. Reversible expansion in lithium-ion cells is an indicator of lithiation within the cell, while irreversible expansion is a consequence of the ageing process; unexpected expansion may indicate the presence of undesirable defects. By measuring expansion in addition to electrical measurements, we aim to make better and faster quality predictions during end-of-line testing, thereby facilitating the early detection of potential defects. To make these predictions, we implement artificial intelligence algorithms to extract information from the measurements. Training these networks requires large training datasets, which are expensive to produce. In this paper, we demonstrate a first-order physical modelling approach for generating synthetic data to pre-train artificial intelligence algorithms that perform anomaly detection on lithium-ion battery cells at the end-of-line. The equivalent circuit model used to generate voltage curves could be fit to real data with a mean absolute error of less than 1%, and the expansion model could be fit to a mean absolute error of less than 2% of the measured values. By pretraining the artificial intelligence network using synthetic data, we can leverage existing physical models to reduce the amount of training data required. Full article

The Kallintiri area (SW Byala Reka–Kechros Dome, Rhodope) hosts a polymetallic (critical, base, and precious metals) ore deposit, tectonically controlled by the late Eocene–Oligocene, top-to-SW Kallintiri Detachment System. The earliest structure associated with the Kallintiri Detachment is a ductile shear zone at the interface between the high-grade footwall gneisses of the Lower and Intermediate Rhodope Terranes. The detachment zone encompasses the uppermost part of the gneisses and the ultramylonitic Makri Unit marble. The marble is bound by a brittle–ductile shear zone at the base and a knife-sharp, low-angle normal fault at the roof, exhibiting considerable brecciation and ultracataclasite development. The hanging wall includes the Makri Unit phyllites and the overlying mid–late-Eocene–Oligocene supra-detachment sediments, which show syn-depositional slump structures and brittle deformation with low- and high-angle faulting and non-cohesive cataclasites. Extensive hydrothermal fluid circulation along the detachment zone and through NW tension gashes and high-angle faults led to pronounced silicification and ore deposition. Field observations and mineralogical and geochemical analyses revealed two primary types of ore mineralization spatially and temporally associated with different structures. Base and precious metals-rich ores are associated with the detachment, while Sb ore deposition is localized mostly within the NW-trending tension gashes and high-angle faults. Full article

The human pupil changes size in response to processing demands or cognitive (work)load and emotional processing. Therefore, it is important to test if automatic tracking of cognitive load by pupil-size measurement is possible under conditions of varying levels of emotion-related processing. Here, we investigated this question in an experiment simulating a highly relevant applied context in which cognitive load and emotional processing can vary independently: a clinical interview. Our participants conducted a live clinical interview via computer monitor with a confederate as an interviewee. We used eye-tracking and automatic extraction of participants’ pupil size to monitor cognitive load (single vs. dual tasks, between participants), while orthogonally varying the emotional content of the interviewee’s answers (neutral vs. negative, between participants). We ensured participants’ processing of the verbal content of the interview by asking all participants to report on the content of the interview in a subsequent memory test and by asking them to discriminate if the answers of the interviewee referred to only herself or to somebody else (too). In the dual-task condition, participants had to monitor additionally if the facial emotional expressions of the interviewee matched the content of her verbal responses. Results showed that pupil-size extraction reliably discriminated between high and low cognitive load, albeit to a lower degree under negative emotional content conditions. This was possible with an algorithmic online measure of cognitive load as well as with a conventional pupil-size measure, providing proof of the external validity of the algorithm/online measure. Full article

Background: Thyroid nodules are common yet remain a diagnostic challenge. While ultrasound and Thyroid Imaging Reporting and Data Systems (TIRADS) are accepted as standard, the use of thyroid scintigraphy in euthyroid patients is debated. The European Association of Nuclear Medicine advocates it, whereas the American Thyroid Association and European Thyroid Association do not. However, it has not been evaluated whether scintigraphy adds value to TIRADS in a multimodal approach. Our study addresses this gap by assessing the impact of integrated pertechnetate scintigraphy on TIRADS accuracy. Methods: The diagnostic performance of ACR-TIRADS, EU-TIRADS, pertechnetate scintigraphy, and multimodal models were retrospectively analyzed for 322 nodules (231 benign, 91 malignant) in 208 euthyroid patients with histopathology as a reference. Generalized estimating equations were used for statistical analysis. Results: On scintigraphy, 210 nodules were hypofunctional, 99 isofunctional, and 13 hyperfunctional. The AUC for thyroid scintigraphy, ACR-TIRADS, and EU-TIRADS were 0.6 (95% CI: 0.55–0.66), 0.83 (95% CI: 0.78–0.88), and 0.78 (95% CI: 0.72–0.83). Integrating scintigraphy with ACR-TIRADS and EU-TIRADS slightly increased diagnostic accuracy (AUC 0.86 vs. 0.83, p = 0.039 and AUC 0.80 vs. 0.78, p = 0.008) and adjusted the malignancy probability for intermediate risk TIRADS categories, with iso- or hyperfunctioning nodules in ACR-TIRADS-TR4 or EU-TIRADS-4 showing comparable malignancy probabilities as hypofunctioning nodules in TR3 or EU-TIRADS-3, respectively. Conclusions: Integrating thyroid scintigraphy with ACR- or EU-TIRADS moderately improves diagnostic performance, potentially benefiting management, especially in complex cases like multinodular goiter or indeterminate FNA. Further research is warranted to validate these findings and explore their clinical implications. Full article

Background: The HHUS market is very complex due to a multitude of equipment variants and several different device manufacturers. Only a few studies have compared different HHUS devices under clinical conditions. We conducted a comprehensive prospective observer study with a direct comparison of nine different HHUS devices in terms of B-scan quality, device handling, and software features under abdominal imaging conditions. Methods: Nine different HHUS devices (Butterfly iQ+, Clarius C3HD3, D5CL Microvue, Philips Lumify, SonoEye Chison, SonoSite iViz, Mindray TE Air, GE Vscan Air, and Youkey Q7) were used in a prospective setting by a total of 12 experienced examiners on the same subjects in each case and then assessed using a detailed questionnaire regarding B-scan quality, handling, and usability of the software. The evaluation was carried out using a point scale (5 points: very good; 1 point: insufficient). Results: In the overall evaluation, Vscan Air and SonoEye Chison achieved the best ratings. They achieved nominal ratings between “good” (4 points) and “very good” (5 points). Both devices differed significantly (p < 0.01) from the other seven devices tested. Among the HHUS devices, Clarius C3HD3 and Vscan Air achieved the best results for B-mode quality, D5CL Microvue achieved the best results for device handling, and SonoEye Chison and Vscan Air achieved the best results for software. Conclusions: This is the first comprehensive study to directly compare different HHUS devices in a head-to-head manner. While the majority of the tested devices demonstrated satisfactory performance, notable discrepancies were observed between them. In particular, the B-scan quality exhibited considerable variation, which may have implications for the clinical application of HHUS. The findings of this study can assist in the selection of an appropriate HHUS device for specific applications, considering the clinical objectives and acknowledging the inherent limitations. Full article

Background: The prevalence of obesity is already a worldwide health concern. The development of straightforward guidelines regarding the whole available armamentarium (i.e., medical, endoscopic, and surgical interventions in conjunction with a guidance program) is paramount to offering the best multimodal approach to patients with obesity. Methods: The International Federation for Surgery of Obesity and Metabolic Disorders-European Chapter (IFSO-EC) identified a panel of experts to develop the present guidelines. The panel formulated a series of clinical questions (based on the patient, intervention, comparison, and outcome conceptual framework), which have been voted on and approved. A GRADE methodology will be applied to assess the quality of evidence and formulate recommendations employed to minimize selection and information biases. This approach aims to enhance the reliability and validity of recommendations, promoting greater adherence to the best available evidence. Results: These guidelines are intended for adult patients with a body mass index (BMI) ≥ 30 kg/m² who are candidates for metabolic bariatric surgery (MBS). The expert panel responsible for developing these guidelines comprised 25 panelists (92% were bariatric surgeons) and 3 evidence reviewers, with an average age of 50.1 ± 10.2 years. The panel focused on 3 key questions regarding the combined use of structured lifestyle interventions, approved obesity management medications, and endoscopic weight loss procedures with MBS. Conclusions: The complexity of obesity as a chronic disease requires a comprehensive knowledge of all the available and feasible therapeutic options. The IFSO-EC society felt the urgent need to develop methodologically valid guidelines to give a full picture and awareness of the possible surgical and non-surgical therapeutic strategies employed with a multimodal approach. Full article

Context/Objective: In order to better understand which metabolic differences are related to insulin resistance in metabolic syndrome (MetSyn), we used hyperinsulinemic–euglycemic (HE) clamps in individuals with MetSyn and related peripheral insulin resistance to circulating biomarkers. Design/Methods: In this cross-sectional study, HE-clamps were performed in treatment-naive men (n = 97) with MetSyn. Subjects were defined as insulin-resistant based on the rate of disappearance (Rd). Machine learning models and conventional statistics were used to identify biomarkers of insulin resistance. Findings were replicated in a cohort with n = 282 obese men and women with (n = 156) and without (n = 126) MetSyn. In addition to this, the relation between biomarkers and adipose tissue was assessed by nuclear magnetic resonance imaging. Results: Peripheral insulin resistance is marked by changes in proteins related to inflammatory processes such as IL-1 and TNF-receptor and superfamily members. These proteins can distinguish between insulin-resistant and insulin-sensitive individuals (AUC = 0.72 ± 0.10) with MetSyn. These proteins were also associated with IFG, liver fat (rho 0.36, p = 1.79 × 10⁻⁹) and visceral adipose tissue (rho = 0.35, p = 6.80 × 10⁻⁹). Interestingly, these proteins had the strongest association in the MetSyn subgroup compared to individuals without MetSyn. Conclusions: MetSyn associated with insulin resistance is characterized by protein changes related to body fat content, insulin signaling and pro-inflammatory processes. These findings provide novel targets for intervention studies and should be the focus of future in vitro and in vivo studies. Full article

The use of hypofractionated radiotherapy in prostate cancer has been increasingly evaluated, whereas accumulated evidence demonstrates comparable oncologic outcomes and toxicity rates compared to normofractionated radiotherapy. In this prospective study, we evaluate all patients with intermediate-risk prostate cancer treated with ultrahypofractionated (UHF) MRI-guided radiotherapy on a 1.5 T MR-Linac within our department and report on workflow and feasibility, as well as physician-recorded and patient-reported longitudinal toxicity. A total of 23 patients with intermediate-risk prostate cancer treated on the 1.5 T MR-Linac with a dose of 42.7 Gy in seven fractions (seven MV step-and-shoot IMRT) were evaluated within the MRL-01 study (NCT04172753). The duration of each treatment step, choice of workflow (adapt to shape-ATS or adapt to position-ATP) and technical and/or patient-sided treatment failure were recorded for each fraction and patient. Acute and late toxicity were scored according to RTOG and CTC V4.0, as well as the use of patient-reported questionnaires. The median follow-up was 12.4 months. All patients completed the planned treatment. The mean duration of a treatment session was 38.2 min. In total, 165 radiotherapy fractions were delivered. ATS was performed in 150 fractions, 5 fractions were delivered using ATP, and 10 fractions were delivered using both ATS and ATP workflows. Severe acute bother (G3+) regarding IPS-score was reported in five patients (23%) at the end of radiotherapy. However, this tended to normalize and no G3+ IPS-score was observed later at any point during follow-up. Furthermore, no other severe genitourinary (GU) or gastrointestinal (GI) acute or late toxicity was observed. One-year biochemical-free recurrence survival was 100%. We report the excellent feasibility of UHF MR-guided radiotherapy for intermediate-risk prostate cancer patients and acceptable toxicity rates in our preliminary study. Randomized controlled studies with long-term follow-up are warranted to detect possible advantages over current state-of-the-art RT techniques. Full article