Search Results (182)

Peritoneal metastases represent one of the most dreadful manifestations of gastric cancer and continue to drive poor outcomes despite significant advances in systemic therapy. Accurate staging—beginning with laparoscopy—remains essential for avoiding non-beneficial surgery and ensuring appropriate allocation to systemic or locoregional treatment pathways. Although modern systemic agents, including immunotherapy and targeted therapies, have transformed the broader management of metastatic disease, their impact in the peritoneal compartment remains limited, reflecting its unique biological and pharmacokinetic constraints. Locoregional approaches such as CRS–HIPEC, PIPAC, and NIPS have expanded the therapeutic armamentarium and have shown encouraging signals in selected populations. Recent randomized studies, including ESTOK01 and PERISCOPE II, emphasize the importance of careful patient selection, technical standardization, and optimal sequencing, while ongoing trials—such as PREVENT, GASTRICHIP, and CONVERGENCE—seek to refine the integration of systemic and intraperitoneal strategies. Yet the field continues to advance without the benefit of validated predictive biomarkers capable of guiding therapeutic decisions. This limitation constrains clinical progress and underscores the need for a stronger translational framework. Future improvement in the management of gastric cancer with peritoneal metastases will depend on the identification of robust biological predictors of response, enabling more rational patient selection and the development of truly personalized multimodal approaches. Full article

We report on a 6-year-old boy with underlying hypoplastic left heart syndrome and a total cavopulmonary connection (Fontan circulation) with a diagnosis of plastic bronchitis. After an initial good response to therapy, his productive cough became significantly stronger again. Four months later, the patient’s mother brought a preserving jar containing an extensive bronchial cast to the clinic, the size of which is rarely seen in small children. Plastic bronchitis is a rare but dreaded complication in patients with Fontan circulation as well as in infectious or inflammatory diseases; its treatment is challenging. Full article

Background: Takotsubo syndrome (TTS) is an acute cardiac condition characterized by transient left ventricular dysfunction. Although generally considered reversible, early arrhythmias are a dreaded complication and their prognostic significance remains incompletely understood. Methods: In this study, 104 consecutive patients diagnosed with TTS (January 2007 to September 2024) were examined for the prognostic relevance of in-hospital arrhythmias during monitoring at the time of diagnosis. The median follow-up was 2.1 years. The primary combined endpoint included cardiac death, TTS recurrence, occurrence of arrhythmias, and rehospitalization for cardiac causes. Results: In-hospital arrhythmias occurred in 35.6% of the patients. Ventricular arrhythmias were significantly associated with an increased risk of adverse cardiac events (odds ratio 3.94, 95% confidence interval 1.22–12.69; p = 0.021). Reduced left ventricular ejection fraction and QTc prolongation, while frequently observed, were not independently associated with adverse outcomes when analyzed separately from arrhythmic events. Supraventricular arrhythmias exhibited a non-significant trend (p = 0.145). Conclusions: In a large registry of consecutive TTS patients, in-hospital ventricular arrhythmias at diagnosis were significantly associated with adverse outcomes, underscoring the importance of early rhythm monitoring. Full article

The rapid digitalization of work and daily life has introduced a wide range of online threats, from common hazards such as malware and phishing to emerging challenges posed by artificial intelligence (AI). While technical aspects of cybersecurity have received extensive attention, less is known about how individuals perceive digital risks and how these perceptions shape protective behaviors. Building on the psychometric paradigm, this study investigated the perception of seven digital threats among a sample of 300 Italian workers employed in IT and non-IT sectors. Participants rated each hazard on dread and unknown risk dimensions and reported their cybersecurity expertise. Optimism bias and proactive awareness were also detected. Cluster analyses revealed four profiles based on different levels of dread and unknown risk ratings. The four profiles also differed in reported levels of expertise, optimism bias, and proactive awareness. Notably, AI was perceived as the least familiar and most uncertain hazard across groups, underscoring its salience in shaping digital risk perceptions. These findings highlight the heterogeneity of digital risk perception and suggest that tailored communication and training strategies, rather than one-size-fits-all approaches, are essential to fostering safer online practices. Full article

A 75-year-old patient was transferred to the oncology department due to the discovery of a large pelvic tumor compressing the femoral neurovascular bundle suspected to be of malignant origin. Further investigation revealed a rare complication related to a 27-year-old total hip arthroplasty (THA). The final diagnosis was a severe adverse local tissue reaction (ALTR) resulting from excessive implant wear—first from a metal-on-metal (MoM) bearing and later exacerbated by a revision to a metal-on-polyethylene (MoP) articulation. The clinical course was further complicated by periprosthetic joint infection (PJI). The patient underwent extensive tumor-like mass resection followed by two-stage revision arthroplasty. Despite these interventions, infection persisted, ultimately necessitating joint resection. This case highlights the rare but serious convergence of dreaded orthopedic complications (ALTR and PJI). It underscores the diagnostic challenge posed by wear-induced pseudotumors, which are rare even among arthroplasty specialists and are often unfamiliar to oncologists. This case illustrates the importance of early orthopedic evaluation, maintaining a high index of suspicion in atypical presentations, and invites further discussion about the interplay between ALTRs and infection risk in arthroplasty patients. Full article

Operating under septic conditions poses significant challenges in vascular surgery. Infection is a serious risk when handling synthetic vessel prostheses and is one of the most dreaded complications. In the event of graft infection, an infection-resistant alternative is necessary. Cryopreserved vascular allografts offer a suitable alternative to replace an infected vessel or a section of a synthetic graft. However, there are no international guidelines for the preparation, storage, and thawing of such vessel grafts. Here, we aimed to investigate the mechanical properties of human cryopreserved arteries across multiple scales, ranging from nanonewton to newton forces and identify the optimal cryogenic storage duration. Human arterial allograft samples were frozen in a slow, controlled process and stored at −80 °C. One native and four cryopreserved samples were examined during a six-month-long period. Dimethyl-sulphoxide was used as a cryoprotectant. The mechanical properties of fresh and stored samples were explored in uniaxial ring tests and nanoindentation. We found no significant changes in the multi-scale mechanical properties during the examination period. Our results indicate that the cryopreserved vascular allografts are mechanically stable for up to six months under cryogenic conditions; hence, they represent ideal samples in vascular surgery. Full article

The integration of Internet of Things (IoT) technologies into solar energy systems has transformed them into smart solar energy systems, enabling advanced real-time monitoring, control, and optimization. However, this connectivity also expands the attack surface, exposing critical components to cybersecurity threats that could compromise system reliability and long-term sustainability. This study presents a comprehensive cybersecurity threat modeling analysis for IoT-based smart solar energy systems using the STRIDE threat model to systematically identify, categorize, and assess potential security risks. These risks, if unmitigated, could disrupt operations and hinder large-scale adoption of solar energy. The methodology begins with a system use case outlining the architecture and key components, including sensors, PV modules, IoT nodes, gateways, cloud infrastructure, and remote-access interfaces. A Data Flow Diagram (DFD) was developed to visualize the data flow and identify the critical trust boundaries. The STRIDE model was applied to classify threats, such as spoofing, tampering, repudiation, information disclosure, denial of service, and elevation of privilege across components and their interactions. The DREAD risk assessment model was then used to prioritize threats based on the Damage Potential, Reproducibility, Exploitability, Affected Users, and Disability. The results indicate that most threats fall into the high-risk category, with scores ranging from 2.6 to 2.8, emphasizing the need for targeted mitigation. This study proposes security recommendations to address the identified threats and enhance the resilience of IoT-enabled solar energy systems. By securing these infrastructures, this research supports the transition to sustainable energy by ensuring system integrity and protection against cyber threats. The combined use of STRIDE and DREAD provides a robust framework for identifying, categorizing, and prioritizing risks, enabling effective resource allocation and targeted security measures. These findings offer critical insights into safeguarding renewable energy systems against evolving cyber threats, contributing to global energy sustainability goals in an increasingly interconnected world. Full article

Cruciferae family vegetables are remarkably high in phytochemicals such as Indole-3-carbinol (I3C) and Diindolylmethane (DIM), which are widely known as nutritional supplements. I3C and DIM have been studied extensively in different types of cancers like breast, prostate, endometrial, colorectal, gallbladder, hepatic, and cervical, as well as cancers in other tissues. In this review, we summarized the protective effects of I3C and DIM against cardiovascular, neurological, reproductive, metabolic, bone, respiratory, liver, and immune diseases, infections, and drug- and radiation-induced toxicities. Experimental evidence suggests that I3C and DIM offer protection due to their antioxidant, anti-inflammatory, antiapoptotic, immunomodulatory, and xenobiotic properties. Apart from the beneficial effects, the present review also discusses the possible toxicities of I3C and DIM that are reported in various preclinical investigations. So far, most of the reports about I3C and DIM protective effects against various diseases are only from preclinical studies; this emphasizes the dire need for large-scale clinical trials on these phytochemicals against human diseases. Further, in-depth research is required to improve the bioavailability of these two phytochemicals to achieve the desirable protective effects. Overall, our review emphasizes that I3C and DIM may become potential drug candidates for combating dreadful human diseases. Full article

Background: Symptomatic intracranial hemorrhage (sICH) is the most dreaded complication after reperfusion therapy for acute ischemic stroke. We performed a meta-analysis of randomized controlled trials to estimate and compare risks of sICH after mechanical thrombectomy (MT) depending on the location of the large vessel occlusion, concomitant use of intravenous thrombolysis, timing of treatment, and core size. Methods: Randomized controlled trials were included, following a comprehensive search of different databases from inception to 1 March 2024. Random-effect models in a meta-analysis were employed to obtain the pooled risk ratios (RRs) and their corresponding 95% confidence intervals (95% CI) for sICH with MT, and were then compared to other reperfusion treatment regimens, including best medical treatment and intravenous thrombolysis (IVT). Results: MT in the anterior circulation was associated with a significantly higher risk of sICH as compared with no-MT (RR: 1.46; 95%CI: 1.03–2.07; p = 0.037). The risk of sICH was comparable between the MT and MT+IVT groups (RR: 0.77; 95%CI: 0.57–1.03; p = 0.079). There was no difference in sICH risk with MT as compared with no-MT within 6 h of last known well (RR: 1.14; 95%CI: 0.78–1.66; p = 0.485) and beyond that time (RR: 1.29; 95%CI: 0.80–2.08; p = 0.252); the risk of sICH was also comparable between MT conducted within 6 h of last known well and MT conducted beyond that time (p = 0.512). The sICH risk for MT in the posterior circulation (RR: 7.48; 95%CI: 2.27–24.61) was significantly higher than for MT in the anterior circulation (RR: 1.18; 95%CI: 0.90–1.56) (p = 0.003). MT was also associated with a significantly higher sICH risk than no-MT among patients with large core strokes (RR: 1.71; 95%CI: 1.09–2.66, p = 0.018). Conclusions: When evaluating cumulative evidence from randomized controlled trials, the risk of sICH is increased after MT compared with patients not treated with MT. Yet, the difference is largely driven by the greater risk of sICH in patients treated with MT for posterior circulation occlusions and, to a lesser degree, large core strokes. Concomitant use of intravenous thrombolysis and the use of MT in the extended therapeutic window do not raise the risk of sICH. Full article

Background: Post-operative delirium is a dreaded complication after surgery in older patients. The identification of risk factors for delirium and comprehensive geriatric assessment is an extensive part of recent research. However, the preoperative assessment of risk factors, such as impaired cognition, is frequently not standardized. Methods: A comprehensive preoperative assessment was performed in 421 surgical patients to investigate the impact of preoperative cognitive impairment (PCI) on the risk of delirium and to evaluate appropriate screening tools (Six-item screener (SIS) and clock-drawing test (CDT)). Results: Both screening tools showed a significantly increased risk of delirium with p < 0.001 (OR 12.5, 95% [6.42; 24.4]) in SIS and p = 0.042 (OR 2.02, 95%CI [1.02; 4.03]) in CDT for existing cognitive impairment. A higher level of care (p < 0.001) and statutory care (p < 0.001, OR 5.42, 95%CI [2.34; 12.6]) also proved to be significant risk factors. The ROC curves of the two tests show AUC values of 0.741 (SIS) and 0.630 (CDT). The COP values for the SIS are 4 points with a Youden index of 0.447; for the CDT, the COP is 2 (Youden index = 0.177). Conclusions: The recording of PCI should be a central component of the preoperative geriatric assessment. The tools used are simple yet effective and can be easily implemented in routine clinical practice. By reliably identifying patients at risk, the available resources can be personalized and used in a targeted approach. Full article

Background and Objectives: Biofilm formation on cochlear implants (CIs) poses a major problem for surgeons, leading to a high incidence of explantation and revision surgery. Therefore, developing appropriate and cost-effective biofilm detection and prevention techniques is of the essence. In this systematic review, we sought to investigate the development of biofilm formation on CIs. We also elaborated on experimental preventative biofilm measures. Materials and Methods: We conducted a systematic search of both in vitro and in vivo literature published in PubMed, Scopus, and ScienceDirect, until 15 June 2024, for published studies evaluating the biofilm formation and strategies for inhibiting biofilm formation on CIs. Depending on the type of the included study, we assessed quality with the modified Consolidated Standards of Reporting Trials tool, the Joanna Briggs Institute Case Reports Critical Appraisal Tool, a modified Delphi technique, and the ROBINS-I tool. We synthesized the available information on biofilm formation on CIs and the infection prevention capacity of the included antibiofilm agents. Results: A total of 26 studies were included in this systematic review. Biofilms in CIs are usually localized in their recesses such as their removable magnet pocket as opposed to their smooth surfaces. S. aureus and P. aeruginosa are the most commonly isolated microorganisms, and they tend to be strong biofilm producers. The optimal treatment strategy for a biofilm-infected CI is explantation. Most of the examined biofilm prevention methods in CIs present sufficient antibiofilm activity. Conclusions: Biofilm formation in CIs is considered one of the most dreadful complications. There have been no specific guidelines for the treatment of those cases, with removal and/or replacement of the CI being the treatment of choice. Various experimental prevention methods provide promising antibiofilm activity both in vivo and in vitro. Full article

A global discourse surrounding physical education (PE) is shifting towards a stronger emphasis on inclusive practises, but research shows that some students still find the subject problematic. This study explores the relationship between students’ dread of physical education (PE) and overall school satisfaction among sixth graders in Tromsø Municipality, Norway, and identifies factors that might explain this relationship. Data were collected from 338 sixth-grade students, with an 85.5% response rate. In this study, we investigate through quantitative analyses whether there is a correlation between students dreading PE and their overall school satisfaction. We find a relatively low correlation between these factors, indicating that dreading PE may be related to factors beyond general school satisfaction. Three significant predictors of students’ apprehension towards PE were identified: self-confidence and self-esteem, discomfort in changing into gym clothes in communal locker rooms, and reluctance to collaborate indiscriminately with peers. These factors could indicate a performance-oriented climate, which contrasts with the mastery-oriented approach emphasised in the national curriculum. The findings highlight the need for PE to be taught in a way that aligns more closely with the curriculum. This study suggests that addressing these issues requires educators who are formally trained to foster a supportive and motivating environment and calls for further research into the translation of curriculum objectives into teaching practises. Full article

Background/Objectives: Glioblastomas (GBMs) are dreadful brain tumors with abysmal survival outcomes. GBM extracellular vesicles (EVs) dramatically affect normal brain cells (largely astrocytes) constituting the tumor microenvironment (TME). We asked if EVs from different GBM patient-derived spheroid lines would differentially alter recipient brain cell phenotypes. This turned out to be the case, with the net outcome of treatment with GBM EVs nonetheless converging on increased tumorigenicity. Methods: GBM spheroids and brain slices were derived from neurosurgical patient tissues following informed consent. Astrocytes were commercially obtained. EVs were isolated from conditioned culture media by ultrafiltration, concentration, and ultracentrifugation. EVs were characterized by nanoparticle tracking analysis, electron microscopy, biochemical markers, and proteomics. Astrocytes/brain tissues were treated with GBM EVs before downstream analyses. Results: EVs from different GBMs induced brain cells to alter secretomes with pro-inflammatory or TME-modifying (proteolytic) effects. Astrocyte responses ranged from anti-viral gene/protein expression and cytokine release to altered extracellular signal-regulated protein kinase (ERK1/2) signaling pathways, and conditioned media from EV-treated cells increased GBM cell proliferation. Conclusions: Astrocytes/brain slices treated with different GBM EVs underwent non-identical changes in various omics readouts and other assays, indicating “personalized” tumor-specific GBM EV effects on the TME. This raises concern regarding reliance on “model” systems as a sole basis for translational direction. Nonetheless, net downstream impacts from differential cellular and TME effects still led to increased tumorigenic capacities for the different GBMs. Full article

Background: Anastomotic leakage (AL) is a dreaded complication after oesophagectomy. Endoluminal vacuum-assisted closure therapy (EVAC) has been increasingly used as a first-line treatment for AL. We aimed to identify any potential adverse effects of a neoadjuvant therapy (chemotherapy (CT) or radiochemotherapy (RCT)) on EVAC. Methods: We performed a retrospective cohort study at our tertiary centre between 2013 and 2024. All patients who underwent EVAC for AL after oesophagectomy were included in this study. Parameters such as success rate, length of therapy, number of sponges needed, changes in treatment, and survival were analysed. Results: A total of 29 patients were included, 19 of whom received CT/RCT and 10 of whom received no neoadjuvant treatment (NT). There was no significant difference in patient survival (30-day survival rate CT/RCT n = 1 (5.3%) vs. NT n = 1 (10%), p = 0.632), success rate (CT/RCT n = 15 (78.9%) vs. NT n = 9 (90%), p = 0.454), and length of therapy (CT/RCT vs. NT 24.11 vs. 23.8, p = 0.681), the number of sponges required (CT/RCT vs. NT 6.26 vs. 6.6, p = 0.835), and the need for changing treatment (CT/RCT n = 5 (26.3%) vs. NT n = 1 (10%), p = 0.303). Conclusions: NT did not affect the success rate or length of therapy. Thus, we found no significant influence of CT/RCT on EVAC for AL after oesophagectomy. Full article

Cancer is a remarkable prothrombotic disease, and cancer-associated thrombosis acts as a dreadful omen for poor prognosis. The cornerstone of venous thromboembolism therapy is anticoagulation; however, in patients with venous thromboembolism who are not suitable for anticoagulation (contraindication, failure, or complication), the inferior vena cava filter appears a valuable option in the therapeutic arsenal. The recently heightened trend of steady rise in filter placement mirrors the spread of retrievable devices, together with improvements in physicians’ insertion ability, medico-legal issue, and novel and fewer thrombogenic materials. Nevertheless, the exact role of the inferior vena cava filter in cancer has yet to be endorsed due to a dearth of robust evidence. Indeed, data that support the inferior vena cava filter are weak and even controversial, resulting in discrepancies in the interpretation and application of guidelines in daily practice. In this narrative review, we aim at clarifying the state of the art on inferior vena cava filter use in malignancies. Furthermore, we provide a feasible, conclusive 4-step algorithm for the treating physicians in order to offer a practical strategy to successfully employ the inferior vena cava filter as a priceless device in the current armamentarium against cancer. Full article