Search Results (107)

Background: Inferior vena cava (IVC) leiomyosarcoma is a rare vascular malignancy for which complete surgical resection remains the only potentially curative treatment. Surgical management is technically demanding, particularly when the tumor involves the renal veins and retrohepatic IVC, requiring complex vascular reconstruction while preserving renal function. Case Presentation: We report the case of a 60-year-old woman with a localized high-grade IVC leiomyosarcoma involving the retrohepatic cava and both renal vein ostia, with cranial intraluminal extension toward the right atrium. Following multidisciplinary evaluation, the patient underwent en bloc tumor resection with reconstruction of the IVC using a 20mm ringed polytetrafluoroethylene (PTFE) graft. Left renal venous drainage was restored through prosthetic reconstruction using a tubular pericardial conduit anastomosed to the prosthetic graft, while renal function on the right side was preserved by renal autotransplantation into the right iliac fossa. Histopathological examination confirmed a high-grade leiomyosarcoma with negative surgical margins (R0 resection). Adjuvant chemotherapy with doxorubicin and dacarbazine was initiated but discontinued after two cycles because of cardiotoxicity. Fourteen months after surgery, the patient remains disease-free with preserved renal function. Conclusions: Radical resection combined with tailored vascular reconstruction remains the cornerstone of treatment for localized IVC leiomyosarcoma. When the renal veins are involved, combining prosthetic caval reconstruction with renal autotransplantation may represent a safe and feasible strategy to preserve renal function while achieving complete oncological resection. Full article

Sea surface temperature (SST) is a key variable regulating ocean–atmosphere interactions, yet the performance of global Level-4 (L4) SST products in complex coastal environments remains insufficiently evaluated. This study assesses four global L4 SST products (C3SSST, OSTIA, MGDSST, and OISST) in the coastal waters surrounding the Shandong Peninsula using both the iQuam dataset and regional moored buoy (MB) observations. Statistical metrics (COR, RMSE, MAE, BIAS) were employed to quantify accuracy. All four SST products show strong agreement with in situ observations, with correlation coefficients exceeding 0.97. Validation against iQuam showed that OISST achieved the lowest RMSE (~1.008 °C), while coastal buoy observations showed that C3SSST achieved the lowest RMSE at Zhifudao (RMSE ≈ 0.833 °C). Pronounced warm biases at Shidao station during summer suggest that L4 SST products may underestimate coastal upwelling along the Shandong Peninsula. The leave-one-out (LOO) ensemble analysis further revealed consistent differences among the four L4 SST products, with C3SSST and OSTIA showing relatively higher consistency, while OISST exhibited larger deviations from the other products. These results indicate that L4 SST performance depends on both product characteristics, including observational data sources, and local environmental conditions. These findings provide useful guidance for SST dataset selection in the Shandong Peninsula. Full article

Efficient aerosol delivery to the maxillary sinuses remains challenging because narrow ostia limit sinus entry. This in vitro study evaluated whether low-frequency, large-amplitude pulsatile flow can deliver humidifier-generated water aerosols to the maxillary sinuses, compared retention with e-vapor under identical conditions, and identified setup modifications required for water aerosol transport. Experiments used three transparent anatomically realistic sinonasal models: two single-passage models with narrow-long (NL) and wide-short (WS) ostial geometries, and one dual-passage dual-maxillary-sinus (RL) model. Water aerosols and e-vapor were delivered using a modified servo-actuated syringe generator under fixed conditions: 50 mL stroke volume, 0.33 Hz frequency, 1 L/min vacuum-induced flow, and 1.5 min delivery. Water aerosols were larger than e-vapor aerosols (D50 = 5.553 µm vs. 3.394 µm) and required setup modification because of greater wall interactions, condensation, coalescence, and transport losses. Pulsatile delivery achieved plume entry into all tested maxillary sinuses. E-vapor showed greater retained mass than water aerosols in NL (1.060 ± 0.152 vs. 0.540 ± 0.089 mg) and WS (0.800 ± 0.071 vs. 0.520 ± 0.110 mg). Water-sensitive Sar-Gel visualization confirmed bilateral water aerosol retention in RL. These findings support pulsatile delivery as a feasible strategy for water aerosol transport to the maxillary sinuses but with a lower efficiency than e-vapor aerosols. Full article

Background/Objectives: Mucinous adenocarcinoma (MAC) is a rare and clinically problematic subtype of rectal cancer, tending to present at an advanced stage and to respond poorly to neoadjuvant therapy. The consistently worse prognosis than that of not-otherwise-specified adenocarcinoma (NOS-AC) is not fully understood, potentially owing to intrinsically more aggressive biology or specific immune evasion mechanisms. We used the IMMUNOREACT multicentre cohort, with external validation in TCGA, to investigate the clinical and immunological features of rectal MAC in detail. Methods: Two hundred patients with rectal adenocarcinoma (16 MAC, 184 NOS-AC) from the IMMUNOREACT 1 (NCT04915326) and IMMUNOREACT 2 (NCT04917263) prospective cohorts were included. To account for the imbalance in baseline characteristics, propensity score matching (PSM) was performed on age, sex, neoadjuvant treatment and TNM stage. The immune microenvironment was characterised using immunohistochemistry (CD3, CD4, CD8, CD8β, Tbet, FoxP3, PD-L1, MSH6, PMS2, CD80), flow cytometry and NanoString PanCancer IO 360™ transcriptomics of adjacent healthy mucosa. Findings were externally validated against TCGA rectal and colon adenocarcinoma datasets. Results: MAC presented at significantly more advanced stage than NOS-AC across all TNM parameters: higher T stage (p = 0.006), N stage (p < 0.001), M stage (p = 0.039) and overall TNM stage (p < 0.001). In the unmatched cohort, MAC was associated with worse overall survival (HR 2.53; 95% CI 1.03–6.23; p = 0.043) and disease-free survival (HR 2.86; 95% CI 1.25–6.55; p = 0.013), but both differences became non-significant after PSM. MAC patients had higher haemoglobin after adjusting for confounders (mean difference [MD] 1.26 g/dL, 95% CI 0.30–2.31, p = 0.012), consistent with a hypothesis of reduced chronic rectal bleeding as a possible mechanism for late presentation. Transcriptomically, MAC showed suppression of HLA class II antigen presentation genes (HLA-DQA1, HLA-DQB1, HLA-DRB1) and myeloid activation genes (S100A8/A9/A12) in adjacent healthy mucosa. Loss of MMR proteins MSH6 and PMS2 in histologically normal mucosa was significantly more frequent in MAC. These findings were replicated in the TCGA cohort, which also showed lower tumour mutational burden and a distinct mucin-associated transcriptomic profile in MAC. Conclusions: The worse outcomes of rectal MAC appear to be driven largely by late-stage presentation, possibly owing to later diagnosis. MAC nonetheless carries a distinct immune phenotype, detectable even in histologically normal surrounding mucosa, that likely contributes to its treatment resistance. These observations provide a basis for developing histotype-specific approaches to both early detection and treatment in this uncommon but clinically challenging tumour subtype. Full article

Background/Objectives: Delirium is a frequent and clinically significant complication in cardiac surgery patients and is associated with prolonged mechanical ventilation, longer Intensive Care Unit (ICU) stay, increased mortality, and long-term cognitive impairment. However, evidence regarding perioperative factors associated with delirium occurrence in cardiac surgery ICU patients remains limited. This study aims to investigate clinical factors associated with postoperative delirium in cardiac surgery patients admitted to the ICU. Methods: A single-center, prospective, observational study was conducted in a 14-bed cardiothoracic ICU in central Italy. Consecutively enrolled adult patients undergoing cardiac surgery were assessed for delirium using the Italian-validated Intensive Care Delirium Screening Checklist (ICDSC) every eight hours for five days. Univariate analysis and multivariate logistic regression were performed to identify factors associated with delirium occurrence. Results: A total of 175 patients were included, and delirium occurred in 44.6%. In the univariate analysis, patients with delirium presented significantly longer mechanical ventilation (10.5 vs. 8.0 h; p = 0.04) and higher APACHE II scores (p = 0.01). In the multivariable analysis, lower Glasgow Coma Scale (GCS) scores were independently associated with delirium occurrence (OR = 0.84; 95% CI: 0.71–0.99; p = 0.04). Urgent admission (OR = 2.02; p = 0.06) and mean arterial pressure (OR = 0.97; p = 0.08) did not reach statistical significance in the multivariable model. Conclusions: Delirium is highly prevalent after cardiac surgery. Lower postoperative GCS scores may represent an early marker of postoperative neurological vulnerability associated with delirium occurrence. Further multicenter studies are warranted to improve delirium risk stratification and clarify the mechanisms underlying postoperative cognitive dysfunction. Full article

Simulation-based training is increasingly used to support skill acquisition in endoscopic sinus surgery (ESS), although many existing simulators lack objective methods for performance evaluation. This study aimed to assess the face and construct validity of a patient-specific, multi-material 3D-printed sinonasal simulator for ESS using both structured technical scoring and postoperative radiological analysis. Fifteen surgeons with different levels of experience (novices, intermediates, and experts; n = 5 per group) performed a standardized sequence of ESS procedures on identical 3D-printed models, including dacryocystorhinostomy, uncinectomy, maxillary antrostomy, anterior and posterior ethmoidectomy, sphenoidotomy, and frontal sinusotomy (DRAF I). Surgical performance was evaluated on video recordings using a modified Objective Structured Assessment of Technical Skills (OSATS) score. After simulation, each model underwent computed tomography (CT) scanning and a dedicated radiological checklist was applied to assess the adequacy of surgical steps, dimensional parameters of enlarged sinus ostia, and potential procedural complications. Mean OSATS scores differed significantly among expertise levels, with experts achieving higher scores (48.0 ± 1.9) than intermediates (39.4 ± 3.4) and novices (28.4 ± 3.8) (p < 0.01). CT analysis showed a significantly greater extent of ethmoidal cell removal in experts compared with novices (87.5% vs. 57.5%, p = 0.02) and a larger latero-lateral diameter of the frontoethmoidal recess compared with intermediates (p = 0.04). Questionnaire results indicated high perceived educational value, particularly among novices, despite some limitations in haptic realism. While the simulator appears to be a promising tool for ESS training, further studies are required to validate its effectiveness in improving surgical performance. Full article

Accurate multi-day sea surface temperature (SST) prediction at sub-mesoscale resolution is challenging due to nonlinear ocean dynamics, heterogeneous multi-source observations, and error accumulation during autoregressive rollout. This paper proposes a hybrid Mamba–ConvLSTM framework that combines recurrent local spatiotemporal encoding with selective state-space long-range spatial modeling. The ConvLSTM branch captures local spatial patterns and short-range temporal dependencies through convolutional gating, while the Mamba branch captures long-range spatial dependencies across each frame through cross-direction window scanning and maintains temporal coherence via persistent hidden states across successive time steps. A physically informed preprocessing stage aligns 0.083° reanalysis variables to the 0.05° OSTIA target grid via a Grow-and-Cut strategy and extracts gradient-based advection and diffusion proxy features under boundary-aware finite differencing. During autoregressive rollout, auxiliary variables are held at their last observed values and physical proxies are recomputed from the predicted SST, following a clearly specified protocol. Experiments on a South China Sea benchmark compare the proposed model against nine baselines—including persistence, daily climatology, ConvLSTM, PredRNN, ConvGRU, TCTN, PANN, Swin-UNet, and ViT-ST—under an identical data-split, normalization, and rollout protocol. Evaluation with RMSE, MAE, SSIM, $R^2$, and anomaly correlation coefficient (ACC) shows that the proposed model achieves a 10-day average RMSE of 0.512 °C, outperforming the strongest learning-based baseline ViT-ST by 5.0% and the persistence forecast by 21.0%. Ablation studies, sensitivity analyses, seasonal evaluation, and statistical significance testing verify the contribution of each component and the robustness of the results. Full article

This study presents the results of in situ analyses conducted on painted plaster fragments recovered during the 2025 excavation campaign at the Ostia Antica Archaeological Park (Italy). The investigations were carried out by the University of Catania and the Polytechnic University of Bari, within the Ostia Post Scriptum project. The excavation area, located near the Piazzale delle Corporazioni, revealed a prestigious late antique villa, including several rooms connected to a possible Jewish religious building. The plaster fragments, found in different layers of fill within the various rooms of the villa, were analyzed using portable Raman and diffuse reflectance spectroscopy. This combined strategy provides complementary and reliable information on pigment nature, such as cinnabar, red and yellow iron-based, and green earth pigments, and white calcium carbonate. The recurrent presence of cinnabar in different stratigraphic layers, together with the decorative features of the plaster, suggests attribution to a decorative phase dating to the Roman Imperial period. This phase corresponds to the Third or Fourth Pompeian Style. Although the fragments were recovered in secondary positions and cannot be directly associated with specific architectural units, the compositional coherence of the pigment palette aligns with Roman imperial mural painting practices documented at Ostia. Full article

Background/Objectives: Heart failure (HF) is associated with substantial morbidity, impaired quality of life (QOL), and reduced functional capacity. In selected patients with symptomatic HF despite Optimal Medical Therapy (OMT), Cardiac Contractility Modulation (CCM) may be a therapeutic option. Identifying patients most likely to benefit from CCM remains an unmet need. The Predict-CCM study aims to evaluate long-term clinical and objective outcomes after CCM therapy and to assess the predictive value of pre-implant low-dose dobutamine stress echocardiography (LDDSE). Methods and Results: Predict-CCM is an independent, non-profit, multicenter, observational cohort study conducted in Italy, with both retrospective and prospective enrollment. The primary endpoint is the proportion of subjects with a clinical response to CCM at 12 months, defined as a ≥1-class reduction in NYHA class. Secondary clinical endpoints include reductions in HF-related hospitalizations, changes in QOL assessed by the Minnesota Living with Heart Failure Questionnaire (MLHFQ), and changes in NT-proBNP levels from baseline to follow-up. Outcomes will be evaluated in the overall cohort and in two subcohorts stratified by pre-implant LDDSE response: (1) reduction in left ventricular end systolic volume (LVESV) ≥ 15% (DeltaLVESV ≥ 15%); and (2) reduction in LVESV < 15% (DeltaLVESV < 15%). Assuming a 70% clinical response rate at 12 months, the estimated sample size is 120 patients. The study was approved by the Ethics Committee in March 2025. Enrollment will continue for 2 years, with a 12-month follow-up period after implant for each subject. Conclusions: This study may provide new criteria for patient selection and outcome assessment in CCM therapy. Left ventricular contractile reserve assessed by stress echocardiography may be a promising predictor of response. Full article

This study presents the first integrated magnetic and electromagnetic (EMI) survey of the Pianabella Basilica (Ostia, Italy), combining high-resolution magnetic gradient measurements with EMI mapping. The site, characterized by late-antique Christian architecture and funerary structures, provides a complex environment for testing non-invasive geophysical techniques. Magnetic data were acquired using the MagEx system (v.1.2.2558), a new prototype based on Micro-Fabricated Atomic Magnetometer (MFAM) technology, marking its first field deployment in archaeological prospection. Simultaneously, EMI measurements using the CMD-Mini Explorer provided data on apparent conductivity and in-phase components across three depth levels (0.5–1.8 m). The magnetic gradient map successfully delineated the Basilica’s planimetric outline, revealing anomalies (~20 nT/m) corresponding to masonry and internal enclosures. A significant anomaly (50–60 nT/m) north of the Basilica suggests a basalt-paved Roman road leading toward Porta Laurentina. EMI results corroborated these findings, with low-conductivity zones outlining walls and in-phase responses highlighting reused Roman building materials. Despite significant urban noise from a nearby railway and fences, this integrated approach enhanced interpretability and reduced ambiguity. These findings demonstrate the efficacy of next-generation magnetic gradiometry and EMI for high-resolution archaeological investigations, providing a new methodological benchmark for cultural heritage prospection. Full article

Background: Accessory ostia (AOs) can notably alter maxillary sinus ventilation, yet configuration-specific effects remain unclear. This study quantified how AO location and orientation regulate sinus ventilation using in vitro measurements and numerical analyses. Methods: One patient-specific sinonasal geometry (control) was used to reconstruct five models with varying AO numbers, locations, and orientations (AO-F, AO-FC, AO-F30, AO-B, AO-FB). E-vapor was used as a visual tracer for sinus clearance under breath-hold and quiet breathing conditions. Complementary simulations characterized flow dynamics and sinus ventilation rates. Results: Both inhalation and AO presence accelerate e-vapor clearance for all conditions considered. The e-vapor clearance time in AO-FB decreases from 51 s under breath-hold to 29 s under quiet breathing (1 m/s). Configuration-wise, posterior AO ventilates the sinus faster than anterior AO, with dual anterior–posterior ostia (AO-FB) consistently performing the best. Among the three anterior AO, an uptilt AO ventilates the sinus faster than a parallel one, which is in turn faster than an AO located closer to the natural ostium (NO), i.e., AO-F30 > AO-F > AO-FC. CFD predictions provide a mechanistic understanding of the configuration-specific differences observed in vitro. Flow patterns in the ostium–sinus region, as well as the ventilation rate and driving pressure, show high sensitivities to AO location and orientation. At 1 m/s, the predicted AO-NO pressure drop ranges 2–18 mPa, with the lowest in AO-FC and highest in AO-B. Conclusions: The high sensitivity of sinus ventilation to AO configurations underscores the clinical importance of examining NO-adjacent openings in surgical planning and physiological interpretation. Full article

Background: Anastomotic leaks (ALs) remain a critical complication after rectal cancer surgery. Emerging evidence suggests that local immune dysregulation may play a key role in anastomotic healing. We investigated the immune microenvironment of histologically normal, tumor-adjacent rectal mucosa—a tumor-conditioned field—as a potential substrate for AL predisposition. Methods: IMMUNOREACT 4 is a sub-analysis of the IMMUNOREACT project (clinicaltrials.gov NCT04915326 and NCT04915326), a multicenter translational study evaluating immune features of histologically normal, tumor-adjacent rectal mucosa of patients undergoing colorectal anastomosis. A prospective cohort (n = 121) was analyzed using flow cytometry, in addition to a retrospective cohort (n = 262) using immunohistochemistry. Immune markers of epithelial activation and lymphocyte subsets were compared between patients with and without postoperative ALs. Exploratory predictive models combining immune and clinical variables were developed and evaluated using discrimination, calibration and decision curve analyses. Results: At flow cytometry, the CK⁺HLAabc⁺ MFI (AUC 0.66, 95% CI 0.52–0.80), CD8⁺CD38⁺ cell rate (AUC 0.65, 95% CI 0.52–0.78) and CD3⁺CTLA4⁺ cell rate (AUC 0.65, 95% CI 0.51–0.80) showed moderate predictive potential for ALs. In immunohistochemistry, CD3⁺ (AUC 0.57, 95% CI 0.54–0.60), CD8⁺ (AUC 0.57, 95% CI 0.52–0.62), CD8β⁺ (AUC 0.59, 95% CI 0.53–0.65) and Tbet⁺ (AUC 0.60, 95% CI 0.56–0.64) showed some predictive ability for ALs. The model including CD8β⁺, the BMI, neutrophile/lymphocyte ratio and tumor location had an AUC of 0.67 (95% CI 0.62–0.72). Conclusions: Immune activation within histologically normal, tumor-adjacent rectal mucosa—characterized by epithelial HLA upregulation and cytotoxic or Th1 T cell infiltration—is associated with postoperative ALs. Although predictive accuracy is limited, these findings support the concept that a tumor-conditioned immune microenvironment may predispose patients to impaired anastomotic healing. Integration of mucosal immune profiling with clinical variables represents a promising exploratory approach that warrants further prospective validation. Full article

Here, we present published data on the influence of ambient current on the pumping rate of sponges, and subsequently, we make interpretations based on a fluid-mechanical approach for analyzing the sponge–pump system. Ambient water flow past a benthic filter-feeding sponge can give rise to an increased osculum out-flow rate (pumping rate = filtration rate) of the sponge. The mechanism at play is the change in pressure distribution over the sponge. Thus, if ambient flow leads to an increased positive pressure at the ostia inlets and a negative pressure at the osculum outlet, both contribute to a negative backpressure (suction at osculum), which shifts the system characteristic to intersect the pump characteristic at a higher volume flow rate, and this may imply a reduced energy expenditure of the sponge pump. The magnitude of such negative backpressures is estimated for an isolated, upright cylindrical sponge, and based on this, we re-interpret earlier experimental data. However, it is unknown if ambient currents may help the sponge to process the same volume of water at lower energy cost. Full article

We describe a patient with recurrent, brief episodes of chest discomfort caused by a highly mobile papillary fibroelastoma originating from the aortic wall and intermittently encroaching on the right coronary artery ostium. Initial 2D and 3D transthoracic and 2D transesophageal echocardiography identified a highly mobile mass in the ascending aorta above the aortic valve; the exact site of attachment and its relationship to the coronary ostia could not be clearly defined. Three-dimensional transesophageal echocardiography enabled precise anatomical reconstruction of the lesion and surrounding structures, clearly demonstrating its pedicle and proximity to the right coronary ostium. This imaging modality clarified the pathophysiological mechanism of symptoms and facilitated optimal surgical planning without the need for additional complex imaging techniques. Full article

In recent years, global sea surface temperature (SST) has risen steadily, with 2023 and 2024 breaking successive historical observation records, thus rendering marine heatwaves (MHWs) an unignorable new marine disaster. To scientifically mitigate and assess the impacts of MHW disasters on China’s coastal waters, this study developed a monitoring and weekly forecast product for MHWs based on the OSTIA (Operational SST and Ice Analysis) SST observational fusion data and SST numerical forecast data. Evaluation shows the following: the quarterly average of the RMSE for the weekly MHWs intensity forecasts is 0.52 °C; and the quarterly average score for the weekly MHW’s category forecasts is 94.4. Characteristic analysis of 2024 MHWs reveals 93.7% of China’s coastal waters and adjacent areas experienced MHWs throughout the year, and the average monthly impact rate of MHWs is 43.8%. High-value areas of total days and cumulative intensity are concentrated in the central-eastern part of the Yellow Sea, which makes it the most severely affected area by MHW disasters in 2024. The weekly MHW’s forecast product developed in this study provides deterministic weekly forecasts of MHWs intensity and categories for China’s coastal waters. This product can serve as a guidance basis for MHW disaster prevention and mitigation, and help reduce losses caused by MHWs to the marine environment and marine economy. Full article