Search Results (586)

Purpose: To present the findings of our preliminary experience using daily image-guided radiotherapy (IGRT) supported by implanted fiducial markers (FMs) in the radiotherapy of the vaginal cuff, in a cohort of post-surgery endometrial cancer patients. Methods: Patients with vaginal cuff cancer requiring adjuvant radiation with external beams were enrolled. Five patients underwent radiation therapy targeting the pelvic disease and positive lymph nodes, with doses of 50.4 Gy in twenty-eight fractions and a subsequent stereotactic boost on the vaginal vault at a dose of 5 Gy in a single fraction. One patient was administered 30 Gy in five fractions to the vaginal vault. These patients underwent external beam RT following the implantation of three 0.40 × 10 mm gold fiducial markers (FMs). Our IGRT strategy involved real-time 2D kV image-based monitoring of the fiducial markers during the treatment delivery as a surrogate of the vaginal cuff. To explore the potential role of FMs throughout the treatment process, we analyzed cine movies of the 2D kV-triggered images during delivery, as well as the image registration between pre- and post-treatment CBCT scans and the planning CT (pCT). Each CBCT used to trigger fraction delivery was segmented to define the rectum, bladder, and vaginal cuff. We calculated a standard metric to assess the similarity among the images (Dice index). Results: All the patients completed radiotherapy and experienced good tolerance without any reported acute or long-term toxicity. We did not observe any loss of FMs during or before treatment. A total of twenty CBCTs were analyzed across ten fractions. The observed trend showed a relatively emptier bladder compared to the simulation phase, with the bladder filling during the delivery. This resulted in a final median Dice similarity coefficient (DSC) of 0.90, indicating strong performance. The rectum reproducibility revealed greater variability, negatively affecting the quality of the delivery. Only in two patients, FMs showed intrafractional shift > 5 mm, probably associated with considerable rectal volume changes. Target coverage was preserved due to a safe CTV-to-PTV margin (10 mm). Conclusions: In our preliminary study, CBCT in combination with the use of fiducial markers to guide the delivery proved to be a feasible method for IGRT both before and during the treatment of post-operative gynecological cancer. In particular, this approach seems to be promising in selected patients to facilitate the use of SBRT instead of BRT (brachytherapy), thanks to margin reduction and adaptive strategies to optimize dose delivery while minimizing toxicity. A larger sample of patients is needed to confirm our results. Full article

This study comprehensively compares the performance of two non-destructive testing (NDT) techniques—active thermography (AT) and digital shearography (DS)—for identifying various damage types in composite structures. Three distinct composite specimens were inspected: a carbon-fiber-reinforced polymer (CFRP) plate with flat-bottom holes, an aluminum honeycomb core sandwich plate with a circular skin-core disbond, and a CFRP plate with two low-energy impacts damage. The research highlights the significant role of post-processing methods in enhancing damage detectability. For AT, algorithms such as fast Fourier transform (FFT) for temperature phase extraction and principal component thermography (PCT) for identifying significant temperature components were employed, generally making anomalies brighter and easier to locate and size. For DS, a novel band-pass filtering approach applied to phase maps, followed by summing the filtered maps, remarkably improved the visualization and precision of damage-induced anomalies by suppressing background noise. Qualitative image-based comparisons revealed that DS consistently demonstrated superior performance. The sum of DS filtered phase maps provided more detailed and precise information regarding damage location and size compared to both pulsed thermography (PT) and lock-in thermography (LT) temperature phase and amplitude. Notably, DS effectively identified shallow flat-bottom holes and subtle imperfections that AT struggled to clearly resolve, and it provided a more comprehensive representation of the impacts damage location and extent. This enhanced capability of DS is attributed to the novel phase map filtering approach, which significantly improves damage identification compared to the thermogram post-processing methods used for AT. Full article

Background: The identification and clinical implementation of robust biomarkers are essential for improving diagnosis, prognosis, and treatment across a wide range of diseases. Pancreatic stone protein (PSP) has recently emerged as a promising candidate biomarker. Objective: This narrative review aims to provide an updated and comprehensive overview of the clinical applications of PSP in infectious, oncological, metabolic, and surgical contexts. Methods: We conducted a structured literature search using PubMed^®, applying the SANRA framework for narrative reviews. Boolean operators were used to retrieve relevant studies on PSP in a wide range of clinical conditions, including sepsis, gastrointestinal cancers, diabetes, and ventilator-associated pneumonia. Results: PSP has shown strong diagnostic and prognostic potential in sepsis, where it may outperform traditional markers such as CRP and PCT. It has also demonstrated relevance in gastrointestinal cancers, type 1 and type 2 diabetes, and perioperative infections. PSP levels appear to rise earlier than other inflammatory markers and may be less affected by sterile inflammation. Conclusion: PSP represents a versatile and clinically valuable biomarker. Its integration into diagnostic protocols could enhance early detection and risk stratification in critical care and oncology settings. However, widespread adoption is currently limited by the availability of point-of-care assay platforms. Full article

Background/Objectives: Heart transplantation (HTx) is a lifesaving procedure for end-stage heart failure patients; however, postoperative infections remain a major challenge due to immunosuppressive therapy and surgical complications. Traditional biomarkers such as C-reactive protein (CRP) and procalcitonin (PCT) have limitations in distinguishing infections from systemic inflammatory response syndrome (SIRS). Emerging markers such as Presepsin and interleukin-6 (IL-6) may improve diagnostic accuracy. This study aimed to evaluate the kinetics and reliability of these four inflammatory biomarkers in heart transplant recipients in the immediate postoperative period. Methods: This retrospective observational study included 126 patients who underwent HTx at Policlinic of Bari between January 2022 and November 2024. Patients were categorized into infected (n = 26) and non-infected (n = 100) groups based on clinical and microbiological criteria. Biomarkers (CRP, PCT, Presepsin, and IL-6) were measured preoperatively and on postoperative days (PODs) 1, 2, 3, 4, 5, and 10. Statistical analyses included the Mann–Whitney U test and logistic regression to identify the independent predictors of infection. Results: CRP and PCT levels differed significantly between the groups only on day 10, limiting their use as early infection markers. In contrast, Presepsin levels were significantly elevated in infected patients from day 1 (p < 0.001), whereas IL-6 levels showed significant differences from day 3 onward. Presepsin showed the strongest association with infection in the early postoperative phase. Conclusions: Presepsin and IL-6 outperformed CRP and PCT in detecting early postoperative infections in heart transplant recipients. Their early elevation supports their use as reliable markers for guiding timely clinical intervention and improving patient outcomes. Further research is needed to validate these findings in larger cohorts and with different immunosuppressive regimens. Full article

Piezocatalytic therapy (PCT) is a promising strategy for combating implant-associated infections due to its high tissue penetration depth and non-invasive nature. However, its catalytic efficiency remains limited by inefficient electron–hole separation. In this work, an ultrasound-responsive heterojunction (BiOI/Ti₃C₂) was fabricated through in situ growth of bismuth iodide oxide on titanium carbide nanosheets. Subsequently, we integrated BiOI/Ti₃C₂ into poly(e-caprolactone) (PCL) scaffolds using selective laser sintering. The synergistic effect between BiOI and Ti₃C₂ significantly facilitated the redistribution of piezo-induced charges under ultrasound irradiation, effectively suppressing electron–hole recombination. Furthermore, abundant oxygen vacancies in BiOI/Ti₃C₂ provide more active sites for piezocatalytic reactions. Therefore, it enables ultrahigh reactive oxygen species (ROS) yields under ultrasound irradiation, achieving eradication rates of 98.87% for Escherichia coli (E. coli) and 98.51% for Staphylococcus aureus (S. aureus) within 10 minutes while maintaining cytocompatibility for potential tissue integration. This study provides a novel strategy for the utilization of ultrasound-responsive heterojunctions in efficient PCT therapy and bone regeneration. Full article

Sepsis represents a major cause of mortality, especially among patients with liver cirrhosis, who are at increased risk due to immune dysfunction, gut-derived bacterial translocation, and altered hepatic metabolism. Traditional biomarkers such as C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6) often have reduced diagnostic reliability in this subgroup, due to impaired liver and renal function. Presepsin, a soluble fragment of CD14 released during phagocytic activation, has emerged as a promising biomarker for early sepsis detection. This systematic review explores the diagnostic and prognostic utility of presepsin in cirrhotic and non-cirrhotic patients with suspected infection. Data from multiple clinical studies indicate that presepsin levels correlate with infection severity and clinical scores such as SOFA and APACHE II. In cirrhotic patients, presepsin demonstrates superior sensitivity and specificity compared to conventional biomarkers, maintaining diagnostic value despite hepatic dysfunction. Its utility extends to differentiating bacterial infections from fungal infections and monitoring treatment response. While preliminary evidence is compelling, further prospective, multicenter studies are required to validate its integration into standard care algorithms. Presepsin may become a valuable addition to clinical decision-making tools, particularly in hepatology-focused sepsis management. Full article

Background: Total hip arthroplasty (THA) is a well-established surgical procedure for end-stage hip arthrosis. Innovations such as minimally invasive approaches and new technologies have improved outcomes and reduced invasiveness. The introduction of short-stem prostheses, which offer potential benefits in bone preservation, has been a significant development in recent years. This prospective case series study aims to compare invasiveness of the short-stem (SS) and conventional-stem (CS) prostheses in THA with a posterolateral approach (PLA) by assessing perioperative serum markers. Methods: A prospective case series was conducted involving consecutive patients who underwent primary THA from January 2022 to December 2023. Demographics and preoperative, postoperative day 1 (POD1), and postoperative day 2 (POD2) serum levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), procalcitonin (PCT), and white blood cells (WBCs) were measured. Results: The study included 21 patients with CS and 19 with SS, with no significant differences between groups in demographic. No statistically significant differences were found in serum markers between SS and CS groups at any time point. Both groups showed significant increases in ESR, CRP, and PCT from preoperative levels to POD2 (p < 0.001), while WBC values increased from preoperative to POD1 but decreased between POD1 and POD2. Conclusion: The short-stem prosthesis does not exhibit significantly different perioperative serum marker profiles compared to the conventional stem, suggesting similar levels of surgical invasiveness between the two implants. Further studies with larger sample sizes are needed to validate these findings and explore other aspects of short-stem THA. Full article

In order to improve the hydrogen storage properties of Laves phase AB₂-type alloys, a series of Ti_1−xZr_xMn_1.0Cr_0.85Fe_0.1 (x = 0.1–0.5) alloys were prepared by arc melting. The effects of Zr content on microstructure and hydrogen storage properties was investigated in detail. Crystal structure characterizations confirmed that all the alloys exhibit a single-phase C14 Laves structure, and the lattice parameters increase with increasing Zr content. The hydrogen storage measurements of the alloys indicate that with increasing Zr content, the hydrogen storage capacity initially increases and then decreases. The hydrogen absorption and desorption measurements of the alloys were performed by a Sieverts-type apparatus. Pressure–composition–temperature (P-C-T) tests at various temperatures showed that all the alloys display sloped plateaus. Increasing Zr content results in a gradual decrease in hydrogen absorption and desorption plateau pressures. Moreover, these alloys exhibit varying degrees of hysteresis, which also becomes more pronounced with a rise in Zr content. In summary, the Ti_0.7Zr_0.3Mn_1.0Cr_0.85Fe_0.1 alloy demonstrates the best comprehensive hydrogen storage capacity. Further investigation on the cyclic performance of the Ti_0.7Zr_0.3Mn_1.0Cr_0.85Fe_0.1 alloy was conducted. It was found that the alloy particles undergo significant pulverization after hydrogenation cycles, but the alloy maintained good phase structure stability and hydrogen storage performance. Full article

Sepsis causes millions of deaths each year. Rapid, targeted therapy can reduce mortality rates. Both bacterial and viral pathogens can trigger sepsis, but the utility of commonly used inflammatory markers for differentiation remains controversial. Moreover, little is known about the time courses of alternative inflammatory parameters. The aim of this prospective, two-center observational study was to investigate the differences in the course of soluble Neuropilin-1 (sNRP-1) levels between bacterial and viral sepsis over a 7-day period. To be included, adult patients had to meet the SEPSIS-3 criteria and be diagnosed with either a bacterial or viral pathogen. Immunosuppressed patients were excluded. While IL-6, PCT, and CRP levels decreased consistently over time, sNRP-1 levels remained elevated in the bacterial group throughout the entire ICU stay. PCT (p < 0.001) and CRP (p = 0.016) levels were significantly associated with the course of sNRP-1. The AUC of sNRP-1 was 0.777 for discriminating between bacterial and viral infections on day 1. sNRP-1 remained stable and significantly higher in bacterial than in viral infections. Furthermore, the AUC values for discrimination ranged from acceptable to good, depending on the day of the ICU stay. sNRP-1 may serve as a potential tool to differentiate between bacterial and viral pathogens in sepsis. Full article

To genetically characterise an epidemic isolate of feline panleukopenia virus (FPLV) harbouring the Ala91Ser mutation in China, a clinical strain (accession number: OR921195.1), named FPLV-CC19-02, was isolated from a PCR-positive faecal swab sample. Phylogenetic analysis revealed that it is far removed from all current commercial vaccine strains and differs from the FPLV prototype strain Cu-4 (M38246.1), specifically the vaccine strain of Fel-O-Vax^® PCT, at positions 91 (Ala91Ser) and 101 (Ile101Thr) within the VP2 protein. This virus can induce the typical cytopathic effect seen in parvovirus infection in feline kidney cells, resulting in severe clinical symptoms in cats, including haematochezia and hyperthermia. Furthermore, infected cats died of virus infection within 5–10 days post-infection (dpi) (100% morbidity and 83% mortality), indicating that FPLV-CC19-02 is a strain with increased virulence. Additionally, it demonstrated good immunogenicity in cats. Overall, these findings may help us to better understand the molecular prevalence of feline panleukopenia virus in cats and provide valuable basic data for the development of effective, locally adapted feline panleukopenia virus vaccines in China. Full article

Background: Early and accurate diagnosis of neonatal sepsis remains a clinical challenge due to nonspecific signs and limitations of conventional biomarkers. The immature platelet fraction (IPF), a novel hematologic parameter reflecting thrombopoietic activity, has emerged as a potential early sepsis indicator. This study aimed to evaluate the diagnostic value of IPF in neonatal sepsis prior to the onset of thrombocytopenia. Methods: This prospective study enrolled neonates with early-onset sepsis (EOS), late-onset sepsis (LOS), and healthy controls. IPF, C-reactive protein (CRP), procalcitonin (PCT), and hematologic indices were measured at diagnosis and 48–72 h post-treatment. Diagnostic performance was evaluated via ROC curve analysis, and correlations between IPF and inflammatory/hematologic markers were examined. IPF levels were also compared based on blood culture results. Results: IPF levels were significantly higher in both EOS (n: 56) and LOS (n: 50) groups compared to controls (n: 44) (p < 0.001). ROC analysis showed excellent diagnostic performance, with AUCs of 0.98 (EOS) and 0.99 (LOS). Following antibiotic treatment, IPF levels declined significantly (p < 0.001), supporting its dynamic value. Strong and moderate correlations were found with MPV and CRP, respectively, and an inverse association with platelet count, but not with PCT. Moreover, IPF levels were higher in culture-positive cases compared to culture-negative ones (13.1% vs. 9.8%; p = 0.017) and exhibited diagnostic performance comparable to CRP in predicting blood culture positivity. Conclusions: This study presents original and clinically relevant data supporting IPF as a promising and practical hematologic biomarker for early detection and treatment monitoring of neonatal sepsis. Its integration into standard sepsis evaluation protocols may improve early risk stratification and clinical decision-making in neonatal intensive care settings. Full article

Background: Multidrug-resistant (MDR) Gram-negative infections, particularly those caused by carbapenem-resistant Enterobacterales (CRE) and difficult-to-treat Pseudomonas aeruginosa (DTR-Pa), present a growing global healthcare challenge, especially in critically ill populations. Imipenem–relebactam (I/R), a novel β-lactam/β-lactamase inhibitor combination, has shown efficacy in clinical trials, but real-world data remain limited. Methods: We conducted a multicenter, retrospective–prospective observational study across tertiary-care hospitals in Italy between January 2020 and May 2025. Adult patients (≥18 years) treated with I/R for ≥48 h for suspected or confirmed MDR Gram-negative infections were included. Primary endpoints were clinical success at the end of therapy and 30-day all-cause mortality. Secondary endpoints included microbiological eradication, recurrence, safety, and predictors of treatment failure. Statistical analysis involved descriptive methods and correlation analysis for mortality predictors. Results: Twenty-nine patients were included (median age 66 years; 58.6% ICU admission; 71.4% mechanical ventilation). Clinical success was achieved in 22/29 patients (75.9%), while 30-day mortality was 24.1% (7/29). The most common pathogen was Klebsiella pneumoniae (62.1%), with 41.4% of infections being polymicrobial. Microbiological eradication was confirmed in all the BSIs. Parenteral nutrition (p = 0.016), sepsis at presentation (p = 0.04), candidemia (p = 0.036), and arterial catheter use (p = 0.029) were significantly more frequent in non-survivors. Survivors showed significant reductions in CRP, PCT, and bilirubin at 48 h, while non-survivors did not. Parenteral nutrition (rho = 0.427, p = 0.023), sepsis (rho = 0.378, p = 0.043), and arterial catheter use (rho = 0.384, p = 0.04) were significantly correlated with mortality. Conclusions: In this Italian multicenter cohort of critically ill patients, imipenem–relebactam demonstrated high clinical success and acceptable mortality rates in the treatment of severe MDR Gram-negative infections, particularly those caused by KPC-producing K. pneumoniae. Early biomarker dynamics may aid in monitoring treatment response. Larger prospective studies are needed to confirm these findings and define optimal treatment strategies. Full article

High thematic resolution vegetation mapping is essential for monitoring wetland ecosystems, supporting conservation, and guiding water management. However, producing accurate, fine-scale vegetation maps in large, heterogeneous floodplain wetlands remains challenging due to complex hydrology, spectral similarity among vegetation types, and the high cost of extensive field surveys. This study addresses these challenges by developing a scalable vegetation classification framework that integrates cluster-guided sample selection, Random Forest modelling, and multi-source remote-sensing data. The approach combines multi-temporal Sentinel-1 SAR, Sentinel-2 optical imagery, and hydro-morphological predictors derived from LiDAR and hydrologically enforced SRTM DEMs. Applied to the Great Cumbung Swamp, a structurally and hydrologically complex terminal wetland in the lower Lachlan River floodplain of Australia, the framework produced vegetation maps at three hierarchical levels: formations (9 classes), functional groups (14 classes), and plant community types (PCTs; 23 classes). The PCT-level classification achieved an overall accuracy of 93.2%, a kappa coefficient of 0.91, and a Matthews correlation coefficient (MCC) of 0.89, with broader classification levels exceeding 95% accuracy. These results demonstrate that, through targeted sample selection and integration of spectral, structural, and terrain-derived data, high-accuracy, high-resolution wetland vegetation mapping is achievable with reduced field data requirements. The hierarchical structure further enables broader vegetation categories to be efficiently derived from detailed PCT outputs, providing a practical, transferable tool for wetland monitoring, habitat assessment, and conservation planning. Full article

Background/Objectives: Febrile neutropenia is a frequent and potentially life-threatening complication in pediatric oncology patients receiving chemotherapy. Due to profound immunosuppression, early diagnosis of infections remains a major clinical challenge. This review evaluates the diagnostic and prognostic utility of infection biomarkers in children with chemotherapy-induced severe neutropenia. Methods: We reviewed clinical studies that assessed the diagnostic performance of inflammatory biomarkers—including C-reactive protein (CRP), procalcitonin (PCT), interleukins (IL-6, IL-8, IL-10), and others—in pediatric febrile neutropenia. The review includes data on sensitivity, specificity, predictive value, and clinical applications. Results: CRP remains a common but nonspecific marker, often insufficient for early stratification. PCT showed consistently high negative predictive value and early responsiveness to bacterial infections. IL-6 and IL-10 demonstrated strong early diagnostic accuracy in the early phase (AUC > 0.80 in multiple studies) and were particularly useful in predicting septic shock when combined. IL-8, while less specific, may help rule out infection when levels are low. Emerging biomarkers such as presepsin, MR-proADM, and PSP showed promising diagnostic performance. Presepsin achieved near-perfect accuracy in some cohorts (AUC up to 0.996), outperforming CRP and PCT, though its ability to discriminate bacteremia at fever onset varied. MR-proADM demonstrated consistent AUCs above 0.75 and may support early sepsis identification. PSP was associated with significantly elevated levels in sepsis. Additional novel markers—including sTNFR-II, sIL-2R, IP-10, Flt-3L, MCP-1-a, and MBL—showed encouraging diagnostic profiles in individual studies, particularly due to high specificity, but require external validation. G-CSF also emerged as a promising candidate in multimarker models. In contrast, TNF-α and IL-1β displayed limited utility as standalone indicators. Conclusions: Biomarkers such as PCT, IL-6, Il-8, and IL-10 offer valuable tools for early infection detection and risk stratification in pediatric febrile neutropenia. Emerging markers—including presepsin, MR-proADM, and PSP—further enhance diagnostic precision and may support early identification of sepsis. Multimarker strategies, particularly those incorporating presepsin, IL-10, or MR-proADM, show potential to improve diagnostic performance beyond conventional markers. Further prospective validation is needed to optimize clinical implementation and guide personalized treatment decisions. Full article

Background: COVID-19 most often affects the respiratory system and may manifest as acute respiratory failure requiring the use of non-invasive respiratory support (NIRS). The aim of this study was to find predictors based on laboratory results and chest computed tomography (CT) scans performed on admission to the hospital indicating the need for NIRS and predicting mortality after hospital discharge. Methods: We retrospectively analysed data from consecutive patients hospitalised in the Pulmonology Department of the Temporary COVID Hospital in Poznan from 1 February 2021 to 31 March 2022. Upon admission to the department, the patients underwent a series of laboratory blood tests and high-resolution chest CT scan. Results: The study group included 282 patients, with an average age of 60.0 ± 15.0 years. In total, 54 (53%) patients of 101 requiring NIRS died from various causes or required intubation. Patients who required NIRS were significantly older and had more severe changes in the lung parenchyma. They had higher white blood cell and neutrophil counts and lower lymphocyte counts, as well as higher concentrations of D-dimer, CRP, PCT, and IL-6 and greater activities of LDH and AST. Conclusions: Laboratory tests and chest CT performed on hospital admission may be useful to rapidly identify patients at higher risk for severe disease. Full article