Search Results (1,471)

Breast-conserving surgery followed by external beam Radiotherapy (RT) is a standard approach for early-stage Breast Cancer (BC). This retrospective study aims to determine the risk of RT-induced lung cancer for both standard and hypofractionated treatments. Fifty-eight Sicilian women treated at Humanitas Istituto Clinico Catanese (Misterbianco, Italy) between 2015 and 2021 with standard fractionated 3D-CRT (50 Gy in 2 Gy/fraction) were included. All treatment plans were designed using a hypofractionated schedule (42.56 Gy in 2.66 Gy/fraction). An Eclipse™ plug-in script was developed using the Eclipse Scripting Application Programming Interface (ESAPI) to extract patient and treatment data from the Treatment Planning System and compute Organ At Risk (OAR) volume, Organ Equivalent Dose (OED), Excess Absolute Risk (EAR), and Lifetime Attributable Risk (LAR) using the Schneider Mechanistic Model and reference data from regional populations, A-bomb survivors, and patients with Hodgkin’s Disease (HD). The OED distributions exhibited a statistically significant shift toward higher values in standard fractionated plans (p < 0.01, one-tailed paired Student’s t-test), leading to increased EAR and LAR. These results indicate that hypofractionated treatment may lower the risk of radiation-induced lung cancer. The feasibility of a priori risk estimation was evaluated by integrating the script into the TPS, allowing rapid comparison of SF and HF plans during planning. Full article

Background/Objectives: This study aims to uncover the variables related to the success of the intervention. Methods: A retrospective study was conducted on patients who underwent joint replacement surgery utilizing a customized alloplastic system between 2018 and 2023, comprising subjects with complete records for both the planning and follow-up phases. The Student’s t-test was applied with a significance threshold of p < 0.05. Results: Forty-eight subjects were admitted for initial analysis, and 31 subjects were evaluated with a minimum follow-up of 1 year and a maximum of 7 years, with a mean age of 36.37 ± 15.53. The TMJ diagnosis was mainly with degenerative TMJ disease, followed by ankylosis and craniofacial syndromes, and an average of 2.1 ± 1.2 previous surgeries were noted. Degenerative joint disease correlated with increased pain (p < 0.0001) and a higher prevalence of prior joint surgery (p < 0.0001). Thirty-one subjects were followed up with 47 prostheses installed; 74.4% underwent complementary surgery with other facial osteotomies. Significant improvements (p < 0.0001) were observed when comparing pain levels pre- and postoperatively, with a decrease from 5.5 (±2.3) to 2.2 (±0.4). Concerning the interincisal opening, there was a significant increase (p < 0001) from 25.85 (±10.2) mm to 35.93 (±4.2) mm in mouth opening. TMJ replacement treatment is efficient and effective, demonstrating stability in follow-up assessments for up to 7 years. Conclusions: The indications for replacement are diverse and may benefit patients who have not yet progressed to end-stage TMJ disease. Full article

This study examined the impact of entrepreneurship education in sustainability on entrepreneurial intention using the theory of planned behavior (TPB). The MEMORE macro was used to analyze within-subject mediation and enabled us to examine how entrepreneurial intention is affected by changes in the factors of the theory of planned behavior (attitude, subjective norms, perceived behavioral control). The survey follows a questionnaire-based, pre-test-post-test design (the research involved 271 business administration students in Athens). A paired sample t-test was used to analyze changes in attitude, subjective norms, perceived behavioral control, and entrepreneurial intention before and after education. The results indicated that after the entrepreneurship course in sustainability, students indicated a significant positive change in entrepreneurial intention, attitude, and perceived behavioral control. MEMORE macro indicated that only the change in perceived behavioral control positively influenced the increase in entrepreneurial intention levels. Based on these findings, entrepreneurship education in sustainability enhances students’ entrepreneurial intentions by increasing their perceived behavioral control. As a result, students’ confidence and knowledge regarding sustainable entrepreneurship are fundamental to the development of sustainable entrepreneurial mindsets. This study emphasizes the importance of integrating targeted pedagogical approaches that enhance perceived behavioral control in sustainable entrepreneurship education by equipping students with practical knowledge and skills to overcome psychological barriers. The use of the MEMORE macro highlights this study’s innovation, uncovering new relationships between the examined variables. Full article

Background: Connubial melanoma, the occurrence of melanoma in non-consanguineous spouses, is rarely described in the literature. This study aimed to evaluate the prevalence of shared risk factors, preventive behaviors, and the influence of couple dynamics on the early diagnosis of cutaneous melanoma (CM). Methods: We conducted a retrospective observational study at the San Gallicano Dermatological Institute IRCCS, Rome, enrolling 52 heterosexual couples diagnosed with CM between 2010 and 2023. Clinical and anamnestic data, including phototype, history of sun exposure, use of tanning devices, and reason for dermatological evaluation, were collected. Dermatological assessments included dermoscopy, total body photography, and histological examination of excised lesions. Statistical analyses were performed using chi-square and Student’s t-tests. Results: Women reported significantly higher use of artificial ultraviolet sources (51.9% vs. 19.2%, p < 0.001) and more frequent histories of sunburn. Phototype II was associated with higher use of tanning devices and a greater prevalence of sunburns. Although the CM stage did not significantly differ between sexes, husbands exhibited a greater Breslow thickness. Melanoma localization differed by sex, with lower limbs more often affected in women and the trunk in men (p < 0.001). In 86.5% of cases, wives initiated their husband’s dermatological evaluation, leading to earlier diagnosis. Conclusions: Despite shared environmental exposures, men and women differ in preventive behaviors and risk profiles. Women play a crucial role in promoting early detection among couples. Couple-based preventive strategies may be instrumental in improving early melanoma diagnosis and outcomes. Full article

The snakes from the genus Bothrops are responsible for most of the ophidic accidents in Brazil, and Bothrops atrox represents one of these species. Envenomation by these snakes results in systemic effects and is often associated with early mortality following snakebite incidents. The present study investigates the pharmacological properties of Bothrops atrox venom (VBA), focusing specifically on its impact on renal blood flow. Following the renal perfusion procedure, kidney tissues were processed for histopathological examination. Statistical analysis of all evaluated parameters was conducted using ANOVA and Student’s t-test, with significance set at p < 0.005. Administration of VBA resulted in a marked reduction in both perfusion pressure and renal vascular resistance. In contrast, there was a significant elevation in urinary output and glomerular filtration rate. Histological changes observed in the perfused kidneys were mild. The involvement of nitric oxide in the pressor effects of Bothrops atrox venom was not investigated in renal perfusion systems or in in vivo models. Treatment with VBA led to elevated nitrite levels in the bloodstream of the experimental animals. This effect was completely inhibited following pharmacological blockade with L-NAME. Based on these findings, we conclude that VBA alters renal function and promotes increased nitric oxide production. Full article

At the Michael G. DeGroote School of Medicine, a significant component of the MD curriculum involves written narrative reflections on topics related to professional identity in medicine, with written feedback provided by their in-person longitudinal facilitators (LFs). However, it remains to be understood how generative artificial intelligence chatbots, such as ChatGPT (GPT-4), augment the feedback process and how MD students perceive feedback provided by ChatGPT versus the feedback provided by their LFs. In this study, 15 MD students provided their written narrative reflections along with the feedback they received from their LFs. Their reflections were input into ChatGPT (GPT-4) to generate instantaneous personalized feedback. MD students rated both modalities of feedback using a Likert-scale survey, in addition to providing open-ended textual responses. Quantitative analysis involved mean comparisons and t-tests, while qualitative responses were coded for themes and representational quotations. The results showed that while the LF-provided feedback was rated slightly higher in six out of eight survey items, these differences were not statistically significant. In contrast, ChatGPT scored significantly higher in helping to identify strengths and areas for improvement, as well as in providing actionable steps for improvement. Criticisms of ChatGPT included a discernible “AI tone” and paraphrasing or misuse of quotations from the reflections. In addition, MD students valued LF feedback for being more personal and reflective of the real, in-person relationships formed with LFs. Overall, findings suggest that although skepticism regarding ChatGPT’s feedback exists amongst MD students, it represents a viable avenue for deepening reflective practice and easing some of the burden on LFs. Full article

Background and Objectives: Immunodeficiency associated with aging comorbidities increases the vulnerability of geriatric patients to sepsis. Early recognition and management of sepsis are essential in this population. This study evaluated the relationships between RDW, MPV, and MPV/PLT ratios and mortality in geriatric sepsis patients. Materials and Methods: This retrospective study was conducted between 2020 and 2024 in the Intensive Care Unit of the Department of Anesthesiology and Reanimation at a university hospital. Patients aged ≥ 65 years with a SOFA score of ≥2 were included. Demographic data (sex, age, height, weight, and BMI), hemogram parameters (RDW, MPV, and PLT), blood gas, and biochemical values were analyzed. Furthermore, their comorbidities; site of infection; ICU length of stay; vital signs; and SOFA, APACHE II, and SAPS II scores, recorded within the first 24 h following ICU admission, were evaluated. Statistical analysis was performed using the chi-square test, Student’s t-test, the Mann–Whitney U test, the Monte Carlo exact test, and ROC analysis. A p-value of <0.05 was considered statistically significant. Results: A total of 247 patients were included, with 46.2% (n = 114) classified as non-survivors during the 28-day follow-up period. Among them, 64.9% (n = 74) were male, with a mean age of 78.22 ± 8.53 years. Significant differences were also found in SOFA, APACHE-II, and SAPS-II scores between non-survivors and survivors (SOFA: 7.64 ± 3.16 vs. 6.78 ± 2.78, p = 0.023; APACHE-II: 21.31 ± 6.36 vs. 19.27 ± 5.88, p = 0.009; SAPS-II: 53.15 ± 16.04 vs. 46.93 ± 14.64, p = 0.002). On days 1, 3, and 5, the MPV/PLT ratio demonstrated a statistically significant predictive value for 28-day mortality. The optimal cut-off values were >0.03 on day 1 (AUC: 0.580, 95% CI: 0.516–0.642, sensitivity: 72.81%, specificity: 65.91%, p = 0.027), >0.04 on day 3 (AUC: 0.602, 95% CI: 0.538–0.663, sensitivity: 60.53%, specificity: 60.61%, p = 0.005), and >0.04 on day 5 (AUC: 0.618, 95% CI: 0.554–0.790, sensitivity: 66.14%, specificity: 62.88%, p = 0.001). Conclusions: The MPV and MPV/PLT ratios demonstrated statistically significant but limited predictive value for 28-day mortality in geriatric patients with sepsis. In contrast, the limited prognostic value of RDW may be related to variability in the inflammatory response and other underlying conditions. The correlations found between SOFA, APACHE II, and SAPS II scores highlight their importance in mortality risk prediction. Full article

Nursing students often face emotional challenges related to death and dying, affecting their psychological well-being, emotional intelligence, and academic success. Cultural and educational factors may influence how they experience and manage these stressors. This study aimed to compare fear of death, emotional intelligence, coping with death, and academic burnout among second-year nursing students in Spain and Portugal to identify cross-cultural differences. A cross-sectional study was conducted among 174 second-year nursing students from the University of Extremadura (Spain) and the University of Évora (Portugal) during the 2023/2024 academic year. The instruments used included the Collett–Lester Brief Fear of Death Scale, the Trait Meta-Mood Scale—24 ítems, the Bugen’s Coping with Death Scale, and the Maslach Burnout Inventory—Student Survey. Descriptive statistics were calculated, and group comparisons were performed using independent samples t-tests and Welch’s t-tests, depending on variance homogeneity. A two-way ANOVA was also conducted to explore interactions between gender and nationality. The Spanish sample comprised 86 women and 21 men, and the Portuguese sample included 58 women and 9 men. The mean age across the sample was 21.5 years (SD = 4.15). No significant differences were observed in fear of death or emotional intelligence between the two groups. However, Portuguese students showed significantly better coping with death, but also higher academic burnout and cynicism. Spanish students reported greater perceived efficacy. Although emotional intelligence and death anxiety were similar, Portuguese students demonstrated stronger coping skills but experienced more burnout. This suggests that coping alone may not buffer academic stress, emphasizing the need for culturally tailored interventions to enhance emotional readiness and reduce burnout. Full article

As yet, no study has investigated the use of a research magnetic resonance imaging (MRI) scanner to support undergraduate medical radiation science (MRS) students in developing their MRI knowledge and practical skills (competences). The purpose of this study was to test an innovative program for a total of 10 s- and third-year students of a MRS course to enhance their MRI competences. The study involved an experimental, two-week MRI learning program which focused on practical MRI scanning of phantoms and healthy volunteers. Pre- and post-program questionnaires and tests were used to evaluate the competence development of these participants as well as the program’s educational quality. Descriptive statistics, along with Wilcoxon signed-rank and paired t-tests, were used for statistical analysis. The program improved the participants’ self-perceived and actual MRI competences significantly (from an average of 2.80 to 3.20 out of 5.00, p = 0.046; and from an average of 34.87% to 62.72%, Cohen’s d effect size: 2.53, p < 0.001, respectively). Furthermore, they rated all aspects of the program’s educational quality highly (mean: 3.90–4.80 out of 5.00) and indicated that the program was extremely valuable, very effective, and practical. Nonetheless, further evaluation should be conducted in a broader setting with a larger sample size to validate the findings of this feasibility study, given the study’s small sample size and participant selection bias. Full article

This study explores asymmetric volatility structures within multivariate hysteretic autoregressive (MHAR) models that incorporate conditional correlations, aiming to flexibly capture the dynamic behavior of global financial assets. The proposed framework integrates regime switching and time-varying delays governed by a hysteresis variable, enabling the model to account for both asymmetric volatility and evolving correlation patterns over time. We adopt a fully Bayesian inference approach using adaptive Markov chain Monte Carlo (MCMC) techniques, allowing for the joint estimation of model parameters, Value-at-Risk (VaR), and Marginal Expected Shortfall (MES). The accuracy of VaR forecasts is assessed through two standard backtesting procedures. Our empirical analysis involves both simulated data and real-world financial datasets to evaluate the model’s effectiveness in capturing downside risk dynamics. We demonstrate the application of the proposed method on three pairs of daily log returns involving the S&P500, Bank of America (BAC), Intercontinental Exchange (ICE), and Goldman Sachs (GS), present the results obtained, and compare them against the original model framework. Full article

Deep neural networks (DNNs) are highly effective for intrusion detection systems (IDS) due to their ability to learn complex patterns and detect potential anomalies within the systems. However, their high resource consumption requirements including memory and computation make them difficult to deploy on low-powered platforms. This study explores the possibility of using knowledge distillation (KD) to reduce constraints such as power and hardware consumption and improve real-time inference speed but maintain high detection accuracy in IDS across all attack types. The technique utilizes the transfer of knowledge from DNNs (teacher) models to more lightweight shallow neural network (student) models. KD has been proven to achieve significant parameter reduction (92–95%) and faster inference speed (7–11%) while improving overall detection performance (up to 6.12%). Experimental results on datasets such as NSL-KDD, UNSW-NB15, CIC-IDS2017, IoTID20, and UAV IDS demonstrate DNN with KD’s effectiveness in achieving high accuracy, precision, F1 score, and area under the curve (AUC) metrics. These findings confirm KD’s ability as a potential edge computing strategy for IoT and UAV devices, which are suitable for resource-constrained environments and lead to real-time anomaly detection for next-generation distributed systems. Full article

Background/Objectives: Diabetic foot (DF) is among the leading causes of diabetes-related disability. It is important to maintain regular follow-up and patient education in the prevention and treatment of DF ulcers. In extraordinary situations such as a pandemic, there are disruptions in regular clinical follow-up and patient education, and the effects of this disruption need to be investigated. The aim of this study was to investigate the impact of the pandemic on the clinical condition of patients hospitalised for DF. Methods: Patients were divided into two groups according to the date of admission to the clinic: the pre-pandemic (1 January 2019–11 March 2020) and the pandemic period (12 March 2020–1 June 2021). Comparisons were made between the two groups in terms of DF data and clinical parameters. Data were analysed with SPSS using chi-square, Student’s t-test and Mann–Whitney U analysis. Results: As a result of the screening, data from 125 DF patients (45 pre-pandemic and 80 pandemic) were collected. The DF stage, according to the Wagner classification, was significantly more advanced in patients during the pandemic period (p = 0.015). However, the time between the onset of symptoms and hospitalisation was longer for patients during the pandemic period (p = 0.035). When analysing treatment outcomes, the rate of wound healing was found to be lower (62.2% vs. 30%), and the rate of transtibial amputation was higher (11.2% vs. 20%) during the pandemic period (p = 0.002). Conclusions: This study found that the number of patients hospitalised for DF increased during the pandemic period, as did the severity of the wound, length of admission and radical treatment interventions. Full article

Background: Pre-season training is pivotal for optimizing athletic performance in collegiate basketball, yet the effectiveness of such programs in improving body composition (BC) under NCAA-mandated hourly restrictions remains underexplored. The aim of this study was to evaluate the impact of a four-week, NCAA Division II-compliant strength and conditioning (SC) program on BC in women’s basketball. Methods: Sixteen student athletes (20.6 ± 1.8 y; 173.9 ± 6.5 cm; 76.2 ± 20.2 kg) completed an eight-hour-per-week micro-cycle incorporating functional conditioning, Olympic-lift-centric resistance, and on-court skill development. Lean body mass (LBM) and body-fat percentage (BF%) were assessed using multi-frequency bioelectrical impedance on Day 1 and Day 28. Linear mixed-effects models were used to evaluate the fixed effect of Time (Pre, Post), including random intercepts for each athlete and covariate adjustment for age and height (α = 0.05). Results The LBM significantly increased by 1.49 kg (β = +1.49 ± 0.23 kg, t = 6.52, p < 0.001; 95% CI [1.02, 1.96]; R² semi-partial = 0.55), while BF% decreased by 1.27 percentage points (β = −1.27 ± 0.58%, t = −2.20, p = 0.044; 95% CI [−2.45, −0.08]; R² = 0.24). Height positively predicted LBM (β = +1.02 kg/cm, p < 0.001), whereas age showed no association (p > 0.64). Conclusions: A time-constrained, NCAA-compliant SC program meaningfully enhances lean mass and moderately reduces adiposity in collegiate women’s basketball athletes. These findings advocate for structured, high-intensity, mixed-modality training to maximize physiological readiness within existing regulatory frameworks. Future research should validate these results in larger cohorts and integrate performance metrics to further elucidate functional outcomes. Full article

Previous research has demonstrated sex-specific differences in muscle cells regarding sex hormone release and steroidogenic enzyme expression after testosterone exposure. The present study aims to elucidate sex-related differences in intracellular processes involved in myogenesis and regeneration. Neonatal 46XX and 46XY human primary skeletal muscle cells were treated with increasing doses of testosterone (0.5, 2, 5, 10, 32, and 100 nM) for 24 h. The molecular pathways involved in muscle metabolism and growth, as well as the release of myokines involved in satellite cell activation, were analyzed using western blot, real-time PCR, and a Luminex assay. The unpaired Student’s t-test and one-way ANOVA for repeated measures were used to determine significant variations within and between groups. An increase in the expression and release of MYF6, IGF-I, IGF-II, and CXCL1, as well as a decrease in GM-CSF, IL-9, and IL-12, was observed in 46XX cells. Conversely, testosterone up-regulated GM-CSF and CXCL1 in 46XY cells but did not affect the release of the other myokines. Preferential activation of the MAPK pathway was observed in 46XX cells, while the PI3K/AKT pathway was preferentially activated in 46XY cells. In conclusion, our findings demonstrate differential responses to androgen exposure in 46XX and 46XY cells, resulting in the activation of muscle cell growth and energy metabolic pathways in a sex-specific manner. Full article

Background and Objectives: Chronic obstructive pulmonary disease (COPD) significantly impacts morbidity and mortality, often due to cardiovascular comorbidities that are frequently overlooked. This study examines the prevalence of left ventricular dysfunction in COPD patients and its association with disease severity, hypoxemia, and exacerbation frequency. Materials and Methods: COPD patients (n = 114) were evaluated using spirometry and transthoracic echocardiography. Statistical analysis utilized Student’s t-test, chi-square test, and multivariable logistic regression with 1000 bootstrapping iterations, considering p < 0.05 as significant differences. Results: Most patients were classified as Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage III (40.4%) and stage IV (44.7%). Diastolic dysfunction was present in 67.5% of the patients (Grade 1: 53.5%, Grade 2: 13. 2%, Grade 3: 0.0.9%), while 18.4% exhibited systolic dysfunction (LVEF < 50%). The prevalence of diastolic dysfunction increased significantly, from 41.2% in GOLD stage II to 92. 2% in GOLD stage IV (p < 0.001). Independent predictors of diastolic dysfunction included GOLD stage IV (Odds Ratio [OR]: 5.39, 95% Confidence Interval [CI]: 1. 42–23.35, p < 0.001), older age (OR: 1.02 per year, 95% CI: 1.01–1.04, p = 0.025), and a history of frequent exacerbations (OR: 1.09 per event, 95% CI: 1.01–1.17, p = 0.039). Systolic dysfunction correlated significantly with GOLD stage IV (OR: 1.83, p = 0.014), oxygen saturation below 88% (OR: 3.12, p = 0.036), and having three or more exacerbations (OR: 4.18, p = 0.008). Conclusions: This study reveals a high prevalence of left ventricular dysfunction in COPD patients, linked to disease severity, hypoxemia, and frequent exacerbations. It supports incorporating complementary echocardiographic assessments in managing advanced COPD, especially for those with frequent exacerbations or oxygen desaturation. Full article