Search Results (967)

Background/Objectives: Western societies introduce school-based or school-linked programs in order to improve the physical health status of students and prevent the negative impact of the late diagnosis of a series of diseases and conditions. Preschool visual acuity (VA) screening represents an established school-based approach aimed at the early detection of amblyopia risk factors and vision-related learning difficulties. In this study, we report the methods and outcomes of the first officially organized kindergarten-based VA screening program in Greece, implemented using the Democritus Digital Visual Acuity Test (DDiVAT) screening suite and involving trained educators as part of the screening workflow. The present analysis focuses on the operational performance and screening outcomes within this defined setting. Methods: This study was a kindergarten-based screening. Each kindergarten was equipped with the DDiVAT screening framework, which consisted of a 32-inch, 4K, Android Smart TV with the DDiVAT application preinstalled, a site-license granting access to the secure DDiVAT database, and two vouchers for teachers to participate in the official lifelong DDiVAT training program. Results: From 2476 enrolled students, 207 (8.36%) were referred due to suboptimal presenting VA in one or both eyes. Average VA ranged from logMAR 0.11 to 0.07, which is consistent with former reports. Conclusions: No major technical difficulties were encountered, suggesting that DDiVAT may represent a feasible digital approach for preschool VA screening in real-world educational settings. Full article

Non-small cell lung cancer (NSCLC) accounts for approximately 85% of lung cancers, and surgical resection is the gold-standard treatment for resectable disease. Minimally invasive surgery (MIS), which includes video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS), has emerged as an alternative option to thoracotomy, with the aim of minimizing perioperative morbidity without compromising oncological efficacy. This narrative review evaluates long-term oncological outcomes (overall survival (OS), disease-free survival (DFS) and recurrence-free survival (RFS)) in patients with NSCLC at different stages who underwent MIS. Retrospective and prospective studies, as well as meta-analyses, are included. VATS has shown comparable and, in many cases, superior oncological outcomes compared to open surgery, with more evident benefits in the early stages of the disease. Although mainly in retrospective studies, RATS has demonstrated efficacy in terms of oncological outcomes comparable to open surgery, even in advanced stages or complex resections. With regard to the direct comparison between VATS and RATS, the two MIS techniques have shown similar OS rates, albeit some prospective data and meta-analyses suggest a potential DFS advantage for RATS. MIS is a safe and effective surgical approach in terms of oncological outcomes for resectable NSCLC; nevertheless, it will be necessary to await the results of further randomized studies currently ongoing to better define the long-term benefits of each technique. Full article

The transition to sustainable energy systems requires the development of efficient hydrokinetic technologies to increase the reliability and competitiveness of renewable energy generation. Vertical-axis H-Darrieus turbines can improve their performance through impeller channels or external flow guidance devices that modify the local mass flow distribution around the rotor. This work introduces a systematic geometric optimization framework that quantitatively evaluates the combined effect of key channel design parameters on turbine performance by employing response surface methodology (RSM) to quantify the influence of two geometric parameters of an impeller channel—specifically, the deflection angle ($\beta$) and the channel length (H)—on the turbine power coefficient ($C_p$). This approach allows for the identification of nonlinear interactions between geometric variables, which have not been explicitly addressed in previous research on impeller channels in H-Darrieus turbines. An experimental design with thirteen treatments was implemented, and numerical simulations were performed using Computational Fluid Dynamics (CFD) in ANSYS FLUENT^®. Statistical analysis of the RSM model showed that both $\beta$ and H have significant effects ($p<0.05$) on turbine performance. The model predicted an optimal configuration with $\beta$ equal to 100° and H equal to 0.2 m, corresponding to the maximum Cp achieved. These findings confirm the potential of impulse channels to improve the aerodynamic efficiency of H-Darrieus turbines and establish a quantitative basis for design optimization in hydrokinetic applications. Full article

Large Language Models (LLMs) are increasingly being adopted in business settings; however, there remains a shortage of evaluation tools that account for country-specific regulations, particularly for Romania’s taxation and financial accounting requirements. RO-FIN-LLM is a benchmark designed to test how well LLMs handle Romania-specific regulatory question answering in taxation (including VAT regimes, income/profit tax, microenterprise rules, and other obligations) and financial accounting (including journal entries/monographs, amortization, provisions, and foreign exchange transactions). The benchmark contains questions curated by experts, each including the applicable regulatory time frames and the legal sources for the answers. Evaluation is performed in two protocols: closed-book and open-book with Retrieval Augmented Generation (RAG), using Tavily Search API. Evaluation metrics are represented by rubrics, namely correctness, legal citation quality, and clarity/structure. A subset of answers produced by three models was additionally evaluated by 12 specialists in the financial-accounting domain. In this revision, we also describe a public release plan for the question schema, prompts, and evaluation scripts to support independent reproducibility. Full article

Objective: The arterial anatomy of the left upper lobe exhibits the greatest variability in branching patterns among all pulmonary lobes. This lobe is commonly described as having four segments: the fused apicoposterior segment (S1+2), the anterior segment (S3), and the lingular segments (S4 and S5). Each segment may contain subsegments with distinct vascular supplies. Although several studies have examined patterns and diversity of branching, a comprehensive assessment of the incidence of these variations has not yet been performed. Methods: This systematic review was conducted in accordance with a protocol registered in PROSPERO (CRD42024546839). The search was performed between December 2023 and February 2024. A systematic search of databases was carried out to identify publications describing arterial branching patterns supplying the left upper lobe of the lung in adults. Furthermore, we collected and analyzed data on the relationship between the different origins of the lingular arteries and the corresponding bronchial and venous patterns. The AUQA tool was used to perform bias assessment. Data extraction included study characteristics, participant demographics (listed in AUQA), and anatomical variables based on the Yamashita classification of LUL arterial patterns and the number of branches supplying the left upper lobe. Results: In total, 15 publications were included (3313 cases). Lobar vasculature was firstly categorized more broadly, analyzing the number of branches from the left pulmonary artery, which supplies the left upper lobe, most commonly four branches. Then, analysis based on the Yamashita classification was performed, and Type A (A3, A(1+2) a+b, A(1+2) c) was established as the most common variant. Conclusions: The left upper lobe is most commonly supplied by four different arterial branches, followed by three and five. Differences in arterial branching patterns between Asian and Western populations may represent an important distinguishing factor. According to Yamashita’s classification, Type A (A3, A1+2a+b, A1+2c) is the most frequently observed pattern. Further attention should be directed to the relationship between the presence of a common trunk and the origin of the lingular arteries. Detailed knowledge of this anatomy remains fundamental for segmental thoracic surgery. Full article

Background: Obesity is a multifactorial chronic disease resulting from sustained energy imbalance and modulated by environmental and demographic factors, and it is associated with numerous comorbidities. DNA methylation is an epigenetic modification associated with obesity. Modulation of DNA methylation is a viable target for obesity control strategies. The flavanol (-)-epicatechin (EC) exerts beneficial effects in overweight individuals, suggesting that EC may influence gene regulation through signaling pathways and epigenetic mechanisms. We evaluated whether EC modulates obesity-associated DNA methylation changes using complementary in silico, in vitro, and in vivo approaches. Methods. In silico analyses were performed to explore potential EC interactions with the DNA methyltransferases DNMT1, DNMT3A, and DNMT3B. DNMT activity was measured in nuclear extracts of 4T1 cells in the presence of EC. Finally, in a C57BL/6 mouse model of diet- induced obesity, we assessed global DNA methylation and the expression of the DNA methyltransferases, as well as metabolism-related genes; peroxisome proliferator-activated receptor gamma coactivator 1 alpha (Pgc-1α), pyruvate dehydrogenase kinase isozyme 4 (Pdk4), and nuclear factor erythroid 2–related factor 2 (Nrf2) and relative mitochondrial DNA content (mtDNA/nDNA ratio) in visceral adipose tissue (VAT) and skeletal muscle. Results. EC showed stable in silico interactions within catalytic/cofactor-binding regions of DNMTs and inhibited DNMT activity in vitro in a concentration-dependent manner. In vivo, the obesogenic diet reduced global DNA methylation and decreased transcript levels of Dnmt1, Dnmt3a, and Dnmt3b in skeletal muscle and adipose tissue. EC counteracted obesity-associated DNA methylation changes in skeletal muscle, restoring global methylation and Dnmt expression toward control levels, whereas effects in VAT were limited. EC increased mitochondrial DNA content. Discussion. In silico and enzymatic data suggest that EC may bind DNMT active sites and inhibit DNMT activity in a concentration-dependent manner, supporting a role for EC in obesity-related epigenetic remodeling, particularly in skeletal muscle. EC also increased relative mitochondrial DNA content in VAT and skeletal muscle despite no obesogenic diet effect on relative mitochondrial abundance, consistent with favorable mitochondrial modulation. In conclusion, EC is an epigenetic modulator and may have positive effects in obesity related dysfunctional tissues. Full article

Background: Elevated abdominal adipose tissue at time of diagnosis is associated with breast cancer mortality. We sought to understand the association between abdominal adipose tissue (subcutaneous, SAT and visceral, VAT) assessed via dual-energy X-ray absorptiometry (DXA) and breast cancer mortality in the prevention setting. Methods: Women enrolled in the Women’s Health Initiative study with baseline whole-body DXA scans were included in the study (n = 9767). Causes of death were adjudicated up to 27 years of follow-up. Competing risk models were used to examine independent associations between baseline VAT, SAT, per 100 cm², and breast cancer-specific deaths; findings were reported as sub-hazard ratios (SHR) and confidence intervals (CI). Time-varying analyses additionally included DXA at years 3 and 6. Covariates included demographic, lifestyle, and tumor factors. Results: Baseline VAT and SAT ranged from undetectable to 616.25 cm² and 55.26–952.46 cm², respectively. There were 738 incident breast cancer cases post-enrollment, and 87 breast cancer-related deaths. Median age at diagnosis was 62 years. In adjusted models, higher baseline VAT and SAT were significantly associated with higher risk breast cancer mortality (49% and 40%, respectively); time-varying models were similar. Conclusions: Higher VAT and SAT were similarly associated with breast cancer mortality in this group of postmenopausal women. Full article

Polymer additive manufacturing (AM) has grown rapidly in the past decade, with material extrusion, vat photopolymerization, powder bed fusion and jetting now widely used for functional polymer parts. The mechanical performance of these parts depends strongly on process parameters such as layer height, build orientation, energy input and post-processing conditions, which motivate the development of predictive models for process–property relationships. Classical approaches based on Taguchi designs, ANOVA and response surface methodology have provided valuable insight, but the potential of modern machine learning (ML) techniques is not yet fully exploited. This review surveys recent work on ML-based prediction of mechanical properties of polymer AM parts using process parameters as inputs. Across the literature, well-tuned artificial neural networks, tree-based ensembles and support vector regression typically achieve prediction errors below about 5–10% for strength and modulus, showing that data-driven surrogates can substantially reduce experimental trial-and-error in process optimization. Ongoing challenges include small datasets, missing standardized error metrics, and limited coverage of non-quasi-static phenomena like fatigue, impact, and environmental degradation. Full article

Background/Objectives: Pyometra is a life-threatening uterine infection of intact bitches and queens. Despite growing reports of multidrug-resistant (MDR) Escherichia coli in canine reproductive and urinary infections, no whole-genome data were previously available for pyometra isolates from Italy. This study aimed to characterise, by whole-genome sequencing and comparative genomics, the population structure, resistome and virulome of E. coli causing pyometra in companion animals from northern Italy in the context of European datasets. Methods: Four E. coli isolates (two canine, two feline) from pyometra cases underwent nanopore long-read sequencing. Genomes were compared with Brazilian and Finnish pyometra isolates using core- and accessory-genome analyses, pan-genome partitioning, phylogeny, and gene-based profiling of antimicrobial resistance and virulence determinants. Results: All Italian isolates belonged to phylogroup B2 and to recognised ExPEC sequence types (ST706/O51:H1, ST141/O2:H6, ST372/O75:H31, ST646/O22:H5). Phenotypically, they were uniformly resistant to several penicillins and early/third-generation cephalosporins but remained susceptible to fluoroquinolones, aminoglycosides and trimethoprim–sulphonamide. The combined 57-genome pan-genome was open yet strongly core-dominated; Italian strains shared an efflux- and regulator-centred intrinsic resistome and a rich ExPEC virulence repertoire (P, S, F1C and type 1 fimbriae, multiple siderophores, colibactin, Vat, haemolysin, CNF1) with Brazilian and Finnish isolates. Conclusions: Pyometra-associated E. coli from northern Italian pets belong to globally disseminated high-risk B2 lineages that combine extensive virulence with a largely intrinsic resistome, and currently retain susceptibility to several key drug classes, underscoring an important but vulnerable therapeutic window. Full article

This study examined effects of two moderate-intensity aerobic exercise prescriptions on inflammatory cytokines and oxidative stress biomarkers in middle-aged obese Hispanic females. Fifty-four subjects were randomly assigned to a lower-moderate intensity group (55% VO₂max, LT, n = 18), an upper-moderate intensity group (70% VO₂max, HT, n = 19), or a non-exercise control group (CON, n = 17). Blood samples collected before and after a 12-week intervention were analyzed for tumor necrosis factor-alpha (TNF-α), adiponectin, C-reactive protein (CRP), total antioxidant status (TAS), and 8-hydroxy-2′-deoxyguanosine (8-OHdG). Body fat percentage (%BF) and visceral adipose tissue (VAT) were assessed using dual-energy X-ray absorptiometry. TNF-α significantly decreased in both LT (p = 0.004) and HT (p < 0.001). Significant increases in adiponectin (p = 0.001) and reductions in CRP (p < 0.001) were observed within the HT, whereas these changes were not significant within the LT. TAS significantly increased in both exercise groups (p < 0.001), and 8-OHdG significantly decreased in the HT (p < 0.001) and LT (p = 0.002). Both LT and HT demonstrated significant reductions in %BF (p < 0.001) and VAT (p < 0.05), with no significant changes in CON. Results indicate that moderate-intensity aerobic exercise improves inflammatory and oxidative stress profiles when total exercise volume is matched, regardless of differences in exercise intensity within the moderate range. Although post-intervention differences between groups were not statistically significant, the observation that CRP, adiponectin, and 8-OHdG changed significantly only within HT suggests that exercise intensity may influence biomarker responsiveness and warrants further investigation. Full article

Background: Lung cancer remains the leading cause of cancer-related morbidity and mortality. Despite advances in surgical management, economically disadvantaged patients experience inequalities in the receipt of treatments. We evaluated the association between socioeconomic status (SES) and type of surgery: robotic-assisted thoracic surgery (RATS), video-assisted thoracic surgery (VATS), and open thoracotomy. Methods: Data came from the National Cancer Database (2015–2022) and included Stage 0–IIIa NSCLC patients. SES was measured by quartiles of median household income in the patient’s zip code. Adjusted multinomial logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Results: Among 84,931 patients with a mean age of 67.8 years, 38.4% underwent open thoracotomy, 33.3% underwent VATS, and 28.2% underwent RATS. Patients residing in the low-income areas (<$46,277) were significantly less likely to undergo RATS (aOR: 0.79, 95% CI: 0.77–0.86) or VATS (aOR: 0.62, 95% CI: 0.59–0.66) compared to patients living in high-income areas (≥$74,063). Community hospitals were less likely to provide RATS (aOR: 0.32, 95% CI: 0.29–0.35) or VATS (aOR: 0.58, 95% CI: 0.54–0.63) than academic centers. Conclusion: Socioeconomic disadvantage is associated with lower use of minimally invasive surgical approaches for NSCLC. Efforts to expand access to advanced surgical care may be necessary to reduce treatment disparities and improve outcomes. Full article

Vat polymerization-based 3D printing has emerged as a promising approach for the rapid, low-cost, and scalable fabrication of microfluidic devices; however, achieving high-resolution and fully clog-free microchannels using commercial resins remains challenging. In this study, we systematically investigate key printing parameters—including channel orientation, length, layer thickness, and exposure time—to elucidate their effects on channel openness, dimensional fidelity, and surface morphology using a commercially available low-cost masked stereolithography (MSLA) printer and printing resin, thereby establishing quantitative fabrication boundaries that define the transition from fully open to blocked microchannels in practice. Under optimized printing conditions, microchannels with characteristic dimensions exceeding 200 µm were fabricated in a reliable and clog-free manner using standard commercial resins. In addition, by implementing a size-compensated design strategy, we achieved the fabrication of complex droplet generator arrays with a minimum central channel width of 400 µm, while maintaining an internal dimensional deviation below 2.5%. These investigations significantly expand the practical applicability of low-cost MSLA 3D printing for microfluidic device fabrication, providing a scalable and accessible pathway for producing high-fidelity microchannels without reliance on custom resins or post-processing-intensive workflows. Full article

Background: Mounting evidence suggests that medical management may differ significantly between female and male patients. Despite studies showing increased sensitivity to pain, female patients receive less opioid analgesia compared to male patients after surgery. It is uncertain whether perioperative multimodal analgesia differs between sexes in thoracic surgery. Methods: A retrospective cohort study from January to July 2023 comparing multimodal analgesia and perceived pain in the early postoperative period between female and male patients after video-assisted thoracic surgery (VATS). The primary endpoint was the opioid demand in the post-anaesthesia care unit (PACU). Secondary outcomes included pain scores, regional anaesthesia and pain therapy by female, male or mixed teams. Results: Overall, 46.0% (n = 92) of the 200 included patients were female and 54% (n = 108) were male. Following VATS, the median piritramide demand was 9.0 [5.3 to 14.9] mg in female vs. 7.7 [4.5 to 12.9] mg in male patients (p = 0.35). Pain scores and regional anaesthesia were comparable between groups. In the early postoperative period, more opioids were administered overall and to female patients by all female anaesthesia teams, compared to mixed or all-male teams. Conclusions: The weight-adjusted dose of postoperative opioids did not differ between groups; neither did postoperative pain scores or the application of nerve blocks. The increased opioid demand in female patients was met by all female teams but not by all-male or mixed teams. Full article

Additive manufacturing, and particularly the vat photopolymerization process, enables the fabrication of complex geometries at high resolution and small length scales, making it well-suited for fabricating cellular structures (e.g., foams and lattices). Among these, elastomeric cellular structures are of growing interest due to their tunable compliance and energy dissipation. However, comprehensive data on the compressive behavior of these structures remains limited, especially for investigating the structure-property effects from changing the density and distribution of material within the cellular structure. This study explores how the mechanical response of polyurethane-based simple cubic structures changes when varying volume fraction, unit cell length, and unit cell patterning, which have not been systematically investigated previously in additively manufactured elastomers. Increasing volume fraction from 10% to 50% yielded significant changes in compressive stress–strain performance (decreasing strain at 0.5 MPa by 41.6% and increasing energy absorption density by 3962.5%). Although changing the unit cell length between 2.5 and 7 mm in ~30 mm parts did not result in statistically different stress–strain responses, modifying the configuration of struts of different thicknesses across designs with 30% volume fraction altered the stress–strain behavior (differences of 12.5% in strain at 0.5 MPa and 109.4% for energy absorption density). Power law relationships were developed to understand the interactions between volume fraction, unit cell length, and elastic modulus, and experimental data showed strong fits (R² > 0.91). These findings enhance the understanding of how multiple structural design aspects influence the performance of elastomeric cellular materials, providing a foundation for informing strategic design of tailorable materials for diverse mechanical applications. Full article

Background/Objectives: Abdominal obesity, especially visceral adipose tissue (VAT), is an independent risk factor for coronary artery disease. This study aimed to investigate the association between single-slice CT-measured VAT and significant coronary artery stenosis and to establish an optimal VAT cut-off value for Taiwanese adults. Methods: Patients who underwent abdominal CT and coronary CT angiography (CTA) within 1 month of each other were enrolled in this retrospective study. Axial images of abdominal CT at the L4 pedicle level were selected for further VAT, subcutaneous adipose tissue, and paraspinal muscles analysis. Significant coronary artery stenosis was defined as any luminal stenosis of >50% of the diameter of the vessel that was measured in coronary CTA. Anthropometric and laboratory measurements, including height, weight, waist circumference (WC), blood pressure, blood glucose, and blood lipids, were also analyzed. Results: A total of 779 patients (300 females; 54.9 ± 9.96 years) were enrolled. Only VAT and systolic blood pressure correlated significantly with significant coronary artery stenosis. No significant differences were found in other demographic and anthropometric characteristics between the groups with and without significant coronary artery stenosis. Conclusions: Single-slice CT-measured VAT was associated with significant coronary artery stenosis, and a lower VAT cut-off is recommended for the Taiwanese population. Full article