Search Results (437)

Malignant mediastinal tumors are a group representing some of the most demanding oncological challenges for early, multi-level, and successful management. The timely identification of any suspicious clinical symptomatology is urgent in achieving an accurate, staged histological diagnosis, in order to follow up with an equally detailed medical therapeutic plan (interventional or not) and determine the principal goals regarding efficient overall treatment in these patients. We report a case of a 24-year-old male patient with an incident-free prior medical history. An initial chest X-ray was performed after the patient reported short-term, consistent moderate chest pain symptomatology, early work fatigue, and shortness of breath. The following imaging procedures (chest CT, PET-CT) indicated the presence of an anterior mediastinal mass (meas. ~11 cm × 10 cm × 13 cm, SUV: 8.7), applying additional pressure upon both right heart chambers. The Alpha-Fetoprotein (aFP) blood levels had exceeded at least 50 times their normal range. Two consecutive diagnostic attempts with non-specific histological results, a negative-for-malignancy fine-needle aspiration biopsy (FNA-biopsy), and an additional tumor biopsy, performed via mini anterior (R) thoracotomy with “suspicious” cellular gatherings, were performed elsewhere. After admission to our department, an (R) Video-Assisted Thoracic Surgery (VATS) was performed, along with multiple tumor biopsies and moderate pleural effusion drainage. The tumor’s measurements had increased to DMax: 16 cm × 9 cm × 13 cm, with a severe degree of atelectasis of the Right Lower Lobe parenchyma (RLL) and a pressure-displacement effect upon the Superior Vena Cava (SVC) and the (R) heart sinus, based on data from the preoperative chest MRA. The histological report indicated elements of a combined, non-seminomatous germ-cell mediastinal tumor, posthuberal-type teratoma, and embryonal carcinoma. The imminent chemotherapeutic plan included a “BEP” (Bleomycin^®/Cisplatin^®/Etoposide^®) scheme, which needed to be modified to a “VIP” (Cisplatin^®/Etoposide^®/Ifosfamide^®) scheme, due to an acute pulmonary embolism incident. While the aFP blood levels declined, even reaching normal measurements, the tumor’s size continued to increase significantly (DMax: 28 cm × 25 cm × 13 cm), with severe localized pressure effects, rapid weight loss, and a progressively worsening clinical status. Thus, an emergency surgical intervention took place via median sternotomy, extended with a complementary “T-Shaped” mini anterior (R) thoracotomy. A large, approx. 4 Kg mediastinal tumor was extracted, with additional RML and RUL “en-bloc” segmentectomy and partial mediastinal pleura decortication. The following histological results, apart from verifying the already-known posthuberal-type teratoma, indicated additional scattered small lesions of combined high-grade rabdomyosarcoma, chondrosarcoma, and osteosarcoma, as well as numerous high-grade glioblastoma cellular gatherings. No visible findings of the previously discovered non-seminomatous germ-cell and embryonal carcinoma elements were found. The patient’s postoperative status progressively improved, allowing therapeutic management to continue with six “TIP” (Cisplatin^®/Paclitaxel^®/Ifosfamide^®) sessions, currently under his regular “follow-up” from the oncological team. This report underlines the importance of early, accurate histological identification, combined with any necessary surgical intervention, diagnostic or therapeutic, as well as the appliance of any subsequent multimodality management plan. The diversity of mediastinal tumors, especially for young patients, leaves no place for complacency. Such rare examples may manifest, with equivalent, unpredictable evolution, obliging clinical physicians to stay constantly alert and not take anything for granted. Full article

This paper presents three novel sufficient and necessary conditions for the admissibility of singular fractional-order systems (FOSs), a stabilization criterion, and a solution algorithm. The strict linear matrix inequality (LMI) stability criterion for integer-order systems is generalized to singular FOSs by using column-full rank matrices. This admissibility criterion does not involve complex variables and is different from all previous results, filling a gap in this area. Based on the LMIs in the generalized condition, the improved criterion utilizes a variable substitution technique to reduce the number of matrix variables to be solved from one pair to one, reflecting the admissibility more essentially. This improved result simplifies the programming process compared to the traditional approach that requires two matrix variables. To complete the state feedback controller design, the system matrices in the generalized admissibility criterion are decoupled, but bilinear constraints still occur in the stabilization criterion. For this case, where a feasible solution cannot be found using the MATLAB LMI toolbox, a branch-and-bound algorithm (BBA) is designed to solve it. Finally, the validity of these criteria and the BBA is verified by three examples, including a real circuit model. Full article

The aim of this study is to assess endothelial progenitor cells (EPCs) and circulating endothelial cells (CECs) at the time of type 1 diabetes (T1D) recognition concerning patients’ clinical state, remaining insulin secretion, and further partial remission (PR) occurrence. We recruited 45 children that were admitted to hospital due to newly diagnosed T1D (median age 10.8 yrs), and 20 healthy peers as a control group. EPC and CEC levels were measured at disease onset in PBMC isolated from whole peripheral blood with the use of flow cytometry. Clinical data regarding patients’ condition, C-peptide secretion, and further PR prevalence were analyzed. T1D-diagnosed patients presented higher EPC levels than the control group (p = 0.026), while no statistical differences in CEC levels and EPC/CEC ratio were observed. Considering only T1D patients, those with better clinical conditions presented lower EPCs (p = 0.021) and lower EPC/CEC ratios (p = 0.0002). Patients with C-peptide secretion within a normal range at disease onset presented lower EPC/CEC ratios (p = 0.027). Higher levels of EPCs were observed more frequently in patients with higher glucose, decreased fasting C-peptide, and lower stimulated C-peptide (all p < 0.05). The presence of DKA was related to higher EPC/CEC ratios (p = 0.034). Significantly higher levels of CECs were observed in patients who presented partial remission of the disease at 6 months after diagnosis (p = 0.03) only. In the study group, positive correlations of CECs with age, BMI at onset, and BMI in following years were observed. EPC/CEC ratios correlated positively with glucose levels at hospital admission and negatively with age, BMI, pH, and stimulated C-peptide level. We reveal a new potential for the application of EPCs and CECs as biomarkers, reflecting both endothelial injury and reconstruction processes in children with T1D. There is a need for further research in order to reduce cardiovascular risk in children with T1D. Full article

In this paper, we derive novel results concerning third-order differential subordinations for meromorphic functions, utilizing a newly defined linear operator that involves the inverse of the Legendre chi function in conjunction with the Mittag-Leffler identity. To establish these results, we introduce several families of admissible functions tailored to this operator and formulate sufficient conditions under which the subordinations hold. Our study presents three fundamental theorems that extend and generalize known results in the literature. Each theorem is accompanied by rigorous proofs and further supported by corollaries and illustrative examples that validate the applicability and sharpness of the derived results. In particular, we highlight special cases and discuss their implications through both analytical evaluations and graphical interpretations, demonstrating the strength and flexibility of our framework. This work contributes meaningfully to the field of geometric function theory by offering new insights into the behavior of third-order differential operators acting on p-valent meromorphic functions. Furthermore, the involvement of the Mittag-Leffler function positions the results within the broader context of fractional calculus, suggesting potential for applications in the mathematical modeling of complex and nonlinear phenomena. We hope this study stimulates further research in related domains. Full article

Background: Acute heart failure (AHF) is a major cause of hospitalizations, posing significant challenges to healthcare systems. Despite advancements in management, the rate of poor outcomes remains high globally, emphasizing the need for timely interventions. This study aimed to identify early admission-based factors predictive of poor outcomes in hospitalized AHF patients, in order to contribute to early risk stratification and optimize patient care. Methods: This retrospective single-center study analyzed routine data of adult patients hospitalized for AHF at a public university teaching hospital in Switzerland. Outcomes included in-hospital death, intensive care (ICU) treatment, and length of hospital stay (LOHS). Potential predictors were limited to routine parameters, readily available at admission. Missing predictor data was imputed and predictors were identified by means of multivariable regression analysis. Results: Data of 638 patients (median age 84 years, range 45–101 years, 50% female) were included in the study. In-hospital mortality was 7.1%, ICU admission rate 3.8%, and median LOHS was 8 days (IQR 5–12). Systolic blood pressure ≤ 100 mmHg (Odds ratio (OR) 3.8, p = 0.009), peripheral oxygen saturation ≤ 90% or oxygen supplementation (OR 5.9, p < 0.001), and peripheral edema (OR 2.7, p = 0.044) at hospital admission were identified as predictors of in-hospital death. Furthermore, a stroke or transient ischemic attack in the patient’s history (OR 3.2, p = 0.023) was associated with in-hospital death. ICU admission was associated with oxygen saturation ≤ 90% or oxygen supplementation (OR 22.9, p < 0.001). Factors linked to longer LOHS included oxygen saturation ≤ 90% or oxygen supplementation (IRR 1.2, p < 0.001), recent weight gain (IRR 1.1, p = 0.028), and concomitant chronic kidney disease (IRR 1.2, p < 0.001). Conclusions: This study validated established predictors of AHF outcomes in a Swiss cohort, highlighting the predictive value of poor perfusion status, fluid overload, and comorbidities such as chronic kidney disease. The identified predictors imply potential for developing tools to improve rapid treatment decisions. Future research should focus on the prospective external validation of the identified predictors and the design and validation of risk scores, incorporating these parameters to optimize early interventions and reduce adverse outcomes in AHF. Full article

This work is based on the recently introduced concepts of third-order fuzzy differential subordination and its dual, third-order fuzzy differential superordination. In order to obtain the new results that add to the development of the newly initiated lines of research, a new operator is defined here using the concept of convolution and the normalized Lommel function. The methods focusing on the basic concept of admissible function are employed. Hence, the investigation of new third-order fuzzy differential subordination results starts with the definition of the suitable class of admissible functions. The first theorems discuss third-order fuzzy differential subordinations involving the newly introduced operator. The following result shows the conditions needed such that the fuzzy best dominant can be found for a third-order fuzzy differential subordination. Next, dual results are obtained by employing the methods of third-order fuzzy differential superordination based on the same concept of an admissible function. A suitable class of admissible functions is introduced and new third-order fuzzy differential superordinations are obtained, showing how the best subordinant can be obtained under certain restrictions. As a conclusion of this study, sandwhich-type results are derived, linking the outcome of the two dual fuzzy theories. Full article

Background: Percutaneous screw fixation has increasingly been used for pelvic ring fracture fixation. In older adult patients, especially in patients with a fragility fracture of the pelvis (FFP), minimally invasive techniques followed by early ambulation have been promoted in order to regain pre-injury levels of mobility and independence. The purpose of this study was to evaluate patient-centered outcomes, including post-operative pain relief, functional performance, and satisfaction, in older adults with pelvic ring fractures treated with percutaneous screw fixation and to assess injury characteristics, complications, and return-to-home rates. Methods: In this retrospective cohort study, patients 50 years and older who had their pelvic fracture treated in the Amsterdam UMC location AMC between January 2019 and December 2022 were identified. After a minimum follow-up period of 6 months, a questionnaire was conducted by phone to evaluate the pain, current living situation, and mobility of the patients. Results: A total of 51 patients were included in this study with a median age of 74 years (IQR 62–82), and the vast majority were female (n = 40, 78%). Over half of the pelvic fractures were caused by low-energy trauma (n = 29, 57%). Unilateral or bilateral sacral fractures with unilateral anterior ring fractures were the most common fracture pattern. The interoperative complication rate was 4%, and the in-hospital complication rate was 23%. Forty-five patients were reached to complete the questionnaire. Forty patients (91%) returned to an acceptable level of mobility after treatment, and almost all (n = 44, 98%) were pleased with the results of the surgery. Conclusions: Percutaneous screw fixation of pelvic fractures in older adult patients is a safe and effective operating technique. Most patients preserve their pre-morbid functionality and are able to return to their previous place of residence after admission. Furthermore, patients are almost unanimously very pleased with the results of the surgery despite some residual pain complaints. Full article

Candidemia is a significant cause of morbidity and mortality among critically ill patients. Early-onset candidemia is characterized by occurring within the first seven days after admission to the Intensive Care Unit and presents several important challenges regarding its management. Risk factors may vary among patients with early- and late-onset infection, while clinical manifestations are generally non-specific and covered by the underlying disease and co-morbidities. Diagnosis and appropriate therapy are frequently delayed, with a high risk of progression to invasive, deep-seated infections, leading to rapid clinical deterioration. Management strategies to optimize the approach for patients with early-onset candidemia include the use of both conventional and novel diagnostic techniques, the initiation of appropriate antifungal therapy, administration of an adequate dose, daily evaluation of clinical response, de-escalation treatment whenever possible, and early discontinuation. Incorporating an antifungal stewardship program in clinical practice is essential in order to achieve the best clinical outcomes. Based on a review and analysis of the available literature, this article provides a thorough update on the risk factors, clinical characteristics, diagnostic methods, and management of early-onset candidemia in adult critically ill patients. Full article

Background and Objectives: Medical residency programs play a crucial role in emergency departments (EDs). However, clinical processes may differ between EDs staffed with medical residents and those staffed only by attending physicians. This study aims to compare clinical process times and clinical outcomes between these two types of EDs. Materials and Methods: A retrospective observational study was conducted, analyzing patients aged ≥ 18 years who visited an ED with a medical residency program and an ED staffed only by attending physicians. Time variables, including the time to first physician encounter, first order, CT order, consultation request, consulted specialist arrival, disposition decision, ED length of stay (LOS), and ED dispositions were compared between the two ED settings. Results: A total of 24,942 patients in an ED with a medical residency program and 19,867 patients in an ED staffed only by attending physicians were included in the final analysis. The ED with a medical residency program exhibited significantly longer times in all time variables including time to first physician encounter (7.0 [4.0–12.0] vs. 3.0 [1.0–5.0] min), first order (15.0 [9.0–23.0] vs. 9.0 [5.0–13.0] min), consultation request (95.0 [42.0–146.0] vs. 72.0 [27.0–124.0] min), consulted specialist arrival (156.0 [90.0–238.0] vs. 117.0 [63.0–176.0] min), and disposition decision (134.0 [70.0–208.0] vs. 92.0 [32.0–139.0] min). However, the proportion of discharges, admissions, and deaths were similar between the two EDs. Conclusions: The ED with a medical residency program may contribute to delays in clinical processing times; however, it appears to have no significant impact on clinical outcomes. Full article

Background: Vitamin D deficiency (VDD) during pregnancy has been associated with various obstetric complications, including preeclampsia, gestational diabetes, and premature rupture of membranes. However, its potential link to placental abruption remains underexplored. The aim of this study was to investigate whether low maternal vitamin D levels are associated with an increased risk of placental abruption in pregnancies considered otherwise low-risk. Methods: We conducted a cross-sectional study involving 248 pregnant women who were admitted for delivery at a public hospital in Athens, Greece. Serum levels of 25-hydroxyvitamin D [25(OH)D] were measured upon admission. Levels below 30 ng/mL were classified as insufficient. Although this threshold corresponds to insufficiency according to the Endocrine Society, for the purposes of this study, levels < 30 ng/mL were treated as indicative of vitamin D deficiency in order to capture broader physiological implications. Cases of placental abruption were identified based on obstetric history and clinical documentation at the time of delivery. A Chi-square test was used to assess the association between vitamin D status and placental abruption, and a multivariate logistic regression model was applied to control for potential confounders, including hypertensive disorders of pregnancy, smoking, and preterm birth. The potential role of vitamin D supplementation during pregnancy was also explored as part of the analysis. Results: Our analysis revealed that women with VDD had a significantly higher incidence of placental abruption (p < 0.05). In the multivariate model, VDD remained an independent risk factor (adjusted OR: 3.2, 95% CI: 1.1–9.6). Additional risk factors that showed significant associations with placental abruption included pregnancy-induced hypertension and maternal smoking. Conclusions: These findings support the hypothesis that insufficient maternal vitamin D levels may contribute to adverse pregnancy outcomes, including placental abruption. Further prospective studies are warranted to clarify the causal mechanisms and to evaluate whether early detection and correction of vitamin D deficiency could serve as a preventive strategy in prenatal care. Full article

In this work, we present a numerical approach for solving optimal control problems for fluid heat transfer applications with a mixed optimality system: an FEM code to solve the adjoint solution over a precise restricted admissible solution set and an open-source well-known code for solving the state problem defined over a different one. In this way, we are able to decouple the optimality system and use well-established and validated numerical tools for the physical modeling. Specifically, two different CFD codes, OpenFOAM (finite volume-based) and FEMuS (finite element-based), have been used to solve the optimality system, while the data transfer between them is managed by the external library MEDCOUPLING. The state equations are solved in the finite volume code, while the adjoint and the control are solved in the finite element code. Two examples taken from the literature are implemented in order to validate the numerical algorithm: the first one considers a natural convection cavity resulting from a Rayleigh–Bénard configuration, and the second one is a conjugate heat transfer problem between a fluid and a solid region. Full article

Reviewing academic curricula requires a significant investment of time and expertise. Beyond accreditation, curriculum may be reviewed in part or in whole during other administrative efforts including the consideration of new elective courses, faculty-student advising, admission of transfer students, internal audits, and more. These activities often require multiple people with deep knowledge of the coursework as well as the discipline(s) involved to pour over scattered documentation and comparatively limited assessment data in order to make an informed decision. In this work, we explored the development of a semi-automated computational approach to visualize a curriculum as described in official course listings at a topic level of detail. We show how our approach can help provide a detailed view of how topics are covered across multiple courses and how these visualizations can show similarities and differences for individual student registration records, paving the way for personalized student support. We also identified opportunities for improvement in this method, including the need to develop more robust topic mapping techniques for short texts. Full article

Discrete Sugeno integrals form a significant family of aggregation functions. Several variants of these integrals have been proposed, most of which replace the minimum operation with alternative operations, such as product, overlap functions, and t-norms. Notably, the associativity of t-norms in discrete Sugeno integrals has no significant consequences, leading us to relinquish this property and introduce the concept of partial t-norms. Although interval-valued versions of the discrete Sugeno integral or its variants have been limited, this paper presents a novel approach based on interval-valued partial t-norms, admissible orders, and interval-valued fuzzy measures. We provide rigorous proofs of the properties of this operator class. Full article

The aging population has created a significant challenge affecting the world; social and healthcare systems need to ensure elderly individuals receive the necessary care services to improve their quality of life and maintain their independence. In response to this need, developing integrated digital solutions, such as IoT based wearable devices combined with artificial intelligence applications, offers a technological platform for creating Ambient Intelligence (AI) and Assisted Living (AAL) environments. These advancements can help reduce hospital admissions and lower healthcare costs. In this context, this article presents an IoT application based on MEMS (micro electro-mechanical systems) sensors integrated into a state-of-the-art microcontroller (STM55WB) for recognizing the movements of older individuals during daily activities. human activity recognition (HAR) is a field within computational engineering that focuses on automatically classifying human actions through data captured by sensors. This study has multiple objectives: to recognize movements such as grasping, leg flexion, circular arm movements, and walking in order to assess the motor skills of older individuals. The implemented system allows these movements to be detected in real time, and transmitted to a monitoring system server, where healthcare staff can analyze the data. The analysis methods employed include machine learning algorithms to identify movement patterns, statistical analysis to assess the frequency and quality of movements, and data visualization to track changes over time. These approaches enable the accurate assessment of older people’s motor skills, and facilitate the prompt identification of abnormal situations or emergencies. Additionally, a user-friendly technological solution is designed to be acceptable to the elderly, minimizing discomfort and stress associated with using technology. Finally, the goal is to ensure that the system is energy-efficient and cost-effective, promoting sustainable adoption. The results obtained are promising; the model achieved a high level of accuracy in recognizing specific movements, thus contributing to a precise assessment of the motor skills of the elderly. Notably, movement recognition was accomplished using an artificial intelligence model called Random Forest. Full article

Background and Objectives: Priapism is a condition characterized by a prolonged erection lasting over four hours, either independent of or following sexual stimulation. The primary treatment goal for ischemic and non-ischemic priapism is timely and appropriate intervention in order to preserve erectile function and penile length. This study aims to evaluate the management of recurrent ischemic priapism in sickle cell disease (SCD) patients in an endemic region and compare it with ischemic priapism of other etiologies. Materials and Methods: Patients admitted to our hospital with a diagnosis of priapism between January 2010 and June 2024 were retrospectively reviewed. The patients were divided into two groups: ischemic priapism due to SCD and ischemic priapism due to other etiologies. Patient characteristics, treatment management, and the need for penile prosthesis (PP) were compared. Results: A total of 40 ischemic priapism patients were included in the study; 20 of them had SCD and the other 20 had priapism cases due to different etiologies. In the SCD priapism group, the rate of comorbidity and previous history of priapism were significantly (p < 0.05) higher than in the other etiologies of priapism group. Similarly, in the SCD priapism group, the hospital admission time and the rate of fibrosis findings in MRI (magnetic resonance imaging) were significantly (p < 0.05) higher than in the other priapism groups. The PP implantation rate in the SCD priapism group was found to be significantly (p < 0.05) higher than in the other priapism group. Conclusions: This study highlights the importance of early intervention and patient awareness in SCD-related ischemic priapism, recommending educational programs to improve symptom recognition and prevent complications. Full article