Search Results (59,505)

Background/Objectives: Penile squamous cell carcinoma (PSCC) is a rare malignancy with a potential major impact on survival. Prognostic assessment remains challenging, particularly in underrepresented eastern European populations, where region-specific evidence is lacking. This paper aimed to identify independent predictors of overall survival in surgically treated patients with PSCC from a Romanian high-volume tertiary center. Methods: This retrospective cohort study analyzed 60 patients who were surgically treated for PSCC between October 2020 and December 2024. Univariate and multivariate Cox proportional hazards regression analyses were performed to identify independent prognostic factors. Results: The mean patient age was 62 ± 12 years. T-stage distribution showed 30% pT1, 35% pT2, 31.67% pT3, and 3.33% pT4, with 55% of patients presenting with nodal metastases. Univariate analyses demonstrated significant associations between lymphovascular invasion (p < 0.001), perineural invasion (p = 0.022), and positive surgical margins (p = 0.030) and risk of death. Multivariate analysis identified three independent prognostic factors: absence of histologically documented urethral invasion (HR 0.32; p = 0.027), T3–T4 disease (HR 8.26; p = 0.005 vs. T1), and N3 stage (HR 3.53; p = 0.030 vs. N0–N1). Patients without urethral invasion demonstrated significantly longer median overall survival (63 months vs. 11 months). The final three-variable prognostic model demonstrated good discrimination (C-index 0.78), providing a potential practical risk stratification tool. Conclusions: Urethral invasion, advanced T-stage, and N3 disease independently predict poor survival in surgically treated PSCC. The identification of urethral invasion as an independent prognostic factor warrants consideration in clinical practice. This is the first study of a Romanian cohort to provide critical data for risk-adapted treatment strategies in underrepresented eastern European populations. Full article

This paper provides a comprehensive survey of Human–Robot Interaction (HRI) for indoor mobile robots operating in human-centered environments such as hospitals, laboratories, offices, and homes. We review interaction modalities—including speech, gesture, touch, visual, and multimodal interfaces—and examine key user experience factors such as usability, trust, and social acceptance. Implementation challenges are discussed, encompassing safety, privacy, and regulatory considerations. Representative case studies, including healthcare and domestic platforms, highlight design trade-offs and integration lessons. We identify critical technical challenges, including robust perception, reliable multimodal fusion, navigation in dynamic spaces, and constraints on computation and power. Finally, we outline future directions, including embodied AI, adaptive context-aware interactions, and standards for safety and data protection. This survey aims to guide the development of indoor mobile robots capable of collaborating with humans naturally, safely, and effectively. Full article

Background/Objectives: To compare the maternal, fetal, and neonatal outcomes of pregnancies undergoing amniocentesis with those undergoing non-invasive prenatal testing (NIPT), within a cohort of women with comparable clinical indications, aiming to evaluate differences in adverse outcomes in a risk-indicated population. Methods: In this retrospective cohort study, pregnancy outcomes of 2044 pregnant women who underwent amniocentesis and 7668 pregnant women who underwent NIPT were evaluated using single-center data. The analysis was restricted to pregnancies with normal/reportable test results and without structural or genetic anomalies. Pregnancy loss outcomes were evaluated in the full cohort, while perinatal outcomes were analyzed among cases with available delivery data (377 amniocentesis and 2063 NIPT cases). Pregnancy and perinatal outcomes, including miscarriage, intrauterine fetal demise (IUD), preterm birth (PTB), pregnancy-induced hypertensive diseases (PIHDs), gestational diabetes mellitus (GDM), intrahepatic cholestasis of pregnancy (ICP), low birth weight (LBW), small for gestational age (SGA), and low APGAR scores (<7), were evaluated. Multivariate logistic regression analysis was performed to adjust for potential confounding factors, and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were reported. Results: Amniocentesis was associated with a significantly higher risk of an adverse outcome compared to NIPT in this risk-indicated cohort. The likelihood of miscarriage was significantly higher in the amniocentesis group (aOR: 1.91, 95% CI: 1.17–3.14, p = 0.025), as was the risk of IUD (aOR: 4.10, 95% CI: 2.05–8.20, p < 0.001). PTB risk was also increased (aOR: 1.96, 95% CI: 1.53–2.51, p < 0.001). LBW was significantly more prevalent in the amniocentesis group (aOR: 7.73, 95% CI: 5.40–11.05, p < 0.001), and the likelihood of delivering a SGA neonate was also increased (aOR: 1.45, 95% CI: 1.02–2.06, p = 0.040). A 1st-minute APGAR score < 7 was also more frequent in the amniocentesis group (aOR: 1.51, 95% CI: 1.06–2.16, p = 0.022), although the association with 5th-minute APGAR scores < 7 did not reach statistical significance (aOR: 1.45, 95% CI: 0.83–2.52, p = 0.193). Overall, the risk of composite maternal and perinatal adverse outcomes (aOR: 1.77, 95% CI: 1.41–2.22, p < 0.001) as well as composite fetal and neonatal adverse outcomes (aOR: 1.97, 95% CI: 1.50–2.58, p < 0.001) was significantly higher in the amniocentesis group compared to the NIPT group. No significant association was observed for PIHD, GDM, or ICP. Conclusions: Our findings showed that, apart from fetal loss, amniocentesis may be associated with adverse perinatal outcomes such as PTB, LBW, SGA and low APGAR scores. Full article

Background: Hypermobile Ehlers–Danlos syndrome (hEDS) can present as a complex interplay of widespread symptomatology and multisystem involvement, posing diagnostic and treatment challenges. Objective characterization of cervical spine and neurovascular findings in hEDS has been limited. Previous studies have emphasized upper cervical spine complications in hEDS, yet the relevance and mechanisms underlying associated symptomatology have not been elucidated. This study examined objective test findings in patients with hEDS at an outpatient neck clinic to explore cervical spine and neurovascular pathology that could contribute to further understanding the clinical profile of a subset of patients with hEDS. Methods: This single-center, retrospective observational study included patients with hEDS aged 20–50 years from 1 January 2022–31 December 2024, at an outpatient neck center. It excluded previous neck surgery, traumatic events, or related injury. Demographic, clinical, and diagnostic data were collected through a retrospective chart review, including measurements from standard clinical diagnostic protocols: digital motion X-ray (videofluoroscopy), cone beam CT, Doppler ultrasound, and tonometry. Results: More than 71% of patients reported ≥29 symptoms. Nearly all patients exhibited co-occurring forward head, decreased depth of curve, ligamentous cervical instability, and decreased internal jugular vein (IJV) and vagus nerve cross-sectional area (CSA). Vagus nerve CSA was found to be significantly smaller than the comparative healthy/normal population. IJV CSA was significantly smaller at C1 than at C4–C5, suggesting evidence of carotid sheath compression at C1. Conclusions: This study offers novel evidence that cervical spine pathology, IJV compression, and vagus nerve degeneration are uniformly prevalent in hEDS, which may contribute to, or be an etiological basis for, the multisystem involvement in a subset of patients with this disorder. These findings provide hypothesis-generating data to inform future mechanistic and therapeutic studies, including exploration of new diagnostic and treatment targets. Full article

Over the past few decades, conversions to Islam in Colombia have increased significantly, with Latin American “indigenous” Muslims (converts or direct descendants of converts) now forming the majority in most mosques, congregations and Islamic centers. These conversions arise from various motivations, including spiritual exploration, intellectual curiosity, and relational or emotional factors, often intertwined. A distinction can be drawn between “collective conversions,” where dozens of individuals in a given area embrace Islam together, and “individual conversions,” which are more dispersed and numerous. This article goes beyond examining the motivations and conditions of these conversions to explore the emergence of an “indigenous Islam” in Colombia and the dynamics surrounding the development and assertion of local Muslim communities, primarily composed of converts. Key challenges for these communities include negotiating knowledge and legitimacy within mixed groups of migrants and “indigenous” Muslims, constructing a plural identity that blends local (Latin American) social and cultural elements with Islamic references, including a sense of belonging to the universal Ummah, and contextualizing religious norms and discourses in light of the local social realities. Furthermore, this study delves into the critical issue of sustaining these small, often fragile communities over time. Drawing on fieldwork and qualitative analysis, this paper aims to provide insights into how Islam is being understood, lived, and rooted in a predominantly Catholic and secular Colombian society, contributing to broader discussions on religion, identity, and social change in Latin America. Full article

We present an investigation of the thermal damage threshold of passivated Bi₂Se₃ films upon laser illumination, with a focus on their employment in terahertz (THz) spectroscopic applications. Passivation was achieved by depositing a thin 3 nm Al capping layer which, exposed to the ambient, forms a natural oxide. In THz transient emission experiments, the samples were exposed to a train of 100 fs wide laser pulses with 800 nm wavelength at 78 MHz repetition rate and peak power density up to 295 mW/µm². For the sake of comparison, the films were also exposed to continuous wave laser light with a wavelength of 532 nm in the average optical power density range from 5 × 10⁻² mW/µm² to 50 mW/µm². In both cases, changes in film appearance, detected by optical microscopy, or even film removal in a small area close to the center of the illuminated spot could be induced. Raman spectroscopy provided evidence that the crystalline phase of Bi₂Se₃ films is present in areas that have been exposed but not damaged. Conversely, in the film region illuminated with the highest peak power density no Raman signal was detected in the range under investigation which we ascribe to material removal. At the perimeter of this ablated area, we observed a dominant Raman mode at approximately 255 cm⁻¹ that we can attribute to selenium and indicates partial Bi₂Se₃ decomposition. In contrast, we observed Raman spectra corresponding to as-deposited Bi₂Se₃ only a few micrometers away from the laser-damaged area. Hence, the observed THz radiation originates from this illuminated but undamaged region. This detailed knowledge is expected to serve as a guide for designing the emitter’s thermal management and choosing laser parameters for optimal operation. Full article

Lenvatinib is an oral multi-kinase inhibitor which is used for the treatment of renal cell carcinoma, non-iodine avid differentiated thyroid cancer, hepatocellular carcinoma, and endometrial cancer. We present a series of three (3) patients who, whilst on treatment with Lenvatinib, developed symptoms and radiological findings of acalculous cholecystitis. A radiological review of another nineteen (19) Lenvatinib-treated patients in our center was undertaken, with another three (3) patients exhibiting radiological features of acalculous cholecystitis with gallbladder wall thickening and pericholecystic fluid collection but without abdominal pain or clinical symptoms of cholecystitis. A literature review is also presented of all previous publications of Lenvatinib-induced acalculous cholecystitis, including the results of two pharmacovigilance studies. This review provides evidence that Lenvatinib-induced acalculous cholecystitis is not as rare as initially thought from the Lenvatinib licensing studies; hence, this is an adverse event that merits more attention. Oncologists using Lenvatinib should be aware of this potential toxicity and be familiar with its management. Full article

Background and Objectives: Isoniazid monotherapy has been the most widely used treatment for latent tuberculosis infection (LTBI). Although effective, it has been associated with poor adherence and a higher incidence of adverse events. The shorter duration of rifamycin-based regimens has become increasingly preferable. The one month of daily rifapentine plus isoniazid (1HP) has demonstrated low toxicity and higher completion rates in HIV-infected populations. This study aims to compare the completion rate and adverse events between the 1HP and daily isoniazid for 6 months (6H) regimens in the non-HIV adult population. Materials and Methods: Retrospective, observational, longitudinal study, followed at the National Reference Center for Tuberculosis (Lisbon, Portugal), from January 2024 to January 2025. Treatment-related symptoms and liver function were assessed throughout the treatment. Relevant hepatic toxicity was defined as aspartate transaminase (AST) and/or alanine transaminase (ALT) > 1.5 times the upper limit of normal (ULN). Results: A total of 90 and 74 patients were assigned to the 1HP and 6H groups, respectively. No significant differences were observed in the frequency of reported adverse symptoms between the 1HP and 6H groups (28.9% vs. 23.0%, p = 0.4). The 1HP regimen was associated with a significantly lower risk of relevant hepatic toxicity (4.6% vs. 32.9%, p < 0.001) and a higher rate of treatment completion (97.8% vs. 67.6%, p < 0.001). Adverse drug reactions were the leading cause of treatment discontinuation in both groups, with hepatic toxicity and gastrointestinal intolerance being the most frequent events. A therapeutic switch to rifampicin was required in 16.2% of patients receiving the 6H regimen, whereas no switch was needed in the 1HP group. Conclusions: The 1HP regimen was associated with a higher rate of treatment completion and lower hepatic toxicity with no significant differences in the reported adverse symptoms. Full article

Background and Objectives: Pregnancy and the postpartum period profoundly affect female sexual function, yet longitudinal data integrating obstetric and psychosocial domains are scarce. We aimed to chart sexual-function trajectories from early pregnancy to 12 months postpartum and identify predictors of persistent dysfunction. Materials and Methods: In this single-center prospective cohort, 187 pregnant women were eligible to complete the FSFI at three trimesters and at 6–8 weeks, 3 months, and 6–12 months postpartum, plus postpartum PHQ-9, WHOQOL-BREF, and body-image scales. Associations with FSFI-defined dysfunction (FSFI < 26.55) and continuous FSFI were examined, of which 90 women were included for having documented dysfunction. Results: Mean FSFI declined from 27.4 ± 3.9 (first trimester) to a nadir of 20.1 ± 4.2 at 6–8 weeks postpartum, with partial recovery to 25.5 ± 4.0 at 6–12 months (p < 0.001). Depressive symptoms were higher in women with dysfunction (PHQ-9 8.8 ± 3.3 vs. 6.7 ± 3.5; p < 0.001) and correlated inversely with FSFI (r = −0.39; p < 0.001). A multivariable model explained 19% of FSFI variance, with each 1 SD PHQ-9 increase predicting a 1.2-point FSFI decrease (p = 0.005). Body-image disturbance exerted a partially PHQ-9-mediated effect, and three FSFI trajectory clusters showed postpartum dysfunction rates from 28.6% to 89.7%. A combined psychosocial prediction model achieved an AUC of 0.9 with a sensitivity and specificity of 0.8. Conclusions: Postpartum sexual dysfunction was common and persisted in many women at one year; depressive symptoms, body image, and psychological quality of life were more influential than mode of birth, breastfeeding, or pelvic-floor symptoms. Full article

In the wake of trauma, individuals often experience not only psychological distress but also a profound disruption in their sense of self, meaning, and existence. This paper explores trauma-informed caregiving through an existential lens, emphasizing the need to address both the emotional and philosophical dimensions of trauma. While traditional trauma-informed approaches prioritize safety, trust, and empowerment, an existential perspective expands this foundation by acknowledging humans’ struggle with freedom, isolation, meaninglessness, and mortality. Utilizing an existential conceptual framework that incorporates trauma-informed care to improve person-centered practices is particularly applicable to caregiving with older adults. Encouraging caregivers to cultivate authentic presence, foster autonomy, and support the individual’s capacity to reframe their current life experience. By incorporating psychological insight with existential depth, this approach promotes the reawakening of purpose, agency, and connection while understanding the impact that trauma has in the caregiving process for both the caregiver and the person needing care. Case studies, practical strategies, and emerging research are discussed to support the implementation of this compassionate and holistic caregiving paradigm. Full article

Candida species are frequently detected in bile cultures during endoscopic retrograde cholangiopancreatography (ERCP), but their clinical significance and the value of antifungal treatment remain unclear. We performed a retrospective single-center cohort study of adults with growth of Candida species from bile cultures collected by ERCP performed between 2010 and 2023. We compared inpatients who received vs. those who did not receive antifungals within one week of ERCP and a subgroup with acute cholangitis. The primary outcome was a composite of death and invasive candidiasis within one year. Secondary outcomes included death, invasive candidiasis, and rehospitalization. Inverse probability of treatment weighting (IPTW) was performed using baseline characteristics. Adjusted hazard ratios and odds ratios were calculated. Among 197 inpatients, 51 (25.9%) received antifungals. At one year, the primary outcome occurred in 23 of 51 patients (45.1%) receiving antifungal therapy and in 67 of 146 patients (45.9%) who did not; the IPTW-adjusted hazard ratio was 0.93 (95% confidence interval 0.69–1.27; p = 0.66). No significant differences were seen in the acute cholangitis subgroup (n = 117). In this study, antifungal therapy was not associated with improved survival, lower rates of invasive candidiasis, or fewer readmissions. Findings support a conservative, stewardship-oriented approach to managing Candida-positive bile cultures in the absence of invasive disease. Full article

Objective: Prognosis in SNSCC remains poor mainly for local failure. Due to the rarity of this disease, and heterogeneity as to site and stage, most of the existing studies are based on the experience of individual centers; as such, data from meta-analysis may be of special value. In this meta-analysis, we evaluated patterns of treatment failure—local recurrence (LR), nodal recurrence (NR), and distant metastasis (DM)—and their relationship with overall survival (OS). Data source: A comprehensive search was performed in PubMed/MEDLINE, Web of Science, and Scopus for studies definitely involving treated patients with SNSCC. Review Methods: This study was conducted in accordance with the PRISMA 2000 Statement for Reporting Systematic Reviews Proportional meta-analysis to obtain pooled effect estimates, expressed as OS, local control (LC), distant metastasis-free survival (DMFS), disease-specific survival (DSS), LR rate, nodal recurrence (NR) rate and distant metastases (DM) rate. Rates of LR, NR and DM were analyzed and correlated with 5-year OS. Results: A total of 749 patients in 13 articles were identified. Multimodal treatment was administered in 588 cases (78%), including induction chemotherapy in 300 cases (40%), while 356 patients (47,5%) were treated with surgery followed by adjuvant radiotherapy (RT) or chemoradiotherapy (CHRT). The remaining 393 patients (52,5%) were treated without surgery. The pooled 2-, 3-, 5- and 10-year OS rates were 74%, 51.7%, 50.2% and 46.3%, respectively. The pooled 5-year local control (5-LC) rate was 57%, the pooled LR rate was 27.2% and the pooled NR rate was 11.6%. There was no statistically significant correlation between LR, NR, or DM and 5-year OS. Conclusions: SNSCC remains an aggressive disease with approximately 50% 5-year OS and LR as the main reason of treatment failure, with a rate of 27%. This confirms the necessity of better local control strategies. Full article

To facilitate the next generation of renewable energy devices, it is important to engineer oxygen reduction reaction (ORR) catalysts that balance efficiency and production costs. This work examines oxygen adsorption on the WC (0001) surface as a function of electrode potential, utilizing DFT simulations with an implicit solvent environment. The results demonstrate that electrode potential significantly influences oxygen adsorption energy and electronic structure. Among the adsorption sites examined, the top site exhibits the highest stability across the entire potential range. The observed reduction in adsorption energy at lower potentials is attributed to the d-band center moving further from the Fermi energy, which weakens C–O orbital interactions, as revealed by DOS and COHP analyses. Our results demonstrate the crucial role of electrochemical conditions in modulating catalytic behavior and provide valuable insights for optimizing tungsten carbide (WC)-based electrocatalysts for ORR applications. Full article

Background: Artificial intelligence is emerging as a promising tool in surgical oncology, with growing evidence suggesting potential applications in diagnostic support, intraoperative guidance, and perioperative risk assessment. In gastric cancer surgery, emerging applications range from AI-assisted endoscopic detection to data-driven perioperative risk prediction, while some technological developments, particularly in robotic autonomy, derive from broader surgical or experimental models that may inform future gastric procedures. Methods: A narrative review was conducted following established methodological standards, including the Scale for the Assessment of Narrative Review Articles (SANRA) and the Search–Appraisal–Synthesis–Analysis (SALSA) framework. English-language studies indexed in PubMed, Scopus, Embase, and Web of Science up to October 2025 were included. Evidence was synthesized thematically across five domains: AI-assisted anatomical recognition and lymphadenectomy support, autonomous robotic systems, early cancer detection, perioperative predictive and frailty models, and ethical and regulatory considerations. Results: AI-based computer vision and deep learning algorithms have demonstrated promising capabilities for real-time anatomical recognition, surgical phase classification, and intraoperative guidance, although evidence of direct patient-level benefit remains limited. In diagnostic settings, AI-assisted endoscopy and Raman spectroscopy have been shown to improve early lesion detection and reduce dependence on operator experience. Predictive models, including MySurgeryRisk and AI-driven frailty assessments, may support individualized prehabilitation planning and perioperative risk stratification. Persistent limitations include small and heterogeneous datasets, insufficient external validation, and unresolved concerns related to data privacy, algorithmic interpretability, and medico-legal responsibility. Conclusions: Artificial intelligence is progressively emerging as a promising tool in gastric cancer surgery, integrating automation, advanced analytics, and human clinical reasoning. Its safe and ethical adoption requires robust validation, transparent governance, and continuous surgeon oversight. When developed within human-centered and ethically grounded frameworks, AI can augment, rather than replace, surgical expertise, potentially advancing precision, safety, and equity in oncologic care. Full article

Background and Objectives: Circulating microRNAs may provide minimally invasive biomarkers for laryngeal squamous cell carcinoma (LSCC), but clinically interpretable data for miR-99a-5p and miR-1246 remain limited. We compared circulating levels of these two miRNAs between LSCC patients and controls and explored stage-associated differences within the cancer cohort. Methods: This single-center case–control study was conducted in Timișoara, Romania. Circulating miRNAs were quantified by RT-qPCR. Expression was summarized as ΔCt [Ct(target) − Ct(miR-16)] and as the relative expression (2^−ΔΔCt) using the control group as a calibrator. Group comparisons used Mann–Whitney U tests, associations used Spearman correlation, and the diagnostic performance was assessed by ROC analysis and multivariable logistic regression. Results: Fourteen controls were compared with cancer patients with available miRNA measurements (miR-99a-5p, n = 53; miR-1246, n = 49). miR-99a-5p showed significantly higher ΔCt values in cancer patients than in the controls (5.308 [IQR 4.139–6.864] vs. 3.184 [2.142–3.708], p < 0.001), corresponding to a lower relative expression (fold-change 0.200 [0.068–0.449], p < 0.001). miR-1246 did not differ significantly between cancer and controls (p = 0.09). Within the cancer cohort, advanced-stage disease showed a lower relative miR-1246 expression than early-stage disease (ΔCt 5.820 [4.502–6.972] vs. 4.233 [3.109–5.372], p = 0.01; fold-change 0.363 vs. 1.091, p = 0.01), while miR-99a-5p showed a non-significant difference in the same direction (p = 0.052). miR-99a-5p discriminated cancer patients from the controls with an AUC of 0.842 (95% CI 0.744–0.931), sensitivity of 77.4%, and specificity of 92.9% at ΔCt = 4.018. In multivariable analysis, ΔCt(miR-99a-5p) remained independently associated with cancer status (OR 1.89, 95% CI 1.19–3.00; p = 0.007). Conclusions: Circulating miR-99a-5p showed the strongest diagnostic signal in LSCC, whereas miR-1246 appeared more informative for stage-associated biological stratification. Full article