Search Results (1,762)

Background and Objectives: This study aimed to investigate the influence of continuous positive airway pressure in patients with obstructive sleep apnoea on hearing and the possibility of recovering cochlear receptor cells. Materials and Methods: Forty-two patients with obstructive sleep apnoea (OSA) were assigned to the study group. Patients underwent pure-tone audiometry and transient-evoked (TEOAE) and distortion-product (DPOAE) otoacoustic emissions before starting continuous positive airway pressure (CPAP) therapy and six months after CPAP therapy. Subjects were further divided into the following two groups: those who adequately used the therapy and those who did not adhere to treatment recommendations. Results: There is no significant difference in hearing thresholds for specific frequencies after six months of CPAP therapy. There is no significant difference in TEOAE and DPOAE SNR values at any frequency after 6 months of CPAP therapy. There is no significant difference in hearing threshold results for specific frequencies as a function of subject co-operation with treatment. After therapy, there is a significant difference in the SNR values in TEOAEs at 2 kHz and 4 kHz in subjects of the OSA target group, depending on co-operation, being higher in co-operative subjects, while there are no significant differences at other frequencies. There is a significant difference in the SNR results in DPOAEs, where they are higher in co-operative subjects at 1000, 6000, 7000 and 8000 Hz. Conclusions: The use of continuous positive airway pressure as a therapy for OSA has no effect on hearing and cochlear receptor cell recovery. Co-operation with CPAP treatment does not affect hearing threshold, but does affect cochlear receptor cell function, which is better at mid and higher frequencies in those who co-operate. These findings underscore the clinical significance of treatment adherence. Consistent adherence is associated with measurable improvements in hearing, particularly at higher frequencies, which cannot typically be evaluated in routine clinical practice using standard pure-tone audiometry. Our results emphasise the importance of promoting compliance with CPAP therapy not only for cardiovascular and neurological protection, but also for maintaining hearing health. Full article

Background: Reducing critically ill patients’ exposure to antibiotics is mandatory. In randomized controlled trials, procalcitonin (PCT)-guided algorithms (i.e., antibiotic therapy [ABT] should be stopped whenever PCT is less than 0.5 µg/L or is below 80% of the peak value) reduced the duration of (ABT) more than compliance with the current guidelines. However, the interest of such stopping rules in daily practice remains debated. Thus, we carried out a real-life study addressing this issue. Results: During the study period, 112 patients with sepsis upon intensive care unit admittance were included. The median age was 66 years (56–79). Half of the patients presented with acute respiratory failure. Pneumonia was diagnosed in 78% of them, and 41% met septic shock criteria. The initial ABT was empirical in most cases, and appropriateness rate to the isolated bacteria reached 71%. A median number of four PCT measurements was achieved in both groups. The compliance rate with the PCT algorithm was 54%. The median duration of ABT was 5 (4–7) days if the PCT algorithm was followed, as compared to 7 (5–10) days otherwise (p < 0.001). This ABT stopping rule allowed a 2-day reduction in the treatment duration as compared with those recommended by the guidelines (p < 0.001). The only independent factor associated with shorter treatment duration was compliance with the PCT algorithm (OR = 0.74, 95% CI [0.62; 0.88]; p < 0.001). Regarding safety, no difference in outcome was found between the two groups. Conclusions: Complying with one PCT-based stopping rule is associated with a significant reduction in the duration of ABT in septic critically ill patients, without apparent impact on patient outcomes. Full article

Background: Healthcare 5.0 represents a shift toward intelligent, human-centric care systems. Intensive care units generate vast amounts of data that require real-time decisions, but current decision support systems lack comprehensive frameworks for safe integration of artificial intelligence. Objective: We developed and validated the Learn–Predict–Monitor–Detect–Correct (LPMDC) framework as a methodology for systematic artificial intelligence integration across the critical care workflow. The framework improves predictive analytics, continuous patient monitoring, intelligent alerting, and therapeutic decision support while maintaining essential human clinical oversight. Methods: Framework development employed systematic theoretical modeling integrating Healthcare 5.0 principles, comprehensive literature synthesis covering 2020–2024, clinical workflow analysis across 15 international ICU sites, technology assessment of mature and emerging AI applications, and multi-round expert validation by 24 intensive care physicians and medical informaticists. Each LPMDC phase was designed with specific integration requirements, performance metrics, and safety protocols. Results: LPMDC implementation and aggregated evidence from prior studies demonstrated significant clinical improvements: 30% mortality reduction, 18% ICU length-of-stay decrease (7.5 to 6.1 days), 45% clinician cognitive load reduction, and 85% sepsis bundle compliance improvement. Machine learning algorithms achieved an 80% sensitivity for sepsis prediction three hours before clinical onset, with false-positive rates below 15%. Additional applications demonstrated effectiveness in predicting respiratory failure, preventing cardiovascular crises, and automating ventilator management. Digital twins technology enabled personalized treatment simulations, while the integration of the Internet of Medical Things provided comprehensive patient and environmental surveillance. Implementation challenges were systematically addressed through phased deployment strategies, staff training programs, and regulatory compliance frameworks. Conclusions: The Healthcare 5.0-enabled LPMDC framework provides the first comprehensive theoretical foundation for systematic AI integration in critical care while preserving human oversight and clinical safety. The cyclical five-phase architecture enables processing beyond traditional cognitive limits through continuous feedback loops and system optimization. Clinical validation demonstrates measurable improvements in patient outcomes, operational efficiency, and clinician satisfaction. Future developments incorporating quantum computing, federated learning, and explainable AI technologies offer additional advancement opportunities for next-generation critical care systems. Full article

Small-diameter vascular grafts often fail due to thrombosis and compliance mismatch. Decellularized plant scaffolds are a biocompatible, sustainable alternative. Leatherleaf viburnum leaves provide natural architecture and mechanical integrity suitable for tissue-engineered vessels. However, the persistence of immunogenic plant biomolecules and limited degradability remain barriers to clinical use. This study tested whether mild heat treatment improves scaffold biocompatibility without compromising mechanical performance. Decellularized leatherleaf viburnum scaffolds were treated at 30–40 °C in 5% NaOH for 15–60 min and then evaluated via tensile testing, burst pressure analysis, scanning electron microscopy, histology, and in vitro assays with white blood cells and endothelial cells. Scaffold properties were compared to those of untreated controls. Heat treatment did not significantly affect scaffold thickness but decreased fiber area fraction and diameter across all anatomical layers. Scaffolds treated at 30–35 °C for ≤30 min retained >90% of tensile strength and achieved burst pressures ≥820 mmHg, exceeding physiological arterial pressures. Heat treatment reduced surface fractal dimension while increasing entropy and lacunarity, producing a smoother but more heterogeneous microarchitecture. White blood cell viability increased up to 2.5-fold and endothelial cell seeding efficiency improved with treatment duration, with 60 min producing near-confluent monolayers. Mild alkaline heat treatment therefore improved immune compatibility and endothelialization while preserving mechanical integrity, offering a simple, scalable modification to advance plant-derived scaffolds for grafting. Full article

Telerehabilitation is an effective, accessible addition or alternative to conventional rehabilitation for fracture management, especially in older adults after hip fractures, leveraging video visits, mHealth apps, virtual reality (VR), and wearable sensors to deliver exercise, education, and monitoring at home with high satisfaction and adherence. Across non-surgical and surgical contexts, telemedicine shows feasibility and cost benefits, with mixed superiority but consistent non-inferiority for functional outcomes versus in-person care. In hip fracture populations, randomized and non-randomized studies indicate improvements in functional independence measure (FIM), Timed Up and Go test (TUG), Activities of Daily Living/Instrumental Activities of Daily Living (ADLs/IADLs), and quality of life, with some evidence for reduced anxiety and depression, while effects on mobility, pain, and adverse events remain uncertain overall. In patients with upper-limb fractures, telerehabilitation appears to improve function and pain, though strength gains may lag compared with in-person therapy in some trials; adjuncts like motor imagery and virtual reality may enhance outcomes and motivation. Application is facilitated by user-friendly platforms, caregiver involvement, and simple modalities such as structured phone follow-up. Limitations include small samples, heterogeneous protocols, scarce long-term data, and a predominance of non-inferiority or complementary designs, warranting larger, definitive trials. This technology can lead to improved patient management at home, effortlessly verifying treatment compliance, efficacy, and safety, while simultaneously reducing the need for hospitalization, promoting a more peaceful recovery. Here, we have undertaken a narrative review of the medical–scientific literature in this field. Full article

Background and Objectives: Iron deficiency anemia (IDA) is the most common cause of anemia in pregnant women and can adversely affect both maternal and fetal health. This study aimed to compare pregnancy outcomes between women with and without IDA in Northern Thailand, a region with a high prevalence of anemia. Methods: A retrospective cohort study was conducted on all singleton pregnancies attending antenatal care (ANC) and/or delivering at Maharaj Nakorn Chiang Mai Hospital between 2003 and 2024. The study group consisted of women diagnosed with IDA in the first half of pregnancy, while the control group comprised women with low-risk pregnancies during the same study period. Results: Of the 38,979 pregnancies, after applying exclusion criteria, 634 pregnancies (2.2%) with laboratory-confirmed IDA and 28,132 controls remained available for analysis. Women with IDA had significantly higher parity, lower socioeconomic status, and lower hemoglobin levels throughout pregnancy. Multivariate regression analysis revealed that IDA was significantly associated with increased risks of preterm birth (adjusted odds ratio; aOR 1.04; 95% CI: 1.01–1.07), fetal growth restriction (FGR) (aOR 1.02; 95% CI: 1.00–1.04), and low birth weight (aOR 1.05; 95% CI: 1.03–1.08). Conclusions: IDA, even with treatment, may still slightly increase the risk of adverse pregnancy outcomes, particularly preterm birth, fetal growth restriction, and low birth weight. The residual risk likely reflects incomplete correction of anemia. Optimizing management requires strict compliance, judicious use of parenteral iron, and attention to coexisting nutritional deficiencies, underscoring the need for closer monitoring and improved care strategies. Full article

Aflatoxin (AF) contamination in pistachios remains a critical food safety and trade challenge, given the potent carcinogenicity of AF-B₁ and the nut’s high susceptibility to Aspergillus infection throughout production and storage. Traditional decontamination methods such as roasting, irradiation, ozonation, and acid/alkaline treatments can reduce AF levels but often degrade sensory and nutritional quality, implying the need for more sustainable approaches. In recent years, innovative nonthermal interventions, including pulsed light, cold plasma, nanomaterial-based adsorbents, and bioactive coatings, have demonstrated significant potential to decrease fungal growth and AF accumulation while preserving product quality. Biosensing technologies such as electrochemical immunosensors, aptamer-based systems, and optical or imaging tools are advancing rapid, portable, and sensitive detection capabilities. Combining these experimental strategies with artificial intelligence (AI) and machine learning (ML) models can increasingly be applied to integrate spectral, sensor, and imaging data for predicting fungal development and AF risk in real time. This review brings together progress in nonthermal reduction strategies, biosensing innovations, and data-driven approaches, presenting a comprehensive perspective on emerging tools that could transform pistachio safety management and strengthen compliance with global regulatory standards. Full article

Objective: This study evaluates the efficacy of a novel approach to oral appliance therapy (“OAT”) for the treatment of obstructive sleep apnea (“OSA”). This novel approach utilizes a systemized, oximetry-informed, treatment protocol and a precision-custom oral appliance. Methods: Sixty consecutive patients diagnosed with OSA were treated at Sleep Better Austin (“SBA”) using a structured, multi-step protocol and a precision-custom oral appliance (ProSomnus EVO). Baseline and post-treatment apnea–hypopnea index (“AHI”) values were compared using a matched-pair design. The primary outcome was the percentage of patients achieving a residual AHI of <10 events/h. Secondary outcomes included severity classification improvement. Results: In total, 90% of patients achieved the primary endpoint, and 87% improved by at least one severity classification. The mean AHI improved by 63% from baseline with the precision-custom OAT in situ (p < 0.001). In the moderate-to-severe subgroup, AHI improved by 70%, with 100% of severe patients achieving a residual AHI of <20 and a ≥50% improvement, without patient preselection. No serious adverse events were reported, and all patients continued therapy at follow-up. Conclusions: Precision-custom OAT, when delivered through a standardized clinical protocol informed by oximetry, can be a highly effective and well-tolerated treatment for OSA. These findings support its broader adoption as a non-invasive alternative to continuous positive airway pressure (“CPAP”) and surgical interventions, particularly for patients seeking personalized, high-compliance solutions. Full article

Background: Chronic kidney disease (CKD) in companion animals leads to progressive renal deterioration and metabolic complications such as hyperphosphatemia and metabolic acidosis, particularly in advanced stages. Methods: This 90-day, double-blind, randomized controlled study evaluated the effects of a renal supplement (Renal Combi, Candioli srl, Beinasco, Turin, Italy) in 30 dogs diagnosed with CKD. Dogs were randomly assigned to a treatment group (TRT, n = 15), receiving a commercial renal diet plus the supplement (once daily), or a control group (CTR, n = 15), receiving the same diet and a placebo. Results: Results showed that supplementation effectively reduced proteinuria, blood urea, and phosphorus levels, stabilized creatinine and SDMA, and maintained blood pressure. It also improved markers of systemic inflammation and oxidative stress. Conclusions: The once-daily dosage simplified administration and was especially beneficial for hyporexic dogs or those on multiple medications. This study supports the use of the tested supplement as an effective adjunctive therapy for managing CKD in dogs, offering metabolic, renal, and nutritional benefits while enhancing compliance through convenient dosing. Full article

Background/Objectives: Cancer remains a leading global cause of death, with breast, lung, colorectal, and prostate cancers being among the most prevalent. The integration of Artificial Intelligence (AI) into cancer imaging research offers opportunities for earlier diagnosis and personalized treatment. However, the effectiveness of AI models depends critically on the quality, standardization, and fairness of the input data. The EU-funded INCISIVE project aimed to create a federated, pan-European repository of imaging and clinical data for cancer cases, with a key objective to develop a robust framework for pre-validating data prior to its use in AI development. Methods: We propose a data validation framework to assess clinical (meta)data and imaging data across five dimensions: completeness, validity, consistency, integrity, and fairness. The framework includes procedures for deduplication, annotation verification, DICOM metadata analysis, and anonymization compliance. Results: The pre-validation process identified key data quality issues, such as missing clinical information, inconsistent formatting, and subgroup imbalances, while also demonstrating the added value of structured data entry and standardized protocols. Conclusions: This structured framework addresses common challenges in curating large-scale, multimodal medical data. By applying this approach, the INCISIVE project ensures data quality, interoperability, and equity, providing a transferable model for future health data repositories supporting AI research in oncology. Full article

Recent advances in cardiovascular imaging have revolutionized the assessment and management of abdominal aortic aneurysm (AAA) through the integration of sophisticated haemodynamic biomarkers. This comprehensive review evaluates the clinical utility and mechanistic significance of multiple biomarkers in AAA pathogenesis, progression, and treatment outcomes. Advanced cardiac imaging modalities, including four-dimensional magnetic resonance imaging (4D MRI), computational fluid dynamics (CFD), and specialized echocardiography, enable precise quantification of critical haemodynamic parameters. Wall shear stress (WSS) emerges as a fundamental biomarker, with values below 0.4 Pa indicating pathological conditions and increased risk for aneurysm progression. Time-averaged wall shear stress (TAWSS), typically maintaining values above 1.5 Pa in healthy arterial segments, provides crucial information about sustained haemodynamic forces affecting the vessel wall. The oscillatory shear index (OSI), ranging from 0 (unidirectional flow) to 0.5 (purely oscillatory flow), quantifies directional changes in WSS during cardiac cycles. In AAA, elevated OSI values between 0.3 and 0.4 correlate with disturbed flow patterns and accelerated disease progression. The relative residence time (RRT), combining TAWSS and OSI, identifies regions prone to thrombosis, with values exceeding 2–3 Pa⁻¹ indicating increased risk. The endothelial cell activation potential (ECAP), calculated as OSI/TAWSS, serves as an integrated metric for endothelial dysfunction risk, with values above 0.2–0.3 Pa⁻¹ suggesting increased inflammatory activity. Additional biomarkers include the volumetric perivascular characterization index (VPCI), which assesses vessel wall inflammation through perivascular tissue analysis, and pulse wave velocity (PWV), measuring arterial stiffness. Central aortic systolic pressure and the aortic augmentation index provide essential information about cardiovascular load and arterial compliance. Novel parameters such as particle residence time, flow stagnation, and recirculation zones offer detailed insights into local haemodynamics and potential complications. Implementation challenges include the need for specialized equipment, standardized protocols, and expertise in data interpretation. However, the potential for improved patient outcomes through more precise risk stratification and personalized treatment planning justifies continued development and validation of these advanced assessment tools. Full article

Sprayers for vineyards with solution recovery represent an important innovation, offering several advantages, the most important being the efficient use of pesticides and environmental protection. This paper presents the experimental equipment designed to study the treatment process of grapevine foliage, the applied research methods, and the results of optimizing key technological parameters (hydraulic pressure p of the working solution, speed V of the airflow at the nozzle outlet) and design parameters (surface area S of the central orifice of the diffuser) in different growth stages of grapevines with varying foliar density ρ, the response function being the recovery rate of the working solution. The construction of the SVE 1500 (Experimental model, manufactured at the Institute of Agricultural Technology “Mecagro”, Chisinau, Republic of Moldova) vineyard sprayer with solution recovery is presented, along with test results obtained in field conditions, which demonstrated that the experimental model of our machine ensures a 38% reduction in working solution consumption during the active vegetation phase while maintaining treatment quality in compliance with agrotechnical requirements. The SVE 1500 machine can be towed with a sufficient turning radius for use in modern vineyard plantations. Construction documentation has been developed for the production and delivery of the experimental batch of SVE 1500 machines to agricultural enterprises. Full article

In recent years, microneedles (MNs), an innovative transdermal drug delivery system, have demonstrated significant advantages in treating diverse skin diseases. The stratum corneum (SC), with its ‘brick-mortar’ structure, is the main barrier to drug penetration into the skin. MNs—including solid, coated, hollow, dissolving, and hydrogel-forming types—penetrate it minimally to form temporary micro-channels, enabling efficient delivery of a wide range of therapeutic agents. These include small molecules, biologics, nanoparticles, and photosensitizers, among others. This technology has been effectively applied in the treatment of androgenetic alopecia, acne, scars, melanoma, psoriasis, atopic dermatitis, and vitiligo. By avoiding stimulation of dermal blood vessels and nerves, MNs offer low pain and high patient compliance. These advantages underscore their broad clinical potential for dermatologic therapy. Future studies must optimize material selection, drug-carrying efficiency, and scale-up production to facilitate clinical translation. Full article

Lee Silverman Voice Treatment (LSVT) BIG, primarily developed for outpatient use, is a prominent intervention for patients with Parkinson’s disease thanks to its high-intensity, repetitive exercises involving large movements. This study first evaluated the feasibility of an in-hospital LSVT BIG training program by assessing recruitment capability, compliance, and adherence. The secondary objective was to evaluate the effects of LSVT BIG training on gait, balance, and functional outcomes, as well as respiratory function and quality of life, in comparison with a progressive structured rehabilitation program (SC) of similar intensity and frequency. In-hospital LSVT BIG training for people with Parkinson’s disease was feasible, with 95% recruitment rates and 100% safety and adherence. SC (n = 19) and LSVT BIG (n = 19) significantly improved (for all, p < 0.05) pre-to-post balance (MiniBESTest) and lower limb effort tolerance (6MWT). Delta changes between groups favored LSVT for upper limb effort tolerance (UULEX level, time, p < 0.001), gait speed, and UULEX SatO₂ mean, PCEF, MiniBESTest and 6MWT (for all, p < 0.05). Evaluation of the probability associated with the LSVT BIG showed MiniBESTest as being 8.5 times more likely to exceed the MCID compared to SC. Quality of life was unchanged across both groups. This study successfully demonstrates the feasibility of in-hospital LSVT-BIG^® training, and comparison of outcomes, although exploratory and underpowered, showed better improvements in mobility, balance, and effort tolerance, suggesting a complementary role within traditional rehabilitation protocols. Full article

Breast cancer (BC) is the most frequently diagnosed malignancy in women. Currently, BC is treated with a holistic and multidisciplinary approach from diagnostic, surgical, radio-oncological, and medical perspectives, and advances including in early detection and treatment methods have led to improved outcomes for patients in recent years. Yet, BC remains the second most common cause of cancer-related deaths among women and there is an array of gaps to achieve optimal care. To close gaps in cancer care, here we describe a collaborative Request For Proposals (RFP) framework supporting independent initiatives for metastatic breast cancer (MBC) patients and aiming at improving their quality of care. We set up a collaborative framework between Pfizer and Sharing Progress in Cancer Care (SPCC). Our model is based on an RFP system in which Pfizer and SPCC worked together ensuring the independence of the funded projects. We developed a three-step life cycle RFP. The collaborating framework of the project was based on an RFP with a USD 1.5 million available budget for funding independent grants made available from Pfizer and managed in terms of awareness, selection, and monitoring by SPCC. Our three-step model could be applicable and scalable to quality improvement (QI) initiatives that are devoted to tackling obstacles to reaching optimal care. Through this model, seven projects from five different European countries were supported. These projects covered a range of issues related to the experience of patients with MBC: investigator communication, information, and shared decision-making (SDM) practices across Europe; development, delivery, and evaluation of a scalable online educational program for nurses; assessment of disparities among different minority patient groups; development of solutions to improve compliance or adherence to therapy; an information technology (IT) solution to improve quality of life (QoL) of patients with MBC and an initiative to increase awareness and visibility of MBC patients. Overall, an average of 171 healthcare professionals (HCPs) per project and approximately 228,675 patients per project were impacted. We set up and describe a partnership model among different stakeholders within the healthcare ecosystem―academia, non-profit organizations, oncologists, and pharmaceutical companies―aiming at supporting independent projects to close gaps in the care of patients with MBC. By removing barriers at different layers, these projects contributed to the achievement of optimal care for patients with MBC. Full article