Search Results (369)

Objectives: Surface-Guided Radiation Therapy (SGRT) has been widely adopted in breast cancer radiotherapy, particularly for improving setup accuracy and motion management. Recently, its application in lung cancer has attracted growing interest due to similar needs for precision. This study investigates the feasibility and clinical utility of SGRT in lung cancer treatment, focusing on its effectiveness in patient setup and real-time motion monitoring under frameless immobilization conditions. Materials and Methods: A total of 204 treatment records from 17 patients with primary lung cancer who underwent radiotherapy at Korea University Guro Hospital between October 2024 and April 2025 were retrospectively analyzed. Patients were initially positioned using the Identify system (Varian) in the CT suite, with surface data transferred to the treatment room system. Alignment was performed to within ±1 cm and ±2° across six degrees of freedom. Cone-beam CT (CBCT) was acquired prior to treatment for verification, and treatment commenced when the Distance to Correspondence Surface (DCS) was ≤0.90. Setup deviations from the Identify system were recorded and compared with CBCT in three translational axes to evaluate positioning accuracy and PTV displacement. Results and Conclusions: The Identify system was shown to provide high setup accuracy and reliable real-time motion monitoring in lung cancer radiotherapy. Its ability to detect patient movement and automatically interrupt beam delivery contributes to enhanced treatment safety and precision. In addition, even though the maximum longitudinal (Lng) shift reached up to −1.83 cm with surface-guided setup, and up to 1.78 cm (Lat) 5.26 cm (Lng), 9.16 cm (Vrt) with CBCT-based verification, the use of Identify’s auto-interruption mode (±1 cm in translational axes, ±2° in rotational axes) allowed treatment delivery with PTV motion constrained within ±0.02 cm. These results suggest that, due to significant motion in the longitudinal direction, appropriate PTV margins should be considered during treatment planning. The Identify system enhances setup accuracy in lung cancer patients using a surface-guided approach and enables real-time tracking of intra-fractional errors. SGRT, when implemented with systems such as Identify, shows promise as a feasible alternative or complement to conventional IGRT in selected lung cancer cases. Further studies with larger patient cohorts and diverse clinical settings are warranted to validate these findings. Full article

Background: Hypoxic–ischemic encephalopathy (HIE) is a leading cause of severe neurological impairments in childhood. Therapeutic hypothermia (TH) is both safe and effective in neonates born at ≥36 weeks gestation with moderate to severe HIE. We aimed to evaluate short-term outcomes—including brain injury detected on magnetic resonance imaging (MRI)—in infants born at 34–35 weeks of gestation drawing on our clinical experience with neonates under 36 weeks of gestational age (GA). Methods: In this retrospective cohort study, 20 preterm infants with a GA of 34 to 35 weeks and a matched cohort of 80 infants with a GA of ≥36 weeks who were diagnosed with moderate to severe HIE and underwent TH were included. Infants were matched in a 1:4 ratio based on the worst base deficit in blood gas and sex. Maternal and neonatal characteristics, brain MRI findings and short term outcomes were compared. Results: Infants with a GA of 34–35 weeks had a lower birth weight and a higher rate of caesarean delivery (both p < 0.001). Apgar scores, sex, intubation rate in delivery room, blood gas pH, base deficit and lactate were comparable between the groups. Compared to infants born at ≥36 weeks of GA, preterm neonates were more likely to receive inotropes, had a longer time to achieve full enteral feeding, and experienced a longer hospital stay. The mortality rate was 10% in the 34–35 weeks GA group. Neuroimaging revealed injury in 66.7% of infants born at 34–35 weeks of gestation and in 58.8% of those born at ≥36 weeks (p = 0.56). Injury was observed across multiple brain regions, with white matter being the most frequently affected in the 34–35 weeks GA group. Thalamic and cerebellar abnormal signal intensity or diffusion restriction, punctate white matter lesions, and diffusion restriction in the corpus callosum and optic radiations were more frequently detected in infants born at 34–35 weeks of gestation. Conclusions: Our study contributes to the growing body of literature suggesting that TH may be feasible and tolerated in late preterm infants. Larger randomized controlled trials focused on this vulnerable population are necessary to establish clear guidelines regarding the safety and efficacy of TH in late preterm infants. Full article

Periodontitis, a chronic inflammatory disease, causes alveolar bone loss. Current treatments show limitations in achieving dual antimicrobial and anti-inflammatory effects. We evaluated an emodin-loaded thermoresponsive hydrogel as a local drug delivery system for periodontitis treatment. Emodin itself demonstrated antibacterial activity against Porphyromonas gingivalis, with minimal inhibitory and minimal bactericidal concentrations of 50 μM. It also suppressed mRNA expression of proinflammatory cytokines [tumor necrosis factor alpha, interleukin (IL)-1β, and IL-6] in lipopolysaccharide-stimulated RAW 264.7 cells. The hydrogel, formulated with poloxamers and carboxymethylcellulose, remained in a liquid state at room temperature and formed a gel at 34 °C, providing sustained drug release for 96 h and demonstrating biocompatibility with human periodontal ligament stem cells while exhibiting antibacterial activity against P. gingivalis. In a rat model of periodontitis, the hydrogel significantly reduced alveolar bone loss and inflammatory responses, as confirmed by micro-computed tomography and reverse transcription quantitative polymerase chain reaction of gingival tissue. The dual antimicrobial and anti-inflammatory properties of emodin, combined with its thermoresponsive delivery system, provide advantages over conventional treatments by maintaining therapeutic concentrations in the periodontal pocket while minimizing systemic exposure. This shows the potential of emodin-loaded thermoresponsive hydrogels as effective local delivery systems for periodontitis treatment. Full article

Discourses on breastfeeding extend beyond simple scientific evidence, framed within a dialogue between diverse sociocultural perspectives throughout history. Building on this premise, this article aims to explore, from the perspective of the sociology of deviance, the maternal experiences of women who choose not to breastfeed or cease breastfeeding within the hospital setting. To this end, this qualitative and phenomenological study was conducted, using semi-structured interviews with mothers in the municipality of Lorca who had decided not to breastfeed or had discontinued breastfeeding as a data collection tool. The results indicate that breastfeeding is influenced by the repercussions of delivery room routines and a challenging learning process where complications often arise, contradicting the prevailing innatist discourse of maternal instinct. Within this framework, mothers feel pressured by professionals to breastfeed, and their identities are undermined by symbolic stigma when they express their decision not to breastfeed. We conclude that it is essential to propose clinical approaches and support models that genuinely consider the sociocultural, historical, and experiential factors influencing breastfeeding, moving beyond an exclusive focus on its biological or nutritional aspects. Full article

Incorporating probiotics into edible films offers an effective strategy for delivering viable microorganisms to the body. This study aimed to develop edible films based on three types of pregelatinized cassava starch—pregelatinized native starch (PNS), hydroxypropyl distarch phosphate (HDP), and hydroxypropyl starch (HS)—as carriers for Bacillus coagulans (BC). The interactions between probiotic powder and the polymer matrix, as well as the viability of B. coagulans during film drying and subsequent storage, were evaluated to assess the effectiveness of the films as protective delivery systems at room temperature (25 °C). The addition of BC altered the amorphous-to-ordered structure of the starch matrices. Surface morphology analysis showed BC aggregates on PNS films, whereas HDP and HS films retained smooth surfaces. Incorporation of BC increased the tensile strength and Young’s modulus of PNS films but reduced their elongation at break. Additionally, BC decreased both the light transmittance and water contact angle in PNS films, while 1% BC increased the contact angle in HDP and HS films. BC had no significant effect on the solubility of PNS films but enhanced the solubility of HDP and HS films. Notably, B. coagulans maintained viability around 8 log CFU/g after 90 days of storage at room temperature, supporting the potential of pregelatinized starch-based films as effective probiotic carriers. Full article

Background/Objectives: To identify the risk factors and clinical outcomes of persistent pulmonary hypertension of the newborn (PPHN) in very low birth weight (VLBW) infants in a resource-limited setting. Methods: We conducted a 1:4 matched case–control study in a Thai neonatal unit between 2014 and 2023. Neonates born at a gestational age (GA) < 32 weeks and with a birth weight (BW) < 1500 g were included. Neonates who died in the delivery room or had major congenital anomalies were excluded. Matching was based on GA, BW, year of birth, and endotracheal intubation at birth. Conditional logistic regression analysis was performed. Results: Over the 10-year study period, the incidence of PPHN among VLBW neonates was 4.6% (31/667). After matching, there were 31 cases and 124 controls. In univariable analysis, PPHN was significantly associated with lower 1 min and 5 min Apgar scores; however, no significant association remained in multivariable analysis. PPHN was significantly associated with composite adverse outcomes—including mortality and major morbidities (adjusted odds ratio [aOR] = 7.51, 95% confidence interval [CI]: 2.41–23.40), mortality alone (aOR = 2.88, 95% CI: 1.06–7.63), major morbidities (aOR = 2.99; 95% CI: 1.29–6.95), and severe neurological injury (aOR = 4.44, 95% CI: 1.56–12.59). Daily hospital costs were also higher in PPHN cases, with an average increase of 97.1 USD. Conclusions: In VLBW infants, PPHN was associated with a lower Apgar score and surfactant administration. PPHN was significantly linked to adverse outcomes, particularly mortality, major morbidities, and severe neurological injury. Full article

Natural polymer-based nanoparticles have emerged as promising stabilizers for Pickering emulsions, offering biocompatibility, environmental sustainability, and improved protection of active compounds. This study developed chitosan/gum arabic (CH/GA) nanoparticles as solid stabilizers for quercetin-loaded Pickering emulsions to enhance the stability and antioxidant bioactivity of quercetin (QE), a plant-derived flavonoid known for its potent radical-scavenging activity but limited by oxidative degradation. A systematic formulation strategy was employed to evaluate the effects of CH/GA concentration (0.5–2.0% w/v), oil type (olive, soybean, sunflower, and coconut), and oil volume fraction (ϕ = 0.5–0.7) on emulsion stability. The formulation containing 1.5% CH/GA and olive oil at ϕ = 0.6 exhibited optimal physical and interfacial stability. Quercetin (0.1% w/w) was incorporated into the optimized emulsions and characterized for long-term stability, particle size, droplet morphology, rheology, antioxidant activity (DPPH), cytocompatibility, and intracellular reactive oxygen species (ROS) protection using HaCaT keratinocytes. The olive oil-based formulation (D1-QE) exhibited greater viscosity retention and antioxidant stability than its soybean-based counterpart (E2-QE) under both room temperature (RT) and accelerated heating–cooling (H/C) storage conditions. Confocal microscopy confirmed the accumulation of CH/GA nanoparticles at the oil–water interface, forming a dense interfacial barrier and enhancing emulsion stability. HPLC analysis showed that D1-QE retained 92.8 ± 0.5% of QE at RT and 82.8 ± 1.5% under H/C conditions after 30 days. Antioxidant activity was largely preserved, with only 4.7 ± 1.7% and 14.9 ± 4.8% loss of DPPH radical scavenging activity at RT and H/C, respectively. Cytotoxicity testing in HaCaT keratinocytes confirmed that the emulsions were non-toxic at 1 mg/mL QE and effectively reduced H₂O₂-induced oxidative stress, decreasing intracellular ROS levels by 75.16%. These results highlight the potential of CH/GA-stabilized Pickering emulsions as a polymer-based delivery system for maintaining the stability and functional antioxidant activity of QE in bioactive formulations. Full article

Background/Objectives: Operating rooms represent valuable and pivotal units of any hospital. Therefore, their management affects healthcare service delivery through rescheduling, staff shortage/overtime, cost inefficiency, and patient dissatisfaction, among others. To optimize scheduling, we aim to assess preoperative evaluation criteria that influence the prediction of surgery duration for gastric cancer (GC) patients. In GC, radical surgery with curative intent is the ideal treatment. Nevertheless, the intervention sometimes must be palliative if the patient’s status and tumor staging prove too advanced. Methods: A 6-year retrospective cohort study was performed in a tertiary care hospital, including all cases diagnosed with GC (ICD-10 code C16), confirmed through histopathology, and undergoing surgical treatment (N = 108). Results: The results of our study confirm male predominance (63.89%) among GC surgery candidates while bringing new perspectives on patient evaluation criteria and choice of surgical intervention (curative—Group 1, palliative—Group 2). Surgery duration, including anesthesiology (175.19 [95% CI (157.60–192.77)] min), shows a direct correlation with the number of lymph nodes dissected (Surgical duration [min] = 10.67 × No. of lymph nodes removed − 32.25). Interestingly, the aggressiveness of the tumor based on histological grade (highly differentiated being generally less aggressive than poorly differentiated) shows differential correlation with surgery duration among curative and palliative surgery candidates. Similarly, TNM staging indicates the need for a longer surgical duration (pTNM stage IIA, IIB, and IIIA) for curative interventions in patients with less advanced stages, as opposed to shorter surgery duration for palliative interventions (pTNM stage IIIC and IV). Conclusions: The study quantitatively presents the resources needed for the optimal surgical treatment of different groups of GC patients, as the disease coding systems in use regard the treatment of each pathology as “standard” in terms of patient management. The results obtained are anchored in the global perspectives of surgical outcomes and aim to improve the management of operating room scheduling, staff, and resources. Full article

Tetralogy of Fallot (ToF) with pulmonary atresia (PA) and complete right ventricular outflow tract obstruction (RVOTO) represents one of the most critical forms of congenital heart disease in neonates. These cases require complex and timely interventions to ensure survival and optimize long-term outcomes. While surgical correction offers a favorable prognosis, the period from birth to surgery is often marked by significant hemodynamic, respiratory and nutritional challenges, particularly in neonatal intensive care units (NICUs). This study aims to outline a structured, physiology-guided approach to the preoperative management of neonates with ToF and complete RVOTO, emphasizing stabilization strategies, hemodynamic support, ventilatory management and nutritional optimization. We performed a focused literature review of practices in neonatal ToF management and illustrated our experience through two case reports highlighting divergent outcomes in infants with the same anatomical diagnosis. The management strategies covered include delivery room stabilization, the use of prostaglandins, mechanical ventilation techniques, nutritional interventions and the timing of surgical intervention. A phased, physiology-guided management strategy is the key to the successful preoperative treatment of ToF with pulmonary atresia. Optimizing hemodynamics, ensuring adequate pulmonary blood flow and supporting nutritional needs are the main drivers for growth and may reduce the time from diagnosis to surgical correction. Full article

While carboxymethyl cellulose (CMC)—a biocompatible and water-soluble cellulose derivative—holds promise for biomedical applications, challenges remain in synthesizing CMC-based hydrogels with covalent crosslinking through free radical polymerization without requiring complex, multi-step processes. In this study, we introduce a facile one-pot strategy that combines CMC with acrylamide (AAm) under cryogelation and low-intensity UV irradiation to achieve covalent bonding and a high polymerization yield. The resulting polyacrylamide/carboxymethyl cellulose (PAAm/CMC) porous gels were systematically evaluated for their chemical, physical, thermal, and drug-release properties, with a focus on the effects of AAm concentration and polymerization temperature (frozen vs. room temperature). Notably, the cryogel synthesized with 2.5 M AAm (PC2.5) exhibited significantly enhanced mechanical properties—that is, an 8.4-fold increase in tensile modulus and a 26-fold increase in toughness—compared with the non-cryo gel. Moreover, PC2.5 demonstrated excellent cyclic compression stability in water and phosphate-buffered saline (PBS), with less than 10% reduction in modulus after 100 cycles. These increases in the mechanical properties of PC2.5 are attributed to the formation of macropores with high polymer density and high crosslinking density at the pore walls. PC2.5 also showed slower drug release in PBS and good cytocompatibility. This study presents a simplified and efficient route for fabricating mechanically robust, covalently crosslinked PAAm/CMC cryogels, highlighting their strong potential for biomedical applications in drug delivery systems. Full article

The COVID-19 pandemic prompted the use of telehealth interventions for treating depression in older adults. We conducted a pilot study of a telephone-based brief psychological intervention, Behavioral Activation with Mental Imagery (BA-MI), for the treatment of depression in isolated older adults during the COVID-19 pandemic. We achieved promising results regarding a reduction in depressive symptoms. The purpose of the present study was to investigate the participants’ experiences of the intervention and provide insight into how the intervention could be improved. Fourteen participants aged 67–85 years that completed the BA-MI intervention were purposively selected and interviewed. The interviews were analyzed using thematic analysis with a descriptive phenomenological approach. BA was experienced as a good way of increasing activities and improving mood, but the opinions on MI were divided. Telephone delivery reduced barriers due to pandemic restrictions but felt less personal and lacking non-verbal communication. Being recognized and talking to a therapist every week was described as healing. When using manual-based psychological interventions, one should aim to make them as person-centered as possible by making room for the patients as individuals with both a past and a present, rather than just focusing on intervention delivery. Full article

Background: Patient motion poses significant challenges for the accurate delivery of radiotherapy. In children undergoing proton beam therapy (PBT), up to 30 treatments under general anesthesia may be required over a period of 6 to 8 weeks. To date, the impact of this many iterative anesthetic exposures on patient outcomes remains unclear. Objective: The primary objective of this study was to assess the impact of iterative anesthesia with propofol-based total intravenous anesthesia (propofol-TIVA) on overall survival. The secondary objective was to assess the association between propofol-TIVA and the occurrence of an unplanned admission or emergency room visit within 30 days of treatment start. Methods: This was a retrospective study of children (≤19 years) who had undergone PBT (with or without anesthesia) for central nervous system disease. The Log-rank test and Cox proportional hazards models were used for analysis. Propensity score matching and E-value analyses were used to adjust for selection bias. Results: The average age of the 461 children included was 9.0 years (SD ± 4.9). The majority, 261/461 (56.6%), were male, and 267/461 (57.9%) had undergone PBT without anesthesia. The group who underwent PBT with propofol-TIVA were younger (4.7 years vs. 12.2 years, p < 0.001) and had higher proportions of patients with treatment interruptions (111/194 [57.2%] vs. 118/267 [44.2%], p = 0.006), chemotherapy history (64/194 [33.0%] vs. 18/267 [6.7%], p < 0.001), concurrent chemotherapy (37/194 [19.1%] vs. 27/267 [10.1%], p = 0.006), and unplanned admissions/emergency room visits (26/194 [13.4%] vs. 1/267 [0.4%], p < 0.001). Overall survival rates (propofol-TIVA vs. no anesthesia) at 1yr (94% vs. 96%), 2 years (88% vs. 90%), and 3 years (88% vs. 89%) were similar between patient groups (p = 0.558). In the multivariable analysis, PBT with propofol-TIVA was associated with increased odds of an unplanned admission/emergency room visit before (OR, 38.311; 95%CI, 5.139–285.580; p < 0.001) and after (OR, 42.012; 95% CI, 5.322–331.632; p < 0.001; E-value = 83.52) propensity score matching. Conclusions: In this retrospective study of children undergoing PBT for central nervous system disease, there was no association between anesthesia exposure with propofol-based total intravenous anesthesia and overall survival. However, PBT with propofol-based total intravenous anesthesia was associated with an increased risk of an unplanned admission/emergency room visit within 30 days of treatment start. Full article

Background: Ensuring the safety of patients in the operating room, through the monitoring and prevention of adverse events is a central priority of healthcare delivery. In the professionalization of operating room nurses, the processes of identifying, assessing, developing, monitoring, and certifying transversal competencies are crucial. While national and international frameworks have attempted to define such competencies, they often vary in scope and remain inconsistently integrated into education and clinical practice. There is, therefore, a need for a comprehensive and structured identification of transversal competencies relevant to both perioperative and perianesthesiological nursing roles. Objectives: To formulate a validated and structured repertoire of transversal competencies demonstrated by operating room nurses in both perioperative and perianesthesiological contexts. Methods: A qualitative descriptive design was adopted, combining shadowed observation with Hierarchical Task Analysis (HTA). A convenience sample of 46 participants was recruited from a university and a public hospital in Italy. Data were collected between September 2021 and June 2023 and analyzed using content analysis and data triangulation. Results: Through a qualitative, inductive and iterative approach the study identified 15 transversal competencies, 50 sub-competencies, and 153 specific tasks and activities. Specifically, operating room nurses working in perioperative and perianesthesiological roles presented the following transversal competencies: communication and interpersonal relationships, situation awareness, teamwork, problem solving and decision-making, self-awareness, coping with stressors, resilience and fatigue management, leadership, coping with emotions, task and time management, ethical and sustainable thinking, adaptation to the context, critical thinking, learning through experiences, and data, information and digital content management. Each competency was associated with specific tasks observed. Conclusions: This framework complements the existing repertoire of technical-specialist competencies by integrating essential transversal competencies. It serves as a valuable tool for the assessment, validation, and certification of competencies related to patient and professional safety, emotional well-being, relational dynamics, and social competencies. The findings underscore the need for academic institutions to revise traditional training models and embed transversal competencies in both undergraduate and postgraduate nursing education. Full article

Background and Objectives: Labor progression evaluation through repeated vaginal examinations remains the primary method of monitoring in delivery rooms globally. Transperineal intrapartum ultrasound has been shown to be reliable for assessing cervical dilatation, with substantial concordance with digital vaginal examinations. However, none of the analyzed studies investigated the influence of membrane integrity on ultrasound measurements. This study assessed the impact of membrane status on cervical dilatation evaluation via transperineal ultrasound compared to clinical examination, and the extent of agreement based on dilatation level and membrane status. Methods: A nine-month longitudinal observational study was conducted in the Obstetrics and Gynecology Clinic of “Sfântul Pantelimon” Clinical Emergency Hospital (Bucharest, Romania). Patients underwent two clinical examinations and two transperineal ultrasound measurements, one at a dilatation less than 8 cm and the other at a dilatation closer to full dilatation (above 8 cm). Agreement between clinical and ultrasound measurements was analyzed based on membrane integrity and dilatation level. Results: In total, 239 patients were included, and 478 cervical dilatation measurements were obtained. Only the 7–8 cm subgroup exhibited statistically significant differences in accuracy between patients with intact and ruptured membranes. The Pearson correlation results for membrane status were 0.87 (p-value < 0.001) for intact membranes and 0.91 (p-value < 0.001) for ruptured membranes. Both groups show a strong positive correlation, suggesting that ultrasound and clinical measurements tend to increase simultaneously, regardless of membrane status. Conclusions: Transperineal ultrasound is useful for labor monitoring, but its accuracy decreases significantly in advanced labor, especially beyond 8 cm dilatation and in cases with ruptured membranes. Full article

Coenzyme Q10 is a natural antioxidant with anti-tumor and mitochondrial protective effects. However, its unstable physicochemical properties and large molecular weight result in low bioavailability. This study aimed to develop an effective technique for constructing nanoliposomes to improve the physicochemical properties of CoQ10 by using high-pressure microfluidic homogenization. Liposomes were prepared using the ethanol injection method and homogenized by high-pressure microfluidics to optimize their physicochemical properties. Liposome morphology and microstructure were observed via transmission electron microscopy (TEM). The particle size distribution, polydispersity index (PDI), and encapsulation efficiency were assessed, while effects on cell viability and antioxidant properties were investigated in HepG2 cells. The results indicate that the prepared liposomes exhibit favorable characteristics, including high encapsulation efficiency (>96%) and low PDI (<0.3), indicating uniform particle size distribution and good stability. The storage stability of liposomes at room temperature was significantly enhanced compared to liposomes not subjected to high pressure homogenization. In vitro cell experiments confirmed the liposomes’ non-cytotoxicity and substantial antioxidant activity, ensuring their safety for biomedical applications. This study introduced a liposome preparation method combining ethanol injection and high-pressure microfluidic homogenization, offering a novel approach for liposome modification with potential for development and application in innovative drug delivery systems and antioxidant therapy. Full article