Search Results (1,831)

Background and Objectives: High-grade serous ovarian carcinoma (HGSOC) remains the most lethal gynecologic malignancy, with outcomes heavily dependent on early diagnosis and timely multimodal treatment. The COVID-19 pandemic profoundly disrupted oncologic care, leading to diagnostic delays, modified treatment algorithms, and deferred surgeries. This study aimed to assess how these disruptions influenced disease presentation, surgical complexity, and postoperative outcomes during the pandemic and post-pandemic periods in a Romanian tertiary oncology center. Materials and Methods: A retrospective, single-center cohort analysis was conducted on 112 patients with histologically confirmed HGSOC who underwent surgical treatment between 26 February 2020 and 25 February 2024. The cohort was divided into two equal groups: a pandemic cohort (2020–2022) and a post-pandemic cohort (2022–2024). Clinical, pathological, and therapeutic parameters were compared, including FIGO and T staging, surgical duration, ICU admissions, and treatment intervals. Results: The post-pandemic period was marked by a significant rise in advanced-stage presentations (FIGO IV: 17.8% vs. 33.9%, p = 0.003), peritoneal carcinomatosis (58.9% vs. 82.1%, p = 0.004), and multiorgan invasion (7.1% vs. 16.0%, p = 0.039). Mean operative time increased significantly post-pandemic (94.0 ± 36.3 vs. 123.5 ± 52.5 min, p = 0.003), as did ICU admissions (35.7% vs. 60.7%, p = 0.002). While the number of neoadjuvant and adjuvant chemotherapy cycles remained consistent between cohorts, a greater surgical complexity and longer postoperative recovery characterized the post-pandemic cases, suggesting cumulative disease progression and increased treatment demands. Conclusions: The findings indicate an association between the post-pandemic period and more advanced disease profiles at presentation, as well as increased surgical complexity, highlighting potential long-term effects of healthcare disruption. These results highlight the necessity for resilient cancer care systems emphasizing early detection, multidisciplinary coordination, and adaptive treatment models to mitigate future systemic disruptions and preserve survival outcomes in women with HGSOC. Full article

Background: Ectopic pregnancy occurs in about 1–2% of all pregnancies, with 95% implanting in the fallopian tubes. Hepatic implantation is one of the rarest and most dangerous forms of abdominal ectopic pregnancy. Its diagnosis is often delayed because of nonspecific symptoms, and it is also often difficult for routine ultrasound imaging to visualize ectopic pregnancy sites that are not in the pelvis. Since this type of pregnancy carries a risk of severe hemorrhage, early identification is crucial. Case: A 30-year-old woman, gravida 3 para 2, presented with a serum β-hCG of 66,408 mIU/mL, but no intrauterine pregnancy was detected on ultrasound imaging. At an outside facility, a laparoscopy was performed, which also failed to show a pelvic ectopic pregnancy. The patient then received her first dose of methotrexate and was subsequently transferred to a tertiary care center for further evaluation. MRI and liver ultrasound showed a 2.3 cm subcapsular lesion in segment 5 of the liver that was suspicious for a hepatic ectopic pregnancy. However, these imaging studies could not exclude a gestational trophoblastic disease or hepatic neoplasm. A dilation and curettage revealed no trophoblastic tissue. The patient next received two additional doses of methotrexate on hospital days 4 and 7 due to an inadequate decline in interval β-hCG; β-hCG levels declined gradually but steadily over several months until they became undetectable and indicated a successful medical treatment of her hepatic ectopic pregnancy. Conclusions: This case highlights the complex diagnostic and treatment challenges presented by a hepatic ectopic pregnancy. Multimodal imaging, serial monitoring of β-hCG levels, and the engagement of a multidisciplinary team were essential factors in achieving a safe, nonsurgical, and successful resolution of this condition. When a pregnancy of unknown location is suspected, extended imaging studies are critical tools for patient evaluation after initial imaging studies and laparoscopy are inconclusive. Full article

Background: Carbon monoxide poisoning (COP) has emerged as a significant health issue in Asian countries, including Taiwan. It poses serious risks, including long-term complications such as cardiovascular disease (CVD), neurological disorders, and even death. This study investigated the association of COP with the development of cardiovascular diseases and neurological sequelae, while evaluating all-cause and cause-specific mortality as secondary outcomes. Methods: This retrospective study utilized the National Health Insurance Research Database and included the patients aged ≥ 20 years hospitalized with a COP diagnosis between 1 January 2000 and 31 December 2015. The objective was to investigate long-term neurological complications, CVD (such as ischemic heart disease and other cardiac conditions), and associated risk factors. Cox proportional hazard regression was employed to analyze differences in long-term neurological sequelae and cardiovascular outcomes among various groups. Results: A total of 2421 COP patients were enrolled. COP patients with CVD history had a higher incidence of persistent neurological sequelae (PNS) in two different diagnostic codes (8.6%, p < 0.001 and 11.5%, p = 0.018), but COP patients without CVD history had a higher incidence of delayed neurological sequelae (DNS) only in one of the diagnostic codes (6.8%, p < 0.001). The risk from CVD factor was up to 11.92 times. Furthermore, the overall mortality was 8.8%, which is significantly higher than 3.7% in the general population. After adjusting for other factors, the mortality in COP individuals was 7.40 times higher than that of the general population. Conclusions: Patients with COP might be at high risk of developing CVD and have a significantly increased risk of CVD. COP is associated with a higher risk of long-term neurological complications and an increased incidence of CVD. These findings help mitigate the potential long-term health impacts of COP. Full article

Syphilis remains a global public health concern, with maternal infection posing a substantial risk for congenital syphilis, a preventable condition associated with severe morbidity and mortality. Penicillin, particularly benzathine penicillin G, remains the cornerstone of treatment and the only therapy with proven efficacy in preventing vertical transmission during pregnancy. However, recurrent global shortages, limited manufacturing capacity, mislabeling of penicillin allergy, and the absence of validated alternative regimens for pregnant women and neonates threaten progress toward elimination goals. This review summarizes current evidence on the treatment of syphilis in pregnancy and congenital syphilis, highlighting the established maternal and neonatal regimens, diagnostic and therapeutic challenges, and clinical consequences of delayed or inadequate treatment. We examine the scope and drivers of benzathine penicillin G shortages, the overestimation of penicillin allergy and its impact on care, and the role of neonatal management when maternal therapy is suboptimal. Emerging data on alternative antimicrobial agents, including cephalosporins, tetracyclines, lipoglycopeptides, and novel compounds are discussed considering recent advances in Treponema pallidum culture and susceptibility testing. While several non-penicillin agents show promise for non-pregnant populations, robust evidence supporting their use during pregnancy and for the prevention of congenital syphilis is lacking. Addressing these gaps through coordinated supply chain strategies, guideline harmonization, and targeted clinical research is essential to ensure resilient and equitable syphilis control and advance global efforts toward the elimination of congenital syphilis. Full article

Engine oil degradation critically influences the performance, efficiency, and longevity of internal combustion engines. Conventional mileage or time-based replacement schedules often result in premature oil changes or delayed servicing, both of which compromise engine health and increase costs. This review examines recent advances in real-time oil condition monitoring and evaluates the feasibility of a low-cost microcontroller-based system that integrates physical sensors with machine learning models for continuous on-board oil health assessment. Drawing on established techniques from industrial lubrication monitoring, we propose an experimental framework that leverages electrical engineering principles, including sensor interface, analog front-end design, signal acquisition, and embedded AI deployment to enable accurate, affordable, and scalable oil health diagnostics. The review highlights opportunities for innovation in embedded systems and electrical engineering design, positioning AI-driven monitoring as a practical solution for predictive automotive maintenance. Full article

Time synchronization is a fundamental requirement for the reliable operation of Control and Data Acquisition Systems (CODASs) in large-scale fusion experiments such as the Divertor Tokamak Test (DTT). Distributed diagnostics, sensors, and control subsystems must share a unified time reference to guarantee deterministic data acquisition and stable plasma control. This paper presents the FPGA-based implementation and evaluation of a synchronization system that combines the IEEE 1588 Precision Time Protocol (PTP) with Pulse Per Second (PPS) generation. The proposed platform is built on Zynq UltraScale+ Kria KR260 System-on-Modules (SOMs) running a customized PetaLinux distribution with LinuxPTP utilities. Hardware timestamping is enabled through the integrated Timestamping Unit (TSU) in the Gigabit Ethernet MAC, while a hardware logic module generates PPS signals from the synchronized PTP clock. Experimental validation demonstrates nanosecond-level synchronization with an RMS timing accuracy of approximately 8.5 ns. A detailed analysis of PPS offset, network path delay, and servo adjustments confirms stability of the timing system. The proposed design offers a low-cost, flexible, fully customizable and controllable solution for distributed diagnostic and control systems in fusion facilities. Full article

Pregnancy (HP), defined as the coexistence of intrauterine and ectopic gestations, is a rare condition, especially in spontaneous conception, but it is a life-threatening obstetric emergency when rupture occurs, with a reported maternal mortality rate of 0.03%. Diagnosis is often delayed because confirmation of an intrauterine pregnancy can mask clinical signs of a concurrent ectopic gestation. Early recognition and prompt surgical intervention are therefore critical to maternal safety and preservation of intrauterine viability. This case highlights the diagnostic challenges and successful management of a spontaneous ruptured heterotopic pregnancy. Case presentation: A 34-year-old Middle Eastern woman, gravida 4, with a spontaneous conception, presented with sudden severe lower abdominal pain and signs of acute hemoperitoneum (hypotension, tachycardia, and marked peritoneal signs). Transvaginal ultrasound demonstrated a viable intrauterine pregnancy at 9 weeks 4 days gestation, together with a ruptured left tubal ectopic pregnancy of similar gestational age. The patient underwent urgent laparoscopic left salpingectomy with evacuation of approximately 1200 mL of intraperitoneal blood and clots. Postoperatively, she developed significant anemia (hemoglobin drop from 11.2 g/dL on admission to 6.5 g/dL) requiring transfusion of four units of packed red blood cells. Serial ultrasonographic follow-up confirmed ongoing viability of the intrauterine pregnancy, which ultimately resulted in a live birth at term. Progressive resolution of the postoperative pelvic hematoma was also noted. Conclusions: Ruptured heterotopic pregnancy remains a diagnostic and therapeutic challenge. This case, along with a synthesis of the contemporary literature, demonstrates that a high clinical index of suspicion, timely ultrasound diagnosis, and immediate minimally invasive surgical management are paramount. Furthermore, rigorous postoperative monitoring and resuscitation, including targeted transfusion, are essential to achieve maternal stabilization while allowing continuation of a viable intrauterine pregnancy, with reported live birth rates exceeding 70% following timely intervention. Full article

Background and Objectives: Functional dyspepsia (FD) often overlaps with Pancreatic Exocrine Insufficiency (PEI), leading to diagnostic delays. We aimed to evaluate the prevalence of PEI in patients presenting dyspeptic symptoms using the survey-based PEI test and to assess the clinical response to Pancreatic Enzyme Replacement Therapy (PERT). Methods: This study included 91 patients with PEI and 58 control subjects. PEI was evaluated using the PEI Patient-Reported Outcome (PRO) instrument and classified as mild, moderate, or severe according to the 18-item PEI test. Objective fat malabsorption was assessed by the acid steatocrit method using a gravimetric assay. Patients diagnosed with PEI received PERT, and treatment response was evaluated at follow-up with a repeat PEI test. Results: When the case and control groups were compared in terms of PEI scores, a statistically significant difference was found (p < 0.001). Fecal steatocrit value was found to be statistically significant with the PEI score (p = 0.017). No statistically significant difference was found between amylase, lipase, vitamin D, vitamin B12, and folic acid and the PEI score (p = 0.789, p = 0.299, p = 0.865, p = 0.153, and p = 0.855, respectively). A statistically significant difference was found between the pre-treatment PEI score and the post-treatment PEI score (p < 0.001). The mean pre-treatment PEI score was 1.52 ± 0.50, while the post-treatment PEI score was 0.42 ± 0.48. Approximately 72% reduction in PEI score was observed with treatment. Conclusions: The PEI test may represent a useful, non-invasive tool for identifying suspected pancreatic dysfunction in patients initially diagnosed with functional dyspepsia. Early integration of this tool into clinical practice can improve symptom control and prevent the misclassification of PEI as a purely functional disorder. Full article

Background: Contrast-enhanced ultrasound (CEUS) recently emerged as a valuable imaging modality for evaluating pleuropulmonary diseases. By combining morphological information from conventional B-mode ultrasound with real-time assessment of microvascular perfusion, CEUS can provide functional insights that improve diagnostic accuracy, guide interventions, and support patient surveillance. Methods: This review summarizes the current evidence on the use of CEUS in major pleuropulmonary disorders, including pneumonia, pleural effusion, pulmonary embolism, neoplasms, and COVID-19-related lung injury. The most relevant clinical studies and meta-analyses were analyzed, focusing on CEUS parameters, diagnostic performance, and integration with other imaging techniques. Results: CEUS enables the differentiation between inflammatory, ischemic, and malignant lesions through qualitative and quantitative analyses of enhancement patterns. Early and homogeneous enhancement is typical of inflammatory or infectious processes, whereas heterogeneous or delayed enhancement with early washout strongly suggests malignancy or ischemia. In pneumonia and pleural infections, CEUS identifies non-perfused or necrotic areas, guiding drainage and evaluating therapeutic responses. In pulmonary embolism, it reveals avascular consolidations corresponding to infarction, even when CT angiography is inconclusive. For peripheral lung tumors, CEUS assesses angiogenesis and vascular supply, correlating perfusion parameters with histopathology, and improving biopsy targeting. Furthermore, in COVID-19 pneumonia, CEUS can detect microvascular alterations related to thrombosis and fibrosis. Conclusions: CEUS is a safe, noninvasive, and radiation-free technique that provides unique real-time information on pulmonary perfusion. Its integration with conventional ultrasound enhances diagnostic precision, optimizes interventional guidance, and allows for dynamic monitoring of treatment response. Future developments in quantitative analysis, artificial intelligence, and targeted contrast agents are expected to further expand CEUS clinical applications in pleuropulmonary imaging. Full article

Background: Oral squamous cell carcinoma (OSCC) remains a major global health burden due to delayed diagnosis. Although salivary biomarkers have been explored in previous meta-analyses, these studies were limited to specific biomarker types. Methods: This study followed PRISMA guidelines and was registered in PROSPERO (CRD 420261296936). PubMed, Scopus, MEDLINE, and CINAHL were searched for diagnostic accuracy studies of salivary biomarkers for OSCC. Studies providing sufficient data to construct 2 × 2 tables were included. Pooled sensitivity, specificity, DOR, and HSROC curves were estimated using a bivariate random-effects model, and study quality was assessed using QUADAS-2. Results: Eighteen studies comprising 1647 participants yielded 45 diagnostic datasets across multiple biomarker classes. The pooled sensitivity and specificity were 0.64 (95% CI: 0.59–0.69) and 0.71 (95% CI: 0.66–0.76), respectively. The pooled DOR was 4.53 (95% CI: 3.18–6.47), indicating moderate discriminatory ability, with an AUC of 0.75 (95% CI: 0.71–0.79). Fagan’s nomogram analysis demonstrated that these biomarkers are not suitable for screening the general population and should be reserved for enriched populations (pre-test probability > 10%). Conclusions: Salivary biomarkers demonstrate moderate but highly heterogeneous diagnostic accuracy. Clinical utility is context-dependent and limited to enriched populations with a baseline probability of OSCC >10%. In screening the general population (prevalence < 0.01%), these tests offer no significant clinical utility. They should be considered complementary triage tools rather than definitive diagnostic modalities. Full article

Background: Vascular compression syndromes are increasingly recognized as underdiagnosed contributors to morbidity in patients exhibiting dysautonomia. Underlying vascular compression syndromes affecting the head and neck, abdomen, pelvis, and lower extremities may influence venous return, neurohormonal signaling, and autonomic regulation. There is considerable clinical overlap among these syndromes, as well as between hypermobility spectrum disorders (HSD) and dysautonomia, indicating possible shared or interacting pathophysiological mechanisms. Purpose/Aims: This hypothesis-generating narrative review synthesizes current evidence linking vascular compression syndromes with dysautonomia, highlights potential mechanistic pathways, identifies patterns of syndromic overlap, and emphasizes the importance of systematic evaluation in affected patient populations. Key Findings: Evidence from retrospective studies, case series, and clinical observations indicates that vascular compression syndromes may be prevalent among patients with dysautonomia, particularly postural orthostatic tachycardia syndrome (POTS) and HSD, yet are often unrecognized. Proposed mechanisms based on limited data include impaired venous capacitance and preload reserve, increased intracranial pressure, altered renin–aldosterone and cortisol signaling, underlying autoimmune and systemic diseases, and sympathetic ganglion irritation. Several compression syndromes show symptom overlap and frequent co-occurrence, especially in patients with connective tissue disorders. Emerging data suggest that targeted interventions, such as surgical decompression or venous stenting, may improve orthostatic intolerance and quality-of-life measures in selected patients, though high-quality prospective data remain limited. Conclusions: Vascular compression syndromes may be an important yet underappreciated contributor to dysautonomia. Increased clinical awareness and systematic screening may reduce diagnostic delays and morbidity in this underserved population. Prospective studies are needed to clarify prevalence, establish causal relationships, and determine the impact of targeted treatments on autonomic outcomes. Full article

Financial crises repeatedly reveal organizations that appear internally aligned while failing to recognize accumulating tail risks. This paper argues that cohesion is observationally ambiguous. It can arise from information integration, in which heterogeneous inputs are debated and synthesized, or from exclusion, in which variance is removed through conformity pressure, gatekeeping, and intolerance of dissent. This distinction is formalized using a signal aggregation model in which an organization maintains an anchor belief and achieves agreement through two exclusion channels: report shrinkage toward the anchor and a tolerance rule that discards reports deviating beyond a threshold. Relative to a full inclusion benchmark, exclusion based cohesion jointly produces state contingent bias that is small in normal regimes but grows sharply under displacement, illusory precision in which observed disagreement falls as tail regime estimation error rises, effective concentration of decision inputs below the nominal participant count, and, when the anchor updates from filtered aggregates, dynamic lock in with delayed regime recognition and abrupt correction. External inputs that bypass internal filtering shorten recognition delays. The model yields testable governance diagnostics linking latent fragility to observable patterns in recorded dissent, anonymous to formal voting gaps, scenario set diversity, pipeline and method concentration, and anchor lag. The central implication is that governance systems should treat low internal conflict and unanimity as potentially diagnostic of variance depletion and should monitor whether heterogeneity is integrated or excluded before stress reveals the difference. Full article

This experimental study investigates the influence of selected bed joint reinforcement systems on the evolution of damage and crack development in masonry elements subjected to axial compression. Autoclaved aerated concrete masonry samples reinforced with steel truss reinforcement, unidirectional carbon fibre mesh and steel cords embedded in a fibreglass matrix were tested and compared to an unreinforced reference specimen. Full-field deformation and strain localisation were monitored using digital image correlation (DIC). The results indicate that bed joint reinforcement does not lead to a measurable increase in compressive load-bearing capacity, as differences in ultimate load remain within experimental uncertainty. However, clear differences in the evolution and spatial distribution of damage were observed. Steel truss reinforcement promoted strain redistribution and delayed localisation of tensile strains, while the remaining reinforcement systems exhibited only limited influence on crack morphology. The findings confirm that bed joint reinforcement in compressed masonry should be classified as a nonstructural solution and demonstrate the diagnostic value of full-field deformation monitoring for assessing damage evolution and crack control in masonry structures. Full article

Background: Thyroid tuberculosis abscesses (TTA) are rare manifestations of extrapulmonary tuberculosis, with the available literature consisting almost exclusively of individual case reports and small observational series. This systematic review aimed to evaluate current management strategies and associated clinical outcomes for TTA. Methods: Reports describing confirmed TTA, specified treatment regimens and clinical outcomes were systematically identified and synthesised from PubMed, Embase, Web of Science and Google Scholar from the period 1990 to 2025. Studies with suspected but unconfirmed cases were excluded. Risk of bias was assessed using the Joanna Briggs Institute tool. A total of 22 studies comprising 33 patients were included. Results: Significant diagnostic delays were seen. When diagnosis was established, standard four-drug anti-tubercular therapy (ATT) for at least 6 months emerged as the predominant first-line treatment. Surgical or percutaneous drainage procedures were typically reserved for large abscesses, treatment failure, acute suppurative presentations or suspected malignancy. Across published cases, lesion resolution and preservation of euthyroid function were reported in 92% of patients. However, the absence of comparative studies and the reliance on highly selected case material limit definitive conclusions and raise concerns about publication bias. Conclusions: TTA is a rare entity, with established treatment success with ATT, with surgery reserved for selected cases. Higher-quality comparative data are required to inform optimal management strategies. Full article

Background and Objectives: Septic tenosynovitis of the hand remains a surgical emergency associated with significant morbidity and healthcare resource utilization. While prior studies have focused primarily on diagnostic features, microbiology, and functional outcomes, factors influencing prolonged hospitalization remain insufficiently characterized. Length of stay (LOS) represents a pragmatic, patient- and system-centered outcome that may reflect disease burden and treatment complexity. To identify clinical, demographic, and treatment-related factors associated with prolonged hospitalization in patients treated surgically for septic tenosynovitis of the hand, using LOS ≥ 6 days as a clinically meaningful threshold. Materials and methods: A retrospective cross-sectional study was conducted including 38 adult patients treated surgically for acute septic tenosynovitis of the hand at a tertiary referral center between 1 January 2020 and 31 December 2024. Demographic variables, comorbidities, immunosuppressive status, mechanism of injury, anatomical involvement, time to presentation, microbiological findings, number of surgical procedures, inpatient LOS, and outpatient follow-up visits were analyzed. Results: The mean age was 53.2 ± 15.8 years, and the mean LOS was 7.5 ± 3.7 days (range, 2–17 days). Twenty-seven patients (71.1%) experienced an LOS ≥ 6 days. The presence of comorbidities (p = 0.0026) and immunosuppressive status (p = 0.0378) were significantly associated with prolonged hospitalization. In contrast, age, sex, time to presentation, and microbiological culture positivity, were not significantly associated with prolonged LOS. The mean number of outpatient follow-up visits was 2.5 ± 1.9, highlighting an additional post-discharge care burden. Conclusions: Prolonged hospitalization in septic tenosynovitis appears to be driven predominantly by patient-related vulnerability, particularly comorbidities and immunosuppression, rather than by anatomical involvement, microbiological profile, or presentation delay alone. LOS may serve as a useful surrogate marker for treatment burden and resource utilization, supporting early identification of high-risk patients and optimization of inpatient care pathways. Full article