Search Results (290)

This study aimed to develop experimental filler-reinforced resin composites for vat-photopolymerization 3D printing and to evaluate the effects of filler addition on their mechanical, physicochemical, and bonding properties for dental restorative applications. Silanized nano- and/or micro-fillers were incorporated into acrylic resin monomers to formulate photocurable resins suitable for vat-photopolymerization. The rheological behavior of these liquid-state resins was assessed through viscosity measurements. Printed resin composites were fabricated and characterized for mechanical properties—including flexural strength, flexural modulus, and Vickers hardness—both before and after 8 weeks of water immersion. Physicochemical properties, such as water sorption, water solubility, and degree of conversion, were also evaluated. Additionally, shear bond strength to a resin-based luting agent was measured before and after artificial aging via thermocycling. A commercial dental CAD-CAM resin composite served as a reference material. Filler incorporation significantly improved the mechanical properties of the printed composites. The highest performance was observed in the composite containing 60 wt% micro-fillers, with a flexural strength of 168 ± 10 MPa, flexural modulus of 6.3 ± 0.4 GPa, and Vickers hardness of 63 ± 1 VHN, while the commercial CAD-CAM composite showed values of 152 ± 8 MPa, 7.9 ± 0.3 GPa, and 66 ± 2 VHN, respectively. Filler addition did not adversely affect the degree of conversion, although the relatively low conversion led to the elution of unpolymerized monomers and increased water solubility. The shear bond strength of the optimal printed composite remained stable after aging without silanization, demonstrating superior bonding performance compared with the CAD-CAM composite. These findings suggest that the developed 3D-printed resin composite is a promising candidate for dental restorative materials. Full article

Specific Emitter Identification (SEI) is a specialized technique for identifying different emitters by analyzing the unique characteristics embedded in received signals, known as Radio Frequency Fingerprints (RFFs), and SEI plays a crucial role in civilian applications. Recently, various SEI methods based on deep learning have been proposed. However, in real-world scenarios, the scarcity of accurately labeled data poses a significant challenge to these methods, which typically rely on large-scale supervised training. To address this issue, we propose a novel SEI framework based on self-supervised contrastive learning. Our approach comprises two stages: an unsupervised pretraining phase that uses contrastive loss to learn discriminative RFF representations from unlabeled data, and a supervised fine-tuning stage regularized through virtual adversarial training (VAT) to improve generalization under limited labels. This framework enables effective feature learning while mitigating overfitting. To validate the effectiveness of the proposed method, we collected real-world satellite navigation signals using a 40-meter antenna and conducted extensive experiments. The results demonstrate that our approach achieves outstanding SEI performance, significantly outperforming several mainstream SEI methods, thereby highlighting the practical potential of contrastive self-supervised learning in satellite transmitter identification. Full article

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

Background: Art therapy was recently administered to stroke patients using immersive virtual reality technology, chosen to provide the illusion of being able to replicate an artistic masterpiece. This approach was effective in improving rehabilitative outcomes due to the so-called Michelangelo effect: patients’ interaction with artistic stimuli reduced perceived fatigue and improved performance. The aim of the present study was to investigate which factors may influence those outcomes (e.g., type of artwork, esthetic valence, perceived fatigue, clinical conditions). Methods: An observational study was conducted on 25 patients with stroke who performed the protocol of virtual art therapy (VAT). In each trial, patients were asked to rate the esthetic valence of the artworks and their perceived fatigue, whereas therapists assessed patients’ participation in the therapy (Pittsburgh Rehabilitation Participation Scale, PRPS). Moreover, before and after treatment, patients’ independence in daily living activities (Barthel Index, BI), and their upper limb functioning (Manual Muscle Test, MMT) and spasticity (Ashworth Scale, AS) were measured. Results: The after-treatment BI scores depended on the before-treatment BI score (p < 0.001) and on the PRPS score (p = 0.006), which, in turn, was increased by the subjective esthetic valence (p = 0.044). Perceived fatigue is a complex factor that may have influenced the outcomes (p = 0.049). Conclusions: There was a general effect of art in reducing fatigue and improving participation of patients during therapy. The variability observed among patients mainly depended on their clinical conditions, but also on the esthetic valence given to each artwork, that could also be intertwined with the difficulty of the task. Art therapy has a high potential to improve rehabilitation outcomes, especially if combined with new technologies, but psychometric investigation of the effects of each factor is needed to design the most effective protocols. Full article

To achieve climate goals and promote clean energy, China has introduced preferential VAT policies to promote the development of renewable energy power generation industries, but their actual impact on corporate profitability remains underexplored. This study innovatively applies a DID approach, enhanced with PSM and dynamic modeling, to evaluate the causal effects of VAT incentives on firm ROE. Using panel data from 98 listed power generation companies between 2010 and 2024, this study distinguishes treatment effects across the wind, solar, and hydrogen sectors, revealing significant heterogeneity. Unlike prior studies, it further investigates time-lagged impacts and fiscal efficiency indicators to assess policy sustainability. Results show that VAT incentives significantly enhance ROE for wind and solar firms, while the hydrogen sector exhibits weaker responses. These findings not only confirm the effectiveness of targeted tax incentives but also offer new insights for refining fiscal policies to better support sector-specific transitions toward renewable energy. This study provides empirical evidence for the design of China’s fiscal energy policy to maximize the growth of the renewable energy sector. More broadly, this study provides lessons for global green transition policies, illustrating how well-designed fiscal incentives can support sustainable energy development worldwide. Full article

Dietary protein levels greatly influence gut microbial ecosystems; however, their effects on gut archaea and associated functions in ruminants require further elucidation. This study evaluated the impact of varying dietary protein levels on gut archaeal composition, antimicrobial resistance (AMR) genes, virulence factors, and functional capacities in sheep. Eighteen ewes (Yunnan semi-fine wool breed, uniparous, 2 years old, and averaging 50 ± 2 kg body weight) were randomly assigned to diets containing an 8.5 (low; H_1), 10.3 (medium; H_m), or 13.9% (high; H_h) crude protein level from the 35th day of pregnancy to the 90th day postpartum. The total duration of the experiment was approximately 202 days. A total of nine fecal samples (three from each group) were analyzed via 16S rRNA and metagenomics sequencing. Higher archaeal alpha diversity and richness were observed in the H_m and H_h groups compared to the H_l group (p < 0.05). A Beta diversity analysis revealed the archaeal community’s distinct clustering mode based on protein levels. The methanogenic genera Methanobrevibacter and Methanocorpusculum were dominant across the three groups, and their abundance was influenced by protein intake. A functional prediction analysis indicated moderate changes in amino acid and carbohydrate metabolism, which are particularly associated with methane production, an important source of greenhouse gases. AMR genes (e.g., tetA (60), patA, vat, and Erm methyltransferase) and virulence factors (Bacillibactin, LPS) were significantly enriched when animals were fed high-protein diets. Our results demonstrated that dietary protein levels significantly influence gut archaeal composition, AMR gene enrichment, and related functional pathways. Medium-protein diets promoted greater archaeal diversity, whereas high-protein diets favored resistance gene proliferation and enhanced methanogenic activity. Optimizing dietary protein intake may enhance gut health, mitigate antimicrobial resistance risk, and reduce methane emissions, thereby supporting livestock sustainability and environmental protection. Full article

Increased CT-derived fat tissue radiodensity has been indicated as a poor prognostic factor in oncological settings, although the reasons are not clear. One hypothesis is that increased radiodensity may reflect the loss of fat droplets within adipocytes, being a proxy of recent weight loss. This study aims to test this hypothesis by evaluating the association between longitudinal variations in fat tissue radiodensity and area in a cohort of COVID-19 patients. Baseline and 2–3-month follow-up chest CT scans of severe COVID-19 pneumonia survivors were retrospectively reviewed to measure subcutaneous, visceral, and intermuscular adipose tissue (SAT, VAT, and IMAT) areas and densities at the T7–T8 vertebrae, and longitudinal variations were computed for each variable. The associations between each compartment area and radiodensity variations (standardized values) were evaluated in univariate linear models and models adjusted by age and sex. A total of 196 COVID-19 survivors with suitable baseline and follow-up CT scans were included (mean age 65 ± 11 years, 62 (31.6%) females, 25% with diabetes and 2.6% with morbid obesity). Longitudinal variation in SAT area was inversely associated with longitudinal variation in SAT radiodensity in univariate models (coeff −0.91, 95%CI = −1.70/−0.12, p = 0.02) and after adjustment by age and sex (coeff −0.89, 95%CI = −1.7/−0.09, p = 0.03). The effect was similar and stronger for IMAT (coeff −2.1, 95%CI = −3.06/−1.19, p < 0.01 in adjusted models), and absent for VAT. Longitudinal variations in subcutaneous and intermuscular adipose tissue areas and densities are inversely associated. Higher adipose tissue radiodensity may be due to decrease in fat area (i.e., weight loss), explaining the poor prognostic effect found in cancer patients. Full article

Background: The positive effects of oral nutritional supplements (ONS) on postoperative outcomes have been well recognized in several previous studies. However, to date, little data has been available with respect to determining the best immune modulating supplement to use and what its impact might be in thoracic surgery. The aim of this study was to evaluate the role of preoperative immune-nutritional supplement intake as predictor of postoperative cardiopulmonary complications (CPCs) in patients undergoing uniportal video-assisted thoracoscopic (uVATS) lung resection. Methods: This is a retrospective, observational study enrolling consecutive patients who underwent uVATS lung resections for cancer from January 2022 to December 2024 in the context of the Enhanced Pathway of Care (EPC) Program. All patients were evaluated by a nutritionist and dietetics team during the preoperative phase. The nutritional protocol consisted of 250 mL ONS rich in arginine, omega-3-fatty acids, and nucleotides to be taken twice a day for 5–7 days before surgery. Results: Four hundred ninety-one patients were enrolled: 277 patients underwent anatomic lung resection and 214 underwent wedge resection (WR). Utilizing the univariate analysis, we found that in patients undergoing anatomic lung resection, not-ONS-intake, high Body Mass Index (BMI), and arrythmia were correlated with a higher CPCs rate compared to the patients without nutritional supplementation (7.2% ONS vs. 15% not-ONS, p = 0.04; BMI 28.4 kg/m² vs. BMI 26.4 kg/m², p = 0.03; 31.2% arrythmia vs. 9.4% no-arrythmia, p < 0.01). These correlations, except for BMI, were confirmed after stepwise logistic regression. Alternately, in patients undergoing WR, hypertension and low-FEV1% were associated with a higher CPCs rate (5.1% hypertension vs. 0.4% no-hypertension, p = 0.02; FEV1% 79.7% vs. 95%, p = 0.01). Conclusions: Our results demonstrated that preoperative ONS after uVATS anatomic lung resection, in the context of an EPC program, influences the postoperative period, reducing the CPCs rate. Full article

Background/Objectives:Arterial hypertension, increased carotid intima-media thickness (cIMT), and arterial stiffness (AS) are recognized predictors of cardiovascular disease (CVD). Emerging evidence suggests that vascular remodeling may precede the full development of hypertension. Furthermore, body mass index (BMI), fat mass percentage (FM%), and visceral adipose tissue (VAT), are significant risk factors for cardiovascular events. Conversely, adherence to the Mediterranean diet is associated with reduced cardiovascular risk due to its beneficial effects on lipid metabolism, inflammation, and vascular health. Methods: This observational study explored the association between nutritional care and cardiovascular risk in 55 Italian adults (27 women, 28 men) consecutively evaluated at the Section of Clinical Nutrition and Nutrigenomics, University of Rome “Tor Vergata”, in 2024. Nutritional and vascular assessments, including BMI, waist-to-hip ratio (WHR), BIA, DXA, lab tests, blood pressure (BP), pulse wave velocity (PWV), and cIMT, were recorded. Spearman’s rank correlation coefficient was used to evaluate the relationship between vascular and nutritional parameters. Wilcoxon rank sum test; Fisher’s exact test; and Pearson’s Chi-squared test were performed for statistical analysis. Participants were divided into two groups based on cIMT > 0.90 mm and ≤0.90 mm. Results: Significant correlations emerged between higher MEDAS scores and BMI (r = −0.53, p < 0.01), FM% (r = −0.49, p < 0.01), VAT (r = −0.63, p < 0.01), and cIMT (r = −0.88, p < 0.01). Higher WHR and VAT were associated with increased brachial and central BP and PWV. Notable dietary differences were significantly higher between cIMT groups. Total cholesterol/C-HDL, C-LDL/C-HDL, the Atherogenic Index of Plasma, and the HOMA Index differed significantly between groups. Significant differences were also observed in the left ventricular diastolic function (p = 0.04), LVM/BSA, and LVM/h^2.7 in individuals with subclinical atherosclerosis (p < 0.05). Conclusions: These innovative findings underline the importance of multidisciplinary approaches to prevent CVD and suggest long-term benefits of Mediterranean diet adherence on vascular health. Full article

Colibactin toxin-producing Escherichia coli (pks+ E. coli) strains are associated with the occurrence of colorectal cancer in humans. These strains induce DNA damage when in close contact with the cells of the intestinal epithelium. Therefore, maintaining the integrity of the mucus layer that covers the intestinal epithelial mucosa is crucial for counteracting the effects of colibactin. The Vat protein is a mucin protease capable of degrading MUC2 mucus proteins that was previously described in adherent and invasive Escherichia coli strains. Our work shows that the vat gene is found in the genome of all pks+ E. coli strains isolated from patients with colon cancer. In mucus-producing HT29-16E cells, we demonstrated that the Vat protein of E. coli pks+ allows bacteria to penetrate mucus and to reach the epithelial cells. Cells infected with the E. coli pks + vat- strain show a reduction in γ-H2AX staining, a marker of DNA damage. Infection of Apc^Min/+ mice with the E. coli pks + vat+ strain or the E. coli pks + vat- mutant revealed that Vat enhances the ability of pks+ E. coli strains to colonize the intestinal mucosa and, in turn, their pro-carcinogenic effects. This study reveals that Vat promotes crossing of the intestinal mucus layer, gut colonization, and the carcinogenicity of pks+ E. coli. Full article

Video-assisted thoracoscopic surgery (VATS) is a minimally invasive diagnostic and therapeutic procedure utilized in various thoracic conditions. VATS has grown in popularity with ever-expanding knowledge of enhanced recovery after surgery (ERAS) protocols and its benefits regarding patient care and outcomes. Pain control following VATS is of utmost importance to minimize the complication risk. Options for pain control following VATS have traditionally included systemic IV analgesia but have evolved to include loco-regional analgesia as well. The serratus anterior plane block (SAPB) is one form of loco-regional analgesia utilized in VATS that has been shown to provide effective pain control of the anterolateral chest wall. Patients who received SAPB compared to control methods of anesthesia demonstrated significant decreases in postoperative pain and postoperative opioid consumption. SAPB is effective and offers a promising safety profile as the block is typically more superficial than other types of loco-regional analgesia. This review outlines the recent literature surrounding the use of SAPB for pain control in VATS. Full article

Divergences in tax policies are evident among European OECD economies, due to varying priorities of efficiency vs. equity, influenced by the forms of direct vs. indirect taxation. The special interest of this paper is to identify how different tax forms (direct—corporate and personal income taxes (CIT, PIT); and indirect—value added tax (VAT)) affect inequality in European OECD economies in the period 2003–2020. Using heterogeneous non-stationary panel models and the (Pooled) Mean Group (PMG/MG) methods of estimation, a long-run negative relationship between direct tax forms (CIT, PIT) and the Gini coefficient was discovered, meaning that utilizing progressive direct tax forms resulted in more equity. The error-correction terms are heterogeneous, showing that developed economies decrease income inequality by using direct taxes more efficiently than emerging European OECD economies. The short-run statistically significant relationships between VAT and the Gini coefficient are discovered, meaning that certain European OECD economies effectively use VAT revenue to achieve greater equity in society. This study demonstrates that the use of indirect tax forms may be beneficial in terms of collecting more tax revenues, and that using them for redistributive programs can reduce inequality while maintaining economic efficiency. Full article

Background: Previous studies have shown that ventilation strategies used in general anesthesia influence perioperative outcomes of video-assisted thoracoscopic surgery (VATS). This study investigated the perioperative effects of non-intubated anesthesia (NIA) versus intubated anesthesia (IA) in patients with early-stage non-small cell lung cancer (NSCLC) undergoing VATS. Methods: This retrospective cohort study analyzed patients who underwent elective VATS for early-stage NSCLC between January 2015 and December 2022. Patients were categorized into the NIA and IA groups based on the ventilation strategies during general anesthesia. Comprehensive outcome data, including intraoperative and postoperative variables, were compared between the two groups. Univariate and multivariate logistic regression models were used to assess the odds ratios for conversion from NIA to IA. Results: A total of 372 patients who received NIA and 1560 who received IA for VATS were eligible for analysis. After propensity score matching, 336 patients were included in each group. In the matched analysis, patients who received NIA demonstrated favorable perioperative outcomes, including reduced opioid consumption, lower postoperative complication rates, and shorter hospital stays, compared to those who received IA. Additionally, patients with a lower baseline oxygen saturation and those who experienced intraoperative pulmonary and cardiovascular adverse events had a higher risk of conversion from NIA to IA. Conclusions: NIA during VATS in patients with early-stage NSCLC was associated with superior perioperative outcomes. Prospective studies are warranted to further evaluate the impact of NIA on perioperative outcomes in this patient population. Full article

Lung cancer is the leading cause of cancer-related mortality among both men and women worldwide, underscoring the need for an effective treatment strategy. For early-stage non-small cell lung cancer [NSCLC], surgical resection is the standard treatment. Robotic-assisted thoracic surgery [RATS] and video-assisted thoracic surgery [VATS] are better than open thoracotomy because they are less invasive. Recent lung cancer screening programs are detecting NSCLC at earlier stages, which is expected to result in an increase in the number of NSCLC surgeries as early-stage cases are diagnosed. A limited number of randomized controlled trials have compared RATS and VATS in operable NSCLC. We conducted a literature review to summarize the available evidence on these two surgical techniques. The purpose of this study is to compare the intraoperative and postoperative outcomes of RATS and VATS in early-stage NSCLC patients. RATS shows lower conversion rates to thoracotomy (6.3% vs. 13.1% p < 0.01) and more thorough lymph node dissection than VATS (e.g., 7.5 vs. 5.6 stations, p < 0.001). However, RATS is linked to considerably higher costs (USD 22,582 vs. USD 17,874, p < 0.05) and longer operative times (median 241.7 vs. 214.4 min, p = 0.06). The two techniques exhibited minimal differences in postoperative complications and pain, while RATS patients experienced shortened hospital stays (4–5 vs. 5–6 days, p < 0.006). While the accuracy of staging and treatment planning is improved by the improved lymph node retrieval in RATS, the long-term survival rate is still uncertain. Full article

Background/Objectives: Primary hyperparathyroidism (PHPT) is a prevalent endocrine disorder, with ectopic mediastinal parathyroid adenomas accounting for up to 30% of cases, posing significant diagnostic and surgical challenges. While traditional management relies on invasive procedures, minimally invasive techniques such as video-assisted thoracoscopic surgery (VATS) have emerged as viable alternatives. This study addresses a gap in the current literature by presenting our experience with VATS for mediastinal ectopic parathyroid adenomas, particularly in underreported retrotracheal/paraesophageal locations. By integrating a retrospective case series with a systematic literature review, we highlight evolving surgical strategies and their implications for patient outcomes in anatomically complex cases. Methods: A retrospective analysis was conducted over a three-year period on patients diagnosed with mediastinal ectopic parathyroid adenomas. Data on demographic characteristics, preoperative imaging, surgical techniques, intraoperative findings, and postoperative outcomes were collected. This study primarily compared the outcomes of VATS with those of traditional thoracotomy, with a focus on surgical success, complication rates, and length of hospital stay. Results: Six patients underwent surgical resection for mediastinal ectopic parathyroid adenomas (two intrahymic and four retrotracheal/paraesophgeal). VATS was the preferred approach in all cases, with one patient requiring conversion to thoracotomy due to challenging vascular anatomy. Surgical success, defined as the normalization of postoperative serum calcium levels, was achieved in all cases. The median operative time was 80 min, and the mean hospital stay was 6.25 days. One patient developed transient postoperative hypocalcemia, necessitating supplementation. No major surgical complications were observed. Conclusions: This study supports VATS as a safe and effective approach for mediastinal ectopic parathyroid adenoma resection, offering reduced morbidity and shorter recovery times compared to traditional open surgery. The findings align with emerging evidence advocating for minimally invasive techniques in complex mediastinal surgeries. Full article