Search Results (160)

Background and Clinical Significance: Hemophagocytic lymphohistiocytosis (HLH) and autoimmune hemolytic anemia (AIHA) are both life-threatening hematologic syndromes that rarely present together outside of malignancy. Advanced acquired immunodeficiency syndrome (AIDS) creates a milieu of profound immune dysregulation and hyperinflammation, predisposing patients to atypical overlaps of these disorders. Case Presentation: A 30-year-old woman with poorly controlled AIDS presented with three weeks of jaundice, fever, and fatigue. Initial labs revealed pancytopenia, hyperbilirubinemia, and elevated ferritin level. Direct anti-globulin testing confirmed warm AIHA (IgG⁺/C3d⁺) with transient cold agglutinins. Despite intravenous immunoglobulin (IVIG), rituximab, and transfusions, she developed hepatosplenomegaly, extreme hyperferritinemia, and sIL-2R > 10,000 pg/mL, meeting HLH-2004 criteria. Bone marrow biopsy excluded malignancy; further work-up revealed Epstein–Barr virus (EBV) viremia and cytomegalovirus (CMV) reactivation. Dexamethasone plus reduced-dose etoposide transiently reduced soluble interleukin-2 receptor (sIL-2R) but precipitated profound pancytopenia, Acute respiratory distress syndrome (ARDS) from CMV/parainfluenza pneumonia, bilateral deep vein thrombosis (DVT), and an ST-elevation myocardial infarction (STEMI). She ultimately died of hemorrhagic shock after anticoagulation despite maximal supportive measures. Conclusions: This case underscores the diagnostic challenges of HLH-AIHA overlap in AIDS, where cytopenias and hyperferritinemia mask the underlying cytokine storm. Pathogenesis likely involved IL-6/IFN-γ overproduction, impaired cytotoxic T-cell function, and molecular mimicry. While etoposide remains a cornerstone of HLH therapy, its myelotoxicity proved catastrophic in this immunocompromised host, highlighting the urgent need for cytokine-targeted agents to mitigate treatment-related mortality. Full article

With the rise of carbon capture and storage, liquefied carbon dioxide (LCO₂) has emerged as a promising medium for large-scale marine transport. This study evaluates the structural integrity of an IMO Type C cargo tank for a medium-range LCO₂ carrier under four conditions: ultimate limit state, accidental limit state, hydrostatic pressure test, and fatigue limit state, based on IGC Code and classification rules. Seventeen load cases were analyzed using finite element methods with multi-step loading to ensure stability. The highest stress occurred at the pump dome–shell junction due to geometric discontinuities, but all stress and buckling criteria were satisfied. The fatigue damage from wave-induced loads was negligible, with low-cycle fatigue from loading/unloading operations governing the fatigue life, which exceeded 31,000 years. The findings confirm the tank’s structural robustness and its suitability for safe, efficient medium-pressure LCO₂ transport. Full article

Background: Emerging evidence indicates that some individuals recovering from COVID-19 develop persistent symptoms, including fatigue, pain, cognitive difficulties, and psychological distress, commonly known as Long COVID. These symptoms often overlap with those seen in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME), underscoring the need for integrative, non-pharmacological interventions. This Phase II controlled trial aimed to evaluate the feasibility and preliminary efficacy of Heart Rate Variability Biofeedback (HRV-BF) in individuals with Long COVID who meet the diagnostic criteria for CFS/ME. Specific objectives included assessing feasibility indicators (drop-out rates, side effects, participant satisfaction) and changes in fatigue, depression, anxiety, pain, and health-related quality of life. Methods: Participants were assigned alternately and consecutively to the HRV-BF intervention or Treatment-as-usual (TAU), in a predefined 1:1 sequence (quasirandom assignment). The intervention consisted of 10 HRV-BF sessions, held twice weekly over 5 weeks, with each session including a 10 min respiratory preparation and 40 min of active training. Results: The overall drop-out rate was low (5.56%), and participants reported a generally high level of satisfaction. Regarding side effects, the mean total Simulator Sickness Questionnaire score was 24.31 (SD = 35.42), decreasing to 12.82 (SD = 15.24) after excluding an outlier. A significantly greater improvement in severe fatigue was observed in the experimental group (H = 4.083, p = 0.043). When considering all outcomes collectively, a tendency toward improvement was detected in the experimental group (binomial test, p < 0.0001). Conclusions: HRV-BF appears feasible and well tolerated. Findings support the need for Phase III trials to confirm its potential in mitigating fatigue in Long COVID. Full article

Background/Objectives: Childhood cancer, although relatively rare, has a profound impact on the quality of life of affected children and their families. Technological advances have facilitated the development of mobile applications (apps) aimed at enhancing symptom monitoring and improving communication with healthcare teams. This systematic review aimed to analyse the effect of mobile applications on the health of children with cancer, with a specific focus on health-related quality of life (HRQoL). Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines. Searches were performed in PubMed (Medline), CINAHL, Cochrane and Scopus databases using MeSH terms such as Smartphone, Mobile Applications, Child Health, Neoplasms, and Digital Health, with no date restrictions, and including studies published in English, Spanish or Portuguese. We included original research studies that examined the use of mobile apps in paediatric oncology patients. The search was completed in January 2025. Results: Of the 324 records initially identified, 14 studies (mainly pilot studies, early-phase clinical trials, and observational designs) met the inclusion criteria. Interventions commonly focused on symptom tracking (pain, nausea, fatigue), promoting treatment adherence, and delivering educational content. Several studies reported high user acceptance and a potential positive impact on HRQoL, particularly when gamification strategies were incorporated to sustain children’s engagement. Conclusions: Despite the preliminary nature and small sample sizes of most studies, mobile applications appear to be effective in supporting symptom management, communication, and health education in paediatric oncology. Their use may contribute to improvements in HRQoL. Further high-quality research involving younger children and diverse socio-cultural contexts is required to confirm their effectiveness. Full article

Grain boundary weakening in high-temperature environments significantly influences the fatigue crack growth mechanisms of nickel-based superalloys, introducing challenges in accurately predicting fatigue life. In this study, a dislocation-density-based crystal plasticity phase-field (CP–PF) model is developed to simulate the fatigue crack growth behavior of the GH4169 alloy under both room and elevated temperatures. Grain boundaries are explicitly modeled, enabling the competition between transgranular and intergranular cracking to be accurately captured. The grain boundary separation energy and surface energy, calculated via molecular dynamics simulations, are employed as failure criteria for grain boundary and intragranular material points, respectively. The simulation results reveal that under oxygen-free conditions, fatigue crack propagation at both room and high temperatures is governed by sustained shear slip, with crack advancement hindered by grains exhibiting low Schmid factors. When grain boundary oxidation is introduced, increasing oxidation levels progressively degrade grain boundary strength and reduce overall fatigue resistance. Specifically, at room temperature, oxidation shortens the duration of crack arrest near grain boundaries. At elevated service temperatures, intensified grain boundary degradation facilitates a transition in crack growth mode from transgranular to intergranular, thereby accelerating crack propagation and exacerbating fatigue damage. Full article

This study investigates the mechanical behavior and failure characteristics of chain slings under standard and non-standard fastening methods. Through dimensional inspections, fracture tests, and finite element analysis, we identified critical factors influencing chain failure. Chains exhibiting over 10% diameter reduction or increased pitch exceeded discard criteria and showed significant strength loss. Fracture loads in aged chains dropped by more than 35% compared to standards. Structural analysis revealed that standard fastening (using master links) ensures uniform stress distribution and higher load capacity, whereas non-standard fastening (direct wrapping on eyebolts) caused stress concentration, reduced tensile capacity by over 15%, and led to localized failure near contact areas. These results validate the structural soundness of international standards (DIN EN 818-4, ISO 3056) and highlight the risks of improper fastening. Practical recommendations include strict adherence to standard fastening methods, avoidance of direct wrapping, and implementation of regular inspections. The findings emphasize the need for design considerations regarding fastening geometry and suggest further research into fatigue life prediction and contact condition optimization. Full article

This study presents a systematic review of fatigue analysis methodologies and failure criteria for asphalt binders and mixtures employed in various cyclic fatigue testing configurations. The investigation focuses on two principal predictive approaches: phenomenological models and mechanistic frameworks, which are commonly utilized to forecast asphalt pavement fatigue life based on experimental data from different fatigue tests. A critical evaluation is conducted on the diverse failure criteria integrated within these analytical approaches, with particular emphasis on their respective merits and limitations. The current research findings reveal a notable absence of consensus regarding the precise definition of the fatigue failure criteria for asphalt materials. Furthermore, critical parameters including accuracy assessment, reliability verification, and sensitivity analysis of these failure criteria are identified as requiring enhanced research attention. This review recommends specific fatigue failure criteria classified according to fatigue testing methods and material types. This comprehensive analysis of fatigue failure mechanisms in asphalt composites aims to inform strategic refinements for future research trajectories and enhance durability-oriented pavement design practices. Full article

Background: Thyroid disorders are significant endocrine conditions in pediatric populations, sometimes requiring surgical intervention. While surgical outcomes are well-documented, the broader impact on quality of life (QoL) remains insufficiently synthesized. This systematic review aimed to evaluate the effects of thyroid surgery on QoL in pediatric patients, focusing on physical, emotional, and social dimensions. Methods: Following the PRISMA guidelines, we searched PubMed, EMBASE, and SCOPUS from inception to January 2025. Studies reporting health-related QoL outcomes in pediatric patients undergoing thyroid surgery were included. Quality assessment was conducted using the Newcastle–Ottawa Scale. Data synthesis focused on emotional and psychological outcomes, social functioning, physical health, and surgical-approach-specific effects. Results: Five studies (ranging from 37 to 92 participants) met the inclusion criteria. Unilateral thyroidectomy was associated with better QoL outcomes compared to bilateral procedures, particularly in emotional and physical domains. Post-surgical anxiety significantly improved. However, male survivors reported higher levels of depression and reduced motivation. Employment status emerged as a significant factor influencing physical functioning scores. Thyroid cancer patients demonstrated better social functioning than peers with other cancers, yet they lagged behind healthy controls. Long-term follow-up highlighted ongoing challenges in physical functioning and fatigue. Conclusions: Thyroid surgery impacts multiple dimensions of QoL in pediatric patients, with variations depending on surgical approach and patient characteristics. These findings underscore the need for comprehensive post-operative care, including routine QoL assessments and tailored psychological support. Future research should aim to standardize assessment timing and develop targeted interventions for high-risk groups. Full article

Background/Objectives: Rheumatoid arthritis (RA) is a chronic inflammatory disease frequently accompanied by comorbid conditions that contribute to disability and worsen long-term outcomes. Among these, malnutrition and osteosarcopenia remain under-recognised. This cross-sectional study aimed to assess the prevalence of malnutrition and osteosarcopenia among elderly women with RA and explore the clinical impact of these conditions. Methods: Sixty-five women over 65 years with RA were evaluated using Global Leadership Initiative on Malnutrition (GLIM) criteria for malnutrition and EWGSOP2-based assessments for sarcopenia; bone status was measured by dual-energy X-ray absorptiometry (DXA), trabecular bone score (TBS), and three-dimensional DXA (3D-DXA). Results: Malnutrition was identified in 49.2% and osteosarcopenia in 52.3% of participants. A significant bidirectional association was observed: malnourished patients had higher rates of osteosarcopenia (65.6% vs. 34.4%; p < 0.05), and osteosarcopenic patients were more frequently malnourished (61.8% vs. 39.1%; p < 0.05). Both conditions were associated with older age, lower body mass index (BMI), impaired muscle parameters, and reduced bone mineral density. Malnourished and osteosarcopenic patients reported worse fatigue and lower physical quality of life, despite similar inflammatory activity. Significant correlations were found between muscle mass indices and bone quality metrics assessed by 3D-DXA. These findings highlight a substantial burden of malnutrition and osteosarcopenia in elderly women with RA, even with well-controlled disease despite similar inflammatory activity (mean Disease Activity Score 28: 2.8 ± 1.0; 43.1% in remission. Conclusions: There is a substantial burden of malnutrition and osteosarcopenia in elderly women with RA that support the integration of systematic nutritional and musculoskeletal screening into routine care. Future studies should evaluate age- and disease-specific mechanisms and assess the benefit of multidisciplinary strategies to prevent frailty and improve long-term outcomes. Full article

Background: This scoping review aims to map and summarise physical therapy interventions specifically targeting gait and balance in individuals with Charcot-Marie-Tooth disease (CMT), highlighting commonly applied strategies, methodological limitations, and clinical implications. Charcot-Marie-Tooth disease (CMT) is a hereditary neuropathy characterised by progressive motor and sensory impairment, often resulting in reduced mobility, muscle weakness, balance deficits, and fatigue. Although pharmacological options remain limited, rehabilitation is increasingly recognised as a key component of disease management. However, the scope, type, and effectiveness of rehabilitative interventions in CMT remain poorly mapped. Methods: This scoping review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology and the PRISMA-ScR guidelines. Five databases (PubMed, Cochrane, PEDro, Scopus, and Web of Science) were systematically searched up to March 2024. Studies were eligible if they involved participants with CMT undergoing rehabilitation interventions aimed at improving functional outcomes. Data extraction focused on study characteristics, methods, outcome measures, and results. Results: Eleven studies met inclusion criteria, comprising case reports, cohort studies, and two randomised controlled trials. Interventions included aerobic training, strength and balance exercises, videogame-based home programmes, and multidisciplinary rehabilitation. Most studies reported improvements in walking capacity (e.g., 6MWT, 10MWT), postural balance (e.g., BBS), and lower limb strength (e.g., MRC, dynamometry). Some also showed positive changes in fatigue and quality of life, though data were limited. Methodological heterogeneity and small sample sizes limited comparability and generalisability. Conclusions: Rehabilitation appears to yield meaningful improvements in key functional domains in people with CMT. Tailored, multimodal interventions show promise, though long-term benefits remain underexplored. Future research should adopt standardised protocols and outcome measures to better define best practices and optimise patient care. Full article

Cancer remains a major global health burden driven by complex biological mechanisms, and while targeted therapies like tyrosine kinase inhibitors (TKIs) have revolutionized treatment, their efficacy and safety are significantly influenced by drug–drug interactions (DDIs). Tyrosine-kinase receptors (RTKs) regulate critical cellular processes, and their dysregulation through mutations or overexpression drives oncogenesis, with TKIs designed to inhibit these aberrant signaling pathways by targeting RTK phosphorylation. Pharmacokinetic DDIs can critically impact the efficacy and safety of TKIs such as erlotinib, gefitinib, and pazopanib by affecting their absorption, distribution, and metabolism. The modification of pH can influence drug absorption; furthermore, the inhibition or induction of metabolizing enzymes may affect biotransformation, while distribution can be altered through the modulation of transmembrane transporters. Additionally, ensuring quality of life during TKI treatment requires vigilant monitoring and management of adverse events, which range from mild (e.g., rash, diarrhea, fatigue) to severe (e.g., hepatotoxicity, cardiotoxicity). Drug-specific toxicities, such as hyperlipidemia with lorlatinib or visual disturbances with crizotinib, must be assessed using specific criteria, with dose adjustments and supportive care tailored to individual patient responses. Thus, optimal TKI therapy relies on managing drug interactions through multidisciplinary care, monitoring, and patient education to ensure safety and treatment efficacy. Full article

Background: Out-of-hospital cardiac arrest (OHCA) survivors and their relatives may face challenges following hospital discharge, relating to mood, cognition, and returning to normal day-to-day activities. Identified research gaps include a lack of knowledge around what type of intervention is needed to best navigate recovery. In this study, we investigate the feasibility and patient acceptability of a new virtual psychoeducational group intervention for OHCA survivors and their relatives and compare it to a control group receiving a digital information booklet. Methods: V-CARE is a comparative, single-blind randomized pilot trial including participants at selected sites of the STEPCARE trial, in the United Kingdom and Sweden. Inclusion criteria are a modified Rankin Scale (mRS) ≤ 3 at 30-day follow-up; no diagnosis of dementia; and not experiencing an acute psychiatric episode. One caregiver per patient is invited to participate optionally. The intervention group in V-CARE receives four semi-structured, one-hour-long, psychoeducational sessions delivered remotely via video call by a trained clinician once a week, 2–3 months after hospital discharge. The sessions cover understanding cardiac arrest; coping with fatigue and memory problems; managing low mood and anxiety; and returning to daily life. The control group receives an information booklet focused on fatigue, memory/cognitive problems, mental health, and practical coping strategies. Results: Primary: feasibility (number of patients consented) and acceptability (retention rate); secondary: satisfaction with care (Client Satisfaction Questionnaire 8 item), self-management skills (Self-Management Assessment Scale) and, where available, health-related outcomes assessed in the STEPCARE Extended Follow-up sub-study including cognition, fatigue, mood, quality of life, and return to work. Conclusions: If preliminary insights from the V-CARE trial suggest the intervention to be feasible and acceptable, the results will be used to design a larger trial aimed at informing future interventions to support OHCA recovery. Full article

Background and Objectives: Rectal cancer is a major cause of morbidity and mortality worldwide, and although current therapeutic protocols have improved survival, treatment-related toxicities may significantly affect patients’ daily functioning and emotional well-being. This study aimed to prospectively assess the impact of radiotherapy with concurrent capecitabine on functional and symptomatic outcomes in patients with rectal cancer, with a particular focus on the presence of a stoma and treatment strategy. Materials and Methods: From 165 patients initially assessed, 64 were included in this study after applying eligibility criteria. All received pelvic radiotherapy (50.4 Gy in 28 fractions); 62.5% also received CAPOX chemotherapy. The quality of life was assessed using EORTC QLQ-C30 and QLQ-CR29 questionnaires administered at three time points: before treatment, mid-treatment (day 15), and post-treatment. Results: A statistically significant deterioration was observed in physical, emotional, social, and role functioning over the course of treatment, along with an increase in symptom scores for fatigue, pain, gastrointestinal, and urinary complaints. The presence of a stoma was significantly associated with worse gastrointestinal symptoms and emotional functioning. No significant differences were noted between patients with or without chemotherapy. Despite symptom worsening, global quality-of-life scores remained relatively stable. Conclusions: These findings highlight the complex interplay between treatment toxicity and patient adaptation. The presence of a stoma and other clinical or demographic factors significantly influence patients’ experience during therapy. Integrating routine assessment of functional and symptomatic burden into clinical practice could support individualized interventions aimed at maintaining daily functioning and psychological resilience during treatment. Full article

The integration of Recycled Concrete Aggregate (RCA) and Reclaimed Asphalt Pavement (RAP) into Hot Mix Asphalt (HMA) presents a sustainable solution to mitigate environmental impacts and reduce reliance on virgin materials. This study investigates the influence of RCA and RAP as partial replacements for natural limestone aggregates on the volumetric, mechanical, and performance properties of asphalt mixtures. Replacement levels of 11%, 33%, and 66% (by total aggregate weight) were evaluated through comprehensive testing, including dynamic modulus, flow number, stiffness factor, and loss modulus assessments under varying temperatures and loading frequencies. Findings indicate that recycled aggregate incorporation results in a progressive reduction in optimum asphalt binder content, voids in mineral aggregates (VMAs), and voids filled with asphalt (VFAs). While all mixtures demonstrated acceptable stiffness-frequency behavior, the 33% replacement mix provided the best balance of rutting resistance and fatigue performance, satisfying Superpave volumetric criteria. The 11% mix exhibited enhanced fatigue resistance, whereas the 66% mix, despite showing the highest rutting stiffness, failed to meet minimum volumetric thresholds and is therefore unsuitable for structural applications. Statistical analysis (one-way ANOVA) confirmed the significant effect of RCA and RAP content on the mechanical response across performance zones. The results highlight the potential of using moderate recycled aggregate levels (particularly 33%) to produce durable, sustainable, and cost-efficient asphalt mixtures. For regions with mixed distress conditions, a 33% replacement is recommended, while 11% may be preferable in fatigue-critical environments. Further research incorporating viscoelastic continuum damage models and life cycle cost analysis is suggested to optimize design strategies and quantify long-term benefits. Full article

Background/Objectives: Hepatocellular carcinoma (HCC) is a major cause of cancer-related mortality worldwide, with transarterial chemoembolization (TACE) commonly used as a palliative approach for patients who are not candidates for surgical resection. Understanding the factors that influence health-related quality of life (HRQoL) after TACE is essential for improving patient-centered care. This systematic review seeks to consolidate current evidence on the variables that impact HRQoL in HCC patients post-TACE. Methods: In adherence to PRISMA guidelines, a comprehensive search was conducted across five English and Chinese databases—PubMed, Scopus, Web of Science, CNKI, and Wanfang—covering studies from database inception to May 2025. Eligible studies were observational and examined factors affecting HRQoL in post-TACE HCC patients. Two independent reviewers performed screening, data extraction, and quality assessment using the Joanna Briggs Institute (JBI) Critical Appraisal Tools. Results: Nine studies met the inclusion criteria, including six cohort studies and three cross-sectional studies. The quality assessment rated seven studies as high quality and two as moderate. A range of validated HRQoL assessment tools was used, with the EORTC QLQ-C30 and FACT-G being the most commonly employed. The factors influencing HRQoL were grouped into five categories: (1) demographic factors (e.g., age, gender, education level); (2) clinical indicators (e.g., liver function, tumor burden); (3) psychological factors (e.g., depression, anxiety, spiritual well-being); (4) social support (e.g., financial status, coping mechanisms); and (5) physical symptoms (e.g., fatigue, pain, appetite loss). Across studies, both symptom severity and psychological distress were consistently associated with lower HRQoL. Conclusions: The HRQoL of HCC patients following TACE is influenced by a complex interplay of demographic, clinical, psychological, social, and symptomatic factors. Tailored, multidimensional interventions addressing these diverse aspects are crucial to optimizing recovery and improving overall well-being. Full article