Search Results (117)

Background/Objective: The criteria for selecting and managing oral moisturizers have yet to be clearly defined. The purpose of this study was to examine the effects of storage temperature and storage time on the pH and oxidation–reduction potential (ORP) of oral moisturizers. Methods: The pH and ORP of 20 commercially available oral moisturizers stored at 37 °C, 25 °C, and 4 °C were measured immediately after opening (0M) and at 1 month (1M), 3 months (3M), and 6 months (6M) post-opening. The data were analyzed using Fisher’s exact test based on the critical pH of enamel and dentin, two-way repeated-measures analysis of variance (ANOVA), and Pearson’s correlation analysis. Results: At 0M, 25% of the products had pH values below the critical threshold for enamel, and 75% fell below that for dentin. The distribution of products significantly differed based on critical pH thresholds (p < 0.05). The two-way repeated-measures ANOVA showed that the pH was significantly affected by the storage time (p < 0.05), but not by the storage temperature or its interaction with time. By contrast, ORP was significantly affected by the storage temperature, storage time, and their interaction (p < 0.05). The Pearson’s correlation analysis revealed a significant negative correlation between pH and ORP at 4 °C (6M), 25 °C (1M, 3M, 6M), and 37 °C (all time points) (p < 0.05). Conclusions: Many oral moisturizers exhibit acidic pH values, indicating that products with a pH of 6.7 or higher should be selected. Additionally, to minimize degradation, oral moisturizers should be stored at 4 °C and used within 3 months of opening. Full article

A novel unified progressive hybrid censoring is introduced to combine both progressive and hybrid censoring plans to allow flexible test termination either after a prespecified number of failures or at a fixed time. This work develops both frequentist and Bayesian inferential procedures for estimating the parameters, reliability, and hazard rates of the inverted Nadarajah–Haghighi lifespan model when a sample is produced from such a censoring plan. Maximum likelihood estimators are obtained through the Newton–Raphson iterative technique. The delta method, based on the Fisher information matrix, is utilized to build the asymptotic confidence intervals for each unknown quantity. In the Bayesian methodology, Markov chain Monte Carlo techniques with independent gamma priors are implemented to generate posterior summaries and credible intervals, addressing computational intractability through the Metropolis—Hastings algorithm. Extensive Monte Carlo simulations compare the efficiency and utility of frequentist and Bayesian estimates across multiple censoring designs, highlighting the superiority of Bayesian inference using informative prior information. Two real-world applications utilizing rare minerals from gold and diamond durability studies are examined to demonstrate the adaptability of the proposed estimators to the analysis of rare events in precious materials science. By applying four different optimality criteria to multiple competing plans, an analysis of various progressive censoring strategies that yield the best performance is conducted. The proposed censoring framework is effectively applied to real-world datasets involving diamonds and gold, demonstrating its practical utility in modeling the reliability and failure behavior of rare and high-value minerals. Full article

This paper presents a visual active SLAM method considering measurement and state uncertainty for space exploration in urban search and rescue environments. An uncertainty evaluation method based on the Fisher Information Matrix (FIM) is studied from the perspective of evaluating the localization uncertainty of SLAM systems. With the aid of the Fisher Information Matrix, the Cramér–Rao Lower Bound (CRLB) of the pose uncertainty in the stereo visual SLAM system is derived to describe the boundary of the pose uncertainty. Optimality criteria are introduced to quantitatively evaluate the localization uncertainty. The odometry information selection method and the local bundle adjustment information selection method based on Fisher Information are proposed to find out the measurements with low uncertainty for localization and mapping in the search and rescue process. By adopting the method above, the computing efficiency of the system is improved while the localization accuracy is equivalent to the classical ORB-SLAM2. Moreover, by the quantified uncertainty of local poses and map points, the generalized unary node and generalized unary edge are defined to improve the computational efficiency in computing local state uncertainty. In addition, an active loop closing planner considering local state uncertainty is proposed to make use of uncertainty in assisting the space exploration and decision-making of MAV, which is beneficial to the improvement of MAV localization performance in search and rescue environments. Simulations and field tests in different challenging scenarios are conducted to verify the effectiveness of the proposed method. Full article

Background/Objectives: The combination of venetoclax (VEN) and hypomethylating agents (HMA), such as azacitidine (AZA) or decitabine (DEC), has transformed the treatment landscape for acute myeloid leukemia (AML) in patients unfit for intensive chemotherapy. However, optimal management of neutropenia and the impact of post-remission treatment interruptions (washouts) remain unclear. This study aimed to evaluate the safety and efficacy of post-remission washouts and their effect on clinical outcomes. Methods: We conducted a retrospective single-center study of 44 AML patients treated with HMA/VEN between 2020 and 2021. Clinical, molecular, and treatment-related data were collected, including treatment duration, post-remission washout duration, response rates, disease-free survival (DFS), and overall survival (OS). Statistical analyses included Fisher’s exact test and univariate and multivariate Cox models. Results: Overall, 61% of patients responded to therapy, with significantly higher response rates among those potentially eligible for the VIALE-A trial (86% vs. 39%, p = 0.002). Neither treatment duration nor post-remission washout length was associated with DFS or OS. DFS was significantly longer in patients treated with AZA compared to DEC (p = 0.006). Median OS was 7.7 months, with longer OS observed in patients who did not meet VIALE-A trial eligibility criteria (p = 0.021). Achieving complete remission (CR) was associated with improved OS (14.5 months). Conclusions: Post-remission treatment interruptions (washouts) did not negatively impact DFS or OS, suggesting they may be a safe strategy to support hematologic recovery. However, the choice of HMA appears to influence response duration, with AZA outperforming DEC in maintaining disease control. Full article

Purpose/Objective(s): Peritoneal carcinosis can occur in several gastrointestinal or gynecological malignancies and its prognosis is usually poor. With the advent of more effective systemic agents, the overall survival of metastatic patients has been revolutionized and isolated peritoneal or abdominal wall metastases might benefit from local treatments; Stereotactic Body Radiotherapy (SBRT) might be considered in selected patients with oligometastatic presentation. Materials/Methods: Oligometastases were defined according to recent ESTRO/EORTC consensus. Inclusion criteria were as follows: ECOG PS ≤ 2, written informed consent, up to five lesions to be treated at the same time, patients treated with radiotherapy schedules applying minimum 6 Gy per fraction. The primary endpoint of the study was local control (LC); acute and late toxicity, distant progression-free survival (DPFS), time-to-next systemic treatment (TNST), polymetastatic-free survival (PMFS) and overall survival (OS) were secondary endpoints. Toxicity was assessed according to CTCAE criteria v5.0. Statistical associations between clinical variables and outcomes were assessed using Fisher’s exact test, and Kruskal–Wallis test, as appropriate. Survival outcomes were estimated using the Kaplan–Meier method and compared using the log-rank test. Results: Between April 2020 and September 2024 a total of 26 oligometastatic lesions located in the peritoneum or in the abdominal wall detected in 20 patients received SBRT with Helical Tomotherapy. All cases have been assessed by a multidisciplinary team. Only in three patients out of twenty did more than one lesion receive SBRT: two lesions in two patients, and five lesions in a single case of colorectal cancer with ongoing third-line systemic treatment. Median total dose was 30 Gy (27–35 Gy) in five fractions (3–5). The most frequent primary neoplasm was ovarian cancer in 14/20, endometrial in 2/20, while the remaining were colorectal, vaginal, pancreatic and non-small cell lung cancer. Four lesions were located in the abdominal wall, while the remaining twenty-two were located in the peritoneum. Concurrent systemic therapy was administered in 18/20 patients. With a median follow-up of 15 months (range, 6–59), our 1-year LC was 100%, while 1-year DPFS, PMFS, TNTS and OS rates were 54%, 69%, 61% and 83%, respectively. Abdominal wall location and treatment of a subsequent oligometastatic recurrence with a second course of SBRT were both significantly associated with improved OS (p = 0.03 and p = 0.04, respectively). No G ≥ 3 adverse events occurred. Conclusion: Our preliminary data support the use of SBRT in selected cases of oligometastatic disease located in the peritoneum or in the abdominal wall with excellent results in terms of tolerability and promising clinical outcomes. Full article

Background: Magnetic resonance imaging (MRI) plays a crucial role in staging and preoperative evaluation in osteosarcoma patient. Fewer studies have focused on 2-year survival, which reflects tumour aggressiveness and early disease progression. This study examines the association between MRI characteristics and 2-year survival outcomes in osteosarcoma to better understand the imaging characteristic of high-risk patients. Methods: A retrospective case–control study was conducted at a tertiary university hospital. Patients diagnosed with osteosarcoma between 2010 and 2022 were included if they had a pre-treatment MRI and at least 2 years of follow-up. MRI scans were reviewed by two blinded radiologists to assess tumour location, volume, growth pattern, presence of fluid–fluid levels (FFL), pathological fractures, skip metastases, neurovascular bundle involvement, regional lymphadenopathy, and physeal or joint involvement. Statistical analyses, including Fisher’s exact test, Chi-square test, and Mann–Whitney U test, were performed to determine associations between MRI features and survival outcomes. Results: Twenty-eight patients (n = 28) met the inclusion criteria. Larger tumour volume (>300 mls) was significantly associated with poorer 2-year survival (p = 0.008). The presence of skip metastases also correlated with worse outcomes (p = 0.041). While presence of FFL, concentric growth pattern, regional lymphadenopathy, and physeal involvement showed trends toward poorer prognosis, these associations were not statistically significant. Conclusions: MRI characteristics, particularly tumour volume and skip metastases, are significant prognostic indicators of 2-year survival in osteosarcoma. These findings highlight the potential role of MRI in risk stratification and treatment planning, aiding in the identification of high-risk patients that can help with management. Full article

Background/Objectives: In adults with B-cell acute lymphoblastic leukemia (B-ALL), central nervous system (CNS) involvement represents a significant clinical challenge due to its association with adverse outcomes. Infiltration of blast cells into the CNS is primarily detected via cerebrospinal fluid (CSF) microscopy, the current gold standard diagnostic method, although it has limitations in terms of sensitivity. Quantitative polymerase chain reaction (qPCR) offers higher sensitivity and can support the diagnosis of CNS infiltration. This study assessed the mRNA expression levels of CD79A and IL7R in CSF to evaluate their potential for detecting CNS involvement in adults with B-ALL. Methods: CSF samples were collected from adults with B-ALL. The classification criteria for CNS Leukemia (CNS status) were used to evaluate CNS involvement. RNA was extracted from the CSF, and quantitative reverse transcription PCR (RT-qPCR) was used to measure the CD79A and IL7R mRNA expression levels. Results: A total of 19 treatment-naïve adult patients with B-ALL were enrolled over a 19-month period. Four (21%) patients had CNS3 status. Four (21%) patients had CNS3 status. The results also showed that the expression levels of CD79A and IL7R mRNA were significantly higher (median fold change = 0.62 and 2.12, p < 0.05, respectively) in the group with CNS3. Furthermore, using the Haldane-Anscombe correction and Fisher’s exact test, we demonstrated an association between IL7R and CNS3 expression (odds ratio = ∞, due to zero CNS+ in the IL7R group, p < 0.05). Conclusions: CD79A and IL7R mRNA levels in CSF could be potential biomarkers for detecting CNS involvement in adult patients with B-ALL. Full article

Background/Objectives: Sepsis is one of the most common causes of death worldwide, and its diagnosis remains a challenge for clinicians. The main purpose of this study was to appraise the diagnosis and antibiotic prescription pattern for sepsis admitted to the Emergency Department (ED), comparing Sepsis-2 to Sepsis-3 criteria. Methods: The study was conducted in an ED of a tertiary care medical center in Hungary. We included all adult patients who were diagnosed with sepsis in 2023. Data collection was made manually from UD MED System. Diagnosis was assessed based on Sepsis-2 and Sepsis-3 criteria, then compared. Further analyses were made only in cases with confirmed sepsis diagnosis. Antibiotic guideline adherence was determined according to the local guideline in force. Fisher’s exact test, t-test, and ANOVA were applied to compare categorical and continuous variables between groups. The Kaplan–Meier test was applied for probability of survival. Significant p-values were defined as below 0.05. Results: The substantial majority of patients recorded with sepsis in the ED met both the Sepsis-2 and Sepsis-3 criteria (80%), while the rate of misdiagnosis was similar (Sepsis-2: 16/91, 17.6% and Sepsis-3: 14/91, 15.4%). The most important identified risk factors in sepsis were old age (60+ years) and comorbidities (CCI ≥ 4). Elevated LDH (median 325 mg/dL) and decreased albumin levels (median 26 g/L) can be used as early indicators of sepsis. Although the time to first antibiotic administration was not associated with significantly better clinical outcomes, the guideline-adherent agent selection (Sepsis-2: 18/43, 41.9% and Sepsis-3: 19/46: 41.3%) led to a significantly longer survival (median 37 vs. 4 days). Conclusions: No significant differences were found in diagnostic accuracy or prediction of mortality between Sepsis-2 and Sepsis-3. Guideline-adherent antibiotics may lead to significantly higher survival rate in sepsis. Full article

Objectives: To describe the results of nutritional and morphofunctional assessment in a cohort of adults with cystic fibrosis; to evaluate differences in nutritional status between patients with and without exocrine and/or endocrine pancreatic involvement. Methods: Cross-sectional study: A cohort of adults with cystic fibrosis evaluated in a multidisciplinary unit was analyzed. Pancreatic status was examined, and malnutrition was diagnosed according to GLIM criteria. Morphofunctional assessment consisted of nutritional ultrasound, bioelectrical impedance, handgrip dynamometry, and anthropometry. Qualitative variables are expressed as n (%), quantitative variables as median (IQR). For group comparisons, Fisher’s exact test was used for qualitative variables and the non-parametric median comparison test for quantitative variables. Results: n = 101 participants were recruited, of whom 44 (43.6%) were women. Median age was 33 (25–40.5) years. A total of 64 participants (63.4%) had exocrine pancreatic insufficiency (EPI), 44 (43.6%) had endocrine pancreatic insufficiency, and 28 (27.7%) had cystic fibrosis-related diabetes (CFRD). Median BMI was 23.4 (20.1–24.89) kg/m². A total of 48 patients (47.5%) were malnourished. Males with EPI had a higher prevalence of undernourishment than those without (56.4% vs. 16.7%, p = 0.005), but not women. CFRD patients displayed no differences in morphofunctional assessment. Conclusions: Almost half the sample was undernourished using GLIM criteria. Males with exocrine pancreatic insufficiency had worse nutritional status. Endocrine pancreatic involvement did not affect nutritional status. Full article

Given the critical role of fatherhood in child development and the significant challenges faced by fathers in underserved communities, there is a pressing need to better understand the specific barriers they encounter. This exploratory mixed-methods study examines the prevalence of adverse childhood experiences (ACEs) among fathers, including English, Spanish, and Creole speakers, and explores how social determinants of health exacerbate these barriers. Quantitative data were collected from June 2022–2023 using REDCap survey software. Additionally, three focus groups were conducted with 18 fathers residing in Palm Beach County (PBC), each group based on the primary language spoken at home. The focus groups were conducted in person via the Healthy Mothers Healthy Babies Coalition (HMHB) outreach team at community centers within the PBC. Stated barriers to fatherhood were thematically classified according into three main themes: (1) limited access to and knowledge of resources in the community; (2) challenges in navigating new roles, resources, and fatherhood responsibilities; and (3) important values in parenting. Over 40% of the fathers reported barriers to being involved in their child’s life. The most frequent barriers included work (35.4%) and lack of transportation distance (12.5%). Bivariate analysis using the fisher’s exact test showed a significant association between scoring greater than 4 on the ACE criteria checklist and experiencing barriers to being involved in the child’s life (p-value = 0.013). Findings from this study aim to inform the development of culturally tailored interventions that address disparities in fatherhood support, ultimately contributing to improved outcomes for both fathers and their children. Full article

Background/Objectives: Periprosthetic joint infection (PJI) is a severe complication following both total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA). While the microbiological profile of TKA PJI has been well characterized, limited data exist regarding UKA PJIs. This study aimed to compare the causative microorganisms and surgical treatment outcomes in PJI cases following UKA and TKA. Methods: This retrospective cohort study included 82 patients (71 TKA and 11 UKA) who underwent surgical treatment for PJI between January 2017 and May 2024. PJI was diagnosed based on the Musculoskeletal Infection Society (MSIS) criteria. Treatment strategies included debridement, antibiotics, and implant retention (DAIR) or two-stage revision arthroplasty. Microbiological data were extracted from intraoperative cultures. Fisher’s exact test and the Mann–Whitney U test were used for statistical comparisons. Results: Gram-positive organisms, primarily Staphylococcus aureus and coagulase-negative staphylococci, were isolated in all UKA PJIs. In contrast, the TKA group demonstrated greater microbial diversity, including Gram-negative bacilli, polymicrobial infections, and a higher rate of culture-negative cases (33.8% vs. 18.2%). DAIR was performed more frequently in UKA cases (72.7% vs. 28.2%, p = 0.002). Recurrence rates following DAIR were similar in both groups (12.5% in UKA, 20.0% in TKA, p = 1.000). Two-stage revision resulted in no recurrence in UKA and a 9.8% recurrence rate in TKA patients. Conclusions: UKA PJIs appear to be microbiologically less complex than TKA PJI cases, with Gram-positive organisms predominating. Despite these differences, the outcomes of surgical treatment—both DAIR and two-stage revision—were comparable between groups. Standard PJI treatment principles may be applicable to both arthroplasty types; however, larger prospective studies are needed to confirm these findings. Full article

Insomnia is common in individuals with opioid use disorder (OUD). Biopsychosocial factors are important in sleep health, yet this intersection has yet to be fully elucidated in people on buprenorphine for OUD. The objective is to report on patient-reported biopsychosocial factors among people with and without insomnia, specifically among women and men in outpatient OUD treatment. The parent study enrolled adults stabilized on buprenorphine from February 2022–September 2023. Scores of ≥11 on the Insomnia Severity Index (ISI) indicated clinically significant insomnia. Differences were detected by the presence of insomnia, stratified by men and women, using chi-squared and Fisher’s exact tests. Of the overall participants (N = 130), most (n = 77; 59.2%) met the criteria for clinically significant insomnia. Women with insomnia were more likely to report social stressors including discrimination for substance use (p = 0.040), food insecurity (p = 0.032), and transportation difficulties accessing healthcare (p = 0.043) than women without insomnia. Men with insomnia were more likely to report financial difficulties accessing healthcare (p = 0.023) than men without insomnia. These findings provide a unique perspective to consider in the development and implementation of sleep interventions for women and men receiving medication treatment for OUD. Full article

Accurate antimicrobial susceptibility testing (AST) of cefiderocol remains a diagnostic challenge, especially in infections caused by metallo-β-lactamase (MBL)-producing Klebsiella pneumoniae. While disk diffusion offers a cost-effective alternative to broth microdilution, it is highly sensitive to factors such as media composition and the presence of atypical colony morphology. The objective of this study was to evaluate how different agar media and interpretations of isolated colonies affect the performance and reliability of cefiderocol AST by disk diffusion. A total of 50 clinical K. pneumoniae MBL isolates were tested using disk diffusion on Columbia with blood, MacConkey, and chromogenic agars from three manufacturers. Inhibition zones were compared with MICs from broth microdilution. Statistical analyses included paired t-tests and Spearman correlation to assess media effects and zone morphology impact. Variability in inhibition zone diameters was observed between media, notably with chromogenic agar. The most consistent results were obtained using Graso Biotech and Thermo Fisher Columbia with blood agar. Isolated colonies were observed in over half the samples and, depending on how they were interpreted, led to major changes in classification accuracy. Up to 64% of results fell into the EUCAST area of technical uncertainty (ATU), and categorical agreement varied across media and interpretive criteria. Disk diffusion for cefiderocol may be used in resource-limited settings but only if rigorously standardized using validated media, consistent zone reading, and ATU-aware interpretive strategies. In borderline cases or when morphological anomalies are present, broth microdilution should be considered the sole reliable method. Clinical microbiologists are advised to exercise caution with ambiguous results and seek expert or confirmatory testing when needed. Full article

Background/Objectives: CMV (cytomegalovirus) is associated with several developmental disorders. The incidence of congenital cytomegalovirus infection is around 1%, depending on the region. Previous prospective studies have shown that certain ultrasound findings are predictive factors for prenatal CMV infection. Methods: During this systematic review, we searched PubMed and Embas. Out of 569 results, 19 met our search criteria (we included cases where prenatally positive amniocentesis PCR for CMV was performed or autopsy confirmed the CMV diagnosis). A total of 237 cases were reported from 19 studies. Results: In 64 cases, abortion or perinatal death occurred. The most common prenatal abnormalities were small for gestational age (n = 47), ventriculomegaly (n = 51), and hyperechogenic bowels (n = 39). A subependymal cyst was the most common prenatal MRI abnormality (n = 20). Hearing loss was observed in 61 cases (42 mild, 19 severe). Among prenatal signs, we found a correlation between hearing loss and ventriculomegaly (Fisher’s exact test, p = 0.0052). The most common neurological complication was speech delay. We were able to demonstrate a prenatal association with neurological complications and subependymal cyst (Fisher’s exact test, p = 0.00003547), but this pattern could only be reliably seen with MRI. Conclusions: In prenatally diagnosed CMV infection, ultrasound signals may be suitable for estimating the outcome. Conducting a prospective study and establishing a score would be worthwhile for its clinical application. In cases of ultrasound abnormalities and suspicion of CMV, it is worth performing a prenatal MRI, even in everyday practice. Full article

The main goal of this study was to determine the associations between the quality of presentation of GM, motor development, and brain integrity as seen through magnetic resonance imaging. Methods: This is an observational, descriptive, and association study; information derived from it was used to analyze associations between the following variables: Writhing Movements, Fidgety Movements, motor development, and brain integrity. With a confidence level of 95% and an estimation error of 5%, the sample was comprised of 60 children under 5 months old with any neurological risk criteria; these children were either hospitalized in the Neonatal Intensive Care Unit (NICU) or attending the Kangaroo Mother Care Program (KMCP) at the University Hospital of La Samaritana (UHS), Colombia. The data were analyzed using Fisher’s exact test. Results: Over 90% of children with Absent or Sporadic Fidgety Movements had either abnormal or suspicious motor development. We observed a trend of association between the absence of Fidget Movements and alterations in White Matter. Conclusions: Quality of presentation of General Movements is associated with motor development and alterations of brain tissue at an early age, primarily in the White Matter; it is important for early prediction of neurological risk in infants. Full article