Search Results (11,091)

Background and Objective: Adverse pathology to high-risk prostate cancer (PCa) after radical prostatectomy (upgrading) poses a threat to risk stratification and treatment planning. The impact on sexual function, urinary continence, and health-related quality of life (HRQOL) remains unclear. Methods: From 2004 to 2024, 4189 patients with preop low-/intermediate-risk PCa (Gleason score 6 or 7a, PSA ≤ 20 ng/mL) underwent radical prostatectomy at our department and were analyzed. Primary endpoint was HRQOL, erectile function, and urinary continence. Secondary endpoint was rate of salvage therapies and biochemical-free survival. Propensity score matching was performed using “operative time”, “robot-assisted surgery”, “blood loss”, “nerve-sparing surgery”, “age”, and “BMI” to represent comparable surgical approach. Median follow-up was 39 months (Interquartile-range (IQR) 15–60). Key Findings and Limitations: Patients who were upgraded to high-risk PCa showed a higher rate of postoperative radiotherapy and androgen-deprivation therapy compared to patients who were not upgraded (21% vs. 7%, p < 0.001; 9% vs. 3%, p = 0.002). Five-year biochemical recurrence-free survival was 68% in the upgrading group vs. 84% in the no-upgrading group (p < 0.001). We saw no difference in patient-reported HRQOL, urinary continence, or erectile function. Multivariable analysis showed that postoperative upgrading was a significant risk for not achieving good overall HRQOL (OR: 0.77, 95% CI: 0.61–0.97, p = 0.028) during the follow-up. Conclusions and Clinical Implications: Although postoperative upgrading to high-risk PCa leads to worse oncologic outcomes and higher salvage therapy rates, this study indicates that its impact on health-related quality of life is minimal and should not deter a cautious approach to radical prostatectomy. Full article

To accurately assess the effect of different plate thicknesses on the residual stress field of laser shock peened GH3039 superalloy, residual stress measurements were performed on GH3039 alloy plates with thicknesses of 2 mm and 5 mm after laser shock peening (LSP) treatment. Both quasi-static and high strain rate mechanical tests of GH3039 were conducted, and the Johnson-Cook (J-C) constitutive equation for GH3039 alloy at specific strain rates was fitted based on the experimental results. To obtain the parameter C in the J-C constitutive equation of GH3039 alloy under ultra-high strain rates, a modified method was proposed based on LSP experiment and finite element simulation results. Using the modified GH3039 alloy J-C constitutive equation, numerical simulations and comparative analyses of the residual stress field of GH3039 alloy plates of different thicknesses under LSP were carried out using ABAQUS software. The simulated residual stress fields of laser-shocked GH3039 alloy plates of different thicknesses were in good agreement with the experimental measurements, indicating that the modified GH3039 alloy J-C constitutive equation can accurately predict the mechanical behavior of GH3039 alloy under ultra-high strain rates. Based on the modified GH3039 alloy J-C constitutive equation, the effect of different plate thicknesses on the residual stress distribution of laser-shocked GH3039 alloy was studied, along with the underlying mechanisms. The unique distribution characteristics of residual stresses in laser-shocked GH3039 plates with varying thicknesses are primarily attributed to differences in plate bending stiffness and the detrimental coupling effects of reflected tensile waves. Full article

Background/Objectives: Pulmonary typical carcinoid (TC) is a rare type of primary neuroendocrine neoplasm of the lung with indolent behavior and a good prognosis. The main treatment strategy is surgery, the extent of which is controversial given the nature of the disease. The aim of this study is to assess whether the extent of resection influences survival and recurrence in patients undergoing lung resection and lymphadenectomy for TC and to investigate negative prognostic factors for OS. Methods: A single-centre retrospective study of 15 years’ experience was conducted. Data from all patients who underwent lung resection and lymphadenectomy for TC were collected. Patients were divided into two groups: anatomical and non-anatomical resections. Perioperative and long-term oncological results were analyzed. Results: In total, 115 patients were surgically treated for TC, of whom 83 (72%) underwent anatomical resection and 32 (28%) non-anatomical resection. Univariate analyses showed that age, left lower lobe, and many comorbidities had a detrimental effect on OS, whereas on multivariate analysis, only left lower lobe location and a high Charlson–Deyo comorbidity index (CCI) were confirmed as negative prognostic factors for OS. At a median follow-up of 93 months (IQR 57-129), the OS survival curves show a slightly lower trend for non-anatomical resections (p 0.152), while no differences were found for DFS. Conclusions: The results of this study confirm that in selected patients at risk for major resections, non-anatomical resection can be used to treat TC when R0 is achievable. These data, together with evidence from the literature, highlight the importance of patient-centred care in this rare disease. Full article

Background/Objectives: While intravenous thrombolysis (IVT) is the standard treatment for acute ischemic stroke (AIS) within 4.5 h of symptom onset, many patients present beyond this time window. Recent trials suggest that IVT may be both effective and safe in selected patients treated after the standard time window. Methods: We searched MEDLINE, Scopus, and ClinicalTrials.gov for randomized-controlled clinical trials (RCTs) and individual patient-data meta-analyses (IPDMs) of RCTs comparing IVT plus best medical treatment (BMT) to BMT alone in AIS patients who were last-known-well more than 4.5 h earlier. The primary efficacy outcome was a 90-day excellent functional outcome [modified Rankin Scale (mRS)-scores of 0–1]. Secondary efficacy outcomes included good functional outcome (mRS-scores 0–2) and reduced disability (≥1-point reduction across all mRS-strata). The primary safety outcome was symptomatic intracranial hemorrhage (sICH); secondary safety outcomes were any ICH and 3-month all-cause mortality. Subgroup analyses were performed stratified by different thrombolytics, time-windows, imaging modalities, and affected circulation. Results: Nine studies were included, comprising 1660 patients in the IVT-group and 1626 patients in the control-group. IVT significantly improved excellent functional outcome (RR = 1.24; 95%CI:1.14–1.34; I² = 0%) and good functional outcome (RR = 1.18; 95%CI:1.05–1.33; I² = 70%). IVT was associated with increased odds of reduced disability (common OR = 1.3; 95%CI:1.15–1.46; I² = 0%) and increased risk of sICH (RR = 2.75; 95%CI:1.49–5.05; I² = 0%). The rates of any ICH and all-cause mortality were similar between the two groups. No significant subgroup differences were documented. Conclusions: IVT in the extended time window improved functional outcomes without increasing mortality, despite a higher rate of sICH. Full article

Cutibacterium acnes is linked to the prevalent inflammatory skin disorder known as Acne Vulgaris (AV). Some topical agents exhibit unfavorable side effects like dryness and skin inflammation, and antimicrobial resistance (AMR) poses an increasing risk to effective AV management. This study develops and characterizes stable topical essential oil (EO)-loaded microemulgels with in vitro validated antimicrobial activities against C. acnes ATCC 6919, providing a solid scientific basis for their effectiveness. These microemulgels, with their potential to serve as an alternative to AMR-prone synthetic agents, could revolutionize the field of acne treatment. The MICs of the EOs (citronella, tea tree, and lemongrass) against C. acnes were determined. EO-loaded microemulgels were developed using a blend of microemulsion and carbopol/hyaluronic acid gel in a ratio of 1:1 and characterized, and their stability was observed over three months. The MICs of citronella, tea tree, and lemongrass EOs were 0.08, 0.16, and 0.62% v/v, respectively. The microemulgels were whitish and smooth, with characteristic EO odors. They demonstrated pH values ranging between 4.81 ± 0.20 and 5.00 ± 0.03, good homogeneity, a spreadability of 9.79 ± 0.6 and 12.76 ± 0.8 cm², a viscosity of 29,500 and 31,130 cP, and retained stability at 4, 25, and 40 °C. EO-loaded microemulgels were developed with the potential of C. acnes management. The formulation shows adequate potential for further pharmaceutical development towards translational adoption in acne management. Full article

Dye residues from the textile industry constitute a critical wastewater problem. This study aimed to evaluate the removal capacity of methylene blue (MB) in aqueous media, using an adsorbent formulated from activated and sonicated nanoclay (NC) and microatomized Nostoc sphaericum (ANS). NC was obtained by acid treatment, followed by activation with 1 M NaCl and sonication, while ANS was obtained by microatomization in an aqueous medium. NC/ANS was mixed in a 4:1 weight ratio. The NC/ANS synergistic adsorbent was characterized by the point of zero charge (PZC), zeta potential (ζ), particle size, FTIR spectroscopy, and scanning electron microscopy (SEM). NC/ANS exhibited good colloidal stability, as determined by pH_PZC, particle size in the nanometer range, and heterogeneous morphology with functional groups (hydroxyl, carboxyl, and amide), removing between 72.59 and 97.98% from an initial concentration of 10 ppm of MB, for doses of 20 to 30 mg/L of NC/ANS and pH of 5 to 8. Optimal adsorption conditions are achieved at pH 6.8 and 32.9 mg/L of adsorbent NC/ANS. It was observed that the pseudo-first-order (PFO) and pseudo-second-order (PSO) kinetic models best described the adsorption kinetics, indicating a predominance of the physisorption process, with adsorption capacity around 20 mg/g. Isotherm models and thermodynamic parameters of adsorption, ΔS, ΔH, and ΔG, revealed that the adsorption process is spontaneous, favorable, thermodynamically stable, and occurs at the monolayer level, with a regeneration capacity of 90.35 to 37.54% at the fifth cycle. The application of physical activation methods, such as sonication of the clay and microatomization of the algae, allows proposing a novel and alternative synergistic material from organic and inorganic sources that is environmentally friendly and promotes sustainability, with a high capacity to remove cationic dyes in wastewater. Full article

Background: Breast and hematological cancer treatments, especially with anthracyclines, have been shown to be associated with an increased risk of cardiotoxicity (CTX). An accurate prediction of cardiotoxicity risk and early detection of myocardial injury may allow for effective cardioprotection to be instituted and tailored to reverse cardiac dysfunction and prevent the discontinuation of essential cancer treatments. Objectives: The PRoactive Evaluation of Function to Evade Cardio Toxicity (PREFECT) study sought to evaluate the ability of fast-strain-encoded (F-SENC) cardiac magnetic resonance imaging (CMR) and 2D echocardiography (2D Echo) to stratify patients at risk of CTX prior to initiating cancer treatment, detect early signs of cardiac dysfunction, including subclinical CTX (sub-CTX) and CTX, and monitor for recovery (REC) during cardioprotective therapy. Methods: Fifty-nine patients with breast cancer or lymphoma were prospectively monitored for CTX with F-SENC CMR and 2D Echo over at least 1 year for evidence of cardiac dysfunction during anthracycline based chemotherapy. F-SENC CMR also monitored myocardial deformation in 37 left ventricular (LV) segments to obtain a MyoHealth risk score based on both longitudinal and circumferential strain. Sub-CTX and CTX were classified based on pre-specified cardiotoxicity definitions. Results: CTX was observed in 9/59 (15%) and sub-CTX in 24/59 (41%) patients undergoing chemotherapy. F-SENC CMR parameters at baseline predicted CTX with a lower LVEF (57 ± 5% vs. 61 ± 5% for all, p = 0.05), as well as a lower MyoHealth (70 ± 9 vs. 79 ± 11 for all, p = 0.004) and a worse global circumferential strain (GCS) (−18 ± 1 vs. −20 ± 1 for all, p < 0.001). Pre-chemotherapy MyoHealth had a higher accuracy in predicting the development of CTX compared to CMR LVEF and 2D Echo LVEF (AUC = 0.85, 0.69, and 0.57, respectively). The 2D Echo parameters on baseline imaging did not stratify CTX risk. F-SENC CMR obtained good or excellent images in 320/322 (99.4%) scans. During cancer treatment, MyoHealth had a high accuracy of detecting sub-CTX or CTX (AUC = 0.950), and the highest log likelihood ratio (indicating a higher probability of detecting CTX) followed by F-SENC GLS and F-SENC GCS. CMR LVEF and CMR LV stroke volume index (LVSVI) also significantly worsened in patients developing CTX during cancer treatment. Conclusions: F-SENC CMR provided a reliable and accurate assessment of myocardial function during anthracycline-based chemotherapy, and demonstrated accurate early detection of CTX. In addition, MyoHealth allows for the robust identification of patients at risk for CTX prior to treatment with higher accuracy than LVEF. Full article

Background: Epidermal growth factor receptor (EGFR) mutations are presented in approximately 50% of East Asian populations with advanced non-small cell lung cancer (NSCLC). While EGFR-tyrosine kinase inhibitors (TKIs) are the standard treatment, patient outcomes are also influenced by host-related factors. This study aimed to investigate clinical and radiological factors associated with early mortality and develop a prognostic prediction model in advanced EGFR-mutated NSCLC. Methods: A retrospective cohort was conducted in patients with EGFR-mutated NSCLC treated with first line EGFR-TKIs from January 2012 to October 2022 at Chiang Mai University Hospital. Clinical data and radiologic findings at the initiation of treatment were analyzed. A multivariable flexible parametric survival model was used to determine the predictors of death at 18 months. The predicted survival probabilities at 6, 12, and 18 months were estimated, and the model performance was evaluated. Results: Among 189 patients, 84 (44.4%) died within 18 months. Significant predictors of mortality included body mass index <18.5 or ≥23, bone metastasis, neutrophil-to-lymphocyte ratio ≥ 5, albumin-to-globulin ratio < 1, and mean pulmonary artery diameter ≥ 29 mm. The model demonstrated good performance (Harrell’s C-statistic = 0.72; 95% CI: 0.66–0.78). Based on bootstrap internal validation, the optimism-corrected Harrell’s C-statistic was 0.71 (95% CI: 0.71–0.71), derived from an apparent C-statistic of 0.75 (95% CI: 0.74–0.75) and an estimated optimism of 0.04 (95% CI: 0.03–0.04). Estimated 18-month survival ranged from 87.1% in those without risk factors to 2.1% in those with all predictors. A web-based tool was developed for clinical use. Conclusions: The prognostic model developed from fundamental clinical and radiologic parameters demonstrated promising utility in predicting 18-month mortality in patients with advanced EGFR-mutated NSCLC receiving first-line EGFR-TKI therapy. Full article

Development of forming methods for surface-coated metals is a current concern due to their economic and environmental advantages. For a successful forming operation, it is necessary that both components, the substrate and the coating, are able to withstand stress without damage until the final shape and dimensions are reached. This goal can be achieved through good knowledge of the elastic and plastic properties of the substrate and the coating, the compatibility between them, the appropriate surface treatment, and the rigorous control of technological forming parameters. Our study was carried out with flat specimens of pre-painted Al 99.0 sheet that were electromagnetically formed by bulging. Forming behavior was investigated as depending on the initial thickness of the substrate, on the aluminum sheet pretreatment, as well as on the plastic deformation path of the metal–paint structure. To verify the damage to the paint layer, tests with increasing strains were performed, and the interface between the metal and the coating layer was investigated by scanning electron microscopy. The obtained results indicate that electromagnetic forming of pre-painted sheets can be a feasible method for specific applications if the forming degree of the substrate is tightly correlated with the type of desired coating and with the pretreatment method used for the metal surface. Full article

Rural roads are critical for connecting isolated communities to essential services such as education and health and administrative services, as well as production and market opportunities in low-income countries. More than 70% of movements of people and goods in Sub-Saharan Africa are heavily reliant on rural transport systems, using both motorised but mainly alternative means of transport. However, rural roads often suffer from poor construction due to the use of low-strength, in situ soils and limited financial resources, leading to premature failures and subsequent traffic disruptions with significant economic losses. This study investigates the use of rice husk ash (RHA), a waste byproduct from rice production, as a sustainable supplement to Ordinary Portland Cement (OPC) for soil stabilisation in order to increase durability and sustainability of rural roads, hence limit recurrent maintenance needs and associated transport costs and challenges. To conduct this study, soil samples collected from Mulungushi, Zambia, were treated with combinations of 6–10% OPC and 10–15% RHA by weight. Laboratory tests measured maximum dry density (MDD), optimum moisture content (OMC), and California Bearing Ratio (CBR) values; the main parameters assessed to ensure the quality of road construction soils. Results showed that while the MDD did not change significantly and varied between 1505 kg/m³ and 1519 kg/m³, the OMC increased hugely from 19.6% to as high as 26.2% after treatment with RHA. The CBR value improved significantly, with the 8% OPC + 10% RHA mixture achieving the highest resistance to deformation. These results suggest that RHA can enhance the durability and sustainability of rural roads and hence improve transport systems and subsequently improve socioeconomic factors in rural areas. Full article

The worldwide increase in antifungal resistance, particularly in Candida sp., requires the exploration of novel therapeutic agents. Natural compounds have been a rich source of antimicrobial molecules, where peptides constitute the class of the most bioactive components. Therefore, this study looks into the target-specific binding efficacy of insect-derived antifungal peptides (n = 37) as possible alternatives to traditional antifungal treatments. Using computational methods, namely the HPEPDOCK and HDOCK platforms, molecular docking was performed to evaluate the interactions between selected key fungal targets, lanosterol 14-demethylase, or LDM (PDB ID: 5V5Z), secreted aspartic proteinase-5, or Sap-5 (PDB ID: 2QZX), N-myristoyl transferase, or NMT (PDB ID: 1NMT), and dihydrofolate reductase, or DHFR, of C. albicans. The three-dimensional peptide structure was modelled through the PEP-FOLD 3.5 tool. Further, we predicted the physicochemical properties of these peptides through the ProtParam and PEPTIDE 2.0 tools to assess their drug-likeness and potential for therapeutic applications. In silico results show that Blap-6 from Blaps rhynchopeter and Gomesin from Acanthoscurria gomesiana have the most antifungal potential against all four targeted proteins in Candida sp. Additionally, a molecular dynamics simulation study of LDM-Blap-6 was carried out at 100 nanoseconds. The overall predictions showed that both have strong binding abilities and are good candidates for drug development. In in vitro studies, Gomesin achieved complete biofilm eradication in three out of four Candida species, while Blap-6 showed moderate but consistent reduction across all species. C. tropicalis demonstrated relative resistance to complete eradication by both peptides. The present study provides evidence to support the antifungal activity of certain insect peptides, with potential to be used as alternative drugs or as a template for a new synthetic or modified peptide in pursuit of effective therapies against Candida spp. Full article

Metabolic syndrome is a global health crisis. However, there are no effective therapeutic strategies for metabolic syndrome. Therefore, this study was conducted to find out a novel silkworm-based metabolic syndrome model that bridges microbial ecology and metabolic dysregulation by integrating hemolymph lipids and midgut microbiota. Our results showed that the levels of HDL-C in the hemolymph of the lean silkworm strain were significantly higher than that in the obese silkworm strain. Furthermore, correlation analysis revealed that Lactococcus and Oceanobacillus were positively related to HDL-C levels, while SM1A02 and Pseudonocardia were negatively associated with HDL-C levels. These relationships between the identified bacteria in the midgut and HDL-C, known as the “good” lipid, in the hemolymph could help guide the development of new treatments for obesity and metabolic problems like high cholesterol in humans. Overall, our results not only established a framework for understanding microbiota-driven lipid dysregulation in silkworms but also offered potential probiotic targets and a bacterial biomarker for obesity and metabolic dysfunction intervention in humans. Full article

Purpose: To present the findings of our preliminary experience using daily image-guided radiotherapy (IGRT) supported by implanted fiducial markers (FMs) in the radiotherapy of the vaginal cuff, in a cohort of post-surgery endometrial cancer patients. Methods: Patients with vaginal cuff cancer requiring adjuvant radiation with external beams were enrolled. Five patients underwent radiation therapy targeting the pelvic disease and positive lymph nodes, with doses of 50.4 Gy in twenty-eight fractions and a subsequent stereotactic boost on the vaginal vault at a dose of 5 Gy in a single fraction. One patient was administered 30 Gy in five fractions to the vaginal vault. These patients underwent external beam RT following the implantation of three 0.40 × 10 mm gold fiducial markers (FMs). Our IGRT strategy involved real-time 2D kV image-based monitoring of the fiducial markers during the treatment delivery as a surrogate of the vaginal cuff. To explore the potential role of FMs throughout the treatment process, we analyzed cine movies of the 2D kV-triggered images during delivery, as well as the image registration between pre- and post-treatment CBCT scans and the planning CT (pCT). Each CBCT used to trigger fraction delivery was segmented to define the rectum, bladder, and vaginal cuff. We calculated a standard metric to assess the similarity among the images (Dice index). Results: All the patients completed radiotherapy and experienced good tolerance without any reported acute or long-term toxicity. We did not observe any loss of FMs during or before treatment. A total of twenty CBCTs were analyzed across ten fractions. The observed trend showed a relatively emptier bladder compared to the simulation phase, with the bladder filling during the delivery. This resulted in a final median Dice similarity coefficient (DSC) of 0.90, indicating strong performance. The rectum reproducibility revealed greater variability, negatively affecting the quality of the delivery. Only in two patients, FMs showed intrafractional shift > 5 mm, probably associated with considerable rectal volume changes. Target coverage was preserved due to a safe CTV-to-PTV margin (10 mm). Conclusions: In our preliminary study, CBCT in combination with the use of fiducial markers to guide the delivery proved to be a feasible method for IGRT both before and during the treatment of post-operative gynecological cancer. In particular, this approach seems to be promising in selected patients to facilitate the use of SBRT instead of BRT (brachytherapy), thanks to margin reduction and adaptive strategies to optimize dose delivery while minimizing toxicity. A larger sample of patients is needed to confirm our results. Full article

Graphene is considered one of the most promising flexible transparent electrode materials as it has high charge carrier mobility, high electrical conductivity, low optical absorption, excellent mechanical strength, and good bendability. However, graphene-based flexible transparent electrodes face a critical challenge in balancing electrical conductivity and optical transmittance. Here, we present a green and scalable direct ink writing (DIW) strategy to fabricate graphene grid patterns by optimizing ink formulation with sodium dodecyl sulfate (SDS) and ethanol. SDS eliminates the coffee ring effect via Marangoni flow, while ethanol enhances graphene flake alignment during hot-pressing, achieving a high conductivity of 5.22 × 10⁵ S m⁻¹. The grid-patterned graphene-based flexible transparent electrodes exhibit a low sheet resistance of 21.3 Ω/sq with 68.5% transmittance as well as a high stability in high-temperature and corrosive environments, surpassing most metal/graphene composites. This method avoids toxic solvents and high-temperature treatments, demonstrating excellent stability in harsh environments. Full article

Volcanic rock is a natural mineral material which has garnered interest for its potential application in water treatment due to its unique physicochemical properties. In this study, we prepared a polysilicate aluminum chloride (PSAC) coagulant using volcanic rock which exhibited good coagulation–flocculation performance. Further investigation into the influence of synthetic parameters, such as calcination temperature, reaction time, and alkali types, on the structure and performance of a volcanic rock-derived coagulant was conducted. Techniques including Scanning Electron Microscopy, Energy-Dispersive Spectroscopy, Fourier-Transform Infrared Spectroscopy, and X-Ray Diffraction were utilized to characterize it. Also, a ferron-complexation timed spectrophotometric method was used to study the distribution of aluminum species in the coagulant. Results indicated that the volcanic rock that was treated with acidic and alkaline solutions had the potential to form PSAC with Al-OH, Al-O-Si, Fe-OH, and Fe-O-Si bonds, which influenced the coagulation–flocculation efficiency. An acid leaching temperature of 90 °C, 8 mL of 2 mol/L NaOH, a reaction time of 0.5 h, and a reaction temperature of 60 °C were conducive to the preparation. A higher temperature could result in a higher proportion of Alb species, and, at 100 °C, the Ala, Alc, and Alb were 29%, 24%, and 47%, respectively, achieving a residual turbidity lower than 1 NTU at an appropriate dosage, as well as a reduction of over 0.1 to 0.018 in the level of UV₂₅₄. The findings of this study provide a feasible method to prepare a flocculant using volcanic rock. Further application is expected to yield good results in wastewater/water treatment. Full article