Search Results (88,041)

Background and Objectives: The sacrum is formed by five fused vertebrae and connects the lumbar spine to the coccyx. It has four pairs of foramina for sacral nerves and shows important anatomical variations. This study aims to analyze the frequency of atypical sacral morphology in the Korean population using 3D reconstruction of postmortem computed tomography (PMCT) images, and to provide a systematic classification and morphological characterization. Materials and Methods: A total of 29 PMCT datasets (10 males, 19 females) from the National Forensic Service were used to generate 3D sacral models with Mimics software for the analysis of atypical sacral morphology. Key morphometric parameters, including sacral width (SW), sacral length (SL), sacral foramina distances (SFD1, SFD2), sacral vertebral heights (SH1, SH2), sacral curvature (SC), and sacral index (SI), were measured. Sacral foramina were categorized into three groups based on completeness, and auricular surfaces were classified into three types according to their vertical position. Results: Median values for sacral dimensions were as follows: SW 95.3 mm, SL 118.6 mm, SFD1 36.1 mm, SFD2 28.8 mm, SH1 28.0 mm, SH2 29.7 mm, SC 0.92, and SI 0.78. Sacral foramina variations were identified in 12 of 29 cases (41.4%) as incomplete, including one case with an incomplete upper opening. No significant sex-based differences were found in foramen or auricular surface types, although females showed higher values for SW and SI (SW: 97.2 mm, SI: 0.86). Correlation analysis revealed positive associations between SL and both stature (r = 0.635) and weight (r = 0.645), and negative correlations between SI and stature (r = −0.663), SL (r = −0.921), and SC (r = −0.845). Two cases (6.8%) exhibited sacralization, while the remaining 25 cases had the configuration of five lumbar vertebrae and six sacral segments. Conclusions: Our findings support the notion that atypical segmentation patterns are more prevalent than sacralization. Atypical sacral morphology was observed in 29 cases (19.8%), most commonly involving a normal lumbar spine with six sacral segments. These findings highlight the relevance of sacral variation in clinical and anatomical contexts. Full article

Objectives: The potential use of electron density (ED) and effective atomic number (Zeff) derived from dual-energy computed tomography (DECT) as novel quantitative imaging biomarkers for differentiating malignant brain tumors was investigated. Methods: Data pertaining to 136 patients with a pathological diagnosis of brain metastasis (BM), glioblastoma, and primary central nervous system lymphoma (PCNSL) were retrospectively reviewed. The 10th percentile, mean and 90th percentile values of conventional 120-kVp CT value (CTconv), ED, Zeff, and relative apparent diffusion coefficient derived from diffusion-weighted magnetic resonance imaging (rADC: ADC of lesion divided by ADC of normal-appearing white matter) within the contrast-enhanced tumor region were compared across the three groups. Furthermore, machine learning (ML)-based diagnostic models were developed to maximize diagnostic performance for each tumor classification using the indices of DECT parameters and rADC. Machine learning models were developed using the AutoGluon-Tabular framework with rigorous patient-level data splitting into training (60%), validation (20%), and independent test sets (20%). Results: The 10th percentile of Zeff was significantly higher in glioblastomas than in BMs (p = 0.02), and it was the only index with a significant difference between BMs and glioblastomas. In the comparisons including PCNSLs, all indices of CTconv, Zeff, and rADC exhibited significant differences (p < 0.001–0.02). DECT-based ML models exhibited high area under the receiver operating characteristic curves (AUC) for all pairwise differentiations (BMs vs. Glioblastomas: AUC = 0.83; BMs vs. PCNSLs: AUC = 0.91; Glioblastomas vs. PCNSLs: AUC = 0.82). Combined models of DECT and rADC demonstrated excellent diagnostic performance between BMs and PCNSLs (AUC = 1) and between Glioblastomas and PCNSLs (AUC = 0.93). Conclusion: This study suggested the potential of DECT-derived ED and Zeff as novel quantitative imaging biomarkers for differentiating malignant brain tumors. Full article

This study evaluated the effect of delay time and storage conditions after airborne-particle abrasion on the shear bond strength between base metal alloys (BMA) and self-adhesive resin cement. It also assessed whether vacuum sealing or re-airborne-particle abrasion could counteract the time-related degradation of bond strength. Sixty BMA specimens were airborne-particle-abraded and divided into six groups (n = 10): immediate bonding; 1-day, 7-day, and 14-day delays; 14-day vacuum-sealed; and 14-day delay with re-airborne-particle abrasion. Resin cement was applied to standardized bond areas, and composite rods were bonded. All specimens were stored in water at 37 °C for 24 h before shear bond strength testing. Failure modes were examined under a stereomicroscope. One-way ANOVA revealed significant differences among groups (p < 0.05). Immediate bonding yielded the highest strength (26.50 ± 2.74 MPa). Bond strength declined with delays, namely, 1-day (21.19 ± 4.94 MPa), 7-day (15.20 ± 4.52 MPa), and 14-day (16.01 ± 4.69 MPa), with no significant difference between the 7- and 14-day groups. Vacuum sealing for 14 days preserved bond strength (25.92 ± 3.94 MPa) comparable to immediate bonding. Re-airborne-particle abrasion restored bond strength (20.66 ± 3.70 MPa). Prolonged delays resulted in 100% adhesive failures, whereas immediate bonding and intervention groups showed 80% adhesive and 20% mixed failures. Delayed bonding after airborne-particle abrasion significantly reduces bond strength due to oxide layer formation on the BMA surface. However, surface sealing might prevent surface oxidation and maintain bonding potential, while re-airborne-particle abrasion can restore bond strength when delays are unavoidable. Clinically, bonding should be performed immediately after airborne-particle abrasion, or appropriate surface management protocols should be implemented to maintain optimal adhesion. Full article

Background: Endometrial cancer is one of the most common female genital cancers and poses a significant clinical problem due to its increasing incidence and variable prognosis depending on the stage of the disease. The development of EC is largely dependent on interactions with the immune system, including immune checkpoints (ICPs) such as PD-1, PD-L1, and PD-L2. The aim of our study was to evaluate the PD-1/PD-L1/PD-L2 pathway in EC and its clinical significance. Methods: The analysis was performed by flow cytometry on myeloid and plasmacytoid dendritic cells and monocytes (MO) in peripheral blood (PB). The concentration of sPD-1, sPD-L1, and sPD-L2 in plasma was determined by ELISA. Additionally, PD-L1 and PD-L2 gene expression levels in tumor tissue (TT) were assessed using real-time polymerase chain reaction (qPCR). The obtained results were correlated with clinical data of EC patients. Results: Patients with EC had lower percentages of PD-L1-positive MO and pDCs, as well as PD-L2-positive MO and mDCs, compared with the control group. We observed accumulation of sPD-1 and lower levels of sPD-L1 and sPD-L2 in EC patients compared to the control group, with sPD-L2 correlating with PD-L2 gene expression level in the TT. Conclusions: The study results indicate a difference in the distribution of mDCs, pDCs, and MO with PD-L1/PD-L2 expression in EC patients. Reduced percentages of MO and DCs expressing PD-L1 and PD-L2, altered concentrations of soluble forms of these IPCs, and correlations with gene expression in TT suggest that dysregulation of this pathway may influence disease progression. Furthermore, the relationships between immunological parameters and clinical features such as BMI and FIGO stages suggest the potential use of these factors as diagnostic and prognostic biomarkers and the possibility of incorporating them into future therapeutic strategies. However, further studies are necessary to validate this hypothesis. Full article

Background/Objectives: Digital health pathways, including prehabilitation programs, may help reduce complications after urologic procedures. This study assesses the impact of a digital health intervention on infectious complications, urinary retention, and unplanned patient contacts after high-intensity focused ultrasound (HIFU) treatment for prostate cancer. Methods: A pre-/post-intervention study design was applied. The intervention consisted of implementing a mobile health pathway via a mobile application integrated into the perioperative management of patients undergoing HIFU treatment for prostate cancer. Urinary complication rates and unplanned patient contacts with the surgical team before and after implementation were compared using the Mann–Whitney U test. Results: 58 patients were included in the analysis. Demographic, tumor, and treatment characteristics were comparable between both groups. The post-intervention group showed a lower incidence of symptomatic urinary infections (3 vs. 10; p = 0.019) and fewer unplanned visits (4 vs. 10; p = 0.047) after the implementation of the mobile application. No significant differences in rates of acute urinary retention and unplanned communication with the surgical team were observed. Conclusions: Integration of a digital health pathway was associated with reduced infectious complications and fewer unplanned visits after HIFU treatment. Incorporating such tools into perioperative management may improve patient outcomes. Full article

Background: We aimed to identify key molecular drivers of gastric cancer progression and poor prognosis by integrating multi-omics analyses with experimental validation. Methods: Single-cell RNA-seq data were clustered to delineate major cell types. InferCNV identified tumor epithelial cells, and reclustering revealed a malignant subset with poor prognosis. The overlap between subset markers and The Cancer Genome Atlas Stomach Adenocarcinoma (TCGA-STAD) upregulated differentially expressed genes (DEGs) was modeled with univariate, LASSO-, and multivariate Cox to derive a prognostic signature. Patients were stratified according to signature scores, and group differences in survival and immunologic features were compared. Spatial transcriptomics defined the localization patterns of key signature genes. In vitro functional assays (CCK-8, colony formation, EdU incorporation, flow cytometry, Transwell migration and invasion, and wound healing) confirmed the pivotal role of SRI. Results: Reclustering of tumor epithelial cells yielded seven subsets (C0–C6), with C5 displaying marked malignant features and correlating with poor prognosis in multiple cohorts. Intersecting 208 genes yielded a five-gene signature (ASCL2, REPIN1, CXCL3, TMEM176A, SRI). The signature stratified patients into high- and low-risk groups. The high-risk cohort exhibited significantly poorer survival, distinct immune-infiltration patterns, elevated immune-evasion scores, and a reduced predicted response to immunotherapy. Single-cell and spatial transcriptomics localized TMEM176A to fibroblasts and SRI to the tumor epithelium. Finally, in vitro knockdown of SRI inhibited tumor cell proliferation, migration and invasion. Conclusions: Our multi-omics approach identified a malignant epithelial subset, C5, and a five-gene signature that stratifies gastric cancer prognosis and immune response. Functional assays showed that SRI knockdown impairs tumor cell growth, migration and invasion. Full article

Gold nanoparticles (AuNPs) are of significant interest due to their unique properties and applications in biomedicine. While hyaluronic acid (HA) has been used to modify pre-formed AuNPs, its thiolated derivative (HA−SH) has been less explored for the direct synthesis and stabilization of AuNPs. This study investigates the use of thiolated hyaluronic acid as a key component in the synthesis of AuNPs. A series of HA-AuNPs (HA-AuNP1-4) were synthesized by reacting HA-SH with HAuCl₄ at different mass ratios. The resulting nanoparticles were characterized using UV-Vis spectroscopy, scanning/transmission electron microscopy (SEM/STEM), X-ray photoelectron spectroscopy (XPS), photon cross-correlation spectroscopy (PCCS), and zeta potential measurements. The chemical transformations of the thiol ligand were studied using NMR spectroscopy. The morphologies and sizes of AuNPs depended on the HA-SH-to-HAuCl₄ ratio, ranging from icosahedral and triangular particles (≥146 nm) to quasi-spherical particles with a bimodal distribution (6–7 nm and 45–60 nm). XPS confirmed the presence of metallic gold (Au⁰) and a Au−S bond, while NMR and XPS revealed the partial oxidation of thiol groups to sulfonic acid. Zeta potential measurements showed that lower HAuCl₄ concentrations resulted in higher negative charge (up to −41.5 mV), enhancing colloidal stability. This work demonstrates a versatile approach to the synthesis of hyaluronic acid-based gold nanomaterials with tunable properties for potential biomedical applications. Full article

Background: Asthenozoospermia is defined as a condition in which the total motility of sperm in a semen sample is less than 40%. Due to impairing sperm motility, asthenozoospermia was linked to different mitochondrial DNA (mtDNA) alterations. The current study aimed to investigate the relationship between MT-CO2 gene variants and the development of asthenozoospermia and male infertility in the Jordanian population. Materials and Methods: Semen samples were collected from 196 men, including 119 asthenozoospermic (infertile) and 77 normozoospermia (control), from the Royal Jordanian Medical Services in vitro fertilization (IVF) unit. The isolated mitochondrial DNA (mtDNA) was subjected to a polymerase chain reaction to amplify the MT-CO2 gene. Genetic variants were screened using direct Sanger sequencing. Genotypes and allele frequencies between the case and control groups were compared by the chi-square test and Fisher’s exact test. Results: Three novel variants in the MT-CO2 gene were identified in nine asthenozoospermic cases, including two missense variants (m.8222T>A and m.7997G>A) and one synonymous variant (m.7846 A>G). In addition, the current study reported twenty-three known substitutions. In particular, the rs1556423316 T>C variant showed a significant association with asthenozoospermic infertile men in the studied population (p < 0.05). Conclusion: The detected missense variants in the MT-CO2 gene in asthenozoospermic infertile men underscore the important role of these variants in the development of asthenozoospermic male infertility. Full article

Although the clinical impact of empirical antibiotic susceptibility on urinary tract infection (UTI) caused by extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PEs) is limited, the role of definitive antibiotics remains unclear. This study evaluated therapeutic outcomes and recurrence in children with febrile UTI caused by ESBL-PE, focusing on pathogen susceptibility to empirical and definitive antibiotics. Medical records of 376 UTI episodes caused by ESBL-PE in children aged <10 years were retrospectively reviewed, and 319 were analyzed. Episodes were classified as empirical-susceptible (n = 144) and empirical-non-susceptible (n = 175) groups, and further categorized into four groups based on definitive antibiotic susceptibility and treatment duration. Clinical outcomes were comparable between empirical-susceptible and empirical-non-susceptible groups. Among the four definitive-therapy groups, early clinical response did not differ significantly; however, UTI recurrence showed an increasing trend from 1.0% in those receiving empirical and definitive antibiotics to which pathogens were susceptible for ≥7 days to 6.3% in those receiving empirical antibiotics to which pathogens were non-susceptible and not receiving antibiotics to which pathogens were susceptible ≥7 days (p = 0.045). Despite favorable early response to empirical non-susceptible antibiotics, switching to susceptible antibiotics and maintaining therapy for ≥7 days is recommended for children with ESBL-PE UTIs. Full article

The development of sensitive and specific diagnostic methods for secondary bacterial meningitis remains an urgent challenge in neurosurgical and intensive care units. A combination of various clinical and biochemical parameters, as well as biomarkers and metabolites in cerebrospinal fluid (CSF), can be considered for constructing multivariate diagnostic models. In this study, 96 CSF samples from 53 patients with suspected secondary meningitis were analyzed. The first cohort, consisting of patients with sequelae of severe brain damage, included 7 patients (21 CSF samples) with and 29 patients (56 CSF samples) without secondary bacterial meningitis. The second cohort comprised patients after neurosurgical interventions, including 10 patients (12 CSF samples) with and 7 patients (7 CSF samples) without secondary bacterial meningitis. Combined group 1 with 33 CSF samples from patients with secondary bacterial meningitis and combined group 2 with 63 CSF samples from patients without secondary bacterial meningitis had statistically different cell and biochemical compositions and higher CSF concentrations of biomarkers (interleukin-6 and S100 protein) and lactate-containing aromatic metabolites in group 1. Univariate prognostic models constructed on 4-hydroxyphenyllactic, phenyllactic, and indole-3-lactic acids demonstrated outstanding AUC-ROC of more than 0.91. A multivariate model built on all biomarkers and metabolites resulted in AUC-ROC = 0.94 with a sensitivity of 0.94 and specificity of 0.86, and was found to be the most accurate method for the diagnosis of secondary bacterial meningitis. Full article

Currently, few studies have revealed the comprehensive effects of environmental organic matter, freeze–thaw and oxidative aging on the adsorption performance of cadmium (Cd(II)), which is essential for the sustainable stability evaluation of the adsorbent. Herein, we observed that humic acids (HAs) extracted from different soils inhibited the adsorption performance of Cd(II) onto the cuttlebone-derived samples by occupying the different major adsorption active sites of the adsorbent, and the lower cadmium-complexation ability of HAs would increase the occupation of adsorption sites. The freeze–thaw process increased the pore size and volume of the cuttlebone-derived samples, while oxidative aging enhanced the specific surface area and introduced additional C–O/C=O groups. These changes promoted the adsorption performance of Cd(II) in the cuttlebone-derived samples after freeze–thaw or oxidative aging. Additionally, the resistances of cuttlebone-based adsorbents to HAs, freeze–thaw, and oxidative aging were elucidated and optimized by simple alkali boiling or carbonization treatment. Furthermore, the adsorption capacities of Cd(II) by samples in the natural cadmium-contaminated river ranged from 548.99 mg g⁻¹ to 571.55 mg g⁻¹, which are higher values than those of most reported adsorbents. Therefore, this work provides an important experimental basis for the practical application and sustainable design of adsorbents under real environmental conditions. Full article

Background: Instrument-assisted soft-tissue mobilization (IASTM) is a popular intervention used for myofascial treatment. Healthcare professionals using IASTM must consider precautions and contraindications prior to administering the intervention. A recent international Delphi survey of IASTM experts recommended a list of 39 conditions to be considered as precautions and contraindications. The clinical relevance of these recommendations among healthcare professionals is of interest. The purpose of the survey was to explore healthcare professionals’ agreement regarding the IASTM Delphi recommendations for precautions and contraindications. Methods: A 16-question electronic survey was emailed to members of the Academy of Orthopedic Physical Therapy, American Academy of Sports Physical Therapy, National Athletic Trainers Association, and members of private physical therapy and athletic training Facebook^® and LinkedIn™ groups. Survey inclusion criteria included being a healthcare professional who has clinical experience using IASTM with patients. The strength of agreement grade scale was used to explore professionals’ opinions and agreement with the expert recommendations. Results: Four hundred and forty-five professionals (men = 52%; women = 46%; other = 2%) (mean age = 49 ± 12.33 years old) completed the survey. Most respondents (mean = 62%) agreed with 11 of 39 recommended conditions across the strength of agreement grade categories. The conditions included five precautions, three contraindications, and three conditions that could be both. Respondents also listed 32 other conditions they felt were relevant. Discussion: These survey results illustrate diversity among professionals’ agreement with expert recommendations. This may be explained by variations in clinical practice patterns and gaps in the research on this topic. The IASTM Delphi study’s recommended list of precautions and contraindications provides valuable information but is not all-inclusive, as other conditions may exist for different patients. When exploring understudied topics, researchers may want to begin with a Delphi study to establish expert recommendations, followed by an assessment of their clinical relevance through related survey studies of healthcare professionals’ agreement on the topic. Conclusion: This exploratory survey introduced a novel method of assessing the clinical relevance of a Delphi study on IASTM precautions and contraindications among healthcare professionals. Full article

Background/Objectives: Persons identifying as lesbian, gay, bisexual, pansexual, omnisexual, queer, questioning, fluid, asexual, or other non-heterosexual orientations (LGB+ persons) have been identified as a risk group for sexual victimization (SV), which can have long-lasting negative effects on well-being and physical, mental, sexual, and reproductive health. Othering-Based Stress (OBS)—reflecting societal processes of othering and resulting from stigma, prejudice, and discrimination—may contribute to increased vulnerability to SV and its consequences in LGB+ persons and affect help-seeking behavior following victimization. This study examines the impact of SV on LGB+ persons and their help-seeking behavior after victimization. Methods: Using a mixed-methods explanatory sequential design, first survey data from a nationally representative sample of the Belgian population on SV, its consequences, and subsequent help-seeking behavior were collected from 4632 individuals. Of these, 2965 participants (2601 heterosexual and 364 LGB+ individuals) experienced SV and represented the final sample for the quantitative analyses. In a second phase, in-depth interviews were conducted with 40 LGB+ victims to explore their experiences more thoroughly. Results: LGB+ individuals reported more negative consequences following SV than heterosexual persons, particularly regarding identity-related processes such as questioning gender expression and decreases in self-esteem. They also reported additional barriers to disclosing SV and seeking help from professional services or the police, including fears of stigma, invalidation, and concerns about professionals’ LGB+ competence. No significant differences were found between LGB+ persons who explicitly identified as belonging to a sexual minority group and those who did not, neither in the perceived consequences of SV nor in help-seeking barriers. Conclusions: LGB+ victims of sexual violence experienced more severe identity-related consequences and faced greater barriers to professional support than heterosexual victims. These results highlight the urgent need for trauma-informed, LGB+-inclusive services and structural policy measures to improve access to appropriate care. Full article

Introduction: Pelvic exenteration is a radical operation for advanced or recurrent pelvic malignancies, requiring urinary and faecal diversion. The ileal conduit (IC) remains the standard urinary diversion, while the double-barrel uro-colostomy (DBUC) has re-emerged as an alternative that avoids small bowel anastomosis and consolidates diversion into a single stoma. Aims: To evaluate comparative outcomes of DBUC versus IC to clarify relative risks and potential benefits. Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines and registered on PROSPERO (CRD420251090885). PubMed, Scopus, EMBASE, and Medline were searched to March 2025 for studies directly comparing DBUC and IC following pelvic exenteration. Eligible studies reported perioperative or urological outcomes. Results: Four retrospective studies (164 patients; DBUC 88, IC 73) were included. Urinary leak was lower with DBUC (10.2% vs. 15.1%), with pooled analysis showing a higher risk in IC (RR 2.52, 95% CI 1.02–6.20, p = 0.04). Pyelonephritis (42.0% vs. 15.3%; RR 1.37, p = 0.24) and electrolyte derangements (20.6% vs. 15.6%; RR 1.21, p = 0.64) did not differ significantly. Rates of urinary and enteric fistulas were similar. Clavien–Dindo grade III (42.1% vs. 37.1%) and grade IV complications (17.1% vs. 24.2%) were also comparable between groups. Conclusion: DBUC is a feasible alternative to IC after pelvic exenteration, with reduced urinary leak rates and comparable morbidity. Its single-stoma approach may offer patient-centred advantages. Larger prospective studies incorporating long-term and quality-of-life outcomes are needed. Full article

In this study, we investigated the effects of different microwave times (0–120 s) at 900 W power on the nutritional properties of glycosylated soybean 7S protein. The in vitro simulated gastrointestinal digestion revealed that digestibility peaked at 60 s (40.83% gastric, 84.29% intestinal) and was accompanied by a significant increase in hydrolysis. Automatic amino acid analysis indicated superior nutritional quality after 60 s of treatment, as evidenced by optimal amino acid scores (AAS, CS) and the essential amino acid index (EAAI), and by a more favorable amino acid profile for human requirements. However, the proportion of flavor-active amino acids decreased from 83.05% at the initial stage to 53.77%, and the taste activity value (TAV) of fresh amino acids was lower than that of the untreated group, with limited flavor improvement. In conclusion, 60 s is the optimal time for nutritional optimization, which can improve protein digestibility and nutritional value, and the risk of flavor degradation should be considered. Full article