Search Results (5,936)

This study evaluates the seismic performance and life-cycle economic implications of designing essential urban mid-rise reinforced concrete moment-resistant frame (MRF) buildings to maintain linear elastic behavior up to the Immediate Occupancy (IO) performance level. While most urban buildings are commonly designed to respond non-linearly in order to reduce initial construction costs, the current Mexico City Building Code (MCBC) permits that essential facilities, such as hospitals and schools, maintain linear behavior during moderate-to-strong earthquakes. This code establishes a maximum story drift ratio equal to 0.0075 for essential buildings constituted by MRF subjected to seismic events with a 250-year recurrence interval; in addition, it recommends ductile structural behavior to achieve Life Safety performance at a 450-year recurrence interval. Given the significant differences in occupancy, functionality, and contents of critical facilities, here it is analyzed whether the linear elastic design criterion is efficient for both secondary care hospitals and public schools. Two three-story and five-story MRF buildings, located on firm and transition soil, respectively, are analyzed. This study addresses the probability of brittle-type failure risk, the optimal allowable story drift at the IO performance level, the potential need for use-dependent drift limits, and the contribution of contents and nonstructural components to the total expected seismic losses. The seismic risk and economic performance are quantified through seismic hazard analysis, incremental dynamic analysis, fragility modeling, Monte Carlo simulation, and life-cycle cost evaluation. Full article

This study aimed to estimate life expectancy at birth and survival patterns within a multigenerational family from Romania (102 individuals), whose members lived across the period 1900–2024. Life expectancy was estimated using abridged synthetic cohort life tables, and the results were interpreted through survival curve analysis. Life expectancy at birth was estimated at approximately 84 years for females and 80 years for males, while the overall life expectancy for the total family population was 81 years, representing a weighted estimate derived from sex-specific life tables, with weights corresponding to the proportion of females and males in the studied population, rather than a simple arithmetic mean, following standard demographic practice. The resulting survival curves exhibited a clear Type I survival pattern, characterized by low mortality at younger ages and an increasing concentration of deaths at older ages. When contextualized using recent Eurostat data, the life expectancy estimated for the analyzed family exceeds current national-level values reported for Romania and is close to the European Union average, particularly for females. These findings indicate a favorable survival profile at the familial level and illustrate the usefulness of life tables for investigating longevity patterns in small populations. Full article

As demand for energy-efficient buildings grows, the use of expanded polystyrene (EPS) insulation is expected to increase, intensifying the need for material-efficient strategies such as recycling and reuse. This study investigates the technical feasibility, chemical safety, and climate implications of reusing EPS insulation recovered from building and infrastructure applications. EPS boards with service lives exceeding 20 years were collected from demolition sites and characterised for density, compressive strength, thermal conductivity, and hazardous substance content. Measured material properties were compared with historical test reports from 1976 to 2009 to assess long-term performance. The thermal conductivity and compressive strength of the used EPS samples fell within or close to the 95% prediction intervals for the corresponding products at the time of production, indicating limited long-term degradation. No brominated flame retardants or other substances of concern were detected above the detection limits. Life cycle assessment (LCA) results showed that reuse provides greater greenhouse gas (GHG) emission reduction potential than improved recycling alone, primarily through avoided virgin EPS production and reduced processing needs. An important insight from this study is that key material properties of used EPS can be reliably estimated from simple measurements of density, dimensions, and weight, and that direct reuse is feasible for less demanding applications. Additionally, further work is needed to test additional samples from diverse demolition sites across various applications and climates to establish a consistent basis for reuse. Full article

Background: Ulcerative Colitis and Crohn’s Disease are the most common forms of inflammatory bowel disease (IBD), with increasing prevalence both globally and in Poland. Many aspects of how a patient’s everyday function and treatment remain underexplored. Methods: This study recruited adult patients with IBD hospitalized in the Department of Digestive Tract Diseases of the Medical University of Lodz, Poland. The data were collected between June and July 2025 using an author-developed questionnaire assessing patients’ opinions on therapy, their expectations, and overall life satisfaction. Results: A total of 87 patients with IBD were included in the analysis. Overall, 59 patients (67.82%) reported strong satisfaction with their current treatment, indicating a generally positive perception of disease management. Higher treatment satisfaction was associated with patients’ perception that their preferences were respected by the gastroenterologist. Further analysis revealed significant associations between different types of treatment, disease activity, and patient-reported outcomes. Those patients who were treated with biological agents more frequently reported complete satisfaction with the treatment (41/52 vs. 18/35; p = 0.014), low-to-moderate disease activity (42/52 vs. 19/35; p = 0.016), and fewer limitations in their social lives (16/52 vs. 20/35; p = 0.026) compared to the remaining group. Furthermore, the study demonstrated that those patients who reported remission were less likely to have their physical activity limited (27/55 vs. 27/32; p = 0.002). There were significantly more patients under 50 years of age than older patients getting biological therapy (48/74 vs. 4/13; p = 0.045). Additionally, women in the studied group had a higher rate of IBD-related surgical interventions compared to men (15/36 vs. 9/51; p = 0.026). Despite the high overall satisfaction with treatment and physician communication, 20 patients (22.99%) admitted to taking additional, non-prescribed medication or dietary supplements. Similarly, 21 (24.14%) patients modified treatment regimens by discontinuing the medication intake or changing the prescribed dose. Furthermore, 57 patients (65.52%) reported that they feared the possibility of surgical intervention. Nonetheless, the majority of patients who underwent surgical treatment (22/24; 91.67%) were satisfied with the results. Reported rates of undergoing regular colorectal cancer screening were also unsatisfactory—4/37 (10.81%) patients with disease duration >8 years, suggesting inadequate awareness. Conclusions: Biological treatment can positively impact multiple aspects of patients’ lives by lowering the disease’s activity. Gastroenterologists should spend more time discussing patients’ preferences and concerns, as well as explaining the colorectal cancer screening rules. Full article

Background/Objectives: Children with congenital heart disease are exposed to ionizing radiation, which may induce cancer. This study aimed to reassess cancer risk after cardiac catheterization (CC) between 1999 and 2013, with follow-up until 15 years of age, cancer diagnosis, or death. Methods: We studied 2762 children who underwent at least one CC before eight years of age between 1999 and 2013. Cancer diagnoses were obtained from the German Childhood Cancer Registry. For patients with tumors and 60 randomly selected control patients, cumulative effective radiation doses (Deff) were calculated. Results: During 344,80 person-years of follow-up, ten patients developed cancer, whereas 5.3 cases were expected (standardized incidence ratio [SIR] 1.88; 95% CI 0.90–3.46; p = 0.0449). Eight tumors occurred in patients who underwent CC during the first year of life, compared with 3.5 expected (SIR 2.26; 95% CI 0.98–4.46; p = 0.0282). Patients with cancer had a median of 2.0 (1–11) CCs and a median D_eff of 14.6 mSv (2.4–94.3) compared with 1.0 (1–10) CCs and 9.7 mSv (0.7–171.5) in controls. Neither parameter differed significantly. No specific malignancy was predominant. Conclusion: Cardiac catheterization early in life remains associated with an increased cancer risk; however, compared with our previously published 1980–1998 cohort, a reduction in risk was observed. Full article

Breast reconstruction represents an integral component of contemporary breast cancer management, with substantial impact on patients’ psychological well-being, body image, and overall quality of life. Given the profound symbolic and personal significance of the breast, mastectomy—whether total or partial—extends beyond oncologic resection and may result in considerable aesthetic, functional, and psychosocial consequences. For this reason, reconstructive planning should be incorporated into the initial multidisciplinary treatment strategy while ensuring that oncologic safety and adjuvant therapies are never compromised. Breast reconstruction may be achieved using autologous tissue, implant-based techniques, or a combination of both approaches. Each method carries specific advantages, limitations, and potential complications and must be tailored to the individual patient’s oncologic status, anatomy, and expectations. This article provides a historical overview of the evolution of breast cancer treatment and reconstructive techniques. It further examines the principles, benefits, and challenges associated with different reconstructive modalities, highlighting key considerations in clinical decision-making and long-term outcomes. Full article

Background: Although menstrual cycle-based training has attracted increasing attention in endurance sports, research has predominantly focused on ergometric parameters. However, the subjective perspectives and lived realities of athletes remain relatively underexamined. Accordingly, this study aimed to explore performance perceptions and self-regulatory experiences of female endurance athletes within real-life training and competitive contexts. Methods: Qualitative semi-structured interviews were conducted with twelve female endurance athletes (ages 18–42) across triathlon, running, swimming, cycling, and skiing. Data were analysed inductively using descriptive thematic analysis in MaxQDA. Results: Six themes emerged related to menstrual cycle experiences: body awareness and cycle-related perceptions; the influence of expectations and self-efficacy on perceived performance; heterogeneous approaches to cycle-based training; training and recovery adjustments; the ambivalent role of digital tracking tools; and communication openness and barriers. Overall, cycle-based training was applied inconsistently and served more as a framework for interpreting physical symptoms than as a means of optimising performance. Conclusions: In this sample of endurance athletes, cycle-related effects on performance and symptom perceptions were primarily shaped by biopsychosocial factors rather than physiological considerations alone. The menstrual cycle supported self-regulation, but rigid interpretations may risk reinforcing negative expectancies. These insights extend existing work by foregrounding athlete-centred, flexible approaches over deterministic training models. Full article

Introduction: Placental malaria increases the risk of adverse birth outcomes. Current preventive measures are undermined by poor coverage, growing resistance to chemo-preventive and therapeutic drugs, and vector eliminating insecticides. Candidate placental malaria (PM) vaccines (PAMVAC and PRIMVAC) have shown safety and immunogenicity in Phase I trials, but empirical evidence on their potential population-level value is lacking. This study modelled the expected cost-effectiveness of a PM vaccine administered before pregnancy. Methods: A decision-analytic model compared two strategies from the provider’s perspective: vaccinating women of childbearing age versus no vaccination. The model incorporated gravidity-specific risks of PM, neonatal mortality and the malaria attributable fractions from the literature. Since the efficacy of a PM vaccine for malaria prevention is unknown, we assumed a 40% efficacy and varied this estimate widely in sensitivity analyses. Primary outcomes were incremental cost-effectiveness ratios (ICERs) per perinatal disability adjusted life years (DALYs) averted. Baseline, best-case, and worst-case scenarios were analysed. One-way and probabilistic sensitivity analyses were used to assess parameter uncertainty. Cost-effectiveness was defined as an ICER below half of sub- Saharan Africa’s 2025 GDP per capita ($1556). Results: The vaccine was most cost-effective among primigravidae. Under baseline assumptions (40% efficacy; 30% uptake; $5 dose price), the ICER was $321 per perinatal DALY averted for primigravidae versus $4444 for multigravidae. Best-case assumptions further improved cost-effectiveness ($225 vs. $3148). Sensitivity analyses showed robust cost-effectiveness for primigravidae across all plausible parameter ranges, while ICERs in multigravidae were highly sensitive to programme costs and vaccine efficacy. Cost-effectiveness acceptability curves demonstrated that vaccination becomes favourable for primigravidae at relatively low willingness-to-pay thresholds. Conclusions: A placental malaria vaccine delivered before pregnancy has high potential to be cost-effective in endemic areas when targeted to protect primigravidae. These findings support prioritised deployment strategies and highlight the value of early economic modelling to inform vaccine development and policy planning. Full article

Psychrophilic organisms are able to grow at temperatures down to −15 °C, while hyperthermophiles can multiply at temperatures up to 122 °C. What structural changes in extremophile proteins are needed to maintain stable and biochemically active structures under such conditions? Understanding how such extremophiles accomplish this is relevant for human health, biotechnology, and our search for life elsewhere in the universe. The purpose of the current study is to report and compare the structures of four rubredoxins (Rds), the first ever two experimental psychrophile bacteria structures (from Gram-positive Clostridium psychrophilum and Gram-negative Polaromonas glacialis) and two hyperthermophiles from the Gram-negative Thermotoga maritima bacterium and the archaeon Pyrococcus yayanosii, also a piezophile, as part of a program to understand structural variations that support both stability and function under extreme conditions. These structures were obtained using synchrotron radiation X-ray diffraction at 100 K. All four structures had the expected overall rubredoxin fold. Rubredoxin from the only aerobic psychrophilic bacterium Polaromonas glacialis had larger variations in sequence and structure, whereas the other psychrophilic bacterium showed properties closely related to hyperthermophile rubredoxins. Multi-subunit structures showed similar RMSD variability independent from their thermal adaptation status. We propose including functional information in the analysis since temperature optimization may not be the only determinant for a specific protein adaptation. Full article

Breast-conserving therapy, consisting of lumpectomy followed by adjuvant radiotherapy, is the standard of care for early-stage breast cancer, providing oncologic outcomes equivalent to mastectomy while preserving breast anatomy and quality of life. Radiotherapy remains a cornerstone of treatment across disease stages, significantly reducing local recurrence rates and improving long-term survival. Advances in radiotherapy techniques—including conventional fractionation, hypofractionation, tumor-bed boost delivery, and regional nodal irradiation—have optimized oncologic efficacy while inducing a broad spectrum of time-dependent morphological changes in breast tissue. Accurate imaging surveillance is therefore essential to distinguish expected post-radiotherapy changes from tumor recurrence and to avoid unnecessary diagnostic or therapeutic interventions. This review provides a comprehensive overview of contemporary breast radiotherapy protocols, their impact on post-treatment imaging appearances, and current recommendations for imaging surveillance. Characteristic findings across mammography, ultrasound, magnetic resonance imaging, and nuclear medicine modalities are discussed, with emphasis on their temporal evolution from acute inflammatory changes to chronic fibrosis, fat necrosis, and architectural distortion. Recognition of these imaging patterns, together with integration of radiotherapy-related parameters into image interpretation, is crucial for accurate diagnosis, early detection of recurrence, and informed clinical management of breast cancer survivors. Full article

Transcatheter structural heart interventions, including aortic, mitral and tricuspid valve replacement or repair, and patent foramen ovale, atrial septal defect, and left atrial appendage closure, have dramatically expanded over the past two decades, providing substantial improvements in both clinical outcomes and quality of life. These interventions are performed in a high-risk patient population, which is at risk for both thrombotic and bleeding complications. The introduction of prosthetic devices into the arterial or venous circulation under heterogeneous hemodynamic conditions inevitably increases the risk for thrombotic events and thromboembolic complications. Consequently, the selection of antithrombotic therapy (AT) regimen and its duration is complex and should be tailored to each patient’s risk profile, balancing the expected risk and benefits. This state-of-the-art review critically examines the thrombotic risks inherent to transcatheter structural heart interventions, synthesizes available evidence and current guidelines recommendations on antithrombotic management, and defines persisting gaps in knowledge while discussing the most relevant ongoing clinical trials. Full article

With growing global life expectancy, age-related physical problems, including balance impairments, are becoming more prevalent, increasing the risk of falls, mobility limitations, and loss of independence. This review summarizes current evidence on how balance may be influenced and improved by training modalities including reactive, strength-based, and functional exercises, through neuromuscular adaptations relevant to postural control and functional stability in older adults. Emerging evidence suggests that gut microbiota may influence neuromuscular health via neuroimmune, metabolic, and mitochondrial pathways across the gut–muscle–brain axis. However, most studies focus on muscle metabolism, inflammation, and systemic physiological processes rather than direct assessments of balance or postural control. Gut dysbiosis has been associated with sarcopenia and impaired physical function, although evidence linking microbiota alterations to balance outcomes remains limited and mainly observational. Exercise has beneficial effects on neuromuscular function and gut microbial composition, including increased diversity and metabolite production. While exercise-induced neuromuscular adaptations are well supported experimentally, little direct evidence shows the contribution of gut-related mechanisms to balance regulation. Overall, neuromuscular and gut-related processes seem to be associated with balance capacity in older adults; however, further mechanistic and interventional studies are required to clarify the role of the gut–muscle–brain axis for balance. Full article

This paper presents a scenario-based optimization framework for evaluating the life-cycle cost of right-sizing and replacement timing for distribution transformers under demand–growth uncertainty. The proposed formulation jointly considers the discrete commercial transformer ratings, the discounted investment cost, and the monetized iron and copper losses over a 15-year planning horizon. Demand uncertainty is represented by nine scenarios defined by combinations of initial apparent power demand and annual growth rate, with $D_1\in \{45,50,55\}$ kVA and $g\in \{3\%,4\%,5\%\}$. Under these assumptions, the demand envelope evolves from an initial range of 45–55 kVA to approximately 68.1–108.9 kVA in Year 15, while expected demand increases from 50 kVA to about 87 kVA. The optimization results show that the economically optimal policy is to install a 112.5 kVA transformer in Year 1 and maintain that rating throughout the horizon, without triggering any replacement events. The selected transformer maintains expected loading between approximately 0.44 p.u. and 0.77 p.u., while the upper-demand scenario remains below 1.0 p.u. over the entire horizon. These results indicate that, for the demand–growth conditions analyzed, the preferred outcome is a single initial sizing decision rather than a phased replacement strategy. Therefore, the proposed framework provides a consistent scenario-based alternative to deterministic margin-based planning for distribution transformer asset management. Full article

Background: Earlier studies in patients with end-stage renal dysfunction (ESRD) reported no significant difference in long-term outcomes between mechanical and tissue valves after valve surgery, largely due to the limited life expectancy of this population. As survival in patients with ESRD has improved in recent years, this study evaluated whether increased life expectancy affects long-term outcomes according to valve type in patients with ESRD undergoing aortic valve replacement (AVR) using a nationwide cohort. Methods: We analyzed data from the Korean National Health Insurance Service database from January 2005 to December 2021. Among 474 patients with ESRD who underwent AVR, 279 received tissue valves and 195 received mechanical valves. Propensity score matching was performed to balance baseline characteristics, yielding 99 matched patient pairs. Results: In the matched cohort, early mortality (within 30 days) was significantly higher in the tissue valve group (16.2% vs. 4.0%; p = 0.008). However, long-term survival rates at 1, 5, and 10 years did not differ significantly between the groups (all p > 0.05). Stratification by operative era (2005–2013 vs. 2014–2021) similarly showed no significant impact of valve type on survival despite temporal advances in care. Conclusions: Long-term survival and complication rates after AVR in patients with ESRD were comparable between mechanical and tissue valves across operative eras. Valve selection should be guided by shared decision-making, incorporating individual life expectancy and comorbidity profiles rather than assuming mechanical valves as the default option. Full article

Medication-related osteonecrosis of the jaw (MRONJ) represents a major clinical challenge for oral and maxillofacial surgery departments as well as dental practices. With increasing life expectancy and the more frequent use of medications associated with osteonecrosis, the incidence of MRONJ continues to rise. To date, there are no uniform treatment standards with scientifically proven effectiveness for this condition. To evaluate the impact of platelet-rich fibrin (PRF) on the outcomes of MRONJ treatment and to identify factors that may influence the effectiveness of PRF therapy, we conducted a comparative prospective study including 22 patients divided into two groups: patients treated with PRF and patients treated without PRF. PRF was prepared according to the PRF Duo Quattro Process protocol for PRF (Nice, France). The study was registered at ClinicalTrials.gov (NCT07464678). The following parameters were assessed: age, smoking status, gender, lesion location, body mass index (BMI), C-reactive protein (CRP) concentration, pain intensity, presence or absence of fistulas, soft tissue healing and radiological findings. Patients were evaluated preoperatively and postoperatively at 14 days, 6 weeks, and 6 months. The study demonstrated a reduction in pain after surgery among patients treated with PRF. In addition, the use of PRF resulted in improved healing outcomes in patients with elevated CRP. Higher BMI was associated with poorer therapeutic response to PRF. Improvements in soft tissue healing and disease stage were observed in the PRF group; however, these differences did not reach statistical significance. All findings should be interpreted with caution due to the limited sample size. There is still no standardized treatment for MRONJ. The use of platelet-rich fibrin as an inexpensive and safe adjunctive therapy may provide clinical benefits for patients, particularly through a significant reduction in pain. Further large-scale, multicenter studies are required to confirm these findings. Full article