Search Results (197)

Background/Objectives: Despite the long-standing history of liver transplantation (LT) in Spain, no multicenter study has reviewed national outcomes for LT in metastatic neuroendocrine tumors (NETs). In the current era of transplant oncology, auditing these results is essential to refine patient selection and improve long-term outcomes. Methods: This retrospective observational study analyzed data from 13 centers, including 91 patients who underwent LT for NET between 1995 and 2024. Patients were stratified into two groups: Milan IN (those meeting the Milan criteria) and Milan OUT (the remainder). Results: Recurrence occurred in 57.1% of cases, and overall mortality was 51.6%. Of the 91 patients, 71 (78.0%) were Milan IN and 20 (22.0%) were Milan OUT. Five-year overall survival was 71.0% in Milan IN and 58.0% in Milan OUT, with a statistically significant difference. The 5-year disease-free survival (DFS) rate was 58.8% in Milan IN and 36.3% in Milan OUT; this difference was not statistically significant. Conclusions: In conclusion, strict adherence to Milan criteria and incorporation of modern prognostic factors are critical to optimize long-term survival in LT for NET. While the overall outcomes in this historical cohort are modest, future improvements are expected through more rigorous selection and the potential use of bridging or downstaging therapies. Full article

This paper presents the design and implementation of the Power Stage GAIA (PSG), a high-current digital bias board developed by the Italian National Institute for Astrophysics (INAF) to extend the capabilities of the GAIA bias system. The PSG was developed within the Advanced European THz Receiver Array (AETHRA) project to support next-generation cryogenic receivers for millimeter-wave astronomy. Specifically, the AETHRA Work Package 1 (WP1) W-band downconverter integrates Monolithic Microwave Integrated Circuits (MMICs) requiring currents significantly exceeding the 50 mA limit of standard bias boards. To address these requirements, the PSG introduces a modular extension providing ten independent channels, each capable of delivering up to 500 mA with a programmable output range of 0–5 V. A key feature of the design is the adoption of a fully linear architecture based on LT1970 power amplifiers and INA225 precision sensors managed via an I²C digital interface. This approach ensures the high current capability required by modern power amplifiers while strictly avoiding the spectral noise and Radio Frequency Interference (RFI) typical of switching power supplies. Experimental validation confirms the system’s robustness and precision: the board demonstrated linear operation up to 460 mA and exceptional long-term stability, with a measured RMS voltage deviation below 50 µV. These results establish the PSG as a scalable, low-noise solution suitable for biasing high-power MMICs in future cryogenic receiver arrays. Full article

This study aims to (1) examine the impact of AI-driven learning tools (AI-LTs) on educational sustainability (EDS) and (2) investigate the mediating role of students’ engagement (SE) and the moderating effect of digital resilience (DR) in this relationship. Based on sociotechnical systems theory (STS), self-determination theory (SDT), and resilience theory, and (3) developing a multidimensional framework to explore how technological, psychological, and contextual factors interact to shape sustainable learning outcomes. Data were gathered from 387 university students in Saudi universities using a standardized questionnaire and subsequently analyzed utilizing SPSS version 28 and PROCESS Macro Version 4.0. The study performed multiple regression and moderated mediation to evaluate the proposed relationships. The results confirmed that AI-LTs significantly enhance educational sustainability. Based on the findings, AI-LTs significantly improve the long-term viability of education, particularly when it is tailored to individual students, encourages active participation, and is logical from a pedagogical perspective. Student engagement was found to influence the relationship, suggesting that when AI tools are utilized effectively, they foster a sustained commitment to education and improved learning outcomes. Furthermore, digital resilience has a significant influence on the connection between AI-LT–EDS, indicating that students who exhibited improved adaptability to digital challenges reaped considerable benefits. The research enhances the existing literature by integrating three complementary frameworks—STS, SDT, and resilience theory—to provide a comprehensive understanding of AI’s role in sustainable education. Practically, the study underscored the importance of AI integration strategies that improve digital resilience, student engagement, and structural imbalance. The results demonstrated that AI usage necessitates significant institutional support and improved technology to establish educational environments that are adaptable, resilient, and easily accessible to students. Full article

Aircraft pod Low-Voltage Differential Signalling (LVDS) links frequently suffer from transmission errors in adverse environments, compromising reliability. We propose a comprehensive ‘real-time detection—precise prediction—dynamic adaptation’ solution. Firstly, a testing system based on the Xilinx Artix-7 Field Programmable Gate Array (FPGA) was developed using incremental coding, verified across diverse hardware with quantitative physical parameters. Secondly, a Long Short-Term Memory (LSTM)-Transformer fusion network (LT-Net) with weighted loss and dynamic regularization was designed to optimize prediction in critical high Bit Error Rate (BER) regimes. To address distribution drift, an online adaptive mechanism utilizing Elastic Weight Consolidation (EWC) was integrated. Results show LT-Net reduces Mean Squared Error (MSE) by 41.7% and maintains superior Mean Absolute Error (MAE) compared to baseline Transformers, with drift-induced degradation kept within 8%. With an inference latency under 0.28 s, the system meets hard real-time requirements for aircraft pod reliability in complex scenarios. Full article

With global energy systems shifting toward sustainable solutions, Dubai faces the challenge of meeting rising energy needs while minimizing environmental impacts. This study explores long-term (LT) strategic planning for Dubai’s power sector through a techno-environmental–economic lens. Using PLEXOS^® modelling software (Version 9.20.0001) and official data from Dubai’s main utility provider, a comprehensive model examines medium- and LT energy pathways. The analysis identifies solar photovoltaic (PV) technology as central to achieving Dubai’s goal of 100% clean energy by 2050. It also highlights the need to cut emissions from natural gas (NG) infrastructure, targeting a goal of 14.5% retirement of NG energy generation capacities by the mid-century. Achieving zero-emission goals will require complementary technologies such as carbon capture (CC), nuclear energy, and energy storage as part of a broader decarbonization strategy. This study further assesses the economic effects of climate policy, showing that moderate carbon pricing could increase the Levelized Cost of Energy (LCOE) by an average of 6% across the forecast horizon. These findings offer valuable guidance for decision-makers and stakeholders, particularly the Dubai Electricity and Water Authority (DEWA), in advancing a carbon-neutral energy system. By 2050, Dubai’s total installed generation capacity is projected to reach 53.3 GW, reflecting the scale of transformation needed to meet its clean energy ambitions. Full article

Background: Multiple meta-analyses have compared liver resection (LR) with liver transplantation (LT) for hepatocellular carcinoma (HCC), but overlapping primary studies and heterogeneous outcome definitions have complicated interpretation. Methods: A PRISMA/PRIOR-compliant umbrella review (PROSPERO CRD420251069248) was conducted. PubMed, Embase, and CENTRAL were searched for meta-analyses published between 1 January 2000 and 30 September 2025. Quantitative meta-analyses comparing LT and LR were included, while one systematic review of meta-analyses was synthesised narratively. Effect directions were standardised; hazard ratio (HR)-based summaries (LR:LT; values > 1 favour LT) were pooled using random-effects models, whereas odds ratio (OR)-based summaries were described qualitatively because of heterogeneity in endpoint definitions. Results: Four quantitative meta-analyses and one systematic review of meta-analyses met the inclusion criteria. Pooled HRs confirmed LT superiority: overall survival (OS) HR 1.35 (95% CI 1.17–1.55) and disease-free survival (DFS) HR 2.58 (95% CI 2.25–2.96). OR-based summaries from recent meta-analyses were directionally consistent but were not pooled. Conclusions: This umbrella synthesis demonstrates that LT provides superior long-term OS and DFS compared with LR for HCC, with consistent robustness across both Milan and extended selection criteria. Methodological safeguards against study overlap and subgroup insights—including intention-to-treat analyses, viral etiology (hepatitis B virus/hepatitis C virus), era, and geographic region—reinforce LT as the preferred strategy for eligible patients, while LR remains a critical option where graft availability is limited. Full article

Background: Long-term non-invasive ventilation (LT-NIV) can prolong life expectancy and may reduce the number of exacerbations in patients with COPD. The eosinophilic phenotype has recently gained significant attention as a treatable trait in COPD. However, it is less known how this phenotype relates to exacerbations and mortality in patients who are set up on LT-NIV. Methods: A total of 191 patients with COPD (65 ± 8 years, 55% women) who were setup on LT-NIV and followed-up (28/15–49/months) at our tertiary centre were analysed. The eosinophilic phenotype was defined by using an accepted cutoff for blood eosinophil count (≥300 cells/µL). Results: A total of 37 patients had the eosinophilic phenotype (66 ± 9 years, 60% women). There was a higher reduction in the number of exacerbations (1.0/−1.0–3.2/ vs. 0.05/−1.4–1.63/, p < 0.01) and a trend for a reduction in the rate of hospitalisations (1.0/−1.0–2.0/ vs. 0.0/0.0–1.0/, p = 0.07) post-NIV setup in the eosinophilic group. Most importantly, patients with high eosinophil counts had longer overall survival (34/15–74/ vs. 28/15–47/ months, p = 0.02, adjusted for covariates). Conclusions: The eosinophilic COPD phenotype seems to show better clinical responses to long-term NIV than patients without this trait. Further mechanistic studies are warranted to analyse this association. Full article

Background: Liver transplantation (LT) continues to evolve with techniques aimed at minimizing perioperative complications associated with caval and portal vein clamping. Caval-sparing approaches, such as the piggyback technique, preserve hemodynamic stability; however, portal clamping remains necessary and may trigger postreperfusion syndrome, endotoxemia, and hepatic microcirculatory disturbances. Temporary portocaval shunts (PCSs) have been developed to maintain portal flow during LT, mitigating these adverse effects and allowing for hemodynamic stability and a reduced intraoperative bleeding. Portocaval Shunts: Various PCS techniques—including end-to-side, right-branch, portosaphenous, mesenterico-saphenous, iliac-venous conduit interposition, portoumbilical, and Rex-saphenous shunts—allow an individualized approach based on patient anatomy and surgical complexity. Review of Evidence: Available evidence demonstrates that PCS improves intraoperative hemodynamic stability, reduces blood transfusion requirements, and preserves renal function, particularly in patients with high portal flow or severe portal hypertension. PCS may also shorten warm ischemia time, facilitate hepatectomy, and enhance outcomes in extended criteria donor grafts or marginal organs. Meta-analyses and randomized studies support its role in reducing intraoperative blood loss, improving early graft function, and accelerating postoperative recovery. However, the effect of PCS on long-term survival and major postoperative morbidity remains variable, likely due to heterogeneity in patient populations, donor types, and perioperative management. Conclusions: Overall, PCS represents a safe and feasible adjunct in LT, offering significant hemodynamic and technical advantages. Its use should be individualized based on patient risk factors, intraoperative hemodynamics, and anticipated intraoperative challenges. PCS provides a practical strategy to preserve portal flow, minimizing intraoperative complications and facilitating the hepatectomy. However, the decision to create a PCS during LT still depends on the surgeon’s preference. Postoperative outcomes and impact on long-term survival require further investigation. Full article

Background: Switching stable liver transplant (LT) recipients from twice-daily immediate-release tacrolimus (IR-Tac) to once-daily MeltDose^® extended-release tacrolimus (LCPT) has been proven safe and well tolerated. Moreover, the switch has been associated with enhanced treatment adherence, improvement of tremors, and preserved renal function. Here, we hypothesized that switching to LCPT early after LT may enhance long-term patient outcomes significantly. Methods: This single-center, observational study investigated the long-term safety of LCPT in a large cohort of LT recipients (n = 100). Allograft function, emerging adverse events, the incidence of rejection reactions, renal function, lipid and glucose metabolism, and treatment adherence were assessed over 24 months. Results: In 56% of patients, the switch was conducted within 4 weeks post-transplantation. Adverse events occurred in 90% of patients during the 24-month follow-up, including gastrointestinal complications (28%), neurological symptoms (28%), skin disorders (26%), metabolic disorders (22%), and fatigue (18%). Seven patients (7%) developed renal insufficiency, and five patients (5%) developed renal failure. Three episodes of chronic graft rejection reactions (3%) and a single transplant failure (1%) were observed over 24 months. LCPT was discontinued in 10 patients. Liver and renal function markers, blood lipids (cholesterol and triglycerides), and glucose levels remained stable over the 24-month follow-up. However, 58% of LT recipients had one of their liver function markers elevated at baseline (i.e., before the switch), 28% had low glomerular filtration rate (GFR < 60 mL/min/1.73 m²), and 18% had high serum creatinine (>1.3 mg/dL). In these subgroups, the early switch to LCPT was associated with a significant decrease in liver enzymes (p < 0.001 for alanine transaminase; p = 0.032 for gamma-glutamyl transferase; and p < 0.001 for total bilirubin) and a significant decrease in serum creatinine levels (p < 0.001). Self-reported treatment adherence was good and consistent throughout the study. Conclusions: The early switch from IR-Tac to LCPT was safe and effective in our cohort and may be particularly beneficial for patients with suboptimal liver and renal function following LT. Full article

Neutropenia is a common complication in oncology patients receiving chemotherapy, and rapid regeneration of functional neutrophils is critical for effective management. Bletilla striata polysaccharide (BSP) has shown therapeutic potential, but its mechanisms and molecular targets remain unclear. Here, we demonstrate that BSP accelerates the recovery of white blood cells, particularly neutrophils, in a chemotherapy-induced neutropenia (CIN) mouse model with cyclophosphamide (CY). The regenerated neutrophils retained phagocytic activity against bacteria, and BSP treatment significantly reduced mortality in the endotoxin-induced mouse death model. Furthermore, BSP enhanced the repopulation of hematopoietic stem and progenitor cells (HSPCs) in the bone marrow and promoted cell-cycle entry, resulting in increased frequencies of long-term hematopoietic stem cells (LT-HSCs), multipotent progenitors 2 (MPP2), and MPP3/4 subsets. Both in vitro colony formation and in vivo competitive transplantation assays confirmed that BSP reshapes hematopoietic reconstitution and corrects aberrant myeloid differentiation. PCR array analysis of HSPCs indicated that this process is mediated by C/EBPε and its downstream genes (LTF, LCN2, and ELANE). Consistently, BSP failed to support myeloid reconstitution following C/EBPε knockdown in vitro. In a C/EBPε knockout mouse model, HSPCs repopulation and regeneration were impaired, and BSP failed to promote neutrophil recovery after CY challenge or the mobilization of MPP2 and MPP3/4 subsets. The regulatory effects of BSP on C/EBPε target genes were also abolished. In conclusion, our findings identify C/EBPε as a key mediator of BSP activity, driving HSPCs repopulation and restoring hematopoietic function. These results highlight BSP as a potential therapeutic strategy for chemotherapy-induced neutropenia. Full article

Aim: This study explored the differences in functional traits and soil physical and chemical properties of coastal plant communities under different disturbance intensities. It investigated the correlations between them to gain a deeper understanding of how plant communities adjust their functional traits in response to habitat changes. However, the mechanisms by which human disturbance influences plant functional traits remain unclear. This research endeavors to reveal the adaptive mechanisms and ecological strategies employed by coastal plant communities under different levels of anthropogenic disturbance. Methods: The study examined plant communities in three levels of disturbance (severe, moderate, and mild) in the coastal areas of Pingtan Island. Nine soil physicochemical property indicators and 16 plant functional trait indicators were collected to analyze the correlation between coastal green space plant functional traits and soil physicochemical properties. Results: Soil physicochemical properties (ST, SS, pH) of coastal plants varied under different disturbance intensities. Concurrently, plant functional traits (SLA, LDMC, LTD, LNC, LCC, LPC, LSC, RTD, RPC) also exhibited significant differences. Notably, the interactions among plant functional traits also varied under different disturbance intensities. Furthermore, plant functional traits exhibited distinct response mechanisms to changes in soil physicochemical properties. The plant community adjusts its resource allocation strategy to adapt to environmental changes, which is specifically manifested in the coordination of SRL, SRA, SLA, RPC, RNC, RCC, RSC, LPC, LNC, LT, LTD, and LDMC. Conclusions: Under severe disturbance, plant communities tend to adopt short-term rapid investment-return strategies to cope with harsh environmental conditions; moderate disturbance prompts slow investment-return strategies for long-term stable growth; mild disturbance triggers rapid investment-return strategies to enhance environmental adaptability. The research results indicate that by selecting appropriate plant resources based on different habitat characteristics, it is beneficial for the survival and reproduction of the plant community. Full article

Background: The impact of Long-Term Non-Invasive Ventilation (LT-NIV) on patient-relevant outcomes has yet to be clearly established in types 2 and 3 Spinal Muscular Atrophy (SMA). Objectives: The current study aimed to assess LT-NIV effect(s) on tracheostomy-free survival and the need for hospitalization. Its secondary aim was to identify patient characteristics that can be considered risk factors for an unsatisfactory response to treatment. Design: This study is a retrospective analysis of long-term outcomes in types 2 and 3 SMA patients receiving home LT-NIV. Methods:Patients and interventions: Eighteen types 2 and 3 SMA patients who were receiving home LT-NIV between 1 January 1990 and 31 March 2025 were included. Primary study endpoint: The endpoint comprised a composite of tracheostomy-free survival time and hospitalization rate. Results: Twelve patients (66.7%) had a positive response to LT-NIV (group A); the response was unsatisfactory in the remaining 6 (33.3%) (group B). Tracheostomy-free survival time was significantly reduced in the latter compared to the former [66 (range: 2–172) vs. 280 (range: 67–407) months; p = 0.010] and the hospitalization rate was significantly higher [0.35 (range: 0.06–1.44) vs. 0.07 (range: 0.00–0.18) episodes/yr; p = 0.007]. A correlation was found between an unsatisfactory response to LT-NIV and treatment initiation following an episode of acute respiratory failure (OR: 7.90; 95% CI, 0.99–123.2; p = 0.051). Conclusions: LT-NIV has a positive impact on tracheostomy-free survival and hospitalizations in types 2 and 3 SMA patients. The risk of an unsatisfactory response appears to be higher when the treatment is initiated in clinically unstable patients. Full article

Background: Subclinical hyperthyroidism grade 1 (SCH G1, TSH > 0.1 mU/L) is common in patients with thyroid unifocal autonomy (UFA) and associated with cardiovascular risks and increased mortality. While ¹³¹I radioiodine therapy (¹³¹I-RIT) effectively treats UFA, it frequently induces hypothyroidism, partly due to extra-nodular absorbed dose (AD) enhanced by residual TSH stimulation. Objective: We hypothesized that short-term LT3-induced TSH suppression at the time of RIT would promote long-term euthyroidism. Patients and Methods: A retrospective study was conducted on 95 UFA patients with SCH G1 (2001–2024). Patients underwent baseline and post-LT3 thyroid scintigraphy, and then received ¹³¹I-RIT with individualized dosimetry. Long-term bioclinical follow-up was achieved. Results: Short-term low-dose LT3 suppression caused no adverse events and significantly reduced TSH (0.45 to 0.047 mU/L). Whole-gland ¹²³I uptake decreased moderately (11.0 to 8.4%), while extra-nodular lobe uptake dropped markedly (1.77 to 0.73%) (all p < 0.0001). This focused activity on the UFA (2.5-fold increase), maintaining mean UFA AD (about 260 Gy) but reducing extra-nodular AD (61 to 37 Gy, p < 0.0001). Despite low ¹³¹I doses (mean 181 MBq), a dose–response relationship was observed: higher AD correlated with greater nodular lobe volume reduction (p < 0.033). At the 88-month follow-up, 93% of patients achieved normal thyroid function; one had persistent SCH G1, two were borderline hypothyroid, and two required LT4. Conclusions: ¹³¹I-RIT under brief LT3-induced TSH suppression induces sustained euthyroidism in SCH G1 with UFA. This simple, low-risk strategy reduces radioprotection concerns and is under evaluation to determine cardiovascular benefits. Full article

Background/Objectives: Long-term survival among liver transplant (LT) recipients who live beyond one year has remained relatively stable over recent decades. However, reducing long-term morbidity is increasingly important, and metabolomics may enable risk-based, personalized immunosuppression. We aimed to evaluate and compare the serum metabolomic profiles of LT recipients treated with tacrolimus (TAC) versus sirolimus (SIR), to elucidate metabolic pathways associated with these regimens. Methods: Targeted metabolomic profiling of 894 metabolites was conducted on serum samples from 128 LT recipients using the Biocrates MxP^® Quant 500 kit. Data were analyzed with MetaboAnalyst 6.0, and multivariate analysis was performed using Partial Least Squares-Discriminant Analysis (PLS-DA). Metabolites with Variable Importance in Projection (VIP) scores > 1.5 underwent pathway enrichment in OmicsNet, incorporating Gene Ontology annotations and Kyoto Encyclopedia of Genes and Genomes (KEGG)-based network analysis. Results: Eighty-seven metabolites were significantly altered between groups. Phosphatidylcholines (PCs) and ceramides were elevated in TAC-treated patients, while di- and triacylglycerols were higher in the SIR group. Pathway enrichment implicated lipid metabolism, particularly glycerophospholipid, ether lipid, and sphingolipid pathways. Network analysis identified enriched modules related to metabolic regulation and immune response. Conclusions: Divergent metabolomic profiles distinguish TAC- and SIR-treated recipients, suggesting regimen-specific impacts on lipid metabolism with potential relevance to post-transplant complications. Full article

This long-term observational study aimed to define the spectrum of genetic variation in a congenital hypothyroidism (CH) cohort and investigate the correlations between specific genotypes and clinical phenotypes, including treatment requirements and outcomes. We analyzed the maintenance dose of L-thyroxine (L-T4) at 6, 12, 18, and 24 months, alongside clinical outcomes after 3 years. Data were collected from the Neonatal Disease Screening Center at our hospital between January 2011 and March 2024. Of 247 patients with confirmed CH, 119 had available genetic testing and complete clinical information. The genetic positivity rate was 56.3% (67/119). DUOX2 was the most frequently mutated gene (28.57%), followed by TPO, TG, and TSHR. Phenotypic correlation analysis revealed that patients with DUOX2 variants had significantly lower initial screening TSH levels and required lower L-T4 maintenance doses at 12 months compared to those with TPO or TSHR variants. Patients with TPO and TSHR variants exhibited more severe clinical phenotypes and a higher prevalence of thyroid enlargement on ultrasound. Notably, no significant differences in biochemical data, L-T4 doses, or clinical outcomes were observed between patients with monoallelic and biallelic DUOX2 variations, or among the negative, monogenic, and oligogenic variation groups. This study establishes a high genetic diagnostic yield for CH in the studied cohort, with DUOX2 as the predominant genetic etiology. The findings demonstrate significant genotype–phenotype correlations, where variations in different genes are associated with distinct biochemical severities and treatment demands. Crucially, the lack of correlation between the number of affected DUOX2 alleles and disease severity highlights the complex genetic and phenotypic heterogeneity of CH. These results provide valuable insights for the precise management and prognostic counseling of patients with CH. Full article