Search Results (3,135)

Backgrounds: The incidence of gastrointestinal cancers (GICs), though decreased in recent years, still accounts for 35% of all cancer-related mortality. The proper identification of risk factors, early diagnosis, and therapy optimization represent the three cornerstones of GIC treatment. In four-stage diseases, chemotherapy embodies target therapy that may prolong patients’ expectancy when suitably applied. Patients and Methods: There were 133 (82 (62%) male and 51 (38%) female) consecutive patients with a median age of 70 (64–74) years who underwent palliative treatment due to four-stage colorectal cancer (CRC) between 2022 and 2024. The demographic, clinical, and laboratory data and applied chemotherapeutic protocols were evaluated regarding the response to applied therapy, resulting in complete or partial tumor regression. The advancement of the tumor was based on computed tomography (CT) performed before and 6 months after the chemotherapy. Results: The multivariable model revealed red cell distribution width (RDW) from peripheral blood analysis (OR: 0.81, 95% CI: 0.65–1.00, p = 0.049) as a possible predictor for systemic treatment response in colorectal cancer. The receiver operating characteristic curve revealed a predictive value of male sex and RDW prior to systemic therapy, with an area under the curve of 0.672, yielding a sensitivity of 70.0% and specificity of 58.1%. Conclusions: The results of our analysis point out the possible modulatory impact of RDW on six-month systemic therapy in colorectal terminal cancer management. Further studies are required to confirm the presented results. Full article

Calcific aortic stenosis (CAS) is a newly emerging pandemic in elderly individuals due to the aging of the population in the world. Surgical Aortic Valve Replacement (SAVR) and Transcatheter Aortic Valve Replacement (TAVR) are the cornerstone of the management of severe aortic stenosis accompanied by one or more symptoms. Moreover, an appropriate interventional treatment of CAS, in elderly patients, is a very complex decision for heart teams, to avoid bad outcomes such as operative mortality, cardiovascular and all-cause death, hospitalization for heart failure, worsening of quality of life. In fact, CAS in the elderly is not only a focal valve disease, but a very complex clinical picture with different risk factors and etiologies, differing underlying pathophysiology, large phenotypic heterogeneity in a context of subjective biological, phenotypic and functional aging until frailty and disability. In this review, we analyzed separately and in a more integrated manner, the natural and prognostic histories of the progression of aortic stenosis, the phenotypes of myocardial damage and heart failure, within the metrics and aging trajectory. The aim is to suggest, during the clinical timing of valve disease, the best interval time for an appropriate and effective interventional treatment in each older patient, beyond subjective symptoms by integration of clinical, geriatric, chemical, and advanced imaging biomarkers. Full article

This study presents a comprehensive analysis of the chemical composition of bottom ash samples generated during municipal waste incineration. A total of 52 samples were collected and subjected to statistical analysis for 17 elements and 2 element sums using techniques such as correlation analysis and one-way ANOVA. The results confirm a high degree of heterogeneity in the elemental content, reflecting the variability of waste streams and combustion processes. Strong correlations were identified between certain elements, including Cu-Zn, Co-Ni, and HREE-LREE, indicating common sources and similar geochemical properties. The analysis also revealed significant seasonal variability in the content of Ba and Sr, with lower average values observed during the spring season and greater variability noted during summer and winter. Although Al and HREE did not reach classical significance levels, their distributions suggest possible seasonal differentiation. These findings underscore the need for long-term monitoring and seasonal analysis of incineration bottom ash composition to optimize resource recovery processes and assess environmental risk. The integration of chemical data with operational data on waste composition and combustion parameters may contribute to a better understanding of the variability of individual elements, ultimately supporting the development of effective strategies for ash management and element recovery. Full article

Background and Objectives: Surgical smoke generated by energy devices during surgery contains hazardous substances and poses health risks to staff in the operating room. Exposure to surgical smoke must be reduced to minimize the risk of health hazards. Many studies have evaluated surgical smoke qualitatively, but few have performed quantitative assessment. The aim of this study was to quantify the number of particles generated during various breast surgery procedures. Materials and Methods: In this prospective, randomized study, breast surgeries performed at Tokyo Medical and Dental University Hospital (the present Institute of Science Tokyo Hospital) between December 2022 and August 2023 were randomly assigned to two groups: the electrosurgical device group and the electrosurgical device with smoke evacuator group. The number of particles generated by energy devices during surgery was measured using a particle counter. Results: Surgical smoke was generated in all procedures. The number of measured particles was significantly less in the electrosurgical device with smoke evacuator group than in the electrosurgical device group during all procedures (all p < 0.001). Conclusions: All breast surgery procedures produced a significant amount of surgical smoke, which was effectively reduced by using an electrosurgical device with a smoke evacuator. These findings support the routine use of smoke evacuators in breast surgery to reduce occupational exposure to hazardous particles. Implementation of such devices could improve operating room safety and may inform future guidelines and institutional policies regarding surgical smoke management. Full article

Background and Clinical Significance: Obstructive sleep apnea (OSA) is a common comorbidity in patients with cardiac and metabolic disorders. The coexistence of central sleep apnea with Cheyne–Stokes breathing (CSA-CSB) in heart failure patients, especially those with preserved ejection fraction (HFpEF), represents a diagnostic and therapeutic challenge. Data on continuous positive airway pressure (CPAP) failure and successful adaptation to servo-ventilation (ASV) in the context of complex comorbidities remain limited. Case Presentation: We present the case of a 74-year-old male with a history of type 2 diabetes mellitus, paroxysmal atrial fibrillation, HFpEF, essential hypertension, and bladder carcinoma. He was referred for pre-operative OSA screening, reporting excessive daytime sleepiness, insomnia, and witnessed apneas. Initial respiratory polygraphy revealed severe sleep-disordered breathing with dominant CSA-CSB and moderate OSA. Laboratory investigations also revealed severe iron-deficiency anemia, which was managed with parenteral iron supplementation. The patient underwent CPAP titration, which led to modest improvement and residual high apnea–hypopnea index (AHI). After persistent symptoms and an inadequate CPAP response, an ASV device was initiated with significant clinical and respiratory improvement, demonstrating normalization of hypoxic burden and optimal adherence. Conclusions: CSA-CSB in HFpEF patients with anemia poses unique therapeutic difficulties. This case highlights the importance of individualized diagnostic and therapeutic strategies, including transitioning to ASV in CPAP-refractory cases, which can lead to improved adherence, reduced hypoxia, and better overall outcomes in high-risk patients. Full article

Underground gas storage (UGS) in heterogeneous carbonate reservoirs is crucial for energy security but frequently faces wellbore instability challenges, which traditional static methods struggle to address due to dynamic full life cycle changes. This study systematically analyzes the dynamic evolution of wellbore stress in the Bs8 well (Qianmiqiao carbonate UGS) during drilling, acidizing, and injection-production operations, establishing a quantitative risk assessment model based on the Mohr–Coulomb criterion. Results indicate a significantly higher wellbore instability risk during drilling and initial gas injection stages, primarily manifested as shear failure, with greater severity observed in deeper well sections (e.g., 4277 m) due to higher in situ stresses. During acidizing, while the wellbore acid column pressure can reduce principal stress differences, the process also significantly weakens rock strength (e.g., by approximately 30%), inherently increasing the risk of wellbore instability, though the primary collapse mode remains shallow shear breakout. In the injection-production phase, increasing formation pressure is identified as the dominant factor, shifting the collapse mode from initial shallow shear failure to predominant wide shear collapse, notably at 90°/270° from the maximum horizontal stress direction, thereby significantly expanding the unstable zone. This dynamic assessment method provides crucial theoretical support for full life cycle integrity management and optimizing safe operation strategies for carbonate gas storage wells. Full article

The management of resectable pancreatic ductal adenocarcinoma (R-PDAC) and borderline resectable pancreatic ductal adenocarcinoma (BR-PDAC) remains a topic of active debate. Although neoadjuvant therapy (NAT) has shown clinical benefits in BR-PDAC, especially in increasing resectability and achieving higher rates of margin-negative (R0) resections, its role in R-PDAC is less clearly defined. Additionally, the role of immunotherapy in PDAC is still being explored, with ongoing trials investigating new combinations to overcome the tumor’s immune-resistant microenvironment. This article provides a comprehensive narrative review of the current evidence comparing NAT with upfront surgery in pancreatic cancer management, focusing on randomized controlled trials and meta-analyses that assess outcomes in R-PDAC and BR-PDAC. The review aims to determine whether NAT offers a significant survival advantage over traditional post-operative strategies and to clarify which clinical scenarios may benefit most from NAT. The literature was identified through a systematic search of PubMed, Scopus, and Google Scholar databases up to March 2025. Article selection adhered to the PRISMA guidelines. Our review of existing evidence supports NAT as the standard of care for BR-PDAC. Meanwhile, management of R-PDAC should be tailored individually, guided by risk stratification that considers both clinical parameters and molecular features. Immunotherapy and targeted therapies are still in early research phases, and their further integration as NAT remains controversial. Full article

This study addresses the complex challenges associated with flexible mattress (soft mattress) installation in the sharply curved and deep-water sections of the Yangtze River, particularly in the Yaozui revetment reconstruction project. Under extreme hydrodynamic conditions—water depths exceeding 30 m and velocities over 2.5 m/s—the risk of structural failures such as displacement, flipping, or tearing of the mattress becomes significant. To improve construction safety and stability, the study integrates numerical modeling and on-site strain monitoring to analyze the mechanical response of flexible mattresses during deployment. A three-dimensional finite element model based on the catenary theory was developed to simulate stress distributions under varying flow velocities and angles, revealing stress concentrations at the mattress’s upper edge and reinforcement junctions. Concurrently, a real-time monitoring system using high-precision strain sensors was deployed on critical shipboard components, with collected data analyzed through a remote IoT platform. The results demonstrate strong correlations between mattress strain, flow velocity, and water depth, enabling the identification of high-risk operational thresholds. The proposed monitoring and early-warning framework offers a practical solution for managing construction risks in extreme riverine environments and contributes to the advancement of intelligent construction management for underwater revetment works. Full article

When there is an absence of disaster prevention measures, natural hazards can lead to disasters. An essential part of disaster risk management is the geospatial modeling of devastating hazards, where data sharing is of paramount importance in the context of early-warning systems. This research points out the usefulness of Spatial Data Infrastructures (SDIs) for disaster risk reduction through a literature review, focusing on the necessity of data unification and disposal. Initially, the principles of SDIs are presented, given the fact that this framework contributes significantly to the fulfilment of specific targets and priorities of the Sendai Framework for Disaster Risk Reduction 2015–2030. Thereafter, the challenges of SDIs are investigated in order to underline the main drawbacks stakeholders in emergency management have to come up against, namely the semantic misalignment that impedes efficient data retrieval, malfunctions in the interoperability of datasets and web services, the non-availability of the data in spite of their existence, and a lack of quality data, while also highlighting the obstacles of real case studies on national NSDIs. Thus, diachronic observations on disasters will not be made, despite these comprising a meaningful dataset in disaster mitigation. Consequently, the harmonization of national SDIs with international schemes, such as the Group on Earth Observations (GEO) and European Union’s space program Copernicus, and the usefulness of Artificial Intelligence (AI) and Machine Learning (ML) for disaster mitigation through the prediction of natural hazards are demonstrated. In this paper, for the purpose of disaster preparedness, real-world implementation barriers that preclude SDIs to be completed or deter their functionality are presented, culminating in the proposed future research directions and topics for the SDIs that need further investigation. SDIs constitute an ongoing collaborative effort intending to offer valuable operational tools for decision-making under the threat of a devastating event. Despite the operational potential of SDIs, the complexity of data standardization and coordination remains a core challenge. Full article

This study addresses critical safety challenges in sustainable urban mobility by developing a probabilistic framework for lane-change risk prediction on congested expressways. Utilizing unmanned aerial vehicle (UAV)-captured trajectory data from 784 validated lane-change events, we construct a Bayesian network model integrated with an I-CH scoring-enhanced MMHC algorithm. This approach quantifies risk probabilities while accounting for driver decision dynamics and input data uncertainties—key gaps in conventional methods like time-to-collision metrics. Validation via the Asia network paradigm demonstrates 80.5% reliability in forecasting high-risk maneuvers. Crucially, we identify two sustainability-oriented operational thresholds: (1) optimal lane-change success occurs when trailing-vehicle speeds in target lanes are maintained at 1.0–3.0 m/s (following-gap < 4.0 m) or 3.0–6.0 m/s (gap ≥ 4.0 m), and (2) insertion-angle change rates exceeding 3.0°/unit-time significantly elevate transition probability. These evidence-based parameters enable traffic management systems to proactively mitigate collision risks by 13.26% while optimizing flow continuity. By converting behavioral insights into adaptive control strategies, this research advances resilient transportation infrastructure and low-carbon mobility through congestion reduction. Full article

Climate change represents one of the main challenges of this century. The hazards generated by this process are various and involve territorial assets all over the globe. Hydrogeological risk represents one of these aspects, and the violence of rain precipitations has led experts to focus their interest on the study of geotechnical assets in relation to these dangerous weather events. At the same time, geospatial representation in 3D WebGIS based on open-source solutions led specialists to employ this kind of technology to remotely analyze and monitor territorial events considering different sources of information. This study considers the construction of a 3D WebGIS framework for the real-time management of geospatial information developed with open-source technologies applied to the dynamic mapping of precipitation in the metropolitan area of Palermo (Italy) based on real-time weather station acquisitions. The structure considered is a WebGIS platform developed with Cesium.js JavaScript libraries, the Postgres database, Geoserver and Mapserver geospatial servers, and the Anaconda Python platform for activating real-time data connections using Python scripts. This framework represents a basic geospatial digital twin structure useful to municipalities, civil protection services, and firefighters for land management and for activating any preventive operations to ensure territorial safety. Furthermore, the open-source nature of the platform favors the free diffusion of this solution, avoiding expensive applications based on property software. The components of the framework are available and shared using GitHub. Full article

Landslide susceptibility modelling represents an efficient approach to enhance disaster management and mitigation strategies. The focus of this paper lies in the development of a landslide susceptibility evaluation in northwestern Tunisia using the Analytical Hierarchy Process (AHP) and Artificial Neural Network (ANN) approaches. The used database covers 286 landslides, including ten landslide factor maps: rainfall, slope, aspect, topographic roughness index, lithology, land use and land cover, distance from streams, drainage density, lineament density, and distance from roads. The AHP and ANN approaches were applied to classify the factors by analyzing the correlation relationship between landslide distribution and the significance of associated factors. The Landslide Susceptibility Index result reveals five susceptible zones organized from very low to very high risk, where the zones with the highest risks are associated with the combination of extreme amounts of rainfall and steep slope. The performance of the models was confirmed utilizing the area under the Relative Operating Characteristic (ROC) curves. The computed ROC curve (AUC) values (0.720 for ANN and 0.651 for AHP) convey the advantage of the ANN method compared to the AHP method. The overlay of the landslide inventory data locations of historical landslides and susceptibility maps shows the concordance of the results, which is in favor of the established model reliability. Full article

The widespread adoption of liquefied natural gas (LNG) as a marine fuel has driven the development of LNG bunkering operations in global ports. Major international hubs, such as Shenzhen Port, have implemented ship-to-ship (STS) bunkering practices. However, this process entails unique safety risks, particularly hazards associated with vapor cloud dispersion caused by bunkering hose releases. This study employs the Phast software developed by DNV to systematically simulate LNG release scenarios during STS operations, integrating real-world meteorological data and storage conditions. The dynamic effects of transfer flow rates, release heights, and release directions on vapor cloud dispersion are quantitatively analyzed under daytime and nighttime conditions. The results demonstrate that transfer flow rate significantly regulates dispersion range, with recommendations to limit the rate below 1500 m³/h and prioritize daytime operations to mitigate risks. Release heights exceeding 10 m significantly amplify dispersion effects, particularly at night (nighttime dispersion area at a height of 20 m is 3.5 times larger than during the daytime). Optimizing release direction effectively suppresses dispersion, with vertically downward releases exhibiting minimal impact. Horizontal releases require avoidance of downwind alignment, and daytime operations are prioritized to reduce lateral dispersion risks. Full article

Floating solar technology has gained significant attention as part of the global expansion of renewable energy due to its potential for installation in underutilized water bodies. Several countries, including the Netherlands, have initiated efforts to extend this technology from inland freshwater applications to open offshore environments, particularly within offshore wind farm areas. This development is motivated by the synergistic benefits of increasing site energy density and leveraging the existing offshore grid infrastructure. The deployment of offshore floating photovoltaic (OFPV) systems involves assembling multiple modular units in a marine environment, introducing operational risks that may give rise to safety concerns. To mitigate these risks, weather windows must be considered prior to the task execution to ensure continuity between weather-sensitive activities, which can also lead to additional time delays and increased costs. Consequently, optimizing marine logistics becomes crucial to achieving the cost reductions necessary for making OFPV technology economically viable. This study employs a simulation-based approach to estimate the installation duration of a 5 MWp OFPV plant at a Dutch offshore wind farm site, started in different months and under three distinct risk management scenarios. Based on 20 years of hindcast wave data, the results reveal the impacts of campaign start months and risk management policies on installation duration. Across all the scenarios, the installation duration during the autumn and winter period is 160% longer than the one in the spring and summer period. The average installation durations, based on results from 12 campaign start months, are 70, 80, and 130 days for the three risk management policies analyzed. The result variation highlights the additional time required to mitigate operational risks arising from potential discontinuity between highly interdependent tasks (e.g., offshore platform assembly and mooring). Additionally, it is found that the weather-induced delays are mainly associated with the campaigns of pre-laying anchors and platform and mooring line installation compared with the other campaigns. In conclusion, this study presents a logistics modeling methodology for OFPV systems, demonstrated through a representative case study based on a state-of-the-art truss-type design. The primary contribution lies in providing a framework to quantify the performance of OFPV installation strategies at an early design stage. The findings of this case study further highlight that marine installation logistics are highly sensitive to local marine conditions and the chosen installation strategy, and should be integrated early in the OFPV design process to help reduce the levelized cost of electricity. Full article

Container liner shipping companies operate within a complex environment where they must balance profitability and service reliability. Meanwhile, evolving regulatory policies, such as surcharges imposed on ships of a particular origin or type on specific trade lanes, introduce new operational challenges. This study addresses the heterogeneous ship routing and demand acceptance problem, aiming to maximize two conflicting objectives: weekly profit and total transport volume. We formulate the problem as a bi-objective mixed-integer programming model and prove that the ship chartering constraint matrix is totally unimodular, enabling the reformulation of the model into a partially relaxed MIP that preserves optimality while improving computational efficiency. We further analyze key mathematical properties showing that the Pareto frontier consists of a finite union of continuous, piecewise linear segments but is generally non-convex with discontinuities. A case study based on a realistic liner shipping network confirms the model’s effectiveness in capturing the trade-off between profit and transport volume. Sensitivity analyses show that increasing freight rates enables higher profits without large losses in volume. Notably, this paper provides a practical risk management framework for shipping companies to enhance their adaptability under shifting regulatory landscapes. Full article