Search Results (108)

Objectives: To identify clinical, functional, laboratory, and patient-reported parameters associated with medium-term risk of hospitalization or death among older adults attending a multidisciplinary outpatient clinic, and to assess the predictive performance of these measures for individual risk stratification. Methods: In this cohort study, 350 adults aged ≥65 years were assessed at baseline and followed for an average of 8 months. The primary outcome was a composite of hospitalization or all-cause mortality. Parameters assessed included frailty and comorbidity measures, functional parameters, such as gait speed and grip strength, laboratory biomarkers, and patient-reported measures, such as quality of life (QoL, assessed on a Likert scale) and the presence of depressive symptoms. Predictive performance was evaluated using univariable logistic regression and multivariable modeling. Discriminative ability was assessed via area under the ROC curve (AUC), and selected models were internally validated using repeated k-fold cross-validation. Results: Overall, 40 participants (11.4%) experienced hospitalization or death. Traditional clinical risk indicators, including frailty and comorbidity scores, were significantly associated with the outcome. Patient-reported QoL (AUC = 0.74) and Geriatric Depression Scale (GDS) scores (AUC = 0.67) demonstrated useful overall discriminatory ability, with high specificities at optimal cut-offs, suggesting they could act as “red flags” for adverse outcomes. However, the limited sensitivities of individual predictors underscore the need for more comprehensive screening instruments with improved ability to identify at-risk individuals earlier. A multivariable model that incorporated several predictors did not outperform QoL alone (AUC = 0.79), with cross-validation confirming comparable discriminative performance. Conclusions: Patient-reported measures—particularly quality of life and depressive symptoms—are valuable predictors of hospitalization or death and may enhance traditional frailty and comorbidity assessments in outpatient geriatric care. Future work should focus on developing or integrating screening tools with greater sensitivity to optimize early risk detection and guide preventive interventions. Full article

Traditional pre-clinical drug evaluation methods, including animal experiments and static cell cultures using human-derived cells, face critical limitations such as interspecies differences, ethical concerns, and poor physiological relevance. More recently, microphysiological systems (MPSs) that use microfluidic devices to mimic in vivo conditions have emerged as promising platforms. By enabling perfusion cell culture and incorporating human-derived cells, MPSs can evaluate drug efficacy and toxicity in a more human-relevant manner. However, standard MPS protocols rely on discrete medium changes, causing abrupt changes in drug concentrations that do not reflect the continuous pharmacokinetics seen in vivo. To overcome this limitation, we developed a Dialysis Membrane-integrated Microfluidic Device (DMiMD) which maintains continuous drug concentrations through selective medium change via a dialysis membrane. The membrane’s molecular weight cut-off (MWCO) enables the retention of high-molecular-weight drugs while facilitating the passage of essential low-molecular-weight nutrients such as glucose. We validated the membrane’s molecular selectivity and confirmed effective nutrient supply using cells. Additionally, anticancer drug efficacy was evaluated under continuously changing drug concentrations, demonstrating that the DMiMD successfully mimics in vivo drug exposure dynamics. These results indicate that the DMiMD offers a robust in vitro platform for accurate assessment of drug efficacy and toxicity, bridging the gap between conventional static assays and the physiological complexities of the human body. Full article

A one-micron-thick pure zinc oxide (ZnO) and nitrogen-doped zinc oxide (N-ZnO) film were fabricated on p-type, pristine (non-porous), and porous gallium nitride (GaN) substrates using a radio frequency (RF) sputtering technique at room temperature. The doping medium was nitrogen gas, which has a flow rate that ranges from 0 to 10 sccm (0 sccm refers to pure ZnO). The photoelectrochemical etching process, using ultraviolet light, was employed to etch the wafer surface and create a porous GaN substrate. ZnO films were developed on GaN with ZnO powder as the target material under vacuum conditions. This research aimed to investigate how variations in substrate and doping influenced the structural, optical, and electrical characteristics of the resulting thin films. The SEM images indicated that the pores developed on the etched GaN surface had a spherical shape. The A₁ (LO) phonon peak at 750.2 cm⁻¹ was observed in the Raman spectrum of the etched porous GaN. The X-ray diffraction (XRD) analysis confirmed that the films grown on GaN possessed a hexagonal wurtzite structure and the observed peak shift of (101) in all N-ZnO films suggested interstitial nitrogen doping. For the N-ZnO films, the UV-visible cut-off wavelength shifted towards the blue region. The root mean square (RMS) roughness of the N-ZnO films, measured using atomic force microscopy (AFM), was found to decrease with an increasing N-doping concentration. The 10 sccm sample exhibited the lowest roughness value of 1.1 nm, whereas the pure ZnO film showed the highest roughness of 3.4 nm. The N-ZnO thin films were found to exhibit p-type conductivity, as computed by Hall measurements using the van der Pauw method, and the higher value of carrier concentration obtained for the nitrogen gas flow rate of 8 sccm was 5.29 × 10²¹ cm⁻³. Full article

As chronic kidney disease (CKD) prevalence rises, optimizing hemodialysis remains essential. While online hemodiafiltration (OL-HDF) is the gold standard, expanded hemodialysis (HDx), i.e., using high-performance dialyzers in standard hemodialysis, remains the most common clinical practice. Medium cutoff (MCO) membranes aim to enhance middle-molecule removal while preserving protein selectivity, although most studies evaluate them in OL-HDF. To this end, this study aims to compare the Xevonta-Hi (B. Braun), a high-flux (HF) polysulfone dialyzer, and the ELISIO-HX (Nipro), an MCO polyethersulfone dialyzer, in standard hemodialysis. In a prospective, observational study, seven stable patients sequentially received treatment with each dialyzer over four weeks. Pre- and post-dialysis levels of small and middle uremic molecules and inflammatory markers—including procalcitonin, prolactin, serum amyloid A, placental growth factor, interleukin-6, haptoglobin, ceruloplasmin, transferrin, prealbumin, and C-reactive protein—were measured. Both dialyzers demonstrated excellent clearance of small and middle molecules, with no significant differences in efficacy. Albumin and total protein losses remained minimal. Moderate reductions in serum amyloid A, placental growth factor, and interleukin-6 were observed, while no significant reductions occurred in the remaining inflammatory markers. These findings support the safety and effectiveness of both MCO and HF dialyzers in standard hemodialysis. Full article

Background: Removal of large uraemic toxins is still a challenge. Haemodiafiltration (HDF) has produced some results, although large convective volume, optimal vascular access to increase the blood flow rate and strict water quality management are required. Medium cut-off, high-retention-onset membranes have been recently developed, introducing the concept therapy called expanded haemodialysis (HDx). Furthermore, vitamin E-coated membrane has potential beneficial effects on inflammation and oxidative stress. Methods: A prospective longitudinal multicentre study was conducted for 3 months among 24 chronic haemodialysis patients. Patients were randomly assigned into either HDF with high-flux membrane or HDx with Theranova or ViE-X membrane. The primary goal was to assess albumin loss among the three types of dialyzers. Secondary goals included assessment of depurative efficacy for uraemic toxins and clinical outcomes. Results: Mean albumin loss was significantly higher in patients undergoing HDx with Theranova membrane, without any difference in serum albumin concentration among the three groups. Instantaneous clearance of small and middle molecules was significantly higher in patients undergoing HDF, but we did not find differences in removal ratio and Kt/V. Reduction in the erythropoietin resistance index was observed in patients treated with ViE-X membrane due to their lower dialysis vintage. Conclusions: The higher albumin loss during HDx has no effects on pre-dialysis serum albumin. HDx with Theranova in the presence of lower session length, lower Qb, lower convective dose, and lower instantaneous clearance reached the same dialysis efficacy compared to HDF. Full article

Background/Objectives: Renal cell carcinoma (RCC) accounts for 2–3% of all cancers, with approximately 25% of patients being detected at the metastatic stage. This study aimed to determine the prognostic significance of co-evaluating two risk parameters: one, the HALP score based on haemoglobin, albumin, lymphocyte, and platelet counts, and the other, albumin-to-alkaline phosphatase ratio (AAPR) in patients with metastatic RCC treated with targeted therapy. Methods: This retrospective cohort study included 147 patients with metastatic RCC. The HALP score and AAPR values were calculated from pre-treatment blood test results, and followingly, the cut-off value was determined by using ROC analysis. Patients were categorised into three groups with a low, moderate or high combined risk score based on this cut-off value. The effect of these risk groups on survival was evaluated. Results: The mean age of patients was 64.1 ± 11.9. The median follow-up time was 38.3 months, and the mortality rate was 53.7% in all groups. Kaplan–Meier survival analysis showed a statistically significant difference between the combined scores of the risk groups: the median survival time was 51.6 months in the low-risk group, 20.7 months in the medium-risk group, and 10.4 months in the high-risk group (p < 0.001), with 5-year survival rates being 38.8% in the low-risk group, 30% in the intermediate-risk group, and 19% in the high-risk group. When compared to the low-risk group, Cox regression analysis revealed that the mortality risk, i.e., HR (hazard ratio), was 2.42 times higher in the intermediate-risk group and 3.76 times higher in the high-risk group. A nephrectomy operation decreased the mortality risk (HR = 0.24) by 4.16 times. Conclusions: This new combined risk scoring, obtained from co-evaluating the HALP score and AAPR, was found to be an independent prognostic factor in metastatic RCC patients. This combined risk scoring is expected to help clinicians in treatment decisions. Full article

This study assessed the effect of filter parameters on gait characteristics and the performance of machine-learning models. Overground walking trials (n = 99) with and without perturbations (slips, trips) were collected for 33 healthy older adults. Kinematics were collected by a motion capture system. Different Butterworth low-pass parameters were applied to the raw data, including three orders (2–6) and nine cutoffs (4–20 Hz). Spatiotemporal gait outcomes were then calculated to develop classification models to automatically identify the trial type (gait, gait–slip, or gait–trip) using Logistic Regression, Support Vector Classification, and Random Forest Classification. A 3 × 9 ANOVA showed main effects of order and cutoff (p < 0.01 for all) on gait characteristics during both perturbed and regular walking trials. However, the gait characteristics were different between them. The filter parameters significantly affected the performance of classification models using different classifiers, with significant main effects of the filter order (p < 0.05) and cutoff (p < 0.01) on AUC and overall accuracy for all of the models. Our results suggest that the standard Butterworth filter (fourth-order, cutoff: 6 Hz) is suitable for the development of classification models with low–medium complexity, while for models with high complexity (i.e., ensemble models), a filter with a higher order and cutoff (sixth-order, cutoff 10–12 Hz) might yield better performance. Full article

Background: COPD is a chronic disease characterized by frequent exacerbations that require hospitalization, significantly increasing the care burden. In recent years, the use of artificial intelligence-based tools to improve the management of patients with COPD has progressed, but the prediction of readmission has been less explored. In fact, in the state of the art, no models specifically designed to make medium-term readmission predictions (2–3 months after admission) have been found. This work presents a new intelligent clinical decision support system to predict the risk of hospital readmission in 90 days in patients with COPD after an episode of acute exacerbation. Methods: The system is structured in two levels: the first one consists of three machine learning algorithms —Random Forest, Naïve Bayes, and Multilayer Perceptron—that operate concurrently to predict the risk of readmission; the second level, an expert system based on a fuzzy inference engine that combines the generated risks, determining the final prediction. The employed database includes more than five hundred patients with demographic, clinical, and social variables. Prior to building the model, the initial dataset was divided into training and test subsets. In order to reduce the high dimensionality of the problem, filter-based feature selection techniques were employed, followed by recursive feature selection supported by the use of the Random Forest algorithm, guaranteeing the usability of the system and its potential integration into the clinical environment. After training the models in the first level, the knowledge base of the expert system was determined on the training data subset using the Wang–Mendel automatic rule generation algorithm. Results: Preliminary results obtained on the test set are promising, with an AUC of approximately 0.8. At the selected cutoff point, a sensitivity of 0.67 and a specificity of 0.75 were achieved. Conclusions: This highlights the system’s future potential for the early identification of patients at risk of readmission. For future implementation in clinical practice, an extensive clinical validation process will be required, along with the expansion of the database, which will likely contribute to improving the system’s robustness and generalization capacity. Full article

Polydeoxyribonucleotides (PDRNs) and polynucleotides (PNs) are similar DNA-derived biopolymers that have garnered significant scientific attention since the 1990s for their potential applications in wound healing and skin rejuvenation. These biopolymers exhibit a broad molecular weight (MW) range, typically spanning from 50 to 1500 kDa. However, recent studies have expanded this range to encompass fragments as small as 1 kDa and as large as 10,000 kDa. Clinically, PDRN/PN formulations, commercially available in various galenic forms (gels, creams, serums, masks, and injectables), have demonstrated promising effects in significantly promoting skin regeneration, reducing inflammation, improving skin texture, preventing scar formation, and mitigating wrinkles. Importantly, despite their widespread use in cosmetology and aesthetic dermatology, the interchangeable use of the terms “PDRN” and “PN” in the scientific literature (to describe polymers of varying lengths) has led to considerable confusion within the medical and scientific communities. To specifically address this PDRN/PN ambiguity, this narrative review proposes a standardized structure-based nomenclature for these DNA-derived polymers, the “Marques Polynucleotide Cutoff”, set at 1500 kDa. Thus, we propose that the term “PDRN” should be exclusively reserved for small- and medium-chain polymers (MW < 1500 kDa), while the term “PN” should specifically be used to denote longer-chain polymers (MW ≥ 1500 kDa). In a broader perspective, this classification is based on the distinct physicochemical properties and therapeutic effects of these DNA fragments of various MWs, which are comprehensively discussed in the present review. Full article

Hydrogen (H2) offers a green medium for storing the excess from renewables production instead of dumping it, thus being crucial to decarbonisation efforts. Hydrogen also offers a storage medium for the grid’s cheap electricity to be used during grid peak demand or grid power cutoffs. Funded by the Scottish Government’s Emerging Energy Technologies, this paper presents the design and performance analysis of a hydrogen uninterruptible power supply (H2GEN) for Cygnas Solutions Ltd., which is intended to enable continuity of supply in the residential sector while eradicating the need for environmentally and health risky lead–acid batteries and diesel generator backup. This paper presents the design, optimal sizing and analysis of two H2Gen architectures, one powered by the grid alone and the other powered by both the grid and a renewable (PV) source. By developing a model of each architecture in the HOMER space and using residential location weather data, the home yearly load–demand profile, and the grid yearly power outages profile in the developed models, the optimal sizing of each H2Gen design was realised by minimising the costs while ensuring the H2Gen meets the home power demand during grid outages To enable HOMER to optimise its selection, the sizes, technical specifications and costs of all the market-available H2GEN components were added in the HOMER search space. Moreover, the developed models were also used in assessing the sensitivity of the simulation outputs to several changes in the modelled system design and settings. Using a residential home with frequent power outages in New Delhi, India as a case study, it was found that the optimal sizing of H2Gen Architecture 1 is comprised of a 2 kW electrolyser, a 0.2 kg type-I tank, and a 2 kW water-cooled fuel cell directly connected to the AC bus, offering an operational lifetime of 14.3 years. It was also found that the optimal sizing of Architecture 2 is comprised of a 1 kV PV utilised with the same 2 kW electrolyser, 0.2 kg type-I tank and 2 kW water-cooled fuel cell connected to the AC bus. While the second design was found to have a higher capital cost due to the added PV, it offered a more cost-effective and environmentally friendly architecture, which contributes to the ongoing energy transition. This paper further investigated the capacity expansion of each H2GEN architecture to meet higher load demands or increased grid power outages. From the analysis of the simulation results, it has been concluded that the most feasible and cost-effective H2GEN system expansion for meeting increased power demands or increased grid outages can be realised by using the developed models for optimally sizing the expanded H2Gen on a case-by-case basis because the increase in these profiles is highly time-dependent (for example, an increased load demand or increased grid outage in the morning can be met by the PV, while in the evening, it must be met by the H2GEN). Finally, this paper investigated the impact of other environmental variables, such as the temperature and relative humidity, on the H2GEN’s performance and provided further insights into increasing the overall system efficiency and cost benefit through utilising the H2GEN’s exhaust heat in the home space for heating/cooling and selling the electrolyser exhaust’s O₂ as a commodity. Full article

Background: EphA2, a receptor-type tyrosine kinase, is overexpressed in several cancers, including colorectal cancer (CRC), and can be detected as soluble EphA2 in serum. This study aimed to investigate the relationship between soluble EphA2 and CRC. Methods: Serum samples were collected from 65 patients with CRC and 19 healthy individuals. Time-series changes in soluble EphA2 levels were measured in CRC cell lines to verify the release of EphA2 into the culture medium. Results: Soluble EphA2 levels were significantly higher in patients than in healthy individuals (p < 0.0001). Specifically, even in early-stage cancer, there was a notable difference between healthy individuals and patients with Stage I CRC (p = 0.00298), highlighting the potential of EphA2 as a biomarker for early detection. Additionally, correlations were observed with tumor size (p = 0.0346), depth of invasion (p = 0.0311), and lymphatic invasion (p = 0.0431). A receiver operating characteristic (ROC) analysis yielded an area under the curve (AUC) of 0.90 with 93.8% sensitivity and 78.9% specificity at a cutoff value of 448 pg/mL. Conclusions: These findings suggest that serum EphA2 could serve as a valuable biomarker for the early detection of CRC, offering a practical and minimally invasive alternative to conventional tumor markers. Full article

Background: In this retrospective study, we evaluate the diagnostic utility of C-reactive protein (CRP) and leucocyte count within the EAES 2015 guidelines for acute appendicitis (AA) in differentiating uncomplicated (UAA) from complicated AA (CAA). Methods: Conducted at a tertiary care center in Germany, the study included 285 patients over 18 years who were diagnosed with AA from January 2019 to December 2021. Patient data included demographics, inflammatory markers, and postoperative outcomes. Results: CRP levels (Md: 60.2 mg/dL vs. 10.5 mg/dL; p < 0.001) and leucocyte count (Md: 14.4 Gpt/L vs. 13.1 Gpt/L; p = 0.016) were higher in CAA. CRP had a medium diagnostic value for detecting CAA (AUC = 0.79), with a cutoff at 44.3 mg/L, making it more likely to develop CAA. Leucocyte count showed low predictive value for CAA (AUC = 0.59). CRP ≥ 44.3 mg/L was associated with a higher risk of postoperative complications (OR: 2.9; p = 0.002) and prolonged hospitalization (OR: 3.5; p < 0.001). Conclusions: CRP, within the context of the EAES classification, presents as a valuable diagnostic marker to distinguish CAA from UAA, with a higher risk of postoperative complications and hospitalization. Leucocyte count showed low diagnostic value for the identification of CAA. Full article

Reverse flotation is a commonly used method for separating carbonate minerals from apatite, but its application to phosphate beneficiation coarse rejects, which are low in P₂O₅, is often costly due to the high collector dosages used. This study aimed to explore alternative techniques for preconcentration before flotation to improve recovery rates and reduce costs. Our investigation focused on dense medium separation and acid leaching. Dense medium separation, conducted at a cut-off density of 2.76, yielded a preconcentrate with 27% P₂O₅ and a recovery rate of 90%. The feed material had an initial P₂O₅ content of 20.52% and a particle size range of +40 µm to −4 mm. In contrast, acid leaching, employing an 8% acetic acid solution over 35 min, yielded a concentrate with 29.11% P₂O₅, an LOI of 8.99%, and a recovery rate of 100% from an ore fraction [400–200 µm] with an initial P₂O₅ content of 22.82% and an LOI of 15.78%. Furthermore, integrating flotation and leaching resulted in a concentrate with 32.27% P₂O₅ and a recovery rate of 98.38%. These findings suggest that combining acid leaching with flotation can enhance P₂O₅ recovery and reduce processing costs for low-grade phosphate ores. Full article

Medium-nickel cobalt-free cathode materials have attracted much attention in recent years for their low cost and high energy density. However, the structural stability of nickel-based cathode materials becomes compromised when accompanied by the increasing of voltage, leading to poor cycling performance and, thus, hindering their widespread industrial application. In this work, we investigated the optimal charge cut-off voltage for the nickel-based cathode material LiNi_0.6Mn_0.4O₂ (NM64). Within the voltage range of 3.0 to 4.5 V, the electrode energy density reached 784.08 Wh/kg, with an initial Coulombic efficiency of 84.49%. The reversible specific capacity at 0.1 C reached 197.84 mAh/g, and it still maintained a high reversible specific capacity of nearly 150 mAh/g, with a capacity retention rate of 86% after 150 cycles at 1 C. Furthermore, NM64 exhibited an intact morphological structure without noticeable cracking after 150 cycles, indicating excellent structural stability. This study emphasizes the relationship between the stability of NM64 cathodes and different operating voltage ranges, thereby promoting the development of high-voltage layered nickel-based cathode materials. Full article

Background: This study aims to verify the accuracy of item 10 on the energy level of the Short-Form Health Survey (SF-12) in an item screening according to Mood Disorder Questionnaire (MDQ) results, providing a measure of hyper-energy. Methods: Regression techniques were employed in a dataset comprising 4093 records of respondents to test both linear and nonlinear relationships between predictor and outcome variables (energy level and symptoms considered in the MDQ). We examined the relationship of energy level with cases identified using MDQ with a cut-off of 7. Results: Levels of energy, as rated on item 10 of the SF-12, were related to the MDQ score with sensitivity = 0.72 and specificity = 0.70. In linear regression, the associations were stronger with MDQ items on excessive energy or activity, showing a medium effect size and an explained variance of 10% or higher. A greater association was observed for items on excessive energy and activity, as expected, as well as for items concerning self-confidence, sociability, and talkativeness. Conclusions: This result may have implications for the research on risk factors and the pathogenesis of the dysregulation of mood, energy, and social rhythms syndrome (DYMERS), a syndrome that is hypothesized to occur in stressful conditions like those shown under the COVID-19 pandemic. Full article