Search Results (1,105)

Objectives: Surface-Guided Radiation Therapy (SGRT) has been widely adopted in breast cancer radiotherapy, particularly for improving setup accuracy and motion management. Recently, its application in lung cancer has attracted growing interest due to similar needs for precision. This study investigates the feasibility and clinical utility of SGRT in lung cancer treatment, focusing on its effectiveness in patient setup and real-time motion monitoring under frameless immobilization conditions. Materials and Methods: A total of 204 treatment records from 17 patients with primary lung cancer who underwent radiotherapy at Korea University Guro Hospital between October 2024 and April 2025 were retrospectively analyzed. Patients were initially positioned using the Identify system (Varian) in the CT suite, with surface data transferred to the treatment room system. Alignment was performed to within ±1 cm and ±2° across six degrees of freedom. Cone-beam CT (CBCT) was acquired prior to treatment for verification, and treatment commenced when the Distance to Correspondence Surface (DCS) was ≤0.90. Setup deviations from the Identify system were recorded and compared with CBCT in three translational axes to evaluate positioning accuracy and PTV displacement. Results and Conclusions: The Identify system was shown to provide high setup accuracy and reliable real-time motion monitoring in lung cancer radiotherapy. Its ability to detect patient movement and automatically interrupt beam delivery contributes to enhanced treatment safety and precision. In addition, even though the maximum longitudinal (Lng) shift reached up to −1.83 cm with surface-guided setup, and up to 1.78 cm (Lat) 5.26 cm (Lng), 9.16 cm (Vrt) with CBCT-based verification, the use of Identify’s auto-interruption mode (±1 cm in translational axes, ±2° in rotational axes) allowed treatment delivery with PTV motion constrained within ±0.02 cm. These results suggest that, due to significant motion in the longitudinal direction, appropriate PTV margins should be considered during treatment planning. The Identify system enhances setup accuracy in lung cancer patients using a surface-guided approach and enables real-time tracking of intra-fractional errors. SGRT, when implemented with systems such as Identify, shows promise as a feasible alternative or complement to conventional IGRT in selected lung cancer cases. Further studies with larger patient cohorts and diverse clinical settings are warranted to validate these findings. Full article

This paper presents an advanced energy management system (EMS) for optimizing power distribution in a battery/ultracapacitor (UC) hybrid energy storage system (HESS) for electric vehicles (EVs). The proposed EMS accounts for all energy flow scenarios within a practical driving cycle. A regenerative braking control strategy is developed to maximize kinetic energy recovery using an induction motor, efficiently distributing the recovered energy between the UC and battery. Additionally, a power flow management approach is introduced for both motoring (discharge) and braking (charge) operations via bidirectional buck–boost DC-DC converters. In discharge mode, an optimal distribution factor is dynamically adjusted to balance power delivery between the battery and UC, maximizing efficiency. During charging, a DC link voltage control mechanism prioritizes UC charging over the battery, reducing stress and enhancing energy recovery efficiency. The proposed EMS is validated through simulations and experiments, demonstrating significant improvements in vehicle acceleration, energy efficiency, and battery lifespan. Full article

Background: Pain is a complex phenomenon characterized by unpleasant experiences with profound heterogeneity influenced by biological, psychological, and social factors. According to the National Health Interview Survey, 50.2 million U.S. adults (20.5%) experience pain on most days, with the annual cost of prescription medication for pain reaching approximately USD 17.8 billion. Theranostic pain nanomedicine therefore emerges as an attractive analgesic strategy with the potential for increased efficacy, reduced side-effects, and treatment personalization. Theranostic nanomedicine combines drug delivery and diagnostic features, allowing for real-time monitoring of analgesic efficacy in vivo using molecular imaging. However, clinical translation of these nanomedicines are challenging due to complex manufacturing methodologies, lack of standardized quality control, and potentially high costs. Quality by Design (QbD) can navigate these challenges and lead to the development of an optimal pain nanomedicine. Our lab previously reported a macrophage-targeted perfluorocarbon nanoemulsion (PFC NE) that demonstrated analgesic efficacy across multiple rodent pain models in both sexes. Here, we report PFC-free, biphasic nanoemulsions formulated with a biocompatible and non-immunogenic plant-based coconut oil loaded with a COX-2 inhibitor and a clinical-grade, indocyanine green (ICG) near-infrared fluorescent (NIRF) dye for parenteral theranostic analgesic nanomedicine. Methods: Critical process parameters and material attributes were identified through the FMECA (Failure, Modes, Effects, and Criticality Analysis) method and optimized using a 3 × 2 full-factorial design of experiments. We investigated the impact of the oil-to-surfactant ratio (w/w) with three different surfactant systems on the colloidal properties of NE. Small-scale (100 mL) batches were manufactured using sonication and microfluidization, and the final formulation was scaled up to 500 mL with microfluidization. The colloidal stability of NE was assessed using dynamic light scattering (DLS) and drug quantification was conducted through reverse-phase HPLC. An in vitro drug release study was conducted using the dialysis bag method, accompanied by HPLC quantification. The formulation was further evaluated for cell viability, cellular uptake, and COX-2 inhibition in the RAW 264.7 macrophage cell line. Results: Nanoemulsion droplet size increased with a higher oil-to-surfactant ratio (w/w) but was no significant impact by the type of surfactant system used. Thermal cycling and serum stability studies confirmed NE colloidal stability upon exposure to high and low temperatures and biological fluids. We also demonstrated the necessity of a solubilizer for long-term fluorescence stability of ICG. The nanoemulsion showed no cellular toxicity and effectively inhibited PGE2 in activated macrophages. Conclusions: To our knowledge, this is the first instance of a celecoxib-loaded theranostic platform developed using a plant-derived hydrocarbon oil, applying the QbD approach that demonstrated COX-2 inhibition. Full article

Background: Neonatal jaundice is common and can cause severe hyperbilirubinemia if untreated. The early identification of at-risk newborns is challenging despite the existing guidelines. Objective: This study aimed to identify the key maternal and neonatal risk factors for jaundice requiring phototherapy using machine learning. Methods: In this study hospital, phototherapy was administered following the American Academy of Pediatrics (AAP) guidelines when a neonate’s transcutaneous bilirubin level was in the high-risk zone. To identify the risk factors for phototherapy, we retrospectively analyzed the electronic medical records of 8242 neonates admitted between 2017 and 2022. Predictive models were trained using maternal and neonatal data. XGBoost showed the best performance (AUROC = 0.911). SHAP values interpreted the model. Results: Mode of delivery, neonatal feeding indicators (including daily formula intake and breastfeeding frequency), maternal BMI, and maternal white blood cell count were strong predictors. Cesarean delivery and lower birth weight were linked to treatment need. Conclusions: Machine learning models using perinatal data accurately predict the risk of neonatal jaundice requiring phototherapy, potentially aiding early clinical decisions and improving outcomes. Full article

Objective: This study aimed to evaluate and compare maternal and fetal outcomes between pregnancies in women aged 40 and over and those in women under 40 years of age at a tertiary care hospital. Methods: A retrospective cohort study was conducted at Necmettin Erbakan University Medical Faculty Hospital, analyzing data from 345 women aged 40 and over and 366 women under 40 who delivered between January 2015 and December 2024. Maternal and perinatal outcomes—including mode of delivery, gestational age, birth weight, and complications such as gestational diabetes, preeclampsia, and postpartum hemorrhage—were compared between the two groups. Results: Women aged 40 and over had significantly higher rates of cesarean section (73% vs. 36.1%, p < 0.0001), preterm delivery (27.8% vs. 18%, p = 0.002), and gestational diabetes (14.8% vs. 7.7%, p = 0.002). Additionally, these women had a higher incidence of preeclampsia (13% vs. 5.7%, p = 0.001) and postpartum hemorrhage (18% vs. 10.5%, p = 0.003). Despite these increased risks, the 5 min APGAR score was significantly higher in the ≥40 age group (median 8 vs. 7, p < 0.0001). The incidence of chromosomal abnormalities was significantly higher in patients≥ 40 years, with 5 cases (1.4%) reported, compared to no cases (0%) in the <40 age group (p = 0.025). Conclusions: This study shows that pregnancies in women aged 40 and above carry higher maternal and fetal risks compared to younger women. Complications such as preterm labor, cesarean delivery, gestational diabetes, and preeclampsia occur more frequently in this group. However, with careful prenatal care, positive neonatal outcomes are often achievable, highlighting the need for age-specific management and early risk detection. Full article

This study investigates the optimization of urban parcel delivery by integrating logistics vehicles and onboard drones within a static road network. A centralized delivery hub is responsible for coordinating both modes of transport to minimize total vehicle operation costs and customer waiting times. A simulation-based framework is developed to accurately model the delivery process. An enhanced Ant Colony Optimization (ACO) algorithm is proposed, incorporating a multi-objective formulation to improve route planning efficiency. Additionally, a scheduling algorithm is designed to synchronize the operations of multiple delivery bikes and drones, ensuring coordinated execution. The proposed integrated approach yields substantial improvements in both cost and service efficiency. Simulation results demonstrate a 16% reduction in vehicle operation costs and an 8% decrease in average customer waiting times relative to benchmark methods, indicating the practical applicability of the approach in urban logistics scenarios. Full article

By 2030, millions of new cancer cases will be diagnosed, as well as millions of cancer-related deaths. Traditional drug delivery methods have limitations, so developing smart drug delivery systems (SDDs) has emerged as a promising avenue for more effective and precise cancer treatment. Nanotechnology, particularly nanomedicine, provides innovative approaches to enhance drug delivery, including the use of nanoparticles. One such type of SDD is thermosensitive nanoparticles, which respond to internal and external stimuli, such as temperature changes, to release drugs precisely at tumor sites and minimize off-target effects. On the other hand, hyperthermia is a cancer treatment mode that goes back centuries and has become popular because it can target cancer cells while sparing healthy tissue. This paper presents a comprehensive review of smart thermosensitive nanoparticles for cancer treatment, with a primary focus on organic nanoparticles. The integration of hyperthermia with temperature-sensitive nanocarriers, such as micelles, hydrogels, dendrimers, liposomes, and solid lipid nanoparticles, offers a promising approach to improving the precision and efficacy of cancer therapy. By leveraging temperature as a controlled drug release mechanism, this review highlights the potential of these innovative systems to enhance treatment outcomes while minimizing adverse side effects. Full article

Background/Objectives: Recent changes in obstetric practices and population demographics have prompted a re-evaluation of labor patterns. This study aimed to characterize labor patterns in a Greek pregnant population using ultrasound and compare them with established labor curves. Methods: A prospective cohort study was conducted at the Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece, over a two-year period (December 2022 to June 2024). Transabdominal ultrasound was used to determine the fetal head position and transperineal ultrasound was used to measure angle of progression (AoP) and head–perineum distance (HPD) during labor. Maternal and labor characteristics, including body mass index (BMI), parity, labor duration, and mode of delivery, were recorded. Statistical analysis included mixed linear models to assess the relationship between AoP, HPD, and cervical dilatation. Results: In total, 500 parturients were included in this study. Women entered the active phase of labor approximately 5 h before delivery, with AoP increasing sharply and HPD decreasing rapidly at this point. Cesarean section (CS) cases showed a slower increase in AoP compared to vaginal deliveries (VDs), with CS cases having a mean AoP of 117.9° (95% CI: 111.6–124.2°) at full dilation, compared to 133.4° (95% CI: 130.6–136.2°) in VD. HPD values declined more slowly in CS cases, with a mean HPD of 45.1 mm (95% CI: 40.6–49.6 mm) at full dilation, compared to 36.4 mm (95% CI: 34.3–38.5 mm) in VD. Epidural analgesia was associated with steeper increases in AoP and decreases in HPD in the final 2.5 h before delivery, while oxytocin administration accelerated these changes in the last 3–4 h. The mean time to delivery was 3.19 h (95% CI: 2.80–3.59 h) when AoP reached 125° and 3.92 h when HPD was 40 mm (95% CI: 3.53–4.30 h). BMI in women who gave birth via CS was significantly higher compared to VD (32.03 vs. 29.94 kg/m², p-value: 0.008), and the total duration of labor was shorter in VD compared to CS and operative vaginal delivery (OVD) (8 h vs. 15 h, p-value < 0.001 and 8 h vs. 12 h, p-value < 0.001, respectively). Birthweight was also lower in VD compared to CS (3103.09 g vs. 3267.88 g, p-value: 0.05). Conclusions: This study provides the first ultrasonographic characterization of labor patterns in a Greek population, highlighting the utility of ultrasound in objectively assessing labor progression. Full article

Background/Objectives: Pelvic floor disorders (PFDs) have multifactorial etiology. This makes treatment challenging and often unsatisfactory. This project introduces robust data on risk factors for PFDs and explores opportunities for their prevention, focusing on previous gynecological surgical interventions. Methods: We conducted a retrospective analytical cohort study analyzing demographic and clinical data from 832 consecutive patients who underwent pelvic organ prolapse (POP) surgery at a teaching hospital affiliated with the University of Cologne between 2010 and 2019. Patient characteristics—including age, body mass index (BMI), parity, mode of delivery, and symptoms—were collected from medical records. Associations between patient factors and surgical history were assessed using Kendall’s Tau (KT) for correlations and relative risks (RRs) with 95% confidence intervals (CIs) to evaluate the impact of previous hysterectomies and pelvic surgeries on PFD. Results: First vaginal delivery and age were the strongest factors associated with PFD. BMI had a smaller impact, and multiple vaginal deliveries did not significantly influence apical (KT 0.037), posterior (KT 0.007), anterior midline (KT 0.015), or lateral defects (KT 0.015). Cesarean section was protective. Subtotal hysterectomy showed no significant association with PFD. Total hysterectomy was strongly associated with posterior defects (RR 4.750, 95% CI: 1.871–12.059) and anterior midline defects (RR 1.645, 95% CI: 0.654–4.139). Recurrent urinary infections were associated with abdominal colposuspension (RR 4.485, 95% CI: 1.12–18.03). Dyspareunia occurred more frequently after vaginal (RR 3.971, 95% CI: 0.78–20.14) and abdominal hysterectomy (RR 1.620, 95% CI: 0.32–8.15). Vaginal hysterectomy was linked to fecal incontinence (RR 5.559, 95% CI: 1.17–26.30), MUI (RR 2.156, 95% CI: 1.09–4.23), and UUI (RR 4.226, 95% CI: 1.82–6.85). Conclusions: The factors identified as influencing (PFD) offer a solid foundation for evidence-based patient counseling within our population. Our large dataset confirmed key risk factors, notably childbirth and advancing age. However, the influence of BMI on symptoms and anatomical defects appears to be less significant than previously assumed. Subtotal hysterectomy was not associated with new PFD in our cohort and may represent a viable option when hysterectomy is indicated, though further studies are needed to confirm this potential advantage. Full article

Prefabricated construction elements are widely used in both large- and small-scale projects, serving structural and infrastructural purposes. One notable application is in power transmission poles, which ensure the safe and efficient delivery of electricity. Despite their importance, limited research exists on the structural and modal behavior of reinforced concrete power poles. This study presents a comprehensive modal analysis of such poles, focusing on how factors like modulus of elasticity, height, and lower/upper inner and outer diameters influence dynamic performance. A total of 3240 finite element models were created, with reinforced concrete poles partially embedded in the ground. Modal analyses were performed to evaluate natural frequencies, mode shapes, and modal mass participation ratios. Results showed that increasing the modulus of elasticity raised frequency values, while greater pole height decreased them. Enlarging the lower inner and upper outer radii also led to higher frequencies. Regression analysis yielded high accuracy, with R² values exceeding 90% and an average error rate of about 6%. The study provides empirical formulas that allow for quick frequency estimations without the need for detailed finite element modeling, as long as the material and geometric properties remain consistent. The approach can be extended to other prefabricated structural elements. Full article

Background: Physical exercise during pregnancy is strongly recommended due to its well-established benefits for both mother and child. However, its impact on the pelvic floor remains insufficiently studied. This study aimed to evaluate pelvic floor adaptations to a structured prenatal exercise program using transperineal ultrasound, and to assess associations with the duration of the second stage of labor and mode of delivery. Methods: This is a planned secondary analysis of a randomized controlled clinical trial (RCT) (NCT04563065) including women with singleton pregnancies at 12–14 weeks of gestation. Participants were randomized to either an exercise group, which followed a supervised physical exercise program three times per week, or a control group, which received standard antenatal care. Transperineal ultrasound was used at the second trimester of pregnancy and six months postpartum to measure urogenital hiatus dimensions at rest, during maximal pelvic floor contraction, and during the Valsalva maneuver, to calculate hiatal contractility and distensibility and to evaluate levator ani muscle insertion. Regression analyses were performed to assess the relationship between urogenital hiatus measurements and both duration of the second stage of labor and mode of delivery. Results: A total of 78 participants were included in the final analysis: 41 in the control group and 37 in the exercise group. The anteroposterior diameter of the urogenital hiatus at rest was significantly smaller in the exercise group compared to controls (4.60 mm [SD 0.62] vs. 4.91 mm [SD 0.76]; p = 0.049). No other statistically significant differences were observed in static measurements. However, contractility was significantly reduced in the exercise group for both the latero-lateral diameter (8.54% vs. 4.04%; p = 0.012) and hiatus area (20.15% vs. 12.55%; p = 0.020). Distensibility was similar between groups. There were no significant differences in the duration of the second stage of labor or mode of delivery. Six months after delivery, there was an absolute risk reduction of 32.5% of levator ani muscle avulsion in the exercise group compared to the control group (53.3% and 20.8%, respectively; p = 0.009). Conclusions: A supervised exercise program during pregnancy appears to modify pelvic floor morphology and function, reducing the incidence of levator ani muscle avulsion without affecting the type or duration of delivery. These findings support the safety and potential protective role of prenatal exercise in maintaining pelvic floor integrity. Full article

Brain cancer is a heterogeneous collection of malignant neoplasms, such as glioblastoma multiforme (GBM), astrocytomas and medulloblastomas, with high morbidity and mortality. Its treatment is complicated by the tumor’s site, infiltrative growth mode and selective permeability of the blood–brain barrier (BBB). During tumor formation, the BBB dynamically remodels into the blood–brain tumor barrier (BBTB), disrupting homeostasis and preventing drug delivery. Furthermore, the TME (Tumor Micro Environment) supports drug resistance, immune evasion and treatment failure. This review points out the ways in which nanomedicine overcomes these obstacles with custom-designed delivery systems, sophisticated diagnostics and personalized therapies. Traditional treatments fail through a lack of BBB penetration, non-specific cytotoxicity and swift tumor adaptation. Nanomedicine provides greater drug solubility, protection against enzymatic degradation, target drug delivery and control over the release. Nanotheranostics’ confluence of therapeutic and diagnostic modalities allows for dynamic adjustment and real-time monitoring. Nanotechnology has paved the way for the initiation of a new era in precision neuro-oncology. Transcending the limitations of conventional therapy protocols, nanomedicine promises to deliver better outcomes by way of enhanced targeting, BBB penetration and real-time monitoring. Multidisciplinary collaboration, regulatory advancements and patient-centered therapy protocols customized to the individual patient’s tumor biology will be necessary to facilitate translation success in the future. Full article

The emergence of multidrug-resistant (MDR) bacteria and biofilm-associated infections has created a significant hurdle for conventional antibiotics, prompting the exploration of alternative strategies. Photodynamic therapy (PDT), a technique that utilizes photosensitizers activated by light to produce ROS, has emerged as a beacon of hope in the fight against MDR microorganisms. Among the natural photosensitizers, hypocrellins (A and B) have shown remarkable potential with their dual-mode photodynamic action, generating ROS via both Type I (electron transfer) and Type II (singlet oxygen) pathways. This unique action disrupts bacterial biofilms and inactivates MDR pathogens. The amphiphilic nature of hypocrellins further enhances their promise, enabling deep biofilm penetration and ensuring potent antibacterial effects even in hypoxic environments, surpassing the capabilities of synthetic photosensitizers. This study critically examines the antimicrobial properties of hypocrellin-based PDT, emphasizing its mechanisms, advantages over traditional antibiotics, and effectiveness against MDR pathogens. Comparative analysis with other photosensitizers, the role of nanotechnology-enhanced delivery systems, and future clinical applications are explored. Its combination with nanotechnology enhances therapeutic outcomes, providing a viable alternative to conventional antibiotics. Further clinical research is essential to optimize its application and integration into antimicrobial treatment protocols. Full article

Driven by the rapid expansion of e-commerce in China, there is a growing demand for high-efficiency, sustainability-oriented logistics solutions in rural regions, particularly for the time-sensitive distribution of perishable agricultural commodities. Traditional logistics systems face considerable challenges in these geographically complex regions due to limited infrastructure and extended travel distances. To address these issues, this study proposes an intelligent cooperative delivery system that integrates automated drones with conventional trucks, aiming to enhance both operational efficiency and environmental sustainability. A mixed-integer linear programming (MILP) model is developed to account for the diverse terrain characteristics of rural China, including forest, lake, and mountain regions. To optimize distribution strategies, the model incorporates an improved Fuzzy C-Means (FCM) algorithm combined with a hybrid genetic simulated annealing algorithm. The performance of three transportation modes, namely truck-only, drone-only, and truck–drone integrated delivery, was evaluated and compared. Sustainability-related externalities, such as carbon emission costs and delivery delay penalties, are quantitatively integrated into the total transportation cost objective function. Simulation results indicate that the cooperative delivery model is especially effective in lake regions, significantly reducing overall costs while improving environmental performance and service quality. This research offers practical insights into the development of sustainable intelligent transportation systems tailored to the unique challenges of rural logistics. Full article

Background and Objectives: For many patients, the induction-to-delivery interval is shorter with Propess than with Prostin E2. However, some patients also require Prostin E2 to sufficiently boost their dinoprostone levels to achieve cervical change and vaginal delivery. In this study, we compared the efficacy of different timings of Prostin E2 administration after Propess use. Materials and Methods: This single-institution retrospective cohort study was conducted between January 2020 and August 2023. The inclusion criterion was an unfavorable cervix (Bishop score ≤ 6) after Propess use for 8 h. We divided the patients into three groups based on the addition of Prostin E2 at the 8th (group 1), 12th (group 2), and 24th (group 3) hour after Propess insertion. The primary outcome was the cesarean section rate. The secondary outcomes were the induction-to-birth interval, Bishop score at 24 h, neonatal outcomes, and the predictors of labor induction duration. Results: A total of 63 patients were analyzed across three groups based on the timing of Prostin E2 administration (8, 12, and 24 h). The gestational age differed significantly between groups (p < 0.001), with the highest age being observed in the 24 h group. The 8 h group had the shortest induction-to-birth interval (p < 0.001) and the highest Bishop scores after 24 h of Propess use (p < 0.001). Blood loss was lowest in the 12 h group (p = 0.027). No significant differences were found in relation to the mode of birth, tachysystole, neonatal birth weight, or Apgar scores. A multivariable analysis identified gestational age (β = 3.33; p = 0.015) and Bishop score after 24 h of PGE2 (β = −1.99; p < 0.001) as being independent predictors of labor duration. Conclusions: administering Prostin E2 to patients who had a poor response after Propess use was safe; additionally, adding it at the 8th hour after Propess initiation could result in a shorter induction-to-birth interval. Full article