Search Results (728)

We investigate the statistical entropy of black holes within the framework of the generalized uncertainty principle (GUP) by employing effective metrics that incorporate leading-order and all-order quantum gravitational corrections. We construct three distinct effective metrics induced by the GUP, which are derived from the GUP-corrected temperature, entropy, and all-order GUP corrections, and analyze their impact on black hole entropy using ’t Hooft’s brick wall method. Our results show that, despite the differences in the effective metrics and the corresponding ultraviolet cutoffs, the statistical entropy consistently satisfies the Bekenstein–Hawking area law when expressed in terms of an invariant (coordinate-independent) distance near the horizon. Furthermore, we demonstrate that the GUP naturally regularizes the ultraviolet divergence in the density of states, eliminating the need for artificial cutoffs and yielding finite entropy even when counting quantum states only in the vicinity of the event horizon. These findings highlight the universality and robustness of the area law under GUP modifications and provide new insights into the interplay between quantum gravity effects and black hole thermodynamics. Full article

Objectives: To investigate the reliability and validity of the Singer Reflux Symptom Score (sRSS), a new patient-reported outcome questionnaire documenting the severity of reflux symptoms in singing voice is proposed. Methods: Amateur and professional singers consulting the European Reflux Clinic for laryngopharyngeal reflux disease (LPRD) symptoms and findings were prospectively recruited from January 2022 to February 2023. The diagnosis was based on a Reflux Symptom Score (RSS) > 13 and Reflux Sign Assessment (RSA) > 14. A control group of asymptomatic singer subjects was recruited from the University of Mons. The sRSS was rated within a 7-day period to assess test–retest reliability. Internal consistency was measured using Cronbach’s α in patients and controls. A correlation analysis was performed between sRSS and Singing Voice Handicap Index (sVHI) to evaluate convergent validity. Responsiveness to change was evaluated through pre- to post-treatment sRSS changes. The sRSS threshold for suggesting a significant impact of LPRD on singing voice was determined by receiver operating characteristic (ROC) analysis. Results: Thirty-three singers with suspected LPRD (51.5% female; mean age: 51.8 ± 17.2 years) were consecutively recruited. Difficulty reaching high notes and vocal fatigue were the most prevalent LPRD-related singing complaints. The sRSS demonstrated high internal consistency (Cronbach-α = 0.832), test–retest reliability, and external validity (correlation with sVHI: r = 0.654; p = 0.015). Singers with suspected LPRD reported a significant higher sRSS compared to 68 controls. sRSS item and total scores significantly reduced from pre-treatment to 3 months post-treatment except for the abnormal voice breathiness item. ROC analysis revealed superior diagnostic accuracy for sRSS (AUC = 0.971) compared to sRSS-quality of life (AUC = 0.926), with an optimal cutoff at sRSS > 38.5 (sensitivity: 90.3%; specificity: 85.0%). Conclusions: The sRSS is a reliable and valid singer-reported outcome questionnaire for documenting singing symptoms associated with LPRD leading to personalized management of Singers. Future large-cohort studies are needed to evaluate its specificity for LPRD compared to other vocal fold disorders in singers. Full article

Background/Objectives: This study aimed to assess real-world toxicity and efficacy data of patients with early and advanced breast cancer (BC) who received treatment with abemaciclib. Methods: This was a prospective/retrospective multi-institutional collection of clinicopathological, toxicity, and outcome data from patients with early or metastatic hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative BC who received treatment with abemaciclib in combination with endocrine therapy in departments of oncology in Greece. Treatment combinations of abemaciclib with any endocrine therapy were accepted. The primary end point was toxicity rate in all patients of the study. Results: From June/2021 to May/2024, 245 women received abemaciclib/endocrine combination therapy; the median age was 57 years. Of these, 169 (69%) received abemaciclib as adjuvant therapy for early-stage disease, while 76 (31%) were treated for advanced BC. At the time of the data cutoff, 133 (84.7%) patients remained in the 2-year treatment period. The most common adverse event (AE) was diarrhea (51%), primarily Grade ≤ 2. Dose modifications due to AEs were required in 19.2% of cases, while treatment discontinuation occurred in 5.1%. There was no difference in dose modification/discontinuation rates between older patients (>65 years) and the remaining patients. For early-stage BC patients, the 2-year DFS and OS rates were 90.8% and 100%, respectively. In patients with advanced cancer (70, 30.8%), 1-year PFS and OS rates were 78% and 96.3%, respectively. Conclusions: This study confirms the safety and effectiveness of abemaciclib in alignment with registrational trials offering valuable insights into toxicity management and clinical outcomes in routine practice without identifying new safety concerns. Clinical Trial Registration: ClinicalTrials.gov NCT04985058. Full article

Early detection of clinical deterioration in emergency department (ED) patients is critical for timely interventions. This study evaluated the predictive performance of the National Early Warning Score (NEWS) parameters using machine learning. We conducted a single-center retrospective observational study including 27,238 adult ED patients admitted to Merano Hospital (Italy) between June 2022 and June 2023. NEWS vital signs were collected at triage, and mortality at 48 h, 7 days, and 30 days was obtained from ED database. Decision tree analysis (CHAID algorithm) was used to identify predictors of mortality; 10-fold cross-validation was applied to avoid overfitting. Mortality was 0.4% at 48 h, 1% at 7 days, and 2.45% at 30 days. For 48-h mortality, oxygen supplementation (FiO₂ >21%) and AVPU = “U” were the strongest predictors, with a maximum risk of 31.6%. For 7-day mortality, SpO₂ was the key predictor, with mortality up to 48.1%. At 30 days, patients with AVPU ≠ A, FiO₂ > 21%, and SpO₂ ≤ 94% had a mortality risk of 66.7%. Decision trees revealed different cut-offs compared to the standard NEWS. This study demonstrated that for ED patients, the NEWS may require some adjustments in both the cut-offs for vital parameters and the methods of collecting these parameters. Full article

This article investigates how to exploit the high-frequency mmWave for 5G-advanced and beyond, which requires new filters for the wide bandpass and its multi-sub-band. Based on the substrate-integrated waveguide (SIW), spoof surface plasmon polariton (SSPP), and metastructures, like complementary split-ring resonators (CSRRs), the development of a wide bandpass filter and a multi-sub-band filter is proposed, along with an experimental realization to verify the model. The upper and lower cutoff frequencies of the wide bandpass are controlled through an SIW-SSPP structure, whereas the corresponding wide bandpass and its multi-sub-band filters are designed through incorporating new metastructures. The frequency range of 24.25–29.5 GHz, which covers the n257, n258, and n261 bands for 5G applications, was selected for verification. The basic SIW-SSPP wide bandpass structure of 24.25–29.5 GHz was designed first. Then, by incorporating an Archimedean spiral configuration, the insertion loss within the passband was reduced from 1 dB to 0.5 dB, while the insertion loss in the high-frequency stopband was enhanced from 40 dB to 70 dB. Finally, CSRRs were integrated to effectively suppress undesired frequency components within the bandpass, thereby achieving multi-sub-band filters with low insertion losses with a triple-sub-band filter of 0.5 dB, 0.7 dB, and 0.8 dB in turn. The experimental results showed strong agreement with the design scheme, thereby confirming the rationality of the design. Full article

Background: Acute appendicitis is a common emergency requiring abdominal surgery. Despite its prevalence, there are no specific biomarkers for its diagnosis and prognosis. The aim of this study was to assess the basic laboratory tests of patients with acute appendicitis and to evaluate and integrate biochemical variables into the diagnosis of appendicitis. Methods: This was a retrospective, cross-sectional cohort study that included data from patients who underwent an appendectomy. Two groups of patients were considered based on their surgical (non-complicated/complicated appendicitis) or pathological diagnosis (non-perforated/perforated appendicitis). Factor analysis was carried out to identify communalities to put forward classificatory indices. Receiver operating characteristic (ROC) analysis was used to assess the accuracy of the predictions. Results: The cohort included 246 patients (51.6% male, mean age: 24.79 ± 19.32 years). By using their biochemical data, we generated 6 new indices whose areas under the ROC curve (AUC) ranged between 0.632 and 0.762 for complicated appendicitis and from 0.597 to 0.742 for perforated appendicitis. Inflammatory Metabolic Index (IMI) at the fixed cutoffs was a promising biomarker for both histopathological and surgical diagnoses with odds ratios (OR) of 10.45 and 5.21, respectively. The Metabolic-Inflammatory Stress Index (MISI) showed high specificity (over 72%) and significant AUC values for both diagnoses (0.742 and 0.676). These findings were reinforced by significant p-values and Youden indices. Conclusions: IMI and MISI were demonstrated to be effective biomarkers for complicated and perforated appendicitis. IMI provides predictive capability, while MISI offers specificity and significant AUC values for both histopathological and surgical diagnoses. Incorporating these biomarkers could enhance the accuracy of appendicitis diagnosis and potentially guide clinical decision-making. Full article

Aiming at the problems of low withstand voltage and poor RF performance of traditional HEMT devices, a new AlGaN/GaN high electron mobility transistor device with a π-gate (NπGS HEMT) is designed in this paper. The new structure incorporates a π-gate design along with a PN-junction field plate and an AlGaN back-barrier layer. The device is modeled and simulated in Silvaco TCAD 2015 software and compared with traditional t-gate HEMT devices. The results show that the NπGS HEMT has a significant improvement in various characteristics. The new structure has a higher peak transconductance of 336 mS·mm⁻¹, which is 13% higher than that of the traditional HEMT structure. In terms of output characteristics, the new structure has a higher saturation drain current of 0.188 A/mm. The new structure improves the RF performance of the device with a higher maximum cutoff frequency of about 839 GHz. The device also has a better performance in terms of voltage withstand, exhibiting a higher breakdown voltage of 1817 V. These results show that the proposed new structure could be useful for future research on high voltage withstand and high RF HEMT devices. Full article

Substitutional doping of fullerenes represents a significant category of heterofullerenes. Due to the vast number of isomers, confirming the ground state structure poses considerable challenges. In this study, we generated isomers of C_60−nB_n and C_60−nN_n with n ranging from 2 to 12. To avoid overlooking the ground state structures, we applied specific filtering rules: no adjacent nitrogen (N) or boron (B) atoms are allowed, and substitutions in meta-positions within pentagons are prohibited when the substitution number n exceeds nine. Approximately 15,000 isomers across various values of n within the range of 2 to 12 for B and N substituted fullerenes were selected and optimized using density functional theory (DFT) calculations, forming our dataset. We developed a Graph Neural Network (GNN) that aggregates both topological connections and its dual graph with ring types as input information to predict their binding energies. The GNN achieved high accuracy, reaching a root mean square error (RMSE) of 1.713 meV. Furthermore, it operates efficiently; indeed, it can predict over six thousand isomers per second on an eight-core PC. Several predicted stable structures were further optimized by DFT to confirm their ground state configurations. The energy cutoffs of each composition were determined through statistical simulations to ensure that the selected ground state structures possess high confidence levels. Notably, new lower-energy structures have been discovered for boron-substituted fullerenes with substitution number ranging from seven to twelve and nitride-substituted fullerenes with substitution number ranging from seven to eleven. Full article

To enhance the DC and RF performance of AlGaN/GaN HEMTs, a novel device structure was proposed and investigated through simulation. The key innovation of this new structure lies in the incorporation of an Al_0.7In_0.15Ga_0.15N back-barrier layer and an N-type locally doped AlGaN barrier layer (BD-HEMT), based on conventional device architecture. The Al_0.7In_0.15Ga_0.15N back-barrier layer effectively confines electrons within the channel, thereby increasing the electron concentration. Simultaneously, the N-type locally doped AlGaN barrier layer introduced beneath the gate supplies additional electrons to the channel, further enhancing the electron density. These modifications collectively lead to improved DC and RF characteristics of the device. Compared to the conventional AlGaN/GaN HEMT, BD-HEMT achieves a 24.8% increase in saturation drain current and a 10.4% improvement in maximum transconductance. Furthermore, the maximum cutoff frequency and maximum oscillation frequency are enhanced by 14.8% and 21.2%, respectively. Full article

Background/Objectives: Nonvalvular atrial fibrillation (NVAF) is a prevalent arrhythmia associated with elevated risks of stroke, systemic embolism, and mortality. Emerging evidence underscores the pivotal role of inflammation in NVAF pathogenesis. The CHA₂DS₂-VA score is currently the most powerful tool used in the management of patients with atrial fibrillation, and integrating novel inflammatory biomarkers—neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI)—into this score may enhance prognostic accuracy and guide personalized therapy. Methods: In this observational case–control study, a cohort of 330 NVAF patients and 201 controls, inflammatory and biochemical parameters were measured and compared, we employed multivariate logistic regression and ROC analyses to validate the discriminative power of novel inflammatory indexes and novel CHA₂DS₂-VA score, setting a new benchmark for biomarker integration in NVAF management. Results: Inflammatory indexes (NLR, PLR, SII, SIRI) were significantly higher in NVAF patients compared to controls (p < 0.001). Multivariate analysis identified NLR (OR = 4.02), PLR (OR = 1.04), SII (OR = 1.01), and SIRI (OR = 1.87) as independent NVAF risk markers. The CHA₂DS₂-VA score showed the strongest association with NVAF (OR = 5.55), and an optimal cutoff of ≥2 yielded 88.18% sensitivity and 74.63% specificity. Conclusions: Inflammatory markers NLR, PLR, SII, and SIRI, when assessed alongside the CHA₂DS₂-VA score, offer significant and complementary prognostic insight for patients with NVAF. These findings support the integration of inflammatory indexes into routine clinical risk assessment models to enhance early identification of high-risk individuals and inform personalized therapeutic strategies. Moreover, our findings provide a rationale for developing composite risk scores in future studies that integrate inflammatory biomarkers with the CHA₂DS₂-VA score (e.g., a CHA₂DS₂-VA-Inflammation Score). Further large-scale, longitudinal studies are warranted to validate these results and explore the benefits of inflammation-targeted interventions. Full article

Background/Objectives: Given the increasing interest in the predictive role of inflammation in oncology, we aimed to assess the association between inflammatory factors (IFs) and the histopathological characteristics of bladder cancer (BC). Our objective was to correlate some of these IFs with BC progression and recurrence, identifying possible new diagnostic tools. Methods: We retrospectively analyzed 285 patients (79.8% male, 20.4% female; median age 73) who underwent transurethral resection of the bladder (TURB) between January 2016 and January 2022. The preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), pan-immune-inflammation value (PIV), systemic inflammation response index (SIRI), and standard clinical variables were collected one month before TURB and evaluated as predictors of recurrence and progression. Patients were stratified using the Youden Index and ROC analysis. Cox regression models were applied to identify independent predictors. Results: High-grade tumors were present in 74.6% of cases, and 34% were recurrent. Carcinoma in situ was found in 5%. After 72 months, 53% underwent radical cystectomy, and 13.7% died within 5 years. The optimal cutoffs were PLR 139, SIRI 1.12, PIV 248.49, NLR 2, SII 327. Smoking, primary MIBC, age, and lymph node status were significantly associated with recurrence. Elevated PLR correlated with recurrence and T2 progression (p = 0.004). Higher SIRI, PIV, and PLR levels were significantly associated with lymphovascular invasion and nodal metastasis (p < 0.05). PLR was linked to recurrence in tumors ≥ 3 cm post-BCG (p = 0.004); high SIRI predicted recurrence within 48 months (p = 0.05). Conclusions: High PLR and SIRI levels were associated with recurrence. Our findings support the emerging role of IFs in predicting BC outcomes and suggest their potential inclusion in future prognostic models. Full article

Objectives: Inflammation plays an important role in cancer development, and various inflammation parameters are used as potential prognostic markers. This study aimed to evaluate the effectiveness of the combined use of HALP and H index in predicting pathological response to neoadjuvant therapy in patients with HER2-positive early-stage breast cancer. Method: This retrospective cohort study was conducted on 146 HER2-positive breast cancer patients treated in two centers. To stratify patients by their predicted probability of pathological response, HALP and H index values were combined into a composite biomarker score called the combined response score (CRS). Patients were classified into three groups based on biomarker levels: 0 = low CRS (low predictive score), 1 = intermediate CRS, and 2 = high CRS (high predictive score). These groups reflect predicted response likelihood and do not represent actual pathological outcomes. Pathological response results were evaluated according to the combined response score. Pathological complete response (pCR) was defined as residual cancer burden (RCB) 0, indicating no residual invasive tumor in breast or lymph nodes. Results: The mean age of 146 early-stage breast cancer patients included in our study was 52.3 ± 11.3 (min: 29-max: 83). In the ROC analysis, the optimum cut-off value for the HALP score in pathological response classification was found to be 36 (AUC = 0.608, sensitivity = 76.29%, specificity = 44.9%, PPV = 73%, NPV = 47.89%) and 2.3 for the H index (AUC = 0.641, sensitivity = 65.98%, specificity = 51.02%, PPV = 72.73%, NPV = 43.1%). While the pathological complete response rate was 66.4% in all patients, it was 81.8% in those with a combined score of 2, 51% in those with a score of 1, and 58.6% in those with a score of 0 (p < 0.001). In the logistic regression analysis, the probability of pathological response in patients in the combined score = 2 group is 3.77 times higher than in group 0. In the Fagan nomogram, the pretest probability of pathological response is 66%, while the post-test probability for combined response score group 2 is 81.5%, and for the low-H index < 2.3 and the high-HALP ≥ 36 patient group, our estimate for pathological complete response increases to 82%. Conclusions: The HALP-H index combined score is an important predictor of pathological response in early-stage HER2-positive breast cancer patients, independent of histological type and stage. This new score may enable personalized approaches in treatment planning. Full article

This study examined total ammoniacal nitrogen (TAN) rejection by two reverse osmosis (RO) and two nanofiltration (NF) membranes as a function of pH for three ammonium salts to optimize conditions for a hybrid membrane system that can produce high-purity TAN streams suitable for reuse. The results showed that TAN rejection was significantly influenced by membrane type, feed pH, and the ammonium salt used. This study represents the first attempt to simulate real manure wastewater conditions typically found in pig manure. TAN rejection for (NH₄)₂SO₄ and NH₄HCO₃ reached up to 95% at pH values below 7, with the SW30 membrane showing the highest performance (99.5%), attributed to effective size exclusion and electrostatic repulsion of SO₄²⁻ and HCO₃⁻ ions. In contrast, lower rejection was observed for NH₄Cl, particularly with the MPF-34 membrane, due to its higher molecular weight cut-off (MWCO), which diminishes both exclusion mechanisms. TAN rejection decreased markedly with increasing pH across the BW30, NF90, and MPF-34 membranes as the proportion of uncharged NH₃ increased. The lowest rejection rates (<15%) were recorded at pH 11.5 for both NF membranes. These results reveal a notable shift in separation behavior, where NH₃ permeation under alkaline conditions becomes dominant over the commonly reported NH₄⁺ retention at low pH. This novel insight offers a new perspective for optimizing membrane-based ammonia recovery in systems simulating realistic manure wastewater conditions. TAN recovery was evaluated using a hybrid membrane system, where NF membranes operated at high pH promoted NH₃ permeation, and the SW30 membrane at pH 6.5 enabled TAN rejection as (NH₄)₂SO₄. This hybrid system insight offers a new perspective for optimizing membrane-based ammonia recovery in systems simulating realistic manure wastewater conditions. Based on NH₃ permeation and membrane characteristics, the NF90 membrane was operated at pH 9.5, achieving a TAN recovery of 48.3%, with a TAN concentration of 11.7 g/L, corresponding to 0.9% nitrogen. In contrast, the MPF-34 membrane was operated at pH 11.5. The NF90–SW30 system also achieved a TAN recovery of 48.3%, yielding 11.7 g/L of TAN with a nitrogen content of 1.22%. These nitrogen concentrations indicate that both retentate streams are suitable for use as liquid fertilizers in the form of (NH₄)₂SO₄. A preliminary economic assessment estimated the chemical consumption cost at 0.586 EUR/kg and 0.729 EUR/kg of (NH₄)₂SO₄ produced for the NF90–SW30 and MPF-34–SW30 systems, respectively. Full article

Background: Although mental health among students has become a pressing public concern over recent years, the COVID-19 pandemic introduced new stressors, which may further increase the mental health burden for them. While past work has investigated links between pandemic related factors and student mental health and wellbeing, there is conflicting evidence around some symptoms (e.g., anxiety) and little work has focused on less common mental health conditions (e.g., eating disorders). Aims: The current study aimed to detail the prevalence of mental distress in the student population at an early stage of the COVID-19 pandemic and compare university students’ mental health before and during the COVID-19 pandemic. Specifically, we aimed to compare levels of depression, anxiety, and eating disorders in a large sample of students. Methods: We analysed data from a repeated cross-sectional survey on different samples of UK university students before the pandemic (n = 4812) and during the pandemic (n = 3817). Results: There were high levels of depression and anxiety during the COVID-19 pandemic, with more than 50% experiencing levels above the clinical cut-offs. Findings revealed a significant increase in symptoms of depression and anxiety from pre- to mid-pandemic as well as a significant increase in the prevalence of eating disorders. Conclusions: By late 2020, mental health in the student population had deteriorated compared to pre-pandemic levels. These findings provide evidence for increased levels of depression, anxiety, and eating disorders related to the COVID-19 pandemic. There is a need for better preparedness for future crises in order to mitigate the impact on student mental health. Full article

Background/Objectives: Ankylosing spondylitis (AS) is a severe chronic inflammatory rheumatic disease involving the spine, sacroiliacs, and peripheral joints. A lack of therapeutic response leads to severe sequelae. Currently, new markers are being tested to identify patients with poor outcomes. Tenascin C (TNC) is involved in triggering some relevant mechanisms of inflammation. Today, it remains unclear whether TNC levels might be useful as a biomarker of persistent activity. The aim of this study was to evaluate in AS whether serum levels of tenascin C are associated with persistent disease activity despite treatment. Methods: We included AS patients who had been treated with conventional synthetic disease-modifying antirheumatic drugs (cs-DMARDS) or anti-TNF agents for at least three months in a cross-sectional study. Response was assessed with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI); scores ≥ 4 indicate persistent disease activity, while scores < 4 indicate inactive disease. Serum TNC levels, C-reactive protein (CRP) levels, and Erythrocyte Sedimentation Rate (ESR) were determined through the ELISA technique, nephelometry, and the Westergren method, respectively. Results: We evaluated 58 patients with AS (62.1% men); of them, 33 (56.9%) had persistent active disease (BASDAI ≥ 4) despite treatment and 25 (43.1%) had inactive disease (BASDAI < 4). The median TNC level was 18.6 ng/mL. BASDAI correlated with TNC levels (rho: 0.528, p < 0.001), CRP (0.352, p = 0.007), and ESR (0.342, p = 0.009). Patients with persistently active AS had higher serum TNC levels than those with inactive AS (35.2 vs. 6 ng/mL, p < 0.001). No differences in TNC level were found in patients treated with cs-DMARDS vs. anti-TNF agents. The ROC curve for serum tenascin C in active AS patients had an area under the curve = 0.78 (CI 95%: 0.65–0.91) with optimal serum tenascin C cutoff (>13.85 ng/mL). Sensitivity for detecting active AS was higher with TNC compared to ESR and CRP. Conclusions: We suggest that an elevated TNC level may be a useful biomarker of persistent disease activity despite treatment in AS; further studies should investigate the role of TNC levels in predicting the progression of the disease. Full article