Search Results (3,803)

Background/Objectives: Genetic testing in Human Epidermal Growth Factor Receptor 2-negative (HER2−) metastatic breast cancer (mBC) is necessary to enable optimal treatment choices including poly(ADP-ribose)polymerase inhibitors (PARPis). The present study evaluated the implementation of genetic testing in a real-world setting to reveal and subsequently allow targeting of potential inadequacies and risk factors for low testing frequency. Methods: We performed a retrospective analysis including HER2− mBC patients treated at a single academic center starting from 10 April 2019 (date of European Medicines Agency (EMA) approval of Olaparib for germline breast cancer gene mutant (gBRCAm) HER2− mBC) to 7 September 2021. The primary objective of the study was to evaluate the rate of HER2− mBC patients that were recommended to undergo genetic testing by the multidisciplinary tumor board (MTB). The secondary objective was to identify factors that were associated with a higher likelihood of having undergone genetic testing. Results: In total, 47.6% (109 of 229) of HER2− mBC patients had been recommended to undergo genetic testing by the MTB. Of these informed patients, 89.0% (97 of 109) underwent genetic testing, of which 11.6% (11 of 95) had a germline BRCA mutation (gBRCAmut) and were eligible for PARPi treatment. In multivariate analysis, younger age (p-value: 0.0007), hormone receptor positive (HR+)/HER2− subtype (p-value < 0.0001) and positive family history for breast and ovarian cancer (p-value: 0.0001) were significantly associated with the performance of genetic counseling. Conclusions: The present study demonstrated low genetic counseling rates of HER2− mBC patients, especially in individuals without specific risk factors for hereditary breast cancer. Informed patients showed a high willingness to undergo genetic testing. Genetic testing revealed targetable mutations in over 10% of tested patients. Full article

Vehicle-sharing platforms are constantly gaining ground in smart cities around the world, reducing the number of traditional fuel-based vehicles on the roads in busy areas and thus contributing to the development of a sustainable environment. On the other hand, the availability of a plethora of shared vehicles of different types across a city increases the need for their seamless combination, so that they are considered part of a unified transportation system within a smart city rather than independent solutions. In this work, we present a system that enables authorized users to gain access to shared vehicles of different transport modalities, allowing them to reach their destination without relying on a private car or public transport. For this purpose, we have used existing systems and techniques from different fields, such as recommendation systems, machine learning, and route planning, which provide appropriate multimodal routes while taking into consideration several parameters, including user demographics, vehicle status, environmental conditions, and road traffic congestion. The evaluation of the system using simulated data showed that it enables users to identify suitable multimodal routes, either through explicit preferences or by inferring them from historical data, and revealed limitations to be addressed in future work. Full article

Background/Objectives: Micronutrient malnutrition, particularly deficiencies in calcium, vitamin D, iron, zinc, and iodine, remains a significant public health issue among school-aged children in Morocco. Processed cheese, such as “The Laughing Cow” (TLC), has potential as a vehicle for fortification due to its widespread consumption and accessibility. This study aimed to evaluate the impact of fortified TLC on micronutrient intake and adequacy relative to the Recommended Dietary Allowances (RDA), among Moroccan children aged 6–12 years, and to explore differences in effects by socioeconomic status (SES). Methods: Data from the Moroccan Household Budget Survey (2013–2014) included 9266 children (39.4% TLC consumers). Dietary intake was assessed using 24 h recalls, and nutrient composition was analyzed using Ciqual 2020 tables and specialized software. Fortification scenarios were modelled to estimate potential impacts on micronutrient intake and compliance with RDAs. Results: Under the modelling scenarios, consumption of one portion/day of fortified TLC significantly improved RDAs compliance for iron, iodine, and zinc (p < 0.05). There was also an increase in RDA compliance for calcium and vitamin D, but differences were not significant. The impact of fortification on micronutrient intake and RDA compliance increased with socioeconomic status. Consumers of more than one portion/day showed the highest compliance with RDAs (p < 0.001). Fortification effects were consistent across age subgroups. Conclusions: Fortifying processed cheese represents a feasible strategy to address micronutrient deficiencies among Moroccan schoolchildren. This study highlights the potential of targeted fortification programmes to improve public health outcomes, particularly in vulnerable populations. Further research is needed to optimize fortification approaches and ensure sustainability. Full article

Background: The diagnosis of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) relies on sensitive serological detection of MOG-IgG. Fixed cell-based assays (CBAs) may yield low-positive or borderline results that complicate early clinical decision-making, whereas live CBAs—recommended as the reference method—preserve native antigen conformation and offer higher analytical sensitivity. Importantly, low-positive titres should not be confused with true seronegativity, as they may nevertheless be clinically meaningful. Case Presentation: A 14-year-old previously healthy male presented with left optic neuritis and perineuritis following an upper respiratory infection. Initial MOG-IgG testing on a fixed CBA was low-positive (1:10). He partially responded to intravenous methylprednisolone and required intravenous immunoglobulin (IVIG) for complete resolution. Over three years, he experienced sequential, steroid-dependent bilateral optic neuritis with perineuritis, relapsing on every steroid taper. Rituximab and subsequently mycophenolate mofetil failed to induce remission. Repeat testing with a live CBA at a reference laboratory yielded a high-positive MOG-IgG titre of 1:1000, confirming MOGAD. Tocilizumab (8 mg/kg every 4 weeks) was initiated and allowed complete corticosteroid withdrawal. At age 18, the patient remained asymptomatic, with an Expanded Disability Status Scale score of 0, best-corrected visual acuity of 20/20 in both eyes, and stable peripapillary retinal nerve fibre layer thickness on spectral-domain optical coherence tomography. Conclusions: In paediatric patients with recurrent optic neuritis with perineural involvement and borderline fixed-CBA results, confirmatory testing with a live CBA at a reference laboratory should be considered to avoid diagnostic delay and therapeutic misdirection. In refractory, steroid-dependent cases, IL-6 receptor blockade may represent a reasonable therapeutic option, in line with emerging evidence. Full article

Background: Critical illness is characterized by profound and rapidly evolving metabolic derangements driven by systemic inflammation, hypercatabolism, fluid shifts, and endocrine dysregulation. These dynamic changes markedly limit the accuracy of predictive equations, increasing the risk of both underfeeding and overfeeding. Indirect Calorimetry Energy represents the gold standard for measuring energy expenditure, while bioelectrical impedance vector analysis (BIVA) provides complementary insights into hydration status, cellular integrity, and body cell mass. In palliative care, AI-supported integration of indirect calorimetry and BIVA enables goal-concordant artificial nutrition by aligning energy delivery with real-time metabolic status while minimizing symptom burden. Artificial intelligence (AI) has emerged as a promising tool to integrate these heterogeneous data streams and support adaptive nutritional strategies. Methods: We conducted a structured narrative review of the literature published between 2000 and 2025 using PubMed, Scopus, Embase, and Web of Science. Artificial intelligence was not used to perform the literature search or study selection. Instead, AI was analyzed as a clinical and technological component within the included studies and explored as a future enabling strategy. Eligible publications involved adult critically ill patients and addressed indirect calorimetry, BIVA-derived parameters, or AI-based metabolic modeling applied to nutritional support. Given the heterogeneity of study designs and outcomes, findings were synthesized qualitatively. Results: Predictive equations showed substantial inaccuracy in unstable metabolic states, with errors frequently exceeding ±20–40%. Indirect calorimetry enabled individualized assessment of energy expenditure but remained limited by intermittent availability. Serial BIVA assessments consistently identified clinically relevant alterations in hydration status, body cell mass, and phase angle, the latter being strongly associated with adverse outcomes. Studies incorporating AI demonstrated improved integration of calorimetry, BIVA, and clinical variables, allowing identification of metabolic phenotypes, anticipation of metabolic shifts, and generation of adaptive nutritional recommendations. Conclusions: This narrative review highlights the complementary roles of Indirect Calorimetry and BIVA in characterizing metabolic needs in critical illness. Artificial intelligence does not replace these tools but enhances their clinical utility by integrating multidimensional data into dynamic, patient-specific nutritional strategies. The combined AI–IC–BIVA approach represents a promising framework for metabolic precision nutrition in the ICU, warranting prospective validation. Full article

Despite its prevalence, individuals can be reluctant to discuss depression with their general practitioners (GPs). Effective communication strategies can help but their relative impact on patients’ willingness to discuss their mental health and the underpinning theoretical mechanisms is unclear. Using the Morality–Agency–Communion (MAC) model as the theoretical basis, a UK-based online sample (N = 329) rated their respect, liking and trust for GPs (MAC model outcomes), along with their perceived competence, warmth, morality and assertiveness (MAC model trait mechanisms) and willingness to discuss depression (downstream outcome) before and after reading six hypothetical scenarios based on UK communication guidelines. Compared to baseline, following each recommendation improved all outcomes. Liking was the most consistent mediator on willingness to discuss depression; trust, and to a lesser extent, respect, also played a role. Trait mechanisms differed by outcome: warmth was the most robust mediator for liking; for trust, competence; for respect, morality was key. Of the six communication approaches, allowing patients time to describe and discuss any problems or concerns was the most impactful. Consistent with the MAC model, this study suggests that following communication guidelines can improve how much GPs are seen as moral, warm and competent and, in turn, how much they are respected, liked and trusted. GPs could utilise these approaches more consistently to increase how much they are liked and trusted as well as their patients’ willingness to discuss depression within their consultations. Full article

This study evaluates the seismic performance and life-cycle economic implications of designing essential urban mid-rise reinforced concrete moment-resistant frame (MRF) buildings to maintain linear elastic behavior up to the Immediate Occupancy (IO) performance level. While most urban buildings are commonly designed to respond non-linearly in order to reduce initial construction costs, the current Mexico City Building Code (MCBC) permits that essential facilities, such as hospitals and schools, maintain linear behavior during moderate-to-strong earthquakes. This code establishes a maximum story drift ratio equal to 0.0075 for essential buildings constituted by MRF subjected to seismic events with a 250-year recurrence interval; in addition, it recommends ductile structural behavior to achieve Life Safety performance at a 450-year recurrence interval. Given the significant differences in occupancy, functionality, and contents of critical facilities, here it is analyzed whether the linear elastic design criterion is efficient for both secondary care hospitals and public schools. Two three-story and five-story MRF buildings, located on firm and transition soil, respectively, are analyzed. This study addresses the probability of brittle-type failure risk, the optimal allowable story drift at the IO performance level, the potential need for use-dependent drift limits, and the contribution of contents and nonstructural components to the total expected seismic losses. The seismic risk and economic performance are quantified through seismic hazard analysis, incremental dynamic analysis, fragility modeling, Monte Carlo simulation, and life-cycle cost evaluation. Full article

Mycotoxin contamination is an important threat to food and feed safety as well as human and animal health, with particular emphasis on oxidative stress, apoptosis, autophagy, inflammation, and dysbiosis. Mycotoxins represent major health threats because they disturb cellular homeostasis and induce oxidative damage. Nutritional factors, such as dietary antioxidants and bioactive chemicals, can influence the body’s reaction to mycotoxin exposure, either reducing or increasing its effects. This study discusses how mycotoxins (aflatoxin B1, deoxynivalenol, and ochratoxin A) induce oxidative stress by producing reactive oxygen species (ROS)-mediated DNA damage, which induces cellular damage and activates apoptosis, an intended cell death process that is critical for tissue integrity. Furthermore, mycotoxins alter autophagy, a cellular degradation process that can be beneficial or destructive depending on the situation, affecting cell survival. The inflammatory response is particularly important because mycotoxin-induced oxidative stress and cell damage activate inflammatory pathways, which contribute to tissue injury and disease progression. Nutritional factors high in antioxidants, anti-inflammatory substances (Lycopene, Curcumin, Thyme oil, Gum Arabic, and Ginger), probiotics, and prebiotics show potential in mitigating these negative consequences by reducing oxidative stress and inflammation. Advances in molecular biology and omics technologies (transcriptomics, proteomics, metabolomics, and single-cell sequencing) can lead to better knowledge of the underlying pathways, allowing for more tailored nutritional recommendations and medicinal interventions. Finally, combining dietary modulation with mycotoxin risk management is a viable path for protecting health and increasing resilience to mycotoxin-related toxicities in animals. Full article

This study evaluated whether membrane structures can enhance thermal comfort and reduce heat- and cold-related health risks in privately owned public spaces (POPS) under representative seasonal peak conditions. Based on previous in situ measurements revealing severe summer heat stress and winter cold discomfort in two POPS in Tokyo’s Minato-ku Shibaura district, a membrane-based shelter solution is proposed and systematically assessed. Their thermal environmental effects were numerically simulated using a coupled surface energy balance (SEB) and computational fluid dynamics (CFD) model, with evaluations focusing on human health risks and thermal comfort. Results demonstrated that in summer, membrane structures effectively improved thermal comfort by reducing the standard effective temperature (SET*) by 1.9–3.9 °C, although these SET* values still remained above the thermal comfort range. Notably, heat stress-related health risks were significantly mitigated, as deep body temperature (DBT) decreased by 1.2–1.6 °C, falling below the 38 °C heatstroke risk threshold. In winter, although the overall improvement was limited, the membrane structures still reduced cold-related health risks and extended allowable exposure duration (AED). Furthermore, auxiliary measures (e.g., mist sprays for summer and supplementary heating for winter) are recommended to further enhance thermal comfort in POPS. Full article

There is a risk of wire breakage and falls when constructing high-voltage transmission lines. If this occurs, it seriously endangers the safety of crossing objects. As key structures commonly used in power construction to protect crossing facilities from wire breakage, the scientific design and accurate calculation of the safety margins for suspension-crossing frames are particularly important. However, the existing energy transfer mathematical model for impact-bearing cables after conductor fracture cannot accurately describe the physical process, and the value of the fixed break impact coefficient (e.g., 2.89 for the double circuit) adopted in the design specification is not sufficiently accurate. Thus, there is a large deviation in the bearing cable safety factor, which can cause the safety margin to be either too large or insufficient, in turn seriously affecting the safe and efficient completion of cross-line construction. To this end, in this study, we first constructed a mathematical model of impact energy conversion based on the law of conservation of energy; then, we proposed an accurate method for calculating the safety factor of the bearing cable. To verify the method’s accuracy, a full-scale true wire breakage impact test was conducted. The results show that the error between the impact coefficient calculated by this method and the test result is only 6.7%, significantly better than the 38.3% error, found when the traditional design specification is used to fix the value. This method is applied to a 220 kV crossing project case. The analysis shows that, to meet the same safety requirements, the model recommends the use of Φ12 Dyneema rope, while the traditional method requires Φ16 Dyneema rope; simultaneously, for the Φ18 Dyneema rope, the maximum allowable span calculated by this method is 450 m, which is greater than the 400 m calculated using the traditional method. Thus, this method can calculate a more accurate impact coefficient based on actual working conditions, thereby significantly optimizing the selection of load-bearing cables and increasing the upper limit of span design while ensuring construction safety. Overall, the research conclusions provide important theoretical and technical support for optimizing the design and safety check of the suspension-crossing frame. Full article

The idea of using air cabs urban mobility is increasingly becoming a reality. In this project, research is conducted on an energy-efficient air conditioning system for an air cab to efficiently combine range and comfort in the cabin. For this, both simulations using a zonal model are conducted, and a thermal air cab demonstrator platform is developed. Measurements in the air cab demonstrator are used to investigate passenger comfort under various climatic conditions, including warm and moderate environments. In addition, the study focuses on evaluating the energetic efficiency of various air conditioning systems such as air cooling and close-to-body climatization. The data analysis compares user comfort and energy efficiency across technologies based on established comfort standards. This allows recommendations for energy-efficient air conditioning to be identified. Full article

The research aimed to create a hybrid model for assessing the carbon footprint of pilots’ education at a flight school, taking into account the level of implementation of green infrastructure by the educational institution, while excluding indirect emissions from the model. The study implemented an approach that combines fuzzy set theory with expert evaluation methods, utilizing membership functions and convolution mechanisms to incorporate subjective expert assessments into formalized numerical measures. The research was focused on two research questions: Does the proposed hybrid model allow for a practical assessment of a pilot’s carbon footprint during his training? Does the hybrid model provide the ability to automatically determine the level of carbon footprint of an aviation educational institution and generate substantiated recommendations for the strategic management of sustainable development of the educational process? The resulting model enables a quantitative assessment of individual CO₂ emissions during pilot training and provides collective insights into the overall carbon footprint, accounting for the green infrastructure’s level of implementation. The hybrid model was tested and validated using real data from the Technical University of Košice (Slovakia) within the “PILOT” study program (2022–2025). The experimental calculations are based on the Viper SD4, a homogeneous aircraft type. The model is designed to account for multiple aircraft types through weighted aggregation, a feature that can be used in future institutional implementations. These recommendations are practical for managers and specialists at aviation educational institutions, environmental analysts, curriculum developers, and policymakers focused on sustainable development. At the current stage, the model primarily captures direct training-related and institution-level operational emissions, while indirect emissions were included only to a limited extent because of insufficiently available and non-systematically recorded data. Therefore, the proposed framework should be interpreted as an operational decision-support model rather than a full greenhouse gas inventory covering all indirect emission sources. Full article

Background: Botulinum neurotoxin type A is widely used in the management of post-stroke upper-limb spasticity; however, many studies report total injected doses rather than muscle-specific dosing, limiting clinical applicability. This study aimed to evaluate how frequently muscle-level dosing protocols of onabotulinumtoxinA are reported and to assess consistency of dosing patterns across published studies. Methods: A literature search was conducted in PubMed, Wiley/Cochrane Library, and EBSCO/CINAHL using a structured search strategy informed by PRISMA guidelines. Studies published within the last 10 years reporting on onabotulinumtoxinA treatment in post-stroke upper-limb spasticity with muscle-specific dosing data were included. Studies not providing muscle-level dosing or not allowing extraction of post-stroke upper-limb data were excluded. Data were summarized descriptively and compared across studies. Results: Twenty-seven full-text articles were assessed, and five studies met the inclusion criteria. Muscle-specific dosing was consistently reported for commonly treated muscles such as biceps brachii and wrist and finger flexors, whereas other muscles were less frequently targeted. Variability in dosing between studies was observed, particularly in multicenter real-world datasets. Standardized high-dose protocols contrasted with individualized dosing strategies, which generally showed more moderate dose ranges. Expert recommendations often suggest higher doses than those observed in routine clinical practice. Conclusions: Muscle-specific dosing of onabotulinumtoxinA in post-stroke upper-limb spasticity is reported infrequently, and substantial variability exists between studies and clinical practice. Standardized reporting of muscle-level dosing and its relationship to baseline spasticity severity is needed to improve clinical applicability and reproducibility. Full article

Background/Objectives: Coronary perforations are infrequent but potentially fatal complications during percutaneous coronary intervention (PCI). Interventional management aims to stop extravasation and restore distal flow to prevent tamponade and cardiogenic shock. In current practice, the ping-pong technique is recommended to ensure sealing of the perforation during covered stent delivery. However, this method is complex, time-consuming, and requires a second vascular access. Therefore, we developed a technique that seals the perforation and enables covered stent implantation using a single guide catheter. Methods: This technical note describes a novel technique in which a guide extension catheter (GEC) can be advanced across a vascular perforation after balloon inflation. The insertion of the GEC is made possible by detachment of the balloon hypotube. To minimize leakage, a regular coronary wire introducer needle is attached to the snapped hypotube after GEC loading and continuously inflated to hold nominal pressure. Advancement of the GEC across the perforation immediately limits hemorrhage and facilitates covered stent deployment via a single vascular access. The technique was first evaluated in bench testing and subsequently applied in three illustrative clinical cases at a tertiary referral center using standard, commercially available devices. Results: Bench testing confirmed the reproducibility of the ripping maneuver and successful ballon inflation over enough time to advance the GEC with the introducer married with the ripped hypotube. In all clinical cases, the GEC was successfully advanced across the perforation, allowing prompt covered stent deployment where necessary using a single guide catheter and access site without technical failure. Conclusions: The RIP (Rip and Inflate in Perforations)—technique is a feasible and reproducible alternative to the ping-pong technique. Bench validation and initial clinical application suggest that it may simplify the management of large-vessel perforations while reducing procedural complexity and the need for additional vascular access. Full article

Background: Podiatrists are crucial for managing lower limb pathologies, and effective appointment scheduling is vital for allocating adequate consultation time based on patient conditions. While occasional late patient arrivals may not significantly impact services, frequent lateness can disrupt patient flow and quality of care. This study explored the impact of patient lateness on podiatry practices worldwide, where no countries of origin were excluded. This study assessed current strategies to manage patient lateness, evaluated their effectiveness and reported recommendations for improvement. Methods: An international cross-sectional online survey was conducted between January and March 2024. Results: The survey, which garnered 201 responses from podiatrists, revealed that over 90% of podiatrists experienced disruptions in their clinic workflow due to late patients. Common reasons for lateness included traffic issues and difficulties with parking. SMS reminders emerged as the most effective tool for reducing tardiness. Over half (59.3%) of podiatrists implemented a 10-minute grace period before rescheduling late appointments, which effectively reduced lateness by 50%. However, some podiatrists refrained from rescheduling to avoid worsening patients' conditions or dealing with complaints. Additionally, many podiatrists reported a lack of managerial support in handling late patients. Conclusion: The frequency of late arrivals in podiatry is similar to other health professions and negatively impacts clinic workflow and staff morale. Enhanced managerial support is needed to better manage late patients, allowing podiatrists to concentrate on their clinical responsibilities. Full article