Search Results (1,711)

Particulate matter, particularly PM_2.5, poses a significant threat to public health due to its ability to disperse widely and its detrimental impact on the respiratory and circulatory systems upon inhalation. Consequently, it is imperative to maintain regular monitoring and assessment of particulate matter levels to anticipate air pollution events and promptly mitigate their adverse effects. However, predicting air quality is inherently complex, given the multitude of variables that influence it. Deep learning models, renowned for their ability to capture nonlinear relationships, offer a promising approach to address this challenge, with hybrid architectures demonstrating enhanced performance. This study aims to develop and evaluate a hybrid model integrating Convolutional Neural Networks (CNNs) and Recurrent Neural Networks (RNNs) for forecasting PM_2.5 levels in India, Milan, and Frankfurt. A comparative analysis with established deep learning and machine learning techniques substantiates the superior predictive capabilities of the proposed CNN-RNN model. The findings underscore its potential as an effective tool for air quality prediction, with implications for informed decision-making and proactive intervention strategies to safeguard public health. Full article

Focal therapy for prostate cancer (PCa) provides approaches to treat PCa patients in a less invasive manner than traditional whole-gland surgical or radiation modalities. This manuscript provides a case series of high-intensity focused ultrasound (HIFU), cryoablation, and irreversible electroporation (IRE) for PCa at a single institution and cost analysis with a review of the literature. All patients who underwent HIFU, cryoablation, or IRE for localized PCa were retrospectively reviewed, excluding patients who received whole-gland therapy. Functional outcomes were erectile dysfunction and lower urinary tract symptoms. Cost data were collected. A total of 45 patients were included in the study with focal therapy ranging from 2023 to 2025 (4 HIFU, 20 cryoablation, 21 IRE). A total of 30 patients had focally treated lesions, and 15 patients had hemi-gland treatment. The mean preoperative PSA was 7.7 ng/mL. On the paired sample t-test, there was no significant difference between pre-focal and post-focal therapy PSA. Three patients experienced biochemical recurrence requiring prostate biopsy after focal treatment. Mean cost was USD 3804.50 and not significantly different by focal treatment. No metastatic events occurred nor deaths at a median follow-up of 6 months. Patients in this series had largely unaltered functional outcomes. Cost analysis in contemporary publications is lacking. Although follow-up was short, cancer control was adequate. Full article

Background: The guidelines recommend mitral valve repair whenever possible in patients undergoing surgical treatment for active infective endocarditis of the native mitral valve. However, the impact of causative microorganisms in relation to treatment strategies, especially Staphylococcus aureus, has not been studied. In this study, we aimed to compare the outcomes of mitral valve repair versus replacement in patients with native mitral valve infective endocarditis caused by methicillin-susceptible Staphylococcus aureus. Methods: Consecutive patients with definitive active infective endocarditis of the native mitral valve caused by methicillin-susceptible Staphylococcus aureus undergoing cardiac surgery between 2012 and 2022 were selected. Patients were classified according to the treatment received in two groups: repair and replacement. Inverse propensity treatment weighting was employed to correct for confounders. The endpoints were all-cause mortality, incidence of recurrent endocarditis, reoperation rate, and event-free survival at two-year follow-up. Results: Among 170 operated-upon patients with active infective endocarditis of the native mitral valve, 44 cases were caused by methicillin-susceptible Staphylococcus aureus. A total of 23 patients underwent mitral valve repair and 21 patients received mitral valve replacement. Weighted 30-day mortality in the repair group was 43%, versus 27% in the replacement group (p = 0.15). Two-year mortality increased to 57% in the repair group and 32% in the replacement group (p = 0.02). Three patients developed recurrent endocarditis in the repair group, while no recurrent endocarditis occurred in the replacement group. Three patients in the repair group required reoperation due to recurrence and one patient in the replacement group underwent re-operation due to paravalvular leakage. Weighted two-year event-free survival was 29% in the repair group and 59% in the replacement group (p < 0.01). Conclusions: Mortality in patients with mitral valve infective endocarditis caused by Staphylococcus aureus is extremely high, especially in patients undergoing mitral valve repair. The risk of recurrent endocarditis and mid-term mortality seems to be higher in mitral valve repair, resulting in poor event-free survival during two-year follow-up. However, the sample size was likely insufficient for drawing definitive conclusions. Full article

Recurrent facial palsy is a rare event in the pediatric population, mostly idiopathic or associated with common comorbidities or, rarely, observed in syndromic conditions. However, some cases are difficult to explain and need more accurate diagnostic approaches. In this work, we describe a pediatric case of recurrent facial palsy secondary to hyperostosis of the skull and narrowing of the neural foramina related to a SOST-related sclerosing bone dysplasia. To our knowledge, this is the first Italian case that is also related to a novel loss-of-function variant in the SOST gene. We highlight the clinical relevance of a proper early diagnosis and the need for correct monitoring of the clinical evolution, considering the natural history of the disease, to prevent/reduce severe neurological complications. Full article

Aromatase inhibitors (AIs), with or without gonadotropin-releasing hormone analogs, are the cornerstone of adjuvant endocrine therapy for women with hormone receptor-positive early-stage breast cancer, offering significant reductions in recurrence risk and improving long-term survival. Their use is frequently accompanied by treatment-related toxicities that can adversely affect patients’ quality of life (QoL) and adherence to therapy. Commonly reported side effects include vasomotor symptoms, such as hot flashes; musculoskeletal disorders, such as arthralgia and myalgia; mood disorders; and genitourinary discomfort, such as vaginal dryness and dyspareunia. Additionally, AIs are associated with a heightened risk of bone loss, leading to osteoporosis and fractures, and may have implications for cardiovascular health. Effective management of these adverse events is pivotal in maintaining treatment adherence and preserving QoL. Evidence-based strategies to address these toxicities include pharmacological interventions, such as analgesics for joint pain, bisphosphonates or denosumab for bone health, and hormonal or non-hormonal approaches for vasomotor and genitourinary symptoms. Non-pharmacological measures, including physical activity, dietary adjustments, and complementary therapies, can also help mitigate symptoms. This review examines the broad spectrum of AI-associated toxicities, discusses their clinical implications, and provides an overview of evidence-based management strategies. These insights aim to support clinicians in optimizing patient care while minimizing the toxicities of therapy. Full article

Skin cancer is the most common cancer form worldwide, and it is primarily divided into melanoma and non-melanoma types, with non-melanoma being the most prevalent condition. Cutaneous squamous cell carcinoma (cSCC) accounts for 50% of primary skin cancers and is characterized by uncontrolled keratinocyte proliferation. cSCC’s current standard treatment is surgical resection and chemotherapy. Unfortunately, these methods often lead to disfigurement, functional morbiditly, and compromised function. In contrast to immunotherapy, emerging scenarios have shown promising results, especially in neoadjuvant settings. Cemiplimab (Libtayo^®; Regeneron, Tarrytown, NY, USA), a PD-1 monoclonal antibody, has shown efficacy in treating advanced or metastatic cSCC, and its use as a neoadjuvant therapy has been recently explored. This review aims to evaluate Cemiplimab in the neoadjuvant setting for cSCC treatment. The Methodology followed PRISMA guidelines, this review analyzed studies on Cemiplimab as a neoadjuvant therapy for cSCC that were sourced from PubMed, Web of Science, and Scopus. Only controlled trials, cohort studies, case series, and systematic reviews were included. From 341 records, 21 studies were included, and six clinical trials provided key data about neoadjuvant Cemiplimab’s response rates, efficacy, adverse effects, and safety considerations. The targeted data revealed a neoadjuvant Cemiplimab mean pathologic response rate of 72%, with a 62% objective response rate. Treatment-related adverse events (TRAEs) affect 66% of patients, though most cases are not severe. The most common include fatigue, maculopapular rash, and diarrhea. The studies showed high rates of complete pathological responses (cPRs) and major pathological responses (mPRs), suggesting a strong therapeutic potential. Neoadjuvant Cemiplimab for cSCC therapy shows high response rates, low recurrence, improved survival, and manageable side effects. The current literature indicates that Cemiplimab may also be effective when used in immunosuppressed patients. Despite more research still being needed to confirm its long-term benefits and the effects of the drug’s use outside of clinical trials, there is strong evidence to consider neoadjuvant Cemiplimab as a promising and efficient treatment. Full article

Endoscopic ultrasound (EUS)-guided drainage using lumen-apposing metal stents (LAMSs) has become the standard for managing pancreatic fluid collections (PFCs), especially walled-off necrosis (WON). However, LAMS-specific adverse events (AEs), including bleeding, stent occlusion, and infection, remain a concern. To mitigate these complications, some experts advocate placing coaxial double-pigtail plastic stents (DPPSs) within LAMSs. This narrative review critically examines the evidence from retrospective and prospective studies, one RCT, and recent meta-analyses on this combined approach. While the routine use of coaxial double-pigtail plastic stents (DPPSs) within LAMSs is not universally supported, emerging data suggest benefits in select high-risk scenarios, such as large WON, debris-rich cavities, or disconnected pancreatic duct syndrome (DPDS), in which coaxial DPPS within LAMSs can reduce occlusion, infection, and recurrence. In addition, the type of LAMS appears to influence safety outcomes: the SPAXUS stent shows lower bleeding and migration rates than the Hot AXIOS. We propose a pragmatic algorithm for the patient-tailored use of coaxial DPPS and discuss technical innovations to improve outcomes. While evidence is still evolving, personalized strategies and future high-quality studies are needed to define the optimal role of coaxial DPPS within LAMSs in the EUS-guided drainage of PFCs. Full article

High-precision Sea Surface Temperature (SST) prediction is critical for understanding ocean–atmosphere interactions and climate anomaly monitoring. We propose GRU_EKAN, a novel hybrid model where Gated Recurrent Units (GRUs) capture temporal dependencies and the Enhanced Kolmogorov–Arnold Network (EKAN) models complex feature interactions between SST and multivariate ocean predictors. This study integrates GRU with EKAN, using B-spline-parameterized activation functions to model high-dimensional nonlinear relationships between multiple ocean variables (including sea water potential temperature at the sea floor, ocean mixed layer thickness defined by sigma theta, sea water salinity, current velocities, and sea surface height) and SST. L2 regularization addresses multicollinearity among predictors. Experiments were conducted at 25 South China Sea sites using 2011–2021 CMEMS data. The results show that GRU_EKAN achieves a superior mean R² of 0.85, outperforming LSTM_EKAN, GRU, and LSTM by 5%, 25%, and 23%, respectively. Its average RMSE (0.90 °C), MAE (0.76 °C), and MSE (0.80 °C²) represent reductions of 31.3%, 27.0%, and 53.2% compared to GRU. The model also exhibits exceptional stability and minimal Weighted Quality Evaluation Index (WQE) fluctuation. During the 2019–2020 temperature anomaly events, GRU_EKAN predictions aligned closest with observations and captured abrupt trend shifts earliest. This model provides a robust tool for high-precision SST forecasting in the South China Sea, supporting marine heatwave warnings. Full article

Background: Vericiguat, a soluble guanylate cyclase stimulator, reduces cardiovascular events in patients with heart failure with reduced ejection fraction following clinical deterioration against guideline-directed medical therapy. However, the optimal timing for initiating vericiguat remains unclear. Methods: We retrospectively analyzed heart failure patients with reduced/mild-reduced ejection fraction who received vericiguat between 2021 and 2025 upon optimal guideline-directed medical therapy. The primary outcome was a composite of all-cause mortality and heart failure hospitalization. Patients were stratified by the number of prior heart failure hospitalizations (<2 vs. ≥2), and outcomes were assessed using multivariable Cox regression and biomarker trajectories over 6 months. Results: A total of 43 patients (with a median age of 73 years, 35 were men) were included. Of these, 26 (60%) patients had ≥2 prior hospitalizations. A number of hospitalizations ≥ 2 independently predicted the primary outcome (hazard ratio: 8.43; 95% confidence interval: 1.79–39.7; p = 0.007). Only patients with <2 prior hospitalizations showed significant improvements in plasma B-type natriuretic peptide levels (p = 0.049) and left ventricular ejection fraction (p = 0.016). In contrast, no meaningful biomarker changes were observed in patients with ≥2 hospitalizations. Conclusions: A history of two or more heart failure hospitalizations is a strong predictor of poor outcomes during vericiguat therapy. These findings suggest that initiating vericiguat earlier—before recurrent hospitalizations—may yield greater clinical benefit. Full article

Background: Perioperative factors significantly impact oncologic outcomes after radical cystectomy (RC) for bladder cancer. This study aimed to identify key perioperative predictors for overall (OS) and progression-free survival (PFS) and to develop a prognostic nomogram for the identification of high-risk patients adapted to the clinical routines and standard of care of our country. Methods: We retrospectively analyzed 121 patients undergoing RC (2014–2024). Data on patient demographics, comorbidities, tumor pathology, neoadjuvant treatments, extensive intraoperative factors, and postoperative events were assessed using COX models. A prognostic nomogram for 3-year OS was constructed. Results: Median follow-up was 44.33 months. Significant predictors for worse OS included lymphovascular invasion (LVI) (HR 2.22), higher T stage (HR 8.75), N+ status (HR 1.10), and intraoperative complications (HR 3.04). Similar predictors were noted for PFS. The developed nomogram incorporated T-, N-stages, sex, grade, intraoperative complications and early (12 months) recurrence, and was able to significantly identify patients with a higher mortality risk (p < 0.001) with a C-index of 0.74. Conclusions: Our nomogram for mortality prediction of BC patients offers a promising tool for individualized risk stratification. Further studies are required for its external validation. Full article

Background/Objectives: Photoimmunotherapy for head and neck cancer (HN-PIT) is an emerging treatment for unresectable locally advanced or recurrent head and neck cancer. However, real-world data (RWD) are limited. This study examined the safety and effectiveness of HN-PIT. Methods: This multicenter, retrospective cohort study included 40 patients with unresectable locally advanced or recurrent head and neck cancers who underwent HN-PIT from January 2021 to August 2024. The primary endpoint was time to treatment failure (TTF). Secondary endpoints included the objective response rate (ORR), overall survival (OS), progression-free survival (PFS), and adverse events (AEs). Results: The median TTF and 1-year treatment failure rate were 6.0 months and 23.2%, respectively. Moreover, the ORR, disease control rate, median OS, and median PFS were 75.0% (95% confidence interval [CI]: 60.0–86.0%), 95.0% (95% CI: 83.5–99.0%), 26.9 months, and 6.2 months, respectively. The incidence of grade ≥3 AEs was 17.5% (95% CI: 7.1–29.1%). Pain was the most common AE, occurring in 37 patients (92.5%), with grade III pain reported in 5 (12.5%). Mucositis occurred in 32 patients (80.0%), with grade III mucositis reported in 3 (7.5%). Hemorrhages occurred in 31 patients (77.5%), with no grade ≥III hemorrhages reported. Two patients experienced sepsis (5.0%; grades IV and V). Seventeen patients (42.5%) had laryngeal edema, with grade IV edema reported in four (10.0%). Conclusions: Our RWD shows that HN-PIT is effective with an acceptable safety profile. TTF may serve as an endpoint reflecting this treatment’s characteristics. This study provides important basic data for the development of future treatment strategies. Full article

Background: Post-hamstring-injury residual pain may persist despite muscle-tissue healing and impairs athletes seeking early full recovery. Given their unclear cause, recent attention has focused on the role of fascial dysfunction and a method to restore fascial mobility, namely, hydrorelease (HR), involving the ultrasound (US)-guided injection of saline. We evaluated the clinical efficacy of HR for treating residual pain and ascertained the underlying pathological mechanisms. Methods: Seven patients (aged 17–49 years) with residual pain ≥8 weeks after hamstring injury were included. All exhibited localized tenderness and US findings of fascial thickening around the aponeurotic fascia (APF). HR with 6.0 mL saline–lidocaine solution (0.17% lidocaine) was performed and targeted the peri-APF loose connective tissues. Pain was evaluated using a numerical rating scale (NRS) before and after HR. Passive straight leg raise (SLR) was used to assess tightness. Results: Post-HR, the mean NRS score significantly decreased from 10 to 0.86 (p = 0.017). Four patients required a single HR session; three required two–four sessions. Post-HR, the tightness of all patients improved. Short-axis US of the posterior thigh revealed APF fascial thickening in the area of tenderness, including the posterior femoral cutaneous nerve (PFCN). No adverse events or recurrence occurred during the follow-up (mean: 6.6 months). Conclusions: HR targeting the peri-PFCN-APF effectively reduced residual pain following hamstring injury. These findings support the concept of “Perineural fascial pain”—a pathology wherein persistent pain originates not from direct nerve damage or classical myofascial pain syndrome but rather from the dysfunction of the surrounding fascia. Full article

Intensified by climate change and anthropogenic activities, flood disasters necessitate rapid and accurate mapping for effective disaster management. This study develops an integrated framework leveraging synthetic aperture radar (SAR) and cloud computing to enhance flood monitoring, with a focus on a 2024 extreme rainfall event in Liaoning Province, China. Utilizing the Google Earth Engine (GEE) platform, we combine three complementary techniques: (1) Otsu automatic thresholding, for efficient extraction of surface water extent from Sentinel-1 GRD time series (154 scenes, January–October 2024), achieving processing times under 2 min with >85% open-water accuracy; (2) random forest (RF) classification, integrating multi-source features (SAR backscatter, terrain parameters from 30 m SRTM DEM, NDVI phenology) to distinguish permanent water bodies, flooded farmland, and urban areas, attaining an overall accuracy of 92.7%; and (3) Fuzzy C-Means (FCM) clustering, incorporating backscatter ratio and topographic constraints to resolve transitional “mixed-pixel” ambiguities in flood boundaries. The RF-FCM synergy effectively mapped submerged agricultural land and urban spill zones, while the Otsu-derived flood frequency highlighted high-risk corridors (recurrence > 10%) along the riverine zones and reservoir. This multi-algorithm approach provides a scalable, high-resolution (10 m) solution for near-real-time flood assessment, supporting emergency response and sustainable water resource management in affected basins. Full article

Background: Clostridioides difficile infection (CDI) is one of the most common healthcare-associated infections in the United States with increasing rates in younger patients and those in the community. CDI incidence may also be on the rise in peripartum women. Methods: We conducted a literature review to assess the incidence and outcomes of CDI in the peripartum population and review treatment options. Results: Peripartum patients have a high risk of complications and adverse events associated with CDI. Most patients have been treated with vancomycin or metronidazole; however, cases of patients recurring on standard treatment have been described, with patients having successful outcomes with fidaxomicin or fecal microbiota transplantation (FMT). Probiotics have been shown to be safe in peripartum women; however, the role in preventing primary and secondary CDI has not been studied. Conclusions: Peripartum women that develop CDI are at increased risk for complications. Treatment includes vancomycin, metronidazole, or fidaxomicin or FMT for recurrent cases. Full article

The Sultanate of Oman boasts remarkable biodiversity, exemplified by such species as the Arabian leopard (Panthera pardus nimr) and the Arabian oryx (Oryx leucoryx), national symbols that highlight the extensive conservation efforts required to protect the country’s natural heritage. During decades, Omani authorities have taken significant measures to safeguard wildlife and preserve the natural environment. A sanctuary dedicated to the reintroduction of the Arabian Oryx, after extinction in nature in 1972, was established in 1980 in the Al Wusta Governorate under the patronage of the Royal Diwan and currently administrated by the recently established Environment Authority. During the almost 40 years since the reintroduction and the creation of the sanctuary, the oryx population has grown slowly but constantly. In 2021, the sanctuary hosted 738 oryx, allowing the start of the reintroduction of the species into the natural environment. Small groups of animals were released into the wild in selected areas. No animal health adverse events were recorded, and mortality was generally due to injuries received as a consequence of fighting, in particular during mating season. Standard veterinary care, including control of internal and external parasites, was regularly provided. In some occasions, immunization against certain diseases, such as clostridial infections, pasteurellosis, or mycoplasmosis, was also applied. In 2023, an FMD outbreak in cattle reported in Dhofar, about 500 km from the Al Wusta sanctuary, motivated specific prophylactic actions to prevent the risk of diffusion to oryx. From December 2023 to January 2024, an immunization program was undertaken using an FMD vaccine against serotypes A, O, and SAT 1, mostly in male oryx, while pregnant oryx were avoided for abortion risk due to handling. The following year, in January 2025, a severe outbreak occurred in oryx herds held in the sanctuary. The rapid onset and the spread of clinical symptoms among animals (100% morbidity in the second day after the first appearance of signs in some individuals) were suggestive of a highly contagious disease. The animals suffered from severe depression and inappetence, rapidly followed by abundant salivation, erosions of the oral mucosa and tongue, and diarrhea, with a short course characterized by prostration and death of the animal in the most severe cases. Therapeutical attempts (administration of antibiotics and rehydration) were mostly ineffective. Laboratory investigations (ELISA and PCR) ruled out contagious bovine pleuropneumonia (CBPP), Johne’s disease and Peste des petits ruminants (PPR). Both serology and antigen detection showed positiveness to foot-and-mouth disease (FMD). Out of a total population of 669 present in the sanctuary at the beginning of the outbreak, 226 (33.78%) oryx died. Despite the vaccinal status, the 38.49% of dead animals resulted being vaccinated against FMD. Taking into account the incalculable value of the species, the outbreak represented a very dangerous event that risked wiping out the decades of conservation efforts. Therefore, all the available means, such as accrued biosecurity and adequate prophylaxis, should be implemented to prevent the recurrence of such health risks. The delicate equilibrium of wild fauna in Oman requires study and support for an effective protection, in line with the national plan “Vision 2040”, targeting the inclusion of the Sultanate within the 20 best virtuous countries for wildlife protection. Full article