Search Results (160)

Objectives: Oncocyte-rich indeterminate thyroid nodules (O-ITNs) present diagnostic and management challenges due to overlapping features between benign and malignant lesions and differing cytological classifications. This study aimed primarily to assess the ultrasound (US) characteristics and US-based risk of O-ITNs using the American College of Radiology Thyroid Imaging Reporting And Data Systems (ACR TI-RADS). A secondary objective was to compare the Bethesda System for Reporting Thyroid Cytopathology (BSRTC) and Italian Consensus for the Classification and Reporting of Thyroid Cytology (ICCRTC) cytological systems regarding classification and clinical management implications for O-ITNs. Methods: A retrospective study was conducted on 177 ITNs (TIR3A and TIR3B) evaluated between June 2023 and December 2024 at CTO-Alesini, Rome (Italy). Nodules were assessed with US, cytology, and histology. Oncocyte predominance was defined as >70% oncocytes on fine-needle aspiration (FNA). US features were analyzed according to ACR TI-RADS. Nodules were reclassified by BSRTC, and potential differences in clinical case management (CCM) were analyzed. Results: O-ITNs comprised 47.5% of the sample. Compared to non-O-ITNs, O-ITNs were larger and more frequently showed low-risk US features, including a higher prevalence of ACR TI-RADS 3 nodules. However, no progressive increase in the risk of malignancy (ROM) was observed across ACR TI-RADS classes within O-ITNs. Histological malignancy was identified in 47.1% of O-ITNs, a lower proportion compared to non-O-ITNs, though the difference was not statistically significant. Classification discordance with potential management impact was lower in O-ITNs (20.2%) than in non-O-ITNs (38.7%). Conclusions: O-ITNs typically exhibit benign-appearing US features and lower classification discordance between BSRTC and ICCRTC, yet US risk stratification fails to differentiate malignancy risk within O-ITNs. A tailored approach integrating cytology and cautious US interpretation is essential for optimal O-ITN management. Full article

Background/Objectives: Metastatic spine disease (MSD) affects a significant proportion of patients with advanced malignancies and often necessitates surgical intervention to preserve neurological function, alleviate pain, and maintain spinal stability. While oncologic spine surgery is ideally performed in a planned, semi-elective setting, a substantial number of patients require unplanned (urgent or emergent) surgery due to acute deterioration. The impact of surgical planning status on postoperative outcomes following metastatic spine tumor surgery remains underexplored. This study aimed to compare the patient characteristics and short-term outcomes of those undergoing planned versus unplanned surgery for spinal metastases. Methods: We conducted a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2018 to 2023. Patients with disseminated cancer undergoing tumor surgery were identified. Case types were grouped into planned (elective) and unplanned (urgent or emergent). The primary endpoint was failure to rescue (FTR); secondary endpoints included 30-day major complications, 30-day mortality, and length of hospital stay. Univariable and multivariable regression analyses were performed. Results: A total of 2147 patients met our inclusion criteria, out of whom 60% (n = 1284) underwent planned and 40% (n = 863) underwent unplanned surgery. Patients in the unplanned surgery group had a significantly higher prevalence of severe hypoalbuminemia, severe anemia, and ASA class IV status (p ≤ 0.001 for all). For our primary endpoint, a multivariable analysis showed a significant association between unplanned surgery and FTR (OR 2.11 [95% CI 1.24 to 3.56]; p = 0.005). Significant associations were also found with 30-day mortality (OR 1.84 [95% CI 1.25 to 2.72]; p = 0.002) and length of hospital stay (β 2.7 [95% CI 1.97 to 3.43]; p < 0.001). However, unplanned surgery could not independently predict 30-day major complications (OR 1.21 [95% CI 0.97 to 1.51]; p = 0.08). Conclusions: Our study found that unplanned surgery for spinal metastases was associated with significantly higher rates of FTR, 30-day mortality, and extended hospital stay, independent of other covariates. These findings highlight the importance of the timely identification of patients requiring surgery and the potential benefits of semi-elective care. Full article

The plant Synsepalum dulcificum is notable for its considerable edible and medicinal value, with a longstanding history as a folk remedy for diabetes. Its chemical constituents are rich and structurally diverse. However, there is limited information regarding the metabolic basis of these characteristics, and the biological activities and mechanisms underlying its blood glucose-lowering effects remain incompletely understood. In this study, we conducted a widely targeted metabolomics analysis of the stems, leaves, and fruits of S. dulcificum using UPLC-ESI-MS/MS to compare the differences in metabolite profiles among these three tissue types. Our analysis identified a total of 2544 secondary metabolites, primarily consisting of flavonoids and triterpenes, categorized into thirteen distinct compound classes. We selected differential metabolites through multivariate statistical analysis, revealing significant differences among the metabolite profiles of the three tissue types, with flavonoids being the most abundant compounds. Furthermore, we investigated the anti-diabetic mechanisms and potential pharmacological components of S. dulcificum utilizing network pharmacology and molecular docking techniques. Finally, the α-glucosidase inhibitory activity of the potential active components was evaluated using in vitro experiments. These findings establish a foundation for the future application of S. dulcificum in the prevention and treatment of diabetes. Full article

Background/Objectives: Antimicrobial stewardship programs (ASPs) optimize antimicrobial use, improving outcomes and reducing resistance. This study assessed the impact of a ward-specific ASP. Methods: A pre/post quasi-experimental study was conducted in an internal medicine ward at a tertiary hospital in Padua, Italy. During the intervention year (September 2023–August 2024), a multidisciplinary team (infectious disease consultants, pharmacists, microbiologists, nurses, and hygienists) held bi-weekly ward-based audits, reviewing antimicrobial prescriptions and performing bedside assessments. Therapy adjustments followed guidelines and local epidemiology. Educational sessions and infection prevention and control (IPC) protocols were also reinforced. Outcomes were compared to the previous year, considering patient characteristics. The primary outcome was antimicrobial consumption (DDD/100 patient days, DDD/100PD); secondary outcomes included cost savings, length of stay (LOS), and mortality. Results: Fifty audits assessed 1074 patients and 1401 antimicrobial treatments. Patient characteristics were similar. Antibiotic suspension or de-escalation occurred in 37.9% and 22% of patients, respectively. AWARE ACCESS class use increased (+17.5%), while carbapenem (−54.4%) and fluoroquinolone (−42.0%) use significantly declined (p < 0.05). IPC and microbiological culture guidance were provided in 12.1% of cases. Antimicrobial consumption dropped from 107.7 to 84.4 DDD/100PD (p < 0.05). No significant changes in LOS or mortality were observed. Antimicrobial costs fell by 48.8% (with EUR 57,100 saved). Conclusions: ASP reduced antimicrobial consumption, improved prescription quality, and cut costs without compromising patient outcomes. Multidisciplinary collaboration, audits, and education proved essential. Future studies should assess long-term resistance trends and integrate rapid diagnostics for enhanced stewardship. Full article

Increasing road congestion is the main constraint that may influence the economic development of cities and urban freight transport efficiency because it generates additional costs related to delay, influences social life, increases environmental emissions, and decreases service quality. This may result from several factors, including an increase in logistics activities in the urban core. Therefore, this paper aims to define the relationship between the logistics sprawl phenomenon and congestion level. In this sense, we explored the literature to summarize the phenomenon of logistics sprawl in different cities and defined the dependent and independent variables. Congestion level was defined as the dependent variable, while the increasing distance resulting from logistics sprawl, along with city and operational flow characteristics, was treated as independent variables. We compared the performance of several models, including decision tree, support vector machine, gradient boosting, k-nearest neighbor, logistic regression and random forest. Among all the models tested, we found that the random forest algorithm delivered the best performance in terms of prediction. We combined both logistic regression—for its interpretability—and random forest—for its predictive strength—to define, explain, and interpret the relationship between the studied variables. Subsequently, we collected data from the literature and various databases, including transit city sources. The resulting dataset, composed of secondary and open-source data, was then enhanced through standard augmentation techniques—SMOTE, mixup, Gaussian noise, and linear interpolation—to improve class balance and data quality and ensure the robustness of the analysis. Then, we developed a Python code and executed it in Colab. As a result, we deduced an equation that describes the relationship between the congestion level and the defined independent variables. Full article

(1) Background: Parasites can significantly impact growth, reproductive success, and the development of secondary sexual characteristics in various species. Our study investigated the effect of gastrointestinal and lungworm parasite infections on the total annual horn growth of male bighorn sheep (Ovis canadensis canadensis) in Sheep River Provincial Park, Alberta, Canada. (2) Methods: We collected fecal samples of individually marked male bighorns over two years to investigate parasite egg and oocyst numbers and parasite diversity in feces, and how these could potentially affect their annual horn growth. (3) Results: We found that parasite species richness, year, age class, and the interaction between age class and species richness were significant predictors of horn growth, while individual parasite species did not have a significant effect. Notably, parasite species richness positively affected horn growth in young males, whereas it did not predict horn growth in adult and old males. (4) Conclusions: One possible explanation is that young males might prioritize resources for body and horn growth, potentially at the expense of immunity or parasite resistance. Our finding contradicts the idea of parasite-mediated sexual selection, where traits like bright plumage signal good health and parasite resistance. Full article

OT 355 (4FGL J1734.3 + 3858) is a relatively rarely studied but highly variable, moderate-redshift (z = 0.975) flat-spectrum radio quasar (blazar). With this work, we aim to study its optical variability on different timescales, which can help us to better understand the physical processes in relativistic jets operating in blazar-type active galactic nuclei. OT 355 was observed in four colors (BVRI) during 41 nights between 2017 and 2023 using three 1 and 2 m class telescopes. The object was also monitored on intra-night timescales, for about 100 h in total. In addition, secondary standard stars in the field of OT 355 were calibrated in order to facilitate future photometric studies. We detected significant intra-night and night-to-night variations of up to 0.5 mag. Variability characteristics, color changes, and a possible “rms-flux” relation were studied and discussed. Using simple arguments, we show that a negative “rms-flux” relation should be expected if many independent processes/regions drive the short-term variability via Doppler factor changes, which is not observed in this and other cases. This finding raises arguments for the idea that more complex multiplicative processes are responsible for blazar variability. Studying blazar variability, especially on the shortest possible timescales, can help to estimate the strength and geometry of their magnetic fields, the linear sizes of the emitting regions, and other aspects, which may be of importance for constraining and modeling blazars’ emitting mechanisms. Full article

As an important class of microorganisms, filamentous fungi have crucial roles in protein secretion, secondary metabolite production and environmental pollution control. However, characteristics such as apical growth, heterokaryon, low homologous recombination (HR) efficiency and the scarcity of genetic markers mean that the application of traditional gene editing technology in filamentous fungi faces great challenges. The introduction of the RNA-mediated CRISPR/Cas (clustered regularly interspaced short palindromic repeat/CRlSPR-associated protein) system in filamentous fungi in recent years has revolutionized gene editing in filamentous fungi. In addition, the continuously expressed CRISPR system has significantly improved the editing efficiency, while the optimized sgRNA design and reduced cas9 concentration have effectively reduced the off-target effect, further enhancing the safety and reliability of the technology. In this review, we systematically analyze the molecular mechanism and regulatory factors of CRISPR/Cas9, focus on the optimization of its expression system and the improvement of the transformation efficiency in filamentous fungi, and reveal the core regulatory roles of HR and non-homologous end-joining (NHEJ) pathways in gene editing. Based on the analysis of various filamentous fungi applications, this review reveals the outstanding advantages of CRISPR/Cas9 in the enhancement of protein secretion, addresses the reconstruction of secondary metabolic pathways and pollutant degradation in the past decade, and provides a theoretical basis and practical guidance for the optimization of the technology and engineering applications. Full article

Background/Objectives: Sex-related differences in the presentation and outcomes of patients with mitral regurgitation (MR) undergoing mitral valve (MV) surgery remain unclear. We aimed to identify these differences to inform personalized management. Methods: A total of 143 consecutive patients undergoing surgery for MR between 2017 and 2018 were stratified by sex and assessed for differences in characteristics. We performed 1:1 propensity score matching (PSM) by sex, with baseline characteristics as covariates, yielding 38 comparable pairs which were analyzed for differences in all-cause mortality and post-operative length of stay (LOS). Results: Females (n = 67) were more symptomatic (NYHA Class ≥ 3: 73% vs. 45%, p < 0.001), had higher logistic EuroSCORE (5.5 vs. 3.9, p = 0.006), had more urgent operations (25% vs. 11%, p = 0.020), MV replacements (28% vs. 11%, p = 0.007), and secondary MR (43% vs. 16%, p < 0.001). Females had significantly smaller end-diastolic and end-systolic left ventricular (LV) diameters, though indexed diameters showed no significant differences. After PSM, females had significantly longer LOS (7 days vs. 9 days, p = 0.033) and no differences in long-term mortality (hazard ratio [HR]: 1.25, 95% confidence interval [CI]: 0.34–4.76, p = 0.7, median follow-up: 6.67 years). An indexed LV end-systolic diameter (LVESDi) > 19 mm/m² yielded greater specificity (46.0% vs. 26.7%) and comparable sensitivity (69.4% vs. 69.2%) to LVESD > 40 mm. In subgroup analyses, female patients undergoing concomitant tricuspid intervention (HR: 6.80 [1.63–37.92], p < 0.01) or urgent operation (HR: 4.85 [1.08–21.06], p = 0.04) had worse prognoses than males. Conclusions: Females undergoing MV surgery for MR had more symptoms, higher surgical risk, and longer LOS, but similar mortality compared to males. However, concomitant tricuspid intervention and urgent operations were associated with higher mortality. Our results add to the growing body of evidence that current non-indexed LV diameter thresholds may not adequately account for sex differences. Full article

Janus nanorods are a special class of nanorods composed of two distinct surface regions, one hydrophilic and one hydrophobic. This amphiphilic characteristic makes them promising candidates for stabilizing water–oil interfaces. Oily wastewater (OWW) contamination, resulting from industrial activities such as petroleum extraction and refining and vegetable oil processing, poses significant risks to ecosystems, water resources, and public health. Traditional surfactants used in enhanced oil recovery (EOR) and wastewater treatment often introduce secondary pollution due to their persistence and toxicity. In this work, we investigate the interfacial behavior of Janus NRs under two different conditions: a thin oil film surrounded by water and a nanoconfined system with purely repulsive walls. Using dissipative particle dynamics (DPD) simulations, we analyze how nanorod length and confinement influence interfacial tension and self-assembly. In bulk systems, shorter NRs (dimers and quadrimers) effectively reduce interfacial tension by adsorbing at the oil–water interface, while longer NRs (hexamers) exhibit bulk aggregation, limiting their surfactant efficiency. In contrast, under nanoconfinement, all NR sizes increase interfacial tension due to steric constraints, with longer NRs preferentially adsorbing onto the solid–liquid interface. These results pave the way for the rational design of nanostructured materials for applications in enhanced oil recovery, wastewater treatment, and membrane filtration. Full article

The valorization of agricultural and industrial solid by-products as secondary resources in the development of value-added materials can contribute to environmental health protection, particularly in the climate change era. Current advances in environmental legislation also encourage manufacturers to optimize waste management, upgrading and utilization towards resource conservation, energy efficiency and cost reduction in the context of a circular economy. In the present research, the elaboration of novel sustainable ceramics is investigated by sintering (at 800 °C for 2 or 6 h) of compacted mixtures composed of lignite fly ashes along with biomass ash (olive kernel ash) at different proportions. It appears that the chemical, mineralogical and morphological characteristics of these by-products promote their use as starting materials in ceramic engineering. Characterization and evaluation of the ceramics obtained via XRD and SEM-EDX analysis, as well as Vickers microhardness measurements, confirm the effectiveness of the consolidation process. In fact, the material derived from an 85% Class-C fly ash and 15% biomass ash compact, after 6 h sintering, exhibited greater results in terms of ceramic microstructure and microhardness (380 Hv), while a sintering time of 2 h was barely acceptable. The materials developed can be considered for use in various applications. Full article

Ginsenosides, the most active components in Panax ginseng, exhibit pharmacological and therapeutic properties but are limited by their low abundance. Jasmonates (JAs), a class of stress-induced phytohormones, are integral in modulating plant defense responses and the biosynthesis of secondary metabolites, including ginsenosides. Jasmonoyl-isoleucine (JA-Ile), the primary bioactive JA compound, is biosynthesized by JA-Ile synthase 1 (JAR1). In this study, we cloned the 1555 bp PgJAR1 gene from ginseng roots and analyzed its structure, enzyme activity, and expression pattern. The PgJAR1 protein encompasses all the hallmark elements characteristic of the GH3 family. It exhibits N/C-terminal domains analogous to ANL, three ATP/AMP-binding motifs, and distinct secondary structures: an N-terminal beta-barrel with beta-sheets and alpha-helices, and a C-terminal beta-sheet surrounded by alpha-helices, similarly to AtGH3.11/AtJAR1. The recombinant PgJAR1 enzyme expressed in Escherichia coli BL21 specifically catalyzed jasmonic acid (JA) to JA-Ile. PgJAR1 is predominantly expressed in leaves and is upregulated by MeJA treatment. Moderate transient overexpression of PgJAR1 promoted the biosynthesis of both JA-Ile and ginsenosides, highlighting the crucial role of PgJAR1 in JA-Ile biosynthesis and its positive impact on ginsenoside accumulation. Nevertheless, elevated JA-Ile levels can impede cellular growth, reducing ginsenoside production. Consequently, balancing JA-Ile biosynthesis through PgJAR1 expression is essential for optimizing ginseng cultivation and enhancing its medicinal properties. Modulating endogenous JA-Ile levels offers a strategy for increasing ginsenoside production in ginseng plants. Full article

Nerve agents, a highly toxic class of chemical warfare agents, pose serious risks to human health and social stability. Metal oxides are commonly used as catalysts to break down these agents through thermocatalytic decomposition. In particular, bimetallic oxide catalysts offer enhanced stability and catalytic efficiency due to their synergistic effects. In this study, CuO/ZrO₂ composite catalysts with varying Cu/Zr ratios were synthesized using a secondary hydrothermal method, resulting in a hollow microsphere morphology. The catalytic efficiency of these composites in thermocatalytically decomposing dimethyl methylphosphonate (DMMP), a sarin simulant, was systematically evaluated. The findings revealed that the catalyst with a 10%Cu/Zr ratio exhibited the best performance, achieving the longest protection duration of 272 min. The hollow microsphere structure facilitated high dispersion of CuO on the ZrO₂ surface, promoting strong interactions and generation of oxygen vacancies, which enhanced the catalytic activity. Furthermore, the catalytic reaction mechanism was explored by analyzing the surface characteristics of the catalyst and the resulting reaction products. This research addresses a gap in the application of CuO/ZrO₂ catalysts for DMMP decomposition and provides valuable insights for the future development of catalysts for chemical warfare agent degradation. Full article

Flavonoids represent a class of natural plant secondary metabolites with multiple activities including antioxidant, antitumor, anti-inflammatory, and antimicrobial properties. However, due to their structural characteristics, they often exhibit low bioavailability in vivo. In this review, we focus on the in vivo study of flavonoids, particularly the effects of gut microbiome on flavonoids, including common modifications such as methylation, acetylation, and dehydroxylation, etc. These modifications aim to change the structural characteristics of the original substances to enhance absorption and bioavailability. In order to improve the bioavailability of flavonoids, we discuss two feasible methods, namely dosage form modification and chemical modification, and hope that these approaches will offer new insights into the application of flavonoids for human health. In this article, we also introduce the types, plant sources, and efficacy of flavonoids. In conclusion, this is a comprehensive review on how to improve the bioavailability of flavonoids. Full article

Background: Retinal diseases are emerging as a significant health concern, making early detection and prompt treatment crucial to prevent visual impairment. Optical coherence tomography (OCT) is the preferred imaging modality for non-invasive diagnosis. Both diabetic macular edema (DME) and macular edema secondary to retinal vein occlusion (RVO) present an increase in retinal thickness, posing etiologic diagnostic challenges for non-specialists in retinal diseases. The lack of research on deep learning classification of macular edema secondary to RVO using OCT images motivated us to propose a convolutional neural network model for this task. Methods: The VGG-19 network was fine-tuned with a public dataset to classify OCT images. This network was then used to develop three models: unimodal—the input is only the OCT B-scan; multimodal—the inputs are the OCT B-scan and diabetes information, and multi-image—the inputs are the OCT B-scan, the infrared image, and the diabetes information. Seven hundred sixty-six patients from ULS São João were selected, comprising 208 healthy eyes, 207 with macular edema secondary to RVO, 218 with DME, and 200 with other pathologies. The performance metrics include accuracy, precision, recall, F_0.5 score, and area under the receiver operating characteristic curve (AUROC). Results: The multi-image model achieved better results, with an accuracy of 95.20%, precision of 95.43%, recall of 95.20%, F_0.5-score of 95.32%, F₁-score of 95.21%, and AUROC of 99.59% on the classification task between four classes. Conclusions: This study presents a novel method to distinguish macular edema secondary to RVO and DME using diabetes diagnosis, OCT, and infrared images. This research aims to provide a reliable tool for ophthalmologists, improving the accuracy and speed of diagnoses. Full article