Search Results (3,162)

Background: Radiation dose escalation for locally advanced pancreatic cancer (LAPC) using stereotactic magnetic resonance (MR)-guided online adaptive radiation therapy (SMART) or computed tomography (CT)-guided moderately hypofractionated ablative radiation therapy (HART) can achieve favorable outcomes although have not previously been compared. Methods: We performed a multi-center retrospective analysis of SMART (50 Gy/5 fractions) vs. HART (75 Gy/25 fractions or 67.5 Gy/15 fractions with concurrent capecitabine) for LAPC. Gray’s test and Cox proportional regression analyses were performed to identify factors associated with local failure (LF) and overall survival (OS). Results: A total of 211 patients (SMART, n = 91; HART, n = 120) were evaluated, and none had surgery. Median follow-up after SMART and HART was 27.0 and 40.0 months, respectively (p < 0.0002). SMART achieved higher gross tumor volume (GTV) coverage and greater hotspots. Two-year LF after SMART and HART was 6.5% and 32.9% (p < 0.001), while two-year OS was 31.0% vs. 35.3% (p = 0.056), respectively. LF was associated with SMART vs. HART (HR 5.389, 95% CI: 1.298–21.975; p = 0.021) and induction mFOLFIRINOX vs. non-mFOLFIRINOX (HR 2.067, 95% CI 1.038–4.052; p = 0.047), while OS was associated with CA19-9 decrease > 40% (HR 0.725, 95% CI 0.515–0.996; p = 0.046) and GTV V120% (HR 1.022, 95% CI 1.006–1.037; p = 0.015). Acute grade > 3 toxicity was similar (3.3% vs. 5.8%; p = 0.390), while late grade > 3 toxicity was less common after SMART (2.2% vs. 9.2%; p = 0.037). Conclusions: Ablative SMART and HART both achieve favorable oncologic outcomes for LAPC with minimal toxicity. We did not observe an OS difference, although technical advantages of SMART might improve target coverage and reduce LF. Full article

The monitoring of algal communities has traditionally relied on optical microscopy. However, this technique is time-consuming and requires significant expertise to accurately identify species. In recent years, molecular techniques such as environmental DNA (eDNA) metabarcoding have facilitated the identification of algal communities. This study aims to compare both approaches for assessing planktonic microalgal communities in three areas of Lake Titicaca, using inverted light microscopy and eDNA metabarcoding. We found that the taxonomic composition obtained using the two methods differs significantly for Bacillariophyta, Chlorophyta, Charophyta, and Cyanobacteria, although genus- and order-level richness was similar across both approaches. A pronounced shift in species composition between techniques was revealed, with few shared genera and a high proportion of unassigned sequences (>50%) for Bacillariophyta. While microscopy provided more accurate estimates of microalgal density, metabarcoding revealed greater diversity, particularly among nanoplanktonic microalgae from the phyla Cryptophyta, Ochrophyta, Haptophyta, and Rhodophyta. To improve the accuracy and complementarity of these methodologies, it is essential to expand regional reference databases and work toward standardizing both approaches, allowing them to be used synergistically rather than independently. Full article

This article investigates the macroeconomic and labor market conditions that shape the adoption of artificial intelligence (AI) technologies among large firms in Europe. Based on panel data econometrics and supervised machine learning techniques, we estimate how public health spending, access to credit, export activity, gross capital formation, inflation, openness to trade, and labor market structure influence the share of firms that adopt at least one AI technology. The research covers all 28 EU members between 2018 and 2023. We employ a set of robustness checks using a combination of fixed-effects, random-effects, and dynamic panel data specifications supported by Clustering and supervised learning techniques. We find that AI adoption is linked to higher GDP per capita, healthcare spending, inflation, and openness to trade but lower levels of credit, exports, and capital formation. Labor markets with higher proportions of salaried work, service occupations, and self-employment are linked to AI diffusion, while unemployment and vulnerable work are detractors. Cluster analysis identifies groups of EU members with similar adoption patterns that are usually underpinned by stronger economic and institutional fundamentals. The results collectively suggest that AI diffusion is shaped not only by technological preparedness and capabilities to invest but by inclusive macroeconomic conditions and equitable labor institutions. Targeted policy measures can accelerate the equitable adoption of AI technologies within the European industrial economy. Full article

As a typical grain base with a dense population and high-level urbanization, the North China Plain (NCP) faces a serious threat to its sustainable development due to water shortage. Surface water area (SWA) is a key indicator for continuously measuring the trends of regional water resources and assessing their current status. Therefore, a deep understanding of its changing patterns and driving forces is essential for achieving the sustainable management of water resources. In this study, we examined the interannual variability and trends of SWA in the NCP from 1990 to 2023 using annual 30 m water body maps generated from all available Landsat imagery, a robust water mapping algorithm, and the cloud computing platform Google Earth Engine (GEE). The results showed that the SWA in the NCP has significantly increased over the past three decades. The continuous emergence of artificial reservoirs and urban lakes, along with the booming aquaculture industry, are the main factors driving the growth of SWA. Consequently, the expansion of artificial water bodies resulted in a significant increase in water evaporation (0.16 km³/yr). Moreover, the proportion of water evaporation to regional evapotranspiration (ET) gradually increased (0–0.7%/yr), indicating that the contribution of water evaporation from artificial water bodies to ET is becoming increasingly prominent. Therefore, it can be concluded that the ever-expanding artificial water bodies have become a new hidden danger affecting the water security of the NCP through evaporative loss and deserve close attention. This study not only provides us with a new perspective for deeply understanding the current status of water resources security in the NCP but also provides a typical case with great reference value for the analysis of water resources changes in other similar regions. Full article

Since wheats used for use in brewing mainly belong to the winter red hard hybrid endosperm type, this paper examined the influence of different proportions of wheat of this type (seven varieties) in the ratio of 0–100% in the grist, both unmalted and as wheat malt. The quality of the starting wheats, the resulting malts and mashs with different added wheat proportions (100, 80, 60, 40, 20 and 0%) were examined. The obtained results show that the maximum shares of wheat/wheat malt in the infusion are significantly different between varieties of similar initial quality. However, they can differ considerably for the same variety when it is used as unmalted raw material and when it is used as wheat malt. Wheat malt can be added to the mixture in a significantly larger proportion compared to unmalted wheat. Furthermore, when an extended number of criteria (parameters) are applied, some varieties may be acceptable that otherwise would not be if the basic number of parameters were applied (total protein—TP, total soluble protein—TSP and viscosity—VIS) and vice versa. The inclusion of other parameters—filtration speed (FIL), saccharification time (SAC), color (COL), proportion of fine extract (EXT) and fermentability of pomace (FAL) (some of which have the character of so-called “cumulative parameters”)—complicates a clear classification into the aforementioned qualitative groups but also increases the number of varieties acceptable or conditionally acceptable for brewing. Full article

Objective: This study aimed to develop a performance evaluation index system for a district-level public hospital in Chongqing, China, based on Diagnosis-Related Groups (DRGs), to provide a benchmark for performance assessment in similar hospitals. The system was constructed using a literature analysis, the Delphi method, and the Analytic Hierarchy Process (AHP) to identify and weight relevant indicators. Results: The evaluation system consists of three primary indicators and eighteen secondary indicators. Key secondary indicators include the Case Mix Index (CMI), cost consumption index, low-risk group mortality rate, the proportion of patients with three- or four-level surgeries at discharge, and the proportion of medical service revenue to medical income. In 2020, significant improvements were observed in several indicators, such as a decrease in the low-risk group mortality rate to 0% and increases in the proportion of patients with three- or four-level surgeries and CMI by nearly 10% and 13%, respectively. Conclusions: This study successfully developed a comprehensive and scientifically sound performance evaluation index system for a district-level public hospital in Chongqing. The system has proven effective in objectively assessing inpatient medical care performance and providing valuable guidance for improving healthcare services in similar settings. Full article

Heavy metals are a major toxicological concern due to their adverse effects on human health, particularly in children exposed to contaminated areas. This study evaluated biomarkers of exposure in 253 children aged 6 to 12 from Magangue, Achi, and Arjona (Bolivar, Colombia), analyzing their relationship with neurotoxicity and hematological markers. The mean Pb concentrations at the study sites were 1.98 µg/g (Magangue) > 1.51 µg/g (Achi) > 1.24 µg/g (Arjona). A similar pattern was observed for Cd concentrations for Magangue (0.39 µg/g) > Achi (0.36 µg/g) > Arjona (0.14 µg/g). In contrast, Se concentrations followed a different trend for Arjona (0.29 µg/g) > Magangue (0.21 µg/g) > Achi (0.16 µg/g). The proportion of Se/Pb molar ratios > 1 was higher in Arjona (3.8%) than in Magangue (0.9%) and Achi (2.0%). For Se/Cd ratios, values > 1 were also more frequent in Arjona (70.7%), exceeding 20% in the other two locations. Significant differences were found among locations in red and white blood cell parameters and platelet indices. Neurotransmitter-related biomarkers, including serotonin, monoamine oxidase A (MAO-A), and acetylcholinesterase levels, also varied by location. Principal component analysis showed that Pb and Cd had high loadings on the same component as PLT, WBC, and RDW, and while Se loaded together with HGB, PDW, MCHC, MCH, and MCV, suggesting distinct hematological patterns associated with each element. Multiple linear regression analysis demonstrated a statistically significant inverse association between hair Pb levels and serotonin concentrations. Although MAO-A and Cd showed negative β coefficients, these associations were not statistically significant after adjustment. These findings highlight the potential impact of toxic element exposure on key hematological and neurochemical parameters in children, suggesting early biological alterations that may compromise health and neurodevelopment. Full article

Background and Objectives: Anemia and stunting are major public health concerns for young Indonesian children. Limited information is available from studies on multi-micronutrient supplements in Indonesia. The objective of this study was to investigate the effect of 12-month multi-micronutrient powder (MNP) supplementation on serum hemoglobin levels, anemia, and growth. Methods: A randomized double-blinded placebo-controlled study was performed, including 232 eligible children aged 8–10 months old. Children with severe anemia or stunting/those classed as underweight were not included as subjects. The study was performed in a low-socioeconomic-status community in Jakarta. With an active-to-placebo ratio of 60:40, 139 subjects received MNP sachets twice/day, and 93 subjects received placebo sachets, mixed with complementary food. The outcome parameters were hemoglobin level, anemia, and growth indicators. Per-protocol analysis was performed for 179 (intervention: 110; control: 69) subjects. Results: There were no differences at baseline between the groups, except for the weight-for-length z-scores (WLZ). Upon intervention, the serum hemoglobin level and anemia proportion did not change significantly within the group, and no significant differences were found between the groups (p > 0.05). However, subgroup analysis of non-anemic children at baseline showed a significant increase in hemoglobin levels in the youngest age group (8.0–8.9 months old) receiving MNP compared to placebo (0.13 vs. −0.79, p = 0.031). Iron deficiency anemia proportion showed a similar upward trend upon intervention in both groups. No significant differences in growth were found between both groups. Conclusions: This study failed to find a significant effect of 12-month MNP supplementation on serum hemoglobin level, anemia, and growth. Full article

Blue Zones (BZs) are regions across the world associated with exceptional human longevity, where individuals routinely live into their 90s and beyond. These areas share distinct lifestyle and environmental factors that promote healthy aging. The established BZs include Sardinia, Okinawa, Ikaria, and Nicoya, while several “emerging” BZs have been reported in various parts of the globe. This study investigates an area in Sicily for similar longevity patterns. Demographic data from the Italy National Institute of Statistics and local civil registries identify the municipality of Caltabellotta, home to approximately 3000 residents, and the nearby Sicani Mountains as a potential emerging BZ. The area exhibits a significantly higher prevalence of nonagenarians and centenarians compared to national and regional averages. Between 1900 and 1924, the proportion of newborns in Caltabellotta who reached age 90 and above rose from 3.6% to 14%, with 1 out of 166 individuals during this period reaching the age of 100. Historical, dietary, environmental, and sociocultural characteristics align with known BZ traits, including adherence to the Mediterranean diet, physical activity through agrarian routines, strong social cohesion, and minimal environmental pollution. A comparative analysis with the validated Sardinia BZ supports the hypothesis that this Sicilian area may represent an emerging longevity hotspot. Further multidisciplinary investigation is warranted to substantiate these findings. Full article

Background/Objectives: Total thymectomy is currently the gold standard operation for treating thymoma. However, recent studies have suggested the potential health consequences of thymus removal in adults, including possible increased autoimmune disease and all-cause mortality. In this context, we assess oncologic outcomes following total vs. partial thymectomy for early-stage thymoma. Methods: We identified patients diagnosed with WHO types A–B3 thymoma between 2010–2021 from a national hospital-based dataset. We excluded patients with stage II or higher disease, open resections and perioperative chemo-/radiation therapy. We stratified patients into total and partial thymectomy cohorts. We used propensity score matching to minimize confounding, Kaplan–Meier analysis to estimate survival, and Cox proportional hazards to identify associations. Results: Of 1598 patients with early-stage thymoma, 495 (31.0%) underwent partial and 1103 (69.0%) total thymectomy. Patients undergoing partial thymectomy were similar in sex (female 53.7% vs. 53.4%; p = 0.914), race (white 74.5% vs. 74.0%; p = 0.921), comorbidities (0 in 77.0% vs. 75.5%; p = 0.742), and tumor size (48.7 mm vs. 50.4 mm; p = 0.455) compared to total thymectomy. There were no differences in 30-day (0.8% vs. 0.6%, p = 0.747) or 90-day mortality (0.8% vs. 0.8%, p > 0.999), which persisted after matching. Moreover, 10-year survival was similar in both unmatched (p = 0.471) and matched cohorts (p = 0.828). Partial thymectomy was not independently associated with survival (aHR = 1.00, p = 0.976). Conclusions: In patients with early-stage thymoma, partial and total thymectomy were associated with similar short- and long-term outcomes. In light of recent attention to the role of the thymus gland, the results add important insights to shared decision-making discussions. Full article

Background/Objectives: Traumatic brain injury is one of the leading causes of death and disability. When traumatic brain injury is repeated over time, it can lead to the development of Chronic Traumatic Encephalopathy, a chronic neurodegenerative disease commonly observed in individuals who engage in contact sports or military personnel involved in activities with a high risk of repeated head trauma. At autopsy, the examination of the brain reveals regional atrophy, corresponding to high concentrations of glutamate receptors. Microscopically, the primary findings are the deposition of neurofibrillary tangles and neuropil threads. The aim of this study is to highlight the clinical and histopathological characteristics of Chronic Traumatic Encephalopathy, providing diagnostic support to forensic pathologists. Additionally, it seeks to aid in the differential diagnosis of similar conditions. Methods: A review of literature was conducted following the PRISMA criteria. Of 274 articles, 7 were selected. Results: According to these papers, most patients were male and exhibited neurological symptoms and neuropsychiatric impairments, and a proportion of them committed suicide or had aggressive behavior. Conclusions: Chronic Traumatic Encephalopathy remains largely underdiagnosed during life. The definitive diagnosis of Chronic Traumatic Encephalopathy is established post-mortem through the identification of pathognomonic tauopathy lesions. Early and accurate antemortem recognition, particularly in at-risk individuals, is highly valuable for its differentiation from other neurodegenerative conditions, thereby enabling appropriate clinical management and potential interventions. Full article

Crop fidelity is a desirable trait for managed pollinators and is influenced by factors like competing forage sources and colony knowledge of the surrounding environment. In European honey bees (Apis mellifera L.), colonies deployed when the crop is flowering display the highest fidelity. We tested for a similar outcome using a stingless bee species that is being increasingly used as a managed pollinator in Australian macadamia orchards. We observed Tetragonula carbonaria (Smith) colonies deployed in macadamia orchards at three time points: (1) before crop flowering (“permanent”), (2) early flowering (“early”), and (3) later in the flowering period (“later”). We captured returning pollen foragers weekly and estimated crop fidelity from the proportion of macadamia pollen they collected, using light microscopy. Pollen foraging activity was also assessed via weekly hive entrance filming. The early and later introduced colonies initially exhibited high fidelity, collecting more macadamia pollen than the permanent colonies. In most cases, the permanent colonies were already collecting diverse pollen species from the local environment and took longer to shift over to macadamia. Pollen diversity increased over time in all colonies, which was associated with an increase in the proportion of pollen foragers. Our results indicate that stingless bees can initially prioritize a mass-flowering crop, even when flowering levels are low, but that they subsequently reduce fidelity over time. Our findings will inform pollinator management strategies to help growers maximize returns from pollinator-dependent crops like macadamia. Full article

In order to reduce gas consumption and increase the renewable energy proportion, this paper proposes a poly-generation system that couples geothermal, solar, and liquid natural gas (LNG) cold energy to produce steam, gaseous natural gas, and low-temperature nitrogen. The high-temperature flue gas is used to heat LNG; low-temperature flue gas, mainly nitrogen, can be used for cold storage cooling, enabling the staged utilization of the energy. Solar shortwave is used for power generation, and longwave is used to heat the working medium, which realizes the full spectrum utilization of solar energy. The influence of different equipment and operating parameters on the performance of a steam generation system is studied, and the multi-objective model of the multi-generation system is established and optimized. The results show that for every 100 W/m² increase in solar radiation, the renewable energy ratio of the system increases by 1.5%. For every 10% increase in partial load rate of gas boiler, the proportion of renewable energy decreases by 1.27%. The system’s energy efficiency, cooling output, and the LNG vaporization flow rate are negatively correlated with the scale of solar energy utilization equipment. The decision variables determined by the TOPSIS (technique for order of preference by similarity to ideal solution) method have better economic performance. Its investment cost is 18.14 × 10 CNY, which is 7.83% lower than that of the LINMAP (linear programming technique for multidimensional analysis of preference). Meanwhile, the proportion of renewable energy is only 0.29% lower than that of LINMAP. Full article

Background/Objectives: Single-dose pre-operative antibiotic prophylaxis for cardiac-device implantation is recommended but extending antibiotic prophylaxis is common. Locally, 50–60% of patients had extended prophylaxis after pacemaker insertion or generator change. Our antimicrobial stewardship programme (ASP) incorporated behavioural change strategies in implementing a multi-pronged intervention bundle to address this and evaluated its effectiveness and safety. Methods: This single-centre, retrospective cohort study included patients aged 21 years old or older, undergoing uncomplicated pacemaker insertion or generator change at Singapore General Hospital (SGH) from October 2022 to March 2025. To improve antibiotic use, ASP interventions incorporating behaviour change strategies were implemented, namely (1) data-driven feedback, (2) targeted education, (3) identification and engagement of ASP champion, and (4) clinical pathway revision. Results: There were 779 patients evaluated; 380 (48.8%) received standard prophylaxis while 399 (51.2%) received extended prophylaxis with oral antibiotics (mean duration, 3.3 ± 0.8 days). Following ASP interventions, the practice of extended prophylaxis declined significantly from 43.8% to 24.0% (p < 0.01). The incidence of surgical site infections was low and similar in both groups (0.8%, p = 1.000); all infections were superficial. There was also significant reduction in the proportion of patients on all antibiotics from 20.7% to 16.3% (p < 0.01). Identification and engagement of ASP champion proved pivotal in changing prescribing behaviour through peer influence and credibility. Conclusions: The bundled ASP interventions, incorporating behavioural change strategies, have effectively and safely reduced the use of extended prophylaxis post-cardiac device implantation. Behavioural change interventions are essential to achieve sustained stewardship success. Full article

Background/Objectives: The COVID-19 pandemic disrupted global cancer care. This study compared gastric cancer surgical outcomes before and during the pandemic in Turkey. We also aimed to analyze the impact of the pandemic and factors on survival and mortality in gastric cancer patients. Materials and Methods: This retrospective, multicenter cohort study included 324 patients from three tertiary centers in Turkey who underwent gastric cancer surgery between January 2018 and December 2022. Patients were stratified into Pre-COVID-19 (n = 150) and COVID-19 Era (n = 174) groups. Comprehensive demographic, surgical, pathological, and survival data were analyzed. To identify factors independently associated with postoperative mortality, a multivariable logistic regression model was applied. For evaluating predictors of long-term survival, multivariable Cox proportional hazards regression analysis was conducted. Results: The median time from diagnosis to surgery was comparable between groups, while the time from surgery to pathology report was significantly prolonged during the pandemic (p = 0.012). Laparoscopic surgery (p = 0.040) and near-total gastrectomy (p = 0.025) were more frequently performed in the Pre-COVID-19 group. Although survival rates between groups were similar (p = 0.964), follow-up duration was significantly shorter in the COVID-19 Era (p < 0.001). Comparison between survivor and non-survivor groups showed that several variables were significantly associated with mortality, including larger tumor size (p < 0.001), greater number of metastatic lymph nodes (p < 0.001), elevated preoperative CEA (p = 0.001), CA 19-9 (p < 0.001), poor tumor differentiation (p = 0.002), signet ring cell histology (p = 0.003), lymphovascular invasion (p < 0.001), and perineural invasion (p < 0.001). Multivariable logistic regression identified total gastrectomy (OR: 2.14), T4 tumor stage (OR: 2.93), N3 nodal status (OR: 2.87), and lymphovascular invasion (OR: 2.87) as independent predictors of postoperative mortality. Cox regression analysis revealed that combined tumor location (HR: 1.73), total gastrectomy (HR: 1.56), lymphovascular invasion (HR: 2.63), T4 tumor stage (HR: 1.93), N3 nodal status (HR: 1.71), and distant metastasis (HR: 1.74) were independently associated with decreased overall survival. Conclusions: Although gastric cancer surgery continued during the COVID-19 pandemic, some delays in pathology reporting were observed; however, these did not significantly affect the timing of adjuvant therapy or patient outcomes. Importantly, pandemic timing was not identified as an independent risk factor for mortality in multivariable logistic regression analysis, nor for survival in multivariable Cox regression analysis. Instead, tumor burden and aggressiveness—specifically advanced stage, lymphovascular invasion, and total gastrectomy—remained the primary independent determinants of poor prognosis. While pandemic-related workflow delays occurred, institutional adaptability preserved oncologic outcomes. Full article