Search Results (1,059)

Introduction: Haglund’s deformity, characterized by bony enlargement at the back of the heel, often coincides with Achilles tendon pathology due to impingement on the retrocalcaneal bursa and tendon insertion. Surgical management of Haglund’s deformity with a preexisting Achilles tendon rupture is complex, and understanding the outcomes of this subset of patients is essential for optimizing treatment strategies. Methods: This retrospective study reviewed patients undergoing open surgical management for Haglund’s syndrome between January 2015 and December 2023. Patients with chronic degenerative changes secondary to Haglund’s deformity and a preoperative Achilles tendon rupture were compared to those without. Data on demographics, surgical techniques, weightbearing protocols, and complications were collected. Univariate analysis was performed using χ² or Fisher’s exact test for categorical variables, and the T-test or Wilcoxon rank-sum test for continuous and ordinal variables, with normality assessed via the Shapiro–Wilk test. Results: Four hundred and three patients were included, with 13 having a preoperative Achilles tendon rupture. There was a higher incidence of preoperative ruptures among males. Surgical repair techniques and postoperative weightbearing protocols varied, though were not randomized. Complications included persistent pain, wound breakdown, infection, plantar flexion weakness, and revision surgery. While patients with Haglund’s deformity and a preoperative Achilles tendon rupture demonstrated a trend toward higher complication rates, including postoperative rupture and wound breakdown, these differences were not statistically significant in our analysis. Conclusions: A cautious approach is warranted in managing these patients, with careful consideration of surgical planning and postoperative rehabilitation. While our findings provide valuable insights into managing patients with Haglund’s deformity and preoperative Achilles tendon rupture, the retrospective design, limited sample size of the rupture group, and short duration of follow-up restrict generalizability and the strength of the conclusions by limiting the power of the analysis and underestimating the incidence of long-term complications. Therefore, the results of this study should be interpreted with caution. Further studies with larger patient cohorts, validated functional outcome measures, and comparable follow-up durations between groups are needed to confirm these results and optimize treatment approaches. Full article

Purpose: To present the findings of our preliminary experience using daily image-guided radiotherapy (IGRT) supported by implanted fiducial markers (FMs) in the radiotherapy of the vaginal cuff, in a cohort of post-surgery endometrial cancer patients. Methods: Patients with vaginal cuff cancer requiring adjuvant radiation with external beams were enrolled. Five patients underwent radiation therapy targeting the pelvic disease and positive lymph nodes, with doses of 50.4 Gy in twenty-eight fractions and a subsequent stereotactic boost on the vaginal vault at a dose of 5 Gy in a single fraction. One patient was administered 30 Gy in five fractions to the vaginal vault. These patients underwent external beam RT following the implantation of three 0.40 × 10 mm gold fiducial markers (FMs). Our IGRT strategy involved real-time 2D kV image-based monitoring of the fiducial markers during the treatment delivery as a surrogate of the vaginal cuff. To explore the potential role of FMs throughout the treatment process, we analyzed cine movies of the 2D kV-triggered images during delivery, as well as the image registration between pre- and post-treatment CBCT scans and the planning CT (pCT). Each CBCT used to trigger fraction delivery was segmented to define the rectum, bladder, and vaginal cuff. We calculated a standard metric to assess the similarity among the images (Dice index). Results: All the patients completed radiotherapy and experienced good tolerance without any reported acute or long-term toxicity. We did not observe any loss of FMs during or before treatment. A total of twenty CBCTs were analyzed across ten fractions. The observed trend showed a relatively emptier bladder compared to the simulation phase, with the bladder filling during the delivery. This resulted in a final median Dice similarity coefficient (DSC) of 0.90, indicating strong performance. The rectum reproducibility revealed greater variability, negatively affecting the quality of the delivery. Only in two patients, FMs showed intrafractional shift > 5 mm, probably associated with considerable rectal volume changes. Target coverage was preserved due to a safe CTV-to-PTV margin (10 mm). Conclusions: In our preliminary study, CBCT in combination with the use of fiducial markers to guide the delivery proved to be a feasible method for IGRT both before and during the treatment of post-operative gynecological cancer. In particular, this approach seems to be promising in selected patients to facilitate the use of SBRT instead of BRT (brachytherapy), thanks to margin reduction and adaptive strategies to optimize dose delivery while minimizing toxicity. A larger sample of patients is needed to confirm our results. Full article

Introduction: The optimal management of hallux sesamoid fracture nonunions remains a subject of ongoing debate, particularly in the context of personalized medicine. This systematic review aimed to synthesize current evidence regarding surgical strategies for this rare but disabling condition. Methods: A comprehensive literature search was conducted in accordance with the PRISMA guidelines. Results: Six studies met the inclusion criteria, encompassing a total of 80 patients. Surgical techniques varied and included open and arthroscopic sesamoidectomy, autologous bone grafting (alone or combined with screw fixation), and percutaneous screw fixation. When reported, outcomes were generally favorable, with union rates ranging from 90.5% to 100% and with consistent postoperative improvements in clinical function. Complication and reoperation rates were both 6.5%. The most frequent reoperation was sesamoidectomy for persistent pain or nonunion, followed by hardware removal. Conclusions: Despite the limited and low-quality evidence, available data suggest that individualized surgical planning can lead to favorable outcomes with low complication rates. Sesamoidectomy remains the most reliable salvage procedure in refractory cases. These findings support a personalized, stepwise approach to treatment—prioritizing sesamoid preservation, when feasible, while reserving excision for symptomatic nonunions. Further studies are needed to validate tailored algorithms and refine patient-specific decision-making in this challenging clinical scenario. Full article

Background: Lung cancer ranks as the leading cause of cancer-related mortality worldwide. The complexity of tumor delineation, crucial for radiation therapy, requires expertise often unavailable in resource-limited settings. Artificial Intelligence (AI), particularly with advancements in deep learning (DL) and natural language processing (NLP), offers potential solutions yet is challenged by high false positive rates. Purpose: The Oncology Contouring Copilot (OCC) system is developed to leverage oncologist expertise for precise tumor contouring using textual descriptions, aiming to increase the efficiency of oncological workflows by combining the strengths of AI with human oversight. Methods: Our OCC system initially identifies nodule candidates from CT scans. Employing Language Vision Models (LVMs) like GPT-4V, OCC then effectively reduces false positives with clinical descriptive texts, merging textual and visual data to automate tumor delineation, designed to elevate the quality of oncology care by incorporating knowledge from experienced domain experts. Results: The deployment of the OCC system resulted in a 35.0% reduction in the false discovery rate, a 72.4% decrease in false positives per scan, and an F1-score of 0.652 across our dataset for unbiased evaluation. Conclusions: OCC represents a significant advance in oncology care, particularly through the use of the latest LVMs, improving contouring results by (1) streamlining oncology treatment workflows by optimizing tumor delineation and reducing manual processes; (2) offering a scalable and intuitive framework to reduce false positives in radiotherapy planning using LVMs; (3) introducing novel medical language vision prompt techniques to minimize LVM hallucinations with ablation study; and (4) conducting a comparative analysis of LVMs, highlighting their potential in addressing medical language vision challenges. Full article

The article presents a new AM (Additive Manufacturing) process development, necessary to repair parts made from Aluminum 6061 material, with T6 treatment. The laser Directed Energy Deposition (DED) and Extreme High-Speed Directed Energy Deposition (EHLA) capabilities are evaluated for repairing Al large components. To optimize the process parameters, single-track depositions were analyzed for both laser-powder DED (feed rate of 2 m/min) and EHLA (feed rate 20 m/min) for AlSi10Mg and Al6061 powders. The cross-sections of single tracks revealed the bonding characteristics and provided laser-powder DED, a suitable parameter selection for the repair. Three damage types were identified on the Al component to define the specification of the repair process and to highlight the capabilities of laser-powder DED and EHLA in repairing intricate surface scratches and dents. Our research is based on variation of the powder mass flow and beam power, studying the influence of these parameters on the weld bead geometry and bonding quality. The evaluation criteria include bonding defects, crack formation, porosity, and dilution zone depth. The bidirectional path planning strategy was applied with a fly-in and fly-out path for the hatching adjustment and acceleration distance. Samples were etched for a qualitative microstructure analysis, and the HV hardness was tested. The novelty of the paper is the new process parameters for laser-powder DED and EHLA deposition strategies to repair large Al components (6061 T6), using AlSi10Mg and Al6061 powder. Our experimental research tested the defect-free deposition and the compatibility of AlSi10Mg on the Al6061 substrate. The readers could replicate the method presented in this article to repair by laser-powder DED/EHLA large Al parts and avoid the replacement of Al components with new ones. Full article

Proton therapy has emerged as a highly precise and tissue-sparing radiotherapy technique, capitalizing on the unique energy deposition pattern of protons characterized by the Bragg peak. Ensuring treatment accuracy relies on calibration phantoms, often composed of tissue-equivalent polymeric materials. This study investigates the dosimetric behavior of four commonly used polymers—Parylene, Epoxy, Lexan, and Mylar—by analyzing their linear energy transfer (LET) values and Bragg curve characteristics across various proton energies. Experimental LET data were collected and used to train and evaluate the predictive power for Bragg peak of multiple artificial intelligence models, including kNN, SVR, MLP, RF, LWRF, XGBoost, 1D-CNN, LSTM, and BiLSTM. These algorithms were optimized using 10-fold cross-validation and assessed through statistical error and performance metrics including MAE, RAE, RMSE, RRSE, CC, and R². Results demonstrate that certain AI models, particularly RF and LWRF, accurately (in terms of all evaluation metrics) predict Bragg peaks in Epoxy polymers, reducing the reliance on costly and time-consuming simulations. In terms of CC and R² metrics, the LWRF model demonstrated superior performance, achieving scores of 0.9969 and 0.9938, respectively. However, when evaluated against MAE, RMSE, RAE, and RRSE metrics, the RF model emerged as the top performer, yielding values of 12.3161, 15.8223, 10.3536, and 11.4389, in the same order. Additionally, the SVR model achieved the highest number of statistically significant differences when compared pairwise with the other eight models, showing significance against six of them. The findings support the use of AI as a robust tool for designing reliable calibration phantoms and optimizing proton therapy planning. This integrative approach enhances the synergy between materials science, medical physics, and data-driven modeling in advanced radiotherapy systems. Full article

Background. Extensive partial edentulism alters the biological and functional balance of the stomatognathic system, requiring targeted pre-prosthetic procedures to optimize treatment outcomes. Objectives. The aim of this study was to assess the extent of improvement in the clinical–biological scores of the prosthetic field in patients with extensive edentulism, following pre-prosthetic interventions. Materials and Method. This prospective, cross-sectional study investigated 194 subjects with extensive partial edentulism. Clinical–biological scores, initially and following the pre-prosthetic phase, were recorded using a scoring system that evaluated dental and periodontal status, bone and mucosal support, occlusion, and mandibulo-cranial relationships. Statistical comparisons of clinical–biological scores were related to the type of prosthetic therapy. Statistical significance was considered at a p-value < 0.05. Results. There was an overall significant improvement in the clinical–biological scores initially (mean value 20.2) and after pre-prosthetic procedures (mean value 23.22) (p < 0.001). When treatment groups were divided, the implant-assisted prosthesis group showed the best improvement in all domains, followed by the conventional fixed-prostheses group (p < 0.01). Dental support improved significantly in those with semi-rigid composite prostheses (p = 0.014), while periodontal support was improved in both fixed- and hybrid-implant groups. Mucosal and bone support improved mostly in the fixed-implant groups (p = 0.014). Conclusions. Pre-prosthetic procedures significantly enhance the biological and functional readiness of the prosthetic field, with the degree of improvement influenced by the complexity and type of planned prosthetic rehabilitation. The findings underscore the value of individualized pre-prosthetic protocols as an essential component of prosthetic treatment planning. Full article

Background/Objectives: Most patients with non-small cell lung cancer (NSCLC) receive chemo- and/or immunotherapy, which can be associated with adverse events including fatigue. Affected patients may not be able to receive the complete chemo- and/or immunotherapy as planned. In this context, patients may benefit from maintaining their physical activity, which can be challenging. An app reminding patients to perform a certain number of steps may have a positive effect on physical activity during chemo- and/or immunotherapy. Such an app is under development and will be tested in a prospective trial. The current APACHIE-01 study (NCT06993896) is required for proper sample size calculation and design of the planned trial. Methods: The main goal of the APACHIE-01 study is to evaluate patterns and predictors of physical activity during chemo- and/or immunotherapy for locally advanced or metastatic NSCLC. The primary endpoint is the assessment of the mean number of steps per week during the first three cycles of chemo- and/or immunotherapy for lung cancer. The baseline value is represented by the mean number of steps during the last week prior to chemotherapy and/or immunotherapy. Secondary endpoints include associations between mean number of steps per week and a pain score, a distress score, and a fatigue score. The recruitment of the required 38 patients should be completed within 4 months and the treatment period will be 9–10 weeks (three cycles of chemo- and/or immunotherapy), resulting in a total running time of approximately 6 months. The APACHIE-01 study will contribute to the optimal design of a subsequent prospective trial. Full article

Background/Objectives: This study aims to present a structured clinical workflow for offline adaptive Biology-guided Radiotherapy (BgRT) using the RefleXion X1 PET-linac system, addressing challenges introduced by inter-treatment anatomical and biological changes. Methods: We propose a decision tree offline adaptation framework based on real-time assessments of Activity Concentration (AC), Normalized Target Signal (NTS), and bounded dose-volume histogram (bDVH%) metrics. Three offline strategies were developed: (1) preemptive adaptation for minor changes, (2) partial re-simulation for moderate changes, and (3) full re-simulation for major anatomical or metabolic alterations. Two clinical cases demonstrating strategies 1 and 2 are presented. Results: The preemptive adaptation strategy was applied in a case with early tumor shrinkage, maintaining delivery parameters within acceptable limits while updating contours and dose distribution. In the partial re-Simulation case, significant changes in PET signal necessitated a same-day PET functional modeling session and plan re-optimization, effectively restoring safe deliverability. Both cases showed reduced target volumes and improved OAR sparing without additional patient visits or tracer injections. Conclusions: Offline adaptive workflows for BgRT provide practical solutions to address inter-fractional changes in tumor structure and function. These strategies can help maintain the safety and accuracy of BgRT delivery and support clinical adoption of PET-guided radiotherapy, paving the way for future online adaptive capabilities. Full article

Electric buses are key in the strategy towards a greenhouse-gas-neutral fleet. However, their restrictions in terms of range and refueling as well as their increased price point present new challenges for public transport companies. This study aims to address, based on real-world operational data, how energy consumption and charging behavior affect battery aging and how operational strategies can be optimized to extend battery life under realistic conditions. This article presents an energy consumption analysis with respect to ambient temperatures and average vehicle speed based exclusively on real-world data of an urban bus fleet, providing a data foundation for range forecasting and infrastructure planning optimized for public transport needs. Additionally, the State of Charge (SOC) window during operation and vehicle idle time as well as the charging power were analyzed in this case study to formulate recommendations towards a more battery-friendly treatment. The central research question is whether battery-friendly operational strategies—such as reduced charging power and lower SOC windows—can realistically be implemented in daily public transport operations. The impact of the recommendations on battery lifetime is estimated using a battery aging model on drive cycles. Finally, the reduction in CO₂ emissions compared to diesel buses is estimated. Full article

This research assesses the design efficiency of the future centralized wastewater treatment plant (WWTP) in Prishtina, which also takes into consideration rapidly expanding suburban areas, such as Fushë Kosova, Obiliq, and Graçanica. Using a combination of both ATV-DVWK-A 131E deterministic calculations and dynamic simulation with IWASP, this study focuses on the planned configurations for the future Prishtina wastewater treatment plant (WWTP) to evaluate design efficiency alongside operational feasibility. The primary goal was to determine if meeting projected loads for the year 2040 would be possible with compliance requirements for a single-stage CAS system. Simulation data suggest that reliable nitrogen removal would not be possible with a sole CAS stage (aerobic), particularly considering seasonal and peak load dynamics. Alternatively, an optimized three-reactor CAS model, including one anoxic pre-denitrification zone coupled with two alternating aerobic zones, achieved an average total nitrogen (TN) removal efficiency of about 85%, maintaining effluent TN below 10 mg/L. Additional advantages saw COD being removed at rates between 90 and 92%, along with MLSS levels stabilizing around 3500 mg/L. The flexibly scalable design also provides adaptive operation features, including expanded tertiary nutrient removal in phase II. In scenario two’s site comparative analysis, Lismir’s centralized WWTP emerges as the most economically and technically rational option due to the enhanced reactor layout optimization. These findings confirm that enhanced configurations, validated through both static and dynamic analyses, are essential for long-term treatment efficiency and regulatory compliance. Full article

Gastric cancer remains the fourth leading cause of cancer-related mortality worldwide. Advanced disease is associated with a poor prognosis, emphasizing the critical importance of early diagnosis through endoscopy. In addition to prognosis, disease extent also plays a pivotal role in guiding management strategies. Therefore, accurate locoregional staging (T and N staging) is vital for optimal prognostic and therapeutic planning. Endoscopic ultrasound (EUS) has long been an essential tool in this regard, with computed tomography (CT) and, more recently, positron emission tomography–computed tomography (PET–CT) serving as alternative imaging modalities. EUS is particularly valuable in the assessment of early gastric cancer, defined as tumor invasion confined to the mucosa or submucosa. These tumors are increasingly managed by endoscopic resection techniques offering improved post-treatment quality of life. EUS has also recently been utilized in the restaging process after neoadjuvant chemotherapy, aiding in the evaluation of tumor resectability and prognosis. Its performance may be further enhanced through the application of emerging techniques such as contrast-enhanced endosonography, EUS elastography, and artificial intelligence systems. In advanced, unresectable disease, complications such as gastric outlet obstruction (GOO) severely impact patient quality of life. In this setting, EUS-guided gastroenterostomy (EUS-GE) offers a less invasive alternative to surgical gastrojejunostomy. This review summarizes and critically analyzes the role of EUS in the context of gastric cancer, highlighting its applications across different stages of the disease and evaluating its performance relative to other diagnostic modalities. Full article

Winter wheat yield prediction is critical for optimizing field management plans and guiding agricultural production. To address the limitations of conventional manual yield estimation methods, including low efficiency and poor interpretability, this study innovatively proposes an intelligent yield estimation method based on a convolutional neural network (CNN). A comprehensive two-factor (fertilization × irrigation) controlled field experiment was designed to thoroughly validate the applicability and effectiveness of this method. The experimental design comprised two irrigation treatments, sufficient irrigation (C) at 750 m³ ha⁻¹ and deficit irrigation (M) at 450 m³ ha⁻¹, along with five fertilization treatments (at a rate of 180 kg N ha⁻¹): (1) organic fertilizer alone, (2) organic–inorganic fertilizer blend at a 7:3 ratio, (3) organic–inorganic fertilizer blend at a 3:7 ratio, (4) inorganic fertilizer alone, and (5) no fertilizer control. The experimental protocol employed a DJI M300 RTK unmanned aerial vehicle (UAV) equipped with a multispectral sensor to systematically acquire high-resolution growth imagery of winter wheat across critical phenological stages, from heading to maturity. The acquired multispectral imagery was meticulously annotated using the Labelme professional annotation tool to construct a comprehensive experimental dataset comprising over 2000 labeled images. These annotated data were subsequently employed to train an enhanced CNN model based on ResNet50 architecture, which achieved automated generation of panicle density maps and precise panicle counting, thereby realizing yield prediction. Field experimental results demonstrated significant yield variations among fertilization treatments under sufficient irrigation, with the 3:7 organic–inorganic blend achieving the highest actual yield (9363.38 ± 468.17 kg ha⁻¹) significantly outperforming other treatments (p < 0.05), confirming the synergistic effects of optimized nitrogen and water management. The enhanced CNN model exhibited superior performance, with an average accuracy of 89.0–92.1%, representing a 3.0% improvement over YOLOv8. Notably, model accuracy showed significant correlation with yield levels (p < 0.05), suggesting more distinct panicle morphological features in high-yield plots that facilitated model identification. The CNN’s yield predictions demonstrated strong agreement with the measured values, maintaining mean relative errors below 10%. Particularly outstanding performance was observed for the organic fertilizer with full irrigation (5.5% error) and the 7:3 organic-inorganic blend with sufficient irrigation (8.0% error), indicating that the CNN network is more suitable for these management regimes. These findings provide a robust technical foundation for precision farming applications in winter wheat production. Future research will focus on integrating this technology into smart agricultural management systems to enable real-time, data-driven decision making at the farm scale. Full article

Despite recent advances in the treatment of obesity, lifestyle medicine remains foundational to the treatment of individuals with obesity, regardless of the modality chosen by the patient with the guidance of the clinician they are working with, including in conjunction with, as appropriate, anti-obesity medications and metabolic surgery. Lifestyle medicine involves the use of diet, exercise, sleep, stress, and other lifestyle modalities in the treatment of disease. Clinicians and health systems should, after a patient-centered discussion with the patient, do their best to ensure access to lifestyle treatments. Gold standard guidelines recommend intensive, multicomponent lifestyle change programs for obesity treatments with evidence-based diet and exercise counseling and established, theoretically driven behavior change components. Clinicians treating obesity should be aware of their own biases, make efforts to reduce stigmatizing experiences in their practice, and address weight stigma in their treatment plans as needed. A variety of dietary patterns can be used to support patients with obesity, and clinicians should make evidence-based but patient-centered recommendations that aim to maximize adherence. Diet and exercise can play an important role in reducing the side effects of treatment and optimizing outcomes in weight loss, attenuating the effects of metabolic adaptation, and weight maintenance. Exercise should be increased gradually to reduce injury with a goal of 200–300 min (approximately 3.3–5 h) of moderate to vigorous intensity exercise per week to maximize weight maintenance effects with exercise prescriptions customized to patients risks. A variety of practice models can be leveraged along with the use of an interdisciplinary team to provide lifestyle medicine care for those with obesity. Full article

Background: Papillary thyroid microcarcinoma (PTMC), a subtype of papillary thyroid carcinoma ≤ 1 cm in diameter, has shown a marked increase in incidence in recent decades, largely due to the widespread use of neck ultrasonography and fine needle aspiration cytology. Despite its generally indolent course, optimal management of PTMC remains controversial, with treatment strategies ranging from active surveillance to total thyroidectomy. Methods: This retrospective study analyzes five years of experience at a single tertiary care center, including 130 patients diagnosed with PTMC following thyroid surgery between July 2018 and December 2023. Clinical, cytological, and pathological data were collected and analyzed to identify factors influencing surgical decision-making and postoperative outcomes. Patients underwent either total thyroidectomy or hemithyroidectomy, with central and lateral lymph node dissection performed as indicated. Follow-up included clinical and biochemical surveillance for a mean duration of 3 years. Results: Total thyroidectomy was performed in 89.3% of patients, while hemithyroidectomy was limited to 10.7%. Multifocality was observed in 26.1% of cases, with bilateral involvement in 17.7%. Occult lymph node metastases were found in 14.6% (central compartment) and 3.8% (lateral neck). Postoperative radioactive iodine therapy was administered in 23.8% of patients. At final follow-up, 90.7% were disease-free. No significant predictors of recurrence or adverse outcomes were identified, though multifocality and lymph node involvement influenced surgical planning. Conclusions: Our findings support a risk-adapted surgical approach to PTMC, favoring total thyroidectomy in patients with suspicious or multifocal disease to avoid reoperation. While active surveillance and minimally invasive techniques are emerging, total thyroidectomy remains a safe and effective strategy in selected cases. Prospective, multicenter studies are needed to further refine management guidelines for this increasingly common thyroid malignancy. Full article