Search Results (902)

Metal additive manufacturing (AM) has progressed from prototyping toward industrial deployment, yet adoption remains uneven because many initiatives are still driven by isolated process demonstrations rather than system-level manufacturing strategy. This framework review proposes a gated decision workflow for integrating metal AM into industrial systems by coupling process-family selection and route definition, Design for Additive Manufacturing (DfAM) and sustainability considerations. The paper consolidates a comparative matrix of six metal AM process families for early down-selection, introduces a minimal evidence checklist linking each decision gate to required artifacts, and contextualizes the workflow through representative part archetypes. The framework is further supported by practical guidance on process-specific DfAM constraints, including support strategy, residual stress, and surface integrity in powder bed fusion; shrinkage-driven design in sinter-based routes; and machining allowances in repair and hybrid manufacturing. Rather than positioning metal AM as a universal substitute for conventional manufacturing, this work defines it as a complementary, strategy-dependent enabler whose sustainability benefits depend on system-level integration and application context. Full article

Severe early childhood caries (SECC) in preschool children is a progressive, multifactorial disease with far-reaching consequences for child health, family functioning, and health systems. Minimally invasive dentistry (MID), particularly 38% silver diamine fluoride (SDF), is increasingly used to arrest lesions and “buy time” when definitive restorative care is delayed. This narrative review synthesizes current evidence-based guidelines and real-world utilization data to clarify the appropriate role and limits of SDF in SECC management. Professional guidance supports SDF for lesion arrest within an ongoing caries management plan, but does not endorse it as a universal long-term substitute for durable restorative care. Observational studies show that many SDF-treated primary teeth receive additional intervention within approximately 2 years, and any delay in sedation/general anesthesia is typically measured in weeks to months. A large recent private practice study found that 35% of children with caries progressed to higher-intensity treatment (restoration or extraction) over a median of 547 days, reinforcing the time-limited nature of interim stabilization. We propose a “preservation-to-precision” framework that prioritizes child-centered outcomes—freedom from pain and infection, durable function, and acceptable psychosocial impact—through risk-based, tooth- and child-specific planning, realistic follow-up assessment, and clear exit criteria for transition to definitive care. In high-income settings, the ethical value of “buying time” depends on whether systems use that time to advance children toward timely, definitive care rather than normalizing prolonged temporization as routine practice. Full article

Chinese universities are expanding outward, with more campuses now located on the urban fringe. Their boundaries are often open, and the surrounding land uses are mixed. This study examines four spatial attributes, edge definition, night-time lighting, visibility, and environmental maintenance, and how they relate to students’ perceived safety and environmental satisfaction. We draw on crime prevention through environmental design (CPTED) and the stimulus–organism–response (SOR) framework to develop a mediation model: spatial attributes are associated with satisfaction through perceived safety. Survey data were collected from 411 students across two suburban campuses and were analyzed using partial least squares structural equation modeling (PLS-SEM). Visibility and environmental maintenance both strengthen perceived safety, whereas edge definition and night-time lighting do not exhibit significant effects. Perceived safety, in turn, strongly predicts environmental satisfaction and serves as a key design priority in rapidly urbanizing campus settings, and is further translated into reusable spatial design patterns for campus safety assessment and targeted environmental intervention, and may also inform broader discussions of urban wellbeing in suburban contexts. Full article

Background/Objectives: Early identification of breast cancer patients who are likely or unlikely to benefit from neoadjuvant chemotherapy (NAC) remains clinically important because ineffective treatment may delay definitive surgery and expose patients to unnecessary toxicity. Quantitative ultrasound (QUS) radiomics offers a contrast-free and repeatable method for extracting tissue-sensitive imaging biomarkers from raw ultrasound data. This study aimed to evaluate whether baseline QUS radiomic features and early treatment-induced changes could predict a pathologic response to NAC in a real-world single-center cohort. Methods: We designed a prospective observational study including 96 consecutive women with biopsy-proven stage II–III breast cancer treated with NAC at Victor Babes University of Medicine and Pharmacy Timisoara. All patients underwent standardized QUS examinations before treatment and again at week 2. The response was defined pathologically at surgery as residual cancer burden class 0/I versus II/III. Clinical, histopathologic, and QUS variables were compared between responders and non-responders. Group comparisons used Student’s t test, Mann–Whitney U test, chi-square testing, and Fisher’s exact test where appropriate. Multivariable logistic regression was used to identify independent predictors of response. Model discrimination was summarized using the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and accuracy. Results: Forty-three patients (44.8%) were classified as responders and 53 (55.2%) as non-responders. Responders had higher baseline Ki-67 values (47.8 ± 13.1% vs. 41.9 ± 13.0%, p = 0.033), lower baseline homogeneity (0.3 ± 0.1 vs. 0.4 ± 0.1, p = 0.010), and higher peritumoral heterogeneity (0.9 ± 0.1 vs. 0.8 ± 0.2, p = 0.027). At week 2, responders showed larger increases in mid-band fit (3.0 ± 0.8 vs. 1.2 ± 0.8 dB, p < 0.001), greater entropy change (0.7 ± 0.2 vs. 0.2 ± 0.2, p < 0.001), more pronounced spectral intercept reduction (−3.5 ± 1.4 vs. −1.2 ± 1.3, p < 0.001), and greater tumor shrinkage (−24.3 ± 7.0% vs. −11.1 ± 5.7%, p < 0.001). In multivariable analysis, Δ MBF and Δ entropy remained independent predictors of pathologic response. The combined clinical-plus-QUS model achieved an AUC of 0.89. Conclusions: Baseline microstructural heterogeneity and very early QUS-derived treatment changes were strongly associated with the pathologic response to NAC. These findings support the potential role of QUS radiomics as a low-cost, repeatable early-response biomarker in breast cancer. Full article

Background/Objectives: Chronic subdural hematoma (cSDH) is an increasingly prevalent neurosurgical condition in the aging population. Burr hole craniotomy (BHC) with irrigation and postoperative drainage represents the evidence-based standard of care, yet recurrence rates remain substantial. Twist drill craniostomy (TDC), a minimally invasive bedside procedure performed under local anesthesia, offers theoretical advantages for frail patients but has been largely abandoned due to concerns regarding incomplete evacuation and recurrence. This study aimed to identify the predictors of a successful TDC outcome and to compare the recurrence rates between TDC and BHC. Methods: We performed a retrospective cohort study of consecutive patients undergoing surgical treatment for radiologically confirmed cSDH at RWTH Aachen University Hospital between 2015 and 2023. Hematoma morphology was classified using an extended CT-based architecture system and grouped into homogeneous, organized, sedimented, or subacute categories. The primary endpoint was recurrence requiring surgical reintervention. Multivariable logistic regression was used to identify independent predictors of recurrence among patients discharged after definitive TDC. Propensity score matching was performed to compare recurrence rates between TDC and BHC while adjusting for baseline demographic, clinical, and radiographic differences. Results: Among 178 patients initially treated with TDC, 56 (31.5%) were discharged without conversion to BHC. Late recurrence occurred in 26 of 56 patients (46.4%) treated definitively with TDC. In multivariable analysis, homogeneous hematoma architecture was the only independent predictor of recurrence (adjusted OR 4.48, 95% CI 1.10–22.07, p = 0.037). Propensity score matching yielded 48 well-balanced pairs of TDC and BHC patients. Recurrence rates remained significantly higher after TDC compared with BHC (42.6% vs. 17.0%, p = 0.012), as confirmed by conditional logistic regression (adjusted OR 3.20, 95% CI 1.17–8.73). Conclusions: Twist drill craniostomy may provide definitive treatment in carefully selected patients but is associated with substantially higher recurrence rates than burr hole craniotomy, particularly in homogeneous hematomas. Burr hole evacuation remains the preferred standard approach, while optimized drainage protocols and architecture-guided selection may define a limited role for TDC in high-risk patients. Full article

Background: Temporary dental crowns are an essential component of fixed prosthodontic treatment, protecting prepared teeth and maintaining occlusal function and aesthetics until delivery of the definitive restoration. Their clinical performance is strongly influenced by their internal microstructure, which directly affects mechanical behavior. Therefore, the aim of this study was to compare the internal porosity and fracture resistance of temporary dental crowns fabricated using conventional and 3D-printing techniques. Materials and Methods: This in vitro study compared the porosity and fracture resistance of three materials for provisional restorations: a bis-acrylic resin (Protemp^TM 4), an autopolymerizing resin (Success CD), and a 3D-printed light-curing resin (V-Print c&b temp). Thirty-six standardized single-unit crowns (n = 12 per group) were fabricated. All specimens were analyzed using high-resolution micro-computed tomography to determine total crown volume, pore volume, and relative porosity. Fracture resistance was evaluated under monotonic compressive loading in a universal testing machine. Data were analyzed using appropriate parametric or non-parametric statistical tests (α = 0.05). Results: The 3D-printed material exhibited the lowest mean porosity (0.0029%), whereas Protemp^TM 4 and Success CD showed substantially higher porosity values. However, Protemp^TM 4 demonstrated the highest mean fracture resistance, followed by the 3D-printed resin and Success CD. No direct correlation between porosity and fracture resistance was observed, indicating that material chemistry and internal bonding play a more decisive role than void content alone. Conclusions: These findings suggest that 3D printing improves structural homogeneity, while bis-acrylic materials provide superior load-bearing capacity, and that each fabrication method offers distinct advantages depending on clinical requirements. Full article

Background: The management of localized prostate cancer (PCa) suffers from the dilemma between the overtreatment associated with radical surgery and the uncertainty of active surveillance, highlighting a significant therapeutic gap specifically for intermediate-risk patients and selected low-risk patients. Focal therapy (FT) emerges as an advanced technological solution to balance rigorous oncological control with anatomical and functional preservation. Methods: A narrative review of the literature was conducted to analyze the physical principles underlying various ablative energies (thermal, cryogenic, and non-thermal) as well as radiation-based focal approaches. The review examines the oncological rationale of targeted ablation, recent innovations in imaging, and the expanding clinical scenarios for FT application. Results: Evidence supports the oncological rationale of “Index Lesion” ablation as a targeted curative strategy for clinically significant disease, rather than merely a palliative one. The review highlights the emerging concept of “pushing the disease” and demonstrates the valuable role of salvage focal therapy in the setting of radio-recurrent carcinoma. Furthermore, recent innovations in multiparametric magnetic resonance imaging (mpMRI) and fusion systems have significantly refined patient selection, rendering this minimally invasive approach highly targeted. Conclusions: The current barrier to the universal adoption of focal therapy is the lack of a standardized consensus on the definitions of therapeutic failure and the inadequacy of traditional PSA-based criteria. However, evidence suggests that FT represents a promising, organ-sparing alternative for carefully selected patients with localized PCa, though long-term comparative data are still required. Full article

This study empirically analysed the class ruling at two South African universities. The principles underpinning the Canons of Taxation, Consumption Theory, and the Principle of Neutrality were reviewed as analytical benchmarks. The literature review synthesised prior studies that examined the ruling or explored apportionment practices within universities. A sequential mixed-methods approach was adopted, beginning with a quantitative phase followed by a qualitative phase. Quantitative data were collected from thirty (37) university staff members through an online questionnaire, and descriptive statistical analysis was conducted using SPSS (version 29). The qualitative phase involved online interviews with ten (10) tax and finance professionals engaged in apportionment practices at universities, capturing their experiences, perspectives, and insights. The data were analysed using thematic and transcript analysis with the aid of NVivo (version 20). The findings indicate that respondents believe the South African Revenue Service should revisit and improve the existing ruling. Concerns were raised regarding the lack of continuous training at universities, cost implications, and the complexity of Value-Added Tax apportionment. In the context of a rapidly evolving higher education sector, the VAT Act and the definition of educational services appear to require reform. Based on these findings, the study recommends that SARS consider revising the ruling by removing a prescribed apportionment rate and allowing universities to adopt methods that are practical and aligned with their operational contexts. Consistent with prior research, the study also finds that the input-based method remains complex, and that the definition of Value-Added Tax within the educational sector is overly broad. Full article

Background/Objectives: A “misnomer” is a term that is erroneous or inaccurate. Dermatology is replete with well-established misnomers such as “Mycosis fungoides”, “keratoacanthoma”, “actinomycosis”, “granuloma pyogenicum”, or “Kaposi sarcoma”. Misnomers have originated from misconceptions or mistranslations that were passed down historically, and reflect the comparative–descriptive origin of terminology. We aimed to collect and categorize (non-)dermatological misnomers and to assess strategies for abandoning them. Methods: A questionnaire-based survey with 411 senior academic physicians of five university hospitals in Switzerland was conducted to evaluate the frequency of misnomers across dermatology and other specialties. In addition, a systematic review was conducted, complemented by manual searches to collect medical misnomers. Results: The survey and systematic review yielded 536 non-dermatological and 168 dermatological misnomers, pointing to a particular abundance of misnomers in dermatology, which could be categorized into seven categories. A wrong pathological concept was the most common origin of misnomers. Amongst dermatologists, 60.0% regarded misnomers as a relevant problem in their specialty compared to only 35.5% of non-dermatologists. Preferred strategies for abandoning misnomers were avoidance, consensus definitions, and information in teaching. Conclusions: Our results show that misnomers are particularly abundant in dermatology, indicating the need to modernize terminology. Full article

Background: Measurements of the B-cell attracting chemokine CXCL13 in cerebrospinal fluid (CSF) has become increasingly popular in the diagnostic work-up for Lyme neuroborreliosis (LNB). ReaScan is a point-of-care test for CXCL13 with a short turnaround-time. However, the diagnostic cut-off value for LNB has not been firmly established. Methods: We conducted a retrospective cohort study including all ReaScan CXCL13 measurements performed on CSF samples at Copenhagen University Hospital, Rigshospitalet, from patients of all ages suspected for LNB in 2020–2025. Patients were categorized in accordance with the European Federation of Neurological Societies (EFNS) diagnostic guidelines for LNB as definite, possible, or non-LNB based on a retrospective review of patient records. The manufacturer-informed cut-off value for positive test results was applied and the diagnostic accuracy was calculated based on the ability to identify patients with possible and definite LNB. In addition, a Youden-index optimized cut-off value was calculated and evaluated on the cohort. Results: A total of 1181 ReaScan CXCL13 measurements from children and adults were evaluated against final diagnoses. Using the manufacturer-informed cut-off value (14 AU/mL) ReaScan CXCL13 reached a sensitivity of 38% and a specificity of 98% for identifying cases of possible and definite LNB. A Youden-index optimized cut-off value (1.79 AU/mL) significantly improved the diagnostic accuracy reaching a sensitivity value of 71% and a specificity of 92%. Conclusions: These real-world clinical data suggest that the current cut-off value for the ReaScan CXCL13 analysis is not optimal for diagnosing LNB. Lowering the cut-off level would significantly increase the diagnostic accuracy. Full article

This review aims to present an updated, comprehensive analysis of data on the diversity and challenges of current approaches to the screening and monitoring of subjects at risk of T1D, as the earliest interventions during the course of the disease. Previously, screening for T1D was justified only for research purposes. A major turning point occurred when teplizumab, an immunomodulatory drug that delays the onset of overt T1D, was approved. Nowadays, there is a growing number of screening initiatives, and this trend is spreading fast across the world. In this context, novel recommendations emphasize the need for the wider identification of subjects at risk of T1D, suggesting that screening should not include only first-degree relatives of persons with T1D. Furthermore, current experts’ opinions have shifted the detection of T1D risk in the direction of ultimate goal-screening in the general population. Also, subjects at risk should be monitored, undergo metabolic testing, be informed about their risk, and be educated about the disease. Currently, there is a diversity in approaches to the screening and monitoring of subjects at risk of T1D, predominantly in the pediatric population. Several knowledge gaps persist in this area of investigation, especially in recommendations and potential benefits for the adult population. However, the scientific community is focusing on developing and adapting screening and monitoring strategies to suit particular countries, aiming to make them more universal while refining the definition of individual risk for T1D. Nevertheless, the screening and monitoring of subjects at risk should be the earliest interventions focused on delaying T1D. Full article

Neonatal vitamin B12 (B12) deficiency can cause neurodevelopmental harm, and newborn screening (NBS) may enable early detection and treatment. We conducted a multicenter pilot project in four Prague university hospitals between 1 June 2022 and 30 June 2025. Algorithms included the determination of propionylcarnitine-derived primary markers using flow-injection tandem mass spectrometry and second-tier methylmalonic acid (MMA), with total homocysteine measured only when MMA was increased. Of 34,302 screened newborns with consent, 1365 (3.98%) triggered second-tier testing; 9 had MMA >2.5 µmol/L, of which 8 met the case definition after confirmatory testing, giving a birth frequency of 1:4228 (95% CI 1:2176–1:9931). Positive predictive value was 0.59% (95% CI 0.25–1.15%) and 88.89% (95% CI 51.75–99.72%) for the primary test and second-tier MMA, respectively, with a false positive rate of 0.00292% (95% CI 0.000074–0.01625%). All affected infants were treated orally with cyanocobalamin. Maternal work-up identified confirmed B12 deficiency in four of eight mothers and premalignant gastric changes in two of four positive women. These data support the feasibility, low cost, and clinical utility of incorporating B12 deficiency into Czech NBS, with benefits extending beyond newborn health. Full article

Three-dimensional (3D) printing is increasingly used for the fabrication of definitive crowns; however, whether specific post-curing hardware is mandatory for clinical success remains a practical concern. This study provided a practical comparison evaluating the effect of two post-curing units on the biaxial flexural strength (BFS), Weibull modulus (m), Martens hardness (HM), indentation modulus (EIT), water sorption (WSP), and water solubility (WSL) of 3D-printed resins for permanent crowns, compared with a conventional resin composite. A total of 200 specimens were fabricated from two 3D-printed resins (Permanent Crown™ and CrownTec™) and a conventional resin composite (Filtek Universal Restorative™) used as a control. The 3D-printed specimens were post-cured using either a Formcure or an Otoflash G171 unit. WSP and WSL were measured after 90 days of water ageing, while BFS, HM, and EIT were evaluated after 24 h of storage using standardised methods. All materials exhibited WSP and WSL values within ISO limits, with the control group showing significantly higher values and superior mechanical properties. Among the 3D-printed resins, post-curing significantly affected only HM and EIT for Permanent Crown™ resin, with no significant differences in BFS. Overall, the tested 3D-printed resins demonstrated high processing stability across different curing protocols, suggesting that clinical performance remains consistent regardless of the post-curing unit used. Full article

Higher technical and professional education is increasingly discussed in relation to workforce readiness, innovation, and societal inclusion. In Italy, the PNRR-funded Rome Technopole operates as a multi-institutional ecosystem in which universities, research organizations, industry, and public bodies interact through a Hub & Spoke model to support training and innovation activities. Among its components, Spoke 4 addresses professional higher technical education through the co-development of modular learning initiatives involving multiple stakeholders. This commentary examines the role and activities of the Italian National Institute of Health (ISS) within this context, with particular reference to the development of two pilot modules: one on Artificial Intelligence and Algorethics, and one on Accessibility and Assistive Technologies, including applications supported by AI. The paper combines a conceptual discussion of the approach with selected empirical insights derived from pilot implementation, including stakeholder engagement processes, structured evaluations, and thematic prioritization exercises. The findings suggest the perceived relevance of multi-stakeholder co-design, the use of flexible and modular learning formats, and the integration of technical and ethical dimensions in higher technical education. At the same time, they point to challenges related to coordination, scalability, and alignment across institutional actors. Rather than proposing a definitive model, the Spoke 4 experience is discussed as a context-specific case that may offer insights contributing to ongoing debates on the design and implementation of higher technical education in complex, multi-institutional settings. Full article

Background: The AptoDetect™-Lung assay is an aptamer-based test designed for risk assessment in patients with pulmonary nodules, but its potential role in predicting lung cancer stage has not been evaluated. We investigated whether the assay could predict advanced-stage disease beyond conventional diagnostic modalities. Methods: This multicenter prospective cohort study enrolled 1672 patients with Lung-RADS 3–4 pulmonary nodules across ten university-affiliated hospitals in South Korea between June 2023 and December 2024. Among them, 934 patients with histologically confirmed lung cancer were retrospectively selected, and 852 patients were included in the final analysis after exclusions. The AptoDetect™-Lung assay was performed before invasive diagnostic procedures. Results: Among the 852 patients, 450 (52.8%) had advanced-stage disease. The AptoDetect™-Lung score was significantly higher in advanced-stage than in early-stage lung cancer (median, 6.2 vs. 2.8, p < 0.001). In a multivariable logistic regression analysis, a high AptoDetect™-Lung score (≥5) was independently associated with advanced disease (odds ratio 1.99, 95% confidence interval 1.35–2.95, p < 0.001). The AptoDetect™-Lung assay showed moderate discrimination of advanced-stage disease (area under the curve [AUC] 0.696) and in non–small cell lung cancer (AUC 0.720), whereas its discriminative ability was limited in small cell lung cancer (AUC 0.561). A combined prediction model incorporating the AptoDetect™-Lung assay, serum CEA, and radiologic findings demonstrated improved discriminative performance (AUC 0.821). Conclusions: The AptoDetect™-Lung assay score was independently associated with advanced-stage lung cancer and could provide clinically useful information for early risk stratification before definitive diagnosis and staging are available. Full article