Search Results (691)

The UK faces an urgent challenge to simultaneously accelerate housing delivery and reduce whole-life carbon emissions, yet robust empirical evidence on the carbon performance of modular steel housing remains limited. This study aims to quantify the carbon impacts of a modular light-gauge steel frame social housing dwelling in the UK and to benchmark its performance against contemporary low-carbon construction typologies. A cradle-to-grave life cycle assessment was conducted using primary project data from a real modular housing development, with embodied carbon modelled in One Click LCA and operational energy assessed through SAP 10.2-verified datasets. The results indicate a total whole-life carbon footprint of 91.3 tCO₂e over a 50-year period, with embodied emissions (A1–A3) accounting for 38.2% and operational energy and water use contributing 48.1%. The normalised embodied carbon intensity of 366 kgCO₂e/m² (A1–A5) is comparable to recent high-performing cross-laminated timber buildings, demonstrating that optimised modular steel systems can allow for low-carbon outcomes typically associated with bio-based construction. Sensitivity analysis shows that low-carbon foundation concrete, bio-based insulation, and steel optimisation can reduce upfront emissions by approximately 8–10%. Dynamic energy simulations were also used to assess how different design choices influence operational carbon emissions. This study provides transparent, real-project evidence of the whole-life carbon performance of UK modular light-gauge steel frame housing and identifies practical design strategies for further decarbonisation. The findings support informed decision-making for policymakers, designers, and housing providers seeking scalable, low-carbon residential solutions. Full article

Background: Tailored axillary surgery (TAS) and axillary reverse mapping (ARM)-guided axillary lymph node dissection (ALND) have been developed to avoid arm lymphedema without increasing a risk of axillary recurrence. However, the oncological feasibility of TAS and ARM-guided ALND remains a crucial consideration. Methods: This article reviewed the oncological feasibility of TAS and ARM-guided ALND based on the current literature. Results: For ALND performed after TAS, additional involved nodes were found in 70% of upfront surgery patients and 60% of neoadjuvant chemotherapy (NAC) patients. ARM nodes were also involved in up to 64.7% of patients after ALND. However, it is not necessary to preserve all ARM nodes and lymphatics because multiple ARM lymphatic pathways exist. Selective preservation of ARM nodes closest to the axillary vein significantly reduced the incidence of involved ARM nodes (from 64.7% to 15.7%). Conclusions: TAS and ARM-guided ALND remain much less radical than ALND. However, residual nodal disease after TAS or ARM-guided ALND does not always develop axillary recurrence. Postoperative irradiation is effective in achieving local control in patients with low-volume (microscopic) residual nodal disease after TAS or ARM-guided ALND. We await the long-term results of prospective randomized clinical trials comparing TAS and ARM-guided ALND with conventional ALND. Full article

Despite the increasing popularity of upfront decompressive surgery, there are still patients with malignant spinal cord compression (MSCC) and expected longer-term survival receiving irradiation alone. In these patients, local progression-free survival (LPFS) may be improved with doses beyond the commonly applied regimen of 10 × 3.0 Gy. A prospective phase 2 trial (RAMSES-01) investigated the benefit of two regimens, 15 × 2.633 and 18 × 2.333 Gy, compared with a 10 × 3.0 Gy (historical control). Patients in the phase 2 cohort had significantly better local progression-free survival (LPFS) after 1 year. Since recurrent MSCC-related motor weakness is a serious situation, it must be avoided as long as possible. In this respect, it is important to know whether the superiority of 15 × 2.633 and 18 × 2.333 Gy found in the RAMSES-01 trial still exists after 2 or 3 years. This led to the current study. In the phase 2 group, 2- and 3-year LPFS rates were 93.1% and 93.1%, respectively, and survival rates were 54.2% and 36.1%, respectively. According to propensity-adjusted Cox regression analyses, radiotherapy regimens in the phase 2 cohort resulted in significantly better LPFS at 2 (p = 0.017) and 3 (p = 0.013) years. In contrast, survival was not significantly different (p = 0.251 and p = 0.288, respectively). Radiation myelopathy and pathologic vertebral fractures were not observed in any group. Given the limitations of this study, irradiation 15 × 2.633 or 18 × 2.333 Gy may be an alternative option for patients with MSCC and longer expected survival treated with irradiation alone. Full article

A considerable proportion of perishable goods, including fruits and vegetables, deteriorate prior to reaching customers. Inadequate refrigeration infrastructure, particularly in developing nations with arid climates and markets distant from agricultural sources, accounts for most of these losses. A food cold chain has three primary phases: pre-cooling, cold storage, and refrigerated transportation. All phases of the cold chain rely fundamentally on refrigeration to preserve perishable products at designated temperatures, relative humidity, and CO₂ concentrations, thus prolonging their shelf life. Solar-driven or aided refrigeration systems use solar energy to power cooling systems and preserve the food in the cold chain. These systems are especially beneficial in off-grid or developing areas for preserving perishable goods such as fruits, vegetables, and other food items, mitigating postharvest losses that can exceed 30–50% in areas with inconsistent energy supplies. Despite progress in efficiency and scalability, numerous research gaps remain across technological, economic, social, policy, and regional dimensions, including technical aspects, optimization, and integration. There is a need to enhance energy-efficient designs, particularly by managing solar intermittency to address non-uniform cooling, which leads to inconsistent ripening and spoilage, and by integrating sustainable refrigerants to mitigate environmental impact. Further development is necessary for micro-scale, transportable, or decentralized systems designed for small farms, while economic and financing obstacles include high upfront costs and limited financial accessibility. Substantial deficiencies exist in creating affordable models and funding channels for small-scale agriculturalists. Addressing these deficiencies could expedite adoption, thereby reducing global food loss and waste (accounting for 8–10% of GHG emissions) while improving food security. Future research must emphasize multidisciplinary methodologies that amalgamate engineering, economics, and social sciences to provide comprehensive solutions. Full article

Background/Objectives: The emergence of FLT3 inhibitors (FLT3i) has radically transformed the prognostic and therapeutic landscape for FLT3-mutated Acute Myeloid Leukemia, stimulating the need for comprehensive and structured clinical guidance. Methods: We aimed to develop evidence-based recommendations spanning the entire disease continuum of FLT3-mutated AML from leading Italian experts through a modified Delphi consensus process. Results: The panel achieved a high degree of agreement on specific interventions covering diagnostic testing, upfront FLT3i integration, role of allogeneic hematopoietic cell transplantation (allo-HSCT), Minimal Residual Disease (MRD) monitoring, and relapsed/refractory (R/R) strategies. Key recommendations mandate that analysis for both FLT3-ITD and FLT3-TKD mutations is required at diagnosis, with capillary electrophoresis or NGS as preferred methods. All fit patients with FLT3m-AML must receive intensive chemotherapy plus a FLT3i (midostaurin or quizartinib) and be evaluated for allo-HSCT. For unfit patients, the current standard of HMA + venetoclax is considered suboptimal, making the search for alternative strategies imperative. MRD monitoring using available molecular or flow cytometry markers is recommended to assess relapse risk and to optimize the allo-HSCT strategy. In the R/R setting, retesting the FLT3 status is mandatory, and gilteritinib is the standard treatment, serving as a bridge-to-transplant and for post-HSCT maintenance. Conclusions: The integration of FLT3i has shifted FLT3m-AML into a more favorable intermediate prognostic category, enhancing the role of curative strategies like allo-HSCT. This consensus paper provides a structured evidence-based comprehensive guide, translating complex data into clear actionable clinical recommendations that minimize practice variability and ultimately optimize management for this high-risk population. Full article

This review systematically synthesizes technological synergies within a Community Energy System (CES), emphasizing cold-climate contexts where heating-dominant demand profiles and strong seasonality create distinct operational challenges. Drawing on 115 studies (2010–2024), the paper explores how integrated thermal, electrical, and digital infrastructures support net-zero and climate-resilient communities in regions with substantial heating requirements. Thermal–electrical coupling emerges as a foundational mechanism in cold climates, where heating loads dominate annual energy demand and drive winter peak constraints. Power-to-Heat (P2H) systems, cold-climate heat pumps, and hybrid configurations combining Thermal Energy Storage (TES) with Battery Energy Storage Systems (BESS) enable multi-timescale flexibility, allowing renewable energy to be shifted from hours to seasons. District Energy Systems (DES) act as a thermal backbone, enabling this integration across extended heating seasons and transforming thermal demand into a grid-balancing resource. Digital technologies further enhance system coordination under variable climatic conditions. Artificial Intelligence (AI), the Internet of Things (IoT), and Advanced Metering Infrastructure (AMI) support real-time optimization, demand response, and cross-vector control within Renewable Energy Communities (RECs) and Virtual Power Plants (VPPs). At the system level, decentralized architectures—including microgrids, Non-Wire Alternatives (NWAs), and peer-to-peer (P2P) trading—strengthen resilience by maintaining thermal and electrical continuity during grid disruptions. Building on these findings, the review synthesizes cross-cutting technological synergies and proposes deployment pathways tailored to cold-climate CES, supported by comparative case studies. Despite demonstrated benefits, widespread adoption remains constrained by high upfront costs, interoperability challenges, and fragmented regulatory frameworks. The review concludes with policy, governance, and research recommendations to enable scalable, equitable, and climate-responsive CES deployment in heating-dominated regions. Full article

Background: Computer-aided design and manufacturing (CAD/CAM) technology has been increasingly adopted for mandibular and maxillary reconstruction using fibula free flaps. However, its clinical and economic advantages over the conventional freehand technique remain debated. The objective of this study was to compare perioperative outcomes and institutional costs between CAD/CAM-guided and conventional freehand fibula flap reconstructions. Methods: An ambispective observational study was conducted including patients who underwent mandibular or maxillary reconstruction with an osteocutaneous free fibula flap between 2017 and 2024. Reconstructions were performed either using CAD/CAM-guided virtual surgical planning or the conventional freehand technique. Demographic data, perioperative variables, postoperative outcomes, oncologic margin status, transfusion requirements, and total institutional costs were analyzed. Univariate comparisons were performed between groups, and multivariate linear regression models were used to assess the independent association of CAD/CAM guidance with operative time and hospital length of stay. Results: Fifty-one patients were included (25 CAD/CAM-guided and 26 freehand). CAD/CAM-guided reconstruction was associated with a significantly shorter operative time (542.3 ± 65.8 vs. 604.9 ± 79.5 min; p = 0.0036) and a shorter overall hospital stay (19.6 ± 7.2 vs. 30.6 ± 26.2 days; p = 0.047) in univariate analysis. The need for perioperative blood transfusion was significantly lower in the CAD/CAM group. No significant differences were observed in ICU stay, flap failure, reintervention rate, or postoperative hemoglobin decrease. Although margin status did not differ significantly between groups, a higher proportion of negative margins was observed in the CAD/CAM cohort. In multivariate analysis adjusting for age and perioperative variables, CAD/CAM guidance remained independently associated with reduced operative time, but not with hospital length of stay. Despite higher upfront planning costs, total per-patient cost was lower in the CAD/CAM group due to improved perioperative efficiency. Conclusions: CAD/CAM-guided fibula free flap reconstruction is a safe and effective technique that is associated with reduced operative time and lower transfusion requirements while maintaining comparable oncologic outcomes. When perioperative efficiency gains are achieved, these advantages may offset the higher planning costs, resulting in overall cost savings at the institutional level. CAD/CAM-assisted reconstruction may therefore be particularly advantageous in high-volume oncologic centers and anatomically complex cases. Full article

Buildings account for nearly 40% of global energy use and 36% of CO₂ emissions, positioning Net-Zero Energy Buildings (NZEBs) as vital for climate mitigation. However, large-scale adoption remains limited by technical, economic, and policy barriers. This study systematically reviews 1285 peer-reviewed articles (2015–2025) from Scopus and Web of Science, following PRISMA guidelines and thematic analysis to assess renewable energy integration and efficiency strategies. Results indicate that 70% of studies highlight emissions reduction and cost savings as key NZEB benefits, while 60% cite high storage costs and 45% report grid integration challenges. Only 30% of studies address policy dependency, revealing a research gap. Effective measures include passive solar design (up to 25% heating load reduction), high-performance envelopes (15–40% energy savings), and smart energy management (10–20% efficiency gains). Persistent obstacles involve high upfront costs, renewable variability, and rapid technological obsolescence. Achieving NZEB viability requires integrating energy-efficient design, affordable renewables, advanced storage, and coherent policy frameworks to accelerate the transition toward a sustainable, NZEB-built environment. Full article

Non-muscle-invasive bladder cancer (NMIBC) comprises approximately 75% of new bladder cancer cases and generally carries a favorable prognosis, yet high rates of recurrence and progression necessitate close surveillance with frequent cystoscopies and repeated transurethral resections. Upfront treatment for high-risk disease is typically Bacillus Calmette-Guérin (BCG), although combinations with immune checkpoint inhibitors have reported results. Patients with BCG-unresponsive, intolerant, or refractory disease represent a subset of patients with high risk of progression, with early radical cystectomy being the standard approach for this setting. Global BCG shortages and the substantial impact of cystectomy on quality of life underscore the need for therapeutic alternatives. Over the past decade, investigational trials in immunotherapy have expanded treatment options for BCG-unresponsive NMIBC with CIS, leading to FDA approval of intravesical nadofaragene firadenovec, nogapendekin alfa-inbakicept, and systemic pembrolizumab. This narrative review summarizes developments in intravesical and systemic immunotherapies for NMIBC, highlights ongoing trials, and addresses controversies in trial design, treatment sequencing, comparative efficacy, and safety. Full article

Energy Communities (ECs) have emerged as central legal instruments for decentralized renewable energy deployment across Europe; however, their long-term viability depends critically on financial sustainability mechanisms that remain inadequately understood. This study examines the economic foundations of ECs through a narrative literature review of revenue generation, cost allocation, and the capital mobilization pathways in three representative European markets (Germany, Spain, and Italy). A structured Scopus database search identified 280 peer-reviewed studies published between 2019 and 2025. Following systematic screening, 89 articles were selected for analysis through bibliometric mapping in R (Biblioshiny) and qualitative synthesis in NVivo. The analysis reveals that stable feed-in tariffs, tax incentives, and self-consumption remuneration schemes form the primary revenue mechanisms, while cost management effectiveness varies substantially across countries due to differing grid-charge structures and administrative frameworks. Capital access remains constrained for smaller communities despite hybrid financing innovations combining public grants, cooperative equity, and emerging crowdfunding mechanisms. Regulatory heterogeneity, high upfront investment requirements, and limited institutional credit availability continue to impede scalability. The findings emphasize that achieving widespread EC adoption requires harmonized policy frameworks, transparent cost-sharing arrangements, and diversified investment instruments that align local participation with national decarbonization objectives while ensuring equitable access across diverse socio-economic contexts. Full article

The accelerating global demand for renewable heating, cooling and electricity, driven by climate change and rising living standards, presents both a challenge and an opportunity for sustainable energy transitions. This paper introduces the Initial-Aid Cashback (IAC) model, an innovative business model designed to finance renewable energy solutions, with a focus on space cooling, by leveraging citizen participation and collaborative financing mechanisms. The model incentivizes private investors through discounted energy prices, while system operators benefit from reduced upfront capital requirements and minimised financial risk. Through two case studies, an office building in Romania (small-scale case) and the application of the REGEN-BY-2 technology in a mixed housing–office area (large-scale case), the paper demonstrates the model’s potential to accelerate the adoption of renewable cooling technologies, enhance profitability for operators, and provide attractive returns for investors. The findings highlight the model’s adaptability to diverse stakeholder needs, its scalability, and its role in fostering the clean energy transition (CET). However, challenges such as the need for a minimum number of investors, legal complexities, and trust-building among stakeholders are identified as critical barriers to implementation. The paper concludes that the IAC model offers a promising pathway to integrate citizens and small investors into the CET, while emphasising the importance of supportive policies, clear governance structures, and practical testing to ensure its success. Full article

Background: Limited data inform the outcomes of patients with high-risk neuroblastoma (HR-NBL) who relapse after high-dose chemotherapy, autologous stem cell transplantation (ASCT), and external beam radiotherapy (EBRT). Methods: This is a multi-institutional retrospective study of 84 patients with HR-NBL diagnosed between 1997–2021 with a first recurrence after definitive upfront treatment, including ≥1 ASCT and EBRT. Site(s) of first relapse were defined with relation to a patient’s primary tumor location. Progression-free survival (PFS) and overall survival (OS) outcomes were analyzed using Kaplan–Meier curves and log-rank tests. Cox proportional hazard models were used for univariate and multivariable analyses. Results: Twenty-four patients had local recurrences with or without distant relapses (LR) and 60 had distant relapses only. The LR cohort had higher rates of MYCN amplification (70% vs. 36%, p = 0.016). At relapse, the LR cohort had lower rates of additional radiotherapy (32% vs. 61%, p = 0.029) and higher rates of additional surgery (29% vs. 5%, p = 0.005), with similar rates of chemotherapy for both cohorts. With a median follow-up after first relapse of 1.53 years (range: 0.03–15.82), there were no significant differences in interval PFS and OS between the cohorts. After controlling for age at diagnosis and pattern of recurrence, time to interval relapse ≥ 2 years was a significant predictor of improved OS (HR: 0.50, 95% CI: 0.29–0.85, p = 0.011). Conclusions: Patients with relapsed HR-NBL have poor outcomes with median OS < 2 years. Time to relapse was a significant predictor of OS. Full article

Introduction: Conservative or upfront radical management for high- and very high-risk non-muscle-invasive bladder cancer continues to be debated, particularly for cases with adverse pathological features. We aimed to compare survival outcomes among NMIBC patients treated with transurethral resection of bladder tumour (TURBT) followed by either Bacillus Calmette–Guérin (BCG), sequential BCG plus electromotive administration of mitomycin C (EMDA-MMC), or upfront radical cystectomy (RC). Materials and Methods: High- and- very high-risk NMIBC cases undergoing TURBT followed by BCG, BCG plus EMDA-MMC, or RC at two international tertiary referral centres between 2009 and 2024 were retrospectively reviewed. Recurrence-free survival (RFS), progression-free survival (PFS), and overall survival (OS) were estimated using Kaplan–Meier methods. Multivariable Cox regression models were applied to identify factors independently associated with survival outcomes. Results: A total of 1178 patients were included: 852 received BCG, 249 received BCG/EMDA-MMC, and 77 underwent upfront RC. Kaplan–Meier analysis revealed no significant differences in RFS or PFS between the BCG and BCG/EMDA-MMC groups, nor in OS between the three treatment strategies. According to multivariable analysis, concomitant carcinoma in situ (CIS) and increasing T stage at TURBT were independently associated with poorer RFS (HR 1.39; 95% CI 1.05–1.85), PFS (HR 1.95; 95% CI 1.36–2.82), and OS (HR 2.28; 95% CI 1.60–3.25). A second resection conferred a protective effect on PFS (HR 0.72; 95% CI 0.54–0.95). Treatment modality (BCG, BCG/EMDA-MMC, or upfront RC) was not significantly associated with any survival endpoint. Conclusions: In this large multicentre series of patients with high- and very high-risk NMIBC undergoing TURBT, survival outcomes were primarily influenced by clinical–pathological characteristics rather than the adjuvant treatment of choice. Full article

Integrating renewable energy into power grids is critical for advancing low-carbon transitions. However, the inherent variability of renewables requires flexible generation resources—predominantly thermal power units—to maintain real-time grid balancing. Although these flexible generators earn revenue from electricity production, they often incur significant deficits in recovering their upfront investment and retrofitting costs. While existing research has largely focused on short-term balancing expenses, this persistent investment gap remains underexplored. This article analyzes the causes of the investment deficit in the flexible generation assets needed to support renewable integration. To more comprehensively assess system integration costs, we propose a modeling framework that quantifies the investment and construction costs incurred due to renewable volatility. Through simulation, we estimate the required flexible capacity, associated costs, and operational revenues, thereby calculating the investment gap directly attributable to renewable integration. The model feasibility is further verified via sensitivity analysis. Additionally, the study outlines a conceptual cost allocation mechanism and demonstrates how the proposed method can be extended to assess other types of grid-supporting resources. These insights contribute to improved electricity market design, support evidence-based energy policymaking, and facilitate the market-oriented reform of the power sector. Full article

Background: Colorectal liver metastases (CRLM) represent a major determinant of prognosis in patients with metastatic colorectal cancer and account for a substantial proportion of cancer-related mortality worldwide. Over the last decades, survival outcomes have improved significantly as a result of advances in systemic therapies, refinement of surgical techniques, and, most importantly, the widespread implementation of multidisciplinary management strategies. Within this evolving landscape, surgery remains the cornerstone of potentially curative treatment, although its optimal integration with systemic and locoregional therapies requires careful patient selection and individualized treatment planning. Methods: This narrative review explores the contemporary role of surgery within the multidisciplinary management of CRLM, emphasizing how surgical decision-making is integrated with medical oncology, radiology, interventional procedures, and emerging technologies. Results: The pivotal role of multidisciplinary team meetings in defining resectability, treatment sequencing, and therapeutic intent is highlighted. Key technical and oncological criteria guiding upfront resection, neoadjuvant or conversion strategies, and staged approaches are reviewed, including assessment of future liver remnant, optimization of liver volume and function, tumor burden, molecular profile, and dynamic prognostic models. In addition, the review summarizes current evidence supporting parenchyma-sparing liver surgery and the integration of local therapies such as thermal ablation, irreversible electroporation, stereotactic body radiotherapy, selective internal radiation therapy, and hepatic artery infusion chemotherapy within multimodal treatment algorithms. Complex clinical scenarios, including synchronous disease, extensive bilobar metastases, chemotherapy-associated liver injury, and the emerging role of liver transplantation in highly selected patients with liver-only disease, are also addressed. Conclusions: Modern CRLM management has evolved toward a highly individualized, biology-driven approach in which surgery is optimally integrated within a multidisciplinary framework to maximize curative potential and long-term survival. Full article