Search Results (10,760)

Background: Real-world data on the use of lipid-lowering therapy (LLT) in clinical practice show that about 80% of (very) high-cardiovascular (CV)-risk patients disregard the 2019 European Society of Cardiology (ESC) Guidelines’ recommendations on dyslipidemias. The availability of proprotein convertase subtilisin/kexin type 9 monoclonal antibodies (PCSK9mAb) should reduce this gap. Our aim was to provide data on PCSK9mAb use in clinical practice, investigating the achievement of the ESC Guidelines’ recommendations in the real world. Methods: Between April 2018 and December 2022, patients who started on PCSK9mAb therapy (140 mg of evolocumab or 75 mg or 150 mg of alirocumab, subcutaneous injection every 2 weeks) were included in a prospective registry. Our cohort consisted of 256 patients: 95 (37.1%) were women (mean age: 65.43 ± 11.12 yrs), 53 (20.7%) were at high CV risk, and 203 (79.3%) were at very high CV risk. Results: After one year of PCSK9mAb treatment, nearly 60% of patients demonstrated full adherence to the ESC Guidelines’ recommendations, defined as achieving at least a 50% reduction in low-density lipoprotein cholesterol (LDL-C) levels along with reaching LDL-C target levels (≤55 and ≤70 mg/dL for very high and high risk, respectively). Concomitant high-dose statin therapy emerged as the primary predictor of LDL-C target attainment. Heterozygous familial hypercholesterolemia (HeFH), statin intolerance, and female gender were associated with a significant lower probability of achieving LDL-C target levels. Conclusions: Our analysis confirms that PCSK9mAb treatment is safe and effective, enabling 60% of our cohort to fully achieve the LDL-C guideline recommendations. The use of high-intensity statins emerged as a significant predictor of efficacy. Conversely, familial hypercholesterolemia and female gender were identified as predictors of therapeutic failure. Hence, it is crucial to address disparities in cardiovascular disease prevention between genders and to enhance strategies for managing elevated LDL-C in HeFH patients. Full article

The lack of data on flood events poses challenges in flood management. In this paper, we propose a novel approach to enhance flood-forecasting models by utilizing the capabilities of Generative Adversarial Networks (GANs) to generate synthetic flood events. We modified a time-series GAN by incorporating constraints related to mass conservation, energy balance, and hydraulic principles into the GAN model through appropriate regularization terms in the loss function and by using mass conservative LSTM in the generator and discriminator models. In this way, we can improve the realism and physical consistency of the generated extreme flood-event data. These constraints ensure that the synthetic flood-event data generated by the GAN adhere to fundamental hydrological principles and characteristics, enhancing the accuracy and reliability of flood-forecasting and risk-assessment applications. PCA and t-SNE are applied to provide valuable insights into the structure and distribution of the synthetic flood data, highlighting patterns, clusters, and relationships within the data. We aimed to use the generated synthetic data to supplement the original data and train probabilistic neural runoff model for forecasting multi-step ahead flood events. t-statistic was performed to compare the means of synthetic data generated by TimeGAN with the original data, and the results showed that the means of the two datasets were statistically significant at 95% level. The integration of time-series GAN-generated synthetic flood events with real data improved the robustness and accuracy of the autoencoder model, enabling more reliable predictions of extreme flood events. In the pilot study, the model trained on the augmented dataset with synthetic data from time-series GAN shows higher NSE and KGE scores of NSE = 0.838 and KGE = 0.908, compared to the NSE = 0.829 and KGE = 0.90 of the sixth hour ahead, indicating improved accuracy of 9.8% NSE in multistep-ahead predictions of extreme flood events compared to the model trained on the original data alone. The integration of synthetic training datasets in the probabilistic forecasting improves the model’s ability to achieve a reduced Prediction Interval Normalized Average Width (PINAW) for interval forecasting, yet this enhancement comes with a trade-off in the Prediction Interval Coverage Probability (PICP). Full article

Background and Objectives: Endoscopic biliary plastic stenting is a safe and effective temporary therapeutic modality used in various benign biliary disorders. Long-term indwelling stents for more than one year without retrieval are termed “forgotten biliary stents”. In clinical practice, the forgotten stents are underestimated and the majority of data were obtained from case reports. The aim of this study was to determine the forgotten-biliary-plastic-stent-related complications, their management, and the patients’ clinical outcomes. Materials and Methods: This retrospective study was performed at three hospitals during the period from January 2021 to December 2023. In total, 577 patients with biliary plastic stents—inserted for a variety of benign biliary conditions—were included. They were divided into two groups, as follows: group 1 included 527 patients who had biliary stents removed within 3 months, and group 2 included 50 patients with biliary stents retrieved after one year of their deployment. The stent-related complications (e.g., acute cholangitis, stent clogging, distal stent migration, new common bile duct (CBD) stone formation, and proximal stent migration) and the endoscopic management success rate were evaluated. Results: Irretrievable CBD stones were the main indication for biliary plastic stenting in both groups. The stent-related complications, number of endoscopic sessions, and hospital admissions were significantly higher in the patients with forgotten biliary stents than those with stent removal within 3 months. All the study patients were successfully managed endoscopically with uneventful outcomes. Conclusions: Based on this retrospective study, non-adherence to the endoscopists’ instructions is the main reason for retained biliary stents for more than one year. The patients with forgotten stents had significantly higher complication rates, a higher number of endoscopic sessions, and a higher number of hospital admissions than those with stents that were retrieved in the scheduled time. All patients were managed endoscopically with a technical success rate of 100%, and with no complication-related mortality. Full article

A novel, user-friendly bioreactor for the cultivation of cellularised membranes for tissue engineering has been successfully designed, manufactured, and validated. This bioreactor features a culture vessel and a cover, the latter equipped with one or more sidewalls to ensure airtightness in two distinct zones, thereby maintaining sterile conditions. The cover, designed to integrate seamlessly with the culture vessel, includes several ports compatible with commercial connectors. This design allows the introduction of cells and culture medium without requiring the opening of the cover, thus preserving sterility. Additionally, the cover is equipped with flanges that effectively press the membrane against the bottom surface of the culture vessel, preventing it from shrinking or shifting. This ensures that cells can properly adhere to the membrane and proliferate. Manufactured under Good Manufacturing Practice (GMP) conditions, the bioreactor supports cultivation in optimal aseptic environments, thereby preventing external contamination. This feature is critical for the safe transportation of cultivated tissue to clinical settings. Validation tests have confirmed the bioreactor’s excellent performance, endorsing its suitability for intended applications in tissue engineering. Full article

This paper explores the intriguing parallels between bacterial behavior and human actions, specifically the tendency of bacteria to adhere to surfaces, construct bacterial “houses” known as a biofilm matrix, nurture growth and reproduction within the biofilm matrix, and disperse upon maturity. Termed as the bacterial “houses”, biofilm matrices exert significant influence on various aspects of human life. A well-structured biofilm matrix serves as the foundation for establishing biofilm reactors capable of efficiently removing heavy metal pollutants from water. Conversely, a dysfunctional biofilm matrix can lead to infections and subsequent illnesses in the human body. Therefore, the study of the biofilm matrix emerges as pivotal. Employing a bibliographic study methodology, this paper analyzes 1000 web of science articles in the field, investigating key keywords, influential countries/regions, organizations, and their interconnections. The findings illuminate the primary themes in biofilm matrix research and offer insights into future directions for this critical field of study. Full article

The structure of a fabric is a highly complex assembly of fibres, which have order and regularity as well as disorder and randomness. The complexity of the structure poses challenges in defining its mechanical behaviour, particularly at low stress, which is typical to end uses. The coexistence of multiple deformations and the high degree of nonlinearity of the fabric due to fibre friction make its stress–strain relationship complicated. This article reviews the literature on friction related to the low-stress mechanics of fabrics, and it establishes its range and regularity to help with finding a unified reference model, in which although the physical meanings of fabric tensile, shear, and bending vary, they follow consistent mathematical regularities. So, invariably, their disorder and randomness needed in defining them can be obtained from fabric measurement data. It defines the scope and patterns of friction to facilitate the development of a unified reference model. It argues that although the physical interpretations of fabric tensile, shear, and bending characteristics may differ, they adhere to consistent mathematical regularities within this model, and hence extracting disorder and randomness from fabric measurement data may be achievable. This paper concludes with a number of recommendations, postulating that hysteresis caused by friction between fibres in a fabric is an important component of mechanical information, and it coexists with its purely elastic component, but it cannot be obtained directly by measurement. Seeking means to effectively decompose the friction hysteresis and pure elastic components contained in fabric mechanics measurement data will provide an accurate characterization of fabric mechanical properties and hence an accurate modelling and simulation of its behaviour, and will impact many traditional and industrial textile end uses. Full article

Background: Acute Infectious Diarrhea (AID) and the short- and long-term complications associated with it are major causes of hospitalization worldwide. In Italy, due to a lack of robust surveillance programs, only limited data has been collected on their prevalence and circulation. This study aims to evaluate the resistance pattern of enteric pathogens and their epidemiological trends over a six-year period. Methods: This cross-sectional retrospective study was conducted from January 2018 to December 2023. Stool samples were analyzed during routine diagnosis with culture methods, syndromic molecular tests, and enzyme immunoassay. Results: Bacteria were the most isolated enteric pathogens (62.2%), followed by fungi (29.0%), viruses (8.2%), and parasites (0.6%). Most bacteria were isolated from outpatients (29.5%) and from patients in the Oncology ward (26.2%). The most prevalent target was EPEC (11.1%), followed by C. difficile toxin A/B-producing strains (8.3%), C. jejuni (2.5%), and S. enterica, (1%.). Norovirus and Candida spp. were the most prevalent in pediatric patients (6.5% and 39.6%, respectively). In the last years, enteric pathogens have been a frequent cause of infections characterized by a problematic resistance to common antimicrobials. In our study, S. enterica showed resistance to amikacin, gentamicin, ampicillin, levofloxacin, and ciprofloxacin. C. jejuni was susceptible to all tested drugs. Conclusion: Timely notification of gastroenteric infections is crucial in identifying potential outbreak sources and ensuring strict adherence to food safety and hygiene practices, so as to protect the most vulnerable populations. The present study offers insights into the epidemiological characteristics and the antibiotic susceptibility of the main enteric AID pathogens in order to implement infection control measures in health care settings. Full article

Background: While high-flow nasal cannulas (HFNCs) represent the standard of care in the intensive care unit for patients with severe hypoxemia, its use in homecare settings is uncommon despite its potential. The potential benefits and challenges of the high-flow nasal cannula (HFNC) in homecare settings compared to standard long-term oxygen via nasal low-flow therapy are unclear. Methods: We conducted a prospective monocentric feasibility study at the Department of Respiratory Medicine, University Hospital, Goethe University Frankfurt, Germany. Patients with interstitial lung disease or severe bronchiectasis (including cystic fibrosis) were enrolled into the study. The HFNC was introduced during hospitalization. The patients’ compliance with home use advice and arterial blood gas results were evaluated at a 4–6-week follow-up. Results: A total of 12 patients were analyzed. HFNC initiation did not result in a significant improvement of the pO₂/fiO₂ (p/f) ratio. Only 8 out of 12 (66.6%) patients used the HFNC at home after the initial in-hospital initiation. Only 7 of the total 12 patients were using the therapy at a follow-up 3–6 weeks after HFNC onset. Two patients died during the observation, resulting in a surveillance mortality rate of 16.7%. Conclusions: The feasibility data showed low adherence to the HFNC at home. The lack of any positive effect on the p/f ratio may be due to low airflow rates and overall mild hypoxemia compared to patients with severe respiratory failure in the ICU. Full article

Background/Objectives: Several psychological conditions, including stress and depression, can adversely affect oral health; in fact, antidepressants, commonly used to treat depressive disorders, may have conflicting effects on the periodontal status of individuals. The aim of this review was to determine the effects of antidepressants on the periodontium. Methods: A literature search was conducted using electronic databases, Pubmed/MEDLINE, Cochrane Library, focusing on the use of antidepressants and their effects on periodontal health in animals or humans. Results: Seventeen articles have been included with the use of amitriptyline (two studies), desipramine (one study), imipramine (two studies), desvenlafaxine (one study), fluoxetine (six studies), venlafaxine (three studies) and tianeptine (two studies). One study evaluated several categories of antidepressants, such as selective serotonin reuptake inhibitors (SSRI), serotonin-norepinephrine reuptake inhibitors (SNRI), tricyclic, atypical and monoamine oxidase inhibitors (MAO). Most trials showed improvements in periodontal health, especially with fluoxetine, but also with imipramine, desipramine, desvenlafaxine and tianeptine; on the contrary, worsening of clinical periodontal indices and increased loss of alveolar bone were reported with venlafaxine. Conclusions: This review suggests that in the presence of comorbidity between periodontitis and depression, pharmacological treatment with SNRIs, SSRIs and mixed antidepressants is associated with improvement in periodontal parameters, except for venlafaxine. Healthcare professionals (especially oral and mental health professionals) should investigate proper adherence to medication therapy in patients with a history of periodontitis and depression. Further clinical trials are needed to confirm these results. Full article

An evaluation of the behavioral risk factors that contribute to the incidence and evolution of cancer in oncology patients was conducted through a cross-sectional study using a questionnaire completed by 206 patients (101 men and 105 women) diagnosed with various types of cancer. These patients were selected from different oncology centers in Romania, located in Bucharest and Constanta. Among the respondents, 91 are of normal weight, 12 are underweight, 62 are overweight, and 41 are obese, with overweight individuals predominating (p = 0.799). Regarding the presence of behavioral risk factors that can aggravate oncological pathology, it is found that 10 respondents consume alcohol daily, 36 consume it weekly with varying frequencies (p = 0.012), 26 respondents smoke excessively daily, and 12 respondents smoke 1–2 cigarettes daily (p = 0.438). Additionally, 40 respondents rarely engage in physical activity, and 71 respondents do not engage in physical activity at all as they do not typically participate in sports (p = 0.041). Thus, respondents with colon cancer tend to consume sweets, pastries and even fast food or fried foods more often, while the daily consumption of vegetables and fruits is insufficient, according to the recommendations of nutrition guidelines (a minimum of four portions per day). The analysis found that smoking and excessive alcohol consumption were associated with an increased incidence of lung and liver cancer. The lack of regular physical activity was identified as a risk factor for breast and colon cancer. An unhealthy diet, characterized by a low consumption of fruits and vegetables and high intake of processed foods, was correlated with a higher incidence of colorectal cancer. Additionally, non-adherence to medical advice was associated with poorer clinical outcomes and faster disease progression. The majority of respondents who declared that they did not feel an improvement in their state of health in the last period were among those who stated that they did not fully comply with the oncologist’s recommendations. Identifying and modifying behavioral risk factors can play a crucial role in cancer prevention and in improving the prognosis and quality of life of cancer patients. Full article

(1) Background: In glaucoma patients, it is observed that intraocular pressure (IOP) in non-surgical eyes decreases during hospitalization, but detailed data have not been reported. This study aimed to examine changes in IOP in the non-surgical eyes of patients admitted for glaucoma surgery. (2) Methods: This retrospective study included 487 patients (254 males, 233 females). Statistical analysis was performed separately for groups that were and were not under medication treatment. (3) Results: In non-surgical eyes, the difference in IOP between admission and discharge was −1.6 ± 4.8 mmHg (95% confidence interval (CI), −2.1 to −1.2; p < 0.0001) with a significant decrease in the medication group (n = 414), while it was −0.6 ± 4.8 mmHg with no significant change observed (95% confidence interval (CI), −1.7 to 0.57; p = 0.33) in the non-medication group (n = 73). Multiple regression analysis of the medication group showed that IOP at admission (p < 0.0001) and older age (p = 0.03) were associated with the reduction or the rate of reduction in IOP. (4) Conclusions: IOP in the non-surgical eyes of patients admitted for glaucoma surgery with medication decreased during hospitalization. The reduction was more pronounced in individuals with higher IOP at admission and in older patients. It is possible that improved medication adherence contributes to the lowering of IOP. Full article

An innovative approach for creating customized dosage forms and supporting patient populations with specific requirements who need additional support to improve drug adherence is 3D printing. This work introduces liquid crystal display (LCD) 3D printing as a means of developing melatonin (MLT) tablets. For patients who are blind or visually challenged, Braille patterns were displayed on the tablet surface in addition to the optimization of printing hydrogel inks. Owing to the great printing accuracy, blind patients could validate the Braille patterns that provided the required information. Upon further examination MLT was found to be present in the photopolymerized resins in an amorphous state. The choice of poly(ethylene glycol)-diacrylate (PEGDA) with varying molecular weights and the inclusion of surfactants or solubilizers interfered with the photopolymerization of the resin, hence controlling the rates of MLT dissolution towards the sought sustained release. Nuclear magnetic resonance (NMR) analysis showed that photopolymerization of the PEGDA resins in the printed dosage forms has taken place. A small batch scale-up investigation showed that LCDs could print a significant number of tablets quickly—about twenty-four minutes. Full article

Angels and guishen 鬼神, as entities distinct from humans, hold great importance in Chinese and Judaeo-Christian cultures, respectively. Since they share similar roles in providing moral guidance, Jesuit missionaries attempted to identify angels with the guishen to facilitate the introduction of the Catholic cult of angels to China. However, as the Chinese reverence for guishen differed somewhat from the Catholic cult of angels, this identification posed significant doctrinal questions. This article uses the issue of reverence for guishen to review the missionaries’ different understandings and interpretations of Chinese guishen. By distinguishing three different attitudes and positions towards Chinese guishen, it shows that both sides, adhering to their respective cultural centers, are unable to resolve the debates on these spirits, whether interpreting the West through Chinese perspectives, as “Sinicizing Christianity” 以儒化耶, or interpreting China through Western perspectives, as “Christianizing Confucianism” 以耶化儒. Therefore, this article argues that although the controversies over the nature and reverence of guishen between China and the West are unavoidable, there is still common ground in their understanding of sacred existence. As demonstrated by the missionaries’ recognition, interpretation, and understanding of Chinese guishen at different times, it reveals the inherent tension between Chinese and Western cultures. Full article

This review article examines global initiatives in the adoption of building information modeling (BIM) for road infrastructure. It begins with an overview of the distinctions between BIM applications for buildings and infrastructure projects. This study evaluates noteworthy BIM publications (NBPs) from various countries and organizations to understand BIM’s transformative impact on roadway infrastructure projects. It analyzes the evolution of these publications, compares academic output with NBP, identifies the stages of BIM maturity, and evaluates adherence to ISO 19650 standards. Through this analysis, the article presents current global and regional scenarios, providing a comprehensive overview of the current state and future prospects of BIM implementation in the road infrastructure sector. Full article

Background & Aims: Hepatocellular carcinoma (HCC) presents a significant global health challenge, particularly among individuals with liver cirrhosis, with hepatitis C (HCV) a major cause. In people with HCV-related cirrhosis, an increased risk of HCC remains after cure. HCC surveillance with six monthly ultrasounds has been shown to improve survival. However, adherence to biannual screening is currently suboptimal. This study aimed to evaluate the effect of increased HCC surveillance uptake and improved ultrasound sensitivity on mortality among people with HCV-related cirrhosis post HCV cure. Methods: This study utilized mathematical modelling to assess HCC progression, surveillance, diagnosis, and treatment among individuals with cirrhosis who had successfully been treated for HCV. The deterministic compartmental model incorporated Barcelona Clinic Liver Cancer (BCLC) stages to simulate disease progression and diagnosis probabilities in 100 people with cirrhosis who had successfully been treated for hepatitis C over 10 years. Four interventions were modelled to assess their potential for improving life expectancy: realistic improvements to surveillance adherence, optimistic improvements to surveillance adherence, diagnosis sensitivity enhancements, and improved treatment efficacy Results: Realistic adherence improvements resulted in 9.8 (95% CI 7.9, 11.6) life years gained per cohort of 100 over a 10-year intervention period; 17.2 (13.9, 20.3) life years were achieved in optimistic adherence improvements. Diagnosis sensitivity improvements led to a 7.0 (3.6, 13.8) year gain in life years, and treatment improvements improved life years by 9.0 (7.5, 10.3) years. Conclusions: Regular HCC ultrasound surveillance remains crucial to reduce mortality among people with cured hepatitis C and cirrhosis. Our study highlights that even minor enhancements to adherence to ultrasound surveillance can significantly boost life expectancy across populations more effectively than strategies that increase surveillance sensitivity or treatment efficacy. Full article