Search Results (202)

Objective: Progressive apraxia of speech (PAOS) is a neurodegenerative syndrome characterized by impaired motor speech planning and programming, whereas behavioral variant frontotemporal dementia (bvFTD) is characterized by deviant behavioral (e.g., personality and social) features. Clinical and anatomic characteristics of bvFTD in the context of PAOS are understudied. Methods: We identified 12 participants with PAOS and features that were consistent with bvFTD at baseline or follow-up. Eleven completed a head MRI scan. We compared clinical features and anatomical patterns of atrophy in these 11 PAOS-bvFTD participants to 11 matched PAOS participants without bvFTD and 22 age- and sex-matched healthy controls. Statistical Parametric Mapping (SPM) was applied to visualize gray matter volume across both groups compared to controls and each other. Medians and 25th and 75th percentiles were assessed in patients and across groups; Fisher’s Exact Test and Mann–Whitney U tests were applied using BlueSky software, version 10.3.1-Pro. Results: As expected, PAOS-bvFTD participants performed worse on the Frontal Behavioral Inventory (median: 33/72 vs. 10/72), 20-item behavioral assessment scale (4.5/20 vs. 1.0/20), and the Neuropsychiatry inventory (4/36 vs. 1.5/36) compared to the PAOS group (p < 0.01 for all), with no differences in other demographic, neurological, or language tests. Seven of the eleven PAOS-bvFTD participants had bvFTD features develop within three years of symptom onset. The PAOS-bvFTD and PAOS groups showed volume loss in frontal lobe regions compared to controls, with PAOS-bvFTD participants having more prefrontal volume loss than PAOS participants. Conclusions: Behavioral features consistent with bvFTD can co-occur in patients with PAOS and are related to greater atrophy of the prefrontal cortex. Full article

Background/Objectives: Postoperative urinary retention (POUR) occurs in 10–15% of women after surgical procedures for stress urinary incontinence (SUI). Guarding Reflex Inhibition Training (GRIT) is a novel behavioral approach that teaches patients to consciously inhibit involuntary pelvic floor contraction. We evaluated whether preoperative GRIT is associated with decreased POUR after urethral bulking with polyacrylamide hydrogel (PAHG). Methods: We performed a retrospective review of 145 women with SUI. Perioperative care was consistent across groups, separated by date of service; only those treated after November 2023 received structured GRIT instruction. The primary outcome was POUR, defined as the need for >1 episode of straight catheterization or discharge with a catheter. Results: POUR occurred in 15/106 (14.2%) patients without GRIT and 0/39 (0%) patients with GRIT. This difference was statistically significant (Fisher’s exact test p = 0.012), corresponding to an absolute risk reduction of 14.2% (95% CI: 4.8–23.9) and a number needed to treat (NNT) of 7. Post hoc power was >90%. Conclusions: Preoperative GRIT, a novel and reproducible training paradigm, was associated with a reduction in POUR following urethral bulking. By targeting conscious inhibition of the guarding reflex, GRIT highlights the potential for integrating behavioral retraining with procedural therapy across incontinence interventions. Full article

This randomized, prospective clinical trial was conducted to compare the effectiveness of the oscillating chitosan brush (OCB) and an air-abrasive device (AAD) in improving clinical outcomes during non-surgical management of peri-implant mucositis. Fifty-eight patients were randomized and received baseline treatment; of these, 50 completed the 6-month follow-up. Probing pocket depth (PPD), bleeding on probing (BoP), and plaque index (PI) were assessed at six locations per implant and measured again at 2 weeks, 4 weeks, 3 months, and 6 months post-treatment. Differences between groups and time points were analyzed using non-parametric tests (Kruskal-Wallis, Dunn, Friedman, and Fisher’s Exact Test). Both treatment groups demonstrated significant improvements in PPD, BoP, and PI at the 6-month evaluation compared to baseline (p < 0.05). At 24 weeks, the OCB group showed faster reductions in PPD and PI compared with the AAD group (p = 0.03 and p = 0.01, respectively), while BoP did not differ significantly (p = 0.41). Considering the constraints of this 6-month clinical study, the non-surgical management of peri-implant mucositis using both OCB and AAD resulted in comparable clinical outcomes. Both approaches demonstrated a consistent ability to improve clinical parameters associated with this condition. Full article

Background: Sarcopenia is linked with high rates of adverse surgical outcomes, and computed tomography angiography (CTA)-based psoas measurements are used as imaging sarcopenia surrogates. Their prognostic value in patients with chronic limb-threatening ischemia (CLTI) undergoing revascularization remains uncertain. Objectives: To evaluate whether CTA-derived psoas muscle indices predict complications and mortality after lower-limb revascularization for CLTI. Methods: We performed a retrospective cohort study of consecutive adults who underwent open, hybrid, or endovascular revascularization for CLTI at a single tertiary center (March 2018–December 2021). Psoas muscle area (PMA) and density (PMD) were measured preoperatively on CTA at the mid-L3 vertebral level. Psoas muscle index (PMI) was calculated as PMA/height². Patients were stratified by tertiles for each index (lowest tertile = “sarcopenic” vs. upper two tertiles). Outcomes included early in-hospital complications, late complications, overall complications, late mortality, and overall mortality. Group comparisons used χ²/Fisher tests with false discovery rate (FDR) adjustment; multivariable logistic regression with AIC-guided selection assessed independent predictors. Results: A total of 234 patients were included (median age 68 years; 65.4% men). Early complications occurred in 15.8%; late complications in 70.3%; overall mortality during follow-up was 26.6% (38/143 within follow-up data). In tertile analyses, none of the psoas-derived measures were significantly associated with early complications, late complications, overall complications, or mortality after FDR correction. Lower PMD showed consistent but non-significant trends toward higher late complications (84% vs. 64%), overall complications (87% vs. 72%), overall mortality (38% vs. 21%), and late mortality (37% vs. 20%) (all p < 0.05 unadjusted; all p_adj ≥ 0.139). In multivariable models, PMA, PMD, and PMI were not independent predictors of any outcome. Conclusions: In this retrospective cohort study, preoperative CTA-derived psoas indices were not independent predictors of early, late, or overall complications, nor of in-hospital or follow-up mortality after revascularization for chronic limb-threatening ischemia. Although lower psoas muscle density showed consistent trends toward higher risk, these associations did not reach statistical significance after adjustment. Taken together, our findings suggest that psoas-based measures have limited prognostic value in this setting and should be interpreted cautiously, while their potential role warrants confirmation in larger, prospective studies. Full article

The design and production of goods have been completely transformed by additive manufacturing (AM), which makes it possible to create components with intricate and complex geometries that were previously impossible or impractical to produce. However, current technologies continue to produce coarse-surfaced metal components that typically exhibit fatigue properties, resulting in component failure and unfavorable friction coefficients on the printed part. Therefore, to improve the surface quality of the fabricated parts, post-processing of AM-created components is required. With emphasis on electroless nickel plating, ChemPolishing (CP), and ElectroPolishing (EP), this study investigates post-processing methods for stainless steel that is additively manufactured (AM). The rough surfaces created by additive manufacturing (AM) restrict direct use. While ElectroPolishing (EP) achieves high material removal rates but may not be consistent, ChemPolishing (CP) offers uniform smoothening. Nickel plating enhances additive manufacturing (AM) products’ resistance to wear and scratches and corrosion protection. To optimize nickel deposition, medium (6%–9%) and high (10%–13%) phosphorus nickel was tested using the L9 Taguchi design of experiments (DOE). Mechanical properties, including scratch resistance and adhesion, were evaluated using the TABER 5900 reciprocating (Taber Industries, North Tonawanda, NY, USA) abraser apparatus, a 5 N scratch test, and ASTM B-733 thermal shock method. Surface analysis was performed with the KEYENCE VHX-7000 microscope (Keyence Corporation, Itasca, IL, USA), and chemical composition before and after nickel deposition was assessed via the ThermoFisher Phenom XL scanning electron microscope (SEM, Thermo Fisher Scientific, Waltham, MA, USA) Optimal processing conditions, determined using Qualitek-4 software, Version 20.1.0 revealed improvements in both surface finish and mechanical robustness. This comprehensive analysis underscores the potential of nickel-coated additive manufacturing (AM) parts for enhanced performance, offering a pathway to more durable and efficient additive manufacturing (AM) applications. Full article

Work–family conflicts (WFCs) and family–work conflicts (FWCs) have been found to be important to worker morale and retention as well as family (as defined by the respondents) well-being, with particular importance within the military, as indicated by a number of studies in the United States, Canada, and European countries. However, few studies have focused on the impact of WFC and FWC for high ranking officers and their families. This study involved two samples of officers attending an advanced leadership course at Fort Leavenworth, Kansas, in 2007, featuring a total of 262 Army officers and another 45 officers from other services and countries. The sample of Army officers included 239 men (85.4% of whom were a parent) and 22 women (63.6% of whom were a parent; Fisher’s Exact Test, p < 0.02), with one missing case for sex. Of the men and women, respectively, most were married for the first time (190/11), with some never married (14/5), married but divorced (10/1), married/divorced/remarried (20/4), married/spouse died/remarried (1/0), married/divorced/remarried/divorced/remarried (4/0), and married/divorced/remarried/divorced/remarried (0/1). Measures for cohabitation or same-sex partnerships were not used. Two modified measures of WFC and FWC of four items each were tested and found to represent different factors and to have high internal consistency reliability. In general we found few sex differences, but female officers seemed to be more influenced by family–work conflict than male officers. One of our most substantial findings was that work–family conflict was more prevalent than family–work conflict within our sample. Also, we found that marital satisfaction tended to be higher than parental satisfaction and that officers usually found their own retention intentions to be higher than their perception of that of their spouses. Satisfaction with the military was consistently and strongly related to lower levels of work–family conflict while similar but weaker trends were found for family–work conflict. Most of our results were found to cross-validate with a subsample of non-Army officers in our sample. We found bias from marital social desirability to be lower for our marital process scale and for FWC than for marital satisfaction and WFC. In sum, our results confirm adverse effects of deployments and other stressors on military families and a continuing need for military support for families, even among higher ranking officer families. Full article

Background and Objectives: Thoracic epidural analgesia (TEA) is considered the gold standard for postoperative pain control following major abdominal surgery. Bilateral rectus sheath block (RSB) is a promising alternative regional technique. This study aimed to compare the efficacy of RSB and TEA in managing early postoperative pain and enhancing recovery after open gastrectomy. Materials and Methods: Between October 2021 and December 2024, 70 patients scheduled for elective open gastrectomy were randomized into two groups: Group A (RSB with continuous bupivacaine infusion) and Group B (TEA with 10 mg bupivacaine plus 1 µg/mL fentanyl). Primary outcomes included opioid consumption within 72 h postoperatively and pain intensity measured using the visual analog scale (VAS). Statistical analysis was conducted using the Mann–Whitney U test, Friedman’s ANOVA with Bonferroni correction, and Chi-square or Fisher’s exact test for categorical variables. Results: A total of 64 patients were finally included (30 in RSB, 34 in TEA). VAS scores in the RSB group were significantly lower at 24 and 48 h postoperatively compared to baseline (p < 0.001). Between-group comparisons showed consistently lower pain scores in the RSB group at all measured time points. At 48 h, 94% of patients in the TEA group required rescue analgesia, compared to only 17% in the RSB group. Additionally, the RSB group had a significantly shorter postoperative hospital stay (mean 6 vs. 9 days) and demonstrated earlier return of bowel function. Conclusions: RSB is a safe and effective alternative to TEA for analgesia after open gastrectomy. It significantly lowers pain scores, reduces opioid and rescue medication use, shortens hospital stay, and enhances early recovery. Bilateral rectus sheath block with continuous bupivacaine infusion significantly lowers pain scores, reduces opioid and rescue medication use, shortens hospital stay, and facilitates early recovery. Full article

Turfgrass provides significant functional, environmental, recreational and aesthetic benefits; however, its high management inputs raise sustainability concerns due to intensive irrigation, fertilization and mowing. The aim of this study is to evaluate whether adopting a new mowing technology can support or enhance current low-input strategies in turfgrass management, such as reducing synthetic fertilization and deficit irrigation. This study was conducted from September 2023 to October 2024 at the Centre for Research on Turfgrass for Environment and Sports (CeRTES) in Pisa, Italy. Two turf compositions, pure tall fescue and tall fescue–microclover mixture, were managed using an autonomous mower operating daily at three mowing heights, 20, 40 and 60 mm. Turf quality, color, the NDVI, weed cover, leaf morphology, and clover presence were assessed throughout the growing season, including a drought and recovery period. The experimental design consisted of a two-factor split-plot randomized complete block design with four replications, and the statistical approach used was two-way and one-way ANOVAs with Fisher’s LSD at p = 0.05. The results of the study indicated that, under conditions where an autonomous mower was set to operate on a daily basis, the selected mowing height had minimal influence on drought response or recovery when water availability was a limiting factor. Furthermore, when subjected to the lowest mowing heights, the legume species included in the turfgrass mix demonstrated strong resilience, maintaining its presence and performance. In addition, when mowing with a high mowing frequency and at low mowing heights, the overall quality of the turfgrass appeared enhanced. These results serve as an important starting point for considering autonomous mowing technology as an innovative strategy in advancing toward turf management systems that prioritize sustainability and efficient use of resources. Full article

The research focuses on the National Rural Development Programme (NRDP) during the transition period, assessing the absorption level of sub-measure 4.1, “Investments in agricultural holdings”, which impacts rural development in the agricultural sector in western Romania. A quantitative and qualitative analysis of all selection reports associated with sub-measure 4.1 submitted during the transition period (2021–22) was conducted to investigate a potentially relevant link between the number of beneficiaries identified in the analysed region and their location. Fisher’s exact tests indicate that the null hypothesis, which postulates independence between county and measure in the observed dataset, cannot be rejected. Further empirical analysis was conducted using panel data analysis to identify any relevant regression traits. Tests indicate that funding allocation, the spatial dimension and the temporal dimension are all statistically and substantively significant. Larger budget allocations are associated with a higher volume of proposals. Two out of the four analysed counties systematically outperformed the predicted values in the model by submitting more proposals than would be expected given their budgets. Later application stages yielded a greater number of successful proposals, which is consistent with residual demand capture in sequential competitive calls. Full article

Introduction: The management of peri-operative pain significantly impacts the post-operative recovery following kidney transplant. For decades, regional blocks have been utilized for post-operative pain management following abdominal surgery. The data on the routine use of regional blocks peri-operatively during kidney transplants are limited. We aim to review our current clinical practice of peri-operative use of regional blocks during kidney transplants and management of peri-operative pain up to 24 h. Methods: A consecutive series of 100 patients who underwent kidney transplant was reviewed. All demographic data including patient’s age, gender, race, and body mass index were collected. Pre-transplant co-morbidities were summarized for all patients and included the American Society of Anesthesiologists (ASA) score. Patients were divided into two groups based on whether they received a transversus abdominis plane (TAP) block. Group A consisted of patients who received an ultrasound-guided TAP block, while Group B included patients who did not receive any form of TAP block. The intra-operative and post-operative use of analgesia was recorded for up to 24 h post kidney transplant. All peri-operative complications were reviewed. The chi-square test and Fisher’s exact test was used to compare symptoms (nausea, vomiting, and pruritus) between the two groups. Similarly, the use of analgesia was also compared. Results: A total of 100 patients were identified and equally distributed between the two groups [Group A = 50 (TAP block), Group B = 50 (non-TAP block)]. There was a statistically significant reduction in the use of intraoperative fentanyl (p = 0.04) in Group A. There was no difference in the post-operative use of hydromorphone (p = 0.665), oxycodone (p = 0.75), and acetaminophen (p = 0.64) up to 24 h after the kidney transplant procedure. There was no difference between post-operative nausea (p = 0.766), vomiting (p = 0.436), and pruritus. There were no complications recorded secondary to the use of regional blocks in Group A. Conclusions: The use of regional anesthesia in kidney transplant recipients is a safe approach without complications. The study concluded that regional blocks decrease the use of intra-operative opioids. However, there was no difference in the use of post-operative requirements for analgesia or side effects up to 24 h after kidney transplant. Full article

The fixation time of alleles is a fundamental concept in population genetics, traditionally studied using the Wright–Fisher model and classical coalescent theory. However, these models often assume homogeneous environments and equal reproductive success among individuals, limiting their applicability to real-world populations where environmental heterogeneity plays a significant role. In this paper, we introduce a new forward-time model for estimating fixation time that incorporates environmental heterogeneity through the use of fractional calculus. By introducing a fractional parameter α, we capture the effects of heterogeneous environments on offspring production. To solve the resulting fractional differential equations, we develop a novel spectral method based on Eta-based functions, which are well-suited for approximating solutions to complex, high-variation systems. The proposed method reduces the problem to an optimization framework via the operational matrix of fractional derivatives. We demonstrate the effectiveness and accuracy of this approach through numerical examples and show that it consistently captures fixation dynamics across various scenarios. This work offers a robust and flexible framework for modeling evolutionary processes in heterogeneous environments. Full article

Background/Objectives: Sacituzumab govitecan (SG) is an antibody–drug conjugate targeting Trop-2 that has demonstrated clinical benefits in randomised trials for patients with metastatic triple-negative breast cancer (mTNBC) and metastatic hormone receptor-positive/HER2-negative (HR+/HER2− mBC) disease. However, real-world data on its effectiveness and safety are limited, especially in patients with poor performance status or central nervous system (CNS) involvement. This study aimed to evaluate the real-world outcomes of SG in these two subtypes. Methods: We conducted a retrospective, multicentre, observational study across three tertiary hospitals in Spain. Patients with mTNBC or HR+/HER2− mBC treated with SG between June 2022 and March 2025 were included. Clinical data, treatment history, adverse events (AEs), and survival outcomes were also recorded. The median progression-free survival (mPFS) and median overall survival (mOS) were estimated using Kaplan–Meier analysis. Univariate and multivariate analyses were performed to identify the factors influencing outcomes. The association between granulocyte colony-stimulating factor (G-CSF) prophylaxis and neutropenia was assessed using Fisher’s exact test. Results: A total of 56 patients were included in this study (33 with mTNBC and 23 with HR+/HER2− mBC). In the mTNBC group, mPFS was 4.0 months (95% CI: 1.94–5.98) and mOS was 11.0 months (95% CI: 4.80–17.12). In the HR+/HER2− mBC group, mPFS was 3.7 months (95% CI: 2.02–5.44) and mOS was 20.2 months (95% CI: 3.9–36.5). Fatigue, neutropenia, and gastrointestinal toxicity were the most common AEs. Primary G-CSF prophylaxis was not associated with a reduced incidence of neutropenia (p = 0.434). Conclusions: In routine practice, SG shows effectiveness comparable to that of randomised trials across both subtypes, with a safety profile consistent with pivotal studies. The observed toxicity profile was consistent with that described in pivotal clinical trials and other studies. The prophylactic use of G-CSF was not associated with an impact on the occurrence of neutropenia, but the incidence of neutropenia was lower than that in clinical trials and other studies that did not administer G-CSF prophylactically. Full article

This study examined the prevalence of intentionally unreported and potentially unrecognized concussions in community rugby players and whether nondisclosure reasons vary by sex, position, or playing history. An online survey was completed by 1037 players (41.0% female; mean age 31.6 ± 11.3 years; 10.1 ± 8.1 years playing) who reported diagnosed, unreported, and unrecognized concussions. Poisson regression models estimated prevalence ratios (PRs), and Fisher’s exact tests compared reasons for nondisclosure. The diagnosed, unreported, and unrecognized concussion rates were 66.5%, 32.4%, and 42.2%, respectively. Players with diagnosed concussions had a 7.2-fold higher prevalence of nondisclosure and a 2.3-fold higher prevalence of nonrecognition. A longer playing history was linked to greater nondisclosure (PR: 1.2), and males had a higher prevalence of nonrecognition (PR: 1.4). Position and sex were not associated with nondisclosure; position and playing history did not affect recognition. While nondisclosure reasons were mostly consistent across demographics, players with a history of concussion were more likely to report avoiding removal from games or practices (38.5% vs. 13.6%, p = 0.021). Concussions are common in community rugby, with high rates of underreporting and unawareness, influenced by experience and prior concussions. These findings underscore the need for better education and reporting systems to improve player safety. Full article

Background/Objectives: The non-small-cell lung cancer (NSCLC) therapeutic landscape has undergone a profound transformation with the introduction of multiple personalized treatment options. Mutations in ERBB2 (HER2) have recently emerged as promising novel targets for the treatment of non-squamous NSCLC (nsNSCLC). Accurate, rapid, and efficient molecular profiling is crucial for identifying patients who may benefit from targeted therapies, including HER2-directed agents. Materials and Methods: Here, we aimed to retrospectively assess the performance of the Oncomine™ Precision Assay* (OPA) in combination with the Ion Torrent Genexus™ Integrated Sequencer* (Thermo Fisher Scientific. Waltham, MA, USA) for detecting ERBB2 mutations in nsNSCLC. A total of 108 archived nsNSCLC samples, consisting of biopsies, resections, and cytological specimens, were used to assess concordance with in-house-validated orthogonal tests. Results: The OPA showed high sensitivity and specificity with an overall accuracy of 100% for single-nucleotide variants (SNVs) and insertions and deletions (Indels). SNVs and Indels with allele frequencies as low as 5% were correctly identified across samples with a tumor cell content ranging from 5% to 95%. Additionally, the assay demonstrated high reproducibility across the six participating laboratories. The turnaround time of the OPA was notably shorter compared to traditional orthogonal methods, facilitating rapid molecular report generation. Conclusions: The OPA in combination with the Ion Torrent Genexus™ System allows for highly sensitive and specific detection of relevant ERBB2 mutations. The assay’s streamlined workflow, coupled with its automated data analysis pipeline, enables a fast turnaround time for testing across a range of sample types. This includes samples with reduced tumor cell content and limited available input. This study demonstrates the future potential of using this assay in a clinical setting. Full article

Background and Objectives: Exclusive breastfeeding offers optimal nutrition and health benefits for infants, yet many mothers face challenges that impact their ability to breastfeed. This study aimed to explore breastfeeding practices among Romanian mothers and identify factors associated with successful exclusive breastfeeding. Materials and Methods: A cross-sectional online survey was conducted from February to March 2025, targeting Romanian mothers via social media platforms. The questionnaire, developed specifically for this study, collected data on sociodemographics, birth and neonatal variables, hospital practices, feeding intentions, community influences, and breastfeeding outcomes. A total of 874 valid responses were analyzed using Fisher’s exact tests and multivariable logistic regression. Results: While 87.2% of mothers intended to breastfeed, only 56.1% reported exclusive breastfeeding. Factors significantly associated with reduced likelihood of exclusive breastfeeding included maternal age ≥ 30 years (OR = 1.40, p = 0.042), Cesarean delivery (OR = 1.78, p < 0.001), absence of rooming-in (OR = 2.32, p < 0.001), and pacifier use (OR > 4.7, p < 0.001). Protective factors included non-smoking status (OR = 0.52, p < 0.001) and encouragement to breastfeed by medical staff (OR = 1.60, p = 0.004). Despite external advice to use formula, many mothers continued breastfeeding. Conclusions: Although breastfeeding intention was high, exclusive breastfeeding remains suboptimal in Romania. Targeted support—particularly in maternity hospitals and for mothers recovering from Cesarean sections—alongside prenatal education and consistent postnatal guidance are essential to bridge the gap between intention and practice. Full article