Search Results (250)

Background: Cutis marmorata telangiectatica congenita (CMTC) is a rare congenital vascular anomaly characterized by a persistent, violaceous, reticulated skin pattern. It may present as a benign isolated lesion or as part of a broader syndrome with systemic anomalies such as limb asymmetry, glaucoma, or neurological impairment. Methods: We report a case series of three neonates with CMTC, each representing a distinct clinical pattern: localized, segmental, and generalized. All patients underwent comprehensive clinical assessment, including dermatologic, neurologic, and ophthalmologic evaluations. Additionally, a systematic literature review was conducted using PubMed, Scopus, and Web of Science databases, covering publications from 2012 to 2025. Results: Case 1 involved a localized lesion of the calf; Case 2 had segmental involvement of the forearm and leg; Case 3 presented with generalized CMTC covering over 85% of the body surface, accompanied by dysmorphism and bilateral persistent fetal vasculature (PFV). Literature findings highlighted significant clinical variability and a stronger association of generalized forms with systemic abnormalities. Conclusions: CMTC exhibits a broad clinical spectrum. While localized cases often resolve spontaneously, generalized forms may require multidisciplinary evaluation. Early recognition and systemic screening are crucial for optimal management. Full article

Introduction: Acute Myeloid Leukemia (AML) is a hematologic malignancy characterized by the clonal expansion of myeloid progenitors. While it primarily affects the bone marrow, extramedullary relapse occurs in 3–5% of cases, and it is linked to poor prognosis. Central nervous system (CNS) involvement presents diagnostic challenges due to nonspecific symptoms. CNS manifestations include leptomeningeal dissemination, nerve infiltration, parenchymal lesions, and myeloid sarcoma, occurring at any disease stage and frequently asymptomatic. Methods: A 62-year-old man with a recent history of AML in remission presented with diplopia and aching paresthesias in the left periorbital region spreading to the left frontal area. The diagnostic workup included neurological and hematological evaluation, lumbar puncture, brain CT, brain magnetic resonance imaging (MRI) with contrast, and dermatological evaluation with skin biopsy due to the appearance of nodular skin lesions on the abdomen and thorax. Results: Neurological evaluation showed hypoesthesia in the left mandibular region, consistent with left trigeminal nerve involvement, extending to the periorbital and frontal areas, and impaired adduction of the left eye with divergent strabismus in the primary position due to left oculomotor nerve palsy. Brain MRI showed an equivocal thickening of the left oculomotor nerve without enhancement. Cerebrospinal fluid (CSF) analysis initially showed elevated protein (47 mg/dL) with negative cytology; a repeat lumbar puncture one week later detected leukemic cells. Skin biopsy revealed cutaneous AML localization. A diagnosis of AML relapse with CNS and cutaneous localization was made. Salvage therapy with FLAG-IDA-VEN (fludarabine, cytarabine, idarubicin, venetoclax) and intrathecal methotrexate, cytarabine, and dexamethasone was started. Subsequent lumbar punctures were negative for leukemic cells. Due to high-risk status and extramedullary disease, the patient underwent allogeneic hematopoietic stem cell transplantation. Post-transplant aplasia was complicated by septic shock; the patient succumbed to an invasive fungal infection. Conclusions: This case illustrates the diagnostic complexity and poor prognosis of extramedullary AML relapse involving the CNS. Early recognition of neurological signs, including cranial nerve dysfunction, is crucial for timely diagnosis and management. Although initial investigations were negative, further analyses—including repeated CSF examinations and skin biopsy—led to the identification of leukemic involvement. Although neuroleukemiosis cannot be confirmed without nerve biopsy, the combination of clinical presentation, neuroimaging, and CSF data strongly supports the diagnosis of extramedullary relapse of AML. Multidisciplinary evaluation remains essential for detecting extramedullary relapse. Despite treatment achieving CSF clearance, the prognosis remains unfavorable, underscoring the need for vigilant clinical suspicion in hematologic patients presenting with neurological symptoms. Full article

Determining the optimal duration of antibiotic therapy for infections caused by multidrug-resistant Gram-negative bacteria (MDR-GNB) is a critical challenge in clinical medicine, balancing therapeutic efficacy against the risks of adverse effects and antimicrobial resistance. This narrative review synthesises current evidence and guidelines regarding antibiotic duration for MDR-GNB infections, emphasising bloodstream infections (BSI), hospital-acquired and ventilator-associated pneumonia (HAP/VAP), complicated urinary tract infections (cUTIs), and intra-abdominal infections (IAIs). Despite robust evidence supporting shorter courses (3–7 days) in uncomplicated infections caused by more susceptible pathogens, data guiding optimal therapy duration for MDR-GNB remain limited, particularly concerning carbapenem-resistant Enterobacterales (CRE), difficult-to-treat Pseudomonas aeruginosa (DTR-Pa), and carbapenem-resistant Acinetobacter baumannii (CRAB). Current guidelines from major societies, including IDSA and ESCMID, provide explicit antimicrobial selection advice but notably lack detailed recommendations on the duration of therapy. Existing studies demonstrate non-inferiority of shorter versus longer antibiotic courses in specific clinical contexts but frequently exclude critically ill patients or those infected with non-fermenting MDR pathogens. Individualised duration decisions must integrate clinical response, patient immunologic status, infection severity, source control adequacy, and pharmacologic considerations. Significant knowledge gaps persist, underscoring the urgent need for targeted research, particularly randomised controlled trials assessing optimal antibiotic duration for the most challenging MDR-GNB infections. Clinicians must navigate considerable uncertainty, relying on nuanced judgement and close monitoring to achieve successful outcomes while advancing antimicrobial stewardship goals. Full article

Superficial fungal infections (SFIs) remain a common dermatological issue in the pediatric population, with varying prevalence across regions and age groups. This study aimed to assess the epidemiology of SFIs among children and adolescents in northern Poland in the years 2019 to 2024. A retrospective analysis was conducted on 1237 patients under 18 years of age who underwent direct mycological examination and culture, due to suspicion of SFIs. Data were evaluated based on age, gender, infection site, fungal species identified, and place of residence. The prevalence of SFIs in the studied population was 21.4%. The most frequently isolated fungi were Microsporum canis and Trichophyton rubrum complex. Infection patterns varied by age: tinea capitis and tinea cutis glabrae predominated in younger children, while adolescents were more affected by tinea pedis and onychomycosis. A higher proportion of positive results was observed in rural patients, although more urban dwellers were tested. Species distribution also varied with gender and place of residence. No significant change in SFI prevalence or pathogen profile was observed over the study period. This study provides updated insights into the epidemiology of SFIs in Polish children, highlighting the influence of demographic and environmental factors. The findings underscore the importance of accurate diagnosis and suggest a need for further research into behavioral and socio-economic contributors to infection patterns. Full article

Background/Objectives: Hard-to-heal wounds are resistant to standard treatments and significantly impact patients’ quality of life and healthcare costs. Photobiomodulation with blue light has shown potential in wound healing, but evidence in wounds persisting for extended periods is limited. This pilot study evaluated the effectiveness of an accelerated photobiomodulation protocol in patients with hard-to-heal wounds in a nurse-led outpatient setting. Methods: Eleven patients with venous, lymphatic, diabetic, or mixed etiology wounds, unhealed for at least two years, were recruited from two clinics in the North District of the ASL Città di Torino. Participants received twice-weekly sessions of blue light photobiomodulation (EmoLED™, 400–430 nm lasting 60–120 s) for four weeks, in addition to standard care. The wound area was measured at baseline, week 4, and week 12 using the CutiMed Wound Navigator^® Version 2.2.8. The secondary endpoints included pain, wound exudate quantity and quality, and the surrounding skin condition. Results: All participants (average wound duration 5.9 years; mean area 13.1 cm², SD ± 14.4) completed the treatment; two were lost at follow-up due to unrelated clinical events. No adverse reactions were reported. At week 4, an area reduction was shown in 9 of 11 wounds (mean: 9.5 cm², SD ± 11.4), though not statistically significant (p = 0.240). At week 12, a significant reduction was observed (mean: 7.2 cm², SD ± 13; p = 0.04), with a mean percentage area decrease of 40.5%. Significant improvements were also noted in pain levels, exudate characteristics, and surrounding skin conditions over time. Conclusions: Accelerated blue light photobiomodulation appears to support long-term wound healing and symptom improvement in patients with hard-to-heal wounds. These findings warrant confirmation in larger, controlled studies. Full article

Background: Urinary tract infections represent a significant healthcare burden, particularly among vulnerable patients with chronic comorbidities. In this case report, we describe a UTI caused by Kluyvera ascorbata exhibiting an AmpC resistance pattern in an 85-year-old male with stage IV chronic kidney disease and a history of ESBL-positive infection. Methods: A comprehensive diagnostic workup was performed, including clinical evaluation, laboratory tests (urinalysis, complete blood count, renal function tests), and microbiological cultures with antibiogram analysis using the MicroScan WalkAway (Beckman Coulter, Brea, United States) and VITEK2 Compact systems (bioMérieux, Marcy L’Étoile or Craponne, France). Results: The initial urine culture revealed a Gram-negative bacillus and subsequent identification confirmed K. ascorbata, which demonstrated resistance to ampicillin and cefazolin while remaining susceptible to meropenem. The patient received intravenous meropenem therapy for 10 days, resulting in clinical improvement and a subsequent negative urine culture. Conclusions: This case reports a complicated urinary tract infection caused by K. ascorbata with an AmpC resistance pattern, highlighting the importance of considering this infrequently reported pathogen and its resistance profile in vulnerable patients. Its multidrug-resistant profile underscores the necessity for vigilant antimicrobial stewardship and further research to develop standardized treatment protocols for managing infections caused by this organism. Full article

Background/Objectives: Continuous epidural analgesia (CEA) is commonly used to manage postoperative pain in young infants. However, it can impair bladder function, leading to postoperative urinary retention (POUR) and necessitating Foley catheter placement, which carries a risk of urinary tract infection (UTI). Limited research exists on the frequency of POUR and UTIs and factors influencing optimal Foley catheter management in this population. Methods: A retrospective chart analysis conducted at UPMC Children’s Hospital of Pittsburgh included 103 infants who had surgery with CEA. The patients were assigned to Group A (Foley catheter removed before epidural discontinuation), Group B (Foley catheter removed after epidural discontinuation), and Group C (no Foley catheter placement). Data collected included demographics, details regarding urinary complications, epidural analgesia, pain management, and Foley catheter management. Results: The median/IQR age was 8 weeks (0.71–13.29), and the weight was 3.01 (2.55–3.52) kg. POURs occurred shortly after surgery in two (1.9%) infants with no initial Foley catheter placement (p = 0.101). Two (1.9%) infants in Group B developed a UTI (p = 0.327). A total of 10 (9.7%) (Groups A and B) had a preexisting urologic condition (p = 0.040). Common surgeries included exploratory laparotomy with bowel resection (34%) and stoma closure (28.2%). The epidural catheter was discontinued on postoperative day 3 (median) (p = 0.587). Total opioid administration, median/IQR (MME mg/kg), was significantly higher in Group B (1.7/0.6–3.8) and Group A (0.7/0.3–1.8) compared to Group C (0.6/0.3–1.1) (p = 0.029). Conclusions: No POUR occurred when the Foley catheter was removed before the epidural was discontinued. UTIs occurred when the Foley catheter remained after epidural discontinuation. Our findings highlight the importance of individualized assessment for urinary catheter placement and early removal in young infants receiving CEA. Full article

Objective: The aim of this study was to assess the performance and feasibility of ultra-high-frequency ultrasound (UHF-US) in clinical practice for measuring skin thickness in patients with systemic sclerosis (SSc) compared to age- and sex-matched controls. Materials and Methods: A total of 14 patients with SSc and 14 healthy controls (HCs) were enrolled in the study. All subjects underwent US evaluation of the epidermis, dermis and cutis by three experts in the 17 sites of the modified Rodnan skin score (mRSS). All the sonographers were blinded to the mRSS, which was assessed by an experienced rheumatologist who was not involved in, and blinded to, the US assessment. Results: In comparison to HCs, dermal thickness was significantly higher in patients at six sites: the right (p < 0.001) and left (p = 0.001) finger; right (p = 0.027) and left (p = 0.048) hand; left foot (p = 0.010) and face (p < 0.001). The epidermal layer did not differ significantly. At all mRSS sites except for the chest, there were moderate to strong positive correlations between US-assessed dermal thickness and local mRSS. The interobserver reliability for all sites of the mRSS, with the exception of the face, was good to excellent (with an intraclass correlation coefficient [ICC] ranging from 0.724 to 0.939). Conclusions: These data support the use of UHF-US as an objective and reliable tool for the assessment of skin involvement in patients with SSc. Considering its feasibility in clinical practice, we suggest that US assessment of skin in patients with SSc should be restricted to the dermal layer of the fingers and hands, since they are the sites that skin fibrosis typically starts from. Full article

The lacustrine mudstones and shales of the Triassic Yanchang Formation in the Ordos Basin serve as critical hydrocarbon source rocks. However, previous studies predominantly focus on individual lithologies, with comparative investigations into the sedimentary environments of dark mudstones and black shales remaining relatively limited. The study systematically compares sedimentary environment parameters (e.g., paleoclimate, paleosalinity, paleoredox conditions, paleowater depth, and paleoproductivity characteristics) between mudstones and shales, and how these distinct environmental factors governed the differential enrichment mechanisms of organic matter within the depositional aquatic system has been elucidated. Geochemical proxies (e.g., CIA, Sr/Cu, Rb/Sr, Sr/Ba, V/Ni, U/Th, V/Cr, Rb/Zr, P/Ti, Cu/Ti) reveal marked contrasts: In comparison with the Chang 7 and Chang 8 dark mudstones, the Chang 7 black shales exhibit (1) warmer–humid paleoclimatic regimes, (2) higher paleosalinity, (3) intensely anoxic conditions, (4) deeper paleowater depth, and (5) elevated paleoproductivity. These environmental divergences directly govern the significant total organic carbon content disparity between black shales and dark mudstones. Organic enrichment in the Chang 7 dark mudstones and black shales is primarily controlled by paleoproductivity and paleoredox conditions, with secondary influences from paleoclimate and paleowater depth. Based on the above studies, this research established a differential organic matter enrichment model. This research is of significant importance for guiding oil and gas exploration and development in the Ordos Basin. Full article

In this study, copper–titanium (Cu-Ti) composite coatings with 6 wt.% titanium content were fabricated via cold spray additive manufacturing (CSAM) using nitrogen as the propellant gas. The synergistic effects of propellant gas temperatures (600 °C, 700 °C, 800 °C) and post-heat treatment temperatures (350 °C, 380 °C, 400 °C) on the microstructure and tensile properties were systematically investigated. Tensile testing, microhardness characterization, and fractography analysis revealed that increasing the propellant gas temperature significantly enhanced the plastic deformation of copper particles, leading to simultaneous improvements in deposit density and interfacial bonding strength. The as-sprayed specimen prepared at 800 °C propellant gas temperature exhibited a tensile strength of 338 MPa, representing a 69% increase over the 600 °C specimen. Post-heat treatment effectively eliminated the work-hardening effects induced by cold spraying, with the 400 °C treated material achieving an elongation of 15% while maintaining tensile strength above 270 MPa. Microstructural analysis demonstrated that high propellant gas temperatures (800 °C) promoted the formation of dense lamellar stacking structures in copper particles, which, combined with a recrystallized fine-grained microstructure induced by 400 °C heat treatment, enabled synergistic optimization of strength and ductility. This work provides critical experimental insights for process optimization in CSAM-fabricated Cu-Ti composites. Full article

Background/Objectives: Accurate diagnosis of breast cancer-related lymphedema remains a clinical challenge. This study evaluated the diagnostic utility of ultrasound in detecting early lymphedema compared to conventional criteria, including the International Society of Lymphology staging and limb volume measurements. Methods: In this retrospective cross-sectional study, 68 female participants with unilateral breast cancer, who had completed cancer treatment at least six months before study enrolment, underwent both ultrasonographic assessment and standard limb circumference measurements. Ultrasound was performed bilaterally at five standardized anatomical sites. Sonographic parameters included assessment of cutaneous and subcutaneous thickness and echogenicity. Clinical staging and symptom profiles were assessed using ISL criteria and a structured questionnaire. Volume status was determined by relative volume change (RVC). Results: Among 68 participants, 36 were classified as ISL stage 0 and 32 as ISL stage II, 30 had RVC < 5%, while 38 had RVC ≥ 5%. Advanced stages were associated with older age. Multivariate analysis identified increased skin thickness at the medial upper arm cutis as significantly correlated with RVC ≥ 5% (OR 1.49, 95% CI: 1.01–2.21, p = 0.047). A similar trend was observed at the medial forearm (OR 1.3 (95% CI: (0.99, 1.71))). Conclusions: This study highlights ultrasound’s potential for early breast cancer-related lymphedema detection, especially in patients with minimal volume changes where conventional methods fall short. Increased cutaneous thickness in the medial upper arm emerged as a sensitive marker of early disease, while subcutaneous thickness and echogenicity may reflect in advanced stages. This distinction underscores the clinical value of cutaneous thickness as a potential clinical key marker for early lymphedema detection, emphasizing the need for standardized protocols and defined thresholds to guide timely interventions. Full article

This study focuses on cold deformation and age effects on the microhardness and electric conductivity of the Cu-4Ti (wt.%) alloys. The samples were solution treated at 900 °C, quenched in water, and aged at 450–600 °C for 1–120 min. Fifty percent cold rolling was performed before aging to analyze the impact on their microstructure and properties. Hardness and electric conductivity were examined by the Vickers microhardness and Förster testing. Hardness increased significantly while electric conductivity was maintained. The optimal hardness of 298 HV appeared following 50% cold rolling and aging for 120 min at 450 °C, and an electric conductivity of 9.4 MS/m was achieved after 120 min at 600 °C in cold-rolled materials. The deformed and solution-treated materials reached 244 HV after 120 min at 500 °C, and electric conductivity reached 7.7 MS/m. Polynomial models of regression were used to analyze the impact of aging parameters on properties. Process parameters were properly optimized by applying metaheuristic algorithms. These contributions ensure a better understanding of the relationship between the microstructure and properties in Cu-Ti alloys, as well as their application in aircraft and electronics. Full article

Background: Urinary tract infection (UTI) is predominantly caused by uropathogenic Escherichia coli (UPEC). Previous studies have reported that the fimbriae of UPEC are involved in virulence and antimicrobial resistance. We aimed to analyze the fimbrial gene profiles of UPEC and investigate the specificity of these expressions in symptomatic UTI, urinary device use, and levofloxacin (LVFX) resistance/extended-spectrum beta-lactamase (ESBL) production. Methods: A total of 120 UPEC strains were isolated by urine culture between 2019 and 2023 at our institution. They were subjected to an antimicrobial susceptibility test and polymerase chain reaction (PCR) to identify 14 fimbrial genes and their association with clinical outcomes or antimicrobial resistance. Results: The prevalence of the papG2 gene was significantly higher in the symptomatic UTI group by multivariate analyses (OR 5.850, 95% CI 1.390–24.70, p = 0.016). The prevalence of the c2395 gene tended to be lower in the symptomatic UTI group with urinary devices (all p < 0.05). In LVFX-resistant UPEC strains from both the asymptomatic bacteriuria (ABU) and the symptomatic UTI group, the expression of the papEF, papG3, c2395, and yadN genes tended to be lower (all p < 0.05). Conclusion: The fimbrial genes of UPEC are associated with virulence and LVFX resistance, suggesting that even UPEC with fewer motility factors may be more likely to ascend the urinary tract in the presence of the urinary devices. These findings may enhance not only the understanding of the virulence of UPEC but also the management of UTI. Full article

In the present study, composites Cu–Ti₃SiC₂ were obtained via extrusion-based additive manufacturing technology. The composite was characterized in terms of its structure, mechanical properties, and tribological properties. The use of a low-energy additive manufacturing technique allows for the avoidance of the decomposition of the MAX phase while obtaining bulk samples. The optimal composition of 50 vol.% of Ti₃SiC₂ and 50 vol.% of Cu was selected based on the flow rate of feedstock melt and the density of the samples. The resulting composite exhibited a dense copper matrix with Ti₃SiC₂ and TiC inclusions, achieving 97% density and 62% IACS electrical conductivity. Tribological tests under varying loads, speeds, and temperatures demonstrated that increasing the load and speed increased the coefficient of friction and the wear rate, while higher temperatures reduced friction due to surface oxidation. Full article

This study attempts to use fly ash as the brazing filler additive to increase the sustainable use of coal-fired power plant by-product materials. The experimental results show that adding 5 wt% fly ash into the Ag paste filler contributes to the interfacial reactions in heterogeneous reactive air brazing (RAB) of the ZrO₂ and Crofer alloy. The Ag-rich phase dominates the brazed zone. The interfacial reaction layers contain oxidation of the Cu-Ti coating layer, Crofer alloy, and the Si/Al-rich oxides from the fly ash particles. The 5% fly ash RAB joint maintained airtightness for 280 h under 2 psig helium at room temperature. When the test temperature was raised to 600 °C for 24 h, the pressure of the joint assembly still did not drop. When the fly ash addition was increased to 10 wt%, the joint assembly was no longer leak-free at room temperature. Many visible voids and cracks exist in the brazed zone and at the ZrO₂/braze and braze/Crofer interfaces. A high volume fraction of the fly ash particles results in many brittle Si/Al-rich oxides in the joint after RAB, and the fracture of these oxides significantly deteriorates the airtightness of the joint. This study shows the feasibility and potential of introducing 5 wt% fly ash particles to the Ag-rich paste filler during the RAB of ZrO₂ and Crofer for airtight applications. Full article