Search Results (6,046)

Introduction: Three-dimensional (3D) printing technology has rapidly evolved across various fields of medicine and dentistry, particularly in orthodontics. One key application in orthodontics is the fabrication of dental models. Numerous parameters throughout the dental cast fabrication workflow can influence the accuracy of 3D-printed models. This review aims to evaluate the influence of post-processing procedures, specifically post-curing and post-rinsing, on the dimensional accuracy of 3D-printed dental casts. Materials and Methods: An initial data search was conducted using specific keywords across four databases (PubMed, Scopus, Web of Science, and Google Scholar). A secondary search of references and citations was also performed. This systematic review ultimately identified five studies that met the inclusion criteria (in vitro studies and studies referred to post-processing only of 3D-printed models) for further evaluation and analysis, whereas reviews, opinion studies, and papers in languages other than English were excluded. Based on the QUIN tool, all studies were assessed for their risk of bias. Because of the studies’ heterogeneity, a qualitative descriptive synthesis was conducted. Results: All five included studies were in vitro investigations. One study examined the influence of the post-curing process on dimensional accuracy, while the remaining four explored the impact of post-rinsing procedures on both dimensional accuracy and other surface characteristics of 3D-printed dental casts. Conclusions: According to the findings of the included studies, both post-curing and post-rinsing procedures had statistically significant effects on the dimensional accuracy of 3D-printed dental models. Nevertheless, all five studies concluded that the observed deviations remained within clinically acceptable limits, rendering the casts suitable for diagnostic orthodontic purposes or device fabrication. However, further research is needed to reinforce current findings and to enhance our understanding of the optimal post-processing protocols of additively manufactured dental casts. Full article

With the arrival of sixth-generation (6G) wireless systems comes radical potential for the deployment of autonomous aerial vehicle (AAV) swarms in mission-critical applications, ranging from disaster rescue to intelligent transportation. However, 6G-supporting AAV environments present challenges such as dynamic three-dimensional topologies, highly restrictive energy constraints, and extremely low latency demands, which substantially degrade the efficiency of conventional routing protocols. To this end, this work presents a Q-learning-enhanced ad hoc on-demand distance vector (QL-AODV). This intelligent routing protocol uses reinforcement learning within the AODV protocol to support adaptive, data-driven route selection in highly dynamic aerial networks. QL-AODV offers four novelties, including a multipath route set collection methodology that retains up to ten candidate routes for each destination using an extended route reply (RREP) waiting mechanism, a more detailed RREP message format with cumulative node buffer usage, enabling informed decision-making, a normalized 3D state space model recording hop count, average buffer occupancy, and peak buffer saturation, optimized to adhere to aerial network dynamics, and a light-weighted distributed Q-learning approach at the source node that uses an ε-greedy policy to balance exploration and exploitation. Large-scale simulations conducted with NS-3.34 for various node densities and mobility conditions confirm the better performance of QL-AODV compared to conventional AODV. In high-mobility environments, QL-AODV offers up to 9.8% improvement in packet delivery ratio and up to 12.1% increase in throughput, while remaining persistently scalable for various network sizes. The results prove that QL-AODV is a reliable, scalable, and intelligent routing method for next-generation AAV networks that will operate in intensive environments that are expected for 6G. Full article

Spasticity of the distal lower limb substantially impairs stance, gait, and quality of life in patients with upper motor neuron lesions. Although ultrasound-guided botulinum toxin A (BoNT-A) injections are increasingly employed, structured, muscle-specific visual guidance for the distal lower limb remains limited. This study provides a comprehensive guide for ultrasound-guided BoNT-A injections across ten key distal lower limb muscles: gastrocnemius, soleus, tibialis posterior, flexor hallucis longus, flexor digitorum longus, tibialis anterior, extensor hallucis longus, flexor digitorum brevis, flexor hallucis brevis, and extensor digitorum longus. For each muscle, we present (1) Anatomical positioning relative to osseous landmarks; (2) Sonographic identification cues and dynamic features; (3) Zones of intramuscular neural arborization optimal for injection; (4) Practical injection protocols derived from literature and clinical experience. High-resolution ultrasound images and dynamic videos illustrate real-life muscle behavior and guide injection site selection. This guide facilitates precise targeting by correlating sonographic signs with optimal injection zones, addresses common spastic patterns—including equinus, varus, claw toe, and hallux deformities—and integrates fascial anatomy with motor-point mapping. This article completes the Elias University Hospital visual series, providing clinicians with a unified framework for effective spasticity management to improve gait, posture, and patient autonomy. Full article

Background: Massive intraoperative blood loss (IBL) is a serious complication in complex spine surgeries such as deformity correction, multilevel fusion, tumor resection, and revision procedures. While no strict definition exists, blood loss exceeding 1500 mL or 20% of estimated blood volume is generally considered clinically significant. Excessive bleeding increases the risk of hemodynamic instability, transfusion-related complications, postoperative infection, and prolonged hospitalization. Methods: This narrative review summarizes the current understanding of the incidence, risk factors, anatomical vulnerabilities, and evidence-based strategies for managing IBL in spine surgery through comprehensive literature analysis of recent studies and clinical guidelines. Results: Key risk factors include patient characteristics (anemia, obesity, advanced age, medication use), surgical variables (multilevel instrumentation, revision status, operative time), and pathological conditions (hypervascular tumors, severe deformity). Perioperative medication management is critical, requiring discontinuation of NSAIDs (5–7 days), antiplatelet agents (5–7 days), and NOACs (48–72 h) preoperatively to minimize bleeding risk. The thoracolumbar junction and hypervascular spinal lesions are especially prone to bleeding due to dense vascular anatomy. Evidence-based management strategies include comprehensive preoperative optimization, intraoperative hemostatic techniques, antifibrinolytic agents, topical hemostatic products, cell salvage technology, and structured transfusion protocols. Conclusions: Effective management of massive IBL requires a multimodal approach combining preoperative risk assessment and medication optimization, intraoperative hemostatic strategies including tranexamic acid administration, advanced monitoring techniques, and coordinated transfusion protocols. Particular attention to perioperative management of anticoagulant and antiplatelet medications is essential for bleeding risk mitigation. Understanding patient-specific risk factors, surgical complexity, and anatomical considerations enables surgeons to implement targeted prevention and management strategies, ultimately improving patient outcomes and reducing complications in high-risk spine surgery procedures. Full article

Background/Objectives: Urinary angiotensin-converting enzyme (uACE) activity has long been regarded as a promising biomarker for kidney and cardiovascular diseases; however, its clinical applicability has been limited by the presence of endogenous urinary inhibitors and technically demanding assay protocols. We aimed to establish a fast and reproducible method for measuring uACE activity to identify the inhibitory compounds responsible for previous assay failures and to define practical preanalytical conditions suitable for routine laboratory implementation. Methods: A fluorescence-based kinetic assay was optimized for urine samples. Endogenous inhibitors were isolated by membrane filtration and chemically characterized, while the effect of sample dilution was evaluated as a simplified alternative for eliminating inhibitory interference. We assessed the stability of ACE activity under various storage conditions to support reliable measurement. Results: Urea (IC₅₀ = 1.18 M), uric acid (IC₅₀ = 3.61 × 10⁻³ M), and urobilinogen (IC₅₀ = 2.98 × 10⁻⁴ M) were identified as the principal reversible inhibitors, jointly accounting for up to 90% suppression of uACE activity. Their inhibitory effect was effectively eliminated by a 128-fold dilution. ACE activity remained stable for 24 h at 25 °C but was completely lost after freezing. A strong positive correlation between uACE activity and creatinine concentration (r = 0.76, p < 0.0001) justified normalization. ACE activity-to-creatinine ratio turned out to be significantly lower in ACE inhibitor-treated patients than in untreated controls (6.49 vs. 36.69 U/mol, p < 0.0001). Conclusions: Our findings demonstrate that accurate measurement of uACE activity is feasible using a rapid dilution-based protocol. The normalized ACE activity can serve as a practical biomarker for detecting pharmacological ACE inhibition and monitoring therapy adherence in cardiovascular care and may also provide insight into renal pathophysiology such as tubular injury or local RAAS-related processes. Full article

Reproductive outcomes following synchronized ovulation protocol in beef cattle are influenced by multiple factors, making protocol selection based on farm-specific conditions essential. This retrospective study analyzed the relationship between pregnancy rates and associated factors under the CIDR (GnRH with CIDR insertion–PGF_2α with CIDR removal–GnRH), GPG (GnRH–PGF_2α–GnRH), and GPPG (GnRH–PGF_2α–PGF_2α–GnRH) protocols in Hanwoo cattle. The highest pregnancy rate was observed with the CIDR protocol (58.3%), whereas the GPG protocol yielded the lowest (47.5%). The CIDR protocol demonstrated superior suitability compared with the GPG protocol in first service (61.0% vs. 47.0%) and young breeding cattle (parity: 0–2; 61.6–70.0% vs. 47.5–48.6%). The dominant follicle size strongly associated with pregnancy success was 13–16 mm, and the CIDR protocol induced these follicles more frequently than the GPG protocol (50.2% vs. 35.5%). Although interpretive bias may exist from data collected from pregnant animals only, CIDR protocol significantly increased luteinizing hormone levels compared to GPG. The GPPG protocol produced outcomes that were improved relative to the GPG protocol and statistically comparable to the CIDR protocol. These findings addressed the study’s objective, identifying optimal synchronized ovulation strategies and underscoring reproductive management importance for Korean Hanwoo operations. Full article

Tracheal intubation is a frequent and high-risk procedure in the intensive care unit (ICU). Unlike elective intubation in the operating room, ICU intubation is often performed under emergent conditions in physiologically unstable patients, leading to increased technical difficulty and higher complication rates. Among these, hypoxemia is particularly frequent and represents a major determinant of morbidity and mortality. Optimizing preoxygenation is therefore a cornerstone of safe airway management in critically ill patients. The aim of this review is to explore the advantages and limitations of each preoxygenation strategy and to provide clinicians with clear, practical guidance to optimize airway management in the ICU. Preoxygenation aims to increase oxygen reserves in order to prolong the duration of safe apnea. Conventional methods include high-flow oxygen delivery through a tightly fitted face mask, though efficacy depends on minimizing leaks. More advanced strategies include non-invasive ventilation (NIV), which improves both alveolar oxygen fraction and lung volume, and high-flow nasal cannula (HFNC), which additionally allows apneic oxygenation during intubation. Randomized controlled trials, including the recent PREOXY study, demonstrate the superiority of NIV over facemask preoxygenation in reducing peri-intubation desaturation, particularly in hypoxemic patients. HFNC is valuable when NIV is contraindicated, while combined approaches (NIV plus HFNC) may further enhance efficacy. Beyond technique, structured protocols and team organization are crucial to reduce complications. In conclusion, preoxygenation is an essential, patient-specific intervention that mitigates the risks of ICU intubation. Familiarity with available methods enables clinicians to tailor strategies, optimize oxygenation, and improve patient safety during this high-risk procedure. Full article

Background: Trastuzumab deruxtecan (T-DXd), a HER2-directed antibody-drug conjugate, has significantly advanced the management of HER2-expressing malignancies. However, interstitial lung disease (ILD) remains a clinically significant adverse effect. Despite increasing clinical use of T-DXd, real-world data on ILD incidence, characteristics, and outcomes—particularly in Middle Eastern populations remain limited. Methods: This retrospective study analyzed medical records of patients who received trastuzumab deruxtecan (T-DXd) at a tertiary care hospital. Data collected included demographics, tumor characteristics, prior treatments, and interstitial lung disease (ILD)-related outcomes. ILD events were identified and graded according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Descriptive statistics were used to summarize baseline characteristics and ILD features. Univariate logistic regression was performed to assess potential risk factors associated with ILD development. Kaplan–Meier survival analysis was used to evaluate time-to-event outcomes, including time to ILD onset and resolution. Results: Among 65 patients with advanced stage IV cancer (90.8% with breast cancer), 16 (24.6%) developed ILD following T-DXd therapy. The median time to ILD onset was 125.5 days. The most common presenting symptoms were dyspnea and cough (50%). A history of ground-glass opacities was associated with increased odds of ILD (OR 2.7; p = 0.236), though not statistically significant. Patients with Grade ≥ 3 ILD had significantly lower oxygen saturation levels compared to those with milder grades (88.3% vs. 97.7%, p = 0.049). Median time to clinical resolution was 297 days (95% CI: 77.5–516). No significant associations were observed with smoking history, pulmonary metastases, or prior thoracic radiation. Conclusions: In this real-world cohort, ILD occurred in nearly one-quarter of patients receiving T-DXd, predominantly within the first six months of treatment. The findings highlight the importance of early respiratory symptom monitoring and pulse oximetry—particularly in patients with pre-existing pulmonary abnormalities. These results underscore the need for vigilant ILD surveillance strategies and further prospective studies to validate predictive risk factors and optimize management protocols. Full article

Background: Ovarian cancer remains a major contributor to cancer-related morbidity and mortality worldwide. Primary cytoreductive surgery is the cornerstone of treatment, and accurate preoperative assessment of tumor resectability is critical to guiding optimal therapeutic strategies in patients with advanced tubo-ovarian cancer. Methods: A narrative review about the role of ultrasound for assessing tumor spread and prediction of tumor resectability was performed. Results: The ISAAC study represents the largest prospective multicenter trial to date comparing the diagnostic performance of ultrasound (US), computed tomography (CT), and whole-body diffusion-weighted magnetic resonance imaging (WB-DWI/MRI) in predicting non-resectability, using surgical and histopathological findings as the reference standard. Key strengths of the study include the use of standardized imaging and intraoperative reporting protocols across ESGO-accredited high-volume oncologic centers. All three imaging modalities were performed within four weeks prior to surgery by independent, blinded expert operators. US demonstrated diagnostic accuracy comparable to that of CT and WB-DWI/MRI. The study also defined modality-specific thresholds for the Peritoneal Cancer Index (PCI) and Predictive Index Value (PIV), offering quantitative tools to support surgical decision-making. A noteworthy secondary finding was patient preference: in a cohort of 144 participants who underwent all three imaging modalities, nearly half preferred US, while WB-DWI/MRI was the least favored due to discomfort and examination duration. Conclusions: The ISAAC study represents a significant advancement in imaging-based prediction of surgical non-resectability in tubo-ovarian cancer. Its findings suggest that, in expert hands, ultrasound can match or even surpass cross-sectional imaging for preoperative staging, supporting its integration into routine clinical practice, particularly in resource-constrained settings. Full article

Background: There is no consensus on the optimal type of antibiotic-loaded bone cement (ALBC) spacer for ue in the first stage of revision total hip arthroplasty (THA) as a method for treating/managing periprosthetic joint infection (PJI) following THA. The purpose of this study was to determine the influence of ALBC spacer type on a collection of outcome metrics for revision THA (rHA). We hypothesized that infectious complications would be comparable across spacer types, while mechanical complications would be more common with the use of hemiarthroplasty ALBC spacer designs in rHA. Methods: This was a multicenter retrospective review of 144 patients who underwent a planned two-stage revision for THA for PJI between 2011 and 2022. Patients were stratified into three groups: pre-molded articulating hemiarthroplasty ALBC (PHA) spacers, custom articulating hemiarthroplasty ALBC (CHA) spacers, and custom ALBC THA (CTHA) spacers. The types and incidence of complications that arose during the time that the spacer was in situ were obtained. In total, 29 (20.1%) PHA, 11 (7.6%) CHA, and 104 (72.2%) CTHA patients were included. Results: CHA patients were significantly younger (mean age: 54.1 years) than PHA (mean age: 63.9) and CTHA (mean age: 63.9) patients (p = 0.011). The proportion of patients discharged home was significantly higher in the CHA group (81.8%) compared to that in both the CTHA group (64.4%) and the PHA group (34.5%) (p = 0.02). The re-revision rate for hip PJI was higher for CHA (18.2%), followed by PHA (13.8%) and CTHA (5.8%), while hemiarthroplasty spacers had the highest dislocation rate (13.8% in PHA and 18.2% in CHA vs. 3.8% in CTHA, p = 0.055). The vast majority of the outcome metrics did not differ among the three spacer groups, with examples being the incidence of dislocations, the incidence of all types of unplanned procedures for treating/managing re-infection, the time to the second stage in the rHA, and the proportion of spacers that were not removed until the second stage in the rHA. Conclusions: For the vast majority of the outcome metrics determined, the difference among the three study groups was not significant. Thus, the present results suggest that antibiotic-loaded cement spacer type does not influence outcomes when a spacer is used in the first stage of a two-stage protocol for the revision of a THA. Full article

Reverse logistics (RL) plays a crucial role in promoting circularity and sustainability in supply chains, particularly in the face of increasing waste generation and growing environmental demands. In recent years, machine learning (ML) has emerged as a strategic tool to enhance processes, decision-making, and outcomes in RL. This article presents a systematic review of ML applications in reverse logistics, highlighting trends, challenges, and research opportunities. The analysis covers 52 articles retrieved from the Scopus and Web of Science databases, following the PRISMA protocol. The results show that the most frequently employed techniques are supervised models, followed by unsupervised methods and, to a lesser extent, reinforcement learning. The main ML applications in RL focus on return and waste generation forecasting, process optimization, classification, pricing, reliability assessments, and consumer behavior analysis. The studies examined predominantly use traditional evaluation metrics, such as MAPE and F1-score, while few consider multidimensional indicators encompassing long-term social or environmental impacts. Key challenges identified include data scarcity and quality, inherent uncertainties in reverse supply chains, and the high computational cost of models. This article also points to research gaps concerning metadata standardization, the absence of public benchmarks, model explainability, and the integration of ML with simulations and digital twins, indicating pathways toward more robust, transparent, and sustainable RL. Full article

Background: Jehovah’s Witness (JW) patients pose a unique challenge to cardiac surgery due to their refusal of blood products, typically precluding them from becoming candidates for orthotopic heart transplantation (OHT). While “bloodless” cardiac surgery has been described in ideal candidates, anemic or other hematologic-risk patients are typically excluded. We describe a successful “bloodless” OHT in a non-ideal JW patient with anemia and cardiogenic shock, with ventricular assist through a transvalvular pump to bridge and optimize hematologic status prior to operation. Case Presentation: A 58-year-old male JW with end-stage non-ischemic cardiomyopathy (NICM) and an ejection fraction of 15–20% experienced repeated decompensation despite maximal medical therapy and implantable cardioverter–defibrillator (ICD) implantation. Two years since first presentation, he developed cardiogenic shock and required intra-aortic balloon pump (IABP) support. Iatrogenic anemia occurred during IABP placement and required femoral re-access and upgrade to Impella^® 5.5 support. During mechanical support, he was given a total blood conservation plan that included intravenous iron, darbepoetin alfa, restricted phlebotomy, and nutritional supplementation. Hemoglobin was increased from 7.8 to 10.4 g/dL. Successful “bloodless” OHT was subsequently performed on him with an estimated blood loss of 200 mL, 72 min cardiopulmonary bypass duration, and no transfusion. He was discharged on the nineth day after surgery with a hemoglobin level of 9.9 g/dL and returned to full activity. Discussion: Despite inherent risks, bloodless OHT may safely be performed in selected JW patients by means of multidisciplinary coordination, modern mechanical circulatory support, and hematopoietic stimulation. Our case highlights the utility of Impella^® 5.5 as a bridge-to-transplant strategy for anemic, hemodynamically unstable JW patients. This is in harmony with evidence from previous studies indicating similar results for JW and non-JW transplant recipients under strict optimization protocols. It also supports the expansion of candidacy criteria if appropriate planning and modern blood conservation strategies are employed. Conclusions: Transfusion religious objection ought not preclude JW patients from lifesaving OHT. With judicious perioperative planning, third-generation transvalvular pumps, and hematologic optimization, “bloodless” heart transplantation is possible—potentially even in non-ideal candidates. Full article

This study tackles the complex challenge of dynamic multi-objective vehicle routing optimization in large-scale equipment manufacturing, where routing operations significantly impact both economic performance and environmental sustainability. We develop an innovative Dynamic Multi-Objective Vehicle Routing Problem (DMOVRP) model that uniquely integrates three competing objectives: environmental impact reduction, delivery timeliness, and operational robustness. The proposed algorithm combines a dynamic event handler with the NSACOWDRL algorithm—an adaptive multi-objective optimization algorithm with dynamic event handling capability. The proposed system features adaptive mechanisms for handling real-time disruptions through specialized event classification and dynamic rescheduling protocols. Extensive computational experiments demonstrate the algorithm’s superior performance with statistically significant improvements using the Wilcoxon signed-rank test (p < 0.05, n = 30 runs per instance), achieving average relative gains of 15.2% in HV, 12.8% in IGD, and 8.9% in GD metrics compared to established methods. This research makes theoretical contributions through its feasibility quantification metric and practical advancements in routing schedule systems. By successfully reconciling traditionally conflicting objectives through dynamic JIT adjustments and robustness-aware optimization, this work provides manufacturers with a versatile decision-support tool that adapts to unpredictable workshop conditions while maintaining sustainable operations. Full article

In the past decades, significant advancements in the biological and genetic characterization of acute leukemias and optimization of risk-adapted multi-agent treatment protocols have dramatically improved cure rates and quality of life for children with acute lymphoblastic leukemia (ALL). Despite these optimal results, patients with relapsed or chemotherapy-refractory (R/R) disease or with high-risk genetic features still face unsatisfactory outcomes. Further intensification of conventional chemotherapy has reached its limits in achieving the desired efficacy without undue side effects, necessitating innovative approaches to improve cure rates while continuing to minimize the toxicities associated with chemotherapy and hematopoietic stem cell transplantation. In the era of precision medicine, two key therapeutic strategies have emerged in hemato-oncology: molecularly targeted therapies and immunotherapies. Antibody-based and cellular immunotherapies have undoubtedly reshaped the landscape of childhood ALL treatment and have significant potential to play leading roles in current and future frontline regimens; these important therapies are well delineated in recent reviews. Molecularly targeted small molecule inhibitor therapies remain a cornerstone of precision medicine, supported by recent advancements in next-generation sequencing, which have enabled the application of transcriptomic and genomic profiling data to risk stratification and therapy optimization. Clinical trials for children with ALL have been instrumental in refining therapies and improving outcomes, a paradigm that remains critical as treatment strategies become increasingly complex. This comprehensive review focuses upon molecularly targeted therapy approaches for childhood ALL and aims to summarize findings from completed clinical trials to highlight the current landscape of ongoing and upcoming trials and to provide insights into future directions for the precision-driven optimization of pediatric B-ALL and T-ALL treatment. Full article

Avian influenza viruses (AIV) cause severe economic losses in poultry production and pose zoonotic threats, necessitating rapid, field-deployable diagnostics. While real-time PCR is the gold standard, its use is limited in resource-constrained settings. This study aimed to develop and validate optimized loop-mediated isothermal amplification (LAMP) protocols for AIV detection directly at sample collection sites. We optimized Real-Time RT-LAMP and colorimetric LAMP assays targeting the conserved M gene, using primers described in the literature. Analytical sensitivity was assessed with a plasmid standard (10⁶–10⁰ copies/μL); specificity was evaluated against 27 AIV strains (H1–H12) and heterologous avian viruses (Newcastle disease, infectious bronchitis, Gumboro, and laryngotracheitis viruses). Reverse transcription was integrated into the LAMP reaction. Real-Time LAMP with SYBR Green achieved 100% analytical sensitivity (95% CI: 80–100; detection limit: Ct 38), while colorimetric LAMP (cresol red, malachite green, calcein) detected 10² plasmid copies (Ct 32) with 91.67% sensitivity (95% CI: 76.1–100). No cross-reactivity occurred. These optimized LAMP protocols offer sensitivity and specificity comparable to PCR, require minimal equipment, and enable rapid AIV screening, significantly enhancing early detection and epidemiological surveillance in field conditions. Full article