Search Results (550)

Background/Objectives: In 2019, the European Society of Gynaecological Oncology (ESGO) published a set of quality indicators (QIs) for the surgical management of cervical cancer with the aim of improving clinical practice. The objective of this study is to evaluate the influence of ESGO QIs and clinicopathological factors on progression-free survival (PFS) in patients with early-stage cervical cancer in a retrospective cohort. Methods: A retrospective study was conducted in patients with early-stage cervical cancer who underwent radical surgery with pelvic lymph node assessment at La Paz University Hospital between 2005 and 2022. The cohort was divided into two groups according to the timing of surgery (before vs. after 2010), when MRI was implemented as a standardized diagnostic tool and the multidisciplinary tumor board was established. Univariate and multivariate Cox regression analyses were performed, including demographic and histopathological variables, as well as adherence to ESGO QIs, focusing on those related to the overall management. Hazard ratios and 95% confidence intervals were estimated. Kaplan–Meier survival curves were generated and compared between groups. Results: The implementation of systematic MRI and a multidisciplinary tumor board at our center was associated with a significant reduction in positive surgical margins (p = 0.003) and parametrial invasion (p < 0.001), as well as improved diagnostic accuracy, lowering the rate of upstaging from 31.6% before 2010 to 4.4% thereafter (p < 0.001). PFS in the post-2010 cohort was significantly improved (log-rank p = 0.0408), although no differences in overall survival (OS) were observed (log-rank p = 0.2602). Additionally, cervical conization prior to radical hysterectomy was associated with a markedly reduced risk of recurrence (HR 0.12, p < 0.001), representing the most significant prognostic factor for PFS in our cohort. Conclusions: The correct application of ESGO QIs, along with appropriate staging and pathological assessment, is essential to improve prognosis in cervical cancer. Systematic implementation of these standards is recommended to optimize clinical care. Full article

Background and Objectives: Enhancing recovery after cardiac surgery involves minimally invasive procedures, early extubation/mobilization, and swift discharge. While mechanical ventilation is often essential post-operation, prolonged invasive ventilation (IMV) increases mortality risk. Duration is influenced by patient factors (age and comorbidities), surgical complexity, and complications. Prognostic scores like EuroSCORE II, sequential organ failure assessment (SOFA), the Charlson Comorbidity Index (CCI), and the vasoactive–inotropic score (VIS) help to predict ventilation needs. The aim of this study is to analyze the effect of pre-/post-operation factors and procedure type as predictors of ventilation time. Materials and Methods: This is a retrospective cohort observational study analyzing factors affecting the duration of postoperative mechanical ventilation in elective cardiac surgical patients treated between 1 January and 31 December 2024 in a tertiary center in continental Croatia. Patients were stratified into two groups according to the duration of IMV: normal (first three quartiles) and prolonged (upper quartile). In total, 493 elective cardiac surgical patients operated on under general endotracheal anesthesia with sternotomy or mini-sternotomy were admitted postoperatively to the cardiovascular ICU and mechanically ventilated during the observed period, and 463 patients were included in the final analysis after the exclusion criteria had been applied. Results: The mean age was 64.7 ± 9.8 years, and 28.7% of the cohort were females while 71.3% were males. The median Charlton Comorbidity Index was 4 (IQR 3–5), the VIS was 2 (IQR 0–3), the SOFA score at ICU admission was 5 (IQR 3–6), and the adjusted SOFA score was 3 (IQR 2–4). In the multivariate logistic regression model, a significant effect of female sex (OR 1.98), age (OR 1.05), VIS (OR 1.05), and history of previous cardiac surgery (OR 6.67) on the duration of mechanical ventilation was observed. In the time-to-extubation multivariate analysis, there was a significant effect of re-do surgery (HR 3.70), corrected SOFA score (HR 1.14), and VIS (HR 1.05) on the duration of mechanical ventilation. There was no significant effect of the type of surgery (CABG, aorta, aortic valve, mitral/tricuspid valve, or other) or the amount of chest tube drainage on the duration of mechanical ventilation. Conclusions: A history of previous cardiac surgery and the vasoactive–inotropic score during the first 24 postoperative hours in the ICU are the strongest predictors of the duration of mechanical ventilation after elective cardiac surgery, with a statistically significant effect present in both the logistic regression model and hazard ratio analysis. Further analyses with more variables are warranted in the future to refine the prognostic model. Full article

Background: Timely diagnostic colonoscopy (DC) after a positive fecal immunochemical test (FIT+) is essential for effective colorectal cancer (CRC) screening. In Flanders, 16% of FIT+ participants in 2022 had no DC in the 24 months following the FIT+ result. This study evaluated the impact of a failsafe reminder letter—sent 24 months after a FIT+ result without registered correct follow-up—on DC completion and identified factors associated with correct follow-up. Methods: We included all individuals in the Flemish CRC screening program who had a FIT+ result between 2017 and 2019 and later received a failsafe letter due to lacking correct follow-up within 24 months. Correct follow-up was defined as a complete colonoscopy, virtual colonoscopy, or cancer diagnosis. We calculated the proportion of individuals completing correct follow-up within 24 months of the letter. Multivariable logistic regression examined associations between odds of correct follow-up and individual and area-level characteristics. Results: Of the 7175 individuals who received a failsafe letter, 16.1% completed correct follow-up within 24 months. Individuals aged 70–74 had significantly lower odds of correct follow-up than those aged 60–64 (odd ratio (OR) = 0.59; 95% confidence interval (CI): 0.48–0.72). Living in areas with a higher proportion of young adults in higher education was associated with higher odds of correct follow-up (OR = 1.041; 95% CI: 1.002–1.080). Conclusions: The failsafe letter modestly improved follow-up among a hard-to-reach group. Older age and lower area-level educational attainment were linked to reduced odds of correct follow-up. Targeted efforts are needed to improve DC completion in these subgroups. Full article

Background: Despite anatomically successful surgical correction, postoperative hypertension remains a significant concern in patients with coarctation of the aorta, even when repair is performed during infancy. Inflammation and neurohormonal activation have been proposed as contributing mechanisms. Objective: To investigate the association between preoperative inflammatory biomarkers—specifically the interleukin-6 (IL-6) to tumor necrosis factor-alpha (TNF-α) ratio—and the development of hypertension in patients with successful isolated coarctation of the aorta repair under one year of age. Methods: This observational study included 42 infants with isolated CoA. Clinical, echocardiographic, and biochemical parameters were analyzed. Preoperative plasma levels of IL-6, TNF-α, von Willebrand factor (vWF), and renin were measured. Patients were classified based on hypertensive status at 2-year follow-up. Univariate and multivariate logistic regression analyses were performed to identify predictors of postoperative hypertension. Results: Hypertension was diagnosed in 16 out of 41 patients (39%) at follow-up. A preoperative IL-6/TNF-α ratio > 2 was an independent predictor in multivariate analysis for postoperative HT (OR = 6.1, 95% CI = 6.23–9.31, p = 0.02). Conclusions: In this small single-center cohort, an elevated IL-6/TNF-α ratio was associated with postoperative hypertension after coarctation repair. These exploratory findings should be considered hypothesis-generating and warrant confirmation in larger, multicenter studies. Full article

Background and Objectives: The autonomic nervous system (ANS) orchestrates adaptation to stress; however, its reactivity is influenced by demographic, anthropometric, and psychosocial factors. While arterial stiffness and central adiposity are established cardiovascular risk markers, less is known about how maladaptive coping strategies, cumulative life stress, and quality of life influence short-term autonomic regulation. This study examined the age- and sex-specific associations between anthropometry, maladaptive coping, life stress, quality of life, and ANS adaptation in adults. Materials and Methods: In this cross-sectional study, 122 healthy adults aged 21–78 years underwent a standardized lay–stand–lay (LSL) protocol with pulse wave analysis. Hemodynamic outcomes included pulse wave velocity (PWVao), augmentation indices (AIxA and AIxB), and aortic blood pressures (SBPao and PPao). Anthropometric measures comprised BMI, waist and hip circumference, waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR). Psychosocial assessments included the Young Hypercompensation Inventory (maladaptive coping), Holmes–Rahe Life Events Inventory (life stress), and EQ-5D-3L (quality of life). Associations were analyzed using mixed-effects models adjusted for covariates, with false discovery rate correction. Results: Age was the strongest determinant of autonomic reactivity: older adults showed greater recovery of augmentation indices and central pressures after orthostatic challenge. Sex differences were evident, with women displaying consistently higher augmentation indices and men showing greater PWV responses. Central adiposity (WHR, WHtR, and waist circumference) predicted blunted augmentation index reactivity, while hip circumference was protective. BMI-defined obesity showed weaker associations. Maladaptive coping, life stress burden, and quality of life were not significantly associated with ANS indices after correction for multiple comparisons. Conclusions: ANS adaptation to postural stress is largely determined by age, sex, and visceral adiposity, whereas psychosocial measures showed limited influence in this healthy adult sample. These findings highlight the demographic and anthropometric determinants of cardiovascular adaptability, suggesting that psychosocial influences may primarily act through long-term behavioral and neuroendocrine pathways. Full article

This study examines the influence of friction at the specimen–bar interface on the macroscopic response of materials during dynamic compression tests using the split Hopkinson Pressure Bar (SHPB) under high-deformation-rate conditions. A mesoscale model is employed to simulate and compare results with experimental data, and a finite element model of cylindrical specimens with varying slenderness ratios is developed in Abaqus/Explicit. Numerical analyzes show that both specimen geometry and boundary conditions, particularly friction, have a decisive impact on the accuracy and reliability of SHPB measurements. A friction correction method based on barreling factor and plastic deformation demonstrates closer agreement with experimental observations than conventional approaches, revealing that the widely used Avitzur model may overestimate friction by 34–39%. The results highlight the importance of accurate friction correction and the selection of optimal specimen dimensions to minimize testing errors. These findings improve the precision of dynamic material characterization and support the development of more reliable constitutive models to predict material behavior across a broad range of strain rates. Full article

Background: This narrative review aims to assess multiple strategies available to evaluate and manage corneal astigmatism in the context of cataract surgery, with a focus on the surgical techniques, intraocular lens (IOL) selection, and the integration of advanced new technologies. Methods: A narrative review based on a literature search in PubMed/MEDLINE and the Cochrane Library, covering publications from 1990 to 2025, was conducted. Eligible studies included randomized controlled trials, observational studies, prospective and retrospective analyses, and systematic reviews. Key search terms included “astigmatism”, “cataract surgery”, “keratometry”, and “refraction.” Studies were screened and selected by two independent reviewers. Results: Corneal astigmatism is the most common form of astigmatism. While the anterior corneal astigmatism plays a more important role, the posterior corneal astigmatism and the posterior-to-anterior corneal ratio (Gullstrand ratio) can impact the postoperative refractive results in a very important way. While planning the cataract surgery, surgically induced astigmatism (SIA), especially on the posterior cornea, must be taken into consideration. Various approaches, such as opposite clear corneal incisions (OCCIs), toric intraocular lens (IOLs), intraoperative aberrometry, and the integration of artificial intelligence and robotic-assisted surgery, are increasing the precision of astigmatism correction and surgical outcomes. Conclusions: Individualized surgical planning and precise measurement are key factors in reducing residual astigmatism and obtaining the best visual outcomes in patients with corneal astigmatism undergoing cataract surgery. By taking into consideration the posterior corneal data, refining IOL calculations, and embracing the rapidly developing technological innovations, patient satisfaction and visual quality can be substantially improved, and the predictability of the surgical outcome can be enhanced. Full article

The machine unit design for driving a specific work machine is a complex process, in which factors such as power machine type, power transmission drives, total efficiency coefficient, and total gear ratio determine an accurate model for calculating the drive. The correct choice of the above-described factors will lead to the construction of a machine unit with high performance while meeting the requirements of the client. Full article

Background/Objectives: We evaluated the clinical features and natural course of treatment-naïve non-exudative macular neovascularization (NE MNV) associated with age-related macular degeneration in Korean patients. Methods: This retrospective longitudinal study of 21 eyes of 21 patients with NE MNV involved a chart review of best corrected visual acuity (BCVA), optical coherence tomography (OCT), and OCT angiography parameters. Results: This study included 13 men (13/21, 61.9%) and 8 women (8/21, 38.1%), with a mean age of 71.5 ± 9.1 years. The average follow-up period was 15.1 ± 11.8 (range 6.0–49.6) months, and 14 eyes (66.7%) demonstrated exudative changes on OCT scans. The baseline BCVA was 0.15 ± 0.18 logMAR. The initial central macular thickness (CMT), subfoveal choroidal thickness, and the outer retinal layer thickness were 265.3 ± 37.1, 245.2 ± 95.2, and 86.6 ± 5.3 μm, respectively. Cox proportional hazards analysis revealed that older age (hazard ratio [HR]: 1.096, 95% confidence interval [CI]: 1.002–1.200; p = 0.045), larger baseline CMT (HR: 1.025, 95% CI: 1.002–1.049; p = 0.035), and larger baseline MNV (HR: 1.618, 95% CI: 1.035–2.529; p = 0.035) were significant risk factors for exudative changes. Conclusions: We observed the clinical features and natural course of NE MNV in Korean patients and identified that significant risk factors for exudative changes in NE MNV included old age, initially thick CMT, and larger MNV size at baseline. For eyes with NE MNV that have risk factors of exudative conversion, more frequent observation is recommended to ensure the appropriate management. Full article

Background/Objective: The overnight 1-mg dexamethasone suppression test (DST) represents the conventional/standard tool for endogenous hypercortisolemia screening, typically in relationship with adrenal and pituitary masses. Nevertheless, an associated spectrum of challenges and pitfalls is found in daily practice. This analysis aimed to evaluate: (I.) the diagnosis relevance of 1-mg DST in patients with adrenal incidentalomas (AIs) with/without mild autonomous cortisol secretion (MACS) exploring different cutoffs of the second-day plasma cortisol after dexamethasone administration (cs-DST) with respect to cardio-metabolic outcomes; (II.) the potential utility of adding other biomarkers to DST [plasma morning adrenocorticotropic hormone (ACTH), 24-h urinary free cortisol (UFC), late-night salivary cortisol (LNSC), dehydroepiandrosterone sulfate (DHEAS)]; and (III.) DST variability in time. Methods: This narrative analysis was based on searching full-text, English articles in PubMed (between January 2023 and April 2025) via using different term combinations: “dexamethasone suppression test” (n = 239), “diagnosis test for autonomous cortisol secretion” (n = 22), “diagnosis test for mild autonomous cortisol secretion” (n = 13) and “diagnosis test for Cushing Syndrome” (n = 61). We manually checked the title and abstract and finally included only the studies that provided hormonal testing results in adults with non-functional adenomas (NFAs) ± MACS. We excluded: reviews, meta-analyses, editorials, conference abstracts, case reports, and case series; non-human research; studies that did not provide clear criteria for distinguishing between Cushing syndrome and MACS; primary aldosteronism. Results: The sample-focused analysis (n = 13 studies) involved various designs: cross-sectional (n = 4), prospective (n = 1), retrospective (n = 7), and cohort (n = 1); a total of 4203 patients (female-to-male ratio = 1.45), mean age of 59.92 years. I. Cs-DST cutoffs varied among the studies (n = 6), specifically, 0.87, 0.9, 1.2, and 1.4 µg/dL in relationship with the cardio-metabolic outcomes. After adjusting for age (n = 1), only the prevalence of cardiovascular disease remained significantly higher in >0.9 µg/dL vs. ≤0.9 group (OR = 2.23). Multivariate analysis (n = 1) found cs-DST between 1.2 and 1.79 µg/dL was independently associated with hypertension (OR = 1.55, 95%CI: 1.08–2.23, p = 0.018), diabetes (OR = 1.60, 95%CI: 1.01–2.57, p = 0.045), and their combination (OR = 1.96, 95%CI:1.12–3.41, p = 0.018) after adjusting for age, gender, obesity, and dyslipidemia. A higher cs-DST was associated with a lower estimated glomerular filtration rate (eGFR), independently of traditional cardiovascular risk factors. Post-adrenalectomy eGFR improvement was more pronounced in younger individuals, those with lower eGFR before surgery, and with a longer post-operative follow-up. Cs-DST (n = 1) was strongly associated with AIs size and weakly associated with age, body mass index and eGFR. Cortisol level increased by 9% (95% CI: 6–11%) for each 10 mL/min/1.73 m² decrease in eGFR. A lower cs-DST was associated with a faster post-adrenalectomy function recovery; the co-diagnosis of diabetes reduced the likelihood of this recovery (OR = 24.55, p = 0.036). II. Additional biomarkers assays (n = 5) showed effectiveness only for lower DHEAS to pinpoint MACS amid AIs (n = 2, cutoffs of <49.31 µg/dL, respectively, <75 µg/dL), and lower ACTH (n = 1, <12.6 pmol/L). III. Longitudinal analysis of DST’s results (n = 3): 22% of NFAS switch to MACS after a median of 35.7 months (n = 1), respectively, 29% (n = 1) after 48.6 ± 12.5 months, 11.8% (n = 1) after 40.4 ± 51.17 months. A multifactorial model of prediction showed the lowest risk of switch (2.4%) in individuals < 50 years with unilateral tumor and cs-DST < 0.45 µg/dL. In the subgroup of subjects without cardio-metabolic comorbidities at presentation, 25.6% developed ≥1 comorbidities during surveillance. Conclusions: The importance of exploring the domain of AIs/NFAs/MACS relates to an increasing detection in aging population, hence, the importance of their optimum hormonal characterization and identifying/forestalling cardio-metabolic consequences. The spectrum of additional biomarkers in MACS (other than DST) remains heterogeneous and still controversial, noting the importance of their cost-effectiveness, and availability in daily practice. Cs-DST serves as an independent predictor of cardio-metabolic outcomes, kidney dysfunction, while adrenalectomy may correct them in both MACS and NFAs, especially in younger population. Moreover, it serves as a predictor of switching the NFA into MACS category during surveillance. Changing the hormonal behavior over time implies awareness, since it increases the overall disease burden. Full article

Background/Objectives: There is a ubiquitous presence of plastics worldwide, and recent data highlight the continuous growth in their production and usage—a trend paralleled by the rise in chronic diseases like diabetes. The multifactorial nature of these diseases suggests that environmental exposure, notably to bisphenol A (BPA), could be a contributing factor. This study investigates the potential correlation between emerging BPA substitutes, bisphenol S and F (BPS and BPF), and diabetes in a cohort of the general adult population. Methods: A retrospective cohort study was conducted using data from the U.S. National Health and Nutrition Examination Survey (NHANES) 2013–2014 and 2015–2016 cycles. Basic comparative analyses and Pearson correlation tests were performed, followed by logistic regression models. Advanced statistical approaches, including Weighted Quantile Sum (WQS) regression and quantile g-computation, were subsequently applied to evaluate the combined effects of bisphenol exposures. Results: Findings reveal a positive association between combined bisphenols (BPs) and glycated hemoglobin (HbA1c), with binomial logistic regression demonstrating an odds ratio (OR) of 1.103 (1.002–1.214) between BP levels corrected for creatinine (crucial due to glomerular filtration variations) and diabetes. weighted quantile sum (WQS) and quantile G-computation analyses showed a combined positive effect on diabetes, glucose levels, and HbA1c. Individual effect analysis identifies BPS as a significant monomer warranting attention in future diabetes-related research. Conclusions: Replacing BPA with new molecules like BPS or BPF may pose a greater risk in the context of diabetes. Full article

During the service life of steel bridges, the structural stress histories display combined cyclic characteristics due to the superposition of low-frequency thermal loading and high-frequency vehicle loading. To investigate the fatigue performance under such loading patterns, a series of constant-amplitude and high-low frequency superimposed loading fatigue (HLSF) tests were conducted on notched specimens fabricated from Q355D bridge steel. The influence of HLSF waveform parameters on fatigue life was systematically investigated. Based on the fracture evolution mechanism, a concept of low-frequency periodic damage acceleration factor was proposed to effectively model the block nonlinear damage effects, and the applicability of existing fatigue life prediction models was discussed. The results show that the effect of average stress on the fatigue life under HLSF can be effectively considered by Walker’s formula. Low-amplitude ratios and low-frequency ratios indicate unfavorable loading conditions that may accelerate the Q355D fatigue damage accumulation, and these conditions are not adequately accounted for in current life prediction models. Compared to constant amplitude loading, HLSF can lead to a 66% and 46% reduction in high-frequency life when the amplitude ratio reaches 0.12 and the frequency ratio reaches 100. Compared to Miner’s rule, the proposed damage correction method reduces the life prediction error for HLSF by 11%. These findings provide valuable references for the fatigue assessment of bridge steel structures under the coupled effects of temperature and vehicle loading. Full article

Pile foundations are widely used to support offshore wind turbines. While the p-y curve method is adopted for analysis of pile–soil interactions in popular design specifications, including the American Petroleum Institute (API), its accuracy remains unassessed systematically and quantitatively. This study established a database by collecting 491 sets of pile p-y curves from multiple offshore wind turbine projects. The database was used to statistically evaluate the accuracy of the API p-y curve method for cohesionless soils. The model accuracy is represented by a model factor defined as the ratio of measured to predicted values of soil resistance around the pile. The results showed that accuracy assessment using the field data is significantly different from that using the laboratory model test data. On average, the API p-y curve method overestimates the true soil resistance in the field by about 30%, but underestimates that in the laboratory by about 8%. The dispersions in prediction accuracy of both cases are high. Correction terms are introduced to calibrate the current API p-y curves. The calibrated API methods were shown to be accurate in general and medium dispersive in prediction accuracy. Last, the model factors for the current and calibrated API methods were demonstrated to be lognormal random variables. Full article

Background: Metabolic syndrome (MetS) is a major risk factor for cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM), especially in Middle Eastern populations with a high metabolic burden. This study aimed to evaluate the predictive utility of different lipid ratios, including triglyceride-to-high-density lipoprotein cholesterol (TG/HDL-C), total cholesterol (TC)/HDL-C, low-density lipoprotein (LDL-C)/HDL-C, and non-HDL-C/HDL-C, for identifying MetS. In addition, we aimed to characterise the underlying metabolic dysregulation using the most predictive lipid ratio by comparing metabolomic profiles between high-risk (T3) and low-risk (T1) groups. Method: We conducted a cross-sectional study using data from 2179 Qatari adults without CVD and/or T2DM. The predictive value of each lipid ratio for MetS was compared. Untargeted metabolomics was performed to profile metabolic changes between T3 and T1. Results: After adjustment for age, sex, and BMI, TG/HDL-C showed the highest discriminative ability for MetS (AUC = 0.896, 95% CI: 0.88–0.91; OR = 4.36, 95% CI: 3.63–5.28, p < 0.0001). In pairwise AUC comparisons, TG/HDL-C outperformed LDL-C/HDL-C (p = 2.6 × 10⁻⁴, after correction for multiple comparisons), with no significant differences versus other ratios. The high-risk group exhibited raised levels of phosphatidylethanolamines, phosphatidylinositols, and diacylglycerols, and lower levels of sphingomyelins and plasmalogens. These lipid classes have been suggested to be implicated in insulin resistance and metabolic dysfunction. Elevated monoacylglycerols were identified in high-TG/HDL-C groups, representing a previously underreported pattern. Conclusions: The TG/HDL-C ratio showed a better association with MetS compared with other lipid ratios and was linked to distinct metabolomic signatures. These findings suggest potential value for early risk evaluation, but longitudinal and mechanistic studies are needed to confirm clinical applicability. Full article

Stabilization of the resonance frequency in thin-film acoustic devices to variations in environmental conditions is commonly reduced to the passive or active compensation of a single factor (usually temperature) and the isolation or addition of a separate correction circuit for every other factor (e.g., pressure and mass loading). In this work, the possibility of dual-factor compensation is proposed, where the response of a multi-layered thin structure to both temperature and ambient pressure variation vanishes due to the choice of intrinsic parameters (materials and thickness ratios). The response functions are derived for the $S_0$ Lamb mode at long wavelengths in an explicit analytical form in terms of bulk material characteristics. It is demonstrated that the dual-factor intrinsic stabilization requires at least a three-layered structure and can be achieved for materials commonly used in temperature-compensated devices (aluminum nitride, fused silica, and aluminum). Identification of the key material characteristics governing the existence of a stability solution can serve for a targeted search of such composites and implementation of new thin-film dual devices. Full article