Search Results (5,025)

Background and Clinical Significance: In gastric cancer, splenic metastases are found in less than 7% of cases and are usually associated with other systemic secondary determinations; much more rarely, they represent the sole secondary determination of the malignant disease. Case presentation: In this paper, we present the case of a 64-year-old patient who underwent curative surgery for gastric adenocarcinoma 10 months ago and, during oncological monitoring, was diagnosed with a splenic tumor formation with intense metabolic activity on PET-CT examination, raising suspicion of splenic metastases. The medical team observed an increase in carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 19-9, and Cluster of Differentiation (CD) 276 values, along with a slight decrease in Dickkopf Related Protein 3 (DKK 3). Considering that the spleen was the only site of secondary localization of the malignant disease, the patient underwent laparoscopic splenectomy with histopathological confirmation of the presence of gastric adenocarcinoma. There are no signs of loco-regional or distant recurrence 15 months postoperatively. In patients with radical excision of gastric cancer who present only with splenic metastases, splenectomy is indicated and is associated with good disease-free survival. If other secondary manifestations of malignant gastric disease are identified or suspected, chemotherapy treatment and the wait-and-see approach are recommended, as the patient does not have a real benefit from splenectomy. Until now, there is no standard protocol for the diagnostic and therapeutic management of patients with gastric cancer and metachronous splenic metastases; thus, the development of a decision-making scheme for these situations is necessary. Conclusions: The multidisciplinary approach, including the tumor board and an infectious disease specialist, are important steps in the effective management of these cases. The role of new biological markers such as CD 276 and DKK 3 for assessing the progression of malignant disease could constitute a new direction for research. Full article

In parallel with technical training on knowledge and skills of task-specific medical or surgical procedures, wide arrays of soft skills training would contribute to obstetric safety in the contemporary healthcare setting. This article, as a service evaluation, explored the effect of a specialty-based Crew Resource Management (CRM) training series that transforms the concept of human factors into sustainable measures in fostering clinical safety culture of the Department of Obstetrics and Gynaecology (O&G) in the Queen Elizabeth Hospital. Within the last decade, a tri-phasic programme has been implemented by an inter-professional workgroup which consists of a consultant anaesthesiologist, medical specialists and departmental operations manager from O&G, a nurse simulation specialist, hospital administrators, and a research psychologist. (1) Phase I identified different patterns of attitudinal changes (in assertiveness, communication, leadership, and situational awareness, also known as “ACLS”) between doctors and nurses and between generic and specialty-based sessions for curriculum planning. (2) Phase II evaluated how these specific behaviours changed over 3 months following CRM training tailored for frontline professionals in O&G. (3) Phase III examined the coping style in conflict management and the level of sustainability in self-efficacy over 3 months following specialty-based CRM training. The findings showed the positive impacts of O&G CRM training on healthcare professionals’ increased attitude and behaviour in “ACLS” by 22.7% at a p < 0.05 level, character strengths in conflict management, and non-inferior or sustained level of self-efficacy under tough conditions in the clinical setting up to 3 months after training. As a way forward, incorporating a scenario-based O&G CRM programme into existing skills-based training is expected to change service framework with an innovative approach. In addition, exploring actual clinical outcomes representing a higher level of organisational impacts can be a strategic direction for further studies on the effect of this practical and educational approach on obstetric safety culture. Full article

Background: Phelan–McDermid syndrome (PMS), caused by SHANK3 variants or 22q13.3 deletions, often includes systemic features such as gastrointestinal and hepatic abnormalities. This study highlights the overlap between PMS and metabolic-associated steatotic liver disease (MASLD), focusing on PNPLA3 variants and underscoring the need for structured metabolic monitoring. Methods: We describe a 25-year-old male with PMS due to a 22q13.33 microdeletion involving SHANK3. He exhibited developmental delay, seizures, and hypotonia. Genetic testing revealed homozygosity for the PNPLA3 p.I148M variant. Clinical, anthropometric, biochemical, imaging, and metabolic investigations were performed, including liver ultrasound and metabolic profiling of lymphoblastoid cell lines. Results: Ultrasound revealed moderate hepatic steatosis consistent with MASLD. After ursodeoxycholic acid treatment and a Mediterranean-style diet, steatosis improved to mild. Metabolic profiling demonstrated increased nicotinamide adenine dinucleotide generation under metabolic stimuli, suggesting altered energy homeostasis. Conclusions: We highlight the contribution of PNPLA3 to MASLD in PMS and support systematic hepatic monitoring. Genotype–phenotype associations in PMS may provide insights relevant to MASLD research and clinical management. Full article

Disputes are common in the intricate professional setting of the construction sector. When claims cannot be resolved kindly, they often escalate into conflicts that result in litigation. Identifying the root reasons of these claims and understanding their effects on project timelines, costs, and quality can help prevent poor performance in construction contracts. This study makes a unique contribution by developing a cause of claims breakdown structure (CCBS) that systematically categorizes the most frequent roots of claims identified in the building sector through an extensive literature review, and by subsequently assessing these categories using expert-based relative importance indices (RII). Using relative importance indices derived from specialist opinions, the research provides likelihood and influence quantities for 15 typical claim sources in the building sector. These values offer stakeholders in public construction projects a framework for assessing risks and planning mitigation strategies for construction claims. The study reveals the five most significant risk factors for contractual claims in the Kuwait building sector. These issues are ambiguities in contract language, followed by weather-related disruptions, ineffective communication among stakeholders, inadequate planning, and regulatory changes. Full article

Background/Objectives: Pain is a common issue among patients undergoing hemodialysis (HD), and palliative care (PC) aims to improve their quality of life. This study investigates the incidence, nature, and treatment of pain in chronic HD patients in Hungary, along with factors influencing pain intensity and the benefits of PC. Methods: This study used a cross-sectional design involving 159 patients with chronic end-stage kidney disease (ESKD) receiving HD at the National Dialysis Center in Pécs, Hungary. Pain was assessed using a “PQRST” questionnaire, and statistical analyses were performed on clinical and laboratory data to identify potential pain triggers. We also reviewed the latest literature on PC for patients with ESKD undergoing HD. Results: Approximately 57% of patients reported pain, with 88% indicating moderate-to-severe pain levels. While 64% used regular pain medication, only 29% experienced complete pain relief. Non-pharmacological methods, along with adjuvant agents and strong notably different based on parathyroid opioids, were underutilized. Pain intensity was hormone (PTH) and C-reactive protein (CRP) levels. Key factors affecting pain included body mass index (BMI), hypertension (HT), diabetes mellitus (DM), and PTH levels. Research shows that PC is rarely used for patients on HD in many countries, despite being effective in managing symptoms. Conclusions: PC, along with pain assessment and multidisciplinary management, reduces the symptomatic burden for patients with ESKD. Effective management of mild pain should be handled by a nephrologist experienced in PC, while severe, therapy-resistant pain should be managed by PC specialists. Therefore, implementing PC is essential in the treatment of these patients. Full article

Background: Orthopedic scientific publications play an important role worldwide. Because of the limited evidence in the Latin American literature, we aimed to evaluate the determinants of scientific publication among Peruvian orthopedics as an approach to the Latin American context. Methods: Analytical cross-sectional study. Orthopedic specialists and residents were enrolled during the 52nd Peruvian National Congress of Orthopedics and Traumatology. A form validated by experts was applied to collect variables. The crude and adjusted coefficients were calculated using bivariate and multivariate regression with 95% confidence intervals. Results: A total of 310 participants were included in our study. The prevalence of the scientific orthopedic publication was 34.84%. Multivariate regression showed that, working in a private hospitals, having an interest in tumors and pediatric orthopedics, being involved in teaching activity, belonging to a scientific society other than the Peruvian Society of Orthopedics and Traumatology, having more than one research project, having an international rotation, and active participation in meetings were factors associated with publishing orthopedic scientific articles, while coming from a university in the highlands as an undergraduate and having more than ten shifts per month was associated with publishing fewer scientific articles. Among residents, having had an international rotation was associated with publishing scientific articles. Conclusions: The determinants of scientific production described will serve to increase scientific production in different contexts considering the orthopedist’s training stage. Full article

Background and Objectives: Breast cancer (BC) is a complex disease requiring a comprehensive treatment approach due to its diverse characteristics. Critical molecular determinants of BC have been identified using advanced genomic, transcriptomic, and proteomic approaches. Assessing the biomarkers associated with the onset of early-stage BC may help identify the risk of metastasis and inform treatment decisions. A previous bioinformatic analysis using two large BC cohorts identified pumilio RNA binding family member 1 (PUM1) as a key gene in invasive BC. However, no study has yet examined the prognostic and predictive value of PUM1 in invasive BC and its correlation with aggressive tumor behavior. This study aimed to fill this need. Materials and Methods: Correlations between PUM1 expression and patients’ clinicopathological characteristics and outcomes were explored in publicly available BC transcriptomic data acquired using DNA microarrays (n = 10,872) and RNA sequencing (n = 4421) using BC Gene-Expression Miner v5.0. PUM1 expression in samples from 100 patients with invasive BC at King Abdul Aziz Specialist Hospital, Saudi Arabia, was assessed immunohistochemically. Correlations between PUM1 expression and patients’ clinicopathological characteristics (e.g., age, tumor grade, tumor size, and outcome) were assessed. The online platform ROC Plotter was also used to investigate the predictive significance of PUM1. Results: High PUM1 gene and protein expression correlated positively with aggressive features of BC, including high histological grade, high Ki-67 expression, negative hormone receptors, and the triple-negative BC molecular subtype. High PUM1 expression correlated with poor outcomes, and high PUM1 expression was associated with a lower pathological complete response to anti-endocrine treatment but a high response to chemotherapy. Conclusions: These results indicate that PUM1 may serve as a potential prognostic and predictive biomarker in patients with invasive BC. PUM1 may serve as a therapeutic target in BC cases with unfavorable prognoses. However, further validation in larger, multi-center cohorts and further functional assessment are required to deepen our understanding of PUM1’s role in BC. Full article

The NA61/SHINE collaboration conducts research using the SPS CERN accelerator, focusing primarily on the strong interaction program. In this type of research, it is necessary to use a hadronic calorimeter called PSD to determine the centrality value of nuclear collisions. The detector consists of two separate parts, the MPSD and the FPSD. The FPSD, which is a new detector added to the NA61 SHINE experiment from 2022, has not yet had a functional system for remotely changing and measuring the detector position. Such a remote system is necessary for faster detector calibration, more precise positioning of the detector in the accelerator beam path, and improved safety. For these reasons, in 2023, a group of specialists from the NCBJ laboratory at Poland, prepared a project and built a remote position change system for the FPSD detector. In this work, we describe the main design assumptions and main features of the finished system. We also describe its control system based on the Siemens 1200 PLC controller and the way we supervise its operation through an external DCS system based on the EPICS software (ver.3.16). The introduced changes improved the safety and comfort of work, reduced the radiation risk, and, above all, significantly shortened the time required to change the position of the FPSD detector. Full article

Hepatic cancer is a world health concern due to its high lethality. The main risk factor worldwide is having hepatic cirrhosis. The etiology of hepatic cirrhosis has changed in recent years, with metabolic-associated steatotic liver disease (MASLD) becoming the leading cause, displacing hepatitis C and B viruses and alcoholic liver disease. It is of the utmost importance to develop screening programs in at-risk populations for early detection. The survival rate of HCC, as determined by a group of specialists or an interdisciplinary committee, is a challenge we have taken on in a public health hospital in Ecuador. This retrospective study identified 71 patients diagnosed with hepatocellular carcinoma, mostly middle-aged men with a history of liver cirrhosis. No significant association was found between the presence of cirrhosis, laboratory abnormalities, and survival. However, the identification by imaging vascular invasion and extrahepatic extension were associated. This study highlights that patients with liver lesions identified through HCC screening have a higher survival rate over a one-year follow-up period. Full article

Historically, predator control has been a frequent practice conducted in the hunting grounds of Spain. After the approval of Law 42/2007 on Natural Heritage and Biodiversity, and the enforcement of international regulations, predator control methods are required to be selective, non-massive, and conducted by trained specialists when traps are used; however, there is a lack of research on the current status of predator management. Data was gathered from 16 regional wildlife departments and from 373 questionnaires from hunting grounds targeting the conservation of small game species. Seven predatory species were included in the regional game species lists, the most frequently controlled being the red fox (Vulpes vulpes, 90.4%), wild boar (Sus scrofa, 78.3%), and Eurasian magpie (Pica pica, 51.5%), with control intensity differing among regions. In total, 87% of the questionnaire respondents declared controlling at least one predator species, while 49.3% employed gamekeepers to perform the control. In all surveyed regions, shooting was authorized, and it was the most frequent control method in hunting grounds for the aforementioned species (ranging from 76 to 100%), while the use of approved restraint methods was allowed in 11 regions but only used in 7 for foxes (8%) and magpies (25%). The control intensity (animals culled/km²) for foxes was higher when conducted by full-time keepers, while for magpies and wild boars, it was higher when conducted by hunters. The implementation of habitat management (agricultural and forest measures) that helps to reduce predation was higher in hunting grounds not conducting predator control. Based on our results, we propose a national predation management framework focused on controlling rather than removing predators. Full article

Objectives: The study assessed knowledge, attitude, and practices of dentists towards treating pregnant patients. Methods: It was based on a cross-sectional, electronically administered survey of a convenience sample of Russian dentists conducted between March and April 2025. Our questionnaire was developed based on international guidelines and previously published surveys and validated through expert review and pilot testing. It contains four sections: Demographics, Knowledge, Attitude, and Practice. The overall knowledge and attitude scores were calculated and compared across subgroups based on gender, specialty, and experience using the Kruskal–Wallis and Dunn’s tests. Spearman’s coefficient was calculated to reveal pair-wise correlations between knowledge, attitude, and age of the participants. Results: Overall, 403 dentists completed the questionnaire. The majority of the participants (53%) demonstrated fair knowledge about providing dental care throughout pregnancy. Female dentists had a significantly higher median knowledge score compared with that of males; orthodontists and prosthetic dentists showed lower knowledge scores than other specialists. All participants demonstrated a positive attitude toward treating pregnant patients; however, a considerable number of dentists agreed that they do not feel comfortable treating pregnant women and prefer not to do that. A large majority of dental practitioners (83%) indicated that they had treated pregnant women. Liability concerns (42%) and a lack of knowledge (24%) were reported as the main barriers for providing dental care to pregnant patients. Conclusions: It can be concluded that insufficient knowledge influenced by gender and specialty is one of the key barriers to the dental treatment of pregnant women, despite generally positive attitudes of the practitioners. Full article

Background: Lower limb malalignment is a hallmark of knee osteoarthritis, with surgical correction techniques evolving from traditional mechanical alignment (MA) to kinematic alignment (KA) approaches. Restrictive kinematic alignment (rKA) represents a hybrid strategy combining principles from both techniques. This study evaluated short-term functional outcomes following robotic-assisted total knee arthroplasty (RoTKA), comparing MA versus rKA alignment strategies. Methods: This prospective, randomized, single-center study enrolled 96 patients with grade 3–4 idiopathic knee osteoarthritis (Kellgren–Lawrence classification). Patients were randomized to MA (n = 49, mean age 67 ± 9 years) or rKA (n = 47, mean age 66 ± 7 years) groups. Preoperative hip–knee–ankle (HKA) angles were 172.6° ± 1.1° and 172.9° ± 0.9° for MA and rKA groups, respectively. Outcomes were assessed using Visual Analog Scale (VAS) pain scores, range of motion (ROM), Knee Society Score (KSS), Oxford Knee Score (OKS) (primary outcome), SF-36, and Forgotten Joint Score (FJS-12). Results: Postoperative HKA angles were 179.5° ± 1.2° (MA) and 176.0° ± 1.5° (rKA). At 14 days postoperatively, knee ROM increased by 20.5% in the MA group and 25.7% in the rKA group, with a statistically significant 5.2% intergroup difference, indicating faster postoperative recovery (p = 0.008). VAS pain scores decreased by 7% in the rKA group while increasing by 13% in the MA group (p < 0.001). At one-year follow-up, FJS-12 scores were significantly higher in the rKA group (94.8 ± 3.2 vs. 91.9 ± 2.2, p < 0.001). No significant differences were observed in KSS, OKS, or SF-36 score between groups. Conclusions: Restrictive kinematic alignment demonstrated superior early postoperative outcomes compared to mechanical alignment in RoTKA, with significantly reduced pain and improved ROM. While one-year functional outcomes were comparable between techniques, rKA may offer advantages in the immediate postoperative period, supporting its consideration as a viable alignment strategy in robotic-assisted knee arthroplasty. Full article

Background/Objectives: Psychosocial care for siblings and caregivers of youth with cancer (SCYC) is a critical yet under-implemented component of comprehensive pediatric oncology care, as outlined by the Standards for Psychosocial Care for Children with Cancer and Their Families. Despite evidence supporting psychosocial interventions, such as integrative care interventions, as effective for stress mitigation and coping, barriers to implementation include revenue-generating funding models and siloed psychosocial disciplines, which hinder accessibility for adult caregivers within pediatric institutions and geographically dispersed families. This manuscript describes the relevant extant literature as well as a model for leveraging short-term funding opportunities and interdisciplinary collaboration to develop integrative care programs for these underserved groups. Methods: Philanthropic funding supported part-time child life specialist and creative arts therapist deployment to develop and implement integrative virtual group programs, as well as interdisciplinary integrative programs, to serve SCYC. Attendance, engagement, and qualitative feedback were used for program iteration and supported the transition to institutional funding. Results: Integrative programs provided 331 caregiver and sibling encounters during the two-year pilot. Qualitative feedback from caregivers highlighted the value of virtual services in reaching geographically dispersed families and addressing feelings of isolation among SCYC at the universal and targeted levels of care. Communication about these key outcomes led to operational funding and sustained integrated care programs. Conclusions: This manuscript illustrates a successful model of leveraging philanthropic funding to support the development of integrative care programs to serve SCYC. Future research should focus on refining the clinical and financial feasibility of such models and assessing their impact on family well-being. Full article

Objectives: Histopathological growth patterns (HGPs) of liver metastases have been shown to possess prognostic significance. To date, only 2 studies have evaluated the reproducibility of HGP assessment. The aim of our study was to assess the interobserver reproducibility of HGP classification in liver metastases. Methods: A retrospective, consecutive, single-center cohort study was conducted, including patients who underwent surgical resection for liver metastases at the University of Szeged between 2011 and 2023. A comprehensive database was established, incorporating basic histopathological data for each case. Histological slides were independently reviewed by 2 pathologists, 3 pathology specialist trainees, and 2 medical students with varying levels of experience in gastrointestinal pathology. Interobserver agreement was evaluated using intraclass correlation coefficients (ICC) and Fleiss’ kappa. Results: The study included resection specimens from 205 patients, comprising 336 metastatic lesions, predominantly of gastrointestinal origin (n = 188). Excellent interobserver agreement was observed among specialist trainees (ICC = 0.911) and board-certified pathologists (ICC = 0.984). Overall agreement among all 7 evaluators was good (ICC = 0.822). Conclusions: Our findings demonstrate that HGPs can be reliably assessed by individuals with at least 2 years of experience in general pathology. To our knowledge, this is the first study to include the largest number of board-certified pathologists and pathology specialist trainees in a HGP reproducibility analysis. Additionally, no comprehensive literature review on this topic has been previously conducted. Full article

Hybrid marine energy platforms that integrate wave energy converters (WECs) and hydrokinetic turbines (HKTs) offer potential to improve energy yield and system stability in marine environments. This study identifies a compatible WEC–HKT integrated system concept through a structured concept selection framework based on multi-criteria decision analysis (MCDA). The framework follows a two-stage process: individual technology assessment using eight criteria (efficiency, TRL, self-starting capability, structural simplicity, integration feasibility, environmental adaptability, installation complexity, and indicative cost) and pairing evaluation using five integration-focused criteria (structural compatibility, PTO feasibility, mooring synergy, co-location feasibility, and control compatibility). Criterion weights were assigned through a four-level importance framework based on expert judgment from 11 specialists, with unequal weights for the individual evaluation and equal weights for the integration stage. Four WEC types (oscillating water column, point absorber, overtopping wave energy converter, and oscillating wave surge converter) and four HKT types (Darrieus, Gorlov, Savonius, and hybrid Savonius–Darrieus rotor) are assessed using literature-derived scoring and weighted ranking. The results show that the oscillating water column achieved the highest weighted score among the WECs with 4.05, slightly ahead of the point absorber, which scored 3.85. For the HKTs, the Savonius rotor led with a score of 4.05, surpassing the hybrid Savonius–Darrieus rotor, which obtained 3.50, by 0.55 points. In the pairing stage, the OWC–Savonius configuration achieved the highest integration score of 4.2, surpassing the PA–Savonius combination, which scored 3.4, by 0.8 points. This combination demonstrates favorable structural layout, PTO independence, and mooring simplicity, making it the most promising option for early-stage hybrid platform development. Full article