Search Results (4,437)

Introduction: The frozen section intra-operative consultation is a pathology procedure that provides real-time evaluations of tissue samples during surgery, enabling quick and informed decisions. In the pre-analytical phase, errors related to sample collection, transport, and identification are common, and tools like failure mode, effects, and criticality analysis help identify and prevent risks. This study aims to enhance patient safety and diagnostic quality by analyzing risks and optimizing sample management. Materials and Methods: The failure mode, effects, and criticality analysis was conducted by a multidisciplinary team to analyze the workflow of frozen section sample handling from collection in the operating theater to acceptance at the pathology lab. Six steps were identified, each assigned tasks and responsibilities, with risks assessed through the risk priority number, calculated from severity, occurrence, and detectability. Severity was classified based on the WHO framework, ranging from “No Harm” to “Death”, to prioritize risks effectively. Results: The study identified 12 failure modes across 11 sub-processes, prioritized by risk. Key failures included missing patient identification, incorrect sample retrieval, missing labels, misdirected samples, and samples sent to the wrong lab. Discussion: Pre-analytical errors in pathology pose risks to diagnosis and patient care, with most errors occurring in this phase. A multidisciplinary team identified key issues, such as sample mislabeling and delays due to staff unavailability, and implemented corrective actions, including improved signage, staff re-training, and sample tracking systems. Monitoring and regular checks ensured ongoing adherence to protocols and reduced the risks of misidentification, transport delays, and procedural errors. Conclusions: The frozen section intra-operative consultation is vital in surgical pathology, with the pre-analytical phase posing significant risks due to potential errors in sample handling and labeling. Failure mode, effects, and criticality analysis has proven effective in identifying and prioritizing these failures, despite resource demands, by allowing corrective actions that enhance patient safety and healthcare quality. Full article

Beauveria bassiana has distinct nutrient requirements depending on the growth stage, with the mycelial growth stage being particularly nutrient-intense. When nutrients are exhausted, B. bassiana produces numerous spores that re-germinate and release visible hyphae under suitable environmental conditions. This study aimed to use low-cost agricultural by-products for developing an optimized sporulation medium. Single-factor experiments revealed that potato, wheat bran, and wheat had the greatest influence on sporulation after 14 d of culture. Wheat, wheat bran, and corncob had the strongest effect on spore production. Using a mathematical model and Box–Behnken design, the maximum predicted sporulation using the stock medium was 5.55 × 10⁶/mL. The optimized formula comprised 54.82 g potato, 77.74 g wheat bran, and 101.48 g wheat. The actual stock medium produced a spore yield of 5.52 × 10⁶/mL. Similarly, the maximum predicted sporulation was 15.66 × 10⁶/mL for the culture medium. The optimized formula comprised 50.81 g wheat, 99.6 g wheat bran, and 112.59 g corncob, with a spore yield of 15.69 × 10⁶/mL. The high consistency between predicted and experimental values indicated that our model can accurately determine the effect of medium on sporulation. Full article

Urban memory involves the re-creation of a city’s physical, historical, social, and cultural elements in the memories of its inhabitants. However, urban transformation and commercial tourism-oriented projects may threaten the continuity of this memory. This study aims to provide an understanding of the relationship between urban memory and spatial experience while exploring how urban memory elements convey meanings to daily users and local inhabitants of a touristic settlement. The research focuses on Misi Village in Bursa, Turkey, a settlement with a 2000-year history known for its traditional architecture and natural beauty. Over the past two decades, local authorities have pursued extensive restoration projects to rebrand Misi Village as an Art and Tourism Village. The research employs the oral history method, focusing on two user groups: tourists and locals. The findings reveal that while tourists appreciate Misi Village for its natural beauty and recreational activities, they lack a deeper understanding of its history and the transformation of its identity. Instead, they mostly focus on commerce-oriented spatial experiences. In contrast, local residents emphasize daily life and traditional practices as they strive to sustain their livelihoods. By highlighting this difference, strategic planning is proposed to preserve Misi Village’s unique urban memory and promote sustainable, culturally centered tourism. Full article

Rill erosion is a major issue on a global scale, and predicting the presence, position, and development of erosive forms on hillslopes is a significant challenge for the scientific community. Several plot-scale investigations confirmed the reliability of the terrestrial photogrammetric (TP) technique for studying rill erosion and the reliability of a method for extracting the rill network from Digital Surface Models (DSMs) and measuring the corresponding volume. In this paper, for an intense erosive event that occurred at the Sparacia experimental area (Sicily, Southern Italy), TP surveys of three plots, with different length and steepness, incised by rills, were performed to reconstruct the DSMs. For each plot, the rill network was extracted from the DSMs, and the non-contributing network was distinguished from the contributing one, from which the soil loss and the consequent eroded volumes V were determined. The specific aims were to (i) establish the effect of plot steepness on rill depths and some morphometric characteristics of the drainage rill network; (ii) test and calibrate the relationship between V and the total rill length L, using all rill measurements available in the literature and those obtained in this study; and (iii) modify the V–L relationship by including climate forcing and assessing the related performance. The rill depths, h, the drainage frequency, and drainage density of the rill networks detected in the three plots were compared. The analysis demonstrated that h and the morphometric parameters of the contributing rill network increase with plot steepness s. In particular, the mean depth increases from 2.79 to 4.85 cm for slope increasing from 14.9 to 26%. Moreover, the drainage frequency of the contributing rill network varies from 0.16 m⁻² for s = 14.9% to 0.47 m⁻² for s = 26%, while the drainage density of the contributing rill network varies from 0.92 m⁻¹ for s = 14.9% to 2.1 m⁻¹ for s = 26%. Finally, using the data available in the literature and those obtained in this investigation, an empirical relationship between V and the total rill length L was firstly tested and then rearranged considering the event rainfall erosivity R_e. Including R_e in the rearranged equation guaranteed the best performance in V estimation. Full article

In an era with an ever-growing population, sustainability and green transition are the main milestones to be considered within the current European Green Deal program, and the recovery of by-products for the integration of feed with bioactive molecules, that are sustainable and with high nutritional value, is an ambitious mission to be explored also in aquaculture. Olive oil extraction produces a range of solid and liquid by-products, in varying proportions depending on the utilized production techniques, all of which are considered as possible pollutants. However, these products are also rich of polyphenols, bioactive molecules with several and well-known beneficial properties (antimicrobic, anti-inflammatory, antioxidant, and immune-modulating). On this basis, this work aimed at evaluating the effects of dietary supplementation with polyphenols derived from olive mill wastewater on growth performance and on gene expression modulation, by means of RT-qPCR assays, in farmed Sparus aurata. Particularly, some target genes of metabolic, immunity, and oxidative stress pathways have been investigated in breeding gilthead seabream. Differential gene expression analysis was carried out, and differences between the control group (n = 9) and the treated one (n = 9) were computed with Student’s t test. The results have highlighted that supplemented feed enhanced fish growth, with a significant feed conversion ratio between the two groups. Furthermore, the polyphenol diet had a beneficial impact on gene expression fold with a level of significance for fatty acid binding protein 2, superoxide dismutase 1, and interleukin-12 genes at hepatic or intestinal district. These significant and promising preliminary findings promote, in the future, other investigations on polyphenolic by-products and on their putative or possible re-utilization in fish feeding. Full article

Background/Objectives: Effective management of acute pancreatitis (AP) hinges on prompt volume resuscitation and is adversely affected by delays in diagnosis. Given diverse clinical settings (tertiary care vs. community hospitals), further investigation is needed to understand the impact of the initial setting to which patients presented on clinical outcomes and quality of care. This study aimed to compare outcomes and quality indicators between AP patients who first presented to the emergency department (ED) of a tertiary care center and AP patients transferred from community hospitals. Methods: This study included AP patients managed at our tertiary care hospital between 2008 and 2018. We compared demographics and outcomes, including length of stay (LOS), intensive care unit (ICU) admission, rates of local and systemic complications, re-admission rates, and one-year mortality in transferred patients and those admitted from the ED. Quality indicators of interest included duration of volume resuscitation, time until advancement to enteral feeding, pain requiring opioid medication [measured in morphine milliequivalent (MME) dosing], and surgical referrals for cholecystectomy. Categorical variables were analyzed by chi-square or Fisher’s exact test; continuous variables were compared using Kruskal–Wallis tests. Regression was performed to assess the impact of transfer status on our outcomes of interest. Results: Our cohort of 882 AP patients comprised 648 patients admitted from the ED and 234 patients transferred from a community hospital. Transferred patients were older (54.6 vs. 51.0 years old, p < 0.01) and had less frequent alcohol use (28% vs. 39%, p < 0.01). Transferred patients had a significantly greater frequency of gallstone AP (40% vs. 23%), but a lower frequency of alcohol AP (16% vs. 22%) and idiopathic AP (29% vs. 41%) (p < 0.001). Regarding clinical outcomes, transferred patients had significantly higher rates of severe AP (revised Atlanta classification) (10% vs. 2% severe, p < 0.001) and ICU admission (8% vs. 2%, p < 0.001) and longer median LOS (5 vs. 4 days, p < 0.001). Regarding quality indicators, there was no significant difference in the number of days of intravenous fluid administration, or days until advancement to enteral feeding, pain requiring opioid pain medication, or rates of surgical referral for cholecystectomy. Conclusions: Though the quality of care was similar in both groups, transferred patients had more severe AP with higher rates of systemic complications and ICU admissions and longer LOS, with no difference in quality indicators between groups. Full article

Rasmussen encephalitis (RE) is a rare and progressive form of chronic encephalitis that typically affects one hemisphere of the brain and primarily occurs in pediatric individuals. The current study aims to narratively review the literature about RE, including historical information, pathophysiology, and management of this condition. RE often occurs in individuals with normal development, and it is estimated that only a few new cases are identified each year in epilepsy centers. Approximately 10% of cases also occur in adolescents and adults. The hallmark feature of RE is drug-resistant focal seizures that can manifest as epilepsia partialis continua. Also, patients with RE usually develop motor and cognitive impairment throughout the years. Neuroimaging studies show progressive damage to the affected hemisphere, while histopathological examination reveals T-cell-dominated encephalitis with activated microglial cells and reactive astrogliosis. The current therapy guidelines suggest cerebral hemispherotomy is the most recommended treatment for seizures in RE, although significant neurological dysfunction can occur. Another option is pharmacological management with antiseizure medications and immunomodulatory agents. No significant progress has been made in understanding the pathophysiology of this condition in the last decades, especially regarding genetics. Notably, RE diagnosis still depends on the criteria established by Bien et al., and the accuracy can be limited and include genetically different individuals, leading to unexpected responses to management. Full article

Bioengineered livers are currently an acceptable alternative to orthotopic liver transplants to overcome the scarcity of donors. However, the challenge of using a bioengineered liver is the lack of an intact endothelial layer in the vascular network leading to thrombosis. Heparin-modified surfaces have been demonstrated to decrease thrombogenicity in earlier research. However, in our study, we aimed to apply heparin immobilization to enhance the hemocompatibility, endothelial cell (EC) adhesion, and angiogenesis of rat decellularized liver scaffolds (DLS). Heparin was immobilized on the DLS by the end-point attachment technique. The scaffold’s hemocompatibility was assessed using ex vivo blood perfusion and platelet adhesion studies. The heparinized scaffold (HEP-DLS) showed a significantly reduced thrombogenicity and platelet aggregation. HEP-DLS was recellularized with EA.hy926 cells via the portal vein and maintained in the bioreactor for 7 days, showing increased EC adhesion and coverage within the blood vessels. The Resazurin reduction assay confirmed the presence of actively proliferating cells in the HEP-DLS. The scaffolds were implanted subcutaneously into the dorsum of mice for 21 days to evaluate cell migration and angiogenesis. The results showed significant increases in the number of blood vessels in the HEP-DLS group. Our results demonstrated that heparin immobilization reduces thrombosis, promotes re-endothelialization, and enhances angiogenesis in DLS. The research provides insight into the potential use of heparin in the formation of a functioning vasculature. Full article

Introduction: Cholangiocarcinoma (CCA) is a highly lethal malignancy originating in the bile ducts, often diagnosed late with poor prognosis. Differentiating benign from malignant biliary tumors remains challenging, necessitating advanced diagnostic techniques. Objective: This study aims to enhance the diagnostic accuracy of endoscopic ultrasound (EUS) for distal cholangiocarcinoma (dCCA) using advanced convolutional neural networks (CCNs) for the classification and segmentation of EUS images, specifically targeting dCCAs, the pancreas, and the bile duct. Materials and Methods: In this retrospective study, EUS images from patients diagnosed with dCCA via biopsy and an EUS-identified bile duct tumor were evaluated. A custom CNN was developed for classification, trained on 156 EUS images. To enhance the model’s robustness, image augmentation techniques were applied, generating a total of 1248 images. For tumor and organ segmentation, the DeepLabv3+ network with ResNet50 architecture was utilized, employing Tversky loss to manage unbalanced classes. Performance evaluation included metrics such as accuracy, sensitivity, specificity, and Intersection over Union (IoU). These methods were implemented in collaboration with the ADAPTED Research Group at the Technical University of Cluj-Napoca. Results: The classification model achieved a high accuracy of 97.82%, with precision and specificity both at 100% and sensitivity at 94.44%. The segmentation models for the pancreas and bile duct demonstrated global accuracies of 84% and 90%, respectively, with robust IoU scores indicating good overlap between predicted and actual contours. The application performed better than the UNet model, particularly in generalization and boundary delineation. Conclusions: This study demonstrates the significant potential of AI in EUS imaging for dCCA, presenting a robust tool that enhances diagnostic accuracy and efficiency. The developed MATLAB application serves as a valuable aid for medical professionals, facilitating informed decision-making and improving patient outcomes in the diagnosis of cholangiocarcinoma and related pathologies. Full article

Climate change, principally driven by human activities, has led to an increase in global temperature, which is predicted to continue rising in the coming years. This temperature increase is even more pronounced in urban areas due to the heat island effect. This phenomenon is highly influenced by the presence of paved streets made with bituminous mixtures, which are characterised by their high solar radiation absorption capacity. Bituminous mixtures retain and re-emit a large amount of heat that intensifies the urban heat island effect. The novelty of this work is to measure retroreflective properties of bituminous mixtures that present a highly textured surface. In this context, the aim of this study is to evaluate the retroreflectance of different bituminous mixtures for use as pavement surfaces, focusing on the influence of colour and different types of aggregates. For this, total and directional reflectance measurements were conducted to determine the retroreflectance of these mixtures, with the purpose of mitigating the heat island effect in urban environments without affecting users through reflected solar radiation. The results show the retroreflective capacity of the designed mixtures within the visible spectrum, especially those manufactured with light-coloured aggregates and synthetic binders pigmented with titanium dioxide. Thus, the retroreflectance of the lighter mixtures range from 37.9% at a 0° entrance angle to 68.9% at 60°, while the black mixtures exhibit values between 5.1% and 8.4%. Full article

The current work presents the reformulation of a composite based on high-density polyethylene obtained through the recycling of blow-molded containers (rHDPE) with natural fiber residues (wood sawdust). This material is technically and industrially known as WPC (wood plastic composite). The original formulation of this material contains 34% high-density polyethylene and 60% sawdust by weight fraction, while the remaining components include additives and coupling agents such as wax (Coupling Agent TPW 813 for plastic woods), stearic acid, and color pigment. The composite material was processed using the profile extrusion method, from which samples were obtained to conduct various experimental tests. The mechanical analysis revealed that both the strength and Young’s modulus of the tensile and flexural properties slightly increased with the addition of sawdust to the composite. Additionally, the stiffness was higher compared to high-density polyethylene, indicating a direct relationship between these properties and the amount of sawdust incorporated. Besides this, other characterization methods were performed on the material, including density, hardness, and compression tests, as well as differential scanning calorimetry (DSC), thermogravimetric analysis (TGA), natural and accelerated aging tests, Vicat softening temperature, and heat deflection temperature analysis (HDT). The initial evaluation provides a guide to enhance the most important properties with the aim of using the extruded profiles as pergolas in the real estate sector. Therefore, new formulations are developed with the assistance of Minitab 21 software, maintaining a constant proportion of materials that do not affect the mechanical properties, such as wax, stearic acid, and color pigment. Once the formulations are made, each one is characterized through tensile tests to determine which has the best performance. The formulation with the highest strength is re-characterized using the techniques mentioned in the starting material to obtain a material with the most optimal characteristics. Full article

Through the coffin set of Tanethereret—dated to the first half of the 21st Dynasty—this article aims to underline the importance of analysing the masks and human features of ancient Egyptian yellow coffins and their value in disclosing new and important information about the Third Intermediate Period society. By moving between different visualisations, overlapping layers, measuring, and comparing, the sculpted human forms can be, for example, further indices of the quality of the production/”workshop”/artist and of the socio-economic power of the client. The possibility of making a three-piece set—coherent not only in decoration but also in form—suggests the existence of workshops capable of producing high-quality coffins and, consequently, that some people could still economically afford such coffin sets. Gaining access to such “workshops” and this type of production may indeed represent a further attempt to “manufacture social power” for the middle or high elites. Moreover, this specific case study also shows the dynamism of ancient Egyptian artistic production in a period of crisis, with artists able not only to re-adapt and re-commodify an ancient object but also to create possible new compositions with a balanced mix of styles between tradition and innovation. The study of this “invisible” part of the yellow coffins thus represents a new way of reconstructing the history of the people “hidden behind” the yellow coffins and the socio-economic sphere of ancient Egyptian society in the Third Intermediate Period, manifested through the resulting art and material culture. Full article

Objectives: This study aimed to investigate factors that influence the 12-month outcomes after the treatment of multiple gingival recessions (GRs) with a modified coronally advanced tunnel (MCAT) and a subepithelial connective tissue graft (SCTG), with cross-linked hyaluronic acid (HA, tests) or without (controls). Materials and Methods: Twenty-four patients with 266 GRs were treated. A logistic regression model was set to identify the baseline parameters that could predict the 12-month outcomes. The study protocol was registered at ClinicalTrials.gov (ID No. NCT05045586). Results: The evaluated clinical and esthetic parameters showed marked improvement in both groups without any statistically significant differences between the groups, with the exception of the soft tissue texture (STT). The STT was in favor of the HA group (0.96 versus 0.73, p = 0.0091). The likelihood of an MRC > 85%, of achieving CRC, and of gaining an RES = 10 was the highest for the incisors (reference group) and the lowest for the molars (OR = 0.046, p = 0.005). With each 1 mm increase in the baseline clinical attachment level, the odds of failure (MRC < 85%, not achieving CRC) increased, whereas each 1 mm increase in the baseline keratinized tissue width (KTW) improved the chances of an MRC > 85%, of achieving CRC, and of gaining an RES = 10. The application of HA increased the likelihood of a perfect RES more than twofold (OR = 2.683, p = 0.001). Conclusions: The application of HA improved the 12-month esthetic outcomes after the treatment of GRs with the MCAT technique. The baseline CAL, KTW, and tooth type predicted the 12-month MRC, CRC, and RES. An evaluation of the baseline characteristics of the surgical area might help clinicians develop individualized treatment plans. Full article

In 2018, the WHO published a methodology for conducting a point prevalence survey (PPS) of antibiotic use in hospitals. The aim of this study is to report the use of antibiotics in six second-level hospitals in Mexico using this methodology. Methods: A multicenter cross-sectional study based on the 2021–2023 adaptation for Latin American hospitals was conducted in internal medicine, surgery, intensive care unit (ICU), obstetrics and gynecology and pediatrics departments of the IMSS in the western region of the state of Mexico. Results: The overall prevalence of antibiotic use was 61%; the services with the highest prevalence of prescription were general surgery (79%) and the ICU (78%). A total of 846 patients were surveyed; there were no differences in antibiotic use or non-use in terms of gender, surgical procedure and invasive devices, but there were differences in median age and comorbidities. Adherence to guidelines was 53.9%. The three main antibiotics used were third-generation cephalosporins (28%), carbapenems (13%) and glycopeptides (9%); for the type of indication, for CAI and prophylaxis, the rates of use of third-generation cephalosporins were 29.2% and 44.5%, respectively, while for healthcare-associated infections, carbapenems were used (23.9%). By AWaRe group, the watch group was predominant for all types (63.9%), for prophylaxis it was the access group (39.3%), and for HAIs it was the reserve group (4.9%). Full article

Biophilic design is a well-recognised discipline aimed at enhancing health and well-being, however, most buildings lack adequate representation of nature or nature-inspired art. Notable barriers exist such as wealth, education, and physical ability restricting people’s accessibility to nature and associated artworks. An AI-based Biophilic arts curation and personalised recommendation system were developed in this study to improve accessibility to biophilic arts. Existing Biophilic research mainly focuses on building design principles, limited research exists to examine biophilic arts and associated emotional responses. In this paper, an interdisciplinary study addresses this gap by developing metrics for Biophilic art attributes and potential emotional responses, drawing on existing Biophilic architecture attributes and PANAS items. A public survey of 200 participants was developed in this study. The survey collected art viewers’ ratings of Biophilic attributes and associated emotional responses to establish statistical correlations between Biophilic attributes and emotional responses. The statistical analysis established a positive correlation between Biophilic attributes and positive emotions. The public survey results show significant positive emotional impacts (p-value $<0.05$) after exposure to Biophilic images, supporting further research and development of the Biophilic art curation system. This digital curation system employs Computer Vision algorithms (ResNet50) to automate Biophilic art categorisation and generate personalised recommendations. This study emphasises the importance of integrating nature into built environments. It proposes that artificial intelligence could significantly enhance the categorisation and recommendation of Biophilic art, advocating for expanding Biophilic art databases for emotionally responsive art display systems, benefiting mental health, and making art more accessible. Full article