Dear Editor,Systemic sclerosis(SSc)is an autoimmune connective tissue disease in which there are vascular abnormalities,inflammation,and fibrosis[1].These three characteristics primarily affect the skin and lungs.Of a...Dear Editor,Systemic sclerosis(SSc)is an autoimmune connective tissue disease in which there are vascular abnormalities,inflammation,and fibrosis[1].These three characteristics primarily affect the skin and lungs.Of all the autoimmune rheumatic diseases,SSc has the highest all-cause mortality rate,and the underlying pathogenic processes that mediate disease are still obscure,with wide diff erences in presentation and progression[2,3].展开更多
Background:Pressure injury(PI)is a prevalent complication in pediatric cardiac surgery,with higher incidence than in general pediatric populations due to children’s thin skin,underdeveloped subcutaneous tissue,and pr...Background:Pressure injury(PI)is a prevalent complication in pediatric cardiac surgery,with higher incidence than in general pediatric populations due to children’s thin skin,underdeveloped subcutaneous tissue,and prolonged intraoperative pressure.Objective:To evaluate the effectiveness of the curvilinear supine position(CSP)in preventing PI among children undergoing congenital heart disease(CHD)surgery.Methods:Between October 2024 and February 2025,a single-center randomized controlled trial was conducted.Of the 80 children initially enrolled for congenital heart disease(CHD)surgery,77(aged 1 month to 14 years)completed the study and were included in the final analysis after 3 were excluded due to protocol violations.Participants were randomly assigned to the CSP group(n=38)or the conventional supine position group(n=39).Results:The incidence of PI was significantly lower in the CSP group(2.6%)compared to the control group(20.5%)(p=0.029).Postoperative LDH levels were also significantly reduced in the CSP group(422.67±86.52 U/L vs.592.92±215.71 U/L;p=0.031),while preoperative LDH and surgical variables(e.g.,cardiopulmonary bypass time)were comparable between groups.Although the CSP group had a shorter hospital stay(17.24 vs.22.51 days),the difference was not statistically significant(p=0.085).Caregiver satisfaction was significantly higher in the CSP group(100.0%vs.84.6%;p=0.025).Conclusion:CSP effectively reduces PI incidence,mitigates tissue injury,and enhances caregiver satisfaction in pediatric cardiac surgery,offering a safe and feasible strategy for perioperative PI prevention.展开更多
The issue of resistance reduction through hull ventilation is of particular interest in contemporary research.This paper presents multiphase computational fluid dynamics(CFD)simulations with 2-DOF motion of a planing ...The issue of resistance reduction through hull ventilation is of particular interest in contemporary research.This paper presents multiphase computational fluid dynamics(CFD)simulations with 2-DOF motion of a planing hull.The original hull was modified by introducing a step to allow air ventilation.Following an assessment of the hull performance,a simulation campaign in calm water was conducted to characterize the hull at various forward speeds and air insufflation rates for a defined single step geometry.Geometric analysis of the air layer thickness beneath the hull for each simulated condition was performed using a novel method for visualizing local air thickness.Additionally,two new parameters were introduced to understand the influence of spray rails on the air volume beneath the hull and to indicate the primary direction of ventilated air escape.A validation campaign and an assessment of uncertainty of the simulation has been conducted.The features offered by the CFD methodology include the evaluation of the air layer thickness as a function of hull velocity and injection flow rate and the air volume distribution beneath the hull.The air injection velocity can be adjusted across various operating conditions,thereby preventing performance or efficiency loss during navigation.Based on these findings,the study highlights the benefits of air insufflation in reducing hull resistance for high-speed planing vessels.This work lays a robust foundation for future research and new promising topics,as the exploration of air insufflation continues to be a topic of contemporary interest within naval architecture and hydrodynamics.展开更多
The airborne diffusion of saliva droplets during respiratory activities is one of the major factors in the spread of infections.During the COVID-19 pandemic,the use of protective face masks was essential to reduce the...The airborne diffusion of saliva droplets during respiratory activities is one of the major factors in the spread of infections.During the COVID-19 pandemic,the use of protective face masks was essential to reduce the risk of infection and spread of SARS-CoV-2.The face mask is able to significantly reduce the saliva droplet emission in front of the person.However,the use of masks also produces a particle leakage towards the back of the person,which could increase the infection risk of people behind the subject.Most of the experimental investigations applied invasive and/or complex experimental techniques to evaluate the face masks leakage.The primary objective of this study is to develop a novel,non-invasive methodology for assessing rearward droplet emission associated with the use of protective face masks.Specifically,a thermographic analysis of the thermal footprint released during ordinary and extraordinary respiratory activities is presented,evaluating the maximum temperature,the detection time,and the spread area of the thermal footprint.Both surgical and FFP2 face masks were tested.Two different subjects were involved in the experimentation to evaluate the influence of face conformation.The findings indicate that the area influenced by droplet dispersion is larger when wearing a surgical mask compared to an FFP2 mask,with the highest recorded temperatures observed for the surgical mask.The thermal footprint was found to be strongly dependent on individual facial morphology and mask fit.Notably,the FFP2 mask also altered the position of the thermal footprint,which was primarily confined to the region near the neck.展开更多
Sustainable forest management practices frequently confront the tension between economic viability and conservation objectives,particularly where forests occur in environmentally sensitive zones.The use of skidders in...Sustainable forest management practices frequently confront the tension between economic viability and conservation objectives,particularly where forests occur in environmentally sensitive zones.The use of skidders in protected areas is an essential solution for enabling timber harvesting in environments where the establishment of new skidding trails is either prohibited or highly restricted.These machines are the most used timber extraction machines in Central and Eastern Europe,and cable/adapted skidders are used to increase productivity and to reduce labor.This study compared the work cycles,productivity and costs of four types of skidders working in similar coniferous stands:a dedicated cable skidder,a dedicated cable-grapple skidder,a dedicated grapple skidder and an adapted skidder.The comparison of delay-free work cycles of the four skidders showed the largest share is occupied by travel loaded.The cable-grapple skidder had the highest average speed of 5.6 km h^(-1),followed by the grapple skidder at 3.97 km h^(-1),the cable skidder at 3.79 km h^(-1),and the adapted skidder with an average speed of 3.31 km h^(-1).The average delay-free productivity of the study skidders is highest for the adapted skidder,followed by the grapple skidder with a slightly lower rate,the cable-grapple skidder,and the cable skidder.In conclusion,the average payload of the grapple skidder and the cable grapple skidder is less than the maximum payload of the machine.This is due to the narrow skidding roads and because these skidders are not suitable for the specific site-selective felling with marked single and small groups of trees.The dedicated cable skidders and the adapted cable skidder are very close in productivity.The average productivity of dedicated cable skidders was 17.7 m^(3) h^(-1),while the productivity of the adapted skidder is 14.5 m^(3) h^(-1).Considering this,adapted skidders could be a good solution for improving economic productivity in sensitive forests.展开更多
Endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy remains a challenging field in therapeutic endoscopy due to the complex anatomical reconstructions that limit access to t...Endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy remains a challenging field in therapeutic endoscopy due to the complex anatomical reconstructions that limit access to the biliary tree.Over the past two decades,device-assisted enteroscopy(DAE),including singleballoon,double-balloon,and motorized spiral enteroscopy,has expanded the feasibility of ERCP in this population,with overall technical success rates generally reported between 70%and 90%.Nevertheless,these techniques are technically demanding,time-consuming,and frequently affected by limited reach and unstable positioning.More recently,interventional endoscopic ultrasound(EUS)-guided procedures have emerged as highly effective alternatives,significantly improving clinical outcomes in selected patients,particularly in those with long-limb Roux-en-Y reconstructions where conventional methods are less effective.Percutaneous transhepatic biliary drainage continues to represent a valuable salvage option when endoscopic approaches fail,though it is associated with a greater burden of reinterventions and adverse events.This minireview provides a comprehensive overview of the main endoscopic strategies for biliary drainage in altered anatomy,focusing on technical considerations,efficacy,and safety profiles of DAE-assisted ERCP,EUS-guided interventions,and motorized systems.The evolving landscape of biliary drainage in this setting highlights the need for tailored treatment strategies,multidisciplinary collaboration,referral to high-volume centers,and further prospective studies to refine patient selection and optimize clinical outcomes.展开更多
BACKGROUND The CAR-OLT score predicts major adverse cardiovascular events 1 year after liver transplant(LT).AIM To test the hypothesis that the CAR-OLT score may help avoid cardiac stress tests in LT candidates.METHOD...BACKGROUND The CAR-OLT score predicts major adverse cardiovascular events 1 year after liver transplant(LT).AIM To test the hypothesis that the CAR-OLT score may help avoid cardiac stress tests in LT candidates.METHODS This retrospective single-center cohort study included all adult patients undergoing elective evaluation for first cadaveric donor orthotopic LT for liver cirrhosis with or without hepatocellular carcinoma at Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricerca e Cura a Carattere Scientifico in Rome,Italy.Cardiac contraindications for LT listing were defined after a center-specific cardiac workup,which included cardiac stress tests for most patients.The diagnostic accuracy of the CAR-OLT score was evaluated using the area under the receiver operating characteristic(AUROC)method.RESULTS A total of 342 LT candidates were evaluated between 2015 and 2019,with a moderate cardiovascular risk profile(37%diabetes,34%hypertension,22%obesity).Of these,80(23%)candidates underwent coronary angiography.Twenty-one(6%)candidates were given cardiac contraindications to LT listing,48%of which were due to coronary artery disease.The CAR-OLT score predicted cardiac contraindications to LT listing with an AUROC of 0.81.The optimal cut-off for sensitivity was a CAR-OLT score≤23,which showed a 99%negative predictive value for cardiac contraindications to LT listing.A total of 84(25%)LT candidates with a CAR-OLT score≤23 underwent 87 non-invasive cardiac tests and 13 coronary angiographies pre-listing,with estimated costs of approximately 48000€.The estimated savings per patient was€574.70 for the Italian National Health System.CONCLUSION A CAR-OLT score≤23 can identify LT candidates who can be safely listed without the need for cardiac stress tests,providing time and cost savings.These findings require external validation.展开更多
Amyotrophic lateral sclerosis(ALS)is a neuromuscular condition resulting from the progressive degeneration of motor neurons in the cortex,brainstem,and spinal cord.While the typical clinical phenotype of ALS involves ...Amyotrophic lateral sclerosis(ALS)is a neuromuscular condition resulting from the progressive degeneration of motor neurons in the cortex,brainstem,and spinal cord.While the typical clinical phenotype of ALS involves both upper and lower motor neurons,human and animal studies over the years have highlighted the potential spread to other motor and non-motor regions,expanding the phenotype of ALS.Although superoxide dismutase 1(SOD1)mutations represent a minority of ALS cases,the SOD1 gene remains a milestone in ALS research as it represents the first genetic target for personalized therapies.Despite numerous single case reports or case series exhibiting extramotor symptoms in patients with ALS mutations in SOD1(SOD1-ALS),no studies have comprehensively explored the full spectrum of extramotor neurological manifestations in this subpopulation.In this narrative review,we analyze and discuss the available literature on extrapyramidal and non-motor features during SOD1-ALS.The multifaceted expression of SOD1 could deepen our understanding of the pathogenic mechanisms,pointing towards a multidisciplinary approach for affected patients in light of new therapeutic strategies for SOD1-ALS.展开更多
Six aryl-and pyridine-substituted nitronyl-nitroxide radicals were synthesized and characterized to investigate their optical anisotropic properties.Single-crystal X-ray diffraction analysis revealed molecular packing...Six aryl-and pyridine-substituted nitronyl-nitroxide radicals were synthesized and characterized to investigate their optical anisotropic properties.Single-crystal X-ray diffraction analysis revealed molecular packing organized by either halogen and hydrogen bonding or hydrogen bonding alone.Single-crystal electronic absorption spectra in the visible region of three studied radicals exhibit pronounced linear dichroism,while single crystals of other radicals do not demonstrate this property.Time-dependent DFT and ab initio calculations were employed to determine the transition dipole moment(TDM)vectors corresponding to the long-wavelength absorption bands.For all radicals,these vectors are found to be practically parallel to the O⋯O direction of the nitronyl-nitroxide chromophore.Correlation between the dichroic properties and crystal structure was established through comprehensive analysis of TDM vector orientations relative to the crystal surface.The strongest dichroic effect was observed in crystals where all projections of the TDM vectors onto the illuminated face are parallel to each other,while weaker or absent effects correspond to non-parallel arrangements.This study constitutes the first systematic investigation of linear dichroism in paramagnetic organic crystals,thereby establishing new avenues for developing multifunctional materials that respond to both optical and magnetic stimuli.展开更多
Additive manufacturing(AM)has emerged as one of the most utilized processes in manufacturing due to its ability to produce complex geometries with minimal material waste and greater design freedom.Laser-based AM(LAM)t...Additive manufacturing(AM)has emerged as one of the most utilized processes in manufacturing due to its ability to produce complex geometries with minimal material waste and greater design freedom.Laser-based AM(LAM)technologies use high-power lasers to melt metallic materials,which then solidify to form parts.However,it inherently induces self-equilibrating residual stress during fabrication due to thermal loads and plastic deformation.These residual stresses can cause defects such as delamination,cracking,and distortion,as well as premature failure under service conditions,necessitating mitigation.While post-treatment methods can reduce residual stresses,they are often costly and time-consuming.Therefore,tuning the fabrication process parameters presents a more feasible approach.Accordingly,in addition to providing a comprehensive view of residual stress by their classification,formation mechanisms,measurement methods,and common post-treatment,this paper reviews and compares the studies conducted on the effect of key parameters of the LAM process on the resulting residual stresses.This review focuses on proactively adjusting LAM process parameters as a strategic approach to mitigate residual stress formation.It provides a result of the various parameters influencing residual stress outcomes,such as laser power,scanning speed,beam diameter,hatch spacing,and scanning strategies.Finally,the paper identifies existing research gaps and proposes future studies needed to deepen understanding of the relationship between process parameters and residual stress mitigation in LAM.展开更多
Additive manufacturing(AM),as an advanced manufacturing technology,enables the production of personalized orthopedic implant devices with complex geometries that closely resemble bone structures.Titanium and its alloy...Additive manufacturing(AM),as an advanced manufacturing technology,enables the production of personalized orthopedic implant devices with complex geometries that closely resemble bone structures.Titanium and its alloys are extensively employed in biomedical fields like orthopedics and dentistry,thanks to the excellent compatibility with the human body and high corrosion resistance due to the existence of a thin protective oxide layer known as TiO_(2) upon exposure to oxygen on the surface.However,in joint inflammation,reactive oxygen species like hydrogen peroxide and radicals can damage the passive film on Ti implants,leading to their deterioration.Although AM technology for metallic implants is still developing,advancements in printing and new alloys are crucial for widespread use.This work aims to investigate the corrosion resistance of in-situ alloyed Ti536(Ti5Al3V6Cu)alloy produced through electron beam powder bed fusion(EB-PBF)under simulated peri-implant inflammatory conditions.The corrosion resistance was evaluated using electrochemical experiments conducted in the presence of 0.1%H_(2)O_(2) in a physiological saline solution(0.9%NaCl)to replicate the conditions that may occur during post-operative inflammation.The findings demonstrate that the micro-environment surrounding the implant during peri-implant inflammation is highly corrosive and can lead to the degradation of the TiO_(2) passive layer.Physiological saline with H_(2)O_(2) significantly increased biomaterial open circuit potential up to 0.36 mV vs.Ag/AgCl compared to physiological saline only.Potentiodynamic polarization(PDP)plots confirm this increase,as well.The PDP and electrochemical impedance spectroscopy(EIS)tests indicated that adding Cu does not impact the corrosion resistance of the Ti536 alloy initially under simulated inflammatory conditions,but prolonged immersion leads to enhanced corrosion resistance for all biomaterials tested,indicating the formation of an oxide layer after the reduction of the solution oxidizing power.These results suggest that modifying custom alloys by adding appropriate elements significantly enhances corrosion resistance,particularly in inflammatory conditions.展开更多
Pulse pile-up is a problem in nuclear spectroscopy and nuclear reaction studies that occurs when two pulses overlap and distort each other,degrading the quality of energy and timing information.Different methods have ...Pulse pile-up is a problem in nuclear spectroscopy and nuclear reaction studies that occurs when two pulses overlap and distort each other,degrading the quality of energy and timing information.Different methods have been used for pile-up rejection,both digital and analogue,but some pile-up events may contain pulses of interest and need to be reconstructed.The paper proposes a new method for reconstructing pile-up events acquired with a neutron detector array(NEDA)using an one-dimensional convolutional autoencoder(1D-CAE).The datasets for training and testing the 1D-CAE are created from data acquired from the NEDA.The new pile-up signal reconstruction method is evaluated from the point of view of how similar the reconstructed signals are to the original ones.Furthermore,it is analysed considering the result of the neutron-gamma discrimination based on charge comparison,comparing the result obtained from original and reconstructed signals.展开更多
Pamiparib is a potent and selective oral poly(adenosine diphosphate(ADP)-ribose)-polymerase(PARP)1/2inhibitor(PARPi).Pamiparib has good bioavailability and shows greater cytotoxic potency and similar DNA-trapping capa...Pamiparib is a potent and selective oral poly(adenosine diphosphate(ADP)-ribose)-polymerase(PARP)1/2inhibitor(PARPi).Pamiparib has good bioavailability and shows greater cytotoxic potency and similar DNA-trapping capacity compared to olaparib.It is not affected by adenosine triphosphate(ATP)-binding cassette transporters.展开更多
Transcatheter intervention allows to deal with multiple cardiovascular diseases1 in patients with impaired clinical conditions and burdened with multiple comorbidities,both with the advantage of planning number and mo...Transcatheter intervention allows to deal with multiple cardiovascular diseases1 in patients with impaired clinical conditions and burdened with multiple comorbidities,both with the advantage of planning number and modalities of the interventions and deciding,where possible,to realize them in a single session.Here we describe the case of a patient affected by severe aortic stenosis and associated cardiac comorbidities(coronary artery disease,atrial fibrillation and left appendage thrombosis)that needed a multimodal clinical and interventional strategy to lead him to the best clinical condition for performing transcatheter aortic valve implantation(TAVI).展开更多
Heat shock protein family B(small)member 8(HSPB8)is a 22 kDa ubiquitously expressed protein belonging to the family of small heat shock proteins.HSPB8 is involved in various cellular mechanisms mainly related to prote...Heat shock protein family B(small)member 8(HSPB8)is a 22 kDa ubiquitously expressed protein belonging to the family of small heat shock proteins.HSPB8 is involved in various cellular mechanisms mainly related to proteotoxic stress response and in other processes such as inflammation,cell division,and migration.HSPB8 binds misfolded clients to prevent their aggregation by assisting protein refolding or degradation through chaperone-assisted selective autophagy.In line with this function,the pro-degradative activity of HSPB8 has been found protective in several neurodegenerative and neuromuscular diseases characterized by protein misfolding and aggregation.In cancer,HSPB8 has a dual role being capable of exerting either a pro-or an anti-tumoral activity depending on the pathways and factors expressed by the model of cancer under investigation.Moreover,HSPB8 exerts a protective function in different diseases by modulating the inflammatory response,which characterizes not only neurodegenerative diseases,but also other chronic or acute conditions affecting the nervous system,such as multiple sclerosis and intracerebellar hemorrhage.Of note,HSPB8 modulation may represent a therapeutic approach in other neurological conditions that develop as a secondary consequence of other diseases.This is the case of cognitive impairment related to diabetes mellitus,in which HSPB8 exerts a protective activity by assuring mitochondrial homeostasis.This review aims to summarize the diverse and multiple functions of HSPB8 in different pathological conditions,focusing on the beneficial effects of its modulation.Drug-based and alternative therapeutic approaches targeting HSPB8 and its regulated pathways will be discussed,emphasizing how new strategies for cell and tissue-specific delivery represent an avenue to advance in disease treatments.展开更多
This paper presents a thermophysical study approach for a pure environmental control system(ECS),incorporating the geometric dimensions of heat exchangers,ram air duct,and air cycle machine(ACM)blades of the Sabreline...This paper presents a thermophysical study approach for a pure environmental control system(ECS),incorporating the geometric dimensions of heat exchangers,ram air duct,and air cycle machine(ACM)blades of the Sabreliner’s environmental control system.Real flight scenarios are simulated by considering flight input variables such as altitude,aircraft speed,compression ratio of the air cycle machine,and the mass flow rate of bleed air.The study evaluates the coefficient of performance(COP)of the environmental control system,the heat exchanger efficiencies,and the work distribution of the air cycle machine based on five flight scenarios,with a particular focus on considering the effects of humidity on environmental control system performance.The results demonstrate that at cruising altitude(11,000 m),air humidity conditions allow an increase in the COP of around 9.28%compared to dry conditions.Conversely,on land,humidity conditions reduce the performance by 4.26%compared to dry conditions.It was also found that the effects of humidity at high aircraft speeds become negligible.In general terms,the humidity conditions in the air proved to have positive effects on the environmental control system’s performance but negative effects on the heat exchanger efficiencies,reducing them by 0.22%.Additionally,land conditions reflect significant improvements in performance when the compression ratio of the air cycle machine is varied.Furthermore,in the work distribution of the air cycle machine,humidity conditions were demonstrated to consume 2.91%less work fromthe turbine compared to dry conditions.展开更多
AIM: To investigate the correlation between autoimmune thyroid diseases (ATDs) and the prevalence of Cag-A positive strains of Helicobacter pylori (H. pylori) in stool samples. METHODS: We investigated 112 consecutive...AIM: To investigate the correlation between autoimmune thyroid diseases (ATDs) and the prevalence of Cag-A positive strains of Helicobacter pylori (H. pylori) in stool samples. METHODS: We investigated 112 consecutive Caucasian patients (48 females and 4 males with Graves' disease and 54 females and 6 males with Hashimoto' s thyroiditis HT), at their first diagnosis of ATDs. We tested for H. pylori in stool samples using an amplified enzyme immunoassay and Cag-A in serum samples using an enzyme-linked immunoassay method (ELISA). The results were analyzed using the two-sided Fisher' s exact test and the respective odds ratio (OR) was calculated. RESULTS: A marked correlation was found between the presence of H. pylori (P ≤ 0.0001, OR 6.3) and, in particular, Cag-A positive strains (P ≤ 0.005, OR 5.3)in Graves' disease, but not in Hashimoto's thyroiditis, where we found only a correlation with Cag-A strains (P ≤ 0.005, OR 8.73) but not when H. pylori was present. CONCLUSION: The marked correlation between H. pylori and Cag-A, found in ATDs, could be dependent on the different expression of adhesion molecules in the gastric mucosa.展开更多
BACKGROUND Steatotic liver disease(SLD)including metabolic dysfunction-associated SLD is the most prevalent chronic liver disease worldwide and is strongly associated with metabolic dysfunction as well as chronic hepa...BACKGROUND Steatotic liver disease(SLD)including metabolic dysfunction-associated SLD is the most prevalent chronic liver disease worldwide and is strongly associated with metabolic dysfunction as well as chronic hepatitis C(CHC).AIM To compare the characteristics of patients with CHC virus infection and the treatment with direct-acting antivirals(DAAs),considering the presence of SLD comorbidity.METHODS The study included all consecutive hepatitis C virus-infected patients treated with pangenotypic DAA regimens at a single tertiary hepatology center in 2018-2024.SLD was diagnosed via abdominal ultrasound.RESULTS Among 688 patients included in the study,290(42.2%)had comorbid SLD.The highest prevalence(62.3%)was observed in patients infected with genotype 3.The SLD group was predominantly male(62.8%),in contrast to the non-SLD group,where women predominated.Patients with SLD were significantly older(P=0.0007),had a higher body mass index(P<0.0001),and more frequently pre-sented with diabetes(P=0.01),obesity(P<0.0001),hyperlipidemia(P=0.004),and a history of alcohol abuse(P<0.0001).They also had more advanced liver disease as indicated by a higher rate of cirrhosis(35.5%vs 12%in the non-SLD group,P<0.0001),elevated aminotransferase activity(P<0.0001),bilirubin concentration(P<0.0001),and international normalized ratio values(P=0.0001),and lower albumin concentration(P=0.0028).While most patients in both groups completed treatment as planned,adverse events,including severe events and deaths,were more frequent in the SLD group.A sustained virologic response was achieved in 97.6%of the overall population but was significantly lower among patients with SLD compared to the non-SLD group(95.6%vs 99.0%,P=0.0081).However,logistic regression analysis did not identify SLD as an independent predictor of treatment failure.CONCLUSION Comorbid SLD was common among CHC patients treated with DAAs and was associated with adverse baseline characteristics,including older age,higher body mass index,greater comorbidity burden,and more advanced liver disease.Although SLD patients achieved slightly lower rates of sustained virologic response,SLD itself was not an independent predictor of treatment failure.These findings suggest that poorer treatment outcomes in this subgroup are largely attributable to coexisting risk factors rather than SLD per se,highlighting the need for comprehensive management of metabolic and liver-related comorbidities to optimize antiviral therapy outcomes.展开更多
文摘Dear Editor,Systemic sclerosis(SSc)is an autoimmune connective tissue disease in which there are vascular abnormalities,inflammation,and fibrosis[1].These three characteristics primarily affect the skin and lungs.Of all the autoimmune rheumatic diseases,SSc has the highest all-cause mortality rate,and the underlying pathogenic processes that mediate disease are still obscure,with wide diff erences in presentation and progression[2,3].
文摘Background:Pressure injury(PI)is a prevalent complication in pediatric cardiac surgery,with higher incidence than in general pediatric populations due to children’s thin skin,underdeveloped subcutaneous tissue,and prolonged intraoperative pressure.Objective:To evaluate the effectiveness of the curvilinear supine position(CSP)in preventing PI among children undergoing congenital heart disease(CHD)surgery.Methods:Between October 2024 and February 2025,a single-center randomized controlled trial was conducted.Of the 80 children initially enrolled for congenital heart disease(CHD)surgery,77(aged 1 month to 14 years)completed the study and were included in the final analysis after 3 were excluded due to protocol violations.Participants were randomly assigned to the CSP group(n=38)or the conventional supine position group(n=39).Results:The incidence of PI was significantly lower in the CSP group(2.6%)compared to the control group(20.5%)(p=0.029).Postoperative LDH levels were also significantly reduced in the CSP group(422.67±86.52 U/L vs.592.92±215.71 U/L;p=0.031),while preoperative LDH and surgical variables(e.g.,cardiopulmonary bypass time)were comparable between groups.Although the CSP group had a shorter hospital stay(17.24 vs.22.51 days),the difference was not statistically significant(p=0.085).Caregiver satisfaction was significantly higher in the CSP group(100.0%vs.84.6%;p=0.025).Conclusion:CSP effectively reduces PI incidence,mitigates tissue injury,and enhances caregiver satisfaction in pediatric cardiac surgery,offering a safe and feasible strategy for perioperative PI prevention.
基金supported by European Union funding(PON“Ricerca e Innovazione”2014‒2020).
文摘The issue of resistance reduction through hull ventilation is of particular interest in contemporary research.This paper presents multiphase computational fluid dynamics(CFD)simulations with 2-DOF motion of a planing hull.The original hull was modified by introducing a step to allow air ventilation.Following an assessment of the hull performance,a simulation campaign in calm water was conducted to characterize the hull at various forward speeds and air insufflation rates for a defined single step geometry.Geometric analysis of the air layer thickness beneath the hull for each simulated condition was performed using a novel method for visualizing local air thickness.Additionally,two new parameters were introduced to understand the influence of spray rails on the air volume beneath the hull and to indicate the primary direction of ventilated air escape.A validation campaign and an assessment of uncertainty of the simulation has been conducted.The features offered by the CFD methodology include the evaluation of the air layer thickness as a function of hull velocity and injection flow rate and the air volume distribution beneath the hull.The air injection velocity can be adjusted across various operating conditions,thereby preventing performance or efficiency loss during navigation.Based on these findings,the study highlights the benefits of air insufflation in reducing hull resistance for high-speed planing vessels.This work lays a robust foundation for future research and new promising topics,as the exploration of air insufflation continues to be a topic of contemporary interest within naval architecture and hydrodynamics.
文摘The airborne diffusion of saliva droplets during respiratory activities is one of the major factors in the spread of infections.During the COVID-19 pandemic,the use of protective face masks was essential to reduce the risk of infection and spread of SARS-CoV-2.The face mask is able to significantly reduce the saliva droplet emission in front of the person.However,the use of masks also produces a particle leakage towards the back of the person,which could increase the infection risk of people behind the subject.Most of the experimental investigations applied invasive and/or complex experimental techniques to evaluate the face masks leakage.The primary objective of this study is to develop a novel,non-invasive methodology for assessing rearward droplet emission associated with the use of protective face masks.Specifically,a thermographic analysis of the thermal footprint released during ordinary and extraordinary respiratory activities is presented,evaluating the maximum temperature,the detection time,and the spread area of the thermal footprint.Both surgical and FFP2 face masks were tested.Two different subjects were involved in the experimentation to evaluate the influence of face conformation.The findings indicate that the area influenced by droplet dispersion is larger when wearing a surgical mask compared to an FFP2 mask,with the highest recorded temperatures observed for the surgical mask.The thermal footprint was found to be strongly dependent on individual facial morphology and mask fit.Notably,the FFP2 mask also altered the position of the thermal footprint,which was primarily confined to the region near the neck.
基金supported by the inter-institutional agreement between the University of Forestry (Bulgaria)the Mediterranean University of Reggio Calabria (Italy)by the Ph.D. course “Agricultural, Food and Forestry Science” of the Mediterranean University of Reggio Calabria (Italy)—XXXIX cycle。
文摘Sustainable forest management practices frequently confront the tension between economic viability and conservation objectives,particularly where forests occur in environmentally sensitive zones.The use of skidders in protected areas is an essential solution for enabling timber harvesting in environments where the establishment of new skidding trails is either prohibited or highly restricted.These machines are the most used timber extraction machines in Central and Eastern Europe,and cable/adapted skidders are used to increase productivity and to reduce labor.This study compared the work cycles,productivity and costs of four types of skidders working in similar coniferous stands:a dedicated cable skidder,a dedicated cable-grapple skidder,a dedicated grapple skidder and an adapted skidder.The comparison of delay-free work cycles of the four skidders showed the largest share is occupied by travel loaded.The cable-grapple skidder had the highest average speed of 5.6 km h^(-1),followed by the grapple skidder at 3.97 km h^(-1),the cable skidder at 3.79 km h^(-1),and the adapted skidder with an average speed of 3.31 km h^(-1).The average delay-free productivity of the study skidders is highest for the adapted skidder,followed by the grapple skidder with a slightly lower rate,the cable-grapple skidder,and the cable skidder.In conclusion,the average payload of the grapple skidder and the cable grapple skidder is less than the maximum payload of the machine.This is due to the narrow skidding roads and because these skidders are not suitable for the specific site-selective felling with marked single and small groups of trees.The dedicated cable skidders and the adapted cable skidder are very close in productivity.The average productivity of dedicated cable skidders was 17.7 m^(3) h^(-1),while the productivity of the adapted skidder is 14.5 m^(3) h^(-1).Considering this,adapted skidders could be a good solution for improving economic productivity in sensitive forests.
文摘Endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy remains a challenging field in therapeutic endoscopy due to the complex anatomical reconstructions that limit access to the biliary tree.Over the past two decades,device-assisted enteroscopy(DAE),including singleballoon,double-balloon,and motorized spiral enteroscopy,has expanded the feasibility of ERCP in this population,with overall technical success rates generally reported between 70%and 90%.Nevertheless,these techniques are technically demanding,time-consuming,and frequently affected by limited reach and unstable positioning.More recently,interventional endoscopic ultrasound(EUS)-guided procedures have emerged as highly effective alternatives,significantly improving clinical outcomes in selected patients,particularly in those with long-limb Roux-en-Y reconstructions where conventional methods are less effective.Percutaneous transhepatic biliary drainage continues to represent a valuable salvage option when endoscopic approaches fail,though it is associated with a greater burden of reinterventions and adverse events.This minireview provides a comprehensive overview of the main endoscopic strategies for biliary drainage in altered anatomy,focusing on technical considerations,efficacy,and safety profiles of DAE-assisted ERCP,EUS-guided interventions,and motorized systems.The evolving landscape of biliary drainage in this setting highlights the need for tailored treatment strategies,multidisciplinary collaboration,referral to high-volume centers,and further prospective studies to refine patient selection and optimize clinical outcomes.
文摘BACKGROUND The CAR-OLT score predicts major adverse cardiovascular events 1 year after liver transplant(LT).AIM To test the hypothesis that the CAR-OLT score may help avoid cardiac stress tests in LT candidates.METHODS This retrospective single-center cohort study included all adult patients undergoing elective evaluation for first cadaveric donor orthotopic LT for liver cirrhosis with or without hepatocellular carcinoma at Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricerca e Cura a Carattere Scientifico in Rome,Italy.Cardiac contraindications for LT listing were defined after a center-specific cardiac workup,which included cardiac stress tests for most patients.The diagnostic accuracy of the CAR-OLT score was evaluated using the area under the receiver operating characteristic(AUROC)method.RESULTS A total of 342 LT candidates were evaluated between 2015 and 2019,with a moderate cardiovascular risk profile(37%diabetes,34%hypertension,22%obesity).Of these,80(23%)candidates underwent coronary angiography.Twenty-one(6%)candidates were given cardiac contraindications to LT listing,48%of which were due to coronary artery disease.The CAR-OLT score predicted cardiac contraindications to LT listing with an AUROC of 0.81.The optimal cut-off for sensitivity was a CAR-OLT score≤23,which showed a 99%negative predictive value for cardiac contraindications to LT listing.A total of 84(25%)LT candidates with a CAR-OLT score≤23 underwent 87 non-invasive cardiac tests and 13 coronary angiographies pre-listing,with estimated costs of approximately 48000€.The estimated savings per patient was€574.70 for the Italian National Health System.CONCLUSION A CAR-OLT score≤23 can identify LT candidates who can be safely listed without the need for cardiac stress tests,providing time and cost savings.These findings require external validation.
文摘Amyotrophic lateral sclerosis(ALS)is a neuromuscular condition resulting from the progressive degeneration of motor neurons in the cortex,brainstem,and spinal cord.While the typical clinical phenotype of ALS involves both upper and lower motor neurons,human and animal studies over the years have highlighted the potential spread to other motor and non-motor regions,expanding the phenotype of ALS.Although superoxide dismutase 1(SOD1)mutations represent a minority of ALS cases,the SOD1 gene remains a milestone in ALS research as it represents the first genetic target for personalized therapies.Despite numerous single case reports or case series exhibiting extramotor symptoms in patients with ALS mutations in SOD1(SOD1-ALS),no studies have comprehensively explored the full spectrum of extramotor neurological manifestations in this subpopulation.In this narrative review,we analyze and discuss the available literature on extrapyramidal and non-motor features during SOD1-ALS.The multifaceted expression of SOD1 could deepen our understanding of the pathogenic mechanisms,pointing towards a multidisciplinary approach for affected patients in light of new therapeutic strategies for SOD1-ALS.
基金supported by the Russian Science Foundation(No.24-73-10026)https://rscf.ru/en/project/24-73-10026/Investigation of dichroic properties was supported by Ministry of Science and Higher Education of the Russian Federation(No.075-03-2024-118/1)+2 种基金The computational part of this work was supported by the Ministry of Science and Higher Education of the Russian Federation(No.AAAA-A21-121011390040-4)SCXRD experiments were supported by the Ministry of Science and Higher Education of the Russian Federation(No.125021302132-4)The measurement of the solid state electronic absorption spectra was supported by the Ministry of Science and Higher Education of the Russian Federation(No.AAAAA-A21-1210112290043-3).
文摘Six aryl-and pyridine-substituted nitronyl-nitroxide radicals were synthesized and characterized to investigate their optical anisotropic properties.Single-crystal X-ray diffraction analysis revealed molecular packing organized by either halogen and hydrogen bonding or hydrogen bonding alone.Single-crystal electronic absorption spectra in the visible region of three studied radicals exhibit pronounced linear dichroism,while single crystals of other radicals do not demonstrate this property.Time-dependent DFT and ab initio calculations were employed to determine the transition dipole moment(TDM)vectors corresponding to the long-wavelength absorption bands.For all radicals,these vectors are found to be practically parallel to the O⋯O direction of the nitronyl-nitroxide chromophore.Correlation between the dichroic properties and crystal structure was established through comprehensive analysis of TDM vector orientations relative to the crystal surface.The strongest dichroic effect was observed in crystals where all projections of the TDM vectors onto the illuminated face are parallel to each other,while weaker or absent effects correspond to non-parallel arrangements.This study constitutes the first systematic investigation of linear dichroism in paramagnetic organic crystals,thereby establishing new avenues for developing multifunctional materials that respond to both optical and magnetic stimuli.
文摘Additive manufacturing(AM)has emerged as one of the most utilized processes in manufacturing due to its ability to produce complex geometries with minimal material waste and greater design freedom.Laser-based AM(LAM)technologies use high-power lasers to melt metallic materials,which then solidify to form parts.However,it inherently induces self-equilibrating residual stress during fabrication due to thermal loads and plastic deformation.These residual stresses can cause defects such as delamination,cracking,and distortion,as well as premature failure under service conditions,necessitating mitigation.While post-treatment methods can reduce residual stresses,they are often costly and time-consuming.Therefore,tuning the fabrication process parameters presents a more feasible approach.Accordingly,in addition to providing a comprehensive view of residual stress by their classification,formation mechanisms,measurement methods,and common post-treatment,this paper reviews and compares the studies conducted on the effect of key parameters of the LAM process on the resulting residual stresses.This review focuses on proactively adjusting LAM process parameters as a strategic approach to mitigate residual stress formation.It provides a result of the various parameters influencing residual stress outcomes,such as laser power,scanning speed,beam diameter,hatch spacing,and scanning strategies.Finally,the paper identifies existing research gaps and proposes future studies needed to deepen understanding of the relationship between process parameters and residual stress mitigation in LAM.
基金Open access funding provided by Politecnico di Torino within the CRUI-CARE Agreement.
文摘Additive manufacturing(AM),as an advanced manufacturing technology,enables the production of personalized orthopedic implant devices with complex geometries that closely resemble bone structures.Titanium and its alloys are extensively employed in biomedical fields like orthopedics and dentistry,thanks to the excellent compatibility with the human body and high corrosion resistance due to the existence of a thin protective oxide layer known as TiO_(2) upon exposure to oxygen on the surface.However,in joint inflammation,reactive oxygen species like hydrogen peroxide and radicals can damage the passive film on Ti implants,leading to their deterioration.Although AM technology for metallic implants is still developing,advancements in printing and new alloys are crucial for widespread use.This work aims to investigate the corrosion resistance of in-situ alloyed Ti536(Ti5Al3V6Cu)alloy produced through electron beam powder bed fusion(EB-PBF)under simulated peri-implant inflammatory conditions.The corrosion resistance was evaluated using electrochemical experiments conducted in the presence of 0.1%H_(2)O_(2) in a physiological saline solution(0.9%NaCl)to replicate the conditions that may occur during post-operative inflammation.The findings demonstrate that the micro-environment surrounding the implant during peri-implant inflammation is highly corrosive and can lead to the degradation of the TiO_(2) passive layer.Physiological saline with H_(2)O_(2) significantly increased biomaterial open circuit potential up to 0.36 mV vs.Ag/AgCl compared to physiological saline only.Potentiodynamic polarization(PDP)plots confirm this increase,as well.The PDP and electrochemical impedance spectroscopy(EIS)tests indicated that adding Cu does not impact the corrosion resistance of the Ti536 alloy initially under simulated inflammatory conditions,but prolonged immersion leads to enhanced corrosion resistance for all biomaterials tested,indicating the formation of an oxide layer after the reduction of the solution oxidizing power.These results suggest that modifying custom alloys by adding appropriate elements significantly enhances corrosion resistance,particularly in inflammatory conditions.
基金partially supported by MICIU MCIN/AEI/10.13039/501100011033Spain with grant PID2020-118265GB-C42,-C44,PRTR-C17.I01+1 种基金Generalitat Valenciana,Spain with grant CIPROM/2022/54,ASFAE/2022/031,CIAPOS/2021/114the EU NextGenerationEU,ESF funds,and the National Science Centre (NCN),Poland (grant No.2020/39/D/ST2/00466)
文摘Pulse pile-up is a problem in nuclear spectroscopy and nuclear reaction studies that occurs when two pulses overlap and distort each other,degrading the quality of energy and timing information.Different methods have been used for pile-up rejection,both digital and analogue,but some pile-up events may contain pulses of interest and need to be reconstructed.The paper proposes a new method for reconstructing pile-up events acquired with a neutron detector array(NEDA)using an one-dimensional convolutional autoencoder(1D-CAE).The datasets for training and testing the 1D-CAE are created from data acquired from the NEDA.The new pile-up signal reconstruction method is evaluated from the point of view of how similar the reconstructed signals are to the original ones.Furthermore,it is analysed considering the result of the neutron-gamma discrimination based on charge comparison,comparing the result obtained from original and reconstructed signals.
基金supported in part by funding from BeiGene,Ltd.,USA(Grant No.:KPR081)with additional support from the Alessandra Bono Foundation,Italy.
文摘Pamiparib is a potent and selective oral poly(adenosine diphosphate(ADP)-ribose)-polymerase(PARP)1/2inhibitor(PARPi).Pamiparib has good bioavailability and shows greater cytotoxic potency and similar DNA-trapping capacity compared to olaparib.It is not affected by adenosine triphosphate(ATP)-binding cassette transporters.
文摘Transcatheter intervention allows to deal with multiple cardiovascular diseases1 in patients with impaired clinical conditions and burdened with multiple comorbidities,both with the advantage of planning number and modalities of the interventions and deciding,where possible,to realize them in a single session.Here we describe the case of a patient affected by severe aortic stenosis and associated cardiac comorbidities(coronary artery disease,atrial fibrillation and left appendage thrombosis)that needed a multimodal clinical and interventional strategy to lead him to the best clinical condition for performing transcatheter aortic valve implantation(TAVI).
基金supported by:Fondazione Telethon-Italy(No.GGP19128 to AP)Fondazione Cariplo-Italy(No.2021-1544 to RC)+14 种基金Fondazione Italiana di Ricerca per la Sclerosi Laterale Amiotrofica(AriSLA)-Italy(No.MLOpathy to APTarget-RAN to AP)Association Française contre les Myopathies-France(AFM Telethon No.23236 to AP)Kennedy’s Disease Association-USA(2018 grant to RC2020 grant to MG)Ministero dell’Universitàe della Ricerca(MIUR)-Italy(PRIN-Progetti di ricerca di interesse nazionale(No.2017F2A2C5 to APNo.2022EFLFL8 to APNo.2020PBS5MJ to VCNo.2022KSJZF5 to VC)PRIN-Progetti di ricerca di interesse nazionale-bando 2022,PNRR finanziato dall’Unione europea-Next Generation EU,componente M4C2,investimento 1.1(No.P2022B5J32 to RC and No.P20225R4Y5 to VC)CN3:RNA-Codice Proposta:CN_00000041Tematica Sviluppo di terapia genica e farmaci con tecnologia a RNA(Centro Nazionale di Ricerca-CN3 National Center for Gene Therapy and Drugs based on RNA Technology to AP)Progetto Dipartimenti di Eccellenza(to DiSFeB)Ministero della Salute,Agenzia Italiana del Farmaco(AIFA)-Italy(Co_ALS to AP)Universitàdegli Studi di Milano(piano di sviluppo della ricerca(PSR)UNIMI-linea B(to RC and BT).
文摘Heat shock protein family B(small)member 8(HSPB8)is a 22 kDa ubiquitously expressed protein belonging to the family of small heat shock proteins.HSPB8 is involved in various cellular mechanisms mainly related to proteotoxic stress response and in other processes such as inflammation,cell division,and migration.HSPB8 binds misfolded clients to prevent their aggregation by assisting protein refolding or degradation through chaperone-assisted selective autophagy.In line with this function,the pro-degradative activity of HSPB8 has been found protective in several neurodegenerative and neuromuscular diseases characterized by protein misfolding and aggregation.In cancer,HSPB8 has a dual role being capable of exerting either a pro-or an anti-tumoral activity depending on the pathways and factors expressed by the model of cancer under investigation.Moreover,HSPB8 exerts a protective function in different diseases by modulating the inflammatory response,which characterizes not only neurodegenerative diseases,but also other chronic or acute conditions affecting the nervous system,such as multiple sclerosis and intracerebellar hemorrhage.Of note,HSPB8 modulation may represent a therapeutic approach in other neurological conditions that develop as a secondary consequence of other diseases.This is the case of cognitive impairment related to diabetes mellitus,in which HSPB8 exerts a protective activity by assuring mitochondrial homeostasis.This review aims to summarize the diverse and multiple functions of HSPB8 in different pathological conditions,focusing on the beneficial effects of its modulation.Drug-based and alternative therapeutic approaches targeting HSPB8 and its regulated pathways will be discussed,emphasizing how new strategies for cell and tissue-specific delivery represent an avenue to advance in disease treatments.
文摘This paper presents a thermophysical study approach for a pure environmental control system(ECS),incorporating the geometric dimensions of heat exchangers,ram air duct,and air cycle machine(ACM)blades of the Sabreliner’s environmental control system.Real flight scenarios are simulated by considering flight input variables such as altitude,aircraft speed,compression ratio of the air cycle machine,and the mass flow rate of bleed air.The study evaluates the coefficient of performance(COP)of the environmental control system,the heat exchanger efficiencies,and the work distribution of the air cycle machine based on five flight scenarios,with a particular focus on considering the effects of humidity on environmental control system performance.The results demonstrate that at cruising altitude(11,000 m),air humidity conditions allow an increase in the COP of around 9.28%compared to dry conditions.Conversely,on land,humidity conditions reduce the performance by 4.26%compared to dry conditions.It was also found that the effects of humidity at high aircraft speeds become negligible.In general terms,the humidity conditions in the air proved to have positive effects on the environmental control system’s performance but negative effects on the heat exchanger efficiencies,reducing them by 0.22%.Additionally,land conditions reflect significant improvements in performance when the compression ratio of the air cycle machine is varied.Furthermore,in the work distribution of the air cycle machine,humidity conditions were demonstrated to consume 2.91%less work fromthe turbine compared to dry conditions.
文摘AIM: To investigate the correlation between autoimmune thyroid diseases (ATDs) and the prevalence of Cag-A positive strains of Helicobacter pylori (H. pylori) in stool samples. METHODS: We investigated 112 consecutive Caucasian patients (48 females and 4 males with Graves' disease and 54 females and 6 males with Hashimoto' s thyroiditis HT), at their first diagnosis of ATDs. We tested for H. pylori in stool samples using an amplified enzyme immunoassay and Cag-A in serum samples using an enzyme-linked immunoassay method (ELISA). The results were analyzed using the two-sided Fisher' s exact test and the respective odds ratio (OR) was calculated. RESULTS: A marked correlation was found between the presence of H. pylori (P ≤ 0.0001, OR 6.3) and, in particular, Cag-A positive strains (P ≤ 0.005, OR 5.3)in Graves' disease, but not in Hashimoto's thyroiditis, where we found only a correlation with Cag-A strains (P ≤ 0.005, OR 8.73) but not when H. pylori was present. CONCLUSION: The marked correlation between H. pylori and Cag-A, found in ATDs, could be dependent on the different expression of adhesion molecules in the gastric mucosa.
文摘BACKGROUND Steatotic liver disease(SLD)including metabolic dysfunction-associated SLD is the most prevalent chronic liver disease worldwide and is strongly associated with metabolic dysfunction as well as chronic hepatitis C(CHC).AIM To compare the characteristics of patients with CHC virus infection and the treatment with direct-acting antivirals(DAAs),considering the presence of SLD comorbidity.METHODS The study included all consecutive hepatitis C virus-infected patients treated with pangenotypic DAA regimens at a single tertiary hepatology center in 2018-2024.SLD was diagnosed via abdominal ultrasound.RESULTS Among 688 patients included in the study,290(42.2%)had comorbid SLD.The highest prevalence(62.3%)was observed in patients infected with genotype 3.The SLD group was predominantly male(62.8%),in contrast to the non-SLD group,where women predominated.Patients with SLD were significantly older(P=0.0007),had a higher body mass index(P<0.0001),and more frequently pre-sented with diabetes(P=0.01),obesity(P<0.0001),hyperlipidemia(P=0.004),and a history of alcohol abuse(P<0.0001).They also had more advanced liver disease as indicated by a higher rate of cirrhosis(35.5%vs 12%in the non-SLD group,P<0.0001),elevated aminotransferase activity(P<0.0001),bilirubin concentration(P<0.0001),and international normalized ratio values(P=0.0001),and lower albumin concentration(P=0.0028).While most patients in both groups completed treatment as planned,adverse events,including severe events and deaths,were more frequent in the SLD group.A sustained virologic response was achieved in 97.6%of the overall population but was significantly lower among patients with SLD compared to the non-SLD group(95.6%vs 99.0%,P=0.0081).However,logistic regression analysis did not identify SLD as an independent predictor of treatment failure.CONCLUSION Comorbid SLD was common among CHC patients treated with DAAs and was associated with adverse baseline characteristics,including older age,higher body mass index,greater comorbidity burden,and more advanced liver disease.Although SLD patients achieved slightly lower rates of sustained virologic response,SLD itself was not an independent predictor of treatment failure.These findings suggest that poorer treatment outcomes in this subgroup are largely attributable to coexisting risk factors rather than SLD per se,highlighting the need for comprehensive management of metabolic and liver-related comorbidities to optimize antiviral therapy outcomes.
