Background: Cryptococcus neoformans is an opportunistic fungal pathogen that primarily affects immunocompromised individuals. While traditional histologic methods such as hematoxylin and eosin (H&E) staining can s...Background: Cryptococcus neoformans is an opportunistic fungal pathogen that primarily affects immunocompromised individuals. While traditional histologic methods such as hematoxylin and eosin (H&E) staining can sometimes identify fungal organisms, definitive diagnosis typically requires microbiological culture or molecular testing. Stimulated Raman Histology (SRH) is an emerging imaging technology that enables rapid, label-free tissue analysis, potentially improving intraoperative diagnostic workflows. Aim: This case report explores the utility of SRH for the real-time identification of pulmonary cryptococcosis, highlighting its potential to enhance tissue triage and expedite diagnosis. Case Presentation: We report a 44-year-old man with a history of smoking and alcohol use who presented with a right lower lung mass. An ION robotic-assisted bronchoscopy was performed, and SRH was used intraoperatively for real-time tissue evaluation. Within approximately 90 seconds, SRH provided morphologic findings indicative of Cryptococcus neoformans, prompting additional microbiological testing, which confirmed the diagnosis. The patient required a six-week hospitalization with antifungal therapy. Conclusion: This case demonstrates the potential of SRH as a rapid, intraoperative diagnostic tool for detecting fungal infections in pulmonary specimens. By enabling real-time morphological assessment, SRH can optimize biopsy specimen triage, reduce the need for repeat procedures, and improve patient management. Integrating SRH into diagnostic workflows may be particularly beneficial in resource-limited settings, where timely cryptococcosis diagnosis is critical.展开更多
Metal-Supported Solid Oxide Fuel Cells(MS-SOFCs)hold significant potential for driving the energy transition.These electrochemical devices represent the most advanced generation of Solid Oxide Fuel Cell(SOFCs)and can ...Metal-Supported Solid Oxide Fuel Cells(MS-SOFCs)hold significant potential for driving the energy transition.These electrochemical devices represent the most advanced generation of Solid Oxide Fuel Cell(SOFCs)and can pave the way for mass production and wider adoption than Proton Exchange Membrane Fuel Cells(PEMFCs)due to their fuel flexibility,higher power density and the absence of noble metals in the fabrication processes.This review examines the state-of-the-art of SOFCs and MS-SOFCs,presenting perspectives and research directions for these key technological devices,highlighting novel materials,techniques,architectures,devices,and degradation mechanisms to address current challenges and future opportunities.Techniques such as infiltration/impregnation,ex-solution catalyst synthesis,and the use of a pre-catalytic reformer layer are discussed as their impact on efficiency and prolonged activity.These concepts are also described and connected with well-dispersed nano particles,hindrance of coarsening,and an increased number of Triple Phase Boundaries(TPBs).This review also describes the synergistic use of reformers with MS-SOFCs to compose solutions in energy generation from readily available fuels.Lastly,the End-of-Life(EoL),recycling,and life-cycle assessments(LCAs)of the Fuel Cell Hybrid Electric Vehicles(FCHEVs)were discussed.LCAs comparing Fuel Cell Electric Vehicles(FCEVs)equipped with(PEMFCs)and FCHEVs equipped with MS-SOFCs,both powered with hydrogen(H_(2))generated by different routes were compared.This review aims to provide valuable insights into these key technological devices,emphasizing the importance of robust research and development to enhance performance and lifespan while reducing costs and environmental impact.展开更多
The integration of artificial intelligence(AI)into the realm of robotic urologic surgery represents a remarkable paradigm shift in the field of urology and surgical healthcare.AI,with its advanced data analysis and ma...The integration of artificial intelligence(AI)into the realm of robotic urologic surgery represents a remarkable paradigm shift in the field of urology and surgical healthcare.AI,with its advanced data analysis and machine learning capabilities,has not only expedited the evolution of robotic surgical procedures but also significantly improved diagnostic accuracy and surgical outcomes.展开更多
Hydrogen production via catalytic reforming of renewable fuels represents a pivotal strategy in the decarbonization of energy systems.However,conventional catalysts continue to encounter persistent challenges,includin...Hydrogen production via catalytic reforming of renewable fuels represents a pivotal strategy in the decarbonization of energy systems.However,conventional catalysts continue to encounter persistent challenges,including sintering,carbon deposition,and structural degradation under severe reaction conditions.This review addresses the growing need to consolidate the rapidly expanding body of knowledge on medium-and high-entropy materials(MEMs and HEMs),whose unique thermodynamic features position them as next-generation catalysts with the potential to overcome these limitations.The discussion is organized to examine how entropy stabilizatio n,lattice disto rtion,and multi-elemental synergy influence catalytic behavior.Materials are categorized by crystal structure(e.g.,perovskite,spinel,and periclase)and by their roles in key reforming processes,including steam,dry,partial oxidation,and autothermal reforming of renewable fuels such as bioethanol,biomethane,and methanol.A detailed comparison of synthesis methods,configurational entropy thresholds,and physicochemical characteristics is presented.The review synthesizes key insights from recent studies,including advances in exsolution-driven nanostructuring,the impact of oxygen vacancy engineering,and the performance of entropy-optimized compositions under practical reforming conditions.It offers a comprehensive mapping of structureperformance relationships,underscoring how entropy can be harnessed to design more robust,selective,and efficient catalytic systems.Future perspectives emphasize the exploration of underinvestigated entropy-stabilized systems(e.g.,nitrides and sulfides),the integration of data-driven design approaches,and the imperative for long-term stability evaluations under industrially relevant conditions.Finally,the review highlights promising opportunities for scaling up entropy-based catalysts and aligning their development with techno-economic and environmental benchmarks.This work aims to serve as both a comprehensive reference and a strategic outlook for advancing hydrogen production technologies through entropy-engineered catalysis.展开更多
Objectives:Previous studies have shown conflicting results concerning the optimal duration of ureteral stenting after endourologic treatment of stone disease,its effect on patient comfort,and the necessity for emergen...Objectives:Previous studies have shown conflicting results concerning the optimal duration of ureteral stenting after endourologic treatment of stone disease,its effect on patient comfort,and the necessity for emergent,unscheduled care.This study assessed the impact of stent duration,sex,and other patient-associated factors on reported pain scores using a large,international prospective registry.Methods:A prospective observational patient registry on ureteral stents from 10 institutions in 4 countries(United States,Canada,France,and Japan)from 2020–2023 was assessed.The primary outcome was Patient-Reported Outcomes Measurement Information System(PROMIS)pain intensity scores administered on the day of stent removal,before stent removal.Patients were grouped by indwelling time(short,medium,and long),and pain scores were compared.The impact of sex,height vs.stent length,and presence or absence of tether were assessed.Results:359 patients were enrolled in the database,with outcomes analyzed for 268 patients with a unilateral stent placed after an endourologic procedure for stones.No significant difference was detected in pain scores between the indwelling time groups(p=0.41).Height for a given stent length was not significantly associated with pain scores.There was no difference in pain scores with or without tether.Men reported lower pain scores than women(p=0.018).Conclusions:This study did not detect an overall difference in pain scores reported at stent removal within or between stent duration groups.Men reported less pain than women in this study,suggesting that patient factors may be more important than indwelling time when optimizing pain management.展开更多
Osteoporotic fractures are a major public health problem worldwide, but incidence varies greatly across racial groups and geographic regions. Recent work suggests that the incidence of osteoporotic fracture is rising ...Osteoporotic fractures are a major public health problem worldwide, but incidence varies greatly across racial groups and geographic regions. Recent work suggests that the incidence of osteoporotic fracture is rising among Asian populations. Studies comparing areal bone mineral density and fracture across races generally indicate lower bone mineral density in Asian individuals including the Chinese, but this does not reflect their relatively low risk of non-vertebral fractures. In contrast, the Chinese have relatively high vertebral fracture rates similar to that of Caucasians. The paradoxically low risk for some types of fractures among the Chinese despite their low areal bone mineral density has been elucidated in part by recent advances in skeletal imaging. New techniques for assessing bone quality non-invasively demonstrate that the Chinese compensate for smaller bone size by differences in hip geometry and microstructural skeletal organization. Studies evaluating factors influencing racial differences in bone remodeling, as well as bone acquisition and loss, may further elucidate racial variation in bone microstructure. Advances in understanding the microstructure of the Chinese skeleton have not only helped to explain the epidemiology of fracture in the Chinese, but may also provide insight into the epidemiology of fracture in other races as well.展开更多
Hypertension causes significant morbidity and mortal-ity worldwide, owing to its deleterious effects on the cardiovascular and renal systems. Primary hyperaldo-steronism(PA) is the most common cause of revers-ible hyp...Hypertension causes significant morbidity and mortal-ity worldwide, owing to its deleterious effects on the cardiovascular and renal systems. Primary hyperaldo-steronism(PA) is the most common cause of revers-ible hypertension, affecting 5%-18% of adults with hypertension. PA is estimated to result from bilateral adrenal hyperplasia in two-thirds of patients, and from unilateral aldosterone-secreting adenoma in approxi-mately one-third. Suspected cases are initially screened by measurement of the plasma aldosterone-renin-ratio, and may be confirmed by additional noninvasive tests. Localization of aldostosterone hypersecretion is then determined by computed tomography imaging, and in selective cases with adrenal vein sampling. Solitary adenomas are managed by laparoscopic or robotic re-section, while bilateral hyperplasia is treated with min-eralocorticoid antagonists. Biochemical cure following adrenalectomy occurs in 99% of patients, and hemo-dynamic improvement is seen in over 90%, prompting a reduction in quantity of anti-hypertensive medica-tions in most patients. End-organ damage secondary to hypertension and excess aldosterone is significantly improved by both surgical and medical treatment, asmanifested by decreased left ventricular hypertrophy, arterial stiffness, and proteinuria, highlighting the im-portance of proper diagnosis and treatment of primary hyperaldosteronism. Although numerous independent predictors of resolution of hypertension after adrenalec-tomy for unilateral adenomas have been described, the Aldosteronoma Resolution Score is a validated multifac-torial model convenient for use in daily clinical practice.展开更多
Objective:We sought to determine if urodynamic study(UDS)predicted voiding outcomes in men with detrusor underactivity(DU)and benign prostatic enlargement(BPE)who underwent photovaporization of the prostate(PVP).Metho...Objective:We sought to determine if urodynamic study(UDS)predicted voiding outcomes in men with detrusor underactivity(DU)and benign prostatic enlargement(BPE)who underwent photovaporization of the prostate(PVP).Methods:Between September 2010 and July 2015,106 male patients with BPE and DU were identified.All patients underwent PVP.Urinary retention was noted by the preoperative necessity for an indwelling or intermittent catheter.Data collection included comorbidities,quality of life(QoL)scores,prostate volume,prostate-specific antigen(PSA),UDS and perioperative outcomes.UDS parameters included volume at first desire to void,volume at first urge to void,volume of severe urge,volume at capacity,compliance,detrusor contractions,maximum urinary flow rate(Qmax),and postvoid residual(PVR).Results:A total of 106 men were included in this analysis,who had urinary retention with a Foley catheter or clean intermittent catheterization(CIC)at the time of surgery.At baseline we found patients who voided had a detrusor pressure at Qmax(Pdet@Qmax)of 10.05±6.45 cmH2O compared to 16.78±12.17 cmH2O in those who did not void(p=0.071).Postoperatively,96(90.6%,mean age 76.9±26.2 years)of patients voided successfully while 10(9.4%,mean age 80.52±9.61 years)of patients remained in urinary retention.Mean baseline Qmax was 4.895±5.452 mL/s and 2.900±3.356 mL/s(p=0.087)in those who voided and did not respectively.PVR was 319.23±330.62 mL in those who voided and 276.88263.27 mL(p=0.344)in those who did not void.No UDS parameter predicted who would void postoperatively or improvements in QoL.Conclusions:The patients with DU and BPE might be able to successfully void after undergoing PVP regardless of UDS findings.All men who voided had improved international prostate symptom score and QoL scores compared to baseline and these parameters were durable up to 12 months.展开更多
Advances in endoscopic and surgical techniques have increased the frequency and complexity of these procedures and associated complications such as gastrointestinal perforation. With the advancements in the field of g...Advances in endoscopic and surgical techniques have increased the frequency and complexity of these procedures and associated complications such as gastrointestinal perforation. With the advancements in the field of gastroenterology, the promising use of an over the scope clips(OTSC) has fulfilled the unmet need for a reliable endoscopic devise in approximation of gastrointestinal perforation. This novel approach has raised the level of confidence in endoscopist in dealing with this serious complication during endoscopy. Here we have shared our experience with OTSC to evaluate its efficacy and safety in managing iatrogenic gastrointestinal perforations during endoscopy.展开更多
文摘Background: Cryptococcus neoformans is an opportunistic fungal pathogen that primarily affects immunocompromised individuals. While traditional histologic methods such as hematoxylin and eosin (H&E) staining can sometimes identify fungal organisms, definitive diagnosis typically requires microbiological culture or molecular testing. Stimulated Raman Histology (SRH) is an emerging imaging technology that enables rapid, label-free tissue analysis, potentially improving intraoperative diagnostic workflows. Aim: This case report explores the utility of SRH for the real-time identification of pulmonary cryptococcosis, highlighting its potential to enhance tissue triage and expedite diagnosis. Case Presentation: We report a 44-year-old man with a history of smoking and alcohol use who presented with a right lower lung mass. An ION robotic-assisted bronchoscopy was performed, and SRH was used intraoperatively for real-time tissue evaluation. Within approximately 90 seconds, SRH provided morphologic findings indicative of Cryptococcus neoformans, prompting additional microbiological testing, which confirmed the diagnosis. The patient required a six-week hospitalization with antifungal therapy. Conclusion: This case demonstrates the potential of SRH as a rapid, intraoperative diagnostic tool for detecting fungal infections in pulmonary specimens. By enabling real-time morphological assessment, SRH can optimize biopsy specimen triage, reduce the need for repeat procedures, and improve patient management. Integrating SRH into diagnostic workflows may be particularly beneficial in resource-limited settings, where timely cryptococcosis diagnosis is critical.
基金the Fundacao de Amparo à Pesquisa do Estado de Sao Paulo(FAPESP,2022/02235-4,2017/11958-1,2017/11986-5,2014/02163-7)Fundacao de Apoio da UFMG(FUNDEP,27192-36,01-P-38465/2023)Conselho Nacional de Desenvolvimento Científico e Tecnológico(CNPq,405675/2022-4,56405643/2022-5,302180/2022-2,306870/2021-5)。
文摘Metal-Supported Solid Oxide Fuel Cells(MS-SOFCs)hold significant potential for driving the energy transition.These electrochemical devices represent the most advanced generation of Solid Oxide Fuel Cell(SOFCs)and can pave the way for mass production and wider adoption than Proton Exchange Membrane Fuel Cells(PEMFCs)due to their fuel flexibility,higher power density and the absence of noble metals in the fabrication processes.This review examines the state-of-the-art of SOFCs and MS-SOFCs,presenting perspectives and research directions for these key technological devices,highlighting novel materials,techniques,architectures,devices,and degradation mechanisms to address current challenges and future opportunities.Techniques such as infiltration/impregnation,ex-solution catalyst synthesis,and the use of a pre-catalytic reformer layer are discussed as their impact on efficiency and prolonged activity.These concepts are also described and connected with well-dispersed nano particles,hindrance of coarsening,and an increased number of Triple Phase Boundaries(TPBs).This review also describes the synergistic use of reformers with MS-SOFCs to compose solutions in energy generation from readily available fuels.Lastly,the End-of-Life(EoL),recycling,and life-cycle assessments(LCAs)of the Fuel Cell Hybrid Electric Vehicles(FCHEVs)were discussed.LCAs comparing Fuel Cell Electric Vehicles(FCEVs)equipped with(PEMFCs)and FCHEVs equipped with MS-SOFCs,both powered with hydrogen(H_(2))generated by different routes were compared.This review aims to provide valuable insights into these key technological devices,emphasizing the importance of robust research and development to enhance performance and lifespan while reducing costs and environmental impact.
文摘The integration of artificial intelligence(AI)into the realm of robotic urologic surgery represents a remarkable paradigm shift in the field of urology and surgical healthcare.AI,with its advanced data analysis and machine learning capabilities,has not only expedited the evolution of robotic surgical procedures but also significantly improved diagnostic accuracy and surgical outcomes.
基金support of??mbar Energia(PD-00211-0003/2023)the strategic importance of the support given by ANEEL(The Brazilian National Electric Energy)through the R&D levy regulation financial support provided by various Brazilian funding agencies,including FAPESP(2023/17560-0,2017/11958-1,and 2017/11986-5),FUNDEP(27192*36,27192*78,27192*79,and 27192*82),CAPES,and CNPq(405643/2022-5 and 302180/2022-2)。
文摘Hydrogen production via catalytic reforming of renewable fuels represents a pivotal strategy in the decarbonization of energy systems.However,conventional catalysts continue to encounter persistent challenges,including sintering,carbon deposition,and structural degradation under severe reaction conditions.This review addresses the growing need to consolidate the rapidly expanding body of knowledge on medium-and high-entropy materials(MEMs and HEMs),whose unique thermodynamic features position them as next-generation catalysts with the potential to overcome these limitations.The discussion is organized to examine how entropy stabilizatio n,lattice disto rtion,and multi-elemental synergy influence catalytic behavior.Materials are categorized by crystal structure(e.g.,perovskite,spinel,and periclase)and by their roles in key reforming processes,including steam,dry,partial oxidation,and autothermal reforming of renewable fuels such as bioethanol,biomethane,and methanol.A detailed comparison of synthesis methods,configurational entropy thresholds,and physicochemical characteristics is presented.The review synthesizes key insights from recent studies,including advances in exsolution-driven nanostructuring,the impact of oxygen vacancy engineering,and the performance of entropy-optimized compositions under practical reforming conditions.It offers a comprehensive mapping of structureperformance relationships,underscoring how entropy can be harnessed to design more robust,selective,and efficient catalytic systems.Future perspectives emphasize the exploration of underinvestigated entropy-stabilized systems(e.g.,nitrides and sulfides),the integration of data-driven design approaches,and the imperative for long-term stability evaluations under industrially relevant conditions.Finally,the review highlights promising opportunities for scaling up entropy-based catalysts and aligning their development with techno-economic and environmental benchmarks.This work aims to serve as both a comprehensive reference and a strategic outlook for advancing hydrogen production technologies through entropy-engineered catalysis.
文摘Objectives:Previous studies have shown conflicting results concerning the optimal duration of ureteral stenting after endourologic treatment of stone disease,its effect on patient comfort,and the necessity for emergent,unscheduled care.This study assessed the impact of stent duration,sex,and other patient-associated factors on reported pain scores using a large,international prospective registry.Methods:A prospective observational patient registry on ureteral stents from 10 institutions in 4 countries(United States,Canada,France,and Japan)from 2020–2023 was assessed.The primary outcome was Patient-Reported Outcomes Measurement Information System(PROMIS)pain intensity scores administered on the day of stent removal,before stent removal.Patients were grouped by indwelling time(short,medium,and long),and pain scores were compared.The impact of sex,height vs.stent length,and presence or absence of tether were assessed.Results:359 patients were enrolled in the database,with outcomes analyzed for 268 patients with a unilateral stent placed after an endourologic procedure for stones.No significant difference was detected in pain scores between the indwelling time groups(p=0.41).Height for a given stent length was not significantly associated with pain scores.There was no difference in pain scores with or without tether.Men reported lower pain scores than women(p=0.018).Conclusions:This study did not detect an overall difference in pain scores reported at stent removal within or between stent duration groups.Men reported less pain than women in this study,suggesting that patient factors may be more important than indwelling time when optimizing pain management.
基金supported by NIH grants K23 AR053507, a National Osteoporosis Foundation grant, and the Mary and David Hoar Fellowship Program of the New York Community Trust and the New York Academy of Medicine
文摘Osteoporotic fractures are a major public health problem worldwide, but incidence varies greatly across racial groups and geographic regions. Recent work suggests that the incidence of osteoporotic fracture is rising among Asian populations. Studies comparing areal bone mineral density and fracture across races generally indicate lower bone mineral density in Asian individuals including the Chinese, but this does not reflect their relatively low risk of non-vertebral fractures. In contrast, the Chinese have relatively high vertebral fracture rates similar to that of Caucasians. The paradoxically low risk for some types of fractures among the Chinese despite their low areal bone mineral density has been elucidated in part by recent advances in skeletal imaging. New techniques for assessing bone quality non-invasively demonstrate that the Chinese compensate for smaller bone size by differences in hip geometry and microstructural skeletal organization. Studies evaluating factors influencing racial differences in bone remodeling, as well as bone acquisition and loss, may further elucidate racial variation in bone microstructure. Advances in understanding the microstructure of the Chinese skeleton have not only helped to explain the epidemiology of fracture in the Chinese, but may also provide insight into the epidemiology of fracture in other races as well.
文摘Hypertension causes significant morbidity and mortal-ity worldwide, owing to its deleterious effects on the cardiovascular and renal systems. Primary hyperaldo-steronism(PA) is the most common cause of revers-ible hypertension, affecting 5%-18% of adults with hypertension. PA is estimated to result from bilateral adrenal hyperplasia in two-thirds of patients, and from unilateral aldosterone-secreting adenoma in approxi-mately one-third. Suspected cases are initially screened by measurement of the plasma aldosterone-renin-ratio, and may be confirmed by additional noninvasive tests. Localization of aldostosterone hypersecretion is then determined by computed tomography imaging, and in selective cases with adrenal vein sampling. Solitary adenomas are managed by laparoscopic or robotic re-section, while bilateral hyperplasia is treated with min-eralocorticoid antagonists. Biochemical cure following adrenalectomy occurs in 99% of patients, and hemo-dynamic improvement is seen in over 90%, prompting a reduction in quantity of anti-hypertensive medica-tions in most patients. End-organ damage secondary to hypertension and excess aldosterone is significantly improved by both surgical and medical treatment, asmanifested by decreased left ventricular hypertrophy, arterial stiffness, and proteinuria, highlighting the im-portance of proper diagnosis and treatment of primary hyperaldosteronism. Although numerous independent predictors of resolution of hypertension after adrenalec-tomy for unilateral adenomas have been described, the Aldosteronoma Resolution Score is a validated multifac-torial model convenient for use in daily clinical practice.
文摘Objective:We sought to determine if urodynamic study(UDS)predicted voiding outcomes in men with detrusor underactivity(DU)and benign prostatic enlargement(BPE)who underwent photovaporization of the prostate(PVP).Methods:Between September 2010 and July 2015,106 male patients with BPE and DU were identified.All patients underwent PVP.Urinary retention was noted by the preoperative necessity for an indwelling or intermittent catheter.Data collection included comorbidities,quality of life(QoL)scores,prostate volume,prostate-specific antigen(PSA),UDS and perioperative outcomes.UDS parameters included volume at first desire to void,volume at first urge to void,volume of severe urge,volume at capacity,compliance,detrusor contractions,maximum urinary flow rate(Qmax),and postvoid residual(PVR).Results:A total of 106 men were included in this analysis,who had urinary retention with a Foley catheter or clean intermittent catheterization(CIC)at the time of surgery.At baseline we found patients who voided had a detrusor pressure at Qmax(Pdet@Qmax)of 10.05±6.45 cmH2O compared to 16.78±12.17 cmH2O in those who did not void(p=0.071).Postoperatively,96(90.6%,mean age 76.9±26.2 years)of patients voided successfully while 10(9.4%,mean age 80.52±9.61 years)of patients remained in urinary retention.Mean baseline Qmax was 4.895±5.452 mL/s and 2.900±3.356 mL/s(p=0.087)in those who voided and did not respectively.PVR was 319.23±330.62 mL in those who voided and 276.88263.27 mL(p=0.344)in those who did not void.No UDS parameter predicted who would void postoperatively or improvements in QoL.Conclusions:The patients with DU and BPE might be able to successfully void after undergoing PVP regardless of UDS findings.All men who voided had improved international prostate symptom score and QoL scores compared to baseline and these parameters were durable up to 12 months.
文摘Advances in endoscopic and surgical techniques have increased the frequency and complexity of these procedures and associated complications such as gastrointestinal perforation. With the advancements in the field of gastroenterology, the promising use of an over the scope clips(OTSC) has fulfilled the unmet need for a reliable endoscopic devise in approximation of gastrointestinal perforation. This novel approach has raised the level of confidence in endoscopist in dealing with this serious complication during endoscopy. Here we have shared our experience with OTSC to evaluate its efficacy and safety in managing iatrogenic gastrointestinal perforations during endoscopy.
