The physiological loss OF muscle mass and strength with aging is referred to as “sarcopenia”, whose combined effect with osteoporosis is a serious threat to the elderly, accounting for decreased mobility and increased risk of falls with consequent fractures. In previous studies, we observed a high degree of inter-individual variability in paraspinal muscle fatty infiltration, one of the most relevant indices of muscle wasting. This aspect led us to develop a computerized method to quantitatively characterize muscle fatty infiltration in aging and diseases. Magnetic resonance images of paraspinal muscles from 58 women of different ages (age range of 23–85 years) and physio-pathological status (healthy young, pre-menopause, menopause, and osteoporosis) were used to set up a method based on fractal-derived texture analysis of lean muscle area (contractile muscle) to estimate muscle fatty infiltration. In particular, lacunarity was computed by parameter β from the GBA (gliding box algorithm) curvilinear plot fitted by our hyperbola model function. Succolarity was estimated by parameter µ, for the four main directions through an algorithm implemented with this purpose. The results show that lacunarity, by quantifying muscle fatty infiltration, can discriminate between osteoporosis and healthy aging, while succolarity can separate the other three groups showing similar lacunarity. Therefore, fractal-derived features of contractile muscle, by measuring fatty infiltration, can represent good indices of sarcopenia in aging and disease. Full article

Coarse-grained molecular dynamics simulations are employed to investigate the spatiotemporal evolution of vesicles (polymersomes) through the self-assembly of randomly distributed amphiphilic BAB triblock copolymers with hydrophilic A and hydrophobic B blocks in an aqueous solution. The vesiculation pathway consists of several intermediate structures, such as an interconnected network of copolymer aggregates, a cage of cylindrical micelles, and a lamellar cage. The cage-to-vesicle transition occurs at a constant aggregation number and practically eliminates the hydrophobic interfacial area between the B block and solvent. Molecular reorganization underlying the sequence of morphology transitions from a cage-like aggregate to a vesicle is nearly isentropic. The end-to-end distances of isolated copolymer chains in solution and those within a vesicular assembly follow lognormal probability distributions. This can be attributed to the preponderance of folded chain configurations in which the two hydrophobic end groups of a given chain stay close to each other. However, the probability distribution of end-to-end distances is broader for chains within the vesicle as compared with that of a single chain. This is due to the swelling of the folded configurations within the hydrophobic bilayer. Increasing the hydrophobicity of the B block reduces the vesiculation time without qualitatively altering the self-assembly pathway. Full article

Liver transplant patients are frail subjects due to lifelong therapy with immunosuppressants. In these patients, comorbidity and polytherapy increase the risk of adverse drug reactions. In this study, we report the development of hyponatremia, probably related to pantoprazole in a liver transplant patient. Sertraline dismission and treatment with sodium chloride did not improve clinical symptoms and laboratory levels. Pantoprazole dismission induced an improvement in clinical symptoms and the normalization of sodium levels. A five-month follow-up revealed the absence of clinical symptoms and normal serum sodium levels. Full article

Energy transformation powers change in the universe. In physical systems, maximal power (rate of energy input or output) may occur only at submaximal efficiency (output/input), or conversely, maximal efficiency may occur only at submaximal power. My review of power and efficiency in living systems at various levels of biological organization reveals that (1) trade-offs (negative correlations) between power and efficiency, as expected in physical systems, chiefly occur for resource-supply systems; (2) synergy (positive correlations) between power and efficiency chiefly occurs for resource use systems, which may result from (a) increasing energy allocation to production versus maintenance as production rate increases and (b) natural selection eliminating organisms that exceed a maximal power limit because of deleterious speed-related effects; (3) productive power indicates species-wide ‘fitness’, whereas efficiency of resource acquisition for production indicates local ‘adaptiveness’, as viewed along a body size spectrum and within clades of related species; (4) covariation of the power and efficiency of living systems occurs across space and time at many scales; (5) the energetic power/efficiency of living systems relates to the rates and efficiencies/effectiveness of nutrient/water uptake/use, the functional performance of various activities, and information acquisition/processing; and (6) a power/efficiency approach has many useful theoretical and practical applications deserving more study. Full article

This review article gathers the most recent recycling technologies for thermoset and thermoplastic polymers. Results about existing experimental procedures and their effectiveness are presented. For thermoset polymers, the review focuses mainly on fibre-reinforced polymer composites, with an emphasis on epoxy-based systems and carbon/glass fibres as reinforcement, due to the environmental concerns of their end-of-life management. Thermal processes (fluidised bed, pyrolysis) and chemical processes (different types of solvolysis) are discussed. The most recent combined processes (microwave, steam, and ultrasonic assisted techniques) and extraordinary recycling attempts (electrochemical, biological, and with ionic liquids) are analysed. Mechanical recycling that leads to the downgrading of materials is excluded. Insights are also given for the upcycling methodologies that have been implemented until now for the reuse of fibres. As for thermoplastic polymers, the most state-of-the-art recycling approach for the most common polymer matrices is presented, together with the appropriate additivation for matrix upcycling. Mechanical, chemical, and enzymatic recycling processes are described, among others. The use of fibre-reinforced thermoplastic composites is quite new, and thus, the most recent achievements are presented. With all of the above information, this extensive review can serve as a guide for educational purposes, targeting students and technicians in polymers recycling. Full article

Chronic pulmonary aspergillosis (CPA) is a rare but significant complication of lung cancer surgery. Its effect on survival remains unclear. Our aim was to describe the outcomes of the patients who developed CPA following the surgery for non-small cell lung cancer (NSCLC), identify the risk factors associated with its development following lung resection, and evaluate its impact on survival. All the patients with a diagnosis of CPA and operated NSCLC were identified in the National Aspergillosis Centre (NAC) database (2009–2020). Additional patients were identified in the Northwest Clinical Outcomes Research Registry (2012–2019) database. A regression analysis was performed to examine potential links between CPA and long-term outcomes and also to identify the factors associated with the development of CPA. The primary outcomes were the development of CPA, 1-year and 5-year mortality, and overall survival. Thirty-two patients diagnosed with CPA after lung resection were identified in the NAC database, of which 11 were also contained within the NCORR database, with a prevalence of 0.2% (n = 11/4425). Post-operative CPA was associated with significantly lower survival on log-rank analysis (p = 0.020). Mortality at one year was 25.0% (n = 8) and 59.4% (n = 19) at five years after the CPA diagnosis. On univariable analysis, a lower mean percentage-predicted forced expiratory volume in 1 s, ischaemic heart disease, and chronic obstructive pulmonary disease were all significantly associated with CPA development. CPA is a rare complication following lung cancer surgery which has a significant impact on long-term survival. Its development may be associated with pre-existing cardiopulmonary comorbidities. Further research in larger cohorts is required to substantiate these findings. Full article

More research is needed to understand how the maternal consumption of fish and fish-borne toxicants impacts infant neurodevelopment. The present analysis was conducted over 460 mother–infant pairs within the ECLIPSES study. Dietary intake of metals and persistent organic pollutants from fish (including white fish, blue fish, and seafood) was estimated in pregnant women. The infants underwent cognitive, language, and motor function assessments using the Bayley Scales of Infant Development-III at the 40-day postpartum. Associations between dietary toxicants and outcomes were assessed using multivariable linear regression models. Estimated prenatal exposure to fish-borne toxicants, such as arsenic, inorganic arsenic, methylmercury, dioxin-like polychlorinated biphenyls (DL-PCBs), and non-DL-PCBs, was associated with poorer language functions in infants, whereas no significant associations were found with motor or cognitive functions. Maternal fish consumption exceeding the Spanish recommendation of no more than 71 g per day was linked to these adverse effects on language abilities without affecting motor or cognitive development. This highlights the importance of vigilant monitoring of environmental toxicants and the provision of dietary guidance for pregnant women, with potential implications for public health and child development. Full article

Sprayers’ exposure to glyphosate was analyzed through detection of its biomarker in spot urine biological monitoring, and the health risk was assessed using the biomatrix model. Urine samples were collected from 15 sprayers after spraying, and the glyphosate concentration was determined by using the DLLME-HPLC method with a UV detector. The calibration curve for glyphosate was linear in the range of 0.4–100 µg/L, while the limits of detection and quantification were 0.1 µg/L and 0.4 µg/L, respectively. The human health risk was estimated using the hazard quotient (HQ) and the biomatrix of risk assessment. The internal dose ranged from 0.0001 to 0.0021 mg/kg b.w./day. The non-cancer HQ showed no potential health risk concerns (HQ < 1). The biomatrix of health risk assessment, based on urinary glyphosate concentration, exhibited a strong correlation with the health risk matrix model. This correlation was determined by considering the likelihood of exposure, calculated from the quantity of glyphosate used and the usage of personal protective equipment (r = 0.854, p < 0.001). Although low risk was observed in sprayers, proper PPE use and the application of more knowledge are required. The simplified health risk assessment can be used for easy self-assessment of risk in preventive action regarding health risk awareness among sprayers. Full article

With increasing health awareness and the accelerating pace of life, whole-grain prepared foods have gained popularity due to their health benefits and convenience. However, the potential risk of type B trichothecene toxins has also increased, and these mycotoxins in such foods are rarely regulated. In this study, a quantitative method combining a single-valve dual-column automatic online solid-phase extraction system with ultra-high-performance liquid chromatography–tandem mass spectrometry (UHPLC–MS/MS) was developed for the first time using restricted-access media columns. This method can simultaneously determine trace residues of seven type B trichothecenes within 15 min. The method is convenient, sensitive (limit of detection and quantification of 0.05–0.6 μg/kg and 0.15–2 μg/kg, respectively), accurate (recovery rates of 90.3%–106.6%, relative standard deviation < 4.3%), and robust (>1000 times). The established method was applied to 160 prepared food samples of eight categories sold in China. At least one toxin was detected in 70% of the samples. Whole-wheat dumpling wrappers had the highest contamination rate (95%) and the highest total content of type B trichothecenes in a single sample (2077.3 μg/kg). Exposure risk assessment indicated that the contamination of whole-grain prepared foods has been underestimated. The total health risk index of whole-wheat dumpling wrappers, which are susceptible to deoxynivalenol, reached 136.41%, posing a significant threat to human health. Effective measures urgently need to be taken to control this risk. Full article

This paper focuses on terminal air traffic complexity indicators. By thorough analysis of previous research, the benefits and limitations of the existing terminal complexity models are identified. According to these findings, a new approach for determining terminal air traffic complexity indicators is proposed which assumes that terminal complexity could be determined based on approach air traffic controller (ATCO) tasks. The comprehensive list of general approach ATCO tasks was defined using a literature review and observation of training exercises, forming the basis for subsequent expert group workshops which enabled the acquisition of ATCOs’ knowledge data. Through these workshops, new approach ATCO tasks were additionally identified, and terminal complexity indicators were defined with airspace and traffic parameters. These new tasks and indicators present a novelty in this field of research since they incorporate ATCOs’ knowledge as the data input and consider various traffic scenarios, all types of traffic, weather conditions, and off-nominal situations. Full article

Friction is an inevitable phenomenon in mechanical systems that affects the dynamic characteristics of systems. To reduce the modeling complexity of complex multi-rigid-body mechanisms, a novel explicit canonical dynamic modeling method considering joint friction is proposed. Based on the explicit dynamic modeling theory that we have proposed, the solution of the constraint force required by the joint friction modeling of multi-rigid-body mechanisms is derived and improved, which greatly simplifies the solution of the constraint force. According to the obtained explicit expression of the constraint force equations, two joint friction models of the Coulomb–viscous effect and Stribeck effect are derived in analytical form. Moreover, the Stribeck effect of the joint is experimentally analyzed. A five-axis tree-chain mechanism and a three-loop closed-chain mechanism are chosen to demonstrate the method and compared with ADAMS software. Moreover, the proposed model is analyzed and compared with other methods. Full article

Flight control law parameters should be designed to provide a sufficient stability margin for closed-loop aircraft while ensuring command tracking accuracy. The singular perturbation margin (SPM) and generalized gain margin (GGM), which are generalizations of the classical phase margin (PM) and gain margin (GM), respectively, from a linear time-invariant system to a nonlinear time-varying system, can be used to quantitatively characterize the maximum singular perturbation and regular perturbation allowed to maintain system stability. In this paper, the sliding mode flight control structure and the design parameters of the sliding mode control law are first introduced for an oblique wing aircraft (OWA), the SPM-gauge and GGM-gauge are added to this closed-loop aircraft model, and the analytical expressions of the SPM and GGM are derived with respect to the control law parameters. Second, the stability margin design requirements of closed-loop aircraft in flight control system design specifications are converted into limitations on the SPM and GGM to determine the value range of the flight control law parameters. Then, with the goal of reducing the sum of the approaching time and sliding time, the parameter value combination is selected within the control law parameter range that meets the stability margin requirements, thus forming a flight control law design method for OWA during the wing skewing process. Finally, the designed control law parameters are applied to a sample OWA, and the stability margin of closed-loop aircraft during the wing skewing process is verified. Full article

Obesity is a major global health concern linked to cognitive impairment and neurological disorders. Circulating brain-derived neurotrophic factor (BDNF), a protein crucial for neuronal growth and survival, plays a vital role in brain function and plasticity. Notably, obese individuals tend to exhibit lower BDNF levels, potentially contributing to cognitive decline. Physical exercise offers health benefits, including improved circulating BDNF levels and cognitive function, but the specific impacts of acute versus regular exercise on circulating BDNF levels in obesity are unclear. Understanding this can guide interventions to enhance brain health and counter potential cognitive decline in obese individuals. Therefore, this study aimed to explore the impact of acute and regular physical exercise on circulating BDNF in individuals with obesity. The target population comprised individuals classified as overweight or obese, encompassing both acute and chronic protocols involving all training methods. A comprehensive search was conducted across computerized databases, including PubMed, Academic Search Complete, and Web of Science, in August 2022, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Initially, 98 studies were identified, from which 16 studies, comprising 23 trials, met the selection criteria. Substantial heterogeneity was observed for both acute (I² = 80.4%) and long-term effects (I² = 88.7%), but low risk of bias for the included studies. A single session of exercise increased circulating BDNF levels among obese patients compared to the control group (ES = 1.25, 95% CI = 0.19 to 2.30, p = 0.021). However, with extended periods of physical exercise, there was no significant increase in circulating BDNF levels when compared to the control group (ES = 0.49, 95% CI = −0.08 to 1.06, p = 0.089). These findings highlight the need to consider exercise duration and type when studying neurobiological responses in obesity and exercise research. The study’s results have implications for exercise prescription in obesity management and highlight the need for tailored interventions to optimize neurotrophic responses. Future research should focus on elucidating the adaptive mechanisms and exploring novel strategies to enhance BDNF modulation through exercise in this population. However, further research is needed considering limitations such as the potential age-related confounding effects due to diverse participant ages, lack of sex-specific analyses, and insufficient exploration of how specific exercise parameters (e.g., duration, intensity, type) impact circulating BDNF. Full article

This study aimed to evaluate the effects of dietary protein levels on growth performance, serum indices, body amino acid composition, and intestinal gene expression in juvenile hybrid sturgeon (Acipenser baerii × A. schrenckii). Hybrid sturgeons (initial weight 29.21 ± 2.04 g) were fed isolipidic diets containing 30%, 33%, 36%, 39%, 42% or 45% crude protein for 12 weeks (n = 18 tanks, 30 fish/tank). Results showed significant differences between treatments, where weight gain and protein efficiency ratio peaked optimally between 35.9% and 38.3% dietary protein. Serum parameters such as glucose, alanine aminotransferase, aspartate aminotransferase, superoxide dismutase, and lipid peroxidation levels varied significantly with changes in dietary protein levels. Specifically, the highest enzymatic activities and growth parameters were observed in groups fed with 33% to 39% protein, enhancing whole-body concentrations of lysine, leucine, phenylalanine, proline, and glutamic acid. Immune parameters such as immunoglobulin M and lysozyme activity also showed peak levels at higher protein concentrations, particularly notable at 42% for lysozyme and 36% for both component 3 and immunoglobulin M. Gene expression related to immune and growth pathways, including MyD88, TLR1, IL-8, IL-6, NF-κB, and IL1β, was significantly upregulated at protein levels of 33% to 36%, with a noted peak in expression at 39% for TLR1, IL-10, and TOR signaling genes, before diminishing at higher protein levels. Overall, the dietary protein requirement for juvenile hybrid sturgeon ranges from 35.9% to 38.3% crude protein. Full article

The pathogenesis of inflammatory bowel disease (IBD) is still unknown. Mesenteric lymphatics (MLs), which are closely related to the intestine in both anatomy and physiology, have been suggested to be involved in IBD. In the present study, we aim to investigate the effects of ML immune cells on IBD and explore the potential associated mechanisms. Acute colitis was induced in rats using dextran sulfate sodium salt (DSS). Mesenteric lymphangiogenesis, ML stenosis, and dilation were observed, with an increased proportion of MLB cells in DSS-induced colitis rats. The adoptive transfer of B cells isolated from ML (MLB) was employed to investigate their effects on colitis. MLB cells derived from DSS-induced colitis rats exhibited a higher propensity to migrate to the intestine. The proportion of colonic T cells was altered, along with the aggravated colitis induced by the adoptive transfer of MLB cells derived from DSS-induced colitis rats. RNA sequencing revealed increased Cxcr5 expression in MLB cells from colitis rats, while real-time PCR indicated an upregulation of its ligand Cxcl13 in the colon of colitis rats. These findings suggest that MLB cells may migrate to the intestine and aggravate colitis. In summary, colonic T cells respond to MLB cells from colitis rats, and MLB cells aggravate DSS-induced colitis via the CXCR5–CXCL13 axis. Full article

An acute metabolic complication of diabetes mellitus, especially type 1, is diabetic ketoacidosis (DKA), which is due to an increase in blood ketone concentrations. Sodium/glucose co-transporter-2 inhibitor (SGLT2-i) drugs have been associated with the occurrence of a particular type of DKA defined as euglycemic (euDKA), characterized by glycemic levels below 300 mg/dL. A fair number of euDKA cases in SGLT2-i-treated patients have been described, especially in the last few years when there has been a significant increased use of these drugs. This form of euDKA is particularly insidious because of its latent onset, associated with unspecific symptomatology, until it evolves (progressing) to severe systemic forms. In addition, its atypical presentation can delay diagnosis and treatment. However, the risk of euDKA associated with SGLT2-i drugs remains relatively low, but it is essential to promptly diagnose and manage it to prevent its serious life-threatening complications. In this narrative review, we intended to gather current research evidence on SGLT2i-associated euDKA from randomized controlled trials and real-world evidence studies, its diagnostic criteria and precipitating factors. Full article

Plasma volume (PV) undergoes constant and dynamic changes, leading to a large intra-day variability in healthy individuals. Hydration is known to induce PV changes; however, the response to the intake of osmotically different fluids is still not fully understood. In a randomized controlled crossover trial, 18 healthy individuals (10 females) orally received an individual amount of an isotonic sodium-chloride (ISO), Ringer (RIN), or glucose (GLU) solution. Hemoglobin mass (Hbmass) was determined with the optimized carbon monoxide re-breathing method. Fluid-induced changes in PV were subsequently calculated based on capillary hemoglobin concentration ([Hb]) and hematocrit (Hct) before and then every 10 minutes until 120 min (t_0–120) after the fluid intake and compared to a control trial arm (CON), where no fluid was administered. Within GLU and CON trial arms, no statistically significant differences from baseline until t₁₂₀ were found (p > 0.05). In the ISO trial arm, PV was significantly increased at t₇₀ (+138 mL, p = 0.01), t₈₀ (+191 mL, p < 0.01), and t₁₁₀ (+182 mL, p = 0.01) when compared to t₀. Moreover, PV in the ISO trial arm was significantly higher at t₇₀ (p = 0.02), t₁₁₀ (p = 0.04), and t₁₂₀ (p = 0.01) when compared to the same time points in the CON trial arm. Within the RIN trial arm, PV was significantly higher between t₇₀ and t₉₀ (+183 mL, p = 0.01) and between t₁₁₀ (+194 mL, p = 0.03) and t₁₂₀ (+186 mL, p < 0.01) when compared to t₀. These results demonstrated that fluids with a higher content of osmotically active particles lead to acute hemodilution, which is associated with a decrease in [Hb] and Hct. These findings underpin the importance of the hydration state on PV and especially on PV constituent levels in healthy individuals. Full article

Skeletal muscles are heterogenous tissues composed of different myofiber types that can be classified as slow oxidative, fast oxidative, and fast glycolytic which are distinguished on the basis of their contractile and metabolic properties. Improving oxidative metabolism in skeletal muscles can prevent metabolic diseases and plays a protective role against muscle wasting in a number of neuromuscular diseases. Therefore, achieving a detailed understanding of the factors that regulate myofiber metabolic properties might provide new therapeutic opportunities for these diseases. Here, we investigated whether peptidyl-prolyl cis-trans isomerase NIMA-interacting 1 (PIN1) is involved in the control of myofiber metabolic behaviors. Indeed, PIN1 controls glucose and lipid metabolism in a number of tissues, and it is also abundant in adult skeletal muscles; however, its role in the control of energy homeostasis in this tissue is still to be defined. To start clarifying this topic, we compared the metabolome of the tibialis anterior muscle (mainly glycolytic) and soleus muscle (oxidative) in wild-type and Pin1 knockout mice with High-Resolution Magic Angle Spinning (HR-MAS) NMR on intact tissues. Our analysis reveals a clear demarcation between the metabolomes in the two types of muscles and allows us to decode a signature able to discriminate the glycolytic versus oxidative muscle phenotype. We also detected some changes in Pin1-depleted muscles that suggest a role for PIN1 in regulating the metabolic phenotype of skeletal muscles. Full article

Early diagnosis of diseases, especially cancer, is critical for effective treatment. The unique properties of terahertz technology have attracted attention in this field. However, current terahertz bio-detection methods face challenges due to differences between the test environment and the actual in vivo conditions. In this study, a novel method is proposed for detecting in vivo-like cells using a biosensor chip composed of metamaterials and a cavity. The cavity has a thickness of ~50 μm. The structure can protect cells from damage and provides a liquid environment like an in vivo state. Through simulation analysis, the metamaterials sensor exhibits a theoretical sensitivity of 0.287 THz/RIU (Refractive Index Unit) with a 50 μm thick analyte. The detection method is experimentally validated using the apoptosis of glioma cells and various cell types. The biosensor investigates the apoptosis of glioma cells under the impact of temozolomide, and the trend of the results was consistent with the Cell Counting Kit-8 method. Furthermore, at a concentration of ~5200 cells/cm², the experimental results demonstrate that the sensor can distinguish between neurons and glioma cells with a resonance frequency difference of approximately 30 GHz. This research has significant potential for detecting glioma cells and offers an alternative approach to in vivo-like cell detection. Full article

Lumbar lordotic curvature (LLC), closely associated with low back pain (LBP) when decreased, is infrequently assessed in clinical settings due to the spatiotemporal limitations of radiographic methods. To overcome these constraints, this study used an inertial measurement system to compare the magnitude and maintenance of LLC across various sitting conditions, categorized into three aspects: verbal instructions, chair type, and desk task types. Methods: Twenty-nine healthy participants were instructed to sit for 3 min with two wireless sensors placed on the 12th thoracic vertebra and the 2nd sacral vertebra. The lumbar lordotic angle (LLA) was measured using relative angles for the mediolateral axis and comparisons were made within each sitting category. Results: The maintenance of LLA (LLA_dev) was significantly smaller when participants were instructed to sit upright (−3.7 ± 3.9°) compared to that of their habitual sitting posture (−1.2 ± 2.4°) (p = 0.001), while the magnitude of LLA (LLA_avg) was significantly larger with an upright sitting posture (p = 0.001). LLA_dev was significantly larger when using an office chair (−0.4 ± 1.1°) than when using a stool (−3.2 ± 7.1°) (p = 0.033), and LLA_avg was also significantly larger with the office chair (p < 0.001). Among the desk tasks, LLA_avg was largest during keyboard tasks (p < 0.001), followed by mouse and writing tasks; LLA_dev showed a similar trend without statistical significance (keyboard, −1.2 ± 3.0°; mouse, −1.8 ± 2.2°; writing, −2.9 ± 3.1°) (p = 0.067). Conclusions: Our findings suggest that strategies including the use of an office chair and preference for computer work may help preserve LLC, whereas in the case of cueing, repetition may be necessary. Full article

Pirfenidone and Nintedanib have significantly improved the prognosis of patients with idiopathic pulmonary fibrosis (IPF), reducing mortality risk and exacerbations. This study aimed to analyze antifibrotic treatment utilization and its association with clinical outcomes (i.e., acute exacerbation or death) during 2014–2021 in newly diagnosed IPF patients, using Healthcare Utilization Databases of the Marche Region, Italy. Methods: The first 12-month adherence to antifibrotic was estimated using the Proportion of Days Covered (PDC), defining adherence as PDC ≥ 75%. State Sequence Analysis over the initial 52 weeks of treatment was used to identify adherence patterns. The role of adherence patterns on acute exacerbations/death, adjusted by demographic, clinical features, and monthly adherence after the 52-week period (time-dependent variable), was assessed with Cox regression. Results: Among 667 new IPF cases, 296 received antifibrotic prescriptions, with 62.8% being adherent in the first year. Three antifibrotic utilization patterns emerged—high adherence (37.2%), medium adherence (42.5%), and low adherence (20.3%)—with median PDCs of 95.3%, 79.5%, and 18.6%, respectively. These patterns did not directly influence three-year mortality/exacerbation probability, but sustained adherence reduced risk over time. Conclusions: Good adherence was observed in in this population-based study, emphasizing the importance of continuous antifibrotics therapy over time to mitigate adverse outcomes. Full article

Cervical esophageal reconstruction is vital to improve the quality of life in cancer surgery patients. Microsurgery is crucial in providing vascularized tissue for defect repair, particularly in secondary cases with a higher risk of failure due to larger defects and damage from previous surgery and radiotherapy. The purpose of this study was to describe the clinical characteristics of a series of patients who underwent secondary repair of esophageal defects and provide practical information for the management and treatment of such cases based on the authors’ experience and the literature review. Methods: We retrospectively reviewed the electronic medical records of the Plastic Surgery Clinic at the University of Trieste to identify cases of patients who underwent secondary esophageal microsurgical reconstructions following oncological surgery. Patient demographics, the etiology of esophageal defects, previous surgical history, and preoperative assessments were collected from medical records. Surgical techniques utilized for reconstruction, such as pedicled flaps or free tissue transfers, were documented along with intraoperative information. Postoperative outcomes, including complications, graft viability, and functional outcomes, were evaluated during follow-up. Results: We treated 13 cases of secondary esophageal reconstructions between 2011 and 2022. Most commonly, Antero-Lateral Thigh (ALT) flaps were used in 10 cases, while 2 cases employed a radial forearm flap (RFF), and 1 case employed a chimeric parascapular flap. No flap failures occurred during a median 50-month follow-up. One ALT flap patient experienced postop stricture but maintained swallowing ability. A single tracheoesophageal fistula occurred in an RFF patient with a history of radiotherapy and complete lymph node dissection. Conclusions: Cervical esophageal reconstruction significantly impacts patients’ quality of life by restoring oral feeding and phonation. When local flaps fall short, microsurgical reconstruction with intestinal flaps is valuable but is burdened by limitations. For challenging secondary cases, ALT or RFF flaps emerge as safer options due to their robust pedicles, yielding low complication rates and positive functional outcomes. Full article