Mechanical, Surface and Physicochemical Properties of Nanozeolite‐Modified 3D Printed Hybrid Ceramics at Varying Concentrations: An In Vitro Study

ABSTRACT Objectives To evaluate nanozeolite (NZ)‐modified 3D‐printed hybrid ceramics at 0.25%, 0.5%, and 1% versus milled hybrid resin‐ceramics, focusing on fracture toughness, surface roughness, microhardness, degree of conversion (DC), water sorption, and color stability. Materials and Methods NZ was incorporated into 3D‐printed ceramic‐filled resin (VarseoSmile Crown Plus, VA) and tested alongside unmodified VA (control) and milled CAD‐CAM ceramic (Vita Enamic, VE). Bars (18 × 3.6 × 1.8 mm) were prepared for fracture toughness, and discs (10 × 2 mm) for roughness, microhardness, water sorption, and color/translucency. Fracture toughness was measured by the single‐edge notched beam (SENB) method, roughness and microhardness by profilometer and Vickers test, and DC by FTIR. Water sorption/solubility was gravimetrically measured, and ΔE00 and translucency parameter (TP) by spectrophotometry. Tests were conducted before and after thermocycling (1000 cycles, 5°C–55°C). Data were analyzed using ANOVA, Kruskal‐Wallis, t‐tests, and Wilcoxon signed‐rank tests ( p  < 0.05). Results VE exhibited the highest fracture toughness and microhardness, which decreased after thermocycling ( p  < 0.001). NZ‐0.25% improved toughness versus VA both before and after aging ( p  = 0.04), while NZ‐0.5% and 1% slightly reduced toughness but increased microhardness and decreased roughness after aging ( p  < 0.01). All NZ groups showed higher DC than control ( p  < 0.001). Thermocycling reduced toughness in VE and VA, but not NZ‐VA. Water sorption and solubility were significantly lower in all NZ groups ( p  < 0.0001). ΔE00 remained < 1.8 for all groups after thermocycling, with 0.25% NZ‐VA showing the most color stability and 1% NZ‐VA showing minimal TP changes ( p  < 0.05). Conclusion Milled hybrid ceramic (VE) outperformed printed hybrid ceramic (VA). Nanozeolite improved VA, with 0.25% providing the best balance of fracture toughness and microhardness, while preserving color and aging stability. Higher concentrations (0.5%–1%) mainly enhanced surface characteristics but added little to bulk properties and translucency. Clinical Significance Nanozeolite integration at 0.25% enhances strength, durability, and color stability in 3D‐printed hybrid ceramics, improving their reliability for dental restorations. Higher loadings enhance surface properties but may modestly reduce bulk toughness and translucency, relevant for clinical decision‐making.

Ohmic Heating ( OH )‐Assisted Extraction of Bovine Hide Gelatin: Functional and Physicochemical Comparison With Halal Commercial Gelatins

ABSTRACT Conventional gelatin extraction from high‐collagen tissues requires prolonged thermal processing (8–10 h), resulting in high energy consumption and potential degradation of functional properties. To address this limitation, this study investigated ohmic heating (OH) as an alternative extraction method for bovine hide gelatin. Gelatin was extracted using voltage gradients of 5–20 V/cm for 1–5 h and compared with both conventional extraction parameters and commercial halal gelatins. OH markedly reduced the extraction time to 1–5 h while maintaining a maximum temperature of 70°C, resulting in significantly improved extraction efficiency and higher dry matter and protein contents ( p  < 0.05). Although gel strength (122.12–176.81 g) was lower than that of commercial bovine gelatin (242.44 g), all OH‐treated samples except those extracted at 20 V/cm formed stable gels. SDS‐PAGE and compositional analyses indicated that OH induced partial degradation of high‐molecular‐weight fractions, consistent with the observed gel strength trends. The amino acid profiles, dominated by glycine, proline, and hydroxyproline, and the viscoelastic behavior ( G ′ >  G ″) were comparable to commercial references. Thermal analyses further revealed sharper melting transitions and higher Δ H values, suggesting improved thermal stability. Microstructural changes in pore size and distribution supported the observed functional differences. Overall, OH‐assisted extraction provides an efficient, energy‐saving, and thermally controlled approach to gelatin production. To our knowledge, this is the first study to demonstrate the applicability of ohmic heating for extracting gelatin from bovine hide, underscoring its potential as a sustainable alternative to conventional processing methods.

Improving Energy Efficiency and Physical Quality of Camel ( Camelus dromedarius ) Meat Using a Hybrid Ohmic–Sous Vide Cooking Method

ABSTRACT This study investigated a novel hybrid cooking approach that integrates ohmic heating with sous vide (O‐SV) for preparing camel ( Camelus dromedarius ) meat. The method was compared with conventional sous vide (SV) in terms of energy efficiency, cooking yield, and physical attributes (pH and color). Camel meat samples were cooked at 70°C, 80°C, and 90°C for 30–120 min. Results demonstrated that cooking temperature and duration markedly influenced pH and color development. Extended cooking reduced redness and lightness but increased yellowness, reflecting protein denaturation and myoglobin oxidation. Compared with SV, the O‐SV system significantly improved energy efficiency, requiring less electrical and specific energy input while maintaining comparable cooking yields. The O‐SV method also produced distinct color profiles linked to rapid internal heating. These findings highlight O‐SV as a promising cooking system for achieving sustainable energy use and desirable physical quality in camel meat preparation.

Circulating Tumor Cells as Diagnostic and Therapeutic Biomarkers in Hepatocellular Carcinoma: Advancing Precision Oncology Through Liquid Biopsy

ABSTRACT Circulating tumor cells (CTCs) are emerging as promising biomarkers in hepatocellular carcinoma (HCC), offering noninvasive insight into tumor biology, progression, and treatment response. Advances in enrichment and single‐cell technologies have enabled the characterization of CTCs at genomic, transcriptomic, epigenetic, and proteomic levels. CTC detection correlates with tumor stage, vascular invasion, and alpha‐fetoprotein levels, supporting their role in early diagnosis and staging. Specific surface markers such as epithelial cell adhesion molecule, GPC3, ASGPR, and stem cell–associated antigens like CD90 and CD133 help classify CTC subtypes with prognostic and therapeutic relevance. Mesenchymal and hybrid phenotypes, identified via epithelial‐to‐mesenchymal transition markers, are linked to recurrence and metastasis. Furthermore, CTCs provide a platform for companion diagnostics by reflecting mutational and resistance profiles, particularly in the context of targeted therapies and immune checkpoint inhibitors. Despite current limitations in standardization, sensitivity, and scalability, the integration of CTC analysis into clinical practice holds potential to enhance precision medicine strategies in HCC.

Trends in Discharge to Institutional Post‐Acute Care After Total Joint Arthroplasty in the United States and Canada

ABSTRACT Background Recent payment reforms in the United States have been credited with reducing the use of institutional post‐acute care (PAC) after total knee arthroplasty (TKA) and total hip arthroplasty (THA). This dual‐country study of Canada and the United States compares longitudinal trends in discharge to institutional PAC after primary TKA or THA. Methods We conducted serial cross‐sectional analyses to compare discharge to institutional PAC trends among adults aged ≥ 66 years undergoing primary TKA or THA in the United States and Canada from 2013 to 2019. Patient‐level data were obtained from population‐based Medicare claims in the United States and analogous datasets in Ontario. Discharge trends were assessed using standardized differences and linear regression models to evaluate relative changes over time. Results Patients receiving TKA (2,308,001) and THA (1,234,149) in the United States and Ontario (106,721 and 53,371, respectively) were similar in age (73–74 years) and sex (~60% female). The absolute reduction in institutional PAC discharge over time for TKA was greater in the United States (slope = −3.59) than in Canada (slope = −0.53) ( p  < 0.0001), but relative reductions (slope = −8.78 in the United States, slope = −6.99 in Canada) were statistically similar ( p  = 0.08). THA showed a similar trend of absolute reductions; however, the relative reduction trend in the United States (slope = −9.98) was steeper than in Canada (slope = −6.46) ( p  = 0.0009). Conclusions The US payment reforms from 2013 to 2019 were associated with a greater impact on reducing institutional PAC utilization for THA than for TKA.

Bone metastases from neuroendocrine neoplasms: Results of an Italian nationwide survey of natural history and management

Abstract Bone metastases (BMs) were reported in <15% of cases of neuroendocrine neoplasms (NENs). Their clinical behavior is various and clinical management is still undefined. This study aimed to describe the clinical practical management and survival outcome of neuroendocrine neoplasm patients with BMs. This is a retrospective, observational, multicenter, nationwide study, in which clinical‐pathological characteristics, diagnostic tools, skeletal‐related events (SREs), bone targeted agents (BTAs) and their correlation with clinical outcome were collected. Data from 320 patients from 18 Italian centers diagnosed with bone metastases during 2000–2013 were captured. Most patients had a well/moderately differentiated NEN, with synchronous distant metastases, mostly hepatic, the majority of which originated from a gastroenteropancreatic primary site. Bone was the first metastatic site in 41% of patients. After a median follow‐up of 27 months 122 patients died. The median overall survival (OS) was 62 months. In 22% of patients ( n  = 72), SREs were observed, and 31% of patients received a BTA. At multivariable analysis of factors associated with OS after the development of BMs, primary lung site, Ki‐67 ≥55% versus ≤20%, >10 BMs, mixed pattern (osteoblastic/osteolytic) versus osteoblastic, prior lung metastases and SREs were found to be significant poor prognosis factors. At multivariable analysis Ki‐67 ≥55% versus ≤20% remains significantly associated with the development of SREs. Our study represents a real‐life nationwide scenario of a large series of NEN patients with BMs handled at dedicated centers. Several hypotheses generated by this study are warranted to be tested in future homogeneous studies, including objective criteria for the use of BTAs.

Comparative Efficacy and Safety of Intralesional MMR Vaccine and Vitamin D3 in Managing Nongenital Warts: A Systematic Review and Meta‐Analysis

ABSTRACT Background Cutaneous warts are common benign lesions caused by human papillomavirus and often resist conventional treatments. Intralesional immunotherapy with measles–mumps–rubella (MMR) vaccine or vitamin D3 has emerged as an alternative, but their comparative efficacy and safety remain unclear. Methods We conducted a systematic review and meta‐analysis of nine randomized controlled trials (RCTs) including 742 patients comparing intralesional MMR with vitamin D3 for nongenital cutaneous warts. We searched PubMed, Cochrane CENTRAL, and ScienceDirect up to June 2025, and the protocol was registered in PROSPERO (ID: 1128443). Primary outcomes were complete, partial, and no response; secondary outcomes were recurrence and adverse events (erythema, pain, swelling). Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. Results Vitamin D3 achieved lower complete clearance than MMR (RR 0.85; 95% CI 0.75–0.96; p  = 0.01) and a higher risk of no response (RR 2.40; 95% CI 1.40–4.13; p  = 0.002). No significant differences were seen for partial response (RR 1.24; 95% CI 0.94–1.64; p  = 0.13; I 2  = 0%), recurrence (RR 2.20; 95% CI 0.73–6.58; p  = 0.16), or pain (RR 0.92; 95% CI 0.74–1.14; p  = 0.46). Vitamin D3 was linked to more swelling (RR 2.79; 95% CI 1.15–6.75; p  = 0.02), while MMR was associated with more erythema (RR 0.60; 95% CI 0.42–0.86; p  = 0.006). Conclusions Intralesional MMR appears to be more effective than vitamin D3 for cutaneous warts, with superior clearance and distinct adverse event profiles. Larger, standardized trials are warranted to validate these effect sizes and optimize treatment strategies.

A Novel 1726 Nm Laser Therapy for Durable Clearance of Seborrheic Dermatitis

Climate Anxiety and COPD : Unveiling Its Impact on Patients' Quality of Life Through a Multivariate Lens

ABSTRACT Objective To examine the impact of climate anxiety on the quality of life (QoL) of patients with COPD. It also explores how climate anxiety interacts with clinical factors, such as disease severity and comorbidities, to influence QoL. Design Cross‐sectional. Methods A total of 270 COPD patients were recruited using a convenience sampling method. Data were collected through structured interviews and clinical assessments, incorporating the Climate Anxiety Scale, the St. George's Respiratory Questionnaire and the BODE Index. Hierarchical multiple regression analysis was performed to determine the predictors of QoL. Results The study found a statistically significant association between climate anxiety and both QoL ( r  = 0.81, p  < 0.01) and COPD severity ( r  = 0.76, p  < 0.01). COPD severity ( B  = 4.68, p  < 0.01) and climate anxiety ( B  = 0.28, p  < 0.01) were predictors of QoL. Among the covariates, former smokers, older patients and multiple comorbidities reported significantly worse QoL ( B  = 4.80, p  = 0.03; B  = 0.43, p  < 0.01; B  = 0.85, p  = 0.02, respectively). Collectively all predictors explained 86% of the variance in QoL. Conclusion Climate anxiety significantly contributes to reduced QoL in COPD patients, beyond disease severity and demographic factors. Addressing psychological distress in COPD management is essential to improving patient outcomes. Implications for Practice Nurses should recognise climate anxiety as a key variable influencing COPD management. Incorporating climate anxiety screening into nursing assessments and providing targeted interventions can enhance patient support and improve overall COPD care. Impact Climate anxiety is an emerging concern in COPD. While previous research has focused on physical and clinical determinants of COPD‐related QoL, climate anxiety remains underexplored. This study provides new evidence that climate anxiety is a predictor of poorer QoL, highlighting the need for holistic nursing interventions that address both physical and psychological health. Reporting Method This study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). Patient or Public Contribution Patients with COPD were involved in this study.

Risk of rhabdomyolysis with concomitant use of statins and SGLT2 inhibitors: A population‐based cohort study