Search Results (1,650)

Background: Traumatic adrenal injury (TAI) is a rare but significant condition that affects 2.5% of patients with thoracoabdominal trauma. The impact of adrenal hematoma volume on clinical outcomes remains underexplored. This study aimed to evaluate factors associated with morbidity and mortality in patients with TAI, with a particular focus on adrenal hematoma volume as a predictive marker. Methods: Retrospective data from patients with radiologically confirmed TAI between 2013 and 2023 was analyzed. Clinical, demographic, and radiological variables were reviewed. Hematoma volume was calculated from computed tomography (CT) imaging and analyzed using univariate and multivariate models. Receiver operating characteristic (ROC) analysis was employed to evaluate its predictive accuracy. Results: Sixty patients were included in the study. The median hematoma volume was 16.0 cm³, with a predominance of injuries on the right side. The morbidity and mortality rates were 18.3% and 8.3%, respectively. Univariate analysis identified a lower Glasgow Coma Scale (GCS) score, higher Injury Severity Score (ISS), and increased hematoma volume as significant factors. In multivariate analysis, hematoma volume and GCS score remained independent predictors of adverse outcomes. A volume threshold of >23 cm³ was associated with significantly higher morbidity and mortality (AUC = 0.80, 95% CI: 0.68–0.92). Conclusions: This study is the first to demonstrate that the volume of adrenal hematoma is an independent predictor of adverse outcomes in patients with traumatic adrenal injury. Integrating volume into clinical assessment may help identify high-risk patients requiring improved observation and management. Full article

High-precision 6D pose estimation for pick-and-place operations remains a critical problem for industrial robot arms in manufacturing. This study introduces an analytics-based solution for 6D pose estimation designed for a real-world industrial application: it enables the Staubli TX2-60L (manufactured by Stäubli International AG, Horgen, Switzerland) robot arm to pick up metal plates from various locations and place them into a precisely defined slot on a brake pad production line. The system uses a fixed eye-to-hand Intel RealSense D435 RGB-D camera (manufactured by Intel Corporation, Santa Clara, California, USA) to capture color and depth data. A robust software infrastructure developed in LabVIEW (ver.2019) integrated with the NI Vision (ver.2019) library processes the images through a series of steps, including particle filtering, equalization, and pattern matching, to determine the X-Y positions and Z-axis rotation of the object. The Z-position of the object is calculated from the camera’s intensity data, while the remaining X-Y rotation angles are determined using the angle-of-inclination analytics method. It is experimentally verified that the proposed analytical solution outperforms the hybrid-based method (YOLO-v8 combined with PnP/RANSAC algorithms). Experimental results across four distinct picking scenarios demonstrate the proposed solution’s superior accuracy, with position errors under 2 mm, orientation errors below 1°, and a perfect success rate in pick-and-place tasks. Full article

Paper-based colorimetric biosensors represent a promising class of low-cost diagnostic tools that do not require external instrumentation. However, their broader applicability is limited by the environmental concerns associated with conventional metal-based nanomaterials and the subjectivity of visual interpretation. To address these challenges, this study introduces a proof-of-concept platform—using CA19-9 as a model biomarker—that integrates naturally derived melanin nanoparticles (MNPs) with machine learning-based image analysis to enable environmentally sustainable and analytically robust colorimetric quantification. Upon target binding, MNPs induce a concentration-dependent color transition from yellow to brown. This visual signal was quantified using a machine learning pipeline incorporating automated region segmentation and regression modeling. Sensor areas were segmented using three different algorithms, with the U-Net model achieving the highest accuracy (average IoU: 0.9025 ± 0.0392). Features extracted from segmented regions were used to train seven regression models, among which XGBoost performed best, yielding a Mean Absolute Percentage Error (MAPE) of 17%. Although reduced sensitivity was observed at higher analyte concentrations due to sensor saturation, the model showed strong predictive accuracy at lower concentrations, which are especially challenging for visual interpretation. This approach enables accurate, reproducible, and objective quantification of colorimetric signals, thereby offering a sustainable and scalable alternative for point-of-care diagnostic applications. Full article

Background/Objectives: Obesity is a major cause of repolarisation defects of the heart. The frontal QRS-T angle is a new parameter used for cardiac evaluation. This study aimed to evaluate the effects of a laparoscopic cholecystectomy and anaesthetic agents on the frontal QRS-T angle in individuals with obesity. Methods: A total of 91 patients who underwent a laparoscopic cholecystectomy surgery were included in this study. The patients were divided into two groups according to body mass index (BMI) < 30 (n = 68) and ≥30 (n = 23). The frontal QRS-T angle (FQRST), QT interval (QT), corrected QT, and other electrocardiography (ECG) findings were recorded at different time points. Results: In the BMI ≥ 30 group, the frontal QRS-T angle and QT interval measured during the intraoperative period were statistically higher than those of the BMI < 30 group (p < 0.001, p < 0.001). Additionally, the frontal QRS-T angle value was statistically higher in all patients postoperatively compared with the preoperative and intraoperative periods (p < 0.001). Furthermore, there was a positive correlation between the BMI and the frontal QRS-T angle. Our study found that the QRS-T angle and the QT interval duration measured during surgery in the BMI ≥ 30 group who underwent a laparoscopic cholecystectomy were significantly higher than in the BMI < 30 group. Conclusions: We recommend close haemodynamic monitoring during and after surgery for patients with obesity undergoing a laparoscopic cholecystectomy. Full article

In this study, the water-repellent performance of Expanded Perlite (EP) coated with stearic acid (SA) at different coating/EP ratios (0.1%, 0.2%, 0.3%, 0.4%, 0.5%, 1%, 2%, 3%, 4% and 5%) and the capillary water absorption and thermal conductivity behaviors of the modified insulation mortars prepared at these different coating/EP ratios were investigated experimentally. In contrast to the existing literature, experimental studies were carried out for both coated and uncoated EP particles used in mortars to which water-repellent polymers were not added, and the minimum and maximum coating amounts showing the lowest capillary water absorption and slump were determined. In addition, the sustainability of modified insulation mortars consisting of EP-coated SA was determined by sustainable thermal performance (STP). In other words, this study is the first in the literature to determine how the thermal conductivity values of these mortars may change during their use in buildings. According to the experimental results, water absorption, which is an undesirable property, decreased significantly when coated with SA, and even SA-coated expanded coarse perlite (SCP) showed almost no water-absorption behavior at coating levels above 2%. The water-repellent performance of SCP was determined to be 83.2% between 0.1% and 0.4%. In addition, for coarse mortars (MCs), the best water-repellent performance was achieved at a 5% coating/EP ratio, with a 37% reduction in the capillary water-absorption coefficient. In addition, it was found that STP values increased as the coating/EP ratio increased. In other words, modified insulation mortars became more sustainable with an increasing SA coating/EP ratio. The highest STP values were observed in Groups 2 and 4 at a 5% coating/EP ratio, with MC-5 reaching 39.27% in Group 2 and MF-5 reaching 30.30% in Group 4. The results are important from a practical/industrial point of view and from a scientific point of view. Full article

Background/Objectives. Efficient nucleic acid delivery into target cells remains a critical challenge in gene therapy. Due to its advantages in biocompatibility and safety, recent research has increasingly focused on non-viral gene delivery. Methods. A series of copolymers—synthesized by integrating thermally sensitive poly(N-isopropylacrylamide) (PNIPAm), hydrophilic poly(ethylene glycol) (PEG) grafts, and a polycationic poly(L-lysine) (PLL) block of varying lengths ((PNIPAm)₇₇-graft-(PEG)₉-block-(PLL)_z, z = 10–65)—were investigated. Plasmid DNA complexation with the copolymers was achieved through temperature-modulated methods. The resulting polyplexes were characterized by evaluating complex strength, particle size, zeta potential, plasmid DNA loading capacity, resistance to anionic stress, stability in serum, and lysosomal membrane destabilization assay. The copolymers’ potential for plasmid DNA delivery was assessed through cytotoxicity and transfection studies in cancer cell lines. Results. Across all complexation methods, the copolymers effectively condensed plasmid DNA into stable polyplexes. Particle sizes (60–90 nm) ranged with no apparent correlation to copolymer type, complexation method, or N/P ratio, whereas zeta potentials (+10–+20 mV) and resistance to polyanionic stress were dependent on the PLL length and N/P ratio. Cytotoxicity analysis revealed a direct correlation between PLL chain length and cell viability, with all copolymers demonstrating minimal cytotoxicity at concentrations required for efficient transfection. PNL-20 ((PNIPAm)₇₇-graft-(PEG)₉-block-(PLL)₂₀) exhibited the highest transfection efficiency among the tested formulations while maintaining low cytotoxicity. Conclusions. The study highlights the promising potential of (PNIPAm)₇₇-graft-(PEG)₉-block-(PLL)_z copolymers for effective plasmid DNA delivery to cancer cells. It reveals the importance of attaining the right balance between polyplex tightness and plasmid release to achieve improved biocompatibility and transfection efficiency. Full article

Johannes Althusius (1563–1638) was a pioneer of early modern federalism. Opposing Jean Bodin’s theory of absolute sovereignty, his theory, centered on association and symbiosis, laid the groundwork for later concepts such as associationalism, consociationalism, and the principle of subsidiarity. While his ideas have been rediscovered and reinterpreted by scholars since the 20th century, systematic research on his federalist framework, especially contrasting it with rival theories of that time, remains insufficient. This article addresses this research gap by systematically exploring Althusius’s federalism. It argues that Althusius’s covenant-based, multi-level associational/federal framework provided a counter-theory to the concept of absolute sovereignty. Systematically studying his federalism not only helps to restore his federalist ideas to their rightful place in the history of federalist thought, but also provides insights for contemporary governance paradigms struggling with modern pluralism. Full article

This study presents a numerical and experimental evaluation of axial load transfer mechanisms in deep foundations constructed in stratified cohesive soils in İzmir, Türkiye. A full-scale bi-directional static load test equipped with strain gauges was conducted on a barrette pile to investigate depth-dependent mobilization of shaft resistance. A finite element model was developed and calibrated using field-observed load–settlement and strain data to replicate the pile–soil interaction and deformation behavior. The analysis revealed a shaft-dominated load transfer behavior, with progressive mobilization concentrated in intermediate-depth cohesive layers. Sensitivity analysis identified the undrained stiffness (E_u) as the most influential parameter governing pile settlement. A strong polynomial correlation was established between calibrated E_u values and SPT N₆₀, offering a practical tool for preliminary design. Additionally, strain energy distribution was evaluated as a supplementary metric, enhancing the interpretation of mobilization zones beyond conventional stress-based methods. The integrated approach provides valuable insights for performance-based foundation design in layered cohesive ground, supporting the development of site-calibrated numerical models informed by full-scale testing data. Full article

Background/Objectives: Malnutrition in older adults is both preventable and treatable, yet its detection and etiology remain complex. Therefore, the aim of this study was to evaluate the prevalence of malnutrition and various factors involved in the etiology of malnutrition in community-dwelling individuals aged 65 years and older. Methods: This cross-sectional study was conducted with community-dwelling individuals aged 65 years and older in a health center in Ağrı, Türkiye. The nutritional status of older adults was measured using the Mini Nutritional Assessment (MNA). Data were collected through face-to-face interviews and a series of validated instruments, including the Standardized Mini Mental Examination (MMSE), body composition measurements (BIA), dietary intake records, and physical performance tests such as hand grip strength, chair stand, and Timed ‘Up & Go’ (TUG) Test. Statistical analyses included chi-square and Mann-Whitney U tests for group comparisons and logistic regression to investigate independent factors associated with risk of malnutrition. Results: A total of 182 participants were included in the study. The mean age of the participants was 72.1 ± 6.0 years. Of the participants, 59.3% were male. 1.6% of the participants were malnourished, and 25.3% were at risk of malnutrition. Perceived health status compared to peers (OR: 1.734, 95% CI: 1.256–2.392, p = 0.001), lower appetite status (OR: 1.942, 95% CI: 1.459–2.585, p < 0.001) and lower waist circumference (OR: 1.089, 95% CI: 1.040–1.140, p < 0.001) were independent predictors of malnutrition risk. Conclusions: The risk of malnutrition was higher among individuals with lower appetite, poorer self-perceived health status compared to peers, and smaller waist circumference. Reduced physical function and strength were also associated with an increased risk of malnutrition. Full article

Objectives: Febrile neutropenia is a common oncologic emergency with significant morbidity and mortality. Although the MASCC (Multinational Association for Supportive Care in Cancer) score is widely used for risk stratification, its limited sensitivity and lack of laboratory parameters reduce its prognostic utility. This study aimed to evaluate whether incorporating serum lactate and CRP measurements into the MASCC score enhances its predictive performance for hospital admission and the 30-day mortality. Methods: This retrospective diagnostic accuracy study included adult patients diagnosed with febrile neutropenia in the emergency department of a tertiary care hospital between January 2021 and December 2024. The original MASCC score was calculated, and three modified models were derived: the MASCC-L (lactate/MASCC), MASCC-C (CRP/MASCC) and MASCC-LC models (CRP × lactate/MASCC). The predictive accuracy for hospital admission and the 30-day all-cause mortality was assessed using ROC analysis. Results: A total of 269 patients (mean age: 67.6 ± 12.4 years) were included; the 30-day mortality was 3.0%. The MASCC-LC model demonstrated the highest discriminative ability for mortality prediction (area under the curve (AUC): 0.995; sensitivity: 100%; specificity: 98%). For hospital admission prediction, the MASCC-C model had the highest specificity (81%), while the MASCC-LC model showed the best balance of sensitivity and specificity (both 73%). All the modified models outperformed the original MASCC score regarding both endpoints. Conclusions: Integrating lactate and CRP measurements into the MASCC score significantly improves its prognostic accuracy for both mortality and hospital admission in febrile neutropenic patients. The MASCC-LC model, relying on only three objective parameters, may serve as a practical and efficient tool for early risk stratification in emergency settings. Full article

Background/Objectives: Multimodal large language models (LLMs) are increasingly used in radiology. However, their ability to recognize fundamental imaging features, including modality, anatomical region, imaging plane, contrast-enhancement status, and particularly specific magnetic resonance imaging (MRI) sequences, remains underexplored. This study aims to evaluate and compare the performance of three advanced multimodal LLMs (ChatGPT-4o, Claude 4 Opus, and Gemini 2.5 Pro) in classifying brain MRI sequences. Methods: A total of 130 brain MRI images from adult patients without pathological findings were used, representing 13 standard MRI series. Models were tested using zero-shot prompts for identifying modality, anatomical region, imaging plane, contrast-enhancement status, and MRI sequence. Accuracy was calculated, and differences among models were analyzed using Cochran’s Q test and McNemar test with Bonferroni correction. Results: ChatGPT-4o and Gemini 2.5 Pro achieved 100% accuracy in identifying the imaging plane and 98.46% in identifying contrast-enhancement status. MRI sequence classification accuracy was 97.7% for ChatGPT-4o, 93.1% for Gemini 2.5 Pro, and 73.1% for Claude 4 Opus (p < 0.001). The most frequent misclassifications involved fluid-attenuated inversion recovery (FLAIR) sequences, often misclassified as T1-weighted or diffusion-weighted sequences. Claude 4 Opus showed lower accuracy in susceptibility-weighted imaging (SWI) and apparent diffusion coefficient (ADC) sequences. Gemini 2.5 Pro exhibited occasional hallucinations, including irrelevant clinical details such as “hypoglycemia” and “Susac syndrome.” Conclusions: Multimodal LLMs demonstrate high accuracy in basic MRI recognition tasks but vary significantly in specific sequence classification tasks. Hallucinations emphasize caution in clinical use, underlining the need for validation, transparency, and expert oversight. Full article

Traditional wound and burn treatments often fall short in balancing antimicrobial efficacy, patient comfort, and ease of application. This study introduces a novel, transparent, thermoresponsive sol–gel formulation incorporating polyhexamethylene biguanide (PHMB) for advanced topical therapy. Utilizing Poloxamer 407 as a biocompatible carrier, the formulation remains a sprayable liquid at room temperature and instantly gels upon contact with body temperature, enabling painless, pressure-free application on sensitive, injured skin. Comprehensive in vitro and in vivo evaluations confirmed the formulation’s broad-spectrum antimicrobial efficacy (≥5 log₁₀ reduction in 30 s), high biocompatibility (viability > 70% in fibroblasts), non-irritancy (OECD 425-compliant), and physical stability across three months. Importantly, the formulation maintained fibroblast migration capacity—crucial for wound regeneration—while exhibiting rapid sol-to-gel transition at ~34 °C. These findings highlight the system’s potential as a next-generation wound dressing with enhanced user compliance, transparent monitoring capability, and rapid healing support, particularly in disaster or emergency scenarios. Full article

Background and Objectives: Long-acting cabotegravir and rilpivirine (LA-CAB/RPV) offers an alternative to daily oral antiretroviral therapy (ART) for people living with HIV (PLWH). Although LA-CAB/RPV has been approved in Turkey, the country remains in the pre-rollout period, and national data on patient perspectives are lacking. This is the first nationwide study from Turkey, a setting of increasing HIV incidence, assessing PLWH perspectives on switching to LA-CAB/RPV and the influence of motivational factors on treatment preferences. Materials and Methods: A prospective, multicenter, cross-sectional study was conducted across 11 HIV treatment centers representing all regions of Turkey. Virologically suppressed PLWH meeting current eligibility criteria for LA-CAB/RPV were included. Treatment preferences (switch to LA-CAB/RPV or remain on oral ART) and five anticipated motivational domains, namely perceived efficacy, safety, convenience, privacy, and cost, were systematically assessed through structured, face-to-face interviews. Results: Among 200 eligible participants, 86% (n = 172) preferred switching to LA-CAB/RPV. In all subgroups, LA-CAB/RPV was preferred over oral ART, except for those with no formal literacy. Prior awareness of LA-CAB/RPV was significantly associated with the switching preference (p < 0.001), with healthcare providers being the most common source of information, at 45.5% (n = 172) (p < 0.001). Residential proximity to the healthcare center (p = 0.018) and all motivational factors significantly influenced the preference (p < 0.05). Notably, when participants who initially chose to remain on oral ART were asked whether they would reconsider switching if injections were administered every six months, overall preference for long-acting therapy increased from 86% to 98%. Conclusions: High clinical eligibility and strong acceptability for LA-CAB/RPV were observed among Turkish PLWH. Our findings demonstrate that structured motivational factors significantly influence the treatment preference. Addressing these patient-centered factors and logistical barriers may support the successful integration of long-acting therapies into routine HIV care. Future longer-interval agents may improve patient-centered acceptability. Full article

Legume crops are sensitive to shifting environmental conditions, as they depend on a narrow range of climatic stability for growth and nitrogen fixation. This research sought to assess the sustainability of Faba Asturiana (FA) cultivation under current and future climatic scenarios by establishing generalized linear mixed models (GLMMs). Specifically, it aimed to (1) investigate the effects of significant climatic stressors, including higher nighttime temperatures and extended drought periods, on crop viability, (2) analyze future scenarios based on Representative Concentration Pathways (RCP 4.5 and RCP 8.5), and (3) recommend adaptive measures to mitigate threats. Six spatial GLMMs were developed, incorporating variables such as extreme temperatures, precipitation, and the drought duration. Under present-day conditions (1971–2000), all the models exhibited strong predictive performances (AUC: 0.840–0.887), with warm nights (tasminNa20) consistently showing a negative effect on suitability (coefficients: −0.58 to −1.16). Suitability projections under future climate scenarios revealed considerable variation among the developed models. Under RCP 4.5, Far Future, Model 1 projected a 7.9% increase in the mean suitability, while under RCP 8.5, Far Future, the same model showed a 78% decline. Models using extreme cold, drought, or precipitation as climatic stressors (e.g., Models 2–4) revealed the most significant suitability losses under RCP 8.5, with the reductions exceeding 90%. In contrast, comprising variables less affected by severe fluctuations, Model 6 showed relative stability in most of the developed scenarios. The model also produced the highest mean suitability (0.130 ± 0.207) in an extreme projective scenario. The results highlight that high night temperatures and prolonged drought periods are the most limiting factors for FA cultivation. ecological niche models (ENMs) performed well, with a mean AUC value of 0.991 (SD = 0.006) and a mean TSS of 0.963 (SD = 0.024). According to the modeling results, among the variables affecting the current distribution of Protected Geographical Indication-registered AF, prspellb1 (max consecutive dry days) had the highest effect of 28.3%. Applying advanced statistical analyses, this study provides important insights for policymakers and farmers, contributing to the long-term sustainability of PGI agroecosystems in a warming world. Full article

Dense aggregations of species in the family Pinnidae give soft substrata a specific characterization. They may influence the biological and physical properties of the surrounding sediments. Bottom-trawl samplings performed in the Sea of Marmara revealed populations of a large pinnid species, particularly at depths of 40–45 m in soft substrata. Both morphological and DNA analyses confirmed the species’ taxonomic identity as Atrina fragilis. This species had a population density ranging from 31 to 469 ind.km⁻², and the shell lengths ranged from 21.3 to 31 cm. A total of 47 macrozoobenthic species belonging to eight taxonomic groups were found on the shells of ten live and nine dead A. fragilis individuals. Polychaeta accounted for 53% of the total number of species and 75% of the total number of individuals. Among these species, Protula tubularia and Serpula concharum comprised almost 30% of all epifaunal populations. Community parameters changed according to the shell length and width. Different faunal assemblages were encountered on the shells. Given the ecological significance of A. fragilis as both a habitat-forming and sensitive benthic species, conservation measures should prioritize the protection of known habitats and the regulation of activities that lead to seabed disturbance. Full article