Search Results (3,642)

The advent of transcatheter aortic valve implantation (TAVI) has redefined the treatment of aortic stenosis over the last two decades, evolving from a therapy reserved for patients that were deemed to be of prohibitive surgical risk to the standard of care for a large group of patients presenting with symptomatic disease. With improvements in technology, operator and institutional experience and longer-term outcome data, recent guidelines have supported the broadening of indications to low-risk and asymptomatic patients in addition to other pathologies including the management of failed surgical bioprosthetic valves and aortic regurgitation. The rapid developments in the field have resulted in a rapid expansion of TAVI. The focus has moved from the technical aspects of the procedure itself that are now well established to the lifetime management of patients with aortic stenosis, particularly younger patients with regard to valve durability, planning for a further intervention after TAVI and associated considerations including future coronary access. Beyond aortic stenosis, TAVI technology is also increasingly being utilized for the management of failed surgical bioprostheses, bicuspid valve disease, aortic incompetence and mitral/tricuspid disease and these represent future areas of focus in the field. Full article

Since 2018, the Belgian legislator has created several substantial exceptions to the traditional prohibition on agreements concerning future estates. Succession agreements make it possible to create, modify or terminate rights to a person’s future estate among the parties involved. A central innovation of the 2018 Belgian reform is the ‘global succession agreement’, also referred to as a family pact, which allows parents to establish and agree upon an individualized and subjective equilibrium with all of their children, taking into account both prior and present donations to the children, and several other elements deemed relevant to them. The equilibrium is subjective as it is not defined by objective, quantitative criteria, but rather by how the parties qualitatively, together as a family, feel about what constitutes a fair and balanced solution for them. This family confirmation of their own specific equilibrium constitutes a core condition for the validity of the global succession agreement. This contribution first examines how this equilibrium should be understood and how families can effectively attain it in practice, with particular attention to the role of family dynamics. Second, this article explores how global succession agreements can accommodate non-traditional family structures and complex family situations, with the aim of achieving a fair and equitable regulation that reflects the specific wishes and needs of all family members involved. Full article

Background: Hemodynamic depression, characterized by bradycardia and hypotension, is a common complication of carotid artery stenting (CAS) and is primarily attributed to carotid sinus baroreceptor stimulation. While prophylactic atropine is often used in high-risk patients, predictors of unexpected hemodynamic depression among patients initially deemed low-risk remain incompletely defined. Objective: To identify clinical, anatomical, and procedural predictors of hemodynamic depression in patients undergoing CAS without prophylactic atropine. Methods: We performed a retrospective, single-center observational study of consecutive patients undergoing CAS between January 2015 and May 2024. Patients who received prophylactic atropine for low baseline heart rate (HR) were excluded. Hemodynamic depression was defined as a >20% reduction in HR from baseline. Absolute bradycardia (HR <50 bpm) and hypotension (>40% reduction in systolic blood pressure) were recorded descriptively. Results: A total of 158 patients underwent CAS, of whom 33 (20.9%) were excluded due to prophylactic atropine administration for low pre-procedural heart rates (<60 bpm). Among 125 included patients, 62 (49.6%) experienced significant HR reduction during CAS. In multivariable analysis, a shorter distance between the stenotic lesion and the carotid bifurcation was independently associated with hemodynamic depression (OR 0.90 per mm increase; 95% CI 0.82–0.99; p = 0.023). Greater intraprocedural reductions in systolic and mean arterial pressure were also associated with HR depression. Traditional clinical risk factors, including age, sex, comorbidities, degree of stenosis, calcification severity, anesthesia type, and procedure urgency, were not independently predictive. Conclusions: Hemodynamic depression remains frequent during CAS even among patients classified as low risk. Lesion proximity to the carotid bifurcation is a key anatomical predictor of autonomic instability, highlighting the limitations of standard risk stratification and supporting a lesion-specific approach to periprocedural hemodynamic management. Full article

Background: Chlorella, a unicellular green alga, is currently one of the most popular algae supplements due to its high content of bioactive compounds. Chlorella’s wide range of macro- and micronutrients, including chlorophyll compounds and carotenoids, has been suggested to influence various disorders related to the digestive and nervous systems. This review’s primary purpose was to critically analyze the effects of Chlorella intake on gut microbiota and brain function. Methods: The authors conducted a systematic review with narrative synthesis of peer-reviewed articles written in English and published in PubMed, Web of Science, and Scopus spanning the years 2009 to 2026 (PROSPERO registration number CRD42024527705). The search protocol was performed following PRISMA guidelines. Primary outcomes encompassed physiological variables, such as gut microbial composition, short-chain fatty acids, brain-derived neurotrophic factor, and hippocampal cell density. Secondary outcomes were assessed through neurobehavioral tests and psychological questionnaires. Results: Out of the 1333 articles identified, 47 studies were deemed eligible, and 21 met the predefined criteria, subsequently incorporated into this systematic review. In total, 10 articles documented interventions involving Chlorella and their effects on the gut microbiota, whereas 11 articles investigated several variables pertinent to brain function. Most of the studies included were conducted in animal models, with only a limited number of human trials. Nineteen studies (90%), predominantly preclinical, reported positive associations between Chlorella consumption, gut microbiota modulation, and physiological or neurobehavioral markers related to the gut–brain axis. Conclusions: Chlorella consumption may modulate gut microbiota composition and function, potentially influencing brain-related processes. However, the available literature lacks studies simultaneously addressing both gut microbiota and brain health parameters limiting the understanding of the underlying physiological mechanisms. Full article

In milling operations, cutters entering and exiting workpiece boundaries cause varying radial immersions and chip thicknesses. This generates aperiodic cutting forces that often induce vibrations and degrade surface quality. To address this, this study aims to accurately predict milling forces and surface profiles during these critical engagement and disengagement phases. An analytical approach was developed to estimate the changing distances between the cutting teeth and workpiece boundaries, enabling the precise calculation of the dynamic chip thickness as the cutter transitions through the material. Based on these dynamic calculations, milling forces and system responses were simulated. Experimental validation demonstrated a strong agreement between the simulated cutting forces, machined surface profiles, and real-world results. Notably, findings revealed that even cutting parameters deemed stable by traditional stability lobes can still trigger vibrations during these boundary transitions. Consequently, a novel parameter selection strategy is proposed to effectively prevent these transient vibrations, significantly enhancing the final surface finish. Ultimately, this comprehensive modelling framework provides a deeper understanding of the system dynamics throughout the entire milling process, offering high relevance for broader applications, such as optimising energy consumption, predicting tool wear, and improving machining parameter optimisation. Full article

Background/Objectives: With increasing frequency in sublobar resections, accurate intraoperative localization has become essential to ensure adequate resection margins and spare lung parenchyma. Our study evaluates the efficacy of shape-sensing robotic bronchoscopy (SS-RAB) with integrated mobile cone-beam CT (mCBCT) for intraoperative localization of lung tumors using indocyanine green (ICG). We further aimed to explore the feasibility of a single intubation-single positioning technique for bronchoscopy and surgery. Methods: We retrospectively reviewed patients who underwent SS-RAB with integrated mCBCT for ICG marking, followed by minimally invasive sublobar resection. ICG marking was deemed successful when it allowed the operative team to localize and resect the lesion with adequate pathology margins. Results: A total of 28 patients with 30 pulmonary lesions from a single institution were included. Median tumor size was 10.5 mm (IQR, 8.7–14.6 mm) and distance from pleura 7.8 mm (IQR, 2.45–13.8 mm). Twenty lesions (66.6%) were solid, 5 lesions (16.6%) semi-solid, and 5 lesions (16.6%) ground-glass. ICG localization was successful in 28 lesions (93%). Nineteen patients (68%) were intubated only with a double-lumen endotracheal tube (DL-ETT), used for bronchoscopy and surgery, and in 10 patients (36%) ICG marking and surgery were both performed in lateral decubitus. One patient developed a small pneumothorax during bronchoscopy which did not prevent ICG injection. Conclusions: SS-RAB with integrated mCBCT for ICG marking is successful and safe. Single intubation with DL-ETT and lateral decubitus positioning for both bronchoscopy and surgery are feasible. Further studies are needed to prove a potential increase in efficiency with this technique. Full article

Contemporary English speakers often make a distinction between things that are artificial and those that are deemed natural. On the one hand are places, things, and situations that humans have altered, and on the other those that are free (or relatively free) of human influence. This concept of “nature” is an important, if problematic, one: it influences much of the modern environmental movement, where nature often has positive connotations while the artificial is valued negatively. In this paper I will be focusing on an idea found in Tibetan anti-meat literature: that there is a moral difference between eating the meat of animals that “die as a result of their karma” and animals that are slaughtered. This idea, I argue, parallels the distinction between the natural and artificial found in many English language discussions about the environment. As such, my suggestion is that this idea could, with some development, help support dialogue over environmental issues between Western and Buddhist philosophers and communities. Full article

Background/Objectives: The recent approval of the first intranasal calcitonin gene-related peptide receptor antagonist (CGRP-RA), zavegepant, has increased the relevance of this drug class in treating acute migraine. However, introducing an alternative delivery method may result in a different real-world safety profile. Thus, the aim of this study was to assess adverse events (AEs) related to zavegepant through a retrospective pharmacovigilance disproportionality analysis. Methods: We analyzed Individual Case Safety Reports (ICSRs) presenting zavegepant as the suspected drug, submitted to the Food and Drug Administration (FDA) Adverse Event Monitoring System (AEMS) database between 1 January 2023 and 31 December 2025. ICSRs were assessed by using descriptive and disproportionality analyses. Reporting odds ratios (RORs) with 95% confidence intervals (CIs) were used as disproportionality measures. Results were deemed significant if the ROR 95% CI lower bound was >1 and ≥3 ICSRs were available for each drug–event pair. Results: A total of 509 zavegepant-related ICSRs were identified. Most ICSRs involved female patients (n = 353; 69.4%), with a median (quartile 1, Q1–quartile 3, Q3) age of 45 (34–56) years. The Medical Dictionary for Regulatory Activities (MedDRA^®) Preferred Terms with the highest RORs were nasal discomfort (n = 62; ROR = 298.85; 95%CI [228.91, 390.17]), rhinalgia (10; 126.09; [67.34, 236.09]), dysgeusia (147; 94.72; [78.19, 114.75]), pharyngeal ulceration (3; 79.20; [25.42, 246.75]), and upper-airway cough syndrome (16; 62.87; [38.19, 103.49]). Conclusions: These results suggest a safety profile for zavegepant consistent with previous knowledge regarding CGRP-RAs. However, nasal and/or oropharyngeal AEs, plausibly related to intranasal exposure, may affect perceived tolerability and timely use, warranting further investigation. Full article

Background: Vertebral column resection (VCR) has historically been recognized as the most efficacious corrective intervention for severe rigid spinal deformities. Nevertheless, advancements in preoperative optimization, staged corrective methodologies, osteotomies, and contemporary instrumentation have broadened the spectrum of therapeutic options available. The definitive role of VCR in the modern management of rigid congenital spinal deformities remains a topic of ongoing scholarly discourse. Methods: This study presents two illustrative cases of severe congenital spinal deformities that were addressed employing various surgical methodologies, alongside a comprehensive review of the current literature pertaining to VCR and less invasive alternatives, including halo-gravity traction (HGT), temporary internal distraction techniques, pedicle subtraction osteotomy (PSO), asymmetric pedicle subtraction osteotomy (APSO), and multi-rod constructs. Results: The cases elucidated herein underscore the necessity for treatment strategies to be tailored specifically to the characteristics of the deformity, its flexibility, the neurological risks involved, and the individual patient’s specific attributes. In one case, significant deformity correction achieved via preoperative HGT facilitated successful management through multilevel Ponte osteotomies and posterior spinal fusion, thereby obviating the need for VCR. In other patient suffering from severe rigid congenital kyphotic deformity with pronounced anterior column deficiencies, VCR was deemed essential to realize adequate correction and neural decompression. All patients exhibited substantial radiographic correction, enhancements in health-related quality-of-life metrics, diminished disability and pain, while maintaining correction without neurological complications or implant failure at the final follow-up evaluation. Conclusions: VCR continues to be a vital element within the surgical repertoire for the treatment of severe rigid spinal deformities; however, it should not be deemed obligatory in every instance. Diligent preoperative evaluation, staged correction methodologies, and less invasive osteotomy techniques may permit satisfactory correction while mitigating surgical morbidity in suitably selected patients. Treatment approaches should be customized, favoring the least invasive procedure capable of achieving safe and lasting correction whenever practicable. Full article

The green-belly stink bug (GBB), Diceraeus melacanthus (Dallas, 1851) (Heteroptera: Pentatomidae) is a key South American maize (Zea mays L.) pest, feeding on seedlings and causing physiological disorders. Understanding D. melacanthus population distribution and establishing sampling plans is essential to manage this species. Hence, the objective was to determine a distribution pattern, recommend a sampling unit size and develop sampling plans for the GBB, covering maize pre-sow period up to the maize V4 stage. Assessments were carried out in an experimental field and nine crop fields in northern Paraná State. In the experimental field, quadrants of n, 2n, 4n, 8n and 16n (n = 0.25 × 0.25 m²) were tested, thus determining an aggregated distribution with a recommended sampling unit size of 0.5 × 0.5 m². After the nine crop field samplings, a negative binomial distribution was deemed fit to represent GBB in field conditions. Two sampling plans were developed, highlighted is the sequential presence–absence plan, which recommends a maximum of 60 sample points, and a minimum of 25, with at least six presences to make control decisions. For a more assertive sampling, divide the evaluated area into glebes with distinct natural characteristics and employ the sampling plan to each glebe. These sampling plans must be validated before IPM recommendation. Full article

Background: Breast cancer survivorship extends beyond physical recovery to include psychological and social adjustment, particularly how women construct and perceive their identity as survivors. While survivor identity has been widely studied in high-income countries, there is limited evidence from African contexts. This review synthesizes existing literature on breast cancer survivor identity in Africa, with a focus on patterns of self-perception, associated psychosocial factors, and implications for survivorship care. Methods: A systematic search was conducted across PubMed, CINAHL, Scopus, African Index Medicus, and grey literature for studies published between 2010 and 2026. Eligible studies reported primary data on survivorship and survivor identity among African women with Breast Cancer. Two reviewers independently screened studies, extracted data, and assessed methodological quality using the Mixed Methods Appraisal Tool (MMAT). Confidence in qualitative findings was evaluated using the CERQual approach. Results: Of 32 records identified, seven studies met the inclusion criteria, representing Nigeria, Ethiopia, Botswana, and South Africa. Most studies employed qualitative methodologies, including grounded theory, phenomenology, interviews, and focus groups, with two incorporating quantitative or mixed methods. Key psychosocial domains included self-identity, coping strategies, social support, quality of life, and body image. Three overarching survivor identity patterns were identified: (1) Embracing/Constructive, characterized by acceptance of the survivor identity and its integration into personal growth and empowerment; (2) Ambiguous/Fluctuating, reflecting uncertainty and shifting between patient and survivor identities; and (3) Non-salient/Resisting, where the survivor identity was rejected or deemed irrelevant. Methodological appraisal indicated generally high study quality, with strong credibility and confirmability, though transferability was moderate. CERQual assessments indicated high confidence in findings related to embracing identity, moderate-to-high confidence for ambiguous identity, and moderate confidence for resisting identity. Conclusions: Breast cancer survivor identity among African women is diverse and shaped by cultural, psychosocial, and healthcare contexts. Constructive identity formation is associated with empowerment and personal growth, whereas ambiguous or resistant identities suggest ongoing psychosocial challenges. Interventions should incorporate psychosocial support, peer engagement, and culturally responsive survivorship programs to promote positive identity development. Future research should prioritize rural populations and longitudinal designs to better understand identity trajectories over time. Strengthening survivorship care in Africa requires a holistic approach that addresses both psychological and physical dimensions to enhance overall quality of life. Full article

Global food security and climate mitigation goals are placing unprecedented demands on agricultural systems to simultaneously improve soil productivity and reduce carbon emissions. Spent mushroom substrate (SMS), the mushroom industry’s principal waste stream, offers considerable recycling potential, yet its influence on dissolved organic carbon (DOC) chemistry and soil aggregate stability remains unclear. We tested four SMS return regimes on a medium-textured fluvo-aquic soil: CK, 0 t·ha⁻¹; ORS, 22.5 t/ha; ERS, 22.5 t/ha; and SRS, 45 t/ha in total, with 22.5 t/ha applied per SMS return event. It was found that SMS improved soil structural stability across all regimes, with SRS delivering the strongest effects. Compared with CK, SRS raised the proportions of >2 mm and 0.25–2 mm aggregates by 31.62% and 33.42%, while the mean weight diameter (MWD) and geometric mean diameter (GMD) increased by 23.25% and 22.68%. SMS also elevated aromatic carbon abundance, DOC concentration, UV254, and SUVA254. Fluorescence EEM-PARAFAC resolved DOC into three component: namely, two humic-like and one protein-like, and SMS expanded the relative contribution of the humic-like C1 fraction. Overall, under the tested fluvo-aquic soil and wheat–maize rotation conditions, SMS return was associated with changes in DOC composition, higher aggregate stability, and greater aggregate-associated carbon accumulation. These findings suggest that SMS return may be a promising strategy for improving soil structure and recycling agricultural waste under similar field conditions, but its broader applicability requires further validation. Full article

Although prior research indicates that expert reviewers identify AI-generated academic texts with low accuracy, the quantitative analysis presented in this paper has revealed marked, measurable differences between human-authored and AI-generated works. We investigate this duality in the context of Hungarian as an under-represented training language: on one hand, we perform a quantitative text analysis of the lexical, syntactic, and stylistic features of Hungarian-language academic essays by human authors (doctoral candidates) and those generated by Google Gemini, OpenAI GPT, and Anthropic Claude models. On the other hand, using a blind experimental design, we analyze how human reviewers (N = 391) with varying levels of expertise perceive and assess the quality of the texts. The quantitative analysis showed that AI-generated essays are characterized by lower lexical diversity and an absence of epistemic markers. The human evaluation yielded complex results: reviewers active in academic practice (members of the academically active and academically passive clusters) acknowledged the formal and logical precision of the AI-generated texts, yet they noted a lack of originality and critical depth. Reviewers less engaged with academic practice (members of the non-academic and inactive clusters), in contrast, were primarily persuaded by the more natural style and originality of the human-authored texts. The findings suggest that with moderate-level prompting and the provision of source literature, an AI-generated essay can be created in a few hours that reviewers deem superior to human work in certain aspects, such as formal and logical precision. Furthermore, our findings suggest that with targeted, more sophisticated prompt engineering, the quality gap between AI-generated and human-authored texts could narrow further. These findings have significant implications for assessment methods in higher education and for the regulation of academic publishing. Full article

The concept of Brillouin optical time domain reflectometry as a means of distributed temperature monitoring for battery systems is investigated and deemed feasible. The concept has been investigated regarding measurement speed, temperature accuracy, measurement range, and responsivity of the fiber material. The experiments show fast and accurate measurement results for surfaces with a uniformly distributed temperature, with an average absolute error of 0.51 K, a largest absolute error of 2.07 K, and a measurement time of approximately 60 s for a sampling point after 5 km. Additionally, hotspots only impacting 25% of the sensor fiber have been detected. Furthermore, the established concept provides a reliable and scalable solution for simultaneous temperature monitoring of spatially distributed sampling points without the need for individual cabling of every measurement sensor, like in commonly deployed electrical temperature detectors. Full article

HBIM is the application of BIM, a digital information management process, to cultural heritage (CH) assets. Despite the numerous potential benefits posed by the adoption of HBIM, the current practice is limited by a lack of consideration of the end user and a lack of guidance regarding the application of HBIM. To address this, the article presents the HBIM Maturity Model, the culmination of a multi-year research project developing user-centric guidelines for HBIM via consultation with the international heritage community. The article details the development of the HBIM Maturity Model, a scalable, level-based approach for developing and assessing HBIM systems. Subsequently, 122 case studies are evaluated using previously defined HBIM system requirements and the HBIM Maturity Model to assess to what extent the current HBIM application meets the needs of the heritage community. The evaluation concludes that, despite the technological ability to achieve the requirements of the heritage community, the majority of HBIM case studies fail to report outputs deemed most critical by the heritage community, namely, those related to structured information management. This should be considered a key barrier to HBIM adoption. Full article