Search Results (581,980)

Systolic anterior motion (SAM) of the mitral valve remains a clinically relevant complication after mitral valve repair and may result in dynamic left ventricular outflow tract (LVOT) obstruction, SAM-associated mitral regurgitation, and hemodynamic instability. Despite advances in surgical techniques and perioperative imaging, SAM remains an important cause of difficult separation from cardiopulmonary bypass and postoperative circulatory compromise. The development of SAM is multifactorial and results from the interaction between mitral valve anatomy, ventricular geometry, surgical repair characteristics, and perioperative hemodynamic conditions. Contemporary evidence has identified several echocardiographic predictors, including excessive posterior leaflet height, elongated anterior leaflets, reduced coaptation–septal distance, a narrow mitro–aortic angle, basal septal hypertrophy, and small hyperdynamic left ventricles. Recognition of these risk factors facilitates perioperative risk assessment and pre-repair surgical planning. Transesophageal echocardiography plays a pivotal role throughout the perioperative period, enabling risk assessment before repair, early diagnosis after cardiopulmonary bypass, and guidance of therapeutic interventions. Initial treatment is based on preload optimization, afterload augmentation, withdrawal of inotropic stimulation, and heart rate control, whereas refractory cases may require surgical revision. This narrative review summarizes the current understanding of SAM after mitral valve repair, focusing on pathophysiological mechanisms, echocardiographic predictors, surgical prevention and perioperative management, with particular emphasis on the practical role of cardiac anesthesiologists and mitral valve surgeons. Full article

Background/Objectives: Psychiatric inpatient care is characterised by power asymmetries between care providers and care receivers. Despite international guidelines and policies promoting autonomy, involvement, and empowerment, these ideals remain challenging to implement in clinical practice. Psychiatric self-admission has been developed to strengthen autonomy; however, its implementation may challenge established power structures, professional roles, and responsibilities within mental healthcare settings. This study aimed to explore stakeholder perspectives on power transfer during the implementation of psychiatric self-admission in Scandinavia. Methods: A qualitative multi-source study was conducted using semi-structured interviews, focus group interviews, and document collection. Interviews were conducted with 36 participants involved in the development and implementation of self-admission in Denmark, Norway, and Sweden. Additionally, approximately 250 documents were gathered. The documentary material was analysed alongside the interviews and focus groups to provide an understanding of the implementation of self-admission models and how power transfer was represented within these processes. The analyses were inspired by methods in qualitative content analysis and document analysis. Results: Findings on stakeholder perspectives on power transfer during implementation revealed a tension reflected in two subthemes: ‘Responsive and Responsible’, where self-admission was viewed as a necessary response to needs that the healthcare system was unable to address, and ‘Unsafe and Unsound’, where self-admission was associated with uncertainties and risks related to losing control. Conclusions: Implementing psychiatric self-admission, which involved challenging traditional power relations in healthcare, was permeated by trust, distrust, and fear. The findings highlight the need to address stakeholders’ concerns related to safety and professional responsibility. Full article

Large language models (LLMs) can turn a flood of cross-layer industrial logs into a fluent incident narrative, but a narrative that cites only real, resolvable events can still be wrong in every relation that matters: the login came from a different workstation, the write command occurred after the physical change it supposedly caused, the action fell inside a planned maintenance window, and the controller does not even actuate the affected process. A cited event is not necessarily supporting evidence. When such a narrative drives automated response, the error propagates into isolating the wrong controller or revoking a legitimate operator. We present EviGuard, a system that decides when an LLM’s understanding is trustworthy enough to act on. EviGuard stores auditable cross-layer evidence in a provenance graph, lets the LLM propose only hypotheses, compiles each hypothesis into atomic machine-checkable claims in an Incident Claim Language, and has an ensemble of deterministic verifiers label every claim supported, contradicted, or unknown against the graph—honoring interval time, event-time policy and credential versions, network reachability, and physical control dependencies. A response gate forbids any high-impact action whose critical preconditions are not all supported. On EviCPS-Bench (42 hardware-in-the-loop attack chains, 9600 claim-level labels, $\kappa =0.87$), EviGuard cuts the unsupported-claim rate from 12.6% to 1.7%, raises relation-edge $F_1$ from 0.64 to 0.89, holds prompt-injection success to 0.4%, and executes zero unverified high-impact actions across 3200 response decisions, at a median end-to-end latency of 0.44 s. Full article

Cichlid fishes of the genus Rubricatochromis are widely distributed across western, central, and northern Africa, yet their taxonomy has long remained unstable because of overlapping morphological characters, variable coloration, and inconsistent use of species names. We present an integrative taxonomic revision of the genus based on mitochondrial DNA sequence data, molecular species delimitation analyses, morphometric and meristic analyses, qualitative assessment of live coloration, and a previously published multilocus phylogeny. Phylogenetic analyses recovered several deeply divergent lineages, some of which had already been informally recognized in the aquarium trade. Although morphological overlap among species was substantial, several taxa could be diagnosed by combinations of morphometric traits and coloration patterns. We describe four new species, Rubricatochromis gabonensis sp. nov., R. jebeli sp. nov., R. stephenthorntoni sp. nov., and R. vanheusdeni sp. nov.; validate R. fugax; and synonymize R. exsul, R. letourneuxi, R. paynei, and R. saharae with R. guttatus, as well as R. lifalili with R. stellifer. Several newly recognized taxa appear to have highly restricted distributions and may qualify as threatened, emphasizing the conservation importance of West and Central African river systems and the urgent need for biodiversity assessments and habitat protection in these understudied regions. Full article

Breast cancer remains one of the leading causes of global mortality, which has growing driving interest in dietary natural products for potential chemopreventive and complementary approaches. Cherries (Prunus species) are rich in bioactive phytochemicals, notably anthocyanins, hydroxycinnamic acids, and the flavonols quercetin and kaempferol. This review aims to examine and discuss current research on the molecular targets and mechanisms of action of whole cherry extracts and their primary flavonols quercetin and kaempferol across various breast cancer subtypes. Preclinical studies indicate that these compounds exert multi-targeted effects by inducing apoptosis, inhibiting cell proliferation, and suppressing metastatic pathways. Additionally, these flavonols show potential in reversing multidrug resistance. A whole-food approach highlights the candidate synergistic properties of these phytochemical complexes, but low oral bioavailability and rapid metabolism severely limit their clinical translation. Therefore, utilizing innovative drug delivery systems remains crucial to improving their stability, absorption, and overall therapeutic efficacy. Full article

This study examined the effects of dietary carbohydrate levels on growth performance, immune response, and antioxidant capacity of male giant freshwater prawn Macrobrachium rosenbergii. Prawns with an initial body weight of 15.04 ± 0.08 g were fed for 9 weeks on five isonitrogenous, isolipidic diets formulated to contain 10%, 15%, 20%, 25%, and 30% carbohydrate (designated CHO10–CHO30). Weight gain rate and specific growth rate rose from CHO10 to CHO20 and then declined (peak in CHO20); broken-line regression of weight gain rate estimated the optimal dietary carbohydrate level at approximately 19.36% under the present experimental conditions. Moderate carbohydrate inclusion (15–20%) enhanced hepatopancreatic total antioxidant capacity (T-AOC), superoxide dismutase (SOD) and catalase (CAT) activities together with the transcription of cu/znsod, cat and glutathione peroxidase (gsh-px), whereas levels ≥ 25% lowered these defenses and raised hepatopancreatic malondialdehyde (MDA). High-carbohydrate diets also increased hemolymph glucose, triglyceride, total cholesterol and low-density lipoprotein cholesterol, progressively altered the mRNA expression of genes involved in the Toll-like receptor (TLR)/myeloid differentiation primary response 88 (MyD88) signaling pathway (upregulated tlr, myd88, relish and tumor necrosis factor; downregulated inhibitor of NF-κB alpha (IκB-α)), and altered the expression of apoptosis-related genes (downregulated B-cell lymphoma 2 (bcl-2), upregulated caspase-3). These results suggest that M. rosenbergii has an estimated optimal dietary carbohydrate level of approximately 19.36% under the present experimental conditions; intakes at or above 25% are associated with compromised hepatopancreatic health and growth, likely through the induction of oxidative stress, altered transcription of TLR/MyD88 pathway-related genes, and changes in apoptosis-related gene expression. Full article

The development of temporally consistent long-term normalized difference vegetation index (NDVI)climate data records is essential for global change and ecosystem research. The Medium Resolution Spectral Imager-II (MERSI-II) sensor aboard China’s Fengyun-3D (FY-3D) satellite shares similar spectral characteristics with Moderate Resolution Imaging Spectroradiometer (MODIS), offering potential for synergistic applications. However, systematic biases arising from differences in sensor design, radiometric calibration, and atmospheric correction hinder their direct combination. This study established a full-chain framework that integrated cross-calibration of surface reflectance using quasi-synchronous FY-3D/MODIS observations and a MERSI-II-specific atmospheric correction scheme based on the 6S radiative transfer model. After correction, the FY-3D NDVI shows substantially improved consistency with MODIS, achieving a reduction in root mean square error of over 25.9%, an increase in correlation coefficient of approximately 5%, and a decrease in mean absolute error of about 40%. Spatial biases are within ±0.1 over most global land areas, with robust performance across vegetation types and climate zones. Based on this technical framework, a fused FY-3D and MODIS NDVI climate data record was established, which has been operationalized at the Beijing Climate Center for global vegetation monitoring. This work provides a transferable framework for integrating Chinese Fengyun satellite data with international datasets like MODIS/VIIRS. Full article

According to the recent Wealth Thermalization Hypothesis (WTH), the wealth inequality in the world is described by the Rayleigh–Jeans (RJ) thermal distribution of interacting agents in a society with social stratification. In this concept, the wealth layers of society are associated with energy levels from a nonlinear dynamical system conserving two integrals of motion—namely, total energy and the probability norm. This leads to RJ condensation and the formation of a huge poverty phase of low wealth and a tiny oligarchic phase that captures a main part of total society wealth. This RJ phenomenon has similarities with self-cleaning in multimode optical fibers and constraint-driven condensation in various physical systems. We analyze real Lorenz and Pareto curves for wealth of households in countries and the world; gross domestic product of countries; market capitalization of companies on the stock exchanges of Hong Kong, Shanghai, and London; bitcoin transactions; and world trade between countries and show that the WTH theory gives a good description of these curves. On the basis of this comparison, we argue that the RJ thermal distribution provides a universal description of wealth inequality in the world. Full article

Superabsorbent polymers (SAPs), such as sodium polyacrylate (PAAS), are the neutralized form of poly (acrylic acid) and belong to a class of materials characterized by three-dimensional networks of flexible polymer chains with exceptional water absorption and retention capacities. Due to these properties, PAAS has been widely used in agriculture as a soil water conditioner. This study investigates the potential of PAAS as a soil stabilizer for infrastructure applications. Three suction measurement techniques, namely the axis translation method, osmotic technique, and vapor equilibrium method, were employed to determine the suction behavior of PAAS and soil–PAAS mixtures over a wide range of water contents and to develop their soil–water characteristic curves (SWCCs). The investigation covers the full suction spectrum, from near-complete dryness to full saturation. Experimental results show that the SWCC of PAAS exhibits the three characteristic zones commonly observed in soils: boundary, transition, and residual zones. However, when PAAS is mixed with soil, the boundary and transition zones disappear from the SWCCs of the soil–PAAS mixtures. This behavior is attributed to the suppression of PAAS suction capacity caused by soil confinement. Unlike agricultural applications, where SAP particles are relatively unconstrained, engineering applications typically involve highly compacted soils that restrict polymer expansion and water absorption. The study also evaluates the feasibility of predicting the suction behavior of soil–PAAS mixtures using numerical modeling techniques based on limited experimental datasets. Among the methods considered, Lagrange interpolation and K-nearest neighbors (KNN) produced prediction models with errors below 10%. In contrast, deep neural network models demonstrated lower predictive accuracy, primarily due to the limited size of the available dataset. Full article

Myofascial pain syndrome (MPS) of the cervicoscapular girdle—most typically involving the upper trapezius and the rhomboid muscles—is among the most frequent causes of chronic regional musculoskeletal pain, yet the mainstays of interventional treatment (dry needling, local anesthetic trigger point injection, corticosteroid, botulinum toxin) act principally on nociceptive transmission or on the contractile taut band rather than on the disordered tissue biology that sustains it. Two injectable biologics with fundamentally different design logic have been proposed to fill this gap. Platelet-rich plasma (PRP) is an autologous, polypharmacological concentrate that delivers a supraphysiological bolus of platelet α-granule growth factors and leukocyte-dependent immunomodulators. Polydeoxyribonucleotide (PDRN) is a standardized, allogeneic-source (salmonid sperm DNA) low-molecular-weight deoxyribonucleotide mixture that acts through a single defined molecular target, the adenosine A2A receptor, supplemented by nucleoside salvage. This narrative review contrasts the two agents across four axes: (i) molecular and cellular mechanism; (ii) the biological plausibility of each in the specific microenvironment of the myofascial trigger point (MTrP)—an acidic, hypoxic, sensitizer-rich focus; (iii) the current clinical evidence in MPS and, by extension, across tendinopathy, plantar fasciitis, knee osteoarthritis, and acute muscle injury; and (iv) practical translational considerations including standardization, regulatory status, cost, and trial design. We conclude that PRP has the broader and methodologically stronger clinical evidence base in tendon and joint indications but is undermined by preparation heterogeneity and by consistently negative results in acute muscle injury, whereas PDRN offers reproducibility, an anti-inflammatory and pro-angiogenic profile that maps plausibly, based on preclinical evidence, onto MTrP pathophysiology, though direct validation in human myofascial tissue is lacking, and an excellent safety record, but is supported almost entirely by small, short-horizon, and frequently non-randomized studies. Neither agent can currently be recommended as standard care for trapezius or rhomboid MPS. We propose a mechanistic rationale and a concrete trial framework, including muscle-specific ultrasound-guided delivery, pressure pain threshold and Neck Disability Index as co-primary endpoints, and mandatory injectate characterization, for the head-to-head studies that the field now requires. Full article

Chronic oral and maxillofacial diseases are frequently associated with progressive alveolar bone loss, leading to impaired structural integrity of the jaw and increased risk of implant failure, microbial colonization, and microfracture formation. Ceramic scaffolds such as those made of hydroxyapatite (HA) and β-tricalcium phosphate (β-TCP) have attracted considerable attention because of their controlled resorption properties and the promotion of rapid new vital bone formation. The aim of this research is to enhance the performance of scaffolds composed of HA and β-TCP used for guided bone tissue regeneration in oral surgery. HA/β-TCP scaffolds were loaded with simvastatin (SIMV) and coated with multiple layers of alginate (ALG). The proposed strategy was designed to achieve a local and prolonged drug release while simultaneously improving mechanical properties. The scaffolds were characterized in terms of porosity, water absorption, in vitro degradation, in vitro bioactivity, and SIMV release. In addition, microscale mechanical properties were evaluated using Brillouin microscopy before and after the coating process. Cytocompatibility was further evaluated by using murine macrophages as an in vitro cellular model. The results demonstrated that ALG coatings significantly modulated SIMV release, promoting a delayed drug release. Moreover, ALG deposition improved the micromechanical properties of the scaffolds, conferring a dual structure analogous to those of bone tissue. These findings indicate that ALG-coated SIMV-loaded HA/β-TCP scaffolds represent a promising multifunctional platform for the medical field. Full article

This paper presents a comprehensive review of bituminous binder modification using Styrene–Butadiene–Styrene (SBS) copolymer. Bitumen is one of the most widely used binder types in road engineering, and its modification has been extensively studied to enhance performance characteristics. The review outlines the historical development of bitumen modification, discusses binder structural models, and examines the influence of SBS on binder properties. The review focuses on ageing process of Polymer-Modified Bitumen (PMB) and Highly Modified Bitumen (HiMA). The complexity of binder’s origin, polymer structure, ageing factors and the presence of cross-linking agents or other compounds creates significant challenges in predicting binder performance after technological and exploitation ageing. This uncertainty directly affects the assessment of long-term durability and recycling potential. Therefore, it is relevant to incorporate a broader range of ageing factors into standardized laboratory testing procedures to develop effective rejuvenation strategies for SBS-modified PMBs. Full article