Search Results (674)

At 1 km resolution, NDVI projections for heterogeneous landscapes can appear spatially coherent in aggregate while concealing substantial class-level prediction weaknesses, a limitation that has received limited systematic attention in the NDVI projection literature. This study applies a four-component assessment workflow to Northeast China (NEC) for 2040 under SSP1-2.6, SSP2-4.5, and SSP5-8.5, integrating multi-stage model selection, land-cover-stratified validation, quantile-regression-based uncertainty characterization, and validation-priority ranking. Among three candidate tree-based models evaluated using spatial block cross-validation, temporal holdout validation, long-jump extrapolation, and climatic perturbation tests, LightGBM showed the most balanced and consistent performance, with spatial CV R² = 0.654 ± 0.123, temporal holdout R² = 0.710, and long-jump R² = 0.671, and was therefore selected for the 2040 projection. Projected regional mean NDVI increased modestly from 0.393 in 2020 to 0.414–0.417 across scenarios, with limited divergence among SSP pathways at this near-term horizon. Class-stratified validation of the 2020 holdout prediction revealed that global model performance masked strong class-level heterogeneity, with R² values ranging from 0.576 for Construction land to −0.886 for Unused land. Water bodies and Unused land exhibited negative R² values, indicating weak class-level predictive support relative to a simple class-mean benchmark. Residual decomposition showed that Water bodies combined high random error with elevated systematic deviation, whereas Unused land was mainly characterized by systematic bias, suggesting different needs for class-specific model improvement. The Uncertainty Risk Index (URI), derived from 95% prediction intervals, was highest in Construction land and lowest in Cropland across all scenarios. Integrating historical residuals with future URI-identified Water bodies, Unused land, and Construction land as the highest-priority classes for future targeted validation. These priorities arise from both limited class representation and intrinsic NDVI-related complexity, including low vegetation signal, mixed-pixel effects, and heterogeneous land-surface composition. These results demonstrate that land-cover-stratified error decomposition and uncertainty-informed priority ranking reveal class-specific projection limitations that aggregate accuracy metrics can conceal. Full article

Necrotising enterocolitis (NEC) remains an important disease for neonatologists, with diagnostic and management challenges and impacts on mortality and neurodisability. NEC can present in a non-specific way, and differentiating from late-onset sepsis (LOS), focal perforation (FIP) and feed intolerance can be difficult. Biomarkers have been extensively explored as a way to help more definitively identify NEC or rule it out. Many biomarkers that have been studied are blood biomarkers, and several other extensive reviews of biomarkers in NEC exist. In this narrative review, we focus on non-invasive samples, namely stool, urine and saliva, and on tests that are already available as point-of-care tests (POCTs) or are likely to be available as POCTs soon given current technologies. Faecal calprotectin and urinary intestinal fatty acid-binding protein (IFABP) have the most data to currently support their use in larger multi-centre studies and appear most likely to achieve translation into clinical practice. Saliva appears the most under-researched potential source of a non-invasive POCT for a biomarker for NEC. For faecal calprotectin and urinary IFABP, data that are most lacking relate to specificity, particularly the performance of these tests to differentiate NEC from FIP or LOS (occurring in the absence of NEC). We suggest a study design to facilitate moving towards the clinical use of non-invasive biomarkers in NEC. Full article

Fecal calprotectin (FC) is a potential biomarker of gastrointestinal inflammation; however, its physiological behavior in preterm newborns remains poorly understood. This prospective cohort study aimed to characterize the longitudinal variability of FC concentrations during the first month of life in preterm newborns of ≤34 weeks of gestational age admitted to a neonatal intensive care unit. Altogether, 48 preterm newborns and 42 mothers were examined, with 124 fecal samples collected weekly. The median FC levels exhibited wide interindividual and intraindividual variations, ranging from 56 µg/g in the first week to 65 µg/g in the third week, with no significant association with clinical or laboratory variables. No confirmed cases of NEC occurred during follow-up. Among the five preterm newborns with clinical suspicion of NEC, FC levels fluctuated without a consistent temporal pattern or discriminatory profile. Because stool samples were collected according to a predefined weekly schedule rather than at symptom onset, transient FC changes associated with acute gastrointestinal events may not have been captured. The very small number of newborns with clinically suspected NEC, particularly during later follow-up, substantially limited the statistical power of subgroup analyses. Therefore, statistical comparisons involving this subgroup should be interpreted as exploratory and hypothesis-generating rather than confirmatory. Therefore, FC levels may vary substantially in preterm newborns and, within the limitations of this study, these findings primarily characterize the baseline longitudinal variability of FC rather than its diagnostic value for NEC and support cautious interpretation of isolated FC measurements in this population. Full article

A color image encryption scheme is developed by integrating a two-dimensional nonlinear exponential chaotic system (2D-NECS), Queen-driven permutation, and indexed row-column diffusion. The proposed 2D-NECS generates highly sensitive pseudo-random sequences for constructing dynamic permutation indices and diffusion parameters. A Queen-driven traversal mechanism achieves multi-directional pixel scrambling and enhanced cross-channel coupling, while indexed row–column diffusion propagates local changes throughout the entire image. Experimental results show that the encrypted images exhibit uniform histogram distributions, low pixel correlations, and information entropy values close to the theoretical ideal. Moreover, differential, chosen-plaintext, and known-plaintext attack analyses verify the strong security of the proposed scheme. These results demonstrate that the proposed method provides effective resistance against various cryptographic attacks while ensuring accurate image reconstruction. Full article

Background: Abdominal pain in hematological patients, particularly during chemotherapy-induced neutropenia, represents a significant diagnostic challenge due to the broad spectrum of potentially life-threatening conditions, including neutropenic enterocolitis (NEC). Computed tomography (CT) is considered the reference imaging modality; however, its use is limited by radiation exposure, and the need for patient transport. Bedside ultrasound (BS-US) may offer a rapid, non-invasive, and repeatable alternative. Methods: This prospective study compared BS-US and CT in 65 hematological patients presenting with acute abdominal pain. Concordance between the two modalities was evaluated in terms of intestinal site localization, bowel wall thickness (BWT), and final diagnosis. Diagnostic agreement was assessed using Cohen’s kappa coefficient, and additional diagnostic accuracy metrics—including sensitivity, specificity, positive predictive value, and negative predictive value—were calculated. BWT measurements were analyzed using Bland–Altman methods. Results: A high level of agreement was observed between BS-US and CT in both intestinal localization and final diagnosis. Agreement for intestinal site localization was good (Cohen’s κ = 0.964), as was diagnostic concordance (Cohen’s κ = 0.962), and using CT as the reference standard, BS-US showed uniformly good diagnostic performance across all evaluated conditions, with sensitivity, specificity, PPV, and NPV consistently reaching 1.00 and confirming strong agreement between BS-US and CT. These findings were consistent across different clinical settings (hematology unit and Intensive Care Unit) and independent of body mass index. In NEC cases, BWT measurements showed strong concordance between CT and BS-US, with only 4.6% of values outside the limits of agreement in Bland–Altman analysis. Conclusions: BS-US demonstrated a good agreement with CT and proved to be a reliable, safe diagnostic tool in hematological patients with acute abdominal pain. These findings indicate that bedside ultrasound represents a valuable and safe diagnostic tool in neutropenic hematological patients with acute abdominal pain, providing crucial information in a clinically fragile population that may not always be suitable for CT due to their unstable condition. While our study is hypothesis-generating, the role of BS-US in this setting emerges as a reasonable, evidence-supported hypothesis that warrants further prospective evaluation. Full article

Background: Head and neck neuroendocrine carcinoma (HN-NEC) is exceedingly rare. Standardized treatment strategies for this malignancy remain unestablished. This study aimed to explore promising treatment modalities, and to identify prognostic factors in HN-NEC. Materials and Methods: Thirty-nine patients diagnosed with HN-NEC at West China Hospital of Sichuan University between 2006 and 2025 were enrolled. The 5-year survival rates were estimated by Kaplan–Meier analysis. The log-rank test and Firth’s penalized Cox multivariable analysis regression model were used to identify prognostic factors. Results: The 5-year locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), and overall survival (OS) rates for patients who did and did not receive radiotherapy were 63.2% vs. 29.6% (p = 0.031), 75.5% vs. 48.0% (p = 0.065), and 81.4% vs. 46.9% (p = 0.039), respectively. Laryngeal NEC was associated with poorer 5-year DMFS (41.2% vs. 87.5%, p = 0.023) and 5-year OS (38.1% vs. 92.9%, p = 0.027) compared with non-laryngeal HN-NEC. Radiotherapy (HR = 0.152, 95% CI: 0.025–0.757, p = 0.022) was a potentially protective factor influencing LRRFS. Conclusions: Radiotherapy may be associated with improved LRRFS in patients with HN-NEC. HN-NEC originating in the larynx appeared to be associated with a poorer prognosis compared with other primary sites of the head and neck. Full article

Large-scale infrastructure projects routinely divide construction responsibilities across several specialized contractors whose scopes are simultaneously independent and mutually reliant, producing boundary zones where design changes, remedial obligations, and contractual disputes repeatedly emerge. This study examines how interface-related risks are distributed between civil construction contractors and core system contractors, drawing on fieldwork conducted within the Taiwan High Speed Rail (THSR) project. Questionnaire surveys were administered to 38 practitioners who held direct THSR involvement or comparable experience in analogous multi-party infrastructure projects, yielding a valid response rate of 63.3%. Using a weighted influence scoring approach, 37 risk factors grouped into seven interface categories were evaluated. Results show that Variation (top-ranked item A07, score 290/300), Care of Works (B01, 284/300), and Cooperation and Coordination (D04, 285/300) represent the three most consequential risk domains. Analysis of risk-initiation patterns indicates that project owners are the predominant source of variation-related risks, while core system contractors most frequently trigger care-of-works incidents. Structured comparison of FIDIC (1995), AIA/A201 (1997), NEC/ECC (1995), ENAA (1996), and THSR contractual documents uncovers a shared shortcoming: no examined standard form contains explicit provisions tying risk liability to the party whose conduct gave rise to the risk. Evidence from three documented THSR dispute cases is consistent with the survey data and illustrates the real-world consequences of this drafting gap. On this basis, the study proposes a risk-trigger principle as a potential framework for improving interface risk allocation in future multi-party infrastructure contracts. Full article

Necrotizing enterocolitis (NEC) is a multifactorial disease associated with prematurity, intestinal hypoperfusion, dysbiosis, and oxidative stress. Interindividual variability in disease occurrence suggests a role for genetic susceptibility. Null genotypes of the GSTM1 and GSTT1 genes result in absent glutathione S-transferase activity and may impair antioxidant defenses. This study investigated whether GSTM1 and GSTT1 null genotypes are associated with NEC development and severity in preterm newborns. This single-center case–control pilot study included 100 preterm newborns (50 NEC and 50 controls). Genotyping was performed by multiplex polymerase chain reaction. Baseline characteristics were comparable between groups (p > 0.05). Stages II-A and II-B accounted for 82% of NEC cases. A significant inverse correlation was observed between gestational age and postnatal age at NEC diagnosis (r = −0.5994; p < 0.0001). The GSTM1-null genotype was more frequent in the NEC group (60% vs. 36%) and was associated with increased disease risk in both unadjusted (OR = 2.667; 95%CI: 1.188–5.986; p = 0.027) and adjusted analyses (aOR = 3.09; 95%CI: 1.29–7.40; p = 0.011). No significant associations were observed for GSTT1, combined genotypes, or disease severity. These findings provide preliminary evidence of an association between the GSTM1-null genotype and NEC susceptibility. Given the exploratory pilot design, these results should be considered hypothesis-generating and require confirmation in larger prospective studies. Full article

Background: Colorectal neuroendocrine carcinomas (NECs), including small cell (SCNEC) and large cell (LCNEC) subtypes, are rare but aggressive malignancies with limited population-level data. Moreover, prior studies have limited stratification by histologic subtype and anatomic location, despite evidence of disease heterogeneity in colorectal malignancies. This study aimed to characterize the clinical characteristics, treatment patterns, and outcomes of colorectal NEC by histologic subtype and tumor location, and to compare them with neuroendocrine tumors (NETs) and adenocarcinomas (ACs). Methods: A retrospective cohort review was conducted utilizing the SEER database from 2000 to 2022 to identify patients with colorectal SCNEC, LCNEC, NET, and AC. Demographic, clinical, therapeutic and survival data were analyzed and compared using Kaplan–Meier methods, log-rank tests, and Cox proportional hazards regression. Results: A total of 790 SCNEC, 498 LCNEC, 31,200 NET, and 638,898 AC cases were identified. SCNEC and LCNEC were associated with advanced stage at diagnosis (66% and 55% stage IV, respectively) and inferior survival outcomes compared to NET and AC (median OS (mOS) of 7 and 8 months for SCNEC and LCNEC, respectively, p = 0.0002). Stratified by location, colonic SCNEC had the poorest survival (mOS 5 months), worse than rectal SCNEC (mOS 9 months); this pattern was not observed in LCNEC. Surgical resection was associated with improved OS in both NEC subtypes (HR range 0.25–0.56, all p < 0.012). Radiation therapy was associated with improved survival in NEC overall (SCNEC HR 0.58; LCNEC HR 0.71, both p < 0.05), with the observed benefit appearing greatest in rectal NEC. Demographic factors were associated with survival in NET and AC but had no significant impact in NEC. Conclusions: Colorectal SCNEC and LCNEC are highly aggressive malignancies with poor outcomes, with SCNEC demonstrating modestly inferior outcomes compared to LCNEC. This study demonstrates that both histologic subtype and anatomic site of disease are important determinants of prognosis and treatment response. This supports the concept that colorectal NEC represents a biologically heterogeneous disease, with colonic SCNEC showing the worst outcomes and rectal NEC associated with a potential enhanced response to radiation. These findings support the need for further prospective and molecular studies to better define treatment approaches and targeted therapies for these rare malignancies. Full article

Background/Objectives: Early enteral feeding in preterm infants remains controversial because, despite promoting intestinal maturation, concerns about necrotizing enterocolitis (NEC) persist. Donor human milk (DHM) is recommended when the mother’s milk is unavailable, but the optimal initiation timing is unclear. This study evaluated the association between DHM initiation timing and outcomes in very-low-birth-weight (VLBW) infants in Japan. Methods: This multicenter retrospective cohort study used data from a national human milk bank registry (2018–2023) and the Neonatal Research Network of Japan (NRNJ; 2022). Infants with birth weight <1500 g were categorized by DHM initiation timing (≤24, 25–48, or >48 h), with infants in the NRNJ cohort serving as the comparison group. The primary outcome observed was NEC incidence, including all stages; secondary outcomes included in-hospital mortality and time to full enteral feeding. Bayesian regression models were applied. Detailed feeding data were unavailable in the NRNJ cohort. Results: Among 2962 infants, NEC incidence was low across groups. NEC occurred in 1.31% of the ≤24 h DHM group and 1.83% of the NRNJ group, with mortality rates of 4.53% and 6.23%, respectively. Although NEC incidence was numerically lower in the ≤24 h DHM group, estimates were imprecise because of limited events. Early DHM initiation was associated with lower in-hospital mortality and earlier full enteral feeding, particularly in infants with <1000 g birth weight. Conclusions: Early DHM initiation was associated with lower mortality and earlier achievement of full enteral feeding in VLBW infants without elevated NEC risk. However, because detailed feeding information was unavailable in the comparison cohort, these associations should be interpreted cautiously. Given the observational design and heterogeneous nutritional exposures, further prospective studies are warranted. Full article

Preterm birth remains a major global health concern, affecting approximately one in ten neonates, with an estimated 15 million infants born prematurely each year. Prematurity and clinical factors such as antibiotics, cesarean delivery, and limited access to mother’s own milk disrupt microbiota development in VLBW infants; although human milk supplies nutrients and a microbial community, its composition and clinical role are not yet well understood. However, the composition and clinical significance of the human milk microbiota (HMM) in VLBW infants remain insufficiently characterized. Background: This review aims to summarize recent evidence (2021–2025) on the microbiome of MOM in mothers of VLBW (<1500 g) preterm infants and to evaluate its potential role in neonatal health. Methods: The study used a systematic literature review, searching PubMed and Google Scholar with predefined criteria and keywords. Results and Conclusions: MOM microbiota of VLBW in infants is dominated by Staphylococcus, Enterococcus, Streptococcus, Enterobacteriaceae, and Acinetobacter, with lower levels of Veillonella, Clostridium sensu stricto, Pseudomonas, Haemophilus, and Bifidobacterium; its diversity increases over lactation, and feeding type influences infant gut colonization and immune development, though links to necrotising enterocolitis (NEC) remain limited. Further research using multi-omic approaches is needed to clarify these mechanisms and their clinical implications. Full article

Healthcare professionals must acquire and maintain both declarative knowledge and fine psychomotor skills across a wide range of clinical procedures. Human working memory is physiologically limited, and the high cognitive demands of clinical environments frequently contribute to medical errors and adverse events. Intra-individual performance variability—driven by fatigue, stress, and motivation—represents a further challenge that conventional medical safety education has not adequately addressed. According to the World Health Organization, patient harm ranks fourteenth in the global burden of disease, with approximately 10% of hospitalised patients in high-income countries experiencing harm within healthcare facilities. This study reports the design, theoretical rationale, and preliminary outcomes of an augmented reality (AR) glasses system for hands-free, self-directed medical procedural training, developed from a human factors and ergonomics (HFE) perspective. The system integrates a see-through head-mounted display (HMD; Epson Moverio BT-40S), bone-conduction earphones (Shokz OpenComm), and an industrial-grade voice recognition application (NEC Solution Innovators), achieving fully hands-free operation compatible with aseptic technique. Content design is grounded in cognitive load theory (CLT) and the cognitive theory of multimedia learning (CTML), extended by neuroscientific evidence on multisensory integration and memory consolidation. More than 40 procedure-specific modules have been developed in-house at Tokyo University of Technology, spanning airway management, vascular access, respiratory therapy, dialysis, and cardiac support. In a four-year longitudinal survey (virtual reality (VR) simulator; n = 286), major satisfaction items consistently exceeded the scale midpoint. In an AR endotracheal suctioning cohort (n = 38/22), procedural flow understanding was rated 3.95/5.0. A peer-reviewed randomised controlled trial (Clinical Simulation in Nursing, n = 36) demonstrated significantly superior skill improvement (p < 0.001) and learning motivation (p = 0.001) in the AR group versus textbook self-practice. Principal ergonomic limitations of current HMD hardware—excessive weight, narrow field of view, and absence of medical-grade certification—are documented, and AI-based real-time procedural assessment is identified as a priority for the next research phase. Full article

Necrotizing enterocolitis (NEC) remains one of the most serious gastrointestinal emergencies in preterm infants, and imaging plays a central role in diagnosis and clinical management. Historically, evaluation has relied primarily on abdominal radiography, which remains widely available and embedded in established diagnostic frameworks. However, the hallmark radiographic signs of NEC (i.e., pneumatosis intestinalis, portal venous gas, and free air) reflect relatively advanced manifestations of intestinal injury that indicate established mucosal disruption or transmural necrosis. Bowel ultrasound has increasingly complemented radiography by enabling real-time assessment of bowel wall integrity, perfusion, motility, and intra-abdominal fluid, providing physiologic information that may refine clinical interpretation and monitoring of disease progression. Expanding use of neonatologist-performed bowel ultrasound may further improve access to bedside intestinal imaging and facilitate more timely evaluation in neonatal intensive care settings. In parallel, emerging imaging technologies seek to extend the capabilities of conventional imaging by interrogating biologic processes that underlie intestinal injury. Modalities such as contrast-enhanced ultrasound, ultra-high-frequency ultrasound, and photoacoustic imaging offer the potential to characterize bowel microvascular perfusion, tissue oxygenation, and microstructural changes that may precede overt radiographic abnormalities. Complementary physiologic monitoring approaches are also being explored to identify infants at risk before clinical disease develops. Techniques including superior mesenteric artery Doppler, near-infrared spectroscopy, bowel acoustic monitoring, and electrogastrography aim to detect early alterations in intestinal perfusion, oxygenation, and motility. In addition, artificial intelligence applied to imaging and physiologic data may enhance pattern recognition, risk stratification, and clinical decision support. Together, these advances suggest that NEC evaluation is evolving from a paradigm focused on detecting late structural injury toward integrated approaches capable of identifying intestinal vulnerability earlier and monitoring disease more precisely. Full article

Background: Neonatal morbidities are major determinants of clinical outcomes and healthcare utilization in preterm infants. However, population-level evidence quantifying the cumulative contribution of neonatal morbidities to neonatal intensive care unit (NICU) length of stay (LOS) and medical costs remains limited. Methods: We conducted a nationwide retrospective cohort study using the Korean Health Insurance Review and Assessment Service database. Preterm infants admitted to NICUs between 2020 and 2023 were identified. After exclusions, 30,034 infants with complete birth weight data and 31,240 with complete gestational age data were included. Major neonatal morbidities—including bronchopulmonary dysplasia (BPD), patent ductus arteriosus (PDA), sepsis, intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), and periventricular leukomalacia (PVL)—were identified using ICD-10 odes. Associations of individual morbidities and cumulative morbidity burden with NICU LOS and medical costs were evaluated using multivariable regression and generalized linear mixed models. Results: Mean NICU LOS was 26.5 days, and mean total medical cost was 41.9 million KRW. All major morbidities were associated with prolonged LOS and increased costs. BPD showed the strongest association with LOS, whereas NEC and sepsis were associated with the highest costs. NICU LOS and medical costs increased in a stepwise manner with increasing numbers of morbidities; each additional morbidity was associated with an 8.0-day increase in LOS and a 32.5 million KRW increase in medical costs (both p < 0.001). Conclusions: Greater cumulative morbidity burden was associated with prolonged hospitalization and increased healthcare costs in preterm infants. Full article

Background: Determining surgical assessment in infants with necrotizing enterocolitis (NEC) without radiographic pneumoperitoneum remains challenging. This study aimed to describe clinical factors associated with surgical intervention and to retrospectively assess an eight-parameter indicator in this setting. Methods: A retrospective study was conducted on infants with Bell stage II–III NEC treated between July 2014 and June 2023. Patients without radiographic pneumoperitoneum were classified into the conservative management group (CON) and surgical intervention group (SUR). Variables considered clinically relevant and suitable for bedside assessment were evaluated for the construction of an exploratory composite indicator. For selected parameters, each item was coded as present or absent, and the total number of positive parameters was calculated for each infant. Clinical characteristics, parameter frequencies, and the distribution of the composite indicator were compared between groups. Receiver operating characteristic (ROC) curve analysis was used descriptively to summarize the apparent discrimination of the composite indicator for observed surgical intervention. Results: A total of 115 infants were included; 70 received conservative management and 45 underwent surgical intervention. Eight bedside parameters were selected: endotracheal intubation history, hypotension, peritonitis, radiographic abnormalities, leukopenia, thrombocytopenia, acidosis, and hyponatremia. The SUR group had a higher frequency of several bedside abnormalities and a higher composite indicator score than the CON group. The exploratory composite indicator showed an area under the ROC curve of 0.842 for distinguishing infants who underwent surgical intervention from those managed conservatively. Conclusions: Infants with NEC who underwent surgical intervention showed a higher burden of bedside clinical, radiographic, and laboratory abnormalities. This exploratory eight-parameter indicator may provide a practical descriptive summary of disease severity and surgical concern in this challenging clinical setting. Full article