Search Results (37,534)

Background: Hearing impairment affects a significant portion of the global population. The development of assistive technologies, particularly wearable devices, has been pivotal in mitigating these challenges. Methods: We present a systematic literature review on wearable assistive technologies for individuals with hearing impairment, analyzing 106 scientific articles identified from diverse sources (IEEE Xplore, ACM Digital Library, and Web of Science). Our comprehensive analysis is structured around device types, body locations, user study methodologies, sensory modalities, and application domains. Results: Findings reveal a strong emphasis on auditory and visual feedback, a mix of traditional hearing aids complemented by smart wearable devices, and experimental evaluations focusing on speech comprehension and usability. Visual analysis highlights a significant anatomical shift towards body-worn and wrist-worn haptic devices. While speech accuracy is rigorously reported, user-centric metrics like comfort and battery life are frequently neglected. Conclusions: Addressing these disparities, we propose the HEAR framework (Hybrid Architectures, Engaging Experiences, Adaptive Systems, Real-world Validation). This strategic roadmap advocates for a diversification of sensory outputs, more extensive longitudinal user studies, and the development of adaptive, multi-modal solutions that seamlessly integrate into users’ everyday lives. Full article

Decentralized agricultural gasification remains constrained by the thermochemical instability of high-alkali residues, such as straw and stalks. This operational bottleneck is defined by a narrow thermal window: oxidation core temperatures are typically targeted above 1000 °C for effective tar cracking, yet grate temperatures are constrained, often below 850 °C, depending on the specific ash fusion characteristics of the feedstock, to prevent viscous sintering and bed clinkering. This work proposes a conceptual framework for a control strategy designed to address these conflicting requirements through a unified framework integrating inferential soft-sensing, hierarchical Model Predictive Control (MPC), and sensor health monitoring. Machine learning architectures capture temporal dependencies and cumulative thermochemical transformations to reconstruct unobservable internal states. This enables real-time state estimation with reported accuracy levels (average test R² of 0.91–0.97) and 100% physical consistency through monotonicity constraints, effectively managing the critical thermal lag of densified pellets (400–600 s response time). High-fidelity CFD simulations anchor the soft-sensing layer, ensuring model robustness across the inherent variability of agricultural feedstocks. The architecture shifts control logic from reactive adjustments to anticipatory intervention through adaptive multi-mode operation that decouples high-intensity oxidation from grate integrity limits, while dynamic biochar management serves as a multifunctional control variable for tar cracking enhancement and alkali sequestration. Future work will focus on pilot-scale validation under transient feedstock conditions. Full article

Background: Tumour volume percentage (TVP) is considered an important pathological parameter, particularly in prostate cancer, representing the ratio of tumour volume to the total gland, and it can be used to measure the quantity of malignancy. Previous reports have already demonstrated that an elevated tumour volume percentage is associated with unfavourable factors, including extraprostatic extension, positive surgical margins, and lymph node metastasis. The independent value of TVP, especially in high-risk prostate cancer treated by radical prostatectomy, remains an area of active research, despite established prognostic factors such as PSA, ISUP grade, and TNM stage. Materials and Methods: We retrospectively analyzed the records of 159 high-risk prostate cancer patients who underwent open or laparoscopic radical prostatectomy between January 2016 and January 2025 at the Clinic of Urology of Targu Mures. High-risk patients were defined as those with ISUP grade 4–5 or PSA >20 ng/mL or clinical stage ≥T2c or stage cT3–4 and/or lymph node metastasis. Tumour volume percentage was calculated from the final pathology result and was determined as the proportion of prostate cancer volume relative to the total prostate volume. Clinical and pathological features, including PSA, ISUP grade, TNM stage, surgical margin, and lymph node involvement, were reported. To assess TVP as an indicator of tumour aggressiveness, univariate and multivariate regression analyses were performed. A p-value <0.05 was considered statistically significant. Results: A total of 159 high-risk prostate cancer patients (100%), with a median age of 66 years, who underwent open or laparoscopic radical prostatectomy were included. The median tumour volume percentage was 7.6%, and the median prostate volume was 43.8 cc. On univariate analysis, patients with extraprostatic extension (p < 0.001), positive surgical margins (p = 0.005), a higher ISUP grade (p < 0.001), and lymph node metastasis (p = 0.006) exhibited higher TVP compared to their counterparts. A significant correlation was also observed between TVP and the number of positive biopsy cores (p < 0.001), a higher PSA value (p = 0.005), and a younger age (p = 0.041). Conversely, no correlation was identified between TVP and perioperative factors such as hospital stay, surgery duration, ICU days, type of approach, or positive urine culture. Two regression models on multivariate analyses were performed with TVP as the dependent variable. In the continuous variable model (Adjusted R² = 0.43, p < 0.001), independent predictors of higher TVP were the number of positive biopsy cores (B = 0.54, p < 0.001), the number of positive lymph nodes (B = 2.59, p < 0.001), and surgical margin dimension (B = 1.19, p < 0.001). Age, PSA, and perioperative variables showed no significant correlation with TVP on multivariate analysis. In the categorical regression model (Adjusted R² = 0.438), statistical significance was confirmed (F-test, p < 0.001). Independent predictors of increased tumour volume percentage included ISUP grade 5 in the effect-coded model (B = +6.60, 95% CI: 0.96–12.25, p = 0.022), and pathological TNM stage pT4 (B = +24.70, 95% CI: 17.69–31.70, p < 0.001). ROC analysis showed limited-to-moderate discrimination for positive surgical margins (AUC = 0.655; 95% CI 0.565–0.744; p = 0.001) and stronger discrimination for pN1 (AUC = 0.793; 95% CI 0.650–0.936; p = 0.002). The Youden-derived cut-offs were 4.90% for positive surgical margins and 5.77% for lymph-node metastasis. Conclusions: Tumour volume percentage is significantly associated with several adverse pathological features in high-risk prostate cancer. Rather than a standalone biomarker, its association with adverse pathological features underscores its potential role in risk stratification models, and the incorporation into pathology reports and prognostic nomograms may improve clinical decision-making. Full article

Background: Severe aortic stenosis (AS) increases left ventricular afterload and disrupts ventricular–vascular coupling. Transcatheter aortic valve replacement (TAVR) promptly relieves valvular obstruction, but its immediate effects on blood pressure-dependent arterial load and ventricular–vascular interactions are not fully clarified. Estimated pulse wave velocity (ePWV), derived from age and mean arterial pressure, is a convenient surrogate of global arterial load. The study aimed to assess ePWV before and after TAVR and its relationship with ventricular function and inflammatory biomarkers. Methods: In this retrospective observational study, 100 elderly patients with severe AS undergoing TAVR underwent detailed clinical, laboratory, and echocardiographic assessments before and after the procedure. Arterial stiffness was quantified using ePWV, while left ventricular geometry and systolic function were evaluated by standard echocardiography. Post-procedural reassessment was performed at hospital discharge (median 8 days after TAVR). Results: TAVR led to a modest but significant reduction in ePWV (from 12.79 ± 1.54 to 12.39 ± 1.54 m/s, p < 0.01) and improvement in left ventricular ejection fraction (LVEF) (from 44.89 ± 9.2% to 46.7 ± 7.95%, p < 0.01). Higher baseline ePWV correlated with unfavorable left ventricular remodeling and systolic dysfunction, and post-procedural ePWV remained linked to right ventricular performance. Before TAVR, ePWV and LVEF were both associated with inflammatory biomarkers, relationships that disappeared after intervention. Conclusions: Overall, ePWV functioned as an integrated measure of ventricular–vascular interaction and global hemodynamic load, though its interpretation post-TAVR requires caution due to direct blood pressure dependence and confounding by acute procedural inflammation. Full article

Background/Objectives: Coffin–Lowry syndrome (CLS) is a rare X-linked disease caused by pathogenic variants in the RPS6KA3 gene. It is generally characterized by syndromic intellectual disability and distinctive facial features, skeletal abnormalities, stimulus-induced drop attacks in males, and variable manifestations in females. Methods: We report clinical and genetic findings in a series of 10 cases, eight males and two females, evaluated at the Regional Centre of Medical Genetics Dolj—Emergency Clinical County Hospital Craiova. Results: Genetic testing identified 10 de novo variants in the RPS6KA3 gene consisting of six missense mutations, one nonsense variant, one frameshift, and two variants in non-coding or intronic regions. Case management requires multidisciplinary coordination and is limited to resources mostly available in reference centers. Conclusions: CLS highlights the importance of molecular diagnosis in rare genetic disorders, particularly when clinical features are subtle or atypical. These findings have practical implications for clinical management, suggesting the need for comprehensive genetic screening and individualized care approaches. Full article

The detection of plastic explosives in vapor form is extremely challenging due to the very low volatility of their primary components, such as RDX and PETN. To overcome this limitation, volatile chemical markers like 2,3-dimethyl-2,3-dinitrobutane (DMNB) are added to explosive formulations to enable indirect vapor detection. This study presents a rapid method for detecting and quantifying DMNB vapors using a handheld ion mobility spectrometer (IMS) operating near ambient temperature, ammonia-doped and equipped with a non-radioactive corona discharge ionization source. The instrument, model LCD-3.2E (Smiths Detection Ltd.), is based on a twin drift–cell time-of-flight configuration and simultaneously records ion mobility spectra in both positive and negative modes. DMNB generated distinct product ion peaks in both modes, with reduced mobility values (K₀) of 1.42 cm²·V⁻¹·s⁻¹ (positive) and 1.37 cm²·V⁻¹·s⁻¹ (negative). The method demonstrated high sensitivity, with limits of detection calculated at 1.4 ppb_v (10.2 × 10⁻³ mg·m⁻³) in positive mode and 3.1 ppb_v (22.7 × 10⁻³ mg·m⁻³) in negative mode. The IMS system provided rapid responses within seconds and covered a quantifiable concentration range of 5–3000 ppb_v, with saturation estimated to appear above approximately 5 ppm_v (36.6 mg·m⁻³). The simultaneous dual-polarity response of the DT IMS enhances both the selectivity and reliability of identification. These findings confirm the capability of portable IMSs for fast trace vapor detection in DMNB, supporting its application in field-based screening scenarios such as luggage inspection or container interrogation, where indirect detection of plastic explosives is required. Full article

Tirzepatide, a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1) receptor agonist, introduces a mechanistically distinct approach within incretin-based therapies. While its efficacy is established, real-world data comparing post-marketing safety with established GLP-1 receptor agonists remain limited. This study assessed System Organ Class (SOC)-level reporting patterns for tirzepatide versus semaglutide and liraglutide using EudraVigilance data. Aggregated individual case safety reports (ICSRs) were analyzed using pairwise disproportionality analyses based on a case/non-case approach. Reporting odds ratios (RORs) with 95% confidence intervals were calculated. False discovery rate (FDR) correction using the Benjamini–Hochberg procedure and sensitivity analyses restricted to serious and healthcare professional–reported cases were performed to assess robustness. After FDR adjustment, 20 SOCs were significant in tirzepatide–semaglutide and 23 in tirzepatide–liraglutide comparisons; eight SOCs remained significant across all analytical conditions. Compared with semaglutide, tirzepatide showed higher reporting for immune (ROR 1.97, 95% CI 1.75–2.21) and hepatobiliary disorders (ROR 1.71, 95% CI 1.61–1.82). Versus liraglutide, higher odds occurred for musculoskeletal (ROR 2.02, 95% CI 1.85–2.21) and psychiatric disorders (ROR 2.14, 95% CI 1.99–2.30), and lower odds for neoplasms (ROR 0.28, 95% CI 0.26–0.31). Tirzepatide shows heterogeneous reporting patterns compared with GLP-1 receptor agonists, with consistent excess reporting for hepatobiliary, immune, and musculoskeletal disorders. These findings are hypothesis-generating and warrant confirmation in exposure-adjusted studies. Full article

Background: Thrombosis in light chain amyloidosis (LCA) occurs in the context of multiple organ dysfunction and inflammation. Conventional coagulation tests (screening) may not sufficiently capture the procoagulant substrate in the inflammatory/therapeutic dynamics. Methods: A total of 61 consecutive patients with LCA were prospectively included in the study. Clinical data, including organ involvement, time of diagnosis, treatment phase, DOAC exposure and thrombosis history were systematically recorded and subjected to screening. Specialized hemostasis tests such as APTT/PT, fibrinogen, D-dimer, TEG and TGT were performed and conventional times were analyzed in the subgroup without DOAC. Results: The prevalence of documented thrombosis was 32.8%, and thrombosis status was associated with TEG positivity and more strongly with TGT positivity. Hypercoagulability was identified in 50.8% by TEG and 41.0% by TGT, regardless of whether APTT/PT were within the reference values. APTT/PT did not predict thrombosis recurrence (p > 0.05), which was predicted by TEG (p = 0.0027) and TGT (p = 0.0006). An inflammation/fibrin turnover panel (CRP, fibrinogen, D-dimer) predicted TEG positivity (p < 0.0001), but not TGT, and was correlated with assessment at diagnosis, daratumumab-based therapy, and cardiac involvement. Conclusions: Global tests (TEG/TGT) promptly correlate with thrombosis recurrence in our cohort and provide crucial information in addition to clotting times for thrombotic phenotyping. Inflammation can influence TEG, so the decision to recommend the tests and the timing of their performance should be adapted to the clinical, biological, and therapeutic context. Full article

Background: Preoperative differentiation between uncomplicated and complicated paediatric appendicitis remains challenging. This study aimed to evaluate the diagnostic performance of routine admission biomarkers and blood cell count-derived inflammatory indices for severity stratification and to determine whether fibrinogen provides additional predictive value beyond commonly used markers. Methods: We conducted a retrospective single-centre study (2018–2025) using electronically recorded clinical data. Patients with suspected appendicitis were identified through appendicitis-related ICD-10 codes and diagnostically validated. The final analytical cohort required complete admission laboratory data, including C-reactive protein (CRP), fibrinogen, and complete blood count parameters. Derived inflammatory indices included the neutrophil-to-lymphocyte ratio (NLR) and the systemic immune-inflammation index (SII). Diagnostic discrimination and multivariable prediction models were evaluated to assess the ability of these markers to distinguish complicated from uncomplicated appendicitis. Results: Of 1518 screened records, 1132 patients met inclusion criteria (620 complicated; 512 uncomplicated). Complicated appendicitis was associated with higher inflammatory markers and longer hospital stay (all p < 0.001). CRP demonstrated the strongest univariable discrimination (area under the curve [AUC] 0.785), while fibrinogen showed lower performance (AUC 0.744). A combined model including CRP, NLR, and SII achieved good discrimination (AUC 0.812), with minimal improvement after adding fibrinogen (AUC 0.813). In multivariable analysis, log-transformed CRP and SII remained independently associated with complicated appendicitis (both p < 0.001). A rule-out probability threshold of 0.303 achieved 90% sensitivity (negative predictive value 0.803), whereas a CRP cut-off ≥92.24 mg/L showed high specificity (0.943) and positive predictive value (0.900). Conclusions: Routine admission biomarkers and inflammatory indices derived from complete blood counts can support severity stratification in paediatric appendicitis. CRP and SII provide meaningful predictive information, whereas fibrinogen contributes little additional discriminatory value beyond CRP-based models. These findings suggest that a small set of routinely available laboratory markers may assist early risk stratification, although external validation is required before clinical implementation. Full article

Background and Objectives: Dentofacial asymmetries are common in patients with malocclusions, while mild body postural asymmetries are frequently reported in otherwise healthy individuals. However, their interrelationship remains insufficiently investigated in adults without diagnosed spinal disorders. This study aimed to evaluate the association between dentofacial and body postural asymmetries in adults with malocclusions. Materials and Methods: A clinical cross-sectional observational study was conducted on 102 adults (18–45 years) with malocclusions and no spinal pathology. Standardized clinical morphometric examinations assessed dentofacial asymmetries (horizontal and vertical planes), dental parameters (dental midlines deviation and occlusal plane inclination), and body postural asymmetries (head, shoulder, trunk, pelvic, and lower limb alignment). Asymmetries were recorded using predefined clinical thresholds. Statistical analyses included the Wilcoxon signed-rank test, Pearson chi-square test, and Spearman’s rank correlation coefficient. Results: Dentofacial asymmetries were identified in both planes and occurred more frequently on the left side. Horizontal facial asymmetries were most common at the cheek (74.5%), nostril (66.7%), and mandibular angle levels (57.9%), and were influenced by sex, age, facial growth pattern, and facial profile (p ≤ 0.05). Mandibular dental midline asymmetry was present in 55.8% of patients. Body postural asymmetries were also frequent, particularly unilateral (60.8%) or anterior (55.9%) head inclination and shoulder asymmetries (54.9%), with a predominance on the left side and associations with age, body mass index, and postural attitude (p ≤ 0.05). Correlations were identified among facial asymmetries and among body postural asymmetries (p ≤ 0.01), indicating a bilateral distribution pattern. Additionally, right-sided facial asymmetries showed significant positive associations with right-sided body postural asymmetries (ρ = 0.197–0.229; p ≤ 0.05). Conclusions: Dentofacial and body postural asymmetries have been identified in adults with malocclusions and presented side-specific associations regarding the patterns of asymmetry. Full article

Introduction: Artificial intelligence (AI) and robot-assisted platforms are increasingly influencing cardiothoracic surgery. AI enhances risk prediction, imaging interpretation, and early complication detection, while robotics improves visualization, dexterity, and minimally invasive access. This systematic review evaluates the current evidence supporting these technologies and their implications for clinical practice. Methods: A systematic literature search was conducted across PubMed, Embase, Scopus, Web of Science, and Google Scholar (January 2000–May 2025) following PRISMA 2020 guidelines. After screening and eligibility assessment, 67 studies met predefined inclusion criteria and were incorporated into the qualitative synthesis. Additional high-impact reviews and consensus documents were consulted for contextual interpretation. Results: Machine learning models demonstrated modest but consistent improvements in predictive performance compared with EuroSCORE II and STS scores, particularly in high-risk cohorts. Robot-assisted mitral and coronary procedures showed reduced postoperative pain, blood loss, ICU stay, and recovery time in experienced centers, though early learning phases were associated with longer operative, cross-clamp, and bypass times. AI-enabled intraoperative tools, such as video analysis, workflow recognition, and real-time anatomical segmentation, emerged as promising adjuncts for surgical precision. Structured robotic training programs, especially simulation-based and dual-console pathways, accelerated proficiency acquisition. Conclusions: AI and robotic systems act as augmentative technologies that enhance rather than replace the surgeon’s role. Their safe and effective adoption requires standardized training, transparent AI decision pathways, and clear ethical and medico-legal governance. Full article

Therapeutic termination of pregnancy (TToP) represents an intervention that is performed for medical reasons, such as risks to maternal health or severe fetal anomalies. Advances in prenatal screening and diagnostic tools—including serum markers, ultrasound, cell-free fetal DNA, chorionic villus sampling and amniocentesis—have significantly improved early detection and clinical decision-making. This narrative review synthesizes current knowledge on the genetic, environmental and psychosocial determinants that influence the decision of the patients to pursue TToP. The literature search was performed primarily using PubMed database, while Scopus and Google Scholar were used to identify additional relevant studies. Some of the selected studies, as well as certain sections of this review, address both therapeutic and voluntary termination of pregnancy, whereas others focus exclusively on TToP. Moreover, this review describes the types of abortion (medical or surgical/aspiration) along with their management strategies to prevent or address potential complications. It is well known that demographic, cultural and socio-economic factors continue to influence the access to TToP, as well as the perceptions of it. Psychiatric comorbidities (such as anxiety, affective and psychotic disorders) are observed with a higher prevalence among women undergoing TToP and may influence both the decision and psychological outcomes post-procedure. While most women report emotional relief after TToP, some of them experience depression, post-traumatic stress disorder or substance misuse. Legal and ethical considerations further complicate access to safe abortion, leading to situations where patients may resort to unsafe procedures, which result in higher rates of morbidity and mortality. Data from the EUROCAT network show rising trends in congenital anomalies like trisomy 13, trisomy 18 and caudal regression syndrome (conditions commonly associated with TToP). Therefore, it is mandatory to form a multidisciplinary team in these cases, integrating medical, psychological and ethical dimensions. Ensuring safe, evidence-based and compassionate access to TToP remains a critical component of reproductive healthcare. Full article

Phishing attacks remain effective because they exploit human decisions at the moment of action, often before automated defenses intervene. Established countermeasures focus on detection systems or awareness campaigns but rarely provide non-expert users with a formally specified decision procedure. This work presents a lightweight, deterministic phishing avoidance algorithm that users can execute without specialized tools. The algorithm evaluates a finite set of observable indicators and applies a monotonic risk score to produce allow, caution, or block decisions. Formal properties of the procedure include monotonicity, bounded complexity, and decision traceability. A controlled study with 96 participants and 72 messages per participant showed that algorithm use increased mean classification accuracy from 68.4% to 84.7% and reduced the false-negative rate from 31.9% to 11.3%. Median decision time rose from 6.2 s to 8.7 s. These results show that phishing avoidance can be expressed as a human-executable algorithm rather than as advisory guidance, and that structured decision rules can measurably improve user level security outcomes. Full article

The use of olive by-products in livestock farming is a valuable resource, given their high levels of bioactive compounds with antioxidant and health-promoting properties. This preliminary study adopted an integrated approach to evaluate the influence of dietary Olea europaea L. polyphenols on animal welfare, physiological stress response, intestinal morphofunctional traits, and meat quality in Neroametà finishing pigs, a novel Casertana × Large White genetic line (Neroametà). Thirty pigs reared under extensive farming conditions were randomly allocated to two groups (n = 15): a control group fed a standard diet (C) and a treatment group (OL) supplemented with 300 mg/head/day of olive polyphenolic extract for 90 days. The study focused on the systemic correlation between host health and product quality. Meat composition, rheological properties, meat antioxidant activity, stress parameters, and fatty acid profiles of the longissimus lumborum and psoas major muscles were analyzed. Results showed that the OL diet significantly modulated the HPA axis, as evidenced by a marked reduction in plasma ACTH and cortisol levels, alongside improved antioxidant status. These physiological changes were positively associated with a trophic effect on the intestinal mucosa, characterized by increased villus height and a more favorable villus/crypt ratio. Regarding meat quality, the OL group exhibited superior oxidative stability, optimized pH decline, and an improved intramuscular fatty acid profile (increased MUFA and n-3 PUFA, reduced SFA). Despite the pilot scale of 30 animals, these findings provide a solid foundation for characterizing the Neroametà breed. In conclusion, Olea europaea L. polyphenols act as a multi-level modulator, enhancing physiological resilience and meat quality, offering a sustainable strategy for high-quality pork production in line with circular economy and One Health principles. Full article

In this paper, we study a generalization of the Graham–Kohr extension operator, ${\mathsf{\Psi }}_{n,\alpha ,\beta }^{\gamma }\left(f\right)$, which maps functions defined on the unit disk into holomorphic mappings in the unit ball ${\mathbb{B}}^n$. Using the theory of Loewner chains, we show that, under suitable conditions, this operator can be embedded as the first element of a Loewner chain while preserving geometric properties. In addition, for suitable choices of the parameters, we establish subordination relations among starlike functions. Full article