Search Results (14,684)

Background: The prognostic value of treatment-induced necrosis in soft STS remains uncertain. This study evaluated whether MRI-based changes in necrosis (Δ necrosis) between pre- and post-neoadjuvant chemotherapy scans correlate with pathologic necrosis and clinical outcomes. Methods: In this retrospective cohort, 27 patients with STS who received neoadjuvant chemotherapy and underwent pre- and post-treatment MRI were analyzed. Necrosis was graded categorically (<5%, 5–25%, 25–50%, 50–75%, 75–95%, and >95%), and Δ necrosis was calculated as the change in estimated necrosis between scans. Correlations between MRI-derived and pathologic necrosis were assessed using Spearman’s rank coefficient. Survival analyses (progression-free, local recurrence-free, and disease-specific overall survival) were performed using Kaplan–Meier and log-rank tests. Results: Post-treatment MRI necrosis moderately correlated with pathologic necrosis (ρ = 0.44, p = 0.028), whereas Δ necrosis showed a weaker, nonsignificant correlation (ρ = 0.24, p = 0.24). Neither MRI-based nor pathologic necrosis thresholds were associated with survival outcomes. Conclusions: MRI-based Δ necrosis did not predict pathologic necrosis or oncologic outcomes in STS, suggesting that radiologic changes in necrosis may not serve as reliable markers of therapeutic response. Future studies integrating quantitative imaging and standardized pathology protocols together with future exploration of molecular tools such as ctDNA are needed to refine treatment assessment in STS. Full article

Cupressus duclouxiana is an ecologically and economically important conifer endemic to southwestern China (e.g., central Yunnan and southern Sichuan), yet its potential distribution under future climate change remains insufficiently understood. In this study, we employed an ensemble species distribution modeling framework implemented in biomod2 to predict the current and future suitable habitats of C. duclouxiana across China. A total of 154 occurrence records and 17 key environmental variables were used to construct ensemble models integrating twelve algorithms. The ensemble model showed high predictive performance (TSS = 0.99, Kappa = 0.98). Temperature-related variables dominated habitat suitability, with the minimum temperature of the coldest month identified as the primary limiting factor, accounting for 44.1%. Under current climatic conditions, suitable habitats are mainly concentrated in southwestern China, particularly in Sichuan, Yunnan, and Xizang (Tibet). Future projections under three Shared Socioeconomic Pathways (SSP1-2.6, SSP3-7.0, SSP5-8.5) consistently indicate habitat expansion by the late 21st century, accompanied by pronounced northward and northwestward range shifts. The largest expansion is projected under the SSP3-7.0 scenario, highlighting the sensitivity of C. duclouxiana to intermediate warming trajectories. Overall, climate warming is expected to increase habitat availability while reshaping the spatial distribution of C. duclouxiana across China. These findings provide scientific support for climate-adaptive afforestation planning and conservation management, and offer broader insights into the responses of subtropical coniferous species to future climate change. Full article

Objectives: Non-ST-segment elevation myocardial infarction (NSTEMI) in the elderly is frequently complicated by multiple comorbidities, which influence clinical outcomes. However, the prognostic significance of atrial fibrillation (AF) in this context remains uncertain. This study aimed to evaluate the impact of AF on short- and long-term mortality in elderly patients (≥65 years) with NSTEMI. Methods: This cross-sectional observational study included 474 NSTEMI patients aged 65 years and older. Participants were stratified into four groups based on age (65–74 vs. ≥75 years) and the presence or absence of AF. One-month and one-year all-cause mortality were assessed as the primary and secondary endpoints, respectively. Results: AF was detected in 23 (11.6%) of 199 patients aged 65–74 and in 80 (29.1%) of 275 patients aged ≥75. While one-month mortality did not differ significantly among the four groups (p = 0.514), one-year mortality showed a statistically significant difference (p < 0.001). Univariate analysis revealed that AF was not predictive of one-month mortality. In multivariate Cox regression analysis, AF, reduced creatinine clearance, and left ventricular ejection fraction <50% were identified as independent predictors of one-year mortality. Conclusion: AF is not associated with short-term mortality in elderly NSTEMI patients; however, it serves as an independent predictor of one-year mortality. These findings highlight the importance of long-term rhythm monitoring and management in this high-risk population. Full article

This work investigates the structural, acoustic, and thermo-oxidative degradation behavior of elastomeric composites made from neat EPDM and recycled devulcanized EPDM (EPDMd) blends, both with and without silica (SiO₂). SiO₂ plays a complex role in degradation, possibly acting as a catalyst and also affecting the properties of the materials. Samples were subjected to accelerated degradation at 80 °C for 30 days. The characterization included the mechanical, spectroscopical (FTIR-ATR), thermal (TGA), and morphological (SEM) studies of the samples. Given EPDM’s use in construction as a sound-absorber, its acoustic properties were also analyzed. The determination of the mechanical properties shows that the incorporation of SiO₂ improves the Young’s modulus (YM), maintains the tensile strength (TS) at similar values, and causes a decrease in elongation at break (EB). The content of EPDMd slightly decreases both the TS and the EB and increases the YM. The thermo-oxidative degradation of the studied composites does not affect the TS values, but it increases the YM for the samples with and without SiO₂ for EPDMd contents higher than 40 phr, and decreases the EB for samples with and without SiO₂ for all EPDMd contents. The FTIR-ATR, TGA, and SEM results show that the addition of SiO₂ catalyzes the thermo-oxidative degradation process, while the EPDMd inhibits structural degradation. Migration of the ZnSt₂ included in the formulations to the surface is common in these elastomers. In this case, EPDMd forms microaggregates, which retain the exudation of ZnSt₂ crystals, especially in the non-degraded samples. The degraded samples present irregular structures, with microcavities, cracks, and occlusions, which increase the acoustic absorption mainly at frequencies below 1500 Hz. Full article

This study aims to (1) examine the impact of AI-driven learning tools (AI-LTs) on educational sustainability (EDS) and (2) investigate the mediating role of students’ engagement (SE) and the moderating effect of digital resilience (DR) in this relationship. Based on sociotechnical systems theory (STS), self-determination theory (SDT), and resilience theory, and (3) developing a multidimensional framework to explore how technological, psychological, and contextual factors interact to shape sustainable learning outcomes. Data were gathered from 387 university students in Saudi universities using a standardized questionnaire and subsequently analyzed utilizing SPSS version 28 and PROCESS Macro Version 4.0. The study performed multiple regression and moderated mediation to evaluate the proposed relationships. The results confirmed that AI-LTs significantly enhance educational sustainability. Based on the findings, AI-LTs significantly improve the long-term viability of education, particularly when it is tailored to individual students, encourages active participation, and is logical from a pedagogical perspective. Student engagement was found to influence the relationship, suggesting that when AI tools are utilized effectively, they foster a sustained commitment to education and improved learning outcomes. Furthermore, digital resilience has a significant influence on the connection between AI-LT–EDS, indicating that students who exhibited improved adaptability to digital challenges reaped considerable benefits. The research enhances the existing literature by integrating three complementary frameworks—STS, SDT, and resilience theory—to provide a comprehensive understanding of AI’s role in sustainable education. Practically, the study underscored the importance of AI integration strategies that improve digital resilience, student engagement, and structural imbalance. The results demonstrated that AI usage necessitates significant institutional support and improved technology to establish educational environments that are adaptable, resilient, and easily accessible to students. Full article

Placed in the broader discourse on Intercultural Citizenship Education (ICitE) this study explores the anticipated impact of bilingual education (BE) on intercultural competence (IC) and global civic orientations associated with intercultural citizenship (ICit) among students in their final year of secondary school (4th-year ESO) in Spain, focusing on differences in perceptions between bilingual and non-bilingual participants. A quantitative methodology was employed, utilising a closed-ended validated questionnaire administered to 2187 students from bilingual and non-bilingual settings across the whole country. The results reveal that bilingual students perceive BE as beneficial for their IC, whereas their monolingual counterparts assign less such utility to BE. We conclude that even though intercultural education is not explicitly taught in the curriculum, it is implicit in bilingual education programmes due to the positioning of the additional language as a medium and lived daily practice with tangible outcomes rather than an academic requirement. We also discovered that within the bilingual students’ group there are lower expectations regarding BE’s impact on the anticipated development of their global civic identity compared to intercultural awareness. The findings indicate that BE offers a context naturally conducive to IC development and has potential for fostering ICit which appears to be untapped. This study has implications for the discussion on the role of BE in education for the 21st century and urges stakeholders to address BE affordances for nurturing ICit by adding the critical citizenship component to it as proposed in the Intercultural Citizenship Education framework. Full article

Background/Objectives: Cardiac remodeling post-myocardial infarction is a critical process determining patient prognosis. Poland’s Coordinated Specialist Care program enables early cardiac rehabilitation (CSC-Infarct) during peak remodeling period. This study evaluated the safety and effectiveness of very early cardiac rehabilitation initiated during peak remodeling (mean 16.8 ± 3.4 days post- ST-elevation myocardial infarction [STEMI]) within the CSC-Infarct program. We examined outcomes following two training modalities—interval and continuous—applied according to clinical guidelines based on baseline exercise capacity. Methods: We enrolled 288 patients (135 women, 153 men, age 59.7 ± 9.8 years) after first STEMI into a 24-day rehabilitation program (5 sessions/week) within CSC-Infarct. Patients received either interval training (n = 127) or continuous training (n = 161) according to National Health Fund protocols. Hemodynamic, metabolic (metabolic equivalents [MET], maximal oxygen uptake [VO2max]), and functional parameters (6-minute walk test [6MWT]) were assessed pre- and post-rehabilitation. Results: Both groups showed significant improvement in most parameters. The continuous training group achieved higher final MET values (8.9 ± 2.5 vs. 6.5 ± 1.9; p < 0.001), VO₂max (31.0 ± 8.8 vs. 22.9 ± 6.5 mL/kg/min; p < 0.001), and 6MWT distance (530.9 ± 108.9 vs. 455.6 ± 104.3 m; p < 0.001). Significant improvement in heart rate recovery (HRR), indicating autonomic balance, was observed only in the continuous training group (p = 0.026), not in the interval group (p = 0.290). Conclusions: Early rehabilitation within CSC-Infarct (mean 16.8 days post-infarction) during intensive remodeling is safe and effective. Both training modalities produced clinically significant improvements when appropriately matched to patient baseline capacity. Continuous training showed additional benefit in autonomic balance (HRR improvement), while interval training achieved substantial relative gains (+11.8% in 6MWT) in lower-capacity patients. The CSC-Infarct program provides optimal timing for rehabilitation implementation during the critical cardiac remodeling period. Full article

Body mass index (BMI) has shown inconsistent associations with outcomes after transcatheter aortic valve replacement (TAVR), and evidence from the Middle Eastern population is limited. This study evaluated whether BMI independently predicts early complications, mortality, or infection following TAVR in a Saudi Arabian cohort. We conducted a retrospective analysis of 197 patients who underwent TAVR between 2015 and 2024, stratified by BMI < 25, 25–29.9, and ≥30 kg/m². The primary endpoint was the in-hospital Valve Academic Research Consortium-3 (VARC-3) composite safety outcome, with secondary outcomes including individual complications, infection, length of stay, and 30-day mortality or readmission. Overall, patients had a mean age of 74.9 ± 8.8 years and 52.3% were female; in-hospital mortality was 2.0%, technical success 99%, and 30-day readmission 12.7%. BMI category was not independently associated with in-hospital complications or mortality, while advanced age ≥ 75 years (adjusted OR 2.52, p = 0.009), moderate Society of Thoracic Surgeons (STS) risk (adjusted OR 3.75, p = 0.008), and high STS risk (adjusted OR 2.26, p = 0.033) independently predicted complications. Overweight patients had higher in-hospital infection rates (14.1% vs. ~3%, p = 0.020). These findings suggest that physiologic vulnerability and operative risk, rather than BMI alone, should guide early TAVR risk assessment. Full article

Piscine lactococcosis is an emerging bacterial disease that threatens freshwater and marine aquaculture in the Mediterranean region. This study characterized isolates of Lactococcus garvieae and Lactococcus petauri from farmed fish through molecular identification, genomic typing and antimicrobial susceptibility testing. A total of 39 bacterial strains were analyzed using species-specific real-time PCR assays, multilocus sequence typing and broth microdilution to determine minimum inhibitory concentrations. Results suggest a temporal shift in freshwater systems, where L. garvieae predominated in earlier isolates (mainly ST13, CC4), while L. petauri (ST14, CC14) appears as the dominant species in recent years. In marine fish, only L. garvieae was detected, mainly ST95 (CC95), a lineage previously reported in Europe. Molecular variability was found in both species with lineages capable of infecting livestock and humans. Amoxicillin displayed promising results; florfenicol showed moderate activity, while flumequine exhibited no inhibitory effect. Oxytetracycline and trimethoprim–sulfamethoxazole showed variable results requiring prudent use. These region-specific susceptibility profiles provide updated baseline data to guide empirical antimicrobial therapy while awaiting laboratory confirmation, highlighting the evolution of lactococcosis in aquaculture and emphasizing the need for molecular surveillance, antimicrobial stewardship, and vaccine updates within a One Health framework to mitigate impacts on Mediterranean aquaculture and public health. Full article

Background: Postnatal growth failure in very preterm infants remains a major concern in neonatal care and clinical management is complicated by the lack of a standardized definition. This study aims to identify risk factors for growth faltering (GF) and undernutrition (UN) at hospital discharge, defined according to the latest consensus definitions established by the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). Methods: We conducted a retrospective observational study of 416 preterm infants (gestational age < 32 weeks and/or birth weight < 1500 g). Growth was monitored using the Intergrowth 21st standards. In line with ESPGHAN criteria, GF was defined longitudinally as a weight for age (WFA) z-score decline ≥ 1 SD from birth, while UN was defined cross-sectionally as a WFA or length for age z-score < −2 SD at discharge. Logistic regression models were used to determine independent predictors for both growth phenotypes. Results: At discharge, the prevalence of GF and UN was 45.3% and 33.1%, respectively. In infants born without growth restriction (GR), UN was almost entirely driven by GF (89.7%). In contrast, 85.5% of infants born with GR remained undernourished at discharge. Multivariate analysis identified bronchopulmonary dysplasia and higher maximal postnatal weight loss as major independent risk factors for GF, while female sex and human milk feeding at discharge were associated with a lower risk of GF. For infants born with adequate weight, maternal hypertension, extremely low birth weight, and the co-occurrence of GF were the strongest predictors of UN. Conclusions: Nearly half of very preterm infants experience significant growth impairment before discharge. By assessing the dynamic process of GF and the static endpoint of UN, we identified distinct clinical trajectories. Standardized ESPGHAN criteria allow for the identification of high-risk “phenotypes”—particularly those with GR at birth or severe neonatal morbidity—enabling more targeted and intensive nutritional management during the critical developmental window. Full article

Background: Libya, a conflict-affected North African country, has a fragile health system and poor surveillance, leaving it largely underrepresented in global estimates. Earlier Libyan reviews were descriptive, lacking breakpoint standardization, isolate-level pooling, or AMR-attributable mortality and DALY estimates. To our knowledge, this study represents the first comprehensive report that integrates phenotypic and genotypic data to estimate deaths and DALYs attributable to AMR-induced mortality and morbidity, describe spatiotemporal patterns, and model future trajectories. Methods: We performed a meta-analysis according to the PRISMA 2020 guideline of Libyan studies reporting phenotypic or genotypic resistance among clinical bacterial isolates (1970–2024), combined with microbiology records from hospitals and national surveillance systems (preregistered in PROSPERO ID: CRD420251066018). Susceptibility results were standardized to CLSI/EUCAST and deduplicated using WHO GLASS first-isolate rules. We used random-effects meta-regression to estimate pooled resistance, and the counterfactual approach of Global Burden of Disease (GBD) was applied to estimate AMR-attributable DALYs. Molecular data on resistance genes, sequence types, and tuberculosis mutations were systematically collected. Results: We included 62 eligible studies together with national and facility-level surveillance datasets, providing isolate-level susceptibility data for 31,439 clinical isolates from Libya. In 2024, we estimated 2183 deaths (95% UI 1752–2614) attributable to AMR, representing 9.7% (95% UI 7.8–11.6) of total deaths with a mortality rate of 15.2 per 100,000 (12.2–18.2). DALYs attributable to AMR increased from 14,628 (95% UI 11,702–17,554) in 1970 to 96,715 (95% UI 77,372–116,058). The highest pooled resistance involved carbapenem-resistant/MDR A. baumannii, third-generation cephalosporin- and fluoroquinolone-resistant Enterobacterales, and carbapenem-resistant P. aeruginosa. Molecular data showed widespread ESBLs, OXA-/NDM-type carbapenemases, plasmid-mediated colistin resistance, high-risk E. coli ST131 and K. pneumoniae ST147 lineages, and canonical drug-resistant M. tuberculosis mutations. Conclusions: Combined with global and regional evidence, our findings suggest a high and increasing burden of AMR in Libya. These findings emphasize the need for rapid expansion of data collection systems, GLASS-aligned surveillance, diagnostic capacities, and infection control measures. Full article

Background/Objectives: Falls are a leading cause of morbidity and mortality in older adults, even among those who are physically active. This study examined the associations between skeletal muscle mass, muscle strength, and muscle power and fall risk in physically active, community-dwelling older adults. Methods: A cross-sectional analysis was conducted with 280 participants (71.9 ± 5.3 years; 75% women) enrolled in the Stay Up–Falls Prevention Project. Assessments included skeletal muscle mass (anthropometric prediction equation), handgrip strength, lower limb strength and power (Five Times Sit-to-Stand test, 5×STS), and fall history over the past 12 months. Muscle power was calculated from 5×STS performance using the equation proposed by Alcazar and colleagues. Logistic regression models and receiver operating characteristic (ROC) curve analyses were performed. Results: Overall, 26.4% of participants reported at least one fall in the previous year, with a higher prevalence among women (28.9%) than men (18.8%). Fallers showed significantly lower handgrip strength (23.1 vs. 25.4 kg, p = 0.022) and poorer lower limb strength (9.2 vs. 8.7 s, p = 0.007) compared with non-fallers. However, no significant differences were found for skeletal muscle mass or sit-to-stand–derived power. In multivariable models adjusted for age, sex, body mass index, comorbidities, and medications, lower limb strength remained the only independent variable associated with fall status (OR = 1.78, 95% CI: 1.11–2.85, p = 0.016). ROC analysis confirmed fair discriminative capacity for 5×STS performance (AUC = 0.616, p = 0.003), with an optimal cut-off of 8.62 s (sensitivity = 78.4%, specificity = 33.0%). Handgrip strength, muscle mass, and power did not show independent associations with fall status. Conclusions: These findings indicate that the 5×STS test provides a simple, cost-effective, and functional indicator for fall-risk stratification in physically active older adults. Clinicians should consider the 5×STS as a sensitive functional indicator that contributes to fall risk stratification, ideally combined with complementary assessments (e.g., balance, gait, cognition) to improve risk stratification and guide preventive interventions in ageing populations. Full article

Enzymatic browning, driven by polyphenol oxidase (PPO), remains a major postharvest challenge for potato (Solanum tuberosum L.), reducing product quality, shelf life, and consumer acceptance. To mitigate this trait in the elite tetraploid cultivar ‘Yagana-INIA’, we applied a geminivirus-derived CRISPR–Cas9 system to edit the StPPO genes most highly expressed in tubers, StPPO1 and particularly StPPO2. A paired-gRNA strategy generated a double-cut deletion in StPPO1, while StPPO2 editing required a complementary single-gRNA screening workflow. High-resolution fragment analysis and sequencing identified three StPPO2-edited lines, including one that lacked GFP, Cas9, and Rep/RepA sequences, confirming a transgene-free editing outcome. Edited tubers exhibited visibly reduced browning relative to wild type, and biochemical assays showed decreased PPO activity consistent with targeted disruption of StPPO2. Amplicon sequencing verified monoallelic editing at the gRNA2 site in the non-transgenic line. These results demonstrate the utility of a replicon-based CRISPR system for achieving targeted, transgene-free edits in tetraploid potato and identify a non-GM StPPO2-edited line with improved postharvest quality under Chile’s regulatory framework. Full article

The architecture of spas and recreational complexes is increasingly being analyzed not only through the prism of its formal diversity but also through its functional, technical, and esthetic responses to evolving societal expectations. This article descriptively examines the context of evolving user needs and select examples representing new architectural forms integrated into the landscape, responding to the growing demand for beauty (understood subjectively), experiences, and emotional value in 21st-century tourism and recreation. The most diverse and characteristic examples were selected and described in order to maintain a broad context of analysis and illustrate contemporary changes as faithfully as possible. The descriptive approach enables a systematic and comprehensive representation of phenomena, identifying recurring patterns, spatial trends, and contextual relationships. Rather than being limited to numerical data, it provides a structured analytical framework that supports the objective documentation of architectural and urban processes. The aim of this study is to systematize selected design trends that reflect contemporary cultural aspirations and environmental concerns, and to illustrate the evolving relationship between architecture, nature, and users. The results indicate a consistent shift toward landscape-integrated, experiential, and esthetically driven architectural solutions, demonstrating that contemporary tourism facilities increasingly prioritize atmosphere, immersion in nature, and sensory engagement over traditional utilitarian design. This study concludes that beauty, understood as subjective esthetic experience, has become a key determinant in shaping new architectural forms, reinforcing the role of architecture as both a cultural expression and a tool for enhancing well-being in tourism and leisure environments. Full article

The global rise in nursing home (NH) populations presents substantial challenges, as residents frequently experience physical and cognitive decline, low physical activity, and high fall risk. This study evaluates the effectiveness of the BeSt Age App, a tablet-based, staff-supported mHealth intervention designed to promote physical activity and prevent falls among NH residents. Primary outcomes were fall incidence and fall risk (assessed using Berg Balance Scale [BBS] and Timed Up and Go [TUG]); fear of falling was a secondary outcome. In a cluster-randomized controlled trial across 19 German NHs, 229 residents (mean age = 85.4 ± 7.4 years; 74.7% female) were assigned to an intervention group (IG) or control group (CG). The 12-week intervention comprised twice-weekly, tablet-guided exercise sessions implemented by NH staff. Mixed models and generalized estimating equations were used under an intention-to-treat framework. The IG showed significantly greater improvement in BBS scores than the CG (group × time: F(1, 190.81) = 8.25, p = 0.005, d = 0.22), while group × time changes in TUG performance, fear of falling, and fall incidence were nonsignificant. These findings demonstrate the feasibility of a staff-mediated mHealth approach to fall prevention in NH residents, showing significant improvements in BBS scores as one functional indicator of fall risk, while TUG, fall incidence and fear of falling showed no change. Full article