Search Results (15,709)

Background: Evidence on powered wearable exoskeleton gait training in patients with chronic hypoxic-ischemic encephalopathy (HIE) is virtually absent, and existing studies have focused on macroscopic functional outcomes while neglecting joint-level neuromuscular force-generation characteristics such as rate of force development (RFD). Objective: To examine the effects of a six-week powered exoskeleton gait training program on isometric hip strength and RFD, sit-to-stand (STS) performance, frontal-plane hip strength, and center-of-pressure (CoP) dynamics in a patient with chronic HIE-induced quadriparesis. Methods: A case report with pre- and post-intervention evaluation was conducted. A 47-year-old male with chronic HIE-induced quadriparesis (onset 2017) completed 18 sessions (three per week, six weeks) of powered lower-limb exoskeleton gait training. Outcomes included isometric hip peak force and RFD (DynaMo, Vald Performance), STS peak force and body mass-normalized RFD (ForceDecks, Vald Performance), frontal-plane hip strength (ForceFrame, Vald Performance), and CoP path length and mean velocity. Results: Hip extension peak force increased by 247–256% bilaterally, and hip extension RFD increased by 174–188%, whereas hip flexion peak force showed minimal change (+3.3–5.2%). Body mass-normalized STS RFD increased by 250% (10 to 35 N·s⁻¹·kg⁻¹), representing the largest relative gain. Hip abduction strength increased by 27.1–36.8% with improved bilateral symmetry; hip adduction imbalance reversed from right to left dominance. CoP path length and mean velocity each decreased by 3.7%. Conclusions: Six weeks of powered exoskeleton gait training selectively enhanced time-dependent neuromuscular output—particularly RFD—beyond maximal strength gains, with meaningful improvements in functional weight acceptance during STS. These findings support exoskeleton-based training as a promising rehabilitation strategy for patients with chronic CNS injury. Full article

Acromegaly is a rare chronic endocrine disorder characterized by delayed diagnosis, multisystem comorbidity, and heterogeneous therapeutic response. We aimed to describe the clinical characteristics, tumor profile, treatment patterns, biochemical control, pituitary insufficiencies, and comorbidity burden in an endocrinology tertiary center in northeastern Romania. This observational retrospective study included 87 adult patients admitted for general inpatient evaluation between December 2023 and November 2024, with retrospective data collected from diagnosis and follow-up assessed through the last available hospital visit at St. Spiridon Clinical Emergency Hospital. Clinical, hormonal, imaging, and therapeutic data were analyzed using descriptive statistics and inferential statistical tests. Most patients were diagnosed in middle adulthood, with a female predominance. Macroadenomas and extrasellar extension were common, consistent with advanced tumor stage at presentation. Treatment was predominantly multimodal, with surgery as the main therapeutic intervention and somatostatin receptor ligands as the main medical treatment backbone. Biochemical improvement was observed over time, although complete remission was achieved only in a subset of patients. These findings describe the clinical and therapeutic complexity of acromegaly in a single tertiary-center inpatient cohort and support the need for individualized long-term monitoring. Full article

Shiga toxin–producing Escherichia coli (STEC) are important zoonotic pathogens that can disseminate through environmental water systems, yet data from Southern Italy remain scarce. The aim of this study was to investigate the occurrence and genetic characteristics of STEC isolated from surface water samples collected from rivers and lakes in the Apulia region (Southern Italy). A total of 120 samples were processed according to ISO/TS 13136:2012, followed by whole genome sequencing (WGS) for isolate confirmation and characterization. Overall, 20% of the samples were stx-positive in screening. STEC strains were isolated from 4.2% of stx-positive enrichments, corresponding to one sample out of a total of 120 (0.8%). The isolate was identified as O139:H1, carrying the stx2e subtype and belonging to sequence type ST1. Genomic analysis revealed multiple virulence-associated determinants, including the complete F18 fimbrial operon (fedA-F), hlyA, csgA, gad, chuA, yehA-D, and ompT, along with stress-resistance and tellurite-resistance genes. The strain was susceptible to all antibiotics tested. The genomic profile suggests a swine-associated lineage with multiple environmental persistence traits but limited antimicrobial resistance. The detection of a swine-associated STEC strain in surface waters highlights potential environmental dissemination pathways and underscores the importance of continued monitoring within integrated water–livestock surveillance frameworks. Full article

Understanding the spatial organization of the new materials industry chain is essential for promoting sustainable industrial development. However, existing research rarely examines it as an integrated intercity network spanning multiple segments and specialized sub-sectors. To address this gap, this study constructs the New Materials City Association Network (NM-CityNet) using firm-level cross-regional equity investment data for 294 Chinese cities from 2010 to 2024. NM-CityNet includes two dimensions: segment networks (upstream, midstream, downstream) and sub-sector networks (advanced basic materials, critical strategic materials, and frontier new materials). A chain-lock model is applied, combined with social network analysis and the quadratic assignment procedure. Location quotients are integrated with weighted degree to capture specialized division-of-labour patterns. Using these methods, this study reveals the regional distribution, network structure, specialization patterns, and formation mechanisms of NM-CityNet. Results show that: (1) upstream core cities cluster in eastern China, midstream activities diffuse toward central and western regions, and downstream activities concentrate along the south-eastern coast; (2) NM-CityNet remains sparse and shows clear community structures, while different segments form differentiated spatial organization mechanisms; (3) sub-sectors exhibit clear specialization, with critical strategic materials showing broader spatial coverage; (4) drivers are heterogeneous: administrative proximity promotes link formation; government S&T financial-support differences are positively associated with link formation, although this association may partly reflect selective investment effects; economic and transport disparities inhibit link formation; innovation differences matter only in the midstream segment; and resource-endowment differences matter upstream and downstream. Full article

Background: Foliar fertilization is a crucial practice in modern viticulture to enhance grape yield and fruit quality. Micronized calcite is a fine-particle mineral fertilizer that potentially improves vine performance; however, its treatment timing and optimal dosage require further scientific validation under field conditions. Methods: This study investigated the effects of the use of micronized calcite as a foliar biostimulant on the Red Globe grape variety. Control and three treatments were compared: a control (no treatment), a single treatment (pre-bloom, 0.5%), two treatments (pre- and post-bloom, 0.5% + 0.5%), and three treatments (pre-bloom, post-bloom, and véraison, 0.5% + 0.5% + 0.5%). The evaluation encompassed phenological stages, total effective temperature, yield components, cluster and berry characteristics, and must composition. This was a single-season trial (2022) conducted at a single location with three replicates per treatment (n = 3); multi-year, multi-location validation is therefore required before the findings can be generalized. Results: All micronized calcite treatments slightly shortened the vegetation period compared to the control. Under the conditions of this single-season trial, the single pre-bloom treatment was associated with the highest yield parameters, with the average number of clusters per vine, cluster weight, and total grape yield per vine being higher than the control by 48.67%, 51.16%, and 121%, respectively. For must composition, only must yield differed significantly (between the 1st and 3rd treatments; p < 0.05); soluble solids content (+5.64%) and ripening index (+16.99%) were numerically higher but not statistically significant (p ≥ 0.05) and are therefore reported as trends rather than improvements. By contrast, the two-treatment (pre- and post-bloom) showed the highest values for physical berry traits, with cluster width and 100-berry weight exceeding the control by 35.03% and 11.11%, respectively. Conclusion: Under the semi-arid conditions of this single-season trial, foliar treatments of micronized calcite, particularly a single pre-bloom application, were associated with notable improvements in yield and must quality of Red Globe grapevines. These preliminary findings suggest that finely milled calcite may serve as a promising supplementary foliar fertilizer in viticulture; however, the results are context-specific, and multi-year, multi-location trials are required before broader recommendations can be made. Full article

Multidrug-resistant (MDR) Enterococcus faecium is an opportunistic pathogen. Its resistance and virulence genes can spread through the food chain, posing risks to public health. This study investigated the antimicrobial resistance and genomic characteristics of MDR E. faecium isolated from milk samples from cows with mastitis in Ningxia between 2019 and 2024. From 2019 to 2024, 1341 milk samples were collected in Yinchuan, Yinnan, and Yinbei. MDRE. faecium was identified using plate screening, mass spectrometry, broth microdilution, and hemolysis detection. Whole-genome sequencing enabled SNP, MLST, pan-genome, and COG analyses, focusing on ARGs and MGEs. MRPP, AMOVA and PCoA were applied to compare gene communities and identify driver genes. Ninety-one E. faecium strains were isolated. Resistance to florfenicol, ceftiofur, and chloramphenicol exceeded 60%, while resistance to vancomycin and linezolid showed an overall increasing trend over the study period. Phylogenetic clustering revealed two subtypes, three clades, and 10 novel STs. Spearman correlation analysis revealed strong positive correlations among the resistance genes optrA, cfr(A), and vanF. Antibiotic resistance, particularly MDR, increased over time, and strains carried diverse ARGs and MGEs. Overall, strengthened surveillance of mastitis-derived E. faecium is warranted to support the control of bovine mastitis and safeguard public health. Full article

In this study, we propose SiStNet, a single-stage deep learning architecture for vehicle detection in autonomous driving scenarios. The proposed architecture is trained entirely from scratch on domain-specific data without relying on pretrained backbones and is evaluated against representative baseline detectors under identical training conditions. Experiments are conducted on the KITTI dataset under a consistent training and evaluation protocol. An ablation study conducted under a reduced training budget (20% of data, 30 epochs) revealed that multi-scale detection, data augmentation, and anchor-based prediction did not contribute positively to detection performance under the given training conditions. Based on these findings, the final SiStNet architecture was simplified by removing these three components and re-trained under the full training budget. The resulting model achieves a mean Average Precision (mAP) of $0.5033\pm 0.0072$ and a recall of $0.6935\pm 0.0214$, representing substantial improvements over the initially reported values ($0.3896$ and $0.439$, respectively). The inference speed of SiStNet is $24.41\pm 0.02$ FPS, which satisfies the real-time threshold of 20 FPS defined in this study. The model achieves lower mAP than baseline detectors that employ larger and deeper architectures; all models were trained from scratch under identical conditions, so the accuracy gap reflects architectural capacity differences rather than pretraining advantages. SiStNet is presented as a domain-specific, scratch-trained alternative that achieves competitive detection performance without reliance on large-scale pretraining, at the cost of lower mAP relative to deeper baselines. Full article

Takotsubo syndrome (TTS) is an acute disorder characterized by transient left ventricular dysfunction with typical regional wall motion abnormalities, most commonly apical ballooning. It accounts for 1–3% of all suspected acute coronary syndromes and up to 5–6% in women presenting with ST-segment elevation myocardial infarction requiring coronary angiography to exclude obstructive coronary artery disease. The pathophysiology of TTS is complex and not fully elucidated, with sympathetic hyperactivation playing a central role through calcium dysregulation, oxidative stress, and metabolic alterations. Both clinical and experimental data demonstrate the importance of inflammation, with cell infiltration and persistent immune activation exceeding the acute phase. Increasing evidence highlights the impact of coronary microvascular disfunction (CMVD) as a secondary phenomenon, with some findings that support its role as a causative substrate. Beyond well-known predisposing conditions such as female sex, postmenopausal age, and neurological and psychiatric disorders with the trigger of a physical or psychological event, numerous case reports associate the syndrome with chronic autoimmune diseases, even if clear experimental evidence remains poor and worthy of further study. Echocardiography and advanced imaging techniques, including cardiac magnetic resonance and positron emission tomography, have provided insights into transient CMVD, reversible myocardial edema, and metabolic impairment, strengthening our knowledge of the syndrome as a dynamic process. It is also of growing interest to perform invasive hemodynamic assessment to explain the increase in microvascular resistance. This review offers a comprehensive and up-to-date overview of these techniques in the context of TTS. Since clinically, TTS may be associated with significant morbidity and mortality, with some unexplained cases of long-term myocardial disfunction or even recurrence, a deeper understanding of the interplay between catecholamines, inflammation, immune substrate, and CMVD may improve risk stratification and lead to the development of targeted therapeutic strategies. Full article

Gas pipeline leakages in urban underground utility tunnels pose a severe threat to public safety. Leakages of varying aperture sizes trigger differentiated risks of diffusion and explosion; thus, achieving precise identification of leakage hole size has become a critical issue in safety management. To address the difficulty of traditional methods in effectively separating the acoustic features of different leakage levels within complex utility tunnel environments, this paper proposes a gas pipeline leakage risk level identification method based on a lightweight Spatial–Temporal Graph Neural Network (ST-GNN). First, relying on a real utility tunnel simulation platform, acoustic signals under different pressures and leakage hole size are collected, and time-frequency magnitude features are constructed through Short-Time Fourier Transform (STFT). Furthermore, each acoustic sample is independently converted into a graph with STFT time frames as nodes, where temporal neighborhood edges and K-nearest neighbor edges jointly encode local dynamics and non-local spectral similarities. This transforms unstructured acoustic signals into graph-structured data that embodies spatial–temporal coupling relationships. Building upon this, a lightweight Chebyshev graph convolutional network is designed to progressively extract discriminative features strongly correlated with leakage levels using multi-layer convolution. Experimental results on the actual utility tunnel simulation platform dataset demonstrate that the proposed method achieves excellent performance in a three-level leakage classification task. The t-SNE visualization reveals the effective separation of features, progressing from complete mixing in the input layer to distinct separation in the output layer. Through multiple training statistics and ablation experiments, the impact of dataset size and the number of network layers on the identification performance is analyzed, validating the robustness of the proposed model under limited samples and the effectiveness of its lightweight structure. This provides a feasible solution for the automated and refined identification of gas pipeline leakage levels in underground utility tunnels. Full article

Background/Objectives: Minimally invasive (MIS) mitral valve surgery has been proven to be a safe and effective alternative to median sternotomy (ST), with advantages in postoperative recovery and morbidity. However, its role in the setting of infective endocarditis (IE) remains uncertain. This meta-analysis aims to evaluate the outcomes of MIS in mitral valve surgery for infective endocarditis. Methods: A PRISMA-compliant search for studies including patients undergoing MIS for mitral valve IE was performed through 14 January 2026, in PubMed, Scopus and Cochrane. Time-to-event data were reconstructed from published Kaplan–Meier curves. A secondary comparative analysis focusing on MIS versus ST techniques was conducted. Results: Fourteen retrospective studies comprising 949 patients were analyzed. In the MIS cohort, early mortality was 4.2% (95%CI: 1.8%, 7.4%). Overall survival was 86.7% at 1 year, 75.2% at 5 years and 56.2% at 10 years. Freedom from IE-related reoperation remained high at 97.5%, 95.9%, and 90.7% at 1, 5, and 10 years, respectively. Mitral valve repair was performed in 52.5% of patients. In secondary comparative analyses, overall survival at 4-year follow-up was not different between MIS and ST [HR: 0.82 (95%CI: 0.43, 1.57), p = 0.55]. MIS was associated with a significantly shorter intensive care unit (ICU) stay [MD: −1.52 days (95%CI: −2.08, −0.97), p < 0.01]. Conclusions: MIS for mitral valve IE is associated with favorable early and long-term outcomes, comparable survival with sternotomy, and reduced ICU stay. These findings suggest that MIS may be considered as a feasible and potentially effective alternative for the management of mitral valve IE in carefully selected patients. Further prospective comparative studies are warranted. Full article

This is a companion paper for the short paper published in the proceedings of the 1st International Online Conference of the Journal Philosophies, presenting the view that the multiple, diverse manifestations of human, artificial, and natural intelligence do not preclude a uniform characteristic of intelligence, which could be called meta-intelligence, and that this uniform characteristic can be found in the triadic relationship of intelligence, information, and complexity, in which intelligence is considered the capacity to overcome complexity of information. While the conference paper was focused on overcoming the view of a diversity of unrelated forms of intelligence through the lifting of the level of abstraction of the study, and with the use in its background of auxiliary concepts of information and its complexity, the present paper defends, but only indirectly, the same vision of meta-intelligence, but with a shift of the focus to the metaphysical study of a triadic conceptual framework with its relationship to free will, agency, causality, and interaction, and the necessary high level of generality for the concept of information. The arguments used in the conference paper for the conceptualization of intelligence are not repeated here. Instead, this paper provides comprehensive metaphysical and epistemological foundations for the study of the triad of intelligence, information, and complexity, which in the earlier paper were only fragmentary. Full article

This study examines how future mathematics teachers perceive the importance of AI-related and digital competencies and their self-reported performance in these areas. The study was conducted in a Mathematics Education course in Spain with 198 Primary Education students. Using an Importance–Performance Map Analysis (IPMA) framework, the questionnaire assessed six dimensions: AI awareness, AI usage, AI evaluation, AI ethics, AI trust, and digital skills, with items adapted from previous studies. The results showed that students assigned higher importance to all competencies than the level of performance they reported. AI evaluation, AI trust, and digital skills received the highest importance scores, whereas AI awareness obtained the lowest scores. The IPMA identified AI usage as the main priority for improvement, as students considered it relevant but reported comparatively lower performance. Differences by academic year and self-reported AI knowledge level suggest that students’ stage of training and perceived AI knowledge influenced their perceptions. These findings reveal a gap between the importance future teachers assign to AI-related competencies and their perceived level of development. The study highlights the need for more specific and pedagogically grounded AI training in Mathematics Education and offers practical implications for teacher education curricula in response to the demands of 21st-century classrooms. Full article

Background: Soft tissue sarcomas (STS) are clinically heterogeneous, yet local recurrence (LR) and metastasis are typically analyzed as separate endpoints. We aimed to determine whether recurrence in STS is better understood as distinct phenotypes defined by the interaction between local and metastatic disease. Methods: A total of 668 patients with histologically confirmed STS from two tertiary sarcoma centers were analyzed using prospective registry data (2018–2025). Patients were stratified into four predefined recurrence phenotypes: no event, metastasis only, LR only, and combined LR and metastasis. Tumor characteristics, treatment variables, surgical factors, recurrence timing, and event sequence were analyzed across groups. Results: Phenotypes were distributed as follows: no event (52.2%), metastasis only (23.8%), LR only (13.5%), and combined recurrence (10.5%). High-grade tumors (G3) were more frequent in metastasis-only (73.0%) and combined phenotypes (65.7%) than in LR only (38.9%) and no event (28.9%) (p < 0.001). Early LR (≤365 days) occurred substantially more often in the combined phenotype (51.4%) than in isolated LR (17.8%), whereas late LR predominated in isolated cases (82.2% vs. 48.6%) (p < 0.001). Among patients with LR, high grade (OR 2.79, 95% CI 1.42–5.49) and axial location (OR 2.28, 95% CI 1.17–4.47) were independently associated with combined recurrence. In the combined phenotype, metastasis preceded LR in 40.0%, LR preceded metastasis in 34.3%, and events were synchronous in 25.7%. Conclusions: Recurrence in STS comprises distinct phenotypes defined by the interaction of local and metastatic disease. In particular, the clinical significance of local recurrence depends on its metastatic context. Full article

Rickettsia spp. is ubiquitous in nature and capable of causing diseases of varying severity. The most extensive group comprises the spotted fever group (SFG) Rickettsiae, the members of which are predominantly transmitted by ticks. The expansion of tick habitats observed in recent decades poses an increasing threat of dissemination of tick-borne infections into regions previously considered non-endemic. The aim of this study was to determine the prevalence of SFG Rickettsiae in ixodid ticks collected in Northwest Russia and to characterize the species diversity of these pathogens within the study area. Questing adult ixodid ticks (n = 4566) were collected from eight regions of Northwest Russia (Arkhangelsk, Kaliningrad, Leningrad, Novgorod, Pskov and Vologda Regions, as well as the Republic of Karelia and St. Petersburg) in 2023 to 2025 (from April to September). The species composition included Ixodes ricinus (n = 1683), Ixodes persulcatus (n = 2404), and Dermacentor reticulatus (n = 479). Genomic DNA was extracted from individual ticks and screened for SFG Rickettsiae using real-time PCR, followed by conventional PCR targeting the gltA, ompA, ompB, and sca4 (gene D) genes. Nucleotide sequences obtained for a subset of positive samples for the various genes were analyzed. The overall prevalence of SFG Rickettsiae was 12.6% (95% CI: 11.7–13.6). Circulation of the following species was detected: Rickettsia helvetica, Rickettsia conorii subsp. raoultii, Candidatus Rickettsia tarasevichiae, Rickettsia monacensis, and Rickettsia felis. The findings indicate considerable species diversity of SFG Rickettsiae in natural foci of Northwest Russia. Rickettsia monacensis was detected in ixodid ticks within the study area for the first time, and R. felis was identified in Russia for the first time. Full article