Search Results (955)

Background: Fulminant type 1 diabetes (FT1D) is a rare but life-threatening subtype of type 1 diabetes. The concurrence of FT1D with myocarditis is uncommon and attracts further clinical attention. Case Presentation: A 33-year-old female was transferred by a local hospital to West China Hospital because of altered consciousness, abrupt onset of hyperglycemia with ketoacidosis, significantly increased cardiac biomarkers, and ST segment elevations. Her random blood glucose at the local hospital was 50.19 mmol/L. Insulin infusion and fluid resuscitation were started immediately before referral. On admission, her random blood glucose was 14.17 mmol/L. HbA1C and glycosylated albumin (GA) were 6.3% and 21.45%, respectively. Her fasting C-peptide level was 0.022 nmol/L. Anti-Glutamic Acid Decarboxylase (anti-GAD) antibody was 25.06 IU/mL. FT1D was diagnosed based on the 2012 New Diagnosis Criteria of FT1D. Electrocardiogram showed significant ST segment elevation in leads II, III, aVF, and V3-V6. Echocardiography revealed a mildly reduced left ventricular ejection fraction (LVEF) of 46%. Coronary angiography displayed no abnormality. Cardiac magnetic resonance imaging revealed areas of increased signal intensity in the interventricular septum, basal and mid inferolateral walls, and apical inferior wall and subepicardial late gadolinium enhancement (LGE), particularly in the lateral aspects of the left ventricle on T2-weighted imaging (T2WI). Acute myocarditis was diagnosed based on the European Society of Cardiology 2013 Task Force Criteria. She was treated with insulin, fluid resuscitation, and supportive care, leading to rapid recovery of ketoacidosis and cardiac function. At the four-month follow-up, she remained on insulin therapy with good glycemic control but persistent low C-peptide levels. Conclusion: This case report raises awareness about FT1D, determines the differential diagnosis of acute cardiac presentations in an FT1D patient, and highlights clinical reasoning so that clinicians can recognize and manage similar presentations on time. Full article

Clinical Relevance and Background: Motion sickness is a common manifestation of autonomic dysfunction. Increasingly induced by modern technology, such as virtual reality (VR), it presents a pressing challenge that warrants investigation. However, the relationship between binocular function, visual perception, and motion sickness remains largely unexplored. Therefore, this study investigated the correlations between binocular visual functions, visual perception, and motion sickness susceptibility in adults. Methods: Adults aged 20 to 25 years were recruited. Based on a background and motion sickness susceptibility questionnaire, participants were divided into two groups: the Sick Tendency (ST) group (n = 21) and the Normal group (n = 33). Clinical assessments included habitual distance prescription and visual acuity (VA), phoria, fixation disparity (FD), positive/negative fusional vergence (PFV/NFV), vertical fusional vergence (VFV), positive/negative relative accommodation (PRA/NRA), accommodative facility (AF), vergence facility (VF), stereopsis, contrast sensitivity (CS), near point of convergence (NPC), and near point of accommodation (NPA). Additionally, motor-free visual perception test (MVPT), peripheral awareness (PA), and body balance (center of pressure) were assessed. Results: The ST group exhibited significantly higher distance NFV, distance VFV, and near PFV. Conversely, their NPA, stereopsis, and body balance (center of pressure) were significantly poorer than those of the Normal group. These deficits may be attributed to the accommodation–convergence conflict. Conclusions: Motion sickness susceptibility is closely associated with specific binocular functions. Individuals susceptible to motion sickness exhibit poorer postural stability, likely due to diminished stereopsis and accommodative amplitude (NPA). Future research should further investigate the underlying mechanisms and their clinical implications. Full article

Antimicrobial resistance (AMR) poses a critical challenge to global health, with food animal production systems recognized as significant reservoirs of antimicrobial-resistant bacteria. This study evaluated the prevalence and distribution of antimicrobial resistance genes (ARGs) and virulence factors (VFs) across small-scale poultry and cattle farms. A total of 468 samples (soil, feces, water, and natural land soil) were collected from four farms and analyzed using shotgun metagenomics. Proteobacteria (34.91%) were the dominant phylum across environments, followed by Cyanobacteria (15.67%), Actinobacteria (14.95%), Firmicutes (10.57%), and Bacteroidetes (8.69%). Tetracycline (33.41%) and beta-lactam (30.30%) resistance genes were the most abundant, with macrolide (9.32%) and aminoglycoside (8.39%) resistance also detected. Both tetracycline and beta-lactam resistance genes were significantly enriched across sample types (p < 0.05). The detection of diverse VFs alongside ARGs highlights the pathogenic potential of bacterial communities in these production systems. Collectively, the findings reveal that small-scale animal farms are reservoirs of AMR with implications for public health through foodborne transmission. Targeted surveillance and control measures are necessary to prevent the dissemination of ARGs into the broader food chain and to safeguard both human and animal health. Full article

Accurate prediction of the mechanical performance of fiber-reinforced cement mortars (FRCM) is challenging because fiber geometry and properties vary widely and interact with the cement matrix in a non-trivial way. In this study, we propose an interpretable, computationally light framework that combines principal component analysis (PCA) with multiple linear regression (MLR) to predict compressive strength (Cs) and flexural strength (Fs) from mix proportions and fiber parameters. The literature-based dataset of 52 mortar mixes reinforced with polypropylene, steel, coconut, date palm, and hemp fibers was compiled and analyzed, covering Cs = 4.4–78.6 MPa and Fs = 0.75–16.7 MPa, with fiber volume fraction V_f = 0–15% and fiber length F_l = 4.48–60 mm. PCA performed on the full dataset showed that PC1–PC2 explain 53.4% of the total variance; a targeted variable-selection strategy increased the captured variance to 73.0% for the subset used for regression model development. MLR models built using PC1 and PC2 achieved good accuracy in the low-to-mid strength range, while prediction errors increased for higher-strength mixes (approximately Cs ≳ 60 MPa and Fs ≳ 10 MPa). On an independent validation dataset (n = 10), the refined model achieved mean absolute percentage errors of 11.3% for Fs and 18.5% for Cs. The proposed PCA-MLR approach provides a transparent alternative to more complex data-driven predictors, and it can support preliminary screening and optimization of fiber-reinforced mortar designs for durable structural and repair applications. Full article

Filled-polymer coatings enable functional surfaces for selective metallisation, wetting control and local conductivity, but pulsed-laser texturing is often limited by process non-uniformity caused by scan kinematics and plume shielding. Here, we develop a three-tier numerical workflow for nanosecond pulsed-laser surface treatment of a thermoplastic coating containing glass microspheres (baseline case: PLA matrix with V_f = 0.20; spheres represented via an effective optical transport model). Tier 1 predicts spatially resolved ablation depth under raster scanning, using an incubation law and regime switching (no-removal/melt-limited/logarithmic ablation/blow-off) coupled to a dynamic shielding factor. Tier 2 computes the 1D transient (pulse-averaged) temperature field and the thickness of the thermally softened layer. Tier 3 models post-pulse capillary redistribution of the softened layer to estimate groove reshaping. The simulations show that scan overlap and shielding dynamics dominate groove homogeneity more strongly than average power alone: under identical average power, variations in local pulse count and shielding lead to significant changes in depth statistics and regime fractions. The workflow produces quantitative maps and summary metrics (mean depth, P5–P95 range, uniformity index and regime fractions) and demonstrates how controlled reflow can smooth peaks while preserving groove depth. These results provide a predictive tool for laser parameter selection and process optimisation prior to experimental trials. Full article

Neuropeptide VF (NPVF) is a member of the RFamide family of peptides and is suggested to be involved in homeostatic regulations. However, direct evidence is sparse. Here, we generated a NPVF knockout mouse model to comprehensively investigate its role in energy and glucose homeostasis controls. We show that while male Npvf^−/− mice on chow were WT-like at both room temperature (RT 22 °C) and thermoneutrality (TN 28 °C) with regards to body weight, body composition, and the parameters involved in energy homeostasis, female Npvf^−/− mice exhibit significantly reduced water intake at RT and TN regardless of food access, significantly increased the femur bone mineral content at RT and reduced the adiposity at TN. Strikingly, sex differences are absent under high-fat diet (HFD) conditions, with Npvf deletion leading to hyperphagia and increased weight gain in both sexes. Furthermore, Npvf^−/− mice on chow at RT exhibit normal glucose tolerance and insulin action for both sexes. On a HFD or at TN, Npvf^−/− mice display improved and impaired insulin action in females and males, respectively, with female Npvf^−/− mice at TN further showing an improved glucose tolerance. Collectively, these findings establish NPVF as a key regulator of energy and glucose metabolism with sex dimorphism, and are critically dependent on environmental and nutritional factors. Full article

Background: Bovine mastitis (BM) remains an economically significant disease in the global dairy industry. Multidrug resistance (MDR) in Klebsiella pneumoniae and Klebsiella grimontii has increased in recent years, representing an area of concern related to BM. Methods: Bovine mastitis 1-DH1 and 2-DH2 isolates (n = 2) were investigated. Antimicrobial susceptibility testing was performed using the Neg-Urine-Combo98 panel. Antimicrobial resistance genes (ARGs), virulence factor (VF) genes and plasmid replicons were identified by whole-genome sequencing (WGS). Phylogenomic analyses were performed for a visual comparison of the genomes. Results: Phenotypically, isolates 1-DH1 and 2-DH2 were identified as K. pneumoniae-1DH1 and Klebsiella oxytoca, respectively; the latter was subsequently confirmed as K. grimontii-2DH2 by WGS. K. pneumoniae-1DH1 (20.0%, 5/25) exhibited phenotypic resistance to amoxicillin–clavulanic acid, ampicillin (AM), cefuroxime, colistin (Cl), and nitrofurantoin (Fd), whereas K. grimontii-2DH2 (8.0%, 2/25) was resistant to AM and nalidixic acid (NA). In total, 31 and 32 ARGs and 10 and 15 VF genes were identified in K. pneumoniae-1DH1 and K. grimontii-2DH2, respectively. Two plasmid replicons were detected in K. pneumoniae-1DH1 (one harboring the blaCTX-M ARG) compared to one in K. grimontii-2DH2 (encoding both the blaCTX-M ARG and the astA VF gene) isolates, respectively. Phylogenomic analysis showed that K. pneumoniae-1DH1 clustered most closely with human-derived K. pneumoniae isolates, whereas K. grimontii-2DH2 grouped with environmental K. grimontii isolates. Conclusions: Novel phenotypic resistance profiles were observed in the BM-associated K. pneumoniae-1DH1 (MDR, Cl and Fd) and K. grimontii-2DH2 (AM and NA) isolates. Notably, K. grimontii-2DH2 harbored a plasmid replicon carrying both the blaCTX-M ARG and the astA VF gene. Full article

Objective: To clarify the pathophysiology of myopic optic neuropathy (MON) and its relationship to glaucomatous optic neuropathy (GON). Background: MON is presumed to be associated with posterior pole ectasia and deformation of the lamina cribrosa (LC) and parapapillary region. Its dependance on intraocular pressure is expected to be weaker than that of GON; however, the characteristics and clinical behavior of MON remain incompletely understood. Methods: A PubMed search using the keywords myopia, glaucoma, retinal nerve fiber, optic disc, and axonal transport identified 234 relevant publications, which were analyzed in this narrative review. Results: In myopic eyes, a large optic disc, thin or defective LC, and parapapillary microvasculature dropout (pMvD) are considered signs of increased vulnerability to glaucomatous injury. Despite these structural risk factors, visual field (VF) progression in myopic patients with glaucoma is often slow. The involvement of MON, which likely develops in young adulthood and stabilizes with aging, may explain this discrepancy. MON may substantially contribute to the development of central VF defects in myopic glaucoma, which are associated with elongation of papillomacular bundle, pMvD, and normal tension glaucoma. Experimental studies demonstrating impaired axonal transport at the optic disc margin provide important insights into the pathogenesis of MON. Additionally, optic disc deformations in myopia including disc tilting, rotation, and focal thinning or defects of the LC may contribute to atypical VF defects and altered susceptibility to glaucomatous damage. Conclusions: Interaction between MON and GON may explain atypical VF defects and the relatively slow VF progression observed in myopic patients with glaucoma-like VF defects. Full article

Background and Objectives: Primary open-angle glaucoma (POAG) is one of the leading ocular diseases leading to irreversible blindness and is often asymptomatic until advanced cases. While intraocular pressure reduction remains the cornerstone of treatment, neuroprotective strategies targeting retinal ganglion cell metabolism are actively investigated. Niacinamide (nicotinamide, vitamin B3), a precursor of NAD+, has shown neuroprotective potential in preclinical models. This exploratory study evaluated the short-term functional, structural, and electrophysiological effects of oral niacinamide supplementation in POAG. Materials and Methods: In this interventional study, patients with POAG received oral niacinamide 500 mg daily for six months. Visual field (VF) global and localized sensitivity (Mean Deviation [MD], Pattern Standard Deviation [PSD]), Optic Coherence Tomography (OCT)-derived peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell complex (GCC), and Visual evoked potentials (VEP) latency parameters (P2 1.4 Hz, P100 1°, and P100 15′) were assessed at baseline and at six months. Because both eyes from some participants were included, primary longitudinal inference was based on clustered analyses using generalized estimating equations and linear mixed-effects models to account for inter-eye correlation. Eye-level paired analyses were used for exploratory comparison. Change–change relationships across modalities were explored using Spearman correlation. Results: After accounting for inter-eye correlation, no statistically significant change in MD was detected (mean ΔMD +0.43 dB; GEE p = 0.099; LME p = 0.101), and PSD remained stable. RNFL thickness showed a small decrease (−1.26 µm; GEE p = 0.046), while GCC did not change significantly. VEP P100 latencies remained stable, whereas P2 latency showed a small increase (+3.9 ms; GEE p = 0.039). Correlation analysis revealed a moderate association between changes in GCC and MD (ρ = 0.44), suggesting concordance between macular structural stability and global visual field performance. Conclusions: When inter-eye correlation is appropriately accounted for, six months of niacinamide supplementation in POAG is associated with overall functional, structural, and electrophysiological stability, without evidence of clinically meaningful improvement or progression. These findings support short-term safety and highlight the importance of clustered analytical approaches and macular-centered biomarkers in future glaucoma neuroprotection trials. Full article

In recent years, dietary intervention has garnered significant attention for T2DM prevention and adjunctive treatment. Lentinula edodes (commonly known as shiitake mushroom), a common edible fungus, has been demonstrated to improve T2DM, primarily attributed to its main bioactive components like peptides and polysaccharides, while their synergistic characteristics are still not fully explained. Therefore, this study investigated the anti-T2DM molecular mechanisms of L. edodes peptides and polysaccharides by integrating network pharmacology and molecular docking. First, systematic searches of the PubMed and HERB databases using keywords such as “Lentinula edodes peptides”, “Lentinula edodes polysaccharides” and “T2DM” and “Lentinula edodes/shiitake mushroom” yielded 25 peptides and 14 polysaccharides. Second, network pharmacology analysis revealed 541 common interaction targets between these peptides/polysaccharides and T2DM. Topological analysis further identified nine core targets: ESR1, MAPK1, AKT1, SRC, EGFR, STAT3, JUN, PIK3CA, and PIK3R1. Third, pathway enrichment analysis showed that these core targets were significantly enriched within the PI3K-Akt signaling pathway and the AGE-RAGE signaling pathway in diabetic complications, suggesting potential anti-T2DM effects through regulation of these key pathways. Finally, molecular docking validation ensured strong binding affinities between peptides/polysaccharides and some core targets, with particularly prominent binding capacities observed for peptides VF and LDELEK with EGFR; peptides KIGSRSRFDVT, LDYGKL, and EDLRLP along with polysaccharides D-glucan and β-glucan with PIK3CA; and peptide DVFAHF with PIK3R1. In summary, this study revealed that L. edodes peptides and polysaccharides may exert synergistic anti-T2DM effects via the regulation of key signaling pathways, including the PI3K-Akt signaling pathway, EGFR tyrosine kinase inhibitor resistance, and the AGE-RAGE signaling pathway in diabetic complications, through their actions on critical targets such as ESR1, PIK3CA, and PIK3R1. These results offer a synergistic mechanism for the anti-T2DM effect of L. edodes, which could be helpful for the development of functional foods and drugs derived from L. edodes. Full article

Background/Objectives: Beta-lactam antibiotics (BLAs) and vancomycin have remained the cornerstones of therapy for serious bacterial infections, especially bloodstream infections (BSIs). The clinical impact of administering BLAs before vancomycin on outcomes remains unclear and poorly synthesized. Therefore, this systematic review aims to synthesize the available evidence on the impact of the relative timing of BLA administration to vancomycin initiation on important clinical outcomes in patients with BSIs. Methods: A comprehensive search was performed to retrieve clinical studies that evaluated the impact of the sequence of BLA and vancomycin administration on clinical outcomes. Beta-lactam–first group (BLF) included patients who received a BLA before vancomycin, while vancomycin–first group (VF) included patients who received vancomycin prior to BLAs. The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: A total of three retrospective observational studies were included, with a sample size of 29,005 patients, with 24,356 patients in the BLF and 4649 patients in the VF. One study reported that prioritizing BLAs over vancomycin resulted in a 52% reduction in 7-day mortality (adjusted OR, 0.48; 95% CI, 0.33–0.69) and a 55% reduction in 48 h mortality (adjusted OR: 0.45; 95% Cl, 0.24–0.83). Similarly, another study found the BLF strategy was associated with a modest reduction in in-hospital mortality (adjusted OR: 0.89; 95% CI: 0.80–0.99). However, no difference was found in the most recent small, single-institution study that included patients with BSIs. Conclusions: The evidence suggests a potential survival benefit for the BLF strategy over VF in patients with suspected or confirmed BSIs. Larger prospective studies are required to confirm the findings. Full article

Decarbonisation of the aviation sector is essential for achieving global-climate targets, with hydrogen propulsion emerging as a viable alternative to battery–electric systems for vertical flight. Unlike previous studies focusing on clean-sheet eVTOL concepts or fixed-wing platforms, this work provides a comprehensive retrofit evaluation of a two-seat light helicopter (Cabri G2/Robinson R22 class) to a hydrogen–electric hybrid powertrain built around a Toyota TFCM2-B PEM fuel cell (85 kW net), a 30 kg lithium-ion buffer battery, and 700 bar Type-IV hydrogen storage totalling 5 kg, aligned with the Vertical Flight Society (VFS) mission profile. The mass breakdown, mission energy equations, and segment-wise hydrogen use for a 100 km sortie are documented using a single main rotor with a radius of R = 3.39 m, with power-by-segment calculations taken from the team’s final proposal. Screening-level simulations are used solely for architectural assessment; no experimental validation is performed. Mission analysis indicates a 100 km operational range with only 3.06 kg of hydrogen consumption (39% fuel reserve). The main contribution is a quantified demonstration of a practical retrofit pathway for light rotorcraft, showing approximately 1.8–2.2 times greater range (100 km vs. 45–55 km battery-only baseline, including respective safety reserves). The Hawk demonstrates a 28% reduction in total propulsion system mass (199 kg including PEMFC stack and balance-of-plant 109 kg, H₂ storage 20 kg, battery 30 kg, and motor with gearbox 40 kg) compared to a battery-only configuration (254.5 kg battery pack, plus equivalent 40 kg motor and gearbox), representing approximately 32% system-level mass savings when thermal-management subsystems (15 kg) are included for both configurations. Full article

In this study, small-scale experiments were performed to examine fuel distribution effects on discrete flame spread behavior under natural convection and ambient wind. To this end, birch rod arrays with regularly varying column number (n) and array spacing (S) were designed. The results indicate that fuel distribution exerts a comparable influence on flame spread under both natural convection and ambient wind conditions. The flame spread rate (V_f), flame length (L_f), and mass loss rate (MLR) are insensitive to changes in S but have an exponential relationship with n. Based on the mass conservation law, prediction correlations for the mass loss rate based on S and n in the stable flame spread stage are proposed. We discovered that nondimensional mass loss has a power law dependence on the fuel coverage rate. In addition, radiative heat transfer dominates the flame spread process for the discrete array. Horizontal flame spread across discrete rod arrays exhibits critical spacing under natural convection. Finally, we established a comprehensive heat transfer model for flame spread under natural convection conditions and obtained a derivation of a critical sustainability criterion for the discrete flame spread process, which considers radiative and convective heat transfer. Full article

Lamivudine/dolutegravir (3TC/DTG) is an effective and well-tolerated antiretroviral regimen for most people with HIV (PWH) who are virologically suppressed; however, specific clinical characteristics, such as prior hepatitis B virus (HBV) exposure or archived resistance-associated mutations (RAMs), may influence the risk of virological failure (VF). We conducted a retrospective, monocentric cohort study to evaluate the incidence and predictors of VF among PWH who switched to 3TC/DTG after achieving virological suppression (HIV-RNA < 50 copies/mL). A total of 188 PWH were included. Over 5082 patient-years of follow-up (PYFU), 8 individuals (4.3%) experienced VF, corresponding to an incidence rate of 1.45 per 1000 PYFU. The cumulative probabilities of VF at 1, 2, 3, 4, and 5 years were 0.6%, 2.7%, 2.7%, 4.2%, and 22.3%, respectively. In exploratory multivariable analyses, anti-HBc positivity was associated with an increased risk of VF (adjusted hazard ratio [aHR] 4.80, 95% CI 1.03–22.43; p = 0.046). After adjustment for age and sex, individuals with anti-HBc positivity who had switched from a tenofovir-containing regimen showed the highest risk of VF compared with anti-HBc-negative individuals without prior tenofovir exposure (aHR 15.06, 95% CI 1.40–161.38; p = 0.025). Given the limited number of virological events, these findings should be interpreted with caution. Nevertheless, they suggest that prior HBV exposure, particularly in the context of tenofovir discontinuation, may represent a clinically relevant factor when considering simplification to 3TC/DTG. Full article

The current study investigates the influence of intersubject variability in ocular characteristics on the mapping of visual field (VF) sites to the pointwise directional angles in retinal nerve fiber layer (RNFL) bundle traces. In addition, the performance efficacy on the mapping of VF sites to the optic nerve head (ONH) was compared to ground truth baselines. Fundus photographs of 546 eyes of 546 healthy subjects (with no history of ocular disease or diabetic retinopathy) were enhanced digitally and RNFL bundle traces were segmented based on the Personalized Estimated Segmentation (PES) algorithm’s core technique. A 24-2 VF grid pattern was overlaid onto the photographs in order to relate VF test points to intersecting RNFL bundles. The PES algorithm effectively traced RNFL bundles in fundus images, achieving an average accuracy of 97.6% relative to the Jansonius map through the application of 10th-order Bezier curves. The PES algorithm assembled an average of 4726 RNFL bundles per fundus image based on 4975 sampling points, obtaining a total of 2,580,505 RNFL bundles based on 2,716,321 sampling points. The influence of ocular parameters could be evaluated for 34 out of 52 VF locations. The ONH-fovea angle and the ONH position in relation to the fovea were the most prominent predictors for variations in the mapping of retinal locations to the pointwise directional angle (p < 0.001). The variation explained by the model (R² value) ranges from 27.6% for visual field location 15 to 77.8% in location 22, with a mean of 56%. Significant individual variability was found in the mapping of VF sites to the ONH, with a mean standard deviation (95% limit) of 16.55° (median 17.68°) for 50 out of 52 VF locations, ranging from less than 1° to 44.05°. The mean entry angles differed from previous baselines by a range of less than 1° to 23.9° (average difference of 10.6° ± 5.53°), and RMSE of 11.94. Full article