Search Results (2,509)

Extra-pulmonary tuberculosis (EPTB) can affect any organ of the body, producing a wide variety of clinical manifestations that make the diagnosis and treatment of EPTB challenging. The optimum treatment varies depending on the site of EPTB, its severity, and response to treatment. There is often uncertainty about the best management practices, with a significant departure from national guidelines. This study aims to identify gaps and barriers in adhering to the national guidelines for the diagnosis and treatment of EPTB. We included 433 patients having EPTB and followed up at predefined intervals of 2 months, 6 months, 9 months, and 12 months. Questionnaire-based interviews of the treating physician and the patients in different departments were conducted. For confirmatory diagnosis, heavy dependence on clinical-radiological diagnosis without microbiological support was observed, which is a deviation from National Tuberculosis Elimination Programme (NTEP) guidelines and raises concerns about the potential for misdiagnosis and overtreatment. Apart from patient delays, long health system delays in EPTB were observed. The median patient delay, health system delay, and total treatment delay times were 4.2, 4, and 10.1 weeks, respectively. To enhance EPTB diagnosis and management, there is a pressing need for improved access to microbiological testing, enhanced physician training on adherence to NTEP guidelines, and greater utilisation of imaging and histopathological techniques. Full article

Basketball requires intense movements like jumping and sudden changes in direction, increasing the risk of slips and falls due to poor shoe–court traction. Therefore, a significant demand is for good traction performance in basketball shoes, particularly in the heel region on different court surfaces, to prevent slipping. This study examined the traction performance of fifteen common basketball shoe designs that were considered and developed using thermoplastic polyurethane to assess the available coefficient of friction (ACOF) on popular floorings (hardwood, synthetic, and polyurethane) under dry and wet conditions using a robotic slip tester. Results indicate that the hardwood flooring provided better traction, followed by the synthetic flooring, while the polyurethane flooring showed reduced friction. The study also examined the traction with apparent contact areas. Shoes with herringbone and circular tread patterns demonstrated the highest traction on all flooring in dry conditions. This research is anticipated to help basketball shoemakers choose safer shoes for player safety and performance, providing a foundation for future research on shoe flooring interaction in basketball. Full article

Superhydrophobic coatings possess distinct wettability characteristics and hold significant potential in metal corrosion protection and underwater drag reduction. However, their practical application is often hindered by poor durability arising from the fragility of their micro/nanostructured surface roughness. In this study, a durable superhydrophobic coating featuring a hierarchical, hydrangea-like micro/nanostructure was successfully fabricated on an aluminum alloy substrate via a simple one-step cold-spraying technique. The coating consisted of hydrangea-shaped SiO₂ nanoparticles modified with 1H,1H,2H,2H-perfluorodecyltrimethoxysilane (PFDT) to produce multiscale roughness, while epoxy resin (EP) served as the binding matrix to enhance mechanical integrity. The hydrangea-like SiO₂ nanostructures were characterized by solid cores and wrinkled, petal-like outgrowths. This unique morphology not only increased the surface roughness but also provided more active sites for air entrapment, thereby enhancing the coating’s overall performance. The h-SiO₂@PFDT-EP composite coating exhibited excellent superhydrophobicity, with a WCA of 170.1° ± 0.8° and a SA of 2.7° ± 0.5°. Durability was evaluated through sandpaper abrasion, tape peeling, acid and alkali immersion, artificial weathering, and salt spray tests. The results demonstrated that the coating retained stable superhydrophobic performance under various environmental stresses. Compared with bare 6061 aluminum and EP coatings, its corrosion current density was reduced by four and three orders of magnitude, respectively. Furthermore, the coating achieved a maximum drag-reduction rate of 31.01% within a velocity range of 1.31–7.86 m/s. The coating also displayed excellent self-cleaning properties. Owing to its outstanding durability, corrosion resistance, and drag-reducing capability, this one-step fabricated superhydrophobic coating showed great promise for applications in marine engineering and defense. Full article

Background and Objectives: During pandemics, emergency departments face the challenge of managing critically ill patients with limited resources. Point-of-Care Ultrasound (POCUS) has emerged as a crucial diagnostic tool in such scenarios. This study aimed to develop a standardized POCUS protocol using expert consensus via a modified Delphi survey to guide physicians in managing these patients more effectively. Materials and Methods: A committee of emergency imaging experts and board-certified emergency physicians identified essential elements of POCUS in the treatment of patients under investigation (PUI) with shock, sepsis, or other life-threatening diseases. A modified Delphi survey was conducted among 39 emergency imaging experts who were members of the Korean Society of Emergency Medicine. The survey included three rounds of expert feedback and revisions, leading to the development of a POCUS protocol for critically ill patients during a pandemic. Results: The developed POCUS protocol emphasizes the use of POCUS-echocardiography and POCUS-lung ultrasound for the evaluation of cardiac and respiratory function, respectively. The protocol also provides guidance on when to consider additional tests or imaging based on POCUS findings. The Delphi survey results indicated general consensus on the inclusion of POCUS-echocardiography and POCUS-lung ultrasound within the protocol, although there were some disagreements regarding specific elements. Conclusions: Effective clinical practice aids emergency physicians in determining appropriate POCUS strategies for differential diagnosis between life-threatening diseases. Future studies should investigate the effectiveness and feasibility of the protocol in actual clinical scenarios, including its impact on patient outcomes, resource utilization, and workflow efficiency in emergency departments. Full article

Background/Objectives: We define severe postpartum hemorrhage (PPH) with macroscopic hematuria as clinical disseminated intravascular coagulation (DIC), a life-threatening condition. We also report a methodology using machine learning, a subtype of artificial intelligence, for developing the boundary criterion for predicting hematuria on the fibrinogen–fibrin/fibrinogen degradation product (FDP) plane. A positive FDP–fibrinogen/3–60 (mg/dL) value indicates hematuria; otherwise, non-hematuria is observed. We aimed to validate this criterion using severe placental abruption (PA), and to examine the activation of the coagulation–fibrinolytic system in clinical DIC. Methods: Of 17,285 deliveries across nine perinatal centers in Japan between 2020 and 2024, 13 had severe PA without hematuria, 18 had severe PPH without hematuria, and 3 had severe PPH with hematuria, i.e., clinical DIC. We calculated the values of the criterion formula for 13 cases of severe PA to validate the boundary criterion and compared the laboratory tests for coagulation–fibrinolytic activation among the three groups. Results: The calculated values using the criterion for the 13 PA without hematuria ranged from −108.91 to −5.87 and all were negative. In cases of clinical DIC, fibrinogen levels (median, 62 mg/dL) were lower (p < 0.05), while levels of FDP (96 mg/dL), the thrombin–antithrombin complex (120 ng/mL), and the plasmin-α₂–plasmin inhibitor complex (28.4 μg/mL) were significantly higher than in the other two groups. Conclusions: This study demonstrated the validity of the boundary criterion for predicting hematuria using severe PA. The coagulation–fibrinolytic test results suggested that PPH cases with hematuria were assumed to have clinical DIC, indicating that this criterion may be considered for diagnosing DIC during delivery. However, further additional patient data are needed to confirm the usefulness of this criterion because of the very low number of hematuria cases. Full article

Background/Objectives: Colorectal cancer is a leading cause of cancer-related death worldwide, with rising incidence in younger adults. Unhealthy diets high in red and processed meat and low in fiber are key modifiable risk factors, highlighting the need for preventive nutritional strategies targeting CRC through dietary interventions. Methods: A one-day sample diet for colorectal cancer prevention, consisting of fiber-rich meals excluding red meat and incorporating whole grains, legumes, vegetables, fruits, nuts, and lean protein alternatives (such as fish and poultry), was developed. Its acceptability was assessed in a cross-sectional study using an online questionnaire among healthy Romanian adults aged 18–50, with a total of 395 included participants. Results: Of the 395 respondents meeting the inclusion criteria (aged 18–50, no cancer or chronic gastrointestinal disorders), 63.5% were females, predominantly urban (90.1%), and highly educated. Mean age was 32.4 years; mean BMI was 25.07 kg/m². The proposed colorectal cancer-preventive diet was rated as “quite attractive” and “very attractive” by 74.9% of participants. All meals received high ratings, with dinner and the first snack being most favored. Most respondents (77.2%) found the diet satisfying and the satiety level and energy adequate, and 90.4% were willing to adopt it at least a few times per week. Financial accessibility was affirmed by 77.2% of the respondents. However, 61.8% reported difficulty eliminating red meat consumption. Female participants rated the diet significantly more attractive than males did (p = 0.041). Willingness to adopt the diet strongly correlated with higher acceptability (p < 0.0001), while BMI and education level showed no significant effect. Conclusions: The proposed colorectal cancer-preventive diet was well accepted by Romanian adults aged 18–50, with higher receptivity among women and those with higher education; willingness to adopt the diet at least a few days per week was high, especially among those psychologically ready for dietary change, while key barriers included red meat reduction and perceived cost, underscoring the need for gender-sensitive, culturally adapted interventions and further research on long-term adherence and clinical impact. Full article

Identifying and eliminating critical links in multi-hop networks is essential for enhancing overall network resilience. In this study, we propose a novel algorithm to detect links that significantly impact the pairwise connectivity of multi-hop networks. We formulate the critical link detection problem as minimizing pairwise connectivity subject to a total edge weight constraint c. The proposed method first computes the maximum flow between neighboring nodes to evaluate strong connections, and then progressively contracts these nodes to expose weaker connections. Throughout this iterative process, the algorithm records previously identified flows to minimize redundant flow computations. At each step, it also keeps track of the cut sets that reduce the network’s pairwise connectivity. Ultimately, it selects the subset of these cut sets whose removal minimizes pairwise connectivity while satisfying the total weight constraint c. This approach consistently identifies fewer yet more impactful critical edges than traditional Min-Cut or Greedy strategies. We evaluate the performance of our method against existing algorithms across various network sizes and node degrees. Experimental results show that the proposed method consistently discovers more influential edges and achieves a 34–38% reduction in pairwise connectivity, outperforming Greedy (22–24%), Min-Cut (24–32%), and Degree-based (12–19%) methods. Full article

Monitoring Peripheral Oxygen Saturation (SpO₂) is an important vital sign both in Intensive Care Units (ICUs), during surgery and convalescence, and as part of remote medical consultations after of the COVID-19 pandemic. This has made the development of new SpO₂-measurement tools an area of active research and opportunity. In this paper, we present a new Deep Learning (DL) combined strategy to estimate SpO₂ without contact, using pre-magnified facial videos to reveal subtle color changes related to blood flow and with no calibration per subject required. We applied the Eulerian Video Magnification technique using the Hermite Transform (EVM-HT) as a feature detector to feed a Three-Dimensional Convolutional Neural Network (3D-CNN). Additionally, parameters and hyperparameter Bayesian optimization and an ensemble technique over the dataset magnified were applied. We tested the method on 18 healthy subjects, where facial videos of the subjects, including the automatic detection of the reference from a contact pulse oximeter device, were acquired. As performance metrics for the SpO₂-estimation proposal, we calculated the Mean Absolute Error (MAE), Root Mean Squared Error (RMSE), and other parameters from the Bland–Altman (BA) analysis with respect to the reference. Therefore, a significant improvement was observed by adding the ensemble technique with respect to the only optimization, obtaining 14.32% in RMSE (reduction from 0.6204 to 0.5315) and 13.23% in MAE (reduction from 0.4323 to 0.3751). On the other hand, regarding Bland–Altman analysis, the upper and lower limits of agreement for the Mean of Differences (MOD) between the estimation and the ground truth were 1.04 and −1.05, with an MOD (bias) of −0.00175; therefore, MOD $\pm 1.96\sigma$ = −0.00175 ± 1.04. Thus, by leveraging Bayesian optimization for hyperparameter tuning and integrating a Bagging Ensemble, we achieved a significant reduction in the training error (bias), achieving a better generalization over the test set, and reducing the variance in comparison with the baseline model for SpO₂ estimation. Full article

Background/Objectives: Hospitalized peripartum patients who later decompensate and require an upgrade to the intensive care unit (ICU) may have an increased risk for poor outcomes. Most of the literature regarding the need for ICU involves Modified Early Warning Scores in already hospitalized patients or the evaluation of specific comorbid conditions or diagnoses. This systematic review and meta-analysis aimed to assess the differences in clinical scores at admission among adult peripartum patients to identify the later need for ICU. Methods: We systematically searched Ovid-Medline, PubMed, EMBASE, Web of Science and Google Scholar for randomized and observational studies of adult patients ≥18 years of age who were ≥20 weeks pregnant or up to 40 days post-partum, were admitted to the wards from the emergency department and later required critical care services. The primary outcome was the Sequential Organ Failure Assessment (SOFA) score. Secondary outcomes included other clinical scores, the hospital length of stay (HLOS) and mortality. The Newcastle–Ottawa Scale was utilized to grade quality. Descriptive analyses were performed to report demographic data, with means (±standard deviation [SD]) for continuous data and percentages for categorical data. Random-effects meta-analyses were performed for all outcomes when at least two studies reported a common outcome. Results: Seven studies met the criteria, with a total of 1813 peripartum patients. The mean age was 27.2 (±2.36). Patients with ICU upgrades were associated with larger differences in mean SOFA scores. The pooled difference in means was 2.76 (95% CI 1.07–4.46, p < 0.001). There were statistically significant increases in Sepsis in Obstetrics Scores, APACHE II scores, and HLOS in ICU upgrade patients. There was a non-significantly increased risk of mortality in ICU upgrade patients. There was high overall heterogeneity between patient characteristics and management in our included studies. Conclusions: This systematic review and meta-analysis demonstrated higher SOFA or other physiologic scores in ICU upgrade patients compared to those who remained on the wards. ICU upgrade patients were also associated with a longer HLOS and higher mortality compared with control patients. Full article

A combination of high potential productivity and ecological stability is essential for current cultivars, which is achievable by breeding. Interspecific/intergeneric hybridization remains a key approach to producing new high-yielding and resistant cultivars. Interspecific reproductive barriers (IRBs) appear in the interaction between the pollen and pistil of interspecific/intergeneric hybrids. The mechanisms underlying these hybridization barriers are to a considerable degree unknown. The pollen–pistil interaction is decisive because the pollen of distantly related plant species either is not recognized by stigma cells or is recognized as foreign, preventing pollen tube (PT) germination and/or penetration into the stigma/style/ovary. This review mainly focuses on (1) the pollen–pistil system; (2) IRB classification; (3) similarity and differences in the function of self-incompatibility (SI) barriers and IRBs; and (4) physiological and biochemical control of IRBs and their overcoming. The main goal is to illuminate the physiological, biochemical, and molecular mechanisms underlying the growth arrest of incompatible PTs and their death. In general, this review consolidates the current understanding of the interaction of the male gametophyte with the sporophyte tissues of the pistil and outlines future research directions in the area of plant reproductive biology. Full article

Background: Mucosal immunity plays a pivotal role in preventing infections with SARS-CoV-2. While COVID-19 mRNA vaccines induce robust systemic immune responses in patients with inflammatory bowel disease (IBD), little is known about their efficacy in the mucosal immune compartment. In this sub-investigation of the ongoing STAR-SIGN study, we present the first analysis of mucosal immunity elicited by XBB.1.5 mRNA vaccines in immunocompromised patients with IBD. Methods: IgG and IgA antibodies targeting the receptor-binding domain of the SARS-CoV-2 JN.1 variant were quantified longitudinally in the saliva of IBD patients using the multiplex immunoassay MultiCoV-Ab. Antibody levels were quantified before and 2–4 weeks after vaccination with XBB.1.5 mRNA vaccines. All patients previously received three doses with original COVID-19 vaccines. Results: Mucosal IgG antibodies were readily induced by XBB.1.5 mRNA vaccines (p = 0.0013 comparing pre- and post-vaccination levels). However, mucosal IgA levels were comparable before and after vaccination (p = 0.8233). Consequently, mucosal IgG and IgA antibody levels correlated only moderately before and after immunization (pre-vaccination: r = 0.5294; p = 0.0239; post-vaccination: r = 0.4863; p = 0.0407). Contrary to a previous report in healthy individuals, vaccination did not induce serum IgA in patients with IBD (p = 0.5841 comparing pre- and post-vaccination levels). These data suggest that COVID-19 mRNA vaccines fail to elicit mucosal IgA in patients with IBD. Conclusions: Since mucosal IgA plays a pivotal role in infection control, the lack of IgA induction indicates that patients lack sufficient protection against SARS-CoV-2 infections which warrants the development of mucosal COVID-19 vaccines. Full article

Kiwifruit is a high-value subtropical crop with significant nutritional and economic importance, but its cultivation faces growing challenges due to climate change, particularly in Caucasus. This study aims to study the impact of abiotic stressors such as temperature extremes, drought, and frost on the yield of the ‘Hayward’ cultivar over a 20-year period (from 2003 to 2022). Using a combination of agroclimatic data analysis, measurements of soluble solid content, and soil moisture assessments, this research identified key factors which limit kiwifruit cultivation productivity. The results revealed a high yield variability—68%, with the mean value declining by 16.6% every five years due to increasing aridity and heat stress. Extreme temperature rises of up to 30 °C caused yield losses of 79–89%, and the presence of frost led to declines of 71–94%. In addition, it is objectively proven that the vulnerability of kiwifruit is subject to climate-driven water imbalances. This highlights the need for adaptive strategy formation in the area of optimized irrigation for the sustainable cultivation of fruit in the subtropics. One of the study’s limitations was that it was organized around a single variety of kiwifruit (‘Hayward’). In view of the fact that there are significant differences in growth characteristics among kiwifruit varieties, future research should focus on overcoming this shortcoming. Full article

This study investigates how demographic characteristics, severity of intimate partner violence (IPV), social support, gender equality awareness, and demographic factors (e.g., living with children at home) influence help-seeking behaviors among 2527 IPV-experienced women in Beijing, Shanghai, Guangzhou, and Shenzhen. Drawing on the help-seeking model and conservation of resource theory, the study distinguishes between formal (e.g., police, legal aid) and informal (e.g., family, friends) help-seeking. Logistic regression results reveal that greater violence severity, stronger perceived social support, and higher gender equality awareness significantly increase both formal and informal help-seeking. Notably, living with children is associated with a higher likelihood of seeking formal help, possibly due to increased concerns for children’s safety and the desire to change the abusive environment. While help-seeking behavior is on the rise overall, particularly among women with strong support networks and progressive gender attitudes, structural and cultural barriers remain. The findings underscore the need to improve public education, reduce stigma, and enhance accessibility of support systems. This study contributes to the growing literature on IPV in China and provides evidence for refining policy interventions and service delivery. Full article

Background and Objectives: Alcoholic hepatitis (AH) is a growing public health concern with its rising incidence and its contribution to nearly half of all cirrhosis-related deaths in the United States. In this systematic review, we aimed to comprehensively evaluate the current evidence and trials on the use of anti-interleukin-1 (anti-IL-1) drugs in patients with AH, assessing their efficacy and adverse events compared to routinely prescribed drugs like corticosteroids. Materials and Methods: A comprehensive literature search was conducted across five databases to identify randomized controlled trials (RCTs) evaluating the role of anti-IL-1 agents like canakinumab and anakinra among patients diagnosed with AH. Data was extracted and pooled in the form of mean and standard deviation for continuous variables and event and total for dichotomous variables. Results: Three RCTs were included for quantitative synthesis, encompassing 307 patients. Using canakinumab, 58% of patients showed improvement in histology. Prednisolone was associated with higher 90-day survival (90% vs. 70%; hazard ratio for death = 0.34, 95% CI 0.14–0.83, p = 0.018) and transplant-free survival. Overall, a higher incidence of acute kidney injury and new-onset cardiac disorders was noted in the anti-IL-1 arm when compared to placebo. Conclusions: This study concludes the lack of efficacy of anti-IL-1 agents in causing improvement in patient outcomes when compared to standard therapies. A higher incidence of adverse events was also noted in the anti-IL-1 arm. These results emphasize the need for future clinical trials to evaluate the use of anti-IL-1 agents in AH objectively. Full article

Drought conditions impact plants at the morphological, physiological, and molecular levels. Plant tolerance to drought conditions is frequently associated with maintaining proteome stability, highlighting the significance of proteomic analysis in understanding the mechanisms underlying plant resilience. Here, we performed proteomic and peptidomic analysis of spring wheat (Triticum aestivum L.) under drought stress conditions. Using isobaric tags for relative and absolute quantitation (iTRAQ), we identified 497 and 157 differentially abundant protein (DAP) groups in leaves and roots, respectively. The upregulated DAP groups in leaves were primarily involved in stress responses, such as oxidative stress and heat response, whereas those in roots were associated with responses to water deprivation and sulfur compound metabolic processes. The analysis of the extracellular root peptidome revealed 2294 native peptides, including members of small secreted peptide (SSP) families. In the peptidomes of stress-induced plants, we identified 16 SSPs as well as peptides derived from proteins involved in cell wall catabolism, intercellular signaling, and stress response. These peptides represent potential candidates as regulators of drought responses. Our results help us to understand adaptation mechanisms and develop new agricultural technologies to increase productivity. Full article