Search Results (21,959)

Background: Aortic stenosis (AS) is the most common valvular heart disease, associated with poor outcomes if left untreated. Current guidelines recommend that transcatheter aortic valve implantation (TAVI) procedures be performed in hospitals with an on-site cardiac surgery unit due to potential complications requiring surgical intervention. Objective: Based on our experience, we evaluated the feasibility and outcomes of implementing a TAVI program in a cardiology department without an on-site cardiac surgery unit, in collaboration with a remote hospital for surgical backup. Methods: The TAVI program involved pre- and post-procedural evaluations conducted at Meir Medical Center (Kfar Saba, Israel) with a remote surgical team available. The study population included 149 consecutive patients with severe aortic stenosis treated at the Meir valve clinic between November 2019 and December 2023. Procedures were performed by the center’s interventional cardiology team. Results: The mean age of the 149 patients was 80 ± 6 years, and 75 (50%) were female. The average STS score was 4.3, and the EuroSCORE II was 3.1. Among the patients, 68 (45%) were classified as New York Heart Association (NYHA) class III-IV. The valve types used included ACURATE neo2 (57 patients, 38%), Edwards SAPIEN 3 (43 patients, 28%), Evolut-PRO (41 patients, 27%), and Navitor (7 patients, 4%). There were no cases of moderate to severe paravalvular leak and no elevated post-implantation gradients, and there was no need for urgent cardiac surgery. One case of valve embolization was successfully managed percutaneously during the procedure. In-hospital follow-up revealed no deaths and only one major vascular complication. At one-year follow-up, six patients had died, with only one death attributed to cardiac causes. Conclusions: Our findings support the safe and effective performance of transfemoral TAVI in cardiology departments without on-site cardiac surgery, in collaboration with a remote surgical team. Further prospective, multicenter studies are warranted to confirm these results and guide broader clinical implementation of this practice. Full article

Background/Objectives: Constitutive activation of the PI3K/AKT/mTOR signaling cascade underlies the aggressive phenotype of fibroblast-like synoviocytes (FLSs) in rheumatoid arthritis (RA); however, a quantitative synthesis of in vitro data on pathway inhibition remains lacking. This systematic review and meta-analysis aimed to (i) aggregate standardized effects of pathway inhibitors on proliferation, apoptosis, migration/invasion, IL-6/IL-8 secretion, p-AKT, and LC3; (ii) assess heterogeneity and identify key moderators of variability, including stimulus type, cell source, and inhibitor class. Methods: PubMed, Europe PMC, and the Cochrane Library were searched up to 18 May 2025 (PROSPERO CRD420251058185). Twenty of 2684 screened records met eligibility. Two reviewers independently extracted data and assessed study quality with SciRAP. Standardized mean differences (Hedges g) were pooled using a Sidik–Jonkman random-effects model with Hartung–Knapp confidence intervals. Heterogeneity (τ², I²), 95% prediction intervals, and meta-regression by cell type were calculated; robustness was tested with REML-HK, leave-one-out, and Baujat diagnostics. Results: PI3K/AKT/mTOR inhibition markedly reduced proliferation (to –5.1 SD), IL-6 (–11.1 SD), and IL-8 (–6.5 SD) while increasing apoptosis (+2.7 SD). Fourteen of seventeen outcome clusters showed large effects (|g| ≥ 0.8), with low–moderate heterogeneity (I² ≤ 35% in 11 clusters). Prediction intervals crossed zero only in small k-groups; sensitivity analyses shifted pooled estimates by ≤0.05 SD. p-AKT and p-mTOR consistently reflected functional changes and emerged as reliable pharmacodynamic markers. Conclusions: Targeted blockade of PI3K/AKT/mTOR robustly suppresses the proliferative and inflammatory phenotype of RA-FLSs, reaffirming this axis as a therapeutic target. The stability of estimates across multiple analytic scenarios enhances confidence in these findings and highlights p-AKT and p-mTOR as translational response markers. The present synthesis provides a quantitative basis for personalized dual-PI3K/mTOR strategies and supports the adoption of standardized long-term preclinical protocols. Full article

Background/Objectives: Malnutrition is an imbalance of nutrients required for growth, development, and organ function. Its impact on bone development is known, but its effects on cartilage remain unclear. This study aimed to evaluate the femoral cartilage thickness in children with primary malnutrition. Methods: In this cross-sectional observational study, 83 children with primary malnutrition and 62 age- and sex-matched healthy controls were included. Patients with primary malnutrition were classified as mild, moderate and severe. Femoral cartilage thickness measurements of all children were taken by ultrasound from the femoral lateral condyle, femoral medial condyle and intercondylar area for both knees with the patient in a supine position with the knees flexed 90 degrees. Results: The right lateral, right medial, left lateral, and left medial femoral cartilages were significantly thicker in patients with malnutrition compared to those without malnutrition (p = 0.002, 0.004, <0.001, and 0.001, respectively). A significant negative correlation was found between age, weight Z-score, and height Z-score and triceps skinfold thickness. Conclusions: Distal femoral cartilage thickness is significantly greater in children with primary malnutrition. This demonstrates the effect of nutritional factors on cartilage tissue and suggests that children with chronic malnutrition are at risk for both knee joint problems and short stature later in life. Full article

Integrating artificial intelligence (AI) and cause-related marketing has reshaped corporate social responsibility practices while triggering a conflict between technological instrumental rationality and moral value transmission. Building on the Persuasion Knowledge Model (PKM) and AI aversion literature, this research employs two experiments to reveal that AI disclosure exerts a unique inhibitory effect on consumers’ purchase intentions in cause-related marketing contexts compared to non-cause-related marketing scenarios. Further analysis uncovers a chain mediation pathway through consumer skepticism and advertisement attitudes, explaining the psychological mechanism underlying AI disclosure’s impact on purchase intentions. The study also identifies the moderating role of AI aversion within this chain model. The findings provide a new theoretical perspective for integrating AI disclosure, consumer psychological responses, and marketing effectiveness while exposing the “value-instrumentality” conflict inherent in AI applications for cause-related marketing. This research advances the evolution of the PKM in the digital era and offers practical insights for cause-related marketing enterprises to balance AI technology application with optimized disclosure strategies. Full article

Water scarcity and spatial variability in soil fertility are key constraints to stable grain production in the Huang-Huai-Hai Plain. However, the interaction mechanisms between regulated deficit irrigation and soil fertility influencing yield formation and water-nitrogen use efficiency in winter wheat remain unclear. In this study, a two-year field experiment (2022–2024) was conducted to investigate the effects of two irrigation regimes—regulated deficit irrigation during the heading to grain filling stage (D) and full irrigation (W)—under four soil fertility levels: F1 (N: P: K = 201.84: 97.65: 199.05 kg ha⁻¹), F2 (278.52: 135: 275.4 kg ha⁻¹), F3 (348.15: 168.75: 344.25 kg ha⁻¹), and CK (no fertilization). The results show that aboveground dry matter accumulation, total nitrogen content, pre-anthesis dry matter and nitrogen translocation, and post-anthesis accumulation significantly increased with fertility level (p < 0.05). Regulated deficit irrigation promoted the contribution of post-anthesis dry matter to grain yield under the CK and F1 treatments, but suppressed it under the F2 and F3 treatments. However, it consistently enhanced the contribution of post-anthesis nitrogen to grain yield (p < 0.05) across all fertility levels. Higher fertility levels prolonged the grain filling duration by 18.04% but reduced the mean grain filling rate by 15.05%, whereas regulated deficit irrigation shortened the grain filling duration by 3.28% and increased the mean grain filling rate by 12.83% (p < 0.05). Grain yield significantly increased with improved fertility level (p < 0.05), reaching a maximum of 9361.98 kg·ha⁻¹ under the F3 treatment. Regulated deficit irrigation increased yield under the CK and F1 treatments but reduced it under the F2 and F3 treatments. Additionally, water use efficiency exhibited a parabolic response to fertility level and was significantly enhanced by regulated deficit irrigation. Nitrogen partial factor productivity (NPFP) declined with increasing fertility level (p < 0.05); Regulated deficit irrigation improved NPFP under the F1 treatment but reduced it under the F2 and F3 treatments. The highest NPFP (41.63 kg·kg⁻¹) was achieved under the DF1 treatment, which was 54.81% higher than that under the F3 treatment. TOPSIS analysis showed that regulated deficit irrigation combined with the F1 fertility level provided the optimal balance among yield, WUE, and NPFP. Therefore, implementing regulated deficit irrigation during the heading–grain filling stage under moderate fertility (F1) is recommended as the most effective strategy for achieving high yield and efficient resource utilization in winter wheat production in this region. Full article

To address the inefficiency of traditional concrete crack detection methods and the heavy reliance of supervised learning on extensive labeled data, in this study, an intelligent assessment method of concrete damage based on pseudo-label semi-supervised learning and fractal geometry theory is proposed to solve two core tasks: one is binary classification of pixel-level cracks, and the other is multi-category assessment of damage state based on crack morphology. Using three-channel RGB images as input, a dual-path collaborative training framework based on U-Net encoder–decoder architecture is constructed, and a binary segmentation mask of the same size is output to achieve the accurate segmentation of cracks at the pixel level. By constructing a dual-path collaborative training framework and employing a dynamic pseudo-label refinement mechanism, the model achieves an F1-score of 0.883 using only 50% labeled data—a mere 1.3% decrease compared to the fully supervised benchmark DeepCrack (F1 = 0.896)—while reducing manual annotation costs by over 60%. Furthermore, a quantitative correlation model between crack fractal characteristics and structural damage severity is established by combining a U-Net segmentation network with the differential box-counting algorithm. The experimental results demonstrate that under a cyclic loading of 147.6–221.4 kN, the fractal dimension monotonically increases from 1.073 (moderate damage) to 1.189 (failure), with 100% accuracy in damage state identification, closely aligning with the degradation trend of macroscopic mechanical properties. In complex crack scenarios, the model attains a recall rate (Re = 0.882), surpassing U-Net by 13.9%, with significantly enhanced edge reconstruction precision. Compared with the mainstream models, this method effectively alleviates the problem of data annotation dependence through a semi-supervised strategy while maintaining high accuracy. It provides an efficient structural health monitoring solution for engineering practice, which is of great value to promote the application of intelligent detection technology in infrastructure operation and maintenance. Full article

Microplastics are pervasive environmental pollutants that pose risks to human health through ingestion and inhalation. This review synthesizes current practices to reduce exposure and toxicity by examining major exposure routes and dietary interventions. More than 130 papers were analyzed to achieve this aim. The findings show that microplastics contaminate a wide range of food products, with particular concern over seafood, drinking water, plastic-packaged foods, paper cups, and tea filter bags. Inhalation exposure is mainly linked to indoor air quality and smoking, while dermal contact poses minimal risk, though the release of additives from plastics onto the skin remains an area of concern. Recommended strategies to reduce dietary exposure include consuming only muscle parts of seafood, moderating intake of high-risk items like anchovies and mollusks, limiting canned seafood liquids, and purging mussels in clean water before consumption. Avoiding plastic containers, especially for hot food or microwaving, using wooden cutting boards, paper tea bags, and opting for tap or filtered water over bottled water are also advised. To mitigate inhalation exposure, the use of air filters with HyperHEPA systems, improved ventilation, regular vacuuming, and the reduction of smoking are recommended. While antioxidant supplementation shows potential in reducing microplastic toxicity, further research is needed to confirm its effectiveness. This review provides practical, evidence-based recommendations for minimizing daily microplastic exposure. Full article

Background: Computed tomography urography (CTU) is routinely used to evaluate the upper urinary tract in patients with hematuria. CTU may detect incidental findings outside the urinary tract, but it remains unclear if this adds value. This study aimed to develop a deep learning algorithm that automatically segments and selectively visualizes the urinary tract on CTU. Methods: The urinary tract (kidneys, ureters, and urinary bladder) was manually segmented on 2 mm dual-phase CTU slices of 111 subjects. With this dataset, a deep learning-based AI was trained to automatically segment and selectively visualize the urinary tract on CTU scans (including accompanying unenhanced CT scans), which we dub “focused view CTU”. Focused view CTU was technically optimized and tested in 39 subjects with hematuria. Results: The technically optimized focused view CTU algorithm provided complete visualization of 97.4% of kidneys, 80.8% of ureters, and 94.9% of urinary bladders. All urinary tract organs were completely visualized in 66.6% of cases. In these cases (excluding 33.3% of cases with incomplete visualization), focused view CTU intrinsically achieved a sensitivity, specificity, positive predictive value, and negative predictive value of 100.0%, 92.3%, 92.9%, and 100.0% for lesions in the urinary tract compared to unmodified CT, although interrater agreement was moderate (κ = 0.528). All incidental findings were successfully hidden by focused view CTU. Conclusions: Focused view CTU provides adequate urinary tract segmentation in most cases, but further research is needed to optimize the technique (segmentation does not succeed in about one-third of cases). It offers selective urinary tract visualization, potentially aiding in assessing relevance and cost-effectiveness of detecting incidental findings in hematuria patients through a prospective randomized trial. Full article

China’s economy is shifting from an era of rapid expansion to one focused on high-quality development, making it imperative to tackle environmental degradation linked to energy use. Understanding how New Quality Productive Forces (NQPF) interact with energy efficiency, along with the mechanisms driving this relationship, is essential for economic transformation and long-term sustainability. This study establishes an evaluation framework for NQPF, integrating technological, green, and digital dimensions. We apply fixed-effects models, the spatial Durbin model (SDM), a moderation model, and a threshold model to analyze the influence of NQPF on Green Total Factor Energy Efficiency (GTFEE) and its spatial implications. This underscores the necessity of distinguishing it from traditional productivity frameworks and adopting a new analytical perspective. Furthermore, by considering dimensions such as input, application, innovation capability, and market efficiency, we reveal the moderating role and heterogeneous effects of artificial intelligence (AI). The findings are as follows: The development of NQPF significantly enhances GTFEE, and the conclusion remains robust after tail reduction and endogeneity tests. NQPF has a positive spatial spillover effect on GTFEE; that is, while improving the local GTFEE, it also improves neighboring regions GTFEE. The advancement of AI significantly strengthens the positive impact of NQPF on GTFEE. AI exhibits a significant U-shaped threshold effect: as AI levels increase, its moderating effect transitions from suppression to facilitation, with marginal benefits gradually increasing over time. Full article

The TP53 gene, frequently mutated across multiple cancer types, plays a pivotal role in regulating the cell cycle and apoptosis through its protein, p53. Missense variants of uncertain significance (VUSs) in TP53 present challenges in understanding their impact on protein function and complicate clinical interpretation. This study aims to analyze the effects of missense VUSs in p53, as reported in the gnomAD database, with a specific focus on their impact on protein stability and phosphorylation. In this study, 33 missense VUSs in TP53 reported in the gnomAD database were analyzed using in silico tools, including PhosphositePlus v6.7.4, the Kinase Library v0.0.11, and Dynamut2. Of these analyzed variants, five disrupted known phosphorylation sites, while another five created new consensus sequences for phosphorylation. Moreover, 20 variants exhibited a moderate destabilizing effect on the protein structure. At least three missense VUSs were identified as potentially affecting p53 function, which may contribute to cancer development. These findings highlight the importance of integrating in silico structural and functional analysis to assess the pathogenic potential of missense VUSs. Full article

Background and Objectives: Depression is a leading cause of disability globally, with treatment challenges including limited access, stigma, and poor adherence. Gamification, which applies game elements such as points, levels, and storytelling into non-game contexts, offers a promising strategy to enhance engagement and augment traditional treatments. Our research is the first study designed to explore the implementation of gamification within the Malaysian context. The objective was to explore the feasibility of implementation of gamification as an adjunctive treatment for adults with depression. Materials and Methods: Focus group discussions were held with five mental health professionals and ten patients diagnosed with moderate depression. The qualitative component assessed perceptions of gamified interventions, while quantitative measures evaluated participants’ depressive and anxiety symptomatology. Results: Three key themes were identified: (1) understanding of gamification as a treatment option, (2) factors influencing its acceptance, and (3) characteristics of a practical and feasible intervention. Clinicians saw potential in gamification to boost motivation, support psychoeducation, and encourage self-paced learning, but they expressed concerns about possible addiction, stigma, and the complexity of gameplay for some patients. Patients spoke of gaming as a source of comfort, escapism, and social connection. Acceptance was shaped by engaging storylines, intuitive design, balanced difficulty, therapist guidance, and clear safety measures. Both groups agreed that gamification should be used in conjunction with standard treatments, be culturally sensitive, and be presented as a meaningful therapeutic approach rather than merely as entertainment. Conclusions: Gamification emerges as an acceptable and feasible supplementary approach for managing depression in Malaysia. Its success depends on culturally sensitive design, robust clinical oversight, and seamless integration with existing care pathways. Future studies should investigate long-term outcomes and establish guidelines for the safe and effective implementation of this approach. We recommend targeted investment into culturally adapted gamified tools, including training, policy development, and collaboration with key stakeholders to realistically implement gamification as a mental health intervention in Malaysia. Full article

Background/Objectives: An influenza pandemic is likely to occur in the coming decades and will be associated with substantial healthcare and financial burdens. In this study, we evaluated the potential economic costs of different vaccination scenarios for the US population in the context of a moderate or severe influenza pandemic. Methods: Economic analysis was performed for initiation of pandemic vaccination from 3 months vs. 6 months in the US after declaration of a pandemic. We evaluated three vaccine effectiveness levels (high, moderate, low) and two pandemic severity levels (moderate and severe). Results: No vaccination would lead to total direct and indirect costs of $116 bn in a moderate pandemic and $823 bn in a severe pandemic. Initiation of vaccination at 3 months would result in cost savings versus no vaccination (excluding vaccine price) of $30–84 bn and $260–709 bn in a moderate and severe pandemic, respectively, whereas initiation of vaccination at 6 months would result in cost savings of $4–11 bn and $36–97 bn, respectively. Cost savings of $20 bn and $162 bn would occur in a moderate or severe pandemic, respectively, from use of a low effectiveness vaccine from 3 months instead of a high effectiveness vaccine from 6 months. Conclusions: Rapid initiation of vaccination would have a greater impact than increased vaccine effectiveness in reducing the economic impacts of an influenza pandemic. Full article

Background/Objectives: Early gut colonization by bifidobacteria, occurring more favorably in vaginally born infants than in those delivered via C-section, is crucial for maintaining overall health. The study investigated the health-promoting properties of Limosilactobacillus vaginalis BC17 both as viable cells and as postbiotics (i.e., cell-free supernatant and heat-killed cells), with the purpose of developing oral formulations to support intestinal health. Methods: The safety, effects on the adhesion of bifidobacteria and enteropathogens to intestinal cells, and anti-inflammatory properties of L. vaginalis BC17 viable cells and postbiotics were evaluated. Fast-disintegrating tablets were formulated by freeze-drying cell-free supernatant in combination with heat-killed or viable cells alongside maltodextrins. Results: The formulations were shown to be non-genotoxic and compatible with intestinal cell lines (Caco-2 and HT-29). BC17 viable cells survived in co-culture with intestinal cells up to 48 h and exhibited moderate adhesion to the cell lines. Notably, both BC17 viable cells and postbiotics enhanced the adhesion of beneficial bifidobacteria to Caco-2 cells by up to 250%, while reducing enteropathogens adhesion by 40–70%. Moreover, they exerted significant anti-inflammatory effects, reducing nitric oxide production in macrophages by 40–50% and protecting intestinal cells from SDS-induced damage. The formulations allowed administration of at least 10⁹ BC17 cells in infants and adults through easy and rapid dispersion in milk or water, or directly in the oral cavity without chewing, and preserved their functional properties for up to 3 months of storage. Conclusions: L. vaginalis BC17 viable cells and postbiotics, as well as fast-disintegrating tablets, showed promising functional and safety profiles. Although further in vivo validation is needed, this approach represents a compelling strategy for promoting gut health. Full article

This study was conducted to examine the moderating effect of size on the impact of human capital on bank performance, using data from 26 commercial banks in Vietnam from 2008 to 2023 through panel data regression methods. The results indicate that bank size and human capital are important resources for commercial banks to increase their performance, which is consistent with the resource-based view and economies of scale theory. However, bank size fails to exhibit a significant moderating effect on the impact of human capital on the bank performance in Vietnam. This phenomenon can be explained by the relatively limited influence of size effects on human capital, coupled with the fact that the majority of Vietnamese commercial banks place significant strategic emphasis on human capital development within their operational frameworks. In addition, this study highlights the impact of some internal factors and the macroeconomic conditions on bank performance. From these empirical findings, this paper recommends several critical policies. Full article

Lotus corniculatus L. is a valuable fodder legume, recognized for its ecological adaptability and high potential for production and fodder quality. In this study, 18 genotypes collected from wild flora were analyzed to highlight genetic variability and facilitate the selection of genotypes with superior potential. The collection area was in the western part of Romania and featured a diverse topography, including parts of the Banat Plain, the Banat Hills, and the Southern and Western Carpathians. The genotypes selected from the wild flora were cultivated and evaluated for morpho-productive and forage quality traits, including pod weight, average number of seeds/pods, green mass production, and protein percentage. PCA highlighted the main components explaining the variability, and K-means clustering allowed for the identification of groups of genotypes with similar performances. ANOVA showed statistically significant differences (p < 0.001) for all traits analyzed. According to the results, genotypes LV-LC-3, LV-LC-4, LV-LC-6, and LV-LC-16 showed high productive potential and were highlighted as the most valuable for advancing in the breeding program. The moderate relationships between traits confirm the importance of integrated selection. The identified genetic variability and selected genotypes support the implementation of effective breeding strategies to obtain high-performance Lotus corniculatus L., adapted to local soil and climate conditions and with a superior forage yield. Full article