Search Results (1,663)

Background and Clinical Significance: Malignant priapism is a rare manifestation of advanced malignancy caused by malignant infiltration of the corpora cavernosa. We report a case of persistent and refractory priapism associated with penile carcinoma and extensive metastatic disease, with a suspected pulmonary primary. Case Presentation: An 81-year-old man with a history of prostate cancer treated by radical prostatectomy and persistently undetectable PSA levels developed persistent low-flow priapism. Despite aspiration and irrigation, followed by distal and proximal shunting procedures, the condition recurred with progressive corporal induration and severe pain. Cavernous biopsy was initially interpreted as moderately differentiated squamous carcinoma, while total penectomy performed for refractory pain showed poorly differentiated carcinoma with morphological adenosquamous features. CT and PET/CT demonstrated a pulmonary mass and widespread metastatic disease, although bronchoscopy was non-diagnostic and no histological confirmation of the pulmonary lesion was obtained. A focused review of the literature identified 32 published cases of malignant priapism; bladder cancer was the most frequently reported primary malignancy (37.5%), followed by prostate cancer (18.8%) and renal cell carcinoma (9.4%), while penectomy was performed in 34.4% of cases. Conclusions: Persistent or recurrent priapism associated with corporal induration, progressive or atypical pain, failure of conventional treatment, or discordant imaging findings should raise suspicion of malignant infiltration and prompt consideration of repeat imaging and tissue sampling. In the present case, carcinoma involving the penile structures was histologically confirmed, whereas pulmonary origin remained a clinicoradiological suspicion; penectomy provided immediate pain relief in the setting of extensive refractory local disease. Full article

Background and Objectives: Superior mesenteric artery syndrome (SMAS) is an uncommon cause of proximal duodenal obstruction that requires clinicoradiological correlation. Materials and Methods: We retrospectively reviewed 13 patients with SMAS identified at the Clinical County Emergency Hospital Bihor, Romania, during 2019–2024. Clinical records and contrast-enhanced computer tomography (CT) examinations were reviewed descriptively. Results: The cohort included 13 adults aged 19–85 years (mean 45.5 ± 17.8; median 43 years). Abdominal pain was reported in 12/13 patients (92.3%), vomiting or emetic symptoms in 6/13 (46.2%), feeding difficulty or appetite disturbance in 5/13 (38.5%), and documented weight loss in 3/13 (23.1%). CT measurements were available for the aortomesenteric angle in 7/13 patients (range, 10–25°) and for the aortomesenteric distance in 8/13 (range, 3–8 mm); direct third-part duodenal compression and proximal dilatation were interpreted together with compatible symptoms. Imaging showed Nutcracker-type left renal vein compression in 3/13 patients (23.1%) and possible May–Thurner anatomy in 1/13 (7.7%); these findings were not adjudicated as clinical syndromes without corresponding manifestations. Based on the management labels, 9/13 patients (69.2%) underwent surgery at some point and 4/13 (30.8%) received medical therapy only. Standardized follow-up and procedure-level outcome data were not available for all patients. Conclusions: This small, retrospective series is descriptive and cannot estimate prevalence, diagnostic delay, or comparative treatment effectiveness. It illustrates heterogeneous adult presentations and supports interpreting aortomesenteric measurements together with compatible symptoms and evidence of duodenal obstruction. Full article

Reliable spatiotemporal traffic data are fundamental to Intelligent Transportation Systems (ITS), where traffic planning and management depend on continuous observations from multiple sensors. However, sensor failures, equipment maintenance, and communication disturbances can cause data loss and degrade the reliability of traffic information used by ITS applications. To address this issue, the study develops an Adaptive Reweighted Triple Tensor Decomposition (ARTTD) framework for reliable spatiotemporal traffic data reconstruction. Traffic features are organized as a third-order tensor with day, time interval, and sensor location. Unlike conventional triple decomposition methods with predefined ranks, ARTTD calculates from an initial candidate rank and evaluates latent component contributions. The nonconvex log-sum regularization, proximal alternating minimization, and adaptive triple-rank pruning are integrated to suppress redundant latent components and identify an effective triple rank. In addition, a Spatial Correlation Rate (SCR) index is designed to characterize sensor information dependencies and construct different sensor configurations. Experiments using real-world License Plate Recognition (LPR) data from Chongqing, China, consider point-wise and line-wise data loss patterns with missing ratios ranging from 10% to 80%. The results reveal relationships among sensor configuration, effective triple rank, and reconstruction accuracy, demonstrating that the ARTTD framework can support reliable traffic data reconstruction under diverse conditions and provides methodological support for data-driven intelligent transportation applications. Full article

Carnivore protoparvovirus 1 variants (CPV-2a, CPV-2b, CPV-2c) have progressively expanded their host range to domestic cats (Felis catus), causing subclinical infection or panleukopenia-like disease. CPV-2c dominates among dogs in Western Mexico, but its presence in the local feline population had not been investigated. A cross-sectional survey was conducted (2018–2022) in 210 apparently healthy domestic cats from five municipalities of the Guadalajara Metropolitan Area, Jalisco, Mexico. Genomic DNA from EDTA-anticoagulated blood was screened by generic protoparvovirus PCR; positive samples were characterized by CPV-2-specific VP2 PCR and Sanger sequencing, with variant classification based on VP2 residue 426, and phylogenetic relationships assessed by maximum-likelihood analysis (T92+I model; 1000 bootstrap replicates). Carnivore protoparvovirus 1 DNA was detected in 14/210 cats (6.7%); 13/14 sequenced isolates were classified as CPV-2c (Glu426, >99% nucleotide identity), clustering with regional canine strains and showing greatest affinity with Uruguayan isolates. In a Firth bias-reduced multivariable model adjusting for age and vaccination status, shared litter box use remained independently associated with detection (adjusted OR 18.03; 95% CI 3.30–98.58); the age association was attenuated after adjustment, suggesting incomplete vaccination, rather than age itself, as the more proximal risk factor. Free-roaming/outdoor access and hunting behavior showed direct crude associations with detection (OR 3.82 and 7.22, respectively). These findings show that cats can harbor CPV-2c DNA in blood without clinical signs, phylogenetically linked to local canine strains, underscoring the need for integrated CPV-2 surveillance across companion species; however, whether infected cats can transmit the virus remains undetermined. Full article

This paper proposes a Priority–Urgency Index (PUI) mechanism to address the multi-objective conflict problem in electric vehicle charging scheduling at public fast-charging stations. The mechanism dynamically quantifies the charging urgency of each vehicle based on remaining dwell time, current state of charge (SoC), and target SoC, enabling differentiated service prioritization under resource scarcity. The PUI is systematically integrated into four multi-agent reinforcement learning (MARL) algorithms. To handle the time-varying number of vehicle entities caused by random arrivals and departures, the chargers are modeled as fixed agents; a partially observable Markov decision process (POMDP) is formulated, and a centralized training with decentralized execution (CTDE) architecture is adopted. On this basis, a state-aware dynamic threshold mechanism is introduced to distinguish urgency levels of charging tasks, and an adaptive reward function is designed to accommodate complex operating conditions. Empirical comparisons show that PUI-MAPPO (multi-agent proximal policy optimization) achieves the best performance among all PUI-enhanced variants. Under extreme supply–demand conditions—such as resource-scarce and heavy-traffic scenarios—PUI-MAPPO improves the target-SoC fulfillment rate and net revenue by up to 42.7% and 23.2%, respectively, and reduces the cumulative grid-limit exceedance by 22.8% to 47.3%, relative to the first-come, first-served (FCFS) baseline. Ablation studies further validate the individual effectiveness of the PUI urgency mechanism, the dynamic threshold framework, and the adaptive reward function. Full article

Background: Low back pain (LBP) remains the leading global cause of years lived with disability, and image-guided nerve blocks occupy a central position in its diagnostic and therapeutic pathway. Two paraspinal targets separated by only a few centimetres of tissue address entirely different neural territories: the medial branch of the lumbar dorsal ramus, addressed by the medial branch block (MBB), and the ventral rami of L1–L4 that form the lumbar plexus within psoas major, addressed by the psoas compartment block (PCB). Despite this anatomical proximity, the two techniques have matured within largely separate literatures—interventional pain medicine for the MBB and regional anaesthesia for the PCB—and have never been compared head-to-head in a randomised trial. Methods: This narrative review searched PubMed/MEDLINE, Embase, Scopus, the Cochrane Library, and Google Scholar to 1 August 2026 and synthesises evidence on the anatomical rationale, technical performance, effectiveness, and safety of both blocks as they apply to patients presenting with LBP. Results: The MBB is supported by extensive diagnostic-accuracy data and guideline endorsement for facet-mediated axial pain, but requires controlled blocks to constrain false-positive rates and confers only short-lived therapeutic benefit. The PCB reliably produces dense lumbar plexus analgesia and has a well-defined perioperative role, yet direct evidence in chronic LBP is confined to small series, and its complication profile—including epidural spread and retroperitoneal haematoma—is materially more demanding. Conclusions: We propose a phenotype-driven selection framework in which the MBB serves posterior-element axial pain while the PCB is reserved for plexus-mediated, hip–spine overlap, and perioperative indications, and we outline the comparative studies required to test it. Full article

Congenital heart defects (CHDs) are defects present at birth that can often lead to perinatal death, or, rarely, can be asymptomatic and detected later in life. Ectopia cordis is a rare type of malformation in which the heart is not located in its normal position. Other congenital abnormalities can be associated with this condition. In this article, we describe a case of ectopia cordis thoracalis with atrial septal defect in association with unilateral renal agenesis in a male Romanian Spotted calf. Clinical examination, dissection, and whole-genome sequencing were performed to describe and identify a possible cause of the abnormalities. Clinical examination revealed the presence of the heart in the thoracic region, subcutaneously, without apparent impairment of major physiological functions. Upon dissection, the external appearance of the heart was normal. However, the internal examination revealed an atrial septal defect measuring 1 cm in diameter in the proximal third of the interatrial septum. The case presented unilateral agenesis of the left kidney. VEP annotation of the joint callset identified 2270 missense variant annotations predicted as deleterious by SIFT and, separately, 12 high-impact start-loss variants by VEP consequence annotation. The OR51F5C and OR8J17 variants were homozygous in the calf. Analyzing genes involved in cardiac and renal development, the following genes—SHH, TBX18, NOTCH1, GATA3, TBX2, FOXC1, and RET had mutations with moderate impact. Mutations in the FOXC1 gene occurred in homozygous states for both the calf and mother genomes, while the RET gene had two mutations in a homozygous state just in the calf genome, and in a heterozygous state in the mother’s genome. One limitation of the present study is the unavailability of the paternal genome for comparative analysis; in addition, maternal genomic profiling did not reveal a contribution to the identified variants. Although the specific pathogenic relevance of the variants detected to the observed phenotype cannot be conclusively established, the findings expand the current genomic knowledge of this rare disorder and provide valuable data for future investigations into its genetic basis. Full article

Background: Reconstruction with megaprostheses is an important limb-salvage option in cases of bone tumors and metastases, as it allows extensive bone resection while preserving the limb. However, postoperative shoulder instability remains a frequent complication. Although implant instability is one of the leading causes of treatment failure, the factors contributing to it are still not clearly defined. This study analyzes the correlation between resection length, implant type, and involvement of the deltoid and rotator cuff in relation to postoperative instability and the risk of postoperative dislocation. Methods: Twenty-five patients treated at our institution between 2014 and 2025 who underwent proximal humerus replacement with a megaprosthesis were included. Patients were divided into two groups: those with postoperative dislocation (Group A) and those without (Group B). Functional outcomes were assessed using the MSTS and DASH scores. The mean follow-up was 20.38 ± 11.87 months. Results: Of the twenty-five patients included, six (24%) experienced instability and subsequent dislocation (Group A). Rotator cuff invasion was present in 100% of Group A and 36.8% of Group B (p < 0.001), while deltoid invasion was present in 83.3% of Group A and 21% of Group B (p = 0.001). The mean resection length was 14.4 ± 2.2 cm in Group A and 13.7 ± 3.7 cm in Group B (p = 0.636). No significant differences were found between the groups in DASH and MSTS scores. Conclusions: In this cohort, rotator cuff and deltoid involvement were significantly associated with postoperative shoulder instability following proximal humerus megaprosthetic reconstruction. These findings suggest that careful preoperative assessment of rotator cuff and deltoid involvement may help identify patients at higher risk of postoperative instability and optimize surgical planning. Future studies should focus on preoperative planning and the development of a risk score to identify patients at higher risk of instability, potentially allowing for additional procedures such as latissimus dorsi flap reconstruction. Full article

Generalized category discovery (GCD) aims to classify known categories while discovering novel ones in unlabeled data, yet existing methods lack mechanisms to correct boundary-ambiguous samples that receive noisy pseudo-labels, as they primarily rely on visual feature learning without external semantic guidance. Vision-language models (VLMs) offer a natural source of cross-modal semantic correction. However, applying VLM-guided contrastive signals directly within the GCD training loop proves counterproductive because the locally-oriented InfoNCE loss conflicts geometrically with the globally oriented K-means objective in the shared backbone space. We identify the root cause as a dual resource allocation problem: the VLM-derived signal must be allocated to the correct feature subspace to avoid geometric conflict with K-means clustering (space allocation), and the limited VLM inference budget must be allocated to the correct samples to maximize discriminative return (budget allocation). These two decisions are coupled; failure on either renders the other ineffective. To resolve this, we propose DualGLEAN, a framework that addresses the dual allocation challenge through two coupled mechanisms: decoupled contrastive alignment (DCA), which routes the VLM-guided neighbor contrastive loss to a dedicated projector space while preserving the backbone space for global clustering, and compound uncertainty querying (CUQ), a three-stage filtering metric that jointly evaluates predictive entropy, boundary proximity, and local label inconsistency to direct VLM queries exclusively to truly boundary-critical samples. Extensive experiments on the AID and RSSDIVCS datasets demonstrate that DualGLEAN achieves strong performance, improves four diverse GCD baselines as a plug-in module, generalizes across seven VLM backbones, introduces zero additional trainable parameters to the base GCD network, and incurs a total VLM API cost of only CNY 2.45 per full training run on the AID dataset under the default search-scope configuration, with the cost scaling linearly with the query budget. Full article

Under the vehicle as a service (VaaS) paradigm, intelligent connected vehicles continuously generate large-scale, computation-intensive perception data processing tasks. However, limited onboard computing resources and power supply prevent vehicles from handling these tasks efficiently. Vehicular edge computing (VEC) extends available computing resources through vehicle–infrastructure collaboration. Nevertheless, continuous vehicle mobility causes intermittent communication links between vehicles and roadside units, posing new challenges for VEC task scheduling. Therefore, this paper proposes a reinforcement learning-based VEC task scheduling approach that integrates a fuzzy reward mechanism with multi-agent proximal policy optimization (FRMPPO). First, a system architecture is developed by integrating the directed acyclic graph task model, dynamic communication model, and computation model. The scheduling problem is formulated as a partially observable Markov decision process, with the objective of minimizing task completion latency and vehicle energy consumption. Second, a fuzzy reward mechanism is designed to guide the training of multi-agent proximal policy optimization. It takes edge node load pressure and communication state as inputs to adaptively combine local immediate rewards and the global reward, eventually guiding the agents toward a globally optimized cooperative policy. Finally, real-time scheduling decisions under communication intermittency are enabled through a centralized training and decentralized execution framework and gated recurrent unit-based state encoding. Simulation results demonstrate that FRMPPO effectively solves the VEC task scheduling problem, achieving significantly superior performance over existing algorithms in terms of both task completion latency and vehicle energy consumption. The proposed method thereby satisfies the real-time processing demands of perception tasks in VaaS scenarios. Full article

Background/Objectives: Post-hepatectomy biliary leakage (BL) remains a major source of postoperative morbidity. While traditional risk models treat BL as a single clinical entity, its chronological presentation follows distinct patterns that raise the hypothesis of distinct underlying pathophysiological mechanisms. This study aimed to stratify post-hepatectomy biliary fistulas into early and late onset to identify unique independent risk factors and clarify their separate risk profiles. Methods: This retrospective cohort study evaluated 370 patients who underwent hepatic resection between 2020 and 2024. BL was defined according to the International Study Group of Liver Surgery criteria. Based on the bimodal distribution of diagnostic timing within the cohort, patients were stratified by the postoperative day (POD) of diagnosis into Early Biliary Leakage (EBL, diagnosed on POD ≤ 7) and Late Biliary Leakage (LBL, diagnosed on POD > 7). Independent predictors were identified using binary and multinomial logistic regression models. Results: The overall incidence of BL was 9.7% (36/370), with diagnostic peaks occurring at PODs 3 and 11. EBL accounted for 55.6% of leaks, while LBL accounted for 44.4%. In multivariable analysis, an operative time exceeding 5 h was the sole independent global predictor for overall leakage (OR = 6.9; 95% CI 2.4–19.4; p < 0.001). For EBL, independent predictors were tumor proximity to major intrahepatic vessels (OR = 4.1; 95% CI 1.5–11.6; p = 0.007) and an operative time exceeding 5 h (OR = 5.2; 95% CI 1.4–19.2; p = 0.012). For LBL, an operative time exceeding 5 h was the single independent predictor, carrying a substantial risk (OR = 12.2; 95% CI 2.6–56.7; p = 0.001). Histologically, cholangiocarcinoma was significantly overrepresented in the leakage cohort compared to non-leak patients (41.7% vs. 11.7%; p = 0.05). Conclusions: Stratifying post-hepatectomy biliary leakage by diagnostic timing highlights critical differences in patient pathways and hospital readmission rates. While EBL are identified during the initial stay, LBL present insidiously after an uneventful first week, causing a higher 30-day readmission rate (62.5% vs. 30.0%, p = 0.091). Clinical surveillance and patient education at discharge are essential to identify late biliary complications early. Full article

Carya illinoinensis (pecan) has recently emerged as a promising oilseed crop in Eastern Europe; however, its oil has not been systematically characterized under regional growing conditions or directly compared with that of the established nut crop, Juglans regia (walnut). This study evaluated the proximate composition, fatty acid profile, and short-term oxidative stability of oils from six pooled sample groups, comprising three pecan and three walnut composite samples collected from Romania and the Republic of Moldova. Oils were extracted by hot pressing, kernel composition was determined using standard official (AOAC) methods, fatty acid composition was analyzed by gas chromatography–mass spectrometry (GC–MS), and oxidative stability was assessed by peroxide value (PV) and thiobarbituric acid reactive substances (TBARS) during 20 days of storage. Romanian pecan oils contained 67–68% total fat and were rich in linoleic acid (55–57%), whereas walnut oils contained 59–61% fat and were dominated by oleic acid (57–58%). The PNC composite sample exhibited an oleic acid-dominant profile that differed from those of the other two pecan samples. Because cultivar identity, genotype, and environmental variables were not determined, the cause of this difference cannot be established from the present study. All samples remained below the Codex Alimentarius PV limit (3.0 meq O₂/kg). TBARS changes differed among the analyzed composite oils; however, these differences cannot be attributed solely to fatty acid composition because antioxidant constituents were not measured. Oleic and linoleic acids were strongly and inversely correlated (Pearson r = −0.9998, p < 0.001). These findings provide the first comprehensive characterization of pecan oil produced under Eastern European conditions and demonstrate compositional variation among the analyzed composite samples, although the factors responsible for this variation could not be determined. Full article

Material extrusion 3D printing has been widely used in industrial, educational and residential environments. However, the associated emissions and exposure health impacts need to be evaluated, especially for the new and emerging filament materials. This study characterized particle and chemical emissions from 3D printing using five different metal composite filaments, which contain over 90% (by weight) of metal powder blended with polymer binders. The emission characterization was conducted using an exposure chamber following a standard testing method. Real-time particle measurements showed that particle emission rates ranged from 8 × 10⁹ to 2 × 10¹¹ particles/h for particle number and 200 to 1400 µg/h for particle mass. Over 98% of the emitted particles were smaller than 1 µm, which poses an inhalation hazard. Inductively coupled plasma–mass spectrometry analysis detected manganese, copper, zinc, and selenium in emitted particles from all filaments. However, metal powder in raw filaments tended not to be transferred into particle emissions, resulting in the total metals (and metalloids) accounting for 0.07% to 0.95% of emitted particle mass. Sorbent tube sampling and analytical analyses showed various volatile organic compounds emitted during printing, including hydrocarbons, alcohols, aldehydes, and aromatic compounds. Overall, metal composite filaments generated lower levels of volatile organic compounds (VOCs) compared to thermoplastic polymer filaments; in addition, the emitted VOC compositions differed. Organic chemicals associated with metal composite filament emissions included formaldehyde, benzaldehyde, acetaldehyde, naphthalene, and trimethylbenzene, exposure to which may cause irritations or other adverse health impacts. This study estimated personal exposure to hazardous components assuming a person is close to the printer with low ventilation to represent an acute worst-case exposure scenario. Modeled personal exposure to emissions showed potential exceedances of exposure to fine (PM_2.5) and coarse (PM₁₀) particulate matter, arsenic, manganese, formaldehyde, caprolactam, acetaldehyde, and naphthalene compared to reference levels. A modeled office room with ventilation showed reduced exposure levels by up to two orders of magnitude, assuming the same emission source. Users can avoid close proximity to an operating printer and increase dilution through larger room volumes and higher air change rates to reduce potential inhalation exposures at given printing conditions. Full article

In district heating systems where radiators and floor radiant heating terminals coexist, the high-temperature supply water must be cooled by mixing with return water before delivery to underfloor heating terminals. However, overheating frequently occurs at these terminals in practice. Taking the mixing water system for underfloor heating terminals as the research object, this study develops a required mixing ratio model and a coupled hydraulic–thermal model to investigate the underlying overheating mechanism. The results show that the supply control valve has reached its lower regulation limit, and the actual mixing ratio remains below the target value—this mismatch is identified as the primary cause of terminal overheating. Quantitative analysis reveals that the original system exhibits temperature deviations of 3.5–6.0 °C under proximal high-pressure conditions and 1.6–2.1 °C under distal low-pressure conditions. To resolve this issue, three graded retrofit schemes are proposed: supply valve parameter enhancement (Scheme A), three-way valve scheme (Scheme B), and dual-valve scheme (Scheme C). Simulation results indicate that Scheme B reduces the temperature deviation to within ±0.5 °C under distal conditions, while Scheme C achieves the same under proximal conditions. Economic analysis indicates that, under the precondition that temperature control requirements are satisfied, the recommended schemes yield static payback periods of 3.8 years for mild overheating with Scheme A, 3.9 years for moderate overheating with Scheme B, and 4.1 years for severe overheating with Scheme C. A field case study of Scheme A demonstrates that the supply water temperature deviation is reduced from approximately 2.0 °C to within 0.5 °C under low-load conditions, confirming the effectiveness of the valve enhancement strategy. Due to current field constraints, the experimental validation is limited to Scheme A, while Schemes B and C are evaluated through the validated simulation model. The findings offer a quantitative reference for overheating diagnosis and retrofit selection in existing mixing water systems for underfloor heating terminals. Full article

Chemically induced proximity (CIP) has revolutionized small-molecule pharmacology by moving beyond traditional occupancy-based inhibition and activation. Within this paradigm, monovalent nondegrading molecular glues (ndMGs) represent a structurally compact and mechanistically distinct class of linkerless compounds. These agents stabilize or induce selective biomolecular interactions, altering the functional state or cellular localization of macromolecular complexes without causing component degradation. Once considered rare phenomena unique to specific natural products, ndMGs are now being actively engineered across diverse therapeutic landscapes, with multiple candidates advancing into clinical trials and achieving regulatory validation. We systematically highlight their evolving capabilities to modulate oncogenic networks, intervene with immune activity, rectify metabolic signaling, control neurodegenerative trafficking and stress networks, and disrupt critical pathogen assemblies, while broadening the druggable landscape into non-canonical mechanisms. In each section, we analyze the therapeutic value of the targets, the molecular mechanisms of action, the latest progress, and the unique challenges faced by these strategies. In summary, the ndMG modality represents a highly versatile strategy to unlock the undruggable proteome. Full article