Search Results (6,624)

Background: Dysphagia is a common problem in older adults, characterized as a swallowing disorder that prevents food from passing from the mouth to the esophagus. Besides impairing dietary intake and leading to malnutrition, dysphagia also severely restricts water intake. Purpose: This study aimed to develop polysaccharide-based hydrogels as dysphagia-friendly finger foods designed to provide high water content and enable controlled vitamin delivery to older persons with dysphagia. Procedures: Agar–carboxymethylcellulose (Agar-CMC) composite hydrogels with incorporated vitamins C, B₉, B, and D₃ were developed and tested for their textural and rheological properties, vitamin stability during storage, and vitamin release under simulated gastrointestinal conditions. Finally, a fiberoptic endoscopic swallowing assessment and sensory evaluation were conducted. Main Findings: Increasing the agar concentration in Agar-CMC hydrogels improved their internal structure and handling properties as finger foods, while still being easily breakable during swallowing. Agar-CMC hydrogels’ structure protected vitamins during processing and six weeks of storage. Vitamin release started immediately and remained steady in the gastric phase, with a noticeable increase at the beginning of the intestinal phase, resulting in 70–100% vitamin release by the end of this phase. The Fiberoptic Endoscopic Swallowing Evaluation confirmed their suitability for individuals with mild to moderate oropharyngeal dysphagia, with a low risk of aspiration (1 point on the Penetration-Aspiration Scale out of 8). Principal Conclusions: The developed Agar-CMC hydrogels present a promising dysphagia-friendly finger food alternative with high water content. They effectively deliver essential vitamins throughout the gastrointestinal tract, and notably demonstrate a low aspiration risk, making them suitable for individuals with mild to moderate oropharyngeal dysphagia. Full article

Background/Objectives: Coagulopathy is a common complication of liver cirrhosis, partly due to impaired synthesis of vitamin K-dependent coagulation factors. Despite its frequent use, the efficacy of vitamin K in this setting remains uncertain. This study aimed to evaluate the effect of vitamin K administration on coagulation parameters in patients with cirrhosis. Methods: We performed a retrospective study of 122 cirrhotic patients hospitalized between 2020 and 2024, who received vitamin K for coagulopathy correction. Coagulation and liver function parameters were monitored over time. Results: An early and progressive improvement in INR values was observed, in a subset of patients, following vitamin K administration. INR values across time points were strongly correlated, while only weak associations were observed with bilirubin levels. These findings support a selective therapeutic effect, rather than universal efficacy. Discussion: Despite current guidelines discouraging routine vitamin K use in cirrhosis, our findings suggest that selected patients—particularly those with reversible deficiency—may benefit from supplementation. The observed decrease in INR values supports a targeted, context-based approach rather than empirical management. Conclusions: However, due to the retrospective design and absence of a control group, the observed improvements cannot be conclusively attributed to vitamin K administration. Vitamin K may improve coagulation in cirrhotic patients with reversible deficiency, but its efficacy is not universal. Its use should be individualized and guided by clinical and biochemical context, as part of a broader treatment strategy. Full article

Left ventricular hypertrophy (LVH) refers to the pathological thickening of the myocardial wall and is strongly associated with several adverse cardiac outcomes and sudden cardiac death. While the biomechanical drivers of LVH are well established, growing evidence points to a critical role for cardiac and systemic metabolism in modulating hypertrophic remodeling and disease pathogenesis. Despite the efficiency of fatty acid oxidation (FAO), LVH hearts preferentially increase glucose uptake and catabolism to drive glycolysis and oxidative phosphorylation (OXPHOS). The development of therapies to increase and enhance LFCA FAO is underway, with promising results. However, the mechanisms of systemic metabolic states and LCFA dynamics in the context of cardiac hypertrophy remain incompletely understood. Further, it is unknown to what extent cardiac metabolism is influenced by whole-body energy balance and lipid profiles, despite the common occurrence of lipotoxicity in LVH. In this study, we measured whole-body and cellular respiration along with analysis of lipid and glycogen stores in a mouse model of LVH. We found that loss of the cardiac-specific gene, myosin-binding protein C3 (Mybpc3), resulted in depletion of adipose tissue, decreased mitochondrial function in skeletal muscle, increased lipid accumulation in both the heart and liver, and loss of whole-body metabolic flux. We found that supplementation of exogenous LCFAs boosted LVH mitochondrial function and reversed cardiac lipid accumulation but did not fully reverse the hypertrophied heart nor systemic metabolic phenotypes. This study indicates that the LVH phenotype caused systemic metabolic rewiring in Mybpc3^−/− mice and that exogenous LCFA supplementation boosted mitochondrial function in both cardiac and skeletal muscle. Full article

Background/Objectives: Pulmonary nodules (PNs) are a common incidental finding on conventional imaging. Differentiating benign from malignant lesions remains a diagnostic challenge. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) has become an essential imaging modality in this setting. This review aims to evaluate the clinical impact of PET/CT parameters and techniques, focusing on semi-quantitative imaging biomarkers and dual-time-point imaging. Methods: This review is organized into three main sections. First, qualitative analysis and PET key metrics are analyzed, including standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) indices, highlighting their diagnostic and prognostic significance. The second section focuses on the clinical utility of dual-time-point imaging (DTPI), evaluating its ability to differentiate between benign and malignant PNs through changes in SUV over time (ΔSUVmax). We compare these advanced imaging approaches with histopathological diagnosis, the current gold-standard method, highlighting the potential of advanced PET/CT techniques in clinical decision-making. The last section focuses on future applications of PET/MR, artificial intelligence, and PET radiomics. Results: Evidence indicates that high SUV, MTV, and TLG values are significantly associated with malignant PNs and aggressiveness. Moreover, DTPI with ΔSUV, ΔMTV, and ΔTLG further enhances specificity and accuracy in characterizing PNs. Despite a lack of standardization, studies have shown better accuracy when advanced PET/CT parameters are used. Conclusions: While DTPI and semi-quantitative PET parameters are not yet universally adopted in daily clinical practice, evidence supports their role in enhancing the characterization of indeterminate PNs. More prospective studies are needed. Full article

Common polymeric materials (neat polymers) are quite well known, and their properties are often available in appropriate material databases. However, material data, e.g., rheological data, for materials such as polymer blends, polymer composites (including wood plastic composites), and filled plastics are simply lacking in material databases. This paper addresses the problem of determining viscosity curves for one of the most widely used advanced polymeric materials: wood plastic composites. Studies were conducted in laboratory and production settings, i.e., on-line. Laboratory tests were conducted in two ways: on the basis of classical rheometric measurements, i.e., High-Pressure Capillary Rheometry (HPCR), and on the basis of Melt Flow Index (MFI) measurements, also including tests based on a limited number of measurement points. Tests in production conditions, i.e., on-line, were conducted during the extrusion process using the measurement of the process output (material flow rate) and pressure in a specialized extrusion die. The test results (viscosity curves) obtained from Melt Flow Index (MFI) measurements and on-line measurements were presented and evaluated against the background of the results (viscosity curves) obtained from classical capillary rheometry measurements (HPCR). Due to the lack of rheological data of wood plastic composites in available databases, in-house research methods based on the two-point viscosity curve determination in the plastometric (MFI) tests and the tests under production conditions, that is, on-line, have been proposed. The two-point method, based on the power law model, is quick and easy to implement, and allows for solving many polymer processing issues analytically. On-line tests have the significant advantage of being conducted under the actual flow conditions of the tested material, rather than under laboratory conditions, as is the case with rheometric and plastometric tests, which do not take into account the processing history of the tested material. The issues of rheology and modeling of wood plastic composite processing, e.g., extrusion and injection molding, which have not yet been resolved and require practical solutions, were also discussed. The results of this part of the study (viscosity curves and models) will be used in the second part of the study to evaluate the impact of rheological testing methods and rheological models on the accuracy of process modeling (extrusion). Full article

Background/Objectives: Uterine leiomyomas (ULs) and breast fibroadenomas (FAs) are the most common benign tumors in women, both arising in hormone-responsive mesenchymal tissues and often co-occurring during reproductive years. Despite their shared hormonal sensitivity and frequent MED12 mutations, their downstream molecular evolution remains poorly characterized. This study aimed to investigate whether ULs and FAs, though initiated by similar genetic alterations, diverge in their oncogenic trajectories, thereby addressing the molecular basis for their distinct clinical behaviors. Methods: We performed whole-exome sequencing (WES) on 15 uterine leiomyomas and 7 publicly available fibroadenomas with matched normal controls to compare somatic mutations, copy number alterations (CNAs), and mutational signatures. All UL samples were derived from Korean patients who underwent surgical treatment at a tertiary hospital between 2017 and 2019. Somatic variants were analyzed using MuTect2 and Strelka2. FACETS was used to estimate copy number changes in individual samples, and GISTIC2 to identify recurrent and statistically significant copy number alterations across patient cohorts. Mutational processes were inferred using SigProfiler. Microsatellite instability status was determined with MSIsensor2. The study was approved by the Institutional Review Board (UC17SNSI0092). Results: Comparative whole-exome sequencing of 15 ULs and 7 FAs from matched tumor-normal samples in an East Asian cohort confirmed both tumor types harbor identical MED12 p.G44D mutations, establishing shared molecular initiation. However, post-initiation evolution diverged dramatically: ULs exhibited chromosomal instability with 15 copy number amplifications, 6 of which affected oncogenes, but relatively modest point mutations. In contrast, FAs remained chromosomally stable but hypermutated, harboring 1.47× more variants than ULs despite lower tumor purity. Notably, one histologically benign FA harbored multiple loss-of-function mutations plus an EGFR gain-of-function mutation typically associated with malignant breast cancer, challenging traditional benign-malignant classifications. Conclusions: Despite sharing a common initiating mutation in MED12, ULs and FAs evolve through fundamentally distinct genomic pathways. UL evolves through chromosomal instability, whereas FA evolves through a mutator phenotype, with important implications for understanding tumor biology and molecular-based risk stratification. These findings support a paradigm of tissue-specific oncogenic evolution and underscore the potential clinical utility of genomic profiling in distinguishing benign tumors with atypical molecular features. Full article

Spasticity of the distal lower limb substantially impairs stance, gait, and quality of life in patients with upper motor neuron lesions. Although ultrasound-guided botulinum toxin A (BoNT-A) injections are increasingly employed, structured, muscle-specific visual guidance for the distal lower limb remains limited. This study provides a comprehensive guide for ultrasound-guided BoNT-A injections across ten key distal lower limb muscles: gastrocnemius, soleus, tibialis posterior, flexor hallucis longus, flexor digitorum longus, tibialis anterior, extensor hallucis longus, flexor digitorum brevis, flexor hallucis brevis, and extensor digitorum longus. For each muscle, we present (1) Anatomical positioning relative to osseous landmarks; (2) Sonographic identification cues and dynamic features; (3) Zones of intramuscular neural arborization optimal for injection; (4) Practical injection protocols derived from literature and clinical experience. High-resolution ultrasound images and dynamic videos illustrate real-life muscle behavior and guide injection site selection. This guide facilitates precise targeting by correlating sonographic signs with optimal injection zones, addresses common spastic patterns—including equinus, varus, claw toe, and hallux deformities—and integrates fascial anatomy with motor-point mapping. This article completes the Elias University Hospital visual series, providing clinicians with a unified framework for effective spasticity management to improve gait, posture, and patient autonomy. Full article

An incision point acts as the pivot point when a minimally invasive surgery procedure is applied. The assistive robot arms employed for such operation must have the capability to perform a remote center of motion (RCM) at this pivot point. Other than designing RCM mechanisms, a common practice is to use a readily available spatial serial robot arm and control it to impose this RCM constraint. When this assistive robot is required to be backdriven by the surgeon, the relation between the interaction forces/moments and the motion with RCM constraint becomes challenging. This paper carefully formulates a hybrid position/force control scheme for this relationship when any readily available robot arm that is coupled with a force/torque sensor is used for an RCM task. The verification of the formulation is carried out on a readily available robot arm by implementing the additional constraints that are derived from a surgical robot application. Full article

Drying is a key step in the primary processing of agricultural products. It alters the type and content of volatile flavor compounds (VOCs), imparting distinctive flavors to the products. This article reviews the common physical and chemical reactions occurring during the drying of agricultural products, the types of VOCs, the detection and analysis methods, and the research progress on the effects of different drying methods on the VOCs of agricultural products. The article serves as a reference point for further research into the VOCs of agricultural products after drying, and provides a theoretical foundation for subsequent research into the development and utilization of agricultural resources. Full article

Background: Stress urinary incontinence (SUI) and mixed urinary incontinence (MUI) are common disorders that impair quality of life. While transobturator tension-free vaginal tape (TVT-O) is established for SUI, outcomes in MUI remain uncertain. Methods: We analyzed 111 women who underwent TVT-O at Keelung Chang Gung Memorial Hospital. Baseline data included demographics, Overactive Bladder Symptom Score (OABSS), uroflowmetry [peak flow rate (PFR), residual urine (RU)], and Pelvic Organ Prolapse Quantification (POP-Q) stage. The primary outcome was OABSS improvement (≥1-point reduction); secondary outcomes were longitudinal OABSS, uroflowmetry, pad usage, and POP-Q stage. Results: At 3 months, 31.5% (35/111) met responder criteria. Symptom improvement occurred more often in MUI than in SUI, with about half of women with MUI (48.6%) and one quarter of those with SUI (27.4%) reporting subjective improvement (p = 0.018). OABSS improved in MUI (7.92 → 7.18, p = 0.001) but worsened in SUI (6.84 → 7.52, p < 0.001). In SUI, PFR increased (p = 0.001) and RU decreased (p = 0.029); no significant changes occurred in MUI. MUI independently predicted response (OR, 2.59; 95% CI, 1.10–6.14) and greater ΔOABSS (β = −1.391, p < 0.001); higher baseline OABSS also predicted improvement (β = −0.093, p = 0.049). For pad usage, MUI was associated with persistence (OR, 3.855, p = 0.010). ROC analysis showed modest discrimination for MUI (AUC 0.626, p = 0.034). Conclusions: TVT-O provided symptom relief, with about half of the women with MUI, and one quarter of those with SUI experienced subjective improvement. Women with MUI and higher baseline OABSS were more likely to improve, but these findings should be interpreted with caution, given the modest sample size. Full article

Due to the influence of materials, construction quality, environmental conditions, and artificial factors, debonding damage in external thermal insulation composite systems (ETICS) has become a common issue in the construction field. A reliable and efficient method for identifying the debonding is still lacking. In this study, four groups of external insulation specimens with different degrees of debonding were fabricated. A non-contact detection method based on nonlinear vibration characteristics was employed, using a laser Doppler vibrometer to acquire the vibration response signals of the specimens. The results demonstrate that this technique can effectively distinguish specimens with different levels of debonding and accurately identify and locate the damage. Moreover, the relative position of the signal acquisition point with respect to the debonding area has no significant impact on the detection results. Full article

This paper presents a novel method for locally estimating vehicle density on highways based on vehicle-to-vehicle (V2V) communication, a communication mode within intelligent transport systems (ITSs), enabled via IEEE 802.11p and 3GPP C-V2X technologies. Awareness messages (AMs), such as basic safety messages (BSMs, SAE J2735) and cooperative awareness messages (CAMs, ETSI EN 302 637-2), are periodically broadcast by vehicles and can be leveraged to sense the presence of nearby vehicles. Unlike existing approaches that directly combine the number of sensed vehicles with measured packet reception ratio (PRR) of the AM, our method accounts for the deviations in PRR caused by imperfect channel conditions. To address this, we estimate the actual packet reception probability (PRP)–distance curve by exploiting its inherent downward trend along with multiple measured PRR points. From this curve, two metrics are introduced: node awareness probability (NAP) and average awareness ratio (AAR), the latter representing the ratio of sensed vehicles to the total number of vehicles. The real density is then estimated using the number of sensed vehicles and AAR, mitigating the underestimation issues common in V2V-based methods. Simulation results across densities ranging from 0.02 vehs/m to 0.28 vehs/m demonstrate that our method improves estimation accuracy by up to 37% at an actual density of 0.28 vehs/m, compared with methods relying solely on received AMs, without introducing additional communication overhead. Additionally, we demonstrate a practical application where the basic safety message (BSM) transmission rate is dynamically adjusted based on the estimated density, thereby improving traffic management efficiency. Full article

Background/Objectives: Atrial fibrillation (AF) is the most common sustained arrhythmia, with catheter ablation outcomes differing significantly between paroxysmal and persistent forms. While pulmo-nary vein isolation (PVI) remains the cornerstone of ablation, persistent AF is often associ-ated with atrial remodeling and non-pulmonary vein triggers, reducing procedural success rates and necessitating repeat interventions. However, in selected patients with minimal atrial substrate, a single PVI may achieve durable rhythm control. This case report illus-trates such a scenario in a young patient with persistent AF and tachyarrhythmia-induced cardiomyopathy (TIC). Methods: A 42-year-old previously healthy male presented with newly diagnosed persistent AF complicated by TIC and heart fail-ure (left ventricular ejection fraction [LVEF] 25%). Despite rate control, anticoagulation, guideline-directed heart failure therapy, amiodarone pretreatment, and two failed electrical cardioversions, the patient remained symptomatic. Elec-troanatomic mapping was performed to assess atrial substrate prior to radiofrequency ablation. Results: Mapping revealed no extensive low-voltage zones, indicating absence of significant atrial fibrosis. During ablation, si-nus rhythm was restored spontaneously with a single application targeting the infero-posterior aspect of the right infe-rior pulmonary vein. No additional arrhythmogenic substrate was identified. The patient maintained sinus rhythm throughout 14 months of follow-up, with marked clinical improvement, normalization of LVEF (55%), regression of atrial and ventricular enlargement, and resolution of heart failure symptoms. Quality of life, assessed by the ASTA question-naire, improved from 24 to 0 points. Conclusions: This case highlights that even in therapy-resistant persistent AF with severe structural and functional cardiac impairment, arrhythmia may be driven by discrete pulmonary vein-dependent mechanisms. Careful patient selection, particu-larly in younger individuals without advanced atrial remodeling, can identify those in whom PVI alone achieves durable rhythm control and reverse cardiac remodeling. Full article

Background: Pediatric odontogenic infections pose significant diagnostic challenges, particularly in distinguishing between cellulitis and abscess. Accurate differentiation is crucial for guiding appropriate management—antibiotics alone for cellulitis versus surgical incision and drainage (I&D) for an abscess—but can be difficult without specialized expertise or advanced imaging. Objective: We aimed to evaluate the diagnostic accuracy of handheld point-of-care ultrasound (POCUS; Philips Lumify), utilized by non-specialist clinicians, in differentiating cellulitis from abscess in pediatric odontogenic infections. A secondary objective was to assess its impact on reducing hospital admissions and emergency department (ED) burden. Methods: This prospective cohort study involved 111 pediatric patients (aged 1–17 years) presenting with maxillofacial odontogenic infections to a tertiary care academic medical center. Following clinical evaluations, handheld POCUS assessments were performed by trained non-specialist clinicians. Findings from I&D or clinical resolution with antibiotics served as the reference standard. Ninety cases were included in the final diagnostic accuracy analysis after 21 exclusions. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy with 95% confidence intervals (CIs) were calculated. Hospital admission trends were compared before (2017–2021) and after POCUS implementation (January 2022–April 2025). Interpretation should consider potential verification bias from the asymmetric reference standard (I&D for abscess vs. clinical resolution for cellulitis). Results: Handheld POCUS exhibited a sensitivity of 72.97% (95% CI: 57.02–84.60%), specificity of 73.58% (95% CI: 60.42–83.56%), PPV of 65.85% (95% CI: 50.55–78.44%), NPV of 79.59% (95% CI: 66.36–88.52%), and overall accuracy of 73.33% (95% CI: 63.38–81.38%). Following POCUS implementation, the annualized hospital admission rate for pediatric facial odontogenic infections decreased from 60.0 to 19.5 admissions/year; rate ratio (RR) = 0.33 (95% CI: 0.25–0.42), p < 0.001 (Poisson regression with log-offset for period length). Conclusions: Handheld POCUS, operated by non-specialist clinicians after a defined training protocol, was associated with a lower annualized admission rate and demonstrated moderate diagnostic accuracy. Its adoption was associated with a notable reduction in hospitalizations, suggesting its potential for alleviating ED overcrowding, reducing healthcare costs, and minimizing pediatric stress. Wider adoption, supported by standardized training, could enhance healthcare efficiency and quality in managing this common pediatric condition. Full article

Background: Cardiac involvement, one of the most life-threatening complications of sarcoidosis, remains under-recognized due to its oligo-symptomatic presentation in some patients. This retrospective study aimed to evaluate the utility of various clinical predictors of cardiac sarcoidosis (CS) development. Methods: The study included patients with pulmonary sarcoidosis diagnosed according to the recent ATS guidelines between January 2020 and July 2024 who underwent cardiac magnetic resonance (CMR) due to clinical suspicion of CS. The original Lake Louise criteria were used to identify active myocarditis. Results: Out of 393 patients diagnosed with pulmonary sarcoidosis, CMR was performed in 92 patients. Cardiac sarcoidosis was confirmed in 48 patients (52%, CS+), and excluded in 44 patients (48%, CS−). CS(+) patients demonstrated significantly more frequent Holter ECG abnormalities and liver/spleen sarcoidosis compared to CS(−) patients. Stage IV pulmonary disease, ECG abnormalities, and hypercalcemia were more common in CS(+) than in CS(−) patients; however, these differences did not reach statistical significance. Multivariate analysis identified Holter ECG abnormalities and liver/spleen involvement as significant predictive factors for CS, increasing the risk of cardiac involvement by approximately 4- and 6-fold, respectively. An AI-assisted simple scoring system based on five parameters: ECG abnormalities, Holter ECG abnormalities, liver/spleen involvement, gender, and stage of sarcoidosis predicted CS with a sensitivity of 76% and specificity of 74%, using an optimal cut-off value of ≥7.6 points. Conclusions: In patients with pulmonary sarcoidosis, an AI-assisted scoring algorithm derived from L1-regularized logistic regression results accurately predicted cardiac involvement on CMR with high specificity and sensitivity. Prospective validation of this algorithm is necessary to confirm its clinical utility in predicting cardiac sarcoidosis. Full article