Search Results (631)

Background: Anti-amyloid monoclonal antibodies represent the first disease-modifying therapeutic strategy targeting amyloid-β pathology in early Alzheimer’s disease (AD). Although several agents have demonstrated the ability to reduce cerebral amyloid burden, their clinical efficacy and safety remain subjects of substantial scientific and regulatory debate. This study aimed to synthesize randomized evidence evaluating the benefit–risk profile of anti-amyloid monoclonal antibodies in biomarker-confirmed early AD. Methods: A systematic review and classical pairwise meta-analysis of randomized controlled trials (RCTs) was conducted following the PRISMA 2020 guidelines. PubMed/MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched for phase III placebo-controlled trials evaluating lecanemab, donanemab, aducanumab, and gantenerumab in patients with mild cognitive impairment due to AD or mild AD dementia with biomarker confirmation of amyloid pathology. The primary outcome was change from baseline in the Clinical Dementia Rating–Sum of Boxes (CDR-SB) at the longest available follow-up. Safety outcomes included amyloid-related imaging abnormalities with edema or effusion (ARIA-E), amyloid-related imaging abnormalities with hemorrhage (ARIA-H), serious adverse events, and treatment discontinuation. Random-effects meta-analyses were performed. Results: Six randomized comparisons derived from four phase III trials involving 7695 participants met the eligibility criteria. Anti-amyloid monoclonal antibodies were associated with a statistically significant slowing of clinical progression compared with placebo (pooled mean difference in CDR-SB: −0.42 points; 95% CI −0.59 to −0.25; I² = 78%). The observed effect was primarily driven by trials of lecanemab and donanemab, whereas aducanumab demonstrated discordant results across trials and gantenerumab showed no clinically meaningful benefit. Despite statistical significance, the magnitude of the pooled effect approached the lower boundary of the minimal clinically important difference reported for CDR-SB in early AD. Treatment was associated with a markedly increased risk of ARIA-E (pooled risk ratio 10.1; 95% CI 7.8–13.0), with moderate heterogeneity across studies. Most ARIA-E events were asymptomatic and detected through protocol-mandated MRI monitoring. Conclusions: In biomarker-confirmed early Alzheimer’s disease, anti-amyloid monoclonal antibodies produce a statistically significant but modest slowing of clinical decline accompanied by a substantially increased risk of ARIA. The benefit–risk profile appears heterogeneous across individual antibodies and may reflect pharmacological differences in amyloid targeting and clearance mechanisms. These findings support cautious, individualized use of anti-amyloid therapies and highlight the need for longer-term studies to determine whether short-term slowing of decline translates into clinically meaningful disease modification. Full article

The pronounced heterogeneity of tight sandstone reservoirs in the Sulige Gas Field poses significant challenges to the uniform propagation of multi-cluster hydraulic fractures during horizontal well staged fracturing, often leading to uneven stimulation and compromised productivity. To address this issue, a coupled fluid–solid fracture propagation model based on the displacement discontinuity method (DDM) was developed, incorporating dynamic fluid distribution, rock deformation, and temporary plugging mechanisms. The model was validated against microseismic monitoring data from the Sulige field and subsequently employed to investigate the effects of reservoir heterogeneity—including porosity, permeability, and in situ stress—on multi-cluster fracture growth. Results indicate that permeability and stress heterogeneity exert the most significant influence on fracture non-uniformity, as reflected by increased coefficients of variation in fracture length. Engineering measures such as the use of high-viscosity guar gum fracturing fluids, variable perforation strategies (e.g., 6, 10, and 16 holes per cluster), and optimized temporary plugging parameters (timing of 0.5 with 12 balls) were shown to effectively mitigate these effects and promote more balanced fracture propagation. This study provides a quantitative framework for optimizing fracturing design in heterogeneous tight gas reservoirs and offers practical guidance for enhancing stimulation uniformity and gas recovery efficiency in the Sulige Gas Field. Full article

Accurate and robust detection of leaf diseases is a key enabler for precision agriculture and large-scale crop health monitoring. Despite the strong generalization of modern one-stage detectors (e.g., YOLOv8), two domain-specific challenges remain: (i) weak or blurry lesion boundaries hinder precise localization, and (ii) low color contrast between diseased and healthy tissues forces models to rely on subtle texture patterns rather than salient shapes. To tackle these challenges, we reframe the core agricultural disease detection task as the identification of “asymmetric morphological anomalies” and propose a domain-tailored enhancement framework. First, we introduce an Edge Enhancement Module (EEM) that explicitly strengthens boundary-aware representations. Inspired by the natural symmetry of healthy leaves, our EEM is specifically designed to capture symmetry-breaking boundary discontinuities and localized asymmetric edges caused by disease lesions. Our method enhances edge and texture cues that are indicative of disease lesions, which often exhibit local asymmetries and boundary discontinuities. The EEM includes a Differential Normalized Pooling Block (DNPB) that highlights edge responses through discrepancies between max pooling and average pooling, which also models cross-group edge correlations. Second, the Lightweight Texture-Sensitive Feature Enhancement (LTSFE) mechanism amplifies texture-discriminative channels under low-contrast conditions by leveraging complementary global statistics and efficient channel mixing, all with negligible computational overhead. We evaluated our method on a self-constructed dataset of 106,434 images with 225,640 annotations covering diverse crops. Experiments show that the proposed method achieves state-of-the-art accuracy (81.54% mAP@0.5:0.95) while maintaining real-time inference (142 FPS), consistently outperforming strong baselines. Ablations confirm the effectiveness and complementarity of EEM and LTSFE, demonstrating that domain-specific architectural design, inspired by biological symmetry, can substantially improve agricultural vision systems. Full article

Introduction: Teprotumumab (Tepezza^®), an insulin-like growth factor-1 receptor (IGF-1R) antagonist, is the first FDA-approved targeted therapy for thyroid eye disease (TED). While effective for reducing proptosis and inflammation, increasing post-marketing evidence has linked teprotumumab to auditory adverse events. IGF-1 signaling is essential for cochlear maintenance and neuroprotection; therefore, systemic IGF-1R inhibition presents a biologically plausible mechanism for ototoxicity. Despite growing recognition of these effects, no standardized approach exists for audiologic assessment or monitoring of patients receiving teprotumumab. This review aimed to (1) summarize proposed mechanisms and the reported spectrum of teprotumumab-related auditory effects, (2) evaluate current methods used to assess and monitor these patients, and (3) identify areas of consensus and ongoing uncertainty. Methods: An updated narrative review of the literature was conducting using PubMed, CINAHL, and Google Scholar using Boolean strings targeting teprotumumab exposure and hearing-related outcomes. Studies from 2022 onward were identified using Boolean search strings targeting teprotumumab exposure and hearing-related outcomes. Peer-reviewed English language studies reporting audiometric findings were eligible for inclusion. Results: Ten studies met inclusion criteria. Reported effects most commonly included bilateral high-frequency SNHL, tinnitus, and aural fullness, typically emerging after three to six infusions. Many cases demonstrated persistent deficits despite drug discontinuation. Baseline audiometric assessment was not uniformly reported across studies, and monitoring protocols varied considerably, with inconsistent incorporation of speech testing and immittance measures. Conclusions: Teprotumumab-associated ototoxicity is increasingly recognized and potentially irreversible. Current evidence is insufficient to guide standardized monitoring. Prospective studies are urgently needed to establish evidence-based audiologic surveillance protocols. Full article

Mining-subsidence-induced surface cracks pose substantial risks to ecological systems, infrastructure stability, and mining safety. Their thin, elongated, discontinuous, and low-contrast characteristics make accurate detection from unmanned aerial vehicle (UAV) imagery challenging, particularly under complex environmental conditions. This study proposes an enhanced YOLO11n framework for detecting surface cracks in mining subsidence areas. Switchable Atrous Convolution (SAConv) was incorporated to strengthen multi-scale feature extraction, while Cascaded Group Attention (CGA) was introduced to suppress background interference and improve feature discrimination, and Shape-IoU loss was adopted to enhance the localization of slender crack targets. The model was evaluated using 5000 annotated UAV images collected in the Zhungeer mining area. It achieved a precision of 85.6%, a recall of 77.9%, an mAP@0.5 of 84.3%, and an F1-score of 81.6%. Compared with the baseline YOLO11n, precision, recall, and mAP@0.5 increased by 1.4, 4.6, and 3.2 percentage points, respectively. Cross-dataset evaluation on the public Crack500 dataset further demonstrated improved robustness under domain variation. These results indicate that the proposed framework improves the detection and localization of slender and discontinuous cracks in complex mining environments, supporting its application in UAV-based geological hazard monitoring. Full article

Background/Objectives: To analyse postoperative pain trajectories after anterior cruciate ligament (ACL) reconstruction using data from a digital rehabilitation system, and to determine (i) whether combined ligament injuries are perceived as more painful than isolated ACL tears, (ii) which patient characteristics are associated with clinically relevant pain (visual analogue scale [VAS] > 5), and (iii) whether higher early pain is associated with later discontinuation of digital monitoring. Methods: This retrospective cohort study used routine data recorded by a validated sensor-based home rehabilitation system in patients after ACL reconstruction. This approach has previously been used to analyse functional recovery trajectories. All patients with ACL-related indications who performed at least one postoperative test were included and classified into four groups: isolated ACL rupture, ACL + meniscus, ACL + collateral ligament, and ACL + collateral ligament + meniscus. Pain during exercises and tests was recorded on a 0–10 VAS. High pain was defined as VAS > 5. Group comparison between indication types, anthropometric and activity-related variables and the proportion of high-pain events were performed using chi-square tests. Early pain (first postoperative month) was analysed in relation to the presence of later tests (≥3 months) to explore associations with discontinuation of digital monitoring. Results: Combined ligament injuries showed a significantly higher proportion of high-pain events during rehabilitation compared with isolated ACL ruptures (5.8% vs. 2.4%, overall p < 0.001). In particular, combined ligament injuries with ACL + collateral ligament rupture were associated with a greater share of VAS > 5 ratings in the early rehabilitation phases. No relevant association was observed between sex or BMI category and the occurrence of high pain, while age group showed an overall association without a consistent directional pattern. Sport activity level showed a strong relationship with high pain (p < 0.001). Early pain demonstrated a small but statistically significant negative correlation with later test participation (r = −0.15, approximately 2% of variance, p = 0.0076); however, this association was attenuated and no longer statistically significant when analysed using mixed-effects models accounting for within-patient clustering, indicating that patients with higher early pain tended to discontinue digital monitoring. Conclusions: Digital routine data after ACL reconstruction suggest that (i) combined ACL–collateral ligament injuries are perceived as more painful than isolated ACL tears, (ii) high postoperative pain is more closely related to activity level and injury pattern than to sex or BMI, while age group shows an overall but non-directional association, and (iii) higher early pain shows a weak bivariate correlation with digital disengagement that was not confirmed in mixed-effects models. Pain is therefore an exploratory marker warranting further investigation, rather than a confirmed independent predictor of adherence in app-based rehabilitation. Full article

The synergistic transition toward digital transformation and green development has been widely regarded as a core pathway to achieving sustainable development in knowledge production. Using balanced panel data from 39 economies covering 2018–2024, this study employed a two-way fixed-effects model to examine the associations of the energy efficiency of digital infrastructure and the energy structure with carbon intensity (CI). The findings showed that: (1) Reductions in Power Usage Effectiveness (PUE) values were significantly associated with higher macro-level CI (coefficient = −2.1564, p < 0.05), which is consistent with the possibility of a rebound effect in the digital sector. Further, time-series discontinuity tests further suggested that the surge in AI computing power, especially in 2023–2024, may have coincided with a structural shift in this relationship (Chow test, p < 0.05). (2) A Panel Threshold Regression (PTR) identified an optimal renewable energy threshold at 59.82%. Crucially, the carbon rebound effect remained highly significant across both high and low green power regimes, demonstrating that supply-side energy transition alone cannot fully absorb the exponential carbon footprint of digital expansion. Furthermore, Instrumental Variable (IV-2SLS) and Placebo Break Tests confirmed the strict validity of these findings. (3) The emission-reduction benefits related to digital knowledge spillovers appeared to be subject to time lags and a possible energy lock in effect, while current environmental policies and carbon pricing mechanisms appear to impose insufficient constraints. This study provides a crucial quantitative framework for monitoring and evaluating the environmental sustainability of the ICT sector. By highlighting the limitations of pure supply-side greening and the necessity of absolute carbon caps, our findings offer integrated policy approaches to align the exponential growth of Generative AI with global sustainable development goals. Full article

Background: Critical illness leads to profound metabolic, neuroendocrine and immune disorders that affect the prognosis of patients treated in intensive care units (ICUs). The ketogenic diet, a high-fat and low-carbohydrate eating model, is gaining increasing importance as a potential metabolic intervention in the ICU. Preliminary data suggest that the ketogenic diet (KD) may support the control of seizures in a super-refractive epileptic state (SRSE), stabilize glycemia, reduce insulin demand, and modulate the immune response in sepsis. The aim of this review was to present a synthetic presentation of the current state of knowledge regarding use of the KD in intensive care patients. Methods: The review was carried out in accordance with the guidelines of the Joanna Briggs Institute and PRISMA-ScR. PubMed, Scopus, EBSCO, Web of Science, Google Scholar and Cochrane Library databases were searched (10–19 April 2026) using the Population–Concept–Context model. Full-text observational studies, randomized trials and reviews of the use of KDs in ICU patients were included. Data extraction was performed independently by two reviewers. Results: Of the 42 publications identified, seven studies were included in the analysis. The KD was feasible and safe in both critically ill adults and children. In SRSE, most patients achieved stable ketosis within a few days, which often allowed for reduction or discontinuation of anesthetics. In sepsis, the KD led to glycemic stabilization, reduced insulin demand and reduced immune deregulation; in one study, “after day 4, none of the patients in the KD group required insulin treatment.” The KD also showed beneficial effects on cellular bioenergetics and mitochondrial function. The safety profile was acceptable and adverse reactions were manageable with appropriate monitoring. Conclusions: The KD represents a promising, non-pharmacological metabolic intervention in intensive care, particularly in the treatment of SRSE and in the stabilization of glucose metabolism in sepsis and other critical conditions. Despite the growing number of positive clinical observations, the available evidence remains limited due to small samples, heterogeneous protocols, and a lack of randomized trials. Further, well-designed prospective studies are needed to determine optimal KD implementation protocols and identify the patient populations that benefit most. Full article

Background: Neuroendocrine tumours (NETs) are heterogeneous neoplasms with several treatment options. Response rates, disease progression, and haematological toxicities can limit the use of some indicated treatments. Case Presentation: A 73-year-old woman with a well-differentiated grade 2 pancreatic NET (Ki-67 18%) underwent surgical resection and later developed hepatic recurrence. First-line treatment with sunitinib plus octreotide achieved temporary disease stabilisation. Upon progression, peptide receptor radionuclide therapy (PRRT) with ¹⁷⁷Lu-DOTATATE was initiated, resulting in stable disease but complicated by grade 3 thrombocytopenia. Two years later, PRRT retreatment was performed due to disease progression, which led to grade 4 thrombocytopenia. Further treatments with capecitabine and everolimus were limited by progression and significant thrombocytopenia. Therapy was switched to streptozocin plus 5-fluorouracil, which resulted in recovery of platelet counts, absence of haematological toxicity, and a sustained radiologic response until March 2025, when she presented with hepatic progression. FOLFOX chemotherapy was initiated but discontinued after one cycle due to severe thrombocytopenia. Deterioration in general condition ultimately led to supportive care and death in March 2026. Conclusions: This case highlights the risk of cumulative haematological toxicity with PRRT, particularly in retreatment settings. Careful patient selection and close monitoring are essential. Streptozocin-based chemotherapy may be an effective and well-tolerated alternative for patients with treatment-limiting toxicity. Full article

Slope stability in open-pit mining is not a static condition but evolves continuously as excavation progresses and geomechanical conditions change. In this study, an integrated approach combining ground-based radar monitoring, satellite-based InSAR time-series analysis, and numerical stability modeling was applied to evaluate slope behavior in a large-scale open-pit copper mine with complex geological and structural characteristics. Radar data revealed progressive and episodic deformation concentrated in specific slope sectors, while InSAR observations showed that deformation continued at lower rates after the main movement phase, providing a longer-term perspective of slope response. Stability analyses using limit equilibrium and finite element methods indicate that the slope operates close to a limit equilibrium condition, particularly under saturated scenarios where factors of safety approach critical levels and strain localization becomes more pronounced. The results show a clear link between observed deformation patterns and calculated stability conditions, with structural discontinuities and groundwater playing a dominant role in controlling slope behavior. Based on these findings, an integrated workflow is proposed that links monitoring data with stability assessment, enabling the identification of critical zones and supporting the evaluation of slope conditions during ongoing mining operations. This approach contributes to more reliable decision-making and supports safer and more sustainable open-pit mining practices. Full article

Background/Objectives: Low-dose atropine eye drops are widely used to slow myopia progression in children, but by reducing accommodation they may affect near ocular alignment and binocular visual function. Evidence on ocular alignment and strabismus-related findings remains insufficiently synthesized. This review examined low-dose atropine for pediatric myopia control in relation to ocular alignment and strabismus-related findings. Methods: PubMed/MEDLINE and Web of Science Core Collection were searched from inception to 16 April 2026. English-language studies addressing low-dose atropine, myopia control, ocular alignment, strabismus, binocular vision, accommodation, and vergence were screened. Of 247 records, 166 underwent screening after duplicate removal. Twenty-three database-derived and four manually identified full-text articles were reviewed. Eleven studies were included. Results: Of eleven included studies, six were clinical or interventional studies and five were case reports or case series. Case-based reports described near-predominant esodeviation, convergence excess-type deviation, elevated accommodative convergence/accommodation (AC/A) ratios, diplopia, reduced fusion, and acquired esotropia during fixed low-dose or escalating atropine use; most fixed low-dose cases improved after discontinuation or treatment modification. Clinical and interventional studies did not show consistent worsening of ocular alignment, near point of convergence (NPC), fusional vergence, or binocular vision. More consistent changes included pupil dilation, receded near point of accommodation (NPA), reduced accommodative amplitude and facility, selected fusional vergence changes, and short-term binocular or accommodative fluctuations. Conclusions: Low-dose atropine appears to be useful for pediatric myopia control and is generally well tolerated. However, selected cases may be temporally associated with ocular alignment abnormalities or strabismus-related findings. Careful monitoring may be warranted in children with unstable binocular systems and during dose escalation. Full article

Monitoring inland surface water quality is essential for water security, ecosystem conservation, public health, and sustainable water resource management. Although in situ measurements remain indispensable, they are often limited by high costs, restricted spatial coverage, low temporal frequency, and discontinuous monitoring networks. This study presents a systematic literature review, guided by the PRISMA 2020 framework, of empirical studies published between 2021 and 2025 on the integration of artificial intelligence (AI) and remote sensing (RS) for inland surface water quality monitoring. Searches were conducted in the Web of Science database, resulting in a final corpus of 367 peer-reviewed articles. Preliminary bibliometric characterization and qualitative content analysis were performed to identify sensors, platforms, AI paradigms, algorithms, estimated parameters, validation strategies, limitations, challenges, trends, and research gaps. The results show rapid growth in the field, with Sentinel-2 and Landsat-8 as the most recurrent sensors and multispectral data as the dominant spectral source. Machine learning approaches, especially Random Forest, Artificial Neural Networks, XGBoost, and Support Vector Machine, predominated, while deep learning, multi-source integration, hybrid models, and Explainable AI emerged as relevant trends. AI–RS integration shows strong potential to complement conventional monitoring, but persistent challenges remain regarding in situ data dependence, limited external and temporal validation, model transferability, generalization, uncertainty reporting, validation robustness, and interpretability. Full article

Geometric monitoring of slender support structures, particularly steel lattice transmission towers, is a critical component of power infrastructure diagnostics. Such structures are susceptible to environmental influences and long-term deformation processes, which necessitates precise assessment of their geometric axis. The aim of this study was to evaluate the influence of the terrestrial laser scanning (TLS) scanner class and point cloud registration strategy on the determination of the geometric axis of a steel high-voltage lattice transmission tower (hereafter LTT). Unlike previous studies focused primarily on TLS-based axis reconstruction, this work introduces a comparative assessment of registration strategies, an error propagation model, and the proposed Axis Drift Index (ADI) as quantitative indicators of axis stability. The analysis was based on data obtained using a tachymetric method (reference), a compact scanner (Leica BLK360), and a survey-grade scanner (Riegl VZ-400i). The comparison included planimetric axis deviation, consistency of deformation direction, variation in results with height, and the influence of registration quality. The results show that TLS measurements performed using a survey-grade scanner and target-based registration exhibit high agreement with tachymetric results. In contrast, cloud-to-cloud registration without a stable reference framework leads to cumulative errors and instability of the reconstructed axis, particularly in the upper parts of the structure. The observed deviations in the BLK360 dataset were dominated by registration-related geometric instability rather than unequivocal structural deformation signals. The findings indicate that the accuracy of geometric axis determination in slender structures is governed more by the adopted point cloud registration strategy than by the scanner class itself. The proposed ADI parameter and linear error propagation model additionally enabled a quantitative assessment of geometric consistency with height. From an engineering perspective, this highlights the importance of stable reference systems and appropriate survey design in high-precision TLS applications. Although the study was conducted on a single lattice tower, the results provide practical insight into the reliability of TLS workflows for slender structures characterized by discontinuous geometry and high sensitivity to registration errors. Full article

Background: 5q spinal muscular atrophy (SMA) is a hereditary neuromuscular disorder characterized by progressive muscle weakness. Nusinersen, the first disease-modifying therapy for SMA, has demonstrated efficacy in both clinical trials and real-world studies. However, the precise timing of therapeutic onset following Nusinersen administration remains unclear. Methods: This retrospective study analyzed clinical data from patients with genetically confirmed 5q SMA who received Nusinersen treatment for at least six months at Peking University First Hospital. Motor function was assessed using standardized scales prior to each dose. Results: In total, 74 patients were screened, of whom 62 were enrolled, including 14 with type 1, 29 with type 2, and 19 with type 3 SMA. Thirty-two patients completed motor function assessments. After six months of treatment, 62.5% achieved a primary clinically meaningful response (an increase of ≥4 points in CHOP-INTEND or ≥3 points in HFMSE). Seven patients (21.9%) attained or regained motor milestones. Median improvements were 6 points in CHOP-INTEND (p = 0.001), 4 points in HFMSE (p = 0.003), and 1.5 points in RULM (p = 0.045). Further analysis indicated that the available median time to treatment response was approximately 2 months. In patients with severe scoliosis or prior spinal surgery, ultrasound-guided lumbar puncture demonstrated a high success rate (94.9%). Regarding safety, intrathecal injection-related adverse events occurred in eight patients (12.9%), and no adverse events led to treatment discontinuation. Conclusions: During the loading phase, Nusinersen provides clinical benefit for the majority of patients, with a median time to therapeutic response for monitoring of approximately 2 months. Ultrasound-guided intrathecal administration is the preferred approach for individuals with complicated spinal conditions. These findings may help guide clinical expectations for physicians, patients, and caregivers. Full article

Recent advances in roadside sensing technologies, including camera-based systems, radar, and LiDAR, have enabled high-resolution sampling of vehicle trajectories, overcoming the temporal and spatial limitations of traditional data collection methods. Among these, LiDAR sensing has been widely adopted for traffic monitoring and surrogate safety analysis due to its high spatial accuracy and temporal resolution. However, sensor noise and occlusion in roadside LiDAR frequently introduce tracking point offsets and trajectory discontinuities, reducing the reliability of vehicle counts, traffic state estimation, and conflict analysis. To address these challenges, this study proposes a post-processing method based on time–space analysis to detect and correct occlusion-induced trajectory discontinuities. By exploiting the inherent spatiotemporal consistency of vehicle movements, the proposed approach identifies fragmented trajectories, reconstructs continuous vehicle paths, and recovers realistic traffic patterns. Validated on real-world LiDAR data collected at an urban intersection in Reno, Nevada, across four 30 min traffic periods covering AM and PM peak conditions on weekdays and weekends, the proposed method achieves an average precision of 0.989 and an average F1-score of 0.948, outperforming IMM, GNN-RM, and HMM + Viterbi benchmark methods. Count accuracy improved from 85.5% to 97.4% across all evaluated periods, confirming the method’s effectiveness under occlusion conditions. Full article