Search Results (11,096)

Background and Clinical Significance: Epstein–Barr virus (EBV) is a common infection that rarely causes acute pancreatitis. EBV-associated acute pancreatitis is an uncommon but potentially serious complication that may result from direct viral invasion of pancreatic tissue or immune-mediated inflammation. Because its presentation can overlap with other causes of acute pancreatitis, EBV may be overlooked when common aetiologies are not identified. Recognising EBV as a potential cause is important for accurate diagnosis and appropriate management, particularly in patients presenting with pancreatitis alongside features of acute EBV infection; Case Presentation: We report a case of 58-year-old female with EBV-induced acute pancreatitis. She had a flu like illness two weeks prior to hospital admission, tested positive for EBV IgM antibodies and received supportive treatment by her general practitioner. However, her condition deteriorated, leading to hospital admission. She developed epigastric pain and investigations showed elevated serum lipase, impaired liver function tests and acute kidney injury. CT abdomen showed hepatosplenomegaly, lymphadenopathy and peripancreatic oedema consistent with acute pancreatitis. She was initially treated with antibiotics, however; her condition worsened and she developed severe hypotension requiring intensive care admission. Aggressive fluid resuscitation, inotropic support and continuous veno-venous haemofiltration (CVVH) were required. She gradually improved and subsequently was stepped down to the medical ward for supportive care and rehabilitation. She made full recovery and was discharged home after a 6-week length of stay; Conclusions: EBV-associated acute pancreatitis is an uncommon but potentially severe complication of EBV infection. EBV should be considered in patients with acute pancreatitis when common aetiologies have been excluded, particularly when pancreatitis occurs alongside features of acute viral infection. Early recognition and appropriate supportive management may be important in preventing or limiting severe complications. Full article

Background/Objectives: Evidence regarding the prognostic impact of outpatient physical therapy (PT) initiated shortly after discharge in older patients with chronic kidney disease (CKD) hospitalized for worsening heart failure (HF) is limited. We evaluated the association between outpatient PT initiation within 30 days of discharge and the primary endpoint of all-cause mortality within 1 year after discharge. Methods: In this retrospective multicenter cohort study, we applied a 30-day post-discharge landmark design. Patients who died or were rehospitalized within 30 days after discharge were excluded, and 6359 eligible 30-day event-free survivors were included in the analysis. Of these, 244 (3.8%) underwent outpatient PT within 30 days of discharge, and the remaining patients had no documented outpatient PT within that period. Propensity scores were estimated from prespecified covariates and used for 1:1 matching. We assessed associations with 1-year all-cause mortality, cardiovascular (CV)-related rehospitalization, and their composite using Cox proportional hazards models in the propensity score-matched cohorts and pooled estimates across the 50 imputed and matched datasets using Rubin’s rules. Results: Within 1 year of discharge, 1099 participants died, 1586 were rehospitalized for CV-related reasons, and 2325 experienced either event. In pooled Cox regression analyses, outpatient PT initiation within 30 days was associated with lower all-cause mortality (hazard ratio [HR], 0.46; 95% confidence interval [CI], 0.22–0.97; p = 0.042) and the composite outcome (HR, 0.67; 95% CI, 0.48–0.94; p = 0.021), but not CV-related rehospitalization alone (HR, 0.78; 95% CI, 0.55–1.10; p = 0.178). Conclusions: Among patients with HF and study-defined CKD who were alive and free from CV rehospitalization at the 30-day landmark, early outpatient PT participation was associated with a lower risk of subsequent all-cause mortality. Given the observational design, treatment selection, and residual confounding, this finding does not establish a causal effect and requires confirmation in prospective controlled studies. Full article

Background: Autism spectrum disorder (ASD) is often diagnosed well after developmental concerns first emerge, and evidence on factors associated with the duration of the recognition-to-diagnosis pathway remains limited in the Middle East. This study aimed to identify factors associated with the overall recognition-to-diagnosis interval and potential areas for earlier recognition, referral, and access to appropriate assessment. Methods: This multisite cross-sectional survey of 384 caregivers of children with confirmed ASD was conducted across Jordanian governorates. Diagnostic timing was known for 338 participants. Five sequential nested ordinal logistic regression models were fitted on a common complete-case sample (N = 299), successively adding background characteristics, recognition, caregiver response, help-seeking route, and access/professional response variables. Robustness was assessed via grouping-specific binary models, multiple imputation, and bootstrap resampling. Results: Caregivers reported first concerns at a median age of 2.0 years. Among those with known diagnostic timing, 60.7% were in the “6 Months to 1 Year” delay category or longer, 46.2% were in the “1–2 Years” category or longer, and 24.0% were in the “More than 2 Years” category. The background characteristics model showed limited explanatory capacity (Nagelkerke R² = 0.021), and adding recognition variables did not improve model fit (p = 0.562). Fit improved significantly with caregiver response (p = 0.001), help-seeking route (p = 0.008), and access/professional response (p < 0.001). The final model reached a Nagelkerke R² = 0.178, indicating modest overall explanatory capacity. Longer diagnostic delay was independently associated with caregivers who reported that early signs had initially not been acted upon because they were interpreted as part of normal development (AOR = 2.21). It was also associated with first contact via a speech/learning center (AOR = 2.27) or other service (AOR = 2.72) rather than a pediatrician. Caregiver-reported previous professional reassurance that the child did not have ASD was also associated with longer delay (AOR = 2.18). Professional reassurance was the most consistent correlate across sensitivity analyses. Definite appointment difficulty showed a significant Yes-versus-No contrast (AOR = 1.81), although the appointment difficulty variable was not statistically significant in the global test. Sociodemographic factors showed no independent association. Among 11 exploratory barriers, only prior misdiagnosis survived multiplicity correction (AOR = 2.21). Conclusions: In this Jordanian cohort, the length of the recognition-to-diagnosis interval was associated with factors operating after developmental concerns were first recognized, rather than with the timing or breadth of recognition itself. Caregiver response, entry route into care, and professional response emerged as potentially important pathway markers. However, the modest explanatory capacity of the final model indicates that substantial variability in diagnostic delay remains unaccounted for by the measured variables. These findings support provider- and system-level measures, including clearer referral pathways, explicit follow-up when reassurance is provided, improved appointment access, and expanded diagnostic capacity, complemented by caregiver-facing information and support. Full article

Aluminum alloys used in aircraft structures are susceptible to corrosion fatigue cracking under combined aggressive environments and cyclic loading, threatening structural integrity. Pure data-driven models often fail under distribution shifts, while single-physics-informed neural networks (PINNs) lack flexibility in complex conditions. This paper proposes a dual-physics-informed neural network (DPINN) that integrates Walker and Forman crack growth models into a deep residual network. The model adaptively fuses both physical formulas via a trainable weight α and predicts material constants. A hybrid loss function with α regularization ensures physically consistent predictions. Using comprehensive corrosion fatigue data covering eight aluminum alloys, we evaluate the model on an internal test set and, more importantly, on an independent external test set simulating real-world distribution shifts. We further investigate an incremental learning scenario where the model is sequentially fine-tuned with increasing fractions of the external set. Results demonstrate that DPINN rapidly rectifies initial distribution mismatch, crossing the engineering reliability threshold (R² > 0.90) at an early incremental stage, and achieves superior performance after fine-tuning, significantly outperforming both a single Walker-PINN and gradient boosting regressors. SHAP feature importance analysis identifies ΔK and stress ratio as dominant drivers, confirming mechanistic consistency. The proposed architecture offers a data-efficient and interpretable tool for corrosion fatigue crack growth prediction in aluminum alloy structures. Full article

Anti-N-methyl-D-aspartate receptor encephalitis (anti-NMDAR-E) is a severe autoimmune encephalitis that predominantly affects young women and is frequently associated with ovarian teratomas. Increasing evidence indicates that these tumors play a central role in disease initiation by providing a peripheral immunological trigger. This comprehensive review summarizes current knowledge on the immunopathogenesis, clinical manifestations, diagnostic approach, therapeutic strategies, and long-term outcomes of ovarian teratoma-associated anti-NMDAR-E. We discuss the unique immunogenic properties of ovarian teratomas, including the presence of neuroglial tissue expressing the GluN1 receptor subunit (formerly known as NR1) of the N-methyl-D-aspartate receptor (NMDAR), dense immune cell infiltrates, and tertiary lymphoid structure-like formations that support local antibody production. These features are thought to promote molecular mimicry and loss of immune tolerance, leading to B-cell activation, intrathecal antibody synthesis, and antibody-mediated neuronal dysfunction. Furthermore, we review the characteristic multistage clinical course, key diagnostic findings in cerebrospinal fluid, imaging and electrophysiology, and the importance of early tumor removal combined with immunotherapy. Emerging therapeutic approaches and experimental models that provide insight into disease mechanisms and novel treatment targets are also highlighted. An improved understanding of tumor-driven neuroimmunological interactions is essential for earlier diagnosis, optimized treatment strategies, and better long-term outcomes in affected patients. Full article

This narrative review summarizes current data on the role of desialylation of low-density lipoproteins (LDL) as a key initiating mechanism of atherogenesis that precedes oxidative modification. The structural and functional significance of sialic acid in apolipoprotein B-100 is considered, and the enzymes of the sialidase (neuraminidase) family responsible for its cleavage are characterized. The pathogenic role of increased sialidase activity in atherosclerosis, type 2 diabetes mellitus, and other diseases is discussed. The advantages of using dietary supplements based on natural sialidase inhibitors for long-term prevention compared with synthetic drugs are shown. Examples of already existing dietary supplements with antiatherosclerotic effects are described. A separate section is devoted to computer methods (molecular docking) for searching for new sialidase inhibitors among flavonoids; according to virtual screening data, gallated catechins were identified as the most promising candidates. The feasibility of further experimental and clinical studies to create effective and safe nutraceuticals that affect the early stages of atherogenesis is substantiated. Full article

Heatstroke is a life-threatening veterinary emergency that is rarely reported in cats, particularly when secondary to household hazards such as clothes dryer entrapment. This report details the successful intensive management and clinical progression of a single feline patient presenting with severe non-exertional heatstroke and concurrent blunt force trauma following approximately 20 min of entrapment in an operating dryer. Upon presentation, the cat exhibited severe hyperthermia (43.0 °C), circulatory shock, oral hemorrhage, and generalized seizures. The rapid initiation of active cooling and aggressive hemodynamic resuscitation prevented further life-threatening complications beyond the initial day of seizures, leading to clinical stabilization and discharge on day 6 at the owner’s request, with a full recovery confirmed at a recheck appointment on day 11. Furthermore, serial biomarker tracking during hospitalization revealed a continuous elevation in feline serum amyloid A (fSAA) accompanied by intermittent hyperthermia. This sustained inflammatory response suggests that feline heatstroke shares a pathophysiological mechanism with systemic inflammatory response syndrome (SIRS). Ultimately, this case highlights the hidden but severe dangers of household appliances and suggests that early recognition and the immediate initiation of targeted therapy are critical for achieving favorable outcomes in feline non-exertional heatstroke. Full article

Background/Objectives: Idiopathic pulmonary fibrosis (IPF) may progress despite antifibrotic therapy, highlighting the need for biomarkers of early treatment-associated biological changes. This study aimed to assess the potential role of hepcidin in monitoring treatment response by evaluating pre- and post-treatment serum hepcidin levels in patients with IPF receiving antifibrotic therapy. Methods: This prospective observational cohort study included 38 clinically stable patients diagnosed with IPF according to the 2022 American Thoracic Society/European Respiratory Society (ATS/ERS)criteria between January and July 2025. Serum hepcidin was measured by ELISA at antifibrotic therapy initiation and month 3. Demographic data, pulmonary function tests, diffusing capacity for carbon monoxide (DLCO), and 6 min walk test results were recorded. Analyses were performed using SPSS 25.0. Results: Mean serum hepcidin decreased from 33.00 ± 16.74 to 24.41 ± 12.42 ng/mL (p < 0.001), with reductions observed in 30 of 38 patients (78.9%). Mean forced vital capacity (FVC) increased from 73.83 ± 18.10% predicted to 77.74 ± 15.70% predicted (p < 0.001). Median DLCO increased from 68.50 (51.00–80.50)% predicted to 72.50 (60.00–83.75)% predicted (p < 0.001). Six-minute walk distance did not change significantly (p = 0.078), nor did hemoglobin, C-reactive protein, or erythrocyte sedimentation rate. The change in hepcidin did not differ between the pirfenidone and nintedanib groups (p = 0.817). Although FVC and DLCO increased over three months, these short-term functional changes should be interpreted cautiously, as test familiarization, measurement variability, and regression to the mean cannot be excluded; therefore, they should not be considered evidence of fibrosis reversal or a direct treatment effect. Conclusions: Our study provides the first real-world data demonstrating a significant decrease in serum hepcidin following antifibrotic treatment in patients with IPF. These findings suggest that serum hepcidin may have potential clinical utility as a biomarker for assessing response to antifibrotic therapy in IPF. Full article

Vanishing twin syndrome (VTS) denotes the spontaneous loss of one conceptus from an initially recognized multiple pregnancy, most often during the first trimester. Its clinical relevance has increased with in vitro fertilization and embryo transfer (IVF-ET), as multiple embryo transfer creates the substrate for dizygotic VTS, while blastocyst transfer may be followed by monozygotic splitting and serial early ultrasonography increases detection. However, the literature remains heterogeneous, with empty gestational sacs, losses after fetal cardiac activity, and later single fetal demise often grouped together despite different biological and prognostic implications. New evidence published in recent years on frozen embryo transfer outcomes, cell-free DNA screening, and early childhood development warrants an updated synthesis of vanishing twin syndrome to inform individualized risk assessment, counselling, and standardized research reporting. Overall, the surviving singleton appears to have a lower risk than an ongoing twin pregnancy but a higher risk than a primary singleton, particularly for preterm birth, low birthweight, and small-for-gestational-age birth, with risk increasing when loss occurs after fetal cardiac activity or later in gestation. Nevertheless, evidence is not unanimous, as several well-characterized cohorts and earlier meta-analyses reported no measurable perinatal disadvantage. Two reports from a single tertiary center, based on substantially overlapping recruitment periods, further suggest that VTS may be proportionally less frequent among established twin pregnancies after IVF/ICSI than after spontaneous conception, while IVF-associated VTS has been linked to placental abnormalities, diabetes, and fetal growth restriction; this observation requires independent confirmation. Contemporary frozen embryo transfer cohorts indicate that VTS remains relevant in modern practice, whereas limited long-term data have not demonstrated impaired early childhood growth or development. Management should document the initial number of gestational sacs, embryonic structures, cardiac activity, chorionicity, and timing of loss, while adapting aneuploidy screening to residual trophoblastic DNA and individualizing fetal-growth surveillance. Elective single-embryo transfer remains the most effective preventive strategy, although it cannot eliminate monozygotic twinning. Standardized definitions and long-term offspring follow-up are needed. Full article

In this study, the effects of suppressing oxygen and moisture diffusion through the application of surface finishing materials on the initiation and progression of steel corrosion in concrete were comparatively evaluated. To this end, the type of binder and the chloride ion content were selected as the main variables, and the corrosion behavior of embedded steel was analyzed using the Half-Cell Potential Method, which enables quantitative assessment of electrochemical changes during the early stage of corrosion. Through this approach, the study aimed to provide fundamental data for establishing rational criteria for the intrinsic chloride ion content in cement. The results showed that the incorporation of ground granulated blast-furnace slag and the application of a coating were effective in delaying or reducing steel corrosion through chloride ion immobilization and the suppression of oxygen and moisture diffusion, respectively. However, under the condition of using ordinary Portland cement (OPC) alone, the likelihood of corrosion was found to increase significantly when the chloride ion content exceeded the critical threshold. Full article

The Wavepiston modular energy collector is a string of vertical ‘sails’, each comprising several vertical ‘paddles’, that respond primarily in surge to incident wave excitation. In an early device development stage, the sails were designed to allow spacing between the vertical paddles to minimise hydrodynamic forces, in extreme conditions, to improve survivability. However, the benefit for survivability was at the cost of energy absorption performance as a result of a substantial decrease in the sail excitation force. Therefore, flexible paddles, which can deform in response to large surge wave loads, are considered a feasible design strategy to minimise the energy-capture–survivability trade-off. An experimental wave tank test campaign was undertaken to investigate the response of paddle materials, with different paddle flexibility and overlaps, to wave-induced and forced motion excitation. This paper explores how different configurations of these hydroelastic structures affect the wave-induced load experienced by a fixed sail and the wave energy absorption potential of the sail. Two metrics are proposed to assess how different paddle overlaps and material properties affect device performance and survivability at particular deployment locations. The sail response is characterised and depicted through these metrics for increasing excitation amplitudes to provide initial insights into how the sail configuration design choices and materials impact the device capacity factor. Full article

Background/Objectives: Previous studies regarding the efficacy of cranial remolding orthoses (CROs) have shown that earlier treatment initiation is associated with more favorable outcomes, but there are few studies utilizing 3D-printed CROs. This study evaluated the impact of treatment initiation age on the success of 3D-printed CROs in terms of morphological measurement changes and caregiver satisfaction. Methods: A total of 1054 infants who initiated treatment with a 3D-printed CRO during 2023 across six pediatric clinics in Canada were included in this retrospective cohort study. Participants were stratified by treatment initiation age (<6 months, 6–9 months, and 9–12 months) and deformational head shape: deformational plagiocephaly (DP), deformational brachycephaly (DB), or deformational asymmetric brachycephaly (DAB). Results: Relevant pre-treatment measurements for DP were CVAI = 7.98 ± 2.30, for DB were CR = 97 ± 4%, and DAB were CVAI = 7.22 ± 2.21 and CR = 95 ± 3%. All head shapes improved during treatment and overall caregiver satisfaction was high (94.4%). A total of 66.89% of participants achieved full correction of their cranial deformation (CR ≤ 90% and CVAI < 3.5), with the highest correction observed among the youngest infants for each head shape type. Cranial correction rates were highest for DP (76.85%), followed by DAB (57.73%) and DB (54.68%). The mean correction rate varied greatly between treatment initiation age and deformation type subgroups (21.74% to 82.73%). Conclusions: Treatment with 3D-printed CROs resulted in measurement improvement across all participants and caregiver satisfaction remained high. Earlier treatment initiation was associated with significantly better correction rates, supporting early referral and intervention whenever possible. These findings provide evidence to inform clinical recommendations and support caregivers in making decisions regarding treatment for cranial deformation and appear akin to the findings of studies utilizing traditionally fabricated CROs. Full article

Both hive displacement and entrance relocation can challenge honeybee homing navigation, yet the temporal dynamics of colony-level homing behavior following hive entrance displacement remain poorly quantified. To address this, we established a non-invasive automated pipeline integrating YOLO11m-based detection, OC-SORT tracking, and the Homing Rate (HR) to monitor nine honeybee (Apis mellifera) colonies under semi-natural apiary conditions. HR links trajectory endpoints with the experimentally defined valid entrance state and provides a colony-level measure of entrance-targeting accuracy. Horizontal entrance displacement caused a substantial reduction in HR in the treated colonies, whereas the Control Group showed only a small concurrent change. During the subsequent four-day observation period, all six treated colonies displayed a similar dynamic pattern characterized by an initial rapid increase in HR, followed by a slower increase. The asymptotic exponential model provided a better descriptive representation of these temporal dynamics than a linear model. The 14-day observation of Colony A1 further revealed an early increase, a transient decline, and subsequent recovery toward a relatively stable level, indicating that the post-displacement trajectory was not strictly monotonic. Overall, this study provides an automated quantitative pipeline for continuously characterizing colony-level entrance-targeting behavior and its temporal dynamics following hive entrance displacement. Full article

Background: Organising pneumonia secondary to COVID-19 (OP-COVID-19) is a recognised inflammatory complication of SARS-CoV-2 infection. We assessed the 2-year clinical, radiological, and functional evolution of patients hospitalised with OP-COVID-19 and identified factors independently associated with long-term fibrotic-like lesions. Methods: This ambispective longitudinal study included adults consecutively hospitalised with OP-COVID-19 from March 2020 to February 2021. Diagnosis was based on clinical assessment and high-resolution computed tomography (HRCT). Patients underwent standardised follow-up at 3, 6, 12, and 24 months after hospital discharge, including clinical assessment, chest HRCT, pulmonary function tests, and the six-minute walk test. Longitudinal radiological changes were assessed using paired comparisons, and exploratory multivariable logistic regression identified factors independently associated with long-term fibrotic-like lesions. Results: OP-COVID-19 was diagnosed in 271 patients (4.9%), and 228 were included in the follow-up cohort. Inflammatory HRCT abnormalities resolved progressively, with paired comparisons showing a significant reduction in consolidations, peribronchovascular opacities, crazy-paving pattern, reversed halo sign, and perilobular opacities at 3–6 months compared with the initial HRCT (p < 0.05 for all). Among the 221 patients with an ascertainable final radiological outcome, persistent pulmonary abnormalities were observed in 14.9%, including fibrotic-like lesions in 10.4%. No statistically detectable late radiological progression was observed among patients undergoing extended imaging follow-up. The need for respiratory support during the acute phase (odds ratio [OR] 5.79, 95% confidence interval [CI] 1.81–18.52), bronchial dilatation (OR 3.50, 95% CI 1.10–11.11), and architectural distortion and/or volume loss on initial HRCT (OR 4.72, 95% CI 1.80–12.35) were independently associated with long-term fibrotic-like abnormalities. Pulmonary function was largely preserved, with mildly reduced diffusing capacity for carbon monoxide (DLCO) in the assessed subsets. Conclusions: OP-COVID-19 has a favourable long-term prognosis, with progressive resolution of inflammatory abnormalities in most patients. Fibrotic-like lesions occur in a minority of patients and are associated with greater initial disease severity and early structural abnormalities on HRCT. These findings support risk-stratified follow-up for patients with OP-COVID-19. Full article

Background/Objectives: Immune checkpoint inhibitors (ICIs) can cause pancreatic immune-related adverse events ranging from isolated pancreatic enzyme elevation to severe acute pancreatitis. This study aimed to describe the clinical presentation, diagnostic classification, management, and outcomes of ICI-related pancreatic injury in patients with lung cancer. Methods: We conducted a retrospective, single-center case series of six patients with lung cancer who developed pancreatic injury during or after ICI treatment between January 2016 and December 2024. Clinical characteristics, laboratory and imaging findings, toxicity grade, management, and outcomes were extracted from the available medical records and analyzed descriptively. Results: The median time from ICI initiation to pancreatic injury was 8.6 months (range, 2.3–16.4 months). The recorded Common Terminology Criteria for Adverse Events (CTCAE) severity grade was 2 in two patients, 3 in one patient, and 4 in three patients; pancreatic enzyme elevations were evaluated separately from clinical pancreatic adverse-event severity. Five patients required hospitalization and received supportive care, including intravenous fluids and corticosteroids. One patient received mycophenolate mofetil, and one developed acute necrotizing pancreatitis requiring intensive care, endoscopic procedures, and repeated surgical interventions. Two patients died during follow-up. In one patient, death followed a prolonged course of severe necrotizing pancreatitis complicated by infected necrosis and multiorgan failure; in the second patient, the available retrospective records did not permit reliable attribution of the cause of death to pancreatic toxicity. Immunotherapy was resumed in two patients; recurrent pancreatic enzyme elevation occurred after rechallenge, but recurrent clinically overt pancreatitis was not documented. Conclusions: ICI-related pancreatic injury has a heterogeneous clinical presentation. Pancreatic enzyme elevation alone should not be considered equivalent to acute pancreatitis. Diagnostic classification requires integration of symptoms, biochemical findings, imaging, and exclusion of alternative etiologies. Management should be individualized, and severe cases may require early multidisciplinary involvement. The benefits of corticosteroids and routine pancreatic enzyme monitoring remain uncertain. Full article