Search Results (26,243)

Dental caries is a biofilm-mediated, non-communicable, multifactorial disease in which the balance between demineralization and remineralization determines whether an initial enamel lesion remains stable, arrests, or progresses toward cavitation. Contemporary caries management prioritizes preservation of tooth structure and emphasizes individualized decisions based on lesion activity, cavitation status, cleansability, radiographic depth, and patient’s caries risk. Resin infiltration has emerged as a microinvasive approach positioned between noninvasive preventive strategies and conventional restorative treatment. This evidence-based narrative review summarizes the current literature on resin infiltration for incipient, non-cavitated proximal carious lesions in permanent teeth, with emphasis on diagnosis, case selection, clinical protocol, and current evidence. A structured search of three databases (PubMed, Embase, and the Cochrane Central Register of Controlled Trials) identified randomized clinical trials, observational clinical studies, systematic reviews, narrative reviews, and relevant in vitro investigations. The strongest clinical evidence supports resin infiltration for non-cavitated proximal lesions in permanent teeth, particularly enamel and selected outer dentin lesions, where long-term studies demonstrate reduced radiographic progression. In vitro studies indicate that lesion penetration, enamel hardness, and surface roughness depend on lesion characteristics, pretreatment, and technique, and help explain the caries-arresting effect. Current evidence shows that resin infiltration should be considered a selective microinvasive option for incipient proximal caries, guided by lesion assessment and patient’s caries risk rather than a universal substitute for prevention or restoration. Full article

Adaptive decision-making has emerged as an important direction in audio classification. Reinforcement learning (RL) and multi-armed bandit (MAB) methods offer principled frameworks for sequential and localized decision-making. However, despite growing interest in these approaches and the availability of review studies on audio classification and audio-based learning, their role within the audio classification pipeline remains fragmented and has not been systematically synthesized. This study presents a systematic review of RL- and MAB-based approaches in audio classification, to characterize how adaptive decision-making is formulated, where it is applied within the pipeline, and what impact it has on system performance, robustness, and efficiency. The review followed PRISMA guidelines. A literature search across IEEE Xplore, Scopus, Nature, and Google Scholar identified 1896 records. Thirty-one studies met the predefined inclusion criteria and data were extracted for analysis. Reporting quality was assessed using the TRIPOD framework, and methodological reliability was evaluated using a domain-specific risk-of-bias tool. The findings show that adaptive decision-making in audio classification is evolving toward a control-centric paradigm. RL-based optimization and control approaches dominated the literature, whereas bandit-based approaches remained comparatively underused. A central finding of the review is a structural mismatch between problem type and method choice. Many adaptive tasks are inherently local and repeated decision problems, yet they are predominantly addressed using full RL frameworks rather than lighter bandit formulations. This review introduces a taxonomy of adaptive decision-making mechanisms and proposes a unified framework that reframes audio classification as a layered decision-making process under uncertainty. The evidence suggests that the future of audio classification lies not only in improved prediction, but in adaptive decision-making architectures capable of managing uncertainty, variability, and real-world deployment constraints. Full article

Background/Objectives: Achondroplasia is the most common genetic skeletal dysplasia associated with disproportionate short stature and is primarily caused by gain-of-function variants in the fibroblast growth factor receptor 3 (FGFR3) gene. Constitutive FGFR3 activation disrupts growth plate homeostasis and endochondral ossification through complex alterations in chondrocyte proliferation, differentiation, hypertrophy, extracellular matrix organization, and intracellular signaling. The increasing understanding of these mechanisms has enabled the transition from exclusively supportive management toward disease-modifying and precision-based therapeutic strategies. This narrative review aimed to critically synthesize current evidence on the genetic basis, molecular pathogenesis, growth plate abnormalities, and current and emerging targeted therapies in achondroplasia. Methods: A narrative literature review was conducted using PubMed/MEDLINE, Scopus, and Web of Science Core Collection, with Google Scholar used as a supplementary source, together with manual screening of the reference lists of relevant original studies, clinical trials, reviews, consensus documents, and clinical guidelines. The principal literature search covered publications from January 2010 to March 2026, while selected seminal primary studies published before 2010 were included when necessary to document the original identification of pathogenic FGFR3 variants and foundational mechanisms of FGFR3-mediated growth plate regulation. Particular emphasis was placed on FGFR3 variants, receptor activation mechanisms, growth plate dysfunction, intracellular signaling pathways, vosoritide, C-type natriuretic peptide-based therapies, FGFR3 inhibitors, ligand–receptor blockade, drug repurposing, Wnt/β-catenin modulation, and gene-based therapeutic approaches. Results: Achondroplasia is characterized by marked molecular homogeneity, with the recurrent p.Gly380Arg substitution accounting for most cases. Mutant FGFR3 displays sustained activity through partial ligand independence, enhanced receptor dimerization and kinase activation, increased receptor stability, and reduced degradation. Excessive signaling through MAPK/ERK, STAT, PI3K/AKT, IHH/PTHrP, and related pathways impairs chondrocyte proliferation and hypertrophic differentiation, alters extracellular matrix turnover, disrupts primary cilium function, and reduces longitudinal bone growth. Vosoritide provides clinical proof that pharmacological modulation of FGFR3-related signaling can improve growth velocity. Additional therapeutic strategies under clinical or preclinical investigation include long-acting CNP analogues, selective FGFR inhibitors, decoy receptors, RNA aptamers, repurposed drugs, Wnt/DKK1 pathway modulation, and gene- or enhancer-targeted interventions. Conclusions: Achondroplasia is increasingly understood as a disorder of dysregulated growth plate signaling rather than solely a condition of reduced stature. Although vosoritide has established the feasibility of disease-modifying treatment, substantial uncertainty remains regarding final adult height, skeletal proportionality, cranio-spinal development, orthopedic outcomes, and long-term safety. Future progress will depend on mechanistically informed therapeutic combinations, improved biomarkers, advanced cellular and animal models, and long-term clinical and real-world evidence. Full article

Accurate pavement distress identification is essential for infrastructure maintenance. However, prevailing models frequently underperform in complicated environments due to extreme scale variations, atypical defect geometries, and severe background noise. To mitigate these limitations, this study presents BDC-YOLO, an upgraded detection network built upon the YOLOv8 baseline. The proposed architecture structurally incorporates three specialized mechanisms: Bi-level Routing Attention (BRA) to isolate relevant target features from background artifacts; Dynamic Snake Convolution (DySnakeConv) to capture the topological characteristics of elongated and irregularly shaped cracks; and Content-Aware ReAssembly of FEatures (CARAFE) to minimize information degradation during upsampling and refine multi-scale feature fusion. Evaluated on the RDDChina dataset, BDC-YOLO demonstrates superior accuracy over the baseline and comparative state-of-the-art methods. Specifically, the framework yields a mAP_0.5 of 88.9%, representing an absolute gain of 4.7% against the standard YOLOv8 model while achieving an inference speed of 175.4 FPS. Full article

This study proposes an innovative framework that combines hydroclimatic and agro-environmental predictors, including nitrate concentration and NDVI, with climatic factors such as Rainfall, temperature, and evapotranspiration to forecast piezometric level variations in the Saïss Basin, Morocco. Eight Machine Learning (ML) models were benchmarked, and feature importance was assessed using Shapley Additive exPlanations (SHAP) to ensure model transparency and interpretability. In parallel, the PELT algorithm was applied to detect structural change points, while Sen’s slope estimator and the Mann–Kendall test were used to quantify long-term trends. The Extra Trees (ET) model achieved the best performance (R² = 0.92), with Rainfall emerging as the most influential predictor, followed by nitrate concentration, confirming the added value of hydrochemical indicators for groundwater forecasting. Change-point analysis revealed significant declines during the 1980s and 1990s, followed by lower-amplitude fluctuations since the late 2000s. Projections toward 2050 suggest partial stabilization in the central part of the basin under favorable recharge conditions, whereas persistent declines are expected to continue in peripheral areas subjected to sustained groundwater abstraction pressure. These findings provide a robust and transferable decision-support tool for the sustainable management of groundwater resources in semi-arid agricultural area. Full article

With the rapid evolution of next-generation mobile communications, semantic communication has emerged as an intelligent communication paradigm capable of surpassing the Shannon limit. A fundamental prerequisite for this paradigm is the synchronization of background knowledge between the transmitter and receiver, making the semantic knowledge base (SKB) a critical cornerstone. However, effectively selecting appropriate content from massive cloud-based knowledge repositories for edge deployment remains a significant challenge. This paper conducts systematic research to address the key issues in the flow deployment of SKBs at the edge, including insufficient adaptation to personalized preferences, inadequate timeliness management, and the complexity of multi-objective optimization. First, a comprehensive system model is constructed, integrating user preferences, knowledge relevance, transceiver matching degree, and the Age of Information (AOI). Second, the Generative Adversarial Network (GAN)-assisted Preference-based Reinforcement Learning (GaPbRL) algorithm is proposed. The experimental results demonstrate that this method outperforms traditional schemes in terms of knowledge-base hit rate, transceiver matching degree, and algorithm convergence speed, while significantly reducing the overhead of manual fine-tuning. This study provides a robust framework for the personalized and efficient cloud–edge collaborative deployment of SKBs. Full article

Background/Objectives: Obstructive sleep apnea (OSA) is a highly prevalent sleep-related breathing disorder caused by recurrent upper-airway collapse during sleep, leading to intermittent hypoxia, sleep fragmentation, and excessive daytime sleepiness. Although continuous positive airway pressure (CPAP) remains the first-line therapy, long-term adherence is often suboptimal, underscoring the need for more tolerable and flexible treatment options. This review aims to summarize the pathophysiological rationale for pharmacotherapy in OSA and to discuss recent developments in drug-based interventions. Methods: We conducted a narrative review of the literature on pharmacological interventions for OSA, with a systematic search of PubMed, Embase, Cochrane Library, and ClinicalTrials.gov up to 4 August 2026. We included randomised controlled trials, observational studies, meta-analyses, and mechanistic human or animal studies that reported relevant sleep and respiratory outcomes, and graded evidence according to the principles of GRADE framework. Results: Several drug classes have shown promise: agents that increase upper-airway dilator muscle activity, respiratory stabilizers that reduce loop gain, medications that raise the arousal threshold, topical anti-inflammatory drugs for mucosal edema, and systemic metabolic modulators such as glucagon-like peptide-1 receptor agonists and dual incretin receptor agonists. Emerging strategies, including gene therapy directed at the hypoglossal motor system, are also under investigation at the preclinical stage. Moreover, combining pharmacotherapy with CPAP or other devices can produce synergistic benefits, enabling lower device pressures and enhanced patient comfort. Conclusions: Pharmacotherapy for OSA is progressively moving from exploratory research towards targeted, phenotype-driven personalized treatment. Future studies should focus on robust patient phenotyping, multi-mechanistic combination regimens, and long-term clinical outcome evaluations to facilitate the integration of drug-based therapies into routine OSA management, particularly in specific subgroups such as those with COMISA. Full article

Endovascular aortic aneurysm repair (EVAR) has become the first-line treatment for abdominal aortic aneurysms (AAA); however, its long-term durability is affected by Type II endoleak. This narrative review describes the evolution of sac filling techniques and concepts developed to address this complication. In selected cases of diagnosed Type II endoleaks, early therapeutic sac filling, while clinically indicated, is frequently constrained by difficult access, variable success rates, and recurrence. Consequently, prophylactic sac filling during primary EVAR has been adopted as an alternative approach, with reported high technical success and reduced endoleak incidence. The subsequent Nellix Endovascular Aneurysm Sealing (EVAS) system, although early results showed technical feasibility, was associated with graft migration, endobag separation, and reintervention at long-term follow-up, leading to its withdrawal from the market. Currently, devices based on shape memory polymer (SMP) provide early observations of decreased endoleaks and sac regression. This review outlines the transition from reactive management to preventive strategies, and, more recently, to patient-specific, material-based approaches, while showcasing emerging strategies that may influence long-term EVAR outcomes. However, these novel approaches remain under investigation, and larger controlled studies with extended follow-up are required to establish their clinical utility. Full article

Background: The menopausal transition may be accompanied by several disabling symptoms which impair quality of life. Many women cannot proceed with and/or refuse hormonal replacement therapy (HRT) and, thus, they rely on non-hormonal remedies to manage climacteric syndrome. Methods: This was a retrospective study analyzing the impact of a combination of Purified Cytoplasm of Pollen (PCP) with vitamin D (vitD) and vitamin K2 (vitK2) on menopausal symptoms and bone parameters in a sample of symptomatic women (Group A, n = 22) compared to controls (Group B, n = 23). Results: We found that blood levels of vitD (25OHD) significantly increased within Group A (p = 0.0004) whereas no significance was reached within Group B (p > 0.05) after a three-month therapy. Compared with the baseline, serum C-terminal telopeptide of type I collagen (CTX) turned out to be significantly reduced within Group A (p = 0.0415) but not within Group B (p > 0.05). Comparing Group A and Group B, the values of CTX significantly differed after treatment (p = 0.0458). In comparison to the baseline, significant differences emerged within Group A for physical, psychosocial, and vasomotor domains of Menopause-Specific Quality of Life (MenQol) (p < 0.05) whereas no significant difference was found for the sexual domain (p > 0.05). Comparing Group A and Group B, significant differences were observed for all MenQol domains (p < 0.05), except for the sexual domain (p > 0.05) after therapy. Conclusions: Based on our findings, the combination of PCP, vitD, and vitK2 could be used for managing vasomotor and mood disturbances associated with menopause, whilst also offering the added benefit of maintaining bone health. Full article

Background: Ovarian torsion is a pediatric surgical emergency in which timely diagnosis and preservation of ovarian tissue are important considerations for future reproductive and endocrine function. This study aimed to describe the clinical characteristics, diagnostic evaluation, surgical management, and outcomes of pediatric ovarian torsion and explore factors associated with ovarian preservation and oophorectomy. Methods: A retrospective, single-center cohort study was conducted including 56 girls with surgically confirmed ovarian torsion treated at a tertiary pediatric center between January 2010 and December 2025. Secondary analyses of factors associated with oophorectomy were considered exploratory. Demographic, clinical, imaging, operative, and outcome data were extracted from medical records. Variables included symptom duration, degree of torsion, laterality, diagnostic assessment, gynecologist consultation, associated pathology, intraoperative macroscopic color change following detorsion, oophoropexy, oophorectomy, postoperative complications, and recurrence. Univariable comparisons were performed using the Mann–Whitney U test, chi-square test, Fisher’s exact test, or Monte Carlo exact test, as appropriate. Exploratory multivariable logistic regression, supplemented by Firth penalized logistic regression, was performed in the postnatal cohort to assess factors associated with oophorectomy. Results: The median age at diagnosis was 10 years (range 0–17) and the median duration of symptoms before admission was 18 h (IQR 8–72). Ovarian preservation was achieved in 35 patients (62.5%), whereas complete oophorectomy or adnexectomy was performed in 21 (37.5%). Complete macroscopic color change following detorsion was observed in 19 patients (33.9%), partial color change in 13 (23.2%), and no macroscopic color change in 24 (42.9%). Prenatal ovarian torsion represented a clinically distinct subgroup and was associated with a high oophorectomy rate (8/8, 100%), compared with 13/48 (27.1%) among patients with postnatal torsion (p < 0.001). In the postnatal cohort, complete oophorectomy or adnexectomy occurred in 19.4% of patients with preoperative gynecologist consultation and 41.2% of those without consultation (unadjusted OR 0.34, 95% CI 0.09–1.28; p = 0.173). In exploratory multivariable analysis adjusting for age and calendar period, preoperative gynecologist consultation was not independently associated with oophorectomy (adjusted OR 0.41, 95% CI 0.09–1.78; p = 0.234); Firth penalized regression yielded similar results. Associated pathology was identified in 66.1% of patients. Documented recurrence occurred in three patients (5.4%), and postoperative complications were uncommon (3.6%). Conclusions: Ovarian preservation was achieved in more than half of pediatric patients with ovarian torsion, whereas prenatal torsion was associated with a high oophorectomy rate. Preoperative gynecologist consultation was associated with a numerically lower unadjusted oophorectomy rate; however, this association was not statistically significant in either unadjusted or adjusted analyses, and residual confounding and changes in clinical practice over the 15-year study period cannot be excluded. Full article

Background and Objectives: The 2024 Korean medical–political conflict caused the mass resignation of trainee physicians, raising concerns about the quality of care for time-critical emergencies. This study aimed to assess the impact of workforce disruptions on the management and outcomes of adults presenting to the emergency department (ED) with septic shock. Materials and Methods: This retrospective single-center cohort study was conducted at a tertiary care ED and included adults with septic shock between September 2022 and August 2025. This study compared the pre-conflict period, operating under a resident-supported model, with the conflict period characterized by a specialist-led staffing model. The primary outcome was the all-cause in-hospital mortality. The secondary outcomes included process-related time intervals and clinical course measurements. Multivariate logistic regression was used to identify the independent predictors of mortality. Results: Altogether, 343 patients were included (159 pre-conflict, 184 conflict). During the conflict, ED crowding significantly decreased (average concurrent ED patients: 14.9 vs. 7.6, p < 0.001). Key diagnostic process metrics, including time to blood gas analysis, blood sampling, blood culture, computed tomography, and total ED length of stay, were significantly shortened. Time-critical therapeutic intervals, such as time to empirical antibiotics, remained unchanged. In-hospital mortality did not differ significantly between the pre- and conflict periods. Multivariate analysis demonstrated that the conflict period was not independently associated with mortality; only initial serum lactate levels and Acute Physiology and Chronic Health Evaluation II scores remained significant predictors. Conclusions: The 2024 Korean medical–political conflict was not associated with increased in-hospital mortality among patients with septic shock. Process-related metrics improved, while key therapeutic intervals and overall clinical outcomes remained stable. These findings may reflect reduced ED crowding, organizational adaptation, and continued adherence to established septic shock management practices. Reduced ED volume likely contributed substantially to improvements in diagnostic and throughput-related processes. Full article

The surgical management of rectal cancer has evolved from open resection to laparoscopic and, more recently, robotic minimally invasive approaches. Laparoscopy established the short-term benefits of minimally invasive rectal surgery but is limited within the confines of the bony pelvis, prompting adoption of the robotic platform with its three-dimensional visualization, wristed instruments, and tremor filtration. Whether these refinements translate into measurable clinical benefit remains debated. This narrative review compares the two approaches across oncologic, perioperative, functional, and economic domains. Pathologic outcomes are broadly equivalent, though contemporary evidence—most notably the REAL trial—suggests a possible emerging robotic advantage, although further study is necessary in this regard. Robotic surgery offers potential advantages in conversion rates, blood loss, and postoperative urinary and sexual function, while laparoscopy retains advantages in operative time and cost. At present, platform choice should be guided by patient anatomy, tumor characteristics, and surgical expertise, with robotic surgery likely most valuable in anatomically challenging cases where laparoscopy is most limited. Full article

A standardized extract of cultured Lentinula edodes mycelia (ECLM), commercially known as AHCC^®, shows anti-inflammatory, immunomodulatory, and organ-protective properties. Experimental studies have indicated that ECLM modulates innate and adaptive immunity, including natural killer (NK) cell activity, antigen-presenting cell function, T-cell responses, and cytokine balance. These effects are particularly relevant in oncology because surgical stress and ischemia–reperfusion injury (IRI) generate a transient perioperative environment characterized by immune suppression, inflammation, and conditions favorable for metastatic progression. Recent animal studies have demonstrated the protective effects of ECLM in intestinal and hepatic IRI models, providing a potential mechanistic rationale for improving the perioperative host microenvironment. Clinical studies on hepatocellular carcinoma, pancreatic cancer, and gynecological malignancies suggest that ECLM may offer potential benefits in immune preservation, nutritional support, symptom management, and recurrence prevention, although most studies are small and hypothesis-generating. Emerging evidence from patient-derived xenograft and spontaneous carcinogenesis models further suggests that ECLM may influence tumor biology beyond host immune activation, although the underlying mechanisms require elucidation. This review summarizes the mechanistic, preclinical, translational, and clinical evidence supporting the use of ECLM as a candidate for perioperative immunonutritional strategies. We propose the hypothesis that ECLM may function as a perioperative microenvironmental stabilizer that integrates immune preservation and intestinal barrier protection. Full article

The transition to a new industrial paradigm beyond Industry 5.0 demands hyperconnectivity and massive processing, creating a paradox where high computational demand can threaten corporate sustainability goals (ESG). This study aims to structure and prioritize a Multilayer Framework of multicloud technologies to balance disruptive advances, lean optimization, and decarbonization. A mixed, sequential, and exploratory-normative approach was used. Initially, the literature was triangulated with expert panels and suppliers to map 21 technological functionalities, structuring them into four layers of a bidirectional value flow. Then, a hybrid multi-criteria modeling (AHP-TOPSIS) was applied to rank these technologies against five market constraints. Calibration with AHP revealed that Cyber Resilience, approximately 38%, and Process Optimization, approximately 27%, lead executive priorities, surpassing environmental impact or cost efficiency. As a result, the TOPSIS ranking highlighted Human–Machine Symbiosis (BCI/neuroergonomic readiness), Zero Trust architecture, Federated Learning, and GenAI KPI Analytics as the leading functionalities in their respective layers, with Hyper-BPM emerging as a closely associated optimization engine at the governance layer. Finally, the proposed roadmap was assessed using an anonymized industrial Proof of Concept (PoC) in a brownfield advanced manufacturing facility, providing evidence of its operational feasibility for integrating lean optimization with legacy systems and ESG-oriented monitoring. It is concluded that industrial sustainability does not rely solely on green technologies, but on decentralized orchestration along the Edge-Cloud continuum. Environmental gains are therefore more likely to emerge when cyber governance and lean-oriented operational management jointly support decentralized multicloud orchestration. Full article

Infective endocarditis (IE) continues to represent a major challenge for global health systems. In 2019, its annual incidence was estimated at 13.8 cases per 100,000 individuals, contributing to approximately 66,300 deaths worldwide. Due to its high morbidity and mortality rates, enhancing preventive measures has become a priority in both clinical practice and ongoing research efforts. Since the publication of the 2015 ESC Guidelines for the management of IE, several pivotal studies have emerged, prompting a re-evaluation and potential update of the existing recommendations. One growing concern is the increasing antibiotic resistance among oral streptococci, particularly to macrolides such as azithromycin and clarithromycin, which now show higher resistance levels than penicillin. Changes in national antibiotic stewardship programs may have inadvertently contributed to a rise in IE incidence, in part due to altered prophylactic practices. At the same time, advances in diagnostic modalities—including more widespread and targeted use of echocardiography in patients with positive blood cultures for organisms like Enterococcus faecalis, Staphylococcus aureus, and various streptococci—have likely improved detection rates. Additionally, innovations in imaging, particularly computed tomography (CT) and nuclear medicine techniques, have enhanced the diagnosis of IE, especially among patients with prosthetic heart valves or implantable cardiac devices. This has allowed for better characterization of patient populations, aiding in the refinement of diagnostic criteria and therapeutic approaches. Furthermore, updated antibiotic treatment protocols, informed by EUCAST’s antimicrobial susceptibility data, have helped tailor antimicrobial regimens to current resistance trends. The combination of improved diagnostic sensitivity and evolving microbial resistance patterns has also led to an increased number of patients being considered for cardiac surgery as part of their treatment pathway. This review seeks to synthesize the latest findings and guideline revisions, offering an integrated overview of recent progress in the diagnosis, medical treatment, and surgical management of infective endocarditis. It will also explore current therapeutic strategies and operative indications in light of the most recent evidence. Full article