Search Results (259)

Background: Extremely premature neonates are at increased risk for respiratory complications, often resulting in recurrent hospitalizations during early childhood. Early identification of preterm infants at highest risk of respiratory hospitalizations could enable targeted preventive interventions. While clinical and demographic factors offer some prognostic value, integrating transcriptomic data may improve predictive accuracy. Objective: To determine whether early-life gene expression profiles can predict respiratory-related hospitalizations within the first four years of life in extremely preterm neonates. Methods: We conducted a retrospective cohort study of 58 neonates born at <32 weeks’ gestational age, using publicly available transcriptomic data from peripheral blood samples collected on days 5, 14, and 28 of life. Random forest models were trained to predict unplanned respiratory readmissions. Model performance was evaluated using sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUC). Results: All three models, built using transcriptomic data from days 5, 14, and 28, demonstrated strong predictive performance (AUC = 0.90), though confidence intervals were wide due to small sample size. We identified 31 genes and eight biological pathways that were differentially expressed between preterm neonates with and without subsequent respiratory readmissions. Conclusions: Transcriptomic data from the neonatal period, combined with machine learning, accurately predicted respiratory-related rehospitalizations in extremely preterm neonates. The identified gene signatures offer insight into early biological disruptions that may predispose preterm neonates to chronic respiratory morbidity. Validation in larger, diverse cohorts is needed to support clinical translation. Full article

Mango is highly sensitive to heat stress, which directly affects the yield and quality. The extreme heat waves of 2024, with temperatures reaching 41–47 °C over 25 days, caused significant impacts on sensitive cultivars. The impact of heat waves on ten commercial cultivars from subtropical regions viz.,‘Dashehari’, ‘Langra’, ‘Chausa’, ‘Bombay Green’, ‘Himsagar’, ‘Amrapali’, ‘Mallika’, ‘Sharda Bhog’, ‘Kesar’, and ‘Rataul’, and thirteen selected elite hybrids H-4208, H-3680, H-4505, H-3833, H-4504, H-1739, H-3623, H-1084, H-4264, HS-01, H-949, H-4065, and H-2805, is reported. The predominant effects that were observed include the following: burning symptoms or blackened tips, surrounded by a yellow halo, with premature ripening in affected parts and, in severe cases, tissue mummification. Among commercial cultivars, viz., ‘Amrapali’ (25%), ‘Mallika’ (30%), ‘Langra’ (30%), ‘Dashehari’ (50%), and ‘Himsagar’ and ‘Bombay Green’ had severe impacts, with ~80% of fruits being affected, followed by ‘Sharda Bhog’. In contrast, mid-maturing cultivars like ‘Kesar’, ‘Rataul’, and late-maturing elite hybrids, which were immature during the stress period, showed no symptoms, indicating they are tolerant. Biochemical analyses revealed significantly elevated total soluble solids (TSS > 25 °B) in affected areas of sensitive genotypes compared to non-affected tissues and tolerant genotypes. Aroma profiling indicated variations in compounds such as caryophyllene and humulene between affected and unaffected parts. The study envisages that the phenological maturity scales are indicators for the selection of climate-resilient mango varieties/hybrids and shows potential for future breeding programs. Full article

Background: Poststroke dysphagia is a common condition that can lead to complications such as aspiration pneumonia and malnutrition, significantly affecting the quality of life. Most patients recover their swallowing function spontaneously, but in others difficulties persist beyond six months. Can we predict this in advance? On the other hand, there have been recent attempts to use machine learning to predict disease prognosis. Therefore, this study aims to investigate whether machine learning can predict the long-term prognosis for poststroke dysphagia using early videofluoroscopic swallowing study (VFSS) data. Methods: Data from VFSSs performed within 1 month of onset and swallowing status at 6 months were collected retrospectively in patients with dysphagia who experienced their first acute stroke at a university hospital. We selected 14 factors (lip closure, bolus formation, mastication, apraxia, tongue-to-palate contact, premature bolus loss, oral transit time, triggering of pharyngeal swallow, vallecular residue, laryngeal elevation, pyriform sinus residue, coating of the pharyngeal wall, pharyngeal transit time, and aspiration) from the VFSS data, scored them, and analyzed whether they could predict the long-term prognosis using five machine learning algorithms: Random forest, CatBoost classifier, K-neighbor classifier, Light gradient boosting machine, Extreme gradient boosting. These algorithms were combined through an ensemble method to create the final model. Results: In total, we collected data from 448 patients, of which 70% were used for training and 30% for testing. The final model was evaluated using accuracy, precision, recall, F1-score, and Area Under the Receiver Operating Characteristic Curve (AUC), resulting in values of 0.98, 0.94, 0.84, 0.88, and 0.99, respectively. Conclusions: Machine learning models using early VFSS data have shown high accuracy and predictive power in predicting the long-term prognosis of patients with poststroke dysphagia, and they are likely to provide useful information for clinicians. Full article

Objectives: Kangaroo care is vital for the development of premature and low-birthweight infants. However, detailed data on skin-to-skin times, especially for extremely preterm infants in NICUs, is lacking. This study quantifies skin-to-skin times for these infants at the neonatology department in Salzburg, considering factors like the COVID-19 pandemic, the opening of Ronald McDonald House, and sibling presence. Methods: We retrospectively analyzed data from the first eight weeks of life of 93 extremely preterm infants (<28 gestational weeks, <1500 g birth weight) treated at the Salzburg NICU from 2019 to 2023. Skin-to-skin times were recorded to the minute. Results: The mean value skin-to-skin time per visiting day was 241 min (±83), skin-to-skin was performed on 79.0% (±16.8) of the days of stay examined. During the pandemic, skin-to-skin care was performed on 64% of visit days, after the pandemic on 91% (p < 0.001). Before the Ronald McDonald House opened, the skin-to-skin time per visiting day was 215 min (±57.9), afterwards it was 273 min (±97) (p = 0.001). For Primipara the Kangaroo-Care time per day of visit was 257 min (±93), for Multipara 217 min (±52) (p = 0.043). Conclusions: Skin-to-skin is crucial for extremely premature infants and can be implemented for many hours a day. It is an integral part of parent-child interaction in a neonatal intensive care unit. External factors such as infrastructure, pandemic restrictions or siblings have a significant impact on skin-to-skin. Full article

Intraventricular hemorrhage (IVH) is a common complication encountered in extremely-low-birth-weight (ELBW) and very-low-birth-weight (VLBW) premature babies. The neurologic outcome of these patients is influenced by the magnitude of the hemorrhagic process that damages the involved anatomic structures but also by the impaired circulation of cerebrospinal fluid (CSF) through the ventricular system, leading to posthemorrhagic ventriculomegaly (PHVM). Cranial ultrasound (CUS) performed by neonatologists (point-of-care ultrasound—POCUS) facilitates the early diagnosis of IVH and PHVM and can objectively quantify structural alterations. Our aim was to identify the best sonographic criteria to follow-up with ventricular dilatation and predict the need for neurosurgery and neurologic deterioration. We performed a literature review in search of the most relevant ventricular measurements considered by neurosurgeons, neonatologists, and pediatric neurologists to reflect the risk of white matter injury and high intracranial pressure (HIP), thus anticipating neurologic developmental impairment (NDI). The tridimensional picture of ventricular dilatation is best captured if more than one index (ventricular index and anterior horn width) or ratio (Evans ratio, fronto-occipital horn ratio, and fronto-temporal horn ratio) is used. Conclusions: If performed using the correct protocol, serially and comprehensively, CUS is an indispensable tool for the diagnosis and follow-up of neurologic complications of preterm babies, and it can make a difference in guiding adequate intervention and improving long-term developmental outcomes. Full article

Dothistroma needle blight (DNB) is one of the most significant diseases of conifers, causing premature defoliation, growth reduction, and, in extreme cases, mortality. Histological analysis was undertaken on inoculated seedlings of three different seed sources of Pinus sylvestris L. to investigate the process of infection and degradation of needle tissue on this host species. Seedlings were inoculated using a single spore isolate of Dothistroma septosporum (Doroguine) M. Morelet (D636) from northern Scotland. Mesophyll degradation in the needles occurred by four weeks after inoculation; collapse of mesophyll, bundle sheath tissues, and tracheids by five weeks; and eruption of fruiting bodies in near proximity to stomatal openings by six weeks. Significantly greater collapse of mesophyll during the early stages of infection occurred in the Austrian provenance compared with the United Kingdom provenance, although in the later stages of infection, this difference disappeared. Furthermore, disease severity, assessed as the proportion of needles with D. septosporum conidiomata on each tree, was not significantly different between seed sources. Full article

Background/Objectives: Postnatal growth faltering (PGF) significantly affects premature neonates, leading to compromised neurodevelopment and an increased risk of long-term health complications. Methods: This retrospective study at a level III NICU of a tertiary hospital analyzed 650 preterm neonates born before 33 weeks. Postnatal growth was evaluated using the Fenton2013 and INTERGROWTH-21st growth charts, with changes in weight z-scores from birth to discharge classified as normal growth (ΔZ ≥ −1), non-severe PGF (−2 ≤ ΔZ < −1), and severe PGF (ΔZ < −2). Results: Mean gestational and postmenstrual age at discharge was 30 weeks (SD 1.9) and 37.1 weeks (SD 2.7), respectively. Fenton2013 growth curves revealed a higher prevalence of non-severe and severe PGF (43% and 14.6%) compared to INTERGROWTH-21st (24.5% and 10.3%). A more rapid establishment of full enteral feeds was strongly associated with reduced severe PGF prevalence in both growth charts (p < 0.001), as was shorter hospitalization. Late-onset sepsis was associated with an increased risk of severe PGF, while being small for gestational age (SGA) was protective against severe PGF across both growth charts (p < 0.001). A trend of decreasing PGF prevalence was noted over the study years, most probably attributed to the implementation of updated nutritional guidelines. Interestingly, when machine learning classification models were evaluated in our Greek cohort, a notable decline in predictive accuracy depending on the growth standard applied was observed. Conclusions: Our study highlights the need for standardizing PGF definition in an attempt to enhance nutritional management and further investigate the long-term impacts of nutritional interventions on growth, neurodevelopment, and overall health outcomes. Full article

Climate change negatively affects agricultural productivity by altering weather patterns, increasing the frequency of extreme events, and disrupting growing seasons. These changes lead to reduced crop yields, soil degradation, and challenges to food security. This research investigates how climate change affects plant cultivation and agricultural farming operations in Khemisset Province of Morocco. A research study based on surveys of 120 farmers combines quantitative and qualitative methods to determine their views about climate change and their adaptive measures. The researchers select their farmers according to land conditions, plant life, and livestock management patterns. The obtained data demonstrate climate parameter deterioration throughout the period extending from 1985 to 2015, which corresponds with meteorological measurements. Climate variability produces adverse environmental effects which negatively affect agricultural output. The Zemmour tribe members and other farmers use different agricultural adaptation strategies, including fertilizer application, rotational cropping, and planting maturation-premature seeds. The research findings highlight the necessity of developing specific adaptation methods that defend agricultural sectors against climate change risks and secure food supplies. This investigation adds to climate resilience knowledge by delivering important findings that guide agricultural sustainability policy development and implementation. Full article

Background: Cervical insufficiency (CI) is a painless cervix dilation in the second or early third trimester due to a structural or functional defect. However, CI is often diagnosed retrospectively. A cervix with CI cannot retain the fetus. This condition significantly increases the morbidity associated with extreme prematurity. Women diagnosed with cervical incompetence and dilatation in the mid-second trimester are offered interventions to prolong the duration of pregnancy, with the mainstay of therapy being emergency cerclage. A prophylactic cerclage may be offered to women with a history of extremely preterm birth due to isthmic cervical incompetence. Aim: The aim of this study was to evaluate the perinatal outcomes of elective and emergency cerclages. Materials and Methods: A 10-year retrospective analysis, from 1 January 2015 to 29 February 2024 of pregnancies with indications for cervical cerclage, was conducted. Obstetric and neonatal outcomes were assessed. Results: Prophylactic cervical cerclage was performed in 43 (57%) and emergency cerclage in 32 (43%) of all analyzed cases. The mean prolongation of gestation (measured as the period between cerclage insertion and delivery) was higher in the elective cerclage group compared with the emergency cerclage group (18.6 ± 5.4 vs. 12.2 ± 6.4 weeks; p < 0.0001). The mean gestational week at cerclage removal was also higher in the elective group (36.1 ± 2.2 vs. 31.4 ± 5.6 weeks; p < 0.001). Deliveries in the extreme prematurity period (before 28 completed weeks of gestation) were five times more often in the rescue cerclage group. A significantly higher mean birthweight was reported in the elective cerclage group, at 2920.4 ± 946.8 g vs. 2078.8 ± 1147.8 g (p = 0.0004). Emergency cerclage insertion was associated with a higher need for NICU hospitalization (28% vs. 5%, p = 0.003), continuous positive airway pressure (38% vs. 2%, p < 0.0001), and intubation (22% vs. 0%, p = 0.003). Conclusions: While elective cerclage is associated with more favorable perinatal and neonatal outcomes, this likely reflects earlier intervention in lower-risk pregnancies rather than inherent superiority of the approach. Emergency cerclage, performed under urgent and often suboptimal conditions, remains a critical and effective intervention capable of prolonging gestation and improving neonatal survival in high-risk cases. Full article

Climate-change-induced extreme environments exacerbate pavement degradation in arid regions, where traditional concrete incurs 23~40% higher life-cycle costs due to premature cracking. Particularly in the Gobi Desert, concrete pavements suffer from conflicting performance requirements—high flexural-to-compressive strength ratio (R_f/R_c), low shrinkage, and controlled porosity—with traditional design methods failing to address multi-objective trade-offs. Existing optimization methods have proven insufficient for such complex environments, with conventional approaches addressing only individual parameters or employing subjective weighting techniques that fail to capture the interrelated nature of critical performance indicators. This study develops an integrated optimization framework combining Response Surface Methodology (RSM), Non-dominated Sorting Genetic Algorithm III (NSGA-III), Criteria Importance Through Intercriteria Correlation (CRITIC) weighting, and VIšekriterijumsko KOmpromisno Rangiranje (VIKOR) decision-making to optimize the mix proportions water–cement ratio (W/C), sand ratio, and an air-entraining agent (AEA) for sustainable pavement concrete. Response Surface Methodology (RSM) analysis via Box–Behnken design revealed distinct parameter dominance: AEA exhibited the strongest non-linear effects on R_f/R_c and porosity, while W/C primarily governed shrinkage. NSGA-III generated 73 Pareto-optimal solutions, with CRITIC selecting an optimal mix (W/C = 0.35), sand ratio = 36%, AEA = 0.200%) validated experimentally (R_f/R_c = 0.141), shrinkage = 0.0446%, porosity = 2.82%. Microstructural characterization using scanning electron microscopy and low-field nuclear magnetic resonance (SEM/LF-NMR) demonstrated refined pore distribution and enhanced compactness. This framework effectively resolves trade-offs between performance indicators, providing a scientifically robust method for designing durable pavement concrete that reduces shrinkage by 13.0% and porosity by 13.5% compared to conventional mixes, lowering maintenance costs in arid regions. Full article

To address the issues of non-stationarity, noise interference, and insufficient discriminative power of traditional fault feature extraction methods in rolling bearing vibration signals, this paper proposes a fault diagnosis method based on multi-scale permutation entropy (MPE) and a multi-strategy improved sparrow search algorithm (MSSA) under local mean decomposition (LMD). First, LMD is employed to adaptively decompose the original signal. Effective product functions (PFs) are then selected using the Pearson correlation coefficient, enabling signal reconstruction that suppresses noise interference while preserving fault impact components. Second, to overcome the limited capability of traditional time-frequency features in representing complex fault patterns, MPE is introduced to construct a multi-scale complexity feature vector, effectively capturing the scale-dependent differences in the dynamic behavior of signals. Furthermore, considering the instability of classification caused by the empirical setting of hidden layer nodes in the extreme learning machine (ELM), a multi-strategy improved sparrow search algorithm is proposed to optimize ELM parameters. This algorithm integrates an adaptive Levy flight mechanism and dynamic reverse learning. The long-tail jump characteristics of Levy flight enhance the global search capability, while dynamic reverse learning increases population diversity, preventing premature convergence. The experimental results demonstrate that the proposed method achieves an average diagnostic accuracy of over 96% across multiple datasets, verifying its robustness in handling non-stationary signals and fault classification. Full article

Background: Uniparental disomy (UPD) is the inheritance of both copies of a chromosome from a single parent, leading to distinct genetic conditions. Maternal UPD of chromosome 6 (UPD(6)mat) is extremely rare, with few molecularly confirmed cases reported. Methods: We report a prematurely born female with isodisomic UPD(6)mat, presenting with intrauterine growth restriction (IUGR), developmental delay, autism spectrum disorder, dysmorphic features, and a sacrococcygeal teratoma. In addition, we reviewed 24 confirmed UPD(6)mat cases to assess clinical patterns in prenatal findings, birth outcomes, and postnatal features. Results: Trio whole-exome sequencing revealed complete isodisomy of chromosome 6 and a de novo heterozygous DIAPH2 variant of uncertain significance. In the literature review, IUGR was present in 87% of cases, with most individuals born small for gestational age and preterm. Failure to thrive and neurodevelopmental issues were also frequent. While the exact molecular basis remains unknown, imprinting disturbances—similar to those in UPD(6)pat—and cryptic trisomy 6 mosaicism, particularly in heterodisomy, are the most likely mechanisms. No specific gene or consistent epigenetic abnormality has been identified. Conclusions: This study aims to enhance the understanding of the genetic and phenotypic spectrum of UPD(6)mat, improving diagnostic and management approaches for this ultra-rare genetic disorder. We propose a detailed list of clinical assessments and tests to be performed following the detection of maternal uniparental disomy of chromosome 6. Full article

Premature seal failure induced by the unevenness of interstage pressure distribution in multi-stage brush seals significantly compromises the sealing efficiency of Air-Turbo Rocket (ATR) engines operating under high-pressure (megapascal-level) differential conditions. Conventional pressure equalization designs for such seals often result in significant leakage rate increases. This study addresses the pressure imbalance phenomenon in four-tooth three-stage brush composite seals through a novel fractal–geometric porous-media model, rigorously validated against experimental data. Systematic investigations were conducted to elucidate the effects of structural parameters and operational conditions on both sealing performance and pressure distribution characteristics. Key findings reveal that, under the prototype structure parameter, the first-, second-, and third-stage brush bundles account for 18.3%, 30.0%, and 43.3% of the total pressure drop, respectively, with grate teeth contributing 8.4%, demonstrating an inherent pressure imbalance. Axial brush spacing exhibits a minimal impact on the pressure distribution, while the gradient thickness settings of the brush bundles show limited influence. Radial clearance optimization and gradient backplate height adjustment effectively regulate pressure distribution, albeit with associated leakage rate increases. Structural modifications based on these principles achieved only a 5.8% leakage increment while reducing the maximum bundle pressure drop by 23%, demonstrating effective pressure balancing. A simplified analysis of entropy reveals that the fundamental mechanism governing the pressure imbalance stems from non-uniform entropy generation caused by aerodynamic damping dissipation across sequential brush stages. These findings establish a dampened dissipation-based theoretical framework for designing high-performance multistage brush seals in aerospace applications, providing critical insights for achieving an optimal balance between leakage control and pressure equalization in extreme-pressure environments. Full article

Background/Objectives: Probiotic supplementation has been actively investigated in preterm populations to reduce the risk of necrotizing enterocolitis (NEC) and late-onset sepsis. Despite this, few studies have focused on clinically relevant feeding tolerance and growth outcomes, and there is an alarming lack of evidence surrounding extremely preterm infants (defined as birth before 28 weeks gestational age), those most at risk of severe comorbidities. We aimed to investigate whether probiotics improve feeding tolerance, neonatal growth and neonatal morbidity among extremely preterm infants. Methods: A literature search was conducted in Medline, Embase, Cochrane CENTRAL, Web of Science, and clinicaltrials.gov for ongoing trials. We included extremely preterm infants from randomized controlled trials and non-randomized trials with a concurrent control group. Two authors independently performed screening, data extraction and risk of bias assessment using the Risk of Bias 2 tool from Cochrane. The certainty of the evidence was assessed using GRADE. Results: Eleven RCTs and three non-randomized studies with a concurrent control group were included, analyzing a total of 14,888 extremely preterm infants. Meta-analyses revealed lower mean days to full enteral feeds (mean difference 1.1 days lower; 95% CI, 7.83 lower to 5.56 higher) and lower duration of parenteral nutrition (mean difference 2.4 days lower; 95% CI, 7.44 lower to 2.58 higher) in infants treated with probiotics; however, this was not statistically significant. There was a significant reduction in NEC (RR; 0.80, 95% CI; 0.68, 0.93) and all-cause mortality (RR; 0.56, 95% CI; 0.33, 0.93) in the probiotic group. All outcomes were graded at low or very low certainty of evidence. Conclusions: The findings indicate a trend towards a potential beneficial effect of probiotic supplementation in reducing feeding intolerance and a notable reduction of risk of NEC and all-cause mortality in infants receiving probiotics. Future RCTs will focus on feeding intolerance, and growth outcomes are warranted. Full article