Search Results (38,657)

Background and Clinical Significance: Patients with a left ventricular assist device (LVAD) are at risk of ventricular arrhythmias, which are generally hemodynamically tolerated if they occur. In such cases, patients may experience painful implantable cardioverter-defibrillator (ICD) shocks. Case Presentation: A 71-year-old patient with a history of dilated cardiomyopathy caused by a phospholamban (PLN) gain-of-function mutation, with a primary prevention ICD and an LVAD, presented with multiple ICD shocks which she experienced as painful and traumatic. She was found to have ongoing ventricular fibrillation with apparent hemodynamic stability. Conversion to sinus rhythm was achieved through intravenous administration of antiarrhythmic drugs followed by external defibrillation using stacked shocks. Due to the traumatic nature of the shocks, the shock function of the ICD was turned off. Nearly two months later, the patient presented for a second time and was again found to have ventricular fibrillation which had been present for at least six weeks. Conversion to sinus rhythm was unsuccessful and the patient was discharged to her home with an advanced care plan and her LVAD was deactivated. The patient died two months later. Conclusions: Patients with an LVAD can remain hemodynamically stable for prolonged periods of time during ventricular arrhythmias. ICD shocks are therefore mostly experienced as painful and even traumatic. Therefore, the routine use of ICD shock therapy in patients with an LVAD should be reconsidered. Adjustment of ICD programming to higher rates and longer detection may be warranted. Further investigation is warranted regarding a switch to devices with an alarm function rather than therapies for tachyarrhythmias. Full article

Deep learning is increasingly integrated into oral rehabilitation workflows, particularly in implant planning, prosthodontic design automation, and peri-implant diagnosis. However, reported performance is heterogeneous and difficult to compare across tasks, modalities, and validation designs. The goal of this study was to critically analyze deep learning architecture families applied to oral rehabilitation and to provide task-driven selection guidance supported by an evidence table reporting dataset characteristics, validation strategy, and performance metrics. A focused narrative review was conducted using transparent, database-specific search criteria (final n = 10 included studies), emphasizing implant planning (cone–beam computed tomography [CBCT]-based segmentation), prosthodontic design (intraoral scan [IOS]/mesh inputs), and peri-implant diagnosis (periapical/panoramic radiographs). Evidence certainty for each clinical task was assessed using GRADE-informed ratings (High/Moderate/Low/Very Low). Extracted variables included clinical task, imaging modality, dataset size, architecture, validation strategy (internal vs. internal + external), split level, ground truth protocol, and performance metrics. A structured computational and hardware feasibility analysis was conducted for each architecture family to support real-world deployment planning. Encoder–decoder networks (U-Net/nnU-Net) dominate CBCT segmentation for implant planning, while detection architectures (Faster R-CNN, YOLO) support implant localization and peri-implant assessment on radiographs. Generative models (3D GANs, transformer-based point-to-mesh networks) enable crown design from three-dimensional scans. Hybrid CNN–Transformer architectures show promise for multimodal CBCT–IOS fusion, though direct evidence from the included studies remains limited to a single study. External validation remains uncommon yet essential given the risk of domain shift. In conclusion, architecture selection should be anchored to task geometry (2D vs. 3D), artifact burden, and required clinical output type. Reporting standards should prioritize dataset transparency, validation rigor, multi-center external testing, and uncertainty-aware outputs. Full article

Mental fatigue (MF) has been hypothesized to contribute to injury risk in athletes, but observational studies have not directly investigated this relationship. Therefore, the current study evaluates potential relationships between mental fatigue and subsequent injury occurrence in basketball. Using an observational design, we monitored fourteen male semi-professional basketball players (age: 22 ± 4 years; stature: 192.6 ± 8.8 cm; body mass: 85.5 ± 9.1 kg; Tier 3) from a single team for 21 weeks throughout the competitive season. Each week, the players participated in 5 team-based training sessions, 2–4 individual training sessions, and 1–2 official games. Subjective MF ratings were collected using 100 mm visual analogue scales twice a week (the day before and after the official game) and then averaged. Time-loss injuries were registered, noting the body location, mechanism, and context (training and games). Generalized logistic mixed models were employed to evaluate whether MF levels were associated with injury occurrence in the subsequent 1, 3, and 5 days and 1, 2, 3, and 4 weeks of basketball activity. A total of 11 injuries were registered during the study (7.40 per 1000 h of basketball activity), with an average time loss of 12 ± 19 days. There were no associations between MF and injury occurrence in the following 1, 2, 3 or 4 weeks (all p > 0.05, odds ratios: 1.00–1.28). In male semi-professional basketball settings, preliminary evidence indicates that MF might not be associated with injury occurrence. However, due to the dearth of injury events, the statistical power of this study is insufficient to detect potential small–medium effects. Therefore, the current results should be considered exploratory as opposed to a definitive rejection of the hypothesis. Future studies should evaluate the relationship between MF and injury risk in larger samples and among professional athletes. Full article

With the explosive growth of the Internet of Things (IoT) and cloud-computing traffic, Intrusion Detection Systems (IDSs) have become a cornerstone of network security. However, modern traffic data often exhibits extreme class imbalance and long-tailed distributions, leading to persistently high miss rates for minority attack categories in Machine Learning (ML)-based IDSs. Conventional oversampling may introduce decision noise, whereas standard Generative Adversarial Networks (GANs) can suffer from training instability and mode collapse when modeling high-dimensional tabular traffic features. To address these challenges, we propose a high-fidelity traffic augmentation framework based on an Adaptive Hybrid-loss Conditional GAN (AH-CGAN). Specifically, AH-CGAN introduces an iteration-dependent adaptive gradient penalty (AGP) schedule to enforce the Lipschitz continuity constraint more effectively during training and incorporates a feature-matching objective to align intermediate critic representations between real and synthetic traffic. Experiments on the CIC-IDS2017 benchmark show that AH-CGAN generates distribution-consistent synthetic samples and that augmentation improves downstream detection across multiple classifiers. In particular, the weighted F1-score of Logistic Regression increases from 0.8237 to 0.8697 (Δ = +0.0460, i.e., +4.6%). Overall, the proposed approach enhances minority coverage in the feature space and can improve class separability, providing a practical solution for long-tailed IDS. Full article

Background/Objectives: Asymptomatic hyperuricemia has been associated with increased cardiovascular risk; it is related to factors such as diet, genetic predisposition, and drug-related side effects. Impairment of uric acid control has been associated with the calcineurin inhibitors cyclosporin and tacrolimus, although available studies did not reach the same conclusions. Their widespread use in solid organ transplantation potentially exposes this population to higher cardiovascular risk. This systematic review aimed to assess their role in hyperuricemia risk compared with other immunosuppressive treatments and to clarify potential differences between cyclosporin and tacrolimus. Methods: The search was conducted in MEDLINE and Embase, limited to adult subjects, using the following terms: ((cyclosporin) OR (cyclosporine) OR (tacrolimus) OR (calcineurin inhibitor)) AND ((uric acid) OR (urate) OR (hyperuricemia)) AND ((transplant) OR (transplantation)). We assessed the quality of the studies according to the Critical Appraisal Skills Programme checklist. Results: After screening 639 manuscripts, we selected 36 studies that were relevant to our focus: 28 evaluated kidney transplant patients, while only eight focused on other solid organ transplants. Specifically, 20 studies compared calcineurin inhibitors with other immunosuppressants, while 15 assessed the impact of cyclosporin versus tacrolimus, and one study contributed to both scenarios. The prevalence of hyperuricemia ranged from 30 to 80% among patients receiving calcineurin inhibitors, with a slightly higher prevalence with cyclosporin than with tacrolimus (51–61% vs. 36–42%, respectively). The overall quality of the included studies was generally rated as low to moderate, with only ten studies focusing on uric acid control. Conclusions: Given the heterogeneity and overall quality of the available studies, no definitive conclusions can be drawn. In particular, the comparative effect of cyclosporin and tacrolimus remains uncertain because of conflicting findings across studies. Although calcineurin inhibitors may adversely affect uric acid control in transplant recipients, this association may be influenced by several confounding factors. Full article

Quantitatively characterizing the dynamic evolution of fracture swarms under offset well low-frequency distributed acoustic sensing (LF-DAS) monitoring remains a significant challenge. This study proposes a physics-data dual-driven closed-loop inversion framework to address this problem. The framework consists of three core modules: (1) a fluid–solid coupled semi-analytical forward model applicable to variable-rate injection and shut-in conditions; (2) an automatic key feature identification method based on multi-scale scanning and physical polarity constraints; and (3) a dynamic inversion model for fracture swarms based on adaptive particle swarm optimization (APSO). Validation against the classical PKN model confirms that the proposed forward model accurately reproduces the fundamental fracture propagation behavior, with good agreement in fracture half-length and net pressure evolution. In synthetic inversion cases, the method successfully recovers the number of fractures, the dynamic flow rate allocation history, fracture length evolution, and the spatiotemporal strain rate response. A field application further demonstrates that three dominant fractures were generated during stimulation, reaching the vicinity of the monitoring well at 18, 27, and 46 min with corresponding spacings of approximately 21 m and 16 m. The proposed framework provides a new route for advancing LF-DAS monitoring from qualitative interpretation to quantitative dynamic inversion. Full article

The determination of the arc rating of arc-resistant materials for the manufacture of personal protective clothing is conducted by measuring the incident and transmitted energies through calorimetry using thermocouples coupled to copper discs during the electric arc events. In this study, custom calorimeters were constructed by incorporating both a thermocouple wire and an embedded optical-fiber temperature sensor, and the arc ratings of different fabrics were determined in terms of their arc-thermal-performance value (ATPV). The results revealed differences between the measurements obtained with the two sensor types. Notably, the absence of electromagnetic interferences generated by the arc current and the enhanced time response achieved with the optical-fiber temperature sensor signal led to an ATPV arc rating approximately 27% lower than that measured with the thermocouple. These findings underscore the importance of investigating the current methodology used for determining arc ratings to ensure accurate measurement of incident and transmitted energy. Full article

Filtration systems are essential for drip irrigation using sediment-laden water sources such as the Yellow River. This study focused on a sand filter (filtration accuracy: 150 μm), a disc filter (filtration accuracy: 125 μm), and their combined multi-stage filtration system (flow rate: 30–50 m³/h). In situ tests were conducted under Yellow River water conditions in the Hetao Irrigation District, Inner Mongolia, China, to evaluate the response of filtration performance to sediment characteristics, flow rate, and operating time. On this basis, Differential Evolution-optimized Random Forest Regression (DE/RFR) was further established to predict filtration performance. The results showed that: (1) Under sediment concentrations of 0.62–3.6 g/L and median particle sizes of 4.70–16.03 μm, the head loss of the sand filter (ΔH_si) remained stable over the operating time. Conversely, the head loss of the disc filter (ΔH_di) increased with the operating time; the magnitude of this increase grew with higher flow rates, sediment concentrations, and median particle sizes, reaching 0.07 MPa after 16–235 min of operation. The head loss of the multi-stage filtration system (ΔH_i) was primarily generated by the disc filter. (2) The filtration efficiency of the filters and the filtration system was 2.5–6.4%. The outlet sediment concentration and particle size distribution were linearly correlated with the inlet values, and the outlet sediment particle size distribution remained below the clogging risk threshold for emitters. (3) Prediction models for ΔH_si, ΔH_di, and ΔH_i were developed based on MLR, RFR, and DE/RFR. Among these, DE/RFR exhibited the highest accuracy in predicting these variables, with R² values ranging from 0.71 to 0.93 and RMSE values from 0.0017 to 0.0104 MPa. (4) Results from Pearson correlation and feature importance analysis indicated that ΔH_si, ΔH_di, and ΔH_i were primarily influenced by flow rate, sediment concentration and operating time, and flow rate and operating time, respectively. (5) Building upon the DE/RFR model, a Filtration Cycle Prediction Model (FCPM) was developed to determine the operational duration required for the head loss across both the filters and the filtration system to reach 0.07 MPa. The two models developed in this study provide technical support for the configuration and operation of drip irrigation filtration systems using sediment-laden water. Full article

Ocean Thermal Energy Conversion (OTEC) is characterized by its abundant reserves and pollution-free nature, enabling stable power generation around the clock. Since the power output of an OTEC system is significantly influenced by the energy available from cold and warm seawater, the accurate evaluation of the outlet temperature of the cold-water pipe (CWP) is crucial. To analyze the heat transfer performance of the CWP, this paper investigates the temperature field of the OTEC CWP and employs numerical simulation methods to conduct finite element analysis of the temperature field under different discharge conditions. The results indicate that during the pumping of deep-sea cold water through the CWP, heat is absorbed from the warmer upper seawater layers. When the pumping discharge rate is higher, the shorter fluid residence time due to higher flow velocity results in a lower outlet temperature. Compared to steel CWPs, high-density polyethylene (HDPE) is more suitable for OTEC systems due to its lower thermal conductivity and density. Full article

Human astroviruses are small, non-enveloped RNA viruses belonging to the family Astroviridae. Among the four species known to infect humans, the species Mamastrovirus hominis (the classical human astroviruses, formerly MAstV1) is associated with gastrointestinal illness worldwide, while three more recently identified species have been linked to lethal central nervous system infections. High substitution rates and recombination drive their rapid evolution, yet recombination patterns in classical human astroviruses remain poorly characterized. This study systematically analyzes patterns and temporal dynamics of natural recombination in classical human astroviruses. Publicly available genomes of classical human astroviruses were analyzed to identify recombination hotspots. Recombinant forms were defined as stable phylogenetic lineages unaffected by recombination, and their half-lives were estimated based on time-scaled phylogenies (BEAST2v2.7.7). Recombination in classical human astroviruses occurred most frequently at the ORF1b/ORF2 junction, but also within ORF1a, at the ORF1a/ORF1b junction, and within ORF2. Only the 3′-part of ORF1a and a fragment of ORF1b exhibited robust temporal signal, yielding substitution rates of 2.35 × 10⁻³ and 2.14 × 10⁻³ s/s/y, respectively. The half-lives of recombinant forms varied considerably by genomic region: longest for exchanges between the parts of ORF1a (21 years), intermediate for ORF1a/ORF1b recombinants (7–9 years), and shortest for ORF1ab/ORF2 recombinants (2.5–3.6 years). The estimated half-lives for recombinants align with those reported for human enteroviruses and noroviruses. These findings highlight the dynamics of the generation of astrovirus diversity and may inform advanced surveillance of emerging strains. Full article

Background: Ventricular septal rupture (VSR) following acute myocardial infarction (AMI) creates an abrupt left-to-right shunt that can progress to cardiogenic shock (CS). Once CS develops, mortality increases dramatically and delayed repair becomes less feasible. Intra-aortic balloon pumps (IABPs) are widely used to facilitate delayed repair; however, whether initiating IABP before CS onset improves survival remains unclear. Methods: We retrospectively analyzed 124 patients with AMI-related VSR (2009–2024), categorized by IABP timing relative to CS onset (defined as first catecholamine administration) into pre-CS, post-CS, and no-IABP groups. The primary outcome was all-cause mortality within 90 days after AMI onset. Kaplan–Meier curves and Cox proportional hazards models were applied, with subgroup analyses by CS status. Results: The 90-day survival rate was 68.2% in the pre-CS IABP group, 14.3% in the post-CS group, and 35.1% in the no-IABP group. Pre-CS IABP was associated with significantly lower mortality compared with no-IABP (adjusted HR = 0.401, 95% CI 0.174–0.925, p = 0.032) and post-CS IABP (adjusted HR = 0.369, 95% CI 0.149–0.910, p = 0.030). In the CS subgroup, IABP use did not improve survival (19.4% vs. 17.6%, p = 0.365). Among non-CS patients, IABP use was independently associated with lower mortality (85.7% vs. 50.0%, p = 0.027; adjusted HR = 0.178, 95% CI 0.040–0.801, p = 0.025). Conclusions: Given the retrospective design and limited sample size, these findings are hypothesis-generating. Early IABP use was associated with improved short-term survival, an effect not observed once CS had developed. These findings support early risk stratification to identify high-risk patients who may benefit from timely hemodynamic support. Full article

Background/Objectives: Hypothyroidism, including subclinical hypothyroidism, may affect mental health in children and adolescents through disturbances of neurotransmission and dysregulation of the hypothalamic–pituitary–thyroid and stress axes. Anxiety disorders are common in this population and frequently coexist with somatic symptoms overlapping those of hypothyroidism, complicating diagnosis and treatment. This study aimed to evaluate the association between levothyroxine treatment for hypothyroidism and the need for psychiatric interventions in children and adolescents with anxiety disorders. Methods: A retrospective cohort study was performed using data from the TriNetX global research network. Patients aged 5–18 years with diagnoses of hypothyroidism (ICD-10: E03) and anxiety disorders (ICD-10: F41) were included. Two propensity score–matched cohorts were analysed: patients treated with levothyroxine (n = 1861) and untreated patients (n = 1861). Outcomes included psychiatric hospitalisations, use of selective serotonin reuptake inhibitors and tricyclic-like antidepressants, frequency of psychiatric and psychotherapeutic consultations, and the occurrence of suicidal ideation and self-harm. Results: Levothyroxine treatment was associated with lower odds of SSRI use (OR = 0.58; p < 0.001), fewer psychiatric consultations (OR = 0.48; p < 0.001), and lower recorded use of psychotherapy (OR = 0.75; p = 0.029). Suicidal ideation and self-harm were recorded less frequently in the treated group (OR = 0.53; p = 0.001). No significant differences were observed in psychiatric hospitalisation rates. Use of tricyclic-like antidepressants was uncommon and did not differ significantly between groups. Conclusions: Among children and adolescents with comorbid anxiety disorders, levothyroxine treatment for hypothyroidism is associated with lower recorded utilization of certain psychiatric services and lower recorded rates of suicidal ideation and self-harm. Due to the retrospective design, causal inferences cannot be made, and the findings should be considered hypothesis-generating, requiring confirmation in prospective studies with standardised psychiatric outcome measures. Full article

Due to the highly complex geological environment of the Tibetan Plateau, landslides occur frequently, and signs of ancient landslide reactivation are widespread, posing significant threats to major infrastructure and local communities. Taking the Lumei landslide in Cuomei County as a case study, detailed field investigations were conducted, and Sentinel-1A SAR data (84 scenes from January 2017 to December 2023) were collected to characterize surface deformation. Both PS-InSAR and SBAS-InSAR methods were applied for long-term time-series monitoring, and the results of the two techniques were comparatively analyzed. Furthermore, the influencing factors of landslide deformation were explored on the basis of analyzing the deformation characteristics. The findings reveal that the surface deformation rate exhibits significant spatial heterogeneity, with deformation values decreasing progressively outward from the central region. The surface deformation rates obtained from PS-InSAR and SBAS-InSAR range from −36.55 to −21.81 mm/yr and from −30 to −10 mm/yr, respectively. Both methods indicate a general subsidence trend along the line-of-sight (LOS) direction and show strong spatial consistency and high correlation. By combining the high-precision point results obtained from PS-InSAR and the spatially continuous surface results derived from SBAS-InSAR, the fine spatial deformation characteristics of the Lumei landslide are revealed. The research results can provide an important reference for landslide monitoring, disaster prevention and mitigation in this region. Full article

This study numerically investigates the influence of different fluid temperatures on the cavitation characteristics of a space-use micropump under microgravity conditions. A homogeneous multiphase model coupled with a thermal modified Zwart–Gerber–Belamri cavitation model is employed, and the SST turbulence model is applied to resolve the cavitating flow under rated and off-design flow rates. Results indicate that cavitation behavior is strongly dependent on both temperature and flow rate. At low temperatures, cavitation intensity increases, leading to reductions in head and efficiency and a slight increase in shaft power. In contrast, elevated temperatures suppress cavitation development, resulting in milder performance degradation and, in some cases, slight improvements in head and shaft power. Internal flow analysis reveals that lower temperatures promote more extensive vapor fraction distributions and greater flow distortion, while entropy production analysis shows that cavitation contributes limited additional loss overall, though entropy generation rises markedly under combined low temperature and high flow rate conditions. The findings highlight that cavitation effects are more pronounced at low temperatures and are further amplified at higher flow rates, providing insights for the design and reliable operation of space micropumps in on-orbit thermal management systems. Full article

Polyolefin bonding technologies with metal foils are extensively employed in various sectors, particularly in automotive, electronics, and aerospace industries. This research examined the innovative electromagnetic joining of polyolefins to aluminum by evaluating the behavior of hot-melt adhesives derived from polyolefins containing metallic particles. The study aimed at establishing the specific absorption rate (SAR, expressed in W/kg) via electromagnetic simulation using CST Studio Suite software. It was observed that, regardless of particle size, Al was the most efficient particle, while the distribution of particles has a negligible impact on Total SAR values. The most significant beneficial effect of the inserts on the absorption capacity of the hot-melt material is primarily observed with a particle size of 1 μm. When connecting polyolefins to aluminum, the power loss density and SAR values exceed those for bonding polyolefins to polyolefins by at least 10 times, owing to aluminum’s conductive properties, which influence the absorption of additional energy in the hot melt mass, likely due to the Salisbury screen effect generated by the bonding arrangement. For hot melts made from polyethylene, a higher frequency of 5.8 GHz is suggested, which is a newly approved frequency used in advanced industrial applications. This positively impacts the effectiveness and viability of the bonding process of polyolefins to aluminum, resulting in reduced exposure times and/or decreased microwave exposure power. It was observed that the hot melts derived from HDPE and PP yielded greater SAR values. Conversely, the SAR values increase when aluminum is attached to HDPE. As a result, the strongest bond of polyolefins to Al occurs when connecting HDPE to Al using HDPE-based hot melts. The proposed simulation methodology may offer considerable improvement in evaluating the efficacy of bonding technology for dissimilar materials subjected to electromagnetic energy Full article