Search Results (1,219)

Background: Uterine rupture is a rare but severe obstetric complication with significant maternal and neonatal consequences. While partial uterine ruptures (PURs) are generally associated with less severe outcomes, complete uterine ruptures (CURs) carry a higher risk of serious impact on both mother and child. The present study aimed to evaluate outcomes and identify risk factors for each type of rupture, and also to define high- and low-risk uterine ruptures based on clinical outcomes. Methods: A retrospective analysis of 112 uterine rupture cases, including 29 CURs and 83 PURs, was conducted at the Women’s Hospital of the University of Cologne from October 2010 to January 2021. Results: Maternal outcomes revealed that CUR was associated with higher risks of prolonged hospitalization (p = 0.003), postpartum hemorrhage (p < 0.001), maternal transfusion (p = 0.003), and ICU transfer (p = 0.004) compared to PUR. Neonatal outcomes showed a significantly higher risk of severe acidosis (p < 0.001), low APGAR scores (p < 0.001), NICU transfers (p = 0.004), and resuscitation needs (p = 0.016) in CUR cases. Factors increasing the risk of CUR included pathological CTG (OR = 1.9, 95% CI: 0.99–7.14, p = 0.05), abdominal pain (OR = 2.63, 95% CI: 1.10–6.25, p = 0.03), previous vaginal birth (OR = 7.14, 95% CI: 0.025–20, p < 0.001), and no uterine contractions (OR = 7, 95% CI: 1.21–40.56, p = 0.03). A previous cesarean section significantly increased the risk of CUR (OR = 4.94, 95% CI: 1.38–17.67, p = 0.014), whereas more than two cesarean sections reduced the risk (OR = 0.66, 95% CI: 0.13–3.22, p = 0.61). A comparison of CUR with maternal and neonatal high-risk rupture groups revealed that low gestational age and a history of previous cesarean sections were significant risk factors for neonatal high-risk rupture. Conclusion: Vaginal birth and abdominal pain were identified as key risk factors for CUR, which lead to severe maternal and neonatal outcomes. Recognizing these risk factors can help clinicians optimize risk stratification and decision-making, and enhance monitoring strategies to prevent adverse outcomes. Full article

Background: Previously, we found that the pathological changes in the corpus spongiosum (CS) in hypospadias were mainly localized within smooth muscle tissue, presenting as a transformation from the contraction phenotype to synthesis. The role of low-intensity pulsed ultrasound (LIPUS) in regulating smooth muscle cells (SMCs) and angiogenesis has been confirmed. Objectives: To demonstrate the feasibility of regulating the phenotypic transformation of corpus spongiosum smooth muscle cells (CSSMCs) in hypospadias using LIPUS and to explore the potential mechanisms. Materials and Methods: The CSSMCs were extracted from CS in patients with proximal hypospadias. In vitro experiments were conducted to explore the appropriate LIPUS irradiation intensity and duration which could promote the phenotypic transformation of CSSMCs. A total of 71 patients with severe hypospadias were randomly divided into a control group and a LIPUS group to verify the in vivo transition effect of LIPUS. Consequently, the potential mechanisms by which LIPUS regulates the phenotypic transformation of CSSMCs were explored in vitro. Results: In vitro experiments showed that LIPUS with an intensity of 100 mW/cm² and a duration of 10 min could significantly increase the expression of contraction markers in CSSMCs and decrease the expression of synthesis markers. Moreover, LIPUS stimulation could alter the phenotype of CSSMCs in patients with proximal hypospadias. RNA sequencing results revealed that peroxisome proliferator-activated receptor gamma (PPAR-γ) significantly increased after LIPUS stimulation. Overexpression of PPAR-γ significantly increased the expression of contraction markers in CSSMCs, and the knockdown of PPAR-γ blocked this effect. Conclusions: LIPUS can regulate the transition of CSSMCs from a synthetic to a contractile phenotype in hypospadias. The PPAR-γ-mediated signaling pathway is a possible mechanism involved in this process. Full article

The investigation of the neuromuscular components of fatigue in team sports, especially in developmental ages, is limited. This study aimed to examine the neuromuscular fatigue and recovery patterns in prepubertal and adult female handball players, focusing on the soleus (SOL) and tibialis anterior (TA) muscles. Fifteen prepubertal (11.1 ± 0.9 years) and fourteen adult (22.0 ± 3.4 years) females performed a sustained isometric plantar flexion at 25% of maximal voluntary contraction (MVC) until exhaustion. The electromyographic (EMG) activity of the SOL and TA, torque, and central activation ratio (CAR) were recorded throughout the experiment. Endurance time was similar between groups (girls: 104 ± 93.5 s; women: 94.4 ± 30.2 s, p > 0.05), and both demonstrated progressive increases in muscle activation, without significant group differences for SOL and TA EMG (p > 0.05). Following fatigue, the torque and soleus (SOL) EMG activity decreased significantly compared to the pre-fatigue values in both groups (p < 0.001) and recovered (p > 0.05) in prepubertal and adult females within the first 3 and 6 min, respectively. The CAR remained unchanged over time, without significant differences observed between age groups (p > 0.05). These findings suggest that neuromuscular responses to fatigue are comparable between prepubertal and adult females, but recovery is significantly faster in prepubertal girls. Consequently, these findings underscore the need for age-specific recovery strategies in training programs, with tailored exercise-to-rest ratios to enhance performance and reduce fatigue during handball-specific activities. Full article

Plasma-derived fibrin hydrogels are widely used in tissue engineering because of their excellent biological properties. Specifically, human plasma-derived fibrin hydrogels serve as 3D matrices for autologous skin graft production, skeletal muscle repair, and bone regeneration. Nevertheless, for advanced applications such as in vitro skin equivalents and engineered grafts, the intrinsic limitations of native fibrin hydrogels in terms of long-term mechanical stability and resistance to degradation need to be addressed to enhance the usefulness and application of these hydrogels in tissue engineering. In this study, we chemically modified plasma-derived fibrin by incorporating succinimidyl alginate (SA), a version of alginate chemically modified to introduce reactive succinimidyl groups. These NHS ester groups (N-hydroxysuccinimide esters), attached to the alginate backbone, are highly reactive toward the primary amine groups present in plasma proteins such as fibrinogen. When mixed with plasma, the NHS groups covalently bond to the amine groups in fibrin, forming stable amide linkages that reinforce the fibrin network during hydrogel formation. This chemical modification improved mechanical properties, reduces contraction, and enhanced the stability of the resulting hydrogels. Hydrogels were prepared with a final fibrinogen concentration of 1.2 mg/mL and SA concentrations of 0.5, 1, 2, and 3 mg/mL. The objective was to evaluate whether this modification could create a more stable matrix suitable for supporting skin tissue development. The mechanical and microstructure properties of these new hydrogels were evaluated, as were their biocompatibility and potential to create 3D skin models in vitro. Dermo-epidermal skin cultures with primary human fibroblast and keratinocyte cells on these matrices showed improved dermal stability and better tissue structure, particularly SA concentrations of 0.5 and 1 mg/mL, as confirmed by H&E (Hematoxylin and Eosin) staining and immunostaining assays. Overall, these results suggest that SA-functionalized fibrin hydrogels are promising candidates for creating more stable in vitro skin models and engineered skin grafts, as well as for other types of engineered tissues, potentially. Full article

Background: Solid Organ Transplant Recipients (SOTRs) face an elevated risk of Sars-CoV-2 infection and poor outcomes if they contract the infection. This can induce or exacerbate anxiety and depressive symptoms. We used the Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety (A) and Depression (D) scores to conduct a repeated cross-sectional (“pseudo-longitudinal”) comparison of SOTRs’ anxiety and depressive symptoms before and after the COVID-19 pandemic onset. Methods: This secondary analysis used cross-sectional data from a convenience sample of adult SOTRs (kidney, kidney–pancreas, and liver) recruited between 2016 and 2024. The exposure was categorized as follows: “Pandemic Experience” was categorized as PRE (pre-pandemic reference; transplanted and anxiety and depressive symptoms assessed pre-pandemic onset), POST-1 (transplanted before and assessed after onset), and POST-2 (transplanted and assessed after onset). The outcomes were PROMIS-A and PROMIS-D scores. The differences were assessed using multivariable linear regression-estimated means. Results: Of the 816 participants, 588 (72%) were PRE, 135 (17%) were POST-1, and 93 (11%) were POST-2. In the fully adjusted model, the POST-2 group had significantly higher PROMIS-A scores (more severe symptoms) compared with PRE (adjusted mean [95% CI]: 54.2 [52.3; 56.1] vs. 51.7 [50.9; 52.4], p = 0.02). The proportion of patients with potentially clinically significant anxiety was also higher in the POST-2 group, compared with PRE (OR [95%CI] 1.59 [1.0; 2.5]). The PROMIS-A scores were similar between PRE and POST-1, and between POST-1 and POST-2. The PROMIS-D scores were not different across the exposure groups. Conclusions: SOTRs transplanted after the pandemic onset experienced more anxiety but similar depression symptoms compared with pre-pandemic levels. Future research should explore mental health support for SOTRs during crisis situations involving infectious risk. Full article

Background: Since the pathophysiology of long COVID is not yet fully understood, there are no specific methods for its treatment; however, its individual symptoms can currently be treated. Long COVID is characterized by symptoms that persist at least 2 to 3 months after contracting COVID-19, although it is difficult to predict how long such symptoms may persist. Methods: In the present study, 774 patients who first visited our outpatient clinic during the Omicron period from February 2022 to October 2024 were divided into two groups: the early recovery (ER) group (370 cases; 47.8%), who recovered in less than 180 days (median 33 days), and the persistent-symptom (PS) group (404 cases; 52.2%), who had symptoms that persisted for more than 180 days (median 437 days). The differences in clinical characteristics between these two groups were evaluated. Results: Although the median age of the two groups did not significantly differ (40 and 42 in ER and PS groups, respectively), the ratio of female patients was significantly higher in the PS group than the ER group (59.4% vs. 47.3%). There were no significant differences between the two groups in terms of the period after infection, habits, BMI, severity of COVID-19, and vaccination history. Notably, at the first visit, female patients in the PS group had a significantly higher rate of complaints of fatigue, insomnia, memory disturbance, and paresthesia, while male patients in the PS group showed significantly higher rates of fatigue and headache complaints. Patients with more than three symptoms at the first visit were predominant in the PS groups in both genders. Notably, one to two symptoms were predominant in the male ER group, while two to three symptoms were mostly reported in the female PS group. Moreover, the patients in the PS group had significantly higher scores for physical and mental fatigue and for depressive symptoms. Conclusions: Collectively, these results suggest that long-lasting long COVID is related to the number of symptoms and presents gender-dependent differences. Full article

Background and Objective: This study aimed to examine the possibility of using surface electromyography (sEMG) to aid in assessing the correctness of overhead deep squat performance. Electromyography signals were recorded for 20 athletes from the lower (rectus femoris (RF), vastus medialis (VM), biceps femoris (BF), and gluteus (GM)) and upper (deltoid (D), latissimus dorsi (L)) muscles. The sEMG signals were categorized into three groups based on physiotherapists’ evaluations of deep squat correctness. Methods: The raw sEMG signals were filtering at 10–250 Hz, and then the mean frequency, median frequency, and kurtosis were calculated. Next, the maximum excitation of the muscles expressed in percentage of maximum voluntary contraction (%MVC) and co-activation index (CAI) were estimated. To determine the muscle excitation level, the pulse interference filter and variance analysis of the sEMG signal derivative were applied. Next, analysis of variance (ANOVA) tests, that is, nonparametric Kruskal–Wallis and post hoc tests, were performed. Results: The parameter that most clearly differentiated the groups considered turned out to be %MVC. The statistically significant difference with a large effect size in the excitation of RF & GM (p = 0.0011) and VM & GM (p = 0.0002) in group 3, where the correctness of deep squat execution was the highest and ranged from 85% to 92%, was pointed out. With the decrease in the correctness of deep squat performance, an additional statistically significant difference appeared in the excitation of RF & BF and VM & BF for both groups 2 and 1, which was not present in group 3. However, in group 2, with the correctness of the deep squat execution at 62–77%, the statistically significant differences in muscle excitation found in group 3 were preserved, in contrast to group 1, with the lowest 23–54% correctness of the deep squat execution, where the statistical significance of these differences was not confirmed. Conclusions: The results indicate that sEMG can differentiate muscle activity and provide additional information for physiotherapists when assessing the correctness of deep squat performance. The proposed analysis can be used to evaluate the correctness of physical exercises when physiotherapist access is limited. Full article

The inherent limitations of ordinary cement mortar—characterized by its high brittleness and low flexibility—result in a diminished load-bearing capacity, predisposing concrete pavements to cracking. A novel approach has been proposed to enhance material performance by incorporating emulsified asphalt and latex into ordinary cement mortar, aiming to improve the flexibility and durability of concrete pavements effectively. To further validate the feasibility of this proposed approach, a series of comprehensive experimental investigations were conducted, with corresponding conclusions detailed herein. As outlined below, the flexibility properties of the modified cement mortar were systematically evaluated at curing durations of 3, 7, and 28 days. The ratio of flexural to compressive strength can be increased by up to 38.9% at 8% emulsified asphalt content at the age of 28 days, and by up to 50% at 8% latex content. The mechanism of emulsified asphalt and latex-modified cement mortar was systematically investigated using a suite of analytical techniques: X-ray diffraction (XRD), Fourier transform infrared (FTIR) spectroscopy, thermogravimetric analysis (TG-DTG), X-ray photoelectron spectroscopy (XPS), and scanning electron microscopy (SEM). Through comprehensive analyses of microscopic morphology, hydration products, and elemental distribution, the enhancement in cement mortar toughness can be attributed to two primary mechanisms. First, Ca²⁺ ions combine with the carbonyl groups of emulsified asphalt to form a flexible film structure during cement hydration, thereby reducing the formation of brittle hydrates. Second, active functional groups in latex form a three-dimensional network, regulating internal expansion-contraction tension in the modified mortar and extending its service life. Full article

Background/Objectives: In recent years, scientific literature has illustrated the growing interest in telerehabilitation after ACL reconstruction. The aim of this study is to compare the effectiveness of remotely supervised rehabilitation with traditional supervised rehabilitation after ACLR, focusing on objective postoperative functional assessment outcomes. Methods: A retrospective analysis of prospectively collected data was carried out, selecting patients that underwent arthroscopic ACLR by a single surgeon. Functional assessments of the patients were carried out at 1 and 2 weeks and 1, 2 and 3 months after surgery, including range of motion (ROM), maximal voluntary isometric contractions (MVICs) of extensor and flexor muscles, the sit-to-stand test and the countermovement jump. Intergroup statistics were carried out using a non-inferiority hypothesis. Results: A total of 251 patients were included in this study (supervised rehabilitation n = 165; remotely supervised rehabilitation n = 86). Functional assessment improved over time in both groups. The extension ROM deficit decreased to 0 difference 30 days after surgery. The median flexion ROM ILD at 60 days was significantly different among the groups, with a residual 10° ILD in the Group R compared with 0° ILD in group S (p = 0.01). All other assessments did not achieve statistical significance. Conclusions: The results support the integration of a digital rehabilitation tool in post-ACLR recovery programs. The results suggest that remotely supervised rehabilitation can be a viable alternative to traditional supervised rehabilitation for early-stage recovery. However, more research is needed to optimize protocols and to identify patients who may benefit most from this approach. Full article

Aluminum alloy, due to its low melting point and high thermal conductivity, deforms and contracts significantly during welding. To mitigate this and achieve full penetration in a single pass, this study uses GTAW (Gas Tungsten Arc Welding) additive manufacturing and optimizes welding groove parameters via the Box-Behnken Response Surface Methodology. The focus is on improving tensile strength and penetration depth by analyzing the effects of groove angle, root face width, and root gap. The results show that groove angle most significantly affects tensile strength and penetration depth. Hardness profiles exhibit a W-shape, with base material hardness decreasing and weld zone hardness increasing as groove angle rises. Root face width reduces hardness fluctuation in the weld zone, and an appropriate root gap compensates for thermal expansion, enhancing joint performance. The interaction between root face width and root gap most impacts tensile strength, while groove angle and root face width interaction most affects penetration depth. The optimal welding parameters for 7xxx aluminum alloy GTAW are a groove angle of 70.8°, root face width of 1.38 mm, and root gap of 0 mm. This results in a tensile strength of 297.95 MPa and penetration depth of 5 mm, a 90.38% increase in tensile strength compared to the RSM experimental worst group. Microstructural analysis reveals the presence of β-Mg₂Si and η-MgZn₂ strengthening phases, which contribute to the material’s enhanced mechanical properties. Fracture surface examination exhibits characteristic ductile fracture features, including dimples and shear lips, confirming the material’s high ductility. The coexistence of these strengthening phases and ductile fracture behavior indicates excellent overall mechanical performance, balancing strength and plasticity. Full article

This paper examines the impact of carbon capture and storage (CCS) deployment on national carbon intensity (CI) across 43 countries from 2010 to 2020. Using a dynamic common correlated effects (DCCE) log–log panel, we estimate the elasticity of CI with respect to sectoral CCS facility counts within four income-group panels and the full sample. In the high-income panel, CCS in direct air capture, cement, iron and steel, power and heat, and natural gas processing sectors produces statistically significant CI declines of 0.15%, 0.13%, 0.095%, 0.092%, and 0.087% per 1% increase in facilities, respectively (all p < 0.05). Upper-middle-income countries exhibit strong CI reductions in direct air capture (–0.22%) and cement (–0.21%) but mixed results in other sectors. Lower-middle- and low-income panels show attenuated or positive elasticities—reflecting early-stage CCS adoption and infrastructure barriers. Robustness checks confirm these patterns both before and after the 2015 Paris Agreement and between emerging and developed economy panels. Spatial analysis reveals that the United States and United Kingdom achieved 30–40% CI reductions over the decade, whereas China, India, and Indonesia realized only 10–20% declines (relative to a 2010 baseline), highlighting regional deployment gaps. Drawing on these detailed income-group insights, we propose tailored policy pathways: in high-income settings, expand tax credits and public–private infrastructure partnerships; in upper-middle-income regions, utilize blended finance and technology-transfer programs; and in lower-income contexts, establish pilot CCS hubs with international support and shared storage networks. We further recommend measures to manage CCS’s energy and water penalties, implement rigorous monitoring to mitigate leakage risks, and design risk-sharing contracts to address economic uncertainties. Full article

Background/Objectives: The objective of this study was to compare muscular strength and neuromuscular activation characteristics between male gymnasts and physical education (PE) students during isometric shoulder extension and flexion tasks. Methods: Thirteen competitive male gymnasts (age: 19.59 ± 1.90 years; body mass: 66.54 ± 6.10 kg; height: 169.38 ± 6.28 cm; mean ± SD) and thirteen male physical education (PE) students (age: 20.96 ± 2.30 years; body mass: 74.00 ± 8.69 kg; height: 174.96 ± 4.93 cm) voluntarily participated in the study. Peak torque (PT), rate of torque development (RTD), RTD normalized to body mass (RTD/BM), and muscle activation assessed via surface electromyography (EMG), normalized to maximal EMG activity (EMG/EMGmax), were evaluated during bilateral isometric shoulder extension and flexion at a joint angle of 45°. Measurements were analyzed across the following time intervals: −50 to 0 ms (pre-tension), 0–30 ms, 0–50 ms, 0–100 ms, and 0–200 ms relative to contraction onset. Custom MATLAB R2024b scripts were used for data processing and visualization. One-way and two-way multivariate analyses of variance (MANOVAs) were conducted to test for group differences. Results: Gymnasts exhibit higher values of PT, PT/BM, RTD, and RTD/BM particularly within the early contraction phases (i.e., 0–50 ms and 0–100 ms) compared to PE students (p < 0.05 to <0.001; η² = 0.04–0.66). Additionally, EMG activity normalized to maximal activation (EMG/EMGmax) was significantly greater in gymnasts during both early and mid-to-late contraction phases (0–100 ms and 0–200 ms), (p < 0.05 to <0.001; η² = 0.04–0.48). Conclusions: These findings highlight gymnasts’ superior explosive neuromuscular capacity. Metrics like RTD, RTD/BM, and EMG offer valuable insights into rapid force production and neural activation, supporting performance monitoring, training optimization, and injury prevention across both athletic and general populations. Full article

Background: Sarcopenia (loss of muscle mass) and dynapenia (loss of strength) are prevalent in older adults aged 70 years and over. Both have an impact on their functional ability and quality of life, with type II muscle fibres being particularly affected. Although traditional resistance training (TRT) is effective, it presents technical difficulties and an increased risk of injury among this vulnerable population. Isometric strength training (IST) is a potentially safer, more accessible and more effective alternative. Objective: To describe the protocol of a single-arm, pre-post intervention trial designed to evaluate the efficacy and applicability of a 16-week IST programme on muscle strength, skeletal muscle mass, quality of life and applicability (safety, acceptability, perceived difficulty) in 18 older adults aged 70 years and above with a diagnosis of sarcopenia and dynapenia. The influence of genetic and environmental factors on the variability of response to IST will also be explored. Methodology: The participants, who have all been diagnosed with sarcopenia according to EWGSOP2 (European Working Group on Sarcopenia in Older People 2) criteria, will perform two IST sessions per week for 16 weeks. Each 30-min session will consist of one progressive set (total duration 45 s to 90 s) for each of the eight major muscle groups. This series will include phases at 20% and 40% of individual Maximal Voluntary Isometric Contraction (MVIC), culminating in 100% Maximal Effort (ME), using the CIEX SYSTEM machine with visual feedback. The primary outcome variables will be: change in knee extensor MVIC and change in Appendicular Skeletal Muscle Mass Index (ASMMI). Secondary variables will be measured (other components of sarcopenia, quality of life by EQ-5D-5L, use of Likert scales, posture and physiological variables), and saliva samples will be collected for exploratory genetic analyses. The main statistical analyses will be performed with t-tests for related samples or their non-parametric analogues. Discussion: This protocol details a specific IST intervention and a comprehensive evaluation plan. The results are expected to provide evidence on the feasibility and effects of IST among older adults with sarcopenia and dynapenia. Understanding individual variability in response, including genetic influence, could inform the design of more personalised and effective exercise strategies for this population in the future. Full article

Introduction: Ventricular arrhythmias may lead to sudden cardiac death and, when occurring during the recovery phase after exercise testing, are associated with increased cardiovascular risk. Aim: To investigate the association between psychosocial stress and the risk of premature ventricular contractions (PVCs) during the recovery phase after treadmill testing in asymptomatic individuals. Methods: A total of 282 asymptomatic adults underwent treadmill testing. Participants were categorized into a stress-present group (+S, n = 176) or a stress-absent group (−S, n = 106) based on their self-reported psychosocial stress levels. Inclusion criteria included exercising for at least 6 min and reaching at least 85% of the age-predicted maximum heart rate. Exclusion criteria comprised pre-exercise VAs, unreadable ECGs, chronic medication use, systolic blood pressure ≥180 mmHg, and diastolic blood pressure ≥110 mmHg. This study was registered on ClinicalTrials.gov (NCT05987891). Results: Compared to the −S group, the +S group had a higher body mass index (BMI) (p = 0.0025); 26.5 (23.9; 29.0) and larger waist circumference (p = 0.0001); 95 (86; 103), and reported lower physical activity levels (p = 0.0004). Notably, only psychosocial stress and BMI were statistically associated with PVCs during the recovery phase, immediately following the stress test. For each 1 kg/m² increase in BMI, the risk of PVCs decreased by 9%. Participants reporting psychosocial stress had a 9.03-fold higher risk of PVCs compared to those who did not report stress. Conclusions: Self-reported psychosocial stress significantly increases the risk of PVC occurrence during the recovery phase of treadmill exercise testing in asymptomatic individuals. These findings may support the development of improved PVC detection strategies and enhance cardiovascular risk assessment in clinical settings. Full article

Herein, we further examine how we can value nonmarket goods and services by considering the costs associated with environmental conflicts. Focusing on two American rules—the asymmetric reimbursement system and the contingent fee contract—we develop a strategic game-theoretic model in which a citizens group engages a delegate through a contingent fee compensation contract, while a polluter engages a delegate through an hourly fee compensation contract. If the citizens group prevails, the polluter is obligated to contribute a portion of the contingent fee. Solving for the subgame perfect equilibrium, two results emerge. First, the 4x-rule can be maintained through the adjustment of the asymmetric reimbursement system. Second, the asymmetric reimbursement system can serve both as a supplementary method to measure nonmarket valuation and to reduce the rent dissipation resulting from environmental conflicts under general circumstances. Full article