Search Results (893)

(1) Background: This follow-up retrospective analysis used electronic medical record (EMR) data from a health system to identify patients and medications prescribed in accordance with Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines. (2) Methods: This analysis included EMR data from a clinical research data warehouse encompassing 928,291 patients seen at an academic medical center between 2020 and 2024. The study evaluated 75 commercially available medications linked to 52 evidence-based CPIC pharmacogenomic (PGx) guidelines. (3) Results: Of the 928,291 patient encounters, 709,673 medication orders were recorded, with 416,621 patients (44.8%) prescribed at least 1 of the 75 CPIC-associated medications. This compares with 845,518 patients who had an encounter in 2015–2019 with 590,526 medication orders, and 335,849 (56.9%) patients had medication orders represented by CPIC-associated medications. One to three CPIC-associated medications accounted for 76.6% of patients in 2020–2024 compared to 75.6% in 2015–2019. (4) Conclusions: The findings demonstrate that the proportion of patients prescribed a CPIC-actionable medication remained just under half of those evaluated within a single institution’s EMR. About three-quarters of patients over the ten-year period had between one to three CPIC-associated medications identified, and the top five classes of medications remained the same in the two periods. This understanding of patient volume may help organizations as they begin to assess the implementation of PGx services. Full article

Background: Pachychoroid pigment epitheliopathy (PPE) is a non-exudative entity within the pachychoroid disease spectrum characterized by increased choroidal thickness and isolated serous pigment epithelial detachment (PED) without subretinal fluid. Although photodynamic therapy (PDT) is established for chronic central serous chorioretinopathy (CSC), its efficacy in isolated pachychoroid-related PED remains insufficiently defined, with available evidence limited to small case series. Purpose: This study aims to characterize symptomatic pachychoroid-related PED and evaluate anatomical and functional outcomes following half-dose PDT (hd-PDT), with additional analysis according to lesion localization and CSC history. Methods: This retrospective study included 34 eyes of 27 patients treated with hd-PDT between June 2022 and December 2024. PEDs were categorized as central (fovea-involving) or paramacular. Best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography parameters—central subfield thickness (CST), mean subfield thickness (MST), macular volume (MV), subfoveal choroidal thickness (SFCT), and PED height—were assessed at baseline, 1 month, and 6 months. Treatment planning was based on indocyanine green angiography (ICGA) and spectral-domain optical coherence tomography (SD-OCT) findings. Statistical analyses employed non-parametric tests and generalized estimating equations. Results: Central lesions were associated with longer disease duration, worse baseline BCVA, and greater retinal thickness and PED height (p < 0.05). Complete PED resorption occurred in 79.4% of eyes at 1 month and 73.5% at 6 months (central: 86.3% and 81.8%; paramacular: 66.6% and 58.3%). Mean BCVA improved significantly from 0.22 ± 0.24 to 0.10 ± 0.16 logMAR at 6 months (p < 0.0001), with greater functional gain in central lesions. Significant reductions were observed in CST, MST, MV, and PED height, whereas SFCT remained stable. Better final BCVA correlated with younger age, shorter disease duration, smaller baseline retinal volume, smaller PDT spot size, and absence of CSC history. Non-responders had worse baseline BCVA, higher PED height, and larger treatment areas. No treatment-related complications were detected. Conclusions: Half-dose PDT was associated with favorable anatomical and functional outcomes in symptomatic pachychoroid-related PED, particularly in centrally located lesions. Baseline disease severity appeared to influence treatment response. Prospective studies with longer follow-up are warranted to confirm long-term efficacy and safety. Full article

In the era of big data, data is key to the accuracy of analytical models, and cloud computing services are often used to efficiently process large volumes of data. However, outsourcing sensitive data to a third-party cloud service provider results in a loss of direct control over the data, raising serious security concerns. The target of this study is to propose highly efficient and privacy-preserving protocols that compute the maximum/minimum value in large-scale data. To achieve the improvements in efficiency, the proposed protocols reuse the intermediate results generated in independent subprotocols. Existing privacy-preserving maximum/minimum protocols are based on approximation methods that sacrifice accuracy or reveal information during execution. They use costly comparison operations that are proportional to the size of the input data and are not suitable for large-scale data applications. In contrast, the proposed protocols theoretically reduce the number of communication rounds by 25%, the communication size by 50%, and the computational cost by 42% compared to the existing protocols. Nevertheless, the accuracy and privacy are fully maintained. In order to demonstrate these efficiency improvements concretely, we conducted experiments and demonstrated that the proposed protocols reduce the communication volume by half and the execution time by 22%. Because the proposed protocols support parallel execution, their performance can be substantially enhanced in cloud environments that provide large-scale parallel processing resources. Even data owners with restricted computational capabilities can use the protocols without exposing their information. Under the secure version, even cloud servers executing the protocol learn nothing about the input data or the computation results. Full article

Background: Slowly expanding lesions (SELs) have been introduced as a radiological marker of chronic active demyelination and smoldering inflammation. These lesions are recognized as indicators of disability worsening and brain atrophy in people with multiple sclerosis (PwMS). We aimed to provide an overview of the available evidence on the prevalence and clinical relevance of SELs in PwMS. Methods: PubMed, Embase, Scopus, and Web of Science were systematically searched up to 25 May 2025, to identify studies evaluating SELs in PwMS. Risk of bias was assessed using the Newcastle–Ottawa Scale. We conducted a thorough review to evaluate the clinical relevance of SELs in MS. Additionally, a meta-analysis was performed using R software to estimate the pooled prevalence of SELs in MS. Results: Twenty studies on 4970 PwMS met the inclusion criteria. Meta-analysis indicated that the pooled prevalence of SELs in PwMS was 57.1% (95% CI: 44.9% to 69.3%). Moreover, the systematic review showed that SELs were associated with chronic neuroinflammation, ongoing demyelination, disability, microstructural damage, and axonal degeneration. Intervention studies also indicated that the number and volume of SELs were decreased following the administration of disease-modifying therapies. Conclusions: SELs are revealed to affect around half of PwMS and are associated with disability and disease progression in MS. These results highlight the potential role of SELs as a critical radiomarker in MS. However, future studies are warranted to validate these preliminary findings. Full article

Agricultural rivers are often silent receivers of microplastics (MPs) from diffuse, non-point sources; however, their pollution dynamics during rainfall events remain poorly understood. In this study, MP transport was investigated at three sampling points in an agricultural river catchment, where mulching films are used, and sewage sludge is not applied. Sampling was conducted in the Umeda River and its tributaries during six sampling events. MP flux exhibited a strong positive correlation with river discharge (L–Q relationship; n = 1.49–1.61, R² = 0.67–0.87). The L–Q model indicates that a tenfold increase in discharge results in approximately a 600-fold increase in MP flux and a 1000-fold increase in total suspended solid flux. MP abundance during rainfall was up to four times higher than that during baseflow, ranging from 73 ± 64 to 200 ± 111 particles/m³, while peak flux reached 6736 particles/s, with an MP mass of 811 mg/s. Regarding particle characteristics, rainfall enhanced the heterogeneity of MPs, although fragments and polyethylene/polypropylene polymers remained consistently dominant across all hydrological stages. First-flush behavior was observed at HU, with more than half of the total MP mass exported within the initial 50% of the event flow volume. These findings help to inform mitigation strategies that should prioritize a reduction in upstream plastic inputs in order to effectively manage MP transport in agricultural rivers. Full article

Introduction: Acute ischemic stroke demands interventions that restore perfusion and protect neurons within a narrow therapeutic window. We propose a unified theranostic platform that couples adaptive imaging, topology-aware decision-making, and immediate neuroprotective and micro-dosimetric intervention. Methods: The platform integrates three components. First, a topology-preserving MR–PET engine employs adaptive Poisson-disc sampling, partial Fourier constraints, and structured Hankel low-rank priors in a closed loop. Persistent-homology metrics quantify vascular graph uncertainty and guide subsequent k-space and PET projections, reducing acquisition time while preserving collateral topology. Second, immediate post-reperfusion delivery of glycolic acid attenuates glutamate-driven calcium influx and stabilizes mitochondrial function. Third, trace doses of sol–gel-derived, neutron-activated ⁹⁰Y₂O₃ microspheres provide sharply confined beta irradiation for micro-scale metabolic modulation. Results: In a porcine stroke model replicating the human recanalization workflow, the imaging engine maintained vascular Betti-number invariants within three percent of fully sampled reference scans while reducing acquisition time by nearly half. Glycolic acid reduced glutamate-induced intracellular calcium rise by approximately sixty percent in vitro and decreased infarct volume by thirty-eight percent in vivo. Micro-dosimetry confirmed a mean perivascular beta dose of twenty-eight grays, and histology demonstrated a forty-two percent increase in NeuN-positive neuronal survival compared with standard recanalization. Conclusions: These results demonstrate that intelligent compressed-sensing MR–PET, targeted micro-radioembolization, and glycolic acid neuroprotection can act synergistically to bridge diagnostic imaging and immediate intervention. By coupling imaging, decision-making, and therapy in a closed-loop manner and elevating topological fidelity from a reconstruction byproduct to a control variable, the proposed platform reframes MR–PET from passive diagnostics into an active, decision-driven theranostic system and establishes a foundation for future human trials. Full article

Since the 19th century, the United States has continuously conducted plant introductions from around the world to expand high-quality germplasm resources for agriculture and horticulture. Beginning in 1898, China—shaped by millennia of agrarian civilization and characterized by exceptionally rich biodiversity—became a key focus of these efforts. To clarify the historical trajectory of the introduction of plants originating in China into the U.S., this study compiles the Office of Foreign Seed and Plant Introduction series Inventory of Seeds and Plants Imported (The Inventory of Seeds and Plants Imported is a serial publication compiled by the SPI since 1898, documenting plant introduction activities of the United States worldwide. The original volumes and their digitized versions are publicly accessible through the USDA National Agricultural Library (NAL) Digital Collections. These archival records constitute the primary source of the historical plant-introduction data used in this study.) and synthesizes the history of introductions from 1898 to 1949; after verifying and analyzing the composition and selectivity of introduced taxa in terms of scientific nomenclature, spatiotemporal distribution, collectors, taxonomic structure, and plant uses, we find that 23,890 introduction records were documented, encompassing 159 families, 869 genera, and 2252 species, spanning 34 provincial-level administrative regions and 230 prefecture-level cities in China, with more than 566 collectors participating over nearly half a century, among whom F. N. Meyer, J. F. Rock, P. H. Dorsett, W. J. Morse, and F. A. McClure made particularly prominent contributions. Plant introductions from China enriched U.S. germplasm collections, expanded the genetic and functional diversity of U.S. plant resources, and reshaped the composition of agricultural and landscape systems. Full article

Background/Objectives: Whether PCCT-derived virtual non-iodine (VNI) images can replace true non-contrast (TNC) for coronary artery calcium scoring (CACS) remains uncertain, particularly for small, low-density plaques. We aimed to evaluate agreement between VNI and TNC for CACS at the patient and lesion levels and to quantify risk-category reclassification. Methods: In this retrospective single-center sample (May 2024–May 2025), 211 patients without prior coronary intervention and with nonzero CAC on TNC underwent PCCT. VNI (55 keV, QIR 1; 60 keV, QIR 4; PureCalcium) and TNC were reconstructed with matched section thickness/increment and kernel. Agatston and total calcified volume were recorded. Paired comparisons used Wilcoxon tests; reclassification across CAC categories (0, 1–99, 100–399, ≥400) and lesion-level false negatives (FNs) were assessed with TNC as the reference. Results: Low-keV VNIs (55–60 keV) underestimated CAC versus TNC. The median Agatston score decreased from 35.9 (IQR, 10.3–121.2) on TNC to 23.6 at 55 keV (p = 0.0006) and 22.2 at 60 keV (p = 0.0003); the total volume declined from 37.8 mm³ to 20.2 mm³ (p = 0.001) and 18.3 mm³ (p < 0.0001), respectively. More than half of patients were reassigned to a lower CAC category; despite no patient being CAC = 0 on TNC, 46.9% (55 keV) and 47.4% (60 keV) were labeled CAC = 0 on VNI. Because this study deliberately included only patients with nonzero CAC on the TNC reference, these CAC = 0 rates on VNI represent misclassification within a CAC-positive sample and should not be interpreted as population-level prevalence. At the lesion level, 95% of patients had ≥1 FN plaques (430 FN plaques total), typically small (median 8 mm³) and of low density (median Agatston 6). Conclusions: In this single-center sample with relatively low-burden calcification, low-keV VNI (55–60 keV) significantly underestimates CAC and down-classifies patients, with frequent “false-zero” assignments (defined as CAC_VNI = 0 despite CAC_TNC > 0) driven predominantly by small, low-density plaques. Full article

Water scarcity and soil salinization are major challenges for sustainable agriculture in arid regions, affecting crop growth, yield, and quality. In greenhouse systems, optimizing irrigation and nutrient management under brackish (slightly to moderately saline) irrigation water (1–5 g L⁻¹) is essential for maintaining productivity and resource efficiency. This study investigated the effects of irrigation water salinity, irrigation volume, and nitrogen, phosphorus, and potassium application on growth, yield, fruit quality, and water–nutrient use efficiency of greenhouse-grown pepper (Capsicum annuum L., cv. ‘Qilin 99’) in southern Xinjiang. A five-factor, five-level half-fractional quadratic orthogonal rotatable design was employed. Pepper yield showed a unimodal response to increasing salinity, peaking at 3 g L⁻¹ with 4800 m³ ha⁻¹ irrigation and N, P₂O₅, K₂O rates of 225, 160, and 500 kg ha⁻¹, respectively. Water use efficiency and fertilizer partial factor productivity decreased significantly with increasing salinity and irrigation amount, reaching maximum under moderate irrigation water mineralization combined with low and medium irrigation levels, respectively. Fruit quality traits, including vitamin C, capsaicin, and free amino acids, were enhanced under moderate to relatively high salinity levels, whereas fruit size and single fruit weight were highest at lower salinity combined with higher irrigation. Irrigation water salinity was identified as the main limiting factor for yield and quality. Overall, greenhouse pepper exhibited a nonlinear dual-threshold response to combined water, nutrient, and salinity management, with an optimal threshold around 3 g L⁻¹. These findings provide practical guidance for improving water and nutrient use efficiency in greenhouse agriculture under slightly saline irrigation. Full article

This study introduces a novel intraday volume-based uncertainty (IVU) proxy—the ratio of opening-half-hour volume to total volume of the preceding seven intervals—to predict final half-hour return direction in the Chinese stock market. Using threshold regression, we identify a statistically significant IVU critical value of 0.476225 (p < 0.001), which splits the sample into distinct uncertainty regimes. Logistic regression incorporating this threshold reveals that the joint condition of high opening volume and low IVU (high uncertainty) significantly amplifies the predictive power of initial returns, achieving 63.04% accuracy in the high-uncertainty, high-volume regime. XGBoost further captures complex non-linear interactions, with IVU-related features ranking among the most important predictors and achieving 71.43% out-of-sample accuracy under high-volume, high-uncertainty conditions. A machine learning trading strategy leveraging these predictions yields a total return of 117.99% with a Sharpe ratio of 3.02 over seven years, significantly outperforming benchmarks. Our findings highlight information uncertainty as a critical moderator of intraday momentum and a valuable source of actionable alpha. Full article

Conventional multi-channel ultrasonic motor (USM) drive systems commonly adopt a one-motor–one-driver architecture, in which each drive channel requires an independent isolated power supply and inverter stage. As the number of motors increases, the system volume and structural complexity grow significantly. To address this issue, this paper proposes a shared DC-bus multi-channel drive architecture for traveling-wave USM. In the proposed scheme, multiple half-bridge power stages are connected in parallel to a common high-voltage DC-bus to achieve centralized energy supply and distributed driving. A DC-side midpoint reference network is introduced to establish an AC voltage reference under a unipolar DC supply, while an independent series matching inductor is employed in each channel to shape the half-bridge output into a quasi-sinusoidal motor-terminal voltage through resonant filtering. Based on the equivalent electrical model of the USM, a unified analytical model is established to analyze the voltage formation mechanism under shared DC-bus conditions. Time-domain simulations and experimental tests are carried out on a two-channel prototype operating at a 150 V DC-bus and a 40 kHz switching frequency. The results demonstrate stable quasi-sinusoidal output voltages, preserved phase consistency, and limited inter-channel coupling during parallel operation. Compared with conventional independent-supply solutions, the proposed architecture achieves an approximately 27% reduction in overall system volume for a three-motor configuration, demonstrating good scalability for compact multi-channel USM drive systems. Full article

Background/Objectives: Patients with early-stage non-small cell lung cancer (NSCLC) or limited lung metastases and compromised lung function, such as those with interstitial lung disease (ILD) or chronic obstructive pulmonary disease (COPD), or other factors rendering them high-risk for surgery or medically inoperable, face increased risks of treatment-related toxicity from stereotactic ablative radiation therapy (SABR). This study evaluated a novel treatment approach to mitigate these risks. Methods: We investigated Personalized Ultra-Fractionated Stereotactic Adaptive Radiotherapy (PULSAR), delivered as pulsed radiation every three weeks, in patients with <5 cm lung tumors and ILD, COPD, or prior therapy. Treatment occurred between 2022 and 2024. Online adaptive radiotherapy (o-ART) was employed in 20 patients (80%) to modify treatment plans when anatomical changes warranted replanning. Primary outcomes included volumetric tumor response, changes in dose to organs at risk (OARs) and acute events, while secondary outcomes included local and tumor control, and overall survival. Results: Twenty-three patients received PULSAR treatment at doses between 40 Gy and 60 Gy in 5 fractions and one patient received 54 Gy in 3 fractions, with a median follow-up time of 16.2 months. Approximately half of treated patients demonstrated volumetric tumor response, with median residual volume of 70% (range 36–100%) at maximal response. Among the 20 patients (80%) who underwent online adaptive replanning, significant reductions in OAR dosimetry were observed for all organs assessed including the Dmax for heart (p = 0.0053), bronchus (p = 0.0003), esophagus (p = 0.0005), spinal cord (p = 0.025), and the lung V20 Gy and V12.5 Gy (p < 0.0001). Treatment-related toxicity included two grade 1–2 adverse events and six grade 3 events consisting of pneumonitis, dyspnea or lung infection, with no grade 4 or 5 events. Median progression-free survival was 21.1 months, with 1-year overall survival of 74% and 1-year local control of 100%. Conclusions: PULSAR shows promise as a feasible treatment option for high-risk patients with NSCLC or lung metastases, demonstrating no grade 5 events and complete tumor control. Additional research is needed to fully evaluate the safety profile of PULSAR in the high-risk subgroups and whether PULSAR’s treatment intervals and adaptive planning advantages lead to improved long-term outcomes compared to conventional, uninterrupted SABR regimens. Full article

Surface plasmon resonance (SPR)-based optical fibre sensors have transformed label-free biosensing; however, single-interface evanescent field interactions continue to limit their sensitivity. This study presents a novel π-configuration optical fibre-based surface plasmon resonance sensor that greatly increases sensitivity by enabling dual plasmonic excitation on two symmetrically polished surfaces coated with optimized metallic thin films (Ag, Au, or Cu). We show, using finite element method simulations in COMSOL Multiphysics v6.3, that the π-configuration increases the interaction volume between the analyte and guided light, resulting in an enhanced sensitivity of 3300 nm/RIU for silver at refractive index (RI) 1.37–1.38, which is a 120% improvement over traditional D-shaped sensors (1500 nm/RIU). The maximum field norm for the π-configuration sensor is approximately 1.4 times greater than the maximum observed for the D-shaped SPR sensor at an analyte RI of 1.38. The sensor’s performance is evaluated using full-width half-maximum, wavelength sensitivity, and wavelength interrogation metrics. For the π-configuration sensor at an analyte RI of 1.38, the values of the FWHM, figure of merit, detection accuracy, and confinement loss were 36 nm, 94.29 RIU⁻¹, 0.94, and 38.5 dB/cm, respectively. The results obtained are purely simulated using COMSOL. With the support of electric field confinement analysis, a thorough theoretical framework describes the crucial coupling regime that causes ultra-high sensitivity at low RI. This design provides new opportunities for environmental monitoring, low-abundance biomarker screening, and early-stage virus detection, where it is necessary to resolve minute RI changes with high precision. Full article

Background/Objectives: Hemodynamic and neurohormonal factors, including renal perfusion and venous pressure, may affect diuretic response, which may be modulated by body position. This study aimed to assess whether supine versus upright positioning influences diuretic efficacy and neurohormonal activation during early decongestion in patients with AHF and reduced ejection fraction (HFrEF). Methods: This single-center, prospective, pilot randomized study enrolled 12 hospitalized patients with decompensated HFrEF receiving guideline-directed medical therapy. Participants were randomized (1:1) to remain in either the supine or upright/seated position during intravenous furosemide administration (1 mg/kg: half of the dose administered as a bolus, half as a 2-h infusion). Serial measurements of urine volume, electrolyte excretion, and neurohormonal biomarkers (renin, aldosterone, catecholamines) were performed at baseline, 2, and 6 h after diuretic administration. Results: No significant differences were found between supine and upright groups in total urine output, urine dilution, sodium excretion, or weight change after 6 h. There were no statistically significant differences in renin and aldosterone levels across subsequent timepoints; however, renin concentration tended to be higher in upright than in supine individuals. Interestingly, supine participants demonstrated greater urinary adrenaline concentration after furosemide administration, alone and after adjustment for urinary creatinine. Conclusions: No clinically meaningful differences were found between supine versus upright position patients with AHF, receiving neurohormonal blockade. Full article

Current saw- and pin-type lint-cleaning systems used by the ginning industry have challenges retaining lint quality. The objective of the research was to test a novel pneumatic fractionator for the lint cleaning of an Upland cotton variety that was both saw- and roller-ginned. The process variables tested were initial lint moisture content in the range of 5.5–15% w.b., line pressure in the range of 276–552 kPa, and residence time in the range of 15–45 s. Experiments were conducted based on a central composite design. Models based on response surface methodology (RSM) were developed for final lint moisture, total trash extracted during lint cleaning, and High-Volume Instrument (HVI) fiber quality. The RSM models adequately described the pneumatic fractionation process, as indicated by the coefficient of determination, predicted vs. observed plots, and residual values. The results indicated that the interactions among initial lint moisture content, residence time, and line pressure significantly affected lint quality. At the optimized pneumatic fractionator process conditions, the predicted lint quality attributes were better for both roller- and saw-ginned lint compared to lint cleaned with saw- and pin-type lint cleaners. The upper half mean length increased by 1 mm, the uniformity index was higher by 0.5–1 percentage points, the strength was 1–2 g/tex higher, and the short fiber content was reduced by more than one percentage point. Color grades were better for pneumatic fractionated lint compared to saw- and pin-type lint cleaning methods. Lint value was approximately 4 cents/kg higher for both saw- and roller-ginned pneumatic fractionated lint, compared to lint cleaned using saw- and pin-type lint cleaners. The novel pneumatic fractionator, when compared to industry-standard saw- and pin-type lint cleaners, effectively cleaned lint while retaining fiber quality and removing most of the motes and trash. Full article