Search Results (55,411)

Necrotizing enterocolitis (NEC) and sepsis/late-onset sepsis (LOS) are significant contributors to preterm infant morbidity and mortality, with prematurity and low birth weight representing major risk factors for these interconnected conditions. Although the pathogenesis of NEC and LOS is not fully understood, there is a clear association with an immature intestinal mucosal barrier, which may enable bacterial invasion and translocation, resulting in an inflammatory cascade. Increasing recognition of the gut microbiome as a marker for health and disease has driven interest in probiotics, particularly Bifidobacterium spp. and Lactobacillus spp., as potential adjunctive agents for the prevention and management of NEC and LOS in preterm infants, which is the area of focus of this review. The focus of this paper was to analyze clinical studies using different probiotic strains, and compare single-strain versus multi-strain probiotic formulations. Several studies support that probiotic supplementation in preterm infants has the potential to decrease NEC incidence and, to a lesser extent, sepsis/LOS. Nonetheless, inconsistent results due to strain differences and clinical heterogeneity limit the widespread adoption of this mode of therapy, as do safety concerns in this vulnerable population. Further high-quality standardized studies are necessary to establish consistent guidelines for probiotic use in preterm infants. Full article

Background: This study investigates the impact of anatomically constrained preprocessing and deep learning architecture selection on benign versus malignant breast lesion classification in contrast-enhanced mammography (CEM), with the goal of improving robustness and clinical reliability across heterogeneous data sources. Methods: In this retrospective multicenter study, CEM images from 300 patients (314 lesions) were combined with 1003 publicly available CEM images, yielding a total of 1120 breast cases. Automatic breast segmentation was performed using the LIBRA framework to generate breast-mask images. Eleven deep learning models, including classical convolutional neural networks, attention-based networks, hybrid convolutional neural networks (CNNs), Transformer architectures, and mammography-specific models, were trained and evaluated using both original DICOM images and breast-mask inputs. Performance was assessed using accuracy, balanced accuracy, sensitivity, specificity, AUROC, and AUPRC on cross-validation and independent test sets. Hyperparameter optimization was conducted for the best-performing architecture. Results: Models trained on breast-mask images consistently outperformed those trained on original DICOM images across all architectures and metrics, with AUROC improvements ranging from +0.06 to +0.21. Among all models, ResNet50 trained on breast-mask images achieved the best performance (AUROC = 0.931; AUPRC = 0.933; balanced accuracy = 0.834), further improved after optimization (balanced accuracy = 0.886; sensitivity = 0.842; specificity = 0.930). Classical CNN architectures demonstrated performance comparable to or exceeding that of more complex hybrid CNN–Transformer models when anatomically focused preprocessing and rigorous optimization were applied. Conclusions: Anatomically constrained preprocessing through breast-mask segmentation substantially enhances deep learning performance and stability in CEM-based breast lesion classification. These findings indicate that input representation quality and training optimization are critical determinants of clinically relevant performance, often outweighing architectural complexity, and may support more reliable AI-assisted decision support in CEM workflows. Full article

Biodiesel is a sustainable and promising alternative energy source produced from renewable raw materials using various methods. One effective approach is simultaneous esterification and transesterification, which relies on suitable catalysts that can be either homogeneous or heterogeneous. Homogeneous catalysts (acid or base) offer high activity but are corrosive and difficult to recover, necessitating energy-intensive processes such as aqueous quenching and neutralization, which can lead to soap formation and stable emulsions. By comparison, heterogeneous catalytic systems overcome many of these challenges due to their ease of recovery, reusability, and simplified product separation, which collectively enhance economic viability and environmental sustainability. This review highlights recent progress in the application of zeolite-based solid catalysts for biodiesel synthesis, with particular emphasis on their use in converting waste cooking oil and other low-cost feedstocks, including non-edible oils, non-food biomass sources, algal resources, and genetically engineered microorganisms. Key factors such as catalytic activity, selectivity, catalyst loading, and reusability are discussed, highlighting the advantages of zeolites due to their unique crystal structure, high thermal stability, and ease of product recovery. Overall, this review underscores the challenges and opportunities in zeolite-based catalysis to provide a comprehensive understanding of its potential to enhance the efficiency and scalability of biodiesel production. Full article

Background: Aquatic therapy is increasingly used in post-stroke rehabilitation, but its effects on balance and gait in the chronic phase remain variably reported. This systematic review aimed to evaluate the effects of aquatic therapy, alone or combined with land-based rehabilitation, on balance and gait in individuals with chronic stroke. Methods: A systematic search of PubMed, Embase, Scopus, and Web of Science was conducted between February and March 2026. Randomized controlled trials enrolling adults with chronic stroke and evaluating aquatic-containing interventions with quantitative balance and/or gait outcomes were included. Owing to clinical and methodological heterogeneity, the primary synthesis was narrative. An exploratory random-effects meta-analysis was additionally performed for post-intervention Berg Balance Scale (BBS) scores. Results: Thirteen randomized controlled trials involving 468 participants were included. Overall, aquatic therapy was associated with more consistent improvements in balance than in gait, while combined aquatic and land-based programs generally showed broader functional gains than land-based rehabilitation alone. In the exploratory meta-analysis, the primary pooled analysis of four studies favored aquatic-containing interventions for post-intervention BBS scores (MD = 3.69, 95% CI 2.69 to 4.69; p < 0.001), with no observed heterogeneity (I² = 0%). Conclusions: Aquatic therapy may be a useful adjunctive rehabilitation strategy for improving balance in chronic stroke, whereas effects on gait appear more variable. These findings should be interpreted cautiously because the quantitative synthesis was exploratory and the overall evidence base remains heterogeneous and limited by small sample sizes and short follow-up. Full article

Lung cancer remains the leading cause of cancer-related mortality worldwide, and although immunotherapy has transformed the treatment landscape of advanced non-small cell lung cancer (NSCLC), durable benefit is limited to a subset of patients. PD-L1 immunohistochemistry and tumor mutational burden, while clinically utilized, demonstrate imperfect predictive capacity, underscoring the need for more robust biomarkers. This review highlights emerging multimodal biomarkers—including circulating tumor DNA (ctDNA), the gut microbiome, and artificial intelligence (AI)-driven radiomics—as promising tools to enhance the prediction of immunotherapy response. Longitudinal ctDNA monitoring offers a minimally invasive method to assess tumor burden dynamics, detect early molecular response, distinguish pseudo-progression from true progression, and stratify risk, with ctDNA clearance correlating with improved survival outcomes. The gut microbiome has also been associated with ICI efficacy, as specific bacterial taxa and composite scoring systems correlate with treatment response, though methodological heterogeneity limits clinical translation. Radiomic analyses leveraging CT and PET imaging extract quantitative tumor features that, when integrated with clinical and molecular data, demonstrate improved predictive performance compared to single-modality approaches. Despite promising advances, challenges including assay standardization, external validation, data harmonization, interpretability of AI models, and infrastructure requirements remain barriers to widespread adoption. Multimodal integration of genomic, microbiome, and imaging biomarkers represents a critical step toward precision immuno-oncology, with prospective validation needed to translate these approaches into improved outcomes for patients with advanced NSCLC. Full article

Background/Objectives: Haemoadsorption has recently emerged as an extracorporeal treatment option for sepsis, septic shock, intoxications, and cardiac surgery to modulate dysregulated inflammatory responses or remove a wide range of circulating molecules. To ensure appropriate clinical use of the CytoSorb^® haemoadsorber, it is essential to understand the extent to which specific drugs are adsorbed by the device. Methods: We conducted a systematic literature review using the PubMed and Ovid MEDLINE database to identify studies on drug binding to the CytoSorb^® haemoadsorber, including both in vivo and in vitro studies. Publications in English language, available up to 31 December 2025 that reported or enabled calculation of percentage of drug removal, CytoSorb^® clearance or half-life during CytoSorb^® therapy were included. Records were screened, eligibility and quality were assessed, and data were extracted independently by two reviewers. Results: We found that 26 studies reported on the binding of 56 drugs to CytoSorb^®, with most available information relating to antibiotics used in the treatment of sepsis and septic shock. CytoSorb^® appears to remove vancomycin and linezolid but not meropenem, although data for other antibiotics are insufficient to assess clinical relevance. Data on the removal of anticoagulant and antithrombotic drugs with CytoSorb^® before and during cardiac surgery indicate that using this procedure to reduce complications associated with apixaban and ticagrelor is feasible and safe. The available evidence on the use of CytoSorb^® for drug poisoning is of very low quality. Conclusions: Although the number of studies on drug binding to the CytoSorb^® is increasing, the review is limited by the marked heterogeneity among the included studies. It is advised to use therapeutic drug monitoring whenever possible during CytoSorb^® treatment. Research of binding of drugs to CytoSorb^® is crucial for its safe and effective clinical use, but adequate methodology is necessary. Full article

Background: RASopathies represent a clinically and genetically diverse group of syndromes resulting from germline mutations in genes regulating the RAS/mitogen-activated protein kinase (MAPK) signaling cascade. Methods: The aim of this study was to describe the clinical features and genetic variants identified in patients with genetically confirmed Noonan syndrome (NS) in a limited cohort from Romania. A total of 25 patients with positive genetic testing for NS-associated genes were included. Genetic testing was performed primarily using next-generation sequencing. Results: A total of twenty-six variants were identified in twenty-five patients, as one patient carried two pathogenic variants in the PTPN11 gene (c.188A>G and c.922A>G). Of these variants, twenty-four (92.31%) were classified as pathogenic and two (7.69%) as variants of uncertain significance (VUS). Pathogenic variants were found in different genes, including PTPN11, LZTR1, SOS1, and RAF1, with PTPN11 being the most frequently affected gene. Males predominated (17/25), with a male-to-female ratio of approximately 2:1. Two patients inherited the pathogenic variant from an affected parent. Cardiovascular involvement was present in 21 patients (84%), with pulmonary valve stenosis (PVS) being the most common finding (48%), followed by hypertrophic cardiomyopathy (16%). Additional cardiac anomalies included atrial septal defect, valvular regurgitation, dysplastic valves, coarctation of the aorta, and sinotubular junction narrowing. Short stature was observed in 64% of patients, and craniofacial dysmorphism was present in 96%. Cutaneous, ectodermal, dental, ophthalmologic, and auditory manifestations were variably observed. Conclusions: Although based on a limited cohort from Romania, this study provides insights into clinical features suggestive of NS. Our findings highlight the genetic heterogeneity of NS and emphasize the importance of comprehensive genetic testing for confirming diagnosis, guiding clinical management, and supporting family counseling. Full article

Breast cancer (BRCA) is the most common cancer worldwide, with an incidence exceeding that of lung cancer. Protein lactylation, a newly identified post-translational modification involving the binding of lactic acid to lysine residues, plays an important role in BRCA. However, its role in BRCA progression remains largely unexplored. This study aims to identify and characterize the lactylation-related genes involved in BRCA biology. Transcriptomic and clinical data of BRCA and normal breast tissues were obtained from TCGA and GEO. Lactylation-related genes were curated from literature and intersected with BRCA datasets to identify candidates. A prognostic risk model was constructed using LASSO and Cox regression. Functional enrichment was performed using KEGG, GSVA, and GSEA. Immune correlations were evaluated by ESTIMATE, CIBERSORT. Single-cell RNA-seq data were integrated to assess gene expression heterogeneity across tumor and immune compartments. In vitro, MDA-MB-231 cells were treated with sodium L-lactate and lactylation-inducing agents, and gene expression was validated by Western blot and RT-qPCR, while EdU and wound healing assays evaluated proliferation and migration. We identified six hub genes associated with the immune microenvironment. Notably, S100A4 is significantly underexpressed, suggesting their potential regulatory roles in BRCA. Further analysis demonstrated that lactylation-related genes are closely linked to immune regulation in BRCA, indicating a possible crosstalk between metabolic modification and tumor immunity. Additionally, we found that lactylation significantly influences gene expression patterns and immune infiltration in BRCA. Importantly, lactic acid ions were shown to upregulate lactylation levels in BRCA cells, underscoring the functional impact of metabolic signals on post-translational modifications in tumorigenesis. Our findings indicate a potential mechanism wherein lactylation affects BRCA progression via lactic acid-driven regulation of the immune microenvironment; they also highlight the possible involvement of S100A4 in this process and offer new insights that could contribute to the diagnosis and treatment of BRCA. Full article

Accurately identifying medium- and low-yield farmlands (MLYF) and diagnosing their constraints are essential for targeted improvement of productivity and national food security. However, traditional evaluation is usually limited by coarse spatial resolution and high labor costs, and a methodological gap remains between large-scale MLYF classification and system constraints diagnosis. To address the current methodological gaps, this study developed a comprehensive framework to determine the spatial distribution of MLYF in northern China and clarify their key constraints. The framework combined the Spatio-Temporal Random Forest (STRF) algorithm with vegetation indices (VIs), climate, and soil data to delineate MLYF and uses interpretable machine learning to diagnose major constraints. The model showed high explanatory power and ensured the reliability of attribution results. The results showed that MLYF exhibited obvious spatial heterogeneity, accounting for 48.66% of the total cultivated land in the study area. These MLYF are primarily concentrated in the northwestern Loess Plateau (LP), the central Along the Great Wall (ATGW) region, and the peripheries of the Huang-Huai-Hai (HHH) Plain. In addition to spatial classification, our analysis revealed significant differences in constraint mechanisms: soil structural, nutrient, and salinization constraints predominantly restrict productivity in the HHH Plain, whereas water stress and soil erosion are the primary drivers of yield gaps in the LP and ATGW regions. These findings provide new data and insights for understanding the spatial heterogeneity of farmland quality in typical dryland agricultural regions in northern China, and offer a scientific basis for targeted land improvement and regional agricultural sustainability. Full article

Metabolically-dysfunction-associated steatotic liver disease (MASLD) represents the most common chronic liver disease in the pediatric population, and its prevalence has doubled over the past decade. The etiology is multifactorial, including genomic risk factors, perinatal and developmental or behavioral factors. Still, many cases of MASLD are associated with being overweight and obesity, particularly in children who have poor dietary habits and sedentary lifestyles that contribute to excessive weight gain. Given the progressive and heterogeneous nature of MASLD, early identification of high-risk patients before the development of severe liver disease is a major clinical priority. Recent studies indicate that disorders of amino acid metabolism are closely linked to both obesity and MASLD, reflecting profound alterations in systemic metabolic homeostasis. The reported data sustain significant changes in circulating amino acid profiles, particularly elevated levels of branched-chain amino acids (BCAAs) and aromatic amino acids. These alterations are thought to reflect fundamental metabolic disturbances, including insulin resistance, compromised mitochondrial activity, and altered hepatic lipid metabolism. Consequently, alterations in amino acid metabolism have been proposed as potential biomarkers for disease progression and metabolic dysfunction in MASLD. This review aims to evaluate the correlation between the amino acid profile and histological changes in pediatric MASLD, including steatosis, steatohepatitis, and fibrosis. Full article

Corporate carbon disclosure has become increasingly important in China’s transition toward sustainability and low-carbon development, yet existing research often focuses on isolated determinants and relies mainly on linear empirical models. Using 48,187 observations of Chinese A-share firms from 2012 to 2024, this study identifies the key predictors of corporate carbon disclosure. It develops an interpretable machine learning model and compares its predictive performance with that of linear regression, LASSO, decision tree, random forest, support vector machine, GBDT, and XGBoost. The results show that ensemble methods outperform linear models in both in-sample and out-of-sample predictions. GBDT delivers the best out-of-sample performance, with an R² of 0.5191, suggesting that nonlinear relationships and interaction effects matter in predicting corporate carbon disclosure. The key factors identified are firm size, media attention, environmental policy intensity, market concentration, and executive financial background. The heterogeneity tests show that regulatory and governance factors are more important for firms in heavily polluting industries, state-owned firms, and firms in central and western China, whereas market factors are more important for firms in eastern China, private firms, and firms in less polluting industries. Overall, the paper provides new evidence on the prediction of corporate carbon disclosure and offers practical implications for regulators and firms seeking to improve their sustainability-related disclosure practices. Full article

Arsenic contamination in polymetallic mining areas is closely linked to surrounding iron-rich manganese minerals. However, conclusive evidence remains limited regarding the retention and migration process of As(V) in naturally manganese-rich manganese ores (especially those with different manganese/iron mass ratios) under dynamic flow conditions. This study investigated As(V) adsorption and transport by four natural manganese minerals (FM1–FM4) through batch/column experiments, characterization, and numerical modeling. Their Mn/Fe mass ratios were 22.7 for FM1, 4.2 for FM2, 3.7 for FM3, and 16.4 for FM4. Batch experiments showed that As(V) adsorption on FM1–FM3 was better described by the Freundlich model, indicating heterogeneous adsorption behavior. Under the tested experimental conditions, the apparent Langmuir qₘ values of these minerals decreased from 0.066 to 0.015 mmol·g⁻¹ with decreasing Mn/Fe ratio. However, As(V) adsorption on FM4, which had the lowest Mn and Fe contents, followed the Langmuir model (qₘ = 0.012 mmol·g⁻¹), suggesting monolayer adsorption. Column experiments demonstrated rapid As(V) retention for all minerals. In the time domain, increasing the flow rate from 0.5 to 2.0 mL·min⁻¹ generally advanced breakthrough and shortened the desorption tail, although the breakthrough behavior expressed in pore-volume coordinates was not strictly monotonic for all minerals. The Two-Site Kinetic Attachment Model (TSKAM) successfully simulated these dynamics (R² > 0.90, RMSE < 0.05), revealing adsorption controlled by fast and slow kinetic sites, with slow-site contributions diminishing at higher flow rates. Characterization results indicated that adsorbed arsenic on FM1 remained mainly as As(V) and was immobilized primarily through surface complexation involving surface hydroxyl and Fe/Mn–O groups. XRD and SEM-EDS suggested the participation of Fe/Mn-bearing phases, while XPS on FM1 showed pronounced changes in Mn surface species during adsorption. Therefore, As(V) removal by these natural manganese minerals is a coupled physicochemical process influenced by both mineral properties, including Mn/Fe ratio, specific surface area, pore structure, pH_PZC, and Mn surface-state changes, and hydrodynamic conditions in the polymetallic mining areas. Full article

The sixth-generation (6G) mobile communication systems are anticipated to be operational by 2030, prompting extensive research efforts by governments and private entities. Designed to meet societal, economic, and technological demands unaddressed by fifth-generation (5G) networks, 6G integrates scalability, security, and reliability with ubiquity and resource-intensive artificial intelligence. Envisaged as multi-band, decentralized, autonomous, flexible, and user-centric, 6G networks incorporate innovative technologies, including cell-free (CF), three-dimensional heterogeneous networks (3D HetNet), reconfigurable intelligent surfaces (RIS), integrated sensing and communication (ISAC), as well as artificial intelligence/machine learning (ML). In 6G 3D HetNets, the densification of access points (APs) continues, accommodating increased connections and traffic volumes, alongside the use of higher frequency bands. Although 6G networks are not fully standardized, they target demanding Quality of Service (QoS) standards, such as a peak data rate of 1.0 Tbps and latency of 0.1 ms. This paper conducts a comprehensive literature review on radio resource management (RRM) in 6G cell-free and 3D HetNet systems, emphasizing challenges such as interference mitigation. It presents a taxonomy of RRM approaches, systematically studying, categorizing, and qualitatively analyzing recent techniques, outlining the current state, and indicating future trends, technologies, and challenges shaping 6G systems. Full article

To develop secure, fast, and interoperable smart substations, it is vital to understand the current situation and potential future directions of the technologies involved. This study presents the evolution and state of the art of the Generic Object Oriented Substation Event (GOOSE) communication protocol, defined by the International Electrotechnical Commission (IEC) 61850 standard. A Systematic Literature Review (SLR) was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. This included journal articles published from 2004 to 2025 and conference papers from 2020 to 2025, written in English within Engineering. Only studies primarily focusing on GOOSE, citing it at least ten times, and indexed in the Scopus, IEEE Xplore, and Web of Science databases were included. The quantitative analysis used SciMAT software, complemented by a qualitative analysis. Due to the bibliometric and thematic nature of this review, potential biases were considered at the review level rather than by applying a formal study-level risk-of-bias tool. The final analysis comprised 82 journal articles and 84 conference papers. The results offer a comprehensive mapping of GOOSE research evolution, identify nine main challenges and limitations from the last 22 years, and highlight current research directions. The literature reveals methodological heterogeneity, a predominance of simulation-based approaches, and limited large-scale empirical validation. Full article

Diagenetic anomalies within the Upper Paleozoic coal-bearing strata of the Longdong area, Ordos Basin, represent a complex interplay between thermal maturation and fluid evolution, yet their governing mechanisms remain poorly understood. This study integrates petrographic analysis, X-ray diffraction, vitrinite reflectance (Ro) measurements, and fluid inclusion microthermometry to evaluate the discrepancy between organic thermal maturity and mineralogical diagenetic records. The results indicate that the mudstones achieved high thermal maturity, with mean Ro and Tmax values of 2.3% and 555.1 °C, respectively. However, the associated sandstones exhibit anomalous mineral assemblages, characterized by persistent high levels of illite/smectite (I/S) mixed-layer minerals and authigenic kaolinite, which are inconsistent with the anticipated advanced diagenetic stage. Furthermore, homogenization temperatures (Th) of fluid inclusions are significantly lower than expected, implying a localized suppression of illitization. We propose that this atypical diagenetic trajectory is governed by sluggish fluid–rock interactions in a confined diagenetic environment. Specifically, the dissolution of feldspars during acidic diagenesis provided a localized Al³⁺ supply, favoring kaolinite precipitation, while the limited availability of reactive feldspar precursors and pore-fluid retention effectively stalled the progression of illitization. These findings demonstrate that reactant availability and reaction kinetics can decouple mineralogical evolution from organic thermal maturation in coal-bearing sequences. This study provides a novel mechanistic framework for interpreting anomalous diagenetic signatures in heterogeneous sedimentary basins, offering significant implications for reservoir quality prediction in deep-seated, thermally mature strata. Full article