Search Results (1,988)

Objective: To evaluate reproductive outcomes following fertility-sparing surgery for deep endometriosis (DE), specifically assessing the impact of bowel resection on spontaneous conception rates and the predictive value of the Endometriosis Fertility Index (EFI). Design: Retrospective observational cohort study. Setting: High-volume tertiary referral center for endometriosis. Patients: A total of 507 women with histologically confirmed endometriosis and documented infertility or active desire for pregnancy, managed between 2018 and 2025. Patients undergoing hysterectomy were excluded. Interventions: Laparoscopic complete excision of endometriotic lesions using a nerve-sparing technique. The surgical strategy for bowel involvement was tailored to nodule characteristics: 194 patients (38.3%) underwent segmental colorectal resection, 38 (7.5%) underwent rectal shaving, and 9 (1.8%) were treated with advanced organ-sparing techniques (lateral rectal resection or extra-mucosal excision—EMEB). Main Outcome Measures: Postoperative pregnancy rate (PR), mode of conception (spontaneous vs. ART), and factors influencing fertility. Results: The cohort presented with severe disease (mean rASRM stage 3.4) and a high prevalence of primary infertility (79.3%). During the follow-up period, 310 patients achieved pregnancy, resulting in an overall pregnancy rate of 61.1%. Notably, 70.3% of these pregnancies were achieved spontaneously. Radicality did not compromise fertility: the segmental resection group achieved a pregnancy rate of 91.2% (177/194), while patients treated with rectal shaving achieved 100%. The EFI score was identified as a robust predictor of success (mean score 5.5 in pregnant vs. 4.9 in non-pregnant patients, p < 0.05). Conclusions: Comprehensive nerve-sparing excision of DE, including segmental bowel resection, is associated with high pregnancy rates and a predominant restoration of natural fertility. Surgery should be considered a first-line strategy to reduce dependency on assisted reproductive technologies. Full article

The Upper Yellow River Basin (UYRB) is one of the most tectonically complex and seismically active regions in China, but the detailed crustal deformation and interseismic fault couplings, providing the essential parameters for geodynamics and seismic hazard analysis, are still unclear in this region. We thus adopt Sentinel-1 Synthetic Aperture Radar images to form frame-based line-of-sight velocity maps, and then derive a high-resolution surface deformation map around the UYRB. Slip rates and coupling states are further inverted for some active yet less-investigated faults. For instance, we estimate a right-lateral strike-slip motion of ~2.3–3.5 mm/yr along the Riyueshan Fault, and a thrust rate of ~2.0–3.5 mm/yr across the Lajishan Fault. Finally, the seismic moment budgets and the potential magnitudes are calculated based on the fault slip deficits and historical earthquakes. The accumulated moment deficit could produce earthquakes of M_W ≥ 6.0 in most active faults, and up to M_W ≥ 7.0 along the Dongdatan-Xidatan and Maqin-Maqu segments of the East Kunlun Fault and the Jinqianghe segment of the Haiyuan Fault. Our inverted slip rates, interseismic coupling states, and potential seismic moment on the active faults provide a basis for understanding kinematic processes and assessing seismic hazards within the UYRB. Full article

The treatment of chronic lymphocytic leukemia (CLL) has shifted from chemoimmunotherapy to targeted therapy, resulting in improved outcomes and patient survival. The aim of this study was to evaluate the efficacy and safety of venetoclax-based regimens in patients with relapsed/refractory CLL, as well as their effectiveness in patients previously treated with ibrutinib. We retrospectively analyzed 98 patients with CLL who received venetoclax in the second or later lines of therapy in Slovakia between 2018 and 2024. The median age was 68 years, and treatment was administered either as monotherapy or in combination with rituximab. Response to treatment was assessed according to the iwCLL 2018 criteria and clinical practice. Patients who achieved complete hematologic and clinical remission but did not undergo confirmatory bone marrow examination were classified as having unconfirmed complete remission (uCR). An overall response was achieved in the majority of patients (in 99%), with 2% achieving complete remission, 65% incomplete complete remission and 32% partial remission. At a median follow-up of 34 months, median overall survival was not reached (mean 52.5 months), and median progression-free survival was 45 months. Survival outcomes were evaluated using Kaplan–Meier analysis. Patients previously treated with ibrutinib had significantly worse outcomes (p = 0.022). Adverse events were predominantly hematological (64%), with 19% being grade 3–4. In line with the conclusions of clinical trials and retrospective analysis from real-life practice, we can say that venetoclax-based treatment regimens are highly effective in patients with CLL in higher lines of treatment, with acceptable and well-manageable toxicity. Full article

Background: Walking is a dynamic activity that relies on inputs from the multisensory system, i.e., somatosensory, vision, and vestibular. These inputs are processed and integrated in the central nervous system to produce motor impulses for efficient walking balance. The Sensory Organization Test (SOT) is established as the gold standard for assessing sensory contributions to standing balance. However, no comparable assessments have been developed for the clinical evaluation of balance during gait. This study evaluated the Gait Sensory Interaction Test (GaitSIT), a novel virtual reality (VR)-based assessment for characterizing sensory-condition-specific changes in walking balance. Methods: The GaitSIT comprises a VR environment with a physical compliant foam walking surface that evaluates gait–balance by systematically manipulating and evaluating the sensory systems. Twenty-nine healthy young adults (mean age 24.9 ± 6.4 years) were instructed to complete 6 m walking trials under six standardized conditions (C): eyes open, eyes closed/dark scene, and rotating visual scenes on a firm surface, then repeated on a foam surface. Wearing an Oculus VR headset, participants were instructed to walk in a straight line at their preferred speed, as naturally as possible, in two test sessions on the same day, followed by a third test session 24 h later. Headset-derived sway measures, including position, velocity, and acceleration data, were recorded, and the continuous trajectory deviation angle (i.e., directional control) and sensory ratios were calculated. Linear mixed-effects models included trial-level walking speed as a covariate. Additionally, participants completed the modified Clinical Test of Sensory Interaction on Balance (mCTSIB) as a clinical standing-balance reference measure; its concurrent-validity findings will be reported separately. Results: Significant condition effects were observed for position, velocity, acceleration, and CTDA after adjustment for trial-level walking speed (all $p<0.001$), indicating that the six sensory conditions elicited distinct gait–balance responses. Significant differences relative to the baseline condition (C1) were observed across conditions C2–C6 for position, C3–C6 for velocity, and C2 and C5 for acceleration. Session effects were not significant for any primary kinematic outcome after speed adjustment. A significant condition × session interaction was observed for position ($p<0.001$), whereas velocity, acceleration, and CTDA demonstrated no significant interactions. Walking speed was significantly associated with position, acceleration, and CTDA, but not velocity. Sensory-ratio analyses revealed larger visual and vestibular ratios relative to somatosensory ratios, with the visual and vestibular ratios generally decreasing across sessions. Conclusions: GaitSIT successfully manipulated sensory conditions during overground walking and produced significant changes in gait-related sway, directional control, and sensory-ratio measures. These findings support the feasibility of GaitSIT as a portable, low-cost, and immersive assessment framework for characterizing sensory-condition-specific gait–balance responses after accounting for walking speed and providing indirect behavioral indices related to sensory reweighting. Full article

TAR DNA binding protein (TARDBP) is one of the major causative genes of amyotrophic lateral sclerosis (ALS), which drives disease progression through both gain-of-toxicity (GOT) and loss-of-function (LOF) mechanisms. The mutant TDP-43 exhibits aberrant nucleocytoplasmic distribution and forms cytotoxic hyperphosphorylated aggregates, a process that can be robustly recapitulated in vitro. Thus, functional assays in cell lines serve as a reliable metric for the pathogenicity classification of TARDBP variants. In this study, we performed in vitro experiments to classify the pathogenicity of 28 TARDBP variants of uncertain significance (VUS) among the 172 previously reported TARDBP variants. 22 of these VUS were determined to be functionally abnormal, of which 12 could be further classified as likely pathogenic (LP) variants according to American College of Medical Genetics (ACMG) and the ClinGen Sequence Variant Interpretation (SVI) Working Group guidelines. We also summarized the clinical characteristics of 35 ALS patients carrying 12 variants in the TARDBP gene. Pathogenic missense variants were predominantly clustered in the C-terminal domain (CTD) of TARDBP. Variants in TARDBP exon 6 may lead to an earlier age at onset. ALS caused by TARDBP mutations exhibits marked phenotypic heterogeneity, along with incomplete penetrance in carriers. Patient-derived primary skin fibroblasts serve as a feasible cellular model for the functional assessment of variant pathogenicity. Our findings expand the TARDBP mutation spectrum, and provides a preliminary basis for preclinical research on TARDBP-targeted therapies for ALS. Full article

Three-dimensional numerical investigations into the synergistic mechanism of composite pile retaining systems consisting of large-diameter bored cast-in-place piles and small-diameter micro-grouted steel pipe piles remain limited. To address this gap, a refined three-dimensional finite element model was established using ABAQUS based on the Hutan Park Station excavation project of Dalian Metro Line 5. Five design cases were analyzed by varying pile diameter, pile spacing, and the presence or absence of micro piles. The main findings are as follows: (1) The maximum horizontal soil displacement in all cases remained below 8 mm, indicating satisfactory excavation stability. (2) The inclusion of micro piles promoted stress redistribution within the inter-pile soil and was associated with a more pronounced soil arching tendency, as indicated by the displacement contour patterns. (3) Based on the comparison between Case 3 and Case 5, where the spacing between bored cast-in-place piles increased from 2.0 m to 3.0 m while maintaining the composite support configuration, the maximum horizontal displacement and maximum bending moment decreased by approximately 12% and 9%, respectively. The inserted micro-grouted steel pipe piles participated in lateral load transfer, enhanced stress redistribution, and reduced local stress concentrations acting on the primary bored piles. Under the investigated geological and support conditions, the numerical results suggest that the introduction of micro steel pipe piles may improve deformation control and load-sharing performance in composite pile-supported excavations. The proposed support configuration shows potential for reducing the number of large-diameter bored piles while maintaining acceptable excavation performance and overall support stability. Full article

Introduction: Isolated peroneus longus (PL) tendon tears are rare injuries and an often-overlooked cause of chronic lateral ankle pain. Evidence regarding optimal conservative management, especially in elite athletes, remains limited. Focused extracorporeal shockwave therapy (F-ESWT) has shown promising results in tendinopathies, yet its application in acute tendon tears is poorly documented. Methods: We present the case of a professional football player in his late twenties who sustained an isolated longitudinal PL tear. The player underwent a combined conservative protocol including F-ESWT, physiotherapy, and custom orthotics. Pain (Visual Analog Scale, VAS) and function (AOFAS Ankle–Hindfoot Score) were assessed at baseline, three months, and in an 18-month follow-up. MRI scans were obtained at diagnosis and after six weeks to evaluate tendon healing. Results: The conservative treatment protocol, including eight sessions of ultrasound-guided F-ESWT (2500–4000 impulses per session, 50–550 µJ/mm²) led to marked pain relief and functional improvement. VAS decreased from 7/10 to 1/10, while AOFAS improved from 57 to 95 points, maintained at 18 months. MRI after six weeks of treatment demonstrated decreased intratendinous hyperintensity, reduced lesion length, and re-establishment of normal tendon architecture. The player returned to training after eight weeks and full competition after 12 weeks, remaining asymptomatic thereafter. Conclusions: A multimodal treatment consisting of F-ESWT, physiotherapy with progressive loading and orthotic correction resulted in rapid and durable healing of an isolated PL tear in a professional athlete. This case supports the potential role of a multimodal conservative treatment strategy including F-ESWT as a first-line, non-invasive option for acute peroneal tendon tears. Full article

Pediatric Monteggia fracture-dislocations may be overlooked when ulnar injury is incomplete or plastically deformed and radiocapitellar malalignment is subtle. Radiographic interpretation is further complicated by incomplete ossification, non-standard projection, and the limitations of applying a single alignment line across all ages and imaging scenarios. This narrative review synthesizes clinically relevant evidence on radiocapitellar alignment assessment in suspected pediatric Monteggia lesions and proposes an imaging interpretation framework for radiographs and problem-solving imaging. The review integrates developmental anatomy, radiographic adequacy, radiocapitellar line behavior, forearm-based P-line assessment, lateral humeral line assessment, ulnar bow sign, and targeted second-line imaging with ultrasound, MRI, and arthrography. The framework emphasizes three practical steps: first determining whether the available images are adequate for line-based assessment; then selecting the line or sign according to age, ossification stage, projection, and available landmarks; and finally reporting discordant or limited studies as equivocal rather than forcing a binary normal/abnormal interpretation. We also summarize diagnostic error considerations, structured reporting elements, and future directions for AI-assisted measurement and uncertainty-aware interpretation. The proposed framework is intended to support consistent radiologic reasoning and communication among emergency physicians, radiologists, and pediatric orthopedic surgeons. It is not a validated diagnostic rule, and prospective observer-performance studies are needed before implementation as a clinical pathway. Full article

Background: Impacted maxillary canines frequently cause external root resorption of adjacent lateral incisors, a complication that may compromise tooth survival and orthodontic outcomes. Cone-beam computed tomography (CBCT) enables precise three-dimensional assessment of canine position and resorption severity, yet the quantitative relationship between canine angulation and resorption remains incompletely characterized. Objectives: The objectives were to quantify the correlation between impacted maxillary canine angulation relative to the vertical reference line and the severity of adjacent lateral incisor root resorption using CBCT and to evaluate the influence of crown position on resorption prevalence. Materials and Methods: This retrospective cross-sectional study was conducted at the Department of Oral Radiology, King Abdulaziz University Dental Hospital (KAUDH), Jeddah, Saudi Arabia, using CBCT scans acquired between January 2018 and December 2023. CBCT scans of 262 patients with impacted maxillary canines were analyzed. A total of 108 impacted canines from 88 patients were evaluated. Canine angulation was measured as the acute angle between the canine long axis and a vertical reference line on coronal CBCT sections. Crown position was classified as palatal, buccal, or center. Lateral incisor root resorption was graded using the modified Kaley and Phillips classification (Grade 0–4), where Grade 4 represents side resorption. Statistical analyses included Spearman rank correlation, Mann–Whitney U test, chi-square test, and Kruskal–Wallis test with post hoc comparisons (α = 0.05). Results: Lateral incisor root resorption was detected in 17 of 108 canines (15.7%). Mean canine angulation was significantly higher in the resorption group (45.5° ± 21.4°) compared with the no-resorption group (32.7° ± 18.0°; Mann–Whitney U = 809.5, p = 0.019). Spearman correlation revealed a significant positive association between angulation and resorption grade (ρ = +0.243, p = 0.019). Canines angled ≥ 45° exhibited a 3.5-fold higher resorption rate (32.1% vs. 9.2%; OR = 4.66, Fisher’s Exact p = 0.012). Palatal crown position was associated with significantly higher resorption prevalence (25.5%) compared with center (5.1%) and buccal (11.1%) positions (χ² = 7.258, p = 0.027). Unilateral impaction was associated with significantly higher resorption prevalence than bilateral (22.4% vs. 4.9%; p = 0.031). Conclusions: Larger canine angulation from the vertical reference line is significantly correlated with increased severity of adjacent lateral incisor root resorption. Palatal crown position, angulation ≥ 45°, and unilateral impaction pattern are important risk indicators. CBCT-based angulation measurement provides clinically relevant quantitative data to inform early intervention and treatment planning. Full article

We show that halide evaporation during melt growth of ${\mathrm{CsPbBr}}_3$ on polycrystalline FTO under partially open conditions drives discrete phase selection between the line compounds of the CsBr–PbBr₂ system, producing a sharp ${\mathrm{CsPbBr}}_3/{\mathrm{CsPb}}_2{\mathrm{Br}}_5$ bilayer instead of compositional grading. In situ optical imaging shows that solidification begins with nucleation and lateral growth of a planar ${\mathrm{CsPbBr}}_3$ single crystal while the melt layer is still thick enough to average over the FTO relief. As the crystal thickens, the residual melt then becomes inhomogeneous and unstable, producing a buried porous layer of faceted ${\mathrm{CsPb}}_2{\mathrm{Br}}_5$ grains with a characteristic in-plane spacing of 1–10$\mathsf{\mu }\mathrm{m}$). This morphology is consistent with a faceted Mullins–Sekerka-type instability under a non-conservative evaporative boundary condition. Beneath the single-crystal cap, the first-formed faceted islands are large and become progressively smaller as the advancing front approaches the FTO pyramids, while elevated ambient halide partial pressure suppresses the instability, consistent with diffusion–capillarity selection under decreasing residual melt thickness and steepening local gradients, modified by evaporative flux. Oxygen associated with microvoids or the oxide substrate enables a secondary reaction–diffusion pathway forming Pb–Br–O crystallites without altering the primary length scale. These results identify evaporation as an active control parameter coupling phase equilibria and interfacial stability in volatile halide melts. In the buried, porous bilayer morphology observed here, the secondary phases and porosity reduce the active ${\mathrm{CsPbBr}}_3$ volume and are expected to degrade scintillation through increased trapping, nonradiative recombination, and light scattering. Full article

In traditional mechanical de-icing technologies, the time-frequency evolution and spatial propagation mechanisms of transient high-frequency impact signals in flexible transmission lines remain unclear. To address this issue, transient impact responses were experimentally investigated using a full-scale transmission line model. An active de-icing exciter, featuring controllable impact energy and the potential for sustained online operation, was independently developed. High-frequency transient acceleration signals were acquired at multiple measurement points on a 20 m single-span line. The spatial distribution and time-frequency attenuation characteristics of the impact energy were quantitatively evaluated by extracting high-order time-domain statistical features, including root mean square, kurtosis, and crest factor, together with frequency-domain analyses based on Fast Fourier Transform (FFT) and wavelet entropy. The results indicate that: (1) The exciter generated highly impulsive transient responses, with a kurtosis up to 795.3 and a crest factor approaching 40. This suggests a strong local concentration of impact energy at the excitation source, which provides a dynamic basis for analyzing potential localized stress concentration and dynamic responses of the conductor system. (2) The transmission line structure exhibited a significant low-pass filtering effect on transient high-frequency shock waves. As the shock wave propagated towards the distal end, its high-frequency components above 30 Hz were substantially attenuated, likely due to internal dry friction within the stranded conductor. Consequently, the dominant frequency decreased to a low-frequency macroscopic sway of approximately 12 Hz, indicating a reduced risk of transmitting high-frequency shock loads to distal fittings and towers. (3) Under geometric nonlinear coupling, the vertical impact energy was partially transferred to the longitudinal and lateral directions during propagation, leading to sustained out-of-plane swaying. This study reveals the signal evolution characteristics of transient impacts in overhead transmission lines and provides experimental evidence for optimizing excitation parameters and assessing the engineering safety of active impact de-icing technologies. Full article

Alfalfa (Medicago sativa L.) exhibits high feeding value in agricultural and livestock production, with its above-ground parts determining yield and quality. Promoting the development of molecular breeding of alfalfa helps to clarify the function of MsARG4 in regulating its growth. Obtaining MsARG4-overexpressing and RNA interference-positive plants via genetic transformation, we compared their phenotypic, nutritional, physicochemical, and cellular structural characteristics with those of wild-type plants. The results showed that the plant height, stem diameter, number of branches, number of lateral branches, internode length, and crude protein content of overexpressing plants were significantly higher than those of wild-type and RNAi plants (p < 0.05). Furthermore, we observed that the cell area of OE lines was larger than that of WT and RNAi lines. The stem-to-leaf ratio of overexpressing plants in the branching and budding stages was significantly lower than in wild-type and RNAi plants (p < 0.05). Our study suggests that MsARG4 promotes alfalfa quality improvement and rapid stem growth. Full article

Skeletal deterioration is a major welfare and production concern in laying hens, as substantial quantities of calcium are mobilized from bone to support eggshell formation during the laying cycle. Nutritional strategies that promote skeletal development during the pullet phase may therefore improve bone integrity later in production. The objective of this study was to evaluate the effects of dietary genistein supplementation on growth performance, bone development, and mineralization in Hy-Line Brown pullets. A total of 600 pullets were randomly assigned to four dietary treatments consisting of a control diet (0 mg/kg genistein; CON) or diets supplemented with 20 (G20), 60 (G60), or 100 mg/kg (G100) genistein from 5 to 17 weeks of age. Growth performance, bone mineral density, muscle deposition, biomechanical strength, bone ash content, and circulating bone formation biomarkers were evaluated. Pullets receiving G60 and G100 supplementation exhibited greater body weight, bone mineral density, cortical bone area, muscle weights, biomechanical strength, bone ash percentage, and circulating concentrations of BALP and P1NP compared with CON and G20 birds. Feed intake did not differ among treatments. These findings indicate that genistein supplementation, particularly at 60 and 100 mg/kg, may enhance skeletal development during the pullet rearing period. Further research is warranted to determine whether these improvements persist throughout the laying cycle and influence production, as well as the potential deposition of genistein-derived compounds in eggs. Full article

Optimizing a high-fidelity GT3 race car setup is a serious dimensional, nonlinear problem in which small changes to mechanical parameters can affect lap time, handling balance, and vehicle stability. Existing motorsport AI studies largely emphasize racing line optimization, autonomous control, race strategy, or offline vehicle dynamics estimation, while the mechanical setup layer is often treated as fixed or tuned manually. This paper presents a staged simulator-based setup optimization framework augmented with setup-conditioned telemetry response modeling. Using the virtual BMW Z4 GT3 vehicle model implemented within the Assetto Corsa (v1.16.4) simulation environment as a controlled GT3 test platform, 134 setup configurations were evaluated at the Red Bull Ring under a fixed simulator AI driving policy. The staged search improved the best lap time from 91.430 s to 91.040 s, corresponding to a 0.390 s reduction. To move beyond a single aggregate lap-time claim, the full telemetry corpus was processed into 585 stable laps and 29,250 track-position segment samples. A setup-conditioned LightGBM model was trained to predict segment time and local vehicle response metrics from setup parameters and segment context, using five-fold GroupKFold validation by telemetry file to avoid random row leakage. The setup-conditioned segment model reconstructed held-out file-level lap time with 0.223 s mean absolute error and Spearman correlation of 0.961, outperforming a setup-only model at 0.288 s, a track-only segment model at 0.687 s, and a shuffled-setup placebo at 0.776 s. The same setup-conditioned model also improved the prediction of segment-level speed, slip angle, tire load spread, rake (defined here as rear-front ride height difference), tire temperature, yaw response, and lateral acceleration. These results show that high-frequency telemetry can support not only staged setup search, but also quantifiable learning of where and how setup changes alter vehicle behavior around the lap. Full article

Transposable elements (TEs) play important roles during development and disease, including through transcriptional activation of TE-associated genes during early human development. Moreover, based on the functional and epigenetic similarities between early development and cancer, TE-associated genes contribute not only to early human development, but frequently contribute to cancer progression. In this study, we hypothesised that recruitment of TE-associated genes during cancer onset occurs through epigenetic regulatory processes, especially involving DNA hypomethylation accompanied by transcriptional upregulation of early developmental pathways, such that, when reactivated inappropriately in later life, they may drive malignancy. It is unknown, however, to what extent DNA methylation changes are critically involved in the transcriptional activation of TE-associated genes. Accordingly, to investigate this we used the RepExpress tool to identify developmentally regulated TE-associated genes in placenta and human embryonic stem cells (hESCs), which we then investigated by targeted deep bisulfite sequencing (TDBS) to determine the methylation status of the identified TE-associated genes in placenta, somatic tissues, and melanoma cell lines. Outcomes suggest that DNA methylation may be one of the regulatory factors underscoring transcriptional activation of TE-associated genes, but that methylation is not necessarily the sole factor involved in regulating the transcriptional activation of TE-associated genes during malignant transformation. Full article