Search Results (992)

Robotic colorectal surgery has revolutionized minimally invasive techniques worldwide, offering a more stable operative platform, superior 3D visualization, and wristed instrumentation for challenging pelvic dissections. This narrative review describes the global evolution of robotic colorectal surgery, from the use of multi-port to single-port systems, modular platforms and endoluminal robotic devices. Using Hong Kong’s role as an innovation and research hub, this review demonstrates how integrated innovation, structured training, workflow efficiencies and digital policy frameworks can overcome barriers and inform international implementation of robotic colorectal surgery. Since 2005, The Chinese University of Hong Kong has been pioneering the use of robotic platforms in colorectal surgery, performing first-in-human trials of the da Vinci SP system, the locally developed Sentire C1000 and the EndoMaster EASE for robotic ESD. There is increasing evidence supporting the use of the robotic platform over laparoscopic colorectal surgery, with benefits including reduced open conversions, fewer intraoperative complications, shorter hospital stay, better long-term functional outcomes and improved oncologic outcomes. However, several challenges remain before robotics can be implemented widely on a global scale, such as higher initial capital costs, limited training access, surgeon credentialing and governance for AI-driven data analytics. Full article

Background: Wrist osteomyelitis caused by Scedosporium apiospermum is exceedingly rare. Its indolent course and destructive potential may result in extensive bone loss and pose substantial diagnostic and therapeutic challenges. Methods: We report a case of chronic wrist osteomyelitis caused by Scedosporium apiospermum in a 68-year-old kidney–pancreas transplant recipient. Results: Following diagnosis, systemic antifungal therapy with voriconazole was initiated, and multiple surgical debridements were performed to achieve local disease control, resulting in a large defect of the carpus and distal forearm. Hand salvage was attempted using an osteocutaneous triple-barrel fibula flap. The postoperative course was complicated by congestion of the fibula skin island, which was managed with leech therapy. Subsequent infection with a multi-resistant Aeromonas spp. and Morganella morganii led to flap necrosis, ultimately requiring transradial forearm amputation. Conclusions: Destructive Scedosporium apiospermum osteomyelitis in immunocompromised patients is a major challenge for reconstructive surgeons. Interdisciplinary management is essential as mold eradication is only achievable through a combined surgical and antimicrobial approach. In advanced destructive osteomyelitis, the choice between limb salvage and amputation should be individualized, considering patient comorbidities, reconstructive risk, and patients’ preferences. This case highlights the importance of balancing careful indication and patient counseling in complex clinical scenarios. Full article

Background: The global demographic shift towards an aging population has driven a steady, exponential increase in the utilization of cardiac implantable electronic devices (CIEDs). Consequently, device-related infectious complications have emerged as a leading cause of morbidity and healthcare expenditure. Patients in their eighth decade of life—octogenarians (aged 80–90 years)—represent an exceptionally high-risk demographic due to the compounding factors of physiological frailty, immunosenescence, and complex multi-morbidity. Despite this growing demographic, their specific clinical presentations, microbiological profiles, and procedural outcomes following infection remain poorly defined in the current literature. This study aimed to comprehensively compare the clinical characteristics, pathogen distribution, and in-hospital outcomes of CIED infections in an octogenarian cohort against a younger patient population. Methods: We conducted a robust retrospective cohort analysis of 383 consecutive patients treated for confirmed CIED infections at one major tertiary referral center (Heidelberg University Hospital) between January 2002 and December 2022. The cohort was stratified by age into octogenarians (n = 76) and a younger control group (n = 307). We systematically extracted and compared data regarding baseline clinical presentation, chronic comorbidities, detailed microbiological cultures (pocket, blood, and extracted leads), and definitive in-hospital outcomes, primarily mortality and length of stay. Results: The octogenarian cohort exhibited a significantly heavier comorbidity burden, notably higher rates of coronary artery disease (51.3% vs. 29.6%, p < 0.001), systemic hypertension (55.3% vs. 38.1%, p = 0.007), and chronic obstructive pulmonary disease (7.9% vs. 1.6%, p = 0.003). Furthermore, therapeutic systemic anticoagulant use was substantially more prevalent in the elderly group (60.5% vs. 45.0%, p = 0.015). Octogenarians presented overwhelmingly with localized generator pocket infections (73.0% vs. 30.0%, p < 0.001) but paradoxically also demonstrated higher rates of systemic bacteremia and sepsis (26.3% vs. 15.0%, p = 0.019). Microbiological analysis revealed a unique pathogen profile, with Staphylococcus capitis found with significantly higher frequency in the generator pockets of the elderly cohort. Remarkably, despite possessing a higher average lead burden (2.1 vs. 1.2 leads) and extreme comorbidity profiles, octogenarians demonstrated no statistically significant differences in in-hospital mortality (3.9% vs. 4.2%, p = 1.000) or overall length of hospital stay (14.7 vs. 17.2 days, p = 0.386) when compared to the younger cohort. Conclusions: Octogenarians suffering from CIED infections display highly distinct clinical and microbiological profiles, characterized predominantly by elevated rates of localized pocket infections, specific opportunistic pathogens, and a severe underlying comorbidity burden. Crucially, our findings indicate that with the application of modern extraction and management protocols, advanced age alone does not intrinsically correlate with increased in-hospital mortality. Future prevention and perioperative management strategies tailored to this rapidly expanding demographic must heavily prioritize the mitigation of pocket-related complications, particularly considering the high prevalence of concurrent anticoagulation therapy. Full article

Machining stability in profile grinding directly affects surface quality and form accuracy, while the variation in local contact conditions induced by complex contour geometries makes its stability behavior more complicated than that of conventional grinding. This study investigates chatter stability under the coupled effects of contour geometric features and process parameters. A dynamic grinding force model is developed based on a tool nose micro-element method, explicitly considering the coupled effects of contour geometric parameters, wheel–workpiece contact, and regenerative effects. A chatter stability model is then established, and an iterative method is proposed to predict stability limits under different contour features. The results indicate that wheel speed and grinding depth dominate system stability. Under the same curvature radius, convex contours exhibit the highest stability, followed by straight and concave contours. As the curvature radius increases, the stability boundaries gradually converge toward that of the straight contour. Increasing the contour normal angle (CNA) significantly enhances stability and promotes the transition of the dominant unstable mode from single-direction to multi-directional coupling. Grinding experiments on a composite curved workpiece validate the model, showing strong agreement between predicted stability regions and measured chatter marks and spectra. The proposed model provides a basis for parameter selection and chatter suppression in complex profile grinding. Full article

Systemic sclerosis (SSc) is a multi-organ autoimmune disease characterized by fibrosis of the skin and internal organs. Interstitial lung disease (ILD) is a major complication and leading cause of mortality in SSc. Transforming growth factor-β (TGF-β) has been implicated as a central mediator of fibrosis; however, while TGF-β1 has been extensively studied, the roles of TGF-β2 and TGF-β3 remain incompletely defined. Here, we systematically compared the effects of TGF-β1, TGF-β2, and TGF-β3 in dermal and lung fibroblasts, evaluating extracellular matrix synthesis and contraction, cytokine secretion, proliferation, and myofibroblast differentiation. TGF-β2 and TGF-β3 induced greater profibrotic cytokine release of Interleukin (IL)-6 and IL-11 and increased collagen-I and fibronectin synthesis compared with TGF-β1 in dermal and lung fibroblasts (all p < 0.05). TGF-β2 and TGF-β3 stimulated greater collagen-I contraction in dermal fibroblasts (p < 0.05), but greater myofibroblast differentiation in lung fibroblasts (p < 0.05). The TGF-β isoforms did not affect proliferation. All TGF-β isoforms activated SMAD2/3 signalling; however, TGF-β2 and TGF-β3 reduced expression of TGF-β Receptor II and the inhibitory regulator, SMAD7. In summary, TGF-β2 and TGF-β3 have a more pronounced profibrotic effect than TGF-β1 on dermal and lung fibroblast functions, making them potential targets for treatment for skin and lung fibrosis in diseases such as SSc. Full article

State-of-charge (SOC) estimation for lithium-ion batteries in smartphones is complicated by nonlinear load variation, electro-thermal coupling, aging effects, and heterogeneous user behaviors. This study proposes a multi-physics coupled SOC estimation framework, termed the Multi-Physics Thermo-Electrochemical Coupled SOC Model (MTEC-SOC), to characterize battery behavior under representative user-load conditions within controlled ambient thermal boundaries. The model combines system-level power profiling, thermal evolution, voltage dynamics, and aging-related capacity correction within a unified framework. To support model development and validation, a dual-source dataset is established using laboratory battery characterization data and real-world smartphone behavioral data, from which users are classified into light, heavy, and mixed usage patterns. Comparative results against four benchmark models (M1–M4) show that MTEC-SOC achieves the highest overall accuracy, with average MAE, RMSE, and TTE error values of 0.0091, 0.0118, and 0.08 h, respectively. The results suggest distinct degradation tendencies across user types: calendar aging dominates under prolonged high-voltage dwell in light-use scenarios, whereas, within the tested thermal range, heavy-use scenarios exhibit stronger voltage sag, relative temperature rise, and polarization-related stress; mixed-use scenarios are characterized by transient responses induced by abrupt load switching. Sensitivity analysis further indicates that the predictive behavior of the model is strongly scenario-dependent, with higher-load operation within the calibrated range amplifying parameter perturbations. Overall, the proposed MTEC-SOC framework provides accurate SOC estimation and physically interpretable insight within the evaluated dataset and operating conditions, offering potential guidance for battery management and energy optimization in intelligent mobile terminals. Full article

Background/Objectives: Celiac disease (CD) is a chronic, immune-mediated enteropathy induced by dietary gluten exposure in genetically predisposed individuals. Along with non-celiac gluten sensitivity (NCGS), these disorders present with multiple intestinal and extra-intestinal symptoms leading to multisystemic involvement, with complications documented in the oral cavity as well. Persistent immune activation and dysregulation, chronic inflammation, nutrient deficiencies, xerostomia, and microbial dysbiosis found in CD and NCGS constitute shared pathological findings, providing biological plausibility for an association with periodontitis. Methods: A narrative literature review was conducted based on a systematic search of four databases (PubMed, Scopus, Web of Science, Cochrane Library) and the gray literature through January 2026. A comprehensive set of clinical, radiographic, biochemical and immunological parameters was assessed. Two reviewers independently screened and selected studies, with disagreements resolved by consensus. Results: A total of 15 studies met the eligibility criteria and were included in the review. Available evidence, mainly derived from cross-sectional observational studies, remains limited, methodologically heterogeneous, and largely inconclusive. Across adult and pediatric populations, findings do not consistently demonstrate a clinically meaningful association between CD or NCGS and periodontal inflammation, irrespective of gluten-free diet (GFD) adherence. Observed differences, when reported, are modest and inconsistent, and can be mainly attributed to oral hygiene behaviors and dental visit patterns. Conclusions: Despite considerable biological plausibility linking gluten-related disorders with periodontal inflammation, current evidence does not support a definitive conclusion regarding the impact of CD or NCGS on periodontal health. Full article

Steel slags are major by-products of steelmaking, and their variable composition complicates recycling and valorization strategies. This study investigates four representative slag samples obtained from different production pathways at an industrial steel plant in Uzbekistan, using a combined multi-scale characterization approach. Bulk elemental composition was determined using X-ray fluorescence (XRF), while microstructural and phase-level analysis was carried out using scanning electron microscopy with energy-dispersive spectroscopy (SEM–EDS), including both point analysis and automated phase mapping. The XRF results revealed two distinct compositional groups, with one slag dominated by Mn–Si–O chemistry and three slags characterized by high Ca content. SEM–EDS phase mapping further resolved these differences at the microscale, identifying manganese silicate and oxide phases in the Mn-rich slag, Ca–F–O dominant phases in two slags associated with fluorite flux addition, and a more heterogeneous Ca-based system with localized enrichments of Mn, Zn, and Cu in the fourth sample. The combined results demonstrate that slag composition strongly reflects steel grade and fluxing practice. The integration of XRF and SEM–EDS provides a robust framework for linking bulk chemistry with phase distribution, improving slag classification and supporting informed decisions for reuse and environmental management. Full article

With the rapid evolution toward 6G networks, ensuring robust physical layer security (PLS) in highly dynamic and heterogeneous wireless environments has become a key challenge. Traditional security methods often struggle to adapt to time-varying channels, especially in the absence of perfect channel state information. Furthermore, the dynamic nature of node selection and power allocation in heterogeneous networks creates a complex hybrid action space operating across multiple timescales, significantly complicating the design of efficient and adaptive security strategies. To address this, this paper proposes a novel constrained hierarchical reinforcement learning (CHRL) framework for secure cooperative communications in next-generation wireless systems. The framework is designed to optimize secrecy performance within a hybrid action space comprising both discrete node selection and continuous power allocation, operating at different timescales. By hierarchically decoupling the joint optimization problem, the upper layer performs risk-aware node selection to maximize long-term secrecy capacity (SC) while guaranteeing a stable and secure link. At the lower layer, we develop a constrained MiniMax Multi-objective Deep Deterministic Policy Gradient (M3DDPG) algorithm that optimizes power allocation considering worst-case conditions. Lagrange multipliers are integrated to enforce a strictly positive SC constraint throughout transmission, effectively preventing security outages. Simulation results under time-varying Rayleigh fading channels demonstrate that the proposed CHRL framework outperforms existing HRL methods, achieving up to 17% improvement in SC while strictly maintaining security constraints. These results validate the effectiveness of the proposed approach for enhancing PLS in next-generation cooperative wireless networks. Full article

Under maize–soybean rotation systems, weeds and crops at the seedling stage in dryland fields exhibit high similarity in morphological structure, scale distribution, and spatial arrangement. In addition, complex illumination conditions, occlusion, and background interference further complicate accurate weed discrimination. To address these challenges, this study proposes an improved YOLOv11n-based weed detection method for seedling-stage crops under dryland rotation conditions, aiming to enhance detection accuracy and robustness in UAV-acquired field images. Three key improvements were introduced to enhance model performance: (1) the incorporation of Dynamic Convolution (DynamicConv) to adaptively strengthen feature representation for weeds with varying morphologies and scales in low-altitude remote sensing imagery; (2) the design of a SlimNeck lightweight feature fusion architecture to improve multi-scale feature propagation efficiency while reducing computational cost; (3) the cascaded group attention mechanism (CGA) is integrated into the C2PSA module, thereby improving discrimination capability under complex background conditions. These results represent consistent improvements over baseline models, including YOLOv5, YOLOv6, YOLOv8, YOLOv11, and YOLOv12. Specifically, detection performance for broadleaf weeds and Poaceae weeds reached mAP@0.5 values of 87.2% and 73.9%, respectively. Overall, the proposed method demonstrates superior detection accuracy and stability for seedling-stage weed identification under rotation conditions, providing reliable technical support for variable-rate herbicide application and precision field management. Full article

Background/Objectives: Neurodegenerative diseases like Alzheimer’s, Parkinson’s, and Amyotrophic lateral sclerosis (ALS) share common molecular pathways, including neuroinflammation and oxidative stress, which complicate the effectiveness of single-target treatments. Garcinia mangostana L. (mangosteen) has shown neuroprotective properties, but previous studies focused on lipophilic xanthones, which have poor bioavailability and uncertain blood–brain barrier permeability. Methods: In the current study, polar metabolites from G. mangostana peel aqueous extract (GMPE) were assessed for potential multi-target interactions via UHPLC-QTOF-MS-based metabolomics, systems pharmacology, and molecular docking analysis. Further, in silico ADMET screening and network-based analyses assessed for overlap between GMPE compounds and genes associated with neurodegeneration (AD, PD, ALS). Results: Analysis of genes linked to AD, PD, and ALS revealed 121 common molecular targets influenced by GMPE metabolites. Network and enrichment analyses indicated that the compounds derived from GMPE may be involved in common pathways related to oxidative stress, neuroinflammation, and neuronal survival. Molecular docking analyses suggest that selected metabolites are likely to exhibit moderate binding affinities to their respective protein targets. Conclusions: The results presented in this study provide evidence that GMPE may possess potential multi-target interactions within common neurodegenerative pathways. However, since the data are based on computational and predictive approaches, these results should be considered hypothesis-generating and warrant further experimental validation. Full article

West Nile virus (WNV) is a mosquito-borne flavivirus of growing importance for both human and equine health in Europe. Horses are highly susceptible to neurological disease and, because they share ecological exposure with humans, they represent valuable sentinels for detecting local viral circulation within a One Health framework. However, diagnosis of WNV infection in equines is complicated by the short and low-level viraemia, which limits the sensitivity of molecular assays, and by serological cross-reactivity with related flaviviruses and the confounding effects of vaccination. In this narrative review, we summarise the current diagnostic tools for WNV in horses, including direct detection methods (RT-qPCR, virus isolation, antigen detection) and indirect serological approaches (IgM and IgG ELISA, virus neutralisation tests), and discuss their practical performance and constraints in clinical and surveillance settings. We further examine equine surveillance systems, passive clinical reporting, active serosurveys and sentinel cohorts, and their integration with vector, avian and environmental monitoring. Key challenges include methodological heterogeneity, limited access to confirmatory testing and variable cross-sector data sharing. Finally, we outline future directions, highlighting the need for harmonised laboratory protocols, innovative field-deployable diagnostics, genomic surveillance and integrated, multi-source monitoring systems to strengthen early warning capacity and improve preparedness for WNV outbreaks in equine populations. Full article

Background: Polysubstance use, particularly the combination of opioids and stimulants, represents a growing public health concern due to its high risk of severe multisystem complications and mortality. Here, we present a case illustrating the lethal synergy of opioid–stimulant co-use. Methods: A 37-year-old male with chronic Hepatitis C and documented polysubstance use reported recent use of fentanyl, cocaine, methamphetamine, and cannabis. He presented with generalized weakness, left lower limb pain, tense edema, and anuria. Clinical assessment included monitoring of vital signs, physical examination, capillary blood gas analysis, extended laboratory panels (muscle and cardiac enzymes, electrolytes, and coagulation parameters), urinalysis, and Doppler imaging. Management over five days included intravenous hydration, diuretics, urinary alkalinization, electrolyte correction, anticoagulation, metabolic and vitamin therapy, hemodialysis, and comprehensive supportive care. Results: Laboratory evaluation revealed massive rhabdomyolysis (peak CK 161,050 U/L), severe hyperkalemia (K⁺ 8.4 mmol/L), metabolic acidosis, acute kidney injury with oligoanuria, and left-sided deep vein thrombosis. Despite intensive multidisciplinary interventions, the patient’s repeated refusal of ongoing treatment critically contributed to a fatal outcome. Conclusions: This case underscores the high mortality risk associated with opioid–stimulant co-use and the crucial impact of treatment refusal. Clinicians and public health stakeholders should recognize the rapid progression of multisystem dysfunction in polysubstance users and prioritize early, aggressive interventions combined with patient engagement strategies to mitigate fatal outcomes. Full article

Ultra-low-formaldehyde medium-density fiberboard (MDF) is commonly produced using low-molar-ratio urea-formaldehyde (UF) resins; however, the reduced formaldehyde-to-urea ratio also lowers resin reactivity and can complicate curing. The aim of this research work was to investigate and evaluate the performance of ammonium bisulfite and urea–metabisulfite as formaldehyde scavengers for a low-molar-ratio UF resin (F/U = 1.06) at 1, 3, and 5 wt% (based on dry UF resin solids) used for MDF panel manufacturing. The modified adhesive systems were first screened by simultaneous thermal analysis in air to determine changes in the curing profile, and laboratory panels were then produced and evaluated for formaldehyde content by the perforator method (EN ISO 12460-5:2015) and for the main physical and mechanical properties. Ammonium bisulfite shifted the main curing peak to higher temperatures, indicating stronger retardation of the principal polycondensation stage, whereas urea–metabisulfite generated a broader, multi-peak curing profile. Despite these differences, both additives reduced the perforator values substantially. The control MDF already met the E0 level (3.84 mg/100 g oven-dry board), while 3 wt% ammonium bisulfite and 5 wt% urea–metabisulfite reached the super E0 levels (<1.5 mg/100 g; 1.36 and 1.26 mg/100 g, respectively). To note, scavenger addition up to 5 wt% (based on dry UF resin solids) did not significantly affect density, water absorption/thickness swelling, or bending and internal bond properties. The results demonstrate that sulfite-based scavengers can be incorporated into low-molar-ratio UF adhesives to obtain ultra-low-formaldehyde MDF while maintaining the main panel properties. Full article

Plywood has emerged as a key sustainable material in modern building. Yet, ensuring its consistent performance requires rigorous quality control of the rotary-cut veneers used in its manufacture. This task is complicated by the high-speed nature of industrial conveyors, where motion blur and the complex, varying textures of eucalyptus wood drastically reduce the effectiveness of real-time surface inspection. This study proposes an intelligent, real-time defect detection system specifically optimized for the diverse defect morphology of eucalyptus veneers. A lightweight model, YOLOv11-DMS-Veneers, was developed by integrating MobileNetV4 as the backbone, a Dynamic Head for multi-scale feature extraction, and a Shape-IoU loss function to precisely localize irregular defects like cracks and knots. Additionally, an ERD video enhancement framework (combining ESRGAN, RIFE, and DnCNN) was implemented to mitigate motion blur in dynamic environments. Experimental results demonstrate that the proposed model achieves a mean Average Precision (mAP@50) of 96.0% and a Precision of 95.7% with a low computational cost of only 4.5 GFlops, significantly outperforming traditional algorithms. Notably, the detection precision for challenging linear cracks reached 93.9%. In dynamic tests at conveyor speeds up to 24 m/min, the video enhancement strategy increased the average detection confidence by 0.288, maintaining a maximum confidence of 0.890. This technology offers a robust solution for the automated quality control of eucalyptus veneers, facilitating the production of high-performance plywood and advancing the efficient application of engineered wood in the building industry. Full article