Search Results (739)

A 51-year-old female presented to the emergency department with vertigo, visual disturbances, involuntary rapid repetitive eye movements, incoordination, and imbalance. Physical examination revealed opsoclonus, myoclonus, and bilateral limb and gait ataxia. Initial workup was negative for intracranial abnormalities, and no abnormalities were noted on blood work or cerebrospinal fluid analysis. Tumor markers were within normal limits. As part of her diagnostic workup, a positron emission tomography (PET) scan was performed, which showed a highly FDG-avid solitary 7 mm left axillary lymph node. Ultrasound-guided percutaneous biopsy revealed metastatic poorly differentiated carcinoma. Histopathological examination could not conclusively distinguish between adenocarcinoma and squamous cell carcinoma. She was diagnosed with seronegative opsoclonus-myoclonus ataxia syndrome of paraneoplastic origin from an occult primary malignancy and started on pulsatile corticosteroids and intravenous immunoglobulin (IVIG), with only moderate symptomatic improvement. Given the anatomic location and immunohistochemical staining pattern of the lymph node, the malignancy was considered as being of primary breast origin. A left axillary lymph node dissection was performed, with 1/12 nodes testing positive for poorly differentiated carcinoma. The patient experienced significant improvement in her neurological symptoms 2–3 days following resection of the solitary malignant lymph node, largely regaining her functional independence. She went on to receive adjuvant radiotherapy to the breast and axilla, as well as adjuvant hormonal therapy. Full article

The article is focused on the quantitative assessment of the thermal impact of polar mesospheric clouds (PMCs) on the mesopause caused by the emission of absorbed solar and terrestrial infrared (IR) radiation by cloud particles. For this purpose, a parameterization of mesopause heating by PMC crystals has been developed, the main feature of which is to incorporate the thermal properties of ice and the interaction of cloud particles with the environment. Parametrization is based on PMCs zero-dimensional (0-D) model and uses temperature, pressure, and water vapor data in the 80–90 km altitude range retrieved from Solar Occultation for Ice Experiment (SOFIE) measurements. The calculations are made for 14 PMC seasons in both hemispheres with the summer solstice as the central date. The obtained results show that PMCs can make a significant contribution to the heat balance of the upper atmosphere, comparable to the heating caused, for example, by the dissipation of atmospheric gravity waves (GWs). The interhemispheric differences in heating are manifested mainly in the altitude structure: in the Southern Hemisphere (SH), the area of maximum heating values is 1–2 km higher than in the Northern Hemisphere (NH), while quantitatively they are of the same order. The most intensive heating is observed at the lower boundary of the minimum temperature layer (below 150 K) and gradually weakens with altitude. The NH heating median value is 5.86 K/day, while in the SH it is 5.24 K/day. The lowest values of heating are located above the maximum of cloud ice concentration in both hemispheres. The calculated heating rates are also examined in the context of the various factors of temperature variation in the observed atmospheric layers. It is shown in particular that the thermal impact of PMC is commensurate with the influence of dissipating gravity waves at heights of the mesosphere and lower thermosphere (MLT), which parameterizations are included in all modern numerical models of atmospheric circulation. Hence, the developed parameterization can be used in global atmospheric circulation models for further study of the peculiarities of the thermodynamic regime of the MLT. Full article

The essay offers an expansive and multi-stratified investigation into the role of esoteric traditions within the development of Russian modernity, reframing occultism not as an eccentric deviation but as a foundational epistemological regime integral to Russia’s aesthetic, philosophical, and political evolution. By analyzing the arc from Petrine-era alchemical statecraft to the techno-theurgical aspirations of Russian Cosmism and the esoteric visual regimes of the avant-garde, this essay discloses the deep ontological entanglement between sacral knowledge and modernist radical experimentation. The work foregrounds figures such as Jacob Bruce, Wassily Kandinsky, and Kazimir Malevich, situating them within broader transnational currents of Hermeticism, Theosophy, and Rosicrucianism, while interrogating the role of occult infrastructures in both late-imperial and Soviet paradigms. Drawing on recent theoretical frameworks in the global history of esotericism and modernist studies, the long-read article elucidates the metaphysical substrata animating Russian Symbolism, Abstraction, Malevich’s non-Euclidian Suprematism and Moscow Conceptualism. This study contends that esotericism in Russia—far from marginal—served as a generative matrix for radical aesthetic innovation and ideological reconfiguration. It proposes a reconceptualization of Russian cultural history as a palimpsest of submerged sacral structures, where utopia and apocalypse, magic and technology, converge in a distinctively Russian cosmopoietic horizon. Ultimately, this essay reframes Russian and European occultism as an alternate technology of cognition and a performative semiotic universe shaping not only artistic modernism but also the very grammar of Russian historical imagination. Full article

Rapid industrialization and urbanization have progressed in Korea, yet public attention to hazardous pollutants emitted from industrial complexes remains limited. With the increasing coexistence of industrial and residential areas, there is a growing need for real-time monitoring and management plans that account for the rapid dispersion of hazardous air pollutants (HAPs). In this study, we conducted spatiotemporal data collection and analysis for the first time in Korea using real-time measurements obtained through mobile extractive differential optical absorption spectroscopy (Me-DOAS) mounted on a solar occultation flux (SOF) vehicle. The measurements were conducted in the Saha Sinpyeong–Janglim Industrial Complex in Busan, which comprises the Sasang Industrial Complex and the Sinpyeong–Janglim Industrial Complex. BTEX compounds were selected as target volatile organic compounds (VOCs), and real-time measurements of both BTEX and fine particulate matter (PM) were conducted simultaneously. Correlation analysis revealed a strong relationship between PM₁₀ and PM_2.5 (r = 0.848–0.894), indicating shared sources. In Sasang, BTEX levels were associated with traffic and localized facilities, while in Saha Sinpyeong–Janglim, the concentrations were more influenced by industrial zoning and wind patterns. Notably, inter-compound correlations such as benzene–m-xylene and p-xylene–toluene suggested possible co-emission sources. This study proposes a GIS-based, three-dimensional air quality management approach that integrates variables such as traffic volume, wind direction, and speed through real-time measurements. The findings are expected to inform effective pollution control strategies and future environmental management plans for industrial complexes. Full article

The development of Daoism in Italy is deeply connected to how its classical texts were received and circulated. Although Italian Christian missionaries were among the earliest Western commentators on Daoism, significant Italian engagement with Daoist works only emerged in the 20th century. During the first half of that century, Italian publishers released six translations of the Laozi, three partial translations of the Zhuangzi, and several general works on Daoism. This surge of interest was influenced by two major 19th-century developments: the rise of sinology as an academic field in France, which spurred European scholarly interest in Chinese culture, and the spread of international esoteric and occult movements, which drew heavily from Eastern philosophies. This paper focuses on two important Italian translations of the Laozi from the interwar period—Julius Evola’s 1923 translation and Attilio Castellani’s 1927 version. These translations exemplify the dual influences of academic sinology and esoteric movements on the Italian reception of Daoism. By comparing these works, this paper highlights how Daoist ideas were introduced and interpreted in Italy, shaped both by the translators’ personal backgrounds and their distinct intellectual aims, thus revealing the varied contexts in which Daoism was received in early 20th-century Italy. Full article

Background/Objectives: The extensive use of computed tomography (CT) has led to a significant increase in the detection of small and non-palpable pulmonary nodules, necessitating the use of invasive methods for definitive diagnosis. Video-assisted thoracoscopic surgery (VATS) has become the preferred procedure for nodule resections; however, intraoperative localization remains challenging, especially for deep or subsolid lesions. This study explores whether SPECT/CT improves the technical and clinical outcomes of radio-guided occult lesion localization (ROLL) before uniportal video-assisted thoracoscopic surgery (u-VATS). Methods: This is a retrospective study involving consecutive patients referred for the resection of pulmonary nodules who underwent CT-guided ROLL followed by u-VATS between September 2017 and December 2024. From January 2023, SPECT/CT was systematically added after planar imaging. The cohort was divided into a planar group and a planar + SPECT/CT group. The inclusion criteria involved nodules sized ≤ 2 cm, with ground glass or solid characteristics, located at a depth of <6 cm from the pleural surface. ^99mTc-MAA injected activity, timing, the classification of planar and SPECT/CT image findings (focal uptake, multisite with focal uptake, multisite without focal uptake), spillage, and post-procedure complications were evaluated. Statistical analysis was performed, with continuous data expressed as the median and categorical data as the number. Comparisons were made using chi-square tests for categorical variables and the Mann–Whitney U test for procedural duration. Cohen’s kappa coefficient was calculated to assess agreement between imaging modalities. Results: In total, 125 patients were selected for CT-guided radiotracer injection followed by uniportal-VATS. The planar group and planar + SPECT/CT group comprised 60 and 65 patients, respectively. Focal uptake was detected in 68 (54%), multisite with focal uptake in 46 (36.8%), and multisite without focal uptake in 11 patients (8.8%). In comparative analyses between planar and SPECT/CT imaging in 65 patients, 91% exhibited focal uptake, revealing significant differences in classification for 40% of the patients. SPECT/CT corrected the classification of 23 patients initially categorized as multisite with focal uptake to focal uptake, improving localization accuracy. The mean procedure duration was 39 min with SPECT/CT. Pneumothorax was more frequently detected with SPECT/CT (43% vs. 1.6%). The intraoperative localization success rate was 96%. Conclusions: SPECT/CT imaging in the ROLL procedure for detecting pulmonary nodules before u-VATs demonstrates a significant advantage in reclassifying radiotracer positioning compared to planar imaging. Considering its limited impact on surgical success rates and additional procedural time, SPECT/CT should be reserved for technically challenging cases. Larger sample sizes, multicentric and prospective randomized studies, and formal cost–utility analyses are warranted. Full article

Background: Community-acquired pneumonia (CAP) is the leading cause of mortality in children from middle- to low-income countries; diagnosing CAP includes clinical evaluation, laboratory testing and pulmonary imaging. Lung ultrasound (LUS) is a sensitive, accessible, non-invasive, non-radiant method for accurately evaluating the lung involvement in acute diseases. Whether LUS findings can be correlated with CAP’s severity or sepsis risk remains debatable. This study aimed to increase the importance of LUS in diagnosing and monitoring CAP. We analyzed 102 children aged 1 month up to 18 years, hospital admitted with CAP. Mean age was 5.71 ± 4.85 years. Underweight was encountered in 44.11% of children, especially below 5 years, while overweight was encountered in 11.36% of older children and adolescents. Patients with CAP presented with fever (79.41%), cough (97.05%), tachypnea (18.62%), respiratory failure symptoms (20.58%), chest pain (12.74%) or poor feeding. Despite the fact that 21.56% had clinically occult CAP and six patients (5.88%) experienced radiologically occult pneumonia, CAP diagnosis was established based on anomalies detected using LUS. Conclusions: Detailed clinical examination with abnormal/modified breath sounds and/or tachypnea is suggestive of acute pneumonia. LUS is a sensitive diagnostic tool. A future perspective of including LUS in the diagnosis algorithm of CAP should be taken into consideration. Full article

Background: Bulgaria carries a high burden of colorectal cancer (CRC) but, at the start of this study, lacked a nationwide organized screening program. Understanding specialist views (particularly on mail-based fecal testing) is essential for effective policy development. Objective: The objective is to assess the attitudes towards, practices of, and perceived barriers to CRC screening among Bulgarian gastroenterologists, with a focus on the feasibility of mail-based fecal occult blood testing (FOBT). Methods: A cross-sectional survey of 38 gastroenterologists examined clinical use of FOBT, screening method preferences, and perceived systemic and patient-level barriers to CRC screening. Results: Among respondents, 57.89% reported using FOBT in clinical practice, and 71.05% indicated they would undergo the test themselves and recommend it to relatives. Colonoscopy was the preferred diagnostic tool for 84.21% of participants; however, the existing literature raises concerns about its feasibility for large-scale population screening. Key systemic barriers, rated on a 5-point Likert scale, included financial constraints (mean = 3.08), inadequate infrastructure (2.89), and healthcare workforce shortages (2.71). Patient-level barriers were led by low health literacy (4.13), lack of motivation (3.95), and procedural fears (3.26). A majority (84.38%) believed that mail-based FOBT would increase screening uptake, and 57.89% supported annual distribution of test kits. Nearly all respondents (97.37%) favored initiating screening at age 50. Conclusions: This study highlights strong support among Bulgarian gastroenterologists for a national CRC screening program, with particular endorsement of mail-based FOBT. Despite acknowledged systemic and population-level barriers, the findings suggest that such an approach could increase screening coverage, promote early detection, and support the strategic rollout of Bulgaria’s emerging cancer control initiatives. Full article

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare, progressive form of pre-capillary pulmonary hypertension characterized by persistent, organized thromboemboli in the pulmonary vasculature, leading to vascular remodeling, elevated pulmonary artery pressures, right heart failure, and significant morbidity and mortality if untreated. Despite advances, CTEPH remains underdiagnosed due to nonspecific symptoms and overlapping features with other forms of pulmonary hypertension. Basic Methodology: This review synthesizes data from large international registries, epidemiologic studies, translational research, and multicenter clinical trials. Key methodologies include analysis of registry data to assess incidence and risk factors, histopathological examination of lung specimens, and molecular studies investigating endothelial dysfunction and inflammatory pathways. Diagnostic modalities and treatment outcomes are evaluated through observational studies and randomized controlled trials. Recent Advances and Affected Population: Research has elucidated that CTEPH arises from incomplete resolution of pulmonary emboli, with subsequent fibrotic transformation mediated by dysregulated TGF-β/TGFBI signaling, endothelial dysfunction, and chronic inflammation. Affected populations are typically older adults, often with prior venous thromboembolism, splenectomy, or prothrombotic conditions, though up to 25% have no history of acute PE. The disease burden is substantial, with delayed diagnosis contributing to worse outcomes and higher societal costs. Microvascular arteriopathy and PAH-like lesions in non-occluded vessels further complicate the clinical picture. Conclusions: CTEPH is now recognized as a treatable disease, with multimodal therapies—surgical endarterectomy, balloon pulmonary angioplasty, and targeted pharmacotherapy—significantly improving survival and quality of life. Ongoing research into molecular mechanisms and biomarker-driven diagnostics promises earlier identification and more personalized management. Multidisciplinary care and continued translational investigation are essential to further reduce mortality and optimize outcomes for this complex patient population. Full article

Background: Papillary thyroid microcarcinoma (PTMC), a subtype of papillary thyroid carcinoma ≤ 1 cm in diameter, has shown a marked increase in incidence in recent decades, largely due to the widespread use of neck ultrasonography and fine needle aspiration cytology. Despite its generally indolent course, optimal management of PTMC remains controversial, with treatment strategies ranging from active surveillance to total thyroidectomy. Methods: This retrospective study analyzes five years of experience at a single tertiary care center, including 130 patients diagnosed with PTMC following thyroid surgery between July 2018 and December 2023. Clinical, cytological, and pathological data were collected and analyzed to identify factors influencing surgical decision-making and postoperative outcomes. Patients underwent either total thyroidectomy or hemithyroidectomy, with central and lateral lymph node dissection performed as indicated. Follow-up included clinical and biochemical surveillance for a mean duration of 3 years. Results: Total thyroidectomy was performed in 89.3% of patients, while hemithyroidectomy was limited to 10.7%. Multifocality was observed in 26.1% of cases, with bilateral involvement in 17.7%. Occult lymph node metastases were found in 14.6% (central compartment) and 3.8% (lateral neck). Postoperative radioactive iodine therapy was administered in 23.8% of patients. At final follow-up, 90.7% were disease-free. No significant predictors of recurrence or adverse outcomes were identified, though multifocality and lymph node involvement influenced surgical planning. Conclusions: Our findings support a risk-adapted surgical approach to PTMC, favoring total thyroidectomy in patients with suspicious or multifocal disease to avoid reoperation. While active surveillance and minimally invasive techniques are emerging, total thyroidectomy remains a safe and effective strategy in selected cases. Prospective, multicenter studies are needed to further refine management guidelines for this increasingly common thyroid malignancy. Full article

The impacts of the solar eclipse that occurred on 8 April 2024 over the United States on various atmospheric parameters are investigated. We analyzed surface and vertical profiles of temperature and humidity to understand how this eclipse affected the atmosphere from the ground to the stratosphere. Our findings show a significant response throughout the atmospheric range. The eclipse caused a decrease in shortwave radiation, leading to cooler Earth surfaces and a subsequent drop in surface temperature. This cooling effect also resulted in high relative humidity and lower wind speeds at the surface. Furthermore, GPS radio occultation data from COSMIC-2 revealed a decrease in tropospheric temperature and increase in stratospheric temperature during the eclipse. We also observed a reduction in both the temperature and height of the tropopause. The uniqueness of the present investigations lies in delineating the solar eclipse’s effects on the land and ocean. Our analysis indicates that land regions experienced a more pronounced temperature change compared to ocean regions. Full article

Background: This study aimed to evaluate the effectiveness of a saliva-based screening method for periodontal disease among community-dwelling older adults in Japan. Methods: A total of 372 study participants (mean age: 73.1 years) with 20 or more remaining teeth were included in the study. Of the six parameters assessed by the Salivary Multi Test (SMT), this study focused on the three parameters related to periodontal disease: occult blood, leukocytes, and proteins. Periodontal tissue examinations were performed based on the Community Periodontal Index (CPI) using partial mouth recording. To evaluate screening accuracy, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each of the three markers: occult blood, leukocytes, and proteins. Receiver operating characteristic (ROC) analysis was performed for each SMT item, and area under the curve (AUC) was calculated. Logistic regression analysis was used to calculate the odds ratios for combinations of SMT markers, with the presence of periodontal pockets and gingival inflammation as the respective outcome variables. Results: Among the individual markers, occult blood showed the highest diagnostic performance for detecting both periodontal pockets and gingival inflammation. The combination of elevated occult blood and leukocyte levels yielded the highest odds ratios for both periodontal pockets and gingival inflammation. Conclusions: While several SMT markers showed associations with periodontal conditions, their utility for screening in older Japanese adults remains to be further validated. Combining markers may help improve diagnostic performance, but additional studies are warranted. Full article

Surface soil moisture (SM) is a critical factor in hydrological modeling, agricultural management, and numerical weather forecasting. This paper presents a highly effective soil moisture retrieval algorithm developed for the FY-3E (FengYun-3E) GNOS-R (GNSS Occultation Sounder II-Reflectometry) instrument. The algorithm incorporates a first-order vegetation model that considers vegetation density and volume scattering. Utilizing multi-angle GNOS-R observations, the algorithm derives surface reflectivity, which is combined with ancillary data on opacity, vegetation water content, and soil moisture from SMAP (Soil Moisture Active Passive) to optimize the retrieval process. The algorithm has been specifically tailored for different surface conditions, including bare soil, areas with low vegetation, and densely vegetated regions. The algorithm directly incorporates the angle-dependence of observations, leading to enhanced retrieval accuracy. Additionally, a new approach parameterizes surface roughness as a function of angle, allowing for refined corrections in reflectivity measurements. For vegetated areas, the algorithm effectively isolates the soil surface signal by eliminating volume scattering and vegetation effects, enabling the accurate estimation of soil moisture. By leveraging multi-angle data, the algorithm achieves significantly improved retrieval accuracy, with root mean square errors of 0.0235, 0.0264, and 0.0191 (g/cm³) for bare, low-vegetation, and dense-vegetation areas, respectively. This innovative methodology offers robust global soil moisture estimation capabilities using the GNOS-R instrument, surpassing the accuracy of previous techniques. Full article

While space weather indices (e.g., F10.7, Dst index) are commonly employed to characterize ionospheric activity levels, the Global Mean Electron Content (GMEC) provides a more direct and comprehensive indicator of the global ionospheric state. This metric demonstrates greater potential than space weather indices for calibrating empirical ionospheric models such as IRI-2020. The COSMIC-2 constellation enables continuous, all-weather global ionospheric monitoring via radio occultation, unimpeded by land–sea distribution constraints, with over 8000 daily occultation events suitable for GMEC modeling. This study developed two lightweight GMEC models using COSMIC-2 data: (1) a POD GMEC model based on slant TEC (STEC) extracted from Level 1b podTc2 products and (2) a PROF GMEC model derived from vertical TEC (VTEC) calculated from electron density profiles (EDPs) in Level 2 ionPrf products. Both backpropagation neural network (BPNN)-based models generate hourly GMEC outputs as global spatial averages. Critically, GMEC serves as an essential intermediate step that addresses the challenges of utilizing spatially irregular occultation data by compressing COSMIC-2’s ionospheric information into an integrated metric. Building on this compressed representation, we implemented a convolutional neural network (CNN) that incorporates GMEC as an auxiliary feature to calibrate IRI-2020’s global ionospheric maps. This approach enables computationally efficient correction of systemic IRI TEC errors. Experimental results demonstrate (i) 48.5% higher accuracy in POD/PROF GMEC relative to IRI-2020 GMEC estimates, and (ii) the calibrated global IRI TEC model (designated GCIRI TEC) reduces errors by 50.15% during geomagnetically quiet periods and 28.5% during geomagnetic storms compared to the original IRI model. Full article

In postmenopausal women with high-grade cervical intraepithelial neoplasia (CIN3), hysterectomy is frequently performed after loop electrosurgical excision procedure (LEEP) due to the concern for residual disease or occult carcinoma. However, the decision to proceed with hysterectomy is often made without validated predictive criteria, increasing the risk of overtreatment or underdiagnosis. The aim of this study is to identify independent predictors of residual CIN2+ (CIN2, CIN3, adenocarcinoma in situ, invasive carcinoma) or invasive disease in hysterectomy specimens following LEEP in this high-risk population. Methods: We conducted a multicenter retrospective study including 154 postmenopausal women (aged 50–75) who underwent total hysterectomy within 12 months after LEEP for histologically confirmed CIN3. Data collected included human papillomavirus (HPV) genotyping (pre- and post-LEEP), endocervical curettage (ECC), cone margin status, transformation zone type, and histopathological outcomes of the hysterectomy specimen. Logistic regression and ROC curve analysis were used to assess predictive factors. Results: Residual disease (CIN2+, AIS, or carcinoma) was found in 38 patients (24.7%), including 7 cases (4.5%) of occult carcinoma. Persistent high-risk HPV post-LEEP was the strongest independent predictor (adjusted OR for HPV 16/18: 74.0; p < 0.001), followed by positive ECC (OR: 3.64; p = 0.028). Cone margin status was not independently associated. The multivariate model showed good discriminative performance (AUC = 0.860; sensitivity 67.2%, specificity 72.8%). Conclusions: Our findings suggest that persistent high-risk HPV infection and positive ECC are reliable predictors of residual or occult disease. These markers should be integrated into post-LEEP follow-up protocols to better identify candidates for hysterectomy and minimize unnecessary surgeries. Full article