Search Results (3,857)

Background/Objectives: Irritable Bowel Syndrome (IBS) is a widely prevalent chronic disorder of brain–gut interaction which represents a clinical challenge due to its complex underlying causes and the lack of a standardized treatment approach. This cross-sectional research collected real-world data (RWD) on the effectiveness, safety, and usage pattern of a natural substance-based medical device, Colilen IBS, indicated for the treatment of IBS. Methods: Surveys were conducted both in Italy and Germany with 6101 participants, including 4425 patients, 1014 pharmacists, and 662 physicians using a structured GxP web platform that allows voluntary participants to share their experiences with the device. The validated platform was designed to comply with post-market surveillance requirements of EU Regulation 2017/745. Statistical analyses included descriptive evaluations of responses to gauge overall effectiveness and safety of the device. Results: The effectiveness reported with the medical device was judged extreme or great by 79.2% of patients, with 89.2% of whom observed symptom improvement within one month. Both safety and tolerability were rated extreme or great by 90.7% of patients. Healthcare professionals reported a similar rate on the overall effectiveness, with 94.9% of pharmacists and 95.9% of physicians indicating it extreme or great. Similarly, the safety profile was corroborated by nearly all pharmacists (97.0%) and physicians (98.2%) reporting extreme or great satisfaction with both safety and tolerability of the medical device. Conclusions: This research provides RWD supporting the effectiveness and safety of the product for treating IBS. The strong coherence among patients, pharmacists, and physicians in positively rating the device’s performance suggests that this medical device represents a therapeutic option that effectively addresses patient needs while minimizing safety concerns. Continuous RWD collection is essential, as it offers insights into real-world practice and ensures ongoing confirmation of the product’s safety and effectiveness. Ultimately, this will advance IBS patient care by integrating real-world evidence into clinical management. Full article

This paper explores the ethical implications of an ongoing debate about evolution, animal suffering, and the goodness of God. Christopher Southgate describes a “fault-line” between those who believe the struggle, suffering, and destruction of the evolutionary process are aligned with God’s good purposes in creation and those who regard these evolutionary “disvalues” as contrary to God’s good purposes. Recent efforts at dialogue across the fault line have not resolved this basic disagreement, but have achieved notable consensus on eschatology: both sides share the hope of eschatological fulfilment for other-than-human creatures and an end to the suffering, struggle, and destruction of the present age. One under-explored aspect of this dialogue is its ethical significance; since evolutionary theodicies are theological evaluations of the natural world, they should inform our understanding of what we must do in response to its struggle and suffering. Having outlined the present state of the dialogue, I consider its implications for three particular ethical issues: (1) Eating meat. Southgate and Bethany Sollereder consider meat-eating in itself ethically unproblematic, for reasons not unconnected with their evolutionary theodicies. By contrast, I argue that the eschatological hope they, like me, affirm mandates Christians to refrain from avoidable violence toward our fellow-creatures. For many westerners, “avoidable violence” includes the killing of animals for food. (2) Ending extinction. Southgate has called for humans to be “co-redeemers,” sharing with God in the healing of the evolutionary process, including efforts to combat both anthropogenic and non-anthropogenic species extinction. Skeptical that humans are called to be co-redeemers, I agree that reducing anthropogenic species extinction is a proper act of repentance for the sin of ecological destruction, but am more wary of human attempts to prevent non-anthropogenic extinction. (3) Responding to pain. While I agree with Southgate and Sollereder that pain is usually biologically adaptive in this world, I refer to good scientific evidence for the existence of pain that is non-adaptive and detrimental to the flourishing of both humans and other animals. There is a prima facie ethical obligation to do what is in our power to relieve such pain. Full article

The rapid development of Convolutional Neural Networks (CNNs) has markedly boosted the performance of object detection in remote sensing. Nevertheless, tiny objects typically account for an extremely small fraction of the total area in remote sensing images, rendering existing IoU-based or area-based evaluation metrics highly sensitive to minor pixel deviations. Meanwhile, classic detection models face inherent bottlenecks in efficiently mining discriminative features for tiny objects, leaving the task of tiny object detection in remote sensing images as an ongoing challenge in this field. To alleviate these issues, this paper proposes a tiny object detection method based on Normalized Gaussian Label Assignment and Multi-scale Hybrid Attention. Firstly, 2D Gaussian modeling is performed on the feature receptive field and the actual bounding box, using Normalized Bhattacharyya Distance for precise similarity measurement. Furthermore, a candidate sample quality ranking mechanism is constructed to select high-quality positive samples. Finally, a Multi-scale Hybrid Attention module is designed to enhance the discriminative feature extraction of tiny objects. The proposed method achieves 25.7% and 27.9% AP on the AI-TOD-v2 and VisDrone2019 datasets, respectively, significantly improving the detection capability of tiny objects in complex remote sensing scenarios. Full article

Background: Among many deleterious effects on the well-being of children and youth, the COVID-19 pandemic contributed to a surge in youth mental health distress. This, coupled with pre-existing prolonged wait times for mental health care, highlighted the need for accessible community-based mental health supports. The Healthy Living Project (HELP) is a virtual lifestyle change support program aimed at promoting positive lifestyle changes and improved mental well-being among youth with mental distress. A pilot feasibility study explored youth engagement with HELP e-resources, and preliminary mental health and lifestyle measures over a 3-month period. Methods: Youth were enrolled in a 3-month pilot of the HELP e-resource. Feasibility metrics (recruitment, retention, and platform engagement) were documented, while exploratory self-reported data on emotional and behavioral difficulties, youth quality of life, sedentary behavior (screen time), sleep hygiene, and physical activity were assessed at baseline and 3 months. Results: Twenty-three youth (mean age 15.7 years, SD 1.7) completed baseline assessments and started the intervention, with ten participants retained by the end of the study. Compared with non-completers (n = 13), study completers (n = 10) tended to report higher quality of life and healthier habits (lower screen time, improved sleep hygiene, and higher activity). Ongoing access to HELP over 3 months was associated with suggestive trends toward improvement in emotional and behavioral difficulties and sleep hygiene. Engaged participants who received screen time education tended to report lower screen times as compared to unengaged counterparts. Conclusions: This study provides early insights into the implementation and acceptability of HELP e-resources among youth experiencing mental distress, with suggestive trends toward potential benefit. Low recruitment and high attrition preclude definitive conclusions, and the findings should be interpreted as exploratory. Lessons from this pilot will inform the design of a subsequent trial to more rigorously evaluate feasibility and the potential impact of HELP on youth with mental distress. Full article

Polymeric microfiltration membranes are among the most utilized pressure-driven membranes due to their excellent permeation flux, moderate removal efficiency, low operating pressure, low cost, as well as their potential for reusability and cleanability. Therefore, these membranes are used in different crucial sectors, including the water and wastewater, dairy, beverage, and pharmaceutical industries. However, well-known polymeric microfiltration membranes suffer from their poor hydrophilic properties, causing fouling phenomenon. A reduction in permeate flux, a shortened operational lifespan, and increased energy consumption are the primary negative consequences of membrane fouling. Over the years, a broad spectrum of studies has been performed to modify polymeric microfiltration membranes to improve their hydrophilic, transport, and antifouling characteristics. Despite extensive research, this issue remains a subject of ongoing discussion and scrutiny within the scientific community. This review article provides promising information about different physical and chemical modification methods—such as polymer blending, the incorporation of nanomaterials, surface coating, chemical crosslinking, in situ nanoparticle immobilization, and chemical surface functionalization—for polymeric microfiltration membranes. The physical and chemical modification methods are comparatively evaluated, highlighting their positive and negative aspects, supported by findings from recent investigations. Moreover, promising ideas and future-oriented techniques were proposed to obtain polymeric microfiltration membranes containing superior efficiency, extended service life, and mechanical strength. Full article

Belatacept, a selective costimulation blocker targeting the CD28–CD80/86 pathway, represents a major innovation in solid organ transplantation immunosuppression. By providing upstream inhibition of T-cell activation without calcineurin inhibition, belatacept offers the potential for improved long-term graft and patient outcomes with reduced nephrotoxicity and metabolic adverse effects. This review summarizes the mechanistic rationale, pivotal evidence, and clinical experience supporting the use of belatacept as first-line or conversion therapy in solid organ transplantation, while addressing safety, pharmacoeconomic impact, and future research directions. A comprehensive analysis of pivotal phase II–III trials (BENEFIT, BENEFIT-EXT), recent prospective conversion studies, and ongoing trials in liver, heart, and lung transplantation was performed. Safety data and health–economic evaluations were critically appraised. In kidney transplantation, belatacept-based immunosuppression provides superior renal function and improved metabolic profiles compared with calcineurin inhibitors (CNIs), though with higher early acute rejection rates. In liver, heart, and lung transplantation, evidence remains limited, with de novo use contraindicated in liver grafts due to excess mortality and rejection. Conversion from CNI to belatacept in selected patients improves renal outcomes without compromising graft survival. Safety considerations include a higher risk of post-transplant lymphoproliferative disorder (PTLD) in Epstein–Barr virus-negative recipients. Belatacept represents a paradigm shift in transplant immunology by targeting upstream T-cell activation. While currently approved only for kidney transplantation, ongoing studies in thoracic and hepatic grafts may expand its therapeutic role. Personalized patient selection, combination regimens mitigating rejection risk, and real-world cost-effectiveness analyses will define its place in future precision immunosuppression strategies. Full article

In the current context of the energy transition, the reuse of offshore oil and gas (O&G) structures that have reached the end of their operational life presents new engineering challenges. Many projects aim to adapt existing facilities for a range of alternative uses. This paper outlines guidelines for identifying the most suitable conversion options aligned with the goals of the ongoing energy transition, focusing on the Italian offshore area. The study promotes the reuse—instead of partial or full removal—of existing offshore platforms originally built for the exploitation of hydrocarbon reservoirs. From an engineering perspective, the project describes the development of guidelines based on an innovative methodology to identify new uses for both offshore oil and gas platforms and the depleted reservoirs, with a focus on safety and environmental impact. The guidelines identify the most suitable and effective conversion option for the platform–reservoir system under consideration. To ensure a realistic approach, the developed methodology allows one to identify the preferable conversion option even when some piece of information is missing or incomplete, as often happens in the early stages of a feasibility study. The screening process provides an associated level of uncertainty related to the degree of data incompleteness. The outcome is a complete evaluation procedure divided into five phases: definition of criteria; assignment of an importance scale to determine how critical each criterion is; connection of indices and weights to each criterion; and analysis of the relationships between them. The guidelines are implemented in a software tool that supports and simplifies the decision-making process. The results are very promising. The developed methodology and the related guidelines applied to a case study have proven to be an effective decision-support for analysts. The study shows that it is possible to identify the most suitable conversion option from a technical, engineering, and operational point of view while also considering its environmental impact and safety implications. Full article

Background: Cardiovascular implications in systemic lupus erythematosus (SLE) are common and varied, including impacts on the pericardium, myocardium, valves, coronary arteries, and conduction system; all of these could be potential substrates or triggers of cardiac arrhythmias by interfering with disease severity and specific medication. Therefore, this narrative review aimed to assess the cardiac involvement in SLE underlying, mainly, cardiac arrhythmias. Methods: We analyzed studies, published between 2015 and 2025 on PubMed, which explore cardiovascular involvement with a focus on arrhythmias in SLE from the perspectives of epidemiology, underlying mechanisms, diagnostic techniques, and the impact of standard and biologic therapies. Results: The cardiac manifestation of LES (lupus pericarditis, lupus myocarditis, Libman–Sacks endocarditis, coronary artery disease, coronary vasculitis or myocardial fibrosis) represents a substrate for arrhythmia risk. These substrates, in association with other arrhythmias mechanisms considered as triggers or conduction abnormalities, determined arrhythmogenic conditions in these patients. In addition to structural heart disease, arrhythmias in SLE are caused by ongoing inflammation, immune system irregularities, microvascular problems, autonomic imbalance, oxidative stress, and side effects from treatments. Despite this complex background, arrhythmias are often overlooked and not routinely investigated in SLE care. Data that show how disease-modifying drugs may affect arrhythmias are limited and inconsistent, highlighting significant gaps in knowledge. Cardiac arrhythmias are a significant but, as yet, insufficiently underrecognized aspect of SLE, with serious implications for prognosis. Conclusions: Systemic lupus erythematosus causes cardiovascular involvement that is associated with arrhythmias through various and complexes mechanisms, mainly related to direct cardiovascular structural damage, systemic inflammation or specific therapies. Data on arrhythmias secondary to cardiovascular damage in patients with SLE in the literature are limited. Therefore, early detection of electrical issues, regular cardiovascular evaluation in high-risk patients, and careful management of treatment effects are vital. A coordinated, multidisciplinary cardio-rheumatology approach is essential to improving arrhythmia detection, tailoring treatments, and ultimately decreasing cardiovascular complications and deaths in SLE patients. Full article

The increasing need to regenerate public housing stock highlights the importance of adopting integrated evaluation tools capable of supporting transparent, sustainable, and public value-oriented investment decisions. This study compares two alternative intervention strategies—renovation with extension and demolition followed by reconstruction—by applying a Cost–Benefit Analysis (CBA) model developed in two phases. In the first phase, the analysis focuses on social benefits, with the aim of assessing their contribution to collective well-being. The second phase incorporates potential energy-related benefits, estimated on the basis of performance improvements associated with the two design scenarios. The results demonstrate that the integrated consideration of economic, social, and energy–environmental dimensions affects the relative performance differences between the examined strategies, offering a more comprehensive evaluation framework than conventional approaches based solely on monetary costs. The proposed model, which is replicable in Mediterranean contexts, contributes to the ongoing international debate on ex ante evaluation tools and provides operational insights to support urban regeneration policies oriented towards more effective, equitable, and policy-consistent solutions, in line with the objectives of the European Green Deal and the 2030 Agenda. The two-phase structure allows decision-makers to distinguish between short-term social effects and long-term energy-related benefits, offering a transparent support tool for public investment choices under fiscal constraints. Full article

Background: Visual dysfunction resulting from damage to the optic nerve and retinal neurons represents a significant concern in the postoperative management of childhood-onset craniopharyngioma (CP) survivors. The study aims to evaluate the influence of clinical parameters assessed in patients before and after neurosurgery of CP on peripapillary retinal nerve fiber layer (RNFL) thickness results, using optical coherence tomography (OCT) as early markers of compressive neuropathy. Methods: This study retrospectively examined 73 eyes from 38 individuals diagnosed with CP and 64 eyes from 32 healthy controls matched for age and sex. All patients in the study group underwent a complete endocrine examination before and after surgery. Moreover, all participants in both groups underwent a thorough ophthalmological examination and OCT imaging. The average RNFL thickness was analyzed, along with the RNFL in the superior and inferior sectors and in eight peripapillary sectors around the optic nerve. Clinical variables were analyzed to assess how they relate to alterations in RNFL thickness within specific sectors. Results: After surgery, the peripapillary RNFL thickness was much lower in the CP group than in the healthy control group. Preoperative factors significantly affecting RNFL reduction are as follows: age below 5 years at the time of diagnosis, birth in the country, optic disc oedema, delayed puberty, arginine vasopressin deficiency (AVD), growth hormone deficiency (GHD), hyperprolactinemia, and the degree of preoperative hypothalamic involvement. Moreover, syndrome of inappropriate secretion of antidiuretic hormone (SIADH), as well as the end of AVD, memory disorder and hyperfagia after surgery, correlated with damage to RNFL. Conclusions: CP causes significant thinning of the RNFL, which demonstrates the tumor’s impact on the visual pathway. Monitoring optic nerve damage and assessing outcomes after surgery can be performed effectively using OCT. Additionally, the relationship between RNFL thickness in specific areas and clinical indicators can provide vital information for diagnosing and monitoring. This highlights their usefulness in forecasting visual results. As a result, ongoing RNFL assessments should be part of the long-term management of CP patients to improve visual outlook and identify ongoing or remaining damage. Full article

The rapid adoption of generative artificial intelligence (AI) in higher education has intensified a pedagogical dilemma: while AI tools can increase immediate classroom engagement, they do not necessarily foster the self-regulated learning (SRL) capacities required for ethical and reflective professional practice, particularly in human-service fields. In this two-time-point, pre-post cohort-level (repeated cross-sectional) evaluation, we examined a six-week AI-integrated curriculum incorporating explicit SRL scaffolding among social work undergraduates at a Taiwanese university (pre-test N = 37; post-test N = 35). Because the surveys were administered anonymously and individual responses could not be linked across time, pre-post comparisons were conducted at the cohort level using independent samples. The participating students completed the AI-Enhanced Learning Attitude Scale (AILAS); this is a 30-item instrument grounded in the Technology Acceptance Model, Attitude Theory and SRL frameworks, assessing six dimensions of AI-related learning attitudes. Prior pilot evidence suggested an engagement regulation gap, characterized by relatively strong learning process engagement but weaker learning planning and learning habits. Accordingly, the curriculum incorporated weekly goal-setting activities, structured reflection tasks, peer accountability mechanisms, explicit instructor modeling of SRL strategies and simple progress tracking tools. The conducted psychometric analyses demonstrated excellent internal consistency for the total scale at the post-test stage (Cronbach’s α = 0.95). The independent-samples t-tests indicated that, at the post-test stage, the cohorts reported higher mean scores across most dimensions, with the largest cohort-level differences in Learning Habits (Cohen’s d = 0.75, p = 0.003) and Learning Process (Cohen’s d = 0.79, p = 0.002). After Bonferroni adjustment, improvements in the Learning Desire, Learning Habits and Learning Process dimensions and the Overall Attitude scores remained statistically robust. In contrast, the Learning Planning dimension demonstrated only marginal improvement (d = 0.46, p = 0.064), suggesting that higher-order planning skills may require longer or more sustained instructional support. No statistically significant gender differences were identified at the post-test stage. Taken together, the findings presented in this study offer preliminary, design-consistent evidence that SRL-oriented pedagogical scaffolding, rather than AI technology itself, may help narrow the engagement regulation gap, while the consolidation of autonomous planning capacities remains an ongoing instructional challenge. Full article

Non-small cell lung cancer (NSCLC) represents over 80% of all lung cancer cases and still has a huge mortality worldwide. Targeting epidermal growth-factor receptor (EGFR) alterations with overall response rates of more than 80% has provided a paradigm shift in the treatment of NSCLC; however, NSCLC patients harbouring uncommon mutations and exon 20 insertions still have a dismal prognosis underscoring the urgent need to develop novel EGFR tyrosine kinase inhibitors (TKIs) with proven activity against these EGFR alterations. Zipalertinib is a newly developed oral, irreversible compound which is characterized by its unique pyrrolopyrimidine structure which discriminates this novel TKI from others. It is active against the classical mutations (i.e., del19, L858R) and some of the uncommon mutations (e.g., T790M, G719X, S768I, L861Q, but not C797S) and is predominantly active in NSCLC cells harbouring exon20ins. Zipalertinib is currently being extensively evaluated in several clinical NSCLC trials (REZILIENT 1–4) and has shown significant clinical activity in NSCLC patients with uncommon mutations, exon20ins, and in brain metastases (REZILIENT 3 trial). Moreover, zipalertinib in combination with platinum-based chemotherapy followed by zipalertinib monotherapy as first-line therapy is currently being evaluated in the pivotal, ongoing REZILIENT 3 randomized trial. In addition, the efficacy of zipalertinib is also studied in the adjuvant setting (REZILIENT 4 trial, stage IB-IIIA NSCLCs with exon20ins and uncommon mutations). The role and the integration of therapies targeting exon20ins or uncommon mutations into the first- and second-line treatment armamentarium for NSCLC patients is not yet fully established, and the therapeutic impact of monotherapies (e.g., sunvozertinib, firmonertinib) versus combinations with standard platinum-based chemotherapy (e.g., zipalertinib, amivantamab) currently still lacks robust evidence to further change the therapeutic landscape for these patients. Therefore, results from the ongoing trials are eagerly awaited and are expected to shed some light on these open questions. Full article

Acute myeloid leukemia (AML) is a highly aggressive malignancy defined by significant biological diversity and variable patient outcomes. A key subset of AML is driven by abnormalities that lead to the overexpression of the oncogenic transcription factors HOXA9 and MEIS1. These abnormalities include KMT2A (formerly MLL) rearrangements and NPM1 mutations, as well as other rare lesions such as NUP98 rearrangements. This review focuses on the biology of the KMT2A, NPM1, and HOX/MEIS1 pathways, dissecting their molecular mechanisms of leukemogenesis. A central theme is the role of the scaffolding protein menin in the epigenetic regulation of this pathway, which ultimately drives malignant transformation. Currently, the clinical landscape is being transformed by the emergence of menin inhibitors as promising therapeutic agents for AML harboring these specific genetic anomalies. We evaluate the latest data on various menin inhibitors—both as monotherapy and in combinations—emphasizing their efficacy and safety profiles. As new evidence continues to accumulate with recent drug approvals and ongoing randomized, phase 3 studies, menin inhibitors are rapidly becoming a component of the AML treatment paradigm for relapsed/refractory and likely newly diagnosed disease. Full article

With the ongoing miniaturization of smart devices, fine-grained hand gesture recognition using millimeter-wave radar has attracted increasing attention, yet practical deployment remains challenging in continuous-gesture segmentation, robust feature extraction, and reliable classification. This paper presents an end-to-end fine-grained gesture recognition framework based on frequency modulated continuous wave(FMCW) millimeter-wave radar, including gesture design, data acquisition, feature construction, and neural network-based classification. Ten gesture types are recorded (eight valid gestures and two return-to-neutral gestures); for classification, the two return-to-neutral gesture types are merged into a single invalid class, yielding a nine-class task. A sliding-window segmentation method is developed using short-time Fourier transformation(STFT)-based Doppler-time representations, and a dataset of 4050 labeled samples is collected. Multiple signal classification(MUSIC)-based super-resolution estimation is adopted to construct range–time and angle–time representations, and instance-wise normalization is applied to Doppler and range features to mitigate inter-individual variability without test leakage. For recognition, a variable-channel deep residual shrinkage network (DRSN) is employed to improve robustness to noise, supporting single-, dual-, and triple-channel feature inputs. Results under both subject-dependent evaluation with repeated random splits and subject-independent leave one subject out(LOSO) cross-validation show that DRSN architecture consistently outperforms the RefineNet-based baseline, and the triple-channel configuration achieves the best performance (98.88% accuracy). Overall, the variable-channel design enables flexible feature selection to meet diverse application requirements. Full article

Healthcare-associated infections remain an ongoing concern across medical and dental practice, prompting continuous evaluation of infection prevention measures. In dental extractions, the necessity of sterile gloves is debated, as the oral cavity represents an inherently contaminated environment. This systematic review and meta-analysis evaluated whether the use of sterile gloves reduces postoperative socket infections compared with non-sterile gloves. A search of MEDLINE, Embase, Web of Science, Cochrane CENTRAL, and Google Scholar identified randomized controlled trials, clinically controlled trials, and observational trials directly comparing sterile versus non-sterile glove use during dental extractions. The primary outcome of this study was extraction socket infection at day 7 post-surgery. A meta-analysis using relative risk (RR) was performed for dichotomous data. Of the initial 7170 publications found, seven articles met inclusion criteria. Infection rates ranged from 0% to 3.9%, with an overall infection rate of 0.3% in the sterile glove group (672 patients) and 1.3% in the non-sterile glove group (758 patients). Three studies qualified for meta-analysis, resulting in an RR of 0.30 (95% CI 0.07–1.24), indicating no significant difference in postoperative infections between sterile and non-sterile glove usage. Given the limitations of small sample sizes, low event rates, incomplete reporting, and lack of subgroup data for surgical versus non-surgical extractions, no difference in postoperative infection was found between sterile and non-sterile glove use. Additional research is needed to determine whether glove sterility influences infection risk, particularly in surgical procedures. Full article