Search Results (6,494)

Objectives: Facial paralysis is a devastating yet frequent complication of skull base surgery, significantly impacting quality of life through functional impairments and psychosocial consequences. Management is complex and requires an individualized approach based on duration of paralysis, etiology and extent of nerve injury, overall prognosis, and rehabilitative goals. This review provides a comprehensive overview of current strategies for managing post-skull base surgery facial paralysis. Methods: A narrative review of the literature was performed, analyzing surgical reanimation techniques (nerve grafting, nerve transfers, regional and free muscle transfers), static procedures for facial symmetry and ocular protection, and non-surgical interventions such as physical therapy, botulinum toxin injections, and psychological support. Key criteria guiding treatment selection, including muscle viability and timing since injury, were examined. Results: Dynamic surgical approaches remain central to restoring movement. Nerve grafting and transfers are effective when viable musculature is present, whereas regional or free muscle transfers are required in long-standing paralysis with irreversible atrophy. Static procedures provide adjunctive improvements in resting symmetry and eye protection. Non-surgical strategies, including rehabilitation therapy and botulinum toxin, enhance functional outcomes and reduce synkinesis. Psychological counseling addresses the profound emotional burden associated with facial disfigurement. Across modalities, individualized treatment planning is crucial. Conclusions: Management of facial paralysis after skull base surgery demands a multidisciplinary, patient-centered approach. Combining surgical and non-surgical interventions optimizes functional and aesthetic outcomes, helping restore both facial movement and psychosocial well-being. Full article

As an effective energy storage solution, gas reservoir compressed air energy storage (CAES) can efficiently utilize curtailed wind power to meet urban electricity demands. Well pattern optimization enables rational design and adjustment of well layouts to maximize productivity, efficiency, and economic benefits while reducing energy losses and operational costs. To address limitations in conventional optimization methods—including oversimplified constraints, neglect of reservoir heterogeneity, and insufficient consideration of complex flow regimes—this study proposes an innovative multi-constraint well pattern optimization method incorporating productivity, energy conversion efficiency, drainage area, and economic performance for quantitative evaluation of well configurations. First, the reservoir flow domain was partitioned based on two flow regimes (Darcy and non-Darcy flow) near wells. Mathematical flow equations accounting for reservoir heterogeneity were established and solved using the rectangular grid method to determine productivity and formation pressure distributions for vertical and horizontal wells. Second, a drainage radius prediction model was developed based on pressure drop superposition principles to calculate gas drainage areas. Finally, an optimization function F, integrating productivity models and drainage radius calculations through ratio optimization criteria, was formulated to quantitatively characterize well pattern performance. An optimization workflow adhering to inter-well interference minimization principles was designed, culminating in a comprehensive CAES well pattern optimization framework. Case studies and sensitivity analyses on the depleted Mabei Block 8 CAES reservoir demonstrated the following: The quantitative optimization metric w decreases with increasing reservoir heterogeneity. w exhibits a unimodal relationship with production pressure differential, peaking at approximately 2.5 MPa. Optimal configuration was achieved with 3 horizontal wells and 23 vertical wells. Full article

The development of sustainable concrete capable of trading off the mechanical performance and cost remains a persistent scientific and engineering challenge. Although previous research has employed multi-objective optimization for binary and ternary cement blends, the simultaneous optimization of quaternary-blended systems, incorporating multiple supplementary cementitious materials, has received little systematic attention. This study addresses this gap by introducing an interpretable artificial intelligence (AI)-driven approach that integrates the Category Boosting (CatBoost) algorithm with the Non-Dominated Sorting Genetic Algorithm II (NSGA-II) to model and optimize the compressive strength (CS) and total cost of quaternary-blended concretes. A curated database of 810 experimentally documented mixtures was used to train and validate the model. CatBoost achieved superior predictive performance (R² = 0.987, MAE = 1.574 MPa), while Shapley additive explanations identified curing age, water-to-binder ratio, and Portland cement content as the dominant parameters governing CS. Multi-objective optimization produced Pareto-optimal elite mixtures achieving CS of 51–80 MPa, with a representative 60 MPa mix requiring approximately 62% less cement than conventional designs. The findings establish a scientifically grounded, interpretable methodology for data-driven design of low-carbon, high-performance concretes and demonstrate, for the first time, the viability of AI-assisted multi-criteria optimization for complex quaternary-blended systems. This framework offers both methodological innovation and practical guidance for implementing sustainable construction materials. Full article

Artistic gymnastics is one of the most physically demanding sports, characterized by a high incidence of both acute and chronic injuries. Although previous research has primarily focused on biomechanical and training-related factors, the multifactorial etiology of injuries—including molecular and genetic aspects—remains insufficiently explored. This systematic review aimed to synthesize current evidence on the causes, mechanisms, and prevention of injuries in artistic gymnastics, with particular emphasis on biomechanical, molecular, and genetic determinants of injury risk and athletic performance. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and was registered in the PROSPERO database (Registration No: CRD420251167521). Electronic databases (PubMed, KoBSON, and Google Scholar) were searched for studies published between 2015 and 2025 using the keywords “gymnastics injuries,” “overuse injuries,” “injury prevention,” “biomechanics,” “IL-6,” “TNF-α,” and “miRNA biomarkers.” Nineteen studies met the inclusion criteria and were analyzed based on injury incidence, localization, mechanisms, and molecular and genetic associations. The majority of injuries were localized in the joints of both upper and lower extremities, particularly during puberty and at higher competitive levels. Repetitive loading, improper technique, and insufficient recovery were identified as the main etiological factors. Molecular biomarkers such as IL-6, TNF-α, and miRNAs (miR-155, miR-146a) were found to play key roles in inflammatory responses, while genetic polymorphisms including ACTN3 R577X, ESR1 rs2234693, and CYP19A1 rs936306 were associated with flexibility, explosive strength, and susceptibility to injury. Injury prevention in artistic gymnastics requires a personalized and multidisciplinary approach that integrates biomechanical, clinical, molecular, and genetic data. Incorporating molecular and genetic profiling into training and rehabilitation programs may enhance early detection of overuse conditions and optimize both health and performance outcomes in gymnasts. Full article

Background/Objectives: Human breast milk is a mammary gland secretion with a dynamic composition, containing important bioactive factors for infant growth. Epigenetic factors, like microRNAs, are found in breast milk and can regulate gene expression and, thus, infant growth. Obesity is, among others, a major global health concern with long-term consequences, making its prevention during early life a public health priority. Maternal lifestyle factors, including diet and body weight status, may influence infant growth patterns and susceptibility to obesity. The aim of this review is to explore the hypothesis that miRNA content in breast milk might be influenced by maternal obesity, eventually affecting the obesity risk in offspring. Methods: This systematic review was carried out in line with the PRISMA 2020 statement and included observational (cohort) studies that met the inclusion criteria and compare the expression of miRNAs in OW/OB lactating mothers and associate this to the obesity development in the offspring. Results: According to the included studies, the most common miRNAs are miR-148a, miR-30 family, and miR-let7 family, with miR-30b and miR-let7a among the most discussed that participate in adipogenesis. Some of these miRNAs secreted in breast milk pass on a genetic predisposition for obesity to the next generation, while others provide a protective role against obesity in the offspring. Conclusions: Eventually, even though individual miRNAs may fluctuate, the overall miRNA profile remains stable. The findings underscore the importance of balanced maternal nutrition and optimal health during lactation, both for supporting healthy infant development and for potentially reducing the risk of obesity later in life. Full article

Androgenetic alopecia (AGA) is a prevalent, multifactorial hair disorder affecting a substantial portion of both males and females, with significant psychosocial consequences. Over the past decade, regenerative medicine has reshaped AGA treatment, offering biologically driven alternatives to conventional pharmacological and surgical therapies. Among these, Autologous Micrografting Technology (AMT) (Regenera Activa^® by Rigenera^® Technology, Barcelona, Spain) emerged 10 years ago as a notable innovation leveraging the body’s intrinsic regenerative potential through micrografts derived from a healthy scalp tissue. This review provides a comprehensive overview of the pathophysiology of AGA—including genetic, hormonal, and inflammatory contributors—and evaluates the clinical efficacy, safety, and mechanistic basis of AMT in comparison with other regenerative strategies such as platelet-rich plasma, adipose-derived mesenchymal stem cells, and exosome-based treatments. Clinical studies demonstrate that AMT yields significant short-term improvements in hair density and thickness with favorable safety outcomes. Moreover, advancements in device technology and treatment protocols have enhanced consistency and reproducibility. As multimodal and personalized approaches gain traction in hair restoration, AMT is a minimally invasive point-of-care procedure within the evolving regenerative landscape. Future studies are warranted to optimize treatment algorithms, extend follow-up data, better define patient selection criteria for maximizing outcomes with AMT, and expand the indication of autologous micrografting technology. Full article

Background/Objectives: The optimal rate of enteral feeding advancement in preterm infants remains uncertain despite decades of clinical research. This uncertainty arises from concerns that rapid feeding progression may increase the risk of feeding intolerance and necrotizing enterocolitis (NEC), two major causes of morbidity and mortality in this population. The feeding rate may also influence intestinal oxygenation due to mesenteric hemodynamic changes during feeding. This study aimed to evaluate whether the rate of enteral feeding advancement (slow vs. rapid) affects intestinal oxygenation and its association with feeding intolerance (FI) or necrotizing enterocolitis in very low birth weight preterm infants. Methods: This prospective, randomized, two-center study included infants born at 28–32 weeks of gestation. Group 1 received slow advancement (20 mL/kg/day) and Group 2 rapid advancement (30 mL/kg/day) of enteral feeds. Splanchnic (srSO₂) and cerebral (crSO₂) oxygenation were monitored daily using the FDA-approved INVOS NIRS device during feeding periods (08:00–16:00). Monitoring was performed during minimal enteral nutrition (Phase 1), advancement phases (Phase 2), and for two days after achieving full enteral feeding (Phase 3). The splanchnic-to-cerebral oxygenation ratio (SCOR) was also calculated. Percentage changes in srSO₂ and SCOR during and after feeding were calculated from baseline (prefeeding) values and analyzed. Results: Sixty infants were enrolled. Mean gestational age and birth weight were 29.76 ± 1.33 weeks and 1375.05 ± 271.19 g, respectively. Group 2 achieved full enteral feeding significantly earlier (p = 0.001), with no other demographic differences between groups. No cases of NEC were observed. Feeding intolerance occurred in 14 infants (23.3%): 8 in Group 1 and 6 in Group 2 (p = 0.192). Both groups exhibited increased srSO₂ and SCOR during feeding; however, the between-group differences were not statistically significant (Phase 2 srSO₂ and SCOR: p = 0.07, 0.08; Phase 3 srSO₂ and SCOR: p = 0.069, 0.071). However, the percentage change from baseline in srSO₂ and SCOR during and after feeding was significantly greater in Group 2 during the advancement and full enteral feeding phases (Phase 2 srSO₂ and SCOR: p = 0.03, 0.022; Phase 3 srSO₂ and SCOR: p = 0.015, 0.048). Infants with feeding intolerance demonstrated significantly lower srSO₂ and SCOR values compared to tolerant infants, and this reduction persisted even after reaching full enteral feeding. ROC analysis suggested gestational age < 30 weeks, birth weight < 1180 g, srSO₂ < 52, and SCOR < 0.6 were associated with feeding intolerance. Conclusions: Intermittent bolus feeding increased intestinal oxygenation, with a more pronounced effect in the rapid advancement group. No difference in gastrointestinal adverse outcomes was observed between groups. Lower intestinal oxygenation was associated with feeding intolerance, and the suggested predictive criteria may help guide individualized feeding strategies. Full article

Background: Minimally invasive hyperthermia and regenerative therapies require materials that deliver precise, localized heat without compromising biocompatibility. Most conventional polymers are thermally insulating and challenging to control in vivo, motivating this review. Objectives: We aimed to (i) examine the use of thermally enhanced biopolymers in hyperthermia-based therapies, (ii) appraise evidence from clinical and preclinical studies, (iii) identify and classify principal applications in regenerative medicine. Methods: A PRISMA-guided systematic review (2020–2025) with predefined inclusion/exclusion criteria was conducted and complemented by a bibliometric analysis using VOSviewer for mapping and visualization. Results: Modifying biopolymers—via functionalization with photothermal or magnetic nanoagents (Au; Fe₂O₃/Fe₃O₄/CoFe₂O₄; CuS; Ag; MXenes, e.g., Nb₂C), crosslinking strategies, and hybrid formulations—significantly increased thermal conductivity, enabling localized hyperthermia and controlled drug release. In vitro and in vivo studies showed that europium-doped iron oxide nanoparticles embedded in chitosan generated heat efficiently while sparing healthy tissues, underscoring the need to balance biocompatibility and thermal performance. Hydrogel systems enriched with carbon nanomaterials (graphene, carbon nanotubes) and matrices such as GelMA, PNIPAM, hyaluronic acid, and PLA/PLGA demonstrated tissue compatibility and effective thermal behavior; graphene was compatible with neural tissue without inducing inflammation. Conclusions: Thermally conductive biopolymers show growing potential for oncology and regenerative medicine. The evidence supports further academic and interdisciplinary research to optimize safety, performance, and translational pathways. Full article

Hereditary hemorrhagic telangiectasia (HHT), also known as Osler–Weber–Rendu disease, is an autosomal dominant vascular disorder caused most commonly by pathogenic variants in the ENG and ACVRL1/ALK1 genes. It is characterized by mucocutaneous telangiectasias and arteriovenous malformations (AVMs) in various organs, leading to recurrent epistaxis, gastrointestinal bleeding, and iron deficiency anemia. Diagnosis relies on the Curaçao Criteria, which include recurrent nosebleeds, characteristic telangiectasias, visceral AVMs, and family history. This review aims to present current therapeutic approaches and emerging treatment strategies for HHT. Traditional surgical and laser-based methods are increasingly complemented or replaced by targeted pharmacological interventions. Antiangiogenic agents such as bevacizumab and thalidomide have demonstrated efficacy in reducing bleeding frequency and transfusion requirements, although adverse effects may limit long-term use. Novel therapies under investigation target molecular pathways involved in vascular remodeling, including tyrosine kinase inhibitors (sorafenib, nintedanib), anti-ANGPT2 antibodies, and modulators of BMP9/ALK1 signaling (tacrolimus, sirolimus). Preclinical and early clinical studies suggest that these agents may provide disease-modifying benefits. Continued research should focus on optimizing treatment efficacy, reducing toxicity, and developing individualized therapeutic regimens based on genetic and clinical characteristics. Full article

The three northeastern provinces of China are the country’s most important grain-producing region, particularly for maize, soybean, and rice, and form its largest commercial grain base. Over the past two decades, cropping structures in this region have undergone notable shifts driven by both climate change and human activities. Generating long-term, high-resolution maps of multi-crop distribution and evaluating their suitability is essential for understanding cropping dynamics, optimizing land use, and promoting sustainable agriculture. In this study, we integrated multi-source satellite imagery from Landsat and Sentinel-2 to map the distribution of rice, maize, and soybean from 2000 to 2023 using a Random Forest classifier. A crop suitability assessment framework was developed by combining a multi-criteria evaluation model with the MaxEnt model. Reliable training samples were derived by overlaying suitability evaluation results with stable crop growth areas, and environmental variables—including climate, topography, soil, hydrology, and anthropogenic factors—were incorporated into MaxEnt to assess suitability. Furthermore, the spatial consistency between actual cultivation and suitability was evaluated to identify areas of misallocated land use. The results show that: (1) the six classification maps achieved an average overall accuracy of 91.05% and a Kappa coefficient of 0.857; (2) the cultivation area of all three crops expanded, with maize showing the largest increase, followed by soybean and rice, and the dominant conversion being from soybean to maize; (3) suitability areas ranked as soybean (376,692 km²) > maize (329,056 km²) > rice (311,869 km²), with substantial spatial overlap, particularly between maize and soybean, suggesting strong competition; and (4) in 2023, highly suitable zones accounted for 57.39% of rice, 39.69% of maize, and 28.89% of soybean cultivation, indicating a closer alignment between actual distribution and suitability for rice, weaker for maize, and weakest for soybean, whose suitable zones were often displaced by rice and maize. These findings provide insights to guide farmers in optimizing crop allocation and offer a scientific basis for policymakers in designing cultivated land protection strategies in Northeast China. Full article

As a cornerstone of recoverable reserve prediction in water flooding projects, characteristic curve analysis has proven to be critical for reservoir management in the G Oilfield. This study introduces an enhanced methodology that significantly improves prediction accuracy through three key innovations: (1) development of a modified Type A curve with correction factor c to address early-stage nonlinear deviations, reducing prediction errors from 12.7% to 4.3% across 35 wells; (2) establishment of phase-specific model selection criteria demonstrating Type C curve superiority (>80% water cut) versus Zhang/Yu-type curves’ effectiveness in heterogeneous reservoirs (water cut ≥ 50%, errors < 5%); and (3) implementation of an integrated workflow incorporating linear segment optimization and economic threshold standardization. Field validation through 15-year production data (2008–2023) confirms <6% error in recovery factor predictions, significantly enhancing development strategy formulation. The technical framework provides novel insights into the water flooding curve theory while offering practical solutions for mature field management, particularly in complex continental reservoirs. Full article

Background/Objectives: Malnutrition in hospitalized older adults is associated with increased healthcare utilization, prolonged hospitalizations, and higher readmission rates. Specialized oral nutritional supplements enriched with β-hydroxy-β-methylbutyrate (HMB-ONS) have shown benefits in preserving muscle mass, improving functional outcomes, and reducing readmission rates, yet real-world data on their effectiveness remain limited. This study evaluated the association between HMB-ONS use and hospital readmission rates, as well as healthcare costs, in patients with malnutrition or at risk of malnutrition. Methods: This retrospective study analyzed electronic medical records (2015–2021) of hospitalized patients at risk of malnutrition at two tertiary care hospitals in Israel. Patients receiving HMB-ONS during hospitalization were compared with those receiving standard ONS (S-ONS). Propensity score matching (PSM) was employed to reduce potential confounding due to differences in observable characteristics. Primary outcomes were readmission rates at 1-, 3-, and 6-month post-discharge. A cost analysis estimated per-patient hospitalization costs and financial savings from reduced readmissions. Results: Of 391,838 hospitalizations, 16,751 patients met the inclusion criteria. Patients with malnutrition or at risk of malnutrition who received HMB-ONS during hospitalization were PSM-matched to those who received S-ONS (n = 1440, 53.5% female, average age of 78.25 (±15.62) years). Patients who received HMB-ONS had significantly lower odds of readmission compared with those receiving S-ONS at 1 month (OR = 0.698; 95% CI: 0.548–0.888; p = 0.0034), 3 months (OR = 0.772; 95% CI: 0.623–0.958; p = 0.0187), and 6 months (OR = 0.780; 95% CI: 0.633–0.961; p = 0.0195). Based on these differences, the economic analysis estimated net cost savings of EUR 387.61 (USD 403.29) per patient for HMB-ONS versus S-ONS. Conclusions: HMB-ONS was associated with significantly lower readmission rates and healthcare costs compared to S-ONS in patients with malnutrition or at risk of malnutrition. These findings may support the use of specialized nutritional interventions to improve clinical outcomes and optimize hospital resource utilization in patients with malnutrition or at risk of malnutrition. Full article

Modern cosmology continues to struggle with unresolved questions concerning the origins of dark matter and dark energy. To explore these challenges, this study presents the Source Energy Field Theory (SEFT)—a new theoretical framework that offers an alternative view of how cosmic structures may form and evolve. SEFT envisions the universe as filled with a fundamental energy field, where the observed cosmological redshift does not result from accelerated expansion but rather emerges from the distance-dependent modulation of the energy field and the curvature produced by this field. To evaluate this idea, a nonlinear wave equation was developed to connect redshift with right ascension, declination, and distance. The model was optimized using 1701 observational data points from the Pantheon+ and SH0ES samples, which include Type Ia supernovae and Cepheid variables spanning distances from 6.3 to 17,241 Mpc. Its performance was compared with that of the standard ΛCDM model. SEFT achieved a slightly lower root-mean-square error (145.521 vs. 147.665 Mpc), a marginally higher determination coefficient (R² = 0.9910 vs. 0.9908), and significantly improved information criteria values (ΔAIC = −41.753, ΔBIC = −19.997). These results provide robust statistical support for SEFT and suggest that it can complement—and potentially extend—the ΛCDM paradigm in describing the structure and evolution of the universe. Full article

Background: Growing interest in optimizing rowing performance has led to numerous ergometer-based testing protocols. However, this diversity has created a lack of consensus on which physiological variables best predict rowing performance. This systematic review provides an updated synthesis of the main ergometer testing protocols and identifies the variables most strongly associated with 2000 m performance. Methods: A systematic search was conducted across PubMed, Web of Science, and Scopus databases, following PRISMA and STROBE guidelines. Studies were selected based on predefined inclusion criteria, and methodological quality was assessed accordingly (PROSPERO: CRD420251027702). Results: Thirty-four studies comprising 909 rowers (657 men, 252 women) across elite (20%), sub-elite (32%), and recreational (47%) levels were analyzed. The 2000 m test was the most frequently employed protocol (79%), followed by incremental (INCR) tests. The 2000 m test reflects competition performance, whereas INCR tests are primarily used to assess VO₂max and PPO, the variables most strongly correlated with 2000 m outcomes. Power at lactate threshold and CP also showed strong associations with performance, particularly when measured through short, time-efficient protocols that minimize fatigue. Conclusions: The strongest and most consistent correlates of 2000 m ergometer performance are VO₂max and PPO (r = 0.83–0.99). CP is likewise strongly associated (n = 4 studies) but rests on a smaller evidence base. Given that 72% of the analyzed sample comprised male participants, extrapolation of these findings to female rowers warrants caution. Full article

Urban managers and decision-makers may approach Urban Environmental Quality (UEQ) assessment with perspectives that range from highly pessimistic to highly optimistic scenarios. The objective of this study was to introduce a scenario-driven spatial decision support system framework for optimizing UEQ zoning. The proposed framework includes six steps: (1) building a geodatabase of criteria, (2) standardizing criteria using minimum and maximum methods, (3) determining criteria weights using the Analytic Hierarchy Process (AHP) method, (4) combining criteria and creating scenarios using the OWA method, (5) analyzing UEQ maps with statistical analyses, and (6) examining variability through histogram analysis of UEQ values across scenarios. The results indicate that, among environmental and infrastructural criteria, air pollution and population density had the most significant impact on UEQ zoning in Isfahan city. In the five decision-making scenarios (highly pessimistic, pessimistic, neutral, optimistic, and highly optimistic), 8% (19), 12% (15), 16% (12), 21% (8), and 25% (5) of Isfahan’s area were classified as poor, respectively. Additionally, the percentage of the population in poor classes across the scenarios was 5% (14), 10% (11), 13% (7), 17% (5), and 20% (3), respectively. The findings demonstrate that the proposed framework offers high flexibility and capability for assessing UEQ across different decision-making scenarios. Full article