Search Results (479)

Background and Objectives: Autologous stem cell transplantation (ASCT) remains the standard of care for relapsed or refractory Hodgkin lymphoma (R/R HL), and an increasing proportion of patients receive programmed cell death protein 1 (PD-1) inhibitors prior to transplantation. Engraftment syndrome (ES) is a noninfectious inflammatory complication classically associated with neutrophil recovery; however, early peri-transplant inflammatory manifestations remain poorly characterized and may mimic infectious complications. We aimed to evaluate peri-transplant inflammatory events after ASCT, with particular emphasis on ES-compatible manifestations occurring before neutrophil engraftment and their association with prior PD-1 inhibitor exposure. Materials and Methods: In this single-center retrospective cohort study, 64 consecutive adult patients with HL undergoing ASCT between 2018 and 2025 were analyzed. ES was defined according to Spitzer and Maiolino criteria. Inflammatory manifestations fulfilling these criteria but occurring prior to neutrophil recovery were classified as pre-engraftment syndrome (pre-ES). Clinically significant events were defined by the requirement for systemic corticosteroid therapy. Clinical and laboratory parameters were compared using non-parametric statistical analyses. Results: No cases fulfilled the Spitzer criteria for classical ES, while three patients (4.7%) met the Maiolino criteria, none requiring corticosteroid therapy. Using the broader Maiolino definition, pre-ES was observed in 34 patients (53.1%) when the conventional engraftment time window was disregarded; however, only three patients required systemic corticosteroid therapy. Importantly, all three cases also fulfilled the Spitzer criteria outside the conventional time window, whereas the remaining Maiolino-defined pre-ES cases were self-limiting. All steroid-requiring pre-ES cases occurred exclusively in PD-1-exposed patients, and prior PD-1 therapy was significantly associated with severe pre-ES (p = 0.0007), although this finding is based on a very small number of events. These patients also demonstrated significantly higher early C-reactive protein (CRP) levels. Conclusions: While classical ES after ASCT was uncommon, clinically significant pre-ES occurred exclusively in PD-1-exposed patients. These early inflammatory events may represent a distinct phenotype and require prompt recognition and timely corticosteroid therapy after exclusion of infection. Prospective studies are warranted to validate these findings and refine risk stratification and monitoring strategies. Full article

Introduction: Delirium is one of the most common and serious neuropsychiatric complications following cardiac surgery. It is associated with increased mortality, prolonged intensive care unit (ICU) and hospital stay, long-term cognitive decline, and reduced quality of life. Aims and Objectives: The aim of this study is to synthesize current evidence on the epidemiology, psychiatric and psychosocial risk factors, biological mechanisms, perioperative modifiers, prevention strategies, and long-term outcomes of delirium after cardiac surgery, with particular emphasis on its role as a marker of brain vulnerability. Materials and Methods: A narrative literature review was conducted using articles published between 1990 and 2025, identified through the PubMed and ScienceDirect databases. The search strategy included the terms “delirium,” “cardiac surgery,” “psychiatric disorders,” and “cognitive impairment.” Results: Recent evidence suggests that approximately one quarter of patients undergoing cardiac surgery develop delirium, with hypoactive forms frequently remaining underrecognized in clinical practice. Pre-existing depression, cognitive impairment, substance use disorders, low educational level, frailty, and social isolation significantly increase the risk of postoperative delirium. Within a stress–diathesis framework, peripheral physiological insults may be reflected centrally as acute brain dysfunction in vulnerable individuals. Modifiable perioperative factors include sedative choice and depth, as well as sleep and circadian disruption. Multicomponent non-pharmacological interventions, early mobilization, structured psychiatric and cognitive screening, and dexmedetomidine-based sedation have demonstrated consistent efficacy in reducing the incidence and/or duration of delirium. Furthermore, delirium has been associated with persistent cognitive and psychiatric morbidity, functional decline, and increased long-term mortality. Conclusions: Delirium following cardiac surgery is a multifactorial syndrome with significant short- and long-term consequences. A comprehensive, multidisciplinary approach integrating biological, psychiatric, and perioperative perspectives is essential for effective risk stratification, prevention, and long-term follow-up. Full article

Inadvertent perioperative hypothermia increases susceptibility to surgical site infection (SSI) through impaired immune function, reduced oxidative killing, and altered collagen deposition. We performed a narrative review of recent clinical and translational studies evaluating active thermal management for SSI prevention, with emphasis on forced-air warming (FAW) and conductive systems, and on high-risk settings (prolonged surgery, elevated BMI, and pediatric patients). Across studies, active warming more reliably maintains intraoperative normothermia than passive insulation; however, evidence for a consistent reduction in SSI rates is strongest in vulnerable cohorts and lengthy procedures and remains heterogeneous across specialties. FAW demonstrates high warming efficiency, yet its use in implant-based operations continues to be debated because of potential airflow disruption and bacterial mobilization concerns. The literature increasingly supports precision approaches, including pre-warming protocols, improved perioperative temperature monitoring, and predictive models to identify patients at greatest risk of hypothermia. In conclusion, effective SSI prevention requires procedure- and patient-specific thermal strategies, selecting devices that balance warming performance with sterility considerations while integrating perioperative risk stratification and real-time monitoring. Full article

Serious games and negotiation simulations such as the Phosphorus Negotiation Game (P-Game) are increasingly used to support sustainability-oriented education. To broaden accessibility, a smartphone-based version of the face-to-face P-Game was developed and is presented here. A comparative design integrating quantitative pre–post survey measures with analysis of open-ended responses was employed to examine self-reported knowledge gains and learning experiences among participants who completed the P-Game in face-to-face workshops and those who played the virtual version. Both formats were associated with significant increases in participants’ perceived understanding of phosphorus science and negotiation science/practice. Self-reported knowledge of phosphorus science increased by 92.3% (global face-to-face), 70.7% (Hungarian face-to-face), and 88.4% (online), with comparable gains observed in negotiation science and practice across groups. Qualitative findings complemented these results, indicating that while learning gains were broadly similar, the modes differed in experiential emphasis: face-to-face delivery elicited performance-oriented and socially embedded reflections, whereas the online format was more frequently described in terms of structured participation and reflective processing. User satisfaction with the virtual P-Game was high, reflected by a System Usability Scale (SUS) score above 80. Overall, the findings suggest that the virtual P-Game represents a viable and accessible complement to traditional face-to-face implementation, maintaining educational impact while extending reach. Further research with larger and more diverse participant samples is recommended to strengthen generalizability and explore long-term learning outcomes in sustainability contexts. Full article

Initial teacher education is increasingly expected to prepare pre-service teachers for ongoing professional development and teacher research, yet it remains unclear how systematically these competences are embedded in programmes and how prepared pre-service teachers feel. We used a mixed-methods design, combining a content analysis of 47 teacher education programmes at the University of Ljubljana with two cross-sectional surveys involving 443 pre-service (303 enrolled in first-cycle programmes and 140 in second-cycle programmes) and 138 in-service teachers. Programme documents frequently referenced professional development and research; however, research was more often stated as a competence outcome than as an explicit programme goal. In the surveys, pre-service teachers rated teaching competences highly, whereas perceived current competence was lower for professional development and lowest for teacher research, particularly for active research engagement. Across all items, pre-service teachers reported substantial gaps between current and required competence. Perceived current competence increased with study stage, while required competence varied less by stage. Required competence ratings were largely aligned between pre-service and in-service teachers, although pre-service teachers assigned higher ratings to selected research engagement items. The findings indicate a misalignment between curricular emphasis and perceived preparedness, and support stronger integration of practice-embedded professional learning and inquiry across coursework. Full article

This scoping review summarizes current computational image analysis and artificial intelligence (AI) approaches for the assessment of hair and scalp disorders, with emphasis on quantitative trichoscopy and operator-independent evaluation. A deep Medline search was performed using a citation network-based approach using MeSH terms and complementary keywords covering diagnostic imaging, trichoscopy/videodermoscopy, image processing, algorithms, AI, and mobile/smartphone-based workflows. Overall, relatively few studies assess algorithms in real-world clinical pathways, and much of the retrieved literature is predominantly pre-clinical or methodology-driven. In parallel, commercially available AI-assisted trichoscopy platforms have little or no traceable peer-reviewed evidence; their validation methods and underlying datasets are often proprietary, undisclosed, and not directly comparable, limiting independent verification and cross-platform benchmarking. The most mature academic applications focus on follicular unit quantification (hair density, shaft diameter distribution, vellus-to-terminal ratio, and severity mapping), mainly using convolutional neural networks with object detection and instance segmentation. In conclusion, AI-assisted trichoscopy may support a shift toward standardized quantitative outputs, but clinical translation remains early and constrained by small or proprietary datasets, heterogeneous acquisition/annotation protocols, limited external validation, and scarce prospective studies. Full article

Background: Obstructive sleep apnea (OSA) is a highly prevalent and heterogeneous sleep disorder. This study aimed to investigate age- and sex-specific phenotypes of OSA in a large clinical cohort, with special emphasis on the effects of aging and menopause on disease severity, hypoxemic component, symptom expression, comorbidities, and screening tool performance. Methods: A retrospective cross-sectional analysis was conducted on 3736 patients with confirmed OSA referred to a tertiary sleep clinic in Greece between 2013 and 2023. Participants were stratified by age and sex. Women were further classified as pre- and post-menopausal using age as a proxy. Clinical characteristics, comorbidities, questionnaire data and polysomnographic indices were analyzed using parametric and non-parametric statistical methods. Results: OSA severity peaked in middle age and remained high in older adults, while nocturnal hypoxemia and cardiometabolic comorbidities worsened with age. Women presented at an older age and with higher body mass index but lower Apnea Hypopnea Index (AHI) compared to men, yet experienced significantly longer hypoxemia and more severe insomnia. Women over 45 years exhibited a markedly more severe and hypoxic phenotype and substantially higher rates of comorbidities. Screening tool performance varied across subgroups: STOP-BANG was the most consistent, while symptom-based tools performed poorly in young women and elderly patients. Conclusions: OSA is a dynamic dependent disorder with distinct phenotypes across the lifespan. Current screening strategies fail to adequately capture these variations, particularly in women and older adults. A personalized, sex- and age-specific approach to OSA diagnosis and management is essential to reduce underdiagnosis and improve outcomes. Full article

Background/Objectives: Distal biceps tendon rupture (DBTR) significantly impairs upper-limb function, particularly in movements requiring elbow flexion and forearm supination. This condition continues to attract clinical interest due to its complex biomechanics, evolving surgical strategies, and the growing emphasis on comprehensive rehabilitation. Contemporary evidence highlights the value of a multidisciplinary approach that integrates precise surgical repair with structured, progressive physiotherapy to optimize outcomes effectively. Methods: We performed a comprehensive review of the literature by searching PubMed/MEDLINE, and a narrative review format was adopted to synthesize the available evidence. Results: Studies comparing single-incision and double-incision techniques show that both achieve excellent outcomes, although the decision should be tailored to patient-specific factors, surgeon expertise, and the reported complication risk, which may vary between 5% and 63%. Regardless of technique, restoring tendon integrity is essential for regaining normal strength and supination capability. Rehabilitation following DBTR repair relies on a phased and carefully monitored program. Early physiotherapy focuses on a controlled range of motion and the prevention of stiffness while protecting the repair. As healing progresses, strengthening exercises targeting the biceps, triceps, and brachialis are introduced, alongside endurance training to enhance overall functional capacity. Evidence strongly supports early mobilization protocols, where active motion and graded resistance are initiated within the first postoperative week, resulting in faster and more complete functional recovery compared to prolonged immobilization. Conclusions: Long-term outcomes after DBTR repair are consistently favorable. Most patients return to full activity or sport at an average of 5.4 months, although timelines vary with rehabilitation intensity and baseline fitness. Notably, 93–100% recover their pre-injury activity level, including participation in competitive sports. Full article

The growing emphasis on sustainability, regional distinctiveness, and spontaneous fermentation in winemaking necessitates a more comprehensive understanding of local yeast populations and their functional mechanisms. In total, 115 indigenous yeast strains were examined for their enzymatic activities of potential vitivinicultural significance. The yeasts were screened for chitinase activity (biocontrol potential), glycosidase activity (terpene release), β-lyases (thiol release), and sulfite reductases (off-flavor formation), followed by quantitative analysis of the selected subsets. Yeasts were further evaluated for inhibition of fungal mycelial growth, VOC-mediated inhibition, and tolerance to commonly applied fungicides. Pre-field selection was refined using the niche overlap index and grapevine leaf disc assay. The results confirmed chitinolytic activity in four species; all strains exhibited hydrolase activities, with H. uvarum 116 displaying the highest cell-associated activity (6.32 U/g), while T. delbrueckii Sut94 showed the highest extracellular activity (1.36 U/g). β-glucosidase and β-lyase activities were widespread, whereas hydrogen sulfide production was infrequent. P. guilliermondii ZIM 624 showed the most comprehensive overall enzymatic profile, together with strong inhibition patterns. A field trial on Pinot cultivars (V. vinifera L.) further evaluated P. guilliermondii ZIM 624 within an integrated disease management approach, with responses being more pronounced in ‘Pinot noir’ than in ‘Pinot gris’. Full article

This study examines prospective teachers’ perceptions of sustainable development (SD) and explores the relationship between the SD scenarios they developed and the actions they performed. Based on 58 scenarios and 128 actions reported by pre-service teachers, the study found that scenarios primarily focused on education, resource conservation, and waste management. While the environmental dimension emphasized protection, economic and social dimensions were largely associated with financial savings and public welfare. In contrast, participants’ actual behaviors were predominantly limited to simple resource conservation, such as turning off lights and saving water. A significant discrepancy emerged: despite the strong emphasis on education-related themes in scenarios, educational actions were notably limited in practice. These results suggest that prospective teachers’ high cognitive awareness of SD is only partially reflected in their practical engagement. The findings highlight a “cognitive–practice gap,” underscoring the need for teacher education programs to prioritize action-oriented competencies. Full article

This study presents a newly conducted comprehensive investigation into the lateral torsional buckling (LTB) behavior of un-bonded pre-stressed (PS) thin-walled steel I-beams subjected to non-uniform bending moments, combining a numerical study with a machine learning (ML) approach and experimental validation. Despite extensive prior work, no exact analytical solution exists particularly for non-uniform bending or can be extremely complicated, as the resulting differential equations contain variable coefficients particularly under non-uniform bending due to the complexity of the PS system. To overcome this limitation, a numerical study using finite element (FE) analysis is first conducted with emphasis on the key geometric and pre-stressing parameters, including unbraced beam length, tendon eccentricity, deviators configurations, and pre-stressing force, to evaluate the LTB behavior. The FE modeling was then validated against experimental testing to ensure the accuracy and reliability of the FE solutions. Subsequently, a comprehensive dataset is generated using FE simulations to train the ML models aimed at predicting the LTB resistance of the PS system. This study presents three ML approaches, including support vector regression (SVR), random forest (RF) and least-square boosting (LSBoost), and their optimal hyperparameters are determined using Bayesian optimization (BO) to enhance the prediction performance. The results indicate that the LTB capacity predicted by the Bayesian-optimized ML models achieve high predictive accuracy and are in close agreement with numerical FE simulations, thereby highlighting their potential in capturing the complex, underlying non-linear interactions influencing the buckling behavior of the PS structural system. Accordingly, the proposed framework offers a robust and effective predictive tool for evaluating LTB resistance, particularly under non-uniform bending where exact analytical solutions are not available, and for supporting the design and assessment of PS steel structures. Full article

Autonomous mobile robots require robust traversability perception to navigate safely in diverse outdoor environments. However, traditional deep learning approaches are data-hungry, requiring large-scale manual annotations, and struggle to adapt quickly to unseen environments. This paper introduces TARTS (Training-free Adaptive Reference-guided Traversability Segmentation), a novel framework combining one-shot prototype initialization with trajectory-guided online adaptation for terrain segmentation. Using a single reference image of desired traversable terrain, TARTS establishes an initial prototype from pre-trained DINO Vision Transformer (ViT) features. The system performs segmentation through superpixel-based feature aggregation and valley-emphasis Otsu thresholding while continuously refining the prototype via Exponential Moving Average (EMA) updates driven by automated footprint supervision from the robot’s traversed trajectory. Extensive experiments on our introduced Reference-guided Traversability Segmentation Dataset (RTSD) and the challenging Off-Road Freespace Detection (ORFD) benchmark demonstrate strong performance, achieving 94.5% IoU on RTSD and 94.1% IoU on ORFD, outperforming state-of-the-art supervised methods that require multi-modal inputs and dedicated training. The framework maintains efficient performance (17–24 FPS) on embedded platforms, enabling practical deployment with only a reference image as initialization. Full article

Hypoxia frequently triggers mass mortality events in pearl oysters during the summer months. Hypoxic preconditioning (HP), repeated exposure to sublethal low-oxygen conditions, has been proposed as a potential strategy to enhance stress resistance. Here, we investigated how HP affects hypoxia tolerance in the pearl oyster Pinctada fucata martensii, with emphasis on host apoptotic and immune regulation and the gut microbiota. Pearl oysters assigned to HP (experimental group, EG) and to a non-preconditioned control group (CG) were subjected to sustained hypoxic challenge (1.5 ± 0.1 mg/L DO for 15 days). HP significantly increased the expression of apoptosis- and immunity-related genes (MyD88, IκK, NF-κB) while suppressing JNK expression in gills after extended hypoxia (MyD88: EG 2.26 ± 0.65 vs. CG 0.96 ± 0.29, p < 0.05, ~2.3-fold increase; NF-κB: EG 1.50 ± 0.20 vs. CG 0.81 ± 0.31, p < 0.05, ~1.8-fold increase; IκK: EG 1.55 ± 0.38 vs. CG 0.65 ± 0.12, p < 0.05, ~4.0-fold increase; JNK: EG 0.49 ± 0.25 vs. CG 1.44 ± 0.51, p < 0.05, ~0.34-fold), consistent with a pre-activated yet controlled stress response. In parallel, HP markedly reshaped the intestinal microbial community under hypoxia, increasing alpha diversity (Ace, Chao, and Sobs indices) and enriching potentially beneficial bacterial phyla such as Planctomycetota, Nitrospirota, and Fusobacteriota, groups often linked to nutrient cycling and short-chain fatty acid production. Collectively, these results suggest that HP-enhanced hypoxia tolerance in P. f. martensii is associated with coordinated modulation of host apoptotic and immune signaling and concomitant shifts in gut microbiome diversity. These findings highlight the role of the host–microbiota axis in environmental acclimation and suggest that HP may be a practical tool for improving bivalve performance under hypoxic stress in aquaculture. Full article

Volunteered Geographic Information (VGI) is geographic data obtained from voluntary contributions of individual contributors on social media and non-social media platforms, where contributors exhibit diverse interests and behavior patterns. While studies have found that the COVID-19 pandemic has influenced VGI contributor behavior on social media platforms (Facebook, X, and Instagram, etc.), less is known about contribution behaviors on non-social media VGI platforms such as OpenStreetMap (OSM). This study investigates how individual OSM contributors’ data contribution behaviors changed after the COVID-19 outbreak, using New York City as a case study. Metrics quantifying temporal, spatial, thematic, participation, and social interaction aspects of contribution behavior were developed to characterize individual-level contribution behaviors in both the pre- and post-COVID periods (2016–2019 and 2020–2023, respectively). Contributors were clustered into three groups based on pre-COVID behavioral patterns (as reflected by the metrics) using the K-Means algorithm. The resulting model was then applied to identify changes in contributors’ cluster memberships in the post-COVID period. Results reveal differences in contribution behaviors between the two time periods. Compared to pre-COVID contributors, post-COVID contributors, on average, showed stronger contribution engagement, including longer lifespans, larger spatial extent of edits, higher contribution volumes, a greater emphasis on modification over creation, and stronger co-editing network interactions. Healthcare amenity-related edits remained a small fraction of total contributions across both periods and all clusters. Contributors participating in data contribution in both time periods generally increased data contribution engagement after the COVID outbreak, characterized by longer lifespans, broader spatial coverage, more balanced creation and modification, and stronger network centrality. These findings highlight changes in individual contribution behavior under COVID-19 and exhibits the value of examining VGI contribution at the individual level. Full article

Background/Objectives: Despite recent advances in breast cancer diagnostics, therapies and personalized medicine through genetic profiling, effective treatment of aggressive subtypes, particularly triple-negative breast cancer (TNBC), remains a considerable clinical challenge. MicroRNAs (miRNAs) are post-transcriptional regulators of gene expression that influence tumor progression and are detectable extracellularly in biofluids, where they are typically protected within extracellular vesicles (e.g., exosomes) or associated with RNA-binding proteins and lipoprotein complexes. This review integrates current evidence on oncogenic and tumor-suppressive extracellular miRNAs in breast cancer, with emphasis on subtype-specific functions and potential clinical relevance as liquid-biopsy biomarkers and therapeutic targets. Methods: A PubMed-based literature review (January 2000–February 2026) was conducted using search terms combining “breast cancer” with “miRNA/microRNA” and “circulating/plasma/serum/exosomal/extracellular vesicle.” Studies were prioritized if they provided validated targets/mechanisms and/or human clinical evidence for diagnostic, prognostic, or predictive utility; discrepant findings were evaluated in a subtype-aware framework. Findings were organized into functional categories (e.g., EMT/metastasis, cell-cycle/DNA damage, immune modulation, and hormone/growth factor signaling). Clinical and translational studies evaluating circulating miRNAs for diagnosis, prognosis, treatment response, and toxicity prediction were synthesized, together with key pre-analytical and analytical variables that affect reproducibility. Results: Across mechanistic and clinical studies, miR-21 and miR-155 recur as prominent oncogenic miRNAs, whereas miR-205 is frequently reported as a tumor-suppressive miRNA that is reduced in breast cancer and in circulation in several cohorts. Panels combining these miRNAs show promise for sensitive and specific breast cancer diagnostics. Additionally, several miRNAs show context- or subtype-dependent effects, with opposing activities reported between TNBC and estrogen receptor (ER)-positive disease (e.g., miR-17-92, miR-425, miR-181 family members, miR-31, and miR-24). Conclusions: Circulating miRNAs represent a promising class of minimally invasive biomarkers and potential therapeutic targets; however, translation is constrained by biological context dependence and by pre-analytical and analytical variability. Standardized protocols and rigorously validated, subtype-aware biomarker panels will be essential for clinical implementation and for enabling miRNA-informed precision oncology in breast cancer. Full article