Search Results (2,571)

Membranous nephropathy (MN) is the most prevalent cause of nephrotic syndrome (NS) in adults, and it can be primary (idiopathic) with an unknown cause or secondary due to a variety of conditions (lupus, infections, malignancies, medications, etc.). It progresses to chronic kidney disease (CKD) in up to 60% of patients, and 10 to 30% develop end-stage kidney disease (ESKD). This retrospective study examines the importance of specific factors, including baseline demographic and clinical data, kidney biopsy PH findings, and selected biochemical parameters, influencing MN outcomes after 10 years of follow-up. The cohort included 94 individuals in whom a diagnosis of MN was established by percutaneous biopsy of the left kidney’s lower pole at the University Clinical Center of Serbia (UCCS) between 2008 and 2013. According to the outcomes, patients were divided into three groups: the recovery (Rec) group, with complete remission, including normal serum creatinine (Scr) and proteinuria (Prt), the group with development of chronic kidney disease (CKD), and the group with development of end-stage kidney disease (ESKD). Nephropathologists graded pathohistological (PH) results from I to III based on the observed PH findings. During the follow-up period, 33 patients were in the Rec group, CKD developed in 53 patients, and ESKD developed in 8 patients. Baseline creatinine clearance levels (Ccr), Scr, and uric acid (urate) were found to be significantly associated with the outcomes (p < 0.001). The lowest values of baseline Scr and urate were observed in the Rec group. The presence of acute kidney injury (AKI) or CKD at the time of kidney biopsy was associated with the more frequent development of ESKD (p = 0.02). Lower Ccr was associated with a higher likelihood of progressing to CKD (B = −0.021, p = 0.014), whereas older age independently predicted progression to ESKD (B = 0.02, p = 0.032). Based on this study, it was concluded that the most important biochemical and clinical factors that are associated with the outcomes of this disease are the values of Scr, Ccr, and urate and the existence of CKD at the time of kidney biopsy. Unlike most previous studies, the presence of HTN had no statistical significance in the outcome of the disease. Full article

In this study, we aimed to address the lack of systematic research on key collision dynamics parameters (elastic restitution coefficient) in the full mechanization of rapeseed operations, which hinders the development of precision agriculture. In this present work, the restitution coefficient of rapeseed was systematically investigated, and a predictive model (R² = 0.959) was also established by using Box–Behnken design response surface methodology (BBD-RSM). The results show that the collision restitution coefficient varies in the range of 0.539–0.649, with the key influencing factors ranked as follows: moisture content (M_c) > material layer thickness (L) > drop height (H). The EDEM simulation methodology was adopted to validate the experimental results, and the results show that there is a minimal relative error (−1% < δ < 1%) between the measured and simulated rebound heights, indicating that the established model shows a reliable prediction performance. Moreover, by comprehensively analyzing stress, strain, and energy during the collision process between rapeseed and Q235 steel, it can be concluded that the process can be divided into five stages—free fall, collision compression, collision recovery, rebound oscillation, and rebound stabilization. The maximum stress (1.19 × 10⁻² MPa) and strain (6.43 × 10⁻⁶ mm) were observed at the beginning of the collision recovery stage, which can provide some theoretical and practical basis for optimizing and designing rapeseed machines, thus achieving the goals of precise control, harvest loss reduction, and increased yields. Full article

Background: Seiza, a traditional sitting posture requiring deep ankle plantarflexion and knee flexion, often becomes difficult after ankle fracture surgery because of restricted mobility. Increased stiffness of the tibialis anterior (TA) muscle, particularly in its deep and superficial fibres, may limit plantarflexion and affect functional recovery. This study aimed to investigate the relationship between TA muscle stiffness, assessed using shear wave elastography (SWE), and the ability to assume the seiza posture after ankle fracture surgery. We also sought to determine whether the stiffness in the deep or superficial TA fibres was more strongly correlated with seiza ability. Methods: In this cross-sectional study, 38 patients who underwent open reduction and internal fixation for ankle fractures were evaluated 3 months postoperatively. Seiza ability was assessed using the ankle plantarflexion angle and heel–buttock distance. The shear moduli of the superficial and deep TA fibres were measured using SWE. Ankle range of motion, muscle strength, and self-reported seiza pain were also measured. Multiple linear regression was used to identify the predictors of seiza performance. Results: The shear moduli of both deep (β = −0.454, p < 0.001) and superficial (β = −0.339, p = 0.017) TA fibres independently predicted ankle plantarflexion angle during seiza (adjusted R², 0.624). Pain during seiza was significantly associated with reduced plantarflexion, whereas muscle strength was not a significant predictor. Conclusions: TA muscle stiffness, especially in the deep fibres, was significantly associated with limited postoperative seiza performance. Targeted interventions that reduce deep TA stiffness may enhance functional outcomes. Full article

The effects of long-term adjustments in body weight on the lipid balance in patients with severe obesity are not well understood. This study aimed to evaluate a non-invasive lipidomic approach to identifying biomarkers that could help predict which patients may require additional therapies before and after weight loss. Using mass spectrometry, 275 lipid species were analysed in non-obese controls, patients with severe obesity, and patients one year after bariatric surgery. The results showed that severe obesity disrupts lipid pathways, contributing to lipotoxicity, inflammation, mitochondrial stress, and abnormal lipid metabolism. Although weight loss improved these disturbances, surgery did not fully normalise the lipid profiles of all patients. Outcomes varied depending on their baseline liver health and genetic differences. Persistent alterations in cholesterol handling, membrane composition, and mitochondrial function were observed in partial responders. Elevated levels of sterol lipids, glycerophospholipids, and sphingolipids emerged as markers of complete metabolic recovery, identifying candidates for targeted post-surgical interventions. These findings support the use of lipidomics to personalise obesity treatment and follow-up. Full article

Background and Objectives: There is a global rise of public interest in integrative medicine. The principles of integrative medicine combining conventional medicine with evidence-based complementary therapies have been implemented in many medical areas, including plastic surgery, to improve patient’s outcome. The aim of the present study was to systematically analyze the application and use of additional non-pharmacological interventions (NPIs) of patients of a German department of plastic surgery. Materials and Methods: The present real-world data study utilized data from the Network Oncology registry between 2016 and 2021. Patients included in this study were at the age of 18 or above, stayed at the department of plastic surgery and received at least one plastic surgical procedure. Adjusted multivariable logistic regression analyses were performed to detect associations between the acceptance of NPIs and predicting factors such as age, gender, year of admission, or length of hospital stay. Results: In total, 265 patients were enrolled in the study between January 2016 and December 2021 with a median age of 65 years (IQR: 52–80) and a male/female ratio of 0.77. Most of the patients received reconstructive surgery (90.19%), followed by hand surgery (5.68%) and aesthetic surgery (2.64%). In total, 42.5% of the enrolled patients accepted and applied NPIs. Physiotherapy, rhythmical embrocations, and compresses were the most often administered NPIs. Conclusions: This exploratory analysis provides a descriptive overview of the application and acceptance of NPIs in plastic surgery patients within a German integrative care setting. While NPIs appear to be well accepted by a subset of patients, further prospective studies are needed to evaluate their impact on clinical outcomes such as postoperative recovery, pain management, patient-reported quality of life, and overall satisfaction with care. Full article

Understanding species composition and forest dynamics is essential for predicting biomass productivity and informing conservation in tropical montane ecosystems. We evaluated floristic, demographic, and biomass changes in eighteen 0.1 ha permanent plots in the Colombian Sub-Andean forest, including both primary (ca. 60 y old) and secondary forests (ca. 30 years old). Two censuses of individuals (DBH ≥ 2.5 cm) were conducted over 7–13 years. We recorded 516 species across 202 genera and 89 families. Floristic composition differed significantly between forest types (PERMANOVA, p = 0.001), and black oak (Trigonobalanus excelsa Lozano, Hern. Cam. & Henao) forests formed distinct assemblages. Demographic rates were higher in secondary forests, with mortality (4.17% yr), recruitment (4.51% yr), and relative growth rate (0.02% yr) exceeding those of primary forests. The mean aboveground biomass accumulation and the rate of annual change were higher in primary forests (447.5 Mg ha⁻¹ and 466.8 Mg ha⁻¹ yr⁻¹, respectively) than in secondary forests (217.2 Mg ha⁻¹ and 217.2 Mg ha⁻¹ yr⁻¹, respectively). Notably, black oak forests showed the greatest biomass accumulation and rate of change in biomass. Annual net biomass production was higher in secondary forests (8.72 Mg ha⁻¹ yr⁻¹) than in primary forests (5.66 Mg ha⁻¹ yr⁻¹). These findings highlight the ecological distinctiveness and recovery potential of secondary Sub-Andean forests and underscore the value of multitemporal monitoring to understand forest resilience and assess vulnerability to environmental change. Full article

Multimodal sentiment analysis (MSA) faces key challenges such as incomplete modality inputs, long-range temporal dependencies, and suboptimal fusion strategies. To address these, we propose MGMR-Net, a Mamba-guided multimodal reconstruction and fusion network that integrates modality-aware reconstruction with text-centric fusion within an efficient state-space modeling framework. MGMR-Net consists of two core components: the Mamba-collaborative fusion module, which utilizes a two-stage selective state-space mechanism for fine-grained cross-modal alignment and hierarchical temporal integration, and the Mamba-enhanced reconstruction module, which employs continuous-time recurrence and dynamic gating to accurately recover corrupted or missing modality features. The entire network is jointly optimized via a unified multi-task loss, enabling simultaneous learning of discriminative features for sentiment prediction and reconstructive features for modality recovery. Extensive experiments on CMU-MOSI, CMU-MOSEI, and CH-SIMS datasets demonstrate that MGMR-Net consistently outperforms several baseline methods under both complete and missing modality settings, achieving superior accuracy, robustness, and generalization. Full article

The diffusion coefficient (DC) of CO₂ in brine is a key parameter in geological carbon sequestration and CO₂-Enhanced Oil Recovery (EOR), as it governs mass transfer efficiency and storage capacity. This study employs three machine learning (ML) models—Random Forest (RF), Gradient Boost Regressor (GBR), and Extreme Gradient Boosting (XGBoost)—to predict DC based on pressure, temperature, and salinity. The dataset, comprising 176 data points, spans pressures from 0.10 to 30.00 MPa, temperatures from 286.15 to 398.00 K, salinities from 0.00 to 6.76 mol/L, and DC values from 0.13 to 4.50 × 10⁻⁹ m²/s. The data was split into 80% for training and 20% for testing to ensure reliable model evaluation. Model performance was assessed using R², RMSE, and MAE. The RF model demonstrated the best performance, with an R² of 0.95, an RMSE of 0.03, and an MAE of 0.11 on the test set, indicating high predictive accuracy and generalization capability. In comparison, GBR achieved an R² of 0.925, and XGBoost achieved an R² of 0.91 on the test set. Feature importance analysis consistently identified temperature as the most influential factor, followed by salinity and pressure. This study highlights the potential of ML models for predicting CO₂ diffusion in brine, providing a robust, data-driven framework for optimizing CO₂-EOR processes and carbon storage strategies. The findings underscore the critical role of temperature in diffusion behavior, offering valuable insights for future modeling and operational applications. Full article

Background/Objectives: While robot-assisted radical cystectomy (RARC) has shown potential benefits over open radical cystectomy (ORC), such as reduced blood loss and quicker recovery, its adoption has been limited because of its complexity and long learning curve, especially for urinary diversion. We assessed whether a RARC program with fully intracorporeal urinary diversion could be safely implemented in a hospital with no prior experience in RARC, but with expertise in ORC and other robotic surgeries. We also compared perioperative outcomes and complications between RARC and ORC during the implementation phase. Methods: This retrospective comparative study included 50 consecutive patients who underwent RARC between June 2023 and January 2025 and 50 patients previously treated with ORC. All RARC cases were performed with intracorporeal urinary diversion. A structured proctoring program guided two surgeons through a stepwise training approach by an expert RARC surgeon. Perioperative outcomes and 90-day complications were compared. Results: All RARC procedures were completed fully intracorporeally with no conversions to open surgery. Compared with ORC, RARC was associated with significantly shorter operative times (for ileal conduit diversion) and hospital stays, lower estimated blood loss, and fewer postoperative complications. There were no differences in intraoperative complications. Worst single grade ≥ 3 complications were significantly less frequent in the RARC than the ORC group (11 [11%] versus 21 [21%], p = 0.045). On multivariable analysis, the robotic approach independently predicted fewer any-grade complications (odds ratio 0.81, 95% confidence intervals 0.65–0.95, p = 0.01). Conclusions: A RARC program can be safely and effectively implemented in a previously RARC-naïve centre with existing surgical expertise. The robotic approach offers clear perioperative benefits and may represent a favourable alternative to open surgery. Full article

In recent years, recovering precious and base metals such as silver and copper from end-of-life products has become a fundamental factor in the sustainable development of many countries. This not only supports environmental goals but is also a profitable economic activity. Therefore, in this study, we investigate the recovery of silver and copper from an end-of-life photovoltaic panel powder using an alternative leaching system containing sulfuric acid and ferric sulfate instead of nitric acid-based leaching systems, which are susceptible to producing hazardous gases such as NO_x. To obtain this goal, a series of experiments were designed with the Central Composite Design (CCD) approach using Response Surface Methodology (RSM) to evaluate the effect of reagent concentrations on the leaching rate. The leaching results showed that high recovery rates of silver (>85%) and copper (>96%) were achieved at room temperature using a solution containing only 0.2 M sulfuric acid and 0.15 M ferric sulfate. Analysis of variance was applied to the leaching data for silver and copper recovery, resulting in two statistical models that predict the leaching efficiency based on reagent concentrations. Results indicate that the models are statistically significant due to their high R² (0.9988 and 0.9911 for Ag and Cu, respectively) and the low p-value of 0.0043 and 0.0003 for Ag and Cu, respectively. The models were optimized to maximize the dissolution of silver and copper using Design Expert software. Full article

The sustainable management of Municipal Solid Waste (MSW) relies heavily on community participation in separating it at the source and delivering it to collection systems. These practices are crucial for reducing pollution, protecting ecosystems, and maximizing resource recovery. However, in the Global South context, with conditions of socioeconomic vulnerability, community participation in the sustainable management of MSW remains limited, highlighting the need to generate context-specific interventions. MSW includes items such as household appliances, batteries, and electronic devices, which require specialized handling due to their size, hazardous components, or material complexity. This study implemented a Community-Based Social Marketing approach during the research and design phases of an intervention focused on promoting source separation and management of hard-to-manage MSW in five municipalities within the administrative region of Norte de Santander (Colombia), which borders Venezuela. Using a mixed-methods approach, we collected data from 1775 individuals (63.83% women; M _age = 33.48 years; SD = 17.25), employing social mapping, focus groups, semi-structured interviews, participant observation, and a survey questionnaire. The results show that the source separation and delivery of hard-to-manage MSW to collection systems are limited by a set of psychosocial, structural, and institutional barriers that interact with each other, affecting communities’ willingness and capacity for action. Furthermore, a prediction model of willingness to engage in separation and delivery behaviors showed a good fit (R2 = 0.83). The strongest predictors were awareness of the negative consequences of non-participation and perceived environmental benefits, with subjective norms contributing to a lesser extent. Based on these results, we designed a context-specific intervention focused on reducing these barriers and promoting community engagement in the sustainable management of hard-to-manage MSW. Full article

Earthquakes can severely disrupt power distribution networks, causing extensive outages and disconnection from the transmission grid. This paper proposes a two-stage restoration method tailored for post-earthquake distribution systems. First, earthquake-induced damage is modeled using ground motion prediction equations (GMPEs) and fragility curves, and degraded network topologies are generated by Monte Carlo simulation. Then, a time-domain generator start-up model is developed as a mixed-integer linear program (MILP), incorporating cranking power and radial topology constraints. Further, a prioritized load recovery model is formulated as a mixed-integer second-order cone program (MISOCP), integrating power flow, voltage, and current constraints. Finally, case studies demonstrate the effectiveness and general applicability of the proposed method, confirming its capability to support resilient and adaptive distribution network restoration under various earthquake scenarios. Full article

The characterization of Large Reasoning Models (LRMs) as exhibiting an “illusion of thinking” has recently emerged in the literature, sparking widespread public discourse. Some have suggested these manifestations represent bugs requiring fixes. I challenge this interpretation by reframing LRM behavior through dual-process theory from cognitive psychology. I draw on more than half a century of research on human cognitive effort and disengagement. The observed patterns include performance collapse at high complexity and counterintuitive reduction in reasoning effort. These appear to align with human cognitive phenomena, particularly System 2 engagement and disengagement under cognitive load. Rather than representing technical limitations, these behaviors likely manifest computational processes analogous to human cognitive constraints. In other words, they represent not a bug but a feature of bounded rational systems. I propose empirically testable hypotheses comparing LRM token patterns with human pupillometry data. I suggest that computational “rest” periods may restore reasoning performance, paralleling human cognitive recovery mechanisms. This reframing indicates that LRM limitations may reflect bounded rationality rather than fundamental reasoning failures. Accordingly, this article is presented as a hypothesis paper: it collates six decades of cognitive effort research and invites the scientific community to subject the dual-process predictions to empirical tests through coordinated human–AI experiments. Full article

Sweet potato is a valuable root due to its nutritional benefits, health-promoting properties, and technological applications. The peel, often discarded during food processing, can be employed in the food industry, supporting a circular economy. Purple sweet potato peel (PSPP) is rich in anthocyanins, which can be used as natural colourants and antioxidants. Optimising their extraction can enhance yield and reduce costs. The current work aimed to optimize anthocyanin and antioxidant recovery from PSPP using a Box-Behnken design and sonotrode ultrasound-assisted extraction (sonotrode-UAE). Three independent variables were analysed: extraction time (2–6 min), ethanol concentration (35–85%), and liquid-to-solid ratio (10–30 mL/g). The dependent variables included total monomeric anthocyanin content (TMAC), individual anthocyanins, and antioxidant activity. TMAC in 15 extracts ranged from 0.16 to 2.66 mg/g PSPP. Peonidin-3-caffeoyl-p-hydroxybenzoyl sophoroside-5-glucoside was the predominant anthocyanin. Among four antioxidant assays, Ferric-reducing antioxidant power (FRAP) showed the highest value. Ethanol concentration significantly influenced anthocyanin and antioxidant recovery (p < 0.05). The model demonstrated adequacy based on the coefficient of determination and variation. Optimal extraction conditions were 6 min with 60% ethanol at a 30 mL/g ratio. Predicted values were validated experimentally (coefficient of variation <10%). In conclusion, PSPP is a promising matrix for obtaining anthocyanin-rich extracts with antioxidant activity, offering potential applications in the food industry. Full article

Background/Objective: This study examines the composite influence of frailty, malnutrition, and anemia on postoperative outcomes for patients with adult spinal deformity (ASD). Methods: In this retrospective cohort study using the 2011–2022 NSQIP database, we utilized CPT and ICD codes to identify ASD patients who underwent PSF. Subjects were stratified based on frailty status. Frail patients were then classified according to malnutrition and anemia status. Frailty was determined using the revised risk analysis index (RAI-rev). Our primary outcomes were extended length of stay (LOS), non-routine discharge (NRD), 30-day adverse events (AE), and 30-day mortality. For each outcome, we fitted four nested multivariable logistic regression models (RAI-rev + anemia + malnutrition, RAI-rev + anemia, RAI-rev + malnutrition, and RAI-rev alone) and compared the incremental discrimination of each model using receiver operating characteristic (ROC) analysis. Results: Of 3639 patients, 460 were frail alone, 266 were frail + anemic, 37 were frail + malnourished, 121 were frail + anemic + malnourished, and 2755 were not frail. RAI-rev (aOR: 1.84, 95% CI: 1.45–2.35), anemia (aOR: 1.84, 95% CI: 1.45–2.35), and malnourishment (aOR: 2.34, 95% CI: 1.69–3.24) were independent predictors of extended LOS. RAI-rev (aOR: 1.07, 95% CI: 1.04–1.11) and anemia (aOR: 2.09, 95% CI: 1.66–2.61) were associated with an increased risk of 30-day AEs. RAI-rev and malnutrition were independent predictors of NRD (RAI-rev: aOR: 1.11, 95% CI: 1.06–1.16; Malnutrition: aOR: 1.57, 95% CI: 1.08–2.29) and 30-day mortality (RAI-rev: aOR: 1.10, 95% CI: 1.04–1.17; Malnutrition: aOR: 3.79, 95% CI: 1.24–11.60). Based on ROC analysis, RAI-rev + anemic + malnourished was a superior predictor of LOS and 30-day AEs (both p < 0.001). Compared to RAI-rev, RAI-rev + anemic superiorly predicted LOS and 30-day AEs, and RAI-rev + malnutrition superiorly predicted LOS (all p < 0.001). Conclusions: Our results reveal RAI-rev combined with malnutrition and anemia superiorly predicts 30-day AEs and LOS in postoperative ASD patients. Future studies should investigate the feasibility and efficacy of these models for perioperative risk stratification and optimized recovery planning to improve outcomes for ASD patients. Full article