Search Results (14,866)

Background/Objectives: Traditional surgeries for benign prostatic hyperplasia (BPH), such as transurethral resection of the prostate (TURP), carry risks including sexual dysfunction and extended recovery. EchoLaser transperineal laser ablation (TPLA) offers a minimally invasive alternative with potential benefits in preserving sexual function and reducing recovery time. This exploratory study evaluated the safety and efficacy of EchoLaser TPLA for the treatment of prostate-related voiding symptoms. Methods: This retrospective, single-center study enrolled seven patients with lower urinary tract symptoms due to BPH. TPLA was performed under local anesthesia, and follow-up was conducted at 1, 3, 6, and 12 months. The primary outcome was measured by the International Prostate Symptom Score (IPSS). Secondary outcomes included PSA levels, prostate and transition zone (TZ) volume, Q_max, post-void residual (PVR) volume, quality of life (QoL) score, Sexual Health Inventory for Men (SHIM) score, and Male Sexual Health Questionnaire to assess for ejaculatory dysfunction (MSHQ-EjD) score. Results: Statistically significant improvements in IPSS, Q_max, PVR, and QoL relative to baseline were observed at 1 month post-treatment, and these improvements remained significant throughout the 12-month follow-up period. Post-treatment reductions in PV and TZ volume were statistically significant at 6 months; while PV was further reduced at 12 months, this change lacked statistical significance. No statistically significant post-treatment changes were observed in SHIM, MSHQ-EjD 3-Item or Bother scores, or PSA. Mean pain score on the 10-point visual analog scale for procedural pain was 2.14 ± 0.69. Conclusions: Although limited by a lack of generalizability, our findings are consistent with previous studies that have shown EchoLaser TPLA to be a safe and effective in-office treatment for prostate-related voiding symptoms, with minimal discomfort and negligible impact on sexual function. Further studies with larger cohorts and extended follow-up are needed. Full article

Severe mitral regurgitation (MR) is one of the most common valvular heart diseases and is frequently associated with advanced left ventricular (LV) systolic dysfunction. Transcatheter edge-to-edge repair (TEER) offers effective symptom relief but may induce abrupt hemodynamic changes leading to afterload mismatch and acute LV failure. Levosimendan may help mitigate this complication by improving contractility, yet evidence supporting its use in this setting is scarce. Therefore, the aim of this study was to systematically evaluate the evidence on the effects of Levosimendan in patients with severe MR and LV dysfunction undergoing TEER. We performed a comprehensive search of PubMed, Embase, Scopus, and Google Scholar. Primary outcomes were postprocedural LV ejection fraction (LVEF) and systolic pulmonary artery pressure (sPAP). Secondary outcomes included procedural success, procedure duration, and in-hospital complications. Five studies comprising 315 patients (n = 141 Levosimendan, n = 174 controls) met the inclusion criteria. Pooled analysis showed no significant difference in postprocedural LVEF between Levosimendan-treated patients and controls (mean difference 0.45%, 95% CI [−1.46–2.35] p = 0.65) and no significant change from baseline. Similarly, postprocedural sPAP did not differ significantly. Procedural success was higher with Levosimendan, and procedure duration was shorter. These hypothesis-generating findings highlight the need for larger, prospective randomized trials to clarify the role of Levosimendan in this setting. Full article

Background/Objectives: Evidence on pulmonary rehabilitation (PR) in paediatric post-COVID-19 condition (PPCC) is scarce. This study aimed to evaluate the association of a PR programme with changes in physical and mental health and quality of life in PPCC over a 12-month follow-up. Methods: A quasi-experimental pre–post single-arm study was conducted, with no control group, in PPCC patients attending an outpatient PR unit. The primary outcome was change in exercise capacity (6 min walk test, 6MWT). Secondary outcomes included inspiratory and peripheral muscle strength, quadriceps muscle morphology by ultrasound, fatigue, physical activity, quality of life, and psychiatric symptoms, assessed using validated paediatric instruments. Results: A total of 115 PPCC patients (mean age 13.3 years; 66.1% female) completed the PR. 6MWD distance increased from 509 ± 87 to 546 ± 86 (+37 m; p < 0.001; D: 0.50). Handgrip strength increased by 2.4 kg, maximal inspiratory pressure increased by 15 cmH₂O, physical activity increased by 2.4 points, fatigue score improved by 9.3 points, and quality of life improved by 11 points (all p < 0.001). Rectus femoris thickness increased by 0.56 mm (p = 0.005), psychiatric symptom scores decreased by 4.5 points (p < 0.001), and rectus femoris echo-intensity decreased (p = 0.003). Conclusions: Multidisciplinary PR appears feasible and potentially effective in improving physical function, psychological well-being, and quality of life in PPCC, supporting the need for evidence-based paediatric rehabilitation. Full article

Climate variability plays a crucial role in shaping drinking water quality, yet the quantitative links between meteorological factors and microbiological contamination remain underexplored in temperate continental climates. A secondary data analysis was conducted on 15,394 microbiological water quality test results collected between 2015 and 2024, including heterotrophic plate counts (22 °C and 37 °C), coliform bacteria, and Escherichia coli, and their associations with local meteorological conditions across groundwater wells and piped distribution networks were examined. A clear distinction emerged: groundwater wells showed higher vulnerability to primary microbial contamination (coliforms and E. coli), whereas distribution networks exhibited higher odds of heterotrophic plate count exceedances, indicating greater susceptibility to post-treatment microbial regrowth. In groundwater wells, temperature showed strong positive associations with all microbial indicators (p < 0.001), with pronounced summer peaks in coliforms and E. coli, while precipitation triggered short-term contamination spikes characterized by a 2-day lag. In contrast, piped networks exhibited weaker and more delayed meteorological responses. These results highlight the need for a shift from climate-responsive to climate-pre-emptive water quality monitoring by incorporating meteorological forecasts, especially for non-chlorinated groundwater sources. Full article

Background: Menstrual hygiene management (MHM) is a vital aspect of adolescent girls’ health and well-being. However, in many Gulf countries, including Saudi Arabia, this issue has received less attention because of cultural taboos, misconceptions, and a lack of knowledge about factors affecting menstrual hygiene practices. Thus, it is crucial to promote adolescent health and develop effective school-based interventions. Aim of the Study: Our aim was to assess menstrual hygiene practices and their determinants among adolescent girls in secondary schools in Bisha, Saudi Arabia. Methods: A cross-sectional descriptive approach was used to study 320 female secondary school students in Bisha City, southwestern Saudi Arabia. Sample: The subjects were selected by using a stratified random sampling procedure. Information was obtained using a previously validated and culturally sensitive self-administered questionnaire on knowledge and menstrual hygiene. Descriptive statistics, chi-square tests, and binary logistic regression analyses were conducted to determine factors associated with good menstrual hygiene practices. Results: A total of 320 adolescent girls participated, of whom 53.8% demonstrated good menstrual hygiene practices. In the multivariable analysis, independent predictors of good practices were increased age (AOR = 2.69, 95% CI:1.59–4.56), urban residency (AOR = 2.62, 95% CI: 1.46–4.69), and good menstrual knowledge (AOR = 2.13, 95%CI: 1.24–3.67). Maternal primary education (AOR = 8.033, CI: 1.44–44.99) and maternal employment in the government sector (AOR = 7.346, CI: 2.29–23.54) also showed strong positive associations with good menstrual hygiene practices. Conversely, experiencing menarche after age 12 was associated with lower odds of good menstrual hygiene (AOR = 0.49). Conclusions: Although a good proportion of girls practiced adequate menstrual hygiene, major knowledge and behavior gaps persist. Providing strong menstrual education in schools and through community-based efforts is critical for supporting the health of adolescent girls and promoting menstrual equity in Saudi Arabia. Full article

Background and Objectives: The association between different anesthesia modalities and spermiogram parameters and reproductive outcomes in patients undergoing microscopic subinguinal varicocelectomy (MSV) remains unclear. In this retrospective cohort study, we aimed to compare spermiogram parameters and pregnancy rates between patients receiving general anesthesia (GA) versus spinal anesthesia (SA) for MSV with 2-year follow-up data. Materials and Methods: Male patients aged between 18–50 years, with ASA physical scores between I–III, who underwent unilateral or bilateral primary MSV, were included in the study. To minimize selection bias and balance the baseline characteristics between the GA group and SA group, we employed a propensity score matching approach, matching all 38 SA patients with 380 GA patients selected from a larger pool. Patients with complete 24-month follow-up data were included in the final analysis. The primary outcome of our study was determined as evaluating sperm count changes. Secondary outcomes included other sperm parameters (motility, morphology and semen volume), natural pregnancy rates, perioperative complications and recovery parameters. Results: The final analysis included 418 patients who met all inclusion criteria and completed the follow-up period. The study population comprised 380 patients in the GA group and 38 in the SA group. No significant difference was found between the groups in terms of sperm count. Greater improvement in sperm motility was observed in the SA group starting from the third month onwards (p = 0.027). Natural pregnancy was achieved in 16/38 (42.1%) of SA patients versus 125/380 (32.9%) of GA patients (p = 0.031). In addition, better results were obtained in terms of recovery parameters in the SA group. Other results were comparable between the groups. Conclusions: Spinal anesthesia for MSV was associated with greater improvement in sperm motility and higher natural pregnancy rates compared to general anesthesia, despite comparable sperm count improvements. These associations warrant further investigation in prospective randomized trials. Full article

The increasing demand for energy combined with depleting conventional energy sources has led to the evolution of distributed generation using renewable energy sources. Integrating these distributed generations with the existing grid is a complicated task, as it risks the stability and synchronisation of the system. Microgrids (MG) have evolved as a concrete solution for integrating these DGs into the existing system with the ability to operate in either grid-connected or islanded modes, thereby improving reliability and increasing grid functionality. However, owing to the intermittent nature of renewable energy sources, managing the energy balance and its coordination with the grid is a strenuous task. The hierarchical control structure paves the way for managing the dynamic performance of MGs, including economic aspects. However, this structure lacks the ability to provide effective solutions because of the increased complexity and system dynamics. The incorporation of artificial intelligence techniques for the control of MG has been gaining attention for the past decade to enhance its functionality and operation. Therefore, this paper presents a critical review of various artificial intelligence (AI) techniques that have been implemented for the hierarchical control of MGs and their significance, along with the basic control strategy. Full article

The shift toward digital and smart manufacturing requires an accurate prediction of cutting behavior, such as cutting forces. Controlling cutting forces in machining is important for maintaining product quality, particularly in steels such as X5CrNi18-10. This steel has high toughness, which resists cutting, thereby increasing overall cutting forces. Proper selection of machining parameters and conditions can help reduce cutting forces during machining. Several studies have been dedicated to understanding the influence of cutting parameters on cutting forces. However, limited attention is given to the influence of the cutting conditions on cutting forces. The primary objective of this study is to understand the behavior of cutting forces in chromium-nickel alloy steel by varying machining parameters, specifically cutting conditions (dry and wet), using a full factorial (3¹ × 2²) design of experiments (DoE). The secondary objective is to develop a multilinear regression model to predict cutting forces. The root mean square (RMS) values of the cutting force components were calculated from the acquired data and analyzed using OriginPro 2025b. In addition, this study analyzes the effects of cutting parameters and cutting forces on root mean square (RMS) surface roughness (R_q) to understand their impact on quality using the AltiSurf 520 profilometer. The results suggest a significant effect of the selected machining parameters and conditions on cutting force reduction and on improved surface quality when cutting forces are low. This research provides a valuable insight into optimizing the machining process for hard steels. Full article

Background: Opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) for clavicle fracture pain management carry significant adverse effect and allergic reaction risks. This study assessed ultrasound-guided nerve block (USNB) efficacy for acute clavicle fracture pain in emergency department (ED) patients, providing an alternative to NSAIDs and opioids with fewer adverse effects. Methods: This retrospective, single-center observational study was conducted in accordance with Methods of Medical Record Review Studies in Emergency Medicine Research guidelines. Adult patients (≥20 years) who presented to the ED with traumatic clavicle fractures between 1 January 2015 and 30 November 2023 were included. Of the 343 eligible patients, 12 received ultrasound-guided nerve blocks (USNB) and 331 received standard care. To improve exchangeability, 1:10 matching with replacement was performed according to patients’ characteristics, such as age, sex, initial pain score, and comorbidities. The primary outcome was pain relief, assessed via the pain intensity difference (PID) on the Numerical Rating Scale within 360 min post-intervention. Meaningful pain relief was defined as a PID ≥ 4. Secondary outcomes included rescue opioid use, ED length of stay, hospital length of stay, and USNB-associated complications, such as vascular puncture, nerve injury, or local anesthetic systemic toxicity. Data were analyzed using time-course, time-to-event (time to meaningful pain relief), and linear regression analyses. Results: A total of 12 patients in the USNB group and 85 matched patients in the standard care group were analyzed after baseline characteristics matching with replacement. Compared to standard care, USNB was associated with significantly greater pain relief (p < 0.001). In the time-to-event analysis, USNB led to a 3.41-fold faster achievement of meaningful pain relief compared with that achieved with standard care (HR = 3.41; 95% CI, 1.47–7.90; p = 0.004). No significant differences were observed between groups in rescue opioid use, ED length of stay, or hospital length of stay. No USNB-associated complication developed in the USNB group. Conclusions: In patients with traumatic clavicle fractures, USNB provides more rapid and sustained pain relief than standard analgesic care in the ED, without increasing the ED length of stay. Large prospective studies are needed to confirm these findings. Full article

Polysaccharide-based wound dressings face challenges in mechanical properties and effective wound repair for infected wound surfaces. This study presents a novel polyvinyl alcohol (PVA)/Salecan (Sal) composite hydrogel dressing with high toughness, biocompatibility, and wound healing capabilities, developed using an interpenetrating polymer network strategy. The primary network was formed through electrostatic interactions between polydopamine (PDA) and biocompatible polysaccharide Salecan, followed by incorporation of AgNO₃, which was in situ reduced to silver nanoparticles within the hydrogel. PVA was introduced as a secondary matrix, further reinforcing the hydrogel network through cyclic freeze–thawing. The resulting hydrogel exhibited a tensile strength of 0.31 MPa, an elongation at break of 158.9%, and a toughness of 31.16 J·m⁻², demonstrating enhanced mechanical performance compared to both Salecan/PDA and previously reported Salecan/Fe³⁺ hydrogel. Co-culture experiments showed the hydrogel’s strong antibacterial effects, inhibiting 80.1% of Escherichia coli (E. coli) and 99.5% of Staphylococcus aureus (S. aureus). Fibroblast culture tests confirmed its excellent cytocompatibility. In vivo studies on infected wounds showed nearly complete healing in the S. aureus + hydrogel group within 12 days. Quantitative immunohistochemical analysis of CD31 revealed that hydrogel treatment significantly upregulated CD31 expression, indicating enhanced neovascularization. Complementary Western blot analysis further demonstrated that hydrogel-treated groups exhibited a marked downregulation of pro-inflammatory factors alongside CD31 upregulation. In summary, the PVA/Sal-based hydrogel represents a valuable strategy for reducing inflammation and promoting regeneration in the management of infected wounds. Full article

Osteoporosis is a prevalent skeletal disorder characterized by reduced bone mass and microarchitectural deterioration, leading to increased fracture risk, particularly in aging populations. Postmenopausal osteoporosis (PMOP) remains the most common primary form and results from abrupt estrogen deficiency after menopause, which disrupts bone remodeling by accelerating the receptor activator of nuclear factor-κB ligand (RANKL)-mediated osteoclastogenesis, suppressing Wnt/β-catenin signaling, and promoting inflammatory cytokine production. In contrast, drug-induced osteoporosis (DIOP) encompasses a heterogeneous group of secondary bone disorders arising from pharmacologic exposures. Glucocorticoids suppress osteoblastogenesis, enhance osteoclast activity, and increase reactive oxygen species; long-term bisphosphonate therapy may oversuppress bone turnover, resulting in microdamage accumulation; denosumab withdrawal triggers a unique rebound surge in RANKL activity, often leading to rapid bone loss and multiple vertebral fractures. Medications including aromatase inhibitors, SSRIs, proton pump inhibitors, heparin, and antiepileptic drugs impair bone quality through diverse mechanisms. Standard antiresorptive agents remain first-line therapies, while anabolic agents such as teriparatide, abaloparatide, and romosozumab provide enhanced benefits in high-risk or drug-suppressed bone states. Transitional bisphosphonate therapy is essential when discontinuing denosumab, and individualized treatment plans—including drug holidays, lifestyle interventions, and monitoring vulnerable patients—are critical for optimizing outcomes. Emerging approaches such as small interfering RNA (siRNA)-based therapeutics, anti-sclerostin agents, digital monitoring technologies, and regenerative strategies show promise for future precision medicine management. Understanding the distinct and overlapping molecular mechanisms of osteoporosis is essential for improving fracture prevention and long-term skeletal health. Full article

From the perspective of educational inclusion proposed by Booth and Ainscow, the transformation of school systems revolves around three key dimensions: presence, participation and learning. These dimensions constitute the axes of the so-called Inclusion Index and allow for a holistic analysis of the barriers that limit equity and inclusion in school contexts. Based on this theoretical framework, this study aims to systematically map the barriers documented in recent academic literature (2000–2025) that affect these dimensions at the primary and compulsory secondary education levels, with a special focus on intersectional variables that amplify inequalities (gender, migration, disability, mental health, among others). Full article

Coffee grounds can be used in agriculture as a bio-input to enhance soil fertility and biodiversity in the long term. Furthermore, the use of coffee grounds in agriculture is a sustainable practice because it reuses an organic waste product as natural fertilizer and minimizes the environmental impact resulting from the improper disposal of waste. This study aimed to identify the effects of coffee grounds on the growth and yield of iceberg lettuce plants. The experiment was conducted in a greenhouse using 4 kg of substrate in containers with a 5.356 dm³ capacity, following a completely randomized design in a 2 × 2 factorial arrangement. The primary treatment consisted of plants grown in two types of substrate: soil and sand (01) and soil, sand, and 10% coffee grounds (02). The secondary treatment corresponded to irrigation with water (01) and a 10% coffee ground extract solution (02). Coffee grounds incorporated into the soil increase soil fertility; however, they reduce lettuce growth due to the toxicity of the compounds present and should not be used without prior treatment. Processing coffee grounds into irrigation solutions shows promise due to its high potential for use as an agricultural bio-input in lettuce production. This solution enhances the growth and development of the species, resulting in vigorous plants with market value. Full article

The integration of Educational Robotics (ER) into teaching and learning has increased in recent years. While several studies have described the design and use of simulators, no content analysis has systematically documented the features and contribution of simulators in ER. Therefore, a systematic review of eight databases was conducted. From 1200 retrieved articles, 89 met the inclusion criteria. The emerged articles comprised two distinct categories: (a) simulator framework studies—describing tools or platforms (54 articles)—and (b) simulator-based intervention studies—reporting empirical implementations (35 articles). Each article was analyzed by two independent researchers who recorded the design features of simulators, their domain of use, the educational level at which the implementation occurred, intervention characteristics, teacher involvement in the studies, and the skills they tried to promote. Findings showed that simulators were primarily designed for STEM education. Most operated in coding environments, used 3D visualization, and were freely available. Interventions were more frequent at the tertiary level, with fewer at primary and secondary levels. Many empirical studies that used simulators employed small samples in short durations, limiting the generalizability of the findings. Simulator-based practices were mainly linked to programming, problem solving, and computational thinking. Higher-order competences such as collaboration or metacognition were rarely addressed. Finally, most intervention studies reported either no or only moderate teacher involvement. This article aims to be a basis for researchers who study ER implementation and simultaneously serve as a basis for choosing, designing, and adopting ER simulators as teaching tools. Full article

Objective: To evaluate the diagnostic utility of antepartum amnioinfusion in cases of severe oligo- and anhydramnios and to descriptively report perinatal outcomes. Methods: This retrospective single-center study analyzed all antepartum amnioinfusions performed between 2009 and 2024 in pregnancies between 16 + 0 and 34 + 0 weeks of gestation. The primary endpoint was diagnostic impact following amnioinfusion. Secondary endpoints were descriptive perinatal outcomes. No inferential statistical analyses were performed. Results: A total of 37 amnioinfusions were performed in 31 patients. Median gestational age at first amnioinfusion was 22 ± 4.3 weeks, with a mean infusion volume of 259 ± 59.4 mL. The most frequent etiologies were preterm prelabor rupture of membranes (PROM, 29%), fetal growth restriction (FGR, 25.8%), and urogenital malformations (22.6%). Amnioinfusion improved sonographic visualization and diagnostic assessment in the majority of cases. Pregnancy prolongation was observed in selected subgroups; however, causal inference regarding therapeutic efficacy cannot be drawn. Conclusions: Antepartum amnioinfusion represents a valuable adjunct for prenatal diagnostic evaluation in severe oligo- and anhydramnios. Observed perinatal outcomes should be interpreted descriptively. Further prospective, controlled studies are required to define the role of amnioinfusion beyond diagnostic feasibility. Full article