Search Results (53)

Background: Critical illness leads to profound metabolic, neuroendocrine and immune disorders that affect the prognosis of patients treated in intensive care units (ICUs). The ketogenic diet, a high-fat and low-carbohydrate eating model, is gaining increasing importance as a potential metabolic intervention in the ICU. Preliminary data suggest that the ketogenic diet (KD) may support the control of seizures in a super-refractive epileptic state (SRSE), stabilize glycemia, reduce insulin demand, and modulate the immune response in sepsis. The aim of this review was to present a synthetic presentation of the current state of knowledge regarding use of the KD in intensive care patients. Methods: The review was carried out in accordance with the guidelines of the Joanna Briggs Institute and PRISMA-ScR. PubMed, Scopus, EBSCO, Web of Science, Google Scholar and Cochrane Library databases were searched (10–19 April 2026) using the Population–Concept–Context model. Full-text observational studies, randomized trials and reviews of the use of KDs in ICU patients were included. Data extraction was performed independently by two reviewers. Results: Of the 42 publications identified, seven studies were included in the analysis. The KD was feasible and safe in both critically ill adults and children. In SRSE, most patients achieved stable ketosis within a few days, which often allowed for reduction or discontinuation of anesthetics. In sepsis, the KD led to glycemic stabilization, reduced insulin demand and reduced immune deregulation; in one study, “after day 4, none of the patients in the KD group required insulin treatment.” The KD also showed beneficial effects on cellular bioenergetics and mitochondrial function. The safety profile was acceptable and adverse reactions were manageable with appropriate monitoring. Conclusions: The KD represents a promising, non-pharmacological metabolic intervention in intensive care, particularly in the treatment of SRSE and in the stabilization of glucose metabolism in sepsis and other critical conditions. Despite the growing number of positive clinical observations, the available evidence remains limited due to small samples, heterogeneous protocols, and a lack of randomized trials. Further, well-designed prospective studies are needed to determine optimal KD implementation protocols and identify the patient populations that benefit most. Full article

Background/Objectives: Nipple–areolar complex (NAC) necrosis following nipple-sparing mastectomy (NSM) delays adjuvant therapy and compromises oncological outcomes. This retrospective propensity-matched cohort study compared continuous topical oxygen therapy (cTOT), hyperbaric oxygen therapy (HBOT), and standard care (SOC) in patients with NAC necrosis after NSM. Methods: Between January 2020 and August 2025, 213 patients with NAC necrosis after NSM at a single academic center met eligibility criteria (cTOT, n = 57; HBOT, n = 59; SOC, n = 97). Propensity score matching (1:1:1, 15 covariates, all standardized mean differences < 0.1) yielded 57 matched triplets (171 patients). The primary outcome was time to complete epithelialization, with restricted mean survival time (RMST) at 56 days designated as a co-primary metric. Results: cTOT was associated with the fastest healing (mean 30.5 ± 9.9 days vs. HBOT 36.4 ± 9.0, p = 0.007, vs. SOC 45.1 ± 10.6, p < 0.001). RMST analysis demonstrated a mean gain of 14.0 unhealed days (95% CI, 10.5–17.5) for cTOT versus SOC. Eight-week healing rates were 98.2% (cTOT), 96.5% (HBOT), and 87.7% (SOC). Multivariable Cox regression identified cTOT as an independent predictor of accelerated healing (HR 4.61; 95% CI, 2.99–7.11; p < 0.001), with results stable across incision-type and ptosis-grade sensitivity analyses. The treatment association was most pronounced in larger wounds (≥2.0 cm²; HR 6.85; p for interaction = 0.018). cTOT patients also reported significantly lower pain and higher satisfaction, with no device-related discontinuations (0/57). Conclusions: cTOT was associated with significantly accelerated NAC necrosis healing and, as a portable home-based therapy, may support oncological treatment timelines after NSM. The shorter time to adjuvant initiation observed for cTOT (continuous outcome) was not paralleled by a significant reduction in the >6-week delay endpoint, which requires confirmation in multicenter randomized trials. Full article

To elucidate the evolution of dynamic recrystallization (DRX) mechanisms in cold-worked Cr4Mo4Ni4V martensitic steel, tensile tests were conducted on a 50% cold-deformed material at 600–850 °C at a fixed strain rate of 0.001 s⁻¹, combined with systematic microstructural characterization. Under this specific strain rate, the results reveal a temperature-dependent transition from continuous dynamic recrystallization (CDRX) to discontinuous dynamic recrystallization (DDRX). At 600 °C, CDRX dominates, producing recrystallized grains with orientations close to the parent matrix and relatively strong texture. At 750 °C, CDRX and DDRX coexist, while DDRX is significantly enhanced, characterized by grain boundary nucleation and random orientations, leading to a marked reduction in texture intensity; simultaneously, the fraction of recrystallized grains and high-angle grain boundaries reaches a maximum. At 850 °C, DDRX becomes dominant. This transition in DRX mechanism governs the high-temperature plasticity, with optimal superplasticity achieved at 800 °C, corresponding to an elongation of 748%. Cavities are primarily initiated at carbide/matrix interfaces, and their growth and coalescence dominate the fracture process. These findings clarify the temperature-dependent DRX evolution and its role in regulating superplasticity, providing guidance for microstructure design and superplastic forming of martensitic steels. Full article

Background: Growth disorders, including central precocious puberty and delayed puberty, can significantly affect linear growth, skeletal maturation, metabolic regulation, and psychosocial development during childhood and adolescence. This systematic review synthesizes the current evidence regarding the effectiveness and safety of hormone-based therapies used in children with disorders of pubertal maturation. Methods: A PRISMA-guided systematic search was carried out between January 2016 and March 2026 in different databases, such as MEDLINE (PubMed), EMBASE, CENTRAL, Scopus, Web of Science, CINAHL, LILACS and OpenGrey; the protocol was previously registered in the PROSPERO database (CRD420251068048). Non-randomized, randomized controlled trials and observational research including participants aged 0–18 years receiving hormone therapies were eligible. Risk of bias was assessed using validated, design-specific tools. Results: Twenty studies involving 21,812 participants were included. GnRHa therapy improved final adult height (+3.5 to +4.5 cm) and reduced bone age advancement (−0.6 to −1.3 years) in children with central precocious puberty. rhGH therapy increased growth velocity (+3.0 to +5.0 cm/year) and height SDS (+0.3 to +0.9), particularly in idiopathic short stature and Prader–Willi syndrome. Combined GnRHa plus rhGH therapy showed greater short-term growth benefits than GnRHa alone. Both therapies showed favorable safety profiles, with predominantly mild adverse events and discontinuation rates below 2%. However, the evidence was limited by substantial heterogeneity and moderate-to-serious risk of bias. Conclusions: GnRHa and rhGH therapies are generally effective and safe for improving growth and pubertal outcomes in pediatric endocrine disorders. However, further long-term studies are needed to clarify their metabolic and psychosocial effects in adulthood. Nevertheless, these conclusions should be interpreted with caution due to the study’s moderate-to-serious risk of bias and heterogeneity. Full article

Background: Guselkumab, a selective anti-IL-23p19 monoclonal antibody, has shown high efficacy in randomized trials for moderate-to-severe psoriasis and active psoriatic arthritis (PsA). Real-world evidence is essential to assess treatment performance in broader and more heterogeneous patient populations. Objectives: To synthesize the available real-world evidence on the effectiveness and safety of guselkumab in psoriasis and PsA, and to quantify pooled clinical responses across clinically relevant follow-up windows. Methods: A systematic review and meta-analysis was conducted according to PRISMA 2020. PubMed/MEDLINE, MEDLINE, and Web of Science were searched for observational real-world studies of guselkumab in adults with psoriasis and/or PsA. Primary pooled outcomes were PASI 90 and PASI 100 in psoriasis and DAPSA < 14 in PsA. Random-effects meta-analysis of proportions was performed using a logit transformation. Cohort overlap was explicitly assessed and overlapping publications were not allowed to contribute concurrently to the same pooled estimate. Results: Thirty-four studies were included (29 psoriasis, 5 PsA). In psoriasis, pooled PASI 90 response rates were 50.8% (95% CI 46.8–54.8) at 12–16 weeks, 68.4% (95% CI 66.3–70.4) at 20–28 weeks, 71.2% (95% CI 64.9–76.8) at 36–60 weeks, and 77.1% (95% CI 74.9–79.3) at ≥96 weeks. Pooled PASI 100 response rates were 49.8% (95% CI 47.5–52.2) at 20–28 weeks and 49.7% (95% CI 47.1–52.3) at 36–60 weeks. In PsA, pooled DAPSA < 14 response rates were 56.9% (95% CI 23.0–85.3) at 20–28 weeks and 69.5% (95% CI 62.5–75.7) at 48–60 weeks. Safety reporting was heterogeneous, but serious adverse events and discontinuations due to adverse events were uncommon. Conclusions: Real-world evidence supports guselkumab as an effective treatment for psoriasis and a clinically useful option for PsA, with a safety profile broadly consistent with the known trial experience. Interpretation remains limited by observational designs, heterogeneous denominators, and inconsistent safety reporting. Full article

Inherent defects in engineering rock masses inevitably lead to randomness in mechanical parameters and uncertainty in tunnel deformation and failure. To address these challenges, this study proposes a novel coupled analysis method that integrates complex function theory, physical model testing, and Monte Carlo simulation (MCS) for the deformation estimation and failure probability analysis of non-circular tunnels. Theoretically, this method provides a high-speed, high-accuracy analytical framework that overcomes the limitations of purely numerical approaches, particularly in handling continuous–discontinuous failure processes. Practically, it enables a more reliable and efficient stability assessment of tunnel systems under uncertain geological conditions. The proposed method is applied to a traffic tunnel at the Baihetan Hydropower Station. A series of uniaxial compression tests on 40 rock specimens are conducted to obtain statistical distributions of rock deformation parameters. An analytical solution for tunnel displacement is derived using plane elastic complex function theory, and the random displacement field is estimated via MCS. Physical model tests reveal that the elastic stage accounts for 83% of the overload failure process, based on which an elastic limit displacement function is established for tunnel arch settlement and surrounding rock convergence. The failure probability of the tunnel is then calculated, and the effects of the mean, coefficient of variation, and cross-correlation coefficient of rock deformation parameters on failure probability are discussed. The entire computational process is characterized by high speed and precision, offering a new and practical tool for tunnel stability evaluation and reliability-based design. Full article

The semantic segmentation of sparse array synthetic aperture radar (SAR) 3D point clouds remains a significant challenge. These datasets are characterized by extreme sparsity, irregular distribution, and structural discontinuity, factors that diminish the reliability of local neighborhoods and impede the performance of traditional segmentation algorithms. This study introduces an enhanced PointNet++ framework specifically tailored for the semantic segmentation of sparse array-SAR 3D point clouds. Utilizing PointNet++ as a hierarchical backbone, the proposed architecture incorporates three geometry-oriented modifications: a feature enhancement strategy integrating normalized height, surface normals, and local density; an EdgeConv module positioned at an intermediate abstraction stage to reinforce local geometric modeling; and an FP-Refine module designed to optimize cross-scale feature propagation and recovery within sparse regions. Rather than proposing a fundamentally distinct universal architecture, this research focuses on a task-oriented adaptation of PointNet++ to address the neighborhood instability and structural gaps inherent in sparse array-SAR data. Experimental evaluations using the SARMV3D-1.0 dataset indicate that the proposed method consistently outperforms the PointNet++ baseline, maintaining stable performance across various random seeds with an mIoU between 55% and 58%. Further validation through ablation studies, parameter sensitivity analyses, and perturbation-based robustness assessments confirms the utility of the integrated components. Additionally, cross-dataset experiments on S3DIS and Toronto3D suggest that the framework generalizes effectively to point clouds with varying densities and spatial configurations. The findings demonstrate that the method is particularly successful for categories defined by distinct vertical geometry and structural continuity, such as trees, roofs, and facades, though performance remains limited for weakly structured classes like roads. Full article

Evidence from observational studies plays a central role in shaping public policy in health, education, and financial regulation, where randomized experiments are rarely feasible. Propensity score matching (PSM) is a widely used method to approximate fair comparisons between treatment and control groups. Incorporating machine learning into the estimation of propensity scores can strengthen prediction and enhance the credibility of findings. However, stronger predictive models create a “predictability paradox”. As predictive accuracy improves, estimated propensity scores for treated and control units become more distinct when treatment assignment is strongly predictable from observed covariates, revealing limited overlap between groups. In the limit, near-perfect prediction produces near-complete separation between groups, rendering traditional matching infeasible and confining inference to a narrow subset of units near the boundary of the propensity score distribution, a setting analogous to a regression discontinuity design (RDD). Researchers thus face perverse incentives to use weaker models for statistically significant but spurious results. These dynamics jeopardize the reliability of evidence for policy. To safeguard decision-making, we propose a simple reform: require that studies using PSM disclose model error rates, including false positive and false negative rates, along with information on overlap and effective sample size. Full article

Background: Post-traumatic stress disorder (PTSD) affects millions globally, with 40–50% of patients not responding adequately to first-line treatments. Prism neurofeedback, an FDA-cleared electroencephalography (EEG)-based system targeting amygdala-derived biomarkers, has demonstrated efficacy in randomized controlled trials (RCTs) and multicenter studies. Real-world implementation data from community clinical practice remain limited. Objective: To evaluate clinical outcomes and patient-developed self-regulation strategies of Prism neurofeedback in patients with PTSD in community clinical practice. Methods: Retrospective case series of 28 consecutive patients with PTSD treated with Prism neurofeedback in a community psychiatry practice. The primary outcome was change in PTSD Checklist for DSM-5 (PCL-5) from baseline to end of treatment. Results: Twenty-one of 28 patients (75.0%) completed treatment. Mean PCL-5 reduction was 37.0 ± 18.2 points (Cohen’s d = 2.03). Response rates were 100% for any improvement and 90.5% for clinically significant improvement (≥10-point reduction). Five patients (23.8%) achieved excellent response with ≥50-point reduction. Limited follow-up data (1–3 months post-treatment) were available for three patients; two of three (67%) exceeded their end-of-treatment gains. Four patients receiving booster sessions showed continued improvement. Limitations: The uncontrolled, retrospective design precludes causal attribution of improvements to the intervention versus placebo effects or regression to the mean. The 25% early discontinuation rate may introduce attrition bias. Durability data are available for only three patients. Conclusions: This case series provides real-world evidence supporting the feasibility and potential clinical utility of Prism neurofeedback in community practice, with outcomes comparable to controlled studies and preliminary evidence of durable treatment effects. These findings complement existing RCT evidence by demonstrating successful implementation outside research settings. Full article

Background: Adolescent migraine is highly prevalent and associated with substantial functional and psychosocial burden. Conventional oral preventives are widely used off-label with limited pediatric efficacy and frequent tolerability problems. Real-world data on calcitonin gene-related peptide (CGRP) monoclonal antibodies in adolescents are scarce. Methods: We conducted an exploratory, retrospective cohort analysis of depersonalized routine-care data from adolescents with migraine in the German Pain e-Registry. Patients were eligible if they had at least one 6-month episode with high-evidence conventional oral preventives (HECP) and one 6-month episode with a CGRP monoclonal antibody (CGRP-mAb), each with baseline and follow-up documentation, enabling intra-individual descriptive comparisons. The primary endpoint was a pragmatic composite of 6-month treatment persistence and ≥50% reduction in monthly migraine days (MMD). Secondary outcomes included MMD, MMD with acute medication (MMDAM), migraine-related sick-leave days (MMSLD), disability (MIDAS), and patient-reported psychosocial outcomes. Results: A total of 422 adolescents contributed 1448 HECP and 422 CGRP-mAb episodes. Premature discontinuation occurred in 68.8% (HECP) and 11.9% (CGRP-mAb) of episodes; corresponding 6-month persistence was 30.6% and 88.2%, respectively. Mean MMD decreased from 11.7 to 9.4 during HECP episodes and from 11.6 to 4.4 during CGRP-mAb episodes. A ≥50% MMD reduction occurred in 25.4% (HECP) and 70.9% (CGRP-mAb) of episodes; the composite endpoint was met in 23.7% and 69.9%, respectively. CGRP-mAb episodes were associated with numerically larger improvements across secondary outcomes. Conclusions: In this high-burden adolescent cohort, CGRP-mAb treatment episodes were associated with higher persistence and broader improvements than prior conventional preventive episodes. Given the retrospective, non-randomized, sequential design, these findings are hypothesis-generating and do not constitute evidence of comparative effectiveness. Controlled pediatric trials and long-term safety studies are warranted. Full article

The standard first-line treatment for metastatic non-small cell lung cancer (NSCLC) without oncogenic alterations and programmed death-ligand 1 (PD-L1) expression < 1% is a combination of chemotherapy (CT) and immunotherapy (IO). However, real-world overall survival (OS) appears more modest than in clinical trials, averaging 10–13 months. This retrospective study aimed to assess treatment patterns and real-world outcomes at the Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ). Patients diagnosed between January 2019 and December 2023 with advanced PD-L1 <1% NSCLC and treated with palliative intent at IUCPQ were included and categorized by first-line treatment. Progression-free survival (PFS) and OS of the CT + IO and CT groups were compared using Kaplan–Meier curves and Cox regression analyses. Data regarding regimen selection, adverse events and subsequent treatment lines were collected. Among 217 eligible patients, 82 (37.8%) received CT + IO, 32 (14.7%) CT alone, 16 (7.4%) targeted therapy, and 87 (40.1%) supportive care. Median PFS was 5.3 vs. 4.7 months (p = 0.5) and OS 14.4 vs. 13.5 months (p = 0.2) for CT + IO and CT alone, respectively. In the CT + IO group, treatment discontinuation was mainly due to disease progression (59.4%) or adverse events (36.2%). Immune-related adverse events occurred in 29.3%, most frequently pneumonitis (8.5%). Therefore, in this cohort, no statistically significant survival difference was observed between CT + IO and CT alone. However, these findings should be interpreted cautiously given the non-randomized design, baseline imbalances between groups, and the limited sample size of the CT alone cohort. Tolerability of CT + IO was consistent with that observed in clinical trials. Full article

Toppling failure is a fundamental mode of instability in rock slopes and occurs predominantly in reservoir bank anti-dip bedded rock masses. Reservoir impoundment changes seepage conditions and weakens slopes, whereas discontinuity non-persistence introduces uncertainty and complicates the identification of coupled toppling–sliding mechanisms. To address this, a probabilistic framework using the Goodman–Bray limit equilibrium method is developed. Equivalent strength parameters are introduced to unify the strength contrast between unsaturated and saturated segments along a common basal surface. Basal discontinuity connectivity is modeled as a random variable, and a Monte Carlo simulation is used to derive failure mode probabilities and a probability-weighted factor of safety. The framework is applied to the Huangcaoping anti-dip slope in the Dagangshan reservoir area at a normal water level of 1130 m. The most probable scenario has a probability of 0.116, involving sliding at 1120–1420 m and toppling at 1420–1550 m, with a probability-weighted mean factor of safety of 0.978. Predicted failure characteristics and deformation intervals are consistent with engineering observations, confirming the method’s effectiveness. This integration enables the simultaneous characterization of stability levels and the evolution mechanism. The approach provides mechanism-explicit mode likelihoods and a robust stability metric to support hazard assessment, monitoring placement, and reinforcement design. Full article

We evaluated the effects of rapeseed oil (RSO, rich in oleic, linoleic, and linolenic acids) and a commercial fat source (BOVI-LM, rich in palmitic and stearic acids) on the growth performance and blood biochemical parameters of dairy calves during the pre- and post-weaning phases. Eighteen crossbred bull calves were randomly allocated in a randomized complete block design to three dietary treatments (Control, RSO, and BOVI-LM) during the milk-replacer phase (Phase 1, days 0–28). Due to technical issues, BOVI-LM supplementation was discontinued in Phase 2 (starter-feed phase, days 35–77), leaving only Control (n = 12) and RSO (n = 6). Energy supply was calculated to support target average daily gains of 0.6 (Phase 1) and 1.0 kg (Phase 2). Body weight, clinical health, and blood samples for biochemical analysis were monitored throughout the trial. No treatment effect on body weight or blood biochemical parameters was detected (main effect of treatment: p ≥ 0.18 for all analytes). In contrast, phase and time effects were significant for most biochemical parameters (p < 0.05), reflecting the metabolic transition from a milk-based to a solid-feed diet. Aspartate aminotransferase activity increased over time (p < 0.001), whereas glucose concentrations decreased post-weaning (time × phase: p = 0.020). The treatment × phase interaction was non-significant for all variables (p ≥ 0.13), supporting the absence of detectable carry-over effects and justifying the pooling of former BOVI-LM calves into the Control group in Phase 2. Full article

Background: Apnea of prematurity affects at least 85% of infants born before 34 weeks’ gestation and represents a significant clinical challenge in neonatal intensive care. Methylxanthines, including caffeine, theophylline, and aminophylline, have emerged as the primary pharmacological intervention for this condition. Objective: To conduct a comprehensive systematic review of the use of methylxanthine in the treatment and prevention of apnea episodes in preterm infants, evaluating efficacy, safety, and long-term outcomes. Methods: We searched multiple databases including PubMed, Embase, Web of Science for randomized controlled trials, retrospective studies, or case–control studies of methylxanthine effects in preterm apnea. Risk of bias was assessed using the Cochrane Risk of Bias tool. Results were summarized narratively and grouped by methylxanthine type, study design, and primary outcomes (reduction in frequency and severity of apnea episodes, success of extubation, risk of bronchopulmonary dysplasia). Results: Twenty-five studies (n = 4599 preterm infants) were included. The landmark Caffeine for Apnea of Prematurity (CAP) trial (n = 2006) demonstrated that caffeine therapy significantly reduced bronchopulmonary dysplasia (36.3% vs. 46.9%, adjusted OR 0.63) and facilitated the earlier discontinuation of positive airway pressure (median 1 week earlier). Studies with a smaller number of cases have consistently demonstrated the efficacy of methylxanthines in reducing the incidence of bronchopulmonary dysplasia and apneic episodes and in supporting successful extubation. Long-term follow-up at 11 years showed improved pulmonary function (FEV₁ z-score −1.00 vs. −1.53). Discussion: Limitations of this review include heterogeneity in outcome definitions, small sample sizes in early studies, and the dominance of evidence from the CAP trial. Methylxanthines, particularly caffeine, are an evidence-based intervention used for apnea of prematurity, with demonstrated benefits that extend beyond reducing the frequency and severity of apnea episodes, including decreasing the risk of bronchopulmonary dysplasia as well as reducing the need for mechanical ventilation. No external funding was received for this review. No registration record exists for this systematic review. Full article

Campus buildings often present hidden safety risks such as falls and wheelchair instabilities, which are closely related to architectural layout, material selection, and accessibility design. This study develops YOLOv11-Safe, an attention-enhanced and geometry-aware framework that functions as both a detection model and a spatial diagnostic tool for building safety assessment. The framework integrates a modified SimAM attention mechanism and a normalized Wasserstein distance (NWD) loss to improve detection accuracy in complex indoor environments, trained on a dataset of 1000 annotated images covering fall and wheelchair accident scenarios. To interpret spatial risk patterns, a Random Forest classifier combined with SHAP analysis was applied to quantify the contribution of five architectural–behavioral variables: body–ground contact ratio (BGCR), accessibility index (AI), event duration (D), body posture angle (PA), and spatial density (SD). Results show that BGCR and AI dominate the risk-level prediction, while D, PA, and SD refine boundary conditions. Scene-based verification further demonstrated that the framework accurately localized unsafe features—such as uneven drainage edges and discontinuous handrails—and translated them into actionable design feedback. The proposed approach thus links deep-learning detection with interpretable spatial analysis, offering a quantitative foundation for evidence-based architectural safety optimization in university campuses. Full article