Search Results (777)

Shoulder pain and shoulder surgery are increasingly prevalent and encompass a broad spectrum of pathologies, including rotator cuff disease, glenohumeral osteoarthritis, and shoulder instability. Growing evidence suggests that gender-related factors influence disease presentation, patient-reported outcomes, and postoperative recovery; however, these effects remain inconsistently reported across the literature. This current concepts review synthesizes available evidence on the influence of gender on pre-operative characteristics, non-operative management, and postoperative outcomes following common shoulder procedures, including rotator cuff repair, anatomic and reverse shoulder arthroplasty, and surgical stabilization for instability. A comprehensive literature search of PubMed, the Cochrane Library, and Google Scholar was performed for studies published through October 2025, with outcomes assessed using validated instruments such as the Western Ontario Rotator Cuff Index, American Shoulder and Elbow Surgeons score, Constant–Murley score, Simple Shoulder Test, Visual Analog Scale, and Shoulder Pain and Disability Index. Across shoulder pathologies, female patients consistently demonstrated worse pre-operative functional scores, higher pain levels, and greater perceived disability despite similar structural disease severity. Postoperatively, both genders experienced meaningful clinical improvement; however, females often reported higher early postoperative pain and lower absolute functional outcomes, particularly following shoulder arthroplasty for glenohumeral osteoarthritis and surgical treatment of multidirectional instability. In contrast, outcomes following rotator cuff repair and anterior instability stabilization were largely comparable between genders. Recognition of these gender-related differences is essential for individualized patient counseling, expectation setting, and optimization of management strategies, and highlights the need for future studies with robust gender-disaggregated analyses. Full article

To address the challenges of difficult feature extraction for rolling bearing vibration signals, low efficiency in optimizing diagnostic model parameters, and the tendency to get trapped in local optima, this paper proposes an improved ICEEMDAN feature extraction method based on Bayesian optimization and adaptive noise signal ratio enhancement (BAYES-ICEEMDAN-SNR) and combines it with the improved Coriolis force optimization algorithm (ITOC) to optimize the least squares support vector machine (LSSVM) fault diagnosis model. Firstly, Bayesian optimization is used to adaptively determine the noise parameters and introduce a dynamic signal-to-noise ratio adjustment mechanism to enhance the robustness of feature extraction; secondly, Chebyshev chaotic mapping, Cauchy mutation, and dynamic reverse learning strategies are applied to enhance the global search and local escape capabilities of ITOC, thereby optimizing the hyperparameters of LSSVM; and finally, the Keesey-Chestnut University bearing dataset and Huazhong University of Science and Technology gear dataset are used for verification. The experimental results show that the average fault identification accuracy of the proposed method reaches over 97%, which is superior to that of the comparison models, and the effectiveness of each core improvement module of the proposed model is verified through ablation experiments, providing an effective solution for intelligent fault diagnosis of rolling bearings and gears. Full article

Background and Objectives: Pediatric and adolescent obesity is a growing global health concern that is often associated with cardiometabolic comorbidities. Lifestyle interventions represent first-line therapy; however, many adolescents with moderate-to-severe obesity fail to achieve clinically meaningful weight loss. The objective of this review is to provide a comprehensive overview of surgical and endoscopic interventions for adolescent obesity. Materials and Methods: A structured search of PubMed, Scopus, Web of Science and the Cochrane Library was conducted. Studies reporting outcomes of bariatric surgery (sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), adjustable gastric banding (AGB)) and endoscopic interventions (endoscopic sleeve gastroplasty (ESG) and intragastric balloons (IGBs)) in patients ≤ 21 years were included. Data on weight loss, BMI reduction, metabolic outcomes, adverse events and follow-up were extracted and summarized. Results: Bariatric surgery remains the most effective intervention, with SG and RYGB achieving substantial and durable weight loss and high rates of comorbidity remission. ESG is an emerging intervention with preliminary short-term efficacy and safety data, though evidence is limited to small pediatric cohorts. IGBs provide reversible, non-surgical weight reduction with consistent short-term efficacy, but long-term durability is variable and largely dependent on adherence to behavioral programs. Across all interventions, psychosocial support, family involvement and multidisciplinary care significantly influence the outcomes. Conclusions: Procedural interventions play a pivotal role in adolescents with moderate-to-severe obesity. IGBs could represent a minimally invasive, reversible option, particularly as bridging or adjunctive therapy. Prospective, long-term studies are needed to optimize patient selection, evaluate developmental safety and determine sustainable outcomes. Full article

I developed a mathematical method to search for DNA regions that are significantly enriched in reverse complement triplets (RCTs) and are located in sequences with strongly expressed triplet periodicity (TP). The method makes it possible to exclude the influence of TP on the number of RCTs. To search for RCTs, I used the difference between triplet frequencies and their expected number, which was determined by taking into account the TP of the analyzed region. I analyzed the genomes of 42 bacteria representing all bacterial phyla, and found that the number of DNA regions containing RCTs ranged from several hundred to several thousand per genome depending on its size. The average length of the region was about 850 DNA bases. The most common inversion symmetry (IS) pattern of the RCT-containing regions was the enrichment of the first, second, and third triplet positions with {A, G}, {A, T}, and {T, C} bases, respectively. When the sequence was rotated 180 degrees and the bases were replaced with complementary ones (IS), such enrichment of triplet positions was preserved. I suggest that the emergence of IS could be a result of evolutionary processes such as inversions, transpositions, and recombinations. Full article

Achieving improvement of energy performance in listed buildings remains a complex challenge due to the need to combine innovative solutions with preservation of the characteristics that define the historical and architectural value of these buildings. The aim of this study is to better understand the state of the art regarding the compatibility of energy efficiency measures with the protection of listed buildings. A systematic review was performed that included peer-reviewed publications in English and Italian from Scopus, Web of Science, and Google Scholar (last search: November 2025). Sixty-nine studies were included and organized into methodological, applicative, review and theoretical-reflective studies. Results show a European predominance, particularly Italian, and identify four recurring themes: balancing efficiency with conservation, decision-making processes, evaluation criteria, and technological strategies. Current research is focusing on developing objective evaluation methods, moving toward multi-criteria methodologies that quantify aesthetic, technical, and environmental compatibility. While there is a preference for minimally invasive and reversible technological solutions, the review reveals a lack of shared protocols and limited generalizability of results. The study concludes that a strategic shift is required: moving from isolated experiments to integrated urban policies. Furthermore, it highlights a need for increased technical training to bridge the gap between research and practical application. Future research should focus on validating evaluation criteria using real cases and developing regional policy tools to support decision-making. This review was not registered. Full article

Modern information security relies heavily on symmetric-key cryptography such as AES. As quantum computing advances, these classical schemes face increasing pressure from quantum key-search attacks, most notably Grover’s algorithm. To evaluate and compare quantum security quantitatively, the core components of symmetric-key algorithms must be implemented and optimized as quantum circuits. Among them, the S-box is a key source of nonlinearity and often dominates the circuit cost. In this paper, we introduce ADOQ (Automatic Depth Optimizer for Quantum circuits), a modular Python (version 3.13.3) framework that automatically synthesizes reversible quantum circuits from S-box specifications and applies a sequence of depth optimization techniques to produce optimized QASM circuits. Our experiments show that ADOQ achieves circuit depths comparable to prior work on 4-qubit S-boxes, and it also supports synthesis for larger S-boxes. Full article

Male contraceptive options remain largely limited to condoms and vasectomy, while family planning services and monitoring indicators often prioritize women, contributing to inequities in contraceptive responsibility. This review examines how future male hormonal contraceptives (MHCs) could support more equitable, rights-based family planning, and what policy and implementation pathways are needed for responsible integration. We conducted a narrative synthesis of peer-reviewed studies and policy/advocacy guidance on male engagement in family planning and on MHC development (searches in PubMed/Scopus/Google Scholar and key organizational sources; 2000–May 2025), focusing on acceptability, service-delivery readiness, governance, and potential system impacts. Evidence indicates substantial interest in MHCs among men and women in hypothetical studies and trials, but highlights persistent barriers: gender norms, limited routine sex-disaggregated data on men’s participation, provider and service constraints, and insufficient public/private investment. Model-based analyses suggest that novel, reversible male methods could avert unintended pregnancies (with larger effects in settings with lower baseline contraceptive uptake) and that preventing unintended pregnancies can yield cost savings to health systems. Ethical discussions increasingly emphasize a dyadic perspective on risk and decision-making, alongside safeguards for autonomy and rights. We conclude that coordinated policy action—linking regulation, financing, service delivery, communication, and monitoring—is needed to expand couple-focused counselling, reduce stereotyping in care, strengthen indicators, and accelerate implementation pathways for MHCs while safeguarding women’s options and agency. Full article

Sliding failure is a common form of instability for reverse rock slopes. The determination of the failure plane for such unstable slopes is currently a key and challenging issue in research. To pinpoint the position of the failure surface with higher accuracy, this paper proposes a key equilibrium model based on the symmetric bidirectional evolutionary structural optimization (BESO) method. This model is based on the basic parameters of the slope, the BESO method, and the limit equilibrium theory. It uses its own algorithm program to search and determine the key failure plane of the slope. At the same time, two rock slope model tests were conducted to verify the effectiveness of this method in slope stability analysis. The calculated results exhibit a good consistency with the experimental outcomes, which confirms the feasibility of using the key equilibrium-bidirectional evolutionary structural optimization (CE-BESO) method for stability evaluation of this type of slopes. Full article

Background/Objectives: Alcohol-associated liver disease (ALD) is a major cause of chronic liver injury, in which disruption of the gut–liver axis plays a key pathogenic role. Probiotics have been proposed as a potential therapeutic strategy to mitigate alcohol-induced liver damage; however, the preclinical evidence has not been systematically synthesised. This systematic review aimed to evaluate and summarise the hepatoprotective effects of probiotic supplementation in experimental animal models of ALD. Methods: The review protocol was pre-registered in PROSPERO (CRD420250653666) and followed PRISMA guidelines. A systematic search was conducted across PubMed, EMBASE and AGRICOLA databases using relevant keywords from inception to 30 April 2025. We included preclinical randomised controlled trials evaluating single-strain probiotic interventions against placebo or untreated controls in animal models of ALD. Risk of bias was assessed using SYRCLE’s tool, and the certainty of evidence for critical outcomes was evaluated using the GRADE framework. A narrative synthesis was performed, as a quantitative meta-analysis was precluded by incomplete numerical outcome reporting. Results: From initial 628 records, 36 studies were included in the final synthesis. Probiotic supplementation consistently attenuated alcohol-induced liver injury, as evidenced by marked reductions in serum ALT and AST levels and improved liver histology. Mechanistically, probiotics restored gut barrier integrity, reduced systemic endotoxemia, and suppressed pro-inflammatory pathways. Furthermore, probiotic treatment effectively counteracted alcohol-induced gut dysbiosis by increasing microbial diversity and restoring taxonomic balance, notably by reversing the alcohol-induced expansion of Proteobacteria. Despite these consistent directional effects, the overall certainty of evidence for the critical outcomes was rated as very low. Conclusions: Although the preclinical literature suggests hepatoprotective effects of probiotics in experimental ALD, these findings should be interpreted with caution due to the very low certainty of evidence. The observed benefits are limited by methodological shortcomings, indirectness inherent to animal models, and incomplete outcome reporting. This review provides a structured preclinical framework to inform the design of future translational studies and well-controlled clinical trials evaluating probiotics as potential adjunctive therapies in human ALD. Full article

Background/Objectives: Perioperative neurocognitive disorders (PND), including postoperative delirium and cognitive dysfunction (POCD), represent significant complications in elderly surgical patients undergoing general anesthesia. The choice of neuromuscular blockade reversal agent may influence POCD risk through different mechanisms and side effects. This systematic review and meta-analysis evaluated the comparative effect of neostigmine versus sugammadex on POCD incidence in elderly patients. Methods: A systematic search of PubMed, Web of Science, Scopus, and Google Scholar was conducted from database inception to September 2025, following PRISMA 2020 guidelines with PROSPERO registration (CRD420251058187). Randomized controlled trials involving elderly patients (≥60 years) undergoing general anesthesia with neuromuscular blockade were included, comparing neostigmine and sugammadex for reversal. Primary outcomes included POCD incidence, assessed using validated cognitive tools, including the Mini-Mental State Examination and Montreal Cognitive Assessment. Meta-analysis was performed using Review Manager 5.4.1, with results expressed as odds ratios (ORs) and 95% confidence intervals (CIs). Results: Six randomized controlled trials involving 795 elderly patients published between 2017 and 2024 met the inclusion criteria. Studies encompassed non-cardiac surgery, robotic-assisted radical cystectomy, and pars plana vitrectomy. Pooled meta-analysis showed neostigmine was associated with a higher risk of POCD than sugammadex (OR 1.74, 95% CI 1.00–3.02, p = 0.05), with low heterogeneity (I² = 39%). Secondary outcomes, including prevention of POCD, management strategies, and related complications, were inconsistently reported and unavailable across all six RCTs. Subgroup analysis stratified by neostigmine dosage demonstrated that administration of a higher dose (≥0.04 mg/kg) was associated with reduced POCD incidence compared to a lower dose (<0.04 mg/kg) (OR 0.31, 95% CI 0.15–0.63, p = 0.001), with negligible heterogeneity (I² = 0%). Conclusions: This meta-analysis suggests that sugammadex may be associated with reduced early postoperative neurocognitive disorders compared to neostigmine in elderly patients, likely through rapid neuromuscular blockade reversal that minimizes residual paralysis and respiratory complications. Full article

Urban built environments face unprecedented challenges in resource management and sustainability, necessitating innovative approaches that integrate circular economy principles with construction technologies. This study addresses the critical research gap at the intersection of circular city initiatives and modular integrated construction (MiC) by employing a structured literature review methodology to systematically analyze existing knowledge. Following PRISMA guidelines, the search screened 438 papers (209 on MiC, 229 on Circular City Initiatives), of which 68 papers were included after quality appraisal for thematic synthesis using MAXQDA. The analysis offers a structured basis for operationalizing circular economy principles in the construction sector and provides a roadmap for future inquiry. The research develops a conceptional requirement matrix framework that bridges circular city principles with MiC implementation. Through systematic analysis, the study establishes six key requirements for construction technologies resulting from circular city initiatives and evaluates them against the six key MiC characteristics: prefabrication and assembly; speed and efficiency; quality and safety; standardization and mass production; sustainability; integration with technology. This matrix represents the first systematic approach to operationalizing circular economy principles through modular construction methodologies. The framework reveals that MiC constitutes a transformative paradigm for circular urban development through multiple synergistic pathways: prefabrication enhances reversibility and durability, extending service life and enabling material loop closure; eco-design integration improves safety and quality standards; deconstructability facilitates adaptive reuse; and BIM-based tools enhance material efficiency and recycling capabilities. The requirement matrix demonstrates strong alignment between circular city requirements and MiC characteristics, with adaptive reuse and modularity showing the strongest correspondence. Stakeholder engagement and policy support emerge as critical enablers across all implementation dimensions. While the framework is grounded in a structured literature review, it remains theoretical and serves as a foundation for future empirical validation. Full article

Introduction: Resting-state EEG (rsEEG) is a scalable window onto trait-like “executive readiness,” but findings have been fragmented by task impurity on the executive-function (EF) side and heterogeneous EEG pipelines. This review synthesizes rsEEG features that reliably track EF in healthy samples across development and aging and evaluates moderators such as cognitive reserve. Materials and methods: Following PRISMA 2020, we defined PECOS-based eligibility (human participants; eyes-closed/eyes-open rsEEG; spectral, aperiodic, connectivity, topology, microstate, and LRTC features; behavioral EF outcomes) and searched MEDLINE/PubMed, Embase, PsycINFO, Web of Science, Scopus, and IEEE Xplore from inception to 30 August 2025. Two reviewers were screened/double-extracted; the risk of bias in non-randomized studies was assessed using the ROBINS-I tool. Sixty-three studies met criteria (plus citation tracking), spanning from childhood to old age. Results: Across domains, tempo, noise, and wiring jointly explained EF differences. Faster individual/peak alpha frequency (IAF/PAF) related most consistently to manipulation-heavy working may and interference control/vigilance in aging; alpha power was less informative once periodic and aperiodic components were separated. Aperiodic 1/f parameters (slope/offset) indexed domain-general efficiency (processing speed, executive composites) with education-dependent sign flips in later life. Connectivity/topology outperformed local power: efficient, small-world-like alpha networks predicted faster, more consistent decisions and higher WM accuracy, whereas globally heightened alpha/gamma synchrony—and rigid high-beta organization—were behaviorally sluggish. Within-frontal beta/gamma coherence supported span maintenance/sequencing, but excessive fronto-posterior theta coherence selectively undermined WM manipulation/updating. A higher frontal theta/beta ratio forecasts riskier, less adaptive choices and poorer reversal learning for decision policy. Age and reserve consistently moderated effects (e.g., child frontal theta supportive for WM; older-adult slow power often detrimental; stronger EO ↔ EC connectivity modulation and faster alpha with higher reserve). Boundary conditions were common: low-load tasks and homogeneous young samples usually yielded nulls. Conclusions: RsEEG does not diagnose EF independently; single-band metrics or simple ratios lack specificity and can be confounded by age/reserve. Instead, a multi-feature signature—faster alpha pace, steeper 1/f slope with appropriate offset, efficient/flexible alpha-band topology with limited global over-synchrony (especially avoiding long-range theta lock), and supportive within-frontal fast-band coherence—best captures individual differences in executive speed, interference control, stability, and WM manipulation. For reproducible applications, recordings should include ≥5–6 min eyes-closed (plus eyes-open), ≥32 channels, vigilant artifact/drowsiness control, periodic–aperiodic decomposition, lag-insensitive connectivity, and graph metrics; analyses must separate speed from accuracy and distinguish WM maintenance vs. manipulation. Clinical translation should prioritize stratification and monitoring (not diagnosis), interpreted through the lenses of development, aging, and cognitive reserve. Full article

Background/Objectives: Miller–Fisher syndrome (MFS) is a rare Guillain–Barré variant defined by ophthalmoplegia, ataxia, and areflexia. Pediatric MFS is uncommon, and infectious triggers remain underrecognized. Human herpesvirus 6 (HHV-6) is neurotropic but rarely linked to immune-mediated neuropathies. In this paper, we describe a child with MFS associated with HHV-6 detected in cerebrospinal fluid (CSF) and review reported pediatric infections related to MFS. Methods: A 5-year-old girl presented with acute ophthalmoplegia, ataxia, and diminished reflexes. Neuroimaging, ophthalmologic tests, CSF analyses, and serologic andpolymerase chain reaction (PCR) assays were performed, including multiplex reverse transcription–PCR of cerebrospinal fluid using the BioFire^® Meningitis/Encephalitis panel. A literature search was performed on Pubmed to identify pediatric (0–18 years) MFS cases with infectious triggers. Two reviewers independently screened and summarized the literature, and a PRISMA-style flow diagram was used to transparently report the study selection process. Results: HHV-6 DNA was detected via CSF PCR twice, while tests for other pathogens were negative. Anti-GQ1b and related antibodies were negative or borderline. The patient received intravenous immunoglobulin and corticosteroids, with full recovery after one month. Among 20 published pediatric cases (1997–2021), Campylobacter jejuni was most frequent, followed by Mycoplasma pneumoniae and influenza viruses. Anti-GQ1b IgM positivity and favorable outcomes were commonly reported, including cases managed conservatively. Conclusions: This case raises the hypothesis that HHV-6 may represent a potential post-infectious association in pediatric MFS. The review findings indicate that pediatric MFS generally follows infection, responds well to immunotherapy, and has an excellent prognosis. Viral testing may be considered in selected, hypothesis-generating contexts in atypical or seronegative pediatric MFS presentations. Full article

Background/Objectives: Penile prosthesis implantation is a safe and effective treatment for erectile dysfunction, with low complication rates. Glans ischemia is a rare but serious postoperative complication that can lead to irreversible tissue loss. However, not all postoperative glans color changes reflect true ischemia, and distinguishing reversible from irreversible perfusion compromise remains challenging. The objective was to describe the clinical course, management, and outcomes of four patients who developed glans color changes following penile prosthesis implantation, emphasizing the role of glans sensibility in guiding treatment. Methods: We conducted a retrospective case series supplemented with a narrative literature review. Clinical data were obtained from medical records, operative reports, and follow-up visits. Literature searches were performed using PubMed, Scopus, and Google Scholar. Results: Four patients developed postoperative glans discoloration. Two patients, with preserved glans sensibility and no evidence of tissue necrosis, were managed conservatively with cylinder deflation and removal of compressive dressings, resulting in full recovery without tissue loss. Two patients, who exhibited impaired glans sensitivity, developed progressive ischemia. One had prior pelvic radiation, and the other underwent combined grafting and glanspexia. Both required surgical debridement and reconstruction, with permanent tissue loss. Conclusions: Glans color changes after penile prosthesis implantation do not always indicate irreversible ischemia. Preserved glans sensibility is a useful clinical marker of potentially reversible perfusion compromise and may support a conservative management strategy with close monitoring. Conversely, loss of sensation and necrosis should prompt urgent consideration of prosthesis explantation to prevent further tissue loss. Full article

Background: Cardiogenic shock (CS) and post-cardiac arrest syndrome (PCAS) are frequently associated with a systemic inflammatory response resulting from ischemia–reperfusion injury, endothelial dysfunction, and microcirculatory impairment. This inflammatory biology may be further amplified by temporary mechanical circulatory support (tMCS) through blood–surface interactions and shear-related hemolysis. Extracorporeal cytokine adsorption has therefore been proposed as an adjunctive strategy to attenuate hyperinflammation and facilitate shock reversal in selected patients. Methods: We conducted a narrative review, guided by a targeted PubMed and Scopus search and reference screening, to summarize the current pathophysiological concepts and clinical evidence on extracorporeal cytokine adsorption in CS-, PCAS-, and tMCS-supported states. Results: Across porous polymer hemoadsorption cartridges (e.g., CytoSorb^®), membrane-based or hybrid filters with adsorptive properties (e.g., oXiris^®), and selective approaches targeting inflammatory mediators (e.g., PentraSorb^® CRP), available studies most consistently report short-term physiological effects, including reduced vasopressor demand, improved metabolic stabilization, and modulation of inflammatory markers. However, evidence of benefits to clinically relevant endpoints remains inconsistent in various clinical settings, and randomized data are limited. Conclusions: Extracorporeal cytokine adsorption is a biologically plausible adjunct in inflammation-driven acute cardiovascular syndromes, but current evidence does not support routine use. Phenotype-guided patient selection, early timing, and adequately powered, mechanism-informed randomized trials are required to define clinical efficacy and safety in defined patient populations. Full article