Search Results (23,326)

Background: In patients with left ventricular hypertrophy, resting structural parameters alone may not explain exertional symptoms. Hence, we investigate whether combined Cardiopulmonary Exercise Testing- Exercise Stress Echocardiography (CPET-ESE) can provide an integrated functional characterisation of hypertrophic phenotypes. Methods: As a preliminary investigation, this prospective single-centre pilot study enrols 43 patients, categorised into: obstructive hypertrophic cardiomyopathy (n = 19), transthyretin cardiac amyloidosis (n = 15), or preserved-ejection-fraction hypertrophic phenotypes (n = 9). Patients undergo symptom-limited semi-supine CPET-ESE on an electronically braked cycle ergometer with an individualised ramp protocol. Peak effort is defined by symptom limitation and respiratory exchange ratio criteria ($RER\ge 1.05$), while peak VO₂ is defined as the highest 30 s averaged value. Results: Exercise responses differ across phenotypes. Patients with obstructive hypertrophic cardiomyopathy have higher peak VO₂ than the other groups, despite their lower chronotropic reserve. The preserved-ejection-fraction hypertrophic group shows lower peripheral oxygen extraction, whereas transthyretin amyloidosis shows a mixed central and peripheral limitation pattern. Right ventricle–pulmonary artery uncoupling is observed in the latter two groups. Conclusions: The use of CPET-ESE may help describe distinct physiological exercise profiles in hypertrophic phenotypes, but these findings should be considered exploratory. The small, heterogeneous and single-centre cohort precludes definitive mechanistic or predictive conclusions and supports the need for larger validation studies. Full article

Threat modelling is a methodology employed for identifying and analysing threats and applicable mitigations for web applications, mobile applications, infrastructure, and environments including smart home environments. Threat modelling starts with a tabletop exercise to identify threats. It provides extremely important insights into what can go wrong if certain events or a series of events take place. The identification of these events is critical to ensuring the right mitigation strategies are applied. Threat modelling also helps to identify security controls that may be assumed to provide required security, but, in reality, may not be addressing the existing and applicable threat(s). Existing literature, in the public domain and in academia, discusses threat materialisation for smart homes; however, entry points for a threat to materialise and exploit these vulnerabilities are not explored and a dedicated threat model for smart home environments is currently unavailable. Whilst threats can be mitigated by smart home device manufacturers, there are also mitigations that need to be applied by smart home owners who are both technology-aware and technology-unaware. In this paper, we propose a structured, domain-specific threat modelling methodology for smart home environments. The methodology models threats from a smart home owner’s perspective, identifies entry points and the mitigations that need to be implemented by a smart home owner. It also acknowledges that the attack surface expands and contracts and is not constant; which is addressed by applying zero-trust principles. Full article

Face recognition technologies are increasingly deployed in transport infrastructures to improve efficiency and security, but they raise significant privacy and data protection concerns. This study reviews how privacy-preserving face recognition techniques can address these challenges in real-world settings. Using a systematic literature review approach, the paper analyses research across technical, operational, and governance perspectives. The findings show that while advanced methods such as encryption, federated learning, and de-identification can reduce data exposure, they are rarely implemented in operational systems, which tend to prioritize performance and scalability. At the same time, governance-focused studies emphasize issues such as proportionality, accountability, and fundamental rights, often without clear links to technical solutions. Overall, the review highlights a fragmented landscape and a gap between research and practice, underscoring the need for integrated approaches that align privacy-preserving techniques with practical deployment constraints and regulatory requirements. Full article

Australia’s ban on social media for under-16s, introduced in December 2025, made it the first country worldwide to implement a nationwide prohibition on major platforms for adolescents. This narrative literature review compares Australia’s age-based restriction with international approaches to protecting young people from online risks. The review synthesized 26 academic studies and 15 grey literature sources (policy documents, legislation, and official reports published between 2015 and 2025). It employed Bronfenbrenner’s bioecological systems theory to examine effects across family, platform, institutional, and broader socio-legal contexts. Three key themes emerged: (A) Empirical findings on age-threshold policies remain inconclusive and context-dependent. While unregulated use relates to psychological vulnerabilities, structured and intentional engagement can promote social connection, identity exploration, and support access, especially for marginalized youth. (B) Global responses vary, favoring alternatives like parental consent, platform duty-of-care obligations, and screen-time control measures. (C) Balanced, sustainable harm reduction depends on combining parental involvement, platform accountability, and digital literacy education. Overall, while Australia’s precautionary approach addresses legitimate developmental and public health concerns, its effectiveness seems limited by enforcement challenges, risks of digital exclusion, and potential human rights issues. Bronfenbrenner’s framework underscores the need for coordinated governance across interconnected systems to lessen online harm. Full article

Background: An important role in postural control is played by the plantar proprioceptive inputs, as they contribute to the sensorimotor integration of the Tonic Postural System (TPS). Although plantar stimulation is an excellent strategy for improving balance, evidence remains limited. Therefore, the aim of this pilot study was to examine the acute effects of plantar proprioceptive training on dynamic balance performance and ankle range of motion (ROM). Methods: In this randomized controlled trial, 26 physically active young adults were divided into an experimental group (EG; n = 13) and a control group (CG; n = 13). The EG performed plantar proprioceptive training including walking on a reflexology mat and balance exercises on a proprioceptive pad. The CG remained lying supine on a couch for the same amount of time as the experimental intervention. The Y-Balance Test (YBT) was used to assess dynamic balance, while the ankle ROM (i.e., dorsiflexion and plantarflexion) was measured using an inertial sensor. All measurements were taken before (T0) and immediately after (T1) the experimental or control condition. Results: Improvements in the YBT were found in the EG from T0 to T1 for both right (p = 0.002; SE = 1.24) and left (p = 0.015) foot, but no changes from T0 to T1 were observed in the CG for both right and left foot (p > 0.05). No changes were observed for ankle ROM in both groups (p > 0.05). Conclusions: These preliminary results suggest that plantar proprioceptive training can provide acute improvements in dynamic balance with no significant changes in ankle ROM. The findings support a potential role of plantar stimulation in postural control mechanisms. Full article

Background: Emerging evidence highlights the importance of the MIF–sCD74 axis in health and disease, including its role in regulating cell death. While studies in routine cardiac surgery suggest perioperative relevance, its role in end-stage heart failure (ESFH) patients undergoing left ventricular assist device (LVAD) implantation remains unexplored. Moreover, although MIF and sCD74 induce necroptosis in neonatal cardiac myofibroblasts, the effects of MIF, its paralog D-DT, and sCD74 on adult cardiac myofibroblasts (CMFs) are unknown. Methods: Plasma concentrations of sCD74, MIF and D-DT were measured perioperatively in a small cohort of patients with ESHF undergoing LVAD implantation (n = 20). As a preclinical model of ESHF, primary adult CMFs were treated with recombinant MIF, D-DT and sCD74 to evaluate their effects on cellular viability and health. Results: In LVAD patients, sCD74 and D-DT levels were significantly increased 24 h postoperatively, whereas MIF levels were reduced compared to baseline. ROC curve analysis demonstrated a good discriminatory power of 24 h post-OP sCD74 (AUC = 0.83), sCD74/MIF ratio (AUC = 0.82), and D-DT levels (AUC = 0.88) for acute kidney injury, composite outcome, and right heart failure (RHF), respectively. In adult CMFs, MIF and sCD74 synergistically reduced viable cell counts (p = 0.0083), whereas D-DT reduced cell counts in an sCD74-independent manner (p = 0.0004). Yet, measures of metabolism, proliferation, apoptosis and necrosis along with inflammatory gene expression remained unchanged. Conclusions: Our findings indicate that the balance of MIF, D-DT, and sCD74 during LVAD implantation may be clinically relevant. In particular, an imbalance characterized by elevated sCD74 or D-DT and reduced MIF levels 24 h post-surgery was associated with unfavorable clinical outcomes. Yet, the current findings are exploratory and hypothesis-generating because of a small sample size. Thus, the prognostic value of plasma levels for postoperative complications after LVAD implantation, and the effects of MIF/D-DT/sCD74 imbalance on cardiac myofibroblasts, need to be validated in larger cohorts and in advanced human experimental models. Full article

Climate change and environmental degradation are increasingly recognized as major drivers of human mobility, operating through both sudden-onset disasters and slow-onset processes such as sea-level rise, desertification and resource scarcity. Although estimates vary widely, projections suggest that millions of people may become displaced by 2050 because of climate change, predominantly within their own countries but also across international borders. This article examines the emerging phenomenon of “environmental migration” against the backdrop of international refugee law and broader human rights frameworks. It first maps the diverse environmental scenarios that trigger displacement before analyzing the existing international legal landscape. Particular attention is paid to the contested terminology surrounding “climate refugees”, “environmental migrants” and “environmentally displaced persons” and to the protection gaps that arise from current categorizations. This article argues that, while existing norms on human rights, disaster risk reduction and internal displacement offer partial safeguards, they do not provide coherent legal status or systematic protection for people displaced across borders by climate-related harms. It concludes that climate-related displacement should be addressed through a combination of evolving human rights-based climate litigation, enhanced use of existing instruments and the progressive elaboration of specific normative frameworks. Full article

Background: Oncocytic lipoadenoma is an exceptionally rare benign fat-containing salivary gland tumor that most commonly arises in the parotid gland. Previous case reports have largely focused on histopathology with limited or single-modality imaging documentation; therefore, practical preoperative radiological characterization remains challenging. Case Presentation: A 46-year-old male presented with a 2-year history of a slowly enlarging right-sided parotid mass. Computed tomography and magnetic resonance imaging showed a well-circumscribed fat-containing mass with a discrete medially enhancing solid component, mild diffusion restriction and small cystic foci without aggressive features. Ultrasonography revealed a heterogeneously hypoechoic parotid mass; however, limited acoustic penetration hindered evaluation of the deep portion. A core-needle biopsy was inconclusive, and an atypical lipomatous tumor could not be excluded. Subsequent surgical excision confirmed an oncocytic lipoadenoma, a biphasic tumor comprising mature adipose tissue and cytokeratin 7-positive oncocytic epithelial nests. The patient has remained recurrence-free for 7 years after surgery. Conclusions: Fat-containing parotid tumors can be diagnostically challenging because imaging findings are often nonspecific, and biphasic lipoepithelial entities are rarely encountered. This case highlights that awareness of the pattern of macroscopic fat with a discrete enhancing non-fat component, interpreted alongside histopathological findings, may help narrow the differential diagnosis, guide management, and reduce diagnostic uncertainty. Full article

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper extremity and results from compression of the median nerve within the fibro-osseous carpal tunnel. Anatomical variants such as a bifid median nerve (BMN) and a persistent median artery (PMA) may increase tunnel occupancy and complicate both diagnosis and treatment. High-resolution musculoskeletal ultrasound enables detailed evaluation of these anatomical variations and facilitates image-guided interventions. Ultrasound-guided hydrodissection has emerged as a minimally invasive technique capable of mechanically releasing perineural adhesions and restoring nerve mobility. Alpha-2 macroglobulin (A2M), an autologous plasma protease inhibitor with anti-inflammatory and cytokine-binding properties, has recently been explored as a biologic adjunct in musculoskeletal conditions. We report the case of a 60-year-old right-handed woman who presented with a one-year history of numbness, paresthesia, and pain within the median nerve distribution of her dominant hand. Ultrasound examination demonstrated a bifid median nerve accompanied by a persistent median artery and perineural edema within the proximal carpal tunnel. The patient underwent three weekly sessions of ultrasound-guided hydrodissection using autologous A2M prepared through the APEX filtration system. The patient reported progressive clinical improvement following treatment. Grip strength increased from 12 kg at baseline to 22 kg at week twelve. Follow-up ultrasound performed ten months after treatment showed restoration of median nerve fascicular architecture and normalization of nerve morphology, findings consistent with interval structural improvement. This case highlights the role of ultrasound in the integrated evaluation and management of CTS with anatomical variants, including diagnosis, procedural guidance, and longitudinal assessment. Ultrasound-guided hydrodissection with A2M may represent a feasible minimally invasive approach in selected patients; however, further prospective studies are required to determine its safety and therapeutic efficacy. Full article

Farmland management rights (FMR) mortgage lending has been advanced as a central instrument of rural credit reform in China, yet the program has consistently failed to sustain itself in the absence of direct government facilitation. Drawing on five national and provincial pilot counties in Henan Province, this study investigates the structural factors underlying this sustainability failure. We employ a sequential mixed-methods design: grounded theory analysis of in-depth interviews, policy documents, and media reports from five focal sites to inductively construct a constraint framework, followed by structural equation modeling (SEM) validation using 1055 survey responses. Our grounded theory analysis identifies three internal constraint categories—property rights insecurity, a thin secondary land market, and subject-level agricultural risk—and one external environmental constraint, which together produce a state of mutual non-recognition: neither financial institutions nor farming households regard FMR as legitimate collateral. Notably, the effect of collateral acceptance on farmer mortgage willingness is statistically insignificant, revealing that demand-side barriers are more deeply entrenched than supply-side institutional improvements alone can resolve. These findings challenge the premise that legal formalization of land rights is sufficient to generate market-driven credit activity, and call attention to the equally important role of institutional ecosystem development—encompassing land markets, appraisal capacity, supervisory infrastructure, and rural credit culture. The insights carry direct relevance for developing economies exploring land-backed agricultural credit as a rural finance strategy. Full article

Background and Objectives: Previous comparisons between right anterior mini-thoracotomy (RAT) and partial upper sternotomy (PS) for aortic valve replacement (AVR) have shown similar clinical outcomes. This study aims to assess the potential in-hospital cost differences in one technique over the other. Materials and Methods: Between 2018 and 2023, 303 patients at our institution underwent minimally invasive isolated AVR (241 PS vs. 62 RAT). Endocarditis, emergencies, and reinterventions were excluded. A 1:1 nearest neighbor propensity-matched analysis without replacement was performed. Perioperative clinical outcomes and hospital costs were analyzed, comparing total and average (per patient) direct, indirect, and total hospital costs between the two groups. Multivariable linear regression identified significant predictors of hospital costs. Results: Sixty-two well-matched pairs were analyzed. Significant differences were found in intraoperative (PS: 27/62, 43.5% vs. RAT: 10/62, 16.1%, p = 0.002) and postoperative transfusions (PS: 33/62, 53.2% vs. RAT: 16/62, 25.8%, p = 0.003), and median intensive care unit (ICU) hours (PS: 52.2 vs. RAT: 45.7, p = 0.007). Average direct, indirect, and total hospital costs were significantly higher for PS (p = 0.038, p = 0.040, and p = 0.035, respectively), with significant blood bank cost differences favoring RAT (p = 0.010). Multivariable linear regression showed that intraoperative and postoperative transfusions, ICU, and hospital length of stay were significantly associated with hospital costs, but not the surgical approach. Conclusions: PS and RAT have comparable perioperative clinical outcomes, with differences observed only in the number of transfusions and ICU stay, both favoring RAT. Given the significant perioperative differences and regression analysis results, the cost advantage of RAT is likely mediated through its impact on these perioperative outcomes. Full article

Nowadays, it is central to generate innovations that convert agricultural by-products and food waste into valuable animal products while promoting the long-term resilience and sustainability of vulnerable animal production systems. Nutraceuticals (i.e., ‘nutrition + pharmaceutical’) are derived from foods that offer health benefits. In animal production, nutraceutical supplementation with Withania somnifera and Lepidium meyenii has shown positive effects on the endocrine, cardiopulmonary, and central nervous systems. We aimed to evaluate the possible impact of nutraceutical supplementation on rams fed a diet based on surplus feed from a highly industrialized Holstein cow production system, on corporal (live weight [LW], kg; body condition score [BCS], units), metabolic (blood glucose [GLU], mg dL⁻¹; serum protein [PRO], g 100 mL⁻¹), and sexual–testicular variables [sexual odor (ODOR, units); scrotal circumference (SC, cm); testicular volumes (TVOL, cm³); and estimated daily sperm production (EDSP, millions)]. Black Belly rams (n = 12; LW = 70.36 ± 1.2 kg; BCS = 2.96 ± 0.03 units; age = 3.8 ± 0.2 years; 25° N) were divided into 3 experimental groups: (1) WITH, supplemented with Withania somnifera (400 mg kg⁻¹ LW d⁻¹); (2) LEPI, supplemented with Lepidium meyenii (400 mg kg⁻¹ LW d⁻¹); and (3) CONT, not supplemented. The variables LW, BCS, GLU, PRO, and SC, as well as some components of TVOL, did not differ (p > 0.05) among the main effects of treatment or time; only ODOR, right transverse testicular diameter, and total testicular volume differed among treatments, generally favoring the WITH group. Furthermore, the TRT × T interaction demonstrated superior performance (p < 0.05) in the WITH group, with the largest values for LW, GLU, PRO, ODOR, SC, width of the right testicle, volume of the right testicle, total testicular volume, and EDSP. From a productive–reproductive perspective, the Robin Hood Effect—through the use of rejected dairy cattle rations as the base diet for rams—and supplemented with nutraceuticals (WITH and LEPI), emerges as a viable alternative to improve not only the productive–reproductive performance of Black Belly rams, but also other productive and socioeconomic outcomes; the latter contributing to the strengthening of producer and family well-being. Full article

Typhoon passages typically induce significant upper-ocean responses, especially on the right side of the typhoon track. However, how mesoscale eddies modulate this left–right asymmetry remains insufficiently understood. Using high-resolution remote sensing data and reanalysis datasets, this study examines the impacts of a mesoscale eddy dipole influenced by Typhoon Ma-on (2011). The study finds that: (1) The eddy responses exhibit significant asymmetry: during Typhoon Ma-on (2011), the amplitude, circulation speed, and radius of the left side cyclonic eddy (CE) showed anomaly increases of 8.6 cm, 4.3 cm/s, and 54.3 km, respectively, whereas those of the right-side anticyclonic eddy (AE) showed anomaly decreases of 2.9 cm, 4.8 cm/s, and 13.9 km. (2) Mesoscale eddies modulate sea surface cooling with significant left–right asymmetry, differing from the conventional pattern of stronger right-side cooling. The left side CE enhanced surface cooling by up to 2.38 °C, while the right-side AE exerted a suppressing effect, with a cooling magnitude of 0.96 °C. (3) Within the CE, a significant negative temperature anomaly develops below about 20 m. Despite a relatively high Richardson number ($Ri$) and weak vertical shear that suppress excessive turbulent mixing, negative $W_s$-driven upwelling dominates, allowing cold water to be efficiently uplifted and maintaining or intensifying surface cooling. In contrast, the AE exhibits surface cooling but persistent positive anomalies below about 40 m, reflecting the partial retention of its subsurface warm water. In this case, reduced $Ri$ and enhanced shear instability promote stronger vertical mixing, enabling subsurface heat to be transported upward, thereby offsetting and weakening the surface cooling signal. Full article

The Akseki–Kuyucak bauxite deposits, located in the Western Taurus Belt in southwestern Türkiye, represent karst-type bauxite mineralization derived from carbonate platform phases. This work integrates field observations, X-ray diffraction (XRD) analysis, and extensive geochemical data, including major, trace, and rare earth elements (REEs), to clarify the mineralogical characteristics, geochemical processes, and genetic implications of the deposits. Field and petrographic investigations indicate that the bauxite deposits occur as irregular fills and lens-shaped formations on paleokarstic surfaces of carbonate substrates. The XRD examination reveals that the major minerals in the bauxite samples are boehmite, hematite, and anatase, with some samples exhibiting a predominance of calcite, indicating a strong genetic relationship between the ore bodies and the carbonate host rocks. Major oxide analysis reveals a distinct compositional disparity between bauxitic and carbonate-dominated materials: bauxitic samples exhibit elevated Al₂O₃ and Fe₂O₃ levels, with reduced SiO₂ and CaO concentrations. In contrast, carbonate-rich samples show higher CaO and loss-on-ignition values. Ternary discrimination diagrams categorize most bauxitic samples into the ferritic bauxite and robust lateritization domains, indicating substantial weathering and residual enrichment processes. The trace element and REE studies reveal ΣLREE values ranging from 22.3 to 240.2 ppm, with a right-skewed distribution indicating heterogeneous enrichment. Correlation studies indicate that ΣLREE has a positive correlation with SiO₂ and K₂O, suggesting that the enrichment of REEs is more closely associated with silicate/clay minerals than with iron oxide phases. Furthermore, spider diagrams and the study of immobile components emphasize the significance of residual concentration processes in bauxitization. In contrast, modest TiO₂ levels indicate a composite source derived from both insoluble carbonate remnants and detrital siliciclastic materials. In summary, the Akseki–Kuyucak deposits are categorized as intricate karst bauxite systems, characterized by significant lateritization, regulated accumulation governed by paleokarst characteristics, and a complex geochemical evolution. The results demonstrate that integrating mineralogical, geochemical, and statistical methods provides a thorough framework for evaluating REE behaviors and the effects of source-related factors in karst bauxite deposits. Full article

Background: Iron overload cardiomyopathy (IOC) is a major determinant of outcomes in hemochromatosis, and conventional echocardiography may miss early myocardial toxicity. Comparative data on primary (PH) versus secondary hemochromatosis (SH) using myocardial work (MW) indices are limited. Methods: We performed a retrospective cross-sectional study of 34 adults (16 PH and 18 SH patients) at a tertiary center. They all underwent echocardiography with speckle-tracking to obtain LV global longitudinal strain (GLS) and non-invasive MW indices from pressure-strain loops: global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE). Echocardiographic phenotypes were classified as a Normal, Dilated, Restrictive, or right ventricular/pulmonary hypertension (RVPH) phenotype. Results: SH patients showed higher iron burden and neurohormonal activation than PH patients (maximum ferritin 2954 vs. 444 ng/mL; BNP 93 vs. 13.5 pg/mL; both p < 0.001) and accounted for all deaths (33% vs. 0%) despite similar 3D LVEFs and GLSs. PH patients predominantly exhibited Normal phenotypes (81%), whereas SH patients more often showed advanced phenotypes, mainly RVPH and Dilated. GWI correlated inversely with ferritin (ρ ≈ −0.40), particularly ferritin at echocardiography in SH patients, while PH patients showed no significant correlations. GWW was higher in Dilated/RVPH compared to Normal phenotypes, and in SH patients, higher maximum ferritin was associated with impaired right ventricular free-wall strain. Conclusions: PH and SH patients exhibit distinct IOC phenotypes, with SH patients showing more advanced remodeling and worse outcomes. In this exploratory analysis, MW indices showed modest associations with iron burden markers, suggesting they may provide complementary information beyond LVEF and GLS. These preliminary findings require validation in larger, prospective studies. Full article