Search Results (8,324)

Background: Vitamin B12 deficiency is a recognized but frequently under-integrated cause of global developmental delay (GDD) in infancy and early childhood. Early diagnosis is critical because neurological impairment may be partially or completely reversible with timely treatment. Objective: This narrative review aims to synthesize current evidence on the role of vitamin B12 deficiency in the diagnostic evaluation of GDD, with a focus on clinical phenotype, risk factors, biomarkers, treatment outcomes, and practical integration into contemporary diagnostic algorithms. Methods: A structured, non-systematic search of PubMed/MEDLINE, Embase, and Web of Science was performed to identify clinical studies, case series, reviews, and guideline documents addressing pediatric vitamin B12 deficiency and neurodevelopmental delay. Results: Vitamin B12 deficiency in early childhood is most commonly associated with maternal deficiency and exclusive breastfeeding without adequate supplementation. Evidence from recent clinical and observational studies indicates that vitamin B12 deficiency may present with nonspecific neurological symptoms, including developmental regression, hypotonia, and feeding difficulties. Incorporating vitamin B12 assessment—using serum vitamin B12, holotranscobalamin, methylmalonic acid, and homocysteine—into early diagnostic algorithms for GDD may facilitate timely identification of a treatable cause of neurodevelopmental impairment. The proposed diagnostic framework emphasizes early biochemical evaluation in infants with unexplained developmental delay, thereby supporting prompt treatment during a critical window of neurological reversibility. Conclusions: Targeted assessment of vitamin B12 status in children with GDD, together with evaluation of maternal status, represents a clinically relevant approach to identifying a potentially preventable and treatable cause of neurodevelopmental impairment. Integration of functional biomarkers into diagnostic pathways and the development of pediatric-specific reference standards are key priorities for future research and clinical practice. Full article

Cardiomyopathies comprise a heterogeneous group of myocardial disorders characterized by structural and/or functional abnormalities in the absence of secondary causes of myocardial dysfunction. Although genetic determinants play a central role in many forms of the disease, incomplete penetrance and the frequent absence of identifiable pathogenic variants suggest that additional mechanisms contribute to disease onset and progression. Growing evidence supports the pathogenic role of autoimmune processes in several cardiomyopathy phenotypes. A spectrum of autoantibodies targeting cardiac self-antigens, including structural proteins, intercalated disc components, intracellular proteins such as calreticulin, and G protein-coupled receptors, has been identified in affected patients. Experimental and clinical data suggest that these autoantibodies may exert functional effects on cardiomyocyte signaling pathways and intercellular coupling, thereby promoting maladaptive remodeling, progressive ventricular dysfunction, and an increased risk of arrhythmias. Accordingly, autoantibody profiling may facilitate the identification of biologically distinct cardiomyopathy subsets with potential diagnostic and prognostic implications. From a therapeutic perspective, pathogenic autoantibodies can be removed from patient serum through plasmapheresis or immunoadsorption strategies, and these approaches have been associated with improvements in hemodynamic parameters and clinical outcomes in selected patients. Full article

Type 1 diabetes is the most common autoimmune endocrine disorder in children and adolescents, with incidence rising worldwide. Its management demands comprehensive care encompassing glucose monitoring, insulin therapy, and individualized nutritional education to support glycemic control and overall health. Establishing normal eating patterns is pivotal not only for prandial euglycemia but also for reducing the risk of disordered eating behaviors and eating disorders that are more frequently observed in youth with diabetes. Because eating patterns and self-management capabilities vary by developmental stage, interventions must be tailored to the physical, psychological, and social context of each age group. Screening tools such as the Diabetes Eating Problem Survey—Revised (DEPS-R) enable timely identification of at-risk individuals. In this scoping review we present the data from the literature regarding the eating patterns and deviations from infancy to adolescence, report the complications and discuss the challenges and insights for their management. Full article

Seismic collapse can cause catastrophic losses, and acceptable annual collapse probability with its CMR target is a core metric in performance-based design. Existing ATC-63-based CMR research mainly addresses non-damped systems and often uses a single lumped dispersion, obscuring damper-reliability contributions and hindering alignment with CECS 392 limits. This study proposes a unified, code-consistent decision framework for acceptable annual collapse probability and CMR that jointly accounts for seismic hazard and damper-related uncertainty. The total collapse dispersion is decomposed as ${\sigma }_{\mathrm{total},\mathrm{damp}}^2={\sigma }_{\mathrm{base}}^2 +{ \sigma }_{\mathrm{damper}}^2$, where ${\sigma }_{\mathrm{b}\mathrm{a}\mathrm{s}\mathrm{e}}$ represents background dispersion independent of dampers and ${\sigma }_{\mathrm{d}\mathrm{a}\mathrm{m}\mathrm{p}\mathrm{e}\mathrm{r}}$ captures incremental uncertainty induced by degradation and partial failure. A code-designed viscous-damped RC frame is evaluated under three scenarios (nominal damping, 20% damping-coefficient reduction, and 7% random damper failures). Using the same 14 records and $\mathrm{S}\mathrm{a}\left({\mathrm{T}}_1,5\%\right)$ as the intensity measure, multi-stripe IDA and Probit-based lognormal fragility fitting yield median collapse intensities $\mathrm{S}\mathrm{c}\approx 2.18-2.24 \mathrm{g}$, with only ~2–3% reduction under mild degradation/failure. A random-effects variance decomposition identifies σ_damper ≈ 0, indicating a limited marginal contribution of damper-related uncertainty within the degradation range considered in this study. Closed-form relationships between annual collapse rate, $\mathrm{S}\mathrm{c}$, and ${\sigma }_{\mathrm{t}\mathrm{o}\mathrm{t}\mathrm{a}\mathrm{l},\mathrm{d}\mathrm{a}\mathrm{m}\mathrm{p}}$ are then derived under a power-law hazard model and inverted to generate acceptable-risk intervals and CMR target curves/matrices. Results show that higher design intensity and larger ${\sigma }_{\mathrm{t}\mathrm{o}\mathrm{t}\mathrm{a}\mathrm{l},\mathrm{d}\mathrm{a}\mathrm{m}\mathrm{p}}$ demand substantially higher CMR, highlighting potential risk underestimation when relying solely on nominal CMR. The framework enables explicit identification of damper-related uncertainty from limited collapse data and provides a practical workflow for collapse-prevention design and post-assessment under explicitly defined scenario conditions, with a clear pathway for extension to broader scenario spaces. Full article

Runway incursions remain a major threat to airport surface safety, and effective prevention depends on the accurate identification of causal risk factors and their interaction mechanisms. However, existing studies have mainly focused on isolated risk factors or static causal relationships, offering limited insight into the hierarchical structure and dynamic propagation of runway incursion risk in complex operational environments. To address this gap, this study proposes a quantitative framework for runway incursion risk analysis by integrating grounded theory and complex network theory. Published runway incursion cases in the Chinese civil aviation system from 2022 to 2025 were systematically analyzed through open coding, axial coding, and selective coding, resulting in a hierarchical indicator system comprising five main categories, twelve subcategories, and 112 risk indicators. Based on this system, a runway incursion causal network was constructed to characterize the causal interdependencies among risk factors. Node importance was evaluated using a TOPSIS-based multi-criteria method integrating multiple network metrics, and a load-distribution-based propagation mechanism was introduced to quantify the risk propagation probability and risk propagation intensity of each node. The results indicate that insufficient night lighting (N99), taxi-route memory errors (N14), ambiguous controller instructions (N1), and excessive controller workload (N10) exhibit relatively high risk propagation probability and risk propagation intensity, indicating their critical roles in the evolution and cascading propagation of runway incursion risk. These findings demonstrate that the proposed framework can effectively capture both the structural importance and propagation characteristics of causal risk factors. Therefore, this study provides quantitative support for understanding runway incursion risk evolution and for developing targeted prevention strategies and post-incident response measures to improve runway safety management. Full article

This paper presents an active prevention and control technology for bed separation water inrush hazards, the effectiveness of which has been validated. Based on the hazard degree identification of such hazards and corresponding preventive measures, the Fuzzy Analytic Hierarchy Process (FAHP) and Expert Grading System (EGS) are adopted to analyze the prevention mechanisms and determine the indicator weights of different influencing factors. The results show that enhancing drainage capacity and accurately predicting bed separation water inflow are two effective measures to prevent water inrush or reduce the hazard risk coefficient. In addition, controlling the development of water-conducting fractured zones and optimizing drainage measures are also effective approaches to reducing the risk coefficient. The research results provide a theoretical basis and practical guidance for the prevention and control of bed separation water inrush hazards, and offer an effective and cost-efficient method for addressing such mining-induced hazards. Full article

Background: There is limited contemporary evidence on predictors of adverse outcomes in ST-elevation myocardial infarction (STEMI) involving the right coronary artery (RCA). We examined this in a single-centre retrospective cohort study, focusing on 30-day outcomes. Methods: Consecutive patients presenting to an Australian tertiary hospital between May 2022 and April 2024 with acute STEMI who underwent primary percutaneous coronary intervention (PCI) or rescue PCI were eligible. Patients were divided into STEMI due to RCA and non-RCA culprit lesions, and their characteristics were compared. The primary outcome was a composite of 30-day all-cause mortality and cardiogenic shock. Results: Among 320 included patients, the primary composite outcome was similar between the RCA and non-RCA groups (12% vs. 15%, p = 0.44), although 30-day mortality was lower in the RCA-STEMI group (2% vs. 8%, p = 0.01). In the RCA-STEMI cohort, right ventricular (RV) longitudinal dysfunction on echocardiogram, defined as a tricuspid annular plane systolic excursion (TAPSE) < 17 mm or RV tissue doppler lateral annular systolic velocity (RV S′) < 10 cm/s (p = 0.04), and Thrombolysis in Myocardial Infarction (TIMI) flow < 3 in the RV marginal branch post-PCI (p = 0.04) were independently associated with the primary outcome. The latter was also associated with a higher risk of intensive care unit admission for cardiogenic shock (p < 0.01) and heart failure requiring inpatient diuresis (p = 0.02). Conclusions: In patients with RCA-STEMI, compromised RV marginal branch flow post-PCI and impaired RV function were independently associated with the composite primary outcome of 30-day all-cause mortality and cardiogenic shock. These characteristics may assist early identification of at-risk individuals who could benefit from pro-active monitoring and early implementation of therapies for cardiogenic shock. Full article

With the continuous renewal of urban greening, pollen released by allergenic tree species has become a prominent environmental issue affecting residents’ health. However, existing research still lacks city-wide, rapidly replicable methods for identifying allergenic tree species and assessing exposure risks. Taking Beijing’s central urban districts as a case study, this research establishes a method for the automated identification of allergenic tree species and the assessment of pollen exposure risks based on high-resolution satellite imagery. This study coupled tree species distribution results derived from model inference with population density per unit area to delineate three tiers of exposure risk zones. Subsequently, these risk zones were overlaid with the road network within the study area to determine the distribution of roads with low, medium, and high exposure risk. Public transport stop locations were then introduced as a proxy variable for areas of high population mobility. Lorenz curves and Gini coefficients were calculated to quantify the spatial equity of pollen exposure risk. The results indicate that the model reliably identifies target tree species, with approximately 117,000 valid targets. Exposure risks exhibit significant clustering characteristics and can form continuous expansions along road networks. Incorporating population factors shows minimal change in risk concentration, suggesting pollen exposure risk is primarily driven by the spatial clustering of allergenic tree species and their accessibility within road networks. This risk is highly correlated with the spatial distribution patterns and accessibility characteristics of allergenic tree species, rather than being solely determined by population size. This study provides foundational data and methodological support for urban tree species identification, pollen exposure risk management, and optimised greening configurations. Full article

Background: Ulcerative colitis (UC) is an intestinal disease characterized by long-term inflammation. Circadian rhythm disorder (CRD) affects various biological activities and has been linked to several diseases, including UC. This study aimed to investigate the role and significance of CRD in UC. Methods: Bulk RNA-seq data from five independent UC cohorts were obtained from the Gene Expression Omnibus (GEO) database and integrated into a single dataset. The dataset underwent differential analysis to identify differentially expressed genes (DEGs) in association with CRD. Expression levels and pathway enrichment of CRD genes were analyzed, and signature genes were identified using machine learning algorithms. Based on these signature genes, a UC risk prediction model and CRD-related molecular subtypes were established. Furthermore, single-cell RNA-seq data of UC were analyzed to discuss the key role of CRD and signature genes in the UC microenvironment. RT-PCR analysis was employed to validate the expression levels of the identified signature genes. Results: 247 DEGs associated with CRD in UC were identified (referred to as CRD-DEGs). Gene set enrichment analysis (GSEA) revealed a strong association between CRD and inflammation, as well as immune cell infiltration in UC. This association potentially impacts intestinal fibrosis. A comparison of three machine learning algorithms (Lasso, SVM-RFE, and Random Forest) resulted in the identification of 12 signature genes. A UC risk prediction model and two UC CRD subtypes were developed using these genes. Among them, STXBP1 was identified by all three machine learning algorithms and was further analyzed. STXBP1 was predominantly enriched in pathways related to inflammatory response. Elevated levels of STXBP1 are mainly caused by reduced levels of methylation of its gene promoter. RT-PCR confirmed elevated expression of certain genes in mouse UC models. Conclusions: This study is the first to establish a strong association between CRD and the onset of UC. The newly developed UC nomogram based on CRD demonstrated high predictive accuracy, although further clinical validation is required. Understanding the intrinsic relationship between CRD and UC enhances our understanding of the potential pathogenesis of UC. This study introduces novel ideas and methods for early diagnosis, treatment, and prognosis of UC. Full article

Arsenic (As) is a ubiquitous and highly toxic metalloid with well-established carcinogenicity. Its accumulation and secondary release from lake sediments pose potential risks to lake ecosystem integrity and human health. Meanwhile, the ongoing intensification of lake eutrophication at the global scale has altered the sources, composition, and environmental behavior of internally derived dissolved organic matter (DOM). These changes have profoundly influenced As mobilization and transformation at the sediment-water interface (SWI). To advance understanding of the regulatory roles and underlying mechanisms of algal dissolved organic matter (ADOM) and submerged macrophyte dissolved organic matter (SMDOM) in As biogeochemical cycling under lake ecosystem regime shifts, extensive findings from the international literature were synthesized. The characteristic properties and environmental behaviors of ADOM and SMDOM were systematically compared, and their distinct regulatory pathways in lacustrine systems were further summarized. Results indicate that ADOM is typically characterized by low molecular weight, weak aromaticity, and high bioavailability. It can enhance As dissolution and mobilization from sediments through direct complexation, competition for adsorption sites, and stimulation of microbial metabolism and Fe(III) reduction. In contrast, SMDOM exhibits higher molecular weight, greater aromaticity, and a higher degree of humification. It tends to form stable complexes with mineral phases. Under the influence of radial oxygen loss (ROL) from submerged macrophyte roots during the growth phase, its capacity to promote mineral reduction is relatively limited. This process favors stable As retention in sediments. The regulatory effects of ADOM and SMDOM on As behavior are strongly modulated by environmental factors such as pH, redox potential (Eh), temperature, and light conditions, as well as by microbial communities. ADOM is more sensitive to reducing environments and photochemical processes. SMDOM, in contrast, exerts more persistent control under oxidizing conditions and at mineral-water interfaces. In addition, ADOM more readily drives microbial community shifts toward assemblages with enhanced capacities for Fe(III) reduction and As reduction or methylation. SMDOM is less likely to trigger strongly reducing processes. Based on these mechanisms, the outbreak and decay phases in algal-dominated lakes often correspond to critical periods of enhanced As mobilization and elevated ecological risk. In submerged macrophyte-dominated lakes, the decay phase may represent an important window for sedimentary As release. Finally, a conceptual framework describing the differential regulation of As biogeochemical cycling by ADOM and SMDOM is proposed. This framework provides a theoretical basis for As risk identification, the determination of critical risk periods, and the development of management strategies across lakes with different trophic states. Full article

Low-accessible Cultural Heritage, including hypogeal sites, rupestrian architectures, and fragile structures, represents a major challenge for conservation, documentation, and continuous monitoring. These limitations stem from multiple inaccessibility factors, classified as physical (morphological complexity), asset risk (microclimatic instability), health and safety (structural vulnerability), managerial (lack of public access), and cognitive (lack of documentation). This research aims to transform digital models from mere representational tools into integrated cognitive and operational systems supporting decision-making and preventive conservation. The proposed methodological workflow is structured into five main phases: Preliminary Knowledge and Multidisciplinary Data Structuring (Ph1. PK–MDS), Comprehensive Digital Survey (Ph2. CDS), Development of Integrated Digital Models (Ph3. IDMs), Advanced Diagnosis and Monitoring (Ph4. ADM) and the implementation of an Integrated Digital Environment for Hypogeal Heritage Management (Ph5. IDE). Ph4 operates on two complementary scales: at the site scale, range-based point clouds enable the semi-automatic identification of extensive decay patterns, such as biological colonization. At the detail scale, the Random Forest algorithm enables the segmentation and quantification of material loss on frescoed surfaces through a diachronic comparison of historical and current data. Validated on the San Pellegrino complex in Matera, selected as a paradigmatic case study of low-accessibility hypogeal sites, representative of a broader system comprising approximately 150 rupestrian cult architectures, the methodology demonstrates how immersive digital environments function as shared knowledge spaces, supporting more informed, inclusive, and resilient heritage conservative management. Full article

Background/Objectives: Several studies previously investigated the risk factors for post-operative recurrence of primary spontaneous pneumothorax (PSP), with conflicting results. Identification of patients at greater risk of recurrence may help optimize therapeutic strategies. The aim of this study is to identify potential predictors of post-operative recurrence of PSP and compare our results with the available literature. Methods: We retrospectively evaluated all patients who underwent surgery for PSP at our institution between January 2005 and December 2022. We analyzed data on patient characteristics, surgical details, method of pleurodesis and perioperative outcomes and used Cox regression analysis to identify predictors post-operative ipsilateral recurrence. Results: 226 patients were included in our study, of which 29 (12.8%) developed an ipsilateral recurrence of pneumothorax. A positive history of previous contralateral episodes (37.9% vs. 19.3%, p = 0.03) and the positioning of larger chest drains after the procedure (65.5% vs. 44.8%, p = 0.032) were more frequent in the recurrence group. At multivariable regression analysis, a history of previous contralateral pneumothorax was found to be the only independent predictive factor of pneumothorax recurrence (HR 2.16, 95% C.I. 1.001–4.662, p = 0.049). Conclusions: Previous contralateral pneumothorax is a risk factor for the development of post-operative recurrences. Full article

Offshore pipeline systems associated with floating platforms operate under complex environmental and operational conditions that significantly influence their structural integrity and inspection requirements. Limited accessibility, harsh marine environments, and time-dependent degradation mechanisms require inspection planning to be supported by structured decision-making frameworks capable of explicitly accounting for both degradation processes and failure consequences. In this study, a Risk-Based Inspection (RBI)-driven integrity assessment is applied to three carbon steel pipeline systems associated with a SPAR offshore platform. The analysis integrates system description, identification of dominant damage mechanisms, and RBI quantification to evaluate probability of failure and consequence-related risk under offshore operating conditions. Internal corrosion is identified as the dominant long-term degradation mechanism for all analyzed pipelines, while external corrosion governs short-term inspection interval definition due to its higher growth rate and sensitivity to insulation characteristics and environmental exposure. Although all pipelines are classified within the same overall qualitative risk category, significant differences in failure probability, risk intensity, and consequence-driven risk behavior are observed, reflecting variations in system configuration, insulation systems, length, and functional role within the offshore production infrastructure. To enable meaningful comparison between pipeline systems of significantly different total lengths, normalized risk indicators per unit length are introduced. These indicators provide additional insight into local risk intensity and spatial risk distribution that are not evident from absolute risk values alone. The results highlight the importance of treating risk as a dynamic quantity rather than a static classification and demonstrate that RBI-based assessment supported by normalized risk metrics can enhance inspection prioritization and maintenance decision-making for SPAR-associated offshore pipeline systems. Full article

Invasive candidiasis (IC) remains a significant cause of morbidity and mortality among critically ill, hematologic, and neonatal patients worldwide. Rapid and accurate diagnosis is essential to guide timely antifungal therapy and improve outcomes. Among available diagnostic tools, 1,3-β-D-glucan (BDG), a polysaccharide component of the fungal cell wall, has emerged as a key biomarker. BDG assays allow for early detection of probable IC, often preceding positive blood cultures, and offer prognostic information based on serial measurements. Species-specific differences in Candida cell wall composition influence BDG release and diagnostic sensitivity. Candida albicans generally correlates with high BDG levels, whereas Nakaseomyces glabrata, Candida parapsilosis, and Candida auris exhibit variable or lower glucan exposure, limiting assay sensitivity. BDG performance is affected by patient-specific factors, such as prior surgery, transfusions, or coexisting bacterial infections, which may lead to false-positive results. Molecular techniques, including PCR-based assays, provide complementary diagnostic accuracy and species identification, and their combination with BDG testing enhances sensitivity up to 90%. Serial BDG monitoring supports risk stratification and treatment response assessment, with persistent elevations predicting worse outcomes. In neonatal and pediatric populations, optimal cut-off values remain under investigation, highlighting the need for integration with clinical and microbiological data. Overall, BDG represents a valuable adjunct in a multimodal diagnostic workflow, providing both diagnostic and prognostic insights in invasive candidiasis management. Full article

Background/Objectives: Antimicrobial resistance (AMR) in companion animals is an emerging public health threat due to zoonotic potential and limited therapeutic options. Dogs with otitis externa may harbor multidrug-resistant (MDR) bacteria, including Escherichia coli (E. coli), Proteus mirabilis (P. mirabilis), and Enterobacter cloacae complex (E. cloacae complex), some producing extended-spectrum beta-lactamase (ESBL) or AmpC β-lactamases. This study aimed to assess the prevalence, AMR patterns, MDR occurrence, β-lactamase production, and co-infection profiles of these pathogens in canine otitis externa. Methods: Ear canal samples were collected from 592 dogs presenting clinical signs of otitis externa, with one sample per dog included in the analysis. Samples were collected from veterinary clinics in Timiș County, Romania, from 2022 to 2025. Samples were cultured on blood agar and MacConkey agar, followed by biochemical testing and MALDI-TOF mass spectrometry for bacterial identification. Antimicrobial susceptibility testing against 15 agents across six classes was performed using the VITEK^® 2 system. MDR and β-lactamase production (ESBL, AmpC) were determined according to CLSI 2018 veterinary guidelines. Co-isolation with bacterial and fungal species were recorded. Results: E. coli, P. mirabilis, and E. cloacae complex were isolated in 9.12%, 6.25%, and 1.2% of cases, respectively. E. coli exhibited the highest resistance to aminoglycosides (tobramycin 72.2%, gentamicin 61.1%) and full susceptibility to carbapenems. P. mirabilis showed the highest resistance to ampicillin (54%) and trimethoprim + sulfamethoxazole (46%), with complete susceptibility to carbapenems and fluoroquinolones. E. cloacae complex displayed universal resistance to cephalosporins but remained susceptible to non-cephalosporin β-lactams (piperacillin–tazobactam), carbapenems and aminoglycosides. MDR prevalence was 35.2% for E. coli, 18.9% for P. mirabilis, and 14.3% for the E. cloacae complex. ESBL production was detected in 13% of E. coli and 8.1% of P. mirabilis isolates, while all E. cloacae complex isolates were AmpC-positive. Co-isolations were common, primarily involving Staphylococcus pseudintermedius (S. pseudintermedius) and Malassezia pachydermatis (M. pachydermatis). Conclusions: MDR and β-lactamase-producing bacteria were identified in dogs with otitis externa, emphasizing the importance of routine antimicrobial susceptibility testing, targeted therapy based on local resistance profiles, and continuous AMR surveillance to prevent treatment failure and mitigate zoonotic risk. Full article