Search Results (846)

This paper discusses the evolution of convolutional (CNN) and recurrent (RNN) artificial neural networks in applications for Building Information Modeling (BIM). The paper outlines the milestones reached in the last two decades. The article organizes the current state of knowledge and technology in terms of three aspects: (1) computer visualization coupled with BIM models (detection, segmentation, and quality verification in images, videos, and point clouds), (2) sequence and time series modeling (prediction of costs, energy, work progress, risk), and (3) integration of deep learning results with the semantics and topology of Industry Foundation Class (IFC) models. The paper identifies the most used architectures, typical data pipelines (synthetic data from BIM models, transfer learning, mapping results to IFC elements) and practical limitations: lack of standardized benchmarks, high annotation costs, a domain gap between synthetic and real data, and discontinuous interoperability. We indicate directions for development: combining CNN/RNN with graph models and transformers for wider use of synthetic data and semi-/supervised learning, as well as explainability methods that increase trust in AECOO (Architecture, Engineering, Construction, Owners & Operators) processes. A practical case study presents a new application, Bimetria, which uses a hybrid CNN/OCR (Optical Character Recognition) solution to generate 3D models with estimates based on two-dimensional drawings. A deep review shows that although the importance of attention-based and graph-based architectures is growing, CNNs and RNNs remain an important part of the BIM process, especially in engineering tasks, where, in our experience and in the Bimetria case study, mature convolutional architectures offer a good balance between accuracy, stability and low latency. The paper also raises some fundamental questions to which we are still seeking answers. Thus, the article not only presents the innovative new Bimetria tool but also aims to stimulate discussion about the dynamic development of AI (Artificial Intelligence) in BIM. Full article

Background: Ticagrelor is a reversible, direct inhibitor of the platelet adenosine diphosphate (P2Y12) receptor, widely used in combination with acetylsalicylic acid (ASA) as dual antiplatelet therapy (DAPT) in patients with acute coronary syndrome (ACS) to prevent cardiovascular events. Despite its well-established efficacy, ticagrelor may cause adverse effects ranging from common ones (e.g., bleeding, dyspnea) to rare but potentially serious reactions such as bradyarrhythmias. These rare events are likely related to elevated adenosine levels secondary to inhibition of the human equilibrative nucleoside transporter 1 (hENT1). Methods: We describe two clinical cases of ticagrelor-associated bradyarrhythmia observed in patients following ACS. Both cases were analyzed in terms of clinical presentation, ECG findings, management strategy, and outcomes after discontinuation of the drug. Results: The first case concerns a 67-year-old woman with non-ST-segment elevation myocardial infarction (NSTEMI) who developed complete atrioventricular block (third degree) with a 45 s asystolic pause and syncope. The second case involves a 67-year-old man with anterior ST-segment elevation myocardial infarction (STEMI) who experienced recurrent sinus pauses lasting up to 5 s. In both cases, symptoms resolved following ticagrelor discontinuation and theophylline administration. No recurrence of arrhythmia was observed after switching to prasugrel. Conclusions: Ticagrelor-induced bradyarrhythmias, although rare, represent an important and reversible adverse effect that clinicians should be aware of, particularly during the early post-ACS phase. Prompt recognition and drug withdrawal may prevent severe outcomes and avoid unnecessary interventions such as pacemaker implantation. Further studies are warranted to identify patient-specific risk factors predisposing to ticagrelor-related conduction disturbances. Full article

Reinforced concrete structures constitute a fundamental component of modern construction; however, the execution process is highly susceptible to construction errors that may reduce the safety and durability of structural elements. Despite numerous studies addressing failures and degradation mechanisms, there is a lack of methods enabling quantitative, multi-criteria assessment of the significance of individual execution errors. The aim of this article is to identify, evaluate, and prioritize execution errors occurring during the construction of reinforced concrete structures, considering their impact on safety, durability, and repair costs. A hybrid decision-making model combining the fuzzy WINGS and fuzzy TOPSIS methods was developed to enable the assessment of execution errors under uncertainty. The scientific novelty of this study lies in the application of a hybrid fuzzy approach to the evaluation of construction errors in reinforced concrete works, allowing for the simultaneous consideration of criterion importance and the intrinsic ambiguity of expert judgments. Fuzzy WINGS was used to determine the criterion weights, while fuzzy TOPSIS facilitated the development of error rankings. Within the reinforcement-related errors, the most critical were the following: insufficient concrete cover (0.89), non-compliant reinforcement layout (0.82), and reinforcement discontinuity (0.81). Among formwork errors, the highest importance was assigned to exceeding permissible geometric deviations (0.94), while for concreting errors, the most significant were discontinuity of concreting (0.35) and improper technological joints (0.34). The proposed model provides a practical decision support tool for technical supervision, quality management, and risk assessment in reinforced concrete construction. Due to the universal structure of the hybrid fuzzy WINGS–fuzzy TOPSIS methodology itself, the approach may also be adapted in future research to other decision-making problems, should their nature justify the use of fuzzy multi-criteria methods. Full article

Background: Transition from paediatric to adult care in congenital heart disease (CHD) represents a pivotal and vulnerable phase that critically influences long-term survival, morbidity, and quality of life. Advances in paediatric cardiology and surgery have generated a rapidly growing population of adults with congenital heart disease who exhibit complex, lifelong, and multidisciplinary needs. However, survival does not equate to cure, and discontinuity of care during adolescence remains a major predictor of adverse outcomes. Despite widespread recognition of their importance, transition programmes are heterogeneous worldwide, and standardised, evidence-based protocols are missing. Objective: This review calls for action acknowledging the urgent need for structured and standardised transition programmes in CHD care, integrating the key elements that should be addressed in any programme to optimise outcomes. Content: Transition should be understood as a multidisciplinary, longitudinal process integrating medical management, patient and family education, psychological preparation, and societal inclusion. Core domains include tailored physical activity, nutritional counselling, cardiovascular risk factor management, infective endocarditis prevention, reproductive health, psychosocial support, and engagement of primary care providers, educators, and employers. Evidence demonstrates that structured transition programmes enhance health literacy, adherence, and self-management, while reducing loss to follow-up. The active involvement of primary care providers, psychologists, educators, and employers is essential to sustain holistic and equitable care. Conclusions: Transition should be reframed as an essential, lifelong component of CHD care. The development and implementation of standardised, multidisciplinary, evidence-based transition protocols are urgently required to ensure continuity, empower patients, and optimise long-term clinical and psychosocial outcomes for adults with CHD. Full article

Background/Objectives: Parkinson’s disease (PD) and Dementia with Lewy Bodies (DLB) are neurodegenerative disorders characterized by the accumulation of misfolded alpha-synuclein protein in the brain. Mutations in the glucocerebrosidase 1 (GBA1) gene have been identified as a significant genetic risk factor for both PD and DLB. GBA1 encodes for the lysosomal enzyme glucocerebrosidase, which is responsible for the breakdown of glucosylceramide (GC). Deficiencies in glucocerebrosidase activity lead to the accumulation of glucosylceramide within lysosomes, contributing to lysosomal dysfunction and impaired protein degradation. The aim of this narrative review is to update the underlying mechanisms by which GBA1 mutations contribute to the pathogenesis of PD and DLB. Methods: A comprehensive literature search was conducted across four major electronic databases (PubMed, Web of Science (Core Collection), Scopus, and Embase) from inception to 8 November 2025. The initial search identified approximately 1650 articles in total, with the number of hits from each database being as follows: PubMed (~450), Web of Science (~380), Scopus (~520), and Embase (~300). Results: The mechanism by which mutations in the GBA1 gene contribute to PD involves both loss-of- function and gain-of-function pathways, which are not mutually exclusive. Typically, GBA1 mutations lead to a loss of function by reducing the activity of the GCase enzyme, impairing the autophagy- lysosomal pathway and leading to α-synuclein accumulation. However, some mutant forms (GBA1L444P) of the GCase enzyme can also acquire a toxic gain of function, contributing to α-synuclein aggregation through mechanisms like endoplasmic reticulum stress and misfolding. While Venglustat effectively reduced GC levels, a key marker associated with GBA1-PD, the lack of clinical improvement led to the discontinuation of its development for this indication. Conclusions: GBA1-mediated lysosomal and lipid dysregulation represents a key pathogenic axis in PD and DLB. Understanding these mechanisms provides crucial insight into disease progression and highlights emerging therapeutic strategies—such as pharmacological chaperones, substrate reduction therapies, and gene-targeted approaches—aimed at restoring GCase function and lysosomal homeostasis to slow or prevent neurodegeneration. Full article

Background: Breastfeeding provides optimal nutrition and immunological protection, offering critical benefits for infants with congenital heart disease (CHD) and their mothers. This study aims to determine the prevalence of breastfeeding practices and identify common obstacles among mothers with and without CHD whose children are diagnosed with CHD. Methods: This cross-sectional study assessed breastfeeding prevalence and obstacles among mothers with and without congenital heart disease (CHD) whose children were also diagnosed with CHD. Data were collected from January to August 2025 across tertiary hospitals and pediatric cardiology units in Saudi Arabia. A validated bilingual questionnaire (Cronbach’s α = 0.816) captured maternal, infant, and breastfeeding-related factors. Descriptive statistics, chi-square tests, and odds ratios were applied, with significance set at p < 0.05. Results: A total of 419 mothers of children with congenital heart disease (CHD) participated. Maternal CHD was reported in 15.8% of participants and was significantly associated with older maternal age, family history of CHD, low birth weight, and the presence of other chronic diseases (p < 0.05). Ventricular septal defect (VSD) and mitral stenosis were more frequent among children of CHD mothers. Breastfeeding initiation (≈91%) and duration did not differ significantly between CHD and non-CHD mothers. Interestingly, CHD mothers reported fewer breastfeeding obstacles (27.3% vs. 43.1%, p = 0.04) and were less likely to cite fatigue or pain as reasons for discontinuation. Conclusions: This study provides novel insights into breastfeeding practices and maternal child health characteristics among mothers and infants affected by CHD in Saudi Arabia. The current study findings revealed that maternal CHD was significantly associated with advanced maternal age, family history, low birth weight, and coexisting chronic conditions, highlighting important genetic and perinatal risk factors. Despite these health burdens, breastfeeding initiation and duration did not significantly differ between CHD and non-CHD mothers, suggesting that maternal CHD alone does not hinder breastfeeding success. Full article

Background/Objectives: Biologic therapies have transformed the management of inflammatory bowel disease (IBD), but their high cost has prompted the introduction of biosimilars. Although switching from biologic originators to biosimilars is increasingly common, real-world evidence remains limited. We aimed to explore the safety and efficacy of switching between biologic originators and biosimilars. Methods: We conducted a retrospective chart review of patients with IBD between 2015 and 2025. Adult patients receiving adalimumab-adaz or adalimumab-atto were included. Patients who were non-medically switched once from adalimumab originator (Humira^®) to any biosimilar were classified as group A. Patients who also switched back to originator (multiple switches) were classified as group B. The outcomes of the study were safety and efficacy of the biosimilars. Logistic regression identified switching predictors. Results: A total of 237 patients were included in the study. The number of patients in group A and group B was 208 and 58 patients, respectively. Sustained clinical remission was achieved in 198 (95.4%) of group A and 54 (93.6%) of group B participants. Sustained normalization of inflammatory markers was also comparable, occurring in 190 (91.5%) of group A and 54 (92.3%) of group B participants. No treatment-emergent AEs, infections, or treatment discontinuations were reported in either group (0%). Regression analysis identified older age and prior immunomodulator use as significant predictors of switching. Conclusions: Multiple switches of adalimumab biosimilars can be safely undertaken without increasing the risk of adverse reactions or treatment failure. This study provides meaningful evidence to guide policy and physician confidence in biosimilar interchangeability as a sustainable IBD therapeutic strategy. Full article

Cervicofacial actinomycosis is a well-recognized infectious disease caused by Actinomyces, a Gram-positive filamentous bacterium. In contrast, Nocardia, a morphologically similar, hyphae-forming organism, is an exceedingly rare cause of cervicofacial abscesses, and even more uncommon associated osteomyelitis of mandible. We present such a case involving a kidney transplant recipient who presented with opioid-induced constipation, along with left jaw pain and swelling. CT scan of the soft tissue in the neck revealed a complex cervicofacial abscess with enhancement of underlying mandible. Culture growth and RNA sequencing of USG-guided aspirate identified a Nocardia species closely related to N. beijingensis/exalbida. The patient initially received broad-spectrum antibiotics, including ceftriaxone, imipenem, and trimethoprim-sulfamethoxazole (TMP-SMX). Imipenem was later discontinued in view of new-onset unexplained encephalopathy and replaced with linezolid, which was subsequently switched to minocycline following thrombocytopenia development. Minocycline therapy was intended for a total of 12 months. TMP-SMX was avoided long-term due to avoid nephrotoxicity risk in kidney transplant patients. On six-month follow-up, the patient showed clinical and radiological improvement; minocycline was discontinued after additional six months. This case highlights the importance of considering Nocardia as a differential diagnosis in immunosuppressed patients presenting with cervicofacial symptoms, especially following orofacial surgery or trauma. Early recognition, prompt diagnosis, and appropriate antibiotic therapy with adequate bone penetration seem crucial for optimal management and may help avoid the need for surgical intervention. Full article

Indocyanine green (ICG) is widely used in minimally invasive surgery for real-time fluorescence imaging of vascular, biliary, and urological structures. Although its intravenous use has been extensively validated, data on intraureteral administration remain scarce, particularly regarding renal safety. We report the case of a 50-year-old woman undergoing laparoscopic bilateral endometrioma excision with intraureteral ICG instillation for ureteral visualisation. Despite an uneventful surgery, the patient developed anuria and acute kidney injury (AKI) within 24 h, requiring temporary hemodialysis. Imaging demonstrated bilateral renal dysfunction without evidence of ureteral transection. Renal function gradually improved with supportive care, and dialysis was discontinued. This is, to our knowledge, the first reported case of AKI following intraureteral ICG use. Potential mechanisms include dye-induced tubular toxicity, ischemic injury, and multifactorial perioperative stressors. Given the increasing adoption of near-infrared fluorescence in gynecologic and urologic surgery, our case highlights the urgent need for systematic studies on the renal safety of intraureteral ICG administration. Until further evidence emerges, surgeons should use the technique with caution, particularly in patients with preexisting risk factors for AKI. Full article

Background and Clinical Significance: Tyrosine kinase inhibitors (TKIs) have transformed Philadelphia chromosome-positive chronic myeloid leukemia (Ph+ CML) into a largely manageable chronic disease. However, off-target toxicities are increasingly recognized; rarer complications such as bone marrow edema (BME) remain underreported. BME is a radiological syndrome characterized by excess intramedullary fluid on fat-suppressed T2/STIR magnetic resonance imaging sequences and may progress to irreversible osteochondral damage if unrecognized. We report a case series of TKI-associated BME and propose a practical diagnostic-therapeutic framework. Case Presentation: We describe three patients with Ph+ CML who developed acute, MRI-confirmed BME of the lower limb during TKI therapy. Case 1 developed unilateral then bilateral knee BME, temporally associated first with dasatinib and subsequently with imatinib; symptoms improved after TKI interruption, bisphosphonate therapy, and supportive measures, and did not recur after switching to bosutinib. Case 2 presented with proximal femoral BME during long-term imatinib; imatinib was stopped, intravenous neridronate administered, and bosutinib initiated with clinical recovery and later near-complete radiological resolution. Case 3 experienced multifocal foot and ankle BME during imatinib; symptoms resolved after drug discontinuation and bisphosphonate therapy, and disease control was re-established with bosutinib without recurrence of BME. All patients underwent molecular monitoring and mutational analysis to guide safe therapeutic switching. Discussion: Temporal association across cases and the differential kinase profiles of implicated drugs suggest PDGFR (and to a lesser extent, c-KIT) inhibition as a plausible mechanistic driver of TKI-associated BME. PDGFR-β blockade may impair pericyte-mediated microvascular integrity, increase interstitial fluid extravasation, and alter osteoblast/osteoclast coupling, promoting intramedullary edema. Management combining MRI confirmation, temporary TKI suspension, bone-directed therapy (bisphosphonates, vitamin D/calcium), symptomatic care, and, when required, therapeutic switching to a PDGFR-sparing agent (bosutinib) led to clinical recovery and preservation of leukemia control in our series. Conclusions: BME is an underrecognized, potentially disabling, TKI-related adverse event in CML. Prompt recognition with targeted MRI and a multidisciplinary, stepwise approach that includes temporary TKI adjustment, bone-directed therapy, and consideration of PDGFR-sparing alternatives can mitigate morbidity while maintaining disease control. Prospective studies are needed to define incidence, risk factors, optimal prevention, and management strategies. Full article

Background/Objectives: Nemolizumab provides rapid and effective relief from pruritus in patients with atopic dermatitis. However, it is frequently associated with cutaneous adverse events, and reliable predictors of their severity have not yet been clearly identified. This study aimed to investigate the relationship between the severity of nemolizumab-associated cutaneous adverse events and patients’ clinical background and to explore baseline factors that may be useful in predicting their severity. Methods: We retrospectively analyzed data from 40 patients with atopic dermatitis who received nemolizumab between May 2023 and March 2025. Clinical variables included demographics, prior therapies, phenotype, baseline Eczema Area and Severity Index subscores, serum biomarker levels, and treatment courses. The severity of cutaneous adverse events was classified as mild (<10% body surface area or limited to dryness/desquamation) or moderate-to-severe (≥10% body surface area). Results: Cutaneous adverse events occurred in 31 of 40 patients (78%); 13 were moderate-to-severe and 18 were mild. Most events appeared within 16 weeks of treatment initiation. Severity was associated with age, duration of disease, serum Thymus and Activation-Regulated Chemokine (TARC) level, and clinical phenotype. Patients with trunk-dominant phenotypes showed more severe cutaneous adverse events than patients with extremity-dominant or prurigo-type atopic dermatitis. Most cutaneous adverse events resolved within 12 weeks using topical therapy, without requiring treatment discontinuation. Conclusions: Baseline characteristics such as age, duration of disease, serum TARC levels, and severity of trunk lesions may be useful in predicting the risk of severe cutaneous adverse events, supporting their potential use in pre-treatment assessment and patient counseling. Full article

Landfills situated in karst terrains pose unique sustainability challenges due to the complex geological characteristics of these environments. This is mainly due to the well-developed underground drainage systems, including discontinuities and caves that can quickly transport contaminants over long distances, reaching the water sources and ecosystems. The focus of this study is on multi-geophysical assessment incorporating electrical resistivity tomography (ERT) and seismic refraction tomography (SRT) to evaluate the volume of the waste and to delineate the contact between the waste material and the karst, offering a more comprehensive view of subsurface conditions. The presented examples include geophysical mapping of the landfills Sodol and Sorinj, situated in the immediate vicinity of sensitive water bodies, increasing the potential risk of environmental contamination. At both sites, the boundary between waste material and bedrock was clearly delineated. Bedrock was identified with P-wave velocities of approximately 3000 m/s at Sodol Landfill and 2000 m/s at Sorinj Landfill. Waste material, observed at both sites, exhibited electrical resistivity values up to 120 Ω·m. The combined use of ERT and SRT provides extensive coverage of the landfill area, surpassing what can typically be achieved through traditional methods such as boreholes or excavations. Overall, the obtained results show promising potential for using integrated geophysical methods to accurately characterize landfill sites in karst terrains, thereby improving environmental protection strategies in karst regions and contributing to sustainable waste management. Full article

Background: Prevention of hospital-onset Clostridioides difficile infection (HO-CDI) is a priority for hospitals. In addition to standard infection control measures, some probiotics show promise in reducing HO-CDI incidence. However, prior research has produced mixed results. Methods: Retrospective, observational cohort study of HO-CDI incidence among inpatients treated with or without BioK+ probiotic prophylaxis. BioK+, a probiotic with three Lactobacilli strains, was administered to patients on antibiotics with high risk for HO-CDI. BioK+ was continued for 5 days after antibiotics were discontinued, or the patient was discharged. The primary outcome was HO-CDI incidence. Results: Out of 494 eligible patients on high-risk antibiotics, 343 patients received BioK+ probiotics. No cases of HO-CDI were identified in patients who received BioK+, compared to three cases among patients not on BioK+ (p = 0.028). In the baseline period (1 April 2021–31 March 2022) the HO-CDI incidence density was 5.62 per 10,000 bed-days. In the BioK+ probiotic period (1 April 2022–31 March 2023), the incidence density was 2.22 cases per 10,000 patient days (p = 0.03). Conclusions: When bundled with standard infection control practices, the use of BioK+ probiotics was associated with a statistically significant decreased incidence of HO-CDI among patients prescribed high-risk antibiotics. Full article

This paper presents a knowledge-based and interpretative model for the conservation of the House of Arianna, located in the Archaeological Park of Pompeii, developed within the CHANGES project, Spoke 6—History, Conservation and Restoration of Cultural Heritage. The research focused on two critical components of the site: the free-standing peristyle columns and the mosaic and frescoed surfaces preserved in situ. This workflow yielded a high-resolution digital model, analytical condition maps, and diagnostic datasets that directly inform conservation decisions. The results show that the columns exhibit internal discontinuities and weaknesses at their joints, a condition linked to heterogeneous construction techniques which increases the risk of drum slippage under wind and seismic loading. The mosaics display a marked loss of tesserae in exposed sectors over recent years, driven by moisture ingress, biological growth and mechanical stress. These findings support the adoption of low-impact, reversible measures, embedded within a prevention-first strategy based on planned conservation. The study formalizes a replicable methodology that aligns diagnostics, monitoring and conservation planning. By linking ‘skin’ and ‘structure’ within a unified interpretative matrix, the approach enhances both structural safety and material legibility. The workflow proposed here offers transferable guidance for the sustainable preservation and inclusive interpretation of exposed archaeological ensembles in the Vesuvian context and beyond. Full article

Background/Objectives: With the increasing use of immune checkpoint inhibitors (ICIs), their administration in pregnant patients is expected to become more frequent. Although immunotherapy has transformed melanoma treatment, its use during pregnancy remains complex and controversial. Methods: We present the case of a young female patient diagnosed with advanced melanoma in whom combination ICI therapy was initiated. Results: During maintenance nivolumab treatment, a routine staging CT scan revealed an incidental pregnancy. Immunotherapy was discontinued upon pregnancy detection. The pregnancy proceeded without significant complications related to melanoma or the immunotherapy. During follow-up, the patient remained in remission and delivered a healthy male infant at 38 weeks of gestation. Conclusions: The most frequently reported side effects of ICIs during in utero exposure include fetal growth restriction, premature delivery, fetal distress syndrome, and occasional congenital abnormalities such as hypothyroidism and hand malformations. While existing evidence highlights potential risks, isolated case reports—including the present case—demonstrate that favorable pregnancy and neonatal outcomes are possible with careful monitoring and multidisciplinary care. Given the limited literature on ICI use during pregnancy, our case adds meaningful clinical insights to the field and underscores the need for further research and data collection to establish definitive guidelines, with an emphasis on individualized risk assessment and multidisciplinary care. Full article