Search Results (6,303)

Multi-UAV cooperative search with static unknown targets requires both efficient regional allocation and responsive local maneuvering. However, single-level learning methods often suffer from redundant coverage, unclear division of labor, and unstable training. This paper proposes a high- and low-level decoupled reinforcement learning method for multi-UAV cooperative search. The high level periodically generates UAV-specific regional goals from visitation maps, target-existence belief maps, and UAV positions, while a spatial self-attention module enhances the representation of unvisited regions, high-belief target areas, and UAV distributions. The low level performs discrete steering actions based on local observations and high-level contexts, supported by a structured reward that encourages coverage, target discovery, goal-oriented progress, repeated-visit suppression, and boundary-safe motion. Simulation experiments are conducted in a two-dimensional grid environment with static targets and ideal sensing. Under this simplified simulation setting, the proposed method achieves higher training return and coverage rate than representative baseline algorithms while maintaining a high final target discovery rate and reaching the discovery threshold earlier. Ablation and visualization results further demonstrate the effectiveness and interpretability of the proposed hierarchical guidance mechanism within the considered simulation scenario. Full article

Exercise is one of the safe and effective methods to improve obesity and its complications, but the mechanism has not been fully elucidated. Sestrin2 (SESN2) is a stress-induced protein that protects cells from stress damage. The role and mechanism of SESN2 in the improvement of obesity-induced cardiac dysfunction by exercise are still unclear. Male C57BL/6J mice were used to prepare a high-fat diet-induced obesity mouse model and conducted aerobic exercise training. After training, echocardiography was used to evaluate the cardiac function of mice, and HE and Masson staining were used to assess the extent of cardiac damage. Cell experiments were conducted using the H9C2 cell line derived from embryonic rat hearts, with the intervention of palmitic acid ester and exogenous SESN2. We detected indicators related to myocardial cell damage, fibrosis, inflammation, and oxidative stress, as well as the activation level of the AMPK-PGC-1α signaling pathway. The results showed that aerobic exercise significantly inhibited myocardial fibrosis, inflammation, oxidative stress, and cell damage in HFD mice, upregulated cardiac SESN2 expression, and activated the AMPK-PGC-1α signaling pathway. Cell experiments have found that exogenous SESN2 pretreatment alleviates palmitate-induced injury, inflammation, and oxidative stress in H9C2 cardiomyocytes, and activates the AMPK-PGC-1α signaling pathway. This indicates that aerobic exercise significantly upregulates the expression of SESN2 and activates the AMPK-PGC-1α signaling pathway, which is potentially involved in alleviating myocardial inflammation, oxidative stress, cardiac fibrosis and cardiac dysfunction in HFD mice. Full article

Background/Objectives: Artificial intelligence (AI) is increasingly transforming cardiology through advanced analytical tools capable of identifying complex patterns across cardiovascular imaging, electrophysiology, and clinical datasets. Machine learning (ML) and deep learning (DL) algorithms are being integrated into echocardiography, cardiac computed tomography (CT), cardiac magnetic resonance imaging (MRI), and electrocardiography (ECG), enabling earlier diagnosis and more personalized cardiovascular care. This narrative review summarizes current clinical and organizational applications of AI in cardiology and discusses emerging concepts related to explainable and trustworthy AI. Methods: A narrative review was conducted according to SANRA recommendations using the PubMed, MEDLINE, Web of Science, and Scopus databases, including peer-reviewed publications from 2015 to 2026 addressing clinical, organizational, and ethical applications of AI in cardiology, with particular emphasis on cardiovascular imaging, electrocardiography, heart failure, digital health, and explainable AI frameworks. Results: Substantial evidence demonstrates that AI-based tools can achieve expert-level performance in cardiovascular imaging interpretation, automated electrocardiographic analysis, and clinical risk prediction. Across multiple cardiovascular settings, AI has been associated with improved diagnostic accuracy, enhanced workflow efficiency, and earlier detection of cardiovascular disease. Predictive models support risk stratification in heart failure and ischemic heart disease, while chatbots and digital health platforms may facilitate patient engagement, remote monitoring, and continuity of care. Despite these advances, important challenges remain, including algorithmic bias, limited transparency, insufficient external validation, data heterogeneity, and barriers to routine clinical implementation. Emerging explainable AI approaches may improve model interpretability, clinician confidence, and the safe adoption of AI-driven decision support systems. Conclusions: Artificial intelligence is rapidly evolving from a research-oriented technology into a clinically relevant component of cardiovascular care. Current evidence indicates that AI can enhance diagnostic performance, improve risk prediction, streamline clinical workflows, and facilitate more personalized management across multiple cardiovascular domains. However, the successful translation of AI into routine practice will depend on robust external validation, transparent decision-making mechanisms, regulatory oversight, and clinician acceptance. The development of explainable and trustworthy AI frameworks represents a critical step toward the safe, ethical, and sustainable integration of AI into modern cardiology. Full article

Objective: Minimally invasive surgery in Hirschsprung disease (HSCR) management was introduced in the mid-1990s. Despite decades of clinical application of various laparoscopic approaches, there remains a paucity of high-powered prospective studies and comprehensive systematic reviews in the literature. This study aimed to systematically review and summarize published techniques and outcomes of laparoscopic- and robotic-assisted surgery in HSCR. Methods: A systematic literature review was conducted using PubMed and the Cochrane Library. Studies reporting technical and outcome data of laparoscopic- or robotic-assisted surgery for HSCR were included. Data extraction and analysis were performed in accordance with the PRISMA 2020 guidelines. Parameters of interest included surgical technique, age at primary pull-through (PT), operative time, and functional outcomes. Outcomes of laparoscopic- versus robotic-assisted Yancey–Soave PT were compared. Results: A total of 700 publications were screened, of which seven studies met the inclusion criteria. Data from 556 patients were analyzed. A total of 338 underwent laparoscopic-assisted, and 218 underwent robotic-assisted pull-through. Large variability of the reported transanal resection technique (modified Yancey–Soave PT) was reported. Four studies reported functional outcomes in patients aged over four years. Three studies directly compared laparoscopic- and robotic-assisted PT; two reported no difference in the incidence of postoperative Hirschsprung-associated enterocolitis (HAEC). Functional outcomes were assessed using the Krickenbeck classification in three studies and the bowel function score in one study, with no significant differences reported in patients aged >4 years. Conclusions: Laparoscopic- and robotic-assisted Yancey–Soave PT appears to be safe for HSCR. Large variability in the applied surgical technique—despite being commonly classified as modified Yancey–Soave PT—as well as heterogeneity in the bowel function assessment, limit direct comparability between studies. To date, no single minimally invasive approach has demonstrated clear superiority over others. Prospective, randomized controlled studies are required to enable robust comparative evaluation of techniques, overall costs, and outcomes. Full article

Deep-mining operations are increasingly challenged by severe thermal hazards, which have become a critical bottleneck for achieving safe, efficient, and sustainable mineral extraction. While research on deep-mine cooling and heat hazard mitigation has proliferated, the field lacks a systematic, critical review that explicitly examines these advances through the lens of sustainability science. To address this gap, this study conducted a comprehensive bibliometric analysis of 432 publications (1994–2024) retrieved from the Web of Science Core Collection. The methodology employs Bibliometrix, Vosviewer, and CiteSpace to map the intellectual landscape, research hotspots, and evolving frontiers of the field. The results reveal a clear three-stage development trajectory and identify China, the USA, South Africa, and Canada as leading contributors, with national research emphases on ventilation, energy conservation, and refrigeration, respectively. Crucially, keyword clustering and burst detection uncover a notable paradigm shift: the focus has moved from isolated cooling techniques toward integrated, multi-objective strategies—including geothermal energy co-exploitation, phase-change material applications, and system-level energy optimization—signaling a growing alignment with resource efficiency and low-carbon mining principles. However, a critical finding is that the literature remains predominantly techno-centric, overwhelmingly evaluating performance through operational energy savings while largely neglecting life-cycle environmental impacts, holistic sustainability assessment metrics, and the influence of policy drivers. This review thus not only provides a structured overview of the domain, but, more importantly, exposes these critical knowledge gaps. We argue that future research must pivot toward a multi-dimensional sustainability framework that integrates technical, economic, and environmental dimensions, thereby guiding the next generation of research toward truly sustainable deep-mining practices. Full article

Background: Patients with mild traumatic brain injury (mTBI) have a small but clinically relevant risk of intracranial injury (ICI), requiring timely detection. Computed tomography (CT) remains the diagnostic gold standard but is costly and exposes patients to ionising radiation. Combining blood-based biomarkers, glial fibrillary acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), with clinical decision rules may allow safe exclusion of ICI without CT, reducing unnecessary imaging, radiation exposure, and resource use. Methods: A systematic review of clinical and economic studies in patients with mTBI was registered in PROSPERO (CRD420251051158). Searches were conducted in January 2025 and updated in May 2025 in MEDLINE, Embase, and the Cochrane Library. The aim was to assess the diagnostic accuracy and economic value of the combination of GFAP and UCH-L1 compared with CT scanning to rule out ICI in both adults and children with mTBI. Where available, studies directly comparing GFAP and UCH-L1 with S100β were also analysed descriptively. The quality of the clinical evidence was assessed with QUADAS-2 and GRADE. Meta-analyses used a bivariate random-effects model, with heterogeneity and sensitivity analyses explored. Results: Overall, 21 studies were considered in our review. Moderate- to high-quality evidence indicates that GFAP and UCH-L1, when used together with clinical assessment, have very high sensitivity and can reliably rule out ICI in adults with mTBI presenting within 12 h to the emergency department. Evidence for paediatric populations shows promise but remains very limited. Specificity is low, particularly in older adults, which limits the ability to reduce CT use in this high-risk group. Research on age-adjusted cut-offs is ongoing and may help to reduce the proportion of false positive tests without compromising sensitivity. Few studies directly compared GFAP and UCH-L1 with S100β, with slightly higher to equivalent sensitivity for GFAP and UCH-L1. Economic evaluations suggest possible cost savings and reduced CT utilisation, but these analyses rely on assumptions unsupported by robust data and are highly context-dependent. There is a lack of clarity in the included studies regarding whether existing clinical head rules were used to define the study populations (i.e., to determine which patients would be recommended for CT scanning) and, if so, which specific rules were applied. Conclusions: Evidence shows that GFAP and UCH-L1 can safely exclude ICI in adults with mTBI in whom a CT scan would otherwise be considered based on clinical assessment or decision rules. Nevertheless, real-world evidence and cost-effectiveness data are scarce. Further prospective studies, including paediatric and elderly populations, and integration with clinical decision rules will be informative to ensure optimal use in clinical practice. Full article

The seedling production stage of lettuce (Lactuca sativa L.) is crucial for crop success, as it determines the initial quality of the plants. The use of seeds with rapid and uniform germination is essential to ensure proper seedling establishment. Among sustainable alternatives for water management, irrigation with ozonated water stands out due to its disinfectant potential and its ability to stimulate plant physiology. This study evaluated the effects of irrigation with ozonated water on the production and development of lettuce seedlings. The experiment was conducted in a completely randomized design (CRD) arranged in a 2 × 2 factorial scheme, with four replications. Two lettuce cultivars were tested: one with smooth leaves and another with crisp leaves. The variables analyzed included germination parameters (final percentage, germination index and mean germination rate, uniformity, and time to reach 10, 50, and 90% germination), as well as initial growth parameters (total height, shoot and root height, and dry matter content). Analyses were performed on 20 seedlings per cultivar. Irrigation with ozonated water promoted significant growth (p < 0.05) of the shoot and root growth, with increases of 16.90 and 4.99% for the smooth-leaf cultivar, and 24.27 and 9.26% for the crisp-leaf cultivar, compared to the control. Ozone application did not alter the microbiological, physical, or chemical parameters of the water. These growth-promoting effects are likely associated with increased oxygenation of the root zone, enhanced oxidation of organic matter in the substrate, and improved nutrient availability promoted by ozone-derived radicals, which may also optimise root respiration and reduce pathogenic pressure. The applied concentration of 5 mg L⁻¹ O₃ over a 25-day seedling production cycle proved effective and did not cause phytotoxic effects. Irrigation with ozonated water is an efficient and environmentally safe alternative for producing vigorous lettuce seedlings. Full article

Background and Clinical Significance: The Coronary Sinus Reducer (CSR) is a percutaneous therapeutic option for patients with refractory angina who are unsuitable for further myocardial revascularization. The procedure has a generally favorable safety profile, with a low rate of reported procedural complications. To our knowledge, major atrioventricular (AV) conduction disturbances during CSR implantation have not been previously described. This case highlights a rare but clinically relevant intraprocedural complication; Case Presentation: A 71-year-old man with multivessel coronary artery disease and previous coronary artery bypass grafting was referred for CSR implantation because of refractory angina despite optimal medical therapy and lack of further revascularization options. The procedure was performed via a right jugular venous approach. Baseline electrocardiography showed right bundle branch block and findings consistent with previous inferior myocardial infarction, without definite criteria for left anterior fascicular block. During coronary sinus cannulation, the patient developed transient complete AV block, resulting in an approximately 8–10-second ventricular pause without a stable ventricular escape rhythm. The conduction disturbance resolved after catheter withdrawal and repositioning. Given the severity of the event, a temporary transvenous pacemaker was inserted via the right femoral vein, allowing safe completion of CSR implantation. At three-month follow-up, angina had improved from Canadian Cardiovascular Society class III to class I, and no recurrent advanced AV block was documented; Conclusions: Transient complete AV block may occur during CSR implantation, particularly during coronary sinus manipulation and possibly in patients with pre-existing conduction disease. Careful catheter handling, prompt recognition of conduction disturbances, and immediate availability of temporary pacing support should be considered in selected high-risk patients undergoing CSR implantation. Full article

With the rapid development of the hydrogen economy, Type IV composite pressure vessels have emerged as the core components of on-board hydrogen storage systems. However, accurate fatigue life prediction remains a critical bottleneck limiting their design optimization and safe operation. Existing methods often exhibit prediction errors exceeding ±50% due to the inherent scatter, anisotropy, and complex service environments of composites. This study proposes an improved simulation method for fatigue life prediction of Type IV cylinders. Systematic tension–tension fatigue tests were conducted on carbon fiber-reinforced polymer (CFRP) laminates at four ply angles (0°, ±15°, ±30°, ±45°) and PA6 liner at three temperatures (−30 °C, 25 °C, 82 °C) to establish comprehensive S-N curve databases. The results reveal that ply angle is the predominant factor governing CFRP fatigue performance, while temperature significantly influences PA6 behavior, and failure mode transitions from fiber fracture to matrix-dominated damage as ply angle increases. A fatigue analysis model was developed in nCode, incorporating the ply fatigue Algorithm to characterize the anisotropic fatigue behavior of CFRP overwraps. Full-scale validation on Type IV cylinders under cyclic pressure (2–87.5 MPa) confirmed the method’s effectiveness, achieving prediction errors of 11.5% and 35.3% for the two failed specimens, with failure locations well predicted. This study provides a rapid and reliable engineering calculation method and data support for the anti-fatigue design, safety assessment, and life management of Type IV cylinders. Full article

Consumption trends have shifted towards added-value, natural, less-processed, and more nutritious foods. Key factors shaping these trends include animal welfare, sustainability, globalization, cultural influences, socio-demographics, food safety, health, and nutrition. This structured and narrative review, following a systematic approach, analyzes future trends in food consumption, considers preclinical and clinical studies, and examines related industrial challenges. A comprehensive search across Scopus, Web of Science, and Google Scholar was conducted, including original articles and reviews on food consumption trends or industrial processes, using Boolean operators. Potential gaps and biases of the analyzed articles were also included. Of 8742 articles, 58 studies were included. It was found that animal welfare has led consumers to adopt plant-based alternatives, protein, and more sustainable food consumption. Rising health awareness has led to the development of personalized nutrition, functional, and nanoparticle-encapsulated nutrient-based foods. Physiologically, trends indicate improvements in body weight, glycemic control, and lipid profiles, whereas emerging formulations show promise in enhancing cognitive function and nutrient bioavailability. Industrial challenges include refining and scaling up new technologies, encouraging sustainable production practices, ensuring food safety, fulfilling consumer demands, and developing safe, nutritious, and functional foods. Compliance with global health regulations should be prioritized. Continued multidisciplinary research is essential to understand the impact of emerging food trends on consumer health. Full article

Background: Access to safe drinking water remains a critical public health concern in rural Ghana, particularly in climatically vulnerable and underserved settings. This study assessed the microbiological and chemical quality of drinking water and evaluated nitrate-related health risks in the North Gonja and North-East Gonja Districts of the Savannah Region. Methods: A cross-sectional study was conducted between January and March 2025. A total of 460 water samples were collected from groundwater sources and household storage containers. Microbial analyses targeted total coliforms and Escherichia coli. Physicochemical and chemical parameters included nitrate-nitrogen, pH, residual chlorine, major ions, and trace metals. Data was analyzed using descriptive statistics, chi-square tests, spatial interpolation, and non-carcinogenic health risk assessment based on the hazard quotient (HQ) approach. Results: Widespread microbial contamination was observed, with 91.5% of household water samples positive for total coliforms and 46.6% for E. coli. Contamination of source water was significantly higher in North Gonja than in North-East Gonja. Overall, 49.1% (n = 55) of groundwater sources exceeded the World Health Organization guideline value for nitrate-nitrogen, with exceedances predominantly occurring in North Gonja. Additionally, 67.0% (n = 75) of samples were outside the acceptable pH range (6.5–8.5), including 74 samples below 6.5 and one above 8.5. Residual chlorine was not detected in any of the samples. Health risk assessment indicated potential non-carcinogenic risks associated with nitrate exposure, particularly among infants and children. Conclusions: The study demonstrates significant microbial contamination and nitrate-related health risks in the study area, particularly in North Gonja. Interventions such as improved source protection, routine water quality monitoring, chlorination, household water treatment, and implementation of Water Safety Plans are recommended to enhance drinking water safety and reduce associated public health risks. Full article

Background: Vertebrogenic low back pain (LBP) is a distinct subtype of chronic LBP (cLBP) arising from nociceptive sensitization of the basivertebral nerve (BVN) within pathologically altered vertebral endplates. Modic type 1 and type 2 changes on MRI are primary imaging biomarkers for patient selection. Basivertebral nerve ablation (BVNA), a minimally invasive intraosseous radiofrequency procedure, has emerged as a targeted treatment for this condition. This narrative review aims to synthesize current evidence on the pathophysiology of vertebrogenic LBP, patient selection criteria, procedural outcomes, safety profile, and cost-effectiveness of BVNA. Methods: We conducted this narrative review of the literature, encompassing randomized controlled trials (including the SMART and INTRACEPT studies), prospective registries, and real-world cohort studies evaluating BVNA for vertebrogenic LBP. Clinical and imaging-based selection criteria, procedural techniques, outcome measures, adverse events, opioid utilization, and healthcare utilization data were examined. Results: Evidence demonstrates consistent and durable reductions in pain and disability following BVNA, with a favorable safety profile. Complication rates are low, with vertebral compression fracture and procedure-related radicular pain reported as the most frequent adverse events. BVNA is associated with reduced opioid consumption and decreased overall healthcare utilization. Moreover, emerging data suggest efficacy beyond originally defined inclusion criteria, including cases of osteoporosis, multilevel Modic changes, adult spinal deformity, and complex comorbid presentations. Conclusions: BVNA represents an effective and safe treatment option within the multimodal management of vertebrogenic LBP. Current evidence supports a gradual expansion of procedural indications, with implications for healthcare resource optimization and opioid stewardship. Full article

Background: Patients with prolonged mechanical ventilation (PMV) frequently require tracheostomy due to failure to wean, yet the pathway from ventilator dependence to successful decannulation remains complex and poorly standardised. Comprehensive respiratory rehabilitation is recognised as a core strategy for improving decannulation outcomes, but no unified, evidence-based guidelines currently exist for this population. This review addresses that gap by synthesising current evidence on respiratory rehabilitation and decannulation strategies for tracheostomized PMV patients. Methods: A narrative review was conducted through a systematic search of PubMed/MEDLINE covering publications indexed from May 2019 to February 2026, supplemented by targeted searches of Embase and the Cochrane Library. The search combined free-text keywords and Medical Subject Headings (MeSH) terms across eight search string combinations. Following title and abstract screening of 830 deduplicated records, 51 studies met eligibility criteria and were included in the final narrative synthesis. Results: Six core rehabilitation intervention domains were identified: respiratory muscle training, physical rehabilitation and nutritional optimisation, sedation and delirium management, speaking valve use, airway complication management, and ventilator mode optimisation. High-intensity inspiratory muscle training at no less than 50% of maximal inspiratory pressure is currently supported by the strongest available evidence among the interventions reviewed, although this threshold derives primarily from general ICU populations and has not been specifically validated in heterogeneous tracheostomized PMV cohorts. Decannulation readiness assessment may benefit from evaluating five core domains—neurological readiness, secretion management capacity (suctioning ≤ 4 times/24 h), cough efficacy (peak cough flow > 160 L/min), safe swallowing confirmed by instrumental assessment, and upper airway patency confirmed by fiberoptic bronchoscopy—using a structured multidisciplinary framework. Conclusions: Successful decannulation in tracheostomized PMV patients requires integration of evidence-based rehabilitation interventions, structured multidisciplinary assessment, and a patient-centred outcome framework that extends beyond physiological endpoints to encompass voice restoration, psychological well-being, and social reintegration. Significant evidence gaps remain—particularly for expiratory muscle training, population-specific decannulation protocols, and adapted rehabilitation models for resource-limited settings—representing priority areas for future research. Full article

Background: In the context of population aging and the growing burden of chronic conditions, promoting exercise participation has become an important strategy for supporting healthy aging. However, older adults with chronic conditions often face multiple constraints related to symptom burden, risk perception, and everyday life. A theory-informed understanding of the determinants of exercise participation in this population is therefore needed. Methods: This study adopted a theory-informed qualitative descriptive design and conducted face-to-face semi-structured interviews with 30 community-dwelling older adults with chronic conditions. Purposive sampling was used to ensure variation in age, sex, chronic condition type, and exercise participation. Data were analyzed using the framework method guided by the Theoretical Domains Framework (TDF), and the resulting themes were subsequently mapped onto the Capability, Opportunity, Motivation–Behavior (COM-B) model. Results: Participants were aged 60–86 years, and most were women, had low educational attainment, came from rural backgrounds, and lived with multimorbidity. Participants described exercise participation as a day-to-day process of negotiating symptoms, risk, functional boundaries, and everyday responsibilities rather than as a simple matter of willingness. Although most participants recognized the value of exercise, many lacked disease-specific knowledge about suitable exercise types, safe intensity, progression, and warning signs. Symptom burden and functional limitations constrained exercise, but many participants used symptom-based self-regulation strategies, such as resting, slowing down, or modifying activity when discomfort occurred. Family members, peers, health professionals, and community resources could either facilitate exercise or restrict it, depending on their accessibility, continuity, specificity, and practical relevance. Continued participation was closely linked to perceived benefits, controllable risk, self-efficacy, positive emotional experience, and immediate bodily feedback. Conclusions: Exercise promotion for older adults with chronic conditions should move beyond general advice and provide disease-adapted exercise education, symptom-based self-regulation strategies, family and peer support, professional guidance, age-friendly community resources, and feedback mechanisms that support long-term maintenance. Full article

Decision-making is a critical module for intelligent vehicles to achieve safe and efficient autonomous driving. However, most existing reinforcement learning-based decision-making methods optimize policies by maximizing the expected return, which may inadequately account for low-probability but high-cost safety risks in complex traffic interactions. To address this issue, this paper proposes a Risk-Sensitive Distributional Proximal Policy Optimization (PPO) method, termed Risk-Sensitive Distributional Proximal Policy Optimization (RSDPPO), for highway lane-changing decision-making. Within the PPO framework, a distributional state-value function is introduced to model the return distribution under the current policy, and a Wang distortion-based risk measure is further incorporated to construct a risk-sensitive advantage function. In this way, risk information contained in the return distribution can be propagated into the policy gradient update, guiding the learned policy to avoid high-risk driving behaviors while maintaining training stability. Simulation experiments are conducted in a highway lane-changing scenario with heterogeneous surrounding vehicles. The results show that, under medium-density traffic, the proposed method outperforms representative baseline algorithms in cumulative reward, success rate, and safety reward. Further evaluation under higher-density traffic demonstrates that RSDPPO maintains better overall performance, indicating stronger adaptability to denser traffic conditions. Ablation studies further show that risk-averse distortion improves the balance between safety and efficiency by increasing safety margins during car-following and lane-changing maneuvers. These results indicate that RSDPPO provides an effective risk-sensitive policy optimization framework for safety-oriented highway lane-changing decision-making. Full article