Search Results (253)

A multi-target robust observation method for satellite constellations based on hypergraph algebraic connectivity and observation precision theory is proposed to address the challenges posed by the surge in space targets and system failures. First, a precision metric framework is constructed based on nonlinear batch least squares estimation theory, deriving the theoretical precision covariance through cumulative observation matrices to provide a theoretical foundation for tracking accuracy evaluation. Second, multi-satellite collaborative observation is modeled as an edge-dependent vertex-weighted hypergraph, enhancing system robustness by maximizing algebraic connectivity. A constrained simulated annealing (CSA) algorithm is designed, employing a precision-guided perturbation strategy to efficiently solve the optimization problem. Simulation experiments are conducted using 24 Walker constellation satellites tracking 50 targets, comparing the proposed method with greedy algorithm, CBBA, and CSA-bipartite Graph methods across three scenarios: baseline, maneuvering, and failure. Results demonstrate that the CSA-hypergraph method achieves 0.089 km steady-state precision in the baseline scenario, representing a 41.4% improvement over traditional methods; in maneuvering scenarios, detection delay is reduced by 34.3% and re-achievement time is decreased by 47.4%; with a 30% satellite failure rate, performance degradation is only 9.8%, significantly outperforming other methods. Full article

Background: Primary cicatricial alopecias (PCA) are inflammatory disorders that cause permanent hair loss through follicular destruction and fibrosis. Hair transplantation (HT) may restore coverage in stable or end-stage PCA cases. This review assesses the efficacy of HT in PCA including optimal timing, graft survival rates, and the risk of disease reactivation. Material & Methods: A PubMed literature search identified 33 studies of HT in lichen planopilaris (LPP), frontal fibrosing alopecia (FFA), discoid lupus erythematosus, central centrifugal cicatricial alopecia, pseudopelade of Brocq, morphea en coup de sabre, and folliculitis decalvans from the 1960s to present. Reviews were excluded. Results: Among 147 PCA patients, 87.8% had positive HT outcomes. LPP showed high graft survival (70–90%). In contrast, eyebrow FFA (75%), folliculitis decalvans (25%), and scalp FFA (8.6%) had the highest failure rates. Follicular unit extraction was used slightly more than follicular unit transplantation. Notably, 46 patients developed PCA post-HT for presumed androgenetic alopecia. Discussion: HT in PCA can succeed with careful patient selection and stable disease (ideally ≥12–24 months). Graft survival varies by subtype. LPP has consistently reported successful outcomes post-transplantation, whereas folliculitis decalvans and FFA had the poorest outcomes. Adjuncts like immunosuppressants, PRP, and minoxidil may enhance results. Conclusions: Hair transplantation is viable in quiescent PCA, but outcomes are subtype-dependent. Many surgeons already perform these surgeries, but the published literature is lacking, and more research is needed to establish standardized timing, improve long-term graft survival, and clarify the risk of post-HT PCA onset. Full article

BioFlx crowns represent an innovative hybrid resin polymer-based alternative for pediatric full-coverage restorations, addressing the clinical dilemma between durable-but-unaesthetic stainless steel crowns (SSCs) and technique-sensitive zirconia crowns. This narrative review synthesizes current evidence of BioFlx crowns’ mechanical properties, clinical performance, and material characteristics through a comprehensive literature search across PubMed, Scopus, and Web of Science from August through September 2025. The search identified 18 studies comprising four randomized controlled trials, two case reports/series, and twelve in vitro studies. In vitro analyses demonstrated favorable stress distribution under physiological loads (≤311 N) with notable brand-dependent performance variations. NuSmile BioFlx exhibited greater wear than zirconia, but superior wear resistance compared to SSCs, while Kids-e-Dental BioFlx crowns demonstrated less crown wear relative to zirconia, with both brands causing less antagonist wear than zirconia. BioFlx showed intermediate fracture resistance, comparable surface roughness to SSCs but higher than zirconia, and intermediate marginal gaps. Resin cements demonstrated superior retention compared to manufacturer-recommended glass ionomer and resin-modified glass ionomer cements. Clinical studies with a 12 month follow-up demonstrated 92–98% retention rates compared to 100% for SSCs, with significantly higher patient satisfaction and reduced plaque accumulation versus SSCs. However, a failure rate of 6.7% was observed. Color change values were lower than those of zirconia crowns; however, they remained clinically unacceptable (ΔE > 3.3), and stain resistance was lower than that of SSCs. Marginal integrity remained clinically acceptable, though some anatomic form deterioration occurred over time. Case reports highlighted clinical utility in nickel-allergic patients and for masking silver diamine fluoride discoloration. BioFlx crowns represent a clinically valuable esthetic alternative in pediatric dentistry, though evidence remains limited by recent market introduction, brand-specific performance variations (NuSmile vs. Kids-e-Dental), anterior tooth applicability constraints, and contraindications in bruxism and for the Hall technique. Future randomized controlled trials with ≥2 year follow-up periods are imperative to establish long-term performance. Until such evidence emerges, BioFlx crowns represent a viable clinical option for esthetically sensitive cases and nickel-allergic patients when applied with rigorous case selection. Full article

This narrative review synthesizes our current understanding of sepsis and septic shock burden in intensive care units (ICUs) worldwide. Based on a comprehensive but non-systematic literature search from 2000 to 2025, this review synthesizes our current understanding across eight key domains: epidemiology, pathophysiology, diagnostics, management strategies, long-term outcomes, disparities, and future directions. The global burden of sepsis, especially in the developed and developing world, is great: over 48 million cases per year, with mortality rates at the ICU level in the range of 30 to 50%, depending on geography and resources. The pathophysiological progression from an initial hyper-inflammatory state to immune paralysis underlies organ failure and complicates therapeutic targeting. Diagnostic approaches, including clinical scoring systems, biomarkers (e.g., procalcitonin, MR-proADM), and emerging AI tools, offer improved early detection but face challenges in reliability and accessibility. Management in the ICU remains anchored in timely antimicrobial administration, hemodynamic stabilization with balanced fluids and vasopressors, source control, and organ support, including lung-protective ventilation and kidney replacement therapy. Novel adjuncts, such as immunomodulators and extracorporeal therapies, show promise but demand further validation. Importantly, survivors face significant long-term sequelae—post-intensive care syndrome (PICS)—encompassing physical, cognitive, and psychological impairments, which require structured rehabilitation and follow-up. The future of sepsis care lies in integrating precision medicine—through molecular diagnostics, individualized immunotherapy, and AI-supported monitoring—with scalable, equitable implementation strategies that bridge the gap between high- and low-income settings. Addressing disparities and expanding rehabilitation services are essential to improving survival and long-term quality of life in sepsis survivors. Full article

The Lamb wave-based damage detection method shows great potential for composite impact failure assessments. However, the traditional single signal feature-based methods only depend on partial structural state monitoring information, without considering the inconsistency of damage sensitivity and detection capability for different signal features. Therefore, this paper proposes a damage fusion detection method based on distance analysis and evidence theory for composite laminate panels. Firstly, the signal features of different dimensions are extracted from time–frequency domain perspectives. Correlational analysis and cluster analysis are applied to achieve feature reduction and retain highly sensitive signal features. Secondly, the damage detection results of highly sensitive features and the corresponding basic probability assignments (BPAs) are acquired using distance analysis. Finally, the consistent damage detection result can be acquired by applying evidence theory to the decision level to fuse detection results for highly sensitive signal features. Impact tests on ten composite laminate panels are implemented to validate the proposed fusion detection method. The results show that the proposed method can accurately identify the delamination damage with different locations and different areas. In addition, the classification accuracy is above 85%, the false alarm rate is below 25% and the missing alarm rate is below 15%. Full article

Background: Severe acute pancreatitis (SAP) presents with Multiple Organ Dysfunction Syndrome (MODS) in ~15% of cases, accounting for ~35% of early deaths within 48 h. Major complications—shock, renal failure, and respiratory insufficiency—arise from an overwhelming systemic inflammatory response driven by markedly elevated pro-inflammatory cytokines. Massive release of IL-2, IL-6, and TNF-α underlies the systemic inflammatory response syndrome (SIRS). Continuous veno-venous hemofiltration (CVVH) with the oXiris filter, adsorbing endotoxins and cytokines, has been used in sepsis and applied early in SAP to reduce cytokine load and organ injury. Aims: To evaluate the efficacy and safety of early CVVH with the oXiris filter in modulating the systemic inflammatory response by removing toxic cytokines from the bloodstream in patients with SAP complicated by organ dysfunction and refractory sepsis. Methods: This single-centre, retrospective, observational study was conducted at a tertiary university hospital between 2000 and 2022. Forty-eight consecutive patients with SAP at onset, defined according to the 2012 Atlanta Classification, with an APACHE II score ≥ 19 and persistent organ dysfunction (>48 h), were included. All patients were unresponsive to initial intensive care within the first 24 h and underwent urgent laparotomy with extensive peritoneal lavage, pancreatic necrosectomy, and placement of multiple abdominal drains, followed by transfer to the intensive care unit. CVVH (Prismax system) with the oXiris filter was initiated within 12 h post-surgery. IL-6 and TNF-α were selected as inflammatory markers and measured in both serum and ultrafiltrate at baseline (0 h) and at 24, 48, 72, and 96 h. These measurements were correlated with clinical parameters and prognostic scores (APACHE II, SOFA). Results: Treatment was well tolerated in all patients. The 28-day survival rate was 97.9%. There was a significant time-dependent decrease in IL-6 (p = 0.019) and TNF-α (p = 0.008) concentrations in the ultrafiltrate, consistent with high early adsorption followed by a reduced cytokine burden, whereas serum levels showed a non-significant downward trend (IL-6 p = 0.08; TNF-α p = 0.310). The APACHE II score decreased from 23 postoperatively to 8 by the second week (−65.2%; p = 0.013), with a statistically significant correlation between cytokine reduction and clinical improvement. Adverse events were rare and manageable. Conclusions: Early CVVH with the oXiris filter in SAP, complicated by MODS and refractory sepsis, proved safe, well-tolerated, and potentially effective in reducing cytokine burden and improving prognostic indices. These findings support the hypothesis of a relevant immunomodulatory effect, warranting prospective controlled trials to confirm its true impact on survival and organ recovery. Full article

End-stage kidney disease is preferably treated by kidney transplantation. The function of the allograft often determines kidney-controlled processes and requires long-term monitoring. Kidneys are organs with a very high metabolic rate, and, thus, a metabolomics approach is suitable to observe systemic metabolic changes that are related to graft adaptation. To understand these ongoing changes in post-transplant pediatric patients, we applied a targeted liquid chromatography/tandem mass spectrometry-based metabolomics approach. Time-dependent changes of 140 metabolites in plasma samples prospectively collected from 23 pediatric kidney graft recipients receiving tacrolimus-based immunosuppression were monitored over the first 4 years after transplantation and compared to levels prior to transplantation. Furthermore, by comparing the pre-transplant metabolite levels to those measured in healthy children, we were able to obtain insights into the pathways associated with kidney failure. Arginine biosynthesis, alanine, aspartate, glutamine, and glutamate metabolism, taurine and tryptophan metabolism were the most affected pathways that separate the pediatric patients with and without kidney failure. Accumulation of uremic toxins such as various tryptophan/kynurenine and tryptophan/indole metabolism pathway intermediates, and betaine and methionine cycle metabolites was evident in patients with restricted kidney function. Furthermore, reduced nicotinamide production, insufficient hydroxylation of phenylalanine to tyrosine, lowered cysteine, arginine, glutamine, taurine, and overall amino acid utilization, as well as diminished levels of protective antioxidants such as glutathione and vitamins B6 and C, were all the result of progressive kidney failure leading to transplantation. Importantly, following kidney transplantation and recovery of kidney function, the levels of most of the previously described metabolites normalized toward the levels observed in healthy participants. The here identified metabolic patterns could be used as markers to monitor the progression of pediatric chronic kidney disease patients towards kidney failure, and assuming their direct association with kidney function, they could serve as markers of successful graft adaptation. Full article

Divers’ navigation heavily depends on their experience and physical condition, and accidents caused by failure to return occur every year. To address this issue, we developed a navigation system for divers. This navigation system leverages Raspberry Pi and low-cost sensors, including an accelerometer, gyro sensor, geomagnetic sensor, and pressure gauge, to guide divers along predefined routes back to their starting point. The system employs a 20 Hz sampling frequency and applies high-pass filtering (HPF) to acceleration signals to eliminate gravitational interference. Velocity integration errors are corrected using the rate of pressure change, while impulse noise in accelerometer and geomagnetic sensors is removed via the Robust Kalman Filter (RKF). A time-varying system noise covariance matrix enhances accuracy during rotational states. Quaternion-based attitude avoids gimbal lock, with the Kalman Filter (KF) fusion of accelerometer/geomagnetic data mitigating gyro sensor drift. Forced oscillator trials achieved pitch/roll RMS errors of ±1.23° and ±0.26°. In Kanagawa, Japan, divers successfully navigated 44 waypoints (<5 m spacing) along a route with obstacles (30 m rope, Authors, reefs), with a start/end GNSS positioning error of 6.67 m. Full article

This paper develops a dynamic information-theoretic network framework to quantify systemic risk in China’s maritime–commodity nexus with a focus on the Yangtze River Basin using eight monthly indicators, CCFI, CBCFI, BDI, YRCFI, GAUP, MPCT, CPUS, and ASMC. We resample, impute, standardize, and difference series to achieve stationary time series. Nonlinear interdependencies are estimated via KSG mutual information (MI) within sliding windows; networks are filtered using the Planar Maximally Filtered Graph (PMFG) with bootstrap edge validation (95th percentile) and benchmarked against the MST. Average MI indicates moderate yet heterogeneous dependence (about 0.13–0.17), revealing a container/port core (CCFI–YRCFI–MPCT), a bulk/energy spine (BDI–CPUS), and commodity bridges via GAUP. Dynamic PMFG metrics show a generally resilient but episodically vulnerable structure: density and compactness decline in turbulence. Stress tests demonstrate high redundancy to diffuse link failures (connectivity largely intact until ∼70–80% edge removal) but pronounced sensitivity of diffusion capacity to targeted multi-node outages. Early-warning indicators based on entropy rate and percolation threshold Z-scores flag recurring windows of elevated fragility; change point detection evaluation of both metrics isolates clustered regime shifts (2015–2016, 2018–2019, 2021–2022, and late 2023–2024). A Systemic Importance Index (SII) combining average centrality and removal impact ranks MPCT and CCFI as most critical, followed by BDI, with GAUP/CPUS mid-peripheral and ASMC peripheral. The findings imply that safeguarding port throughput and stabilizing container freight conditions deliver the greatest resilience gains, while monitoring bulk/energy linkages is essential when macro shocks synchronize across markets. Full article

Substantial time-dependent deformation and support failure in deep tunnels through water-rich red-bed soft rock present critical engineering challenges, yet the underlying mechanisms under hydro-mechanical coupling remain inadequately quantified. This study integrates wireless remote monitoring, laboratory testing, and theoretical analysis to investigate the stress-deformation behavior of surrounding rock and support structures. Results reveal that deformation evolves through four distinct stages as follows: sharp, slow, stable, and creep, with the creep stage—governed by pore-water pressure—accounting for over 40% of total displacement. Groundwater-induced clay mineral hydration and stress redistribution significantly weaken rock self-support capacity. Support elements exhibit degraded performance; rock bolts suffer interfacial bond failure, steel arches yield asymmetrically, and the secondary lining resists transmitted deformation pressure. A novel deformation rate-based failure criterion is proposed, revealing a progressive “local breakthrough-chain transmission–global instability” failure pathway. These findings provide a theoretical basis for stability control in deep buried tunnels under hydro-mechanical coupling. Full article

This study explores advanced methods for analyzing the two-parameter alpha-power exponential (APE) distribution using data from a novel generalized progressive hybrid censoring scheme. The APE model is inherently asymmetric, exhibiting positive skewness across all valid parameter values due to its right-skewed exponential base, with the alpha-power transformation amplifying or dampening this skewness depending on the power parameter. The proposed censoring design offers new insights into modeling lifetime data that exhibit non-monotonic hazard behaviors. It enhances testing efficiency by simultaneously imposing fixed-time constraints and ensuring a minimum number of failures, thereby improving inference quality over traditional censoring methods. We derive maximum likelihood and Bayesian estimates for the APE distribution parameters and key reliability measures, such as the reliability and hazard rate functions. Bayesian analysis is performed using independent gamma priors under a symmetric squared error loss, implemented via the Metropolis–Hastings algorithm. Interval estimation is addressed using two normality-based asymptotic confidence intervals and two credible intervals obtained through a simulated Markov Chain Monte Carlo procedure. Monte Carlo simulations across various censoring scenarios demonstrate the stable and superior precision of the proposed methods. Optimal censoring patterns are identified based on the observed Fisher information and its inverse. Two real-world case studies—breast cancer remission times and global oil reserve data—illustrate the practical utility of the APE model within the proposed censoring framework. These applications underscore the model’s capability to effectively analyze diverse reliability phenomena, bridging theoretical innovation with empirical relevance in lifetime data analysis. Full article

Aiming at the problems of borehole shrinkage and pipe sticking caused by creep in salt-gypsum rock formations during deep well drilling, multi-field coupling creep experiments on deep salt-bearing gypsum mudstone were carried out. Furthermore, a nonlinear creep constitutive model was constructed based on the Drucker–Prager criterion, and the critical value of liquid column pressure for borehole shrinkage was determined through numerical simulation. Experiments show that at 140 °C, salt-gypsum rock is mainly subjected to brittle failure with single shear fracture, while at 180 °C, multiple sets of cross-cutting shear bands form, shifting to plastic flow-dominated composite failure. The coupling effect of confining pressure and deviatoric stress is temperature-dependent; the critical deviatoric stress is independent of confining pressure at 140 °C, but decreases significantly with increasing confining pressure at 180 °C, revealing that salt-gypsum rock is more prone to plastic flow under high temperatures and confining pressure. The creep constitutive equation was further determined, and fitting parameters show that the stress exponent m = 2–5 and the time exponent n decrease linearly with the increase in deviatoric stress, and the model can accurately describe the characteristics of three-stage creep. The numerical simulation found that there is a nonlinear relationship between the drilling fluid density and borehole shrinkage; the shrinkage rate exceeds 1.47% when the density is ≤2.0 g/cm³, and the expansion amount is >1.0 mm when ≥2.4 g/cm³. The critical safe density range is 2.1–2.3 g/cm³, which is consistent with the field data in the Bayan area. The research results provide an experimental basis and quantitative method for the dynamic regulation of drilling fluid density in deep gypsum rock formations, and have engineering guiding significance for preventing borehole wall instability. Full article

The impact mechanism of long-term creep in gas-containing coal on coal and gas outbursts has not been fully elucidated and remains insufficiently understood for the purpose of disaster engineering control. This investigation conducted triaxial creep experiments on raw coal specimens under controlled confining pressures, axial stresses, and gas pressures. Through systematic analysis of coal’s physical responses across different loading conditions, we developed and validated a novel creep damage constitutive model for gas-saturated coal through laboratory data calibration. The key findings reveal three characteristic creep regimes: (1) a decelerating phase dominates under low stress conditions, (2) progressive transitions to combined decelerating–steady-state creep with increasing stress, and (3) triphasic decelerating–steady–accelerating behavior at critical stress levels. Comparative analysis shows that gas-free specimens exhibit lower cumulative strain than the 0.5 MPa gas-saturated counterparts, with gas presence accelerating creep progression and reducing the time to failure. Measured creep rates demonstrate stress-dependent behavior: primary creep progresses at 0.002–0.011%/min, decaying exponentially to secondary creep rates below 0.001%/min. Steady-state creep rates follow a power law relationship when subject to deviatoric stress (R² = 0.96). Through the integration of Burgers viscoelastic model with the effective stress principle for porous media, we propose an enhanced constitutive model, incorporating gas adsorption-induced dilatational stresses. This advancement provides a theoretical foundation for predicting time-dependent deformation in deep coal reservoirs and informs monitoring strategies concerning gas-bearing strata stability. This study contributes to the theoretical understanding and engineering monitoring of creep behavior in deep coal rocks. Full article

Background: The development of brain metastases (BM) is a relatively uncommon but significantly adverse event in the spread of colorectal cancer (CRC). Although management of CRC BM has improved with advances in imaging and systemic therapies, clinical outcomes remain poor. Methods: This retrospective cohort study used the U.S. National Cancer Database to evaluate survival outcomes, treatment patterns, and prognostic factors in CRC patients diagnosed with BM between 2010 and 2020. Patients with isolated brain-only metastases formed the primary analytic cohort, while those with additional extracranial metastases were included for descriptive comparison. Multivariable Cox proportional hazards and logistic regression models were used to assess factors associated with of survival. Proportional hazards assumptions were tested using Schoenfeld residuals. Accelerated failure time models were also employed. Results: From a cohort of 1,040,877 individuals with CRC, 795 had metastatic disease present along with relevant data, of which 296 had isolated BM. Median overall survival (mOS) in BM-only metastatic disease group was 7.82 months (95% CI: 5.82–9.66). The longest survival was observed among patients treated with stereotactic radiosurgery combined with systemic therapy (SRS+Sys), with a median OS of 23.26 months (95% CI: 17.51–41.95) and a 3-year survival rate of 35.8%. In adjusted Cox models, SRS, systemic therapy, and definitive surgery of the primary site were each independently associated with reduced hazard of death. Rectal cancer patients had longer survival than those with colon primaries (mOS: 10.35 vs. 6.08 months). Age, comorbidity burden, and insurance status were not associated with survival in adjusted analyses. Conclusions: SRS+Sys was associated with longer survival compared to other treatment strategies. However, treatment selection is highly dependent on individual clinical factors such as performance status, comorbidities, and disease extent; therefore, these findings must be interpreted with caution Future prospective studies incorporating molecular and biomarker data are warranted to better guide care in this rare and high-risk group. Full article

Objective: This study aimed to assess the effect of antibiotic de-escalation on 30-day mortality, duration of intravenous (IV) antibiotic therapy and length of hospital stay (LOS) in severe community-acquired pneumonia (sCAP). Methods: We performed a retrospective analysis of prospectively collected data from a cohort of adults diagnosed with sCAP and microbiologically confirmed etiology between 1995 to 2022. Two distinct time points of the de-escalation were analyzed: 3 and 6 days post-admission, corresponding, respectively, to the availability of microbiological results and the median time to clinical stability. Inverse propensity score-weighted binary logistic regression was used to adjust for potential confounders. Results: A total of 398 consecutive cases of sCAP were analyzed. No significant differences were observed between the de-escalation and non-de-escalation groups in terms of age, sex, comorbidities, or severity-related variables (such as impaired consciousness, shock, respiratory failure, or multilobar pneumonia). Patients in the de-escalation group had lower rates of leukopenia, bacteremia and empyema, and less need for mechanical ventilation, with variations depending on the timing of de-escalation. After adjusting for confounding factors in an inverse propensity score-weighted analysis, de-escalation within 3 or 6 days after admission was not associated with increased mortality risk (adjusted odds ratio [aOR] 1.48, 95% confidence interval [CI] 0.29–7.4; p = 0.63, and aOR 0.57, 95% CI 0.14–2.31, p = 0.43, respectively). Similar findings were observed for prolonged LOS. However, antibiotic de-escalation was related to a lower risk of prolonged IV antibiotic. Conclusions: Antibiotic de-escalation in microbiologically confirmed sCAP did not negatively impact clinical outcomes, supporting the safety of this strategy for optimizing antibiotic use in this serious infection. Full article