Search Results (9,386)

Introduction: A validated clinical decision tool predictive of favorable functional outcomes following endovascular thrombectomy (EVT) in acute ischemic stroke (AIS) remains elusive. We performed a retrospective case series of patients at our regional Comprehensive Stroke Center, over a four-year period, who have undergone EVT to elucidate patient characteristics and factors associated with a favorable functional outcome after EVT. Methods: We reviewed all cases of EVT at our institution between February 2018 and February 2022 in the extended time window from 6–24 h. Demographic, clinical, imaging, and procedure co-variates were included. A favorable clinical outcome was defined as a modified Rankin scale of 0–2. We included patients with M1 or internal carotid artery occlusion treated with EVT within 6–24 h after symptom onset. We used a univariate and multivariate logistic regression analysis to identify patient factors associated with a favorable clinical outcome at 90 days. Results: Our study included evaluation of 121 patients who underwent EVT at our comprehensive stroke center. Our analysis demonstrates that a higher recanalization score based on the modified Thrombolysis In Cerebral Infarction (mTICI) scale (2B-3) was a strong indicator of a favorable outcome (OR 7.33; CI 2.06–26.07; p = 0.0021). Our data also showed that a higher baseline National Institutes of Health Stroke Scale (NIHSS) score (p = 0.0095) and the presence of pre-existing hypertension (p = 0.0035) may also be predictors of an unfavorable outcome (mRS > 2) per our multivariate analysis. Conclusion: Patients without pre-existing hypertension had more favorable outcomes following EVT in the expanded time window. This is consistent with other multicenter data in the expanded time window that demonstrates greater odds of a poor outcome with elevated pre-, peri-, and post-endovascular-treatment blood pressure. Our data also demonstrate that the mTICI score is a strong predictor of favorable outcome, even after controlling for other variables. A lower baseline NIHSS at the time of thrombectomy may also indicate a favorable outcome. Furthermore, the presence of clinical or radiographic mismatch based on the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) and NIHSS per DAWN and DEFUSE-3 criteria did not emerge as a predictor of favorable outcome, which is congruent with recent randomized controlled trials and meta-analyses. Full article

Objective: This study aimed to investigate whether the subjective assessments of strong and weak muscles in the Functional Myodiagnosis muscle test (FMD-MT) can be objectively and reproducibly verified using physically measurable parameters. Additionally, we sought to evaluate the reliability of the manual muscle test in order to reinforce the scientific evidence supporting this accepted, yet not widely adopted, complementary medicine method. Methods: In a crossover observational study, three experienced medical practitioners conducted the FMD-MT of the rectus femoris muscle on 24 healthy participants using a specially designed therapy bench, with all measurements recorded via an oscillogram. The study investigated the force–time integral, joint angle change, additional force load, mean force turning point 1, as well as the interrater reliability and validity of both examiner assessments and instrumental analyses for the two muscle reaction variants: strong and weak. Results: A significant difference between the response pattern of strong and weak muscles was identified for the force–time integral (p = 0.005), the change in joint angle (p < 0.001), and the additional force load (p = 0.001). No difference between strong and weak muscles could be detected regarding the force turning point 1 (p = 0.972). The examiners demonstrated 100% accuracy in identifying weak muscle reactions as weak, and 99.2% accuracy in identifying strong muscle reactions as strong (p = 0.316). The overall intra-class correlation coefficient was 0.984. The oscillogram correctly visualized weak muscle reactions in weak muscles with an accuracy of 81.7%, and strong muscle reactions in strong muscles with an accuracy of 86.7% (p = 0.289). Conclusions: The Functional Myodiagnosis muscle test (FMD-MT) enables a clear and objective differentiation between strong and weak muscles, with statistically significant differences observed in the force–time integral, additional force load, and joint angle changes. Under rigorously standardized testing conditions, the FMD-MT of the rectus femoris muscle demonstrates a validity rate of 99.6% and an excellent reliability (ICC 0.984). Consequently, the FMD muscle test proves to be a reliable, reproducible, and objective diagnostic method. Trial registration: German Register of Clinical Studies U1111-1212-6622. Full article

While the Ankom RF system facilitates efficient high-throughput in vitro fermentation studies, its high cost and limited flexibility constrain its broader applicability. To address these limitations, we developed and validated a low-cost, modular gas monitoring system (FerME), assembled from commercially available components. To evaluate its performance and reproducibility relative to the Ankom RF system (Ankom Technology, Macedon, NY, USA), in vitro rumen fermentation experiments were conducted under strictly controlled and identical conditions. Whole rumen contents were collected approximately 2 h post-feeding from individual mid- or late-lactation dairy cows and immediately transported to the laboratory. Each fermenter received 50 mL of processed rumen fluid, 100 mL of anaerobically prepared artificial saliva buffer, and 1.2 g of the donor cow’s diet. Bottles were sealed with the respective system’s pressure sensors, flushed with CO₂, and incubated in a 50 L water bath maintained at 39 °C. FerME (New Taipei City, Taiwan) and Ankom RF fermenters were placed side-by-side to ensure uniform thermal conditions. To assess the effect of filter bag use, an additional trial employed Ankom F57 filter bags (Ankom Technology, Macedon, NY, USA; 25 μm pore size). Trial 1 revealed no significant differences in cumulative gas production, volatile fatty acids (VFAs), NH₃-N, or pH between systems (p > 0.05). However, the use of filter bags reduced gas output and increased propionate concentrations (p < 0.05). Trial 2, which employed filter bags in both systems, confirmed comparable results, with the FerME system demonstrating improved precision (CV: 4.8% vs. 13.2%). Gas composition (CH₄ + CO₂: 76–82%) and fermentation parameters remained consistent across systems (p > 0.05). Importantly, with 12 pressure sensors, the total cost of FerME was about half that of the Ankom RF system. Collectively, these findings demonstrate that FerME is a reliable, low-cost alternative for real-time rumen fermentation monitoring and could be suitable for studies in animal nutrition, methane mitigation, and related applications. Full article

Metacognitive monitoring plays a crucial role in self-regulated learning, as accurate monitoring enables effective control, which in turn impacts learning outcomes. Most studies on metacognitive monitoring have focused on learners’ monitoring abilities when they are explicitly prompted to monitor. However, in real-world educational settings, learners are more often prompted to control their learning, such as deciding whether to allocate additional time to a learning target. The primary goal of this study was to investigate whether retrieval is engaged when learners are explicitly prompted to control their learning processes by making study decisions. To address this, three experiments were conducted. In Experiment 1, participants (N = 39) studied 70 Swahili–English word pairs in a learning task. Each trial displayed a word pair for 8 s, followed by a distractor task (a two-digit mental addition) and a study decision intervention (choose “Study Again” or “Next”). After learning, participants provided a global judgment of learning (JOL), estimating their overall recall accuracy. Finally, they completed a cued recall test (Swahili cue). Responses were scored for accuracy and analyzed alongside study decisions, study decision reaction time (RT), and metacognitive judgments. Reaction times (RTs) for study decisions correlated positively with test accuracy, global judgments of learning (JOLs), and judgments of confidence (JOCs), suggesting retrieval likely underlies these decisions. Experiment 2 (N = 74, between-subjects) compared memory performance and intervention response time between single-study, restudy, retrieval (explicit recall prompt), and study decision (study decision prompt) groups to have better control over study time and cognitive processes. Although no significant group differences in test accuracy emerged, the retrieval group took longer to respond than the study decision group. Within-subject analyses revealed similar recall accuracy patterns: participants recalled successfully retrieved or “no restudy” items better than failed-retrieval or “restudy” items, implying shared cognitive processes underlying retrieval and study decision interventions. Experiment 3 (N = 74, within-subject, three learning conditions: single-study, retrieval, and study decision) replicated these findings, with no condition effects on test accuracy but longer RT for retrieval than study decisions. The similar recall accuracy patterns between retrieval and study decision interventions further supported shared cognitive processes underlying both tasks. Self-reports across experiments confirmed retrieval engagement in both retrieval and study decision interventions. Collectively, the results suggest that retrieval likely supports study decisions but may occur less frequently or less deeply than under explicit monitoring prompts. Additionally, this study explored objective, online measures to detect retrieval-based metacognitive monitoring. Full article

Background: Optimal timing for surgery following acute rotator cuff tears remains unclear. This study examines how the timing of arthroscopic rotator cuff repair (RCR) affects retear rates and functional outcomes. Methods: This PROSPERO-registered review (CRD42024528249) followed PRISMA guidelines and included randomized trials, and cohort, studies on adults with imaging-confirmed full-thickness rotator cuff tears. Studies lacking timing data or key outcomes were excluded. Risk of bias was assessed using ROBINS-I. Meta-analysis of retear rates was performed comparing surgical timing. Qualitative analysis was conducted classifying results as early-beneficial, delayed-detrimental, or neutral. Results: Our review included 13 studies and 871 patients with an average age of 57.9. Meta-analysis of eight studies comparing retear rates between early and delayed RCR demonstrated a significant benefit associated with early intervention risk ratio 0.60 (95% CI: 0.38–0.96). Functional outcomes also favored early intervention with four studies demonstrating significantly greater postoperative functional improvements in the early intervention group. Conclusions: Early arthroscopic RCR decreased the rate of retear and improved functional outcomes. No study found early intervention to be detrimental or delayed intervention to be superior. These findings support consideration of early repair when clinically appropriate. Future studies should determine more finite timing guidelines. Full article

Background/Objectives: The aim of this systematic review was to compare the effectiveness of virtual reality (VR)-based training with conventional exercise programs in improving functional outcomes related to fall risk among older adults with various health conditions. Methods: The review was conducted in accordance with the PRISMA 2020 guidelines and registered in PROSPERO (registration number CRD42022345678). The databases Scopus, PubMed, Web of Science, and EBSCO were searched up to 31 March 2025. Randomized controlled trials (RCTs) were included if they involved participants aged ≥60 years, a VR intervention lasting ≥6 weeks, and a control group performing traditional exercises or receiving usual care. Methodological quality was assessed using the PEDro scale, and a narrative synthesis was performed across four outcome domains: balance, mobility, cognitive function, and fall risk. Results: Seven RCTs were included in the analysis (totaling 664 participants). VR training was found to be at least as effective as conventional exercise in improving balance (e.g., Berg Balance Scale) and mobility (e.g., Timed Up and Go), with some studies showing superior effects of VR. One RCT demonstrated that combining VR with balance exercises (MIX) yielded the greatest improvements in muscle strength and physical performance. Additionally, two studies reported cognitive benefits (e.g., MoCA) and a 42% reduction in fall incidence within six months following VR intervention. The methodological quality of the included studies was moderate to high (PEDro score 5–9/10). Conclusions: VR-based training represents a safe and engaging supplement to geriatric rehabilitation, effectively improving balance, mobility, and, in selected cases, cognitive function, while also reducing fall risk. Full article

This study develops and validates an artificial intelligence (AI)-assisted internship learning platform for automotive electronics based on the Llama 3 large language model, aiming to enhance pedagogical effectiveness within vocational training contexts. Addressing critical issues such as the persistent theory–practice gap and limited innovation capability prevalent in existing curricula, we leverage the natural language processing (NLP) capabilities of Llama 3 through fine-tuning based on transfer learning to establish a specialized knowledge base encompassing fundamental circuit principles and fault diagnosis protocols. The implementation employs the Hugging Face Transformers library with optimized hyperparameters, including a learning rate of 5 × 10⁻⁵ across five training epochs. Post-training evaluations revealed an accuracy of 89.7% on validation tasks (representing a 12.4% improvement over the baseline model), a semantic comprehension precision of 92.3% in technical question-and-answer assessments, a mathematical computation accuracy of 78.4% (highlighting this as a current limitation), and a latency of 6.3 s under peak operational workloads (indicating a system bottleneck). Although direct trials involving students were deliberately avoided, the platform’s technical feasibility was validated through multidimensional benchmarking against established models (BERT-base and GPT-2), confirming superior domain adaptability (F1 = 0.87) and enhanced error tolerance (σ² = 1.2). Notable limitations emerged in numerical reasoning tasks (Cohen’s d = 1.15 compared to human experts) and in real-time responsiveness deterioration when exceeding 50 concurrent users. The study concludes that Llama 3 demonstrates considerable promise for automotive electronics skills development. Proposed future enhancements include integrating symbolic AI modules to improve computational reliability, implementing Kubernetes-based load balancing to ensure latency below 2 s at scale, and conducting longitudinal pedagogical validation studies with trainees. This research provides a robust technical foundation for AI-driven vocational education, especially suited to mechatronics fields that require close integration between theoretical knowledge and practical troubleshooting skills. Full article

Background: Patients in Intensive Care Units (ICUs) often develop non-thyroidal illness syndrome. Potentially, thyroid hormones may be removed during continuous veno-venous hemodiafiltration (CVVHDF), as their molecular size is smaller than the filter pores’ cutoff. The study’s main aim was to assess whether the serum concentration of thyroid hormones changes over time during CVVHDF. Methods: This was a prospective observational trial that included 30 patients treated in an ICU. All patients developed acute kidney injury (AKI) and had clinical indications for implementation of CVVHDF. Blood samples were collected before initiation of CVVHDF and at 1, 2, 3, 6, 9 and 12 days after. The last sample was collected three days after CVVHDF withdrawal. Thyroid function was evaluated by determining the serum concentration of TSH, thyrotropin-releasing hormone (TRH), free triiodothyronine (fT₃), free thyroxine (fT₄), total triiodothyronine (tT₃), total thyroxine (tT₄) and reverse triiodothyronine (rT₃). We additionally calculated the total activity of peripheral deiodinases (G_D) using a mathematical model. Results: TRH and TSH levels remained mostly within normal ranges. fT4 and tT4 were in normal range or slightly below. In contrast, fT3 and tT3 were undetectably low in most patients throughout. Reverse T3 levels remained within normal limits. There were no statistically significant changes in any thyroid hormone levels over the CVVHDF treatment period. The calculated peripheral G_D activity was lower than normal, but importantly, it did not change significantly over time. Conclusions: Thyroid hormones are not lost due to hemodiafiltration. Decreased deiodinases activity is responsible for alterations in serum concentrations of thyroid hormones in patients during CVVHDF. Full article

Most research on domestic dog (Canis familiaris) behavior has focused on pets with restricted movement. However, free-ranging dogs exist in diverse cultural contexts globally, and their interactions with humans are less understood. Tourists can facilitate unrestricted dog movement into wilderness areas, where they may negatively impact wildlife. This study investigated which stimuli—namely, voice, touch, or food—along with inherent factors (age, sex, sociability) motivate free-ranging dogs to follow a human stranger. We measured the distance (up to 600 m) of 129 free-ranging owned and stray dogs from three villages in southern Chile as they followed an experimenter who presented them one of the above stimuli or none (control). To evaluate the effect of dog sociability (i.e., positive versus stress-related or passive behaviors), we performed a 30 s socialization test (standing near the dog without interacting) before presenting a 10 s stimulus twice. We also tracked whether the dog was in the company of other dogs. Each focus dog was video-recorded and tested up to three times over five days. Generalized linear mixed-effects models revealed that the food stimulus significantly influenced dogs’ motivation to follow a stranger, as well as a high proportion of sociable behaviors directed towards humans and the company of other dogs present during the experiment. Juveniles tended to follow a stranger more than adults or seniors, but no effects were found for the dog’s sex, whether an owner was present, the repetition of trials, the location where the study was performed, or for individuals as a random variable. This research highlights that sociability as an inherent factor shapes dog–stranger interactions in free-ranging dogs when food is given. In the context of wildlife conservation, we recommend that managers promote awareness among local communities and tourists to avoid feeding dogs, especially in the context of outdoor activities close to wilderness. Full article

T-cell-engaging antibodies are a promising new type of treatment for patients with refractory or relapsed (R/R) diffuse large B-cell lymphoma, which has changed the prognosis and evolution of these patients in clinical trials. Bispecific antibodies (BsAbs) bind to two different targets (B and T lymphocytes) at the same time and in this way mimic the action of CAR (chimeric antigen receptor) T-cells. They are the T-cell-engaging antibodies most used in practice and are a solution for patients who do not respond to second- or later-line therapies, including chemoimmunotherapy, followed by salvage chemotherapy and hematopoietic stem cell transplantation. They are a therapeutic option for patients who are ineligible for CAR T-cell therapy and are also active in those with prior exposure to CAR T-cell treatment. A remarkable advantage of BsAbs is their rapid availability, even if the disease progresses rapidly, unlike CAR T-cell treatment, and they avoid the practical and financial challenges raised by autologous CAR T-cell therapies. CAR-T has been proven to have better efficacy compared to BsAbs, but cytokine release syndrome and neurotoxicity have appeared significantly more frequently in patients treated with CAR T-cells. The possibility of combining BsAbs with chemotherapy and their administration for relapses or as a frontline therapy is being studied to increase their efficacy. BsAbs are a life-saving therapy for many patients with diffuse large B-cell malignant non-Hodgkin’s lymphoma (NHL) who have a poor prognosis with classical therapies, but are not without adverse effects and require careful monitoring. Full article

Background/Objectives: Frailty is a prevalent geriatric syndrome associated with impaired postural control and elevated fall risk. Although conventional exercise is a core strategy for frailty management, adherence remains limited. Virtual reality (VR)-based interventions have emerged as potentially engaging alternatives, but their effects on objective postural control and task-specific confidence in frail populations remain understudied. This study aimed to evaluate the effectiveness of a supervised VR training program using the Nintendo Ring Fit Plus™ on postural control, functional mobility, and balance confidence among frail community-dwelling older adults. Methods: Fifty-one adults aged ≥65 years classified as frail or prefrail were enrolled in a four-week trial. Participants were assigned to either a VR intervention group (n = 28) or control group (n = 23). Participants were non-randomly assigned based on availability and preference. Outcome measures were collected at baseline and post-intervention. Primary outcomes included center of pressure (CoP) metrics—sway area, mean velocity, and sway path. Secondary outcomes were the Timed Up and Go (TUG), Berg Balance Scale (BBS), Activities-specific Balance Confidence (ABC), and Falls Efficacy Scale–International (FES-I). Results: After adjusting for baseline values, age, and BMI, the intervention group showed significantly greater improvements than the control group across all postural control outcomes. Notably, reductions in sway area, mean velocity, and sway path were observed under both eyes-open and eyes-closed conditions, with effect sizes ranging from moderate to very large (Cohen’s d = 0.57 to 1.61). For secondary outcomes, significant between-group differences were found in functional mobility (TUG), balance performance (BBS), and balance confidence (ABC), with moderate-to-large effect sizes (Cohen’s d = 0.53 to 0.73). However, no significant improvement was observed in fear of falling (FES-I), despite a small-to-moderate effect size. Conclusions: A supervised VR program significantly enhanced postural control, mobility, and task-specific balance confidence in frail older adults. These findings support the feasibility and efficacy of VR-based training as a scalable strategy for mitigating frailty-related mobility impairments. Full article

Blood flow restriction training (BFRT) offers notable advantages, including simplicity and time efficiency. However, no meta-analysis has yet comprehensively evaluated its effects on glucose and lipid metabolism in overweight or obese adults. This meta-analysis examines the potential efficacy of BFRT in improving glycemic and lipid control in overweight/obese adults. The literature was searched in six databases, with the search period up to 31 March 2025. A total of eight randomized controlled trials involving 267 participants were identified. Data were analyzed using Stata 18.0 and RevMan 5.4 with random effects models. Outcomes included fasting blood glucose (FBG), homeostasis model assessment of insulin resistance (HOMA-IR), and lipid profiles, and risk of bias and publication bias (Egger’s test) were assessed. BFRT significantly reduced FBG (Hedges’ g = −1.13, 95% CI: −1.65 to −0.62, p < 0.01; I² = 66.34%) and HOMA-IR (Hedges’ g = −0.98, 95% CI: −1.35 to −0.61, p < 0.01; I² = 17.33%) compared with the controls. However, no significant changes were observed in lipid profiles. Our analysis demonstrates that BFRT exhibits the favorable effect of improving glucose metabolism in overweight/obese adults; however, current evidence does not support significant advantages of BFRT for lipid metabolism improvement. Full article

The intersection of religion and education in the United States dates to colonial times, as do attempts by religious institutions and individuals to regulate educational content. After a prominent retreat by religious fundamentalists following the Scopes Monkey Trial, conservative Christians have once again entered political debates about educational content in the form of modern culture wars issues. Both conservatives and liberals have attempted to punish educators for political comments made in class, but the influence of religion on individual attitudes has yet to be examined. In this article, we use an original survey experiment to examine individuals’ propensity to punish a professor who makes politically charged comments in class. We also assess whether religious individuals are more likely to punish professors for comments disparaging conservatives or liberals. We find that high-attending religious individuals, including both Evangelicals and Catholics, are more likely to support punishing the professor. However, we find that the propensity to punish is not related to the target of the professor’s comments. These findings suggest a resurgence of religious interest in education as a cultural issue at the individual, and not just institutional, level and a coalition between Evangelicals and Catholics on this issue. Full article

Background: Peritoneal metastases (PM) represent a common and challenging manifestation of several gastrointestinal and gynecologic malignancies. Bidirectional treatment—combining Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) with systemic chemotherapy—has emerged as a strategy to enhance locoregional control while maintaining systemic coverage. Objective: This systematic review aimed to analyze the study design, characteristics, and timing of the treatments administered—including the type of systemic chemotherapy, intraperitoneal agents used in PIPAC, and interval between administrations—as well as the clinical outcomes, safety profile, and overall methodological quality of the available literature on bidirectional treatment for peritoneal metastases. Methods: A systematic literature search was conducted across the PubMed, Embase, and Cochrane Library databases up to April 2025. Studies were included if they reported clinical outcomes of patients undergoing bidirectional treatment. Data extraction focused on survival, response assessment (PRGS, PCI), adverse events, systemic and intraperitoneal regimens, treatment interval, and study methodology. Results: A total of 22 studies involving 1015 patients (742 treated with bidirectional therapy) were included. Median overall survival ranged from 2.8 to 19.6 months, with the most favorable outcomes observed in gastric and colorectal cancer cohorts. PRGS improvement after multiple PIPAC cycles was reported in >80% of evaluable cases. High-grade adverse events (CTCAE ≥ 3) occurred in up to 17% of patients in most studies, with only one study reporting treatment-related mortality. However, methodological quality was generally moderate, with considerable heterogeneity in treatment protocols, response criteria, systemic regimens, and toxicity attribution. Conclusions: Bidirectional therapy with PIPAC and systemic chemotherapy appears to be a feasible and potentially effective strategy for selected patients with peritoneal metastases. Despite encouraging outcomes, definitive conclusions are limited by the retrospective nature and heterogeneity of available studies. Prospective standardized trials are needed to confirm efficacy, clarify patient selection, and optimize treatment protocols. Full article

Background: In recent years, there has been increasing interest in the application of repetitive Transcranial Magnetic Stimulation (rTMS) and transcranial Direct-Current Stimulation (tDCS) to enhance and rehabilitate the language abilities in individuals with neurodegenerative diseases. Objective: The aim of this narrative literature review is to investigate the usefulness of rTMS and tDCS to improve language abilities in people with Primary Progressive Aphasia (PPA). Methods: This narrative literature review was conducted through a search of the PubMed online database to identify studies investigating the effects of multiple sessions of rTMS or tDCS on language abilities in PPA patients, applied either as stand-alone interventions or in combination with language treatment. Results: Thirty-three studies fulfilled the inclusion criteria; five studies employed rTMS without language treatment; two studies applied tDCS as stand-alone intervention; twenty-two studies combined tDCS with language treatment; and four studies assessed the effects of tDCS during verbal task without language treatment. Conclusions: rTMS and tDCS applied with or without concomitant language treatment appear to be promising interventions for enhancing language abilities in PPA, with sustained effects reported over time. Further research is necessary to optimise stimulation protocols and to improve our understanding of their long-term effects. Moreover, randomised controlled trials (RCTs) with larger sample sizes are critically needed to clarify the true impact of brain stimulation in PPA, with a focus on changes in cognitive and functional performance, neural activity, and potential molecular correlates. Full article