Search Results (751)

Background: Single-access transfemoral transcatheter aortic valve implantation (TAVI) reduces the need for multiple vascular access and therefore, the related risk of related complications. However, the impact of patient age on its clinical outcomes remains uncertain. Methods: This is a secondary analysis of previously reported propensity score matched study comparing clinical outcomes of single- versus dual-access transfemoral TAVI using SAPIEN-3-Ultra. We examined the relation between patient age, access strategy and outcomes—specifically, 30-day safety endpoint according to the Valve Academic Research Consortium 3 (VARC-3) and major adverse cardiovascular events (MACE), defined as death, permanent pacemaker, neurological or vascular complications—using logistic regression interaction analyses, and restricted cubic spline modelling. Results: A total of 204 patients (propensity score-matched cohort) were included in the study. The elderly group were more likely to have hypertension, peripheral vascular disease or stroke. The use of single access was comparable. The elderly cohort demonstrated a tendency toward longer fluoroscopy and procedural times compared with the non-elderly group. This pattern likely reflects the greater technical complexity and heightened procedural caution often associated with older patients, including more challenging vascular anatomy and the need for careful device handling. Although not statistically significant, these findings remain clinically meaningful and are consistent with the notion that procedures in elderly patients frequently require more meticulous planning and execution. There was a significant interaction between access strategy and age in reducing MACE, but not in VARC-3 safety outcomes. Single access was associated with a significant reduction in MACE (5.4% vs. 26.7%, p = 0.015) with comparable technical and safety outcomes when compared with elderly patients who underwent dual-access TAVI. Conclusions: Single-access TAVI was linked to favourable early outcomes, maintained procedural success, and suggested a possible age-dependent pattern in the occurrence of MACE. Our findings support the need for randomised studies to demonstrate superiority of single- versus dual-access TAVI, particularly in the elderly population. Full article

Background: Severe maxillary atrophy often precludes placement of conventional dental implants and frequently requires invasive bone augmentation procedures. This prospective pilot study evaluated a treatment concept using immediately loaded 5.2-mm ultra-short implants connected by a patient-specific CAD/CAM inter-implant bar system (VD CLIC BAR^®) to support maxillary overdentures. Methods: Thirteen completely edentulous patients with severe maxillary atrophy (Cawood–Howell Class V or VI) were treated with six to eight immediately loaded 5.2-mm ultra-short implants connected by a patient-specific CAD/CAM inter-implant bar (VD CLIC BAR^®) supporting a maxillary overdenture. The primary outcome was implant survival. Secondary outcomes included oral health-related quality of life (OHIP-14), self-reported chewing ability (VAS), implant stability (Periotest), and prosthetic rehabilitation. Results: A total of 96 initial implants and 8 additional implants were placed following early implant failures. The primary implant survival rate after two years was 83.3%. Implant failures occurred predominantly during early healing and were unevenly distributed across the cohort. Early failures were managed by placement of additional ultra-short implants, enabling definitive implant-supported rehabilitation in all patients. Periotest values demonstrated a significant increase in implant stability over time (p < 0.001). Median OHIP-14 scores improved from 32.0 (IQR 20.0–44.0) at baseline to 4.0 (IQR 1.0–20.0) at two years (p = 0.006). Median chewing ability at two years was 82.7 (IQR 50.1–91.9). Conclusions: This prospective pilot study demonstrates the feasibility of an immediately loaded treatment concept using 5.2-mm ultra-short implants splinted with a patient-specific CAD/CAM inter-implant bar (VD CLIC BAR^®) to support maxillary overdentures in patients with severe maxillary atrophy. Although early implant failures occurred and required placement of additional ultra-short implants in some patients, all patients ultimately achieved functional implant-supported rehabilitation. These preliminary findings require confirmation in larger controlled studies with longer follow-up. Full article

The management of traumatic brain injury remains one of the greatest challenges in modern medicine. Determining whom to treat, when to intervene, and how aggressively to proceed and persist continues to define the central dilemma of neurotrauma care. While the injured brain possesses only limited regenerative capacity, substantial opportunity remains to mitigate the cascade of secondary brain injury. Previous technological and scientific advances have progressively challenged the therapeutic nihilism historically associated with severe neurotrauma, and the accelerating pace of innovation is invigorating efforts to push the boundaries of care. Contemporary neurotrauma research increasingly seeks to reduce the incidence of injury through prevention, enable ultra-early diagnosis and intervention, biologically subclassify heterogeneous injury patterns, and integrate multimodal neuromonitoring into precision-guided therapeutic strategies. Advances in artificial intelligence, computational modelling, imaging, biomarker science, and neurocritical care now build upon decades of foundational work established by prior generations of clinicians and scientists. Together, these developments may enable increasingly individualised approaches to neurotrauma management, with the aim of preserving meaningful neurological function, quality of life, and human potential on a global scale. Although many challenges remain, modern neurotrauma increasingly stands at the threshold of such transformation. This narrative review explores the emerging technologies, evolving paradigms, and future directions that may shape the next era of neurotrauma care. Full article

This study quantitatively investigates the coupled effects of curing temperature and slurry density on the early-age acoustic maturation of ultra-low-density Hollow Glass Microsphere (HGM)-modified oil well cement systems, addressing the critical challenge of determining reliable sonic logging timing under lightweight cementing conditions. Longitudinal wave velocity evolution was systematically characterized across a broad thermo–density domain, revealing a consistent three-stage acoustic trajectory comprising percolation-driven acceleration, transition-controlled consolidation, and acoustic stabilization. The results demonstrate that curing temperature primarily regulates the kinetic rate of acoustic maturation through hydration activation, whereas slurry density modulates the initial structural configuration, HGM-induced acoustic impedance heterogeneity, and development of effective solid connectivity. A derivative-based dual-criterion approach was proposed to define the optimal sonic logging time based on intrinsic acoustic stabilization behavior rather than conventional empirical strength-based thresholds. Furthermore, a thermo–density coupled semi-empirical model incorporating Arrhenius-type thermal activation and density-dependent structural effects was developed, providing reliable prediction of sonic logging timing with clear physical interpretability. The model captures the nonlinear interaction between thermal activation and structural constraints, revealing that acoustic maturation is accelerated under elevated-temperature and higher-density conditions but substantially delayed under low-temperature and ultra-low-density scenarios. This study establishes a physics-informed temperature–density–acoustic coupling framework that links hydration-controlled structural evolution with sonic logging optimization, providing a rational basis for improving cement bond evaluation reliability and operational efficiency under challenging wellbore conditions. Full article

Early cancer detection is critical for improving patient outcomes, yet current diagnostic approaches often fail to identify malignancies when tumor-specific biomarkers are relatively scarce. Emerging CRISPR/Cas-based technologies have revolutionized the ultra-sensitive detection of cancer biomarkers in liquid biopsies, overcoming the inherent limitations of traditional diagnostic approaches such as tissue biopsies and imaging, which frequently fail to detect early-stage malignancies with sufficient sensitivity. This review explores recent advances in CRISPR/Cas diagnostics (CRISPR/Cas-Dx) that employ programmable CRISPR effectors, including Cas9, Cas12, Cas13, and Cas14. In particular, the collateral (trans-) cleavage activities of Cas12, Cas13, and Cas14 enable signal amplification for highly sensitive detection of circulating tumor DNA, microRNAs, exosomes, and other multi-omics biomarkers, often without the need for extensive nucleic acid amplification. Representative CRISPR/Cas-Dx platforms include amplification-coupled assays, amplification-free frameworks, biosensing and multiplexing capabilities, and new digital or droplet-based configurations that include artificial intelligence to improve analytical precision. These technologies demonstrate single-molecule resolution and adaptability for point-of-care testing in malignancies such as non-small cell lung, colorectal, and breast carcinoma. Finally, we outline a clinical translation roadmap encompassing manufacturability, regulatory and standardization requirements, and real-world implementation challenges. This perspective offers a blueprint for CRISPR-powered, ultra-sensitive liquid biopsy diagnostics that can enable population-scale early cancer screening and truly preventive oncology by bridging molecular insights, engineering innovation, and clinical imperatives. Full article

This study maps the dynamic response of the IEA 15 MW reference wind turbine mounted on the UMaine VolturnUS-S semi-submersible platform across seven wave headings, spanning $\beta$ = 0–180°. A fully coupled aero–hydro–servo–elastic OpenFAST model with lumped-mass catenary mooring is simulated over three environmental groups: below-rated operation, a severe sea state at rated wind, and a parked extreme, combined with seven wave headings and supplemented by a 77-case operational envelope sweep across hub wind speeds of 4–24 m/s. Responses are analyzed through time-domain and frequency-domain statistics, drift kinematics, and exceedance curves. At operating states, the maximum side-to-side moment rises from 80.44 to 273.60 MNm between following and beam seas, while the maximum fore–aft moment reduces from 566.90 MNm to 485.23 MNm, respectively. The parked extreme LC-C maximum pitch response (2.77° at following seas, 2.59° at beam seas) is roughly half that of the severe operating LC-B (6.29° and 5.38°, respectively). This directional coupling is robust across environmental severities. In the parked group, the lateral motions (sway, roll) are amplified, as feathering reduces the rotor’s aerodynamic contribution to lateral damping. The developed wind speed misalignment response atlas condenses the aforementioned data, providing a compact basis for rapid early screening of ultra-large floating offshore wind turbines. Full article

Glass sponges (Porifera: Hexactinellida) have been the subject of scientific investigation for over two centuries, yet the temporal and thematic structure of this research effort has never been quantitatively evaluated. Here, we assessed taxonomic activity, geographical and bathymetric coverage, and keyword trends extracted from the indexed literature. We found two different periods of intense taxonomic activity occurring in the late 19th century and early 20th century, and then following World War II, with a steady increase in currently indexed publication output following the establishment of the modern peer-review system. However, research has been disproportionately concentrated on mesophotic and bathyal depths, whereas shallow and abyssal glass sponges have received comparatively little attention, while hadal records remained largely confined to the non-indexed literature until very recently. Furthermore, we found a decline in the number of active experienced glass sponge taxonomists, with few new experts being trained. This mismatch occurs as abyssal and hadal environments become increasingly accessible, potentially constraining our ability to adequately study the taxonomy and ecology of ultra-deep glass sponges. Full article

Ultra-high-performance concrete (UHPC) typically contains high cement and steel-fiber contents, leading to high cost and carbon emissions. This study developed a low-carbon UHPC by partially replacing cement with industrial solid waste (ISW) composed of ground granulated blast-furnace slag and calcium carbide slag, and by partially replacing steel fibers with recycled plastic fibers (RPF). The effects of ISW and RPF on flowability, mechanical properties, hydration behavior, microstructure, carbon emissions, and raw-material cost were investigated. ISW had a limited influence on flowability, whereas RPF markedly reduced flowability. Appropriate ISW and RPF contents increased flexural and compressive strengths by up to 41.02% and 14.93%, respectively. The 30% ISW-50% RPF mixture provided the highest flexural strength, while 30% ISW-30% RPF achieved the highest compressive strength with acceptable flowability. Hydration heat, XRD, SEM, and FTIR analyses showed that moderate ISW promoted early hydration and C-S-H/C-A-S-H gel formation, whereas excessive ISW caused dilution and reduced matrix compactness. Therefore, 30% ISW-30% RPF is recommended as the balanced formulation, whereas 50% ISW-50% RPF is more suitable for carbon- and cost-sensitive applications and maintains approximately 150 MPa compressive strength. Full article

Early detection of incipient fire signs, such as dilute smoke emerging at valve hall penetration seals, remains a critical challenge for fire safety in ultra-high-voltage (UHV) converter stations. This study addresses the limitation through controlled valve hall sealing simulations that systematically reproduce the complete fire evolution process—from initial dilute smoke leakage, through dense smoke accumulation, to eventual flame overflow—thereby constructing a high-fidelity dataset tailored to complex converter station environments with low-contrast and varying illumination conditions. Building on this dataset, an attention-enhanced YOLOv5s model integrating multiple attention mechanisms (GAM, CBAM, CA, and ECA) is proposed as the core of an end-to-end visual detection framework. Rigorous experiments and ablation studies validate the framework’s superiority: dilute smoke detection precision improves substantially from a baseline of 57% to 81%, with recall increasing from 61% to 84%; dense smoke and flame detection achieve accuracies of 92% and 98%, respectively. Compared with the original model, false and missed alarm rates are significantly reduced, demonstrating strong robustness against background interference and lighting variations. The proposed method enables reliable, high-precision monitoring across all fire stages, providing a novel technical pathway for early fire warning in UHV converter stations and offering extensibility to other large-scale industrial fire monitoring scenarios. Full article

This study investigates the effects of grape-derived exosomes on prediabetic mice and elucidates their underlying mechanisms through an integrated metabolomics approach. A prediabetic mouse model was established, with 18 mice randomly assigned to three groups: model control group, grape exosome treatment group, and antioxidant nutrient supplementation group. Therapeutic efficacy was assessed using fasting plasma glucose (FPG) and homeostasis model assessment of β-cell function (HOMA-β). Intestinal content metabolites were profiled via both untargeted ultra-high performance liquid chromatography coupled with orbitrap electrospray mass spectrometry (UHPLC-OE-MS) and targeted metabolomics analyses. Grape exosomes effectively mitigated prediabetes progression. Untargeted metabolomics revealed 1222 downregulated and 425 upregulated metabolites in the grape exosome group relative to the model control group, among which riboflavin (upregulated) was potentially associated with amino acid metabolism. Targeted metabolomics identified 23 upregulated and 41 downregulated metabolites, with glycine showing a significant elevation. Notably, both the grape exosome group and antioxidant nutrient supplementation group exhibited increased glycine levels and shared enriched metabolic pathways, including D-glutamine and D-glutamate metabolism, phenylalanine, tyrosine and tryptophan biosynthesis, as well as valine, leucine, and isoleucine biosynthesis. Integrated untargeted and targeted metabolomics analysis demonstrates that grape exosomes ameliorate diabetes-related metabolic disorders and slow the progression of prediabetes, indicating that grape-derived exosomes have great potential as a functional intervention agent for early glucose metabolism dysfunction. Full article

Background: Imidacloprid, a widely used neonicotinoid insecticide, is routinely applied to control pests in Astragalus membranaceus var. mongholicus, a crucial medicinal herb producing Astragali Radix. However, the early short-term transcriptional and metabolic responses of its seedlings under imidacloprid gradient stress remain poorly characterized. Methods: In this study, 80-day seedlings were subjected to three foliar spray treatments: blank control (CK), the recommended imidacloprid concentration (2000-fold dilution, 475 mg·L⁻¹), and an excessively high concentration (500-fold dilution, 1900 mg·L⁻¹). Leaf samples were harvested 24 h post-treatment for untargeted ultra-high-performance liquid chromatography-tandem mass spectrometry (UPLC–MS/MS) metabolomics (6 biological replicates) and RNA-seq transcriptome sequencing (3 biological replicates). Results: The low- and high-dose treatments induced 1076 and 860 differential metabolites and 6818 and 7283 differentially expressed genes, respectively. Flavonoids, saponins, terpenoids, amino acid metabolites, and energy-related pathways were prominently affected. KEGG enrichment indicated activation of flavone/flavonol biosynthesis, phenylpropanoid metabolism, amino acid metabolism, MAPK signaling, cutin/suberin/wax biosynthesis, and ABC transporter pathways, whereas high-dose exposure was associated with stronger changes in genes related to DNA replication and cell wall remodeling. Integrated network analysis highlighted CHS, PAL, MYC2, KCS, and ABCG40 as candidate regulators linking stress signaling, secondary metabolism, and metabolite transport. Conclusions: Seedlings of A. membranaceus var. mongholicus exhibit dose-dependent acute responses to imidacloprid. Moderate pesticide exposure primarily activates defensive secondary metabolism, whereas excessive dosage triggers genome-wide transcriptional reprogramming. This work identifies key metabolic pathways and hub genes, offering candidate molecular markers for investigating pesticide stress adaptation in medicinal Astragalus and guiding standardized pesticide application in cultivation. Full article

Deep and ultra-deep hydrocarbon resources are of strategic importance for energy security. The pronounced ductility of deep reservoirs and faults makes hydraulic fracture propagation and induced seismicity mechanisms fundamentally different from those in conventional brittle reservoirs. This review systematically synthesizes recent theoretical, experimental, and numerical advances in hydraulic-fracturing-induced seismicity, covering triggering mechanisms, fault reactivation risk evaluation, and perspectives. A core distinction is identified: brittle faults exhibit instantaneous stick-slip rupture with high seismic frequency and significant magnitude, whereas ductile faults undergo stable aseismic creep and progressive slip, with long-term deformation prone to delayed large earthquakes—their nucleation shows unique mechanical responses including high stress drop, low rupture velocity, and low seismic radiation efficiency. Subsequently, four major challenges are distilled for risk evaluation systems: insufficient dynamic characterization of mechanical parameters in ductile reservoirs, lack of fracturing-control strategies adapted to ductile behavior, poor understanding of multi-scale slip transition mechanisms, and inadequacy of multi-field coupling models in capturing long-term delayed evolution. Traditional brittle-based risk frameworks cannot characterize the time-dependent slip and progressive reactivation of ductile faults, limiting their applicability to deep reservoirs. Future works are proposed, including refined characterization of mechanical parameters under high temperature and pressure, intelligent full-cycle hydrofracturing control, quantitative criteria for slip activation, and optimization of long-term multi-field coupling models. This study elucidates recent progress in hydrofracturing-induced seismicity mechanisms and quantitative risk assessment in ductile reservoirs, filling a gap in the conventional brittle-dominant research. It also provides theoretical support for seismic risk evaluation and early warning in deep fracturing operations, with significant implications for improving induced seismicity management and ensuring safe, efficient, and sustainable deep-resource development. Full article

Tuberculosis (TB) remains a leading cause of morbidity and mortality among people living with human immunodeficiency virus (HIV), in whom immunosuppression often results in atypical clinical manifestations, paucibacillary disease, extrapulmonary involvement, and disseminated forms that complicate timely diagnosis. This narrative review summarizes current and emerging diagnostic approaches for TB-HIV, with emphasis on their diagnostic performance, clinical applicability, implementation challenges, and potential integration into future algorithms. Conventional methods, including sputum smear microscopy, mycobacterial culture, and chest radiography, remain relevant but have important limitations in people living with HIV (PLHIV), particularly in advanced immunosuppression. Rapid molecular tests, especially Xpert MTB/RIF and Xpert MTB/RIF Ultra, have improved early detection of Mycobacterium tuberculosis and rifampicin resistance, although diagnostic gaps persist in sputum-scarce and extrapulmonary disease. Non-sputum-based tests, particularly WHO-recommended urine LF-LAM and emerging next-generation assays such as FujiLAM II, offer important opportunities for severely ill patients and those with advanced HIV disease. Host-derived biomarkers, transcriptomic signatures, and artificial intelligence-assisted chest imaging may further strengthen screening, triage, and diagnostic prioritization. Integrated, context-adapted diagnostic algorithms combining microbiological, molecular, urinary, imaging, and host-response tools are needed to improve early TB detection and reduce mortality in resource-limited settings. Full article

High-angle fractures are widely developed in ultra-low permeability reservoirs in the Ordos Basin, and their propagation has a significant influence on waterflooding performance. However, few studies have focused on the identification of high-angle fractures, let alone the impact of their propagation on waterflooding performance. Therefore, a waterflooding model considering dynamic fracture propagation was developed to evaluate the impact of fracture propagation on waterflooding performance in this study. Firstly, based on the logging response characteristics of high-angle fracture intervals, the high-angle fracture identification model was established by the fuzzy comprehensive evaluation method, and a comprehensive index was proposed to identify high-angle fracture intervals. A threshold of approximately 70 effectively distinguishes high-angle fracture intervals from non-high-angle fracture intervals. After that, the waterflooding model considering dynamic fracture propagation was established to investigate the effect of its parameters on waterflooding performance. A smaller initial leak-off coefficient and a faster decline rate reduce fluid loss, promote fracture propagation, and ultimately improve oil recovery. Higher injection rates promote dynamic fracture propagation, accelerate water cut rise, mitigate production decline, and enhance cumulative oil production, while improving the waterflooding response of wells along the fracture direction. Optimal well group performance is achieved at a fracture orientation of 45°, beyond which production declines. Increasing well spacing reduces the water cut rise rate and the production decline rate, thereby improving cumulative oil production. However, it leads to a faster production decline in the early development stage. This work could provide theoretical guidance for waterflooding in ultra-low permeability reservoirs. Full article

Background: Blood-accessible biomarkers may support future personalization of prostate cancer radiotherapy, but their interpretation depends on sampling timing relative to radiotherapy, androgen deprivation therapy, and post-treatment recovery. We mapped clinical evidence for selected biomarker domains beyond prostate-specific antigen: γ-H2AX/DNA damage response, IL-6/inflammatory mediators, testosterone/endocrine recovery and a prespecified galectin-1/3 immune–stromal domain evaluated as a potential evidence gap. Methods: We conducted a PRISMA-ScR scoping review of PubMed, Scopus, and Web of Science searched on 7 January 2026. Eligible original human studies evaluated soluble serum/plasma analytes or peripheral blood cell-based assays in prostate RT pathways. Data were charted by biomarker domain, treatment context, RT modality/fractionation, assay reporting, sampling schedule, and endpoint linkage. Results: Of 3499 records, 45 studies were included. No eligible study reported repeated circulating galectin-1/3 kinetics anchored to prostate radiotherapy, identifying a distinct clinical evidence gap. The remaining evidence was dominated by testosterone studies (n = 28), followed by IL-6/inflammatory mediators (n = 12) and γ-H2AX/DDR (n = 5). Testosterone studies were mapped as separate RT-only endocrine kinetics and ADT-anchored recovery streams. IL-6 studies mainly used during-RT or early post-RT sampling and linked trajectories to acute toxicity, fatigue, symptoms or inflammatory phenotypes; no included study directly validated serial IL-6/inflammatory trajectories against biochemical control, metastasis-free survival, or overall survival. γ-H2AX studies were characterized by ultra-acute, fraction-anchored sampling. Across domains, baseline definition and sampling timing limited interpretability more than assay platform alone. Conclusions: Evidence maturity was unequal across the selected domains. Testosterone provided the comparatively more developed longitudinal clinical literature, whereas IL-6/inflammatory mediators remained exploratory and were linked mainly to acute toxicity, fatigue, symptoms, and inflammatory phenotypes. γ-H2AX remained predominantly a translational and biodosimetry-oriented marker, while galectin-1/3 represented a hypothesis-generating clinical evidence gap. None of these biomarkers currently supports routine biomarker-guided prostate RT personalization. Future biomarker-embedded studies may benefit from domain-specific sampling considerations, explicit RT/systemic-therapy context stratification, standardized assay reporting, and clinically relevant endpoints. Full article