Search Results (131)

This study presents a DIKWP-driven artificial consciousness framework for IoT-enabled smart healthcare, integrating a Data–Information–Knowledge–Wisdom–Purpose (DIKWP) cognitive architecture with a software-defined IoT infrastructure. The proposed system deploys DIKWP agents at edge and cloud nodes to transform raw sensor data into high-level knowledge and purpose-driven actions. This is achieved through a structured DIKWP pipeline—from data acquisition and information processing to knowledge extraction, wisdom inference, and purpose-driven decision-making—that enables semantic reasoning, adaptive goal-driven responses, and privacy-preserving decision-making in healthcare environments. The architecture integrates wearable sensors, edge computing nodes, and cloud services to enable dynamic task orchestration and secure data fusion. For evaluation, a smart healthcare scenario for early anomaly detection (e.g., arrhythmia and fever) was implemented using wearable devices with coordinated edge–cloud analytics. Simulated experiments on synthetic vital sign datasets achieved approximately 98% anomaly detection accuracy and up to 90% reduction in communication overhead compared to cloud-centric solutions. Results also demonstrate enhanced explainability via traceable decisions across DIKWP layers and robust performance under intermittent connectivity. These findings indicate that the DIKWP-driven approach can significantly advance IoT-based healthcare by providing secure, explainable, and adaptive services aligned with clinical objectives and patient-centric care. Full article

Multivalent lectin–glycan interactions (MLGIs) are vital for viral infection, cell-cell communication and regulation of immune responses. Their structural and biophysical data are thus important, not only for providing insights into their underlying mechanisms but also for designing potent glycoconjugate therapeutics against target MLGIs. However, such information remains to be limited for some important MLGIs, significantly restricting the research progress. We have recently demonstrated that functional nanoparticles, including ∼4 nm quantum dots and varying sized gold nanoparticles (GNPs), densely glycosylated with various natural mono- and oligo- saccharides, are powerful biophysical probes for MLGIs. Using two important viral receptors, DC-SIGN and DC-SIGNR (together denoted as DC-SIGN/R hereafter), as model multimeric lectins, we have shown that α-mannose and α-manno-α-1,2-biose (abbreviated as Man and DiMan, respectively) coated GNPs not only can provide sensitive measurement of MLGI affinities but also reveal critical structural information (e.g., binding site orientation and mode) which are important for MLGI targeting. In this study, we produced mannuronic acid (ManA) coated GNPs (GNP-ManA) of two different sizes to probe the effect of glycan modification on their MLGI affinity and antiviral property. Using our recently developed GNP fluorescence quenching assay, we find that GNP-ManA binds effectively to both DC-SIGN/R and increasing the size of GNP significantly enhances their MLGI affinity. Consistent with this, increasing the GNP size also significantly enhances their ability to block DC-SIGN/R-augmented virus entry into host cells. Particularly, ManA coated 13 nm GNP potently block Ebola virus glycoprotein-driven entry into DC-SIGN/R-expressing cells with sub-nM levels of EC₅₀. Our findings suggest that GNP-ManA probes can act as a useful tool to quantify the characteristics of MLGIs, where increasing the GNP scaffold size substantially enhances their MLGI affinity and antiviral potency. Full article

Background and Objectives: Immunodeficiency associated with aging comorbidities increases the vulnerability of geriatric patients to sepsis. Early recognition and management of sepsis are essential in this population. This study evaluated the relationships between RDW, MPV, and MPV/PLT ratios and mortality in geriatric sepsis patients. Materials and Methods: This retrospective study was conducted between 2020 and 2024 in the Intensive Care Unit of the Department of Anesthesiology and Reanimation at a university hospital. Patients aged ≥ 65 years with a SOFA score of ≥2 were included. Demographic data (sex, age, height, weight, and BMI), hemogram parameters (RDW, MPV, and PLT), blood gas, and biochemical values were analyzed. Furthermore, their comorbidities; site of infection; ICU length of stay; vital signs; and SOFA, APACHE II, and SAPS II scores, recorded within the first 24 h following ICU admission, were evaluated. Statistical analysis was performed using the chi-square test, Student’s t-test, the Mann–Whitney U test, the Monte Carlo exact test, and ROC analysis. A p-value of <0.05 was considered statistically significant. Results: A total of 247 patients were included, with 46.2% (n = 114) classified as non-survivors during the 28-day follow-up period. Among them, 64.9% (n = 74) were male, with a mean age of 78.22 ± 8.53 years. Significant differences were also found in SOFA, APACHE-II, and SAPS-II scores between non-survivors and survivors (SOFA: 7.64 ± 3.16 vs. 6.78 ± 2.78, p = 0.023; APACHE-II: 21.31 ± 6.36 vs. 19.27 ± 5.88, p = 0.009; SAPS-II: 53.15 ± 16.04 vs. 46.93 ± 14.64, p = 0.002). On days 1, 3, and 5, the MPV/PLT ratio demonstrated a statistically significant predictive value for 28-day mortality. The optimal cut-off values were >0.03 on day 1 (AUC: 0.580, 95% CI: 0.516–0.642, sensitivity: 72.81%, specificity: 65.91%, p = 0.027), >0.04 on day 3 (AUC: 0.602, 95% CI: 0.538–0.663, sensitivity: 60.53%, specificity: 60.61%, p = 0.005), and >0.04 on day 5 (AUC: 0.618, 95% CI: 0.554–0.790, sensitivity: 66.14%, specificity: 62.88%, p = 0.001). Conclusions: The MPV and MPV/PLT ratios demonstrated statistically significant but limited predictive value for 28-day mortality in geriatric patients with sepsis. In contrast, the limited prognostic value of RDW may be related to variability in the inflammatory response and other underlying conditions. The correlations found between SOFA, APACHE II, and SAPS II scores highlight their importance in mortality risk prediction. Full article

Background and clinical significance: Acute reduction in vigilance is a frequent reason for emergency department admissions, especially among the elderly. While intracranial causes or infections with fluid depletion are often responsible, there remain cases where imaging, laboratory tests, and clinical examination fail to provide a clear diagnosis. Case presentation: A 91-year-old woman was presented to the emergency department with recurrent episodes of somnolence to deep coma. On admission, her vital signs were stable, and cerebral CT imaging revealed no intracranial pathology. Laboratory analyses, including blood gas measurements, were unremarkable. Empirical treatment for possible intoxications with benzodiazepines or opioids using flumazenil and naloxone had no effect. An Addison’s crisis was considered but excluded following methylprednisolone administration without improvement in consciousness. Eventually, an isolated elevation of serum ammonia was identified as the cause of the reduced vigilance. Further investigation linked the hyperammonemia to abnormal intestinal bacterial colonization, likely due to a prior ureteroenterostomy. There was no evidence of liver dysfunction, thus classifying the condition as non-hepatic hyperammonemia. Therapy was initiated with rifaximin, supported by aggressive laxative regimens. Ammonia levels and vital parameters were closely monitored. The patient’s condition improved gradually, with serum ammonia levels returning to normal and cognitive function fully restored. Conclusions: This case highlights an uncommon cause of coma due to non-hepatic hyperammonemia in the absence of liver disease, emphasizing the diagnostic challenge when standard evaluations are inconclusive. It underscores the need for broad differential thinking in emergency settings and the importance of considering rare metabolic disturbances as potential causes of altered mental status. Full article

Background: The early repolarization pattern (ERP) on electrocardiography (ECG) has been associated with an increased risk of ventricular arrhythmias in susceptible individuals. This study aimed to evaluate the impact of exercise on echocardiographic parameters to explore the potential influence of ERP on hemodynamic response. Methods: Twenty-five healthy, young males with ERP (ERP+ group) and 25 age-matched healthy males without ERP (ERP− group) were enrolled. Comprehensive transthoracic echocardiography was performed at rest and during the early recovery phase following a treadmill exercise test. Baseline values and exercise-induced changes in both conventional and strain-derived echocardiographic parameters were analyzed and compared between groups. Results: Anthropometric measures and resting vital signs were similar in both groups. At baseline, the ERP+ group had a shorter QRS duration. Both groups demonstrated excellent cardiovascular fitness, with comparable chronotropic and pressor responses to exercise. Resting and early recovery-phase echocardiographic parameters were largely similar between ERP+ and ERP− individuals, with no overt structural or functional abnormalities observed in either group. However, ERP+ individuals showed significantly greater reductions in left ventricular end-diastolic volume and stroke volume following exercise, suggesting a distinct volumetric response to physical stress. Conclusions: ERP in healthy young males is not associated with structural cardiac abnormalities or overt myocardial dysfunction. The observed exercise-induced volumetric changes may indicate subtle differences in hemodynamic adaptation, warranting further investigation. Full article

Background: Coronavirus disease 2019 (COVID-19) involves a complex interplay of dysregulated immune responses, a pro-inflammatory cytokine storm, endothelial injury, and thrombotic complications. This study aimed to evaluate the impact of kidney function on clinical, laboratory, and outcome parameters in patients hospitalized with COVID-19. Methods: We conducted a retrospective analysis of 359 patients admitted during the first wave of COVID-19, stratified by estimated glomerular filtration rate (eGFR < 60 vs. ≥60 mL/min/1.73 m²). Data on demographics, vital signs, laboratory values, and clinical outcomes—including mortality, hemodialysis requirement, intensive care unit (ICU) admission, and mechanical ventilation (MV)—were collected. Univariate and multivariate linear regression, as well as area under the receiver operating characteristic curve (AUC-ROC) analyses, were performed. A p-value < 0.05 was considered statistically significant. Results: Patients with an eGFR < 60 were older and more likely to have systemic hypertension, chronic kidney disease, a history of solid organ transplantation, and immunosuppressive therapy. This group showed higher rates of mortality (41.6% vs. 19.2%), hemodialysis requirement (32.3% vs. 9.6%), ICU admission (50.9% vs. 37.9%), and MV (39.8% vs. 21.2%). Laboratory results revealed acidosis, anemia, lymphopenia, elevated inflammatory markers, and hyperkalemia. Conclusions: An admission eGFR < 60 mL/min/1.73 m² is associated with worse clinical outcomes in COVID-19 and may serve as a simple, early marker for risk stratification. Full article

Background/Objectives: Impaired consciousness has various causes. One such cause includes hypoglycemia, which may be symptomatic or asymptomatic and is associated with high mortality. Autonomic abnormalities are also common in hypoglycemic patients. Early detection is critical for improving prognosis. In this study, we evaluated changes in vital signs and pupillary responses before and after glucose administration in patients with hypoglycemia managed in a prehospital emergency setting. Methods: This retrospective observational study included 583 adult patients from the Tokyo Fire Department database. All patients were suspected by emergency medical technicians (EMTs) to have hypoglycemia-related impaired consciousness and showed improved consciousness after receiving intravenous glucose infusion at the scene. Vital signs, level of consciousness, and pupillary responses were assessed before and after glucose administration. Results: The mean patient age was 58.9 years, and approximately 90% had comorbid diabetes mellitus. Tachypnea was common at the scene, with 27% showing tachycardia, while blood pressure remained normal. Miosis and abnormal pupillary light reflexes were observed in 68% and 84% of cases, respectively. Anisocoria occurred in 7.6% of the patients. After glucose administration, both abnormal reflexes and anisocoria significantly decreased (both p < 0.0001). Although vital signs did not consistently reflect autonomic responses, changes in pupillary findings were prominent. Conclusions: Altered pupillary responses are common in hypoglycemic coma. Findings such as miosis and anisocoria can result from various causes, including central nervous system disorders and cholinergic toxicity; thus, careful differential diagnosis is essential. Normal blood pressure may help to distinguish hypoglycemic coma during prehospital care. Full article

Background/Objectives: Potassium-competitive acid blockers (P-CABs) offer rapid gastric acid inhibition and lower toxicity compared to proton pump inhibitors (PPIs). This study investigates the drug–drug interaction between P-CABs and immunosuppressants tacrolimus and mycophenolate in kidney transplant recipients (KTRs). Methods: Sixty-two KTRs were randomized to receive either 50 mg of tegoprazan or 20 mg of pantoprazole. Patients were monitored using a smart clinical trial platform incorporating remote monitoring and safety management systems, which tracked drug adherence and vital signs. General and gastrointestinal (GI) symptoms were surveyed via a self-developed app on patients’ phones. Trough levels of tacrolimus and mycophenolate were measured every 4 weeks over 12 weeks. Results: Medication adherence was 100% in both groups. A total of 13,726 biometric data points and 5031 questionnaire responses were collected, with 5704 feedback messages and 56 video visits conducted. At 12 weeks, the mean trough levels of tacrolimus and mycophenolate were similar between the tegoprazan and pantoprazole groups (5.5 ± 1.6 vs. 5.8 ± 2.0 ng/mL, p = 0.50 and 2.7 ± 1.4 vs. 2.6 ± 1.4 µg/mL, p = 0.57, respectively). The intragroup difference in trough levels from baseline to week 12 was not significant in either group. GI symptoms scores, vital signs, and allograft function remained stable and comparable between groups. Conclusions: Tegoprazan does not alter the blood trough levels of tacrolimus and mycophenolate during the 12-week follow-up in KTRs and has a similar impact on GI symptoms as pantoprazole. This study confirms the feasibility and safety of using a smart clinical trial system with remote monitoring for randomized trials. Full article

Cow’s milk allergy is one of the most prevalent food allergies in infancy. Exclusive breastfeeding is the recommended source of nutrition for the first six months of life, but some infants may develop cow’s milk allergy due to the transfer of milk proteins such as β-lactoglobulin through breast milk. There are still many uncertainties about cow’s milk allergy in breastfed babies. The purpose of this review is to summarize the latest findings mainly focused on immunological mechanisms and challenges in diagnosis. We pointed out which clinical signs in breastfed infants are associated with immediate IgE responses and which are linked to delayed non-IgE mechanisms or mixed IgE/non-IgE-mediated reactions. Since standard IgE tests are often useless in non-IgE cases, diagnosis typically involves dietary elimination and cow’s milk challenge. This study addresses the controversial topic of maternal elimination diets, assessing the nutritional risks to both mothers and infants in relation to their possible benefits. It has also been discussed whether the microbiota signature could be a potential factor in both tolerance development and the risk of cow’s milk allergy in early life. Overall, accurate diagnosis and personalized treatment plans are vital to prevent overdiagnosis and ensure proper growth while maintaining the practice of breastfeeding. Full article

Background and Objectives: Chronic wounds pose a significant healthcare burden due to their prolonged healing times and susceptibility to infection. Electric field (EF)-enabled smart bandages offer a promising solution by combining therapeutic stimulation with real-time physiological monitoring. Materials and Methods: This study assessed a smart bandage integrating spiral stainless steel electrodes delivering a 200 millivolts per millimeter (mV/mm) EF for 5 h daily over 14 days to full-thickness excisional wounds in 100 Sprague–Dawley rats. Vital signs including heart rate (BPM), oxygen saturation (SpO₂), and temperature were monitored continuously. Machine learning models were trained on these data to predict wound healing status. Results: By Day 7, EF-treated wounds demonstrated significantly faster healing, achieving an average wound closure rate of 82.0% ± 2.1% compared to 70.75% ± 2.3% in the control group (p < 0.05). By Day 14, wounds in the experimental group had significantly reduced to 0.01 ± 0.005 cm², while the control group retained a wound size of 0.24 ± 0.03 cm² (p < 0.05). Histological analysis revealed enhanced neovascularization, collagen alignment, and epithelial regeneration in the EF group. Physiological data showed no systemic inflammatory response. Predictive modeling using XGBoost and Random Forest achieved >98% accuracy, with SHAP (SHapley Additive exPlanations) analysis identifying EF exposure and treatment duration as key predictors. Conclusions: The findings demonstrate that EF-based smart bandages significantly enhance wound healing and enable highly accurate prediction of outcomes through machine learning models. This bioelectronic approach holds strong potential for clinical translation. Full article

Background: The combination of two or more different types of traumatic dental injuries occurring concurrently to the same tooth presents a significant clinical challenge. By focusing on a rare combination of injuries, this case study explores the issues of delayed management of root fractures accompanied by coronal extrusions in immature maxillary permanent central incisors, underscoring the necessity for tailored approaches when guidelines for intervention were unmet. Methods: The case involves an eight-year-old boy who delayed seeking care for approximately a year after suffering trauma to his upper front teeth in a fall accident at school. The clinical examination revealed partial displacement of two maxillary central incisors in an incisal direction, resulting in increased mobility. Radiographs further showed horizontal root fractures in the apical third of both extruded incisors. Encouragingly, the injured teeth exhibited a normal response to electric pulp testing without signs or symptoms of pulpal pathology, suggesting pulp vitality and eliminating the need for root canal treatment. The extruded coronal fragments were repositioned orthodontically using a utility arch. Results: At the 14-month follow-up, the affected incisors were clinically asymptomatic, functionally satisfactory, and esthetically pleasing. Conclusions: Conservative orthodontic management of extrusive luxation concomitant with root fracture in immature permanent teeth may prove effective in select cases, particularly when long-term follow-up and proper oral care are maintained. Full article

In the context of Doppler radar, studies have examined the changes in the phase shift of the S₂₁ transmission coefficient related to minute movements of the human chest as a response to breathing or heartbeat. Detecting human vital signs remains a challenge, especially when obstacles interfere with the attempt to detect the presence of life. The sensitivity of a measurement system’s perception of vital signs is highly dependent on the monitoring systems and antennas that are used. The current work proposes a computational approach that aims to extract an empirical law of the dependence of the phase shift of the transmission coefficient (S₂₁) on the sensitivity at reception, based upon a set of four parameters. These variables are as follows: (a) the frequency of the continuous wave utilized; (b) the antenna type and its gain/directivity; (c) the electric field strength distribution on the chest surface (and its average value); and (d) the type of material (dielectric properties) impacted by the incident wave. The investigated frequency range is (1–20) GHz, while the simulations are generated using a doublet of dipole or gain-convenient identical Yagi antennas. The chest surface is represented by a planar rectangle that moves along a path of only 3 mm, with a step of 0.3 mm, mimicking respiration movement. The antenna–target system is modeled in the computational space in each new situation considered. The statistics illustrate the multiple regression function, empirically extracted. This enables the subsequent building of a continuous-wave bio-radar Doppler system with controlled and improved sensitivity. Full article

This study explores nursing students’ stress responses while they are being trained in a mixed reality (MR) setting that replicates highly stressful clinical scenarios. Using measurements of physiological indices such as heart rate, electrodermal activity, and skin temperature, the study assesses the level of stress when the students interact with digital patients whose vital signs and symptoms interact dynamically to respond to student inputs. The simulation consists of six segments, during which critical events like hypotension and hypoxia occur, and the patient’s condition changes based on the nurse’s clinical decisions. Machine learning algorithms were then used to analyze the nurse’s physiological data and to classify different levels of stress. Among the models tested, the Stacking Classifier demonstrated the highest classification accuracy of 96.4%, outperforming both Random Forest (96.18%) and Gradient Boosting (95.35%). The results showed clear patterns of stress during the simulation segments. Statistical analysis also found significant differences in stress responses and identified key physiological markers linked to each stress level. This pioneering study demonstrates the effectiveness of MR as a training tool for healthcare professionals in high-pressured scenarios and lays the groundwork for further studies on stress management, adaptive training procedures, and real-time detection and intervention in MR-based nursing training. Full article

Background: Primary cardiac tumors (PCTs) are rare entities, with only a minority being malignant and capable of distant dissemination. Among the rarest and most challenging metastatic events are brain metastases originating from cardiac tumors. Due to the heart’s direct access to systemic circulation, even benign tumors such as atrial myxomas may cause cerebral embolic phenomena. Understanding the distinct biological behavior, diagnostic pathways, therapeutic strategies, and prognostic implications of these cases remains limited by the scarcity of the available literature. Methods: A systematic review was conducted following PRISMA guidelines. PubMed, Scopus, Embase, and other major databases were systematically searched using specific MeSH terms and keywords related to cardiac tumors and brain metastases. After applying strict inclusion and exclusion criteria, nineteen studies were included, comprising sixteen single-patient case reports and three multi-patient series. Extracted data included tumor histology, cardiac and brain imaging findings, neurological presentation, treatment approaches, and patient outcomes. Results: A total of 320 patients were analyzed. Atrial myxomas represented the predominant benign tumors causing embolic cerebral events, while angiosarcomas and other cardiac sarcomas were responsible for true hematogenous brain metastases. Brain involvement was frequently hemorrhagic and manifested with seizures, focal deficits, or signs of intracranial hypertension. Cardiac echocardiography and cardiac magnetic resonance imaging (CMR) were essential for tumor detection, while brain MRI, including SWI and DWI sequences, and CT scanning were critical for cerebral lesion characterization. Treatment strategies varied according to tumor type and included surgery, radiotherapy, and systemic therapies. Malignant cardiac tumors correlated with a poor prognosis, with median survival post-CNS involvement ranging from 12 to 14 months. Conclusions: Brain metastases from PCTs, though rare, represent a distinct and serious clinical phenomenon. Benign tumors like myxomas mainly cause embolic cerebral events, whereas malignant tumors, particularly sarcomas, lead to true metastatic brain lesions. Recognizing this biological distinction is crucial for diagnosis, prognostication, and therapeutic planning. An integrated multidisciplinary approach combining advanced cardiac and neuroimaging techniques is vital for early detection and appropriate management. Despite multimodal treatment, survival remains limited, underscoring the urgent need for novel targeted therapies and improved surveillance strategies. Full article

Background: Acute kidney injury (AKI) has emerged as a significant complication in patients with coronavirus disease 2019 (COVID-19). The pathophysiology of COVID-19-associated AKI is multifactorial, involving both direct viral effects on renal cells and indirect mechanisms such as systemic inflammation and cytokine storms. This highlights the critical need for early detection and effective management strategies to mitigate kidney injury and improve patient outcomes. The aim of our study is to assess the potential predictive role of inflammatory biomarkers in determining the risk of developing COVID-19-associated AKI in patients with and without pre-existing CKD. Methods: This study included 84 patients stratified by pre-existing chronic kidney disease (CKD) status. Demographic, clinical, and laboratory data were collected, including vital signs, hematological profiles, renal function markers, inflammatory biomarkers, coagulation parameters, and treatments. Outcomes such as acute kidney injury (AKI) and in-hospital mortality were documented. Results: In patients with pre-existing CKD, IL-6 and NLR demonstrated high predictive accuracy for AKI onset. In patients without pre-existing CKD, white blood cell (WBC) count emerged as a significant predictor of AKI onset. Conclusions: The differential roles of IL-6, NLR, and WBC in predicting AKI onset highlight distinct physiopathological pathways influenced by COVID-19. In CKD+ patients, chronic inflammation and immune dysregulation are key drivers of AKI, with IL-6 and NLR serving as robust markers of this inflammatory state. In contrast, in CKD− patients, AKI may be more influenced by acute inflammatory responses and infectious factors, as reflected by WBC count. Full article