Search Results (318)

Objective: Type B aortic dissection is a life-threatening medical condition. Endovascular closure of the primary entry by means of TEVAR is considered, nowadays, the gold standard if operative treatment is necessary. The aim of this study is to analyse the theoretical applicability of selective endovascular entry sealing using different occluder systems. Methods: A CT-graphic analysis of 102 patients who received TEVAR from January 2017 to June 2023 was performed. Patients with an intramural haematoma were excluded. The study patients were divided in two groups: type B aortic dissection (n = 87) and distal stent graft-induced new entry (n = 15). The TBAD group included patients with acute (n = 63), subacute (n = 12), and chronic aortic dissections (n = 12). The CTA analysis of the location, length, and width of the entry was performed using Aquarius iNtuition (TeraRecon, Inc., Foster City, CA, USA). After completion of the data collection, the possible application of all three occluder systems (ASD-Occluder, Septal-Occluder, and Amplatzer™-Occluder) was analysed, with reference to the Instructions for Use. Results: The ASD-Occluder from GORE is produced in five different sizes. It can be used in 81.4% (n = 83) of all patients in the overall study, including 82.8% TBAD (n = 72) and 73.3% of dSINE (n = 11) patients. When using the ASD-Occluder, 10.3% (n = 9) of patients are expected to have complete vascular coverage of the LSA based on our CTA analysis. The Septal-Occluder from GORE is offered in three different sizes. Complete entry closure can theoretically be achieved in fifty patients (57.5%) with TBAD and in nine patients (60%) with dSINE, based on CTA analysis and IFU criteria. With the use of the Septal-Occluder, 3.9% (n = 4) of the dSINE patients and 4.6% (n = 4) of the TBAD patients were expected to have complete aortic branch occlusion. The Amplatzer™-Occluder from Abbott is provided in 27 different sizes to effectively seal defects with a diameter of 4 to 56 mm. It can technically be used in 90.1% of patients (n = 92), of which 89.7% with TBAD (n = 78) and 93.3% with dSINE (n = 14) to completely seal the entry. Conclusions: CTA analysis in patients with TBAD and dSINE demonstrated that by the theoretical application of occluder systems, a seal of the entry would be achieved in 57.8% to 90.1% of the patients. However, in addition to entry closure, the use of occluder systems can also lead to unintentional partial (10.7–23.5%) or complete (3.9–22.5%) coverage of adjacent aortic branches. The clinical significance and applicability of the occluder system should be reviewed in future studies and practical applications to evaluate safety, efficacy, and possible complications in order to define the benefit–risk balance. Full article

Objective: The role of the frozen elephant trunk technique in the treatment of acute aortic dissections is currently based on results from high-volume centers only. We investigated the patient selection process, intraoperative data, the evolution of surgical practice and outcomes from a low-volume center. Methods: A retrospective analysis was conducted on 202 acute aortic dissection (AAD) patients treated between October 2014 and December 2023. Patients were categorized into those receiving less invasive open aortic repair (group 1, n = 136) and those undergoing frozen elephant trunk procedures (FETs) (group 2, n = 66). Data on demographics, surgical procedures, and outcomes were analyzed. Results: Overall 30-day mortality was 16% (13% vs. 23%; p = 0.068). Rates of postoperative disabling stroke were similar (9% vs. 8%, p = 0.190). FET procedures required longer cardiopulmonary bypass (195 min vs. 234 min, p = 0.011), hypothermic circulatory arrest (26 min vs. 43 min, p < 0.001), and selective cerebral perfusion times (26 min vs. 47 min, p < 0.001). Follow-up indicated that 17% of FET patients received completion thoracic endovascular aortic repair (TEVAR) versus 4% in non-FET patients (p = 0.002), whereas no difference was seen in open surgical reintervention. Median follow-up at 33 months showed an overall mortality of 27%, with no significant difference between groups (23% in group 1 vs. 35% in group 2, p = 0.123). Conclusions: The FET technique is feasible in low-volume centers, yielding outcomes comparable to high-volume centers. FET proximalization and a liberal use of extra-anatomical left subclavian artery (LSA) grafts ease the learning curve. Completion treatments can be effectively conducted following FET implantation to further induce positive aortic remodelling. Full article

Enterococci, commonly found in the normal intestinal flora of humans and animals, have emerged as an important human pathogen. A total of 184 isolates (88 isolates in 2015 and 96 isolates in 2016) were collected from 46 flocks. Two predominant enterococcus species were identified: Enterococcus faecalis (59%) and Enterococcus faecium (~39%). Resistance to penicillin was significantly decreased in the overall enterococci community, while it remained unchanged in the multi-class drug resistant (MDR) community. We identified the emeA and efrAB genes, which encode efflux pump systems, in 93% (26/28) of the MDR isolates with (intermediate) resistance to levofloxacin. The ermB gene was present in all MDR strains with resistance to erythromycin. The lsa gene was detected in 87% (84/97) of the MDR isolates with resistance to quinupristin/dalfopristin. About 82.2% of MDR strains in 2015 and 100% of MDR strains in 2016 carried the insertion sequence IS256, which is known to be associated with AMR genes, conferring resistance to erythromycin, gentamicin and vancomycin in enterococci. These results support the need for monitoring AMR in Gram-positive bacteria in poultry production, specifically in broiler chicken farms, to complement current AMR data, and develop a timely intervention framework. Full article

Introduction: Isolated true subclavian artery aneurysm (SAA) is a rare form of peripheral arterial aneurysm that poses significant anatomical challenges to endovascular repair, especially in cases requiring planned vertebral artery (VA) sacrifice. The Balloon Occlusion Test (BOT) is a critical preoperative tool for evaluating collateral circulation before VA embolization. Case Report: A 74-year-old male was admitted with a pulsatile mass in the left supraclavicular fossa, and a 65 mm aneurysm of the intrathoracic segment of the left subclavian artery (LSA) involving critical arterial branches was diagnosed by computed tomography angiography. Due to his comorbidities, the patient was judged unfit for an open surgical repair of the aneurysm, and a two-stage endovascular subclavian aneurysm repair (EVSAR) was planned. The first step included embolization of the internal mammary artery and thyrocervical trunk, followed by BOT of the left VA, which confirmed an adequate perfusion of the posterior cerebral and cerebellar circulation that allowed safe VA embolization. The second step included zone 2 thoracic endograft placement (TEVAR) with LSA coverage and vascular plug occlusion of the proximal segment of the LSA and the axillary artery. Postoperative monitoring revealed no neurological deficit, and the patient was discharged home without complications. Follow-up imaging up to 24 months confirmed complete aneurysm exclusion and significant sac shrinkage. Conclusions: EVSAR with thoracic endograft and VA sacrifice, preceded by BOT, may be a safe and effective minimally invasive approach for the treatment of intrathoracic SAA. Full article

As robotic systems advance in autonomy and sophistication while being used in uncertain environments, the challenge of building reliable and robust electric motors that are embedded into robotic systems has never been a more important engineering problem. Thermal distress caused by extended operation or excessive loading can negatively affect a motor’s performance and efficiency and lead to catastrophic hardware failure. This paper proposes a novel intelligent control framework that includes real-time thermal feedback for hybrid electric motors that are embedded into robotic systems. The framework relies on adaptive control techniques and lightweight machine learning techniques to estimate internal motor temperatures and dynamically change operational parameters. Unlike traditional reactive methods, this framework provides a spacious active/predictive method of heat management, while preserving efficiency and allowing for responsive control. Simulations, experimental validations, and preliminary trials that deployed real robotic systems demonstrated that our framework allows for reductions in peak temperatures by up to 18% and extends motor lifetime by 22%, while retaining control stability and a range of variations in PWM adjustments of ±12% across disparate workloads. These results demonstrate the efficacy of intelligent and thermally aware motor control architectures and processes to improve the reliability of autonomous robotic systems and open the door for next-generation embedded controllers that will allow robotic platforms to self-manage thermal effects in resilient, adaptable robots. Full article

This study investigates the microstructural and mechanical evolution of Ti6Al4V alloy surfaces modified through laser surface alloying (LSA) with antimicrobial elements silver (Ag) and copper (Cu) to enhance surface performance for biomedical applications. The as-received Ti6Al4V exhibited a typical equiaxed $\alpha \text{-}\beta$ microstructure with baseline hardness. Following LSA treatment using a 1000 W pulsed laser, distinct transformations were observed in the melt zone (MZ) and heat-affected zone (HAZ), influenced by the specific alloying element. Ag incorporation led to the development of ultrafine acicular martensitic structures and a higher fraction of high-angle grain boundaries, resulting in moderate hardness improvement. In contrast, Cu alloying promoted the formation of Ti₂Cu intermetallic phases, dendritic morphologies, and pronounced solute segregation, leading to a more significant increase in hardness. Electron Backscatter Diffraction(EBSD) and Energy Dispersive Spectroscopy (EDS) analyses revealed grain refinement, texture evolution, and elemental redistribution across the modified regions, while X-ray Diffraction XRD confirmed the presence of new phases. The comparative analysis highlights that although both Ag and Cu improve microstructural complexity and hardness, Cu-modified zones exhibited higher hardness values than Ag-modified zones, suggesting a stronger surface strengthening effect under the tested conditions. These findings contribute valuable insights into the structure–property relationships of LSA-modified Ti alloys, supporting their potential for durable and antimicrobial biomedical implants. Full article

Sign language recognition technology serves as a crucial bridge, fostering meaningful connections between deaf individuals and hearing individuals. This technological innovation plays a substantial role in promoting social inclusivity. Conventional sign language recognition methodologies that rely on static images are inadequate for capturing the dynamic characteristics and temporal information inherent in sign language. This limitation restricts their practical applicability in real-world scenarios. The proposed framework, called SSTA-ResT, integrates ResNet, soft spatiotemporal attention, and Transformer encoders to achieve this objective. The framework utilizes ResNet to extract robust spatial feature representations, employs the lightweight SSTA module for dual-path complementary representation enhancement to strengthen spatiotemporal associations, and leverages the Transformer encoder to capture long-range temporal dependencies. Experimental results on the LSA64 Argentine Sign Language (ASL) dataset demonstrate that the proposed method achieves an accuracy of 96.25%, a precision of 97.18%, and an F1 score of 0.9671. These results surpass the performance of existing methods across all metrics while maintaining a relatively low model parameter count of 11.66 M. This demonstrates the framework’s effectiveness and practicality for sign language video recognition tasks. Full article

Hoarseness is a common voice symptom that can impair communication and lead to psychosocial difficulties. It has been hypothesized that chronic hoarseness may contribute to elevated social anxiety. This study aimed to assess the impact of hoarseness on quality of life and social anxiety in affected individuals. Thirty-eight patients with chronic hoarseness (voice disorders) and 40 matched healthy controls were evaluated in a prospective case-control study. Quality of life was measured using the WHOQOL-BREF questionnaire (Physical, Psychological, Social, and Environmental domains). Social anxiety was assessed with the Liebowitz Social Anxiety Scale (LSAS), and general anxiety and depression with the Hospital Anxiety and Depression Scale (HADS). Group scores were compared using appropriate statistical tests, and effect sizes with 95% confidence intervals were calculated. Patients with hoarseness had significantly lower Psychological Health and Social Relationships scores on the WHOQOL-BREF than controls (p < 0.01 for both; large effect sizes), indicating worse quality of life in these domains. Physical Health and Environmental domain scores did not differ between groups. The hoarseness group also showed higher social anxiety: LSAS total scores and Social Interaction subscale scores were significantly greater than those of controls (p < 0.01 and p < 0.05, respectively; moderate-to-large effects), whereas the Performance Anxiety subscale was similar between groups. By contrast, HADS anxiety and depression scores did not differ significantly between patients and controls. Notably, mean HADS scores in both groups fell in the mild (borderline) range rather than the normal range. Chronic hoarseness is associated with reduced quality of life in emotional and social domains and with increased social anxiety symptoms, but not with elevated general anxiety or depression. These findings underscore the need to address psychosocial factors, particularly social anxiety, in the clinical management of patients with voice disorders. Full article

Background/Objectives: Laparoscopic appendectomy (LsA) is a standard acute surgical procedure typically performed under general anesthesia (GA). However, GA is associated with side effects such as hemodynamic instability and postoperative nausea/vomiting. Regional anesthesia (RA) has gained attention as an effective alternative in such surgeries, as it reduces surgical stress responses, provides adequate postoperative analgesia, and promotes early mobilization. This study evaluates the effectiveness of the combined use of spinal anesthesia (SA) and transversus abdominis plane block (TAPB) in LsA procedures. Methods: This retrospective observational study included 220 patients who underwent LsA between 2020 and 2023. Patients were divided into two groups: Group 1 (n = 110) received bilateral TAPB, and Group 2 (n = 110) received unilateral TAPB, both under SA. Postoperative pain was assessed using the Visual Analog Scale (VAS), and outcomes such as time to first analgesic requirement, analgesic consumption, and patient satisfaction were recorded. Results: This study evaluated the effects of SA combined with TAPB in LsA. Bilateral TAPB significantly prolonged the time to first analgesic request (13.7 vs. 12.1 h; p = 0.001) and reduced analgesic requirements (p = 0.008) compared to unilateral TAPB. VAS scores were significantly lower in Group 1 at the 9th and 12th hours postoperatively (p = 0.003 and p = 0.039). Although overall satisfaction scores were similar, a higher proportion of patients in Group 1 reported being “very satisfied” or “excellent” (55.5% vs. 42.7%). Conclusions: The combination of spinal anesthesia and bilateral TAPB is a safe and effective anesthetic strategy for LsA. Compared to unilateral TAPB, it offers superior postoperative analgesia and improved patient satisfaction. Full article

Traditional landslide susceptibility assessment (LSA) methods typically adopt a global modeling strategy, which struggles to account for the pronounced spatial heterogeneity arising from variations in topography, geology, and vegetation conditions within a region. Furthermore, model predictive performance is often undermined by feature redundancy. To address these limitations, this study focuses on the landslide disaster early-warning demonstration area in Honghe Prefecture, Yunnan Province. It proposes an ensemble learning model termed heterogeneity feature optimized stacking (HF-stacking), which integrates spatial heterogeneity partitioning (SHP) with feature selection to improve the scientific rigor of LSA. This method initially establishes an LSA system comprising 15 static landslide conditioning factors (LCFs) and two dynamic factors representing the average annual deformation rates derived from interferometric synthetic aperture radar (InSAR) technology. Based on landslide inventory data, an SHP method combining t-distributed stochastic neighbor embedding (t-SNE) and iterative self-organizing (ISO) clustering was developed to divide the study area into subregions. Within each subregion, a tailored feature selection strategy was applied to determine the optimal feature subset. The final LSA was performed using the stacking ensemble learning approach. The results show that the HF-stacking model achieved the best overall performance, with an average AUC of 95.90% across subregions, 4.23% higher than the traditional stacking model. Other evaluation metrics also demonstrated comprehensive improvements. This study confirms that constructing an SHP framework and implementing feature selection strategies can effectively reduce the impact of spatial heterogeneity and feature redundancy, thereby significantly enhancing the predictive performance of LSA models. The proposed method contributes to improving the reliability of regional landslide risk assessments. Full article

Seeking to advance mutual clustering of the tourism economy and cultural industries while safeguarding cultural sustainability in tourism, this paper delves into the patterns of co-development and the contributing forces across spatial and temporal dimensions in the Yellow River Basin. Using a combined spatial and temporal analytical lens, along with spatial autocorrelation testing and a spatial Durbin model embedded in a synergetic systems approach, the present study analyzes the evolutionary characteristics of the spatiotemporal pattern of the collaborative agglomeration of the Yellow River Basin’s tourism and cultural industries in 2011 and 2021 and the internal mechanism of its influencing factors. We then propose countermeasures and suggestions to boost the quality–efficiency synergy agglomeration of the basin’s tourism and cultural industries. The results showed the following: ① From 2011 to 2021, a positive overall spatial autocorrelation was noted in the basin’s tourism and cultural industries. Temporally, it presented a variation trend of “rise–fall–rise”, and spatially, it presented a distribution characteristic of “higher in the central and eastern regions versus in its western parts”. ② From 2011 to 2021, the local spatial autocorrelation (LSA) of the basin’s tourism and cultural industries remained at a low level. Moreover, significant differences were noted in the LSA among different regions. In spatial terms, the clustering intensity of tourism and cultural industries was stronger in the central and eastern parts of the basin versus in its western parts. ③ Influencing variables for tourism–culture collaborative agglomeration across the basin involve both temporal superposition effects and spatial radiation driving effects. The industrial economy, policies, and innovation exert enduring effects on the development and cross-regional spillover outcomes of the two collaborative agglomerations. Serving as a theoretical reference and policy resource, this study addresses how to promote the quality–efficiency synergy in the Yellow River Basin’s tourism and cultural industries while enhancing cultural sustainability in the tourism industry. Moreover, it can also provide experiences and references for other similar regions. Full article

Broad bean is one of the most important leguminous crops worldwide. However, its productivity is greatly affected by the infestation of Aphis fabae and Aphis craccivora (Hemiptera: Aphididae). The main objective of the current study was to identify the most susceptible phenological stages of the broad bean variety (Histal) against black aphids’ herbivory. This had been achieved through an evaluation of plant resistance mechanisms such as antixenosis and antibiosis. The results regarding an antixenosis test revealed that the four tested phenological stages of V. faba did not have a significant effect on the preference of A. craccivora and A. fabae towards the crop plant. Overall, a slightly higher number of adults settled on the three and four unfolded leaves’ stage of the crop plant. Similarly, the highest number of developed embryos were found in the four leaves’ stage of the crop, and the lowest in the second leaf stage. The adult body size of A. craccivora was slightly larger in the case of the three unfolded leaves. Furthermore, the maximum body size of A. fabae adults was recorded in the case of the first unfolded leaf stage crop. Linear correlations between the biological parameters for both species revealed only one significant relationship between developed and total embryos for A. craccivora. The results of the current study highlight the need to protect broad bean crops against infestations of black aphids, i.e., A. craccivora and A. fabae. This is essential for reducing direct damage and preventing the transmission of phytoviruses. However, future studies should aim to evaluate the susceptibility of all developmental phenological stages of the crop against black aphids to mitigate potential crop losses. Full article

The formation mechanism of Virtual Reality (VR) Immersive Experience (VRIE) is notably complex; this study aimed to dynamically decode its underlying drivers by innovatively integrating Flow Theory and Privacy Calculus Theory, focusing on Perceptual-Interactive Fidelity (PIF), Consumer Willingness to Immerse in Technology (CWTI), and the applicability of Loss Aversion Theory. To achieve this, we analyzed approximately 30,000 user reviews from Amazon using Latent Semantic Analysis (LSA) and regression analysis. The findings reveal that user attention’s impact on VRIE is non-linear, suggesting an optimal threshold, and confirm PIF as a central influencing mechanism; furthermore, CWTI significantly moderates users’ privacy calculus, thereby affecting VRIE, while Loss Aversion Theory showed limited explanatory power in the VR context. These results provide a deeper understanding of VR user behavior, offering significant theoretical guidance and practical implications for future VR system design, particularly in strategically balancing user cognition, PIF, privacy concerns, and individual willingness. Full article

Creating high-fidelity digital twins (DTs) for Industry 4.0 applications, it is fundamentally reliant on the accurate 3D modeling of physical assets, a task complicated by the inherent imperfections of real-world point cloud data. This paper addresses the challenge of reconstructing accurate, watertight, and topologically sound 3D meshes from sparse, noisy, and incomplete point clouds acquired in complex industrial environments. We introduce a robust two-stage completion-to-reconstruction framework, C2R3D-Net, that systematically tackles this problem. The methodology first employs a pretrained, self-supervised point cloud completion network to infer a dense and structurally coherent geometric representation from degraded inputs. Subsequently, a novel adaptive surface reconstruction network generates the final high-fidelity mesh. This network features a hybrid encoder (FKAConv-LSA-DC), which integrates fixed-kernel and deformable convolutions with local self-attention to robustly capture both coarse geometry and fine details, and a boundary-aware multi-head interpolation decoder, which explicitly models sharp edges and thin structures to preserve geometric fidelity. Comprehensive experiments on the large-scale synthetic ShapeNet benchmark demonstrate state-of-the-art performance across all standard metrics. Crucially, we validate the framework’s strong zero-shot generalization capability by deploying the model—trained exclusively on synthetic data—to reconstruct complex assets from a custom-collected industrial dataset without any additional fine-tuning. The results confirm the method’s suitability as a robust and scalable approach for 3D asset modeling, a critical enabling step for creating high-fidelity DTs in demanding, unseen industrial settings. Full article

Objective: To systematically review the scientific literature on lysergic acid amide (LSA), focusing on its physical, neurobiological, and social effects, as well as its potential risks and therapeutic uses. Methods: A systematic review was conducted across PubMed, Google Scholar, and Web of Science up to December 2023, using keywords such as “ergine,” “lysergic acid amide,” and “legal high.” Studies were included if they reported original human data on the physical, neurobiological, psychological, or social effects of LSA; seventeen studies were included. Animal studies, in vitro research, and non-original articles were excluded. Two independent reviewers screened and selected the studies, with a third resolving discrepancies. Data were extracted using a standardized form. The review followed PRISMA guidelines and was prospectively registered on the Open Science Framework. Results: LSA is primarily consumed through preparations made from the seeds of Convolvulaceae plants. Reported effects include euphoria, hallucinations, nausea, and anxiety. Severe adverse outcomes, such as psychosis, hypertension, and hospitalization, have also been documented. Some evidence suggests its potential therapeutic application for cluster headaches. However, variability in dosing and misinformation on digital platforms heighten the risks associated with LSA use. Conclusions: LSA poses significant health risks, exacerbated by online misinformation and variability in its effects, and a lack of scientific studies. Further research is essential to clarify its pharmacological profile, establish guidelines for safe use, and raise public awareness about its dangers. Full article