Search Results (2,283)

Background: Functional Neurological Disorder (FND) encompasses a spectrum of symptoms—including motor, cognitive, and seizure-like manifestations—that are not fully explained by structural neurological disease. Accumulating evidence suggests that comorbid psychiatric and somatic conditions significantly influence the clinical course, diagnostic complexity, and treatment response in FND. Objective: This study systematically explores psychiatric and medical comorbidities across major FND subtypes—Functional Cognitive Disorder (FCD), Functional Movement Disorder (FMD), and Psychogenic Non-Epileptic Seizures (PNES)—with an emphasis on subtype-specific patterns and shared vulnerabilities. Methods: We conducted a narrative review of the published literature, guided by systematic principles for transparency, covering both foundational and contemporary sources to examine comorbid conditions in patients with FCD, FMD, PNES, PPPD and general (mixed) FND populations. Relevant studies were identified through structured research and included based on methodological rigor and detailed reporting of comorbidities (PRISMA). Extracted data were organized by subtype and comorbidity type (psychiatric or medical/somatic). Results: Across all FND subtypes, high rates of psychiatric comorbidities were observed, particularly depression, anxiety, PTSD, and dissociative symptoms. FCD was predominantly associated with internalizing symptoms, affective misattribution, and heightened cognitive self-monitoring. FMD demonstrated strong links with trauma, emotional dysregulation, and personality vulnerabilities. PNES was characterized by the highest burden of psychiatric illness, with complex trauma histories and dissociation frequently reported. Somatic comorbidities—such as fibromyalgia, chronic pain, irritable bowel syndrome, and fatigue—were also prevalent across all subtypes, reflecting overlapping mechanisms involving interoception, central sensitization, and functional symptom migration. Conclusions: Comorbid psychiatric and medical conditions are integral to understanding the presentation and management of FND. Subtype-specific patterns underscore the need for individualized diagnostic and therapeutic approaches, while the shared biopsychosocial mechanisms suggest benefits of integrated care models across the FND spectrum. Full article

Background/Objectives: Accurate full-arch impressions are crucial for predictable prosthodontic outcomes. While intraoral scanners (IOSs) are increasingly adopted, evidence comparing their accuracy with conventional analog impressions across full mandibular arches—particularly under both laboratory and clinical conditions using an objective intraoral reference—is limited. Our study aims to evaluate the in vitro and in vivo accuracy of digital impressions compared to conventional methods in full-arch scans using an intraoral reference tool. Methods: In this study, a custom stainless steel transfer aid carrying four 5 mm steel spheres in a trapezoidal configuration, provided with known reference distances, was used. Ten mandibular Frasaco models (in vitro) and ten healthy young adults (18–30 yrs) with intact lower arches (in vivo) received the bonded spheres. Six inter-sphere distances were defined: intermolar (BL-BR), interpremolar (FL-FR), diagonals (BL-FR, FL-BR), and lateral spans (BL-FL, BR-FR). Each arch underwent a digital scan (Medit i700) and a conventional monophase PVS impression, which was poured in Type IV stone and digitized (GOM Scan 1). The inter-sphere linear distances were measured in GOM Inspect, and trueness (deviation from reference) and precision (SD) were calculated. Data normality and homogeneity were verified; parametric t-tests and one-sample tests (α = 0.05) assessed differences between workflows and against reference values. Results: In vitro, analog impressions closely matched reference distances, with only the long-span BL-BR showing minor deviation (0.053 mm, p < 0.001). Digital scans showed significantly greater deviations across all spans (max 0.117 mm), particularly over long distances. In vivo, both workflows demonstrated comparable accuracy: only BL-BR (analog) and BR-FR (digital) differed significantly from the reference, and all AMEs remained within clinical thresholds (≤0.10 mm), except for BL-BR and BL-FL spans. ICC values ranged from moderate to high. Direct paired comparisons revealed statistically equivalent performance across most spans. Conclusions: Analog impressions outperformed digital scans in vitro, particularly across longer spans, confirming their superior dimensional fidelity under controlled conditions. However, in vivo, both workflows delivered statistically comparable and clinically acceptable accuracy. These findings suggest that while analog impressions remain the gold standard for precision-demanding contexts, modern intraoral scanners—when used correctly—can offer reliable full-arch mandibular impressions. The four-sphere reference system proved valuable for objective, anatomy-independent measurement. Full article

Background/Objectives: To assess the “footprint” sign in voiding cystourethrogram (VCUG) for its diagnostic and prognostic significance in indicating a “pop-off” mechanism that may reduce pressure on the contralateral kidney. Methods: A retrospective analysis included patients with a “footprint” sign or high-grade vesicoureteral reflux (VUR) in VCUG. They were categorized into two groups: those with (Group A) and those without (Group B) the “footprint” sign. Results: Among 55 patients (median age 18 months), 18 exhibited the “footprint” sign. Group A had predominantly male patients. Bilateral VUR was less common in Group A (38.9%) compared to Group B (51.4%), though not statistically significant (p-value: 0.385). The “footprint” sign was predominantly associated with the left side (77.8% in Group A). The median differential renal function (DRF) was significantly lower in kidneys with the “footprint” sign (11.5%) compared to those without (44.5%, p-value < 0.001). All patients with a DRF under 20% exhibited the “footprint” sign. Conclusions: The “footprint” sign correlates with poor renal function, suggesting a potential pop-off mechanism protecting the contralateral kidney. Management should prioritize the contralateral kidney with normal function. The “footprint” sign alone in VCUG may suffice to indicate compromised renal function, negating the need for further ipsilateral kidney assessment. Full article

HIV mother-to-child transmission (MTCT) continues to pose a significant public health challenge, especially in regions with limited resources, although the worldwide distribution of antiretroviral therapy (ART) has drastically lowered the risk of vertical transmission to even below 1% in some regions. There are still uncertainties regarding the safety of some ART regimens during pregnancy and their longer-term effects on infants who are perinatally exposed to HIV but remain uninfected. This review explores current evidence regarding the interplay between maternal HIV infection, ART during pregnancy, and both maternal and pediatric outcomes. Particular attention is given to the risk/benefit ratio surrounding different drug classes, with integrase inhibitors seeming promising choices in MTCT due to their rapid viral suppression and favorable safety profiles. Meanwhile, regimens containing protease inhibitors or nucleoside reverse transcriptase inhibitors have been linked to some adverse outcomes such as low birth weight, growth restriction, and potential mitochondrial or metabolic disturbances. Although ART remains central in preventing MTCT, a deeper understanding of its effects on fetal development and postnatal health is needed, and it should be thoroughly monitored through future research and longitudinal surveillance. Full article

The importance of H. pylori infection in the development of non-alcoholic fatty liver disease, liver fibrosis, cirrhosis, insulin resistance, and non-alcoholic steatohepatitis has been shown in earlier studies. Our work aims to assess the risk of developing hepatic fibrosis in patients with or without H. pylori, using noninvasive scores such as the APRI index, the BARD score, or the FIB-4 index, and to evaluate a possible association between the severity of fibrosis scores and histopathology evidence (such as chronic gastritis, gastric atrophy, gastric metaplasia, and gastric dysplasia). Moreover, the risk of preneoplastic stomach lesions was assessed in patients with hepatic fibrosis. The study enrolled a total of 110 patients: 65 were H. pylori-positive and 45 were negative. The differences in BARD, APRI, and FIB-4 indexes between H. pylori-positive and negative cases were assessed using the Mann–Whitney test. Noticeably higher BARD scores and APRI indexes were observed when comparing H. pylori-positive patients with NAFLD to H. pylori-negative ones. In terms of the FIB-4 index, an insignificant increase was observed in H. pylori-positive versus H. pylori-negative patients. Multiple linear regression was performed for the BARD scores and APRI indexes, revealing further significant associations with age and H. pylori status. A substantial correlation was demonstrated between H. pylori and elevated hepatic fibrosis scores in individuals with NAFLD and gastritis, suggested by the complexity features of infection and the intricacies of histology. Full article

Platelet-rich plasma (PRP) therapy is a non-invasive, autologous treatment with regenerative potential in gynaecology beyond fertility applications. This review evaluates PRP in non-fertility-related gynaecological conditions affecting women’s quality of life (QoL). Methods: Following PRISMA-ScR guidelines, we searched Embase, CINAHL, Web of Science, Scopus, CENTRAL, and MEDLINE for studies on PRP in conditions such as vulvar lichen sclerosus (VLS), vulvovaginal atrophy (VVA), sexual dysfunction (SD), stress urinary incontinence (SUI), and interstitial cystitis/bladder pain syndrome (IC/BPS). Of 3660 records screened, 43 studies (randomised controlled trials, quasi-experimental, cohort, and case series) were included. Results: PRP improved symptoms and QoL in several conditions, particularly VLS and SD, and was generally well tolerated with minor adverse effects (e.g., injection-site pain, transient discomfort). Evidence for abnormal uterine bleeding (AUB) and pelvic organ prolapse (POP) was inconclusive. Considerable heterogeneity in preparation protocols and outcome measures limited cross-study comparison. Conclusions: PRP shows promise as a minimally invasive therapy for certain gynaecological conditions. Standardisation of preparation and administration, along with large-scale RCTs, is needed to determine long-term efficacy and safety. Full article

Hepatocellular carcinoma (HC) ranks as the fifth most prevalent form of cancer among humans and is a significant contributor to cancer-related deaths. During the latest year, an interesting scientific fascination arose around gold nanoparticles (AUNPs) following the recovery of their remarkable properties. Some studies suggest that AUNPs can enhance drug targeting in cancer treatment and reduce its toxicity. The major purpose of this paper is to systematically review the effectiveness, safety, and prospective mechanism of gold nanoparticles in delivering drugs for liver cancer treatment. Comprehensive research was conducted using major scientific databases (i.e., PubMed, Web of Science, and Scopus) to identify studies focusing on AUNPs in drug delivery systems. We mainly focused on studies that specifically analyzed liver cancer. The current results of the systematic review show that the application of gold nanoparticles (AUNPs) in liver cancer drug delivery enhances drug targeting to liver tumors. This efficient factor improves the bioavailability and elevates the therapeutic index of chemotherapeutic agents in treatment. This systematic review highlights the significant potential of AUNPs to increase the delivery of drugs for liver cancer treatment effectively. The major findings indicate that AUNPs improve the targeting and bioavailability of chemotherapeutic agents, enhancing therapeutic outcomes such as tumor suppression and improved survival rates. While the results of this review are encouraging; however, further research is necessary to ensure the safety and efficacy of AUNPs in clinical settings. Human trials must address concerns regarding long-term toxicity and regulatory approval. Full article

This article examines the use of satire in the song lyrics of two eco-themed pop songs: Talking Heads’s “(Nothing but) Flowers” (1988) and Anohni’s “4 Degrees” (2015). A close listening approach to these songs reveals ironic discrepancies between the experience produced by musical performance and the sentiments expressed in the song lyrics. A rhetorical framework informs how an examination of such discrepancies may enable new perceptions of the environmental theme to come to mind through what Charles A. Knight calls a satiric “frame of mind”. The satire in these songs not only targets attitudes to convey a moral judgment on them but also provokes audiences to undertake the task of self-examination. If successful, satire in popular song lyrics can contribute to the reconfiguration of listeners’ perceptions of the relationship between humans and nonhuman nature. Full article

Abscisic acid (ABA) is a key phytohormone involved in regulating plant growth and responses to environmental stress. As receptors of ABA, pyrabactin resistance 1 (PYR)/PYR1-like (PYL) proteins play a central role in initiating ABA signal transduction. In this study, a total of 30 PopPYL genes were identified and classified into three sub-families (PYL I–III) in the pan-genome of 17 Populus species, through phylogenetic analysis. Among these subfamilies, the PYL I subfamily was the largest, comprising 21 members, whereas PYL III was the smallest, with only four members. To elucidate the evolutionary dynamics of these genes, we conducted synteny and Ka/Ks analyses. Results indicated that most PopPYL genes had undergone purifying selection (Ka/Ks < 1), while a few were subject to positive selection (Ka/Ks > 1). Promoter analysis revealed 258 cis-regulatory elements in the PYL genes of Populus euphratica (EUP) and Populus pruinosa (PRU), including 127 elements responsive to abiotic stress and 33 ABA-related elements. Furthermore, six structural variations (SVs) were detected in PYL_EUP genes and significantly influenced gene expression levels (p < 0.05). To further explore the functional roles of PYL genes, we analyzed tissue-specific expression profiles of 17 PYL_EUP genes under drought stress conditions. PYL6_EUP was predominantly expressed in roots, PYL17_EUP exhibited leaf-specific expression, and PYL1_EUP showed elevated expression in stems. These findings suggest that the drought response of PYL_EUP genes is tissue-specific. Overall, this study highlights the utility of pan-genomics in elucidating gene family evolution and suggests that PYL_EUP genes contribute to the regulation of drought stress responses in EUP, offering valuable genetic resources for functional characterization of PYL genes. Full article

This paper presents a deep learning-based system designed for generating, storing, and retrieving embeddings, specifically tailored for analyzing craquelure networks in paintings. Craquelure, the fine pattern of the craquelure network formed on a painting’s surface over time, is a unique “fingerprint” for artwork item authentication. The system utilizes a modified VGG19 backbone, which effectively balances computational efficiency with the ability to extract rich, multi-scale features from high-resolution grayscale images. By leveraging this architecture, the model captures global structural patterns and local texture information, which are essential for reliable analysis. Full article

Traditional Forest Management Plans (FMPs), which often span hundreds of pages on paper, present significant challenges due to their extensive length and lack of clear spatiotemporal context. This study aimed to integrate complex data from FMPs into an interactive, spatially referenced database. Using Gârda Forest in Romania’s Apuseni Mountains as a case study, we gathered raw data, developed the geodatabase’s spatial and alphanumerical components, and conducted spatial analyses related to ecological and production factors. Our GIS was designed to accommodate multiple attributes within the compartment layer’s attribute table. Unlike previous studies, we incorporated the full range of information from the Compartment Description, not just isolated management aspects. This comprehensive approach enabled spatial analysis to highlight, in maps, key features across the 50 compartments (totaling 752.5 ha) including dominant species (Norway spruce, silver fir, beech), target species composition (Norway spruce as the predominant target), land protection needs (required for 4% of the area), median forest volume (1565 m³ per compartment), elevation range (1020–1420 m), compartments with production functions, and silvicultural treatments. These thematic maps provide a tool for further analyses and clear spatial visualization. Our GIS-based methodology supports rapid condition assessments and aids forest professionals and decision-makers in promoting sustainable forest management. Full article

Background/Objectives: De novo stress urinary incontinence (SUI) can develop postoperatively in patients without prior symptoms, and can persist beyond 6 months, posing clinical challenges. This study aimed to identify predictors of persistent de novo SUI after transvaginal mesh (TVM) surgery and to evaluate management strategies. Methods: A retrospective review of 817 women with anterior and apical pelvic organ prolapse (POP) (stage II–IV) who underwent TVM surgery from 2013 to 2021 was conducted. Fifty patients developed de novo SUI postoperatively. Assessments included urodynamic studies, validated symptom questionnaires, and POP quantification (POP-Q) staging. Logistic regression analysis was used to identify predictors of persistent symptoms. Results: Spontaneous resolution occurred in 30% (15/50) of participants within six months, while 70% (35/50) had persistent SUI. Concomitant posterior mesh repair was more frequent in the persistent group compared to the self-limiting group (29% vs. 7%), and was significantly associated with symptom persistence (OR 5.6, 95% CI, 0.65–48.4; p = 0.03, chi-square test). During conservative management with observation alone, 30% (15/50) experienced spontaneous resolution within 6 months, while 70% (35/50) had persistent symptoms. Among those with persistent symptoms, 56% required no further treatment, 10% improved with vaginal laser therapy, and 4% underwent sling surgery. Conclusions: Conservative management remains critical in the early postoperative period, given the high rate of spontaneous symptom resolution. For persistent cases, minimally invasive options such as vaginal laser therapy may be beneficial. Notably, only 4% required anti-incontinence surgery. Full article

Background: Heart failure with preserved ejection fraction (HFpEF) is increasingly prevalent worldwide due to ageing and comorbidities. Emerging evidence suggests that Philadelphia-negative chronic myeloproliferative neoplasms (MPNs), particularly those with JAK2 mutations, may contribute to the development of HFpEF, especially by promoting inflammation and increasing thrombotic risk. Methods: This prospective case–control study assessed 58 patients with Philadelphia-negative MPNs and 41 controls, by clinical, paraclinical, and echocardiographic evaluation, to diagnose diastolic dysfunction and HFpEF according to the ESC guideline criteria. Results: Patients with MPNs had a significantly higher prevalence of HFpEF compared to controls (p = 0.008), higher H₂FPEF scores (median 5 vs. 3, p < 0.001), and significant echocardiographic abnormalities, including a higher left ventricular mass index (LVMI) (100.1 vs. 76.6 g/m², p < 0.001), E/e’ (11.00 vs. 7.00, p < 0.001), and pulmonary artery systolic pressure (PASP) (26.0 vs. 7.42 mmHg, p < 0.001). Multivariable logistic regression models identified male sex (OR = 8.993, p = 0.001) and the presence of JAK2 mutation (OR = 5.021, p = 0.002) as independent risk factors for HFpEF in this population. Conclusions: Patients with chronic MPNs, particularly males and those with JAK2 mutations, are at an increased risk of HFpEF, highlighting the importance of routine cardiologic assessment to improve outcomes in this patient population. Full article

Resource-based cities, characterized by a prolonged dependence on resource extraction and persistent urban expansion, frequently exhibit significant imbalances between the supply and demand of ecosystem services (ESs). Understanding how various types of resource-based cities respond to urbanization in terms of ESs supply–demand relationships is crucial for advancing sustainable urban development. This study examines three representative resource-based cities in Sichuan Province—Nanchong (growing), Luzhou (declining), and Panzhihua (mature)—to analyze changes in six key ESs from 2000 to 2020, including soil retention, carbon sequestration, water yield, habitat quality, food production, and recreational services. Ordinary least squares (OLS) regression and random forest (RF) models were employed to evaluate the effects of gross domestic product (GDP) density, construction land proportion (CLP), and population (POP) density on the ecosystem service supply–demand ratio (ESDR), and to explore variations in sensitivity among these cities. The results demonstrate that (1) ESs’ supply–demand patterns differ significantly among the three city types. Nanchong exhibited a declining supply and increasing demand for regulating services; Luzhou displayed improvements in its water yield and recreational services but persistent degradation of habitat quality; and Panzhihua achieved notable gains in carbon sequestration and habitat quality. (2) Urbanization generally reduced the ESDR across all three cities. However, the GDP density positively influenced the ESDR in Nanchong, while the CLP and the POP density exerted widespread negative effects. In Luzhou, the ESDR was primarily constrained by the CLP, whereas in Panzhihua, both the CLP and the POP density significantly reduced the ratio. (3) The sensitivity analysis revealed distinct response patterns: Nanchong was most sensitive to CLP, Luzhou responded most strongly to GDP density, and Panzhihua was highly sensitive to both GDP density and POP density. These findings underscore the necessity of formulating city-type-specific development strategies—such as land restoration, population control, and industrial upgrading—tailored to different types of resource-based cities, in order to reconcile urbanization with ecosystem service dynamics, promote green transformation, and contribute to the achievement of the Sustainable Development Goals (SDGs). Full article

As the supply of cocoa becomes increasingly volatile, biotechnological innovations such as lipid engineering with lipases play a crucial role in supporting more stable, ethical, and sustainable chocolate production systems. This study explores the potential of Pseudomonas fluorescens lipase immobilized on eggshell membrane-based carriers for the synthesis of a cocoa butter substitute (CBS). The carriers were prepared by treating eggshells with different acids to generate chemically distinct support materials. Lipase immobilization was performed using both adsorption and covalent binding techniques. All resulting biocatalysts were characterized and compared to the free enzyme with respect to pH and temperature optima, as well as thermal and solvent stability. Immobilization caused shifts in the enzyme’s optimal operating conditions and significantly improved its stability at elevated temperatures and in the presence of organic solvents. Among the tested systems, the lipase immobilized by adsorption onto a hydrochloric acid-treated carrier exhibited the best performance. Using this biocatalyst, a CBS containing 93.54 ± 0.16% of the target triacylglycerols (POP, POS, and SOS) was successfully synthesized and reused over five consecutive synthesis cycles without significant loss of activity. These findings demonstrate the potential of waste-derived biomaterials for the development of efficient, stable, and reusable biocatalysts in the enzymatic production of functional lipids. Full article