Search Results (14,584)

Background and Objectives: Non-invasive biomarkers reflecting neurodegeneration are increasingly important in multiple sclerosis (MS). Optical coherence tomography (OCT) provides quantitative measures of retinal structure, most commonly peripapillary retinal nerve fiber layer (pRNFL) thickness. However, the potential clinical relevance of optic nerve head morphology, including cup-to-disc ratio (CDR), remains insufficiently explored. We investigated associations between OCT-derived parameters, subjective visual vertical (SVV), and disability in MS. Materials and Methods: In this retrospective study, 100 patients with MS were included. OCT parameters (pRNFL thickness and area-based CDR) were analyzed at baseline and follow-up. Clinical disability was assessed using the Expanded Disability Status Scale (EDSS). Detailed optic neuritis history was not consistently available in the retrospective clinical records and therefore could not be systematically accounted for in the analyses. SVV was evaluated in 37 patients using a virtual reality–based protocol. Associations were assessed using Spearman correlation and linear regression analyses. Multivariable regression models were adjusted for age, sex, and follow-up duration. Results: pRNFL thickness was not associated with baseline EDSS (rho = −0.06, p = 0.55) or annualized EDSS change. Baseline CDR correlated with both baseline EDSS (rho = 0.30, p = 0.0065) and follow-up EDSS (rho = 0.46, p < 0.0001). In univariable regression analysis, baseline CDR was associated with follow-up EDSS (B = 3.33, R² = 0.23, p < 0.0001), remaining significant after adjustment for age, sex, and follow-up duration (B = 2.59, 95% CI 1.26–3.92, p = 0.0002). No significant associations were observed between OCT parameters and SVV measures. Conclusions: Higher CDR values, but not pRNFL thickness, were associated with disability measures in this exploratory MS cohort. However, these findings should be interpreted cautiously because optic neuritis history could not be systematically accounted for and physiological optic disc variability may substantially influence CDR measurements. Full article

Juvenile intestinal ischemia–reperfusion (JII/R) is a pediatric surgical emergency caused by mesenteric vessel occlusion and has a high mortality rate. Malrotation can cause intestinal ischemia in infants due to midgut volvulus. It affects not only the intestine itself but also other organs, such as cardiac tissue. Therefore, searching for more effective therapeutic solutions is an essential critical need. This directed our thoughts to evaluate the role of ambrisentan (AMB) in a rat model of induced JII/R by clamping the superior mesenteric artery. Forty juvenile male Wistar albino rats (3–4 weeks old) were randomly divided into four experimental groups: control (CON) group, JII/R group, and AMB-treated groups (30, 60 mg/kg) with JII/R. Induction of JII/R results in significant changes in cardiac enzymes, oxidative stress, inflammatory, and apoptotic parameters with high expression of endothelin receptor A (ERA). Also, histopathological changes revealed extensive mucosal damage, loss of intestinal villi, dysregulated and degenerated cardiac fibers with inflammatory cell infiltration, and tissue necrosis. In contrast, AMB administration significantly reduced the elevated levels of cardiac enzymes, malondialdehyde (MDA), nuclear factor kappa B (NF-κB), ERA, and caspase-3 expression. However, AMB treatment increased immune expressions of phosphatidylinositol 3-kinase (PI3K), protein kinase B (Akt), Ki-67, and mammalian target of rapamycin (mTOR) and showed remarkable improvement in the histopathological changes. AMB could be considered as an adjuvant medical treatment for cases of JII/R. Full article

This study aimed to investigate the effects of dietary Herba Epimedii Folium (HEF) supplementation on semen quality, reproductive hormones, immune parameters, gut microbiota, and seminal plasma metabolites in aged boars, and to evaluate its potential for extending their reproductive lifespan. A total of 18 Bama boars (approximately 3 years of age) were randomly assigned to three groups (n = 6 per group). The control group received a basal diet, while the treatment groups were fed the basal diet supplemented with 3 g/kg or 5 g/kg of HEF for 8 weeks. The results showed that adding HEF to the diet of aged boars increased the motility and concentration of their sperm and reduced the proportion of abnormal sperm. Treatment with 3 g/kg HEF increased serum LH and IgG levels, whereas the 5 g/kg dose elevated IgA levels in both serum and seminal plasma, as well as IgG levels in seminal plasma. Furthermore, 16S rRNA sequencing revealed that dietary HEF supplementation reduced the relative abundance of Streptococcus and Oscillospiraceae UCG-002 in the gut of aged boars. PICRUSt2 analysis predicted that pathways involved in lysine biosynthesis, arginine and proline metabolism, glycine, serine and threonine metabolism, and amino acid-related enzymes were enriched in the HEF treatment group. Semen metabolite profiling showed that the HEF treatment enriched several key metabolites, including 5-hydroxytryptophan, acetylcarnitine, tretinoin, methyltestosterone, prostaglandin A3, and prostaglandin B2. Spearman correlation analysis revealed a negative association between Streptococcus abundance and sperm motility, whereas acetylcarnitine, 5-hydroxytryptophan, and prostaglandin A3 were positively associated with motility. Furthermore, 5-hydroxytryptophan levels were positively linked to both sperm concentration and serum LH. In summary, our study demonstrates that Epimedii Folium may enhance the semen quality of aged Bama boars by improving the intestinal microbiota and the metabolic profile of seminal plasma. These findings may offer a theoretical basis for optimizing reproduction and conserving germplasm resources in aged Bama miniature pigs. Full article

This study proposes a canopy-adaptive TAD-IRRT* (target-biased sampling, artificial potential field, and dynamic step-size informed rapidly-exploring random tree star) algorithm to solve the collision-free 3D path-planning problem for a 6-DOF apple-harvesting robotic arm. To improve computational speed and search directionality, the method integrates target-biased sampling and a distance-regulated artificial potential field (APF) into the Informed-RRT* framework. Furthermore, an obstacle-distance-based dynamic step-size mechanism is introduced to optimize spatial exploration. The generated routes undergo greedy path pruning and cubic B-spline smoothing to ensure kinematic executability. The simulation results in complicated ROS-based scenarios demonstrate that the TAD-IRRT* algorithm achieves a 100% planning success rate, reducing the average computational time and joint-space path length by approximately 60.1% and 15.6%, respectively, compared to the standard Informed-RRT*. Kinematic analysis via Fourier curve fitting ($R^2=0.9849$) confirms continuous angular velocity and acceleration without high-frequency chattering. Physical prototype experiments in the dense-obstacle scenarios show that the proposed method increases the path execution success rate by 36.7% and reduces the average execution time by 41% compared to the standard Informed-RRT* algorithm. The proposed approach effectively balances high-quality path generation with low computational overhead, providing a reliable and safe solution that significantly reduces mechanical wear. Full article

Rhizoctonia solani is a necrotrophic phytopathogenic fungus that causes disease in various crops. In agriculture, many crops suffer from root or seedling rot caused by this soil-borne pathogen, whereas cabbage and rice develop lesion-like symptoms on aboveground tissues. Diseases caused by R. solani are generally controlled using chemical fungicides; however, environmentally friendly alternatives are needed for sustainable agriculture. In this study, we evaluated the efficacy of lecithin, a mixture of phospholipids previously registered in Japan as an agrochemical for controlling cucumber powdery mildew, against Rhizoctonia diseases. In cabbage, foliar spraying of 0.2–1.0% soybean lecithin effectively suppressed leaf symptoms caused by R. solani isolate RhiCa-2, which was identified as AG-1 IB. In rice and Brachypodium distachyon, 0.2–1.0% lecithin significantly suppressed leaf symptoms induced by R. solani AG-1 IA. Hyphal staining of inoculated leaves revealed reduced hyphal density on lecithin-treated leaves. Consistently, hyphal growth of R. solani on cellophane placed on water agar was retarded by lecithin treatment. However, 5.0% lecithin induced phytotoxicity in B. distachyon. Egg yolk-derived lecithin also exhibited disease-suppressive activity in cabbage and B. distachyon, with efficacy comparable to that of soybean lecithin under the conditions tested. These results suggest that lecithin suppresses foliar infection by R. solani, at least in part, through direct inhibitory effects on fungal hyphae, and may serve as a potential alternative material for disease control in sustainable crop production. Full article

High sound pressure level (SPL) acoustic sensing requires miniaturized microphones that can operate under large acoustic loading while maintaining mechanical linearity, sufficient sensing response, and broadband audio frequency behavior. This work targets high-SPL operation and numerically investigates a graphene piezoresistive MEMS microphone based on a membrane-supported beam–island diaphragm. The proposed structure retains a continuous membrane for acoustic load bearing, while the upper beam–island topology redirects deformation-induced strain toward beam root regions where graphene piezoresistors are placed. This design is intended to increase the local strain available for piezoresistive readout without simply relying on larger global diaphragm deflection. Finite-element analysis was used to optimize the diaphragm geometry and evaluate strain enhancement, pressure response linearity, modal behavior, and harmonic response. Under the 170 dB SPL reference condition, the optimized structure increases the peak structural strain from 47.83 με in a thickness-equivalent solid diaphragm to 562.53 με, achieving an approximately 11.8-fold enhancement in local sensing strain while maintaining a highly linear pressure response (R2 > 0.9999). Additionally, the results also show that the sensor exhibits a high first natural frequency of 64.07 kHz and a small response variation of approximately 0.94 dB within the 0–20 kHz target frequency range, indicating excellent dynamic stability and high-fidelity signal transduction characteristics. To connect the structural response with piezoresistive readout, first-order electromechanical output estimation was further performed using representative graphene gauge factors, quarter-bridge readout assumptions, contact resistance correction, and Johnson-noise-limited signal-to-noise ratio estimation. A ±5% geometric tolerance check further indicates that the membrane side length is the most fabrication-sensitive parameter, while the selected design remains generally robust except for reduced linearity margin under positive membrane side-length deviation. These results demonstrate the potential of the proposed graphene-based MEMS microphone for high-SPL broadband acoustic sensing applications in harsh and high-intensity acoustic environments. Full article

Background: Oxidative stress contributes significantly to premature skin aging and inflammatory dermatological conditions. While plant-derived antioxidants have demonstrated considerable promise in topical applications, Bougainvillea glabra Choisy remains underexplored in standardized pharmaceutical dosage form development despite its documented phytochemical richness. Objective: This study aimed to develop, standardize, and characterize topical cold cream formulations incorporating B. glabra ethanolic leaf extract, with HPTLC-based quantification of marker compounds, validated antioxidant assessment, and preliminary dermal safety evaluation. Methods: The ethanolic leaf extract was prepared by maceration and characterized by preliminary phytochemical screening and HPTLC fingerprinting with quantitative densitometric analysis of quercetin and pinitol. Three cold cream formulations were developed at 10% (F1), 20% (F2), and 30% (w/w) (F3) extract loading. Formulations were evaluated for organoleptic properties, pH, homogeneity, spreadability, and viscosity. Antioxidant activity was assessed using a validated methanol extraction procedure followed by DPPH radical scavenging and potassium permanganate reduction assays. Ex vivo skin permeation was evaluated using Franz diffusion cells with freshly excised goat skin. Accelerated stability was conducted at 40 ± 2 °C/75 ± 5% RH for 90 days with HPTLC-based marker retention monitoring. Primary dermal safety was assessed in Wistar albino rats (n = 6) following OECD Test Guideline 404. Results: Quantitative HPTLC confirmed quercetin (4.82 ± 0.14 mg/g dry extract) and pinitol (2.31 ± 0.09 mg/g) as marker compounds, with linearly increasing content across F1–F3. All formulations demonstrated acceptable physicochemical properties (pH 5.7–5.9, viscosity 440,000–460,000 cP, spreadability 11.8 ± 0.3 cm·g/s). F3 exhibited the highest DPPH scavenging activity (56.68 ± 1.05%) with IC₅₀ of 1.3 ± 0.1% w/v, demonstrating a 3.2-fold improvement over F1. Extraction recovery from the cream matrix was 96.4–97.1%, validating the antioxidant data. Ex vivo quercetin permeation through goat skin reached 51.3 ± 2.8 μg/cm² at 24 h for F3, following Higuchi diffusion kinetics (R² > 0.99). No dermal irritation was observed (Primary Irritation Index = 0). Accelerated stability confirmed ≥98.3% retention of both marker compounds and antioxidant activity after 90 days. Conclusions: B. glabra leaf extract was successfully incorporated into a physicochemically stable, non-irritating cold cream with demonstrated dose-dependent antioxidant efficacy and cutaneous delivery capability. The study establishes preliminary dermal safety and in vitro antioxidant efficacy warranting further controlled clinical evaluation. Full article

In this study, Fe₇₀Ni₃₀ metal was deposited onto continuous glass fiber composites via magnetron sputtering, followed by surface coating with SiO₂. The effects of key process parameters-including Fe₇₀Ni₃₀ sputtering duration (2, 5, 10, 20, and 30 min) and SiO₂ surface coating-on the electromagnetic properties and microwave absorption performance of the materials were systematically investigated. Scanning electron microscopy (SEM) characterization revealed that as sputtering time increased, the metal coating evolved from discrete small particles into a continuous film. Cross-sectional SEM analysis further demonstrated the formation of a bilayer structure after SiO₂ introduction. X-ray diffraction (XRD) patterns confirmed the presence of diffraction peaks corresponding to the Fe₇₀Ni₃₀ alloy solid solution. Electromagnetic parameter measurements indicated that the influence of sputtering time on electromagnetic properties was primarily pronounced during the metal layer growth stage; once a continuous film was formed, the variation in electromagnetic parameters diminished. Concurrently, the SiO₂ coating exhibited a significant regulatory effect on dielectric parameters. Reflection coefficient calculations showed that the optimal absorption thickness for the single-layer material ranged from 2.5 to 3.0 mm, with the absorption peak shifting toward lower frequencies as thickness increased. However, the effective absorption bandwidth (EAB) was only 3–5 GHz, failing to meet wideband requirements. In contrast, the three-layer composite structure (total thickness: 3.8 mm) optimized via genetic algorithm achieved impedance gradient and loss synergy, expanding the EBW (R < −10 dB) from 4.8 GHz (single layer) to 10 GHz (8–18.0 GHz)-a substantial improvement over the single-layer configuration. This work provides experimental evidence and technical support for the structural design and process optimization of lightweight, high-efficiency, wideband microwave-absorbing materials. Full article

This study investigated the influence of carrot cryopowder, obtained by cryogenic grinding, on the rheological, physicochemical, and structural characteristics of a structured curd product. The experiment was conducted using a three-factor Box–Behnken design, varying the mass fraction of curd (70–90%), carrot cryopowder content (2–6%), and fat content in cream (7–33%). Viscosity values ranged from 914 to 2810 mPa·s, with the highest value of (2810 mPa·s) recorded in experimental sample No. 5. The best overall characteristics were observed in this sample, which showed a β-carotene content of 2.76 ± 0.03 µg/g, while the concentrations of vitamins B1, B2, B3, B5, B6, and folic acid were 20–31% higher compared to the control sample. The regression model (R² = 0.9164) identified the optimal formulation: 89.6% curd, 5.4% carrot cryopowder, and 31.3% fat in cream. Storage stability studies conducted over 28 days at 4 ± 1 °C demonstrated additional practical advantages. The addition of carrot cryopowder significantly reduced syneresis to 12.4 ± 1.1% on day 28 (compared to 28.7 ± 2.3% in the control), improved microbiological stability, and maintained acceptable sensory properties with an overall acceptability score of 6.8 ± 0.6 points after 28 days. FTIR analysis confirmed that the carrot cryopowder was not merely mechanically dispersed within the matrix but actively participated in the formation of new intermolecular interactions, leading to the modification of the product’s chemical structure. The obtained results showed that the incorporation of carrot cryopowder not only increased the nutritional and functional value of the curd product but also enhanced its structural stability and potential shelf life without negatively affecting the main technological indicators. Full article

The voluntary carbon market (VCM) has emerged as a promising mechanism for climate mitigation; however, farmer participation in developing countries remains limited. This study combines the Theory of Planned Behavior (TPB) and the Capability–Opportunity–Motivation–Behavior (COM-B) framework to investigate factors associated with Thai farmers’ intention and self-reported stage of participation in VCM. Data were collected through face-to-face interviews with 240 farmers across multiple crop systems in Thailand and analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM). The model explained substantial variance in intention and behavior (R² = 0.610 and 0.555, respectively), although PLS-Predict indicated limited predictive performance. Perceived behavioral control (PBC) showed the strongest positive association with reported participation behavior (β = 0.493, p < 0.001), followed by intention (β = 0.343, p < 0.001). Access to extension and technical support (AES) was positively associated with intention (β = 0.624, p < 0.001) and PBC (β = 0.338, p < 0.001). Knowledge was positively associated with PBC (β = 0.324, p < 0.001) but negatively associated with intention (β = −0.106, p = 0.045). No significant association was observed between attitude and intention; however, subjective norms were negatively associated with intention (β = −0.336, p < 0.001). Indirect associations through intention and PBC were also observed. Overall, the findings suggest that capability-, opportunity-, and trust-related factors are associated with farmers’ reported participation in VCM and may inform the design of future policies and support programs. Although the model demonstrated useful explanatory capability, its predictive performance was limited, indicating that the findings should be interpreted primarily as explanatory rather than predictive. Full article

Background and Objectives: The neurocognitive sequelae of COVID-19 have attracted attention as part of post-COVID condition (PCC), yet standardized tools for screening and quantifying PCC-related cognitive impairment remain scarce. The present study aimed to develop and validate the Screening for Neurocognitive Abilities Post-COVID (SNAP-COVID), a self-report questionnaire designed to capture current symptom burden and perceived changes in cognitive functioning relative to pre-COVID status in a Greek-speaking sample. Materials and Methods: Data collection occurred in three phases between August 2024 and February 2025. Dataset A (N = 27) was used for test–retest reliability. Dataset B (N = 300) was used for exploratory factor analysis (EFA), reliability testing, and convergent validity analyses with the Brain Fog Scale (BFS). Dataset C (N = 317) was used for independent validation through confirmatory factor analysis (CFA). Results: Initial EFA of the 30-item SNAP-COVID scale suggested a four-factor model, yet further item refinement yielded a robust three-factor, 24-item solution: (1) General Cognitive Functions (17 items, α = 0.948), (2) Sensory Hypersensitivity (4 items, α = 0.829), and (3) Language and Communication (3 items, α = 0.950). The total scale demonstrated excellent internal consistency (α = 0.95). Convergent validity was evident by significant correlations between SNAP impact scores and BFS scores (r = −0.442, p < 0.001). CFA confirmed the three-factor structure with acceptable fit indices (χ²(249) = 677.29, p < 0.001; CFI = 0.882; TLI = 0.869; RMSEA = 0.074; SRMR = 0.032). Conclusions: The SNAP-COVID scale is a reliable and valid instrument. Its multidimensional structure captures global and domain-specific difficulties, addressing a critical gap in post-infectious cognitive assessment. Full article

Background/Objectives: This study examined weight pressures and symptoms of eating disorders in professional modern dancers. Methods: Eighty-six female dancers (age: 20.7 ± 2.5 y, dancing experience: 14.2 ± 4.4 y) completed the Eating Attitudes Test 26 (EAT-26), the Weight-Pressures in Sport inventory for females (WPS-F), and provided information on their dance lessons. Results: Twenty-five dancers (29.07%) scored ≥20 in EAT-26. Positive associations were found between EAT-26 and its subscales with WPS-F and its subscales (r = 0.217 to 0.600, p ˂ 0.05). Negative associations were found between age and dancing experience with the EAT-26 score and its subscales Dieting and Bulimia and Food Preoccupation (r = −0.286 to −0.373, p ˂ 0.001) and between body weight and BMI with Oral Control (r = −0.300 to −0.372, p ˂ 0.001). Multiple regression analysis showed that Pressures regarding Appearance and Performance, age, and dancing experience accounted for 38.3% of the variance in EAT-26 (p ˂ 0.001), with age and training experience showing a negative coefficient. Moderation analysis showed that dancing experience moderates the relationship between Pressures regarding Appearance and Performance and eating disorder symptoms (interaction b = −0.329, p = 0.040). Conclusions: Professional female dancers are at elevated risk for disordered eating. Inherent pressures regarding appearance and performance were associated with and explained a significant portion of the variance in eating disorder symptom scores, while dancing experience appeared to attenuate this association, although the cross-sectional design of this study precludes conclusions regarding the direction of this effect. Full article

Background and Objectives: This study aimed to examine the level of depression in children who had undergone pediatric liver transplantation and to evaluate the potential role of liver enzymes as biomarkers of depression. Materials and Methods: The study was conducted with 50 pediatric liver transplant recipients followed at the Liver Transplantation Institute of İnönü University, and data were collected through face-to-face interviews. The Personal and Transplant Information Form, Child Revised Impact of Event Scale, and Patient Health Questionnaire–Depression were used as data collection tools. In addition to descriptive statistics, Student’s t-test, Mann–Whitney U test, correlation analyses, and regression analyses were performed. Results: The median PHQ-9 score was 1.00 (Q1–Q3: 0.00–5.00), indicating generally low levels of depression. A significant positive correlation was found between CRIES and PHQ-9 scores (r = 0.414, p < 0.01). In contrast, no consistent significant associations were observed between liver enzyme levels and depression scores in multivariate analyses, although bilirubin showed a modest negative correlation with PHQ-9 scores. In the multivariate analysis, although the overall regression model was not statistically significant, the CRIES score showed an individual association with PHQ-9 scores within the model (B = 0.117, p = 0.037). Conclusions: Liver enzymes cannot be considered strong biomarkers of depression in pediatric liver transplant recipients; however, post-traumatic stress symptoms may be an important clinical indicator for assessing psychological adjustment. Full article

Background: This randomized parallel-group clinical study evaluated salivary cortisol as a biomarker of perioperative stress response during surgical extraction of impacted mandibular third molars performed under local anesthesia administration of ropivacaine and dexamethasone. Methods: The trial was registered in the ISRCTN registry (ISRCTN87752106). Ninety patients undergoing impacted mandibular third molar surgery were randomly assigned (1:1:1; n = 30/group) to receive inferior alveolar nerve block with 0.5% ropivacaine plus dexamethasone (R+D group), 0.5% ropivacaine (R group), or 0.5% bupivacaine (B group). Salivary cortisol as the primary outcome was measured at 15 min before anesthesia, and 15 min and 24 h postoperatively. Preoperative psychological stress was assessed using the Revised Norman Corah Dental Anxiety Scale. Results: No significant differences were observed between groups in preoperative anxiety (p = 0.890) or baseline salivary cortisol levels (p = 0.984). Significant intergroup differences in cortisol levels were observed at 15 min (p = 0.002) and 24 h postoperatively (p = 0.001). Cortisol levels at 15 min postoperatively were significantly lower in the R+D group compared to the R (p = 0.001) and B groups (p = 0.004) and after 24 h (R+D vs. R: p = 0.005; R+D vs. B: p < 0.001). Conclusions: The ropivacaine–dexamethasone administration significantly reduced perioperative salivary cortisol levels compared to ropivacaine alone or bupivacaine alone during impacted mandibular third molar surgery. This modulation of the neuroendocrine response likely results from dexamethasone-induced suppression of hypothalamic–pituitary–adrenal axis and the improved analgesic effects of this combination. The observed results may contribute to improved physiological stability, postoperative recovery and the clinical benefit of this anesthetic approach in oral surgery. Full article

Background/Objectives: Vancomycin-resistant (VRE) and vancomycin-variable (VVE) Enterococcus spp. represent an increasing clinical challenge due to limited treatment options and the potential for undetected dissemination of such resistance genes. Data on Enterococci genomic epidemiology in healthcare settings remain rather limited. Our study aimed to investigate vancomycin resistance determinants in Enterococcus spp., clonal structure, and occurrence of VVE using whole-genome sequencing (WGS) in Latvia. Methods: Clinical isolates collected from hospitalised patients in two tertiary-level hospitals in Latvia (2021–2024) were analysed using WGS following routine laboratory identification. Vancomycin resistance determinants were identified in silico, along with MLST and cgMLST genotyping. Results: Of 532 sequenced isolates, 482 met the quality and inclusion criteria. E. faecalis (56.64%) and E. faecium (40.25%) predominated. Among 125 isolates carrying vancomycin resistance genes, vanB (54.40%) was the most frequent, followed by vanA (38.20%) and vanC (6.40%); vanC was restricted to E. gallinarum and E. casseliflavus. Vancomycin resistance was more prevalent in E. faecium (51.03%) than in E. faecalis (6.59%). cgMLST identified outbreak clusters among E. faecium ST80 and ST78 with complex type-specific resistance patterns and hospital specificity. E. faecalis showed polyclonal endemicity with the vanB gene present in different clades. Three (0.62%) vancomycin-variable E. faecium (VVE) isolates were identified in one hospital, harbouring vanA-type gene clusters comprising vanHAX but lacking the sensory gene vanS and the regulatory gene vanR. Conclusions: The VanB gene predominated in both hospitals, driven by clonal expansion of hospital-adapted E. faecium ST80/ST78, contrasting with earlier vanA predominance in Europe but aligning with recent regional vanB trends. The detection of VVE highlights clinically relevant genotype–phenotype discordance, underscoring the importance of integrating genomic surveillance with routine phenotypic testing to detect cryptic resistance and guide effective antimicrobial therapy. Full article