Search Results (14,524)

Sewer systems are essential for sustainable infrastructure management, influencing environmental, social, and economic aspects. However, sewer network capacity is under significant pressure, with many systems overwhelmed by challenges such as climate change, ageing infrastructure, and increasing inflow and infiltration, particularly through groundwater infiltration (GWI). Current research in this area has primarily focused on general sewer performance, with limited attention to high-resolution, spatially explicit assessments of sewer exposure to GWI, highlighting a critical knowledge gap. This study responds to this gap by developing a high-resolution GWI assessment. This is achieved by integrating fuzzy-analytical hierarchy process (AHP) with geographic information systems (GISs) and machine learning (ML) to generate GWI probability maps across the Dawlish region, southwest United Kingdom, complemented by sensitivity analysis to identify the key drivers of sewer network vulnerability. To this end, 16 hydrological–hydrogeological thematic layers were incorporated: elevation, slope, topographic wetness index, rock, alluvium, soil, land cover, made ground, fault proximity, fault length, mass movement, river proximity, flood potential, drainage order, groundwater depth (GWD), and precipitation. A GWI probability index, ranging from 0 to 1, was developed for each 1 m × 1 m area per season. The model domain was then classified into high-, intermediate-, and low-GWI-risk zones using K-means clustering. A consistency ratio of 0.02 validated the AHP approach for pairwise comparisons, while locations of storm overflow (SO) discharges and model comparisons verified the final outputs. SOs predominantly coincided with areas of high GWI probability and high-risk zones. Comparison of AHP-weighted GIS output clustered via K-means with direct K-means clustering of AHP-weighted layers yielded a Kappa value of 0.70, with an 81.44% classification match. Sensitivity analysis identified five key factors influencing GWI scores: GWD, river proximity, flood potential, rock, and alluvium. The findings underscore that proxy-based geospatial and machine learning approaches offer an effective and scalable method for mapping sewer network exposure to GWI. By enabling high-resolution risk assessment, the proposed framework contributes a novel proxy and machine-learning-based screening tool for the management of smart cities. This supports predictive maintenance, optimised infrastructure investment, and proactive management of GWI in sewer networks, thereby reducing costs, mitigating environmental impacts, and protecting public health. In this way, the method contributes not only to improved sewer system performance but also to advancing the sustainability and resilience goals of smart cities. Full article

Objective: Stroke is one of the leading causes of death and disability worldwide. Compared to developed countries, the prognosis of stroke is less favourable in developing countries. The objective of this study is to identify inter-ethnic variation in risk profiles and stroke outcomes amongst Bangladeshi, Indian, Nepalese, Pakistani, and Sri Lankan expatriates living in Qatar. Methods: Data from the Qatar Stroke Registry were retrospectively analyzed from April 2014 to June 2025. A total of 8825 patients were included. The chi-square test was used to analyze sociodemographic variables, while the Kruskal–Wallis test was used to analyze continuous variables. Post hoc analysis was performed. Multivariate logistic regression and multivariate multiple regression were used to identify the predictors associated with poor clinical outcomes and mortality at 90 days. Results: Ischemic stroke was the predominant stroke type in all groups, with Nepalese patients presenting with stroke at a younger age, whilst Pakistanis tended to be older (p < 0.001). In terms of stroke outcomes, Nepalese patients had the highest proportion of a poor functional outcome at 90 days as well as NIHSS at discharge (p < 0.05). However, Bangladeshis had the highest proportion of mortality at 90 days compared to the other cohorts. Multivariable logistic regression revealed that undiagnosed dyslipidemia, Nepalese ethnicity, and moderate and severe NIHSS admission scores were independent predictors of a poor functional outcome at 90 days, whilst male sex and prior antidiabetic therapy were protective factors (p < 0.001). In terms of mortality at 90 days, only a severe NIHSS admission score (>10) was a significant predictor (p < 0.001). A severe NIHSS admission score was also the only predictive factor of mortality and poor functional outcome at 90 days (p < 0.05). Conclusions: There was a significant variation in stroke presentation and outcomes among South Asian subpopulations in Qatar, suggesting the importance of tailored public health strategies as a uniform approach to stroke care is insufficient for this diverse population. Full article

Thermal oxidative aging failure of high-temperature vulcanized silicone rubber (HTV) in high-voltage insulators is the core hidden danger of power grid security. In this study, terahertz time domain spectroscopy (THz-TDS) and attenuated total reflection infrared spectroscopy (ATR-FTIR) were combined to reveal the quantitative structure–activity relationship between dielectric response and chemical group evolution of HTV during accelerated aging at 200 °C for 80 days. In this study, HTV flat samples were made in the laboratory, and the dielectric spectrum of HTV in the range of 0.1 THz to 0.4 THz was extracted by a terahertz time–domain spectrum platform. ATR-FTIR was used to analyze the functional group change trend of HTV during aging, and the three-stage evolution of the dielectric real part (0.16 THz), the dynamics of the carbonyl group, the monotonic rise of the dielectric imaginary part (0.17 THz), and the linear response of silicon-oxygen bond breaking were obtained by combining the double Debye relaxation theory. Finally, three aging stages of HTV were characterized by dielectric loss angle data. The model can warn about the critical point of early oxidation and main chain fracture and identify the risk of insulation failure in advance compared with traditional methods. This study provides a multi-scale physical basis for nondestructive life assessment in a silicon rubber insulator. Full article

Background/Objectives: Wet age-related macular degeneration (AMD) is a progressive retinal disease characterized by macular neovascularization (MNV). Currently, the standard treatment for wet AMD is intravitreal anti-VEGF administration, which aims to control disease activity by suppressing neovascularization. In clinical practice, the decision to continue or discontinue treatment is largely based on the presence of fluid on optical coherence tomography (OCT) and changes in visual acuity. However, discrepancies between anatomic and functional responses can occur during these assessments. Methods: This article presents an artificial intelligence (AI)-based classification model developed to objectively assess the response to anti-VEGF treatment in patients with AMD at 3 months. This retrospective study included 120 patients (144 eyes) who received intravitreal bevacizumab treatment. After bevacizumab loading treatment, the presence of subretinal/intraretinal fluid (SRF/IRF) on OCT images and changes in visual acuity (logMAR) were evaluated. Patients were divided into three groups: Class 0, active disease (persistent SRF/IRF); Class 1, good response (no SRF/IRF and ≥0.1 logMAR improvement); and Class 2, limited response (no SRF/IRF but with <0.1 logMAR improvement). Pre-treatment and 3-month post-treatment OCT image pairs were used for training and testing the artificial intelligence model. Based on this grouping, classification was performed with a Siamese neural network (ResNet-18-based) model. Results: The model achieved 95.4% accuracy. The macro precision, macro recall, and macro F1 scores for the classes were 0.948, 0.949, and 0.948, respectively. Layer Class Activation Map (LayerCAM) heat maps and Shapley Additive Explanations (SHAP) overlays confirmed that the model focused on pathology-related regions. Conclusions: In conclusion, the model classifies post-loading response by predicting both anatomic disease activity and visual prognosis from OCT images. Full article

Background/Objective: The overnight 1-mg dexamethasone suppression test (DST) represents the conventional/standard tool for endogenous hypercortisolemia screening, typically in relationship with adrenal and pituitary masses. Nevertheless, an associated spectrum of challenges and pitfalls is found in daily practice. This analysis aimed to evaluate: (I.) the diagnosis relevance of 1-mg DST in patients with adrenal incidentalomas (AIs) with/without mild autonomous cortisol secretion (MACS) exploring different cutoffs of the second-day plasma cortisol after dexamethasone administration (cs-DST) with respect to cardio-metabolic outcomes; (II.) the potential utility of adding other biomarkers to DST [plasma morning adrenocorticotropic hormone (ACTH), 24-h urinary free cortisol (UFC), late-night salivary cortisol (LNSC), dehydroepiandrosterone sulfate (DHEAS)]; and (III.) DST variability in time. Methods: This narrative analysis was based on searching full-text, English articles in PubMed (between January 2023 and April 2025) via using different term combinations: “dexamethasone suppression test” (n = 239), “diagnosis test for autonomous cortisol secretion” (n = 22), “diagnosis test for mild autonomous cortisol secretion” (n = 13) and “diagnosis test for Cushing Syndrome” (n = 61). We manually checked the title and abstract and finally included only the studies that provided hormonal testing results in adults with non-functional adenomas (NFAs) ± MACS. We excluded: reviews, meta-analyses, editorials, conference abstracts, case reports, and case series; non-human research; studies that did not provide clear criteria for distinguishing between Cushing syndrome and MACS; primary aldosteronism. Results: The sample-focused analysis (n = 13 studies) involved various designs: cross-sectional (n = 4), prospective (n = 1), retrospective (n = 7), and cohort (n = 1); a total of 4203 patients (female-to-male ratio = 1.45), mean age of 59.92 years. I. Cs-DST cutoffs varied among the studies (n = 6), specifically, 0.87, 0.9, 1.2, and 1.4 µg/dL in relationship with the cardio-metabolic outcomes. After adjusting for age (n = 1), only the prevalence of cardiovascular disease remained significantly higher in >0.9 µg/dL vs. ≤0.9 group (OR = 2.23). Multivariate analysis (n = 1) found cs-DST between 1.2 and 1.79 µg/dL was independently associated with hypertension (OR = 1.55, 95%CI: 1.08–2.23, p = 0.018), diabetes (OR = 1.60, 95%CI: 1.01–2.57, p = 0.045), and their combination (OR = 1.96, 95%CI:1.12–3.41, p = 0.018) after adjusting for age, gender, obesity, and dyslipidemia. A higher cs-DST was associated with a lower estimated glomerular filtration rate (eGFR), independently of traditional cardiovascular risk factors. Post-adrenalectomy eGFR improvement was more pronounced in younger individuals, those with lower eGFR before surgery, and with a longer post-operative follow-up. Cs-DST (n = 1) was strongly associated with AIs size and weakly associated with age, body mass index and eGFR. Cortisol level increased by 9% (95% CI: 6–11%) for each 10 mL/min/1.73 m² decrease in eGFR. A lower cs-DST was associated with a faster post-adrenalectomy function recovery; the co-diagnosis of diabetes reduced the likelihood of this recovery (OR = 24.55, p = 0.036). II. Additional biomarkers assays (n = 5) showed effectiveness only for lower DHEAS to pinpoint MACS amid AIs (n = 2, cutoffs of <49.31 µg/dL, respectively, <75 µg/dL), and lower ACTH (n = 1, <12.6 pmol/L). III. Longitudinal analysis of DST’s results (n = 3): 22% of NFAS switch to MACS after a median of 35.7 months (n = 1), respectively, 29% (n = 1) after 48.6 ± 12.5 months, 11.8% (n = 1) after 40.4 ± 51.17 months. A multifactorial model of prediction showed the lowest risk of switch (2.4%) in individuals < 50 years with unilateral tumor and cs-DST < 0.45 µg/dL. In the subgroup of subjects without cardio-metabolic comorbidities at presentation, 25.6% developed ≥1 comorbidities during surveillance. Conclusions: The importance of exploring the domain of AIs/NFAs/MACS relates to an increasing detection in aging population, hence, the importance of their optimum hormonal characterization and identifying/forestalling cardio-metabolic consequences. The spectrum of additional biomarkers in MACS (other than DST) remains heterogeneous and still controversial, noting the importance of their cost-effectiveness, and availability in daily practice. Cs-DST serves as an independent predictor of cardio-metabolic outcomes, kidney dysfunction, while adrenalectomy may correct them in both MACS and NFAs, especially in younger population. Moreover, it serves as a predictor of switching the NFA into MACS category during surveillance. Changing the hormonal behavior over time implies awareness, since it increases the overall disease burden. Full article

Introduction: Overuse injuries are a growing concern among adolescent soccer players, with the repetitive nature of the sport placing significant physical demands on young athletes. These injuries can have long-term implications for physical development, performance, and overall well-being. This narrative synthesis aimed to evaluate the existing literature on the epidemiology, risk factors, and management strategies for overuse injuries in adolescent soccer players. Methods: A comprehensive literature search was conducted using PubMed and Embase. A total of 123 articles were identified, 27 of which met the inclusion criteria after screening. Studies focusing on overuse injuries in adolescent soccer players aged 10–18 years were included, while those addressing acute injuries, non-soccer populations, or adult athletes were excluded. Relevant quantitative and qualitative data were extracted and evaluated. Due to heterogeneity in study designs and outcomes, findings were narratively synthesized rather than meta-analyzed. Results: The period around peak height velocity (PHV: 11.5 years in girls, 13.5 years in boys) was consistently identified as a high-risk window, with seven studies demonstrating a significantly increased incidence of overuse injuries. Additional risk factors included leg length asymmetry, truncal weakness, early sport specialization, high ratios of organized-to-free play, and increased body size. Injury burden was greatest for hamstring and groin injuries, often leading to prolonged time lost from play. Preventive interventions such as plyometric training, trunk stabilization, and structured load monitoring demonstrated reductions in injury incidence in several prospective studies, though protocols varied widely. Conclusion: This narrative synthesis highlights PHV as the most consistent risk factor for overuse injuries in adolescent soccer players, alongside modifiable contributors such as training load, sport specialization, and free play balance. Evidence supports neuromuscular training and structured monitoring as promising preventive strategies, but there remains a lack of standardized, evidence-based protocols. Future research should focus on optimizing and validating interventions, integrating growth and load monitoring, and leveraging emerging approaches such as machine learning-based risk prediction. Full article

Background: Female infertility represents a significant global public health concern, yet its evolving trends and data-driven risk prediction remain under examined in nationally representative cohorts. This study investigates temporal changes in infertility prevalence and evaluates Machine Learning (ML) models for infertility risk prediction using harmonized clinical features from NHANES cycles (2015, 2016, 2017, 2018, 2021, 2022, and 2023). Methods: Women aged 19 to 45 with complete data on infertility-related variables (including reproductive history, menstrual irregularity, Pelvic Infection Disease (PID), hysterectomy, and bilateral oophorectomy) were analyzed. Descriptive statistics and cohort comparisons employed ANOVA and Chi-square tests, while multivariate Logistic Regression (LR) estimated Adjusted Odds Ratios (OR) and informed feature importance. Predictive models (LR, Random Forest, XGBoost, Naive Bayes, SVM, and a Stacking Classifier ensemble) were trained and tuned via GridSearchCV with five-fold cross-validation. Model performance was evaluated using accuracy, precision, recall, F1-score, specificity, and AUC-ROC. Results: We observed a notable increase in infertility prevalence from 14.8% in 2017–2018 to 27.8% in 2021–2023, suggesting potential post-pandemic impacts on reproductive health. In multivariate analysis, prior childbirth emerged as the strongest protective factor (Adjusted OR $\approx 0.00$), while menstrual irregularity showed a significant positive association with infertility (OR $=0.55$, 95% CI $0.40$ to $0.77$, $p<0.001$). Unexpectedly, PID, hysterectomy, and bilateral oophorectomy were not significantly associated with infertility after adjustment ($p>0.05$), which may partly reflect the inherent definition of self-reported infertility used in this study. All six ML models demonstrated excellent and comparable predictive ability (AUC $>0.96$), reinforcing the effectiveness of even a minimal common predictor set for infertility risk stratification. Conclusions: The rising prevalence of self-reported infertility among U.S. women underscores emerging public health challenges. Despite relying on a streamlined feature set, interpretable and ensemble ML models successfully predicted infertility risk, showcasing their potential applicability in broader surveillance and personalized care strategies. Future models should integrate additional sociodemographic and behavioral factors to enhance precision and support tailored interventions. Full article

In this paper, an intelligent simulation method for chloride ion diffusion behavior in marine concrete is established based on a physical information neural network. The dimensionless constraint equation is constructed to solve the influence of different physical parameter dimensions on the generalization ability of the model. The performance of the simulation method is verified by field measured data. The influence of different exposure ages and chloride ion diffusion coefficients on chloride ion diffusion behavior is quantified. The temporal and spatial distribution characteristics of chlorine ion (C) in concrete under a multi-dimensional diffusion state are analyzed, and the reliability model is further constructed to evaluate the degradation law of the service performance of marine concrete. The results show that the dimensionless physical information neural network model can effectively simulate the diffusion behavior and spatial–temporal distribution of C in marine concrete. The maximum error between the predicted value and the experimental value obtained by the method proposed in this paper is less than 15%. The dimension problem of high-order nonlinear equations can be solved by Non-PINN, with the maximum error value less than 5%. The spatial–temporal distributions of C on different exposed surfaces under a multi-dimensional diffusion state are independent of each other. The service performance of marine concrete will increase with an increase in slag content and protective layer thickness, and decrease with an increase in surface chloride ion concentration. Full article

Background and Objectives: The impact of sarcopenia and myosteatosis on renal transplantation (RT) outcomes has yet to be explained, certainly due to differences in assessment methods. The role of visceral adiposity is also not clearly defined. This retrospective study aimed to evaluate pretransplant body composition—including sarcopenia, myosteatosis, and visceral adiposity ratio (VSR)—using computed tomography (CT) and analyze their relationship with short- and long-term graft outcomes. Materials and Methods: A total of 94 patients who underwent RT between 2019 and 2023 and had pretransplant non-contrast abdominal CT scans were included. Skeletal muscle area (SMA) was assessed at the L3 vertebral level, including multiple muscle groups. Sarcopenia was defined by a low skeletal muscle index (SMI), while myosteatosis was defined by high intramuscular adipose tissue content (IMAC). Visceral adiposity was evaluated by the visceral-to-subcutaneous adipose tissue ratio (VSR). These parameters were compared with post-transplant outcomes. Results: The mean age was 42.69 ± 12.47 years, with 54.3% male patients. High IMAC was significantly associated with early graft failure (p = 0.026), delayed graft function (p = 0.005), death-censored graft failure (p = 0.036), and overall graft failure (p = 0.047). One-year mortality was also higher in the high IMAC group (14.8% vs. 0.0%, p = 0.012). SMI and VSR were not significantly associated with outcomes. Myosteatosis emerged as a significant risk factor in univariate analysis but was not independently predictive in multivariate analysis. Among the established risk factors identified in the study, recipient age was found to be a significant predictor for overall graft failure, donation type (cadaveric vs. living) for death-censored graft failure, and cold ischemia time for delayed graft function (OR: 1.068, 95% CI: 1.001–1.141, p = 0.049; OR: 147.7, 95% CI: 2.1—10,427.0, p = 0.021; OR: 1.003, 95% CI: 1.001–1.006, p = 0.023). Conclusions: Myosteatosis correlates with worse graft outcomes and higher mortality, but its independent prognostic value requires further investigation. Full article

The promise of sustainability of ecotourism relies on comprehending the psychological mechanism that converts experience into post-visit environmental concern. This research formulates and examines a model that connects three antecedents—Perceived Trip Quality (PTQ), Aesthetic/Spiritual Experience (ASE), and Environmental Concern (EC)—with Responsible Post-Visit Behavior (RPB) through two mediators: Tourist Satisfaction (SAT) and Personal Norms (PN). Structural equation modeling based on a quantitative, cross-sectional design examined survey responses from 585 Greek ecotourists. All three precursors meaningfully predicted RPB, directly and indirectly through SAT and PN, with partial mediation on all but the direct pathway. Mediation effects also named PN a stronger channel than SAT, particularly in converting affective and moral involvement into stable intentions. Multi-group tests for gender, age, education, environmental orientation, and previous ecotourism experience revealed significant differences; younger, inexperienced, and high-orientation tourists were more sensitive to normative and affective mechanisms. The research develops environmental and tourism psychology by combining value-based and experience-based routes to post-visit action. Practical recommendations are made to policymakers, educators, and operators to develop transformational, norm-activating experiences. Full article

Background/Objectives: Frailty is a multidimensional syndrome characterized by diminished physiological reserves, reduced mobility, and increased fall risk. While clinical assessments are commonly used to screen for frailty, they may not capture minor deficits in postural control. Center-of-pressure (CoP) metrics from force plates provide objective markers of postural control, yet their role in frailty screening remains underexplored. This study aimed to investigate the associations between functional performance measures and CoP-based metrics to identify predictors of frailty among older adults. Methods: Eighty-three adults aged ≥ 55 years with a history of falls were classified as frail or pre-frail based on modified Fried criteria. Functional assessments (Timed Up and Go (TUG), grip strength, Berg Balance Scale [BBS], Falls Efficacy Scale [FES]) and CoP metrics (mean velocity, sway path; eyes open/closed) were evaluated. Both unadjusted and age-adjusted logistic regression models were used to identify independent predictors of frailty. Results: Increased TUG time and number of falls were the strongest risk factors for frailty, while increased sway path and CoP velocity were protective. In particular, sway path under eyes-closed conditions showed the strongest protective association (OR = 0.323, p < 0.001). Additionally, fear of falling (OR = 1.078, p = 0.013) emerged as a significant psychological factor, consistently associated with increased frailty risk regardless of physical performance. Correlation analysis supported these findings, showing that better functional performance was linked to lower frailty risk. Conclusions: CoP sway path and mean velocity independently predict frailty status and offer added value beyond traditional clinical tools. These findings highlight the importance of incorporating instrumented balance assessments into frailty screening to capture nuanced postural control deficits and guide early intervention strategies. Full article

Objectives: To investigate the correlation between intraoperative conventional ultrasound, SWE, and SMI ultrasound manifestations of glioma and the expression of immunohistochemical markers. Methods: Patients with single superficial supratentorial glioma scheduled for brain tumor resection in our neurosurgery department from October 2020 to October 2022 were prospectively included. High-grade glioma (HGG) and low-grade glioma (LGG) were classified by pathological histological grading, and the differences in conventional ultrasound, SWE Young’s modulus, and SMI intratumoral and peritumoral blood flow architecture between HGG and LGG were analyzed, and the SWE diagnostic cut-off value was calculated by the Youdon index. Logistic regression models were used to analyze the independent predictive ultrasound signs associated with the diagnosis of HGG. HGG and LGG were classified by pathological histological grading. IDH1 expression was measured by immunohistochemical methods to analyze the correlation between IDH1 expression in glioma and clinical and ultrasound characteristics. Results: Forty-eight patients with glioma admitted to our hospital from October 2020 to October 2022 were included in this study, including 30 (62.5%) with HGG and 18 (37.5%) with LGG. For conventional ultrasound, HGG was often associated with severe peritumoral edema compared with LGG (p = 0.048). The sensitivity of HGG was 88.9%, the specificity was 86.7%, and the AUC was 0.855 (95% confidence interval: 0.741–0.968, p = 0.001) using Young’s mode 13.90 kPa as the threshold. Logistic analysis showed that SWE Young’s modulus values, and peritumoral and intratumoral SMI blood flow structures, were associated with the diagnosis of HGG. Among the 48 gliomas, 22 (45.8%) were IDH1-positive and 26 (54.2%) were IDH1-negative, with no statistical difference in age between the two groups and a statistical difference in histological grading (p < 0.05). There was a statistical difference between IDH1 mutant and wild type in terms of peritumoral edema and SMI intratumoral and peritumoral tissue vascular architecture. Logistic regression models showed that intratumoral and peritumoral tissue SMI vascular architecture was a valid predictor of IDH1 positivity, with a classification accuracy of 81.3%, sensitivity of 90.9%, and specificity of 73.1%. Further group analysis of mutant Young’s modulus values in LGG were higher than wild-type Young’s modulus values (p = 0.031). Conclusions: Peritumoral and intratumoral tissue SMI vascular architecture was a valid predictor of IDH1 positivity. Based on intraoperative ultrasound multimodality images, we can preoperatively determine the expression of molecular markers of lesions, which is of clinical significance for optimizing surgical strategies and predicting prognosis. Full article

Background/Objectives: A subset of children with monosymptomatic nocturnal enuresis (MNE) remains unresponsive to standard treatments such as desmopressin and alarm therapy. This study aimed to identify clinical predictors of response to biofeedback therapy in treatment-resistant MNE and to evaluate the role of bladder capacity as a stratification parameter. Methods: In this prospective study, 89 children with treatment-resistant MNE underwent six weekly sessions of biofeedback therapy involving visual pelvic floor feedback. Based on treatment outcomes, patients were classified as complete responders or partial/non-responders. Clinical characteristics including age-adjusted maximal voided volume (MVV), nocturnal polyuria, and wetting frequency were compared. Results: Patients with a complete response had significantly lower baseline MVV and age-adjusted MVV (p < 0.001). Nocturnal overactivity was more common among responders (60.6% vs. 33.9%, p = 0.017), whereas nocturnal polyuria was more frequent in non-responders (p = 0.027). Age-adjusted MVV emerged as the only independent predictor of treatment success in multivariate analysis (p = 0.045), with ROC analysis confirming its predictive value (AUC = 0.767, 95% CI: 0.667–0.866). Conclusions: These findings suggest that reduced bladder capacity and frequent night-time wetting may help identify patients who are more likely to benefit from biofeedback therapy. Bladder capacity assessment may thus serve as a useful tool in tailoring management strategies for refractory MNE. Full article

Background/Objectives: Nutritional status affects postoperative outcomes, but the effect of standardized preoperative nutritional preparation on morbidity in malnourished patients undergoing pancreatoduodenectomy (PD) remains unclear. This study evaluated preoperative nutritional parameters following the standardization of nutritional screening and intervention in patients undergoing PD. The influence of nutritional parameters on postoperative morbidity was also assessed. Methods: This prospective cohort study was conducted from 2019 to 2021 at the Department of Surgery, University Hospital, Olomouc. A total of 133 patients were categorized nutritionally as “high risk” (weight loss or reduced appetite with restricted intake) or “low risk” (no weight or appetite loss). High-risk patients received enteral supplementation of 600 kcal/day. A multivariate logistic regression model was used to evaluate the association between major postoperative complications and risk factors, including sex, age, ASA score, BMI, weight and appetite loss, malignancy, duct diameter, pancreatic texture, serum albumin, prealbumin, MUST, and NRS2002 scores. Results: Eighty patients (60.2%) were “high risk,” and 53 (39.8%) were “low risk.” Major morbidity and 90-day mortality occurred in 24 (18.0%) and 4 (3.0%) patients, respectively. No significant differences were observed between high- and low-risk groups in CD morbidity grade, 90-day mortality, POPF, PPH, DGE, or hospital stay. Major morbidity was associated with prealbumin < 0.2 g/L, duct diameter ≤ 3 mm, soft texture, and male sex, with respective odds ratios of 3.307, 3.288, 4.814, and 2.374. Conclusions: High-risk patients receiving preoperative nutrition had comparable rates of major complications and POPF as low-risk patients. Low serum prealbumin predicts major postoperative complications after PD. Full article

This study provides an in-depth structural analysis of UNESCO World Heritage Apulian trulli, considering the three-layer dry-stone structure of their characteristic conical roofs. An integrated approach involving laser scanning, ground-penetrating radar, endoscopic investigation, and laboratory materials testing is used to identify and characterize the multi-wythe masonry system. A detailed finite element model is created in ANSYS to analyze seismic performance on Italian building codes. The model is validated through ambient vibration testing using accelerometric measurements. The diagnostic survey identified a three-layer system including exterior stone wythe, interior wythe, and rubble core, with compressive strength of stone averaging 2.5 MPa and mortar strength of 0.8 MPa. The seismic assessment will allow the examination of displacement patterns and stress distribution under design load conditions (ag = 0.15 g). The structural analysis demonstrates adequate performance under design loading conditions, with maximum stress levels remaining within acceptable limits for historic masonry construction. The experimental validation confirmed the finite element model predictions, with good correlation between numerical and experimental frequencies. The improvement of the overall seismic performance with the multi-wythe configuration and the role of wall thickness and geometric proportions will be taken into account. The methodology aims to provide technical evidence supporting the continued use of vernacular buildings while contributing to scientifically informed conservation practices throughout the region. Full article