Search Results (6,753)

Background/Objectives: Streptococcus pyogenes (Group A Streptococcus, GAS) is a major human pathogen that causes a wide spectrum of diseases. While mild infections like pharyngitis and impetigo are common, severe and invasive infections, though less frequent, pose significant health risks, particularly in children. In recent years, the re-emergence of hypervirulent GAS strains has heightened global concern. Nowadays, the absence of universally accepted guidelines compels clinicians to rely on a combination of clinical judgment, microbiological data and available evidence to manage these infections effectively. Our aim was to assess the current management of invasive GAS (iGAS) infections in Italy and the variability in therapeutic and preventive approaches. Methods: A web-based current clinical practice survey about invasive and severe GAS infections was designed according to the Checklist for Reporting of Survey Studies (CROSS) methodology and circulated among the members of the Italian Society of Pediatric Infectious Diseases (SITIP). Results: The survey reveals that while many practices are commonly shared among clinicians, particularly regarding first-line therapies (penicillin or ceftriaxone depending on the infection site), significant uncertainties remain, particularly about the use of combined antibiotic regimens and supportive treatments. The use of combined antibiotic regimens was considered appropriate as first-line therapy for STSS, NF and brain abscesses. Clindamycin was the preferred agent for combination with beta-lactam for most infections, except for brain abscesses, where linezolid was favored. However, there was disagreement regarding the optimal timing for de-escalation to beta-lactam monotherapy. Responses varied widely concerning the indications and dosages for IVIG, as well as the use of corticosteroids. Conclusions: Addressing the burden of invasive GAS (iGAS) infections in children requires enhanced surveillance, early recognition, prompt treatment and preventive strategies. Further work to increase surveillance, e.g., developing national registries, and to standardize the management of the disease, e.g., developing country-specific guidelines, is essential to build solid evidence on the most effective approaches. Full article

Background: Inflammatory Bowel Disease (IBD), comprising Crohn’s disease and ulcerative colitis, requires accurate assessment over time. Imaging techniques play a crucial role in diagnosis, monitoring disease activity, and guiding therapeutic response. This review summarizes the current evidence on radiologic imaging techniques in IBD, focusing on intestinal ultrasound (IUS), computed tomography enterography (CTE), magnetic resonance enterography (MRE), and other emerging technologies. Methods: A literature review was conducted using PubMed, EMBASE, Scopus, and the Cochrane Library, encompassing publications up to 31 October 2024. Results: IUS offers a non-invasive tool for assessing bowel wall thickness, vascularity, and complications. CTE and MRE provide detailed visualization of luminal and extraluminal disease, with MRE preferred for routine monitoring due to the absence of ionizing radiation. Standardized indices and scoring systems aid in objective disease activity assessment. Emerging technologies like Positron Emission Tomography (PET)/MRI and radiomics show promise in combining metabolic and morphological information for complex cases. Conclusions: Imaging has a central role in IBD management, with IUS, CTE, and MRE demonstrating high diagnostic accuracy. Radiomics and Artificial Intelligence (AI) are paving the way for precision imaging. Integrating advanced imaging techniques, scoring systems, and AI-driven analytics represents a transformative step toward more effective and individualized care for patients with IBD. Full article

Objectives: To evaluate the potential associations of the type of complete hydatidiform mole (CHM) initial treatment (hysterectomy or uterine evacuation) with GTN development, need for chemotherapy, and treatment outcome in women aged ≥ 40 years. Methods: This multicentric retrospective cohort study included women ≥ 40 years with CHM, initially treated between 1990 and 2018, at four different centers. Data collected included patient demographics and clinical characteristics. The outcome variables were post-CHM GTN development, need for chemotherapy for hCG normalization, surgical complications, and time to remission. Univariate and multivariate analyses were performed using chi-square, Mann–Whitney, Fisher’s exact tests, and Poisson regression. Results: 275 women with CHM aged ≥ 40 years were included in the analysis. Median patient age was significantly higher among hysterectomy patients (47 × 44 years, p = 0.01). Multivariate analysis showed that compared with uterine evacuation (244/275, 89%), hysterectomy (31/275, 11%) was associated with a 5.8-fold lower risk of GTN [RR = 0.17 95% CI = (0.04–0.71); p = 0.015] and an 11.3-fold lower risk of requiring chemotherapy [RR: 0.08 (0.01–0.64), p = 0.016]. Median time to hCG normalization did not statistically differ between treatments. No significant differences were observed between hysterectomy and uterine evacuation in terms of FIGO staging (p = 0.221) or prognostic risk score (p = 0.576). Resistance to first-line chemotherapy (17/72; 23.6%) and relapse (3/72; 4.1%) were observed only in patients undergoing initial uterine evacuation. Hysterectomy complications occurred in 45.1% (14) of the patients. Conclusions: CHM initial treatment with hysterectomy was associated with a lower risk for GTN occurrence and need for chemotherapy in women aged 40 years or older. However, shared decision-making about surgery should be tailored to each patient and their risk factors and preferences. Further, larger controlled studies are required to support our findings. Full article

Background/Objectives: Meniscectomy is commonly performed to treat meniscal injury. Recovery of patients and restoration of functional capacity may be influenced by several factors, among which postoperative rehabilitation could play a significant role. The objective was to compare clinical and functional status in patients undergoing meniscectomy according to receipt of postoperative rehabilitation. Methods: An ambispective cohort study was conducted in 89 patients who underwent meniscectomy. The primary outcome was functional capacity, assessed using the Timed Up and Go (TUG) test. The primary exposure was receipt of postoperative rehabilitation. Secondary outcomes included knee range of motion (goniometry), pain intensity (visual analogue scale, VAS), and kinesiophobia (Tampa Scale of Kinesiophobia). Results: Functional capacity differed significantly between patients who received postoperative rehabilitation and those who did not (U = 490; p = 0.03), with lower (better) TUG times in the rehabilitation group. A significant difference was also observed between patients who did and did not engage in preoperative regular physical exercise (U = 680.0; p = 0.01), with better postoperative functional performance in those who had not exercised preoperatively. A sex difference was identified, with females demonstrating superior functional performances compared with males (U = 1187.0; p = 0.01). Older age was positively associated with functional impairment (β = 0.02; p = 0.02). Conclusions: Postoperative rehabilitation was associated with superior objective functional performance after meniscectomy, alongside improvements in pain, range of motion, and kinesiophobia. Female sex and younger age predicted better function; preoperative inactivity was associated with superior postoperative performance, while postoperative exercise showed no clear association. Findings should be interpreted cautiously in view of potential residual confounding and the small non-rehabilitation subgroup, and warrant validation in larger, preferably randomised, cohorts. Full article

In the context of the global transition toward carbon neutrality and the circular economy, remanufacturing has emerged as a vital strategy for enhancing resource efficiency and reducing environmental impact. However, the remanufacturing sector faces significant uncertainties—including fluctuations in market demand, variability in the quality of returned products, and dynamic policy changes. These factors collectively challenge production decision-making and system sustainability. Following the preferred peporting items for systematic reviews and meta-analyses (PRISMA) guidelines, this study conducted a systematic review and bibliometric analysis of 98 core articles published between 2015 and 2024, with a focused examination of three interdisciplinary themes: (1) decision-making and optimization under uncertainty, (2) supply chain coordination and policy mechanisms, and (3) digital transformation and the application of emerging technologies. A novel micro–meso–macro analytical framework is proposed to integrate fragmented findings. The results highlight a paradigm shift from static models to dynamic, real-time decision-making systems, facilitated by digital twins (DTs), blockchain, and intelligent algorithms. Furthermore, the study identifies the synergistic effects of carbon-financial instruments and policy incentives in aligning economic and environmental objectives. This research develops a systematic framework to understand and address uncertainties in remanufacturing, offering policymakers and industry practitioners actionable insights to enhance the resilience, sustainability, and global applicability of remanufacturing systems. Full article

Losing a loved one is a painful process that usually diminishes over time. Despite that, one out of ten bereaved adults are at risk of developing Prolonged Grief Disorder (PGD) Internet-delivered cognitive-behavioral therapies (iCBTs) can reach individuals in need of therapy and are both cost-effective and clinically effective. This study aimed to investigate the feasibility of an iCBT for Spanish-speaking individuals with PGD (GROw) compared to the same intervention delivered in a face-to-face videoconferencing format. As a secondary objective, the potential efficacy of GROw was explored. A total of 31 participants were randomized to the experimental group (N = 16) (GROw) and the active control group (N = 15) (videoconferencing treatment). There were four assessment points: baseline, after intervention, and 3- and 12-month follow-ups. Both GROw and videoconferencing treatments were well accepted in terms of preferences, expectations, satisfaction and evaluation about the usefulness of the intervention, and showed significant symptomatology reduction with large effect sizes in most of the outcomes. The dropout rate was 50% in the GROw and 33.33% in the videoconferencing group. GROw is a feasible, well-accepted iCBT for the treatment of PGD with promising results related to its potential efficacy. Full article

With the increasing consumption of mulberry fruits in commercial markets, flavor profiles have emerged as critical determinants of consumer preference and market acceptance. This investigation utilized four Morus laevigata (Morus L.) accessions exhibiting pronounced variations in fruit pigmentation and flavor characteristics as experimental materials. Comprehensive two-dimensional gas chromatography coupled with time-of-flight mass spectrometry (GC × GC-TOF MS) was employed to identify key volatile aromatic compounds, while integrated untargeted metabolomics and transcriptomics approaches were applied to elucidate the underlying mechanisms of flavor biosynthesis. Analysis revealed that aldehydes, ketones, lactones, and heterocyclic compounds constitute the primary volatile organic compounds responsible for M. laevigata flavor complexity. The biosynthesis of these volatile aromatic compounds exhibits a direct correlation with lipid metabolite oxidation pathways. Concurrently, oxidative processes are modulated by M. laevigata flavonoid metabolites with antioxidant properties, which subsequently regulate both the compositional profile and quantitative distribution of volatile aromatic compounds. These findings offer novel insights into the metabolite–volatile compound interactions within mulberry systems, establishing a foundational framework for advancing fruit flavor research and cultivar development programs. Full article

Objectives: Ketamine has demonstrated rapid and sustained antidepressant effects; however, its clinical utility is limited by the risk of addiction and systemic side effects. This study aimed to develop ketamine-loaded nanodroplets (Ket-NDs) with high encapsulation efficiency (EE) and stability for targeted low-dose intravenous (IV) administration in a mice model of depression. Low-intensity focused ultrasound (LIFU) was employed to induce transcranial, region-specific drug release in the lateral habenula (LHb). Methods: Ket-NDs were synthesized using a thin-film hydration method with sonication and emulsification, incorporating perfluoropentane as the core material. Characterization was performed using light microscopy, cryogenic scanning electron microscopy (cryo-SEM), transmission electron microscopy, and dynamic light scattering (DLS). Drug EE and loading efficiency (LE) were quantified by reversed-phase high-performance liquid chromatography. A chronic restraint stress model was established, and Ket-NDs were administered intravenously followed by LIFU targeting the LHb. Antidepressant efficacy and biosafety were systematically evaluated. Results: (1) Ket-NDs exhibited uniform spherical morphology and a narrow size distribution, as confirmed by DLS (particle size: 139.75 ± 9.43 nm; Polydispersity index: 0.225 ± 0.025) and cryo-SEM analysis (number-average diameter: 109.5 ± 10.4 nm). The zeta potential was −15.93 ± 5.906 mV, and the formulation remained stable under 4 °C storage. (2) Ket-NDs demonstrated high EE (78.25 ± 16.13%) and LE (15.55 ± 4.49%). (3) In depressive mice, IV administration of Ket-NDs followed by LIFU targeting the LHb significantly improved behavioral outcomes: increased locomotor activity in the open field test, elevated sucrose preference index, and reduced immobility time in the tail suspension test. (4) Safety assessments revealed no significant organ toxicity or brain tissue damage in ultrasound-exposed regions. Conclusions: In summary, this study developed stable Ket-NDs. When combined with LIFU, they enable precise regional drug delivery to the brain, showcasing a promising treatment strategy for depression with reduced systemic side effects. Full article

This study introduces a machine learning–driven extended reality (XR) interaction framework that leverages electroencephalography (EEG) for decoding consumer intentions in immersive decision-making tasks, demonstrated through functional food purchasing within a simulated autonomous vehicle setting. Recognizing inherent limitations in traditional “Preference vs. Non-Preference” EEG paradigms for immersive product evaluation, we propose a novel and robust “Rest vs. Intention” classification approach that significantly enhances cognitive signal contrast and improves interpretability. Eight healthy adults participated in immersive XR product evaluations within a simulated autonomous driving environment using the Microsoft HoloLens 2 headset (Microsoft Corp., Redmond, WA, USA). Participants assessed 3D-rendered multivitamin supplements systematically varied in intrinsic (ingredient, origin) and extrinsic (color, formulation) attributes. Event-related potentials (ERPs) were extracted from 64-channel EEG recordings, specifically targeting five neurocognitive components: N1 (perceptual attention), P2 (stimulus salience), N2 (conflict monitoring), P3 (decision evaluation), and LPP (motivational relevance). Four ensemble classifiers (Extra Trees, LightGBM, Random Forest, XGBoost) were trained to discriminate cognitive states under both paradigms. The ‘Rest vs. Intention’ approach achieved high cross-validated classification accuracy (up to 97.3% in this sample), and area under the curve (AUC > 0.97) SHAP-based interpretability identified dominant contributions from the N1, P2, and N2 components, aligning with neurophysiological processes of attentional allocation and cognitive control. These findings provide preliminary evidence of the viability of ERP-based intention decoding within a simulated autonomous-vehicle setting. Our framework serves as an exploratory proof-of-concept foundation for future development of real-time, BCI-enabled in-transit commerce systems, while underscoring the need for larger-scale validation in authentic AV environments and raising important considerations for ethics and privacy in neuromarketing applications. Full article

Background/Objectives: Microglia are the primary immune cells in the central nervous system (CNS) and are known as “resident” macrophages. The aim of this study was to determine the effect of acute ethanol (EtOH) on the microglia state and monocyte infiltration into the CNS, with particular attention to the role of peripheral and central dopamine (DA) D2 receptors (D2Rs) in mediating EtOH effects on peripheral and central substrates. We hypothesize that EtOH interacts with peripheral immune mediators via D2Rs including monocyte-derived macrophages (MDMs) to modulate midbrain neurons, DA transmission in the mesolimbic pathway from the ventral tegmental area (VTA) to nucleus accumbens (NAc), and the intoxicating effects of acute EtOH. Methods: Using the Macrophage FAS-Induced Apoptosis (MaFIA) mouse model (GFP+ on Csf1r promoter), we assessed the effects of three intraperitoneal (IP) doses of EtOH (1, 2, and 4 g/kg) at three time points (0.5, 1, and 2 h after injection) on D2R expression in blood leukocytes and microglia, as well as midbrain neuronal activity, DA release, and behavior. Results: Acute EtOH significantly enhanced lymphocyte and monocyte D2R expression at 1.0 g/kg by 2 h after injection in vivo but decreased D2R expression in vitro. Ethanol enhanced microglia D2R expression in the NAc, while not altering D2R expression in the VTA, but altered the microglia state in these areas, shifting them toward an inflammatory phenotype. Acute EtOH induced prolonged and progressive hypersensitivity of D2R activation of VTA GABA neurons. Intravenous injection of the macrophage depleter liposomal clodronate significantly reduced blood macrophages by 55.3% and blocked the typical inhibition of VTA GABA neurons by EtOH, as well as the enhancement of DA levels in the NAc, and the locomotor indices of intoxication produced by acute EtOH, but not choice place preference. Conclusions: These findings strongly suggest a neuroimmune peripheral connection for acute low-dose EtOH use and challenge the dogma that central actions of EtOH exclusively mediate its effect on DA neuronal activity and release. Full article

Providing age-friendly metro service substantially enhances the elderly’s mobility and well-being. Despite recent progress in user profiling and mobility prediction, the prediction of the elderly’s metro travel patterns remains limited. To fill this gap, this study proposes a framework integrating user profiling and knowledge graph embedding to predict the elderly’s activity types at metro trip destinations, utilizing 180,143 smart card records and 885,072 points of interest (POI) records from Chongqing, China in 2019. First, an elderly metro travel profile (EMTP) tag system is developed to capture the elderly’s spatiotemporal metro travel behaviors and preferences. Subsequently, an elderly metro travel knowledge graph (EMTKG) is constructed to support semantic reasoning, transforming the activity types prediction problem into a knowledge graph completion problem. To solve the completion problem, the Temporal and Non-Temporal ComplEx (TNTComplEx) model is introduced to embed entities and relations into a complex vector space and distinguish between time-sensitive and time-insensitive behavioral patterns. Fact plausibility within the graph is evaluated by a scoring function. Numerical experiments validate that the proposed model outperforms the best-performing baselines by 13.37% higher Accuracy@1 and 52.40% faster training time per epoch, and ablation studies further confirm component effectiveness. This study provides an enlightening and scalable approach for enhancing age-friendly metro system service. Full article

Adequate peri-implant hard and soft tissue volume is critical for ensuring implant stability, long-term functionality, and optimal esthetic results. While autogenous connective tissue grafts (CTGs) remain the gold standard for soft tissue augmentation, volume-stable collagen matrices (VCMXs) have emerged as a promising alternative, offering key advantages such as eliminating donor-site morbidity, reducing postoperative pain, and improving patient acceptance. This review summarizes the evidence on VCMXs from studies published between 1995 and 2024, with a focus on mucosal thickness gain, soft tissue stability, and patient-reported outcomes. To date, the evidence on VCMXs is still conflicting. Randomized controlled trials indicate that VCMXs can effectively increase peri-implant mucosal thickness (ranging from 0.3 to 1.0 mm), although the included clinical studies are very heterogeneous in terms of follow-up time. According to the literature, CTGs demonstrate superior long-term volumetric stability, particularly in highly esthetic zones. On the other hand, VCMXs demonstrated comparable mid-term outcomes while offering reduced postoperative discomfort, as confirmed by multicenter noninferiority trials. While VCMXs may yield slightly inferior clinical outcomes compared to CTGs, their patient-centered benefits make them a viable and often preferable option for soft tissue augmentation in implant dentistry. In conclusion, current evidence supports the use of VCMXs as valuable tools in contemporary implant therapy, particularly for specific indications where their benefits outweigh limitations. Full article

For the correct evaluation of climate trends and climate variability, it is important to remove non-climatic biases from the observed data. Such biases, referred to as inhomogeneities, occur for station relocations or changes in the instrumentation or instrument installation, among other reasons. Most inhomogeneities are related to a sudden change (break) in the technical conditions of the climate observations. In long time series (>30 years), usually multiple breaks occur, and their joint impact on the long-term trends and variability is more important than their individual evaluation. Benova is the optimal method for the joint calculation of correction terms for removing inhomogeneity biases. Cenova is a modified, imperfect version of Benova, which, however, can also be used in discontinuous time series. In the homogenization of section means, the use of Benova should be preferred, while in homogenizing probability distribution, only Cenova can be applied. This study presents the Benova and Cenova methods, discusses their main properties and compares their efficiencies using the benchmark dataset of the Spanish MULTITEST project (2015–2017), which is the largest existing dataset of this kind so far. The root mean square error (RMSE) of the annual means and the mean absolute trend bias were calculated for the Benova and Cenova results. When the signal-to-noise ratio (SNR) is high, the errors in the Cenova results are higher, from 14% to 24%, while when the SNR is low, or concerted inhomogeneities in several time series occur, the advantage of Benova over Cenova might disappear. Full article

The objective of this research was to apply static and dynamic sensometric techniques to determine the impact of processing factors (dehydration time, frying exposure time) and storage duration on the sensory and cognitive characteristics, as well as consumer preference, of chayote chips. A total of 18 types of chips were prepared (using a combination of three frying temperatures [140, 150, 160 °C], two exposure times [5 and 10 s], and three periods of storage [0, 30, and 60 days]). A panel of 100 consumers was formed to evaluate sensory and cognitive attributes (emotions and memories) as well as overall liking, using static techniques such as Rate-All-That-Apply (RATA), Check-All-That-Apply (CATA), and a hedonic scale. Finally, the temporal dominance of sensations (TDS) dynamic technique was used to study the behavior of chips with higher levels of preference. The results of the sensory techniques indicated that the storage day factor influenced the sensory results. The samples prepared on the same day were perceived with high intensities of typical attributes of this type of food (bitter-BT, Fried-A, Sweet-A, Potato-A, Toasted-A, Chayote-A, Potato-F, Crunchy, Chayote-F, and Sweet-BT) while evoking positive emotions and memories in consumers (active, enthusiastic, free, good, good nature, happy, interested, satisfied, traditional food, family, summer, party, and mild weather). In terms of preference, consumers selected the chip samples with 0 days of storage. The TDS curves determined that the dominant attributes of the chayote chips with 0 days of storage were chayote flavor, sweet, and fried (with a dominance t = 5–20 s). Regarding the cognitive aspect, these chayote chips evoke positive dominant emotions (good, satisfied, and happy from t = 8–20 s) as well as dominant positive memories of childhood (t = 9–20 s), traditional food (t = 11–20 s), and friendship (t = 11–20 s). Full article

This study investigates how Mexican Spanish/U.S. English heritage bilinguals process scope ambiguities in sentences containing the existential quantifiers a/una and the universal quantifiers every/cada in English and Spanish. Sentences like ‘A person bought every book’ are syntactically ambiguous in both languages, allowing for multiple possible interpretations. Research suggests that one interpretation is often preferred due to lower cognitive demand, though degree of preference varies across languages. Notably, heritage bilinguals may have distinct interpretation preferences in each language, highlighting the complexity of bilingual processing. Sixty Spanish/English heritage bilinguals (Age M = 25.48, SD = 2.65) completed a timed and graded truth-value judgment task in both languages, along with language proficiency tests. We analyzed interpretation ratings, response times, and potential effects of proficiency. Results reveal nearly identical preferred interpretation ratings (Spanish: M = 4.19, SD = 0.56; English: M = 4.14, SD = 0.66) and response times (Spanish: M = 6.97 s, SD = 2.70; English: M = 6.67 s, SD = 1.80) across languages, with one interpretation consistently favored and associated with faster response times. Language proficiency had no significant impact. Our experimental findings offer new insights into heritage bilinguals’ processing of competing linguistic structures and inform models of bilingual syntax and cognitive flexibility. Full article