Frozen shoulder, also known as adhesive capsulitis, is a common and disabling condition that causes shoulder pain and progressive stiffness. Patient information leaflets (PILs) are produced by UK National Health Service (NHS) Trusts to help patients understand frozen shoulder and treatment options. However, the content and consistency of these PILs and their alignment with national clinical guidance are currently unclear. This study aimed to identify, analyse and describe the non-surgical management recommendations presented in publicly available NHS Trust PILs for frozen shoulder and to assess their alignment with the National Institute for Health and Care Excellence (NICE) Clinical Knowledge Summary and British Elbow and Shoulder Society (BESS) best practice resources. An online search was undertaken by one reviewer to identify publicly available PILs produced by NHS Trusts detailing non-surgical management of frozen shoulder. Relevant data were extracted and analysed by one reviewer and verified by five reviewers. Descriptive statistics were used to summarise findings. Thirty-eight PILs were identified from 38 NHS Trusts with publication dates ranging from April 2013 to March 2025. Considerable variation was observed in the content, including reference to analgesia, activity modification, exercise prescription and corticosteroid injections. No single PIL reflected all key elements recommended in the NICE Clinical Knowledge Summary and BESS best practice. The findings demonstrate substantial variation in content, frequent misalignment with current national guidance and best practice exercise recommendations. Such variation may limit and may reduce the clarity, consistency and usefulness of information provided to patients.
This paper proposes a hybrid reinforcement learning-assisted distributionally robust optimization (RL-DRO) framework for robust and economically efficient energy management in interconnected multi-microgrid systems under renewable, demand, and price uncertainty. The framework integrates deep reinforcement learning to generate adaptive scheduling policies with a Wasserstein-metric distributionally robust optimization formulation that enhances robustness against probability distribution shifts and non-stationary uncertainty. The upper level maximizes cumulative rewards of reinforcement learning agents representing individual microgrids, while the lower level optimizes power dispatch and energy exchange decisions subject to operational and network constraints. A five-microgrid test system equipped with photovoltaic generation, battery storage, and flexible loads is evaluated using 300 stochastic scenarios derived from historical data. Simulation results demonstrate that the proposed RL-DRO framework achieves a superior trade-off between cost efficiency and operational robustness when compared with deterministic, stochastic, and standalone reinforcement learning benchmarks. Specifically, the framework reduces expected operational cost by 14.8%, improves operational feasibility and service continuity as reflected by a proxy-based resilience indicator from 84.5% to 96.1%, and decreases the loss-of-load probability from 4.8% to 2.1%. Furthermore, the proposed approach maintains near-optimal performance as the Wasserstein ambiguity radius increases to 0.25, highlighting its robustness to distributional shifts and adverse uncertainty realizations. Rather than modeling explicit physical disturbances or fault-driven contingencies, the proposed framework focuses on sustaining feasible, adaptive, and cost-effective operation under severe uncertainty and stressed operating conditions. The hybrid learning-optimization paradigm thus unifies data-driven adaptability with theoretical robustness, providing a scalable and uncertainty-aware pathway for autonomous operation of future distribution networks.
The prognosis of heart failure is highly dependent on patient self-management, and short-video platforms have become a key channel for the public to access information about heart failure (HF). This cross-sectional study systematically evaluated HF-related short videos on TikTok and Bilibili platforms. After screening from January 10 to 11, 2026, 190 videos were included (103 from Bilibili and 87 from TikTok). Two cardiologists conducted quality assessments using the Global Quality Score, modified DISCERN scale, and Patient Education Assessment Tool for Audiovisual Materials (PEMAT-A/V). Results showed higher engagement for TikTok videos and longer duration for Bilibili videos (both P < 0.05). Content primarily focused on symptoms (71.1%) and treatment (66.3%), with insufficient coverage of prevention (36.3%). Overall quality was moderately low: median scores were 3 on both the Global Quality Score and modified DISCERN scale; PEMAT understandability score was 69%, and actionability score was 50%. Bilibili videos scored higher on actionability (P = 0.029), and videos uploaded by professional institutions demonstrated the best quality (P = 0.045). Longer video duration and inclusion of symptom-related content were independent predictors of higher GQS scores. Notably, video interactivity showed no positive correlation with content quality, revealing an obvious quality-dissemination decoupling phenomenon. This finding carries important clinical implications, as high-quality professional medical content fails to gain corresponding public dissemination, which hinders standardized popular science and long-term self-management among HF patients. The overall quality of heart failure short videos urgently requires improvement, necessitating enhanced professional content supply and rigorous quality control via multiparty collaborative mechanisms. Additionally, short-video health education should be integrated into routine clinical management and telemedicine systems to optimize patient self-management.
To address the dilemma of homogeneous talent training and the efficiency bottleneck of human resource management in universities, this study proposes an innovative personalized training framework integrating artificial intelligence, big data, and deep learning. Based on the 18-dimensional full-cycle behavior dataset of 5,000 students and OULAD dataset, a multimodal heterogeneous data fusion pipeline is constructed. This study adopts Generative Adversarial Network (GAN) for data imputation and bias optimization, designs Hierarchical Attention Graph Neural Network (HA-GNN) to capture hierarchical correlations among features, and uses Long Short-Term Memory (LSTM) to model temporal behavior patterns. The experimental results demonstrate that, under 10 independent repeated runs with random seed variation, the Hierarchical Attention Graph Neural Network-Long Short-Term Memory (HA-GNN-LSTM) model achieves lower prediction error on the academic performance prediction task, with a Mean Absolute Error (MAE) of 4.2 ± 0.3. Compared with the Temporal Fusion Transformer (TFT) baseline model, MAE is reduced by 31.1%. Welch's two-tailed t-tests based on independent run results remain statistically significant after Holm-Bonferroni multiple comparison correction [Formula: see text]. The Normalized Discontinued Cumulative Gain at Top 5 (NDCG @ 5) index of personalized recommendation system reaches 0.90, which verifies the effectiveness of spatio-temporal feature modeling. At the management application level, the improvements in advisor allocation response time and resource idle rate are derived from simulation experiments based on historical data replay, rather than online deployment in real campus management systems. The simulation results demonstrate that, under established constraints and historical sample distributions, advisor allocation response time could be reduced by 60% and resource idle rate could be decreased by 63.4%. These findings indicate the framework's potential for optimizing educational resource allocation. However, its managerial benefits require further validation through subsequent real-world deployment and long-term follow-up studies.
Controlling agricultural ammonia (NH3) and nitrous oxide (N2O) emissions is vital for air quality and climate goals, yet policy synergies and trade-offs in mitigating these reactive nitrogen (Nr) remain unclear. Here, through an integrated framework combining high-resolution emission inventories with policy-specific scenario analysis, we evaluate China's national agricultural policies for abating Nr emissions (2000-2022) and estimate synergies between NH3 and N2O abatements. China's NH3 and N2O emissions peaked around 2015 and subsequently declined by 16% and 30% by 2022, respectively. Post-2015 synergistic achievements were driven mainly by fertilizer-reduction policies (~90% of abatements) with a sixfold increase in their synergetic level. Manure-management and straw-utilization policies showed limited overall effectiveness and trade-offs, though post-2015 synergies emerged in non-pastoral regions, highlighting spatial and sectoral heterogeneity. Optimized full-chain livestock management could reverse the overall trade-offs in this sector in the short term, achieving synergetic levels comparable to the fertilizer-reduction policies.
Chronic obstructive pulmonary disease (COPD) represents a major global health burden, largely attributable to tobacco exposure, including emerging patterns such as early initiation and dual use with electronic cigarettes. Early detection through spirometry in primary care remains suboptimal, potentially limiting timely identification of early disease stages, including Pre-COPD and Preserved Ratio Impaired Spirometry (PRISm). This study aimed to assess whether the implementation of a structured, spirometry-based COPD clinic within primary care networks (Aggregazioni Funzionali Territoriali, AFTs) may be associated with improved diagnostic appropriateness, more consistent therapeutic management, and more efficient use of healthcare resources. We conducted a retrospective observational analysis of routinely collected clinical data from approximately 30,000 patients across three AFTs in the Campania Region (Italy), each including about 10,000 individuals. One AFT was equipped with a dedicated respiratory clinic providing in-house spirometry performed by trained personnel, while the other two followed standard care pathways without structured respiratory services. Key variables included spirometry utilization, diagnostic confirmation of COPD, patterns of care, and selected indicators of healthcare use. In the two standard AFTs, COPD diagnoses were not supported by spirometric confirmation in approximately 65% and 70% of cases, respectively. In contrast, the AFT with a dedicated clinic showed a substantially higher use of spirometry (approximately 80% vs. 30-35%), predominantly performed within the primary care setting. This organizational model was associated with improved alignment between diagnosis and objective testing, and with indicators suggestive of better therapeutic adherence and more appropriate use of secondary care services. The integration of structured, spirometry-enabled respiratory services within primary care networks may contribute to more appropriate COPD diagnosis and management. While the availability of spirometry alone is insufficient, organizational models that incorporate trained personnel, standardized procedures, and coordinated care pathways could represent a potentially effective approach to addressing under- and misdiagnosis in COPD.
Urolithiasis is increasingly common, with rising rates driven by obesity, diabetes and metabolic syndrome. Patients with cancer have additional, unique risks of stone formation owing to effects on fluid and electrolyte balance, systemic cancer therapies, tumour lysis syndrome and anatomical alterations after urinary diversion or nephrectomy. Moreover, urolithiasis itself has been linked to increased rates of renal cell carcinoma, urothelial carcinoma and bladder cancer, potentially mediated by chronic inflammation, recurrent infections and shared metabolic or environmental factors. Management in this setting is complex and must be individualized. Percutaneous nephrolithotomy achieves the highest stone-free rates in patients with altered urinary tract anatomy, whereas retrograde intrarenal surgery and shock wave lithotripsy have more selective roles. Preventive strategies focus on thorough metabolic evaluation, hydration optimization and addressing cancer-specific risk factors such as hypercalcaemia, acidosis and chronic urinary stasis. Despite these insights, data on the epidemiology, mechanistic underpinnings and optimal management of urolithiasis in patients with cancer remain limited. Prospective studies are needed to clarify causal relationships, refine preventive strategies and develop evidence-based treatment algorithms for this growing and complex population.
Persistent pain after total hip arthroplasty (THA) is a common complication requiring extensive diagnostic effort and is often associated with potentially invasive and morbid treatment options. With THA volume expected to steadily increase there is a similarly growing need for creative and effective diagnostic and therapeutic options for these clinically challenging patients. Hip arthroscopy has emerged as a promising tool in the setting of persistent pain after THA with expanding indications and promising outcomes. The purpose of this article was to provide a review of the current state of literature regarding arthroscopic and endoscopic solutions for common causes of persistent pain after THA with a focus on patient selection, indications, surgical considerations, outcomes, and complications. The most common indication for hip arthroscopy after THA is iliopsoas tendinopathy, showing excellent outcomes with symptom resolution in greater than 90% of patients after arthroscopic iliopsoas release or lengthening. The second most common indication is diagnostic arthroscopy in the setting of otherwise negative extensive work-up, which has shown diagnostic value for occult implant loosening, capsular fibrosis, and metal hypersensitivity. Endoscopic decompression for the treatment of ischiofemoral impingement and sciatic nerve decompression has also shown consistent improvements in pain and function. In addition to these well described indications, future utilization of hip arthroscopy for loose body removal, capsular plication for instability, and management of prosthetic joint infection are potentially emerging indications. Hip arthroscopy after THA is a safe and effective tool for the management of common causes of persistent pain after THA with robust support for iliopsoas pathology and emerging evidence and outcomes for less common indications. Future research will both expand and narrow these indications as diagnostic criteria, patient selection, and surgical techniques are refined.
Malaria remains a major public health challenge in Ethiopia, with Plasmodium falciparum and Plasmodium vivax accounting for most malaria cases. Continuous monitoring of antimalarial drug efficacy and safety is essential to ensure effective case management and to detect early signs of emerging drug resistance. In addition, understanding gametocyte clearance following treatment is important because persistent gametocytaemia can sustain malaria transmission. This study assessed the therapeutic efficacy, safety, and gametocyte clearance following antimalarial treatment among patients with uncomplicated P. falciparum and P. vivax malaria in Northeast Ethiopia. A prospective observational study was conducted from November 2024 to January 2026 among 159 patients with uncomplicated malaria, including 81 P. falciparum and 78 P. vivax infections. Patients received treatment according to national guidelines, with artemether-lumefantrine for P. falciparum and chloroquine for P. vivax, while a subset also received a single low dose of primaquine. Participants were followed for 28 days to assess therapeutic outcomes, fever clearance, asexual parasite clearance, haemoglobin recovery, gametocyte clearance and adverse events. Data were analysed using SPSS version 26.0. Kaplan-Meier survival analysis was used to evaluate fever, parasite, and gametocyte clearance. Statistical significance was considered at p < 0.05. Therapeutic efficacy was high in both species, with adequate clinical and parasitological response rates of 88.9% among P. falciparum patients and 97.4% among P. vivax patients. Fever and asexual parasite clearance occurred more rapidly in P. vivax than in P. falciparum, with median fever clearance times of 2 and 3 days and median parasite clearance times of 2 and 4 days, respectively. Haemoglobin levels improved throughout follow-up in both groups, although P. falciparum infections were associated with lower baseline haemoglobin levels. Antimalarial treatments were generally well tolerated, with most adverse events being mild and no treatment discontinuations recorded. A transient increase in gametocyte carriage on day 3 was observed more frequently among participants who did not receive primaquine. Primaquine significantly accelerated gametocyte clearance, reducing the median clearance time from 11 to 7 days in P. falciparum and from 7 to 4 days in P. vivax. Higher baseline gametocyte density was associated with slower gametocyte clearance, particularly among P. falciparum patients. First-line antimalarial treatments remain highly effective and well tolerated for the management of uncomplicated P. falciparum and P. vivax malaria in Northeast Ethiopia. However, post-treatment gametocyte persistence may contribute to ongoing transmission, particularly in P. falciparum infections. The addition of low-dose primaquine significantly enhanced gametocyte clearance in both species, highlighting its potential role in reducing transmission and supporting malaria elimination efforts.
It is important to identify the molecular subtypes of gliomas to determine appropriate management strategies for patients. However, genetic testing requires tumor tissue obtained through surgical resection, which imposes a considerable burden on patients. Hence, we propose a computerized molecular subtype classification method based on brain magnetic resonance (MR) images using a pretrained 3D foundation model. Our dataset consists of T1-weighted (T1w), T2-weighted (T2w), fluid-attenuated inversion recovery (FLAIR), and contrast-enhanced T1-weighted (T1ce) brain MR images from the BraTS2020 dataset. The proposed model was trained and evaluated using this dataset, which comprises data from 148 patients for training and 70 patients for testing. Our proposed SAM-Med3D-based multi-modal network incorporates four modality-specific 3D image encoders for the T1w, T2w, FLAIR, and T1ce images. Each encoder is efficiently adapted using low-rank adaptation, and a classification head is introduced for glioma molecular subtype classification. Multi-modal MR images are independently processed by the modality-specific encoders to extract image embeddings. These embeddings, together with the prompt embeddings generated by the 3D prompt encoder, are integrated by the 3D mask decoder to produce tumor segmentation outputs. The shared encoder features are concatenated and sent to the classification head for glioma molecular subtype classification. The area under the curve for the proposed method was 0.931, exceeding that of the conventional networks such as SGPNet (0.827), MA-MTLN (0.902), and MTTU-Net (0.910). This result indicates that the proposed SAM-Med3D-based network could enable effective and accurate molecular subtype classification using multi-modal brain MR images.
Aerobic exercise is beneficial in managing Parkinson disease (PD), yet its potential remains less clear in early stages. This study investigates the impact of long-term aerobic exercise habits in individuals with early-stage PD compared with healthy controls. Cross-sectional study. To evaluate whether long-term exposure to moderate- to high-intensity exercise was associated with more favorable physical, cognitive, and patient-reported outcomes in early PD, by comparing "highly active" individuals (self-reported moderate- to high-intensity aerobic exercise ≥ twice weekly for >3 months) with "low-active" individuals (self-reported moderate- to high-intensity aerobic exercise ≤ twice weekly for >3 months) and healthy controls. University. Seventy low-active individuals with PD, 35 highly active individuals with PD, and 35 healthy controls were included. Not applicable. Assessments included Timed Up and Go Test, Six Spot Step Test, 6-Minute Walk Test, Mini Balance Evaluation Systems Test, Lower Extremity Muscle Peak Power, Aerobic Capacity, Physical Activity, Montreal Cognitive Assessment, Symbol Digit Modalities Test, Parkinson's Disease Questionnaire, Non-Motor Symptoms Questionnaire, Falls Efficacy Scale-International, European Quality of Life Questionnaire, Beck Depression Inventory-II, and Movement Disorders Society-sponsored revision of the Unified Parkinson's Disease Rating Scale. Highly active individuals with PD outperformed low-active individuals with PD (p < .05) in physical function outcomes, motor symptom severity, physical activity levels, and nonmotor symptoms, while showing comparable results to healthy controls across several tests covering physical and cognitive function and physical activity level. Low-active participants showed impairments in several physical function and activity outcomes relative to healthy controls (p < .05). Cognitive function outcomes were comparable across the PD groups, but healthy controls performed better in processing speed (p < .05). No significant differences were found between participant groups in quality of life or depressive symptoms. Regular engagement in moderate- to high-intensity aerobic exercise in early PD may preserve physical function, suggesting a potential role in limiting disease-related motor decline. These findings support the consideration of early, high-intensity aerobic exercise interventions as part of a comprehensive management strategy for PD.
There is a complex relationship between gastroesophageal reflux disease (GORD), hiatus hernia, obesity, and metabolic bariatric surgery. We report the outcomes of laparoscopic hiatus hernia repair (HHR) with BIO-A® mesh in the management of GORD post LSG in patients who developed a hiatus hernia with migration of the proximal gastric sleeve. A retrospective review of 50 patients who previously underwent LSG and revisional surgery (HHR, n = 25; RYGB, n = 25) between 2011 and 2022. The modified DeMeester scoring system was used to assess the severity of the patient's GORD symptoms pre-HHR/pre-RYGB and 6 months post-op. Twenty-five patients underwent HHR with BIO-A® mesh following a previous LSG. The severity of GORD six months post-HHR was significantly lower (0.96 ± 0.84 vs. 2.60 ± 0.50, p = < 0.0001). After HHR, 3/25 (12%) patients had ongoing GORD symptoms that were not medically controlled and underwent conversion to RYGB. In contrast, 25 patients underwent direct conversion to RYGB following a previous LSG. The severity of GORD at 6 months post-RYBG was significantly lower (0.40 ± 0.50 vs. 2.36 ± 0.64, p = < 0.0001). At six months, there was no significant difference in GORD symptoms when HHR was compared with RYGB (3.32 ± 1.6 vs. 3.76 ± 1.54, p = 0.4296). In appropriately selected patients, HHR with BIO-A® mesh appears safe and effective in managing persistent GORD following LSG, within the limits of this study. However further research is needed to explore its role and the long-term outcomes.
Chronic ocular graft-versus-host disease (coGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) may lead to irreversible ocular surface damage and even vision loss. Current management of coGVHD faces challenges, with frequent missed or misdiagnosed cases. This study aimed to leverage a multimodal large language model (MLLM) to develop an early warning and diagnostic system for coGVHD. A total of 666 post-allo-HSCT patients (early warning model) and 805 post-allo-HSCT patients (1574 eyes, diagnostic model) were enrolled for construction, internal validation, and external validation of the corresponding models. We proposed the GVHD-MLLM, a multitask multimodal network that fused latent representations from four modal sequences to provide high-precision, real-time predictions for two tasks. The GVHD-MLLM achieved high performance in internal testing, with AUROCs of 93.44% (95% CI: 91.85-95.03%) for early warning, 98.98% (95% CI: 98.59-99.36%) for diagnosis, and 98.24% (95% CI: 98.05-98.43%) for disease severity grading. In external validation, the early warning AUROC was 83.45%, while diagnostic AUROCs across three external sites were all above 96.0%. The disease severity of patients seeking medical treatment after using the early warning model was significantly lower. Junior ophthalmologists also improved diagnostic accuracy using the model as an auxiliary tool. The GVHD-MLLM can process rich multi-modal information collected in clinical practice, and is expected to become an effective tool for managing coGVHD.
This study investigates the combined effects of heavy metals (lead and nickel) and three pesticides (abamectin, propargite, and chlorpyrifos) on the bulb mite, Rhizoglyphus robini (Acaridae). Toxicity bioassays were conducted to determine the heavy metal ratios (HMR) and the LC50 of pesticide alone divided by LC50 of pesticide with heavy metal pretreatment. The results revealed that exposure to lead and nickel enhanced the toxicity of propargite and chlorpyrifos but significantly reduced the toxicity of abamectin, indicating an antagonistic effect. Specifically, for propargite, lead increased toxicity by 2.67-fold and nickel by 1.73-fold. For chlorpyrifos, lead increased toxicity by 1.75-fold and nickel by 1.17-fold. In contrast, for abamectin, lead and nickel reduced toxicity by 0.82-fold and 0.86-fold, respectively (HMR < 1), confirming an antagonistic interaction. Biochemical analyses showed that lead exposure significantly increased cytochrome P450 activity, while nickel reduced glutathione S-transferase (GST) activity. The observed changes in enzyme activities suggest that heavy metals may affect detoxification pathways. Our results highlight the importance of considering environmental contaminants when designing pest management strategies, as combined exposure to heavy metals and pesticides can either enhance or reduce the efficacy of control measures.
Cardiovascular disease (CVD) and cancer are the two leading health issues in the world, with CVD being the leading cause of death in all age groups and cancer, particularly prostate cancer (PCa), emerging as a significant concern among elderly men. Common risk factors like metabolic disorders, chronic inflammatory diseases, and hormone abnormalities have been theorized to be responsible for the increasing prevalence of these diseases. In this study, we examined the relationship between CVD and PCa, with emphasis on the pathophysiological events that connect them and how their coexistence affects patient outcomes. Common PCa treatments, such as androgen deprivation therapy (ADT) as well as androgen receptor signaling inhibitors (ARSI), have been linked to higher rates of hypertension, myocardial infarction, arrhythmias, and metabolic abnormalities. These cardiovascular side effects complicate the effective management of PCa, resulting in poorer overall results. It is essential to implement new integrated approaches to tackle these comorbid conditions. Recommendations include changes in lifestyle, personalized treatment plans, multidisciplinary collaborative efforts, and routine cardiovascular examinations for patients on PCa treatment. Evidence found that personalized exercise regimens and pharmaceutical treatments like statins and antihypertensives may lower cardiovascular risks and enhance outcomes in patients undergoing PCa treatment. Also, emerging technological interventions like wearable devices and telemedicine, such as smartwatches and mobile ambulatory blood pressure monitors (ABPMs), offer real-time cardiovascular monitoring and improve health outcomes among these patients. This study identifies the substantial gaps in clinical guidelines, notably in cardio-oncology integration, and emphasizes the importance of further research into biomarkers, shared inflammatory pathways, and individualized therapy methods. Hence, addressing these gaps will enable a more comprehensive approach to patient care, improving their quality of life and survival.
House dust mites (HDMs), particularly Dermatophagoides farinae, are commonly found in household dust and play a key role in allergic diseases such as asthma and allergic rhinitis. Beyond clinical management, allergen removal strategies are crucial for improving quality of life. Hence, this study investigated the effects of ozone exposure on D. farinae, focusing on changes in protein expression, surface bacterial composition, mortality, and mobility. Mites were exposed to ozone concentrations of 0.05, 0.5, and 1 ppm for 24, 48, and 72 h in a controlled chamber, with non-exposed mites serving as controls. Western blotting using anti-Der f 1 and anti-Blo t 5 antibodies assessed changes in allergen profiles, while 16 S rRNA sequencing characterised changes in surface bacterial communities. Mortality was evaluated using 100 mites per group under varying exposure durations. To assess behavioural responses, a three-chamber mobility assay was conducted, where mites were placed in a central compartment flanked by no-ozone and low-ozone chambers, and their distribution was recorded after 72 h. Ozone exposure resulted in a concentration- and time-dependent reduction of Der f 1 protein intensity, suggesting allergen degradation. Surface bacterial profiling revealed distinct compositional shifts following ozone exposure. Mortality increased proportionally with ozone concentration and duration. In the mobility assay, mites predominantly remained in the no-ozone chamber, indicating avoidance of ozone. Collectively, these findings demonstrate that ozone exposure affects D. farinae at molecular, microbial, and behavioural levels, highlighting ozone's potential role in modulating mite allergenicity and ecology.
This study investigates how emotionally ambiguous words can influence performance in the N-back task. In two experiments, we measured differences in behavior (performance accuracy and reaction times) and management of visual attention (eye-tracking measurement: number of fixations, mean duration of fixation) for ambiguous and unambiguous words. We hypothesized that words ambiguous on one of three emotional spaces - valence (positivity and negativity), origin (automaticity and reflectiveness), and activation (arousal and subjective significance) - would increase accuracy in the N-back task (Experiment 1), but also elicit more and longer fixations (Experiment 2) compared to the unidimensional, unambiguous words. The behavioral hypotheses were confirmed for words of ambiguous valence and origin, but not for activation ambiguity. Furthermore, all eye-tracking hypotheses were confirmed, finding differences between control words and all ambiguous groups of words. Our findings further show that ambiguity may be found in emotional spaces other than valence (i.e., origin), which may significantly influence our cognitive functioning.
Professional tennis involves repeated short-duration, high-intensity anaerobic efforts interspersed with brief recovery intervals. Powerful serves, explosive sprints, rapid directional changes, and muscular contractions place substantial physiological demands and may lead to distinct long-term adaptations at both neuromuscular and biochemical levels, enabling efficient fatigue management and sustained high-level performance during training and competition. This study aimed to analyse the effect of a long-term professional tennis training adaptations both on neuromuscular and biochemical level in context of the fatigue induced by maximal anaerobic effort (MAnE). 14 professional tennis players (TP) (20.00 ± 0.96 years), and 15 physically active men (PAM) (20.07 ± 1.59 years) finished the study. The testing protocol consisted of MAnE in form of 2 × 30-second Wingate Anaerobic Test and maximal voluntary isometric contractions (MVICs) and submaximal isometric contractions at 20% and 50% of MVIC of the knee extensors and flexors with a surface electromyography evaluation before and after MAnE. Blood samples were collected at baseline, immediately after, and 3 and 24 h after MAnE to assess serum markers, including 8-hydroxy-2'-deoxyguanosine, albumin, interleukins (IL-6, IL-10, IL-15), and total antioxidant capacity (TAC). TP exhibited superior absolute (7.8%, p = 0.05) and relative peak power (10.1%, p < 0.01) during MAnE in compare with PAM. After the MAnE, TP were able to maintain their performance in form of peak rate of torque development in knee flexion of MVIC, while PAM showed it reduction by 26% (p < 0.05). In addition, rectus femoris muscle in TP showed increase in muscle activity (52-62%, p < 0.05) after MAnE in both knee flexion and extension at 20% of MVIC. In context of biochemical analysis, TP had higher TAC levels at baseline (47.8%, p < 0.01) and 24 h after MAnE (34.7%, p < 0.01) compared to PAM. Additionally, while IL-10 concentrations were significantly higher in TP at baseline (22.0%, p < 0.05), at 3 h (14.2%, p < 0.05) and 24 h after MAnE (26.8%, p < 0.05), IL-6 showed attenuated increase after MAnE and its concentrations immediately after (19.8%, p < 0.01) and 3 h (27.5%, p < 0.01) were lower than PAM. The findings indicate that, compared with physically active men, elite tennis players exhibit distinct neuromuscular and biochemical responses to standardized MAnE, which may reflect long-term training-related physiological adaptations.
Titanium clips are commonly used to close mucosal defects after gastric lesion endoscopic submucosal dissection (ESD). However, prolonged titanium clip retention beyond the healing period may have potential negative effects on postoperative outcomes. This study developed and validated a scoring model to predict titanium clip retention at six months post-gastric ESD. A multicenter retrospective study was conducted on 1,055 patients who underwent gastric ESD with titanium clips closure for wound management. Patients were grouped into a training cohort (TC, n = 509), an internal validation cohort (IVC, n = 218), and an external validation cohort (EVC, n = 328). Univariate and multivariate logistic regression were applied to identify risk factors for titanium clip retention at the 6-month follow-up. A scoring system was then built by assigning weighted scores based on the regression coefficients of independent predictors. The model's performance was evaluated using the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and predictive values. Among the patients, 132 (12.5%) experienced prolonged titanium clip retention. Multivariate analysis revealed three independent predictors: tumor in the upper third of the stomach (2 points), diabetes (1 point), and the use of ≥ 8 clips (1 point). The scoring model exhibited strong predictive ability, with AUCs of 0.809 in the IVC and 0.855 in the EVC, along with high negative predictive values (0.946 and 0.984, respectively). Risk stratification classified patients into low-risk (0-1 points), intermediate-risk (2-3 points), and high-risk (4 points) groups. The observed retention rates were 3.5%, 14.8%, and 58.8% in the IVC, and 1.6%, 20.8%, and 76.5% in the EVC, respectively. The proposed predictive score, which combines tumor location, diabetic status, and clip number, effectively stratifies the risk of long-term titanium clip retention after ESD. This tool may assist in risk stratification for personalized postoperative surveillance, pending prospective validation.
The reliable smart tools that detect surface cracks in an efficient and accurate manner are needed for the heritage structure preservation. In this paper, an entirely automated framework is proposed in which high-resolution images have to be processed and relevant structural information and cracks are extracted in real-time. Image preprocessing, Skeleton-based analysis, and a lightweight deep learning model efficiently detect controlled and real environments in such a way that he workflow is integrated. An exclusive application was developed, through which users can also upload images, if needed, or snap shot images directly through a live camera so that the whole system can Then be applied in reality for practical site inspections. The model showed very high accuracy and very consistent performance under real-time on-field testing. Detection is not all that the system can do; scantling would also be offered on activities like crack width, average width, orientation, and severity. Thus, the proposed approach is just a proper and scalable answer to structural assessment while enabling a more rationalized action for maintenance decision-making in heritage management.