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Effects of transcutaneous auricular vagus nerve stimulation combined with repetitive facilitative exercise on lower limb motor function in patients with intracerebral hemorrhage: A pilot randomized controlled trial
Objective To evaluate the clinical efficacy of transcutaneous auricular vagus nerve stimulation (taVNS) combined with repetitive facilitative exercise (RFE) in improving lower limb function in patients with intracerebral hemorrhage. Methods The research protocol was registered on the Chinese Clinical Trial Registry website (ChiCTR2500106064). Sixty patients with intracerebral hemorrhage were randomly assigned to either the experimental group (n = 30) or the control group (n = 30). The experimental group received real taVNS combined with RFE, while the control group received sham taVNS combined with RFE. Before and after 6 weeks of treatment, functional assessments were conducted using the Fugl-Meyer Assessment-Lower Extremities (FMA-LE), the Functional Ambulation Category (FAC) scale, and a three-dimensional gait analysis system to obtain kinematic parameters of the pelvis during the walking cycle. Results Baseline demographic and clinical characteristics showed no significant differences between the two groups (all P > 0.05). After 6 weeks of intervention, both groups exhibited significant improvements in FMA-LE, FAC, stride length, peak hip extension angle, and peak hip joint moments (all P < 0.05). However, the experimental group demonstrated superior outcomes compared to the control group in FMA-LE (t = 3.233, P = 0.002), FAC (t = 2.868, P = 0.006), stride length (t = 3.077, P = 0.003), and peak hip extension angle (t = 2.682, P = 0.010). No significant difference was observed in peak hip joint moments (t = −0.212, P = 0.833) between the two groups after treatment. No adverse effects or dropouts were reported during the study. Conclusion Compared to sham taVNS combined with RFE, taVNS combined with RFE can significantly enhances lower limb motor function in patients with post-stroke hemiplegia following intracerebral hemorrhage. The research protocol has been registered on the Chinese Clinical Trial Registry website ( ChiCTR2500106064 ).
A comprehensive urine workflow enables robust methylation and fragmentation analysis of cell-free DNA
Impact of kidney function on the metabolome in the general population
Background A reduction in kidney function cause metabolites that normally are cleared by the kidney to accumulate. These accumulated metabolites could potentially link kidney function to an increased risk of cardiovascular disease. Aim To assess the relationships between creatinine-based estimated glomerular filtration rate (eGFR) and the metabolome (791 endogenous metabolites) in the general population, as well as the cortisol to cortisone ratio. Patients and methods Three population-based cohorts, Epihealth, PIVUS and POEM (total n = 3,444), were used with a discovery/validation approach. Metabolomics was measured by mass spectroscopy. eGFR was calculated using the 2021 CKD-EPI creatinine-based equation. Multivariable linear regression was used to assess the correlations between each metabolite concentration and eGFR, adjusting for sex, % fat mass, cardiovascular risk factors and medications. The metabolites significant in the linear regression were analyzed using MultiVariable Mendelian Randomization (MVMR), adjusting for diabetes and BMI. Results Nighty-six metabolites were significantly associated to eGFR and had the same direction of association in both linear regression and MVMR. The vast majority of these associations were negative. Apart from creatinine, N-acetylalanine, N,N-dimethyl-pro-pro, N,N,N-trimethyl-alanylproline betaine (TMAP) were the top findings. Pathway enrichment analysis (Metaboloanalyst 6.0) found five significantly enriched pathways, two of which involved amino acid metabolism. Conclusions In a general population with only mild to moderately reduced kidney function, several metabolites were associated with kidney function, including the cortisol to cortisone ratio. This finding is of interest since several of these metabolites might link reduced kidney function to an increased risk of cardiovascular disease.
The effect of amniotic membrane application on post-cesarean wound healing and cosmetic outcomes
Abstract Post-cesarean wound complications—such as surgical site infection (SSI), dehiscence, and hypertrophic scarring—remain a challenge in obstetric surgery. We evaluated whether intraoperative autologous amniotic membrane application improves postoperative outcomes. In a single-blind, randomized controlled trial, 372 women undergoing elective cesarean section were allocated to an amniotic membrane group ( n = 174) or control group ( n = 198). SSI incidence was lower with amniotic membrane (4.3% vs. 10.8%; p < 0.05), and wound dehiscence was reduced (2.1% vs. 6.4%; p < 0.05). Postoperative pain scores (Visual Analog Scale) were significantly lower in the amniotic membrane group on postoperative day 1 (3.38 ± 1.36 vs. 4.05 ± 1.53; p = 0.01) and day 2 (1.25 ± 0.71 vs. 2.01 ± 0.98; p = 0.001). Clinician-rated cosmetic appearance (Modified Hollander Wound Evaluation Scale) did not differ between groups ( p = 0.863), whereas patient-reported satisfaction was higher with amniotic membrane ( p = 0.001). No predefined adverse events were observed. These findings suggest that amniotic membrane application may reduce wound-related complications and postoperative pain and improve patient satisfaction after cesarean delivery; confirmatory studies in broader populations are warranted.
Time to maternal death and its predictors among obstetric ICU patients in a resource-limited setting: A 10-year survival analysis
Background Maternal mortality remains a major concern in resource-limited settings, particularly among critically ill obstetric patients requiring intensive care unit (ICU) admission. Objective To assess the time to maternal death and identify its predictors among obstetric patients admitted to the intensive care unit (ICU) in a resource-limited tertiary hospital in southern Ethiopia, over a ten-year period. Methods A retrospective cohort study was conducted among 378 obstetric patients admitted to the ICU between 2014 and 2023. Kaplan-Meier analysis estimated survival probability, multivariable Cox proportional hazards regression identified independent predictors of time to maternal death reported as adjusted hazard ratios (AHR) with 95% confidence intervals, and a Fine-Gray competing-risks model was additionally conducted with discharge alive as the competing event. Results Of 378 obstetric ICU admissions, 126 resulted in maternal death, with a median time to death of 2.71 days (95% CI: 2.13–3.44); 71.4% of deaths occurred within the first five days, and survival probability declined rapidly before stabilizing after ten days. Rural residency (AHR 1.56, 95% CI 1.03–2.37), shock (AHR 2.27, 95% CI 1.44–3.56), multi-organ failure (AHR 1.75, 95% CI 1.09–2.78), mechanical ventilation (AHR 1.82, 95% CI 1.11–2.98), and impaired consciousness (moderate GCS: AHR 2.94; severe GCS: AHR 5.43, both p < 0.001) were independently associated with higher hazard of death, with findings consistent across the Fine–Gray competing-risks model. Conclusion Maternal ICU deaths occurred early, with most fatalities within the first week of admission and survival probability declining sharply in the first ten days. Shock, multi-organ failure, invasive mechanical ventilation, impaired consciousness at admission, and rural residency were independent predictors of shortened time to maternal death. Interventions targeting these conditions must be initiated early and urgently, particularly within the critical first days of ICU admission, to improve survival in resource-limited settings.
A hybrid DenseNet121-random vector functional link (RVFL) approach for plant leaf classification
Abstract The Random Vector Functional Link (RVFL) network provides an efficient and quick method of training feedforward single hidden neural networks. It solves major disadvantages of classical neural networks, i.e. dealing with slow convergence and overfitting by exploiting fixed random weights and closed-form output computation. DenseNet121 architecture has huge potential in the artificial intelligence field and more specifically in object recognition tasks. The major drawback, however, is its inability to provide insights into its intermediate levels of analysis of classification, which is why this algorithm offers limited flexibility to analyze the training procedure. To resolve this problem, we offer a combined solution by integrating DenseNet121 with RVFL. Within the framework described, deep features are obtained in relation to the input leaf pictures with the pre-trained DenseNet121 model that captures important texture and contour structure. To, firstly, minimize the dimension of these features and, secondly, remove superfluous redundancies, Principal Component Analysis (PCA) is used, and only the most informative components are retained. This smaller feature set is then marked to the RVFL classification, whose responsibility is a final classification. Understanding how the proposed DenseNet121-RVFL approach performs, we have conducted some comparative experiments against several baseline classifiers, such as DenseNet121- Support Vector Machine, DesnseNet121-Twin Support Vector Machine, DenseNet121-Extreme Learning Machine, DenseNet121 and DenseNet 121-Kernel Ridge Regression. The findings of the experiment reveal that the hybrid DenseNet121-RVFL model has the best effect in comparison to the other methods, as it provided the highest accuracy of 94.45, F1-Score is 0.955, Geometeric Mean(G-Mean) of 0.898 and Area Under Curve (AUC) of 0.961 on the test dataset.
Characterization of entomological drivers of malaria transmission in five villages, Keerom Regency, Papua, Indonesia
Background Keerom Regency remains one of the high-malaria-endemic regencies in Indonesia. Despite the accelerated malaria elimination strategy underway in Papua, malaria transmission in this regency has not declined. To characterize the entomological and human behavioral factors sustaining and driving malaria transmission, a rapid entomological assessment paired with human behavior observations (HBOs) and household surveys was conducted in five villages of Keerom Regency. Methods Entomological surveys were conducted on three occasions in 2022 and 2023. Human landing catches (HLC), night indoor resting collection, and mosquito larval site surveys were conducted alongside human behavior observations (HBO) and structured household surveys. Results Six species of Anopheles were identified including Anopheles koliensis , An. punctulatus , An. hinesorum , An. kochi , An. bancroftii and An. peditaeniatus . The dominant species were An. koliensis and An. punctulatus . Outdoor Anopheles human biting rates (HBR) averaged 1.4 ± 1.7 bites per person per hour (bph), higher than indoor HBRs of 0.8 ± 1.2 bph. Vector incrimination detected Plasmodium DNA in ten An. koliensis mosquitoes in 2023, including Plasmodium falciparum (n = 2, 20%), P. vivax (n = 7, 70%) and P. ovale (n = 1, 10%). Blood meal analysis showed mixed feeding on humans and dogs, with human blood indices of 58.3% for An. koliensis and 66.7% for An. punctulatus . HBOs highlighted a substantial gap in indoor protection during the early evening before sleeping. Household surveys identified several drivers of exposure, including the absence of window and door screens, limited indoor residual spraying coverage, low usage of insecticide-treated nets, and unprotected outdoor activity. Conclusions Members of the An. punctulatus group were abundant across all study villages, with An. koliensis and An. punctulatus being the primary species. Vector incrimination confirmed active malaria transmission. These vectors demonstrated opportunistic feeding behavior, primarily on humans but also on dogs, which may offer an avenue for targeted interventions. Multiple gaps in personal and household protection were identified, both indoors and outdoors. Strengthening indoor protection through increased ITN use, installation of house screens, and evaluation of complementary tools such as spatial repellents may reduce indoor transmission. Community-led larval source management in and around households may help reduce outdoor transmission.
Examining the physiological and molecular impact of biochar on polyol synthesis and drought resistance in tomato plants
Abstract Biochar is widely reported to buffer drought by improving soil water-holding capacity and nutrient availability, but whether it also modulates polyol metabolism linked to osmotic adjustment in tomato remains underexplored. Here we integrate physiological (polyol pools, SDH enzyme) and molecular (SDH transcripts) readouts with explicit soil and material characterisation to test how a wood-derived biochar alters the sorbitol/ribitol–SDH axis during water limitation. Tomatoes grown in biochar-amended soil (WB, 20 g kg −1 ) versus unamended soil (OB) were exposed to 100%, 75% and 45% soil water content (SWC). Under drought, OB plants accumulated more ribitol and sorbitol, with concomitant increases in SDH activity and SDH mRNA, whereas WB plants showed significantly attenuated polyol accumulation and SDH upregulation. At 75% and 45% SWC, SDH transcripts in OB were ~ 2 × and 4 × the 100% baseline, respectively, versus ~ 1 × and ~ 2 × in WB (two-way ANOVA, irrigation × biochar interaction p < 0.01). Novelty: The data indicate that biochar attenuates the polyol-associated stress response (lower osmolyte demand and SDH induction) while maintaining growth, consistent with improved plant water status. These findings suggest that biochar may contribute to reducing osmotic stress responses, complementing its agronomic benefits in arid systems and supporting sustainable tomato production.
Validation of deep learning enabled software MetronMind to measure vertebral heart size and vertebral left atrial size in dogs
Background Vertebral heart size (VHS) and vertebral left atrial size (VLAS) are objective radiographic measurements of heart and left atrial size, respectively and are associated with inter- and intraobserver variability when measured by humans. Artificial intelligence (AI) tools to determine VHS and VLAS have been developed and may reduce variability and save time. Objectives To compare two manual methods for measuring VHS and VLAS on right and left lateral canine thoracic radiographs and to compare measurements of VHS and VLAS made by deep learning-enabled program, MetronMind, with those made by a trained observer on right and left lateral radiographs. Animals Client-owned dogs (n = 1058) including 80 breeds with a variety of heart sizes, thoracic conformations and radiographic quality. Methods Retrospective, single-center, method-comparison study. Pearson’s correlation, Bland-Altman plots and Passing-Bablok regression were used to assess agreement. Results Correlation between traditional and modified manual measurements for VHS and VLAS was strong (r = 0.994 and r = 0.974, respectively), with minimal bias (−0.10 and 0.04 vertebrae, respectively) indicating that the modified methods closely approximate traditional measurements obtained from right lateral views. MetronMind measurements of VHS and VLAS from right lateral radiographs also correlated well with the human observer’s modified measurements (r = 0.947 and r = 0.811 respectively), showing small mean biases (0.08 and 0.07 vertebrae, respectively). Correlation between left and right lateral radiographic measurements of VHS (0.87 and 0.91) was higher than for VLAS (0.73 and 0.64) and bias was larger for VHS (0.26 and 0.31 vertebrae) than for VLAS (−0.13 and −0.10 vertebrae) for humans and MetronMind, respectively.
Comparison of techniques for the evaluation of taste sensitivity
Abstract Taste is essential for proper nutritional intake and thus has a significant effect on quality of life, yet clinical assessments of gustatory function are often underutilized or poorly standardized. This study aimed to compare two contrasting methodologies for evaluating taste sensitivity: Bayesian adaptive taste thresholds versus taste strip identification scores. One hundred participants underwent two sessions of gustatory testing, with a series of up to 20 trials of spray-based dilutions of sweet, sour, salty, and bitter tastants (QUEST) and the 16-item tastant-impregnated paper strips test. The log-transformed QUEST scores showed similar test–retest reliability to the taste strips score, with the bitter tastant showing the greatest correlation. There was no significant correlation between QUEST thresholds and taste strips identification scores. The QUEST spray test was rated more favorably by the participants for comprehensibility and pleasantness but took 12.38 min (± 33 s) on average, compared to 4.19 min (± 25 s) for the taste strips test. Tastant misidentifications on the taste strips assessment revealed that sour was disproportionately perceived as bitter at low concentrations but as salt at higher concentrations. QUEST logarithmic taste thresholds and tastant misidentifications on the taste strips test may serve as independent clinical measures of hypogeusia progression alongside taste strips identification score.
Retraction: Robust policy evaluation from large-scale observational studies
Risk factors for abscess formation during or following endodontic treatment in an outpatient setting
Abstract This retrospective matched case-control study aimed to identify potential risk factors associated with the development of dental abscesses during or after endodontic treatment. The study analyzed data from 133 patients (74 males, 58 females; mean age 43.1 ± 16.5 years) with abscess formation of endodontic origin and compared them with a 1:1 matched control group without abscess. Matching was performed based on age and the specifically treated tooth. Collected variables included preoperative symptoms, radiographic findings, type and stage of endodontic intervention, and systemic medical conditions. Statistical analysis used chi-square or Fisher exact tests to compare between groups. STROBE and PROBE guidelines were followed. Among 2637 maxillofacial infections of odontogenic origin, 526 cases (19.9%) were related to endodontic treatment. No statistically significant associations were found regarding age, sex, or underlying systemic diseases ( p > 0.05). Teeth exhibiting apical radiolucency were at significantly higher risk for abscess development ( p < 0.001). Teeth that had undergone definitive root canal filling were significantly less likely to develop abscesses compared to those left without temporary filling after trepanation ( p < 0.001) or treated with intracanal medication and temporary filling ( p = 0.009). The highest incidence of abscess formation was observed within the first four days post-treatment ( p < 0.001). Within the limitations of this retrospective study, abscess formation during or after endodontic treatment was linked to local procedural and radiographic factors, whereas systemic diseases did not demonstrate a measurable influence. The absence of temporary sealing and the presence of apical radiolucency were identified as significant risk indicators and may warrant increased clinical attention, particularly in the early postoperative period. Given the retrospective design and limited sample size, these findings should be interpreted with caution and require confirmation in prospective studies.
Dual cross-attentive mutual teaching for semi-supervised 3D medical segmentation
Semi-supervised learning can reduce the dependence on large-scale labeled data in 3D medical image segmentation.In this work, we propose a new Dual Crossed Attention Mutual Teaching (DCA-MT) framework that effectively utilizes both labeled and unlabeled data by integrating high-dimensional feature alignment, semantic-level crossed attention, and bidirectional knowledge distillation. Specifically, we employ a two-branch VNet architecture where the teacher-student network co-evolves through mutual mentoring and collaborative learning.To enhance representation consistency, we introduce maximum mean difference (MMD) loss and inter-class and intra-class contrast constraints to achieve global feature distribution alignment and class-level separability. A multi-head cross-attention module is designed to facilitate fine-grained semantic interaction between the two networks, allowing the two branches to dynamically exchange complementary features.In addition, the two-way mutual distillation strategy ensures that teacher and student networks benefit from each other's knowledge. Numerous experiments on the left atrial and pancreatic nih datasets show that our proposed approach has better performance and verifies the effectiveness and robustness of DCA-MT.
F-BEGAN: BEGAN-enabled federated learning for imbalance data security and privacy-preserving of IoMT-based Healthcare 5.0
Spatial characteristics, similarity in business scope, and expansion network of listed companies in China’s food manufacturing industry
Using a multi-source dataset of 777 Listed Companies in the Food Manufacturing Industry (LCFMI), this study examines their spatial and relational organization in China. Key findings are: 1) The geographical distribution of LCFMIs closely aligns with China’s macro-economic landscape, with more developed regions hosting a greater concentration and larger scale of firms. 2) While similarity in business scope (SBS) is generally low, significant distance-decay effect is noted, particularly within “0 ~ xx km”; the resulting SBS network demonstrates small-world properties and distinct clustering patterns based on both geography and industrial sub-categories, highlighting the interplay between spatial and cognitive proximity. 3) The inter-city recruitment network, which reflects the spatial expansion of corporate influence, is predominantly shaped by transportation accessibility between cities. This research provides new empirical insights into the geographical organization of manufacturing and the formation of city networks, offering practical implications for regional industrial policy and infrastructure planning.
An open-source 3D printing system enabling in-situ freeze-thaw processing of hydrogels
Abstract Hydrogels are widely used in tissue engineering and scaffold fabrication due to their excellent biocompatibility, while 3D printing excels at creating complex architectures. Among various techniques, low-temperature extrusion-based 3D printing has shown promise for hydrogel scaffold fabrication, as rapid solidification under controlled cooling can improve shape retention during deposition. However, commercial low-temperature DIW systems are often expensive, closed-source, and difficult to customize. Moreover, most require a two-step post-processing workflow involving external freeze-thaw cycles, which can damage structures through mechanical disturbance and temperature gradients, increasing contamination risk. To address these issues, we developed a low-cost, open-source low-temperature 3D printing platform by modifying a commercial FDM printer with custom hardware and upgraded software. It maintains stable − 30 °C ± 1 °C and supports in-situ freezing and freeze-thaw processing. Using a Poly(vinyl alcohol)-lignosulfonate sodium-TEMPO-oxidized cellulose nanofibrils (PVA-LS-TOCNF) hydrogel as the model ink, we achieved stable printing of various patterns and mechanical test specimens, with tensile properties comparable to those from ex-situ freeze-thaw methods. Overall, this platform significantly lowers barriers to low-temperature hydrogel 3D printing and improves accessibility.
Dynamic patterns of communication and workload during cardiac surgery: An explorative study
Background Effective communication amongst operating room (OR) teams is crucial for ensuring patient safety and optimizing surgical outcomes. This study aimed to investigate communication within the context of physiologically assessed workload during cardiac surgeries. Specifically, the relationship between team members’ workload and both case-relevant and case-irrelevant communication exchanges was explored, as well as their association with the length of surgical phases. Methods Intraoperative communication exchanges were annotated from incision until skin closure across 24 recorded cardiac surgeries (>100h surgery time). OR team members wore heart rate monitors throughout the surgical procedures. HRV was calculated as the RMSSD across 5-minute non-overlapping windows. Mixed effect models were used to assess the relationship between workload and the frequency of communication exchanges across OR roles and surgical phases. Results Relevant communication was most frequent during the initiation and discontinuation of extracorporeal bypass, while case-irrelevant communication was most frequent during the final closing phase of surgery. Team members were more likely to engage in case-irrelevant communication during periods of reduced workload ( χ 2 = 30.15, p = .001). However, this did not necessarily align with the workload of other team members, as increased workload was associated with more frequent case-irrelevant communication initiated by other team members ( χ 2 = 5.97, p = .015). Workload and case-relevant communication had a significant effect on surgical phase length. Conclusions The findings highlight the dynamic relationship between workload and intraoperative communication patterns. Integrating observational data with physiological indicators of workload appears a promising approach to studying team dynamics in the operating room, though further research is needed to advance the use of such methods for improving team performance.
First demonstration of lead free CsSnI3 on GaN hybrid heterostructure for dual mode, broadband and self powering photo sensing
Short-term rewetting after summer drought does not alter soil fungal community composition and manganese peroxidase activity in managed temperate beech forests
Climate change is increasing the frequency of drought–rewetting cycles in temperate forests, yet the short-term responses of soil fungal communities to these events remain poorly resolved. We investigated whether an intense summer drought followed by heavy rainfall alters fungal community composition and oxidative enzyme activity in managed temperate beech forests of Central Slovakia. Soil samples from litter and mineral horizons were collected before and seven days after a rainfall event that followed an 18-day dry period. Fungal communities were characterized using ITS2 metabarcoding, and manganese peroxidase (MnPox) activity was measured as an indicator of oxidative decomposition potential. Fungal communities differed strongly between litter and mineral soil horizons across taxonomic and trophic classifications. Ectomycorrhizal fungi and soil saprotrophs dominated the mineral soil, whereas plant pathogens, litter saprotrophs, and wood-decomposing fungi were more abundant in the litter layer. In contrast, short-term rewetting did not produce detectable changes in fungal community composition or alpha diversity within either horizon. MnPox activity showed substantial spatial variability among plots but no consistent response to the rainfall event. Together, these results indicate that vertical stratification exerts a stronger influence on fungal community structure than short-term moisture fluctuations in these beech forest soils. The absence of rapid compositional change suggests that fungal communities in mature temperate forests may exhibit short-term resistance to drought–rewetting pulses, highlighting the importance of soil structure and litter layers in buffering microbial communities against transient climatic extremes.