Athens, a metropolis characterized by agglutination and compactness, but at the same time facing numerous urban and transport issues, saw its population swell during the 20th century which led to extensive urbanizatio...Athens, a metropolis characterized by agglutination and compactness, but at the same time facing numerous urban and transport issues, saw its population swell during the 20th century which led to extensive urbanization phenomena. This continued urbanization increases profoundly all urban activities with transportation being the key driver in energy consumption. Theories for sustainable cities prerequisite are the integration of a number of acts in order to reduce energy consumption, with mobility being the first consideration among others. The aim of this paper is to critically explore implemented policies and plans as well as forthcoming strategic plans in terms of sustainable mobility as imposed in large scale regeneration plans in contemporary Athens. Research focuses on strategic interventions since the 1980s, such as the Athenian Daktylios （ring road for circulation management） and its later adjustments, the upcoming pedestrianization and unification of the commercial triangle and its subsequent tram line extension as well as the notable implementation of the metropolitan cycling network. Moreover, the discussion takes into consideration the implications of the Greek economic crisis in mobility choices, as aimless travels have been reduced to a minimum, several cars have been abandoned and cyclists seem to tentatively claim some space in the urban environment. What will likely be the next day in the Athenian historic centre？ Considering the transformations that are expected in the immediate future, this research paper explores their potential to enhance urban environment, reduce climate change impacts and amplify resilience.展开更多
AIM: To assess the prevalence of hepatitis B and C serological markers in a population of refugees living in Athens.METHODS: One hundred and thirty refugees (81 males and 49 females, mean age ±SD: 31.7±8 yea...AIM: To assess the prevalence of hepatitis B and C serological markers in a population of refugees living in Athens.METHODS: One hundred and thirty refugees (81 males and 49 females, mean age ±SD: 31.7±8 years) were included in the study. The hepatitis B virus surface antigen (HBsAg),the hepatitis B virus core antibody (anti-HBc) and the hepatitis C virus antibody (anti-HCV) were detected using a third-generation immunoassay.RESULTS: Twenty individuals (15.4%) were HBsAg positive and 69 (53.1%) were anti-HBc positive. The prevalence of HBsAg and anti-HBc was higher among refugees from Albania and Asia (statistical significant difference, P＜0.008 and P＜0.001 respectively). The prevalence of these markers was found irrelevant to age or sex. Anti-HCV was detected in the serum of 3 individuals (2.3 %). No differences among age, sex or ethnicity regarding anti-HCV prevalence were found.CONCLUSION: It can be concluded that refugees living in Athens are an immigrant population characterized by a high incidence of HBV infection. The prevalence of HBV markers is higher among refugees from Albania and Asia. It is therefore believed that the adherence to general precautions and the initiation of HBV vaccination programs will be necessary in the future, especially in these communities.Although the prevalence of HCV infection seems to be relatively low, extended epidemiological surveys are needed to provide valid results.展开更多
Earth observation (EO) provides the opportunity for periodic and spatially detailed assessment of the state of the environment in urban areas. In this study, the potential of EO based indicators (EI) to assess the sta...Earth observation (EO) provides the opportunity for periodic and spatially detailed assessment of the state of the environment in urban areas. In this study, the potential of EO based indicators (EI) to assess the state of environment in the urban agglomeration of Athens (UAA) is examined. EO based indicators as used in the study, include land surface temperature, land use, land cover and aerosols distribution. The indicators are also related to the household density and population density, as extracted from census data, for the same area. Indicators are applied at the municipal scale and are also used to estimate an aggregate environmental indicator (AEI), at municipal scale, by integrating all indicators mentioned above in a GIS environment. It is found that the urban agglomeration of Athens is practically “dichotomized”, by being divided in a western and eastern area, with considerably different environmental conditions. Results are considered important for focused interventions supporting environmental urban planning, whereas they represent the high potential of EO based indicators to monitor and assess the state of the urban environment.展开更多
Power system protection has evolved significantly due to the ongoing energy transition and digitalization.The development and standardization of information and communication technologies(ICTs)used for power system pr...Power system protection has evolved significantly due to the ongoing energy transition and digitalization.The development and standardization of information and communication technologies(ICTs)used for power system protection,monitoring,and control have led to the digitalization of substations and the introduction of new protection and control schemes.These include virtualized centralized protection and control for in-tra-substation applications,as well as advanced wide-area monitoring,protection,and control(WAMPAC)for inter-substation applications.This paper reviews the development of virtualized centralized protection,with a focus on key practical advancements,emerging technolo-gies,and state-of-the-art studies in centralized protection and control(CPC)and WAMPAC systems.It also identifies directions for future research.展开更多
The retrospective study by Edwar et al reinforces the role of therapeutic penetrating keratoplasty(PK)as a vital intervention in severe,treatment-resistant infectious keratitis.In advanced cases—often complicated by ...The retrospective study by Edwar et al reinforces the role of therapeutic penetrating keratoplasty(PK)as a vital intervention in severe,treatment-resistant infectious keratitis.In advanced cases—often complicated by trauma,delayed presentation,and corneal perforation—PK restores globe integrity and provides limited visual recovery.However,its application is constrained by graft-related complications and donor shortages,particularly in low-resource settings.These limitations highlight the need for earlier,globe-sparing strategies to prevent progression and reduce surgical demand.Photoactivated chromophore for infectious keratitis-corneal collagen cross-linking(PACK-CXL)has emerged as a promising adjunct or alternative.With both antimicrobial and tissue-stabilizing effects,PACK-CXL may control infection and preserve corneal structure in earlier stages.A layered treatment framework that incorporates PACK-CXL as an initial intervention and reserves PK for refractory cases may help improve clinical outcomes.Further studies are needed to define their best use in practice.展开更多
Latest digital advancements have intensified the necessity for adaptive,data-driven and socially-centered learning ecosystems.This paper presents the formulation of a cross-platform,innovative,gamified and personalize...Latest digital advancements have intensified the necessity for adaptive,data-driven and socially-centered learning ecosystems.This paper presents the formulation of a cross-platform,innovative,gamified and personalized Learning Ecosystem,which integrates 3D/VR environments,as well as machine learning algorithms,and business intelligence frameworks to enhance learner-centered education and inferenced decision-making.This Learning System makes use of immersive,analytically assessed virtual learning spaces,therefore facilitating real-time monitoring of not just learning performance,but also overall engagement and behavioral patterns,via a comprehensive set of sustainability-oriented ESG-aligned Key Performance Indicators(KPIs).Machine learning models support predictive analysis,personalized feedback,and hybrid recommendation mechanisms,whilst dedicated dashboards translate complex educational data into actionable insights for all Use Cases of the System(Educational Institutions,Educators and Learners).Additionally,the presented Learning System introduces a structured Mentoring and Consulting Subsystem,thence reinforcing human-centered guidance alongside automated intelligence.The Platform’s modular architecture and simulation-centered evaluation approach actively support personalized,and continuously optimized learning pathways.Thence,it exemplifies a mature,adaptive Learning Ecosystem,supporting immersive technologies,analytics,and pedagogical support,hence,contributing to contemporary digital learning innovation and sociotechnical transformation in education.展开更多
Purpose:ATLAS is a cross-sectional study aiming to investigate environmental and genetic determinants of athletic performance in healthy Greek competitive athletes(CA).This article presents the study design,investigat...Purpose:ATLAS is a cross-sectional study aiming to investigate environmental and genetic determinants of athletic performance in healthy Greek competitive athletes(CA).This article presents the study design,investigates the muscle strength performance(MSP)of 289 adult and teenage CA,exercisers,and physically inactive individuals(PI),and proposes predictive models of MSP for adults.Methods:Muscle maximal,speed,and explosive strength(MMS/MSS/MES)at unilateral maximal concentric flexion and extension contraction(FC/EC)were evaluated using Biodex System 3 PRO^(TM)at 60°/s,180°/s,and 300°/s,while additional performance markers were assessed through field ergometric testing.Participants were interviewed about their lifestyle,dietary habits,physical activity,injury,and medical history.Body composition was assessed via bioelectrical impedance.gDNA was extracted from biochemical samples and then genotyped.Statistical analysis was conducted using IBM SPSS Statistics v21.0 and R.Results:Age,fitness,and sex impacted correlations of MSP with body composition and anthropometric measurements(p<0.05).Among CA,females outperformed males in accuracy(p<0.001)while,males outperformed females in anaerobic power,MSP,speed,and endurance(p<0.001).Adult CA outperformed exercisers and PI in MMS,MSS,and MES(p<0.05).Multiple linear regression models,with predictors age,FFM,body extremity,training load explained the majority of variation in MMS(R^(2)_(adj):71.4%–88.9%),MSS(R^(2)_(adj):64.8%–78.4%),and MES(R^(2)_(adj):52.7%–68.4%)at EC,FC,and their mean(p<0.001).Conclusions:Muscle-strengthening strategies should be customized according to individual fitness levels,body composition,and anthropometric measurements.The innovative sex-specific regression models assessing MMS,MSS,and MES at EC and FC provide a framework for personalizing rehabilitation and skill-specific training strategies.展开更多
N umerous neurological disorders negatively impact the nervous system,either through loss of neurons or by disrupting the normal functioning of neural networks.These impairments manifest as cognitive defects,memory lo...N umerous neurological disorders negatively impact the nervous system,either through loss of neurons or by disrupting the normal functioning of neural networks.These impairments manifest as cognitive defects,memory loss,behavioral abnormalities,and motor dysfunctions.Decades of research have significantly advanced our understanding of the pathophysiology underlying neurodegene rative diseases,including Alzheimer's disease(AD),Parkinson's disease,amyotrophic lateral sclerosis,and others.展开更多
Background The rapid emergence of multidrug-resistant Salmonella in poultry demands alternative control strategies beyond conventional antibiotics.In this study,we evaluated a combination of lytic Salmonella-infecting...Background The rapid emergence of multidrug-resistant Salmonella in poultry demands alternative control strategies beyond conventional antibiotics.In this study,we evaluated a combination of lytic Salmonella-infecting bacteriophages(SLAM_phi ST45 and SLAM_phiST56)and a probiotic bacterium Limosilactobacillus reuteri(SLAM_LAR11)in a chick model challenged with Salmonella enterica serovar Typhimurium infection.Results Co-administration with two-phage cocktail and a probiotic showed markedly reduced Salmonella colonization in the gut and systemic organs of chicks,comparable to the effect of phage-only treatment.In contrast with phage-only treatment,the combined therapy significantly improved the rate of body-weight change from the day of infection to necropsy(P<0.0001)and alleviated infection-associated splenomegaly(P=0.028)and hepatomegaly(P=0.011).In the ileum,the villus height-to-crypt depth ratio(VH/CD)increased significantly(P=0.044).In the colon,expression of tight-junction genes OCLN(P=0.014),TJP1(P<0.0001),and MUC2(P=0.011)was elevated,whereas the pro-inflammatory cytokine IL6 was reduced(P=0.018).These improvements were accompanied,in the cecum,by trends toward decreases in Escherichia-Shigella(P=0.09)and Clostridium(P=0.16)and a trend toward an increase in Blautia(P=0.11);additionally,in the ileum,Lactobacillus(P=0.037)and Blautia(P=0.016)increased significantly,yielding a more balanced microbiota than with phage-only treatment.Consistently,levels of functional metabolites,including acetic acid(LDA=3.32)and lactic acid(LDA=5.29),were increased.Conclusion Taken together,these findings demonstrate that phage-probiotic co-administration not only enhances the clearance of multidrug-resistant Salmonella more effectively than phage treatment alone but also promotes intestinal health,highlighting its potential as an antibiotic-alternatives strategy to improve intestinal health and ensure food safety in poultry production systems.展开更多
Eucalyptus(Eucalyptus camaldulensis Dehnh.)is an important exotic species in northern Nigeria commonly used for poles and timber.Sustainable management of this resource would require quantifying its volume.Stem taper ...Eucalyptus(Eucalyptus camaldulensis Dehnh.)is an important exotic species in northern Nigeria commonly used for poles and timber.Sustainable management of this resource would require quantifying its volume.Stem taper equations are one of the main and most efficient methods for estimating stem volume to any merchantable limit of a species.There is currently no taper equation for Eucalyptus species in Nigeria.Therefore,this study developed taper equations for E.camaldulensis in northern Nigeria.Data for this study were obtained from a private plantation in Jalingo Local Government Area,Taraba State,Nigeria.68 trees were felled and sectioned into 1-m bolt across the stem to a merchantable limit of 5 cm,which were used as the fitting dataset.An additional 22 trees were felled and used to validate the taper equations for stem volume estimation.Seven taper equations were initially fitted to the dataset using nonlinear least squares.The best taper equation was then refitted using a nonlinear mixed-effects approach and calibrated using diameters of one to five sections from the butt end.The taper equations were numerically integrated to obtain the stem volume,which was compared with empirical volume equations.The result shows that the Kozak(Can J For Res 27(5):619-629.10.1139/x97-011,1997)equation,which included eight parameters,provided the best fit for predicting section diameters for under and over bark.The mixed-effects taper equation(NLME-TE)explained most stem diameter variations in the fitting dataset(pseudo-R2:0.986-0.987;RMSE:0.547-0.578 cm)without substantial residual trends.The validation showed that the prediction accuracy of the integrated NLME-TE improved as the number of sectional diameter measurements increased,with at least a 35%reduction in volume estimate error.For practical implementation,two calibration sectional diameter measurements taken from the butt end per tree are recommended.This approach would reduce measurement effort and cost while improving model performance.展开更多
Bio-upcycling is an emerging end-of-life strategy for the polymer waste treatment that uses the power of mi-croorganisms to biocatalyticaly convert the pre-treated polymer waste monomers into high-added materials.Poly...Bio-upcycling is an emerging end-of-life strategy for the polymer waste treatment that uses the power of mi-croorganisms to biocatalyticaly convert the pre-treated polymer waste monomers into high-added materials.Poly(ethylene terephthalate)(PET),one of the leading synthetic polyesters in the global polymer market,produced from petrol based feedstock,still has no completely green alternative to meet global demand.Therefore,putting the PET based waste into a circular loop has become one of the major challenges of plastic waste management.In that context,the present study addressed the conversion of PET containing hydrolysates collected after the thermal pretreatment into bacterial nanocellulose(BNC),nowadays one of the most promising biopolymers produced in a sustainable manner.After the optimization of the BNC production cultivated under different conditions in PET hydrolysates,in a static way,the optimal conditions(yield of 3.0 mg/ml)was applied for scaling up.To further open the applicative potential of the BNC produced from PET containing plastic waste,platinum nanoparticles were deposited onto BNC developing new catalyst active in the methanol oxidation re-action.In order to enhance BNC ability to support Pt nanoparticles,it was blended with poly(vinyl alcohol),PVA,producing new PVA/BNC composites,recognized as an improved solid support,rich in hydroxyl groups that serve as an anchor points to Pt deposition.Due to the enrichment of BNC by PVA,it was possible to prepare highly active Pt-based catalyst with only 3 wt% of loaded Pt,which significantly reduce the cost of catalyst production.The cost-effective catalyst was prepared using sodium boron hydride as a reducing agent associated with film casting and fully characterized using FTIR,TGA,XRD,XPS,TEM,SEM-EDX analysis and its potential was confirmed in methanol oxidation reaction.This study explored the circular pathway from PET plastic waste to BNC and further to its potential application in direct methanol fuel cell(DMFC).展开更多
The expansion of 5G-enabled Internet of Things(IoT)networks,while enabling transformative applications,significantly increases the attack surface and necessitates security solutions that extend beyond traditional intr...The expansion of 5G-enabled Internet of Things(IoT)networks,while enabling transformative applications,significantly increases the attack surface and necessitates security solutions that extend beyond traditional intrusion detection.Existing intrusion detection systems(IDSs)mainly operate in an open-loop manner,excelling at classification but lacking the ability for autonomous,safety-aware remediation.This gap is particularly critical in 5G environments,where manual intervention is too slow and naive automation can lead to severe service disruptions.To address this issue,we propose a novel Self-Healing Intrusion Detection System(SH-IDS)framework that develops a closed-loop cyber defense mechanism.The main technical contribution is the integration of a deep neural networkbased threat detector,which offers uncertainty-quantified predictions,with a safety-aware reinforcement learning(RL)engine formulated as a Constrained Markov Decision Process(CMDP).The CMDP explicitly models operational safety as cost constraints,and a new runtime safety shield actively adjusts any unsafe action proposed by the RL agent to the nearest safe alternative,ensuring operational integrity.Additionally,we introduce a composite utility function for the comprehensive evaluation of the system.Empirical analysis on the 5G-NIDD dataset demonstrates the superior performance of our framework:the detector achieves 98.26%accuracy,while the safe RL agent learns effective mitigation policies.Importantly,the safety shield blocked up to 70 unsafe actions under strict constraints,and analysis of the learned Q-tables confirms that the agent internalizes safety,avoiding overly disruptive actions,such as isolating nodes for minor threats.The system also maintains high efficiency with a compact model size of 121.7 KB and sub-millisecond latency,confirming its practical deployability for real-time 5G-IoT security.展开更多
Optimization is the key to obtaining efficient utilization of resources in structural design.Due to the complex nature of truss systems,this study presents a method based on metaheuristic modelling that minimises stru...Optimization is the key to obtaining efficient utilization of resources in structural design.Due to the complex nature of truss systems,this study presents a method based on metaheuristic modelling that minimises structural weight under stress and frequency constraints.Two new algorithms,the Red Kite Optimization Algorithm(ROA)and Secretary Bird Optimization Algorithm(SBOA),are utilized on five benchmark trusses with 10,18,37,72,and 200-bar trusses.Both algorithms are evaluated against benchmarks in the literature.The results indicate that SBOA always reaches a lighter optimal.Designs with reducing structural weight ranging from 0.02%to 0.15%compared to ROA,and up to 6%–8%as compared to conventional algorithms.In addition,SBOA can achieve 15%–20%faster convergence speed and 10%–18%reduction in computational time with a smaller standard deviation over independent runs,which demonstrates its robustness and reliability.It is indicated that the adaptive exploration mechanism of SBOA,especially its Levy flight–based search strategy,can obviously improve optimization performance for low-and high-dimensional trusses.The research has implications in the context of promoting bio-inspired optimization techniques by demonstrating the viability of SBOA,a reliable model for large-scale structural design that provides significant enhancements in performance and convergence behavior.展开更多
Background and purpose: Lifelong endurance exercise is generally associated with cardiovascular health benefits.However, recent studies suggest that prolonged high-volume training may contribute to coronary atheroscle...Background and purpose: Lifelong endurance exercise is generally associated with cardiovascular health benefits.However, recent studies suggest that prolonged high-volume training may contribute to coronary atherosclerosis,even in athletes with low traditional cardiovascular risk. This case report aims to explore the cardiovascular status of a master endurance athlete with an exceptionally high lifetime training volume, in light of recent concerns raised in the literature.Methods: We present the case of a 60-year-old recreational male marathon runner with no history of cardiovascular disease, who completed over 500 marathons between the ages of 30 and 60 years, covering ~127 000-km running. In 2024 alone, he completed 60 marathons. Cardiovascular evaluation included clinical risk assessment and coronary computed tomography angiography(CTCA).Results: The runner was asymptomatic, had a low ESC-SCORE2(3.3%), a favorable lipid profile, and normal levels of high-sensitivity C-reactive protein and lipoprotein(a). CTCA revealed no evidence of calcified, mixed, or non-calcified coronary plaques.Conclusions: This case highlights that some master athletes may demonstrate resilience to coronary atherosclerosis despite decades of high training volume. In low-risk individuals, prolonged endurance training alone may not necessarily lead to coronary artery disease, emphasizing the need for individualized cardiovascular screening strategies.展开更多
This study aims to divide traffic into meaningful clusters （regimes） and to investigate their impact on accident likelihood and accident severity. Furthermore, the likelihood of pow- ered-two-wheelers （PTWs） invol...This study aims to divide traffic into meaningful clusters （regimes） and to investigate their impact on accident likelihood and accident severity. Furthermore, the likelihood of pow- ered-two-wheelers （PTWs） involvement in an accident is examined. To achieve the aims of the study, traffic and accident data during the period 2006-2011 from two major arterials in Athens were collected and processed. Firstly, a finite mixture cluster analysis was imple- mented to classify traffic into clusters. Afterwards, discriminant analysis was carried out in order to correctly assign new cases to the existing regimes by using a training and a testing set. Lastly, Bayesian logistic regression models were developed to investigate the impact of traffic regimes on accident likelihood and severity. The findings of this study suggest that urban traffic can be divided into different regimes by using average traffic occupancy and its standard deviation, measured by nearby upstream and downstream loop detectors. The results revealed potential hazardous traffic conditions, which are discussed in the paper. In general, high occupancy values increase accident likelihood, but tend to lead slight acci- dents, while PTWs are more likely to be involved in an accident, when traffic occupancy is high. Transitions from high to low occupancy also increase accident likelihood.展开更多
Machine learning(ML)is a type of artificial intelligence that assists computers in the acquisition of knowledge through data analysis,thus creating machines that can complete tasks otherwise requiring human intelligen...Machine learning(ML)is a type of artificial intelligence that assists computers in the acquisition of knowledge through data analysis,thus creating machines that can complete tasks otherwise requiring human intelligence.Among its various applications,it has proven groundbreaking in healthcare as well,both in clinical practice and research.In this editorial,we succinctly introduce ML applications and present a study,featured in the latest issue of the World Journal of Clinical Cases.The authors of this study conducted an analysis using both multiple linear regression(MLR)and ML methods to investigate the significant factors that may impact the estimated glomerular filtration rate in healthy women with and without non-alcoholic fatty liver disease(NAFLD).Their results implicated age as the most important determining factor in both groups,followed by lactic dehydrogenase,uric acid,forced expiratory volume in one second,and albumin.In addition,for the NAFLD-group,the 5th and 6th most important impact factors were thyroid-stimulating hormone and systolic blood pressure,as compared to plasma calcium and body fat for the NAFLD+group.However,the study's distinctive contribution lies in its adoption of ML methodologies,showcasing their superiority over traditional statistical approaches(herein MLR),thereby highlighting the potential of ML to represent an invaluable advanced adjunct tool in clinical practice and research.展开更多
Azoospermia is characterized by the absence of sperm in the ejaculate and is categorized into obstructive azoospermia(OA)and nonobstructive azoospermia(NOA).For men with NOA,testicular sperm extraction(TESE)is the onl...Azoospermia is characterized by the absence of sperm in the ejaculate and is categorized into obstructive azoospermia(OA)and nonobstructive azoospermia(NOA).For men with NOA,testicular sperm extraction(TESE)is the only method to obtain sperm for assisted reproductive technology(ART).Given the rarity of these sperm and the unpredictable success of subsequent retrieval attempts,cryopreservation of microdissection-TESE-obtained sperm is essential.Effective cryopreservation prevents the need for repeated surgical procedures and supports future ART attempts.After first delving into the physiological and molecular aspects of sperm cryopreservation,this review aims to examine the current methods and devices for preserving small numbers of sperm.It presents conventional freezing and vitrification techniques,evaluating their respective strengths and limitations in effectively preserving rare sperm,and compares the efficacy of using fresh versus cryopreserved testicular sperm.展开更多
BACKGROUND Pubic ramus fractures are generally considered fragility fractures in the elderly population,commonly deriving from a low-impact fall.Treatment is ordinarily conservative and hemodynamic complications are e...BACKGROUND Pubic ramus fractures are generally considered fragility fractures in the elderly population,commonly deriving from a low-impact fall.Treatment is ordinarily conservative and hemodynamic complications are exceedingly infrequent.Notwithstanding,patients with copious comorbidities should be carefully monitored for potential vascular injury.CASE SUMMARY This case report presents the management of a 75-year-old male patient with a history of diabetes mellitus and arterial hypertension who was admitted to the emergency room with a superior pubic ramus fracture.The patient experienced a significant drop in hematocrit and hemoglobin levels post-admission,necessi-tating urgent intervention.A computed tomography angiography revealed active bleeding,leading to the embolization of the medial femoral branch.The patient was stabilized hemodynamically and was discharged after 15 days,with recom-mendations for home-based follow-up care.CONCLUSION This report denotes the various challenges and strategies in managing simple fractures that are treated conservatively,but need prompt monitoring for occult vascular injuries that can be fatal.展开更多
The estimated annual incidence of out-of-hospital cardiac arrest(OHCA)is approximately 120 cases per 100000 inhabitants in western countries.Although the rates of bystander cardiopulmonary resuscitation(CPR)and use of...The estimated annual incidence of out-of-hospital cardiac arrest(OHCA)is approximately 120 cases per 100000 inhabitants in western countries.Although the rates of bystander cardiopulmonary resuscitation(CPR)and use of automated external defibrillator are increasing,the likelihood of survival to hospital discharge is no more than 8%.To date,various devices and methods have been utilized in the initial CPR approach targeting to improve survival and neurological outcomes in OHCA patients.The aim of this review is to discuss strategies that facilitate resuscitation,increase the chance to achieve return to spontaneous circulation and improve survival to hospital discharge and neurological outcomes in the prehospital setting.展开更多
BACKGROUND Gastric neuroendocrine tumors(G-NETs)are rare tumors originating from enterochromaffin-like cells,with an incidence of 0.4 per 100000 annually.There are three main types:(1)Type I,linked to chronic atrophic...BACKGROUND Gastric neuroendocrine tumors(G-NETs)are rare tumors originating from enterochromaffin-like cells,with an incidence of 0.4 per 100000 annually.There are three main types:(1)Type I,linked to chronic atrophic gastritis and hypergastrinemia,makes up 75%–80%of G-NETs;(2)Type II,associated with Zollinger-Ellison syndrome(ZES)and multiple endocrine neoplasia,comprises 5%;and(3)Type III,sporadic tumors with a higher metastatic potential,accounting for 15%–25%.Diagnosis involves endoscopy,biopsy,and histological examination.Additional methods include serum gastrin testing,immunohistochemistry,and imaging techniques such as computer tomography or magnetic resonance imaging for detecting metastasis.Type I treatment usually involves endoscopic resection(ER),with surgical resection for recurrence.Somatostatin analogs(SSAs)can reduce tumor size,and the prognosis is generally excellent.Type II treatment centers on surgical removal of the gastrinoma,with ER for smaller lesions and SSAs for symptom management.Type III requires surgical resection(partial or total gastrectomy)with lymph node dissection,and possibly chemotherapy.This type has a worse prognosis due to its aggressive nature.Emerging treatments like Peptide Receptor Radionuclide Therapy are promising for advanced cases,and ongoing research into immunotherapies is expanding future treatment options.Regular endoscopic follow-up is crucial to monitor for recurrence or metastasis across all types.Our literature review explores the current perspectives on G-NETs and highlights the importance of further research to improve diagnostic precision and treatment,particularly for those associated with less favorable cases.AIM To improve diagnostic precision and treatment,particularly for those associated with less favorable cases.METHODS A systematic search was conducted in PubMed,Scopus,and Web of Science until September 2024.Two independent reviewers screened titles,abstracts,and full texts for eligibility based on G-NET treatment in adults.Eligible studies included cohort studies,clinical trials,case series,and case reports,while in vitro,pediatric,and non-English studies were excluded.Relevant data were extracted independently,and disagreements were resolved through discussion.Study quality was assessed using appropriate tools.RESULTS G-NETs are rare,classified into three types:(1)Type I;(2)Type II;and(3)Type III.Type I G-NETs,often associated with chronic atrophic gastritis,are typically slow-growing and low-grade,with favorable outcomes following surgical resection.Type II G-NETs arise in hypergastrinemia conditions like multiple endocrine neoplasia and ZES,showing moderate malignancy risk.Type III G-NETs,the most aggressive and least common,present with distant metastases and poor prognosis.Diagnosis relies on endoscopy,imaging,and biomarkers like chromogranin A.Treatment varies by type,ranging from ER to aggressive surgery and chemotherapy for advanced cases.Regular follow-up is essential to monitor recurrence,particularly for type III G-NETs.CONCLUSION G-NETs require tailored diagnosis and treatment based on type and stage.Types I and II generally have better prognosis,while types III and IV are linked to poorer outcomes due to invasion and metastasis.Treatment strategies vary from ER for type I to extensive surgery for type III.Emerging therapies,like somatostatin analogs and peptide-receptor radionuclide therapies,show promise in advanced cases.Further research is essential to improve early diagnosis and treatment,particularly for high-risk lesions.展开更多
文摘Athens, a metropolis characterized by agglutination and compactness, but at the same time facing numerous urban and transport issues, saw its population swell during the 20th century which led to extensive urbanization phenomena. This continued urbanization increases profoundly all urban activities with transportation being the key driver in energy consumption. Theories for sustainable cities prerequisite are the integration of a number of acts in order to reduce energy consumption, with mobility being the first consideration among others. The aim of this paper is to critically explore implemented policies and plans as well as forthcoming strategic plans in terms of sustainable mobility as imposed in large scale regeneration plans in contemporary Athens. Research focuses on strategic interventions since the 1980s, such as the Athenian Daktylios （ring road for circulation management） and its later adjustments, the upcoming pedestrianization and unification of the commercial triangle and its subsequent tram line extension as well as the notable implementation of the metropolitan cycling network. Moreover, the discussion takes into consideration the implications of the Greek economic crisis in mobility choices, as aimless travels have been reduced to a minimum, several cars have been abandoned and cyclists seem to tentatively claim some space in the urban environment. What will likely be the next day in the Athenian historic centre？ Considering the transformations that are expected in the immediate future, this research paper explores their potential to enhance urban environment, reduce climate change impacts and amplify resilience.
文摘AIM: To assess the prevalence of hepatitis B and C serological markers in a population of refugees living in Athens.METHODS: One hundred and thirty refugees (81 males and 49 females, mean age ±SD: 31.7±8 years) were included in the study. The hepatitis B virus surface antigen (HBsAg),the hepatitis B virus core antibody (anti-HBc) and the hepatitis C virus antibody (anti-HCV) were detected using a third-generation immunoassay.RESULTS: Twenty individuals (15.4%) were HBsAg positive and 69 (53.1%) were anti-HBc positive. The prevalence of HBsAg and anti-HBc was higher among refugees from Albania and Asia (statistical significant difference, P＜0.008 and P＜0.001 respectively). The prevalence of these markers was found irrelevant to age or sex. Anti-HCV was detected in the serum of 3 individuals (2.3 %). No differences among age, sex or ethnicity regarding anti-HCV prevalence were found.CONCLUSION: It can be concluded that refugees living in Athens are an immigrant population characterized by a high incidence of HBV infection. The prevalence of HBV markers is higher among refugees from Albania and Asia. It is therefore believed that the adherence to general precautions and the initiation of HBV vaccination programs will be necessary in the future, especially in these communities.Although the prevalence of HCV infection seems to be relatively low, extended epidemiological surveys are needed to provide valid results.
文摘Earth observation (EO) provides the opportunity for periodic and spatially detailed assessment of the state of the environment in urban areas. In this study, the potential of EO based indicators (EI) to assess the state of environment in the urban agglomeration of Athens (UAA) is examined. EO based indicators as used in the study, include land surface temperature, land use, land cover and aerosols distribution. The indicators are also related to the household density and population density, as extracted from census data, for the same area. Indicators are applied at the municipal scale and are also used to estimate an aggregate environmental indicator (AEI), at municipal scale, by integrating all indicators mentioned above in a GIS environment. It is found that the urban agglomeration of Athens is practically “dichotomized”, by being divided in a western and eastern area, with considerably different environmental conditions. Results are considered important for focused interventions supporting environmental urban planning, whereas they represent the high potential of EO based indicators to monitor and assess the state of the urban environment.
基金supported by the CIRP-5G Project(Business Finland)(No.6937/31/2021)the Otto A.Malm Foundation.
文摘Power system protection has evolved significantly due to the ongoing energy transition and digitalization.The development and standardization of information and communication technologies(ICTs)used for power system protection,monitoring,and control have led to the digitalization of substations and the introduction of new protection and control schemes.These include virtualized centralized protection and control for in-tra-substation applications,as well as advanced wide-area monitoring,protection,and control(WAMPAC)for inter-substation applications.This paper reviews the development of virtualized centralized protection,with a focus on key practical advancements,emerging technolo-gies,and state-of-the-art studies in centralized protection and control(CPC)and WAMPAC systems.It also identifies directions for future research.
文摘The retrospective study by Edwar et al reinforces the role of therapeutic penetrating keratoplasty(PK)as a vital intervention in severe,treatment-resistant infectious keratitis.In advanced cases—often complicated by trauma,delayed presentation,and corneal perforation—PK restores globe integrity and provides limited visual recovery.However,its application is constrained by graft-related complications and donor shortages,particularly in low-resource settings.These limitations highlight the need for earlier,globe-sparing strategies to prevent progression and reduce surgical demand.Photoactivated chromophore for infectious keratitis-corneal collagen cross-linking(PACK-CXL)has emerged as a promising adjunct or alternative.With both antimicrobial and tissue-stabilizing effects,PACK-CXL may control infection and preserve corneal structure in earlier stages.A layered treatment framework that incorporates PACK-CXL as an initial intervention and reserves PK for refractory cases may help improve clinical outcomes.Further studies are needed to define their best use in practice.
文摘Latest digital advancements have intensified the necessity for adaptive,data-driven and socially-centered learning ecosystems.This paper presents the formulation of a cross-platform,innovative,gamified and personalized Learning Ecosystem,which integrates 3D/VR environments,as well as machine learning algorithms,and business intelligence frameworks to enhance learner-centered education and inferenced decision-making.This Learning System makes use of immersive,analytically assessed virtual learning spaces,therefore facilitating real-time monitoring of not just learning performance,but also overall engagement and behavioral patterns,via a comprehensive set of sustainability-oriented ESG-aligned Key Performance Indicators(KPIs).Machine learning models support predictive analysis,personalized feedback,and hybrid recommendation mechanisms,whilst dedicated dashboards translate complex educational data into actionable insights for all Use Cases of the System(Educational Institutions,Educators and Learners).Additionally,the presented Learning System introduces a structured Mentoring and Consulting Subsystem,thence reinforcing human-centered guidance alongside automated intelligence.The Platform’s modular architecture and simulation-centered evaluation approach actively support personalized,and continuously optimized learning pathways.Thence,it exemplifies a mature,adaptive Learning Ecosystem,supporting immersive technologies,analytics,and pedagogical support,hence,contributing to contemporary digital learning innovation and sociotechnical transformation in education.
文摘Purpose:ATLAS is a cross-sectional study aiming to investigate environmental and genetic determinants of athletic performance in healthy Greek competitive athletes(CA).This article presents the study design,investigates the muscle strength performance(MSP)of 289 adult and teenage CA,exercisers,and physically inactive individuals(PI),and proposes predictive models of MSP for adults.Methods:Muscle maximal,speed,and explosive strength(MMS/MSS/MES)at unilateral maximal concentric flexion and extension contraction(FC/EC)were evaluated using Biodex System 3 PRO^(TM)at 60°/s,180°/s,and 300°/s,while additional performance markers were assessed through field ergometric testing.Participants were interviewed about their lifestyle,dietary habits,physical activity,injury,and medical history.Body composition was assessed via bioelectrical impedance.gDNA was extracted from biochemical samples and then genotyped.Statistical analysis was conducted using IBM SPSS Statistics v21.0 and R.Results:Age,fitness,and sex impacted correlations of MSP with body composition and anthropometric measurements(p<0.05).Among CA,females outperformed males in accuracy(p<0.001)while,males outperformed females in anaerobic power,MSP,speed,and endurance(p<0.001).Adult CA outperformed exercisers and PI in MMS,MSS,and MES(p<0.05).Multiple linear regression models,with predictors age,FFM,body extremity,training load explained the majority of variation in MMS(R^(2)_(adj):71.4%–88.9%),MSS(R^(2)_(adj):64.8%–78.4%),and MES(R^(2)_(adj):52.7%–68.4%)at EC,FC,and their mean(p<0.001).Conclusions:Muscle-strengthening strategies should be customized according to individual fitness levels,body composition,and anthropometric measurements.The innovative sex-specific regression models assessing MMS,MSS,and MES at EC and FC provide a framework for personalizing rehabilitation and skill-specific training strategies.
基金supported by the National Institute on Aging(Nos.AG000723 and AG000578)(to VAB)the Fondation Sante(No.19656),Greece 2.0+1 种基金the National Recovery and Resilience Plan’s flagship program TAEDR-0535850the European Research Council(No.101077374-Synapto Mitophagy)(to KP)。
文摘N umerous neurological disorders negatively impact the nervous system,either through loss of neurons or by disrupting the normal functioning of neural networks.These impairments manifest as cognitive defects,memory loss,behavioral abnormalities,and motor dysfunctions.Decades of research have significantly advanced our understanding of the pathophysiology underlying neurodegene rative diseases,including Alzheimer's disease(AD),Parkinson's disease,amyotrophic lateral sclerosis,and others.
基金supported by the National Research Foundation of Korea(NRF)grant funded by the National Research Foundation of Korea Grantfunded by the Korean government(MEST)(NRF-2021R1A2C3011051)by the Korea government(MSIT)(No.RS-2023-00218476)。
文摘Background The rapid emergence of multidrug-resistant Salmonella in poultry demands alternative control strategies beyond conventional antibiotics.In this study,we evaluated a combination of lytic Salmonella-infecting bacteriophages(SLAM_phi ST45 and SLAM_phiST56)and a probiotic bacterium Limosilactobacillus reuteri(SLAM_LAR11)in a chick model challenged with Salmonella enterica serovar Typhimurium infection.Results Co-administration with two-phage cocktail and a probiotic showed markedly reduced Salmonella colonization in the gut and systemic organs of chicks,comparable to the effect of phage-only treatment.In contrast with phage-only treatment,the combined therapy significantly improved the rate of body-weight change from the day of infection to necropsy(P<0.0001)and alleviated infection-associated splenomegaly(P=0.028)and hepatomegaly(P=0.011).In the ileum,the villus height-to-crypt depth ratio(VH/CD)increased significantly(P=0.044).In the colon,expression of tight-junction genes OCLN(P=0.014),TJP1(P<0.0001),and MUC2(P=0.011)was elevated,whereas the pro-inflammatory cytokine IL6 was reduced(P=0.018).These improvements were accompanied,in the cecum,by trends toward decreases in Escherichia-Shigella(P=0.09)and Clostridium(P=0.16)and a trend toward an increase in Blautia(P=0.11);additionally,in the ileum,Lactobacillus(P=0.037)and Blautia(P=0.016)increased significantly,yielding a more balanced microbiota than with phage-only treatment.Consistently,levels of functional metabolites,including acetic acid(LDA=3.32)and lactic acid(LDA=5.29),were increased.Conclusion Taken together,these findings demonstrate that phage-probiotic co-administration not only enhances the clearance of multidrug-resistant Salmonella more effectively than phage treatment alone but also promotes intestinal health,highlighting its potential as an antibiotic-alternatives strategy to improve intestinal health and ensure food safety in poultry production systems.
文摘Eucalyptus(Eucalyptus camaldulensis Dehnh.)is an important exotic species in northern Nigeria commonly used for poles and timber.Sustainable management of this resource would require quantifying its volume.Stem taper equations are one of the main and most efficient methods for estimating stem volume to any merchantable limit of a species.There is currently no taper equation for Eucalyptus species in Nigeria.Therefore,this study developed taper equations for E.camaldulensis in northern Nigeria.Data for this study were obtained from a private plantation in Jalingo Local Government Area,Taraba State,Nigeria.68 trees were felled and sectioned into 1-m bolt across the stem to a merchantable limit of 5 cm,which were used as the fitting dataset.An additional 22 trees were felled and used to validate the taper equations for stem volume estimation.Seven taper equations were initially fitted to the dataset using nonlinear least squares.The best taper equation was then refitted using a nonlinear mixed-effects approach and calibrated using diameters of one to five sections from the butt end.The taper equations were numerically integrated to obtain the stem volume,which was compared with empirical volume equations.The result shows that the Kozak(Can J For Res 27(5):619-629.10.1139/x97-011,1997)equation,which included eight parameters,provided the best fit for predicting section diameters for under and over bark.The mixed-effects taper equation(NLME-TE)explained most stem diameter variations in the fitting dataset(pseudo-R2:0.986-0.987;RMSE:0.547-0.578 cm)without substantial residual trends.The validation showed that the prediction accuracy of the integrated NLME-TE improved as the number of sectional diameter measurements increased,with at least a 35%reduction in volume estimate error.For practical implementation,two calibration sectional diameter measurements taken from the butt end per tree are recommended.This approach would reduce measurement effort and cost while improving model performance.
基金financially supported from the European Union’s Horizon Europe EIC Pathfinder programme under agreement No 101046758(EcoPlastiC)by the Ministry of Science,Innovation and Technological Development of the Republic of Serbia(Agreement No.451-03-66/2024-03/200042 and No.451-03-66/2024-03/2000026)by the Science Fund of the Republic of Serbia under the grant No 7739802.
文摘Bio-upcycling is an emerging end-of-life strategy for the polymer waste treatment that uses the power of mi-croorganisms to biocatalyticaly convert the pre-treated polymer waste monomers into high-added materials.Poly(ethylene terephthalate)(PET),one of the leading synthetic polyesters in the global polymer market,produced from petrol based feedstock,still has no completely green alternative to meet global demand.Therefore,putting the PET based waste into a circular loop has become one of the major challenges of plastic waste management.In that context,the present study addressed the conversion of PET containing hydrolysates collected after the thermal pretreatment into bacterial nanocellulose(BNC),nowadays one of the most promising biopolymers produced in a sustainable manner.After the optimization of the BNC production cultivated under different conditions in PET hydrolysates,in a static way,the optimal conditions(yield of 3.0 mg/ml)was applied for scaling up.To further open the applicative potential of the BNC produced from PET containing plastic waste,platinum nanoparticles were deposited onto BNC developing new catalyst active in the methanol oxidation re-action.In order to enhance BNC ability to support Pt nanoparticles,it was blended with poly(vinyl alcohol),PVA,producing new PVA/BNC composites,recognized as an improved solid support,rich in hydroxyl groups that serve as an anchor points to Pt deposition.Due to the enrichment of BNC by PVA,it was possible to prepare highly active Pt-based catalyst with only 3 wt% of loaded Pt,which significantly reduce the cost of catalyst production.The cost-effective catalyst was prepared using sodium boron hydride as a reducing agent associated with film casting and fully characterized using FTIR,TGA,XRD,XPS,TEM,SEM-EDX analysis and its potential was confirmed in methanol oxidation reaction.This study explored the circular pathway from PET plastic waste to BNC and further to its potential application in direct methanol fuel cell(DMFC).
基金appreciation to the Deanship of Research and Graduate Studies at King Khalid University for funding this work through the Large Group Project under grant number(RGP2/245/46)Princess Nourah bint Abdulrahman University Researchers Supporting Project number(PNURSP2026R333)Princess Nourah bint Abdulrahman University,Riyadh,Saudi Arabia.
文摘The expansion of 5G-enabled Internet of Things(IoT)networks,while enabling transformative applications,significantly increases the attack surface and necessitates security solutions that extend beyond traditional intrusion detection.Existing intrusion detection systems(IDSs)mainly operate in an open-loop manner,excelling at classification but lacking the ability for autonomous,safety-aware remediation.This gap is particularly critical in 5G environments,where manual intervention is too slow and naive automation can lead to severe service disruptions.To address this issue,we propose a novel Self-Healing Intrusion Detection System(SH-IDS)framework that develops a closed-loop cyber defense mechanism.The main technical contribution is the integration of a deep neural networkbased threat detector,which offers uncertainty-quantified predictions,with a safety-aware reinforcement learning(RL)engine formulated as a Constrained Markov Decision Process(CMDP).The CMDP explicitly models operational safety as cost constraints,and a new runtime safety shield actively adjusts any unsafe action proposed by the RL agent to the nearest safe alternative,ensuring operational integrity.Additionally,we introduce a composite utility function for the comprehensive evaluation of the system.Empirical analysis on the 5G-NIDD dataset demonstrates the superior performance of our framework:the detector achieves 98.26%accuracy,while the safe RL agent learns effective mitigation policies.Importantly,the safety shield blocked up to 70 unsafe actions under strict constraints,and analysis of the learned Q-tables confirms that the agent internalizes safety,avoiding overly disruptive actions,such as isolating nodes for minor threats.The system also maintains high efficiency with a compact model size of 121.7 KB and sub-millisecond latency,confirming its practical deployability for real-time 5G-IoT security.
文摘Optimization is the key to obtaining efficient utilization of resources in structural design.Due to the complex nature of truss systems,this study presents a method based on metaheuristic modelling that minimises structural weight under stress and frequency constraints.Two new algorithms,the Red Kite Optimization Algorithm(ROA)and Secretary Bird Optimization Algorithm(SBOA),are utilized on five benchmark trusses with 10,18,37,72,and 200-bar trusses.Both algorithms are evaluated against benchmarks in the literature.The results indicate that SBOA always reaches a lighter optimal.Designs with reducing structural weight ranging from 0.02%to 0.15%compared to ROA,and up to 6%–8%as compared to conventional algorithms.In addition,SBOA can achieve 15%–20%faster convergence speed and 10%–18%reduction in computational time with a smaller standard deviation over independent runs,which demonstrates its robustness and reliability.It is indicated that the adaptive exploration mechanism of SBOA,especially its Levy flight–based search strategy,can obviously improve optimization performance for low-and high-dimensional trusses.The research has implications in the context of promoting bio-inspired optimization techniques by demonstrating the viability of SBOA,a reliable model for large-scale structural design that provides significant enhancements in performance and convergence behavior.
文摘Background and purpose: Lifelong endurance exercise is generally associated with cardiovascular health benefits.However, recent studies suggest that prolonged high-volume training may contribute to coronary atherosclerosis,even in athletes with low traditional cardiovascular risk. This case report aims to explore the cardiovascular status of a master endurance athlete with an exceptionally high lifetime training volume, in light of recent concerns raised in the literature.Methods: We present the case of a 60-year-old recreational male marathon runner with no history of cardiovascular disease, who completed over 500 marathons between the ages of 30 and 60 years, covering ~127 000-km running. In 2024 alone, he completed 60 marathons. Cardiovascular evaluation included clinical risk assessment and coronary computed tomography angiography(CTCA).Results: The runner was asymptomatic, had a low ESC-SCORE2(3.3%), a favorable lipid profile, and normal levels of high-sensitivity C-reactive protein and lipoprotein(a). CTCA revealed no evidence of calcified, mixed, or non-calcified coronary plaques.Conclusions: This case highlights that some master athletes may demonstrate resilience to coronary atherosclerosis despite decades of high training volume. In low-risk individuals, prolonged endurance training alone may not necessarily lead to coronary artery disease, emphasizing the need for individualized cardiovascular screening strategies.
基金supported by the special fund for research grants of NTUA for PhD studies
文摘This study aims to divide traffic into meaningful clusters （regimes） and to investigate their impact on accident likelihood and accident severity. Furthermore, the likelihood of pow- ered-two-wheelers （PTWs） involvement in an accident is examined. To achieve the aims of the study, traffic and accident data during the period 2006-2011 from two major arterials in Athens were collected and processed. Firstly, a finite mixture cluster analysis was imple- mented to classify traffic into clusters. Afterwards, discriminant analysis was carried out in order to correctly assign new cases to the existing regimes by using a training and a testing set. Lastly, Bayesian logistic regression models were developed to investigate the impact of traffic regimes on accident likelihood and severity. The findings of this study suggest that urban traffic can be divided into different regimes by using average traffic occupancy and its standard deviation, measured by nearby upstream and downstream loop detectors. The results revealed potential hazardous traffic conditions, which are discussed in the paper. In general, high occupancy values increase accident likelihood, but tend to lead slight acci- dents, while PTWs are more likely to be involved in an accident, when traffic occupancy is high. Transitions from high to low occupancy also increase accident likelihood.
文摘Machine learning(ML)is a type of artificial intelligence that assists computers in the acquisition of knowledge through data analysis,thus creating machines that can complete tasks otherwise requiring human intelligence.Among its various applications,it has proven groundbreaking in healthcare as well,both in clinical practice and research.In this editorial,we succinctly introduce ML applications and present a study,featured in the latest issue of the World Journal of Clinical Cases.The authors of this study conducted an analysis using both multiple linear regression(MLR)and ML methods to investigate the significant factors that may impact the estimated glomerular filtration rate in healthy women with and without non-alcoholic fatty liver disease(NAFLD).Their results implicated age as the most important determining factor in both groups,followed by lactic dehydrogenase,uric acid,forced expiratory volume in one second,and albumin.In addition,for the NAFLD-group,the 5th and 6th most important impact factors were thyroid-stimulating hormone and systolic blood pressure,as compared to plasma calcium and body fat for the NAFLD+group.However,the study's distinctive contribution lies in its adoption of ML methodologies,showcasing their superiority over traditional statistical approaches(herein MLR),thereby highlighting the potential of ML to represent an invaluable advanced adjunct tool in clinical practice and research.
文摘Azoospermia is characterized by the absence of sperm in the ejaculate and is categorized into obstructive azoospermia(OA)and nonobstructive azoospermia(NOA).For men with NOA,testicular sperm extraction(TESE)is the only method to obtain sperm for assisted reproductive technology(ART).Given the rarity of these sperm and the unpredictable success of subsequent retrieval attempts,cryopreservation of microdissection-TESE-obtained sperm is essential.Effective cryopreservation prevents the need for repeated surgical procedures and supports future ART attempts.After first delving into the physiological and molecular aspects of sperm cryopreservation,this review aims to examine the current methods and devices for preserving small numbers of sperm.It presents conventional freezing and vitrification techniques,evaluating their respective strengths and limitations in effectively preserving rare sperm,and compares the efficacy of using fresh versus cryopreserved testicular sperm.
文摘BACKGROUND Pubic ramus fractures are generally considered fragility fractures in the elderly population,commonly deriving from a low-impact fall.Treatment is ordinarily conservative and hemodynamic complications are exceedingly infrequent.Notwithstanding,patients with copious comorbidities should be carefully monitored for potential vascular injury.CASE SUMMARY This case report presents the management of a 75-year-old male patient with a history of diabetes mellitus and arterial hypertension who was admitted to the emergency room with a superior pubic ramus fracture.The patient experienced a significant drop in hematocrit and hemoglobin levels post-admission,necessi-tating urgent intervention.A computed tomography angiography revealed active bleeding,leading to the embolization of the medial femoral branch.The patient was stabilized hemodynamically and was discharged after 15 days,with recom-mendations for home-based follow-up care.CONCLUSION This report denotes the various challenges and strategies in managing simple fractures that are treated conservatively,but need prompt monitoring for occult vascular injuries that can be fatal.
文摘The estimated annual incidence of out-of-hospital cardiac arrest(OHCA)is approximately 120 cases per 100000 inhabitants in western countries.Although the rates of bystander cardiopulmonary resuscitation(CPR)and use of automated external defibrillator are increasing,the likelihood of survival to hospital discharge is no more than 8%.To date,various devices and methods have been utilized in the initial CPR approach targeting to improve survival and neurological outcomes in OHCA patients.The aim of this review is to discuss strategies that facilitate resuscitation,increase the chance to achieve return to spontaneous circulation and improve survival to hospital discharge and neurological outcomes in the prehospital setting.
文摘BACKGROUND Gastric neuroendocrine tumors(G-NETs)are rare tumors originating from enterochromaffin-like cells,with an incidence of 0.4 per 100000 annually.There are three main types:(1)Type I,linked to chronic atrophic gastritis and hypergastrinemia,makes up 75%–80%of G-NETs;(2)Type II,associated with Zollinger-Ellison syndrome(ZES)and multiple endocrine neoplasia,comprises 5%;and(3)Type III,sporadic tumors with a higher metastatic potential,accounting for 15%–25%.Diagnosis involves endoscopy,biopsy,and histological examination.Additional methods include serum gastrin testing,immunohistochemistry,and imaging techniques such as computer tomography or magnetic resonance imaging for detecting metastasis.Type I treatment usually involves endoscopic resection(ER),with surgical resection for recurrence.Somatostatin analogs(SSAs)can reduce tumor size,and the prognosis is generally excellent.Type II treatment centers on surgical removal of the gastrinoma,with ER for smaller lesions and SSAs for symptom management.Type III requires surgical resection(partial or total gastrectomy)with lymph node dissection,and possibly chemotherapy.This type has a worse prognosis due to its aggressive nature.Emerging treatments like Peptide Receptor Radionuclide Therapy are promising for advanced cases,and ongoing research into immunotherapies is expanding future treatment options.Regular endoscopic follow-up is crucial to monitor for recurrence or metastasis across all types.Our literature review explores the current perspectives on G-NETs and highlights the importance of further research to improve diagnostic precision and treatment,particularly for those associated with less favorable cases.AIM To improve diagnostic precision and treatment,particularly for those associated with less favorable cases.METHODS A systematic search was conducted in PubMed,Scopus,and Web of Science until September 2024.Two independent reviewers screened titles,abstracts,and full texts for eligibility based on G-NET treatment in adults.Eligible studies included cohort studies,clinical trials,case series,and case reports,while in vitro,pediatric,and non-English studies were excluded.Relevant data were extracted independently,and disagreements were resolved through discussion.Study quality was assessed using appropriate tools.RESULTS G-NETs are rare,classified into three types:(1)Type I;(2)Type II;and(3)Type III.Type I G-NETs,often associated with chronic atrophic gastritis,are typically slow-growing and low-grade,with favorable outcomes following surgical resection.Type II G-NETs arise in hypergastrinemia conditions like multiple endocrine neoplasia and ZES,showing moderate malignancy risk.Type III G-NETs,the most aggressive and least common,present with distant metastases and poor prognosis.Diagnosis relies on endoscopy,imaging,and biomarkers like chromogranin A.Treatment varies by type,ranging from ER to aggressive surgery and chemotherapy for advanced cases.Regular follow-up is essential to monitor recurrence,particularly for type III G-NETs.CONCLUSION G-NETs require tailored diagnosis and treatment based on type and stage.Types I and II generally have better prognosis,while types III and IV are linked to poorer outcomes due to invasion and metastasis.Treatment strategies vary from ER for type I to extensive surgery for type III.Emerging therapies,like somatostatin analogs and peptide-receptor radionuclide therapies,show promise in advanced cases.Further research is essential to improve early diagnosis and treatment,particularly for high-risk lesions.
