Search Results (3,052)

Climate change-induced alterations in monsoon patterns have exacerbated flooding challenges in Balochistan, Iran. This study addresses the urgent need for improved flood prediction methodologies in data-scarce arid regions by integrating the Muskingum–Cunge model with advanced optimization techniques. Particle swarm optimization (PSO) and harmony search (HS) algorithms were applied and compared across eight major rivers in Balochistan, each with distinct hydrological characteristics. A comprehensive multi-metric evaluation framework was developed to assess the performance of these algorithms. The results demonstrate PSO’s superior performance, particularly in complex terrain conditions. For instance, at the Kajou station, PSO improved the Coefficient of Residual Mass (CRM) by 0.01, efficiency (EF) by 0.92, Agreement Index (d) by 0.98, and Normalized Root Mean Square Error (NRMSE) by 0.10 compared to HS. Correlation coefficients ranging from 0.6558 to 0.9645 validate the methodology’s effectiveness in data-scarce environments. This research provides valuable insights into algorithm performance under limited data conditions and offers region-specific parameter optimization guidelines for similar geographical contexts. By advancing flood routing science and providing a validated framework for optimization algorithm selection, this study contributes to improved flood management in regions vulnerable to climate change. Full article

Images often suffer from various types of noise during their collection and transmission, such as salt-and-pepper, speckle, and Gaussian noise. The wavelet transform (WT) is widely utilized for denoising. However, the decomposition level and threshold significantly impact the quality of the resulting images, but they are difficult to set. This paper uses a modified whale optimization algorithm (MWOA) to optimize the parameters of the WT to achieve better image denoising. The MWOA is enhanced through position updates and mutation to improve the solution quality of WOA and enlarge the search space of the WT. In benchmark images, experimental comparisons with other optimization algorithms like WOA, adaptive cuckoo search (ACS), and social spider optimization (SSO) show that the proposed denoising method achieves superior results in terms of the peak signal-to-noise ratio (PSNR), mean square error (MSE), and structural similarity index (SSIM). Full article

Background: This systematic review assesses the role of the Cooperative Health Insurance System (CHIS) in achieving Universal Health Coverage (UHC) in Saudi Arabia’s evolving healthcare system by consolidating and analyzing findings from diverse studies to provide a comprehensive overview of CHIS’s impact and also identifies contextual challenges and practical insights that can inform similar reforms globally. Methods: We report results following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The following six databases were searched for relevant studies: PubMed, Scopus, CINAHL, Business Source Complete, APA PsycINFO, and SocIndex. The review protocol was registered with PROSPERO. Inclusion criteria focused on studies examining the impact of CHIS on the UHC dimensions based on the following themes: population covered, affordability, quality, efficiency, access, services covered, and financial coverage. The initial search identified 1316 publications. Results: A total of 30 studies met the inclusion criteria. Our synthesis indicates that CHIS has significantly improved healthcare access and quality, particularly in the private sector. CHIS was also associated with increased healthcare efficiency through standardized benefit packages and reduced out-of-pocket expenditures. However, these studies noted challenges such as rising insurance premiums, infrastructural deficiencies, and cultural barriers. Conclusions: CHIS is integral to Saudi Arabia’s healthcare reform, substantially contributing to UHC’s objectives. Despite notable advances, continuous efforts are needed to address existing challenges and expand coverage. The findings suggest that enhanced government support and public awareness are crucial for advancing UHC goals in Saudi Arabia. Full article

Background: Hepatitis E virus (HEV) is a leading cause of acute viral hepatitis in adults. The schedule for HEV 239, the only approved anti-HEV vaccine, consists of three doses at 0, 1, and 6 months, which is unsuitable for use in emergency and outbreak situations where quick protection is desired. We, therefore, undertook a systematic review of data on immunogenicity, efficacy, and effectiveness of alternative accelerated schedules. Methods: Data sources on immunogenicity, efficacy, and effectiveness of the HEV 239 vaccine following accelerated schedules published between 22 January 2005 and February 2024 were identified from five electronic databases, and the relevant data were extracted. Results: The search identified seven relevant reports, including one phase II pre-licensure trial, three reports from the phase III licensure trial, and three post-licensure reports. In these studies, following administration of the HEV 239 vaccine in two doses at 0 and 1 month or a three-dose rapid (0, 7, and 21 days) schedule, anti-HEV antibody seroconversion rates were similar to and geometric mean concentrations of anti-HEV antibody were only slightly lower than those following the standard three-dose schedule. In individuals who were seropositive for anti-HEV antibodies at baseline, the antibody response persisted for several years irrespective of the number of vaccine doses, and in those who were seronegative at baseline, administration of two vaccine doses induced antibodies whose level remained substantially high till at least 13 months of follow-up. Administration of two doses was also associated with a high protective efficacy against HEV infection and associated disease. Conclusions: The available data indicate that two doses of HEV 239 administered one month apart confer sufficiently high antibody titers and protection for at least 13 months, a duration which should be adequate for its use as an outbreak control measure. Full article

Avian Metapneumovirus (aMPV) is a significant poultry pathogen with a global presence, primarily causing respiratory issues in turkeys. It also affects chickens, although the severity of its impact is often lessened in this species. In Morocco, aMPV has been detected in broiler flocks, prompting the need to deeply analyze circulating strains to better understand the epidemiology and develop control measures accordingly. This research focuses on the sequencing and molecular characterization of aMPV in these flocks. Additionally, aMPV isolated from turkeys displaying Turkey Rhinotracheitis (TRT) signs was included in the study to compare the findings. RNA extracted from positive swabs was subjected to nested PCR, targeting the attachment protein of the G gene, followed by gel electrophoresis. Amplicons were purified and sequenced using the Sanger method. Bioinformatics tools facilitated sequence analyses, including BLAST for similarity searches and Mega^® for phylogenetic analysis using the maximum likelihood method with 1000 bootstrap replicates. The investigation unveiled the existence of two distinct clades of the aMPV/B isolates, which originated from used vaccines, all circulating in broilers and turkeys and indicating potential virus transmission between both poultry species. This article presents the first-ever molecular characterization of aMPV isolated from Moroccan broilers and turkeys, encompassing comprehensive investigations on its presence and subtype, and genetic characterization. Full article

As a critical component of the engine, the failure of aviation fuel pumps can lead to serious safety accidents, necessitating the development of effective maintenance programs. Fault Tree Analysis (FTA) has a clear structure and strong interpretability in maintenance decision making. However, it heavily relies on expert knowledge, which is subject to uncertainty and incoherence. Therefore, this paper proposes the NOA (Nutcracker Optimization Algorithm)–GNN (Graph Neural Network) model to enhance the accuracy and robustness of FTA by mitigating the uncertainty and inconsistency in expert knowledge. The NOA algorithm efficiently searches the solution space to identify globally optimal solutions. An FTA-TOPSIS (Technique for Order of Preference by Similarity to Ideal Solution) maintenance decision-making framework has also been developed. By integrating FTA with TOPSIS, the proposed method provides a comprehensive and systematic approach that combines qualitative and quantitative analyses, thereby improving the effectiveness and reliability of maintenance decision making. Full article

Background: Renal adverse drug reactions (ADRs) associated with tyrosine kinase inhibitors (TKIs) in the treatment of chronic myeloid leukemia (CML) are relatively rare, and there is currently no standardized protocol for their management. Therefore, this study aimed to summarize renal ADRs related to TKIs use in CML and propose an evidence-based approach to monitor and manage these ADRs. Methods: A systematic literature review was performed to identify renal ADRs associated with TKIs in CML. Two authors screened the search results and extracted data from 37 eligible studies. These findings were then used to develop a scheme for clinicians to monitor and manage these ADRs. Results: Overall, imatinib seemed to be significantly linked to renal adverse events compared to other TKIs, and switching to dasatinib or nilotinib significantly improved renal function. Similar events were reported with bosutinib, although they were not statistically significant. However, most of the renal events reported on dasatinib were described as nephrotic syndrome that resolved with switching to imatinib. Few cases were reported with nilotinib that described tumor lysis syndrome (TLS)-related kidney injury. Conclusions: Recommendations include monitoring for progressive decline in the estimated glomerular filtration rate with imatinib, nephrotic syndrome with dasatinib, and TLS with nilotinib. Additionally, holding the offending TKI and managing renal ADRs according to local guidelines were adopted more frequently than reducing the TKI dose. Full article

Background/Objectives: Laurocapram (Azone) attracted attention 40 years ago as a compound with the highest skin-penetration-enhancing effect at that time; however, its development was shelved due to strong skin irritation. We had already prepared and tested an ante-enhancer (IL-Azone), an ionic liquid (IL) with a similar structure to Azone, consisting of ε-caprolactam and myristic acid, as an enhancer candidate that maintains the high skin-penetration-enhancing effect of Azone with low skin irritation. In the present study, fatty acids with different carbon numbers (caprylic acid: C8, capric acid: C10, lauric acid: C12, myristic acid: C14, and oleic acid: C18:1) were selected and used with ε-caprolactam to prepare various IL-Azones in the search for a more effective IL-Azone. Methods: Excised porcine skin was pretreated with each IL-Azone to assess the in vitro skin permeability of antipyrine (ANP) as a model penetrant. In addition, 1,3-butanediol was selected for the skin permeation test to confirm whether the effect of IL-Azone was due to fatty acids and if this effect differed depending on the concentration of IL-Azone applied. Results: The results obtained showed that C12 IL-Azone exerted the highest skin-penetration-enhancing effect, which was higher than Azone. On the other hand, many of the IL-Azones tested had a lower skin-penetration-enhancing effect. Conclusions: These results suggest the potential of C12 IL-Azone as a strong and useful penetration enhancer. Full article

Ginseng has multi-directional pharmacological properties. Some data suggest that ginseng can enhance physical endurance, which, in turn, leads to protection of the cardiovascular system. However, not all experiments are conclusive. For this reason, the main aim of this research was to perform a meta-analysis and review of studies published between the years 2013 and 2023 concerning the ginseng effect on physical performance in animal and human models. Medline, Pubmed, and ClinicalKey electronic databases were used to analyze data. The search strategy included the following criteria: ginseng and exercise; ginseng supplementation; and ginseng supplements. The results suggest that ginseng supplementation may have a positive effect on CK levels in animal studies. Similar observations were stated in relation to serum lactate and BUN. Furthermore, a human study showed a significant increase in exercise time to exhaustion and VO2 max after supplementation. The review of the literature and conducted meta-analysis identified that ginseng supplementation may have a positive effect on exercise endurance. Due to the fact that most of the current studies were based on animal models, further research on human models is needed to identify the most effective dosage or form of applied ginseng to be a supportive element in CVD management. Full article

This study mainly addresses the issues of an excessive model parameter count and computational complexity in Detection Transformer (DETR) for remote sensing object detection and similar neural networks. We propose an innovative neural network pruning method called “ant colony evolutionary pruning (ACEP)” which reduces the number of parameters in the neural network to improve the performance and efficiency of DETR-based neural networks in the remote sensing field. To retain the original network’s performance as much as possible, we combine population evolution and ant colony algorithms for dynamic search processes to automatically find efficient sparse sub-networks. Additionally, we design three different sparse operators based on the structural characteristics of DETR-like neural networks. Furthermore, considering the characteristics of remote sensing objects, we introduce sparsity constraints to each network layer to achieve efficient network pruning. The experimental results demonstrate that ACEP is effective on various DETR-like models. After removing a significant number of redundant parameters, it greatly improves the inference speed of these networks when performing remote sensing object detection tasks. Full article

Background: Vulvar epidermolytic hyperkeratosis (EHK) is an exceedingly rare dermatological condition, often presenting as solitary or multiple lesions in the vulvar region. Due to its clinical resemblance to other vulvar disorders, such as condyloma acuminatum, Bowenoid papulosis, and squamous cell carcinoma, vulvar EHK poses significant diagnostic challenges. While individual case reports and small case series have documented instances of vulvar EHK, comprehensive studies systematically consolidating the clinical, histopathological, and therapeutic aspects of this condition remain lacking. Objectives: To address this gap, this systematic review consolidates all available case reports and case series on vulvar EHK. The review aims to provide a comprehensive analysis of clinical presentations, histopathological features, diagnostic challenges, treatment approaches, and patient outcomes. Methods: We conducted a systematic review following the PRISMA guidelines. We searched multiple databases (PubMed, Web of Science, Scopus) for studies published up to 30 September 2024. Only case reports and case series with histopathologically confirmed vulvar EHK were included, as no higher-level studies (e.g., randomized controlled trials or cohort studies) were available due to the rarity of this condition. Exclusion criteria were male cases, oral EHK or other unrelated conditions, and literature reviews. We extracted and analyzed data on: patient demographics, time to diagnosis, anatomical distribution, clinical presentation, associated symptoms, histopathological features, patient history, risk factors, HPV status, treatment, and outcomes. Risk of bias was assessed using the CARE checklist and JBI Checklist for Case Series. Additionally, original clinical and histopathological images from our department were included to enhance the review. Results: A total of 19 studies, encompassing 30 cases of histopathologically confirmed vulvar EHK, were identified. Most cases presented with hyperkeratotic plaques and papules localized on the labia majora. Histopathological analysis consistently revealed hyperkeratosis, acanthosis, and vacuolar degeneration in the granular and spinous layers. Misdiagnosis was common, with lesions frequently mistaken for condyloma acuminatum or other vulvar neoplasms. Conservative management, including observation and topical therapies, was associated with disease stability in asymptomatic cases, while surgical excision demonstrated complete remission in all cases where it was employed. The rarity of vulvar EHK and reliance on case reports and series limit the generalizability of findings. Conclusions: Vulvar EHK is often misdiagnosed due to its similarity to malignancies and sexually transmitted infections. This review, the first of its kind, highlights the importance of prompt histopathological diagnosis to avoid the psychological impact of a cancer or sexually transmitted disease diagnosis and unnecessary, distressing, or aggressive treatments. Further research is needed to explore the role of HPV in vulvar EHK and to establish standardized diagnostic and treatment guidelines. Full article

Background: Strangulation by ligature, most frequently employed for homicidal purposes, is not a common suicide method. Even more infrequent is the use by the victim of cable ties as a tool of self-strangulation. Methods: We describe a case of a 50-year-old woman who was found dead with a cable tie tight around her neck. In our case, analysis of the circumstantial data and the psychopathological history of the victim—along with an external examination, an autopsy, and toxicological findings—was crucial in the differential diagnosis between death intentionally inflicted by a third person and suicide. Through a narrative review conducted by performing a literature search using online resources (PubMed, Google Scholar, and ScienceDirect). Results: we were only able to identify eight similar cases. Conclusions: These were compared with our case, to trace similarities and differences, useful in guiding the forensic doctor in the diagnosis of death in such circumstances. Full article

Objectives: The aim of this study was to systematically revise the state of art of the accuracy of digital and conventional impressions in clinical full-arch scenarios. Methods: Electronic and manual searches were conducted up to December 2024. Only trials comparing the accuracy of digital versus conventional impressions were selected by two independent reviewers. Accuracy was evaluated by analysing the fit of the prostheses obtained through conventional workflows and those obtained from digital workflows using intraoral scanners. Alternatively, accuracy was assessed by comparing the standard tessellation language data acquired from intraoral scanning with those obtained from scanning the physical model. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. Meta-analysis was conducted to pool the mean differences from the included studies, with heterogeneity tested by Cochran’s Q test and quantified by the I² index. Results: We included 9 relevant studies from a total of 2535 identified studies. The risk of bias was evaluated as low, and the main results of all the included articles reported similar accuracy between digital and conventional impressions. Random effects meta-analysis resulted in a pooled mean difference of 152.46 (95% C.I. = 76.46–228.46, p-value < 0.001, I² = 93.48%). Conclusions: In conclusion, the results of the present systematic review reveal contradictory findings regarding the accuracy of digital impressions. However, most studies analysing the clinical performance of prostheses obtained through digital impressions suggest that their accuracy falls within clinically acceptable thresholds. Future research should report comparable outcomes and focus attention on linear deviations, comparing differences between conventional and digital impressions not in absolute terms, but relative to the distance measured. Full article

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its global spread have left an indelible mark, disrupting multiple aspects of human life. It is therefore crucial to retrospectively analyze the factors that have contributed more to the initial inefficiency of the global response, thus enhancing preparedness and proactively addressing the risk of similar events occurring in the future. Critical areas were identified based on our expertise. Relevant bibliographic references were subsequently gathered through an open search of scientific databases to substantiate the concepts discussed in this article. The key issues that hindered an effective response to coronavirus disease 2019 (COVID-19) are numerous and multifaceted, and some of these will be critically examined in this article, including delayed identification of the pathogen, inadequate public health preparedness, inadequate therapeutic management, and deficiencies in laboratory diagnostics. From this analysis, key areas for improvement emerge to ensure more efficient responses to future health crises, including (i) enhancing and strengthening health information systems, (ii) improving pandemic preparedness and response planning, (iii) developing a resilient healthcare workforce, (iv) increasing investment in research and development, (v) expanding the use of telemedicine and digital health, (vi) ensuring universal access to healthcare, and (vii) improving public health communication and trust. Full article

Introduction: Segmental tibial defects pose significant challenges in orthopedic surgery due to their complexity and high complication rates. This systematic review aimed to evaluate both the effectiveness and outcomes of distraction osteogenesis (D.O.) and the Masquelet technique in treating post-traumatic segmental tibial defects. Materials and Methods: A literature search was performed on PubMed, Scopus, and Cochrane. Relevant retrospective and prospective observational studies with a minimum of 12 months follow-up were included. The primary outcome was bone union rate; the secondary outcomes were the type and rate of complications and the clinical and radiological outcomes. Results: Twenty-seven studies met the inclusion criteria, 18 studies reported data on D.O. and 9 on the Masquelet technique. D.O. demonstrated an overall union rate of 79.4% across 422 patients, and the Masquelet technique demonstrated an overall bone union rate of 85% across 113 patients. For D.O., on average, there was one complication per patient, and with the Masquelet technique, there were 0.5 complications per patient. Conclusions: D.O. and the Masquelet technique are the main treatment options for post-traumatic segmental tibial defects. Although union rates are similar, the Masquelet technique showed fewer complications. Treatment choice should consider patient-specific factors and more comparative studies are needed. Full article