Search Results (199)

Background/Objectives: Autosomal dominant polycystic kidney disease (ADPKD) is a progressive genetic disorder marked by bilateral renal cysts and extrarenal manifestations, ultimately resulting in renal failure. Emerging research indicates that metformin might influence the intracellular mechanisms of ADPKD, though its clinical significance remains uncertain. Methods: We applied the Taiwan National Health Insurance Database (NHIRD) to investigate the clinical impact of metformin utilization in ADPKD patients in real-world practice. The metformin user group was defined by more than 90 days of usage. To mitigate selection bias, we established a non-user group with a 1:2 ratio, matching for age, sex, and comorbidities by a propensity score matching method. Results: A total of 10,222 ADPKD cases were identified in the NHIRD between 2009 and 2018. After matching, the metformin user group was composed of 778 cases with a mean age of 59.5 ± 13.9 years, and the non-user group of 1546 cases with a mean age of 59.3 ± 14.4 years. The time from the index date to the outcome of ESKD in ADPKD was 5.3 ± 2.2 years in the metformin user group and 5.3 ± 2.3 years in the metformin non-user group, respectively. The metformin user group exhibited a significant reduction in the risk of end-stage kidney disease (ESKD), as indicated in the fully adjusted model (0.75, 95% CI 0.58–0.97, p = 0.03). A decreased risk of major adverse cardiovascular events (MACEs) was noted in metformin users, with an adjusted hazard ratio (HR) of 0.78 (95% CI 0.65–0.95, p = 0.01). Sensitivity analysis showed similar results by excluding late-stage CKD (CKD stage 5 or erythropoietin-stimulating agents use). Conclusions: Metformin usage in real-world practice showed lower hazards of ESKD and MACEs in patients with ADPKD, except for those with advanced CKD. Full article

Background/Objectives: Cochlear implantation is the primary treatment for severe-to-profound hearing loss, yet outcomes vary significantly among recipients. While visual–auditory cross-modal reorganization has been identified as a contributing factor to this variability, its impact in early-implanted children remains unclear. To address this knowledge gap, we investigated visual processing and its relationship with auditory outcomes in children who received early bilateral cochlear implants. Methods: To examine potential cross-modal reorganization, we recorded visual evoked potentials (VEPs) in response to pattern-reversal stimuli in 25 children with cochlear implants (CIs) (mean implantation age: 1.44 years) and 28 age-matched normal-hearing (NH) controls. Analysis focused on both the occipital region of interest (ROI: O1, OZ, and O2 electrode sites) and right temporal ROI, examining VEP components and their correlation with speech perception outcomes. Results: Unlike previous studies in later-implanted children, the overall occipital ROI showed no significant differences between groups. However, the left occipital electrode (O1) revealed reduced P1 amplitudes and delayed N1 latencies in CI users. Importantly, O1 N1 latency negatively correlated with speech-in-noise performance (r = −0.318; p = 0.02). The right temporal region showed no significant differences in VEP N1 between groups and no correlation with speech performance in CI users. Conclusions: Early bilateral cochlear implantation appears to preserve global visual processing, suggesting minimal maladaptive reorganization. However, subtle alterations in left occipital visual processing may influence auditory outcomes, highlighting the importance of early intervention and the complex nature of sensory integration in this population. Full article

Background: Metabolic syndrome (MetS) is a common comorbidity associated with hypertension that occurs more often in primary aldosteronism (PA). Our work aims to investigate the prevalence of MetS and its determinants in unilateral PA and bilateral PA, as confirmed by adrenal venous sampling (AVS). Methods: This was a retrospective, cross-sectional study. We investigated metabolic indicators in 160 cases of PA, categorized by AVS—82 with unilateral PA and 78 with bilateral PA. A control group of 80 non-PA patients with essential hypertension, matched for age and sex, was also included. Results: Unilateral PA had a higher aldosterone–renin ratio and lower serum potassium levels than bilateral PA. Nevertheless, bilateral PA exhibited a higher prevalence of MetS (41% vs. 30.5%; p = 0.001), obesity, BMI, LDL hypercholesterolemia, and hypertriglyceridemia than unilateral PA. Conclusions: Bilateral PA presents a greater incidence of MetS than unilateral PA, in spite of the latter showing a higher aldosterone–renin ratio and lower serum potassium levels. The results suggest that the mechanisms underlying MetS may differ between unilateral and bilateral PA. Full article

Recovery from anterior cruciate ligament reconstruction (ACLR) induces bilateral functional and physiological adaptations. Neurophysiologic measures of motor control have focused on the involved knee joint, limiting understanding regarding the extent of bilateral neural adaptations. Therefore, the aim of this study was to investigate differences in neural activity during uninvolved-limb motor control after ACLR compared to healthy controls. Methods: Fifteen participants with left ACLR (8 female and 7 male, 21.53 ± 2.7 years, 173.22 ± 10.0 cm, 72.15 ± 16.1 kg, Tegner 7.40 ± 1.1, 43.33 ± 33.1 mo. post-surgery, 2 patellar tendon, and 13 hamstring) and 15 matched controls (8 female, 23.33 ± 2.7 years, 174.92 ± 9.7 cm, 72.14 ± 15.4 kg, Tegner 7.33 ± 1.0) participated. Neural activity was evaluated using functional magnetic resonance imaging on a 3T Siemens Magnetom scanner during four 30-s cycles of a right (uninvolved) knee flexion-extension task paced with a metronome (1.2 Hz) and was completed interspersed with 30 s of rest. A significance threshold of p < 0.05 was used for all analyses, cluster corrected for multiple comparisons, and z-thresholds of >3.1 (subject level), and >2.3 (group level). Results: The ACLR group had greater neural activity in one statistically significant cluster corresponding to the left middle frontal gyrus (MFG) (834 voxels, z = 3.81, p < 0.01 multiple comparisons corrected) compared to controls. Conclusions: These data indicate a potential contribution to uninvolved-knee neuromuscular deficits after injury and support the limitations of using the uninvolved side as a clinical reference. Uninvolved knee motor control after ACLR may require greater cognitive demand. Clinicians should be aware that the uninvolved limb might also demonstrate whole brain alterations limiting clinical inference from functional symmetry. Full article

Background: The study presents a detailed examination and follow-up of a Slovenian patient with an Leber Hereditary Optic Neuropathy (LHON)-like phenotype and bilateral optic neuropathy in whom genetic analysis identified a novel variant MT-CYB:m.15309T>C (Ile188Thr). Methods: We provide detailed analysis of the clinical examinations of a male patient with bilateral optic neuropathy from the acute stage to 8 years of follow-up. Complete ophthalmological exam, electrophysiology and optical coherence tomography (OCT) segmentation were performed. The genotype analysis was performed with a complete screening of the mitochondrial genome. Furthermore, proteomic analysis of the protein structure and function was performed to assess the pathogenicity of a novel variant of unknown significance. Mitochondrial function analysis of the patient’s peripheral blood mononuclear cells (PBMCs) was performed with the objective of evaluating the mutation effect on mitochondrial function using flow cytometry and high-resolution respirometry. Results: The patient had a profound consecutive bilateral visual loss at 19 years of age due to optic neuropathy with characteristics of LHON; however, unlike patients with typical LHON, the patient experienced a fluctuation in visual function and significant late recovery. He had a total of three visual acuity deteriorations and improvements in the left eye, with concomitant visual loss in the right eye and a final visual acuity drop reaching nadir 9 months after onset. The visual loss was characterized by centrocecal scotoma, abnormal color vision and abnormal VEP, while deterioration of PERG N95 followed with a lag of several months. The OCT examination showed retinal nerve fiber layer thinning matching disease progression. Following a two-year period of legal blindness, the patient’s visual function started to improve, and over the course of 5 years, it reached 0.5 and 0.7 Snellen (0.3 and 0.15 LogMAR) visual acuity (VA). Mitochondrial sequencing identified a presumably pathogenic variant m.15309T>C in the MT-CYB gene at 65% heteroplasmy, belonging to haplogroup K. Mitochondrial function assessment of the patient’s PBMCs showed a lower respiration rate, an increase in reactive oxygen species production and the presence of mitochondrial depolarization, compared to an age- and sex-matched healthy control’s PBMCs. Conclusions: A novel variant in the MT-CYB:m.15309T>C (Ile188Thr) gene was identified in a patient with optic nerve damage and the LHON phenotype without any additional systemic features and atypical presentation of the disease with late onset of visual function recovery. The pathogenicity of the variant is supported by proteomic analysis and the mitochondrial dysfunction observed in the patient’s PBMCs. Full article

Objectives: We wished to compare the diagnostic performance of texture analysis (TA) against that of a visual qualitative assessment in identifying early sacroiliitis (nr-axSpA). Methods: A total of 92 participants were retrospectively included at our university hospital institution, comprising 30 controls and 62 patients with axSpA, including 32 with nr-axSpA and 30 with r-axSpA, who underwent MR examination of the sacroiliac joints. MRI at 3T of the lumbar spine and the sacroiliac joint was performed using oblique T1-weighted (W), fluid-sensitive, fat-saturated (Fs) T2WI images. The modified New York criteria for AS were used. Patients were classified into the nr-axSpA group if their digital radiography (DR) and/or CT results within 7 days from the MR examination showed a DR and/or CT grade < 2 for the bilateral sacroiliac joints or a DR and/or CT grade < 3 for the unilateral sacroiliac joint. Patients were classified into the r-axSpA group if their DR and/or CT grade was 2 to 3 for the bilateral sacroiliac joints or their DR and/or CT grade was 3 for the unilateral sacroiliac joint. Patients were considered to have a confirmed diagnosis if their DR or CT grade was 4 for the sacroiliac joints and were thereby excluded. A control group of healthy individuals matched in terms of age and sex to the patients was included in this study. First, two readers independently qualitatively scored the oblique coronal T1WI and FsT2WI non-enhanced sacroiliac joint images. The diagnostic efficacies of the two readers were judged and compared using an assigned Likert score, conducting a Kappa consistency test of the diagnostic results between two readers. Texture analysis models (the T1WI-TA model and the FsT2WI-TA model) were constructed through feature extraction and feature screening. The qualitative and quantitative results were evaluated for their diagnostic performance and compared against a clinical reference standard. Results: The qualitative scores of the two readers could significantly distinguish between the healthy controls and the nr-axSpA group and the nr-axSpA and r-axSpA groups (both p < 0.05). Both TA models could significantly distinguish between the healthy controls and the nr-axSpA group and the nr-axSpA group and the r-axSpA group (both p < 0.05). There was no significant difference in the differential diagnoses of the two TA models between the healthy controls and the nr-axSpA group (AUC: 0.934 vs. 0.976; p = 0.1838) and between the nr-axSpA and r-axSpA groups (AUC: 0.917 vs. 0.848; p = 0.2592). In terms of distinguishing between the healthy control and nr-axSpA groups, both the TA models were superior to the qualitative scores of the two readers (all p < 0.05). In terms of distinguishing between the nr-axSpA and r-axSpA groups, the T1WI-TA model was superior to the qualitative scores of the two readers (p = 0.023 and p = 0.007), whereas there was no significant difference between the fsT2WI-TA model and the qualitative scores of the two readers (p = 0.134 and p = 0.065). Conclusions: Based on MR imaging, the T1WI-TA and fsT2WI-TA models were highly effective for the early diagnosis of sacroiliac joint arthritis. The T1WI-TA model significantly improved the early diagnostic efficacy for sacroiliac arthritis compared to that of the qualitative scores of the readers, while the efficacy of the fsT2WI-TA model was comparable to that of the readers. Full article

Two convex polyhedra that markedly resemble the head of the flatback sea turtle hatchling are identified. The first example is a zygomorphic tetragonal dodecahedron, while the other, an even better matching structure, is a related tetradecahedron, herein speculated to arise from this particular dodecahedron via known mechanisms gleaned from studies of the behavior of foams. A segmented, biomorphic, convex polyhedral model to address cephalic topology is thus presented stemming from solid geometry, anatomical observations, and a recently computed densest local packing arrangement of fifteen slightly oblate spheroids in which fourteen oblate spheroids surround a central such spheroid. This particular array of oblate spheroids shares salient structural features with the aforementioned dodecahedron. Successful testing of the model has been achieved by converting this array of fifteen oblate spheroids constructed with putty to the cephaloid dodecahedron in a process involving ventral elongation induced by stretching in the anterior direction along the anteroposterior axis (convergent extension). During convergent extension, the two left most anterolateral oblate spheroids that are in direct contact with the ventral spheroid of the array merge into a single lateral facet of the incipient dodecahedron, while the corresponding two right such oblate spheroids do the same. Thus, the fourteen outer oblate spheroids of the array give rise to the twelve facets of the finalized dodecahedron, while the central oblate spheroid remnant assumes an interior dodecahedral position. The hypothetical dodecahedron to tetradecahedron transformation entails the collapse of a tetravalent vertex (which is known to occur in foams as part of a T1 transition) followed by bilateral facet splitting. Remarkably, a model stipulating that convexity is to be retained in connection with this sequence of steps necessitates that the starting dodecahedral template undergoes modification to become a tetradecahedron in possession of precisely the highly ordered feature found at the top of the head of numerous specimens of the flatback sea turtle hatchling, namely, a fused medial pentagon–heptagon pair in the form of a pentagonal frontal scute and heptagonal frontoparietal scute. Such a possible new instance of geometric biomorphy, taken together with the correct anticipation of the cephalic pentagon–heptagon pair, might serve to instill further confidence in renewed efforts to shed light on morphogenesis with foam embryo models. Full article

This study examines the quarterly export data of forest products at the Harmonized System 6-digit level from China′s 31 provinces to destination economies from 2017 to 2023 to examine the impact of the Regional Comprehensive Economic Partnership agreement on bilateral forest product trade. A time-varying Difference-in-Differences model is constructed using the effective dates of the agreement for each member, combined with the Propensity Score Matching method, comparing export flows between China with member and non-member economies in the pre- and post-agreement periods. The main findings indicate that the effective commitments of the Regional Comprehensive Economic Partnership in destination economies have significantly enhanced the bilateral exports of forest products from China’s provinces. Compared with non-member destination economies, China’s exports of timber forest products to member countries increased by over 22% after the agreement came into effect, with notable increases in eastern coastal provinces and in processed forest products including wooden furniture and paper products. To maximize the promotion of forest product exports under this framework, it is suggested that China enhance transportation links between its central and western inland provinces to reduce transportation costs. Additionally, closer trade cooperation among member countries is recommended to facilitate the development of trade in intermediate products. Furthermore, the strengthened collaboration between upstream and downstream industries could facilitate the integrated development of the regional timber processing industry supply chain. Full article

A model of Edgeworthian economies is studied, in which participants are randomly chosen at each period to exchange two goods to increase their utilities, as described by the Cobb–Douglas utility function. Participants can trade deviating from their bilateral equilibrium, provided that the market and the trade follow appropriate symmetry conditions. The article aims to study the convergence to equilibrium in a situation where individuals or small groups of participants trade in a market, and prices are determined by interactions between the participants rather than by demand and supply alone. A dynamic matching and bargaining game is considered, with statistical duality imposed on the market game, ensuring that each participant has a counterpart with opposite preferences. This guaranties that there is sufficient incentive for trade. It is shown that, in each period, the expected logarithm of the trading price in the Edgeworthian economy equals the expected Walrasian price. This demonstrates that, under symmetry conditions, the trading price in the Edgeworthian economy is related to the Walrasian price, indicating convergence of the trading price in the Edgeworthian economy towards the Walrasian price. The study suggests that, under the right conditions, the decentralized trading model leads to price convergence similar to what would be expected in a more classical Walrasian economy, where prices balance demand and supply. Full article

The connection between the green certificate market and the CCER market can further achieve the dual carbon goals, so it is imperative for the green certificate market, CCER market, and the connection market to coexist. it is necessary to convert green certificates into CCER in the connection market to achieve transactions between the two. The research is aimed at exploring the interface between green certificates and CCER, with the main objective of finding trading mode and trading method to address the interface between the two. This paper firstly proposes a concept of contribution degree that assists fair trading in the market, based on the different ways in which contribution degree is introduced in the trading of green certificates, CCER markets, and connecting markets, and establishes basic trading mode, unilateral contribution trading mode (UCM) and bilateral contribution trading mode. Then, the rolling matching trading model with the goal of maximizing total social welfare, the contribution degree model and the effect test model are established to realize the implementation of the above three modes through different combinations of the models. Finally, the quantitative results are obtained by simulating the trading situation of the three modes, and CCER offset ratio and contribution degree indicator weight are discussed. The results show that it is feasible to build a bridging market between green certificate and CCER by using the contribution degree, in which the UCM is the optimal solution to achieve the dual-carbon goal and market development. The setting of CCER offset ratio can be based on the difference of enterprise types, and the weight of indicators affecting the contribution level should be adjusted with the policy. The research in this paper has the following contributions: (1) a new criterion to satisfy fair trade—contribution degree is proposed to provide ideas for mutual recognition of products in the bridging market, and proposed a contribution degree calculation model for the green certificate and CCER markets, as well as the bridging market; (2) from the perspective of the contradiction between supply and demand in the market and fair trade, different schemes to build a bridging market are given in a fixed context and compared and analyzed; (3) from the market level, the quantitative analysis of the indicator settings affecting emission reduction, providing suggestions for the differentiated evaluation of warrants and the formulation of carbon reduction policies. Full article

To meet the preference demands of the crew members of high-speed railway trains while forming a crew team, and to automate the compilation of adaptable crew member schemes, a bilateral matching decision method for crew members is proposed based on complete preference order information. This method first describes the mutual selection process between the chief stewards and stewards of a high-speed railway train as a one-to-many bilateral matching decision process between the chief stewards and stewards Subsequently, by constructing a virtual train chief stewards, the original one-to-many bilateral matching relationship between the chief stewards and stewards is transformed into a one-to-one bilateral matching relationship between the virtual chief stewards for modeling. Then, a dual-objective integer programming model is established with the minimum sum of preference order values as the objective. Finally, an optimization solver is used to calculate the problem under different scales, and a genetic algorithm is designed for large-scale scenarios. The analysis results of numerical examples show that the model and algorithm of train crew members based on bilateral matching decisions can meet the actual requirements of the crew department and have good application value. Full article

In the planning of public charging facilities and the charging activity network of users, there is a decision-making conflict among three stakeholders: the government, charging station enterprises, and electric vehicle users. Previous studies have described the tripartite game relationship in a relatively simplistic manner, and when designing charging facility planning schemes, they did not consider scenarios where users’ choice preferences undergo continuous random changes. In order to reduce the impacts of queuing phenomenon and resource idleness on the three participants, we introduce a bilateral matching algorithm combined with the dynamic Huff model as a strategy for EV charging selection in the passenger flow problem based on the three-dimensional activity network of time–space–energy of users. Meanwhile, the Dirichlet distribution is utilized to control the selection preferences on the user side, constructing uncertain scenarios for the choice of user charging activities. In this study, we establish a bilevel programming model that takes into account the uncertainty in social responsibility and user charging selection behavior. Solutions for the activity network and facility planning schemes can be derived based on the collaborative relationships among the three parties. The model employs a robust optimization method to collaboratively design the charging activity network and facility planning scheme. For this mixed-integer nonlinear multi-objective multi-constraint optimization problem, the model is solved by the NSGA-II algorithm, and the optimal compromise scheme is determined by using the EWM-TOPSIS comprehensive evaluation method for the Pareto solution set. Finally, the efficacy of the model and the solution algorithm is illustrated by a simulation example in a real urban space. Full article

The maxillary canine is the second most commonly impacted tooth after the maxillary third molar. Identifying risk factors for impaction is crucial for timely intervention; panoramic radiographs are particularly valuable for screening and identification purposes. This study aims to explore the association between transverse maxillary deficiency with bilateral crossbite, and the risk of maxillary canine impaction. A cross-sectional retrospective study was conducted on records of pediatric patients (7–13 years old) undergoing orthodontic evaluations. Panoramic radiographs were analyzed to assess the risk of canine impaction using the sectorial method, distance from the occlusal plane, and the alpha angle. Results from 48 canines of patients with transverse maxillary deficiency and bilateral crossbite were compared to canines of sex- and age-matched patients without these malocclusions. Statistical analysis was performed by the Shapiro–Wilk test, Levene’s test, or a t-test. There were no significant differences in high-risk canine impaction between groups when considering sector classification or distance from the occlusal plane. However, the control group showed a significantly higher risk according to the alpha angle (≥25°). No overall significant difference in risk was observed, suggesting that transverse maxillary deficiency with bilateral crossbite may not increase the risk of maxillary canine impaction. Full article

Digital gait monitoring is increasingly used to assess locomotion and fall risk. The aim of this work is to analyze the changes in the foot–floor contact sequences of Parkinson’s Disease (PD) patients in the year following the implantation of Deep Brain Stimulation (DBS). During their best-ON condition, 30 PD patients underwent gait analysis at baseline ($T_0$), at 3 months after subthalamic nucleus DBS neurosurgery ($T_1$), and at 12 months ($T_2$) after subthalamic nucleus DBS neurosurgery. Thirty age-matched controls underwent gait analysis once. Each subject was equipped with bilateral foot-switches and a 5 min walk was recorded, including both straight-line and turnings. The walking speed, turning time, stride time variability, percentage of atypical gait cycles, stance, swing, and double support duration were estimated. Overall, the gait performance of PD patients improved after DBS, as also confirmed by the decrease in their UPDRS-III scores from 19.4 ± 1.8 to 10.2 ± 1.0 ($T_0$ vs. $T_2$) (p < 0.001). In straight-line walking, the percentages of atypical cycles of PD on the more affected side were 11.1 ± 1.5% (at $T_0$), 3.1 ± 1.5% (at $T_1$), and 5.1 ± 2.4% (at $T_2$), while in controls it was 3.1 ± 1.3% (p < 0.0005). In turnings, this percentage was 13.7 ± 1.1% (at $T_0$), 7.8 ± 1.1% (at $T_1$), and 10.9 ± 1.8% (at $T_2$), while in controls it was 8.1 ± 1.0% (p < 0.001). Therefore, in straight-line walking, the atypical cycles decreased by 72% at $T_1$, and by 54% at $T_2$ (with respect to baseline), while, in turnings, atypical cycles decreased by 43% at $T_1$, and by 20% at $T_2$. The percentage of atypical gait cycles proved an informative digital biomarker for quantifying PD gait changes after DBS, both in straight-line paths and turnings. Full article

Acute and chronic hypertension causes cerebral vasculopathy, increasing the risk of ischemia and stroke. Our study aimed to compare the effects of arterial pressure reduction on the pial microvascular responses induced by hypoperfusion and reperfusion in spontaneously hypertensive Wistar rats, desamethasone-induced hypertensive Wistar rats and age-matched normotensive Wistar rats fed for 3 months with a normal diet or normal diet supplemented with L-arginine or Taurisolo^® or L-arginine plus Taurisolo^®. At the end of treatments, the rats were submitted to bilateral occlusion of common carotid arteries for 30 min and reperfusion. The microvascular parameters investigated in vivo through a cranial window were: arteriolar diameter changes, permeability increase, leukocyte adhesion to venular walls and percentage of capillaries perfused. Hypoperfusion–reperfusion caused in all rats marked microvascular changes. L-arginine treatment was effective in reducing arterial blood pressure causing vasodilation but did not significantly reduce the damage induced by hypoperfusion–reperfusion. Taurisolo^® treatment was less effective in reducing blood pressure but prevented microvascular damage from hypoperfusion–reperfusion. L-arginine plus Taurisolo^® maintained blood pressure levels within the physiological range and protected the pial microcirculation from hypoperfusion–reperfusion-induced microvascular injuries. Therefore, the blood pressure reduction is not the only fundamental aspect to protect the cerebral circulation from hypoperfusion–reperfusion damage. Full article