Background/Objectives: Adenomyosis is a benign condition characterized by the presence of endometrial tissue within the myometrium. Despite surgery being a valuable approach, medical options are considered as the first-line approach and have been investigated in the treatment of adenomyosis, although strong evidence in favor of these is still lacking. This study aims to gather all available data and determine the effectiveness of the aforementioned medical options in patients with associated pain and not currently seeking pregnancy, both in comparison to placebo and to one another. Methods: For this study, PubMed and EMBASE were used as data sources, searched up to January 2024. A systematic review and meta-analysis were performed in accordance to guidelines from the Cochrane Collaboration. The primary outcomes investigated were changes in dysmenorrhea, quantified by means of VAS scores, HMB in terms of number of bleeding days, and changes in uterine volume determined at ultrasound. Twelve eligible studies were selected. Results: The results highlighted that dienogest yields a reduction in dysmenorrhea that is significantly superior to that of the rest of the medical treatments investigated (p-value of <0.0002). On the other hand, GnRH agonists seem to play a more prominent role in reducing uterine volume (p-value of 0.003). While it was not possible to determine which medical treatment better decreased the number of bleeding days, it was observed that COC performed significantly worse than the other treatments studied (p-value of 0.02). Conclusions: While this meta-analysis provides valuable insights in the comparative efficacy of different treatments, the paucity of relevant studies on the topic might impact the reliability of some of the conclusions drawn. Full article

Dengue is an endemic disease in tropical countries, mainly in South America, Southwest Asia, and Africa, which, despite having a low lethality rate, can overwhelm health systems. Strengthening the immune system through regular physical activity can be an important tool to prevent contagion, worsening, hospitalizations, and deaths caused by the disease, as seen in the COVID-19 pandemic. Therefore, this point of view aims to analyze the possible association between physical activity and dengue and its repercussions on public health. Comments were made on the main characteristics of dengue as well as on the main vaccines available to date. It was also discussed the impacts of dengue on health systems, in addition to the main repercussions for public health when a very large number of people are infected. It was also commented on the main factors that contribute to the worsening of the clinical stage of dengue, in addition to discussions and reflections on physical activity, strengthening the immune system, and dengue. There are assumptions that regular physical activity can be an important public health strategy to prevent contagion, severity, and hospitalizations caused by dengue and that it needs to be promoted by governments around the world as a tool for preventing and treating not only chronic communicable diseases but also infectious diseases. Full article

This review was written with the aim of examining the effects that cause an insult, such as a wound, to an organ, such as the skin. Before examining the cellular mechanisms relating to wound healing, the reader is invited to read about the structure of the skin as a necessary basis for understanding the final aim of this review. The structure of the skin as a basis for understanding the phenomena relating to wound healing is addressed, taking into account the updated literature that addresses the numerous problems of the skin microenvironment. Starting from this awareness, the paragraphs dedicated to wound healing become complicated when this phenomenon is not implemented and therefore while the problems of chronic wounds, keloids, and hypertrophic scars are addressed, these are pathologies that are still difficult to understand and treat today. Full article

The Modular Multilevel Converter (MMC) is a promising converter for medium-/high voltage applications due to its various features. The waveform quality could be enhanced further by expanding the number of generated voltage levels, which increases the number of submodules (SMs); however, this improvement enlarges the size and cost of the converter, posing a persistent challenge. Hence, there exists a trade-off between power quality and the size and complexity of the converter. To verify the performance of such a complex converter and to validate the effectiveness of the control system, especially in the absence of a physical system, Real-Time (RT) simulation becomes crucial. However, the large number of components of a MMC creates important numerical challenges and computational difficulties in RT simulation. This paper proposes a grid-connected MMC employing a Z Packed U-Cell converter as a SM to generate a higher number of voltage levels while minimizing the required number of SMs. The ZPUC-MMC is implemented on an FPGA-based RT simulation platform using Electric Hardware Solver to reduce computational burden and simulation time, while improving the accuracy of the obtained results. Conventional controllers of MMCs are applied to assess the effectiveness and robustness of the proposed system during steady-state and dynamic operations. Full article

(1) Problem Statement: The development of clustering algorithms for neural recordings has significantly evolved, reaching a mature stage with predominant approaches including partitional, hierarchical, probabilistic, fuzzy logic, density-based, and learning-based clustering. Despite this evolution, there remains a need for innovative clustering algorithms that can efficiently analyze neural spike data, particularly in handling diverse and noise-contaminated neural recordings. (2) Methodology: This paper introduces a novel clustering algorithm named Gershgorin—nonmaximum suppression (G–NMS), which incorporates the principles of the Gershgorin circle theorem, and a deep learning post-processing method known as nonmaximum suppression. The performance of G–NMS was thoroughly evaluated through extensive testing on two publicly available, synthetic neural datasets. The evaluation involved five distinct groups of experiments, totaling eleven individual experiments, to compare G–NMS against six established clustering algorithms. (3) Results: The results highlight the superior performance of G–NMS in three out of five group experiments, achieving high average accuracy with minimal standard deviation (SD). Specifically, in Dataset 1, experiment S1 (various SNRs) recorded an accuracy of 99.94 $\pm$ 0.01, while Dataset 2 showed accuracies of 99.68 $\pm$ 0.15 in experiment E1 (Easy 1) and 99.27 $\pm$ 0.35 in experiment E2 (Easy 2). Despite a slight decrease in average accuracy in the remaining two experiments, D1 (Difficult 1) and D2 (Difficult 2) from Dataset 2, compared to the top-performing clustering algorithms in these categories, G–NMS maintained lower SD, indicating consistent performance. Additionally, G–NMS demonstrated robustness and efficiency across various noise-contaminated neural recordings, ranging from low to high signal-to-noise ratios. (4) Conclusions: G–NMS’s integration of deep learning techniques and eigenvalue inclusion theorems has proven highly effective, marking a significant advancement in the clustering domain. Its superior performance, characterized by high accuracy and low variability, opens new avenues for the development of high-performing clustering algorithms, contributing significantly to the body of research in this field. Full article

A fitness landscape analysis of the loss surfaces produced by product unit neural networks is performed in order to gain a better understanding of the impact of product units on the characteristics of the loss surfaces. The loss surface characteristics of product unit neural networks are then compared to the characteristics of loss surfaces produced by neural networks that make use of summation units. The failure of certain optimization algorithms in training product neural networks is explained through trends observed between loss surface characteristics and optimization algorithm performance. The paper shows that the loss surfaces of product unit neural networks have extremely large gradients with many deep ravines and valleys, which explains why gradient-based optimization algorithms fail at training these neural networks. Full article

The replication of species A rotaviruses (RVAs) involves the recruitment of and interaction with cellular organelles’ lipid droplets (LDs), both physically and functionally. The inhibition of enzymes involved in the cellular fatty acid biosynthesis pathway or the inhibition of cellular lipases that degrade LDs was found to reduce the functions of ‘viral factories’ (viroplasms for rotaviruses or replication compartments of other RNA viruses) and decrease the production of infectious progeny viruses. While many other RNA viruses utilize cellular lipids for their replication, their detailed analysis is far beyond this review; only a few annotations are made relating to hepatitis C virus (HCV), enteroviruses, SARS-CoV-2, and HIV-1. Full article

This essay examines a little-known but important installation entitled Insure the Life of an Ant, conceived by artist Mike Malloy and displayed at the O.K. Harris Gallery in New York in April of 1972. This provocative and idiosyncratic piece confronted gallery-goers, who became viewer–participants, with the option of killing or saving a live ant displayed like a sculpture on a pedestal, either by pushing a button or not. The artist made the piece, which can function almost like a psychology experiment, to engender a “moral dilemma”. I explore the particular role of affect in a participatory art installation, distinct from response to inanimate art. I investigate the roles of emotion and reason in dealing with the work; whether ratiocination can be considered an “anti-affect”; and how the tension between competing thoughts and feelings helped create a psychological drama. The essay looks at how an art space can operate as a zone of moral exceptionalism to encourage questionable actions. It also locates the piece in relation to the emergence of a more behaviorist art in the early 1970s, as discussed by critic Gregory Battcock, and the larger notion of postmodernism. Other contexts investigated include art and animal rights and issues of sentience and speciesism; social and military violence, including capital punishment and the Vietnam War; the 1961 Milgram experiment; Hannah Arendt’s concept of the “banality of evil” as a Nazi war criminal defense; and other works of art involving maltreatment or violence toward both human and non-human animals, including those by Marina Abramović, Marco Evaristti, and Edward and Nancy Reddin Kienholz. Full article

The International System of Units (SI), the current form of the metric system and the world’s most used system of units, has been continuously updated and refined since the Metre Convention of 1875 to ensure that it remains up to date with the latest scientific and technological advances. The General Conference on Weights and Measures, at its 26th meeting in 2018, decided to adopt stipulated values of seven physical constants linked to seven measurement units (the second, meter, kilogram, ampere, kelvin, mole, and candela). This paper reviews the technologies developed, in intense and long-standing work, to determine the Avogadro and Planck constants, which are now integral to realising the kilogram. Full article

Patients with long COVID syndrome present with various symptoms affecting multiple organs. Vaccination before or after SARS-CoV-2 infection appears to reduce the incidence of long COVID or at least limit symptom deterioration. However, the impact of vaccination on the severity and extent of multi-organ long COVID symptoms and the relationship between the circulating anti-spike protein antibody levels and the severity and extent of multi-organ symptoms are unclear. This prospective cohort study included 198 patients with previous PCR-verified SARS-CoV-2 infection who met the criteria for long COVID syndrome. Patients were divided into vaccinated (n = 138, 69.7%) or unvaccinated (n = 60, 30.3%) groups. Anti-spike protein antibody levels were determined at initial clinical presentation and compared between the groups. Long COVID symptoms were quantified on the basis of the number of affected organs: Class I (mild) with symptoms in three organs, Class II (moderate) with symptoms in four to five organs, and Class III (severe) with symptoms in six or more organ systems. Associations between time to infection and vaccination with anti-spike protein antibody levels were assessed. The anti-spike protein antibody levels were 1925 ± 938 vs. 481 ± 768 BAU/mL (p < 0.001) in the vaccinated vs. unvaccinated patients. The circulating anti-spike antibody cutoff of 665.5 BAU/mL allowed us to differentiate the vaccinated from the unvaccinated patients. Vaccinated patients had fewer class II and class III multi-organ symptoms (Class II 39.9% vs. 45.0%; Class III 10.1% vs. 23.3%, p-value 0.014). Anti-spike antibody level correlated negatively with multi-organ symptom classes (p = 0.016; 95% CI −1.229 to −0.126). Anti-spike antibody levels in unvaccinated patients declined markedly with time, in contrast to the persistence of high anti-spike antibody levels in the vaccinated patients. Multi-organ symptoms were lower in vaccinated long-COVID patients, especially in those with higher anti-spike antibody levels (≥665.5 BAU/mL). Classifying the symptoms on the basis of the number of affected organs enables a more objective symptom quantification. Full article

Rett syndrome (RTT) is a rare neurodevelopmental disorder caused by mutation in the X-linked gene methyl-CpG-binding protein 2 (Mecp2), a ubiquitously expressed transcriptional regulator. RTT results in mental retardation and developmental regression that affects approximately 1 in 10,000 females. Currently, there is no curative treatment for RTT. Thus, it is crucial to develop new therapeutic approaches for children suffering from RTT. Several studies suggested that RTT is linked with defects in cholesterol homeostasis, but for the first time, therapeutic evaluation is carried out by modulating this pathway. Moreover, AAV-based CYP46A1 overexpression, the enzyme involved in cholesterol pathway, has been demonstrated to be efficient in several neurodegenerative diseases. Based on these data, we strongly believe that CYP46A1 could be a relevant therapeutic target for RTT. Herein, we evaluated the effects of intravenous AAVPHP.eB-hCYP46A1-HA delivery in male and female Mecp2-deficient mice. The applied AAVPHP.eB-hCYP46A1 transduced essential neurons of the central nervous system (CNS). CYP46A1 overexpression alleviates behavioral alterations in both male and female Mecp2 knockout mice and extends the lifespan in Mecp2-deficient males. Several parameters related to cholesterol pathway are improved and correction of mitochondrial activity is demonstrated in treated mice, which highlighted the clear therapeutic benefit of CYP46A1 through the neuroprotection effect. IV delivery of AAVPHP.eB-CYP46A1 is perfectly well tolerated with no inflammation observed in the CNS of the treated mice. Altogether, our results strongly suggest that CYP46A1 is a relevant target and overexpression could alleviate the phenotype of Rett patients. Full article

The present study deals with the reuse of agro-industrial waste with a specific focus on biochar (processed plant biomass or biochar) consisting of organic and inorganic waste biomass subjected to thermochemical processes. The objective of this work is to carry out a systematic review of the literature according to the Methodi Ordinatio methodology and select a bibliographic portfolio of high relevance to this study that makes it possible to present the concepts, applications and interest on the part of companies in including biochar in their processes, as well as addressing the environmental impacts linked to incorrect waste disposal. In this sense, biochar presents an interesting potential solution from both a waste management and environmental point of view. The current challenge is studies that prove economic viability. Full article

An efficient and reliable management system for a cluster of distributed energy resources (DERs) is essential for the sustainable and cost-effective peak management (PM) operation of the power grid. The virtual power plant (VPP) provides an efficient way to manage a variety of DERs for the PM process. This paper proposes a VPP framework for PM of local distribution companies by optimizing the self-scheduling of available resources, considering uncertainties and constraints. The study examines two separate scenarios and introduces novel algorithms for determining threshold values in each scenario. An approach is suggested for the transaction between VPP and the aggregator models. The proposed technique intends to determine the optimal amount of capacity that aggregators can allocate for the day-ahead PM procedure while accounting for both thermostatically controlled and non-thermostatically controlled loads. The proposed VPP framework shows promising results for reducing demand charges and optimizing energy resources for PM. Full article

Smart grids are a cornerstone of the transition to a decentralised, low-carbon energy system, which offer significant benefits, including increased reliability, improved energy efficiency, and seamless integration of renewable energy sources. However, ensuring the security and resilience of smart grids is paramount. Cyber attacks, physical disruptions, and other unforeseen threats pose a significant risk to the stability and functionality of the grid. This paper identifies the research gaps and technical hurdles that hinder the development of a robust and secure smart grid infrastructure. This paper addresses the critical gaps in smart grid security research, outlining the technical challenges and promising avenues for exploration by both the industry and academia. A novel framework designed to enhance the reliability and security of smart grids was proposed against cyber attacks, considering the interconnectedness of the physical and cyber components. The paper further explores future research trends and identifies the key open issues in the ongoing effort to strengthen the security and resilience of smart grids. Full article

Double bituminous surface treatment (DBST) has been a widely utilized pavement maintenance material due to its capability to restore the surface roughness of existing pavement and provide a layer of protection against weathering, aging, and moisture. However, DBST is highly prone to aggregate loss at an early stage, which is a very common problem experienced by surface treatment. Therefore, to lessen the aggregate loss and prolong the service life of DBST, fiber additive can be incorporated to strengthen the adhesion between the asphalt emulsion and aggregates. This study investigated the performance of glass fiber-reinforced polymer-modified DBST against aggregate loss by conducting laboratory tests using typical DBST as the benchmark of the test results. Four laboratory tests were chosen to represent different loading applications on the surface of the pavement: the bitumen bond strength (BBS) test, the sweep test, the Hamburg wheel-track test (HWT test), and a one-third-scale model mobile load simulator (MMLS3) model. Furthermore, the curing time of the asphalt emulsion was considered in the BBS test and sweep test. Based on all results from the conducted laboratory tests, polymer-modified DBST with glass fiber reinforcement presented an increased resistance to aggregate loss compared with typical DBST. Moreover, it was found that a longer curing time of the asphalt emulsion, whether it was typical or modified, strengthened the surface treatment’s resistance to aggregate loss. Full article

The plant-based food market is rapidly growing, offering innovative options to meet consumer expectations. However, a comprehensive analysis of the nutritional quality of these foods is lacking. We aimed to characterize industrial plant-based food products’ nutritional value and degree of processing. A cross-sectional study was conducted on two market-leading Portuguese food retail chains by assessing the nutritional composition of all the available pre-packaged plant-based food products (n = 407). These products were categorized into meal alternatives, dairy alternatives, and other products containing dairy/meat alternative ingredients including ready meals and desserts. The products’ nutritional quality was assessed according to the cut-offs established by the Portuguese Directorate General of Health [DGS] on total fat, saturated fat, sugar, and salt, and considering the degree of processing using NOVA classification. One-tenth of the products were classified as having a high total fat, saturated fat, sugars, or salt content. In some sub-categories, half of foods were classified as high in saturated fat, and over two-thirds were considered high salt products. Less than one-third exhibit a good nutritional profile based on the national cut-offs. A total of 84.3% of plant-based food products were ultra-processed. These findings emphasize the need to improve the nutritional profile of plant-based options. Full article

Carposina coreana is an important pest of Cornus officinalis, distributed in China, Korea, and Japan. In recent years, its damage to C. officinalis has become increasingly serious, causing enormous economic losses in China. This study and prediction of current and future suitable habitats for C. coreana in China can provide an important reference for the monitoring, early warning, prevention, and control of the pest. In this study, the potential distributions of C. coreana in China under current climate and future climate models were predicted using the maximum entropy (MaxEnt) model with ArcGIS software. The distribution point data of C. coreana were screened using the buffer screening method. Nineteen environmental variables were screened using the knife-cut method and variable correlation analysis. The parameters of the MaxEnt model were optimized using the kuenm package in R software. The MaxEnt model, combined with key environmental variables, was used to predict the distribution range of the suitable area for C. coreana under the current (1971–2000) and four future scenarios. The buffer screening method screened data from 41 distribution points that could be used for modeling. The main factors affecting the distribution of C. coreana were precipitation in the driest month (Bio14), precipitation in the warmest quarter (Bio18), precipitation in the coldest quarter (Bio19), the standard deviation of seasonal variation of temperature (Bio4), minimum temperature in the coldest month (Bio6), and average temperature in the coldest quarter (Bio11). The feature class (FC) after the kuenm package optimization was a Q-quadratic T-threshold combination, and the regularization multiplier (RM) was 0.8. The suitable areas for C. coreana under the current climate model were mainly distributed in central China, and the highly suitable areas were distributed in southern Shaanxi, southwestern Henan, and northwestern Hubei. The lowest temperature in the coldest month (Bio6), the average temperature in the coldest quarter (Bio11), and the precipitation in the warmest quarter (Bio18) all had good predictive ability. In future climate scenarios, the boundary of the suitable area for C. coreana in China is expected to shift northward, and thus, most of the future climate scenarios would shift northward. Full article

Objectives: Benign prostatic hyperplasia is one of the most common urological diseases. Among these patients, the presence of detrusor underactivity or acontractility represents a challenging condition since no medical treatment is available. Our objective is to evaluate early term outcomes following transurethral anatomical enucleation of the prostate with Tm:YAG support. Methods: In a retrospective analysis of 115 patients who underwent this procedure between January 2019 and March 2022 due to lower urinary tract symptoms, 8 patients with urodynamic evidence of detrusor underactivity secondary to a non-neurogenic aetiology were identified. Detrusor underactivity was defined as a bladder contractility index of <100. Results: Median age, prostate volume and bladder contractility index were 73.2 years, 78.5 cm³ and 63.9, respectively. Median International Prostate Symptom Score/quality of life, Q_max and post-void residual volume were 15/3.5 points, 4.4 mL/s and 189 mL, respectively. Postoperatively, immediate catheter-removal success rate was 87.5% (7/8), at 2 months all patients were catheter-free and remained so at 1-year follow-up. Significant improvements for quality of life, Q_max and post-void residual volume were detected. Median postoperative International Prostate Symptom Score/Quality of life, Q_max and post-void residual volume were 7/2, 21.6 mL/s and 0 mL, respectively. Conclusions: This surgical approach offers high catheter-free rates, significantly improves functional voiding parameters and increases patient satisfaction in patients with benign prostatic hyperplasia and concomitant detrusor underactivity. Therefore, it can be regarded as an effective approach for such patients. Full article

Background: A decrease in populations could affect healthcare access and systems, particularly in medically underserved areas (MUAs) where depopulation is becoming more prevalent. This study aimed to simulate the future population and land areas of MUAs in Japan. Methods: This study covered 380,948 1 km meshes, 87,942 clinics, and 8354 hospitals throughout Japan as of 2020. The areas outside a 4 km radius of medical institutions were considered as MUAs, based on the measure of areas in the current Japanese Medical Care Act. Based on the population estimate for a 1 km mesh, the population of mesh numbers of MUAs was predicted for every 10 years from 2020 to 2050 using geographic information system analysis. If the population within a 4 km radius from a medical institution fell below 1000, the institution was operationally assumed to be closed. Results: The number of MUAs was predicted to decrease from 964,310 (0.77% of the total Japanese population) in 2020 to 763,410 (0.75%) by 2050. By 2050, 48,105 meshes (13% of the total meshes in Japan) were predicted to be new MUAs, indicating a 31% increase in MUAs from 2020 to 2050. By 2050, 1601 medical institutions were tentatively estimated to be in close proximity. Conclusions: In Japan, the population of MUAs will decrease, while the land area of MUAs will increase. Such changes may reform rural healthcare policy and systems. Full article

A variety of events such as high-altitude electromagnetic pulses, extreme solar storms, and coordinated cyber attacks could result in a catastrophic loss of infrastructure on a continental or global scale. The lengthy repair of critical infrastructure creates a need for alternative fuels such as wood gas. Wood gas is produced by heating wood in a low-oxygen environment and can be used to power combustion engines. This work investigates a novel wood chipper, designed as an energy-efficient tool for producing wood gas stock, wood chips, aiming to speed up the transition to alternative fuel. A prototype is built and tested to determine the energy efficiency and production rate of the device. The results suggest that the wood chipper could produce one cord of wood chips, 3.6 m³, in less than a day and is a viable alternative to other manual wood-processing methods. In addition, the global scaling up of production of the wood chipper is considered, indicating that the mass production of the wood chipper could accelerate the transition of wood gas production methods from manual to machine-driven immediately after a catastrophic event. Full article

Background/Objectives: Relapsed B-cell acute lymphoblastic leukemia (B-ALL) remains an unresolved matter of concern regarding adverse outcomes. This case study aimed to evaluate the effectiveness of blinatumomab, with or without door lymphocyte infusion (DLI), in treating measurable residual disease (MRD)-positive B-ALL. Methods: All patients who received blinatumomab salvage therapy were included in this study. Eleven patients were included in the study. All patients were evaluated for MRD-negativity. Results: Before starting blinatumomab therapy, seven patients tested positive for MRD, three tested negative, and one had refractory disease. Hematopoietic cell transplantation (HCT) was reserved for five patients with persistent MRD. Six patients became MRD-negative and subsequent HCT was not performed. Only two patients relapsed; one patient died of relapse, and the other one received carfilzomib-based therapy and was MRD-negative thereafter. Nine patients were MRD-negative at a median follow-up of 28 months (15–52 months). Two of three MRD-positive post-transplant patients remained in complete molecular remission after preemptive DLI at the last follow-up date. In the first salvage, blinatumomab may achieve complete remission and bridging to HCT in pediatric patients with end-of-induction MRD-positive B-cell precursor ALL. Conclusions: The decision on how to treat post-transplant relapse continues to affect survival outcomes. Blinatumomab combined with DLI may extend the armamentarium of release options for high-risk pediatric patients. This approach is encouraging for high-risk ALL patients who are MRD-positive post-transplantation. Full article