OBJECTIVE Brainstem cavernous malformations (BSCMs) were once considered inoperable. Microsurgical resection now represents a valuable option for treating patients with hemorrhagic or symptomatic lesions. The aim of this study was to provide a practical guide for surgical planning by analyzing postoperative neurological and functional outcomes. METHODS The early- and long-term neurological (National Institutes of Health Stroke Scale [NIHSS] score) and functional (modified Rankin Scale [mRS] and Glasgow Outcome Scale [GOS] scores) outcomes of 32 patients who underwent surgery for hemorrhagic BSCM were reviewed. The three-step surgical planning was based on an anatomosurgical algorithm. RESULTS Nine lesions (28.1%) were located in the mesencephalon, 19 (59.4%) in the pons, and 4 (12.5%) in the medulla. A fronto-temporo-orbito-zygomatic approach was selected to reach anterior mesencephalic BSCMs (2, 6.3%). A retrosigmoid approach and its extended variant were selected for lateral mesencephalic (6, 18.8%), anterior (2, 6.3%) and lateral (13, 40.6%) pontine, and anterior (1, 3.1%) and lateral (1, 3.1%) medullary BSCMs. A supracerebellar infratentorial approach was selected for posterior mesencephalic BSCMs (1, 3.1%). A telovelar approach was selected for posterior pontine (4, 12.5%) and medullary (2, 6.3%) BSCMs. Total resection was achieved in 29 cases (90.6%), with a 12.5% rate of surgical complications. The NIHSS score progressively improved at both the early (5.16 ± 3.70 vs 4.63 ± 2.78, p = 0.446) and late (4.63 ± 2.78 vs 2.41 ± 2.39, p < 0.001) postoperative evaluations. Functional outcomes showed an initial deterioration followed by a long-term improvement (mRS score: 2.66 ± 1.07 vs 3.06 ± 1.11 vs 2.13 ± 1.29, GOS score: 3.78 ± 0.61 vs 3.59 ± 0.62 vs 4.19 ± 0.78). Time to surgery significantly correlated with early- and long-term NIHSS, mRS, and GOS scores, while the number of hemorrhages before surgery correlated with early- and long-term mRS and GOS scores. CONCLUSIONS Early surgery after the first bleed following systematic surgical planning may be considered as an effective option for managing hemorrhagic BSCMs with acceptable operative morbidity and relatively favorable early- and long-term neurological and functional outcomes.

BACKGROUND Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous entity including patients with different phenotypes of near normal, normal, and supernormal left ventricular (LV) function. OBJECTIVES To assess the value of resting LV elastance (also known as force) with transthoracic echocardiography (TTE) to identify HFpEF phenotypes. METHODS In a prospective, observational, multicenter study, 2380 HFpEF patients were recruited from July 2016 to May 2024. Systolic blood pressure (SBP) was measured. We assessed LV end-diastolic volume (EDV), end-systolic volume (ESV), EF, force (SBP/ESV), stroke volume (SV), arterial elastance (AE), ventricular-arterial coupling (VAC), and left atrial volume index (LAVI). Global longitudinal strain (GLS) was available in 1164 (48.9%) patients. 680 patients finished follow-up with a composite end-point of major adverse cardiac events (MACEs). Patients were divided into three groups: low force (< 25th percentile, Group 1, < 3.24 mmHg/ml), intermediate force (≥ 25th percentile and ≤ 75 th percentile, Group 2, 3.24-5.48 mmHg/ml), and high force (> 75 th percentile, Group 3, >5.48 mmHg/ml). RESULTS The 3 groups showed a gradient with descending values (Group 3>2>1) for SBP, EF, GLS, AE, and VAC, with the opposite gradient (Group 1> 2> 3) for EDV, ESV, SV, and LAVI values (all P<0.01). After a median follow-up of 16 months, 205 MACEs occurred in 138 patients. Cumulative MACEs rate was lowest in group 2 (14.7% person-year), higher in group 1 (16.1% person-year) and 3 (22.9% person-year, log rank p = 0.036). CONCLUSIONS HFpEF patients present with different LV contractile phenotypes, easily identified with resting LV force and volumetric TTE. The dominant hemodynamic feature of hypocontractile phenotype is a preload recruitment with larger LV EDV and normal SV, while the hypercontractile phenotype is characterized by a small LV with reduced SV. The hypercontractile and hypocontractile phenotypes are associated with a higher risk of subsequent events.

Over the past decade, stress echocardiography has evolved from a test for assessing epicardial artery stenosis to a comprehensive functional test, targeting multiple cardiovascular parameters. The new approach includes several structured steps: (a) evaluating regional wall motion abnormalities to detect epicardial artery stenosis or vasospasm; (b) assessing pulmonary congestion and diastolic function via B-lines with lung ultrasound; (c) gauging preload and contractile reserve with volumetric echocardiography; (d) measuring coronary microvascular reserve using Doppler-based coronary flow velocity in the middistal left anterior descending artery; and (e) determining cardiac sympathetic reserve by tracking heart rate reserve on an ECG. This evolution was supported extensively by the Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI), which played a key role in five areas: (1) developing the initial, curiosity-driven project; (2) disseminating protocols and results at national and international conferences, supporting logistic infrastructure and publication expenses; (3) establishing a digital platform (customized Redcap) for data entry and storage; (4) facilitating patient recruitment across 19 Italian centers; and (5) offering formal endorsement through six presidencies, adding credibility and reach beyond any single institution. The protocol quickly advanced from concept to high-impact publications, earning inclusion in 2024 specialty guidelines. Initially Italian-led, the study now includes 50 centers across 20 countries (e.g. USA and China). Beyond the 50 peer-reviewed papers published in 2016–2024, this study offers a novel, sustainable approach to cardiac stress testing, providing more information at lower costs, with zero radiation and minimal environmental impact. SIECVI’s endorsement was instrumental in amplifying the study’s rigor and outreach.

Lung ultrasound (LUS) is a valuable, non-invasive tool for detecting pulmonary congestion in patients with acute heart failure (AHF), with a higher sensitivity relative to physical examination. However, the association between LUS-detected pulmonary congestion and cardiovascular outcomes in patients with ST-segment elevation (STEMI) is not well established. This systematic review and meta-analysis evaluated cardiovascular outcomes in patients with STEMI and congested (wet) or non-congested (dry) lungs by LUS. We searched PubMed, Embase, and Cochrane databases, and conference abstracts for clinical trials evaluating LUS-congestion (LUS+) versus non-LUS-congestion (LUS-) in patients with STEMI. Risk ratios (RRs) and hazard ratios (HR) with 95%CIs were pooled using R software under random-effects models. We also calculated LUS sensitivity, specificity, and area under the curves (AUCs) for the prediction of in-hospital mortality and cardiogenic shock. We included five studies with 1,454 patients. The mean age was 60 to 65 years; 1,066 (73.3%) were male, and 451 (31%) had congested lungs (LUS+). Patients with congestion on LUS had a significantly higher risk of the composite endpoint of death, heart failure, acute coronary syndrome, and cardiogenic shock (HR 4.00; 95%CI 2.12-7.54; p<0.01; Figure 1A). There was also a higher risk of in-hospital mortality (RR 5.09; 95%CI 2.25-11.49; p<0.001; Figure 1B) and cardiogenic shock (RR 5.01; 95%CI 2.47-10.17; p<0.001; Figure 1C) compared to patients with non-congested lungs. Reinfarction was similar between groups (p=0.08; Figure 1D). LUS had high diagnostic accuracy for in-hospital mortality (SROC-AUC: 0.82) and cardiogenic shock (SROC-AUC: 0.77); a high sensitivity (0.84; 95%CI 0.49-0.97; Figure 2A), and moderate specificity (0.78; 95%CI 0.67-0.87; Figure 2A) for in-hospital mortality; and moderate sensitivity (0.75; 95%CI 0.42-0.93; Figure 2B) and specificity (0.76; 95% CI 0.61-0.87; Figure 2B) for cardiogenic shock. Congested lungs on LUS are significantly associated with a higher risk of in-hospital mortality and cardiogenic shock in patients with STEMI. Moreover, LUS has a high AUC for identifying in-hospital mortality and cardiogenic shock in this patient population. Figure 1 Figure 2

Network emulators play an important role in testing network systems, applications, and protocols. Emulators bridge the gap between simulation setups that lack realism in results and real-world trials that are accurate but often expensive, non-reproducible, and uncontrollable. This article presents an extended model of the Quantum Key Distribution Network Simulation Module (QKDNetSim) with a model catalog of QKD components and functionalities. We explore emulations of point-to-point connections in QKD networks and the interaction of essential components within QKD nodes. The presented tool will undoubtedly spur future development and teaching, and it is critical for testing novel applications and protocols applied to QKD networks.

This paper explores the impact of performance expectancy (PE) and effort expectancy (EE) on the behavioral intention (BI) of managers to implement environmental, social, and governance (ESG) practices in small and medium-sized enterprises (SMEs) in Bosnia and Herzegovina. Us ing the Technology Acceptance Model (TAM), the study analyzes how these factors influence decision-makers’ engagement in sustainable business activities. A survey of 247 managers was conducted to assess their BI, PE, and EE for each ESG component. The collected data were ana lyzed using structural equation modeling (SEM) to construct a second-order latent model that measures the combined effects of these factors. The study fills a gap in the literature by examin ing sector-specific differences in the factors influencing ESG implementation. The results reveal that both PE and EE significantly affect an organization’s intention to adopt ESG practices, with varying impacts between the manufacturing and service industries. The findings highlight the different challenges and complexities each industry faces in implementing ESG practices. While focusing on PE and EE, it is acknowledged that other factors such as organizational culture, stakeholder pressure, and industry-specific dynamics also play roles in ESG adoption. The main contribution of this work is the use of a second-order latent construct within the TAM model for ESG practices, offering a unique perspective on understanding behavioral intention.

Introduction Renal angiomyolipomas (AMLs) are neoplasms that can rarely rupture, causing hemorrhagic shock as the most serious complication. This pathological condition, (referring to AML) is classified as a benign tumor arising from the proliferation of epithelioid cells, consisting of fat tissue, blood vessels, and smooth muscle. Wunderlich syndrome describes a spontaneous, nontraumatic bleeding into the subcapsular or perirenal space. Most individuals with renal AML exhibit no symptoms and are often diagnosed incidentally, however, some may experience life-threatening complications such as rupture, hemorrhage, and circumstantial hypovolemic shock. Case outline Description of the clinical presentation of AML with rupture in a female patient with a brief overview of other cases of AML in the literature. Female patient, 68 years old, admitted for examination due to sudden severe pain in the abdomen with propagation to the right lumbar region accompanied by nausea and fatigue. After a complete physical examination, an abdominal ultrasound, and a CT scan, surgery was performed during which the right kidney was removed alongside the hematoma and the kidney envelopes, which were sent for pathohistological analysis. The result of the histopathological analysis confirmed that it was AML. Conclusion AMLs are benign neoplasms with potentially serious complications. The most serious complication of AML is rupture, leading to retroperitoneal hemorrhage, with tumor size being a significant risk factor. Considering the clinical importance of this potential complication, it is important to establish a swift and accurate radiological diagnosis, with the aim of timely therapeutic intervention and reduction of potential additional complications.

Timely and accurate defect detection is essential in the leather industry, as the quality of raw leather directly impacts both the usability and value of finished products. This paper provides a systematic overview of state-of-the-art solutions and proposes a novel approach for automated detection of leather surface defects using deep neural networks based on the Inception-V3 architecture. Five defect categories are introduced, focusing on their impact on leather quality. In addition, two deep neural network architectures were analyzed and implemented for defect detection and classification: a single-channel model and a multi-channel model with arbitration. The evaluation was carried out using a combination of a custom-developed dataset and publicly available datasets, assessed with standard performance metrics. Moreover, an image annotation tool was developed to facilitate precise defect labeling and the creation of variable-size datasets. Both models demonstrated promising results on the custom dataset, achieving accuracy rates exceeding 93%. The suggested methodology enhances the research domain of leather inspection automation by creating an openly accessible image dataset, performing a comparative analysis of detection models and creating software tools for data preparation. These contributions lay the foundation for further research in leather defect detection and potential industrial implementation.

Je li umjetna inteligencija, koja je danas pobudila sveopći znanstveni i javni interes, prilika koja se može pokazati korisnom za demokraciju ili je ona prijetnja koja donosi korjenite promjene i oko koje se trebamo duboko zabrinuti? S jedne strane, umjetna inteligencija može biti prilika za poboljšanje demokratskoga procesa u smislu jednostavnijega uključivanja u demokratsku raspravu i samim time u poboljšanju procesa kreiranja politika. S druge strane, rizici za demokraciju koje može generirati umjetna inteligencija mogu biti lažne informacije koje mogu izazvati različite društvene sukoba te kreirati mišljenja koja ne predstavljaju mišljenje javnosti. U oba slučaja, i kao prilika i kao prijetnja, umjetna inteligencija promijenit će mnoge aspekte demokracije, uglavnom na načine koje još ne možemo pojmiti. Ključne riječi: umjetna inteligencija; demokracija, izborni proces.

Heavy metals ubiquitously found in soil and water, as a serious environmental problem, are disrupting plant mineral nutrition homeostasis, osmotic balance, and metabolism. Application of some biostimulants can alleviate the disruption. Melatonin as a signal molecule, and antioxidant plays an important role in plant growth and stress tolerance due to its ability to directly neutralize reactive oxygen and nitrogen species. The reduction or mitigation of heavy metals adverse effects in valerian plants grown in open field conditions using melatonin was investigated in this paper. HPLC-FLD technique was used to identify and quantify melatonin concentration in valerian root extracts. Also, physiological, and biochemical plant status under abiotic stress was examined, especially in 100 ?M melatonin pre-treated plants. Higher concentrations of endogenous melatonin were measured in roots of Cd and Zn treated plants. Melatonin application alleviated the negative effect of Cd, particularly evident in Cd-Melatonin treatment which restored or enhanced bioactive compound levels. Melatonin effectively mitigates Cd and Zn-induced stress in valerian by enhancing both non-enzymatic and enzymatic antioxidant systems and promoting the synthesis of protective compounds. These findings highlight melatonin potential as a sustainable biostimulant to support plant resilience and productivity in heavy metal-stressed environments.

Red clover is one of the most important perennial forage legumes in livestock feed production. It also plays a significant role in organic farming, as it enriches the soil with nitrogen through symbiotic fixation by nodule-forming bacteria, reducing the need for excessive use of mineral nitrogen. The application of foliar biofertilizers can have a significant impact on the productivity and nodulation of red clover. Since the productivity and quality of red clover largely depend on soil fertility, environmental conditions, variety selection, and the plant’s developmental stage at the time of mowing, the aim of this research was to determine the influence of red clover variety and foliar biofertilizer (BF0, BF1, BF2, BF4) on dry matter yield, crude protein content, and the abundance of nodule-forming bacteria. The research results showed that variety selection and the application of biofertilizer at higher concentrations had a significant effect on dry matter yield and crude protein content. However, the total number of nodules on red clover roots decreased with increasing biofertilizer concentration. The highest annual dry matter yield was achieved in the BF4 variant for the Una variety (12.71 t ha-1) and the Global variety (11.43 t ha-1). Similarly, the highest crude protein yield was recorded in the BF4 variant for the Una variety (1896.4 kg ha-1) and the Global variety (1678.0 kg ha-1).

Sweet corn (Zea mays L. var. saccharata) is one of the popular varieties of corn in the human diet. Its quality is influenced by various properties such as grain moisture, colour, ear weight, ear length, texture, and sugar content, while its health benefits are attributed to its total phenolic content and antioxidant activity. The aim of this research is to determine the impact of N fertiliser application and sowing date on yield indicators, total phenol content and antioxidant capacity of sweet corn. The treatments of the experiment consisted of a combination of two factors, two different nitrogen regimes and two different sowing dates. The results show that the applied treatments significantly influenced the researched traits of sweet corn. Dehusked and husked ear mass, ear length, and yield were higher when sown earlier (385 g, 264 g, and 21 cm, respectively) than later sowing (364 g, 242 g, and 20 cm, respectively). Additionally, higher values of dehusked and husked ear mass, ear length, were recorded with a higher dose of fertiliser. Furthermore, total phenol contents ranged from 57.0 to 80 mg GAE 100 g-1 and depended on sowing date, fertilisation, and year of study.