Military Institute

<title>Abstract</title> Background Odontogenic sinusitis (ODS) is a common cause of unilateral maxillary sinusitis, and it arises from periapical lesions (PAL) or other odontogenic foci. This infection is polymicrobial and anaerobe-rich, thus standard culture methods often underestimate its diversity. Molecular techniques such as quantitative polymerase chain reaction (QPCR) and next-generation sequencing (NGS) may better characterize the microbial burden and composition. Methods Paired sinus mucosal biopsy (SIN) and the tissue scrapings from periapical lesion (PAL) specimens were collected from 28 patients with ODS. Bacterial detection was performed using conventional culture, and QPCR targeting ten clinically relevant taxa. For paired sampled from three randomly selected patients 16S rRNA amplicon sequencing was performed. Microbial load, taxa richness, and the similarity of bacterial communities between the two anatomically connected sites were compared across the molecular methods. Statistical analysis included the Wilcoxon signed-rank, McNemar, and Bray–Curtis dissimilarity testing. Results Culture yielded low detection rates, identifying only a limited set of pathogens ( <italic>Staphylococcus aureus</italic> , <italic>Streptococcus anginosus</italic> , and <italic>Fusobacterium nucleatum</italic> ) in a minority of samples. In contrast, QPCR demonstrated significantly higher detection frequencies, particularly in PAL specimens. <italic>Porphyromonas gingivalis</italic> (96.8%), <italic>F. nucleatum</italic> (90.3%), and the <italic>S. anginosus</italic> group (90.3%) were highly prevalent in PAL, while SIN samples showed lower but overlapping positivity (89.3%, 67.9%, and 50.0%, respectively). Overall, PAL samples harbored significantly higher bacterial loads and taxa richness than SIN specimens (Wilcoxon p = 0.0004). 16S rRNA amplicon sequencing confirmed the presence of polymicrobial communities in both sites and revealed additional taxa beyond those included in the QPCR panel. Jaccard distance and Bray–Curtis analyses revealed patient-specific overlap: some PAL and SIN pairs shared nearly identical microbiota, while others exhibited marked divergence. Conclusions PALs represent a reservoir of mostly anaerobic bacterial species that may translocate into the maxillary sinus, establishing ODS. While there is overlap in bacterial communities, sinus samples exhibit a lower burden and site-specific shifts in taxa composition. Culture alone underestimates ODS microbial complexity, whereas QPCR and 16S rRNA amplicon sequencing provide much deeper insights. Combined molecular approaches are essential for accurate pathogen detection and for guiding effective management of ODS.

The object of the study is intelligent decision support systems. The problem addressed in the research is to improve the accuracy of modeling the functioning process of intelligent decision support systems. A polymodel complex for resource management of intelligent decision support systems has been developed. The originality of the study lies in: – the comprehensive description of the functioning processes of intelligent decision support systems; – the capability to model both an individual process occurring in intelligent decision support systems and to perform comprehensive modeling of the processes taking place within them; – the establishment of conceptual dependencies in the functioning process of intelligent decision support systems. This makes it possible to describe the interaction of individual models at all stages of solving computational tasks; – the description of coordination processes in hybrid intelligent decision support systems, which ensures an increase in the reliability of managerial decision-making; – the modeling of processes for solving complex computational tasks in intelligent decision support systems through the conceptual description of the specified process; – the coordination of computational processes in intelligent decision support systems, which leads to a reduction in the number of computational resources of the systems; – the comprehensive resolution of conflicts through a set of corresponding mathematical models. The proposed polymodel complex is advisable for use in solving the problem of managing intelligent decision support systems characterized by a high degree of complexity

<title>Abstract</title> Purpose Pulmonary arterial hypertension (PAH) is a rare disease with poor prognosis. The same treatment is recommended in patients with PAH associated with connective tissue disease (CTD) and idiopathic PAH (IPAH). However, the effectiveness of PAH-specific treatment in these both groups is inconsistent. Methods The study incorporated data from the prospective, multicentre polish registry (BNP-PL) by comparison of baseline vs. 1-year follow-up clinical, laboratory, echocardiographic and hemodynamic parameters in PAH-CTD vs. IPAH group. The all-cause 1-year mortality was also analyzed. Results 624 patients were included in the study: 176 (28%) PAH-CTD and 448 (72%) IPAH. 48 (8% of the total 624) patients died during 1-year follow up: 32 (7%) with IPAH and 16 (9%) with PAH-CTD (p = 0.4). The effectiveness of treatment was examined in 421 patients: 115 (27%) PAH-CTD and 306 (73%) IPAH. The improvement of treatment was effective in both groups in terms of WHO FC (p &lt; 0.001 in both groups), 4-strata risk model (p &lt; 0.001 in both groups), six minute walking test (6MWT, p &lt; 0.001 in IPAH, p = 0.001 in PAH-CTD), Δ6MWT (p = 0.19 between PAH-CTD and IPAH), tricuspid annular plane systolic excursion (p &lt; 0.001 in both groups), NT- proBNP (p &lt; 0.001 in IPAH and p &lt; 0.01 in PAH-CTD), mean pulmonary arterial pressure (p = 0.043 in IPAH and p = 0.01 in PAH-CTD), pulmonary vascular resistance (p &lt; 0.001 in both groups) and cardiac output (p &lt; 0.001 in IPAH and p = 0.034 in PAH-CTD). Conclusions PAH specific treatment in PAH-CTD patients is as effective as in IPAH patients during 1-year observation. 1-year all-cause mortality was not significantly higher in PAH-CTD patients compared to IPAH patients.

Abstract Sepsis, a critical medical emergency driven by a dysregulated host response to infection, remains a leading cause of global morbidity and mortality. Current diagnostic methods are slow, blood culture-dependent, and often lack sensitivity or specificity, delaying timely intervention and contributing to poor outcomes. Recent advances in surface-enhanced Raman spectroscopy (SERS) and artificial intelligence (AI) offer promising solutions. Yet, existing machine learning studies have either failed to achieve clinical-grade performance or have not directly targeted rapid sepsis detection from blood cultures. In this study, we collected an extensive set of blood culture samples from a diverse patient cohort attended tertiary level hospital in Qatar, including both clinically confirmed sepsis-positive and control cases, then constructed a large SERS spectral dataset with additional external validation from an independent cohort. We propose SuperRamanNet, a novel deep learning framework based on lightweight, one-dimensional super generative neuron operational neural networks (Super-ONNs), for rapid sepsis recognition and multiclass pathogen identification directly from SERS spectra. The system demonstrates robust performance, achieving 99.67% accuracy for sepsis recognition and 98.84% accuracy for pathogen identification on the primary dataset, with similarly high results on external validation. Comparative analysis confirms that SuperRamanNet consistently outperforms benchmark models and previous literature, supported by ablation studies highlighting the impact of data augmentation and architectural innovations. In conclusion, this work establishes SuperRamanNet as a clinically viable, high-throughput, and portable diagnostic tool, capable of transforming sepsis detection and pathogen identification at the point of care and potentially reducing the global burden of sepsis.

Gaucher disease is an autosomal recessive spirochete disease caused by a deficiency of the enzyme glucocerebrosidase. A mutation in the GBA1 gene induces the accumulation of abnormal products in macrophages resulting in the transformation into Gaucher cells in many organs. There are three main types of the disease, 1 being the most common type (non-neuropathic). The 2nd and 3rd types of the disease are neuropathic types and these occur mainly in childhood. Among paediatric patients, Gaucher's disease manifests mainly with enlargement of the liver, spleen, thrombocytopenia, anaemia, but skeletal, ocular and central nervous system symptoms may be present. Diagnosis based on enzymatic and genetic tests - analysis of the GBA1 gene mutation - is essential to prolong patients' lives, improve their quality of life and select an appropriate form of treatment. Currently, care for patients with this disease is based on ERT (enzyme replacement therapy), SRT (substrate replacement therapy). The disease is characterised by rather non-specific symptoms and course, and can be interpreted by physicians as a haematological-proliferative disease due to frequent changes in the structure of the liver, spleen and changes in blood morphological parameters. Increased awareness among doctors of the symptoms of this disease would allow earlier detection and implementation of treatment. This paper presents the current diagnostic and therapeutic methods and the characteristic symptoms any paediatrician may encounter. The challenges of diagnosing this disease are also highlighted.

BACKGROUND: Analysis of cardiovascular system variability in the frequency domain allows for the assessment of both neural and non-neural mechanisms of cardiac regulation. This analysis is challenging due to the multiple input and output mechanisms of cardiovascular and respiratory control. AIM: The work aimed to investigate changes in spectral, phase, and coherence relationships, as well as the transfer function |gain(f)|, between oscillations of left ventricular end-diastolic pressure, specific peripheral vascular resistance, left ventricular stroke volume, and R–R intervals of the electrocardiogram during acute hypoxia at the dominant spectral component corresponding to the respiratory frequency. METHODS: Effective (n = 17) and ineffective (n = 20) types of adaptation were determined based on the direction of changes in the heart pumping parameters during the transition from normoxia to hypoxia. Effective and ineffective types of adaptation were demonstrated in the same subject during different hypoxic tests, just as the same subjects could demonstrate either only effective or only ineffective adaptation. RESULTS: Changes in gain(f) and cross-spectral power density in pairs of oscillatory processes were used to assess alterations in cardiac regulation (Frank–Starling mechanism, arterial–cardiac baroreflex, and others). For effective adaptation during hypoxia, a statistically significant (p 0.05) increase in gain for end-diastolic pressure–stroke volume relationship was observed, whereas spectral power of this parameter did not change, reflecting inability to increase CO through heterometric myogenic autoregulation during hypoxia at rest. Under these conditions, increase in CO occurs mainly due to chronotropic effect. In pairs of oscillatory processes—end-diastolic pressure–specific peripheral resistance or specific peripheral resistance–R–R intervals—cross-spectral power density significantly decreased (p 0.05) during effective adaptation. Reduction in amplitudes of these oscillatory pairs reflects adequate functioning of arterial–cardiac baroreflex in decreasing specific peripheral resistance during effective adaptation. CONCLUSION: Quantitative changes in analyzed indices of cardiac pump function under acute hypoxia are determined by alterations in their rhythmic interactions, both among themselves and with oscillations of R–R intervals at dominant respiratory frequency, as well as by displacement of AQRS (the maximum depolarization vector) in frontal plane. Identified patterns represent effectiveness of adaptation to severe hypoxia.

IntroductionA 27-week analysis of this phase 3 study demonstrated the interchangeability of the adalimumab biosimilar CT-P17 and reference adalimumab. The current 52-week analysis reports secondary data from the open-label extension period (OLE) of the study.MethodsIn this randomized, double-blind, active-controlled phase 3 study, adults with moderate-to-severe chronic plaque psoriasis received (via prefilled syringe) 80 mg subcutaneous reference adalimumab on day 1, then 40 mg 1 week later, and every other week (EOW) until week 11. At week 13, patients were randomized (1:1) to continue reference adalimumab (“continuous” group) or undergo repeated switching between CT-P17 and reference adalimumab (“switching” group) until week 25. Thereafter, patients entered an OLE and received 40 mg CT-P17 EOW from week 27 to 49, with an end-of-study visit at week 52. Here we present findings from the OLE. Pharmacokinetics (PK), efficacy (including mean percent improvement from baseline in Psoriasis Area Severity Index [PASI] score), safety, and immunogenicity were evaluated. Post hoc subgroup analyses were also conducted.ResultsOf 327 patients who initiated the OLE, 152 and 160 patients from the switching group and continuous group, respectively, completed the study. Mean serum concentrations were similar between groups throughout the OLE. Efficacy improvements observed up to week 27 were maintained during the OLE and were comparable between groups. At week 52, overall mean (standard deviation [SD]) improvement from baseline in PASI score was 90.34% (16.59). Safety profiles were similar between groups, and immunogenicity did not increase during the OLE. The mean (SD) percent improvement from baseline in PASI score was slightly lower in patients who were antidrug antibody (ADA)-positive versus those who were ADA-negative (89.57 [17.27] versus 97.29 [4.08]) at week 52.ConclusionsPK, efficacy, safety, and immunogenicity findings remained consistent throughout the OLE, regardless of prior treatment, and were generally comparable across timepoints.Trial registrationClinicalTrials.gov: NCT05495568.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13555-025-01383-5.

The challenge of managing heat generated by high-power electronic systems has increased due to the miniaturization of these systems, resulting in higher flux levels, estimated at 1kW/cm². Heat management must be a higher priority because minimal effective heat removal leads to overheating, material degradation, impacts reliability, and reduces operational lifetimes. Traditional active heat mitigation approaches rely on air and single-phase liquids. Active approaches can become bulky and require mechanical pumps, which tend to be a source of mechanical failure. As a result, single-phase liquids become unphysically large, and active systems become unphysically extensive, costly, and burdensome in the aerospace/aviation marketplace. This work introduces an innovative system of thermally driven heat removal. The system operates on the principle of heat removal by evapotranspiration using vertically arrayed micropillars. It harnesses the principles of low liquid transport in small capillary systems, intermolecular adhesion, cohesion, surface tension, and the high latent heat of vaporization of water (2,257 kJ/kg). The system achieves remarkable heat removal via small liquid volumes, presenting a promising solution to the heat management challenge. The optimized design features micropillars with dimensions of 20 μm in diameter, 100 μm in height, and 100 μm in spacing, corresponding to a density of 10,000 pillars/cm². The pillars provide passive fluid transport through capillary action microchannels, while the pillars of the evaporative microcooler provide evaporative cooling. Primary limits of the system's thermal performance due to moisture and non-condensable gases is the working fluid's evaporation, specifically evaporation dry-out, and the associated heat flux. To deal with the computational demands associated with simulating around 10^6 micropillars, a customized multi-scale modeling strategy has been implemented. The creation of systems to model and capture the dynamics of such a vast number of micropillars is a challenging task. High-fidelity micro-scale models provide detailed analyses of single unit cells where thin-film evaporation, contact line dynamics, and phase change are intricately resolved. The lost evaporation energy is used to inform simplified macro-scale models, where the micropillar arrays are treated as a porous medium, providing adequate and comprehensive heat sink models. Advanced interface tracking and adaptive mesh refinement techniques enable real-time feedback via the mesh in high-heat-flux thin film regions. The simulations are conducted in COMSOL Multiphysics 6.3 or ANSYS Fluent for coupled analysis of the multiple solving spectra. Model 1 evaluates constant temperature fields, calculates evaporation rates (ṁ), and determines heat fluxes (q̇ₑᵥₐₚ = ṁ·Lᵥ), in the presence of turbulent airflow (1-5 m/s) and high temperatures (60-100°C). In Model 2, we shift our attention to evaluating the periodic pillar arrays and optimizing their geometry for maximum heat transfer. The estimated heat flux is 11,000 W/cm², with a critical heat flux of 465 W/cm², indicating that the value exceeds the standards set by the aerospace industry. Targets that are expected to be met include: (1) the mass transfer being confirmed as capillary driven, (2) the definition of the micropillars that are structurally optimal, (3) the critical heat flux, which is the quantitative measure, and (4) the design that is integrative with aerospace electronics. The system is an example of how systems can supplant conventional pumps. This would amplify the system's reliability and improve the Overall Size, Weight, and Power (SWaP) of the system. With the capability to manage thermal power densities of 1,500 W/cm², this system represents a significant advancement in the thermal control of aerospace systems, instilling optimism for the future of aerospace's cooling technology.