University of Murcia

To evaluate the effectiveness and safety of external cephalic version (ECV) performed with tocolysis and sedation or spinal anesthesia, and to identify predictors of ECV success, complications, and delivery outcomes after successful ECV. This 10-year cohort study included 990 pregnant women with term non-cephalic presentation at a tertiary hospital in Spain. Data were collected retrospectively (2014-2020) and prospectively (2020-2024). All ECVs followed a standardized protocol using ritodrine plus either propofol sedation or spinal anesthesia. Multivariable logistic regression identified predictors of ECV success and complications, and delivery outcomes were recorded. ECV was successful in 691/990 (69.8%). Factors associated with higher success included a deepest amniotic fluid pocket >30 mm (OR = 1.80; 95%CI 1.04-3.11) and transverse lie (OR = 3.60; 95%CI 1.74-7.45). Lower success was observed in nulliparous women (OR = 0.55; 95%CI 0.40-0.76) and those with BMI between 30 and 35, and >35 kg/m2 (OR = 0.53 and 0.49 respectively). Complications occurred in 101/990 (10.2%), including 67/990 (6.7%) emergent cesarean sections. After successful ECV, 556/691 (80.5%) delivered vaginally. In this high-volume tertiary center, ECV performed with systematic tocolysis and sedation or spinal anesthesia achieved high success and low complication rates, supporting the safety and feasibility of this optimized protocol.

People with Epilepsy exhibit low levels of physical activity compared with the general population, despite evidence suggesting potential benefits for seizure control, physical fitness and psychosocial well-being. Persistent barriers such as fear of seizures, limited access to supervised programs, transportation difficulties, and time constraints contribute to sedentary behaviour. Telecoaching (TC), which delivers structured exercise programs through digital technologies, may help overcome these barriers. This systematic review aimed to evaluate the feasibility and potential effects of TC-based training physical activity interventions in individuals with epilepsy, focusing on adherence, QoL, physical fitness and psychological outcomes. A systematic search of PubMed, Web of Science, and Scopus identified 1086 records, of which 7 studies involving 342 participants met the inclusion criteria. Interventions included remotely delivered aerobic, resistance, flexibility, and combined exercise programs. Study quality ranged from "fair" to "good". TC-based interventions were generally safe and feasible, with no major adverse events reported. Evidence suggest potential benefits for physical fitness and psychosocial outcomes, particularly in paediatric populations, although the limited number and heterogeneity of studies preclude definitive conclusions, especially regarding seizure-related outcomes. Future research should focus on standardized TC programs, long-term follow-up, and adequately powered randomized trials to confirm effectiveness and sustainability.

Whipple's disease (WD) is a rare infectious disease caused by Tropheryma whipplei , which primarily affects the gastrointestinal tract but may also involve the joints, central nervous system, and skin. Although cutaneous manifestations are often overlooked, they can provide valuable diagnostic clues. We report the case of a 54-year-old male with long-standing seronegative migratory polyarthritis refractory to conventional treatment, who subsequently developed multiple subcutaneous inflammatory nodules and systemic symptoms. Histopathological examination of these lesions revealed a non-vasculitic, septal-predominant panniculitis with foamy macrophages containing periodic acid-Schiff (PAS)-positive diastase-resistant intracytoplasmic inclusions, raising a strong suspicion of Whipple's disease. Subsequent duodenal biopsies confirmed the diagnosis by electron microscopy and polymerase chain reaction (PCR) for T. whipplei . Panniculitis in WD represents a highly specific but rarely reported finding, characterized by thickened subcutaneous septa with partial lobular involvement, foamy macrophage infiltration, and absence of vasculitis. A literature review identified 15 cases of histologically confirmed WD-associated panniculitis, suggesting that this manifestation may be under-recognized in clinical practice. This study underscores the importance of cutaneous pathology in WD and expands current knowledge on its dermatological manifestations by providing clinicopathologic, ultrastructural, and literature-based data.

ABSTRACT This study empirically investigated the influence of the carbon trading mechanism (CTM) on firms' total factor productivity (TEP). It also examined the mediating roles of digital technology, ESG performance, and innovation attention. The study used a sample of 3209 manufacturing enterprises listed on the Shanghai and Shenzhen A‐share markets from 2010 to 2023. A difference‐in‐differences (DD) approach was employed by treating the implementation of carbon trading pilots as a quasi‐natural experiment. Digital technology was examined from two dimensions: digital technology management (DTM) and digital technology innovation (DTP). The results showed that the CTM significantly increased enterprises' TEP by 7.5%. Further analysis indicated that carbon trading improved TEP by incentivizing firms to strengthen both DTM and DTP. The results also show that a strong focus on ESG performance and innovation may inhibit the impact of CTMs on enhancing enterprises' TEP. The heterogeneity analysis revealed that state‐owned enterprises and low‐carbon‐emission enterprises were more responsive to the CTM. The results provide valuable insights for businesses pursuing sustainable growth strategies in response to carbon pricing policies and deepen our understanding of how market‐based environmental regulation can boost productivity through digital transformation.

This study utilises mobile augmented reality (AR) to enhance our understanding of multiword expressions (MWEs) and emphasise that linguistic diversity is part of cultural heritage. The main objective was to implement and evaluate the impact of a multilingual AR resource (in Moldovan, English, Russian, and Spanish) in educational settings and to identify a corpus of MWEs located in Spain. The research was conducted by applying a marker-based AR system in five academic subjects involving N = 220 undergraduate students enrolled in education degrees. Data were collected through two surveys, using both qualitative and quantitative methods that combined descriptive statistics with content analysis. Large Language Models (LLMs) were used to assist with data coding, complemented by iterative human validation. The findings revealed that the application was highly positively received, with 94% of participants acknowledging its usefulness and 83% expressing satisfaction. Furthermore, this study identified a teaching–learning procedure to enhance linguistic diversity in classrooms. Overall, the results suggest that mobile AR constitutes an effective and inclusive pedagogical tool that fosters active learning as a multimodal learning process and provides valuable localised MWE data to support future developments in corpus annotation.

Roses held profound cultural and economic significance in ancient Greece and Rome, yet comprehensive documentation of their species diversity, cultivation practices, and horticultural innovations remains fragmented across archaeological, iconographic, and textual sources. This multidisciplinary study synthesizes evidence from classical texts, archaeological remains including recently identified rose stem fragments from Oplontis, and iconographic materials—including frescoes, coins, and mosaics—to reconstruct the horticultural systems and cultural landscape of roses in classical antiquity. Analysis of literary sources, particularly Theophrastus’s fourth-century BCE taxonomic descriptions, reveals systematic cultivation of diverse rose varieties with flowers ranging from white to deep crimson, including yellow variants, characterized by morphologies from simple to double forms and valued for fragrance intensity and re-blooming capacity. Archaeological evidence from sites such as Paestum, Pompeii, and Oplontis, including pollen samples, preserved wood fragments with diagnostic prickle patterns, and fresco representations, documents commercial rose production and specialized cultivation techniques that demonstrate significantly greater morphological diversity than textual sources alone indicate. Field research and collection documentation establish the origins of Mediterranean rose cultivation, while iconographic analysis identifies roses in religious ceremonies, festivals, and daily life contexts. Textual sources provide detailed propagation methods, seasonal management practices, and evidence of Mediterranean hybridization events, alongside extensive documentation of medicinal and cosmetic applications. Economic analysis reveals specialized trade networks, commercial production centers, and diverse applications in perfumery, garland making, and pharmaceutical industries. This research establishes that Greek and Roman civilizations developed sophisticated rose cultivation systems integrating botanical selection, horticultural innovation, and cultural symbolism that directly influenced medieval and Renaissance practices and informed modern trait categorization systems. These findings demonstrate the foundational role of classical antiquity in European rose heritage, revealing how ancient horticultural knowledge, species diversification through hybridization, and cultivation techniques created an unbroken transmission that shaped contemporary rose industries and established conservation priorities for this horticultural heritage.

The aim of this study was to analyze the effects of different competition formats on the plyometric performance of under-13 basketball players, considering the influence of maturational age and monitored through GPS devices. Thirty-seven under-13 male basketball players (age = 12.91 ± 0.57 years) from four southeast Spanish teams participated in two different tournaments. On the first day, the tournament was played according to the official Spanish Basketball Federation (FEB) rules for under-14 players. On the second day, the competition was held with modified rules (Modified Tournament), in which the basket height was lowered to 2.90 m and the three-point line was replaced by a rectangle located 4 m from the basket. Plyometric variables, such as number of impacts (total and in zones), number of horizontal impacts (total and in zones), number of steps, number of jumps (total and in zones) and g-force of jumps during takeoff and landing, were assessed using GPS monitoring. In addition, the moderating effect of maturational age on the intervention in each of the variables under study will be evaluated. The results showed that the modified tournament (MT) showed significant differences compared to the standard format (FEB) in playing time, steps, landings 5–8 G, and takeoffs >8 G during positional attacks, as well as in horizontal impact variables during counterattacks and effective playing time. Bayesian analysis provided moderate-to-strong evidence for several of these variables, and extreme evidence for playing time and impacts during effective time. Moreover, maturational age (%PAH) consistently moderated the intervention effects, particularly in impact loads and locomotor demands. These findings can provide useful insights for coaches and practitioners in youth basketball. Adjusting competition rules and considering maturational status may optimize player development by creating contexts that enhance plyometric performance while adapting to the physical and biological characteristics of young athletes.

Commercial gluten-free (GF) breads often exhibit low nutritional quality due to limited fiber and bioactive compounds. The enzymatic treatment of vegetable by-products, such as broccoli and artichoke, represents a sustainable strategy to release soluble dietary fiber and phenolic compounds, enhancing the functional value of GF products. Five GF bread formulations were developed: a control bread, breads containing broccoli or artichoke extracts (BB and BA), and breads with enzymatically treated extracts using Viscozyme® L and Celluclast® 1.5 L (BBE and BAE). A commercial GF bread (BC) served as a reference. Nutritional composition, dietary fiber fractions, phenolic content, antioxidant capacity, starch digestibility, physicochemical parameters, and sensory properties were evaluated. Enzymatic treatments significantly improved the nutritional and functional properties of GF breads. Viscozyme L® produced the highest increases in antioxidant capacity and phenolic content (up to 30% higher in FRAP), while Celluclast® 1.5 L generated the highest rise in soluble dietary fiber (up to 2.75 g/100 g) and the best sensory acceptance. Moreover, Celluclast® 1.5 L significantly modified starch digestibility, reducing rapidly digestible starch by 14% and increasing slowly digestible starch by over 150%, suggesting a lower predicted glycemic response. Incorporating the enzyme-treated artichoke and broccoli by-products into GF breads effectively enhances soluble fiber, antioxidant potential, and sensory quality. Among treatments, Celluclast® 1.5 L applied to artichoke proved most effective overall, providing a balanced improvement in nutritional and functional attributes. These findings revealed the potential of Celluclast® 1.5 L-treated artichoke by-products as a source of natural bioactive compounds for developing clean-label, nutritionally enhanced GF breads.

(1) Background: Understanding suicide risk across cultures requires examining both universal and culturally specific factors that inform assessment and intervention. This study explores the influence of interpersonal variables—such as interpersonal competence, perceived social support, and constructs from the Interpersonal Theory of Suicide (ITS)—on suicidal behaviour in two culturally distinct samples: young adults from Spain and Japan. (2) Methods: A total of [437] participants (Spanish sample: n = 260; Japanese sample: n = 177) completed validated measures assessing suicide risk, depression, perceived burdensomeness, thwarted belongingness, acquired capability for suicide, interpersonal competence, and perceived social support. Moderated mediation and SEM comparative analyses were conducted to identify predictors of suicide risk in each cultural context. (3) Results: Social support was a consistent protective factor against depression and suicidal ideation, and interpersonal competence showed more contextual protective effects, significant only in the Japanese sample. Perceived burdensomeness stood out as a robust predictor of depression and suicidal ideation in both samples, and suicidal ideation was strongly associated with suicidal behaviour, while acquired capability for suicide and interpersonal competence did not show a direct association with it. (4) Conclusions: The findings highlight the protective role of interpersonal competence and perceived social support in the progression to suicidal behavior, suggesting cultural similarities and differences in how these factors operate.