Early energy analyses of agriculture revealed that behind higher labor and land productivity of industrial farming, there was a decrease in energy returns on energy (EROI) invested, in comparison to more traditional organic agricultural systems. Studies on recent trends show that efficiency gains in production and use of inputs have again somewhat improved energy returns. However, most of these agricultural energy studies have focused only on external inputs at the crop level, concealing the important role of internal biomass flows that livestock and forestry recirculate within agroecosystems. Here, we synthesize the results of 82 farm systems in North America and Europe from 1830 to 2012 that for the first time show the changing energy profiles of agroecosystems, including livestock and forestry, with a multi-EROI approach that accounts for the energy returns on external inputs, on internal biomass reuses, and on all inputs invested. With this historical circular bioeconomic approach, we found a general trend towards much lower external returns, little or no increases in internal returns, and almost no improvement in total returns. This “energy trap” was driven by shifts towards a growing dependence of crop production on fossil-fueled external inputs, much more intensive livestock production based on feed grains, less forestry, and a structural disintegration of agroecosystem components by increasingly linear industrial farm managements. We conclude that overcoming the energy trap requires nature-based solutions to reduce current dependence on fossil-fueled external industrial inputs and increase the circularity and complexity of agroecosystems to provide healthier diets with less animal products.The online version contains supplementary material available at 10.1007/s13593-023-00925-5. Sustainable Farm Systems: Long-Term Socio-Ecological Metabolism in Western Agriculture (SFS), in which different research teams have been working since 2012 to compile the largest dataset on energy balances of past and present agroecosystems calculated so far using the same approach and methodology. The environmental history perspective of the SFS project has led us to rethink the energy accounting methods applied for half a century to mainly contemporary agricultural systems, calculating a single energy return on energy inputs (EROI) expended by farmers only considering the industrial inputs bought from outside of their farms . The more diverse and integrated through internal matter-energy flows these funds are, the more complex and circular the agroecosystem is Fig. . DependiA sustainability assessment of the evolution of energy efficiency of farming must take these structural changes into account Fig. , given tThe differentiation between external inputs and recirculation of internal biomass flows is the cornerstone of our circular bioeconomic approach that combines three EROI indicators to analyze the changing flow-fund patterns of agroecosystems Table .Table 1FP or final produce). The most aggregate EROI indicator is the final EROI (or FEROI), which measures the energy return in terms of the ratio of FP biomass flows to the whole set of energy carriers used as inputs, either coming from outside or within the agroecosystem :Based on this multi-EROI accounting method explained in Tello et al. , we calcTIC can be split into external inputs (EI) and the internal flows of biomass reused (BR), where FEROI into two other energy indicators, theand theBR and EI flows, and accounting for them in a systemic way, provides a consistent analysis of the long-term IFEROI is not only a partial indicator of energy efficiency, but also the ratio of the biomass energy reinvested in the reproduction of the agroecosystem living funds to the FP dissipative energy extracted from it. The core idea underpinning this conceptual approach is the principle that all living systems rely on internal biophysical cycles that sustain their reproduction over time . In Fig. FEROI values.In any visualization of empirical results, this surface is limited by the highest EROI value found in the analyzed agroecosystems, since despite the increasing curvature of the surface towards the vertical axis it does not have a theoretical upper limit. The curvature reveals the existence of diminishing returns at any point  of the case study , the year to which each energy balance corresponds (Y), the final energy product per unit of farmland area (FP), the human labor performed in energy terms per farmland area (L), the relation between woodland and farmland area (WS), the livestock energy produce per farmland area (LV), and the proportions of final product obtained from woodland (W_FP) and from livestock (LV_FP). Each case study was introduced as a random effect nested within its country. FP and L are used as control variables for natural resource endowment, land use intensification, and technical change, which are needed given the large differences between the case studies in these respects. Introducing Y as independent variable avoids temporal autocorrelation, and introducing the random effect avoids spatial autocorrelation. The analysis was performed with the package “Rcmdr” , intermediate organic-industrial (1901–1950), and full industrial agriculture (1951–2012). Paired sample h et al. .FEROI values are shown with contour lines.Figure FEROI-EFEROI-IFEROI industrial farming data near to the origin axes of the three-dimensional surface encompassing all possible values these three EROIs can simultaneously take. In 16 out of 19 case studies, energy returns on external inputs (EFEROI) were higher in the traditional organic group than in the industrial farming group. In the industrial group, the energy returns on internal biomass flows (IFEROI) were greater than in the traditional organic cases in 15 cases, but these IFEROI increases are smaller than the corresponding EFEROI decreases  greater than the corresponding increases in final product (FP), and greater than decreases in biomass reuses (BR) when they occurred, has brought their energy profiles closer to the origin vertex of the energy map where the values of the three EROIs are the lowest  from traditional organic (1830–1900) to intermediate organic-industrial farming (1901–1950), but differences were close to significance for EFEROI (p = 0.052) and for FEROI (p = 0.07). This confirms that the main structural changes in the flow-fund patterns of agroecosystems  and IFEROI (p = 0.007), as it is from traditional organic (1830–1900) to full industrial farming (1951–2012) for EFEROI (p = 0.003) and IFEROI (p = 0.04) as well, but not for FEROI in both cases. This confirms that the higher dependence on fossil-fueled external inputs (EI) went hand in hand with lower efforts in biomass-energy reinvestment (BR) in the reproduction of the living funds of the agroecosystems from the 1950 onwards. Conversely, the much lower reliance on EI of past organic farming involved higher BR values per unit of final produce (FP).The general picture of the energy trap of industrial farm systems shown in Fig. EFEROI here) of industrial farming from the 1980–1990s onwards  or lower (Chase) FEROI values in 1954 also depending on variations in rainfall, soil quality, and proportion of livestock raising . In the Czech village of Holubí Zhoř, the FEROI and IEFROI values of traditional organic farming were scant due to the cost of livestock feeding in the poor soils of the Bohemian-Moravian highlands with low temperatures and rainfall, compared to a current organic farm in this place , compared to traditional organic farming when livestock densities were similar but meant a higher energy burden , whereas they decrease as human labor (L) per unit of land and the livestock produce share in the final product (LV_FP) increase, as expected. This is shown in the mixed-effects model (5) where log (FEROI) values also significantly decrease as the year (Y) of the energy balance is more contemporary:The results of the mixed-effects models confirm that the growing relevance of livestock production and the declining relevance of forestry have been two main drivers of the FEROI), the ones with the greatest weight are LV_FP, WS, and FP, in this order. AIC values for the chosen models and their null models and chi sq. and p (>chi sq.) values for each variable are given in the Supplementary Material for all the three mixed-effects models.Among all the variables that have a significant effect on log (IFEROI) into the dependent variable gives the following Eq. (FP) have a higher weight than the relevance of woodland in the farmland area (WS):Converting log  is significant given that forestry entails a much higher energy FP with any BR per unit of land. On the other side, the predominant BR trends per unit of land found in the dataset  are the maintenance of internal biomass reuse flows (BR) devoted to livestock feeding or too slight a decrease of them, which turn LV share in FP statistically not significant here. However, we know that behind those steady trends in livestock-related BR flows, there has been a profound structural change from mixed organic farming, where extensive grazing integrated all land uses with each other, to livestock feeding in linear industrial feedlots disintegrated from the rest of farmland  as dependent variable to obtain statistically significant results in Eq. (Regarding s in Eq. :7\documeY) so that when the year is more recent, the lower is EFEROI. This clearly confirms the energy trap of industrial agriculture driven by increases of external energy inputs (EI) greater than the growth in the final energy produce (FP) obtained. The second most significant drivers are the share of the final energy product obtained from woodland (W_FP) with a positive effect and that obtained from livestock (LV_FP) with a negative effect. This confirms the importance for the energy trap of the reduction or abandonment of forestry in most places of the Global North, together with the dietary transition to a greater production and consumption of meat. And then, finally, the control variable of labor intensity (L) appears significative with the negative sign as expected.The variable with the most important effect is the year of the balance sheet , greater than machinery and fuel , our results show that blundering into the energy trap has to do with the structural change of agroecosystems in the relationship between farmland and livestock that has limited or totally offset the BR decreases while deeply modifying its role , is the second structural change that drove the energy trap of industrial agriculture by disintegrating forests from the rest of agroecosystem living funds  and reinforced the decrease of external returns (EFEROI) as well.The decline of forestry and agroforestry, and the consequent shrinking relevance of wood biomass in agricultural produce  for internal functioning of natural processes (BR), both belowground through the turnover of organic matter that feeds soil biota and sustains its fertility  by changing their internal and external energy returns , by reintegrating the living funds of agroecosystems into more complex and bio-economically circular food territories  through self-production of renewable energy. However, like any other factory, these would no longer be agroecosystems but industrial sites. They can only produce provisioning goods, not all the regulatory and supporting ecosystem services that complex agroecology landscapes provide through their aboveground and belowground biodiversity  the latter energy aggregation problem, and the recent proposals made by Jean Hercher-Pasteur with other colleagues at the Institut Agro in Montpellier have started overcoming the previous linearity required to account for emergy transformities Supplementary file2 (DOCX 1980 KB)Below is the link to the electronic supplementary material.


Speech Language Pathology roles include assessment and treatment of communication, orofacial contractures and oral motor weaknesses, head and neck mobility, ventilator weaning, progression towards tracheostomy decannulation, and swallowing. Specific services may include augmentative and alternative communication, speaking valve implementation on and off the ventilator, advance instrumental assessment of swallowing, and innovative therapeutic interventions. The speech-language pathologists at a single verified burn center recognized a gap in knowledge regarding the scope services they provide resulting in underutilization by the multidisciplinary burn team. The purpose of this study was to develop and disseminate a proposed clinical guideline leading to the inclusion of the speech-language pathologist in the multidisciplinary burn team.Two hospital-based Speech-Language Pathologists undertook an exploratory research approach with an extensive review of available literature describing and defining their professional role both within the hospital system, and, more specifically, as a member of the burn multidisciplinary team. Burn team members were queried regarding their knowledge of speech services and appropriate patient referrals. Interviews and discussions with fellow professionals at other verified burn centers provided practice examples for comparison and consideration.Results from the review of literature and interprofessional discussions within our institution and with other verified burn centers were synthesized into the development of a structured practice guideline. Speech-Language pathology was officially included in the burn multidisciplinary team at our institution. The guideline was shared with outside Speech-Language Pathologists who were not yet a part of their burn multidisciplinary teams to describe and validate the role.This foundational study led to increased awareness of Speech-Language pathology and the potential benefits to the hospitalized adult burn population. Active participation in the burn multidisciplinary conference has expanded patient care planning and led to generation of appropriate new consultations. Dissemination of the guideline supports the inclusion of Speech-Language in the burn multidisciplinary team.This guideline details the many specialty services provided by speech-language pathology and provides the foundation for future research to detail the impact on burn patient outcomes.


The rapid solidification process is relevant to many emerging metallurgical technologies. Compared with conventional solidification processes, high-density microstructure defects and residual thermal stress are commonly seen in rapidly solidified metals. Among the various defects, potentially beneficial twin boundaries have been observed in the rapidly solidified nanocrystalline microstructures of many alloy systems. In this work, a pathway for forming twin boundaries in rapid solidification processes is proposed. A detailed derivation of strain inhomogeneities upon thermal shrinkage and the deformation twinning phase field method is given. By calculating cooling-induced thermal strain inhomogeneity in nanocrystalline metals and growth thresholds for deformation twinning using the phase field method, it is shown that residual thermal strain hotspots in the microstructure can reach the threshold for deformation twinning when the shear elastic property of grain boundaries is significantly different from the bulk. Rapid solidification technologies for metals have been under development for several decades. Depending on the cooling rate, the solidified metal may form nanocrystalline structures or amorphous metallic glasses. While nanocrystalline metals have been known for their high strength due to blockage of dislocation motions by high-density grain boundaries (GB), their relatively low ductility may pose an issue in applications that require failure resistance . Twin boGrowth twinning and deformation twinning are the two classical mechanisms of twin formation in metals. It is proposed that twin boundaries could be formed through recrystallization and growth twinning in rapid solidification processes. Through the quench of the Ni80Cu20 alloy, followed by subsequent annealing, Xu et al. observed the formation of twin boundaries in their study . Phma etIn this work, a twin boundary formation mechanism involving residual thermal stresses and the deformation twinning in rapidly solidified microstructures is proposed. By calculating thermally induced strain inhomogeneity in nanocrystalline metals  and the Understanding the elastic response of materials microstructure under external deformation is an essential part of the study of the mechanical properties of materials. The microstructure is not only a heterogeneous elastic media with complex structures, it also evolves and changes its properties under the elastic load. During the structural evolution, interfaces between different parts of the microstructure may change from the coherent state to the semi-coherent or incoherent states and vastly modify the elastic strain field on both sides of the interface. To apply the continuum elasticity theory to microstructures, a key parameter is the elastic property of the microstructural interfaces . For thePre-melting of the grain boundaries at a high temperature is another mechanism that may drastically change the elastic shear response of the polycrystalline materials. Many simulations and experimental results ,16,17,18n et al.  examinedTo account for the various factors that may contribute to the elastic properties of the GB in the calculation of thermally induced strain inhomogeneity in the nanocrystalline structure, the following assumptions were used: 1. The GB elastic properties are assumed to be independent of temperature. 2. In order to account for the potential drastic change of the GB properties discussed above, the strain inhomogeneity was calculated and compared using various fractions of the bulk shear modulus for all materials discussed in this work. 3. The elastic properties in the grain interiors are considered independent of the grain lattice orientation. While the approximations introduced above are strong, the calculation results should be sufficient to give, at least, a semi-quantitative picture of the strain inhomogeneity in the nanocrystalline structure.A polycrystalline grain structure, as shown in While the material is undergoing a volumetric shrinkage from the cooling process, strain inhomogeneities will develop in the grain structure due to the difference in elastic properties between the bulk and the GBs. Following the method introduced by Hu et al.  and SaswUsing Equations (2) and (3), the mechanical equilibrium condition in Equation (1) is written asEquation (4) above can be rearranged in the following formIn the first-order approximation, the term ith component of the displacement field.In order to solve the heterogeneous strain field The displacement field By using Equations (7) and (8), the first-order approximation in Equation (6) is rewritten using the The first-order The first-order heterogeneous strain field High-order approximations for the heterogeneous strain field  in ref.  that a rA twin structure consists of two regions with identical crystallographic orientation, but with a mirror-image stacking sequence. The two mirror crystal structures are separated by a planar defect known as the twin boundary. Deformation twinning is the formation of twin boundaries from the cooperative shift of lattice atoms under external shear stress ,24. UponMaterials with higher stacking fault energy can also activate twinning when the grain size decreases to nanoscale. In nanocrystalline materials, deformation twinning can occur through both heterogeneous and homogeneous mechanisms ,37. The While several mechanisms may lead to the nucleation of the twin boundaries, two essential steps, nucleation of new twinning partial dislocations and gliding of existing twinning partial dislocations, are related to a further growth of the twins. Normal to the existing twin boundary, nucleation of new twinning partials is needed to thicken the twins. Along the existing twin boundary, the twinning partial dislocations need a large enough shear stress to glide through the lattice and further grow the twin boundary to a larger area. PF models ,38,39 haThere are 12 possible twinning modes in FCC metals which may take place on Within the 2D simulation plane, the crystal may stay in the twinning state or the undeformed state. A spatially dependent order parameter field By defining a reference frame where the tructure . The strTo track the growth of the twinning region, a PF free energy functional considering the two twinning modes and the corresponding elastic energy is given byThe energy landscape term y et al. , the eneThe interface between the twinning region and the undeformed matrix is defined by a transition region where the twin . The disthe twin . This stculation .To calculate the term The elastic energy term in Equation (16) isThis is a summation of the twinning-induced strains from the two twinning modes with a weight function This weight function ensures that the derivative of the twinning-induced strain becomes zero in the twinning and the undeformed states in the dynamic equations presented later.The total strain To obtain the strain field during the twinning process, the mechanical equilibrium equationl method .jth component of the Using Equations (7), (8) and (19), Equation (22) becomesThe evolution of the twinning order parameters is calculated based on the time-dependent Ginzburg–Landau (TDGL) equationSince the total deformation of the system is an input parameter which is a constant during the evolution of the twin structure, a penalty term,,In the Fourier space, Equation (26) becomesEquation (27) is then approximated using the following semi-implicit Fourier spectral methodIn this work, the growth of the deformation twins in three FCC metals, aluminum, nickel, and copper, aisre examined. Although aluminum has a relatively high stacking fault energy, deformation twinning in nanocrystalline aluminum has also been well-recognized . The elaaterials  are list,andThe evolution of the twinning structure is tracked by solving Equation (28) under the equilibrated strain field through Equation (23). All the calculations were conducted in a square domain with To validate our numerical model, the theoretically predicted twinning direction was first reproduced. An initial twin may grow or shrink depending on the magnitude of the local shear strain in the reference frame. For a single crystal, the local shear strain can be controlled by applying a homogenous strain A critical strain magnitude can be obtained by applying In a polycrystalline system, the deformation twinning may happen in the region where the shear strain in the grain interiors surpasses the critical shear strain shown in The method introduced in the thermal strain inhomogeneity section is used here to estimate the shear strain in the polycrystals induced by thermal shrinkage. There is typically a large temperature drop involved in rapid solidification processes, the thermal expansion coefficients become temperature-dependent in this case ,41,46. TGiven the significant distinction between GBs and bulk, coupled with the sensitivity of GBs to temperature changes, it becomes imperative to assign different modulus values when simulating a homogeneous strain on the polycrystalline system. Considering the presence of various mechanisms such as pre-melting and segregation, which can significantly influence the elastic behavior of GBs, certain approximations must be made regarding the GB elastic properties. In this particular study, an approximation approach was employed, where the shear modulus in the GB region was set as a fixed fraction of the shear modulus in the grain interiors. Three sets of simulations were performed, each with varying values for the grain boundary (GB) shear modulus. In these simulations, the GB shear modulus was assigned as 30%, 50%, and 70% of the bulk value, respectively. Additionally, the GB bulk modulus was uniformly set to 50% of the bulk value. By extracting shear strains from the simulations within the grain interiors, a comparison was made with the critical shear strains specified in When the value of shear modulus is set at 30% of the bulk value, all three materials report possible twinning regions near the junction of the GBs, as shown in evidence  indicateIn copper, although twinning regions are present, their fraction is considerably smaller compared to Nickel. The simulative potential twinning in Nickel and Copper is supported by Wang et al. , who obsWhen the value of the shear modulus of GBs is set at 70% of the bulk value, all three materials show no potential twinning region, which is much different compared to a 30% case. The explanation for this phenomenon can be attributed to multiple factors. Firstly, grain boundaries with higher shear modulus exhibit greater resistance to deformation, making them less susceptible to the thermal shrinkage-induced strain which is the primary driving force for twinning. Secondly, the shear modulus of grain boundaries influences the transmission of shear stress across them. Higher shear modulus at grain boundaries, closer in value to that of the grain interior, facilitates a more efficient load transfer and redistribution between neighboring grains, thereby promoting a more homogeneous distribution of strain. Consequently, in the case where the grain boundary shear modulus is set to 70% of the bulk value, the resulting local strain is more uniform and of a smaller magnitude. This uniform and limited strain distribution ultimately precludes the emergence of potential deformation twinning in all three materials. Since the deformation twinning in the results depends strongly on the grain boundary shear modulus, one might be able to validate the results by observing the twinning behavior of materials with a trace amount of alloying element that segregates strongly to the GB area, therefore modifying the GB shear properties.The simulative findings emphasize the significance of deformation twinning, which predominantly occurs near grain boundaries. This phenomenon is particularly pronounced in materials such as nickel, with high melting points and relatively low critical shear strains. Understanding the prevalence and behavior of deformation twinning provides insights for real-world applications. Twin boundaries act as effective barriers to dislocation motion, resulting in improved strength, hardness, and ductility of the material. By carefully selecting the appropriate material or alloy, it is possible to anticipate a higher prevalence of twinning boundaries within the material. Materials can be designed to exhibit enhanced strength, ductility, and strain-hardening capabilities. For instance, Zhang et al.  conducteIt is noted that the current model did not explicitly consider the effect of the semi-solid mushy zone which has been extensively studied in previous works ,54,55. SThe deformation twinning mechanism for the formation of twin structures in rapid solidification processes is examined numerically in this work. Critical shear strains for the growth of deformation twins were calculated for Ni, Cu, and Al using a PF approach. The critical strain is then compared with the thermal shrinkage-induced strain in polycrystalline structures. The main findings are summarized below.For Ni, the calculated critical shear strain for deformation twinning is about 0.4% which is similar to the experimentally observed residual strain.The formation of deformation twins is strongly affected by the shear modulus of the GBs.When the GB shear resistance is significantly reduced, the shear strains in grain interiors become large enough to trigger the deformation twinning.While the current model did not consider the semi-solid mushy zone explicitly, one may expect that the additional stress generated in this region may further increase the strain inhomogeneity in the solidified microstructure.


A high incidence and prevalence of neurodegenerative diseases and neurodevelopmental disorders justify the necessity of well-defined criteria for diagnosing these pathologies from brain imaging findings. No easy-to-apply quantitative markers of abnormal brain development and ageing are available. We aim to find the characteristic features of non-pathological development and degeneration in distinct brain structures and to work out a precise descriptive model of brain morphometry in age groups. We will use four biomedical databases to acquire original peer-reviewed publications on brain structural changes occurring throughout the human life-span. Selected publications will be uploaded to Covidence systematic review software for automatic deduplication and blinded screening. Afterwards, we will manually review the titles, abstracts, and full texts to identify the papers matching eligibility criteria. The relevant data will be extracted to a ‘Summary of findings’ table. This will allow us to calculate the annual rate of change in the volume or thickness of brain structures and to model the lifelong dynamics in the morphometry data. Finally, we will adjust the loss of weight/thickness in specific brain areas to the total intracranial volume. The systematic review will synthesise knowledge on structural brain change across the life-span. Brain structure continuously changes throughout life. In healthy individuals, age-related brain atrophy and neurodevelopment account for these changes. In patients with mental and psychological disorders, disease-related brain atrophy takes place. The atrophy can start in late adolescence and young adulthood and lead to abnormal brain development . DiffereThe necessity of continuous research on the aforementioned issue is paramount. Autism spectrum disorder puts a substantial socio-economic burden, and the average diagnostic delay after initial concerns does not differ among high-, medium- and low-income countries . On averNeurocognitive slowing is a typical functional outcome of normal brain ageing, while cognitive decline is a sign of cognitive deterioration. In high-income countries, the numbers of people with cognitive decline has been rising due to population ageing. The latest favourable trends in dementia incidence are typical for the Western countries. Meanwhile, wealthy countries of other regions show the opposite tendency . It is eThe identification of infants and elderly at risk of neurological disorders is important for optimal disease management . For thiScientists fail to describe the exact pathophysiological mechanisms in which age-related brain atrophy contributes to malfunctioning of the nervous system. Many publications cover either the structural or functional impairment. High variability in individual anatomy and physiology complicates studies on structure–function association ,23,24,25Hypothetically, different brain parts have a common pace of age-related structural changes in the normal ageing, while a disproportion in the regional atrophy indicates accelerated brain ageing. Another hypothesis of the current study is the specificity of brain morphometry findings regarding normal growing and maturation in childhood and adolescence. In analogy to late life, morphometric changes in the pediatric population also remain an object of ongoing studies . For thiThe aim of our review is to find the characteristic features of non-pathological development and decline in distinct brain structures and to work out a precise descriptive model of brain morphometry among age groups. Specifically, we want to determine whether diverse brain compartments develop and decline proportionally throughout life and to calculate the annual rate of change.We will perform a meta-analysis of available findings and modelled age-related changes in the brain. This approach is advantageous over a retrospective analysis or prospective observation, especially when researchers want to establish populational norms. A meta-analysis serves as a reliable source of data if performed in accordance with the standardized methodology ,31. AnotThis protocol will be prepared in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocol (PRISMA-P) and registered in the PROSPERO International database of prospectively registered systematic reviews (protocol No: CRD42022354112). The PRISMA-P checklist is included in the supporting material .To perform the search, we will pre-define and list the inclusion and exclusion criteria for the literature see . Given tA comprehensive systematic search for literature will be conducted using four biomedical databases: PubMed, Embase, Scopus, and Web of Science. The pre-search was performed in September–October 2022 in PubMed and its Medical Subject Headings (MeSH). The review is set to start in November 2023. The strategy will be updated ahead of the manuscript submission. The names of 112 brain structures will be used as the keywords for the search strategy. The structures will be segmented from the brain MRI with the FreeSurfer software . We willOnce the papers are uploaded to the Covidence software, two independent reviewers will subsequently screen the title/abstract and full text against the predefined criteria. A third reviewer will resolve the discrepancies identified with the software. The reasons for exclusion of full text records will be stored. A PRISMA flow diagram will be used to report the screening process.Two independent reviewers will extract the data from the final list of papers into a summary of findings table. These records will include the basic characteristics  in addition to the targeted data (change in size and volume of a brain structure within a period of time). The third reviewer will resolve eventual discrepancies in the data collection.Two independent reviewers will critically appraise each individual study included into the analysis. They will assess the quality of individual studies with the Joanna Brigs Institute checklist for analytical cross-sectional studies . The tooWe will construct funnel plots for each brain region and visually assess them. In the diagrams, the effect size is plotted against the standard error of the effect size. Asymmetry of the graph indicates publication bias. In our review, the effect size corresponds to annual atrophy of a studied brain structure.Prior to statistical analysis, we will explore the heterogeneity level of the studies with the Higgins–Thompson I2 test . PotentiWe will calculate the mean value of the left and right side volumes to receive the average size. To compensate for the variability in head size, the data will be estimated on a normalised volume in percentage to the total intracranial volume. Afterwards, we will compute the percentage of relative change per year, which is the first derivative of the model divided by the initial value and provided in % per year. To model the lifelong evolution of volumetric data for specific brain areas, we will consider linear, quadratic, cubic, or higher degree equations (see Equations –4)). Sc). Sc4)).We will also use hybrid models with exponential cumulative distributions for growth with the linear, quadratic, cubic, or higher degree equations (see Equations –7)).(5).(57)).Then, we will select the model explaining most of the data with a minimum number of parameters. To identify the best one among the candidate models, we will use a Bayesian information criterion  an atrophy rate of brain parts vulnerable to changes in neurodevelopmental delay and neurodegenerative disorders and (2) brain structural correlates of the aforementioned pathologies.Relationships between environmental factors and brain structure are not the major research topic for the study. Still, the data on environmental risks may show the multidimensionality of the research question. The latter is not limited to brain changes across the life, but it also includes the impact of adverse life events, dietary patterns, physical exercise, and vitamin or mineral supplementation on cognitive function in children and the elderly ,69,70,71The necessity of the current systematic review arises from the absence of reliable markers of delayed neurodevelopment and accelerated ageing: no threshold criteria for abnormal annual change in the brain are established. Visual assessment of the MRI by the radiologist can confirm dementia diagnosis when cognitive decline becomes prominent. However, subtle changes in the brain remain misreported . This evStatistics for meta-analysis help to diminish the risk of unreliable research outcomes resulting from inter-study heterogeneity. The meta-analytic approach allows for combining evidence from numerous studies, thus enlarging the study sample, as well as consolidating complex and sometimes conflicting findings . After rOur meta-analysis will illustrate life-long trends in brain volumetric changes. We will use regression models to provide trendlines for the variables of interest ,74. The We will focus on the studies of cognitively normal people and model the annual rate of change in their brains. A reason for narrowing the research question to the cognitively intact population is limitations of the concept of accelerated ageing, which should be critically reappraised. For example, it remains unknown whether neurodegeneration is a kind of accelerated ageing ,76 or anWhen studying accelerated ageing, one should consider individual multi-component reserves in the brain. The structural reserve refers to the number of neurons and synapses, whereas the cognitive reserve determines the ability of the brain to cope with structural brain damage . SupposeThe objective of the current study totally fits the idea of ‘Precision Medicine’, which is a concept of personalizing disease prevention and treatment. The concept integrates advanced statistical analysis into routine assessment of clinical findings along with the environmental, social, and behavioral factors impacting the individual . CurrentWe aim to improve the situation by applying quantitative assessment of radiological findings (radiomics) into practice instead of keeping it exceptionally for research. Radiomical findings will support early diagnostics and clinical decision making, thus meeting the demand of time. Radiomics mine high-dimensional data on organ structure and correlate this information with age and clinical endpoints . ModelliThis meta-analysis will help modelling the populational curves of brain development and ageing. For performing a comprehensive assessment of life-long structural changes, we will take into analysis multiple morphometry parameters, e.g., volume, thickness, length and width of brain regions. A systematic review and meta-analysis is the preferable study design for the formulated research question. Combining data from cross-sectional studies and longitudinal observations will allow us to acquire more statistical data on structural changes in the brain. The theoretical value of the future study is the implementation of highly sensitive screening and quantitative assessment of individual risks, which fully fits the idea of ‘Precision Medicine’. The practical application of the study is establishing the reference norms that could be used in screening individuals for developmental delay and cognitive decline.


In addition to their contribution to neuronal homeostasis, the implication of central nervous system (CNS) non-neuronal cells in the building, regulation and maintenance of the neuronal network of the brain has been widely investigated in the recent years, involving all types of glial cells. They contribute during development to neuronal migration, axonal guidance, synaptic pruning and in the mature CNS, they are involved in synaptic modulation, adjustment of axonal conductance, among factors modulating the appropriate neuronal activity to the local circuitry and the connectivity within specific networks. Dysfunction of the cellular properties of glial cells contributes to pathologies impacting cognitive and sensorimotor functions. The regional heterogeneity among glial cells contributes also to specific properties of the neuronal networks in the various parts of the brain.This series includes seven original research and review articles covering different aspect of the topic outlined above.Shafqat et al. provides a comprehensive overview on the dual roles of the glial scar in the context of spinal cord injury (SCI). Although the glial scar formation is commonly regarded as a mechanism to protect the nervous system after injury, it has been for long time considered a process hindering axonal regeneration. In this work, new evidence is discussed for vital neuroprotective functions of glial and stromal responses to SCI. Glial heterogeneity and beneficial outcome of reactivity in scar formation are extensively examined, with a special focus on astrocytes, microglia and oligodendrocytes. Finally, this review proposes and discusses targeted manipulations of cellular components of the glial scar to enhance axonal regeneration and improve SCI outcomes.The review by Elsayed et al. deals with the mechanisms at the base of the diabetes-induced central neuropathy in the spinal cord and the pharmacological use of curcumin for its innovative treatment. Diabetes is a multifactorial disease with high prevalence in the global population, entailing a classic peripheral and central neuropathy. The identification of new medical approaches, therefore, is a priority to prevent and, hopefully, tackle microglial/glial activation as well as neuronal degeneration induced by diabetes in the spinal cord. Curcumin, which is a novel and promising natural compound, proved effective in counteracting the spinal neuropathy, via suppression of the neuroinflammatory NF-kB signaling, as well as suppression of gliosis and neuronal apoptosis.The paper by Thapaliya et al. developed a detailed biophysical model replicating key observations about Na+ and Ca2+ homeostasis in cortical and hippocampal astrocytes with the aim of providing deeper insight into the role of NMDA and AMPA receptors in the observed heterogeneity of Na+ and Ca2+ homeostasis in astrocytes. They also deciphered the effects of heterogenous expression of NMDA receptors on Na+ and Ca2+ dynamics and ATP consumption in the cortical and hippocampal astrocytes when stimulated by a high concentration of glutamate or NMDA (with Na+/K+-ATPase suppressed) as would be the case in numerous pathologies such as ischemic stroke, migraine, and traumatic brain injury.The paper by Andreeva et al. describes the different types of satellite glial cells (SGS) found in sensory and autonomic ganglia, reflecting the variety of neurons they surround and their involvement in pain conditions. Hyperexcitability and low threshold stimulation level of sensory neurons affected by nerve injury is associated changes in uptake by SGC of glutamate and various ions. The increased release of ATP and proinflammatory cytokines is associated with pain transmission.The mini review by Tang et al. reports on the involvement of astrocytes in the pathogenesis of glaucoma. Although intraocular pressure (IOP) and aging are major risk factors, some patients still develop glaucoma after lowering IOP. Heterogenous populations of astrocytes display up- or down-regulations of molecular changes over time and space which impact retinal ganglionic cell survival in glaucoma. Several second messenger pathways have either beneficial  or detrimental  opening up strategies for protective treatment for glaucoma patients in the future.The review by Plastini et al. tested the hypothesis that intrinsic dysfunction in oligodendrocytes (OLs), may contribute to etiopathology of the primary progressive multiple sclerosis (PPMS), in mature OLs obtained from differentiated human induced pluripotent stem cell (hiPSC) lines derived from PPMS and healthy individuals. The authors found that PPMS derived OLs displayed hundreds of differentially expressed genes compared to control OLs, including the inflammasome component Nlrp2 thus suggesting that mature OLs in PPMS carry intrinsic abnormalities that could contribute, at least in part, to the pathophysiology of this form of the disease.The paper by Decoeur et al., the effects of n-3 polyunsaturated fatty acids (n-3 PUFAs) on microglia in the developing white matter are discussed. Since low maternal intake of n-3 PUFAs has been associated with deficits in brain myelination, the authors set to investigate whether microglia, which notably contribute to this process, are implicated. Combining light and electron microscopy, this work shows that n-3 PUFAs maternal deficiency reduces microglial density and interaction with myelin in the corpus callosum of the offspring. In addition, mitochondrial content per microglia is increased in association with n-3 PUFAs deficiency. Taken together, these findings indicate that maternal n-3 PUFA deficiency affects white matter microglia in the early post-natal brain, highlighting the critical role of maternal diet for microglial modulation and offspring brain development.In the research article by This series of articles illustrates how the diversity in glial cells contributes to normal function or dysfunction at different stages of development and different brain regions and systems. It illustrates how much non-neuronal cells contribute, with their diversities and distributions, to the building, maintenance, and functional regulation of the neuronal circuits.All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.


The frozen elephant trunk is a formidable tool for the aortovascular surgeon. An appreciation of how to size the graft in different pathologies is key in achieving optimal results. Herein, we demonstrate worked examples of how imaging can be used to plan for a frozen elephant trunk and discuss the nuisances and uncertainties of sizing using three index cases: Type A aortic dissection, distal thoracic aortic aneurysm and chronic dissection. The management of complex arch and descending thoracic aortic pathologies presents some of the most formidable operative challenges in aortovascular surgery. The initial development of the classical elephant trunk by Borst  and the However, to make the most of the FET’s versatility, the surgical team needs to carefully interrogate the pre-operative Computed Tomography Angiogram (CTA) and individualise the approach for each patient based on pathology, body habitus and aortic configuration.Here, we will discuss the central role of using imaging to guide sizing of the FET based on underlying pathology using three examples of using the FET in acute aortic dissection, chronic dissection and aortic aneurysms.Key demographic data, clinical characteristics and operative reports were analysed across our case series of frozen elephant trunk implantations (69 cases from November 2007 to June 2023) to identify three indicative cases, for acute type A dissection, degenerative aneurysm and chronic dissection.All imaging were anonymised and patients consented to imaging being used for research and subsequent publication.Key images are presented with a 3D reconstruction of the whole aorta pre- and post-operatively with demonstration of cross-section analysis perpendicular to the aorta at different levels. We provide key cross-sections of the descending thoracic aorta at the level of the elephant trunk portion and distal to the elephant trunk, demonstrating pertinent diameters of the aorta and true/false lumen as indicated.All analyses were performed using the 3mensio Vascular software There are many proposed methods and a lack of consensus on how to size the FET. Various protocols have been suggested by multiple experienced aortic teams  that is always parallel to the vessel, thus giving the ability to obtain true cross-sections perpendicular to the aorta at all levels. Perimeter-derived diameters are measured in several levels of the ascending aorta, aortic arch and thoracoabdominal aorta.The key concern is to minimise the risk of spinal cord ischaemia without compromising the outcome of treatment.We routinely size the FET endopart length to go around the curvature of the distal arch but not more than the level of T7, especially if there are patent intercostal arteries of significant size.Lengths are always measured in vessel stretch display.Additional to the centreline, an outer curve line is also drawn from the intended FET distal anastomosis level to distal descending aorta to estimate the anticipated distal landing zone more accurately.Size: Measurements of true as well as the total aortic diameter  are taken at the level of the left atrium to determine the graft size.In this case, a pre-operative 3D reconstruction with centreline analysis and multiplanar reconstruction of a De Bakey I dissection is shown in In Other imaging considerations: Inspect presence and location of re-entry tears in thoracic and abdominal aorta to avoid issues of FET malposition in false lumen and malperfusion of distal branches.Size: We size chronic dissections based on the true lumen perimeter-derived diameter as the rest of the aorta and the septum between the true and false lumen can be very stiff/non-compliant. Measurements are taken at 2 cm intervals on the descending aorta and the graft is sized at the location where we expect the endopart to be deployed.In this case, , a youngOther imaging considerations: Careful inspection should be made to see if the false lumen is supplying intercostal/visceral arteries and whether distal re-entry tears are present. In the absence of distal re-entry and dependence of perfusion on the false lumen only, implantation of the FET might be catastrophic.Size: In chronic thoracic aortic aneurysms, we suggest a 10–20% oversize and aim for a landing zone of more than 30 mm. The key consideration in aneurysmal disease is to minimise both the chance of endoleak as well as avoid occlusion of lower intercoastal arteries.Finally, Our report demonstrates the use of pre-operative aortic imaging and downstream reconstruction to size the frozen elephant trunk, in advance of any operation.Due to the lack of consensus as to how to size a FET, we present the key considerations presented in the literature, as well as a potential generic algorithm for sizing in different pathologies.Finally, we summarise our recommendations for future research and guideline development in this evolving field.We feel that a high-quality, ECG-gated CTA from the circle of Willis and down to the femoral arteries should be mandatory in all cases where aortic interventions are contemplated.Downstream analysis should use dedicated software for aortic centreline measurements and multiplanar reconstructions for ascertaining aortic lengths and orthogonal diameters. Specialised vascular imaging software can be used that provides dedicated workflows for high-quality and reproducible measurements, such as our demonstration of the use of 3mensio.(a)Maximise true lumen perfusion;(b)Minimise spinal cord injury;(c)Minimise risk of type Ib endoleak;(d)Mitigate the risk of future re-interventions.Appropriate sizing for the diameter and length of the stent graft is key to:We feel that the key components to examine in a pre-FET CTA should include the diameters of the ascending, arch and DTA at the level of the pulmonary artery and/or left atrium, the diameter of arch vessels and the distance between the arch vessels/landing zones .Furthermore, one should make note of the dominance, origin and patency of the vertebral artery and presence and location of the artery of Adamkiewicz.In cases of aortic dissection, the location and extent of proximal aortic communicating tears and their relation to the left subclavian origin, as well as distal communicating tears, should be noted. The patency of the true lumen, presence of radiological malperfusion and dependence of peripheral vascular beds on false lumen perfusion are also key considerations.Other, generic considerations such as assessment of cannulation sites for cardiopulmonary bypass, aortic wall quality , etc. are also important in achieving successful outcomes.p < 0.0001) [Maximising false lumen thrombosis is a key consideration in optimising long-term outcomes beyond the early post-operative period. A meta-analysis from Li et al. in 2016 demonstrates the key role of the residual patent false lumen in long-term mortality, as well as aortic re-intervention   highligh 0.0001) ,12. Yet,Sizing to the total aortic diameter allows the still compliant dissection flap (septum) to fully re-expand and minimise false lumen flow ,14. ThisOn the contrary, there can be some apprehension that sizing to total diameter can risk leading to improper expansion of the stent graft, aortic injury and dSINEs . As suchWhen considering the risk of dSINEs, it is important to remember that they can be associated with up to 25% risk of mortality post-acute dissection repairs and are much more relevant post-FET  ,16. HencComplicating matters further, there are no established clinical risk factors for post-FET dSINEs, and oversizing does not appear to always be a key pathway leading to dSINEs. Proposed mechanisms include short grafts, with a sharp angle between the graft–lumen interface and the presence of connective tissue disease ,17.With the lack of clear evidence, we feel that in most cases of acute dissections, sizing to the total aortic diameter with no oversizing is acceptable to maximise FL thrombosis and achieve optimal remodelling and long-term positive outcomes without an excessive risk of injury to the aortic wall or intima.The use of the elephant trunk technique can help in excluding false lumen dilation evident in chronic dissection, promoting aortic remodelling and minimising the risk for further re-interventions.There is some variability in sizing practices at major aortic institutions for chronic dissections with the Bologna group  sizing tThe main concern in sizing for a chronic dissection is that the flap becomes more inelastic, as suggested by computational models and clinical observation . As suchThis concern is mostly extrapolated from the TEVAR literature , where cFinally, sizing a FET for chronic dissection also needs a careful examination of the CT aortogram to assess whether false lumen flow is responsible for distal vascular bed perfusion and whether any distal communication tears are providing flow to key intercostal, visceral or peripheral vascular beds. Excluding the false lumen and inducing false lumen thrombosis in this setting can lead to catastrophic malperfusion.To mitigate the risk of potential aortic injury, we suggest  toUtilising the FET for aneurysmal disease, one needs to balance the risk of type 1b endoleak by appropriately oversizing the graft and distal sealing zone length versus the risks of spinal cord injury, graft crumpling and aortic disruption.Kandola et al. in a retrospective analysis of FET use in aneurysms demonstrate that the majority of endoleaks occurred with <10% oversizing and <30 mm distal seal zone and virtually no endoleaks when oversizing was achieved by >10% and a >30 mm distal landing zone . FurtherWe recommend, in the absence of larger-scale registries, to adopt 10–20% oversizing and an at least 30 mm distal seal zone.Paralysis or paraparesis post-FET is a devastating complication that compromises long-term outcomes and has a detrimental effect on quality of life. This can occur in up to 25% of patients. The Preventza meta-analysis identified a subgroup of patients in whom the graft length was >15 cm and covered beyond T8 that had a risk of spinal injury of 11.6% (95% CI 6.1–21.1%) versus 2.5% (95% CI 1.5–4.0%) where a coverage <T8 and <15 cm was achieved [On the contrary, there is some evidence that it is safe to achieve a longer graft coverage with up to 12 segmental arteries being sacrificed without substantial increased spinal injury risk . As suchHowever, we err on the side of caution and aim for coverage up to T7 based on the subgroup analysis from the largest meta-analysis on the topic.Timely diagnosis and intervention in acute aortic syndromes and large aneurysms are a key priority for healthcare systems due to their associated morbidity and mortality. However, diagnosis can be challenging due to the rarity of the condition and its variable presentation, including mimicking other emergencies such as stroke and myocardial infarction.Fast-tracking the identification of patients with high pre-test probability for aortic emergencies to obtain an appropriate CT angiogram is paramount in minimising the risk of misdiagnosis .The comprehensive interpretation and downstream processing of aortic imaging in planning for a FET procedure can be time-consuming and a limiting factor in its uptake in the setting of acute presentations. Development of machine-learning algorithms that can rapidly size the aorta in its whole length and identify the true and false lumen trajectories and communications and the extent of false lumen thrombosis will be a highly anticipated innovation. There is growing literature on the use of artificial intelligence in segmenting the aorta to obtain haemodynamics and dimensions with encouraging results with good correlation with conventionally obtained measurements ,29.Integration of artificial intelligence in expeditious, simple and accurate planning for arch/DTA interventions could be a strong driver in expanding the use of FET in the years to come.It is of importance to highlight that there is still a lack of overall consensus on how to size the FET in the absence of large, well-designed registries aiming to address this question.This is reflected in the variable practice base as observed in a recent survey  of multiExisting data come from small institutional studies of heterogeneous cohorts  with medium-term follow-up or small numbers of patients under long-term follow-up.Furthermore, the effects of sizing on hard clinical outcomes such as re-intervention, spinal injury and mortality are still unclear.Representing the whole spectrum of pathologies treatable by FET;Capturing all commercially available stent grafts;Standardised nomenclature and definitions of how the stent grafts have been sized ;Long-term outcomes reported, with standardised definitions for both aortic adverse outcomes and clinical outcomes.We suggest that large-scale, international registries need to be established with a vision to clarify how to best optimise sizing the FET and achieving optimal outcomes by:A clear statistical plan should be formulated to, as far as possible, clarify the relationship of graft sizing with false lumen thrombosis and subsequently the relationship of false lumen thrombosis with outcomes. Finally, the relationship between distal extent of the graft with disease progression versus spinal cord injury should be examined.This should inform prospective studies to validate the retrospective findings, as well as set the scene for mechanistic/exploratory investigations on the mechanical characteristics of individual stent grafts and aorta–graft mechanical interactions.Lastly, our recommendations do not take into consideration the rare but important subset of patients with non-atherosclerotic arch pathology  or the patients presenting with arch dissection/aneurysms in the peri-partum period ,32. LargOnly then can we make more robust recommendations and set the gold standard in how to optimise FET sizing for achieving optimal outcomes across the spectrum of aortic diseases.In the absence of robust data, we offer a summary of our recommendations for sizing based on current based knowledge and experience (We demonstrate three key cases that highlight the importance of careful pre-operative examination of the CT aortogram in planning for a successful FET across the spectrum of aortic diseases.


Velopharyngeal insufficiency (VPI) is a type of pharyngeal function dysfunction that causes speech impairment and swallowing disorder. Speech therapists play a key role on the diagnosis and treatment of speech disorders. However, there is a worldwide shortage of experienced speech therapists. Artificial intelligence-based computer-aided diagnosing technology could be a solution for this. This paper proposes an automatic system for VPI detection at the subject level. It is a non-invasive and convenient approach for VPI diagnosis. Based on the principle of impaired articulation of VPI patients, nasal- and oral-channel acoustic signals are collected as raw data. The system integrates the symptom discriminant results at the phoneme level. For consonants, relative prominent frequency description and relative frequency distribution features are proposed to discriminate nasal air emission caused by VPI. For hypernasality-sensitive vowels, a cross-attention residual Siamese network (CARS-Net) is proposed to perform automatic VPI/non-VPI classification at the phoneme level. CARS-Net embeds a cross-attention module between the two branches to improve the VPI/non-VPI classification model for vowels. We validate the proposed system on a self-built dataset, and the accuracy reaches 98.52%. This provides possibilities for implementing automatic VPI diagnosis. Velopharyngeal insufficiency and/or incompetency (VPI) refers to abnormal palatopharyngeal function. The airflow passage between the soft palate and the pharyngeal walls (or adenoids in children) does not close completely . This deAccording to the causes of the disease, VPI can be classified as congenital VPI or acquired VPI . CongeniClinical assessment of palatopharyngeal function can be performed using instruments that allow direct visualization of the palatopharyngeal closure status. These include nasoendoscopy , multiviThe noninvasive approach generally relies on a speech-language therapist’s (SLT) assessment of certain phenomena or intermediate data to diagnose hypernasality or nasal air emission caused by VPI. The mirror-fogging test is used to detect nasal air emission . HoweverClinical assessment using speech perception mostly relies on well-trained SLTs for subjective diagnosis of patient speech . The numThe current research on speech-based computer-aided VPI detection algorithms is focused on the automatic detection of speech disorders caused by VPI. In terms of hypernasality speech, the extra nasal resonance is present . The nas(1)An automatic VPI/non-VPI detection system at the subject level based on speech is proposed in this paper. The system takes into account distinctive articulatory symptoms caused by VPI, nasal air emission, and hypernasality. For this purpose, the detection of VPI/non-VPI at the subject level is proposed by integrating the symptomatic manifestations at the phoneme level.(2)VPI causes a change in the propagation path of the airflow through the vocal tract, which affects the acoustic signals radiated from the nasal and oral cavities. For unvoiced consonants, the power spectral density ratio (PSDR) is calculated to indicate airflow leakage to the nasal cavity relative to the oral cavity. This paper proposes relative prominent frequency description and relative frequency distribution features based on PSDR. They are extracted to characterize the perceived acoustic signals radiated from the nasal cavity relative to those from the oral cavity.(3)Mathematical models for VPI patients and non-VPI controls on vowel articulation are established in this paper. Based on the discrepancy between VPI patients and non-VPI controls shown in the models, a cross-attention residual Siamese network (CARS-Net) is proposed for VPI/non-VPI classification at the phoneme level for vowels. A cross-attention module is proposed that is embedded in CARS-Net to enhance the ability to extract the discriminating features for VPI and non-VPI classification at the phoneme level for vowels.This paper proposes an automatic VPI detection system that operates at the subject level. The data are the acoustic signals collected from the nasal and oral channels. VPI/non-VPI automatic classification methods at the phoneme level are proposed for consonants and vowels. The results at the phoneme level for the subjects are fused to obtain the VPI/non-VPI detection result at the subject level. The above methods can assist clinicians in VPI diagnosis. Our main contributions are summarized as follows:The specific clinical structural speech disorders caused by VPI are nasal air emission and hypernasality . The vibNasal air emission symptoms caused by VPI arise from specific types of consonants: plosives, affricates, and fricatives . The airHypernasality symptoms caused by VPI are mainly detected in the articulation of vowels . When naThe data used in this work were collected from volunteers recruited by the Cleft Lip Unit of West China Hospital of Stomatology, Sichuan University. A total of 89 patients with VPI and 46 controls without VPI were included in the dataset. The participants are from 10 provinces in China and aged from 4 to 45. And the average ages (mean ± SD) of the VPI and non VPI groups are 18.64 ± 7.58 and 13.04 ± 7.04, respectively. In terms of sex, there are 66 females and 69 males. Among them, the VPI group consists of 43 females and 46 males, and the non-VPI group consists of 23 females and 23 males. There are 4860 phonemes in the dataset.The Nasometer II 6450  is the acquisition device for the dataset. The two microphones carried by this device are separated by a plate, allowing simultaneous recording of the acoustic signals radiating from the nasal and oral cavities. The nasal channel records the sound of a microphone placed close to the nasal cavity, and the oral channel corresponds to the sound recorded by the microphone placed in front of the oral cavity. The sampling rate is 11,025 Hz.An automatic VPI/non-VPI detection system at the subject level is proposed in this work. As shown in Step 1: VPI/non-VPI classification at the phoneme level.(1)VPI/non-VPI classification at the phoneme level for consonants: The relative prominent frequency description and relative frequency distribution are extracted based on the power spectral density ratio sequence. They are combined with a support vector machine classifier to implement the VPI/non-VPI consonant classification model.(2)VPI/non-VPI classification at the phoneme level for vowels: A cross-attention residual Siamese network (CARS-Net) is proposed in this paper to achieve end-to-end VPI/non-VPI speech classification at the phoneme level for vowels.Due to the different effects of VPI on the pronunciation of unvoiced consonants and vowels, different classification methods are proposed for consonants and vowels, as described below.Step 2: Automatic VPI detection at the subject level by the voting method.The VPI/non-VPI classification results for all phonemes of each subject are aggregated through voting to obtain the VPI detection results at the subject level. A subject is classified as a VPI patient if more than half of the participating phonemes are classified as VPI speech.The proposed automatic VPI/non-VPI speech classification method for consonants is shown in The power spectral density ratio of the acoustic signals of the nasal channel and oral channel is calculated to discriminate unvoiced consonants with and without nasal air emission symptoms caused by VPI. The acoustic signals recorded by the microphones do not only contain the acoustic signal radiated from one cavity, even if there is a separator plate blocking the acoustic signal transmission. This subsection describes the mathematical derivation of the power spectral density of the collected acoustic signals of one channel to approximate the power spectral density of the radiated acoustic signals from the corresponding cavity.i-th frame signals of the oral channel and the nasal channel are denoted as The consonant segments of two-channel acoustic signals collected by microphones in front of the nasal and oral cavities are divided into frames with a frame length of 20 ms and a frame shift of 6 ms. The Assuming the signal attenuation of the microphone with respect to the other channel is a linear attenuation; the relationship between the collected signals and the radiated signals is as shown in the following equations.The pronunciation of the unvoiced consonants is based on the friction between the airflow and the vocal organs. When patients with VPI produce unvoiced consonants, the friction factor generated by the airflow overflowing the nasal cavity is different from that of the oral cavity. Therefore, the frictional sounds radiated from each of the two cavities are regarded as uncorrelated signals in this paper. Then, the autocorrelation functions of Similarly, the autocorrelation functions of Since the value of i-th frame Then, the modulus of the approximate power spectral density ratio of the radiated signals from the nasal and oral cavities of the To remove outliers caused by random noise, the ratios (1) Relative prominent frequency description between the acoustic signals of nasal and oral channelsThe generation of aspirated consonants is directly caused by the friction between the airflow and the gap of the cavity. The intensity of the sounds is positively correlated with the gas dynamic pressure. When patients with VPI produce unvoiced consonants, the airflow overflows into the nasal cavity. Assuming a constant cavity gap and lung dynamics, the relative gas dynamic pressure in the nasal cavity is increased, while the oral gas dynamic pressure is relatively weakened.In this paper, we extract the maximums of the spectral density ratio In addition, the sound quality is related to the shapes of gaps and cavities, which are different in the nasal and oral channels. Therefore, the two cavities produce different frictional noises. The locations of The above three features are concatenated to form a relative prominent frequency description ((2) Relative frequency distribution between the acoustic signals of nasal and oral channelsAspirated consonants are produced by turbulence, which is generated by friction between the airflow and the cavity gap. The different gap shapes of the nasal and oral cavities create different tuning effects. As a result, the frequency band distributions of the signals radiated from the two cavities are different. When patients with VPI produce aspirated consonants, compared with patients without VPI, the spectral density ratio is enhanced compared to the value at the frequency of the signal radiated from the nasal cavity. This is reflected by the difference in the distributions of the power spectral density ratio. The frequency band of the power spectral density is linearly divided into In this paper, a cross-attention residual Siamese network (CARS-Net) is proposed to achieve automatic VPI/non-VPI classification for vowels. Based on the articulation principle of VPI speech, two-channel acoustic signals from oral and nasal cavities are collected for automatic classification. Compared with a single-input network, the Siamese network structure has dual inputs and is suitable for extracting differences in acoustic signals from the oral and nasal cavities. The network structure proposed in this paper is shown in As shown, CARS-Net contains three parts: the input layer, difference feature extractor (DFE), and VPI/non-VPI speech classifier. First, the acoustic signals of vowels are collected by two microphones in front of the oral cavity and nasal cavity. They are transformed into spectrograms as the network inputs. Then, the inputs go through the DFE to produce the difference feature map. The DFE contains two branching networks for the two inputs. The two branching networks are linked by the cross-attention module proposed in this paper. Finally, the difference feature map is fed into the VPI/non-VPI speech classifier for automatic classification. The next four sections describe the details of the three parts and loss function for training the network.The oral and nasal channels of vowels are transformed into spectrograms by framing and short-term Fourier transform operations, and they are then used as inputs to the network. A schematic diagram of the vowel production process is shown in There is a discrepancy between the two channel signals for VPI patients and controls. When a person without velopharyngeal insufficiency (VPI) vocalizes, the switch shown in the figure is open, indicating that the palatopharynx is closed. However, in the case of a VPI patient vocalizing, the switch is closed, indicating that the palatopharynx is not fully closed, thus allowing air to flow into the nasal passage. The system responses include the resonant and radiative effects of the resonant cavity on the vocal cord waves, which can be reflected in the spectrograms of vowels. Furthermore, the spectrograms of vowels change over time compared to the spectrum. In this work, the spectrograms used as the inputs to the network may allow the network to extract the distinguishable features between VPI and non-VPI vowels.Difference Feature Extractor (DFE) is the backbone network of CARS-Net. DFE is mainly used to extract deep features of the input image for subsequent classification. The DFE uses a Siamese-like network structure with two branching networks to extract the differences in the resonance response features contained in spectrograms of the two acoustic signals of the nasal channel and the oral channel.The two branching networks of the DFE extract the deep features of the two input spectrograms of the nasal and oral cavities. The two branching networks in CARS-Net use a ResNet-18 architecture consisting of residual blocks. The residual block  is propoIn this paper, a cross-attention module (CA module) is designed to link the two branching networks. This means embedding a cross-attention block in the residual blocks in the two branching networks. The two input acoustic signals are correlated, and they can be expressed as two signals after obtaining different system responses for a homologous signal, as shown in (17). The traditional Siamese network structure has no connection between the two branching networks. The two branching networks share weights but process the two inputs independently without utilizing the correlation information between the two inputs. The CA module is implemented by coupling the intermediate feature maps of the two channels. This allows the originally independent branching networks to be linked in the feature extraction process, enhancing the model’s ability to control the global information. i-th residual block in each of the two backbone networks are denoted as The input feature maps of the erations . Afterward, a fully connected layer operation is performed to output a weight vector of dimension The output feature maps of the feature extraction module i-th block, as shown in (14).i-th residual block and the input of the i + 1-th residual block.Finally, the weighted feature maps are used to replace the original feature maps with the input feature maps in order to obtain the output feature maps of the CARS-Net uses a fully connected layer for end-to-end VPI/non-VPI classification instead of threshold judgment, in contrast to the traditional Siamese network. The difference feature map obtained by the two branching networks is flattened into vectors, which are then fed sequentially into a fully connected layer and a softmax layer to achieve binary classification. The process is shown in (15).In the traditional Siamese network structure, the Euclidean distances of the final feature maps obtained from the two backbone networks are calculated for threshold classification, as shown in (16).This classification method compresses the feature differences between the two channel signals into a single value, with an eye on the overall differences between the dual-channel inputs. This is equivalent to assigning the same weight to each local feature difference in the classification. In contrast, in the classification task of this work, the individual detailed differences in the two input spectrograms reflect different system response features. Different pronunciation system response features should also make different contributions to the classification. The fully connected layer is a nonlinear operation that assigns different classification weights to features at different positions in the difference feature map.The loss function of CARS-Net consists of two parts, contrast entropy loss and cross-entropy loss, as shown in (17).i-th sample. The cross-entropy loss captures the final classification accuracy, as shown in (18).i-th sample.Scholars  have desFor VPI/non-VPI classification at the phoneme level for consonants, two feature sets, For VPI/non-VPI classification at the phoneme level for vowels, a network structure, CARS-Net, is proposed. The parameters are initialized using the He initialization method  for traiThe VPI/non-VPI classification experiment at the phoneme level for consonants and vowels uses 10-fold cross-validation. To decrease the error introduced by the detection results of individual consonants or vowels, a voting mechanism is used for the classification of the VPI for each patient/subject. The classification results of all phonemes participating in the experiment for a given subject are counted. A subject is classified as a VPI patient if more than half of the phonemes of the subject were identified as VPI speech.As shown in As shown in In terms of the VPI/non-VPI classification results at the subject level, the voting method can improve the robustness of the automatic VPI/non-VPI detection system compared to using individual phoneme classification results. In the clinical diagnosis of VPI, speech therapists synthesize the auditory perception of a whole paragraph rather than a single phoneme. This paper uses a voting mechanism to perform automatic subject level VPI/non-VPI detection based on our proposed phoneme level detection algorithm. This method is consistent with clinical diagnosis.This subsection discusses the VPI speech classification results for consonants. In the VPI/non-VPI classification method for consonants, two sets of features, As shown in Both As shown in This subsection discusses the results of VPI speech classification for different consonants to investigate the effect of articulatory processes and articulatory organs on the proposed VPI consonant classification method.Three types of consonants with different articulatory processes are involved in this experiment: the aspirated plosives , aspirated affricates , and fricatives . These consonants are classified by articulatory organ into bilabial (/p/), alveolar (/t/), velar , front palatal , blade alveola (/c/), retroflexes (/sh/), and labiodental (/f/) as shown in As shown in VPI leads to a partial overflow of air to the nasal cavity and a decrease in oral airflow. After the deblocking process of affricates and fricatives, the airflow passes through small gaps shaped by the articulatory organs , and theAs shown in As shown by the VPI speech classification results from the perspective of different articulatory organs in The front palatals  are pronounced with the front of the tongue against or near the front of the hard palate, where the airflow is obstructed and then formed. The location of articulatory deblocking for the front palatals  is at the hard palate. VPI causes a gap in the plane where the palatopharynx and hard palate are supposed to form, causing it to further interfere with the deblocked articulation process of the hard palate. This makes front palatals  more distinguishable in VPI/non-VPI classification at the phoneme level for consonants.The soft palate is the deblocking site for the velar (/h/). The soft palate is located closer to the palatopharynx than the rest of the affricates and fricatives. VPI results in less impact on the reliance on soft palate position to deblock vocalization when airflow is shunted in the palatopharynx. This results in lower differentiation between the non-VPI and VPI pronunciations of the velar (/h/).As shown in The consonant pronunciation of VPI patients presents stronger nasal radiation acoustic signals than that of non-VPI controls. It produces a change in the percentage of the concentrated frequency band of the oral radiation acoustic signals in the whole frequency band. The frequency of most unvoiced consonants in Mandarin radiated from the oral cavity are higher than 4000 Hz . When NhWhen nonnasalized vowels are produced by VPI patients, the vocal cord wave spills into the nasal cavity, which does not occur without VPI. In this paper, CARS-Net is proposed to perform automatic VPI/non-VPI speech classification for vowels. It captures the different feature maps of the spectrum of the acoustic signals of the nasal and oral channels to distinguish vowels produced by patients with VPI and without VPI. From the VPI/non-VPI speech detection results of the four vowels  shown in The shapes of the tongue and lip constitute different oral resonator shapes, thus producing different vowel sounds. The position of the tongue describes the vertical distance between the upper surface of the tongue and the palate . AccordiIf velopharyngeal function is normal, the airflow only moves toward the oral cavity when nonnasalized sounds are produced. In the presence of VPI, the airflow is directed to both the nasal and oral cavities. When producing higher lingual vowels, the narrower airflow passage between the tongue and the palate may force more airflow toward the nasal cavity. This results in more vocal cord waves flowing into the nasal cavity and fewer into the oral cavity. The difference between the acoustic signals of the nasal and oral channels is more distinguishable between VPI high vowels and non-VPI high vowels. This may explain why the CARS-Net proposed in this paper is more sensitive to high vowels  in automatic VPI/non-VPI speech classification for vowel tasksTo verify the effectiveness of the proposed cross-attention module in this paper, ablation experiments are conducted in this section. As shown in The accuracy of the network model with the CA module improved by 9.49%, 2.93%, 4.46%, and 1.04% on /a/, /e/, /i/, and /u/, respectively, compared with the network model without the CA module. On the one hand, the CA module improved the VPI/non-VPI speech classification results for /a/ most significantly, which is the vowel with the lowest sensitivity in VPI/non-VPI speech classification among the four vowels involved in the experiment. On the other hand, although the network models containing the CA module show different improvements in VPI/non-VPI speech classification based on all four vowels, the VPI speech recognition accuracies of /a/ and /e/ are still lower than those of /i/ and /u/ when using the CA module. The CA module improves the overall recognition effectiveness of the network for VPI speech without changing the relative effectiveness for different vowels. This further indicates that the VPI/non-VPI speech classification method for vowels proposed in this paper has higher discriminative power for /i/ and /u/ than for /a/ and /e/.The loss function used in this paper contains two parts, the cross-entropy loss (As shown, the overall effectiveness of the network model training without the contrast entropy loss is inferior to that of the network model trained by the loss function with the contrast entropy loss. This indicates that the cross-entropy loss provides an optimization direction for difference feature extraction between VPI patients and non-VPI controls.To verify the validity of the proposed network, this subsection describes experiments with three existing classical classification networks with single-channel inputs, namely VGG16 , AlexNetThe experimental results in The rise of artificial intelligence technology has brought new solutions to the scarcity of healthcare resources. The scarcity of speech therapists has prevented large-scale assurance of diagnosis and speech disorder assessment for patients with VPI. This paper presents an automatic system for VPI detection at the subject level. Regarding VPI/non-VPI classification for unvoiced consonants, relative prominent feature description and relative feature distribution features are shown to be effective. Furthermore, the effect of unvoiced consonants with different articulatory organs on the production of VPI symptoms is explored. Regarding vowel classification, the cross-attention module embedded in CARS-Net has been proven to be effective in the VPI/non-VPI classification task. Furthermore, the sensitivity of CARS-Net for vowels with different tongue positions on VPI classification is explored. CARS-Net is more sensitive to high vowels than to vowels of lower tongue position for VPI/non-VPI classification. The experimental results obtained by voting on the phoneme level results also demonstrate the effectiveness of the proposed system for VPI recognition at the subject level. The performance of the system makes screening for VPI and assessment for speech disorders possible even in a global shortage of speech therapists.An automatic ancillary diagnostic approach to speech-based VPI is proposed in the work. It is the achievement of qualitative diagnosis for VPI patients. In the clinical treatment of VPI patients, the assessment of the severity of VPI is also important. This not only helps in developing treatment plans for VPI patients, but also provides an objective basis for the recovery process. In the future work, we will explore the feasibility of assessing severity of VPI patients based on speech data.


The rapidly growing world population and the changing climate are increasing the food demand so much that transitioning to more sustainable horticulture has become one of the main challenges in recent years. Several strategies can enhance sustainability in horticulture, including adopting good agricultural practices (GAP) to improve soil fertility, optimizing water and nitrogen use efficiencies, and implementing low-input management techniques to preserve the environment. In this scenario, horticultural plant breeding is mainly focused on developing varieties adapted to specific environmental conditions and agronomic techniques. These varieties aim to provide higher yields and nutritional values that meet the demands while minimizing the use of resources, contributing to more biodiverse horticulture.The improvement of important agronomic and quality traits for sustainable horticulture can be obtained by using several approaches, ranging from the high-throughput sequencing technologies in the field of the omics sciences  and the new breeding techniques (NBT), to the conservation, enhancement, and the use of plant genetic resources (PGR) with unique organoleptic and functional characteristics .Sustainable horticulture: from omics sciences to new breeding techniques” features three papers that focus on using plant genetic resources to identify genes related to fruit quality in different Solanaceae species. Additionally, it includes a paper exploring the use of magnetized water as an innovative green technology in diverse crops (durum wheat and lentil).The Solanaceae family is one of the most important worldwide in terms of the number of species, economic importance and has a widespread distribution . It is extensively utilized for human consumption, making it crucial to prioritize sustainable practices within the family The Research Topic “Solanum melongena), a study investigated the presence of chlorophyll in fruit peel and its influence on both fruit color and nutritional composition . The dissection of relevant traits has been carried out by using F2 and BC1 mapping populations. However, the advent of multi-parental populations has improved the mapping of quantitative trait loci (QTLs) and the identification of candidate genes related to traits of interest in several species. A multi-parent advanced generation inter-cross (MAGIC) population was employed to identify major candidate genes controlling the fruit skin chlorophyll biosynthesis in eggplant. A genome-wide association study (GWAS) indicated the gene APRR2 (ARABIDOPSIS PSEUDO RESPONSE REGULATOR2) is the principal responsible for fruit chlorophyll in the peel. The APRR2 gene has been validated on the G2P-SOL eggplant germplasm core collection and phylogenetic studies contributed to understanding APRR2 evolution among different species .In the case of eggplant (Solanum lycopersicum L.) for genetic improvement and candidate gene identification . Local or traditional tomato varieties are well adapted to a particular cultivation area where they have been selected over the years by farmers considering quality characteristics and regional market preferences as selection criteria. In this scenario, heirlooms are of great importance both for being a reservoir of genes conferring resistance to biotic and abiotic stress and for being the representation of the local culture. Tripodi et al. studied 60 tomato heirlooms belonging to the Beefsteak, Cherry, Globe, Oxheart, and Plum types, at the phenotypic, genomic, and biochemical levels and identified genes related to important fruit quality characteristics. The biochemical characterization revealed that the selection performed by farmers was focused mainly on morphology (fruit weight) and fruit color (β-carotene). The availability of the SolCAP Tomato Infinium array allowed the authors to perform phylogenetic studies to shed light on the relationships among the heirlooms and to validate the metabolic and genomic data obtained. The accessions were distinguished by the typologies, with plum and cherry types clearly distinguished from beefsteak and globe ones, as well as by fruit sizes and shapes. Furthermore, the genes SLSUN31 and CCD3 are involved in the fruit weight increase and the conversion of all-trans-β-carotene to strigolactones, respectively. These results underscored the significance of the heirloom tomato varieties not only for their fruit quality characteristics but also because they represent a valid material for candidate gene discovery for traits such as resistance to biotic and abiotic stresses.Highlighting the significance of genetic resources, another paper emphasized the immense potential of tomato heirlooms  biosynthesis as the only relevant metabolic route and evaluated the physiological roles of the CGA produced and accumulated mainly regarding the protection against UV-B irradiation. The results demonstrated the complete absence of CGA or other caffeoylquinic acids (CQAs) in edited plants clarifying the role of HQT in the biosynthesis of most abundant phenolic compounds in Solanaceae. Moreover, the serious damage shown by CGA-lacking plants after UV exposure confirms the pivotal role of this metabolite in protecting against UV-B irradiation. It also revealed a reorganization of the phenylpropanoid metabolism involving both the redirection of flux to other biochemical branches and the remodeling of the expression of important regulators .In tomatoes, the most abundant phenolic compound is chlorogenic acid (CGA). This metabolite possesses antioxidant and antimicrobial activities, which confers resistance to some diseases and protects against UV-B light. Sestili et al. demonstrated the positive effects of this practice on the development of durum wheat and lentil plantlets (roots and epicotyls). Although the results varied depending on the species, tissues, and time points considered, compared with tap water (TW), the magnetized water treatment (MWT) led to higher root elongation in both genotypes while no effect was recorded in the epicotyl length. Significant variations were reported also in the metabolic composition. Amino acids in roots and sugars in epicotyls were mainly positively affected by MWT with a higher or even “new” correlation with the growth parameters compared to the control. The study showed that in durum wheat, sugar metabolism was mainly influenced, while in lentil, other than sucrose, organic acids are mostly affected, highlighting the species-specific response to MWT and their correlation with plant development. The results suggest that magnetized water use in agriculture can be considered a sustainable technology that promotes plant development and improves quality while reducing water usage, leading to cost savings and environmental protection.Finally, an innovative approach to contribute to sustainable horticulture and plant growth improvement is the use of magnetized water for irrigation. Although the Research Topic collected few articles, these contributions advance the understanding of agronomic and quality traits. Furthermore, the introduction of innovative technology, such as the use of magnetized irrigation water, offers promising prospects for sustainable agriculture and the production of healthier food.SS: Writing – original draft. JP: Writing – review & editing. NF: Writing – review & editing. RB: Writing – original draft.