Search Results (1,070)

Background: Avoidant/restrictive food intake disorder (ARFID) and selective eating are increasingly recognized in pediatric nutrition, but food selectivity has been predominantly studied in dedicated eating disorder settings and in underweight children, potentially underestimating its prevalence across broader clinical populations. This study aimed to characterize food selectivity as a transdiagnostic feature in children referred to a tertiary pediatric nutrition center, regardless of referral diagnosis or BMI status. Methods: This retrospective observational study included 417 consecutive children and adolescents (median age 9.3 years, IQR 4.1–12.9; 47.5% male) assessed at the General Pediatric Eating Disorders Outpatient Unit of Bambino Gesù Children’s Hospital IRCCS, Rome, Italy, between May 2024 and April 2026. Food selectivity was defined as clinician-documented avoidance of at least one of four food groups (vegetables, fruit, fish, and legumes). Patients were classified as having primary selective eating/ARFID (Group A, n = 141), unrecognized selective eating (Group B, n = 163), or no selectivity (Group C, n = 113). Results: Food selectivity was identified in 293 patients (70.3%), including 70.8% of those referred for obesity or overweight and 50.0% of those referred for eating disorders. Prevalence did not differ across BMI categories (p = 0.554), confirming that selective eating is independent of anthropometric status. Ferritin deficiency showed a significant gradient across groups (Group A 32.2%, Group B 17.9%, Group C 10.8%; p = 0.002). Screen use during meals and ultra-processed food consumption were similarly elevated in Groups A and B and significantly higher than in Group C (p = 0.002 and p < 0.001, respectively), with no difference between the two selective groups. Conclusions: Food selectivity is a transdiagnostic and BMI-independent feature affecting the majority of children referred for pediatric nutritional evaluation. Children with unrecognized selective eating share the same nutritional risks and behavioral correlates as those formally diagnosed with ARFID, supporting the integration of a brief food group avoidance screen into routine nutritional assessment regardless of the primary referral diagnosis. Full article

Aquaponic systems show complex multivariate dynamics in water quality parameters, with dissolved oxygen (DO) being a key indicator of biological stability. This study presents a dynamic multivariate predictive framework for short-term dissolved oxygen forecasting utilizing IoT data gathered from various heterogeneous aquaponic ponds. The issue is redefined as a regression task to forecast future DO values within a brief time-frame (~5 min), enabling early warning functionalities instead of utilizing a rule-based classification method. To ensure structural robustness across systems, we applied intra-pond percentile trimming and normalization procedures to mitigate the differences in scale between ponds. Using a Leave-One-Pond-Out (LOPO) validation scheme, we tested model performance and cross-system generalization. An MLP feedforward neural network with lagged temporal variables had an average RMSE of 0.83 on a normalized scale. Regime-based error analysis showed that the RMSE increased from 0.80 on stable conditions to 1.43 under high-volatile regimes. A comparative LSTM model did not produce substantial performance enhancements. Sensitivity analysis revealed lagged impacts of pH and turbidity on subsequent DO dynamics, indicating the need for operational measures such as aeration modification and suspended solids management. Full article

Background and Objectives: Recent studies suggest that remimazolam, a novel ultra-short-acting benzodiazepine, has an excellent pharmacokinetic and safety profile, favourable for ambulatory procedures. Although remimazolam has been studied as a sole agent for anaesthesia in day case gynaecological surgery, studies assessing its use in combination with other anaesthetics remain scarce. The aim of this study was to investigate the effects of a low-dose remimazolam adjunct on the characteristics of an intravenous propofol–remifentanil anaesthesia regimen. Materials and Methods: A single-centre retrospective observational cohort study was conducted on patients who underwent brief day case gynaecological surgery under general intravenous anaesthesia using remifentanil and propofol from November 2024 to January 2025. The patients were divided into two groups depending on whether they received remimazolam as an adjunct. To account for confounding, propensity scores (PSs) were estimated from baseline characteristics and used to derive stabilised inverse probability of treatment weights (IPTWs). Weighted regression models were then applied to estimate treatment effects on postoperative recovery time measures, consumption of anaesthetics, and incidence of any adverse effects intraoperatively and postoperatively. Cost effectiveness was evaluated using the incremental cost-effectiveness ratio (ICER). Results: The clinical data of 51 patients were retrospectively examined: 32 patients were assigned to the intervention group, and 19 patients were assigned to the reference group; after IPTW and PS trimming, the sum of weights was 22 in the intervention group and 58.8 in the reference group. The use of remimazolam as an adjunct was associated with 3.5 min shorter time to eye opening (p < 0.001) and 3.6 min shorter time to full consciousness (p = 0.002); the total consumption of propofol was decreased by 3 mg/kg (p < 0.001); the median dose of remimazolam adjunct was 0.12 mg/kg, or 10 mg per case. There were no statistically significant adverse effects. ICER was 2.35 € per minute of operating room (OR) time saved. Conclusions: In the setting of day case gynaecological surgery, the addition of remimazolam to a propofol–remifentanil regimen reduced propofol requirements and shortened recovery time without an increase in adverse effects. This may represent a more efficient anaesthetic approach for ambulatory procedures with a comparable safety profile. Full article

Background/Objectives: Ultra-processed food (UPF) consumption has been linked to type 2 diabetes mellitus (T2DM) incidence, but its association with glycemic control in individuals already living with T2DM remains less well characterized. We evaluated the relationship between UPF consumption, assessed with the Turkish version of the short Screening Questionnaire of Highly Processed Food Consumption (sQ-HPF), and HbA1c and poor glycemic control in adults with T2DM. Methods: In this single-centre, cross-sectional observational study, 425 adults aged 18–65 years with T2DM of at least 6 months’ duration were consecutively recruited at a tertiary general internal medicine outpatient clinic. UPF consumption was assessed with the Turkish sQ-HPF (range 0–11; scores ≥ 6 = high UPF consumption). HbA1c was the primary outcome (continuous and dichotomized at 7.0%). Multiple linear and binary logistic regression analyses were performed with hierarchical adjustment for age, sex, body mass index (BMI), diabetes duration, and insulin-based treatment. Results: Total UPF score was positively correlated with HbA1c (r = 0.423, p < 0.001). In the fully adjusted linear model, each one-point increase in total UPF score was associated with a 0.418% higher HbA1c (95% CI: 0.333–0.503; β = 0.413; p < 0.001), explaining 28.9% of HbA1c variance. In the fully adjusted logistic model, each one-point increase in total UPF score was associated with 25.0% higher odds of poor glycemic control (OR = 1.250, 95% CI: 1.110–1.408, p < 0.001). Insulin-based treatment and male sex were also independent predictors. UPF score was not significantly associated with lipid parameters or C-reactive protein. Conclusions: Higher UPF consumption, captured by a brief validated screener, was independently associated with poorer glycemic control in Turkish adults with T2DM. Brief UPF screening may help identify patients who would benefit from targeted nutritional intervention. Full article

Background: Burn injuries are increasingly being recognized as chronic conditions with long-term physical, emotional, and social consequences. As survival after acute burn trauma improves, greater attention has shifted toward health-related quality of life (QoL) in survivors, particularly in regions where data remain limited. Methods: This study included burn survivors treated between January 2022 and December 2023 in the Department of Plastic Surgery and Reconstructive Microsurgery of the Emergency Clinical Hospital “Bagdasar-Arseni,” Bucharest, Romania. Patients who survived hospitalization and follow-up were invited to complete a Romanian-adapted version of the Burn Specific Health Scale-Brief (BSHS-B). Demographic and clinical data were collected from medical records, including burn type, total body surface area (TBSA), burn depth, burn localization, and access to rehabilitation services. Statistical analysis included descriptive methods, chi-square tests, t-tests, Kendall’s tau-b, Cramer’s V, Cronbach’s alpha, and exploratory factor analysis. Results: Thirty-eight patients were included. Most burns were thermal (94.74%), while burns involving <10% TBSA were most frequent (60.53%). Functional outcomes were generally favorable, with most patients reporting no difficulty in basic daily activities such as bathing, dressing, and writing. However, fine motor activities and return to previous work were more frequently affected. Emotional recovery appeared less complete, with persistent mild-to-moderate loneliness, sadness, and emotional distress reported by many participants. Women reported higher levels of loneliness (p = 0.015), while third-degree burns were associated with more frequent depressive symptoms (p = 0.008). Depressive symptoms were also significantly associated with functional limitations (such as getting dressed, p = 0.002) and work impairment (p < 0.001). The adapted functional and emotional subscales showed excellent internal consistency. Conclusions: Post-burn recovery extends beyond physical healing. Although most patients regained functional independence, emotional distress and occupational difficulties often persisted. These findings support the need for multidisciplinary long-term burn care integrating physical rehabilitation, psychological screening, and psychosocial support. Full article

Research examining risk and protective factors of suicidality among Black students remains limited. This study assessed the effects of psychological inflexibility and emotional resilience on suicidal behaviors among Black college students. We conducted a secondary data analysis of the 2022–2024 Healthy Minds Study. Black students (aged 18–24) who completed the suicidality matrix, psychological inflexibility (Acceptance & Action Questionnaire II) and emotional resilience (Brief Resilience Scale) measures were included in the analysis. Logistic regressions were performed to examine the effect of psychological inflexibility and resilience on suicidal ideation, plans for suicide, and suicide attempts. The students (N = 4557) represented diverse backgrounds, with 61% being African American, 12.2% African, 13.8% Caribbean, and 7% Afro-Latinx. Further, 18.7% endorsed suicidal ideation, 9.2% endorsed suicide plans, and 3.2% reported a suicidal attempt within the past 12 months. Psychological inflexibility was associated with increased risk of suicidal ideation (OR = 1.04, p < 0.001), suicidal plan (OR = 1.05, p < 0.001) and suicide attempt (OR = 1.03, p = 0.011). Emotional resilience was not associated with any suicidal behaviors as a protective or risk factor. The findings support previous research identifying psychological inflexibility as a suicidal risk factor. Prevention and intervention strategies may warrant a focus on promoting psychological flexibility. Full article

Background: University students experience increased psychological distress during academic transitions, yet modifiable lifestyle determinants of their subjective well-being remain incompletely understood within integrated analytical frameworks. Methods: A cross-sectional survey (N = 194 undergraduates; 52.6% women; M age = 21.9 years) used validated instruments: the Satisfaction with Life Scale (SWLS), Perceived Stress Scale (PSS-10), Body Appreciation Scale-2 Short Form (BAS-2SF), Brief Resilience Scale (BRS), International Physical Activity Questionnaire Short Form (IPAQ-SF), and single-item measures of financial security and screen time. Physical activity (PA) was log-transformed (MET_log). Multiple simultaneous regression and structural equation modelling (SEM) were conducted. Results: Perceived stress was the strongest negative predictor of life satisfaction (B = −0.561, p < 0.001), while financial security was a significant positive predictor (B = +0.171, p = 0.023). SEM showed that body appreciation was associated with life satisfaction primarily through lower perceived stress (indirect effect = 0.107; consistent with indirect-only association pattern), while PA showed a significant direct association with life satisfaction (β = +0.143, p = 0.030), independent of the stress pathway. The indirect effect of PA via stress was not significant in the SEM. Model fit was acceptable (CFI = 0.951; RMSEA = 0.067). Conclusions: Perceived stress was statistically associated with the relationship between body appreciation and subjective well-being, while PA showed a direct statistical association with well-being that was independent of the stress pathway. Given the cross-sectional nature of this study, these findings suggest that university health promotion programmes may consider integrating positive body image and stress management components alongside PA promotion to support student psychological well-being. Full article

Bacteriophages infecting phytopathogenic bacteria represent promising alternatives for plant disease control; however, some groups, such as filamentous bacteriophages, remain comparatively underexplored. In this study, we present a comprehensive characterization of XaF13, a filamentous bacteriophage that infects Xanthomonas vesicatoria, the causal agent of bacterial spot disease in pepper. Morphological analysis revealed a flexible filamentous virion architecture consistent with members of the family Inoviridae. To refine its genomic features, the XaF13 genome was resequenced through a hybrid approach combining newly generated Oxford Nanopore long reads with previously available Illumina data, resulting in a revised genome of 6965 bp. Comparative genomic analysis and intergenomic similarity assessment revealed low nucleotide identity with related inoviruses, supporting the recognition of XaF13 as a putative novel species based on VIRIDIC species-level thresholds. Phylogenetic reconstruction based on the Zot-like protein placed XaF13 within a broader inovirus lineage and showed that it forms a distinct evolutionary branch. In addition, physicochemical assays revealed that XaF13 remains stable across a broad pH range and tolerates brief exposure to elevated temperatures, whereas chloroform treatment and UV-C radiation reduced viral infectivity over time. Overall, these findings highlight the genomic distinctiveness and in vitro physicochemical stability of XaF13, contribute to a better understanding of filamentous bacteriophage diversity and provide a basis for future studies on its ecological role and possible interactions with phytopathogenic bacteria. Full article

Background/Objectives: Chronic low back pain (CLBP) affects approximately 20% of the global population and is a leading cause of years lived with disability. Long-term, real-world evidence for inhaled cannabis in patients refractory to conventional multimodal therapy remains scarce. We assessed the five-year efficacy and safety of inhaled cannabis in CLBP patients who had documented failure of ≥1 year of opioid analgesics, anticonvulsants, antidepressants, NSAIDs, and physiotherapy, with each patient serving as their own historical control. Methods: We analyzed prospectively collected clinical data from 241 consecutive adults with treatment-refractory CLBP (mean age 49.3 ± 14.9 years; 37.8% female; mean pain duration 15.1 years) initiated on inhaled medical cannabis (predominantly smoking, THC 4–22%, CBD 2–22%) in a single-center tertiary orthopedic clinic between 2020 and 2025 (Hasharon Hospital, Rabin Medical Center, Israel; IRB protocols 0807-21-RMC and 0634-25-RMC). Year-0 outcomes during conventional therapy were compared with outcomes at Years 1–5 on cannabis. Primary outcomes were the Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), and Brief Pain Inventory severity/interference (BPI-S/BPI-I). Concomitant-medication trajectories were a secondary outcome. The primary analysis was a mixed model for repeated measures (MMRM) with random intercept and slope, REML estimation, and time as a categorical fixed effect. Multiple imputation (MAR, m = 20, Rubin’s rules) was the primary missing-data approach; complete-case and tipping-point pattern-mixture sensitivity analyses were used. A multivariate Hotelling T² provided a joint test across the four correlated PROMs. Concomitant-medication discontinuation was modeled with GEE logistic regression and exact McNemar tests. Time to discontinuation was estimated by Kaplan–Meier and Cox regression. The Bonferroni-adjusted significance threshold for the four primary outcomes was α = 0.0125. BioWell gas-discharge-visualization (GDV) parameters were exploratory only. Results: Of 241 patients, 238 (98.8%) provided Year-5 data and 224 (92.9%) remained on cannabis at Year 5; only five patients (2.1%) discontinued for adverse events or inefficacy. All four primary PROMs improved markedly and durably. MMRM-estimated Year-5 minus Year-0 changes were: NRS −5.36 (95% CI −5.65, −5.07), ODI −17.68 (95% CI −19.73, −15.63), BPI-S −6.73 (95% CI −6.99, −6.47), and BPI-I −3.41 (95% CI −3.65, −3.16); all four contrasts had |z| ≥ 16.9 and p < 10⁻²⁰. MI-pooled estimates were within 0.05 of MMRM (FMI < 0.03 for all outcomes). Hotelling T² was F(4, 232) = 872.8, p < 10⁻²⁰. At Year 5, 89.2% achieved ≥30% NRS reduction, 77.2% ≥ 50%, and 93.4% met the NRS minimum clinically important difference (MCID); ODI MCID 65.6%, BPI-S MCID (≥1 pt) 98.3%, BPI-I MCID (≥1 pt) 91.3%. Concomitant opioid use fell from 100% at baseline to 4.6% at Year 5 (within-patient absolute risk reduction 95.4%, McNemar exact p = 1.16 × 10⁻⁶⁹), NSAID from 100% to 7.1%, SSRI/SNRI from 80.5% to 5.4%, and gabapentinoid from 38.6% to 2.5%. The ARR-derived NNT for opioid discontinuation was 1.05; this NNT is referenced to each patient’s own documented maximal-conventional-therapy state and is not equivalent to a between-arm randomized-trial NNT. Cannabis dose × time interaction was consistent with no pharmacological tolerance (β = −0.0044 per gram-month per year, p = 0.074). Across 1205 patient-years of cannabis exposure (calculated as 241 patients × 5 follow-up years from Year 1 through Year 5; baseline Year 0 represents pre-cannabis state and is not included in person-time on cannabis), 1338 organ-system AE events were recorded at 1.110/patient-year (Poisson 95% CI 1.05–1.17); 99.8% of graded events were mild (grade 1), with ocular (476 events, 0.40/PY), cognitive (460, 0.38/PY), and gastrointestinal (368, 0.31/PY) reactions predominating. The Year-3 retention dip reflected a documented telemedicine-clinic phenomenon during 2022–2024, with patients returning to in-person follow-up by Year 4–5. BioWell GDV discriminated NRS ≥ 4 only at chance level (BWS AUC 0.574, 95% CI 0.54–0.60; BWV AUC 0.51). Conclusions: In a treatment-refractory CLBP cohort with five-year longitudinal follow-up, inhaled cannabis was associated with large, sustained, and statistically robust improvements in pain, disability, and pain interference, accompanied by near-total displacement of opioids, NSAIDs, antidepressants, and gabapentinoids. These observational associations, although mechanically less susceptible to bias for the binary medication-discontinuation outcomes than for self-reported PROMs, cannot be interpreted causally in the absence of a concurrent randomized control arm and may reflect a combination of pharmacological effect, regression to the mean from a high pre-treatment baseline, expectancy and self-selection effects intrinsic to an actively chosen open-label therapy, and secular trends in pain reporting. The within-patient benefit-risk profile—ARR-derived NNT ≈ 1 for opioid sparing against a predominantly mild adverse-event burden—supports consideration of cannabis as a potentially clinically meaningful, opioid-sparing option in patients who have failed multimodal conventional therapy, pending confirmation in randomized comparative trials. Full article

Background: Trigeminal neuralgia (TN), a facial pain disorder classically characterized by recurrent brief electric-shock-like paroxysms in one or more trigeminal divisions, frequently traverses dental pathways before specialist evaluation. Conversely, dental extraction, endodontic treatment, implant procedures, and third-molar surgery may injure the inferior alveolar, superior alveolar, mental, or lingual nerves and generate painful post-traumatic trigeminal neuropathy. We sought to define the diagnostic interface between classical TN and post-dental/alveolar nerve-related trigeminal pain in a tertiary referral cohort. Methods: We performed a retrospective single-center diagnostic-pathway study using a clinical dataset comprising 672 unique patients. A dental-interface trigeminal candidate cohort was assembled from aggregated patient-level source notes and adjudicated into five prespecified phenotypes: confirmed alveolar neuropathy, post-extraction neuropathic onset, odontogenic diagnostic misclassification, mixed/uncertain dental-interface pain, and clean classical TN. Extracted variables included demographics, trigeminal branch documentation, sensory deficit, dental procedure history, post-extraction onset, MRI and neurovascular conflict language, secondary structural disease, TN-directed medication exposure, invasive treatment exposure, documented outcomes, and time from first specialist documentation to first dated invasive treatment. Results: Among 201 dental-interface trigeminal candidates, 19 patients (9.5%) had confirmed alveolar neuropathy, 31 (15.4%) had post-extraction neuropathic onset, 20 (10.0%) represented odontogenic diagnostic misclassification, 115 (57.2%) remained mixed/uncertain, and 16 (8.0%) fulfilled a clean classical TN phenotype. Overall, 114 patients (56.7%) carried explicit TN terminology somewhere in the chart. Non-classical alveolar/post-dental syndromes comprised 70 patients (34.8%). Compared with clean classical TN, this non-classical group had higher rates of documented oral sensory deficit (38.6% vs. 0.0%, p = 0.002), post-extraction onset (52.9% vs. 0.0%, p < 0.001), extraction history (61.4% vs. 0.0%, p < 0.001), and secondary structural disease (22.9% vs. 0.0%, p = 0.035). Neurovascular conflict or vascular-loop language did not distinguish non-classical alveolar/post-dental syndromes from clean classical TN (38.6% vs. 37.5%, p = 1.000). Conclusions: A substantial minority of tertiary dental-interface trigeminal referrals represented alveolar/post-dental syndromes rather than clean classical TN, even while carrying TN labels and accumulating TN-directed treatment exposure. Post-extraction onset, lower-lip/chin or intraoral sensory change, and pain persisting despite extraction should prompt careful phenotyping before classical TN-directed escalation. The alveolar–trigeminal interface can be operationalized as a recognizable diagnostic pathway with direct implications for multidisciplinary facial-pain evaluation. Full article

Background: Resistant arterial hypertension (RAH) is a heterogeneous cardiovascular condition influenced by biological, behavioral, psychosocial, and neuroendocrine mechanisms. Within emerging precision medicine frameworks, psychobehavioral assessment may contribute to a more individualized characterization of patients with RAH and help identify modifiable dimensions associated with therapeutic resistance. This study evaluated the feasibility and preliminary outcomes of a brief psychobehavioral intervention in patients with RAH. Methods: This feasibility-oriented exploratory pre–post pilot study included 20 adults with RAH recruited from a tertiary outpatient clinic specialized in resistant hypertension. Participants underwent psychobehavioral assessment using the Hospital Anxiety and Depression Scale (HADS). Individuals presenting clinically significant anxiety and/or depressive symptoms (scores ≥ 8) received an individualized semi-structured brief cognitive–behavioral therapy (CBT) intervention consisting of 8–9 weekly sessions. Feasibility indicators included intervention adherence, completion of the protocol, operational flexibility, and absence of symptom worsening. Pre- and post-intervention emotional symptoms were compared using nonparametric analyses. Results: High baseline emotional burden was observed, with 90% of participants presenting anxiety symptoms and 60% depressive symptoms. Following the intervention, reductions in anxiety [median 11 (IQR 8–13) vs. 6 (4–8); p < 0.001] and depressive symptoms [10 (8–11) vs. 5 (3–8); p < 0.001] were identified. No worsening of symptoms occurred. The intervention demonstrated satisfactory feasibility and acceptability, including flexibility for remote and in-person delivery. Conclusions: These preliminary findings suggest that psychobehavioral phenotyping combined with individualized brief CBT may represent a feasible complementary strategy within precision-oriented cardiovascular care for resistant hypertension. Although causal inference cannot be established due to the pilot design and absence of a control group, the findings support further investigation of psychobehavioral dimensions as potentially relevant components of personalized hypertension management. Full article

Background: Patients with limited English proficiency (LEP) in the United States face significant barriers to safe and equitable healthcare despite federal protections guaranteeing access to qualified interpreter services at no cost. Many patients with LEP remain unaware of these rights, relying instead on informal learning through clinical encounters and community networks which are unreliable pathways that may perpetuate language access disparities. Point-of-care educational interventions grounded in just-in-time and situated learning theory represent a promising but understudied approach to bridging this gap. Objective: The aim was to examine Spanish-speaking emergency department patients’ interpreter access patterns, baseline knowledge of federal language rights, and immediate responses to a brief multilingual point-of-care educational video intervention. Methods: A pre–post survey design was used with a convenience sample of 40 Spanish-speaking adult patients presenting to a large, level 1 trauma center ED in the Southeastern United States between February and April 2025. Participants completed a 22-item iPad-administered Spanish-language survey that included baseline knowledge questions, an embedded 2 min educational video about federal language access rights, and post-video response questions. Descriptive statistics were calculated for quantitative data and thematic analysis was conducted for open-ended responses, with two independent coders achieving substantial inter-rater agreement (κ = 0.75, p < 0.001). Fisher’s exact tests examined associations between interpreter access mode and patient demographic characteristics. Results: Most participants (70%) accessed interpreters passively rather than by self-request, a pattern that did not vary significantly by patient status, age, or length of time in the United States. At baseline, 57.5% knew that federal laws prohibit language discrimination in healthcare and 77.5% knew they were entitled to a free qualified interpreter. Most participants (80%) reported learning something new from the video, with responses centering on rights awareness and anti-discrimination protections. Most participants (70%) reported that knowing their federal rights was helpful, describing increased confidence and reduced anxiety. All participants (100%) reported difficulty communicating without an interpreter and nearly all (97.5%) felt more confident asking questions when one was present. Conclusions: Significant knowledge gaps persist even among patients with some baseline rights awareness; a brief culturally appropriate point-of-care video may meaningfully increase awareness and confidence. The consistently passive pattern of interpreter access across all demographic subgroups underscores the need for proactive institutional practices and patient-facing education that empowers LEP patients to advocate for themselves in healthcare settings. Full article

Maxillofacial defects impair facial aesthetics and oral function, arising from trauma, tumor resection, or congenital anomalies; however, reconstruction using Computer-Aided Design (CAD) and autologous grafts remains complex and time-intensive, and is associated with donor-site morbidity. Although deep learning (DL) has advanced automated reconstruction, existing models often address isolated tasks, lack integrated multi-scale feature learning, and rely on small datasets. This study proposes the Maxillofacial Implant-generation Network (MaxI-Net), a fast, resource-efficient three-dimensional DL framework for end-to-end maxillofacial defect reconstruction and patient-specific implant generation, with a completion step of cavity filling within the assembly. The model employs a 3D encoder–bottleneck-decoder architecture integrating hybrid dilated convolutions, residual connections, squeeze-and-excitation (SE) blocks, and 3D Convolutional Block Attention Modules (CBAM) with multi-scale feature fusion. It was trained on 921 Cone Beam-Computed Tomography (CBCT) scans, augmented to 11,973 maxillary defect pairs, using Dice loss and Adam optimisation with Automatic Mixed Precision, and benchmarked against UNet, UNETR, SegResNet, and SwinUNETR. MaxI-Net achieved the following: superior Dice Similarity Coefficient (DSC) = 0.778; 95th percentile Hausdorff Distance (HD95) = 3.453 mm; DSC Standard Deviation (SD) = 0.094; 95% confidence interval (CI) for mean DSC: 0.775–0.782). It was statistically validated against all competing architectures via pairwise Wilcoxon signed-rank tests, with significant DSC improvements confirmed across all comparators (p < 0.001) and rank-biserial effect sizes ranging from r = 0.250 against the closest competitor SegResNet* with high efficiency (0.06 s/volume; 9.6 min/epoch). Internal cavity filling of the generated implants was performed as a brief manual post-processing step in Autodesk Fusion 360 prior to biomechanical validation. Biomechanical validation using a finite element analysis (FEA) of polyether–ether–ketone (PEEK) implants (~26.53 g) showed 41% stress reduction under physiological loads (100–400 N), predicting a ~9.2-year lifespan. Full article

Background/Objectives: Clinical empathy is a core competency in nursing education and is conceptually relevant to person-centered nursing care. However, limited evidence is available on how clinical empathy in advanced nursing students is associated with dispositional characteristics such as personality traits and resilience. This study aimed to examine cross-sectional associations between clinical empathy, Big Five personality traits, and resilience in third- and fourth-year nursing students. Methods: A descriptive, cross-sectional secondary analysis was conducted using an existing survey database. The final analytic sample comprised 66 third- and fourth-year nursing students from a nursing school in Spain. Clinical empathy was assessed with the Jefferson Scale of Empathy, resilience with the 6-item Brief Resilience Scale, and personality traits with the Big Five Inventory-44. Life satisfaction, academic engagement, and general self-efficacy were included as secondary psychosocial variables. Descriptive analyses, correlation analyses, group comparisons, and exploratory multiple linear regression were performed. Results: Higher agreeableness was associated with higher total clinical empathy (ρ = 0.390, p = 0.001) and perspective-taking (ρ = 0.440, p < 0.001). Higher conscientiousness was also associated with higher total clinical empathy (ρ = 0.480, p < 0.001), perspective-taking (ρ = 0.432, p < 0.001), and compassionate care (ρ = 0.324, p = 0.008). In the exploratory multivariable cross-sectional model, agreeableness and conscientiousness were independently associated with total clinical empathy, whereas resilience was not. Findings involving the Standing in the Patient’s Shoes subscale should be interpreted cautiously because of its low internal consistency. Conclusions: In this exploratory sample of advanced nursing students, self-reported clinical empathy was associated mainly with agreeableness and conscientiousness. These findings should be interpreted as cross-sectional associations based on self-report data and should not be taken as evidence of causal effects, ethical behavior, or person-centered care practices. Further longitudinal and multicenter studies are needed to examine whether these associations are stable and whether they relate to observable educational or clinical outcomes. Full article

Introduction: Vitamin B12 (VB12), particularly its active form methylcobalamin (MeB12), contributes to neuromuscular function and energy metabolism, which may be relevant for sports performance. However, evidence on the acute effects of MeB12 supplementation in athletes remains limited. Objective: To evaluate the effects of short-term (3-day) MeB12 supplementation on anaerobic and cognitive performance in amateur cyclists. Methods: A randomized, triple-blind, placebo-controlled crossover clinical trial was conducted in 18 amateur cyclists. Participants received formulations containing MeB12 (1 mg/day; MecobalActive^®, HTBA, Murcia, Spain) or placebo for three consecutive days. Anaerobic performance was assessed using a repeated Wingate protocol, and cognitive performance was evaluated using a light-based mental agility/reaction test system. Biochemical analyses included serum VB12 concentrations. Primary outcomes included peak power output (absolute and relative), fatigue index across repeated sprints, and cognitive response time. Results: Compared with placebo, MeB12 supplementation was associated with higher peak power output, with increases in absolute maximal power (PMAX: +4.1%, p = 0.016) and relative maximal power (PMAXREL: +4.4%, p = 0.013). MeB12 supplementation was associated with a smaller decline in performance across repeated sprints, with a smaller drop in fatigue index from the first to the fifth sprint (p = 0.012). Pre-exercise cognitive performance improved, with a shorter total reaction test time (−4.9%, p < 0.001) versus placebo. Serum VB12 concentrations increased by 16.8% following MeB12 supplementation. Conclusions: A brief, 3-day intervention with methylcobalamin (1 mg/day) was associated with positive changes, when compared with placebo, in selected markers of anaerobic performance (peak power and fatigue-related decline) and pre-exercise cognitive performance in recreationally trained amateur cyclists, suggesting a possible involvement of peripheral and central mechanisms. Full article