Search Results (255)

Background/Objectives: Adenomyosis is a common estrogen-dependent gynecological condition with a largely undefined genetic architecture. Ciliary dysfunction has been implicated in its pathogenesis, positioning genes governing ciliary structure and motility as biologically plausible candidates for investigation. The DNAH5 gene encodes a critical component of the outer dynein arms within the ciliary axoneme, and pathogenic variants are among the most common causes of primary ciliary dyskinesia. This study aimed to systematically determine the frequency of a novel synonymous DNAH5 variant, NM_001369.3:c.9258C>T, p.(Leu3086=), in a large, histopathologically confirmed sporadic adenomyosis cohort from Turkiye, and to evaluate its occurrence relative to population-level reference data. Methods: A total of 121 women with histopathologically confirmed adenomyosis following hysterectomy were enrolled. Sanger sequencing was performed under stringent quality control conditions, including primer specificity verification by NCBI BLAST and UCSC In Silico PCR. Variant frequency was compared against gnomAD v4.0 and an in-house Turkish exome database (NGS Cloud; ~30,000 sequences) using Fisher’s exact test. In silico splice site analysis was performed using SpliceAI, and variant classification followed ACMG/AMP guidelines. Results: The variant was detected in 63 of 121 patients (52.1%; 95% CI: 43.1–61.0%), exclusively in the heterozygous state; no homozygous carriers were identified. The variant was absent from both gnomAD v4.0 across all populations and the NGS Cloud Turkish exome database (MAF: 0.0000), yielding a frequency difference (p < 2.2 × 10⁻¹⁶). SpliceAI analysis predicted no significant splice site impact (all delta scores < 0.1). The variant was classified as a variant of uncertain significance (VUS; BP7, PM2_supporting). Conclusions: This study identifies a difference in the frequency of a novel synonymous DNAH5 variant between a histopathologically confirmed adenomyosis cohort from Turkiye and population-level reference datasets, in which the variant was absent. Given the unphenotyped nature of the reference dataset, these findings are hypothesis-generating and do not establish a causal genetic association. Replication in independent cohorts and functional studies are warranted to elucidate the biological significance of this variant in adenomyosis susceptibility. Full article

Consolidated bioprocessing (CBP) is difficult to monitor because enzyme production, lignocellulose degradation, sugar release, and fermentation occur simultaneously under sparse measurement, feedstock variability, and plant–model mismatch conditions. This study proposes a computational sensor-set design framework for digital-twin-assisted CBP monitoring. A five-state virtual plant, consisting of active biomass, cellulolytic enzyme activity, residual insoluble substrate, soluble sugar, and ethanol, was used to evaluate all 16 ethanol-mandatory measurement packages formed from ethanol, sugar, biomass, enzyme, and residual-substrate proxy channels. Candidate sensor sets were assessed using finite-difference output sensitivities, Fisher-information-based state-observability and parameter-identifiability analyses, eigenvalue and parameter-correlation diagnostics, and paired Monte Carlo unscented Kalman filter soft-sensing reconstruction. Within the tested five-state virtual-plant benchmark and with the specified excitation schedule, noise assumptions, burden indices, and scoring objective, ethanol-only sensing provided the weakest support for state-aware CBP digital-twin reconstruction. At a $6\mathrm{h}$ sampling interval, the state-observability log-pseudodeterminant increased from 4.18 with ethanol-only sensing to 8.56 after adding soluble sugar and to 16.42 with full-proxy monitoring. The ethanol–sugar–biomass–substrate package also gave strong reduced state-observability performance, with log-pseudodeterminants of 15.12, 13.76, and 12.51 at 6, 12, and $24\mathrm{h}$, respectively. Biomass and enzyme proxies contributed strongly to parameter learning, and the ethanol–sugar–biomass–enzyme package gave the strongest active parameter-identifiability performance, with log-pseudodeterminants of 10.82, 9.06, and 6.67 at 6, 12, and $24\mathrm{h}$, respectively. In the paired soft-sensing analysis, full-proxy monitoring reduced the mean latent-state RMSE from 1.1899 to 0.3756, followed by ethanol–biomass–enzyme–substrate with 0.3843 and ethanol–sugar–biomass–substrate with 0.4121. The primary aggregate ranking identified ethanol–sugar–biomass–substrate as the best overall package, with a sensor-value score of 0.8432 and a burden index of 7.0, followed by full-proxy monitoring with a score of 0.8173 and a burden index of 10.0. Robustness tests showed that ethanol–sugar–biomass–substrate remained top-ranked under uniform noise scaling, full UKF missingness, delay and bias stress test conditions, most scoring-weight scenarios, and all tested sensor-specific burden workflows. Full-proxy monitoring remained a close competitor under independent sensor-specific noise variation conditions and became top-ranked for some alternative operating trajectories. The proposed framework provides a simulation-based method for prioritizing informative measurement packages before implementing CBP digital twins in laboratory and pilot-plant settings. Full article

Background/Objectives: The COVID-19 pandemic had a negative effect on early intervention (EI) delivery to children with developmental delays or disabilities. This study aimed to compare school readiness of children who received, or attempted to receive, EI before, during, and after the COVID-19 pandemic stay-at-home order. Methods: A prospective cohort study was conducted with a single state-funded center that delivers federally mandated EI. School readiness assessments were performed using the Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition (WPPSI-IV). Fisher’s Exact tests, and Kruskal–Wallis ANOVA were performed to compare scores in children who began EI in the three time periods related to the COVID-19 pandemic. Results: A total of 56 children were enrolled in this study, the timing of EI start was available in 43, and 22 were able to complete all assessments. Statistically significant differences were found in WPPSI-IV Verbal Comprehension Index T scores (100 ± 15) across the COVID-19 phases, with the lowest scores arising during the pandemic (76.2 ± 9.3); the highest scores, pre-pandemic (98.0 ± 6.2); and intermediate scores, post-pandemic (81.5 ± 10.1, p < 0.05). Many children exhibited mental health concerns, with 29/56 (52%) being referred to community-based mental health services. Conclusions: In this study, lower scores were reported for markers of school readiness in children who received or attempted to receive EI during the COVID-19 stay-at-home orders compared to those pre- and post-pandemic. High mental health needs were identified, particularly among children with mild–moderate symptoms of autism or those who underwent EI during the COVID-19 stay-at-home orders. Full article

Background/Objectives: Child sexual abuse (CSA) is a serious public health and forensic issue, associated with significant psychological, psychiatric, and social consequences. However, data from forensic psychiatric evaluations regarding victims of this type of abuse are limited, especially in Romania. This study primarily aimed to profile the demographic, clinical, and psychosocial characteristics of minors who were victims of sexual offenses and underwent forensic psychiatric evaluation. Secondary objectives included examining relationships between demographic and clinical variables, describing patterns of victimization, and analyzing the co-occurrence of vulnerability factors. Methods: This study was retrospective, descriptive, and analytical, including 51 minors (under 18 years of age) examined at the Mina Minovici National Institute of Legal Medicine (INML), between 2013 and 2025. Data extracted from forensic psychiatric reports included demographic variables, the type of offense, psychiatric diagnosis, psychological issues, intellectual functioning, family environment, and relationship with the aggressor. Statistical analyses included descriptive statistics, Pearson χ² and Fisher’s exact tests, binary logistic regression, and nonparametric tests for cumulative vulnerability. Results: The sample was predominantly female (94.1%), with a mean age of 13.75 years. Rape was the most frequent offense (45.1%). Most victims originated from disorganized family environments or were institutionalized (70.6%), and 60% had below-normal intellectual functioning. A psychiatric diagnosis was present in 56.9% of cases, while 70.6% exhibited psychological issues. Within an exploratory logistic regression model that did not reach overall statistical significance (omnibus likelihood ratio test χ² = 9.31; p = 0.097), the presence of a psychiatric diagnosis showed the strongest individual association with psychological issues (OR = 5.17; 95% CI, 1.22–21.85; p = 0.026). Cases in which the aggressor was not related to the family environment were the most frequent (60.8%), followed by cases involving family members (23.5%). Most subjects displayed multiple co-occurring vulnerability factors. When the cumulative vulnerability score was recalculated to exclude psychological issues (to avoid construction-induced circularity), higher vulnerability remained significantly associated with extrafamilial victimization (Kruskal–Wallis H = 6.93; p = 0.031), but was no longer associated with psychological issues themselves (Mann–Whitney U = 298.0; p = 0.56), indicating that the originally observed association was an artefact of the score’s construction. Conclusions: Minors who are victims of sexual abuse often face multiple overlapping vulnerabilities, including unstable family environments, cognitive impairments, and psychiatric conditions. These factors frequently coexist in victims evaluated in forensic psychiatric settings and are associated with psychological issues and complex victimization profiles. The findings emphasize the importance of comprehensive, multidisciplinary, and victim-centered methods in forensic psychiatric evaluations. Full article

Background/Objectives: Children of families facing unmet social needs experience higher rates of adverse outcomes compared to those not experiencing unmet social needs. This study aimed to identify factors associated with families’ unmet social needs as reported by parents or guardians at their children’s primary care visits. Methods: This cross-sectional study recruited English-speaking primary caregivers of children less than 18 years of age from the Southwestern Ohio Ambulatory Research Network (SOAR-Net) who were surveyed between January 2023 and August 2024. Surveys included the Maternal Social Support Index, Social Capital Scale, RAND Depression Screener, Children with Special Health Care Needs Screener, Medical Expenses of Children Survey, a 10-item social needs screener, and demographics. Data were analyzed with chi-square or Fisher’s exact tests, adjusted logistic regression, and ANOVA. Results: Among 1167 respondents (78% response rate), 1114 provided complete data. Primary caregivers were predominantly mothers (79.9%) or fathers (13.6%), White (72.0%) or Black (16.0%), and had an associate’s degree or less (65.1%). The mean (SD) index child’s age was 6.4 (5.3) years, and 52.4% were female. Underinsurance, positive depression screens, and poor child health were positively associated with unmet social needs. Higher scores for social support and social capital were associated with fewer social needs. Multinomial logistic regression revealed significant relationships with reporting two or more unmet social needs with the following variables: childhood underinsurance, household annual income < $50,000, positive depression screens, raising a child with a chronic health condition, and Black race/ethnicity. Conclusions: Several significant social factors were independently associated with a greater number of unmet social needs. These findings highlight the complex interplay among social factors in children’s healthcare. Future research should explore the putative longitudinal stability of these relationships. Full article

Background/Objectives: Parents of children with autism spectrum disorder (ASD) often face sustained emotional, practical, and social demands. However, evidence from Romania remains limited, particularly regarding the combined assessment of caregiver burden, emotional distress, and coping strategies of parents. This exploratory study compared these outcomes between parents of children/adolescents with ASD and parents of typically developing children and examined whether coping patterns varied according to selected sociodemographic characteristics. Methods: We conducted a cross-sectional comparative study in Târgu-Mureș, Romania, between 2024 and 2025. The sample included 92 parents: 46 parents of children/adolescents with clinician-confirmed ASD and 46 parents of typically developing children. Participants completed a demographic questionnaire, the Caregiver Burden Inventory (CBI), the Depression Anxiety Stress Scales-21 (DASS-21), and the Strategic Approach to Coping Scale (SACS). DASS-21 data were available for 44 ASD caregivers and 46 controls. Between-group comparisons were performed using t-tests, Mann–Whitney U tests, chi-square tests, or Fisher’s exact tests, as appropriate. Results: The groups were comparable in sex, age, residence, number of children, and household size, but differed significantly in marital status and educational level. Clinically relevant caregiver burden (CBI ≥ 36) was more frequent among parents of children with ASD than among controls (30% vs. 17%), although this difference was not statistically significant. Parents of children with ASD showed trend-level higher depressive and anxiety symptoms, with small effect sizes, whereas stress scores were similar between groups. Coping patterns varied according to sociodemographic characteristics. Marital status was associated with aggressive coping, urban residence was associated with indirect and aggressive coping, and number of children was associated with seeking social support. Conclusions: Parents of children with ASD showed a higher proportion of clinically relevant caregiver burden and trend-level elevations in depressive and anxiety symptoms, while stress scores were comparable between groups. Exploratory adjusted analyses suggested that ASD caregiver status remained associated with caregiver burden and depressive symptoms after controlling for educational level and marital status. Coping strategies appeared heterogeneous and context-dependent. Given the exploratory design, modest sample size, and multiple comparisons, these findings should be interpreted as preliminary and hypothesis-generating. Full article

Background/Objectives: Recessive titinopathies caused by biallelic TTN truncating variants (TTNtvs) present a clinically heterogeneous spectrum from fetal demise to late-onset slowly progressive distal muscular dystrophy. Prognostic counseling is challenging due to the vast size of the TTN gene, complex splicing patterns, and differential expression throughout developmental stages and tissues. This paper aims to delineate the regional genotype patterns and clinical characteristics of recessive titinopathies described from the prenatal period onwards to inform genotype–phenotype associations and genetic counseling. Methods: We analyzed clinical and genetic data from a prenatal-onset cohort with biallelic TTNtvs from both previously reported cases and novel cases from our center. To characterize the regional distribution of biallelic variants within this specific cohort, a two-dimensional scatter plot was utilized to map variants onto 10 biological regions (R1–R10) and 55 analytical units (U1–U55). We also performed Fisher’s exact tests on the subset of 50 cases with confirmed survival records to evaluate statistically significant associations between biallelic regional or percent spliced-in (PSI) thresholds combinations and severe clinical endpoints (intrauterine demise or death before 5 years). Results: A total of 96 prenatal cases from 76 unrelated families were analyzed. Decreased fetal movement was the most commonly reported symptom, observed in 81.3% (78/96) of cases, which was followed by arthrogryposis in 45.8% (44/96) and amniotic fluid volume abnormalities in 35.4% (34/96). Additionally, of the 95 cases with known pregnancy outcomes, 25.3% (24/95) resulted in termination and 11.6% (11/95) resulted in intrauterine demise (IUD), while 63.2% (60/95) reached birth with over 16.7% (10/60) being preterm. Among 60 live-born infants, severe postnatal morbidity was high: 45.0% (27/60) experienced respiratory failure, and 33.3% (20/60) died before the age of five. In this cohort, 84.4% (81/96) of cases possessed at least one TTNtv in either the metatranscript-only or A-band regions. The most common biallelic changes involved TTNtvs in both the A-band and metatranscript-only regions, accounting for 35.4% (34/96) of cases, followed by metatranscript-only combined with I-band variants at 16.7% (16/96), regardless of the PSI score of exons. Overall, 83.3% (80/96) had ≥1 variant on low-PSI (<50%) exons, and 19.8% (19/96) had both alleles on these low-PSI exons. In the 50 patients with confirmed survival records, biallelic changes (excluding splice-site variants) affecting both high-PSI (>90%) exons were significantly associated with severe outcomes (intrauterine demise or death before 5 years; exact p = 0.015), whereas the metatranscript-only plus I-band combination conferred a significantly lower risk of lethality before 5 years of age (exact p = 0.001). Conclusions: Our findings add to the accumulating evidence that TTNtvs on low PSl exons or metatranscript-only regions are frequently observed among reported prenatal-onset recessive titinopathy. Health surveillance for heterozygous carriers among family members is warranted due to the substantial risk for adult-onset dilated cardiomyopathy and peripartum cardiomyopathy. Full article

Alzheimer’s disease (AD) is a major type of cognitive impairment. Most existing studies on cognitive state classification focus on the direct application of various machine learning (ML) algorithms. These studies typically assume consistency in patient features across assessments, without explicitly accounting for the variability introduced by subjective evaluation. While a limited number of studies have attempted to address such variability, their applicability remains constrained. This study addresses the identified gap by proposing a distribution–coherent data refinement method. First, it incorporates SHAP-based feature selection, then excludes a subset of distributionally atypical records. These include records from patients with a single visit that contribute to increased intra-class variance and reduced inter-class separability, as well as records from patients with multiple visits that exhibit inconsistent longitudinal trajectories. The method operates on the training data, and the resulting refined training data is fed to ML algorithms. The experimental results show that detecting a small number of records (1.285%) leads to a minor enhancement in data quality. The Fisher score and Cohen’s f are increased by on average 0.016 and 0.011, while the means for inter-class and intra-class are improved by 0.012 and 0.004, respectively. Furthermore, the refined training data enables ML models to achieve a higher joint correctness rate of up to 7.1% compared with the original data. Additionally, ML models trained on the refined data exhibit improved classification performance, as reflected by an increase in the $F_1$ score. Therefore, the proposed method provides a potential data refinement strategy for the longitudinal restricted cognitive impairment spectrum, specifically for those data describing normal cognition, early mild cognitive impairment, and late mild cognitive impairment. Full article

Background/Objectives: Topical corticosteroids (TCS) are a cornerstone of dermatological treatment for inflammatory skin conditions; however, irrational fear of their use known as corticophobia undermines adherence and worsens clinical outcomes. This study investigated the prevalence of TCS-related concern and phobic behaviors among the general population in Saudi Arabia and identified factors associated with TCS-related concern and phobic attitudes. Methods: A cross-sectional study was conducted between October and December 2025 using an online self-administered questionnaire distributed via social media platforms among a non-probability convenience sample across multiple geographic zones of Saudi Arabia. A total of 481 participants were enrolled. Descriptive statistics summarized demographic and clinical characteristics. Chi-square and Fisher’s exact tests were used to examine differences in proportions between categorical variables and TCS concern, while independent-samples t-tests and one-way ANOVA compared mean phobia scores across subgroups. Results: Of 481 participants, 254 (52.8%, 95% CI 48.3–57.2) expressed concern about TCS use. The predominant reason for refusing prescribed TCS was fear of side effects (93.5%). Phobic behaviors included fear of long-term use (54.2%) and fear of application to sensitive skin areas (63.0%). On the Likert phobia-scale item, 237 (49.8%) totally agreed they would use TCS if prescribed; a separate dichotomous behavioral-intention item, administered only to non-current users (n = 308), showed that 201 (65.3%) would accept TCS if prescribed and 107 (34.7%) would refuse. Concern was significantly more prevalent among females (58.1%, BH-adj p = 0.005), married participants (61.7%, BH-adj p = 0.010), and those refusing prescribed TCS (77.6%, BH-adj p < 0.001). Mean phobia scores (theoretical range 7–28) were significantly higher among females (20.43 ± 4.06 vs. males 18.84 ± 4.68, p < 0.001), participants with Diploma-level education (21.64 ± 3.12, p < 0.001 across education strata), widowed/divorced individuals (21.82 ± 3.57, p = 0.008), and residents of the Southern (20.47 ± 3.99) and Northern (21.40 ± 3.34) regions (p = 0.002 across regions). Conclusions: TCS-related concern was expressed by over half the participants in this social media-recruited sample, posing a substantial barrier to effective dermatological care. Side-effect concern was the most frequently reported reason for refusing prescribed TCS. In adjusted analyses, female sex was the most consistent independent correlate of TCS-related concern and higher phobia score; married status was independently associated with greater concern. These associations should be replicated in probability-based samples before subgroup-targeted interventions are designed. Conclusions: TCS-related concern was prevalent (52.8%) among adults in Saudi Arabia and represented a substantial barrier to dermatological care. Female sex and married status were independently associated with greater concern. Clinicians should proactively address TCS misconceptions during dermatological consultations to improve treatment adherence. Full article

Background: Recurrent pregnancy loss (RPL) remains etiologically unexplained in 40–50% of cases following standard diagnostic workup. Non-criteria antiphospholipid antibodies (non-criteria aPL) are increasingly considered potential markers of seronegative obstetric antiphospholipid syndrome (APS); however, their diagnostic value in this clinical setting requires further investigation. Objective: To assess the diagnostic value of non-criteria aPL in women with RPL and to construct an exploratory immunological scoring model for diagnostic stratification. Methods: Antiphospholipid antibody detection was performed using a single-measurement semi-quantitative line immunoblot assay (Anti-Phospholipid 10 Dot, Generic Assays, Germany). Statistical analysis included χ², Fisher’s exact test, Mann–Whitney U test, binary logistic regression, and ROC analysis. Results: Statistically significant associations with RPL were observed for anti-prothrombin antibodies (OR = 11.1; 95% CI 1.8–68.0; p = 0.022 [Haldane–Anscombe correction]), anti-annexin V (OR = 4.28; 95% CI 1.18–15.6; p = 0.023), and anti-β₂GP I (OR = 3.31; 95% CI 1.18–9.28; p = 0.019). The exploratory composite immunological score demonstrated moderate discriminatory performance (AUC = 0.701; 95% CI 0.588–0.814; p = 0.005). The overall logistic regression model was statistically significant (χ² = 8.564; p = 0.036), although none of the individual predictors retained independent significance, indicating a contribution of cumulative immunological burden rather than any single marker. Conclusions: In this single-center cross-sectional study, non-criteria aPL were frequently detected in women with RPL and were statistically associated with the condition. The findings should be interpreted as hypothesis-generating only, given the cross-sectional design, single-measurement immunoblot, small control group, and absence of external validation. Confirmation in larger prospective multicenter cohorts using ELISA-based assays with the internationally recommended 12-week repeat measurement is required before any clinical implementation. Full article

Background/Objectives: Immediate provisionalization in the esthetic zone is a well-documented but technique-sensitive procedure, and the choice of provisional connection geometry, with or without an antirotational index, remains debated. The aim of this retrospective single-arm cohort clinical study was to evaluate the clinical performance of a digitally planned, guide-delivered provisionalization protocol using prefabricated provisional crowns connected to 5-degree Morse taper implants without an antirotational index, with emphasis on emergence profile shaping and peri-implant tissue stability at one year; Methods: Twenty consecutive single-implant cases treated according to the standardized protocol from January 2024 onward and completing at least one year of follow-up after definitive crown delivery by the February 2026 data-lock date were included (19 female, 1 male; mean age 38.1 ± 12.7 years; 18 anterior and 2 premolar sites). All implants were placed with primary insertion torque ≥ 30 N·cm (mean 34.75 ± 2.55 N·cm) and immediately restored with a digitally designed, non-antirotational provisional crown. Primary outcome was provisional retention without major intervention; secondary outcomes included biologic complications, papilla score, marginal bone change at T0–T3 and T3–T4, and buccal contour change (T0 vs. T2 intraoral scan superimposition). Wilson 95% confidence intervals, Fisher’s exact test, and Mann–Whitney U test were used (α = 0.05); Results: Provisional retention without major intervention was 75.0% (15/20; 95% CI 53.1–88.8). Biologic complications were uncommon (bleeding on probing, suppuration, midfacial recession, and chairside adjustment, each 5.0%). Mean total marginal bone loss at one year was 0.37 ± 0.20 mm; mean buccal contour gain was 1.41 ± 0.48 mm. A complete papilla was preserved in 70.0% of cases. Conclusions: Digitally planned, guide-delivered provisionalization on a non-antirotational 5-degree Morse taper interface appears clinically feasible for emergence profile shaping in the esthetic zone, with favorable peri-implant tissue outcomes at one year. Full article

Background/Objectives: Early mobilization following open-heart surgery is a key component of postoperative recovery, yet psychological barriers such as kinesiophobia (fear of movement) may limit patient participation. This study examined the association between kinesiophobia and mobilization level in patients after open-heart surgery and explored sociodemographic and clinical correlates of both variables. Methods: A cross-sectional descriptive design was used. The sample comprised 96 adult cardiac surgery patients recruited consecutively from cardiovascular surgery ICUs at two centers in Istanbul—a public training and research hospital and a foundation-affiliated university hospital—between December 2024 and April 2025. Data were collected via a Personal Information Form, the Tampa Scale of Kinesiophobia (TSK), and the Intensive Care Units Mobility Scale (IMS). Analyses (SPSS 25.0) included Mann–Whitney U and Kruskal–Wallis H tests, Pearson correlation with 95% confidence intervals (CIs) calculated via Fisher’s z-transformation, Bonferroni correction for k = 12 subgroup comparisons within each outcome, and a multivariable linear regression adjusted for sex, age, smoking, and history of surgery. Results: Of the 96 patients enrolled, 76.0% were male, with a mean age of 58.30 ± 6.50 years (SD) and a mean body mass index of 27.53 ± 5.84 kg/m². The mean TSK total score was 46.81 ± 6.51 and the mean IMS score was 5.48 ± 0.73. Kinesiophobia and mobilization showed a small inverse association that reached statistical significance (r = −0.104; 95% CI: −0.298 to 0.099; r² = 0.011; p = 0.041), accounting for approximately 1% of the variance in mobilization. After multivariable adjustment, kinesiophobia was no longer a significant predictor (β = −0.092; p = 0.360), whereas smoking (β = −0.279; p = 0.008) and female sex (β = 0.215; p = 0.039) emerged as the strongest independent correlates. Mobilization level differed by gender and smoking, and kinesiophobia level differed by marital status, history of surgery, and family history of heart disease at the uncorrected level; however, none of these subgroup differences remained significant after Bonferroni correction. Conclusions: Higher kinesiophobia scores were associated with lower mobilization levels following open-heart surgery, but the effect size was small and the association did not persist after adjustment for clinical confounders. The cross-sectional design precludes causal inference. Kinesiophobia may be considered as one of several psychosocial factors potentially relevant to postoperative mobilization rather than as a primary determinant. Full article

Background: The rising incidence of vertebral body fractures, vertebral infections and metastatic disease increases the need for diagnostic modalities with high specificity. Biopsy remains essential, yet comparative data on CT-guided versus intraoperative percutaneous fluoroscopy-guided biopsy are limited. Methods: This retrospective study compared two cohorts biopsied for spinal lesions between April 2015 and April 2024: CT-guided biopsy (n = 62), and intraoperative percutaneous biopsy (n = 154). Groups were analyzed for demographic and clinical characteristics, and diagnostic yield was defined by the conclusiveness of the primary biopsy; statistical comparisons were performed using Fisher’s exact test. Results: CT-guided biopsy yielded conclusive results in 46 of 62 cases (74.2%), whereas intraoperative, fluoroscopy-guided biopsy was conclusive in 41 of 154 cases (26.6%), representing a statistically significant difference (p < 0.001). In analogy, propensity score matching (1:1) resulted in similar significant (p < 0.001) results (CT-guided group vs. intraoperative, fluoroscopy-guided group: 86.7% vs. 35.6%) Conclusions: CT-guided biopsy demonstrated a substantially higher rate of conclusive results compared with intraoperative biopsy in this cohort. Further studies with larger and more balanced cohorts are needed to strengthen clinical recommendations. Full article

Background: Studies of fish supply chain efficiency often rely on price spreads or frontier-based measures, which do not fully capture actor-level coordination performance in heterogeneous, informal supply chains. This study addresses this gap by developing a composite Market Efficiency Index (MEI) that integrates financial performance, operational quality, service equity, and relational governance. Methods: The MEI, a multidimensional alternative to frontier-based measures, was developed and applied to data collected from 250 supply chain actors in Sri Lanka. Results: The results show a clear efficiency gradient along the supply chain, with fishers scoring the lowest (MEI = 0.44), intermediaries moderate (MEI = 0.54), and retailers the highest (MEI = 0.67), yielding an overall system efficiency of 0.55 and relational governance emerging as the weakest system-level dimension. These results indicate persistent structural differences in value distribution and in how well the fish supply chain functions as a cohesive network, driven by liquidity constraints, information asymmetry, and weak cold-chain infrastructure. Conclusions: A multidimensional supply chain assessment provides a more effective basis for diagnosing coordination constraints and enables targeted digital interventions that offer feasible pathways to improve transparency, liquidity, and inclusiveness in smallholder-dominated fish supply chains. Full article

Background: Helicobacter pylori remains a major cause of chronic active gastritis and a clinically relevant precursor of peptic ulcer disease and gastric neoplasia. Host-derived non-invasive biomarkers that reflect infection-related gastric inflammation are still insufficiently developed. This study evaluated the clinical relevance of fecal miR-146a in patients with H. pylori-associated gastritis. Methods: We conducted a prospective study over a 3-year period (2023–2025) at the County Clinical Emergency Hospital Sibiu, Romania. The study included 85 adults: 45 patients with confirmed H. pylori-associated gastritis and 40 controls. Demographic, clinical, inflammatory, endoscopic, histopathological, and molecular data were analyzed. Continuous variables were compared using the Mann–Whitney U test and categorical variables using the chi-square or Fisher’s exact test. Multivariable analysis was performed using Firth’s penalized logistic regression. Results: Patients with H. pylori-associated gastritis showed significantly higher fecal miR-146a expression than controls (2.05 [1.77–2.37] vs. 0.88 [0.77–0.99], p < 0.001). They also had higher CRP, ESR, WBC, abdominal pain scores, and a greater burden of endoscopic and histopathological abnormalities. In both multivariable models, fecal miR-146a remained the only significant variable associated with disease status. Conclusions: Fecal miR-146a is markedly elevated in H. pylori-associated gastritis and may represent a promising non-invasive biomarker of infection-related gastric inflammation. Larger prospective studies are needed for validation. Full article