Search Results (36,065)

Background: Temporomandibular disorders (TMDs) are common musculoskeletal conditions associated with pain, functional limitation, and reduced quality of life (QoL). Despite the widespread use of conservative and minimally invasive treatments, the available evidence remains fragmented across heterogeneous interventions, diagnostic criteria, and outcome measures, limiting comparative interpretation and clinical applicability. Objectives: The primary objective of this systematic review is to evaluate the effectiveness of conservative and minimally invasive interventions for pain reduction in adult patients with temporomandibular disorders. Secondary objectives include assessing effects on mandibular function and QoL and exploring differences across intervention categories, TMD subtypes, diagnostic criteria, and follow-up durations. Methods: This protocol is registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD420251250251) and adheres to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. A systematic search will be conducted in PubMed/MEDLINE, Web of Science, Scopus, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) for randomized controlled trials (RCTs) published from 1 January 2015, up to the date of study initiation, using controlled vocabulary terms and free-text keywords combined with Boolean operators. Eligible studies will include adult patients (≥18 years) diagnosed with temporomandibular disorders using validated diagnostic criteria and treated with conservative or minimally invasive interventions, compared with placebo/sham, no treatment or usual care, or active comparators, in accordance with the PICOS framework. Two reviewers will independently screen studies and extract data, with disagreements resolved by consensus or consultation with a third reviewer; the study selection process will be documented using a PRISMA 2020 flow diagram. Interventions will be synthesized within predefined clusters (e.g., physical and manual therapies, occlusal splint therapy, physical agent modalities, and minimally invasive joint procedures). Risk of bias will be assessed using the revised Cochrane Risk of Bias tool (RoB 2). The primary outcome will be pain intensity, while secondary outcomes will include mandibular function and QoL. Where appropriate, meta-analysis using a random-effects model will be performed; otherwise, a structured narrative synthesis will be provided. Expected Impact: The systematic review is expected to deliver an updated and methodologically rigorous synthesis of evidence on conservative and minimally invasive interventions for TMDs. By addressing existing research gaps such as the fragmentation of evidence across intervention types, heterogeneity in diagnostic criteria, and variability in outcome measures, this review will support evidence-based clinical decision-making and identify priorities for future research. Full article

The recognition of microRNAs as components of animal-source foods (ASFs) with epigenetic characteristics and regulation has spurred research in an interesting direction, particularly in understanding their microRNAs (miRNAs) fraction. Thus, a constant supply of them through food intake, with equally conserved targets, may facilitate their accumulation in tissues rich in their targets. Here, we consider the potentially dominant miRNAs in animal-source foods (ASFs) documented in the literature, identified through a frequency-weighted ordinal recurrence approach. let-7d-5p, miR-101-3p, and miR-133b consistently showed dominant rankings in a product-specific manner in lean meat. In meat fat, let-7i-5p, miR-30c-5p, and miR-23a-3p were highly ranked. Among various types of meat offal, miR-145-5p, miR-92-5p, and miR-24-3p emerged as the predominant miRNAs. Similarly, in dairy products, miR-200a-3p, miR-200c-3p, miR-223-3p, miR-25-3p, miR-29a-3p, and miR-29b-3p were recurrently dominant, whereas miR-17-5p, miR-184, miR-30e-5p, and miR-92b-3p showed a comparable prevalence in seafood. Even though bioinformatic approaches suggest miRNAs from raw ASFs showed major enrichment of processes and pathways culminating in epithelial barrier integrity modulation, such putative functions tend to be equally enriched by predicted targets of the miRNAs in processed products. Product-specific highly ranked miRNAs from food categories stipulate possible preferential enrichment in contexts of cell–cell adhesion, cytoskeletal dynamics, and inflammatory control by meat (lean, fat, offal), immune homeostasis by dairy, and neural signalling by seafood, providing hypotheses for future functional studies. However, a limited understanding of their stability during gastrointestinal transit may present a more immediate limitation to their potential translational applicability. Full article

Within industrialised and emerging industrialised economies people typically spend over 95% in industrialised and emerging industrialised economies typically spend over 95% of their time in built environments, yet the neurophysiological impact of architectural design remains poorly understood. While previous studies link visual patterning to cortical activity, the cortical-to-autonomic stress pathway remains largely unexplored—a key omission given that chronic stress contributes to allostatic overload. This study examined how architectural façade design influences neurophysiological stress through a multimodal approach combining functional near-infrared spectroscopy (fNIRS) to monitor occipital cortical activity with heart rate variability (HRV) as an index of autonomic regulation. Eighteen participants provided HRV data and subjective ratings for nine systematically varied façade images characterised by their deviation with respect to natural statistics, while a subset of twelve completed fNIRS recording due to signal acquisition constraints. Façade identity significantly affected discomfort, complexity, and interest ratings ($p<0.001$), and deviation from natural statistics predicted all three measures ($p<0.01$). Façade type also showed a small but significant effect on HRV ($p=0.003$), although variance was dominated by individual differences. No stimulus-specific occipital fNIRS differences were observed. However, due to the limited sample size, further research is needed to verify this observed result. Whilst global generalisations cannot be drawn due to the small sample size, these pilot research findings indicate that façades deviating from natural image statistics influence perceptual comfort and may modestly modulate autonomic balance. However, the present data does not provide clear evidence of stimulus-specific cortical effects, which, if present, likely remain below the detection thresholds of the current protocol given its methodological constraints. This study highlights methodological hurdles and establishes a scalable framework for linking computational visual metrics to physiological responses, informing future investigations into how architectural features influence human health. Full article

The Three Gorges Reservoir (TGR) in China is one of the world’s largest hydropower projects. Interval inflow, originating from ungauged areas between the upstream gauging control stations (Zhutuo, Beibei, Wulong) and the TGR dam site, is a critical component of total reservoir inflow, but its hydrological characteristics have not been fully clarified. The accurate estimation and prediction of interval inflow are essential for reservoir safety and flood control operations. Using daily hydrological data from 2009 to 2017, we propose an integrated analytical framework combining (i) flow travel time estimation using cross-correlation analysis, (ii) multi-scale statistical characterization, and (iii) K-means clustering with bootstrap validation and algorithm comparison. This framework systematically identified hydrological regimes of interval inflow and their associated flood control risks. The key findings are as follows. (1) The optimal flow travel time from the upstream gauging stations to the dam site is 1 day (correlation coefficient $\rho =0.9809,p<0.001$), and it remains stable across different flow regimes. (2) The interval inflow exhibited a highly right-skewed distribution (mean 1279 m³/s, standard deviation 1651 m³/s) and contributed on average 10.1% to the total inflow. The contribution ratio exhibited an inverted U-shaped relationship with increasing total inflow, peaking at 11.4% when the total inflow ($Q$) was 13,014 m³/s. The quartile thresholds were 5788 m³/s, 9575 m³/s, and 16,869 m³/s (corresponding to Q1, Q2, and Q3, respectively), and the 10th and 90th percentiles (P10 and P90) were 4865 m³/s and 24,625 m³/s, respectively. (3) Five distinct hydrological patterns (C1–C5) were successfully identified, among which Cluster C4 (5.7% of days) was defined as the high-impact pattern based on reservoir operational criteria, with a mean $I$ of 6425 m³/s, a mean $R$ of 27.8% (up to 44% in extreme events), a mean flood duration of 5.8 days, a mean flood volume of 36.1 × 10⁸ m³, and a flashiness index of 1.48. (4) C4 is predominantly triggered by localized heavy rainfall, and its flashy nature implies a substantially shorter forecast lead time compared with mainstream-dominated floods, posing major challenges to real-time reservoir operations. This study demonstrates that interval inflow risk is pattern-dependent and that the proposed framework provides a scientific basis for developing pattern-specific reservoir operation strategies. The proposed framework is transferable to other large river-type reservoirs facing similar ungauged interval inflow challenges. Full article

Objectives: Physician-modified endografts (PMEGs) expand endovascular treatment options in urgent or cost-sensitive settings where industry-provided custom-made devices (CMDs) are not available. Current PMEG manufacturing techniques are time-consuming, lack standardization, and often require repeated adjustments to achieve strut-free fenestration positioning. Mixed reality (MxR) may streamline this process by overlaying virtual templates directly onto the physical stent graft guiding fenestration positioning. Methods: We developed a standardized MxR-assisted workflow for four-fenestrated PMEG preparations and compared it to a conventional marking technique. In this experimental set-up, between May 2025 and July 2025, three stent grafts were evaluated (Endurant II^® 28 mm, Valiant Captivia^® 30 mm, and Valiant Captivia^® 32 mm). Five observers performed fenestration marking on 20 grafts per device type (10 per method), resulting in 60 PMEGs and 240 fenestrations. Outcomes included absolute positional error, relative positional error, number of strut-free fenestrations, number of re-attempts to achieve strut-free configuration, time required, and usability assessed via the System Usability Scale (SUS). Results: Across 240 fenestrations, both methods achieved high accuracy. Median absolute errors ranged from 0 to 1.25 mm for the conventional method and 0 to 1.75 mm for MxR. Relative positional errors were similarly small, with no significant differences between methods. MxR achieved higher rates of strut-free fenestration in the 28 mm Endurant II^® device. Re-attempts were fewer with MxR. Median procedure time was significantly reduced for the MxR-assisted workflow in Valiant Captivia 30 mm (5.0 vs. 9.8 min, p = 0.049) and 32 mm (5.6 vs. 8.2 min, p = 0.049) while a trend was observed for Endurant II (7.5 vs. 15.6 min, p = 0.066). SUS scores favored MxR (76.2 vs. 62.6), though not significantly. Conclusions: The MxR-assisted PMEG production workflow seems promising in this pre-clinical, experimental study and warrants continued development and investigation. Full article

African swine fever virus (ASFV) causes a fatal disease in domestic pigs and wild boars (Sus scrofa), leading to nearly 100% mortality during acute infection and significant economic losses in swine production. Unlike other eukaryotic viruses, ASFV encodes a histone-like nucleic acid-binding protein, pA104R, which is highly conserved and present in all described ASFV isolates of different genotypes. Moreover, A104R-like sequences have been identified in the genomes of soft ticks, which can replicate and transmit ASFV. Using a virulent genotype IX field isolate from Kenya, we analyzed the importance of A104R for viral replication in a permissive wild boar cell line (WSL). In this study, we confirmed that A104R is not essential for in vitro replication of ASFV. Loss of A104R did not detectably affect viral DNA replication or RNA transcription but led to a moderate reduction in virus titers and plaque sizes. Substitution of A104R with a similar ASFV-like element derived from the genome of an Ornithodoros moubata soft tick was not capable of rescuing the deletion mutant phenotype. In contrast, reintroduction of the authentic A104R open reading frame (ORF) into the deletion mutant fully restored wild-type virus growth properties. In accompanying studies, we verified the DNA-binding activities of the ASFV- and tick-derived A104R proteins and performed mass spectrometric analyses of the pA104R interactome. These experiments revealed, besides DNA-dependent co-precipitated proteins, specific DNA-independent protein–protein interactions of pA104R with other viral and cellular proteins. Full article

Studies conducted in first-episode psychosis (FEP) patients have shown alterations in inflammation and metabolism. Our objective was to investigate potential treatment-related effects on these systems in Italian FEP patients undergoing either an experimental treatment consisting of a multi-element psychosocial intervention (EXP), including cognitive–behavioural therapy, or treatment as usual (TAU). A total of 191 FEP patients with first contact between April 2010 and March 2011 were clinically assessed at baseline and after 9 months of treatment, and the serum levels of 19 analytes were determined through single or multiplex enzyme-linked immunosorbent assays (ELISAs). A significant increase was observed in leptin levels and a significant decrease in Glucagon-Like Peptide-1 (GLP-1) levels during the treatment (time effect, p < 0.001 for both), with no significant interaction between time and treatment type. Although ghrelin levels changed significantly over time in the whole cohort (p = 0.008), a significant decrease was observed only in the EXP group (post hoc test: p = 0.001). None of the biomarkers measured at baseline showed a predictive effect on treatment efficacy, and no significant associations were identified between changes in clinical scores and changes in biomarker levels. These results suggest that early-phase psychosis treatments are associated with possible effects on metabolic regulation. Full article

This paper presents two capacitors fabricated using the metallic nanowire membrane (MnM) interposer technology operating at mmWaves. Standard 2D interdigital capacitors (IDCs) are designed to operate up to 70 GHz, which presents a straightforward and non-complex fabrication. In comparison, this work also proposes an improved device that is more compact and exhibits large capacitance density, as high-performance vias enable the realization of high-depth capacitors. The fabrication process of 3D devices presents advanced maturity and innovation as it takes advantage of the porous nature of the interposer material to overcome the device complexity, and is also described in detail. Both capacitor types are modeled by a numerical lumped-element model that also considers parasitics. The 3D capacitors were successfully fabricated and characterized up to 70 GHz, displaying capacitance values between 30 fF and 160 fF and self-resonant frequencies in good agreement with mmWave applications. The quality factor of these devices, measured at 40 GHz, lies between 16 and 4, and the superficial capacitance density is between 4 pF/mm² and 8 pF/mm², showing that these devices are indeed promising for mmWave applications. These devices present considerably larger capacitance density compared to 2D traditional capacitors fabricated on the high-performance substrate, highlighting the advantage of 3D fabrication using nanowire growth. In addition, thin-film resistances are simulated and fabricated, projecting their functions as an RF-choke in a bias tee configuration using Ti thin film sputtering deposition step that is also part of the capacitors fabrication. Full article

Internet of Things (IoT) applications often require only minimal necessary information—such as threshold judgments, binning, or prefixes—yet they must control privacy leakage arising from multi-round and cross-entity access without exposing raw values. Existing solutions, however, frequently rely on ciphertext structures and server-side states, making it difficult to define a leakage upper bound for restricted answers in the sense of Differential Privacy (DP), or they lack unified information budgeting and k-use control. To address these challenges, this paper proposes a verifiable differential privacy partial disclosure scheme for IoT. We employ DP accounting to uniformly constrain the leakage of three types of operators: threshold, binning, and prefix. Furthermore, we design stateless k-use tokens based on Verifiable Random Functions (VRFs) and chained receipts to generate publicly verifiable compliance evidence for each response. We implemented an end-edge-cloud prototype system and evaluated its performance on two use cases: smart meter threshold alarms and industrial sensor out-of-bound detection. Experimental results demonstrate that compared with a baseline relying on server-state counting for k-use control, our stateless k-use mechanism improves throughput by approximately 25–37% under concurrency scales of 1, 8, and 16, and reduces p95 latency by an average of 15%. Meanwhile, in multi-party splicing attack experiments, the re-identification accuracy remains stable in the 0.50–0.52 range, approximating random guessing. These results validate that the proposed scheme possesses low-energy engineering feasibility and audit-friendliness while effectively suppressing splicing risks. Full article

Monoclonal antibodies represent one of the fastest-growing sectors of the biopharmaceutical industry. Their high therapeutic efficacy and reduced incidence of adverse effects compared to conventional therapies have led to an increasing demand for these products. The costliest stages of monoclonal antibody production are the separation and purification processes, which underscores the need for continuous development and optimization of applied methodologies. Active pharmaceutical ingredients must exhibit high purity and preserved biological activity in order to meet stringent regulatory requirements. Macromolecules such as monoclonal antibodies possess complex conformational structures that significantly influence their stability. The application of multi-step chromatographic processes during purification from cell culture harvests may induce structural alterations, including protein unfolding and aggregation, ultimately resulting in decreased product quality and therapeutic effectiveness. Such structural changes may also increase immunogenicity risk and reduce product shelf life, posing additional challenges for downstream processing. In addition, chromatographic media create microenvironments that differ markedly from bulk solution (e.g., high local protein concentration, confined pore spaces and heterogeneous surface chemistry). These effects can promote either self-association driven by colloidal interactions or partial unfolding followed by irreversible aggregation, depending on the unit operation and operating window. Practical mitigation is therefore rarely achieved by a single lever; instead, it requires an integrated view of resin selection, buffer composition (pH, salt type and ionic strength, and stabilizing additives), residence time and temperature, as well as an analytics strategy that combines orthogonal aggregation assays with structural probes. This work discusses the phenomena of unfolding and aggregation of therapeutic proteins, with particular emphasis on monoclonal antibodies occurring during chromatographic purification. Furthermore, key analytical methods, characterization techniques, and mitigation strategies aimed at improving product quality and reducing manufacturing costs are reviewed. Full article

Potentially toxic element (PTE) contamination of urban soils poses long-term ecological and public health risks. Ornamental vegetation is increasingly discussed within green-infrastructure-based risk management. We screened and synthesised 167 field studies (>120 ornamental and horticultural plant species) to characterise the scope, reporting structure and design features of the available phytoremediation-related evidence. Studies assessed a mean of 3.21 elements (SD = 1.37); Pb, Cd and Zn were most frequently investigated (67%), whereas Ni, Cr and B occurred in <10%. Reported element richness differed by setting, averaging 3.8 ± 1.5 in wastewater-affected sites versus 2.6 ± 1.1 in urban parks. Using a study-by-element presence/absence matrix, co-reporting patterns separated three recurrent co-reporting profiles. The first three PCs explained 64.5% of variance (PC1: Pb–Zn–B; PC2: Cu–Ni; PC3: Cd–Cr). Accumulation was reported most often (56.8%), while stabilisation (17.9%) and translocation (25.3%) were less commonly addressed. For public space applications, accumulation-focused plantings require a defined maintenance pathway (pruning/harvest, biomass removal, and safe handling or disposal) to avoid recirculation of metal-bearing material within the urban environment. Sampling focused on aboveground tissues (73.4%) more than roots (28.9%). In multiple regression, environmental type was associated with element richness (Adj. R² = 0.08, p = 0.001). Here, richness is treated as an index of reporting breadth. Overall, the dominant quantitative signals reflect context-dependent reporting and study design patterns. They do not represent harmonised, concentration-based remediation outcomes. These patterns provide an evidence map to support context-aware interpretation and future study standardisation. Full article

This study aimed to investigate the impacts of chestnut tannin (CT) on growth performance, immune response, and intestinal health of broilers challenged with necrotic enteritis (NE) through the cyclic GMP-AMP synthase (cGAS)-stimulator of interferon genes (STING)-ferroptosis pathway. A total of 240 one-day-old male Cobb 500 broilers (44.54 ± 0.51 g) were randomly divided into four groups, including a Control group, NE group, 500 mg/kg CT group (L-CT), and 1000 mg/kg CT group (H-CT), with six replicates per group and ten broilers per replicate. Sporulated coccidia oocysts on day 14 and Clostridium perfringens solution from days 19 to 21 were given to all broilers except the Control group through oral administration to establish the NE infection model. The results demonstrated that dietary supplementation with CT improved (p < 0.05) growth performance, intestinal morphology, and intestinal mucosal barrier function of broilers challenged with NE. CT supplementation decreased (p < 0.05) interleukin (IL)-1β, IL-6, type I interferon, interferon-γ, and tumor necrosis factor-α concentrations and increased (p < 0.05) IL-10 concentration in the jejunal mucosa. Furthermore, CT supplementation decreased (p < 0.05) Fe²⁺ concentration, malondialdehyde concentration, mitochondrial DNA level, and mitochondrial reactive oxygen species level in the jejunal mucosa. Broilers under NE challenge had upregulated (p < 0.05) jejunal protein expression of cGAS, STING, phospho-TANK-binding kinase 1, phospho-interferon regulatory factor 7, phospho-nuclear factor kappa B, ferroptosis suppressor protein 1, prostaglandin-endoperoxide synthase 2, acyl-CoA synthetase long-chain family member 4, WD repeat domain phosphoinositide-interacting protein 2, nuclear receptor co activator factor 4 and autophagy related protein 5 and downregulated (p < 0.05) glutathione peroxidase 4, ferritin heavy chain 1, ferritin light chain and ferroportin 1 compared with the Control group, while the supplementation of CT reversed these effects. In conclusion, CT improved intestinal inflammatory damage of broilers challenged with NE by inhibiting the cGAS-STING-ferroptosis pathway, which was more effective at a dose of 1000 mg/kg in this study. Full article

Background: Minimally invasive spinal stabilization (MISS) is increasingly used in metastatic spine surgery, but comparative evidence vs. open posterior stabilization (OPEN) remains limited. We compared perioperative outcomes, focusing on wound-related morbidity. Methods: This retrospective single-center cohort included 71 patients undergoing posterior stabilization for spinal metastases (MISS n = 45; OPEN n = 26). Wound-healing disorder was the primary endpoint. Groups were compared using nonparametric exact tests; adjusted and propensity score analyses were performed to assess robustness. Results: Baseline SINS, operated segment, and instrumented levels were comparable. BMI was higher in MISS (25.8 [24.0–29.7] vs. 22.1 [20.0–24.9] kg/m²; p = 0.001), and urgent admissions were more frequent in OPEN (42.3% vs. 11.1%; p = 0.006). Wound-healing disorders occurred in 6.7% (3/45) of the MISS group vs. 30.8% (8/26) of the OPEN group. (p = 0.014; crude RR 4.62, 95% CI 1.34–15.88). After adjustment for admission type, BMI, and ECOG (n = 65), the association was attenuated (adjusted RR 1.80, 95% CI 0.24–13.68; p = 0.572). SSI occurred in 1/45 (2.2%) MISS vs. 5/26 (19.2%) OPEN (p = 0.022). Estimated blood loss was similar between groups (MISS: 500 [350–800] vs. OPEN: 600 [500–700] mL; p = 0.357). The median length of stay was shorter in the MISS group, though this did not reach statistical significance. In trimmed IPTW (64 complete cases), OPEN remained associated with higher weighted risk (RR 1.91, 95% CI 0.42–8.65; p = 0.403). Conclusions: OPEN surgery was associated with higher unadjusted wound-related morbidity than MISS, while blood loss did not differ between approaches. Length of stay tended to be shorter after MISS, but analyses were underpowered. Full article

Monochamus alternatus larvae, as concealed trunk-boring pests, evade conventional insecticide contact due to their cryptic feeding niche. To overcome this limitation, previous studies have engineered strains of the naturally entomopathogenic bacterium Yersinia entomophaga. The lethality of these strains against M. alternatus was enhanced by incorporating extracellular secretion systems and enriching insecticidal proteins within the larval midgut. However, plasmid loss occurs during serial subculturing. Here, we established an engineered strain that expresses the red fluorescent protein gene mCherry to explore the applicability of bacterial conjugation transfer to Yersinia. We then constructed a chromosomally integrated strain (CSLH88-pCHSW) that incorporates extracellular secretion systems. The results of stability assays demonstrated 100% retention of the mCherry and Cry3Aa-T-HasA genes over 78 generations. SDS-PAGE and Western blot analyses confirmed the extracellular secretion of the Cry3Aa-T protein in the CSLH88-pCHSW strain. Bioassays revealed that the CSLH88-pCHSW strain was significantly more virulent against M. alternatus larvae than both the wild-type strain (CSLH88) and the plasmid-transformed strain (CSLH88-pCHKW), and exhibited markedly faster insecticidal kinetics. Our study reveals the application of bacterial conjugation transfer technology for constructing biocontrol strains. This genomically stabilized Yersinia strain eliminates the risks of failure associated with plasmid loss in the field, enabling the sustainable control of M. alternatus. Full article

Background and Objectives: Psychosocial symptoms and oral behaviors can complicate routine dental care, yet available screeners yield multiple separate scores. Explainable artificial intelligence offers a pragmatic way to integrate such multidomain measures into a single, auditable output that can support screening-oriented stratification and standardized documentation (non-diagnostic). Therefore, we aimed to develop an interpretable, deterministic Mamdani fuzzy inference system (FIS) integrating GAD-7, PHQ-9, and OBC-21 into a 0–10 psychobehavioral composite score (PCS) to support screening-oriented stratification and standardized documentation (non-diagnostic). Materials and Methods: Cross-sectional multicenter study in 18 private dental clinics in Romania (October 2024–March 2025; n = 460). A rule-based Mamdani Type-1 FIS was specified a priori (48 rules; triangular membership functions; centroid defuzzification) without supervised training. Internal evaluation assessed coherence across severity strata, robustness to predefined input perturbations (±1 point; ±5%) and membership-function variation (±10%), and benchmarking against linear composites (Z-mean; PCA PC1). Results: Median PCS was 2.30 (IQR 2.03–3.56). PCS correlated with GAD-7 (Spearman ρ = 0.886), PHQ-9 (ρ = 0.792), and OBC-21 (ρ = 0.687) (all p < 0.001), increased monotonically across anxiety and depression severity strata, and was higher in high OBC-21 risk. Robustness was excellent under input perturbations (ICC(3,1) = 0.983 for ±1 point; 0.992 for ±5%) and high under ±10% membership-function variation (ICC(3,1) = 0.959). Concordance with linear baselines was high (Spearman ρ = 0.956 for Z-mean; 0.955 for PCA PC1), with a small systematic nonlinearity at higher scores. Conclusions: PCS provides a fully auditable, rule-based integration of three patient-reported measures with coherent internal behavior and robustness to plausible measurement noise and specification changes. This study reports internal evaluation of a deterministic, rule-based aggregation; external clinical validation against independent outcomes is required before any clinical utility claims. Full article