Search Results (4,923)

Background and Objectives: Elderly patients with head and neck tumours frequently present with multiple comorbidities and a potentially difficult airway, making general anaesthesia high-risk. Dexmedetomidine, a selective alpha-2 adrenoceptor agonist, provides conscious sedation without clinically significant respiratory depression, offering a compelling locoregional alternative. This study evaluated the haemodynamic profile, sedation kinetics, and satisfaction outcomes of a standardised dexmedetomidine-based protocol for head and neck surgery under local infiltration anaesthesia. Materials and Methods: A prospective, single-centre observational study was conducted at the University Hospital Centre Zagreb. Twenty-three consecutive adult patients received a continuous dexmedetomidine infusion at 0.5 μg/kg/h, initiated preoperatively in the post-anaesthesia care unit without a loading dose. Haemodynamic parameters, sedation-to-incision interval, cumulative dose, and postoperative patient and surgeon satisfaction (NRS 1–10) were recorded. Spearman rank-order correlation and the Mann–Whitney U test were used for statistical analysis. Results: The primary outcome of haemodynamic stability—defined as the absence of vasoactive or inotropic rescue—was achieved in all 23 patients (100%). The median cumulative dexmedetomidine dose was 52 μg (IQR 44–68 μg). Controlled hypotension was achieved in all patients, with a median nadir systolic blood pressure of 98 mmHg. Supplemental oxygen was required in only 2 of 23 patients (8.7%). Patient and surgeon satisfaction reached a median NRS score of 10 in both groups. The sedation-to-incision interval correlated with total drug dose (ρ = 0.74, p < 0.001), consistent with fixed-rate infusion pharmacokinetics. Hypertensive patients exhibited a greater reduction in systolic blood pressure (median 45 vs. 28 mmHg; p = 0.015). Conclusions: A fixed-rate dexmedetomidine infusion initiated in the post-anaesthesia care unit provides a feasible and potentially effective conscious sedation strategy for head and neck surgery under local infiltration anaesthesia in selected elderly and comorbid patients. In this pilot series, the protocol was associated with haemodynamic stability in all cases, low supplemental oxygen requirements, and high procedural satisfaction among both patients and surgeons. These findings are preliminary and require confirmation in larger, controlled studies. Full article

Purpose: To analyze choroidal thickness (CT) and choroidal volume (CV) using ultra-wide-field (UWF) spectral-domain optical coherence tomography (SD-OCT) in patients with central serous chorioretinopathy (CSC) and to assess their associations with disease duration and best-corrected visual acuity (BCVA). Methods: This prospective case–controlled study included 50 eyes of 41 CSC patients and 56 eyes of 32 healthy controls matched for age and sex. CT was measured at 24 points using the REVO 130 UWF SD-OCT device with a wide-field adapter, covering a 21 × 21 mm retinal area across central, mid-peripheral (4 mm), and peripheral (8 mm) zones. CV was estimated using a quadratic nonlinear model. ROC curve analysis and univariate logistic regression were applied to evaluate discriminative capacity and odds ratios (OR) for CT and CV. Results: CT was significantly higher in CSC eyes at all 24 measurement points (all p < 0.0001). Mean subfoveal CT was 472.6 µm vs. 344.8 µm in controls (+37%), with greater relative increases at mid-peripheral (+46%) and peripheral (+44%) zones. Mean CV was 61.47 (±11.37) mm³ vs. 42.29 (±10.02) (+45%; p < 0.0001). CV showed a higher OR for CSC occurrence than central CT (OR = 2.88; 95% CI: 1.53–5.42 vs. OR = 1.04; 95% CI: 1.02–1.07). Significant discriminative CT points (AUC > 0.60) clustered at the 2/8, 4/10, and 6/12 clock meridians. Both CT and CV correlated positively with disease duration (Spearman rho 0.35–0.41; p ≤ 0.0004) but not with BCVA. Conclusions: UWF SD-OCT confirms diffuse pachychoroid thickening in CSC extending to the periphery. CV is a sensitive biomarker in association with CSC status. Peripheral CT and CV correlate with disease duration, supporting the link between higher volumetric choroidal values and longer disease course. Integration of these parameters may improve CSC diagnosis and prognostic evaluation. Full article

Taking 563 national key rural tourism villages across 12 provinces, autonomous regions, and municipalities in western China as the research object, this study integrates multi-source data on physical geography, transportation location, socioeconomic conditions, and historical culture based on the ArcGIS platform. It comprehensively applies kernel density analysis, spatial autocorrelation analysis, buffer analysis, Spearman correlation analysis, Geodetector, and the relative enrichment index to examine the spatial distribution characteristics of these villages and their associated spatial factors. The results show that key rural tourism villages in western China exhibit an overall clustered and uneven distribution, forming a spatial pattern characterized by “high concentration in core areas, extension along secondary corridors, and sparse distribution across vast hinterlands.” The core agglomeration areas are mainly located in the Sichuan Basin, the Chongqing metropolitan area, and the Guanzhong Plain. In terms of physical geography, the distribution of key villages shows certain spatial associations with major river basins, low-slope areas, and low-relief terrain. In terms of human factors, population density and road network density are important associated factors, and the combined population–transportation conditions have strong explanatory power for the spatial differentiation of key village density. With regard to historical culture, folk-custom inheritance villages and red-culture heritage villages account for relatively high proportions, while different cultural types show certain regional agglomeration or corridor-like distribution characteristics. The findings can provide references for zoned optimization, transportation connectivity, cultural resource integration, and coordinated regional development of key rural tourism villages in western China. Full article

High-intensity 5 km running offers an ideal framework to analyze the organism’s multidimensional responses. Since previous research primarily analyzed isolated aspects of fatigue, this study aimed to examine the integrated acute neuromuscular, metabolic, and perceptual responses to a 5 km run. Twenty-one recreational male runners participated. Pre- and post-race assessments included body composition, blood lactate, m. rectus femoris ultrasound thickness, quadriceps maximal voluntary isometric contraction (MVIC), heart rate, perceived exertion (Borg CR10), and 5 km finish time. Statistical analysis was performed in the Jamovi software, utilizing descriptive statistics, the Shapiro–Wilk test of normality, the Wilcoxon signed-rank test with effect size calculation, and Spearman’s correlation coefficient, at a significance level of p < 0.05. Post-race measurements revealed a significant decrease in quadriceps MVIC (pre: 305 ± 99 N vs. post: 259 ± 88 N; p = 0.002) and an increase in blood lactate (pre: 0.8 ± 0.4 vs. post: 6.9 ± 1.4 mmol/L; p < 0.001), alongside high average heart rates (165 ± 16 bpm). However, ultrasound-assessed muscle architecture remained unchanged. The 5 km run induced pronounced neuromuscular and metabolic fatigue. Unchanged muscle architecture suggests that acute strength decline is primarily mediated by metabolic and neural mechanisms, rather than immediate structural–morphological factors. These findings highlight the value of an integrated assessment approach for understanding acute fatigue responses following high-intensity 5 km running and may contribute to more precise training-load prescription and recovery monitoring in recreational runners. Full article

Accurate rainfall estimates are essential for managing water resources and planning for climate risks in semi-arid regions, yet long-term gauge networks in these environments are often extremely limited. In this study, we evaluate three widely used multi-source precipitation datasets—CHIRPS, IMERG, and ERA5-Land—against long-term observations from Ed Dueim and Kosti, the two main reference stations in White Nile State, central Sudan. The assessment covers monthly and annual scales across each product’s available record (1952–2022) and uses a broad set of metrics, including Pearson and Spearman correlations, NSE, KGE, RMSE, MAE, percent bias, and categorical detection scores (POD, FAR, CSI). All three datasets capture the region’s single-peak June–October monsoon pattern, but their accuracy differs sharply when it comes to rainfall amounts and year-to-year variability. CHIRPS performs best overall, with the strongest monthly efficiency scores of any product and a consistent, operationally correctable dry bias of 5–13%. IMERG shows strong monthly correlations but consistently overestimates rainfall by 25–42%, which leads to unreliable annual totals. ERA5-Land performs worst across nearly all metrics, with monthly NSE near or below zero, and frequent false alarms during the dry season. Taken together, the evidence points to CHIRPS as the most reliable dataset for routine hydro-climatic monitoring in White Nile State, while IMERG and ERA5-Land may still be useful in more specialized or time-specific applications. Full article

Background/Objectives: Adolescent mental health problems have increased in recent years, with growing concern about the impact of digital behaviors such as problematic video game use and gambling. Internet Gaming Disorder (IGD) and Problem Gambling Symptoms may share psychological risk markers, but evidence in Spanish adolescents is limited. This study aimed to examine the relationship between IGD, problem gambling symptoms, and mental health, and to identify sociodemographic, psychological, and behavioral factors associated, including microtransactions and loot boxes. Methods: A cross-sectional study was conducted with secondary education students from Extremadura (Spain). The final sample included 343 participants. Measures included an ad hoc questionnaire on video game use, the IGDS9-SF, SOGS-RA, and the Strengths and Difficulties Questionnaire (SDQ). Descriptive analyses, Spearman correlations, and multivariable regression (Poisson and negative binomial) were performed. Results: IGD and gambling were positively correlated (Spearman’s ρ = 0.386, p < 0.001) and associated with higher mental health difficulty scores (IGD: ρ = 0.299, p < 0.001; gambling: ρ = 0.214, p < 0.001). Male gender was associated with both outcomes (IGD: incidence rate ratio [IRR] = 1.21 [95% Confidence Interval: 1.13–1.30]; gambling: IRR = 2.90 [1.85–4.60]). Microtransactions were associated with both behaviors (IGD: IRR = 1.17 [1.09–1.25]; gambling: IRR = 1.74 [1.19–2.54]), while loot box use was related only to IGD (IRR = 1.13 [1.05–1.21]). Total SDQ score was positively associated with both IGD (IRR = 1.02 [1.02–1.03]) and gambling (IRR = 1.10 [1.06–1.13]). Younger age was associated with higher IGD scores (IRR = 0.97 [0.96–0.99]). Conclusions: There are similarities in the associations among the examined factors and increased scores of IGD and gambling in adolescents, particularly male gender, higher mental health difficulties scores, and involvement in monetized gaming systems. School-based, family, and public health prevention strategies may benefit from addressing the importance of psychological well-being and increase awareness of the potential risks associated with digital gaming practices. Full article

Background: A complex interplay between viral activity and host immune responses drives the progression of liver fibrosis in chronic hepatitis B. The T helper 17 (Th17) immune pathway, which produces the pro-inflammatory cytokine interleukin-17A (IL-17A), has been implicated in hepatic fibrogenesis. However, the relationship between IL-17A levels, IL-17A G197A (rs2275913) gene SNP, and the degree of liver fibrosis across different phases of the natural history of chronic hepatitis B remains insufficiently explored. Methods: This study employed an analytical observational design with a cross-sectional approach in treatment-naïve patients with chronic hepatitis B. The degree of liver fibrosis was assessed using liver elastography. IL-17A (rs2275913) gene SNP was analysed using Real-Time PCR, while serum IL-17A levels were measured using enzyme-linked immunosorbent assay. Statistical analyses included Spearman’s correlation, the contingency coefficient, the Chi-square test, the Kruskal–Wallis test, and the Mann–Whitney test, with a significance level set at p < 0.05. Results: A total of 76 patients with chronic hepatitis B were included in this study. The phase of disease progression was significantly associated with the degree of liver fibrosis (p = 0.016). Median IL-17A levels increased in parallel with fibrosis severity (p = 0.003), with a particularly significant association observed during the R phase (p = 0.002). However, no significant association was found between the IL-17A G197A (rs2275913) gene SNP and either liver fibrosis severity or serum IL-17A levels. Conclusions: Elevated serum IL-17A levels were associated with greater liver fibrosis severity, particularly during the reactivation phase of chronic hepatitis B. These findings suggest a potential relationship between IL-17A-mediated immune responses and liver fibrosis in patients with chronic hepatitis B. Full article

Background: Dynamic risk stratification is fundamental to the modern management of pulmonary arterial hypertension (PAH). However, data on the impact of sequential add-on therapy in patients with Group 1.4 PAH—particularly in Latin American populations—remains limited. This study evaluated changes in risk classification using COMPERA 2.0 and REVEAL Lite 2 scores in patients treated with endothelin receptor antagonist (ERA) and phosphodiesterase type 5 inhibitor (PDE5i) combination therapy (macitentan + sildenafil) at a referral center in Mexico. Methods: In this single-center, retrospective cohort study, 25 patients with a confirmed diagnosis of PAH between 1st January 2022 and 31st December 2024 were evaluated at baseline and after 24 weeks of treatment. Clinical, functional, and biochemical parameters were recorded. Within-patient changes were analyzed using the Wilcoxon signed-rank test, and agreement between risk assessment tools was assessed using Spearman’s correlation coefficient. Results: At 24 weeks, patients demonstrated significant improvement in World Health Organization functional class (p = 0.002) and a significant reduction in brain natriuretic peptide levels (p = 0.003). Both COMPERA 2.0 and REVEAL Lite 2 scores showed a consistent shift toward lower-risk categories. A strong concordance between the two tools was observed. Conclusions: Sequential add-on ERA + PDE5i therapy was associated with meaningful improvement in risk stratification among patients with Group 1.4 PAH. These findings support the clinical utility of simplified, noninvasive risk assessment tools in real-world settings, particularly in resource-constrained environments. Full article

Background: Physical activity is a key modifiable factor influencing healthy aging, yet data on activity patterns and their physiological correlates in older adults from Central Asia remain limited. Understanding these relationships is essential for informing region-specific health promotion strategies. Objectives: This study assessed physical activity levels among urban-dwelling older adults in Astana, Kazakhstan, and examined associations between activity level, body composition, visceral fat accumulation, metabolic indicators, and muscle strength. Methods: A cross-sectional study was conducted among 608 adults aged ≥60 years (median age: 68 years; 82.1% women). Physical activity was measured using the validated Physical Activity Scale for the Elderly (PASE). Anthropometric and body composition indicators, including BMI, total and visceral fat, skeletal muscle mass, and handgrip strength, were evaluated. Spearman correlation and linear regression analyses were applied. The analyses were exploratory and did not include adjustment for potential confounders such as sex, chronic disease burden, or socioeconomic status; therefore, the observed associations should be interpreted with caution. Results: The median PASE score was 55.55, with 61.8% of participants demonstrating moderate activity levels, primarily through walking and household tasks. In analyses without adjustment for potential confounding factors, PASE scores showed weak inverse associations with visceral fat (ρ = −0.214; p < 0.001) and waist-to-hip ratio (ρ = −0.154; p < 0.001), as well as weak positive associations with handgrip strength. Across the reported significant associations, correlation coefficients ranged from |ρ| = 0.103 to 0.235, and the explanatory capacity of the regression models was low, with R² values ranging from 0.6% to 8.2%. Conclusions: Higher habitual physical activity may be linked to selected bioelectrical impedance parameters, WHR, and handgrip strength among urban older adults. Given the cross-sectional design, causal interpretation should be approached with caution. These findings provide meaningful regional baseline evidence for future longitudinal and intervention studies on physical activity and healthy aging in Central Asia. Full article

Background: Early identification of balance impairments is critical for detecting the fall risk in older adults. Force plates are the standard for measuring postural sway, but are restricted in practice because they are cumbersome and expensive. The Balance Mat is a portable device that requires comprehensive validation against force plates and clinical benchmarks in older adult populations. Objective: The objective of this study was to evaluate the technical validity and clinical discriminative ability of the Balance Mat against a laboratory-grade force plate, clinical tests, and the fall history in an older adult cohort. Methods: Fifty-six community-dwelling older adults performed static balance assessments across six stance conditions. Postural sway data were recorded simultaneously using the Balance Mat and a force plate. The technical validity was assessed using Spearman’s rank correlation and intraclass correlation coefficients. Linear regression models were applied to calibrate the Balance Mat outputs against the force plate. The diagnostic accuracy for classifying the fall risk against the timed up and go test, the Falls Efficacy Scale-International, and the retrospective fall history was evaluated using an area-under-the-curve analysis. Results: The Balance Mat demonstrated strong associations with force plate measurements, particularly for the sway path/velocity, variance and Area95 ($r>0.80$). Following calibration, the absolute agreement for the sway path/velocity reached excellent levels ($ICC=0.93$) and good levels for Area95 and RMS ($ICC>0.75$), whereas the mean sway demonstrated a poor agreement and was excluded. For fall-risk classification, the calibrated Balance Mat achieved a fair accuracy for the retrospective fall history and a high Falls Efficacy Scale-International concern (area under the curve, 0.76-0.78), and a fair accuracy for the timed up and go thresholds (area under the curve, 0.70). Conclusions: The calibrated Balance Mat provided valid measurements of postural sway that aligned with the force plate parameters, particularly for the sway path/velocity and Area95. The within-stance agreement for the sway path/velocity ranged from ICC= 0.44 to 0.88, and the pooled value should not be interpreted as the uniform performance across all stance conditions. Given its fair diagnostic accuracy, the device is best utilised as a portable screening tool in combination with standard clinical assessments and the fall history rather than as a standalone diagnostic test. Full article

Background: Childhood oral hygiene behaviors are crucial to preventing oral diseases and can influence the development and progression of malocclusions. The World Health Organization (WHO) Oral Health Questionnaire is a standardized tool for assessing oral hygiene behaviors, oral health-related behaviors, and preventive dental awareness in children. Aim: This study aimed to assess oral hygiene behaviours and examine associations between WHO Oral Health Questionnaire variables and Angle malocclusion classes among children aged 6–9 years. Materials and Methods: This cross-sectional study included 90 children aged 6–9 years from the Pristina region, Kosovo. Data were collected using the WHO Oral Health Questionnaire for Children, which assessed oral hygiene habits, toothbrushing frequency, fluoride awareness, dental attendance, dietary behaviors, oral symptoms, and oral-health-related quality of life. Malocclusion was classified according to Angle classification into Class I, II, and III malocclusions with 3D intraoral scanners, Aerolscan 3. Descriptive statistical analysis, Chi-square (χ²) test, Spearman correlation analysis, and reliability analysis using Cronbach’s Alpha were performed using SPSS Statistics 23.0 (IBM Corp., Armonk, NY, USA) and Statistica 7.1 (StatSoft Inc., Tusla, OK, USA). Results: Most participants reported regular oral hygiene practices, with 46.7% brushing their teeth two or more times daily. However, limited awareness regarding fluoride-containing toothpaste was observed, as most children answered “don’t know” regarding fluoride use. Occasional toothache or oral discomfort was reported by 33.3% of participants, while 23.3% reported dissatisfaction with dental appearance. Difficulty biting hard foods was present in 34.4% of children. Reliability analysis of the Q10 section demonstrated moderate internal consistency (Cronbach’s Alpha = 0.500). Chi-square analysis demonstrated no statistically significant association between Angle malocclusion classes and WHO questionnaire variables (p > 0.05). The highest χ² value was observed for tooth-cleaning frequency (Q7) (χ² = 11.97; p = 0.152), although the association remained statistically non-significant. Psychosocial impact questions and oral health-related quality of life questions also demonstrated no statistically significant association with malocclusion classes. Conclusions: oral hygiene practices, preventative oral health practices, and oral health-related experiences were comparatively similar among children in different Angle malocclusion classes. Although there were no statistically significant correlations found between malocclusion classes and WHO questionnaire variables, the results show that some children have psychosocial concerns about their dental appearance and insufficient awareness of preventive oral health. The WHO Oral Health Questionnaire is a useful epidemiological tool for evaluating pediatric oral health behaviors and may help build youth orthodontic and preventive oral health policies. Full article

Background. Accurate prediction of pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) in muscle-invasive urothelial bladder cancer (MIBC) remains an unmet clinical need. The neutrophil-to-platelet/hemoglobin-to-lymphocyte (NPLH) ratio, a composite hematologic index that reflects both systemic inflammation and nutritional oxygen-carrying capacity, has not been previously evaluated as a predictor of NAC response in this setting. Methods. We retrospectively analyzed 114 consecutive patients with MIBC (cT2–T4, N0–N3) who received accelerated MVAC (aMVAC) NAC followed by radical cystectomy at a single academic center. Pretreatment NPLH (calculated as [neutrophils × platelets]/[hemoglobin × lymphocytes]) was assessed as a predictor of pCR (ypT0N0) and tumor regression grade (TRG). Receiver operating characteristic (ROC) curve analysis, Mann–Whitney U test, and logistic regression were used. NPLH performance was compared to NLR and PLR. Results. pCR was achieved in 35 patients (30.7%). Median NPLH was significantly lower in pCR vs. non-pCR patients (33.9 [IQR 23.1–42.4] vs. 47.6 [IQR 30.7–90.4]; p = 0.0007). NPLH yielded an AUC of 0.700 (bootstrap 95% CI 0.596–0.794) for pCR prediction, numerically superior to NLR (AUC 0.645 [0.542–0.741]) and PLR (AUC 0.643 [0.533–0.747]); DeLong test: NPLH vs. NLR p = 0.079, NPLH vs. PLR p = 0.090. At the optimal cut-off of 44.5, NPLH demonstrated 80.0% sensitivity and 57.0% specificity. pCR rates declined progressively across NPLH quartiles: 48.3% (Q1) to 10.3% (Q4). On multivariate logistic regression, log-transformed NPLH was the only independent predictor of pCR (parsimonious model, OR 0.292, 95% CI 0.131–0.652; p = 0.003; EPV = 17.5). A positive correlation was observed between NPLH and TRG score (Spearman r = 0.284; p = 0.0022), with significant differences between TRG 1 and TRG 3 subgroups (p = 0.0036). Conclusions. Pretreatment NPLH is an independent predictor of pCR to aMVAC in MIBC and is numerically superior to NLR and PLR (DeLong p = 0.079). Consisting exclusively of standard complete blood count parameters, NPLH is readily available and inexpensive. This single-center exploratory study is hypothesis-generating and requires prospective external validation before clinical implementation. Full article

The interindividual phenotypic heterogeneity in Alpha-1 Antitrypsin Deficiency (AATD), despite a shared genetic etiology (the Z-allele of SERPINA1), is explained by the interaction of dual pathogenic mechanisms (gain-of-function vs. loss-of-function), additional genetic modifiers, and environmental or metabolic factors. Building on recent evidence suggesting divergent disease trajectories, we investigated whether pulmonary and hepatic impairments represent coupled manifestations or independent clinical dimensions within a large European cohort. Methods: This international multicenter study utilized the European Alpha-1 Research Collaboration (EARCO) registry (n = 1217). Pulmonary and hepatic severities were quantified using concurrent 0.0–10.0 composite indices. Independence was evaluated via partial Spearman correlations, multivariable multinomial regression, and geometric mapping across a continuous phenotypic space. Results: Cross-domain correlations between respiratory metrics and liver stiffness were near zero (r = −0.03), demonstrating statistical independence. Phenotypic dominance classification isolated distinct profiles; the lung-dominant group exhibited a higher age (57.0 vs. 54.0 years; p < 0.001) and tobacco exposure, while the liver-dominant group registered a higher body mass index (25.8 vs. 24.4 kg/m²; p < 0.001). Multivariable models identified age (OR 1.03; 95% CI 1.02–1.05) and smoking as independent predictors of lung dominance, whereas body mass index was independently associated with liver dominance (OR 1.04; 95% CI 1.01–1.07). Geometric mapping revealed advanced disease clusters at orthogonal margins rather than forming a systemic continuum. Conclusions: Hepatic and pulmonary impairments in AATD operate as independent clinical dimensions modulated by distinct metabolic and environmental factors. Risk stratification must transition toward organ-specific prognostic models. Full article

Myopia is increasingly recognized as an inflammatory ocular disease. Vitamin D₃ is a potential modulator of the gut–eye axis, but its role in inflammation-induced myopia remains unclear. This study investigated whether vitamin D₃ supplementation attenuates myopia progression by regulating retinal inflammation, gut microbiota composition, and microbiota-derived metabolites in a TGF-β2–induced myopia model. Three-week-old Brown Norway rats received weekly periocular TGF-β2 injections with or without daily oral vitamin D₃, and myopia development was evaluated on days 1 and 21 by axial length and refractive error. Cecal contents were analyzed for α- and β-diversity and taxonomic differences, and day-21 serum underwent untargeted metabolomic profiling of microbiota-derived metabolites, including bile acids and imidazole derivatives; Spearman correlation linked microbial or metabolic alterations with myopia progression. TGF-β2 induced axial elongation, myopic refractive shifts, and upregulated retinal pro-inflammatory cytokines (p-NFκB, IL-1β, TNF-α), while vitamin D₃ supplementation markedly attenuated myopia progression and retinal inflammation. Cecal α-diversity did not differ among control, vitamin D₃, TGF-β2, and TGF-β2+vitamin D₃ groups, but vitamin D₃ significantly reshaped β-diversity and reduced the Firmicutes/Bacteroidota ratio. Distinct metabolite profiles were observed, with the vitamin D₃ group showing reduced hyodeoxycholic acid and elevated imidazole derivatives (imidazolepropionic and methylimidazoleacetic acids). Vitamin D₃ supplementation attenuated myopia progression by reducing retinal inflammation and concurrently reshaping the gut microbiome and its metabolites compared to the control and myopic groups. These results underscore the potential of vitamin D₃ to modulate the gut–retina axis as a nutritional approach for mitigating myopia development. Full article

Background: Artificial intelligence in medicine has largely relied on supervised training of disease-specific models, limiting scalability in conditions where labeled data are scarce. Large language models (LLMs), which encode broad medical knowledge through large-scale pretraining, offer an alternative paradigm in which structured physiological measurements can be interpreted directly without task-specific model training. Objective: To evaluate whether smartphone-derived ocular motor biomarkers can be translated into clinically meaningful probabilistic assessments of Huntington’s disease (HD) using general-purpose LLMs operating as inference engines. Methods: In this prospective proof-of-concept study, 26 participants (13 with genetically confirmed HD and 13 age-matched controls) completed a standardized ocular motor assessment using a custom smartphone application. Quantitative eye-movement metrics were validated against expert neurologist ratings. Structured physiological features were then provided to four general-purpose LLMs without task-specific training or diagnostic labels, and the models generated an AI-Assigned HD Probability Score (HAIPS). Discriminative performance and associations with clinical severity measures were evaluated. Results: Smartphone-derived ocular motor metrics showed strong agreement with clinician assessments (Spearman ρ = 0.76–0.95; all p < 0.001), confirming preservation of clinically meaningful physiological signals. LLM-derived HAIPS distinguished HD from controls with high accuracy (AUC 0.879–0.944), with no significant differences across models. Discrimination was statistically equivalent to a supervised logistic regression model trained on the same features. HAIPS correlated strongly with established measures of disease severity, including cognitive (MoCA, ρ = −0.86), functional (TFC, ρ = −0.74), and motor impairment (UHDRS, ρ = 0.85) (all p ≤ 0.003). Conclusions: Structured ocular motor biomarkers acquired using a consumer smartphone can be translated into clinically meaningful probabilistic assessments of HD by general-purpose LLMs without disease-specific model training. These findings support a framework in which physiologically grounded digital biomarkers are coupled with general-purpose inference models, potentially enabling scalable assessment in rare neurological diseases where labeled data are limited. Full article