Search Results (2,117)

Objective: Heart failure (HF) remains a major global health challenge. We evaluated ten-year trends in clinical profiles, diagnostic/therapeutic management, and outcomes in patients hospitalized for de novo acute heart failure (AHF). Methods: We compared two multicenter cohorts of patients admitted to Internal Medicine departments in Spain for a first episode of HF (excluding acutely decompensated chronic HF): a retrospective cohort (CH-2005; n = 600) and a prospective cohort (CH-2015; n = 180). We assessed clinical characteristics, adherence to guideline-recommended diagnostic testing, discharge treatment, and 12-month outcomes (HF readmissions and all-cause mortality). Results: The patients in CH-2015 showed a markedly higher comorbidity burden (Charlson Comorbidity Index > 2: 90.0% vs. 12.8%, p < 0.001) and higher chronic kidney disease prevalence (17.8% vs. 11.8%, p = 0.01), while mean age was similar (75.0 vs. 73.6 years, p = 0.16). Diagnostic adherence improved with higher echocardiography use (92.2% vs. 66.5%, p < 0.001). Discharge beta-blocker prescriptions increased (50.6% vs. 31.3%, p < 0.001). HF readmissions were higher in CH-2015 at 1 month (35.6% vs. 7.3%, p < 0.001) and 12 months (49.4% vs. 21.2%, p < 0.001). One-year mortality was higher in CH-2015 (22.5% vs. 16.3%, p = 0.07). In the multivariable analyses, the between-cohort difference in mortality was not significant, whereas the higher readmission risk in CH-2015 persisted. Conclusions: Over a decade, de novo AHF admissions shifted toward a more complex, multimorbid phenotype. Despite improved diagnostic testing and small advances in evidence-based therapy, the readmission burden increased, highlighting the need for integrated, post-discharge management strategies in older multimorbid populations. Full article

Background: Parkinson’s disease (PD) is characterized by motor disturbances that significantly impact balance, gait, and quality of life. Personalized Rhythmic Auditory Stimulation (pRAS) is an emerging rehabilitative approach that utilizes auditory entrainment to improve step and gait control. The aim of this systematic review is to critically summarize the data from the most recent evidence concerning the use of pRAS in gait rehabilitation for patients with Parkinson’s disease. Methods: A systematic review was conducted following PRISMA guidelines, including records that evaluated music-based or technological interventions based on personalized RAS. Primary outcomes included spatiotemporal gait parameters and distance covered. Results: Ten studies were included in the analysis. All the studies reported clinically relevant improvements: increases in gait speed, step length, and amplitude. Moreover, a reduction in freezing of gait episodes (up to 36%), greater walking distance, and good adherence were reported. Conclusions: Personalized, adaptive, or on-demand solutions proved more effective than traditional forms of cueing. Moreover, the available evidence suggests that pRAS constitutes an effective and safe rehabilitative option for gait disturbances in PD. However, further studies with larger sample sizes and prolonged follow-up periods are necessary to evaluate its long-term impact and transferability into clinical practice. Full article

Background/Objectives: Intraductal papillary mucinous neoplasms (IPMN) are the most common pancreatic cystic lesions and are established precancerous entities. Side-branch IPMN (SB-IPMN) is the most prevalent subtype and generally carries a low risk of malignant transformation. The revised 2024 Kyoto guidelines define management and surveillance strategies based on high-risk stigmata and worrisome features; however, real-life adherence to these recommendations remains variable. To compare real-world management of SB-IPMN at a tertiary medical center with Kyoto guideline-based recommendations using an AIgo-based decision-support tool. Methods: SB-IPMN cases were retrospectively analyzed. An algorithm implementing the Kyoto guidelines was used to generate recommended management strategies based on imaging, clinical, and laboratory data, and these recommendations were compared with actual clinical decisions. Long-term clinical and radiological follow-up data were collected, including development of pancreatic ductal adenocarcinoma (PDAC). Results: A total of 368 patients (69% male; median age 69.5 years) were followed for a median of 48.5 months radiologically and 64 months clinically. Median cyst size at presentation was 10 (6–14) mm. Only 58 patients (15.8%) were managed in accordance with the Kyoto guidelines; most underwent more intensive surveillance (60.3%), while 23.9% received less intensive monitoring (p = 0.04). Larger cyst size (>2 cm) was associated with higher concordance with current guidelines. Younger patients, including all patients under 50 years of age, were more frequently over-surveilled. Over-surveillance resulted in an excess of 0.42 MRI/MRCP examinations per patient-year. Only one PDAC case occurred, arising after more than five years of cyst stability. Conclusions: Fewer than 20% of patients with SB-IPMN were managed according to Kyoto guidelines. Over-surveillance was common, particularly in younger patients, without apparent oncologic benefit. AIgo-based decision-support tools may help standardize care and optimize resource utilization. Full article

Analysis of game management and trophy game populations in Osijek-Baranja County shows that this region is one of the most valuable hunting areas in Croatia, with rich populations of red deer, roe deer, and wild boar, as well as stable annual population growth. The methodological framework included products and services in hunting based on data analysis from the Croatian Hunting Association, big-game trophy records (ETD forms), the Central Hunting Register, and the official price list of game culling and hunting services. Data on harvests and trophy values indicate long-term population stability and high economic potential of hunting, with red deer generating the highest total revenue (EUR 7.29 million), while roe deer and wild boar contribute to overall stability and harvest volume. The total trophy value over 12 hunting seasons reaches EUR 11.99 million, underscoring the economic importance of hunting tourism for local communities. Differences among hunting ground users suggest that private companies and the state company Croatian Forests Ltd. often achieve higher trophy values, while county hunting associations report more modest results. However, regression analysis shows there is not a strong statistical correlation between management structure and trophy outcomes, highlighting the significant influence of ecological and spatial factors on game quality. International hunters, primarily from Germany and Austria, represent a key segment of demand, confirming the market potential for further development of hunting tourism. Despite the rich natural base, results indicate the need for better marketing approach, digital visibility, and integration of hunting products with other forms of tourism, such as gastronomic, wine, and nature tourism. Effective positioning of Croatia as a competitive hunting destination requires adaptation to contemporary market trends and adherence to international sustainable management guidelines (FAO, ELC, CBD). In conclusion, hunting in Croatia represents an important non-wood forest product and a vital resource for rural and economic development. Sustainable population management, quality promotion, and integration of traditional and innovative practices are essential for reinforcing biodiversity conservation, supporting community livelihoods, and strengthening Croatia’s role in the European and global hunting-tourism market. Full article

Background/Objectives: Safe delivery and correct identification of newborns are critical aspects of healthcare systems globally. The accreditation of healthcare and standards regulation significantly promotes the adoption of modern technologies to address risks related to infant abduction and misidentification. The effectiveness and extent of these mandates vary across settings and countries. Therefore, this study aims to map and explore modern technologies used for safe newborn delivery and correct identification aligned with healthcare accreditation and regulatory frameworks. Methods: This review adheres to the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for scoping reviews (PRISMA-ScR) guidelines. The Problem, Intervention, Comparison, and Outcome (PICO) framework was employed to facilitate the development of the research question. This study examined studies reporting technologies such as radio frequency identification (RFID), biometric identification, and real-time monitoring across healthcare settings for infant protection through the Normalization Process Theory (NPT). Among three databases and search engines (PubMed, Google Scholar, and Web of Science). The risk of bias for each study was assessed using the AACODS Checklist, SQUIRE 2.0 Checklist, TIDieR Checklist, and JBI tools. Results: Out of 8753 records, only 27 reports were eligible to be included in this review. The most frequently reported technologies were RFID systems (11 studies, 37.9%) and biometric systems such as footprint and facial recognition (6 studies, 20.7%). Despite strong technological potential, many healthcare institutions struggled with the adoption of infant protection technologies. Accreditation systems among the high-resource settings actively mandate advanced technologies and support the integration of staff training and simulation drills. Comparably, middle- and low-income regions usually face challenges related to regulatory enforcement, infrastructure, staff readiness, and limited adoption of modern technologies. Conclusions: Accreditation and standards development are critical catalysts for the adoption of modern infant protection technology. Standards must be comprehensible, adaptable, and supported by investment in human resources and infrastructure. Future regulation must focus on strengthening enforcement, continuous quality improvement, and capacity building to achieve sustainable protection across the world. Full article

Background: Radiomics has emerged as a promising approach to non-invasively characterize the molecular landscape of gliomas, providing quantitative, high-dimensional data derived from routine MRI. Given the recent shift toward molecularly driven classification, radiomics may support precision oncology by predicting key genomic, epigenetic, and phenotypic alterations without the need for invasive tissue sampling. This systematic review aimed to synthesize current radiomics applications for the non-invasive prediction of molecular biomarkers in gliomas, evaluating methodological trends, performance metrics, and translational readiness. Methods: This review followed the PRISMA 2020 guidelines. A systematic search was conducted in PubMed, Ovid MEDLINE, and Scopus on 10 January 2025, and updated on 1 February 2025, using predefined MeSH terms and keywords related to glioma, radiomics, machine learning, deep learning, and molecular biomarkers. Eligible studies included original research using MRI-based radiomics to predict molecular alterations in human gliomas, with reported performance metrics. Data extraction covered study design, cohort size, MRI sequences, segmentation approaches, feature extraction software, computational methods, biomarkers assessed, and diagnostic performance. Methodological quality was evaluated using the Radiomics Quality Score (RQS), Image Biomarker Standardization Initiative (IBSI) criteria, and Newcastle–Ottawa Scale (NOS). Due to heterogeneity, no meta-analysis was performed. Results: Of 744 screened records, 70 studies met the inclusion criteria. A total of 10,324 patients were included across all studies (mean 140 patients/study, range 23–628). The most frequently employed MRI sequences were T2-weighted (59 studies, 84.3%), contrast-enhanced T1WI (53 studies, 75.7%), T1WI (50 studies, 71.4%), and FLAIR (48 studies, 68.6%); diffusion-weighted imaging was used in only 7 studies (12.8%). Manual segmentation predominated (52 studies, 74.3%), whereas automated approaches were used in 13 studies (18.6%). Common feature extraction platforms included 3D Slicer (20 studies, 28.6%) and MATLAB-based tools (17 studies, 24.3%). Machine learning methods were applied in 47 studies (67.1%), with support vector machines used in 29 studies (41.4%); deep learning models were implemented in 27 studies (38.6%), primarily convolutional neural networks (20 studies, 28.6%). IDH mutation was the most frequently predicted biomarker (49 studies, 70%), followed by ATRX (27 studies, 38.6%), MGMT methylation (8 studies, 11,4%), and 1p/19q codeletion (7 studies, 10%). Reported AUC values ranged from 0.80 to 0.99 for IDH, approximately 0.71–0.953 for 1p/19q, 0.72–0.93 for MGMT, and 0.76–0.97 for ATRX, with deep learning or hybrid pipelines generally achieving the highest performance. RQS values highlighted substantial methodological variability, and IBSI adherence was inconsistent. NOS scores indicated high-quality methodology in a limited subset of studies. Conclusions: Radiomics demonstrates strong potential for the non-invasive prediction of key glioma molecular biomarkers, achieving high diagnostic performance across diverse computational approaches. However, widespread clinical translation remains hindered by heterogeneous imaging protocols, limited standardization, insufficient external validation, and variable methodological rigor. Full article

With the electrification of automotive powertrains, aerodynamic noise has emerged as the primary factor affecting vehicle comfort. This systematic review, adhering to PRISMA 2020 guidelines, bridges the gap between biological fluid mechanics and automotive engineering by synthesizing recent advances in aerodynamic mechanisms and bionic control strategies. Based on a comprehensive search of Web of Science, ScienceDirect, SAE Mobilus, and Google Scholar for the literature published between 2016 and 2025, 90 eligible studies were analyzed to provide a rigorous evidence-based synthesis. The review details complex flow phenomena, such as turbulent separation and vortex shedding across key regions like A-pillars and mirrors, drawing parallels to bio-inspired fluid–structure interactions. Numerical prediction methods, including large eddy simulation (LES), detached eddy simulation (DES), and lattice boltzmann method (LBM), are critically examined for their efficacy in resolving both conventional and bionic flow structures. A significant focus is placed on bio-inspired mitigation technologies, where quantitative findings demonstrate substantial noise suppression: specifically, the reviewed data shows that bionic riblet surfaces on tires can reduce noise levels by up to 5.18 dB, while beetle-head-inspired protuberances on exterior mirrors can achieve reductions of up to 10 dB. Finally, this work suggests future research directions in integrated fluid–acoustic–structural simulation frameworks and self-adaptive bionic systems, providing a robust reference for developing high-performance, low-noise vehicles inspired by natural organisms. Full article

Background: Thyroid hormones regulate energy homeostasis, lipid/glucose metabolism, and protein turnover. Chronic Hepatitis C Virus (HCV) infection is highly associated with autoimmune hypothyroidism, which may have profound metabolic implications. This study evaluates thyroid dysfunction and anti-thyroid peroxidase (anti-TPO) autoimmunity in HCV patients and explores its potential metabolic implications in a high-prevalence region. Methods: In this comparative cross-sectional study adhering to STROBE guidelines, we enrolled 100 PCR-confirmed chronic HCV patients and 100 age/gender-matched controls from District Peshawar, Pakistan. Serum TSH, fT3, fT4, and anti-TPO antibodies were quantified. Multivariable logistic regression, adjusted for age, gender, and viral load, was used to compute adjusted odds ratios (aOR) with 95% confidence intervals (CI). Results: Thyroid dysfunction affected 41% of HCV patients vs. 12% of controls (aOR 5.2, 95% CI 2.8–9.6, p < 0.001), predominantly hypothyroidism (29% overall; 18% overt, 11% subclinical). Anti-TPO positivity was 38% in HCV vs. 8% in controls (aOR 6.7, 95% CI 3.1–14.5, p < 0.001). Anti-TPO titers correlated positively with TSH (r = +0.62, p < 0.001) and inversely with fT3/fT4. Subgroup analysis showed higher dysfunction in patients aged ≥40 years (52% vs. 28%, p = 0.012) and viral load ≥ 10⁶ IU/mL (48% vs. 32%, p = 0.041). We hypothesize that these findings may have significant metabolic implications, including impaired mitochondrial β-oxidation and insulin resistance. Conclusions: HCV infection is strongly associated with autoimmune hypothyroidism, which may amplify cardiometabolic risk. The paper has not explicitly identified metabolic parameters, including lipid profiles, indices of insulin resistance, and metabolomic signatures, and, therefore, any metabolic inferences are speculative and based on established thyroid and HCV pathophysiology. Routine thyroid screening pre- and post-DAA therapy is recommended, alongside metabolomic profiling to validate these proposed metabolic pathways. Full article

Background: Management of pediatric anaphylaxis in the emergency department remains clinically important. The research investigated pediatric anaphylaxis medical indicators together with physician adherence to international treatment protocols at a Turkish tertiary medical center. Methods: Between September 2014 and July 2025, 166 pediatric anaphylaxis patients were retrospectively reviewed for triggering factors, clinical findings, treatment approaches, and quality indicators. Results: The mean age of the patients was 7.4 ± 5.6 years. Food allergy was the main cause with 53%, followed by drugs with 24.7%. Food allergy in infants was 85.7%, while drug reactions in adolescents reached 37.2% (p < 0.001). Skin findings were present in 93.4% of the patients, and respiratory symptoms were present in 67.5% of the patients. Epinephrine was administered to 97.6% of patients, 95.2% of whom were given intramuscularly. The rate of epinephrine administration in the first 30 min was 61.1%. Drug-induced anaphylaxis showed the highest proportion of severe cases (81.6%, p < 0.001). A biphasic reaction was seen in 6%. The auto-injector prescription rate was 7.8%, and the allergist referral rate was 15.7%. No deaths were observed. Conclusions: While acute-phase management largely adheres to international guidelines, significant gaps persist in post-discharge care with low auto-injector prescription and allergist referral rates. Full article

Background/Objectives: Cystic fibrosis (CF) is a genetic condition with an increasing life expectancy in recent years. As a result, addressing psychosocial aspects in this population has become an increasingly important concern. This mixed-methods systematic review aimed to update the current knowledge on the psychosocial aspects of living with CF in adults. Methods: Following PRISMA guidelines, a literature search was conducted in November 2024 across several databases, including Scopus, ScienceDirect, Academic Search Complete, MEDLINE, Supplemental Index, Complementary Index, APA PsycInfo, Business Source Complete, SciELO, and the Directory of Open Access Journals via EBSCO. Results: Of the 701 articles retrieved, 24 were analyzed, including a total of 2023 participants (mean age: 31.2 years; 57.2% female). Quantitative findings identified optimistic coping as the most frequent strategy associated with improved survival. High social support and gratitude emerged as key factors for treatment adherence and quality of life, while depression remained the primary mental health concern. Qualitatively, the findings highlighted concerns with adult life transitions and financial stressors. Participants described experiences of social stigma and embarrassment linked to chronic symptoms, often leading to selective disclosure to avoid discrimination. Conclusions: This review confirms that psychosocial factors are central to the adult CF experience, shifting the focus beyond biological survival and highlighting areas that require clinical intervention. As life expectancy increases, clinical care must evolve to incorporate interventions that address these factors to improve mental health and overall quality of life (QoL), ensuring that patients are supported through the unique challenges of extended adulthood. Full article

Objectives: This study aimed to assess the prevalence and patterns of GLP-1 receptor agonist (GLP-1 RA) use for weight loss and to identify factors associated with their use among overweight and obese adults in the Eastern Province of Saudi Arabia. Methods: A cross-sectional study was conducted among overweight and obese adults aged 18 years and older residing in the Eastern Province. Data were collected in December 2024 using an online, self-administered questionnaire. Descriptive statistics were used to assess the prevalence of GLP-1 RA use, while chi-square tests and logistic regression analyses were performed to examine associations between GLP-1 RA use and relevant independent variables. Results: A total of 1264 participants were included. The lifetime prevalence of GLP-1 RA use was 18.2%, with 14.2% reporting current use. Injectable semaglutide (Ozempic) was the most commonly used medication (73.9%). Most individuals reported initiating treatment based on a doctor’s recommendation (70.4%), although 36.5% began use based on personal decision. Multivariable logistic regression identified several factors significantly associated with GLP-1 RA use, including obesity status, diabetes, prior weight-loss attempts, having family members or friends who use GLP-1 RAs, and studying or working in a health-related field. Conclusions: GLP-1 RA use is substantial among overweight and obese adults in the Eastern Province. In addition to medical conditions, social influences and involvement in health-related fields appear to shape use. These findings emphasize the need for awareness initiatives promoting appropriate GLP-1 RA use and stricter adherence to prescription guidelines. Full article

Amblyopia affects 1–4% of the population and remains a leading cause of unilateral visual impairment, with adherence and residual deficits limiting outcomes of standard therapies. This systematic review and meta-analysis compared the effectiveness of conventional and emerging amblyopia treatments in children, adolescents, and adults with anisometropic, strabismic, or mixed amblyopia. Following PRISMA guidelines and PROSPERO registration (CRD420251123552), PubMed, Web of Science, and Scopus were searched up to 5 August 2025 for randomized controlled trials. Sixty-six trials (sample sizes 7–404) were included, with thirty-six contributing to the meta-analysis. Primary outcomes were best-corrected visual acuity (logMAR) and stereopsis. Risk of bias was assessed using the Cochrane tool, and certainty of evidence was assessed using GRADE. Atropine penalization and occlusion demonstrated equivalent effects on visual acuity (mean difference 0.04 logMAR; 95% CI −0.04 to 0.12; moderate-certainty evidence). Digital, dichoptic, binocular, and virtual reality therapies showed a statistically significant but small improvement over patching (mean difference 0.02 logMAR; 95% CI 0.00–0.04; low-certainty evidence). Pharmacological adjuvants combined with patching yielded slightly larger gains (mean difference 0.08 logMAR; 95% CI 0.03–0.13; low-to-moderate certainty). No consistent benefit was observed for stereopsis outcomes. Overall, the certainty of evidence ranged from low to moderate, and most pooled effects were below commonly accepted thresholds for clinically meaningful visual acuity improvement (≈0.1 logMAR, one line). Atropine and occlusion remain equivalent first-line treatments, while adjunctive and multimodal approaches may offer limited additional benefit in selected patients when adherence, tolerability, and engagement are prioritized. Full article

As China’s urban underground area grows, deep foundation pit projects in complex geological circumstances, particularly near critical infrastructure, must adhere to tight deformation control guidelines. However, limited research has been conducted on the deformation behavior of internal bracing systems in Sichuan’s sandy cobble strata. This research centers on a deep excavation near civil defense facilities in Pujiang County, Chengdu. We investigated the deformation characteristics of retaining piles and internal bracing systems using field monitoring, finite element simulations, and parameter sensitivity analysis, and proposed optimization solutions for the support scheme. Road settlement, pile-head vertical displacement, building settlement, and deep lateral displacement of retaining piles were all monitored in the field at different phases of excavation. MIDAS/GTS was used to generate a 3D finite element model that included bored piles as a contiguous pile wall. The model was verified against monitored data and showed a maximum variation of 3.7%. Parametric studies were conducted to optimize the equivalent stiffness of the contiguous pile wall and the standardized internal bracing system. The findings indicate that the maximum lateral displacement of retaining piles is the primary optimization restriction. Reducing the equivalent stiffness to 0.6t (relative to the baseline thickness t) causes displacement to surpass the warning threshold (35 mm), whereas increasing it to 1.2t or 1.4t limits deformation without incurring significant costs. Case G of the standardized internal bracing system ensures that the maximum pile displacement (21.95 mm) remains below the warning criterion (24.5 mm) while improving constructability. This work elucidates the deformation characteristics of internal bracing systems in sandy cobble strata near sensitive buildings, offering theoretical and practical assistance for comparable projects. Full article

Background/Objectives: Self-care is a cornerstone of healthy aging and chronic disease management; however, evidence on the most effective intervention models for improving quality of life in older adults with chronic non-communicable diseases (NCDs) remains fragmented. This review aimed to evaluate the effectiveness of self-care interventions in promoting quality of life and health outcomes in older adults with NCDs. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD420251040613). Randomized and non-randomized clinical trials published between 2019 and 2024 were retrieved from Scopus, Web of Science, and EBSCOhost. Eligible studies included adults aged ≥60 years with NCDs receiving self-care interventions. Data extraction and risk of bias assessment were independently performed using Joanna Briggs Institute tools. Results: Twenty-nine studies involving 7241 older adults were included. Self-care interventions comprised nurse-led educational programs, digital health strategies, community- and peer-based approaches, and person-centered care models. Multicomponent and continuous interventions demonstrated consistent improvements in physical and psychological domains of quality of life, self-efficacy, autonomy, symptom management, and treatment adherence. Digital interventions enhanced monitoring and engagement, although their effectiveness varied according to sensory and health literacy limitations. Conclusions: Structured, person-centered, and nurse-led self-care interventions are effective in improving quality of life and autonomy among older adults with NCDs. These findings support their integration into primary and community-based care, reinforcing their relevance for clinical practice, care planning, and the development of assistive and educational strategies in aging care. Full article

Objectives: This study aimed to evaluate adherence to therapy in hypoparathyroidism and related endocrine–metabolic disorders and to assess its association with biochemical outcomes, hypocalcemia episodes, and health-related quality of life (HRQoL). Methods: In accordance with PRISMA 2020 guidelines, PubMed, Scopus, Google Scholar, and the Cochrane Library were searched until September 2025. The eligible studies were randomized controlled trials, cohort, case–control studies, cross-sectional, and observational studies that reported adherence to calcium/vitamin D or recombinant parathyroid hormone therapy. Results: twenty-three studies were included in the qualitative synthesis, and 11 studies were included in the quantitative meta-analysis. Pooled medication adherence compliance was 70–82% and improved with simplified regimens and the use of recombinant PTH. Additionally, this was also associated with an improvement in HRQoL (p < 0.0001) and a lower risk of hypocalcemia (p < 0.0001). Conversely, multifactorial regulation was observed as the level of adherence had no significant effect on serum calcium levels (p = 0.7116). Sensitivity analyses demonstrate the strength of findings and indicate no significant publication bias. Conclusions: Medication adherence is a key factor in determining patient-centered outcomes in hypoparathyroidism. Better adherence is linked to a higher quality of life and fewer episodes of hypocalcemia, while its effect on biochemical parameters seems minimal. Educational programs, simple treatment regimens, and wider access to rhPTH therapy can be used to improve patient management of the disease over time. Full article