Search Results (913)

Background: Parkinson’s disease (PD) is a progressive neurodegenerative disorder marked by both motor and non-motor symptoms. The home-based wearable sensor monitoring Parkinson’s KinetiGraph (PKG) evaluates clinical efficacy, caregiver satisfaction, and cost-effectiveness in the clinical management of Parkinson’s disease (PD) compared to prior usual standard care. Methods: We analyzed 50 patients with Parkinson’s disease, comparing baseline clinical outcomes, healthcare utilization, and caregiver burden without PKG to follow-up data after 12 months with PKG. We used IBM SPSS Statistics for the analysis. Statistical significance was set at p < 0.05 for hypothesis testing. We employed the Wilcoxon signed-rank test to evaluate differences between the two time points, while exploratory bivariate associations between caregiver burden (Zarit score) and various outcomes were examined using Spearman’s rank correlation. Results: Over a 12-month period following the implementation of PKG-guided care, significant improvements were observed in various clinical, functional, and economic areas for the patients. Key findings include the following: motor function improved, with UPDRS Part III scores showing a 20% median reduction (from 25 to 20); medication adjustments decreased by 40% (from 5 to 3); outpatient visits were reduced by 60% (from 5 to 2); hospital admissions decreased by 100% (from 1 to 0); caregiver burden, as measured using the Zarit caregiver burden score, declined by 37.5% (from 48 to 30); and total direct medical costs decreased by 17.9% (from AED 261,800 to AED 215,000). Conclusions: These findings indicate substantial reductions in healthcare utilization, costs, and caregiver burden following the integration of PKG monitoring into clinical practice. Full article

Background: Cardiometabolic risk is increasingly observed in young adults, particularly during university years, and is not limited to individuals with elevated body mass index. Emerging evidence highlights the presence of normal weight obesity—characterized by excess adiposity and unfavorable body composition despite normal BMI—which may confer early metabolic vulnerability. Dietary diversity is often promoted as a marker of dietary adequacy; however, its relationship with adiposity, body composition, and muscular health remains inconsistent, particularly in Latin American populations. Moreover, few studies have directly contrasted dietary diversity indicators with empirically derived dietary patterns in relation to cardiometabolic and functional outcomes. Objective: To examine the associations between dietary diversity, dietary patterns, and indicators of adiposity, muscular strength, and relative muscle mass in Ecuadorian university students. Methods: A cross-sectional study was conducted among 349 undergraduate students aged 18–26 years enrolled in health sciences programs in Ecuador. Dietary intake was assessed using a validated food frequency questionnaire. Dietary diversity was quantified using the Food and Agriculture Organization’s Individual Dietary Diversity Score, while dietary patterns were identified through principal component analysis followed by k-means clustering. Outcomes included excess body weight, relative muscle mass assessed by bioelectrical impedance analysis, and handgrip strength. Multivariable Poisson and linear regression models were fitted, adjusting for age, sex, academic program, physical activity level, and pre-existing conditions. Results: Despite their young age and low prevalence of diagnosed disease, approximately one-third of the participants exhibited markers of early cardiometabolic risk, including excess body weight and central adiposity. Higher dietary diversity was independently associated with a higher prevalence of excess body weight (adjusted prevalence ratio per one-unit increase in IDDS: 1.17; 95% CI: 1.06–1.30) and with greater relative muscle mass (adjusted β = 0.13; 95% CI: 0.05–0.22), whereas no association was observed with handgrip strength. In contrast, dietary patterns derived from multivariate analysis showed no significant associations with adiposity, muscular strength, or relative muscle mass after adjustment. Conclusions: In this young adult population, dietary diversity captured aspects of overall dietary exposure associated with both increased adiposity and greater lean mass, but not with muscular strength. Empirically derived dietary patterns demonstrated limited discriminatory capacity, likely reflecting dietary homogeneity within the cohort. These findings indicate that dietary diversity alone does not necessarily reflect diet quality and underscore the importance of interpreting diversity metrics alongside indicators of food quality, energy density, and body composition when evaluating early cardiometabolic risk in contemporary food environments. Full article

Background: Diabetes mellitus is known to affect the prognosis of critically ill patients; however, its impact on independence in activities of daily living (ADL) at hospital dis-charge remains unclear. This study aimed to investigate whether preexisting diabetes is associated with reduced ADL independence at hospital discharge among critically ill patients. Methods: In this prospective cohort study, 423 adult intensive care unit (ICU) patients who were admit-ted for ≥48 h were enrolled and categorized by the presence or absence of diabetes. Primary outcomes included time to achieve walking independence (unassisted walking over 50 m) and the Barthel Index at discharge. Secondary outcomes were handgrip strength, ICU length of stay, and highest ICU Mobility Scale (IMS) scores. Multivariable analyses adjusted for age, illness severity, and other confounders. Results: Among the 101 patients with diabetes, time to achieve walking independence at discharge was significantly longer compared to those without diabetes (p = 0.013). The diabetes group also had a lower Barthel Index (p = 0.020), longer ICU stays (p = 0.003), weaker handgrip strength (p = 0.041), and lower maximum IMS scores (p = 0.002). Multivariable analysis confirmed that diabetes was independently associated with reduced ADL independence and poorer physical function at discharge. Conclusions: Preexisting diabetes is an independent predictor of impaired ADL independence in critically ill patients. These findings highlight the importance of early and individualized rehabilitation strategies for patients with diabetes in the ICU. Full article

To address the problem of insufficient detection accuracy, high false negative rate of small targets, and large positioning errors of ships in complex marine environments and foggy conditions, an improved DBL-YOLO method based on YOLOv11 is proposed. This method customizes and optimizes modules according to the characteristics of foggy scenes—the C3k2-MDSC module is designed to efficiently extract and fuse multi-scale spatial features, and a dynamic weight allocation mechanism is adopted to balance the contributions of features at different scales in the foggy and blurred environment; a lightweight BiFPN structure is introduced to enhance the efficiency of cross-scale feature transmission and solve the problem of feature attenuation in foggy conditions; a novel fusion of the Deformable-LKA attention mechanism is innovated, which combines a large receptive field and spatial adaptive adjustment capabilities to focus on the key contour features of blurred ships in foggy conditions; an Inner-SIoU regression loss function is proposed, which optimizes the positioning accuracy of dense and small targets through an auxiliary bounding box dynamic scaling strategy. Experimental results show that in foggy scenes, the recall rate is increased by 3.4%, the F1 score is increased by 1%, and mAP@0.5 and mAP@0.5:0.95 are increased by 1.4% and 3.1%, respectively. The final average precision reaches 98.6%, demonstrating excellent detection accuracy and robustness. Full article

Background/Objectives: Physical activity (PA) has been associated with better inhibitory control (IC), which may support self-regulatory processes related to eating. However, whether regular PA is related to food-specific IC and its neural correlates remains insufficiently understood. This cross-sectional study aimed to examine the relationship between regular PA, behavioral performance, and neural correlates of IC, with a focus on high-reward food-related contexts. Methods: Sixty-one healthy right-handed young Chinese adults were classified into a regular physical activity group (RPG; n = 30, 24 males) or an inactive group (IAG; n = 31, 17 males) based on self-reported frequency and volume of PA. Stop-signal tasks performed during functional MRI under high-calorie food and neutral image conditions were used to assess IC. Stop-signal reaction time (SSRT) indexed IC performance. Neural correlates of IC were examined using whole-brain and region-of-interest analyses, with brain activation values derived from general linear models including age, sex, body mass index, depressive scores, and subjective appetite ratings as covariates. Given the relatively small sample size and unbalanced distribution of sex and body mass index, sensitivity analyses were performed by varying covariate adjustments to assess the robustness of the primary results. Results: RPG demonstrated significantly shorter SSRT than IAG across both high-calorie food and neutral stimulus conditions. In contrast to successful-stop trials relative to baseline, IAG showed lower activation in the bilateral precuneus than RPG under the high-calorie food condition. In comparison, RPG showed lower activation than IAG under the neutral condition. In contrast to failed-stop trials relative to successful-go trials, IAG exhibited greater activation in the left caudate than RPG under the high-calorie food condition. These behavioral and neural patterns were generally robust across sensitivity analyses. Conclusions: Regular PA was associated with superior general IC, and this advantage was maintained in the presence of high-calorie food cues. At the neural level, regular PA was associated with stimulus-dependent neural responses in the bilateral precuneus and left caudate. Future studies using larger, more representative samples, objective measures of PA, and stratification by sex or BMI are warranted. Full article

Background: Atrial Fibrillation (AF) is associated with a prothrombotic state and increased risk of ischemic stroke. Type 2 diabetes mellitus (T2DM) is a major cardiometabolic comorbidity in AF and independently increases thromboembolic risk. D-dimer is a well-established biomarker of coagulation activation and fibrin turnover, but the specific contribution of T2DM to D-dimer levels in AF remains insufficiently characterized in real-world cohorts. Methods: We conducted a retrospective, observational, single-center study including 300 adult patients with non-valvular AF evaluated at a tertiary university hospital. Patients were stratified according to the presence of T2DM (150 with T2DM and 150 without diabetes). Plasma D-dimer levels were compared between groups and analyzed across clinically relevant thresholds and CHA₂DS₂-VASc categories. Multivariable linear and logistic regression models were used to assess the independent association between T2DM and D-dimer levels after adjustment for demographic factors, comorbidities, renal function, prior stroke, CHA₂DS₂-VASc score components, and oral anticoagulation. Results: Patients with T2DM exhibited significantly higher D-dimer levels than non-diabetic patients (median 0.94 vs. 0.63 µg/mL FEU, p < 0.001). T2DM was independently associated with higher log-transformed D-dimer levels (adjusted β = 0.19, p < 0.001) and with increased odds of elevated D-dimer above both 0.5 µg/mL and 1.0 µg/mL thresholds. Across all CHA₂DS₂-VASc categories, patients with T2DM consistently showed higher D-dimer concentrations. Findings remained robust in sensitivity analyses restricted to anticoagulated patients. Conclusions: In patients with atrial fibrillation, type 2 diabetes mellitus is associated with increased coagulation activity as reflected by higher D-dimer levels, independent of clinical thromboembolic risk. These results support the concept of a diabetes-associated hypercoagulable AF phenotype and highlight the potential role of coagulation biomarkers in refining risk stratification. Full article

Background: Early risk stratification in ST-elevation myocardial infarction (STEMI) remains critical, particularly for anticipating adverse outcomes such as the coronary no-reflow phenomenon (NRP) and early mortality. The Endothelial Activation and Stress Index (EASIX), calculated from routine laboratory parameters, has emerged as a potential biomarker reflecting systemic endothelial dysfunction. This study evaluated the prognostic value of admission EASIX for the NRP and in-hospital mortality in STEMI patients undergoing primary percutaneous coronary intervention (pPCI). Methods: In this retrospective single-center cohort, 1931 STEMI patients treated with pPCI between January 2023 and January 2025 were included. EASIX was calculated at admission. NRP was defined as post-PCI TIMI flow ≤ 2 or TIMI 3 flow with impaired myocardial blush (TMPG ≤ 1). Multivariable logistic regression, reclassification analyses (NRI/IDI), ROC analysis, and calibration methods were used to assess predictive performance. Sensitivity and interaction analyses were conducted. Results: NRP occurred in 14.1%, and in-hospital mortality was 2.5%. EASIX was independently associated with both outcomes (NRP: adjusted OR 1.485, 95% CI 1.286–1.715; mortality: adjusted OR range 1.371–2.096 across models; all p < 0.001). EASIX significantly improved risk reclassification for both NRP and in-hospital mortality (NRI > 0.20). ROC-AUCs were 0.706 for NRP and 0.810 for mortality. Restricted cubic spline and LOWESS analyses revealed nonlinear risk escalation. Calibration plots and Brier scores confirmed model reliability. Associations persisted across ischemic time and renal function strata. Conclusions: Admission EASIX is independently associated with NRP and in-hospital mortality in STEMI. Easily accessible and integrative, EASIX may enhance early risk stratification. External validation is warranted before clinical implementation. Full article

Background: Traumatic brain injury (TBI) is a global healthcare problem, and post-traumatic amnesia (PTA) is a known predictor of long-term and societal outcomes. However, factors influencing PTA recovery during the inpatient rehabilitation phase remain underexplored, particularly in Asian populations. Objective: To identify factors associated with PTA duration and emergence during inpatient rehabilitation and examine their impact on functional outcomes. Materials and Methods: We conducted a retrospective, single-center cohort study over a 7-year period among patients with acute TBI who were admitted to an inpatient rehabilitation hospital. Outcomes included PTA emergence and duration, discharge Functional Independence Measure (FIM), rehabilitation length of stay, and Glasgow Outcome Scale (GOS) at ≥1 year. Results: A total of 100 patients were analyzed. In an adjusted Cox regression, age ≥ 55 years (Hazard Ratio [HR] 0.47) and non-infective medical complications during rehabilitation (HR 0.31) were associated with reduced likelihood of PTA emergence, while mild admission GCS (13–15; HR 4.80) and epidural hemorrhage (EDH) (HR 2.00) were associated with PTA emergence. PTA non-emergence was associated with approximately a 20-point lower discharge FIM total score (adjusted model, p < 0.001). A PTA duration of ≥90 days was associated with a lower total discharge FIM score by approximately 45 points compared with those with a PTA duration of <28 days (p < 0.001). PTA emergence was associated with better GOS at ≥1 year (odds ratio [OR] 3.92, p = 0.02). Conclusion: Both acute injury characteristics and intra-rehabilitation factors were associated with PTA recovery functional outcomes. PTA emergence, beyond PTA duration, was strongly associated with discharge functional status and long-term global outcome, supporting the clinical value of PTA in prognostication, rehabilitation planning, and goal setting. Full article

The development of Geospatial Artificial Intelligence (GeoAI), combining deep learning and remote sensing imagery, is of great interest for automated spatial inference and decision-making support. In this paper, a GeoAI-based efficient object detection framework named RS-YOLO is introduced by adopting the YOLOv11 architecture. The model integrates Dynamic Convolution for adaptive receptive field adjustment, Selective Kernel Attention for multi-path feature aggregation, and the MPDIoU loss function for geometry-aware localization. The proposed approach outperforms in experimental results on the TGRS-HRRSD dataset of 13 scenes from different geospatial scenarios, giving an 89.0% mAP and an 87 F1-score. Beyond algorithmic advancement, RS-YOLO provides a GeoAI-based analytical tool for applications such as urban infrastructure monitoring, land use management, and transportation facility recognition, enabling spatially informed and sustainable decision-making in complex remote sensing environments. Full article

Background: Sleep is a key determinant of recovery and performance in elite athletes, yet its optimization extends beyond sleep duration alone and encompasses multiple subjective and physiological dimensions. Environmental factors, including the sleep surface, represent modifiable components of sleep that may influence perceived sleep quality. This study aimed to examine whether an individually adjustable modular sleep system improves subjective sleep quality in elite athletes and whether alterations in objective sleep metrics, circadian timing, or nocturnal autonomic physiology accompany such changes. Methods: Forty-three elite athletes participated in this pre–post-intervention study (without a control group). Subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), while objective sleep and physiological parameters were recorded using a wearable device (Oura Ring, 3rd generation). Outcomes were averaged across three consecutive nights at baseline (T0) and post-intervention (T1). Baseline values were derived from the final three nights of a standardized pre-intervention monitoring period (minimum 7 nights), and post-intervention values from the final three nights following a standardized intervention exposure period (minimum 14 nights). Statistical analyses included paired frequentist tests and complementary Bayesian paired-sample analyses. Results: Subjective sleep quality improved significantly following the intervention, with a mean reduction in PSQI score of 0.67 points (p < 0.001). In contrast, no meaningful changes were observed in total sleep time (p = 0.28), REM duration (p = 0.26), circadian timing (p = 0.47), or nocturnal minimum heart rate (p = 0.42), as supported by the absence of physiological changes in these parameters. Conclusions: It seems that an individually adjustable sleep system can be able to improve perceived sleep quality in elite athletes without disrupting sleep architecture, circadian regulation, or nocturnal autonomic function. In athletes whose sleep duration and physiological sleep metrics are already near optimal, such micro-environmental interventions may offer a feasible, low-risk means of enhancing recovery by targeting subjective sleep quality. This dimension dissociates from objective sleep measures. Optimizing the sleep surface may therefore represent a practical adjunct to existing recovery strategies in high-performance sport. Full article

Background: Chronic pain is a serious health issue associated with significant functional and emotional impairment. Chronic pain acceptance, which can be described as engaging in valued activities despite ongoing pain, is associated with better psychological adjustment and quality of life. This study aimed to translate the Eight-Item Chronic Pain Acceptance Questionnaire (CPAQ-8) into Croatian and investigate its reliability and validity. Methods: A total of 229 outpatients with chronic musculoskeletal pain completed the Croatian version of the CPAQ-8, as well as the SF-36 Health Status Questionnaire (SF-36), the Hospital Anxiety and Depression Scale (HADS), the Pain Catastrophizing Scale (PSC), and the Numeric Pain Rating Scale (NRS). Results: The Croatian version of the CPAQ-8 demonstrated good internal consistency for the total score and its subscales, and the exploratory factor analysis revealed the original two-factor structure. Concurrent validity was supported through theoretically consistent correlations with psychological distress, quality of life, and pain-related constructs. Conclusion: The Croatian version of the CPAQ-8 is a reliable and valid instrument for assessing pain acceptance in patients with chronic musculoskeletal pain and can be confidently used in both clinical practice and research settings. Full article

Background: The relationship between comorbidity burden, as measured by the American Society of Anesthesiologists (ASA) classification, and functional recovery after total hip replacement (THR) remains uncertain. This study aimed to clarify whether ASA grade independently predicts postoperative patient-reported outcomes. Methods: We conducted a retrospective analysis of 218 consecutive patients from a prospectively maintained institutional registry who underwent primary unilateral THR between March 2021 and March 2024 in a single center. Patients were stratified into ASA 1–2 and ASA 3 groups. The Oxford Hip Score (OHS, 0–48) was collected preoperatively and at 1 week, 3 months, and 6 months postoperatively. Between-group differences were assessed, and multivariable linear regression was used to identify predictors of 6-month OHS. Results: Compared with ASA 1–2 patients, ASA 3 patients had lower preoperative OHS and longer hospital stay, but both groups showed substantial improvement over time and achieved excellent mean OHS at 6 months. In the adjusted model, higher ASA grade remained an independent negative predictor of 6-month OHS, whereas higher preoperative OHS and BMI were positive predictors. Conclusions: Despite presenting with worse baseline function and requiring longer hospitalization, ASA 3 patients experienced clinically meaningful recovery and achieved favorable 6-month outcomes after THR. Higher ASA status should therefore inform perioperative optimization rather than preclude surgery. Full article

Background: Irritable Bowel Syndrome (IBS) is a heterogeneous gastrointestinal disorder characterized by complex brain–gut interactions. Patient Similarity Networks (PSNs) offer a novel approach for exploring this heterogeneity and identifying clinically relevant patient subgroups. Methods: We analyzed data from 78 participants (49 IBS patients and 29 healthy controls) with 36 brain morphometric measures (FreeSurfer v7.4.1) and 6 measures of cognitive functions (5 RBANS domain indices plus a Total Scale score). PSNs were constructed using multiple similarity measures (Euclidean, cosine, correlation-based) with Gaussian kernel transformation. We performed community detection (Louvain algorithm), centrality analyses, feature importance analysis, and correlations with symptom severity. Statistical validation included bootstrap confidence intervals and permutation testing. Results: The PSN comprised 78 nodes connected by 469 edges, with four communities detected. These communities did not significantly correspond to diagnostic groups (Adjusted Rand Index = 0.011, permutation $p=0.212$), indicating IBS patients and healthy controls were intermixed. However, each community exhibited distinct neurobiological profiles: Community 1 (oldest, preserved cognition) showed elevated intracranial volume but reduced subcortical gray matter; Community 2 (youngest, most severe IBS symptoms) had elevated cortical volumes but reduced white matter; Community 3 (most balanced IBS/HC ratio, mildest IBS symptoms) showed the largest subcortical volumes; Community 4 (lowest cognitive performance across multiple domains) displayed the lowest RBANS scores alongside high IBS prevalence. Top network features included subcortical structures, corpus callosum, and cognitive indices (Language, Attention). Conclusions: PSN identifies brain–cognition communities that cut across diagnostic categories, with distinct feature profiles suggesting different hypothesis-generating neurobiological patterns within IBS that may inform personalized treatment strategies. Full article

Background: Probable sarcopenia, indicated by low handgrip strength, is a prevalent condition among hospitalized older adults and may reflect broader functional and nutritional decline. Methods: We examined differences in nutritional, functional, and cognitive status between Alzheimer’s clinical syndrome (ACS) patients with probable sarcopenia and those without sarcopenia. A cross-sectional analysis was conducted on 194 hospitalized older adults with ACS. Probable sarcopenia was defined using European Working Group on Sarcopenia in Older People (EWGSOP2) handgrip strength thresholds. Results: Patients with probable sarcopenia (n = 137) had significantly lower Mini-Mental State Examination (MMSE) scores, Geriatric Nutritional Risk Index (GNRI), albumin, hemoglobin, and gait speed compared to those without. After age and sex adjustment, MMSE (p = 0.023), GNRI (p = 0.002), hemoglobin (p = 0.022), albumin (p = 0.003), and gait speed (p < 0.001) remained significantly different. In the sex- and age-adjusted multivariable model (adjusted R² = 0.442), higher nutritional risk (β = 0.26, p = < 0.001), lower MMSE scores (β = 0.17, p = 0.029), polypharmacy (β = −4.20, p = 0.002), and slower gait speed (β = 4.12, p = 0.010) were associated with reduced handgrip strength. In the multivariable binary logistic regression model (adjusted for age and sex), moderate or high nutritional risk and slow gait speed emerged as independent predictors of probable sarcopenia, with OR 5.14 (95% CI 1.34–19.75; p = 0.017) and OR 3.13 (95% CI 1.30–7.52; p = 0.011), respectively. Conclusions: Probable sarcopenia in hospitalized older adults with ACS is highly prevalent and is associated with higher nutritional risk, poorer cognitive and physical function, and polypharmacy; its early recognition may help to guide more targeted nutritional and functional interventions. Full article

Underwater images often suffer from luminance attenuation, structural degradation, and color distortion due to light absorption and scattering in water. The variations in illumination and color distribution across different water bodies further increase the uncertainty of these degradations, making traditional enhancement methods that rely on fixed parameters, such as underwater dark channel prior (UDCP) and histogram equalization (HE), unstable in such scenarios. To address these challenges, this paper proposes a multi-operator underwater image enhancement framework with adaptive parameter optimization. To achieve luminance compensation, structural detail enhancement, and color restoration, a collaborative enhancement pipeline was constructed using contrast-limited adaptive histogram equalization (CLAHE) with highlight protection, texture-gated and threshold-constrained unsharp masking (USM), and mild saturation compensation. Building upon this pipeline, an adaptive multi-operator parameter optimization strategy was developed, where a unified scoring function jointly considers feature gains, geometric consistency of feature matches, image quality metrics, and latency constraints to dynamically adjust the CLAHE clip limit, USM gain, and Gaussian scale under varying water conditions. Subjective visual comparisons and quantitative experiments were conducted on several public underwater datasets. Compared with conventional enhancement methods, the proposed approach achieved superior structural clarity and natural color appearance on the EUVP and UIEB datasets, and obtained higher quality metrics on the RUIE dataset (Average Gradient (AG) = 0.5922, Underwater Image Quality Measure (UIQM) = 2.095). On the UVE38K dataset, the proposed adaptive optimization method improved the oriented FAST and rotated BRIEF (ORB) feature counts by 12.5%, inlier matches by 9.3%, and UIQM by 3.9% over the fixed-parameter baseline, while the adjacent-frame matching visualization and stability metrics such as inlier ratio further verified the geometric consistency and temporal stability of the enhanced features. Full article