Search Results (6,042)

Background: The rapid aging of China’s population poses significant challenges, particularly in public health and medical services. Frailty, a reversible geriatric syndrome, is a critical intervention target for disability prevention among older adults. Objective: We hypothesize that both intervention groups will demonstrate significant improvements in Short Physical Performance Battery (SPPB) scores compared to the control group, and that these improvements will be accompanied by parallel reductions in inflammatory markers and beneficial alterations in the gut microbiota. Methods: The MultIfaceted NUtrition inTervention for frail Elderly (MINUTE) trial is a randomized, parallel-group controlled trial. In Beijing, China, 315 frail older adults were recruited and randomly assigned to 3 groups: a control group receiving routine community health management only, multifaceted nutrition intervention group, and a multifaceted nutrition and exercise combined intervention group, each comprising 105 participants. The study consists of a three-month intervention period followed by a nine-month follow-up. During the three-month intervention period, the control group receives routine community health management, while the multifaceted nutrition intervention group receives daily dietary guidance, personalized nutrition consultations, and health education. Additionally, the combined intervention group receives exercise interventions in addition to the nutritional components. After the three-month intervention, all three groups will be followed up for nine months to assess the sustainability of the study. Results: The primary outcomes are the changes in the SPPB scores. The secondary outcomes include frailty scores, intrinsic capacity, malnutrition risk, frailty recovery rates, serum differential metabolites, inflammatory factors, and gut microbiota changes. This study aims to establish a scalable and sustainable pathway for frailty prevention among community-dwelling older adults in China and provide valuable insights to inform strategies for healthy aging. Trial registration: This study is conducted in accordance with the Declaration of Helsinki and approved by the Peking University Institutional Review Board (IRB00001052-23178), with all amendments subject to prior review and approval. Informed consent is obtained from participants, and findings will be disseminated through peer-reviewed publications, conference presentations, and summaries for school staff and participants. ClinicalTrials.gov (NCT06547593) registered 30 July 2024. Full article

Background: Vitamin D deficiency (VDD) is highly prevalent in pediatric critically ill patients and is a potentially modifiable risk factor during critical illness. There are no established national or international recommendations for vitamin D supplementation in Pediatric Intensive Care Unit (PICU) patients. Objectives: This monocentric study aims to compare the practices regarding vitamin D supplementation before and after the introduction of a nutrition protocol (NP). Methods: We retrospectively analyzed vitamin D administration (time from PICU admission to initiation, amount of supplementation, accordance with existing guidelines) in children aged 0 to 16 who were admitted to the PICU of Lausanne University Hospital for more than 48 h the year before and the year after the introduction of a NP. Results: Vitamin D supplementation increased after NP introduction (95 IU per day more, p < 0.0001). More patients received vitamin D during their stay (95% after vs. 77% before, p < 0.0001). The dose adhered to NP recommendations for children under 12 and was higher for older children. According to Swiss guidelines for the general pediatric population, vitamin D supplementation was accurate in children under one year old before and after NP implementation. However, it was less than recommended for patients over one year old. Conclusions: The implementation of a NP significantly enhanced the scope of vitamin D supplementation. This study also highlights the practical limitations in meeting the recommended requirements with certain galenic formulations. Full article

Background: Repeated vertical jump tests are widely used to assess neuromuscular function and lower limb performance. However, inconsistent formulas for average power output produce large discrepancies, limiting comparability across studies and limiting practical applications. This study aimed to compare three different models for the calculation of average power output, Bosco, Miron Georgescu (MG), and Modified Miron Georgescu-15s (MGM-15), applied to identical jump test data, in order to evaluate their computational behavior and practical relevance in athlete performance profiling. Methods: A single-group quasi-experimental study was conducted with 25 physically active male university students (mean age: 21.4 ± 2.7 years), who performed a 15 s repeated vertical jump test on the OptoJump Next system. Raw parameters including flight time, contact time, and jump height were recorded and exported. Average power output (W/kg) was subsequently calculated using three distinct computational models, each applied to the same dataset of flight and contact times. A repeated-measures ANOVA was used to compare outputs across models, with Bonferroni-adjusted pairwise comparisons for post hoc analysis (α = 0.05). Results: Significant differences were observed (p < 0.001). The Bosco model produced the highest values of average power (40.13 ± 8.56 W/kg), followed by MG (21.07 ± 5.92 W/kg), while MGM-15 yielded the lowest and most consistent outputs (4.08 ± 0.61 W/kg). Effect sizes were very large (η²_p = 0.952), confirming that calculation models strongly influenced the outcomes. Conclusions: The findings demonstrate that average power output differed markedly across formulas, despite identical performance data. Bosco and MG models tended to overestimate values due to simplified assumptions, whereas the MGM-15 method produced lower and more consistent outputs that may better capture repeated jump demands. The standardization of computational models is fundamental to ensure comparability and to improve athlete performance profiling in research and practice. Full article

Artificial intelligence (AI) is profoundly transforming heritage tourism through the incorporation of technological solutions that reconfigure the ways in which cultural heritage is conserved, interpreted, and experienced. This article presents a critical and systematic review of current AI applications in this field, with a special focus on their impact on destination management, the personalization of tourist experiences, universal accessibility, and the preservation of both tangible and intangible assets. Based on an analysis of the scientific literature and international use cases, key technologies such as machine learning, computer vision, generative models, and recommendation systems are identified. These tools enable everything from the virtual reconstruction of historical sites to the development of intelligent cultural assistants and adaptive tours, improving the visitor experience and promoting inclusion. This study also examines the main ethical, technical, and epistemological challenges associated with this transformation, including algorithmic surveillance, data protection, interoperability between platforms, the digital divide, and the reconfiguration of heritage knowledge production processes. In conclusion, this study argues that AI, when implemented in accordance with principles of responsibility, sustainability, and cultural sensitivity, can serve as a strategic instrument for ensuring the accessibility, representativeness, and social relevance of cultural heritage in the digital age. However, its effective integration necessitates the development of sector-specific ethical frameworks, inclusive governance models, and sustainable technological implementation strategies that promote equity, community participation, and long-term viability. Furthermore, this article highlights the need for empirical research to assess the actual impact of these technologies and for the creation of indicators to evaluate their effectiveness, fairness, and contribution to the Sustainable Development Goals. Full article

Background and Objectives: Ixekizumab is a human monoclonal antibody targeting interleukin-17A, approved for the treatment of moderate-to-severe plaque psoriasis. Given its demonstrated efficacy and safety in clinical trials, this study aimed to evaluate the real-world drug survival of Ixekizumab and identify clinical predictors of treatment discontinuation. Materials and Methods: A retrospective, observational, hospital-based study was conducted in the Department of Dermatology at the Central University Hospital of Asturias (HUCA). Patients with moderate-to-severe plaque psoriasis who initiated treatment with Ixekizumab (Taltz^®) between 8 June 2017 and 10 October 2024, were included. Demographic data, comorbidities, age at disease onset, family history, PASI score, and previous treatments were recorded. Drug survival was assessed using Kaplan–Meier survival curves and the log-rank test. Predictors of discontinuation were analyzed using univariate and multivariate Cox proportional hazards models. Results: A total of 103 patients (55.3% women) were included. Drug survival rates were 85% at one year, 73% at two years, and 61% at four years, with a mean treatment duration of 52.5 months (95% CI: 46.01–58.99). Multivariate analysis showed that patients under the age of 65 had a significantly higher risk of treatment discontinuation (hazard ratio: 1.813; p < 0.05). The most common reason for discontinuation was secondary treatment failure (45.16%). Ixekizumab demonstrated sustained drug survival in a real-world setting, with rates falling within the mid-to-upper range reported in the literature. Older age (>65 years) was associated with greater treatment persistence, highlighting a potential influence of age on long-term therapeutic adherence. Full article

Background/Objectives: To delineate integrated lifestyle profiles combining physical activity (PA) and dietary intake (DI) and test their links with lower limb injury in physically active young adults. Methods: We analyzed a cross-sectional convenience sample of university students (men: n = 91, 20.5 ± 1.0 years; women: n = 118, 20.3 ± 0.8 years). PA (IPAQ) and DI (QEB) were assessed alongside self-reported injuries. Latent class modeling derived PA–DI profiles. Injury prevalence across profiles was compared (χ²), and logistic regression examined injury odds adjusting for sex, age, and BMI. Results: Four profiles emerged. Two reflected less healthy patterns (Profiles 2–3) and two healthier ones (Profiles 1, 4). Profile 4 showed higher vegetables/legumes/fermented milk and lower fast food/sugary drinks; Profile 3 combined greater sitting and fried/sweetened items with lower walking/milk intake. Overall injury prevalence was 56.9%, ranging from 44.1% (Profile 2) to 66.7% (Profile 4 exceeded Profile 2 in pairwise comparison (χ² (1) = 5.08, p = 0.024)). In adjusted models, men had higher injury odds (OR = 1.94, 95% CI: 1.09–3.48, p = 0.025); profile membership was not independently predictive, and profile × sex interactions were null. Conclusions: Young adults cluster into distinct PA–DI patterns that differ behaviorally, but sex—rather than profile—was the most consistent correlate of injury. Prevention should integrate lifestyle screening with sex-specific strategies. Full article

Objectives: Hearing aids (HAs) are the most common intervention recommended for hearing loss (HL). Many adults with HL do not seek HA rehabilitation. Several studies have attempted to identify barriers and facilitators to using HAs. Different bureaucratic processes for acquiring HAs may lead to different barriers and facilitators. In addition, studies have not yet explored the factors influencing compliance with a recommendation for an HA consultation. This study focuses on the stage prior to consultation in a context where HAs are heavily subsidized. Methods: 148 patients who had undergone a hearing test during 2022 at Hadassah University Medical Center and received a recommendation to undergo a hearing aid consultation were contacted for a telephone survey. Seventy-two adults, 48 male and 24 female, aged 25–85 years, with HL ranging from slight to profound, responded to a telephone questionnaire. The questionnaire, based on two previously published English questionnaires and translated and adapted into Hebrew, was used to assess the main reasons a person did or did not comply with the recommendation to pursue an HA consultation. Results: HL was more severe in those who sought hearing rehabilitation. The main reasons for seeking hearing rehabilitation are the need and desire to hear better and pressure from others. The foremost reasons for not pursuing hearing rehabilitation are feeling that there is currently no need, esthetics, lack of time, and self-consciousness. No significant gender- or age-based differences were found. Conclusions: There are additional barriers to seeking HAs aside from cost and accessibility. Understanding the reasons for avoidance of hearing rehabilitation may help in developing strategies that encourage people to seek hearing rehabilitation and use HAs when the need exists. Full article

Objective: This study conducted a comprehensive analysis of molecular transmission networks and pretreatment drug resistance (PDR) in newly diagnosed HIV-1 infections in Taizhou, China. Methods: From 2021 to 2023, we collected 1126 plasma samples from newly diagnosed HIV patients in Taizhou. The HIV pol gene was amplified, and the obtained sequence was used to construct a maximum likelihood (ML) phylogenetic tree and molecular transmission network. PDR-related mutations were analyzed based on the Stanford University HIV Resistance Database. We conducted genotyping analysis and analysis of factors related to the larger clusters (≥10). Results: We successfully amplified and sequenced the pol region from 937 (83.2%, 937/1126) treatment-naïve HIV-1 patients, each with comprehensive epidemiological documentation. Phylogenetic characterization revealed significant subtype heterogeneity, with CRF07_BC (42.1%, 395/937), CRF01_AE (27.6%, 259/937) and CRF08_BC (22.1%, 209/937) being the most prevalent. Notably, 11.4% of the sequenced population (107/937) presented detectable PDR mutations. Univariate analysis revealed that larger clusters (≥10) are more inclined to be aged ≥60, divorced or widowed, have high or technical secondary school education, and have sexual contact with homosexuality. Multivariate analysis revealed that age ≥60 years and not having a PDR mutation (p < 0.05) were factors associated with larger clusters (≥10). Conclusions: Molecular transmission networks suggest that CRF08_BC is spreading rapidly among the older male population. Consequently, targeted interventions aimed at this population are crucial for halting the ongoing rapid dissemination of this subtype. Full article

Mobile learning (m-learning) technologies are gaining popularity in universities but not uniformly across institutions because of cognitive, affective, and behavior obstacles. This research tested and applied an expansion of the Technology Acceptance Model (TAM) with technostress (TECH) and resistance to change (RTC) as affective obstacles, as well as the core predictors of perceived usefulness (PU), perceived ease of use (PE), and perceived risk (PR). By employing a cross-sectional survey of Greek university students (N = 608) and partial least squares structural equation modeling (PLS-SEM), we tested direct and indirect impacts on behavioral intention (BI) to apply m-learning applications. The results affirm that PU and PE are direct predictors of BI, while PR has no direct impact on BI but acts indirectly through TECH and RTC. Mediation is partial in terms of PE and PU and indirect-only (complete) in terms of PR with respect to the impact of affective states on adoption. Multi-group comparisons found differences in terms of gender, age, confidence, and years of use but not frequency of use, implying that psychological and experiential characteristics have a greater impact on intention than habitual patterns. These results offer theory-driven and segment-specific guidelines for psychologically aware, user-focused m-learning adoption in higher education. Full article

Hormone replacement therapy (HRT) has been utilized in clinical practice for decades as a main therapeutic approach for mitigating menopausal symptoms. The symptoms mostly encompass vasomotor and genitourinary issues resulting from the deficiency of estrogen and progesterone. Initially identified as a universally advantageous and indispensable intervention, hormone replacement therapy subsequently became the subject of considerable scientific and clinical debate, especially after the publication of extensive epidemiological studies indicating potential adverse effects associated with cardiovascular and cancer risk. This study aims to reassess the role of HRT in clinical practice by analyzing its historical evolution, expanded clinical uses, and changes in guidelines necessitated by resent scientific studies. Current evidence from clinical studies and meta-analyses unequivocally demonstrates that hormone replacement therapy is the most efficacious treatment for vasomotor and urogenital symptoms, and also acknowledging its potential role in osteoporosis prevention. The administration of HRT requires careful individual assessment, considering the patient’s age, timing of initiation, existence of comorbidities. In this setting, therapy decisions have to be based on a combination of the most up-to-date clinical guidelines, risk stratification, and the patient’s preferences. In conclusion, the assessment of HRT confirms its primary role in reducing menopausal symptoms while also highlighting the imperative for a individual strategy that balances benefits and risks to improve outcomes for women. Full article

Objective: This article evaluates the reconstructive potential and functional outcomes, as well as the risks and potential perioperative complications of using free flaps in patients with advanced-stage malignant laryngeal neoplasms who require salvage surgery and reconstruction. Additionally, it assesses the effectiveness of various flap harvesting and in-setting techniques, including the performance of microvascular anastomoses. Materials and Methods: This retrospective study included 13 male patients (age range 47–76 years) diagnosed with laryngeal neoplasms, who were referred to the Department of Otolaryngology at the University of Verona between 2017 and 2022. All patients underwent salvage total laryngectomy followed by concurrent reconstructive surgery utilizing microvascular flaps. Recovery of function (phonation) and incidence of complications were evaluated in a follow-up of at least three years. Results: Only one patient experienced necrotic failure of the microvascular free flap, probably due to post-op complications. The patient required revision on the 10th day after surgery and was reconstructed using a pedicled pectoralis major muscle flap. Two patients developed a pharyngocutaneous fistula. Other three patients had pharyngoesophageal stenosis, two experienced recurrence, and one patient passed away due to septic shock. All patients achieved satisfactory functional outcomes regarding vocalization, while complete oral intake was restored in eight patients. Conclusions: Considering the limited sample size, the findings suggest that microvascular flaps represent a feasible option for reconstructing advanced laryngeal tumors, though complication rate may still be considerable. Tailoring reconstructive approaches to individual patients may enhance surgical outcomes. Full article

The formation and evolution of galaxies and other astrophysical objects have become of great interest, especially since the launch of the James Webb Space Telescope in 2021. The mass, size, and density of objects in the early universe appear to be drastically different from those predicted by the standard cosmology—the $\mathsf{\Lambda }$CDM model. This work shows that the mass–size–density evolution is not surprising when we use the CCC+TL cosmology, which is based on the concepts of covarying coupling constants in an expanding universe and the tired light effect contributing to the observed redshift. This model is consistent with supernovae Pantheon+ data, the angular size of the cosmic dawn galaxies, BAO, CMB sound horizon, galaxy formation time scales, time dilation, galaxy rotation curves, etc., and does not have the coincidence problem. The effective radii $r_e$ of the objects are larger in the new model by $r_e\propto {\left(1+z\right)}^{0.93}$. Thus, the object size evolution in different studies, estimated as $r_e\propto {\left(1+z\right)}^s$ with $s=-1.0$ ± $0.3$, is modified to $r_e\propto {\left(1+z\right)}^{s+0.93}$, the dynamical mass by ${\left(1+z\right)}^{0.93},$ and number density by ${\left(1+z\right)}^{-2.80}$. The luminosity modification increases slowly with $z$ to 1.8 at $z=20$. Thus, the stellar mass increase is modest, and the luminosity and stellar density decrease are mainly due to the larger object size in the new model. Since the aging of the universe is stretched in the new model, its temporal evolution is much slower (e.g., at $z=10$, the age is about a dex longer); stars, black holes, and galaxies do not have to form at unrealistic rates. Full article

Background: Fractures of the first and second cervical vertebrae are common in both young and elderly patients. Surgical management of C1–C2 fractures in elderly patients is controversial. The aim of this study is to report the rate of fusion in elderly patients who underwent surgery for C1 or C2 fractures. Methods: A retrospective review of all patients over the age of 65 years old who underwent surgical treatment for C1 or C2 fracture was reported. Visual analog scale (VAS) and neck disability index (NDI) were used to assess patients’ clinical outcome at 1 year follow-up. Cervical spine computer tomography (CT) scans were performed in all cases before surgery and at 1 year follow-up to evaluate the long-term postoperative rate of fusion, according to Lenke fusion grade. Results: From 2019 to 2023, 105 patients with cervical craniocervical junction (CCJ) fracture underwent surgical treatment in our Pisana University Hospital. Among all these, 74 patients (70.5%) were over 65 years old. The mean age of the study population was 76.9 years old (12.2% aged 65–70, 51.4% aged 70–79, and 36.5% over 80). According to the AO Spine Upper Cervical Injury Classification System, 6 (8.1%) patients presented a type II fracture and 68 (91.9%) patients presented a type III fracture. At admission, neurological examination resulted in American Spinal Injury Association (ASIA) E in 97.3% of cases. Over 60% of all patients underwent C1–C2 posterior fixation. Postoperative complications occurred in 12.25% of patients. According to the criteria described by Lenke, a good rate of fusion (A-B grade) was obtained in 71.6% of patients. Conclusions: In elderly patients with CCJ fractures, precision medicine can help identify those at higher risk for complications and guide personalized treatment strategies. Surgical treatment of CCJ fractures in elderly patients, although not always associated with bone fusion, can be performed with an acceptable incidence of mortality and morbidity, allowing rapid mobilization and return to pre-trauma levels of independence. Full article

Previous cross-sectional studies have explored associations between basic psychological need satisfaction, fear of missing out (FoMO), and depression. However, the longitudinal nature of these relationships and their underlying mechanisms remain unclear. This study aimed to utilize longitudinal tracking methods to investigate the relationships among basic psychological need satisfaction, fear of missing out, and depression in university students. Longitudinal data collection was conducted among 750 university students (mean age = 18.12 ± 0.73) in China over two years at three time points. Participants were investigated using paper–pencil survey versions of the Basic Psychological Needs Scale, the Fear of Missing Out scale, and The Center for Epidemiological Studies Depression Scale. The results revealed that, over the two-year study period, basic psychological need satisfaction (β = −6.239, p < 0.001) among university students demonstrated a declining trend, while FoMO (β = 1.360, p < 0.001) and depression (β = 3.602, p < 0.001) demonstrated an upward trend. The initial levels and development rates of basic psychological need satisfaction directly predicted the initial levels (β = −0.236, p = 0.031) and development rates of depression (β = −0.144, p < 0.001; β = −0.181, p = 0.005). The initial level of FoMO mediated the relationship between basic psychological need satisfaction and depression (β = −0.132, p = 0.007; β = −0.104, p = 0.036), and this mediating effect did not exhibit significant gender differences. These findings help to reveal the temporal relationships among the three variables from a dynamic perspective, providing important practical guidance for mental health education in universities. Full article

In this paper, we analyze the agegraphic dark energy from the entropy of the anti-de Sitter black hole using the age of the universe as the IR cutoff. We constrain its parameter with the Pantheon+ Type Ia supernova sample and observational Hubble parameter data, finding that the Akaike Information Criterion cannot effectively distinguish this model from the standard $\Lambda$CDM model. The present value of Hubble constant $H_0$ and the model parameter $b^2$ are constrained to $H_0=67.7\pm 1.8$ and $b^2=0.{303}_{-0.024}^{+0.019}$. This model realizes the whole evolution of the universe, including the late-time accelerated expansion. Although it asymptotically approaches the standard $\Lambda$CDM model in the future, statefinder analysis shows that late-time deviations allow the two models to be distinguished. Full article