Search Results (3,859)

Background and Objectives: Peripheral blood indices have been proposed as prognostic biomarkers in endometrial cancer, but most reports include mixed histological subtypes, do not control for benign uterine pathology that independently alters hematological profiles, and evaluate these indices in isolation. We evaluated all three categories head-to-head in a histologically homogeneous endometrioid cohort and formally tested whether they add prognostic information beyond established clinicopathological variables. Materials and Methods: Of 195 patients operated for endometrioid-type endometrial cancer between 2018 and 2024, 142 were included; adenomyosis or leiomyoma on final histopathology, active infection and hematological disease were exclusion criteria. Fourteen preoperative blood-derived indices spanning the three categories were analyzed as continuous variables. A pre-specified clinical model (age category, grade, FIGO stage) was compared with models adding the biomarkers using likelihood-ratio tests, Harrell’s concordance index, time-dependent areas under the curve, bootstrap internal validation, and influence diagnostics. Results: Median follow-up was 52.5 months; 34 patients (23.9%) died and 5-year overall survival was 74.1%. None of the conventional inflammatory ratios were associated with survival (SII p = 0.893; all others p ≥ 0.26). In the multivariable model, histologic grade and NRBC% remained associated with survival (NRBC% HR 3.30 per 1%, 95% CI 1.09–9.97, p = 0.034). Adding NRBC% to the clinical model improved fit (likelihood-ratio p = 0.039) but not discrimination (ΔC 0.006, 95% CI −0.041 to 0.053, p = 0.814), and no index retained significance after Benjamini–Hochberg adjustment. The NRBC% association disappeared on dichotomization at the detection limit and could not be estimated once the five patients with values above 0.30% were excluded. Conclusions: In a predominantly early-stage endometrioid endometrial cancer cohort, preoperative blood-derived indices added no measurable discriminatory information beyond established pathological variables. The NRBC% association rests on very few observations at the upper end of its distribution and is hypothesis-generating only. Full article

Background/Objectives: Alzheimer’s disease is one of the most prevalent forms of dementia and is accompanied by progressive anatomical changes within the brain. However, large-scale analyses that compare global and local anatomical differences across age, sex, diagnosis, and repeated scans remain limited. Methods: We constructed a cohort of 1385 total participants, with 3593 scans, who were diagnosed as cognitively normal or with Alzheimer’s at entry into the study. Global and medial temporal brain volumes from 3T MRI scans were normalized to intracranial volume, and we used a linear mixed-effects model to analyze the association between participants’ age, sex, and diagnosis while also accounting for multiple follow-up scans. Diagnosis-dependent relationships between global and medial temporal structures, brain parenchymal and hippocampal fractions, and body mass index were also calculated. Results: Older age was associated with a decrease in normalized brain volume across each region of interest. In general, AD participants had significantly lower volumes than cognitively normal individuals, with a greater degree of difference in medial temporal regions. Global measures did have different degrees of separation, with gray matter showing greater separation than white matter. Exponential model equations showed that the AD group generally had a greater age-associated percentage decrease across-ROI/ICV association. BMI nor BMI x diagnosis was significantly associated with brain volumes within the model, while the exploratory pooled pTau217 analysis showed it was 4.6 times higher in AD and negatively associated with most morphometric areas. Conclusions: This large, integrated analysis supports the use of MRI morphometry as a valuable tool to directly compare AD-associated differences across global and medial temporal areas and also evaluate diagnosis-dependent relationships across anatomically related structures. Findings indicate that medial temporal measures provide a greater AD vs. CN separation than global measures, with GM being more sensitive than WM. Plasma pTau217 also gives biological context, which helps suggest that MRI results should be interpreted with multiple clinical and biological factors. Full article

Obesity is among the most prevalent health conditions worldwide. Incorporating variables beyond metabolic factors, such as body image (BI), may improve understanding of its underlying mechanisms. Body image dissatisfaction (BID) and body size misperception (BSM) have been associated with psychological outcomes; however, further research is needed. This study aimed to characterize BI in Mexican adults with obesity and examine its relationships with BSM and BID. A cross-sectional study was conducted at the Unidad de Investigación en Epidemiología Clínica in 2025. The Stunkard Figure Rating Scale, BSQ-34, BAS-2, and Rosenberg Self-Esteem Scale assessed BSM, body concern (BC), body appreciation (BA), and self-esteem (SE), respectively. Pearson correlations and two PROCESS serial mediation models (6) were applied, with BMI as the dependent variable and age and sex as covariates. Model 1 specified BSM as the independent variable and BC, BA, BID and SE as sequential mediators; Model 2 specified BID as the independent variable and included BSM as the final mediator. BSM and BID were associated with BMI (B = 1.46, p < 0.01 and B = 1.43, p < 0.01). No significant indirect effect was observed. These findings suggest distinct associations of psychological components of body image with obesity. Full article

The Chenghai Fault Zone is a major active intrablock structure within the Sichuan–Yunnan Block at the southeastern margin of the Tibetan Plateau and exhibits pronounced along-strike kinematic segmentation. However, the Quaternary left-lateral slip rate of its central Qina segment remains poorly constrained. Here, we integrate field investigations, remote-sensing geomorphic mapping, UAV photogrammetry, and U-series dating to investigate the fault-offset Qiaonan paleolandslide along the Jinjiang Fault. The Qina segment consists mainly of the NNE-striking Qina and Jinjiang faults, which together form an overall left-stepping fault system dominated by left-lateral strike-slip motion. Geomorphic restoration of well-preserved landslide margins using high-resolution UAV-derived orthophotos and digital surface models indicates a cumulative left-lateral displacement of approximately 100 m. Independent DEM-based restoration yields a horizontal displacement of ~97 m, providing a consistent estimate of the fault offset. U-series dating of secondary carbonate cement within the landslide deposit yields a ^230Th–U age of 257.7 ± 3.2 ka. Because the dated carbonate precipitated after landslide emplacement, this age provides only a minimum-age constraint on the paleolandslide. Consequently, the calculated apparent left-lateral slip rate of ~0.39–0.47 mm/yr should be regarded as an upper-bound estimate rather than a precisely determined slip rate for the Jinjiang Fault. The Jinjiang Fault also left-laterally offsets the Jinsha River by ~3.04–3.25 km. Assuming that this displacement began to accumulate with the initiation of the Dali faulted-basin system at ca. 7.6 Ma, the corresponding long-term average slip rate is ~0.40–0.43 mm/yr. However, this estimate depends on an assumed fault-initiation age and therefore represents an end-member long-term average. When considered together with previous interpretations of possible fault-activity migration within the Chenghai Fault Zone, the Quaternary upper-bound rate is compatible with, but does not demonstrate, a reduction in the left-lateral strike-slip component during the Late Cenozoic. Such temporal variations may reflect changes in deformation partitioning among intrablock faults within the Dali faulted-basin system, although this interpretation remains tentative and requires additional chronological and slip-rate constraints. Our results demonstrate the potential of fault-offset paleolandslides to provide valuable geomorphic and chronological constraints on the Quaternary behavior of slowly slipping intrablock faults, while highlighting the importance of independent chronological control for resolving long-term variations in fault slip. Full article

As ESG disclosure and climate governance requirements become increasingly institutionalized, understanding how firms respond to external sustainability pressures through specific governance mechanisms and how these responses relate to carbon performance has become an important research issue. Moving beyond aggregate ESG ratings, this study examines the informational value of specific ESG-related factors for corporate carbon management, including energy management systems, innovation capability, human capital, market valuation, and board governance. Using data on Taiwanese listed and over-the-counter companies from the ESG database of the Financial Supervisory Commission, the Taiwan Economic Journal, and the Leadership ISO Survey, this study employs a time-lagged design linking 2023 firm characteristics to 2024 carbon emission intensity. Multiple regression analysis is the primary method, with firm size, leverage, capital intensity, profitability, and firm age included as firm-level controls in extended models; exploratory data analysis (EDA) serves as a supplementary diagnostic for data distribution, nonlinearity, and variable operationalization. Cross-year, alternative dependent-variable, and supplementary analyses are used to assess the stability of the estimates. The results show that ISO 50001 certification is positively associated with subsequent carbon emission intensity, whereas the structural characteristics of R&D investment and independent director governance show more stable negative associations. Average salary, female director representation, and Tobin’s Q yield inconsistent results. Proportion-based board measures outperform director-count and threshold-based measures, but no clear critical-mass threshold is supported. Results also vary under alternative carbon-performance measures, suggesting that carbon intensity and absolute emissions capture different dimensions of environmental performance. These findings indicate conditional statistical associations rather than causal effects. Full article

In developing countries, railway networks often create operational bottlenecks by combining older single-track sections with modern, double-track, signaled infrastructure. This study addresses train scheduling in such hybrid networks using a segment-based rather than a train-based approach. A mixed integer linear programming (MILP) model is developed that minimizes total waiting time across all journey segments, incorporating directional safety intervals separating single-track and double-track sections and co-directional and counter-directional movements. Train-type priority is included in the objective function as a class-dependent, age-adjusted weight, rather than a rigid priority rule; thus preventing the unlimited delay that a rigid priority ranking might otherwise impose on lower-priority trains in heavily shared resources. Since an exact MILP solution is impractical on a national scale, a segment-based heuristic method is developed; the age-weighted heuristic method, validated against exact solutions on smaller subnetworks, is found to require 35% more time to reach full optimum. This approach, applied to Turkey’s national railway network (109 routes, 997 stations or siding sections, 2281 transit segment between two stations or siding sections, 1539 daily services), has reduced daily waiting times from 2508 h to 609 h. This corresponds to an annual saving of approximately $13.2 million in fuel and labor costs and a reduction of 24,260 tons/year in CO₂ emissions. Since diesel-fueled services account for more than 99% of the cost savings, sensitivity analyses show that these estimates are robust against fuel price assumptions. The study offers a low-cost solution for improving railway capacity before costly infrastructure investments and is expected to be generalized to similar heterogeneous national networks. Full article

Background/Objectives: To evaluate systemic and ocular factors associated with glaucoma in young adults using data from a large health screening cohort. Methods: This cross-sectional observational study analyzed baseline data from 16,002 Korean adults younger than 40 years (range, 18–39 years) in the Gangnam Eye Cohort. Participants underwent comprehensive health screening examinations, including standardized ophthalmic evaluation and fundus photography. Glaucoma was defined by structural glaucomatous changes on fundus photographs, and retinal arteriosclerosis was graded using a modified Scheie classification. Univariable and multivariable logistic regression models were used to identify factors associated with glaucoma. Results: Among 16,002 participants, 257 (1.61%) were classified as having glaucoma; 186 of these participants (72.4%) had unilateral glaucoma. In multivariable logistic regression analysis, retinal arteriosclerosis showed the strongest association with glaucoma (OR, 6.033; 95% CI, 4.417–8.240; p < 0.001). Older age, male sex, higher intraocular pressure, and higher low-density lipoprotein cholesterol level were also independently associated with glaucoma. A graded relationship was observed between retinal arteriosclerosis severity and glaucoma, with adjusted ORs of 5.51 (95% CI, 3.96–7.66) for grade 1 and 13.15 (95% CI, 6.41–26.99) for grade ≥ 2. Conclusions: In young adults, retinal arteriosclerosis was strongly and dose-dependently associated with glaucoma. These findings suggest that retinal microvascular abnormalities visible on routine fundus photographs may provide clinically accessible information for identifying young adults with structural features of glaucomatous optic neuropathy in health screening settings. Full article

Fast charging is critical to the wider adoption of electric vehicles, but simply increasing the charging current intensifies polarization and degradation, creating an inherent conflict between the charging speed and battery lifetime. Multi-stage charging can alleviate this conflict by redistributing the current throughout charging, although its performance depends jointly on the protocol structure and stage parameters. To address this problem, this work proposes a hierarchical multi-objective optimization method that coordinates these two design levels. A reduced-order electrochemical–thermal–aging model, developed and validated using systematic degradation experiments, is employed to predict electrothermal responses and capacity loss throughout the battery lifetime. For each candidate stage number, the charging rates, switching voltages, and exit-current ratios are jointly optimized, while the resulting Pareto performance and implementation complexity are compared at the structure level. The results showed that a three-stage structure captures most of the attainable performance gains without unnecessary control complexity. Full-lifetime cycling experiments demonstrated that the representative protocols achieved different balances between charging speeds and cycle lives. The 4C-referenced protocols extended cycle lives by 25.2–35.9% with only 2.7–4.1% longer initial charging times. The 3C-referenced protocols shortened initial charging times by 5.6–8.6%, while their cycle lives remained broadly comparable to 3C CCCV, ranging from a 9.5% decrease to a 6.9% increase. Multi-level degradation analyses further associated the lifetime improvements with a slower accumulation of anode-related capacity loss and interfacial deposits, together with reduced impedance growth. Full article

Equitable access to health-promoting public services is an important component of socially sustainable urban development, yet fitness-facility accessibility is often assessed under homogeneous demand assumptions. This study develops an age-differentiated framework for central Harbin, China, integrating 100 m age-stratified population data, facility functional area, pedestrian-network travel costs, and physical-activity participation rates within an MGH-3SFCA model. Accessibility was evaluated for four age groups at 15 min, with shorter-threshold comparisons, population exposure analysis, bivariate LISA, and sensitivity tests. Adults and students generally formed the relatively higher-accessibility pair, whereas children and seniors remained more disadvantaged. More than 91% of each age group was located in zero, very low, or low accessibility classes. High-intensity ball-sports facilities were dominated by geographic non-coverage, while resistance-training facilities were more widely reachable but mostly at very low levels. The adult–senior zero-accessibility population gap widened from 3.52 percentage points at 15 min to 13.66 at 5 min. High–Low clusters occupied only 5.90–7.39% of land grids but contained 11.77–13.25% of corresponding populations. Broad spatial patterns were stable to alternative composite weighting, while some age contrasts were specification-dependent. The framework supports age-responsive and socially sustainable neighbourhood planning by distinguishing spatial coverage, population exposure, and potential local mismatch. Full article

Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by impaired social communication, restricted interests, and repetitive behaviors. Although traditionally considered a disorder of early brain development, growing evidence indicates that many ASD-associated genes continue to regulate neuronal physiology throughout adulthood. These genes participate in conserved cellular processes involved in synaptic organization, mitochondrial homeostasis, calcium signaling, proteostasis, intracellular trafficking, neuroimmune regulation, and circadian biology, many of which are also implicated in brain aging. This convergence supports the concept that developmental alterations can influence neuronal function long after neural circuits have formed. In this context, the fruit fly Drosophila melanogaster (Drosophila) has emerged as a powerful translational model for investigating the conserved mechanisms linking neurodevelopment and aging. Its high genetic conservation with humans, sophisticated neurogenetic tools, short lifespan, and robust behavioral assays enable longitudinal examination of developmental genetic alterations within a single experimental organism, facilitating mechanistic studies of neuronal function, stress adaptation, and age-dependent behavioral phenotypes. This review examines ASD from the perspective of lifelong neuronal vulnerability, highlighting how genetically diverse ASD-associated genes converge on common biological mechanisms that remain active beyond development. Furthermore, I discuss how Drosophila has advanced our understanding of these conserved pathways and provides a unique experimental platform for investigating how early developmental alterations shape neuronal function across the lifespan. Full article

Autonomous navigation of a USV during moving-underwater-target tracking becomes difficult when passive-acoustic contact is intermittent and periodic position priors are stale or inaccurate. We formulate the task as online path planning and develop UCA-PPO, a quality-conditioned cross-attention extension of PPO. Its actor separately encodes USV context, acoustic cues, and position priors. Prior age and stated error, contact status, bearing confidence, and signal excess form a dynamic observation-quality token that conditions cross-attention fusion, after which a Gaussian policy head produces speed and heading-increment commands. The token is a deterministic engineering descriptor rather than a calibrated Bayesian, posterior, or predictive uncertainty estimate. PPO training uses an asymmetric critic, whereas deployment does not require target truth. The two-dimensional simulator combines GEBCO 2025 bathymetry, World Ocean Atlas 2023 hydrography, and range-dependent acoustic-model transmission loss. The evaluation spans three prior-quality regimes, five training seeds, 70 independently trained policies, and 70,000 held-out episodes, with PPO, CA-PPO, targeted ablations, parameter-matched controls, and three non-learning controllers as references. Under severe prior degradation, UCA-PPO improves return, 5 km dwell, and modeled detection probability over PPO by 9.2%, 10.2%, and 13.6%, respectively, while reducing conditional first-contact time by 26.3%. Its mean advantage over CA-PPO is small, although its across-run dispersion is lower. A 135,000-episode frozen-policy factorial test shows that UCA-PPO leads only when 5 km position error is combined with 30- or 60-decision updates. In a 15,000-episode zero-shot Munk-profile transfer, UCA-PPO retains the highest acquisition success (0.944) but not the highest return or shortest distance. Five 300,000-episode retraining runs without the sole acoustic reward retain acquisition success of 0.966, but reduce 5 km dwell from 0.600 to 0.447 and more than double cumulative turn. Across these controlled acoustic settings, the results support quality-conditioned multisource fusion mainly as a means of improving acquisition robustness when external navigation information is substantially degraded, not general superiority over CA-PPO or field readiness. Full article

Brain aging is accompanied by changes in RNA homeostasis, intercellular communication, and stress responses that increase vulnerability to neurodegenerative diseases. The neuronal protein HuD (ELAVL4) and the broadly expressed HuR (ELAVL1) regulate RNA stability, translation, localization, and selected microRNA (miRNA) activities. Recent studies further show that HuD can promote export of let-7a and miR-125b during differentiation of PC12 cells, whereas HuR can bind selected miRNAs and engage endosomal export or intracellular buffering mechanisms in other cellular contexts. These observations support an emerging ELAVL–miRNA–extracellular vesicle (EV) framework. They do not yet establish an integrated HuD/HuR-dependent neuron–glia pathway in aging human brain or Alzheimer’s disease (AD). We therefore distinguish direct, model-specific findings from hypotheses that age-, amyloid-, or inflammation-associated changes in ELAVL abundance, localization, or RNA binding could redistribute miRNAs between intracellular pools and EVs. Testing this framework in primary human neural cells, induced pluripotent stem cell-derived systems, organoids, and in vivo models may identify context-specific mechanisms and therapeutic opportunities. Full article

Background: Population ageing, multimorbidity, and chronic conditions have increased the demand for person-centred care in Primary Health Care. Current stratification systems rely on diagnoses or resource utilization and fail to capture the multidimensional nature of care complexity, which also depends on functional, social, environmental factors. Objective: To develop a HealthCare Complexity Index using routinely collected electronic health record (EHR) data and the Person-Centred Care Knowledge Model. Methodology: A retrospective, cross-sectional observational study was conducted in Primary Health Care in the Community of Madrid (Spain). Deductive Care Methodology was used to identify functional assessment variables associated with four care dimensions: vulnerability, risk, etiology, and signs/symptoms. A multidisciplinary expert panel selected and validated the variables through iterative consensus rounds. A weighted scoring algorithm, the Care Complexity Index, was designed to quantify care complexity on a 0–100 scale. Relationships between the selected variables and NANDA-I nursing diagnoses were established and validated by an expert in standardized nursing languages. Results: 27 assessment variables were identified and classified into the 4 dimensions of the care model. These variables were integrated into a weighted complexity index with five severity levels ranging from low to critical complexity. Furthermore, 48 NANDA-I nursing diagnoses were linked to the selected variables. Conclusions: The HealthCare Complexity Index provides a standardized, person-centred approach for estimating care complexity using routinely available (EHR) data. It may support early identification of individuals with complex care needs, facilitate individualized care planning, and strengthen clinical decision-making. Future studies should validate its predictive performance and implementation in other clinical practice. Full article

The vestibular apparatus is substantially organized before birth, whereas human equilibrium emerges only gradually through head control, sitting, standing, and independent walking. We propose an Innately Constrained Bayesian Model of Vestibular Development in which a phylogenetically shaped architecture constrains an initial model space; prenatal and postnatal experience calibrate internal models of self-motion and gravity; and developmentally gated plasticity modulates the rate of updating. We explicitly distinguish established evidence from interpretations and model-derived hypotheses. Recent human and nonhuman primate work on internal models, active self-motion, and multisensory recalibration is integrated with developmental and clinical evidence. The framework is then tested conceptually across congenital and acquired vestibular loss, altered gravity, and aging. Its proposed novelty lies not in Bayesian inference or internal models themselves, but in combining phylogenetic constraints, prenatal calibration, a qualitative transition at birth, time-dependent plasticity, and life-span context switching within a single developmental account. Finally, we operationalize the model through measurable predictions involving VOR adaptation, sensory-weighting coefficients, anticipatory postural responses, context-specific readaptation, and postural stability. The framework is intended as a falsifiable perspective rather than a definitive mechanistic account. Full article

Background/Objectives: Rubidium-82 (⁸²Rb) PET myocardial perfusion imaging (MPI) yields, in a single study, quantitative absolute myocardial blood flow (MBF, mL/min/g), myocardial flow reserve (MFR), and gated left ventricular (LV) function (LVEF, EDV, ESV, SV). These quantitative values depend on the tracer, scanner, kinetic model, software, and underlying population and have been characterised almost exclusively in North American and European cohorts. The Arabian Gulf, where Kuwait has among the highest age-standardised diabetes prevalence worldwide (25.6%), is essentially unstudied, so the distribution and behaviour of these parameters in such a real-world cardiometabolic population are unknown. To evaluate the distribution of the quantitative ⁸²Rb PET parameter set in a real-world Arabian Gulf cohort and, within a small clinically defined normal subgroup, to describe sex- and age-related patterns in absolute MBF, MFR, and LV function. Given the limited size of the normal subgroup, these values are presented as exploratory, hypothesis-generating observations rather than definitive population reference norms. Methods: Retrospective single-centre study of 330 consecutive ⁸²Rb PET/CT studies (analytic cohort n = 292 after exclusion of repeat studies and those with incomplete quantitative output; mean age 63.1 ± 12.1 years) who underwent adenosine-stress ⁸²Rb PET/CT MPI. The clinically defined normal subgroup, normal perfusion (C1), normal global MFR (≥2.0), normal resting LVEF, and no documented cardiac history, comprised 44 patients (25 female, 19 male). Reference values are reported as sex- and age-stratified centiles (5th, 25th, median, 95th percentiles), with the 5th percentile reported for each parameter. Sex differences used Mann–Whitney U with rank-biserial r and Cohen’s d (95% CI); age was examined across broad bands. All analyses followed APA 7 standards with Bonferroni correction. Results: In the clinically defined normal subgroup, median global stress MBF was 2.94 mL/min/g (5th percentile 2.03) and median global MFR was 2.72 (5th percentile 2.06); every value satisfied the C1 definition (MFR ≥ 2.0) by construction, so these limits describe the preselected subgroup and cannot independently validate the 2.0 threshold. Women had higher resting MBF than men (median 1.07 vs. 0.90 mL/min/g; p = 0.007), with numerically lower global MFR that did not survive correction for multiple comparisons (2.57 vs. 2.98; p = 0.022); stress MBF did not differ by sex (3.00 vs. 2.91; p = 0.522). LV volumes were smaller in women, while LVEF was similar between sexes. The 5th percentile for stress LVEF was 54% (women) and 53% (men). These absolute-flow reference values are lower than those reported for Western low-risk cohorts (stress MBF ~3.25 mL/min/g; MFR ~3.18), consistent with the higher cardiometabolic burden of this population. Conclusions: In this exploratory single-centre evaluation, quantitative ⁸²Rb PET flow values in a small clinically defined normal Arabian Gulf subgroup were lower than Caucasian-derived values, while sex-related differences in resting flow were evident and age-related differences were numerically consistent with previously reported trends. Because the normal subgroup is small, these findings are hypothesis-generating and require confirmation in larger, prospectively screened cohorts before use as population reference values; they nonetheless indicate that population- and pipeline-specific calibration is needed when quantitative ⁸²Rb thresholds derived elsewhere are applied locally. Full article