Search Results (11,126)

Introduction: Influenza has a major impact on public health. The best way to prevent it is through vaccination. In Catalonia, influenza vaccination has been recommended for children aged 6 to 59 months since the 2023–24 season. Objective: To assess the association between the implementation of this vaccination program and changes in influenza diagnoses in primary care and influenza-related hospitalizations in all age groups. Materials and Methods: Quasi-experimental study with interrupted time series (ITS) analysis. All influenza diagnoses made in primary care (PC) and all influenza-related hospitalizations in the Central Catalonia health region between October 2018 and August 2025 were included. The monthly aggregated cases were analyzed using segmented negative binomial regression models that accounted for temporal trends, the onset of COVID-19, and the introduction of systematic pediatric influenza vaccination. Results: A total of 6804 influenza diagnoses made in PC and 3252 hospitalizations for influenza were analyzed. A statistically significant decrease was observed in the percentage of influenza diagnoses in PC in the 2–4 (13.5% vs. 10.6%) and 5–14 (26.1% vs. 16.3%) age groups. In the ITS analysis conducted in primary care (PC) settings, the vaccination period was significantly associated with a 13% reduction in expected influenza cases among individuals aged 15–64 years (RR 0.87 [0.78; 0.99]). After sensitivity analysis, these results were no longer statistically significant. The ITS analysis in the hospital setting has not shown a significant reduction in expected influenza cases or in expected admissions. Conclusions: Systematic influenza vaccination in children aged 6 to 59 months has not been shown to be associated with a reduction in influenza cases in primary care or hospitals settings during the early stages of implementation of the new vaccination program. Full article

Furuncular myiasis is rarely reported in Southeast/Eastern Europe and may be underrecognized or misdiagnosed in non-endemic settings. We described two imported furuncular myiasis cases diagnosed in Romania following travel to Peru and confirmed the etiologic agent by larval morphology and mitochondrial cytochrome c oxidase subunit I (COI) sequencing. We also conducted a narrative review of published case reports/series from Southeast/Eastern Europe (1900–2025) and summarized case characteristics. A previously healthy 31-year-old woman and 32-year-old man presented with painful furuncle-like lesions on the upper back near the shoulder and the posterolateral upper arm, respectively, associated with pruritus and a sensation of movement. Each lesion had a central punctum with intermittent air bubbles. Occlusion of the breathing pore with petroleum jelly facilitated mechanical extraction of one barrel-shaped larva per lesion. Microscopy showed features consistent with second-instar Dermatobia hominis larvae, and COI sequencing demonstrated 97.14–99.33% identity with reference D. hominis sequences. Literature review identified 25 travel-associated cases, with D. hominis involved mostly after travel to Central/South America. These cases highlight the value of travel history and key diagnostic clues for D. hominis myiasis in travelers that may enable timely diagnosis and minimally invasive management. Greater awareness and reporting are needed to better define epidemiology. Full article

Objective: To investigate the method and clinical outcomes of employing plantar propeller perforator flaps for the repair of defects in the plantar region. Methods: This was a retrospective case series of 40 patients (20 males, 20 females; age range 20–75 years) who underwent plantar defect reconstruction using the horn-shaped perforator flap technique between January 2020 and October 2025. Defect etiologies included malignant melanoma (n = 24), melanocytic nevus (n = 3), and refractory wounds (n = 13). Defect sizes ranged from 2 cm × 1.5 cm to 5 cm × 5 cm. The primary outcome was flap survival; secondary outcomes included functional recovery (American Orthopaedic Foot and Ankle Society AOFAS score), sensory recovery (Semmes–Weinstein monofilaments), and time to full weight-bearing. Results: Complete flap survival was achieved in 38/40 patients (95%). Two patients (5%) experienced minor distal wound dehiscence and necrosis, successfully managed with full-thickness skin grafting and dressing changes without compromising final outcomes. Mean follow-up was 14.2 ± 6.8 months (range 3–24 months). Mean AOFAS score was 91.3 ± 5.6, with 80% achieving excellent functional recovery. Protective sensation was present in 87.1% of the tested patients. Mean time to full weight-bearing was 6.4 ± 1.8 weeks. No local tumor recurrence occurred in melanoma patients during follow-up. Conclusions: The horn-shaped perforator flap provides a reliable source of homologous glabrous skin for reconstructing small-to-medium-sized plantar defects while avoiding skin grafting at the donor site. Its combined rotation–advancement mechanism, flexible triangular leading-edge strategies, and preservation of multiple perforators contribute to favorable functional and aesthetic outcomes. Prospective comparative studies with standardized plantar-specific outcome measures are warranted. Full article

While touch screen technology is largely available, people with intellectual and developmental disabilities might have difficulties using it due to erratic touch responses. This study included six adults with intellectual and developmental disabilities who were managing touch screen technology modified via an input adaptation module. Such a module allowed them to activate the screen and access leisure events and complete match-to-sample tasks with various response configurations (e.g., precise clicks, heavy/prolonged touch, and taps). The first question of the study was whether successful history with the modified technology would facilitate the participants’ use of standard touch screen technology. A second (subordinate) question was whether practice with standard touch screen technology would improve their use of it. To address these questions, the participants were presented with series of sessions with standard technology in alternation with series of sessions with the modified technology. The results showed that the participants were highly successful with the modified technology and partially (or minimally) successful with the standard technology. Only three of them seemed to improve their performance with the standard technology following practice. In conclusion, the modified touch screen technology was consistently effective in helping participants with intellectual and developmental disabilities who continued to have difficulties in using standard touch screen technology. Full article

Background: Eyelid reconstruction is particularly challenging because of the delicate anatomy and its critical functional and aesthetic roles. Although various methods have been described for anterior and posterior lamellar repairs, no standardized approach has been established. We developed a single-stage technique integrating reconstruction of both lamellae. Methods: This retrospective case series included seven consecutive patients who underwent full-thickness eyelid reconstruction between 2012 and 2024. Patients were included if they had full-thickness defects requiring reconstruction of both lamellae, underwent reconstruction using a nasal septal chondromucosal graft combined with a large local flap, and had at least 12 months of follow-up. The posterior lamella was reconstructed using nasal septal chondromucosal grafts, and the anterior lamella using large local flaps. Donor sites were managed using various methods. Results: All patients (7/7) achieved complete graft survival without partial or total graft loss. All patients achieved complete eyelid closure without lagophthalmos, and no cases of ectropion, corneal complications, or graft failure were observed. Buccal mucosal grafting demonstrated the most favorable donor-site outcomes, with uneventful healing and no septal perforation or airway-related complications. Conclusions: This single-stage approach combining chondromucosal grafts and local flaps is a feasible and reproducible option for selected patients, providing reliable structural support and satisfactory functional outcomes. Full article

Background: Atypical teratoid/rhabdoid tumors (AT/RT) are rare, highly aggressive pediatric central nervous system (CNS) malignancies. AT/RT of the lateral ventricle is an exceptionally rare subgroup, with only 11 reported cases. SMARCB1 inactivation is the primary molecular feature of AT/RT. Current consensus is to classify AT/RT based on methylation and molecular profiles into the following subgroups: AT/RT-TYR, AT/RT-SHH, AT/RT-MYC, and a potentially distinct SMARCA4-deficient subtype. AT/RT-MYC exhibits high levels of CD8⁺ tumor-infiltrating lymphocytes, indicating immunogenic potential. Case presentation: We report three pediatric cases presenting with intracranial hypertension and seizures. Diagnosis was confirmed via histopathology and molecular profiling. Interventions included gross total resection, chemotherapy, radiotherapy, and combined immune checkpoint inhibitors (pembrolizumab and ipilimumab). Outcomes varied from rapid progression to 3-year recurrence-free survival. A cohort of 14 pediatric patients with lateral ventricle AT/RT, comprising 3 institutional cases and 11 cases identified from the PubMed database, was evaluated through a narrative synthesis. Conclusions: These advancements highlight the crucial role of molecular subtyping in tailoring personalized treatments, including epigenetic modifiers and immune-based regimens. However, clinical validation is essential to establish standardized protocols. Integrating genomic, epigenetic, and immune microenvironment profiling may enhance risk assessment and treatment precision, ultimately improving survival and quality of life in pediatric patients. Full article

Multiple linear regression remains a foundational predictive methodology across a broad range of applications. We propose a novel regression framework that, rather than minimising the aggregate prediction error associated with the dependent variable, explicitly distributes the risk evenly across all model parameters. This approach provides a structural safeguard that is particularly suitable for data affected by substantial noise, as is often the case in time series environments characterised by regime shifts, structural breaks, and evolving trends. We provide a theoretical characterisation of our proposed estimator, named Parity Regression, and benchmark its analytical properties against existing penalised and shrinkage estimators in the literature. Both synthetic experiments and empirical applications demonstrate that the theoretical guarantees of the proposed method translate into enhanced out-of-sample forecasting stability in practice. Full article

Aim: Percutaneous liver ablation is a challenging procedure and operator-dependent. During the time when transarterial liver oncological therapies are favored over percutaneous liver ablation, we discuss the challenges of liver ablation with bowel interposition within the needle tract. Materials and Methods: In this IRB-approved retrospective review, we analyzed 481 cases of percutaneous microwave ablation performed between 2012 and 2025 using the NeuWave microwave ablation system with 15 or 20 mm probes under non-contrast CT guidance, with needle trajectories planned based on ultrasound. Dissection techniques were not performed, as intraprocedural ultrasound and CT assessment suggested that the ablation zone would remain confined to hepatic parenchyma. Cases of bowel transgression or close proximity were identified on post-procedural CT imaging, with a follow-up duration of 3 months performed consistently across all cases. Results: Three cases (0.6%) of bowel transgression or close proximity to bowel loops during needle placement were identified. There was no evidence of transmural bowel perforation or clinically significant bowel injury on clinical or radiologic follow-up. Post-procedural imaging demonstrated no free intraperitoneal air or fluid collections. Conclusions: In cases where the ablation zone is confined to hepatic parenchyma, bowel proximity to or inadvertent traversal by the cooled antenna shaft may not result in clinically significant injury and can be managed conservatively in selected patients. Full article

The carbonate massifs of the southern Italian Apennines host extensive karst aquifers, which represent the principal drinking water resources. This study focuses on the Dragone Plain polje, a vast closed karst depression located in the main recharge sector of the Terminio–Tuoro carbonate massif. The polje drains a ~55 km² endorheic catchment and may be flooded during the cold and wet season, forming a temporary lake. We employed continuous hydroclimatic time series (rainfall, groundwater level, spring discharge, and river level) together with sparse Sentinel-2 true color satellite images for the period 2020–2024 to analyze the flooding process in the polje and its hydraulic connection with the saturated zone of the karst aquifer. Results indicate that lake formation depends on the balance among soil moisture, rainfall intensity, and runoff development, which were modeled on a daily scale. Daily recharge was also estimated and compared with groundwater level time series from the deep karst aquifer. The modeling was integrated with cross-correlation analysis of the time series, providing insights into the propagation of precipitation pulses through the hydrogeological system. This case study represents an important example for understanding the relationship between karst polje hydrological functioning and climate in a Mediterranean area. Full article

Accurate photovoltaic (PV) power forecasting is essential for the efficient operation of residential energy systems and microgrids, as reliable short-term predictions enable improved energy scheduling, demand management, and operational planning in distributed energy environments. In this study, one-hour-ahead forecasting of residential PV power generation is investigated using real-world data collected from multiple households within an Irish energy community. Several deep-learning architectures, including long short-term memory (LSTM), gated recurrent unit (GRU), convolutional neural networks (CNN), CNN–LSTM hybrid networks, and attention-based LSTM models, are evaluated and compared with a seasonal autoregressive integrated moving average (SARIMA) statistical model. A sliding-window approach is employed to transform the PV time series into a supervised learning problem. To ensure statistical robustness, deep-learning models are evaluated using a multi-run framework, and results are reported as mean ± standard deviation based on MAE, RMSE, MAPE, and R² metrics across multiple households. The results indicate that deep-learning models achieve consistently strong forecasting performance, with GRU frequently providing the most reliable predictions across several households. For instance, in House 5, GRU achieved an RMSE of 142.02 ± 1.87 W and an R² of 0.694 ± 0.008, while in Houses 11 and 13 it attained R² values of 0.837 ± 0.002 and 0.835 0.08, respectively. However, performance varied across households, reflecting the influence of data variability and generation patterns on model effectiveness. In comparison, the SARIMA model demonstrated competitive performance and, in certain cases, outperformed deep-learning models. For example, in House 4, it achieved the lowest RMSE of 90.68 W and the highest R² of 0.709. Overall, these findings highlight that while deep-learning models offer greater adaptability and stability, statistical models remain effective for more regular PV generation patterns. Consequently, the study emphasizes the importance of evaluating forecasting models under realistic household-level conditions and demonstrates that both deep-learning and statistical approaches can provide short-term PV forecasting. Full article

Background: Accurate mortality prediction remains a major challenge in public health due to the complex interactions among demographic, socioeconomic, behavioral, and medical factors. This problem is particularly relevant for identifying high-risk groups and improving preventive healthcare strategies. While existing studies demonstrate strong predictive performance, they mainly rely on clinically structured data and focus on model performance. Challenges such as misclassification and atypical cases remain less explored. Methods: Using the Integrated Public Use Microdata Series National Health Interview Survey (IPUMS-NHIS) 2010 and 2015 datasets (193,765 records, 104 features), this study investigates mortality prediction through comparative Machine Learning. Data preprocessing included feature engineering, categorical encoding, and removal of missing entries. Class imbalance was addressed using SMOTE and SMOTE-ENN resampling, followed by hyperparameter tuning. Three models—Logistic Regression, Random Forest, and XGBoost—were trained to classify mortality, with recall prioritized to ensure accurate identification of deceased cases. Results: Results showed that XGBoost achieved the best performance (Recall = 69%, F1 = 0.39, AUC = 0.92), outperforming other models in balancing sensitivity and specificity. Feature importance and permutation analyses highlighted age, employment status, self-reported health, and lifestyle indicators as key predictors. Misclassification analysis combined with Isolation Forest revealed atypical profiles not captured by standard models. Conclusions: The findings underscore XGBoost’s effectiveness and demonstrate the value of integrating anomaly detection with classification to improve mortality prediction and inform public health planning. Full article

Background/Objectives: Collision tumors between seborrheic keratosis and melanoma represent a well-known diagnostic pitfall, particularly when the benign keratinocytic component constitutes the predominant portion of the lesion. In such cases, melanoma-specific dermoscopic clues may be obscured by typical seborrheic keratosis patterns, leading to potential underestimation. The aim of this scoping review was to map and summarize the dermoscopic interface features reported in melanoma–seborrheic keratosis collision tumors. Secondary aims were to discuss diagnostic pitfalls, explore potential tumor microenvironment considerations, and assess the adjunctive role of Wood’s lamp-assisted dermoscopy. Methods: This review was conducted as a scoping review and reported according to the PRISMA-ScR guidelines using PubMed, Scopus, and Web of Science. Studies reporting histologically confirmed melanoma–seborrheic keratosis collision tumors with available dermoscopic documentation were included. Eligible articles consisted of case reports and case series. Dermoscopic features at the interface between seborrheic keratosis and melanoma were qualitatively synthesized. Results: Five studies describing five melanoma-seborrheic keratosis collision tumors met the inclusion criteria. In all cases, the seborrheic keratosis component was dermoscopically recognizable. Asymmetric interface-related hyperpigmentation was consistently observed in collisions involving pigmented melanomas, whereas it was absent in the single reported case of hypopigmented melanoma. Conclusions: Asymmetric interface-related hyperpigmentation within seborrheic keratosis is a recurrent dermoscopic finding in melanoma–seborrheic keratosis collision tumors and could be considered a monitoring clue rather than a melanoma-specific diagnostic criterion. Given the dynamic nature of melanoma growth, longitudinal assessment of the dermoscopic interface may be particularly informative. Adjunctive techniques, including Wood’s lamp-assisted dermoscopy, may support interface-focused evaluation in selected equivocal cases. Full article

Background/Objectives: Survival after pediatric intensive care unit (PICU) admission has improved, yet many children experience post-intensive care syndrome in pediatrics (PICS-p), including persistent feeding difficulties that impair growth and quality of life. An intensive feeding program (IFP), also known as intensive interdisciplinary behavioral treatment (IIBT), reduces tube dependence and improves oral intake; however, outcomes in PICU survivors remain understudied. This study aimed to evaluate feeding outcomes in children with prior PICU admission who completed IIBT. Methods: This study was a retrospective case series of children (0–18 years) admitted to the HDVCH, Corewell Health, Grand Rapids, Michigan, who subsequently completed IIBT (from 2007 to 2024). Variables included demographics, PICU course (admission indication, complications, length of stay, ventilation, and nutrition status) and IIBT outcomes (feeding modality, oral skills, and malnutrition status). Feeding outcomes were compared pre- and post-IIBT. Results: Sixteen patients were included (62.5% female; mean age 1.44 ± 1.21 years). Primary PICU admission causes were post-operative recovery (68.8%) and acute respiratory failure (25%). PICU complications included acute respiratory failure (43.8%) and the need for respiratory support beyond baseline (62.5%). At PICU discharge, 75% remained tube-fed and 18.8% were malnourished. The mean time from PICU discharge to IIBT initiation was 641 ± 385 days. At IIBT baseline, 75% were tube-fed and all were non-self-feeders. Following IIBT completion (mean length of stay 4.8 ± 0.9 weeks), 58% of tube-fed patients achieved tube removal eligibility; 44% transitioned to partial or full self-feeding; problematic mealtime behaviors decreased (45.7% → 9.9%); oral acceptance improved (62% → 95%); and mouth clearance improved (59% → 96%). Malnutrition prevalence decreased (20% → 12%). Conclusions: Children with prior PICU admission demonstrated substantial feeding and behavioral improvement during IIBT participation, with over half achieving tube-weaning eligibility. The time from referral to program start reflects barriers that delay intervention. Full article

Background and Clinical Significance: Parry–Romberg syndrome (PRS), also known as progressive hemifacial atrophy, is a rare disorder characterized by progressive unilateral hemifacial atrophy, with potential involvement of the cranial bones and the brain. Although neurological manifestations are frequently described, central nervous system involvement may be subclinical and detectable only through neuroimaging. Owing to its rarity and the lack of standardized diagnostic criteria, most available data derive from case reports and small case series. Case Presentation: We report the case of a 38-year-old female patient diagnosed with PRS (stage 2 according to the Guerrerosantos classification), with onset in childhood characterized by left parietal alopecia, followed by progressive left-sided hemifacial atrophy and a linear “en coup de sabre” lesion. Neurological examination was normal, with no history of seizures or focal deficits. Brain MRI revealed ipsilateral cutaneous, subcutaneous, muscular, and osseous atrophy, as well as atrophy of the left parotid and submandibular glands. Additionally, subcortical white matter lesions were identified in the left frontal lobe in the absence of hemispheric cerebral atrophy. Conclusions: This case highlights a significant radioclinical dissociation, demonstrating that central nervous system involvement may occur even in clinically stable and paucisymptomatic forms of PRS. This disease may be associated with subclinical intracranial abnormalities, underscoring the need for systematic neuroimaging evaluation even in the absence of neurological manifestations. Based on the available literature and the specific features of the present case, we propose a practical clinical framework and imaging algorithm to facilitate early diagnosis and to contribute to the standardization of the diagnostic approach in this rare disorder. Full article