Search Results (103)

Background: Despite the widespread implementation of Hepatitis B vaccination, some children fail to develop protective immunity. Thus, identifying markers for vaccine unresponsiveness is crucial for optimizing current strategies. As interleukin-12 (IL-12), a central cytokine in Th 1 immune activation, has shown potential as a predictive biomarker, the aim of this study was to determine its role in the Hepatitis B vaccine response, highlighting novel findings regarding the threshold level of IL-12 in the pediatric population in doing so. Methods: A cross-sectional study was conducted on a community in Bandung City. The subjects were 7–12-month-old babies who had completed primary Hepatitis B vaccination (0, 2, 3, and 4 months of age). Blood tests for anti-HB examination were performed with a Chemiluminescent Microparticle Immunoassay (CMIA) to determine the response and non-response groups, and an Enzyme Immunosorbent Assay (ELISA) was used for IL-12 detection. Data were analyzed using the Kruskal–Wallis test, Chi-square test, Spearman Correlation, and Receiver Operating Characteristics. Statistical analysis was conducted with SPSS version 18.0. Results: The results of this study indicate that 4.5% of the subjects were unresponsive to the Hepatitis B vaccine. The most important finding was a significant correlation between IL-12 and the presence of anti-HB titers in the responsive and non-responsive groups (p = 0.016). The Receiver Operating Characteristics (ROC) curve for IL-12 identified a cut-off point of ≥10.65 pg/mL (>100 mIU/mL in anti-HBs), with a sensitivity of 64.23%, specificity of 68.75%, and accuracy of 65.2%. Conclusions: Interleukin-12 can be considered as an early candidate biomarker for responsiveness to the Hepatitis B vaccine in children. Full article

We tested the longitudinal invariance of seven short versions of the Center for Epidemiological Studies Depression Scale (CES-D) in maternal caregivers, following recent analytic recommendations for ordered categorical responses. Data for this study were drawn from the Longitudinal Studies in Child Abuse and Neglect (LONGSCAN) consortium, based on responses from 427 maternal caregivers across five waves corresponding to their children’s ages: 4, 6, 12, 14, and 16 years. We employed a comprehensive approach using differences in two approximate fit indices (CFI and RMSEA), the chi-square difference test (χ²), and a sensitivity analysis based on predicted response differences. Only one version demonstrated full invariance across all levels, while the others showed only partial evidence for loading or threshold invariance. These findings highlight concerns regarding the use of brief CES-D versions in longitudinal research, particularly over extended time periods. They also underscore the need to reassess whether item content aligns with current definitions of depressive syndrome. Our results suggest that evaluating the longitudinal invariance of short depression measures is essential to ensure the validity of conclusions about changes over time. Full article

Ransomware is one of the types of malware attacks that most severely affects financial institutions, since they cannot afford to lose their data or experience long-term disruptions. It is crucial for financial institutions to protect themselves from ransomware attacks. To fight zero-day ransomware attacks that are previously unseen attacks, we have presented a method that uses the static header features of portable executables. The method forms a comprehensive static feature set that includes the header fields of portable executables, count of dynamic link libraries (DLLs), DLL average, DLL list, function call average, and a measure of section content randomness. In order to make a compact feature set, a threshold was applied to three feature sets: portable executable header, DLL features, and section randomness. To determine the DLL average usage, the Tanimoto coefficient was applied to measure DLL similarity. The same procedure was applied to determine the function call average. The Chi-square test was applied to measure the section content randomness of portable executables. A stacking classifier was applied to measure the performance of the developed feature set. A publicly available dataset was used for the experiments. The results for the detection of zero-day attacks demonstrated averages of 97.15% accuracy, 98.06% recall, and 92.74% F-measure. When compared with other methods using the same dataset, our proposed method provided slightly better performance for many ransomware families. Full article

Objective: This study aims to explore the relationship between mandibular asymmetry (MA), generalized joint hypermobility (GJH), and temporomandibular disorders (TMD) in pre-orthodontic growing individuals. Methods: This cross-sectional study included 74 pre-orthodontic individuals aged 8–16 years. Mandibular asymmetry was evaluated through posteroanterior cephalometric analysis, using menton deviation ≥ 4 mm as the threshold for asymmetry. GJH was assessed using the Beighton Score (BS ≥ 4 = GJH-positive), while TMD was diagnosed based on Axis I of the DC/TMD. Associations among the variables were tested using a chi-square test (p < 0.05; SPSS v.24). Results: The study included 74 patients (25.7% males; mean age 12.7 ± 2.16 years). The GJH-positive group (n = 41) showed a higher prevalence of TMD (85.4%) compared to the GJH-negative group (51.5%) (p = 0.002). MA was more frequent in the GJH-positive group (68.3% vs. 45.5%; p = 0.041). A significant association was also found between TMD and MA (71.2% vs. 27.3%; p < 0.001). In both groups, patients with TMD were more likely to present MA (GJH-negative p = 0.022; GJH-positive p = 0.046). Conclusions: MA emerged as a key factor associated with the presence of TMD, particularly when combined with GHJ. These findings indicate that MA alone is significantly related to the occurrence of TMD, regardless of joint hypermobility status. However, the risk appears to be amplified in individuals who also present with GJH. Effect size analysis indicated that most associations were small, with only the one between TMD and MA reaching a moderate level. This highlights the importance of evaluating statistical significance in the context of effect size to better assess clinical relevance. Full article

Background/Objectives: Sudden sensorineural hearing loss (SSNHL) represents a challenging clinical entity with variable prognosis. Audiometric curve configuration has been proposed as a predictor of recovery. This study aimed to evaluate the association between audiogram morphology at onset and hearing outcome in patients with idiopathic unilateral SSNHL treated with standardized therapy. Methods: We retrospectively analyzed 156 patients with idiopathic SSNHL. Hearing thresholds at key frequencies were measured at baseline and 4 weeks post-treatment. Patients were categorized into upsloping, flat, downsloping, or U-shaped audiogram subgroups. Recovery was classified into four levels. Comparisons were made across subgroups for audiometric and laboratory data using ANOVA and chi-square tests. Results: Baseline PTA values were comparable across audiogram subgroups (p = 0.12). Hearing recovery differed significantly according to audiogram configuration (chi-square, p < 0.001), with upsloping and U-shaped patterns showing the best outcomes. Flat and downsloping curves were associated with poorer recovery, lower HDL, and elevated NLR values. Conclusions: Audiogram configuration is a relevant prognostic marker in SSNHL. Patterns linked to adverse metabolic and inflammatory profiles may benefit from tailored treatment strategies in a personalized medicine framework. Full article

Background: this retrospective cohort study aimed to identify risk factors and establish cutoff values for the initial development of carotid atherosclerosis (CAS) in middle-aged adults. Methods: from an initial cohort of 3583 participants, we finally analyzed 1141 individuals. The observation group comprised subjects who developed CAS without concomitant fatty liver disease (FLD), using their last normal clinical measurements as predictors. The control group consisted of participants who remained free of both CAS and FLD throughout the follow-up period. Statistical analyses included Student’s t-test, Mann–Whitney U test, and chi-square test for group comparisons, along with logistic regression, COX regression, ROC curve analysis, and Kaplan–Meier survival analysis to identify risk factors and determine optimal cutoff values. Repeated-measures ANOVA assessed longitudinal changes. Results: over a mean follow-up of 1.09 years, elevated leukocyte count (AUC: 0.622, 95% CI: 0.540–0.704) and LDL-C (AUC 0.600, 95% CI: 0.516–0.683) were associated with CAS development in middle-aged adults (mean age 49.6 ± 8.0 years). ROC analysis established leukocyte count >5.00 × 10⁹/L and LDL-C >125.1 mg/dL as optimal predictive thresholds. Conclusions: leukocyte count and LDL-C are early warning indicators for CAS development within approximately one year, with leukocyte count showing a slightly stronger correlation with arteriosclerosis progression than LDL-C. Full article

Background/Objectives: Anaemia and malnutrition remain global public health challenges, particularly affecting low-income countries such as Mozambique, especially during the complementary feeding period. This study aimed to assess caregivers’ knowledge, attitudes, and practices (KAPs) regarding infant feeding and to explore associations with anaemia and nutritional status among infants aged 6 to 8 months in urban Maputo. Methods: A cross-sectional baseline survey was conducted in 2024 in two primary health centres. A total of 496 caregiver–child pairs participated. Children underwent anthropometric measurements and haemoglobin testing, and caregivers completed a structured KAP questionnaire. Descriptive statistics were generated, and chi-square tests were used to examine associations between KAP domains and child health outcomes. Results: Anaemia was detected in 77.0% of children, with moderate anaemia being most common (48.6%). Eutrophic nutritional status was observed in 73.1% of children, 7.0% had acute malnutrition, and 14.1% were overweight. While 97.3% of caregivers demonstrated positive attitudes, only 52.1% had adequate knowledge and practices. Adequate knowledge was significantly associated with both the absence of anaemia (p = 0.001) and eutrophic status (p = 0.001). No significant associations were found for attitudes or practices. Caregiver practices were significantly associated with household income, and anaemia was more frequent among children from low-income households. Conclusions: Anaemia was highly frequent among 6–8-month-old infants, even among those with normal weight-for-length and knowledgeable caregivers. This paradox highlights the need for early, integrated interventions, such as nutrition education and home fortification with micronutrient powders, and supports the WHO’s recommendation to revisit haemoglobin thresholds in some contexts. Full article

Background/Objectives: Artificial Intelligence (AI) is increasingly being applied in otolaryngology, including cochlear implants (CIs). This study evaluates the accuracy and completeness of ChatGPT-4 and Microsoft Copilot in determining the appropriate implantation side based on audiological and radiological data, as well as the presence of tinnitus. Methods: Data from 22 CI patients (11 males, 11 females; 12 right-sided, 10 left-sided implants) were used to query both AI models. Each patient’s audiometric thresholds, hearing aid benefit, tinnitus presence, and radiological findings were provided. The AI-generated responses were compared to the clinician-chosen sides. Accuracy and completeness were scored by two independent reviewers. Results: ChatGPT had a 50% concordance rate for right-side implantation and a 70% concordance rate for left-side implantation, while Microsoft Copilot achieved 75% and 90%, respectively. Chi-square tests showed significant associations between AI-suggested and clinician-chosen sides for both AI (p < 0.05). ChatGPT outperformed Microsoft Copilot in identifying radiological alterations (60% vs. 40%) and tinnitus presence (77.8% vs. 66.7%). Cronbach’s alpha was >0.70 only for ChatGPT accuracy, indicating better agreement between reviewers. Conclusions: Both AI models showed significant alignment with clinician decisions. Microsoft Copilot was more accurate in implantation side selection, while ChatGPT better recognized radiological alterations and tinnitus. These results highlight AI’s potential as a clinical decision support tool in CI candidacy, although further research is needed to refine its application in complex cases. Full article

Background/Objectives: We sought to characterize the variance and overlap among definitions of Proximal Junctional Kyphosis (PJK) used in the adult spinal deformity (ASD) literature. PJK is defined as excess in PJK angle, a Cobb angle between the upper-instrumented vertebra (UIV) and a supra-adjacent vertebra (SAV), either one (UIV+1) or two (UIV+2) levels rostral of the UIV. No expert consensus exists for threshold angle or which SAV to use. Methods: A total of 116 thoracolumbar fusion patients ≥ 65 years old were reviewed. The UIV+1 and UIV+2 angles were measured. Six definitions of PJK from the literature were evaluated. These definitions were selected based on citation frequency, historical relevance, and accessibility through commonly used databases. Pearson’s Chi-squared and pairwise comparisons were performed to evaluate the distinctness and agreement rates among these definitions. Results: The six definitions of PJK were as follows: [PJK20] PJK angle ≥ 20° with UIV+2 as the (SAV), [PJK10] PJK angle ≥ 10° with a >10° change from pre-op with UIV+2 as the SAV, [PJK2SD] PJK angle > 2 standard deviations from average with UIV+1 as the SAV, [PJK10+10] PJK angle ≥ 10° with a >10° change from pre-op with UIV+1 as the SAV, [PJK15] PJK angle > 15° with UIV+1 as the SAV, and [PJK30] PJK angle > 30° with UIV+2 as the SAV, or displaced rod fracture, or reoperation within 2 years for junctional failure, pseudoarthrosis, or rod fracture. [PJK10] and [PJK2SD] were the most distinct definitions while [PJK20], [PJK10+10], [PJK15], and [PJK30] showed no significant pairwise differences. [PJK2SD] was stringent, while definition [PJK30] included unique diagnostic information not captured by other definitions. Conclusions: The use of [PJK20], [PJK10+10], [PJK15], or [PJK30] is recommended for consistency, with [PJK15] presenting the best balance. Stringent [PJK2SD] may be beneficial for identifying severe PJK, though with low sensitivity. Overall, PJK definitions must be standardized for the consistent reporting of clinical outcomes and research comparability. Full article

Background: Tyrosine kinase inhibitors (TKIs) have significantly improved outcomes in non-small cell lung cancer (NSCLC), especially among patients with actionable genetic mutations. However, the influence of family and personal medical history (FPMH) on clinical and treatment outcomes with TKI therapy remains underexplored. Methods: We conducted a retrospective cohort study involving 136 NSCLC patients receiving TKIs, categorized into two groups based on the presence or absence of documented FPMH. Clinical variables assessed included demographic data, comorbidities, Eastern Cooperative Oncology Group (ECOG) performance status, tumor characteristics, genetic mutations (EGFR, ALK, ROS1), treatment responses, toxicity profiles, and survival outcomes. Statistical analyses included Chi-square tests, t-tests, Mann–Whitney U tests, Spearman correlation, and univariate logistic regression (p < 0.05 threshold for significance). Results: Patients with FPMH (n = 34) had a significantly higher burden of chronic diseases (58.8% vs. 15.7%), poorer ECOG scores (≥3: 8.8% vs. 1.0%), increased recurrence (41.2% vs. 20.6%), and greater chemotherapy-related toxicity (50.0% vs. 28.4%) compared to those without FPMH (n = 102). However, there were no significant differences in survival duration or mutation status between the two groups. Conclusions: FPMH may be a predictive factor for treatment complications and recurrence in NSCLC patients receiving TKIs, although it does not appear to influence survival or genetic mutation status. These findings support the need for personalized clinical monitoring strategies based on medical history. Full article

Background/Objectives: Cochlear “injury” is thought to be a significant cause of tinnitus in patients with hearing loss. Interestingly, individuals with normal hearing may also experience tinnitus. This study evaluates otoacoustic distortion product emissions (DPOAEs) in individuals with normal hearing who experience tinnitus perception. Methods: In this prospective study, the tinnitus group (TG) consisted of 34 subjects with tinnitus (four unilaterally) and normal hearing (threshold ≤ 25 dBHL at 0.25–8 kHz). The control group (CG) comprised 10 healthy volunteers (20 ears) without tinnitus and normal hearing. Medical history was recorded, and all participants underwent a complete otolaryngological examination, pure tone audiometry, and DPOAE recording (DP-gram, L1 = 55 dB, L2 = 65 dB, for F2: 619–10,000 Hz). Moreover, participants in the TG completed a detailed tinnitus history (with self-rated loudness scoring) and the Tinnitus Handicap Inventory (Greek-version THI-G) and underwent tinnitus analysis. Results: The recorded mean DPOAE values during the DP-gram of the CG were significantly larger in amplitude at low (t-test, Bonferroni-corrected p < 0.09) and high frequencies (t-test, Bonferroni-corrected p < 0.02) compared with the TG. Tinnitus assessment showed tinnitus pitch matching at the frequency area in the DP-gram, where the acceptance recording criteria were not met. There were no statistically significant differences in tinnitus onset, self-rated loudness scores of >70, and severe disability (THI-G > 58) for TG subjects in whom DPOAEs were not recorded at frequencies of ≤1000 Hz. Participants with abnormal DPOAEs at around 4000 Hz had tinnitus of sudden onset and severe disability (THI-G > 58). Finally, those with pathological recordings of DPOAEs at ≥6000 Hz had gradual onset tinnitus (Pearson Chi-square test, p < 0.05). Conclusions: DPOAEs in normal hearing individuals with tinnitus show lower amplitudes in low and high frequencies compared with normal hearing individuals without tinnitus. The tinnitus matched-frequency coincided with the frequency area where DPOAEs were abnormal. Full article

Objective: The aim of this study was to describe the presenting characteristics and outcomes of neonates with respiratory failure referred for extracorporeal membrane oxygenation (ECMO) support, compare those who received ECMO support (ECMO group) to those who did not (non-ECMO group), and evaluate the predictive variables requiring ECMO support. Methods: All neonates (<15 days) with respiratory failure (without congenital diaphragmatic hernia or congenital heart disease) referred to our regional ECMO center from 2014 to 2023 were included in this retrospective study. Patient demographics, birth history, and clinical and outcome variables were analyzed. Oxygenation indices and vasoactive–inotropic scores obtained at PICU arrival and four hours after arrival were compared between the two groups using ROC analysis, with ECMO initiation as an outcome variable. Youden’s index was used for optimal threshold values. Chi-square, Mann–Whitney U, and binary logistic regression were used for comparative analyses. Results: Out of the 147 neonates, 96 (65%) required ECMO support. The two groups significantly differed in the prevalence of pulmonary hypertension (pHTN; systemic or suprasystemic pulmonary pressures), lactate level, and oxygenation indices. Mortality was not different between the two groups. Presence of oxygen saturation index (OSI) ≥ 10 had a sensitivity 96.8% in predicting the need for ECMO support. On regression analysis, OSI and pHTN were independent predictors of ECMO support. Conclusions: Oxygenation indices and echo findings predict the need for ECMO support in neonatal hypoxemic respiratory failure. These findings help non-ECMO centers make appropriate and timely transfers of neonates with respiratory failure to ECMO centers. Full article

In complex underwater environments, the stability of navigation for autonomous underwater vehicles (AUVs) is critical for mission success. To enhance the reliability of the AUV-integrated navigation system, fault detection technology was investigated. Initially, the causes and classifications of faults within the integrated navigation system were analyzed in detail, and these faults were categorized as either abrupt or gradual, based on variations in sensor output characteristics under fault conditions. To overcome the limitations of the residual chi-square method in detecting gradual faults, a cumulative residual detection approach with error coefficient amplification was proposed. The algorithm enhances gradual fault detection by using eigenvalue analysis and constructing fault-frequency-based error amplification coefficients with non-parametric techniques. Furthermore, to improve the detection of gradual faults, artificial intelligence-based fault detection methods were also explored. Specifically, the particle swarm optimization (PSO) algorithm was employed to optimize the hyperparameters of a long short-term memory (LSTM) neural network, leading to the development of a PSO-LSTM fault detection model. In this model, the fault detection function was formulated by comparing the predictions generated by the PSO-LSTM model with those derived from the Kalman filter. The experimental results demonstrated that the fault detection function formulated by PSO-LSTM exhibited enhanced sensitivity to gradual faults and enabled the timely isolation of faulty sensors. In unfamiliar marine regions, the PSO-LSTM method demonstrates greater stability and avoids the need to recalibrate detection thresholds for each sea area—an important advantage for AUV autonomous navigation in complex environments. Full article

Improved medical treatments have extended survival and life expectancy in adults with congenital heart defects (ACHD), placing greater emphasis on psychosocial health. Up to one-third of ACHD experience anxiety or depression, and half develop a mental illness during their lifetime. While there is solid evidence on the prevalence of mental health, many do not receive psychological, psychotherapeutic, or psychiatric treatment (PST) and the psychological care situation remains understudied. In a nationwide, online cross-sectional survey conducted in Q1 2024, 1486 ACHD aged 18 to 85 (M_age = 36.84 years; 60.8% female) registered in the German National Register for Congenital Heart Defects (NRCHD) completed self-report questionnaires on sociodemographics, illness identity (Illness Identity Questionnaire), mental well-being, and utilisation of PST. CHD diagnoses were determined in conformity with the International Pediatric and Congenital Cardiac Code (IPCCC) and CHD was classified according to Warnes et al. (simple/moderate/complex). Analyses included chi-square tests, t-tests, and binary logistic regression. Overall, 32.8% of participants reported current and/or previous PST (women 37.5%, men 25.3%). PST utilisation was significantly higher in those with complex (40.2%) compared to moderate (29.6%) and simple CHD (25.3%) (ps < 0.01). Primary treatment reasons were mental illness (41.7%) and CHD-related concerns (37.2%). Nearly half of treatments were self-initiated (45.8%) and about one-third were physician-recommended (30.8%). Logistic regression revealed CHD severity as a significant predictor of PST use (ps < 0.05), with lower odds for simple (OR = 0.48) and moderate (OR = 0.66) compared to complex CHD when controlling for sex (p < 0.001, OR = 1.87), age (p = 0.022, OR = 1.011), education level (ps between 0.060 and 0.780), and net income (ps < 0.05). Those receiving PST showed significantly higher maladaptive illness-identity scores (engulfment, rejection) and lower acceptance. Approximately one in three ACHD requires mental health support, particularly those with complex CHD. The CHD itself acts as a key stressor and treatment motivator. Findings underscore the need for integrated care linking cardiological and psychosocial services. Routine screening for psychological distress and low-threshold access to PST—also for patients with simple and moderate CHD—are essential to identify and address mental health needs early. Full article

Background: Patients with inflammatory bowel disease (IBD) experience disproportionately high rates of anxiety and depressive symptoms, representing a 2–3-fold increased risk versus the general population. While psychological morbidity is well-documented, the relative contributions of disease activity (active vs. inactive), IBD subtype (ulcerative colitis [UC] vs. Crohn’s disease [CD]), and sociodemographic factors remain clinically contested. This study aimed to quantify these relationships to guide targeted interventions. Methods: We conducted a cross-sectional, single-center study comparing 94 consecutive IBD patients (61 UC, 33 CD; mean age 34.2 ± 11.1 years) with 79 age- and sex-matched healthy controls. The psychological status was assessed using the validated Turkish version of the Hospital Anxiety and Depression Scale (HADS), with 14 items (7 per subscale, 0–21 range) and established cutoffs (≥10 for anxiety, ≥7 for depression). Disease activity was objectively classified: UC patients via the Truelove–Witts Index (inactive, mild, moderate, or severe) and CD patients via the Crohn’s Disease Activity Index (CDAI < 150 inactive, ≥150 active). Statistical analyses employed SPSS 20.0 (IBM Corp., Armonk, NY, USA), including Student’s t-tests, Mann–Whitney U tests, and chi-square tests, with p < 0.05 as the significance threshold. Results: Disease activity was the strongest predictor: active IBD patients exhibited 64% higher anxiety symptom scores (11.2 ± 3.1 vs. 6.8 ± 2.4, p < 0.001) and 107% higher depressive symptom scores (8.9 ± 2.7 vs. 4.3 ± 1.9, p < 0.001) than inactive patients. Gender and education modulated the risk: females showed 23% elevated anxiety (OR 1.23, 95% CI 1.06–1.43; p = 0.008), while college education correlated with 31% lower depression odds (OR 0.69, 95% CI 0.51–0.93; p = 0.026). Strikingly, 32.1% of IBD patients met depressive symptom thresholds versus 17.7% of controls (p = 0.028). No UC/CD subtype differences emerged (p > 0.05). Conclusions: Our findings confirm that active IBD inflammation—not the disease subtype (UC/CD)—is the strongest predictor of anxiety and depressive symptoms, with one in three patients meeting clinical depression thresholds. Women and those with less education face heightened risks, underscoring the need for routine mental health screening during flares and targeted psychosocial support. These results advocate for integrated psychiatric care in IBD management to address this invisible burden. Full article