Search Results (14,678)

Background/Objectives: The relationship between diabetes and pancreatic cancer (PCa) is controversial. In this meta-analysis and systematic review, we investigated diabetes and time since diagnosis as risk factors for PCa. Methods: Cohort and case-control studies were retrieved through a literature search. RevMan 5.4 software and a random effects model were used to estimate summary risks with their 95% confidence intervals (CIs), and the Newcastle–Ottawa Scale (NOS) was used to assess study quality. Results: Included were 23 studies representing 30,875,355 participants and 86,980 cases of PCa. The summary risk for the 14 case-control studies was 2.30 (95% CI: 2.03–2.62) and for the 9 cohort studies was 2.39 (95% CI: 2.09–2.73). The risk decreased with time after diabetes diagnosis: 3.27, 2.25, 1.55, and 1.12 for <2, 2–5, 5–10, and >10 years, respectively, in the case-control studies. The cohort studies also showed an increased risk of PCa in the first 2 years (4.29) and a decrease over time. Quality scores according to the NOS were 6–9 (good and fair quality), for an overall average of 7.82. Conclusions: Diabetes is a risk factor for PCa and this risk is much higher in the 2 years following diabetes diagnosis. In this period, the subgroup of patients who, through clinical follow-up and/or cancer screening, would have better clinical outcomes should be identified. Bearing in mind the poor survival rate for PCa, diabetes interventions focused on preventing onset and delaying progression via modifiable risk factors to reduce PCa incidence. Full article

Modern healthcare and engineering both rely on robust reliability models, where handling censored data effectively translates into longer-lasting devices, improved therapies, and safer environments for society. To address this, we develop a novel inferential framework for the ZLindley (ZL) distribution under the improved adaptive progressive Type-II censoring strategy. The proposed approach unifies the flexibility of the ZL model—capable of representing monotonically increasing hazards—with the efficiency of an adaptive censoring strategy that guarantees experiment termination within pre-specified limits. Both classical and Bayesian methodologies are investigated: Maximum likelihood and log-transformed likelihood estimators are derived alongside their asymptotic confidence intervals, while Bayesian estimation is conducted via gamma priors and Markov chain Monte Carlo methods, yielding Bayes point estimates, credible intervals, and highest posterior density regions. Extensive Monte Carlo simulations are employed to evaluate estimator performance in terms of bias, efficiency, coverage probability, and interval length across diverse censoring designs. Results demonstrate the superiority of Bayesian inference, particularly under informative priors, and highlight the robustness of HPD intervals over traditional asymptotic approaches. To emphasize practical utility, the methodology is applied to real-world reliability datasets from clinical trials on leukemia patients and hydrological measurements from River Styx floods, demonstrating the model’s ability to capture heterogeneity, over-dispersion, and increasing risk profiles. The empirical investigations reveal that the ZLindley distribution consistently provides a better fit than well-known competitors—including Lindley, Weibull, and Gamma models—when applied to real-world case studies from clinical leukemia trials and hydrological systems, highlighting its unmatched flexibility, robustness, and predictive utility for practical reliability modeling. Full article

Background: Diabetes often causes microvascular complications such as neuropathy. Autonomic neuropathy remains under-recognized, and its impact on quality of life (QoL) is unclear. This study investigated associations between symptoms of autonomic dysfunction, including organ-specific subdomains, and QoL in individuals with type 1 (T1D) and type 2 diabetes (T2D). Methods: A cross-sectional population-based survey was conducted in the North Denmark Region among individuals with T1D and T2D, assessing autonomic symptom burden with the Composite Autonomic Symptom Score-31 (COMPASS-31), general well-being with the Short Form Health Survey (SF-36), and psychological well-being with the Hospital Anxiety and Depression Scale. Multivariate linear regression assessed associations between autonomic symptom scores and QoL outcomes. Results: The COMPASS-31 scores were 8.9 (2.9; 22.8) in T1D and 12.4 (5.3; 26.1) in T2D. SF-36 physical composite scores were 52.1 (43.2; 56.4) in T1D and 49.3 (40.3; 54.8) in T2D, with similar mental composite scores (50.7 (40.3; 56.9) vs. 51.4 (41.2; 57.2)). Signs of moderate to severe anxiety were observed in 9.9% (95% confidence interval (CI): 8.1–11.9) of T1D and 8.9% (95% CI: 8.1–9.6) of T2D, while depression was present in 5.9% (95% CI: 4.5–7.6) and 5.1% (95% CI: 4.5–5.7). Higher autonomic symptom burden, especially pupillary, vasomotor, and bladder domains, was associated with lower SF-36 score and higher anxiety and depression scores. Conclusions: the Autonomic symptom burden is associated with reduced QoL and increased psychological distress in individuals with diabetes. These findings emphasize the importance of assessing and managing autonomic symptoms in diabetes care to support overall well-being. Full article

Study objective: Electronic vapor product (EVP) use remains prevalent among adolescents in the United States. EVP use may be associated with high-risk substance use behaviors. This study investigates the association between current EVP use and current opioid misuse in high school students. Methods: We conducted a secondary analysis of the 2021 Youth Risk Behavior Survey (YRBS) (n = 7471). We first examined the prevalence rates of current prescription opioid misuse between participants ages 14 to 19 who reported any EVP use compared to those who did not report any EVP use. We conducted an adjusted Poisson regression analysis to determine whether EVP use was associated with prescription opioid misuse after controlling for multiple variables, including age, biological sex, race, ethnicity, alcohol use, other tobacco use, marijuana use, and depressive symptoms. Results: Among participants, 17.2% (95% confidence interval (CI): 15.4–19.1%) reported current EVP use. The prevalence of current opioid misuse was higher in the group of students who use EVPs (13.3%) as compared to students who do not use EVPs (3.2%) (p < 0.0001). Compared to participants who did not use EVPs, those with EVP use had an 80% greater prevalence of opioid misuse, after adjusting in regression analyses (adjusted prevalence rate ratio: 1.8, 95% CI: 1.4–2.3, p < 0.0001). Conclusions: Our findings highlight the significantly increased prevalence of opioid misuse among this population and the need to educate adolescents about the additional risks associated with nicotine and EVP use. Longitudinal studies are needed to test causal relationships and better understand the biobehavioral mechanisms that connect EVP use and opioid misuse. Full article

Background/Objectives: We compared the efficacy of audiovisual sexual stimulation (AVSS) using 3D virtual glasses with a desktop monitor. Methods: In this randomized crossover study, 60 patients with ED underwent two penile duplex Doppler ultrasound sessions 1 week apart, each after intracavernosal prostaglandin E1 injection. Patients were randomly assigned to receive AVSS via 3D virtual glasses or a desktop monitor in the first session, with crossover in the second. We measured the resistive index (RI), erectile hardness score (EHS), peak systolic velocity (PSV), anxiety (State-Trait Anxiety Inventory), and satisfaction (visual analog scale). Results: 3D virtual glasses were associated with superior outcomes. The linear mixed models analysis showed higher adjusted mean RI (p < 0.001), PSV (p < 0.001), and satisfaction (p < 0.001) for 3D glasses. Generalized estimating equations analysis showed patients were 6.68 times more likely to achieve functional erection (EHS ≥ 3) with 3D glasses (odds ratio 6.68, 95% confidence interval [2.54, 17.55], p < 0.001). Anticipatory anxiety before subsequent examinations was lower with virtual glasses (p < 0.001). Conclusions: AVSS with 3D virtual glasses is associated with superior hemodynamic parameters and clinical responses consistent with reduced false-positive diagnoses. It also lowers anticipatory anxiety for subsequent procedures, enhancing patient experience. Full article

Introduction: Robotic splenectomy has emerged as a promising alternative to laparoscopic surgery, offering potential advantages in precision, ergonomics, and individualized surgical planning. In the context of personalized medicine, robotic technology may enable tailoring of surgical strategies to patient-specific anatomy, spleen size, and comorbid hematologic conditions. However, its clinical superiority remains uncertain due to limited and heterogeneous evidence. Methods: We performed a systematic review and meta-analysis following PRISMA guidelines, utilizing PubMed, CINAHL, Web of Science, and EMBASE databases to locate studies on robotic splenectomies in children. This review was prospectively registered in PROSPERO (CRD420251104285). Risk of bias was assessed using the ROBINS-I tool for non-randomized studies. Random-effects models were fitted using restricted maximum likelihood (REML), and confidence intervals were adjusted using either Knapp–Hartung (HKSJ) or modified Knapp–Hartung (mKH) methods when appropriate. 95% prediction intervals were calculated, and the certainty of evidence for each outcome was assessed using the GRADE approach. Results: This review included 272 pediatric patients from 16 studies conducted between 2003 and 2025, of which five were included in the meta-analysis. No statistically significant differences were observed between robotic and laparoscopic splenectomy for operative time, intraoperative blood loss, conversion to open surgery, blood transfusions, or complications. However, the direction of effect estimates consistently favored the robotic approach. A statistically significant reduction in hospitalization days (−0.93 days; 95% CI: −1.61 to −0.24; p = 0.01) was found, though this became marginally significant after HKSJ adjustment (p = 0.06). Intraoperative blood loss showed significance in the primary model (−63.88 mL; 95% CI: −120.38 to −7.38; p = 0.03), but not after mKH correction (p = 0.16). Heterogeneity was substantial-to-extreme for several outcomes and was only partially accounted for by leave-one-out sensitivity analyses. All findings were rated as very low certainty according to the GRADE framework. Conclusions: Robotic-assisted splenectomy in pediatric patients has been reported as technically feasible and performed safely in selected cases. However, the small number of studies, their retrospective design, substantial methodological heterogeneity, and the resulting very low certainty of the evidence according to GRADE preclude any firm conclusions about its comparative safety or efficacy versus laparoscopy. Well-designed prospective studies are needed to clarify its clinical benefits. Full article

The paper presents a comparison of two methods for determining the burning time of an electric arc in a vacuum chamber: the classic oscilloscope method and the author’s own photographic analysis using an ultra-high-speed camera. A specially designed laboratory station enabled precise recording of electrical and optical parameters during switching operations conducted at different pressures in the discharge chamber. The photographic method consisted of a time-lapse analysis of the ignition and extinction of the arc using dedicated software to precisely determine its duration based on the recorded images. In total, five repeated measurements were performed for each pressure value. All the results were subjected to a detailed statistical analysis, including the determination of standard deviations and confidence intervals. The reported mean relative error for the new photographic method did not exceed 1.12%. The developed photographic method proved to be a reliable tool for assessing the duration of the arc, while also enabling a detailed analysis of the dynamics of arc channel development. Possible applications include laboratory testing and diagnostics of switching devices, especially where traditional measurement methods are difficult to apply. Full article

Power line sag monitoring is critical for ensuring transmission system reliability and optimizing grid capacity utilization. Traditional sag detection methods rely on hyperbolic cosine models that assume ideal catenary behavior under uniform loading conditions. However, these models impose restrictive assumptions about weight distribution and suspension conditions that limit accuracy under real-world scenarios involving wind loading, ice accumulation, and non-uniform environmental forces. This study introduces a novel Bézier curve-based mathematical framework for transmission line sag detection and monitoring. Unlike traditional hyperbolic cosine approaches, the proposed methodology eliminates idealized assumptions and provides enhanced flexibility for modeling actual conductor behavior under variable environmental conditions. The Bézier curve approach offers enhanced precision and computational efficiency through intuitive control point manipulation, making it well suited for Dynamic Line Rating (DLR) applications. Experimental validation was performed using a controlled laboratory setup with a 1:100 scaled transmission line model. Results demonstrate improvement in sag measurement accuracy, achieving an average error of 1.1% compared to 6.15% with traditional hyperbolic cosine methods—representing an 82% improvement in measurement precision. Statistical analysis over 30 independent experiments confirms measurement consistency with a 95% confidence interval of [0.93%, 1.27%]. The framework also demonstrates a 1.5 to 2 times increase in computational efficiency improvement over conventional template matching approaches. This mathematical framework establishes a robust foundation for advanced transmission line monitoring systems, with demonstrated advantages for power grid applications where traditional catenary models fail due to non-ideal environmental conditions. The enhanced accuracy and efficiency support improved Dynamic Line Rating implementations and grid modernization efforts. Full article

Background: A comprehensive medical history is fundamental to dental care, supporting accurate diagnosis, personalized treatment, and the prevention of adverse outcomes. Despite its importance, patients may underestimate its relevance or hesitate to disclose information to dental professionals. This study aimed to assess patients’ awareness and willingness to disclose medical histories to dental professionals, as well as the effect of an educational intervention on their knowledge. Methods: A descriptive cross-sectional study was conducted from 1 December 2023 to 30 September 2024 in Riyadh, Saudi Arabia. Data were collected through a structured bilingual questionnaire assessing demographics, awareness of the importance of medical history, willingness to disclose information, and post-intervention knowledge. The questionnaire’s validity and reliability were established through expert evaluation and test–retest reliability, yielding Aiken’s V values greater than 0.90. Internal consistency was confirmed with a Cronbach’s alpha coefficient of 0.8. A convenience sampling technique was used to recruit the study participants. Results: A total of 515 participants completed the survey, with 43.9% withholding medical information from their dentists. Chi-square analysis revealed that disclosure practices were significantly associated with demographic factors, particularly age (p ≤ 0.05). Although 90.7% acknowledged the importance of sharing their medical history, only 67.8% reported disclosing it to dental professionals. The regression analysis revealed that participants under 18 years of age (Odds Ratio (OR) 7.08, Confidence Interval (CI) 3.53–50.90) and those aged 18–29 years (OR 14.36, CI 3.45–25.26), as well as participants with elementary (OR 4.55, CI 2.72–20.57) and middle school education levels (OR 4.55, CI 2.72–20.57), were less likely to disclose any underlying medical condition to their dentist. The younger age group (under 18) respondents were significantly more likely to indicate that it was not essential to inform the dentist about their medical condition (OR 6.60, CI 1.05–41.42). Additionally, a significant number of these respondents (OR 5.77, CI 1.87–17.84) reported being unaware of the reasons why dentists request this information, compared to the older age groups. Conclusions: The findings reveal a significant knowledge gap concerning patient disclosure of medical history in dental care and highlight the importance of patient education. Implementing targeted educational initiatives is recommended to promote patient disclosure, foster interdisciplinary collaboration, and improve overall patient safety and treatment outcomes. Full article

Urban green spaces provide measurable cooling that can mitigate urban heat islands, yet few studies have quantified these effects over multiple decades. This study analyzed Landsat imagery from four epochs (1990, 2000, 2013, 2018) to derive land surface temperature (LST) and vegetation indices—NDVI for greenness and NDMI for moisture content—for four large urban parks in Krakow. Late spring/summer LST in parks was compared with that of urban areas within 0–150 m and 150–300 m of park boundaries. Statistical significance was evaluated using bootstrapped confidence intervals, long-term trends were assessed via the Mann–Kendall test, and correlation analysis was used to examine relationships between LST and each vegetation index. Results show a persistent park cooling effect, with park interiors ~2–3 °C cooler than adjacent urban areas in all years. Despite an overall city-wide LST rise of ~5–6 °C from 1990 to 2018, the park cool island intensity (temperature difference between park and city) remained stable (no significant long-term trend, p > 0.7). Bootstrapped 95% confidence intervals confirmed that each park’s cooling effect was statistically significant in each year analyzed. NDMI (vegetation moisture content) correlated more strongly with LST (r ~ −0.90) than NDVI (r ~ −0.7 to −0.9), highlighting the importance of vegetation moisture in park cooling. These findings demonstrate that well-watered urban parks can sustain substantial cooling benefits over decades of urban development. The persistent ~2–3 °C daytime cooling observed underscores the value of water-sensitive green space planning as a long-term urban heat mitigation strategy. Full article

Objectives: Maternal folic acid supplementation is recommended to prevent neural tube defects (NTDs), yet its influence on offspring neurodevelopmental disorders (NDDs) remains uncertain. This umbrella review aims to evaluate whether maternal folic acid supplementation before and/or during pregnancy affects the risk of NDDs. Methods: We conducted a systematic search in MEDLINE, Cochrane Library, EMBASE, PubMed, and Web of Science from inception to 30 June 2025, to identify systematic reviews (SRs) and meta-analyses (MAs) that synthesized evidence from non-randomized studies on maternal folic acid supplementation and NDDs. Methodological quality was assessed using the AMSTAR-2 assessment and evidence certainty using the GRADE framework. Results: A total of 23 SRs/MAs were included, of which 14 did not perform meta-analysis. Most included SRs/MAs were methodologically limited, with 50.00% rated as very low quality and only 36.37% achieving high or moderate quality. MAs indicated a protective effect of supplementation, with odds ratio (OR) of 0.66 (95% confidence interval (CI): 0.55–0.79) for autism spectrum disorder (ASD), 0.86 (95% CI: 0.78–0.95) for attention-deficit/hyperactivity disorder (ADHD), and 0.75 (95% CI: 0.63–0.91) for behavioral problems. No significant associations were found for motor, intellectual/cognitive, or language development. SRs reported inconsistent conclusions across most outcomes. Conclusions: In summary, maternal folic acid supplementation may reduce the risk of ASD, ADHD, and behavioral problems in offspring. Although the current evidence is of low quality, supplementation guidelines are justified by the well-established benefits for NTDs. Further research is required to address remaining uncertainties. Full article

Background/Objectives: Pacemaker-associated heart failure (PaHF) is a recognized complication of chronic ventricular pacing, yet its long-term incidence and prognostic impact remain incompletely defined. Previous studies on PaHF have been largely limited by small sample sizes, single-center designs, and insufficient long-term or time-dependent analyses. We aimed to evaluate the incidence, clinical predictors, and mortality risk of PaHF in a nationwide real-world cohort. Methods: Using the Korean National Health Insurance Service database, we identified 32,216 patients who underwent de novo pacemaker implantation between 2008 and 2019 without prior heart failure. Results: During a median follow-up of 3.8 years, 4170 patients (12.9%) developed new-onset PaHF and 6184 (19.2%) died. PaHF was independently associated with increased all-cause mortality (adjusted hazard ratio [HR]: 3.11, 95% confidence interval [CI]: 2.93–3.32, p < 0.001), even after accounting for immortal-time bias and relevant covariates. The incidence of PaHF and its associated mortality risk both peaked within the first six months post implantation and remained persistently elevated throughout follow-up; notably, PaHF-associated mortality showed a late resurgence. Sensitivity and subgroup analyses consistently demonstrated higher mortality among patients with PaHF across a wide range of clinical characteristics. Conclusions: In this large, nationwide cohort, the development of PaHF was associated with a substantial and sustained increase in mortality risk following pacemaker implantation. Given the persistent and dynamic nature of this risk, longitudinal monitoring of cardiac function and individualized pacing strategies may be warranted to mitigate long-term adverse outcomes. Additionally, these findings provide real-world benchmarks to guide future pacing strategies and surveillance efforts. Full article

The Poisson distribution is a discrete probability model, widely used in science and engineering to describe various natural and man-made phenomena. It possesses an important feature, namely being inherently asymmetric, but as its parameter becomes large, the distribution becomes approximately symmetric. To broaden its use, multiple extensions and variations have been developed. Determining whether a data set follows a Poisson distribution involves hypothesis testing at a chosen significance level. When sampling from a Poisson distribution, confidence intervals provide an estimated range instead of a single value. Due to the discrete nature of the Poisson distribution, confidence intervals cannot be derived from a simple formula, and are therefore computed using specialized algorithms. In this paper, three alternatives are given and discussed. Full article

Objective: To determine whether a third-trimester drop in insulin requirements in pregnant people with pre-existing diabetes is associated with a subsequent occurrence of adverse pregnancy outcomes. Research Design and Methods: We conducted a retrospective cohort study of patients with type 1 and 2 diabetes who were followed at a tertiary referral center in Toronto, Canada. We collected data on insulin dosing in the third trimester (after 28 weeks of pregnancy) and compared outcomes in those with and without a third-trimester drop of 15% or more in their total insulin requirements. Our primary outcome was a composite of stillbirth, spontaneous preterm birth or preterm premature rupture of membranes, and iatrogenic preterm birth or cesarean birth for fetal wellbeing concerns, occurring following the drop in insulin requirements. We conducted regression analyses controlling for early pregnancy glycosylated hemoglobin, body mass index, and diabetes-related microvascular disease, and presented results as odds ratios (OR) with 95% confidence intervals (95%CI). Results: We included 350 pregnant people—146 with type 1 and 204 with type 2 diabetes. Of these, 54 (15.4%) had a third-trimester drop of 15% or more in their total insulin requirements. There was no difference in the primary outcome between groups (OR 0.97; 95% CI 0.41–2.10). Conclusions: Based on this single-center study, limited by sample size and analytic constraints, in people with pre-existing diabetes, a third-trimester drop of ≥15% in total insulin requirements was not associated with subsequent occurrence of adverse pregnancy outcomes. Larger prospective studies looking at associations between a drop in insulin requirements and subsequent occurrence of adverse pregnancy outcomes are necessary to inform meta-analyses and clinical decision making. Full article

Background/Objectives: Numerous older patients undergo transcatheter valve implantation (TAVI) and frequently experience preoperative malnutrition and anemia, which markedly influence postoperative outcomes. This study investigated whether the Hemoglobin-Geriatric Nutritional Risk Index (H-GNRI) could predict major adverse cardiovascular events (MACEs) after TAVI. Methods: Patients who underwent TAVI at a single institution were classified into three groups according to their H-GNRI scores: low-risk (H-GNRI score = two), intermediate-risk (H-GNRI score = one), and high-risk (H-GNRI score = zero). The primary outcome was the occurrence of MACEs post-TAVI, and Kaplan–Meier survival and Cox proportional-hazard analyses were performed. Results: Of the 205 patients analyzed, 123, 67, and 15 were assigned H-GNRI scores of two, one, and zero. Kaplan–Meier survival analysis revealed that patients with H-GNRI scores of one and zero developed significantly more MACEs than those with a score of two (log-rank p = 0.0030; 1 vs. 2, p = 0.0032; 0 vs. 2, p = 0.0077). In the Cox proportional-hazard analysis, factors associated with MACEs included H-GNRI score (using score two as reference; score one: hazard ratio [HR] = 2.02, 95% confidence interval [CI] = 1.10–3.60, p = 0.021; score 0: HR = 2.67, 95% CI = 1.10–6.44, p = 0.028), procedure time (HR = 1.00; 95% CI = 1.00–1.01; p = 0.0093), and length of hospital stay after TAVI (HR = 1.02; 95% CI = 1.01–1.04, p = 0.0003). Conclusions: Preoperative H-GNRI scores were markedly associated with the incidence of postoperative MACEs in patients undergoing TAVI. Full article