Search Results (28,705)

Background: Previous longitudinal evidence suggested that screen exposure at age 4 was associated with dysregulation symptoms and lower academic achievement up to age 8. Yet, it remains unclear whether these effects persist in preadolescence and extend to higher-order developmental outcomes such as the capacity to be alone, a marker of self-regulation and autonomy within the developmental psychopathology framework. Aim: This follow-up study re-contacted the original cohort at age 12 (T3) to examine whether early screen time predicted dysregulation, academic achievement, and capacity to be alone, testing the mediating role of dysregulation at ages 6 (T1) and 8 (T2), and the moderating role of maternal scaffolding at age 4. Methods: A community sample of N = 323 children and their mothers, previously assessed at T0–T2, was re-evaluated at T3 (mean age = 12.2 years, SD = 0.7). At T0, screen exposure and maternal scaffolding were measured using the StimQ (PIDA subscale). Dysregulation at T1–T3 was assessed with the Teacher Report Form (TRF). Academic achievement in mathematics and literacy was rated by teachers using the Teacher Academic Ratings. At T3, children also completed the Capacity to Be Alone Scale for Children (CBASC). Structural Equation Modeling (SEM) tested longitudinal direct, indirect, and moderated pathways, adjusting for sex, maternal education, and socioeconomic status. Results: Screen time at age 4 was associated with elevated dysregulation at T1 and T2, which in turn mediated poorer mathematics and literacy outcomes and reduced capacity to be alone at age 12 (all p < 0.01). Maternal scaffolding buffered early dysregulation but did not prevent long-term academic or self-regulatory impairments. Conclusions: Findings indicate that early excessive screen use contributes to a cumulative cascade of dysregulation, undermining both academic achievement and the developmental capacity to be alone by preadolescence. Preventive strategies should integrate screen-time guidelines with parental scaffolding interventions. Full article

Background/Objectives: Spinal fusion with static fixation—surgically joining two or more vertebrae to eliminate motion—is commonly employed to treat degenerative spinal disease. However, the rigidity imposed by static constructs and the increased load on the adjacent segments frequently result in complications such as disc or facet degeneration, spinal stenosis (SS), and segmental instability. This study investigates the effectiveness of pedicle-based dynamic stabilization using the Dynesys system, particularly in a dynamic-transitional optima (DTO) hybrid configuration, in mitigating adjacent segment disease (ASD) and improving clinical outcomes. In this work, we analyzed the mechanical performance and intermediate-term clinical effects of the DTO hybrid lumbar device, focusing on how the load-sharing properties of the Dynesys cord–spacer stabilizers may contribute to junctional complications in individuals with diverse grades of intervertebral disc degeneration. Study Design/Setting: We designed a combined biomechanical finite element (FE) and experimental analysis to predict the clinical outcomes. Patient Sample: Among 115 patients with lumbar SS enrolled for analysis, 31 patients (mean age: 68.5 ± 7.5 years), with or without grade I spondylolisthesis (18/13), underwent a two-level DTO hybrid procedure—L4–L5 static fixation and L3–L4 dynamic stabilization—with minimal decompression to preserve the posterior tension band. Post-surgical follow-ups were conducted for over 48 months (range: 49–82). Outcome Measures: Radiological assessments were performed by two neurosurgeons, one orthopedic surgeon, and one neuroradiologist. The posterior disc height, listhesis distance, and dynamic angular changes were measured pre- and postoperatively to evaluate ASD progression. Methods: Dynamic instrumentation was assigned to the L3–L4 motion segment with lesser disc deterioration, in contrast to the L4–L5 segment, where static fixation was applied due to its greater degree of degeneration. FE analysis was performed under displacement-controlled conditions. Intersegmental motion analysis was conducted under load-controlled conditions in a synthetic model. Results: The DTO hybrid devices reduced stress and motion at the transition segment. However, compensatory biomechanical effects were more pronounced at the adjacent cephalad than the caudal segments. In the biomechanical trade-off zone—where balance between motion preservation and stabilization is critical—the flexible Dynesys cord significantly mitigated stiffness-related issues during flexion. At the L3–L4 transition level, the cord–spacer configuration enhanced dynamic function, increasing motion by 2.7% (rotation) and 12.7% (flexion), reducing disc stress by 4.1% (flexion) and 12.9% (extension), and decreasing the facet contact forces by 4.9% (rotation) and 15.6% (extension). The optimal cord stiffness (50–200 N/mm) aligned with the demands of mild disc degeneration, whereas stiffer cords were more effective for segments with higher degeneration. The pedicle screw motion in dynamic Dynesys systems—primarily caused by axial translation rather than vertical displacement—contributed to screw–vertebra interface stress, influenced by the underlying disc or bone degeneration. Conclusions: Modulating the cord pretension in DTO instrumentation effectively lessened the interface stress occurring at the screw–vertebra junction and adjacent facet joints, contributing to a reduced incidence of pedicle screw loosening, ASD, and revision rates. The modified DTO system, incorporating minimal decompression and preserving the posterior complex at the dynamic level, may be biomechanically favourable and clinically effective for managing transitional degeneration over the mid-term. Full article

Background/Objectives: Breast cancer is the most common cancer among Spanish women. Carriers of certain genetic variants are at increased risk, which can significantly impact their quality of life. The main objective of the present research was to describe the health-related quality of life in women with breast cancer-associated genetic risk variants, distinguishing between those who had already developed cancer and those who did not. Additionally, we aimed to identify the variables influencing the decision to undergo risk-reducing surgery. Methods: Descriptive using the questionnaires BREAST-Q, SF-12 and DASS-21. Results: A total of 63 women participated, with a mean age of 43.38 years. In the 38.1% the genetic variant was identified during the diagnosis of breast cancer, while the rest did not have cancer. We found significantly lower scores for women with breast cancer in the BREAST-Q modules Satisfaction with breasts (p = 0.035) and Physical well-being: chest (p = 0.007), as well as in the physical component of SF-12 questionnaire (p = 0.005). Anxiety scores with DASS-21 were significantly higher in breast cancer patients (p = 0.017). A total of 55.6% of the patients decided to undergo bilateral prophylactic mastectomy, while 60.31% bilateral adnexectomy. These rates were significantly higher in breast cancer patients (p = 0.003), older women (p = 0.001), those with at least one child (p = 0.002) and those who were already menopausal (p = 0.0021). Women who underwent bilateral prophylactic mastectomy reported significantly lower scores in the BREAST-Q modules Satisfaction with breasts (p = 0.033) and Physical well-being: chest (p = 0.025), compared to the ones who decided to undergo a follow-up. Conclusions: Health-related quality of life is significantly lower in women with pathogenic genetic variants who have developed breast cancer. This may contribute to a higher rate of risk-reducing surgeries in this group. Full article

Background: Disability-linked neurodegeneration involves cholinergic dysfunction, amyloidogenesis, glutamatergic excitotoxicity, and dopaminergic imbalance, highlighting the need for multi-target modulation. Catharanthus roseus contains a diverse array of metabolites with potential polypharmacological properties. Methods: We curated 318 Catharanthus roseus metabolites and performed structure-based virtual screening against five CNS targets, namely BACE1, AChE, MAO-B, NMDAR, and D1, using target-specific positive controls. Cross-target intersection ranking nominated three hits. We assessed dynamic stability by 200 ns all-atom molecular dynamics simulations (MDS) and MM/PBSA; ADMET-AI profiled CNS-relevant properties. Results: The three metabolites (PubChem CIDs 485711, 56964592, and 162963996) repeatedly ranked among top binders across targets. All five protein–ligand complexes reached stable MD plateaus (RMSD < ~0.30 nm) with sustained key interactions; BACE1 and AChE showed the highest contact persistence and most favorable ΔG_total/ligand-efficiency. Conclusions: Convergent docking, MDS, and MM/PBSA support these metabolites as tractable multi-target leads, with BACE1/AChE prioritized for enzyme-level validation and the remaining targets for follow-up studies. Full article

Background/Objectives: Capsular contracture remains the most common complication after breast augmentation. The Baker score is a classical, yet subjective method to assess the contracture, therefore more objective and reproducible measures are necessary to not only evaluate but also to predict a capsule formation. The aim of the prospective study was to assess the predictive value of sonoelastography, tonometry and physical examination at different time points after the surgery and with association with Baker score, since this early period is considered critical for the initiation of capsular formation. Methods: 28 patients (range of age 21.0–40.0) after breast augmentation completed the study protocol. A total of 56 breasts underwent clinical (modified Baker score), tonometric, and elastographic evaluation before surgery, on postoperative days 7 and 14, and after one year. Measurements were taken at the boundaries of the four breast quadrants and included adipose, glandular, muscular and fascial tissues. Results: At long-term follow-up, tonometric and elastographic values were lower than on postoperative days 7 and 14. Early measurements in certain quadrants and tissue regions showed some association with Baker scores at one year. All tissues increased in stiffness postoperatively and remained stiffer at the 1-year follow-up. No significant differences in tissue stiffness were observed between days 7 and 14, except for higher values in adipose tissue in the inner quadrant and lower values at the peri-implant region in the outer quadrant. Conclusions: Sonoelastography is a precise and objective tool for detecting capsular changes after breast augmentation and may improve early prediction of contracture. Full article

Background and Objectives: Heart failure (HF) represents a clinical syndrome characterized by symptoms and signs such as fatigue, dyspnea, edema of the lower limb, or pulmonary rales. It usually occurs in elderly individuals due to decreased cardiac pumping function and/or increased diastolic ventricular filling pressures. The COVID-19 pandemic deeply altered many daily life habits, and one of the most affected groups of people were those with chronic diseases because of their need for regular medical follow-up. Furthermore, SARS-CoV-2 infection itself has been shown to exacerbate cardiovascular diseases (CVDs). Materials and Methods: This retrospective, observational, and comparative study aimed to characterize and compare patients with chronic heart failure hospitalized in the Cardiology Department of Medical Clinic II, Mureș County Emergency Clinical Hospital, in Târgu Mureș, Romania, between January and December 2019 (pre-pandemic), January and December 2021 (pandemic), and January and December 2023 (post-pandemic). Results: A total of 406 patients were analyzed: 202 patients hospitalized in 2019, 101 patients hospitalized in 2021, and 103 patients hospitalized in 2023. Women with HF were significantly older (median age 72 years) than men (median age 65 years; p < 0.001). During the pandemic, the median length of hospitalization increased (8 days vs. 7 days in the other periods). The pandemic period was also associated with a decrease in left ventricular ejection fraction (LVEF), as reflected by a higher incidence of patients with HF with reduced ejection fraction (42% during the pandemic; p < 0.01). Conclusions: During and after the pandemic, men exhibited significantly higher rates of right and left bundle branch blocks, as well as chronic obliterating artery disease of the lower limb. Left ventricular function declined during the pandemic in both men and women. Throughout the years, we observed distinct patterns between male and female patients regarding associated diseases or behaviours, suggesting lifestyle and psychological changes due to the COVID-19 pandemic. Full article

Background/Objectives: Oman Vision 2040, the national blueprint for socio-economic transformation, aims to elevate the Sultanate to developed nation status, with the “Health” priority committed to building a “Leading Healthcare System with International Standards” via a Health in All Policies (HiAP) approach. This paper critically reviews Oman’s strategic health directions and implementation frameworks under Vision 2040, assessing their alignment with global Sustainable Development Goals (SDGs) and serving as a case model for health system transformation. Methods: This study employs a critical narrative synthesis based on a comprehensive literature search that included academic, official government reports, and international organization sources. The analysis is guided by the World Health Organization’s (WHO) Health Systems Framework, providing a structured interpretation of progress across its six building blocks. Results: Key interventions implemented include integrated governance (e.g., Committee for Managing and Regulating Healthcare), diversified health financing (e.g., public private partnership (PPPs), Health Endowment Foundation), and strategic digital transformation (e.g., Al-Shifa system, AI diagnostics). Performance metrics show progress, with a rise in the Legatum Prosperity Index ranking and an increase in the Community Satisfaction Rate. However, critical challenges persist, including resistance to change during governance restructuring, cybersecurity risks from digital adoption, and system fragmentation that complicates a unified Non-Communicable Disease (NCD) response. Conclusions: Oman’s integrated approach, emphasizing decentralization, quality improvement, and investment in preventive health and human capital, positions it for sustained progress. The transformation offers generalizable insights. Successfully realizing Vision 2040 demands rigorous, evidence-informed policymaking to effectively address equity implications and optimize resource allocation. Full article

Figurative language (metaphor, idiom, irony/sarcasm) is central to pragmatic communication but is frequently challenging for children and adolescents with autism spectrum disorder (ASD). A scoping review was conducted to map pedagogical and clinical interventions that target figurative-language skills in school-age learners with ASD and to summarize reported outcomes. Following a PCC (Population–Concept–Context) framework and PRISMA-ScR reporting, systematic searches were performed in ERIC and Google Scholar (2010–2025). Eligibility required an ASD sample (ages 5–18), an intervention explicitly addressing figurative-language comprehension, and empirical outcome data from educational or related practice settings. Seven studies met inclusion criteria: five targeting metaphors, one targeting idioms, and one targeting sarcasm/irony. Interventions were predominantly delivered one-to-one or in small groups and emphasized structured, explicit instruction with visual scaffolds and stepwise prompting. Across studies, participants demonstrated clear gains on trained items. Generalization beyond trained material was most often observed for metaphor and sarcasm interventions, particularly when instruction highlighted underlying semantic relations or cue-based pragmatic signals; by contrast, the idiom program yielded item-specific learning with minimal near-term transfer. Limited follow-up data suggested short-term maintenance where assessed. Reported variability across individuals was substantial, underscoring the influence of underlying structural-language skills and social-pragmatic demands. Overall, the evidence indicates that figurative-language skills in ASD are amenable to targeted intervention; effective programs tend to combine explicit teaching, visual supports, multiple exemplars, and planned generalization opportunities. Given small samples and methodological heterogeneity, further classroom-based trials with longer follow-up and detailed learner profiles are needed. The findings support integrating figurative-language goals within individualized education and speech-language therapy plans, while aligning instructional complexity with each learner’s linguistic and pragmatic profile. Full article

Background: The peritoneal dialysis (PD) catheter is commonly placed using an open surgery approach. However, mechanical peritoneal catheter-related complications are common causes of peritoneal dialysis technical failure. In recent years, laparoscopic procedures have been recommended because of less invasiveness and high effectiveness in reducing catheter dysfunction; however, this approach is burdened by higher costs and higher risks related to general anesthesia. Methods: We have developed a new advanced video-laparoscopy (ALS) approach with a simple technique that does not require general anesthesia. By using an ultrasound-guided procedure it is possible to place a PD catheter by regional anesthesia (Transversus Abdominis Plane (TAP) block associated with bilateral quadratus lumborum (QLB) block). Results: We here report the outcomes of 20 patients who underwent ALS implantation of straight-neck, double-cuffed Tenckhoff catheters using cutaneous anesthesia with TAP and QLB block. No major complications, including bleeding, were reported. No patient needed intravenous treatment for pain control, and all procedures were well tolerated. During a median follow-up of 21 months [IQR, 15–35] no mechanical complication was reported. Conclusions: ALS without general anesthesia is a simple and well-tolerated technique that can be used in patients at high risk. It therefore allows recruiting a greater number of patients for PD and ensuring well-performing catheters with lower risk of mechanical complications. Full article

Background/Objectives: Severe knee osteoarthritis (KOA) is a degenerative disease that significantly affects quality of life (QoL). Although intra-articular (IA) injections of plasma rich in growth factors (PRGF) have proven effective, the subchondral bone plays a crucial role in pathogenesis. The objective of this study was to evaluate the efficacy of intraosseous (IO) PRGF infiltrations in comparison with a saline placebo, followed by the conventional standard treatment of three IA PRGF injections, in enhancing clinical outcomes in patients suffering from severe KOA. Methods: A prospective, randomized, double-blind, multicenter clinical trial was conducted. Eighty-six patients with Kellgren–Lawrence grade III-IV KOA were randomly assigned to two groups: one received an IO infiltration of PRGF and the other received an IO saline solution. Both groups subsequently received three IA PRGF injections. Clinical outcomes were assessed using the KOOS and WOMAC scales at baseline and at 3, 6, and 12 months. Results: Both groups showed a statistically significant improvement in all KOOS and WOMAC subscales at all follow-up points compared to their baseline values. However, the group that received the IO PRGF infiltration demonstrated significantly greater improvements in nearly all domains of the KOOS and WOMAC scales (pain, symptoms, function, and quality of life) at 3, 6, and 12 months compared to the saline group (p < 0.05). No serious adverse events were recorded. Conclusions: The combination of intraosseous and intra-articular PRGF infiltrations is a superior therapeutic strategy to the combination of intraosseous saline solution and intra-articular PRGF for treating severe KOA. These findings suggest that treating the subchondral bone directly with PRGF has a significant and clinically relevant therapeutic effect, resulting in greater pain reduction and functional improvement at one-year follow-up. Full article

The occurrence of antibiotic residues in the environment is of concern not only because of their contribution to the spread of bacterial resistance, but also due to their possible toxicity to non-target organisms. In this study, the aquatic environmental toxicity of ciprofloxacin (CIP) and sulfamethoxazole (SMX) was assessed in the following model organisms: Daphnia magna and Artemia salina (embryonic and immobilisation test with a 10-d follow-up), Phaeodactylum tricornutum (algal growth inhibition test), and Spirodela polyrhiza (duckweed growth inhibition test). Results showed that among the two saltwater organisms, A. salina was insensitive to both antibiotics, whilst P. tricornutum responded only to SMX with an EC₅₀ of 2.7 mg L⁻¹. In freshwater species, D. magna embryos were more sensitive than juveniles to SMX (EC₅₀ 53.8 and 439.2 mg L⁻¹, respectively), whereas the opposite trend was observed for CIP (EC₅₀ 95.9 and 15 mg L⁻¹, respectively). S. polyrhiza confirmed the remarkable sensitivity of aquatic plants to fluoroquinolones, with EC₅₀ values between 0.28 and 0.34 mg L⁻¹ depending on the endpoint considered. Notably, this species was also more sensitive to SMX than expected, with EC₅₀ values between 1.5 and 2.5 mg L⁻¹, which are an order of magnitude lower than those typically obtained with Lemna spp. exposed to sulphonamides. Considering the high environmental input of these antibiotics from both human and veterinary treatments, adverse effects on aquatic plants cannot be excluded, potentially leading to ecosystem-level consequences. Full article

Background/Objectives: Following the global spread of SARS-CoV-2, there was an urgent need for vaccine development to support immune protection. This study aimed to evaluate the impact of active and hybrid immunity on the durability of immunoglobulin G (IgG), neutralizing antibodies, and cellular immune responses over a two-year period. Methods: This longitudinal study was conducted from February 2021 to December 2023 at the Public Health Institute in Ostrava, Czech Republic. Anti-S IgG was measured using ELISA (Euroimmun), neutralizing antibodies via an in-house virus neustralization test (VNT), and cellular immune response using the IGRA test (ELISA, Euroimmun). Participants also completed a questionnaire on demographics, COVID-19 history, symptoms, and vaccination. Statistical analysis included descriptive and non-parametric tests (Mann–Whitney U, Kruskal–Wallis) at a 5% significance level. Results: The cohort included 149 individuals, 97.3% of whom were vaccinated with Comirnaty (Pfizer/BioNTech). A total of 17% had confirmed infection prior to vaccination and showed up to two-fold higher neutralizing antibody levels (p < 0.001) within 2–6 weeks postvaccination. Postvaccination infection was reported in 35% of participants. Although antibody levels declined over the 2–100 week period, participants remained seropositive across all three parameters. Cellular immune response (interferon-γ) remained consistently high throughout follow-up. Conclusions: The study demonstrates long-term durability of IgG and neutralizing antibodies and confirms durable cellular immunity up to two years postvaccination. Hybrid immunity significantly enhanced neutralizing antibody levels, supporting its added value in protective immunity against SARS-CoV-2. Full article

Background: Artificial intelligence (AI) has been proposed as a transformative tool in suicide prevention, yet most evidence remains observational. To provide a rigorous benchmark, we systematically reviewed randomized controlled trials (RCTs) evaluating AI-based interventions targeting suicidal thoughts, behaviours, or help-seeking. Methods: Following PRISMA 2020 guidelines, MEDLINE, Web of Science, and Scopus were searched to 31 May 2025. Eligible studies were RCTs in humans that incorporated AI or machine learning for risk prediction, automated intervention, or treatment allocation. Methodological quality was assessed with the PEDro scale and certainty of evidence with GRADE. Results: From 1101 screened records, six RCTs (n = 793) met all criteria. Three studies tested machine learning risk prediction, two evaluated fully automated interventions (a transformer-based recommender and a digital nudge), and one examined AI-assisted treatment allocation. Risk-prediction models stratified short-term suicidal outcomes with accuracies of up to 0.67 and AUC values around 0.70. Digital interventions reduced counsellor response latency or increased crisis-service uptake by 23%. Algorithm-guided allocation reduced the occurrence of suicidal events when randomisation aligned with model recommendations. Methodological quality was moderate to high (median PEDro = 8/10), but GRADE certainty was low due to small samples and imprecision. Conclusions: AI can enhance discrete processes in suicide prevention, including risk stratification, help-seeking, and personalized treatment. However, the current evidence is limited, and larger multisite RCTs with longer follow-up, CONSORT-AI compliance, and equity-focused design are urgently required. Full article

Photon-counting computed tomography (PCCT) introduces a new era in thoracic imaging by offering ultra-high spatial resolution, reduced noise, spectral imaging capabilities, and lower radiation dose compared to conventional CT. These features are particularly relevant in thoracic surgery, where precise anatomical and functional assessment is essential throughout the perioperative period. This narrative review outlines the clinical potential of PCCT in surgical planning, intra- and postoperative evaluation, and follow-up of both oncologic and non-oncologic thoracic conditions. PCCT enables accurate bronchovascular mapping and iodine-based perfusion imaging, supporting sublobar resection planning and risk stratification in patients with complex anatomy or reduced lung function. Postoperatively, it enhances detection of subtle complications—such as air leaks or hematomas—and improves image quality near metallic implants through advanced artifact reduction techniques. The ability to combine high-resolution imaging with functional data allows for comprehensive evaluation in a single scan and may aid in differentiating fibrosis from local recurrence. Despite its promises, PCCT adoption is currently limited by high cost, restricted availability, and the need for training and system integration. Furthermore, prospective clinical studies are still needed to determine its impact on surgical outcomes. As technological and infrastructural challenges are addressed, PCCT may become a valuable component of image-guided thoracic surgery, contributing to safer, more personalized care. Full article

Background: A systematic exercise programme using low-cost virtual reality devices can help maintain and improve postural control in older adults. This study aimed to evaluate the effectiveness of two different exergame programme modalities: telerehabilitation (TR) and face-to-face (FF). Methods: A randomised controlled trial was conducted with 16 participants aged 65 to 75. Both groups completed an 18-session exergame intervention over six weeks, with the TR group (exposure) receiving remote sessions and the FF group having in-person (control) sessions with a physiotherapist. Assessments were carried out at baseline, at weeks 2, 4, and 6, with two follow-ups at weeks 8 and 10. Centre of Pressure (CoP) measures in tasks: eyes open (EO), eyes closed (EC), medial-lateral (ML) weight-shifting exergame and anterior–posterior (AP) weight-shifting exergame, and clinical tests were used to evaluate postural control. Results: TR and FF significantly reduced the CoP_Sway-area during EC (TR: p < 0.01; FF: p = 0.01) at 6 weeks and only FF demonstrated a significant reduction during EO (p < 0.01). Post hoc analysis revealed that TR maintained a significant reduction in the secondary outcomes of the CoP at 8 and 10 weeks, while FF did not sustain these effects over time. Between-group comparisons revealed a greater effect of TR in CoP_Sway-area, and secondary outcomes during the AP weight-shifting task (p < 0.01) at 6 weeks, whereas the FF had a greater effect in secondary CoP outcomes during the ML weight-shifting task (p < 0.01) at 6 weeks. Conclusion: Both six-week exergame programmes were equally effective at improving postural control. Given the observed specific effects of TR and FF delivery, physiotherapists can consider either modality to suit individual needs and access, or as a complementary approach to maintain and improve postural control in older adults. Full article