Search Results (9,282)

Excessive fluoride intake from drinking water remains a public health concern in geogenic high-fluoride regions, yet direct evidence linking environmental fluoride levels to internal exposure in remote high-altitude areas is limited. This study integrated environmental monitoring with human biomonitoring to assess fluoride exposure and health risks in the Taruo Lake region of the Tibetan Plateau. Surface water (n = 45 for Taruo Lake; n = 8 for its tributaries) and groundwater samples (n = 4) were collected and analyzed for fluoride concentrations, and blood ionic fluoride (BIF) levels were measured in 122 local residents (47 adults, 75 children). The results showed that fluoride concentrations in most surface water tributaries of Taruo Lake and groundwater sources were below China’s drinking water standard, whereas those in Taruo Lake exceeded this limit (routine monitoring mean 2.54 mg/L; multi-site mean 2.79 mg/L). BIF levels were significantly higher in adults (0.126 ± 0.041 mg/L) than in children (0.075 ± 0.032 mg/L) and showed a positive correlation with age (r = 0.533, p < 0.001). Notably, 23.4% of adults and 1.3% of children exceeded 0.15 mg/L, an empirical threshold typical for healthy populations in non-endemic areas. Based on the hazard quotient (HQ) model recommended by the US EPA, most drinking water sources posed acceptable non-carcinogenic risks (HQ < 1). In contrast, Taruo Lake water presented an elevated risk (HQ > 1) in 2024 primarily due to the regional geological background, and although not used for daily drinking, this finding offers an indicative reference for local water management and risk prevention. This preliminary monitoring and biomonitoring assessment provides baseline data for future studies and underscores the necessity of continuous surveillance and evaluation of total dietary fluoride intake to protect the health of this vulnerable high-altitude population. Full article

Background and Objectives: The relationship between preoperative inflammatory markers and lymphovascular space invasion (LVSI) in endometrioid-type endometrial cancer (EC) remains incompletely defined and warrants evaluation using robust statistical methods. This study aimed to evaluate the independent association of preoperative inflammatory markers, analyzed strictly as continuous variables, with the presence of LVSI, and to develop a refined predictive nomogram adjusted for established clinical confounders. Materials and Methods: Data from 156 patients who underwent standard staging surgery for endometrioid-type EC were retrospectively analysed. To preserve statistical power and avoid structural artifacts from data forcing, preoperative glucose-to-lymphocyte ratio (GLR), platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (NLR) were modeled on their original continuous scale. Multivariable logistic regression analysis was performed to identify independent risk factors for LVSI, adjusting for patient age and maximum tumor diameter. Internal validation was conducted using bootstrap resampling (1000 iterations). Results: In the multivariable logistic regression model, continuous PLR emerged as a significant independent risk factor for the presence of LVSI (adjusted OR: 1.013 per 1-unit increase, 95% CI: 1.001–1.024; p = 0.033). Among clinical parameters, maximum tumor diameter demonstrated the strongest independent association with LVSI (adjusted OR: 1.595 per 1 cm increase, 95% CI: 1.211–2.099; p = 0.001). Continuous NLR (p = 0.513) and GLR (p = 0.545) did not retain statistical significance due to overlapping explanatory variance and shared hematological components. The optimized 3-variable nomogram (PLR, tumor size, and age) demonstrated an apparent C-index of 0.816 (95% bootstrap CI: 0.719–0.920) and a robust optimism-corrected C-index of 0.794. The bootstrap-corrected calibration slope was 0.909, and Decision Curve Analysis (DCA) demonstrated a positive net clinical benefit across clinically relevant threshold probabilities. Conclusions: Preoperative PLR, evaluated as a continuous parameter, provides a statistically stable framework for preoperative risk stratification in endometrioid EC. When integrated with tumor size and age, the proposed nomogram demonstrates promising discriminative performance and potential clinical utility pending external validation for predicting LVSI. However, given the limited number of LVSI-positive events (n = 17), these findings should be regarded as exploratory and hypothesis-generating and require external validation before clinical use. Full article

This study presents a closed-form analytical solution for large-deformation pressure-induced stress and displacement fields in thick-walled, functionally graded (FG) hyperelastic polyvinyl chloride (PVC) cylinders subjected to internal pressure. The formulation inherently satisfies incompressibility—an aspect not guaranteed by standard finite element methods (FEMs)—and provides explicit expressions for all stress and deformation components. Using a Mooney–Rivlin model with an exponential–logarithmic gradation law, the study examines bi-layer and tri-layer configurations under varying property-changing scenarios. The governing equations are reduced to a single nonlinear scalar relation for the radial mapping constant, ensuring computational efficiency. Analytical predictions demonstrate excellent agreement with FEM results (errors < 1%) and recover homogeneous limits, and demonstrate that continuous gradation significantly reduces stress concentrations compared to discrete layering. The proposed model offers an efficient tool for designing pressure-resistant FG hyperelastic components for engineering applications such as pipes, hoses, biomedical devices, and protective casings. Full article

Hemorrhoidal disease is a common anorectal condition that may require treatment when bleeding, prolapse or persistent symptoms fail to respond to conservative or office-based therapy. Radiofrequency ablation (RFA) has emerged as a minimally invasive, tissue-sparing technique for symptomatic internal hemorrhoids, based on controlled delivery of high-frequency energy into hemorrhoidal tissue. The resulting thermal effect induces coagulative necrosis, fibrosis, mucosal fixation and progressive reduction in hemorrhoidal volume, without excisional removal of anoderm or rectal mucosa. This narrative review summarizes the mechanism, technical principles, clinical advantages, comparative evidence and remaining uncertainties surrounding RFA, with particular attention to the Rafaelo procedure and related radiofrequency-based approaches. Current evidence suggests that RFA may reduce postoperative pain, analgesic requirements, wound-related morbidity, hospital stay and time to return to normal activity compared with conventional hemorrhoidectomy, while maintaining acceptable short- and mid-term symptom control in selected patients, especially those with grade II–III internal hemorrhoids. However, available studies remain heterogeneous in design, technique, patient selection, outcome definitions and follow-up duration. The relationship between modern probe-based RFA and earlier radiofrequency-based approaches, including Ellman surface coagulation, Celon bipolar radiofrequency-induced thermotherapy and radiofrequency-assisted hemorrhoidectomy, remains insufficiently standardized in the literature. Further randomized trials, standardized outcome reporting, long-term recurrence data and cost-effectiveness analyses are required to define the optimal indications and therapeutic position of RFA. Full article

Web service classification plays an important role in software reuse, service discovery, and automatic metadata organization. Although recent deep learning approaches have improved classification performance by using service names and natural-language descriptions, most existing methods still operate as black-box models and offer limited insight into how different metadata sources influence classification decisions. This lack of transparency reduces their practical usefulness for developers who need to verify predicted categories, analyze incorrect classifications, and improve service metadata quality. A well-trained interpretable model can not only help developers choose more appropriate and reliable categories for each web service, but also help write a more reasonable service name and description. In this paper, we present xServeNet, an explainability-oriented extension of ServeNet for transparent web service classification. xServeNet preserves the BERT-based representation and CNN–BiLSTM feature extractor of ServeNet and introduces (i) an instance-wise dynamic source-fusion mechanism that adaptively combines service-name and service-description features according to their semantic contribution, and (ii) model-internal importance indicators at both the source and word levels that support inspection of classification decisions without introducing additional trainable parameters. We benchmark xServeNet against eleven machine learning baselines on two real-world ProgrammableWeb datasets of 10,943 and 14,086 services covering 50 categories. xServeNet reaches 71.08% Top-1/91.35% Top-5 accuracy on the original dataset and 74.10% Top-1/92.95% Top-5 accuracy on the updated dataset, consistently improving Top-1 accuracy over ServeNet while remaining competitive on Top-5, and achieving the lowest per-category Top-5 standard deviation among all twelve compared methods. In practice, the importance indicators support three concrete activities at the service registry: helping developers verify predicted categories at registration time, iterating on description wording when the predicted category looks wrong, and supporting registry curators in flagging likely mislabelled services for review. Full article

Background/Objectives: Hysteroscopy is the gold standard for visualization and treatment of intrauterine pathology. Because hysteroscopic interpretation remains operator-dependent, artificial intelligence (AI) has been evaluated as a tool to improve consistency, lesion recognition, and decision support. We aimed to systematically review AI, machine learning (ML), deep learning (DL), or computer-aided diagnosis (CAD) applications in hysteroscopy. Methods: A systematic search of PubMed/MEDLINE and EBSCOhost was performed from database inception to 8 March 2026, supplemented by targeted searches. Risk of bias was assessed using QUADAS-2 (diagnostic), PROBAST (prognostic), RoB2, and structured technical quality domains. Results: Nineteen primary studies were included, covering five areas: diagnostic classification and object detection (n = 8), real-time lesion detection and localization (n = 4), segmentation and visual-field support (n = 3), operative guidance (n = 1), and prognostic or decision-support applications (n = 3). Performance was highest in narrowly defined binary tasks and in large multicenter systems (e.g., ECCADx: AUC 0.979 internal, 0.975 external) and in prognostic fertility-prediction models after hysteroscopic adhesiolysis (AUC up to 0.992). Broader multiclass classification of heterogeneous lesions showed uneven and lower performance. Most studies were single-center, retrospective, and lacked external validation. Only one randomized study linked AI support to measurable procedural outcomes. Conclusions: The available studies indicate good technical performance in selected hysteroscopic tasks, particularly binary classification, focal lesion detection, and postoperative fertility stratification. Current evidence, however, remains limited by retrospective design, operator-dependent image acquisition, inconsistent validation, and scarce outcome-based clinical testing. In the short term, the most likely role of these systems is to support image interpretation, improve visual quality control, highlight suspicious lesions, and integrate hysteroscopic findings with complementary clinical data. Full article

Standard diagnostic categories (International Classification of Diseases (ICD) and Diagnostic and Statistical Manual of Mental Disorders (DSM)) were developed as a pragmatic compromise between competing theoretical schools in psychiatry and psychotherapy. Focused on recognizable patterns of symptoms, they produce reliable descriptions and facilitate clinical communication, research, and reimbursement. Such a focus, however, necessarily falls short of the etiological complexity of bodily, personal, interpersonal, and cultural processes that shape human suffering. This article argues that beneath the diversity of approaches seeking to address this gap, a fundamental complementarity emerges—one constitutive of human existence itself: the complementarity between two irreducible ways of being in the world. The first is the organismic–biological dimension, elaborated in Jakob von Uexküll’s biosemiotics: sign-governed, evolutionarily pre-formed processes of meaning-attribution that operate prior to and independent of language. The second is the symbolic–cultural dimension, developed in Ernst Cassirer’s philosophy of symbolic forms: the embedding of human beings in socially created, intersubjectively shared symbol systems through which the world is seen and understood. Although both approaches were published nearly a century ago, this article is not primarily a historical contribution. Rather, it argues that psychopathology and therapy can be understood more fully—and clinical practice enriched—when both dimensions are taken into account as genuinely complementary perspectives. Full article

Background/Objectives: The trainer–doctor model (TDM) is a participatory paradigm in which the physician acts as a mentor and educator. Effective health communication and patient engagement are key determinants of treatment adherence and health outcomes. Based on this conceptual framework, the present study aimed to assess preferences for the Trainer–Doctor Model among dental practitioners and patients, examine the influence of demographic variables, and provide a preliminary psychometric evaluation of the TDM questionnaire in accordance with the COSMIN (COnsensus-based Standards for the selection of health Measurement Instruments) criteria. Methods: A cross-sectional survey was conducted in Romania between May 2023 and April 2024. The study included dental practitioners recruited during scientific dental conferences and patients recruited from a private dental practice in Alba Iulia, Romania. Eligible participants were adults aged 18 years or older who provided written informed consent and completed the data protection requirements. Individuals younger than 18 years of age or those who did not provide complete informed consent were excluded. Participants completed a 12-item Likert-type questionnaire assessing preferences toward the Trainer–Doctor Model. Results: Both groups showed high TDM preference (practitioners: 43.93 ± 5.56; patients: 44.77 ± 4.84; p = 0.195); 71–76% of responses were high-preference (≥4). Cronbach’s α with reverse-scored items was 0.752/0.651. EFA (KMO = 0.740; Bartlett’s p < 0.001) identified a 3-factor structure, explaining 51.3% of the variance. Patients scored significantly higher on items A (p = 0.002), B (p = 0.022), and F (p = 0.005). Conclusions: Both groups demonstrate a strong, consistent preference for TDM across demographics. The preliminary psychometric evaluation indicates acceptable internal consistency and structural validity; however, further validation, including Delphi-based content validation and confirmatory factor analysis, is required. Full article

Although the goal of “sustainable” urbanism has generated an impressive array of international frameworks and declarations, systemic progress remains elusive. A prior paper by the author identified “lock-in” as a central cause: the economic incentives, professional standards, codes, and institutional feedback structures that reinforce unsustainable patterns of urban development despite stated commitments to reform. This paper advances that diagnosis by asking what sustains the lock-in itself, and what structural intervention can address it at the root. We argue that the answer lies in recognizing a fundamental deficit in the feedback architecture governing urban development—a systematic failure to account for two categories of capital on which human welfare depends: natural and resource capital, whose depletion standard metrics render invisible, and human and value-added capital, including the built public realm and the economies of place that markets systematically undersupply. Standard welfare-economic instruments, including Pigouvian taxes, address this at the level of price signals but are unable to fully resolve it there, because multiple forms of goods—referred to as “polycapital”—are structurally interrelated and resist single scalar remedies. The paper proceeds to advance two complementary conclusions: first, that a generative modeling methodology, capable of encoding the interrelated, multi-scale character of polycapital structures, is a necessary precondition for adequate institutional response, and that pattern language methodology provides this capacity; and second, that new transactional mechanisms going substantially beyond Pigouvian instruments—which we outline—represent a necessary direction and a promising research frontier. Full article

Lateral femoral neck and peritrochanteric fractures are common and clinically challenging injuries, particularly in the elderly population, with significant implications for morbidity, mortality, and functional recovery. Traditional classification systems are widely used to guide treatment, yet their reproducibility and clinical applicability remain debated. Increasing attention has been directed toward trabecular architecture and its role in fracture behavior and reduction strategies. This review aims to summarize current evidence on classification systems, trabecular-based fracture patterns, pre-operative reduction techniques, and fixation strategies. A narrative review was conducted using PubMed/MEDLINE, Embase, and Scopus databases up to May 2026. Original studies, reviews, and biomechanical investigations focusing on proximal femur fracture classification, reliability, trabecular alignment, reduction techniques, and fixation methods were included. Data were qualitatively analyzed, with emphasis on interobserver reliability, biomechanical implications, and clinical outcomes. Conventional classification systems, including anatomical, Evans–Jensen, and AO/OTA frameworks, demonstrated variable and generally moderate reproducibility, with reported interobserver agreement ranging from approximately κ = 0.30 to 0.60. Emerging evidence highlights the importance of trabecular architecture, distinguishing intradigital fractures—confined within trabecular pathways and relatively stable—from extradigital fractures, which disrupt load-bearing structures and are associated with increased mechanical instability and higher failure rates. Biomechanical and clinical studies indicate that inadequate reduction with trabecular misalignment significantly increases the risk of varus collapse and implant cut-out. Reduction strategies tailored to fracture pattern, such as internal rotation for intradigital fractures and external or combined maneuvers for extradigital patterns, improve alignment and load transfer. In terms of fixation, dynamic hip screws remain effective in stable fractures, whereas cephalomedullary nails demonstrate superior performance in unstable patterns, with lower reoperation rates reported (approximately 5–8% vs. 10–15%). Management of lateral femoral neck and peritrochanteric fractures should extend beyond traditional classification systems to incorporate trabecular biomechanics. Restoration of trabecular alignment, alongside established parameters such as neck–shaft angle and tip–apex distance, is critical for optimizing outcomes. Further prospective studies are needed to validate trabecular-based classifications and standardize reduction strategies. Full article

Background: Post-thyroxine treatment of thyroid dysfunction remains a clinical concern, especially in Middle Eastern populations. Methods: This descriptive cross-sectional study was conducted in 2023 at King Fahad Hospital, Hufof, Kingdom of Saudi Arabia. Of the 237 patients treated with L-thyroxine (L-T4) for hypothyroidism, 163 patients, almost exclusively females (152 females, 11 males), met the inclusion criteria and were enrolled. Thyroid hormones, lipid profiles, and 25-hydroxyvitamin D (25OH-D) were measured using standard laboratory assays. Results: Only 57% of patients achieved euthyroid status following L-T4 treatment, while 12.3% developed post-thyroxine-treatment (PTT) hyperthyroidism, and 30.7% developed PTT hypothyroidism. Older age was significantly associated with dysthyroidism (p = 0.018), whereas obesity (p = 0.937) and vitamin D levels (p = 0.982) were not. Total cholesterol (TC) and LDLc positively correlated with TSH levels, while elevated triglycerides (TGs) were significantly associated with PTT hyperthyroidism. The two dysthyroid subgroups were comparable across all non-thyroid parameters, including age, BMI, 25(OH)D levels, and lipid fractions. However, free T4 was significantly higher in PTT hyperthyroidism (p < 0.001); free T3 showed a trend toward higher levels in PTT hyperthyroidism (p = 0.052); and TSH was significantly higher in PTT hypothyroidism (p < 0.001). Conclusions: The proportions of patients with PTT hypo- and hyperthyroidism are aligned with international observations. Furthermore, the age was significantly associated with dysthyroidism, and dyslipidemia is the most consistent biochemical correlate of suboptimal thyroid status; however, the associations of PTT dysthyroidism with hypovitaminosis D and BMI were not noticed in this setting. Full article

Background: In May 2011 the IARC (International Agency for Research on Cancer) classified radiofrequency electromagnetic fields as a possible human carcinogen mainly based on epidemiological studies about the association between mobile phone (MP) use and brain tumors. Considering that brain tumors have long latencies of around 30 years, it is unlikely that this association is due to an ‘initiating’ activity of MPs since virtually all studied brain tumor cases must have had already a covertly growing tumor when they started MP use. But there could be other adverse effects exerted by a MP when acting on later stages of malignant development. We propose that MP use acts adversely by increasing tumor growth rate and model it by an impact on the latency distribution shifting the age-incidence function to younger age. Methods: We calculate (1) relative risks (RRs) for MP use in comparison to the meta-analytic RR estimate for glioma in adults; (2) RRs for neuroepithelial childhood brain tumors in comparison to the findings of the MOBIkids study; and (3) hazard ratios in comparison to the results of the Million Women Study (MWS). Results: The meta-analytical odds ratio for glioma and long-term MP use in adults of 1.22 (95% confidence-interval: 1.02–1.46) could be explained by a shift in the age-incidence function by 32% of MP usage duration. Applying a 20% shift for childhood neuroepithelial brain tumors reproduced the ORs that were predominantly less than 1 in the MOBIkids study. For glioma risk in perimenopausal women in relation to long-term MP use in the MWS we found hazard-ratios close to 1 applying a 32% shift in the age-incidence function. Conclusions: The standard interpretation of relative risk estimates must be revised if exposure to the agent commenced after the malignant development has already started. All reported RR estimates of MP use can be reproduced by positing MP use increased tumor growth rate. However, since these results are obtained applying a modeling approach, further tests using epidemiological methods, which will be difficult or hardly feasible, or utilizing more promising laboratory methods are needed. Full article

Background: Type II workplace violence by patients, relatives, or visitors is an occupational health and patient-safety concern in primary care. Cranston Ridge Medical Clinic (CRMC), a single urban family medicine and walk-in primary care clinic in Calgary, Alberta, plans to implement a universal, risk-informed workplace-safety bundle that is based on observable behaviour, situational risk, and documented safety concerns rather than demographic profiling. Methods: This article describes a single-site internal quality improvement and workplace-safety evaluation protocol. The comparison is CRMC usual practice during the pre-implementation baseline period; there is no concurrent external control group. The planned evaluation will use aggregate, de-identified operational data from a 12-month pre-implementation baseline, a four-week implementation period, and 12 months of post-implementation monitoring. All clinic staff will receive workplace-safety training as part of routine implementation. No staff, patients, or visitors will be recruited as research participants, and the evaluation will not use individual-level staff survey, interview, or focus-group data. Patient/visitor information will be used only as aggregate operational monitoring data when needed to assess safety, access, patient flow, and complaints. Intervention and analysis: The bundle includes worksite analysis, staff training, a brief arrival safety screen, a response algorithm, standardized reporting, monthly safety huddles, and post-incident support. The primary metric will be the Type II workplace-violence incident rate per 1000 clinic visits. Planned analyses include run charts, pre–post rate ratios, and Poisson or negative binomial segmented regression if monthly counts are sufficient. Implementation learning will be summarized from routine training records, safety-huddle summaries, post-incident debrief themes, and other aggregate de-identified operational indicators. Expected contribution: The protocol contributes a transparent, equity-sensitive, and operationally feasible model for balancing staff safety with patient access in primary care. Full article

Objective: This study aimed to compare the neuromuscular control characteristics of international- and national-level squash players during forehand strokes using a multichannel surface electromyography (sEMG)-based sensing framework. By integrating wearable biosignal acquisition with muscle synergy and intermuscular coherence analyses, this study sought to identify sensor-derived markers of performance-related neuromuscular control and to provide evidence for sensor-informed squash training and athlete monitoring. Methods: Participants performed standardized forehand strokes, during which multichannel sEMG signals were synchronously collected from major upper-limb, lower-limb, and trunk muscles. The recorded sensor signals were preprocessed and analyzed using non-negative matrix factorization to extract muscle synergies, including the number of synergies, muscle weightings, and synergy activation durations. In addition, time–frequency intermuscular coherence analysis was performed on the sEMG sensor data to quantify coherence differences in the α, β, and γ frequency bands between upper-limb–trunk and lower-limb–trunk muscle pairs. Results: No significant difference was found between the two groups in the number of muscle synergies, with both groups clustering into four synergy modules. However, the sEMG sensor-based analysis revealed clear between-group differences in synergy structure and coordination patterns. International-level players showed higher muscle weightings in major proximal muscles, including the deltoid, pectoralis major, erector spinae, and gluteus maximus, and lower weightings in relatively smaller or more distal muscles such as the biceps brachii and lateral gastrocnemius. In terms of synergy timing, international-level players exhibited significantly shorter activation durations in SYN1 and SYN2, but a significantly longer activation duration in SYN3, than national-level players. For intermuscular coherence, international-level players showed significantly lower coherence in the α, β, and γ bands for multiple upper-limb–trunk and lower-limb–trunk muscle pairs. Conclusions: A multichannel sEMG sensing approach was effective in detecting performance-level differences in neuromuscular control during the squash forehand stroke. International-level players exhibited more efficient and refined neuromuscular coordination, characterized by optimized proximal muscle recruitment, more task-specific synergy timing, and reduced intermuscular coherence across selected muscle pairs. These findings highlight the value of wearable EMG sensors and sensor-based neuromuscular feature extraction for quantitative athlete assessment, movement monitoring, and the development of sensor-guided training strategies in squash. Full article

Background: Anal fissure is a common benign condition, yet its management varies widely. The International Society of University Colon and Rectal Surgeons (ISUCRS) conducted a global snapshot audit to describe contemporary real-world management patterns. Methods: During a 2-week period (June–July 2022), 56 colorectal surgeons from 21 countries prospectively recorded data for consecutive patients presenting with anal fissure. Exclusion criteria included inflammatory bowel disease, pregnancy or lactation, psychiatric disorders, immunosuppression, and anorectal sepsis. Acute fissure was defined as symptoms <6 weeks without sentinel pile; chronic fissure as >6 weeks or fibrotic edges/sentinel pile. The “Cure” was defined as complete symptom resolution or healed fissure on clinical or tele-follow-up. Results: A total of 302 patients were analyzed (mean age 41 ± 13 years; 52% women). Acute fissure was present in 42%, chronic in 58%. Conservative treatment (dietary advice, stool-softeners, topical agents, botulin toxin, pelvic-floor training) was initiated in 236 (78%) patients, while 66 (22%) underwent surgery, most commonly lateral internal sphincterotomy (LIS). At 8-week follow-up, 73% of patients treated conservatively and 88% of those treated surgically achieved clinical resolution of symptoms or healed fissure. Conclusions: Global management of anal fissure remains heterogeneous. Most surgeons favor conservative measures such as first-line therapy, reserving LIS for chronic or refractory fissures. Standardized definitions and outcome reporting are needed to improve comparability and guide future international guidelines. Full article