Search Results (2,069)

Background: This study aimed to investigate the relationship between dental fear and mindfulness levels, and to examine how this relationship varies across different dental specialties. Methods: The Dental Fear Scale (DFS) and the Mindful Attention Awareness Scale (MAAS) were administered to 411 adult patients receiving treatment in six different clinics of the Faculty of Dentistry at Kafkas University. Data were analyzed using the Kruskal–Wallis, Mann–Whitney U, Chi-square, and Spearman’s correlation tests. Results: A moderate, significant, and negative correlation was found between MAAS and DFS scores (r = −0.41; p < 0.001). Mean scores differed significantly across clinics. Patients in the Prosthodontics Department exhibited the highest levels of fear (62.21 ± 4.62) and the lowest levels of mindfulness (3.22 ± 0.23), whereas patients in the Oral and Maxillofacial Radiology Department demonstrated the lowest fear levels (40.60 ± 15.76) and the highest mindfulness levels (4.30 ± 1.00). Consistent with these score-level differences, the distribution of dental fear categories varied across clinics, with a significantly higher prevalence of high anxiety in the Prosthodontics clinic (75.7%) compared to the Orthodontics and Radiology clinics. Conclusions: Higher levels of mindfulness were associated with lower levels of dental fear, and this relationship was consistent across all clinical settings. The study highlights that clinical context significantly influences both mindfulness and fear levels, with invasive specialties showing a higher risk profile. Brief mindfulness-based interventions may serve as effective and feasible strategies to enhance patient cooperation and improve treatment outcomes, particularly in clinics where high levels of fear are prevalent. Full article

Hypertension is a leading global health risk and requires accurate and continuous monitoring for effective management. Although photoplethysmography (PPG) is a promising non-invasive modality for cuffless blood pressure (BP) assessment, many existing approaches (especially raw-signal deep learning) are vulnerable to data leakage, overfitting on small datasets, limited interpretability, and poor performance on minority BP stages. To address these limitations, we propose a robust and physiologically grounded framework for multi-class BP stage classification based on interpretable PPG features. Our approach centers on a comprehensive multi-domain feature engineering pipeline that extracts 124 PPG features, including demographic, morphological, functional decomposition, spectral, nonlinear dynamics, and clinical composite indices. We apply rigorous preprocessing and feature selection prior to model training. We validate the framework on two datasets: PPG-BP dataset (657 segments, 4 classes) for benchmarking and PulseDB (283,773 segments, 3 classes) to assess scalability. We evaluate the proposed framework using a segment-level train/test split, appropriate for assessing intra-subject BP tracking after initial personalization. For the PulseDB dataset, this follows the protocol established by the dataset creators, while for the PPG-BP dataset, it enables direct comparison with prior work given practical dataset constraints. On PPG-BP, LightGBM trained on the selected features achieved macro-F1 = 0.78 and accuracy = 0.74, outperforming comparable deep-learning models. On the PulseDB, a custom Residual MLP achieved accuracy = 0.81 and macro-F1 = 0.79, supporting generalization at scale. These results show that the proposed feature-based approach can outperform complex end-to-end deep-learning models on small datasets while providing improved interpretability. This work establishes a reliable and transparent pathway toward clinically viable continuous BP staging, moving beyond black-box models toward physiologically grounded decision support. Ablation analysis reveals that engineered features provide most of the predictive power (F1 = 0.911), while raw PPG features alone achieve modest performance (F1 = 0.384). For the minority hypertension stage 2 (HT-2) class, a bootstrap 95% confidence interval of [0.762, 1.000] is reported, reflecting uncertainty due to limited sample size. Full article

In a network invaded by a mutant according to the birth–death updating rule and uniform initialization, in order to minimize the amplifying effect of any directed network, the adjacency matrix is modified at each time step up to a given time horizon, subject to resource constraints. The fixation probability of an invasive mutant is deduced from the first eigenvector of the resulting modified Markov transition matrix. Large-scale minimization is solved numerically for a representative sample of directed graphs of dimensions 6 to 8. The effects of the determinants of the optimal reduction of the fixation probability are estimated using a Heckman selection model. The number of neighbors, the heterogeneity of the incoming edge weights, and the homogeneity of the outgoing edge weights of the initial network increase the likelihood that the graphs are amendable. Among the amended networks, the reduction in the fixation probability is greater when the outgoing edge weights of the initial network are heterogeneous, those of its incoming edges are homogeneous, and the sequence of modifications increases the variance of the outgoing edge weights and decreases that of the incoming edge weights, thereby creating a trade-off, which is estimated numerically. Full article

The demand for refined anaesthetic protocols in ovine experimental surgery has increased due to ethical considerations and the need to improve perioperative stability. This study evaluated the analgesic efficacy of ultrasound-guided combined sciatic and saphenous nerve blocks using two different local anaesthetics in Hair Canarian Sheep undergoing invasive orthopaedic hindlimb surgery. Fifteen clinically healthy sheep were randomly assigned to one of three groups: lidocaine (2%), bupivacaine (0.5%), or control (general anaesthesia alone). Intraoperative physiological parameters, including heart rate, respiratory rate, and arterial blood pressure, were recorded, and postoperative pain was assessed using a modified Melbourne Pain Scale. Sheep receiving locoregional anaesthesia showed significantly lower postoperative pain scores compared with control animals. Intraoperatively, a significant difference between groups was observed only for respiratory rate, with lower values in the bupivacaine group. The bupivacaine group exhibited lower and more stable respiratory rates, with a trend towards lower heart rates during surgery, as well as consistently lower pain scores during the early postoperative period. Lidocaine provided limited intraoperative and postoperative effects compared with the control group. Respiratory rate appeared to be more closely associated with pain scores than other physiological parameters. In conclusion, ultrasound-guided sciatic and saphenous nerve blocks were associated with improved perioperative analgesia in sheep undergoing orthopaedic surgery. The use of bupivacaine was associated with lower respiratory rates intraoperatively and reduced postoperative pain scores, suggesting a potential benefit in perioperative analgesia. Full article

This study proposes a non-invasive, simplified muscle force estimation model (NSMFEM) designed for elderly individuals and stroke patients under slow walking conditions. The model estimates lower limb muscle forces dynamically using only kinematic parameters—with real-time muscle fiber length as the key variable—thus avoiding the limitations of traditional surface electromyography (sEMG)-based approaches such as environmental interference, signal noise, and difficulty in obtaining deep muscle sEMG. A personalized Digital Twin Musculoskeletal Model (DTMSM) was constructed by scaling a reference kinematic model and calibrating muscle origin/insertion markers based on individual anthropometry. Muscle architecture indices were derived from a multiple regression model with publicly available anatomical data. Twelve elderly subjects (eight healthy ESND and four post-stroke ESP) were evaluated at varying walking speeds. Results at slow speeds (X-slow and slow) show strong Pearson correlations between NSMFEM predictions and reference data for the majority of nine representative lower limb muscles (e.g., TFL, Iliacus, Pectineus, Tib_Ant, Soleus); passive forces of TFL, Iliacus, and Vas_Int also correlate strongly. As speed rises, correlations for some muscles (e.g., Vas_Int, Tib_Post) decline, reflecting the growing influence of segmental acceleration and muscle activation—factors omitted in the model. For stroke patient gait (ESP), Spearman analysis indicates maintained strong correlations for affected side muscles Glut_Max1, TFL, Pectineus, and Soleus, supporting the model’s utility in stroke rehabilitation assessment. Overall, NSMFEM offers a practical, sEMG free method for non-invasive dynamic muscle force estimation in slow walking elderly and post-stroke populations, aiding functional assessment and personalized rehabilitation planning. Future efforts will aim to incorporate muscle activation corrections to extend the model to faster walking speeds. Full article

Background and Objectives: Enlarged perivascular spaces (ePVS) demonstrated by MRI have recently been associated with cerebral small vessel disease and glymphatic dysfunction, implicated in Parkinson’s disease (PD) pathophysiology. This study aimed to quantify the burden of ePVS in PD patients versus healthy controls and to examine associations with cognitive performance. Materials and Methods: A total of 51 participants underwent 3T MRI, including a T2-weighted sequence. Twenty-one patients with Parkinson’s disease and 21 age-matched healthy controls were included in the final analysis. The ePVS burden was assessed quantitatively by counting visible PVS in the basal ganglia and centrum semiovale, and qualitatively using Potter and Heier rating scales. Cognitive function was measured with the Montreal Cognitive Assessment (MoCA). Statistical analyses used Mann–Whitney U tests and Spearman correlations. Results: PD patients had significantly higher total PVS counts in the basal ganglia (84.8 vs. 48.0; p < 0.001) and centrum semiovale (290.6 vs. 143.9; p < 0.001). Potter scale ratings were higher in PD across regions (p ≤ 0.025). Largest per-slice PVS counts negatively correlated with MoCA scores in right basal ganglia (ρ = −0.362, p = 0.012) and bilateral centrum semiovale (right: ρ = −0.421, p = 0.003; left: ρ = −0.431, p = 0.002). Heier scale differences were significant only in the right centrum semiovale (p = 0.023). PVS diameters were larger in PD only in the centrum semiovale (right: p = 0.010; left: p = 0.040). Conclusions: In this cohort, increased ePVS burden in the basal ganglia and centrum semiovale was associated with cognitive impairment in PD patients. Qualitative and quantitative PVS assessment, notably the largest-per-slice counts, may serve as a sensitive, non-invasive imaging biomarker for neurodegeneration and cognitive decline in PD. Larger group studies and longitudinal data are needed to assess their prognostic value in the long term, as well as the development of automatic quantification applications for better reproducibility. Full article

Cutaneous squamous cell carcinoma (cSCC) is the second most prevalent skin cancer diagnosed worldwide after basal cell carcinoma. CSCC represents a growing global public health challenge due to its higher potential of local invasion, recurrence, and metastasis. Incidence rates of cSCC are projected to increase due to rising exposures to risks factors. Ultraviolet light exposure is the primary cause, and lighter skin pigmentation, immunosuppressive conditions and skin phototype are the primary risk factors. CSCC typically presents as a red, scaly, flat lesion (in situ tumors) or a red, firm, raised lesion with scale or erosion (invasive tumors). Surgical excision remains the standard-of-care for localized cSCC and is often curative. Although, most patients achieve favorable outcomes, a subset of cSCC exhibits a highly aggressive and metastatic phenotype (postoperative recurrence rates are approximately 5%). Addressing the clinical challenge posed by these high-risk cases requires a more comprehensive understanding of the underlying molecular drivers. This review examines the interaction between transglutaminase 2 (TG2) and the G-protein-coupled receptor 56 (GPR56) as a pivotal driver of the aggressive cSCC phenotype. This molecular axis is particularly significant for its role in the maintenance of epidermal cancer stem (ECS) cells, which contribute to tumor progression and therapy resistance. While the definitive link between the TG2-GPR56 complex and systemic metastasis in cSCC is currently being elucidated, significant evidence from analogous malignancies and in vitro keratinocyte models provides a clear mechanistic roadmap for its involvement in tumor invasion. Full article

Background and Objectives: Substance use disorders (SUDs) are associated with maladaptive neuroplasticity and chronic dysregulation of cortical arousal. EEG provides a non-invasive tool for quantifying these neurophysiological alterations through spectral power and reactivity indices. Prior research consistently reports elevated beta and diminished alpha activity in SUD, reflecting cortical hyperarousal and reduced inhibitory control. This study sought to identify EEG-based markers of dependence-related neurophysiological alterations by integrating rule-based and score-based models incorporating the theta/beta ratio (TBR), alpha and beta powers, the hyperarousal index, and alpha-blocking measures. Materials and Methods: EEG recordings from 47 individuals with SUD were systematically analyzed, focusing on frontal and central cortical regions. Spectral parameters were derived using power spectral density estimation, and composite indices were computed via Python-based signal analysis. A rule-based Dependence Likelihood variable and a continuous Dependence Score (0–1 scale) classified cases as dependence-related (≥0.7), borderline (0.5–0.7), or normal (<0.5). Results: Low alpha power and an elevated hyperarousal index (mean = 3.45) characterized most participants. Dependence-related EEG profiles were identified in 87.2% of cases (mean score = 0.86). Alpha blocking remained intact in 46.8% of cases, whereas post-hyperventilation recovery was attenuated in 61.7% of cases. Segmental analysis indicated sustained cortical activation with low TBR (0.37) and elevated beta across all conditions. Conclusions: Quantitative EEG analysis revealed consistent hyperarousal and inhibitory deficits in SUD. The combined Dependence Likelihood and Score framework provides an interpretable, reproducible approach for identifying dependence-related EEG signatures and holds promise as a biomarker in addiction neurophysiology. Full article

Background/Objectives: Non-invasive radiofrequency (NIRF) therapy is increasingly used in physical rehabilitation. However, its efficacy across different lower limb pathologies remains unclear. This study aimed to evaluate the effects of NIRF on pain intensity and functional status in patients with musculoskeletal, neurological, and vascular conditions of the lower limb. Methods: A systematic review with meta-analysis of randomized controlled trials (RCTs) was conducted following PRISMA guidelines. The PubMed, Scopus, Web of Science, PEDro, and Cochrane Library databases were searched for RCTs comparing NIRF with sham, standard care, or other physical modalities. Methodological quality was assessed using the PEDro scale. Statistical analysis was performed using RevMan 5.4 to calculate Mean Differences (MD) and Standardized Mean Differences (SMD). Results: Nineteen RCTs comprising 911 participants were included in the qualitative review, of which 14 were included in the quantitative meta-analysis. The mean methodological quality was 7.78/10. The meta-analysis revealed favorable results for NIRF in reducing pain intensity compared to control groups (MD = −2.04; 95% CI = −3.14 to −0.93; p = 0.0003; I² = 96%). Functional outcomes also showed significant improvement in favor of the experimental group (SMD = −0.51; 95% CI: −0.85 to −0.16; p = 0.004; I² = 78%). Additionally, narrative synthesis indicated benefits for spasticity management (stroke) and limb volume reduction (lipedema/lymphedema). Conclusions: The results suggest a trend favoring NIRF for reducing pain and improving function in lower limb musculoskeletal conditions, particularly when used as an adjunct to active therapy. Evidence also suggests preliminary beneficial effects for neurological and vascular disorders. However, these findings must be interpreted with caution due to the high statistical heterogeneity observed, the broad diversity of the clinical populations included, and the wide variability in the treatment protocols applied. Further rigorous research with standardized protocols is highly recommended. Full article

Lithium-ion batteries (LIBs) are pivotal for energy storage in electric vehicles and renewable systems, but how to effectively monitor their conditions and ensure their operational reliability is still a concern today. This study employs electrochemical impedance spectroscopy (EIS) to systematically investigate the evolution of impedance characteristics in nickel–cobalt–manganese oxide (NCM) lithium-ion batteries (LIBs) under varying states of charge (SOCs), states of health (SOHs), temperatures, and mechanical compression displacements. Results reveal that higher SOC and temperature reduce impedance by enhancing ion kinetics and interfacial activity, with $R_{ct}$ (charge transfer resistance) exhibiting a U-shaped dependence on SOC, minimized at 40–60%. As SOH declines from 100% to 80%, $R_{SEI}$ (SEI film resistance) and $R_{ct}$ increase progressively, reflecting SEI thickening and electrode degradation. Mechanical compression (0–8 mm) elevates all resistances, particularly $R_{ct}$ at high SOC, due to structural deformation and hindered diffusion. DRT (distribution of relaxation times) spectra highlight amplified low-frequency peaks with aging and low SOC, underscoring diffusion limitations. These findings elucidate multi-scale failure mechanisms, from interfacial polarization to structural instability, providing a framework for non-invasive health monitoring and lifetime prediction. Full article

Background and Objectives: Minor otologic procedures in adults are often performed under local anesthesia, either via injection or topical application, thereby avoiding general anesthesia-associated risks. This study aims to compare pain levels with the use of a lidocaine spray versus lidocaine injections. Materials and Methods: Fifty adult patients underwent local anesthetic myringotomy and ventilation tube placement, 30 unilaterally, and 20 bilaterally. Lidocaine injections were administered to 29 patients, and 21 received a lidocaine spray. Postoperatively, they were asked to mark their perceived pain level on a visual analogue scale (VAS, 0–100 mm), verbal rating scale (VRS, 0–3), and numeric rating scale (NRS, 0–10). Data normality was assessed using the Shapiro–Wilk test, continuous variables were analyzed using analysis of variance (ANOVA), and VRS outcomes were analyzed using binary logistic regression. A p-value ≤ 0.05 indicated statistical significance. Results: Pain levels were low in both groups, although consistently lower in the topical lidocaine group. The average VAS score was 23.14 mm (±14.69) for injection versus 9.76 mm (±11.41) for topical anesthesia (ANOVA, p = 0.002), while NRS scores averaged at 2.41 (±1.57) and 1.19 (±1.17), respectively (ANOVA, p = 0.009), indicating significantly lower pain with topical lidocaine. Logistic regression of the VRS indicated the same trend, although it did not reach statistical significance (OR = 0.153, 95% CI:0.017–1.389, p = 0.095). Conclusions: Lidocaine spray was associated with lower pain levels compared to lidocaine injections in patients undergoing myringotomy and ventilation tube placement. Our findings suggest that topical anesthesia may represent an effective alternative, offering a less invasive approach and reducing the needle-related psychological distress of patients. Full article

Background: Systemic venous congestion is a key driver of organ dysfunction in heart failure (HF), yet accurate non-invasive quantification remains challenging. Recognizing residual congestion is critical, since it predicts HF readmissions and mortality. Traditional assessments (physical exam, jugular venous pressure, inferior vena cava [IVC] size) are imprecise. The Venous Excess Ultrasound Score (VExUS) is a semi-quantitative point-of-care ultrasound (POCUS) protocol that integrates IVC diameter with Doppler flow patterns in the hepatic, portal and intrarenal veins to grade systemic venous overload. Methods: We conducted a narrative review of literature (2018–2025) regarding the usefulness of VExUS in HF, covering congestion pathophysiology, clinical evidence (hemodynamic correlations, organ dysfunction, outcomes), potential applications, integration with lung ultrasound, echocardiography and biomarkers, limitations of its assessment and future directions. Results and Discussions: In HF, elevated right atrial pressure causes venous congestion. VExUS integrates IVC diameter with Doppler waveforms of hepatic, portal, and intrarenal veins to grade congestion. Emerging evidence shows higher VExUS grades correlate with elevated filling pressures, renal dysfunction, and worse outcomes. Its use may guide diuretic therapy, aid discharge planning, and monitor outpatient congestion, especially when combined with lung ultrasound and biomarkers. However, VExUS has limitations: it is technical and operator-dependent. Importantly, large trials validating VExUS-guided management are lacking. Future directions include AI-driven automation of Doppler analysis and integration with multimodal congestion monitoring to provide a comprehensive congestion assessment. Conclusions: VExUS is a promising noninvasive tool for quantifying congestion in HF. Higher grades are associated with organ dysfunction and poor prognosis. Incorporating this technique into HF care may improve congestion-guided therapy, but large-scale validation is required before routine use. Full article

Background: Knee osteoarthritis (KOA) is one of the leading causes of chronic pain and long-term disability worldwide. Despite its high prevalence, KOA remains underrepresented in repetitive peripheral magnetic stimulation (rPMS) research. While total knee arthroplasty remains the definitive treatment, there is a growing need for non-invasive approaches to reduce symptoms in patients seeking conservative alternatives or awaiting surgery. Methods: Thirty patients with KOA underwent a non-invasive treatment program consisting of eight sessions of double-coil repetitive peripheral magnetic stimulation (rPMS) over three weeks. Outcome measures included pain intensity assessed by the Visual Analog Scale (VAS), functional ability evaluated by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Timed Up and Go test (TUG), and joint mobility measured as knee flexion and extension. Clinical relevance was evaluated using the Minimal Clinically Important Difference (MCID), and subgroup analyses were performed according to Kellgren-Lawrence (KL) grade. Results: Double-coil rPMS was associated with statistically and clinically significant improvements in all outcomes. MCID responder rates exceeded 80% for VAS and TUG, exceeded 70% for WOMAC, and approached 50% for joint mobility outcomes. Subgroup analysis indicated that patients with lower KL grades experienced greater pain reduction, whereas those with higher grades showed greater functional gains. Conclusions: Double-coil rPMS provided preliminary evidence of potential clinical benefit as a non-invasive approach in patients with KOA. Given the single-arm pilot design, the findings should be interpreted cautiously and require confirmation in adequately powered randomized controlled trials with longer follow-up. Full article

Bladder cancer (BCa) is a major global urinary tract malignancy characterized by high incidence, frequent recurrence, and significant mortality. Early diagnosis is crucial for improving prognosis and minimizing invasive procedures; however, current standard techniques, cystoscopy and urine cytology, are limited by invasiveness, cost, low sensitivity, and subjectivity. This has spurred the development of non-invasive diagnostic strategies based on urine analysis. This review highlights five emerging approaches: AI-augmented urine cytology, genomic biomarker assays (e.g., PCR and NGS for mutations and copy-number variations), DNA methylation profiling, RNA biomarkers (mRNA, miRNA, lncRNA), and protein/peptide/metabolite detection utilizing ELISA, SERS, nanozymes, and mass spectrometry. We assess the diagnostic accuracy, innovations, and clinical potential of each, while addressing persisting issues such as lack of standardization, high costs, and insufficient sensitivity for early-stage lesions. Future directions include integrating multi-omics data with AI, advancing point-of-care devices, and conducting large-scale multicenter trials. Together, these developments promise to shift BCa management toward molecular-based early detection, enabling more precise, non-invasive, and personalized patient care. Full article

Gallbladder disease is a common cause of morbidity in dogs, and cholecystectomy remains the definitive treatment in many cases. Although minimally invasive approaches offer recognized advantages, their adoption is limited by technical complexity and by the physiological effects of carbon dioxide (CO₂) pneumoperitoneum. This cadaveric study evaluated the feasibility of performing primarily gasless robot-assisted cholecystectomy under abdominal wall suspension in five canine cadavers. A normobaric operative field was established using a suspension device combined with the VersiusTM robotic platform. “Primarily gasless” was operationally defined as abdominal wall suspension without continuous pneumoperitoneum, allowing short-duration low-pressure CO₂ insufflation (≤8 mmHg) exclusively as a rescue maneuver when exposure was insufficient. Surgical feasibility was assessed through structured case-level reporting, including docking time, operative time, exposure quality of the hepatocystic triangle (predefined ordinal scale), clipping feasibility, intraoperative events, instrument exchanges, and need for rescue CO₂ insufflation. All procedures were completed in the cadaveric specimens. In three cadavers, the procedure was performed entirely without CO₂. In two cadavers, a single short-duration low-pressure CO₂ insufflation (6–8 mmHg for 3–5 minutes) was applied as a rescue maneuver. Adequate or optimal visualization of the hepatocystic triangle was achieved in all cases, and no intraoperative injuries occurred. These findings support the technical feasibility of a primarily gasless robotic approach in a canine cadaveric model. Controlled in vivo studies are required to evaluate the physiological impact, perioperative outcomes, and translational applicability before clinical implementation. Full article