Search Results (1,572)

Background and Objectives: Evidence on epilepsy surgery from Central Asia is limited, reflecting the real-world challenges of developing this service in low- and middle-income settings. We evaluated one-year seizure outcomes after resective surgery for drug-resistant focal epilepsy at a single center in Kazakhstan, and we assessed whether the use of advanced presurgical imaging was associated with seizure freedom. Materials and Methods: A retrospective cohort study was conducted, including consecutive adults who underwent curative-intent resective epilepsy surgery from 2017 to 2023. Outcomes at 12 months or more post-surgery were classified using the Engel criteria. Logistic regression was used to examine associations between the advanced presurgical diagnostic tool and achieving an Engel class I outcome. Crude and adjusted risk ratios (RRs) for not achieving Engel I were estimated using modified Poisson regression with robust SEs. Results: Among 112 patients (median age 31 years; median epilepsy duration 19 years), 76% underwent temporal lobe procedures and 71% had lobectomies. At one year, 74 patients were seizure-free (Engel II: 15.2%, III: 11.6%, IV: 7.1%). Year-to-year Engel I rates varied without a significant linear trend from 2018 to 2023. In bivariable analyses, MRI-defined atrophy (RR, 3.14) and mixed lesions (RR, 2.62) were associated with a higher risk of not achieving Engel I, whereas longer epilepsy duration was linked to a lower risk (RR, 0.97 per year). In adjusted models, predictors of not achieving Engel I included generalized tonic–clonic seizures (aRR, 1.96), atrophy (aRR, 2.98), mixed lesions (aRR, 2.45), and undergoing any advanced diagnostic test (aRR, 3.38). Longer epilepsy durations remained protective (aRR 0.95 per year). In modality-specific logistic models, fMRI use was associated with higher odds of Engel I (aOR 3.39), and MR spectroscopy was associated with lower odds (aOR 0.33). Conclusions: In this Central Asian single-center cohort, about two-thirds of adults achieved complete seizure freedom one year after resective surgery—comparable to international benchmarks. Advanced imaging modalities showed divergent associations with outcomes, likely reflecting confounding by indication. These findings support the feasibility of effective epilepsy surgery in a low-resource context and the value of targeted use of advanced imaging. Full article

Background: This study introduces the Adaptive Graph Fusion Network, an interpretable graph-based learning framework developed for large-scale prediction of intensive care outcomes. The proposed model dynamically constructs patient similarity networks through a density-aware kernel that adjusts neighborhood size based on local data distribution, thereby representing both frequent and rare clinical patterns. Methods: To characterize physiological evolution over time, the framework integrates a short-horizon convolutional encoder that captures acute variations in vital signs and laboratory results with a long-horizon recurrent memory unit that models gradual temporal trends. The approach was trained and internally validated on the publicly available eICU Collaborative Research Database, which includes more than 200,000 admissions from 208 hospitals across the United States. Results: The model achieved a mean area under the receiver operating characteristic curve of 0.91 across six critical outcomes, with in-hospital mortality reaching 0.96, outperforming logistic regression, temporal long short-term memory networks, and calibrated Transformer-based architectures. Feature attribution analysis using SHAP and temporal contribution mapping identified lactate trajectories, creatinine fluctuations, and vasopressor administration as dominant determinants of risk, consistent with established clinical understanding while revealing additional temporal dependencies overlooked by existing scoring systems. Conclusions: These findings demonstrate that adaptive graph construction combined with multi-horizon temporal reasoning improves predictive reliability and interpretability in heterogeneous intensive care populations, offering a transparent and reproducible foundation for future research in clinical machine learning. Full article

Background: Iodinated contrast agents are widely used in computed tomography (CT) imaging; however, they can cause adverse drug reactions (ADRs) ranging from mild hypersensitivity to severe anaphylaxis. While several clinical risk factors have been identified, large–scale studies incorporating environmental variables remain limited. This study aimed to assess the prevalence and predictors of contrast agent-related ADRs over a 10-year period. Methods: We retrospectively analyzed 221,962 adult outpatients who underwent contrast-enhanced CT between January 2014 and December 2023 at a single tertiary center: Patient characteristics, clinical conditions (e.g., hypertension, allergy history), contrast agent types, premedication status, seasonal trends, temperature, and humidity were examined. ADRs were categorized as mild, moderate, or severe based on American College of Radiology (ACR) guidelines. Logistic regression was used to identify independent predictors. Results: The overall prevalence of ADRs was 0.64% (1423 cases). ADRs were more frequent in females, younger patients, and those receiving premedication. Seasonal and environmental patterns were evident: higher ADR rates occurred in summer and autumn, with positive correlations to ambient temperature and humidity. Among contrast agents, Ioversol (1.4%) and Iomeprol (1.2%) showed the highest ADR rates. The prevalence of mild ADRs increased in the post–COVID-19 period, while that of moderate reactions declined. Conclusions: This real–world study identified multiple clinical and environmental factors associated with ADRs to iodinated contrast agents in CT imaging. The findings suggest the importance of individualized risk assessment and the consideration of environmental factors when planning contrast administration. Full article

Parvovirus B19 (B19V) infection during pregnancy represents a significant clinical concern due to its potential impact on the fetus and pregnancy outcome. We analyzed temporal, spatial, and seasonal B19V seroepidemiology in childbearing-aged and pregnant women in Croatia over 10 years (2015–2024). A total of 976 women who underwent routine TORCH screening were included. The overall B19V IgG and IgM seroprevalence was 63.7 and 8.7%, respectively, with significant temporal differences (IgG 36.8–72.3%, IgM 1.3–18.4). Significant differences in the IgG seropositivity were observed among age groups, from 42.3% in the 16–20 group to 72.7% in the 36–40 group. Spatial analysis showed no significant differences in the IgG or IgM seroprevalence between regions (City of Zagreb/Northern Croatia, Pannonian and Adriatic Croatia) and settlements (urban, suburban/rural). Additionally, seropositivity did not differ significantly in relation to obstetric history. In a logistic regression model, age was a significant predictor for IgG seroprevalence, with each additional year of age associated with increased odds of IgG seropositivity. Year, region, and settlement type were not significant predictors, indicating no evidence of temporal trends, regional differences, or differences between urban and rural settings after adjusting for age. Year of sampling, age, and region were significant predictors for IgM positivity. Acute infections were most common from March to July (61.2%) and December (9.4%), with regional variations in seasonal prevalence patterns. Given that screening in pregnancy is not routinely recommended, the high susceptibility to B19V observed in Croatia supports targeted serologic testing in women with clinical symptoms, known exposure, or occupational risk. Full article

It is essential that the extracted raw material, after mining, is transported to its processing facility. In mining companies, this transfer is managed by a logistics system. However, it is crucial to first adopt the Mining 4.0 concept and subsequently begin implementing new technological trends. This study thoroughly analyzes and evaluates the transportation system of a specific mining operation. The application of modeling and simulation introduces several benefits to this process. Developing a comprehensive model from pre-verified components is the most effective way to represent the system reliably. The objective is to achieve and verify the potential for a monthly output of 10,000 tons of raw material. Experimentation with the model produced a significant amount of data, indicating that the transportation system may achieve the production target. With proper maintenance and precise alternation of processes, as determined by the modeled experiments, the system could be even more effective. The simulation outputs also identified the productivity of other processes within the logistics system. The experiments focused on both improving the system and ensuring its sustainability for the future. The company must ensure and strengthen its system, particularly in terms of its components and management, as this will have the greatest impact on system safety, longevity, and reliability. Full article

Background/Objectives: Oxidative stress is a central mechanism in the pathogenesis of cirrhosis, yet its clinical significance relative to established predictors remains unclear. Methods: We conducted a retrospective cohort study of 90 patients with cirrhosis hospitalized between October 2024 and March 2025. Clinical data, biochemical parameters, systemic inflammatory indices, and oxidative stress markers [malondialdehyde (MDA), 8-epi-prostaglandin F2α (8-epi-PGF2α)] were assessed at admission. Statistical analyses included non-parametric group comparisons, Spearman correlations, logistic regression with interaction terms, ROC analysis with bootstrap confidence intervals, model calibration and discrimination metrics, reclassification indices (NRI, IDI), and decision curve analysis (DCA). Results: Patients with advanced encephalopathy (HE3) had significantly higher MDA levels compared with HE1 (123.4 [107.6–248.4] vs. 131.0 [66.9–301.1] ng/mL; p = 0.021), while 8-epi-PGF2α showed a non-significant but consistent trend. Both oxidative markers correlated with biochemical dysfunction (MDA with INR and albumin; 8-epi-PGF2α with direct bilirubin). ROC analyses demonstrated modest discriminative ability (AUC 0.55–0.60) compared with albumin (AUC 0.74–0.90) and INR (AUC 0.72–0.88). In regression models, albumin remained the strongest independent predictor, whereas oxidative markers did not retain significance. Interaction models suggested that oxidative stress exerted context-dependent effects, particularly in patients with elevated inflammatory indices. Incremental predictive value beyond age and albumin was minimal (ΔAUC ≤ 0.01; NRI + 2–4%). DCA confirmed no added clinical utility. Conclusions: Classical clinical markers, particularly albumin and INR, dominate predictive accuracy in cirrhosis. Oxidative stress markers lack independent predictive power but consistently associate with worsening encephalopathy and liver dysfunction, underscoring their biological relevance and suggesting their role is best understood in conjunction with systemic inflammation. Full article

Background/Objectives: Depression is a prevalent mental health problem among undergraduate students, and dietary patterns may play a role in its prevention. Phytochemical-rich diets have been proposed to be potential protective factors against depression due to their antioxidant, anti-inflammatory, and neuroprotective properties. This study aimed to investigate the association between the Dietary Phytochemical Index (DPI) and depressive symptoms among undergraduate students in Türkiye. Methods: A descriptive, cross-sectional study was conducted among 789 undergraduate students at Erciyes University between May 2024–May 2025. Dietary data were collected using a 101-item Food Frequency Questionnaire, and the DPI was calculated as the percentage of total daily energy derived from phytochemical-rich foods. Depressive symptoms were assessed via the Burns Depression Checklist (BDC). Statistical analyses included correlation and logistic regression models adjusted for gender, income, and academic department. Results: Participants with higher DPI scores exerted significantly lower BDC total and sub-dimension scores, including activities and personal relationships, physical symptoms, and suicidal urges (all p < 0.05). The inverse association between DPI and total depression score remained significant across all adjusted models (p < 0.001), and a significant linear trend was observed across DPI quartiles (p-trend < 0.001). Conclusions: Higher dietary phytochemical intake was associated with lower depressive symptom levels among undergraduate students. These results suggest that phytochemical-rich dietary patterns, characterized by increased consumption of fruits, vegetables, whole grains, legumes, and nuts, may contribute to improved psychological well-being. Promoting the intake of phytochemical-dense foods could be a practical nutritional strategy for supporting mental health in young adults. Full article

Background and Objectives: Facebook groups have become support spaces for people with rare diseases such as amelogenesis imperfecta (AI). While their potential for revealing patient needs is recognized, no systematic analysis has been conducted in France. This study aims to better understand the psychological and practical needs of French AI patients by analyzing interactions within a dedicated Facebook group. Methods: A semantic and thematic analysis was conducted on 881 texts (39,647 words) from the French Facebook group Amelogenesis Imperfecta. A custom tool, TEXTRA©, and IRaMuTeQ© software were used for analysis, including similarity analysis (lexical co-occurrences), Descending Hierarchical Classification (DHC), Correspondence analysis to reveal discourse structures. Results: Correspondence analysis revealed two main discourse trends: individual experiences (symptoms, treatment logistics, and medical engagement) and collective narratives (focused on awareness, mobilization, and institutional recognition). DHC identified four thematic classes: (a) difficulties accessing healthcare, (b) genetic framing and family implications, (c) dental symptoms and treatment experiences, and (d) community advocacy. These findings highlight how the group fosters emotional support, peer exchange, and empowerment. Conclusions: Online communities play a vital role in supporting patients with rare diseases. This study shows that the analysis of user-generated content can guide improvements in clinical practice, psychosocial support, and health policy. Full article

Background: The introduction of prophylactic HPV vaccination has transformed cervical cancer prevention worldwide, yet many low- and middle-income countries face persistent challenges in implementation, coverage gaps, and vaccine hesitancy. This article presents a narrative review of global and Brazilian HPV vaccination programs, highlighting achievements, pitfalls, and lessons for future strategies. Methods: We reviewed peer-reviewed literature and official reports from WHO, PAHO, CDC, Brazilian institutions, and others, focusing on programmatic performance, coverage trends, and vaccine acceptance. Results: In high-income settings such as Australia and the United Kingdom, school-based vaccination programs have driven sharp declines in HPV prevalence, genital warts, and precancerous lesions, in some cases approaching elimination thresholds. The United States has made progress but continues to struggle with disparities in uptake linked to socioeconomic and cultural factors. In India and several African nations, recent evidence supports single-dose regimens as a cost-effective and logistically feasible strategy. In Brazil, HPV vaccination was introduced in 2014 via the National Immunization Program (PNI), initially targeting girls aged 9–13 years through school campaigns. First-dose coverage exceeded 80% in the first year but subsequently declined, with full-schedule completion rates dropping below 60%. Contributing factors include misinformation, weakening of school-based delivery, and pandemic-related disruptions. Brazil later expanded eligibility to boys and immunocompromised populations and, more recently, extended catch-up vaccination to older adolescents. Conclusions: HPV vaccination has the potential to substantially reduce cervical cancer incidence globally. However, sustained impact depends not only on infrastructure and universal access but also on consistent school-based delivery, adaptive policies such as single-dose regimens, and robust communication strategies to counter misinformation. Brazil’s experience offers both inspiration and caution, providing lessons for countries striving to meet the WHO 90-70-90 targets. Full article

As pivotal hubs in maritime logistics networks, ports bear a growing responsibility to harmonize economic activities with environmental stewardship. Evaluating and enhancing port environmental efficiency (PEE) is therefore imperative for maritime decarbonization and sustainability. However, conventional approaches often assume homogeneous abatement capacities across heterogeneous ports, which may distort evaluation results. To address this flaw, we develop a modified EBM-Undesirable model embedding weak disposability and non-uniform abatement factors, explicitly accounting for heterogeneity the in port’s abatement capabilities. Drawing on panel data from China’s major coastal ports during 2013–2022, this study further employs the Global Malmquist Index and Dagum Gini coefficient to investigate dynamic characteristics and regional disparities in PEE. Key findings reveal: (1) PEE exhibits a modest yet volatile upward trend, accompanied by pronounced inter-port divergence; (2) Total factor productivity (TFP) demonstrates sustained improvement attributable to technical efficiency advancements, yet reveals untapped potential in technological level; (3) Substantial spatial heterogeneity persists, dominated by interregional differences, though overall inequality is gradually converging. Given the observed regional disparities and technological potential, policy suggestions are proposed to advance port decarbonization, regional coordination, and maritime sustainability. Full article

Aim: This study compared the expression of four long non-coding RNAs (lncRNAs)—XIST, UCA1, MALAT1, and ANRIL—in endometrial polyps (EP), endometrial cancer (EC), and normal endometrium to assess their diagnostic and prognostic potential. Materials and Methods: In this prospective study, 150 women undergoing endometrial biopsy between August 2021 and April 2024 were included (50 EP, 50 EC, 50 controls). RNA was extracted from FFPE tissue, converted to cDNA, and analyzed using SYBR Green-based qRT-PCR with U6 snRNA as reference. Statistical analysis included ANOVA/Kruskal–Wallis, logistic regression, and ROC analysis; p < 0.05 and fold change ≥±2 were considered significant. Results: The mean age was significantly higher in EC than in EP and controls (p < 0.05), with BMI also elevated (p = 0.006). UCA1 expression was upregulated in EP compared with controls (p = 0.008) but markedly downregulated in EC (p < 0.0005). XIST, MALAT1, and ANRIL showed upward trends in EC without independent statistical significance. Logistic regression identified age and UCA1 as the only independent predictors. Diagnostic accuracy was high: EC vs. control AUC = 0.98; EP vs. control AUC = 0.86; EC vs. EP AUC = 0.87. Age predicted malignancy, while high UCA1 was associated with EP and low UCA1 with EC. Discussion: Age and UCA1 expression were the strongest discriminators between lesion types. UCA1’s dual, context-dependent role—promoting benign proliferation in EP and decreasing in EC—suggests potential biomarker utility. Other lncRNAs aligned with oncogenic functions but lacked independent predictive value. Combining molecular and clinical parameters could improve risk stratification and early detection, warranting validation in larger cohorts. Full article

Trends in electrical energy efficiency are key factors influencing production costs in food industry plants, as all production equipment relies on electricity. Accurate forecasting is essential for predicting future consumption and enabling effective energy management. This study aims to analyze and forecast trends in electrical energy efficiency in the food industry. Production and electricity consumption data from January 2022 to December 2023 were used to calculate the difference in electrical energy (DIFF) and the cumulative sum of electrical energy differences (CUSUM), which served as the basis for forecasting. The Long Short-Term Memory (LSTM) model, based on the deep learning approach, was employed to simulate the algorithmic patterns of electrical energy data in the food industry. Its forecasting performance was then compared with two alternative models, namely decomposition and logistic regression, using evaluation data from January to December 2024. Model accuracy was assessed using the Mean Absolute Percentage Error (MAPE) criterion. The results revealed that the decomposition model achieved lower MAPE values for both DIFF (14.47%) and CUSUM (24.13%), while the logistic regression model yielded higher MAPE values of 73.70% and 66.85%, respectively. Therefore, the decomposition model was identified as the most suitable method for forecasting electrical energy consumption trends in the food industry, providing higher accuracy and reliability than logistic regression. Forecasting energy consumption trends using the decomposition model can support strategic energy planning to enhance efficiency, reduce costs, and promote the sustainable development of the food industry in the future. Full article

Background: Age is a well-established determinant of sepsis outcomes, often integrated into severity scoring systems. However, most studies focus on critically ill patients in intensive care units (ICUs), with limited insight into how age influences mortality in non-ICU settings, particularly across the full adult lifespan. Objective: To investigate the relationship between age and in-hospital mortality in patients with sepsis hospitalized in internal medicine wards, using age-stratified logistic and spline regression models. Methods: We conducted a retrospective, multicenter cohort study involving 4300 adult patients admitted to internal medicine wards at eight academic hospitals affiliated with Clalit Health Services in Israel between December 2001 and October 2020. All patients were diagnosed with sepsis during hospitalization and died during their hospital stay. Patients were stratified into seven age groups (18–34, 35–44, 45–54, 55–64, 65–74, 75–84, >85 years). Logistic regression identified age-specific comorbidities associated with mortality. Adjusted spline regression models were used to estimate mortality probabilities across age ranges. Results: The cohort had a mean age at death of 78.84 years, and 51.7% were female. Mortality probability increased with age but demonstrated non-linear trends. Sharp fluctuations in predicted mortality were observed in middle-aged groups (especially ages 45–54), with peaks not captured in conventional binary or linear models. Hematologic and solid neoplasms were strongly associated with mortality in younger groups, while cardiovascular comorbidities such as heart failure and atrial fibrillation were more prominent in older adults. Conclusions: Age is a major determinant of in-hospital mortality in septic patients on internal medicine wards, but its effect is non-linear and age-specific. Our findings highlight a unique population of patients with severe sepsis not managed in critical care settings and underscore the need for more nuanced, age-stratified risk assessment models outside of the ICU. Full article

Background: Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is linked to metabolic syndrome, obesity, and type 2 diabetes. Omega-3 fatty acids, especially EPA and DHA from fish, may protect against hepatic steatosis. Methods: From 2015 to 2018, all participants were invited to the first follow-up, where 1426 (62% response rate) responded and underwent the same standardized protocol as at baseline. For this analysis, the study is a cross-sectional investigation focusing solely on follow-up data, which included 1297 adults. MASLD was diagnosed via standardized ultrasound, and dietary intake was assessed using the validated EPIC Food Frequency Questionnaire. Associations between total EPA and DHA intake and MASLD were examined using logistic regression models adjusted for age, sex, marital status, occupation, income, Mediterranean diet adherence, liver enzymes, and C-reactive protein. Results: Overall, 48.5% of participants had MASLD. Higher total EPA and DHA intake was associated with lower odds of MASLD (EPA highest vs. lowest quartile: OR = 0.572, 95% CI 0.400–0.818; DHA highest vs. lowest quartile: OR = 0.516, 95% CI 0.361–0.739). Intake of fatty fish contributed most strongly to this protective effect (EPA highest vs. lowest quartile: OR = 0.556, 95% CI 0.390–0.794; DHA highest vs. lowest quartile: OR = 0.575, 95% CI 0.403–0.820), whereas mollusks, crustaceans, and some processed/frozen fish showed weaker or no associations. A statistically significant trend of decreasing MASLD risk was observed across increasing quartiles of both EPA and DHA intake. Conclusions: Higher intake of EPA and DHA, especially from fatty fish, is linked to lower MASLD risk in this Mediterranean population, supporting recommendations for regular fish consumption to protect liver health. Full article

Background and Objectives: Percutaneous endoscopic gastrostomy (PEG) is a widely accepted method for long-term enteral nutrition, but procedure-related complications and early mortality remain major concerns. Nutritional and inflammatory indices such as serum albumin, C-reactive protein (CRP), Prognostic Nutritional Index (PNI), and Nutrition Risk Screening (NRS-2002) may provide prognostic value, yet comparative data in PEG cohorts are limited. This study aimed to identify predictors of complications and 90-day mortality after PEG and to compare the prognostic performance of nutritional indices. Materials and Methods: A retrospective cohort of 122 consecutive adult patients undergoing PEG between January and December 2024 was analyzed. Demographic, clinical, and laboratory parameters were collected, including albumin, CRP, PNI, and NRS-2002. Complications were categorized as early (≤30 days) or late (>30 days), and all-cause mortality was assessed at 30 and 90 days. Univariate and multivariate logistic regression models were used to evaluate predictors of complications and 90-day mortality. To address multicollinearity, albumin, PNI, and NRS-2002 were separately tested in adjusted models, with model performance assessed by AIC, BIC, Nagelkerke R², and C-index. Results: Early complications occurred in 4.9% and late complications in 8.2% of patients, for a total complication rate of 13.1%. Thirty-day mortality was 4.1%, 90-day mortality 17.2%, and total in-hospital mortality during the study year 30.3%. Neuromuscular indication was independently associated with increased risk of complications (aOR 5.0, 95% CI 1.2–20.0, p = 0.028) but reduced 90-day mortality (aOR 0.15, 95% CI 0.03–0.80, p = 0.025). Lower baseline albumin independently predicted higher 90-day mortality (aOR 0.92, 95% CI 0.86–0.99, p = 0.034). Elevated CRP demonstrated a borderline association with mortality (p = 0.051), while NRS-2002 ≥5 and Δ-PNI showed borderline trends toward increased mortality risk. In model comparison, none of the nutritional indices achieved independent statistical significance, but all demonstrated similar performance (AIC = 114, C-index 0.72–0.74). Conclusions: PEG outcomes are strongly influenced by baseline indication and nutritional–inflammatory status. Neuromuscular patients and patients with dysphagia face higher complication risk but lower short-term mortality, while hypoalbuminemia, elevated CRP, and high NRS-2002 or declining PNI identify patients at greater risk of death. Systematic integration of albumin, CRP, PNI, and NRS-2002 may improve risk stratification and management in PEG candidates. Full article