Search Results (22,840)

Background/Objectives: Anterior direct composite restorations are evaluated through instrumental color matching, clinician appraisal, and patient perception, but these endpoints may diverge by age. This cross-sectional study compared adolescents/young adults (AYA, 15–25 years) with adults/elderly (AE, 50–75 years) for spectrophotometric color difference (ΔE*ab), patient and clinician aesthetic ratings, patient–clinician agreement, and oral-health-related quality of life (OHRQoL). Methods: Consecutive recall patients with at least one anterior direct composite restoration placed ≥6 months earlier were screened; 128 were enrolled, and 126 completed all assessments (AYA n = 64; AE n = 62). Participants completed the OHIP-14 and aesthetic visual analogue scale (VAS) before receiving any USPHS, clinician VAS, or spectrophotometric feedback. A separate clinician, masked to patient scores and spectrophotometric outputs but not to patient age, recorded clinician VAS and modified USPHS criteria. Results: AE restorations showed higher ΔE*ab than AYA restorations (4.8 ± 1.6 vs. 3.2 ± 1.1; p < 0.001), whereas AYA reported lower patient VAS (72.4 ± 12.3 vs. 81.6 ± 10.8; p < 0.001) and higher OHIP-14 psychosocial burden (7.2 ± 2.8 vs. 4.0 ± 2.3; p < 0.001). Clinician VAS was higher in AYA (85.2 ± 7.3 vs. 79.4 ± 8.9; p < 0.001). Patient VAS correlated modestly with ΔE*ab (ρ = −0.38 in AYA; ρ = −0.31 in AE) and more strongly with psychosocial OHIP-14 scores (ρ = −0.54 and −0.47, respectively). Patient-clinician agreement was poor in AYA (ICC = 0.26) and moderate in AE (ICC = 0.58), with larger negative patient-minus-clinician discrepancies in AYA. Exploratory mediation statistically decomposed the age-related patient-satisfaction difference more through patient–clinician discrepancy than through ΔE*ab; causality cannot be inferred. Conclusions: Younger patients may experience dissatisfaction and psychosocial burden despite better instrumental color match. Assessment of anterior composites should combine objective shade measurement with patient-centered expectation clarification, and longitudinal studies should test temporal mechanisms and communication interventions. Full article

Bayesian estimation of nonlinear mixed-effects models typically relies on Markov-Chain Monte Carlo (MCMC) methods due to the intractability of the posterior distribution. While widely used for longitudinal data with missing observations, the performance of MCMC algorithms is often taken for granted, despite their critical impact on inference quality. This paper investigates MCMC-based estimation for Bayesian nonlinear mixed-effects models with missing data, focusing on convergence behavior and computational efficiency. We propose a hybrid sampling framework that combines Gibbs sampling with Metropolis–Hastings (MH) and adaptive MH algorithms to improve mixing and stability. Convergence diagnostics, the effective sample size, and computational performance are systematically evaluated. Simulation studies assess the effects of the iteration length, burn-in proportion, and sample size, and the methodology is illustrated using orthodontic growth data and the Treatment of Lead-Exposed Children (TLC) trial. Full article

Background/Objectives: Magnetic resonance elastography (MRE) provides an accurate and reproducible non-invasive assessment of liver stiffness and fibrosis severity in metabolic dysfunction-associated steatotic liver disease (MASLD). Although longitudinal changes in liver stiffness have been associated with clinical outcomes, the association between short-term and longitudinal changes remains unclear. This study aimed to evaluate the association between short-term and long-term changes in MRE-derived liver stiffness in patients with MASLD undergoing serial MRE assessments. Methods: In this retrospective cohort study, 100 patients with MASLD who underwent three MRE examinations at approximately baseline, 1 year, and 3 years were analyzed. Early response was defined as a ≥19% reduction in liver stiffness at the second examination relative to baseline. The association between early response and long-term liver stiffness changes was evaluated using logistic regression analysis. Results: A total of 22 patients (22%) were classified as early responders. Early responders were significantly more likely to achieve a ≥19% reduction in liver stiffness at the third MRE compared with non-early responders (59% vs. 27%, p = 0.006). In multivariable analysis adjusting for baseline liver stiffness, early response remained independently associated with long-term improvement (odds ratio 3.41, 95% CI 1.18–9.86; p = 0.023). Higher baseline liver stiffness was also associated with subsequent improvement (OR per 1 kPa increase, 1.44, 95% CI 1.11–1.87; p = 0.006). Conclusions: Early reductions in liver stiffness measured by MRE were associated with subsequent long-term improvements in patients with MASLD, suggesting that short-term MRE changes may provide insight into subsequent longer-term stiffness changes. Full article

Background: In the US, obesity is still a serious public health issue. Bariatric surgery utilization has recently been influenced by the COVID-19 pandemic and the 2022 American Society for Metabolic and Bariatric Surgery (ASMBS)/International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) guideline expansion. The combined effects of these events on national utilization trends remain unclear. Methods: We conducted a retrospective longitudinal study using electronic medical record data from the TriNetX network, including adults aged ≥18 years from 2018 through 2024. Primary bariatric procedures were identified using validated CPT and ICD codes. Quarterly surgery rates per 100,000 adults were calculated using the number of unique adults with at least one healthcare encounter per quarter as the denominator. Level and slope changes related to the start of COVID-19 (Q2 2020) and the application of the 2022 ASMBS guidelines (Q1 2022) were evaluated using interrupted time series models. Procedure-type distributions were also evaluated. Results: A total of 215,072 procedures were identified. Utilization was stable before Q2 2020, when a significant decline occurred following the onset of COVID-19. Rates recovered through 2021. After Q1 2022, a modest immediate increase was observed, followed by a sustained downward trend through 2024. Sleeve gastrectomy accounted for approximately two-thirds of procedures throughout the study period. Conclusions: Bariatric surgery utilization was markedly disrupted by COVID-19 and showed limited sustained growth after guideline expansion. These patterns might be a reflection of more general changes in the management of obesity, such as the growing accessibility of medication. Full article

Background/Objectives: Age-related functional decline is increasingly linked to chronic low-grade inflammation (inflammaging) and sarcopenia, two interconnected processes contributing to frailty, metabolic dysregulation, and impaired physical function. These conditions share several underlying mechanisms, including immune dysregulation, mitochondrial dysfunction, oxidative stress, and impaired anabolic signaling. This narrative review critically evaluated the mechanistic and translational interactions between natural bioactive compounds and lifestyle interventions in modulating inflammaging and sarcopenia. Methods: Evidence from molecular, experimental, epidemiological, and clinical studies was synthesized to examine the effects of bioactive compounds—including polyphenols, flavonoids, carotenoids, and omega-3 fatty acids—as well as physical activity and dietary patterns. Particular emphasis was placed on inflammatory regulation, redox homeostasis, mitochondrial adaptation, and muscle metabolism, including NF-κB, AMPK–mTOR, and Nrf2 signaling pathways. Results: Observational studies and randomized controlled trials generally indicate that anti-inflammatory dietary patterns and regular physical activity are associated with improved muscle strength, physical performance, and inflammatory status in older adults. Mechanistically, nutritional bioactives and exercise appear to converge on several pathways involved in mitochondrial function, oxidative stress, anabolic signaling, and immune activation. Emerging evidence suggests potential convergence and interaction of biological pathways affected by nutritional and lifestyle interventions; however, formal evidence demonstrating true synergistic effects in humans remains limited. Nevertheless, substantial heterogeneity persists regarding intervention protocols, dosage strategies, bioavailability, and long-term clinical outcomes. Conclusions: Natural bioactive compounds and lifestyle-based interventions represent promising approaches for targeting biological processes implicated in inflammaging and sarcopenia. By integrating current evidence within a hormesis-oriented geroscience framework, this review highlights the importance of adaptive redox regulation, metabolic resilience, and evidence-based lifestyle strategies in healthy aging. Future well-designed longitudinal and intervention studies are needed to clarify the clinical relevance of these interactions and optimize translational implementation. Full article

Background and Objectives: Cervicogenic headaches (CGH) are increasingly common among college students and may negatively affect academic performance and sleep quality. This study aimed to identify the self-reported prevalence of cervicogenic-type head and neck pain in a convenience sample of Saudi college students and to examine its associations with electronic device use, physical activity, and sleep quality among college students in Saudi Arabia. Materials and Methods: A cross-sectional study was conducted among 313 college students from various Saudi university colleges using an online self-administered questionnaire. The questionnaire gathered information on sociodemographic characteristics, electronic device usage, neck pain awareness, physical activity levels, and sleep quality. Descriptive statistics were used to summarize the data, and chi-square tests were used to explore associations between potential predictors and the prevalence of self-reported cervicogenic-type head and neck pain consistent with possible CGH. Results: Most participants were female (84.3%) and aged 18–25 years (95.2%). Cervicogenic-type head and neck pain were reported by 65.2% (n = 204/313), while 56.5% experienced moderate to severe stress. A significant association was found with perceived stress (p = 0.002). Prolonged electronic device use (>4 h/day: 77.9%; p < 0.01), lower physical activity (p = 0.056), medication use (p < 0.01), headache exacerbation with inactivity (p = 0.006), and poor sleep quality (95.1% with PSQI > 10; p = 0.044) were significantly associated. Conclusions: These findings highlight associations between excessive electronic device use, low physical activity, and poor sleep quality with self-reported cervicogenic-type head and neck pain among Saudi college students. Future longitudinal studies and randomized controlled trials are needed to determine whether targeting these factors reduces the prevalence of CGH. Full article

Background/Objectives: Post-radiation fibrosis is a common complication in patients with head and neck cancer (HNC), characterised by increased tissue stiffness and functional limitations. Shear wave elastography (SWE) enables objective assessment of tissue stiffness, while self-reported outcome measures provide insight into symptom burden. However, the longitudinal evolution of these outcomes and their relationship remains insufficiently described. This study aimed to characterise post-radiation fibrosis over time using objective SWE measurements of sternocleidomastoid (SCM) muscle stiffness and self-reported fibrosis-related symptoms, and to examine their longitudinal association. Methods: This prospective longitudinal study included 56 patients with HNC undergoing primary or postoperative (chemo)radiotherapy. Muscle stiffness was measured using SWE, and fibrosis-related symptoms were assessed with the Lymphoedema Symptom Intensity and Distress Survey-Head and Neck (LSIDS-H&N) at 1 week, 6 weeks, 12 weeks, 6 months, and 12 months after the start of radiotherapy. Longitudinal analyses were performed using mixed-effects models adjusted for surgery and radiation dose, and within-subject associations were evaluated using repeated measures correlation. Results: Muscle stiffness increased over time, with estimated mean stiffness values rising from 4.12 m/s at baseline to 4.76 m/s at 6 months and 4.92 m/s at 12 months. Significant increases were observed at 6 months (p = 0.007) and 12 months (p = 0.012) compared with baseline. In contrast, self-reported fibrosis-related symptoms remained stable, with no significant differences between time points. No significant within-subject association was found between muscle stiffness and self-reported fibrosis-related symptoms (r = −0.13, p = 0.498). Conclusions: Muscle stiffness measured with SWE increased over time following radiotherapy, whereas self-reported fibrosis-related symptoms remained stable. No significant longitudinal association was found between these outcomes, suggesting they may capture different aspects of fibrosis. Full article

Background: Extremely and very preterm infants are at high risk for adverse neurodevelopmental outcomes. Early prediction remains challenging when relying on static clinical markers or single time-point neuroimaging. Serial cranial ultrasound (CUS) enables repeated bedside assessment of cerebral growth and may provide longitudinal trajectory biomarkers integrable with routine clinical data. Methods: In this retrospective two-center cohort study, 89 preterm infants (<32 weeks’ gestation and/or <1500 g birth weight) were assessed using the Bayley-III at 24 months corrected age. Brain volume trajectory features were derived from serial CUS using a standardized ellipsoid model. A three-level analytical framework was applied as follows: univariate regression (62 models, Bonferroni and Benjamini–Hochberg correction), multivariate SVM classification with five-fold GroupKFold cross-validation, ensuring patient-level data separation and feature importance analysis with interaction characterization using stratified Spearman correlation and two-dimensional partial dependence plots. Results: Multivariate classification yielded modest but above-chance performance (balanced accuracy 0.277–0.463, Cohen’s κ 0.042–0.152). Respiratory morbidity duration—mechanical ventilation and BPD severity—were the most robustly associated univariate predictors, surviving Bonferroni correction. Brain volume trajectory features showed no significant univariate associations but contributed conditionally within the multivariate framework as follows: the interaction between brain volume slope and trajectory linearity was the strongest for cognitive outcome (Δr = 0.47), and postnatal growth restriction showed amplified adverse effects at lower birth weight for motor outcome (Δr = 0.47). Conclusions: This study demonstrates the value of ML methods as structured analytical tools for characterizing predictor–outcome relationships in preterm neurodevelopment; respiratory morbidity and brain volume trajectory features emerged as the most informative predictor classes. Prospective multicenter validation is required before clinical translation. Full article

Background/Objectives: Teachers in educational institutions are continuously exposed to high occupational demands, which may contribute to the development of increased adiposity and comparatively unfavorable health-related quality of life (HRQoL) scores. However, there is limited evidence regarding how years of professional experience is associated with these indicators in teachers. The objective of this study is to examine the association between years of professional experience, adiposity indicators, and HRQoL among teachers in educational institutions. Methods: An observational, relational, exploratory cross-sectional study was conducted in 175 teachers from educational institutions in the city of Temuco, Chile. Body mass index (BMI), waist-to-height ratio (WHtR), and waist-to-hip ratio (WHR) were assessed as adiposity indicators, and health-related quality of life (HRQoL) was measured using the SF-12. Age, sex, and years of professional experience were recorded. Simple and multivariable linear regression models were used to analyze the association between years of experience and the study variables, adjusting for age and sex. Additionally, experience tertiles were compared using ANOVA and ANCOVA. Results: In the unadjusted analyses, greater years of professional experience were associated with higher adiposity indicators, including BMI (β = 0.071; 95% CI: 0.020 to 0.129). However, after adjustment for age and sex, these associations were attenuated and no longer statistically significant (adjusted BMI: β = −0.172; 95% CI: −0.434 to 0.053). Associations with PCS and MCS scores were also not statistically significant after adjustment. Conclusions: Teachers exhibited high levels of adiposity and HRQoL scores suggesting an unfavorable perceived health profile. The observed associations between years of professional experience and adiposity or HRQoL appear to be largely explained by age rather than by professional experience itself. Future longitudinal studies are needed to more precisely distinguish between the effects of aging and prolonged occupational exposure. However, the findings should be interpreted cautiously given the convenience sampling design and the inclusion of teachers from a single city. Full article

With the rapid aging of the global population, constipation has become a major gastrointestinal concern among elderly individuals. Bowel sounds provide a non-invasive acoustic signal for assessing gastrointestinal function, but their automatic analysis remains challenging due to sparsity and non-stationarity. This study proposes a two-stage bowel sound analysis framework based on continuous abdominal recordings. First, a Convolutional Neural Network-MAMBA (CNN-MAMBA) model was used for salient bowel sound detection. Second, a patient-level constipation classification model was developed using multi-view spectral representations and a Convolutional Neural Network-Conformer-Multiple Instance Learning (CNN-Conformer-MIL) architecture. On a held-out test set, the detection model achieved an accuracy of 0.87, an F1-score of 0.78, and a ROC-AUC of 0.93. For patient-level classification under binary Bristol Stool Form Scale (BSFS) grouping, five-fold cross-validation yielded a mean accuracy of 0.665 and an F1-score of 0.755. All BSFS labels were annotated by clinical physicians and temporally aligned with bowel sound recording. Given the modest improvement and cross-validation variability, the patient-level results should be interpreted as preliminary feasibility evidence. These findings suggest that bowel sound analysis may serve as an auxiliary screening or longitudinal monitoring tool rather than a stand-alone diagnostic system. Full article

Multisystem inflammatory syndrome in children (MIS-C) and Kawasaki disease (KD) are pediatric inflammatory conditions which share overlapping clinical features, yet their long-term cardiovascular trajectories remain incompletely characterized. Understanding differences in myocardial strain evolution and coronary artery Z-score progression is essential for optimizing surveillance strategies and risk stratification. Aims of this review were to comprehensively compare the long-term evolution of myocardial strain parameters and coronary artery Z-scores in children with MIS-C versus KD through mid- and long-term follow-up assessment studies, and to identify clinical implications for monitoring and management. A comprehensive literature search was conducted in PubMed to identify studies evaluating myocardial strain and coronary artery Z-scores in MIS-C and KD. Publications from January 2020 to February 2026 were considered for MIS-C, with earlier key studies on KD included to contextualize established cardiac outcomes. Observational studies and cohort reports describing echocardiographic findings and follow-up data were reviewed. Available evidence indicates that MIS-C commonly presents with acute myocardial dysfunction, frequently characterized by reduced global longitudinal strain despite preserved or mildly reduced ejection fraction; in most cases, myocardial strain abnormalities substantially improve within weeks to a few months following treatment. In contrast, myocardial strain impairment in KD, which typically presents at less than 5 years of age, is less pronounced; coronary artery involvement shows an opposite trend, as KD is more frequently associated with coronary dilations and aneurysm formation, reflected by persistent elevations in coronary artery Z-scores, whereas coronary abnormalities in MIS-C are milder and often transient. Recovery patterns therefore differ, with MIS-C demonstrating rapid myocardial functional recovery, and KD carrying a greater risk of long-term coronary artery sequelae. MIS-C and KD exhibit distinct cardiovascular phenotypes: MIS-C is primarily characterized by reversible myocardial dysfunction, whereas KD remains a condition most strongly associated with a risk of persistent coronary artery abnormalities. Deciphering these differences may help guide disease-specific cardiac monitoring and long-term follow-up strategies in affected children. Full article

Drought remains a persistent challenge affecting agricultural and pastoral livelihoods, particularly in dryland mixed crop–livestock systems. Water Monitoring and Early Warning Systems (WM-EWS) have increasingly been promoted as tools for delivering climate information services and supporting drought-related decision-making. However, empirical understanding of how users perceive and engage with such systems in pastoral contexts remains limited. This study explores stakeholder perceptions regarding the usefulness and operational relevance of a WM-EWS implemented in the Borana zone of Ethiopia. A mixed-methods approach was employed, combining survey data from 71 purposively selected mixed stakeholders with qualitative insights obtained through focus group discussions and key informant interviews. Findings indicate that respondents widely reported using WM-EWS information for water-related decision-making and perceived the system as useful in supporting drought preparedness and adaptive responses. Participants associated WM-EWS use with perceived changes in areas such as livestock management, access to water-related information, and coordination among stakeholders. Respondents also reported adopting multiple coping strategies, including early livestock sales, strategic herd mobility, and engagement with external support mechanisms. Respondents perceived fewer conflicts over water resources and greater engagement from humanitarian actors following WM-EWS implementation. Overall, the study provides exploratory insights into stakeholder experiences, perceived usefulness, and operational relevance of user-centered WM-EWS in drought-prone pastoral systems. The findings contribute to understanding how pastoral communities engage with climate information services while highlighting the need for future research using objective and longitudinal approaches to assess system effectiveness more rigorously. Full article

Laser powder bed fusion (LPBF) of high-strength aluminum alloy 7075 (AA7075) is severely limited by hot cracking. However, the underlying mechanisms, particularly the coupling between thermal fields, solidification microstructure, and cracking behavior, remain insufficiently clarified. This study elucidates these mechanisms by integrating experimental characterization with thermal simulation to investigate the temperature field, microstructure, and cracking relationships in both AA7075 and a crack-resistant 7075-Er-Zr alloy. Results show that coarse hot crack morphology is highly dependent on linear energy density E_L. In AA7075, E_L < 450 J/m promotes laterally inclined cracks (short, narrow cracks extending from the melt pool boundary toward the track center), whereas E_L higher than that value leads to the continuous centerline cracks (long, wide cracks along the track center). Fine microcracks are also observed at melt pool boundaries. The 7075-Er-Zr alloy demonstrates superior crack resistance. At E_L = 600 J/m, longitudinal centerline cracks still penetrate along the track, but the alloy achieves crack-free tracks at 200 W with scanning speeds above 1000 mm/s, otherwise exhibiting only short discontinuous cracks. Microcracks at melt pool boundaries are markedly suppressed in the modified alloy. The enhanced crack resistance is attributed to Er/Zr-induced grain refinement and a transition to an equiaxed grain structure, which disrupts intergranular gaps. Critically, thermal simulations identify an annular region with a peak temperature gradient. In AA7075, this region develops aligned columnar grains that facilitate both microcracks and centerline cracks. In the 7075-Er-Zr alloy, microcracks are fully eliminated within this region. However, a residual crystallographic texture persists in the annular region, which promotes the continued occurrence of centerline cracks under high energy density (e.g., E_L = 600 J/m). The annular region remains a critical weak link, and its microstructural control determines the prevailing crack type. This work provides a fundamental understanding of the thermal-microstructural origins of cracking and offers a theoretical foundation for developing crack-resistant aluminum alloys via LPBF. Full article

We review the structure of pseudoscalar mesons within an algebraic model formulated in the light-front framework. The approach provides a unified description of leading-twist parton distribution amplitudes, light-front wave functions, generalized parton distributions, parton distribution functions, elastic electromagnetic form factors, charge radii, and impact-parameter space distributions, all obtained from the same underlying Bethe–Salpeter wave-function representation. The analysis covers light mesons $(\pi ,K)$, the mixed $\eta$–${\eta }^{\prime }$ system, heavy–light states $(D,D_s,B,B_s,B_c)$, and heavy quarkonia $({\eta }_c,{\eta }_b)$, thereby enabling a systematic study of quark-mass effects, flavor-symmetry breaking, and the transition from emergent hadronic mass to heavy-quark dynamics. Where available, results are compared with experimental measurements, functional methods such as lattice-QCD calculations and Dyson–Schwinger Equation formalism, and other phenomenological approaches. The algebraic model thus offers a transparent, symmetry-preserving, and analytically tractable framework for connecting the longitudinal, transverse-momentum, and spatial structure of pseudoscalar mesons across all quark-mass regimes. Full article

Accurately obtaining aircraft aerodynamic parameters is essential for improving flight performance, optimizing design and control strategies, and ensuring flight safety. In this study, the improved Northern Goshawk Optimization (SPNGO) algorithm is used to optimize the kernel parameters and regularization coefficients of the Kernel Extreme Learning Machine (KELM). To address the defects of the original NGO algorithm, such as insufficient global optimization ability and being prone to falling into local optimums, two improvement strategies are proposed. The enhanced SPNGO algorithm is verified by 14 benchmark test functions, and the proposed SPNGO-KELM model is evaluated using open-source F-16 nonlinear simulation data for longitudinal aerodynamic parameter identification. The results demonstrate its effectiveness under the considered simulation conditions, while further validation with real flight-test data is required before application to actual flight environments. Comparative analysis with KELM, NGO-KELM, SSA-KELM, and WOA-KELM models shows that a single KELM is difficult to achieve high-precision aerodynamic parameter identification, and other comparison models have obvious fitting deviations in non-steady-state and strong nonlinear regions. Notably, the SPNGO-KELM model achieves the best identification performance, with a determination coefficient (R²) of 0.96537 and a mean absolute percentage error (MAPE) as low as 3.1574%. Its comprehensive identification accuracy is 1.81% to 37.98% higher than that of the comparison models, and it can effectively suppress error oscillations in nonlinear regions. Experimental results show that the proposed algorithm has excellent identification accuracy, generalization ability, and anti-interference performance. Full article