Search Results (6,839)

Background: As China enters the digital era and actively promotes an active aging strategy, smart wearable devices have become increasingly prevalent among older adults; however, their impact on health inequality remains unclear. This study investigates the association between smart wearable devices and health, as well as health inequality, among Chinese older adults, and further examines the mediating roles of joy of living and social participation. Methods: Data were derived from two waves (2018 and 2020) of the China Longitudinal Aging Social Survey (CLASS), with a final sample of 7098 adults aged 60 and above. A two-way fixed-effects model, propensity score matching–difference-in-differences (PSM-DID) approach, and mediation analysis were employed. Results: Smart wearable devices were significantly positively associated with both health and health inequality among older adults in China. Mediation analysis revealed that joy of living and social participation played an intermediary role. Conclusions: This study provides preliminary evidence that smart wearable devices are associated with health and health inequality among Chinese older adults. Policy efforts should focus on developing more user-friendly devices, promoting digital literacy among older adults, and supporting disadvantaged groups. Furthermore, the mediating effects suggest that fostering joy of living and encouraging active social participation may serve as effective pathways to improve health. Full article

Dirofilaria immitis constitutes a significant global veterinary burden and an emerging zoonotic risk. Despite decades of study, the structural evolution of its scientific landscape remains unexplored. This study provides a comprehensive longitudinal analysis of global research on D. immitis to evaluate its trajectory, intellectual structure, and conceptual shifts over the last eight decades. A systematic bibliometric analysis was conducted following PRISMA guidelines adapted for bibliometrics. Data were retrieved from Web of Science Core Collection and Scopus, covering the period from 1945 to 2025. After deduplication and manual screening, a final corpus of 3589 documents was analyzed using performance indicators and science mapping techniques to assess growth patterns, geographic leadership, collaboration networks, and thematic evolution. The field exhibits a mature profile with a sustained mean annual growth rate of 2.39%. Production is geographically polarized, with the United States and Italy acting as the primary research hubs, though international collaboration networks are increasingly integrating endemic regions in the Global South. Thematic analysis reveals a profound paradigm shift: while early research (1945–1980) focused on parasite morphology and clinical description, the 21st century is characterized by a multidisciplinary approach dominated by molecular biology, the study of the endosymbiont Wolbachia, and the genetic mechanisms of macrocyclic lactone resistance. The intellectual structure is currently organized into distinct but interconnected clusters, linking established clinical pathology with emerging genomic and environmental control strategies. Research on D. immitis has evolved from a classical parasitology discipline into a complex biomedical ecosystem aligned with the One Health framework. The persistence of the disease, driven by drug resistance and climate-mediated vector expansion, has catalyzed a transition toward integrative research models. Future control strategies must transcend geographic borders, combining advanced genomic surveillance with ecological modeling to mitigate the impact of this transboundary disease on both animal and human health. Full article

Background/Objectives: To characterize sectoral corneal thickness (CT) profiles in eyes with primary open-angle glaucoma (POAG) compared with healthy eyes and to evaluate potential associations between CT, retinal nerve fiber layer (RNFL) thickness, and optic disc rim area (RA). Methods: In this cross-sectional study, 192 participants (91 with POAG and 101 controls) contributed 297 eyes (145 glaucoma eyes and 152 control eyes). All participants underwent comprehensive ophthalmological examination and spectral-domain optical coherence tomography (OCT; Optovue Solix, Fremont, CA, USA) to obtain peripapillary RNFL measurements, optic disc rim area, and corneal pachymetry maps across five sectors (central, superior, inferior, temporal, and nasal). Repeated-measures correlation analyses were used to assess within-subject associations between CT and RA, and generalized estimating equation (GEE) models were applied to evaluate independent associations between CT, glaucoma status, disease severity, and RNFL thickness while adjusting for relevant covariates. Results: Eyes with POAG exhibited significantly thinner corneas across all sectors compared with controls (all p < 0.05), with the greatest differences observed in the superior (median 607.0 μm vs. 640.0 μm, p < 0.001) and temporal (562.0 μm vs. 579.5 μm, p < 0.001) regions. Average RNFL thickness and rim area were also significantly reduced in glaucoma eyes (all p < 0.001). However, no independent associations between sectoral CT and RNFL thickness or RA were observed after adjustment for multiple comparisons. Although nominal associations between thinner inferotemporal CT and reduced RNFL thickness were observed in unadjusted analyses, these did not remain statistically significant after false discovery rate correction. In multivariable GEE models, glaucoma diagnosis and greater disease severity were consistently associated with reduced RNFL thickness (β range: −11.0 to −42.2 μm; all p < 0.001), whereas CT was not independently associated with RNFL thickness (all adjusted p > 0.07). Conclusions: Sectoral corneal thickness is significantly reduced in eyes with POAG but does not independently correlate with RNFL thickness or optic disc rim area after adjustment for confounding factors. These findings support the concept that corneal thinning reflects structural and biomechanical susceptibility to glaucoma rather than serving as a marker of established neuroretinal damage severity. Further longitudinal studies incorporating comprehensive biomechanical assessments are warranted to clarify the role of corneal structure in glaucoma pathophysiology. Full article

Background: X-linked immunodeficiency with magnesium defect, Epstein–Barr virus (EBV) infection, and neoplasia (XMEN) disease is a rare inborn error of immunity caused by loss-of-function mutations in MAGT1, leading to impaired N-linked glycosylation. Although chronic EBV viremia is a hallmark of XMEN disease, the mechanisms underlying its marked clinical heterogeneity remain poorly understood. Methods: We performed an in-depth clinical, immunological, and genetic characterization of two siblings carrying a pathogenic MAGT1 variant (c.369_370insCC; p.Gly124fs), validated and deposited in ClinVar (SCV007293792). Assessments included whole-exome sequencing, multiparametric flow cytometry focusing on NKG2D expression, and longitudinal clinical follow-up. Results: Despite shared absence of NKG2D expression, the siblings exhibited strikingly divergent phenotypes. One sibling developed progressive neurodegeneration with central nervous system atrophy. The other presented with a complex immuno-hematologic phenotype, including EBV-positive Hodgkin lymphoma, recurrent autoimmune cytopenias, and lymphoma-associated thrombotic microangiopathy, representing a novel clinical association in XMEN disease. Comparative immunophenotyping revealed shared defects in B-cell maturation but distinct T-cell differentiation patterns. To contextualize neurological variability, we propose a descriptive, hypothesis-generating three-category conceptual classification comprising early-onset neurodevelopmental forms, adult-onset neurodegenerative manifestations, and secondary immune-mediated or vascular involvement of the nervous system. Conclusions: These findings demonstrate profound intrafamilial heterogeneity in XMEN disease and suggest a model in which modifier-sensitive factors influence organ-specific disease expression. The observation of lymphoma-associated thrombotic microangiopathy and the proposed descriptive neurological classification provide a conceptual framework that may help guide tailored, multidisciplinary surveillance beyond the primary genetic defect. Full article

Background: Liquid biopsy using circulating tumor DNA (ctDNA) is rapidly reshaping gastrointestinal (GI) oncology. The highest-impact applications are molecular residual disease (mRD) detection after curative-intent therapy and early recognition of progression or resistance during systemic treatment. Methods: We performed a structured, clinically oriented narrative synthesis by using explicit search, eligibility, evidence prioritization, and clinical interpretation rules, integrating landmark prospective cohorts, randomized ctDNA-guided strategy trials where available, meta-analyses, key methodological research (e.g., pre-analytics, assay design, and clonal hematopoiesis (CH)/clonal hematopoiesis of indeterminate potential (CHIP)), and selected trial registries. Results: In resected colorectal cancer (CRC), postoperative ctDNA positivity is among the strongest known biomarkers of recurrence risk; large prospective studies demonstrate clear separation of disease-free survival (DFS)/overall survival (OS) between mRD+ and mRD− patients. In stage II colon cancer, randomized data (DYNAMIC) show that a ctDNA-guided strategy reduces adjuvant chemotherapy exposure without compromising long-term outcomes. In metastatic CRC, ctDNA supports early response monitoring and resistance tracking; ctDNA-selected anti-EGFR rechallenge provides a model of biomarker-driven actionability (CHRONOS). In gastroesophageal cancers, longitudinal ctDNA dynamics correlate with relapse risk and treatment efficacy, and in esophageal squamous cell carcinoma, ctDNA after neoadjuvant chemoradiotherapy informs residual disease risk and adjuvant stratification. In pancreatic ductal adenocarcinoma and hepatobiliary malignancies, sensitivity is constrained by low shedding and background cell-free DNA (cfDNA), yet ctDNA positivity remains clinically meaningful, and emerging data in resected extrahepatic cholangiocarcinoma (STAMP-linked analyses) show that ctDNA dynamics during adjuvant therapy predict recurrence. Conclusions: ctDNA is a clinically validated biomarker for mRD in CRC, whereas in other GI cancers, it remains a promising but methodologically heterogeneous tool whose clinical utility is tumor- and context-dependent. The next phase requires interventional trials demonstrating outcome improvement, harmonized sampling and reporting standards, and rigorous control of confounders (notably CH/CHIP). Full article

More and more urban underpass tunnels are being constructed to alleviate traffic congestion; however, for this type of underground structure, the soil–structure interaction mechanisms under earthquake loading remain unclear, and dedicated advice and guidance for their seismic design are still lacking. This paper endeavors to investigate the dynamic interaction mechanisms of an underpass tunnel and surrounding soft ground using the finite element (FE) method. Firstly, the accuracy of the FE model in reproducing seismic responses of the layered half-space is validated by comparison with results of equivalent linear one-dimensional site response. Then, the dynamic response characteristics of 3D boat-shaped excavation are analyzed to determine the influence of potential local site amplification on the underpass tunnel. Finally, seismic behaviors of open and buried sections of the underpass tunnel are investigated in detail. The results show that under high-intensity rare earthquakes, severe damage occurs at the ceiling slab near the longitudinal beam and at the base of the side wall of the tunnel’s buried section; seismic underpass–site interactions might be influenced the most by the local topography effect of the 3D boat-shaped excavation, as well as a sudden stiffness change between the open and buried sections. Full article

Anchored in the strategic framework of Vision 2030, the research departs from anecdotal or survey-based approaches by exclusively leveraging publicly available, auditable data from national ministries, international university rankings, and scholarly publication databases. An original Integrated Green Transformation Framework (IGTF) is operationalized through fixed-effects regression modeling, longitudinal policy document analysis, and cross-sectional benchmarking of sustainability performance indicators across twelve Saudi universities. The findings demonstrate a statistically significant and temporally coherent association between national green policy milestones, such as the Saudi Green Initiative and the National Renewable Energy Program 2018, and measurable improvements in university-level sustainability strategies, operational efficiency, and research output. The average share of renewable energy utilization across sampled institutions increased from 2.1 percent in 2016 to 18.7 percent in 2023, representing substantial progress yet remaining below the Vision 2030 national target of 50%, while per-student water consumption declined by 34 percent over the same period. Scholarly publications in green economy domains rose by 638 percent, with a strong positive correlation (r = 0.76, p < 0.001) between research intensity and curriculum integration of sustainability content. Despite these advances, persistent disparities exist in resource allocation and implementation depth, particularly between historically endowed universities and newer regional institutions, highlighting a “sustainability divide” that requires targeted policy intervention. Full article

To address the problems of high digging resistance, elevated energy consumption, and severe soil adhesion encountered during mechanized potato harvesting, a bionic potato digging shovel inspired by the corrugated dorsal structure of the white grub was developed. Based on reverse-engineered geometric curves, two longitudinally corrugated shovel models (L-S-1 and L-S-2) were constructed, and a coupled soil–potato–shovel model was established using the Discrete Element Method (DEM) to evaluate soil disturbance characteristics and digging resistance at a forward speed of 0.5 m/s and an entry angle of 35°. The simulation results indicated that the longitudinally corrugated shovel L-S-2 exhibited the best overall performance, reducing digging resistance by 13.87% and increasing the soil fragmentation rate by 20.67% compared with a conventional flat shovel (P-S). Using L-S-2 as the baseline design, additional DEM simulations were conducted at forward speeds ranging from 0.4 to 0.6 m/s to systematically investigate the influence of operating speed on digging performance. To further enhance anti-adhesion performance, a composite bionic shovel (H-L-S-2) was developed by embedding polytetrafluoroethylene (PTFE) hydrophobic material into the surface of L-S-2 and reinforcing the shovel tip using laser cladding. Soil-bin experiments were then performed under controlled conditions with forward speeds of 0.4–0.6 m/s and soil moisture contents of 15–20% at an entry angle of 35°, and the results showed an average resistance reduction rate of 17.46%, with a maximum reduction of 18.02%. Both DEM simulations and soil-bin tests confirmed the effectiveness of the composite bionic shovel in reducing soil adhesion, with the number of adhered soil particles decreasing by 41.2% in simulations and the mass of adhered soil reduced by 37.5% in physical tests. These results demonstrate that coupling a bionic corrugated structure with surface material modification can effectively reduce digging resistance, enhance soil fragmentation, and mitigate soil adhesion, providing a practical approach for optimizing the design of potato digging shovels. Full article

The shear strength of reinforced concrete members without transverse reinforcement remains a critical design issue, particularly for thick and slender structural members where pronounced size effects may significantly reduce the nominal shear strength. This study investigates the combined influence of member depth, concrete compressive strength, and longitudinal reinforcement ratio on the shear capacity of beams without stirrups through nonlinear finite element analyses (NLFEA). Beam depths ranging from 1000 mm to 4000 mm and concrete strengths between 30 MPa and 50 MPa were considered, together with variations in different longitudinal reinforcement ratios. The numerical results confirmed a clear deterministic size effect, with nominal shear stresses decreasing systematically as the effective depth increased, while the influence of compressive strength was found to be secondary. The depth-dependent response was successfully represented using Bažant’s energetic Size Effect Law (SEL Type II), and the calibrated parameters provided an excellent fit to the numerical database. Furthermore, the numerical predictions of shear capacity were compared with major design provisions, including ACI 318 (2014 and 2019), Eurocode 2 (EN 1992-1-1:2005 and EN 1992-1-1:2023), and fib Model Code approaches with levels of approximation (LoA) 1 and 2. The results highlight that older formulations such as ACI 318-2014 and EN 1992-1-1:2005 tend to be unconservative for deep members, whereas EN 1992-1-1:2023 offers significantly improved agreement with reduced scatter. Among the evaluated expressions, fib Model Code LoA1 was the most conservative, while LoA2 provided the most accurate overall predictions. The findings emphasize the importance of incorporating size-effect considerations in modern shear design models, particularly for large reinforced concrete structures such as bridge decks, thick slabs, and dam walls. Full article

In order to evade interception, advanced aircraft often adopt jump-gliding trajectories to efficiently utilize aerodynamics and achieve complex maneuvers. Precise guidance of UAVs for intercepting such targets is critically challenged due to their high speed and uncertain maneuvers. For terminal guidance scenarios, the extremely short engagement window necessitates strict convergence within the predefined finite time. While PPC offers a promising framework to ensure such convergence with guaranteed transient performance, it suffers from singularity when target uncertainties drive tracking errors beyond performance bounds. To address these challenges, this paper proposes an adaptive prescribed-performance guidance law with predefined-time convergence for UAVs. Built upon the analysis that jump-gliding targets exhibit predominantly longitudinal oscillatory maneuvers, we first establish a velocity model to characterize their motion uncertainties. Using the derived uncertainty bounds and estimated parameters, a predefined-time performance function (PPF) is then developed and robustly modified to eliminate the singularity risk. By integrating this modified PPC with an adaptive law, the proposed framework achieves robust predefined-time convergence of the line-of-sight angle while simultaneously compensating for unknown target maneuvers. Theoretical analysis verifies the framework’s stability, and simulation results demonstrate its effectiveness in intercepting highly maneuverable targets. Full article

Background/Objectives: Translating brain volumetric biomarkers to individual-level Alzheimer’s disease (AD) diagnosis remains challenging due to difficulty interpreting raw volumes without longitudinal monitoring or matched controls. We tested a classification model using population-referenced volumetric percentiles to distinguish AD from cognitively normal (CN) subjects and evaluated its generalization across independent cohorts. Methods: Brain volumes from 95 regions were extracted using an automated segmentation pipeline and converted to age and sex adjusted percentiles using a reference population (N = 1833). A logistic regression classifier was trained on ADNI subjects (N = 873; AD = 183, CN = 690) split into training (60%), validation (20%), and test (20%) sets. The model was evaluated on two independent validation datasets: the held-out ADNI validation set and an external Korean cohort (N = 72; AD = 36, CN = 36) acquired with different scanner protocols and demographic characteristics. Results: The model achieved excellent discrimination across all evaluation sets: ADNI validation (AUC = 0.963, accuracy = 90.3%), ADNI test (AUC = 0.960, accuracy = 89.7%), and Korean external validation (AUC = 0.981, accuracy = 87.5%). The minimal validation gap (0.018) demonstrated robust generalization. Positive coefficients for ventricular regions reflected AD-associated atrophy patterns, while negative coefficients for medial temporal structures indicated their contribution within multivariate patterns distinguishing AD from normal aging. Conclusions: Population-referenced brain volumetric percentiles enable accurate AD classification with robust generalization across populations and scanner protocols. By contextualizing individual brain structure relative to normative populations while accounting for age and sex, this approach demonstrates potential for clinical translation as an accessible neuroimaging-based diagnostic tool. Full article

There are limited data on sequential computed tomographic (CT) evaluation and objective CT assessment of the metacarpal condyles in Thoroughbred racehorses. This longitudinal study aimed to document changes in attenuation of the metacarpal condyles during the first two years of training and racing. Fan-beam CT examination of the metacarpophalangeal regions was performed on 40 non-lame Thoroughbred yearlings, and repeated four more times, approximately six months apart. Mean Hounsfield Unit (HU) measurements were obtained on sagittal reconstructions of the dorsal and palmar halves of the medial and lateral condyles and parasagittal grooves. One-way ANOVA with a post hoc Tukey’s Test was used to investigate differences between mean HU values over time at the different regions of interest. Multivariable mixed-effects linear regression models assessed the association between dorsal and palmar HU and potential explanatory variables. Mean HU increased significantly with training, especially during the first six months, with a maximal sequential mean increase found in the medial parasagittal groove (119.8 [95% confidence interval 85.3, 154.30], p < 0.001). Dorsal regions had higher HU than palmar regions, with the highest HU recorded in the dorsal aspect of the medial condyle at time 3 (mean HU 1120.1 ± 63.4). Condyles had higher HU than parasagittal grooves (p < 0.001), the palmar half of the right condyles had higher HU than the left (p = 0.045) and the dorsal aspect of the medial condyle had higher HU than the lateral (p < 0.001). An increasing number of race starts and higher body weight:height ratio were associated with higher HU (p < 0.001). The main limitation was the loss of horses to follow-up as the study progressed. In conclusion, density of most regions of the metacarpal condyles increased with time spent in training, reflecting adaption to racehorse training. Full article

Background: Poor sleep quality is common in older adults and closely tied to emotional well-being. While life satisfaction has been linked to sleep outcomes, the psychological pathways remain underexplored. Purpose: This study examines whether psychological resilience and anxiety symptoms mediate the relationship between life satisfaction and sleep quality among older adults, and whether chronic disease moderates these pathways. Methods: Data were drawn from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey, including 3089 community-dwelling adults aged 65 years and older. Sleep quality and life satisfaction were measured using validated single-item indicators. Psychological resilience was assessed using five self-reported items capturing adaptive functioning, and anxiety symptoms were measured using the 7-item Generalized Anxiety Disorder Scale. A parallel mediation model and a moderated mediation model were tested using SPSS with bootstrapping procedures (5000 samples). Results: Life satisfaction was significantly associated with sleep quality among older adults. This association was partially mediated by both psychological resilience (indirect association = −0.0100, 95% CI [−0.0163, −0.0045]) and anxiety symptoms (indirect association = −0.0356, 95% CI [−0.0483, −0.0238]). The direct association remained significant (β = −0.2399, p < 0.001), indicating a partial mediation pattern. Furthermore, in the moderated mediation model, chronic disease moderated the association between anxiety symptoms and sleep quality, whereas the indices of moderated mediation were not significant. Conclusions: Life satisfaction was associated with sleep quality, with psychological resilience and anxiety symptoms accounting for part of this association. Although chronic disease strengthened the association between anxiety symptoms and poorer sleep quality, the overall moderated mediation effect was not significant. Full article

Background/Objective: Breast cancer is one of the leading diseases affecting the Brazilian population and is often diagnosed at advanced stages. Due to its heterogeneity, treatment involves multiple therapeutic modalities, such as chemotherapy, hormone therapy, immunotherapy, and radiotherapy. The aim of this study was to characterize the profile of patients undergoing treatment for breast cancer in a private hospital in southern Brazil, and to assess the physical and psychological effects associated with different therapeutic modalities. Methods: An ambidirectional longitudinal cohort study was conducted from September 2018 to December 2024, incorporating retrospective data since 2013. Clinical and therapeutic data were collected, and Patient-Reported Outcome Measures (PROMs) using the QLQ-C30 Summary Score (QLQ-BR23, FACT-ES, BREAST-Q, LMC21) and Symptom Global Score questionnaires were analyzed using mixed-effects models to evaluate physical, emotional, cognitive, social, and overall quality-of-life domains, as well as body image. The temporal trend of time-to-treatment was assessed via linear regression. Results: Among 871 individuals evaluated, 98.4% were female, and invasive ductal carcinoma was the predominant histological type (75.1%). Radiotherapy was one of the most frequently used treatment modalities (39.2%), while immunotherapy had the lowest usage rate (2.7%). A significant reduction in the time between diagnosis and initiation of treatment was observed from 2013 to 2024 (from 21.0 to 10.9 days; p < 0.01), reflecting improvements in healthcare services. Mixed-effects models for PROMs indicated significant improvements across all assessed domains (p < 0.01) over the 48-month follow-up, despite a median follow-up of 22 months. Conclusions: High-quality and timely oncological care provided to breast cancer patients in a private hospital in southern Brazil demonstrates the implementation of a dynamic, agile, and human-centered care model, contributing to improved clinical and patient-reported outcomes validated by robust longitudinal analysis. Full article

Traffic calming measures are widely used to reduce operating speeds and mitigate crash risk in urban corridors; however, the way drivers adapt their control strategy when traversing Berlin speed cushions is still poorly described from a multivariate behavioral perspective. This study proposes a behavior-oriented analysis to identify recurring speed-cushion traversal strategies using driving simulator telemetry. A fixed-base simulator reproduced a real urban corridor, and trajectories were segmented in device-centered spatial windows capturing approach, traversal, and immediate recovery. Each segment was summarized by three indicators describing longitudinal and lateral control: mean speed, peak braking demand, and average lane position deviation. Features were standardized and clustered using k-means. The number of clusters was selected primarily through mean silhouette evaluation, while resampling-based checks and a Gaussian mixture modeling comparison were used as supportive evidence rather than competing decision rules. Three traversal profiles emerged: smooth cautious, reactive cautious, and unmoderated fast. The introduction of speed cushions shifted the distribution of segments towards cautious profiles, while driver-level concentration within a single profile was moderate. Overall, results indicate that speed cushions influence the whole vehicle control strategy, offering a quantitative basis for behavior-oriented evaluation of local traffic calming interventions in smart-city contexts. Full article