Search Results (9,018)

Background/Objectives: Mild Cognitive Impairment (MCI) is a transitional stage between normal aging and early dementia, affecting up to 20% of older adults. Sleep disturbances, particularly insomnia, affect around 60% of individuals with MCI, contributing to declines in cognitive and physical function. Although Cognitive Behavioral Therapy for Insomnia (CBT-I) is an evidence-based non-pharmacological treatment, few studies have adapted it for individuals with MCI. This pilot study developed and evaluated Slumber, a clinician-supported mobile CBT-I app tailored for older adults with MCI and insomnia. Methods: The study had three aims: (1) to develop the app for delivering CBT-I to individuals with MCI; (2) to evaluate its usability and refine smart messaging prompts; and (3) to assess the feasibility of outcome measurement while detecting exploratory signals of change through a 6-week pilot trial. N = 19 participants completed the trial. Results: A significant reduction in insomnia severity was observed (mean difference = −2.06; p = 0.0131), while changes in cognitive and physical functioning were not statistically significant. Participants reported high satisfaction with the app’s tracking features and motivational reminders, though some noted technical challenges with presenting and interpreting sleep analysis charts. Conclusions: Findings support the usability of the Slumber app and the feasibility of outcome measurement in this population. The observed improvement in sleep quality provides an initial signal of promise. Future studies should address user feedback, enhance technical features, and evaluate clinical effectiveness in a larger randomized trial. Full article

Investigating vegetation dynamics and their drivers in ecologically vulnerable regions is essential for evaluating ecological restoration outcomes. This study examined the spatiotemporal evolution of the Normalized Difference Vegetation Index (NDVI) and its influencing factors in Fengning county, the Bashang region from 2001 to 2023 using land use transition matrix, trend analysis, and geographical detector methods. Key findings include the following: (1) Land use transition exhibited a clear phased pattern, shifting from cropland-to-grassland conversion (2001–2010) to grassland-to-forest conversion (2010–2023).(2) The annual mean NDVI increased significantly, showing a southeast–northwest spatial gradient consistent with landforms. The long-term trend followed a sequential “degradation–improvement–consolidation” trajectory. (3) Factor detection identified land use type as the primary driver of vegetation spatial heterogeneity (q = 0.297), highlighting the dominant influence of human activities. (4) Interaction detection demonstrated bivariate enhancement for all factor pairs, with the combination of land use type and precipitation yielding the highest explanatory power (q = 0.440). This underscores that vegetation dynamics are predominantly governed by nonlinear interactions between human-driven land use and climate. The research highlights the effectiveness of ecological restoration policies and offers valuable insights for guiding future ecosystem management in ecologically fragile areas under climate change. Full article

Background/Objectives: Balloon eustachian tuboplasty (BET) is an effective surgical option for obstructive eustachian tube dysfunction (OETD). However, the feasibility of performing BET under local anesthesia (LA) using simplified analgesic protocols remains underexplored. We examined the feasibility of a streamlined LA-BET protocol. Methods: Fifty patients (sixty-four ears) diagnosed with primary OETD between March 2024 and December 2025 were enrolled. All patients underwent BET under LA using intramuscular ketorolac and topical lidocaine gel without sedation or nerve blocks. Pain scores, blood pressure changes, and patient acceptance were analyzed for each patient; Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) scores, tympanogram types, and Valsalva results were analyzed for each ear. All outcome measures were assessed 3 months postoperatively. Results: The mean ETDQ-7 score significantly improved from 24.9 ± 7.4 to 11.9 ± 5.4 (p < 0.001). The minimal clinically important difference (MCID ≥ 3.7) was achieved in 90.6% of ears, and normalization (ETDQ-7 ≤ 14.5) in 75.0%. The proportion of ears with positive Valsalva maneuvers increased from 39.1 to 76.6% (p < 0.01), and type A tympanograms improved from 64.1 to 84.4% (p = 0.018). Mean pain scores were 3.5 during insertion, 2.1 during balloon inflation, and 0.6 after deflation. All patients completed the procedure, and 96% would undergo LA again. Conclusions: LA-BET performed using intramuscular ketorolac and topical lidocaine gel is safe, tolerable, and effective. This protocol provides symptom relief and functional improvement without sedation or nerve block and offers a practical outpatient alternative for chronic OETD management. Full article

Background/objectives: Metabolic abnormalities, independent of excess weight, may contribute to cancer risk even among individuals of normal weight, though their role remains unclear. This study sought to ascertain if metabolically unhealthy normal-weight (MUNW) individuals, generally characterized by a normal body mass index alongside the presence of metabolic abnormalities, have higher cancer risk than metabolically healthy peers, to analyze variations in risk across obesity-related cancer types, and to examine which single specific metabolic components can predict cancer independently in normal-weight individuals. Methods: Two authors systematically searched the PubMed, EMBASE, and Web of Science databases for longitudinal studies, published from inception to July 2025, that included normal-weight adults, classified participants by metabolic health status, and reported incident cancer outcomes in metabolically unhealthy versus healthy normal-weight groups. Hazard ratio (HR) estimates were extracted from each study and were pooled using random-effects inverse-variance model with empirical Bayes variance estimator. Results: Thirty-five studies involving 18,210,858 participants (56.0% females, mean age = 53.8 years) were included. A total of 280,828 new cancer cases were diagnosed during follow-up (mean = 10.6 years). In comparison with metabolically healthy normal-weight individuals, MUNW individuals had a 20% higher risk of cancer (HR = 1.20, 95% confidence interval [CI]: 1.13–1.28). Increased risks were observed for gastric cancer (HR = 1.40, 95% CI: 1.04–1.87), pancreatic cancer (HR = 1.37, 95% CI: 1.21–1.54), and colorectal cancer (HR = 1.34, 95% CI: 1.14–1.57), which were the cancer types showing statistically significant associations in subgroup analyses. Normal-weight participants presenting specific metabolic factors like central adiposity or glucose metabolism abnormalities had a 20% (HR = 1.20, 95% CI: 1.13–1.37) and 23% (HR = 1.23, 95% CI: 1.06–1.41) increased cancer risk, respectively. Conclusions: MUNW individuals are at higher risk of cancer, with specific metabolic abnormalities, particularly central adiposity and impaired glucose regulation, emerging as the factors most strongly associated with increased risk in normal-weight individuals. Routine metabolic screening and detailed phenotyping are crucial to identify these risks. Full article

Background/Objectives: This study aimed to characterize objective sleep measures in subacute acquired brain injury (ABI) and examine if disturbed sleep is associated with poor recovery outcomes. Another objective was to compare the functional connectivity of the brain between ABI poor sleepers and ABI normal sleepers as measured by resting state functional magnetic resonance imaging (rs-fMRI). Methods: This was a pilot, prospective, observational study of ABI subjects compared with age and gender-matched healthy controls. A total of 27 ABI subjects (consisting of ischemic or haemorrhagic stroke, or traumatic injury) were recruited from the outpatient clinics of a tertiary hospital with a neurological centre, and 49 healthy controls were recruited by word-of-mouth referrals. Study procedure involved subjective and objective sleep measures, self-report psychological measures, cognitive tests, and structural and functional MRI of the brain. Results: The frequency of poor-quality sleep was 66.67% in the ABI group and not significantly different from 67.35% in the control group when compared by chi-squared test (p = 0.68). ABI subjects with poor sleep had worse performance on a test of sustained attention (Colour Trails Test 1) than healthy controls with poor sleep when compared by Student’s t-test (mean 55.95 s, SD ± 18.48 vs. mean 40.04 s, SD ± 14.31, p = 0.01). Anxious ABI subjects have poorer sleep efficiency and greater time spent awake after sleep onset (WASO). ABI-poor sleepers show significantly greater functional connectivity within a frontoparietal network and bilateral cerebellum. Conclusions: Sleep problems after ABI are associated with poorer cognitive and psychological outcomes. ABI-poor sleepers exhibit altered functional connectivity within regions that contribute to motor planning, attention, and self-referential processes, suggesting that disrupted sleep after ABI may impair the integration of sensorimotor and cognitive control systems, and therefore, impair recovery. Full article

Necrotizing enterocolitis (NEC) is a life-threatening inflammatory disease of preterm infants, increasingly viewed as a cytokine-driven disorder of the immature intestine. We aimed to characterize local peritoneal concentrations of interleukin (IL)-1β, IL-6 and tumor necrosis factor-α (TNF-α) in a standardized neonatal rat NEC model and relate them to histopathological injury. Seventy-four SPRD/Mol/Lodz rat pups were allocated to a control group (CTRL; n = 12) or subjected to a hypoxia-hypothermia-formula-feeding NEC protocol (NEC; n = 62). After 72 h, small-intestinal samples were scored using a four-tier NEC scale (0–3), and peritoneal fluid cytokine levels were measured by ELISA. All CTRL animals exhibited normal histology (grade 0), whereas NEC pups showed a wide spectrum of lesions, with 66.6% classified as grade 2–3 and a significantly higher mean NEC score in NEC than CTRL (p < 0.001). Peritoneal IL-1β and TNF-α concentrations were markedly elevated in NEC versus CTRL animals (both p < 0.001), while IL-6 levels showed no statistically significant between-group difference. These findings indicate that experimental NEC in this model is accompanied by a pronounced local pro-inflammatory response dominated by IL-1β and TNF-α, whereas IL-6 may follow distinct temporal or compartment-specific kinetics. Peritoneal cytokine profiling may help refine mechanistic understanding and guide future biomarker and immunomodulatory strategies in NEC. Full article

Environmental, social and governance (ESG) metrics increasingly inform sustainable investment yet suffer from inter-rater heterogeneity and incomplete reporting, limiting their utility for forward-looking allocation. In this study, we developed and validated a two-level stacked-ensemble machine-learning framework to predict total ESG risk scores for S&P 500 firms using a comprehensive feature set comprising pillar sub-scores, controversy measures, firm financials, categorical descriptors and geospatial environmental indicators. Data pre-processing combined median/mean imputation, one-hot encoding, normalization and rigorous feature engineering; models were trained with an 80:20 train–test split and hyperparameters tuned by k-fold cross-validation. The stacked ensemble substantially outperformed single-model baselines (RMSE = 1.006, MAE = 0.664, MAPE = 3.13%, $R^2$ = 0.979, CV_RMSE_Mean = 1.383, CV_R²_Mean = 0.957), with LightGBM and gradient boosting as competitive comparators. Permutation importance and correlation analysis identified environmental and social components as primary drivers (environmental importance = 0.41; social = 0.32), with potential multicollinearity between component and aggregate scores. This study concludes that ensemble-based predictive analytics can produce reliable, actionable ESG estimates to enhance screening and prioritization in sustainable investment, while recommending human review for extreme predictions and further work to harmonize cross-provider score divergence. Full article

In the context of mineral resource exploration, spatial prediction must cope with heterogeneous, non-normal data distributions and limited sampling. While conventional geostatistics and standard machine learning provide baseline estimates, they often suffer from excessive smoothing or fail to capture continuous spatial dependencies. This study proposes a geospatially aware Wasserstein conditional Generative Adversarial Network (GSA-cGAN) to complement existing workflows for multivariate mineral interpolation. The framework augments a baseline cGAN with WGAN-GP for stable adversarial training, CoordConv to encode absolute spatial coordinates and Self-Attention to capture long-range spatial dependencies. Eight model configurations were trained on 272 samples from a mineralized zone in the Taebaek Mountains, Korea, and strictly benchmarked against Ordinary/Universal Kriging and multivariate machine learning baselines (Random Forest, XGBoost). Under the adopted experimental design, the full GSA-cGAN achieved the lowest test root mean squared error and highest coefficient of determination, demonstrating a significant performance improvement over the baselines. Furthermore, distribution analysis confirmed that the model effectively overcomes the smoothing limitations of regression-based methods, generating high-resolution 10 m × 10 m maps that preserve statistical variance, hotspot anomalies, and complex spatial patterns. The results indicate that deep generative models can serve as practical decision-support tools for identifying drilling targets and prioritizing follow-up exploration in geologically complex settings. Full article

Background: Descemet membrane endothelial keratoplasty (DMEK) is the most frequently performed keratoplasty procedure in many countries. One of the most common early complications is an elevation of intraocular pressure (IOP). The aim of this study was to characterize early postoperative IOP behavior following DMEK performed with 10% sulfur hexafluoride (SF₆) tamponade and to determine the frequency and timing of required IOP-lowering interventions within the first 48 h. Methods: We retrospectively reviewed postoperative outcomes of 116 consecutive DMEK procedures between May and December 2024 at the University Medical Center in Mainz, Germany. No specific exclusion criteria were applied. All surgeries included a surgical iridectomy at the 6 o’clock position, 10% (SF₆) tamponade, and maintaining a mid-normal IOP at the end of surgery. Postoperative assessments included IOP measured using Goldmann applanation tonometry, the percentage of gas fill in the anterior chamber evaluated at the slit lamp, and the need for IOP-lowering interventions as determined by the on-call resident at 3, 24, and 48 h after surgery. IOP-lowering interventions consisted of venting in cases of elevated IOP, gas fill > 90%, and/or suspected angle closure or pupillary block, as well as intravenous or oral acetazolamide in cases of moderate IOP elevation with a lower gas fill and a patent iridectomy. If a single intervention was insufficient, a combined approach was used. Results: A total of 116 eyes from 98 patients (62 female, mean age 73.0 ± 9.8 years) were analyzed. DMEK was combined with cataract surgery in 41 eyes, and 4 eyes underwent phakic DMEK. Postoperatively, all iridectomies remained patent, and no cases of pupillary block occurred. Mean IOP and gas fill were within normal limits and declined steadily during the first 48 h. IOP-lowering procedures were performed in 11 eyes (9.5%), including venting (n = 3), acetazolamide administration (n = 7), and a combination of both (n = 1). There was no difference between DMEK and triple-DMEK regarding postoperative gas fill, IOP, or the need for IOP-lowering interventions. Mean postoperative IOP was significantly higher, and IOP-lowering interventions were more frequent in glaucoma vs. non-glaucoma patients. Re-bubbling was performed in 12 eyes (10.3%). Two cases of primary graft failure (1.7%) were recorded. Conclusions: In our patient cohort, a standardized surgical approach incorporating a surgical iridectomy at the 6 o’clock position, 10% SF₆ tamponade, and maintaining a mid-normal IOP at the end of surgery effectively prevented pupillary block. We recommend early postoperative assessment of IOP and percent gas fill to promptly identify and manage impending IOP elevation, which is particularly important in patients with glaucoma. Full article

Background: Flexible flatfoot is a common pediatric condition. Surgical intervention is indicated for symptomatic cases unresponsive to conservative treatment. This study evaluates the outcomes of two established procedures, Grice extraarticular subtalar arthrodesis and subtalar arthroereisis, in children treated for symptomatic flatfoot. Methods: A retrospective analysis was conducted on 158 patients (286 feet) treated between 2013 and 2024. Among them, 34 underwent Grice arthrodesis and 124 underwent arthroereisis. Demographic and procedural data were collected, including age, sex, neurological impairment (cerebral palsy), laterality, and concurrent Achilles tendon lengthening. Radiographic parameters assessed pre- and postoperatively included Meary’s, Pitch, and Kite’s angles (frontal and sagittal view), uncovering of the talus, and Cyma line. Only patients with both pre- and postoperative measurements were included in paired analysis. Statistical tests included paired t-tests within groups and Welch’s t-tests for between-group comparisons. Results: Grice patients were younger (mean age 9.0 ± 3.1 years) and included all cerebral palsy cases (18/34; 52.9%), while arthroereisis patients were older (10.8 ± 2.6 years) and typically neurologically normal. Achilles tendon lengthening was performed in 100% of Grice and 48% of arthroereisis cases. Both groups showed significant radiographic improvement across all measured parameters (all p < 0.05). Grice arthrodesis produced greater reductions in Meary’s angle (right Δ = −19.8° ± 9.2 vs. −13.1° ± 7.5; p = 0.024), while arthroereisis yielded larger increases in Pitch angle (left Δ = +9.2° ± 7.2 vs. +5.5° ± 6.2; p = 0.055). Other angular improvements (Kite’s, uncovering, and Cyma line) were statistically significant within both groups but not between groups. Conclusions: Symptomatic flat-valgus foot in children remains a relevant public health issue. Treatment should be individualized, while cases secondary to unrecognized or untreated congenital conditions often require surgery to restore normal foot biomechanics. Full article

To address the challenge of obtaining high-spatiotemporal-resolution and high-precision temperature grids for agricultural meteorological monitoring, this research focuses on rice heat stress monitoring with the China Meteorological Administration Land Data Assimilation System (CLDAS) and develops a temperature correction model that synergizes physical mechanisms with a data-driven strategy by introducing a GeoAI framework. Ensemble learning methods (XGBoost, LightGBM, and Random Forest) were utilized to process a comprehensive set of predictors, integrating dynamic surface features derived from FY-4 satellite’s high-frequency observation data. The data comprised surface thermal regime metrics, specifically the daily maximum land surface temperature (LST_max) and its diurnal range (LST_{max_min}), along with vegetation indices including the normalized difference vegetation index (NDVI) and enhanced vegetation index (EVI). Further, topographic attributes derived from a digital elevation model (DEM) were incorporated, such as slope, aspect, the terrain ruggedness index (TRI), and the topographic position index (TPI). The approach uniquely capitalized on the temporal resolution of geostationary data to capture the diurnal land surface dynamics crucial for bias correction. The proposed models not only enhanced temperature data quality but also achieved impressive accuracy. Across China, the root mean square error (RMSE) was reduced to 1.04 °C, mean absolute error (MAE) to 0.53 °C, and accuracy (ACC) to 0.97. Additionally, the most notable improvement was that the RMSE decreased by nearly 50% (from 2.17 °C to 1.11 °C), MAE dropped from 1.48 °C to 0.80 °C, and ACC increased from 0.72 to 0.96 in the southwestern region of China. The corrected rice heat stress data (2020–2023) indicated that significant negative correlations exist between yield loss and various heat stress metrics in the severely affected middle and lower Yangtze River region. The research confirms that embedding geostationary meteorological satellites within a GeoAI framework can effectively enhance the precision of agricultural weather monitoring and related impact assessments. Full article

Rapid and reliable analytical methods are required to support quality control and decision-making in lithium-bearing mineral processing. In this study, the application of Fourier Transform Infrared (FTIR) spectroscopy combined with Partial Least Squares (PLS) chemometric modeling is evaluated for the simultaneous prediction of lithium oxide (Li₂O) and spodumene contents in pegmatitic samples. Two independent PLS models were developed using FTIR spectra preprocessed with first derivative and/or Standard Normal Variate (SNV). Spectral regions were selected based on the vibrational response of Al–O, Si–O, and OH⁻ groups, which are indirectly influenced by lithium-bearing phases. The spectral datasets were divided into calibration and independent external test sets, and model performance was assessed using statistical metrics and Principal Component Analysis (PCA). The Li₂O model achieved an R² of 0.9934 and an RMSEP of 0.185 in external validation, with a mean absolute error below 0.15%. The spodumene model achieved an R² of 0.9961, an RMSEP of 1.79, and a mean absolute error of 2.80%. These results demonstrate that the FTIR-PLS approach enables efficient quantitative estimation of lithium-bearing minerals, with reduced analytical time, good predictive accuracy, and suitability for application in process control and mineralogical sorting environments. PCA confirmed the statistical representativeness of the test sets, with no evidence of spectral extrapolation. Full article

Terrestrial ecosystems in Hunan Province have undergone marked yet spatially heterogeneous vegetation changes under concurrent climate change and intensifying human activities. The aim of this study is to resolve how vegetation responses vary among land-use types by quantifying kernel Normalized Difference Vegetation Index (kNDVI) dynamics during 2000–2023 using precipitation, temperature, and solar radiation, coupled with trend analysis and a partial-derivative-based attribution. Mean kNDVI increased overall at 0.0016 yr⁻¹; vegetation improved over 76.30% of the area, whereas 5.72% of the area experienced degradation. Built-up land exhibited the largest degraded fraction (35.04%). Human activities and temperature emerged as the dominant drivers of kNDVI change, contributing 62.25% and 27.92%, respectively, while precipitation (3.08%) and solar radiation (6.77%) played comparatively minor roles. Spatially, human activities primarily controlled vegetation dynamics in plains and urban clusters (~78% of the area), whereas temperature constrained vegetation in high-elevation mountain ranges. Analysis along the human footprint (HFP) gradient reveals that driver composition remains steady in resilient ecosystems (farmland and forest), despite increasing anthropogenic pressure, whereas fragile ecosystems (grassland and bareland) exhibited pronounced volatility and heightened sensitivity to environmental constraints. These findings provide a quantitative basis for developing sustainable ecological security strategies, incorporating region-specific measures such as adaptive afforestation, sustainable agricultural management, and strict ecological protection, to enhance ecosystem resilience by prioritizing the climate resilience of mountain forests and the stability of fragile grassland systems. Full article

Background/Objectives: We aim to develop an image linearization process and a program capable of quantifying vertical and left–right asymmetries observed in macular scans. We then sought to verify its applicability in clinical settings. Methods: In this single-center cross-sectional study, we examined 37 consecutive patients with unilateral open-angle glaucoma and analyzed paired data (glaucomatous eye vs. fellow normal eye). Spectral-domain OCT images were automatically processed by a custom program to align the disc–fovea axis and temporal raphe, and the following parameters were evaluated: (1) mean inner retinal thickness difference (superior–inferior), (2) Vertical Asymmetry Score, and (3) Quadrantal Asymmetry Score. Results: We analyzed 37 healthy eyes and 37 POAG eyes. After linearization, the mean inner retinal thicknesses for the normal and POAG groups were 93.4 µm (interquartile range [IQR]: 90.1–98.5) and 80.3 µm (IQR: 77.3–85.0), respectively. The Vertical Asymmetry Score was 6.80 (IQR: 6.15–7.25) for healthy eyes and 9.69 (IQR: 9.16–11.58) for POAG eyes. The Quadrantal Asymmetry Score was 6.35 (IQR: 5.94–7.19) for healthy eyes and 8.47 (IQR: 8.11–9.63) for POAG eyes. Significant differences were found between groups for all parameters (p < 0.001). The Vertical Asymmetry Score (AUC = 0.967, p < 0.001) and Quadrantal Asymmetry Score (AUC = 0.946, p < 0.001) demonstrated significantly greater accuracy in detecting glaucoma compared to the mean inner retinal thickness (AUC = 0.743). Conclusions: The developed linearization program and asymmetry scores have shown promise as parameters for objectively quantifying macular asymmetry using spectral-domain OCT. External validation in independent cohorts, including bilateral disease, is warranted. Full article

Reconstruction of the nipple is the final step of breast reconstruction following skin-sparing mastectomy (SSM) and plays a critical role in restoring breast symmetry and aesthetic completeness. Various nipple reconstruction techniques have been described, including split transplantation of normal nipples and flap-based procedures; however, long-term maintenance of nipple projection and volume remains challenging due to postoperative tissue loss. This study evaluates the clinical outcomes of a previously described long V-Y flap technique, focusing on its ability to mitigate postoperative nipple projection and volume loss. A retrospective analysis was performed on 27 patients who underwent nipple reconstruction using the long V-Y flap following SSM with tissue expander–implant reconstruction. Nipple projection and volume were measured immediately after surgery and at follow-up beyond six months, and volume loss rates were calculated. Outcomes were compared descriptively with projection loss rates reported for other commonly used flap techniques in the literature. The mean nipple volume loss was 34.23%, and the mean projection loss was 32.79%, while nipple width remained largely unchanged over time. These values were numerically lower than those reported for skate, star, bell, and arrow flaps in prior studies. The long V-Y flap appears to be a practical and reliable option for nipple reconstruction after SSM, particularly for larger nipples, with favorable short- to mid-term maintenance of projection and volume. Full article