Search Results (14,520)

Background: Pediatric asthma is a multifactorial condition influenced by environmental, biological, and social determinants. The COVID-19 pandemic introduced new variables that may have affected the severity and management of asthma in children and adolescents, particularly through changes in healthcare access, treatment adherence, and exposure to environmental risk factors. Objective: To evaluate the association between asthma severity and various factors including nutritional status, corticosteroid use, COVID-19 vaccination, and pollutant exposure before and during the COVID-19 pandemic in a pediatric population. Methods: A retrospective analysis was conducted using 307 medical records of patients aged 3 to 17 years. Data collected included sociodemographic characteristics, nutritional indicators, history of corticosteroid use, vaccination status against COVID-19, and exposure to environmental pollutants. Asthma severity was assessed using the pulmonary score, and multiple statistical analyses, including logistic regression using the Bayesian Logistic Regression Model (BLRM), were employed to identify significant associations. Results: The analysis revealed a statistically significant impact of the pandemic on hospitalization rates (p = 0.0187) and the use of corticosteroids (p = 0.009), indicating changes in asthma management during this period. Notable differences were observed in the geographic distribution of mild versus severe asthma cases prior to the pandemic, associated with nutritional status and gender (p = 0.018). During the pandemic, breastfeeding history, body weight, and hospitalization emerged as significant predictors of asthma severity (p < 0.05). In addition, breastfeeding in young children (aged 3 to 6 years) and hospitalization were strongly associated with pulmonary scores, with significance values of 0.022 and 0.012, respectively, as identified by the BLRM. Conclusions: These findings suggest that the pandemic context influenced both the clinical course and management of pediatric asthma. Preventive strategies should consider individual and environmental factors such as nutrition, early-life health practices (e.g., breastfeeding), and equitable access to appropriate asthma care and vaccination. Tailoring pediatric asthma management to these variables may improve outcomes and reduce disparities in disease severity. Full article

Cyprus is located between Europe, Asia and Africa, and its location is vulnerable to dust transport from the Sahara Desert, wildfire smoke particles from surrounding regions, and other anthropogenic emissions caused by several factors, mostly due to business activities on harbor areas. Moreover, the country suffers from heavy traffic conditions caused by the limited public transportation system in Cyprus. Therefore, taking into consideration the country’s geographic location, heavy commercial activities, and lack of good public transportation system, Cyprus is exposed to dust episodes and high anthropogenic emissions associated with multiple health and environmental issues. Therefore, continuous and qualitative air quality monitoring is essential. The Department of Labor Inspection of Cyprus (DLI) has established an air quality monitoring network that consists of 11 stations at strategic geographic locations covering rural, residential, traffic and industrial zones. This network measures the following pollutants: nitrogen oxide, nitrogen dioxide, sulfur dioxide, ozone, carbon monoxide, particulate matter 2.5, and particulate matter 10. This case study compares and evaluates the agreement between Copernicus Atmosphere Monitoring Service (CAMS) air quality products and ground-truth data from the DLI air quality network. The study period spans from January to December 2024. This study focuses on the following three pollutants: particulate matter 2.5, particulate matter 10, and ozone, using Ensemble Median, EMEP, and CHIMERE near-real-time model data provided by CAMS. A data analysis was performed to identify the agreement and the error rate between those two datasets (i.e., ground-truth air quality data and CAMS air quality data). In addition, this study assesses the reliability of assimilated datasets from CAMS across rural, residential, traffic and industrial zones. The results showcase how CAMS near-real-time analysis data can supplement air quality monitoring in locations without the availability of ground-truth data. Full article

Objective: There is scarce reporting of radial head fracture epidemiology and patient characteristics beyond age and sex. This study aimed to describe demographic, socioeconomic, and injury pattern characteristics for people sustaining a radial head fracture admitted to trauma centers over a 15-year period. Methods: Analysis of Victorian Orthopaedic Trauma Outcomes Registry data was conducted to describe the demographic and case characteristics of patients with radial head fractures admitted to collaborating hospitals. Cohort and case characteristics were compared by center type (Level 1 vs. other trauma centers). Results: A total of 991 cases with a unilateral radial head fracture were recorded over 15 years, with 827 admitted to Level 1 trauma centers and 164 admitted to other centers. The mean age at time of injury was 48.7 years (SD 19.7), with male predominance (n = 621, 62.7%). Most patients resided in major cities (n = 824, 85.2%), were treated under the universal healthcare system (n = 546, 56.1%), and had no Charlson Comorbidity Index conditions (n = 738, 74.5%). A higher proportion of patients managed at Level 1 centers were male (65.7% vs. 47.6%), younger (mean 47.7 vs. 53.7 years), living in major cities (86.6% vs. 78.5%), and working prior to injury (71.3% vs. 57.1%). Over 85% of the cohort sustained concomitant injuries, with Level 1 centers receiving a higher proportion of multiple injury cases (87.8% vs. 73.2%). Elbow dislocations constituted the largest proportion of concomitant injuries (n = 257, 25.9%). Conclusions: This study has provided new insights into the demographic characteristics, comorbidity status, and associated injuries of radial head fracture populations admitted to Level 1 and other trauma centers, using long-established registry data. Full article

Introduction: Gastrointestinal stromal tumors (GISTs) are primarily driven by mutations in KIT (KIT proto-oncogene receptor tyrosine kinase) or PDGFRA (platelet-derived growth factor receptor alpha), but resistance to tyrosine kinase inhibitors (TKIs) such as imatinib remains a major clinical challenge. Alterations in fibroblast growth factor receptor 2 (FGFR2), although rare, are emerging as important contributors to tumor progression and drug resistance. This review evaluates the molecular mechanisms, expression profiles, detection methods, and therapeutic implications of FGFR2 in GIST. Methods: We searched PubMed, Web of Science, Google Scholar, and ClinicalTrials.gov for studies published between January 2010 and June 2025, using combinations of keywords related to FGFR2, gastrointestinal stromal tumor, resistance mechanisms, gene fusion, amplification, polymorphisms, and targeted therapy. Eligible studies were critically assessed to distinguish GIST-specific data from evidence extrapolated from other cancers. Results:FGFR2 is expressed in multiple normal tissues and at variable levels in mesenchymal-derived tumors, including GIST. Its alterations occur in approximately 1–2% of GIST cases, most commonly as gene fusions (e.g., FGFR2::TACC2, <1%) or amplifications (1–2%); point mutations and clinically significant polymorphisms are extremely rare. These alterations activate the MAPK/ERK and PI3K/AKT pathways, contribute to bypass signaling, and enhance DNA damage repair, thereby promoting TKI resistance. Beyond mutations, mechanisms such as amplification, ligand overexpression, and microenvironmental interactions also play roles. FGFR2 alterations appear mutually exclusive with KIT/PDGFRA mutations but occasional co-occurrence has been reported. Current clinical evidence is largely limited to small cohorts, basket trials, or case reports. Conclusions:FGFR2 is an emerging oncogenic driver and biomarker of resistance in a rare subset of GISTs. Although direct evidence remains limited, particularly regarding DNA repair and polymorphisms, FGFR2-targeted therapies (e.g., erdafitinib, pemigatinib) show potential, especially in combination with TKIs or DNA-damaging agents. Future research should prioritize GIST-specific clinical trials, the development of FGFR2-driven models, and standardized molecular diagnostics to validate FGFR2 as a therapeutic target. Full article

This paper provides a theoretical investigation of the OR-product (∨-product) in soft set theory, an operation of central importance for handling uncertainty in decision-making. A comprehensive algebraic analysis is carried out with respect to various types of subsets and equalities, with particular emphasis on M-subset and M-equality, which represent the strictest forms of subsethood and equality. This framework reveals intrinsic algebraic symmetries, particularly in commutativity, associativity, and idempotency, which enrich the structural understanding of soft set theory. In addition, certain missing results on OR-products in the literature are completed, and our findings are systematically compared with existing ones, ensuring a more rigorous theoretical framework. A central contribution of this study is the demonstration that the collection of all soft sets over a universe, equipped with a restricted/extended intersection and the OR-product, forms a commutative hemiring with identity under soft L-equality. This structural result situates the OR-product within one of the most fundamental algebraic frameworks, connecting soft set theory with broader areas of algebra. To illustrate its practical relevance, the int-uni decision-making method on the OR-product is applied to a pilot recruitment case, showing how theoretical insights can support fair and transparent multi-criteria decision-making under uncertainty. From an applied perspective, these findings embody a form of symmetry in decision-making, ensuring fairness and balanced evaluation among multiple decision-makers. By bridging abstract algebraic development with concrete decision-making applications, the results affirm the dual significance of the OR-product—strengthening the theoretical framework of soft set theory while also providing a viable methodology for applied decision-making contexts. Full article

Background/Objectives: Breast cancer (BC) is the most commonly diagnosed cancer in women and the leading cause of cancer-related deaths globally. Molecular subtyping is crucial for prognosis and treatment planning, with immunohistochemistry (IHC) being the most commonly used method. However, IHC has limitations, including observer variability, a lack of standardization, and a lack of reproducibility. Gene expression profiling is considered the ground truth for molecular subtyping; unfortunately, this is expensive and inaccessible to many institutions. This study investigates the potential of an artificial intelligence (AI) model to predict BC molecular subtypes directly from hematoxylin and eosin (H&E)-stained whole-slide images (WSIs). Methods: A pretrained deep learning framework based on multiple-instance learning (MIL) was validated on the Stavanger Breast Cancer (SBC) dataset, consisting of 538 BC cases. Three classification tasks were assessed, including two-class [triple negative BC (TNBC) vs. non-TNBC], three-class (luminal vs. HER2-positive vs. TNBC), and four-class (luminal A vs. luminal B vs. HER2-positive vs. TNBC) groups. Performance metrics were used for the evaluation of the AI model. Results: The AI model demonstrated strong performance in distinguishing TNBC from non-TNBC (AUC = 0.823, accuracy = 0.833, F1-score = 0.824). However, performance declined with an increasing number of classes. Conclusions: The study highlights the potential of AI in BC molecular subtyping from H&E WSIs, offering an easily applicable and standardized method to IHC. Future improvements should focus on optimizing multi-class classification and validating AI-based methods against gene expression analyses for enhanced clinical applicability. Full article

Investment decision-making is often characterized by uncertainty and the subjective weighting of criteria. This study aims to develop a more robust decision support framework by integrating the Generalized Interval-Valued Hesitant Intuitionistic Fuzzy Soft Set (GIVHIFSS) with the Analytic Hierarchy Process (AHP) to objectively weight criteria and handle multi-evaluator hesitancy. In the proposed GIVHIFSS-AHP model, the AHP is employed to derive mathematically consistent criterion weights, which are subsequently embedded into the GIVHIFSS structure to accommodate interval-valued and hesitant evaluations from multiple decision-makers. The model is applied to a numerical case study evaluating five investment alternatives. Its performance is assessed through a comparative analysis with standard GIVHIFSS and GIFSS models, as well as a sensitivity analysis. The results indicate that the model produces financially rational rankings, identifying blue-chip technology stocks as the optimal choice (score: +2.4). The comparative analysis confirms its superiority over existing models, which yielded less-stable rankings. Moreover, the sensitivity analysis demonstrates the robustness of the results against minor perturbations in criterion weights. This research introduces a novel and synergistic integration of the AHP and GIVHIFSS. The key advantage of this approach lies in its ability to address the long-standing issue of arbitrary criterion weighting in Fuzzy Soft Set models by embedding the AHP as a foundational mechanism for ensuring validation and objectivity. This integration results in mathematically derived, consistent weights, thereby yielding empirically validated, more reliable, and defensible decision outcomes compared with existing models. Full article

Background: Multiple high-powered magnet ingestion is a surgical emergency due to inter-loop attraction leading to ischemia, necrosis, perforation, and fistula formation. While well documented in children, adult cases—particularly those complicated by entero-enteric fistula—remain rare, and management is largely extrapolated from pediatric guidelines. Objective: To present a rare case of adult entero-enteric fistula following multiple neodymium magnet ingestion, we review the literature and propose an adapted management algorithm for adults. Methods: A narrative PubMed review was performed to identify pediatric and adult cases of magnet ingestion complicated by gastrointestinal fistula. Search terms included magnet ingestion, entero-enteric fistula, neodymium, and adult. Reported case characteristics, diagnostic modalities, treatments, and outcomes were analyzed. Results: A 38-year-old male with schizophrenia presented with small bowel obstruction five days after ingesting multiple magnets. Abdominal radiography revealed clustered radiopaque bodies in the distal ileum. Emergency laparotomy identified an entero-enteric fistula caused by pressure necrosis from inter-loop magnetic attraction. Segmental enterectomy with side-to-side anastomosis was performed, with uneventful recovery. The literature review identified only a few adult cases, which showed similar pathophysiology but frequent diagnostic delays and higher complication rates compared with pediatric cases. Conclusions: This case adds to the scarce adult literature on magnet-induced entero-enteric fistula and supports the adaptation of pediatric-based protocols for adults, with attention paid to psychiatric comorbidity and delayed presentation. Early imaging, timely intervention, and multidisciplinary care are essential to prevent severe gastrointestinal injury. Full article

Autonomous social robots aim to reduce human supervision by performing various tasks. To achieve this, they are equipped with multiple perceptual channels to interpret and respond to environmental cues in real time. However, multimodal perception often leads to sensory overload, as robots may receive numerous simultaneous stimuli with varying durations or persistent activations across different sensory modalities. Sensor overstimulation and false positives can compromise a robot’s ability to prioritise relevant inputs, sometimes resulting in repeated or inaccurate behavioural responses that reduce the quality and coherence of the interaction. This paper presents a Bioinspired Attentional System that uses Reinforcement Learning to manage stimulus prioritisation in real time. The system draws inspiration from the following two neurocognitive mechanisms: Inhibition of Return, which progressively reduces the importance of previously attended stimuli that remain active over time, and Attentional Fatigue, which penalises stimuli of the same perception modality when they appear repeatedly or simultaneously. These mechanisms define the algorithm’s reward function to dynamically adjust the weights assigned to each stimulus, enabling the system to select the most relevant one at each moment. The system has been integrated into a social robot and tested in three representative case studies that show how it modulates sensory signals, reduces the impact of redundant inputs, and improves stimulus selection in overstimulating scenarios. Additionally, we compare the proposed method with a baseline where the robot executes expressions as soon as it receives them using a queue. The results show the system’s significant improvement in expression management, reducing the number of expressions in the queue and the delay in performing them. Full article

Background: Primary spinal gliomas are rare in the pediatric population. Separately, FGFR1 genomic aberrations are also uncommon in spinal cord tumors. We report a case of a previously well adolescent who presented with progressive symptoms secondary to an intramedullary tumor with unique radiological and molecular characteristics. Case Presentation: A previously well 17-year-old male presented with worsening mid-back pain associated with lower limb long-tract signs. Magnetic resonance imaging (MRI) of his neuro-axis reported a long-segment intramedullary lesion with enhancing foci and a multi-septate syrinx containing hemorrhagic components from C4 to T12. The largest enhancement focus was centered at T7. Additional MRI sequences observed no intracranial involvement or vascular anomaly. He underwent an emergent laminoplasty and excision of the thoracic lesion. Intraoperative findings demonstrated a soft, grayish intramedullary tumor associated with extensive hematomyelia that had multiple septations. Active fenestration of the latter revealed blood products in various stages of resolution. Postoperatively, the patient recovered well, with neurological improvement. Final histology reported a circumscribed low-grade glial neoplasm. Further molecular interrogation via next-generation sequencing panels showed activating FGFR1 p.K656E and V561M missense alterations. The unique features of this case are presented and discussed in corroboration with a focused literature review. Conclusions: We highlight an interesting case of an intramedullary tumor with unusual radiological and pathological findings. Emphasis is on the importance of tissue sampling in corroboration with genomic investigations to guide clinical management. Full article

Autologous stem cell transplantation (ASCT) is the standard frontline consolidation strategy in fit, eligible patients with chemosensitive multiple myeloma, and it also serves as salvage option in other haematological malignancies, such as diffuse large B cell lymphoma. Moreover, ASCT is known to disrupt the gut microbiome (GM), and the impact on clinical outcomes has been understudied. The aim of this review is to examine the associations between the GM and outcomes in patients undergoing ASCT. Using the PRISMA 2020 guidelines for systematic reviews and meta-analyses, a total of 11 articles were included in this review, comprising both observational studies (cohort studies, case–control studies) and interventional trials (randomised controlled trials). Consistent findings included a notable decrease in beneficial bacteria, including Bacteriodetes, Firmicutes and Faecalibacterium prausnitzii, which maintain gut homeostasis and modulate immune responses. Conversely, an increase in pathogenic bacteria, including Escherichia coli, Enterococcus spp. and Klebsiella spp., was observed post-transplantation. This review includes an overview of the GM following ASCT and the techniques commonly used to assess it, and highlights gaps, thereby identifying key areas for future research, although conclusions are limited by variation in sample size and reporting inconsistencies. Understanding the GM’s role in ASCT may lead to interventions that optimise patient outcomes through therapeutic manipulation of the GM. Full article

The legalization of cannabis in multiple U.S. states and several other countries, along with its increasing social acceptance across diverse demographic and socioeconomic groups, has led to a growing number of patients presenting for interventional procedures with a history of cannabis use. Although anesthetic and sedation-related implications may be less pronounced than in major surgery, they remain clinically relevant and warrant careful consideration. Key factors include acute intoxication, chronic use, and cannabis use disorder. Cannabis users often require higher—and sometimes unpredictable—doses of propofol and other sedatives. Inhalational use is associated with airway hyperreactivity, increasing the risk of bronchospasm and, in severe cases, life-threatening laryngospasm. Acute intoxication may also impair the patient’s ability to provide informed consent. Cardiovascular manifestations, including tachycardia, hypertension, and an elevated risk of myocardial infarction, may occur depending on the timing and extent of recent cannabis exposure. Although these effects are unlikely to cause major complications during routine screening colonoscopy or diagnostic esophagogastroduodenoscopy, advanced therapeutic procedures may pose significant challenges for sedation providers. This narrative review summarizes the chemistry, pharmacology, and sedation-related implications of cannabis use in patients undergoing sedation requiring interventional procedures, with a specific focus on GI endoscopy. Full article

Background and Clinical Significance: Moyamoya disease (MMD) is a progressive intracranial vasculopathy characterized by stenosis or occlusion of the terminal internal carotid arteries and the development of fragile collateral networks. It predisposes patients to ischemic and hemorrhagic strokes. Although both direct and indirect revascularization procedures are recommended to restore cerebral blood flow, recurrent cerebrovascular events may still occur, and delayed hemorrhage following revascularization is particularly uncommon. Case Description: We report the case of a 42-year-old woman who presented with seizure, syncope, and aphasia. Cranial computed tomography (CT) revealed a large left temporal–insular intraparenchymal hematoma with a midline shift. Computed tomography angiography (CTA) demonstrated bilateral internal carotid artery narrowing and collateral vessel proliferation, without aneurysm. Her history indicated a hemorrhagic stroke 15 years earlier, at which time MMD was diagnosed by magnetic resonance angiography (MRA) and managed with multiple burr hole surgeries. She remained free of cerebrovascular events until the current presentation. The patient underwent emergent hematoma evacuation, followed by intensive care management. Postoperatively, she demonstrated neurological improvement, though with residual motor aphasia and right-sided weakness, and was discharged for rehabilitation. Conclusions: This case underscores the rare occurrence of delayed intracerebral hemorrhage 15 years after indirect revascularization in MMD. Although revascularization surgery remains the standard therapeutic approach, this report highlights the importance of sustained long-term surveillance, strict risk factor management, and careful postoperative follow-up. The key point is that late hemorrhagic complications, though uncommon, must be considered in the long-term care of MMD patients following revascularization. Full article

Maximum likelihood estimation (MLE) in infinite mixture distributions often lacks closed-form solutions, requiring numerical methods such as the Newton–Raphson algorithm. Selecting appropriate initial values is a critical challenge in these procedures. This study introduces a bootstrap-based approach to determine initial parameter values for MLE, employing both nonparametric and parametric bootstrap methods to generate the mixing distribution. Monte Carlo simulations across multiple cases demonstrate that the bootstrap-based approaches, especially the nonparametric bootstrap, provide reliable and efficient initialization and yield consistent maximum likelihood estimates even when raw moments are undefined. The practical applicability of the method is illustrated using three empirical datasets: third-party liability claims in Indonesia, automobile insurance claim frequency in Australia, and total car accident costs in Spain. The results indicate stable convergence, accurate parameter estimation, and improved reliability for actuarial applications, including premium calculation and risk assessment. The proposed approach offers a robust and versatile tool both for research and in practice in complex or nonstandard mixture distributions. Full article

Background: Hypophosphatemia is a frequently underestimated metabolic disorder, yet it can be one of the first biochemical findings in primary hyperparathyroidism (PHPT). Current diagnostic and surgical criteria for PHPT do not include serum phosphate, despite its potential value as an early marker. Methods: We report the case of a 79-year-old woman with type 2 diabetes mellitus, hypertension and osteoarthritis, followed since 2015 for persistent hypophosphatemia (0.8 mg/dL) and stress fractures. Results: Initial calcium and vitamin D levels were normal, but PTH was elevated. Bone scintigraphy revealed multiple stress fractures, while ultrasound and sestamibi scan were inconclusive. Despite cholecalciferol and calcitriol supplementation, hypophosphatemia persisted. From 2023, progressive hypercalcemia developed (10.9 mg/dL), with sustained hypophosphatemia (1.7 mg/dL), persistently high PTH (121 pg/mL) and markedly elevated FGF-23 (1694 kRU/L). Renal phosphate wasting was demonstrated, with reduced tubular reabsorption. An 18F-fluorocholine PET-CT performed in 2024 identified two right parathyroid adenomas, establishing the diagnosis of PHPT. The patient was referred for parathyroidectomy. Conclusions: Hypophosphatemia may serve as a complementary biomarker in the diagnostic and therapeutic approach to PHPT, but only after other potential causes of low phosphate levels have been excluded, as illustrated in this case. Its consideration could facilitate the early identification of PHPT and improve clinical decision-making, particularly in patients who do not meet classical surgical indications. Full article