Search Results (12,280)

Background Peri-implant diseases are primarily driven by microbial biofilm accumulation on the implant surface, leading to inflammatory destruction of the soft and hard tissues supporting dental implants, with progressive marginal bone loss and potential implant failure. Objectives: To analyze the subgingival microbial profiles of peri-implant sites and adjacent teeth in peri-implantitis and to assess the modifying effects of smoking and periodontal status. Methods: In this cross-sectional study, 43 adults (mean age: 54.5 years) contributed 100 dental implants and 50 adjacent natural teeth. Implants were classified as healthy implants (HI; n = 74) or peri-implantitis sites (PI; n = 26), and sampled teeth (TT) were categorized as periodontally diseased (n = 19) or periodontally healthy (n = 31). Subgingival biofilm was collected with sterile paper points and analyzed by quantitative polymerase chain reaction using the Paro x panel (ADD Laboral), which reported qualitative and quantitative data for 22 bacterial taxa. Additional subgroup analyses were performed according to smoking and periodontal status. Results: Peri-implantitis sites showed a significantly greater bacterial load than adjacent teeth for 10 taxa after false discovery rate correction, including Campylobacter rectus (β = 1.292, 95% CI 0.773–1.811; adjusted p = 2.38 × 10⁻⁵) and Porphyromonas gingivalis (β = 1.374, 95% CI 0.730–2.019; adjusted p = 3.22 × 10⁻⁴). Additional significant increases at peri-implantitis sites were observed for the Streptococcus constellatus group, Fusobacterium nucleatum, Eubacterium nodatum, Filifactor alocis, Parvimonas micra, Tannerella forsythia, Actinomyces odontolyticus, and Treponema denticola. In contrast, no taxon differed significantly in bacterial load between HI and TT after multiple-testing correction, and no taxon remained significant in prevalence analyses for either PI versus TT or HI versus TT. Clinically, significantly higher proportions of bleeding on probing and suppuration were present in PI sites vs. HI sites (96.15% of PI sites compared with 28.38%, 2.7%, 18.00%, and 8.00% of TT sites, respectively). Subgroup analyses by smoking and periodontal status suggested additional variation in microbial overlap, but these findings should be interpreted with caution given the limited subgroup sizes, particularly among smokers. Conclusions: Peri-implant and adjacent tooth sites shared substantial microbiological overlap; however, peri-implantitis sites showed higher detection frequencies and bacterial loads for selected taxa, whereas comparisons between healthy implant and tooth sites were less consistent. Full article

Background/Objectives: Human papillomavirus (HPV) is a well-established risk factor for oropharyngeal squamous cell carcinoma (OPSCC), with p16 expression serving as a reliable surrogate marker for HPV involvement and an important prognostic indicator. While data exist on the demographic and clinical features of p16-positive OPSCCs on a national scale, limited data exist for Nevada. Methods: This retrospective study evaluated the relationship between p16 positivity and OPSCC presentation in Northern Nevada, with specific attention to associations between p16 status, sex, socioeconomic factors, smoking history, and presenting symptoms. We reviewed medical records of 296 patients diagnosed with OPSCC with concomitant HPV testing at the Renown Regional Medical Center from 2014–2024. Variables of interest included sex, age at diagnosis, smoking pack-years, Nevada census-based income quintile, county of residence, and initial symptoms such as dysphagia and sore throat. Multivariate logistic regression was performed to assess associations between these variables and p16 status. Conclusions: We found that sex was the only variable significantly associated with p16 positivity: females had significantly lower odds of being p16-positive compared to males (OR: 0.36, 95% CI: 0.20–0.65, p = 0.001). This finding of sex-based disparity in HPV-related OPSCC is consistent with national trends. This study is limited by its regional focus and lack of data on other social determinants of health. Nonetheless, the results underscore the importance of gender-informed prevention strategies and highlight the need for further research into the biological and behavioral contributors to this disparity. Full article

Conventional polyurethane (PU) grouting materials face a severe trade-off between curing exotherm safety, flame retardancy, and mechanical performance in deep coal mining. Herein, we propose a synergistic strategy combining chemical prepolymerization with fly ash (FA) incorporation to develop high-performance prepolymer-based polyurethane/fly ash (PUP/FA) composite grouting materials. Prepolymerization combined with FA addition successfully mitigated the maximum reaction temperature to 98.3 °C while sustaining a rapid curing rate within 3 min. At an optimal FA loading of 20 wt%, the PUP/FA-20% composite sustained a robust compressive strength of 42.5 MPa, satisfying underground reinforcement standards. Crucially, limiting oxygen index (LOI) and cone calorimetry tests demonstrated outstanding flame retardancy and smoke suppression; the LOI reached 28.5%, and the total smoke production plummeted to 21.3 m². This performance enhancement is governed by a synergistic mechanism where dimethyl methylphosphonate acts via gas-phase radical scavenging, while uniformly dispersed FA particles serve as rigid barrier nodes to construct a dense protective shield in the condensed phase. This work offers a highly effective, waste-valorized, and fire-safe grouting solution for sustainable deep-underground engineering reinforcement. Full article

Train fires in railway bridge–tunnel connection sections (BTCSs) create severe evacuation challenges because tunnel–bridge spatial transitions interact with heat, smoke, visibility loss, and constrained rescue conditions. Existing evacuation management methods remain limited in coupling quantitative risk assessment with adaptive route guidance under evolving fire hazards. To address this issue, this paper proposes a large language model (LLM)-enhanced intelligent decision-support system (IDSS) framework for quantitative risk assessment and dynamic evacuation routing in BTCS fire scenarios. First, a multi-dimensional risk assessment model is established using the analytic hierarchy process and fuzzy comprehensive evaluation to quantify post-stop evacuation risk from the perspectives of evacuation organization, structural damage, and line recovery. Second, a dynamic topology-based routing method is developed to prune fire-threatened nodes and identify safer evacuation paths under evolving hazard conditions. The risk assessment model and routing algorithm are further embedded as callable tools into an LLM-enhanced evacuation IDSS under a perception–reasoning–recommendation architecture, in which an LLM orchestrates tool invocation, situational reasoning, and recommendation generation, thereby enabling autonomous risk interpretation, dynamic route replanning, and cross-regional collaborative decision support. The proposed framework is validated through a representative real-world railway engineering case. The results show that the IDSS-recommended routes achieved higher comprehensive safety scores (80.44 and 79.56) than routes involving fire-affected areas did (77.00 and 77.88). Workflow analysis further indicates that the proposed IDSS reduces the manual route-derivation workload by integrating risk assessment, topology pruning, and route allocation into structured, human-reviewable evacuation recommendations. Expert evaluations further confirm the rationality and compliance of the outputs, with review scores ranging from 1.76 to 1.92 out of 2.00. Overall, the proposed framework offers a feasible decision-support approach for intelligent evacuation management in complex railway fire emergencies. Full article

Background: Obesity is a major public health concern and shows a clear social gradient, with higher prevalence among individuals with lower socioeconomic position. Educational level is a key indicator of socioeconomic status, but the extent to which lifestyle factors explain its association with obesity remains unclear. Objective: To examine the association between educational level and obesity in a working-age population and to evaluate how adjustment for lifestyle factors influences the magnitude of the association between educational level and obesity. Methods: A cross-sectional study was conducted among 3108 working-age adults undergoing occupational health assessments in Spain. Educational level was categorised into three groups (higher, intermediate, and primary or none). Obesity was defined as a body mass index ≥30 kg/m². Lifestyle variables included smoking status, physical activity assessed using the International Physical Activity Questionnaire (IPAQ-SF), and adherence to the Mediterranean diet evaluated with the MEDAS-14 score. Sequential logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (95% CI), with progressive adjustment for demographic, behavioural, and clinical factors. Results: The overall prevalence of obesity was 16.6%, with a clear gradient across educational levels (11.5% in higher education vs. 19.8% in primary or no education). In crude analyses, individuals with the lowest educational level had higher odds of obesity (OR 1.89; 95% CI 1.46–2.45). Adjustment for age and sex attenuated the association (OR 1.72; 95% CI 1.32–2.24), with further reduction after inclusion of lifestyle factors (OR 1.63; 95% CI 1.24–2.13). In the fully adjusted model, the association remained statistically significant (OR 1.61; 95% CI 1.18–2.21), indicating that adjustment for lifestyle factors attenuated the association between educational level and obesity, although the association remained statistically significant. Conclusions: Lower educational level is associated with a higher risk of obesity. Adjustment for lifestyle factors attenuated this association, although a statistically significant relationship remained. These findings support the role of education as a fundamental determinant of health and highlight the need for strategies addressing broader social and structural determinants of obesity. Full article

Background: Secondhand exposure to heated tobacco products (HTPs) is increasingly common, but its impact on human milk composition is unclear. We investigated whether secondhand exposure to HTP aerosols affects major human milk components and cotinine concentrations in lactating women. Methods: This observational study included 15 lactating women whose household members used HTPs (secondhand HTP exposure group) and 33 lactating women who did not live with any smokers (non-exposed group). Human milk was analyzed for macronutrients, total solids, energy, lactoferrin, secretory immunoglobulin A (sIgA), calcium, inorganic phosphorus, zinc, and cotinine. Cotinine was measured in all women in the secondhand HTP exposure group and in three women in the non-exposed group. Results: Background characteristics did not differ significantly between groups. No significant differences were observed in lipid, protein, total solids, energy, true protein, lactoferrin, calcium, inorganic phosphorus, or zinc. Carbohydrate concentration differed significantly between the non-exposed and secondhand HTP exposure groups (non-exposed vs. secondhand HTP exposure: 8.20 vs. 8.10 g/dL, p = 0.032), although the absolute difference was small. sIgA tended to be higher in the secondhand HTP exposure group (non-exposed vs. secondhand HTP exposure: 1244 vs. 1706 μg/mL, p = 0.072). Cotinine concentrations did not differ significantly between groups; qualitative cotinine tests were negative in all samples. Conclusions: Secondhand exposure to HTPs was not associated with clear differences in major human milk components or cotinine concentrations. However, the findings should be interpreted cautiously because of the small sample size and limited cotinine assessment. Larger studies with objective exposure assessment and infant follow-up are needed. Full article

Background/Objectives: Pregnancy is characterized by profound metabolic and physiological adaptations that influence systemic redox balance. Longitudinal data assessing trimester-specific changes in antioxidant status and oxidative stress markers remain limited. Methods: In this longitudinal study, plasma levels of non-enzymatic antioxidants (vitamins A, C, E, and carotenoids) and oxidative stress markers (malondialdehyde, conjugated dienes, protein carbonyls, and DNA strand breaks) were analyzed in 31 healthy non-smoking pregnant women during the first, second, and third trimester. Environmental tobacco smoke exposure was evaluated using urinary cotinine. Statistical analyses were performed using Friedman repeated-measures tests followed by Dunn’s post hoc comparisons with Benjamini–Hochberg false discovery rate correction. Results: Vitamin A was the only antioxidant that consistently decreased across all trimesters and represented the only antioxidant marker showing a consistent decline. In contrast, α-tocopherol, γ-tocopherol, xanthophylls, and lycopene increased significantly during gestation, whereas vitamin C remained relatively stable. Markers of oxidative damage, including malondialdehyde, conjugated dienes, protein carbonyls, and DNA strand breaks, showed significant trimester-dependent increases. Total antioxidant capacity (FRAP) remained unchanged throughout pregnancy. Conclusions: Physiological pregnancy is characterized by coordinated, marker-specific adaptations in systemic redox balance. Vitamin A was the only antioxidant showing a consistent decline across gestation, whereas several lipid-soluble antioxidants increased and total antioxidant capacity remained stable. These findings indicate that pregnancy is associated with increased oxidative activity accompanied by preservation of systemic antioxidant capacity rather than global antioxidant depletion. Full article

Acute aortic syndrome (AAS) comprises acute aortic dissection, intramural haematoma, penetrating atherosclerotic ulcer, and limited intimal tear, conditions that require rapid recognition because mortality and resource use are strongly influenced by time to diagnosis, anatomical extent, malperfusion, and the need for emergency surgical or endovascular intervention. This revised narrative review synthesizes contemporary evidence on clinical, genetic, environmental, and health-system determinants of prolonged hospitalisation, intensive care unit (ICU) utilisation, bed occupancy, and costs in patients with AAS. Beyond summarising established risk factors, the review adds a resource-oriented framework that links hypertension, advanced age, female sex, smoking-related comorbidity, hereditary aortopathies, haemodynamic instability, malperfusion, delayed diagnosis, operative complexity, and postoperative complications to measurable downstream outcomes such as ICU length of stay, total hospital length of stay, reoperation, readmission, and longitudinal imaging surveillance. We searched PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar for relevant studies, registries, guideline documents, and cost analyses published between January 2000 and May 2026, with particular emphasis on studies from the last five years. The review was not designed as a meta-analysis; therefore, effect estimates are interpreted according to study design and generalisability. AAS imposes a disproportionate burden on hospital systems because high-risk patients often require advanced imaging, prolonged haemodynamic monitoring, complex open or endovascular repair, ICU care, and lifelong follow-up. Earlier diagnosis, structured risk stratification, targeted genetic evaluation, aggressive control of modifiable risk factors, and system-level pathways such as dedicated aortic networks may shorten hospital stay and reduce avoidable costs. Full article

Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are characterized by substantial biological heterogeneity and complex regulation of apoptosis, metabolism, and angiogenesis. The aim of this study was to evaluate the concentrations of selected proteins: FGF2, HGF, Fas/CD95, CASP9, ALDH1A1, and GLUT1 in tumor and margin samples and assess correlations with clinical and demographic parameters. A total of 59 samples from patients with GEP-NETs were analyzed using multiplex immunoassay and ELISA methods. Significant differences in protein expression between tumor and margin tissues were observed. Fas/CD95 levels were lower in tumor samples, whereas HGF concentration was higher. Elevated HGF, FGF2 and Fas/CD95 levels were associated with advanced tumor stage. HGF and GLUT1 concentrations varied depending on nodal status, while FGF2, Fas/CD95, and CASP9 levels were increased in metastatic cases. Additionally, differences related to tumor localization and the influence of smoking and alcohol consumption were identified. Dysregulation of apoptotic, metabolic, and angiogenic pathways plays a crucial role in GEP-NETs progression and highlights the importance of the tumor microenvironment. GEP-NET exhibit biological heterogeneity and complex progression driven by multiple interacting molecular pathways. The factors analyzed may have potential significance as biomarkers of disease progression; however, their exact role requires further investigation in larger, prospective cohorts. Full article

To investigate the effects of coagulation methods on the structure and properties of sheet rubber, this study prepared natural rubber using different coagulation systems, including acetic acid, formic acid, biological coagulants, and pineapple juice, and systematically analyzed their non-rubber components, gel content, molecular weight distribution, rheological behavior, and mechanical properties of the vulcanized rubber. The results indicate that the type of coagulant significantly affects the protein, phospholipid, and gel content. Among these, the pineapple juice gel exhibited the lowest residual protein content, suggesting that the proteases, organic acids, and active components it contains promote the degradation and removal of non-rubber components. GPC and rheological results show that pineapple juice gel and bio-gel samples possess a broad molecular weight distribution and exhibit a more pronounced viscoelastic response at high temperatures. After uniform vulcanization, the differences in hardness, tensile strength, and tear resistance among the various samples were minimal, indicating that the vulcanized network determines the final mechanical properties, while the coagulation method primarily regulates microstructure and processing behavior. This study provides a theoretical basis for the application of bio-coagulants in the processing of green shikigai gum. Full article

Background: Traditional genotype-guided dosing often fails to predict real-time variability in the metabolic phenotype during complex polypharmacy. This secondary analysis of a retrospective cohort aims to elucidate mechanisms underlying real-time phenoconversion during antipsychotic therapy, focusing on homozygous loss-of-function CYP3A5*3/*3 non-expressors. Methods: Using an additive phenoconversion model that integrates a genotype-derived baseline with environmental modifiers for drug–drug interactions (DDI), systemic inflammation (CRP), and renal function (eGFR), we demonstrate that the expressed metabolic phenotype is a dynamic, context-dependent construct that can markedly diverge from the genotype-predicted state. Objectives: Our data show that patients with CYP3A5*3/*3 and CYP3A inhibitors (e.g., ritonavir) had a quetiapine plasma concentrations reached 1850 ng/mL, corresponding to 3.7-fold above the internationally accepted therapeutic reference range of 100–500 ng/mL. Acute systemic inflammation (CRP > 50 mg/L) induced a functional poor metabolizer phenotype (P_act < −0.9) in individuals with a genotypic normal metabolizer status. In contrast, strong inducers such as carbamazepine, phenytoin, and heavy smoking promoted an ultra-rapid metabolizer state (CL_ind > 4.0 L/h, quetiapine < 30 ng/mL), consistent with treatment failure. In this cohort, the additive P_act model showed a strong association with observed clearance and identified clinically relevant phenoconversion mechanisms not predicted from genotype alone. Conclusions: These results support a dynamic, multi-parametric approach that integrates pharmacogenomics, therapeutic drug monitoring, biomarker profiling (CRP, eGFR), and structured DDI assessment to enable higher-resolution, real-time phenotype tracking and more informed dose individualization in high-risk psychiatric polypharmacy. Full article

We develop a two-age smoking-dynamics model for youth and adult groups that incorporates education acquisition, aging, cessation and relapse, disease progression, age-dependent social mixing, and a weak Allee effect in smoking initiation. Education is modeled as a protective status acquired through schooling and aging transitions, while initiation depends on both education status and prevalence-dependent social reinforcement. We establish the well-posedness of the system, derive the smoking-free equilibrium in closed form, and obtain the compact age-structured threshold ${\mathcal{R}}_0^{\mathrm{age}}=\rho \left(\mathrm{diag}(g_Y,g_A)C\right)$, where C is the age-mixing matrix and $g_a$ summarizes the within-age smoking-invasion potential. Using center-manifold analysis, we derive conditions under which Allee-type social reinforcement can generate a backward bifurcation, implying that reducing ${\mathcal{R}}_0^{\mathrm{age}}$ below one may not always be sufficient for elimination when endemic prevalence is high. We also analyze the impact of cross-age mixing on the threshold and use a quasi-steady-state approximation to characterize the quitting–relapse loop while preserving the threshold structure. Numerical simulations illustrate baseline youth and adult prevalence trends, identify youth initiation, relapse, cessation, and education protection as dominant drivers of threshold sensitivity, and show that education-based interventions are most effective when they directly reduce the susceptibility of educated youths to smoking initiation. Full article

Background and Objectives: Recovering from COVID-19 does not always imply a full return to health and may lead to the development of post-COVID-19 syndrome. Post-COVID-19 manifestations include, among others, symptoms of depression and/or anxiety. The aim of the study was to assess the prevalence of anxiety and depressive disorders and to identify their exogenous and endogenous predictors in individuals with post-COVID-19 syndrome. Materials and Methods: The study included 200 participants (116 women and 84 men, aged 18–80) diagnosed with post-COVID-19 syndrome. Participants completed psychological assessments, including the Hospital Anxiety and Depression Scale (HADS), the Generalized Anxiety Disorder 7 (GAD-7), and the Beck Depression Inventory (BDI). Comorbidities were also evaluated. Results: Based on the HADS, anxiety was identified in 41.5% of respondents and depression in 39.5%. Generalized anxiety disorder was screened positive for 36.5% of respondents (GAD-7), while mild depression was observed in 37.0% (BDI). Among participants with post-COVID-19 syndrome and diabetes, the risk of developing depression was three times higher than in individuals without comorbidities. In smoking women with post-COVID-19 syndrome and diabetes, the risk of developing depressive disorders was estimated to exceed 90%. Conclusions: The risk of developing anxiety and depressive disorders in individuals with post-COVID-19 syndrome and multimorbidity is very high, highlighting the need for preventive psychological care, including targeted screening programs, for those at greatest risk. Full article

Aim: The aim of this observational cross-sectional study was to evaluate whether blood renalase concentration, total antioxidant status (TAS), main cardiovascular risk factors, and obstructive sleep apnea severity are associated with the anatomical severity of coronary artery disease assessed by CCTA in patients with suspected OSA. Materials and methods: The study included 93 patients with suspected OSA. All patients were assessed for main risk factors for cardiovascular disease. Polysomnography was performed to verify the suspicion of OSA, as well as coronary computed tomography angiography (CCTA) with a systematic assessment of the severity of coronary artery disease using the CAD-RADS classification. Blood renalase concentration and total antioxidant status (TAS) were determined. Results: The apnea–hypopnea index (AHI) in the study group was 16.57 ± 17.17 /h. OSA was diagnosed in 73.1% of the study group. In CCTA examinations, significant coronary artery disease (CAD-RADS ≥ 3) was suspected in 22.6% of the subjects, including 16.1% classified as CAD-RADS 3, 4.3% as CAD-RADS 4, and 2.1% as CAD-RADS 5. Patients with AHI ≥ median were significantly more often classified as CAD-RADS ≥ 3 than patients with AHI < median. Patients with blood renalase concentration ≥ median were significantly less often classified as CAD-RADS ≥ 3 than patients with blood renalase concentration < median. Similarly, patients with TAS ≥ median were significantly less often classified as CAD-RADS ≥ 3 than those with TAS < median. Older age, higher systolic blood pressure, higher blood cholesterol levels, and lower TAS were independently associated with CAD-RADS ≥ 3 in logistic regression analysis. In multivariable regression analysis, higher pack-years of smoking, higher AHI, and lower blood renalase concentration were independently associated with lower TAS. Conclusions: Higher pack-years of smoking, higher AHI values, and lower blood renalase concentration were associated with lower total antioxidant status, which, along with older age, higher systolic blood pressure, and higher total cholesterol concentration, was independently associated with suspected anatomically significant coronary artery disease on CCTA. Full article

Background: Small-cell lung cancer (SCLC) accounts for 15% of lung cancers, with 70% diagnosed at extensive-stage (ES). Systemic therapy is often considered in very unwell patients, although outcomes for inpatients with ES-SCLC are not well understood. Methods: We reviewed patients with de novo ES-SCLC who had an inpatient medical oncology consultation at the Ottawa Hospital between 2013 and 2021. The primary endpoint was overall survival (OS). Secondary endpoints included length of stay (LOS) and tumor lysis syndrome (TLS) incidence. Results: There were 127 patients identified. Median age was 68 years (range 50–87), 58% female, 99% had prior smoking history, 22% had brain metastases, and 64% had liver metastases. Ninety-two (72%) received chemotherapy. Median OS for treated patients was 5.9 months (95% CI, 4.5–7.3 m), and a median LOS of 13 days. Patients in the non-treatment cohort had a median OS of 14 days (95% CI, 0.2–0.7 m), a median LOS of 11 days, and 54% in-hospital death rate. TLS occurred in six of the 76 (8%) evaluated patients, all dying within 7 days of chemotherapy. Conclusions: Chemotherapy was associated with longer survival among inpatients with ES-SCLC. TLS was rare but uniformly fatal, highlighting the need for aggressive prophylaxis among patients with identified risk factors. Full article