Search Results (506)

Background and Objectives: Medication overuse headache (MOH) presents unique clinical challenges in older adults due to age-related changes and comorbidities. However, data on MOH characteristics and treatment responses in this population remain limited. This study investigated the clinical features, treatment patterns, and short-term outcomes of MOH in older patients. Methods: We analyzed data from the RELEASE registry, a nationwide, multicenter prospective cohort of MOH patients in South Korea. Participants were stratified into older (≥65 years) and younger (<65 years) groups. We compared clinical features, treatment patterns, and 3-month outcomes, and identified factors associated with treatment response in the older group. Results: Among 791 patients, 72 (9.1%) were older. Compared to younger patients, older patients reported more monthly headache days (30.0 vs. 27.0, p = 0.012), more days using acute medication (30.0 vs. 20.0, p < 0.001), and fewer headache-free days (0.0 vs. 3.0, p = 0.012). They also experienced more severe headache days (12.5 vs. 10.0, p = 0.056). Despite this, older patients showed lower disability, with significantly lower Migraine Disability Assessment scores (30.0 vs. 46.0, p < 0.001) and a trend toward lower Headache Impact Test-6 scores (64.5 vs. 66.0, p = 0.065). In multivariable analysis, poor adherence to preventive treatment (≤24%) was significantly associated with non-response (OR 0.13, 95% CI: 0.02–0.96, p = 0.045) at 3 months. Conclusions: Older patients with MOH showed distinct clinical features, including higher headache frequency and severity but relatively lower disability. Improving adherence to preventive treatment may enhance treatment response. Age-specific management strategies are needed. Full article

Four biostimulants (phycocyanin, γ-aminobutyric acid (GABA), glycine betaine (GB), and the mycorrhizal fungus Rhizophagus intraradices) were applied foliarly to six cultivars of mature creeping bentgrass (Agrostis stolonifera) under non-stressed greenhouse conditions. Phycocyanin was most effective at increasing total shoot greenness, which was most consistent over time with the cultivars Penncross, T1, and Tyee. GABA was most effective at increasing total root fresh and dry weight, most strongly for Penncross and T1, respectively. GB was most effective at increasing total shoot fresh and dry weight, with both most strongly increased for Tyee. By comparison, R. intraradices had relatively low effectiveness for increasing any of these parameters. The appearance of the grass at the end of the experiment revealed that 007 and Focus generally showed the most and least growth benefit, respectively, with all four biostimulants. However, all cultivars showed increases in more than one parameter for each biostimulant, and thus, no cultivar was uniformly responsive or non-responsive to all the biostimulants. This research shows that phycocyanin, GABA, and GB may benefit multiple creeping bentgrass cultivars under non-stressed conditions, but each one tended to be more beneficial to a particular aspect of plant growth and quality. End users need to be aware of the importance of creeping bentgrass genotype when considering biostimulant application. Full article

Background: Immunocompromised patients are at risk of severe varicella zoster virus (VZV) infection and reactivation. In VZV seronegative immunocompromised persons, live-attenuated VZV vaccination is contraindicated, thus the recombinant herpes zoster vaccine (rHZV) remains a safe alternative, although an off-label application. Yet, data on the induction of a VZV-specific immune response in immunocompromised individuals with VZV-specific IgG below the assay’s cut-off are only available for patients after solid-organ transplantation (SOT). Methods: We retrospectively analyzed the induction of VZV-specific IgG antibody levels after vaccination with rHZV in immunocompromised patients who previously tested anti-VZV-IgG negative between March 2018 and January 2024. Results: Of 952 vaccinees screened that received 2 or 3 doses rHZV, depending on the underlying disease, 33 patients (median age 53.0; 51.5% female) with either hematopoietic stem cell transplantation (82%) or high-grade immunosuppressive treatment (18%) fulfilled the inclusion criteria. Upon rHZV vaccination, 88% (29/33) individuals mounted a significant antibody response exceeding the assay’s cut-off level for seropositivity (p < 0.0001). We detected higher geometric mean antibody concentrations after three compared to two doses. However, 12% remained below the assay’s cut-off level and were therefore considered non-responsive. Conclusions: The rHZV is immunogenic in VZV-seronegative immunocompromised individuals and therefore presents a valid option to induce seroconversion. However, antibody testing in high-risk groups should be considered to identify humoral non- and low responders. Full article

Questionnaire data plays a key role in social research, especially when evaluating public attitudes using Likert-type scales. Yet, traditional analyses often merge some ordinal categories and exclude responses such as Don’t Know, No Answer, or Refused—risking the loss of valuable information. This study introduces BS-TOSIE (Belief Structure-Based TOPSIS for Survey Item Evaluation), a novel method that preserves and integrates all response types, including ambiguous ones. By combining the Belief Structure framework with the TOPSIS (Technique for Order Preference by Similarity to Ideal Solution) method, BS-TOSIE offers a structured approach to ranking and evaluating individual survey items measured on an ordinal scale, even in the presence of missing or incomplete data. Response distributions are transformed into a belief structure vector, enabling comparison against ideal and anti-ideal benchmarks. We demonstrate this approach using data from the Quality of Life in European Cities survey to assess perceptions of local governance in European cities. This study analyzes changes in citizen satisfaction with local public administration across five key dimensions—timeliness, procedural clarity, fairness of fees, digital accessibility, and perceived corruption—in 83 European cities between 2019 and 2023. The findings reveal persistent regional disparities, with Northern and Western European cities consistently outperforming those in Southern and Eastern Europe, although some cities in Central Europe show signs of improvement. Zurich consistently received high satisfaction scores, while other cities, such as Rome and Palermo, showed lower scores. Unlike traditional methods, our approach preserves the full spectrum of responses, yielding more nuanced and interpretable insights. The results show that BS-TOSIE enhances both the clarity and depth of survey analysis, making a methodological contribution to the evaluation of ordinal data and offering empirical insights into public perceptions of local city administration. Full article

To study the orbits of satellites, a galaxy can be modeled either by means of a static gravitational potential or by live N-body particles. Analytic potentials allow for fast calculations but are idealized and non-responsive. On the other hand, N-body simulations are more realistic but demand higher computational cost. Our goal is to characterize the regimes in which analytic potentials provide a sufficient approximation and those where N-bodies are necessary. We perform two sets of simulations, using both Gala and Gadget, in order to closely compare the orbital evolution of satellites around a Milky Way-like galaxy. Focusing on the periods when the satellite has not yet been severely disrupted by tidal forces, we find that the orbits of satellites up to ${10}^8{\mathrm{M}}_{\odot }$ can be reliably computed with analytic potentials to within 5% error if they are circular or moderately eccentric. If the satellite is as massive as ${10}^9{\mathrm{M}}_{\odot }$ then errors of 9% are to be expected. However, if the orbital radius is smaller than 30 kpc then the results may not be relied upon with the same accuracy beyond 1–2 Gyr. Full article

Enterovirus (EV) infections in neonates can be transmitted vertically or horizontally, with symptoms ranging from mild to severe, including myocarditis, meningoencephalitis, and hepatitis. Neonates with EV-induced myocarditis may present severe cardiovascular disease with sudden onset of arrhythmia. Neonatal arrhythmias, particularly in low birth weight or critically ill infants, can impair cardiac function and worsen outcomes. EV targets cardiomyocyte receptors, inducing apoptosis pathways and triggering cardiac conduction disturbances. We present an extremely low-birth-weight preterm infant (GW 27 + 6) who developed EV-induced myocarditis, complicated with a sudden onset of supraventricular tachycardia (SVT), pericardial effusion and bi-atrial enlargement. Despite multi-agent regimen, including propranolol, flecainide, and amiodarone, the infant showed persistent junctional rhythm until seven months of age, later transitioning to atrial rhythm with stable cardiac function. A review of previously published rhythm disturbances due to EV-induced myocarditis is presented. Newborns with EV-induced arrhythmia may require a multi-modal treatment such as a multi-agent medical regimen or, in severe non-responsive cases, an electrophysiological approach. EV infections may cause long-term cardiovascular comorbidities (such as left ventricular dysfunction or mitral valve regurgitation), necessitating continuous monitoring through echocardiography and ECG. Collaboration between neonatologists and pediatric cardiologists is crucial for effective treatment and follow-up. Full article

When education in STEM, social science, and the humanities are disconnected from each other and from place, it is inauthentic and nonresponsive to the lived experiences of people and communities. In rural spaces, the Food–Energy–Water (FEW) Nexus, a framework for problem solving and decision-making around these central resources, is salient because of the concentration of FEW resource production and extraction present. Storying the FEW Nexus is an interdisciplinary pedagogical framework that is theoretically rooted in a critical pedagogy of place and socio-ecological systems. Storying the FEW Nexus brings together these two related but distinct frameworks, calling attention to the need for relevant, place-based, and rural-focused narratives within STEM instruction. Developed for K-12 learners in rural places, Storying the FEW Nexus positions STEM knowledge and skills as resources that, alongside local narratives, are vital to the sustainability and viability of communities with unique and intertwined environmental justice histories and current realities. The FEW Nexus is leveraged to support rural learners in developing sustainable solutions to local socio-ecological systems issues. In this conceptual paper, we review the literature base supporting this integrated approach, describe the framework within the context of these aims, and make suggestions for researchers and practitioners. Full article

Background: Remote symptom monitoring via electronic platforms may identify patients at risk for unplanned acute care visits after surgery. Since 2016, the Memorial Sloan Kettering Cancer Center (MSKCC) has employed the Recovery Tracker (RT), a patient-reported outcome (PRO) system, for symptom monitoring after ambulatory procedures. In 2021, RT was extended to patients undergoing inpatient colorectal surgery. Objective: To evaluate the impact of RT implementation on urgent care utilization and readmission rates in patients undergoing elective inpatient colorectal surgery and to determine whether patient engagement with RT influences these outcomes. Methods: In this retrospective observational study at MSKCC, we compared patients undergoing elective colorectal surgery during the RT implementation period (March 2021–December 2022) to a historical control cohort (February 2019–February 2020). The primary outcome was a potentially unnecessary urgent care center (UCC) visits—defined as a visit not requiring inpatient admission. Secondary outcomes included 30-day readmission and survey engagement. Multivariable logistic regression was used for adjusted comparisons. Results: A total of 1941 patients in the RT cohort and 1206 in the control group met the inclusion criteria. The RT cohort had higher rates of UCC visits without admission (4.43% vs. 1.6%) and 30-day readmissions (9.74% vs. 6.88%). RT period surgery was independently associated with increased odds of UCC visits (OR 2.80, 95% CI 1.71–4.58, p < 0.0001) and readmissions (OR 1.43, 95% CI 1.09–1.88, p = 0.0098). Notably, RT users who completed at least one survey (70.2%) had significantly lower odds of readmission (OR 0.56, 95% CI 0.41–0.77, p = 0.0003) compared to non-responders. Discussion: Engagement with the RT system was associated with a 44% reduction in readmission risk, identifying non-responders as a vulnerable subgroup. While the overall rates of post-discharge care utilization increased after RT implementation, active participation in PRO reporting emerged as a protective factor. Conclusions: These findings highlight the need for strategies to promote engagement and support patients less likely to interact with remote monitoring tools. Non-response may signal barriers such as technological challenges or increased vulnerability, warranting proactive engagement strategies. Full article

Canine chronic inflammatory enteropathy (CIE) has been associated with coagulation abnormalities, predisposing affected dogs to a hypercoagulable state and potential thromboembolic events. This study aimed to evaluate the coagulation status in dogs with CIE using a viscoelastic point-of-care device, a Viscoelastic Coagulation Monitor (VCM Vet^®). A retrospective review of medical records identified 38 dogs diagnosed with CIE that underwent VCM Vet^® testing. Coagulation profiles were classified as hypercoagulable, normocoagulable, or hypocoagulable. The results demonstrate that 81.5% of dogs exhibited hypercoagulability, and significant associations were found between the coagulation status and the type of CIE. Hypercoagulability was more commonly found in immunosuppressive-responsive enteropathy (IRE) cases. Albumin and cobalamin were significantly higher in food-responsive enteropathy, whereas the canine chronic enteropathy clinical activity index (CCECAI) was significantly higher in immunosuppressive-responsive enteropathy and non-responsive enteropathy. One dog with protein-losing enteropathy (PLE) was suspected of having developed possible pulmonary thromboembolism. These findings reinforce previous reports of hypercoagulability in CIE and suggest that VCM Vet^® is a valuable and easy tool to assess coagulation abnormalities in a clinical setting. Further investigation is warranted to evaluate the clinical implications of hypercoagulability in CIE and the potential role of anticoagulant therapy in disease management. Full article

Missing data remain a challenge for researchers and decision-makers due to their impact on analytical accuracy and uncertainty estimation. Many studies on missing data are based on randomness, but randomness itself is problematic. This makes it difficult to identify missing data mechanisms and affects how effectively the missing data impacts can be minimized. The purpose of this paper is to examine a potentially simple test to diagnose whether the missing data are missing at random. Such a test is developed using an extended taxonomy of missing data mechanisms. A key aspect of the approach is the use of single mean imputation for handling missing data in the test development dataset. Changing this to random imputation from the same underlying distribution, however, has a negative impact on the diagnosis. This is aggravated by the possibility of high inter-variable correlation, confounding, and mixed missing data mechanisms. The verification step uses data from a high-quality real-world dataset and finds some evidence—in one case—that the data may be missing at random, but this is less persuasive in the second case. Confidence in these results, however, is limited by the potential influence of correlation, confounding, and mixed missingness. This paper concludes with a discussion of the test’s merits and finds that sufficient uncertainties remain to render it unreliable, even if the initial results appear promising. Full article

Background: Invasive aspergillosis (IA) is a life-threatening fungal infection that primarily affects immunocompromised individuals and has high morbidity and mortality rates, necessitating timely diagnosis and treatment. This study aimed to evaluate the prognostic utility of serum and bronchoalveolar lavage (BAL) fluid galactomannan levels, as well as galactomannan kinetics, in patients with IA. Methods: We retrospectively reviewed the medical records of patients who were diagnosed with proven or probable IA from March 2016 to April 2024 at a tertiary cancer center. The collected data included patient characteristics, baseline and peak galactomannan levels in serum and BAL fluid, galactomannan trends, and clinical outcomes. Subgroup analyses were performed to assess the prognostic value of dual-source galactomannan positivity (positive serum and BAL fluid galactomannan levels). Results: Elevated baseline serum galactomannan levels independently predicted treatment non-response (p = 0.039) and 12-week all-cause mortality (p < 0.001). Peak serum and BAL fluid galactomannan levels were strongly associated with poor clinical outcomes (p < 0.01). Compared to single-source galactomannan positivity, dual-source galactomannan positivity was linked to reduced treatment response (22% vs. 43%, p = 0.01) and higher IA-attributable mortality (52% vs. 27%, p = 0.002). Patients with neutropenia had poorer outcomes compared to patients without neutropenia, but neutrophil recovery dramatically improved survival (25% vs. 69% mortality, p < 0.0001). Early galactomannan kinetics and malignancy type had limited prognostic value. Conclusions: Our findings highlight the potential role of galactomannan as a key biomarker for early prognostication for IA. The strong association between galactomannan levels and clinical outcomes suggests its utility in identifying high-risk patients who may benefit from more aggressive management. Further studies are needed to introduce a nuanced and context-specific use of galactomannan into clinical practice and assess its role as a prognostic biomarker. Full article

(1) Background: Neoadjuvant chemotherapy (NAC) is an integral part of breast cancer management, and response to NAC is an important prognostic factor associated with improved survival outcomes. However, the current standard for response assessment relies on post-surgical histopathological analysis, which limits early therapeutic decision-making and treatment personalization. This study aimed to develop and evaluate a machine learning model that integrates pre-treatment MRI radiomics and clinical features to predict response to NAC in breast cancer patients. (2) Methods: In this study, a machine learning model was developed to predict breast cancer response to NAC using pre-treatment magnetic resonance imaging (MRI) radiomics and clinical data. Radiomic features were extracted from contrast-enhanced T1-weighted (CE-T1) and T2-weighted (T2) MRI sequences using both intratumoral and peritumoral segmentations. Furthermore, this study uniquely examined two response assessment criteria: (1) pathologic complete response (pCR) versus non-pCR, and (2) clinical response versus non-response. A total of 254 patients with biopsy-confirmed breast cancer who completed NAC were included. Radiomic features (n = 400) and clinical features (n = 7) were analyzed to build a predictive model employing the XGBoost classifier. Performance was measured in terms of accuracy, precision, sensitivity, specificity, F1-score, and AUC. (3) Results: The integration of radiomic features with clinical data significantly enhanced the predictive performance. For pCR and non-pCR prediction, the combined features model achieved an accuracy of 80% and AUC of 0.85, outperforming both the clinical features model (Accuracy = 68%, AUC = 0.81) and radiomic features model (Accuracy = 66%, AUC = 0.60). Similarly, for the clinical response and non-response prediction, the combined features model achieved an Accuracy of 74% and AUC of 0.75, outperforming both the clinical features model (Accuracy = 63%, AUC = 0.68) and radiomic features model (Accuracy = 66%, AUC = 0.57). (4) Conclusions: These findings highlight the synergistic effect of integrating clinical data and MRI-based radiomics to improve pre-treatment NAC response prediction, which has the potential to enable more precise and personalized treatment strategies. Full article

The identification of model parameters is a central challenge in the analysis of nonignorable nonresponse data. In this paper, we propose a novel penalized semiparametric likelihood method to obtain sparse estimators for a parametric nonresponse mechanism model. Based on these sparse estimators, an instrumental variable is introduced, enabling the identification of the observed likelihood. Two classes of estimating equations for the nonlinear regression model are constructed, and the empirical likelihood approach is employed to make inferences about the model parameters. The oracle properties of the sparse estimators in the nonresponse mechanism model are systematically established. Furthermore, the asymptotic normality of the maximum empirical likelihood estimators is derived. It is also shown that the empirical log-likelihood ratio functions are asymptotically weighted chi-squared distributed. Simulation studies are conducted to validate the effectiveness of the proposed estimation procedure. Finally, the practical utility of our approach is demonstrated through the analysis of ACTG 175 data. Full article

Methotrexate (MTX) is the conventional synthetic disease-modifying anti-rheumatic drug (csDMARD) recommended as the first-choice anti-rheumatic drug for rheumatoid arthritis (RA). However, responses to MTX may be influenced by genetic variants. We aim to evaluate the association of the rs2372536, rs4673990, and rs4673993 genetic variants of the ATIC gene with therapeutic failure of MTX in patients with RA. A case–control study was performed. Disease activity was measured using the disease activity score based on erythrocyte sedimentation rate (DAS28-ESR). RA patients were classified into two groups: (a) responders (DAS28-ESR ≤ 3.2), which is the group of patients who did respond to methotrexate, and (b) non-responders (DAS28-ESR > 3.2), which is the group of patients who did not respond to methotrexate. Serum levels of the 5-aminoimidazole-4-carboxamide ribonucleotide (AICAR) enzyme and Interleukin-6 (IL-6) were quantified using an enzyme-linked immunosorbent assay (ELISA). Genotyping of ATIC genetic variants was performed with quantitative polymerase chain reaction (qPCR) using TaqMan probes. A total of 260 patients with RA were included. In total, 142 (54.6%) were non-responders to MTX. IL-6 levels were increased in the non-responder group (p = 0.002), while no statistical differences were observed in the AICAR levels. The variables associated with non-response were higher HAQ-Di, weekly MTX dose, glucocorticoid use, erythrocyte sedimentation rate, and carriers of the polymorphic homozygous variant of rs4673993 (OR = 4.5, 95% CI: 1.04–19.34; p = 0.04). The use of sulfazaline offered protective effects. Our findings indicate that the polymorphism rs4673993 gene variant of the AICAR protein may significantly influence MTX resistance. Therefore, these results support the importance of the pathway generating extracellular adenosine and its effects on promoting the immune regulation for the mechanism of MTX therapy of RA. Full article

Objectives: To explore the possible relationship between Toll-like receptor (TLR) gene encoding and a predictive outcome for the loss of response (LOR) to IFX treatment among Japanese patients with Crohn’s disease (CD). Methods: An association analysis that involved 25 single-nucleotide polymorphisms (SNPs) across the TLR1, TLR2, TLR4, TLR6, TLR9, and TLR10 genes was performed on a cohort of 127 Japanese patients with CD. The therapeutic responses were evaluated at 10 weeks, 1 year, and 2 years using three different inheritance models. Results: The CD patients with a G/G genotype of rs5743565 in TLR1 were significantly less likely in the responders at 10 weeks compared with the non-responders (p = 0.023, OR = 0.206). The frequencies of the C/T or T/T genotypes of rs5743604 in the TLR1, G/A, or A/A genotypes of rs13105517 in TLR2, both in the minor allele dominant model, were significantly higher in the responders at 10 weeks as compared with those in the non-responders (p = 0.035, OR = 4.401; p = 0.017, OR = 5.473). The patients with an A/A genotype of rs13105517 in TLR2 in the minor allele recessive model were significantly less likely in the responders at one year of IFX treatment compared with those in the non-responders (p = 0.004, OR = 0.195). Conclusions: The polymorphisms of TLR1 and TLR2 can be useful as biomarkers for predicting initial and secondary LOR to IFX in Japanese CD patients. The IFX response in genetic testing may target molecules for new drugs to overcome the non-response and LOR to IFX. Full article