Search Results (174,367)

Background and Objectives: Knee osteoarthritis (OA) is a leading cause of pain and disability, with radiographic severity influenced by age, biomechanical alignment, and structural joint features. Data describing the association between common radiographic parameters and OA severity in Eastern European clinical populations remain limited. This study aimed to evaluate the associations between radiographic OA severity and coronal alignment, patellar height, and chondrocalcinosis in a Romanian clinical cohort. Materials and Methods: This single-center cross-sectional study included adult patients undergoing knee radiography for knee-related symptoms and/or functional assessment at a rehabilitation hospital between 2023 and 2025. Radiographs were obtained in the supine, non-weight-bearing position and included anteroposterior and lateral views. OA severity was graded using the Kellgren–Lawrence (KL) classification. Coronal alignment was assessed using the femorotibial angle, patellar height using the Insall–Salvati ratio (ISR), and chondrocalcinosis was recorded as present or absent. Associations between radiographic parameters and KL grade were analyzed using non-parametric statistics. Receiver operating characteristic (ROC) analyses were performed for exploratory assessment of limited separation between distributions. Results: Moderate to severe OA (KL ≥ 3) was present in 49% of patients. KL grade showed a moderate positive correlation with age (r = 0.50, p < 0.001) and differed significantly across coronal alignment categories (p < 0.001). Varus/valgus and pathological alignment classifications demonstrated moderate sensitivity (0.69–0.85) and variable specificity (0.52–0.85) for higher KL grades. ROC analyses of continuous alignment and ISR measures yielded area under the curve values ranging from approximately 0.65 to 0.68, indicating limited separation between distributions. Radiographically detected chondrocalcinosis was present in 5.3% of patients and showed no significant association with OA severity, and neither did patellar height. Conclusions: In this single-center Romanian clinical cohort, radiographic OA severity was associated with coronal plane alignment but not with patellar height or chondrocalcinosis. Alignment measures demonstrated limited discriminative ability and should be interpreted as complementary rather than diagnostic indicators of OA severity. These findings provide descriptive radiographic data from an Eastern European clinical population and highlight the need for longitudinal and population-based studies incorporating mechanical axis assessment and functional outcomes. Full article

Background: Intervertebral motion is a fundamental aspect of spinal biomechanics, crucial for understanding lumbar spine function, pain mechanisms, and surgical outcomes. Various methods exist for measuring and interpreting it, each with its own advantages, limitations, and specific applications. However, a comprehensive and standard taxonomy of study types for the measurement and interpretation of in vivo intervertebral motion in the lumbar spine is lacking. Objectives: This review aimed to systematically identify, characterise, and categorise the diverse study types deposited in the literature. Eligibility criteria: Only studies in English and of lumbar spine intervertebral motion in living subjects were considered, and only those that employed objective measurement of motion sequences were included. Sources of evidence: A comprehensive literature search was performed in PubMed, CINAHL, and SCOPUS for articles published between January 2000 and October 2025. Charting methods: After removal of duplicates, all studies were subjected to Title and abstract screening, followed by full-text screening of potentially eligible studies. Data selected were charted into tables under the headings: author, year, country, purpose, technology, participants, measurement, interpretation, radiation dosage, and significance of findings. Results: Forty-nine studies were abstracted and are described under 11 study types. These formed a taxonomy constituting the following six categories: normal biomechanical mechanisms, pathological and injury mechanisms, direct kinematic measurement, spinal stabilisation, dynamic radiography, and clinical markers. The resulting taxonomy will serve as a resource for researchers, clinicians, and policymakers by facilitating a more coherent understanding of the field and promoting standardisation in research design and reporting. Full article

Background/Objectives: Despite the publication of several systematic reviews on adolescent health literacy, comprehensive evaluations of the relationship between health literacy and health-related behaviors are still limited. This systematic review sought to synthesize and critically appraise the available evidence on associations between health literacy and health behaviors among adolescents. Methods. A systematic search of three databases (Scopus, PubMed, and PsycINFO) was conducted in accordance with PRISMA guidelines. Thirty-seven eligible cross-sectional studies were selected for qualitative synthesis. Methodological quality was evaluated using the Newcastle–Ottawa Scale adapted for cross-sectional studies. Results: The 37 included studies encompassed 71,558 adolescents (mean age range 11.0–17.0 years) and were conducted primarily in Europe (n = 22), with additional studies from the USA (n = 5), Asia (n = 8), and cross-cultural settings (n = 2). Across studies, 11 HL instruments were used (including two eHealth literacy measures), most commonly the Health Literacy for School-aged Children scale (n = 14). Physical activity (n = 22), nutrition-related indicators (n = 26), and smoking/alcohol/drug outcomes (n = 16) were assessed using heterogeneous operationalisations. Overall, higher HL was more often associated with healthier behavioral profiles, with more consistent patterns for nutrition-related outcomes. Findings for physical activity and substance use were more heterogeneous and, in some cases, varied depending on the HL measurement approach (subjective vs. objective) and the behavioral reference period. Conclusions: Current evidence indicates that higher health literacy in adolescents is generally associated with more favorable health behaviors, particularly regarding nutrition-related indicators. However, study heterogeneity and the predominance of cross-sectional designs limit comparability and causal inference. Future research should prioritize standardized measurement tools and longitudinal designs to clarify directionality and underlying mechanisms. Full article

Objectives: This study aimed to investigate the cost of hospitalization and length of stay (LOS) associated with dental infections and their impact on healthcare resources. Materials and Methods: Web of Science, Medline via Ovid, and Google Scholar were searched for articles published from 2013 to 2023 using relevant MeSH terms. A descriptive summary was produced to describe study characteristics, and selected studies were analyzed to evaluate financial implications and hospitalization outcomes. Results: After removing duplicates, 125 articles were screened, with 25 read in full and 9 excluded. Sixteen retrospective studies were included, encompassing 156,487 patients. Hospital length of stay ranged from 1.15 to 10 days, and hospitalization costs ranged from AUD 2402 to USD 47,836.60. Variability in outcomes appeared to be influenced by infection severity, healthcare infrastructure, and geographic setting. Conclusions: Dental infections impose a substantial and variable burden on healthcare systems. These findings emphasize the need for timely intervention, preventive strategies, and standardized management protocols to reduce clinical complications and financial strain on healthcare services. Full article

Background: Facial asymmetry affecting the mandibular contour may significantly impact facial harmony even in patients with stable occlusion. Although orthognathic surgery remains the standard for skeletal correction, it carries substantial morbidity. In selected cases, contour-focused approaches can achieve meaningful esthetic improvement with reduced surgical burden. Objective: To describe the virtual surgical planning (VSP) workflow and clinical outcome of a unilateral Wing osteotomy for mandibular contour asymmetry. Case presentation: A 24-year-old woman presented with left-sided mandibular contour deficiency and facial asymmetry, despite stable Class I occlusion and preserved function. VSP with contralateral mirroring guided the design of the osteotomy and fabrication of a stereolithographic model and patient-specific cutting guide. Surgery was performed through a tunnelized mandibular approach using a 702 bur and reciprocating saw. Fixation was achieved with pre-bent 2.0 plates adapted to the 3D model, and Bio-Oss Collagen was interposed within the osteotomy gap. Occlusion and mental nerve function were preserved. Results: Postoperatively, the patient demonstrated improved facial symmetry, uneventful healing, preserved long-term neurosensory function, and high esthetic satisfaction. Conclusions: Unilateral Wing osteotomy guided by VSP and patient-specific instrumentation is a predictable, minimally invasive alternative to bimaxillary orthognathic surgery with genioplasty in selected patients presenting contour-focused asymmetry and stable occlusion. This case highlights a rare, underreported application of the technique. Full article

Background/Objectives: International guidelines—including the 2017 Japanese Circulation Society—recommend antibiotic prophylaxis before invasive dental procedures only for patients with clearly defined cardiac conditions at increased risk of infective endocarditis (IE), primarily Class I or IIa. However, IE prevention is not systematically incorporated into Japanese dental education, and dentists’ understanding of these indications remains unclear. We assessed dentists’ knowledge of guideline-based cardiac and procedural indications for prophylaxis, as well as their clinical practices regarding timing, duration, and antibiotic selection. Methods: A self-administered questionnaire was mailed to 3109 members of the Hyogo Dental Association. The survey evaluated recognition of Class I and IIa cardiac indications, dental procedures requiring prophylaxis, and self-reported prophylactic practices. Respondents were grouped by years of practice (≤20 vs. ≥21 years). Results: Overall, 367 dentists responded (11.8%). Correct identification of Class I indications was high for prosthetic valves (83.4%) and previous IE (93.7%) but low for complex congenital heart disease (55.5%) and post-shunt surgery (52.0%). Recognition of Class IIa indications was limited (36.4–51.1%). Awareness of procedural indications was high for tooth extraction (92.9%) and periodontal surgery (84.3%) but low for subgingival scaling (47.6%) and root canal treatment (36.7%). Only 60.5% of dentists correctly understood that prophylaxis is indicated for a Class I/IIa cardiac condition and an invasive dental procedure. Furthermore, 32.5% of dentists administered antibiotics within 1 h before treatment, and single-dose regimens were uncommon (14.7%). Multi-day regimens were frequently used. Amoxicillin was the most commonly selected antibiotic (40.8%). No major differences were observed between the groups. Conclusions: Although dentists demonstrated good awareness of major procedural indications, substantial gaps remain in recognizing Class I and IIa cardiac indications and in adhering to guideline-recommended timing and duration. Targeted education and improved collaboration between medical and dental professionals are needed to promote evidence-based IE prevention and reduce unnecessary antibiotic use. Full article

Background/Objectives: Iron deficiency and associated iron deficiency anaemia represent a major global health burden. Parenteral nutrition (PN) patients are at increased risk of iron deficiency due to inadequate iron supplementation. Currently, iron is added to all-in-one (AIO) PN mostly as low-dose ferric chloride in trace element solutions, limited to 1–2 mg in adults, to ensure emulsion stability and prevent lipid peroxidation. The objective of this study was to evaluate the compatibility and stability of selected, widely used complex-bound iron products added to AIO PN over a 48 h period. Methods: Ferric carboxymaltose and iron sucrose were added as non-biological complex intravenous iron oxide carbohydrate products to two different commercial AIO PN admixtures for adults. The iron concentrations used were 100 and 400 mg/L (1.79 and 7.16 mmol/L), corresponding to approximately 200 mg (3.58 mmol) of iron dose per PN bag. Free and complex-bound iron were separated using 100 kDa dialysis tubes. Free and complex-bound iron were assessed at 4, 24, and 48 h after admixing. pH was measured before and at 0, 4, 24, and 48 h after admixture. Iron quantification was performed by inductively coupled plasma mass spectrometry (ICP-MS). Results: No significant changes in complex-bound iron concentration were observed over the 48 h incubation period (p-value = 0.449; estimate 0.060 mg/L per h, 95% CI −0.089, 0.201 mg/L per h). The concentration of free iron was very low and increased only slightly over time. Iron recovery ranged from 95.8% to 103.9%. The addition of the alkaline iron sucrose significantly increased the pH of the AIO admixture (p-value = 0.033), whereas the addition of ferric carboxymaltose did not affect the pH (p-value = 0.351). After the initial increase, the pH of all conditions remained stable over the 48 h incubation period (p-value = 0.07). Conclusions: Ferric carboxymaltose demonstrated stable intravenous iron admixtures within the PN formulations tested. Before the clinical application of these findings, further studies should specifically evaluate the lipid peroxidation and stability of the lipid emulsions, the most sensitive and important PN compatibility and safety characteristics of AIO PN. Full article

Background and Objectives: Anatomical staging alone insufficiently explains survival heterogeneity in patients with resected non-small cell lung cancer (NSCLC). Although inflammation-based biomarkers have demonstrated prognostic value, the clinical relevance of erythrocyte-derived indices—particularly mean corpuscular volume (MCV)—remains poorly characterized in this setting. This study evaluated the prognostic significance of preoperative MCV and examined whether its integration with the Noble and Underwood (NUn) score improves survival prediction. Methods: We retrospectively analyzed patients with stage I–IIIA NSCLC who underwent complete surgical resection. Associations between clinicopathological variables and overall survival (OS) were assessed using Cox proportional hazards models. Prognostic performance was evaluated using the concordance index and the integrated time-dependent area under the curve. Continuous variables were modeled on their original scale without dichotomization. Results: Model comparison using the Akaike Information Criterion indicated that incorporation of the composite NUn–MCV index into the intermediate model—comprising age, basal metabolic rate, American Society of Anesthesiologists physical status, pleural invasion, and pathological stage—provided a superior model fit compared with inclusion of the NUn score and MCV as separate covariates. On this basis, the composite NUn–MCV model was selected as the full model. Across all evaluations, the full model demonstrated consistently greater discriminative ability for survival prediction than both the intermediate model and the baseline model based solely on pathological stage. Conclusions: Preoperative MCV independently predicts OS in patients with resected stage I–IIIA NSCLC. Integration of MCV with the NUn score into a composite index provides incremental prognostic value beyond anatomical staging and established clinical factors, supporting its use as a complementary tool for postoperative risk stratification. Full article

Health Internet of Things (Health IoT) systems continuously stream sensitive physiological data, making data access governance safety-critical under conflicting objectives such as privacy risk, latency, energy/resource cost, and robustness, especially when conditions change during emergencies. This paper proposes FiB-MOBA-EAFG, a hybrid blockchain–AI framework that separates on-chain accountability from off-chain decision intelligence. Off-chain, fuzzy context inference parameterizes scenario priorities, Pareto-based multi-objective search generates candidate governance policies, an emergency-aware feasibility guard filters unsafe trade-offs, and a bargaining-based selector chooses a single deployable policy. On chain, the blockchain layer records consent commitments, access events, and hashes of the selected policy and decision trace, serving as an immutable audit and accountability substrate rather than an online decision or optimization engine, while raw health data remain off-chain. Using simulation studies of home remote monitoring, clinic telehealth, and emergency triage under stochastic network variation and adversarial device behavior, FiB-MOBA-EAFG improves robustness and yields more repeatable policy selection than rule-based control and scalarized baselines within the evaluated simulation scenarios, while maintaining latency within ranges compatible with modeled edge deployment constraints through explicit emergency-aware feasibility constraints. A budget-matched random-search ablation further indicates that structured Pareto exploration is needed to reliably obtain robust, low-risk governance policies. Full article

Background and objectives: Since postprandial lipid metabolism has emerged as a risk factor for cardiovascular disease, the quality of dietary fat may have a crucial role in atherogenesis and metabolic inflammation. In this study, we propose that the quality of dietary fats and the metabolic status of individuals modulate postprandial triglyceride-rich lipoprotein (TRL) composition and the response of macrophages to TRL. Methods: Randomized controlled crossover trial in the postprandial phase in 12 normal-weight adults and 12 adults with obesity. Each participant consumed both a Western-style (WB) and a Mediterranean-style (MB) breakfast in separate sessions, containing butter or olive oil as the fat source, respectively. Blood samples were collected at baseline (0 h), 2 h, and 4 h postprandially, and TRL were isolated and used to treat THP-1 macrophages. Results: The intake of the WB led to higher concentrations of inflammatory-related markers, particularly in individuals with obesity, and resulted in a higher content of saturated fatty acids and lower of monounsaturated fatty acids in TRL compared to the MB. Staining TRL-treated macrophages with Oil Red O revealed substantial lipid accumulation, which was more pronounced in cells cultured with 4 h TRL from individuals with obesity. This was also evidenced by upregulation of gene expression of lipoprotein uptake receptors following the consumption of the WB. Conclusions: Consumption of a WB led to a more pro-inflammatory postprandial profile and promoted greater lipid accumulation in macrophages, particularly in individuals with obesity, compared to a MB. These findings highlight the importance of fat quality in meals for cardiovascular risk management, especially in populations with obesity. Full article

Background: Digital technologies, particularly CAD/CAM workflows, have transformed implant prosthodontics by improving the accuracy and efficiency of impression procedures, facilitating clinician–laboratory communication, and supporting the preservation of peri-implant tissues. Objective: To compare the three-dimensional accuracy (trueness) and passive fit of five conventional and digital impression techniques for fixed prostheses supported by two implants. Methods: An in vitro experimental study was conducted using a partially edentulous maxillary model with two implants supporting a three-unit zirconia bridge. Five impression workflows were evaluated: conventional techniques (open-tray and closed-tray, splinted and non-splinted) and digital impressions using plastic and titanium scan bodies. Three-dimensional accuracy was assessed by digital superimposition analysis, and passive fit was evaluated by marginal gap measurements using digital microscopy and ImageJ (version 1.54r) software. Statistical analyses were performed using exploratory ANOVA with Welch’s correction and Games–Howell post hoc tests (p < 0.05), complemented by effect size analysis. Results: Three-dimensional superimposition analysis revealed that digital impression workflows and the splinted conventional open-tray technique exhibited the highest trueness, with minimal spatial deviations relative to the reference model, together with the lowest marginal gap values (<1 µm). The non-splinted open-tray technique presented higher discrepancies (7.37 ± 0.94 µm), although all techniques remained within clinically acceptable tolerance ranges (60–150 µm). Conclusions: Under controlled in vitro conditions, both digital impression techniques and conventional splinted protocols achieve high three-dimensional accuracy and clinically acceptable passive fit for multi-implant-supported fixed prostheses. Digital workflows represent a predictable and efficient alternative, while conventional splinted impressions remain a reliable option depending on clinical and technological considerations. Full article

Submarine structures are typically classified into pressure hulls and non-pressure hulls. The pressure hull is a critical component designed to withstand external pressure at operational depths while ensuring internal structural integrity. It is generally composed of ring frames and bulkheads. However, in modern large-scale submarines, bulkheads are often replaced with deep frames to improve equipment layout flexibility. Deep frames serve as essential structural reinforcements, compensating for the loss of stiffness due to the absence of bulkheads. Despite their importance, research on the design of deep frames remains scarce, and in the absence of established design standards, engineers rely on conservative approaches based on practical experience. Therefore, the objective of this study is to propose initial scantling formulas for deep frames in submarine pressure hulls based on finite element analysis (FEA) and parametric studies. To this end, six design cases reflecting actual ship design ranges were selected, and the structural integrity of the pressure hull ring frames was verified through material and geometric nonlinear analysis using ANSYS Mechanical APDL. Subsequently, a total of 82,440 parametric studies were conducted with the reinforced shell thickness, effective length, height and thickness of the deep frame web, and the width and thickness of the deep frame flange as variables. As a result, the proposed formulas satisfied all Validation cases in terms of structural integrity and were found to be applicable within the section length range of 1.5 to 2.0 times the pressure hull diameter. The results of this study are expected to be effectively utilized in the initial design of deep frames for submarine pressure hulls. Full article

Background/Objectives: This study aims to assess the prevalence and predictors of burnout among urology professionals in Pakistan using a validated tool and to explore underlying causes through qualitative input. Methods: A cross-sectional survey was conducted among urology trainees, fellows, and consultants across Pakistan. Burnout was measured using the Maslach Burnout Inventory–Human Services Survey (MBI-HSS). Burnout was defined using a criterion of high emotional exhaustion or high depersonalization. Descriptive statistics and chi-square tests were used to assess associations. Thematic analysis was applied to open-ended responses. Results: A total of 183 responses were received. When using the high emotional exhaustion (EE) or depersonalization (DP) criterion, 62% was classified as experiencing burnout. Significant predictors included excessive working hours (more than 80 h per week), frequent night calls, avoidance-based coping, workplace favouritism, and discrimination. No association was found with gender, age, or designation. Thematic responses highlighted five common causes of burnout. Conclusions: Burnout is prevalent among urology professionals in Pakistan and is largely driven by modifiable factors. Interventions must target institutional support, work–life balance, and healthier coping mechanisms. Full article

Propelled by the “dual-carbon” strategy, green and intelligent ports are rapidly advancing toward low-carbon and intelligent development. However, the large-scale incorporation of renewable energy and the extensive electrification of transport equipment have substantially heightened system volatility and scheduling complexity. To address the challenges associated with multi-energy coupling and economic operation in medium and large ports, a hierarchical collaborative optimization scheduling strategy is proposed. The upper layer employs an improved Bio-enhanced Dung Beetle Optimization (BDBO) algorithm for parameter optimization and carbon-cost minimization. Meanwhile, the lower layer establishes a rolling time-series control mechanism grounded in Adaptive Dynamic Hierarchical Decoupling Planning (ADHDP), thereby constituting an integrated BDBO-ADHDP dual-agent system. Simulation results across four seasonal scenarios demonstrate that the proposed methodology outperforms DQN, PSO, GA, ACO, and DBO algorithms in reducing grid power purchases, enhancing renewable energy utilization, mitigating curtailment, and lowering operational costs. Moreover, it achieves faster convergence, superior robustness, and effective carbon-emission control. This study substantiates the efficacy of the proposed strategy within green port integrated energy systems and highlights its potential for broader application in other multi-energy coupled systems. Full article

Background/Objectives: Vision language models (VLMs) show strong potential for medical image understanding, but their large scale often limits practical deployment. This study investigates whether a compact VLM can be effectively adapted for dermatology, with a focus on explaining bacterial skin disease images. Methods: We curate a dataset derived from PMC-OA using the BIOMEDICA dataset and construct PMC-derma-VQA-bacteria by pairing images with inherited figure captions and synthetically generated question–answer (QA) supervision produced by Google’s Gemini model. SmolVLM is fine-tuned under three supervision settings: QA-only, caption-only, and a combined QA+caption strategy. The models are evaluated on a held-out test set for both text-generation quality and diagnostic classification performance. Results: QA-only supervision yields the best report-generation performance, while the combined QA+caption setting achieves the highest classification accuracy (70.20%). Conclusions: Synthetic QA supervision can meaningfully enhance compact VLMs for medical image understanding and diagnostic support in dermatology. Full article