Search Results (1,475)

Fluids whose viscosity and surface tension depend on deformation history are poorly described by integer-order models, and fractional differential equations have been adopted for them across rheology and applied mathematics. Work on this subject remains scattered, and no synthesis has established which operators are in use, how the equations are solved, or what remains undone. This review supplies that synthesis and states the open problems that follow. Under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 protocol, 682 records from Scopus, ScienceDirect, and SpringerLink were reduced to 23 eligible articles by deduplication of 61 records, title and abstract screening of 533, and full-text assessment of the 81 retrievable reports. A supplementary search on the term “fractional viscoelastic”, run as a sensitivity analysis, added five more, giving a final corpus of 28 studies from 1986 to 2026, classified by operator, model, solution method, fluid, property, and validation status. The springpot-based Fractional Maxwell Model and the Caputo-derivative dominate, no study applies the Atangana–Baleanu–Caputo or Caputo–Fabrizio operator constitutively, and joint modeling of the two properties is confined to three studies of one lubricating oil. Five open problems are stated, each with its supporting evidence and the direction that would resolve it. Full article

Background/Objectives: Proximal junctional kyphosis (PJK) is a frequent mechanical complication following adult spinal deformity (ASD) surgery, and osteoporosis is a well-recognized risk factor. However, whether the underlying risk factor profiles for PJK differ according to bone mineral density status remains unclear. This study aimed to identify and compare independent risk factors for PJK between osteoporotic and non-osteoporotic patients following long-segment posterior spinal fusion for ASD. Methods: This retrospective cohort study included 356 patients who underwent ≥5-level posterior fusion to the sacrum or pelvis for ASD with a 2-year follow-up. Patients were stratified into a non-osteoporotic (non-OP; n = 284) and an osteoporotic (OP; n = 72) group based on preoperative dual-energy X-ray absorptiometry (T-score ≤ −2.5). PJK was defined as a proximal junctional angle (PJA) ≥20° with an increase of ≥10° from the preoperative value. Demographic, surgical, and radiographic variables were analyzed separately for each group using univariate and stepwise multivariate logistic regression analyses. Predictive performance was assessed using receiver operating characteristic curve analysis. Results: The overall PJK incidence tended to be higher in the OP group than the non-OP group (36.1% vs. 24.6%, p = 0.055), and fracture-type PJK occurred significantly more frequently in osteoporotic patients (29.2% vs. 15.8%, p = 0.016). The variables that reached statistical significance differed between the two groups. In the non-OP group, lower Hounsfield units at the upper instrumented vertebra (UIV; OR = 0.990, p = 0.011), higher preoperative PJA (OR = 1.098, p < 0.001), and greater L1 pelvic angle (L1PA) offset indicating relative overcorrection (OR = 1.136, p < 0.001) were independent predictors of PJK. In the OP group, higher preoperative PJA (OR = 1.149, p = 0.007) and greater age-adjusted pelvic incidence–lumbar lordosis offset (OR = 1.052, p = 0.039) were identified as independent risk factors. Multivariable models demonstrated acceptable discriminative ability in both groups (area under the curve [AUC] = 0.741, 95% confidence interval [CI] = 0.671–0.804 for the non-OP group; AUC = 0.753, 95% CI = 0.632–0.867 for the OP group; optimism-corrected AUC 0.729 and 0.735 after bootstrap internal validation). Conclusions: The variables associated with PJK differed according to osteoporosis status following ASD surgery. Careful UIV selection avoiding kyphotic junctional alignment may be relevant for both groups. Avoiding overcorrection relative to the age-adjusted target may warrant particular attention in osteoporotic patients, while UIV bone quality and L1PA overcorrection may be relevant to surgical planning in non-osteoporotic patients. Full article

Background: Sacubitril/valsartan is a cornerstone of guideline-directed medical therapy for heart failure with reduced ejection fraction (HFrEF), yet data regarding reverse remodeling after ARNI initiation in patients previously treated with cardiac resynchronization therapy (CRT) remain limited. This study evaluated echocardiographic reverse remodeling following sacubitril/valsartan initiation in a real-world cohort of CRT-treated patients and explored the association between treatment timing and remodeling response. Methods: This single-center retrospective pilot study included 188 patients with HFrEF treated with CRT who subsequently initiated sacubitril/valsartan. Patients were categorized into early (≤12 months after CRT, n = 112) and late (>12 months, n = 76) initiation groups. Echocardiographic parameters and functional status were assessed at baseline and at approximately 12 months. Reverse remodeling was evaluated using changes in left ventricular ejection fraction (LVEF), ventricular volumes, and clinical status. Multivariable logistic regression was used to explore factors associated with reverse remodeling (ΔLVEF ≥ 10%). Results: Sacubitril/valsartan therapy was associated with significant improvements in LVEF, left ventricular end-diastolic volume, left atrial volume, and NYHA functional class in both groups. The magnitude of improvement in echocardiographic parameters was similar between early and late initiation groups. In exploratory multivariable analyses, earlier ARNI initiation was associated with clinically meaningful reverse remodeling (ΔLVEF ≥ 10%) (OR 6.36, 95% CI 1.59–25.50, p = 0.009). SGLT2 inhibitor therapy was also associated with reverse remodeling (OR 5.76, 95% CI 1.86–17.87, p = 0.002), while a longer CRT-to-ARNI interval was associated with lower odds of response (OR 0.77 per year, 95% CI 0.62–0.96, p = 0.018). Analysis of CRT-to-ARNI interval as a continuous variable showed only a weak association with reverse remodeling, while receiver operating characteristic analysis did not identify a meaningful temporal threshold (AUC 0.497). Conclusions: Sacubitril/valsartan initiation after CRT was associated with significant reverse remodeling, including in patients who initiated therapy several years after CRT implantation, although the late-initiation subgroup was of limited size, and treatment intervals beyond the interquartile range (4.0–7.0 years) were sparsely represented. Absolute echocardiographic improvements were broadly similar between groups, and receiver operating characteristic analysis did not identify a discriminative temporal threshold (AUC 0.497), indicating no discriminative ability beyond chance. Exploratory multivariable analysis identified an association between earlier initiation and clinically meaningful reverse remodeling, but this finding was not supported by a clinically meaningful temporal threshold. Full article

Background/Objectives: A reactive anti-HCV antibody result requires confirmatory testing because seropositivity does not necessarily indicate active hepatitis C virus (HCV) infection. Although anti-HCV signal intensity may provide clinically useful information, it remains underutilized, particularly in low-reactivity ranges where diagnostic uncertainty is substantial. This study evaluated the diagnostic performance of anti-HCV signal-to-cutoff (S/Co) values and aimed to define a clinically meaningful uncertainty interval. Methods: In this retrospective study, 565,726 anti-HCV test results were screened, and the analysis was performed within the anti-HCV reactive cohort (≥1.0 S/Co; n = 2950), comprising 1581 patients with true HCV infection and 1369 without infection. Infection status was assigned using a uniform virological reference standard, every case being supported by at least one documented positive HCV-RNA PCR result. Receiver operating characteristic (ROC) analysis was used to assess discrimination, and multivariable logistic regression to model the probability of true infection. Results: Anti-HCV signal intensity discriminated true infection well across the reactive cohort (AUC 0.991), but less within the diagnostic uncertainty interval (1.00–4.99 S/Co; AUC 0.832), where only 5.7% of reactive results represented true infection. A Youden-optimal threshold of 4.65 S/Co provided >95% sensitivity, specificity and positive predictive value in the reactive cohort. The probability of true infection rose steeply with signal level, and each doubling of the S/Co value increased the odds of infection 23–fold. No threshold within the uncertainty interval raised the positive predictive value above 58.2%. Restricting confirmatory testing to values above 2.50 S/Co would avoid 41.7% of confirmatory tests while missing 1.96% of true infections. Conclusions: Anti-HCV signal intensity is strongly associated with the probability of true infection, but a single fixed cut-off is insufficient for clinical interpretation. Graded, signal-based interpretation may improve diagnostic accuracy, clarify low-level reactivity, and reduce unnecessary confirmatory testing. Full article

Background: The Falls Efficacy Scale-International (FES-I) is an assessment tool designed to measure the level of fear of falling in older adults. This scale was developed to evaluate how much an individual fears falling during various daily activities. The aim of the study was to assess the discriminatory power of FES-I to predict falls within 2 years. The secondary objective was to evaluate the relationship between FES-I and vascular status. Material and Methods: In this prospective study, 130 patients (mean age, 64.7 ± 14.6 years) with chronic kidney disease (CKD) were analyzed. Of these, 90 patients had nondialysis CKD: 15 had stage G3 (G3a, n = 5; G3b, n = 10), 38 had stage G4, and 37 had stage G5. The remaining 40 patients (30.7%) were prevalent patients receiving maintenance hemodialysis. The most frequent cause of CKD was hypertension and diabetes in 57 (43.8%) of patients. The Falls Efficacy Scale-International (FES-I) was used to assess fear of falling. The Charlson Comorbidity Index (CCI) was used to measure comorbidity, and the 10-year cardiovascular risk was assessed using a web-based calculator QRESEARCH Cardiovascular Risk Algorithm, version 3 (QRISK^®3), and hemodynamic parameters were measured using a Mobil-O-Graph monitor. Participants were followed for 2 years to assess the occurrence of falls. Results: During the two-year follow-up, 49 of 130 participants (37.7%) experienced at least one fall. FES-I demonstrated good discrimination for falls (AUC 0.836; bootstrap 95% CI, 0.760–0.903). In multivariable logistic regression adjusted for age, sex, dialysis status, comorbidity, and functional status, FES-I remained independently associated with falls (adjusted OR per 1-point increase, 1.145; 95% CI, 1.060–1.237; p < 0.001). Addition of FES-I to the basic clinical model increased the AUC from 0.826 to 0.874, although the difference was of borderline statistical significance in paired receiver operating characteristics (ROC) comparison (p = 0.053). The data-derived Youden-optimal threshold was 25 points; however, bootstrap analysis indicated threshold variability, and this cut-off should be considered exploratory. Conclusions: Higher FES-I scores were independently associated with falls during two-year follow-up and may provide additional prognostic information beyond selected clinical risk factors. FES-I may represent a candidate screening instrument for fall-risk assessment in CKD; however, the proposed cut-off (25 points) requires prospective external validation. Full article

Background/Objectives: Surgically treated oral cancer patients often face velopharyngeal insufficiency, which adversely impacts their quality of life (QOL). Our past investigations revealed noticeable MR signal shifts in velopharyngeal-related muscles during water deglutition on CMR among healthy individuals. We hypothesized that analyzing these distinct signal fluctuations could offer a novel visual perspective for detecting deglutition anomalies in surgical oral cancer cases. This feasibility study aimed to assess velopharyngeal-related muscular performance via CMR in post-operative oral cancer patients. Methods: Nineteen patients with oral malignancies were prospectively evaluated pre- and post-operatively. Twelve quantitative CMR metrics alongside subjective dysphagia scores were investigated. We analyzed whether signal intensity (SI) ratio alterations in these muscles correlated with dysphagia severity and clinical parameters. Results: Although three specific CMR parameters significantly worsened post-operatively, muscle MR signal values increased during deglutition without significant variation between pre- and post-surgical states. Subjective swallowing assessments remained entirely normal across all subjects. Conclusions: This preliminary investigation indicates that CMR can visualize stable velopharyngeal-related muscle activity after surgery in oral cancer patients maintaining adequate swallowing status. Nevertheless, confirmation via larger, symptomatic patient cohorts alongside gold-standard techniques remains mandatory. Full article

This study assessed the current status of irrigation systems and water management practices in Rwanda’s irrigated agricultural zones, focusing on the Nasho Government-Funded Irrigation (GFI) scheme in Kirehe District and the Kagitumba Irrigation Scheme in Nyagatare District. A mixed descriptive approach was used, combining field observations with structured questionnaires administered via KoboToolbox to 224 respondents in Nasho and 188 in Kagitumba. Field observations were used to evaluate the physical condition and functionality of irrigation infrastructure, while questionnaires captured stakeholder perceptions, water management practices, institutional arrangements, and operational challenges. Results show that both irrigation schemes are operational but function below optimal efficiency due to multiple constraints. In Nasho, irrigation performance is primarily affected by sedimentation in canals and reservoirs, pump inefficiencies, and inadequate maintenance practices, resulting in unreliable water delivery. In Kagitumba, despite the use of modern center pivot systems, performance is constrained by pipeline corrosion, pressure losses, sediment-laden water, and uneven water distribution. Across both schemes, more than 80% of respondents reported frequent system failures, while over 95% indicated the absence of formal irrigation scheduling practices. Water management remains largely reactive, with limited preventive maintenance and weak technical capacity among users and institutions. The study concludes that improving irrigation efficiency in Rwanda requires integrated interventions that combine infrastructure rehabilitation, strengthened maintenance systems, improved water governance, and farmer capacity development to enhance sustainable water use and agricultural productivity. Full article

Objectives: This study aimed to describe the incidence and clinical spectrum of external cephalic versión (ECV)-related complications, to evaluate pre-procedural predictors of their occurrence, and to develop and internally validate a prediction model for ECV-related complications. Methods: This single-center cohort study included ECV procedures performed in singleton pregnancies with non-cephalic presentation at term between January 2014 and December 2025. All procedures followed a standardized protocol, including tocolysis and either deep sedation or spinal anesthesia. ECV-related complications were defined as maternal or fetal adverse events occurring during the procedure or within 24 h after ECV. A prespecified multivariable logistic regression model was developed using clinically relevant pre-procedural variables. Model discrimination was assessed using the area under the receiver operating characteristic curve (AUC), and internal validation was performed by bootstrap resampling. Results: A total of 1050 ECV procedures were included, of which 733 (69.7%) were successful. Complication status was available for 1050 procedures, among which 113 ECV-related complications were recorded (10.8%). Complications were more frequent after failed than successful ECV (17.6% vs. 7.8%). The most frequent events were non-reassuring fetal heart rate patterns, major vaginal bleeding, spotting, and uterine contractions. Emergent cesarean delivery within 24 h occurred in 72 complication cases (63.7%). No neonatal deaths occurred among cases with ECV-related complications. In the final multivariable model, lower maternal body mass index (adjusted OR 0.92 per kg/m²), lower deepest vertical pocket (adjusted OR 0.69 per 10 mm), and breech rather than transverse lie (adjusted OR 0.24) were independently associated with ECV-related complications. Adding deepest vertical pocket significantly improved model discrimination from an AUC of 0.645 to 0.714. Bootstrap internal validation demonstrated limited optimism, with an optimism-corrected AUC of 0.699. Conclusions: ECV performed under a standardized protocol achieved a high success rate with an acceptable safety profile, although approximately one in ten procedures was associated with an ECV-related complication when broadly defined. Lower maternal BMI, reduced amniotic fluid volume, and breech presentation were the main pre-procedural predictors of complications. These findings may facilitate individualized counselling and procedural planning, although external validation is required before clinical implementation. Full article

Accurately assessing the fatigue levels of air traffic controllers is crucial for reducing human errors in ATC and ensuring the safe and orderly operation of the civil aviation transportation system. In remote tower scenarios, air traffic controllers’ work environments and task interaction modes differ significantly from those in traditional towers, and traditional fatigue detection approaches relying on physiological monitoring can cause intrusive disruptions to ATC operations. To overcome these limitations, this study proposes a scenario-based, non-invasive assessment framework for accurate and low-interference fatigue recognition. Taking three key scenario elements (traffic load, main operation screen brightness, and core work area illuminance) as the basis for measuring fatigue, the framework bridges the mapping from scenario elements to fatigue status, thereby enabling the transition of assessment inputs from physiological metrics to scenario features. In this mapping, fatigue labels are determined using a fusion strategy. Specifically, objective fatigue labels are derived from optimal wave features extracted from electroencephalogram data using one-way analysis of variance (OW-ANOVA), which are then fused with subjective labels based on the Karolinska Sleepiness Scale (KSS) self-reports through fuzzy C-means (FCM) clustering. Ultimately, a hybrid intelligent classification model integrating the Gannet optimization algorithm (GOA) and random forest (RF) is constructed to perform the primary assessment task. The experimental results indicate that the proposed framework achieves a recognition accuracy of 95.00%, outperforming six other commonly used classification or combination models. Ablation experiments and robustness tests validate the effectiveness of the fused labeling strategy and GOA modules, as well as the method’s excellent stability in resisting data noise. Furthermore, feature interpretability analysis reveals the quantitative influence of the three core fatigue drivers used. The research findings confirm the feasibility of non-invasive fatigue assessment for remote tower controllers leveraging scenario-based elements, which can offer intelligent decision support for controller shift scheduling, visual environment optimization, and targeted safety interventions. Full article

Background: The ASA Physical Status (ASA-PS) classification and the Charlson Comorbidity Index (CCI) are common pre-operative scoring tools. Language models could automate structured pre-operative scoring, but direct comparisons require paired inference because all models are evaluated on the same patients. Methods: In this retrospective single-center concordance analysis, 101 consecutive adult orthopedic patients were independently rated by two clinicians; the rounded mean for ASA-PS and arithmetic mean for CCI formed a clinician-derived composite reference. The cohort contained no ASA-PS IV-V patients. Six model configurations received identical prompts. Agreement was assessed using quadratic weighted kappa, ICC(2,1), exact and adjacent agreement, MAD, RMSE, and Bland–Altman limits. Post hoc between-model comparisons used 10,000 patient-level paired bootstrap replicates with Benjamini–Hochberg correction. Results: Inter-clinician weighted kappa was 0.713 for ASA-PS and 0.914 for CCI. GPT-5.2 reached kappa 0.884 for ASA-PS and 0.970 for CCI. In paired analyses, GPT-5.2 had significantly higher quadratic weighted kappa than every other tested model for both outcomes and significantly higher ICC for CCI after multiplicity correction. Phi4 and deepseek-r1-70B were not significantly different from inter-clinician agreement for CCI kappa or ICC; equivalence was not tested. Conclusions: Among the six evaluated model configurations, GPT-5.2 achieved significantly higher agreement with the clinician-derived composite reference than the other tested models for both ASA-PS and CCI in post hoc paired analyses with multiplicity correction. Locally deployable phi4 and deepseek-r1-70B showed CCI agreement estimates that were not statistically distinguishable from inter-clinician agreement, although equivalence was not tested. These findings are limited to the evaluated models and study cohort. Full article

Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are associated with substantial morbidity and mortality, highlighting the need for simple and reliable biomarkers for early risk stratification. The C-reactive protein to albumin ratio (CAR) and the modified Glasgow Prognostic Score (mGPS) reflect systemic inflammation and nutritional status, but their prognostic value in hospitalized patients with AECOPD remains incompletely defined. This study aimed to evaluate the associations of CAR and mGPS with one-year mortality and indicators of disease severity in hospitalized patients with AECOPD. Methods: In this retrospective single-center cohort study, 1556 adult patients hospitalized with a primary diagnosis of AECOPD between January 2020 and January 2026 were included. Patients with concomitant pneumonia and other major inflammatory conditions were excluded. Demographic, clinical, laboratory, arterial blood gas, and pulmonary function data were retrospectively analyzed. CAR was calculated from admission C-reactive protein and serum albumin levels, whereas mGPS was determined according to established criteria. Independent predictors of one-year mortality were identified using multivariable logistic regression analyses. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the discriminatory performance of CAR. Results: During the one-year follow up, 140 patients (9.0%) died. Compared with survivors, non-survivors had significantly higher CRP levels, higher CAR values, lower serum albumin levels, more severe hypercapnia and acidosis, and higher rates of intensive care unit admission and invasive mechanical ventilation (all p < 0.001). The distribution of mGPS differed significantly according to mortality status, with patients in the mGPS 2 category exhibiting the highest mortality rates (p < 0.001). After adjustment for clinically relevant covariates, age, acidosis, invasive mechanical ventilation, and CAR remained independently associated with one-year mortality. CAR demonstrated excellent discriminatory performance for predicting one-year mortality (AUC 0.907, 95% CI 0.893–0.922; p < 0.001), with an optimal cut-off value of >3.96, yielding 98.6% sensitivity and 84.3% specificity. Increasing mGPS scores were associated with progressively worse clinical outcomes, including higher rates of intensive care unit admission, invasive mechanical ventilation, in-hospital mortality, and one-year mortality. Conclusions: Inflammation and nutrition-based biomarkers are closely associated with disease severity and one-year mortality in hospitalized patients with AECOPD. CAR remained an independent predictor of one-year mortality and demonstrated excellent discriminatory performance, supporting its role as a simple and readily available complementary biomarker for prognostic assessment. Increasing mGPS scores were associated with progressively worse clinical outcomes, suggesting that mGPS may also contribute to risk stratification in hospitalized patients with AECOPD. Prospective multicenter studies with external validation are warranted to confirm these findings and to further define the prognostic value of these biomarkers. Full article

The operational reliability of shaft systems in hydropower units has become increasingly critical as these units are frequently engaged in grid regulation under new power systems. This paper presents a sensor-driven method for operational status assessment and trend prediction of Francis turbine generator unit shaft systems using vibration and swing signals. Time domain features are extracted from the sensor-acquired signals to construct a multi-dimensional quantitative index system for characterizing the operational state, and a combined Entropy Weight–Coefficient of Variation–TOPSIS model with dynamic health thresholds is established for adaptive condition assessment. To address the nonlinear and non-stationary characteristics inherent in such signals, a decomposition–prediction–reconstruction fusion framework is developed, incorporating Variational Mode Decomposition (VMD) for signal decomposition and noise reduction, iTransformer for capturing global multi-variable interactions, and Bidirectional Long Short-Term Memory (BiLSTM) for bidirectional temporal feature extraction. The hybrid model achieves a coefficient of determination R² of 0.9845 on complex vibration and swing signals, demonstrating its superior prediction capability. Based on the prediction results, health scores and dynamic thresholds are calculated to perform trend analysis and health early warning. A case study is conducted using real-world monitoring data from a 306 MW Francis turbine unit. The results demonstrate that the proposed method effectively characterizes the shaft system operational state, achieving a closed-loop integration from condition monitoring to fault diagnosis and predictive maintenance. The operational status assessment and trend prediction analyses are in good agreement with actual operating conditions, providing reliable technical support for the intelligent health management of hydropower units. Full article

The construction sector generates over one-third of all waste in Europe, yet the reuse of building components remains marginal compared to recycling, and circular strategies are rarely aligned on the territorial scale at which materials, stakeholders and infrastructure operate. This paper investigates the regulatory, institutional, infrastructural and operational conditions under which reuse to become a systemic practice. A desk-based comparative analysis of six European contexts (Belgium, the Netherlands, Switzerland, Germany, France, Denmark) was conducted on 282 documents, using a framework of seven dimensions grouped into three macro-families drawn from the literature on territorial circular ecosystems. The findings show that these conditions form a dependency chain of five ordered links: legal recognition of the non-waste status; a standardized pre-demolition audit; preparation and storage physical hubs, in parallel with research infrastructures, absorbing technical uncertainty; a guarantee system covering performance, liability and insurability; and a demand-side activation. The guarantee link is a constraint and a key element in demand activation. Regulation is necessary but not sufficient, since binding instruments target recycling or auditing while reuse remains voluntary in all six contexts. The chain yields a typology of ecosystem configurations and a replicable diagnostic instrument, whose transferability is assessed on the Italian case. Full article

Background: Prenatal diagnosis of congenital heart defects (CHD) is important for perinatal planning, yet the gestational week at which CHD is diagnosed varies considerably. In referred cohorts, diagnostic timing may be influenced by maternal, fetal, temporal, and lesion-specific factors. This study examined factors associated with the gestational week of prenatal diagnosis among pregnancies with prenatally recognized and subsequently confirmed CHD referred to a national tertiary fetal cardiology centre. Methods: This study analyzed 833 pregnancies with confirmed CHD managed between 2005 and 2020. The primary outcome was the gestational week of prenatal diagnosis. Univariable associations with binary predictors were assessed using Student’s t-test, Welch’s t-test, or the Mann–Whitney U test according to distributional assumptions. A primary fully adjusted multivariable linear regression model with heteroscedasticity-robust standard errors was used to evaluate variables associated with the gestational week of diagnosis. The model included maternal age, calendar year as a continuous variable, twin pregnancy, amniotic fluid abnormalities, chromosomal status, and selected lesion-specific diagnoses. Chromosomal status was modelled hierarchically as no chromosomal abnormality, Down syndrome, or other chromosomal abnormality. Results: In univariable analyses, advanced maternal age, Down syndrome, and chromosomal abnormalities were associated with earlier diagnosis, whereas oligohydramnios was associated with later diagnosis. In the primary fully adjusted multivariable model, increasing maternal age was associated with earlier diagnosis (β = −0.169 weeks per year, 95% CI −0.238 to −0.099; p < 0.001), as was later calendar year (β = −0.211 weeks per year, 95% CI −0.311 to −0.111; p < 0.001). Coarctation of the aorta/aortic arch stenosis (β = 2.276 weeks, 95% CI 0.787 to 3.764; p = 0.003), pulmonary stenosis (β = 1.996 weeks, 95% CI 0.376 to 3.617; p = 0.016), and oligohydramnios (β = 2.097 weeks, 95% CI 0.228 to 3.965; p = 0.028) were associated with later prenatal diagnosis. Down syndrome showed a borderline association with earlier diagnosis (β = −1.350 weeks, 95% CI −2.702 to 0.002; p = 0.050). The model explained 12.2% of the variability in the gestational week of diagnosis, with an adjusted R² of 0.107. Conclusions: In this tertiary referral-centre cohort of pregnancies with prenatally recognized and confirmed CHD, the gestational week of prenatal diagnosis was associated with maternal age, calendar year, oligohydramnios, and selected lesion-specific diagnoses. These findings should be interpreted as observational associations within an already recognized referral cohort rather than determinants of prenatal CHD detection in the general pregnant population. Future studies should incorporate referral pathways, screening history, ultrasound quality, operator experience, fetal position, and lesion-specific imaging characteristics to better characterize factors influencing the timing of prenatal CHD diagnosis. Full article

Background/Objectives: Phase angle (PhA), derived from bioelectrical impedance analysis (BIA), has been proposed as an indicator of cellular health, nutritional status, and physical function. This study aimed to investigate the association between PhA, physical function, and sarcopenia defined according to the Asian Working Group for Sarcopenia (AWGS) 2025 criteria in community-dwelling older adults. In addition, we explored a preliminary PhA cutoff for discriminating women with prevalent sarcopenia. Methods: This cross-sectional study included 317 participants (81 men, 236 women) aged ≥65 years who participated in functional assessments conducted in three locations of Fukushima Prefecture, Japan, in 2024. PhA at 50 kHz was measured using BIA. Assessments included body composition, grip strength, knee extension strength, maximum walking speed, Timed Up and Go (TUG), the Montreal Cognitive Assessment, Japanese version (MoCA-J), and the Kihon Checklist (KCL). Sarcopenia was defined according to the AWGS 2025 criteria. Group differences were examined using the Mann–Whitney U test, and associations were assessed using Spearman’s rank correlation coefficients. Age-adjusted logistic regression analysis was performed in women to examine the association between PhA and sarcopenia. Receiver operating characteristic (ROC) analysis was performed in women to explore a preliminary PhA cutoff because the limited number of men with sarcopenia precluded a stable sex-specific analysis. Results: Sex-specific Spearman’s rank correlation analyses showed that lower PhA values were associated with lower muscle strength (grip strength and knee extension strength) and poorer physical function (maximum walking speed and Timed Up and Go [TUG] performance) in both men and women. Lower PhA values were independently associated with prevalent sarcopenia in women after adjustment for age (odds ratio, 0.26; 95% CI, 0.09–0.80). ROC analysis identified an exploratory PhA cutoff of 4.48° for discriminating women with prevalent sarcopenia (AUC = 0.67; sensitivity = 0.65; specificity = 0.71), indicating modest discriminative performance. Conclusions: Lower PhA values were cross-sectionally associated with poorer physical function and prevalent sarcopenia among community-dwelling older women. An exploratory PhA cutoff of 4.48° was identified to discriminate prevalent sarcopenia in women. However, this cutoff should be considered hypothesis-generating rather than an established clinical threshold and requires validation in larger, independent cohorts and prospective longitudinal studies before clinical application. Full article