Search Results (36,841)

Objective: To compare the clinical prognosis of metal endoprosthetic reconstruction versus biological reconstruction in the treatment of limb osteosarcoma and to analyze associated prognostic factors. Methods: From October 2014 to October 2021, a retrospective study was carried out of patients with high-grade extremity osteosarcoma. Patients were categorized into two groups based on the type of reconstruction: endoprosthetic reconstruction and biological reconstruction. Demographic data and prognosis were systematically compared between the two groups. Furthermore, a Cox proportional hazards model was employed to evaluate the risk factors associated with recurrence and survival outcomes. Results: A total of 133 patients were enrolled in the study, comprising 88 patients in the endoprosthetic reconstruction group and 45 patients in the biological reconstruction group. The 5-year overall survival (OS) and disease-free survival (DFS) rates for the endoprosthetic reconstruction group were 76.2% and 70.5%, respectively, which were higher than those observed in the biological reconstruction group (64.3% and 60%). Additionally, the local recurrence rate was significantly higher in the biological reconstruction group compared to the endoprosthetic reconstruction group (17.8% vs. 2.3%, p = 0.004). Cox regression analysis revealed that pathological fracture (p = 0.034) and the biological reconstruction (p = 0.007) were independent risk factors for local recurrence. Conclusions: Endoprosthetic reconstruction may be preferable for patients requiring early functional recovery or presenting with pathological fractures. Biological reconstruction may be considered for younger patients with diaphyseal defects and demanding long-term functional requirements, albeit with elevated local recurrence risk. Individualized decision-making incorporating tumor location, patient age, and functional goals is essential. Full article

Background/Objectives: Hypertensive disorders of pregnancy (HDP) increase the risk of cardiovascular disease (CVD), but few studies have explored the efficacy of lifestyle interventions to improve CVD risk post-HDP. This study compared the 6 month (6M) and 12 month (12M) dietary and physical activity outcomes of women post-HDP participating in one of three lifestyle interventions. Methods: This sub-study of the Blood Pressure Postpartum (BP²) randomised controlled trial included participants from six hospitals across Sydney, Australia, randomly assigned to one of three groups: Group 1 (usual care) received general postpartum health information; Group 2 (brief education) received usual care plus an individualised cardiovascular risk assessment and lifestyle counselling; Group 3 (extended lifestyle) received all Group 2 components plus enrolment in a six-month telephone coaching programme. Baseline and post-intervention data were collected at 6M and 12M, respectively. Diet and physical activity were assessed using the NSW Population Health Survey, alongside cardiometabolic measures. Results: Overall, 405 women provided complete 6M and 12M data (Group 1 n = 129, Group 2 n = 137, Group 3 n = 139). From 6M to 12M, Group 3 increased their vegetable serves/day (3.0 vs. 2.0, p = 0.001). No significant changes in fruit intake and physical activity levels were observed among groups. Groups 2 and 3 reported that nutritional information had a greater influence on their food choices at 12M (p = 0.010 and p < 0.001, respectively). At 12M, higher vegetable and fruit intake correlated with lower body mass index (BMI) (p = 0.006, p = 0.003) and waist circumference (p = 0.035, p = 0.014), and increased vigorous and strength exercise correlated with lower BMI (p = 0.005, p = 0.003) and waist circumference (p < 0.001, p < 0.001). Conclusions: Intensive lifestyle interventions improved vegetable intake and nutrition awareness in post-HDP women at 12M, holding promise for long-term cardiometabolic health benefits. Full article

Introduction: Humanitarian corridors were first established in Italy in 2015 as part of the Protected Entry Procedures (PEPs). These corridors provide a safe and legal route to Europe for migrants in need of protection, offering an alternative to perilous and illegal routes. As the first filter at entry with regard to health needs, the National Institute for Health, Migration and Poverty (NIHMP) ensures an overall individual health assessment, the primary aim of which is to identify potential infectious diseases and disorders that may require management and medical inquiry. This study aims to analyze the health data related to the humanitarian corridors that Italy has implemented and in which the NIHMP has taken part between 2018 and 2024. Materials and Methods: Health information and organizational records were gathered for every corridor. The analysis focused on health outcomes and on the sample’s sociodemographic characteristics. If the p-value was less than 0.01 it was considered statistically significant. Cramer’s V was calculated to assess the strength of each statistically significant result. Results: A total of 1250 refugees have been able to enter Italy thanks to the 14 NIHMP-verified humanitarian corridors. In the majority of the corridors, infectious conditions are present in less than 15% of the total number of refugees, and in only one corridor are they higher than 50%. There are statistically significant differences in nationality in the inferential analysis based on all health findings and in corridor and nationality according to the inferential analysis conducted for infectious conditions. The analysis relating to the differences by other health findings show statistically significant results in corridor, number of reports of vulnerability, and nationality. Lastly, considering the analysis done for all refugees < 18 years of age, there were statistically significant results in the number of reports of vulnerability, gender, and nationality, but there were not for any kind of health data. Conclusions: This study is one of the first attempts at reporting and analyzing vulnerable flags and health data concerning refugees who arrived through NIHMP-verified humanitarian corridors. Certain characteristics of our sample have few or no counterparts in the literature due to the limited availability of scientific literature on the subject. Despite this, our findings have statistical significance and scientific value, highlighting the need for further research on this subject. Full article

Low back pain (LBP) remains one of the most prevalent and disabling musculoskeletal conditions worldwide, shaped by interacting mechanical, neurophysiological, inflammatory, vascular, and behavioral factors. Conventional care often relies on generalized exercise programs and episodic, predominantly subjective assessment, which can underrepresent inter-individual heterogeneity and longitudinal change. Recent bioengineering advances enable continuous, multimodal monitoring of objective correlates of function—neuromuscular activation and coordination (sEMG/polyEMG), movement patterns and activity exposure (IMU), and complementary physiological context (e.g., autonomic and perfusion-related signals). Rather than measuring pain directly, these signals can contextualize symptoms, support treatment stratification within non-surgical care, and enable trajectory monitoring with early non-response flags to guide timely rehabilitation adjustment under clinician oversight. When integrated with transparent, implementation-oriented analytics, biosensing can also support incremental closed-loop rehabilitation through patient-facing feedback and adaptive progression rules. This review synthesizes current and emerging biosensing approaches for LBP and highlights key translational requirements—outcome-linked validation, standardization, and workflow integration—to bridge engineering innovation with clinically usable, data-informed rehabilitation. Full article

Background/Objectives: Population ageing is accelerating, and adults aged ≥75 years (the “very old”) have distinct functional, cognitive, and social needs. Game-based digital interventions—including exergames, serious/digital games, and gamification—may promote multidimensional well-being; however, findings are often reported for broad “older adult” samples without age-disaggregated results. This scoping review mapped the use and effects of game-based digital interventions in adults aged ≥75 years and assessed how frequently studies reported age-specific outcomes. Methods: The review was conducted in accordance with JBI guidance. PubMed, CINAHL, PsycINFO, Scopus, and Web of Science were searched. Records were screened in Rayyan by two reviewers. Data were extracted using a standardized charting form, and outcomes were classified into predefined outcome domains and implementation-related categories. Results: Nineteen studies were included, predominantly European and largely conducted in supervised institutional settings. Exergames were the most common intervention type. Physical outcomes were reported most frequently, whereas cognitive, emotional, social, and quality-of-life outcomes were assessed less consistently. Conclusions: In adults aged ≥75 years, evidence on game-based digital interventions is mainly based on supervised exergame programmes and emphasizes physical-function outcomes, while age-disaggregated reporting and person-centred outcomes remain limited. Future research should routinely report results specific to participants aged ≥75 and broaden outcome assessment to better inform intervention design for the very old. Full article

This research examines how financial development, energy efficiency and energy inefficiency, green technology, and research and development (R&D) affect environmental conditions and ecological footprint in the Group of Seven (G7) countries. The study combines two theoretical models, including the Environmental Kuznets Curve (EKC) and the Stochastic Impacts by Regression on Population, Affluence, and Technology (STIRPAT), within a unified framework. This study addresses a key gap in the literature by examining whether financial development follows a distinct nonlinear environmental pathway beyond the traditional income-based EKC framework. Using annual data from 1994 to 2023, the analysis applies the Cross-Sectional Autoregressive Distributed Lag (CS-ARDL) approach to account for cross-sectional dependence and long-run heterogeneity among G7 economies. The findings indicate that the G7 does not support the traditional EKC hypothesis, although a U-shaped relationship between environmental degradation and financial development exists. Energy-related factors play a central role in shaping environmental outcomes, with energy efficiency and green technology significantly alleviating environmental pressure, and green technology proving to be the most influential among them. While energy inefficiency is associated with greater environmental stress, its effect remains statistically insignificant, suggesting that efficiency improvements are more decisive than reductions in inefficiency. Beyond energy dynamics, financial development and R&D investment also contribute significantly to environmental improvement, highlighting the complementary role of technological progress and financial systems in promoting environmental sustainability. The robustness results confirm the main findings. Overall, the study underscores the critical role of technological innovation and energy efficiency in promoting sustainability and challenges the applicability of the traditional EKC framework in advanced economies. The findings contribute to a deeper understanding of the multifaceted relationships between financial development, energy efficiency and inefficiency, green technology, and R&D, and their implications for sustainable development. Full article

Background: The prognosis of glioblastoma (GBM) patients remains poor. Dendritic cell (DC) vaccination has been investigated as an immunotherapy option, mainly in early-phase clinical studies. Herein, we report the feasibility, safety, and descriptive clinical and radiological outcomes of a retrospective series of newly diagnosed GBM patients treated with standard radio-chemotherapy and autologous DC vaccination as compassionate use. Methods: We retrospectively reviewed the medical and radiological records of patients with newly diagnosed GBM who received autologous tumor lysate–pulsed DC vaccination in addition to standard-of-care treatment at a tertiary academic center between 2009 and 2017. Clinical data, treatment characteristics, adverse events, survival outcomes, and radiological responses were collected and analyzed descriptively. Results: Twenty-four patients were included. All patients underwent surgical resection and were further treated with autologous tumor lysate–DC vaccination and standard radio-chemotherapy. Histology of GBM was confirmed in all patients. The first vaccine was administered in 75% of patients after a median of 21 days (range: 6–30 days) following surgery and prior to radiotherapy initiation. DC vaccination was continued following radiotherapy at specific time points, with no observed significant adverse events. Median OS was 21.1 months (95% CI, 27.9–75.0 months), and median PFS was 10.3 months (95% CI, 15.6–26.6 months). Presence of O6-methylguanine DNA methyltransferase (MGMT) promoter methylation was associated with longer survival and higher 12-month PFS rates, consistent with its established prognostic value. Radiological responses were retrospectively assessed according to RANO and RANO 2.0 criteria. Conclusions: In this retrospective single-center series, autologous DC vaccination administered as compassionate use in combination with standard radio-chemotherapy was feasible and safe in routine clinical practice. Survival and radiological outcomes are reported descriptively and should be interpreted with caution given the absence of a control cohort. These findings support further prospective controlled studies to properly assess the clinical role of DC vaccination in newly diagnosed GBM. Full article

International accreditation has become a pivotal mechanism through which universities outside Europe seek legitimacy and alignment with global quality regimes, particularly regarding sustainable development goals (SDGs). This study investigates how non-EU universities adapt to ASIIN accreditation, focusing on its role in developing a sustainable quality culture that supports long-term educational excellence and social responsibility. Drawing on new institutionalism, the analysis views accreditation as a process of institutional change under isomorphic pressures necessary for the sustainability of quality assurance (QA). Data were derived from a triangulated dataset, including 78 publicly available final accreditation reports via the DEQAR database and expert on-site observations across multiple non-EU universities. The analysis identifies systemic challenges, such as ‘facade conformity’ in learning outcomes and fragmented QA loops, which reveal an ‘adaptive lag’ impeding the sustainable implementation of quality standards. The study concludes by proposing an “Expert-Facilitated, Institutionally-Embedded Evidence Loop” framework to bridge external compliance and internal quality enhancement, thereby ensuring the long-term viability and global relevance of engineering education in alignment with SDGs. Full article

Cohabitation has become an increasingly common context for childrearing, yet children living with cohabiting parents often exhibit poorer academic outcomes than peers with married parents. This study examines whether these disparities stem from cohabitation itself, subsequent family transitions, or underlying mechanisms related to resources, stress, or selectivity. Using data from the Growing Up in Australia: Longitudinal Study of Australian Children (LSAC), we follow 920 children born to cohabiting parents and track family structure changes alongside teacher-rated literacy and mathematics performance from ages 6 to 11 years. Generalized estimating equation models show that, although children whose parents transitioned to single-parent or other non-cohabiting arrangements initially appear to score lower academically, these differences are no longer significant once resource, stress, and selectivity variables are included. Instead, parental education, parental efficacy, homeownership, extracurricular participation, residential mobility, and parents’ region of origin more consistently predicts educational outcomes. Children with stably cohabiting parents and those whose parents later married do not differ significantly. Findings suggest that among children born to cohabiting parents in Australia, differences in later educational outcomes are largely explained by differences in parental education, efficacy, housing stability, and related factors, rather than by cohabitation or family instability alone. Full article

Green innovation has been widely regarded as an important driver of sustainable development; however, its implications for biodiversity conservation remain insufficiently explored. Existing studies primarily focus on the roles of green innovation in pollution control and energy efficiency, leaving its relationship with biodiversity outcomes largely understudied. This gap is particularly pronounced in regions experiencing intense ecological pressure, such as the Yangtze River Economic Belt (YREB), where rapid industrialization and human activities have substantially altered ecosystems. Using panel data from 11 provinces in the YREB over the period 2017–2020, this study examines the impact of green innovation development on biodiversity. Employing a two-way fixed-effects model, the results indicate that green innovation development is positively associated with biodiversity conservation, and this association remains robust to a range of endogeneity checks and robustness tests. To further explore potential transmission channels, we conduct a mechanism analysis. The findings provide indicative evidence that green innovation is associated with biodiversity outcomes through carbon emission reduction and improvements in environmental governance. Overall, this study contributes to the literature by shedding light on the biodiversity implications of green innovation and offers policy-relevant insights for regions seeking to balance innovation-driven growth with ecological protection. Full article

Background: Increased nuchal translucency (NT) is associated with an elevated risk of genetic abnormalities and structural malformations. The clinical utility of invasive testing and the optimal diagnostic approach in mildly increased NT (3.0–3.4 mm) is debated. This study aimed to evaluate genetic and ultrasound findings in this subgroup and to assess the diagnostic yield of advanced genetic testing. Methods: We retrospectively included a total of 107 fetuses with NT between 3.0 and 3.4 mm from a single fetal medicine unit. Complete outcome data were available for 97 pregnancies. Invasive prenatal testing with standard karyotype, chromosomal microarray analysis (CMA) and RASopathy panel testing were offered. All patients underwent detailed ultrasound examination to detect structural abnormalities at 16 and 20 weeks, regardless of whether invasive testing was performed. Results: Invasive prenatal testing, amniocentesis or chorionic villus sampling, (CVS), was performed in 77/97 cases (79.4%). Genetic abnormalities were detected in 28/97 (28.9%). Overall, five rare genetic anomalies were identified; none would have been detected by quantitative fluorescent polymerase chain reaction (QF-PCR) or non-invasive prenatal testing (NIPT). Two anomalies were detectable by standard karyotype, two exclusively by CMA and one exclusively by RASopathy panel. When considering all cases undergoing advanced genetic testing (CMA or RASopathy panel, n = 35) the overall diagnostic yield was 8.5% (3/35). When calculated across the entire cohort with complete follow-up, the additional diagnostic yield was 3.1% (3/97). Major structural malformations were identified in 17/97 cases (17.5%), of which 10 (58.8%) were associated with genetic abnormalities. Conclusions: Fetuses with NT measurements between 3.0 and 3.4 mm show a substantially increased risk of genetic abnormalities and structural malformations. These findings support a comprehensive prenatal evaluation, including invasive testing with advanced genetic analysis and detailed ultrasound assessment, to optimize diagnosis and counseling. Full article

Aim: Brain training games offer a promising avenue for promoting cognitive engagement and healthy aging among older adults. However, little is known about how design features align with the specific needs of this demographic to promote sustained usage and thereby cognitive intervention. The aim of this study was to characterize how all aspects of the game design and player experience might influence adherence mechanisms, and assess the feasibility and acceptability of a wearable brain-activity measuring device. Methods: We use an exploratory mixed-methods approach with n = 6 community-dwelling older adults (mean age 68 ± 3.94) within a smart-home-style Living-Lab. Participants played two commercially available brain-training games. One of the games uses a wearable brain-activity measuring device. We collected System Usability Scale (SUS) and User Experience Questionnaire (UEQ) scores and conducted focus-group interviews and structured observations. We performed a qualitative theory-informed analysis through the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) framework. Results: Participants reported high motivation to play brain-training games for dementia prevention. They preferred large, high-contrast text, intuitive navigation, touch-based controls, and a relaxed pacing. The wearable device was acceptable and comfortable for home use. There were requests for a clearer meaning of brain activity scores and the integration of personalized brain data with other health apps and broader health metrics. Quantitative scales (SUS and UEQ) showed similar ratings for both games, with both meeting the threshold for acceptability. Conclusions: In this formative study, concrete design features that plausibly increase engagement, persistence and adherence were identified, alongside evidence for the feasibility of integrating a wearable brain-sensor. Our findings motivate a follow-on trial testing whether an adherence-optimized design increases the training dose and downstream cognitive outcomes. Full article

Background and Objectives: Severe asthma poses significant clinical and economic burdens, with adherence to monitoring and treatment remaining a challenge despite biologic therapies. This pilot study aimed to evaluate the feasibility of telemedicine-based home monitoring using the AioCare system in patients with severe asthma and to determine if weekly reminder messages improved adherence compared to standard monitoring. Materials and Methods: In this prospective, single-center randomized controlled pilot study, 30 adults with severe asthma were assigned to either a reminder group (weekly SMS or in-app messages) or a control group without reminders. All participants performed weekly home spirometry for 12 weeks using the AioCare system. Lung function parameters, Asthma Control Test (ACT) scores, adherence to monitoring, and patient satisfaction were assessed. Longitudinal data were analyzed using mixed-effects and generalized estimating equation models. Results: Adherence to home monitoring was significantly higher in the reminder group (11.47 ± 0.92 vs. 9.13 ± 3.16 sessions; p = 0.044). Overall, patient satisfaction was higher in the intervention group (p = 0.0044), with universal endorsement of the reminders and perceived educational benefit. No significant between-group differences were observed in lung function parameters. ACT scores showed a favorable trend in both groups, with a medium between-group effect size favoring the intervention (d = 0.42), although this did not reach statistical significance. Conclusions: Home monitoring with reminders is feasible, safe, and enhances adherence and satisfaction in severe asthma, although it did not significantly affect short-term changes in lung function or symptom control. Larger, longer-term studies are warranted to determine whether these engagement benefits translate into improved long-term clinical outcomes. Full article

Background/Objectives: The precise classification of non-small-cell lung cancer (NSCLC) into lung adenocarcinoma (LUAD) and lung squamous cell carcinoma (LUSC) has important role in treatment decisions and in prognosis. Proper subtyping ensures that patients receive the most appropriate therapeutic strategies and allows clinicians to make informed evaluations regarding disease outcomes. This study presents a deep neural-network-based classification approach utilizing genome-wide DNA methylation profiles from the Illumina HumanMethylation450 BeadChip platform. Methods: A total of 5000 of the most discriminative CpG probes are identified through variance-based feature selection in the presented methodology, which are then classified through a five-layer deep neural network with batch normalization and dropout regularization. Training and validation were performed using data from The Cancer Genome Atlas (TCGA), with external validation conducted on two independent Gene Expression Omnibus (GEO) datasets: GSE39279 and GSE56044. Results: The model achieved 96.92% accuracy with an area under the receiver-operating characteristic curve (AUC-ROC) of 0.9981 on the TCGA test set. Robust generalization was obtained in cross-dataset validation experiments, with the GEO-trained model achieving 88.92% accuracy and 0.9724 AUC-ROC when validated on TCGA data. The most influential CpG biomarkers contributing to classification decisions are analysed using SHAP (Shapley Additive Explanations). Conclusions: These findings demonstrate the potential of DNA methylation-based deep learning approaches for reliable NSCLC subtype classification with clinical applicability. Full article

Background and Objective: This study examines the factors associated with child undernutrition among children under five in Ethiopia, Kenya, Madagascar, and Tanzania. It uses the Composite Index of Anthropometric Failure to measure the full burden of undernutrition, combining weight-for-height (WHZ), weight-for-age (WAZ), and height-for-age (HAZ) indicators. This approach captures children facing multiple forms of failure that single indicators miss. Methods: The study analyzed 37,570 children using nationally representative Demographic and Health Survey (DHS) data for Ethiopia 2019, Kenya 2022, Madagascar 2021, and Tanzania 2022. A binary logistic regression model identified key predictors of child undernutrition across countries. Results: The prevalence of anthropometric failure ranged from 24% to 44%. Higher parental education, child’s age, socioeconomic status, child’s sex, and a postnatal checkup within 2 months were associated with a lower odds of anthropometric failure. Children of educated mothers in Ethiopia (AOR = 0.547) and Tanzania (AOR = 0.606) had better outcomes. Educated fathers in Kenya (AOR = 0.589) and Madagascar (AOR = 0.369) reduced the risk of child undernutrition. Children aged 13–24 months had a higher risk in all countries. In Madagascar (AOR = 0.309), children who received a postnatal checkup had a decreased risk of malnutrition. Children from rich households in Ethiopia (AOR = 0.645) and from middle (AOR = 0.683) and rich (AOR = 0.535) households in Kenya had significantly lower odds of undernutrition. In comparison, female children had lower odds of anthropometric failure in all four countries. Conclusions: Viewed through a nutrition equity lens, these findings underscore the importance of recognizing how the intersectionality of anthropometric failures disproportionately affects children from poorer households and communities with limited access to education and postnatal care. This study advances existing knowledge by using the Composite Index of Anthropometric Failure to show overlapping and hidden forms of undernutrition. The findings identify child age, parental education, postnatal checkup, child sex, and socioeconomic status as shared priorities for reducing undernutrition. The results provide country-specific insights for designing integrated, evidence-based nutrition interventions in Eastern Africa. Full article