Search Results (44,417)

Background: Endotracheal intubation is a painful and stressful procedure for neonates, and premedication is recommended for non-emergent settings. However, there is no consensus on the optimal pharmacological regimen. In recent years, several drugs have emerged as treatment options to improve comfort and safety of neonates undergoing endotracheal intubation. Worldwide, a range of agents are used. Remifentanil is a short-acting opioid with rapid onset and recovery characteristics that may be useful for neonatal intubation. Methods: A structured search of PubMed/MEDLINE, Embase, and Cochrane Library databases (1990–December 2024) identified publications evaluating remifentanil for neonatal intubation. Clinical studies, pharmacokinetic investigations, reviews and guidelines were qualitatively synthesized with an emphasis on dosing, efficacy, safety, dosing, administration technique, and clinical context. Results: The literature search retrieved 45 publications, but only a small subset were randomized clinical studies. Findings generally support feasibility and short-term efficacy, while results vary across studies, particularly for intubation conditions and respiratory adverse events. Chest wall rigidity, apnea, and desaturation appear to be influenced by dose, administration rate, patient characteristics, and co-medication, although the available studies are too small and heterogeneous to define an optimal regimen. Conclusions: Remifentanil can be considered for selected non-emergent neonatal intubation and INSURE procedures when administered by experienced teams under appropriate monitoring conditions. Particular caution is warranted in clinically unstable infants, during LISA procedures where preservation of spontaneous breathing is desirable, and in settings where immediate airway rescue capabilities are unavailable. The study did not demonstrate clear superiority of remifentanil. Current evidence is limited and heterogeneous, and larger comparative studies with standardized dosing, administration, and outcome definitions are needed. Full article

Background: Metabolic complications and weight gain have emerged as primary concerns among virologically suppressed and immunologically competent people living with HIV. Particularly integrase strand transfer inhibitors (INSTIs) and tenofovir alafenamide (TAF) are being connected with this issue. Objectives: This study aimed to evaluate the prevalence of metabolic syndrome (MetS) and its components within a highly homogeneous, virologically suppressed cohort, assessing the impact of antiretroviral therapy (ART) and HIV-unrelated factors. Methods: We conducted a single-center cross-sectional analysis of 93 HIV-positive patients receiving stable ART for >2 years, in Wrocław, Poland. To minimize confounding, individuals with HBV/HCV co-infections or significant alcohol use were excluded. Participants were stratified primarily by regimen, INSTI/TAF-based (n = 50) vs. PI/TAF-based (n = 28), and secondarily by the particular drugs taken. Clinical assessment included anthropometric parameters, lipid profiles, and glucose metabolism. Results: The prevalence of MetS was 10.8%. No statistically significant differences were observed in the incidence of MetS, insulin resistance, or dyslipidemia between the INSTI/TAF and PI/TAF groups. A marginally significant trend toward lower total cholesterol was identified in patients receiving dolutegravir/TAF compared to those on darunavir/TAF. Conclusions: In this stable Caucasian cohort with long-term viral suppression, we found no statistically significant differences in metabolic outcomes between modern INSTI- and PI-based regimens. However, due to the limited sample size and low statistical power, these findings do not prove clinical equivalence. Our results suggest that in particular tightly selected settings of well-controlled patients, traditional risk factors and lifestyle may remain the primary drivers of metabolic health, although modest drug-related effects cannot be ruled out. Full article

Large language models (LLMs) are increasingly being deployed as multi-agent systems (MASs), yet limited evidence exists on when such architectures are warranted and how reliably they perform in decision-critical workflows. This paper investigates these questions through veterinary insurance claims adjudication, a document-intensive, policy-driven task requiring structured reasoning, regulatory compliance, and human oversight. We first propose a four-condition framework for assessing MAS suitability and identify claims adjudication as the highest-priority veterinary application. We then develop a self-hosted MAS integrating specialised LLM agents with deterministic policy evaluation, immutable audit logging, and mandatory human review. To support reproducible evaluation, a synthetic benchmark is released, comprising 150 veterinary insurance claims with independently computed ground-truth adjudication outcomes. The proposed system achieves a 97.3% workflow completion rate and 90.0% adjudication accuracy, increasing to 92.5% for completed claims and approaching the corpus ceiling of 96.0%. The evaluation shows that reliable deployment depends primarily on system engineering rather than model capability alone. Explicit orchestration and verification eliminate common LLM tool-use failures, deterministic adjudication achieves perfect agreement with the reference oracle, and completing the inter-agent policy contract increases agreement from 91.8% to 100%. These results demonstrate that hybrid MASs combining probabilistic document understanding with deterministic policy execution provide a practical and auditable approach for decision-support applications in insurance and other policy-governed domains. Full article

Background/Objectives: Adolescent pregnancy is associated with an increased risk of adverse perinatal outcomes; however, its hematological characteristics remain incompletely understood. The aim of this study was to compare antepartum and postpartum complete blood count (CBC) parameters together with hemogram-derived inflammatory indices in adolescent and adult pregnancies and to investigate their associations with maternal and neonatal outcomes. Methods: This retrospective comparative cohort study included 428 singleton pregnancies comprising 205 adolescent (14–17 years) and 223 adults (18–42 years). Antepartum blood samples were obtained at admission for delivery, whereas postpartum samples were collected approximately six hours after delivery according to the institutional practice. CBC parameters (including neutrophil, lymphocyte, monocyte, and platelet counts) were recorded, and hemogram-derived inflammatory indices, including neutrophil-to-lymphocyte ratio (NLR), Platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), aggregate index of systemic inflammation (AISI), and systemic inflammation-monocyte index (SIMI), were subsequently calculated. Comparisons were adjusted for gestational age at sampling and parity using a prespecified non-redundant marker set, and multiple testing was controlled using the Benjamini-Hochberg false discovery rate procedure. Multivariable logistic regression and machine-learning analyses were performed to evaluate associations with adverse maternal and neonatal outcomes. Results: Adolescent pregnancies demonstrated significantly higher antepartum neutrophil and monocyte counts than adult pregnancies (q < 0.05), and these differences remained significant after adjustment for gestational age at sampling and parity (both q < 0.01), whereas differences in hemoglobin and platelet counts were no longer significant (both q = 0.138). Low birth weight (10.2% vs. 4.5%), neonatal intensive care unit admission (15.1% vs. 8.5%), composite adverse outcome (22.9% vs. 15.2%), and birth weight below the 10th percentile (14.7% vs. 8.0%) were numerically more frequent among adolescents but were not statistically significant after false discovery rate correction (all q > 0.05). Across 30 prespecified marker–outcome associations, none remained significant after false discovery rate correction. Antepartum neutrophil count was not independently associated with low birth weight after multivariable adjustment (OR 1.233, 95% CI 0.858–1.737; p = 0.248, q = 0.413). Exploratory machine-learning models demonstrated only modest discrimination, with the highest cross-validated AUC of approximately 0.60, and did not outperform conventional regression models. Conclusions: Adolescent pregnancy was associated with higher neutrophil and monocyte counts during both the antepartum and postpartum periods, reflecting modest differences in hematological profile rather than an independently predictive inflammatory profile. These hematological differences were not independently associated with adverse maternal or neonatal outcomes after adjustment for confounding factors and correction for multiple testing. Hemogram-derived inflammatory indices should therefore be interpreted as mathematical transformations of routine CBC parameters rather than biologically independent biomarkers. Because blood samples were obtained at admission for delivery, these findings characterize the peripartum inflammatory profile and should not be interpreted as evidence of early pregnancy risk prediction. Full article

Background/Objectives: Preoperative risk stratification in renal cell carcinoma (RCC) remains challenging for tumor aggressiveness and for adherent perinephric fat (APF) relevant to surgical planning. Although intratumoral radiomics are established, the peritumoral and perirenal fat microenvironment is biologically active and may encode imaging biomarkers. This systematic review and meta-analysis evaluated CT-based peritumoral and perirenal fat radiomics for preoperative grading, staging, and APF prediction and examined whether fat-derived features add incremental value beyond intratumoral models. Methods: Following PRISMA 2020 and a registered protocol (PROSPERO CRD420251150155), databases were searched through March 2026, with documented verification searches through August 2026. Eligible studies extracted CT radiomics from peritumoral or perirenal fat in adults with RCC and reported discrimination metrics. Random-effects meta-analyses (restricted maximum likelihood with Hartung–Knapp intervals) were performed; incremental value was estimated from nested within-study AUC differences under predefined rules; and methodological quality was assessed with PROBAST, RQS, METRICS, and TRIPOD, and certainty with an adapted GRADE framework. Results: Twenty-five retrospective studies (10,761 patients) were included. Fat radiomics were most consistent for APF prediction (pooled AUC 0.848, 95% CI 0.738–0.917; I² = 0%). Pooled AUCs were 0.772 (0.599–0.884; I² = 93%; 95% prediction interval 0.298–0.964) for grade and 0.813 (0.681–0.899; I² = 72%) for stage. Combined fat-plus-tumor models were numerically higher than tumor-only models in 12 of 15 studies (exploratory p = 0.022), but the formally estimable nested increment (stage family, five studies) was small (delta-AUC +0.017; governing modified Hartung–Knapp 95% CI −0.008 to +0.042) and statistically compatible with no true difference; fat-only models showed no evidence of differing from tumor-only models. PROBAST rated 72% of studies at high risk of bias, and 88% originated from China. Certainty ranged from VERY LOW (grade prediction; grade-family fat-versus-tumor comparison) to LOW (all remaining outcomes). Conclusions: CT-based peritumoral and perirenal fat radiomics show the most consistent signal for APF prediction, while the measurable increment from adding fat features to tumor models is small and of unestablished clinical utility. Standardized fat segmentation, calibration and decision-curve reporting and prospective multicenter validation are required before clinical translation. Full article

Background/Objectives: Vestibular socket therapy (VST) is a minimally invasive technique for immediate implant placement (IIP) in compromised extraction sockets that reconstructs the deficient buccal plate while preserving the crestal soft tissue. Despite growing clinical adoption, the randomized evidence on its predictability and biological performance remains limited. Methods: Following PRISMA 2020 and prospectively registered in PROSPERO (CRD420261288724), PubMed/MEDLINE and EMBASE were searched to January 2026 for randomized controlled trials (RCTs) evaluating VST with IIP. Risk of bias (RoB 2) and certainty of evidence (GRADE) were assessed. Final follow-up buccal bone plate thickness was pooled using a random-effects model; trials comparing variations within VST were reported narratively but not pooled. Results: Seven RCTs (186 participants) were included; implant survival was 99.5%, with no shield exposure, peri-implantitis, or dehiscence. Meta-analysis of the three trials comparing VST against a distinct alternative technique showed no significant between-group difference in final buccal bone plate thickness at any level: crestal +0.24 mm (95% CI−0.13 to 0.61; I² = 45%), mid-root +0.32 mm (−0.45 to 1.09; I² = 82%), or apical +0.19 mm (−0.48 to 0.87; I² = 67%). VST showed minimal mid-facial recession, stable papillae, and Pink Esthetic Scores of 10.29–13.17. Certainty was very low for all outcomes. Conclusions: VST achieved high implant survival and favorable soft tissue and esthetic outcomes but did not significantly outperform comparator techniques in buccal bone plate thickness, with very low certainty. Adequately powered, independent trials with longer follow-up are needed. Full article

Background: Work-related musculoskeletal disorders impose substantial global burdens. Although Pilates is a recognized biopsychosocial intervention, a quantitative synthesis evaluating its occupational efficacy remains limited. Objective: To compute the pooled effect sizes of workplace Pilates interventions on musculoskeletal pain intensity, functional disability, muscular endurance, and health-related quality of life (QoL). Methods: Twelve randomized controlled trials (14 reports) involving diverse occupational cohorts were analyzed. Data dependency was resolved via outcome aggregation. Random-effects models calculated pooled effect sizes (Hedges’ g), 95% confidence intervals (CI), and 95% prediction intervals (PI). Risk of bias was assessed using RoB 2. Results: The meta-analysis demonstrated a moderate, statistically significant reduction in functional disability (g = −0.660, 95% CI [−1.091, −0.229], p = 0.011). Conversely, pooled estimates for pain intensity (g = −0.461, p = 0.360), muscular endurance (g = 1.354, p = 0.223), and QoL (g = −0.146, p = 0.815) were non-significant. Substantial heterogeneity was observed (I²: 32.02–98.25%), and all prediction intervals crossed the null, indicating high uncertainty regarding future effects. Conclusions: Workplace Pilates consistently mitigates functional disability, but current evidence does not support significant pooled improvements in absolute pain, endurance, or QoL. This divergence between functional recovery and pain reduction aligns with biopsychosocial frameworks, suggesting improved work capacity despite variable pain relief. Given the high heterogeneity and wide prediction intervals, findings must be interpreted cautiously, highlighting the need for rigorously standardized trials. Full article

Background/Objectives: Cancer cell migration is a hallmark of cancer and is associated with metastasis. While large-scale functional screens have identified regulators of migration, less is known about how intrinsic transcriptional heterogeneity drives highly migratory phenotypes within individual cancer models or whether these transcriptional changes are conserved across different models of varying tissues of origin. This study aims to define shared and cell line-specific transcriptional programs associated with cancer cell migration and analyze their relevance to patient datasets. Methods: Five cancer cell lines across three cancer types (breast, colorectal, and melanoma) were subjected to transwell-based migratory sorting to isolate highly and weakly migratory subpopulations. Bulk RNA sequencing, differential gene expression analysis, Gene Ontology (GO) enrichment, and upstream regulator prediction were performed. Public tumor datasets were analyzed to evaluate gene expression and its association with patient survival. Results: EVA1A was consistently upregulated in all highly migratory (HM) subpopulations. Multiple GO terms were enriched across all cell lines, often driven by distinct gene signatures, indicating convergence at the level of biological processes despite transcriptional divergence. TEAD4 was predicted as an upstream regulator, and increased TEAD4 nuclear localization was observed in four of the five HM subpopulations. EVA1A and TEAD4 expression were elevated in tumors relative to normal tissues, with cancer type-dependent survival outcomes. Conclusions: Migratory selection was accompanied by extensive transcriptional change within each model, yet across five models spanning three tissue types these changes converged on shared biological processes rather than shared genes. Migration-associated phenotypes may therefore be better defined by pathway-level than single-gene analyses, and the clinical relevance of regulatory nodes such as TEAD4 appears conditional on cancer type. Full article

The widening gap between planning blueprints and actual implementation outcomes in transit-oriented development (TOD) has become a critical concern in China’s rail transit expansion. Using Xiamen Metro Line 1 as a case study, this paper develops a three-tiered spatial framework (corridor, planning district, and station catchment) to evaluate plan conformance across land-use efficiency (LUE), category (LUC), and intensity (LUI). The results reveal that, despite generally high implementation levels, significant deviations from statutory targets persist, characterized by cross-island spatial polarization, structural imbalances, and localized extreme outliers. Key bottlenecks include delayed conversion of low-efficiency land, functional mismatches, and overall implementation stagnation in off-island areas. Crucially, these deviations do not merely denote planning failure but expose a profound governance gap between static blueprint regulations and the dynamic complexities of TOD execution. To bridge this divide, this study proposes an integrated governance framework emphasizing context-adaptive implementation models, synchronized “transit–land–planning” institutional mechanisms, and lifecycle-wide adaptive policies. Full article

Background: The relationship between postoperative nausea and vomiting (PONV) and postoperative pain (POP) has not yet been fully clarified. This investigation aimed to evaluate the association between postoperative nausea severity and the intensity of POP following minor oral and maxillofacial surgery (OMS) under general anesthesia. Methods: This retrospective cohort study reviewed data from patients aged 16 to 70 years who received general anesthesia with nasal intubation for minor OMS at our institution from January 2021 to August 2022; patients with pre-existing conditions influencing POP or PONV were excluded from the analysis. Predictor variables included nausea scores assessed with a 100 mm visual analog scale (VAS), with a secondary sub-analysis excluding asymptomatic patients. The primary and secondary outcomes were VAS-rated POP levels at early (2 h) and late and delayed (6 h and 24 h) time points post-surgery, respectively. Covariates encompassing patient demographics, anesthetic details, and surgical factors were adjusted for, with statistical significance defined as p < 0.05. Results: Out of the 160 patients analyzed, the PONV incidence rates were 20.0% (n = 32) at 0–2 h, 4.4% (n = 7) at 2–6 h, and 0% (n = 0) at 6–24 h. The results from the adjusted multivariate model analysis show that, in this cohort of 160 patients—regardless of the presence or absence of PONV—higher nausea severity was not significantly associated with a reduction in POP intensity at the 2 h mark in the primary analysis. However, in an exploratory subgroup analysis, in the 32 patients who experienced PONV at the 2 h time point, higher nausea severity was significantly associated with lower POP levels [regression coefficient = −0.45, 95% confidence interval = −0.77 to −0.14, p = 0.006]. Conclusions: These results demonstrate an inverse statistical association between nausea severity and POP intensity at 2 h within a small subgroup of 32 patients with PONV. However, these findings do not establish a causal relationship. Full article

Intelligent Transportation Systems (ITS) increasingly combine sensing, communication, computation, data platforms, and mobility services. This article presents a structured, literature-based mapping review of ITS applications from a standards-oriented perspective. The study analyzes 42 studies organized into five thematic groups and evaluated through 63 article–standard assessments using selected ITU-T Recommendations as an analytical lens. The rubric used in this work examined whether each study reported, or allowed reviewers to infer, evidence on architecture, data handling, interoperability, security and privacy, deployment assumptions, and digital-twin capabilities. Partial alignment was the most frequent outcome, accounting for 25 of 63 article–standard assessments (39.7%). At group level, satisfactory or optimal alignment occurred in 5 of 8 assessments (62.5%) in the digital-twin group and in 3 of 13 (23.1%) in the Big Data group; in the latter, 6 of 13 assessments (46.2%) showed limited or no alignment. Stronger alignment was usually found when studies described architectures, data flows, sensing mechanisms, service workflows, physical–virtual modeling, or system-management components relevant to the Recommendation, and weaker alignment when they focused mainly on algorithms, datasets, prediction accuracy, authentication, or secure dissemination without sufficient detail on interfaces, data governance, gateway roles, deployment conditions, or platform integration. The review proposes a five-dimension standards-facing reporting checklist addressing interoperability, data lifecycle and governance, security and privacy, operational readiness, and standards-facing evidence. It supports traceable reporting through explicit evidence-status categories and locations, and can be implemented as a Standards and Interoperability Reporting Statement (SIRS) for authors, reviewers, and editors. Overall, the findings show that standards-oriented assessment depends not only on technical performance but also on explicit and traceable integration evidence, while the proposed reporting profile provides a practical mechanism for making such evidence more systematically visible in future ITS studies. Full article

Professional drivers are exposed to work conditions that may affect sleep quality. Although poor sleep quality has been associated with lower mental health (MH) and vitality (VT), its relationship with these outcomes in professional drivers remains unclear. This cross-sectional study examined the association between sleep quality and selected health-related quality-of-life (HRQoL) domains among 399 professional drivers. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). At the same time, HRQoL was evaluated using the Mental Health, Vitality, and Bodily Pain domains of the 36-Item Short Form Health Survey. Correlation and regression analyses were performed. The mean PSQI score was 8.59, indicating overall poor sleep quality. Higher PSQI scores were negatively associated with MH (ρ = −0.384, p < 0.001) and VT (ρ = −0.495, p < 0.001). Sleep quality remained an independent predictor of MH (B = −2.47, p < 0.001; R² = 0.155) and VT (B = −4.10, p < 0.001; R² = 0.268), whereas age showed a modest association only with VT (B = −0.235, p = 0.035). Poor sleep quality was associated with lower MH and VT scores among professional drivers. The stronger association observed for VT suggests that sleep quality may be particularly relevant to energy levels and daily functioning in this study population. Full article

Background: Skeletal muscle depletion and malnutrition are common in heart failure (HF) and are associated with poor outcomes. Whether imaging-derived skeletal muscle reserve and laboratory-based nutritional indices provide complementary prognostic information remains unclear. We evaluated the prognostic value of total pectoral muscle area (TPMA), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT) scores in patients hospitalized with HFmrEF/HFrEF. Methods: In this retrospective single-center study, consecutive patients hospitalized with decompensated HF between 2017 and 2025 who underwent thoracic computed tomography were included. TPMA was measured at the T4 level. Nutritional status was assessed using PNI and CONUT. Receiver operating characteristic analysis, Kaplan–Meier analysis, Spearman correlation, and Cox regression were used to evaluate long-term all-cause mortality. Results: A total of 138 patients (median age 66 years; 35.5% women) were included. During a median follow-up of 34.4 months, 87 patients (63.0%) died. Non-survivors had lower TPMA (2589 vs. 3012 mm², p = 0.002) and PNI (46.0 ± 5.5 vs. 50.2 ± 7.2, p < 0.001). TPMA (AUC 0.661, p = 0.001) and PNI (AUC 0.663, p = 0.001), but not CONUT (AUC 0.561, p = 0.226), predicted mortality. TPMA correlated modestly with PNI (ρ = 0.325, p < 0.001). Low TPMA (<3000 mm²; HR 1.911, p = 0.018), higher BNP (HR 1.024 per 100 pg/mL, p = 0.014), and lower PNI (HR 0.956, p = 0.024) independently predicted mortality. Conclusions: Reduced TPMA and lower PNI were independently associated with long-term mortality in hospitalized patients with HFmrEF/HFrEF. Their modest correlation suggests that they may capture partly distinct aspects of systemic impairment; however, the incremental prognostic value of their combined assessment requires further evaluation. Full article

Industrial artificial intelligence (AI) fault-diagnostic systems can identify plausible causes under uncertainty, but their outputs alone do not determine how diagnostic support should be delivered during maintenance. This paper presents WrenchBuddy, a human-centered governance framework that manages three decisions during a fault episode: how much diagnostic structure to expose, what assistance posture to provide, and which first confirmatory question to prioritize. The framework is method-agnostic. In this illustration, its roles are instantiated using capped Bayesian-network views, a Comprehensive Operational Cost burden proxy, Fault-Situation Difficulty, a scenario-level physiological readiness input, Data Envelopment Analysis, a Help/Escalate rule, and Value of Information query ranking. A maintenance corpus from approximately 300 remotely monitored uninterruptible power supply machines provides 429 tagged incidents, while an independent physiological dataset provides the scenario-level readiness input. The reconstructed cause–alarm graph has 35 nodes and 34 edges. The Bounded view retains approximately 85% of Baseline coverage with approximately 57% of its interpretability burden. At the selected operating point, three alarms are escalated; bootstrap analysis shows that the two highest-difficulty decisions are stable, whereas the third is a borderline result based on seven incidents. Because the two datasets are not synchronized, the study evaluates governance-policy behavior rather than operational-outcome improvement. WrenchBuddy therefore provides an auditable framework for governing diagnostic exposure, assistance, and first-query selection, while synchronized human-subject validation remains future work. Full article

Background/Objectives: Probiotic preparations have attracted increasing attention because of their potential to modulate the gut microbiota and improve health outcomes in a wide range of gastrointestinal and extraintestinal diseases. However, their efficacy and safety are strain-specific and remain inconsistent across many clinical indications. The aim of this review was to evaluate current evidence regarding the efficacy, safety, mechanisms of action, and clinical applications of probiotic preparations. Methods: A narrative literature review was conducted using the PubMed, Scopus, and Web of Science databases to identify publications addressing the efficacy, safety, and clinical applications of probiotic preparations. The literature search was last updated in July 2026. No publication-year restrictions were applied; the studies included in this review were published between 2000 and 2026. Priority was given to systematic reviews, meta-analyses, randomized controlled trials, international clinical practice guidelines, and mechanistic studies. Results: The reviewed evidence indicates that probiotics may contribute to intestinal homeostasis through modulation of the gut microbiota, enhancement of intestinal barrier function, and regulation of immune responses. The strongest evidence supports the use of selected probiotic strains for the prevention of antibiotic-associated diarrhea, whereas evidence for the prevention of necrotizing enterocolitis is generally favorable but depends on the specific probiotic preparation, product quality, and clinical setting. Evidence for most other gastrointestinal and extraintestinal disorders remains heterogeneous and strain-specific. Although probiotics generally exhibit a favorable safety profile, rare infectious complications have been reported in high-risk patients. Conclusions: Current evidence indicates that the efficacy and safety of probiotics depend on the specific strain, clinical indication, and patient characteristics. Further high-quality, strain-specific clinical studies are needed to optimize their use in medical practice. Full article