Search Results (4,445)

Background: The COVID-19 pandemic substantially altered the epidemiology of respiratory infections. Its impact on the clinical course of influenza in hospitalised children remains insufficiently characterised. Objectives: We aimed to compare the clinical course, complications, and selected laboratory parameters of influenza in children before, during, and after the COVID-19 pandemic. Methods: This single-centre retrospective study included 553 children hospitalised with laboratory-confirmed influenza between September 2017 and August 2025. Patients were divided into three groups: pre-pandemic, pandemic, and post-pandemic. Clinical complications and inflammatory markers (CRP, PCT, neutrophil counts) were analysed. Results: Influenza-related complications occurred in 59.5% of patients and were significantly more frequent after the pandemic compared to the pre-pandemic period (64.3% vs. 52.9%, p = 0.02). Pneumonia was the most common complication across all groups, but its incidence was lowest during the pandemic. Myositis occurred most frequently during the pandemic and appears to coincide with a higher proportion of influenza B infections. No significant differences were observed in CRP, PCT concentrations, or neutropenia rates between groups. Conclusions: The COVID-19 pandemic influenced the clinical presentation of influenza in children, with a post-pandemic increase in complications. These findings may reflect delayed access to healthcare and the phenomenon of immunity debt, highlighting the need for continued surveillance and preventive strategies. Full article

Background: Osteoarthritis (OA) is a common degenerative joint disease that often leads to impaired postural control, pain, and reduced physical function. Exercise is considered a first-line treatment, with sensorimotor training being an effective approach for managing OA. However, the optimal method of sensorimotor training for individuals with OA has not yet been established. Thus, the aim of this study was to compare the effects of a 24-week Gyrokinesis method (GK) versus Pilates (PL) intervention on balance control, function, pain and kinesiophobia in women with knee OA. Methods: Twenty women (aged 60 ± 7 years) with grade 2 or 3 knee OA were assigned to either GK (n = 12) or PL (n = 8). Both groups trained twice weekly for 24 weeks. Pre- and post-intervention assessments included postural sway parameters (RMS, velocity, frequency), physical function tests (e.g., TUG, Sit-to-Stand), flexibility, pain (Brief Pain Inventory), kinesiophobia (Tampa Scale), and quality of life (SF-36). Results: GK resulted in significantly greater improvements than PL in postural sway mean velocity AP right (GK −53.85% vs. PL −20.17%), AP left (GK −43.48% vs. PL +13.45%), and ML left (GK −40.18% vs. PL +37.95), pain reduction (GK −82.5% vs. PL −33.3%), and physical function (Sit-to-Stand: GK +75.9% vs. PL +3.7%; TUG: GK −16.4% vs. PL −13.8%; Step Test right: GK +34.2% vs. PL +19.9%; Step Test left: GK +41.4% vs. PL +18.1%) (all, p < 0.05). No significant between-group differences were observed for kinesiophobia or SF-36 scores (both, p > 0.05). Conclusions: Gyrokinesis method may be more effective than Pilates in enhancing balance, reducing pain, and improving physical function in women with knee OA. These findings support the use of the Gyrokinesis method in rehabilitation programs for individuals with OA. Full article

Surface finish plays a critical role in the tribological performance of additively manufactured engineering components. In exploring part characteristics in laser powder-bed fusion (L-PBF), this study investigates the effect of contouring strategies on the upskin surface of inclined specimens (30°, 45°, and 60°) made with L-PBF, using post- and pre-contouring strategies with various levels of process parameters. The surface data of fabricated inclined specimens were acquired by white-light interferometry, followed by a quantitative analysis using surface images. The results show that post-contouring leads to better surface finishes, with the lowest S_a of 8.68 µm attained at the highest laser power (195 W) and the slowest scan speed (500 mm/s) on 30°-inclined specimens, likely due to increased remelting and less step-edges. In contrast, pre-contouring produces distinct surface textures on the upskin of L-PBF specimens, resulting in a rougher surface morphology, with a maximum S_a of 33.39 µm also from 30°-inclined specimens at the lowest power (100 W) and the highest speed (2000 mm/s), suggesting an insufficient remelting of surface defects. In comparative analysis, in general, post-contouring yields smoother upskin surfaces, with a 17%–30% reduction in S_a, than those from equivalent pre-contouring conditions, highlighting the potential of scan sequences for optimizing L-PBF to improve the surface finish of inclined structures. Full article

The COVID-19 pandemic led to an unprecedented slowdown in global economic and transportation activities, offering a unique opportunity to assess the relationship between human activity and atmospheric pollution. This study analyzes global variations in major air pollutants and meteorological conditions during the pandemic period using multi-satellite and reanalysis datasets. Nitrogen dioxide (NO₂) data were obtained from the OMI sensor aboard NASA’s Aura satellite, while carbon monoxide (CO) observations were taken from the MOPITT instrument on Terra. Reanalysis products from MERRA-2 were used to assess CO, sulfur dioxide (SO₂), black carbon (BC), organic carbon (OC), and key meteorological variables, including temperature, precipitation, evaporation, wind speed, and direction. Average concentrations of pollutants for April, May, and June 2020, representing the lockdown phase, were compared with the average values of the same months during 2017–2019, representing pre-pandemic conditions. The difference between these multi-year means was used to quantify spatial changes in pollutant levels. Results reveal widespread reductions in NO₂, CO, SO₂, and BC concentrations across major industrial and urban regions worldwide, consistent with decreased anthropogenic activity during lockdowns. Meteorological analysis indicates that the observed reductions were not primarily driven by short-term weather variability, confirming that the declines are largely attributable to reduced emissions. Unlike most previous studies, which examined local or regional air-quality changes, this work provides a consistent global-scale assessment using harmonized multi-sensor datasets and uniform temporal baselines. These findings highlight the strong influence of human activities on atmospheric composition and demonstrate how large-scale behavioral and economic shifts can rapidly alter air quality on a global scale. The results also provide valuable baseline information for understanding emission–climate interactions and for guiding post-pandemic strategies aimed at sustainable air-quality management. Full article

Background and Objectives: Soft tissue sarcomas account for approximately 7% of all malignant tumors in the pediatric population. Diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) measurements may provide early functional biomarkers of treatment response by reflecting changes in tumor cellularity. This study evaluated whether ADC-derived parameters can serve as quantitative biomarkers of neoadjuvant chemotherapy response in pediatric rhabdomyosarcoma. Materials and Methods: This retrospective single-center study included 14 patients aged ≤18 years with histopathologically confirmed rhabdomyosarcoma who underwent MRI before treatment and after three cycles of chemotherapy. Twenty-five patients were initially identified; eleven were excluded due to imaging artifacts or absence of baseline examination. ADC maps were generated on 1.5T and 3T scanners. Regions of interest were placed over the entire lesion and areas with the lowest ADC signal. Relative ADC (rADC) was calculated by normalizing tumor ADC to adjacent healthy muscle. Paired t-tests were used to compare pre- and post-treatment values. Results: At baseline, 13/14 patients (93%) demonstrated diffusion restriction. Mean ADC increased from 1.11 × 10⁻³ mm²/s (SD ± 0.48) at baseline to 1.63 × 10⁻³ mm²/s (SD ± 0.67) after treatment. The paired t-test for rADC yielded t = −3.089 (p = 0.0086, 95% CI: −0.79 to −0.14), indicating a statistically significant change. There was a significant difference between the ADC values of the entire lesion and the areas with the lowest signal in tumors with a heterogenic structure, t = 2.862, p = 0.013. Conclusions: ADC and rADC increased significantly after neoadjuvant chemotherapy in pediatric rhabdomyosarcoma, suggesting potential utility as early functional biomarkers of treatment response. These preliminary findings require validation in larger multicenter prospective studies with correlation to histopathological response and clinical outcomes before clinical implementation. Full article

Background: Treatment of chronic painful insertional Achilles tendinopathy is known to be challenging. If non-surgical treatment does not give sufficient relief of symptoms, surgery may be indicated. Treatment with ultrasound (US)- and colour Doppler (CD)-guided wide-awake-local-anaesthetic-no-tourniquet (WALANT) surgery for insertional Achilles tendinopathy is a new approach with promising clinical results. This study aimed to evaluate clinical results of this new approach on patients suffering from insertional Achilles tendinopathy. Methods: Forty-eight consecutive patients with 53 symptomatic tendons (33 men with 34 tendons, mean age 49.3 ± 12.0 years; 14 women with 18 tendons, mean age 55.0 ± 7.4 years) and a duration of more than 12 months with painful insertional Achilles tendinopathy (including tendon, bursae, bone, and plantaris pathology) were included. US- and CD-guided WALANT surgery with removal of pathological bursae, bone, and tendons was used. Immediate weight-bearing loading was allowed, followed by a structured rehabilitation protocol for the first 12 weeks after surgery. VISA-A scores before and after surgery and a questionnaire that evaluated subjective satisfaction with the treatment and current activity level were used. Results: In total, 42/48 patients with 46/53 tendons participated in a 3-year follow-up (mean 34 ± 9 months) by an independent examiner; 39/42 patients with 43/46 tendons were satisfied (n = 37) with the treatment. The mean VISA-A score increased significantly from 41.9 ± 18.2 pre-operatively to 87.7 ± 18.2 post-operatively (p < 0.001). There were three surgical complications, two superficial wound infections, and one minor wound rupture. Conclusions: Patients who suffered from chronic painful insertional Achilles tendinopathy treated with US- and CD-guided WALANT surgery followed by immediate weight-bearing showed high patient subjective satisfaction rates and better functional scores at the 3-year follow-up with a low complication rate. This novel treatment approach warrants more study, including randomised trials comparing it against traditional surgical procedures according to Nunley and Keck and Kelly. Full article

Background/Objectives: Post-COVID-19 pulmonary fibrosis (PCPF) and idiopathic pulmonary fibrosis (IPF) exhibit significant clinical and pathophysiological overlap, suggesting convergent molecular pathways driving fibrosis. This prospective longitudinal study investigates the sustained dysregulation of matrix metalloproteinases (MMP)-2 and MMP-9 and its relationship with evolving systemic inflammation and endothelial dysfunction in convalescent COVID-19 patients, with comparative analysis to IPF. Methods: We conducted a prospective observational study of 86 patients at 6 and 12 months post-SARS-CoV-2 infection, stratified by high-resolution CT evidence of PCPF (FB+ group, n = 32) or absence of fibrosis (FB− group, n = 54). Gene expression of MMP-2 and MMP-9 in peripheral blood leukocytes and circulating levels of MMP-2, MMP-9, pro-inflammatory cytokines (TNF-α, IL-6), and endothelial dysfunction markers (Endothelin-1 [ET-1], adhesion molecules) were quantified via qRT-PCR and ELISA. A pre-pandemic healthy control group (HD, n = 20) and an IPF patient group (n = 10) served as comparators. Results: A significant, sustained elevation of MMP-2 and MMP-9 was observed in all post-COVID-19 patients versus HDs, most pronounced in the FB+ group and qualitatively similar to IPF. A critical divergence emerged: FB− patients showed resolution of systemic inflammation (reduced TNF-α, IL-6), whereas FB+ patients exhibited persistent cytokine elevation. Critically, a delayed, severe endothelial dysfunction, characterized by a profound surge in ET-1 and elevated adhesion molecules, manifested exclusively in the FB+ cohort at 12 months. Positive correlations linked plasma MMP-2/9 levels with ET-1 (r_s = 0.65, p = 0.004; r_s = 0.49, p = 0.009) and ET-1 with sICAM-1 (r_s = 0.68, p = 0.01). Conclusions: The development of PCPF is associated with a distinct pathogenic triad: sustained MMP dysregulation, failure to resolve inflammation, and severe late-phase endothelial dysfunction. The correlative links between these components suggest a self-reinforcing loop. This systemic signature mirrors patterns in IPF, underscoring shared final pathways in fibrotic lung disease and identifying the MMP–inflammation–endothelial axis as a promising target for biomarker development and therapeutic intervention. Full article

Background and Objectives: Hysteroscopy has become the “gold standard” in assessing uterine cavity abnormalities, and currently it can be performed in an “office setting”. Although office hysteroscopy has a better level of comfort than operative hysteroscopy, pain is a common concern. Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used for pre-procedure analgesia, but they may cause gastrointestinal side effects. Paracetamol offers to be a safer alternative, but its efficacy in this setting is limited. This study aimed to compare the efficacy and safety of oral paracetamol with oral ketoprofen for pain management during office hysteroscopy. Materials and Methods: Double-blind, parallel-group, randomized controlled trial conducted at a single hysteroscopy center in Jakarta, Indonesia, over a 2-year period. Sixty women undergoing office hysteroscopy were randomized (1:1) to receive paracetamol 1000 mg orally or ketoprofen 100 mg orally 1 h before the procedure. Results: All participants completed the trial and were included in the analysis. The median visual analog score (VAS) during the procedure was 2 (range 0–8) in the paracetamol group versus 3 (range 0–6) in the ketoprofen group (p = 0.266). Median cramping scores 30 min post-procedure in the paracetamol group were 0 (range 0–5) vs. 0 (range 0–4) in the ketoprofen group, respectively (p = 0.499). Side effects occurred in 3 participants (10%) in the ketoprofen group and none of the paracetamol group. Comfort scores were high in both groups (median 9/10). No vagal reflexes were observed. Conclusions: Oral 1000 mg paracetamol was as effective as oral 100 mg ketoprofen for pain management during and after office hysteroscopy, with fewer side effects. Paracetamol may be a safe and cost-effective alternative for pre-procedure analgesia in office hysteroscopy. Full article

Background/Objectives: The growing integration of Artificial Intelligence (AI) and chatbots in health professional education offers innovative methods to enhance learning and clinical preparedness. This study aimed to evaluate the educational impact and perceptions in university students of Human Nutrition and Dietetics, regarding the utility, usability, and design of the E+DIEting_Lab chatbot platform when implemented in clinical nutrition training. Methods: The platform was piloted from December 2023 to April 2025 involving 475 students from multiple European universities. While all 475 students completed the initial survey, 305 finished the follow-up evaluation, representing a 36% attrition rate. Participants completed surveys before and after interacting with the chatbots, assessing prior experience, knowledge, skills, and attitudes. Data were analyzed using descriptive statistics and independent samples t-tests to compare pre- and post-intervention perceptions. Results: A total of 475 university students completed the initial survey and 305 the final evaluation. Most university students were females (75.4%), with representation from six languages and diverse institutions. Students reported clear perceived learning gains: 79.7% reported updated practical skills in clinical dietetics and communication were improved, 90% felt that new digital tools improved classroom practice, and 73.9% reported enhanced interpersonal skills. Self-rated competence in using chatbots as learning tools increased significantly, with mean knowledge scores rising from 2.32 to 2.66 and skills from 2.39 to 2.79 on a 0–5 Likert scale (p < 0.001 for both). Perceived effectiveness and usefulness of chatbots as self-learning tools remained positive but showed a small decline after use (effectiveness from 3.63 to 3.42; usefulness from 3.63 to 3.45), suggesting that hands-on experience refined, but did not diminish, students’ overall favorable views of the platform. Conclusions: The implementation and pilot evaluation of the E+DIEting_Lab self-learning virtual patient chatbot platform demonstrate that structured digital simulation tools can significantly improve perceived clinical nutrition competences. These findings support chatbot adoption in dietetics curricula and inform future digital education innovations. Full article

Circulating irisin, a myokine implicated in energy expenditure and adipose tissue regulation, has been increasingly studied as a potential biomarker of metabolic dysfunction. This study evaluated the relationship between serum irisin and metabolic indices, including the atherogenic index of plasma (AIP), the lipid accumulation product (LAP), and hypertriglyceridemic-waist (HTGW) phenotype in individuals with prediabetes (PreDM) and newly diagnosed type 2 diabetes mellitus (T2DM). A total of 138 participants (48 PreDM, 90 T2DM) were assessed for anthropometric, glycemic, and lipid parameters. Serum irisin levels were measured by enzyme-linked immunosorbent assay (ELISA) and correlated with insulin resistance indices (Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), Quantitative Insulin Sensitivity Check Index (QUICKI)), glycemic control (glycosylated hemoglobin A1c (HbA1c)), and composite lipid markers (total triglycerides-to-high-density lipoprotein cholesterol (TG/HDL-C)). Group differences were evaluated using non-parametric tests; two-way ANOVA assessed interactions between phenotypes and markers; multiple linear regression (MLR) and logistic regression models explored independent associations with metabolic indices and HTGW; receiver operating characteristic (ROC) analyses compared global and stratified model performance. Serum irisin was significantly lower in T2DM than in PreDM (median 140.4 vs. 230.7 ng/mL, p < 0.0001). Irisin levels remained comparable between males and females in both groups. Post hoc analysis shows that lipid indices and irisin primarily distinguish HTGW phenotypes, especially in T2DM. In both groups, irisin correlated inversely with HOMA-IR, AIP, and TG/HDL-C, and positively with QUICKI, indicating a possible compensatory role in early insulin resistance. MLR analyses revealed no independent relationship between irisin and either AIP or LAP in PreDM, while in T2DM, waist circumference remained the strongest negative predictor of irisin. Logistic regression identified age, male sex, and HbA1c as independent predictors of the HTGW phenotype, while irisin contributed modestly to overall model discrimination. ROC curves demonstrated good discriminative performance (AUC = 0.806 for global; 0.794 for PreDM; 0.813 for T2DM), suggesting comparable predictive accuracy across glycemic stages. In conclusion, irisin levels decline from prediabetes to overt diabetes and are inversely linked to lipid accumulation and insulin resistance but do not independently predict the HTGW phenotype. These findings support irisin’s role as an integrative indicator of metabolic stress rather than a stand-alone biomarker. Incorporating irisin into multi-parameter metabolic panels may enhance early detection of cardiometabolic risk in dysglycemic populations. Full article

Background/Objectives: The cognitive processes underlying learning are critical for educational practices. While mindfulness-based approaches to strengthening these cognitive processes have become widespread, studies focusing on game-based development of executive functions, particularly in preschool settings, are limited. The primary objective of this study is to develop a play-based mindfulness intervention program for preschool children and to examine the effects of this program on preschool children’s resilience, emotion regulation skills, and executive functions. Methods: The study employed a pretest–post-test control-group experimental design. The study group consisted of 40 children (20 experimental and 20 control) aged 5–6 years, attending a kindergarten in Malatya province, Türkiye. The Devereux Early Childhood Assessment Scale (DECA-P2), Emotion Regulation Scale (ERS), and Childhood Executive Functions Inventory (CHEXI) were used as data collection tools. Independent-samples t-tests were used for baseline analysis, and a two-way repeated-measures ANOVA was used to evaluate the program’s effects. Results: Findings showed that there was a statistically significant difference between the pre-test and post-test mean scores of the children in the experimental group compared with those in the control group for resilience, emotion regulation, and executive function (p < 0.05). Conclusions: Strong evidence was obtained that play-based mindfulness training has positive effects on the cognitive and emotional development of preschool children. Full article

Wildfires are increasing globally and pose major challenges for assessing post-fire vegetation recovery and ecosystem resilience. We analyzed long-term Landsat time series in two contrasting fire-prone ecosystems in the United States and Australia. Vegetation area was extracted using the Enhanced Vegetation Index (EVI) with Otsu thresholding. Recovery to pre-fire baseline levels was modeled using linear, logistic, locally estimated scatterplot smoothing (LOESS), and generalized additive models (GAM), and their performance was compared using multiple metrics. The results indicated rapid recovery of Australian forests to baseline levels, whereas this was not the case for forests in the United States. Among climatic factors, temperature was the dominant parameter in Australia (Spearman ρ = 0.513, p < 10⁻⁸), while no climatic variable significantly influenced recovery in California. Methodologically, GAM consistently performed best in both regions due to its success in capturing multiphase and heterogeneous recovery patterns, yielding the lowest values of AIC (United States: 142.89; Australia: 46.70) and RMSE_cv (United States: 112.86; Australia: 2.26). Linear and logistic models failed to capture complex recovery dynamics, whereas LOESS was highly sensitive to noise and unstable for long-term prediction. These findings indicate that post-fire recovery is inherently nonlinear and ecosystem-specific and that simple models are insufficient for accurate estimation, with GAM emerging as an appropriate method for assessing vegetation recovery using remote sensing data. This study provides a transferable approach using remote sensing and GAM to monitor forest resilience under accelerating global fire regimes. Full article

Lower respiratory infections (LRIs) are responsible for significant morbidity and mortality in Ecuador; however, evidence to support prevention strategies is limited. This study aimed to identify age-specific trends, spatial patterns, and sociodemographic risk factors of LRI mortality in Ecuador between 2012–2022, utilizing national mortality data sourced from the Ecuadorian National Institute for Statistics and Censuses (INEC). Age-sex-specific trend analysis was performed using Joinpoint regression. LRI age-standardized mortality rates (ASMRs) were mapped by province of death, and percentage change was calculated between 2012 and 2019. Multivariable logistic regression was performed to assess risk factors pre- and post-2020. A change in trend in LRI mortality rate, from a decreasing trend to a marginal increasing trend, was identified for both genders in children aged 0–4 and 5–15 years. There were significant increasing trends for males (2014–2019 APC: 2.21%, 95% CI: 0.57, 6.70) and females (2016–2019 APC: 4.62%, 95% CI: 0.84, 10.58) aged ≥ 70 years. From 2012 to 2019, the highest average LRI ASMR was in Guayas (30.90 deaths per 100,000 inhabitants), and the greatest percentage increase was observed in Orellana (419.54%). Before 2020, LRI mortality, compared to deaths of other causes, was significantly associated with sex, age, education, ethnicity, place of death and climate region, with major shifts post COVID-19 pandemic. Full article

Background and Objectives: This study compared the effects of two posterior-chain strength training strategies on eccentric hamstring strength, jump and sprint performance, and hamstring injury incidence in elite youth soccer players. Materials and Methods: Twenty-three players were randomly allocated to either a Nordic Hamstring Exercise Group (NHEG; n = 11) or a Deadlift + Leg Curl Slides Group (D + LCSG; n = 12). Both groups completed a 9-week in-season resistance training program consisting of one strength-oriented session (MD-4) and one power-oriented session (MD-2) per week, in addition to regular soccer training. Pre- and post-intervention assessments included eccentric hamstring strength (NordBord), countermovement jump (CMJ), and 10 m and 30 m linear sprint performance. Results: Eccentric hamstring strength increased significantly only in the NHEG (p ≤ 0.05), though this improvement did not transfer to enhancements in jump or sprint performance (p > 0.05). No significant changes were observed in the D + LCSG for any variable (p > 0.05), and no between-group differences were found across all performance outcomes. During the 12-week monitoring period, one hamstring injury was recorded, occurring in the NHEG. Conclusions: These findings suggest that, while the NHE elicited greater exercise-specific eccentric strength gains, neither posterior-chain strategy produced improvements in sprint or jump performance. However, given the small sample size and low number of injury events, these trends cannot be attributed with certainty to the implemented protocols, and both programs reported a low incidence of hamstring injuries per 1000 h of exposure with no statistically protective effect associated with the use of the NHE. Full article

Hydrological behavior plays a critical role in seasonally dry forest ecosystems, as it underpins water availability for multiple productive activities, including forestry, agriculture, grazing, and urban supply. This study evaluated the hydrological effects of thinning treatments in a semi-arid oak–pine forest of Chihuahua, Mexico, using a Before–After–Control–Impact (BACI) design. Three Micro-catchments (MC) with initially comparable tree density and canopy cover were monitored during the rainy seasons of 2018 (pre-thinning) and 2019 (post-thinning). Thinning treatments were applied at 20% and 60% canopy cover in two MC, while a third remained unthinned as a 100% control. Precipitation and surface runoff were recorded at the event scale, and data were analyzed using Weibull probability models with a log link to capture the frequency and magnitude of runoff events. Precipitation patterns were broadly comparable across years, although 2018 included an extreme storm event (59 mm). In contrast, runoff volumes in 2019 were lower despite marginally higher seasonal rainfall, reflecting the absence of large storms. Statistical modeling indicated that for each additional millimeter of precipitation, mean runoff increased by approximately 12%, although thinning significantly altered baseline conditions. Relative to 2018, mean runoff ratios were 0.087 in the 100% canopy catchment, 0.296 in the 60% treatment, and 0.348 in the 20% treatment, suggesting that reduced canopy cover retained proportionally more runoff than the control. BACI contrasts confirmed that thinned catchments maintained higher proportions of runoff than the unthinned control, although statistical significance was marginal for the 20% canopy treatment. Overall, the study provides ecohydrological insights relevant to the management of semi-arid forest ecosystems. Full article