Search Results (11,791)

Background: Machine learning-based Artificial Intelligence (AI) models have shown significant potential in the biomedical field, offering promising advances in diagnostics, personalized medicine, and patient care. However, to build these models, we have to deal with important challenges, including (1) the scarcity and low quality of available datasets in many important applications and (2) privacy concerns associated with sensitive patient data. Synthetic data (SD) generation has emerged as a promising strategy to address these challenges, yet many existing approaches struggle to simultaneously preserve privacy and accurately model tabular data, the predominant format in healthcare. Methods: We propose Kernel Density Estimation–K-Nearest Neighbors (KDE-KNN), a privacy-aware tabular data generation method, and evaluate its performance against state-of-the-art techniques. Using sepsis detection as a real-world case study, we assess both data utility and privacy protection. Results: Models trained on KDE-KNN-generated SD outperformed those trained on real data across both internal testing and external validation. In particular, a support vector machine achieved superior performance when trained on SD relative to real data. This gain is likely driven by the balanced class distribution of the synthetic dataset, underscoring KDE-KNN’s utility as an effective data balancing strategy. Consistent performance in external validation further supports the robustness and generalizability of the proposed approach. Privacy evaluation indicated a lower re-identification risk, with a mean distance to closest record of 4.971 between synthetic and real samples, compared with 2.715 among real samples. Conclusions: KDE-KNN effectively captures underlying population distributions while generating high-quality SD that preserve statistical fidelity and protect sensitive information. By balancing the trade-off between utility and privacy, the method produces representative datasets without exposing individual records. These findings position KDE-KNN as a valuable tool for data-scarce and privacy-sensitive applications, with broad potential across healthcare and other data-driven domains. Full article

Because of their special optical and electrochemical characteristics, superior biocompatibility, adjustable surface chemistry, and inexpensive, scalable synthesis, carbon dots (CDs), including carbon quantum dots and graphene quantum dots, have become powerful and adaptable nanomaterials for advanced pharmaceutical analysis and other toxicants. The sensitive and selective detection of active pharmaceutical substances, degradation products, contaminants, biomarkers, and therapeutic medication levels in complex matrices has shown great promise in recent years with CD-based nanobiosensors. The development of various sensing platforms, such as electrochemical, optical, and dual-mode biosensors, as well as integration into microfluidic, paper-based, and wearable point-of-care (POC) devices, is made possible by their intrinsic fluorescence, effective electron transfer capacity, and ease of functionalization. With an emphasis on sensing mechanisms, biorecognition techniques, and analytical performance, this study critically reviews current developments in CD-based nanobio/chemosensors for pharmaceutical analysis. It includes a thorough discussion of important applications in drug development, stability research, therapeutic drug monitoring, and drug quality control. Along with new developments like green synthesis, AI-assisted signal processing, and smart sensing platforms, current issues with reproducibility, standardization, biocompatibility, and regulatory validation are highlighted. Lastly, prospects for the industrial application and clinical translation of CD-based nanobiosensors are discussed. Full article

Background/Objectives: This exploratory single-arm study evaluated the effects of non-ablative Erbium-doped Yttrium Aluminum Garnet (Er:YAG) laser therapy in a real-world healthcare setting. Methods: A prospective pre–post study was conducted in 47 postmenopausal women who received two sessions of non-ablative Er:YAG vaginal laser therapy (IncontiLase^®®/IntimaLase^®®). Assessments were performed at baseline and two follow-ups (FSFI, ICIQ-SF, I-QOL, and Oxford Scale). Wilcoxon signed-rank tests and Spearman correlations were used. Results: Vaginal hiatus was significantly reduced from 2.5 cm (IQR 2.0–3.0) to 2.0 cm (IQR 1.0–3.0) (p < 0.001). Vaginal length showed a small, non-significant increase, and pelvic floor strength was unchanged. Total FSFI scores remained stable; pain showed a non-significant upward trend, and arousal decreased transiently. ICIQ-SF scores did not significantly improve, although they correlated inversely with vulvar energy at second follow-up (r = −0.424; p = 0.016). I-QOL domains showed short-term improvements in social embarrassment (p = 0.002), psychosocial impact (p = 0.002), and behavioral limitations (p = 0.013) at first follow-up. Cystocele stage improved at second follow-up (p = 0.013). Conclusions: Non-ablative Er:YAG vaginal laser therapy was associated with reduced vaginal hiatus and produced short-term improvements in select quality-of-life domains and cystocele stage, while effects on sexual function and urinary symptoms were limited. Findings remain exploratory and inform the design of future controlled studies evaluating innovative outpatient care models for GSM. Given the absence of a control group and short follow-up, these findings should be interpreted as hypothesis-generating and may be influenced by placebo or expectation effects. Full article

Background: Educational interventions are central to breast cancer survivorship care, yet adherence may vary depending on delivery modality. Objective: To compare the effectiveness of face-to-face, online, telephonic, and mixed educational modalities on patient adherence among breast cancer survivors. Methods: A systematic review of randomized controlled trials and Bayesian network meta-analysis were conducted following PRISMA 2020 guidelines. Randomized controlled trials evaluating educational interventions in breast cancer survivors were included. Methodology quality of included studies was assessed using the RoB-2 tool. Pairwise meta-analyses using random-effects models estimated Odds Ratios (ORs) for adherence. A Bayesian network meta-analysis synthesized direct and indirect evidence, and treatment rankings were calculated using SUCRA values. Results: Eleven trials comprising 963 participants were included. In pairwise meta-analysis, no modality demonstrated statistically significant superiority over usual care: face-to-face (OR 0.79; 95% CI 0.44–1.41), mixed (OR 0.42; 95% CI 0.07–2.37), online (OR 0.90; 95% CI 0.49–1.68), and telephonic (OR 0.57; 95% CI 0.18–1.78). The network meta-analysis confirmed the absence of statistically significant differences across modalities. SUCRA rankings suggested that usual care (76.7%) and online modalities (73.1%) had the highest probability of being among the best-performing strategies, followed by face-to-face (51.9%), telephonic (25.4%), and mixed (23.0%). Conclusions: No educational modality demonstrated superior adherence compared to usual care. Delivery format alone may not determine engagement in breast cancer survivorship programs. Decisions should prioritize feasibility and patient preference. Full article

Hypospadias is a congenital malformation of the male external genitalia resulting from incomplete fusion of the urethral folds during embryonic development. The perineal form represents the most severe phenotype and is frequently associated with abnormalities such as cryptorchidism and penile hypoplasia. Although surgical correction is generally recommended in young dogs, the long-term clinical course of severe hypospadias under conservative management remains poorly documented. In this study, we describe an unusual canine case of severe perineal hypospadias that survived to geriatric age under conservative management and subsequently developed bilateral testicular tumors arising from cryptorchid testes. Despite recurrent urinary tract infections during early life, the patient maintained an acceptable quality of life with long-term supportive care, providing a rare clinical example of extended survival without surgical correction. Because no molecular material was available from the patient, publicly available mouse transcriptomic datasets related to genital tubercle development and Leydig cell differentiation were consulted only as contextual reference. These datasets illustrate established developmental regulators and steroidogenic pathways relevant to genital formation and testicular function but do not represent direct molecular findings from the reported case. This report primarily highlights the clinical course and management of severe hypospadias in a dog, while using existing transcriptomic knowledge solely to provide biological context. The findings should therefore be interpreted as descriptive and hypothesis-generating rather than as evidence of a direct mechanistic link between developmental abnormalities and endocrine tumorigenesis. Full article

Globalization refers to the increasing density of economic, social, and technological interconnections on a global scale. In the healthcare industry, it simultaneously accelerates innovation and increases systemic vulnerabilities. This study aims to review and conceptually synthesise the main channels of impact: (1) pharmaceuticals, clinical development, and regulation; (2) supply chains and resilience; (3) service mobility (health tourism); (4) human resources and competencies; (5) digitalization, artificial intelligence (AI), and data governance; (6) ethics, law, and public policy; and (7) sustainability and climate change. The COVID-19 pandemic highlighted the risks associated with global interdependencies, particularly in supply chains, while also demonstrating the innovation-accelerating effects of knowledge sharing and international cooperation. Particular attention is given to artificial intelligence and digital health, which open up new potential for efficiency and quality improvement from research and development through diagnostics to healthcare organization, while simultaneously intensifying concerns related to data protection, cyber security, and liability. Telemedicine, platform-based systems, and real-world data may contribute to addressing the care needs of ageing societies, but only when supported by appropriate competencies and sound data governance. As global data flows intensify, the importance of data protection, bias mitigation, transparency, and accountability correspondingly increases. Through the cultural channels of globalization, health-conscious lifestyles and complementary approaches are also spreading, which we address in a brief, separate subsection. The guidelines of international organizations foster standardization; however, due to differences in local capacities and institutional environments, the effects are not homogeneous. In conclusion, the study emphasises the dual nature of globalization; it expands access and accelerates innovation, while at the same time creating new vulnerabilities—in supply chains, labour mobility, and data security—and, together with climate-related risks, generating complex adaptive pressures for the healthcare industry. Full article

Introduction: Asthma is a chronic inflammatory disease that impairs daily functioning and quality of life. Despite effective therapies, asthma control remains suboptimal and may improve through greater engagement of community pharmacists. This study assessed the knowledge, practices, and perceived barriers of community pharmacists regarding asthma management in the Aseer region, Saudi Arabia. Methods: A cross-sectional study was conducted using a self-administered online questionnaire covering demographics, asthma-related knowledge, practice, and perceived barriers. Results: A total of 290 community pharmacists participated. Overall, 64.8% showed high asthma-related knowledge, while 51.7% reported high asthma counseling practice. Pharmacists showed strong knowledge of asthma symptoms, triggers, determinants of poor control, and counseling on medication-related adverse effects, but moderate knowledge of asthma control assessment, guideline-based management, and treatment-related side effects. Commonly reported services included patient education on asthma and medications, identification of modifiable risk factors, and discussion of treatment side effects, whereas written asthma action plans, symptom control assessment, and follow-up visits were less common. In multivariable logistic regression, high knowledge (p = 0.002), interest in asthma training (p < 0.001), and greater work experience (p = 0.01) were associated with higher counseling practice, while patient volume showed a borderline association (p = 0.051). Conversely, higher practice (p = 0.002), working in independent community pharmacies (p < 0.001), and pharmacy location (p = 0.034) were associated with higher asthma knowledge. Conclusions: Community pharmacists demonstrated moderate-to-high knowledge of asthma management, but gaps remain in guideline-based practice and follow-up. Strengthening guideline-oriented training and pharmacist integration into asthma care may improve outcomes. Full article

Background/Objectives: Preterm infants are particularly vulnerable to nutritional deficiencies and electrolyte imbalances during the early stages of extrauterine life. To ensure optimal metabolic support, they often require the early initiation of “aggressive” parenteral nutrition (PN), which is a known risk factor for Refeeding Syndrome (RS), a potentially serious metabolic condition characterized by fluid and electrolyte disturbances, the most significant of which is hypophosphatemia. Hypophosphatemia can impair the metabolism, survival, and function of red blood cells, leading to a reduction in key intracellular metabolites and the development of a metabolic block that alters their quality and decreases their stability. It is therefore hypothesized that RS may contribute to the development of anemia of prematurity (AOP). At the same time, early enteral nutrition (EN) may promote metabolic adaptation and reduce exposure to the complications of prolonged parenteral support, potentially protecting against AOP. The primary aim of this study was to determine whether preterm infants who develop RS are at increased risk of AOP. A secondary aim was to evaluate whether early EN may act as a protective factor against the development of AOP. Methods: This retrospective observational study was conducted on infants with a gestational age ≤ 34 weeks and/or birth weight ≤ 1500 g, admitted to the Neonatal Intensive Care Unit of Policlinico Umberto I—Sapienza University of Rome, between January 2015 and November 2022. Infants diagnosed with AOP were classified as cases, while those without AOP served as the control group. Results: A total of 412 preterm infants were enrolled (110 cases, 302 controls). Refeeding Syndrome was significantly more frequent in infants with AOP (30.9% vs. 11.6%, p < 0.001). In the logistic regression model adjusted for gestational age, RS was independently associated with AOP (OR = 2.81; 95% CI: 1.55–5.10; p < 0.001), along with gestational age ≤ 34 weeks (OR = 7.10; 95% CI: 2.13–24.0; p = 0.001). Early enteral nutrition during the first week of life was associated with a significantly lower risk of AOP (OR = 0.12; 95% CI: 0.029–0.52; p = 0.005). The association between RS and AOP was confirmed in the model adjusted for birth weight (OR = 2.06; 95% CI: 1.16–3.79; p = 0.021). Infants with AOP showed significantly higher parenteral nutrition intake, delayed initiation of enteral feeding, and later achievement of full enteral nutrition compared with controls (all p < 0.001). Conclusions: RS is significantly associated with AOP in preterm infants, likely through pathophysiological mechanisms related to hypophosphatemia. Importantly, early EN may be a protective factor against AOP, suggesting that timely initiation and advancement in enteral feeding may counteract the metabolic derangements associated with intensive parenteral support. These findings support a nutritional approach that prioritizes early and progressive enteral nutrition as a strategy to reduce the risk of both RS and AOP. Further prospective studies are needed to confirm these associations and to define optimal EN protocols for this population. Full article

Inguinal hernia repair remains one of the most frequently performed surgical procedures, but the problem of early postoperative complications remains significant, particularly in the context of surgical technique selection and patient age. The aim of this study was to compare the incidence of early complications and the length of hospital stay in patients undergoing laparoscopic and open inguinal hernia repair. To achieve this goal, a retrospective study was conducted, analyzing data from 172 patients who underwent laparoscopic and open mesh repair. The results showed that no early complications occurred in patients undergoing laparoscopic repair, whereas complications were reported in 6.4% of patients undergoing open repair, primarily in older adults. The average hospital stay was also shorter with the laparoscopic approach. These data suggest advantages of laparoscopic surgery, especially for elective procedures, which may help reduce complication rates and accelerate recovery. The practical significance of the work is that the obtained results can be used to optimize the selection of surgical technique in the treatment of inguinal hernia, especially in the context of limited financial resources and the need to improve the quality of medical care in Polish medical facilities. Full article

Capsule endoscopy (CE) is evolving from a primarily small-bowel imaging modality into a broader diagnostic platform that increasingly incorporates artificial intelligence (AI), robotic technologies, biosensing capabilities, and decentralized models of care. The REFLECT symposium brought together an international, multidisciplinary audience of clinicians, engineers, scientists, and healthcare stakeholders to critically evaluate the present and future role of CE across a range of gastrointestinal (GI) applications, including inflammatory bowel disease, GI bleeding, coeliac disease, and colorectal cancer screening. Discussions explored the clinical impact of panenteric and colon capsule endoscopy, the potential of AI to enhance diagnostic performance and streamline workflows, innovations in capsule hardware, and the design of patient-centred diagnostic pathways. While conventional endoscopy continues to serve as the benchmark in many clinical scenarios, CE was recognized for its ability to improve access, acceptability, and scalability when deployed in appropriately selected populations. The symposium also identified key barriers to broader implementation, such as reinvestigation rates, absence of standardized quality indicators, limited real-world evidence for AI tools, and ongoing economic and environmental challenges. Overall, the meeting highlighted the importance of gradual, evidence-driven integration of CE, supported by robust validation, standardized metrics, close clinician-engineer collaboration, and meaningful incorporation of patient experience, to support the development of a safe, equitable, and sustainable pathway. Full article

Despite the growing interest in organic personal care products (OPCPs), their repurchase remains challenging, as product quality may be difficult to verify even after use. Integrating the theory of consumption values (TCV) with reference dependence theory (RDT), this study conceptualizes post-use loyalty as a comparative benchmarking process and positions comparative perceived quality (CPQ) as a mechanism linking realized values to repurchase intention (RPI). Using survey data from 298 OPCP consumers, we employed partial least squares structural equation modeling (PLS-SEM), necessary condition analysis (NCA), and importance–performance map analysis (IPMA). The results indicate that efficacy, hedonic, and health values are positively associated with RPI, whereas environmental value is associated with CPQ rather than directly with RPI. CPQ mediates the effects of efficacy and hedonic value on RPI, lending support to comparative evaluation in post-use loyalty formation. Consumer expertise also conditions these relationships, with environmental value more salient among higher-expertise consumers and hedonic cues more influential among lower-expertise consumers. NCA suggests threshold effects for stronger repurchase outcomes, while IPMA highlights consumer expertise as an important but underperforming lever. Overall, the study provides a diagnostic account of the trial–repurchase gap in OPCPs and offers insights into retention in sustainability-oriented credence-based categories. Full article

Background/Objectives: Pediatric HIV case-finding and monitoring remain constrained by delayed early infant diagnosis (EID), loss to follow-up, and limited viral load (VL) testing—challenges particularly consequential in the operationally diverse Asia–Pacific region. We systematically reviewed innovations in point-of-care (POC) and near-patient HIV diagnostics and digital monitoring relevant to children and adolescents. Methods: Following a registered protocol (INPLASY2025110058) and PRISMA 2020 guidance, we searched PubMed, EMBASE, Cochrane Library, and WHO Global Index Medicus for studies on POC/near-patient EID and VL testing, dried blood spot (DBS) workflows, and digital monitoring tools. Risk of bias was assessed using RoB 2, QUADAS-2, and MMAT. Results: Fifty-three primary studies were included (39 sub-Saharan Africa, 12 Asia–Pacific, 1 multi-country/global, 1 Americas/Caribbean). Patient selection and flow/timing were common limitations in diagnostic accuracy studies; sample representativeness and nonresponse bias were frequent concerns in implementation studies. The most consistent benefits of POC EID and near-patient VL testing were shorter turnaround times and improved cascade completion when paired with quality assurance and connectivity. Conclusions: POC diagnostics and digital monitoring can help close pediatric HIV cascade gaps, though evidence derives predominantly from sub-Saharan Africa. Impact depends on implementation design. Asia–Pacific programs should prioritize generating context-specific evidence alongside the adaptation of established lessons. Full article

Background/Objectives: Patients with cystic fibrosis (CF) have been reported to have eating disorders. This can contribute to poor weight gain, which can result in increased morbidity and mortality. The aim of this review is to understand the prevalence and impact of eating disorders (ED) and body image disturbance in the CF population. Methods: A review of the current literature on eating disorders in CF. Results: Disordered eating behaviors appear common in CF. However, it is unclear if the prevalence is greater or similar to that of the general population. Conclusions: Routine screening for eating disorders is important in the care of CF patients to help prolong survival and quality of life in this patient population. Full article

Background/Objectives: Epilepsy is a long-term condition that affects the brain and has a big impact on a person’s daily life, especially in areas where people do not have a lot of money or access to good healthcare. This study aimed to evaluate the relationship between medication adherence and QoL and to assess the role of seizure severity in the association between them among patients with epilepsy. Methods: A cross-sectional study of 1100 adult patients with epilepsy was conducted using registry data and structured interviews. The main outcomes that were assessed are quality of life (QoL), medication adherence, and seizure severity. Results: Reduced QoL was observed in 62% of patients. Low medication adherence was significantly associated with reduced QoL (OR = 4.33 [3.24–5.79] unadjusted; 3.90 [3.07–5.80] fully adjusted). Seizure severity was also associated with reduced QoL (OR = 1.62, p = 0.002; OR = 2.05, p < 0.001). Cognitive impairment showed the strongest association with reduced QoL, with ORs of 14.6 for mild and 80.8 for moderate-severe impairment in unadjusted models, remaining significant after adjustment. Medication adherence was significantly associated with seizure severity (OR = 1.18, p = 0.002), and attenuation of its effect after adjustment suggests that these variables are interrelated, although causality cannot be determined in this study. Additional factors associated with reduced QoL included lower education, longer disease duration, polytherapy, structural brain abnormalities, and comorbidities. Conclusions: Reduced QoL in epilepsy is strongly influenced by cognitive impairment and medication nonadherence, with seizure severity potentially contributing to this association, although causality cannot be inferred. These findings support integrated care strategies targeting adherence, cognition, and seizure control to improve patient outcomes. Full article

Background/Objectives: The objective of this study was to map and synthesize the current evidence on hemostasis in chronic and acute liver disease within the framework of Patient Blood Management (PBM). Methods: Because research in this field is heterogeneous—spanning mechanistic studies, observational data, randomized controlled trials, guidelines, and expert reviews—a scoping review was selected to comprehensively map concepts. Findings were synthesized narratively to reflect the breadth and heterogeneity of available research. Results: Hemostasis in liver disease is characterized by a fragile state of rebalanced coagulation, where parallel reductions in pro- and anticoagulant factors coexist with variable fibrinolytic disturbances and thrombocytopenia. Conventional coagulation tests (CCTs) do not accurately reflect bleeding risk, whereas viscoelastic assays and thrombomodulin-modified thrombin generation testing provide a more physiologic assessment, though with limitations. Most bleeding events arise from portal hypertension rather than coagulopathy, and the routine prophylactic correction of abnormal results of CCTs is not supported by evidence. PBM-aligned strategies—such as restrictive transfusion, targeted fibrinogen replacement, and use of thrombopoietin receptor agonists (TPO-RAs)—reduce unnecessary blood product use. Thrombosis burden is increasingly recognized in this patient population. Anticoagulation is generally safe when individualized to liver function and clinical context, however significant variability persists in clinical practice, and high-quality data remain limited for advanced disease. Conclusions: Hemostasis in liver disease reflects a dynamic and unstable equilibrium rather than a simple bleeding tendency. Diagnostic and therapeutic strategies grounded in PBM principles improve safety by avoiding unnecessary transfusion and emphasize individualized care. Despite advances in understanding rebalanced hemostasis, major gaps remain in predicting thrombotic risk, standardizing advanced coagulation testing, and defining optimal management across disease stages. Full article