Search Results (2,890)

Background/Objectives: This study aimed to examine personality profiles at the intrapsychic level (“Oneself”) in adult and older patients with cancer and to compare potential differences between these age groups. Methods: In this observational, cross-sectional comparative study, 273 patients with cancer (all disease stages) were categorized into two age groups: adults (40–64 years, n = 141) and older adults (≥65 years, n = 132). Personality was assessed using the Structural Analysis of Social Behavior (SASB) Form-A. Descriptive and inferential bivariate statistical analyses, including Chi-square tests and independent-samples t-tests, were performed to evaluate differences between the two age groups. To further examine the association between age group and SASB Cluster 1, a multivariable exploratory post hoc factorial General Linear Model (factorial GLM) was conducted. Results: Comparisons between adults and older adults revealed significant differences in socio-demographic backgrounds, with older patients being more frequently widowed and having lower educational attainment (both p < 0.001). Regarding personality dimensions, a significant difference was observed exclusively in SASB Cluster 1 (Autonomy-Assertive and Separating), with higher scores among older participants (4.4 vs. 3.9; p = 0.002). However, in the adjusted factorial GLM, the main effect of age group was no longer statistically significant (p = 0.054), and no significant two-way interactions emerged, including the age-group-by-education interaction (p = 0.222). This indicates that the initial unadjusted age-group association was attenuated after accounting for selected socio-demographic variables. No significant differences were found between the two groups in the remaining SASB Clusters. Conclusions: These findings caution against overestimating the role of chronological age as an isolated variable in psycho-oncological research. Personality differences in Cluster 1 co-occur with distinct cohort-specific and socio-demographic life-course profiles. Understanding how personality relates to shifting socio-demographic circumstances across the lifespan may support the development of more tailored, context-sensitive psycho-oncological interventions. Full article

Orofacial pain is a multifactorial condition that severely impacts basic functions and overall quality of life in patients, underscoring the need for non-opioid therapeutic strategies. Targeting the Transient Receptor Potential Vanilloid 1 (TRPV1) pathway has emerged as a biologically plausible approach, given its central role in nociceptive transduction and peripheral sensitization. Capsaicin, a selective TRPV1 agonist, induces receptor desensitization and has shown potential in chronic pain modulation; however, its efficacy in orofacial conditions remains unclear. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of capsaicin in managing orofacial pain, compared to placebo or other pharmacological interventions. Following PRISMA guidelines, a comprehensive search of five databases (PubMed, Scopus, Web of Science, CDSR, and LILACS) was conducted without language or date restrictions. Studies involving human participants with orofacial pain treated with capsaicin were included. The protocol was registered in PROSPERO (CRD420251004538). Risk of bias was assessed using the RoB2, RoB2 crossover trial and ROBINS-I checklist, and meta-analyses were performed using random-effects models. Nine studies enrolling a total of 164 participants met the eligibility criteria and encompassed temporomandibular disorders, burning mouth syndrome, oral mucositis, trigeminal neuralgia, and neuropathic facial pain. Although placebo-controlled comparisons showed a trend toward pain reduction that did not reach statistical significance (MD = –1.87; [95% CI: –3.94, 0.19]; p = 0.08; I² = 86%), and no significant difference was found between capsaicin concentrations (MD = 0.46; [95% CI: –2.67, 3.60]; p = 0.77, I² = 66%), pre–post analyses of uncontrolled (single-arm) studies demonstrated a significant and clinically meaningful reduction in pain following capsaicin treatment (MD = –6.39; [95% CI: –7.40, –5.38; p < 0.001, I² = 0%). Capsaicin also showed an acceptable safety profile: although adverse events were significantly more frequent than with control (OR = 19.84; [95% CI: 4.32–91.21]; p < 0.001, I² = 0%), these were mild, localized, and self-limited. Capsaicin may provide clinically meaningful pain relief in selected orofacial conditions, particularly burning mouth syndrome, where uncontrolled evidence was most consistent (I² = 0%); evidence for temporomandibular disorders was more heterogeneous and did not reach significance in pooled placebo-controlled analyses. Full article

Malnutrition, a key factor in oncology, affects 20–70% of cancer patients and influences both cancer risk and outcomes, being linked to decreased treatment tolerance, higher toxicity, lower quality of life, and shorter survival. Although international guidelines recommend early and systematic nutritional screening, its adoption in clinical practice remains inconsistent. This study, promoted by the Italian College of Hospital Medical Oncology Directors (CIPOMO), aimed to provide a national snapshot of current organizational practices regarding nutritional screening, assessment, and management in Italian oncology centers. A 15-item survey was sent to 165 centers to investigate organizational practices and awareness of nutrition and physical activity in cancer care. Data were collected and analyzed as overall percentages. A total of 100 centers responded (61%). Although a nutritional assessment is routinely conducted at diagnosis in 67% of centers (n = 67), only 31 centers perform it for all patients. The remaining centers limit nutritional assessment to high-risk or selected patient groups. Moreover, although 86% of centers have dedicated professionals, multidisciplinary integration remains limited. Validated nutritional screening tools are used in 69% of centers, but follow-up reassessment is rarely systematic (15%). However, awareness of the importance of nutrition is high, with nearly all centers supporting educational interventions and dedicated nutritional pathways. Despite this high level of awareness, a significant gap remains between guideline recommendations and daily clinical practice. Standardizing early nutritional screening, enhancing multidisciplinary collaboration, and ensuring equitable and consistent access to nutritional services are crucial to fully integrating nutrition into oncology care and improving patient outcomes. Full article

Background/Objectives: Sagittal spinal alignment is a key determinant of function and quality of life in degenerative spinal disorders. While age is an established determinant of sagittal balance, the independent contribution of BMI remains insufficiently characterized, particularly in degenerative scoliosis cases. This study aimed to investigate the association between BMI and sagittal alignment, quantify its effect relative to age, and explore potential sex-specific differences. Methods: This retrospective single-center study included 293 adults with degenerative scoliosis who underwent standing full-spine EOS imaging. Multivariable linear regression models assessed the association between BMI and sagittal vertical axis (SVA), adjusting for age, sex, diabetes mellitus, and osteoporosis. Secondary analyses examined associations with coronal deformity (Cobb angle) and lumbar degeneration (Wilke score). Sex-stratified analyses and Receiver Operating Characteristic (ROC) analyses for sagittal decompensation were also performed. Results: The cohort had a median BMI of 26.2 kg/m² (56% female; median age 71 years). Median SVA measured 56.4 mm (interquartile range 30.6–87.1), and 58% of patients exhibited sagittal decompensation. In sex-stratified analyses, higher BMI was independently associated with greater SVA in women (p = 0.015), whereas no significant association was observed in men (p = 0.061). ROC analysis demonstrated limited overall discrimination; however, a BMI ≥ 35 kg/m² showed high specificity and positive predictive values exceeding 80% for sagittal decompensation. Conclusions: BMI is independently associated with sagittal alignment in degenerative scoliosis and contributes to sagittal decompensation to a degree comparable to age. These findings suggest that body weight represents a clinically relevant biomechanical factor that should be considered alongside age and spinopelvic parameters when interpreting sagittal alignment, although BMI’s limited discriminatory performance for sagittal decompensation precludes its use as a standalone screening tool. Full article

Background: Orofacial pain (OFP) comprises a heterogeneous group of conditions with overlapping clinical manifestations that frequently complicate diagnosis and therapeutic decision-making. Diagnostic inaccuracies may contribute to delayed management, unnecessary dental procedures, and reduced quality of life. Despite the availability of standardized classifications and diagnostic criteria, their translation into routine clinical practice remains variable. Aim: This systematic review aimed to systematically identify, describe, and critically evaluate diagnostic frameworks proposed for the differential diagnosis of OFP. Diagnostic frameworks were broadly defined as structured approaches to clinical decision-making, including clinical practice guidelines (CPGs), classification systems, clinical algorithms, consensus documents, and other explicit diagnostic models. The review focused on their methodological quality, evidentiary support, clinical applicability, and operational utility in dental practice. Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases were searched using predefined terms related to OFP. Eligible studies included investigations assessing diagnostic protocols, clinical decision-making frameworks, or therapeutic implications in patients with OFP. Non-systematic expert opinions, editorials, and book chapters were excluded from the analysis. Data extraction and qualitative synthesis were performed independently by the reviewers. Results: A total of 184 records were identified through database searching. After duplicate removal and eligibility assessment according to the PRISMA flowchart, 12 studies were included in the qualitative synthesis. Additionally, the International Classification of Orofacial Pain (ICOP) was used as an external contextual reference framework and was not included in the PRISMA study count. The included studies demonstrated marked heterogeneity in diagnostic approaches, including theoretical, pathophysiological, clinical reasoning, classification-based, and algorithm-driven frameworks. Methodological quality was generally moderate to high. The scope and clarity domains showed the strongest performance, whereas development rigor remained limited across studies. Overall, clinically applicable frameworks frequently lacked methodological rigor. Conclusions: Current diagnostic frameworks for OFP remain methodologically heterogeneous and vary considerably in their degree of operationalization and empirical validation. Future diagnostic frameworks and CPGs should incorporate standardized terminology, reproducible diagnostic criteria, structured examination pathways, and clinically applicable recommendations to improve diagnostic consistency and facilitate implementation in routine practice. Full article

Background: Heart failure (HF) substantially affects health-related quality of life (HRQoL), but evidence across left ventricular ejection fraction (LVEF) categories in Jordan remains limited. Methods: This multicenter cross-sectional study included 516 adults with HF attending outpatient cardiac clinics in northern Jordan between May and November 2025. SF-36 Version 1.0 items were recoded to eight 0–100 domains, and unweighted SF-36 physical and mental four-domain composite scores were analyzed using expanded multivariable ordinary least-squares models with HC3 robust standard errors. A total of 476 participants had complete data for all model variables. Results: The mean SF-36 physical and mental four-domain composite scores were 48.80 (SD 21.14) and 51.88 (SD 20.57), respectively. Both scores differed across EF categories before adjustment (physical p < 0.001; mental p < 0.001), but the adjusted EF omnibus tests were not significant (physical p = 0.111; mental p = 0.613). Lower physical scores were associated with NYHA class II and III, physical inactivity, sleeping difficulty, retirement, and higher anxiety and depression scores, whereas self-care efficacy was positively associated with physical HRQoL. Lower mental scores were associated with NYHA class II and III, physical inactivity, and higher anxiety and depression scores, while self-care efficacy was positively associated with mental HRQoL. Conclusions: In this cross-sectional sample, functional limitation, anxiety and depressive symptoms, physical inactivity, and self-care efficacy were more consistently associated with HRQoL than EF category after adjustment. These findings support multidimensional assessment alongside cardiac measures. Full article

Background/Objectives: Hip ultrasound is the standard screening method for developmental dysplasia of the hip (DDH) in infants, yet sonographic acetabular rim irregularities (SARIs) remain understudied regarding their prevalence and clinical associations. Methods: A total of 1010 infants within the first four months of life, referred to a specialized pediatric orthopedic hip clinic between 2014 and 2019 for suspected or confirmed DDH, were included in this retrospective cohort study. Hip ultrasound was performed using the standardized Graf technique. Clinical, demographic, and sonographic data were extracted from patient records. Two pediatric orthopedic specialists assessed all ultrasound hip images for the presence of an SARI and measured its relative size (d/D). Associations among SARI, patient characteristics, and sonographic parameters were analyzed using appropriate univariate and multivariable statistical methods (p < 0.05). Results: We identified SARI in 9.11% of all hips and in 13.07% of all infants, with many developing during Pavlik harness treatment. Univariate and multivariate analyses revealed cesarean delivery as an independent factor associated with SARI occurrence. SARIs that developed over time had a significantly larger d/D ratio compared with those that were visible from the very beginning (p = 0.04). Conclusions: These findings establish a baseline prevalence and highlight potential risk markers for SARI in a dysplasia-enriched cohort. Further prospective studies are warranted to elucidate the clinical significance of SARI and its impact on treatment outcomes and hip development. Full article

This cross-sectional observational study with prospectively collected outcome data compared speech recognition in noise and patient-reported outcomes in adults with single-sided deafness (SSD) who had previously received either a Baha Connect or an Osia bone-conduction hearing implant. Thirty-five patients were invited, of whom 32 had complete data available for analysis (questionnaires alone: n = 34). Speech-in-noise performance was assessed using the Digits-in-Noise test and expressed as the speech reception threshold at 50% intelligibility (SNR50) in frontal and side presentation conditions. Subjective hearing benefit and hearing-related quality of life were evaluated using the Glasgow Benefit Inventory, the Abbreviated Profile of Hearing Aid Benefit, and the Speech, Spatial and Qualities of Hearing Scale. No significant differences were observed between Baha Connect and Osia users in aided SNR50 thresholds or in any patient-reported outcome measure. A linear mixed-effects model showed a significant interaction between listening condition and presentation side (p = 0.023), indicating that speech-in-noise benefit depended on the spatial listening configuration rather than on device type. Both groups reported positive subjective outcomes, although spatial hearing remained the lowest-rated domain. Correlations between SNR50 improvement and questionnaire scores were weak and non-significant (Spearman’s ρ < 0.20; p > 0.29), suggesting that objective speech-in-noise improvement and perceived benefit capture partly different aspects of hearing rehabilitation. Baha Connect and Osia provided comparable objective and subjective outcomes in adults with SSD. Therefore, device selection should not be based solely on expected speech-in-noise performance, but should be guided by patient-specific surgical, practical and lifestyle factors. Full article

Background: Active surveillance (AS) represents a cornerstone of personalized medicine in uro-oncology, offering an individualized management strategy for low- and selected favourable intermediate-risk prostate cancer that aligns treatment intensity with patient-specific risk profiles; however, real-world adherence data from southern European academic centres remain scarce. This study aimed to evaluate AS discontinuation rates, reasons for transition to active treatment, and quality of life (QoL) in a single-centre Greek university hospital cohort. Methods: This is an observational retropective cohort study of patients enrolled in an AS protocol at the First Department of Urology, Aristotle University of Thessaloniki, between October 2016 and July 2022. Treatment-free survival (TFS) was estimated using Kaplan–Meier analysis. Associations between AS discontinuation and age at diagnosis, PSA level, and Charlson Comorbidity Index (CCI) were explored using univariable and multivariable Cox proportional hazards regression. QoL, erectile function, and anxiety were assessed cross-sectionally in patients remaining on AS using SF-12, IIEF-6, STAI-6, and MAX-PC. Results: Thirty-six patients were included (32 low-risk; 4 favourable intermediate-risk), with a median age of 69.5 years, median PSA of 6.92 ng/mL, and median CCI of 3. After a median follow-up of 24 months (IQR 21–45), 19 patients (52.8%) transitioned to active treatment; the median time to treatment was 21 months (IQR 17–34). Among the 10 patients with a known reason for discontinuation, 6 (31.6% of all discontinued) showed histopathological or clinical disease progression, 3 (15.8%) had a PSA increase alone, and 1 (5.3%) transitioned due to urinary symptoms; the reason was unknown in 9 cases (47.4%). In exploratory Cox regression, PSA ≥ 7.0 ng/mL was the only factor with complete documented output significantly associated with transition to active treatment (univariable HR 3.70, 95% CI 1.35–10.1, p = 0.011; multivariable HR 3.93, 95% CI 1.42–10.9, p = 0.008). Cross-sectional QoL assessment in 10 patients remaining on AS demonstrated median scores above established population norms for SF-12 and below clinical anxiety thresholds on STAI-6 and MAX-PC. Conclusions: In this single-centre cohort, AS discontinuation occurred early and at a rate higher than that of established international programmes, consistent with the institution’s initial AS experience. Higher PSA at diagnosis was the only factor with complete analytical documentation to be significantly associated with earlier transition. Full article

Microalgal lipid production requires cultivation strategies that reduce freshwater demand while maintaining biomass productivity and improving the quality of fatty acid methyl ester (FAME) profiles for downstream applications. In this context, salinity is a relevant but still insufficiently characterized factor, particularly for Auxenochlorella protothecoides, whose response to salt stress in terms of growth dynamics, lipid productivity, and FAME composition remains poorly understood. This study investigated the effect of NaCl concentrations ranging from 0 to 50 g L⁻¹ on the growth, lipid accumulation, FAME profile, and predicted biodiesel-related properties of A. protothecoides. Growth kinetics were described using logistic and Gaussian models. The highest carrying capacity was observed at 10 g L⁻¹ NaCl, whereas the modeled optimum for specific growth rate occurred under moderate salinity, close to 20 g L⁻¹ NaCl. Lipid analyses showed that C16–C18 fatty acids (FAs) dominated across treatments, accounting for more than 90% of total FAMEs, and that increasing salinity shifted the profile from a more saturated C16:0-rich composition toward higher proportions of unsaturated C18 FAs, particularly oleic and linoleic acids. Biodiesel property estimations indicated that mild salinity (5 g L⁻¹) improved some fuel-relevant parameters relative to the other salinity treatments, including cetane number, iodine value, cold-flow-related properties, and oxidative stability. Nevertheless, the predicted viscosity values were below the EN 14214 specification range for all treatments, and oxidative stability at 5 g L⁻¹ only marginally met the European minimum requirement, indicating partial rather than full compliance with biodiesel standards. These findings indicate that salinity can be used as a practical tool to tune biomass production and lipid quality in A. protothecoides, supporting its potential use in microalgal biorefineries and oleochemical applications. Furthermore, the ability of the strain to tolerate saline conditions may support the future use of brackish water, seawater, or saline waste streams, potentially reducing freshwater demand; however, this environmental benefit was not quantified in the present study and should be validated through dedicated water-footprint or life-cycle assessment. Direct biodiesel application also remains limited by incomplete compliance with fuel standards, and further optimization through cultivation in real saline or wastewater-based media, process scale-up, blending, or downstream upgrading will be required to improve industrial feasibility. Full article

Ferrofluid seals provide non-contact operation, low friction, and strong sealing performance in high-speed rotating equipment and liquid-sealing systems. However, high speed, liquid contact, thermal loading, vibration, and eccentricity can cause ferrofluid loss, performance degradation, leakage, and premature failure. Here, intelligent reliability denotes a reliability-centered framework that integrates condition monitoring, physically interpretable health assessment, fault diagnosis, uncertainty-aware prognosis, condition-based maintenance, and feedback-driven active control. This structured review synthesizes centrifugal, thermal, liquid-medium, eccentricity-related, and material-degradation mechanisms and evaluates pressure, leakage, temperature, torque, vibration, and acoustic-emission signals. It also assesses health indicators, diagnostic methods, remaining useful life (RUL) prediction, maintenance decisions, and health-management strategies. Its principal contribution is a framework linking degradation physics with observable evidence, health assessment, diagnosis, prognosis, and maintenance and design feedback. The framework also distinguishes direct ferrofluid-seal evidence from transferable methods and supports sensor selection, indicator design, validation planning, and intervention development. Key limitations include scarce public degradation datasets, inconsistent evaluation protocols, weak physical consistency of health indicators, and limited closed-loop implementation. Future work should prioritize public run-to-failure data, physics-informed multisource assessment, uncertainty-aware RUL prediction, and experimentally validated condition-based interventions and active-control strategies. Full article

Tourism is carbon-intensive, with transport and mobility driving much of its greenhouse-gas emissions, yet destination-level evidence on carbon hotspots and decarbonization from a supply-chain perspective remains scarce, especially in developing regions. This study examines low-carbon tourism supply chain management in seven purposively selected provinces of Northeastern Thailand (Isan) using a qualitative-dominant convergent mixed-methods design that integrates demand- and supply-side evidence. A visitor survey yielded 74 open-ended responses (60 complete questionnaires), alongside seven semi-structured key-informant interviews with tourism supply chain operators across the seven provinces. Quantitative data were analyzed with descriptive statistics, and qualitative data with thematic analysis using qualitative data analysis software, drawing on code-frequency and co-occurrence analysis; the two strands were triangulated in joint displays. Visitors reported moderate satisfaction (grand mean 3.91 on a five-point scale) but rated environmental management and safety lowest, engaging with sustainability through visible service cues rather than emissions. Key informants identified perceived carbon hotspots, carrying capacity, and seasonality as dominant concerns, attributing the destination’s footprint chiefly to transport dependence (informant-reported estimates ranging from approximately 80% to nearly 100% private-car arrivals, amid limited public transport) and accommodation energy; these hotspots reflect stakeholder perceptions rather than measured emissions, as no carbon accounting, environmentally extended input–output analysis, or life-cycle assessment was conducted. Integration revealed a demand–supply perception gap and five proposed, interdependent low-carbon pathways: coordinated mobility, accommodation energy efficiency, strengthened local procurement, carrying-capacity and waste management, and multi-stakeholder governance. The findings offer a developing-region, supply-chain-oriented basis for future tourism decarbonization research and practice. Full article

Concrete mix design increasingly requires rapid screening of mixture proportions against mechanical and resource-efficiency targets. This study develops an explainable, cement-reduction-oriented computational screening framework based on the UCI Concrete Compressive Strength dataset. The dataset records Portland cement, fly ash, blast furnace slag, aggregates, water, superplasticizer, curing age, and compressive strength, but does not report clinker factor, material-specific emission factors, or durability performance. Cement dosage is therefore minimized only as a surrogate objective; the study does not claim quantified embodied-carbon optimization. A LightGBM surrogate was trained using raw mixture variables and domain-informed ratios. On the held-out test set, the model achieved an $R^2$ of 0.946 and a mean absolute error of 2.639 MPa. Shapley Additive Explanations were used to examine the statistical influence of mixture variables, with the water-to-binder ratio emerging as the dominant predictor. Constraint-filtered Monte Carlo sampling and non-dominated sorting were then used to screen Pareto-efficient binder allocations. For a 28-day target of 45 MPa, repeated searches identified candidates with a mean Portland cement dosage of $164.4 {\mathrm{kg/m}}^3$, 44.2% below the mean of empirical mixtures in the same strength band. The evaluated numerical modules were embedded in a Streamlit prototype in which a DeepSeek large language model performs only intent parsing and report generation. The main contribution is this tool-augmented separation of language interaction from deterministic engineering computation. The resulting mixtures remain computational candidates and should next be validated experimentally and assessed using material-specific life-cycle carbon and durability data. Full article

Natural fibre-reinforced polymer biocomposites are increasingly considered for construction applications because of their renewable reinforcement, low density and potentially reduced environmental impact. Their durability, however, is strongly constrained by moisture, which promotes fibre swelling, weakens the fibre–matrix interphase and creates conditions favourable to fungal colonisation. This review examines the effects of moisture and biodeterioration on the structural and thermal performance of natural fibre-reinforced polymer composites used in construction. Across the reviewed studies, moisture and hygrothermal ageing produced tensile-strength reductions ranging from less than 10% to approximately 40%, while losses in stiffness or impact performance exceeded 40–70% in particularly susceptible systems. In contrast, directly comparable quantitative data linking fungal biodeterioration with changes in thermal conductivity remain scarce, representing a major research gap. Current durability standards, particularly ISO 846:2019, provide useful screening data but do not fully reproduce the cyclic hygrothermal conditions experienced by porous, hygroscopic construction biocomposites. More reliable durability assessment requires integrated microbiological, hygrothermal, mechanical and microstructural testing supported by advanced non-destructive diagnostics. Protection strategies should combine moisture control and biological resistance while considering long-term service performance, environmental impacts, recyclability and end-of-life constraints. Full article

Background: Chronic rhinosinusitis (CRS) impairs the quality of life (QoL), but its impact and risk factors remain unknown among Iraqis, including medical students. We aim to assess the QoL using the Sino-Nasal Outcome Test-22 (SNOT-22) in CRS-affected Iraqi medical students, categorize impairment severity, and identify associated correlates via multivariable analysis. Methods: We surveyed 435 Iraqi undergraduates with CRS to identify QoL correlates, SNOT-22 severity strata, associated symptoms, seasonality, and treatment history. Data analysis, including multivariable models, was conducted in IBM SPSS version 27. Results: Among 435 surveyed individuals, 76.6% had impaired QoL. Binary logistic regression identified key correlates: immune disturbances (OR = 2.68; p = 0.028), family history (OR = 2.12; p = 0.003), chronic comorbidities (OR = 2.07; p = 0.037), and pre-clinical (basic) educational level (OR = 1.95; p = 0.007). In sex-stratified models, chronic comorbidities predominated in females (OR = 4.64; p < 0.001) and immune disturbances in males (OR = 3.89; p = 0.014). Ordinal regression confirmed immune disturbances (β = 0.65; p = 0.017), chronic comorbidities (β = 0.58; p = 0.023), and family history (β = 0.57; p = 0.003). Logistic and ordinal regression exhibited good model fitting (p > 0.05) and showed comparable statistical accuracy (76.8% vs. 76.1%). Conclusions: Impaired QoL was common among CRS-affected medical students, with immune disturbances and family history as the strongest correlates. Sex-specific differences existed. Findings highlight the need for personalized management of high-risk groups. Full article