Search Results (8,428)

Thoracoabdominal aortic aneurysms (TAAAs) are rare and often remain asymptomatic until rupture, leading to high morbidity and mortality. Elastin degradation, largely mediated by matrix metalloproteinases (MMPs), plays a central role in their pathogenesis. This study aimed to evaluate plasma desmosine (pDES), a specific biomarker of elastin breakdown, as a non-invasive tool for TAAA detection and risk stratification. In a prospective single-centre case–control study, 30 patients with TAAA and 30 age- and sex-matched controls were enrolled. Plasma pDES levels were quantified using liquid chromatography–tandem mass spectrometry (LC–MS/MS). Aortic wall samples from 12 patients were analysed for elastic fibre content and MMP expression by histology and western blotting. Statistical analyses included correlation testing, propensity score matching, and receiver operating characteristic (ROC) analysis. TAAA patients exhibited significantly higher pDES levels compared with controls (0.40 ± 0.31 vs. 0.22 ± 0.15 ng/mL; p < 0.001). pDES correlated positively with MMP-2 (ρ = 0.68, p = 0.02), TIMP-1 (ρ = 0.72, p = 0.01), and the proportion of elastic fibres in the aortic media (ρ = 0.61, p = 0.03). ROC analysis showed good diagnostic performance (AUC = 0.82), with a threshold of 0.27 ng/mL yielding 78.6% sensitivity and 76.7% specificity. Elevated pDES levels reflect aortic elastolytic activity and may serve as a promising biomarker for TAAA detection and risk assessment. Full article

Impulsive overtopping generated by dam-break surges is a critical hazard for dikes and flood-protection embankments, especially in reservoirs and mountainous catchments. Unlike classical coastal wave overtopping, which is governed by long, irregular wave trains and usually characterized by mean overtopping discharge over many waves, these dam-break-type events are dominated by one or a few strongly nonlinear bores with highly transient overtopping heights. Accurately predicting the resulting overtopping levels under such impulsive flows is therefore important for flood-risk assessment and emergency planning. Conventional cluster-then-predict approaches, which have been proposed in recent years, often first partition data into subgroups and then train separate models for each cluster. However, these methods often suffer from rigid boundaries and ignore the uncertainty information contained in clustering results. To overcome these limitations, we propose a GMM+MoE framework that integrates Gaussian Mixture Model (GMM) soft clustering with a Mixture-of-Experts (MoE) predictor. GMM provides posterior probabilities of regime membership, which are used by the MoE gating mechanism to adaptively assign expert models. Using SPH-simulated overtopping data with physically interpretable dimensionless parameters, the framework is benchmarked against XGBoost, GMM+XGBoost, MoE, and Random Forest. Results show that GMM+MoE achieves the highest accuracy ($R^2=0.9638$ on the testing dataset) and the most centralized residual distribution, confirming its robustness. Furthermore, SHAP-based feature attribution reveals that relative propagation distance and wave height are the dominant drivers of overtopping, providing physically consistent explanations. This demonstrates that combining soft clustering with adaptive expert allocation not only improves accuracy but also enhances interpretability, offering a practical tool for dike safety assessment and flood-risk management in reservoirs and mountain river valleys. Full article

Background/Objectives: Self-care is a cornerstone of healthy aging and chronic disease management; however, evidence on the most effective intervention models for improving quality of life in older adults with chronic non-communicable diseases (NCDs) remains fragmented. This review aimed to evaluate the effectiveness of self-care interventions in promoting quality of life and health outcomes in older adults with NCDs. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD420251040613). Randomized and non-randomized clinical trials published between 2019 and 2024 were retrieved from Scopus, Web of Science, and EBSCOhost. Eligible studies included adults aged ≥60 years with NCDs receiving self-care interventions. Data extraction and risk of bias assessment were independently performed using Joanna Briggs Institute tools. Results: Twenty-nine studies involving 7241 older adults were included. Self-care interventions comprised nurse-led educational programs, digital health strategies, community- and peer-based approaches, and person-centered care models. Multicomponent and continuous interventions demonstrated consistent improvements in physical and psychological domains of quality of life, self-efficacy, autonomy, symptom management, and treatment adherence. Digital interventions enhanced monitoring and engagement, although their effectiveness varied according to sensory and health literacy limitations. Conclusions: Structured, person-centered, and nurse-led self-care interventions are effective in improving quality of life and autonomy among older adults with NCDs. These findings support their integration into primary and community-based care, reinforcing their relevance for clinical practice, care planning, and the development of assistive and educational strategies in aging care. Full article

Objective: Visceral adipose tissue is a primary driver of insulin resistance and dysglycemia in type 2 diabetes (T2D), yet its clinical assessment remains challenging. This study aimed to validate neck circumference (NC) as a novel, practical anthropometric biomarker for estimating visceral fat area (VFA) and identifying metabolic risk in a T2D cohort, facilitating its integration into public health and primary care screening strategies. Methods: In a cross-sectional study of 1139 T2D patients, we collected data on NC, biochemical parameters (fasting plasma glucose, hemoglobin A1c, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides), and precisely measured VFA and subcutaneous fat area (SFA) via bioelectrical impedance analysis (Omron HDS-2000). We employed Pearson’s correlation and multivariate logistic regression to analyze the relationship between NC and metabolic indicators. Receiver operating characteristic (ROC) curve analysis was used to establish sex-specific NC cut-off values for predicting abnormal VFA. Results: The cohort comprised 687 (60.3%) males and 452 (39.7%) females. NC demonstrated strong positive correlations with VFA (p < 0.001), as did body mass index (BMI), waist–hip ratio (WHR), and SFA. In males, NC was further positively correlated with key metabolic biomarkers including fasting insulin, Insulin Resistance Index, triglycerides, and creatinine. ROC analysis identified NC > 39.5 cm for males and >35.5 cm for females as the optimal cut-off points for detecting abnormal visceral adiposity, highlighting its diagnostic utility. Conclusions: NC serves as a highly accessible and effective biomarker for visceral adiposity and associated metabolic dysfunction in patients with T2D. The established sex-specific cut-off values provide a simple, non-invasive tool for risk stratification in clinical and public health settings, enabling early intervention and improved management of metabolic disease. Full article

Background/Objectives: Trigeminal Neuralgia (TN) is a chronic neuropathic condition characterized by sudden, severe facial pain. Anticonvulsants are the cornerstone of pharmacological management, yet comparative evidence based on pharmacological class remains scarce. This systematic review aimed to evaluate the efficacy and safety of anticonvulsants in TN, stratified by their mechanism of action. Methods: A systematic search in PubMed, Scopus and Web of Science was conducted following PRISMA 2020 guidelines. Studies employing a pharmacological approach including human patients with TN, published in English since 2000, were included. Risk of bias was assessed using the Cochrane RoB 2, the ROBINS-I and the ROBINS-E tools, according to the study design. Results: Out of 922 initial records, 12 studies met the eligibility criteria. Sodium channel inhibitors showed high efficacy but frequent adverse effects, particularly hyponatremia and central nervous system symptoms. Calcium channel modulators offered a more favorable safety profile. Combination therapies showed benefits, levetiracetam and topiramate were moderately effective and well tolerated. Although the evidence has limitations, anticonvulsants continue to be the primary treatment for TN. Sodium-channel blockers demonstrate strong efficacy, whereas alternative agents generally provide superior tolerability. Conclusions: These findings support selecting drugs according to their underlying mechanisms of action. Equally important is tailoring therapy to pain phenotype and patient characteristics, balancing mechanism with tolerability and efficacy. Full article

Diet plays a central role in shaping the composition and metabolic activity of the oral microbiota, thereby influencing both oral and systemic health. Disturbances in this delicate host–microbe balance, triggered by dietary factors, smoking, poor oral hygiene, or antibiotic use, can lead to microbial dysbiosis and increase the risk of oral diseases such as periodontitis, as well as chronic systemic disorders including diabetes, cardiovascular disease, Alzheimer’s disease, and certain cancers. Among dietary contaminants, exposure to toxic heavy metals such as cadmium (Cd), lead (Pb), mercury (Hg), nickel (Ni), and arsenic (As) represents an underrecognized modifier of the oral microbial ecosystem. Even at low concentrations, these elements can disrupt microbial diversity, promote inflammation, and impair metabolic homeostasis. Saliva has recently emerged as a promising, non-invasive biofluid for monitoring nutritional status and early metabolic alterations induced by diet and environmental exposures. Salivary biomarkers, including metabolites, trace elements, and microbial signatures, offer potential for assessing the combined effects of diet, microbiota, and toxicant exposure. This review synthesizes current evidence on how diet influences the oral microbiota and modulates susceptibility to heavy metal toxicity. It also examines the potential of salivary biomarkers as integrative indicators of nutritional status and metabolic health, highlights methodological challenges limiting their validation, and outlines future research directions for developing saliva-based tools in personalized nutrition and precision health. Full article

Mining-induced seismicity presents significant challenges to the safety and operational continuity of underground mines, particularly in deep and highly stressed environments. This study proposes a methodological framework for seismic risk evaluation inspired by predictive-maintenance principles and applied to a high-resolution microseismic catalog from a Chilean underground mine. Using a combination of data filtering and correlation analyses, we identify the seismic parameters that control the most variability in the dataset: moment magnitude, frequency corner, and both dynamic and static stresses. Based on this, we perform a Principal Component Analysis (PCA), which clearly demonstrates the physical interconnection between the selected parameters, thereby helping to better characterize the seismic events and the mining environment. Using these results, a PCA-based risk map is constructed, enabling the delineation of zones with different levels of seismic risk. Additionally, a temporal tracking of potentially hazardous seismicity is included. The proposed methodology demonstrates that microseismic behavior can be effectively represented in a reduced-dimension space, offering a promising foundation for predictive and data-driven risk-assessment tools capable of supporting real-time decision-making in underground mining operations. Full article

The rapid advancement of Artificial Intelligence (AI) technologies has significantly transformed teaching, learning, and research practices within higher education institutions (HEIs). Although a growing body of literature has examined the application of AI in higher education, existing studies remain fragmented, often focusing on isolated tools or outcomes, with limited synthesis of best practices, core functionalities, and implementation challenges across diverse contexts. To address this gap, this systematic review aims to comprehensively examine the best practices, functionalities, and challenges associated with the integration of AI in HEIs. A comprehensive literature search was conducted across major academic databases, including Google Scholar, Scopus, Taylor & Francis, and Web of Science, resulting in the inclusion of 35 peer-reviewed studies published between 2014 and 2024. The findings suggest that effective AI integration is supported by best practices, including promoting student engagement and interaction, providing language support, facilitating collaborative projects, and fostering creativity and idea generation. Key AI functionalities identified include adaptive learning systems that personalize educational experiences, predictive analytics for identifying at-risk students, and automated grading tools that improve assessment efficiency and accuracy. Despite these benefits, significant challenges persist, including limited knowledge and skills, ethical concerns, inadequate infrastructure, insufficient institutional and management support, data privacy risks, inequitable access to technology, and the absence of standardized evaluation metrics. This review provides evidence-based insights to inform educators, institutional leaders, and policymakers on strategies for leveraging AI to enhance teaching, learning, and research in higher education. Full article

Background: Pulmonary infarction (PI) is the result of the occlusion of distal pulmonary arteries resulting in damage to downstream lung areas that become ischemic, hemorrhagic, or necrotic, and it is often a complication of an underlying condition such as pulmonary embolism (PE). Since in most of cases it is located peripherally, lung ultrasound (LUS) can be a good evaluation tool. The typical radiological features of PI are well-known; however, there are limited data on its sonographic characteristics and its evolution. Methods: The aim of this study is to evaluate, using LUS, a convenience sample of patients with acute PE with computed tomography (CT) consolidation findings consistent with PI. Patients’ clinical characteristics were collected and LUS findings at baseline and their short-term progression was assessed. LUS was performed within 72 h of PE diagnosis (T0) and repeated after one (T1) and four weeks (T2). Each procedure started with a focused examination of the areas of lesions based on CT findings, followed by an exploration of the other posterior and lateral lung fields. The convex probe was used for initial evaluation integrating LUS evaluation with the linear one was employed for smaller and more superficial lesions and when appropriate. Color Doppler mode was added to study vascularization. Results: From June to October 2023, 14 consecutive patients were enrolled at the Respiratory Unit of the University Hospital of Pisa. The main population characteristics included the absence of respiratory failure and prognostic high-risk PE (100%), the absence of significant comorbidities (79%), and the presence of typical symptoms, such as chest pain (57%) and dyspnea (50%). The average number of consolidations per patient was 1.4 ± 0.6. Follow-up LUS showed the disappearance of some consolidations and some morphological changes in the remaining lesions: the presence of hypoechoic consolidation with a central hyperechoic area (“bubbly consolidation”) was more typical at T1 while the presence of a small pleural effusion often persisted both at T1 and T2. A decrease in wedge/triangular-shaped consolidations was observed (82% at T0, 67% at T1, 24% at T2), as was an increase in elongated shapes, representing a residual pleural thickening over time (9% at T0, 13% at T1, 44% at T2). A reduction in size was also observed by comparing the mean diameter, long axis, and short axis measurements of each consolidation at the three different studied time points: the average of the short axes and the median of the mean diameters showed a statistically significant reduction after four weeks. Additionally, a correlation between lesion size and pleuritic pain was described, although it did not achieve statistical significance. Conclusions: Patients’ clinical characteristics and ultrasound features are consistent with previous studies studying PI at PE diagnosis. Most consolidations detected by LUS change over time regarding size and form, but a minority of them do not differ. LUS is a safe and non-invasive exam that could help to improve patients’ clinical approach in emergency rooms as well as medical and pulmonology settings, clinically contextualized for cases of chest pain and dyspnea. Future studies could expand the morphological study of PI. Full article

Background: Malnutrition is frequently under-investigated during remission in patients with Inflammatory Bowel Disease (IBD), despite its significant impact on clinical outcomes and quality of life. This study aimed to evaluate the increase in diagnostic performance of five nutritional screening tools (NSTs) when serially administered to IBD outpatients in sustained clinical remission. Methods: In this prospective, single-center cohort study, NSTs were administered, and body composition analysis was performed in IBD patients at baseline and after six months. At both time points, the sensitivity, specificity, predictive values, and accuracy of NSTs in detecting malnutrition and persistent malnutrition per ESPEN and GLIM criteria were evaluated, comparing repeated to single-point assessments. A sensitivity analysis using low FFMI as a reference was also performed. Results: Sixty-six IBD patients (32 Crohn’s disease; 34 ulcerative colitis) were enrolled. At baseline, 25.7% and 9% of patients were malnourished according to ESPEN and GLIM criteria, respectively, with 7.5% exhibiting low FFMI. Malnutrition prevalence increased over time to 53%, 16.6%, and 16.6%, respectively. Among NSTs, MUST and SaskIBD-NR consistently exhibited the highest specificity for malnutrition detection at baseline, at 6 months, and for persistent malnutrition for ESPEN, GLIM and low FFMI. Serial (repeated) NST administration markedly improved the specificity of all tools, compared to single-point assessments. Conclusions: Serial nutritional screening with MUST or SaskIBD-NR significantly enhances the specificity of malnutrition risk detection in IBD patients in remission, supporting the incorporation of repeated nutritional assessments into clinical practice to offer a practical strategy to enhance screening effectiveness in IBD outpatient care. Full article

Agricultural production remains highly susceptible to water-related risks, such as drought and flooding. Although hydrologic forecasting systems, such as the National Water Model (NWM), have advanced considerably, their outputs are rarely used for real-time agricultural decision-making. This study developed the Agricultural Water Risk Indicator (AWRI), a framework that translates NWM streamflow forecasts into crop-specific risk assessment indicators. The AWRI framework has three key components: (1) the hydrological threat and exposure characterization based on NWM streamflow forecasts (B1); (2) crop sensitivity by growth stage and water needs (B2); and (3) adaptive capacity reflecting the presence of irrigation or drainage infrastructure (B3). The AWRI was evaluated across three NWM reach IDs covering five farm sites in the Black Belt region of Alabama, USA. The results show that the AWRI captured variations in hydrologic conditions, risk, and crop tolerance across the research sites within the one- to four-week forecast range. Crops in the reproductive stage were especially sensitive. Without resilience measures, up to 55% of the crops simulated at some sites had high-risk AWRI categories. Including irrigation or drainage decreased risk scores by one to two levels. The AWRI tool provides farmers and stakeholders with critical information to support proactive agricultural water management. Full article

Nanotechnology is becoming a key tool in plant biotechnology, enabling nanoparticles (NPs) to deliver biomolecules with high precision and to enhance plant and tissue resilience under stress. However, the literature remains fragmented across genetic delivery, in vitro regeneration, stress mitigation, and germplasm cryopreservation, and it still lacks standardized, comparable protocols and robust long-term safety assessments—particularly for NP use in cryogenic workflows. This review critically integrates recent advances in NP-enabled (i) genetic engineering and transformation, (ii) tissue culture and regeneration, (iii) nanofertilization and abiotic stress mitigation, and (iv) cryopreservation of plant germplasm. Across these areas, the most consistent findings indicate that NPs can facilitate targeted transport of DNA, RNA, proteins, and regulatory complexes; modulate oxidative and osmotic stress responses; and improve regeneration performance in recalcitrant species. In cryopreservation, selected nanomaterials act as multifunctional cryoprotective adjuvants by suppressing oxidative injury, stabilizing cellular membranes, and improving post-thaw viability and regrowth of sensitive tissues. At the same time, NP outcomes are highly context-dependent, with efficacy governed by dose, size, and surface chemistry; formulation; plant genotype; and interactions with culture media or vitrification solutions. Evidence of potential phytotoxicity, persistence, and biosafety risks highlights the need for harmonized reporting, mechanistic studies on NP–cell interfaces, and evaluation of environmental fate. Expected outcomes of this review include a consolidated framework linking NP properties to biological endpoints, identification of design principles for application-specific NP selection, and a set of research priorities to accelerate the safe and reproducible translation of nanotechnology into sustainable plant biotechnology and long-term germplasm preservation. Full article

Background: Auricular defects resulting from congenital anomalies, trauma, or oncologic resection pose significant functional and psychosocial challenges. When autologous reconstruction is not feasible or not desired, implant-retained auricular prostheses represent a reliable alternative with high patient satisfaction. This study aimed to systematically evaluate the clinical performance of craniofacial implants used for auricular prosthetic rehabilitation, focusing on implant survival, prosthetic outcomes, workflow typologies, and complications. A secondary objective was to illustrate the long-term validity of a minimally invasive navigation technique through a clinical case with 6-year follow-up. Methods: A systematic review was conducted according to PRISMA guidelines. Clinical studies published between 2005 and 2025 reporting outcomes of implant-retained auricular prostheses were searched in PubMed and Scopus databases. Data were extracted on implant type, survival rates, prosthetic performance, workflow, and complications. Risk of bias was assessed using appropriate tools based on each study design. Results: A total of thirty-two studies were included, comprising fifteen case reports, fifteen case series, one cohort study, and one prospective observational study. Implant survival was consistently high across all workflow categories, with failures predominantly associated with irradiated or anatomically compromised bone. Prosthetic outcomes were favorable, showing excellent esthetics, stable retention, and high patient satisfaction irrespective of manufacturing method, although digital and navigation-assisted workflows improved reproducibility, symmetry, and planning precision. Complication rates were low and generally limited to mild peri-abutment inflammation manageable with conservative care. The clinical case confirmed these findings, showing stable osseointegration, healthy soft tissues, and uncompromised prosthetic function at 6-year follow-up. Conclusions: Implant-retained auricular prostheses show predictable long-term success, independent of whether traditional, hybrid, or fully digital workflows are employed. Digital technologies enhance surgical accuracy, minimize morbidity, and streamline prosthetic fabrication, although high-quality comparative studies remain limited. Full article

Background/Objectives: Energy availability (EA), defined as the dietary energy remaining after exercise energy expenditure (EEE), is a central determinant of both health and performance in athletes. Chronic insufficient EA leads to low energy availability (LEA), which is an underlying mechanism of Relative Energy Deficiency in Sport (REDs). This narrative review critically explores the conceptual evolution of EA and LEA, summarizes current physiological evidence, and discusses methodological and practical challenges in their assessment and application in free-living athletes. Methods: Evidence from experimental and observational studies was reviewed to describe the hormonal, metabolic, and performance outcomes associated with LEA. Screening tools, including the Low Energy Availability in Females Questionnaire (LEAF-Q) and the Low Energy Availability in Males Questionnaire (LEAM-Q), were also evaluated for their validity and applicability in different sports contexts. Results: LEA is associated with alterations in thyroid and reproductive hormones, which, in turn, contribute to reduced resting metabolic rate, lower bone mineral density, and delayed recovery. While screening questionnaires can help identify athletes at risk, their accuracy varies by sport and individual characteristics. Incorporating hormonal and metabolic biomarkers provides a more direct and sensitive method for detecting physiological stress. Measuring dietary intake, EEE, endocrine balance and body composition in real-world settings remains a major methodological challenge. Combining hormonal, metabolic, and behavioral indicators may improve the identification of athletes experiencing LEA. Conclusions: EA plays a central role in the interaction between nutrition, exercise, and athlete health, but methodological limitations in its assessment may compromise accurate diagnosis. Improving measurement techniques and adopting integrated monitoring strategies are essential to improve early detection, guide individualized nutrition, and prevent RED-related health and performance impairments. Full article

(1) Background: Drug–drug interactions (DDIs) are a frequent cause of medication-related harm, particularly in ambulatory care. Community pharmacists are uniquely positioned to identify and manage these risks. This study assessed DDI knowledge, practices, and barriers among community pharmacists in the Jazan Region, Saudi Arabia. (2) Methods: A structured, self-administered questionnaire was distributed to community pharmacists. The survey assessed DDI knowledge using 26 clinically relevant drug pairings and included questions on professional behavior, training exposure, software use, and educational needs. Descriptive and inferential statistics were applied to identify associations between knowledge scores and demographic or practice-related variables. (3) Results: A total of 219 pharmacists participated in the study. The mean knowledge score was (9.63 ± 4.58) out of 26, reflecting suboptimal to moderate awareness. Female pharmacists demonstrated significantly higher DDI knowledge scores than males (10.74 ± 5.4 vs. 9.08 ± 4.2; p = 0.016). Knowledge scores also differed significantly by academic qualification (p < 0.001), with PharmD holders scoring higher than B. Pharm and postgraduate degree holders. Pharmacists with less than 10 years of experience had significantly higher scores compared with those with longer practice duration (p = 0.002). Additionally, pharmacists who graduated from Saudi institutions scored higher than those trained outside Saudi Arabia (10.22 ± 4.7 vs. 8.44 ± 4.2; p = 0.005). Pharmacists who had received professional development training and those who attended workshops regularly also scored significantly higher. Familiarity with guidelines showed a positive trend. Reported barriers to effective DDI counseling included time constraints, limited patient understanding, and poor collaboration with prescribers. Self-rated awareness of DDIs was positively associated with actual knowledge scores. Pharmacists expressed strong preferences for workshops, online courses, and webinars as future training formats. (4) Conclusions: Pharmacists in the Jazan Region demonstrate moderate awareness of DDIs, with variation influenced by training, experience, and qualifications. Enhancing access to structured professional development and integrating clinical decision support tools could strengthen pharmacists’ role in preventing DDIs in community practice. Full article