Search Results (2,764)

Background: Ambulatory blood pressure monitoring (ABPM) is increasingly recognized as a more reliable indicator of blood pressure status in children than clinic-based measurements, with superior predictive value for cardiovascular morbidity and mortality. However, evidence on the clinical utility of ABPM-derived indices, such as pulse pressure (PP), pulse pressure index (PPI), rate pressure product (RPP), ambulatory arterial stiffness index (AASI), and average real variability (ARV), remains underexplored in the pediatric population, particularly among children with chronic kidney disease (CKD). Objective: To evaluate the correlation between ABPM-derived indices in children, with a subgroup analysis comparing those with and without CKD. Secondary objectives included identifying factors associated with AASI and ARV and assessing their utility in cardiovascular risk stratification. Methods: In this bicentric cross-sectional study, 70 children (41 with CKD and 29 controls) were enrolled. ABPM indices (PP, PPI, RPP, AASI, and ARV) were calculated, and both descriptive and inferential statistical analyses, including linear regression, were performed. Results: Systolic and diastolic hypertension were significant predictors of elevated ARV (p < 0.05), while body mass index (BMI) and glomerular filtration rate (GFR) were positively associated with AASI (p < 0.05). Use of angiotensin-converting enzyme inhibitors (ACEIs) was associated with reduced arterial stiffness (p = 0.02). Significant differences were observed in weight, BMI, PP, and PPI between the CKD and non-CKD groups, with ABPM demonstrating greater sensitivity in detecting vascular health markers. Conclusions: ABPM-derived indices, particularly PP, PPI, and ARV, show promise in improving cardiovascular risk assessment in children. These findings support the broader use of ABPM metrics for refined cardiovascular evaluation, especially in pediatric CKD. Full article

Teacher mental health is a growing concern in educational and public health systems worldwide. This meta-analysis systematically examines the relationship between teacher self-efficacy—a core construct in social cognitive theory—and job satisfaction, both considered crucial indicators of occupational well-being. A total of 39 studies involving teachers across 18 countries were analyzed, yielding a significant positive correlation between self-efficacy and job satisfaction (r = 0.41, p < 0.001), with notable heterogeneity (I² = 97%). Subgroup analyses revealed that the relationship was significantly stronger among teachers in high school and post-secondary contexts, and in studies conducted in Southern Hemisphere countries, highlighting the role of contextual and systemic moderators such as educational level and geographic inequality. The findings underscore the need for school- and policy-level interventions that bolster teachers’ self-efficacy through professional development, emotional support, and improved working conditions. Such interventions are essential not only for enhancing job satisfaction and reducing attrition but also for promoting the psychological resilience and well-being of the global teaching workforce. The study provides evidence-based insights into education and health policymakers aiming to support teacher retention and mental health through scalable, targeted initiatives. Full article

Background: The mechanisms linking loneliness to frailty in older adults with diabetes remain unclear. Guided by the Loneliness–Health Outcomes Model, this study is the first to simultaneously validate the dual mechanisms (mediation and moderation) of social support in the loneliness–frailty relationship among older Chinese adults with diabetes. Methods: A cross-sectional study enrolled 442 community-dwelling adults aged ≥ 60 years with type 2 diabetes in Beijing. Standardized scales assessed loneliness (UCLA Loneliness Scale), frailty (Tilburg Frailty Indicator), and social support (SSRS). Analyses included Pearson’s correlations, hierarchical regression, and PROCESS macro to evaluate mediating/moderating effects, after adjusting for demographics and comorbidities. Results: The frailty prevalence was 55.2%. Loneliness was positively correlated with frailty (r = 0.327, p < 0.01), while social support showed inverse associations with both loneliness (r = −0.496) and frailty (r = −0.315) (p < 0.01). Social support partially mediated loneliness’s effect on frailty (indirect effect: 30.86%; 95% CI: 0.028–0.087) and moderated this relationship (interaction β = −0.003, p = 0.011). High-risk clusters (e.g., aged ≥ 80 years, widowed, and isolated individuals) exhibited combined “high loneliness–low support–high frailty” profiles. Conclusions: Social support reduces the frailty risk through dual mechanisms. These findings advocate for tiered clinical interventions: (1) targeted home-visit systems and resource allocation for high-risk subgroups (e.g., solo-living elders aged ≥80 years); and (2) the integration of social support screening into routine diabetes care to identify individuals below the protective threshold (SSRS < 45.47). These findings advance psychosocially informed strategies for diabetes management in aging populations. Full article

Background: The atherogenic index of plasma (AIP), a prognostic indicator for cardiovascular disease, has not been fully explored in relation to clinical outcomes in patients receiving peritoneal dialysis. This study aims to elucidate the relationship between baseline AIP levels and all-cause mortality, cardiovascular mortality, and the peritonitis risk in this population. Methods: This retrospective cohort study included incident peritoneal dialysis patients in our center from 1 January 2006 through 31 December 2021. The end of the follow-up time was 31 December 2023. The participants were stratified by baseline AIP levels. Kaplan–Meier curves, Cox regression analyses, and subgroup analyses were used to evaluate associations with clinical outcomes. Results: The average age of the 2460 participants in this study was 45.9 years, and 1456 (59.2%) of them were men. Diabetic nephropathy (19.5%) was the second most common kidney disease, after primary glomerulonephritis (60.8%). The higher AIP tertile group was significantly associated with increased risks of all-cause mortality, cardiovascular mortality, and peritonitis compared to the lowest AIP group, as evidenced by the Kaplan–Meier curves and the multivariate analyses. Continuous AIP levels also showed a positive correlation with the all-cause mortality and peritonitis risk, even after controlling for covariates. Conclusions: Our study highlights AIP as a predictive marker for adverse outcomes in PD patients, emphasizing its potential utility in risk stratification and clinical management. Full article

The prognosis of sarcopenia is poor in cancer patients. Recently, urinary titin, a biomarker of muscle damage, has been suggested as a potential marker for sarcopenia. However, its utility in patients with unresectable digestive malignancies remains unclear. In addition, sex differences have been reported in the association between sarcopenia and urinary titin levels. This study aimed to evaluate urinary titin as a diagnostic marker for unresectable digestive malignancies, focusing on sex differences. This retrospective study enrolled 96 patients (58 males, 38 females; median age 70), and urinary titin was evaluated as a diagnostic biomarker in relation to clinical factors (e.g., age, Eastern Cooperative Oncology Group performance status [ECOG PS], albumin [Alb]) and muscle indicators (e.g., psoas muscle index [PMI], handgrip strength). In male patients, urinary titin levels were significantly higher in the sarcopenia subgroup (5.78 vs. 2.79 pmol/mgCr, p = 0.008), and multivariate analyses identified urinary titin as an independent predictor of sarcopenia (odds ratio 13.4, p = 0.028). The receiver operating characteristic (ROC) analysis demonstrated fair diagnostic performance (area under the curve [AUC] 0.729), with an optimal cutoff value of 3.676 pmol/mgCr. Urinary titin may serve as a useful non-invasive diagnostic biomarker for sarcopenia in patients with unresectable digestive malignancies, particularly in males. These findings suggest that sex-specific approaches are required for sarcopenia assessment with urinary titin. Full article

Background/Objectives: In this study, we aimed to evaluate probiotics’ clinical efficacy and safety in adults with chronic rhinosinusitis (CRS), and summarize mechanistic evidence related to mucosal immunity and microbiota modulation. Methods: We performed a systematic review and random-effects meta-analysis. MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library were searched until May 2025. Eligibility: Randomized controlled trials (RCTs) and mechanistic studies investigating probiotics (any strain, dose, or administration route) in adults with CRS were eligible. Primary outcomes included changes in Sino-Nasal Outcome Test (SNOT-20/22) scores and CRS relapse rates. Secondary outcomes were adverse events and mechanistic endpoints. Results: Six studies (four RCTs, n = 337; two mechanistic studies) met the inclusion criteria. Probiotics did not significantly improve SNOT scores compared with the placebo, but trended in that direction (pooled mean difference—2.70; 95% CI −7.12 to 1.72; I² = 0%). Furthermore, probiotic use was associated with a non-significant trend towards fewer CRS relapses (risk ratio 0.41; 95% CI 0.16–1.04; p = 0.06; I² = 48%). Adverse events were mild and comparable to the placebo (risk ratio 0.87; 95% CI 0.33–2.34). Mechanistic data indicated that intranasal Lactococcus lactis W136 might downregulate type 1 inflammatory pathways and modestly increase microbiome diversity. Subgroup analyses (by route, duration, and CRS subtype) revealed no statistically significant effect modifiers, though mechanistic insights suggest possible differences in efficacy based on the CRS endotype and delivery method. Conclusions: Probiotics appear safe and may provide a small, non-significant improvement in CRS symptoms; emerging evidence of reduced relapse rates warrants further investigation through larger, endotype-stratified trials utilizing targeted probiotic strains and optimized delivery methods. Full article

Background: Electronic patient-reported outcomes (ePROs) enable real-time symptom monitoring and early intervention in oncology. Large language models (LLMs), when combined with retrieval-augmented generation (RAG), offer scalable Artificial Intelligence (AI)-driven education tailored to individual patient needs. However, few studies have examined the feasibility and clinical impact of integrating ePRO with LLM-RAG feedback during radiotherapy in high-toxicity settings such as head and neck cancer. Methods: This prospective observational study enrolled 42 patients with head and neck cancer undergoing radiotherapy from January to December 2024. Patients completed ePRO entries twice weekly using a web-based platform. Following each entry, an LLM-RAG system (Gemini 1.5-based) generated real-time educational feedback using National Comprehensive Cancer Network (NCCN) guidelines and institutional resources. Primary outcomes included percentage weight loss and treatment interruption days. Statistical analyses included t-tests, linear regression, and receiver operating characteristic (ROC) analysis. A threshold of ≥6 ePRO entries was used for subgroup analysis. Results: Patients had a mean age of 53.6 years and submitted an average of 8.0 ePRO entries. Frequent ePRO users (≥6 entries) had significantly less weight loss (4.45% vs. 7.57%, p = 0.021) and fewer treatment interruptions (0.67 vs. 2.50 days, p = 0.002). Chemotherapy, moderate-to-severe pain, and lower ePRO submission frequency were associated with greater weight loss. ePRO submission frequency was negatively correlated with both weight loss and treatment interruption days. The most commonly reported symptoms were appetite loss, fatigue, and nausea. Conclusions: Integrating LLM-RAG feedback with ePRO systems is feasible and may enhance symptom control, treatment continuity, and patient engagement in head and neck cancer radiotherapy. Further studies are warranted to validate the clinical benefits of AI-supported ePRO platforms in routine care. Full article

In light of constrained resources and the rise of digitalisation in higher education, management control systems (MCSs) have emerged as essential tools for university management because of their integrity, flexibility, and effectiveness. This paper aims to elucidate the current challenges in the implementation and functioning of MCSs in higher education. To this end, a systematic literature review was undertaken in the Scopus and Web of Science databases, following the PRISMA guidelines. The review yielded 15 relevant sources published between 2020 and June 2025. Induction, deduction, content analysis, and K-means clustering were employed to analyse them. Forty-eight challenges to MCSs in higher education were identified and systematised into four groups (Growth Threats, Limitations, Malpractices, and Stakeholder Issues), covering twelve subgroups. These subgroups were ranked according to their frequency of mention. The top-ranked subgroups were HR problems (first), organisational constraints and management engagement (second), and technological integration and lack of technology training (third). All challenges were classified into clusters based on the countries analysed in the reviewed sources. This review primarily contributes to the existing knowledge by identifying and categorising the challenges to MCSs in higher education. Practically, it lays the groundwork for improving these MCSs, thus contributing to enhanced university management. Full article

Background: Reduced short-chain fatty acids (SCFAs) in inflammatory bowel disease (IBD) impair the gut barrier and immune function, promoting inflammation and highlighting microbiome-targeted therapies’ therapeutic potential. The purpose of this meta-analysis was to study the changes in SCFAs in IBD and their potential role in the occurrence and development of IBD. Methods: The analysis employed a random-effects model to assess the standardized mean difference (SMD) with a 95% confidence interval. A literature search was conducted in databases from 2014 to 20 July 2024 to identify studies investigating SCFAs in IBD. Results: Subgroup analyses revealed a significant reduction in fecal SCFA levels—specifically butyrate, acetate, and propionate—in all IBD subgroups compared to healthy controls. Active IBD showed a greater decrease in butyrate (p = 0.004), and UC showed a notable reduction in propionate (p = 0.03). When comparing UC and CD, differences were observed mainly in propionate (SMD = −0.76, p = 0.00001). Dietary interventions in IBD patients led to increased SCFA levels, with butyrate showing the most improvement (SMD = 1.03), suggesting the potential therapeutic value of dietary modulation. Conclusions: In conclusion, this meta-analysis demonstrates a significant reduction in fecal SCFA levels in patients with IBD, particularly during active phases of the disease and most markedly in CD. Full article

Background: Reliable and non-invasive methods for assessing welfare in poultry are essential for improving evidence-based welfare monitoring and advancing management practices in commercial production systems. The iris-to-pupil (IP) ratio, previously validated by our group in primates and cattle, reflects autonomic nervous system balance and may serve as a physiological indicator of stress in laying hens. This study evaluated the utility of the IP ratio under field conditions across diverse commercial layer housing systems. Materials and Methods: In total, 296 laying hens (Lohmann Brown, n = 269; White Leghorn, n = 27) were studied across four locations in Canada housed under different systems: Guelph (indoor; pen), Spring Island (outdoor and scratch; organic), Ottawa (outdoor, indoor and scratch; free-range), and Toronto (outdoor and hobby; free-range). High-resolution photographs of the eye were taken under ambient lighting. Light intensity was measured using the light meter app. The IP ratio was calculated using NIH ImageJ software (Version 1.54p). Statistical analysis included one-way ANOVA and linear regression using GraphPad Prism (Version 5). Results: Birds housed outdoors had the highest IP ratios, followed by those in scratch systems, while indoor and pen-housed birds had the lowest IP ratios (p < 0.001). Subgroup analyses of birds in Ottawa and Spring Island farms confirmed significantly higher IP ratios in outdoor environments compared to indoor and scratch systems (p < 0.001). The IP ratio correlated weakly with ambient light intensity (r² = 0.25) and age (r² = 0.05), indicating minimal influence of these variables. Although White Leghorn hens showed lower IP ratios than Lohmann Browns, this difference was confounded by housing type; all White Leghorns were housed in pens. Thus, housing system but not breed was the primary driver of IP variation. Conclusions: The IP ratio is a robust, non-invasive physiological marker of welfare assessment in laying hens, sensitive to housing environment but minimally influenced by light or age. Its potential for integration with digital imaging technologies supports its use in scalable welfare assessment protocols. Full article

Background/Objectives: The importance of resistance training for functional recovery in Total Knee Arthroplasty (TKA) patients has been emphasized. Therefore, this systematic review and meta-analysis was conducted to analyze its effects on pain, muscle strength, and function in patients with TKA. Methods: The following databases were used: PubMed, Web of Science, the Cochrane Library, and Embase. Randomized controlled trials that administered resistance training to patients undergoing TKA and measured pain, strength, and function were included. The risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. Effect sizes were calculated using Hedges’ g and are presented as Standardized Mean Differences (SMDs) with 95% Confidence Intervals (CIs). Subgroup analyses were conducted to determine the effect size based on the type and duration of the intervention. Results: The study selection process resulted in the inclusion of seven studies comprising a total of 439 participants. The bias assessment found that three studies had a low risk of bias and four had some concerns. Resistance training was effective in improving pain (SMD: 0.84, 95% CI: 0.11; 1.57, I²: 89.6%), muscle strength (SMD: 1.03, 95% CI: 0.29; 1.77, I²: 83.1%), self-reported function (SMD: 1.58, 95% CI: 0.15; 3.01, I²: 93.1%), and performance-based function (SMD: 0.74, 95% CI: 0.38; 1.11, I²: 68.9%). Subgroup analysis revealed significant differences in pain, strength, and performance-based function by comparison group, performance-based function by intervention duration, and self-reported function by intervention type. Conclusions: Resistance training improves pain, muscle strength, and function in TKA patients. Additionally, resistance training appears particularly effective when implemented as a standalone intervention or for durations under 12 weeks. These findings suggest that the design of resistance training protocols should be considered in clinical practice. Full article

Background: MRA is used in our center for monitoring post-treatment residual aneurysmal neck and stent patency. IV CBCT offers better spatial resolution and may provide significant advantages. Objective: This study investigates the image quality of IV CBCT compared to that of MRA for the follow-up of intracranial aneurysms. Materials and Methods: In this prospective cohort study, 97 patients (mean age: 63.1 ± 11.7; 75 women and 22 men) with 114 treated cerebral aneurysms were included from July 2023 to April 2024. All patients underwent IV CBCT and MRA on the same day. Two neurointerventional radiologists assessed image quality using a five-point Likert scale on two separate occasions six weeks apart. Diagnostic values were evaluated across six parameters. Intra-observer and inter-observer agreements were calculated. Subgroup analyses were performed. Results: Overall, IV CBCT and MRA are comparable in terms of their ability to assess parent vessel status and the degree of artifacts (p > 0.05) though MRA shows a slight advantage in evaluating residual aneurysmal neck (p = 0.05). For clipped aneurysms, IV CBCT is superior in assessing residual aneurysmal neck (OR = 16.0, p < 0.001) and parent vessel status (OR = 15.1, p < 0.001) with significantly fewer artifacts (OR > 100, p < 0.001). For aneurysms solely treated with stents, IV CBCT is superior in assessing residual aneurysmal neck (OR > 20, p = 0.002) and parent vessel status (OR > 20, p = 0.002) with significantly fewer artifacts (OR > 20, p = 0.002). IV CBCT outperforms MRA in evaluating stent struts and the vessel wall status of a stented segment when MRA is non-diagnostic. Conclusions: IV CBCT and MRA have their own strengths and roles in the follow-up of post-treatment intracranial aneurysms. Overall, IV CBCT is superior in terms of its assessment of intracranial aneurysms treated solely with stents or surgical clips. Full article

Background/Objectives: Sepsis is a leading cause of mortality. The AST/ALT ratio may serve as a valuable marker for prediction in patients with various diseases. This study analyzed the prognostic value of this ratio in patients with sepsis. Methods: A retrospective analysis was performed on data from a prospective registry of septic shock patients, collected across multiple centers from October 2015 to December 2022. The main outcome of interest was mortality within 28 days. We evaluated the predictive accuracy of 28-day mortality for variables with the Sequential Organ Failure Assessment (SOFA) score, aspartate transaminase (AST) levels, alanine transaminase (ALT) levels, the AST/ALT ratio, and the combination of the SOFA + AST/ALT ratio using the area under the receiver operating characteristics curve (AUROC). A Kaplan–Meier curve was used to compare the 28-day mortality between the AST/ALT subgroups (≥1.84 and <1.84). Stepwise multivariable Cox proportional hazards analyses were performed to determine the association between 28-day mortality and an AST/ALT ratio ≥ 1.84. Results: The AST/ALT ratio had a significantly higher discriminatory ability for predicting 28-day mortality compared to either AST or ALT. In addition, combining the AST/ALT ratio with the SOFA score improved the predictive accuracy compared to the SOFA alone. A multivariable Cox regression analysis demonstrated that an AST/ALT ratio ≥ 1.84 was associated with a higher risk of death within 28 days. Conclusions: The AST/ALT ratio at emergency department admission in sepsis patients is associated with 28-day mortality and, when combined with the SOFA score, provides additional prognostic information with moderate accuracy. Full article

Hemp (Cannabis sativa L.) products have gained attention in poultry nutrition for their rich content of polyunsaturated fatty acids (PUFAs), bioactive compounds, and potential functional benefits. However, findings on their impact on laying-hen performance, egg quality, and yolk fatty acid profiles have been inconsistent. This meta-analysis aimed to evaluate the effects of dietary hemp products on laying-hen performance, egg quality traits, and yolk fatty acid composition, while exploring potential sources of heterogeneity across studies. A comprehensive literature search identified 21 studies that met the inclusion criteria. A random-effects model was used to calculate standardized mean differences (SMDs) with 95% confidence intervals (CIs) for various outcomes, including production performance, egg quality, and yolk fatty acid profiles. Subgroup and meta-regression analyses assessed the influence of factors such as inclusion level, hen age, and hemp product type. The results showed that hemp supplementation had no significant effect on hen-day production, egg mass, feed conversion ratio, or feed intake. However, yolk redness (SMD = 4.40; 95% CI: 2.46, 6.33; p < 0.001) and yellowness (SMD = 4.45; 95% CI: 2.75, 6.16; p < 0.001) were significantly enhanced. Hemp feeding also increased n-3 PUFA levels in egg yolk, including C18:3n3, C20:5n3, and C22:6n3, while reducing saturated and monounsaturated fatty acids. Subgroup analysis indicated that inclusion levels > 10% and hen age ≤ 25 weeks were associated with slight reductions in hen-day production, whereas older hens (>25 weeks) showed increased egg weight. In conclusion, hemp products can enrich yolk pigmentation and n-3 PUFA content in eggs, supporting the production of functional, value-added eggs without compromising the laying-hen performance. Full article

Background. Several psychological processes can influence the adjustment of cardiac patients. Psychological flexibility has been linked to significant improvements in psychological well-being during cardiac rehabilitation (CR). It can be understood as the dynamic interaction of three key processes: openness to experience (OE), behavioral awareness (BA), and value-driven action (VA). This study aimed to (1) evaluate the distinct role of these processes in predicting anxiety, depression, and psychological well-being in cardiac patients, and (2) assess these associations over the course of CR. Methods. A total of 194 CR patients participated in this longitudinal study, with 156 completing follow-up assessments at T2. Anxiety and depression were measured using the Patient Health Questionnaire-4, psychological well-being with the Psychological Well-being Index-Short, and psychological flexibility using the Comprehensive Assessment of ACT Processes. Results. Cross-sectional regression analysis revealed that all three psychological flexibility dimensions were negatively associated with anxiety and depression and positively associated with psychological well-being at T1. However, longitudinal analyses showed that only VA was positively associated with a decrease in depressive symptoms following CR. A sensitivity analysis conducted on the subgroup of patients with mild to severe symptoms of anxiety and depression further confirmed the robustness of these findings. Conclusions. These results highlight the potential benefits of measuring specific psychological flexibility processes when examining the psychological status of cardiac patients and when planning psychological interventions during CR. Full article