Search Results (4,123)

The availability of reliable and spatially distributed rainfall data is a key element flood and landslide risk assessment, both for forecasting and post-event analysis. In this context, this study evaluates the contribution of radar-based rainfall estimates to enhancing the spatial accuracy of precipitation fields with respect to those derived from rain gauge networks alone. The analysis was conducted over a ~100 km² area in the Liguria Region, north-western Italy, characterized by a dense rain gauge network, with an average density of one gauge per 10 km², and covers seven years of hourly rainfall observations. Radar-derived rainfall fields, available at a 1 × 1 km² spatial resolution, were locally corrected across the study area by interpolating gauge-based local correction factors through an Inverse Distance Weighting (IDW) scheme. The corrected radar fields were then assessed through Leave-P-Out Cross-Validation and rainfall-intensity-based classification, also simulating scenarios with progressively reduced gauge density. The results demonstrate that radar-corrected estimates systematically provide a more accurate spatial representation of rainfall, especially for high-intensity events and in capturing the actual magnitude of local rainfall peaks, even in areas covered by a dense rain gauge network. Regarding the implications for rainfall-induced landslide hazard assessment, the analysis of 56 landslides from the ITALICA (Italian Rainfall-Induced Landslides Catalogue) database showed that including radar information can lead to significant differences in the estimation of rainfall thresholds for landslide initiation compared with gauge-only data. Full article

The mechanical reliability of glass substrates is a key challenge for their adoption in advanced semiconductor packaging. This study employs finite element analysis to systematically evaluate the risk of edge crack propagation in large glass panels during redistribution layer (RDL) fabrication. The influence of critical factors—including crack location, number of RDLs, glass material and thickness, dielectric ABF properties, Cu content, and edge clearance—was examined. Results revealed that top-edge crack near the RDL/glass interface pose the highest failure risk due to elevated peeling stress and increased energy release rate (ERR). The risk of propagation intensifies with more RDLs and thinner glass, while high CTE (coefficients of thermal expansion) glasses such as D263, Gorilla, and ceramic glass markedly suppress crack growth compared with borofloat 33 and fused silica. Among ABF dielectrics, GZ-41 demonstrated superior crack resistance owing to its low CTE and moderate stiffness. Although higher Cu content slightly reduced ERR, its effect remained limited. Edge clearance strongly affects reliability, with ≥300 µm providing effective suppression of crack propagation. These findings provide quantitative design guidelines for glass interposer structures, emphasizing the optimization of dielectric material selection, glass substrate and thickness, and layout constraints such as edge clearance. The proposed methodology and results will contribute to establishing reliable strategies for deploying ultra-thin glass panels in advanced semiconductor packaging. Full article

Safety is a central concern in aviation, where aircraft operations involve complex processes and interactions exposed to multiple hazards. Addressing these hazards requires systematic risk management and the selection of effective safety measures. This study introduces a novel hybrid multi-criteria decision-making (MCDM) framework that integrates the grey Delphi method, the grey Analytic Hierarchy Process (AHP), and the grey Axial-Distance-Based Aggregated Measurement (ADAM) method. The framework provides a rigorous engineering-based approach for evaluating and ranking safety measures under uncertainty and diverse stakeholder perspectives. Application of the model to aircraft operations demonstrates its ability to identify the most effective measures, including the development of critical infrastructure protection plans, rerouting of flight paths from high-risk areas, and strengthening of regulatory oversight. The proposed methodology advances decision-support tools in aviation safety engineering, offering structured guidance for optimizing resource allocation and improving system resilience. Full article

In recent years, several randomized controlled trials have been published regarding cervical cancer therapy and significantly changed the treatment landscape. Recent advances have improved the treatment options and allow personalized treatment concepts with escalation of treatment in high-risk disease and de-escalation with reduction in morbidity in selected low-risk patients. This review aims to provide a comprehensive analysis of the latest landmark studies that are poised to significantly influence clinical practice. Personalized treatment concepts with careful patient selection allow de-escalation in the surgical treatment of cervical cancer. In low-risk cervical cancer patients (lesions of ≤2 cm with limited stromal invasion), simple hysterectomy (SH) was non-inferior to radical hysterectomy in terms of 3-year incidence of pelvic recurrence and was associated with a lower risk of urinary incontinence or retention and improved sexual health and quality of life. Furthermore, sentinel lymphadenectomy is constantly replacing systematic pelvic lymphadenectomy in patients with low-risk cervical cancer. In addition, further studies are necessary to clarify the role of postoperative therapy for patients with intermediate-risk cervical cancer. Starting in 2008, the EMBRACE studies assess the role of Image guided adaptive brachytherapy (IGABT) in LACC in addition to modern external beam radiotherapy concurrent to chemotherapy. The publication of the results of the EMBRACE I prospective study established MRI guided IGABT as state-of-the-art brachytherapy for LACC. EMBRACE II and additional prospective studies emerging from this consortium will address important questions in modern radiotherapy for LACC. Immune checkpoint inhibitors (CPIs) have been evaluated across various clinical settings and are expected to be utilized in numerous scenarios due to several positive randomized trials. Particularly, the combination of platinum-based chemotherapy and pembrolizumab, with or without bevacizumab, has been established as the new standard treatment for primary metastatic or recurrent PD-L1 positive high-risk cervical cancer. In locally advanced cervical cancer, two new treatment escalation regimens—neoadjuvant chemotherapy and adjuvant CPI therapy—have been evaluated in addition to chemoradiation. Furthermore, antibody-drug conjugates, such as tisotumab-vedotin, represent a promising future therapeutic option for recurrent cervical cancer. Full article

Background: Early cancer detection remains a critical challenge in clinical oncology, requiring further development of innovative diagnostic methods with improved sensitivity and specificity. This study addresses the issue by investigating the potential of exhaled air metabolome analysis, using highly porous carbon material for sample collection, as a promising approach for the early diagnosis of laryngeal cancer. Volatile organic compounds (VOCs) present in exhaled breath are known to reflect underlying metabolic changes. This research explores the feasibility of using VOC-derived metabolomic signatures as non-invasive biomarkers for cancer detection. Methods: The primary objective was to evaluate exhaled air metabolome analysis as a diagnostic tool for individuals at risk of respiratory tract malignancies. The study involved 36 participants, including 13 patients diagnosed with laryngeal cancer and 23 healthy individuals serving as a control group. Breath samples were collected using a highly porous carbon material, selected for its superior sorption properties, enabling efficient capture and stabilization of VOCs. These samples were subsequently analyzed using gas chromatography-mass spectrometry (GC-MS) to identify and compare VOC patterns between the two groups. Results: Preliminary analysis revealed apparent differences in VOC profiles between cancer patients and healthy individuals, with cancer patients exhibiting elevated peak intensities for specific metabolites such as diethyl phthalate, nonadecane, and trimethyl-dodecane. Multivariate analysis using principal component analysis (PCA) demonstrated separation between the two groups, reflecting systematic differences in exhaled VOC signatures. Conclusions: This initial study supports the potential of breath VOC profiling for laryngeal cancer detection, laying the groundwork for further validation and refinement of this diagnostic approach. The use of porous carbon material facilitated efficient VOC capture, supporting its role in non-invasive breath analysis. Full article

The paper presents the issue of acquired and secondary auditory processing disorder (APD) in children and adolescents in the Polish population. The authors analyzed a group of individuals with APD and younger children who were at risk based on a detailed interview with parents. A comparison of developmental factors showed several similarities between the risk and diagnosed APD groups, including abnormal muscle tone (64.29% vs. 33.33%), ear diseases (42.86% vs. 57.58%), and complicated delivery (32.14% vs. 39.39%). In terms of school factors, the most significant difficulties were associated with poor concentration (78.57% vs. 54.55%), irregularities in mastering phonology related to writing (67.86% vs. 75.76%), and reading (64.29% vs. 78.79%), as well as problems with understanding speech-in-noise perception (60.71% vs. 57.58%). A comparison of children at risk of APD and those with a confirmed diagnosis revealed multiple similarities. The results were visualized using Pareto charts to highlight the most influential factors. The results indicate the need to disseminate screening that could show the APD risk group. Therefore, the diagnostic process could be performed more quickly in such individuals. Based on recurring developmental factors, the Risk Assessment Questionnaire (RAQ) was developed as a non-clinical screening tool to identify children potentially at risk of APD. The RAQ demonstrated a moderate discriminative potential (AUC = 0.68; sensitivity = 75%; specificity = 68%) and may support early referral for diagnostic evaluation. The results highlight the value of systematic screening to accelerate diagnosis and intervention, especially in populations where access to formal assessment is limited. Full article

Objectives: Patients with severe to profound sudden sensorineural hearing loss (SSNHL) generally experience poorer hearing recovery; however, the associated risk factors have not been identified. This study synthesizes current evidence to explore prognostic risk factors in this patient group. Methods: Databases were systematically searched through PubMed, Embase, Web of Science, and the Cochrane Library, from their inception to 18 October 2025. Three researchers independently extracted and recorded patient information and relevant data from all selected studies. Any inconsistencies were clarified through discussion or by consulting a fourth researcher. Results: The study included 2632 patients from 15 articles published between 2002 and 2025 and evaluated 8 prognostic risk factors. The results showed that profound hearing loss (OR = 4.68; 95% CI: 3.57–6.13; p < 0.001) and vertigo (OR = 1.95; 95% CI: 1.28–2.98; p = 0.002) were correlated with poorer hearing recovery. Subgroup analyses based on different prognostic criteria confirmed the consistent impact of hearing loss severity on poor outcomes. The remaining 6 risk factors did not show statistically meaningful associations. Conclusions: Profound hearing loss and vertigo are significantly associated with poorer prognosis in patients with severe to profound SSNHL. These findings may help identify high-risk patients early and inform the design of personalized therapeutic approaches in clinical settings. Full article

Background/Objectives: Cancer-related cognitive impairment (CRCI) is a frequent and clinically significant consequence of breast cancer (BC) and its treatments. With rapidly evolving therapeutics and a growing body of biomarker research, a BC-specific synthesis is needed. This review aimed to evaluate associations between blood- and saliva-based biomarkers and objective and patient-reported cognitive outcomes in adults with non-metastatic BC, while accounting for treatment modality and assessment timing. Methods: This systematic review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and was pre-registered in the International Prospective Register of Systematic Reviews (PROSPERO, ID: CRD420251079969). PubMed, Embase, and Web of Science were searched for articles published up until April 2025. Eligible studies included adults with BC that investigated associations between blood and/or saliva biomarkers and cognitive outcomes. Results: A total of 53 studies met inclusion criteria: 31 examined biochemical biomarkers; 17, genetic; and 5, both. Assessments were predominantly post-treatment. Baseline measures were more infrequent. Chemotherapy (ChT) predominated, while endocrine therapy (ET) and radiotherapy (RT) were variably examined. Targeted therapies and immunotherapies were rarely included. IL-6 and TNF-α were most consistently linked to poorer cognition, although results varied by timing and assessment type. CRP and derived indices showed intermittent associations. Stress-axis markers and BDNF were mainly related to subjective outcomes. Genetic findings implicated DNA repair and oxidative stress pathways, while APOE, COMT, and BDNF results were inconsistent. Conclusions: Evidence for biomarker correlates of CRCI in BC is highly heterogeneous. Longitudinal, harmonized, and treatment-specific studies are needed to establish reproducible biomarker panels for risk stratification and targeted intervention. Full article

Investigating ecological irrigation risks associated with mine water utilization is of great significance for alleviating water resource shortages in arid mining regions of western China, thereby supporting efficient coal extraction and coordinated ecological development. In this study, a representative mining area in Xinjiang was investigated to reveal the evolution patterns of mine water quality under arid geo-environmental conditions in western China and to systematically assess environmental risks induced by ecological irrigation. Surface water, groundwater, and mine water samples were collected to study ion ratio coefficients, hydrochemical characteristics, and evolution processes. Based on this, a multi-index analysis was employed to evaluate ecological irrigation risks and establish corresponding risk control measures. The results show that the total dissolved solids (TDS) of mine water in the study area are all greater than 1000 mg/L. The evolution of mine water quality is mainly controlled by water–rock interaction and is affected by evaporation and concentration. The main ions Na⁺, Cl⁻, Ca²⁺, and SO₄²⁻ originate from the dissolution of halite, gypsum, and anorthite. If the mine water is directly used for irrigation without treatment, the soluble sodium content, sodium adsorption ratio, salinity hazard, and magnesium adsorption ratio will exceed the limits, leading to the accumulation of Na⁺ in the soil, affecting plant photosynthesis, and posing potential threats to the groundwater environment. Given the evolution process of mine water quality and the potential risks of direct use for irrigation, measures can be taken across three aspects: nanofiltration combined with reverse osmosis desalination, adoption of drip irrigation and intermittent irrigation technologies, and selection of drought-tolerant vegetation. These measures can reduce the salt content of mine water, decrease the salt accumulation in the soil layer, and lower the risk of groundwater pollution, thus reducing the environmental risks of ecological irrigation with mine water. The research will provide an important theoretical basis for the scientific utilization and management of mine water resources in arid areas by revealing the evolution law of mine water quality in arid areas and clarifying its ecological irrigation environmental risks. Full article

Background: Periodontal dysbiosis contributes to liver injury through systemic inflammation, oral–gut microbial translocation, and endotoxemia. Lipopolysaccharides (LPSs) and virulence factors derived from periodontal pathogens, particularly Porphyromonas gingivalis (P. gingivalis) activate Toll-like receptor (TLR) signaling, trigger NF-κB-mediated cytokine release (e.g., TNF-α, IL-1β, IL-6), and promote oxidative stress and Kupffer cell activation within the liver. The present systematic review summarized clinical evidence supporting these mechanistic links between periodontal pathogens and hepatic outcomes, highlighting the role of microbial crosstalk in liver pathophysiology. Methods: A PRISMA-compliant systematic review was conducted by searching PubMed, Scopus, and the Cochrane library, as well as gray literature. Eligible study designs were observational studies and trials evaluating P. gingivalis and other periodontal pathogens (Aggregatibacter actinomycetemcomitans, Prevotella intermedia, and Tannerella forsythia) for liver phenotypes (Non-Alcoholic Fatty Liver Disease [NAFLD]/Metabolic Dysfunction-Associated Steatotic Liver Disease [MASLD], fibrosis/cirrhosis, acute alcoholic hepatitis [AAH], and Hepatocellular carcinoma [HCC]). Risk of bias was assessed using the Newcastle–Ottawa Scale adapted for cross-sectional studies (NOS-CS) for observational designs and the RoB 2 scale for single randomized controlled trials (RCTs). Due to the heterogeneity of exposures/outcomes, results were summarized narratively. Results: In total, twenty studies (2012–2025; ~34,000 participants) met the inclusion criteria. Population-level evidence was conflicting (no clear association between anti-P. gingivalis serology and NAFLD), while clinical cohorts more frequently linked periodontal exposure, particularly to P. gingivalis, to more advanced liver phenotypes, including fibrosis. Microbiome studies suggested stage-related changes in oral communities rather than the effect of a single pathogen, and direct translocation into ascitic fluid was not observed in decompensated cirrhosis. Signals from interventional and behavioral research (periodontal therapy; toothbrushing frequency) indicate a potential modifiability of liver indices. The overall methodological quality was moderate with substantial heterogeneity, precluding meta-analysis. Conclusions: Current evidence supports a biologically plausible oral–liver axis in which periodontal inflammation, often involving P. gingivalis, is associated with liver damage. Causality has not yet been proven; however, periodontal evaluation and treatment may represent a low-risk option in periodontitis-associated NAFLD. Well-designed, multicenter prospective studies and randomized trials with standardized periodontal and liver measurements are needed. Full article

Background/Objectives: Demand for dermatologic services exceeds specialist capacity, with average wait times of 26–50 days in the United States. Current triage methods rely on subjective judgment or disease-specific indices that do not generalize across diagnoses or translate to operational decisions. We developed and validated the Dermatologic Complexity Score (DCS), a standardized instrument to guide case prioritization across dermatology care settings and evaluate DCS as a workload-reduction filter, enabling safe delegation of approximately half of routine teledermatology cases (DCS ≤ 40) away from specialist review. Methods: We conducted a prospective validation study of the DCS using 100 consecutive teledermatology cases spanning 30 common conditions. The DCS decomposes complexity into five domains (Diagnostic, Treatment, Risk, Patient Complexity, Monitoring) summed to a 0–100 total with prespecified bands: ≤40 (low) (41–70), (moderate) (71–89), (high), ≥90 (extreme). Five board-certified dermatologists and an automated module independently scored all cases. Two primary care physicians completed all ≤40 cases to assess feasibility. Primary outcomes were interrater reliability using ICC (2,1) and agreement with automation. Secondary outcomes included time-to-decision, referral rates, and primary care feasibility. Results: Mean patient age was 46.2 years; 47% of cases scored ≤40, 33% scored 41–70, 18% scored 71–89, and 2% scored ≥90. Interrater reliability was excellent (ICC (1,2)) = 0.979; 95% CI 0.974–0.983), with near-perfect agreement between automated and mean dermatologist scores (r = 0.998). Time-to-decision increased monotonically across DCS bands from 2.11 min (≤40) to 5 (90) min (≥90) (p = 1.36 × 10⁻¹⁴). Referral rates were 0% for ≤40, 3% for 41–70, 27.8% for 71–89, and 100% for ≥90 cases. DCS strongly predicted referral decisions (AUC = 0.919). Primary care physicians successfully managed all ≤40 cases but required 6–8 additional minutes per case compared to dermatologists. Conclusions: The DCS demonstrates excellent reliability and strong construct validity, mapping systematically to clinically relevant outcomes, including decision time and referral patterns. The instrument enables standardized, reproducible triage decisions that can optimize resource allocation across teledermatology, clinic, procedural, and inpatient settings. Implementation could improve access to dermatologic care by supporting appropriate delegation of low-complexity cases to primary care while ensuring timely specialist evaluation for high-complexity conditions. Full article

Objectives: Maternal folic acid supplementation is recommended to prevent neural tube defects (NTDs), yet its influence on offspring neurodevelopmental disorders (NDDs) remains uncertain. This umbrella review aims to evaluate whether maternal folic acid supplementation before and/or during pregnancy affects the risk of NDDs. Methods: We conducted a systematic search in MEDLINE, Cochrane Library, EMBASE, PubMed, and Web of Science from inception to 30 June 2025, to identify systematic reviews (SRs) and meta-analyses (MAs) that synthesized evidence from non-randomized studies on maternal folic acid supplementation and NDDs. Methodological quality was assessed using the AMSTAR-2 assessment and evidence certainty using the GRADE framework. Results: A total of 23 SRs/MAs were included, of which 14 did not perform meta-analysis. Most included SRs/MAs were methodologically limited, with 50.00% rated as very low quality and only 36.37% achieving high or moderate quality. MAs indicated a protective effect of supplementation, with odds ratio (OR) of 0.66 (95% confidence interval (CI): 0.55–0.79) for autism spectrum disorder (ASD), 0.86 (95% CI: 0.78–0.95) for attention-deficit/hyperactivity disorder (ADHD), and 0.75 (95% CI: 0.63–0.91) for behavioral problems. No significant associations were found for motor, intellectual/cognitive, or language development. SRs reported inconsistent conclusions across most outcomes. Conclusions: In summary, maternal folic acid supplementation may reduce the risk of ASD, ADHD, and behavioral problems in offspring. Although the current evidence is of low quality, supplementation guidelines are justified by the well-established benefits for NTDs. Further research is required to address remaining uncertainties. Full article

Nutrition is being increasingly recognized as a modifiable adjuvant factor in symptom management, yet few studies have examined the direct contribution of fruit consumption to chronic disease outcomes. The existing research largely emphasizes broad dietary patterns or isolated nutrients, rather than specific fruit species and their complex bioactive profiles. This gap is particularly evident in conditions lacking disease-specific pharmacological treatments, such as fibromyalgia syndrome (FMS), where patients often depend on lifestyle adjustments and complementary strategies for symptom relief. The therapeutic use of fruits presents methodological challenges, as their biochemical composition is strongly influenced by abiotic and biotic stresses, seasonal and regional variations, as well as post-harvest handling and storage. Such variability complicates reproducibility and obscures causal links in clinical research. While reductionist approaches that isolate single compounds offer dose control, they risk losing synergistic effects inherent to whole fruits. Conversely, whole-fruit consumption preserves integrative complexity but introduces variability. Overcoming these limitations requires rigorous standardization across agricultural, nutritional, and clinical domains, accurate species and cultivar identification, controlled cultivation conditions, chemical fingerprinting, and biomarker validation. In this context, cacti fruits such as Opuntia ficus-indica (prickly pear), which is rich in betalains and polyphenols, emerge as promise adjuvant agents for FMS symptom management. We propose a protocol designed to systematically evaluate their efficacy and feasibility in clinical application, aiming to strengthen the reliability and accuracy of research outcomes. Full article

This study collected 427 cultivated topsoil samples from the Mohe watershed in Tangcheng County, eastern China. By integrating positive matrix factorization (PMF) for quantitative source apportionment with self-organizing maps (SOMs) for spatial clustering, we effectively identified pollution factors and conducted a systematic evaluation of pollution sources, environmental capacity, and health risks. The results show that: (1) the soils were slightly acidic and enriched in Cd, Cr, Cu, Hg, and Pb, with Cd and Hg showing high spatial variability linked to anthropogenic inputs. (2) Quantitative source apportionment indicated that 25.9% of heavy metals (As, Cr, Ni, Pb) originated mainly from natural pedogenic sources, while agricultural activities contributed 20.8% (Cd) and 42.8% (Cu, Zn). Hg (10.5%) enrichment was attributed to residential coal combustion and wind patterns, demonstrating source-specific anthropogenic influences. (3) The environmental capacity assessment indicated a moderate capacity level across the study area. However, the improved index (PI_min) revealed overload phenomena at localized sites, and these overloaded areas exhibited high spatial consistency with the distributions of agricultural and mixed sources. (4) Health risk evaluation indicated that hand-to-mouth ingestion was the dominant exposure pathway, with children facing significantly higher risks than adults. Non-carcinogenic risks remained within safe limits, but carcinogenic risks were non-negligible, with 86.7% of sites exceeding the threshold for children, especially in cultivated lands and riverbank villages. Findings underscore the importance of addressing synergistic effects of natural and agricultural sources in watershed management and prioritizing children’s health protection. Full article

Background: The pathological response to neoadjuvant chemotherapy (NAC) is an established predictor of long-term outcomes in breast cancer. However, conventional binary assessment based solely on pathological complete response (pCR) fails to capture prognostic heterogeneity across molecular subtypes. This study aimed to develop an interpretable deep learning model that integrates multiple clinical and pathological variables to predict both recurrence and metastasis development following NAC treatment. Methods: We conducted a retrospective analysis of 832 breast cancer patients who received NAC between 2013 and 2022. The analysis incorporated five key variables: tumor size changes, nodal status, Ki-67 index, Miller–Payne grade, and molecular subtype. A Multi-Layer Perceptron (MLP) model was implemented on the PyTorch platform and systematically benchmarked against SVM, Random Forest, and XGBoost models using five-fold cross-validation. Model performance was assessed by calculating the area under the curve (AUC), accuracy, precision, recall, and F1-score, and by analyzing confusion matrices. Results: The MLP model achieved AUC values of 0.86 (95% CI: 0.82–0.93) for HER2-positive cases, 0.82 (95% CI: 0.70–0.92) for triple-negative cases, and 0.76 (95% CI: 0.66–0.82) for HR+/HER2-negative cases. SHAP analysis identified post-NAC tumor size, Ki-67 index, and Miller–Payne grade as the most influential predictors. Notably, patients who achieved pCR still had a 12% risk of developing recurrence, highlighting the necessity for ongoing risk assessment beyond binary response evaluation. Conclusions: The proposed deep learning system provides precise and interpretable risk assessment for NAC patients, facilitating individualized treatment approaches and post-treatment monitoring plans. Full article