Search Results (4,130)

Background. Radiographic bone loss is a primary determinant of periodontitis stage. Intraoral radiographs (periapical and bitewing) are the standard projections for assessing interproximal bone levels, yet their interpretation is subjective and poorly reproducible, and previous syntheses have pooled intraoral with panoramic imaging. Objectives. To appraise and synthesise studies developing or validating deep learning (DL) models for detecting, quantifying, staging or classifying alveolar bone loss on intraoral radiographs. Methods. Seven databases and six supplementary sources were searched from 1 January 2015 to 12 June 2026 (PROSPERO CRD420261455818, registered retrospectively). Two reviewers screened, extracted and appraised in duplicate using QUADAS-2 with AI-specific signalling questions, CLAIM and APPRAISE-AI; certainty was rated by GRADE. Heterogeneity precluded pooling; synthesis was narrative. Results. Sixteen publications reporting 15 independent datasets (2018–2026) were included (11 periapical, two bitewing, three mixed; 39–21,819 radiographs). The architectures employed comprised classification, segmentation, object-detection, keypoint-localisation and transformer-based models. Accuracy for binary detection ranged from 0.73 to 0.97, Dice coefficients reached ≥0.91, and intraclass correlation with expert measurement was 0.75–0.85. Performance fell for multiclass staging, posterior sites and furcations. Only two studies used an external test set; none was prospective; risk of bias was mostly high or unclear. Conclusions. Performance lies within the range observed for calibrated readers, but the evidence is dominated by small, single-centre, retrospective datasets with annotation-based reference standards and almost no external validation; certainty is very low. Deep learning is best regarded as a clinician-supervised adjunct for screening, triage and quality assurance rather than an autonomous diagnostic device. Full article

Unexpected events have led to potential disruptions in upstream supply systems. Downstream enterprises often hold inventory to mitigate disruption risks. Previous studies have rarely focused on inventory under partial supply disruption, and responsive pricing and ordering decisions in two periods, even though this combined scenario is more applicable to real economic life. Motivated by the gap, this paper studies two-period game models of responsive pricing and ordering decisions without inventory (Model N) and with inventory (Model H), and considers partial supply disruption risks in the second period. We find that, under partial supply disruption, compared with the model without inventory (Model N), the order quantity of the model with inventory (Model H) may be either lower or higher; its retail price may also be either lower or higher. When the inventory holding cost is high, the retailer and supply chain are more inclined toward no inventory (Model N). Under certain conditions, the manufacturer supports the retailer in holding inventory. Interestingly, the expected profits of the retailer and the supply chain may increase as the disruption probability increases, and this holds true even when the inventory holding cost is very high. These findings have theoretical and practical significance for the resilience of supply chain systems. Full article

Objectives: The objective of this cross-sectional online survey was to determine university students’ knowledge about whole grain (WG), sorghum, and prediabetes risk. Methods: The survey included 45 items to learn about the students’ WG perception, practices, primary nutrition information source, and physical activity level (PAL). Recruitment was carried out using the university’s official email announcement and data was collected through Qualtrics. Two-hundred-and-forty-eight undergraduate and graduate students, aged 18–44 years, completed the questionnaire. Results: Sixty-three percent of the students were at risk of prediabetes based on the CDC Prediabetes Risk Test, a recommended screening tool by the National Diabetes Prevention Program. Compared to females, males were at a significantly higher risk of prediabetes and T2DM. Males had a mean ± sd score of 1.70 ± 0.93 versus females (0.64 ± 0.92), (t(246) = −9.07, p < 0.001). Participants scored low on overall knowledge (sorghum and WG combined) (4.21 ± 2.04), WG knowledge (2.82 ± 1.03) and sorghum knowledge (3.21 ± 1.23). Despite reporting a high PAL, less than half had a very good health status, with 45.2% of them having overweight or obesity. Social media was the main nutrition information source for 60% of participants. Logistic regression showed that students with obesity had almost four times greater odds compared to those with normal weight (OR = 3.97, 95% CI: 1.66–9.45, p = 0.002). Conclusions: These results have important public health implications, providing the rationale for our future research on a theory-based nutrition education intervention emphasizing sorghum consumption and metabolic effects on individuals with overweight and obesity, aiming to combat diet-related diseases. Full article

Fms-related receptor tyrosine kinase 3 internal tandem duplication (FLT3-ITD) mutations occur in approximately 20–25% of patients with acute myeloid leukemia (AML) and are associated with increased relapse risk and inferior survival outcomes. Although measurable residual disease (MRD) has become a key prognostic tool for guiding post-remission treatment decisions, FLT3-ITD was historically considered a suboptimal MRD marker because of its subclonal nature, structural heterogeneity and dynamic behavior during disease evolution. In addition, FLT3-ITD has not yet been fully integrated into routine MRD monitoring due to methodological limitations and a lack of standardized workflows. The latest European LeukemiaNet (ELN)-DAVID 2025 recommendations stressed the use of ultra-high sensitivity (UHS) next-generation sequencing (NGS) technologies to detect FLT3-ITD MRD with improved precision, enabling reliable longitudinal tracking of patient-specific clones at very low variant allele frequencies (VAF). Indeed, despite prospective evidence supporting this approach remaining limited, FLT3-ITD-based MRD monitoring is emerging as a clinically relevant prognostic indicator, contributing to the identification of patients at increased risk of relapse and refining risk stratification, while also informing therapeutic decision-making, particularly in the peri-transplant setting. The present review summarizes the biological underpinnings of FLT3-ITD mutated (FLT3-ITD^mut) AML, discusses the methodological challenges of MRD detection, and critically evaluates the evolving role of MRD in refining relapse prediction, supporting post-remission therapy tailoring, and contributing to a harmonized framework for FLT3-ITD^mut AML management. Full article

The rapid expansion of high-speed railway networks has increased the operational energy demand and indoor overheating risk of large-scale, high-volume railway station buildings. Natural ventilation is a climate-responsive passive strategy that can improve indoor environmental quality and reduce reliance on mechanical cooling. However, its contribution to the operational sustainability of large transportation buildings remains insufficiently quantified, particularly in hot-summer and cold-winter regions. This study investigates a seasonally adaptive window-opening strategy for Chengdu Station, with particular attention to major functional spaces such as waiting halls and commercial areas. A DesignBuilder model was used to simulate six ventilation scenarios, ranging from doors-only operation to fully open doors and windows. The effects of different window-opening ratios on hourly indoor temperature, relative humidity, adaptive thermal comfort, and annual building energy use were systematically evaluated. The simulation approach was further assessed against field measurements obtained from a comparable large railway station. The results reveal a pronounced nonlinear and seasonal response to the window-opening ratio. In winter, maintaining a very low opening ratio or keeping only the entrance doors open limits unnecessary heat loss. During the transitional seasons, opening ratios of 40–60% are sufficient to remove residual indoor heat while maintaining acceptable thermal conditions. In summer, the marginal improvement in ventilation performance becomes limited when the side-window opening ratio exceeds approximately 80%; therefore, an opening ratio of 80% was selected as a practical operating threshold rather than an absolute thermal optimum. Based on these seasonal characteristics, a month-by-month window-opening strategy was developed. Compared with the doors-only baseline, the proposed strategy reduced the annual high-temperature-hour ratio from 33.4% to 16.36%, corresponding to a decrease of 17.04 percentage points and a relative reduction of approximately 51.0%. Total annual building energy use decreased from 32,238.8 MWh to 25,923.8 MWh, representing an energy saving of 19.6%. These findings demonstrate that seasonally adaptive natural ventilation can simultaneously reduce overheating risk and operational energy demand while maintaining acceptable indoor thermal conditions. The proposed strategy provides a quantitative basis for the sustainable, energy-efficient, and intelligently managed operation of large-space railway stations in hot-summer and cold-winter regions. Full article

Very large-scale biogas (biomethane) projects are important infrastructure systems for integrating organic waste treatment, renewable energy substitution, and carbon mitigation under China’s carbon peaking and carbon neutrality goals. However, their long process chains, concentrated hazardous media, and frequent confined-space operations create coupled safety risks that may undermine sustainable operation. To identify the dominant risk drivers and safety governance priorities, this study investigated five operating very large-scale biogas projects in Shanxi Province, China. On-site inspections, semi-structured interviews, and document reviews were used to identify ten safety-risk causative factors. The Decision-Making Trial and Evaluation Laboratory (DEMATEL) method was combined with Interpretive Structural Modeling (ISM) to quantify causal relationships and reveal the hierarchical transmission structure among the factors. The results show a structural imbalance between document-based compliance and operational implementation. Although basic safety documents were generally established, only 20% of the projects had scenario-specific emergency response plans for major accident scenarios; the compliance rate of explosion-proof electrical equipment, the configuration rate of fixed monitoring and alarm systems for combustible and toxic gases, and the effective operation rate of forced ventilation facilities were 40%, 60%, and 40%, respectively. Insufficient enterprise safety investment (M1) and unclear external regulatory responsibilities (M2) were the dominant root causes of system-level risk propagation, while inadequate control of high-risk operations (M9) and unsafe worker behavior (M10) were the final manifestations. A four-pillar governance pathway is proposed, including policy and standard improvement, technological support and equipment upgrading, personnel capacity enhancement, and sustainable funding mechanisms. The findings provide empirical evidence for risk-based supervision and indicate how operational safety governance can serve as an enabling condition for the long-term sustainability of the biomethane industry, rather than as a direct measurement of carbon-mitigation or energy-performance outcomes. Full article

Background: Patients with atrial fibrillation (AF) and a history of gastrointestinal (GI) bleeding represent a particularly challenging clinical population due to the coexistence of elevated thromboembolic and hemorrhagic risks. Percutaneous left atrial appendage occlusion (LAAO) has emerged as an alternative strategy for stroke prevention in patients in whom long-term oral anticoagulation is contraindicated or poorly tolerated. However, evidence specifically addressing clinical outcomes and optimal postprocedural antithrombotic management in this subgroup remains limited. Methods: A comprehensive systematic literature search was conducted across PubMed, Scopus, Web of Science, and Cochrane CENTRAL from database inception to April 2026. Studies were eligible if they included patients with prior gastrointestinal bleeding as the primary study population or reported separately extractable outcomes for a predefined gastrointestinal bleeding subgroup. The primary outcomes were recurrent GI bleeding, thromboembolic events, and all-cause mortality, while secondary outcomes included procedural success, device-related thrombosis, and postprocedural antithrombotic strategies. Owing to substantial clinical and methodological heterogeneity, findings were synthesized qualitatively in accordance with PRISMA 2020 recommendations. Results: Five observational studies reporting GI bleeding-specific outcomes were included in the systematic evidence synthesis. Procedural success rates were consistently high, and LAAO was associated with acceptable thromboembolic outcomes during follow-up. Nevertheless, recurrent GI bleeding remained a clinically relevant complication, particularly in patients with a prior bleeding history. Postprocedural antithrombotic regimens varied widely, ranging from short-term oral anticoagulation to dual or single antiplatelet therapy and reduced-intensity strategies. Less intensive regimens appeared feasible in carefully selected patients at very high bleeding risk; however, no universally optimal approach could be identified. Conclusions: Available observational evidence suggests that LAAO may represent a stroke prevention option in selected patients with AF and prior GI bleeding, although firm conclusions regarding net clinical benefit and the optimal postprocedural antithrombotic strategy cannot currently be drawn. Its net clinical benefit is closely linked to individualized postprocedural management, particularly the choice and intensity of antithrombotic therapy. These findings highlight the importance of a multidisciplinary, patient-centered approach and underscore the need for prospective studies to establish evidence-based treatment strategies in this high-risk population. Full article

The EU AI Act makes fairness metrics for high-risk AI systems’ compliance evidence, turning their trustworthiness into a safety and accountability concern. Fairness audits assume that test data reflects the properties of real-world conditions, whereas standard evaluation protocols use test data drawn from the same biased records as the training data. Studies measuring how strongly this bias in test data distorts fairness metrics between the validation phase and real-world deployment are still very rare. We conduct an experiment on synthetic and real data, measuring this discrepancy across five fairness interventions on four unfairness types (1000 repetitions per combination, 20,000 total runs). Synthetic data lets us encode human bias in labels and compare fairness metrics on biased test labels (data available during development) against clean labels (conditions models face in deployment). We find that a systematic evaluation bias is present across all metrics, so the same models on the same test data can support opposite fairness conclusions and mask the mistreatment of the most disadvantaged groups. This pattern of fairness misevaluation is confirmed by a real-world validation on the Adult Census Income dataset. We conclude that trustworthy fairness auditing and regulatory standards should require bias-aware evaluation protocols, in which observed labels are not treated as ground truth. Full article

Background/Objectives: A body shape index (ABSI) has been proposed as an anthropometric measure reflecting abdominal body shape beyond body mass index (BMI). However, its relative cross-sectional discriminative ability compared with conventional anthropometric measures and surrogate markers of insulin resistance for prevalent diabetes and cardiovascular disease (CVD) remains poorly characterized in Korean adults. Methods: This cross-sectional study included 11,448 Korean adults aged 18–64 years from the 2019–2021 Korean National Health and Nutrition Examination Survey (KNHANES). Using receiver operating characteristic (ROC) curve analyses, we compared the discriminative ability of ABSI with BMI, waist circumference, waist-to-height ratio, homeostatic model assessment for insulin resistance (HOMA-IR), triglyceride-to-HDL cholesterol ratio (TG/HDL-C), and the triglyceride–glucose index (TyG) for prevalent diabetes and CVD. Multivariable logistic regression analyses assessed associations after adjustment for demographic and socioeconomic factors. Results: ABSI showed the highest ROC-AUC for both prevalent diabetes (74%) and CVD (74%) among the compared indices. In multivariable-adjusted analyses, individuals in the very high ABSI risk group had higher odds of prevalent CVD (OR, 3.75; 95% CI, 1.60–8.78) than those in the very low-risk group. Among individuals with diabetes, the odds of comorbid CVD were also higher in the very high ABSI group (OR, 3.38; 95% CI, 2.26–5.07). Similar patterns appeared in obesity-subgroup analyses. Conclusions: ABSI showed greater discriminative ability for prevalent diabetes and CVD than several conventional measures and insulin-resistance markers, supporting its potential utility as a simple marker of cardiometabolic disease burden. Prospective studies are needed to determine its prognostic value. Full article

Background and Objectives: Movement representation techniques (MRTs), including motor imagery and mirror therapy, have been investigated in several chronic pain conditions; however, their effectiveness in chronic non-specific spinal pain (CNSP) has not been specifically synthesized using meta-analytic methods. This systematic review and meta-analysis aimed to evaluate the effects of MRTs on pain intensity, disability, and kinesiophobia in adults with CNSP. Materials and Methods: A systematic search was conducted in PubMed, CINAHL, Scopus, Cochrane Library, and PEDro, supplemented by grey literature sources. Randomized and non-randomized controlled trials investigating MRTs as a standalone or adjunct intervention in adults with CNSP were eligible. Methodological quality was assessed using the PEDro scale, risk of bias was evaluated using the RoB 2 tool, and certainty of evidence was evaluated using the GRADE approach. Effect sizes were calculated as Hedges’ g using a random-effects model. The review was registered in PROSPERO (CRD42023488671). Results: Nine studies involving 411 participants were included in the systematic review, of which eight randomized trials (337 participants) contributed to the meta-analyses. MRTs showed a large and statistically significant effect on pain intensity (Hedges’ g = −1.63; 95% CI: −2.56 to −0.70; p = 0.001) and a moderate statistically significant effect on disability (Hedges’ g = −0.64; 95% CI: −1.03 to −0.26; p = 0.001). The effect on kinesiophobia was large but not statistically significant (Hedges’ g = −1.55; 95% CI: −3.25 to 0.16; p = 0.075). In analyses restricted to motor imagery, significant effects were observed for pain intensity (Hedges’ g = −1.87; 95% CI: −2.95 to −0.79) and disability (Hedges’ g = −0.75; 95% CI: −1.15 to −0.35), consistent in direction with the primary analyses. Heterogeneity was substantial for pain intensity and kinesiophobia; all pooled trials were judged to be at high risk of bias or to raise some concerns, and the certainty of evidence was very low for all three outcomes. Conclusions: Very low-certainty evidence suggests that MRTs may reduce pain intensity and improve disability in adults with CNSP. Given the high risk of bias and substantial heterogeneity, these estimates are exploratory and do not support firm clinical recommendations. Further well-designed randomized controlled trials with standardized MRT protocols and long-term follow-up are needed. Full article

Background/objective: Postpartum depression (PPD) is a significant public health issue affecting about 19% of mothers globally. It has well-documented impacts on maternal well-being, mother–infant relationships, and child developmental outcomes. At the same time, the level of vitamin D deficiency in women of reproductive age is very high (affecting 60–87 percent of pregnant women globally). The review aims to synthesize current evidence and highlight priority research areas to improve maternal mental health outcomes. Methods: A systematic literature search of PubMed, Scopus, and Google Scholar (2015–2026) was conducted, followed by narrative synthesis of mechanistic, observational, and interventional evidence. Results: Adequate vitamin D status may contribute to a reduced risk of postpartum depression through multiple interacting pathways, including serotonin synthesis and metabolism (via tryptophan hydroxylase 2 (TPH2) and monoamine oxidase-A (MAO-A) regulation), neuroplasticity via brain-derived neurotrophic factor (BDNF) signaling, and suppression of the pro-inflammatory cytokine cascade. Dose–response meta-analyses and large prospective cohort studies indicate consistent negative relationships between maternal vitamin D levels and postpartum depressive and anxiety symptoms with optimal serum 25-hydroxyvitamin D (25(OH)D) levels of 90–110 nmol/L. Conclusions: There is still limited evidence on the intervention; it is still methodologically diverse, and only a few randomized controlled trials have been carried out on specifically postpartum populations. Full article

The continuous slowdown in the research and development of new antibiotics and antibiotic overuse have turned the problem of antibacterial resistance into a global public health crisis. As a very promising alternative to multi-drug-resistant bacterial infection, phage therapy is receiving renewed attention. However, the inherent biological limitations of natural phages restrict their extensive clinical application. This review examines how synthetic biology can be harnessed to transform phages and to build the next generation of antibacterial therapies. We outline the main advantages of natural phages, including high host specificity, self-amplification, bactericidal activity and the ability to degrade biofilms. We also point out the bottlenecks of clinical applications of bacteriophages, such as narrow host range, rapid removal in the body and potential genetic safety risks. Moreover, we elaborate on the core synthetic biological tools used to overcome the above limitations, including CRISPR-Cas gene editing, receptor-binding protein reprogramming, functional load delivery and immunogenic regulation, and summarize the recent clinical progress and personalized treatment process. The increasing clinical evidence shows that synthetic biology can effectively overcome the inherent defects of natural bacteriophages, confirming the safety and initial efficacy of bacteriophage therapy. Engineered phages provide a practical strategy to meet the antimicrobial resistance challenge. Clinical applications of such phages will mainly depend on progress in production standardization, regulatory framework construction and scientific and reasonable joint treatment program development. Full article

Early warning has been widely proven to be reliable in lowering the risk of instability for biological processes. However, it is very difficult for the warning systems used currently to achieve satisfactory accuracy, timeliness and universality simultaneously. This study developed a novel early warning system for instability in food waste anaerobic digestion (FWAD) by bioimitating the human disease screening paradigm. It consists of single, comprehensive and microbiological indicators. Findings showed that single-factor early warning systems resembled acute patient diagnosis, having high accuracy but low timeliness and poor universality. Each of the chosen single indicators showed distinct early warning performances and clear preferences for diverse inhibitions concerning the instabilities of high organic load rate, high ammonia, and high fat in FWAD. Then, a new comprehensive indicator was developed using the entropy weights of several indicators. Confirmatory tests revealed that the comprehensive indicator-based early warning system was analogue to the resident sub-health diagnostic regarding superior foresight and good operability but poor targeting. Therefore, an early warning system based on microbial changes was proposed for potential instability in FWAD by bioimitating human periodic physical examination. The sensitive bacteria were identified as norank_o_ norank_c_Dojkabacteria and Rikenellaceae_RC9_gut_group. Enlarged tests showed that the developed system could be used for emergent, indistinct and potential early warnings simultaneously while avoiding the shortcomings of existing systems. More preciously, this study provided a paradigm for developing early warning systems of FWAD, which is also suitable to be applied to the intelligent systems that rely on automated machine learning. Full article

Background: Chronic kidney disease (CKD) is highly prevalent in older adults, yet distinguishing pathological CKD from age-related decline in kidney function remains challenging. KDIGO guidelines recommend combined assessment of estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (uACR), but implementation in primary care is uncertain. We evaluated CKD screening patterns, KDIGO risk categories, and the prognostic value of eGFR and albuminuria for all-cause mortality in adults aged ≥75 years. Methods: We conducted a retrospective population-based cohort study of 587,603 community-dwelling adults aged ≥75 years using Primary Care electronic records. Complete CKD screening was defined as at least two eGFR and two uACR measurements ≥ 3 months apart during 2015–2019. CKD prevalence, KDIGO risk categories, and 40-month all-cause mortality were assessed. Multivariable Cox regression models evaluated the independent and joint associations of eGFR and albuminuria with mortality. Results: Only 19.0% of participants underwent complete KDIGO-recommended screening, mainly because of limited albuminuria testing. Among screened individuals, CKD prevalence was 25.7%, with over half classified as high or very high KDIGO risk. Mortality increased progressively with declining eGFR, increasing albuminuria, and worsening KDIGO risk. Macroalbuminuria (HR 1.87, 95% CI 1.75–2.00) and eGFR < 30 mL/min/1.73 m² (HR 1.91, 95% CI 1.79–2.04) were independently associated with mortality. Conclusions: Complete KDIGO-recommended screening was performed in only one in five adults aged ≥75 years, identifying a major implementation gap in primary care. Albuminuria provided prognostic information beyond eGFR, improving identification of older adults at highest risk of death. These findings support systematic combined eGFR–uACR assessment to improve risk stratification, guide kidney-protective management, and inform healthcare planning for ageing populations. Full article

Hip fractures are among the most devastating fragility fractures, associated with excess mortality, disability, loss of independence, and substantial healthcare costs. Although age-standardized incidence has declined in several high-income countries, absolute case numbers continue to rise because of population aging. This review summarizes contemporary PubMed-indexed evidence on the epidemiology, risk stratification, and prevention of proximal femoral fractures, with emphasis on hip-fracture outcomes rather than vertebral or composite endpoints alone. We discuss secular trends, FRAX-based case findings and screening, non-pharmacologic strategies, pharmacologic therapy, and health-system interventions relevant to both primary and secondary prevention. Among non-pharmacologic measures, long-term balance-challenging and resistance-based exercise has the most consistent evidence for reducing falls and likely contributes to fracture prevention, whereas multifactorial interventions, home hazard modification, calcium/vitamin D supplementation, and hip protectors are best targeted to selected high-risk populations and care settings. Among medications, bisphosphonates, denosumab, and romosozumab-based sequential strategies show the strongest evidence for reducing hip-fracture risk, while teriparatide and abaloparatide have important roles in very-high-risk patients despite less direct hip-fracture evidence. Menopausal hormone therapy reduces hip fractures in younger postmenopausal women but is limited by extra-skeletal risk, and selective estrogen receptor modulators are primarily vertebral-fracture agents. A major message of this review is that effective prevention depends not only on drug efficacy but also on implementation. Fracture liaison services, orthogeriatric co-management, prompt treatment after fragility fracture, and sustained adherence support are essential to close persistent care gaps. Preventing hip fractures therefore requires an integrated, risk-stratified approach that combines skeletal protection, falls prevention, and reliable health-system delivery. Full article