Search Results (3,096)

Background: Non-melanoma skin cancers (NMSCs) of the head and neck represent a therapeutic challenge due to the region’s complex anatomy, functional considerations, and frequent involvement of high-risk anatomical zones. Local recurrence remains a clinically significant concern, however real-world data regarding recurrence patterns and associated risk factors in facial NMSCs are limited. Objectives: To evaluate the incidence of local recurrence of facial skin cancers after surgical treatment and to determine clinicopathological and anatomical actors associated with an increased risk of recurrence. Methods: In this single-center retrospective cohort study, consecutive patients undergoing surgical excision of facial NMSC were included. The treatment of choice was always surgical excision under general or local anesthesia, with an adequate margin of macroscopically unchanged tissue. Mohs surgery was not used, and none of the patients received immunosuppression. Clinical and pathological data were extracted from medical records. Histopathological examination constituted the basis for establishing the final clinical diagnosis and thus was not verified otherwise. The primary outcome was histologically confirmed local recurrence defined as the reappearance of a tumor of the same histopathological type at the same anatomical site as the previously excised lesion. Patients in the non-recurrence group were defined as those who did not experience any recurrence within a 5-year follow-up period after the initial surgical treatment. Fisher’s exact test and the Mann–Whitney U test were used for statistical analysis. Logistic regression was performed to explore factors associated with recurrence. Due to incomplete follow-up data for the non-recurrent group, we limited the timing analysis to recurrent cases only, as these limitations precluded the use of standard survival analysis. Results: A total of 302 lesions were analyzed, with recurrence status available for 291 tumors. The overall recurrence rate was 28.52%. Basal cell carcinoma (BCC) was the most common histopathological subtype. Recurrences occurred more frequently in anatomically high-risk areas, particularly the scalp, temple and nose. Infiltrative BCC subtypes demonstrated higher recurrence rates than nodular and superficial subtypes. Patients with recurrent tumors were younger than those without recurrence. A history of prior skin radiotherapy was associated with increased odds of recurrence. Tumor size and surgical margin width were not significantly associated with recurrence. Multivariate models showed limited discriminatory ability, suggesting that additional unmeasured factors contribute to recurrence risk. Conclusions: Local recurrence of non-melanoma skin cancers in the head and neck region remains a substantial clinical concern, particularly in high-risk anatomical sites and tumors with aggressive histopathological features. These findings highlight the importance of long-term follow-up and support further prospective studies to improve recurrence risk assessment and treatment strategies. Full article

Background/Objectives: Adequate choline intake is critical across the peripartum period for optimal maternal-offspring health. Maternal depressive symptoms are associated with poor dietary quality, but the relationship between postpartum depression and choline intake in lactating mothers of preterm infants, a period of heightened intake requirements, has not been previously explored. Methods: Lactating mothers of hospitalized preterm infants (born ≤36 weeks gestational age) completed depression screening with the Edinburgh Postnatal Depression Scale (EPDS) and a dietary choline intake survey. Mann–Whitney U tests compared maternal choline intake based on EPDS screen status (low-risk or at-risk for depression). Multivariable linear regression assessed the relationship between maternal depressive symptoms and choline intake. Results: EPDS screens were at-risk in 18 (42%) of the 43 participants. Median choline intake across the cohort was <50% of recommended dietary intake (median [IQR] 221 [147, 308] mg), with lower intake in mothers with at-risk EPDS screens compared to low-risk screens (median [IQR] score: 156 [105, 218] mg vs. 298 [196, 357] mg, p < 0.01). In multivariable linear regression, EPDS score was negatively associated with maternal choline intake (β [95% CI] = −0.13 [−0.26, −0.01], p = 0.03). Conclusions: Dietary choline intake is low among lactating mothers of preterm infants, particularly those with postpartum depressive symptoms. Full article

Background/Objectives: Immediate patient access to radiology reports has increased the need for communication that patients can understand, yet it remains unclear whether simplifying report language improves comprehension without worsening psychological distress. This study aimed to determine whether AI-based simplification of a brain MRI report improves patient understanding, to assess whether anxiety differs between standard and AI-simplified reports, and to examine the relationships among anxiety, report understanding, and health literacy. Methods: We conducted a minimal-risk, survey-based randomized experimental study using Qualtrics and Amazon Mechanical Turk. A total of 803 participants were randomized 1:1 to view either an original radiology report (control, n = 402) or an AI-simplified version of the same report (intervention, n = 401). The stimulus was a single de-identified brain MRI/MRV report. Primary outcomes were report understanding and post-exposure anxiety, and secondary measures included radiology literacy and general health literacy assessed with the Short Test of Functional Health Literacy in Adults (S-TOFHLA). Between-group differences were analyzed using Mann–Whitney U tests, and associations between variables were examined using correlation analyses. Results: Participants who received the AI-simplified report achieved significantly higher understanding scores than those who viewed the original report (mean 5.78 ± 1.31 vs. 5.61 ± 1.49; p = 0.007). Anxiety scores were similar between groups (mean 3.24 ± 0.84 vs. 3.23 ± 0.85; p = 0.103). A positive correlation was observed between anxiety and general health literacy (r = 0.283, p < 0.001), and report understanding was also positively correlated with anxiety (r = 0.182, p < 0.001). Age was negatively associated with anxiety, whereas income showed a weak positive association. Conclusions: AI-based simplification improved patient understanding of radiology reports but did not reduce anxiety. Greater understanding was associated with higher anxiety, suggesting that clearer language alone may be insufficient to address the emotional burden of reading radiology results without clinical context or reassurance. Full article

Background/Objectives: Reverse total shoulder arthroplasty (rTSA) is the preferred treatment for elderly patients with complex proximal humerus fractures. Accurate humeral stem positioning remains challenging in these cases due to complex fracture patterns, which may lead to postoperative complications. Virtual surgical planning (VSP) may assist in optimizing humeral stem and greater tuberosity positioning; however, its clinical impact in fracture-related rTSA has not yet been evaluated. This study aimed to assess whether VSP improves postoperative range of motion (ROM). Methods: A comparative cohort study was conducted, comprising a prospective VSP group and a retrospective control group. Patients underwent rTSA for proximal humerus fractures. Primary outcomes were ROM during forward elevation, abduction, and external rotation at two months and one year postoperatively. Secondary outcomes included complications, procedure time, greater tuberosity repositioning and healing, and postoperative deviation in humeral stem height compared with the preoperative plan. Statistical analyses included independent t-tests, Mann–Whitney U tests, and chi-square tests. Results: A total of 48 patients were included: 27 in the VSP group and 21 in the non-VSP group. At two months, abduction was significantly greater in the VSP group (76° vs. 63°, p = 0.05). Forward elevation and external rotation were numerically higher in the VSP group but did not reach statistical significance (p < 0.1). Stem height deviation was significantly lower in the VSP group (3 mm vs. 12 mm, p < 0.001). Conclusions: VSP enables more accurate humeral stem positioning in rTSA for proximal humerus fractures. Although no statistically significant improvements in ROM were observed at one year, VSP demonstrated superior accuracy in stem positioning. Full article

Background: Providing effective peer feedback is a challenge in nursing education. While Generative AI (GenAI) can assist, students often struggle with the task. Metacognitive scaffolding may help guide students through this complex process. Aim: This study aimed to evaluate the effects of a metacognitive scaffolding-based GenAI-assisted peer feedback provision (MGPFP) approach on nursing students’ feedback engagement and behavioral patterns. Methods: A quasi-experimental study was conducted with 71 nursing students. The experimental group (n = 35) used the MGPFP approach, while the control group (n = 36) used a standard GenAI-assisted approach without scaffolding. A Mann–Whitney U test was used to compare feedback engagement. Lag sequential analysis was used to examine feedback giving behavior patterns based on coded video data. Results: The experimental group reported significantly higher engagement than the control group across four dimensions: behavioral, cognitive, social, and emotional engagement. The experimental group generated 5219 coded behaviors, while the control group generated 1861. In the experimental group, common behaviors included referring external resources (19.58%), comparing and making judgements (17.80%), and recognizing the purpose (15.77%). Non-feedback behaviors were much higher in the control group (2.69%). Lag sequential analysis identified 17 significant sequences in the experimental group and 14 in the control group. Conclusions: Integrating metacognitive scaffolding into GenAI-assisted peer feedback can improve nursing students’ engagement and promote more productive and structured feedback behaviors. This approach is a valuable strategy for enhancing the quality of peer feedback in nursing education. Full article

This exploratory study examines whether chatbot-mediated written interaction supports adult B2 English learners’ performance in online interaction, pluricultural competence, and mediation in Official Language Schools (OLS) in Spain. The intervention was built around a fictional-culture scenario in which learners had to resolve a cultural misunderstanding between a Spanish visitor and a host from an invented culture. In the experimental condition, students interacted with a chatbot previously configured with information about the fictional culture; in the control condition, students worked in pairs in a chatroom, with one peer acting as the cultural expert. Interaction texts were independently rated by two researchers using a Common European Framework of Reference for Languages (CEFR) Companion Volume-informed rubric. The dataset comprised 16 learners in the control group and 24 in the experimental group, each rated by two evaluators. Inter-rater reliability reached acceptable levels for all aggregated dimensions, with ICC(2,1) values above 0.70. Mann–Whitney U tests showed no significant between-group differences in online interaction or pluricultural competence, whereas the chatbot-supported condition, which included sustained-questioning scaffolding, was associated with significantly higher mediation scores. The findings suggest that chatbot use may be pedagogically promising for mediation-oriented writing tasks, although the evidence should be interpreted cautiously because the study is exploratory, the sample is small, and the scenario relied on a fictional cultural frame. Full article

Background: Rosacea is a chronic inflammatory dermatosis with emerging links to the gut–skin axis, yet integrative data connecting fecal microbiota with metabolic and immune parameters remain scarce. Methods: Within a cohort of Croatian women (N = 300, aged 30–35), participants with self-reported physician-diagnosed rosacea (n = 19) were compared to controls (n = 281). Assessments included validated questionnaires, anthropometrics, fasting blood parameters, and fecal 16S rRNA gene sequencing (QIIME2). Taxonomic profiling at four levels (899 features) used Mann–Whitney U tests with per-level Benjamini–Hochberg FDR correction. This study follows STROBE and STORMS guidelines. Results: On the host side, rosacea was nominally associated with higher BMI (p = 0.037), poorer sleep quality (p = 0.038), elevated monocytes (p = 0.031), and higher HOMA-B (p = 0.013); these comparisons were not corrected for multiple testing. Fecal 16S rRNA analysis (rosacea n = 18, controls n = 265) identified 15 nominally significant genera, including depleted Bifidobacterium (p = 0.007), Roseburia (p = 0.033), and enriched Anaerostignum (p < 0.001). However, no taxon survived FDR correction at any taxonomic level (lowest q = 0.165), and the total number of nominally significant features (48/899, 5.3%) did not exceed chance expectation (binomial p = 0.340). All key taxa remained nominally significant after BMI adjustment. An exploratory Random Forest classifier (five genera + HOMA-B + cortisol) achieved LOOCV AUC = 0.785, but feature selection on the training data limits interpretation. Conclusions: In this narrowly age-defined female cohort, host-side metabolic and immune differences reached nominal significance without multiple-testing correction. Fecal microbiota differences were exclusively exploratory: no taxon survived FDR correction, and the overall signal did not exceed chance expectation. The pattern of findings is compatible with—but does not constitute evidence for—a gut–skin axis contribution to rosacea. Confirmation in adequately powered cohorts with clinical rosacea verification, comprehensive confounder capture, and pre-registered analyses is required before any mechanistic or clinical conclusions can be drawn. Full article

Background: Autism spectrum disorder (ASD) arises from complex gene–environment interactions. While trace element abnormalities have been studied, associations with autism severity remain inconsistent. Ratios indicating detoxification balance, rather than single toxic elements, may better reflect severity. Objective: To examine the relationships between urinary trace element levels, detoxification-related element ratios, and autism severity measured by the Childhood Autism Rating Scale (CARS). Methods: In a cross-sectional study of 168 participants (103 ASD, 65 controls), thirty urinary trace elements were quantified by ICP-MS. ASD patients were stratified by CARS into subthreshold ASD (n = 29), mild–moderate ASD (n = 36), and severe ASD (n = 38). Analyses included Mann–Whitney U, Kruskal–Wallis, and Spearman correlation tests, focusing on Li/Pb, Cu/Pb, and Cr/Pb ratios. Results: Individual elements showed weak associations with CARS; lead correlated positively (ρ = 0.209, p = 0.035) and lithium inversely (ρ = −0.194, p = 0.051). In contrast, element ratios showed stronger links: Li/Pb (ρ = −0.349, p = 0.0003), Cu/Pb (ρ = −0.320, p = 0.0011), and Cr/Pb (ρ = −0.209, p = 0.035). Severe ASD exhibited modest 90th-percentile elevations for toxic elements but high heterogeneity. Conclusions: Single-element levels showed limited associations with ASD severity. Element ratios, particularly Li/Pb, showed stronger statistical associations than individual elements in this cross-sectional dataset; however, these findings should be interpreted as candidate correlates rather than causal or clinically validated biomarkers. Full article

Background: Rectal neuroendocrine tumors (r-NETs) measuring 20 mm or less are increasingly diagnosed during colorectal cancer screening, but the optimal depth of endoscopic resection remains uncertain. Endoscopic submucosal dissection (ESD) is well established, whereas endoscopic intermuscular dissection (EID) may provide deeper resection for fibrotic or recurrent lesions. We hypothesized that EID would provide reliable deep-margin clearance without compromising safety. Methods: We retrospectively reviewed 42 consecutive patients treated at a tertiary center between 2018 and 2025. Thirty-two primary lesions underwent ESD and 10 lesions or scars suspicious for deep invasion underwent EID. Primary outcomes were en bloc and R0 resection; secondary outcomes were procedure time, adverse events, and length of stay. Groups were compared with the t, Mann–Whitney U, and chi-square tests. Results: En bloc resection was achieved in all cases. Histology confirmed R0 resection in all 26 primary lesions. Among 16 excision scars, 14 showed fibrosis only and 2 harbored grade 1 NET recurrence; both recurrent lesions were resected R0 with EID. Lesion size and procedure time were similar between groups. No major adverse events occurred. Self-limited intraprocedural bleeding occurred in five patients, and all patients were discharged within 2 postoperative days. Conclusions: Both techniques are safe and effective for r-NETs measuring 20 mm or less, and EID may be preferred for fibrotic or recurrent lesions. Large prospective multicentre studies are needed to validate the depth-tailored use of EID in r-NETs. Full article

Background: Direct comparisons between uniportal robotic-assisted (uRATS) and uniportal video-assisted (uVATS) thoracoscopic anatomical lung resection for non-small cell lung cancer (NSCLC) remain scarce. We compared oncologic radicality and perioperative outcomes between the two uniportal approaches in a single-center contemporaneous cohort. Methods: This retrospective cohort study included 56 consecutive NSCLC patients undergoing uniportal anatomical resection between January 2024 and December 2025 (uRATS, n = 12; uVATS, n = 44). The primary endpoint was oncologic radicality of lymph-node dissection (stations sampled, total nodes, mediastinal sampling, R0 rate). Secondary endpoints included operative time, blood loss, pain, recovery metrics, and a composite textbook outcome. Comparisons used Mann–Whitney U and Fisher’s exact tests. Results: Complete (R0) resection was achieved in all 56 patients. The operating surgeon dissected more lymph nodes in the uRATS group (median 13 vs. 7; p = 0.049), with a trend toward more mediastinal stations sampled (4 vs. 3; p = 0.061). Operative time was longer with uRATS (220 vs. 135 min; p < 0.001), but air-leak duration (0 vs. 2 days; p < 0.001), hospital stay (2 vs. 3 days; p = 0.022), and discharge pain (p = 0.017) all favored uRATS. Textbook outcome was achieved in 83% versus 48% (p = 0.047). Conclusions: In a uniportal-experienced unit, uRATS showed comparable intraoperative oncologic-quality metrics to uVATS with directional perioperative-recovery differences favoring uRATS. Larger multicenter studies with longer follow-up are warranted. Full article

Serum S100B has been proposed as a peripheral biomarker associated with neuroinflammatory and astroglial stress-related processes in major depressive disorder (MDD). This study aimed to evaluate serum S100B levels in patients with MDD and suicidal ideation and to investigate whether childhood trauma mediates the relationship between suicide probability and S100B levels. This study included patients with MDD and suicidal ideation (n = 29), patients with MDD without suicidal ideation (n = 30), and healthy controls (n = 29). Serum S100B levels were measured before and after treatment in patients with suicidal ideation. Suicide Probability Scale (SPS), Childhood Trauma Questionnaire (CTQ), and Rosenberg Self-Esteem Scale (RSES) scores were assessed. Group comparisons were performed using Mann–Whitney U and Kruskal–Wallis tests with Dunn–Bonferroni post hoc analysis. Logistic regression and mediation analyses were conducted to examine the relationships among suicide probability, childhood trauma, and S100B levels. Pre-treatment serum S100B levels were significantly higher in patients with MDD and suicidal ideation compared with healthy controls (median 10.95 vs. 8.97 pg/mL, p = 0.001), whereas post-treatment levels did not differ between groups (median 7.84 vs. 8.97 pg/mL, p = 0.323). Within-group analysis demonstrated a significant reduction in S100B levels after treatment (Z = −3.359, p < 0.001). Additional three-group comparison revealed a significant overall difference in S100B levels among the study groups (H = 8.17, p = 0.017). Logistic regression analysis showed that serum S100B levels were independently associated with suicidal ideation (OR = 1.14, 95% CI 1.02–1.27, p = 0.021). Mediation analyses demonstrated a significant indirect effect of suicide probability on S100B levels through childhood trauma (Sobel Z = −2.45, p = 0.014). Serum S100B levels were elevated during the acute phase of MDD with suicidal ideation and decreased following treatment; however, the specificity of this longitudinal change to suicidality could not be determined within the present study design. The relationship between suicide probability and S100B levels appears to be mediated by childhood trauma, suggesting that S100B may reflect trauma-related neurobiological vulnerability rather than a disease-specific biomarker of suicidality. These findings support a potential association between peripheral glial-related biomarkers and stress-responsive neurobiological processes underlying suicidality. Full article

Bark beetle infestations present a considerable risk to coniferous forest ecosystems, resulting in substantial ecological and economic losses. Monitoring and mapping vegetation health using remote sensing techniques is an important step in identifying and controlling areas of susceptibility, especially for bark beetles that cause significant damage to forest ecosystems. This study assessed the statistical discriminative efficacy of vegetation indices obtained from Landsat 8 OLI data at the stand level in discriminating between forest stands impacted and unaffected by Ips sexdentatus damage. Eighty forest stands (40 forest stands, both with and without Ips sexdentatus damage) selected through fieldwork in the Araç Forest Directorate, Kastamonu, were studied. Five frequently utilized vegetation indices (NDVI, NDMI, MSI, TCW, and RGI) were applied, and the minimum, maximum, and average values were computed for each stand. Given the non-normal distribution of the data, the Mann–Whitney U test was utilized, revealing significant differences (p < 0.001) between stands with and without beetle damage across all indices except TCW(max.). NDVI and NDMI values decreased in damaged stands, whereas MSI and RGI values increased. MANOVA results indicated substantial distinction among groups (Pillai’s Trace = 0.870, p < 0.001), whereas PCA demonstrated significant differentiation, accounting for 75.4% of the total variance. The mean values of NDVI and NDMI showed the greatest discriminatory potential among the indices. In summary, the Landsat 8 vegetation indicators tested in this study showed substantial discriminating potential. Full article

Objective: Skeletal mandibular asymmetry (MA) is a pathological condition characterised by asymmetric mandibular growth, resulting in chin deviation and, in some cases, non-coincident dental midlines. Because it is a skeletal condition, some clinicians choose to treat it with functional appliances. The present study therefore evaluated whether functional appliances with asymmetric activation can promote more symmetrical growth of the mandibular condyles and rami. Methods: Eighty-five patients with MA were retrospectively selected based on cervical skeletal maturation stage 2 or 3, the presence of skeletal and dental Class II malocclusion, and the availability of good-quality orthopantomograms taken before and after treatment. Among the enrolled patients, 40 were treated with functional appliances to protrude and re-centre the mandible (study group), while 45 were treated only with a rapid maxillary expander (positive and treated control group). This control group was chosen because it has no direct effects on the mandible and avoided the ethical concerns associated with postponing time-sensitive treatment to recruit a negative control group. Ramus and condyle asymmetry were evaluated pre- and post-treatment using Habets’ method. The Mann–Whitney U-test was used to compare pre- and post-treatment asymmetry indices between the two groups. Results: Although both groups showed a post-treatment symmetry improvement, no statistically significant between-group differences were observed (p = 0.712, effect size r = 0.14 for ramal symmetry; p = 0.663, effect size r = −0.01 for condylar symmetry). Conclusions: Within the limitations of this study, functional appliances did not demonstrate greater skeletal effects than the positive control treatment. Full article

Background/Objectives: Hyperventilation-induced nystagmus (HVIN) has been described as a sensitive clinical sign in vestibular schwannoma (VS), potentially reflecting a reversible conduction block in partially demyelinated vestibular nerve fibers. However, its relationship with tumor size and instrumental vestibular deficits remains controversial. This study aimed to investigate the association between HVIN, tumor size, clinical presentation, and vestibular function assessed by the video Head Impulse Test (vHIT) and functional Head Impulse Test (fHIT). Methods: Eighty consecutive patients with unilateral VS were retrospectively evaluated. All underwent bedside vestibular examination, the vHIT, the fHIT, and the Hyperventilation Test (HVT). Tumors were classified according to the modified Koos–Sanna grading system. Associations between HVIN (presence and direction), demographic and clinical variables, vestibular deficits, and tumor size were analyzed using binary logistic regression, Fisher’s exact test, Welch’s independent samples t-test, and the Mann–Whitney U test. Results: HVIN was observed in 73% of patients. Among the patients with HVIN, ipsilesional horizontal nystagmus occurred in 57% of cases, 41% of the subjects showed contralesional nystagmus and one patient had downbeat nystagmus. vHIT abnormalities were identified in 54% of patients, while 30% of these also demonstrated fHIT deficits. No patient presented isolated fHIT abnormality. HVIN was detected even in patients with intracanalicular or small tumors and in some asymptomatic individuals. No statistically significant correlations were found between tumor size and HVIN presence, HVIN direction, or vestibular deficits in the vHIT/fHIT (all p > 0.05). Conclusions: HVIN is frequently observed in patients with VS, including those with small or asymptomatic lesions. However, neither its presence nor direction correlates with tumor size or objective vestibular deficit. The Hyperventilation Test should not be considered a prognostic tool but may serve as a simple and valuable adjunctive bedside examination in the early diagnostic suspicion of vestibular schwannoma. Full article

Background/Objectives: Lung cancer remains a leading cause of cancer-related mortality and is characterized by complex tumor–host interactions, including systemic inflammation, metabolic dysregulation, and immune imbalance. This study aimed to evaluate whether a diagnosis of anemia reflects underlying inflammatory burden and to explore phenotype-based interactions between anemia, inflammation, and muscle depletion in lung cancer patients. Methods: A retrospective cohort study was conducted, including 70 patients diagnosed with lung cancer between 2019 and 2023. Anemia was defined using standard hemoglobin thresholds (<12 g/dL in women, <13 g/dL in men). Systemic inflammation was assessed using complete blood count-derived indices (NLR, PLR, SII, SIRI, and AISI), both individually and combined into a cumulative inflammatory score. Sarcopenia was evaluated through CT-based quantification of skeletal muscle area at the L3 level. Patients were stratified into four phenotypes based on anemia status, inflammatory burden, and sarcopenia. Statistical analyses like Mann–Whitney U, Kruskal–Wallis with Dunn post hoc testing, and univariate logistic regression were used. Results: Anemia was present in 44.3% of patients and was associated with a significantly higher inflammatory score compared to non-anemic patients (median 5 [IQR 4–5] vs. 4 [3–5], p = 0.024). Among inflammatory markers, PLR was significantly associated with anemia (OR = 4.94, 95% CI: 1.57–15.52, p = 0.004). The cumulative inflammatory score showed a non-significant association with anemia (OR = 1.28, 95% CI: 0.93–1.75, p = 0.124). Phenotype-based analysis revealed significant differences in skeletal muscle area (p = 0.004), with the sarcopenic-inflammatory phenotype exhibiting significantly lower muscle mass compared to other groups. No associations were observed between phenotypes and tumor stage or histological subtype. Conclusions: Anemia in lung cancer patients is closely associated with systemic inflammation and may reflect underlying biological vulnerability rather than tumor-specific characteristics. A phenotype-based approach integrating anemia, inflammatory markers, and sarcopenia provides a more comprehensive understanding of disease heterogeneity and may improve risk stratification. Further studies are needed to validate these findings and assess their prognostic implications. Full article