Search Results (45,323)

Background/Objectives: With the rising prevalence of mental health (MH) disorders, improving the effectiveness and quality of MH care has become increasingly imperative. To improve patient care outcomes, it is essential to accurately assess staffing needs and compare outcomes across providers to identify best practices. However, without a robust case-mix adjustment system that accounts for disease severity, efforts to measure staffing requirements and evaluate patient outcomes are of limited value. This study aimed to develop such a system by leveraging a large study population, more clinically homogeneous groups, and advanced modeling techniques. Methods: In this retrospective population-based study, over two million MH patients (n = 2,088,174) were grouped into 162 clinically homogeneous categories using Clinical Classifications Software Refined (CCSR) to enhance predictive accuracy. We evaluated the performance of four statistical models and four artificial intelligence (AI) models to identify the model that delivered the highest predictive power. Results: Among the statistical models, the Box–Cox regression yielded the highest predictive power (R² = 0.42; percent of variation explained [PVE] = 0.300). Among the AI models, CatBoost performed best (R² = 0.458; PVE = 0.311). While the AI models outperformed traditional statistical models, the improvements were modest. Sensitivity analyses confirmed the robustness of these models. Conclusions: Both the Box–Cox and CatBoost models demonstrated superior predictive performance compared to those reported in the literature. These findings suggest that a case-mix system based on either model can be used for risk adjustment to optimize staffing levels and benchmark patient outcomes for quality improvement. Full article

Background: Persistent rotational instability and graft failure remain major challenges following anterior cruciate ligament reconstruction (ACLR). The addition of anterolateral ligament reconstruction (ALLR) and suture tape augmentation may enhance graft protection and early stability. This study aimed to assess the short-term clinical outcomes of combined ACLR and ALLR with suture tape augmentation, hypothesizing that this technique would yield favorable results in patients with ACL injury. Methods: Twenty-four patients (16 males, 8 females; mean age 30.8 years) with high grade pivot shift who underwent combined ACLR and ALLR with suture tape augmentation between 2022 and 2024 were retrospectively reviewed. Objective assessments included pivot-shift grading and anterior tibial translation (ATT) using a GNRB arthrometer. Patient-reported outcome measures (PROMs) comprised the International Knee Documentation Committee (IKDC), Marx activity score, and Single Assessment Numeric Evaluation (SANE) scores. Subgroup analysis compared graft diameters < 8 mm versus ≥8 mm. Results: The mean follow-up period was 23.4 months. Significant improvements were observed postoperatively in IKDC (45.9→83.7), Marx (4.4→9.9), SANE (49.2→85.2), and ATT (4.7→1.1 mm) (all p < 0.001). Full range of motion was regained at a mean of 3.2 months. Twenty-one patients presented no pivot shift and three with grade one postoperatively. No significant differences were found between the small (<8 mm) and large (≥8 mm) graft groups. MRI at one year showed intact grafts without adverse reactions. Conclusions: Combined ACL and anterolateral ligament reconstruction with suture tape augmentation demonstrated promising short-term stability and functional recovery without significant complications. This technique may enhance biomechanical reinforcement of both ACL and ALL grafts and represents a viable option for patients with smaller graft diameters. Full article

Background/Objectives: Open reduction and internal fixation with plates and screws is the treatment of choice for bicondylar tibial plateau fractures. The use of a surgical approach remains a topic of debate regarding the site and number of incisions that ensure best access for reduction with minimum additional soft tissue damage. This retrospective cohort study compared clinical, radiological, and functional outcomes of single- (anterior) versus dual-incision (anterolateral and medial) approaches that are widely used in the operative treatment of Schatzker V–VI tibial plateau fractures. Methods: Eighty-two patients treated between 2005 and 2020 were retrospectively analyzed. Fifty-two underwent a single-incision (SI) approach and 30 a dual-incision (DI) approach. Operative parameters, complications, reduction quality, Knee Society Score (KSS), Oxford Knee Score (OKS), and post-traumatic arthritis incidence were assessed. Results: Mean patient age was 50.6 years, with a mean follow-up of 8.5 years. Operative time was shorter in the SI group, though fluoroscopy time was longer. No significant difference was observed in reduction quality or wound complications. Post-traumatic arthritis occurred in 57.6% of SI and 53.3% of DI patients, with severe arthritis more frequent in SI (30% vs. 12.5%, p < 0.05). Seven patients required conversion to total knee arthroplasty (five SI, two DI). Functional recovery was similar: mean KSS 68.6% (SI) vs. 70.5% (DI) and OKS 36.1 vs. 40.8 (p > 0.05) at 5 years. Conclusions: Both single- and dual-incision approaches for complex tibial plateau fractures provide satisfactory long-term outcomes. While differences in complications and arthritis rates were minor, surgical choice should be guided by the fracture morphology, patient characteristics, and surgeon’s experience to balance reduction quality with soft tissue preservation. Full article

Facial reconstructive surgery requires precise preoperative planning to optimize functional and aesthetic outcomes, but current imaging technologies like CT and MRI do not offer visualization of expected post-surgical appearance, limiting surgical planning capabilities. We developed a deep learning framework integrating facial inpainting and monocular depth estimation models to predict surgical outcomes and enable 2D and 3D planning from clinical photographs. Three state-of-the-art inpainting architectures (LaMa, LGNet, MAT) and three monocular depth estimation approaches (ZoeDepth, Depth Anything V2, DepthPro) were evaluated using the FFHQ dataset for inpainting and C3I-SynFace dataset for depth estimation, with comprehensive quantitative metrics assessing reconstruction quality and depth accuracy. For anatomically specific facial features, LGNet demonstrated superior performance across eyebrows (PSNR: 25.11, SSIM: 0.75), eyes (PSNR: 20.08, SSIM: 0.53), nose (PSNR: 25.70, SSIM: 0.88), and mouth (PSNR: 22.39, SSIM: 0.75), with statistically significant differences confirmed by paired t-tests (p < 0.001) and large effect sizes (Cohen’s d = 2.25–6.33). DepthPro significantly outperformed competing depth estimation models with absolute relative difference of 0.1426 (78% improvement over Depth Anything V2: 0.6453 and ZoeDepth: 0.6509) and δ₁ accuracy of 0.8373 (versus 0.6697 and 0.5271 respectively). This novel framework addresses a critical gap in surgical planning by providing comprehensive preoperative visualization of potential outcomes from standard clinical photographs, supporting applications from maxillofacial reconstruction to orbital and nasal procedures. Full article

Background: Atrial fibrillation (AF) is a prevalent condition with a major influence on patients’ quality of life, especially when blood glucose and heart rate are disrupted and systemic inflammation is present. Objective: This study aimed to compare Kansas City Cardiomyopathy Questionnaire (KCCQ) scores of diabetic patients by AF type and their correlations with different clinical and biological parameters. Material and methods: The retrospective study included 220 patients, from which only 200 were selected because of missing data. Patients were divided into three groups: paroxysmal AF (n = 49), persistent AF (n = 54), and permanent AF (n = 97). Demographic, clinical, and analytical data, echocardiographic parameters, heart rate, blood glucose, renal function, and inflammatory markers were compared between the three groups and their relationship with KCCQ scores. Results: The KCCQ score was significantly higher in patients with paroxysmal AF (69.50 ± 5.93), compared to persistent AF (56.92 ± 3.04) and permanent AF (42.28 ± 5.89), p < 0.001. In subanalyses, based on left ventricular ejection fraction (LVEF), the same trend was maintained, with lower KCCQ scores associated with more severe forms of AF. Significant negative correlations of the KCCQ score with blood glucose level (r = −0.2535, p = 0.0003), heart rate (r = −0.3071, p < 0.0001), and neutrophil–lymphocyte ratio (NLR) (r = −0.2395, p = 0.0006), and a positive correlation with glomerular filtration rate (GFR) (r = 0.4349, p < 0.0001) were identified. Conclusions: The type of atrial fibrillation significantly influences the quality of life assessed by the KCCQ score. Clinical and analytical parameters such as blood glucose, heart rate, systemic inflammation, and renal function significantly correlate with patients’ perception of health, indicating the importance of integrated management of AF. Full article

The diaphragm plays a central role in respiration, and its dysfunction may contribute to respiratory distress (RD). Although ultrasound is widely used to assess diaphragmatic function in humans, its value in veterinary patients remains poorly defined. Fifty-eight dogs undergoing cardiorespiratory evaluation were classified as normal (n = 31) or with RD (n = 27) based on clinical scores. All underwent standardised echodiaphragmatic assessment (M-mode and tissue Doppler imaging, TDI), and interobserver measurement reproducibility was analysed. Demographic characteristics did not differ significantly between groups. Respiratory rate (RR) and body weight were the main factors influencing echodiaphragmatic parameters, with RR being the most relevant. Both groups exhibited mild asymmetry between hemidiaphragms. The mean left–right excursion difference was 4.9% (−79.9 to 79.4%) in the no-RD group and 15.2% (−63.2 to 69.6%) in RD dogs. Significant differences between groups were observed for RR (p = 0.039), as well as TDI-derived peak contraction velocity (p = 0.019) and peak relaxation velocity (p = 0.01). However, no single echodiaphragmatic variable demonstrated strong discriminatory ability for RD in ROC or multivariable logistic analyses. Interobserver reproducibility was excellent for all measurements (intraclass correlation coefficient >87%). In conclusion, M-mode and TDI provide reliable quantitative evaluation of diaphragmatic motion in dogs. A mild dynamic asymmetry exists between hemidiaphragms, but RD is not necessarily indicative of diaphragmatic dysfunction. Respiratory rate remains the main factor influencing echodiaphragmatic parameters. Full article

Background: Tumor angiogenesis is a key step in oral squamous cell carcinoma (OSCC) development. Here, we evaluated the expression patterns of junctional cadherin 5-associated (JCAD), a pathological angiogenesis protein, and interleukin-33 (IL-33) in OSCC to investigate their roles in pathological angiogenesis. Methods: Wound healing assays were performed to evaluate pathological angiogenesis in JCAD knockout (JCAD-KO) mice. In human mandibular gingival SCC and lymph nodes specimens, the numbers of blood vessels positive for CD34 (a vascular endothelial cell marker), CD105 (a well-established tumor angiogenesis marker), JCAD, and IL-33 were counted. We also evaluated the effects of tumor necrosis factor-α (TNF-α) stimulation as a pro-angiogenic factor on human umbilical vein endothelial cells (HUVECs) with JCAD knockdown. Results: In JCAD-KO mouse skin, wound healing and angiogenesis were significantly disturbed. In the clinical samples, the number of microvessels in which CD105 and JCAD were expressed but intranuclear IL-33 expression was lost significantly increased in the intratumoral area compared with the normal area. JCAD knockdown restored the TNF-α-induced loss of intranuclear IL-33 expression in HUVECs. Conclusions: Our combined assessment of JCAD and IL-33 supports the evaluation of tumor angiogenesis in OSCC. JCAD is a potential target for controlling tumor angiogenesis mediated by TNF-α. Full article

Background: Aberrant or loss of cell adhesion drives invasion and metastasis, key hallmarks of cancer progression. In this work, we hypothesized that a gene signature related to cell adhesion could predict breast cancer prognosis. Methods: Highly variant genes were tested for association with overall survival using Cox regression. Adhesion-related genes were identified through gene ontology analysis and multivariate Cox regression, with AIC selection, defined the prognostic signature. The AdhesionScore was then calculated as a weighted sum of gene expression, with risk stratification assessed by Kaplan–Meier and log-rank tests. Results: We found that the AdhesionScore was a significant independent predictor of poor survival in three large independent datasets, as it provided a robust stratification of patient prognosis in the Molecular Taxonomy of Breast Cancer International Consortium (METABRIC) (HR: 2.65; 95% CI: 2.33–3.0, p = 2.34 × 10⁻⁵¹), The Cancer Genome Atlas (TCGA) (HR: 3.46; 95% CI: 2.35–5.09, p = 3.50 × 10⁻¹⁰), and the GSE96058 (HR: 2.83; 95% CI: 2.20–3.65, p = 6.29 × 10⁻¹⁶) datasets. The 5-year risk of death in the high-risk group was 32.41% for METABRIC, 27.8% for TCGA, and 17.54% for GSE96058 datasets. Consistently, HER2-enriched and triple-negative breast carcinomas (TNBC) cases showed higher AdhesionScores than luminal subtypes, indicating an association with aggressive tumor biology. Conclusions: We have developed, for the first time, a molecular signature based on cell adhesion, as well as an associated AdhesionScore that can predict patient prognosis in invasive breast cancer, with potential clinical application. We developed a novel adhesion-based molecular signature, the AdhesionScore, that robustly predicts prognosis in breast cancer across independent cohorts, highlighting its potential clinical utility for patient risk stratification. Full article

Peri-implantitis, a common biological complication of dental implants, is characterized by soft-tissue inflammation and progressive bone loss. Oxidative stress is increasingly implicated in its pathogenesis, yet the diagnostic potential of salivary redox biomarkers remains unclear. This study’s objective was to assess the association between salivary malondialdehyde (MDA) and total antioxidant capacity (TAC) and peri-implant disease via a pre-registered, quantitative meta-analysis of previously published studies using predefined statistical criteria. Following a priori PROSPERO registration, we systematically searched PubMed, Scopus, and Web of Science (2004–September 2025), extracted data in duplicate, and pooled effects using random-effects models; certainty of evidence was appraised with GRADE (Grading of Recommendations Assessment, Development and Evaluation) and risk of bias with ROBINS-I (Risk Of Bias In Non-randomized Studies of Interventions)/QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2). Twelve studies were included qualitatively: seven (n = 726) contributed to MDA and five (n = 485) to TAC meta-analyses. Peri-implant disease was associated with elevated MDA (SMD = 1.64, 95% CI 1.39–1.88) and reduced TAC (SMD = −1.88, 95% CI −2.17 to −1.58); statistical heterogeneity was not detected, and results were robust to sensitivity and exploratory assay-based subgroup analyses. Salivary MDA and TAC show consistent, large, standardized differences in peri-implant disease; however, observational designs, assay variability, and the absence of validated diagnostic thresholds warrant cautious interpretation and prospective validation before clinical adoption. Full article

The ABO blood group system, characterized by specific glycosyltransferase activity, is linked to various biological and clinical traits. However, findings often lack consistency due to small sample size and ethnic variability. This research explores potential associations between ABO blood types and physical, mental, and physiological traits in a substantial Taiwanese population. We utilized data from 146,374 individuals in the Taiwan Biobank. Compared to people with blood type O, those with blood types A and B exhibited a reduced risk of peptic ulcers (11% and 8%, respectively). Blood type A was associated with a 16% increased risk of hyperlipidemia and an 18% increased risk of asthma. It also had 2.3% higher total cholesterol and 3.3% higher LDL-C than type O. Blood type B showed 1.6% higher triglyceride levels. This study observes possible associations between ABO blood types and physical diseases, including gastric ulcers and asthma, as well as unique biochemical profiles. The results suggest that ABO blood typing may offer supplementary value in population-level risk assessment. Future research should elucidate underlying mechanisms and validate findings across populations. Full article

Conventional respiratory monitoring is often invasive, while most non-contact technologies like radar or cameras are limited to estimating respiratory rate, failing to reconstruct the detailed waveform of the respiratory flow itself. This gap limits their clinical utility for advanced diagnostics. We introduce a novel system that bridges this gap by combining a contactless, impedance-based sensor (the Thoraxmonitor) with a dedicated machine learning framework to directly reconstruct the full respiratory flow signal. Operating at 433 $\mathrm{M}$$\mathrm{Hz}$, the system’s antenna array detects subtle changes in thoracic impedance, which are then translated into a quantitative flow signal by a Multilayer Perceptron Regressor. Based on data from 17 subjects benchmarked against a gold-standard flowmeter, our system accurately detected 98% of respiratory cycles. It achieved remarkable precision in timing respiratory events, with mean deviations of + 60 $\mathrm{m}$$\mathrm{s}$ (±79 $\mathrm{m}$$\mathrm{s}$) for inspiration and + 50 $\mathrm{m}$$\mathrm{s}$ (±63 $\mathrm{m}$$\mathrm{s}$) for expiration, making it suitable for time-critical applications. While a systematic bias in absolute tidal volume prediction currently limits inter-subject comparisons, the system excels at tracking relative intra-subject changes. Crucially, our model quantifies its own reliability, providing an intrinsic self-assessment mechanism. This work demonstrates a significant step beyond simple rate detection towards comprehensive, comfortable, and reliable respiratory analysis in clinical and everyday settings. Full article

Background/Objectives: This study aimed to investigate the preoperative clinicopathologic and imaging features associated with subsequent breast cancer events detected on postoperative abbreviated MRI in early-stage breast cancer patients following breast and axillary surgery. Methods: A retrospective analysis was conducted on 1171 patients (median age, 53 years; range, 24–90 years) diagnosed with clinical stage I or II breast cancer between January 2013 and December 2017. Logistic regression analysis was used to evaluate preoperative imaging features—including breast density assessed on mammography and MRI descriptors—along with clinicopathologic characteristics, to identify factors independently associated with subsequent breast cancer events during abbreviated MRI screening. Results: Among the patients, 57 (4.9%) experienced subsequent breast cancer events at a median follow-up of 74 months. In the multivariable analysis, high nuclear grade (odds ratio [OR] = 2.821; 95% confidence interval [CI], 1.427–5.577; p = 0.003), dense breast tissue on mammography (OR = 4.680; 95% CI, 1.113–19.684; p = 0.035), and absence of heterogeneous internal enhancement on preoperative MRI (OR = 0.429; 95% CI, 0.206–0.891; p = 0.023) were independently associated with subsequent breast cancer events detected using an abbreviated breast MRI protocol. Age ≥ 40 years (OR = 0.448; 95% CI, 0.193–1.039; p = 0.061) and clinical T2 stage (OR = 1.744; 95% CI, 0.969–3.139; p = 0.064) showed borderline significance. Conclusions: High nuclear grade, dense breast tissue on mammography, and absence of heterogeneous internal enhancement on preoperative MRI were associated with an increased risk of subsequent breast cancer events in patients undergoing abbreviated MRI surveillance following surgery for early-stage breast cancer. Full article

Background: Saliva sampling is increasingly used for respiratory virus diagnostics in dentistry and oral medicine due to patient comfort and reduced exposure risk. How routine behaviors—mechanical oral hygiene, rinsing, and food intake—affect short-term SARS-CoV-2 detectability remains insufficiently characterized for clinical workflows. Methods: In this international two-center pilot study, twelve RT-PCR-confirmed COVID-19 patients provided paired mouth-rinse saliva samples and pharyngeal swabs at predefined time points. The study assessed (I) an intensified 3 min mechanical oral hygiene protocol (toothbrushing of teeth, gingiva, tongue, and palate, followed by toothpaste–saliva gargling); (II) repeated short mouth rinses; and (III) postprandial sampling. Viral RNA was quantified by RT-PCR; Ct-trajectories were analyzed intra-individually. Results: Cycle threshold (Ct) values from pharyngeal swabs remained relatively stable over time, whereas mouth-rinse samples exhibited notable fluctuations throughout the 24 h period. An average increase of 3 Ct units was observed three minutes after the final mouth rinse (T24+3). Meal ingestion was associated with increased Ct values, rising by 4–5 units for pharyngeal swabs and 3–11 units for mouth rinses immediately after eating. Conclusions: In clinical dental settings, saliva diagnostics are feasible but acutely modulated by common behaviors. Mechanical oral hygiene, brief rinsing, and food intake can transiently reduce detectable oral SARS-CoV-2 RNA, with potential implications for timing of sampling, chairside triage, and infection-control protocols. This pilot study provides initial evidence supporting the development of standardized pre-analytical instructions (e.g., fasting window, pre-rinse policy, and sampling timing relative to oral hygiene and meals) to enhance the reliability of saliva-based testing in dental care. Full article

Bacille Calmette-Guérin (BCG) remains the only licensed vaccine against tuberculosis (TB), administered to >100 million neonates annually. It confers approximately 70–80% protection against tuberculous meningitis and miliary TB in early childhood, under-pinning its continued use in high-burden settings. As a live-attenuated vaccine, however, BCG can rarely cause adverse reactions ranging from self-limited local lesions to life-threatening disseminated BCG disease (BCGosis), which almost exclusively occurs in infants with severe primary or acquired immunodeficiencies such as SCID, MSMD, CGD, or symptomatic HIV infection. Implementation of universal newborn screening for severe combined immunodeficiency (SCID) using the T-cell receptor excision circle (TREC) assay now enables prospective identification and deferral of these high-risk neonates, virtually eliminating fatal BCGosis. Here we synthesize global data published since 2010 on the clinical spectrum, immunopathogenesis, and epidemiology of BCG-related complications, highlighting the impact of vaccine substrain, administration technique, and host immune status on adverse-event rates. On the basis of this evidence, we propose a practical, evidence-based risk-assessment checklist (BCG-RAKE) to support safer vaccine deployment while preserving the substantial TB-control benefits of universal BCG immunization. Full article

Background: Infections caused by antimicrobial-resistant bacteria are difficult to treat and increase the risk of death in animals. This report describes a fatal case of diarrhea in a horse that, despite intensive treatment including surgery and broad-spectrum antimicrobials (ceftiofur and amikacin), experienced a worsening of its condition and subsequent death. Methods: A fecal swab sample was subjected to microbiological culture for the identification of bacteria and assessment of their phenotypical antimicrobial susceptibility profiles using the disk-diffusion and broth microdilution methods. The double-disk synergy test, polymerase chain reactions for the detection of genes encoding extended-spectrum β-lactamases, and whole-genome sequence-based analysis were also performed. Results: Strains of Salmonella enterica and Escherichia coli were isolated, with the E. coli strain DSL-HVUVV-2025 presenting resistance to a third-generation cephalosporin. Accordingly, the bla_CTX-M-2 gene was identified in the DSL-HVUVV-2025 strain, which was submitted to whole-genome sequencing. Genomic analysis showed several antimicrobial resistance determinants, as well as virulence genes, including those associated with the enteroaggregative pathotype. The bla_CTX-M-2 gene was surrounded by an ISCR1 element and embedded in a complex class 1 integron that is part of the Tn7337 transposon. Strain DSL-HVUVV-2025 belonged to a novel sequence type. Conclusions: This case highlights the importance of monitoring antimicrobial resistance and performing genomic characterization of bacteria involved in equine diarrhea to guide effective clinical management in veterinary hospitals. It also reinforces the role of horses as potential carriers of WHO critical priority pathogens and the need for responsible antimicrobial use. Full article