Search Results (532)

Metabolic dysfunction-associated steatotic liver disease (MASLD) has replaced older exclusion-based terminology as the preferred term for steatotic liver disease associated with cardiometabolic risk factors. MASLD is now among the most common causes of chronic liver disease and may progress from simple steatosis to metabolic dysfunction-associated steatohepatitis (MASH), fibrosis, cirrhosis, and hepatocellular carcinoma. This updated rigorous narrative review synthesizes current evidence on MASLD diagnosis and management, with emphasis on the gut–liver axis and the therapeutic potential of combining probiotics with metformin. A structured narrative search was conducted in PubMed, PMC, ScienceDirect, Taylor & Francis, Cochrane Library, and Google Scholar using the keywords “MASLD”, “MAFLD”, “NAFLD”, “MASH”, “probiotics”, “synbiotics”, “metformin”, and “gut-liver axis”. The review was designed as a narrative synthesis rather than a systematic review. Current guidance supports stepwise risk stratification using serum fibrosis scores followed by elastography or advanced imaging when indicated. Ultrasonography remains accessible but has limited sensitivity for mild steatosis, is operator-dependent, and is not sufficient for comprehensive assessment of fibrosis or disease activity. Metformin is appropriate for type 2 diabetes mellitus and improves insulin resistance, but current guidelines do not recommend it as a targeted treatment for MASH because histological benefit has not been consistently demonstrated. Probiotics and synbiotics may improve aminotransferases, inflammatory markers, lipid parameters, intestinal barrier function, and gut dysbiosis; however, findings vary by strain, formulation, dose, treatment duration, population, and endpoint. The combination of probiotics and metformin is mechanistically plausible because it targets both metabolic dysfunction and intestinal dysbiosis, but human evidence remains limited. Larger, strain-specific, adequately powered trials using standardized MASLD criteria and clinically meaningful endpoints are required before routine clinical recommendations. Full article

Background/Obejctives: Sarcopenic obesity (SO) has gained growing attention in metabolic dysfunction-associated steatotic liver disease (MASLD), yet data in Caucasian populations remain limited. The aim of this study was to assess the prevalence of SO using different definitions and to explore its relationship with steroid androgens, physical performance and frailty in MASLD individuals. Methods: Two hundred Caucasian patients with MASLD and available dual-energy X-ray absorptiometry (DEXA) data were evaluated. Clinical, biochemical, hormonal and elastography data were recorded, while physical performance was assessed using the Short Physical Performance Battery (SPPB) and Liver Frailty Index (LFI). Results: SO prevalence ranged from 34.5% to 76.5% depending on the definition applied (AIMSO score, body mass index, and body fat percentage-based criteria). Across definitions, SO individuals showed greater hepatic steatosis, more metabolic comorbidities and demonstrated poorer physical performance. Lower dehydroepiandrosterone sulfate (DHEAS) levels were independently associated with SO when the definition is based on total body fat percentage, and waist circumference (WC) was consistently linked to SO across all definitions. Separate analysis based on gender, confirmed that DHEAS was independently associated with SO in men, while WC represented an independent factor associated with SO in both genders. Conclusions: In conclusion, SO is common among Caucasian MASLD patients and is accompanied by metabolic, hepatic, hormonal, and functional alterations. These findings may help recognize patients at risk of SO and support more focused assessment and monitoring in clinical practice. Full article

This paper establishes a rigorous analysis of a coupled hybrid fractional differential system involving a generalized Hilfer operator under integral and antiperiodic boundary conditions. The existence and uniqueness of solutions are proved using Dhage’s fixed point theorem for existence and the Banach contraction principle for uniqueness. Furthermore, we establish Ulam–Hyers stability by deriving the following explicit and computable bound estimate: $\left(\begin{array}{c}\parallel \widehat{u}-u\parallel \\ \parallel \widehat{v}-v\parallel \end{array}\right)\le {(I-\mathit{\chi })}^{-1}\left(\begin{array}{c}{C}_1{ϵ}_1\\ C_2{ϵ}_2\end{array}\right)$, where $C_1$ and $C_2$ are positive constants depending on the system parameters, ${ϵ}_1,{ϵ}_2$ denote the perturbation bounds, and $\mathit{\chi }$ is the associated Lipschitz matrix. This formulation provides a more detailed stability description than scalar criteria, as it captures the interactions among the system components through the entries of $\mathit{\chi }$, leading to a more informative stability estimate. Two illustrative examples confirm the theoretical results and demonstrate their potential applicability for modeling real-world phenomena where memory effects are present. Full article

Background/Objectives: Total knee arthroplasty (TKA) is one of the most common surgeries among people over 60. Joint line restoration plays an important role in knee biomechanics, with joint line elevation or depression after TKA being associated with poorer postoperative outcomes, although there is no consensus regarding the threshold at which these variations become clinically relevant. The objectives of this study were to evaluate whether a joint line variation greater than 4 mm after primary TKA affects postoperative outcomes, and to assess the concordance between different radiographic methods used to measure joint line height. Methods: A retrospective study was conducted including patients over 60 who underwent primary TKA for knee osteoarthritis. Joint line height variations were evaluated preoperatively and postoperatively using three radiographic measurements: lateral femoral epicondyle–fibular head (LEFH) distance, adductor tubercle–joint line (ATJL) distance, and Blackburne–Peel index. Quality of life was assessed using the Short Form-12 (SF-12) questionnaire, and functionality using the Knee Society Score (KSS). Statistical analysis was carried out using R software. Results: Seventy-three patients were included. No statistically significant associations were found between joint line displacement and functional outcomes (KSS), quality of life (SF-12), or postoperative complications. Concordance analysis between radiographic methods showed a significant but weak correlation between the LEFH and ATJL measurements (ρ = 0.419; p < 0.001). Conclusions: Joint line displacement after primary TKA was not associated with poorer postoperative outcomes in this cohort. These findings suggest that its clinical impact may depend more on its magnitude than on its mere presence and may also be influenced by additional factors. The weak concordance observed between radiographic measurement methods highlights the need for standardized criteria. Full article

Insurance pricing plays a central role in risk management and financial decision-making, as accurate premium estimation directly impacts portfolio stability and profitability. This study investigates insurance pure premium estimation by integrating classical actuarial models with modern machine learning techniques. We compare the traditional frequency–severity decomposition framework with direct modeling approaches, including XGBoost and Tweedie models. For claim frequency, we evaluate Poisson-based models, generalized additive models, and XGBoost. For claim severity, we compare a Gamma generalized linear model with XGBoost. The results show that XGBoost improves predictive performance for both components based on the evaluation metrics considered. Within the decomposition framework, the XGBoost–XGBoost model achieves the lowest prediction error among the models considered. However, lift-based analysis reveals that the XGBoost–Gamma model provides superior risk segmentation, highlighting a trade-off between prediction accuracy and risk ranking. Direct modeling approaches, while competitive, do not consistently achieve lower error than the decomposition framework across the evaluation metrics considered. Overall, the findings demonstrate that machine learning enhances predictive performance, but its effectiveness is maximized within the frequency–severity framework. The results highlight the importance of both frequency and severity modeling in insurance pricing, while suggesting that their relative contributions to risk segmentation depend on model specification and evaluation criteria. These findings have important implications for risk management and pricing strategies in insurance portfolios. Full article

Background/Objectives: Modern restorative dentistry increasingly focuses on achieving optimal aesthetic integration while simplifying clinical procedures. Single-shade resin composites were introduced to reduce the complexity of conventional multi-shade layering techniques through enhanced color adjustment potential and structural color technology. However, concerns remain regarding their long-term color stability. The aim of this systematic review was to evaluate the color stability and aesthetic performance of single-shade resin composites compared with conventional multi-shade systems under different staining and aging conditions. Methods: This systematic review was conducted according to PRISMA 2020 guidelines and registered in the Open Science Framework. A systematic search was performed in PubMed, Scopus, and Cochrane Library up to 31 October 2025. Studies evaluating color stability using the CIEDE2000 (ΔE₀₀) formula after staining and aging procedures were included. Risk of bias was assessed using the RoBDEMAT tool. Results: The search identified 169 records, of which 11 in vitro studies met the inclusion criteria. Across the included studies, discoloration increased progressively over time, and chromogenic agents frequently induced ΔE₀₀ values exceeding clinical acceptability thresholds. Turmeric and red wine demonstrated the highest staining potential, whereas distilled water and artificial saliva showed minimal color variation. Single-shade composites generally exhibited greater susceptibility to discoloration than multi-shade systems, although variability among materials was observed depending on composition and experimental conditions. Conclusions: Single-shade resin composites simplify restorative procedures and provide initial aesthetic integration; however, they appear more susceptible to clinically relevant discoloration under experimental conditions. Further clinical and in vitro investigations are required to confirm these findings. Full article

The rapid integration of UAVs (Unmanned Aerial Platforms) introduces new operational capabilities but also raises critical challenges. This paper presents a quantitative risk assessment approach for evaluating the risks related to drone-assisted systems. The methodology combines established standards with the principles of the multi-criteria hierarchy concept. First, a qualitative analysis is performed to identify and register the required risk elements. Following this, a hierarchical model is developed to model the dependencies between systems’ components, environmental factors, structural limitations, and operational uncertainties. An AHP-based (Analytic Hierarchy Process) process is applied to enable elements quantification. To demonstrate the applicability and feasibility of the proposed methodology, two different drone-assisted systems are examined, showcasing their effectiveness in evaluating critical risk elements and computing cumulative risk contribution to quantify and prioritize potential risk events. The results indicate the significance of the methodology in ranking the verified risk elements and identifying those that made the greatest contribution to system failure. As revealed, power- and weather-related elements are among the most significant contributors to performance deterioration. In addition, operator-related factors significantly contribute to the system’s overall functional performance, especially when it is manually controlled. Finally, a comparative analysis underscores the sensitivity of risk ranking to variations in AHP scoring. Full article

Recent advancements in autonomous driving technology are transforming the automotive industry, with advanced driver assistance systems (ADAS) recognized as a crucial transitional technology toward fully autonomous driving. ADAS enhances driver safety and comfort through features such as emergency braking, lane-keeping, and adaptive cruise control, ultimately aiding in traffic accident prevention and reduction in driver fatigue. However, commercial ADAS implementations show substantial variability due to differences in sensor configurations, operational design domain (ODD) definitions, and operational criteria across automakers. To address this gap, this study provides a structured comparative review of commercialized ADAS technologies across 11 major Western and Asian automakers. By encompassing both Western and Asian OEMs, this study compares manufacturer-declared sensor configurations, ODD settings, activation conditions, driver-monitoring requirements, takeover and fallback logic, and update-related characteristics. The review identifies implementation-level differences that affect comparability, user understanding, validation requirements, and standardization needs. Rather than ranking OEM systems by safety performance, this study clarifies the trade-offs among redundancy-oriented, camera-centric, HD-map-dependent, geofenced, and OTA-driven ADAS strategies. The findings support future work on standardized ODD communication, user-centered HMI design, independent validation, and update-aware review frameworks for commercial ADAS. Full article

Background and Objectives: Keloids are fibroproliferative disorders marked by excessive fibroblast activity, abnormal collagen deposition, and impaired wound healing. They are frequently associated with pain, pruritus, and significant aesthetic concerns, leading to reduced quality of life. Surgical excision alone is burdened by high recurrence rates, underscoring the need for effective adjuvant therapies. This systematic review aimed to assess the effectiveness of surgical excision combined with adjuvant physical and pharmacological therapies in keloid management, with particular emphasis on recurrence rates. Materials and Methods: The review was conducted in accordance with PRISMA guidelines. A systematic search of PubMed and Web of Science identified studies evaluating surgical excision of keloids with adjunctive therapies. Twenty-one studies involving more than 8627 patients met the inclusion criteria. Extracted data included study design, patient and lesion characteristics, treatment modalities, and recurrence rates. Due to marked heterogeneity among treatment protocols, a meta-analysis was not performed. Results: Among physical adjuvant therapies, postoperative brachytherapy showed the lowest recurrence rates (3.1–15%), outperforming radiotherapy and external-beam radiation therapy (14–29.3%). Compression therapy achieved recurrence rates of 10.66% and 14%, particularly effective in auricular keloids. Pharmacological adjuvant therapies demonstrated variable efficacy. Triamcinolone acetonide injections were associated with recurrence rates ranging from 6.6% to 33%, depending on the protocol. Adjuvant 5-fluorouracil reduced recurrence compared with surgery alone, whereas imiquimod 5% showed higher and less consistent recurrence rates. Combination pharmacological therapies consistently yielded better outcomes than monotherapy. Conclusions: Surgical excision combined with adjuvant therapy is the most effective strategy for keloid treatment. Multimodal approaches significantly reduce recurrence compared with surgery alone. However, substantial heterogeneity in lesion characteristics, treatment timing, and therapeutic protocols limits comparability between studies. Further high-quality, standardised clinical trials are needed to optimise management strategies and develop evidence-based guidelines. Full article

Background/Objectives: Lower circulating testosterone concentrations in postmenopausal women have been associated with adverse sexual, skeletal, and metabolic outcomes, yet population-level prevalence estimates remain inconsistent. In the absence of universally accepted diagnostic thresholds for androgen deficiency in women, interpretation of serum testosterone concentrations remains variable. This study aimed to describe the distribution of serum total testosterone and to evaluate demographic and hormonal correlates among physiologic postmenopausal women in the United States. Methods: This cross-sectional study analyzed women meeting criteria for physiologic menopause from the 2011–2016 and 2021–2023 National Health and Nutrition Examination Survey (NHANES) cycles. Participants using androgenic medications were excluded. Because no universally accepted diagnostic threshold exists for testosterone deficiency in women, serum total testosterone <30 ng/dL was used as an operational, population-based reference point, with <20 ng/dL evaluated as a sensitivity threshold. Survey-weighted analyses characterized the cohort and examined associations between testosterone concentrations below the <30 ng/dL operational threshold and demographic and hormonal variables using logistic regression. Results: Among 2707 postmenopausal women, the weighted mean total testosterone was 25.2 ± 1.1 ng/dL. Using operational, distribution-based thresholds, 56.0% of women had testosterone concentrations <20 ng/dL and 79.9% had concentrations <30 ng/dL (Rao–Scott χ², p < 0.001). In the weighted distribution, both thresholds lay above the weighted median, with 30 ng/dL exceeding the 75th percentile. The proportion of women with testosterone concentrations below the <30 ng/dL threshold differed significantly by race/ethnicity (p < 0.01) and age group (p < 0.01), highest among Non-Hispanic Asian (87.7%) and Mexican American (89.4%) women and lowest among Non-Hispanic Black women (75.5%). In multivariable models, higher sex hormone binding globulin (SHBG) (adjusted OR = 0.720; 95% CI: 0.633–0.820; p < 0.001) and higher estradiol (adjusted OR = 0.577; 95% CI: 0.389–0.856; p < 0.05) were independently associated with lower odds of testosterone concentrations below the <30 ng/dL threshold. Conclusions: Testosterone concentrations below operational thresholds are highly prevalent among U.S. postmenopausal women, although estimates vary depending on the cutoff applied. Higher SHBG and estradiol levels were inversely associated with testosterone concentrations below these thresholds, underscoring the physiologic interrelationship of these hormones in postmenopausal women. These findings highlight the need for standardized, population-specific reference thresholds and clearer clinical frameworks for interpreting androgen levels in women. Full article

Leaves of Persea americana Mill. are a potential source of bioactive compounds; however, current knowledge is limited by the lack of studies that simultaneously evaluate multiple cultivars and leaf developmental stages under comparable field conditions, as well as by inconsistent sampling criteria across studies. This study aimed to assess how leaf developmental stage and cultivar influence phenolic composition and antioxidant activity in avocado leaves grown under field conditions. Total polyphenols, total flavonoids, quercetin-3-O-galactoside, and chlorogenic acid were selected as representative compounds due to their relevance in plant defense and antioxidant capacity. These compounds, together with antioxidant activity, were quantified in young expanding (E1) and fully expanded (E6) leaves of seven avocado cultivars using spectrophotometric methods and HPLC-DAD, and analyzed through two-way ANOVA. Results showed that leaf developmental stage significantly influenced flavonoid content, chlorogenic acid, and antioxidant activity, which were consistently higher in E1 leaves. In contrast, total polyphenol content exhibited cultivar-dependent responses, increasing toward E6 only in specific genotypes, while quercetin-3-O-galactoside remained stable across developmental stages but varied among cultivars. Overall, the results indicate that phenolic metabolism in avocado leaves is regulated by both developmental stage and genotype in a compound-specific manner, with no consistent pattern associated with racial background. From a practical perspective, these findings provide a basis for selecting leaf material according to the intended application: young leaves for higher antioxidant capacity and flavonoid content, and specific cultivars at advanced stages for higher total polyphenol accumulation, supporting the functional valorization of avocado leaves as a source of bioactive compounds. Full article

Electrocardiogram (ECG) heartbeat classification is an essential component of automated arrhythmia detection and intelligent cardiac monitoring systems. Traditionally, ECG analysis has depended on manual interpretation by clinicians and conventional machine learning approaches based on handcrafted features, which are labor-intensive, noise-sensitive, and inadequate for capturing complex nonlinear morphological and temporal characteristics of ECG signals. Furthermore, real-world ECG datasets are highly imbalanced, noisy, and exhibit overlapping waveform patterns across heartbeat classes, leading to biased learning, poor minority class detection, and unreliable predictions. To address these challenges, this paper presents a calibration-aware, reliability-oriented evaluation framework for ECG heartbeat classification, incorporating hybrid deep learning architectures that combine convolutional feature extraction, bidirectional GRU-based temporal modeling, and attention mechanisms. The framework assesses probabilistic reliability using calibration metrics, such as the Brier Score and Expected Calibration Error (ECE), rather than explicitly modeling predictive uncertainty methods. Experimental results on the ECG Heartbeat dataset show that CNN achieves the highest testing accuracy (98.44%), largely due to strong performance on the majority class in an imbalanced setting. Among hybrid approaches, a representative hybrid CNN + BiGRU + Attention model attains a competitive accuracy of 97.80%, along with a higher macro F1-score (0.9052), improved training stability, and good calibration behavior (Brier Score = 0.0417, ECE = 0.1023). As the experiments are conducted on preprocessed, fixed-length segments, the results reflect performance under controlled conditions rather than real-world clinical deployment conditions and should therefore be interpreted as a benchmark-level evaluation. Furthermore, no single model consistently outperforms others across all evaluation criteria, as different metrics capture distinct aspects of performance. Full article

Background/Objectives: Arterial hypertension might lead to serious organ damage and complications like hypertensive retinopathy. The retina is the only place in the human body where microscopic blood vessels can be directly investigated. This enables early diagnosis of arterial hypertension-mediated organ damage. Untreated hypertensive retinopathy leads to vision loss in its advanced stages. There are many methods of assessing changes in the arterioles; however, the most accurate is adaptive optics (RTX1™ device with AODetectArtery software, ver. 3.0., Imagine Eyes, Orsay, France). It provides a resolution of 1.6 μm, which is superior to conventional imaging techniques. Optical coherence tomography angiography can serve as an early, minimally invasive marker of microvascular damage. Across the studies analyzed, the WLR (Wall-to-Lumen Ratio) exhibited significantly higher values when comparing individuals with hypertensive retinopathy to normotensives (0.31 vs. 0.26). The main aim of this review is to present the application of adaptive optics in the early diagnosis of hypertensive retinopathy. Methods: The search strategy included 267 original studies, among which 12 were selected to be described and analyzed in this review based on criteria including original research and studies performed on humans with hypertensive retinopathy. Results: RTX1™ enables the assessment of arterial parameters such as the Wall Thickness (WT), Lumen Diameter (LD), Outer Diameter (OD), Wall-to-Lumen Ratio (WLR) and Wall Cross Sectional Area (WCSA). These parameters differ depending on the arterial hypertension. The WLR was identified to be the parameter that differs in the vast majority of analyzed studies when comparing hypertensive patients to normotensive patients. Vascular parameters were also found to change depending on different organisms’ states, treatment applications and etiological causes of disease. Furthermore, changes in retinal arterial parameters were associated with increased cardiovascular risk in observational studies. RTX1™ was also identified to provide very good intra- and interobserver variability. Conclusions: RTX1™ is a valuable tool in the examination of arterial vessels and in establishing associations between retinal vascular parameters and a patient’s clinical state. Full article

Background/Aim: Cardiovascular disease (CVD) represents a relevant global public health challenge with dyslipidemia as a major modifiable cardiovascular risk factor (CVRF). Recent advances have introduced injectable lipid-lowering therapies (LLT). Their clinical effectiveness in real-world practice seems to depend not only on pharmacological efficacy but also on patients’ acceptance, adherence, and persistence, influenced directly by perceived barriers and facilitators. The main objective of this scoping review is to map the barriers and facilitators related to the use of novel injectable LLTs among adult patients with dyslipidemia or CVD. Methods: This review was conducted in accordance with JBI methodology and reported according to Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for scoping reviews (PRISMA-ScR); pre-registration on Open Science Framework (OSF) was performed. A search was conducted in MEDLINE from PubMed, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL) from EBSCOhost, and Google Scholar up to June 2025. Eligible studies included qualitative, quantitative, mixed-methods, and review papers involving adult patients with dyslipidemia who reported experiences, perceptions or challenges related to the use of injectable LLT in any healthcare or community setting worldwide. Two reviewers independently screened studies, selected and extracted data. Results: Out of 665 records identified, 7 studies met the inclusion criteria. Patients’ adherence to injectable LLTs is shaped by psychological fears, prior negative experiences, and perceived efficacy. Satisfaction increases when patients feel supported and informed. Convenience, self-administration, and motivational meaning facilitate persistence. Organizational support and economic accessibility further influence uptake, highlighting that adherence depends on both patient experience and structural factors. Conclusions: Patient acceptance and persistence with injectable LLT depends on a complex interplay of emotional, clinical, organizational and economic factors, beyond pharmacological efficacy alone. Fear of injections, previous statin-related experiences, administrative complexity, and high costs remain major barriers, while shared decision-making, trust in healthcare providers, perceived efficacy, regimen convenience, and supportive structures act as strong facilitators. Addressing these challenges requires multidimensional and multidisciplinary strategies for policy makers and clinical managers. Full article

Background: The relationship between AMH (anti-Müllerian hormone) levels, fat distribution, and insulin resistance in women with PCOS has been widely studied, yet findings remain inconsistent. Recent guidelines emphasize the growing role of AMH in PCOS diagnosis and suggest its potential inclusion among diagnostic criteria, highlighting its relevance for guiding therapeutic management. Objectives: This retrospective study aimed to evaluate the association between AMH levels and metabolic parameters in overweight and obese reproductive-age women with PCOS. Ethical approval was obtained from the bioethics committee. Methods: Two groups of 52 women each were selected from PCOS patients treated at our clinic between 2024 and 2025: one with a waist-to-hip ratio (WHR) ≤ 0.85 and the other with a WHR > 0.85. Venous blood samples were collected to measure AMH, fasting glucose, and fasting insulin. Body height and weight were recorded to calculate body mass index (BMI), and insulin resistance was assessed using HOMA-IR. Waist and hip circumferences were measured to determine WHR. Results: The association between central adiposity and AMH in overweight and obese women with PCOS depended on insulin resistance. In insulin-resistant women, higher WHR was linked to lower AMH, whereas in women without insulin resistance, higher WHR corresponded to higher AMH levels. Conclusions: Insulin resistance appears to influence AMH in opposite directions depending on a woman’s WHR, suggesting its potential role in tailoring individualized treatment strategies. Full article