Search Results (362)

Background: The accuracy and consistency of complete-arch digital impressions are fundamental for long-term success of implant-supported rehabilitations. Recently, artificial intelligence (AI)-assisted tools, such as SmartX (Medit Link v3.4.2, MEDIT Corp., Seoul, South of Korea), have been introduced to enhance scan body recognition and data alignment during intraoral scanning. Objective: This in vitro study aimed to evaluate the impact of SmartX on impression accuracy, consistency, operator confidence, and technique sensitivity in complete-arch implant workflows. Methods: Seventy-two digital impressions were recorded on edentulous mandibular models with four dummy implants, using six experimental subgroups based on scan body design (double- or single-wing), scanning technique (occlusal or combined straight/zigzag), and presence/absence of SmartX tool. Each group was scanned by both an expert and a novice operator (n = 6 scans per subgroup). Root mean square (RMS) deviation and scanning time were assessed. Data were tested for normality (Shapiro–Wilk). Parametric tests (t-test, repeated measures ANOVA with Greenhouse–Geisser correction) or non-parametric equivalents (Mann–Whitney U, Friedman) were applied as appropriate. Post hoc comparisons used Tukey HSD or Dunn–Bonferroni tests (α = 0.05). Results: SmartX significantly improved consistency and operator confidence, especially among novices, although it did not yield statistically significant differences in scan accuracy (p > 0.05). The tool mitigated early scanning errors and reduced dependence on operator technique. SmartX also enabled successful library alignment with minimal data; however, scanning time was generally longer with its use, particularly for beginners. Conclusions: While SmartX did not directly enhance trueness, it substantially improved scan reliability and user experience in complete-arch workflows. Its ability to minimize technique sensitivity and improve reproducibility makes it a valuable aid in both training and clinical settings. Further clinical validation is warranted to support its integration into routine practice. Full article

Background/Objectives: Diabetes mellitus (DM) is a disorder which affects carbohydrate metabolism and has been associated with other conditions such as disease-related malnutrition (DRM), leading to specific challenges in its management. This study aims to evaluate the implications of DM, its complications, and its duration on energy and protein intake in patients at high risk of malnutrition. Methods: Descriptive cross-sectional study in 179 patients with high risk of malnutrition. Patients were compared based on the presence or absence of DM, diabetes duration and the presence of complications. Age, gender, body mass index, bioimpedanciometry, ultrasonography and dynamometry parameters and the diagnosis of sarcopenia were recorded. Energy and protein requirements were calculated, and the composition of the patients’ three-day diet was analyzed. Results: DM was associated with lower weight-adjusted energy intake (Overall: 29.15 (9.99) vs. DM: 24.87 (8.28) vs. NoDM: 30.65 (10.13) kcal/kg/day; p < 0.01) and lower weight-adjusted protein intake (Overall: 1.29 (0.47) vs. DM: 1.18 (0.39) vs. NoDM: 1.33 (0.49) g of protein/kg/day; p < 0.05). DM was a risk factor for poorer compliance with energy requirements (OR: 2.38, 95% CI: 1.13–5.01, p < 0.05). Similarly, the occurrence of complications was identified as a risk factor associated with reduced adherence to energy intake requirements (OR: 1.78, 95% CI 1.06–2.98; p < 0.05), and a duration of diabetes mellitus exceeding 10 years was linked to lower adherence to protein intake requirements (OR 1.79, 95% CI 1.08–2.99; p < 0.05). Conclusions: Among patients at high risk of malnutrition, diabetes mellitus was associated with suboptimal adherence to both caloric and protein intake requirements. The presence of diabetes and its related complications emerged as risk factors for inadequate fulfillment of energy needs, while a longer disease duration was specifically linked to reduced compliance with protein requirements. Full article

High-resolution spatiotemporal prediction information on fishing vessel activities is essential for formulating and effectively implementing fisheries policies that ensure the sustainability of marine resources and fishing practices. This study focused on the tuna longline fishery in the Western and Central Pacific Ocean (130° E–150° W, 20° S–20° N) and constructed a CLA U-Net deep learning model to predict fishing effort (FE) distribution based on 2017–2023 FE records and environmental variables. Two modeling schemes were designed: Scheme 1 incorporated both historical FE and environmental data, while Scheme 2 used only environmental variables. The model predicts not only the binary outcome (presence or absence of fishing effort) but also the magnitude of FE. Results show that in short-term predictions, Scheme 1 achieved F1 scores of 0.654 at the 0.5°-1-day scale and 0.763 at the 1°-1-day scale, indicating substantial improvement from including historical FE data. In medium-term predictions, Scheme 1 and Scheme 2 reached maximum F1 scores of 0.77 and 0.72, respectively, at the optimal spatiotemporal scale of 1°-30 days. The analysis also quantified the relative importance of environmental variables, with sea surface temperature (SST) and chlorophyll-a (Chl-a) identified as the most influential. These findings provide methodological insights for spatiotemporal prediction of fishing effort and support the refinement of fisheries management and sustainability strategies. Full article

The Order Polycladida comprises a diverse yet understudied group of free-living flatworms, traditionally divided into Cotylea and Acotylea based on the presence or absence of a ventral adhesive organ known as a cotyl. Species identification, particularly within Acotylea, is often challenging due to the need for histological examination of reproductive structures and the scarcity of molecular data. The Tropical Western Atlantic, especially the Caribbean Sea, hosts high polyclad diversity but remains poorly surveyed. This study updates the checklist of Acotylea from the Colombian Caribbean, combining new collections from Santa Marta with the literature records. Field work yielded 22 acotylean species from 14 genera and 10 families, with DNA sequences (28S rDNA and/or COI mtDNA) obtained for 20 species. 11 species are new records for Colombia, and five for the Caribbean Sea: Latocestus brasiliensis Hyman, 1953, Notocomplana martae (Marcus, 1948), Interplana evelinae (Marcus, 1952), Triadomma curvum Marcus, 1949, and Adenoplana evelinae Marcus, 1950. In total, 29 species are now documented from the region. We provide photographs of live specimens, whole mounts, and histological sections; DNA barcodes for most species; and the first dichotomous key for Colombian Caribbean acotyleans, based primarily on external traits, providing a practical tool to support further taxonomic, ecological, and biodiversity research. Full article

Background and Objectives: The clinical significance of gastrointestinal (GI) tract wall thickening incidentally detected on abdominal imaging remains unclear. This study aimed to examine the relationship between GI tract wall thickening seen in imaging and what is found during endoscopy, as well as to explore how hemoglobin, C-reactive protein (CRP), and albumin levels can help predict the presence of malignancy. Materials and Methods: In this retrospectively designed study, 209 patients were included who were found to have GI tract wall thickening on radiological imaging and underwent endoscopy within 90 days. Endoscopic findings and laboratory data were recorded. Patients were compared based on the presence or absence of malignancy, and a receiver operating characteristic analysis was performed. Results: Malignancy was detected in 8.5% and 10.9% of the upper and lower GI tract cases, respectively. In patients with upper GI tract malignancy, hemoglobin levels were significantly lower and CRP levels were higher (p < 0.001 and p = 0.015, respectively). Similarly, in lower GI tract malignancy, hemoglobin levels were lower (p = 0.033), whereas CRP did not show a significant difference (p = 0.115). Cut-off values were determined as 11.8 g/dL for hemoglobin and 40.75 g/L for albumin, and both were found to have high negative predictive values. Conclusions: GI tract wall thickening detected radiologically is clinically significant and should be further investigated endoscopically. Certain biochemical parameters may aid in ruling out malignancy; however, endoscopy remains essential for definitive diagnosis. Full article

Background/Objectives: This study aims to build an interpretable and accurate predictive model for myocardial infarction (MI) using Explainable Boosting Machines (EBM), a state-of-the-art Explainable Artificial Intelligence (XAI) technique. The objective is to identify and rank clinically relevant biomarkers that contribute to MI diagnosis while maintaining transparency to support clinical decision making. Methods: The dataset comprises 1319 patient records collected in 2018 from a cardiology center in the Erbil region of Iraq. Each record includes eight routinely measured clinical and biochemical features, such as troponin, CK-MB, and glucose levels, and a binary outcome variable indicating the presence or absence of MI. After preprocessing (e.g., one-hot encoding, normalization), the EBM model was trained using 80% of the data and tested on the remaining 20%. Model performance was evaluated using standard metrics including AUC, accuracy, sensitivity, specificity, F1 score, and Matthews correlation coefficient. Feature importance was assessed to identify key predictors. Partial dependence analyses provided insights into how each variable affected model predictions. Results: The EBM model demonstrated excellent diagnostic performance, achieving an AUC of 0.980, an accuracy of 96.6%, sensitivity of 96.8%, and specificity of 96.2%. Troponin and CK-MB were identified as the top predictors, confirming their established clinical relevance in MI diagnosis. In contrast, demographic and hemodynamic variables such as age and blood pressure contributed minimally. Partial dependence plots revealed non-linear effects of key biomarkers. Local explanation plots demonstrated the model’s ability to make confident, interpretable predictions for both positive and negative cases. Conclusions: The findings highlight the potential of EBM as a clinically useful and ethical AI approach for MI diagnosis. By combining high predictive accuracy with transparency, EBM supports biomarker prioritization and clinical risk stratification, thus aligning with precision medicine and responsible AI principles. Future research should validate the model on multi-center datasets and explore additional features for broader clinical use. Full article

We report the first occurrence of an arboreal spiny rat of the tribe Echimyini in the Early Holocene of southern South America. The specimen, a lower deciduous premolar, was recovered from fluvial deposits exposed along the right bank of Doll Creek, in northeastern Argentina. Morphological comparisons indicate strong affinities with the extant Amazonian genus Lonchothrix, although the fossil exhibits distinct traits such as thicker enamel and a transverse, short posterior mesofossettid. The available evidence of strong climatic niche conservatism in Echimyini supports its interpretation as an indicator of the transient presence of humid, Amazonian-like forests in the region around 10,000 years ago. Sedimentological and stratigraphic evidence correlates this warming phase with an Early Holocene transgression in the Paraná Delta. The absence of aff. Lonchothrix in the recent fauna may be the result of a post-optimum extinction event triggered by a drier phase during the Middle Holocene. This discovery provides novel evidence for a short-lived biogeographic connection between Amazonia and the southern cone during a climatic window of expansion for tropical biotas. It also highlights the role of the fossil record of Echimyidae as a sensitive proxy for reconstructing paleoenvironmental changes in temperate South America. Full article

Background: Weekend presentation to the emergency department (ED) has been associated with increased morbidity and mortality in various clinical settings. However, the literature is scant whether such an effect exists for patients presenting with COVID-19 infection. Additionally, comparative analyses of mortality predictors in COVID-19 patients evaluated at the emergency department need further exploration. Methods: This retrospective cohort study examined factors associated with mortality among adult patients (aged ≥ 18 years) who presented with COVID-19 to the emergency departments of five hospitals within the Johns Hopkins Health System (combined capacity: 2513 beds) between March 1 and 4 May 2020. Data were extracted from electronic health records. Multivariable logistic regression was utilized to assess the relationship between mortality and a range of variables, including sociodemographic characteristics, clinical presentation, laboratory parameters, pre-existing comorbidities, and weekend versus weekday presentation. Results: Of the 2767 patients, 685 (25%) presented to the emergency department on weekends. Compared to weekday presenters, weekend patients were more likely to be hospitalized (64%), and these patients had a mean symptom duration of 5 days (SD ± 6). Weekend presenters also exhibited higher rates of clinical frailty, dehydration, hypoxia, and respiratory distress upon arrival. In multivariable logistic regression analysis adjusting for sociodemographic characteristics, clinical risk factors, and laboratory findings, independent predictors of increased mortality included absence of a primary care provider (OR 3.47; 95% CI: 2.37–5.07), peripheral oxygen saturation (SpO₂) < 95% at presentation (OR 1.46; 95% CI: 1.001–2.12), and hyperglycemia (OR 2.13; 95% CI: 1.25–3.65). Notably, the presence of crackles on physical examination demonstrated a trend toward reduced mortality (OR 0.47; 95% CI: 0.24–0.92). Conclusions: While weekend presentation was associated with higher hospitalization rates among patients with COVID-19, it did not independently predict increased mortality. Absence of a primary care provider, hypoxia, and hyperglycemia at presentation emerged as strong, independent predictors of mortality in the ED setting. Race, gender, and obesity were not significantly associated with mortality in this cohort, warranting further investigation. These findings may support more effective triage and risk stratification strategies in current and future public health emergencies. Full article

Background and Objectives: Thickening of the maxillary sinus mucosa is commonly detected in asymptomatic individuals through various radiographic techniques. This study aimed to evaluate the maxillary sinus mucosal thickness (MT), also known as Schneiderian membrane thickness, in patients with periodontal bone loss (PBL) using cone-beam computed tomography (CBCT). Material and Methods: In this retrospective study, CBCT images from 315 patients who presented to the Department of Periodontology, Faculty of Dentistry, Dicle University, between January 2023 and January 2025 for various indications were evaluated. PBL, the presence or absence of mucosal thickening at the maxillary sinus floor, age, and gender were recorded. Statistical analyses were conducted to assess the relationships between age, gender, PBL, and MT. Results: A significant association was observed between PBL and MT. Sinus mucosal thickening was notably more prominent in individuals with advanced bone loss. Gender had no statistically significant effect on MT. A moderate, positive, and statistically significant correlation was found between age and MT. Conclusions: This study demonstrates that PBL exerts a significant and measurable impact on MT. Compared to conventional diagnostic methods, CBCT provides superior diagnostic accuracy for detecting periodontal bone defects and evaluating the soft tissue morphology at the base of the maxillary sinus. Full article

Burrowing mammals function as ecosystem engineers by creating spatial heterogeneity in the soil structure and vegetation composition, thereby providing microhabitats for a wide range of organisms. These keystone species play a crucial role in maintaining local ecosystem functions and delivering ecosystem services. However, in Mongolia, where overgrazing has accelerated due to the expansion of a market-based economy, scientific knowledge remains limited regarding the impacts of human activities on such species. In this study, we focused on the Siberian marmot (Marmota sibirica), an ecosystem engineer inhabiting typical Mongolian steppe ecosystems. We assessed the relationship between the spatial distribution of marmot burrows and vegetation conditions both inside and outside Hustai National Park. Burrow locations were recorded in the field, and the Normalized Difference Vegetation Index (NDVI) was calculated, using Planet Lab, Dove-2 satellite imagery (3 m spatial resolution). Through a combination of remote sensing analyses and vegetation surveys, we examined how the presence or absence of anthropogenic disturbance (i.e., livestock grazing) affects the ecological functions of marmots. Our results showed that the distance between active burrows was significantly shorter inside the park (t = −2.68, p = 0.0087), indicating a higher population density. Furthermore, a statistical approach, using beta regression, revealed a significant interaction between the burrow type (active, non-active, off-colony area) and region (inside vs. outside the park) on the NDVI (e.g., outside × non-active: z = −5.229, p < 0.001). Notably, in areas with high grazing pressure outside the park, the variance in the NDVI varied significantly as a function of burrow presence or absence (e.g., July 2023, active vs. off-colony area: F = 133.46, p < 0.001). Combined with vegetation structure data from field surveys, our findings suggest that marmot burrowing activity may contribute to the enhancement of vegetation quality and spatial heterogeneity. These results indicate that the Siberian marmot remains an important component in supporting the diversity and stability of steppe ecosystems, even under intensive grazing pressure. The conservation of this species may thus provide a promising strategy for utilizing native ecosystem engineers in sustainable land-use management. Full article

Background: The widespread use of cardiac magnetic resonance imaging (MRI) in clinical practice has enabled the identification of numerous patients with evident damage from previous myocarditis, whether known or unknown. For years, myocardial fibrosis has been a topic of interest due to its established correlation with arrhythmic events in various clinical settings, including ischemic heart disease, dilated cardiomyopathy, and hypertrophic cardiomyopathy. MIBG scintigraphy is a method widely used in patients who are candidates for defibrillator implantation or have experienced heart failure. This examination evaluates the sympathetic innervation of the myocardium. Objective: To assess the real arrhythmogenic risk of non-ischemic scars identified in symptomatic or asymptomatic patients through the use of MIBG. Methods: Patients were retrospectively selected based on the presence of non-ischemic myocardial fibrosis detected by cardiac MRI, consistent with a myocarditis outcome (even in the absence of a clear history of myocarditis). These patients underwent myocardial scintigraphy with MIBG using a tomographic technique. Results: A total of 50 patients (41 males, mean age 51 ± 16 years) who underwent MRI from 2019 to June 2024 were selected. The primary indication for MRI was ventricular ectopic extrasystoles detected on Holter ECG (n = 12, 54%), while five patients underwent MRI following a known acute infectious event (23%, including three cases of COVID-19 infection). All symptomatic patients presented with chest pain in the acute phase, accompanied by elevated hsTNI levels (mean value: 437 pg/mL). The MRI findings showed normal ventricular volumes (LV: 80 mL/m², RV: 81 mL/m²) and normal ejection fractions (56% and 53%, respectively). The mean native T1 mapping value was 1013 ms (normal range: 950–1050). T2 mapping values were altered in the 5 patients who underwent MRI during the acute phase (mean value: 57 ms), without segmentation. Additionally, three patients had non-tamponade pericardial effusion. All patients exhibited LGE (nine subepicardial, seven midwall, six patchy). All patients underwent myocardial scintigraphy with MIBG at least 6 months after the acute event, with only one case yielding a positive result. This patient, a 57-year-old male, had the most severe clinical presentation, including more than 65,000 premature ventricular beats (PVBs) and multiple episodes of paroxysmal supraventricular tachycardia (PSVT) recorded on Holter ECG. MRI findings showed severe left ventricular dysfunction, a slightly dilated LV, and midwall LGE at the septum, coinciding with hypokinetic areas. Conclusions: MIBG scintigraphy could be a useful tool in assessing arrhythmic risk in patients with previous myocarditis. It could help reduce the clinical burden of incidental findings of non-ischemic LGE, which does not appear to be independently associated with an increased risk profile. Full article

This study investigates the potential of transient potentiometric signals generated by an array of ion-selective electrodes (ISEs) as the basis for a potentiometric electronic tongue capable of identifying and quantifying a range of inorganic and organic cations. Six distinct polymeric membrane ISEs were fabricated, differing in plasticizer type (either NPOE or DEHS), and in the presence or absence of a lipophilic ion exchanger (KTClPB) and/or an ionophore (DB18C6). Transient potential responses were recorded following the exposure of the electrode array to various cations at different concentrations. A total of 810 transient signals were analyzed through visual inspection and principal component analysis (PCA), revealing characteristic dynamic patterns influenced by membrane composition, ion type, and ion concentration. PCA was conducted both on the transient signals from each individual electrode and on the aggregated dataset comprising signals from the full six-electrode array (electronic tongue). The electronic tongue exhibited a markedly enhanced capacity for discriminating and quantifying ion concentrations in comparison to any single electrode. Full article

Background/Objectives: Interstitial lung disease (ILD) is a frequent complication of rheumatoid arthritis (RA), representing the most common extra-articular manifestation (with a prevalence of about 10–60%) and the second cause of mortality. Spondyloarthritides (SpAs) are chronic arthritides that share with RA both a similar disease burden and similar therapeutical approaches. The evaluation of ILD is challenging, given the low sensitivity of X-ray and pulmonary function tests, and the radiation exposure linked to repetitive HRCT. Lung ultrasound (LUS) has shown potential in the evaluation of ILD in autoimmune diseases. The purpose of this study is to assess the prevalence of ILD in a cohort of SpA patients (pts) using LUS in comparison with healthy subjects (HSs). The secondary aim is to evaluate potential correlations between ILD and clinical features within the SpA cohort using LUS. Methods: Consecutive SpA out-patients were examined by LUS, applying the definition for pleural line irregularity (PLI) recently provided by the OMERACT taskforce for LUS in systemic sclerosis. Seventy-one intercostal spaces were studied (14 in the anterior chest, 27 lateral and 30 posterior) in all the pts/HS using an Esaote MyLab25 Gold US machine with a linear 7.5–10 MHz probe. A total pleural score was calculated. Each patient answered to Italian-validated PROs on respiratory function (Leicester and Saint-George), global health (SF-36) and dyspnea (mMRC scale). Clinical data on disease duration, disease onset, disease activity (at the moment of the examination) and methotrexate (MTX) or biologics treatment were collected from the medical records. Results: Seventy-three SpA pts (46 psoriatic arthritis -PsA- and 27 ankylosing spondylitis -AS-) and 56 HS were studied. No significant differences were demonstrated between groups (SpA vs. HS and PsA vs. AS) for age, sex, BMI and smoking habits. The total PLI score was significantly higher in SpA pts than in HS (p < 0.001). A positive correlation was found between the total PLI score and the PLI score from anterior, posterior and lateral chest. The posterior region of the chest showed a higher PLI score than the anterior and lateral regions. No statistically significant differences were found between PsA and AS. MTX use was not a risk factor for PLI (no differences were found between SpA MTX+ and SpA MTX- patients). PROs (Leicester, Saint-George and SF-36) were not related to the PLI total score. A significant correlation was found only between the SF36 score and the presence of PLI in the anterior chest. PROs were instead correlated with each other, showing a good concordance for absence/presence of symptoms. Disease activity, disease duration and age at disease-onset were not related to PLI total score. Smoking habit was found to be predictive of a significantly higher PLI score both in SpA patients and HSs. Conclusions: LUS examination shows a higher amount of PLI in SpA patients with respect to HSs. Smoking habit was the only clinical feature correlated to PLI on LUS examination in our population. Full article

Background: Identifying high-grade strictures (HGS) in patients with primary sclerosing cholangitis (PSC) relies upon subjective assessments of magnetic resonance cholangiopancreatography (MRCP). Quantitative MRCP (MRCP+) provides objective evaluation of MRCP examinations, which may help make these assessments more consistent and improve patient management and selection for intervention. We evaluated the impact of MRCP+ on clinicians’ confidence in diagnosing HGS in patients with PSC. Methods: Three expert abdominal radiologists independently assessed 28 patients with PSC. Radiological reads of MRCPs were performed twice, in a random order, three weeks apart, then a third time with MRCP+. HGS presence was recorded on semi-quantitative confidence scales. The cases where readers definitively agreed on presence/absence of HGS were used to assess inter- and intra-reader agreement and confidence. Results: When using MRCP alone, high intra-reader agreement was observed in identifying HGS within both intra- and extrahepatic ducts (64.3% and 70.8%, respectively), while inter-reader agreement was significantly lower for intrahepatic ducts (42.9%) than extrahepatic ducts (66.1%) (p < 0.01). Using MRCP+ in the third read significantly improved inter-reader agreement for intrahepatic HGS detection to 67.9% versus baseline reads (p = 0.02) and was comparable with extrahepatic ducts. Reader confidence tended to increase when supplemented with MRCP+, and inter-reader variability decreased. MRCP+ metrics had good performance in identifying HGS in both extra-hepatic (AUC:0.85) and intra-hepatic ducts (AUC:0.75). Conclusions: MRCP evaluation supported by quantitative metrics tended to increase individual reader confidence and reduce inter-reader variability for detecting HGS. Our results indicate that MRCP+ might help standardize MRCP assessment and subsequent management for patients with PSC. Full article

Background: Plantar fasciitis (PF) is a common enthesopathy in patients with ankylosing spondylitis (AS). Shear wave elastography (SWE) and the Belgrade ultrasound enthesitis score (BUSES) may detect PF, but their comparative diagnostic performance is unclear. Objective: To compare SWE with the BUSES for identifying PF in individuals with and without AS. Methods: In this cross-sectional study, 96 participants were stratified into AS and non-AS populations, each further divided based on the presence or absence of clinical PF. Demographic data, the American Orthopedic Foot and Ankle Society Score (AOFAS), and the BASDAI score were recorded. All subjects underwent grayscale ultrasonography, the BUSES scoring, and SWE assessment of the plantar fascia. Logistic regression models were constructed for each population, controlling for age, body mass index (BMI), and fascia–skin distance. ROC curve analyses were performed to evaluate diagnostic accuracy. Results: In both AS and non-AS groups, SWE and the BUSES were significant predictors of PF (p < 0.05). SWE demonstrated slightly higher diagnostic accuracy, with area under the curve (AUC) values of 0.845 (AS) and 0.837 (non-AS), compared to the BUSES with AUCs of 0.785 and 0.831, respectively. SWE also showed stronger adjusted odds ratios in regression models. The interobserver agreement was good to excellent for both modalities. Conclusions: Both SWE and the BUSES are effective for PF detection, with SWE offering marginally superior diagnostic performance, particularly in AS patients. SWE may enhance the early identification of biomechanical changes in the plantar fascia. Full article