Search Results (2,487)

Large Language Models (LLMs) are increasingly deployed as automated annotators in semantic multimedia systems, yet their reliability varies significantly across architectures. This study extends prior cross-model evaluations by benchmarking ChatGPT-5, Qwen-3, and Gemini-3-flash against human expert annotations using the HRAST hotel review dataset. We adopt a bias-by-design framework to analyze systematic divergences in sentiment, topic, and aspect labeling across real and synthetic data, while investigating the moderating effects of annotation mode. Findings reveal model-contingent polarity bias: ChatGPT-5 exhibits a pronounced neutrality bias, while Qwen-3 and Gemini-3-flash align more closely with human polarization. Agreement is substantial for concrete topics but diverges on abstract evaluative dimensions. Synthetic data consistently inflates reliability metrics while masking ambiguity. These findings highlight that annotation bias is structurally embedded in model design choices and operational conditions. Cross-architectural triangulation and mode-aware deployment strategies are recommended for robust semantic multimedia system development. Full article

The diffusion model (DM) is a hot topic in deep generative models and is widely applied in image generation. In diffusion models, there are four main “secrets” that affect high-quality image generation: constructing the diffusion model, improving the sampling velocity, designing the diffusion process, and guiding diffusion models. How should one construct the diffusion model? How can one improve the sampling velocity? How should one design the diffusion process? How should one guide diffusion models? These questions are critical to enhancing diffusion model performance. However, most existing review papers focus on applications, while discussion of the four key technical aspects remains limited. In response, this paper summarizes four key technologies and six representative application directions. First, the basic principles of diffusion models are reviewed from three perspectives: denoising diffusion probabilistic models, noise conditional score network models, and stochastic differential equation models. Second, key techniques for improving sampling velocity are summarized from three perspectives: non-Markovian sampling, knowledge distillation sampling, and discrete optimization sampling. Third, the diffusion process design is summarized from three perspectives: latent space, Transformer-based diffusion, and non-Euclidean space. Fourth, guidance strategies are summarized from three perspectives: classifier guidance, classifier-free guidance, and multimodal guidance. Fifth, the advantages and applications of diffusion models are discussed in high-quality text-to-image generation, high-quality text-to-video generation, and high-quality image-to-image generation. Finally, this paper discusses the challenges faced by diffusion models in image generation. Overall, this review systematically discusses the four “secrets” of diffusion models for image generation and provides a useful reference for future research in this field. Full article

Flow lines in aluminum alloy forgings are not merely post-deformation metallographic features; they are integrated indicators of material transport, microstructural evolution, defect susceptibility, and service performance. This review critically examines the mechanisms controlling flow-line evolution, with emphasis on constitutive flow behavior, dynamic recovery and recrystallization, second-phase redistribution, friction, thermal gradients, and die/preform design. It then evaluates how abnormal flow paths promote key defects, including folding/laps, flow-through discontinuities, vortex-like instability, and exposed flow lines, and distinguishes well-established mechanisms from topics that still rely on indirect evidence. Particular attention is given to the effects of flow-line morphology on anisotropy, notch sensitivity, corrosion-assisted damage, and fatigue life in forged aluminum alloys. Current control strategies, including preform optimization, FE-based backward tracing, multiphysics defect indices, frictional heat management, and isothermal forging, are also assessed. The available literature shows that stable contour-following flow lines are essential for the simultaneous control of defect formation, microstructural homogeneity, and durability, while major research needs remain in in situ validation, quantitative defect criteria, and digitally closed-loop process control. This review is therefore framed as a critical narrative synthesis rather than a formal systematic review; emphasis is placed on forging-centered studies that directly relate flow-path evolution to defect formation, anisotropy, fatigue, and process optimization, while evidence transferred from adjacent processes is treated as mechanistic support rather than equivalent proof. Full article

Background: Acute radiation-induced skin injury (aRISI) is one of the most frequent adverse effects of radiotherapy (RT) in patients with head and neck cancer (HNC) and may compromise treatment delivery and quality of life. Topical glucocorticosteroids (GCS) are commonly used in clinical practice for aRISI management; however, evidence supporting their proactive use remains inconsistent. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of proactive topical GCS therapy during RT for HNC. Methods: A systematic search of PubMed, Embase, and the Cochrane Library was conducted from database inception to July 2025 in accordance with PRISMA 2020 guidelines. Randomized controlled trials comparing topical GCS with placebo or standard skin care in adult patients undergoing curative RT or RChT for HNC were included. The primary outcomes were incidence of clinically significant aRISI (grade ≥ 2) and severe aRISI (grade ≥ 3), assessed using validated grading systems (RTOG or CTCAE). Random-effects meta-analyses were performed to calculate pooled risk ratios (RRs) with 95% confidence intervals (CIs). Risk of bias was assessed using the Cochrane RoB 2 tool. Results: Three randomized controlled trials comprising 459 patients were included. Proactive topical GCS did not significantly reduce the pooled incidence of grade ≥ 2 aRISI compared with placebo or standard skin care (RR 0.87, 95% CI 0.60–1.27). Similarly, no statistically significant reduction in grade ≥ 3 aRISI was observed in pooled analysis (RR 0.81, 95% CI 0.22–3.06). Qualitative synthesis of secondary outcomes reported in individual trials suggested potential benefits of topical GCS, including delayed onset or slower progression of aRISI, and, in one large double-blind study, a reduced risk of severe reactions. No increase in treatment-related adverse events was observed in any included trial. Conclusions: Proactive topical GCS do not significantly reduce the overall incidence of aRISI in pooled analysis. Individual studies showed trend towards delayed onset, slower progression, and reduced severe aRISI without compromising safety. These findings support the judicious use of topical GCS as part of proactive supportive care in HNC RT, while highlighting the need for larger, standardized trials to define optimal regimens and patient selection. Full article

Background and Objectives: The joint study of cerebral asymmetries and bipolar disorder (BD) has long attracted the interest of researchers and clinicians. Nevertheless, despite the increasing awareness of hemispheric asymmetries in BD, the combined investigation of these two constructs constitutes a relatively recent area of inquiry. The main objective of the present systematic review is to systematically examine the existing literature in order to identify, integrate and critically discuss evidence of hemispheric asymmetry in BD patients in terms of brain anatomy, physiology and neuropsychological function. The initial hypotheses support the presence of atypical cerebral asymmetry and differential hemispheric activation as a function of mood states in BD. Materials and Methods: Following the collection and analysis of numerous research papers through several databases and search engines, specific papers were identified and screened according to specified inclusion and exclusion criteria. Research papers on the adult bipolar population were included, while papers including comorbidity with other disorders, lesions, or an underage or elderly population, as well as meta-analyses and reviews, were excluded. This paper aligns with the procedures in the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA 2020) guidelines, and was assessed for risk of bias according to the Cochrane guidelines by the Newcastle–Ottawa Scale (NOS). Results: A total of 56 papers were identified as eligible in this review. Despite inconsistent findings across the included studies, an emerging pattern suggests the presence of atypical hemispheric asymmetry in BD, both in terms of specific brain structures and functional activity. Moreover, several studies associate depressive states with increased activation of the right hemisphere, whereas manic states appear to be linked with increased activation of the left hemisphere. Conclusions: These findings support the aforementioned hypotheses and partly align with the theoretical framework of emotional laterality theories. However, although certain patterns were observed, a comprehensive understanding of functional hemispheric asymmetry in BD has not yet been achieved. The presence of contradictory findings highlights the need for further extensive and systematic research to improve understanding of this topic. Full article

The synergistic effects of soil acidification and heavy metal pollution present major challenges for global agroecosystems. To systematically trace the evolution of research and identify key topics in this field, this study employed CiteSpace to visualize and analyze 691 records from the China National Knowledge Infrastructure (CNKI) and 6747 highly relevant articles or reviews from the Web of Science (WOS) Core Collection database from 2005 to 2025. The results indicate a steady to rapid rise in global publications, with China contributing the largest share, at 2468 publications. This has produced a research cluster centered around the Chinese Academy of Sciences (CAS); however, the centrality of its international cooperation remains limited. Studies in the CNKI database are driven by agricultural needs, focusing on national food security, rice yield stability, improvement of arable land, and heavy metal passivation and remediation, with a concentration on basic agricultural science. By contrast, research in the WOS database emphasizes fundamental mechanisms and interdisciplinary integration, addressing aluminum toxicity, microbial communities, the nitrogen cycle, and global climate change, intersecting fields such as environmental science, soil science, ecology, and microbiology. The evolution of research hotspots shows a clear trajectory: from acidity regulation and chemical speciation analysis of heavy metals (2005–2013), to heavy metal passivation, remediation, and phytoremediation (2014–2018), and then to biochar materials, microbiome analysis, and the synergistic role of carbon sequestration (2019–2025). This study argues that future research should move beyond single remediation measures and adopt integrated strategic management to jointly improve bioremediation efficiency, promote soil carbon sequestration and soil health, and enhance microbial adaptation to global climate change. Full article

Maritime traffic complexity (MTC) is a term that has gained increased importance in the last decade in the maritime safety domain. It is a concept for understanding navigational safety and operational challenges in congested maritime environments. Although research interest in MTC has grown, it is a concept that remains fragmented, with various interpretations of definitions, indicators, and modeling approaches present in the literature. This study presents a comprehensive literature review and bibliometric analysis to synthesize the current state of research on MTC as a scientific construct and clarify its conceptual foundations from an analytical perspective. In accordance with PRISMA guidelines and systematic literature review (SLR) methodology, relevant studies were identified and screened across major scientific databases. A detailed analysis was conducted on 40 scientific publications. The findings indicate that most existing MTC models rely mainly on Automatic Identification System (AIS) data and corresponding derived metrics. MTC is primarily assessed through geometric vessel–vessel interactions, relative motion parameters, and collision-risk indicators. Bibliometric analysis demonstrates a rapid increase in scientific interest in this topic since 2015, with research concentrated in several leading journals. The study identifies a significant methodological limitation in current frameworks, which often overlook the heterogeneity of marine traffic, environmental conditions, vessel reliability, and human factors. Therefore, this study highlights the need for a more comprehensive MTC evaluation framework that incorporates operational, geographical constraint-based, environmental, and behavioral variables alongside traditional AIS-based metrics. Full article

Background/Objectives: Constipation is a common gastrointestinal problem in older adults and is associated with reduced quality of life, functional decline, frailty, and an increased risk of delirium and cognitive impairment. Its pathogenesis is multifactorial, involving age-related changes in gastrointestinal motility, neural regulation, comorbidities, and polypharmacy. However, this condition has traditionally been regarded as a localized gastrointestinal disorder, which may not fully reflect its systemic clinical significance in older populations. While prior narrative reviews have described multifactorial contributors to constipation, none have formally applied a geriatric syndrome framework to integrate these dimensions. This review proposes a three-criterion operational definition—multifactorial pathogenesis, association with functional decline and frailty, and contribution to adverse systemic outcomes—to characterize constipation in older adults as a “systemic geriatric syndrome,” and evaluates available evidence against each criterion. Methods: A narrative literature search was conducted using PubMed to identify relevant studies published between 1 January 2023, and 31 December 2025. MeSH terms included “Constipation” [Major Topic] and “Aged” [MeSH Terms]. Eligible articles included English-language original studies, systematic reviews, and clinical or epidemiological studies involving individuals aged ≥65 years. Results: Diagnosis in older adults is often complicated by secondary causes, including medications and neurological disorders, as well as atypical symptom presentations in individuals with cognitive impairment. Key pathophysiological mechanisms include reductions in interstitial cells of Cajal, impaired smooth muscle contractility, dysfunction of the enteric and autonomic nervous systems, and gut microbiota dysbiosis, which may promote chronic low-grade inflammation. Major contributing factors include physical inactivity, sarcopenia, dehydration, inappropriate defecation posture, and polypharmacy, particularly opioids and anticholinergic agents. Importantly, these factors interact through the brain–gut–microbiota axis, contributing not only to gastrointestinal dysfunction but also to systemic outcomes such as frailty, cognitive decline, and increased healthcare burden, thereby supporting a multidimensional disease framework. Conclusions: The available evidence collectively supports the plausibility of framing constipation in older adults as a systemic geriatric syndrome, though formal validation of this classification requires further longitudinal and mechanistic research. Comprehensive and individualized management strategies, extending beyond simple laxative use, are essential to reduce complications and preserve functional health in aging populations. Further studies are required to validate this framework. Full article

Patient Blood Management (PBM) has evolved from a transfusion-centered practice to a structured, patient-focused perioperative strategy aimed at improving surgical outcomes while preserving blood resources. In the operating room, where bleeding risk is anticipated and modifiable, PBM requires proactive intervention rather than reactive transfusion. This review synthesizes current evidence on perioperative blood conservation strategies specifically relevant to surgeons and anesthesiologists. Preoperative optimization begins with systematic identification and correction of anemia, most commonly iron deficiency, using appropriately timed oral or intravenous iron therapy and, in selected cases, erythropoiesis-stimulating agents. Careful management of anticoagulant and antiplatelet therapies, early recognition of acquired or inherited coagulopathies, and protocol-driven reversal strategies further reduce perioperative hemorrhagic risk. Intraoperatively, blood conservation depends on meticulous surgical technique, respect for anatomical planes, minimally invasive approaches, and the judicious use of advanced energy devices and topical hemostatic agents. Pharmacologic interventions—particularly tranexamic acid administered with appropriate timing and dosing—have demonstrated consistent reductions in blood loss and transfusion requirements across multiple surgical disciplines. Goal-directed coagulation management guided by viscoelastic testing allows targeted correction of specific hemostatic deficits while minimizing unnecessary blood product exposure. Acute normovolemic hemodilution and intraoperative cell salvage provide additional benefit in selected high-blood-loss procedures. Collectively, these multimodal strategies shift perioperative care from product-driven transfusion toward physiology-based blood conservation. When embedded within institutional protocols and supported by multidisciplinary collaboration, perioperative PBM reduces transfusion exposure, decreases morbidity, shortens hospital stay, and promotes sustainable stewardship of blood resources without compromising patient safety. Full article

Background/Objectives: Depot medroxyprogesterone acetate (dMPA) is a synthetic progestin commonly used for contraception. Recent studies have reported an increased association between dMPA exposure and diagnosis of cerebral meningioma. The current systematic review aims to provide a review of literature on the topic of dMPA and cerebral meningioma as well as conduct a meta-analysis by the duration of dMPA use. Methods: The current study presented a systematic review and meta-analysis of observational studies of dMPA and cerebral meningioma derived from PubMed, Web of Science, and Embase database searches for relevant studies published through February 2026. Odds ratios (ORs) and associated 95% confidence intervals were reported to determine the pooled effect of dMPA on cerebral meningioma diagnosis. Quality of evidence was assessed through the GRADE methodology. Results: Nine case-control studies and one cohort study were selected for review and analysis. The overall pooled OR was 2.78 (95% CI 2.20–3.52). This association was strongest for prolonged (i.e., ≥two-years) dMPA exposure (OR 3.49, 95% CI 2.35–5.18). GRADE analysis suggested a moderate quality of evidence. Conclusions: The results of this meta-analysis indicate that dMPA exposure is associated with an over two-fold increased odds of cerebral meningioma. This effect is consistent across studies and is stronger for prolonged dMPA exposure relative to short-term exposure, suggesting a dose–response effect. Clinicians should consider discussing with patients the cerebral meningioma risks associated with dMPA use when considering long-term birth control options. Full article

Background: Evidence on the presence of an association between epicardial adipose tissue (EAT) and myocardial perfusion imaging (MPI) as assessed by positron emission tomography (PET) has been reported. This systematic review aimed to synthesize the existing literature investigating this topic. Methods: A comprehensive and systematic search of the PubMed/MEDLINE, Scopus, and Embase databases was performed to identify published studies investigating the association between EAT and myocardial perfusion assessed by PET imaging. Eligible studies included original research articles evaluating EAT and reporting PET MPI outcomes. Data regarding the study design, patient characteristics, imaging protocols, and main findings were extracted and qualitatively analyzed. Results: Ten studies were included in the final analysis. Overall, most studies demonstrated a significant association between increased EAT and impaired myocardial perfusion on PET imaging. In several studies, EAT remained an independent predictor of abnormal PET MPI after adjustment for traditional clinical risk factors. Nonetheless, important methodological differences among studies were observed, including heterogeneity in EAT measurement techniques, quantification methods, and PET tracers used for MPI evaluation, which limit the generalizability of these findings. Conclusions: This systematic review seems to suggest a potential association between increased EAT and impaired myocardial perfusion, as assessed by PET. However, significant methodological heterogeneity across the available studies—including differences in EAT quantification, PET protocols, and tracer selection—limits the strength of this conclusion. Standardized imaging protocols and larger, prospective, multicenter studies are required to validate this relationship, determine its incremental prognostic value, and evaluate its potential for integration into routine clinical risk stratification pathways. Full article

Background/Objectives: Fragility fractures cause disability, independence loss, and death in older adults with osteoporosis. While exercise rehabilitation is recommended, its effectiveness and consistency in improving function, quality of life, and outcomes after a fracture remain uncertain. This study aimed to systematically assess the impact of structured exercise programs on physical function, quality of life, falls, morbidity, and mortality among adults recovering from fragility fractures. Methods: This review and meta-analysis followed PRISMA guidelines, with protocol registration in PROSPERO (CRD42024503933). MEDLINE, PubMed, EMBASE, Cochrane Library, CINAHL, and Web of Science were searched. Randomized controlled trials and quasi-experimental studies including adults (mean age ≥ 50 years) with fragility fractures were eligible if they evaluated structured exercise programs lasting ≥8 weeks compared with usual care or minimal intervention, and reported physical function, quality of life, falls, mortality, or morbidity outcomes. Risk of bias was assessed following the Cochrane Handbook for Systematic Reviews of Interventions guidelines. Primary outcomes comprised physical function, strength, balance, and health-related quality of life. Random-effects meta-analysis was applied where data were comparable. Results: Twenty-six studies with 4142 participants were included (n = 4142; ~80.4% women; mean age ~74.83 years). Interventions were mainly multicomponent (strength, balance, mobility, and functional training). Exercise improved physical function outcomes. At 12 months, pain measured by QUALEFFO-41 decreased (MD −11.61; 95% CI −22.99 to −0.23). Effects on strength, balance, and cognitive outcomes were inconsistent. Conclusions: Exercise-based rehabilitation after fragility fractures may improve physical function and reduce pain, but pooled effects are inconsistent and often highly heterogeneous. Evidence for effects on falls and mortality is sparse and does not support firm conclusions. Physical function measures may be the most practical primary endpoint for evaluating these interventions, interpreted cautiously. Funding: PIGE-0040-2020. Full article

Introduction: Paget’s disease of bone (PDB), the second most common bone disease after osteoporosis, is still of unknown etiology and thus deserves attention. PDB and chronic kidney disease (CKD) are chronic diseases characterized by alterations in bone turnover, mineralization, volume, and strength. Both conditions carry an increased cardiovascular risk, as well as increased morbidity and mortality. Both are common in the Western world and primarily affect men over 50 years of age. Despite these similarities, little data exists on their coexistence. Purpose and Methodology: By evaluating the available literature, we found extensive documentation on individual diseases, which has led to consolidated guidelines. The coexistence of the two diseases has provided sporadic studies describing individual cases or small case series. More limited information is available on patients who have received or are eligible for kidney transplants and also have PDB. This narrative (non-systematic) review aims to examine the topic with a particular focus on the relationship between PDB and CKD, especially concerning issues around kidney transplantation. The overlapping factors of the two diseases, and their impact on PDB diagnosis and treatment are discussed. Additionally, examining CKD patients may offer valuable insights for the design of prospective longitudinal or cross-sectional studies aimed at expanding our understanding of PDB. Limitations: The different points of discussion that emerged from the examination of this topic may be useful in the management of PDB-CKD patients but, at the moment, there are not enough data available to draw definitive conclusions to support clinical practice. Conclusions and Future Directions: The coexistence of PDB and CKD is not a rare phenomenon; studying patients with both diseases could provide insights into new research avenues. Above all, and more immediately, attention to the coexistence of the two diseases could improve patient management with personalized choices based on their renal function. Full article

Objective: To compare the efficacy and safety of gas-based therapies for chronic wounds using a systematic review and network meta-analysis (NMA). Methods: Following PRISMA 2020, we systematically searched PubMed, Embase, Web of Science, Cochrane CENTRAL, and CBM from inception to 1 October 2025, screened studies in duplicate, and resolved disagreements by arbitration (κ = 0.87). Randomized controlled trials (RCTs) enrolling adults with chronic wounds were eligible; the primary endpoint was complete wound healing. Pairwise meta-analysis used risk ratios (RRs) with 95% CIs; heterogeneity was assessed with Q/I² and random-effects models were applied when appropriate. A frequentist NMA synthesized direct and indirect evidence, and treatments were ranked with SUCRA. Publication bias (Egger/Begg) and evidence certainty (GRADE) were evaluated. Results: Twenty-seven RCTs comprising 1673 participants were included. In pairwise pooling, gas therapies significantly increased complete healing versus standard care (random-effects RR = 2.17, 95% CI 1.61–2.94), with substantial heterogeneity (I² = 75.7%); results were directionally consistent and robust to sensitivity analyses. Prespecified subgroup analyses suggested effect modification by intervention type and wound etiology. In the NMA, most gas modalities showed beneficial trends versus standard care; however, SUCRA ranking placed standard care highest (93.9%), a finding attributed by the authors to network structure and between-study variability. Ozone therapy and topical oxygen ranked next, whereas HBOT and cold atmospheric plasma ranked mid-range; CO₂ therapy ranked lowest due to sparse evidence. Small-study effects were likely (Egger p < 0.001; Begg p = 0.013), and overall certainty was graded as moderate, limited primarily by heterogeneity, imprecision, and potential publication bias. Conclusions: Across RCTs, gas therapies as a class improve the probability of complete healing in chronic wounds relative to standard care, but effect sizes vary by modality and wound type. Given heterogeneity, possible publication bias, and inconsistencies within the evidence network, these findings should be applied with caution. HBOT remains the modality supported by the broadest evidence base, while large, high-quality, multicenter RCTs are needed to refine comparative effectiveness and safety rankings across gas therapies. Full article

Background/Objectives: Biomechanical research in surfing provides important insights into performance optimization and injury prevention, but the evidence remains fragmented across multiple domains. Methods: This scoping review aimed to systematically organize the existing literature on surfing biomechanics and evaluate the quality of the included studies. Searches were conducted by two independent reviewers in PubMed, Scopus, and Web of Science in accordance with the PRISMA Extension for Scoping Reviews. Systematic searches were performed up to 31 July 2025 using Boolean operators guided by the PECO framework. Methodological quality was assessed using the Downs and Black Quality Assessment Checklist. Results: Of the 195 records identified, 53 duplicates were removed. Following screening and fulltext review, 26 studies were included. Five studies employed randomized controlled designs, while 21 were non-randomized. Publications ranged from 2010 to 2025, with the majority conducted in Australia (65.4%). A total of 490 healthy surfers (mean age: 22.9 ± 16.1 years) were analyzed, with sample sizes ranging from 6 to 42 participants. Research topics included anthropometry, paddling biomechanics, aerial maneuvers, core and trunk strength and mobility, lower-limb function, frontside bottom turns, and pop-up performance. The studies’ methodological quality score was 11.7 points with substantial inter-reviewer agreement (κ = 0.77). Research on surf biomechanics remains limited in volume and exhibits methodological heterogeneity. Conclusions: Although existing studies provide valuable insights into key performance actions, further high-quality and standardized research on performance phases (e.g., paddling, pop-up, turns, aerials) and with different research designs (e.g., longitudinal, sex inclusive, ecological designs integrating lab and in-water measures) is needed. Full article