Search Results (11,835)

Building extraction in landslide-affected scattered mountainous areas is essential for sustainable development, as it improves disaster risk management, fosters sustainable land use, safeguards the environment, and bolsters socio-economic advancement; however, this process entails considerable challenges. This study proposes a Res-Unet-based model to extract landslide-affected buildings from unmanned aerial vehicle (UAV) data in scattered mountain regions, leveraging the feature extraction capabilities of ResNet and the precise localization abilities of U-Net. A landslide-affected, scattered mountainous region within the Three Gorges Reservoir area was selected as a case study to validate the model’s performance. Experimental results indicate that Res-Unet displays high accuracy and robustness in building recognition, attaining accuracy (ACC), intersection-over-union (IOU), and F1-score values of 0.9849, 0.9785, and 0.9892, respectively. This enhancement can be attributed to the combined model, which amalgamates the skip connections, the symmetric architecture of U-Net, and the residual blocks of ResNet. This integration preserves low-level detail during recovery at higher levels, facilitating the extraction of multi-scale features while also mitigating the vanishing gradient problem prevalent in deep network training through the residual block structure, thus enabling the extraction of more complex features. The proposed Res-Unet approach shows significant potential for the accurate recognition and extraction of buildings in complex terrains through the efficient processing of remote sensing images. Full article

Background: Patients with head and neck cancer often experience impaired sleep. Moreover, the treatment may negatively affect sleep quality. The aim of this observational study was to evaluate the sleep quality after treatment for head and neck cancer, and its relationship with quality of life and psychological distress. Methods: A total of 151 patients who underwent treatment for head and neck cancer at our department were included in the study. Quality of life, sleep quality, risk of sleep apnea, sleepiness, pain, and psychological distress were assessed by means of specific questionnaires. Results: The median follow-up was 30 months. Poor sleep quality was observed in 55.6% of the cases. An association between PSQI global sleep quality and EORTC global health status was found. The DT, HADS anxiety, and HADS depression scores were associated to PSQI global score, sleep quality, sleep latency, sleep disturbances, and daytime dysfunction. Conclusions: Sleep disturbances, particularly OSA and insomnia, are frequent in HNC patients, and significantly impact their quality of life and psychological well-being. Given the effect of sleep on overall well-being, addressing sleep disorders should be a priority in the care of HNC patients. Full article

Background: Patients with inflammatory bowel disease (IBD) have an increased risk of developing immune-mediated diseases. However, the genetic basis of IBD is complex, and an integrated approach should be used to elucidate the complex genetic relationship between IBD and immune-mediated diseases. Methods: The genetic relationship between IBD and 16 immune-mediated diseases was examined using linkage disequilibrium score regression. GWAS data were synthesized from two IBD databases using the METAL, and multi-trait analysis of genome-wide association studies was performed to enhance statistical robustness and identify novel genetic associations. Independent risk loci were meticulously examined using conditional and joint genome-wide multi-trait analysis, multi-marker analysis of genomic annotation, and functional mapping and annotation of significant genetic loci, integrating the information of quantitative trait loci and different methodologies to identify risk-related genes and proteins. Results: The results revealed four immune-mediated diseases (AS, psoriasis, iridocyclitis, and PsA) with a significant relationship with IBD. The multi-trait analysis revealed 909 gene loci of statistical significance. Of these loci, 28 genetic variants were closely related to IBD, and 7 single-nucleotide polymorphisms represented novel independent risk loci. In addition, 14 genes and 514 proteins were found to be associated with susceptibility to immune-mediated diseases. Notably, IL1RL1 emerged as a key player, present within pleiotropic genes across multiple protein databases, highlighting its potential as a therapeutic target. Conclusions: This study suggests that the common polygenic determinants between IBD and immune-mediated diseases are widely distributed across the genome. The findings not only support a shared genetic relationship between IBD and immune-mediated diseases but also provide novel therapeutic targets for these diseases. Full article

China’s chemical industry has faced severe environmental, social, and governance (ESG) issues, such as high safety and environmental accidents and risks. To address these issues and promote industrial upgrading, China’s central government has issued a national relocation and improvement policy targeting its chemical industry. However, its countrywide policy implementation may also lead to other ESG risks during the relocation of chemical enterprises, namely industrial transfer. The typical ESG risks that appear to occur in developed eastern region provinces include a one-size-fits-all solution and unemployment, while less developed central and western region provinces may encounter pollution transfer, carbon leakage, environmental injustice, and health disparities. These ESG risks might overlap with other economic and financial (non-ESG) risks, like stranded assets, industry hollowing-out, and debt sustainability issue. These ESG and non-ESG risks could result from potential mismatches between chemical enterprises and chemical parks, categorized as mismatching errors explained by social-ecological systems, behavioral economics, and information economics. To better manage these risks, we propose an ESG matching policy comprising a national standardized ESG scoring and ranking system, a deferred acceptance mechanism, and a score announcement instrument. Such a policy innovation aims at achieving fair and efficient chemical enterprise–chemical park pairs, which would help manage both ESG and non-ESG risks and provide a just transition toolkit for China and other developing countries. Full article

Background/Objectives: This study aims to develop and validate a Glaucoma Health Score (GHS) that incorporates multiple individual glaucoma risk factors to enhance glaucoma detection in screening environments. Methods: The GHS was developed using a retrospective dataset from two clinical sites, including both eyes of glaucoma patients and controls. The model incorporated age, central corneal thickness, intraocular pressure, pattern standard deviation from a visual field threshold 24-2 test, and two parameters from an optical coherence tomography (OCT) test: the average circumpapillary retinal nerve fiber layer thickness and the minimum thickness of the six sectors of the macular ganglion cell plus the inner plexiform layer. The GHS was then validated in two independent datasets: one from primary care sites using Maestro OCT data (test dataset 1) and another from an academic center using DRI OCT Triton (test dataset 2). Results: Both eyes of 51 glaucoma patients and 67 controls were included in the development dataset. Setting the GHS cutoff at 75 points out of 100, test dataset 1, which comprised 41 subjects with glaucoma and 41 healthy controls, achieved an area under the receiver operating characteristic curve (AUROC) of 0.98, with a sensitivity of 71% and specificity of 98%; test dataset 2, which included 53 patients with glaucoma and 53 healthy controls, resulted in an AUROC of 0.95, with a sensitivity of 75% and specificity of 96%. A decision curve analysis across all datasets demonstrated a higher net benefit for the GHS model compared to individual OCT parameters. Conclusions: The GHS offers a feasible, standardized approach for early detection of glaucoma, providing strong specificity and acceptable sensitivity, with clear decision-making benefits in screening settings. Full article

Background/Objectives: Acute kidney injury (AKI) is a potential complication of cardiovascular disorders and is associated with worse outcome. The aim of this study was to assess the incidence of early AKI after endovascular therapy for acute ischemic stroke, identify predictors for this complication, and test the association between AKI and mortality or death or dependency. Methods: This was a single-center cohort study involving consecutive patients with acute ischemic stroke submitted to endovascular therapy between 2015 and 2022. AKI was defined according to the KDIGO criteria and evaluated at 48 h. Other outcomes of interest were vital status and functional dependency at 3 months using the modified Rankin Scale, with death or dependency being defined as a score > 2. An adjustment for potential confounders was performed using logistic regression. Results: Overall, 1150 patients were included in the analysis, with a mean age of 74 years and a slight female preponderance (56%). The median NIHSS was 15, the mean onset-to-groin time was 392 min, and 92% of patients were successfully recanalized. The overall incidence rate of AKI was 6%. On univariate analysis, patients with AKI were older (p = 0.002), had a longer time to EVT (p = 0.042), higher NIHSS (p = 0.006), higher blood glucose (p = 0.033), and lower baseline glomerular filtration rate (GFR) (p < 0.001). After adjustment for confounders, AKI was independently associated with NIHSS (p = 0.012), time to treatment (p = 0.004), and lower baseline GFR (p < 0.001). AKI was also independently associated with higher mortality (OR = 2.302, p = 0.003). Conclusions: Patients with impaired baseline renal function and more severe stroke are at higher risk of AKI, and AKI begets worse stroke outcome. Better strategies are required to optimize treatment outcome in these patients and avert this vicious cycle. Full article

Background/Objectives: Postoperative delirium is a prevalent and serious complication among elderly patients following surgical procedures. Prior research indicates that reduced competence in daily living, as evidenced by limitations in performing Activities of Daily Living (ADL), is directly associated with reduced patient mobility. This study aimed to investigate the potential role of preoperative mobility as a risk factor for the development of postoperative delirium. Methods: To assess preoperative mobility, a comprehensive geriatric evaluation of daily living competence was conducted. This included the Katz Index of Independence in ADL, which assessed basic daily activities over the preceding 14 days, and the Instrumental Activities of Daily Living Scale (IADL). Postoperatively, delirium monitoring was performed twice daily for seven days using validated delirium screening tools, including the Nursing Delirium Screening Scale, the Confusion Assessment Method, and the 4ATest. Results: A significant correlation was observed between the incidence of delirium and the IADL scores in all patients, with p < 0.001 for men and p = 0.001 for women. Among emergency patients, the Katz Index scores significantly differed between those who developed delirium and those who did not (p = 0.015). Additionally, a significant correlation was found between the Katz Index and the incidence of delirium in both groups (p < 0.001). Conclusions: The findings of this study emphasize the necessity of preoperative geriatric assessment using tools such as the Katz Index or IADL to identify patients at risk of delirium. The results confirm the importance of enhanced postoperative monitoring for potential delirium. For elective patients, prehabilitation should be considered when reduced daily living competence is identified. For emergency patients, immediate postoperative interventions, including intensive mobilization and orthogeriatric co-management, are recommended. Full article

Pulmonary fibrosis detected during the acute phase of SARS-CoV-2 infection may significantly influence patient prognosis. This study aimed to evaluate the prognostic value of initial high-resolution computed tomography (HRCT) findings of pulmonary fibrosis in hospitalized COVID-19 patients and to examine how these findings relate to disease severity and clinical outcomes, with a particular focus on the development and validation of predictive scoring systems. In this multicentric prospective cohort study from January 2023 to January 2024, 120 adult patients with confirmed SARS-CoV-2 infection requiring hospitalization were enrolled from two Romanian university hospitals. Patients were categorized based on the presence (n = 60) or absence (n = 60) of pulmonary fibrosis signs on admission HRCT scans, identified by reticular opacities, traction bronchiectasis, honeycombing, and architectural distortion. Biochemical analyses, severity scores (SOFA, APACHE II, NEWS 2), and novel compound scores combining clinical and radiological data were assessed. Patients with HRCT evidence of pulmonary fibrosis had significantly higher severity scores and worse clinical outcomes. The HRCT score alone was a strong predictor of severe COVID-19 (area under the ROC curve [AUC] = 0.885), with a best cutoff value of 9.72, yielding 85.7% sensitivity and 79.8% specificity. Compound Score 1, integrating SOFA, APACHE II, and HRCT scores, demonstrated excellent predictive performance with an AUC of 0.947, sensitivity of 92.5%, and specificity of 88.9%. Compound Score 2, combining systemic inflammation markers (SIRI, SII) and NEWS 2, also showed a strong predictive capability (AUC = 0.913), with 89.2% sensitivity and 85.7% specificity at the optimal cutoff. Regression analysis revealed that Compound Score 1 had the highest hazard ratio for severe COVID-19 outcomes (HR = 4.89; 95% CI: 3.40–7.05), indicating its superior prognostic value over individual markers and traditional severity scores. Initial HRCT findings of pulmonary fibrosis are significantly associated with increased disease severity in hospitalized COVID-19 patients. The HRCT score is a valuable prognostic tool, and, when combined with clinical severity scores into Compound Score 1, it enhances the prediction of severe COVID-19 outcomes with high sensitivity and specificity. These compound scores facilitate the early identification of high-risk patients, guiding clinical decision-making and optimizing patient management to improve outcomes. Full article

Background: Acute kidney injury (AKI) is a major concern in pediatric critical care, often occurring in conjunction with sepsis. This study aimed to identify the incidence, outcomes, and risk factors for AKI in the context of pediatric sepsis. Methods: This was a bicentric retrospective cohort study conducted at two university hospitals in Saudi Arabia. All patients aged 1 month to 14 years admitted to pediatric intensive care units (PICUs) with evidence of sepsis between January 2021 and December 2022 were included. AKI was defined and staged according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Demographic, clinical, and laboratory data were collected from electronic medical records. Results: 309 patients were included, 38 (12.3%) developed stage 1 AKI, 64 (20.7%) developed stage 2 AKI, and 183 (59.2%) developed stage 3 AKI. Patients with sepsis-associated AKI had significantly longer PICU stays and higher mortality rates than those without AKI (p < 0.01). Inflammatory markers and certain medications were associated with increased AKI risk. Factors independently associated with stage 3 AKI include younger age, positive blood culture, gentamycin use, and higher SOFA score. Conclusions: Sepsis-associated AKI is a common and serious complication in critically ill children, contributing to increased morbidity and mortality. Identification of specific risk factors may facilitate early recognition and targeted interventions to mitigate the impact of AKI in this vulnerable population. Full article

Background: Head and neck carcinosarcoma (HNCS) is a rare and highly aggressive malignancy with limited research, resulting in an incomplete understanding of disease progression and a lack of reliable prognostic tools. This study aimed to retrospectively analyze the clinical characteristics and outcomes of HNCS patients using data from the Surveillance, Epidemiology, and End Results (SEER) database and to develop a nomogram to predict overall survival (OS) and cancer-specific survival (CSS). Methods: Patients diagnosed with HNCS from 1975 to 2020 were identified in the SEER database. Univariate and multivariate Cox regression analyses were conducted to identify independent prognostic indicators, with the optimal model selected using the minimal Akaike Information Criterion (AIC). The identified prognostic factors were incorporated into nomograms to predict OS and CSS. Model performance was assessed using the concordance index (C-index), area under the curve (AUC), calibration curves, and decision curve analysis (DCA). Survival curves were generated using Kaplan–Meier analysis and compared via the log-rank test. Results: A total of 152 HNCS patients were included, with 108 assigned to the training cohort and 44 to the validation cohort in a 7:3 ratio. Prognostic factors including age, primary tumor site, marital status, radiotherapy, chemotherapy, tumor size, pathological grade, and tumor stage were incorporated into the nomogram models. The models demonstrated strong predictive performance, with C-index values for OS and CSS of 0.757 and 0.779 in the training group, and 0.777 and 0.776 in the validation group, respectively. AUC values for predicting 3-, 5-, and 10-year OS were 0.662, 0.713, and 0.761, and for CSS the values were 0.726, 0.703, and 0.693. Kaplan–Meier analysis indicated significantly improved survival for patients with lower risk scores. The 3-, 5-, and 10-year OS rates for the entire cohort were 54.1%, 45.6%, and 35.1%, respectively, and the CSS rates were 62.9%, 57.5%, and 52.2%, respectively. Conclusions: This study provides validated nomograms for predicting OS and CSS in HNCS patients, offering a reliable tool to support clinical decision-making for this challenging malignancy. These nomograms enhance the ability to predict patient prognosis and personalize treatment strategies. Full article

The freight transportation system faces complex operations globally to meet customer demands. Intense competition prompts companies to enhance performance. Transportation modes (road, sea, air) impact service levels, each with distinct features, benefits, costs, environmental effects, and societal risks. Shippers confront challenges in mode selection due to numerous factors, compounded by an increase in low-volume, high-frequency shipments. Rising logistics costs for a few products of exporters affect the socio-economic situation of a country. This research introduces a hybrid approach for a shipment selection model, focusing on pharmaceutical drugs. Utilizing ma- chine learning algorithms (decision tree, Random Forest, logistic regression, XGboost, SVM) and multi-criteria decision-making methods (SAW, MARCOS, TOPSIS, MULTIMOORA, VIKOR), this study predicts the optimal shipping method (land, air, sea) based on dataset features (shipping cost, origin-destination, cargo weight, dimensions). Evaluation metrics include F1 score, Recall, Precision, and Accuracy score. XGboost stands out as the optimal algorithm, demonstrating an accuracy of eighty-four percent, with random forest, decision tree, SVM, and logistic regression following in descending order. This comprehensive approach addresses the complexities of pharmaceutical shipment selection, considering various influential factors. Full article

Background and Objectives: Diabetic ketoacidosis (DKA) is a critical complication of diabetes mellitus (DM). The primary objective of this study was to identify relevant clinical and biochemical predictors and create a predictive score for in-hospital DKA mortality. Materials and Methods: A 6-year retrospective cohort study of adult patients diagnosed with DKA and admitted to Chiang Mai University Hospital, a tertiary care center in Chiang Mai, Thailand, from 1 January 2015 to 31 December 2021, was conducted. Baseline clinical data and laboratory investigations were collected. The primary outcome was in-hospital mortality. Multivariable logistic regression analysis, clustered by type of diabetes, was performed to identify significant predictors. A predictive risk score was created using significant predictive factors identified by multivariable analysis. The results were presented as odds ratios (ORs) and 95% confidence intervals (CIs), with a significant p-value set at <0.05. Results: Ninety-three patients diagnosed with DKA were included in the study. Ten patients died during admission. Significant predictors for in-hospital mortality of DKA included age > 55 years (OR 7.8, p = 0.007), female gender (OR 3.5, p < 0.001), anion gap > 30 mEq/L (OR 2.6, p = 0.003), hemoglobin levels < 10 g/dL (OR 16.9, p < 0.001), and the presence of cardiovascular disease (OR 1.3, p = 0.046). The predictive risk score ranged from 1 to 14 for low risk, and 14.5–23.5 for high risk of in-hospital mortality. The predictive performance of the scoring system was 0.82 based on the area under the curve, with a sensitivity of 73.8% and specificity of 96.4%. Conclusions: Multiple clinical and biochemical factors, along with a predictive risk score, could assist in predicting in-hospital mortality of DKA and serve as a guide for physicians to identify patients at high risk. Nevertheless, as the predictive score was internally validated with data from a single institution, external validation in diverse healthcare settings with larger datasets or prospective cohorts is crucial to confirm the model’s generalizability and predictive accuracy. Full article

Background/Objectives: The literature on consumption of ultra-processed food (UPF) using the NOVA classification is still limited. Therefore, the aim of the present study was twofold: (i) to compare the UPF consumption, sedentary behaviors, and well-being perception between boys and girls; and (ii) to investigate the association between the UPF consumption and risk of overweight, sedentary behaviors, and well-being in adolescents. Methods: The present cross-sectional study comprised a sample of 245 adolescents (131 boys) aged 12–17 years-old (M = 14.20; SD = 1.09). Height and weight were assessed, and subsequently, the BMI was computed; furthermore, total body fat percentage was measured with bioelectrical impedance. Daily consumption of UPF was assessed by the NOVA screener and time spent sedentary was assessed by the Midlands Behavior Health 2024 questionnaire. The Mental Health Continuum-Short Form (MHC-SF) was used to measure adolescents’ psychosocial well-being. Pearson’s correlations and logistic regression analysis were used, controlling for biological, behavioral, and socio-economic confounders. Results: No sex differences were observed for the different UPF NOVA subscales. Boys reported higher computer use levels than girls on the weekend (p = 0.025), and they spent more time playing electronic games during the week (p = 0.005) and on the weekend than their female counterparts (p < 0.001). Moreover, boys reported higher scores in all well-being dimensions (p < 0.001) than girls. Conclusions: The findings revealed, after controlling for sex, sedentary time, and active behaviors, adolescents who consumed UPF on the previous day tended to be associated with a higher risk of being overweight, but also marginally without statistical significance (OR = 0.91, 95% CI: 0.83–1.01, p = 0.06). Of relevance, the present study revealed that both boys and girls of mothers with high educational levels were less likely to be classified as overweight or obese youth. Full article

Parkinson’s disease is neurodegenerative, and additionally, a percentage higher than 60% is represented by the patients with associated psychiatric symptoms, such as anxiety disorders and depression. Due to illness itself and to therapy secondary effects, there is a high risk for these patients to develop impulse control disorders like ICDs: compulsive shopping, pathological gambling binge eating disorder, and hypersexuality. There is high interest in therapy so as to diminish, as much as possible, the associated ICD symptoms. This article presents a study on pharmacological treatment of impulse control disorders in Parkinson disease carried on a sample of patients in hospitals where the authors have their clinical work. This study was carried on for a period of 6 years and is focused on research of different treatment plans. The patients were evaluated by the Hamilton Rating Scale. Statistical analysis of the obtained data (given by the HAM-A scores) is used for data processing. All patients showed a reduction in their impulse behavior. The directions of further research development are mentioned. Full article

Background: The early identification of patients at risk of peri-procedural complications and poor prognosis is particularly important. We conducted our study to determine whether serum orexigenic neuropeptide Y (NPY) concentration is associated with nutritional status and prognosis among patients undergoing surgery for colorectal cancer (CRC). Materials and Methods: A cohort study with a 3-month follow-up was conducted with 84 consecutive inpatients who underwent elective surgery in one center between 2016 and 2019 for primary CRC. The clinical characteristics and nutritional status of all patients were assessed. In long-term follow-ups (median; IQR: 1322; 930–1788 days; average 3.6 years), the patients’ survival status was also checked during a telephone consultation. Results: Before CRC surgery, patients with serum NPY concentrations equal to or higher than the median value (661.70 pg/mL) had higher scores in their Mini Nutritional Assessment, Barthel, and Instrumental Activities of Daily Living (IADL) questionnaires, greater handgrip strength, a lower score in the Patient-Generated Subjective Global Assessment, and almost a three-times lower risk of perioperative complications, as well as higher Barthel and IADL scores and larger calf circumference at the 3-month follow-up visit in comparison to individuals with lower serum NPY concentrations. A higher serum NPY concentration was predictive of a low Nutritional Risk Screening 2002 score at the 3-month visit, and this was also found to have significantly influenced the patients’ survival during the 1200 days after CRC surgery. Conclusions: A higher preoperative serum NPY concentration may be related to lower nutritional risk, more favorable patient nutritional and functional status, and better survival, but further studies are required. Full article