This study provides a comprehensive evaluation and classification of 35 soft decision-making (SDM) algorithms based on fuzzy parameterized fuzzy soft matrices (fpfs-matrices). Although fpfs-matrices offer a strong mathematical framework for modeling uncertainty, there has been a lack of large-scale comparisons of their derivative SDM methods in machine learning. To address this, we used the Comparison Matrix-Based Fuzzy Parameterized Fuzzy Soft Classifier (FPFS-CMC) to benchmark these 35 algorithms across ten diverse datasets from the UCI Machine Learning Repository. The methods were thoroughly assessed utilizing metrics such as accuracy, precision, recall (sensitivity), specificity, and F1-score, and statistical significance was confirmed using the Friedman and Nemenyi tests. Our results show that SDM methods via fpfs-matrices perform competitively in classification tasks involving uncertainty. Notably, the best algorithms according to F1-scores were A19 (Rank 1), YHX14 (Rank 2), and a three-way tie for Rank 3 among VMH16, AKO18o, and A19/2. By identifying the most effective algorithms and offering a structured decision-support framework, this research provides both a theoretical reference and practical guidance for practitioners selecting SDM methods for complex machine learning challenges.
Human anatomy is the cornerstone of medicine. Currently, there is a lack of effective learning tools that can establish a correlation between 2D sectional anatomy and 3D stereoscopic anatomy and facilitate the conversion between the two. This study aimed to evaluate the efficacy of the Imaging Anatomy Virtual Simulation Experiment (IAVSE) course in undergraduate education. This nonrandomized controlled trial was conducted with 102 third-year medical students from the 2017 and 2018 cohorts: 50 medical students who elected to take the IAVSE course were assigned to the experimental group, and 52 students who took the traditional laboratory course served as the control group. Primary outcomes assessed by teaching evaluation included the third-year human anatomy theory scores and fourth-year medical imaging theory, practical test, and total scores. The secondary outcome was a 7-item Likert scale questionnaire based on Bloom's Taxonomy of Educational Objectives. Statistical analyses were performed using SPSS (IBM Corp), with the independent samples t test applied for normally distributed continuous data and the Mann-Whitney U test for nonnormally distributed data. A two-tailed P<.05 was considered statistically significant for all tests. The results of the teaching evaluation indicated a statistically significant difference between the experimental group and the control group. The experimental group achieved higher scores in human anatomy theory (experimental group: median 85, IQR 84.25-85.50, control group: median 81.75, IQR 78.13-83.00; P<.001), medical imaging theory (experimental group: median 61.03, IQR 60.41-61.53, control group: median 59.03, IQR 55.66-59.53; P<.001), practical testing (experimental group: median 22.50, IQR 21.50-23.00, control group: median 20.50, IQR 19.00-22.00; P<.001), and total scores (experimental group: mean 83.26, SD 2.58; control group: mean 78.46, SD 3.76; P<.001). Student feedback collected via a Likert questionnaire also revealed significantly higher ratings in the experimental group across multiple domains, including enjoyment, interactivity, participation, satisfaction, learning efficiency, usability, and acceptance (all P values <.001, except for serviceability, P=.02). Furthermore, the experimental group demonstrated a higher level of acceptance toward the virtual simulation course. The IAVSE course effectively bridges the gap between human anatomy and medical imaging. It enhances students' spatial understanding and academic performance and stimulates their learning interest. It thus holds significant potential for broader application in undergraduate medical education.
Chronological age is commonly used to study aging, but biological aging may more accurately reflect cumulative life experiences and psychosocial stressors. This study examines whether epigenetic clocks function as markers of resilience by assessing how marital status transitions are associated with biological aging and health outcomes in later life. Using data from 1,654 non-Hispanic White participants in the Health and Retirement Study, we analyzed thirteen epigenetic clocks derived from DNA methylation profiles. Ordinary least squares and Cox regression models assessed the associations between marital transitions, depressive symptoms, and mortality, adjusting for genetic and social factors. Interaction terms tested whether epigenetic clocks moderated these associations. Results showed limited associations between marital status and epigenetic clocks. Marital status changes were associated with increased depressive symptoms, but were not statistically significantly associated with mortality risk. In the full sample, interactions between epigenetic clocks and marital status change were not statistically significant for depressive symptoms, although a buffering interaction was observed for the Garagnani clock among men. For mortality, significant moderation was observed for the Hannum, Garagnani, and GrimAge clocks, with moderating patterns concentrated among men. Overall, these interaction results suggest that biologically older individuals, particularly men, exhibited greater resilience to these transitions. These findings raise the possibility that epigenetic clocks reflect accumulated life experiences and psychosocial adaptation, potentially including elements of resilience in older adults.
This study examined whether cognitive fusion statistically mediated the cross-sectional associations of pain interference with depressive and anxiety symptoms among individuals with spinal cord injury (SCI). Cross-sectional mediation models estimated using path analysis were used to test cognitive fusion as a mediator between pain interference and depressive or anxiety symptoms. Online survey completed by adults with SCI in the United States. 156 adults (51.3% female; mean age = 42.1 years) with traumatic (78.2%) or non-traumatic (21.8%) SCI. Pain interference was measured using the spinal cord injury - Quality of Life (SCI-QOL) Pain Interference Short Form. Cognitive fusion was assessed with the Cognitive Fusion Questionnaire-7. Depressive and anxiety symptoms were measured using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7, respectively. Grief due to SCI, measured using the SCI-QOL Grief and Loss Short form, was retained as a covariate. Pain interference was significantly associated with higher cognitive fusion and greater depressive and anxiety symptoms. After controlling for SCI-related grief, cognitive fusion partially mediated these relationships, accounting for 45.4% of the total effect of pain interference on depressive symptoms and 42.3% of the total effect on anxiety. Cross-sectional path analyses supported an indirect statistical association between pain interference and depressive/anxiety symptoms through cognitive fusion. These findings highlight cognitive fusion as a critical, modifiable psychological mechanism underlying this relationship. Targeting cognitive fusion in interventions such as acceptance and commitment therapy may help mitigate the psychological impact of pain interference and improve mental health.
Dynamic total body positron emission tomography (TB-PET) makes it feasible to measure the kinetics of the tracer in all organs of the body simultaneously which may lead to important applications in multi-organ disease and systems physiology. Since whole-body kinetics are highly heterogeneous with variable signal-to-noise ratios, parametric images should ideally comprise not only point estimates but also measures of posterior statistical uncertainty. However, standard Bayesian techniques, such as Markov chain Monte Carlo (MCMC), are computationally prohibitive at the total body scale. We introduce a generative consistency model (CM) that generates samples from the posterior distributions of the kinetic model parameters given measured time-activity curves and arterial input function. CM is able to collapse the hundreds of iterations required by standard diffusion models into just 3 denoising steps. The CM was evaluated using physiologically realistic simulations and an application to a subject's dynamic [18F]FDG TB-PET dataset analyzed with a standard single-input two-tissue compartment model. When trained on 500,000 physiologically realistic two-tissue compartment model simulations, the CM produces similar accuracy to MCMC (median absolute percent error < 5%; median K-L divergence < 0.5) but is more than five orders of magnitude faster. CM produces more reliable Ki images than the Patlak method by avoiding the assumption of irreversibility, while also offering valuable information on statistical uncertainty of parameter estimates and the underlying model. The proposed framework removes the computational barrier to routine, fully Bayesian parametric imaging in TB-PET and is readily extensible to other tracers and compartment models.
Attention-deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD) frequently co-occur. However, evidence on the clinical effects of stimulant treatment in ADHD-BPD comorbidity remains limited. This prospective study aimed to investigate the longitudinal effects of methylphenidate (MPH) on borderline personality features in adults with ADHD-BPD. Thirty-six adults diagnosed with ADHD who also met the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition criteria for BPD were treated with MPH and followed for at least 16 weeks. Clinical ratings of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition BPD criteria and psychometric measures assessing symptom severity and personality functioning were obtained at baseline and follow-up. Twenty-four participants (66.7%) completed the follow-up. Follow-up duration ranged from 3.9 to 12.3 months, with a mean duration of 7.8 ± 2.48 months. The number of BPD criteria significantly decreased after treatment (r = 0.82, P < 0.001). Nineteen participants no longer met the diagnostic threshold for BPD, and 10 achieved remission (≤2 BPD criteria). Baseline anger dysregulation (P = 0.009) and mood stabilizer use (P = 0.029) were associated with continued MPH treatment. Our findings preliminarily suggest that MPH, especially combined with mood stabilizers, may be associated with clinical benefits and acceptable tolerability in patients with comorbid ADHD-BPD. While causal conclusions cannot be drawn, replication in randomized controlled trials is warranted.
Antibiotic therapies are the main treatment for bacterial infections, but growing antibiotic resistance is a major global health threat, severely impacting patients with sepsis. Rapid selection of the most effective antibiotic therapy is critical for survival and for preventing further resistance. Physicians must consider numerous factors for proper empiric treatment selection. A clinical decision support system (CDSS) aims to support physicians in this process, facilitating rapid and targeted therapy. The purpose of this work is to explore the extent to which the realization of a CDSS is possible based on the data available to us and to document insights gained during the development of a foundational model designed to assist physicians in determining empiric treatment options for patients with sepsis. In this regard, rather than aiming to develop a CDSS for clinical application, we highlight the importance of close interprofessional collaboration between scientists from various disciplines and analyze the effects of data quality and quantity on the performance of our statistical models. Empirical scientists conducted interviews with medical practitioners to acquire the medical knowledge required to develop sound statistical models. We developed and applied 2-step cross-sectional, as well as time-series classification models, to carefully preprocessed data of patients with sepsis admitted to the intensive care unit of a German hospital. We identified several factors as crucial information for valid decisions on empiric therapy for treating patients with sepsis. These include the patients' core data, especially the infection focus. To prevent further resistance, individual risk factors such as travel history and professional background should be considered. The evaluation of a therapy's effectiveness is mainly based on the patient's general condition and blood values such as procalcitonin and interleukin 6. One key factor in the acceptance of a CDSS is the explainability of the results produced by the applied methods. Our models demonstrated mainly weak predictive ability for all considered empiric antibiotic therapies. However, they are not yet suitable for use in clinical practice, especially as they are based on prescribing habits rather than on optimal treatment decisions. This work highlights the importance of interprofessional collaboration between medical experts and model developers, ensuring that data quality and clinical relevance are central to the process. It emphasizes the urgent need for high-quality, comprehensive data to overcome challenges such as data discontinuity and improve model performance, particularly through enhanced digitization in health care. This feasibility study will facilitate future efforts to develop a CDSS for treating patients with sepsis and to translate it into clinical use.
Carminatti, LJ, de Souza, PV, Cetolin, T, Mohr, PA, Netto, AS, Ortiz, JG, da Silva, JF, and Teixeira, AS. A cross-sectional analysis of Carminatti's test versions: Age- and position-specific variations and normative reference values in male soccer players. J Strength Cond Res XX(X): 000-000, 2026-The primary aims were: (a) to compare the peak speed (PST-CAR) and peak heart rate (HRpeak) between the 2 Carminatti's test (T-CAR) protocols, and (b) to compare T-CAR performance across age groups and playing positions. Part I used a randomized crossover design where 26 elite U-20 players completed the original T-CAR (starting at 9 km·h-1) and a modified, shorter version (starting at 12 km·h-1) to assess their interchangeability. Part II involved a cross-sectional analysis of a large data set (n = 3,161) to establish normative values and assess T-CAR performance from Under-11 to professional levels. Statistical significance was set at 5%. Part I revealed no significant differences in PST-CAR or HRpeak between the 2 T-CAR versions, with a nearly perfect correlation for PST-CAR (r = 0.93) and a very large correlation for HRpeak (r = 0.89). The intraclass correlation coefficient results indicated excellent consistency, with values of 0.96 (95% CI = 0.92 to 0.98) and 0.94 (95% CI = 0.87 to 0.97) for PST-CAR and HRpeak, respectively. Part II demonstrated that T-CAR performance improved with age, with the most substantial gains occurring between the U-13 and U-15 age groups. Furthermore, position-specific differences emerged from the U-15 level onward, with wide defenders and midfielders generally outperforming central defenders. In conclusion, the modified T-CAR is a valid and time-efficient alternative to the original protocol for assessing intermittent endurance performance in highly trained soccer players. The normative data established in this study provide valuable benchmarks for practitioners to monitor long-term athletic development according to age and playing position.
Far-from-equilibrium thermodynamics were studied in patients with either lung cancer or pulmonary inflammatory diseases. Histological and mechanical activities were due to myofibroblasts. A study on isolated lung fragments treated with the Huxley formalism showed that mechanical abnormalities were similar in both groups: maximum velocity, isometric tension, maximum efficiency, force of non-muscle (NM) myosin crossbridge (CB), time stroke (ts), rate constants for CB detachment, and catalytic constant. Only maximum myosin ATPase activity, myosin content, and CB attachment constant were higher in inflammatory processes than in cancers. Contractile samples were open systems. In each group, β-catenin, NMIIA and B myosins were present. Thermodynamic force (TFo) and flow (TFl) did not show any significant difference between the two groups of patients. In both groups, TFo varied nonlinearly with TFl. This showed that these two systems behaved far-from-equilibrium. Entropy production rate was equal to the TFo × TFl product and did not show any significant statistical difference between the two groups. Excess entropy production was negative in both groups which showed that they were self-organized. In conclusion, the two groups of patients evolved towards self-organized dissipative structures driven by TGF-β1, which created a tissue capable of contractility thanks to myofibroblasts generated by inflammation.
This cross-sectional study aims to screen for eating disorders and low energy availability, as well as identify associated factors among female trail runners. An online survey was used, collecting participants' sociodemographic data, trail running habits, medical indicators, and screening questionnaires for eating disorders (BEDA-Q) and low energy availability (LEAF-Q). A total of 276 female trail runners were included in the analysis. The mean age was 36.2 (± 8.1) years and body mass index (BMI) was 22.0 (± 2.5) kg/m2. They reported 6.2 (± 5.0) years of trail running experience and 7.7 (± 4.3) hours of training per week. Statistical analysis was conducted to analyse the frequency of positive screening based on the sociodemographic characteristics, trail running habits, and medical indicators. Multivariate logistic regression was used to analyse factors associated with a positive screening for eating disorders and low energy availability. A total of 53.6% participants had a positive BEDA-Q score (defined as a score ≥ 0.27), screening positive for eating disorders. Independent risk factors associated with a positive screening for eating disorders were BMI above 24 kg/m2 (p = 0.001), high school education (p = 0.049), doctoral degree (p = 0.023) and a positive screening for depression (p < 0.001). Overall, 55.1% participants had a positive LEAF-Q score (defined as a score ≥ 8), indicating a risk of low energy availability. Associated factors were a decrease in libido (p = 0.043) and a positive screening for depression (p = 0.027). Trail running more than 3 years (p = 0.020) was the only independent risk factor for low energy availability. The independent protective factors for low energy availability were BMI above 24 kg/m2 (p = 0.047) and doctoral degree (p = 0.014). An association between eating disorders and low energy availability was also demonstrated. We present novel data on eating disorders and low energy availability in female trail runners. The elevated rates of these conditions highlight the importance of creating awareness, screening, and early interventions in this population.
Triple-negative breast cancer (TNBC), an aggressive subtype with poor prognosis, is of higher frequency in African American women and women of Sub-Saharan African origin. In France, legal constraints on obtaining health data on race, ethnicity, or nationality in cancer registries and medical records make it difficult to estimate the frequency of TNBC according to women's origins. These constraints result from a historical "universalist" approach to French citizenship which prohibits the routine collection of ethnoracial data. An anonymous, statistical survey we conducted from a single-hospital case series of 780 women with breast cancer followed in a university hospital in Paris showed that TNBCs were at least 3 times more common in patients born in Sub-Saharan Africa than in patients born in France. The former consulted at a more advanced stage of the disease than the latter. The results of an ethnographic study of African women in the Paris region with breast cancer, conducted for several years, highlighted some explanatory factors: low breast cancer awareness, perceived causes distinct from biomedical etiology, the weight of shame and secrecy, prior recourse to local healing, difficulties in communicating with health professionals and navigating the healthcare system. Although considered a public health priority, TNBCs are an emblematic example of the limits produced by French race and ethnicity blindness in public health, epidemiology, prevention and health care.
Detecting ultra-rare objects (frequency < 10-6) without positive annotations remains a critical challenge in computer vision. We propose a Synthesis-Prior Driven paradigm that eliminates the need for real positive samples. Our core insight is that models trained on statistically and perceptually indistinguishable synthetic data can generalize effectively to real-world environments. To achieve this, we introduce a Differentiable Morphological Modeling framework, which embeds explicit physical and geometric priors into a differentiable synthesis engine. Unlike black-box generative models, this approach ensures high-fidelity imagery with perfectly accurate, objective annotations. We validated this paradigm on the safety-critical task of detecting Circulating Genetically Abnormal Cells (CACs). Perceptual assessments confirmed that synthetic data is indistinguishable from clinical imagery (expert accuracy ≈ 50%). Consequently, our model, trained exclusively on synthetic data, achieved state-of-the-art performance on real patient samples (98.43% accuracy, 97.40% sensitivity), outperforming both human experts and existing automated methods. Furthermore, the model demonstrated exceptional robustness across a multi-center cohort (CV < 0.8%) and achieved high-precision zero-shot transfer in industrial defect inspection (DAGM 2007). This study establishes a principled methodology for ultra-rare object detection, offering broad applicability across domains with definable geometric priors.
Although whole-body phase angle (PhA) is a recognized prognostic marker in cardiovascular surgery, the clinical significance of segmental PhA and the impact of fluid overload on its interpretation remain insufficiently elucidated. This study investigated the associations between segmental PhA, physical function, and long-term prognosis in patients undergoing cardiovascular surgery. This retrospective cohort study included consecutive patients who underwent elective cardiovascular surgery between October 2016 and March 2021 at Nagoya Heart Center, Japan. Preoperative whole-body, upper extremity, and lower extremity PhA were measured using bioelectrical impedance analysis. We analyzed correlations between PhA and physical functions. Additionally, the impact of fluid overload was assessed by stratifying patients based on an extracellular-to-total body water ratio (ECW/TBW) cut-off of 0.400. Long-term all-cause mortality was evaluated using multivariate Cox regression analyses adjusting for confounders including age, sex, cardiac and renal function. A total of 859 patients were included in the present analysis (mean age = 68.4 ± 11.9 years, 67.6% male). Segmental PhA significantly correlated with muscle mass, grip strength, and knee extension strength. However, in patients with fluid overload (ECW/TBW ≥0.400), the associations between PhA and physical function were attenuated, and the correlation with age lost statistical significance. Regarding prognosis, low PhA values across all segments were independent predictors of long-term all-cause mortality, even after adjusting for confounders. Segmental PhA is a robust predictor of long-term mortality in cardiovascular surgery patients. However, because fluid overload confounds the relationship between PhA and physical function, clinicians must account for fluid status when interpreting PhA as a marker of muscle quality..
This study identifies the long-term and short-term users of home-delivered meals, i.e., Meals on Wheels (MOW) services, and how they differ across socioeconomic and health status. The analysis relies on a nationally representative sample of 65+ Medicare beneficiaries from the 2013-2021 National Health and Aging Trends Study. A fixed effect multinomial logit model, with lagged indicators and complex survey design, predicts the probabilities of being a short-term (1 year or less) or long-term (2+ years) MOW client. Beneficiaries' characteristics predictive of long-term MOW use include identifying as Black, being on Medicaid, pre-frail, and having 2+ IADL limitations. Medicaid enrollment is one of the few statistically significant predictors for short-term MOW use. These results reveal that long-term MOW users are more heterogeneous and vulnerable than short-term users. Understanding the reasons various individuals rely on MOW services for multiple years may inform policy on the social and care needs of older adults.
There is a growing burden of hypertension (HTN) among adults living in rural Vietnam, which is associated with reduced health related quality of life (HRQoL). Few community-based interventions have, however, attempted to improve the quality of life in patients with uncontrolled HTN. This study aimed to examine the impact of a multi-component intervention on HRQoL in adults with uncontrolled HTN. This cluster-randomized controlled trial was conducted in sixteen communities (8 intervention and 8 comparison) living in a rural setting in Vietnam (2017-2022). Consenting adults with uncontrolled HTN were enrolled. The comparison arm received training sessions about HTN prevention and management and patient education materials. The intervention arm received information similar to the comparison group and three enhancement components, namely a storytelling intervention, home blood pressure (BP) self-monitoring, and expanded community health worker services. The primary outcome was the differential change in HRQoL over 12-month follow-up period, measured using the 12-Item Short Form Health Survey (SF-12), which generates a Physical Component Summary (PCS-12) and a Mental Component Summary (MCS-12). The total HRQoL score was calculated as the sum of PCS-12 and MCS-12, with higher scores indicating better HRQoL. A total of 671 patients were studied; their mean age was 66 years and 55% were women. At the 12-month follow-up, the intervention group showed a significant increase in their PCS-12 with a multivariable-adjusted difference of 4.2 points (95% CI: 2.0-6.4) compared with the control group. While the MCS-12 scores increased for both groups, their differential change over 12 months was not statistically significant (multivariable-adjusted difference: 1.4 points; 95% CI: -0.6; 3.5). Our results demonstrate that a multicomponent intervention effectively improved overall HRQoL with a significant impact on physical health-related HRQoL in individuals with uncontrolled HTN. ClinicalTrials.gov, Registration number: https://clinicaltrials.gov/study/NCT03590691, (registration date July 17, 2018).
Butyrate-producing bacteria, which are components of the gut microbiome, activate host defense mechanisms against several types of infections, including respiratory viral infections. However, the clinical effectiveness of butyrate-producing Clostridium butyricum (CB)-containing probiotics in patients with coronavirus disease 2019 (COVID-19) remains unclear. We investigated the in-hospital mortality, period of mechanical ventilation, and incidence of secondary bacterial pneumonia in patients with COVID-19 from 2020 to 2021. The patients were divided into the probiotic (27) and non-probiotic (256) groups. The two groups did not show a significant difference in the SOFA scores (probiotic vs. non-probiotic, 2.1 ± 2.3 vs. 2.1 ± 2.9). Additionally, all patients received antiviral agents to treat COVID-19; however, the two groups did not show significant difference in their distribution. However, patients receiving CB preparations showed the shorter periods of mechanical ventilation (1.1 ± 2.5 days vs. 3.9 ± 9.4 days). Although not statistically significant, they also showed lower incidence of secondary bacterial pneumonia (7.4% vs. 15.6%) and the lower in-hospital mortality (3.7% vs. 15.2%) compared to the non-probiotic group. This retrospective clinical study revealed that the administrations of CB preparations might attenuate clinical symptoms related to COVID-19 and improve mortality. However, further clinical and basic studies are required to validate our findings.
Tetrathiatriarylmethyl (trityl) radicals are key spin probes for electron paramagnetic resonance (EPR) spectroscopy and crucial building blocks for high-performance dynamic nuclear polarization (DNP) agents. However, their applications have been limited by complex synthesis and structural modifications. In this study, we address this limitation by developing an oxidative radical-polar crossover (ORPC) strategy for trityl derivatization. This approach utilizes oxidization of trityl radicals by nitrosyl tetrafluoroborate (NOBF4) to the corresponding trityl carbocations, which subsequently undergo aromatic nucleophilic substitution (SNAr) with a diverse range of nucleophiles to afford various trityl derivatives. This method exhibits several notable advantages: (1) wide substrate scope, compatible with N-, S-, P-, and C-centered nucleophiles, including water-sensitive organozinc reagents; (2) high regioselectivity for monofunctionalization of a single aryl ring, avoiding statistical reaction mixtures; (3) iterative ORPC reaction which enables the synthesis of both symmetric trityls with three identical substituents and asymmetric trityls with three distinct substituents; (4) significantly improved yields which are 1.5-2 fold higher than those reported in the literature. This straightforward approach provides a powerful tool for tailoring trityl radicals to advance their applications in the fields of EPR and DNP.
Pleomorphic adenoma (PA) is the most common benign salivary gland neoplasm detected by fine-needle aspiration (FNA). However, metaplastic changes within PA can complicate its cytologic interpretation. This study evaluates the impact of metaplasia on the FNA interpretation in a large, multi-institutional cohort. A two-armed study design was employed: one included 200 consecutive PA resections and the corresponding FNAs, and the second included 53 PA cases with known metaplastic features identified by cytologic or pathologic review. Histologic assessment revealed metaplasia in 16% of the 200 PA cases. Although the majority (83%) were cytologically classified as Neoplasm: Benign, indeterminate diagnoses were more common in cases with metaplasia (25%) than in those without (15.5%). Squamous metaplasia was frequently interpreted as indeterminate relative to other types of metaplasia, and a statistical trend was observed between the extent of metaplasia and indeterminate categorization. In the multicenter arm, FNA cases with metaplasia were more frequently interpreted as indeterminate compared to FNA cases without metaplasia (61.8% vs. 15.8%, p < .01). Metaplastic change in PA can pose diagnostic challenges. Although most FNA cases with limited metaplastic features are appropriately classified, extensive metaplasia is more likely to result in an indeterminate interpretation.
Domestic dogs are frequently exposed to tick-borne pathogens such as Babesia vogeli, Hepatozoon canis, Anaplasma platys and Ehrlichia canis, which can cause a wide range of clinical manifestations, although little is known about the epidemiological and clinicopathological profiles of mono- and co-infections. This study aimed to characterize infection patterns and identify clinical and epidemiological factors associated with mono-infections, and co-infections with two or more pathogens in naturally infected dogs. We analyzed 181 dogs from a hospital population with suspected hemoparasitic infections, assessed hematocrit and platelet counts, and used statistical models (Chi-square, Fisher's exact test, odds ratios, and multinomial logistic regression) to evaluate associations between infection types and clinical or epidemiological variables. This is the first comprehensive Brazilian study correlating infection type with clinical and epidemiological factors. Dogs with a history of tick infestation were 3.41 times more likely to be co-infected with two pathogens, and infections involving two (84.6%) or three or more pathogens (90.9%) were more frequent in dogs without the use of tick control medications. Male dogs and those presenting epistaxis, hyporexia or anorexia, dehydration, onychogryphosis, and ectoparasites were more likely to be co-infected with three or more pathogens. Thrombocytopenia was common in all groups, with dogs co-infected with three or more pathogens showing 16.3 times higher odds and dogs co-infected with two pathogens had increased odds of anemia (OR = 2.11). These results underscore the importance of tick control and comprehensive pathogen screening in endemic regions, especially in Brazil's semi-arid northeast, to enhance diagnosis, management, and prevention strategies.
Plyometric jump training (PJT) is an effective means of developing speed, strength, and neuromuscular parameters in youth athletes. However, the effect of PJT on performance outcomes as a function of biological maturation remains unclear. Employing a 12-week training intervention, 37 youth male soccer players aged 10-18 years were stratified by biological maturity using the Mirwald equation (pre-PHV versus post-PHV) and subsequently randomized to a PJT group (pre-PHV: n = 10, post-PHV: n = 10) or a control group (pre-PHV: n = 7, post-PHV: n = 10). The PJT group trained twice per week, with sessions based on multidirectional and short ground contact time exercises. The following performance outcomes were assessed: 20-m sprint, L-run, broad jump, unilateral triple jump, countermovement jump, reactive strength index, and relative leg stiffness. A three-way ANOVA for repeated measures was used for statistical analysis. No significant time × intervention × maturity interaction was detected for any variable (all p ≥ 0.21). The 20-m sprint improved significantly in both PJT groups (p ≤ 0.002), whereas the control group improved only in pre-PHV (p = 0.038). Performance in the L-run improved across all groups (p ≤ 0.003), with no specific intervention effect. Broad jump improved only following PJT (p = 0.001). Unilateral triple jump showed significant gains in both PJT groups (p ≤ 0.032). Relative leg stiffness increased in both PJT groups (p ≤ 0.003), while it decreased significantly in the post-PHV control group (p = 0.013) and remained unchanged in the pre-PHV control group (p = 0.68). PJT appears to be a suitable and effective method for developing speed, explosive power and neuromuscular performance in youth male soccer players both before and after PHV. However, our results indicate that the role of PJT in influencing physical qualities during adolescence may be different.