BACKGROUND Loss of smell can impair quality of life. Olfactory disorders are often caused by viral infections, including SARS-CoV-2. The aim of the study was to evaluate the effectiveness of a structured, multidisciplinary rehabilitation program, including pharmacological treatment and speech therapy-guided olfactory training, in patients with post-COVID olfactory disorders. MATERIAL AND METHODS A total of 75 patients (15 men, 60 women) were allocated to a study group (n=50) or control group (n=25) using a systematic assignment method. Both groups received the same pharmacological treatment (intranasal corticosteroids and topical vitamin A), saline nasal irrigation, and elements of speech therapy-guided olfactory training. In addition, the study group performed classical olfactory training using 4 odorants twice daily. Olfactory function was assessed using the Sniffin' Sticks Test (SST). RESULTS For the total SST score, the mean change before and after intervention in the study group was 7.9 points (P<0.001). In the control group, the mean change was 2.8 points (P=0.006). CONCLUSIONS Classical olfactory training was associated with greater improvement in post-COVID olfactory disorders compared with pharmacological treatment supplemented with speech therapy-guided olfactory training alone. The observed effects may be related to the combined use of intranasal corticosteroids, topical vitamin A, and saline nasal irrigation; however, the individual contribution of these interventions cannot be determined. The potential contribution of a multidisciplinary approach involving a physician, speech therapist, and psychologist remains to be established.

BACKGROUND Osteoporosis poses a growing public health challenge in China's rapidly aging population. However, updated epidemiological data on osteoporosis prevalence and risk factors among community-dwelling older adults remain limited. This study aimed to investigate the prevalence of osteoporosis and identify its associated risk factors in community-dwelling older people in Eastern China. MATERIAL AND METHODS A community-based cross-sectional study was conducted among 2533 adults aged 65 years and older in Hangzhou, China, between February and December 2023. Bone mineral density at the lumbar spine, femoral neck, and total hip was measured using dual-energy X-ray absorptiometry. Osteoporosis was defined as a T score ≤-2.5 at any site according to WHO criteria. Demographic characteristics, lifestyle factors (smoking, alcohol consumption, physical activity), and medical history (diabetes, hypertension) were collected through standardized questionnaires. Multivariable logistic regression was employed to identify independent risk factors for osteoporosis. RESULTS The overall prevalence of osteoporosis was 32.8% (95% CI: 31.0%-34.6%), with significantly higher prevalence in women than in men (48.3% vs 15.2%, P<0.001). Prevalence increased progressively with age, from 24.6% in those aged 60 to 69 years to 45.7% in those aged ≥80 years (P for trend <0.001). Multivariable analysis revealed that female sex (OR=4.82, 95% CI: 3.91-5.94), advanced age (OR=1.58 per 10-year increase, 95% CI: 1.38-1.81), low body mass index (BMI <18.5 kg/m[2]; OR=2.36, 95% CI: 1.58-3.52), and physical inactivity (OR=1.54, 95% CI: 1.18-2.01) were independently associated with increased osteoporosis risk. Diabetes and hypertension showed no significant association after multivariable adjustment. CONCLUSIONS Osteoporosis affects nearly one-third of community-dwelling older adults in Eastern China, with particularly high burden among women and the oldest-old. Low BMI and physical inactivity emerged as important modifiable associated factors. These findings suggest potential targets for communitybased screening and lifestyle programs, although causal inferences cannot be drawn from this crosssectional design.

BACKGROUND Khat is a green leaf with amphetamine-like effects. Khat chewing was once a socially acceptable behavior but has come to involve children and affects oral and general health. We evaluated an awareness program addressing the adverse health risks of khat chewing (AHRKC) among secondary school students, in addition to exploring the variables associated with post-intervention awareness. MATERIAL AND METHODS A quasi-experimental pre-post study design was used. A total of 450 secondary school students were recruited (intervention, n=225; control, n=225) using multistage random sampling. Self-administered questionnaires were used for data collections. For the intervention group, the khat chewing educational program included lectures and seminars, posters, billboards, and brochures. Statistical analyses included chi-squared tests, t tests, and logistic regression modelling. RESULTS A total of 427 students completed both baseline and follow-up surveys. The overall levels of exposure to anti-khat messages and awareness were significantly higher in the intervention group than in the control group after the program (P<0.001). The multivariable analysis revealed that older students (odds ratio (OR)=3.35; 95% confidence interval (CI)=1.11-10.14, P=0.031), students' monthly pocket money (OR=2.39; 95% CI=1.04-5.47, P=0.018), and frequent exposure to mass media channels (OR=2.40; 95% CI=1.06-5.46, P=0.023) were significantly associated with enhanced awareness of the AHRKC in the intervention group. CONCLUSIONS The customized educational program improved awareness of AHRKC among secondary school students. Age, pocket money, and message exposure frequency were among the factors that influenced the observed program outcomes.

BACKGROUND This study investigated the association between postoperative C2-7 sagittal vertical axis (SVA) and axial symptoms after posterior cervical surgery, and explored whether this association differed between open-door expansive laminoplasty (LP) and total laminectomy with fusion (LF). MATERIAL AND METHODS This single-center retrospective cohort study included 64 patients with MCSM, including 33 in the LP group and 31 in the LF group, after propensity score-based trimming and covariate balance assessment. Cervical sagittal parameters, range of motion (ROM), and clinical outcomes were evaluated preoperatively and during 2 to 3 years of follow-up. Logistic regression and receiver operating characteristic (ROC) analyses were performed as exploratory analyses. RESULTS The incidence of axial symptoms did not differ significantly between the LP and LF groups (21.2% vs 32.3%, P=0.40). Both groups showed significant improvements in visual analog scale, Japanese Orthopaedic Association, and Neck Disability Index scores. Compared with LP, LF was associated with greater postoperative changes in C2-7 SVA, C2-7 Cobb angle, C7 slope, and ROM reduction. Postoperative C2-7 SVA was associated with AS. Exploratory ROC analyses suggested optimal C2-7 SVA cutoffs of 3.46 cm in the LP group and 3.10 cm in the LF group. The group × C2-7 SVA interaction was statistically significant but based on a small number of axial symptom events. CONCLUSIONS Postoperative C2-7 SVA may be associated with axial symptoms, and this association appeared stronger after LF in this small cohort. All ROC-derived thresholds and interaction findings are exploratory, hypothesis-generating, and not clinically actionable, pending validation in larger prospective studies.

BACKGROUND This retrospective study from a single center included 105 patients with avascular necrosis of the talus in our hospital from January 2021 to January 2024 and aimed to compare outcomes from management with customized 3-dimensional (3D) printed partial talus replacement with ankle arthrodesis. MATERIAL AND METHODS The replacement group (n=49) received digital customized 3D-printed partial talus replacement surgery, and the arthrodesis group (n=53) underwent ankle arthrodesis. Efficacy of the 2 surgical methods was evaluated by comparing the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, pain visual analog scale (VAS), ankle range of motion (ROM), SF-36 quality of life scale, and complication rate before surgery and at last follow-up. RESULTS At final follow-up, the observation group showed significantly better outcomes than the conventional group in AOFAS score (85.88±3.56 vs 78.51±4.12, P<0.001), ankle ROM (48.31°±4.95° vs 0.91°±1.13°, P<0.001), and the SF-36 Physical Component Summary (74.12±4.10 vs 55.83±4.96, P<0.001) and Mental Component Summary (81.26±5.12 vs 68.15±5.93, P<0.001). VAS scores were also significantly lower in the observation group (1.71±0.71 vs 2.57±0.87, P<0.001). Overall complication rates were similar (8.1% vs 11.3%, P=0.592); however, the reoperation rate was lower in the observation group (0% vs 3.7%). CONCLUSIONS In early follow-up, 3D-printed partial talus replacement for extensive talus necrosis demonstrates superior joint function, ROM, and quality of life compared with ankle arthrodesis, without increasing complications, suggesting it is a safe and effective joint-preserving alternative.

BACKGROUND Lacosamide is an antiepileptic drug widely used to treat partial-onset seizures. During extracorporeal therapies or intravenous administration, lacosamide adsorption to filtration membranes and its stability in solutions may influence therapeutic efficacy. This in vitro study evaluated lacosamide adsorption to different dialysis filter membranes in saline and plasma solutions, as well as its stability in these solutions. MATERIAL AND METHODS Lacosamide (200 µg/mL) was prepared in 0.9% NaCl and bovine plasma, then perfused through 3 types of dialysis filters: polysulfone (PS), polyacrylonitrile (PAN), and polyacrylonitrile polyethyleneimine (PAN-PEI). Samples were collected at 0, 5, 15, 30, 45, 60, and 90 minutes. Lacosamide concentrations were measured using high-performance liquid chromatography. Repeated-measures analysis of variance and post hoc tests were used to evaluate concentration changes over time among filter types. RESULTS Lacosamide remained stable in saline and plasma solutions over 90 minutes, showing under 7% variation in concentration. In 0.9% NaCl, significant adsorption occurred across all filters, with total reductions of 14.73% for PAN-PEI, 20.71% for PAN, and 33.52% for PS filters at 90 minutes. In plasma, adsorption was lower for PS filters (17.96%) but greater for PAN-PEI (23.04%) and PAN (27.71%) filters. No significant differences in adsorption were detected among filters (P>0.05). CONCLUSIONS Lacosamide demonstrated chemical stability with measurable adsorption to dialysis membranes. Adsorption was more pronounced in plasma than in saline for PAN-PEI and PAN membranes. These findings indicate that lacosamide concentrations may decrease during extracorporeal circulation and should be considered in settings involving hemodialysis or continuous renal replacement therapy.

BACKGROUND Insulin resistance is associated with kidney stone risk, and estimated glucose disposal rate (eGDR) is a validated surrogate marker of insulin resistance. This study examined the association between eGDR and kidney stone prevalence. MATERIAL AND METHODS Data were derived from a cross-sectional dataset collected at the Health Management Center, Affiliated Hospital of Yangzhou University (HMC-AHYU). Participants were stratified into 4 groups according to eGDR quartile. Logistic regression models were used to estimate the association between eGDR and kidney stone prevalence. Nonlinear relationships were explored via restricted cubic splines and threshold-effect analyses. Subgroup analyses were conducted to examine potential effect modification, and receiver operating characteristic curves were used to compare discriminative performances among metrics. RESULTS Overall, 23 527 individuals from HMC-AHYU were included. When stratified by quartile, lower eGDR values were associated with increased odds of kidney stones. After multivariable adjustment, each 1-unit increase in eGDR was associated with a 16% reduction in the odds of kidney stones (odds ratio [OR]=0.84, 95% confidence interval [CI]: 0.81-0.87). Compared with the lowest quartile (Q1), the highest quartile (Q4) exhibited 48% lower odds (OR=0.52, 95% CI: 0.41-0.65), with a significant dose-response relationship observed across quartiles. Threshold-effect analyses identified eGDR inflection points at 9.02 and 10.87. eGDR demonstrated the strongest discriminative ability for kidney stones (area under the curve=0.692, 95% CI: 0.679-0.705). Validation using 1000 bootstrap resamples confirmed model stability. CONCLUSIONS Lower eGDR levels were associated with increased kidney stone prevalence. eGDR may serve as a biomarker for high kidney stone risk.

BACKGROUND This study aimed to evaluate the accuracy, confidence, and overconfidence behavior of large language models (LLMs) in endodontics using questions derived from a national specialty entrance examination. MATERIAL AND METHODS A total of 123 text-based endodontic questions from the Turkish Dental Specialty Examination (2017-2026) were included after excluding annulled and image-based questions. Three LLMs (ChatGPT, Claude, and Gemini) were assessed. Each model answered all questions using a standardized prompt and provided a confidence score (0%-100%). Accuracy was recorded as correct/incorrect. Overconfidence was defined as incorrect responses with ≥90% confidence. Statistical analyses were performed using Cochran's Q test, Friedman test, and post hoc pairwise comparisons with Bonferroni correction. RESULTS Accuracy rates were 89.4% for ChatGPT, 76.4% for Claude, and 90.2% for Gemini, with significant differences among models (χ[2](2)=21.00, P<0.001). Confidence scores differed significantly (c2(2)=213.40, P<0.001), with Gemini demonstrating highest confidence (99.51±1.49), followed by ChatGPT (90.88±9.19) and Claude (80.22±11.10). Overconfidence rates were 9.8% for Gemini and 5.7% for ChatGPT, while no overconfident responses were observed for Claude (χ[2](2)=14.53, P=0.001). Despite similar accuracy between ChatGPT and Gemini, confidence patterns differed markedly, demonstrating that comparable accuracy does not necessarily reflect comparable reliability. CONCLUSIONS LLMs demonstrated high accuracy in answering text-based endodontic examination questions; however, significant differences were observed in confidence behavior and overconfidence patterns. The presence of high-confidence incorrect responses suggests that accuracy alone may be insufficient to fully evaluate model reliability. These findings highlight the importance of considering confidence-related behavior alongside accuracy when assessing LLM performance in examination-style endodontic tasks.

BACKGROUND Foreign body aspiration (FBA) is a leading cause of preventable injury and death in young children, yet diagnosis can be challenging because the choking event is not always witnessed or recognized and routine investigations have limited sensitivity. Long-duration data from Central-Eastern Europe are scarce. We characterized bronchoscopically confirmed pediatric FBA in a Polish tertiary center and factors associated with complications. MATERIAL AND METHODS In a single-center retrospective cohort, we studied children (<18 years) with a bronchoscopically confirmed foreign body admitted over 20.5 years (2001-2021). Categorical associations were tested with the chi-square, Fisher, or Fisher-Freeman-Halton exact test, and correlations with the Spearman coefficient. A multivariable logistic regression model examined factors associated with complications, with false-discovery-rate control. A 2-sided P<0.05 indicated significance. RESULTS We analyzed data from 254 children (median age 21 months; 60.6% boys). Feeding was the commonest circumstance (57.1%), and organic objects (predominantly nuts) accounted for 73.6%. The chest radiograph was normal in 16.1% and showed the classical triad in 7.5%. Rigid bronchoscopy was definitive in 90.6%, and complications occurred in 13.0%. In multivariable analysis, older age (OR 1.88, 1.18-2.98) and a prolonged or unknown interval to bronchoscopy (OR 2.75, 1.27-5.95) were independently associated with complications, whereas foreign body type was not (OR 1.02, 0.42-2.50). Bronchiectasis and fibrotic changes occurred almost exclusively with intervals exceeding 30 days or unknown. CONCLUSIONS Normal initial clinical and radiographic findings did not exclude FBA in this confirmed-case cohort. Complications were independently associated with older age and a longer or unknown interval to bronchoscopy rather than with foreign body type, although causality cannot be inferred.

BACKGROUND The clinical profile of patients hospitalized with hepatitis B virus (HBV) is increasingly influenced by coexisting conditions and death patterns. This study aimed to assess comorbidities and fatality rates among patients hospitalized for the first time with HBV between 2012 and 2023. MATERIAL AND METHODS A 12-year retrospective nationwide analysis of first-time HBV hospitalizations in Poland was conducted using data from the Nationwide General Hospital Morbidity Study. RESULTS Digestive diseases (15.6%), cardiovascular diseases (10.5%), and endocrine and metabolic disorders (9.6%) were the most prevalent comorbidities. Between 2012 and 2023, marked increases were observed in digestive (12.3%-27.4%) and metabolic (8.5%-18.5%) disorders, while circulatory diseases rose from 7.4% to 18.6% with post-2019 stabilization. Immune-related and genitourinary disorders demonstrated sustained post-2019 growth, whereas several categories, including neoplasms and respiratory diseases, showed growth-decline patterns. Hypertension and liver fibrosis were the most frequent individual diagnoses, with sustained or stepwise increases over time. Age-stratified analyses revealed a shift from infection-related conditions in younger patients toward cardiometabolic and advanced hepatic diseases in older groups. Fatality rates increased from 6.8-15.9 per 1000 hospitalizations (2012-2019) to 23.1-30.7 per 1000 (2020-2023), peaking during 2020-2021, with higher mortality in men. CONCLUSIONS First-time HBV hospitalizations are increasingly characterized by multimorbidity and rising fatality rates, particularly in older patients. These findings highlight a growing clinical and public health burden, underscoring the need for integrated, age-tailored management and improved surveillance to reduce mortality and optimize HBV care.

BACKGROUND The mental foramen (MF) is a key anatomical landmark in oral and maxillofacial surgery; its accurate localization is critical for preventing neurovascular complications. This study aimed to radiologically evaluate MF position, morphology, symmetry, and interforaminal distance using panoramic radiographs, with particular emphasis on clinical relevance in surgical planning. MATERIAL AND METHODS This retrospective study included panoramic radiographs of 500 patients from the Department of Oral and Maxillofacial Surgery, Eskişehir Osmangazi University. MF position was classified into 6 categories based on relationship to adjacent teeth. Shape, symmetry, and interforaminal distance were also assessed. Statistical analyses were performed using SPSS software. RESULTS The most common MF position was at the level of the second premolar (position 4, 50.9%), followed by the area between the first and second premolars (position 3, 38.9%). A round shape was the most frequently observed morphology (40%), followed by irregular (34%) and oval (26%) forms. The MF was asymmetrically located in most cases (80.2%). The mean interforaminal distance was 51.95±7.08 mm. No statistically significant differences were observed among age groups (P=0.308); men exhibited significantly greater interforaminal distances than women (P<0.001). CONCLUSIONS Panoramic radiography is susceptible to positioning errors, magnification, and superposition artifacts; careful image acquisition and interpretation are thus essential for accurate evaluation of the MF. Although panoramic radiography can provide useful preliminary information, advanced imaging modalities may be required in complex cases. These findings may assist clinicians in improving surgical safety and reducing mental nerve injury risk during dental procedures.

BACKGROUND Chronic sacroiliac joint (SIJ) pain is a common cause of chronic low back pain and disability. Cryoneurolysis targeting the sacral lateral branches has emerged as a minimally invasive treatment option for SIJ-mediated pain. MATERIAL AND METHODS This multicenter retrospective cohort study included 107 patients with chronic SIJ-mediated pain confirmed by a diagnostic SIJ block that achieved at least 50% pain relief. All patients underwent cryoneurolysis of the lateral branches of the L5 and S1 to S3 dorsal rami. Pain intensity was assessed using the Numeric Rating Scale (NRS) and Visual Analog Scale (VAS); functional disability was evaluated using the Oswestry Disability Index (ODI). Outcomes were analyzed at baseline and at 3 and 6 months post-procedure. RESULTS Significant reductions in pain intensity were observed at both follow-up time points (P<0.001). Mean NRS scores decreased from 7.4±1.1 at baseline to 3.6±1.5 at 3 months and 4.2±1.7 at 6 months. Mean VAS scores decreased from 74±12 mm at baseline to 38±15 mm and 45±17 mm, respectively. Mean ODI scores improved from 42±9% at baseline to 24±10% at 3 months and 28±11% at 6 months. At least 50% pain reduction was achieved in 59.8% of patients at 3 months and 48.6% at 6 months. No serious adverse events were observed. CONCLUSIONS Cryoneurolysis offers a safe and potentially effective minimally invasive treatment for chronic SIJ-mediated pain, providing short- to mid-term pain relief and functional improvement.

BACKGROUND Polyethylene glycol (PEG)-based bowel preparation before colonoscopy can disrupt gut microbiota, particularly in patients with ulcerative colitis (UC), who already exhibit baseline dysbiosis and impaired microbial resilience. This study evaluated microbiota recovery after bowel preparation and the effects of probiotic supplementation. MATERIAL AND METHODS In this single-center, open-label trial (ChiCTR2200064456), 79 participants (40 healthy controls and 39 patients with UC) undergoing colonoscopy were randomized to receive probiotics or no probiotics for 28 days after colonoscopy. Fecal samples collected at baseline and on days 2, 14, and 28 were analyzed using 16S rRNA gene sequencing to assess microbial diversity, composition, and predicted functional pathways. RESULTS Bowel preparation significantly reduced a diversity and altered β diversity in healthy controls, with gradual recovery by day 28. patients with UC exhibited lower baseline diversity and delayed microbiota recovery. Probiotic supplementation modestly improved microbial recovery in healthy individuals and more substantially improved Shannon diversity and evenness in patients with UC. Probiotics were associated with enrichment of beneficial short-chain fatty acid-producing taxa, including Faecalibacterium, Blautia, and Lachnospiraceae, together with reductions in Proteobacteria and Fusobacteria. Predicted functional pathways related to energy metabolism and nucleotide biosynthesis were transiently suppressed after bowel preparation and showed partial recovery over time. CONCLUSIONS PEG-based bowel preparation induces reversible gut microbiota disruption, with slower recovery in patients with UC. Probiotic supplementation after colonoscopy was associated with improved microbial diversity and enrichment of beneficial taxa, particularly in patients with UC.

BACKGROUND Spinal pedicle screw-rod fixation is widely used, but manual rod bending is time-consuming and prone to contour inconsistencies. Although computer-assisted technologies have been explored, existing systems remain limited by cost, complexity, and insufficient precision. This study evaluated a novel computer-assisted rod design and bending system, with the goal of testing whether computer-assisted rod bending reduces bending plus installation time vs manual bending in unilateral paired cases and to evaluate safety, feasibility, and rod-screw fitting accuracy. MATERIAL AND METHODS A prospective trial enrolled 26 patients (18-75 years) undergoing spinal pedicle screw-rod fixation (≥4 segments) for fractures or degenerative diseases. Twenty patients received unilateral computer-assisted bending (contralateral manual for comparison) and 6 received bilateral assisted bending. The primary outcome was bending plus installation time; secondary outcomes included complications and fitting accuracy. Wilcoxon signed-rank test was used (P<0.05). RESULTS No instrument-related complications were observed (n=26; median age 60.5 years). For 20 unilateral cases, computer-assisted bending (183.3±70.8 seconds) was significantly shorter than manual bending (236.1±119.1 s; mean reduction 52.75 seconds, P=0.017). Subgroup analyses indicated signals of greater time savings in more than 4 segments (93.9 seconds, P=0.039) and BMI of 25 kg/m2 or higher (95.3 seconds, P=0.005), although these were exploratory and not adjusted for multiplicity. CONCLUSIONS The computer-assisted system reduced bending plus installation time vs manual bending, with no instrument-related complications. Subgroup findings were exploratory and require further validation.

BACKGROUND Cancer is a leading cause of global mortality and morbidity, accounting for millions of deaths each year. This study aimed to assess quality of life (QoL), examine the demographic, clinical, and psychological factors associated with QoL, evaluate the prevalence of anxiety and depressive symptoms, and assess the associations between treatment modalities and QoL domains among patients with cancer receiving anticancer therapy in Lahore, Pakistan. MATERIAL AND METHODS A cross-sectional study included 385 cancer patients using a convenience sampling. Data were collected using the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire, which assesses 4 QoL domains: physical well-being (PWB), social well-being (SWB), emotional well-being (EWB), and functional well-being (FWB). The Hospital Anxiety and Depression Scale (HADS) was used to measure anxiety and depression levels. RESULTS The median overall FACT-G score was 68 (IQR: 24), with EWB scoring the highest median of 19 (IQR: 7) and PWB the lowest at 14 (IQR: 12). SWB and FWB had median scores of 16 (IQR: 4) and 18 (IQR: 9), respectively. HADS results indicated that 56.1% of participants had normal depression scores, while 23.4% had high depression. For anxiety, 60% were in the regular category, and 15.3% had clinical anxiety. Higher levels of anxiety and depression were associated with poorer QoL across all domains. Educational level and sex were significantly associated with QoL. CONCLUSIONS Overall, patients with cancer maintained a moderate QoL, with particularly low PWB scores, highlighting the physical burden of cancer treatment. These findings highlight the importance of routine psychological assessment and supportive care to address the physical, emotional, and social needs of cancer patients during treatment.