Heliyon

Objective: Hyperthyroidism and hypothyroidism related to iodine deficiency are major public health concerns in Afghanistan. This study aimed to assess the frequency of thyroid dysfunction among male patients referred for thyroid testing and its association with age, and to examine monthly trends in thyroid dysfunction at Asia Med Laboratory in Herat, Afghanistan, from July 2021 to January 2022. Methods: A retrospective analysis was conducted on 250 male patients aged 0-69 years. We measured Serum TSH, total T4, and total T3 levels, and thyroid status was classified using age specific reference ranges. In addition, the frequency of thyroid dysfunction was analyzed across age groups with monthly trends of thyroid state. Results: Overall, the euthyroid state consisted of 69.2% of participants, 24.8% with overt hypothyroidism, 3.2% with overt hyperthyroidism, and 2.8% with subclinical hyperthyroidism. Thyroid status differed significantly by age (p = 0.0135), with hypothyroidism increasing in older age groups and reaching its highest proportion among men aged 60-69 years (55.6%). Euthyroidism predominated in patients aged 10-39 years, while hyperthyroidism across age groups remained relatively infrequent. After September 2021, a threefold increase was observed in the total number of male patients referred for thyroid testing. During this period, the proportion of hyperthyroidism increased slightly, whereas hypothyroidism cases declined. Conclusion: In conclusion, hypothyroidism was more frequent with older age. The rise in absolute case numbers after September 2021 likely reflects increased patient referrals, underscoring the need for ongoing monitoring of thyroid function. The study may assist in the early management of thyroid disorders and in reducing their complications.

Bangladesh's agricultural sector remains heavily dependent on pesticides and chemical inputs, yet limited attention has been paid to how farmers' knowledge of occupational health and environmental sustainability translates into actual practice across the full agricultural value chain. This study aimed to assess the knowledge and practices of farmers in Pabna District, Bangladesh, regarding occupational health, pesticide handling, environmentally sustainable farming, and market sanitation. A cross-sectional survey was conducted among 301 farmers in 2024 using a structured questionnaire covering socio-demographic characteristics, sustainable farming knowledge and adoption, soil testing and organic farming practices, pesticide handling and occupational health and safety behaviours, post-harvest waste management, and market sanitation conditions. Data were analysed using descriptive statistics. The majority of respondents were male (87.04%) and had no formal education (63.46%). Although most farmers reported knowledge of environmentally sustainable farming practices (97.70%) and pesticide label instructions (98.00%), corresponding safety practices were poor: only 10.63% reported wearing any personal protective equipment and 1.33% reported using a mask during pesticide application. Eye irritation was the most commonly self-reported health symptom following pesticide exposure (92.69%). Market sanitation infrastructure was similarly inadequate, with 89.00% of respondents reporting an absence of sanitary toilets. These findings indicate a consistent gap between farmers' knowledge and their actual practices across multiple domains of the agri-food system. Strengthening extension services, delivering practical hands-on occupational safety training, and investing in market sanitation infrastructure are recommended to close this gap and support safer, more sustainable farming practices in Bangladesh.

Background: Academic achievement is crucial for university students, but various factors affect their performance. This study explores the impact of anxiety, sleep quality, social media use, and socioeconomic status on academic performance (CGPA) among public university students in Bangladesh. Data and Methods: Data were collected from 225 students using a structured questionnaire that assessed anxiety (GAD-7), sleep quality (PSQI), social media use (SMUQ), and socioeconomic status (income, parental education). Structural Equation Modeling (SEM) was used to analyze the relationships between these variables. Outcomes: The results showed that socioeconomic status had a strong positive effect on academic performance ({beta} = 0.745, p < 0.001), while anxiety negatively impacted academic outcomes ({beta} = -0.675, p < 0.001). Sleep quality was positively related to academic performance ({beta} = 0.113, p < 0.05), but with a weaker effect. Social media usage is found to have a negative significant effect on academic performance ({beta} = -0.137, p < 0.001). Conclusion: These findings highlight the importance of controlling social media usage and anxiety to enhance academic performance among adult students. Sleep quality and socioeconomic background of the students are also found to be meaningfully associated with their educational progress.

Abstract: Background: Road traffic injuries (RTI) related trauma is associated with heavy psychosocial burdens for family members involved as informal caregivers after the event. Little is known about the quality of life (QoL) experience of family members of RTI survivors in sub-Saharan Africa. This study investigated the QoL outcomes of family members after the administration of the Friendship Bench psychosocial intervention among RTI survivors in Cameroon. Methods: A pre post study design was utilized in two trauma centers in Cameroon. The relatives underwent assessment both at baseline (Session 1) and follow up sessions (Session 6) using the WHOQOL BREF tool, without being exposed to any intervention. The domain scores were scaled from 0 to 100. Statistical analysis consisted in paired t-tests/Wilcoxon signed-rank tests along with effect sizes using Cohen s d. Results: The study involved twenty nine participants. Baseline assessment revealed overall poor quality of life across all domains, with scores in the poor range (Social = 33.33 [IQR: 25.00 47.92]; Environmental = 34.38 [IQR: 25.78 45.31]; Psychological = 45.83 [IQR: 34.38 50.00]; Physical = 46.43 [IQR: 39.29 56.25]). These scores had a statistically significant increases across all domains after the intervention (p < 0.001), accompanied by medium to large effect sizes (Cohen s d:Social = 1.35; Environmental = 1.57; Psychological = 1.46; Physical = 0.73). The relationship type was found to predict social QoL (F(6,22) = 4.57, p = 0.004), with children of patients demonstrating the greatest gains. Conclusion: Family members of RTI survivors showed a significant improvement in QoL during the Friendship Bench intervention. These results highlight the importance of evaluating family member outcomes in task shifted psychosocial programs in LMICs. Keywords: Quality of life, WHOQOL BREF, road traffic injuries, family caregivers, Friendship Bench, Cameroon, spillover effects

Background: Detecting higher order relationships in datasets of complex traits, such as multiple sclerosis (MS), has been challenging. Conventional statistics largely rely on comparing averages across groups and thereby discard important information on the underlying distribution of datapoints. The Genomic Information Field Theory (GIFT) overcomes this limitation by ranking individuals based on linear measures, for example immunoglobulin titres. The exact role of humoral immune responses against several human herpes viruses in a sex-dependent manner in MS is currently unknown. Materials and methods: We compared the performance of GIFT with conventional statistical frameworks to detect differences in the humoral immune response against 4 highly prevalent herpes viruses linked to an individuals susceptibility to develop MS in 200 MS patients and 137 healthy controls. Results: GIFT validated the well-known association that the Epstein Barr Virus (EBV) protein EBNA1 is strongly linked to MS susceptibility in both sexes. In contrast to conventional statistics, GIFT also identified association between herpes simplex virus, varicella zoster virus and the EBV VCA protein and female susceptibility to develop MS, whereas male MS susceptibility was only linked to CMV immunoglobulin levels. None of these associations was observed using conventional statistical tools. Conclusion and discussion: We here show for the first time that GIFT is able to detect novel associations in human immunoglobulin data linked to MS susceptibility, which remained undetected by conventional statistical frameworks. This shows the power of GIFT to detect complex phenotype-trait associations and underlying subgroups within populations.

The erythrocyte sedimentation rate (ESR) is one of the most common and widely used laboratory diagnostic parameters in connection with inflammatory reactions and it is probable that every reader has already experienced a determination of their ESR. A rapid ESR is a non-specific parameter that provides information about the inflammatory process. Although the origins of this methodology date back to antiquity, the description of the process as the collapse of a percolating gel formed from erythrocytes has only recently been achieved. It was not yet known whether slow ESR has any medically relevant significance. Here we show a variety of clinical pictures that exhibit a systematically slow ESR (e.g., sickle cell disease, neuroacanthocytosis syndromes, chronic mountain sickness). Using a combination of measured data and physical modelling, we show how the accuracy and significance of ESR data can be increased. With this improved ESR (supraESR), we introduce a completely new, cost-effective diagnostic parameter, based on an established and easily automated measurement method, that enables low-cost screening for neuroacanthocytosis syndrome, a group of rare neurodegenerative diseases previously detectable only through complex diagnostic tests.

Beyond their cosmetic significance, eyelashes are critical for retaining ocular moisture and protection against mechanical debris, environmental stressors, and excessive light. While recombinant growth factors support hair growth through activating key follicular signaling pathways, plant-derived EVs modulate local inflammatory and oxidative stress pathways to optimize the follicular microenvironment. Here we conducted a randomized, double-blind, placebo-controlled pilot study to investigate the synergistic effects of a serum containing recombinant Fc-fusion growth factors (rIGF-1, rFGF-7) and extracellular vesicles (EVs) derived from Zingiber officinale (ginger) and Curcuma longa (turmeric). Thirty healthy female participants were recruited and allocated to Group A (active serum) or Group B (placebo) at a ratio of 1:1. Participants applied the intervention twice daily for 8 weeks. The VISIA Skin Analysis System was used during clinical visits to objectively measure eyelash density and average length at baseline, Week 4, and Week 8. Group A exhibited a mean density increase of 3.3% at Week 4 and 4.4% at Week 8 relative to baseline. Eyelash length in Group A exhibited significant increases, reaching 8.1% at Week 4 and 11.0% by Week 8. In contrast, Group B showed slight reductions in length (-1.7% and -3.7% at Weeks 4 and 8, respectively) and a negligible change in density (+0.8% and -1.0% at Week 4 and 8, respectively). Notably, no periocular skin hyperpigmentation, a frequent adverse event associated with pharmacologic agents such as bimatoprost, was observed. These findings demonstrated the potential of combining long-acting recombinant growth factors with plant-derived EVs as an effective, highly tolerable, non-pharmaceutical cosmetic strategy for eyelash enhancement.

Background: Epigenetics, the study of reversible changes in gene expression without altering the underlying DNA sequence, is increasingly applied in medical, commercial, and policy contexts. Yet, little is known about how this emerging science is communicated to the public. The purpose of this study was to examine communication strategies, sources, and modalities in epigenetic-related videos on YouTube- the most accessed platform for informal science education. Methods: We conducted a mixed-methods content analysis of 294 YouTube videos on epigenetics by conducting a keyword-based search on October 17, 2023. Video transcripts and meta-data were coded using a codebook developed both deductively and inductively. Qualitative analysis examined how communication strategies were used within videos and identified emergent themes (RQ1). Quantitative analyses examined the frequency of video and channel characteristics (RQ2), and presentation modalities (RQ3). Results: Findings reveal poor alignment with science communication best practices (RQ1): over 92% of videos failed to acknowledge scientific uncertainty, the comprehensibility level exceeded the recommended 8th-grade level (e.g., average readability grade 10.7), and professional research organizations were notably absent. Narrators were mostly male (56.7%) and white-presenting (73.7%) (RQ2). The majority of the videos used multi-modal strategies (e.g., visual texts mixed with animation and voice-over narration) to communicate epigenetic information (RQ3). Conclusion: Findings highlight the need for professional research organizations to be more proactive in public epigenetic communication efforts. Increasing narrator demographic diversity could broaden audience reach. Evidence-based communication tools are needed for health or science communicators discussing epigenetics on social media.

Introduction: Acute gastroenteritis (AGE) is a global public health problem and a major cause of mortality in low- and lower-middle-income countries. Human bocavirus (HBoV) is among the viral agents associated with this condition. Therefore, investigating the presence of HBoV in cases of AGE in Salvador, Bahia, as well as its prevalence and circulating strains, is important. Objective: To investigate the occurrence of HBoV infection during an AGE outbreak in Salvador. Methods: A total of 178 samples were analyzed for HBoV using nested polymerase chain reaction (nested PCR), and the amplification products were visualized by agarose gel electrophoresis. HBoV was detected in 5.7% of the samples analyzed. Conclusion: This study contributes to the understanding of HBoV epidemiology as a secondary agent associated with acute gastroenteritis during a norovirus outbreak in Salvador. Continued investigation and identification of the etiological agents involved in outbreaks are essential for evaluating the causes of AGE. These findings also highlight the need for broader diagnostic approaches and the importance of phylogenetic analysis for monitoring and controlling viral infections.

Chemotherapy is a common treatment for women with ovarian cancer, and many women treated with chemotherapy experience cognitive dysfunction. However, few studies have investigated the mechanisms of chemotherapy-related cognitive impairment in women with ovarian cancer. The goal of this study was to assess the relationships among neurovascular coupling, iron levels and cognitive functions in women with ovarian cancer after first-line chemotherapy. Simultaneous fNIRS and EEG data were collected in women diagnosed with advanced stage ovarian cancer at baseline (N = 13) and after 3-9 rounds of chemotherapy (N = 8). The attentional network task (ANT) was administered for neurocognitive evaluation. Blood iron levels were measured using standard clinical assays. In parallel, similar concurrent fNIRS-EEG data were acquired in a group of 10 healthy participants in a test-retest design. Cognitive performance declined, as indicated by decreases in ANT sub scores after chemotherapy. Blood iron biomarkers indexing oxygen transport also declined and were related to decreases in the ANT sub scores. Both fNIRS and EEG data responses were shown to have excellent reliability in the healthy subjects, while cancer patients showed significant decreases in oxygenated hemoglobin response in fNIRS, despite no changes in EEG responses after chemotherapy. A significant dose relationship was also found in the changes of fNIRS responses. Our data indicate that chemotherapy produced cognitive deficits and decreases in the oxygenated hemoglobin response and that these may be related to reduced oxygen transport capacity. Results also suggest the utility of using fNIRS-EEG to monitor the progression of cognitive impairment and characterize those mechanisms.

Introduction: High altitude is a physiologically stressful environment due to low barometric pressure and low oxygen availability. This hypoxic stress commonly leads to Acute Mountain Sickness (AMS) during high altitude travel. Additionally, among the physiological adaptations to sustained hypobaric hypoxia, ventilatory acclimatization is characterized by increases in the ventilatory chemoreflex responses to hypoxia and hypercapnia. This study aimed to determine how low-dose prophylactic use of Acetazolamide (ACZ), as utilized for recreational high-altitude travel, impacts these breathing reflexes. Methods: In a double-blind, randomized, placebo-controlled design, participants received 125 mg of ACZ taken twice daily (N=9) or placebo (N=9) starting 2 days prior to ascent to high-altitude (3801 m) and continued until departure. Ventilatory chemoreflex tests were performed at sea level prior to treatment and after 2 days at high altitude. Results: ACZ reduced AMS severity on the first two days at high altitude. ACZ also lowered end-tidal PCO2, indicating elevated baseline alveolar ventilation. Among the ventilatory chemoreflex characteristics, the ventilatory recruitment threshold was significantly lower at high altitude in both groups. We also found a highly significant three-way interaction between location, treatment, and PCO2 on the hypoxic ventilatory response (HVR), indicating that the relationship between PCO2 and the amplitude of the reflex increase in breathing in response to hypoxia is impacted by ACZ. Conclusions: ACZ may sensitize the interaction between the peripheral and central chemoreflex responses. This data provides insight into the mechanisms underlying the beneficial effects of ACZ on sleep quality and AMS symptoms at high altitude.

Autoimmune diseases have shown biased proportion in female population, existing clinical investigations of sex hormones in autoimmune populations have been relatively limited in terms of patient size and types of hormones investigated. In this study, we examined the relationship of sexual hormones and autoimmune antibodies in a large cohort of US women. This retrospective study sample included a total of 15319 female subjects medical information that were collected between December 2015 to May 2019 and tested in the Vibrant America Clinical Laboratory. The present serum sample was limited to female participants who had ever menstruated at the time of blood collection and completed the testing of the autoimmune antibodies and sex hormones. We focused on a total of 13 clinically significant autoantibodies including antinuclear antibody (ANA), 11 anti-extractable nuclear antigens (anti-ENAs), anti-cyclic citrullinated peptide 3 (anti-CCP3), and 11 female sex hormones. First, the prevalence of serological autoantibodies in a large set of adult female subjects divided by the menopause age was investigated. Next, the levels of sex hormones were compared in the seropositive autoimmune subjects and seronegative controls across the pre- and post-menopausal female groups. The presented study involving a large cohort of females showed no statistically different levels of sex hormones in seropositive autoimmune subjects and matched controls except for DHEA-s.

Introduction: Lichen sclerosus (LS) is a chronic inflammatory dermatosis predominantly affecting the anogenital region of both women and men. Sexual dysfunction remains among the most debilitating and overlooked consequences of the disease, as available patient-reported outcome measures are either restricted to one sex or capture sexual health only partially. The aim of the present work is to validate the Qualisex questionnaire (in its the Italian version) in patients with LS and to evaluate its psychometric properties, factor structure, convergent, discriminant validity, and sex symmetry. Methods: A cross-sectional study was conducted on 211 patients (167 women, 44 men; mean age 52.9 years) with a confirmed diagnosis of LS. Participants completed the Italian Qualisex, Skindex-29, DASS-21, and sexual-health-specific scales, the Female Sexual Function Index (FSFI) for women, and the International Index of Erectile Function (IIEF) for men. Construct validity was assessed via Principal Component Analysis (PCA), and reliability via Cronbach's alpha. Convergent and discriminant validities were evaluated against standard psychometric batteries. Results: Item 2 was removed due to low communality (0.167). PCA on the remaining 9 items revealed a two-factor structure accounting for 72.5% of total variance: Component 1 (Sexual Functioning and Satisfaction, 59.89%) and Component 2 (Partner Devaluation, 12.66%). Internal consistency was high (alpha= 0.911 overall; alpha= 0.841 in women; alpha= 0.899 in men). Qualisex scores correlated strongly with Skindex-29 Social Functioning (r = 0.582) and Emotions (r = 0.531) subscales, as well as FSFI (r = -0.391) and IIEF (alpha= -0.566). Discriminant validity was supported by low-to-moderate correlations with DASS-21 domains (r < 0.38). While FSFI and IIEF showed significant negative correlations with age (p = 0.002), Qualisex remained age-independent across sexes (p > 0.05). Conclusion. The 9-item Italian Qualisex is a reliable, sex-symmetrical, and age-independent patient-reported outcome measure for assessing sexual health impairment in LS, successfully isolating disease-specific distress from physiological aging and general distress.

Background: Thyroid disorders represent a substantial endocrine disease burden across South Asia, yet systematic epidemiological data from specific regions of Bangladesh remain scarce. The objective of this study was to determine the prevalence and demographic distribution of thyroid stimulating hormone (TSH) abnormalities among hospital outpatients in Jashore district, southeastern Bangladesh. Methods: A cross-sectional survey was conducted among 200 consecutive outpatients presenting for thyroid evaluation at LabAid Hospital, Jashore, from October 2017 to December 2017. Serum TSH concentrations were measured, and participants were classified as euthyroid, hypothyroid, or hyperthyroid based on standard reference intervals, then stratified by sex and seven age categories. Results: Of the 200 participants (170 female, 30 male), 101 (50.5%) showed abnormal TSH values. Hypothyroidism was identified in 97 participants (48.5%) and hyperthyroidism in 4 (2.0%). The overall prevalence of thyroid dysfunction was nearly identical between sexes (female 50.6% vs male 50.0%, P=1.00), while age group showed a highly significant association with TSH abnormality (P<0.001), peaking in the 40-49-year group (89.7%). The female-to-male ratio for total thyroid dysfunction was 5.7:1, reflecting the much larger proportion of female participants rather than a higher within-sex risk. Conclusion: Thyroid dysfunction, principally hypothyroidism, is highly prevalent among hospital outpatients in Jashore City, with prevalence rising sharply with age and peaking in middle adulthood, supporting the case for systematic age-targeted thyroid screening in this population.

Background: Digitalization and remote work have increased interest in work environments that reduce workload, negative mood, and fatigue. Low-interaction co-presence in virtual spaces may offer a new digital work environment, but its effects on subjective workload remain unclear. Objective: To examine the effects of the 3D-avatar work-support application gogh on subjective workload, mood, and fatigue. Methods: We conducted an open-label randomized two-period crossover trial in 40 gogh desktop users performing desk- or computer-based tasks. Participants completed 30-min task periods with and without gogh, separated by a 30-min break, in randomized order. The NASA Task Load Index (NASA-TLX) was the primary outcome, with the mood and fatigue domains of the Inventory Scale for Mood and Sense of Fatigue as secondary outcomes. Linear mixed-effects models used condition and period as fixed effects and participant as a random intercept. Results: All 40 participants completed both conditions. NASA-TLX scores were 42.3 +/- 12.9 with gogh and 51.7 +/- 15.1 without gogh; the adjusted mean difference was -9.5 (95% confidence interval (CI) -13.4 to -5.5). Adjusted mean differences were -11.4 for mood (95% CI -16.6 to -6.2) and -15.0 for fatigue (95% CI -20.3 to -9.7). Exploratory analyses showed lower Frustration, Effort, and Physical Demand with gogh. Conclusions: The gogh condition was associated with a decrease in post-task perceived workload, negative mood, and fatigue. This combined virtual co-working environment may reduce task-related psychological burden, although objective performance, productivity, and long-term occupational health effects require further study.

Background: Endoscopic submucosal dissection (ESD) of superficial esophageal squamous cell carcinoma (SESCC), with or without the esophageal gland duct involvement (DI or NDI), has been reported in small case series, but ESD-related safety, efficacy, and outcomes remain unknown. We conducted a retrospective study of those issues in consecutive 748 patients treated at our center in China. Material and Methods: Over the study period from January 2014 to January 2019, we identified 748 eligible SESCC patients who were divided into the DI (22.6%, 169/748) and NDI (77.4%, 579/748) groups, based on histopathologic reports. Following the European and Japanese guidelines on endoscopic resection of SESCC, we investigated and statistically compared characteristics of clinicopathology and ESD-related safety, efficacy, and prognosis between DI and NDI groups. Results: The mean age of patients was 64.9 years for the cohort and significantly older in the DI (66.1) than in the NDI (64.5) group (P<0.05). There was no significant difference in smoking/alcohol abuse and comorbidity. Endoscopically, the DI group showed significantly larger tumor size and deeper invasion than the NDI group. There was no ESD-related death in the cohort. Although the en bloc resection rate was 100%, the complete and curative resection rates were significantly lower in the DI (88.2% and 61.2%, respectively) than in the NDI (96.4%, and 86.9%, respectively) group (P<0.01). ESD-related infection (0.7%) and bleeding (2.3%) rates were very low and no significant difference was found between the two groups. Only one perforation (0.1%) occurred in the NDI group. Post-ESD stenosis was 11.9% for the cohort and significantly more common in the DI (20.7%) than in the NDI (9.3%) group (P<0.01). The overall survival rate was 95.7% for the cohort and significantly lower in the NDI (94.6%) than in the DI (100.0%) group (P<0.05). However, there was no significant difference in disease-specific death, recurrence-free survival, distant metastasis, and the requirement for subsequent chemoradiation therapy and surgery between the two groups. Conclusion: In our cohort, there was no ESD-associated death; ESD-related infection and bleeding were minimal; and perforation was rare. Post-ESD stenosis was 11.9% in prevalence and successfully managed by endoscopic dilation. The overall survival rate was 95.7%. Compared to the NDI group, the DI group showed older age, larger tumor size, deeper invasion, lower complete and curative resection rates, higher prevalence of post-ESD stenosis; there was no significant difference in disease-specific death. Taken together, ESD was safe with excellent efficacy and prognosis for endoscopic resection of SESCC with or without esophageal gland duct involvement. Keywords: superficial esophageal squamous cell carcinoma, endoscopic submucosal dissection, ductal involvement, survival, postoperative stenosis.

Abstract Background: Large language models (LLMs) are increasingly explored as adjunct tools in graduate medical education, but their reliability for answering discipline-specific certification examinations remains incompletely characterized. In dentistry in China, the national dental examination serves as a milestone for stomatology trainees. Prior studies predominantly rely on single metric, limiting reproducibility and granularity. Objective: To systematically evaluate the performance of five LLMs in answering the national standardized training examination for dental residents. Method: A total of 1,318 questions covering the six dentistry disciplines were selected. Five LLMs (DeepSeek-V3, DeepSeek-R1, Qwen3-32B, Claude 3.5, and GPT-4o) were evaluated via a single-response protocol on the Dify-based Chatflow framework. Performance combined human verification with automated scoring using the Retrieval-Augmented Generation Systems (RAGAS) framework across seven dimensions. Tasks involving question classification, key-point categorization, and instructional requirement summarization were designed to enable a horizontal comparison of models' cognitive capabilities, assessed using inter-model consistency scores. Results: DeepSeek-R1 achieved the highest correct choice rate (80.90%, p < 0.001) and answer correctness score (0.853, p < 0.001), significantly outperforming the others. All models exhibited limitations, including information insufficiency, redundancy, and hallucination-related issues (lowest 44.20% in DeepSeek-R1). In classification and summarization tasks, Claude 3.5 showed higher consistency scores (186/181) than Qwen3-32B (152/151). Conclusion: Evaluated LLMs demonstrated good performance on dental examination questions and in executing tasks. DeepSeek-R1 consistently outperformed the others. While LLMs showed potential as supportive tools in dental education, further refinement and validation are needed before formal adoption in graduate medical educational and clinical training settings.

The COVID-19 pandemic triggered an unprecedented volume of real-time discourse on social media platforms, with Twitter serving as a global forum for public reactions, fears, and evolving narratives. Traditional sentiment analysis approaches treat tweets as independent, static samples, failing to capture the temporal evolution and geographic heterogeneity of public opinion. This paper presents a comprehensive spatio-temporal framework that integrates fine-grained sentiment classification using COVID-Twitter-BERT with dynamic topic modeling via BERTopic to automatically discover and track evolving narratives. Using a corpus of 2.4 million geolocated tweets collected between January 2020 and June 2022, our analysis reveals distinct pandemic phases: early fear-driven narratives about mask shortages (Q1 2020), vaccine optimism followed by polarization (2021), and pandemic fatigue (2022). Regional comparisons show significant differences, with US discourse dominated by freedom-versus-mandate debates while European discussions emphasized collective solidarity. Our framework achieved 76% F1-score in sentiment classification and successfully identified 50 distinct narratives with high coherence scores. This work provides a powerful methodology for real-time epidemiological narrative surveillance and crisis communication monitoring.

Objective: To perform internal and external validation of a gradient-boosted decision tree (GBDT) fusion model that integrates zygote morphokinetic parameters with conventional embryo assessment features for blastocyst prediction, and to compare its discriminative performance against senior embryologists. Methods: This retrospective cohort study included 631 normally fertilized zygotes from 218 treatment cycles. A GBDT fusion model integrating 84 zygote morphokinetic parameters and 8 conventional assessment features was evaluated internally (5-fold cross-validation) and externally on a public dataset of 523 embryos with blastocyst outcomes. Model performance was assessed using area under the ROC curve (AUC), area under the precision-recall curve (AUPRC), F1 score, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Discrimination was compared with embryologist consensus using the DeLong test; agreement was assessed with Cohen's kappa. Results: The model achieved an internal AUC of 0.78 (95% CI 0.74-0.82), AUPRC 0.72, F1 0.73, sensitivity 0.74, specificity 0.77, PPV 0.72, and NPV 0.79. External validation on the public dataset demonstrated acceptable generalizability (AUC 0.76, 95% CI 0.71-0.81). The model significantly outperformed embryologist consensus (AUC 0.70, P<0.001) with moderate agreement (kappa=0.56). Decision curve analysis confirmed clinical net benefit at threshold probabilities of 0.15-0.55. Conclusions: The GBDT fusion model integrating zygote morphokinetics with conventional assessment demonstrates good discrimination and external generalizability for blastocyst prediction, providing an interpretable decision-support tool for embryo selection in IVF practice.

Introduction: Daytime sleepiness (DS) can compromise athletic performance; however, its influence on Brazilian Jiu-Jitsu (BJJ) athletes remains poorly understood. Daytime naps have been suggested as a strategy to alleviate the effects of DS; however, their impact on physical and specific performance remains inconsistent. Thus, this study investigated the influence of different levels of daytime sleepiness on the physical and specific performance of BJJ athletes and verified the effects of daytime napping on these outcomes. Methods: This investigation employed a randomized, controlled, crossover clinical trial design involving 19 amateur Brazilian Jiu-Jitsu (BJJ) athletes who exhibited excessive daytime sleepiness. Participants performed two experimental conditions, with a 30-minute nap (N30) and without a nap (NN), in a randomized order. Vertical jump (CMJ and SJ), anaerobic power (Wingate ), kimono grip strength (KGST), and specific performance were evaluated using the Jiu-Jitsu Anaerobic Performance Test (JJAPT). Data were analyzed using mixed linear models. Results: Daytime sleepiness significantly influenced all parameters of specific performance (JJAPT), with worse performance observed in athletes classified as having abnormal sleepiness. The opportunity to nap increased the total number of repetitions in the JJAPT of four sets ({approx}20 repetitions; p < 0.001), without consistent changes in physical performance tests. An interaction between napping and sleepiness was observed in relation to isometric endurance strength, indicating that napping may provide greater benefits to athletes experiencing abnormal sleepiness. Conclusion: High levels of daytime sleepiness are associated with reduced specific performance in BJJ athletes. Daytime naps are a simple and potentially effective strategy to mitigate these effects and improve specific performance, reinforcing the importance of monitoring sleepiness and individualizing recovery strategies.