High-risk Regions Research Articles

Abstract 5017: A multimodal deep learning approach to predict survival in never smoking lung cancer patients

Purpose: Lung cancer in never-smokers (LCINS) is the fifth most common cause of cancer deaths worldwide. Identifying subjects who need more aggressive treatment could greatly help improve survival rates. In this study, we investigated whether a multimodal deep learning approach could be used to predict overall survival in a large cohort of never smoking lung adenocarcinoma patients from the Sherlock-Lung study. We leveraged multiple datasets containing different modalities, including clinical, digital pathology (WSIs: whole slide images), and genomic (driver gene mutations in EGFR, KRAS, TP53, RBM10, as well as CDKN2A deletions, ALK fusions, and mutation patterns like Kataegis) data. Method: The sample set contained 495 LCINS cases which were randomly split into training (60%), validation (15%), and testing (25%) sets. Tiles of 256 x 256 pixels were extracted from the WSIs and processed through a customized VGG-19 convolutional neural network. The output of this network was high-dimensional feature vectors representing morphological patterns in the tiles. Genomic and clinical data were modeled separately and then concatenated with the output of the CNN to generate a shared feature space, which was then modeled using a simple densely connected neural network. The final feature vector was then used to predict the risk score using Cox partial likelihood as the loss function. The risk predictor was then validated on the held-out test set. The above procedure was conducted with and without genomic data. We also conducted a gene-specific survival study across LCINS with different driver genes as well as restricting the analysis to stage I cases only. Results: We achieved an index of 0.86 for the concordance between predicted mortality risk and actual survival time on the test set using both approaches, with and without genomic data. The Kaplan-Meier curves for low- and high-risk groups, with the cutoff for the risk score determined by the median value, showed distinct survival patterns - patients predicted to have low risk exhibited a higher survival probability compared to those with higher scores. The log-rank test yielded a p-value of ≤0.05 for overall and gene-specific survival, adjusting for stage and age. Heatmaps generated using the activation map of the image model highlighted non-tumor regions as low-risk regions and tumor regions as high-risk regions. Conclusion: The multimodal approach strongly predicted overall survival across all stages and within stage I in LCINS. Specific driver gene mutations do not significantly enhance survival prediction, highlighting the benefits of modeling on multimodal information over using only molecular data. Such approaches for LCINS prognostication could be used in the future to guide effective treatment modalities. Citation Format: Monjoy Saha, Tongwu Zhang, Praphulla M.S. Bhawsar, Wei Zhao, Jianxin Shi, Soo-Ryum Yang, Jonas S. Almeida, Maria Teresa Landi. A multimodal deep learning approach to predict survival in never smoking lung cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 5017.

Magnetic resonance spectroscopy guided radiotherapy boost for patients with glioblastoma

To assess the feasibility and efficacy of delivering a radiation dose boost to high-risk glioblastoma (GBM) tumor regions, identified using magnetic resonance spectroscopy (MRS) after standard radiotherapy (RT). This retrospective study included patients newly diagnosed with GBM between January 2017 and July 2023. All patients received Intensity-modulated radiotherapy and concurrent temozolomide. Magnetic resonance imaging (MRI) and MRS were performed prior to radiotherapy and after the administration of 60Gy. A biological gross tumor volume (bGTV) was delineated on the simulation CT using the image fusion with the T1 sequence with MRS data after 60Gy. Based on the bGTV volume, patients received an additional 10-20Gy. Survival outcomes were estimated using Kaplan–Meier methods, and Cox regression analysis was applied to explore associations between clinical factors and survival. A total of 114 patients were analyzed. The median patient age was 51 years (range: 18–78 years), and 60.5% were male. Gross total resection was performed in 76 patients prior to RT. IDH1/2 wild-type was identified in 99 patients, and MGMT methylation was present in 40 patients. The median follow-up period was 34.0 months (95% CI, 27.1–40.9 months). The median overall survival (OS) and progression free survival (PFS) were 30.0 months (95%. CI 21.5–38.5 months), and 12.0 months (95%CI 9.5–14.5 months), respectively. Both univariate and multivariate analyses showed that the type of surgical resection and IDH1/2 mutation status were significantly associated with OS and PFS. Headache and fatigue were the most frequently reported symptoms. Delivering a RT boost to high-risk tumor regions identified by MRS after standard RT is feasible in patients with GBM and demonstrate acceptable toxicity. Further prospective clinical trials are warranted to confirm these findings.

Hybrid Poly(Methacrylic Acid-Co-Acrylamide)-Polythiophene Nanofibers for Salivary Diagnosis of Oral Squamous Cell Carcinoma.

Oral squamous cell carcinoma (OSCC) is a major health concern in high-risk regions globally, with rising mortality rates indicating the urgent need for early detection tools. This study presents an innovative point-of-care (POC) diagnostic tool using disposable microelectrodes to detect cholic acid, a crucial OSCC biomarker, in human saliva. By combining a poly(methacrylic acid-co-acrylamide) copolymer (CoP) with polythiophene (PTh) nanofibers as selective coatings for disposable, screen-printed carbon electrodes (SPCE), the developed CoP-PTh/SPCE sensors demonstrate exceptional performance. Using impedance spectroscopy and voltammetric techniques, the electrochemical oxidation of cholic acid in solution and saliva samples is investigated. The CoP-PTh/SPCE sensors exhibit an outstanding sensitivity of 1.05µAcm-2nm-1 (74.2µA µm-1), a detection limit (LOD) of 0.240nm, and a quantification limit (LOQ) of 0.727nm, demonstrating their superior capabilities. Additionally, these sensors exhibit remarkable selectivity against structurally similar compounds such as cholesterol and various salivary analytes. The practical application of CoP-PTh/SPCE sensors is realized through a 97.67±1.08% recovery of spiked cholic acid concentrations in human saliva samples. This study highlights the potential of CoP-PTh/SPCE sensors for reliable, efficient, and non-invasive POC testing, offering a promising solution for the early diagnosis of poorly differentiated OSCC.

External Validation of SCORE2-Diabetes Risk Prediction Model in Chinese Patients with Diabetes.

The updated 2023 European Guideline recommended SCORE2-Diabetes to estimate cardiovascular disease (CVD) risk in patients with diabetes; however, external validation is lacking. The study aims to validate SCORE2-Diabetes in Chinese and assess its broader applicability and adaptability across diverse settings. This study included patients with diabetes aged 40-90 without prior CVD from a population-based Chinese cohort. Ten-year CVD risk was calculated using the original and recalibrated SCORE2-Diabetes, where four sets of scaling factors for different risk regions were provided. The outcome was defined consistently with SCORE2-Diabetes. During a median follow-up of 7.09 years, 50,426 Chinese patients experienced 6,540 CVD events and 2,852 non-CVD deaths. The C-statistic of the SCORE2-Diabetes was 0.702 (95%CI: 0.691-0.713) in men and 0.726 (0.716-0.736) in women. The original SCORE2-Diabetes underestimated risk by 30% in men and 50% in women, whereas the recalibrated SCORE2-Diabetes using high-risk region scaling factor had the best calibration, overestimating risk by only 4% in men and underestimating by 7% in women. 14,501(28.76%) and 20,789(41.23%) patients were classified as very high (≥20%) and high (10-20%) risk categories, respectively. The significant difference between average baseline and targeted LDL-C was observed in the very high-risk group (2.85 vs. 1.40 mmol/L). With the appropriate selection of the scaling factor, SCORE2-Diabetes shows satisfactory discrimination and calibration in Chinese, indicating its good generalisability. According to the latest guideline, the risk assessment in this real-world population indicated a significant demand for medications with cardiovascular efficacy and a substantial burden for lipid management.

Assessing the risks of fintech development: the case of online illegal capital raising

This study examines the impact of financial technology (FinTech) on online illegal capital raising (ICR) in China. Using a large dataset of court judgments from China Judgment Online from 2014 to 2019, we observe a steady increase in the number and proportion of defendants involved in online ICR cases. Our empirical analysis shows that FinTech contributes significantly to the increase in online ICR, particularly in regions with low opportunity costs of crime and limited access to traditional financial services. The findings remain robust to different FinTech proxies, sample adjustments, and considerations of potential endogeneity. Weak regulatory oversight and higher potential criminal returns are key channels through which FinTech promotes online ICR. These findings highlight the need for stronger financial regulation, especially in high-risk regions, alongside efforts to improve public awareness of online investment risks. Strengthening regulation while promoting the positive role of FinTech in financial development is critical to mitigating emerging financial risks.

Probabilistic assessment of climate indices across Europe: analysing risk exposure in population density and land use types

We present a probabilistic approach to climate indices to derive high exposure zones across the European continent, utilizing high-resolution observed data over the last 70 years. 56 distinct climate indices related to drought, global radiation, precipitation, relative humidity, sea level pressure, and temperature are identified, shedding light on the complexity and multifaceted nature of risks encountered by European regions during co-occurrences of the different climatic events. Our findings suggest that precipitation and temperature-based indices are particularly useful in identifying high-risk regions in southern and southeastern Europe, whereas precipitation-based indices are for Northern and Western Europe. Temperature indices and potential evapotranspiration account for most risk exposure to Europe’s dominant land use type. The highest exposure percentage of the population occurs with differences in days above and below the maximum temperature of 17 °C. About 17 climate indices with high-risk magnitudes are present regionally and in specific months, emphasizing diverse risk exposure. Russia, Norway, Iceland, and Sweden experience diverse high-risk co-occurrences, with multiple climate indices related to precipitation and temperature. The findings expand the range of climate indices and demarcate hotspots and risk zones, allowing for more effective climate monitoring and risk mitigation strategies.

Multi-hazard risk assessment of Waling Municipality, Syangja, Nepal

Numerous natural hazards that impose severe damage to the built environment and result in the loss of life and property in Nepal. While keeping track of a single hazard, we might put a blind eye to the other possible occurrences. To promote the use and effectiveness of a multi-hazard map and analyzing the risk considering the vulnerability, the Multi-Hazard Risk Assessment of the Waling Municipality has thoroughly assessed the several hazards that the municipality faces and their possible effects on the environment, infrastructure, and people. Advanced modeling techniques, including Geographic Information Systems (GIS), remote sensing, and the Analytical Hierarchy Process (AHP), are utilized to prepare individual and multi-hazard maps as they enable the spatial analysis of various data types, supporting the development of models for natural hazards. The research reports that ward nos. 11 and 14 have high risks, while wards 2, 3, 5, and 12 are categorized as medium-risk zones, and the remaining wards have low risks due to multi-hazards. This research identifies regions of high risk, which need immediate attention and actions guiding the deployment of resources and disaster preparedness strategy.

Time trends in malaria incidence from 1992 to 2021 in high-risk regions: An age‑period‑cohort analysis based on the Global Burden of Disease study 2021.

Time trends in malaria incidence from 1992 to 2021 in high-risk regions: An age‑period‑cohort analysis based on the Global Burden of Disease study 2021.

To fix or not to fix: A comparison of grafting with fixation versus grafting alone in proximal femur aneurysmal bone cysts.

This study aims to evaluate whether adding internal fixation to grafting could improve radiological and functional outcomes compared to grafting alone in patients with aneurysmal bone cysts (ABCs) of the proximal femur and to investigate whether there was a significant difference between these two treatment methods in terms of the need for a second surgery. Between January 2012 and January 2022, a total of 30 patients (21 males, 9 females; mean age: 13.7±5.1 years; range, 5 to 23 years) with proximal femur ABCs who underwent surgical treatment were retrospectively analyzed. Twelve of them were treated by grafting alone (Group GA), while the remaining 18 were treated by grafting along with fixation using plates and screws (Group GF). The demographic data of these patients, the need for secondary surgery, radiological and functional scores were recorded. The modified Neer Classification was used for radiological evaluations, while the Musculoskeletal Tumor Society (MSTS) scores were utilized for functional assessments. Overall, the mean preoperative MSTS scores were lower than the postoperative MSTS scores in both GF and GA groups (p<0.001 and p=0.002). The postoperative radiological scores of the GF group were superior to the GA group (p=0.012). However, no significant difference was found in the postoperative MSTS scores between the groups (p=0.185). Secondary surgeries were performed in six patients in the GF group due to implant removal and in three patients in the GA group due to recurrence. No significant difference was observed between the GF group and the GA group in terms of secondary surgery (p=0.626). Comparisons of final radiological (p=0.325) and final MSTS (p=0.346) scores after secondary surgeries revealed no significant differences. In proximal femoral ABCs, grafting with fixation may provide more favorable radiological outcomes with lower recurrence rates. While grafting with fixation seems to increase the risk for a secondary surgery due to implant removal, our study shows that recurrence in high-risk regions can also necessitate secondary surgeries with grafting alone. Notably, both approaches can achieve successful outcomes, even with recurrent surgeries.

Global incidence, risk factors, and temporal trends of nasal cancer: A population-based analysis.

Nasal cancer is a rare and fatal disease, with an incidence rate of <1 in 100,000, and a 5-year survival rate of around 30%. The study aims to investigate the worldwide disease burden, associated risk factors, and temporal incidence patterns of nasal cancer. Data were obtained from multiple sources, including the Global Cancer Observatory, Cancer Incidence in Five Continents Plus, the Global Burden of Disease database, the World Bank, and the United Nations. The study utilized multivariable linear regression to investigate the relationship between risk factors and the incidence of nasal cancer by age for each country. Trend analysis was conducted using the joinpoint regression analysis program, and the average annual percentage change (AAPC) was calculated. The accuracy of trend estimations was assessed using the 95% confidence interval (CI). Additionally, the incidence of nasal cancer was examined by age and geographic location. A total of 37,674 new cases were reported in 2020 (ASR 4.2 per 1,000,000). The highest ASRs were observed in South-Eastern Asia (5.3) and Central and Eastern Europe (4.8). A number of risk factors were identified, such as higher HDI regions, higher prevalence of smoking, alcohol drinking, unhealthy dietary, and hypertension. In addition, physical inactivity was related to lower incidence. An overall decreasing trend was reported in the global population, but an increasing trend was discovered in males. The highest burden of nasal cancer was found in South-Eastern Asia and Central and Eastern Europe, potentially due to regional genetic factors and pollution issues. Targeted interventions are need in high-risk regions. Further studies are needed to investigate factors contributing to the increasing temporal trend of nasal cancer among the male population.

Clinical and Demographic Characteristics of Hospitalized Pediatric Measles Cases; The 2023 Outbreak in Northern Jordan.

Measles remains a leading vaccine-preventable cause of childhood morbidity and mortality globally. Despite immunization efforts, outbreaks persist, including a 2023 outbreak in Irbid, Jordan. To describe the clinical, demographic, and vaccination characteristics of pediatric measles patients hospitalized during the 2023 Irbid outbreak and assess complications and outcomes. A retrospective observational study included all children (0-14 years) hospitalized with laboratory-confirmed measles at Princess Rahma Pediatric Hospital, Irbid, from April to December 2023. Data on demographics, vaccination status, symptoms, complications, management, and outcomes were analyzed using descriptive statistics and comparisons between vaccinated/unvaccinated groups. Of 63hospitalized children, 61.9% were under one year old, and 49.2% were male. Most (63.5%) were unvaccinated; 47.6% of these were ineligible due to age (<9 months). Among eligible children (≥9 months), 27.2% were fully vaccinated, 42.5% under-vaccinated, and 30.3% unvaccinated. Fever (95.2%) and rash (96.8%) were the most common symptoms. Pulmonary complications affected 68.3% (bronchopneumonia: 55.5%; pneumonia: 12.7%). Dehydration (34.9%) and gastrointestinal symptoms (vomiting: 30.1%; diarrhea: 28.5%) were frequent. One unvaccinated 7-month-old infant died from measles-associated pneumonia. Vitamin A was administered to all patients, and 82.5% received empirical antibiotics. The average hospital stay was 4.4 days. The measles outbreak in Northern Jordan predominantly affected unvaccinated children, particularly those under nine months of age. While vaccination reduced the risk of severe complications (eg, pneumonia occurred in 75% of unvaccinated vs 25% of vaccinated cases), breakthrough infections in vaccinated children underscore the need for optimized immunization strategies. Respiratory complications, including pneumonia, were the leading cause of hospitalization and mortality, highlighting the vaccine's critical role in mitigating disease severity. Strengthening vaccination coverage and revisiting age-specific policies in high-risk regions remain essential to reduce measles-related morbidity and mortality.

Evaluating the Effectiveness of Early Warning Systems in Reducing Loss of Life in Natural Disasters: A case study of Greece

This paper assesses the impact of Early Warning Systems (EWS) on minimizing loss of life during calamities using Greece case. EWS are useful in disaster risk reduction due to their ability to issue alarm, offer early hazard forecast, educate the public and use technology to enhance the response action. This study aims at evaluating the effectiveness of these six components through a survey of 353 environmental professionals and specialists in Greece. The results show that the Greek EWS tends to offer early warning in most events, which assists in preparing the community. But still, there are critics who argue that the effectiveness of the system is still lacking in delivering urgency of threats. Though they admit that they have a high level of confidence in their hazard predictions, there remain issues with reliability, which need to be worked on constantly to retain the public’s confidence. Although, increased public awareness and education activities have played a positive role in increasing understanding about the EWS, there are shortcomings existing in making sure that everyone realizes what steps they should take when they get a warning. Automated systems such as the IoT implemented to monitor hazardous events and AI integrated to forecast such events have made surveillance faster and more precise. However, access as a concept remains limited, especially for the sensitized population, and there is a need to adopt more inclusive methods of passing information. It also suggests the development of communication-Intensive EWS through the integration of mobile alerting, social media, and other community engagement programs. This study adds value to the existing body of knowledge and practice in disaster management by providing insights into factors that determine success of an EWS in reducing fatalities. Proposals include improving the communication of risks, improving the consistency of forecasts through the use of AI, focusing on more education among the public and spending on improved systems for monitoring. Better communication with relevant authorities and harmonizing of technology-enhanced solutions will provide more efficient and coherent disaster management in areas such as Greece and other high-risk regions.

Understanding spatiotemporal variation of heatwave projections across US cities

Heatwaves are one of the deadliest meteorological hazards, posing a substantial risk to human health, environment, and the economy. The frequency and intensity of heatwaves have substantially escalated throughout the United States (US), as evidenced by a noticeable contrast between the average occurrence of two heatwaves per year during the 1960s and the surge to six per year during the 2010s. The primary objective of this study is to assess the impacts of past heatwave events in major US cities, project future scenarios, and analyze the relationship between heatwaves and their associated health and environmental consequences. First, we investigate the spatio-temporal variations in the intensity, frequency, and duration of past heatwaves, along with anticipated changes under various shared socioeconomic pathways till the end of 2100. Secondly, we examine the adverse heatwave impacts on human health and well-being, considering both current demographics and future projections. Our results highlight significant projected increases in heatwave frequency, intensity, and duration across all US regions, with the most dramatic escalations under high-emission scenarios. By the late twenty-first century, cities could experience up to 2–4 times the frequency and duration of heatwave days annually compared to the baseline period (1985–2014), with night-time heatwave durations potentially covering over half the year in some regions. Furthermore, analysis using composite heatwave indices reveals severe heat stresses, particularly in southwestern cities like Las Vegas and Yuma, and southern cities like Miami, indicating a rising trend of heatwave susceptibility due to both climatic and demographic shifts. This study contributes to the growing body of research advocating proactive measures to address the escalating threat of heatwaves. By integrating projected climate indices and demographic shift, it provides a nuanced assessment of urban heatwave vulnerability, with a specific focus on densely populated cities and high-risk regions.

Spatiotemporal mapping of canine rabies transmission dynamics in Sarawak, East Malaysia from 2017 to 2023.

Canine rabies poses a significant global public health threat, including in Malaysia. Despite this disease's severity, there is a notable research gap concerning the spatial and temporal epidemiology of canine rabies, limiting the development of effective control strategies. This study delves into the spatiotemporal patterns of canine rabies occurrence in Sarawak, East Malaysia, spanning from 2017 to 2023, with the primary goal of offering insights crucial for shaping robust control measures. Utilising surveillance data from the World Animal Health Information System (OIE-WAHIS) and local reports, we employed descriptive statistics to analyse the data. Spatial heat maps were generated to pinpoint rabies hotspots and examine their association with potential transmission predictors. Findings unveiled an overall positivity rate of 28.34%, predominantly affecting dogs. District-specific variations emerged, and spatial risk maps successfully identified hotspots. Predictive factors, including dog versus human population and households, exhibited strong positive correlations with rabies occurrences. High-risk regions displayed associations with human population density and major road networks. This investigation contributes valuable insights that enhance our comprehension of canine rabies transmission dynamics, thereby guiding effective control strategies. The knowledge gained holds the potential to aid in eliminating canine rabies in Sarawak and other regions in east Malaysia.

Seroprevalence and Epidemiological Insights into Severe Fever with Thrombocytopenia Syndrome on Jeju Island, Republic of Korea

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne disease caused by the SFTS virus, posing significant public health challenges in East Asia. This study aimed to evaluate the seroprevalence of SFTS on Jeju Island, Korea, and to identify the demographic and geographic factors influencing exposure to the virus. A total of 1001 serum samples collected from healthy individuals between 2009 and 2016 were analyzed using a double-antigen enzyme-linked immunosorbent assay. The overall seroprevalence was 1.7%, with slightly higher rates observed in females (2.06%) than in males (1.29%); however, this difference was not statistically significant. Seroprevalence increased with age, peaking at 2.50% in individuals over aged 60 and over. Regional analysis revealed elevated seroprevalence in the eastern coastal areas (4.41%), which was attributed to population density and environmental factors favoring human–tick interactions. These findings suggest that population distribution and land use patterns, rather than altitude alone, significantly affect the exposure of SFTS on Jeju Island. Targeted tick control strategies and public health interventions that focus on high-risk regions and demographics could mitigate SFTS transmission. This study provides valuable insights into the epidemiological characteristics of SFTS and emphasizes the importance of tailored preventive measures in endemic regions.

Vaccines and Antiviral Therapies for Mpox Virus in Pregnant and Breastfeeding Women: Efficacy and Maternal–Child Outcomes

Mpox (formerly known as monkeypox), the major public health concern of 2022, has elicited much attention globally. In addition to the usual symptoms observed in smallpox virus infections, infected mothers were found to hold a possible risk of transmission to newborns during delivery. This review aimed to summarize recent clinical trials that involved antiviral therapy, vaccines, immunoglobulin therapy, and other pharmacological interventions specifically for treating infected pregnant women. A comprehensive search was performed using databases such as PubMed, Google Scholar, and Medline to find appropriate disease management strategies. Amongst the vaccines and antivirals being used for treatment, vaccines such as Modified Vaccinia Ankara (MVA/MVA-BN) and Lister clone 16-medium pocket size-8 (LC16m8), while prophylactically effective, have been deemed unsafe for pregnant and lactating females. Antivirals like Tecovirimat, on the other hand, are considered to be a better alternative, but they are not without risks that may outweigh the potential benefits. Additionally, efforts to reduce maternal and fetal complications include administering the MVA-BN vaccine and awareness campaigns regarding herd immunity. Therefore, necessary precautions, prophylactic vaccinations in high-risk outbreak regions, and symptomatic treatment in pregnant and lactating females currently appear to be more feasible approaches against the mpox virus.

Anatomical Mapping of Nasal Arteries in Chilean Patients Using Doppler Ultrasound: Clinical Application for Injectables.

This study aims to assess the anatomical positioning of critical nasal arteries in Chilean patients to improve the safety and efficacy of nonsurgical rhinoplasty procedures. Using Doppler ultrasound, the study seeks to provide a precise vascular map that informs injection protocols and minimizes the risk of vascular complications, particularly in high-risk nasal regions. A cohort of 50 Chilean patients (ages 18-60, BMI 18.5-24.9 kg/m²) with no previous nasal procedures were evaluated. Doppler ultrasound was used to map the nasal vasculature, specifically targeting the dorsal nasal artery (DNA), radix, columella, and facial arteries in the piriform fossa. Key measurements included the depth of each artery relative to the periosteum and the skin surface. Descriptive statistics were used to calculate mean values and standard deviations for arterial distances, and comparative analyses were performed using the Student's t test or Mann-Whitney U test as appropriate, with a significance threshold set at P < .05. The anatomical mapping revealed significant variability in arterial positioning. The DNA was located within 1 mm of the periosteum in 10% of cases, presenting a high risk for vascular complications if not accurately mapped preinjection. The average depth of the facial artery in the piriform fossa was 4.65 ± 0.48 mm on the left side and 4.08 ± 0.53 mm on the right side, with statistically significant differences observed between sides (P < .01). Additionally, the columellar artery showed variability in proximity to the epidermis, averaging 2.42 ± 0.34 mm on the left side and 3.03 ± 0.37 mm on the right (P = .03). These findings underscore the necessity of individualized depth and site adjustments during injections to mitigate risks associated with arterial proximity. This study provides critical insights into nasal vascular anatomy in a Latin American population, highlighting the clinical importance of Doppler ultrasound for preinjection mapping in nonsurgical rhinoplasty. By identifying high-risk areas and statistically significant anatomical variations, this research supports the need for a standardized, evidence-based protocol tailored to individual vascular profiles. The integration of Doppler ultrasound into clinical practice is recommended to enhance patient safety and optimize aesthetic outcomes, establishing a new standard for injectable procedures in high-risk nasal regions.

Analysis of Strategies to Combat Cargo Theft and Robbery in Peripheral Communities of São Paulo, Brazil, Using a Paraconsistent Expert System

Background: Cargo theft represents a persistent challenge to last-mile logistics in the peripheral regions of São Paulo, Brazil, compromising transportation security and increasing operational costs. These high-crime areas disrupt supply chain stability and hinder e-commerce growth. Traditional security methods often fail to address the complexity and uncertainty present in these environments, necessitating adaptive approaches. Methods: This study applies an Expert System based on Paraconsistent Annotated Evidential Logic Eτ to assess the effectiveness of security interventions. Logic Eτ is particularly suited for analyzing uncertain, incomplete, and contradictory data in complex logistics settings. A mixed-methods approach was employed, integrating evaluations from nine experts representing different hierarchical levels within a logistics company. Six key security measures, including GPS tracking, armed escorts, optimized delivery windows, and the hiring of local drivers, were analyzed using favorable degrees and unfavorable degrees for each parameter. Results: The results demonstrated that five measures were effective, contributing to a 58% reduction in security costs in Arujá and 75% in Cajamar, two major distribution hubs. Conclusions: This study highlights the potential of combining Expert Systems and Eτ Logic to enhance cargo transport security, offering a scalable decision support framework for companies operating in high-risk urban regions.

Balanced diet quality and risk of upper gastrointestinal cancers: Insights from a prospective cohort study in China.

Upper gastrointestinal (UGI) cancers are highly prevalent in China and have been linked to dietary factors, yet the impact of overall diet quality remains underexplored. This study aimed to assess the association between Chinese diet quality, as measured by the Chinese Diet Balance Index 2016 (DBI-16) and plant-based diet index (PDI), and UGI cancer risks in high-risk populations. We conducted a prospective cohort study from 2017 to 2019 in five high-risk regions of China. Diet quality was assessed using DBI-16 and PDI. Diet quality was evaluated using DBI-16, which includes higher bound scores (HBS), lower bound scores (LBS), and diet quality distance (DQD), alongside the PDI, which distinguishes between overall, healthy, and unhealthy PDI. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox regression analysis. Over a median follow-up of 55 months, 790 cases of UGI cancers were recorded. A high HBS (excessive intake) was associated with a lower risk of UGI cancers (HR = 0.57, 95% CI: 0.41-0.81) and esophageal cancer (HR = 0.51, 95% CI: 0.32-0.80). Conversely, significant dietary imbalance (high DQD) increased UGI cancer risk (HR = 1.59, 95% CI: 1.08-2.36), while severe inadequate intake (high LBS) was only associated with an increased risk of esophageal cancer (HR = 2.16, 95% CI: 1.00-4.65). A higher overall PDI was protective against UGI cancers (HRQ4vs.Q1 = 0.69, 95% CI: 0.49-0.98), whereas an unhealthy PDI increased the risk (HRQ4vs.Q1 = 1.92, 95% CI: 1.38-2.67). The study concludes that unbalanced diets elevate UGI cancer risk, while balanced, plant-based diets reduce it. Promoting healthier dietary habits may benefit high-risk populations.

Seroprevalence of Toscana virus in blood donors in mainland Portugal

BackgroundToscana virus (TOSV; Phlebovirus toscanaense), a phlebovirus transmitted by sand flies, is a growing public health concern in the Mediterranean region, with infections often being asymptomatic but potentially leading to neuroinvasive disease. Despite its presence in neighboring countries, data on TOSV seroprevalence in Portugal are limited. This study aimed to estimate the national seroprevalence of TOSV among blood donors in mainland Portugal and explore associations with sociodemographic factors and Leishmania infection.MethodsA cross-sectional study was conducted using serum samples from 3593 blood donors across mainland Portugal, collected between February and June 2022. Anti-TOSV antibodies were detected via microneutralization assay, and anti-Leishmania antibodies had previously been tested using ELISA. Sociodemographic data were obtained from self-administered questionnaires. Seroprevalence was estimated by region, and multivariate logistic regression was used to identify factors associated with TOSV infection.ResultsOverall, the estimated national true seroprevalence of TOSV was 2.6% (95% CI 2.1–3.1%). Regional seroprevalence varied significantly, with the highest values (up to 14.8%) in Alto Alentejo, Baixo Alentejo, Douro, Alto Tâmega e Barroso and Oeste regions. Multivariate analysis showed that age ≥ 50 years (aOR 1.70, 95% CI 1.04–2.77), residing in the Alentejo region (aOR 3.05, 95% CI 1.85–5.02) and positive/borderline Leishmania serology (aOR 2.31, 95% CI 1.29–4.15) were significantly associated with TOSV infection.ConclusionsThis study highlights new areas of TOSV circulation in Portugal, particularly in regions with higher Leishmania seroprevalence and visceral leishmaniasis incidence, suggesting co-circulation of these pathogens. Although a lower seroprevalence was obtained compared to neighboring countries, TOSV should still be considered in the differential diagnosis of viral meningitis and encephalitis in Portugal, especially in potentially high-risk regions. Further research is needed to better understand the ecological drivers of TOSV distribution in Portugal.Graphical