BACKGROUND: Whether muscle mass and muscle quality affect the prognosis of elderly patients with aspiration pneumonia is unclear. This study aimed to evaluate the relationship between erector spinae muscle mass and muscle quality on the 30-day prognosis of elderly patients with aspiration pneumonia.
METHODS: Two hundred fifty-eight patients who were diagnosed with aspiration pneumonia and admitted to Sanuki Municipal Hospital for pulmonary rehabilitation intervention were included. The cross-sectional area (ESMCSA/BSA) and CT values (ESMCT) of the erector spinae muscles at the 12th thoracic vertebra were measured on chest CT images to represent muscle mass and quality, respectively. The primary outcome was defined as 30-day survival.
RESULTS: Twenty-six patients died within 30 days after hospitalization. The ESMCSA/BSA ratio was significantly greater in the survival group than in the nonsurvival group (p = 0.001). The cutoff values for 30-day survival were calculated as follows: the ESMCSA/BSA was 11.046 cm2/m2 in male patients and 9.600 cm2/m2 in female patients; the ESMCT was 26.85 HU in male patients and 8.00 HU in female patients. A higher ESMCSA/BSA significantly improved 30-day survival, while ESMCT did not show a significant difference. Cox proportional hazards regression analysis revealed that the ESMCSA/BSA was independently associated with 30-day short-term prognosis (hazard ratio 0.34, p = 0.034).
CONCLUSIONS: The short-term prognosis of elderly patients with aspiration pneumonia may be more strongly influenced by muscle mass than by the muscle quality of the erector spinae muscles.

UNASSIGNED: The large-scale artificial intelligence (AI) language model chatbot, Chat Generative Pre-Trained Transformer (ChatGPT), is renowned for its ability to provide data quickly and efficiently. This study aimed to assess the medical responses of ChatGPT regarding anesthetic procedures.
UNASSIGNED: Two anesthesiologist authors selected 30 questions representing inquiries patients might have about surgery and anesthesia. These questions were inputted into two versions of ChatGPT in English. A total of 31 anesthesiologists then evaluated each response for quality, quantity, and overall assessment, using 5-point Likert scales. Descriptive statistics summarized the scores, and a paired sample t-test compared ChatGPT 3.5 and 4.0.
UNASSIGNED: Regarding quality, \"appropriate\" was the most common rating for both ChatGPT 3.5 and 4.0 (40 and 48%, respectively). For quantity, responses were deemed \"insufficient\" in 59% of cases for 3.5, and \"adequate\" in 69% for 4.0. In overall assessment, 3 points were most common for 3.5 (36%), while 4 points were predominant for 4.0 (42%). Mean quality scores were 3.40 and 3.73, and mean quantity scores were - 0.31 (between insufficient and adequate) and 0.03 (between adequate and excessive), respectively. The mean overall score was 3.21 for 3.5 and 3.67 for 4.0. Responses from 4.0 showed statistically significant improvement in three areas.
UNASSIGNED: ChatGPT generated responses mostly ranging from appropriate to slightly insufficient, providing an overall average amount of information. Version 4.0 outperformed 3.5, and further research is warranted to investigate the potential utility of AI chatbots in assisting patients with medical information.

The school age period is characterized by significant physical and intellectual growth, necessitating the monitoring of macronutrient intake and its impact on weight and height. The objective of this study is to investigate the association between the quality and quantity of protein and fat consumption with anthropometric indices in primary school girls in Kerman. This cross-sectional analysis was conducted on primary school girls aged 6-12 (n 330) from ten schools in Kerman, Iran. A validated and reliable dish-based 185-item food frequency questionnaire was used. We calculated the amount of proteins and fats as the percentage of daily calories and grams per day. Plant-based and animal-based proteins were used to assess the protein quality. To assess the fat quality, we considered trans fatty acids (TFA), cholesterol, vegetable oils, solid vegetable oils, animal oils, omega-6 Polyunsaturated fatty acids (PUFAs), omega-3 PUFA, and (PUFAs + Monounsaturated fatty acids (MUFAs))/Saturated fatty acids (SFAs), PUFAs/SFA, and (MUFA + PUFA)/(SFA + TFA). There was a significant positive association between height-for-age z-score (HAZ) and plant protein (p < 0.001) and vegetable oils (p = 0.038) after adjustment. In higher tertiles of animal protein, weight-for-age z-score (WAZ) (p = 0.024) were significantly higher. A significant positive association was observed between omega-3 PUFA and mid-upper arm circumference (MUAC) (p = 0.039) and BMI-for-age z-score (BAZ) (p = 0.016). Our study emphasizes the importance of monitoring protein and fat intake in primary school girls for optimal growth. Positive associations were found between plant-based protein, vegetable oils and HAZ, as well as animal protein and WAZ, highlighting the impact of protein quality on growth indicators.

Dietary supplement use is common among US adults. We aimed to investigate the quantity, duration, adherence, and reasons for supplement use in individuals who take supplements. Data from 2011 to 2018 from the National Health and Nutrition Examination Survey (NHANES) dataset were analyzed. Four cycles of data were combined to estimate these outcomes. Results are presented as overall group and by subgroups. All analyses were weighted to be nationally representative. The Taylor Series Linearization approach was used to generate variance estimates. A total of 12,529 participants were included. Over 70% of these individuals reported taking more than one unit of dietary supplements daily. Notably, approximately 40% had been taking supplements for more than five years and about 67% were highly adherent to at least one supplement. However, only 26.9% of these supplements were taken following a doctor\'s recommendation. The primary reasons for dietary supplements intake included improving overall health (37.2%), maintaining health (34.7%), bone health (21.4%), and diet supplementation (20.3%). Our findings indicate that most participants proactively used multiple dietary supplements focused on self-managed health and prevention, with substantial dedication to long-term use and high adherence. Healthcare professionals should play a more active role in guiding such behaviors to optimize the health outcomes of dietary supplement users across the United States.

If the tiles of a mosaic are arranged symmetrically, then the image those tiles constitute must be symmetric as well. This paper formulates and defends the general principle at work in this case: roughly, that a symmetry cannot ground an asymmetry. It is argued that the principle supports strong objections to four metaphysical views: qualitativism, relationalism, the tenseless or \'B\' theory of time, and comparativism. A response to these objections is developed which appeals to fragmentalism, the view that reality contains facts which are incompatible with one another. But fragmentalism might be thought too bizarre to tolerate, and if it is, then the objections developed in this paper may well be fatal.

BACKGROUND: The school-age is a crucial period of physical and cognitive growth, which requires an assessment of dietary intake and its influence on body weight and height. This study aims to determine the association between the quality and quantity of carbohydrate intake with selected anthropometric indices in primary school girls in Kerman City, Iran.
METHODS: This cross-sectional study was conducted on 330 primary school girls ages 6-12 years in Kerman. We used a validated and reliable dish-based 185-item food frequency questionnaire to evaluate people\'s food intake. We assessed the amount of carbohydrates in children\'s diets as the percentage of daily calories and grams per day. We used dietary fiber intake (grams/day), the glycemic load, the ratio of whole grain to total grain, and the ratio of solid carbohydrates to total carbohydrates to assess carbohydrate quality. Height, weight, and arm circumference were measured. We calculated body mass index (BMI) by dividing the weight in kilograms by the height in centimeters squared. We used the World Health Organization z-scores charts for girls 5 to 19 years old to assess z-scores for BMI-for-age (BAZ), height-for-age (HAZ), and weight-for-age (WAZ). Socioeconomic status and physical activity were assessed. We used ANOVA and ANCOVA statistical tests to assess the association between anthropometric indices and carbohydrate quantity and quality parameters.
RESULTS: Participants with the highest amount of carbohydrate intake had significantly higher anthropometric indices, including arm circumference, BMI-for-age z score (BAZ), and Height-for-age z score (HAZ) (p < 0.001, p < 0.001, and p = 0.009, respectively). With the increase in glycemic load (GL) and dietary fiber intake, anthropometric indices including arm circumference (GL: p < 0.001, Fiber: p < 0.001), BAZ (GL: p < 0.001, Fiber: P < 0.001), and HAZ (GL: P = 0.009, Fiber: p < 0.001) increased significantly.
CONCLUSIONS: We concluded that there was a positive association between the amount of carbohydrate intake and anthropometric indices (MUAC, BAZ, and HAZ). Also, with the increase in glycemic load and dietary fiber intake, the anthropometric indices including MUAC, BAZ, and HAZ increased.

We aimed to prospectively assess the association between variety and quantity of fruits and vegetables (FV) and cardiovascular diseases (CVD) incidence and mortality due to the limited evidence. Our analysis included 2,918 adults with a follow-up period of 29,559 person-years. An inverse association was detected between fruit intake and the risk of incidence and mortality from CVD. We found no association between diversity scores of fruits, vegetables, and FV with CVD risk. Subjects with high quantity-high variety, high quantity-low variety, and low quantity-high variety of fruits, vegetables, or FV exhibited no difference in CVD risk compared to the subjects with low quantity-low variety intake. Increasing the variety of FV was associated with increases in the intake of β-carotene, lycopene, lutein, vitamin C, selenium, fibre, fat, and protein after adjustment for the quantity and covariates. We detected an inverse association between fruit intake and the incidence and mortality rates of CVD.

BACKGROUND: Changes in mandibular cortical bone have been documented in children with chronic diseases but not in healthy populations.
OBJECTIVE: We aimed to qualitatively and quantitatively evaluate the mandibular cortical bone of a healthy paediatric population using dental panoramic radiographs (DPTs). The secondary objective was to assess the effect of dental status on cortical bone.
METHODS: The DPTs of 660 individuals, aged 6-18 years, were evaluated by two blinded examiners. Bone was qualitatively categorized according to the Mandibular Cortical Index (MCI), and its width was calculated using the Mandibular Cortical Width Index (MCW). Differences between gender and age were tested using Fisher\'s exact and correlation with dental status with the chi-square test.
RESULTS: A significant correlation was observed between bone morphology and gender, with girls having more frequent even and sharp endosteal margins than boys, who showed semilunar defects. The degree of erosion increased with age, as did bone thickness. A positive correlation between thickness and type of dentition was recorded, with normal bone predominating in children in the mixed dentition stage. Νο correlation was found between bone morphology or thickness and the factors associated with dental status.
CONCLUSIONS: Bone quality and quantity vary significantly between different genders and age groups. Dental needs and treatment characteristics did not seem to affect the above parameters.

Influenza vaccines play a vital role in protecting individuals from influenza virus infection and severe illness. However, current influenza vaccines have suboptimal efficacy, which is further reduced in cases where the vaccine strains do not match the circulating strains. One strategy to enhance the efficacy of influenza vaccines is by extended antigen delivery, thereby mimicking the antigen kinetics of a natural infection. Prolonging antigen availability was shown to quantitatively enhance influenza virus-specific immune responses but how it affects the quality of the induced immune response is unknown. Therefore, the current study aimed to investigate whether prolongation of the delivery of influenza vaccine improves the quality of the induced immune responses over that induced by prime-boost immunization.
Mice were given daily doses of whole inactivated influenza virus vaccine for periods of 14, 21, or 28 days; the control group received prime-boost immunization with a 28 days interval.
Our data show that the highest levels of cellular and humoral immune responses were induced by 28 days of extended antigen delivery, followed by 21, and 14 days of delivery, and prime-boost immunization. Moreover, prolonging vaccine delivery also improved the quality of the induced antibody response, as indicated by higher level of high avidity antibodies, a balanced IgG subclass profile, and a higher level of cross-reactive antibodies.
Our findings contribute to a better understanding of the immune response to influenza vaccination and have important implications for the design and development of future slow-release influenza vaccines.

Background: Researchers need accurate measurements of cannabis consumption quantities to assess risks and benefits. Survey methods for measuring cannabis flower and concentrate quantities remain underdeveloped.Objective: We examined \"grams\" and \"hits\" units for measuring flower and concentrate quantities, and calculating milligrams of THC (mgTHC).Methods: Online survey participants (n = 2,381) reported preferred unit (hits or grams), past-week hits and grams for each product, and product %THC. Quantile regression compared mgTHC between unit-preference subgroups. Hits-based mgTHC calculations assumed a universal grams-per-hit ratio (GPHR). To examine individualized GPHRs, we tested a \"two-item approach,\" which divided total grams by total hits, and \"one-item approach,\" which divided 0.5 grams by responses to the question: \"How many total hits would it take you to finish 1/2 g of your [product] by [administration method]?\"Results: Participants were primarily daily consumers (77%), 50% female sex, mean age 39.0 (SD 16.4), 85% White, 49% employed full-time. Compared to those who preferred the hits unit, those who preferred the grams unit reported consuming more hits and grams, higher %THC products, and consequently, larger median mgTHC (flower-hits mgTHC: 32 vs. 91 (95%CI: 52-67); flower-grams mgTHC: 27 vs. 113 (95%CI: 73-95); concentrate-hits mgTHC: 29 vs. 59 (95%CI: 15-43); concentrate-grams mgTHC: 61 vs. 129 (95%CI: 43-94)). \"Two-item\" and \"one-item\" approach GPHRs were similar and frequently 50% larger or smaller than the universal GPHR.Conclusion: Allowing respondents to choose \"hits\" or \"grams\" when reporting cannabis quantities does not compromise mgTHC estimates. A low-burden, one-item approach yields individualized \"hit sizes\" that may improve mgTHC estimates.