Introduction: Medical students, including dental students, are more likely to be burdened with depression, anxiety, burnout, and anorexic tendencies than their peers studying other subjects. In spite of major public health relevance, there is a large knowledge gap regarding mental health issues among Bosnian dental students. The aim of this research is to estimate the depression prevalence among dental students in Sarajevo according to age, gender, and academic year. Methods: A cross-sectional study was conducted among 1st, 3rd, 4th, and 6th year students at the Dental School, University of Sarajevo, during 2023-2024. Depression was evaluated using the self-reported patient health questionnaire-9 (PHQ-9). Statistical analysis included the Shapiro–Wilk test, with data presented as means with standard deviations (SDs), medians (Mdn) with interquartile ranges (IQRs), and frequencies. Comparisons between males and females were analyzed using the Student’s t-test or Mann–Whitney U-test and one-way analysis of variance or Kruskal–Wallis test across academic years. Results: In the total sample (n = 324), females outnumbered males, 244 versus 80. Clinically significant depression (PHQ-9 ≥10) was reported in 52.79% of students. The average PHQ-9 value was Mdn = 10.00, IQR (6.00, 16.00), M = 11.1, SD = 6.66. The highest average PHQ-9 values were observed in the 4th year and the lowest in the 6th year. Female students had significantly higher average PHQ-9 scores (p < 0.05). Conclusion: Dental students in Sarajevo exhibited high depression prevalence, but female students were more affected. These findings emphasize an urgent need for targeted mental health interventions in dental education.

Background Genomic research on rare diseases requires large-scale data sharing to identify pathogenic variants. Traditionally, this is achieved through centralized databases that require the physical transfer of genomic data to third-party servers. However, this approach presents significant challenges under data protection frameworks like the General Data Protection Regulation (GDPR), which considers genomic data inherently identifiable and imposes strict limitations on data sharing. Results To address these limitations, WiNGS-API introduces a federated, automated, and privacy-compliant platform that enables variant-level data sharing across institutions without requiring centralized data transfer. WiNGS-API has been deployed in seven centers, managing over 6,400 samples with single-nucleotide variants (SNV) calls, 1,500 with copy number variants (CNVs), and 500 with structural variants (SVs) from long-read sequencing. The system supports sample-based analysis for variant interpretation and automated trio-based filtering, which reduces candidate de novo variants for clinical review. Federated querying, enables the identification of additional carriers and false positives, as well as improved understanding of variants of unknown significance—outcomes not readily achievable with data from a single institution. Conclusions WiNGS-API bridges the gap between data privacy regulations and genomic collaboration, offering automated variant filtering, annotation, and genotype–phenotype correlation. It provides a scalable solution for multi-center genomic research. WiNGS represents a significant step toward secure, large-scale genomic data sharing, advancing the study of rare diseases while maintaining compliance with ethical and legal standards. WiNGS-API is publicly accessible at https://wings.esat.kuleuven.be/rest-api/api-docs/. Supplementary Information The online version contains supplementary material available at 10.1186/s13073-026-01627-9.

Background/Objectives: Sarcopenia (SP) and osteoporosis (OP) are common yet underrecognized complications of liver cirrhosis, contributing to increased morbidity and mortality. Their coexistence, termed osteosarcopenia (OS), represents a compounded musculoskeletal impairment. Insulin-like growth factor 1 (IGF-1), synthesized in the liver, has been implicated in muscle and bone metabolism. This study aimed to assess the prevalence and association of laboratory and clinical parameters with SP, OP, and OS in cirrhotic patients, with a focus on IGF-1 deficiency and their impact on mortality. Methods: This cross-sectional study included 100 cirrhotic patients at a tertiary center. Sarcopenia was diagnosed using CT-derived L3 skeletal muscle index and osteoporosis via the DEXA scan. IGF-1 levels and metabolic parameters were measured. Multivariate logistic regression identified laboratory and clinical factors associated with musculoskeletal complications. However, due to the cross-sectional design, causal relationships could not be inferred. Results: SP, OP, and OS were present in 41%, 22%, and 11% of patients, respectively. IGF-1 levels were significantly lower in patients with SP, OP, and OS (p < 0.05) and were independently associated with increased risk of SP (OR = 1.797, p = 0.006), OP (OR = 1.873, p = 0.045), and OS (OR = 2.326, p = 0.003). Mortality rates were significantly higher among patients with OS (72.7%), OP (77.3%), and SP (56.1%). OS conferred the highest adjusted mortality risk (OR = 2.739, p = 0.009), followed by SP (OR = 2.278, p = 0.015) and OP (OR = 1.958, p = 0.036). Conclusions: Musculoskeletal complications are highly prevalent and predictive of mortality in cirrhosis. IGF-1 deficiency is a strong independent biomarker for SP, OP, and OS. Routine screening and early intervention targeting IGF-1 pathways and nutrition may improve outcomes in this population.

Rheumatoid arthritis (RA) is an autoimmune systemic disease in which pain remains a major and often refractory symptom even after clinical remission of the disease. Although historically attributed to joint inflammation, recent evidence reveals a multifactorial pathogenesis of RA pain, involving peripheral sensitization, central sensitization, and neuroimmune crosstalk. In these mechanisms, interleukin‐6 (IL‐6) plays a central role not only as one of the inflammatory mediators but also as a classic and trans‐signaling modulator for pain. This review synthesizes current mechanistic and clinical evidence on IL‐6 inhibitors, particularly sarilumab and tocilizumab, concerning their effect on pain in RA. Preclinical studies have already demonstrated that IL‐6 enhances the excitability of nociceptors through the upregulation of ion channels in dorsal root ganglia; it also promotes glial activation within the spinal cord; however, chronic pain sustains these processes. Blockade of IL‐6 receptor reverses these changes and alleviates mechanical hyperalgesia as well as allodynia in different models of diseases. Clinical trials of IL‐6 inhibitors have shown that these compounds provide major pain relief, sometimes better than tumor necrosis factor (TNF) inhibitors, most explicitly for patients with elevated baseline C‐reactive protein (CRP) or who do not respond to TNF inhibitors. Differences in their pharmacokinetics, receptor binding, and suppression of CRP may translate into differences in their analgesic profiles. However, it is analyzed that a subset of patients with persistently painful rheumatoid arthritis despite IL‐6 inhibition demonstrates the existence of non‐inflammatory drivers like nociplastic pain and the inadequacy of conventional indices of disease activity to capture the burden of pain.

BACKGROUND Hyponatremia is a common postoperative electrolyte disturbance in neurosurgical patients and may present with nonspecific neurocognitive symptoms that overlap with intracranial complications. Carbamazepine (CBZ), frequently used for seizure prophylaxis and pain syndromes, is a recognized cause of drug-induced hyponatremia with a syndrome of inappropriate antidiuretic hormone secretion (SIADH)-like profile. CASE SUMMARY A 62-year-old woman underwent elective left supraorbital craniotomy and microsurgical resection of a left anterior skull-base meningioma. Postoperatively, CBZ 400 mg was initiated twice daily for antiseizure prophylaxis. On postoperative day (POD) 2, she developed somnolence and cognitive slowing with serum sodium 131 mmol/L, which progressed to 123 mmol/L (POD 3) and 119 mmol/L (POD 7) despite isotonic saline and increased dietary sodium. Hypertonic saline (3% NaCl) was introduced with partial correction. Evaluation confirmed hypotonic hyponatremia (serum osmolality 254 mOsm/kg) with inappropriately concentrated urine (urine osmolality 560 mOsm/kg) and elevated urine sodium (68 mmol/L) in a clinically euvolemic patient; thyroid and adrenal functions were normal. Given the temporal association and SIADH-like pathophysiology, CBZ-induced hyponatremia was considered the most likely etiology. CBZ was discontinued and replaced with levetiracetam (titrated to 500 mg twice daily), followed by clinical improvement and steady sodium normalization (132 mmol/L at discharge; 136 mmol/L by POD 19), remaining normal at three-month follow-up. We searched PubMed and Google Scholar to for relevant literature review. CONCLUSION This case highlights CBZ as a potentially reversible cause of significant postoperative hyponatremia after meningioma surgery. Early sodium monitoring after CBZ initiation and prompt substitution with alternative antiseizure therapy should be considered when euvolemic hypotonic hyponatremia develops in the postoperative period.

Background/Objectives: Cardiorenal syndrome type 2 (CRS-2) is characterized by progressive renal dysfunction caused by chronic heart failure (HF) and is associated with increased morbidity and mortality. However, the prognostic value of renal biomarkers in patients with CRS-2 hospitalized for decompensated HF remains unclear. Methods: This prospective observational cohort study included 200 consecutive patients hospitalized for decompensated HF in the Intensive Care Unit of the Clinic for Internal Medicine at the University Clinical Centre Tuzla between April and October 2025. CRS-2 was defined as chronic HF with chronic kidney disease persisting for ≥3 months before admission according to KDIGO criteria. Patients were followed for three months. The primary composite outcome was all-cause mortality or initiation of renal replacement therapy. Results: CRS-2 was identified in 130 patients (65.0%) and was associated with higher in-hospital mortality (32.3% vs. 11.4%, p = 0.002) and three-month mortality (44.6% vs. 21.4%, p = 0.002). Within the CRS-2 subgroup, patients who experienced the primary composite outcome had higher admission levels of cystatin C and urinary albumin-to-creatinine ratio (UACR) and lower estimated glomerular filtration rate (eGFR). ROC analysis demonstrated moderate discriminative ability of cystatin C (AUC 0.739) and UACR (AUC 0.733). In Cox regression analysis, cystatin C (HR 1.534, 95% CI 1.263–1.863, p < 0.001) and UACR (HR 1.003, 95% CI 1.001–1.006, p = 0.001) were significantly associated with the primary composite outcome. Conclusions: Renal dysfunction markers, particularly cystatin C and albuminuria, are associated with early adverse outcomes in CRS-2 patients hospitalized for decompensated HF. Routine assessment of these biomarkers may provide additional prognostic information and support risk assessment in this high-risk population.

Global development in recent decades has beencharacterized by increased resource consumption andgrowing environmental pressures, highlighting the need forsustainable economic and social progress. Tourism, despiteits significant contribution to economic growth, often putspressure on natural resources and ecosystems, underscoringthe need for sustainable development in territories withsubstantial rural characteristics, such as islands. Thispaper examines the role of green transformation as adriver of economic resilience and sustainable developmentof Croatian island economies. Research was conductedamong stakeholders in island destinations who are involvedin tourism planning, development and management, usinga structured questionnaire survey. The results from PartialLeast Squares Structural Equation Modeling (PLS-SEM)show that green transformation of tourism positivelyinfluences all four sustainability dimensions of destinationdevelopment, with the strongest effect on environmentalsustainability. These findings support decision-makers inshaping development strategies for island destinations.

Future wireless communication systems will integrate both sub-6 GHz and millimeter wave (mmWave) frequency bands within multi-antenna architectures to meet the increasing demand for high data rates. In such multi-band systems, reliable information obtained from the sub-6 GHz band can be exploited to support communication at mmWave frequencies. To ensure that both systems experience similar multi-path propagation effects, the sub-6 GHz and mmWave antenna arrays have to be colocated and precisely aligned. However, such a configuration may adversely alter the radiation characteristics of the arrays, potentially degrading their performance. In this paper, we investigate the impact of positioning a mmWave antenna structure in front of a sub-6 GHz antenna structure. Through both simulations and measurements, we evaluate how the presence of the mmWave structure affects the radiation pattern of the csub-6 GHz one. The results demonstrate that the influence of the mmWave structure on the sub-6 GHz performance is minor, indicating that co-located configurations are feasible with negligible degradation.

This paper aims to investigate the impact of water use efficiency on income inequality in European countries, exploring how financial development moderates this relationship and controlling for economic, institutional and infrastructural control variables. This study uses Method of Moments Quantile Regression on a panel data set including 32 European countries from 2000 to 2021. The analysis uses the GINI coefficient as a measure of income inequality and assesses its relationship with water use efficiency, financial development and control variables. Water use efficiency has a statistically significant negative impact on income inequality across all quantiles, suggesting that more efficient water use contributes to reducing income disparities. This effect is stronger in countries with already lower levels of inequality. Financial development unexpectedly shows a positive relationship with income inequality, potentially indicating a misallocation of financial resources across income level categories. Government efficiency and inland waterways infrastructure have inequality-reducing effects, while the rule of law augments income inequality in the European Union. This study is limited by the lack of comparable research to benchmark findings against and by potential country-specific institutional, cultural and political factors not fully captured in the model. Future research could explore the role of water efficiency technologies, the impact of climate change on water accessibility and sustainable manufacturing practices in relation to income inequality. This research addresses a significant gap in the literature by examining the impact of water use efficiency on income inequality, presenting novel insights into how water resource management affects socioeconomic disparities in European countries.

Financial institutions face increasing cyber risk while operating under strict regulatory oversight. To manage this risk, they rely heavily on Cyber Threat Intelligence (CTI) to inform detection, response, and strategic security decisions. Artificial intelligence (AI) is widely suggested as a means to strengthen CTI. However, evidence of trustworthy production use in finance remains limited. Adoption depends not only on predictive performance, but also on governance, integration into security workflows and analyst trust. Thus, we examine how AI is used for CTI in practice within financial institutions and what barriers prevent trustworthy deployment. We report a mixed-methods, user-centric study combining a CTI-finance-focused systematic literature review, semi-structured interviews, and an exploratory survey. Our review screened 330 publications (2019-2025) and retained 12 finance-relevant studies for analysis; we further conducted six interviews and collected 14 survey responses from banks and consultancies. Across research and practice, we identify four recurrent socio-technical failure modes that hinder trustworthy AI-driven CTI: (i) shadow use of public AI tools outside institutional controls, (ii) license-first enablement without operational integration, (iii) attacker-perception gaps that limit adversarial threat modeling, and (iv) missing security for the AI models themselves, including limited monitoring, robustness evaluation and audit-ready evidence. Survey results provide additional insights: 71.4% of respondents expect AI to become central within five years, 57.1% report infrequent current use due to interpretability and assurance concerns and 28.6% report direct encounters with adversarial risks. Based on these findings, we derive three security-oriented operational safeguards for AI-enabled CTI deployments.

Highlights What are the main findings? Visual mental imagery engages ventral and dorsal stream systems in a content- and stage-dependent manner, with evidence for stream interaction that varies across paradigms and populations. Structural and clinico-radiological evidence is broadly consistent with disconnection frameworks, suggesting that disruption of long-range pathways (e.g., inferior longitudinal fasciculus (ILF)/inferior fronto-occipital fasciculus (IFOF)/ superior longitudinal fasciculus (SLF)) may contribute to imagery deficits beyond focal cortical damage. What are the implications of the main findings? Stream-sensitive phenotyping (object vs. spatial imagery) and stage-aware paradigms are essential to develop interpretable neuroradiological biomarkers. Multimodal protocols combining structural MRI, diffusion imaging/tractography, functional connectivity, and lesion mapping can improve clinical interpretation of imagery complaints. Abstract Visual mental imagery, the ability to generate and manipulate internal visual experiences without direct sensory input, links perception with memory, planning, and higher cognition. In this targeted narrative review, we synthesize neuroimaging and lesion evidence on the brain basis of visual imagery, with a focus on neuroradiological correlates of the ventral and dorsal visual pathways. Unlike prior cognitive neuroscience reviews that primarily emphasize functional mechanisms, this review is neuroradiology-oriented and integrates lesion patterns and white-matter disconnection to support clinico-radiological interpretation of imagery complaints. Using a dual-stream framework, we contrast ventral occipito-temporal systems that preferentially support object imagery (appearance-based features such as form, faces/objects, and color, with texture remaining under-studied) with dorsal occipito-parietal systems that preferentially support spatial imagery (relations, transformations, and navigation). Across studies, imagery recruitment is strongly task- and stage-dependent: ventral regions are most often engaged during object-focused imagery, whereas parietal regions are prominent during spatial transformation tasks, with evidence for interaction between pathways when demands require both content and spatial operations. Structural and clinico-radiological findings indicate that imagery impairment can arise from focal posterior lesions and posterior neurodegenerative syndromes but also from network disruption affecting long-range connections that support top-down access to posterior representations. Finally, emerging work on aphantasia and hyperphantasia supports a network-level view in which imagery vividness relates to how effectively higher-order systems engage visual representations. We conclude that standardized, stream-sensitive tasks and multimodal approaches combining functional and structural imaging with lesion-based evidence are key to discovering clinically actionable biomarkers of imagery dysfunction.

BACKGROUND AND OBJECTIVES Contrast-associated acute kidney injury (CA-AKI) is a potentially preventable complication after exposure to iodinated contrast media. In patients undergoing endovascular thrombectomy (EVT) for acute ischemic stroke (AIS), the incidence and clinical impact are poorly characterized, and no validated prediction tool is currently available. The aim of this study was to assess the incidence and prognostic significance of CA-AKI in EVT-treated patients with AIS and to develop and validate a predictive score. METHODS A retrospective, multicenter cohort study was conducted involving EVT-treated patients across 73 centers in 16 countries (January-December 2023). Inclusion criteria were age ≥18 years, absence of dialysis, availability of preprocedural and 48-hour postprocedural creatinine levels, and available 90-day follow-up (modified Rankin Scale [mRS] score). The primary outcome was CA-AKI, defined by KDIGO (Kidney Disease: Improving Global Outcomes criteria;creatinine increase ≥0.3 mg/dL or ≥1.5 times baseline, within 48 hours). Secondary outcomes were (1) in-hospital mortality, (2) 90-day mRS score, and (3) 90-day severe disability or death (mRS score >3). Logistic models assessing associations with outcomes accounted for within-center clustering by applying robust standard errors. CA-AKI prediction models were developed across imputed data sets using univariable selection (p < 0.20), backward elimination (p < 0.05), and coefficient-based scoring after categorization of continuous predictors, with internal validation by bootstrap to obtain optimism-adjusted estimates. RESULTS Among 6,638 patients (median age 74 years; 48.7% male), CA-AKI occurred in 326 (4.9%) and was independently associated with in-hospital mortality (adjusted odds ratio [aOR] 2.269; 95% CI 1.615-3.190), higher 90-day mRS scores (adjusted common odds ratio 1.584; 95% CI 1.110-2.258), and 90-day severe disability or death (aOR 1.530; 95% CI 1.057-2.216). A preprocedural risk model including 12 routine clinical variables-sex, ethnicity, arterial hypertension, dyslipidemia, chronic kidney disease, antiplatelet therapy, NIH Stroke Scale score at admission, serum glucose, estimated glomerular filtration rate, hemoglobin, mean arterial pressure, and IV thrombolysis-demonstrated acceptable discrimination (area under the receiver operating characteristic curve 0.710 [95% CI 0.682-0.738]; precision-recall area under the curve 0.13 [95% CI 0.10-0.16]), good calibration (slope 0.870 [95% CI 0.759-0.928]), good overall performance (Brier score 0.045 [95% CI 0.042-0.049]). A second model that included EVT-related variables (e.g., contrast volume) showed similar performances. DISCUSSION In this large, international cohort, CA-AKI occurred in approximately 1 in 20 EVT-treated patients with AIS and was independently associated with poor outcomes. A simple preprocedural risk score enables early identification of high-risk individuals and may support preventive strategies.