This paper presents a unified Lyapunov-based predefined-time stability theorem that includes three sufficient conditions. The standard theoretical analysis method for achieving predefined-time stability of non-linear systems using this theorem is provided within the framework of Lyapunov theory. The developed Lyapunov-based theorem facilitates the establishment of equivalence between the existing Lyapunov theorems concerning predefined-time stability. Furthermore, when the presented sufficient conditions are relaxed, the predefined-time stability conclusion for non-linear systems degenerates into a finite-time one. Consequently, a standard non-singular sliding mode control framework based on the unified Lyapunov-based theorem is developed for a Lagrangian system to ensure its predefined-time stability. Exemplary numerical simulation results are subsequently given, in order to illustrate the convergence behavior of the system states and confirm that the controlled systems are predefined-time stable. Full article

In the healthcare field, diagnosing disease is the most concerning issue. Various diseases including cardiovascular diseases (CVDs) significantly influence illness or death. On the other hand, early and precise diagnosis of CVDs can decrease chances of death, resulting in a better and healthier life for patients. Researchers have used traditional machine learning (ML) techniques for CVD prediction and classification. However, many of them are inaccurate and time-consuming due to the unavailability of quality data including imbalanced samples, inefficient data preprocessing, and the existing selection criteria. These factors lead to an overfitting or bias issue towards a certain class label in the prediction model. Therefore, an intelligent system is needed which can accurately diagnose CVDs. We proposed an automated ML model for various kinds of CVD prediction and classification. Our prediction model consists of multiple steps. Firstly, a benchmark dataset is preprocessed using filter techniques. Secondly, a novel arithmetic optimization algorithm is implemented as a feature selection technique to select the best subset of features that influence the accuracy of the prediction model. Thirdly, a classification task is implemented using a multilayer perceptron neural network to classify the instances of the dataset into two class labels, determining whether they have a CVD or not. The proposed ML model is trained on the preprocessed data and then tested and validated. Furthermore, for the comparative analysis of the model, various performance evaluation metrics are calculated including overall accuracy, precision, recall, and F1-score. As a result, it has been observed that the proposed prediction model can achieve 88.89% accuracy, which is the highest in a comparison with the traditional ML techniques. Full article

Cardiovascular disease (CVD) represents a substantial global health challenge, with its impact on mortality and morbidity rates surpassing that of cancer. The present study was designed to explore the cardioprotective properties of anthocyanin (ACN), a compound derived from black barley, against oxidative stress-induced damage in myocardial cells and to uncover the molecular mechanisms at play. Utilizing both in vitro and in vivo experimental models, our findings indicate that ACN notably reduced cell damage caused by oxidative stress and effectively prevented apoptosis. High-throughput RNA sequencing analysis has shed light on the mechanism by which ACN achieves its antioxidative stress effects, implicating the PTEN-Akt signaling pathway. ACN was found to modulate PTEN expression levels, which in turn influences the Akt pathway, leading to a reduction in apoptotic processes. This novel insight lays the groundwork for the potential clinical utilization of ACN in the management of CVD. While this study has shed light on some of the functions of ACN, it is important to recognize that natural compounds often interact with multiple molecular targets and engage in intricate signaling cascades. Future research endeavors will concentrate on further elucidating the regulatory mechanisms by which ACN influences PTEN expression, with the goal of enhancing our comprehension and expanding the therapeutic potential of ACN in the treatment of cardiovascular conditions. Full article

Circular fashion has gained attention among practitioners and academics. We further contribute to this debate by investigating leasing in the context of rented online clothing in greater depth. First, we conduct a qualitative study and identify several themes important to individuals when renting clothing online. The findings are as follows: social representation, green value, familiarity and innovativeness. Several categories emerged from the interviews with the respondents in relation to social representation: use of technology, feeling good when renting clothing online and renting clothing online as a necessity. Familiarity factors relate to circular fashion’s role in reducing perceived risks associated with a relatively new service in the market. Green value perceptions have emerged among respondents that reflect a growing environmental consciousness. Second, based on the initial qualitative findings, we introduce an ad-hoc theoretical model and put forward propositions. Our theoretical model emphasises the role of four antecedents (i.e., social representation, green value, familiarity and innovativeness) when influencing consumer willingness to rent clothing online and a shift towards circular consumption. We develop theoretical propositions and provide recommendations to marketing managers and public policy makers regarding how to encourage a change towards circular consumption behaviour among individuals. Full article

In the past decade, the therapeutic arsenal for metastatic bladder cancer has expanded considerably, with the development of immune checkpoint inhibitors (ICIs), antibody–drug conjugates such as enfortumab vedotin, and anti-fibroblast growth factor receptor agents. Clinical trials evaluating ICIs as neoadjuvants, adjuvants, or first- or second-line treatments have produced conflicting results. However, first-line therapeutic strategies have been redefined by the recent publication of results from two clinical trials: CheckMate-901, which demonstrated the superiority of combined treatment with nivolumab and chemotherapy in extending overall survival, and EV-302, which demonstrated that combined treatment with pembrolizumab and enfortumab vedotin reduced the risk of death by 53%. In this review, we discuss the role of ICIs, alone or in combination, in bladder cancer management in the metastatic and adjuvant settings in 2024, considering the latest published trials. The potential role of ICIs as neoadjuvants is also discussed. Full article

The endoscopic contralateral transmaxillary (CTM) approach has been proposed as a potential route to widen the corridor posterolateral to the internal carotid artery (ICA). In this study, we first refined the surgical technique of a combined multiportal endoscopic endonasal transclival (EETC) and CTM approach to the petrous apex (PA) and petroclival synchondrosis (PCS) in the dissection laboratory, and then validated its applications in a preliminary surgical series. The combined EETC and CTM approach was performed on three cadaver specimens based on four surgical steps: (1) the nasal, (2) the clival, (3) the maxillary and (4) the petrosal phases. The CTM provided a “head-on trajectory” to the PA and PCS and a short distance to the surgical field considerably furthering surgical maneuverability. The best operative set-up was achieved by introducing angled optics via the endonasal route and operative instruments via the transmaxillary corridor exploiting the advantages of a non-coaxial multiportal surgery. Clinical applications of the combined EETC and CTM approach were reported in three cases, a clival chordoma and two giant pituitary adenomas. The present translational study explores the safety and feasibility of a combined multiportal EETC and CTM approach to access the petroclival region though different corridors. Full article

This study investigates the genetic determinants of seed coat color and pattern variations in cowpea (Vigna unguiculata), employing a genome-wide association approach. Analyzing a mapping panel of 296 cowpea varieties with 110,000 single nucleotide polymorphisms (SNPs), we focused on eight unique coat patterns: (1) Red and (2) Cream seed; (3) White and (4) Brown/Tan seed coat; (5) Pink, (6) Black, (7) Browneye and (8) Red/Brown Holstein. Across six GWAS models (GLM, SRM, MLM, MLMM, FarmCPU from GAPIT3, and TASSEL5), 13 significant SNP markers were identified and led to the discovery of 23 candidate genes. Among these, four specific genes may play a direct role in determining seed coat pigment. These findings lay a foundational basis for future breeding programs aimed at creating cowpea varieties aligned with consumer preferences and market requirements. Full article

Valorisation of food by-products, like spent brewer’s yeast and fruit pomaces, represents an important strategy for contributing to sustainable food production. The aims of this study were to obtain Maillard conjugates based on spent yeast protein hydrolysate (SYH) with dextran (D) or maltodextrin (MD) by means of ultrasound treatment and to use them for developing encapsulation systems for the anthocyanins from aronia pomace. The ultrasound-assisted Maillard conjugation promoted the increase of antioxidant activity by about 50% compared to conventional heating and SYH, and was not dependent on the polysaccharide type. The ability of the conjugates to act as wall material for encapsulating various biologically active compounds was tested via a freeze-drying method. The retention efficiency ranged between 58.25 ± 0.38%–65.25 ± 2.21%, while encapsulation efficiency varied from 67.09 ± 2.26% to 88.72 ± 0.33%, indicating the strong effect of the carrier material used for encapsulation. The addition of the hydrolysed yeast cell wall played a positive effect on the encapsulation efficiency of anthocyanins when used in combination with the SYH:MD conjugates. On the other hand, the stability of anthocyanins during storage, as well as their bioavailability during gastrointestinal digestion, were higher when using the SYH:D conjugate. The study showed that hydrolysis combined with the ultrasound-assisted Maillard reaction has a great potential for the valorisation of spent brewer’s yeast as delivery material for the encapsulation of bioactive compounds. Full article

Among women, ovarian cancer ranks as the fifth most common cause of cancer-related deaths. This study examined the impact of Hippo signaling pathway on ovarian carcinogenesis. Therefore, the signatures related to Hippo signaling pathway were derived from the molecular signatures database (MSigDB) and were used for further analysis. The Z score-based pathway activation scoring method was employed to investigate the expression patterns of these signatures in the mRNA expression profiles of ovarian cancer cohorts. Compared to other subtype tumors, the results of this study show that the Hippo signaling pathway signatures are dysregulated prominently in serous subtype-specific ovarian carcinogenesis. A receiver operating characteristic (ROC) curve-based results of the Hippo gene set, yes-associated protein 1 (YAP1), and mammalian sterile 20-like kinases 1 (MST1) genes can predict the serous subtype tumors by higher specificity and sensitivity with significant areas under the curve values also further reconfirmed these signaling dysregulations. Moreover, these gene sets were studied further for mutation analysis in the profile of high-grade serous ovarian adenocarcinoma in the cBioPortal database. The OncoPrint results reveal that these Hippo signaling pathway genes are amplified highly during the grade three and stage third or fourth of serous type ovarian tumors. In addition, the results of the Dependency Map (DepMap) plot also clearly show that these genes are amplified significantly across the ovarian cancer cell lines. Finally, overall survival (OS) curve plot investigations also revealed that these gene expressions show poor survival patterns linked to highly expressed conditions in serous subtypes of ovarian cancer patients with significant p-values (p < 0.05). Thus, the current finding would help to develop the targeted therapies treatment for serous subtype ovarian carcinogenesis. Full article

Current developments in vehicles have generated great interest in the research and optimization of heating, ventilation, and air conditioning (HVAC) systems as a factor to reduce fuel consumption. One of the key trends for finding solutions is the intensive development of electric transport and, consequently, additional requirements for reducing energy consumption and modifying climate systems. Of particular interest is the optimal functioning of comfort and life support systems during air recirculation, i.e., when there is a complete or partial absence of outside air supply, in particular to reduce energy consumption or when the environment is polluted. This work examines numerical models of airfields (temperature, speed, and humidity) and also focuses on the concentration of carbon dioxide and oxygen in the cabin, which is a critical factor for ensuring the health of the driver and passengers. To build a mathematical model, the Navier–Stokes equations with energy, continuity, and diffusion equations are used to simulate the diffusion of gases and air humidity. In the Ansys Fluent finite volume analysis package, the model is solved numerically using averaged RANS equations and k-ω turbulence models. The cabin of a mainline locomotive with two drivers, taking into account their breathing, is used as a transport model. The problem was solved in a nonstationary formulation for the design scenario of summer and winter, the time of stabilization of the fields was found, and graphs were constructed for different points in time. A comparative analysis of the uniformity of fields along the height of the cabin was carried out with different locations of deflectors, and optimal configurations were found. Energy efficiency values of the climate system operation in recirculation operating modes were obtained. A qualitative assessment of the driver’s blowing directions under different circulation and recirculation modes is given from the point of view of the concentration of carbon dioxide in the breathing area. The proposed solution makes it possible to reduce electricity consumption from 3.1 kW to 0.6 kW and in winter mode from 11.6 kW to 3.9 kW and save up to 1.5 L/h of fuel. The conducted research can be used to develop modern energy-efficient and safe systems for providing comfortable climate conditions for drivers and passengers of various types of transport. Full article

With a phenomenal amount of marine debris being retrieved from the coast and sea, an initiative to engage in marine debris recycling, particularly of plastic debris, has been on the governmental agenda in Taiwan in recent years. Consumers purchasing products made from marine debris is a critical driver behind this initiative. It is therefore important to understand the factors influencing consumers’ purchase intentions towards these products. By employing the Theory of Planned Behavior (TPB), this paper aims to decode the factors and thereby infer potential measures to enhance consumers’ purchase intentions for these specific products in Taiwan, where recycling marine debris is at the beginning stage. By conducting a questionnaire survey, the study collected a total of 392 valid samples and found that a high percentage of respondents had not heard of marine debris labels as well as having never bought products made from marine debris. In addition, by testing the hypotheses using binary logit regression, the study found that ‘environmental attitude’, ‘perceived price’, ‘availability’, and ‘marine debris label’ were the major factors that significantly influenced consumers’ intentions to purchase these products. With a view to increasing market penetration of these products, this paper highlights the need to strengthen environmental education, subsidize manufacturers in the production of products, promote labels and enhance product availability, and enhance public participation in marine conservation activities. Full article

Leukodystrophies represent a large and complex group of inherited disorders affecting the white matter of the central nervous system. Adult-onset leukoencephalopathy with axonal spheroids and pigmented glia (ALSP) is a rare leukodystrophy which still needs the proper identification of diagnostic, prognostic, and monitoring biomarkers. The aim of this study was to determine the diagnostic and prognostic value of chitinases and neurofilament light chain as biomarkers for ALSP. A cross-sectional study was performed to analyze cerebrospinal fluid levels of chitinases (chitotriosidase and chitinase 3-like 2) and neurofilament light chain in five different groups: (i) normal health individuals; (ii) patients with definitive diagnosis of ALSP and genetic confirmation; (iii) asymptomatic patients with CSF1R variants; (iv) patients with other adult-onset leukodystrophies; and (v) patients with amyotrophic lateral sclerosis (external control group). Chitinase levels showed a statistical correlation with clinical assessment parameters in ALSP patients. Chitinase levels were also distinct between ALSP and the other leukodystrophies. Significant differences were noted in the levels of chitinases and neurofilament light chain comparing symptomatic (ALSP) and asymptomatic individuals with CSF1R variants. This study is the first to establish chitinases as a potential biomarker for ALSP and confirms neurofilament light chain as a good biomarker for primary microgliopathies. Full article

¹¹C methionine (¹¹C-MET) is increasingly being used in addition to contrast-enhanced MRI to plan for radiotherapy of patients with glioblastomas. This study aimed to assess the recurrence pattern quantitatively. Glioblastoma patients undergoing 11C-MET PET examination before primary radiotherapy from 2018 to 2023 were included in the analysis. A clinical target volume was manually created and fused with MRI-based gross tumor volumes and MET PET-based biological target volume. The recurrence was noted as an area of contrast enhancement on the first MRI scan, which showed progression. The recurrent tumor was identified on the radiological MR images in terms of recurrent tumor volume, and recurrences were classified as central, in-field, marginal, or ex-field tumors. We then compared the MET-PET-defined biological target volume with the MRI-defined recurrent tumor volume regarding spatial overlap (the Dice coefficient) and the Hausdorff distance. Most recurrences occurred locally within the primary tumor area (64.8%). The mean Hausdorff distance was 39.4 mm (SD 32.25), and the mean Dice coefficient was 0.30 (SD 0.22). In patients with glioblastoma, the analysis of the recurrence pattern has been mainly based on FET-PET. Our study confirms that the recurrence pattern after gross tumor volume-based treatment contoured by MET-PET is consistent with the FET-PET-based treatment described in the literature. Full article

Loads and strains in critical areas play a crucial role in aircraft structural health monitoring, the tracking of individual aircraft lifespans, and the compilation of load spectra. Direct measurement of actual flight loads presents challenges. This process typically involves using load-strain stiffness matrices, derived from ground calibration tests, to map measured flight parameters to loads at critical locations. Presently, deep learning neural network methods are rapidly developing, offering new perspectives for this task. This paper explores the potential of deep learning models in predicting flight parameter loads and strains, integrating the methods of flight parameter preprocessing techniques, flight maneuver recognition (FMR), virtual ground calibration tests for wings, dimensionality reduction of flight data through Autoencoder (AE) network models, and the application of Long Short-Term Memory (LSTM) network models to predict strains. These efforts contribute to the prediction of strains in critical areas based on flight parameters, thereby enabling real-time assessment of aircraft damage. Full article

Immunotherapies can treat many cancers, including difficult-to-treat cases such as lung cancer. Due to its tolerability, long-lasting therapeutic responses, and efficacy in a wide spectrum of patients, immunotherapy can also help to treat lung cancer, which has few treatment choices. Tumor-specific antigens (TSAs) for cancer vaccinations and T-cell therapies are difficult to discover. Neoantigens (NeoAgs) from genetic mutations, irregular RNA splicing, protein changes, or viral genetic sequences in tumor cells provide a solution. NeoAgs, unlike TSAs, are non-self and can cause an immunological response. Next-generation sequencing (NGS) and bioinformatics can swiftly detect and forecast tumor-specific NeoAgs. Highly immunogenic NeoAgs provide personalized or generalized cancer immunotherapies. Dendritic cells (DCs), which originate and regulate T-cell responses, are widely studied potential immunotherapeutic therapies for lung cancer and other cancers. DC vaccines are stable, reliable, and safe in clinical trials. The purpose of this article is to evaluate the current status, limitations, and prospective clinical applications of DC vaccines, as well as the identification and selection of major histocompatibility complex (MHC) class I and II genes for NeoAgs. Our goal is to explain DC biology and activate DC manipulation to help researchers create extremely potent cancer vaccines for patients. Full article

This study aimed to evaluate Cu, Zn, and Mn fractions in vineyard soils in two important wine-growing regions in Latin America, which have soils with different soil organic matter (SOM) and clay contents. Soils were collected from vineyards aged 35, 37, and 39 years (Serra Gaúcha) and 13, 19, and 36 years (Campanha Gaúcha). In each region, soils were collected from a non-anthropized area, and in the oldest vineyards, the collection was conducted on and between the planting lines. The available and total Cu, Zn, and Mn contents were analyzed in addition to the chemical fractions. The ΔCu, ΔZn, and ΔMn were also calculated by subtracting the contents of each fraction of the vineyards from the reference areas. The use of fungicides promotes increased metal contents in vineyard soils. In soils with high SOM contents, Cu tended to increase in the organic fraction in surface and depth. In contrast, Zn increased in the residual fraction, and Mn increased in most bioavailable fractions. Cu and Zn increased their contents in soils with low SOM and clay contents in the organic and mineral fractions. Mn accumulated in the mineral and residual fractions. Full article

A polyethylene (PE) film surface modification method is proposed via benzoic acid (BA) alkylation grafting to improve the surface affinity to polar substances. The procedure involves sequentially spraying AlCl₃ and BA onto the heat-softened PE surface. The occurrence of the alkylation reaction was evaluated through comparative chemical, morphological, and thermal analyses. It was demonstrated that the grafting reaction of BA onto the PE film surface took place, limited to the surface layer, while preserving the bulk properties of PE. The reaction resulted in the formation of aluminum benzoate complexes, which improved the surface affinity to polar compounds. The impact of grafting on the surface properties of PE was further assessed by comparing the behavior of PE films treated with BA and untreated PE films when painted with watercolors. The PE film grafted with BA exhibited increased affinity towards watercolors, providing strong evidence of a change in surface polarity from hydrophobic to hydrophilic. These findings indicate that the proposed methodology effectively renders the PE surface paintable, even with non-toxic water-based inks, making it suitable for applications such as packaging. Full article

Diabetes mellitus (DM) is known as the first non-communicable global epidemic. It is estimated that 537 million people have DM, but the condition has been properly diagnosed in less than half of these patients. Despite numerous preventive measures, the number of DM cases is steadily increasing. The state of chronic hyperglycaemia in the body leads to numerous complications, including diabetic cardiomyopathy (DCM). A number of pathophysiological mechanisms are behind the development and progression of cardiomyopathy, including increased oxidative stress, chronic inflammation, increased synthesis of advanced glycation products and overexpression of the biosynthetic pathway of certain compounds, such as hexosamine. There is extensive research on the treatment of DCM, and there are a number of therapies that can stop the development of this complication. Among the compounds used to treat DCM are antiglycaemic drugs, hypoglycaemic drugs and drugs used to treat myocardial failure. An important element in combating DCM that should be kept in mind is a healthy lifestyle—a well-balanced diet and physical activity. There is also a group of compounds—including coenzyme Q10, antioxidants and modulators of signalling pathways and inflammatory processes, among others—that are being researched continuously, and their introduction into routine therapies is likely to result in greater control and more effective treatment of DM in the future. This paper summarises the latest recommendations for lifestyle and pharmacological treatment of cardiomyopathy in patients with DM. Full article

Background: Achieving high academic success is known to be influenced by many factors including, but not limiting to, physical and mental health. The present study aimed to assess the relationship between physical health, mental health, and university students’ success, and to explore the associations between these factors and their academic achievement. Methods: A cross-sectional, self-administered online survey was used to collect data from college students in three different universities in Lebanon during the Fall 2023 semester. Mental health was evaluated using validated screening tools for depression, anxiety, and stress, specifically the Patient Health Questionnaire (PHQ-9), the General Anxiety Disorder (GAD-7), and Cohen’s Perceived Stress Scale (PSS), respectively. Additionally, general questions regarding physical health and lifestyle factors were incorporated into the questionnaire. Academic achievement was measured using students’ grade point average (GPA). Results: A total of 261 students completed the self-administered online survey. The results revealed that approximately 42% and 36% of students were experiencing moderate to severe symptoms of depression and anxiety, respectively, and 75.1% of students exhibited symptoms of moderate stress. The majority of participants (99.2%) did not report any physical disability. Chi-square analysis revealed a significant association between mental health status (depression, anxiety, and stress) and GPA level (p = 0.03, p = 0.044, p = 0.015, respectively). Multiple logistic regression models identified eight correlates of GPA and highlighted the relationship between physical health and student success. For instance, students who considered themselves moderately active had lower odds of achieving a higher GPA than those who considered themselves active (OR = 0.41, p = 0.045). Conclusions: This is the first investigation into Lebanese university students’ academic success in relation to lifestyle and mental health profiles. The findings indicate that implementing public health programs and interventions targeting mental health and lifestyle behaviors is essential for enhancing student success. Full article

Film cooling needs to be applied to serpentine nozzles due to an increase in thermal load. Adverse pressure gradients (APGs) near the upper wall of such nozzles hinder the forward flow of the coolant, and they may even induce a recirculation zone that complicates the cooling of the film in serpentine nozzles under different APGs. In this study, the film cooling characteristics of a serpentine nozzle under various APGs are investigated through numerical simulations. The studied pressure gradients include strong, moderate, and weak APGs. The results show that the APG weakened the adhesion of the coolant to the surface, thereby reducing the film cooling effectiveness (FCE) and the convective heat transfer coefficient (CHTC). The stronger the APG, the greater its obstructive effect. However, the recirculation zone induced by the strong APG was composed of the coolant, and it adhered tightly to the wall, thereby significantly strengthening the FCE and CHTC. The CHTC under the moderate APG significantly increased due to the convergence of two jets ejected from different holes. For the four blowing ratios, the area-averaged FCE under the strong APG was 29.8% and 24.5% higher than that under the moderate and weak APGs, while the area-averaged ratios of the CHTC under the moderate APG were 1.6% and 16.7% higher than those under the strong and weak APGs. Therefore, more holes should be arranged on the film in the zones of moderate and weak APGs. Full article

The present study aims to propose a general framework of modeling rigid body potentials (RBPs) suitable for analyzing the orbit–attitude coupled motion of a spacecraft (S/C) near small celestial bodies, regardless of gravity estimation models. Here, ‘rigid body potential’ refers to the potential of a small celestial body integrated across the finite volume of an S/C, assuming that the mass of the S/C has no influence on the motion of the small celestial body. First proposed is a comprehensive formulation for modeling the RBP including its associated force, torque, and Hessian matrix, which is then applied to three gravity estimation models. The Hessian of potential plays a crucial role in calculating the RBP. This study assesses the RBP via numerical simulations for the purpose of determining proper gravity estimation models and seeking modeling conditions. The gravity estimation models and the associated RBP are tested for eight small celestial bodies. In this study, we utilize distance units (DUs) instead of SI units, where the DU is defined as the mean radius of the given small celestial body. For a given specific distance in Dus, the relative error of the gravity estimation model at this distance has a similar value regardless of the small celestial body. However, the difference value between the potential and RBP depends on the DU; in other words, it depends on the size of the small celestial body. This implies that accurate gravity estimation models are imperative for conducting RBP analysis. The overall results can help develop a propagation system for orbit–attitude coupled motions of an S/C in the vicinity of small celestial bodies. Full article

Recent studies have revealed increasingly worse and more complex mental health conditions in young people, which is reflected in a growing trend in emergency room (ER) visits for acute psychopathological symptoms (APSs). This phenomenon has become exacerbated in recent decades, with a peak in the post-pandemic period. To better characterize the phenomenon, we investigated the change in the rate and type of ER counseling requests provided at the Child Neuropsychiatry Unit of the University Hospital of Bari, Italy over the period between 2019 and 2023 for subjects younger than 18 years old. For this purpose, we retrospectively analyzed a total number of 1073 urgent consultation reports retrieved through the reporting computerized operating system of our hospital. The distribution of the counseling requests provided for APSs and, among these, the distribution of the numbers of APSs and of the male: female ratio were significantly different over the years, with an increasing linear trend identified for APSs (p = 3.095 × 10⁻⁷), the average number of APSs (p = 3.598 × 10⁻⁷), and female gender prevalence (p = 0.03908), as well as for the patients with a history of psychotropic drug assumption (p = 0.0006319). A significant change in the number of urgent counseling requests received for eating disorders (p = 0.0007408), depression (p = 7.92 × 10⁻⁸), somatization (p = 4.03 × 10⁻⁶), self-harm (SA) (p = 1.358 × 10⁻⁶), and non-suicidal self-injury (NSSI) (p = 8.965 × 10⁻⁶) was found, with a significant increasing trend for anxiety (p = 0.0444), depression (p = 8.06 × 10⁻⁶), somatization (p = 0.004616), SA (p = 3.998 × 10⁻⁸), and NSSI (p = 5.074 × 10⁻⁷). The findings of our study support the hypothesis of an alarming progressive worsening of the mental health of children and adolescents, with an overlapping effect of the pandemic exacerbating the process. Full article