Search Results (151,926)

Background/Objectives: Multifocal Motor Neuropathy (MMN) and Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) are immune-mediated polyneuropathies often treated with immunoglobulin therapy. They were prioritized for COVID-19 vaccination during the pandemic. However, their immune response following COVID-19 vaccination remains unclear. We investigated short- and long-term immune responses to COVID-19 vaccination in patients with MMN and CIDP compared to controls. Methods: In a prospective observational study, patients with CIDP or MMN and matched controls were followed over 24 months. Controls were age- and sex-matched 1:9. Participants received COVID-19 vaccines in accordance with the Danish vaccination program. Primary outcomes were levels of SARS-CoV-2 IgG antibodies and virus-neutralizing capacity. A positive vaccine response was defined as IgG > 225 AU/mL and neutralizing capacity ≥ 25%. Results: We included 34 patients and 306 matched controls. While baseline SARS-CoV-2 IgG levels were similar, controls exhibited higher IgG levels at 6- (mean difference, 88%; p = 0.008), 18- (91%; p = 0.023), and 24 months (160%; p < 0.001). Neutralization capacity was also higher in controls at 6 (10%, p = 0.004), 18 (7%, p < 0.001), and 24 months (9%, p = 0.002). Despite this, the proportion of vaccine responders did not differ between the two groups after 24 months (p = 0.196). In patients receiving immunoglobulin therapy, IgG levels were lower than in controls at 24-month follow-up alone (56%, p < 0.001); all demonstrated a positive vaccine response. Conclusions: Patients with CIDP and MMN demonstrated a positive humoral response to COVID-19 vaccination. Although IgG and neutralization levels were lower than in controls, all patients receiving immunoglobulin therapy were vaccine responders. Full article

Coronavirus disease 2019 (COVID-19) emerged in late 2019 and was declared a pandemic from March 2020 to May 2023, profoundly affecting public health systems, economies, and daily life worldwide. University students were among the most impacted groups, facing abrupt transitions to remote learning, social isolation, and increased psychological distress due to academic and personal uncertainties. During the pandemic, few studies have been conducted with this population and so far, none have evaluated factors associated with COVID-19 infection in university students, so this study aimed to evaluate variables associated with COVID-19 infection among university students in southern Brazil. Data were collected from July to November 2020 through an online questionnaire addressing lifestyle and health, with participation from 1533 students. Among the variables analyzed, statistically significant associations with COVID-19 infection were identified for age, occupation, use of continuous medication, compliance with social distancing, and self-medication practices. Younger students (18–29 years) and those dedicated solely to studying exhibited higher infection rates. Additionally, participants who reported using continuous medication, not adhering to social distancing measures, or engaging in self-medication were significantly more likely to have contracted COVID-19. These results help outline risk profiles within the university student population and contribute to improved preparedness for future disease outbreaks. Furthermore, they underscore attitudes and behaviors that may increase vulnerability to infectious diseases, highlighting the importance of targeted health promotion and prevention strategies in this demographic. Full article

In this study, alkali-activated materials (AAMs) were developed using finely ground coral powder (CP) and granulated blast furnace slag (GBFS) as the primary raw materials, weak alkali as the activator, and sea sand as the fine aggregate. The influence of raw material composition on the macro-mechanical properties was analyzed. Further, combined with micro-analysis techniques, the characteristics of micro-crystal formation and transformation, governed by raw material properties, and the formation and development mechanism of the enhanced micro-gel structure were elucidated. The results indicate that the activation effect of Ca(OH)₂ is significantly superior to that of Na₂CO₃. The excessively high calcium content and insufficient silicon and aluminum content in CP hinder gel formation and mechanical properties development. GBFS addition optimized the calcium-silicon-aluminum ratio and significantly improved CP reactivity. Also, compressive strength is enhanced considerably, accompanied by continuous optimization of the micro-gel structure as the GBFS content increases. At a GBFS-to-CP optimal ratio of 1:1, compressive strength of 21.8 MPa could be achieved at 28 days of age. However, the strengthening effect significantly reduced for the GBFS content > 50%. GBFS promotes the continuous formation of a zeolite-like phase gel structure, leading to a substantial improvement in compressive strength. Full article

Background: Genetic factors pertinent to Parkinson’s disease (PD) might predispose an individual to post-traumatic stress disorder (PTSD). Humans who are heterozygous for the glucocerebrosidase 1 (GBA) L444P Gaucher mutation have an increased PD risk and elevated levels of alpha synuclein (aSyn). Mice that are heterozygous for the GBA mutation and express aSyn with the A53T mutation show elevated anxiety levels at 20 months of age compared to those expressing only A53T. Objective: This study aims to assess whether A53T and A53T-L444P affect the risk of developing PTSD phenotypes and whether sex and age modulate this risk. Methods: Young (5.1 ± 0.2 months) and older (11.3 ± 0.2 months) A53T and GBA L444P female and male mice were tested for fear learning and memory extinction in the contextual fear conditioning and passive avoidance paradigms. Subsequently, the mice were tested for measures of activity and anxiety in the open field and for depressive-like behavior in the forced swim test. Results: In the contextual fear memory extinction paradigm, only young A53T female mice showed contextual fear memory extinction, while older A53T female mice showed increased activity levels over subsequent days. In the passive avoidance memory paradigm, no mice showed extinction of passive avoidance memory. When the frequency of entering the more anxiety-provoking center of the open field was analyzed, a test history x sex x age interaction was observed. In the forced swim test, test history affected the depressive-like behavior in mice trained; there was more depressive-like behavior in mice trained in the contextual fear memory extinction paradigm than in mice trained in the passive avoidance memory extinction paradigm. Moreover, there was an effect of age with more depressive-like behavior in older than in younger mice, and an effect of genotype with more depressive-like behavior in A53T-L444P compared to A53T mice. When cortical phosphorylated tau (pS 199) levels were analyzed, there was an effects of genotype, a sex x age interaction, and ant age x test history interaction. Conclusions: A53T and A53T-L444P affect the risk of developing PTSD phenotypes. Fear extinction test history, genotype, and age affect depressive-like behavior and tau pathology. Full article

This study investigates the effectiveness of designing a gamified Virtual Reality (VR) intervention, grounded in Kolb’s Experiential Learning Theory, in enhancing social reciprocity, affective expression, and daily living skills among Thai children with Autism Spectrum Disorder (ASD). Utilizing the Meta Quest 2 headset, the intervention simulated five real-world contexts—home routines, classroom behavior, street crossing, supermarket shopping, and fast-food interactions. A quasi-experimental pretest-posttest control group design was employed with 33 children aged 6–12, complemented by thematic analysis of caregiver and therapist interviews. Results from the Social Responsiveness Scale, Second Edition (SRS-2), indicated significant improvements in social communication (p = 0.001) and social motivation (p = 0.045), while changes in social awareness (p = 0.233) and repetitive behaviors (p = 0.169) were not statistically significant. However, an ANCOVA analysis controlling for pre-test scores found that the difference in post-test outcomes between the intervention and control groups did not reach statistical significance (p = 0.073), suggesting that observed improvements may be influenced by baseline variability. Qualitative feedback highlighted the program’s engagement value, cultural relevance, and usability, alongside suggestions for increased adaptivity and contextual nuance. These results underscore the potential of VR-based learning while highlighting the need for further research with larger samples and more adaptive systems. These findings offer practical insights for educators, researchers, teachers, and program developers by demonstrating how culturally grounded, gamified VR interventions when guided by experiential learning principles can effectively enhance engagement and support targeted social skill development in children with ASD. Full article

Background: One’s dietary pattern throughout life is established during the perinatal period, especially in the intrauterine environment. This study aims to analyze whether maternal and birth characteristics are associated with food consumption in young adults using baseline data from the Nutritionists’ Health Study (NutriHS). Methods: We employed cross-sectional analysis of data from 386 undergraduate nutrition students and nutritionists. Current food consumption was evaluated as per the NOVA classification. The maternal and birth factors included maternal age, parity, type of childbirth, health problems during pregnancy, prematurity, and birth weight, and multiple correspondence analysis of these variables was performed to identify patterns in them. Results: The energy contribution of ultra-processed foods was positively associated with the pattern characterized by participants whose mothers were 19 years of age or younger, primiparous, and had a vaginal delivery (β = 0.48; 95% confidence interval = 0.02, 1.66). Conclusions: We concluded that maternal age at birth was associated with the dietary patterns of adult children. Participants whose mothers were 19 or younger at birth had significantly higher consumption of ultra-processed foods in adulthood compared to those whose mothers were older. Full article

Spigelian hernia (SH) is an infrequent aponeurotic defect in Spiegel’s semilunar line. The literature on pediatric SH is scarce. A comprehensive review of the previous literature was conducted. Eligible studies were identified by searching primary medical bibliography databases, and a pooled analysis of published case-level data was performed. Medians and interquartile ranges were used to describe the quantitative variables and proportions for categorical variables. The Kruskal–Wallis, Mann–Whitney U, and Fisher’s exact tests were used to compare group variables. Spearman’s and Pearson’s correlation analyses were used to assess the degree of correlation between variables, while Cramér’s V was applied to evaluate the degree of association among the variables. A p-value < 0.05 (two-tailed) was considered statistically significant. Our search identified 82 publications reporting on 123 patients (106 male, 86.2%), with an age range of 0–21 years. Forty-seven patients (38.2%) had a left-sided SH, fifty-six (45.5%) had a right-sided SH, and thirteen (10.6%) had a bilateral SH. Traumatic SH, mostly from bicycle injuries, accounted for 45 cases (36.6%), while 41 (33.3%) were associated with undescended testis (UDT). In this series of published cases, hernia incarceration/strangulation (I/S) was reported in 15 patients (12.2%), who were significantly younger (p = 0.02). Surgical correction was performed in 95 cases (77.2%), 14 of them laparoscopically, with a 35.7% conversion rate. Eight cases (6.5%) were managed conservatively. Overall, outcomes were favorable. SH is an infrequent pediatric condition that, based on the synthesized literature, predominantly affects males. The published cases suggest two main clinical phenotypes: a congenital form, often linked to ipsilateral UDT, and an acquired form, typically resulting from trauma. Analysis of the reported data indicates a higher risk of incarceration in early childhood. Surgical treatment is the most frequently reported approach with generally favorable outcomes, whereas the evidence for conservative management remains limited. This comprehensive review highlights the dual nature of pediatric SH and underscores the need for a high index of suspicion in relevant clinical scenarios. Full article

Background: Millimetric ST-segment elevation (STEMI) rules miss more than half of angiographic coronary occlusions. Re-casting acute infarction as Occlusion MI (OMI) versus Non-Occlusion MI (NOMI) and embedding that paradigm in Bayesian reasoning could shorten time to reperfusion while limiting unnecessary activations. Methods: We derived age- and sex-specific baseline prevalences of OMI from national emergency-department surveillance data and contemporary angiographic series. Pre-test probabilities were adjusted with published likelihood ratios (LRs) for chest-pain descriptors and clinical risk factors, then updated again with either (1) the stand-alone accuracy of ST-elevation or (2) the pooled accuracy of a broader OMI ECG spectrum. Two decision thresholds were prespecified: post-test probability >10% to trigger catheterization and >75% to justify fibrinolysis when angiography was unavailable. The framework was applied to five consecutive real-world cases that had elicited diagnostic disagreement in clinical practice. Results: The Bayesian scaffold re-classified three “NSTEMI” tracings as intermediate or high-probability OMI (post-test 27–65%) and prompted immediate reperfusion; each was confirmed as a totally occluded artery. A fourth patient with crushing pain and a normal ECG retained a 17% post-ECG probability and was later found to have an occluded circumflex. The fifth case, an apparent South-African-Flag pattern, initially rose to 75% but fell after a normal bedside echo and normal troponins. Conclusions: Layering pre-test context with sign-specific LRs transforms ECG interpretation from a binary rule into a transparent probability calculation. The OMI/NOMI Bayesian framework detected occult occlusions that classic STEMI criteria missed. Full article

Maturity-Onset Diabetes of the Young Type 5 (MODY5) is caused by heterozygous pathogenic variants in the HNF1B gene, encoding the transcription factor hepatocyte nuclear factor-1β. HNF1B haploinsufficiency typically leads to young-onset non-immune diabetes and highly variable renal involvement, whose more frequent features are bilateral kidney cysts and renal hypodysplasia. Kidney cysts or echogenic kidneys can be identified by ultrasonography in the prenatal period, but the renal involvement can also start in childhood or later. Notably, a recurrent microdeletion syndrome at 17q12 (deleting HNF1B plus ~15 neighboring genes) accounts for ~40–50% of cases. The 17q12 deletion is a contiguous gene syndrome and affected individuals present with a complex phenotype, including neurodevelopmental disorders, liver and pancreas abnormalities, and other congenital defects. When counseling the patient and the parents, the clinician must consider multiple factors, including the molecular defect and the age of onset of the symptoms, with particular attention to prenatal diagnosis. A multidisciplinary approach and an early diagnosis are essential for the management of these conditions. Full article

Background: Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterized by both motor and non-motor symptoms, including autonomic dysfunction. Structural alterations in the vagus nerve (VN) may contribute to PD pathophysiology, though existing data remain inconsistent. Objective: This study aimed to evaluate morphological changes in the VN using high-resolution ultrasound (USVN) and to investigate associations with autonomic symptoms, heart rate variability (HRV), and clinical characteristics in PD patients. Methods: A cross-sectional study was conducted involving 60 PD patients and 60 age- and sex-matched healthy controls. USVN was performed to assess VN cross-sectional area (CSA), echogenicity, and homogeneity bilaterally. Autonomic symptoms were measured using the Composite Autonomic Symptom Scale 31 (COMPASS-31). HRV parameters—SDNN, RMSSD, and pNN50—were obtained via 24 h Holter monitoring. Additional clinical data included Unified Parkinson’s Disease Rating Scale (UPDRS) scores, transcranial sonography findings, and third ventricle width. Results: PD patients showed significantly reduced VN CSA compared to controls (right: 1.90 ± 0.19 mm² vs. 2.07 ± 0.18 mm²; left: 1.74 ± 0.21 mm² vs. 1.87 ± 0.22 mm²; p < 0.001 and p < 0.02). Altered echogenicity and decreased homogeneity were also observed. Right VN CSA correlated with body weight, third ventricle size, and COMPASS-31 scores. Left VN CSA was associated with body size parameters and negatively correlated with RMSSD (p = 0.025, r = −0.21), indicating reduced vagal tone. Conclusions: USVN detects structural VN changes in PD, correlating with autonomic dysfunction. These findings support its potential as a non-invasive biomarker for early autonomic involvement in PD. Full article

Loneliness contributes to depression in older adults, but research on effective intervention strategies remains limited. This study aims to examine the moderating effects of social capital on the relationship between loneliness and depression in older adults. Social capital was divided into structural and cognitive social categories. A self-report questionnaire was administered to 350 participants aged 65 or older, using the Korean version of the UCLA Loneliness Scale, Short-Form Geriatric Depression Scale, Structural Social Capital Scale, and Cognitive Social Capital Scale. Data from 334 patients were included in the final analysis, and the moderating effect was tested using Model 1 of the PROCESS Macro for SPSS. The results of this study are as follows: (1) it demonstrated that loneliness is a significant predictor of higher levels of depression; (2) structural social capital significantly moderated this relationship, indicating that the impact of loneliness on depressive symptoms varied according to the level of structural social capital; (3) cognitive social capital also moderated this relationship, suggesting that the influence of loneliness on depression differs based on the level of cognitive social capital. This study provides valuable foundational data for the development of prevention and intervention strategies targeting loneliness and depression in old age. Full article

Objectives: Atrial fibrillation (AF) is associated with high risk of ischaemic stroke (IS). Oral anticoagulant therapy (OAT) is the standard of care for stroke prevention, even though its management remains challenging in clinical practice. An emerging problem is embolic events occurring on adequately conducted OAT, the so-called resistant stroke (RS). We aimed to describe pre-stroke prevention therapy, management on hospital discharge, and therapy at follow-up in all patients with AF hospitalized for IS and in the RS subgroup. Methods: We conducted a retrospective monocentric study of patients with known AF hospitalized for an IS. A subgroup with RS was identified. We recorded information on prevention therapy at home, recommended therapy at discharge, and data on outcome and prevention therapy at follow-up. Results: We identified 226 patients, 61% females, median age 84.04 years. Preventive therapy at home was performed in 121 (53.5%) (119 OAT and 2 Left Atrial Appendage Occlusion). At hospital discharge OAT was prescribed to 78.2% of patients. RS was diagnosed in 33 patients whose management at discharge was: same OAT in 12, shift to another Direct Oral Anticoauglant (DOAC) in 5, from DOAC to Vitamin K Antagonist (VKA) and vice versa in 11, non-specified OAT in 4. At final, follow-up of 208 days (range 85–443) 23.3% (34/146) did not assume OAT. OAT was significantly associated with survival probability (p < 0.001). Conclusions: Our findings confirm a scarce adoption of guidelines for AF-related embolic events, even in the absence of absolute contraindication to OAT. RS remains an underexplored clinical entity with empirical management, highlighting the need for targeted research and tailored therapeutic strategies. Full article

Background/Objectives: Oral health plays a crucial role in the physical, emotional, and social well-being of children. Data from 2019 indicate that oral diseases remain a major concern in the Italian paediatric population, affecting not only children’s health but also caregivers’ well-being. This study aimed to assess the importance attributed by Italian families to their children’s oral health and correlate parents’ perceptions with children’s actual oral health status. Methods: A total of 131 children aged 0–12 years, admitted to the IRCCS Giannina Gaslini Children’s Hospital (Genoa, Italy) for reasons other than dental problems, were enroled between January 1 and December 31, 2024. Parents completed validated questionnaires (ECOHIS or PCPQ + FIS) based on their child’s age, along with supplementary questions on socio-demographic background and dental history. Oral examination was performed to assess dmft/DMFT scores, the Index of Orthodontic Treatment Need (IOTN), and the Modified Gingival Index (MGI). Results: In younger children (0–5 years), oral health was generally good, but the presence of caries negatively impacted the family’s quality of life. Older children (6–12 years) showed higher rates of caries and gingival inflammation, affecting their daily functioning and emotional well-being. Poor oral health was more common among children of non-European backgrounds and those with lower parental education. Early dental visits, within the recommended 24 months of age, were rare. Conclusions: Despite clear international recommendations, early dental visits remain uncommon, and many children experience preventable oral health issues. These findings highlight the urgent need to improve caregiver education and public health strategies to promote early preventive dental care. Full article

Background/Objectives: All-inside ACL reconstruction has emerged as a minimally invasive alternative to conventional techniques, with potential advantages in graft configuration and reduced surgical trauma. This study aimed to compare the clinical outcomes of all-inside and full tibial tunnel ACL reconstruction, focusing on graft diameter, postoperative stability, and functional recovery. We hypothesized that the all-inside technique would allow for thicker grafts and yield superior postoperative knee stability and functional outcomes, with postoperative anterior laxity as a major outcome of interest. Methods: This retrospective comparative study reviewed patients who underwent ACL reconstruction between January 2020 and February 2024. From January 2020 to September 2022, a four-strand hamstring autograft with full tibial tunnel technique (FT-4) was used, while from September 2022, a six-strand hamstring autograft with the all-inside technique (AI-6) was adopted to enable thicker grafts and optimize fixation. Among a total of 103 patients, 1:1 propensity score matching (PSM) was performed based on age, sex, BMI, laterality, ALL reconstruction, meniscal lesion, and preoperative anterior laxity (SSD). Graft diameter and clinical outcomes, including knee stability and functional scores, were compared between the matched groups. Results: After PSM, two comparable groups of 29 patients each were established. Graft diameter was significantly larger in the AI-6 group (9.5 ± 0.7 mm) compared to the FT-4 group (7.8 ± 0.8 mm, p < 0.001), while other baseline characteristics remained well balanced between the groups. At the final follow-up, both groups exhibited significant improvements in anterior laxity, functional scores, and pivot shift grades (all p < 0.001). The AI-6 group demonstrated superior outcomes with a significantly higher Lysholm score (82.2 ± 6.7 vs. 75.6 ± 8.9, p = 0.002), lower WOMAC score (8.0 ± 4.3 vs. 12.9 ± 10.5, p = 0.023), and reduced anterior laxity (1.6 ± 1.1 mm vs. 2.5 ± 1.4 mm, p = 0.005) compared to the FT-4 group, whereas no significant differences were observed in the IKDC, Tegner, Korean knee score, or pivot shift test results. A simple linear regression revealed a significant negative correlation between graft diameter and postoperative anterior laxity (B = −0.398, p = 0.048). Conclusions: The present study demonstrated that the use of a six-strand hamstring graft configuration in the AI-6 technique resulted in significantly thicker grafts and was associated with reduced postoperative anterior knee laxity compared to the FT-4 technique. While interpretation of these findings requires caution in light of MCID thresholds, the AI-6 group showed favorable outcomes in anterior laxity and selected functional scores, such as the Lysholm and WOMAC. This technique may offer practical clinical value, particularly in populations prone to smaller graft diameters, as it facilitates adequate graft thickness through multifold preparation, with the all-inside approach accommodating the inherent graft shortening. Full article

Portal venous (PV) flow Doppler velocimetry assesses venous congestion in heart failure, showing PV pulsatility due to backward transmission of right atrial pressure (RAP) through the sinusoids. However, PV pulsatility has also been observed under physiological conditions. We aimed to elucidate the mechanisms and contributing factors of PV pulsatility in healthy adults. Pulsed-wave Doppler recordings of the hepatic venous (HV) and PV flow were obtained with electrocardiography. A- and V-wave velocities and their timings relative to the P- and R-waves (P-HV_A, R-HV_V) were measured from the HV waveforms. From PV waveforms, atrial and ventricular systolic descent flow velocities and their timings (P-PV_A, R-PV_V) were measured. The PV pulsatility index (VPI) was calculated. There were no differences between P-PV_A and P-HV_A, and between R-PV_V and R-HV_V, indicating similar waveforms. Seventy-nine percent of participants showed a VPI ≥ 0.3, with a higher VPI in younger vs. older participants (0.7 vs. 0.3, p < 0.01). Only age was independently associated with VPI (β = −0.56, p < 0.01). PV pulsatility was common in healthy adults, suggesting RAP transmission via the sinusoids; this physiological phenomenon was attenuated with aging. These findings highlight the importance of considering age-related physiological changes when interpreting the PV flow. Full article