Search Results (801)

This study presents and discusses evidence on the value of biomarker testing and precision medicine in Latin America through a health equity lens. It is essential to explore how to harness the benefits of precision medicine to narrow the health equity gap, ensuring all patients have access to the best cancer treatment. The methodology employed to develop this document consists of a non-systematic literature review, followed by a process of validation and feedback with a group of experts in relevant fields. Precision medicine could help reduce health inequities in Latin America by providing better diagnosis and treatment for everyone with cancer. However, its success in achieving this depends on the implementation of policies that promote equitable access. Findings indicate that the current policy landscape in the Latin American region is not conducive to improving access, reach, quality, or outcome-related problems in cancer care, nor to realizing the full potential of precision medicine. The study explores how precision medicine can advance health equity, concluding with an analysis of the challenges and recommendations for overcoming them. Full article

Background/Objectives: This study investigated the association between cochlear implant (CI) users’ assessed perception of musical sound quality and their subjective music perception and music-related quality of life (QoL). The aim was to provide a comprehensive evaluation by integrating a relatively objective Turkish Multiple Stimulus with Hidden Reference and Anchor (TR-MUSHRA) test and a subjective music questionnaire. Methods: Thirty CI users and thirty normal-hearing (NH) adults were assessed. Perception of sound quality was measured using the TR-MUSHRA test. Subjective assessments were conducted with the Music-Related Quality of Life Questionnaire (MuRQoL). Results: TR-MUSHRA results showed that while NH participants rated all filtered stimuli as perceptually different from the original, CI users provided similar ratings for stimuli with adjacent high-pass filter settings, indicating less differentiation in perceived sound quality. On the MuRQoL, groups differed on the Frequency subscale but not the Importance subscale. Critically, no significant correlation was found between the TR-MUSHRA scores and the MuRQoL subscale scores in either group. Conclusions: The findings demonstrate that TR-MUSHRA is an effective tool for assessing perceived sound quality relatively objectively, but there is no relationship between perceiving sound quality differences and measures of self-reported musical engagement and its importance. Subjective music experience may represent different domains beyond the perception of sound quality. Therefore, successful auditory rehabilitation requires personalized strategies that consider the multifaceted nature of music perception beyond simple perceptual judgments. Full article

Objectives: To assess the role of a real-time therapeutic drug monitoring (TDM)-guided expert clinical pharmacological advice (ECPA) program of isavuconazole in preventing under- or overexposure with the intent of improving efficacy and safety outcomes in the critically ill patients. Methods: This retrospective study included critical patients receiving intravenous isavuconazole for prophylaxis or treatment of invasive fungal infections (IFI) and undergoing at least one TDM-guided ECPA in the period 1 March 2021–31 March 2025. Desired isavuconazole exposure was defined as trough concentrations (C_min) of 1.0–5.1 mg/L. Efficacy outcome was assessed by means of bronchoalveolar (BAL) galactomannan (GM) index, breakthrough IFI, and 30-day mortality rate, whereas safety was assessed by means of hepatic test disturbances (HTD). Univariate analysis was carried out for assessing potential variables associated with isavuconazole under- or overexposure and for comparing features of solid organ transplant (SOT) recipients vs. non-SOT patients. Proportions of isavuconazole C_min underexposure, desired exposure, and overexposure were assessed at different timepoints from starting therapy. Trends over time of HTD in relation to isavuconazole exposure were assessed separately in patients having HTD or not at baseline. Results: Overall, 32 critical patients were included. A total of 166 TDM-guided ECPAs were provided. Median (IQR) average isavuconazole C_min was 3.5 mg/L (2.1–4.6 mg/L). Proportions of ECPAs with isavuconazole C_min under- and overexposure were 4.2% (7/166) and 16.3% (27/166), respectively. Patients experiencing underexposure had higher body mass index (30.1 vs. 25.5 kg/m²; p < 0.001). Trends of isavuconazole C_min under- and overexposure changed over time, significantly decreasing the former (10.5% <7 days vs. 4.3% 7–28 days vs. 0.0% >28 days; p < 0.001) and increasing the latter (5.3% <7 days vs. 12.8% 7–28 days vs. 29.3% >28 days; p < 0.001). HTD occurred in 15/32 patients, most of whom (10/15) were affected just at baseline. Patients with transient or persistent overexposure trended toward a higher risk of HTD compared to those without (33.3% vs. 8.3%; p = 0.11). Conclusions: A real-time TDM-guided approach could be a valuable tool for optimizing isavuconazole exposure, especially whenever dealing with obese patients or with prolonged treatment. Full article

Traditional wound and burn treatments often fall short in balancing antimicrobial efficacy, patient comfort, and ease of application. This study introduces a novel, transparent, thermoresponsive sol–gel formulation incorporating polyhexamethylene biguanide (PHMB) for advanced topical therapy. Utilizing Poloxamer 407 as a biocompatible carrier, the formulation remains a sprayable liquid at room temperature and instantly gels upon contact with body temperature, enabling painless, pressure-free application on sensitive, injured skin. Comprehensive in vitro and in vivo evaluations confirmed the formulation’s broad-spectrum antimicrobial efficacy (≥5 log₁₀ reduction in 30 s), high biocompatibility (viability > 70% in fibroblasts), non-irritancy (OECD 425-compliant), and physical stability across three months. Importantly, the formulation maintained fibroblast migration capacity—crucial for wound regeneration—while exhibiting rapid sol-to-gel transition at ~34 °C. These findings highlight the system’s potential as a next-generation wound dressing with enhanced user compliance, transparent monitoring capability, and rapid healing support, particularly in disaster or emergency scenarios. Full article

Background: Soccer is a physically demanding sport characterized by frequent high-intensity efforts, which are particularly relevant in women’s competitions. Improving high-speed running and aerobic capacity has been linked to better on-field performance. Strength training has shown promise in enhancing these physical attributes, but its application in young female soccer players remains underexplored. This study aimed to investigate the effects of a 10-week in-season strength training program on physical performance and match running demands in young female soccer players. Methods: Thirty-two U18 Danish female professional soccer players from two comparable teams voluntarily participated in the study. Teams were allocated to either an experimental group, performing twice-weekly strength training (EG, n = 16) or a control group (CG, n = 16). Vertical jump performance and Yo-Yo IR2 performance as an estimation for maximal oxygen uptake (VO₂max) were assessed both pre and post intervention. Additionally, players’ match external demands (i.e., total distance, distance covered at speeds above 23 km·h⁻¹, and maximum velocity achieved) were monitored using Global Positioning System devices during four matches before and after the intervention. Results: Significant within-group differences were observed across all variables for the EG (p = 0.001; ES = 1.08 to 1.45, large), without differences in the CG (p > 0.01). Between-group analysis indicated significant differences favoring the EG in all variables (F = 27.40 to 47.17; p = 0.001). Conclusions: The application of a 10-week strength training program led to improvements in physical and match running performance among young female soccer players, underscoring the importance of incorporating strength training programs into female soccer periodization to enhance performance. Full article

Background/Objectives: This study aims to present a structured clinical workflow for offline adaptive Biology-guided Radiotherapy (BgRT) using the RefleXion X1 PET-linac system, addressing challenges introduced by inter-treatment anatomical and biological changes. Methods: We propose a decision tree offline adaptation framework based on real-time assessments of Activity Concentration (AC), Normalized Target Signal (NTS), and bounded dose-volume histogram (bDVH%) metrics. Three offline strategies were developed: (1) preemptive adaptation for minor changes, (2) partial re-simulation for moderate changes, and (3) full re-simulation for major anatomical or metabolic alterations. Two clinical cases demonstrating strategies 1 and 2 are presented. Results: The preemptive adaptation strategy was applied in a case with early tumor shrinkage, maintaining delivery parameters within acceptable limits while updating contours and dose distribution. In the partial re-Simulation case, significant changes in PET signal necessitated a same-day PET functional modeling session and plan re-optimization, effectively restoring safe deliverability. Both cases showed reduced target volumes and improved OAR sparing without additional patient visits or tracer injections. Conclusions: Offline adaptive workflows for BgRT provide practical solutions to address inter-fractional changes in tumor structure and function. These strategies can help maintain the safety and accuracy of BgRT delivery and support clinical adoption of PET-guided radiotherapy, paving the way for future online adaptive capabilities. Full article

Hemoglobin plays a critical role in diagnosing various medical conditions, including infections, trauma, hemolytic disorders, and Mediterranean anemia, which is particularly prevalent in Mediterranean populations. Conventional measurement methods require blood sampling and laboratory analysis, which are often time-consuming and impractical during emergency situations with limited medical infrastructure. Although portable oximeters enable non-invasive hemoglobin estimation, they still require physical contact, posing limitations for individuals with circulatory or dermatological conditions. Additionally, reliance on disposable probes increases operational costs. This study presents a non-contact and automated approach for estimating total hemoglobin levels from facial video data using three-dimensional regression models. A dataset was compiled from 279 volunteers, with synchronized acquisition of facial video and hemoglobin values using a commercial pulse oximeter. After preprocessing, the dataset was divided into training, validation, and test subsets. Three 3D convolutional regression models, including 3D CNN, channel attention-enhanced 3D CNN, and residual 3D CNN, were trained, and the most successful model was implemented in a graphical interface. Among these, the residual model achieved the most favorable performance on the test set, yielding an RMSE of 1.06, an MAE of 0.85, and a Pearson correlation coefficient of 0.73. This study offers a novel contribution by enabling contactless hemoglobin estimation from facial video using 3D CNN-based regression techniques. Full article

The Tetranychus urticae Koch (Acari: Tetranychidae) is one of the primary pests affecting buckwheat, and its management has become increasingly critical. Entomopathogenic fungi offer a promising way to solve this problem by providing both pest control and disease resistance, as well as promoting plant growth through endophytic colonization. This study investigated the effects of applying Isaria cateniannulata (Liang) Samson & Hywel-Jones and Beauveria bassiana (Bals.-Criv.) Vuill. on different buckwheat varieties, and analyzed the physiological indices of buckwheat, the population of T. urticae and Euseius nicholsi (Ehara & Lee). Results showed that the optimum concentration for fungal colonization on buckwheat was 1 × 10⁷ spores/mL. The combined application of I. cateniannulata and B. bassiana significantly enhanced buckwheat growth, with root length, plant height, main stem diameter, fresh weight, and dry weight reaching 63.3 mm, 24.1 cm, 2.1 mm, 2.0 g, and 0.1 g, respectively. The highest escape rate of T. urticae was 76.33%. Furthermore, the combined application of mixed fungal suspension and E. nicholsi had the best control effect on T. urticae, with pest suppression exceeding 97.83% and an oviposition as low as 0.25 eggs per female. This study is the first to demonstrate that the joint application of I. cateniannulata and B. bassiana can promote buckwheat growth and, when combined with predatory mites, effectively control T. urticae. These findings provide a theoretical basis for the development of integrated biocontrol strategies combining entomopathogenic fungi and predatory mites. Full article

Background/Objectives: The correlation between drugs and interstitial lung disease (ILD) is reported, but the presence of the substances of abuse in the lung as a cause of disease has never been proved. In this observational study, our aim was to evaluate a possible correlation between ILD radiological findings and cannabinoids presence in broncho-alveolar lavage (BAL) or in resected lung tissue in patients with a history of cannabis smoke. Methods: Data of patients with ILD chest CT scan findings and history of drug use, submitted to BAL (Group 1), or to lung apex removal for pneumothorax (Group 2), were retrospectively collected. In both groups, drug presence was investigated. A subgroup of Group 1 was checked for the concomitant presence in blood. Fisher’s test was used to study the association between the detection of the drug and ILD. Results: In Group 1, cannabinoids were present in 12/26 (46.2%) BAL samples. ILD emerged on chest CT in 75% of the cannabinoid-positive and in 20% of the cannabinoid-negative BAL samples (p = 0.0299). In the subgroup, the patients who tested positive for cannabinoids/cocaine on BAL were 55.6%; 0% were positive only on blood (p = 0.0294). In Group 2, cannabinoids were present in 10/15 (66.7%) specimens. ILD was evident, respectively, in 40% and in 0% of the patients with cannabinoid-positive and cannabinoid-negative surgical specimens (p = 0.2308). Conclusions: The prevalence of ILD in patients with cannabinoid-positive BAL and in those with cannabinoid-positive surgical specimens suggests that ILD could be caused by cannabis smoke. The non-concomitant presence of substances in BAL and in blood advocates the diagnostic usefulness of searching for the drug in the target organ. Full article

Diagnosing and prognosing immune-mediated airway diseases, like hypersensitivity pneumonitis (HP) and sarcoidosis, is complicated due to their overlapping symptoms and the lack of definitive biomarkers. Hence, we wanted to compare bronchoalveolar lavage (BAL) cytokine and chemokine profiles from 92 patients with different immune-mediated and inflammatory airway diseases, namely, HP, sarcoidosis, non-allergic asthma, amiodarone lung, and EGPA. We also compared pulmonary function parameters, BAL’s cellularity, and lymphocyte immunophenotypes. We found significant differences across all measured lung functions (VC, VC%, FEV1, FEV1%, and Tiff%) and in the number of macrophages, lymphocytes, neutrophils, and eosinophils. Furthermore, we showed significant differences in CD4, CD8, and CD4/8 across all included ILDs and OLDs; however, no significant differences were found in CD3, CD19, NK, or NKT. We identified nine biomarkers (IL-1β, IL-6, IL-8, IL-13, VEGF, angiogenin, C4a, RANTES, and MCP-1) that significantly differ in the BAL of patients with HP and sarcoidosis and showed that RANTES and IL-6 are associated with fibrotic outcome. We have demonstrated that interstitial and obstructive lung diseases differ in cytokine and cellular lung imprint, which may, in the future, enable the determination of the disease subtype and thus the identification of targets for the treatment of individuals or subgroups within diseases. Full article

Background: Acinetobacter, specifically A. baumannii, are becoming a great threat to hospitalized patients due to increasing antibiotic resistance. The aim of this study was to describe the epidemiology, clinical characteristics, antimicrobial susceptibility pattern and outcome of Acinetobacter infections in pediatric cancer patients and hematopoietic stem cell transplant (HSCT) recipients in Poland. Methods: A total of 125 episodes of Acinetobacter species infections were reported in patients <18 years treated in Polish pediatric hematology and oncology centers over a period from 2012 to 2023. Infections were subdivided into oncohematological disease (OHD) group (n = 106; 84.8%) and HSCT group (n = 19; 15.2%). Each episode represented a separate infection event; therefore, a patient who was infected more than once during the course of treatment was counted for each infection episode. Results: A. baumannii is the most common Acinetobacter species in all groups. The most common diagnoses in OHD group were acute lymphoblastic leukemia (ALL) (n = 32; 30.2%) and acute myeloid leukemia (AML) (n = 13; 12.3%). The most common underlying diseases that were indication for HSCT were hemophagocytic lymphohistiocytosis (n = 3; 15.8%) and neuroblastoma (n = 3; 15.8%). Mortality was significantly higher in the HSCT group compared to the OHD group. In the OHD group, deaths did not correlate with the type of antibiotic, with an exception for gentamicin, which correlated with higher mortality. In the HSCT group, deaths did not correlate with the type of antibiotic, except for levofloxacin that was correlated with a higher mortality rate. Conclusions: Acinetobacter infections are a great danger to immunocompromised patients. More research is needed in order to prevent and treat antibiotic-resistant bacteria. Full article

Background/Objectives: The porcine respiratory disease complex (PRDC) is a multifaceted, polymicrobial syndrome resulting from a combination of environmental stressors, primary infections (e.g., PRRSV) and secondary infectious agents (viruses and bacteria). PRDC causes severe lung pathology, leading to reduced performance, increased mortality rates, and higher production costs in the global pig industry. Our goal was to conduct a comprehensive study correlating both the anti-PRRSV immune response and 21 secondary infectious agents with PRDC severity. Methods: To this end, PRRSV-negative weaners were vaccinated with a PRRSV-2 MLV and put into a farm with a history of PRDC. Subsequently, anti-PRRSV cellular and antibody responses were monitored pre-vaccination, at 28 days post vaccination (dpv) and during PRDC outbreak (49 dpv). NanoString was used to quantify 21 pathogens within the bronchoalveolar lavage (BAL) at the time of necropsy (51 dpv). PRRSV-2 was present in 53 out of 55 pigs, and the other five pathogens (PCMV, PPIV, B. bronchiseptica, G. parasuis, and M. hyorhinis) were detected in BAL samples. Results: Although the uncontrolled settings of field trials complicated data interpretation, multivariate correlation analyses highlighted valuable lessons: (i) high weaning weight predicted animal resilience to disease and high weight gains correlated with the control of the PRRSV-2 field strain; (ii) most pigs cleared MLV strain within 7 weeks, and the field PRRSV-2 strain was the most prevalent lung pathogen during PRDC; (iii) all pigs developed a systemic PRRSV IgG antibody response which correlated with IgG and IgA levels in BAL; (iv) the induction of anti-field strain-neutralizing antibodies by MLV PRRSV-2 vaccination was both late and limited; (v) cellular immune responses were variable but included strong systemic IFN-γ production against the PRRSV-2 field strain; (vi) the most detected lung pathogens correlated with PRRSV-2 viremia or lung loads; (vii) within the six detected pathogens, two viruses, PRRSV-2 and PCMV, significantly correlated with the severity of the clinical outcome. Conclusions: While a simple and conclusive answer to the multifaceted nature of PRDC remains elusive, the key lessons derived from this unique study provide a valuable framework for future research on porcine respiratory diseases. Full article

This paper investigated the impact of repeated bushfire exposure on the properties of four different types of lightweight aggregate (i.e., expanded perlite, pumice, diatomite and expanded glass) masonry blocks for use in the external walls of bushfire shelters and buildings in bushfire-prone areas. First, the properties of cement, sand and lightweight aggregates were determined. Then, 15 different masonry block cement mixes—control, expanded perlite, pumice, diatomite and expanded glass mixes—were developed using the absolute volume method and lightweight aggregate cement mixes were developed by replacing sand in the control mix with lightweight aggregate on an equal volume basis. The test specimens cast included 100 mm diameter cylinders and 90 mm solid masonry blocks. Prior to bushfire exposure, the density and ambient compressive strength of the cement mixes were determined. Then, masonry blocks were exposed to bushfire flame zone conditions (BAL-FZ) for the first time and then for a second time (i.e., repeated exposure) and the effect of these exposures on the bushfire resistance and compressive strength (i.e., residual strength) of the masonry blocks was examined. The results obtained for the newly developed lightweight aggregate blocks were compared with those of the control block and two different commercially available solid blocks (i.e., Com 1 and Com 2). The control block recorded the highest temperature rises (69 and 84 °C), heating rates (1.26 and 1.47 °C/min) and compressive strength reductions (10.2 MPa) upon first-time and repeated bushfire exposure. The inclusion of lightweight aggregates in the masonry block mix lowered the temperature rises (between 17 and 61 °C) and heating rates (between 1.07 and 0.19 °C/min) on the ambient surface and also resulted in compressive strength reductions (between 3.2 and 9.0 MPa) during first-time and repeated bushfire exposure. Only the diatomite block (D60; block made with 60% diatomite aggregate) and commercial lightweight block (Com 2) remained within the interior temperature limits for bushfire shelters after both the first exposure and repeated exposure. However, only the D60 block satisfied the loadbearing strength requirement of 5 MPa even after repeated exposure. Therefore, considering the need to comply with the temperature limit on the interior surfaces of bushfire shelters during first-time and repeated exposure and to satisfy the loadbearing strength requirement of solid masonry units even after repeated bushfire exposure, the block made with 60% diatomite aggregate is recommended for use in the external walls of buildings in bushfire-prone areas. Full article

Background/Objectives: Febrile neutropenia is a frequent and potentially life-threatening complication in pediatric oncology patients receiving chemotherapy. Due to profound immunosuppression, early diagnosis of infections remains a major clinical challenge. This review evaluates the diagnostic and prognostic utility of infection biomarkers in children with chemotherapy-induced severe neutropenia. Methods: We reviewed clinical studies that assessed the diagnostic performance of inflammatory biomarkers—including C-reactive protein (CRP), procalcitonin (PCT), interleukins (IL-6, IL-8, IL-10), and others—in pediatric febrile neutropenia. The review includes data on sensitivity, specificity, predictive value, and clinical applications. Results: CRP remains a common but nonspecific marker, often insufficient for early stratification. PCT showed consistently high negative predictive value and early responsiveness to bacterial infections. IL-6 and IL-10 demonstrated strong early diagnostic accuracy in the early phase (AUC > 0.80 in multiple studies) and were particularly useful in predicting septic shock when combined. IL-8, while less specific, may help rule out infection when levels are low. Emerging biomarkers such as presepsin, MR-proADM, and PSP showed promising diagnostic performance. Presepsin achieved near-perfect accuracy in some cohorts (AUC up to 0.996), outperforming CRP and PCT, though its ability to discriminate bacteremia at fever onset varied. MR-proADM demonstrated consistent AUCs above 0.75 and may support early sepsis identification. PSP was associated with significantly elevated levels in sepsis. Additional novel markers—including sTNFR-II, sIL-2R, IP-10, Flt-3L, MCP-1-a, and MBL—showed encouraging diagnostic profiles in individual studies, particularly due to high specificity, but require external validation. G-CSF also emerged as a promising candidate in multimarker models. In contrast, TNF-α and IL-1β displayed limited utility as standalone indicators. Conclusions: Biomarkers such as PCT, IL-6, Il-8, and IL-10 offer valuable tools for early infection detection and risk stratification in pediatric febrile neutropenia. Emerging markers—including presepsin, MR-proADM, and PSP—further enhance diagnostic precision and may support early identification of sepsis. Multimarker strategies, particularly those incorporating presepsin, IL-10, or MR-proADM, show potential to improve diagnostic performance beyond conventional markers. Further prospective validation is needed to optimize clinical implementation and guide personalized treatment decisions. Full article

The search for waste management opportunities is crucial for achieving environmentally friendly waste practices and ensuring the country’s energy security. This research aimed to valorize biomass and waste generated in greenhouses and to analyze the potential for electricity production from this waste. The analyses compared the situations in Turkey and Poland, where greenhouse production of vegetables is developing and constitutes an important link in agricultural activities, despite differences in climatic conditions. The cultivation of vegetables and flowers under cover is rapidly expanding in both countries and, with changing climatic conditions, is expected to shape the future of agriculture. In addition to estimating the energy that can be obtained, the study also evaluated the economic benefits of such a solution and the volume of avoided CO₂ emissions from fossil fuels. The issue of utilizing these wastes is significant because current methods of their management do not lead to energy production, so their considerable energy potential is wasted, as highlighted in this study. Moreover, there is a lack of similar studies in the literature. The plant species chosen as materials in this study were tomatoes, peppers, eggplant, watermelon, and melon in the case of Turkey. For Poland, the analysis was conducted for tomatoes and greenhouse cucumbers. These crops represent the largest cultivated areas under cover in the respective countries. Results indicated that the average yearly amount of vegetable residue is approximately 463 thousand Mg in Turkey, and 77 thousand Mg in Poland. The estimated annual electricity potential is 430 GWh in Turkey and 80 GWh in Poland. Considering the efficiency of power generation in a typical power plant, the real amount of electricity to be obtained is 0.46 MWh per Mg of waste in Turkey and 0.52 MWh in Poland. Full article