Search Results (11,296)

Periodontitis (PD) and rheumatoid arthritis (RA) are chronic inflammatory disorders that impose substantial individual and societal burdens worldwide. PD is characterized by progressive destruction of the periodontal ligament and alveolar bone, leading to tooth loss, impaired oral function, and sustained systemic inflammatory burden. RA, affecting approximately 0.5–1% of the population, is a chronic autoimmune disease marked by persistent synovial inflammation, progressive joint destruction, disability, and reduced quality of life. Increasing evidence indicates that these conditions are biologically and clinically interconnected. Both diseases share key pathogenic pathways, including microbial dysbiosis, immune dysregulation, chronic inflammation, genetic susceptibility, and aberrant autoantibody responses. Particular attention has focused on keystone periodontal pathogens such as Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans, which may promote protein citrullination and the formation of anti-citrullinated protein antibodies (ACPA), thereby providing a plausible mechanistic bridge between periodontal infection and systemic autoimmunity. Shared genetic risk factors, including HLA-DRB1 susceptibility alleles, further support a common host predisposition. Clinical, epidemiological, and translational studies increasingly support a bidirectional association. Individuals with PD appear to have a higher risk of RA development, whereas patients with RA demonstrate greater prevalence, severity, and progression of periodontal disease. Interventional studies suggest that nonsurgical periodontal therapy may reduce local periodontal inflammation, circulating inflammatory biomarkers, and RA disease activity indices, while effective pharmacological control of RA may also improve periodontal outcomes. This narrative review critically evaluates the PD–RA relationship across four interconnected domains: (i) epidemiological and clinical associations between PD and RA, (ii) key mechanisms underlying RA pathogenesis, (iii) shared biological pathways linking both diseases, and (iv) the extent to which treatment of one condition influences the other. Particular emphasis is placed on major sources of heterogeneity and confounding—including smoking, metabolic comorbidities, disease stage, therapeutic exposure, and variable diagnostic definitions—that may explain inconsistencies across the literature. By integrating current mechanistic and clinical evidence, this review provides a structured synthesis that extends beyond a descriptive overview of association studies. A clearer understanding of the periodontal–rheumatologic axis may facilitate risk stratification, identify novel therapeutic targets, and support integrated multidisciplinary care. Targeting both oral and systemic inflammation may improve outcomes in patients with coexisting PD and RA and may potentially reduce the risk or severity of one condition in individuals already affected by the other. Full article

The evaluation of intervention strategies for the existing building stock, within the context of energy transition and increasing attention being given to sustainability, requires approaches capable of systematically integrating economic and environmental dimensions over the entire building life cycle. From this perspective, the present study develops and applies an integrated Life Cycle Costing (LCC) and Life Cycle Assessment (LCA) model aimed at comparing two alternative intervention strategies for traditional residential buildings: conservative retrofit of the existing structure and demolition with reconstruction according to Nearly Zero Energy Building (NZEB) criteria. The methodological framework, compliant with ISO 15686-5 and based on a simplified LCA-oriented approach inspired by EN 15978 principles, is applied to a representative case study of Swedish vernacular wooden architecture (röd stuga) located in the municipality of Falun. The assessments are carried out over 50- and 100-year time horizons, adopting Net Present Value (NPV) as the primary economic indicator and Global Warming Potential over 100 years (GWP100) and Cumulative Energy Demand (CED) as environmental indicators. The results show that the NZEB scenario, despite higher initial investment costs, achieves a significant reduction in life-cycle environmental impacts, with a decrease of approximately 20–25% in terms of GWP100 and about 45–50% in terms of CED compared to the retrofit scenario. The analysis also highlights a differentiated behavior of environmental indicators—while operational energy use remains dominant in cumulative energy demand, embodied impacts become increasingly significant in the GWP balance, particularly in high-performance scenarios. From an economic perspective, conservative retrofit results in lower global costs over the considered time horizons, although the economic gap tends to narrow in the long term. The integrated LCC–environmental assessment approach highlights the economic–environmental trade-offs and provides a replicable decision-support framework for sustainable regeneration policies targeting the existing residential building stock. Full article

Vermicomposting is an environmentally sustainable, economically viable, and agronomically valuable method for converting organic waste into nutrient-rich soil amendments, thereby supporting sustainable development. However, the fertilization efficiency of vermicompost can vary significantly depending on the physicochemical properties of the feedstock used. This study aims to compare different feedstocks on vermicompost and evaluate their performance on soil fertility and plant nutritional status. Organic matter (OM), pH, salinity (EC), total Kjeldahl nitrogen (TKN), total phosphorus (TP) and total potassium (TK) of various vermicompost samples were taken into consideration to evaluate their fertilization efficiency as performance determinants in terms of plant growth, plant nutritional status, yield, crop quality and cost with the aim of determining the weights of the specific parameters in the total performance using multi-criteria decision-making (MCDM) methods. The integrated ENTROPY-TOPSIS method was used. Twenty-one different vermicompost feedstock analyses were collected from the literature and compared in order to create an agronomic performance ranking based on the selected criteria. The ENTROPY method revealed that the TP was the most influential factor (21.6%), followed by the EC (20.7%) and the TK (18.5%), while the OM had the lowest impact (11.3%). Based on the TOPSIS ranking, vermicompost from brewer’s spent grain achieved the highest performance, followed by cow manure plus rice straw and olive pruning waste, whereas paper waste ranked at the bottom. A comparative analysis with other objective MCDM weighting methods proved strong correlations, particularly with WENSLO, MPSI and LODECI methods, confirming the robustness of the ENTROPY method. Full article

Background and Objectives: Small bowel obstruction (SBO) is a common surgical emergency, accounting for 15–20% of acute general surgical admissions. Despite the Bologna Guideline’s introduction to the surgical community almost a decade ago, adherence to it remains variable. The therapeutic role of contrast media and the optimal timing of its administration remain a matter of debate. This study aimed to compare SBO resolution rates according to the timing of water-soluble contrast media (WSCM) administration. Materials and Methods: A prospective, randomised pilot trial was conducted at two regional hospitals in Estonia. Patients hospitalised with adhesive or virgin abdomen SBO were randomised to receive WSCM at either 4 h or 24 h after admission. Results: A total of 128 patients were enrolled, with 63 assigned to the 4 h group and 65 to the 24 h group. SBO resolved with conservative management in 74.6% of patients in the 4 h group and 73.8% in the 24 h group. Rates of surgical intervention and bowel resection due to necrosis were comparable between groups. Univariable and multivariable analyses showed no significant association between early administration and improved resolution. A prior history of SBO was associated with a higher likelihood of successful non-operative management. Conclusions: conservative management of SBO is safe and effective, and early WSCM administration did not provide a clear additional benefit in this cohort with respect to resolution or surgical outcomes. A prior history of SBO was associated with a higher likelihood of successful conservative management in this cohort. Larger multicentre studies are warranted to further define the optimal timing of contrast administration and to compare isotonic and hyperosmolar agents with respect to clinical outcomes. Full article

Since their discovery almost 60 years ago, BL Lac objects have been defined by their strong optical variability and their classification in the spectral energy distribution scheme. High-synchrotron-peaked BL Lacs (HBLs) are those whose synchrotron component peaks at frequencies higher than UV/X-rays. Historically, optical variability studies have focused mostly on their counterparts, low-synchrotron-peaked BL Lacs (LBLs), since HBLs have shown weaker optical variability. However, a population-wide study of HBL optical variability is still lacking, and it remains unclear whether HBLs are intrinsically less optically variable as a class or whether this reflects observational biases. Only a handful of HBL sources have been studied extensively due to their strong variability and reported periodicity. These sources have motivated several theoretical models, often conflicting, to explain the optical variability when present. Nevertheless, understanding the connection between the apparent weaker optical variability and the emission processes of HBLs remains a challenge. In this work, we review the current state of knowledge on this topic, with the expectation that upcoming optical monitoring observatories, such as the Vera C. Rubin, will provide new insights into the optical emission (and variability) mechanisms in HBLs. Full article

Background: The impact of climate change on birds’ migration and ticks’ reservoir habits is contributing to the spread of Crimean–Congo hemorrhagic fever (CCHF), caused by CCHF virus (CCHFV), to new continents and countries. CCHF is endemic to the Eastern Mediterranean Region, including Iraq, and is witnessing a substantial surge in confirmed cases with considerable disparity and gaps in managing CCHF cases. The increasing CCHF spread across Asia, Africa, and Europe, including Spain and Turkey, highlights the danger of its expansion. Developing high-confidence diagnostic criteria, identifying risk factors, and accurate predictors of CCHF outcomes are critical to managing suspected and confirmed cases of CCHF and to reducing the current case fatality rate of CCHF, which is the goal of this study. Methods: We completed a retrospective evaluation of 61 confirmed cases of CCHF in Basrah (Iraq). The cases were screened according to the clinical presentation, and CCHF cases were identified by ELISA and validated by PCR. Data was analyzed using SPSS version 22. T-tests, chi-square/Fisher exact tests, and Pearson’s correlation were used, with significance set at p < 0.05 and high significance at p < 0.01. Results: We found that repeated exposure to animals during animal slaughtering was a significant risk factor. In addition, 5% of the patients with confirmed CCHF, mainly from rural areas, reported exposure to rats. Clinical presentations included fever, headache, gastrointestinal problems, eye and orbital symptoms, and hemorrhagic complications. Predictors of death included advanced age, decreased platelet counts, and neuropsychiatric symptoms such as delusions and confusion. Conclusions: Our findings identify clinical and laboratory features of CCHF cases in Iraq, which will help to implement the most effective interventions to manage CCHF cases and protect the public in all Iraqi governorates. In summary, this study highlights a recent and significant rise in CCHF cases in Basrah Governorate, Iraq. Notably, 5% of confirmed cases reported contact with rats. The paper also proposes diagnostic criteria and identifies key predictors of mortality to support improved clinical management of CCHF. These findings underscore the urgent need for strengthened public health interventions, including enhanced infection prevention and control measures, increased awareness, and improved surveillance systems. The findings have important implications for improving control procedures, guiding therapeutic development, informing vaccine strategies, and supporting evidence-based policy alongside future research efforts. Full article

Background/Objectives: Caregiver burden is a relevant dimension of the caregiving experience among informal caregivers of cancer patients and is associated with psychological, physical, and social consequences. Although several instruments are available to assess the phenomenon, there is still limited consistency in the tools used across empirical oncology studies. Methods: A systematic review was conducted according to the PRISMA 2020 statement. A literature search was carried out in PubMed, Scopus, Web of Science, CINAHL, and PsycINFO up to February 2026. Quantitative studies assessing caregiver burden using standardized instruments in informal caregivers of adult cancer patients were included. Results: Thirteen studies met the eligibility criteria. The most frequently used instruments were the Zarit Burden Interview, followed by the Caregiver Burden Inventory. Less frequently used instruments included the Caregiver Reaction Assessment and the Caregiver Burden Scale. Most included studies relied on generic caregiver burden instruments originally developed outside oncology-specific contexts. Conclusions: Considerable heterogeneity exists in the instruments used to assess caregiver burden in oncology research. Empirical studies continue to rely predominantly on generic caregiver burden scales, while oncology-specific tools appear to be underused. Greater consistency in instrument selection may improve comparability across studies and support the integration of caregiver assessment into oncology practice. Full article

Understanding how P availability affects root turnover and P redistribution within plants is essential for optimizing fertilization strategies and sustaining forest growth under low-P soils. This study evaluated the effects of P fertilization on root system dynamics, plant growth, and P nutrition of Handroanthus heptaphyllus, a flowering landscape tree, cultivated in a subtropical climate. Plants were grown under two soil P levels (low and high). Plant height, stem diameter, leaf P concentration, soil P availability, total numbers of living and dead fine roots, total fine root surface area, and fine root production rate were measured at 18, 24, 30, and 36 months after planting. Phosphate fertilization increased soil P availability during the first 24 months and resulted in significant gains in plant height, stem diameter, fine root production, total surface area, and the ratio between living and dead fine roots, indicating a higher proportion of living roots relative to dead ones. Under high P availability, the greatest fine root production and surface area of living fine roots occurred in the 0–20 cm soil layer, reflecting localized P application near the plants. High P availability enhanced root system development, promoted greater soil exploration, and improved P uptake. These results indicate that under P supplementation, plants strategically invest in root growth, improving nutrient acquisition efficiency and reducing dependence on external inputs. Increased phosphorus availability enhances root growth and increases fine root production and turnover. Minirhizotron monitoring effectively captured shifts in root system dynamics driven by P availability, including enhanced root growth, increased fine root production and turnover, and improved nutrient uptake under high P, as well as limited root activity under low P conditions, indicating a more conservative strategy with reduced investment in root production. Full article

Background/Objectives: The co-production of New Delhi metallo-β-lactamases (NDM) and OXA-48-like carbapenemases in Klebsiella pneumoniae represents a major therapeutic challenge due to extensive drug resistance and limited treatment options. This study aimed to investigate the molecular epidemiology, resistance profiles, and mechanisms associated with reduced susceptibility to cefiderocol in clinical isolates co-producing NDM and OXA-48-like carbapenemases. Methods: A total of 45 clinical K. pneumoniae isolates collected in healthcare settings in Northern Italy were analyzed. Antimicrobial susceptibility testing, including cefiderocol and aztreonam/avibactam, was performed according to EUCAST guidelines. Whole-genome sequencing was used to characterize sequence types, resistance determinants, virulence factors, plasmid replicons, and phylogenetic relationships. Mutations in iron uptake and transport genes were investigated in cefiderocol-resistant isolates. Results: Most isolates belonged to the high-risk clone ST147 (44/45) and were grouped into three main phylogenetic clusters. The isolates exhibited extensive multidrug resistance, with universal susceptibility only for aztreonam/avibactam. Cefiderocol resistance was observed in 42.2% of isolates and was unevenly distributed across the phylogeny. Mutations in iron uptake genes, particularly cirA and chrA, were identified in the majority of resistant isolates, although several strains retained wild-type sequences, indicating heterogeneous resistance mechanisms. Comparative phylogenetic analysis demonstrated close relatedness to international isolates, suggesting the global dissemination of related lineages. Conclusions: NDM- and OXA-48-like carbapenemase co-producing K. pneumoniae isolates are characterized by clonal dissemination, complex resistance profiles, and emerging cefiderocol resistance driven by multifactorial mechanisms. The preserved activity of aztreonam/avibactam highlights its potential as a key therapeutic option against these high-risk pathogens. Full article

Evidence suggests that a gluten-free diet may increase the risk of metabolic abnormalities associated with cardiovascular disease in adults with Coeliac Disease (CeD). This 9-week, double-blind, placebo-controlled, randomised pilot study investigated the effects of a combined supplement containing probiotic Lactiplantibacillus plantarum ECGC 13110402 and plant sterols and stanols, on cardiometabolic biomarkers and gut microbiota diversity and composition in adults with CeD and hypercholesterolaemia. Blood lipid profiles and vitamin D concentrations were analysed, and gut microbiota was profiled via 16S rRNA amplicon sequencing. In the active group, significant reductions in total cholesterol, LDL-cholesterol, non-HDL cholesterol, and apolipoprotein B were observed at multiple time points during the treatment phase, with changes generally greater in magnitude compared with the placebo group. Vitamin D levels also increased in the active group during supplementation. Microbiota analysis revealed potentially beneficial changes in participants receiving the active formulation, including higher alpha diversity and higher proportions of Bifidobacterium spp., Christensenellaceae R-7 group, and Lachnospiraceae ND3007 group. Overall, this feasibility study provides exploratory findings that a combined Lactiplantibacillus plantarum ECGC 13110402-phytosterol formulation may support lipid management and beneficially modulate gut microbiota in adults with CeD, particularly for those seeking non-pharmacological approaches to improving cardiometabolic health biomarkers. Full article

Background and Clinical Significance: This case highlights the management of chronic extensor carpi ulnaris (ECU) tenosynovitis in a patient exposed to non-traditional wrist-loading activities. Exercise therapy rehabilitation is well established in shoulder and knee tendinopathies, although it remains less well described for wrist tendinopathies beyond De Quervain’s disease. Moreover, the patient’s active engagement in non-traditional, wrist-intensive sports such as handstands, slacklining, and yoga may have contributed to the development and persistence of chronic extensor carpi ulnaris (ECU) tenosynovitis. Unlike more common ECU injuries observed in tennis or golf players, this case demonstrates how ECU tenosynovitis can develop in less conventional sports. It adds to the scientific literature by showing that chronic ECU tenosynovitis can be effectively managed through non-surgical rehabilitation tailored to the specific needs of the patient, in particular by using exercise therapy. Case Presentation: The patient presented with chronic left wrist pain, especially during ulnar deviation and resisted ECU testing, following two traumatic events. Examination revealed limited range of motion caused by pain, particularly in flexion, extension, and both ulnar and radial deviations. Ultrasound imaging confirmed ECU tenosynovitis with mild inflammation of other wrist tendons and a small synovial cyst on radio-scapho-lunate level. ECU stability during forearm rotation was confirmed both clinically and by ultrasound.  The diagnosis of chronic ECU tenosynovitis was managed conservatively with a targeted rehabilitation program focused on isometric strengthening and progressive resistance exercises. Over one month, the patient demonstrated marked improvement in wrist strength, pain reduction, and functional capacity, allowing for a gradual return to sporting activities. Conclusions: The main takeaway from this case is that chronic ECU tenosynovitis can be successfully managed through individualized, conservative treatment based on exercise therapy. Early intervention, patient adherence, and rehabilitation tailored to the athlete’s specific demands are crucial for recovery, even in chronic cases, without the need for surgical intervention. Full article

Objectives: This systematic review and meta-analysis aimed to evaluate the role of diode and Nd:YAG lasers as adjuncts to scaling and root planing (SRP) in the non-surgical treatment of moderate-to-severe periodontitis. Methods: The protocol was registered in PROSPERO (CRD420250603025) and conducted following PRISMA guidelines. A comprehensive search in Scopus, PubMed, and Cochrane CENTRAL (up to October 2024) identified randomized controlled trials (RCTs), prospective, and retrospective controlled clinical studies comparing SRP alone versus SRP plus adjunctive laser therapy. The primary outcome was probing pocket depth (PPD); secondary outcomes were bleeding on probing (BoP) and the clinical attachment level (CAL). Risk of bias was assessed using Cochrane RoB 2.0 tool for RCTs and Newcastle–Ottawa Scale for non-RCTs. Meta-analysis was undertaken when at least three studies presenting the same outcome at the same follow-up were found. Results: Nine studies with follow-ups from 3 to 120 months were included, representing a total of 423 participants. Both groups showed PPD reduction at all time points, with pooled analyses revealing no statistically significant differences (mean difference −0.12 to −0.35 mm; p > 0.05), although point estimates often favored laser-treated sites, particularly when baseline PPD ≥ 6 mm. Subgroup analysis showed significantly greater PPD reduction in laser-treated sites compared to SRP alone at 12 months in deep pockets (p = 0.001). These findings should be interpreted with caution, given their exploratory nature, limited sample size, and high heterogeneity. Similar patterns were observed for CAL and BoP, with substantial heterogeneity (I² > 70% at several time points). No adverse events were reported. Conclusions: Within the limitations of the available evidence, adjunctive diode and Nd:YAG laser therapy does not demonstrate consistent statistically significant differences compared to SRP alone in non-surgical periodontal treatment. While a potential adjunctive effect may be observed under specific clinical conditions, particularly in deeper pockets, current evidence is insufficient to support its superiority. Full article

Sarcoidosis is a multisystemic inflammatory disease defined by non-caseating granuloma formation in involved organs. The liver is the third most implicated organ after the lungs and lymph nodes. Due to its frequently asymptomatic presentation, the true prevalence of hepatic sarcoidosis may be understated. Increased levels of alkaline phosphatase and gamma-glutamyl transferase are the most frequent biochemical abnormalities. The liver biopsy is still the gold standard and reveals non-caseating granulomas in almost all cases. The use of corticosteroids and ursodeoxycholic acid results in a significant decrease in biochemical parameters. However, the clinical course of hepatic sarcoidosis is diverse and requires individualized management strategies, especially to prevent hepatic complications. This review aims to synthesize the current evidence on epidemiology, pathogenesis, diagnostic approaches, and therapeutic strategies for this disease. Full article

The increasing demand for reliable and high-performance electric vehicle (EV) batteries requires precise and defect-free welding of battery components. Conventional Gaussian laser beam welding faces challenges such as keyhole instability, spattering, porosity, and brittle intermetallic compound formation, particularly in dissimilar Al-Cu joints. These issues significantly affect the electromechanical performance and durability of battery connections. Beam shaping technology has emerged as a core method for improving weld quality, process stability, and efficiency in laser welding, making laser beam welding increasingly vital for high-volume production of e-mobility components. This review systematically evaluates recent advancements in laser beam shaping for laser welding, especially static beam configurations, such as core-ring profiles, flat top, elliptical, and shaped beams; emphasis has been placed on how altering the intensity distribution influences the challenges associated with conventional welding and emerges as an effective solution to address these challenges. By tailoring the spatial energy distribution, beam shaping improves control of heat input, stabilizes melt pool dynamics, and enhances microstructural uniformity. Static beam shaping, compatible with cost-effective near-infrared continuous-wave laser systems, is already being adopted in industry, whereas dynamic beam shaping remains at an earlier stage of industrial maturity. This review highlights key welding challenges in EV battery manufacturing, evaluates beam shaping strategies as practical solutions, and identifies future research directions for large-scale industrial implementation. Full article

The fresh-cut avocado processing generates significant amounts of by-products, mainly peel and seed, with the peel representing a valuable source of phenolic compounds. In this context, the growing demand for sustainable technologies encourages the use of green solvents for bioactive compound recovery. In this study, natural deep eutectic solvents (NaDES) were evaluated as environmentally friendly solvents for the extraction of phenolic compounds from Hass avocado peels through ultrasound-assisted extraction and for their potential application in fresh-cut avocado. Phenolics were extracted using acidic water, ethanol, and NaDES based on choline chloride as a fixed hydrogen bond acceptor (HBA) and hydrogen bond donors (HBDs; lactic acid, glycerol, and citric acid) with the ultrasound-assisted system. The stability of the extracts was monitored for eight weeks (four weeks in darkness followed by four weeks under light exposure). Among the tested formulations, the lactic-acid-based NaDES showed the highest extraction efficiency and the best stability of phenolic compounds during storage (≥20 mg GAE g⁻¹ dw during the storage period). The lactic-acid-based extract was then applied to fresh-cut avocado to evaluate its potential for antioxidant enrichment and browning prevention during refrigerated storage. The treatment increased phenolic content and contributed to improved color stability (during seven days of storage). Overall, lactic-acid-based NaDES represent a promising green solvent system for recovering phenolics from avocado peel and for their functional application in fresh-cut avocado within a circular valorization approach. Full article