Search Results (450)

Background: CAD/CAM dental ceramics are widely used for indirect restorations because of their favorable esthetic properties, biocompatibility, and mechanical performance. However, long-term exposure to thermal fluctuations, moisture, and cyclic loading may compromise their structural integrity. This systematic review and meta-analysis evaluated the effect of artificial aging protocols on the mechanical properties of CAD/CAM dental ceramics. Methods: A systematic search was conducted in PubMed, Embase, Scopus, Web of Science, LILACS, Google Scholar, and ProQuest from inception to June 2026. In vitro studies evaluating CAD/CAM ceramics subjected to thermocycling and/or artificial aging protocols were included. The primary outcomes were flexural strength and fracture resistance. Random-effects meta-analyses were performed using standardized mean differences (SMDs) or pooled means with 95% confidence intervals (CIs). Subgroup analyses were conducted according to ceramic category, and sensitivity analyses were performed using a leave-one-out approach. Results: Five studies comprising 16 independent comparisons were included in the flexural strength meta-analysis, while five studies contributed 11 comparisons to the fracture resistance analysis. Artificial aging protocols significantly reduced the flexural strength of CAD/CAM ceramics (SMD = −1.68; 95% CI: −2.28 to −1.08; p < 0.00001). The greatest reduction was observed in zirconia-based ceramics (SMD = −3.31), followed by hybrid/PICN ceramics (SMD = −1.37) and lithium disilicate/lithium silicate ceramics (SMD = −1.25). Feldspathic and glass-based ceramics showed no significant reduction. The pooled fracture resistance after aging was 1312.85 N (95% CI: 1131.59–1494.10 N), indicating that most CAD/CAM ceramics maintained clinically relevant fracture resistance despite aging. Conclusions: Artificial aging protocols adversely affect the flexural strength of CAD/CAM dental ceramics, particularly zirconia-based materials. Nevertheless, fracture resistance generally remains within clinically acceptable ranges. Material composition plays a critical role in determining susceptibility to aging-related degradation, highlighting the importance of ceramic selection for long-term restorative performance. Full article

Objective: To explore the associations of preoperative waiting time with the incidence of intraoperative blood transfusion and transfusion volume among older patients with hip fracture, to inform perioperative blood management and optimize surgical timing. Methods: Older patients aged ≥65 years who underwent hip fracture surgery at a tertiary trauma center in Northwest China between 1 January 2015 and 30 September 2019 were included. The primary exposure variable was preoperative waiting time. The outcome indicators included intraoperative transfusion status and total transfusion volume. Logistic regression was used for binary transfusion outcomes, and general linear regression was applied for continuous transfusion volume. Multivariate regression models were established to adjust for confounders after univariate screening, and stratified analyses were performed to explore population heterogeneity. Results: A total of 2836 eligible patients were included in this study. The mean age of all participants was 79.52 ± 6.68 years, including 2100 cases of intertrochanteric fracture and 736 cases of femoral neck fracture. Intraoperative blood transfusion was administered in 1415 patients (49.9%). Fully adjusted analyses revealed that each one-day increase in preoperative waiting time was associated with a 6% higher odds of intraoperative transfusion (odds ratio [OR] = 1.06, 95% confidence interval [CI]: 1.02–1.10, p = 0.0007) and a 0.03-unit increase in transfusion volume (β = 0.03, 95%CI: 0.02–0.05, p < 0.0001). However, no independent association was observed for massive transfusion. The associations were generally consistent across strata despite apparent numerical differences (p for interaction tests > 0.05). Conclusions: Among older patients undergoing hip fracture surgery, longer waiting time was associated with higher transfusion risk. These findings highlight the critical importance of optimizing perioperative pathways to minimize surgical delays. Because residual confounding and inability to distinguish medical from administrative delay remain important limitations, these findings should be interpreted as an association rather than proof that surgical delay causes increased transfusion requirements. Full article

The Stress-Repressive Zinc Finger (SRZ) family is a class of zinc finger proteins in plants that has been closely associated with plant growth, development, and stress responses. In this study, we conducted a genome-wide identification of the SRZ family members and identified 14 and 10 members in rice and Arabidopsis, respectively. We further characterized their phylogenetic relationships, gene structures, conserved motifs, promoter cis-elements, synteny, and spatiotemporal expression patterns. To investigate the functional role of this family in rice, we generated targeted mutants of OsSRZ1 using the CRISPR/Cas9 system. Phenotypic analysis revealed that srz1 knockout mutants exhibited significantly reduced plant height. Notably, the homozygous mutant srz1 completely failed in panicle exsertion from the flag leaf sheath, resulting in complete enclosure, whereas the heterozygous mutant srz1(h) exhibited only partial panicle exsertion. Further cytological observations revealed abnormal floral organ development and premature anther senescence in srz1, accompanied by a significant reduction in seed setting rate—srz1(h) set significantly fewer seeds, whereas srz1 exhibited complete sterility with a seed setting rate of 0%. Collectively, these findings suggest that members of the SRZ family may play important roles in rice growth and development. Our results demonstrate that OsSRZ1 is a critical regulator of plant height and panicle exsertion by regulating internode elongation, and that its disruption leads to premature anther programmed cell death (PCD) and consequent seed setting failure. Full article

Akebia trifoliata is an important Chinese traditional medicinal plant, and its abundant triterpenoids are the primary active medicinal components. However, the oxidosqualene cyclase (OSC) gene family responsible for constructing their triterpenoid skeletons has not yet been systematically characterized. In this study, nine AktOSC genes were identified genome-wide in A. trifoliata. Phylogenetic analysis revealed that most AktOSC members formed independent evolutionary subclades. Synteny and selective pressure analyses indicated that multiple duplication modes collectively contributed to the expansion of the AktOSC family, and all members were subjected to strong purifying selection. Sequence alignment showed that all members possess the characteristic motifs of the OSC family, whereas amino acid substitutions at critical active-site residues hinted at potential catalytic product diversity. Cis-acting element prediction revealed an abundance of environmental and phytohormone responsiveness elements within the AktOSC promoter regions. Expression profiling revealed that AktOSC genes exhibited distinct expression patterns across tissues, developmental stages, and disease-susceptibility groups. Finally, AktOSC8, which was specifically and highly expressed in the pericarp, was identified as a highest-priority candidate gene. Collectively, these findings provide essential foundational insights for further elucidating the mechanisms underlying triterpenoid biosynthesis and accumulation in A. trifoliata. Full article

Background: Pulmonary hypertension (PH)-complicating interstitial lung disease (ILD) is a devastating condition that severely limits exercise capacity, diminishes quality of life (QOL), and ultimately determines survival. The pathophysiological assessment of ILD-PH has traditionally focused on right ventricular (RV) parameters reflecting RV pressure overload and dysfunction. However, under extreme RV pressure overload where blood supply to the left heart is severely restricted, the prognostic role of left ventricular (LV) function—which is ultimately responsible for maintaining systemic cardiac output—remains poorly understood. This study aimed to comprehensively evaluate the hemodynamics of ILD patients using non-invasive transthoracic echocardiography, to determine the prognostic importance of LV functional parameters, particularly left ventricular ejection fraction (LVEF). Methods: This single-center, retrospective, observational study included 415 ILD patients diagnosed and treated at the Kanagawa Cardiovascular Respiratory Center. All patients underwent transthoracic echocardiography at diagnosis, from which parameters such as estimated right ventricular systolic pressure (RVSP), tissue Doppler-derived Average e’, and LVEF were obtained. A multivariable Cox proportional hazards model was applied to evaluate the association between these echocardiographic parameters and all-cause mortality. To account for the prognostic impact of the underlying disease, we conducted a stratified analysis of idiopathic pulmonary fibrosis (IPF) and non-IPF cohorts. Furthermore, to evaluate LV function under the most severe hemodynamic compromise, a subgroup analysis was restricted to IPF patients with elevated RVSP (≥median). Results: During a median follow-up of 27.2 months, 75 (18.1%) of the 415 patients died. In the multivariable Cox analysis of the overall cohort, a decreased Average e’ (HR 0.861, p = 0.0038) emerged as a strong independent predictor of poor prognosis. Stratified analysis revealed that in the non-IPF group (n = 208, 15 events), none of the variables achieved statistical significance. Conversely, in the IPF group (N = 207, 60 events), both LV diastolic function (Average e’, p = 0.0199) and LV systolic function (LVEF, HR 0.969, 95% CI 0.940–0.998, p = 0.0305) were extracted as significant prognostic predictors. Most notably, in the stepwise multivariable model restricted to the “IPF with high RVSP” subgroup (N = 104), the prognostic significance of diastolic function (Average e’) was lost (p = 0.4577), whereas LVEF (HR 0.965, 95% CI 0.936–0.995, p = 0.0229) emerged as the sole independent predictor of mortality. Conclusions: In the overall ILD-PH cohort, reduced LV diastolic function (Average e’) is a strong independent predictor of mortality. While elevated RVSP and low BMI showed a trend toward worsening prognosis, they were not statistically significant in multivariable analysis. The prognostic contribution of LV function is primarily driven by the IPF patient group, which has an inherently poor prognosis. Furthermore, in the severe subgroup of IPF patients heavily burdened by right heart overload, LV pump function (LVEF) becomes an independent, critical determinant of ultimate survival. Therefore, routine measurement and careful monitoring of the universal parameter LVEF are of paramount importance for the risk stratification of high-risk patients under such complex hemodynamics. Full article

Nanoplastics (NPs; <1000 nm) are persistent soil contaminants that suppress extracellular enzyme activity, the biochemical engine of terrestrial nutrient cycling. Despite a rapidly expanding primary literature, no comprehensive meta-analysis has systematically integrated quantitative effect-size synthesis with interpretable machine learning (ML) approaches to identify and rank the physicochemical drivers of NP-induced soil enzymatic toxicity. Following the PRISMA 2020 statement, we systematically searched four databases (Web of Science, Scopus, PubMed, Google Scholar) from database inception through December 2024 and extracted 413 effect sizes from 113 peer-reviewed studies. Hedges’ g was estimated using three-level random-effects models with restricted maximum likelihood (REML) estimation implemented in the metafor package. Three supervised ML algorithms—random forest (RF), gradient boosting machines (GBMs), and support vector regression (SVR)—were trained using 18 study-level predictors derived from the complete meta-analytic dataset, and SHapley Additive exPlanations (SHAP) were applied to quantify and rank the relative importance of individual predictors. The overall meta-analysis demonstrated a significant inhibitory effect of NPs on soil enzyme activity (Hedges’ g = −0.94; 95% CI: −1.14 to −0.73; k = 413; I² = 78.4%; τ² = 0.412). Among the evaluated enzymes, dehydrogenase activity exhibited the greatest inhibition (g = −1.12), whereas polystyrene nanoplastics produced the strongest adverse effects (g = −1.15). Particles smaller than 100 nm caused approximately 2.6-fold greater inhibition than particles larger than 500 nm, and dose–response meta-regression identified a nonlinear increase in toxicity at concentrations exceeding 200 mg kg⁻¹. The RF model demonstrated the highest predictive performance, explaining 73% of the variance in an independent testing dataset (R² = 0.73; test set n = 83). SHAP analysis identified particle diameter as the most influential predictor, revealing an approximate critical threshold of 150 nm, below which inhibitory effects increased markedly. Higher soil organic carbon concentrations partially mitigated enzymatic inhibition, likely through competitive adsorption and reduced nanoplastic bioavailability. Overall, our findings demonstrate that NP-induced inhibition of soil enzymatic activity is widespread and primarily governed by particle size, exposure concentration, and soil properties. The identified 150 nm threshold should be interpreted as a data-driven hypothesis requiring further validation under environmentally realistic exposure scenarios rather than as a universal regulatory limit. Nevertheless, the integration of three-level meta-analysis with interpretable machine learning (SHAP) provides a robust and reproducible framework for identifying key toxicity drivers and supports future ecological risk assessment and evidence-based regulatory decision-making for nanoplastics. Full article

Objective: Varicella zoster virus (VZV), a member of the Herpesviridae family, is known as the causative agent of chickenpox (varicella). Following primary infection, VZV can remain latent for life and may reactivate over time to cause herpes zoster (shingles). Advanced age, immunodeficiency, and certain chronic illnesses are major risk factors for the development of herpes zoster. To prevent herpes zoster, a live zoster vaccine was licensed in 2006, followed by a recombinant zoster vaccine with higher efficacy in 2018. In Türkiye, the recombinant zoster vaccine was licensed in 2024. Raising awareness among healthcare workers is important both for their own health and the safety of vulnerable patients. This study aimed to evaluate healthcare workers’ knowledge and awareness of herpes zoster infection and zoster vaccines across the country, as well as to determine the prevalence of prior herpes zoster infection among them. Methods: After obtaining ethical approval, a nationwide multicenter survey was conducted. A questionnaire was distributed to healthcare workers via an online link. Participation was entirely voluntary. The survey collected demographic information (age, sex, profession, years of experience) and included questions on knowledge of herpes zoster, history of zoster infection, symptoms and severity (if applicable), awareness of the zoster vaccine, and vaccination attitudes. Results: A total of 5180 healthcare workers participated, of whom 3505 were female. The participants ranged in age from 18 to 79 years (mean age: 34.24 ± 11.52). Regarding professions: 47.9% were physicians, 21.3% were nurses or midwives, 0.8% were dentists or dental technicians, and 30% were from other healthcare professions. Among participants, 54.4% had ≤10 years of professional experience, 20% had comorbidities, and 10.5% were using immunosuppressive medications. It was found that 9.6% had previously had herpes zoster, 8.8% had no knowledge of the disease, 39.6% were aware of the vaccine, and 20.1% were unwilling to pay for vaccination. Multivariate binary logistic regression analysis revealed that being a physician significantly increased the likelihood of having correct knowledge by 1.961 times compared to other professions (p < 0.001, CI: 1.608–2.392). Similarly, those who had heard of herpes zoster were 3.191 times more likely to answer correctly than those who had not (p = 0.011, CI: 1.650–6.172). Male gender was significantly associated with a lower likelihood of having accurate knowledge compared to females (p = 0.001, OR = 0.720, CI: 0.594–0.874). Conclusions: This study revealed that healthcare workers’ knowledge and awareness regarding herpes zoster and its vaccines are generally insufficient. The recent licensing of the vaccine in Türkiye may explain this, but it is critical for healthcare professionals to be more informed about risk groups and vaccination indications in order to enhance the effectiveness of preventive healthcare services. Given the potential for serious complications of herpes zoster in elderly and immunocompromised individuals, the importance of vaccination should be emphasized more strongly to healthcare workers. Furthermore, the finding that 20.1% of those aware of the vaccine were deterred by its cost highlights the need to improve vaccine accessibility. Economic barriers preventing healthcare workers from being vaccinated emphasize the importance of making the vaccine widely available through public support to protect both healthcare workers and patient safety. Full article

Background/Objectives: Anaemia is a critical public health challenge in Sub-Saharan Africa (SSA), particularly among adolescents. The objective was to estimate the pooled prevalence of anaemia among adolescents in SSA and synthesise evidence on its nutritional and contextual determinants. Methods: A systematic search of databases including PubMed, CINAHL and Web of Science was conducted for studies published from January 2000 to October 2025. The methodological approach was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Pooled prevalence estimates were computed using random-effects models, and heterogeneity was assessed using the I² statistic and Cochran’s Q test. Subgroup and meta-regression analyses were performed to explore sources of variation. Determinants were synthesised as pooled odds ratios with 95% confidence intervals. Publication bias was evaluated through funnel plot asymmetry and Egger’s regression test. Results: Forty-eight (n = 48) studies involving 76,596 adolescents met the inclusion criteria. The pooled prevalence of anaemia was 33% (95% CI: 0.28–0.39), with substantial heterogeneity across studies. Factors associated with higher odds of anaemia included low dietary diversity (OR 1.74, 95% CI: 1.10–2.74) and poor iron or micronutrient supplementation adherence or lack of supplementation (OR 1.94, 95% CI: 1.25–3.01). Infection-related exposures (OR 3.03, 95% CI: 1.99–4.61) and environmental determinants (OR 2.23, 95% CI: 1.41–3.55) were also significantly associated with anaemia. Socio-demographic factors associated with anaemia included menstrual factors among girls (OR 2.51, 95% CI: 1.58–3.99), household size (OR 3.32, 95% CI: 1.61–6.85), awareness (OR 1.71, 95% CI: 1.08–2.70), and age group (OR 2.37, 95% CI: 1.47–3.83). Conclusions: Anaemia among adolescents in SSA remains an important public health concern, although the pooled estimates should be interpreted cautiously because of substantial heterogeneity and methodological differences across studies. The findings suggest that adolescent anaemia is associated with multiple nutritional and contextual factors, but more consistent and context-specific research is needed to refine regional estimates and guide interventions. Full article

Background: People living with dementia (PLWD) are at increased risk for medical complications, including urinary tract infections (UTIs), which are often presented atypically with delirium or behavioral changes. These atypical presentations frequently prompt psychiatric consultation and complicated medical management. As the aging population grows, understanding how dementia influences UTI-related outcomes is critical for C-L psychiatrists working at the interface of medicine and psychiatry. Methods: This retrospective cohort study used the 2021 National Inpatient Sample (NIS) to identify adult inpatients with a principal diagnosis of UTI. Patients were stratified by the presence of a comorbid dementia diagnosis. Multivariate logistic and linear regression models adjusted for demographic, clinical, and hospital-level covariates were used to examine associations between dementia and outcomes: in-hospital mortality (primary), length of stay (LOS), hospital charges, and discharge disposition (secondary). Adjusted models included available demographic, socioeconomic, comorbidity, and hospital-level covariates, including age, sex, race/ethnicity, median household income quartile by patient ZIP code, insurance type, Charlson Comorbidity Index, hospital region, urban hospital location, and hospital teaching status. Results: Among 295,494 hospitalizations for UTI, 78,990 (26.7%) involved patients with dementia. Compared to those without dementia, PLWD were significantly older (mean age 82.5 vs. 69.5 years), more likely to be female, and had greater comorbidity burden. Adjusted analyses revealed that dementia was linked to higher odds of in-hospital mortality (aOR: 1.28, 95% CI: 1.03–1.58), longer LOS (+0.93 days, p < 0.01), and increased hospital charges (+$3243.50, p < 0.01). Additionally, PLWD had lower odds of discharge to home (aOR: 0.53) and higher odds of discharge to skilled nursing facilities (aOR: 1.94). Conclusions: Among patients hospitalized with a principal diagnosis of UTI, comorbid dementia was linked with higher in-hospital mortality, longer length of stay, higher hospital charges, and lower likelihood of discharge home. These findings should be interpreted in the context of important limitations of administrative data, including residual confounding and inability to distinguish symptomatic UTI from asymptomatic bacteriuria. Full article

Background: Non-invasive ventilation (NIV) is a well-established approach for preventing endotracheal intubation (ETI) in critically ill patients with acute respiratory failure (ARF). Sedation is frequently used to improve comfort. This study aimed to analyze the impact of sedation during NIV on ETI rates and NIV success in critically ill patients. Methods: We systematically searched in PubMed, EMBASE, MEDLINE, Web of Science, and CENTRAL up to September 2023, including prospective observational studies, retrospective cohort studies (nRCTs), and randomized controlled trials (RCTs). Primary outcomes were NIV success and ETI rates; secondary outcomes were hypotension, bradycardia, 28-day mortality, delirium, and oversedation. Proportions were used for observational studies, odds ratios (OR) for retrospective studies, and risk ratios (RR) for RCTs. Retrospective studies compared intermittent and continuous analgosedation, while RCTs evaluated dexmedetomidine versus other sedatives, including direct comparisons. Results: Four observational studies, 2 retrospective studies, and 7 RCTs (738 patients) were selected. Dexmedetomidine showed increased NIV success (RR = 1.167, 95%C.I. 1.014–1.343, p = 0.032) and reduced ETI rate (RR = 0.553, 95%C.I. 0.405–0.755, p < 0.001), but higher rate of bradycardia (RR = 2.172, 95%C.I. 1.819–4.042, p < 0.001) and hypotension (RR = 2.441, 95%C.I. 1.608–3.706, p < 0.001). nRCTs revealed higher NIV success (Proportion = 0.694, 95%C.I. 0.528–0.912, p = 0.009), moderate ETI rates (Proportion = 0.379, 95%C.I. 0.282–0.511, p < 0.001), and low bradycardia and hypotension rates. Conclusions: Our findings suggest that sedation, particularly dexmedetomidine-based strategies, may enhance NIV success and lower ETI rates. However, dexmedetomidine was also associated with higher rates of bradycardia and hypotension, especially compared with midazolam. To establish the correct sedation strategy, it is important to tailor the drug to the patient, considering its hemodynamic instability, delirium risk, and mortality risk. Full article

Background: Necrotizing enterocolitis (NEC) is a severe gastrointestinal complication that may develop in term neonates with critical congenital heart disease (CHD), despite the absence of prematurity. We aimed to evaluate the incidence of NEC and identify clinical factors associated with NEC development in term neonates with critical CHD. Methods: This retrospective cohort study included term neonates (≥37 weeks’ gestation) with critical CHD admitted to a tertiary pediatric cardiac intensive care unit between 1 January 2022, and 1 January 2026. NEC was defined as stage IIA or higher according to modified Bell’s criteria. Demographic, clinical, perioperative, and nutritional variables were analyzed. Multivariable logistic regression analysis was performed to identify factors independently associated with NEC development. Results: A total of 780 term neonates with critical CHD were included. NEC developed in 18 infants (2.3%). The median age at NEC diagnosis was 7 days (IQR 5–10), and four patients (22%) required surgical intervention. Seven NEC cases occurred preoperatively, whereas 11 developed after cardiac surgery; among postoperative cases, 64% occurred within the first 72 h after surgery. Birth weight < 2.5 kg (aOR 4.1, 95% CI 1.2–13.4; p = 0.021), gestational age < 38 weeks (aOR 3.9, 95% CI 1.3–12.0; p = 0.018), functional single-ventricle physiology (aOR 5.8, 95% CI 1.6–20.7; p = 0.007), and mechanical ventilation dependency (aOR 5.1, 95% CI 1.7–15.2; p = 0.004) were independently associated with NEC development. Mortality was significantly higher among infants with NEC compared with those without NEC (50% vs. 7.7%, p < 0.001). Conclusions: NEC remains an important complication associated with substantial mortality in term neonates with critical CHD, despite its relatively low incidence. Early-term birth, low birth weight, functional single-ventricle physiology, and dependence on mechanical ventilation were independently associated with increased NEC risk in this vulnerable population. Full article

Background/Objectives: Arterial hypertension (AH) and hepatitis C virus (HCV) infection are interlinked, with AH increasing the risk of severe liver disease and HCV contributing to cardiovascular issues. Treating HCV in hypertensive patients is critical, though data on direct-acting antivirals (DAAs) in this group remain limited. Methods: This retrospective study evaluated the effects of DAAs in AH patients with HCV using data from the 2015–2023 EpiTer-2 project, a multicenter study in Poland. Results: Among the 18,968 HCV-infected DAA-treated patients, 5976 had AH. These patients were older, predominantly women, and had higher rates of obesity, comorbidities, cirrhosis, hepatocellular carcinoma, and genotype 1b infection. Sustained virologic response rates were high and comparable between the AH and non-AH groups in the intent-to-treat (94.8% vs. 94.2%) and per-protocol analyses (97.6% vs. 97.6%). AH was not independently associated with treatment failure (OR 0.87, 95% CI: 0.69–1.10). Predictors of failure included genotype 3, decompensated liver function, cirrhosis, thrombocytopenia, and treatment with asunaprevir + daclatasvir. While therapy discontinuation was more common in the AH patients, most completed treatment, with fatigue being the most frequent adverse event. Although not directly evaluated, the overall safety outcomes suggest that potential drug–drug interactions with antihypertensive therapies are unlikely to have a major clinical impact in routine practice. Conclusions: This study highlights the safety and efficacy of DAAs in AH patients and emphasizes the importance of early HCV detection and treatment in this population. Full article

Background/Objectives: Antimicrobial resistance (AMR) in companion animals is an increasing concern within the One Health framework, particularly regarding opportunistic pathogens such as Klebsiella spp. This retrospective study evaluated the epidemiology, antimicrobial susceptibility profiles, and temporal resistance trends of Klebsiella spp. infections in dogs and cats across the Iberian Peninsula. Methods: A total of 809 clinical isolates collected between 2016 and 2024 and submitted to a private diagnostic laboratory in Barcelona were analysed. Results: Klebsiella pneumoniae was the predominant species (70%), more frequently identified in cats (76%) than in dogs (68%). Dermatological and respiratory samples exhibited the highest prevalence of multidrug-resistant (MDR) isolates. Overall MDR prevalence was high, particularly in cats (51.1%; 95% CI 41.1–60.9%) compared with dogs (38.4%; 95% CI 34.1–42.8%) although it was not statistically significant. K. pneumoniae generally exhibited higher resistance rates than K. oxytoca, particularly to amoxicillin/clavulanic acid, first-/second-generation cephalosporins, third-/fourth-generation cephalosporins (3/4th GC), fluoroquinolones, and tetracyclines. In both bacterial species, resistance rates were consistently higher among feline isolates. In contrast, aminoglycosides and phenicols retained high activity against most isolates. Temporal analysis revealed a significant increasing resistance trend to amoxicillin/clavulanic acid, which is particularly concerning given the widespread use of this antimicrobial as a first-line treatment in small animal practice. However, resistance trend to aminoglycosides showed a significant decline. No significant temporal changes were detected for 3/4th GC and fluoroquinolones, suggesting the persistence of resistant populations within companion animals. Resistance to aminoglycosides and phenicols remained comparatively low in this study. Whereas critically important category B antimicrobials, such as 3/4th GC and fluoroquinolones, exhibited low to moderate effectiveness, raising concerns about their empirical use. Conclusions: These findings highlight the substantial AMR and MDR burden of K. pneumoniae in companion animals in the Iberian Peninsula and reinforce the need for prudent antimicrobial use, routine susceptibility testing, and integrated One Health surveillance strategies. Full article

Background and Objectives: Recurrent myocarditis confers a significant prognostic burden yet lacks validated predictive markers to guide risk stratification. This study aimed to identify independent clinical, electrocardiographic, and cardiac magnetic resonance (CMR) determinants of recurrence at a median of 7 days (IQR: 3–14) after the index event in young adults with acute myocarditis and to evaluate the role of colchicine therapy duration in modulating recurrence risk. Materials and Methods: This retrospective observational cohort study enrolled 162 patients admitted with a diagnosis of acute myocarditis to a tertiary cardiology center between January 2014 and January 2024. Diagnosis was established according to ICD-10 criteria with confirmation by CMR. The primary endpoint was recurrent myocarditis at two-year follow-up. Independent predictors were delineated through binary logistic regression and time-to-event analyses using multivariate Cox proportional hazards modeling. Results: The two-year recurrence rate was 12.3%, with a median time to recurrence of 13.5 months. Time of colchicine use, ST-segment depression on the admission electrocardiogram (OR 14.469, 95%CI 2.416–86.673; p = 0.003), and late gadolinium enhancement (LGE) on CMR (OR 10.362, 95%CI 1.614–66.549; p = 0.014) emerged as independent predictors of recurrence. Colchicine therapy sustained for a minimum of three months was independently associated with a markedly reduced recurrence risk (OR = 0.295, 95%CI = 0.098–0.891; p = 0.030). Cox regression corroborated these associations, demonstrating substantially elevated hazard ratios for ST depression (HR = 10.729, 95%CI = 2.201–52.298; p = 0.003) and LGE (HR = 8.064, 95%CI = 2.036–31.942; p = 0.003), with a protective effect of adequate colchicine duration (HR = 8.577 for treatment cessation; p = 0.025). A multisegmental LGE pattern and index episode onset during the winter months were additionally associated with recurrence. Conclusions: ST-segment depression on admission electrocardiography and CMR-detected LGE may represent potent, independent predictors of myocarditis recurrence. Adequate colchicine duration of at least three months may attenuate recurrence risk, underscoring the critical importance of optimizing anti-inflammatory therapy duration and integrating electrocardiographic and imaging phenotyping into personalized long-term surveillance strategies. Full article

Designing consumer products with lower environmental impact and acceptable cost requires designers to interpret life-cycle evidence across competing alternatives. This study compares two contrasting weighting approaches for multi-criteria decision-making in sustainability-focused consumer product design: the stakeholder-preference-driven Analytic Hierarchy Process (AHP) and the data-driven Criteria Importance Through Intercriteria Correlation–Technique for Order of Preference by Similarity to Ideal Solution (CRITIC–TOPSIS) method. An electric-bike case study was constructed from 24 feasible configurations defined by frame material, battery type, tire material, and coating method. Environmental performance was quantified using Life Cycle Assessment (LCA) with ReCiPe midpoint indicators, and economic performance was represented using a component-level life-cycle cost proxy. The methods identified broadly similar high- and low-performing regions of the design space, but they differed in the ranking of specific alternatives. Statistical comparison showed strong agreement among the ranking methods, although differences remained in the exact ordering of some alternatives. These findings show that weighting methods do not determine product sustainability on their own; rather, they shape how environmental and economic evidence is translated into design decisions. For consumer product development, AHP is useful when stakeholder priorities must be made explicit, whereas CRITIC–TOPSIS is advantageous when repeatable data-driven screening is needed. Full article