Search Results (19,244)

Background/Objectives: Cigarette smoking is a well-established risk factor for periodontal tissue damage caused by oxidative stress and increased proteolytic activity. Electronic cigarettes (e-cigarettes), marketed as less harmful alternatives, deliver nicotine and reactive compounds that may similarly disrupt periodontal health. However, their molecular effects on clinically healthy periodontal tissues remain unclear. This study aimed to compare oxidative stress-related and matrix-degradative biomarkers in the gingival crevicular fluid (GCF) of cigarette smokers (CS), e-cigarette (EC) users, and non-smokers (NS), and to examine the relationships among these markers. Methods: Sixty individuals, who were systemically and periodontally healthy (20 CS, 20 EC, and 20 NS), were examined. Clinical parameters, including probing depth (PD), clinical attachment level (CAL), plaque index (PI), and bleeding on probing (BOP), were recorded. GCF samples were analyzed for reactive oxygen species (ROS), matrix metalloproteinase-9 (MMP-9), and forkhead box protein O-1 (FOXO-1) using ELISA. Initial group comparisons were descriptive, followed by analysis of covariance (ANCOVA) to adjust for age; PI and PD were included as covariates in separate models. Correlations were assessed using Spearman’s analysis. Results: PD was significantly higher in both EC users and CS compared with NS (p = 0.022). MMP-9 levels were significantly higher in CS than in EC users and NS (p < 0.05), while FOXO-1 concentrations were significantly lower in CS compared with NS (p = 0.0227). ROS levels did not differ significantly among groups (p > 0.05). After adjustment for age, PI, or PD, group differences in MMP-9 and FOXO-1 remained statistically significant, whereas ROS levels remained comparable. FOXO-1 demonstrated positive correlations with ROS and MMP-9 within exposure groups; these associations were considered exploratory. Conclusions: In this cross-sectional study, CS and EC use were associated with altered matrix-regulatory biomarker profiles in clinically healthy periodontal tissues, independent of age and periodontal indices. Causal or temporal inferences cannot be drawn, and longitudinal studies are needed to clarify the long-term periodontal implications of these findings. Full article

Background/Objectives: The dietary inflammatory index (DII) has been widely used to examine dietary inflammation in chronic diseases; however, the relative contribution of individual nutrients to the total DII score remains unclear. Identifying nutrient clusters that strongly influence the energy-adjusted DII (E-DII) in patients with diabetes and prediabetes may provide practical guidance for dietary counselling and intervention. This study aimed to identify nutrient clusters based on dietary intake and examine their association with the E-DII in patients with diabetes and prediabetes. Methods: In total, 408 dietary records of 17 patients were analysed. The E-DII was calculated from the reported dietary intake using photographs. Exploratory factor analysis was used to derive nutrient clusters, and ordinary logistic regression analysis was applied to examine their association with the E-DII tertiles. Results: Five nutrient clusters (antioxidant-mineral, protein-B complex, fatty acids, plant-lipids, and immune-modulating micronutrients) were extracted, explaining 69.3% of the total variance. Ordinary logistic regression showed that antioxidant-mineral, fatty acids, and immune-modulating micronutrients predicted classification between low, intermediate, and high E-DII groups. Conclusions: Antioxidant-mineral, fatty acids, and immune-modulating micronutrients were associated with a lower probability of belonging to the pro-inflammatory group. The identification of these clusters highlighted specific nutrient combinations that may protect against diet-induced inflammation. These results provided clinically relevant evidence that nutritional strategies emphasising fruits, vegetables, healthy fats, and balanced protein sources may contribute to lowering dietary inflammatory potential and improving metabolic health in patients with diabetes and prediabetes. Full article

Background: Attention Deficit Hyperactivity Disorder (ADHD) is associated with executive function deficits—such as planning, organization, and prospective memory—that impair autonomy and daily functioning, increase family stress, and create challenges in educational contexts. These consequences underscore the need for accessible and ecologically valid interventions addressing the cognitive, familial, and educational dimensions. Traditional approaches often lack ecological validity, and pharmacological treatment shows a limited impact on functional cognition. Objectives: This protocol outlines a feasibility study of DiverAcción, a web-based telerehabilitation system designed to enhance functional cognition through interactive and gamified tasks integrated into a comprehensive healthcare programme. Methods: A quasi-experimental feasibility study before and after the study will recruit 30 participants aged 9 to 17 years with ADHD. The study comprises an initial face-to-face session for instructions and baseline assessment (T0), followed by twelve supervised online sessions over six weeks. Therapeutic support is provided via integrated chat, email, and two scheduled videoconference check-ins. Feasibility Outcomes: include recruitment, adherence, retention, usability (SUS), acceptability (TAM), satisfaction, user-friendly design, therapeutic alliance (WAI-I), and professionals’ attitudes toward technology (e-TAP-T). Exploratory Measures: include parental self-efficacy (BPSES), parenting stress (PSI-4-SF), ADHD symptomatology (SNAP-IV), executive functioning (BRIEF-2), time management (Time-S), emotional regulation (ERQ-CA), prospective memory (PRMQ-C), and health-related quality of life (KIDSCREEN-52). Analyses emphasize descriptive statistics for feasibility metrics (recruitment, adherence, retention, dropout and fidelity). Assessments are conducted post-intervention (T1) and at three-month follow-up (T2) and analyzed relative to baseline using repeated-measures ANOVA or Friedman tests, depending on data distribution. Conclusions: This feasibility protocol will provide preliminary evidence on the usability, acceptability, and implementation of DiverAcción. Findings will guide refinements and inform the design of a subsequent randomized controlled trial. Full article

Hericium erinaceus (H. erinaceus), a medicinal mushroom, is a source of bioactive compounds with demonstrated neuroprotective potential. This activity is primarily attributed to two distinct classes of compounds: erinacines from the mycelium, which potently induce the synthesis of neurotrophins, protein growth factors essential for neuronal survival and health, and hericenones from the fruiting body, which subsequently appear to enhance or potentiate neurotrophin-activated signaling pathways. Preclinical evidence substantiates their ability to enhance neurotrophin levels, particularly Nerve Growth Factor (NGF) and Brain-Derived Neurotrophic Factor (BDNF), and activate their cognate Trk receptors. Activation of these pathways, including PI3K/AKT/mTOR and MAPK/ERK, converges on transcription factors such as CREB, promoting neuronal survival, neurite outgrowth, and synaptic plasticity. However, the precise molecular mechanisms linking these small molecules to the complex orchestration of neurotrophic gene expression remain incompletely defined. This review synthesizes current knowledge of the neurotrophic pharmacology of H. erinaceus bioactives and proposes a novel framework suggesting that non-coding RNAs (ncRNAs) play a key regulatory role. We hypothesize that hericenones and erinacines modulate key transcriptional hubs, such as CREB, Nrf2, and NF-κB, which in turn regulate the expression of specific ncRNAs (e.g., miR-132, miR-146a) known to control neurogenesis, synaptogenesis, oxidative stress, and neuroinflammation. This ncRNA-mediated mechanism may represent an un-explored axis that explains the pleiotropic neuroprotective effects of these compounds. We critically appraise the existing preclinical evidence, identify significant methodological limitations and translational gaps, and propose a structured research roadmap to test these ncRNA-centric hypotheses, aiming to accelerate the rational development of H. erinaceus-derived compounds for neurodegenerative diseases. Full article

Antimicrobial resistance is a growing threat to public health and the environment, especially in vulnerable ecosystems such as the Amazon. The confluence of the Marañón, Utcubamba, and Chinchipe rivers, known as the Pongo de Rentema, is a strategic area where water pollution could facilitate the spread of antibiotic resistance genes. This study aims to assess water quality in this region under the “One Health” approach by analyzing physicochemical parameters, heavy metals, and the presence of antimicrobial resistance genes. Water samples were collected from five sampling points during September and October 2024. Physicochemical parameters were analyzed in situ, and heavy metal concentrations were determined using atomic emission spectrophotometry. The presence of Escherichia coli and Pseudomonas aeruginosa was evaluated through selective culture, and the detection of resistance genes (marA, ermC, amp, QEP, and qEmarA) was performed using conventional PCR. Physicochemical parameters were within the limits established by Peruvian regulations, except for total dissolved solids in the Utcubamba River. Elevated levels of lead and chromium were detected at some points. Additionally, resistance genes were identified in E. coli and P. aeruginosa, providing evidence of antimicrobial resistance dissemination in the water. Water pollution in the Pongo de Rentema poses an environmental and public health risk due to the presence of heavy metals and antimicrobial resistance genes. Continuous monitoring and environmental management strategies under the “One Health” approach are recommended to mitigate these risks. Full article

Background/Objectives: With the global rise in chronic diseases among older adults, rehabilitation services have become essential, particularly for those with cerebrovascular and central nervous system (CNS) disorders, which lead to significant long-term disabilities. To determine the impact of designated rehabilitation medical institutions on the readmission rates of older patients with CNS disorders who receive surgical interventions. Methods: This was a population-based cohort study. Data was obtained from the National Health Insurance Service database (2002–2019). Fifteen designated institutions participated in the pilot project for convalescent rehabilitation. We analyzed the data of 1019 patients before and after the implementation of the designated rehabilitation institution. The study sample included (1) patients admitted to 15 designated institutions participating in the pilot project for convalescent rehabilitation and (2) patients diagnosed with conditions classified under the rehabilitation patient group, Rehabilitation Impairment Category 1 to 7. The intervention was the pilot project for designated rehabilitation institutions, launched in October 2017. The primary outcome of interest was the readmission rate of older patients with CNS disorders who received surgical interventions. Interrupted time series analysis with segmented regression was used to assess changes in the 30-day readmission rates. Results: Post-intervention, an 8% reduction in 30-day readmission rates (estimate, 0.9225; 95% confidence interval: 0.9129–0.9322, p < 0.0001) was observed. Subgroup analysis showed a significant decline in readmission rates across various patient groups, including those with disabilities, high Charlson Comorbidity Index scores, and extended hospital stays. The regions outside Seoul (capital city), particularly Gyeonggi/Incheon (areas around Seoul) and other areas (i.e., rural), also showed a significant decrease in readmission trends after the intervention. Conclusions: Designated rehabilitation medical institutions led to a significant reduction in readmission rates of older patients with CNS disorders, suggesting that these institutions effectively support recovery and reduce the burden of readmission for patients with severe conditions and those residing in non-capital cities. Full article

Bone conduction hearing implant systems (BCHIs) are established treatments for patients with conductive or mixed hearing loss or single-sided deafness when conventional hearing aids are unsuitable. This study evaluated the cost-effectiveness of the active transcutaneous system Sentio versus a similar system, i.e., Osia in an Australian setting. Scenario analyses also compared Sentio to other systems, i.e., Ponto and Baha Attract. A Markov cohort model was adapted from a previously published source to reflect Australian practice, incorporating device acquisition, surgery, maintenance, battery replacement and adverse event management over a 15-year horizon from a healthcare perspective. Effectiveness inputs were derived from published evidence using a naïve indirect comparison. Extensive sensitivity analyses and external validation tested robustness. In the base case, Sentio was associated with lower costs and a small modelled incremental quality-adjusted life years (QALYs) gain versus Osia. Scenario analyses confirmed cost-effectiveness relative to Ponto and Baha Attract, with outcomes below the Australian willingness-to-pay threshold. Health state utility, device price and reimplantation assumptions were the most influential drivers, yet Sentio remained cost-effective in over 95% of simulations. These findings support Sentio as a clinically and economically efficient BCHI in Australia and highlight the need for direct utility and long-term durability data. Full article

Lung cancer remains a major public health challenge due to high incidence and mortality. The chemokine receptor CXCR4 and its ligand CXCL12 (SDF-1) constitute a critical axis in tumor biology, influencing tumor cell proliferation, invasion, angiogenesis, and immune evasion. Aberrant CXCR4 expression is frequently observed in lung cancer and is closely associated with adverse prognosis, enhanced metastatic potential, and therapeutic resistance. Mechanistically, CXCR4 activates signaling pathways including PI3K/AKT, MAPK/ERK, JAK/STAT, and FAK/Src, promoting epithelial–mesenchymal transition, stemness, and survival. The CXCL12/CXCR4 axis also orchestrates interactions with the tumor microenvironment, facilitating chemotaxis toward CXCL12-rich niches (e.g., bone marrow and brain) and modulating anti-tumor immunity via regulatory cells. Regulation of CXCR4 occurs at transcriptional, epigenetic, and post-transcriptional levels, with modulation by hypoxia, inflammatory signals, microRNAs, and post-translational modifications. Clinically, high CXCR4 expression correlates with metastasis, poor prognosis, and reduced response to certain therapies, underscoring its potential as a prognostic biomarker and therapeutic target. Therapeutic strategies targeting CXCR4 include small-molecule antagonists (e.g., AMD3100/plerixafor; balixafortide), anti-CXCR4 antibodies, and CXCL12 decoys, as well as imaging probes for patient selection and response monitoring (e.g., 68Ga-pentixafor PET). Preclinical and early clinical studies suggest that CXCR4 blockade can impair tumor growth, limit metastatic spread, and enhance chemotherapy and immunotherapy efficacy, although hematopoietic side effects and infection risk necessitate careful therapeutic design. This review synthesizes the molecular features, regulatory networks, and translational potential of CXCR4 in lung cancer and discusses future directions for precision therapy and biomarker-guided intervention. Full article

Background/Objectives: Institutional catering serves vulnerable populations, including schoolchildren. Surfaces in food preparation environments are key control points for food safety and reservoirs and transmission routes for antimicrobial-resistant (AMR) bacteria. This study characterized the hygienic status of food-contact surfaces (FCS) and non-food-contact surfaces (NFCS) in Hungarian school kitchens, identified contamination hotspots, and examined how routine monitoring can support AMR prevention. Methods: We retrospectively analyzed routine environmental hygiene monitoring records from 96 school kitchens (2019–2024). In total, 8412 swab samples were collected, 8407 had quantifiable counts, 6233 from FCS (e.g., plates, trays, boards, utensils), and 2174 from NFCS (e.g., sinks, fridges, workers’ hands). Total aerobic mesophilic counts were measured with a redox-potential method and expressed as CFU/100 cm²; 250 CFU/100 cm² (2.4 log₁₀) was the hygienic threshold. Results: Overall, 12.4% of surfaces exceeded the threshold. Non-food-contact surfaces were more likely to be non-compliant than food-contact surfaces (OR 2.77, 95% CI 2.43–3.17; p < 0.001). Hotspots included transport-container lids (67.2% non-compliant; OR 43.82), sink basins (32.8%; OR 10.46), and cutting boards (21.6%; OR 5.89). Seasonally, non-compliance was highest in summer (16.5%) and lowest in winter (9.0%; p < 0.001). Conclusions: Multi-year monitoring revealed substantial contamination concentrated in a few hotspots that, within a One Health framework—which recognizes the interconnectedness of human, animal, and environmental health—may represent environmental reservoirs and cross-contamination nodes relevant to AMR prevention. Targeted optimization of cleaning and disinfection for these surfaces, combined with trend analysis of indicator data and periodic AMR-focused environmental sampling, could reduce foodborne and AMR-related risks in public catering. Full article

The administration of various medications can induce bone loss as an adverse effect and may result in drug-induced osteoporosis, an important and clinically relevant form of secondary osteoporosis associated with an increased fracture risk. This review summarizes the skeletal effects of selected commonly used drugs with respect to bone metabolism, bone mineral density, and fracture outcomes. Medications may exert direct effects on osteoblasts and/or osteoclasts, leading to impaired bone remodeling and reduced bone mass. Alternatively, indirect mechanisms may contribute to skeletal damage, including disturbances in calcium and vitamin D metabolism with subsequent secondary hyperparathyroidism, as well as therapy-induced hypogonadism. Drug classes frequently associated with drug-induced osteoporosis during long-term use include glucocorticoids, aromatase inhibitors, androgen-deprivation therapy, thyroxine, proton pump inhibitors, anticoagulants (heparin and vitamin K antagonists), antidepressants, neuroleptics, and thiazolidinediones. Importantly, this overview represents a selection of relevant agents and does not aim to provide an exhaustive list. When prescribing potentially bone-damaging medications over extended periods, particularly in older individuals, bone health should be proactively considered. Evaluation should include laboratory assessment, fracture risk estimation (e.g., FRAX^®), and bone mineral density measurement when appropriate. Adequate calcium and vitamin D intake should be ensured, and guideline-based osteoporosis therapy initiated when indicated. Full article

Background/Objectives: Colorectal cancer (CRC) is a major public health challenge in Brazil, characterized by marked regional disparities. Although national legislation mandates that treatment begin within 60 days after diagnosis, compliance remains inconsistent, particularly within the Unified Health System (SUS). This study aimed to analyze the time to treatment initiation for colon (C18) and rectal (C20) cancer in Brazil from 2013 to 2024, assessing regional inequalities, temporal trends, and factors associated with treatment delays. Methods: We conducted an ecological study using secondary data from the Ministry of Health’s PAINEL-Oncologia platform, which integrates information from SIA/SUS, SIH/SUS, and SISCAN. Records of patients diagnosed with colon and rectal cancer (ICD-10 C18–C20) were evaluated. Temporal trends were analyzed using Joinpoint regression, and factors associated with delayed treatment initiation (>60 days) were identified through multiple logistic regression models. Results: Persistent discrepancies were observed between diagnostic and treatment trends from 2013 to 2024, with the Annual Percent Change (APC) for diagnosis exceeding that for treatment, particularly among adults aged 55–69 years. The Southeast and South regions accounted for over 70% of all diagnosed cases, starkly contrasting with the less than 25% in the North and Northeast. More than 50% of patients across all clinical stages initiated treatment after the legally mandated 60-day period. Women with rectal cancer had a 28% higher risk (RR = 1.28) of being diagnosed at stage IV. Chemotherapy was the predominant initial therapeutic modality, while the need for combined chemo-radiotherapy was associated with markedly elevated risk ratios for delay (e.g., RR = 26.53 for stage IV rectal cancer). Treatment initiation delays (>60 days) were significantly associated with residence in the North/Northeast regions, female sex (for rectal cancer), advanced-stage disease, and complex therapeutic regimens. Conclusions: The study demonstrates persistent regional inequalities and highlights a substantial mismatch between diagnostic capacity and therapeutic availability in Brazil. These gaps contribute to treatment delays and reinforce the need to strengthen and expand oncological care networks to ensure equitable access and improve outcomes, particularly in underserved regions. Full article

Canada’s ageing population continues to grow rapidly and significantly more diverse, which will require unique health and home service needs. The COVID-19 pandemic exacerbated existing challenges in Canada’s healthcare system and demonstrated the need for long-term care (LTC). Semi-structured interviews were conducted with 17 decision makers, managers, and leaders in long-term ethnically focused facility care. Braun & Clarke’s six-stage process of thematic analysis was applied using an iterative, deductive approach to examine the experiences of stakeholders involved in the operational, managerial, financial, and clinical aspects of an ethnicity-focused LTC. Findings highlighted salient characteristics of impactful ethnicity-focused care and factors were uniquely shaped by the delivery of culturally specific care. Key subthemes included social isolation and emotional impact, operational and logistic difficulties during COVID-19, mitigation measures implemented in response, and the social, behavioural, and health benefits observed among seniors living in these LTC homes. Participants identified political and economic constraints (e.g., provincial funding) to establishing ethnicity-focused care homes but proposed several solutions and highlighted potential benefits that could support successful implementation. Analysis of experiences of operational challenges in safely and adequately running ethnicity-focused LTC reinforces the value of ethnicity-focused LTC during times of crisis such as the COVID-19 pandemic, as they provide a culturally safe and familiar space with preventive measures applied in a timely manner for seniors to engage with their peers in an environment that meets their health needs, ensuring safety standards. Full article

In the last decade, the interdisciplinary field of neuroarchitecture has grown significantly, revealing measurable links between architectural features and human neural processing. This review synthesizes current research at the nexus of neuroscience and architecture, with a focus on how emerging virtual reality (VR) and artificial intelligence (AI) technologies are being utilized to understand and enhance human spatial experience. We systematically reviewed literature from 2015 to 2025, identifying key empirical studies and categorizing advances into three themes: core components of neuroarchitectural research; the use of physiological sensors (e.g., EEG, heart rate variability) and virtual reality to gather data on occupant responses; and the integration of neuroscience with AI-driven analysis. Findings indicate that built environment elements (e.g., geometry, curvature, lighting) influence brain activity in regions governing emotion, stress, and cognition. VR-based experiments combined with neuroimaging and physiological measures enable ecologically valid, fine-grained analysis of these effects, while AI techniques facilitate real-time emotion recognition and large-scale pattern discovery, bridging design features with occupant emotional responses. However, the current evidence base remains nascent, limited by small, homogeneous samples and fragmented data. We propose a four-domain framework (somatic, psychological, emotional, cognitive-“SPEC”) to guide future research. By consolidating methodological advances in VR experimentation, physiological sensing, and AI-based analytics, this review provides an integrative roadmap for replicable and scalable neuroarchitectural studies. Intensified interdisciplinary efforts leveraging AI and VR are needed to build robust, diverse datasets and develop neuro-informed design tools. Such progress will pave the way for evidence-based design practices that promote human well-being and cognitive health in built environments. Full article

Groundwater, a critical resource for regional water security and public health, faces escalating threats from heavy metal contamination—a pressing environmental challenge worldwide. This study focuses on the central-south Hunan region of China, a mineral-rich, densely populated area characterized predominantly by non-point-source pollution, aiming to systematically unravel the spatial patterns, source contributions, and associated health risks of heavy metals in local groundwater. Based on 717 spring and well water samples collected in 2024, we determined pH and seven heavy metals (As, Cd, Pb, Zn, Fe, Mn, and Tl). By integrating hydrogeological zoning, lithology, topography, and river networks, the study area was divided into 11 assessment units, clearly revealing the spatial heterogeneity of heavy metals. The results demonstrate that exceedances of Cd, Pb, and Zn were sporadic and point-source-influenced, whereas As, Fe, Mn, and Tl showed regional exceedance patterns (e.g., Mn exceeded the standard in 9.76% of samples), identifying them as priority control elements. The spatial distribution of heavy metals was governed the synergistic effects of lithology, water–rock interactions, and hydrological structure, showing a distinct “acidic in the northeast, alkaline in the southwest” pH gradient. Combined application of the APCS-MLR and PMF models resolved five principal pollution sources: an acid-reducing-environment-driven release source (contributing 76.1% of Fe and 58.3% of Pb); a geogenic–anthropogenic composite source (contributing 81.0% of Tl and 62.4% of Cd); a human-perturbation-triggered natural Mn release source (contributing 94.8% of Mn); an agricultural-activity-related input source (contributing 60.1% of Zn); and a primary geological source (contributing 89.9% of As). Monte Carlo simulation-based health risk assessment indicated that the average hazard index (HI) and total carcinogenic risk (TCR) for all heavy metals were below acceptable thresholds, suggesting generally manageable risk. However, As was the dominant contributor to both non-carcinogenic and carcinogenic risks, with its carcinogenic risk exceeding the threshold in up to 3.84% of the simulated adult exposures under extreme scenarios. Sensitivity analysis identified exposure duration (ED) as the most influential parameter governing risk outcomes. In conclusion, we recommend implementing spatially differentiated management strategies: prioritizing As control in red-bed and granite–metamorphic zones; enhancing Tl monitoring in the northern and northeastern granite-rich areas, particularly downstream of the Mishui River; and regulating land use in brick-factory-dense riparian zones to mitigate disturbance-induced Mn release—for instance, through the enforcement of setback requirements and targeted groundwater monitoring programs. This study provides a scientific foundation for the sustainable management and safety assurance of groundwater resources in regions with similar geological and anthropogenic settings. Full article

Substance use, a significant public health concern, may be associated with worsening social connections and feelings of loneliness among adult populations. This study examined the associations between substance use (i.e., binge alcohol, e-cigarette, and traditional cigarette use) and loneliness among adults aged ≥50 years residing in the US. We conducted a secondary analysis of cross-sectional data from the 2023 Behavioral Risk Factor Surveillance System Social Determinant of Health Equity module. The sample included 138,614 adults aged ≥50 years, representing approximately 55.4 million individuals in this age group. Substance use was the key independent variable and categorized into two groups: no substance use and substance use—participants who reported current use of ≥1 of three substances (i.e., binge alcohol, e-cigarette, and traditional cigarette use). Overall, 19.0% of participants reported using ≥1 substance use, 21.0% reported feeling lonely sometimes, and 5.1% feeling lonely always/usually. Participants who reported using ≥1 substance had a 17.0% higher relative risk of feeling lonely always/usually (compared to feeling never/rarely lonely) than adults who did not report substance use, after adjusting for all covariates (RRR 1.17; 95% CI 1.10–1.35; p = 0.029). These findings underscore the strong link between substance use and loneliness among midlife and older adults. Full article