Search Results (1,174)

Background/Objectives: Low back pain (LBP) is the leading cause of disability in Saudi Arabia and contributes substantially to healthcare utilisation, reduced quality of life, and lost productivity. This guideline provides nationally standardised, evidence-based recommendations for the assessment and management of non-specific LBP and sciatica in adults, adapted to the clinical and health-system context in Saudi Arabia. Methods: A multidisciplinary Task Force developed the guideline using the GRADE ADOLOPMENT approach, using NICE guideline NG59 as the primary evidence source. One additional clinical question was formulated to address pain neuroscience education, informed by a relevant systematic review. Update literature searches were conducted in PubMed, Embase, and the Cochrane Library (2016–2022). The evidence was appraised using GRADE, and recommendations were formulated through structured Evidence-to-Decision deliberations and consensus voting. Results: The Task Force addressed eleven clinical questions in this guideline. Strong recommendations were provided for the use of validated risk assessment tools (very low certainty of evidence) and stratified management (moderate certainty of evidence). Conditional recommendations were made for indications for imaging, pharmacological treatment for sciatica, psychological interventions, multidisciplinary return to work programmes, epidural injections, prognostic value of image-concordant pathology, spinal decompression, radiofrequency denervation, and pain neuroscience education, with certainty of evidence ranging from very low to low. Conclusions: The findings indicate that management of non-specific LBP and sciatica in Saudi Arabia should be guided by clinical assessment, with restricted use of imaging, careful selection of pharmacological treatments, and appropriate use of psychological, multidisciplinary, and procedural interventions. Full article

Background/Objectives: Edentulism represents a major public health challenge, causing disorders of social, psychological and biological origin. Full-arch implant-supported restorations represent a viable alternative to mitigate this problem. This study aimed to evaluate immediate implant-supported restorations for the rehabilitation of the edentulous maxilla using four implants and distal implant tilting between 15 and 20 years. Methods: A total of 740 patients were included (women: 440; men: 300; average age: 55.3 years) rehabilitated with 740 prostheses, supported by 2960 dental implants. The primary outcome measure was prosthetic/implant cumulative survival and success (CSurR;CSucR). Secondary outcome measures included marginal bone loss (MBL), and the incidence of complications was evaluated as a secondary outcome measure. The outcomes were evaluated at 15 and 20 years. Results: In total, 287 patients (38.8%) with 1148 implants (38.8%) were lost to follow-up. A total of 170 implants (5.7%) in 101 patients (13.6%) failed, resulting in an implant CSurR and CSucR of 90.7% and 84.6%, respectively, after up to 20 years of follow-up. The prosthetic success rate was 98.1%. The average MBL was 1.07 mm ± 1.38 mm and 1.46 mm ± 1.56 mm at 15- and 20-years, respectively. Mechanical complication incidence was 78.5%, occurring in 581 patients (provisional prostheses: n = 448, 60.5%; definitive prostheses: n = 374, 50.5%). Biological complications occurred in 449 implants (15.2%) in 260 patients (35.1%). Biological complications and smoking habits were major risk indicators. Conclusions: Considering the study limitations, it can be concluded that the current rehabilitation concept is a viable treatment option in the long term, with mechanical and biological maintenance being necessary throughout the patients’ lives. Full article

Background/Objectives: Contrast-induced nephropathy (CIN) is a common iatrogenic or medically induced condition among patients who receive intravenous infusion of iodinated contrast media that can cause renal insufficiency, raise the cost of care, and increase mortality risk. This study evaluated the incidence of CIN and predictors of renal function among cancer patients receiving contrast-enhanced computed tomography (CECT). Methods: A prospective, single-center longitudinal study was conducted at King Abdul-Aziz Medical City’s (Jeddah) medical imaging department from December 2021 to December 2023. Convenience sampling was used to select patients who were exposed to CECT based on data filled in the electronic medical record during the study period. Results: The final sample constituted 80 patients (47.71% attrition, mean age = 55.5 years, 58.75% male). The high attrition rate was associated with participants with incomplete records, those who were lost to follow-up, and those whose follow-up Scr was collected after 72 h from CECT administration. There was no statistically significant change in Scr following contrast exposure (mean increase 0.9 µmol/L; paired t = 1.41, p = 0.162; Wilcoxon p = 0.326). The incidence of CIN was 3.75% (3 of 80 patients; 95% confidence intervals (CI), 1.28–10.39%). Regression analysis showed no statistically significant associations between the percentage change in Scr and age, sex, baseline creatinine, or eGFR category (model R² = 0.07). No clinically meaningful predictors of CIN were identified. Conclusions: The incidence of CIN in this study’s cohort of low-risk cancer patients undergoing CECT was low, and contrast exposure did not produce significant short-term changes in renal function. These findings support the safety of modern contrast agents in oncology imaging, but multi-center studies with larger samples and more robust methods are warranted to refine CIN risk assessment in cancer patients undergoing CECT. Full article

Glomerella leaf spot (GLS), mainly caused by Colletotrichum fructicola, is a destructive disease of apple. However, the underlying pathogenesis mechanisms of GLS are still largely obscure. Previous infection transcriptome analysis showed that transcription factor CfGti1 was induced during leaf infection. The present study confirms that the CfGti1 gene is strongly expressed in conidia and early infection. To identify functions performed, we generated gene deletion mutant ΔCfGti1 by homologous recombination. Phenotypic analysis revealed that ΔCfGti1 lost pathogenicity to apple leaves by blocking appressorium-mediated host penetration, although penetration pegs still developed on cellophane. In addition, ΔCfGti1 colonization and hyphal extension in wounded apple fruit were dramatically decreased. The ΔCfGti1 mutant exhibited defects in growth and development of hyphae, which may be partly responsible for its inability to colonize apple. Comparative transcriptome and qRT-PCR analyses suggested that CfGti1 regulated appressorium-mediated host penetration by modulating genes related to metabolism of appressorial lipid droplets. Interestingly, CfGti1 also regulated the expression of ybtS and AKT1 or AFT1-1 related to biosynthesis of AK and AF host-specific toxins. This study demonstrated that CfGti1 is a pivotal regulator for apple GLS pathogenesis in C. fructicola. Full article

Carbon dioxide capture and storage (CCS) is a technology that can be used to reduce carbon dioxide (CO₂) emissions generated by both natural and anthropogenic industrial processes, particularly petroleum production. To mimic and investigate the effects of CO₂ leakage that may result from CCS, the acute toxicity of seawater acidification induced by continuous CO₂ injection was studied in Asian seabass (Lates calcarifer) fry under static bioassay conditions. Fry (0.828 ± 0.22 g) were exposed to seawater with different pH levels (5.5, 6.0, 6.5, 7.5, and 8.3). Rapid and 100% mortality within 15 min was observed in the pH 5.5 exposure group, while mortality rates ranging from 10.00–41.67% were recorded at 6–96 h in the pH 6.0 exposure group; no mortality was noted in the other pH exposure groups. According to these mortality data, the median lethal concentration at 96 h (96 h LC₅₀) was determined to be a pH of 5.884. Interestingly, after exposure to seawater with pH levels of 5.5 and 6.0, histopathological alterations in the skin, gills, trunk kidney and liver were evident. Additionally, some water quality parameters, especially dissolved oxygen (DO) levels, alkalinity, ammonia levels, and nitrite levels, vary depending on the pH. To further investigate the effects of seawater with pH levels of 8.3 and 5.884 (96 h LC₅₀) and 6.5 (10% safety level) on health status, immune responses and disease susceptibility, fingerling fish (21.25 ± 3.89 g) were studied. Unexpectedly, fish exposed to seawater with a pH of 5.884 rapidly lost muscle control and gradually died, reaching 100% mortality within 24 h, and all response analyses were aborted. Interestingly, with the exception of hematocrit and some immune parameters, various serum innate immune indices, blood biochemistry parameters and immune-related gene expression patterns were similar in fish exposed to seawater with pH levels of 8.3 and 6.5. Additionally, fish were challenged with 0 (control), 1 × 10⁷ and 1 × 10⁹ CFU/mL Vibrio vulnificus, and fish in seawater with a pH level of 6.5 showed a higher sensitivity to 1 × 10⁹ CFU/mL Vibrio vulnificus than fish in seawater with a pH level of 8.3, with mortality rates of 71.24% and 25.44%, respectively (p < 0.05). These findings enhance the understanding of the toxicity effects of seawater acidification caused by CO₂, which will be useful for further assessing the site-specific effects of CCS projects. Full article

Mutations in the POU1F1 gene cause defects in the expression of the genes encoding thyroid-stimulating hormone (TSH)-β subunit, growth hormone (GH), and prolactin (PRL). Here, we characterized 15 missense and nonsense mutations. Protein stability was reduced in the P14L, P24L, F135C, K145X, F233S and E250X mutants. Transactivation by 15 mutants in the TSHβ promoter was moderately correlated with that of the PRL promoter. Based on their transcriptional activity, we classified them into three groups: group I, equivalent to the wild type; group II, partial; and group III, substantially lost. A review of case reports on four patients with group II mutations revealed that TSH deficiency manifested after recombinant GH therapy. A transcription factor, GATA2, is the main activator in the TSHβ gene, while POU1F1 protects its function from inhibition by the suppressor region (SR). We found that the SR is critical for the pathogenesis of TSH deficiency. The transactivation of the TSHβ promoter by the K216E mutant was equivalent to that of wild-type POU1F1; however, that of the PRL promoter was low, while the opposite was found in the R271W mutant. The functional property of K216E suggests that the interaction of POU1F1 with GATA2 may not always be necessary for the activation of the TSHβ promoter. Full article

Aims: Chronic kidney disease (CKD) is associated with adverse cardiovascular outcomes, yet few contemporary studies stratify outcomes by specific CKD stages in the era of modern percutaneous coronary intervention (PCI) techniques and new-generation drug-eluting stents (DESs). We aim to assess the relationship between CKD and post-PCI outcomes in an updated, stage-specific, and long-term cohort. Methods: We retrospectively analyzed 11,489 patients who underwent PCI between 2010 and 2020. Kidney function was classified as preserved (eGFR ≥ 60 mL/min/1.73 m²), stage III CKD (eGFR 30–59), or stage IV/V CKD (eGFR < 30) using the CKD-EPI equation. The primary endpoint was a composite of all-cause mortality, non-fatal myocardial infarction (MI), and target vessel revascularization (TVR) at 1 year; secondary endpoints included individual components and outcomes through 5 years. Associations were evaluated using multivariable Cox regression. Results: Stage III and stage IV/V CKD were present in 18% and 5.6% of patients, respectively. At 1 year, both stage III (HR 2.13, p < 0.01) and stage IV/V CKD (HR 4.91, p < 0.01) were associated with higher risk of the composite endpoint. Mortality rose sharply with CKD severity (33% in stage IV/V vs. 4% in preserved renal function), and MI risk was significantly higher in stage IV/V CKD. These associations persisted after 5 years. Unadjusted TVR risk was higher in stage IV/V CKD but lost significance after adjustment. Conclusions: CKD, particularly in advanced stages, is independently associated with increased mortality and MI after PCI, with effects persisting in the long term. While advanced CKD showed higher unadjusted TVR risk, this was not independent after adjustment. These findings support individualized treatment strategies and extended follow-up in PCI patients with CKD. Full article

Background/Objectives: Financial toxicity (FT) refers to the financial burden directly or indirectly caused by a patient’s medical care. Patients with head and neck cancer (HNC) are particularly vulnerable to FT due to lower rates of return to work and higher out-of-pocket payments (OOPP). In this cross-sectional study, we assessed the amount and types of OOPP, as well as the prevalence of FT, in HNC patients who had completed curative radiotherapy. Methods: We included HNC patients who underwent curative-intent radiotherapy at four private clinics in Romania, within 12 months of completing treatment. Participants completed a 25-item questionnaire capturing sociodemographic information, insurance status, income, and OOPP. To assess subjective FT, we used the validated nine-item Financial Index of Toxicity (FIT), which measures three FT domains: financial stress, financial strain, and lost productivity. Each domain and the total score range from 0 to 100, with higher scores indicating greater financial toxicity. Descriptive statistics were used to summarize patient characteristics. Pearson’s chi-square, t-tests, and one-way ANOVA were used to assess statistical associations, with a significance threshold of p < 0.05. Results: Among 113 patients (mean age: 59), the majority were male (74.3%) and married (74.3%), with 40% having completed university or higher education. The most frequent tumor sites were the oropharynx (29 cases), larynx (22), and oral cavity (21). Concurrent chemoradiation was the most common treatment modality (47%). The mean total FT score was 18.8. Overall, 39.8% of patients experienced financial toxicity, and 29.2% scored above the mean in financial stress. Moderate financial strain (score > 21) was reported by 39.8% of participants, and approximately one-third reported loss of productivity. Transportation and nutritional supplements were the most common OOPP categories. Notably, 42% of patients spent at least 400 euros—equivalent to Romania’s monthly minimum income—on transportation during radiotherapy. FT was significantly associated with employment and marital status, but not with tumor site or treatment type. Conclusions: Among Romanian HNC patients treated with curative radiotherapy, we found substantial OOPP, particularly for transportation and nutritional supplements. While overall FT levels were moderate, divorced patients and those retired due to other chronic conditions were the most vulnerable to financial distress. Financial toxicity can directly affect treatment adherence, survival, and quality of life. By integrating financial counseling, social support, and broader coverage of treatment-related expenses, healthcare systems can mitigate FT for these patients. Full article

The 2025 large-scale forest fire in North Gyeongsang Province (Gyeongbuk) caused habitat fragmentation and disrupted ecological networks. This study quantitatively assessed both structural and functional connectivity loss and derived scientifically grounded restoration priorities. Fire intensity was assessed using Sentinel-2-based dNBR, and connectivity changes before and after the fire were analyzed by integrating MSPA (Morphological Spatial Pattern Analysis) and Omniscape (circuit theory-based model). MSPA captured extreme fragmentation, showing an 84% reduction in core habitats and a 976% increase in isolated patches, but failed to reflect functional movement flows. Omniscape approximated this using circuit theory, quantifying a 60% loss in cumulative current flow within the fire boundary and confirming that structural disconnection led to functional connectivity collapse. The restoration priority assessment (53 patches), based on source–sink theory, identified 14 high-priority patches (66% of total area). These patches were characterized by their adjacency to undamaged external cores, which serve as potential population sources for post-restoration recolonization. Notably, the top-priority areas were identified as key connection points within the national ecological corridor where Juwangsan National Park, the Nakdong Ridge, and Grade 1 Ecological Natural Areas overlap. This study demonstrated that integrating MSPA with Omniscape can simultaneously quantify both morphological fragmentation and functional disconnection caused by forest fires. This framework suggests that restoration planning should consider connectivity with broader ecological networks, in addition to recovering lost habitat area. Full article

Background: Monoclonal antibodies targeting the calcitonin gene-related peptide (CGRP) pathway, such as erenumab (ERE), are effective migraine-preventive therapies for many patients. Identifying clinical and genetic factors associated with treatment failure is crucial for optimizing patient management. Methods: This multicenter, prospective observational study included patients with episodic or chronic migraine treated with ERE for 12 months. Demographics, migraine history, comorbidities, treatment outcomes, and genetic variants in CGRP receptor-related genes (CALCRL and RAMP1) were evaluated for associations with non-response to ERE, defined as a <50% reduction in monthly migraine days. Results: Of the 140 patients starting ERE, 11 were lost to follow up, 12 stopped ERE due to side effects; 18 patients were non-responders and were compared to 99 responders. Arterial hypertension [adjusted OR (aOR): 7.77, p = 0.007], smoking (aOR: 4.98, p = 0.014), and insomnia requiring medication (aOR: 4.51, p = 0.027) were associated with non-responder status. Genetic analysis revealed a nominal association between the RAMP1 rs6431564 polymorphism and non-responder status (nominal p = 0.025), which did not survive Bonferroni correction. The G allele was linked to a reduced risk (aOR per G allele: 0.28, p = 0.025) and caused the increased expression of RAMP1 in an allele-dose manner. Conclusions: Hypertension, smoking, insomnia requiring medication, and, nominally, the RAMP1 rs6431564 polymorphism were associated with non-responder status to ERE in migraine patients. Further validation of the present results in larger cohorts is needed. Full article

Corrosion in reinforced concrete (RC) structures increases seismic fragility by reducing strength, ductility, and bond integrity, which becomes critical in aging infrastructure. This study provides a systematic fragility comparison of intact, corroded, and FRP-strengthened structures across multiple corrosion levels under sequential earthquakes. The seismic fragility of corroded RC frames, with and without fiber-reinforced polymer (FRP) retrofitting, is investigated under both mainshock and aftershock loading conditions. A total of 508 real recorded mainshock–aftershock ground motion sequences are selected as seismic inputs to ensure the representation of earthquake demands. Nonlinear time history analyses are carried out to establish fragility curves for four limit states based on probabilistic demand–capacity relationships. The results show that corrosion significantly decreases the collapse prevention capacity (LS₄), with the maximum reduction reaching about 62%. FRP retrofitting restores seismic performance to varying degrees depending on corrosion severity. For the structure with a 10% corrosion rate, FRP retrofitting enhances the collapse capacity beyond that of the intact case. For the structure with a 20% corrosion rate, FRP retrofitting recovers approximately two-thirds of the lost capacity caused by reduced ductility. The consideration of aftershock effects further increases the fragility of corroded structures, yet FRP retrofitting continues to provide improvement by reducing cumulative damage and improving deformation capacity. The study confirms that the FRP confinement effectively enhances the seismic resilience of aging RC structures and provides a practical basis for performance-based retrofit strategies under sequential earthquake events. Full article

This study investigated the changes in the physical and mechanical properties of glass fiber-reinforced polymer (GFRP) rebars during and after exposure to elevated temperatures. The specimens were tested at 23 °C (ambient), 150 °C, 200 °C, 250 °C, 300 °C, and 350 °C in an electric kiln coupled to a universal testing machine, without exposure to flames. The mechanical properties evaluated were the tensile strength and modulus of elasticity. After exposure, the surface damage was examined using scanning electron microscopy (SEM), and resin loss was quantified through fiber content tests. At ambient temperature, the average tensile strength and modulus of elasticity of the rebars were 956.4 MPa and 44.7 GPa, respectively. Damage observed during heating was more severe than that observed after heating and subsequent cooling. At 350 °C, up to 37% of the tensile strength was lost during heating, whereas the maximum reduction in modulus of elasticity was 8.3%, indicating that the fibers themselves were not significantly compromised by heat. After exposure and cooling, the maximum reduction in tensile strength was less than 1% (after exposure to 150 °C), while the modulus of elasticity exhibited a 7.9% decrease (after exposure to 200 °C). The glass transition temperature was measured at 101.7 °C. SEM analysis revealed signs of resin degradation caused by heat, including superficial damage, microcracks, reduced resin cover over the fibers, and ruptured fibers. Fiber content tests after exposure demonstrated a direct correlation between reduced fiber content and the decline in mechanical properties. The behavior of GFRP rebars after heating and cooling can provide important insights for assessing structural safety in post-fire buildings, since natural cooling led to partial resin recovery and improvements in mechanical performance. Full article

Background: Acute kidney injury (AKI) is a frequent complication following transcatheter aortic valve implantation (TAVI) and has been linked to increased mortality. However, the temporal pattern of this association remains uncertain. This study aimed to evaluate the time-dependent impact of AKI on mortality after TAVI using advanced survival analyses. Methods: We retrospectively analyzed 381 consecutive patients who underwent transfemoral TAVI between December 2016 and October 2024 at two tertiary cardiovascular centers. AKI was defined according to the Acute Kidney Injury Network (AKIN) criteria. The primary outcome was all-cause mortality. Patients were categorized into AKI and non-AKI groups. Clinical outcomes, including 30-day, 1-year, and overall mortality, were evaluated. Results: Among 381 patients who underwent TAVI, 59 (15.5%) developed AKI according to the AKIN criteria. During a 33.9 months (18.0–59.2) median follow-up of overall mortality was significantly higher in the AKI group compared with those without AKI. In the multivariate Cox regression analysis, AKI was significantly associated with long-term mortality (HR: 2.07, 95% CI 1.32–3.25; p = 0.002). The time-varying hazard ratio curve demonstrated that the excess mortality risk associated with AKI was most pronounced in the early period and gradually declined thereafter. In time-interval–specific analyses, AKI was strongly associated with mortality within the first month (HR 6.30, 95% CI 3.03–13.08, p < 0.001) and remained significant up to 12 months (HR 2.18, 95% CI 1.32–3.59, p = 0.002). Beyond the first year, this association attenuated and lost statistical significance at 12–36 months (HR 0.90, p = 0.79), 36–60 months (HR 0.57, p = 0.24), and >60 months (HR 0.43, p = 0.13). Conclusions: AKI is an important predictor of early and mid-term mortality following TAVI, but its long-term prognostic impact is less pronounced. Preventive strategies and early management of AKI may improve outcomes in this high-risk population. Full article

Every year, up to 40% of the crops in the world are lost to pests. Plants have suffered from prolonged biotic stresses and abiotic stresses, which cause significant changes in complex crop ecosystems, necessitating intensive pest management strategies that have often been accompanied by the struggle against plant pests. Plant pests and diseases control methods heavily reliant on chemical pesticides have caused many adverse effects. One innovative method involves using ultrafine bubble (UFB) waters, which can enable pesticide reduction action for the plant pest control. The classification and six properties of UFBs were summarized, and the generation approaches of UFBs were introduced based on physical and chemical methods. The applications of UFBs and ozone UFB waters in plant protection practices were comprehensively reviewed, in which UFB waters against the plant pests and the soilborne, airborne and waterborne diseases were analyzed, and the abiotic stresses of crops in high-salinity soil and contaminated soil, drought, and soil with heavy metals were reviewed. Despite promising applications, UFB technology has limitations. Aiming at pesticide reduction and replacement using UFB waters, the mechanism of UFB water controlling plant pests and diseases, the molecular mechanism of UFB water affecting plant pest resistance, the plant growth in harsh polluted environments, the UFB behavior with hydrophobic and hydrophilic surfaces of crops, and the building of an integrated intelligent crop growth system were proposed. Full article

Objectives: Graves’ disease (GD) is the most common cause of hyperthyroidism and is associated with marked changes in body weight and body composition. Although weight loss is frequently reported, the extent and clinical relevance of body composition alterations, as well as their relationship with thyroid function, remain unclear. This study aimed to evaluate body composition and eating habits in patients with newly diagnosed hyperthyroid GD according to pre-morbid weight variation, and to compare these findings with those of matched euthyroid controls. Methods: Forty-four consecutive GD patients were enrolled and stratified based on the presence or absence of pre-morbid weight loss. Anthropometric measurements, thyroid function tests, thyroid volume, dietary habits (PREDIMED score, macronutrient intake and total daily caloric intake) and body composition assessed by bioelectrical impedance analysis (BIA) were collected. Standardized phase angle (SPA) and body cell mass index (BCMI) were calculated as nutritional indices. Body composition parameters and dietary adherence were compared with those of 44 age-, sex- and BMI-matched euthyroid controls. Results: Most GD patients (70.3%) reported weight loss before diagnosis; however, the magnitude of weight change did not correlate with the biochemical severity of thyrotoxicosis. Patients without weight loss showed higher fat mass percentage and higher caloric intake than those who lost weight. SPA was significantly associated with FT3, FT4 and TRAb levels, independently of age, sex, BMI and fat mass. Compared with controls, GD patients exhibited lower phase angle and SPA, higher extracellular water percentage and reduced BCMI, whereas fat mass and adherence to the Mediterranean diet were similar. Conclusions: Hyperthyroid GD patients display increased extracellular water and reduced body cell mass. SPA is inversely associated with GD severity and represents a valuable clinical tool for assessing nutritional status in thyrotoxic patients. Pre-morbid weight changes are not proportional to disease severity and may instead reflect increased caloric intake. Full article