Search Results (366)

Background: The treatment of perianal fistulas remains challenging, with low healing and high recurrence rates. Autologous adipose-derived regenerative therapies and platelet-rich plasma (PRP) have emerged as adjuncts to surgical intervention for cryptoglandular and Crohn’s disease (CD)-related perianal fistulas (PAF). This systematic review evaluates the outcomes of these therapies as an add-on to surgical intervention. Methods: A systematic search was conducted in several online databases up to December 2025. Studies with ≥10 patients reporting on the use of intraoperative autologous adipose-derived therapies and/or PRP for the treatment of cryptoglandular or CD-related PAF, and clinical healing rates, were included. Other outcomes comprised radiologic healing (as defined in the study), recurrence rates and complications. The study quality was assessed with the Effective Public Health Practice Tool. Results: In total, 28 studies on individual cases were included (n = 1017 patients, range 10–219) (17 in cryptoglandular PAF, 8 in CD-related PAF and 3 in both entities). A total of 57% of the studies were rated low quality. In cryptoglandular PAF, reported healing rates with adipose-derived therapies ranged from 50% to 90% across studies of low to good methodological quality. For PRP, three of the four randomized trials demonstrated no superiority over standard care. In CD-related PAF, healing rates after treatment with adipose-derived therapies ranged from 40% to 80%. For PRP, three studies, of which two were low quality, reported highly variable healing rates (33–80%). Radiologic healing, reported in 10 studies, ranged from 38 to 76% in cryptoglandular and 33–75% in CD-related PAF. Recurrence rates remained <17% for adipose-derived therapies and <31% following treatment with PRP. Major complications occurred in <15% of the patients. Conclusions: High heterogeneity with regard to fistula complexities, outcome definitions and surgical method was observed in the available studies on autologous add-on therapies. This hinders an overall effectiveness analysis. The promising healing rates, low recurrence rates after healing and low complication rates warrant high-quality trials. Full article

Introduction: Globally, 600 million people chew areca nut, also known as betel nut, with habitual use being a major risk factor for oral cancer. Taiwan and India have some of the highest age-standardized incidence and mortality rates of oral cancer, underscoring the significant health burden in these countries. Aims: This observational cross-sectional study aims to investigate the betel nut consumption habits in the Taiwanese and Indian populations and assess their awareness of its association with oral cancer. Methodology: An interview was conducted and completed by 516 adults across Taiwan and 989 in India to assess betel nut habits and awareness of oral cancer risks. Results: In Taiwan, 95.2% (n = 491) were aware that betel nut can cause oral cancer versus 51.3% (n = 507) in India. Lifetime prevalence of betel nut use in Taiwan was 19.2% (n = 99) versus 42.6% (n = 421) in India. Only in India was betel nut chewing (OR: 0.6, 95% CI: 0.4–0.8, p < 0.001) associated with decreased awareness of the oral cancer risk linked to betel nut use. Using the population attributable fraction (PAF), an estimated 70.5% (95% CI: 46.0–85.5%) of oral cancer cases in India and 53.7% (95% CI: 42.2–64.1%) in Taiwan are potentially attributable to betel nut use. Conclusions: Betel nut use remains prevalent in India and Taiwan, with lack of awareness posing a greater challenge in India and betel nut use being associated with higher risks of self-reported oral cancer symptoms. Effective intervention requires country-specific strategies to curb usage, improve awareness of associated risks and government strategies to reduce betel nut cultivation and availability. Full article

Background: To investigate the predictive value of catheter ablation parameters during pulmonary vein isolation (PVI) on long-term recurrence in patients with paroxysmal atrial fibrillation (pAF). Methods: A retrospective analysis was conducted on 386 pAF patients who underwent initial catheter-based radiofrequency ablation (RFA) for PVI. After excluding ineligible cases and those lost to follow-up, 150 patients were included (mean follow-up: 28.86 ± 3.03 months). Patients were divided into recurrence and AF-free groups. Ablation parameters including catheter contact force (CF), ablation index (AI), and GAPs were collected via the CARTO VISITAG Module, and Cox regression was used to identify recurrence predictors. Results: The 2-year AF recurrence rate was 13.33% (20/150). No significant differences in baseline clinical characteristics, AI compliance rate, VISITAG GAP incidence, ablation points and time, or complication rates were observed between groups (p > 0.05). However, CF compliance rate was significantly lower in the AF recurrence group compared to AF-free group (79.17% vs. 90.10%, p < 0.001), and it was an independent predictor of late AF recurrence (HR = 0.950, 95%CI: 0.919–0.981; p = 0.002). Conclusion: CF compliance rate is independently associated with late AF recurrence after PVI. Maintaining stable CF during ablation may promote durable lesions and potentially reduce recurrence risk. Full article

This study examines the pull-out behaviour of power-actuated fasteners (PAFs) in concrete through a combined analytical, experimental, and probabilistic approach. An experimental programme with 40 power-actuated fasteners (PAFs) installed in plain concrete was carried out to investigate how penetration depth, curvature, and surface damage influence pull-out resistance. Image-based analysis of the concrete surface provided quantitative geometric indicators that were correlated with the measured capacities. The analytical model originally proposed by Gerber was recalibrated using these parameters, resulting in improved agreement with the experimental results. In addition, a probabilistic model was developed to describe the likelihood of insufficient pull-out capacity as a function of measurable installation parameters. The combined framework links geometric characteristics and material response to the reliability of PAF anchorage and highlights the potential of measurable post-installation data for the intelligent, data-driven assessment of fastening performance. Full article

Background: Perianal fistulizing Crohn’s disease (CD) is associated with significant morbidity and remains difficult to treat. Although advanced medical therapies are widely used, much of the available evidence derives from heterogeneous fistula populations or luminal CD trials, with limited perianal-specific synthesis and inconsistent outcome definitions. We conducted a systematic review focusing exclusively on perianal-specific clinical, radiologic, and composite outcomes in adults with perianal fistula (PAF) CD. Methods: We performed a systematic review in accordance with PRISMA 2020. Electronic databases were searched from inception through November 2025. We included randomized controlled trials and cohort studies enrolling adults with CD reporting outcomes specific to PAF. Interventions included biologics and small-molecule therapies, compared with placebo or other therapies. Due to substantial heterogeneity in outcome definitions and study designs, a meta-analysis was not performed. Risk of bias was assessed using Risk of Bias 2 (RoB 2) for randomized trials and the Newcastle–Ottawa Scale for observational studies. Results: Seven studies including >1200 participants with PAF-CD met inclusion criteria. Follow-up ranged from 24 weeks to 5 years. Across studies, outcome definitions and assessment modalities varied. Upadacitinib demonstrated significantly higher clinical fistula closure compared with placebo across multiple dose regimens at 52 weeks. In observational comparisons, ustekinumab and vedolizumab were associated with higher clinical closure rates than anti-TNF therapies. However, infliximab demonstrated higher closure rates than adalimumab as a first-line treatment. The definition for radiologic remission was less consistent across studies and often did not parallel clinical outcomes. Composite clinical–radiologic remission and response were reported in a limited number of studies, with filgotinib showing higher composite outcomes in comparison to placebo in a phase 2 trial. Surgical interventions, relapse outcomes, biomarkers [C-reactive protein (CRP)/fecal calprotectin (FCP)], and patient-reported outcomes were variably reported and not consistently significant across comparisons. Conclusions: Evidence for advanced therapies in PAF CD remains limited by heterogeneity in endpoint definitions, subjectivity in clinical observation, inconsistent radiologic reporting, and reliance on subgroup or observational comparisons. While anti-TNF therapy remains the most established option in guidelines, emerging data suggest significant benefits with ustekinumab, vedolizumab, and JAK inhibitors in selected patients. There is a need for PAF-specific, adequately powered randomized trials using standardized composite clinical and radiologic endpoints. Full article

Our study investigates an application of a bottom-up design for keypoint regression, Part Affinity Fields (PAFs), for sign language recognition. Automatic sign language recognition could facilitate communication between deaf people and the hearing majority. Sign languages generally employ both semantic and finger-spelling signing. Semantic signing includes acting out to convey meaning, while finger spelling complements signing through the spelling out of proper names. Specifically, this article addresses an automatic recognition framework for the static point-on-hand (PoH) signing of Thai Finger Spelling (TFS)—the finger-spelling part of Thai Sign Language (TSL). From a pattern recognition perspective, PoH signing is quite distinct among signing schemes for requirement of precise localization of key parts on the signing hands. A recent study addressed PoH using an off-the-shelf version of MediaPipe Hands (MPH) and found shortcomings particularly when there was a high degree of hand-to-hand interaction. The top-down design of MPH was hypothesized to be the culprit. Our study investigates a bottom-up design, Part Affinity Fields (PAFs), along with examination of the related factors. The results support the hypothesis of a high-degree of hand-to-hand interaction posited by the MPH study. However, the overall performance of the PAF-based approach is shown to be modestly effective (72% accuracy vs. 58% and 47% of the MPH- and X-Pose-based approaches). In addition, its generalization is shown to be lacking. Thus TFS point-on-hand sign recognition remains a challenge. Full article

Parkinson’s disease (PD) and associated synucleinopathies are preceded by a prolonged prodromal phase during which neurodegenerative processes evolve years before the onset of motor or cognitive symptoms. Identifying biologically specific and accessible biomarkers during this window is critical for early diagnosis, risk stratification, and the development of disease-modifying therapies. Increasing evidence supports the skin as a key peripheral tissue involved in synucleinopathy, offering a minimally invasive source for in vivo detection of pathological α-synuclein. This review summarizes current evidence on skin-derived biomarkers across the prodromal continuum of PD, with particular emphasis on skin biopsy-based detection of phosphorylated α-synuclein and α-synuclein seed amplification assays (SAAs). Findings in high-risk prodromal phenotypes, including idiopathic REM sleep behavior disorder (iRBD) and pure autonomic failure (PAF), are critically reviewed. Emerging data suggest that cutaneous α-synuclein pathology may precede nigrostriatal dopaminergic degeneration and may predict phenoconversion to overt synucleinopathies. Important knowledge gaps are highlighted, including the lack of data in other prodromal phenotypes such as hyposmia. Overall, skin-based biomarkers appear to represent promising, scalable tools for biological diagnosis, prognostication, and enrichment of prodromal PD cohorts in clinical trials. Full article

Dogs can develop chronic inflammatory diseases that induce progressive tissue damage and illness. Delphinidin is a component of maqui (Aristotelia chilensis) and has anti-inflammatory and antioxidant effects. This study evaluated the immunomodulatory effects of delphinidin chloride (DC) and delphinidin-3-glucoside (D3G) on neutrophils and peripheral blood mononuclear cells (PBMCs) in dogs. Leukocytes were isolated from 20 clinically healthy dogs and treated with DC and D3G at concentrations of 50, 100, and 150 µM. The cells were then stimulated with lipopolysaccharide (LPS), platelet-activating factor (PAF), or phorbol 12-myristate 13-acetate (PMA) to evaluate cell viability, reactive oxygen species (ROS) production, neutrophil extracellular trap (NET) formation, phagocytosis, chemotaxis, matrix metalloproteinase 9 (MMP-9) activity, and cytokine production. The results showed that both compounds preserved cell viability, significantly reducing ROS production and NET formation. DC significantly increased chemotaxis and D3G significantly reduced MMP-9 activity. Both compounds reduced the secretion of interleukin (IL) 1β (IL-1β) and tumor necrosis factor α (TNF-α) in neutrophils. In PBMCs, they decreased the production of IL-4 and IL-6 and modulated the production of interferon γ (IFN)-γ. In conclusion, delphinidin exerts selective anti-inflammatory activities in canine leukocytes, promoting inflammation resolution, suggesting its potential role as a nutraceutical for managing inflammatory pathologies in dogs. Full article

Magnesium is an essential micronutrient that exerts fundamental roles at both the cellular and tissue levels, with broad therapeutic and preventive implications across a range of pathological conditions. Accumulating clinical and experimental evidence indicates that optimal magnesium homeostasis modulates key pathophysiological processes and serves as both a biological and prognostic marker in disorders such as stroke, myocardial infarction, type 2 diabetes mellitus, and renal failure. These disease states commonly originate from two major etiological determinants—hypertension and atherosclerosis—which share a unifying pro-inflammatory mediator: platelet-activating factor (PAF). PAF plays a central role in vascular inflammation by promoting platelet aggregation, macrophage infiltration, leukocyte adhesion, and vasomotor dysregulation. Importantly, magnesium demonstrates an inverse association with both platelet aggregation and PAF activity, underscoring its protective capacity in mitigating vascular inflammation and preserving endothelial function. The objective of this updated literature review is to elucidate the antagonistic interplay between magnesium and PAF, with a focus on its physiological and therapeutic significance across multiple organ systems. While emerging data support a modulatory role of magnesium in PAF-mediated inflammatory pathways, current evidence remains limited. Therefore, further mechanistic, pharmacological, and clinical investigations are warranted to clarify the multifaceted role of magnesium in attenuating PAF-driven disease processes. Full article

Chronic consumption of groundwater arsenic is a well-known risk factor for many cancers, notably lung, bladder, kidney and skin cancers, and is recognized as such in many countries, notably India. Indeed, increasing cancer incidence and mortality in India has been ascribed to such exposure. Notwithstanding this, there has hitherto been a dearth of quantitative data on the magnitude and spatial distribution of groundwater arsenic attributable cancer mortality in India. Here, we combined random forest model-derived data on the spatial distribution of groundwater arsenic in India with India census data on populations and groundwater usage and recently published dose–response relationships to address this knowledge gap through a population attributable fraction (PAF) approach. We show that around 1.4% (95% CI; ±1.8%) of all lung cancer mortality in India can plausibly be attributable to exposure to groundwater arsenic. Whilst this is a substantial range of values, it is too small to sensibly indicate any plausibility of the narrative of groundwater arsenic exposure being primarily responsible for the increased cancer incidence and mortality in India over the last few decades. Nevertheless, the modeled spatial distribution of groundwater arsenic exposure PAF of lung cancer mortality in India may inform public policy aimed at reducing environment-related detrimental health outcomes. Full article

This paper presents PAF-Net, an image dehazing framework that integrates physical priors and adaptive feature modeling. Its aims to enhance image restoration quality in complex non-uniform haze scenes, while maintaining moderate model complexity and computational cost. Built upon the classical FFA-Net backbone, PAF-Net enhances dehazing performance from three complementary perspectives: spatial attention decision, physics-consistent feature representation in feature space, and operator-level adaptability. These perspectives are realized by three corresponding modules. Specifically, a Fog-aware Concentration Attention (FCA) module is introduced. It embeds haze-related spatial guidance into attention-weight generation, reducing attention–allocation imbalance under spatially non-uniform haze and strengthening the model’s focus on dense-haze regions. To improve physical feature consistency under non-uniform haze, a Physics-aware Feature Dehazing Unit (PFDU) is further designed to explicitly model and reorganize transmission-related and atmospheric-light-related feature components under atmospheric scattering priors. In addition, a Dynamic Convolution Module (DCM) is incorporated to adapt convolutional responses at the sample level according to global degradation patterns, enhancing robustness across diverse haze conditions. Experiments on RESIDE SOTS and real-world benchmarks (Dense-Haze and NH-Haze) demonstrate that PAF-Net achieves higher PSNR/SSIM and yields more natural visual results than representative methods. Further experiments and evaluations based on paired remote sensing datasets have verified the applicability of the designed PAF-Net algorithm in remote sensing scenes with spatially varying haze, as well as the algorithm’s generalization ability. Full article

Introduction: Resting-state EEG (rsEEG) is a scalable window onto trait-like “executive readiness,” but findings have been fragmented by task impurity on the executive-function (EF) side and heterogeneous EEG pipelines. This review synthesizes rsEEG features that reliably track EF in healthy samples across development and aging and evaluates moderators such as cognitive reserve. Materials and methods: Following PRISMA 2020, we defined PECOS-based eligibility (human participants; eyes-closed/eyes-open rsEEG; spectral, aperiodic, connectivity, topology, microstate, and LRTC features; behavioral EF outcomes) and searched MEDLINE/PubMed, Embase, PsycINFO, Web of Science, Scopus, and IEEE Xplore from inception to 30 August 2025. Two reviewers were screened/double-extracted; the risk of bias in non-randomized studies was assessed using the ROBINS-I tool. Sixty-three studies met criteria (plus citation tracking), spanning from childhood to old age. Results: Across domains, tempo, noise, and wiring jointly explained EF differences. Faster individual/peak alpha frequency (IAF/PAF) related most consistently to manipulation-heavy working may and interference control/vigilance in aging; alpha power was less informative once periodic and aperiodic components were separated. Aperiodic 1/f parameters (slope/offset) indexed domain-general efficiency (processing speed, executive composites) with education-dependent sign flips in later life. Connectivity/topology outperformed local power: efficient, small-world-like alpha networks predicted faster, more consistent decisions and higher WM accuracy, whereas globally heightened alpha/gamma synchrony—and rigid high-beta organization—were behaviorally sluggish. Within-frontal beta/gamma coherence supported span maintenance/sequencing, but excessive fronto-posterior theta coherence selectively undermined WM manipulation/updating. A higher frontal theta/beta ratio forecasts riskier, less adaptive choices and poorer reversal learning for decision policy. Age and reserve consistently moderated effects (e.g., child frontal theta supportive for WM; older-adult slow power often detrimental; stronger EO ↔ EC connectivity modulation and faster alpha with higher reserve). Boundary conditions were common: low-load tasks and homogeneous young samples usually yielded nulls. Conclusions: RsEEG does not diagnose EF independently; single-band metrics or simple ratios lack specificity and can be confounded by age/reserve. Instead, a multi-feature signature—faster alpha pace, steeper 1/f slope with appropriate offset, efficient/flexible alpha-band topology with limited global over-synchrony (especially avoiding long-range theta lock), and supportive within-frontal fast-band coherence—best captures individual differences in executive speed, interference control, stability, and WM manipulation. For reproducible applications, recordings should include ≥5–6 min eyes-closed (plus eyes-open), ≥32 channels, vigilant artifact/drowsiness control, periodic–aperiodic decomposition, lag-insensitive connectivity, and graph metrics; analyses must separate speed from accuracy and distinguish WM maintenance vs. manipulation. Clinical translation should prioritize stratification and monitoring (not diagnosis), interpreted through the lenses of development, aging, and cognitive reserve. Full article

Background: Ischemic stroke remains the most feared complication of atrial fibrillation (AF), and thromboembolic risk is commonly estimated using clinical scores that may not fully capture the cardiometabolic dimension of cerebrovascular vulnerability. The aim of this research was to assess whether additional parameters can be used, to predict ischemic stroke risk in patients with AF, in order to explore whether TG/HDL-C may complement conventional clinical risk scores for ischemic stroke risk stratification in PAF, and to better characterize a metabolically high-risk phenotype beyond the recommendations provided by the CHA₂DS₂-VA score, which is useful but still far from perfect in predicting AF-associated ischemic stroke risk. Methods: In this retrospective, single-center observational study, we evaluated whether the triglyceride-to-high-density lipoprotein cholesterol ratio (TG/HDLc), a simple surrogate of atherogenic dyslipidemia and insulin resistance, is associated with ischemic stroke risk in patients with paroxysmal atrial fibrillation (PAF). We screened 1111 consecutive AF admissions between 1 January 2015 and 31 December 2016 and, from these 1111 AF cases, we extracted only the patients with PAF for analysis. Patients were stratified based on TG/HDLc values into two groups, Group 1 (TG/HDLc > 2.5; n = 155) and Group 2 (TG/HDLc < 2.5; n = 194). Statistical analysis was performed with MedCalc v23.4.0 using Chi-square and unpaired/Welch’s t-tests as appropriate, Pearson correlations, Kaplan–Meier analysis with log-rank testing, Cox regression for first ischemic stroke, and multivariable logistic regression to identify independent correlates of TG/HDLc > 2.5. Results: Patients with TG/HDLc > 2.5 had a significantly higher prevalence of ischemic stroke after AF onset compared with those with TG/HDLc < 2.5 (37.4% vs. 21.1%, p = 0.0008), despite similar CHA₂DS₂-VA and HAS-BLED scores, and also exhibited a higher burden of cerebrovascular and neurodegenerative findings, including cortical atrophy and cerebral lacunarism. Ischemic stroke-free survival curves diverged significantly over time (log-rank p = 0.0186), and an elevated TG/HDLc ratio was associated with a 68% higher hazard of first ischemic stroke (HR 1.68; 95% CI 1.09–2.60). In multivariable analysis, type 2 diabetes mellitus (OR 4.53), hyperuricemia (OR 3.83), dyslipidemia (OR 1.94), stroke (OR 1.77), and cortical atrophy (OR 4.48) were independently associated with TG/HDLc > 2.5. Conclusions: These findings suggest that TG/HDLc identifies a metabolically high-risk PAF phenotype associated with greater cerebrovascular burden and reduced ischemic stroke-free survival, providing an inexpensive and broadly available marker that may complement conventional clinical risk scores. Full article

Cryopreservation of preantral follicles (PAFs) is a promising tool for gene conservation and fertility preservation. However, standardized protocols for the cryopreservation and in vitro culture of isolated follicles—particularly in pigs—are still lacking. This study aimed to analyze the survival and developmental potential of porcine PAFs vitrified using two different methods: open pulled straw (OPS) and cryotube (CT). Ovaries of Hungarian Large White sows were collected from a local slaughterhouse and enzymatically digested to isolate preantral follicles. Morphologically normal follicles were assigned to three groups: fresh control, OPS-vitrified, and CT-vitrified. All follicles were cultured for 10 days in FSH-supplemented medium, with growth, survival, and estradiol (E2) production monitored. Survival rate was lower in the CT group (83.3%) than that of the control and OPS (97.4% and 94.4%, respectively). The follicular area was consistently larger in control than in CT and OPS, with no difference between vitrified groups. E2 production varied among treatments: OPS follicles showed lower E2 levels on Day 2, no differences were detected on Day 7, and CT follicles produced less E2 on Day 10. These results indicate that OPS is the more suitable vitrification method for porcine PAFs and that the culture system supports hormone production; however, it may require refinement to provide long-term follicle maintenance. Full article

Background: Prostate cancer in the Middle East and North Africa (MENA) region is shaped by a complex interplay of behavioral and environmental risk factors, yet comprehensive estimates of preventable cases remain scarce. To address this gap, we estimated population-attributable fractions (PAFs) for a range of modifiable exposures among men aged 50 years and older and assessed potential reductions in incidence under feasible intervention scenarios. Methods: Regional prevalence data were combined with relative risks from meta-analyses to compute closed-form PAFs for tobacco smoking, obesity, physical inactivity, high dairy and calcium intake, heavy alcohol use, drinking water nitrates, trihalomethanes, arsenic, lead, selenium status, ambient PM_2.5 and NO₂, and occupational diesel exhaust, covering an estimated 47 million men. Estimates were validated using a synthetic cohort simulation of 100,000 individuals, with uncertainty quantified through Monte Carlo sampling. Results: Results showed that drinking water nitrate exposure accounted for the largest single fraction (17.4%), followed by tobacco smoking (9.5%), physical inactivity (6.7%), and trihalomethane exposure (5.0%), while other exposures contributed smaller but meaningful shares. Joint elimination of all exposures projected a 45.5% reduction in incidence, and simultaneous feasible reductions in four targeted exposures yielded a combined potential impact fraction of 12.1%. Conclusions: These findings suggest that integrated water quality management, tobacco control, lifestyle interventions, and targeted environmental surveillance should be prioritized to reduce prostate cancer burden in the MENA region. However, estimates of drinking-water nitrate exposure rely on limited evidence from a single case–control study with a relatively small sample size, and should therefore be considered exploratory and primarily hypothesis-generating. Full article