Search Results (60,784)

Background and Objectives: Brain metastases frequently evolve over time in multiple waves, especially in patients with prolonged survival. Despite repeated imaging and targeted therapies, lesion-level continuity is fragmented in clinical practice, as follow-up is typically limited to pairwise MRI comparisons. The aim of the study is to assess the ability of routine narrative MRI follow-up reports to preserve longitudinal lesion identity and to reconstruct a coherent trajectory of disease evolution. Materials and Methods: We conducted a single-center, retrospective, observational study of all brain MRI examinations performed between June 2024 and June 2025 (n = 731 scans, 616 patients). All imaging reviews and longitudinal lesion tracking were performed by one board-certified neuroradiologist. Adult patients with confirmed brain metastases and at least three MRI examinations (including external studies) were included. We assessed the concordance of routine narrative MRI follow-up reports against a longitudinal review of all available MRIs and treatment timelines, which served as the reference standard. Lesion identity was considered preserved when reports explicitly recognized and linked lesions across time points, and lost when identity was omitted or ambiguous in at least one report. Results: The final cohort comprised 73 patients (477 tracked lesions). More than half of monitored lesions disappeared (42.9%) or evolved into post-treatment sequelae (9.9%), and were omitted from narrative reports, limiting retrospective recognition without prior imaging. The ability of routine reports to preserve lesion identity declined as cases became more complex. Concordance was higher in uniform evolution patterns (≈60%) but dropped to 18.2% in mixed evolution. A similar decline was seen with sequential metastatic waves, defined as new metastases appearing at distinct time points: 65.2% (1 wave), 46.7% (2 waves), 18.2% (3 waves), and complete loss of continuity when >3 waves occurred. Conclusions: Routine narrative MRI follow-up reports generally provide adequate information in simple cases with uniform lesion behavior, but tend to lose critical details as disease trajectories become more complex, particularly in heterogeneous or multi-wave disease. Even when individual lesions are identified across examinations, documentation remains fragmented and reflects only a snapshot of the disease course rather than an integrated longitudinal perspective. These findings highlight a critical vulnerability in current follow-up practices. Improving lesion-level continuity, potentially through AI-assisted tools, may enhance the accuracy, consistency, and clinical utility of MRI surveillance in patients with brain metastases. Full article

Macroalgae plays a significant role in the formulation of innovative and environmentally sustainable approaches to address food challenges. Specifically, green macroalgae serve as dietary supplements aimed at improving the health, growth, and feeding efficiency of various species of marine and freshwater fishes, as well as mollusks. The effects of Chaetomorpha linum extract (CLE) on growth performance, physiological responses, and disease resistance are studied in Bellamya bengalensis against Aeromonas hydrophila. In this experiment, adult B. bengalensis (4412 ± 165.25 mg) were randomly divided into 15 rectangular glass aquariums (35 snail/aquaria; 45 L capacity) and their basal diet was supplemented with different levels of CLE, including 0 (CLE0), 1 (CLE1), 2 (CLE2), 3 (CLE3), and 4 (CLE4) g/kg for 60 days. The growth performance in the CLE3 dietary group was significantly higher that of the CLE0 group, exhibiting both linear and quadratic trends in relation to dietary CLE levels (p < 0.05). The activities of pepsin, amylase, and lipase were found to be highest in CLE3 and lowest in CLE0. Both linear and quadratic responses to dietary CLE levels in digestive enzymes were observed (p < 0.05). The activities of superoxide dismutase and catalase in the hepatopancreas were found to be elevated in snails due to the synergistic effect of the supplemented CLE diet. Among different levels of diet given, CLE2-supplemented snails showed an increase in their enzyme activity (p < 0.05). Interestingly, all the CLE-treated snails expressed elevated levels of mucus lysozyme and mucus protein when compared to control (p < 0.05). Additionally, hepatopancreatic acid phosphatase and alkaline phosphatase activity were elevated in snails consuming CLE3 (p < 0.05). The transcription levels of immune-related genes, including mucin-5ac and cytochrome, were significantly elevated in snails that were fed a diet supplemented with 2–4 g of CLE/kg. Furthermore, the transcription level of the acid phosphatase-like 7 protein gene also increased in snails receiving CLE-supplemented diets. After a 14-day period of infection, snails that consumed a diet supplemented with 3–4 g/kg of CLE exhibited a notable increase in survival rates against virulent A. hydrophila. Based on the above findings, it is suggested that a diet supplemented with 3 g/kg of CLE may enhance growth, antioxidant and immune defense, and disease resistance in the freshwater snail B. bengalensis. Full article

Digital inclusion has become an essential component in ensuring the autonomy, social participation, and well-being of older adults. However, their learning of digital skills depends to a large extent on the quality of support provided by the facilitator, whose age, training, and experience directly influence teaching processes and how older adults relate to technology. This study compares the digital competences, and ICT skills of 107 facilitators of digital literacy programs, classified into three groups: peer educators (PEERS), young students without gerontological training (YOS), and young gerontology specialists (YGS). A quantitative design was used. Statistical analyses included non-parametric tests (Kruskal–Wallis, Mann–Whitney, Kendall’s Tau) and parametric tests (ANOVA, t-tests), to examine associations between socio-demographic variables, the level of digital competence, and ICT skills for teachers (technological and pedagogical). The results show clear differences between profiles. YOS achieved the highest scores in digital competence, especially in problem-solving and tool handling. The YGS achieved a balanced profile, combining competent levels of digital skills with pedagogical strengths linked to their gerontological training. In contrast, PEERS recorded the lowest levels of digital competence, particularly in security and information management; nevertheless, their role remains relevant for fostering trust and closeness in training processes among people of the same age. It was also found that educational level is positively associated with digital competence in all three profiles, while age showed a negative relationship only among PEERS. The findings highlight the importance of creating targeted training courses focusing on digital, technological, and pedagogical skills to ensure effective, tailored teaching methods for older adults. Full article

Background/Objectives: RELiZORB immobilized lipase cartridge (ILC) is a single-use digestive enzyme cartridge that connects in-line with enteral feeding circuits to hydrolyze triglycerides in enteral formulas. It is cleared by the FDA for pediatric and adult use. Limited data have been published regarding the effect of ILC use on growth in children younger than 5 years of age. Methods: We performed a retrospective evaluation of real-world data extracted from a third-party reimbursement program database. All patients in the program database who initiated ILC use with enteral formula when 1 to 4 years of age between 2019 and 2023 were included. Baseline and follow-up weight, height/length, and body mass index (BMI) data were collected for up to 12 months. Results: A total of 186 patients from 90 clinics in the United States were included. A subset (143 patients) with baseline and follow-up growth measurements was included in the efficacy analysis population; 76% were diagnosed with cystic fibrosis. Mean weight and BMI z-scores improved significantly (0.63 [p < 0.001] and 0.53 [p = 0.006], respectively) from baseline to 12 months after initiation of ILC use. Significant improvement in the mean weight z-score was observed after 3 months. Among people with cystic fibrosis (pwCF) who initiated ILC use when 2 to 4 years of age, those with a BMI ≥ 50th percentile increased from 22% at baseline to 43% after 12 months (p = 0.021). Improvement in weight-for-length was also observed in 1-year-old pwCF. Conclusions: Real-world evidence showed that initiation of ILC use was associated with significant improvements in mean weight and BMI z-scores among young children. Full article

Biofilm formation represents a key survival strategy employed by Vibrio cholerae to adapt to the complex intestinal environment of the host. While most previous studies on V. cholerae biofilms have focused on genetic regulation and monospecies cultures, its ability to form dual-species biofilms with other intestinal pathogens is still poorly understood. In this study, using samples from both cholera patients and healthy individuals, Fusobacterium nucleatum was identified as a bacterium capable of co-aggregating with V. cholerae. Untargeted metabolomic analysis revealed that F. nucleatum-derived metabolites, specifically 6-hypoxanthine, enhance biofilm formation in V. cholerae. Further validation confirmed that these F. nucleatum-derived metabolites upregulate the biofilm-associated regulatory gene vpsT. In an adult mouse model, co-infection with F. nucleatum and V. cholerae significantly enhanced the intestinal adaptability of V. cholerae compared to infection with V. cholerae alone. Together, these findings elucidate the mechanism enabling the co-infection of F. nucleatum and V. cholerae in the host intestine, thereby shedding new light on how other pathogenic bacteria can assist in V. cholerae infection. Full article

Schistosomiasis remains a major neglected tropical disease globally and presents particular challenges for countries transitioning from control to elimination. Saudi Arabia represents a unique epidemiological setting, having shifted from historical endemic transmission to very low reported incidence, yet long-term national analyses remain limited. A retrospective longitudinal analysis of national schistosomiasis surveillance data from 2002 to 2024 was conducted to evaluate temporal trends, clinical subtypes, regional distribution, and demographic characteristics. Joinpoint regression was used to identify significant changes in temporal trends, and autoregressive integrated moving average (ARIMA) models were applied to forecast national and regional trajectories. National incidence declined markedly from 5.5 per 100,000 in 2002 to 0.12 per 100,000 in 2024, with a notable change around 2010, followed by sustained low-level incidence. Intestinal schistosomiasis accounted for most cases, with increasing concentration among adult non-Saudi males and near-elimination among children. Regionally, cases were confined to a limited number of western and southwestern regions, particularly Ta’if, Al Baha, Jazan, and Madinah. Forecasting analyses indicated continued low-level detection without evidence of national resurgence. These findings demonstrate a transition to an elimination-maintenance phase and highlight the need for sustained surveillance in historically endemic regions and mobile populations. Full article

Background: Neurogenic bowel dysfunction (NBD) is a major chronic sequela of spinal cord injury (SCI) with substantial implications for rehabilitation and long-term management. However, population-level evidence describing how gastrointestinal (GI) diagnostic codes are used following SCI, particularly within administrative healthcare systems, remains limited. Methods: We conducted a nationwide retrospective cohort study using administrative claims data from the Korean National Health Insurance Service (NHIS). A total of 584,266 adults with trauma-related SCI encounters between 2009 and 2019 were identified. GI diagnostic codes—paralytic ileus (K56), irritable bowel syndrome (K58), and functional bowel disorders (K59)—were evaluated as administrative proxies for bowel dysfunction. Demographic characteristics, disability status, regional factors, and health behaviors were analyzed using multivariable logistic regression. Results: GI diagnostic codes were frequently recorded after SCI, most commonly irritable bowel syndrome (approximately 30%) and functional bowel disorders (approximately 37%), whereas paralytic ileus was uncommon. Greater disability severity, female sex, older age, and rural residence were consistently associated with higher odds of GI diagnostic coding. Physical activity showed robust inverse associations across all models. Inverse associations observed with smoking and alcohol consumption were interpreted as reflecting residual confounding or health-related selection, rather than biological protective effects. Conclusions: Patterns of GI diagnostic coding after SCI likely reflect the clinical burden and management needs of neurogenic bowel dysfunction within healthcare systems, rather than the development of new gastrointestinal diseases. These findings underscore the importance of individualized bowel management, incorporation of structured physical activity into rehabilitation programs, and equitable access to SCI rehabilitation services, particularly for individuals with greater disability or those living in rural areas. Full article

Background: Studies outside Japan have linked sugar-sweetened beverage (SSB) intake with weight gain; however, evidence in Japanese adults is scarce, and no study has examined beverage-derived energy in relation to anthropometric indices and handgrip strength. Methods: The participants were employees of Fujita Health University aged 20–39 years (n = 76; male n = 35, average age: 29.97 ± 4.67 years; female n = 41, average age: 27.29 ± 4.53 years). Energy from beverage intake was assessed via the Brief Beverage Intake Questionnaire-15, and energy from alcoholic drinks, milk, SSBs, and total beverages was calculated. The associations of energy from different beverages with nutrient intake, BMI, skeletal muscle mass index (SMI), and handgrip strength were analyzed via ordinary least squares (OLS) regression; quantile regression (QR) and the generalized additive model (GAM) were used for sensitivity analyses. Results: Increased SSB intake was associated with increased BMI (standardized β = 0.35, 95% CI 0.12–0.58, p(OLS) < 0.001; p(QR) = 0.23; p(GAM) < 0.001) and was nonlinearly associated with increased SMI (standardized β = 0.21, 95% CI 0.043–0.37, p(OLS) = 0.02; p(QR) = 0.11; p(GAM) = 0.02), even after adjustment for total energy intake. Modest milk intake was linked to higher protein intake and a higher SMI without a higher BMI (standardized β = 0.18, 95% CI 0.020–0.35, p(OLS) = 0.03; p(QR) = 0.39; p(GAM) = 0.03). Conclusions: A positive association was found between SSB intake and both BMI and SMI and between MILK intake and SMI. Clarification in larger, diverse Japanese populations will be necessary. Full article

Background/Objectives: We investigated the association between leisure-time physical activity (LTPA) and liver fibrosis, and whether this relationship differs by obesity and diabetes status. Methods: We conducted a cross-sectional analysis using data from the National Health and Nutrition Examination Survey (NHANES) 2017–March 2020 cycle. LTPA was assessed using the Global Physical Activity Questionnaire (GPAQ) and classified as physically active if engaging in ≥600 metabolic equivalent (MET)-minutes per week of moderate-to-vigorous activity, or inactive. Clinically significant liver fibrosis was defined as liver stiffness measurement (LSM) ≥ 8.0 kPa on transient elastography. Multivariable logistic and linear regression models estimated adjusted odds ratios (ORs) for significant liver fibrosis, with additional subgroup analyses according to obesity and diabetes status. Results: In 7662 U.S. adults, physically active participants (n = 2721) had a lower prevalence of significant fibrosis than inactive individuals (5.4% vs. 11.4%, p < 0.001). In multivariable analysis, Participants who were physically active were associated with 42% lower odds of having fibrosis (OR 0.58, 95% confidence interval [CI] 0.41–0.82; p = 0.004). This association remained consistent in subgroup analyses stratified by obesity and diabetes status, even in the non-obese subgroup with body mass index (BMI) < 30 kg/m² (OR 0.54, 95% CI 0.32–0.91; p = 0.022) and the non-diabetic subgroup (OR 0.59, 95% CI 0.39–0.90; p = 0.016). Conclusions: Regular moderate-to-vigorous LTPA was independently associated with lower likelihood of clinically significant liver fibrosis. This beneficial association was significant regardless of obesity or diabetes status, suggesting that LTPA may play a clinically meaningful role in populations at high risk for progressive liver disease. Full article

Background/Objectives: Adult spinal deformity (ASD) management often requires pelvic fixation, with S2 alar–iliac (S2AI) screws emerging as an alternative to traditional iliac screws. Despite multiple meta-analyses comparing these techniques, the methodological quality of these syntheses and technical heterogeneity across primary studies significantly impact their conclusions and subsequent clinical decision-making. This systematic review evaluates the evidence quality of meta-analyses comparing S2AI with traditional iliac screws for ASD management, focusing on methodological rigor, primary study overlap, and clinical heterogeneity. Methods: PubMed, Cochrane, and Epistemonikos were searched for meta-analyses comparing S2AI with iliac screws for patients with ASD. The Quality of Reporting of Meta-analyses (QUOROM) checklist and the revised Assessment of Multiple Systematic Reviews (AMSTAR 2) tool were adopted to assess the methodological quality. Primary study overlap was evaluated using the Corrected Covered Area (CCA) method. Clinical heterogeneity was assessed by examining characteristics of studies included in ≥67% of meta-analyses. Results: From a total of 29 publications, six meta-analyses met the inclusion criteria (4807 patients; mean age: 59 years; 33% female). All included meta-analyses exhibited critically low methodological quality per AMSTAR-2, with common flaws including failure to provide lists of excluded studies and lack of a priori protocols. Very high primary study overlap was observed (CCA: 31%), with only 11% (2 of 19) primary studies included in all meta-analyses, whereas 42% (8 of 19) primary studies were included by only a single meta-analysis. Substantial clinical heterogeneity existed regarding patient characteristics, surgical techniques, and outcome definitions. Conclusions: This systematic review of meta-analyses identified critically low methodological quality, high primary study overlap, and substantial clinical heterogeneity in the existing evidence comparing pelvic fixation techniques for ASD. While published meta-analyses generally favor S2AI screws, these significant limitations prevent drawing definitive conclusions about superiority. Future research should prioritize high-quality prospective studies with standardized reporting to generate more reliable evidence for improving surgical outcomes in ASD management. Full article

Background: The rapid ageing of the cardiovascular population has profoundly transformed clinical practice, with an increasing proportion of patients presenting advanced age, frailty, multimorbidity, and functional vulnerability. Conventional cardiology models, largely derived from younger and selected populations, often fail to adequately address the complexity of cardiovascular care in older adults. Despite the growing development of cardiogeriatrics, the core competencies required for contemporary geriatric cardiology practice remain insufficiently defined. Methods: This narrative review synthesises evidence from cardiology, geriatrics, heart failure, and the palliative care literature, complemented by clinical expertise in integrated cardiogeriatric care pathways, to identify key competencies relevant to the care of older adults with cardiovascular disease. Results: Four major domains of geriatric cardiology competencies were identified: (1) advanced cardiovascular expertise adapted to ageing physiology, frailty, and multimorbidity; (2) integration of comprehensive geriatric assessment into cardiovascular decision-making; (3) a dedicated cardiogeriatric communication mindset supporting shared decision-making under prognostic uncertainty; and (4) system-based competencies focused on multidisciplinary coordination, care transitions, and therapeutic proportionality. Conclusions: Defining the core competencies of the geriatric cardiologist is essential to addressing the clinical and organisational challenges of an ageing cardiovascular population. This framework provides a pragmatic foundation for clinical practice, education, and future research, supporting integrated cardiogeriatric care models aligned with patient-centred outcomes. Full article

Human non-polio enteroviruses (NPEVs) cause a plethora of infections in humans, ranging from mild to severe neurological diseases including aseptic meningitis. NPEVs are the leading cause of aseptic meningitis in both children and adults worldwide. In Russia, reports of NPEV infections have surged, especially in the post-COVID era starting in 2022, with elevated infection rates into 2023. A comprehensive examination of the whole genome is crucial for understanding the evolution of NPEV genes and for predicting potential outbreaks. This study focused on identifying the circulating NPEV strains in the Ural Federal District and Western Siberia, using Sanger sequencing and next-generation sequencing (NGS) methodologies. Biological samples were collected from (n = 225) patients diagnosed with aseptic meningitis. Bioinformatics analysis targeted the nucleotide sequences of the major capsid protein (partial VP1) gene fragment, and the assembly of whole NPEV genomes. A total of 159 NPEVs were characterized, representing 70.7% of the collected samples. The main capsid variants forming the predominant genotypic profile included E30 (n = 39, 24.3%), E6 (n = 31, 19.3%), and CVA9 (n = 25, 15.6%). Using NGS, we successfully assembled 13 whole genomes for E6, E30, EV-B80, CVA9, CVB5, E11, and EV-A71 and 3 partial genomes for E6 and EV-B87. This molecular-genetic analysis provides contemporary insights into the genotypic composition, circulation patterns, and evolutionary dynamics of the dominant NPEV associated with aseptic meningitis in the Ural Federal District and Western Siberia. The laboratory-based monitoring and epidemiological surveillance for genetic changes and evolutionary studies are important for improving prevention and healthcare. Full article

Gastric cancer (GC) is the fifth most common cancer worldwide, with the highest incidence in East Asia. Although H. pylori is a well-known risk factor, carcinogenesis can occur independently of H. pylori infection, and approximately 43% of adults carry H. pylori as part of their native microbiota. This study aimed to identify potential oral and gastric microbial markers across different histological stages of GC in both H. pylori-positive and -negative patients. Buccal swabs and gastric mucosa samples were collected from patients with intestinal metaplasia, low-grade dysplasia, high-grade dysplasia, early GC, or advanced GC. Total DNA was extracted, and 16S rRNA gene amplicon sequencing was performed. Microbiome diversity generally remained stable across histological stages, with no directional shifts in community structure. Differential abundance analysis revealed higher relative abundances of Anaerostipes, Phocaeicola, and Collinsella in the gastric antrum of cancerous samples. Anaerostipes and Phocaeicola are typically enriched in the intestinal microbiota but are rarely observed in the stomach, suggesting their potential ecological and pathological relevance in gastric carcinogenesis. In H. pylori-negative patients, however, a different stage-associated abundance pattern was observed, in which Faecalibacterium, a genus predominantly associated with the intestinal environment, was less abundant in advanced gastric cancer samples than in earlier histological stages within the gastric body. These findings suggest that microbial changes during gastric cancer progression may follow different trajectories depending on H. pylori infection status. In oral samples, Haemophilus and Prevotella were more abundant in intestinal metaplasia than in low-grade dysplasia, and network analysis indicated links between Neisseria and Filifactor at oral and gastric sites. However, as the study population was limited to a single country and ethnicity, the applicability of these microbial markers should be carefully considered. Full article

Background: Emotions—including joy, sadness, fear, and anger—are fundamental expressions of human experience. For children and adults who are deaf or hard-of-hearing, emotional experiences and communication can differ due to linguistic and communication-related factors. Methods: This scoping review identifies instruments that are suitable for assessing emotional intelligence in the context of the lived and cultural experiences of individuals who are deaf or hard-of-hearing. A comprehensive search was conducted in April 2024 following the JBI methodology. Results: Out of 3091 articles, 21 studies were included. Two adapted methods were identified: the Meadow/Kendall Social–Emotional Assessment Inventory and ISEAR-D. Assessments supported by sign language revealed no significant differences in age or gender. Conclusions: The authors recommend further development of screening instruments that reflect the specific experiences of the population who are deaf or hard-of-hearing. Full article

Objective: We aimed to study acquired esotropia in adults and its risk factors, compile treatments performed and describe surgical technique used, with a novel indication. Methods: We conducted a retrospective study of patients with insidious distant esotropia along with distant horizontal diplopia (angles 2–30 PD with wide fusion amplitude): Refractively emmetropic, moderately myopic and mildly hyperopic. No systemic alterations. Results: 30 cases were included, average age: 38.13 ± 14.95. Mean time elapsed from the onset of symptoms to surgical treatment was 22.52. Mean spherical equivalent is −3.19 ± 2.83. Mean preoperative horizontal deviation was 18.58 ± 5.45 PD in distant vision and 5.48 ± 8.35 PD in close vision (p < 0.001). 100% of cases reported diplopia in distance vision. 20% required prismatic treatment (<10 PD) and 80% surgical (>10 PD) by lateral rectus resection, with an average of 4.82 ± 1.23 mm. Sensory result was successful in 100% of the cases and motor in 75%. Conclusions: We are facing a new type of acquired esotropia in adults that can be individualized by its clinical and therapeutic characteristics. Our prismatic and surgical treatment has been successful. Full article