Search Results (2,652)

Background and Objectives: Distal upper limb injuries are frequent in winter sports, but their functional impact is often underestimated. This study aimed to describe the epidemiology, mechanisms, and risk factors for injuries involving the forearm, wrist, hand, and fingers sustained during two consecutive winter seasons in the Italian Dolomites. Materials and Methods: All adult and willing patients presenting to the Emergency Department of Brixen Hospital after ski- or snowboard-related accidents between December 2023 and March 2025 completed a standardized 23-item questionnaire on demographics, experience level, environmental factors, equipment, and trauma mechanism. For the aim of this study only distal upper limb injuries were extracted and analyzed. Statistical analyses compared fracture versus non-fracture injuries, “good” versus “bad” fractures (AO classification and surgical complexity), and isolated ulnar collateral ligament (UCL) injuries. Results: A total of 195 patients were analyzed: 96 (49.2%) sustained a fracture and 33 (16.9%) presented with isolated UCL lesions. Fractures occurred more frequently on blue slopes (56.2% vs. 33.3%, p < 0.001), whereas non-fracture injuries predominated on red and off-piste slopes. Age, BMI, and skill level did not differ significantly between groups. Surgically classified complex distal forearm fractures were significantly more frequent in females (p < 0.005) but were not associated with environmental factors. UCL injuries occurred mainly on red slopes (54.5%) and were often related to pole entrapment during falls. None of the injured patients reported the use of protective wrist or thumb supports. Conclusions: Distal upper limb injuries are a common pattern of alpine sports trauma, with wrist fractures and skier’s thumb being predominant lesions. Low-speed falls on easy slopes are associated with wrist fractures, while UCL injuries are linked to intermediate slopes. Preventive strategies should include fall technique education, protective gloves, and improved pole ergonomics. Full article

Background and objectives: Clinical laboratory analyses are essential for diagnosing and treating allergic diseases mediated by immunoglobulin E (IgE). Identifying the sources of sensitivity, subject to regional variations, enables the implementation of effective management strategies, such as prevention and immunotherapy. Through a cross-sectional study, this study aimed to determine the sensitivity profile to aeroallergens (latent class) and their correlation with age, sex, and season in the population sampled. Methods: The purpose was to map the concentrations of specific IgE serum levels linked to the most prevalent allergens, considering variations related to age, specific IgE levels, and seasons of the year through a cross-sectional study. Results: The 995 reports of specific IgE tests analyzed were clustered into six aeroallergen categories and were predominantly composed of female individuals (57.1%). The most prevalent age group was younger than 18 (56.5%), and most exams were performed in the spring (27.7%). The aeroallergen category ‘grass’ significantly correlated with sex and age, indicating that men have a 65% greater probability of having high levels of specific IgE as a response to this allergen, and age is related to higher IgE levels. Latent class analysis identified an optimal three-class solution for specific IgE sensitization patterns: Class 1: Moderate Sensitization; Class 2: Low Sensitization; and Class 3: High Sensitization. Conclusion: The present study highlights the importance of knowing the local aeroallergen profile for early diagnosis and prevention of allergic diseases, emphasizing the relevance of the allergen category related to the age and sex of the individuals. Full article

Human cytomegalovirus (HCMV) establishes lifelong latency following primary infection, residing within myeloid progenitor cells and monocytes. To achieve this, the virus employs multiple immune evasion strategies. It suppresses innate immune signaling by inhibiting Toll-like receptor and cGAS-STING pathways. In addition, the virus suppresses major histocompatibility complex (MHC)-dependent antigen presentation to evade T cell recognition. As the downregulation of MHC molecules may trigger NK cell activation, the virus compensates for this by expressing proteins such as UL40 and IL-10, which engage inhibitory NK cell receptors and block activating signals, thereby suppressing NK cell immune surveillance. Viral proteins like UL36 and UL37 block host cell apoptosis and necroptosis, allowing HCMV to persist undetected and avoid clearance. In settings of profound immunosuppression, such as after allogeneic hematopoietic stem cell transplantation (allo-HSCT) or solid organ transplantation, slow immune reconstitution creates a window for viral reactivation. Likewise, immunosenescence and chronic low-grade inflammation during aging increases the risk of reactivation. Once reactivated, HCMV triggers programmed cell death, releasing viral PAMPs (pathogen-associated molecular patterns) and host-derived DAMPs (damage-associated molecular patterns). This release fuels a potent inflammatory response, promoting further viral reactivation and exacerbating tissue damage, creating a vicious cycle. This cycle of inflammation and reactivation contributes to both transplant-related complications and the decline of antiviral immunity in the elderly. Therefore, understanding the immune regulatory mechanisms that govern the switch from latency to reactivation is critical, especially within the unique immune landscapes of transplantation and aging. Elucidating these pathways is essential for developing strategies to prevent and treat HCMV-related disease in these high-risk populations. Full article

Background: Polytrauma remains a leading cause of mortality and disability worldwide. Although trauma-related deaths have declined in recent decades, the drivers of this trend remain incompletely understood. Traumatic brain injury (TBI) is the principal cause of death and long-term disability in polytrauma, making it a critical determinant of outcomes. This study aimed to examine long-term trends in clinical characteristics, management strategies, and outcomes of polytraumatized patients with TBI (PTBI), with a particular focus on factors influencing overall and cause-specific mortality. Methods: We conducted a retrospective observational study of a prospectively maintained trauma registry over a 25-year period (1993–2018) at the Gregorio Marañón University General Hospital (Madrid, Spain). Adult patients with PTBI were included. Epidemiological, clinical, and outcome data were analyzed globally and across four time periods. Results: Among 768 patients with PTBI, mean age was 43 years (±20), and 29% were female. Most sustained closed TBIs (96%) with concomitant severe injuries to the head, chest, and extremities (median Injury Severity Score [ISS] 27; median New Injury Severity Score [NISS] 34). Emergency surgery was required in 51%, and 84% were admitted to intensive care. Over time, the incidence of polytrauma decreased, mainly reflecting fewer traffic-related injuries following advances in prevention and legislation. Despite an increasingly older and comorbid population, ISS/NISS and early mortality declined, largely due to improvements in prehospital care and hemorrhage control. Although crude TBI-related mortality appeared unchanged (28%), this pattern likely reflects offsetting influences, including an older and more comorbid patient population, a higher relative burden of severe cases, and the limitations of mortality alone to capture gains in functional outcomes. Conclusions: Advances in trauma systems and preventive policies have substantially reduced the burden of polytrauma and improved survival. However, severe TBI remains the principal unresolved challenge, highlighting the urgent need for innovative neuroprotective strategies and greater emphasis on functional recovery. Full article

The ovary is among the earliest organs to undergo age-related degeneration, limiting the reproductive potential of elite horses and constraining the growth of the equine industry. Follicular development during estrus is a key determinant of fertility, yet the molecular mechanisms underlying its decline, particularly at the level of specific ovarian cell types, remain poorly understood in equids. Here, we constructed a single-cell transcriptomic atlas to investigate ovarian changes in Kazakh horses. Using single-cell RNA sequencing (scRNA-seq), we profiled 112,861 cells from follicle-containing and follicle-absent ovaries, identifying nine distinct ovarian cell types and their subtypes, each with distinct gene expression signatures. Functional enrichment analyses revealed cell type-specific engagement in biological pathways, including ECM–receptor interaction, PI3K-Akt signaling, and oxytocin signaling. Gene expression patterns indicated tightly regulated processes of ovarian activation and cell differentiation. Notably, stromal cells exhibited high expression of ROBO2, LOC111770199, and TMTC2, while smooth muscle cells (SMCs) were marked by elevated levels of CCL5, KLRD1, and NKG7. Moreover, cell–cell interaction analyses revealed robust signaling interactions among SMCs, endothelial cells, neurons, and proliferating (cycling) cells. Together, these findings provide a comprehensive single-cell transcriptomic map of normal and abnormal ovarian states during estrus in Kazakh horses, offering novel insights into the cellular mechanisms of follicular development and identifying potential diagnostic biomarkers and therapeutic targets for ovarian quiescence in equids. Full article

Background: Investigating human exposure to toxic contaminants through dietary consumption is critical to identify disease risk factors and health guidelines. Methods: In this study, we developed a cross-sectional online survey to collect information about dietary patterns and related food consumption habits among adults (age ≥ 18) and adolescents (ages 13–17) in Southern California, focusing on popular staple foods and/or those targeted most commonly under California’s Proposition 65 law for lead and acrylamide exposure. Results: Results identified root vegetables, rice, leafy greens, pasta/noodles, tea, juice, and seafood to be among the most heavily consumed foods by mass, while the daily intake of many foods such as stuffed grape leaves, tamarind/chili candy and herbs/spices varied by age and race/ethnicity, suggesting that many of Proposition 65’s pollution allowances may be exacerbating issues of health inequity and environmental injustice. Moreover, findings from this study indicate that the methods of exposure assessment often applied under Prop 65, especially relating to herbs/spices, are likely to underestimate single-day exposures, thus allowing unsafe products on the market without warning labels. Conclusions: Study outcomes are broadly relevant to environmental health and nutrition science, with particular relevance to public health practitioners and California’s Prop 65 regulators and other stakeholders. Full article

Background: The widespread use of social media among children and adolescents has raised increasing concern about its potential impact on mental health. Given the unique neurodevelopmental vulnerabilities during adolescence, understanding how digital platforms influence psychiatric outcomes is critical. Objectives: This narrative review aims to synthesize current evidence on the relationship between social media exposure and key psychiatric symptoms in youth, including depression, anxiety, body image disturbances, suicidality, and emotional dysregulation. Methods: We conducted a comprehensive narrative review of the literature, drawing from longitudinal, cross-sectional, and neuroimaging studies published in peer-reviewed journals. Specific attention was given to moderators (e.g., age, gender, and personality traits) and mediators (e.g., sleep, emotion regulation, and family context) influencing the relationship between social media use and mental health outcomes. Results: Evidence indicates that certain patterns of social media use, especially passive or compulsive engagement, are associated with increased risk of depression, anxiety, body dissatisfaction, and suicidal ideation. Adolescent girls, younger users, and those with low self-esteem or poor emotional regulation are particularly vulnerable. Neuroimaging studies show that social media activates reward-related brain regions, which may reinforce problematic use. Family support and digital literacy appear to mitigate negative effects. Conclusions: Social media use is not uniformly harmful; its psychological impact depends on how, why, and by whom it is used. Multilevel prevention strategies, including media education, parental involvement, and responsible platform design, are essential to support healthy adolescent development in the digital age. Full article

Background: Chronic neck pain (CNP) is considered a widespread musculoskeletal condition which affects the quality of life and is associated with scapular stabilizer dysfunction patterns. This study aimed to compare the morphological, functional, and strength-related characteristics of the lower trapezius muscle (such as muscle thickness at rest and during contraction, contraction-to-relaxation ratios, contraction and relaxation velocities, and force production) between individuals with CNP and asymptomatic controls. Methods: This cross-sectional study comprises 144 participants (78 with CNP and 76 controls) aged 18–30 years. Ultrasound imaging was used to assess muscle thickness, contraction and relaxation velocities, and contraction ratios. Muscle strength, including peak force and rate of force development, was evaluated using dynamometry. Participants with CNP were categorized by neck disability index (NDI) scores into mild, moderate, and severe groups. Results: Participants with CNP showed reduced contraction velocity (0.60 ± 0.24 cm/s vs. 0.81 ± 0.44 cm/s; p < 0.001; d = 0.61), lower relaxation velocity (0.48 ± 0.28 cm/s vs. 0.58 ± 0.32 cm/s; p = 0.038; d = 0.34), and decreased peak force (4.83 ± 3.27 kg vs. 6.00 ± 3.87 kg; p = 0.043; d = 0.33) compared to controls. Muscle thickness and contraction ratio differences were non-significant. Among CNP subgroups, the contraction ratio was lower in the severe disability group compared to the mild group (0.25 ± 0.19 vs. 0.53 ± 0.33; p = 0.015). Conclusions: The present study showed functional impairments of the lower trapezius muscle in individuals with CNP, particularly reduced contraction and relaxation velocities and lower peak force, with more pronounced deficits in those with severe disability. While no significant differences in muscle thickness were found, these findings suggest that functional alterations may precede structural changes. Full article

Background: Obesity is a well-established risk factor for numerous chronic diseases, including heart disease and type 2 diabetes, and its impact is particularly acute among Black/African American men. According to the Centers for Disease Control and Prevention (CDC), 70.9% of Black men aged 20 and older are overweight or obese. Despite this alarming prevalence, there remains a limited number of studies that specifically investigate the root causes of obesity in this population. Addressing this gap is critical to developing culturally relevant interventions that promote health equity. The purpose of this study was to assess dietary patterns, that are associated with overweight/obesity, in Black men aged 18–65 across the United States of America, to gain an in-depth understanding of variables influencing BMI in Black men. Methods: This study utilized a quantitative approach to collect information from participants. A survey questionnaire was developed and administered via Qualtrics to participants using a web link. The survey collected information across 18 dietary variables. Data was exported to Microsoft Excel for statistical analysis. A simple linear regression was used to determine dietary variables correlation strength and significance with BMI. A significance level of p < 0.05 was used to determine if a variable was statistically significant. Variables were then organized based on significance vs. non significance and correlation strength. Result: The study sample consisted of 466 Black men aged 18 to 65 years. The mean BMI was 30.21. Approximately 19% (n = 87) had a BMI within the healthy range (18.5–24.9), 41% (n = 190) were categorized as overweight (BMI 25.0–29.9), and another 41% (n = 189) were classified as obese (BMI ≥ 30.0). The findings revealed that fruit and vegetable consumption and whole grain cereal consumption were significantly and positively correlated with BMI. Other variables, such as fried foods, processed foods, and sugary drinks, though historically associated with obesity, did not show statistical significance in this population. Conclusions: Results suggest that while multiple dietary factors influence BMI, fruit, vegetable, and whole grain consumption are significantly correlated with BMI in Black men living in America. The findings from this study serve as a foundational step for designing targeted, culturally sensitive interventions aimed at reducing obesity-related health disparities. Future research should further explore how tailored public health messaging and community-based programming can address the specific needs of this population. Full article

Background: Adolescents with obesity participate in self-directed weight loss attempts, and these may be associated with disordered eating. This study aimed to understand prior engagement with a dietitian and previous dieting practices of adolescents presenting for obesity treatment. Additionally, we aimed to understand the association between prior dieting and eating disorder risk, binge eating, weight bias internalisation and body image. Methods: This cross-sectional study included 141 adolescents (median [IQR] age: 14.8 [13.8–15.7] years) with BMI 35.28 (31.99–38.57) kg/m² and ≥1 related complication presenting for a prescriptive dietary intervention. Adolescents were asked whether they had previously seen a dietitian (yes/no) and/or previously trialled any other diets for weight management. Associations between reported diets and the Eating Disorder Examination Questionnaire (EDE-Q), the Binge Eating Scale, the Weight Bias Internalisation scale and Body Appreciation Scale scores were assessed using multiple one-way ANOVAs. Results: A total of 68 (48.2%) adolescents had previously seen a dietitian and 106 (75.2%) had trialled at least one diet. Most adolescents had used one diet type (n = 74; 52.5%), and 29 (20.6%) had used two or three different diets. Most adolescents reported following a healthy eating pattern (n = 76; 53.9%), with 11 trying a low-carbohydrate diet (7.8%) or a specific eating plan, e.g., low sugar, vegetarian (n = 11; 7.8%). There were no associations between dieting attempts and scores of measures of disordered eating, weight bias or body appreciation. Conclusions: Many adolescents presenting for obesity treatment will have trialled diets, with or without the support of a dietitian. Clinicians providing nutrition education and prescribing dietary interventions should be aware of this and the potential influence on adolescent perceptions of dieting practices. Full article

Background/Objectives: To investigate microRNA (miRNA) expression profiles in the anterior lens capsules of patients with glucocorticoid-induced cataracts (GIC) and to identify miRNAs potentially associated with glucocorticoid (GC) exposure and posterior subcapsular cataract (PSC) formation. Methods: A total of 33 participants were divided into four groups based on their GC usage history and cataract type: GIC (n = 10), age-related PSC (n = 6), GC-treated age-related cataract (ARC) (n = 7), and normal control (n = 10). Anterior lens capsule samples were obtained during cataract surgery and total RNA was extracted for quantitative real-time polymerase chain reaction (qRT-PCR). The expression levels of 12 selected miRNAs were quantified using a customized miScript miRNA PCR array. Results: Among the twelve miRNAs analyzed, seven (let-7a-5p, let-7d-5p, miR-15a-5p, miR-16-5p, miR-23b-3p, miR-26a-5p, and miR-125a-5p) were significantly differentially expressed among the groups (p < 0.05). In the GIC group, let-7a-5p, miR-23b-3p, miR-26a-5p, and miR-125a-5p were significantly upregulated, whereas let-7d-5p, miR-15a-5p and miR-16-5p were significantly downregulated compared to that in the normal control group. No significant differences in miRNA expression were observed between the GIC and age-related PSC groups or between the GIC and GC-treated ARC groups. Conclusions: This study demonstrates distinct miRNA expression patterns in the anterior lens capsules of patients with GIC. Altered expression of specific miRNAs may be linked to the pathogenesis of GC-induced PSC formation. These findings provide a molecular basis for further investigation into the regulatory roles of miRNAs in GC-associated cataracts. Full article

Objective: Vitamin D deficiency (VDD) is common in pregnancy and may affect lipid metabolism. The underlying mechanisms are multifactorial, but most evidence so far comes from non-pregnant populations. This study aims to identify metabolites and metabolic patterns associated with VDD in early pregnancy and to evaluate their relationships with maternal lipid profiles. Methods: A nested case–control research was carried out in the Zhoushan Pregnant Women Cohort (ZPWC). Cases were defined as women with VDD (25(OH)D < 20 ng/mL), and controls (≥20 ng/mL) were matched 1:1 using propensity scores based on age, pre-pregnancy BMI, gestational week, and calendar year at blood sampling. The untargeted metabolomics of first-trimester maternal plasma were measured. Metabolic profiles were analyzed using partial least squares-discriminant analysis (PLS-DA). Principal component analysis (PCA) was applied to visualize group separation, and metabolite set enrichment analysis (MSEA) was performed to reveal biologically relevant metabolic patterns. Associations between VDD-related metabolite components in early pregnancy and lipid levels in mid-pregnancy were assessed using linear regression models. Results: 44 cases and 44 controls were selected for the study. There were 60 metabolites identified as being connected to VDD. Among these, 26 metabolites, primarily glycerophospholipids and fatty acyls, exhibited decreased levels in the VDD group. In contrast, 34 metabolites showed increased levels, mainly comprising benzene derivatives, carboxylic acids, and organooxygen compounds. PCA based on these metabolites explained 52.8% of the total variance (R²X = 0.528) across the first six principal components (PC1: 16.4%, PC2: 10.6%, PC3: 9.2%, PC4: 6.3%, PC5: 5.7%, PC6: 4.6%). PC2, dominated by lineolic acids and derivatives, was negatively associated with total cholesterol (TC), triglycerides (TG), and low-density lipoprotein cholesterol (LDL-C) (all p < 0.01). PC3, dominated by glycerophosphocholines, was negatively associated with TC, TG, and high-density lipoprotein cholesterol (HDL-C) (all p < 0.05). MSEA revealed significant enrichment of the pantothenate and CoA biosynthesis pathway after multiple testing correction (FDR < 0.05). Conclusions: This study reveals distinct metabolic alterations linked to VDD and suggests potential mechanisms underlying its association with maternal lipid metabolism in early pregnancy. Full article

Background: Vitiligo is a chronic, progressive skin disorder characterized by the development of sharply demarcated depigmented patches due to the loss of melanocytes. Alopecia areata (AA) is an autoimmune condition that presents with sudden, non-scarring hair loss affecting the scalp or other body areas. Objective: To evaluate serum granulysin (GNLY) levels in patients with vitiligo and AA to explore its potential role in the pathogenesis and activity of both diseases. Methods: A total of 80 participants were included: 65 patients and 15 healthy controls. Patients were divided into four groups: active vitiligo (n = 25), stable vitiligo (n = 25), active AA (n = 15), and a control group (n = 15). Serum GNLY levels were measured and analyzed in relation to clinical and dermoscopic features. Results: No significant correlation was found between GNLY levels and either age or Vitiligo Area Scoring Index in vitiligo patients. However, serum GNLY levels showed a significant association with the Vitiligo Disease Activity score. GNLY levels did not correlate with sex or the starburst pattern. In contrast, significant associations were found between elevated GNLY levels and dermoscopic signs of activity, including ill-defined lesion borders, satellite lesions, perifollicular pigmentation, and loss of pigment network. Both vitiligo and AA patients exhibited significantly higher GNLY levels than controls, with the highest concentrations observed in the active vitiligo group. Conclusions: The significant rise in serum GNLY levels in vitiligo and AA suggests a pathogenic role, with higher levels in active vitiligo indicating its potential utility as a biomarker for monitoring disease activity. Full article

Objectives: To determine the prescribing prevalence of epidermal growth factor receptor (EGFR)- and anaplastic lymphoma kinase (ALK)-positive non-small cell lung cancer (NSCLC) patients in Greece and examine patterns of first-line tyrosine kinase inhibitor (TKI) utilization and associated treatment costs using nationwide real-world data. Methods: A retrospective analysis of the national e-prescription database was performed, identifying patients initiating first-line treatment (FLT) for EGFR- or ALK-positive NSCLC between 1 January 2020 and 31 December 2022. Demographic characteristics, prescribing prevalence data, drug utilization patterns, total annual drug expenditures, and per patient treatment costs were assessed. All statistical analyses were performed using the statistical software SPSS-v.29. Results: Overall, 1188 EGFR-positive (mean age of 70.93 ± 11.6) and 246 (mean age of 64.26 ± 12.6) ALK-positive NSCLC patients initiated FLT during the three-year study period. EGFR mutations were slightly more common in females (53%), peaking in the 70–79 age group (35%). ALK mutations were also more common among females (52%), particularly within the 60–79 age group. In EGFR-positive patients, osimertinib usage markedly increased from 41% in 2020 to 63% in 2022, primarily displacing afatinib (from 32% to 22%) and erlotinib (from 24% to 14%), with gefitinib prescriptions falling below 2%. Among ALK-positive patients, crizotinib utilization declined significantly from 60% to 16%, whereas alectinib increased to 59% by 2022. Annual EGFR-related total drug expenditures remained stable (€11.5 million in 2020 vs. €11.9 million in 2022), driven primarily by increasing osimertinib usage. Similarly, ALK-related annual drug expenditures showed stability, with costs predominantly attributed to rising alectinib utilization. Conclusions: This nationwide analysis highlights the rapid adoption of second- and third-generation TKIs for EGFR- and ALK-positive NSCLC in Greece, reflecting evolving clinical practice patterns. Although the target patient populations are relatively small, the associated economic burden is considerable. To ensure long-term sustainability of the Greek healthcare system, policymakers should critically assess the cost-effectiveness of these innovative therapies and align resource allocation with value-based care principles. Full article

Background/Objectives: The COVID-19 pandemic caused a widespread shift to remote work, significantly altering child supervision. In Australia, prolonged lockdowns created unique conditions where many parents were working from home while simultaneously caring for children. This study aimed to investigate potential changes in the epidemiology of paediatric injury-related presentations to emergency health services among children in Southwest Victoria, Australia, during the COVID-19 pandemic. Methods: A retrospective cross-sectional study was conducted using deidentified emergency presentation data from ten health services in regional Victoria for children aged 0–14 years between 2018 and 2023. Injury data were analysed across three timeframes (Pre-COVID, COVID, Post-COVID). Chi-squared tests assessed differences in injury presentations by age, gender, and service type. Significance was determined at p < 0.05. Results: A total of 21,072 child injury-related presentations occurred. Males accounted for 57.6% of presentations, with the 10–14 age group comprising 39.8% of cases. During lockdown, injury presentations increased among 0–4-year-old females (from 30.2% to 32.0%), likely reflecting reduced supervision as parents juggled work-from-home responsibilities. Conversely, rates declined among older children, particularly 10–14-year-olds, potentially due to reduced participation in sports and outdoor activities. More than half of all cases (59.1%) were presented to Victorian Emergency Minimum Dataset (VEMD)-reporting emergency departments. Conclusions: The shift to working from home during the pandemic had a measurable impact on childhood injury patterns, particularly among younger children. These findings highlight the importance of considering parental work and childcare arrangements in injury prevention strategies and highlight the benefits of additional regional data to provide a more accurate picture of regional health service use. Full article