Search Results (82)

Salmonella remains one of the most critical zoonotic pathogens in the poultry sector, linked to animal disease, foodborne illness, and the global crisis of antimicrobial resistance (AMR). Poultry acts as a major reservoir, enabling Salmonella transmission from hatchery to retail products through horizontal, vertical, and environmental routes. Despite the use of biosecurity, vaccination, antibiotics, and chemical decontamination, effective and sustainable control across the poultry value chain remains difficult, particularly in the face of rising multidrug-resistant strains and growing consumer concerns over chemical residues. Bacteriophages (phages), viruses that selectively infect and lyse bacteria, have emerged as a promising biological alternative for Salmonella control. Although many studies have reported the effectiveness of phages against bacterial species, including Salmonella, in the poultry industry, reports on their full potential to combat antimicrobial-resistant Salmonella across the entire poultry value chain remain limited. Therefore, this review synthesizes current evidence on the application of phages throughout the poultry value chain, including on-farm interventions, processing plant decontamination, and food packaging and storage. Findings from the reviewed articles indicate over a 90% reduction in Salmonella spp. in poultry farms and post-harvest meat, along with lower mortality in phage-treated groups compared to untreated groups; however, these outcomes depend on several factors (e.g., phage strains, concentrations, application methods, and environmental conditions). Laboratory, pilot, and field studies consistently demonstrate that phage preparations, especially when formulated as cocktails or combined with complementary interventions, can achieve substantial reductions in Salmonella, including antibiotic-resistant serovars, in live birds, eggs, poultry environments, and meat products. Unlike antibiotics and chemical sanitizers, phages act with high specificity, preserving beneficial microbiota and maintaining the sensory and nutritional quality of poultry products. Their safety has been supported by toxicological and genomic assessments, and several phage-based products have obtained regulatory approval, including Generally Recognized as Safe (GRAS) status for food applications in the United States. By integrating efficacy, safety, regulatory, and practical deployment data, this review highlights bacteriophages as a scientifically validated and One Health–aligned tool capable of reducing Salmonella transmission from farm to fork across the poultry value chain, thereby laying the foundation for their future adoption in the poultry industry. Phage-based interventions offer a sustainable pathway to enhance food safety, limit antimicrobial resistance (AMR) dissemination, and strengthen consumer confidence in poultry products. However, the major limitation is the emergence of phage-resistant bacterial strains, as well as the potential involvement of some phages in the transfer of resistance and virulence genes, which could raise public concern. Nevertheless, the use of phage cocktails and whole-genome sequencing, involving tools such as ResFinder and virulence finder, can facilitate the selection of safe phages for application. Full article

Background/Objectives: Water scarcity is driving the development of strategies for treating municipal wastewater (MW) to enable its safe reuse. Nonetheless, MW contains contaminants of emerging concern (CECs), such as pharmaceuticals and antimicrobial-resistant (AMR) bacteria, which require innovative treatment technologies. In this context, Corbicula fluminea, an invasive freshwater clam, presents a high biofiltration capacity, and its environmental impact could be mitigated by assigning it a beneficial role in wastewater treatment. Methods: The ability of C. fluminea to remove chemical and biological CECs from real MW secondary-treated effluents was assessed. The effects of real wastewater on the clams’ microbiome and on colony-forming unit (CFU) counts in their soft tissues were also assessed. Results: Under real conditions, the clams achieved over 73% removal for 3 chemical CECs after 24 h, with an average removal of approximately 39%. The clams showed recovery of both CFU counts and microbial community composition, dominated by opportunistic and stress-tolerant groups in the presence of pharmaceuticals. The removal of multidrug-resistant bacteria was evaluated; despite real wastewater reducing clearance rates, the clams significantly reduced these bacteria within 24 h. Conclusions: These results demonstrate that C. fluminea can serve as an effective polishing treatment, improving effluent quality, supporting control of this invasive species. Full article

Background/Objectives: The increased prevalence of multidrug-resistant Escherichia coli and carbapenemase-producing Enterobacteriaceae poses a critical threat to global health and food safety. Antimicrobial Blue Light (aBL) in the 400–470 nm spectrum has emerged as a promising, chemical-free disinfection strategy that targets intracellular porphyrins and flavins to induce oxidative stress. However, the influence of wavelength, dosimetry, and environmental stressors on endogenous photoinactivation remains poorly standardized regarding optical parameters and biological exposure protocols. This systematic review aimed to evaluate the antimicrobial efficacy of pure blue light (400–470 nm) against E. coli across various phenotypes and environmental conditions, excluding the use of exogenous photosensitizers. Methods: PubMed, Scopus, and Web of Science were searched for studies that utilized 400–470 nm light as an antimicrobial agent against E. coli. Data extraction focused on spectral efficiency, total fluence (J/cm²), and log₁₀ reduction. The Risk of Bias was assessed using an adapted Office of Health Assessment and Translation tool for in vitro studies. Results: Synthesis of 11 high-quality studies indicated that wavelengths near 405 nm have the highest germicidal efficiency due to the Soret band absorption of endogenous porphyrins. Efficacy is highly dose-dependent: significant log₁₀ reductions were achieved in planktonic cells, although biofilms required substantially higher fluences. Sub-lethal environmental stressors such as acidic pH, high salinity, and thermal fluctuations demonstrated a synergistic effect, which significantly enhanced the rate of photoinactivation. Multidrug-resistant and carbapenemase-producing Enterobacteriaceae strains showed similar susceptibility to aBL relative to antibiotic-sensitive strains, suggesting no cross-resistance between light and traditional drugs. Conclusions: Endogenous blue light is a highly effective, non-thermal technology for E. coli decontamination. Its efficacy is modulated by the interplay between optical parameters and environmental conditions. These findings provide a framework for the development of standardized protocols for applying aBL to clinical wound care and food industry use cases. They also highlight the potential of aBL as a critical tool in the post-antibiotic era. This systematic review was registered in the International prospective register of systematic reviews (PROSPERO) under protocol CRD420261331871. Full article

The removal of excessive amounts of antibiotics from water systems is of great benefit due to their adverse effects on the ecosystems, living organisms and the persistent increase in antibiotic resistance cases. This study was focused on the adsorption of vancomycin from a simulated aqueous medium using seaweed, a sustainable and low-cost adsorbent. Also, the work focuses on assessing the influence of surface modification on adsorption behaviour and determining if chemical treatment provides improvements over untreated seaweed. In particular, chemically modified seaweed and raw (non-modified) seaweed were assessed as adsorbents suitable for removing traces of vancomycin from water, as gauged from the results of High-Performance Liquid Chromatography (HPLC). In addition, Scanning Electron Microscopy (SEM), Fourier Transform Infrared spectroscopy (FT-IR) and the pH point of zero charge (pH_pzc) were used to measure the surface characteristics of these adsorbents. The degree of antibiotic adsorption was evaluated as a function of different factors, including the pH, adsorbent dosage, contact time, ionic strength and initial concentration of vancomycin. Thermodynamic parameters, such as the enthalpy change (∆H°), the entropy change (∆S°) and the free-energy change (∆G°), were calculated. The FTIR analysis indicates that functional groups, such as carbonyl and hydroxyl groups, were involved in the adsorption process, and their modification influenced adsorption behaviour. It was observed that the adsorption of vancomycin by the modified seaweed was slightly lower (±94%) compared to the level achieved for the raw seaweed (±97%). These figures were obtained with an initial concentration of vancomycin of 25 mg/L, a pH of the aqueous solution of 7.0, an adsorbent dose of 0.2 g and a contact time of 120 min. The results showed that untreated seaweed exhibited slightly higher adsorption efficiency than the treated seaweed, suggesting that chemical modification might not have enhanced adsorption performance. The thermodynamic parameters suggested that the adsorption process was exothermic and that adsorption was favourable for the untreated seaweed and less favourable for the treated seaweed. Regeneration studies showed a decrease in adsorption efficiency over repeated cycles. Although the adsorption capacity is lower than that of advanced nanomaterials, the use of seaweed offers an advantage in terms of low cost, availability and environmental sustainability. The comparable efficiency of the modified and untreated seaweed adsorbent suggests that seaweed adsorbents can be used as viable bio-adsorbents for the decontamination of water. Full article

Background: Reusable tourniquets are widely used across clinical settings, yet their role as reservoirs of microbial contamination and antimicrobial resistance remains poorly characterized. Methods: In this cross-sectional study, 53 polyester–elastane tourniquets were collected from an Emergency Department (SR) and Operating Theater (SBO) over a 28-day period to assess bacterial burden and resistome composition. A 180-target qPCR panel targeting antibiotic and disinfectant resistance determinants was used. qPCR analysis identified 112 distinct resistance genes across all samples, with SR tourniquets harboring significantly richer resistomes than SBO (median 34 vs. 15 genes; p < 0.001). Efflux pump- and disinfectant-associated genes were pervasive, and β-lactamase and quinolone-resistance determinants increased over time in SR samples. Results: Principal component analysis showed clear segregation of resistome profiles by clinical unit and progressive enrichment over time. These findings indicate that reusable, porous tourniquets can accumulate extensive resistance gene profiles under routine clinical use, particularly in high-contact environments. Conclusions: Enhanced decontamination strategies, development of new materials or transition to single-use alternatives may be necessary to mitigate their potential contribution to environmental antimicrobial resistance in hospitals. Full article

Paraburkholderia fungorum (P. fungorum) is an environmental bacterium with biotechnological applications, yet clinical isolations raise concerns about opportunistic infection risk. Genetically related pathogens exhibit substantial antibiotic resistance, motivating the investigation of alternative control strategies. This paper investigates P. fungorum photoinactivation across ultraviolet (222 nm, 254 nm, 313 nm, and 365 nm) and visible (400 nm and 464 nm) wavelengths including ROS (reactive oxygen species) quantification via DCFH-DA fluorescence assay. A two-way ANOVA analysis demonstrated that the wavelength is the dominant determinant of photoinactivation efficacy (F = 100.4, p < 0.001) with ROS generation as a more powerful predictor of inactivation than fluence dose alone (F = 60.6, p < 0.001) at 365 nm, 400 nm, and 464 nm. Ultraviolet irradiation at 254 nm achieved the highest efficiency (5.4 log reduction at 24 mJ/cm²), while 365 nm irradiation demonstrated a high efficacy of 5.2 log reduction at 122 J/cm² with extraordinary ROS production (12,642-fold fluorescence increase). Conversely, inactivation efficiency declined at 400 nm (4.8 log reduction at 378 J/cm² with 122-fold ROS increase) and 464 nm (3.4 log reduction at 3017 J/cm² with lesser ROS detection at 27-fold increase). Wavelength-dependent ROS production correlated directly with bacterial inactivation efficacy, explaining the approximately 500-fold ROS differential between 365 nm and 464 nm. The demonstrated photosensitivity of P. fungorum across multiple wavelengths, with the statistical validation of wavelength-dependent mechanisms, provides a foundation for developing practical, mechanism-based phototherapy protocols tailored to specific clinical and environmental decontamination scenarios. Full article

Articular cartilage (AC) damage heals poorly and can progress to osteoarthritis. Implantation of AC fragments (Minced Cartilage Implantation, MCI) is a promising one-step repair technique but is constrained by the limited availability of healthy AC. In this study, we evaluated the feasibility of MCI using nasal septal cartilage (NSC) as an alternative source of hyaline tissue with strong regenerative capacity. NSC obtained from rhinoplasties was decontaminated using a novel protocol, minced with or without Poloxamer 188 (P188), embedded in collagen I gel (0.5 mL per sample), and cultured for 42 days in platelet-rich plasma (PRP)-supplemented medium. The decontamination procedure with a combination of antibiotics was effective and did not impair cell viability. Histology of the resulting constructs confirmed robust cellular outgrowth and matrix deposition. Tissues produced from NSC and fragmented with P188 contained more cartilaginous matrix than those from NSC fragmented without P188 and those from AC fragmented with P188. NSC fragments embedded in a 1 mL hydrogel, sufficient for clinically relevant defect volumes, also demonstrated strong outgrowth and satisfactory matrix formation. Overall, the developed protocol supports the use of NSC as a viable tissue source in gel-based, injectable MCI grafts for focal cartilage repair. Full article

Background/Objectives: In traditional contrast-based meta-analyses of randomized concurrent controlled trials (RCCTs), topical antibiotic prophylaxis (TAP) appears more effective than either antiseptic-based or non-antimicrobial-based interventions for preventing ventilator-associated pneumonia (VAP). The objective here is to use arm-based methods to determine whether this effectiveness translates towards achieving VAP-zero, both overall and specifically for VAP in association with Staphylococcus aureus, Pseudomonas aeruginosa, and Acinetobacter species among the same RCCTs. Methods: Data were extracted from RCCTs sourced primarily from Cochrane reviews of VAP prevention interventions. Arms-based and contrast-based methods of meta-analyses of the VAP prevention effect size and the VAP incidence per 100 patients receiving mechanical ventilation were obtained using random effects methods. Results: The VAP prevention intervention effect sizes derived by contrast-based versus arms-based meta-analyses were similar for each of the three broad types of interventions. The overall VAP prevention effect of antibiotic-based interventions by contrast-based and arms-based methods were 0.39 (95% confidence interval 0.33 to 0.46; n = 28) versus 0.39 (95% confidence interval 0.32 to 0.47; n = 28), respectively. Surprisingly, the arms-based analysis revealed that the summary VAP incidence, both overall and for each of Staphylococcus aureus, Pseudomonas aeruginosa, and Acinetobacter species within antibiotic intervention groups, were similar to the respective summary incidences within intervention groups of non-antimicrobial RCCTs. Conclusions: VAP-zero, both overall and in association with specific microbial sub-types, has remained elusive using antimicrobial-based interventions. This inference was not evident from a contrast-based analysis. Full article

The growing demand for alternative meat products is accelerating research into reproductive cell sources for cell-based meat processes, also called cultured meat. Porcine umbilical cord tissue is recognized as an advantageous source of mesenchymal stem cells (MSCs). However, effective decontamination must be achieved without compromising tissue integrity and cell recovery. In this study, we evaluated the decontamination of porcine umbilical cords using plasma-functionalized liquid (PFL) generated by a microwave-driven plasma source. It was applied alone and in combination with ultrasound, with the combined approach demonstrating superior performance. Specifically, the ultrasound–PFL combination treatment reduced the initial microbial load of individual tissue samples, ranging from 4.08 to 7.41 log₁₀ CFU/g, approaching the limit of detection of the applied microbiological assays. Statistical analysis indicated a significant contribution of both PFL and ultrasound to microbial reduction, while mesenchymal stem cell yields (5.4 × 10⁵ cells/g tissue) and cell viability (84%) remained comparable to antibiotic-rinsed controls. Recovered cells retained functional capacity, as demonstrated by successful 3D spheroid formation. These results highlight ultrasound-assisted PFL rinsing as an efficient, long-lasting, and antibiotic-free decontamination strategy without compromising tissue compatibility. This study thereby extends the application of plasma-functionalized liquids and demonstrates the feasibility of sustainable stem cell sourcing. It offers opportunities in cultured meat bioprocessing. Full article

Background/Objectives: Methicillin-resistant Staphylococcus aureus (MRSA) continues to pose a significant challenge for infection prevention, particularly because of its ability to persist on surfaces and form resilient biofilms. Although bacteriophages have attracted renewed interest as alternatives or complements to chemical disinfectants, their applied use requires careful assessment of antimicrobial performance, formulation tolerance, and genomic context. Methods: Staphylococcus-infecting bacteriophages were isolated from environmental sources and examined against reference Staphylococcus isolates. Two phage isolates, designated MRSA-W3 and SA-W2, displayed lytic activity against a broad subset of clinical MRSA strains. Using a time-resolved agar-based infection assay, phage exposure resulted in a multiplicity-of-infection-dependent decline in viable MRSA populations. Results: Time-resolved infection assays revealed a multiplicity-of-infection-dependent reduction in viable MRSA, with a pronounced decrease observed approximately 40 min post-infection. At this time point, phage-treated cultures showed a reduction of 1.2–1.8 log₁₀ CFU/mL relative to untreated controls (mean Δlog₁₀ = 1.5; 95% CI, 1.1–1.9), while control cultures remained stable. Quantitative biofilm assays demonstrated that both phages reduced biofilm biomass compared with untreated conditions, with inhibition values ranging from 20% to 45% across isolates (p ≤ 0.05), reflecting strain-dependent but reproducible effects. Assessment of formulation compatibility indicated that both phages retained infectivity following exposure to sodium dodecyl sulfate, Triton X-100, and Tween 80, whereas ethanol (≥10%) and higher concentrations of dimethyl sulfoxide were associated with rapid loss of activity. In surface disinfection models, selected phage–surfactant formulations achieved a maximum reduction of 2.18 log₁₀ CFU/cm² compared with untreated controls (p ≤ 0.05). Infection-coupled whole-genome sequencing of MRSA-infecting phage MRSA-W3 produced a high-quality assembly (99.99% completeness; 0.13% contamination) and revealed a mosaic genome containing incomplete prophage-like regions, which were interpreted conservatively as evidence of shared phage ancestry rather than active temperate behavior. Conclusions: Therefore, these findings suggest that bacteriophage-based approaches may be feasible for MRSA surface decontamination, while clearly emphasizing the need for context-specific validation before practical implementation. Full article

Bacterial contaminants in ambulances could have a major impact on morbidities, mortalities, and healthcare resources, especially if these bacteria are antimicrobial-resistant. As far as we know, this is the first study in Al-Qassim region to evaluate the prevalence of bacterial contaminants in swab samples obtained from ambulances from Alqwarah General Hospital, Al-Qassim region, Saudi Arabia as an indicator for evaluation of the implemented infection control measures, and screen the antibiotics profiles of the isolates against the most regularly used antimicrobials. In total, 204 samples were collected from the ambulances following patient transport. To evaluate the effect of vehicle decontamination, 204 swabs were collected from the same sites of the ambulances immediately after cleaning and disinfection. The isolates were identified using standard bacteriological and biochemical methods, as recommended by the Clinical Laboratory Standard Institute (CLSI). The antibiotic susceptibility patterns were assessed using the Kirby–Bauer disc diffusion method. The prevalence of bacterial contamination in the samples collected following patient transport was 46.08%. In total, 83.33%, 75.00%, and 66.66% of the samples collected from DC shock apparatuses, ceilings, and emergency personnel seats, respectively, were contaminated. Furthermore, ceilings, DC shock apparatuses, emergency personnel seats, cervical collars, and monitors were found to harbor 10.8%, 9.8%, 7.8%, 6.8%, and 6.8% of the 102 bacterial isolates, respectively. Gram-positive organisms represented 96.1% of all bacterial isolates. Bacillus spp. was the most common isolate, accounting for 60.8% of all bacterial isolates. Although Pseudomonas aeruginosa and Proteus spp. isolates were sensitive to all the tested antimicrobials, many Gram-positive bacterial isolates were resistant to some antibiotics in variable frequencies. After 48 h of aerobic incubation (with or without 5–10% CO₂) on nutrient, blood, chocolate, and MacConkey agar plates at 37 °C, no bacterial growth was detected in the samples collected immediately following cleaning and disinfection. This is the second Saudi study to evaluate the prevalence of bacterial contaminants in Saudi Arabian ambulances, and it could help health policy makers in improving the implemented infection prevention and control measures in Saudi Arabian ambulances. The samples taken after patient transport revealed bacterial contaminants with varying rates of antimicrobial resistance. Policies ensuring the optimal cleaning and disinfection of ambulances can minimize the potential of bacterial infection for high-risk patients, their relatives, and healthcare providers. Full article

Background: Clostridioides difficile infections (CDIs) are caused by a Gram-positive, spore-forming bacillus and are defined by more than three episodes of watery diarrhoea per day. CDI is a major cause of morbidity and mortality in older adults, particularly over 65 years. Recurrent CDI leads to higher mortality and prolonged, debilitating illness. Case Presentations: This article presents two patients, aged over 80 years old, who developed recurrent CDI causing complicated and prolonged treatment courses. Patient 1 required an extended course of antibiotics for treatment of discitis and a congruent psoas abscess. Patient 2 developed CDI after multiple short courses of antibiotics for urinary tract infections (UTIs) in the context of multiple comorbidities. Both patients experienced three distinct episodes of CDI and were treated in collaboration with microbiology specialists. Following the third episode, both were successfully treated with oral capsule faecal microbiome transplants (FMTs). Their cases highlight the challenge of balancing systemic antibiotic use against CDI risk. Discussions: These cases underscore known risk factors for recurrent CDI, including advanced age and prolonged antibiotic exposure. Recurrence rates in patients over 65 can reach 58%. The British Society of Gastroenterology and Healthcare Infection Society support the use of FMTs in recurrent cases. Environmental decontamination, including terminal cleaning with sporicidal agents, is critical in reducing reinfection in hospital settings. Conclusions: Recurrent CDI in elderly patients reflects a complex interplay between infection control and managing comorbidities. New guidelines suggest that FMTs can significantly reduce morbidity and mortality. These cases emphasise the need for individualised, multidisciplinary care, adherence to guidelines, and further research to improve safe, effective CDI management in older adults. Full article

Methicillin-susceptible Staphylococcus aureus (MSSA) remains a major pathogen in neonatal intensive care units (NICUs), with colonization and infection posing significant risks. MSSA colonization occurs in up to 42.8% of neonates, while 12–41% of healthcare personnel also carry MSSA, contributing to nosocomial transmission. MSSA accounts for approximately 12% of neonatal S. aureus bloodstream infections, with mortality rates up to 20.5%, particularly among very-low-birth-weight infants. This review analyzes the molecular attributes, epidemiology, risk factors, clinical presentations, decontamination methods, and treatment alternatives for MSSA infections in newborns. MSSA strains show considerable genetic heterogeneity, being distinguished by a wide variety of sequence types (STs) and Staphylococcal Protein A types (SpA). They harbor several pathogenicity genes—including hemolysins, superantigens, adhesins, and Panton–Valentine leukocidin (PVL)—which are implicated in severe infections, while biofilm-associated genes enhance environmental persistence. Prematurity, low birth weight, prolonged hospitalization, and exposure to invasive devices are key risk factors. Active surveillance and decolonization programs have achieved reductions of up to 73% in MSSA infections. β-lactam antibiotics remain first-line therapy, with adjunctive aminoglycosides reserved for severe cases. Ongoing genomic surveillance and targeted preventive strategies are essential to reduce MSSA-associated morbidity and mortality in this vulnerable population. Full article

Bacteriophages or phages are viruses that exclusively target and replicate within bacteria, acting as natural predators in the biosphere. Since their discovery over a century ago, host-specific bacteriophages have been widely advocated as a cost-effective and adaptable approach to controlling and combating bacterial infections. Antibiotic resistance, a growing concern and a significant global public health problem, has further underscored the importance of bacteriophages. Nevertheless, their potential applications span diverse fields, including molecular biology, phage therapy, bacterial detection, food safety, and wastewater decontamination. Furthermore, bacteriophages represent a diverse group of viruses that are relatively easy to handle, making them suitable for use in both treatments and biotechnology research. In this review, we aim to provide a comprehensive overview of bacteriophage history, characteristics, and applications that have been employed to address human challenges, ranging from healthcare to environmental remediation. We will highlight key findings and outcomes, shedding light on ongoing research that will shape the future of bacteriophage applications. Full article

Background/Objectives: Postoperative pneumonia and other infectious complications after robotic-assisted minimally invasive esophagectomy still contribute to morbidity and mortality. Selective oral decontamination of the esophagus prior to surgery might reduce the rate of infectious complications. However, its impact on the esophageal microbiota is unknown. Therefore, this study aimed to analyze whether selective oral decontamination of the esophagus prior to surgery reduces postoperative pneumonia rates and alters the esophageal microbiome. Methods: We conducted a proof-of-principle study including 22 patients who underwent robotic-assisted minimally invasive esophagectomy. Thirteen patients were treated with 50 mg amphotericin B, 8 mg tobramycin, and 10 mg colistin orally 7 days prior to surgery, intraoperatively, and 5 days postoperatively. The remaining nine patients received standard-of-care treatment (no oral decontamination). The esophageal microbiome was assessed using 16S rRNA gene amplicon libraries which were annotated using the Ribosomal Data Project. The incidence of postoperative (at discharge from hospital or 30 days, whichever was later) infectious complications was assessed. Results: Selective oral decontamination was associated with reduced overall rates of infectious complications (7.7% vs. 55.5%, p = 0.008) and postoperative pneumonia (0% vs. 33.3%, p = 0.007). Alterations in the esophageal microbiome depending on selective oral decontamination were detectable. The microbiomes of patients with infectious complications showed higher abundances of Neisseria and lower abundances of Streptococcus than samples without infectious complications. Conclusions: Selective oral decontamination reduced the rate of postoperative complications, postoperative pneumonia in particular, after robot-assisted esophagectomy. Alterations in the microbiome were also evident following decontamination. Further studies with larger sample sizes are necessary to confirm these data. Full article