Search Results (5,385)

Cardiomyopathies comprise a heterogeneous group of myocardial disorders characterized by structural and/or functional abnormalities in the absence of secondary causes of myocardial dysfunction. Although genetic determinants play a central role in many forms of the disease, incomplete penetrance and the frequent absence of identifiable pathogenic variants suggest that additional mechanisms contribute to disease onset and progression. Growing evidence supports the pathogenic role of autoimmune processes in several cardiomyopathy phenotypes. A spectrum of autoantibodies targeting cardiac self-antigens, including structural proteins, intercalated disc components, intracellular proteins such as calreticulin, and G protein-coupled receptors, has been identified in affected patients. Experimental and clinical data suggest that these autoantibodies may exert functional effects on cardiomyocyte signaling pathways and intercellular coupling, thereby promoting maladaptive remodeling, progressive ventricular dysfunction, and an increased risk of arrhythmias. Accordingly, autoantibody profiling may facilitate the identification of biologically distinct cardiomyopathy subsets with potential diagnostic and prognostic implications. From a therapeutic perspective, pathogenic autoantibodies can be removed from patient serum through plasmapheresis or immunoadsorption strategies, and these approaches have been associated with improvements in hemodynamic parameters and clinical outcomes in selected patients. Full article

This article investigates how women’s relative absence from medieval textual archives can be reconsidered through the study of visual and material culture. Focusing on Mongol and Yuan China and read in relation to The Travels of Marco Polo, it argues that women’s artistic production functioned as a form of embedded counter-archive that preserves traces of participation obscured in narrative sources. Drawing on Black feminist epistemology as a heuristic framework and employing critical fabulation and poetic inquiry as analytical methods, the study interprets silence as a meaningful historical trace rather than a void, and considers silence not as absence but as a structured condition of archival production. Four case studies—Guan Daosheng’s literati bamboo painting, the handscroll tradition associated with Lady Su Hui, imperial phoenix embroidery, and Silk Road textile fragments—demonstrate distinct modes through which women’s presence becomes materially legible: mediated visibility, formal containment, infrastructural anonymity, and circulatory displacement. These “quiet arts” reveal how women’s labour and creativity persisted within and alongside patriarchal inscriptional systems even when textual attribution receded. In dialogue with the shadow silhouettes of contemporary artist Kara Walker, the article further situates these premodern archives within a broader visual language of absence and recovery. Rather than reconstructing lost biographies, it proposes a transdisciplinary method—integrating art history, feminist theory, theology, and poetic inquiry—for reading material culture as a site where historical silence becomes structurally legible. It proposes a transdisciplinary approach that expands art historical methods for interpreting gender, authorship, and archival silence in medieval visual culture. Full article

Finite element analysis is widely used to study spinal biomechanics and to compare surgical strategies under controlled loading conditions. By allowing variation in alignment, fixation, and implant design, these models provide insight into stress redistribution and motion changes that are difficult to isolate experimentally. This review examines spine surgery-focused finite element studies published between 2018 and 2024, with emphasis on interbody fusion techniques, adjacent segment mechanics, and implant-related stress behavior. Across lumbar fusion models, constructs incorporating anterior column support demonstrate lower posterior instrumentation stress than posterior-only approaches, with lateral lumbar interbody techniques showing reduced rod and screw stresses across multiple loading conditions compared with posterior lumbar interbody or posterolateral fusion constructs. In the cervical spine, comparisons of plated and zero-profile anterior cervical discectomy and fusion devices show smaller increases in adjacent-level motion and intradiscal pressure with zero-profile constructs, alongside higher localized stress at fixation interfaces. More recent studies apply finite element methods to implant optimization, alignment planning, and patient-specific modeling. Together, these findings suggest that finite element analysis is increasingly used to support surgical planning and implant design, with continued advances in validation and patient-specific simulation likely to strengthen its clinical relevance. Full article

Artificial Intelligence (AI) has transitioned from a specialized research area to a ubiquitous socio-technical infrastructure influencing sectors from healthcare and law to manufacturing and defense. In tandem with its transformative promise, AI has created an exponentially expanding ethics literature questioning, fairness, transparency, accountability, and justice. This review synthesizes publications and key policy developments between 2019 and 2025, bringing sectoral discourses together with cross-cutting frameworks. Grounded in a systematic scoping review methodology, we frame the field along four meta-dimensions: trust and transparency, bias and fairness, governance & regulation, and justice, while we investigate their expression across diverse sectors. Special attention is dedicated to healthcare (patient trust and algorithmic bias), education (integrity and authorship), media (misinformation), law (accountability), and the industrial sector (data integrity, intellectual property protection, and environmental safety). We ground abstract principles in concrete case studies to illustrate real-world harms and mitigation strategies. Furthermore, we incorporate pluralistic ethics (e.g., Ubuntu, Islamic perspectives), environmental ethics, and emerging challenges posed by Generative AI and neuro-AI interfaces. To bridge theory and practice, we propose an operational governance framework for organizations. We contend that success involves transitioning from principles toward ethics-by-design, pluralistic governance, sustainability, and adaptive oversight. This review is intended for scholars, practitioners, and policymakers who need a comprehensive and actionable framework for navigating the complex landscape of AI ethics. Full article

With the acceleration of digital transformation in education, this paper examines how blockchain is being framed as a governance solution for trust, transparency, and decentralization. Using a hybrid bibliometric and thematic analysis of 93 Web of Science and Scopus publications, the study maps publication trends, leading outlets, author networks, and conceptual clusters. We analyze co-authorship networks, keyword co-occurrence patterns, and conceptual structures using VOSviewer version 1.6.19 and the R-based Bibliometrix package. Then, we apply qualitative coding to offer a more profound interpretation of governance stories. Findings show that blockchain in educational governance is predominantly positioned through techno-managerial lenses—focusing on secure credentials, tamper-proof records, and efficiency—while critical perspectives on power, equity, and participation remain limited. Global North institutions and computer science–oriented venues dominate the field, with little engagement from Global South contexts or educational leadership scholarship. The paper concludes by proposing a research agenda that reimagines blockchain not as a neutral tool, but as a socio-technical assemblage that must be interrogated through equity-, ethics-, and community-centered frameworks. Full article

Herbal melanin (HM), previously reported for its antiproliferative and pro-apoptotic properties, has garnered interest as a promising anti-colorectal cancer drug. However, HM’s biological effects and underlying molecular mechanisms and the related signaling pathways in colorectal cancer (CRC) cell motility are poorly investigated. To evaluate the impact of various concentrations (50, 100, and 200 μg/mL) of HM on cell migration, invasion, and tumorigenicity on human HT29 and SW620 CRC cell lines, a real-time cell analyzer instrument and colony formation assays were employed, respectively. An angiogenesis-related protein array was also used, and the levels of protein expression contributing to colony formation and extracellular proteolysis-driven cell migration and invasion, such as E-cadherin, N-cadherin and urokinase-type plasminogen activator receptor (uPAR), were monitored using Western blotting and RT-qPCR technologies. HM significantly decreased CRC cell motility, invasiveness, and formation of colonies, associated with E-cadherin upregulation and N-cadherin downregulation. In addition, HM specifically inhibited uPAR expression levels, which were also decreased by the pharmacological mitogen-activated protein kinase (MAPK) kinase (MEK) inhibitor UO126 and Jun N-terminal kinase (JNK) inhibitor SP600125, in both CRC cell lines, including metastatic CRC (mCRC) SW620 cell line. Addition of HM to cells pretreated with JNK and MEK inhibitors attenuated the blockade of JNK and ERK phosphorylation and alleviated HM-downregulated uPAR expression and HM-inhibited mCRC cell migration. In conclusion, our in vitro studies demonstrate that HM exhibits an inhibitory effect on CRC migration and invasiveness, associated with uPAR downregulation through JNK and ERK pathways. Full article

Objectives: Despite vaccination being the most effective way of preventing infections and vaccination rates recovering worldwide after the COVID-19 pandemic, vaccine hesitancy persists. Some factors, such as psychological and social barriers, can negatively impact views on vaccines and can contribute to vaccine hesitancy. The primary objective of this structured literature review is to investigate the available evidence relating to factors affecting vaccine hesitancy within several countries in Southeastern Europe. Methods: An electronic database search was conducted to identify studies assessing the public and healthcare professionals’ (HCPs) attitudes towards vaccination in Southeastern Europe. These searches were supplemented with grey literature searches. Included studies were conducted in Bulgaria, Croatia, Romania, Serbia, and Slovenia between 1 January 2012 and 31 December 2022. Results: Of the 35 studies identified from the database searches, the most prominent theme observed across Romania, Croatia, and Bulgaria was low confidence in COVID-19 vaccines. Across all age groups, COVID-19 vaccine confidence in these regions was highly dependent on whether individuals thought vaccines were safe and effective, as well as their general trust in vaccines. Confidence in COVID-19 vaccines was seen as relatively high, with attitudes towards routine and elective vaccines being generally positive amongst the general public and HCPs, in Romania, Croatia, Serbia and Slovenia. However, uncertainty around the effectiveness of the vaccine still exists. In Bulgaria, trust in routine and elective vaccines remained low in the general public. Complacency and financial constraints were also identified as underlying causes of vaccine hesitancy. Conclusions: The main cause behind vaccine hesitancy in several countries in Southeastern Europe is distrust in vaccine effectiveness and safety. These key findings can be utilised to support evidence-based decisions regarding where to focus resources to improve public and HCP perception of vaccines in Southeastern Europe. Full article

This study aimed to systematically elucidate the antihyperlipidemic mechanism of paeoniflorin, and we adopted an integrated multi-omics strategy to screen the key molecular targets and regulatory pathways involved in its action, followed by experimental validation to verify the potential regulatory effects of paeoniflorin on the screened targets and metabolic processes. Rats with high-fat diet-induced hyperlipidemia received paeoniflorin treatment. Liver histopathology was evaluated using hematoxylin–eosin and Oil Red O staining. Serum levels of total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, total bile acids, activated partial thromboplastin time, prothrombin time, thrombin time, and fibrinogen were measured using a biochemical analyzer. Integrated multi-omics analyses were performed to investigate paeoniflorin’s lipid-lowering mechanism. Critical pathways and targets identified were validated using Western blotting. Paeoniflorin alleviated pathological liver damage in hyperlipidemic rats and improved blood lipid levels, coagulation function, and liver function markers. Multi-omics analyses verified that paeoniflorin downregulated the expression of TREM-1, TLR4, NF-κB, TNF-α, and IL-1β, thereby alleviating hepatic inflammation. Paeoniflorin also upregulated the expression of low-density lipoprotein receptors (LDLR), liver X receptor alpha (LXRα), and ATP-binding cassette subfamily G member 1 (ABCG1), while downregulating proprotein convertase subtilisin/kexin type 9 (PCSK9) expression, contributing to balanced cholesterol metabolism. Paeoniflorin normalized glycerophospholipid and branched-chain amino acid metabolism, which correlated with reduced inflammation and improved cholesterol metabolism. Paeoniflorin ameliorates hyperlipidemia through multitarget mechanisms, potentially by suppressing the TREM-1-TLR4-NF-κB signaling pathway to reduce inflammation and by regulating cholesterol metabolism via the PCSK9-LDLR and LXRα-ABCG1 pathways. Full article

The menstrual cycle represents a dynamic infradian rhythm characterized by coordinated fluctuations in ovarian steroids that extend beyond reproductive function and influence systemic metabolism. This narrative review synthesizes current evidence on how menstrual cycle phase modulates energy balance, macronutrient metabolism, micronutrient handling, and responses to dietary bioactive compounds. Across phases, small-to-moderate but consistent differences emerge in energy intake, resting energy expenditure, substrate utilization, and protein turnover, with a tendency toward increased energy intake and lipid oxidation during the mid-luteal phase compared with the early follicular and peri-ovulatory phases. Emerging metabolomics data further reveal coordinated cyclical variation in amino acids, B vitamins, and lipid species, suggesting temporally sensitive windows in which low energy availability or micronutrient insufficiency may more readily impair performance, recovery, or symptom burden. Importantly, menstrual cycle-related metabolic variability reflects not only estradiol and progesterone oscillations but also integrated adaptations across the hypothalamic–pituitary–adrenal axis, autonomic nervous system, immune signaling, and gut microbiota. These interconnected systems contribute to inter- and intra-individual heterogeneity in metabolic phenotype. From a clinical and applied perspective, the evidence supports “cycle-aware” but non-dogmatic nutritional strategies, particularly in contexts of metabolic dysfunction, high training loads, or reproductive disorders. Future research should systematically verify cycle phase, incorporate multi-system biomarkers, and adopt sex-specific analytical frameworks to improve translational relevance. Recognizing the menstrual cycle as a biologically meaningful metabolic variable may enhance precision nutrition, exercise prescription, and metabolic risk assessment in women. Full article

Research on ChatGPT GPT-4 and GPT-5 in higher education has focused on quantitative adoption models (intention to use and predictors) and fragmented effects (writing, performance, well-being, dependence, or ethics). However, this approach keeps the debate stuck in an outdated phase of debate about the tool’s acceptance, even though ChatGPT is part of the academic ecosystem. The objective of the study is to understand, from students’ voices, how the quality of academic interaction with ChatGPT is configured, and to identify patterns of decision-making, validation, ethical regulation, and communication (transparency/concealment) in university contexts. An interpretive qualitative approach was followed. A total of 418 university students participated, all of whom provided qualitative data through semi-structured virtual interviews. The data were analyzed using reflective thematic analysis in six phases, with the support of ATLAS.ti software for rooting and density calculations. The results revealed ten categories that structure the phenomenon (adoption, attitudes, writing, translation, performance, cross-cutting skills, integrity, well-being, disciplinary use, and institutional integration). A continuum was observed between high-quality interaction (verification, rewriting, appropriation, and responsible authorship) and low-quality interaction (cognitive delegation, overconfidence, dependence, and concealment). The quality of student interaction with ChatGPT requires critical, ethical, and institutional regulation to guide and legitimize the academic process. Full article

The rapid integration of generative artificial intelligence into scientific publishing is reshaping how academic text can be produced, revised, and scaled. While transparent and limited use of AI for language support may be acceptable, a new structural vulnerability may be emerging in medical publishing: the large-scale production of short, plausible, and weakly individualized correspondence across multiple specialties. In this viewpoint, we describe and conceptualize a pattern that may be termed synthetic authorship, defined not as undisclosed AI use alone, but as a reproducible mode of scholarly output structurally facilitated by automation. We focus particularly on letters to the editor, a format that combines brevity, rapid editorial handling, and formal indexation, and may therefore be especially exposed to this phenomenon. Based on recurring patterns observed in PubMed-indexed literature, including unusually high publication velocity, abrupt thematic dispersion, and stylistic uniformity across unrelated domains, we argue that such outputs may challenge the authenticity, epistemic value, and editorial function of scientific correspondence. We do not present empirical proof of misconduct, but rather outline a conceptual framework for understanding this emerging risk and propose proportionate editorial safeguards, including cross-domain pattern detection and contextual assessment of authorship coherence. As AI lowers the threshold for generating domain-plausible commentary at scale, scientific publishing must adapt its integrity frameworks accordingly. In this context, vigilance toward synthetic authorship may become an essential component of editorial responsibility and post-publication quality control. Full article

Introduction: Remote ischaemic conditioning (RIC) is a promising treatment for neurological disorders. It involves cycles of temporary ischaemic stimulus, usually applied to a limb, and has shown significant improvement in neurological function in many trials. This review focuses on identifying and summarising the biomarkers of RIC that can enhance clinical practice and understanding of its mechanisms. Methods: A search was conducted in MEDLINE and EMBASE up to August 2025 using terms related to ischaemic conditioning. Studies were included if they were RCTs involving cerebrovascular disease, used RIC as treatment, and measured mechanistic biomarkers. We extracted and summarised data on study design, participant characteristics, RIC intervention protocols (including timing, frequency, duration, and pressure), biomarker types and measurement methods, timing of biomarker assessment, and main findings relating biomarker changes to clinical outcomes. Results: The review identified twenty-one RCTs examining biomarkers, including serum biomarkers, imaging markers, and other physiological indicators. Key biomarkers identified include systemic inflammatory cytokines and various imaging markers such as cerebral blood flow (CBF), white matter hyperintensities (WMH), and brachial artery flow-mediated dilation (BA-FMD). Conclusions: The evidence suggests that RIC modulates various biomarkers linked to neuroprotection and recovery. Reliable biomarkers of RIC would enhance the understanding of its mechanisms and improve targeted therapies. The clinical utility of these biomarkers requires further validation through large-scale trials. Standardised protocols and longitudinal studies are essential for optimising RIC therapy and improving patient outcomes in stroke and cerebral small vessel disease. Future research should focus on expanding our understanding of these biomarkers and their interactions with RIC, leading to more personalised and effective treatments. Full article

Background: In revision total knee arthroplasty (rTKA), clinical focus is mainly on the femoral and tibial components, while patellar complications are often underemphasized. However, patellar bone deficiency is a significant issue that can negatively affect surgical outcomes, especially in septic revisions. Objective: This review provides an overview of contemporary approaches to the evaluation and treatment of patellar bone loss in rTKA, emphasizing preoperative planning, classification frameworks, and treatment options. Methods: A narrative review of the literature was conducted. Studies published between 2000 and 2024 addressing preoperative assessment, surgical techniques, and outcomes in the management of patellar bone loss in rTKA were screened. Discussion: A recent consensus has addressed the evaluation, classification, and treatment of significant bone loss after total knee arthroplasty (TKA), providing specific recommendations for the management of patellar bone loss and extensor mechanism involvement in cases of severe bone deficiency. In this review, the principal surgical strategies described in the literature are summarized, including patellar component retention or revision, the use of biconvex inlay and trabecular metal implants, bone grafting, various augmentation techniques, resection arthroplasty, gull-wing osteotomy, and patellectomy. Conclusions: Despite various surgical strategies, no consensus exists on a universally superior approach. Ongoing research is essential to establishing standardized, evidence-based protocols for effective management of patellar bone loss in rTKA. Full article

Background: The Mediterranean diet (MedDiet) has been associated with anti-inflammatory effects and potential benefits in several chronic conditions. However, adherence to the MedDiet and its relationship with lifestyle factors and disease severity across different rheumatological diseases remain poorly characterized. Objectives: This study aimed to evaluate differences in MedDiet adherence among patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and fibromyalgia (FM), and to explore its association with cardiovascular comorbidities, bowel habits, and disease-related outcomes. Methods: In this monocentric cross-sectional study, adherence to the MedDiet was assessed using the 14-item PREDIMED questionnaire. Self-reported data on sociodemographic characteristics, cardiovascular comorbidities, bowel habits, and dietary behaviors were collected through questionnaires. Disease activity and severity were assessed using validated disease-specific measures. Differences in MedDiet adherence across diagnostic groups were evaluated using non-parametric tests. Multivariable models were performed to examine associations between MedDiet adherence and cardiovascular comorbidities or disease outcomes, adjusting for potential confounders including age, sex, BMI, smoking status, and educational level. Results: A total of 422 participants were included (RA n = 165, PsA n = 85, FM n = 172). Significant differences in MedDiet adherence were observed across diagnostic groups (p < 0.001), with the highest adherence in RA, intermediate values in PsA, and the lowest in FM. Compared with the other groups, a higher proportion of FM participants reported food intolerances (46.5%) and restrictive diets, including lactose-free (34.9%) and gluten-free (15.1%) diets. In the FM group, high adherence to the MedDiet was significantly associated with lower FIQR scores (β = −16.9; 95% CI −32.1 to −1.7; p = 0.01) and lower PDS scores (β = −4.34; 95% CI −7.81 to −0.86; p = 0.01). Sensitivity analyses using the continuous PREDIMED score confirmed these associations. Conclusions: Adherence to the MedDiet differs across rheumatological diseases, with the lowest adherence observed in FM. Higher adherence was associated with lower disease severity and impact in FM. These findings highlight the potential relevance of nutritional counselling in rheumatological diseases and support the need for longitudinal and interventional studies evaluating the role of the MedDiet within multidisciplinary disease management. Full article

Environmental exposure to heavy metals, particularly cadmium (Cd), has been increasingly associated with obesity, metabolic dysfunction, chronic inflammation, and related disorders such as type 2 diabetes and cardiovascular diseases. Adipose tissue (AT), a paracrine and endocrine organ central to systemic energy and inflammatory homeostasis, is a major site of heavy metal accumulation and a key target of Cd toxicity. However, the mechanisms by which Cd disrupts adipocyte function, especially through epigenetic pathways, remain poorly understood. In this study, we investigated the effects of Cd on epigenetic regulators, antioxidant enzyme activity, inflammatory mediators, and adipogenic programming in human adipose-derived stromal/stem cells (hASCs) and differentiated adipocytes. Cd exposure altered histone modifiers associated with lysine 27 of histone 3 (H3K27), disrupted redox balance in a concentration-dependent manner, impaired adipogenic differentiation and lipid accumulation, and modulated inflammatory and adipokine responses according to differentiation stage and Cd concentration. Our findings suggest that Cd compromises adipose cell homeostasis through mechanisms involving epigenetic dysregulation, oxidative stress imbalance, and altered adipogenic and inflammatory signalling. These observations point to possible long-term metabolic consequences of environmental Cd exposure due to its accumulation in adipose tissue. Full article