Search Results (1,834)

Pertussis, caused by Bordetella pertussis, remains a public health concern despite long-standing vaccination programs. After a marked decline during the COVID-19 pandemic, a resurgence was observed in Europe and Italy, with a sharp increase in 2024. This study describes pertussis epidemiological trends in the Tuscany Region (Italy) from 2019 to 2024 to identify high-risk groups and inform prevention strategies. A retrospective population-based analysis was conducted using cases reported to the national surveillance system (PREMAL). Incidence rates were calculated using ISTAT population data, and demographic, temporal, and clinical characteristics were analyzed. Overall, 669 cases were reported (mean annual incidence rate: 3.03/100,000 (IC 95% 2.47–3.59; period incidence rate: 18.2/100,000 (IC 95% 16.81–19.56)), with 89% occurring in 2024 (16.34/100,000 (IC 95% 15.03–17.65)). No sex differences were observed, and most cases were reported in Central Tuscany (64%). Children under 15 years accounted for 87% of cases. The highest incidence was observed among 10–14-year-olds, while infants < 1 year, particularly those under 4 months, showed the highest burden in narrower age strata. Hospitalizations occurred in 12.6% of cases, decreasing substantially in 2024. The 2024 resurgence likely reflects waning immunity, disruptions to routine vaccinations during the pandemic, and reduced pathogen circulation in previous years due to containment and isolation measures related to the pandemic. Strengthening surveillance and improving booster and maternal vaccination coverage are essential to protect vulnerable populations. Full article

Dual-fuel combustion is often proposed for diesel engines as a means to partially replace conventional diesel with cleaner and/or more sustainable alternatives, such as those derived from green hydrogen. However, the low reactivity of these fuels (i.e., methane, hydrogen, and ammonia) often leads to prolonged ignition delay (ID) and combustion instability. This challenge could potentially be overcome using nanomaterials, which are additives that could improve reactivity and compensate for autoignition deficiencies. Thus, this study evaluates the effect of carbon nanotubes (CNTs) dispersed in diesel fuel on the autoignition process under dual-fuel operation. CNTs were dispersed at a concentration of 100 mg/L and stabilized with surfactant sodium dodecylbenzene sulfonate (SDBS). The resulting nanofuels were then tested in a constant volume combustion chamber (CVCC) using methane, hydrogen, and ammonia as secondary fuels across various energy substitution ratios and temperatures (535 °C, 590 °C and 650 °C). The results show that the impact of CNTs on ID is negligible, especially at high temperatures. At the lowest tested temperature (535 °C) and 40% methane substitution ratio, only slight reductions in ID were obtained. Nevertheless, this effect is less significant at higher temperatures (590 °C and 650 °C). Regarding pressure gradient, the addition of CNTs and SDBS generally induced a decrease in pressure-peak of up to 15%. This trend is attributed to the trapping of fuel droplets within the CNT structures, which creates a physical barrier that delays vaporization. Results confirm that autoignition, which is expected to be the main phenomenon influenced by CNT addition, is not enhanced. Full article

Sunscreens are essential for photoprotection, but conventional inorganic UV filters raise concerns regarding marine toxicity. This study investigated hydroxyapatite (HAp) derived from skipjack, tongol, and salmon bone waste as a potential synergistic booster for Tinosorb^® S (TS). HAp powders were prepared via alkaline treatment and calcination at 900 °C. XRD and XRF results confirmed highly crystalline HAp as the dominant phase. While 10% HAp alone provided negligible UV protection, a pronounced synergistic effect was observed in 1:1 hybrid formulations (5% HAp:5% TS), significantly enhancing Sun Protection Factor (SPF) and Ultraviolet A Protection Factor (UVAPF). Notably, particle-size refinement of salmon-derived HAp (SM–HAp) yielded an SPF of approximately 35, comparable to a commercial HAp counterpart. This improvement was suggested to be associated with enhanced dispersion, film uniformity, and particle–matrix interactions, which might contribute to achieving PA++++ protection. All formulations complied with microbiological and heavy metal safety standards. These results indicated that fish bone-derived HAp could potentially serve as a viable and sustainable functional additive derived from marine biowaste for the development of high-performance hybrid sunscreens, promoting biomaterial valorization in the cosmetic industry. Full article

Background: House dust mites (HDM) are one of the significant indoor allergen sources which cause IgE-mediated responses in most of the allergic individuals. HDMs are found in human habitats worldwide and Der p 2 is one of the major clinically relevant HDM allergens involved in triggering allergic diseases. The recombinant production of Der p 2 in plant systems provides a cost-effective and viable platform for developing diagnostic kits and allergen-specific immunotherapy. Methods: The D. pteronyssinus Der p 2 allergen was transiently expressed in Nicotiana benthamiana and its immunogenicity was evaluated in mice. The Der p 2 coding sequence was cloned into a geminiviral plant expression vector and introduced into N. benthamiana leaves via Agrobacterium tumefaciens-mediated infiltration. Recombinant Der p 2 proteins were purified from the crude extracts and confirmed by sodium dodecyl sulfate–polyacrylamide gel electrophoresis and Western blot. The immunogenicity of the plant-produced Der p 2 proteins was further evaluated by immunizing mice following a prime–boost immunization regimen, and Der p 2-specific antibody responses were assessed by ELISA. Results: Recombinant Der p 2 was successfully expressed and purified from N. benthamiana, and immunized mice developed high levels of Der p 2-specific IgG antibodies, with antibody titers increased after booster immunization. Conclusions: The results demonstrate that the transient expression of Der p 2 in plants is a feasible and effective strategy for producing immunologically active recombinant allergen proteins for diagnostic and potential clinical applications. Full article

Background: Post-traumatic stress disorder (PTSD) affects millions globally, with 40–50% of patients not responding adequately to first-line treatments. Prism neurofeedback, an FDA-cleared electroencephalography (EEG)-based system targeting amygdala-derived biomarkers, has demonstrated efficacy in randomized controlled trials (RCTs) and multicenter studies. Real-world implementation data from community clinical practice remain limited. Objective: To evaluate clinical outcomes and patient-developed self-regulation strategies of Prism neurofeedback in patients with PTSD in community clinical practice. Methods: Retrospective case series of 28 consecutive patients with PTSD treated with Prism neurofeedback in a community psychiatry practice. The primary outcome was change in PTSD Checklist for DSM-5 (PCL-5) from baseline to end of treatment. Results: Twenty-one of 28 patients (75.0%) completed treatment. Mean PCL-5 reduction was 37.0 ± 18.2 points (Cohen’s d = 2.03). Response rates were 100% for any improvement and 90.5% for clinically significant improvement (≥10-point reduction). Five patients (23.8%) achieved excellent response with ≥50-point reduction. Limited follow-up data (1–3 months post-treatment) were available for three patients; two of three (67%) exceeded their end-of-treatment gains. Four patients receiving booster sessions showed continued improvement. Limitations: The uncontrolled, retrospective design precludes causal attribution of improvements to the intervention versus placebo effects or regression to the mean. The 25% early discontinuation rate may introduce attrition bias. Durability data are available for only three patients. Conclusions: This case series provides real-world evidence supporting the feasibility and potential clinical utility of Prism neurofeedback in community practice, with outcomes comparable to controlled studies and preliminary evidence of durable treatment effects. These findings complement existing RCT evidence by demonstrating successful implementation outside research settings. Full article

This narrative review provides a comprehensive synthesis of patients with cancer disproportionately affected by vaccine-preventable infectious diseases due to malignancy-related immune dysfunction and treatment-induced immunosuppression. Vaccination represents a cornerstone of supportive care in oncology; however, vaccine uptake remains suboptimal and immune responses are frequently attenuated, particularly in patients with hematological malignancies and those receiving highly immunosuppressive therapies. This review provides a comprehensive synthesis of current evidence on vaccine immunogenicity, clinical effectiveness, and safety in oncology patients. We discuss immunological mechanisms underlying impaired vaccine responses, summarize evidence for major vaccines recommended in oncology practice, and address key clinical challenges such as timing relative to anticancer therapies, heterogeneity of immune responses, and vaccine hesitancy. An extended discussion highlights emerging strategies, including booster dosing, adjuvanted vaccines, and personalized vaccination approaches. Finally, future perspectives are outlined to improve integration of vaccination into routine oncology care. Full article

Background: Succinic acid plays a central role in human energy metabolism as a key intermediate of the Krebs cycle that releases energy accumulated as guanosine triphosphate (GTP). Through its conversion via succinate dehydrogenase (SDH), succinate directly links the Krebs cycle to oxidative phosphorylation (OXPHOS), contributing to adenosine triphosphate (ATP) production. Exercise induces pronounced changes in succinate concentrations in skeletal muscle, blood, and saliva, with responses influenced by training status, exercise modality, and intensity. Objective: This systematic review evaluated the effects of succinate-containing supplements or sole-ingredient succinic acid supplementation on exercise performance and post-exercise recovery in healthy trained individuals. Methods: The review was conducted in accordance with PRISMA guidelines. PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar were searched without date restrictions. Interventional studies assessing succinate-containing supplementation with outcomes related to exercise performance or recovery were included. Methodological quality was evaluated using the Cochrane Risk of Bias 2 tool. This study was registered in advance with the International Prospective Register of Systematic Reviews (PROSPERO, CRD420251237042). Results: Six studies involving 153 participants (mean age: 23 years) met the inclusion criteria. Five of the six included studies were rated as having a high risk of bias, while the only study judged to be at low risk of bias reported no beneficial effects on exercise performance outcomes. Supplementation protocols included daily doses of 300–2040 mg for up to 21 days and a single acute dose of 30 mg/kg, with most interventions administering succinate as part of multi-ingredient formulations rather than as an isolated compound. Three studies reported ergogenic effects in direct performance metrics, including improvements in maximal oxygen uptake, oxygen consumption, anaerobic threshold power, and total work performed. Two additional studies demonstrated favorable physiological adaptations indirectly relevant to exercise performance, including improved acid-base regulation, hematological markers related to oxygen transport, and antioxidant status, although validated performance outcomes were not assessed. Substantial heterogeneity and overall methodological limitations precluded meta-analysis. Conclusions: Current evidence suggests that succinate-containing supplements or sole-ingredient succinic acid supplementation may enhance direct performance outcomes such as aerobic performance, total workload, and indirect physiological markers, e.g., acid-base balance, hematological indicators and antioxidant capacity in healthy trained individuals. However, given that the majority of included studies were at high risk of bias and the only low-risk study reported no ergogenic effects, current evidence does not provide reliable support for performance-enhancing benefits of succinate supplementation. Interpretation is further limited by the predominant use of multi-ingredient formulations, making it difficult to isolate the effects of succinic acid. While biologically plausible mechanisms exist, well-controlled trials using isolated succinic acid are required before conclusions regarding efficacy can be drawn. Full article

COVID-19 vaccine hesitancy is well documented, but less is known about booster hesitancy among fully vaccinated adults. A qualitative approach was employed to identify factors affecting COVID-19 booster hesitancy using diffusion of innovation (DoI) theory. The study was conducted in Philadelphia, Pennsylvania. In-depth interviews (n = 30) were done with adults, including those who had (n = 9) and had not (n = 21) been boosted. Participants were categorized into DoI adopter groups or a “refuser” group for those with no intention of getting boosted. Transcripts were analyzed using an iterative coding process with consensus and triangulation to develop thematic categories. Participants had a mean age of 41 and were 63.3% Black; 20% were classified as innovators, 6.7% early adopters, 3.3% early majority, 6.7% late majority, 43.3% laggards and 20% refusers. Three themes varied across groups: level of perceived risk susceptibility of getting COVID-19 in the future, information needs and levels of vaccine literacy, and effects of ongoing institutional mistrust. Those in the laggard and refuser groups generally had lower vaccine literacy, higher levels of institutional mistrust, and were more likely to listen to friends and family for booster advice, all consistent with DoI adopter characteristics. These differences indicate important intervention targets to promote booster uptake, especially in those who have been previously vaccinated. Full article

Background/Objectives: Porcine epidemic diarrhea (PED) is a highly contagious enteric disease caused by porcine epidemic diarrhea virus (PEDV) and is associated with severe clinical signs and high mortality in neonatal piglets. Vaccination is an important strategy for PED control through the induction of humoral immunity. This study aimed to compare immune responses induced by inactivated and live-attenuated PEDV vaccines and to evaluate a heterologous prime-boost vaccination strategy in PEDV-naïve replacement gilts. Methods: Twenty-four PEDV-naïve replacement gilts were randomly assigned to four groups: unvaccinated control, inactivated vaccine administered twice (K/K), live-attenuated vaccine administered twice (L/L), and live-attenuated priming followed by an inactivated booster (L/K). Pigs received two intramuscular vaccinations at 16 weeks of age and two weeks later. Serum samples collected up to 42 days post-vaccination were analyzed for PEDV-specific IgG and IgA antibodies by ELISA, and serum-neutralizing antibody titers were determined using a serum neutralization test. Results: The L/K regimen induced the highest PEDV-specific IgG responses, with peak levels at day 28 post-vaccination that were significantly higher than those in the K/K and control groups. Serum-neutralizing antibody titers were significantly higher in the L/K and L/L groups than in the K/K and control groups. Serum IgA responses were low and transient across all vaccination groups. Conclusions: A heterologous prime-boost vaccination strategy using a live-attenuated PEDV vaccine followed by an inactivated booster induces strong systemic humoral immune responses in replacement gilts and represents a promising approach for PEDV vaccination programs. Full article

Background: The relationship between left atrial (LA) size, LA strain, and long-term prognosis in patients with coronary chronic total occlusion (CTO) remains unclear. This study aimed to evaluate the association of LA size and LA strain with clinical outcomes in CTO patients using cardiac magnetic resonance (CMR). Methods: This retrospective study included 168 patients with left ventricular ejection fraction (LVEF) ≥ 40%. The primary endpoint was the composite of major adverse cardiovascular and cerebrovascular events (MACCE). Model 1 was established by adjusting for clinically relevant parameters and standard CMR metrics. Models 2–4 were developed using Cox regression based on Model 1, with additional adjustment for each LA strain parameter separately. Results: A total of 168 patients with an LVEF ≥ 40% were analyzed, of whom 39 (23.2%) experienced MACCE during a mean follow-up of 45.9 months (median, 42 months). A preliminary model suggested that LA maximum volume index (LAVI_max) was independently associated with MACCE (HR 1.05, 95% CI 1.02–1.08, p = 0.004). Specifically, compared to the first quartile of LAVI_max, the second, third, and fourth quartiles were associated with an increased risk of MACCE (Q2: HR 4.50, 95% CI 1.42–14.27, p = 0.011; Q3: HR 4.40, 95% CI 1.29–14.96, p = 0.018; Q4: HR 5.55, 95% CI 1.71–18.06, p = 0.004). In Models 2–4, higher LAVI_max remained independently associated with MACCE (all p < 0.05), after adjusting for LA reservoir strain, conduit strain and booster strain, separately. In contrast, none of the LA strain parameters were associated with MACCE. Conclusions: Among CTO patients with LVEF ≥ 40%, LAVI_max was independently associated with MACCE. Full article

Injectable skin boosters currently in use mainly provide short-lived volumization or depend on inflammation-mediated collagen stimulation, raising concerns regarding durability and safety. Injectable particulate human acellular dermal matrix (phADM) is a biologically derived extracellular matrix scaffold designed to support constructive dermis remodeling. This randomized, split-face, double-blinded clinical trial evaluated the efficacy of phADM as a facial skin booster in 20 adults with moderate cheek roughness. phADM was injected on one facial side, with hyaluronic acid serving as the contralateral control. Multiple skin parameters were assessed over 20 weeks using validated imaging and biophysical instruments. Mechanistic validation was conducted using complementary in vitro, ex vivo human skin, and in vivo rat models. Clinically, the phADM-treated side demonstrated greater improvements in skin density, volume, elasticity, wrinkle depth, pore area, hydration, and barrier-related parameters at multiple time points compared with HA. In ex vivo human skin, phADM showed homogeneous dermal distribution and preservation of extracellular matrix architecture, along with restoration of basement membrane-associated proteins following UVB irradiation. In vivo rat studies revealed fibroblast infiltration and localized neocollagenesis within the implanted matrix. In vitro assays further indicated enhanced fibroblast proliferation and extracellular matrix synthesis, increased hyaluronan production, suppression of pro-inflammatory cytokines in activated macrophages, and downregulation of melanogenesis-related genes in melanoma cells. No serious adverse events were observed during the clinical study. These findings indicate that phADM functions as a restorative skin booster that promotes durable dermis remodeling and functional rejuvenation with a favorable safety profile. Full article

Background: Healthcare workers are at the forefront of the global battle against COVID-19. Their vaccination perspectives, particularly in regions like Sierra Leone that have faced health crises such as the Ebola outbreak, are essential for shaping public health strategies in low-income countries that routinely face infectious disease outbreaks. Objective: This research sought to understand the perceptions and experiences of Sierra Leone’s healthcare workers concerning COVID-19 vaccination and booster doses, set against the backdrop of global health resource disparities and regional vaccine distribution challenges. Methods: Utilizing a mixed-methods approach, the study analyzed data from an online survey, which saw 1001 complete responses from 2060 participants across six Ebola-impacted districts (October–November 2022), and in-depth interviews with 24 health workers from three of these districts (February–July 2022). Results: Approximately 80% of respondents reported having received a COVID-19 vaccine, predominantly Sinopharm and AstraZeneca, yet only 34% of vaccinated participants had received a booster dose. In multivariable analyses, personally knowing someone who experienced serious COVID-19 illness or death was associated with higher odds of both initial vaccination and booster uptake (p < 0.05). By contrast, prior Ebola-related experiences were not consistently associated with vaccination outcomes. Qualitative findings contextualized these patterns, highlighting the roles of professional exposure, limited booster-related information, and inequities in vaccine availability and distribution. Conclusion: These findings indicate that vaccination strategies must move beyond initial rollout to address barriers to sustained engagement, particularly for booster uptake among healthcare workers. They also emphasize the need for equitable vaccine access and transparent, locally tailored communication to mitigate structural and informational constraints in low-income settings. Full article

Passive transplacental immunity is crucial for neonatal protection from infections. Following Clostridioides difficile (C. difficile) infection, infants do not develop disease, although C. difficile colonization is highly prevalent in infants. This work aimed to characterize humoral immunity specific to C. difficile toxins TcdA and TcdB and to surface proteins FliD and Cwp84, well-known colonizing factors, in pregnant women and their neonates. Anti-C. difficile antibodies were measured in maternal serum, cord blood, and breast milk from 58 healthy pregnant women and their newborns, enrolled in a prospective study, using a quantitative ELISA. Anti-C. difficile antibodies were also measured in pregnant women with C. difficile infection (CDI) in a retrospective peripartum case series. We found a high seroprevalence of IgG specific to the four antigens in healthy pregnant women, regardless of colonization by C. difficile. However, pregnant women exhibited lower concentrations of TcdA-specific IgG antibodies compared to age-matched non-pregnant women. A strong positive correlation between maternal and cord blood IgG specific to TcdA, TcdB, FliD, and Cwp84 was observed, suggesting a transplacental transfer of C. difficile-specific IgG antibodies to neonates. In breast milk, a high seroprevalence of IgA specific to the two toxins was detected, and positive correlations between maternal serum and breast milk antibody levels highlight a preferential transfer of TcdB-specific IgG and Cwp84-specific IgG to breast milk, providing the infant with a protective barrier against C. difficile. Lastly, since pregnant women are at increased risk for C. difficile infection (CDI), we characterized the specific antibody response in a retrospective peripartum case series. Sera from peripartum women with CDI exhibited similar median concentrations of TcdA, TcdB, FliD, and Cwp84 IgM and IgG to those of healthy pregnant women. Moreover, except for one case, antibody concentrations remained stable during the longitudinal evolution of C. difficile response before and after diagnosis of CDI, without any booster effect. Altogether, these data are consistent with antibody-mediated maternal protection of neonates from C. difficile-associated disease. Larger studies exploring immune factors involved in protection from C. difficile-associated disease during pregnancy are needed. Full article

Pediatric patients with SARS-CoV-2 infection are at an increased risk of severe disease and adverse outcomes. Nevertheless, comprehensive data on COVID-19 vaccine effectiveness (VE) in children with diabetes during the post-pandemic period remain limited. This study assessed the VE against severe COVID-19 outcomes during both the pandemic and post-pandemic phases in children with and without diabetes mellitus (DM). A cohort study based on population data was carried out, including all patients under 18 years of age with symptomatic SARS-CoV-2 infection as registered in the Brazilian national surveillance systems from February 2020 to June 2025. The main outcomes were hospitalization due to COVID-19 and severe illness, which included admission to the intensive care unit (ICU), need for invasive ventilation, and death. Utilizing a propensity score-matched cohort, we estimated the VE and the number needed to vaccinate (NNV) for a booster dose against these outcomes by comparing vaccinated and unvaccinated individuals, employing conditional logistic regression adjusted for confounding variables. The cohort comprised 3,730,007 pediatric patients with COVID-19, of whom 7675 (0.2%) had DM. At baseline, children with DM exhibited a significantly higher prevalence of hospitalization (11.2% vs. 2.0%), severe COVID-19 (6.4% vs. 0.6%), and mortality (1.9% vs. 0.1%) than those without DM (all p < 0.001). During the pandemic period, the adjusted VE was consistently higher in children with DM. Against severe disease, the VE was 72.8% (95% CI: 12.3–93.2) in the DM cohort compared with 45.7% (28.1–59.0) in the non-DM cohort. This increased effectiveness corresponded to a more favorable NNV; the NNV to prevent one severe case was 24 (95% CI: 12–232) for children with DM versus 243 (168–440) for those without DM. In the post-pandemic period, the VE remained significantly higher in the DM cohort. Against severe disease, the VE was 76.2% (11.5–93.5) for children with DM and 52.9% (32.7–67.1) for those without. The NNV to prevent one severe case was consistently lower in the DM cohort (8 vs. 591). In conclusion, a complete vaccination regimen, including a booster dose, substantially mitigated severe COVID-19 outcomes in children with DM in the pandemic and post-pandemic periods. Full article

Background/Objectives: African swine fever virus (ASFV), the causative agent of African swine fever (ASF), is a highly contagious virus affecting both domestic and feral pig populations with mortality rates approaching 100% within one week of infection. Currently, there are limited treatments or vaccines available to control the disease. Although ASF is endemic in sub-Saharan Africa, the virus has also spread widely, reaching regions of the European Union, Russia, China, Southeast Asia, and, more recently, to the Dominican Republic and Haiti, bringing the threat closer to the United States (U.S.). ASF introduction to the U.S. would have severe consequences for swine producers and the national pork industry. Consequently, there is an urgent need to develop effective vaccine strategies to manage ongoing outbreaks abroad and mitigate the risk of future ASF incursions. Recent efforts have identified several ASFV epitopes and evaluated them in experimental vaccine trials. However, these vaccine candidates have elicited limited protective immune responses and have not demonstrated full protective efficacy. Methods: In this study, we employed in silico modeling and epitope prediction tools to design a synthetic multiepitope ASF protein incorporating key immunogenic regions of ASFV. The goal was to generate a single-antigen construct capable of inducing broad and robust immune responses when formulated with an established nanoparticle-based vaccine platform. The multiepitope ASF protein was subsequently expressed and entrapped into mannose-conjugated chitosan (M-CS) nanoparticles for vaccine formulation. The candidate vaccine, formulated with M-CS nanoparticle-entrapped adjuvant (ADU S100), was administered intramuscularly to pigs, and both T- and B-cell responses were assessed following the primary (DPV 22) and booster (DPV 42) doses. Results: Our M-CS ASF protein vaccine elicited antigen-specific T- and B-cell responses, both of which are recognized as central correlates of protection against ASFV. Conclusions: These promising preliminary immunological findings suggest that this nanoparticle vaccine has the potential to confer protection against ASFV challenge, a hypothesis that will be examined in future studies. Full article