Search Results (643)

Alternative proteins denote non-traditional, high-protein foods. These innovative sources aim to compete with conventional animal products by providing protein-rich, sustainable, nutritious, and flavorful options. Currently, five main categories of alternative proteins are being developed: plant-based proteins, cultured meat, single-cell proteins, edible insects, and seaweed. Nonetheless, several chemical and microbiological food safety hazards are associated with these alternatives Incorporating novel protein sources into food products may heighten the prevalence of existing food allergies. This could arise from extracting proteins from their natural matrices and utilizing them at significantly higher concentrations. Additionally, the introduction of new proteins may lead to the development of novel food allergies. Proteins that are currently seldom or never consumed may cause primary sensitisation or trigger cross-reactivity with known allergens. To date, alternative proteins have not been thoroughly studied for their allergenic potential, and there is no standardised method for assessing this risk. This review aims to explore non-traditional protein sources, discussing their nutritional and functional properties, as well as their potential allergenicity based on available research. We conducted a literature search in PubMed and Embase databases. We used specific keywords and MESH terms. A total of 157 studies were included in the review. The studies reviewed in our analysis reveal significant limitations, such as inconsistent methodologies, limited participant numbers, and a lack of long-term data, which hinder the ability to make clear conclusions regarding the safety of these new proteins for individuals with allergies. To address current challenge, future research should integrate food science, regulatory perspectives and advanced technologies. Full article

Background and Objectives: General-purpose multimodal large language models (LLMs) are increasingly used for medical image interpretation despite lacking clinical validation. This study evaluates the diagnostic reliability of ChatGPT-4o and Claude 2 in photographic assessment of adolescent idiopathic scoliosis (AIS) against radiological standards. This study examines two critical questions: whether families can derive reliable preliminary assessments from LLMs through analysis of clinical photographs and whether LLMs exhibit cognitive fidelity in their visuospatial reasoning capabilities for AIS assessment. Materials and Methods: A prospective diagnostic accuracy study (STARD-compliant) analyzed 97 adolescents (74 with AIS and 23 with postural asymmetry). Standardized clinical photographs (nine views/patient) were assessed by two LLMs and two orthopedic residents against reference radiological measurements. Primary outcomes included diagnostic accuracy (sensitivity/specificity), Cobb angle concordance (Lin’s CCC), inter-rater reliability (Cohen’s κ), and measurement agreement (Bland–Altman LoA). Results: The LLMs exhibited hazardous diagnostic inaccuracy: ChatGPT misclassified all non-AIS cases (specificity 0% [95% CI: 0.0–14.8]), while Claude 2 generated 78.3% false positives. Systematic measurement errors exceeded clinical tolerance: ChatGPT overestimated thoracic curves by +10.74° (LoA: −21.45° to +42.92°), exceeding tolerance by >800%. Both LLMs showed inverse biomechanical concordance in thoracolumbar curves (CCC ≤ −0.106). Inter-rater reliability fell below random chance (ChatGPT κ = −0.039). Universal proportional bias (slopes ≈ −1.0) caused severe curve underestimation (e.g., 10–15° error for 50° deformities). Human evaluators demonstrated superior bias control (0.3–2.8° vs. 2.6–10.7°) but suboptimal specificity (21.7–26.1%) and hazardous lumbar concordance (CCC: −0.123). Conclusions: General-purpose LLMs demonstrate clinically unacceptable inaccuracy in photographic AIS assessment, contraindicating clinical deployment. Catastrophic false positives, systematic measurement errors exceeding tolerance by 480–1074%, and inverse diagnostic concordance necessitate urgent regulatory safeguards under frameworks like the EU AI Act. Neither LLMs nor photographic human assessment achieve reliability thresholds for standalone screening, mandating domain-specific algorithm development and integration of 3D modalities. Full article

Objectives: Non-cystic fibrosis bronchiectasis (BE) is a chronic airway disease with increasing prevalence, reduced quality of life, and increased mortality. Inhaled corticosteroids (ICS) are used in BE despite limited evidence of effect on lung function parameters. ICS may increase the risk of Staphylococcus aureus (S. aureus) infections in patients with BE, but this is unexplored. We examined the association between ICS use prior to BE diagnosis at different doses and the risk of S. aureus isolation in patients with BE. Methods: We conducted a national register-based cohort study including Danish patients with a BE diagnosis code between 2001 and 2018 with a 1-year follow-up time from the date of diagnosis. ICS exposure was categorized based on accumulated prescriptions redeemed 365 days before BE diagnosis and divided into none, low, moderate, or high use based on clinically relevant doses. A cause-specific Cox proportional hazards regression model was used to estimate the risk of S. aureus isolation. A sensitivity analysis, an inverse probability of treatment weighted model (IPTW), was performed. Results: A total of 5093 patients were included in this study. S. aureus was isolated in 156 patients (3.1%). High-dose ICS was associated with an increased risk of S. aureus isolation, HR 3.81 (95% CI 2.51; 5.79). No association for low or moderate use was found, low-dose HR 1.22 (95% CI 0.77; 1.93), and moderate-dose HR 1.24 (95% CI 0.72; 2.16). IPTW analysis yielded similar results. Conclusions: High-dose ICS use in patients with BE was associated with an increased risk of S. aureus isolation. ICS should be used cautiously in patients with BE. Full article

This study investigates a lithium-ion battery failure in heating insoles that ignited during normal walking while powered off. Through comprehensive material characterization, electrical testing, thermal analysis, and mechanical gait simulation, we systematically excluded electrical or thermal abuse as failure causes. X-ray/CT imaging localized the ignition source to the lateral heel edge of the pouch cell, correlating precisely with peak mechanical stress identified through gait analysis. Remarkably, the cyclic load was less than 10% of the single crush load threshold specified in safety standards. Key findings reveal multiple contributing factors as follows: the uncoated polyethylene separator’s inability to prevent stress-induced internal short circuits, the circuit design’s lack of battery health monitoring functionality that permitted undetected degradation, and the hazardous placement inside clothing that exacerbated burn injuries. These findings necessitate a multi-level safety framework for lithium-ion battery products, encompassing enhanced cell design to prevent internal short circuit, improved circuit protection with health monitoring capabilities, optimized product integration to mitigate mechanical and environmental impact, and effective post-failure containment measures. This case study exposes a critical need for product-specific safety standards that address the unique demands of wearable lithium-ion batteries, where existing certification requirements fail to prevent real-use failure scenarios. Full article

Extensive research in the field of construction safety has predominantly focused on identifying the causes and impacts of construction accidents, evaluating safety plans, assessing the effectiveness of safety education materials, and analyzing relevant policies. However, comparatively limited attention has been given to the systematic formation, management, and utilization of safety-related information and knowledge. Despite significant advancements in information and knowledge management technologies across the architecture, engineering, and construction (AEC) industries, their application in construction safety remains underdeveloped. This study addresses this gap by proposing a novel ontology-based framework specifically designed for construction safety management. Unlike previous models, the proposed ontology integrates diverse safety regulations and terminologies into a unified and semantically structured knowledge model. It comprises three primary superclasses covering key areas of construction safety, with an initial focus on fall hazards—one of the most frequent and severe risks, particularly in roofing activities. This domain-specific approach not only improves semantic clarity and standardization but also enhances reusability and extensibility for other risk domains. The ontology was developed using established methodologies and validated through reasoning tools and competency questions. By providing a formally structured, logic-driven knowledge base, the model supports automated safety reasoning, facilitates communication among stakeholders, and lays the foundation for future intelligent safety management systems in construction. This research contributes a validated, extensible, and regulation-aligned ontology model that addresses critical challenges in safety information integration, sharing, and application. Full article

Non-intentionally added substances (NIAS) in plastic food contact materials represent a critical undercharacterized chemical safety concern, caused by their inherent diversity, potential toxicity, and regulatory challenges. This review synthesizes recent advances and persistent gaps in NIAS analysis, with a primary focus on analytical workflows for non-targeted analysis, alongside a consideration of risk assessment and toxicological prioritization frameworks. Conventional plastics (e.g., polyethylene, polypropylene, or polyethylene terephthalate) as well as emerging materials (e.g., bioplastics and recycled polymers) exhibit different NIAS profiles, including oligomers, degradation products, additives, and contaminants, requiring specific approaches for migration testing, extraction, and detection. Advanced techniques, such as ultra-high-performance liquid chromatography or two-dimensional gas chromatography coupled with high-resolution mass spectrometry, have enabled non-targeted analysis approaches. However, the field remains constrained by spectral library gaps, limited reference standards, and inconsistent data processing protocols, resulting in heavy reliance on tentative identifications. Risk assessment procedures mainly employ the Threshold of Toxicological Concern and classification by Cramer’s rules. Nevertheless, addressing genotoxicity, mixture effects, and novel hazards from recycled or bio-based polymers remains challenging with these approaches. Future priorities and efforts may include expanding spectral databases, harmonizing analytical protocols, and integrating in vitro bioassays with computational toxicology to refine hazard characterization. Full article

Background/Objectives: Prognostic information for nonmetastatic prostate cancer (nmPC) patients with prevalent vertebral fractures (PVFs) is very limited. Vertebral fractures can impair physical function, limit activities of daily living, and decrease quality of life. Prevention of vertebral fractures may be important to improve patient prognosis. This study aims to investigate the impact of the presence and severity of PVFs on overall survival in patients with nmPC undergoing androgen deprivation therapy (ADT). Methods: A total of 275 men (median age: 73 years) with nmPC who underwent ADT were studied retrospectively. The median observation period was 55 months. Variables included age, body mass index, T classification, N classification, Gleason score, and pretreatment serum prostate-specific antigen levels. PVF was diagnosed from the sagittal computed tomography images of Th1 to L5 before initiating ADT, and the severity was determined by the number of PVFs and the Semiquantitative (SQ) method. Hazard ratios and 95% confidence intervals for overall survival were calculated using the Cox proportional hazards model. Results: During the observation period, 30 patients died from all causes. Multivariate Cox regression analysis identified multiple PVFs and high-grade PVFs, as determined by the SQ method, as significant predictors of overall survival. The analysis utilized two adjustment models: one adjusted for age only and the other adjusted for age, Gleason score, and clinical T stage. Conclusions: Multiple PVFs and high-grade PVF determined by the SQ method prior to ADT initiation were associated with higher all-cause mortality in nmPC patients treated with ADT. Full article

Background: The associations between physical activity (PA) and all-cause mortality remain under-investigated among individuals with impaired lung function. Methods: With 201,596 participants from the UK Biobank cohort, baseline pre-bronchodilation lung function tests and a modified International Physical Activity Questionnaire were used to assess lung function status (normal, restricted, obstructed) and PA attributes (volume, intensity, duration). All-cause mortality was determined through linkage to the National Health Services Register. Cox proportional hazard regression was applied to characterize the associations between PA metrics and all-cause mortality among people with different lung function statuses. Dose–response relationships between PA metrics and all-cause mortality risks were examined using restricted cubic splines (number of knots = 4). Results: Over a 11.81-year median follow-up, 5.24% of participants died. All-cause mortality risk declined with increasing total PA volume, plateauing at 1800 MET-min/week without further reduction in individuals with and without impaired lung function. Similar trends were observed for PA intensity and duration, with both factors demonstrating reduced mortality risk that plateaued after reaching a specific threshold. Notably, 24.1% (95% CI: 16.7%, 30.8%) and 43.1% (95% CI: 36.1%, 49.7%) lower mortality risk was observed among individuals with and without impaired lung function for PA with 1201–1800 MET-min/wk. Conclusions: PA was associated with a decreased risk of all-cause mortality among individuals with and without impaired lung function, suggesting that those with impaired lung function might also benefit from PA. Full article

Due to the complexity of planning and constructing underground lines, construction challenges—such as close proximity and multi-line interactions—are increasingly being recognized, along with their associated safety hazards. The visual observation of tunnel deformation and changes in the surrounding strata is difficult. In this study, laboratory model experiments were conducted using a mixture of liquid paraffin, n-tridecane, and silica gel powder, combined in specific proportions to create a transparent material that simulates natural soft rock. The new tunnel was designed to simultaneously cross over and under two existing tunnels. The impact of the new tunnel on the existing tunnels was examined, with excavation length and soil layer thickness considered as the primary influencing factors. The results indicate that excavating the new tunnel causes settlement deformation in the tunnels above and heave deformation in the tunnels below. The magnitude of deformation increases as excavation progresses but decreases with the greater thickness of the soil interlayer. For an existing tunnel, variations in the thickness of the soil interlayer not only affect its own deformation but also disturb the tunnel on the opposite side. Therefore, to ensure safer and orderly urban tunnel construction and to address the “black box” effect, it is essential to study the deformation characteristics of existing tunnels and their surrounding rock during the construction of new tunnels. Full article

Background: Delirium is a frequent yet pathophysiologically still poorly understood complication in the intensive care unit (ICU) and is associated with adverse outcomes for the patients. Currently, guidelines give several recommendations for treating delirium in the ICU, but to date no sufficient drug treatment exists. Dexmedetomidine, primarily used for anesthesia and sedation in ICUs has shown a preventive effect of delirium compared to other sedatives, such as propofol. We hypothesize that overnight administration of dexmedetomidine may prevent and/or shorten the duration of delirium in ICU patients. Methods: The Basel propofol dexmedetomidine (BaProDex) Study was a single-center, prospective, randomized controlled trial. We included adult ICU patients with hyperactive or mixed delirium. Patients with delirium prior to ICU admission, advanced heart block, uncontrolled hypotension, or status epilepticus were excluded. The participants were randomly assigned 1:1 to either receive dexmedetomidine (study group) or propofol (control group) as a continuous infusion overnight. The Intensive Care Delirium Screening Checklist (ICDSC) was applied at least three times per day. Delirium was defined as an ICDSC ≥ 4. The study drug was administered until the end of delirium or ICU discharge. The primary endpoint was the time to delirium episode end, which was analyzed using cumulative incidence curves and a cause specific Cox proportional hazards regression with death as a competing risk. Secondary endpoints included recurrence of delirium until 28 days after ICU discharge, death until day 28, severity of ICU delirium, number of ventilation days, ICU length of stay (LOS) in hours, hospital length of stay in days and survival after three and twelve months after ICU discharge. Due to insufficient recruitment the trial needed to be stopped prematurely. Results: In total, 38 patients were enrolled and randomized in the two groups. The median duration of delirium was shorter in the dexmedetomidine group as compared to the propofol group (ITT: 34 vs. 66 h; PP: 31 vs. 66 h), resulting in a hazard ratio of 1.92 (95% CI 0.89–4.15, p = 0.097) in the ITT and 2.95 (95% CI 1.27–6.86, p = 0.012) in the PP analysis. In the PP analysis, the 28-day mortality was lower in the dexmedetomidine group (1 vs. 5 deaths) and fewer patients needed ventilation (7 vs. 15 patients). Both ICU and hospital LOS were shorter in the dexmedetomidine group (ICU LOS: median 43 vs. 128 h; hospital LOS: median 12 vs. 22 days). Further, mortality up to three and twelve months was lower in the dexmedetomidine group compared to the propofol group (PP: 2 vs. 8 patients died within twelve months, 2 vs. 7 patients died within three months). The recurrence of delirium until 28 days after ICU discharge and severity of delirium were similar in both groups. Conclusions: Despite premature termination, BaProDex provides preliminary evidence for a reduction in the duration of delirium by nocturnal infusion of dexmedetomidine compared to propofol. Therefore, dexmedetomidine may be considered an option to treat hyperactive or mixed delirium in ICU patients. However, due to the small sample size, the study is rather of exploratory nature due to the premature termination, and we cannot rule out that the observed treatment effect is overly optimistic or by chance. Full article

Avian pathogenic Escherichia coli (APEC) causes avian colibacillosis, leading to significant economic losses and concerns for food safety in the poultry industry. This study focused on examining the virulence gene profile, antibiotic resistance prevalence, and resistance patterns of APEC isolates. A total of 250 bacterial strains were collected from birds affected by colibacillosis. Serogrouping revealed diverse serotypes, with O2 being the most common (16%), followed by O1, O8, and O76. All isolates tested positive for at minimum one virulence gene, with 7.2% carrying all five targeted genes, particularly in serogroups O1, O8, O45, and O88. The most detected gene was iss, present in 79.6% of isolates, followed by tsh, iucC, sitA, and papC. The antibiotic resistance analysis showed that all isolates exhibited multidrug resistance, although they remained susceptible to gentamicin, amikacin, ciprofloxacin, and chloramphenicol. Moreover, specific antibiotic resistance genes were known in the isolates, with tetA detected in 54.8%, tetB in 51.7%, sul1 in 50%, and aadA1 in 29.2%. These findings highlight the widespread antibiotic resistance in chicken carcasses, which poses a hazard to human health in terms of transfer of resistance to humans, reduced effectiveness of antibiotics and impaired ability to contain infectious diseases. Therefore, it is crucial to implement strict monitoring programs to regulate antibiotic usage in poultry production. Full article

Background/Objectives: Remote telemedical management (RTM) in heart failure (HF) patients with cardiac implantable electronic devices (CIED) is a reliable approach to follow device-specific and heart failure-related parameters. However, while some positive outcome data is available, results are inconclusive. We aimed to assess the benefits of continuous remote telemonitoring (RTM) compared to the in-person visit (IPV) in reducing all-cause mortality, heart failure hospitalizations (HFH), cardiovascular (CV) deaths, and the occurrence of inappropriate therapy. Methods: The study comprised a systematic review and meta-analysis of randomized controlled trials (RCTs) testing RTM (device-related or other non-invasive telemonitoring systems) vs. IPV for the management of HF patients. The main endpoints were all-cause and CV mortality. Risk of bias and level of evidence were assessed. Hazard ratios (HRs), odds ratios (ORs) and 95% confidence intervals (CI) were calculated. CENTRAL, EMBASE and MEDLINE were searched, and only randomized controlled studies were included. Results: Sixteen RCTs were identified, comprising a total of 11,232 enrolled patients. Seven studies evaluated all-cause mortality, resulting in an OR 0.83 (95% CI 0.72 to 0.96). When CV mortality was assessed, the RTM group showed a significant benefit compared to the IPV group (OR 0.81, 95% CI 0.67 to 0.97). The risk of bias ranged from “low” to “some concerns” for most outcomes, and the certainty was low to moderate depending on the specific outcomes. Conclusions: RTM proved to be superior in reducing all-cause and CV mortality compared to IPV; however, there is a clear need to have standardized alert actions to achieve the mortality benefit. Full article

The Tarim River Basin is an important grain and cotton base in Xinjiang, China. Indeed, cotton production in this basin accounts for one-third of the total cotton production in China. The Tarim River Basin is characterized also by the presence of forestry activities and fruit plantations. However, frequent long-term droughts have seriously affected local agricultural productivity. In this paper, a new standardized precipitation evapotranspiration index (nSPEI), with an improved drought detection effect, was constructed based on the standardized precipitation index (SPI) and the standardized precipitation evapotranspiration index (SPEI). This drought index was subsequently employed as a hazard indicator of disaster-causing factors in the Tarim River Basin. In addition, a drought disaster risk assessment model was constructed using the natural disaster system theory. This model was applied to analyze the hazard of drought-disaster-causing factors, the exposure of disaster-affected bodies, the vulnerability of disaster-bearing environments, drought prevention/mitigation capabilities, and comprehensive drought disaster risks in the Tarim River Basin over the 2001–2021 period. The results demonstrated the applicability of the 12-month nSPEI (nSPEI-12) in the Tarim River Basin. Specifically, the nSPEI-12 values exhibited a decreasing trend, highlighting an aridification trend in the basin. In addition, a 25% increase in the vegetation cover of the Tarim River Basin was observed from 2000 to 2023 and remained unchanged at 4.5%. On the other hand, a decreasing trend of the vegetation cover was found in the remaining parts of the basin. The hazard level of the disaster-causing factors and the exposure of bearing bodies were high in the northeastern and northwestern parts of the Tarim River Basin, respectively. The disaster prevention/mitigation capacity was greater in the northern and southwestern parts, while the vulnerability level of disaster-bearing environments decreased from the northwestern part to the southeastern part. The western and northern parts of the Tarim River Basin exhibited the highest drought risk levels, followed by the northeastern and southeastern parts. Full article

Background/Objectives: The clinical implications of sarcopenia and visceral obesity in patients with cardiovascular disease (CVD) are poorly understood. We evaluated the impact of sarcopenia and visceral obesity on clinical outcomes among older adults with CVD. Methods: This retrospective cohort study included patients aged 65 years and older who had cardiovascular disease and had undergone body composition analysis using dual-energy X-ray absorptiometry (DXA) between November 2021 and October 2022 and been followed through February 2024. Sarcopenia was defined using the 2019 Asian Working Group for Sarcopenia criteria, and visceral obesity was defined using Korean sex-specific visceral adipose tissue area. The primary outcome was a composite of all-cause mortality and major cardiovascular events, including myocardial infarction, stroke, hospitalization for heart failure, and coronary revascularization. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology reporting guidelines. Results: A total of 317 patients were included, of whom 118 patients (37.2%) had sarcopenia, 184 (58.0%) had visceral obesity, and 55 (17.4%) had sarcopenic obesity. The prevalence of sarcopenia or visceral obesity was 93.8% in patients with obesity and 69.3% in those without obesity. Sarcopenic obesity showed a mixture of characteristics of two metabolic conditions in terms of demographics and body mass index. Sarcopenia was associated with an increased risk of primary outcomes (hazard ratio [HR], 1.93; 95% CI, 1.02–3.66), with the highest risk observed in patients with sarcopenic obesity (HR, 6.74; 95% CI, 1.81–25.16). Conclusions: Sarcopenia was associated with 1.9-fold increased risk of cardiovascular events among older adults with CVD, with a greater than 6-fold increased risk when combined with visceral obesity. Full article

Background and Objectives: Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of global morbidity and mortality. The cardiometabolic index (CMI) has been shown to be associated with metabolic disorders and mortality in general populations, but its role in ASCVD-specific mortality risk remains unexplored. Materials and Methods: This cohort study was based on the National Health and Nutrition Examination Survey (NHANES). Weighted Cox proportional hazards models were fitted to estimate the associations between CMI and mortality. Restricted cubic splines were used to explore nonlinear relationships. Subgroup analyses were used to investigate potential differences among specific ASCVD patients. Results: A total of 2157 patients with ASCVD were included. Over a median 83-month follow-up, 887 all-cause and 300 cardiovascular deaths occurred. Each unit increase in CMI was associated with an 11.3% increased risk of all-cause mortality (HR = 1.113, 95% CI: 1.112–1.115) and a 6.4% increased risk of cardiovascular mortality (HR = 1.064, 95% CI: 1.062–1.065). There was a nonlinear J-shaped relationship between CMI and all-cause mortality, while the risk of cardiovascular mortality increased linearly with increasing CMI. Conclusions: These findings underscore the importance of monitoring and managing CMI in patients with ASCVD in clinical practice and suggest that optimizing CMI levels may help reduce the risk of death and improve the long-term prognosis of patients. Full article