Search Results (14,455)

Background: Continuous epidural analgesia is widely used for postoperative pain management in small infants. Epidural catheters may be inserted via a caudal-threaded approach or by direct lumbar/thoracic placement; however, comparative data on placement success, clinical use, postoperative analgesic outcomes, and complications remain limited. This study compared these two epidural techniques in small-weight infants undergoing surgery. Methods: This retrospective observational cohort study included all infants admitted to the Neonatal Intensive Care Unit at UPMC Children’s Hospital of Pittsburgh with documented epidural catheter placement in the chart between January 2018 and December 2024. Demographic and perioperative data were extracted from the electronic medical record. Outcomes included technical success of catheter placement; patient, surgical, and epidural characteristics; epidural medications; postoperative pain and sedation scores; opioid consumption; and epidural catheter complications. Results: A total of 104 patients had documentation of 105 epidural catheter placements in the chart; five procedures were unsuccessful in four patients, resulting in 100 successful epidural catheter placements (70 caudal-threaded and 30 direct lumbar/thoracic). Patient and surgical characteristics, postoperative pain and sedation scores, and opioid consumption did not differ significantly between groups. Direct lumbar/thoracic epidural catheter placement required longer procedure times. Patients in the direct lumbar/thoracic epidural group were more likely than those in the caudal-threaded group to receive a ropivacaine/clonidine infusion (47% vs. 4%; p < 0.001) and a programmed intermittent bolus of epidural infusion (60% vs. 3%; p < 0.001). The direct lumbar/thoracic group experienced more postoperative catheter-related complications than the caudal-threaded group (20% vs. 4%; p = 0.02), primarily catheter leakage requiring premature catheter removal. Conclusions: Epidural catheter placement was successful in 96.2% of patients. No statistically significant between-group differences were detected in postoperative pain scores, sedation scores, or opioid consumption between caudal-threaded and direct lumbar/thoracic epidural catheters in small-weight infants (median 3 kg) when placed by a Pediatric Acute Pain Service. Direct lumbar/thoracic epidural catheters were associated with a higher incidence of postoperative catheter leakage and premature catheter removal; however, these complications cannot be attributed solely to the location of epidural catheter insertion. These findings may help clinicians select the most appropriate epidural technique for postoperative pain management in this population. Full article

Background: Eustachian tube dysfunction (ETD) is associated with several common otologic conditions but lacks standardized diagnostic thresholds in Taiwan. This study aimed to evaluate the diagnostic performance of the GSI TympStar Pro pressure-swallow test and to identify a ROC-derived maximal peak pressure difference (MPD) cutoff for distinguishing clinically diagnosed obstructive Eustachian tube dysfunction (oETD) from healthy controls. Methods: A total of 152 subjects were enrolled, including 100 healthy controls and 52 patients with clinically diagnosed oETD, confirmed by otolaryngologist assessment and supported by ETDQ-7 symptom scoring. Tympanometry and tympanometry-based Eustachian tube function testing using the GSI TympStar Pro ETF–Intact pressure-swallow module, a modified three-tympanogram pressure-swallow protocol, were performed. Group comparisons were conducted using Mann–Whitney U and Chi-square tests. Diagnostic performance was assessed using receiver operating characteristic (ROC) curve analysis. Results: The median MPD was 11 daPa (IQR 6–17) in the control group, compared to 0 daPa (IQR 0–2) in the ETD group (p < 0.001). ROC analysis demonstrated that a cutoff value of ≤4 daPa yielded a sensitivity of 100.0% and specificity of 91.0% in the per-person analysis, and a sensitivity of 97.5% and specificity of 95.5% in the per-ear analysis. In the Type A-only per-ear analysis, MPD retained discriminatory performance, with an AUC of 0.978 (95% CI, 0.961–0.994). Conclusions: When interpreted in conjunction with ETDQ-7 symptom assessment and routine clinical evaluation, pressure-swallow testing may provide complementary objective information for the functional assessment of patients with suspected obstructive Eustachian tube dysfunction, particularly when resting tympanometry is unremarkable. In this single-center Taiwanese cohort, lower MPD values may serve as an adjunctive indicator of impaired Eustachian tube pressure equalization, and the ROC-derived cutoff of ≤4 daPa showed discriminatory value for differentiating symptomatic obstructive ETD from healthy controls. This cutoff should be interpreted as an exploratory, protocol-specific threshold and requires prospective validation in larger multicenter populations before broader clinical application. Full article

The shortage of protein-rich foods is a major challenge due to the rapid growth of the world’s population. For this reason, efforts are being made to achieve sustainability in the food system to produce nutritious foods with better qualities. The present study aimed to utilize a combination of widely consumed legumes with nutritional properties—such as lentils, chickpeas, and beans—considering their physicochemical and functional characteristics, to produce tempeh as a model. A simple mixture design was employed to develop a legume-based product through the production of fermented flour using Rhizopus oligosporus ATCC 22959. For this purpose, proximate composition, water absorption index (WAI), pH, phenolic content, and antioxidant capacity, via the DPPH (2,2-diphenyl-1-picrylhydrazyl) and ABTS (2,2′-azino-bis (3-ethylbenzothiazoline-6-sulfonic acid)) radicals, were determined in the raw legumes. Optimal fermentation conditions were determined through digital image analysis, and fermentations were carried out according to the design. The crude and soluble protein content, phenolic content, and DPPH of the fermented samples were determined, and a statistical optimization was performed by maximizing each variable. Through optimization, it was found that a formulation of 80.81% lentil and 19.19% chickpea presented the best desirability (D = 0.75) according to the criteria mentioned above. These results were also compared with those obtained from the preparation of an original soy tempeh using the microorganism Rhizopus oligosporus; it was found that the protein differences between the original tempeh and the one made from the legume blend were 19 g/100 g dry matter for the original tempeh and 27.5 g/100 g dry matter for the one made with the legume blend, demonstrating that the combination of legumes exerts a favorable interaction within the mixture model on the physicochemical properties of tempeh and could represent significant potential for the production of flours applicable to the development of food products as part of alternative protein sources. Full article

This study aims to systematically review the current applications and development trends of virtual reality (VR) technology in blue space research. It clarifies the main research methods, technical pathways, application scenarios, and existing knowledge gaps, and integrates the advantages of VR technology with the characteristics of blue spaces to provide references for future urban renewal and urban management research. Following the PRISMA-ScR guidelines, this study searched literature published up to January 2026 in the Web of Science and Scopus databases. A total of 41 original studies were included. A scoping review approach was adopted, employing descriptive statistics, cross-analysis, and classification methods. Existing studies mainly focus on blue space types such as rivers and lakes, with immersive head-mounted displays as the primary method. Most experiments adopt single session, short term exposure designs, suggesting potential positive effects of virtual blue spaces in reducing stress, improving mood, and restoring attention. Other studies demonstrate the application of VR technology in environmental education, design assessment, and urban management within blue spaces. As an indirect exposure and supplementary intervention tool, VR shows significant potential in blue space research, particularly in supporting vulnerable populations, large-scale urban planning and design assessment, and risk management. However, current research still faces several limitations, including insufficient multisensory integration, limited capability in simulating dynamic water environments, lack of methodological standardization, uneven sample distribution, absence of longitudinal studies, and weak interactive and social dimensions. The findings highlight the need for further research on these specific aspects. Full article

Background/Objectives: Medication-related osteonecrosis of the jaw (MRONJ) is a known side effect of antiresorptive agents. Although the jawbone has been extensively investigated, histopathological changes in the overlying oral mucosa remain poorly characterized. We previously reported small bone fragments located within the oral mucosa of a patient with MRONJ. This study aimed to investigate the presence and histopathological characteristics of those fragments in other patients with surgically treated MRONJ. Case Presentation: This retrospective case series included six patients with stage 3 mandibular MRONJ who underwent marginal or segmental resection. Archived histological sections from these patients were examined. Oral mucosal specimens had been separated from the underlying osseous lesions for independent histological evaluation. In this study, small intramucosal sequestra were defined as small bone fragments that appeared to be completely surrounded by mucosal connective tissue in individual two-dimensional sections. All sections had been stained with hematoxylin and eosin, and additional von Kossa staining had been performed on oral mucosal sections from five of the six cases. Histopathological evaluation of small intramucosal sequestra included the presence, size range, and association with pseudoepitheliomatous hyperplasia (PEH). Results: Small intramucosal sequestra were identified in all six patients. They were present either singly or in clusters within the connective tissue beneath the oral epithelium. The intramucosal sequestra exhibited empty osteocytic lacunae, indicating devitalized bone, and were positive for von Kossa staining in all five examined cases, confirming their mineralized nature. In two patients, PEH was observed in direct contact with the small sequestra, some of which appeared to be embedded within the advancing epithelial fronts. Conclusions: Small intramucosal sequestra were a recurrent histopathological finding in this selected series of surgically resected stage 3 mandibular MRONJ. Their presence highlights histopathological changes in the oral mucosa overlying necrotic jawbone that have received limited attention. Further studies including broader patient populations and appropriate comparison groups are needed to determine the generalizability and disease specificity of this finding and its potential relevance to MRONJ pathogenesis. Full article

Background: Community-based health insurance is an important strategy for extending healthcare access and financial protection to informal-sector populations. In Tanzania, the Improved Community Health Fund (iCHF) is implemented through region-specific models that differ in benefit packages, premium arrangements, and provider participation. However, evidence on how members experience these different implementation models remains limited. This study compared members’ experiences and perceptions of CHF implementation in Dodoma and Kilimanjaro, two regions operating different iCHF models. Methods: The study used data from a cross-sectional household survey conducted among 420 CHF-enrolled members in Dodoma and Kilimanjaro in January 2018. Data were collected using a structured, interviewer-administered household questionnaire covering socio-demographic characteristics, CHF enrolment history, registration and premium-payment experiences, benefit-package perceptions, trust in CHF management and community participation, perceived healthcare service quality, and perceived benefits of membership. Data were analyzed using descriptive statistics, cross-tabulations, and Pearson’s chi-square tests to assess regional differences. Results: Members generally reported positive experiences with CHF administration. Most had used their CHF cards, renewal intentions were high, premiums were considered affordable, payment arrangements were convenient, and local CHF management was generally perceived as trustworthy. Statistically significant regional differences were observed in renewal intention, satisfaction with CHF officers, perceived healthcare service quality, and perceived household benefit (p < 0.05). Dodoma respondents reported higher renewal intention and a higher proportion of households benefiting from CHF. The distribution of healthcare-quality ratings also differed significantly (p < 0.001): Kilimanjaro had a higher proportion rating care as excellent (16.1% vs. 2.9%), whereas Dodoma had a higher proportion rating care as good (44.6% vs. 38.9%). Challenges in both regions included limited benefit coverage, additional out-of-pocket payments, long waiting times, and limited perceived advantages of CHF membership. Conclusions: Regional differences were observed in members’ experiences; however, because the regional samples differed socioeconomically and the analysis was not adjusted for potential confounders, these differences should not be attributed to the iCHF models themselves. The findings describe members’ experiences during the 2018 pilot period and should not be interpreted as a direct description of current iCHF performance. The results nevertheless highlight the importance of benefit coverage, service responsiveness, financial protection, and healthcare quality alongside efficient administration. Full article

Background and Objectives: Hereditary angioedema due to C1 inhibitor deficiency (HAE-C1INH) is a rare autosomal dominant disorder caused by mutations in the SERPING1 gene and is characterized by considerable clinical variability among affected individuals. Although genotype–phenotype correlations have been reported, data from populations with high consanguinity rates remain limited. Therefore, this study aimed to construct pedigrees of HAE-C1INH families harboring SERPING1 mutations and to investigate whether mutation type is associated with phenotypic characteristics, particularly age at disease onset and C1 inhibitor functional activity. Materials and Methods: Eleven HAE-C1INH probands and their families were followed up at the Allergy and Immunology Department of Internal Medicine, Ege University Faculty of Medicine. Of the 295 family members identified through pedigree construction, 109 had symptoms compatible with HAE-C1INH, and 53 of these symptomatic individuals had both a confirmed SERPING1 genetic result and an available C1-INH functional measurement. Pedigrees were created using the Progeny Pedigree Drawing Software (Progeny Genetics LLC, Delray Beach, FL, USA). Demographic data, disease characteristics, C1-INH function levels, and SERPING1 mutation types were obtained from patient files. Results: A total of 295 individuals (151 males and 144 females) from 11 HAE-C1INH families were identified through pedigree construction. The analytical cohort comprised 53 symptomatic individuals, of whom 7 (13.2%) were homozygous for the variant. Among heterozygous patients (n = 46), 27 (58.7%) had missense mutations, 7 (15.2%) had nonsense mutations, 7 (15.2%) had large deletions, and 5 (10.9%) had frameshift deletion mutations. Patients carrying missense mutations had significantly higher median C1-INH functional activity (28.5%) than those with other mutation types (14.1%) (p = 0.026), and the median age of disease onset was significantly later in the missense group (20 years) than in the non-missense group (8 years) (p < 0.001). Annual HAE attack frequency was also lower in the missense group (median, 12 vs. 48 attacks per year; p = 0.009). Conclusions: Exploratory individual-level analyses showed higher residual C1-INH functional activity and later symptom onset among individuals carrying missense SERPING1 variants than among those carrying pooled non-missense loss-of-function variants. However, familial clustering and the small number of independent families limit the strength and generalizability of these findings. Full article

Background: Metastatic melanoma in East Asian populations is enriched for acral and mucosal subtypes and harbors a distinct molecular landscape compared with Western cutaneous melanoma. However, data on the efficacy of first-line immune checkpoint inhibitor (ICI) therapy and on the impact of molecular characteristics on treatment effect in this population remain limited. We aimed to characterize the genomic landscape of an East Asian metastatic melanoma cohort and to evaluate the predictive values of molecular markers for first-line ICI therapy. Methods: This study included 135 patients with metastatic melanoma who received first-line ICI at Samsung Medical Center between January 2022 and December 2025. Of these, 108 with paired next-generation sequencing (NGS) data were included in the molecular analysis. Survival outcomes were estimated by the Kaplan–Meier method, and the prognostic value of molecular subtype was assessed using univariable and multivariable Cox proportional hazards models. Results: Mucosal melanoma was the most common primary site (58, 43.0%), followed by acral melanoma (31, 23.0%) and cutaneous melanoma (25, 18.5%); 4 (3.0%) had uveal melanoma and 17 (12.6%) had melanoma of other or unknown primary origin. The overall objective response rate to first-line ICI was 37.8% (51 of 135), and median progression-free survival (PFS) was 6.2 months (95% confidence interval [CI] 4.0–9.6). Using the hierarchical classification, 108 patients were classified into five molecular subtypes: BRAF-altered (n = 17, 15.7%), RAS-altered (n = 17, 15.7%), KIT-altered (n = 15, 13.9%), and NF1-altered (n = 7, 6.5%), and quadruple–wild-type (n = 52, 48.1%). TMB-high status (10.2%) showed no significant association with outcomes. Molecular subtype was significantly associated with PFS (log-rank p = 0.009). After multivariable adjustment, BRAF fusion (hazard ratio [HR] 5.05, 95% CI 1.70–14.98, p = 0.003) and KIT-altered status (HR 2.91, 95% CI 1.46–5.77, p = 0.002) emerged as independent adverse prognostic factors, whereas BRAF V600 single-nucleotide variants did not differ significantly from quadruple–wild-type. Conclusions: In this East Asian metastatic melanoma cohort, BRAF fusion and KIT alterations were independent adverse prognostic factors for first-line ICI. These findings suggest that BRAF fusion and KIT-altered tumors may represent distinct subgroups that warrant further investigation. Full article

Background/Objectives: Deep learning-based medical imaging applications often require large and diverse datasets to achieve reliable performance. However, publicly available palpebral conjunctiva datasets for non-invasive hemoglobin assessment remain limited in both size and demographic diversity. The objective of this study was to develop and evaluate a conditioning-guided Latent Diffusion Model (LDM) for controllable palpebral conjunctiva image synthesis under limited-data conditions. Methods: The proposed framework employs an image-to-image latent diffusion strategy conditioned on continuous hemoglobin values together with gender and country information to generate realistic synthetic conjunctiva images with controllable clinical and demographic characteristics. The proposed LDM was compared with GAN-based approaches, including cDCGAN and StyleGAN2-ADA, using evaluation criteria covering image realism, diversity, conditioning consistency, and computational efficiency. Analyses of frequency-domain characteristics, zero-shot cross-population evaluation, and blinded clinical assessment were performed for the proposed LDM. Results: The proposed LDM achieved the lowest FID score ($15.86\pm 0.23$) among the evaluated models, indicating superior image realism relative to cDCGAN and StyleGAN2-ADA, while maintaining image diversity comparable to StyleGAN2-ADA and substantially outperforming cDCGAN. Conditioning evaluation demonstrated strong consistency between the target hemoglobin values and the generated images, achieving a Pearson correlation coefficient of $r=0.910\pm 0.025$. Frequency-domain analysis, zero-shot cross-population evaluation, and blinded clinical assessment further supported the realism, structural consistency, and clinical plausibility of the generated images. Conclusions: The findings demonstrate the potential of conditional latent diffusion models for controllable palpebral conjunctiva image synthesis under limited-data conditions. The proposed framework provides a promising approach for generating realistic synthetic conjunctiva images with controllable clinical and demographic characteristics. Full article

Urban resilience (UR) is shaped by multiple interacting factors, yet existing studies have paid limited attention to the differentiated nonlinear and interactive mechanisms across different resilience dimensions. Based on panel data from 110 prefecture-level and above cities in the Yangtze River Economic Belt (YREB) from 2015 to 2024, this study adopts a four-dimensional framework covering social, economic, ecological, and infrastructure resilience. Spatial analysis and the XGBoost-SHAP model are combined to examine the spatiotemporal evolution, key drivers, nonlinear responses, turning point characteristics, and factor interactions of overall UR and its four dimensions. The results show that overall UR increased steadily, while the four dimensions followed distinct evolutionary trajectories: economic and infrastructure resilience improved most rapidly, ecological resilience increased steadily, and social resilience improved relatively slowly. The importance and effects of key drivers also varied across overall resilience and its four dimensions. Major factors, including technological investment, non-registered population, unemployment insurance coverage, land use, and natural population growth, exhibited distinct nonlinear responses and turning point characteristics, with their effects changing across different variable levels. Furthermore, significant interactions were identified among population and industrial structure, population and transportation, industry and technology, and industry and social security across different resilience dimensions. Overall, UR in the YREB is characterized by differentiated development, nonlinear responses, nonlinear transition patterns, and joint influences of multiple factors. Full article

Background: Dietary behaviors are important modifiable factors related to health and well-being. Sports volunteers represent a population involved in sport-related environments, yet limited evidence is available regarding their specific dietary behaviors and their associations with sociodemographic characteristics. Materials and Methods: A cross-sectional survey was conducted among 297 sports volunteers (184 women, 113 men) at international sporting events in Poznan, Poland. Twenty specific dietary behaviors, including meal frequency, consumption of fruits, vegetables, cereal products, meat, dairy products, fish, sweets, sugar-sweetened beverages, salty snacks, ready-made meals, legumes, water, and selected eating behaviors, were assessed using a 20-item dietary habits questionnaire developed in accordance with dietary recommendations of the National Institute of Public Health and the National Center for Nutrition Education in Poland. Gender, age, educational attainment, and BMI were recorded. Chi-square tests were used to examine bivariate associations between each dietary behavior and sociodemographic characteristics. Multivariable logistic regression models were subsequently applied to dietary behaviors showing statistically significant bivariate associations. Results: Of the 20 dietary behaviors assessed, only a small number varied significantly according to sociodemographic characteristics. Women reported higher adherence to daily fruit consumption (46.8% vs. 28.1%; p = 0.002) and daily consumption of at least three portions of vegetables (44.1% vs. 28.9%; p = 0.013) than men. Participants aged 18 years differed from older age groups in daily fruit consumption and limiting meat consumption to no more than once per day (p < 0.05). Educational attainment was associated with daily fruit consumption, with participants with primary education reporting higher adherence than those with higher education (48.8% vs. 25.3%; p = 0.011). BMI was associated with several dietary behaviors, including fruit consumption, avoiding snacking between meals, and portion control (p < 0.05). In multivariable analyses, female gender remained independently associated with fruit and vegetable consumption, while younger age was independently associated with daily fruit consumption and lower meat consumption. BMI remained independently associated with daily fruit consumption, whereas educational attainment was no longer significantly associated with dietary behaviors after adjustment. Conclusions: Most of the 20 dietary behaviors assessed did not differ significantly according to the examined sociodemographic characteristics. The observed associations were limited to selected behaviors and varied by gender, age, educational attainment, and BMI. Further research should examine additional factors, including physical activity, volunteering characteristics, and socioeconomic conditions, that may contribute to dietary behaviors among sports volunteers. Full article

Acute respiratory distress syndrome (ARDS) represents a major cause of morbidity and mortality in critically ill patients and is most frequently triggered by severe respiratory infections, including nosocomial pneumonia. Hospital-acquired and ventilator-associated pneumonia (HAP/VAP) are highly prevalent in intensive care units and share overlapping pathophysiological mechanisms with ARDS. Despite this close interrelationship, the proportion of patients with nosocomial pneumonia who subsequently develop ARDS remains poorly defined, underscoring the need to identify potential predisposing factors and improve early recognition of patients at risk. While the development of pneumonia in patients with an established diagnosis of ARDS has been extensively investigated, limited data are available on patients who develop ARDS as a complication of HAP/VAP. This narrative review summarizes the limited direct evidence on this topic and discusses potential clinical characteristics, risk factors, and predictive tools, while considering indirect evidence from CAP and broader ARDS populations. Full article

Background and Objectives: Acute rhinosinusitis is associated with a substantial deterioration in quality of life, including symptoms such as nasal obstruction, facial pressure, cough, and sleep disruption. Growing interest in non-pharmacological management strategies has been observed, particularly among populations in whom systemic treatments may be limited, such as pediatric patients and pregnant individuals. NESOSPRAY HE-G is a nasal device containing a filmogenic glycerol formulation designed to create a protective barrier and induce an osmotic effect, thereby promoting nasal decongestion and mucosal protection. Materials and Methods: A randomized, double-blind, placebo-controlled study was conducted to assess the performance and safety of NESOSPRAY HE-G (n = 20) compared with a saline comparator (n = 20) in patients aged 3 years and older presenting with acute rhinosinusitis and a baseline Rhino-Sinusitis Severity Score (RSSS) of at least 25/50. The investigational product was administered as three sprays per nostril, four times daily, over a maximum period of 15 days or until symptom resolution. Efficacy was primarily evaluated through changes in the total RSSS and in key symptoms, including nasal congestion, facial pain, cough, sleep disturbance, and fever. Safety assessments included monitoring adverse events (AE) and evaluating local tolerability. Results: Baseline characteristics were comparable between groups. Treatment with NESOSPRAY HE-G resulted in a statistically significant reduction in total RSSS from Day 2 onwards, with sustained effects throughout the study period. Improvements were also observed across individual symptoms, including early relief of nasal congestion and reductions in cough and facial pain, with faster onset compared to the comparator. Sleep quality showed progressive improvement. Resolution of fever occurred in both groups, with an earlier effect observed in the NESOSPRAY HE-G arm. No serious adverse events (SAE) or hypersensitivity reactions were reported. The product demonstrated good tolerability. Conclusions: NESOSPRAY HE-G provides rapid and sustained alleviation of symptoms associated with acute rhinosinusitis. Its topical mode of action, based on osmotic activity and barrier formation, represents a suitable non-pharmacological option, particularly for patients seeking alternatives to systemic therapies or presenting contraindications to such treatments. Full article

Cold hypersensitivity in hands and feet (CHHF) affects 20–52% of East Asian populations, is more prevalent in women, and is managed with vasodilators in Western medicine or herbal therapies in traditional East Asian medicine. This study was conducted to compare the pharmacological characteristics of two heat-clearing (HCHs, Scutellariae Radix and Coptidis Rhizoma) and two blood-tonifying (BTHs, Angelicae Sinensis Radix and Paeoniae Radix Alba) herbs used for CHHF. Candidate herbs were selected based on herbology classifications, PubMed searches, and the Korean Medicine Clinical Practice Guideline for CHHF. A total of 61 active compounds and 323 corresponding protein targets with CHHF were retrieved from the traditional Chinese medicine systems pharmacology database and analysis platform (TCMSP), standardized via UniProt, and intersected with CHHF-related genes from GeneCards. Protein–protein interaction networks were constructed, core targets identified, and functional enrichment analyses performed using Reactome databases. A total of 166 herb–CHHF common targets were identified, including 24 shared across all four herbs. HCHs were primarily enriched in hemostasis-, immune-, and signaling-related pathways, whereas BTHs were associated with immune regulation, metabolism, and neuronal modulation. Notably, Scutellariae Radix and Paeoniae Radix Alba showed substantial overlap in enriched pathways. These findings suggest that HCHs and BTHs may be associated with distinct yet potentially relevant molecular mechanisms in CHHF. However, because the present analysis was conducted at the single-herb level, these findings cannot be directly generalized to the clinical use of multi-herb formulas and should be interpreted as hypothesis-generating. Full article

Partial cocoa pulp removal may modify substrate availability and affect microbial and metabolic dynamics during fermentation. This study evaluated the effects of beans with pulp and depulped beans on microbial dynamics and metabolite profiles during on-farm cocoa fermentation. Three treatments were evaluated for 144 h: CT, 100% beans with pulp; TA, 75% beans with pulp and 25% depulped beans; and TB, 50% beans with pulp and 50% depulped beans. Physicochemical parameters, culturable microbial populations, selected microbial isolates, sugars, and organic acids were analyzed throughout fermentation. Partial pulp removal was associated with differences in sugar and organic acid profiles, while temperature, pH, and titratable acidity showed the characteristic temporal progression of cocoa fermentation, with significant differences among treatments and fermentation times. Saccharomyces cerevisiae was frequently identified among selected yeast isolates, whereas Acetobacter sp. and Fructobacillus pseudoficulneus were among the bacterial taxa identified. Exploratory principal component and hierarchical cluster analyses indicated that fermentation time was the main factor associated with sample differentiation, while partial pulp removal showed secondary associations with physicochemical and microbiological profiles. Overall, partial pulp removal was associated with differences in microbial and metabolic profiles, indicating its potential for further investigation as a strategy to modulate cocoa fermentation. Full article