Search Results (7,307)

Antimicrobial resistant (AMR) infections are a persistent public health issue causing excess death and economic impacts globally. Because AMR in clinical settings is often acquired from nonpathogenic bacteria that surround us, environmental surveillance must be better characterized. It has been well established that metals can co-select for bacterial AMR. Furthermore, recent studies have shown that compromised microbial community diversity may lead to community invasion by antibiotic resistance genes (ARGs). Widespread legacy mining has led to acid mine drainage and metal contamination of waterways and sediments throughout the western United States, potentially compromising microbial community diversity while simultaneously selecting for AMR bacteria. Our study objectives were to survey metal contaminated sediments from the Bonita Peak Mining District (BPMD) in southwestern Colorado, USA, compared to sites downstream in Durango, CO for bacterial and ARG diversity. Sediment bacteria were characterized using 16S rRNA Ilumina and metagenomic sequencing. We found that overall, bacterial diversity was lower in metal-contaminated, acidic sites (p = 0.04). Metagenomic sequencing revealed 31 different ARGs, with those encoding for efflux pumps (mex and spe gene families) substantially more prevalent in the BPMD sites, elucidating a specific AMR marker fingerprint from the high metal concentration sediments. Raising awareness and providing antimicrobial tracking techniques to resource limited communities could help provide information needed for better antibiotic use recommendations and environmental monitoring. Full article

Pancreatic ductal adenocarcinoma (PDAC) is highly lethal, and many patients cannot undergo curative surgery due to frailty. Multimodal prehabilitation: combining exercise, nutrition, and psychological support improves functional readiness, but its biological impact on the PDAC tumor microenvironment (TME) is unclear. In this exploratory pilot study, we profiled resected PDAC tissues from prehabilitation-treated patients and matched controls using NanoString GeoMx Digital Spatial Profiling across immune, tumor, and stromal compartments (n = 4). Transcriptomic signatures were analyzed via differential expression, pathway enrichment, and MCP-counter deconvolution; protein-level validation used multiplex immunofluorescence (n = 8). Ligand–receptor modeling assessed cell–cell communication, and prognostic relevance was evaluated in TCGA-PDAC (n = 178). Prehabilitation was associated with increased NK-cell cytotoxicity, interferon response, and chemokine recruitment, as well as higher neutrophil signatures (p < 0.01) and reduced fibroblast signatures (p < 0.05). Tumor regions showed lower MAPK and PI3K/AKT activity, while stroma exhibited decreased TGF-β and Wnt signaling. Immunofluorescence confirmed neutrophil infiltration and reduced fibroblast density. TCGA analysis linked neutrophil-high/fibroblast-low profiles to longer survival (1044.6 vs. 458.7 days, p = 0.0052). These findings suggest prehabilitation may promote a more immune-active, less fibrotic TME in PDAC, resembling transcriptional states associated with improved survival. Prospective studies integrating biological and clinical endpoints are warranted. Full article

Practical training and recruitment strategies are critical for the sustainable implementation of psychosocial interventions. However, few studies have examined how to prepare community partners and doctoral students to support culturally adapted psycho-oncology interventions. This pre-pilot study aims first to evaluate two distinct training programs and recruitment procedures, and second to explore preliminary pre-post outcomes of the Caregiver-Patients Support to Cope with Advanced Cancer (CASA) intervention, using the Consolidated Framework for Implementation Research (CFIR). Three clinical psychology graduate students received CASA training, and two community partners completed Recruitment training. We present descriptive pre- and post-assessments, along with qualitative feedback, for both training and institutional (Puerto Rico Biobank) and community-based recruitment outcomes. A related-samples nonparametric analysis examined pre- and post-CASA intervention signals. Results indicated knowledge gains among doctoral students (pre-test M = 3.3; post-test M = 9.3) and community partners (pre-test M = 4.5; post-test M = 9.5). Preliminary outcomes revealed significant improvements in spiritual well-being (Z = −2.618, p = 0.009) and quality of life (Z = −2.957, p = 0.003) and a reduction in depressive (Z = −2.764, p = 0.006), anxiety (Z = −2.667, p = 0.008), and distress (Z = −2.195, p = 0.028) symptoms following CASA. Of 26 recruited dyads, institutional referrals enrolled 16 dyads (61.5%), while community partners referred 10 dyads with a 90.9% success rate. Findings support the feasibility of both training and CASA exploratory outcomes suggest meaningful psychosocial benefits for Latino dyads coping with advanced cancer. Combining institutional infrastructure with community engagement may enhance sustainability and equitable access to psycho-oncology care. Full article

Background: The rapid ageing of the cardiovascular population has profoundly transformed clinical practice, with an increasing proportion of patients presenting advanced age, frailty, multimorbidity, and functional vulnerability. Conventional cardiology models, largely derived from younger and selected populations, often fail to adequately address the complexity of cardiovascular care in older adults. Despite the growing development of cardiogeriatrics, the core competencies required for contemporary geriatric cardiology practice remain insufficiently defined. Methods: This narrative review synthesises evidence from cardiology, geriatrics, heart failure, and the palliative care literature, complemented by clinical expertise in integrated cardiogeriatric care pathways, to identify key competencies relevant to the care of older adults with cardiovascular disease. Results: Four major domains of geriatric cardiology competencies were identified: (1) advanced cardiovascular expertise adapted to ageing physiology, frailty, and multimorbidity; (2) integration of comprehensive geriatric assessment into cardiovascular decision-making; (3) a dedicated cardiogeriatric communication mindset supporting shared decision-making under prognostic uncertainty; and (4) system-based competencies focused on multidisciplinary coordination, care transitions, and therapeutic proportionality. Conclusions: Defining the core competencies of the geriatric cardiologist is essential to addressing the clinical and organisational challenges of an ageing cardiovascular population. This framework provides a pragmatic foundation for clinical practice, education, and future research, supporting integrated cardiogeriatric care models aligned with patient-centred outcomes. Full article

Background/Objectives: Dementia represents a growing public health challenge. The WHO Global Action Plan on the Public Health Response to Dementia emphasizes early detection, risk reduction, and innovation as key priorities. Mild Behavioral Impairment (MBI), defined as the emergence of persistent neuropsychiatric symptoms in older individuals, represents a potential marker of early neurodegeneration and possible window for early intervention. This review explores the role of MBI in dementia prevention, mapping current evidence within the WHO Global Action Plan framework. Methods: A comprehensive search was performed in PubMed, Scopus, and the official WHO website, during 1 September 2025–10 November 2025, without time restrictions. Eligible sources included original clinical studies, reviews, and policy documents addressing MBI, dementia prevention, and public health. Data were thematically synthesized according to the seven objectives of WHO: (1) dementia as a public health priority, (2) dementia awareness and friendliness, (3) dementia risk reduction, (4) dementia diagnosis, treatment, care and support, (5) support for dementia carers, (6) information systems for dementia, and (7) dementia research and innovation. Results: Accumulating evidence indicates that MBI assessment can capture early behavioral manifestations of neurodegenerative and other forms of dementia, correlating with fluid, neuroimaging and genetic biomarkers. Integrating MBI screening through the easy-to-administer MBI Checklist (MBI-C) into clinical and community-based care, including telemedicine pathways and research, may enhance early identification and personalized interventions, enrich the pool for clinical trials, and facilitate research in biomarker and therapy. MBI-related research further supports its integration in remote digital monitoring and population-based prevention. Conclusions: Embedding MBI-informed screening and interventions into national dementia strategies aligns with WHO objectives for early, equitable and scalable prevention and brain health. Full article

Abdominal pain is the cardinal symptom of irritable bowel syndrome (IBS) and the primary determinant of disease burden and healthcare utilization. Despite its diagnostic centrality and high prevalence across all IBS subtypes, effective management remains a clinical challenge. This narrative review explores the pathophysiological mechanisms underlying IBS-related pain, emphasizing the role of visceral hypersensitivity, altered brain–gut communication, and luminal factors such as gas and distension. We examine current guideline recommendations, real-world treatment patterns, and evidence supporting both pharmacological and non-pharmacological interventions. Particular focus is placed on the fixed-dose combination of alverine citrate/simeticone, which targets both motor and sensory pathways. Mechanistic studies demonstrate its smooth muscle relaxant, antinociceptive, and anti-inflammatory actions. Clinical trials support its efficacy in reducing pain, improving quality of life, and lowering healthcare resource use. Despite these advances, several unmet needs remain, including subtype-specific treatment strategies, mechanistic biomarkers, and broader access to integrated care. The review concludes with a call for more personalized, mechanism-based approaches to pain management in IBS, with alverine citrate/simeticone offering a pragmatic option within this evolving therapeutic framework. Full article

Background: Teamwork and effective communication are widely recognized as essential pillars for the safety and quality of healthcare. However, in Portugal, no validated instrument had previously been available to assess healthcare professionals’ attitudes toward teamwork. This study aimed to translate, culturally adapt, and validate the TeamSTEPPS^® Teamwork Attitudes Questionnaire (T-TAQ) for the Portuguese context, resulting in the Portuguese version of the instrument. Methods: A methodological study with a quantitative approach was developed. The translation and cultural adaptation process followed internationally recognized guidelines. The sample consisted of 162 healthcare professionals (136 nurses and 26 physicians) from a hospital in Lisbon. Exploratory and confirmatory factor analysis techniques were used to assess construct validity. The internal consistency of the scale was analyzed using Cronbach’s alpha coefficient. Results: The Portuguese version comprises 30 items distributed across five dimensions: Effective Leadership Support, Team Functional Performance, Teamwork Coordination, Willingness to Engage in Teamwork, and Team Functioning Supervision. The scale demonstrated a total explained variance of 53.9% and an overall internal consistency coefficient (α) of 0.86, indicating good reliability. Confirmatory factor analysis supported the five-factor structure of the scale (χ²/df = 1.461; CFI = 0.900; GFI = 0.821; RMSEA = 0.054; MECVI = 4.731). Conclusions: The T-TAQ-PT proved to be a valid, reliable, and robust instrument for assessing healthcare professionals’ individual attitudes toward teamwork, contributing to the development of research and clinical practice in the Portuguese context. Full article

Background: Intentional tooth replantation (ITR) is a promising treatment option for preserving teeth in cases where conventional endodontic therapy is challenging, or when previous endodontic treatment and apicoectomy have been unsuccessful. The procedure involves extracting the compromised tooth, preserving the alveolar socket and root surface, performing extraoral endodontic therapy, and replanting the tooth in the alveolar socket. Objective: An increase in evidence-based support for ITR has improved the viability of ITR as a treatment option for patients. This review aims to further establish and provide new areas of potential research for ITR with respect to root morphology, extraction, and surgical techniques, maintenance of the tooth socket, and methods for post-op stabilization. Materials and Methods: A literature review was performed across PubMed from 1 January 1980 to 1 July 2025, with a focus on oral surgery techniques, atraumatic extraction techniques, topographical discrepancies in root system anatomy, and ITR procedural outcomes. Conclusions: Although ITR is not a common procedure performed in contemporary clinical practice, gathering sufficient data on the variables influencing the procedure may help patient outcome and improve communication between the endodontist and oral surgeons. Full article

Declining Leydig cell steroidogenesis contributes to late-onset hypogonadism and to age-associated impairment of male reproductive health. Determinants of dysfunction extend beyond chronological aging. This review synthesizes recent experimental and translational evidence on cellular and molecular processes that compromise Leydig cell endocrine output and the interstitial niche that supports spermatogenesis. Evidence spanning environmental endocrine-disrupting chemicals (EDCs), obesity and metabolic dysfunction, and testicular aging is integrated with emphasis on oxidative stress, endoplasmic reticulum stress, mitochondrial dysregulation, apoptosis, disrupted autophagy and mitophagy, and senescence-associated remodeling. Across model systems, toxicant exposure and metabolic stress converge on impaired organelle quality control and altered redox signaling, with downstream loss of steroidogenic capacity and, in some settings, premature senescence within the Leydig compartment. Aging further reshapes the testicular microenvironment through inflammatory shifts and biomechanical remodeling and may erode stem and progenitor Leydig cell homeostasis, thereby constraining regenerative potential. Single-cell transcriptomic atlases advance the field by resolving Leydig cell heterogeneity, nominating subsets that appear more vulnerable to stress and aging, and mapping age-dependent rewiring of interstitial cell-to-cell communication with Sertoli cells, peritubular myoid cells, vascular cells, and immune cells. Many mechanistic insights derive from rodent in vivo studies and in vitro platforms that include immortalized Leydig cell lines, and validation in human tissue and human clinical cohorts remains uneven. Together, these findings frame mechanistically informed opportunities to preserve endogenous androgen production and fertility through exposure mitigation, metabolic optimization, fertility-preserving endocrine stimulation, and strategies that target inflammation, senescence, and regenerative capacity. Full article

Background/Objectives: Antimicrobial resistance (AMR) is considered a major threat by the healthcare community. In this context, the AWaRe (Access, Watch, Reserve) classification of antibiotics is a valuable tool that can assist physicians during the clinical decision process and pharmacists in promoting the rational use of antibiotics. Pharmacovigilance studies based on real-world evidence offer valuable insight into the AMR phenomenon. The aim of this study was the assessment of the resistance, ineffectiveness, and off-label use signals of all five cephalosporins belonging to the Reserve group (ceftazidime/avibactam, ceftaroline, cetolozane/tazobactam, ceftobiprole, and cefiderocol). Methods: The study was conducted using descriptive approaches on EudraVigilance data and disproportionality analyses comparing each of the fourteen cephalosporins in the Watch group. Results: Ceftazidime/avibactam (n = 904, 38.6%) topped the reports, followed by ceftaroline (n = 559, 23.9%) and ceftolazane/tazobactam (n = 560, 23.9%). The lowest number of reports was submitted for cefiderocol (n = 176, 7.5%) and ceftobiprole (n = 146, 6.2%). The resistance to ceftazidime/avibactam, cefiderocol, and ceftolozane/tazobactam was reported with a higher probability than all others, the strongest signal being observed for cefiderocol against cefixime (ROR: 171.25, 95% CI 79.64–368.27). All cephalosporins from the Reserve group (except ceftobiprole) have higher probability for reporting ineffectiveness than cephalosporins from the Watch group; the strongest signal was observed for cefiderocol–cefditoren (ROR: 14.70, 95% CI 6.73–32.11). All cephalosporines from the Reserve group had a higher probability of reporting off-label use by comparison with the ones from the Watch group, except for two cases of no disproportionate signal between cefiderocol–cefoperazone and cefiderocol–ceftizoxime; the strongest signal was observed for ceftolozane/tazobactam–cefotaxim (ROR: 43.61, 95% CI 30.14–63.09). Conclusions: This analysis supplements information from clinical trials and current clinical practice, underscoring the critical need for rigorous antibiotic stewardship programs. Notably, even restricted use of cephalosporins demonstrated therapeutic failure and inappropriate utilization. Full article

Background: Language barriers remain a major obstacle to equitable healthcare access for immigrants and refugees across Europe. Greece, as both a transit and host country, faces persistent challenges in providing linguistically and culturally appropriate care. Methods: This study presents a narrative literature review synthesizing international, European, and Greek evidence on the effects of limited language proficiency, professional interpretation, and intercultural mediation on healthcare access, patient safety, satisfaction, and clinical outcomes. Peer-reviewed studies and selected grey literature were identified through searches of PubMed, Scopus, Web of Science, and CINAHL. Results: The evidence consistently demonstrates that the absence of professional interpretation is associated with substantially higher rates of clinically significant communication errors, longer hospital stays, increased readmissions, and higher healthcare costs. In contrast, the use of trained medical interpreters and intercultural mediators improves comprehension, shared decision-making, patient satisfaction, and clinical outcomes. Comparative European data from Italy, Spain, Germany, and Sweden show that institutionalized interpretation systems outperform Greece’s fragmented, NGO-dependent approach. Greek studies further reveal that limited proficiency in Greek is associated with reduced service utilization, longer waiting times, and lower patient satisfaction. Conclusions: This narrative review highlights the urgent need for Greece to adopt a coordinated, professionally staffed interpretation and intercultural mediation framework. Strengthening linguistic support within the healthcare system is essential for improving patient safety, equity, efficiency, and the integration of migrant and refugee populations. Full article

Criminal justice system (CJS) involvement is common among individuals with opioid use disorder (OUD), yet limited research examines retention in medications for OUD (MOUD) within community settings. This study assessed whether CJS involvement predicted retention on buprenorphine/naloxone and explored related demographic and clinical factors. A retrospective cohort included adults (n = 367) enrolled in a low-barrier outpatient MOUD program in Texas (January 2022–April 2024). CJS involvement was identified from program records. Retention was measured as the number of continuous days with buprenorphine/naloxone prescriptions. Analyses used univariate tests, logistic regression, and nonparametric kernel regression. Nearly one-quarter (24.8%) were CJS-involved. Retention at 180 days was similar between CJS and non-CJS groups (38%). CJS participants initiated substance use earlier and reported higher heroin and injection drug use. Behavioral health sessions were associated with both CJS involvement (OR = 1.10, p ≤ 0.001) and longer retention (β = 10.81 days/session, p = 0.001). With comprehensive, low-barrier services, individuals involved with CJS achieved MOUD retention comparable to their peers. Early behavioral health engagement was a strong predictor of retention, suggesting a key intervention point to enhance outcomes and advance equity for justice-involved populations. Full article

Midline shift (MLS) is one of the conditions that strongly affects mortality and prognosis in critical neurological emergencies such as traumatic brain injury (TBI). Especially, MLS over 5 mm requires urgent diagnosis and treatment. Despite widespread tomography imaging capabilities, the lack of radiologists capable of interpreting the images causes delays in the diagnosis process. Therefore, there is a need for AI-supported diagnostic systems specifically tailored to the field for MLS detection. However, the lack of open, disorder-specific datasets in the literature has limited research in the field and hindered the ability to make comparisons against a reliable reference point. Therefore, the current state of deep learning (DL) methods in the field is not sufficiently addressed. Within the scope of this study, a DL architecture is proposed for MLS detection as a classification task, with millimeter-scale MLS measurements used for evaluation and stratified analysis. This process also comprehensively addresses the status of MLS detection in contemporary DL architecture. Furthermore, to address the lack of open datasets in the literature, two publicly available datasets originally collected with a primary focus on TBI have been annotated for MLS detection. The proposed model was tested on two different open datasets and achieved mean sensitivity values of 0.9467–0.9600 for the Radiological Society of North America (RSNA) dataset and 0.8623–0.8984 for the CQ500 dataset in detecting MLS presence above 5 mm across two different scenarios. It achieved a mean Area Under the Curve-Receiver Operating Characteristic (AUC-ROC) value of 0.9219–0.9816 for the RSNA dataset and 0.9443–0.9690 for the CQ500 dataset. The aim of the study is to detect not only emergency cases but also small MLSs independent of quantity for patient follow-up, so the overall performance of the proposed model (MLS present/absent) was calculated without an MLS quantity threshold. Mean F1 Score values of 0.7403 for the RSNA dataset and 0.7271 for the CQ500 dataset were obtained, along with mean AUC-ROC values of 0.8941 for the RSNA dataset and 0.9301 for the CQ500 dataset. The study presents a clinically applicable, optimized, fast, reliable, up-to-date, and successful DL solution for the rapid diagnosis of MLS, intervention in emergencies, and monitoring of small MLS. It also contributes to the literature by enabling a high level of reproducibility in the scientific community with labeled open data. Full article

Vaccination remains a cornerstone of infection prevention in adult solid organ transplant (SOT) recipients, a population at heightened risk for vaccine-preventable diseases due to chronic immunosuppression and comorbidities. Updated guidelines from the American Society of Transplantation Infectious Diseases Community of Practice (AST IDCOP) and other international bodies emphasize the need for timely and comprehensive vaccination strategies before and after transplantation. This review synthesizes current literature and practice guidelines on vaccination in adult solid organ transplant (SOT) candidates and recipients. Published peer-reviewed studies, clinical trials, and consensus guidelines were evaluated, with emphasis on vaccination timing, safety, immunogenicity, dosing strategies, and serologic response monitoring in the SOT population. Comprehensive vaccination planning before transplantation, combined with appropriate post-transplant booster strategies, remains vital to improving long-term outcomes in SOT recipients. This review provides clinicians with an updated, evidence-based framework for integrating evolving vaccination guidelines into the care of adult transplant patients. Full article

Background: The global increase in orthopedic implant use—both for trauma fixation and arthroplasty—has profoundly transformed musculoskeletal surgery. As a consequence, fractures occurring in the presence of implants have become more frequent and clinically relevant. Yet, these injuries are currently described using highly heterogeneous terminology, including periprosthetic (fracture occurring in the presence of a prosthetic joint replacement) peri-implant (fracture occurring around an osteosynthesis or fixation device), implant-related, and hardware-related fractures (umbrella terms encompassing both prosthetic and fixation devices, used descriptively rather than classificatorily). This coexistence of multiple, context-specific terminologies hinders clinical communication, complicates registry documentation, and limits research comparability across orthopedic subspecialties. Because fractures occurring in the presence of orthopedic implants significantly alter load transfer, muscle force distribution, and musculoskeletal biomechanics, a clear and unified terminology is also relevant for muscle-focused research addressing implant–tissue interaction and functional recovery. Objective: This systematic review aimed to critically analyze the terminology used to describe fractures influenced by orthopedic implants, quantify the heterogeneity of current usage across anatomical regions and publication periods, and explore the rationale for adopting a unified umbrella term—“artificial fracture.” Methods: A systematic search was performed in PubMed, Scopus, and Web of Science from January 2000 to December 2024, following PRISMA guidelines. Eligible studies included clinical investigations, reviews, registry analyses, and consensus statements explicitly employing or discussing terminology related to implant-associated fractures. Data were extracted on publication characteristics, anatomical site, terminology employed, and classification systems used. Quantitative bibliometric and qualitative thematic analyses were conducted to assess frequency patterns and conceptual trends. Results: Of 1142 records identified, 184 studies met the inclusion criteria. The most frequent descriptor in the literature was periprosthetic fracture (68%), reflecting its predominance in arthroplasty-focused studies, whereas broader and more practical terms such as implant-related and peri-implant fracture were more commonly used in musculoskeletal and fixation-related research. Terminological preferences varied according to anatomical site and implant type, and no universally accepted, cross-anatomical terminology was identified despite multiple consensus efforts. Discussion and Conclusions: The findings highlight persistent heterogeneity in terminology describing fractures influenced by orthopedic implants. A transversal, descriptive framework may facilitate communication across subspecialties and support registry-level harmonization. Beyond orthopedic traumatology, this approach may also benefit muscle and musculoskeletal research by enabling more consistent interpretation of data related to muscle–bone–implant interactions, rehabilitation strategies, and biomechanical adaptation. Full article