Search Results (42)

Chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection remain leading causes of cirrhosis and hepatocellular carcinoma (HCC) worldwide, and continue to represent a major challenge despite the growing contribution of alcohol-related and metabolic dysfunction-associated steatotic liver disease. Direct-acting antivirals now cure most patients with chronic HCV infection, while nucleos(t)ide analogues durably suppress HBV replication, producing a rapidly expanding population of treated and cured patients. Many nonetheless retain residual fibrosis, portal hypertension and long-term cancer risk, creating a need for non-invasive long-term liver assessment. Multiparametric ultrasound (MPUS) integrates the evaluation of morphology, fibrosis, steatosis, haemodynamics and perfusion within a single examination. This narrative review summarises the evidence supporting MPUS in chronic viral hepatitis, covering elastographic fibrosis assessment, Baveno VII liver and spleen stiffness criteria for clinically significant portal hypertension, contrast-enhanced ultrasound characterisation of focal liver lesions, and emerging techniques such as microvascular and viscosity-sensitive imaging. Particular attention is given to the confounding effect of inflammatory activity on liver stiffness. MPUS is presented here as a proposed evaluation framework for organising complementary measurements within a single examination, and not as an approach of demonstrated clinical superiority: no comparative or outcome-based study has yet shown that acquiring these parameters together improves clinical decisions relative to the individual techniques applied according to current guidelines. Within this framework, the most plausible role of MPUS in the elimination era is longitudinal assessment of the treated liver, a proposition that requires prospective validation against clinical endpoints. Full article

Underground coal gasification (UCG) requires rigorous geological suitability evaluation to reduce project risks, and scientific site selection is critical for success. Taking the No. 15 coal seam in the Yushe–Wuxiang Block (Qinshui Basin) as the focus, this study evaluates the feasibility of deep UCG using a multi-criteria decision-making framework. A hierarchical evaluation model comprising four primary and 10 secondary geological indicators (e.g., coal thickness, parting coefficient, fault fractal dimension, roof lithology) was constructed. Subjective weights were derived from the Analytic Hierarchy Process (AHP) and combined with objective weights from the coefficient of variation method. The TOPSIS (Technique for Order Preference by Similarity to an Ideal Solution) method was then applied to rank seven development units. Results indicate that the No. 15 coal seam has reasonable potential for UCG implementation. The most favorable areas (Blocks II and VII) are characterized by thick coal seams (>5 m), low parting coefficients (<8%), simple fault networks (fractal dimension ≤0.5–1.05), and competent mudstone roofs. Blocks III, V, and VI are moderately favorable, while Blocks I and IV are marginally favorable. These findings provide a prioritized roadmap for pilot-scale UCG testing in the Yushe–Wuxiang Block. Full article

Background/Objectives: Recompensation in patients with decompensated cirrhosis has significant prognostic implications. In this study, we aimed to evaluate the incidence and predictors of recompensation in cirrhotic patients, specifically focusing on elucidating the influence of sarcopenia and visceral obesity on achieving recompensation in a cohort of decompensated individuals. Methods: We conducted a retrospective analysis of 195 patients with decompensated cirrhosis from 2021 to 2024. Body composition abnormalities were determined by the skeletal muscle index (SMI) and visceral-to-subcutaneous adipose tissue ratio (VSR) on computed tomography (CT), respectively. Factors related to recompensation, defined using the modified Baveno VII criteria, were identified using multivariate regression. Results: Patients who achieved recompensation exhibited a lower age (62 vs. 67, p < 0.05), a higher body mass index (22.8 vs. 21, p < 0.01), a lower aspartate aminotransferase level (32 vs. 39, p < 0.01), a higher albumin level (35.2 vs. 32.3, p < 0.01), a lower ascites prevalence (60% vs. 74.07%, p < 0.05), a lower Child–Pugh score (6 vs. 7, p < 0.01), and a lower End-Stage Liver Disease score (9 vs. 10, p < 0.05) compared to those with non-recompensated cirrhosis. Body composition abnormalities were significantly more prevalent in non-recompensated patients than in recompensated patients (77.04% vs. 63.33%, p < 0.05), mainly because of a significantly higher prevalence of combined sarcopenia and visceral obesity in non-recompensated individuals (28.29% vs. 6.67%, p < 0.01). Multivariate analysis indicated that combined sarcopenia and visceral obesity was the sole independent risk factor for non-recompensation in this population. Furthermore, in the subgroup of patients aged < 70 years, with normal weight and preserved liver function, differences in recompensation rates among various states of body composition abnormalities were more pronounced. Conclusions: Sarcopenic visceral obesity is an independent risk factor for non-recompensation in patients with decompensated cirrhosis, highlighting the need for targeted interventions to mitigate body composition abnormalities in this vulnerable population. Full article

Against the backdrop of global sustainable development and ecological civilization construction, tourism ecological security at cultural landscape heritage sites faces both opportunities and challenges. This study constructs a cultural landscape heritage tourism ecological security (CLHTES) evaluation system based on the Driver–Pressure–State–Impact–Response (DPSIR) framework. It dynamically assesses CLHTES in the Yangtze River Delta Integrated Demonstration Zone (YRDIDZ) from 2014 to 2023 using the entropy-weighted Technique for Order Preference by Similarity to an Ideal Solution (TOPSIS) and linear stretching transformation, identifies obstacle factors with the obstacle degree model, and predicts CLHTES trends for 2024–2030 using a radial basis function (RBF) neural network. Results show that: (1) The CLHTES index in the YRDIDZ presented a three-stage fluctuating upward trend during 2014–2023, with medium-clustered security levels and divergent evolution across the DPSIR criteria layers; (2) CLHTES obstacles feature a multi-level differentiated structure, with rising barriers in D and P layers, the R layer as the future core obstacle, and high-frequency barriers concentrated in cultural and social indicators; (3) Under the assumption of structural continuity in current trajectories, the conditional trend projection suggests that the CLHTES index of the YRDIDZ may sustain a general upward tendency during 2024–2030, with a possibility of approaching Level VII after 2028; however, these projections should be interpreted as exploratory and scenario-like rather than as robust forecasts, given the short annual series and the absence of exogenous disturbance variables. This study explores tourism-ecology interactions from a social-ecological complex system perspective, supporting synergistic tourism development and ecological protection of cultural landscape heritage. Full article

Primary parapharyngeal space (PPS) tumors are rare neoplasms comprising 0.5% of head and neck tumors. Their complex anatomical location and proximity to critical neurovascular structures pose significant surgical challenges. While transcervical and transcervical-combined approaches represent the primary surgical techniques, no comprehensive systematic comparison exists. This systematic review compared surgical success, complications, functional outcomes, and recurrence rates between these approaches. Following PROSPERO registration (CRD420251037201), we searched PubMed, Cochrane, Web of Science, Google Scholar, and ScienceDirect without date restrictions. Independent dual screening identified retrospective cohort studies and case series comparing both approaches. Data extraction and risk of bias assessment employed standardized tools, with synthesis conducted per PRISMA 2020 guidelines using narrative analysis. Ten studies encompassing 505 patients with 508 tumors met inclusion criteria. Both approaches achieved excellent complete resection rates (95–100%). Transcervical approaches demonstrated lower overall complication rates (4.8–52.6%) versus transcervical-combined approaches (7.7–100%), though rates varied substantially by tumor type, and differences likely reflect case selection rather than approach-specific effects. Cranial nerve injuries (VII, X, XII) constituted predominant complications. Infratemporal fossa approaches showed the highest morbidity. Recurrence rates ranged from 0–30.3% without consistent patterns favoring either approach. Transcervical-combined approaches were essential for superior compartment extension and for skull base involvement. Both transcervical and transcervical-combined approaches achieve excellent tumor resection with acceptable morbidity when appropriately selected. For most benign PPS tumors, a transcervical approach may be preferred. Combined approaches may be considered in specific anatomic scenarios that require enhanced exposure, particularly when the superior compartment and skull base are involved, although the decision is always highly individual. Full article

Background/Objectives: Fluoroscopy-guided procedures are widely used across surgical and interventional specialties but expose operators to ionizing radiation with associated stochastic and deterministic effects. The aim is to characterize occupational radiation exposure, evaluate the effectiveness of shielding strategies, assess long-term cancer risks, and identify compliance patterns. Methods: This structured narrative review summarizes evidence on operator dose, shielding effectiveness, compliance with protective practices, and long-term cancer risk. A search of PubMed, Scopus, Embase, and Web of Science (limited to January 2000–March 2024) identified 62 records; 27 full texts were reviewed, and 16 studies met the inclusion criteria. Results: Across studies, unshielded chest exposure averaged 0.08–0.11 mSv per procedure, and eye exposure averaged 0.04–0.05 mSv. Lead aprons reduced exposure by about 90% at 0.25 mm and 99% at 0.5 mm, thyroid collars reduced neck dose by 60–70%, and lead glasses reduced ocular dose 2.5–4.5-fold. Compliance with aprons and thyroid collars was high, whereas lead glasses and lower-body shielding were inconsistently used. Limited epidemiologic data suggested a higher cancer burden in exposed surgeons, and Biologic Effects of Ionizing Radiation (BEIR) VII–based modeling projected increased lifetime risks of solid cancers in chronically exposed operators. Conclusions: Protective equipment substantially reduces operator dose, but exposure variability and inconsistent shielding practices persist and justify standardized monitoring, stronger enforcement of radiation safety protocols, and longitudinal studies. Full article

Introduction: Fluoride-releasing sealants play a crucial role in caries prevention by providing both mechanical protection and controlled ion release. However, the rate and duration of fluoride emission vary depending on material composition and environmental conditions. Objectives: This systematic review aimed to identify and analyze factors influencing fluoride release and recharge capacity from contemporary dental sealants. Methods: A comprehensive literature search was conducted in September 2025 across PubMed, Scopus, Web of Science, Embase, and WorldCat using the keywords “fluoride release” AND “sealant.” Study selection followed PRISMA 2020 guidelines and predefined PICO-based eligibility criteria. Out of the 375 records initially identified, 16 studies fulfilled the inclusion criteria and were incorporated into the qualitative analysis. Results: Glass-ionomer and resin-modified glass-ionomer sealants (e.g., Fuji VII, Fuji IX, Fuji II LC, Ketac Molar, Vitremer) consistently demonstrated higher fluoride release and superior recharge capacity compared with resin-based sealants (e.g., Clinpro, Helioseal F, BeautiSealant). Most studies reported a biphasic fluoride-release pattern, characterized by an initial burst within the first 24–48 h followed by a slower, sustained phase lasting several weeks. Environmental parameters, including storage medium, pH, and temperature, significantly affected fluoride-release kinetics. Additional outcomes such as enamel remineralization, antibacterial activity, microleakage, and surface hardness were also reported. Conclusions: Both material composition and environmental factors substantially influence fluoride release from dental sealants. Glass-ionomer–based materials demonstrate more durable and higher fluoride release, with acidic conditions enhancing ion diffusion. Clinically, these materials are particularly beneficial for patients at high caries risk, whereas resin-based sealants remain preferable in low-risk cases due to better retention and esthetics. Full article

In less than 30 years, Deep Brain Stimulation (DBS) has evolved from an antiparkinsonian rescue intervention into a flexible neuromodulatory therapy with the potential for personalized, adaptive, and enhancement-focused interventions. In this review we collected evidence from seven areas: (i) modern eligibility criteria, and ways to practically improve on these, outside of ‘Core Assessment Program of Surgical Interventional Therapies in Parkinson’s Disease’ (CAPSIT-PD); (ii) cost-effectiveness, where long-horizon models now show positive incremental net monetary benefit for Parkinson’s disease, and rechargeable-devices lead the way in treatment-resistant depression and obsessive–compulsive disorder; (iii) anatomical targets, from canonical subthalamic nucleus (STN) / globus pallidus internus (GPi) sites, to new dual-node and cortical targets; (iv) mechanistic theories from informational lesions, antidromic cortical drive, and state-dependent network modulation made possible by optogenetics and computational modeling; (v) psychiatric and metabolic indications, and early successes in subcallosal and nucleus-accumbens stimulation for depression, obsessive–compulsive disorder (OCD), anorexia nervosa, and schizophrenia; (vi) procedure- and hardware-related safety, summarized through five reviews, showing that the risks were around 4% for infection, 4–5% for revision surgery, 3% for lead malposition or fracture, and 2% for intracranial hemorrhage; and (vii) future directions in connectomics, closed-loop sensing, and explainable machine learning pipelines, which may change patient selection, programming, and long-term stewardship. Overall, the DBS is entering a “third wave” focused on a better understanding of neural circuits, the integration of AI-based adaptive technologies, and an emphasis on cost-effectiveness, in order to extend the benefits of DBS beyond the treatment of movement disorders, while remaining sustainable for healthcare systems. Full article

Prostate cancer is the most common cancer diagnosed in men worldwide and is ranked as the fifth leading cause of cancer-related death in men globally. Background/Objectives: We aimed to identify the effectiveness of cytotoxic plant-derived xanthones against prostate cancer over the past ten years. Methods: Searches were performed in Google Scholar, Web of Science, Scopus and PubMed/Medline for ten years up to December 2024 using pre-defined inclusion and exclusion criteria. The published articles were assessed in accordance with the PRISMA 2020 procedure. Results: From a total number of n = 11,932 results, 9 were retained as included studies, which included 51 xanthones. Conclusions: Garcibractatin A and bracteaxanthone VII exhibited significant cytotoxic effects on human prostate cancer (PC-3 cells) [IC₅₀ value of 2.93 and 4.8 μM] and the human normal prostatic stromal myofibroblast cell line (WPMY-1 cells) [IC₅₀ value of 0.76 and 3.2 μM], which were more potent than the reference etoposide [(IC₅₀ value of 10.07 μM) and (IC₅₀ value of 12.98 μM)]. Parvifolixanthone A showed significant activity on PC-3 (IC₅₀ of 4.65 μM), which was more potent than the reference 5-fluorouracil (IC₅₀ of 30.59 μM); gaudichaudione H, cantleyanone A, isobractatin, isoforbesione, and neobractatin had strong cytotoxicity (IC₅₀ values between 2.10 and 3.39 μM) as compared to etoposide (IC₅₀ of 10.07 μM). Despite these positive outlooks, there are still several restrictions, most notably the absence of in vivo evidence in many studies and well-defined mechanisms of action for all the promising bioactive xanthones identified in this work as well as the absence of studies of their cytotoxicity on certain normal cells. Full article

Atrial fibrillation (AF) is one of the most common cardiac arrhythmias encountered globally, characterized by a pro-inflammatory pattern. This analysis evaluated the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in patients with AF alongside chronic kidney disease (CKD) and/or type 2 diabetes mellitus (T2DM). This retrospective cohort study included 6077 patients admitted to the Third Medical Clinic of Saint Spiridon Hospital in Iasi from 2018 to 2023, all diagnosed with AF, CKD, and T2DM. After applying the exclusion criteria, 1066 AF patients remained eligible. For a multivariate comparative analysis, the patients were divided into groups: I. control group (non-AF patients); II. AF patients; III. T2DM group; IV. CKD-only group; V. AF+CKD group; VI. AF+T2DM group; and VII. AF+T2DM+CKD group. The Mann–Whitney/Kruskal–Wallis test demonstrated a statistically significant difference in NLR and PLR values between the AF group and the non-AF group (H = 70.627, p < 0.001). The receiver operating characteristic (ROC) analysis identified statistical significance and predictive power for NLR (AUC = 0.722; sensitivity = 63.6%; specificity = 76.9%) and neutrophil count in diagnosing AF, T2DM, and CKD. In conclusion, this study illustrated the utility of NLR and PLR as readily available and predictive biomarkers of inflammation in patients with AF, with or without comorbidities. Full article

Background/Objectives: Esophageal varices (EVs) represent an important portal hypertension complication in patients with compensated advanced chronic liver disease (cACLD). Although upper gastrointestinal endoscopy is currently the gold standard for EV diagnosis, recent guidelines recommend non-invasive approaches to assess EV risk in cACLD patients to reduce unnecessary endoscopies. Our study aims to evaluate spleen stiffness measurement (SSM) using 2D shear-wave elastography (2D-SWE) as a non-invasive predictor of EV presence and severity in patients with cACLD. Methods: We included 73 cACLD patients referred to our liver clinic over one year. SSM and liver stiffness measurement (LSM) were performed using 2D-SWE, with specific cut-off values applied to rule in or rule out clinically significant portal hypertension (CSPH) according to Baveno VII consensus criteria. Upper gastrointestinal endoscopy was performed in all patients to confirm EV presence and grade. Results: Among all patients, 49.3% had no EV, while 50.7% presented with different EV grades (15.1% grade I, 13.7% grade II, 9.6% grade III, and 12.3% grade IV). A strong correlation was observed between elevated SSM values and EV presence, with SSM values > 32.8 kPa highly suggestive of EV (AUROC = 0.95, 95% CI: 0.909–0.995, p < 0.001). SSM values exceeding 40.4 kPa were associated with more advanced EV grades. Combining LSM and SSM improved diagnostic accuracy, effectively stratifying EV risk without invasive procedures. Conclusions: SSM via 2D-SWE is a promising, non-invasive tool for EV prediction in cACLD, aligning with Baveno VII recommendations to minimize unnecessary endoscopies. Further validation is required to refine diagnostic thresholds and expand applicability across different chronic liver disease etiologies. Full article

This scoping review aims to understand the cell-based meat production process, including the regulations, potential hazards, and critical points of this production. This review includes studies on cultured meat production processes, health hazards, and regulatory guidelines, excluding those without hazard analysis, incomplete texts, or studies published before 2013. The search was performed in eight electronic databases (MEDLINE, Web of Science, Embase, Cochrane Library, Scopus, LILACS, and Google Scholar) using MeSH terms and adaptations for each database. The search for local studies on regulations and guideline documents was complemented by a manual search on the websites of governments and regulatory agencies from different regions (e.g., FDA, FAO, EFSA, USDA, Health Canada, EC, EU, ANVISA/Brazil, MAPA/Brazil, FSANZ, and SFA). This step involved reading full texts to confirm eligibility and extract key data, including author, year, country, study design, objectives, results, cultured meat protocols, health hazards, and hazard control measures, followed by data analysis. A comprehensive search of the databases yielded 1185 studies and 46 regulatory or guidance documents. After removing duplicate studies and applying eligibility criteria to titles, abstracts and full texts, 35 studies and 45 regulatory or guidance documents were included. The cultured meat production protocols are well-established, highlighting potential hazards and critical control points. Although guidance documents and regulations are limited, they are expanding globally. The development and commercialization of cultured meat require clear, and up-to-date regulations and supervision, which are being studied and formulated by regulatory agencies worldwide. Cultured meat production presents some potential hazards (chemical, biological, and physical) that require food safety considerations: (i) genetic stability of cells/cell lines; (ii) microbiological hazards related to cell lines; (iii) exposure to substances used in the production process; (iv) toxicity and allergenicity of the product or its component for the population; (v) post-harvest microbiological contamination; (vi) chemical contamination/residue levels; and (vii) nutritional aspects/risks. Currently, no standardized testing approach exists for cultured meat. However, effective hazard and safety assessment strategies, such as HACCP combined with best practices, should be implemented throughout the production process. Full article

Background: Digital educational technologies in health have been an important instrument for promoting learning, self-care, self-esteem, and security regarding prevention and health promotion actions that lead to changes in behavior, mainly for non-communicable disease patients, such as type 2 Diabetes Mellitus (DM 2). Objective: This study aimed to describe a protocol for evaluating the effect of an app for cell phones and tablets on the blood glucose of older adults with DM 2. Methods: The protocol will be used to compare the effectiveness of an application for mobile devices concerning the educational booklet in reducing Glycated Hemoglobin in older adults with DM 2 in Primary Health Care. This protocol is part of a Randomized Clinical Trial project entitled Effectiveness of a Mobile Device Application on Glycated Hemoglobin in Elderly People with Type 2 Diabetes Mellitus: a Randomized Clinical Trial. Results: The protocol was structured in the following phases: (i) sample calculation, (ii) invitation to participate in the study according to the eligibility criteria; (iii) participant registration; (iv) randomization and allocation of participants into groups (double blinding); (v) application of the intervention; (vi) post-intervention procedures (post-test); (vii) data analysis. Conclusion: It is expected that encouraging studies on the impact of a mobile application will improve and enhance health education focused on self-care for older adults with DM 2, potentially influencing the local health system by reducing hospitalizations due to conditions that are sensitive to primary care, since health promotion and prevention of DM-related illnesses will be the main focus of the application and booklet developed. Full article

Background and Objectives: The Coronal Plane Alignment of the Knee (CPAK) classification is a pragmatic distribution of nine phenotypes for coronal knee alignment that can be used on healthy and arthritic knees. Our study aimed to describe the CPAK distributions in a Spanish southeast osteoarthritic population and compare them to other populations’ published alignment distributions. Method and Materials: Full-leg standing X-rays of the lower limb from 528 cases originating from the so-called Vega Alta del Segura (southeast of the Iberian Peninsula) were retrospectively analysed. We measured the mechanical hip–knee–ankle, lateral distal femoral, and medial proximal tibial angles. We calculated the arithmetic hip–knee–ankle angle and the joint line obliquity to classify each case according to the criteria of the CPAK classification. Results: Based on the aHKA result, 59.1% of the cases were varus (less than −2°), 32.7% were neutral (0° ± 2°), and 8.2% were valgus (greater than +2°). Based on the JLO result, 56.7% of the cases had a distal apex (less than 177°), 39.9% had a neutral apex (180° ± 3°), and 3.4% had a proximal apex (greater than 183°). The most common CPAK distribution in our Spanish southeast osteoarthritic population was type I (30.7%), followed by type IV (25.9%), type II (21%), type V (11.2%), type III (5%), type VI (2.8%), type VII (2.4%), type VIII (0.6%), and type IX (0.4%). Conclusions: We described the distribution according to the CPAK classification in a sample of the osteoarthritic population from southeastern Spain. In our sample, more than 75% of the patients were classified as type I, II, and IV. Full article

Intense rainfall events frequently occur in Brazil, often leading to rapid flooding. Despite their recurrence, there is a notable lack of sub-daily studies in the country. This research aims to assess patterns related to the structure and microphysics of clouds driving intense rainfall in Brazil, resulting in high accumulation within 1 h. Employing a 40 mm/h threshold and validation criteria, 83 events were selected for study, observed by both single and dual-polarization radars. Contoured Frequency by Altitude Diagrams (CFADs) of reflectivity, Vertical Integrated Liquid (VIL), and Vertical Integrated Ice (VII) are employed to scrutinize the vertical cloud characteristics in each region. To address limitations arising from the absence of polarimetric coverage in some events, one case study focusing on polarimetric variables is included. The results reveal that the generating system (synoptic or mesoscale) of intense rain events significantly influences the rainfall pattern, mainly in the South, Southeast, and Midwest regions. Regional CFADs unveil primary convective columns with 40–50 dBZ reflectivity, extending to approximately 6 km. The microphysical analysis highlights the rapid structural intensification, challenging the event predictability and the issuance of timely, specific warnings. Full article