Search Results (1,254)

Background and Objectives: Oral alitretinoin (9-cis-retinoic acid), a dual retinoic acid receptor/retinoid X receptor agonist, is approved for severe chronic hand eczema (CHE) refractory to potent topical corticosteroids but is also prescribed off-label in routine practice. Long-term real-world data on both uses are limited. We evaluated 10-year prescribing patterns, effectiveness, tolerability, and lipid changes at one Korean academic center. Materials and Methods: Patients prescribed oral alitretinoin between January 2016 and December 2025 were identified from the hospital prescribing database; those with an evaluable course of ≥1 month formed the effective-treatment cohort and underwent chart review. Treatment success was defined as final chart-derived Investigator Global Assessment (IGA) 0/1. Success by initial dose was compared using Fisher exact test; paired lipid changes using paired t-test and Wilcoxon signed-rank test. Results: Of 161 patients, 38 (23.6%) received a single prescription; 99 formed the effective-treatment cohort (50 women, 49 men; mean age 50.7 ± 16.0 years). CHE was the leading indication (70/99, 70.7%), followed by palmoplantar pustulosis (PPP, n = 14), mycosis fungoides (MF, n = 6), parapsoriasis, porokeratosis, palmoplantar keratoderma, and Darier disease. Overall success was 66.7% (66/99) over a mean treatment duration of 12.4 months, highest in CHE (77.1%) and more variable off-label (PPP 42.9%; MF 33.3%). Initiation at 30 mg was associated with higher success than 10 mg (71.1% vs. 43.8%; p = 0.044), but this association did not persist after restriction to patients maintained on their initial dose (62.2% vs. 50.0%; p = 0.498) or after Firth penalized logistic regression adjusting for age, sex, and indication (adjusted odds ratio 1.84; 95% CI 0.56–5.90; p = 0.309). Adverse events occurred in 21 patients (21.2%), most commonly dyslipidemia (n = 12) and headache (n = 7); mean triglyceride rose 42.1 mg/dL and total cholesterol 14.0 mg/dL (both p < 0.001), and new elevation above conventional thresholds occurred in 25.8% (triglyceride) and 27.5% (total cholesterol) of patients with normal baseline values. Thirty patients (30.3%) discontinued, most often for insufficient effectiveness. Conclusions: Alitretinoin showed favorable effectiveness in CHE and variable, exploratory responses off-label. The apparent advantage of 30 mg initiation was not independent of indication and dose adjustment. Lipid elevation was common, supporting routine surveillance. Off-label findings, particularly in PPP and MF, should be interpreted cautiously given small subgroups and non-standardized retrospective assessment. Full article

Background: Canine otitis externa caused by Pseudomonas aeruginosa is frequently chronic and treatment refractory, yet integrated historical phenotype–genotype data remain limited. We characterized an archival Hungarian collection obtained in 2010 and 2017. Methods: Broth microdilution minimum inhibitory concentrations (MICs) were determined for 67 isolates against 13 antimicrobial agents and chlorhexidine, and 59 isolates had matched long-read whole-genome assemblies. Resistance-associated determinants were identified using the Comprehensive Antibiotic Resistance Database, and their predicted proximity to mobile genetic elements and plasmid-like contigs was evaluated. Results: Current canine Clinical and Laboratory Standards Institute breakpoints classified 59/67 isolates (88.1%) as enrofloxacin resistant and 43/67 (64.2%) as marbofloxacin resistant. European Committee on Antimicrobial Susceptibility Testing epidemiological cut-off values identified non-wild-type subsets for ciprofloxacin (7/67), tobramycin (4/67), imipenem (1/67), and piperacillin–tazobactam (51/67), whereas all isolates remained within the available wild-type distributions for ceftazidime, gentamicin, and amikacin. No continuous MIC distribution changed significantly between sampling years after false-discovery-rate correction, although categorical marbofloxacin resistance decreased from 87.5% in 2010 to 42.9% in 2017. Resistance-gene screening identified 64 unique determinants, including near-universal efflux-system components, PDC and OXA-50-like β-lactamases, APH(3′)-IIb, arnA, and basS. The fluoroquinolone-associated determinant crpP occurred in 37/59 genomes and was located on plasmid-predicted contigs in six isolates. No determinant–MIC association remained significant after correction for multiple testing. Conclusions: The discordance between conserved resistance-gene repertoires and heterogeneous MICs demonstrates that sequence-based detection alone is insufficient for therapeutic inference. Integrated phenotypic and genomic surveillance is therefore required to support evidence-based antimicrobial stewardship in canine pseudomonal otitis. Full article

Background: Arrhythmia recurrence after cryoballoon ablation remains a clinically relevant problem in atrial fibrillation (AF). However, factors associated with documented recurrence in low-risk patients without major comorbidities are not well defined. This study aimed to evaluate factors associated with documented arrhythmia recurrence after cryoballoon ablation in a highly selected low-risk AF population. Methods: This retrospective, single-center study included 153 eligible patients selected from an institutional cryoablation database after application of predefined exclusion criteria. Only patients with a CHA₂DS₂-VA (congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke/transient ischemic attack/thromboembolism, vascular disease, and age 65–74 years) score ≤ 1 and without major comorbidities, including diabetes mellitus, hypertension, coronary artery disease, chronic kidney disease, cerebrovascular disease, and heart failure, were included. Recurrence was defined as electrocardiographically documented AF or atrial tachyarrhythmia after the 3-month blanking period over 1 year of follow-up; Holter-detected episodes were required to last ≥30 s. The primary multivariable model included sex, age, AF type, and absolute left atrial diameter; a sensitivity model replaced absolute left atrial diameter with left atrial diameter indexed to body surface area (BSA). Results: The study population included 70 women (45.8%) and 83 men (54.2%). Paroxysmal AF was present in 125 patients (81.7%), whereas 28 patients (18.3%) had persistent AF. Documented arrhythmia recurrence occurred in 40 patients (26.1%). Female sex was more frequent in the recurrence group than in the no-recurrence group (62.5% vs. 39.8%, p = 0.013). The complete-case primary multivariable model included 126 patients with 36 recurrence events. Female sex was associated with documented arrhythmia recurrence (odds ratio [OR] 2.69, 95% confidence interval [CI] 1.14–6.37; p = 0.024). The estimate for left atrial diameter was directionally positive but statistically uncertain (OR 1.086 per mm, 95% CI 0.989–1.192; p = 0.085). In the BSA-indexed sensitivity model (n = 123), the female-sex estimate was attenuated and statistically uncertain (OR 2.16, 95% CI 0.90–5.18; p = 0.084), while left atrial diameter/BSA was also statistically uncertain (OR 1.145 per mm/m², 95% CI 0.977–1.343; p = 0.095). Conclusions: In this selected low-risk cohort undergoing second-generation cryoballoon ablation, female sex was associated with clinically detected, electrocardiographically documented arrhythmia recurrence in the primary model under an intermittent rhythm-surveillance strategy based on scheduled 12-lead electrocardiograms (ECGs) and symptom-driven evaluations. However, the estimate was attenuated and statistically uncertain after indexing left atrial diameter to BSA. Given the retrospective, single-center design, non-systematic rhythm monitoring, and sensitivity of the sex estimate to body-size adjustment, these findings should be interpreted as hypothesis-generating. Full article

Background/Objectives: Cardiorenal syndrome (CRS) is associated with substantially higher morbidity and mortality than either isolated cardiac or renal dysfunction. The application of classical and novel biomarkers has been tested in prompt diagnosis and monitoring of patients with CRS. Methods: This is a comprehensive literature review following a structured approach. We searched MEDLINE and Embase databases from January 2000 to December 2025. Results: The pathophysiology of CRS is complex, and the present review attempts to shed light on the clinical interpretation of the most widely used biomarkers as indices of diagnosis and prognosis. Among them, troponin is elevated in CRS and its absolute levels retain prognostic value, while changes in its levels over time may assist in the diagnosis of acute coronary syndrome. Natriuretic peptides are highly influenced by coexistence of chronic kidney disease (CKD) and in this context have considerable diagnostic and prognostic value. The combination of cystatin C, a biomarker of renal dysfunction, with cardiac biomarkers may create a powerful risk algorithm. Most recently, gene profiling and proteomics have the potential to stratify patients with CRS; however, more data from large cohorts are required for their validation. The therapeutic modulation of biomarkers in CRS patients may help elucidate the underlying pathophysiologic mechanisms. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have emerged as first-line therapy for patients with CRS, despite the fact their mechanisms are mostly unknown. Significant changes in the aforementioned biomarkers and the inflammatory factors may explain their emerging beneficial effects on both heart failure and CKD. Conclusions: The use of biomarkers has increased rapidly in recent years for diagnosis, surveillance and prognostic stratification in CRS. Full article

Automated license plate readers (ALPRs) are often evaluated as discrete police tools, although their public power arises from cross-vendor socio-technical infrastructure. This article examines roadside and mobile sensors, vehicle-attribute classification, cloud archives, commercial databases, real-time crime center integration, interagency access, automated alerts, and police action. Flock Safety supplies the principal documentary case because unusually extensive public records permit system-level tracing; Axon/Fusus, Motorola Vigilant/VehicleManager, and federal access to commercial ALPR data establish the wider vendor-independent boundary. A structured documentary analysis of 59 sources triangulates official records, peer-reviewed research, vendor materials used only for stated functions, and record-based investigations. It integrates boundary critique, control-structure mapping, feedback analysis, constitutional doctrine, a STRIDE-informed threat model, and empirical research on policing effectiveness and surveillance effects through 3 August 2026. The analysis identifies four conditional mechanisms: infrastructure aggregation, authority diffusion, asymmetric feedback, and rights invisibility. The article reformulates the Rights Control Deficit (RCD) as a non-arithmetic profile relation between operational demands and effective governance capacity and applies it to three documented configurations and a clearly labeled normative benchmark. Seven falsifiable propositions specify variables, indicators, suitable methods, and disconfirming conditions for later empirical study. A rights-preserving hybrid-intelligence architecture combines bounded automation with judicial authorization, short retention, sensitive-location protections, immutable audit, availability safeguards, independent review, contestability, sanctions, and credible termination authority. The evidence identifies capabilities, activated pathways, and conditional risks; it does not estimate population prevalence or a universal ALPR-specific causal effect. Meaningful human oversight is an institutional control property, not merely an officer’s presence at an interface. Full article

Alpha-gal syndrome (AGS) is a tick-induced, IgE-mediated hypersensitivity to the oligosaccharide galactose-α-1,3-galactose (α-gal), which is expressed on glycoproteins and glycolipids of non-primate mammals but absent in humans. Gastrointestinal (GI) symptoms dominate the clinical presentation in a substantial proportion of patients yet remain systematically under-recognized, frequently being attributed to irritable bowel syndrome (IBS), non-celiac gluten sensitivity (NCGS), or lactose intolerance. This narrative review synthesizes the current evidence on the epidemiology, GI and systemic phenotype, immunological mechanisms, diagnostic strategies, management approaches, quality-of-life burden, and multi-level public health interventions for AGS, and it identifies critical knowledge gaps as of 2026. We searched PubMed/MEDLINE, Embase, and Web of Science from database inception through 31 March 2026, and synthesized the evidence narratively in accordance with the Scale for the Assessment of Narrative Review Articles (SANRA). GI symptoms occur in 47–69% of patients with AGS, with abdominal pain (58%), diarrhea (42%), nausea (39%), and vomiting (31%) as the cardinal manifestations. A characteristic 2–6 h delay between the ingestion of mammalian-derived food and symptom onset—explained by the glycolipid–chylomicron delivery mechanism—drives diagnostic confusion with functional GI disorders. Among 295,400 tested individuals in the United States, 30.5% were α-gal IgE positive, and an estimated 96,000–450,000 Americans were affected between 2010 and 2022. Despite this burden, 42% of U.S. healthcare providers had never heard of AGS. Strict avoidance of mammalian meat improves symptoms in 53–86% of adherent patients, although the condition carries a meaningful risk of anaphylaxis even among GI-predominant presenters. AGS is a prevalent, frequently misdiagnosed, and clinically morbid condition whose GI phenotype lies squarely within the gastroenterologist’s domain. A coordinated response that integrates clinician education, institutional diagnostic algorithms, and national surveillance infrastructure is urgently needed. Full article

Background: Patients with end-stage renal disease (ESRD) undergoing radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) represent a uniquely high-risk population. While prior studies have demonstrated worse postoperative outcomes among dialysis-dependent patients, no study has systematically compared oncological outcomes between peritoneal dialysis (PD) and hemodialysis (HD) modalities following RNU. This multicenter study evaluates whether dialysis modality (peritoneal dialysis versus hemodialysis) acts as an independent prognostic factor following radical nephroureterectomy. Methods: Using the Taiwan UTUC Collaboration Group Registry—a multicenter, nationwide database comprising 21 tertiary and regional medical centers —we identified 350 ESRD patients who underwent RNU for UTUC between September 1988 and December 2023. Patients were categorized by dialysis modality at the time of surgery: 310 on HD and 40 on PD. Propensity score overlap weighting was applied to account for baseline differences. Multivariate Cox proportional hazards and Fine-Gray competing risk regression models were utilized to evaluate overall survival (OS), cancer-specific survival (CSS), progression-free survival (PFS), and non-UTUC mortality. Results: After overlap weighting, PD was independently associated with significantly worse OS (HR = 2.34, 95% CI 1.29–4.25, p = 0.005) and PFS (HR = 2.06, 95% CI 1.16–3.66, p = 0.013) compared to HD and exhibited a trend toward worse CSS in univariate analysis (log-rank p = 0.094). Survival curve divergence between PD and HD was most pronounced from 12 to 24 months post-surgery onward. Notably, this survival disadvantage persisted despite PD patients being significantly younger (mean age 58.8 vs. 65.1 years) and receiving adjuvant chemotherapy more frequently (20.0% vs. 6.5%). PD was also independently associated with higher non-UTUC mortality on multivariate competing risk analysis (sHR = 2.17, 95% CI 1.22–3.88, p = 0.009). Conclusions: In this first multicenter systematic comparison of PD versus HD patients undergoing RNU for UTUC, PD modality was independently associated with worse OS and PFS and exhibited a trend toward worse CSS in univariate analysis, compared to HD. This survival disadvantage persists despite favorable baseline characteristics and higher rates of adjuvant chemotherapy. We hypothesize these outcomes may be driven by a dual vulnerability: impaired systemic tumor control and elevated non-cancer mortality following surgical disruption of the peritoneal environment. To mitigate these risks, prioritizing minimally invasive or retroperitoneal surgical approaches to preserve peritoneal integrity, combined with modality-specific multidisciplinary surveillance, is recommended. Full article

Background/Objectives: Maternal and neonatal intensive care unit (ICU) admissions are markers of severe perinatal morbidity, yet their co-occurrence within the same birth remains poorly characterized at the population level. The objective of this study was to examine temporal trends, distribution, and maternal risk factors associated with concurrent maternal and neonatal ICU admission among singleton births in the United States. Methods: This population-based, serial cross-sectional study used the US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (WONDER) database from 2016 to 2024. Singleton live births were included and classified into four mutually exclusive ICU phenotypes: maternal ICU admission only, neonatal ICU admission only, concurrent maternal–neonatal ICU admission, and neither. Annual rates per 1000 births were calculated, and temporal trends were assessed using joinpoint regression. Maternal characteristics associated with concurrent ICU admission were evaluated using descriptive analyses and crude relative risks. Results: The analytic cohort included 32,341,764 singleton births. Between 2016 and 2024, rates of neonatal ICU admission increased from 76.35 to 88.46 per 1000 births (average annual percent change [AAPC], 1.65%; 95% CI, 1.35–1.92%) and maternal ICU admission from 1.49 to 1.82 per 1000 births (AAPC, 2.48%; 95% CI, 1.73–3.14%). Concurrent maternal–neonatal ICU admission remained uncommon but increased from 0.70 to 0.92 per 1000 births (AAPC, 3.32%; 95% CI, 1.67–4.88%). Across gestational age, neonatal ICU admission without maternal ICU admission was the dominant phenotype, particularly at earlier gestational ages. Concurrent ICU admission showed a similar but attenuated pattern, whereas maternal ICU admission without neonatal ICU admission remained uncommon, with relatively higher rates at the earliest gestational ages. Concurrent ICU admission was associated with markers of maternal and pregnancy risk. The highest risks were observed among pregnancies complicated by eclampsia, pre-pregnancy diabetes, and pre-pregnancy hypertension, as well as among women with no prenatal care. Risk increased with advancing maternal age and higher body mass index, and disparities were observed across racial groups. Conclusions: Concurrent maternal and neonatal ICU admission is a rare but increasing outcome concentrated among high-risk pregnancies. These findings highlight the need for integrated maternal–neonatal risk assessment and continued surveillance of severe perinatal outcomes. Full article

Culicoides biting midges are important veterinary vectors, yet reported distributional patterns in Türkiye may reflect both ecological structure and uneven sampling. We synthesized 58 eligible Türkiye-specific reports (50 database-derived and eight citation-traced), consolidated them into 43 study/data-source families, and compiled 1164 taxon records representing 62 taxa. The all-explicit province dataset included 33 provinces and 45 taxa, whereas the primary province dataset included 18 provinces and 43 taxa. National taxonomic sources supported 72 species within the eligible evidence chain and 74 under a later taxonomic interpretation. Reported richness was strongly associated with sampling effort (Poisson coefficient = 0.579, 95% CI: 0.385–0.773), whereas biogeographical region was not significant after effort was accounted for (likelihood-ratio p = 0.914). Jaccard PERMANOVA identified an exploratory regional compositional pattern (F = 4.388, R² = 0.369, p = 0.001; PERMDISP p = 0.325), with turnover accounting for approximately 78% of mean between-region dissimilarity. Most richness diagnostics ranged from 54 to 64 taxa, whereas Chao2 was unstable (69.6; 95% CI: 49.5–152.0). Vector-related evidence remained insufficient for species–pathogen risk modeling. Overall, the synthesis is consistent with a Wallacean shortfall strongly associated with uneven sampling and supports standardized, biogeographically balanced surveillance to test transition-zone structure, climate-sensitive phenology and redistribution, and integrated vector-host-pathogen hypotheses under comparable sampling effort. Full article

Today, data are no longer confined to numerical values arranged in row-by-column matrices or stored neatly within relational databases. One of the defining characteristics of big data is its high variety, encompassing unstructured and multimodal forms such as text, audio, images, and video. These data types dominate contemporary domains including social media, digital humanities, biomedical research, education, and surveillance systems. Yet these data types remain difficult to manage and analyze using traditional data management architectures. To cope with this shift, modern data management systems must move beyond schema-driven designs and incorporate multimodal artificial intelligence capable of understanding, integrating, and reasoning across heterogeneous data modalities. This article examines how multimodal AI, in particular large multimodal foundation models, can be leveraged to support the ingestion, representation, organization, and analysis of unstructured data. It discusses emerging multimodal data management frameworks, outlines a conceptual pipeline for multimodal data analysis, and highlights key challenges related to scalability, interpretability, and governance. By situating multimodal AI at the core of data management, this work argues that effective data analysis in the era of big data requires systems that treat meaning, context, and cross-modal relationships as first-class computational objects rather than afterthoughts. Full article

Background/Objectives: Antimicrobial resistance in microbial communities is a global health concern that leads to millions of deaths each year. Many bacterial pathogens have resistance to multiple antibiotics. Domestic wastewater treatment facilities are reservoirs for antibiotic-resistant bacteria and resistance genes. Wastewater-based epidemiology surveillance is crucial for monitoring antibiotic resistance genes (ARGs). Türkiye has one of the highest levels of antibiotic resistance with a lack of research on resistomes. This study is a focused reanalysis of publicly available wastewater metagenomes from Türkiye, comparing them to global and other country’s results. Methods: Ten metagenomic data of wastewater treatment from Türkiye were downloaded from NCBI-SRA database. Metagenome assemblies were performed and high-quality metagenome-assembled genomes (HQ-MAGs) were included in the study. Taxonomic annotations and antibiotic resistance profiles were identified in both the metagenome assemblies and HQ-MAGs. Results: A total of 401 different ARGs in 25 antibiotic classes have been identified, including Mcr (including mcr-1, mcr-2, mcr-3 and mcr-5 variants) and optrA. The vanR two-component regulatory system genes for controlling vancomycin antibiotic resistance were one of the most dominant along with other vancomycin resistance genes such as vanA and vanB. A total of 115 HQ-MAGs were obtained with at least eight ARGs. The HQ-MAG with the highest number of resistance genes (58) was found to belong to E. coli. The most frequently encountered resistance genes in HQ-MAGs were the multidrug ABC transporter, vanR, bacA and patA which confer resistance to multidrug, glycopeptide, bacitracin and fluoroquinolone antibiotic groups, respectively. Conclusions: To effectively address the problems of antibiotic resistance outbreaks, comparable AMR surveillance at national and global levels is required for the identification and prioritization of ARGs and resistance genes. This is the first report conducted in Türkiye. Full article

Background: Pancreatoblastoma (PB) is an exceptionally rare malignant epithelial neoplasm of the pancreas that recapitulates the developing pancreatic anlage. It is defined histologically by acinar-predominant differentiation with characteristic squamoid nests, and it may also show ductal and endocrine differentiation within the same tumor, features that distinguish it from acinar cell carcinoma and solid pseudopapillary neoplasm but that are readily overlooked. It occurs predominantly in young children, although adult-onset disease is well documented. We provide a population-based characterization of PB across the full age spectrum and benchmark it against pancreatic ductal adenocarcinoma (PDAC). Methods: Cases diagnosed between 2000 and 2021 were identified in the Surveillance, Epidemiology, and End Results (SEER) 17-registry database using site and histology codes. Cancer-specific survival (CSS) was estimated and compared, and Cox proportional hazards regression was used to explore associations with cancer-specific mortality. Results: Thirty-nine cases of PB were identified, compared with 155,924 cases of PDAC. The median age at diagnosis was 17 years (range, under 1 to 78 years); 12.8% (n = 5) were younger than 1 year. Males accounted for 69.2% (n = 27) of cases. The cohort was divided at the conventional pediatric-to-adult threshold of 18 years into a pediatric subgroup (age < 18 years; n = 20) and an adult subgroup (age ≥ 18 years; n = 19). CSS at 1 and 5 years was 95.0% and 83.5% in the pediatric subgroup, versus 67.7% and 24.6% in the adult subgroup (log-rank p < 0.001). Five-year CSS was 44.8% in males and 75.0% in females. In an exploratory multivariable model, older age was associated with higher cancer-specific mortality both as a dichotomous variable (adjusted hazard ratio [HR] for age ≥ 18 years 10.7, 95% confidence interval [CI] 2.4–48.2; p = 0.002) and, in a parallel model, as a continuous variable (adjusted HR 1.4 per 10-year increment, 95% CI 1.1–1.8; p = 0.002), indicating an age–mortality gradient. Male sex showed an association in the same direction that did not reach statistical significance (adjusted HR 3.3, 95% CI 0.96–11.6; p = 0.06). Relative to PDAC, PB was more frequently diagnosed in males and was associated with markedly superior survival (1- and 5-year CSS 81.8% and 54.9%, versus 28.8% and 4.0%). Conclusions: Pancreatoblastoma is predominantly a malignancy of young males and carries a substantially more favorable prognosis than PDAC, but outcomes differ markedly across the age spectrum, with adult-onset disease showing considerably poorer survival. Translationally, these population-level estimates support age-stratified prognostic counseling, argue for the referral of adults to centers experienced in rare pancreatic tumors, and provide a rationale for prospective molecular profiling to determine whether adult and pediatric PBs are biologically distinct and whether Wnt/beta-catenin pathway activation is therapeutically actionable. Full article

The molecular epidemiology and antiretroviral (ARV) drug resistance of human immunodeficiency virus type 1 (HIV-1) remain incompletely outlined in the Middle East and North Africa (MENA). The aim of this retrospective molecular epidemiology study was to analyze MENA HIV-1 sequences for phylogenetic clustering and to delineate surveillance drug-resistance mutations (SDRMs) for nucleoside reverse-transcriptase inhibitors (NRTIs), non-nucleoside reverse-transcriptase inhibitors (NNRTIs), and protease inhibitors (PIs) across various periods, locations, and subtypes/circulating recombinant forms (CRFs). Viral sequences were retrieved from the Los Alamos HIV Sequence Database as of 15 April 2026. Analyses were done using multiple sub-gene regions (two env regions (n = 224 and n = 60) and PR (n = 2413) and RT (n = 2103) of the pol gene). Phylogeny construction was conducted using maximum-likelihood estimation, while ARV drug resistance analysis was conducted using the Stanford HIVdb algorithm. The HIV-1 MENA sequences showed a remarkable genetic diversity, with co-circulation of multiple subtypes/CRFs, including subtype B in the Maghreb, Levant, and Egypt sub-regions, subtypes A1, G, CRF01_AE, and CRF02_AG in the Gulf Cooperation Council (GCC) and Yemen sub-region, and subtypes C and D in the Horn of Africa and Sudan sub-region. The percentage of MENA HIV-1 sequences in clusters was 10.3% for env1, 8.3% for env2, 22.0% for PR and 37.2% for RT. Phylogenetic reconstruction hinted at a structured epidemic dominated by small transmission units, with most clusters comprising dyads (n = 260) or networks (n = 142) and a limited number of large clusters (n = 8) that were largely confined within national boundaries, with only occasional cross-border linkages (n = 8). Overall SDRM prevalence was 3.2% in the PR region and 14.9% in the RT region, with a higher percentage of NNRTI-associated mutations (10.0%) than NRTI-associated mutations (9.1%) and dual-class resistance observed in 4.1% of sequences. Phylogenetic clustering was not associated with the probability of harboring SDRMs; however, negative binomial models showed that non-clustered sequences had a greater burden of NRTI-associated mutations, whereas no such association was observed for NNRTI- or PI-associated mutations. The findings showed predominantly localized and fragmented MENA HIV-1 transmission dynamics. Heterogeneous ARV drug resistance dynamics indicated that resistance emergence might be shaped by broader epidemiologic and treatment-related factors rather than ongoing clustered transmission. There is a need for coordinated molecular surveillance and optimized ART strategies across the MENA countries. Full article

Background: Osteoradionecrosis (ORN) is a severe late complication of radiotherapy for head and neck cancer, associated with impaired bone healing, infection, pain, and exposed bone. Periodontal disease may contribute to ORN by maintaining inflammatory and infectious foci within irradiated tissues with reduced vascularity and repair capacity. Objective: To evaluate whether periodontal disease or poor periodontal status is associated with increased ORN risk in patients with head and neck cancer undergoing radiotherapy. Methods: This systematic review and meta-analysis followed PRISMA 2020 recommendations and was structured according to the PECO framework. Searches were conducted in PubMed/MEDLINE, Embase, Scopus, Web of Science, Cochrane Library, ClinicalTrials.gov, WHO databases, and gray literature. Observational studies involving head and neck cancer patients treated with radiotherapy and reporting periodontal status in relation to ORN were included. Risk of bias was assessed using a domain-based approach. Random-effects models estimated pooled relative effect estimates and ORN prevalence. Results: Six studies were included in the primary association meta-analysis. Periodontal disease was significantly associated with increased ORN risk, with a pooled relative effect estimate of 4.83 (95% CI: 1.96–11.93; p = 0.0006; I² = 50.4%). Seven studies including 1785 patients and 118 ORN events were included in the prevalence meta-analysis, showing a pooled ORN prevalence of 9% (95% CI: 6–13%; I² = 78.0%). Conclusions: The findings suggest that periodontal disease or poor periodontal status may be associated with an increased likelihood of ORN in patients with head and neck cancer undergoing radiotherapy. Given the observational nature of the evidence and the moderate between-study heterogeneity, this association should be interpreted cautiously. Comprehensive periodontal assessment and long-term oral surveillance may be considered as components of multidisciplinary care before and after radiotherapy. Full article

Introduction: Artificial intelligence (AI) is becoming part of everyday knowledge work through generative AI, decision-support systems, algorithmic management, and AI-enabled organizational information systems. This development raises a central question: when does AI support employees, and when does it become a source of technostress, surveillance, uncertainty, and reduced autonomy? Objectives: This PRISMA-ScR scoping review mapped evidence on human-centered AI adoption in knowledge-intensive work and examined links with technostress, trust, autonomy, and employee well-being. Methods: Using a population–concept–context approach, we included peer-reviewed journal articles and conference papers addressing AI adoption in knowledge-work settings and at least one human-centered or employee-related outcome. Publicly accessible databases and public metadata records were searched across Scopus, Web of Science Core Collection, IEEE Xplore, ACM Digital Library, ScienceDirect, PubMed/MEDLINE, Business Source Complete, and APA PsycINFO. Searches were conducted in March 2026 and verified between 1 and 15 April 2026. Results: Twenty-six sources were included, comprising 17 journal articles and 9 peer-reviewed conference/proceedings sources. Five evidence clusters were identified: AI as a resource-demand system, information-system properties, generative AI work redesign, organizational implementation conditions, and short- versus long-term employee outcomes. Conclusions: Human-centered AI adoption in knowledge work requires transparent system design, organizational governance, employee participation, and long-term monitoring. The review contributes a business informatics implementation framework for trustworthy, ethically governed, and well-being-oriented AI use. Full article