Search Results (1,484)

Background/Objectives: Persistent symptoms following SARS-CoV-2 infection pose a substantial burden in occupational settings. This study aimed to characterize symptoms following work-related SARS-CoV-2 infection and to assess their associations with sociodemographic and clinical factors. Methods: Data were obtained from a multicenter clinical registry of insured individuals referred for persistent symptoms 12 weeks after laboratory-confirmed work-related SARS-CoV-2 infection. Participants were assessed within a standardized post-COVID diagnostic program at six specialized clinics for occupational accident insurance in Germany. Persistent symptoms reported by ≥50% of participants were analyzed using generalized linear mixed models with random intercepts for center. Results: A total of 1511 participants (76.7% women; median age 54 years) were included, with a median interval of 16 months between infection and assessment. On average, participants reported ten persistent symptoms. The most frequent complaints were limited physical capacity (95.6%), concentration difficulties (78.8%), dyspnea (70.5%), exhaustion/tiredness (68.9%), and memory difficulties (67.5%). Individuals reporting more than ten acute symptoms had increased odds of persistent complaints (ORs between 2.1 and 4.66). Hospitalization was independently associated with persistent dyspnea (OR 1.62; 95%CI 1.17–2.25). Reinfections were linked to exhaustion and cognitive fatigue. Compared with Omicron, wild-type infection was associated with higher odds of concentration difficulties (OR 1.65; 95%CI 1.17–2.33). Comorbidities demonstrated symptom-specific associations. Conclusions: Among individuals with work-related SARS-CoV-2 infection, limited physical capacity and cognitive impairments were the most frequently reported symptoms, and higher acute symptom burden was strongly associated with the development of persistent symptoms. These findings support course-oriented evaluation and symptom-specific approaches in occupational disease assessment and management. Full article

Ionizing radiation therapy has undergone a clear paradigm shift in veterinary oncology and inflammatory disease management, moving from mainly palliative use toward structured, curative treatment programs. This review synthesizes current evidence on key modalities used in veterinary practice, including external beam radiotherapy, brachytherapy, systemic targeted radionuclide therapy, stereotactic radiosurgery, stereotactic body radiotherapy, radiosynoviorthesis, and low-dose radiotherapy. Each modality is discussed in relation to its physical and biological basis, major isotopes or beam types, routes of delivery, target species such as dogs, cats, and horses, clinical indications, and global availability. Comparative analysis highlights differences in clinical acceptance, evidence strength, access, and cost. External beam radiotherapy and stereotactic techniques support curative tumor management, whereas radiosynoviorthesis and low-dose radiotherapy are effective for inflammatory and degenerative disorders. Despite ongoing progress, challenges remain in access, dosimetry standardization, and prospective evidence. Companion animals are also emphasized as valuable translational models, guiding future innovation and collaboration internationally. Full article

Background/Objectives: Obesity is a chronic, relapsing disease in which lifestyle modification represents the cornerstone of treatment. Among dietary strategies, ketogenic diets can induce rapid weight loss, whereas the Mediterranean diet is associated with established cardiometabolic benefits but typically produces slower weight reduction. Very-low-calorie ketogenic diets (VLCKDs) are effective for weight loss but are often limited by cost, reliance on meal replacements, and reduced long-term feasibility. This study aimed to evaluate whether a whole-food Mediterranean ketogenic diet with moderate caloric restriction (MedKD) could represent a feasible and effective alternative to VLCKD for weight loss and metabolic improvement in adults with obesity. Methods: This 3-month prospective, real-world study compared VLCKD and MedKD in adults with obesity attending a clinical nutrition program. The primary outcome was percentage weight loss. Secondary outcomes included changes in waist circumference, waist-to-height ratio, insulin resistance (HOMA-IR), lipid profile, kidney function, and treatment tolerability. Clinical and biochemical parameters were assessed at baseline and after the intervention. Group differences and time-by-group interactions were analyzed to evaluate changes over the study period. Results: Sixty-two participants were enrolled, and 55 completed the study (27 VLCKD, 28 MedKD). Baseline characteristics were generally comparable, although the MedKD group had a higher prevalence of diabetes and higher baseline insulin resistance and triglyceride levels. Both dietary interventions resulted in substantial and comparable weight loss (approximately 15% of initial body weight), accompanied by significant reductions in waist circumference and waist-to-height ratio. Insulin resistance improved in both groups, with a greater reduction in HOMA-IR observed in the MedKD group (time × group p = 0.031). Serum creatinine decreased in the VLCKD group and slightly increased in the MedKD group (p = 0.025). Changes in lipid profile were not significantly different between groups. No severe adverse events were reported. Conclusions: A whole-food Mediterranean ketogenic diet with moderate caloric restriction achieved weight loss and metabolic improvements comparable to those observed with VLCKD over three months. These findings suggest that MedKD may represent a feasible alternative to formula-based ketogenic programs, supporting more flexible and personalized dietary strategies in the clinical management of obesity. Full article

Background and Objectives: Immunohistochemistry (IHC) is a keystone in gastric cancer (GC) management, allowing treatment customization, including for advanced or metastatic diseases. This review aims to evaluate the critical role of IHC markers, analyzing their efficiency in molecular subclassification and prediction of response to gastric cancer-targeted therapies, while also describing state-of-the-art IHC techniques and perspectives. Results: The major challenges for the GC management were structured in two main sections, as follows: (i) the current paradigm of gastric neoplasia diagnosis, which includes subsections related to the methodological and morphological foundations, the epidemiological dynamics, and risk factors, as well as differential diagnosis of poorly differentiated tumors; and (ii) the progress in 3,3′-diaminobenzidine (DAB) application and advanced reagents in gastric cancer immunohistochemistry. Discussion: Considering the role of IHC and DAB, the following topics were successively addressed in seven sections: GC key biomarkers, such as human epidermal growth factor receptor 2 (HER2), programmed death-ligand 1 (PD-L1), and DNA replication mismatch repair (MMR) system, allow direct correlation between tissue morphology and protein expression; intestinal and gastrointestinal differentiation markers; emerging and aggressive histological subtypes; epithelial–mesenchymal transition, E-cadherin, and the process of tumor budding; implementation of innovative procedures in gastric cancer immunohistochemistry; and automation, quality control, and sustainability in the pathology laboratory. Perspectives: The main directions were focused on the integration of artificial intelligence (AI) algorithms for digital quantification of the IHC signal and also on the expansion of panels to new targets, such as Claudin 18.2 (CLDN 18.2), which redefines treatment approaches in advanced stages. Conclusions: Although faced with technical and biological limitations, immunohistochemistry remains indispensable in modern gastric oncology. The evolution towards digital pathology and the refinement of scoring criteria will transform IHC from a complementary test into a visual tool that is essential for personalizing oncological treatment. Full article

Fungal diseases such as soybean stem canker (SSC), frogeye leaf spot (FLS), and sudden death syndrome (SDS) cause substantial yield losses in soybean worldwide. This study aimed to pyramid major resistance genes and QTLs against these diseases through marker-assisted backcrossing (MABC). Diagnostic SSR markers, linked to Rdm4 (SSC), Rcs3 (FLS), and SDS resistance QTLs, were validated and successfully employed for foreground and background selection in crosses between the elite cultivar A8100RR and the resistant donor ‘Forrest’. Molecular analyses confirmed the effective introgression and fixation of multiple resistance loci in BC₂F₅ lines. Under artificial inoculation, lines R30-11 and R25-13 displayed high resistance levels to Diaporthe aspalathi, Cercospora sojina, Fusarium virguliforme, and F. tucumaniae. Genotype R30-11 exhibited the most consistent resistance across pathogens, while R25-13 combined multi-disease resistance with glyphosate tolerance and stable agronomic performance under field conditions comparable to commercial cultivars. These results represent, to our knowledge, the first report of successful pyramiding genes and QTLs against three distinct fungal diseases (SSC, FLS, and SDS) in soybean through MABC. The developed lines constitute valuable germplasm for breeding programs designed to achieve broad-spectrum, durable and sustainable disease management. Full article

Net blotch, caused by Pyrenophora teres, is a major barley disease that occurs in two forms, spot form net blotch (SFNB) and net form net blotch (NFNB), reducing grain yield and quality worldwide. Accurate detection is critical for disease management and breeding resistant cultivars; however, traditional disease scoring is labour-intensive and error-prone. This study evaluates the use of UAV-based red–green–blue (RGB) and multispectral imagery, combined with machine learning, for determining net blotch infection levels at the plot scale across multiple sites and seasons in Australia. Various colour features, vegetation indices, and algorithms were tested, including a cross-domain testing for model generalisation. We propose a robust UAV-driven pipeline enabling precise disease monitoring and phenotyping in barley breeding programs. Full article

Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are the two dominant revascularisation strategies for obstructive coronary artery disease, yet their relative roles continue to shift because they address coronary pathophysiology differently with ever-evolving techniques. PCI has advanced through iterative improvements, including balloon angioplasty, bare-metal stents, and drug-eluting stents, with contemporary outcomes increasingly driven by procedural optimisation using intracoronary imaging and physiology-guided lesion selection rather than device category alone. CABG has progressed through perioperative management, improvements in operative safety, and, critically, conduit durability. Recognition of progressive saphenous vein graft failure has underpinned a conduit-optimisation era in which the left internal mammary artery to left anterior descending artery remains the gold standard. Further, broader arterial grafting (including radial artery use, multiple arterial grafting, and selected total-arterial strategies) has been increasingly applied, albeit with deliverability and competing-risk constraints highlighted in randomised evidence. This perspective review reframes the CABG versus PCI comparison not as a binary contest, but as a context-dependent assessment in which the relative value of each strategy depends on the specific technologies, techniques, and conduits available at the time of comparison. We summarise comparative effectiveness where evidence is most consistent and where it remains sensitive to anatomy, comorbidity, and endpoint definitions. In diabetes with multivessel disease, trial data favour CABG for long-term survival and clinical outcomes despite higher stroke risk. In left main disease, outcomes depend on lesion pattern and overall complexity, with trial-era stent technology and composite endpoint definitions influencing conclusions. In ischaemic left ventricular dysfunction, a long-term survival benefit is established for CABG added to medical therapy, while multi-vessel PCI has not demonstrated comparable prognostic modification in contemporary data. We then examine hybrid coronary revascularisation as territory-specific allocation, highlighting its physiological rationale, program dependence, and limited, adequately powered randomised evidence. Finally, we outline how artificial intelligence (AI) and robotics may accelerate a precision revascularisation paradigm by standardising lesion assessment, supporting procedural planning, improving procedural reproducibility, and enabling more patient-specific selection among PCI, contemporary CABG with optimised conduits, and hybrid pathways. Full article

Aeropalynology, the monitoring and interpretation of airborne pollen, has become increasingly relevant in Latin America as allergic rhinitis and asthma rise alongside rapid urbanization, land-use change, and climate variability. Yet the region’s capacity remains heterogeneous: long-standing traditions in the Southern Cone coexist with emerging programs in tropical and Andean settings, and many series are not translated into standardized products useful for clinical care or public health. We conducted a structured literature review guided by PRISMA 2020 to synthesize the historical evolution, current monitoring infrastructure, dominant pollen taxa, and translational outputs reported across Latin American countries. Evidence indicates that Mexico currently represents the most mature aeropalynological ecosystem in the region, supported by multi-site monitoring, open weekly reporting (REMA), multiple city-level pollen calendars, and emerging computational approaches for pollen identification. Across countries, recurrent high-impact taxa include Cupressaceae, Fraxinus, Platanus, Olea, Poaceae, Urticaceae, Amaranthaceae, Rumex, Ambrosia, and Parietaria, with local dominance shaped by biogeography and urban vegetation. Key gaps include limited long-term continuity outside a few cities, variable methodology (sampler type, taxonomic resolution, units, thresholds), and scarce linkage of pollen exposure metrics with clinical outcomes. Future priorities include harmonized volumetric monitoring, interoperable data standards, routine publication of pollen calendars and thresholds, integration with meteorology for forecasting, and expansion of digital decision-support tools to improve prevention and management of allergic respiratory diseases in Latin America. Full article

Cardiovascular disease (CVD) and cancer frequently coexist in older patients, posing significant challenges in clinical management due to overlapping risk factors and treatment-related complications. This narrative review summarizes current knowledge on the epidemiology, shared pathophysiological mechanisms and clinical impact of neoplastic comorbidities in older adults with cardiovascular diseases. It highlights the increased mortality, morbidity and diminished quality of life resulting from the coexistence of these conditions. The review also discusses personalized management strategies, emphasizing comprehensive geriatric and cardiac assessments, and tailoring oncologic treatments to minimize cardiotoxicity, as well as the role of prevention and rehabilitation programs. As the population ages and cancer survival improves, integrated cardio-oncology care adapted to older adults becomes increasingly essential to optimize outcomes and preserve functional status. Full article

Poly(ADP-ribose) polymerase inhibitors (PARPi) have reshaped therapy for advanced prostate cancer, yet durable benefit remains concentrated in BRCA1/2-altered tumors, especially BRCA2, and most responders eventually relapse. Here, we frame PARPi response and resistance through a unifying model in which DNA damage response (DDR) rewiring (e.g., homologous recombination repair (HRR) restoration, fork protection, checkpoint tolerance, and altered drug handling) converges with treatment-induced dormancy and quiescent therapy-tolerant residual states that sustain minimal residual disease (MRD) under androgen receptor pathway inhibition (ARPI) and PARP blockade. We synthesize clinical and translational evidence for PARPi monotherapy and PARPi-based combinations across disease states. In first-line metastatic castration-resistant prostate cancer (mCRPC), PARPi plus ARPI consistently prolongs radiographic progression-free survival, with the greatest benefit in HRR-altered tumors, and emerging overall-survival signals in selected subgroups. In later-line settings, monotherapy activity is most robust in BRCA2-mutated disease, whereas non-BRCA HRR alterations show heterogeneous and often modest responses, underscoring the need for biomarkers beyond gene panels. We also discuss combination strategies with DDR-targeting agents, radioligand therapies, and immunotherapy, and summarize ongoing phase III programs in metastatic castration-sensitive prostate cancer (mCSPC). Finally, we outline practical considerations for biomarker-informed patient selection, monitoring, sequencing, and toxicity management, with particular emphasis on intercepting MRD and resistance evolution. Full article

Objectives: Design strategies to improve management, outcomes, and quality of life for people with heart failure (HF) in Spain through the identification of areas of improvement regarding diagnosis, treatment, comorbidities, progression of disease and healthcare coordination between specialists. Methods: IC-MMERSIVE project was developed by the Cardiology and Primary Care Integration Working Group of the Spanish Society of Cardiology. The project included a pre-session survey for participants, face-to-face sessions led by a clinical cardiologist, and post-session questionnaires for the moderator and for participants. A web platform was created to host program content and resources and electronic forms for data collection and analysis. Results: A total of 1186 physicians (80.5% cardiologists) participated in 144 face-to-face sessions throughout Spain. When patients are at risk for HF (HF stage B), 78.9% of respondents said they proactively search for HF. Only 38.0% were familiar with and applied the IC-BERG study questions designed to detect falsely stable patients. Specific protocols for optimizing and implementing the four pharmacologic pillars of treatment for HF were used by 51.6% of participants, 53.9% had protocols to reach the guideline-recommended target doses, and 25.6% reported no nursing involvement. Structured follow-up was conducted in 53.9% of cases. Even though 63.0% used shared single medical records, the connection between specialized HF consultations and healthcare centers was occasional in 72.1% of cases. Conclusions: There is marked room to improve HF management in daily clinical practice. These findings highlight specific actionable gaps in HF management and support the need for structured, multidisciplinary strategies to improve patient outcomes. Full article

Background/Objectives: In recent years, the migrant population has been increasing. Migrants are at risk for malnutrition, mental disorders and related health problems. In this study, we aimed to examine the relationships among diet quality, eating behavior, posttraumatic stress disorders and sleep quality in Syrian migrants. Methods: This study included 78 female and 72 male Syrian adult migrants. The participants completed a questionnaire including demographic information, the Pittsburgh Sleep Quality Index, the Posttraumatic Stress Disorder Short Scale, and a three-factor eating questionnaire. For the diet quality calculation, a 24 h retrospective food consumption record was taken. Results: A total of 94.0% of the participants had mild to moderate risk of posttraumatic stress disorder. It was determined that 90.7% of Syrian migrants had low or moderate diet quality. There was a positive correlation between the PTSD score and age (r = 0.244) and the Pittsburgh sleep quality index score (r = 0.244) and between the Pittsburgh sleep quality index score and uncontrolled eating (r = 0.171) (p < 0.05). The probability of impaired sleep quality increased in individuals with PTSD scores in the T2 (11–19 points) (OR: 1.342; 95% CI: 1.073–1.678) and T3 (20–31 points) (OR: 1.485; 95% CI:1.157–1.905) groups, whereas the probability of improved diet quality increased in individuals in the T2 (11–19 points) (OR: 1.042; 95% CI: 1.000–1.086) group. Conclusions: Poor diet quality, risk of posttraumatic stress disorder and poor sleep quality are very common among Syrian migrants. In this respect, evaluating Syrian migrants and taking necessary precautions may help reduce the risk of chronic diseases related to nutrient deficiencies and mental problems. There is a need for policies and programs to manage PTSD among Syrian refugees. Full article

Accurately monitoring physical activity, including stationary cycling on an exercise bike, is important in managing chronic diseases and rehabilitation after lower limb surgery. This study aimed to validate a new smartphone-based sensor application (the BeSAFE+) for activity recognition and step counting across five phone placements, using the SENS Motion^® system as a reference standard, and observed activity time as ground truth. In a laboratory-based study, 20 participants performed walking, brisk walking, running, high- and low-intensity cycling, sitting, standing, and lying activities while carrying five smartphones placed in the front and back trouser pockets, a backpack, a running armband, and a fanny pack, and wearing the activity tracker. The front pocket placement had the most accurate classification during cycling activities (89–93%) versus SENS Motion^® (96–98%). For other activities, the highest overall classification accuracy was achieved with the phone in the back pocket. Overall, the SENS Motion^® activity tracker demonstrated higher classification accuracy than most smartphone placements across all activities, except for running. Nevertheless, several smartphone placements and Application Programming Interface (API) approaches achieved activity recognition and step count estimates that were not significantly different from the SENS Motion^® activity tracker, indicating that smartphone-based activity recognition can be valid under specific conditions. Full article

Background/Objectives: Carbapenem-resistant Acinetobacter spp. represent an emerging concern in human medicine; however, their epidemiology and genetic backgrounds in companion animals in Japan remain unclear. This study aimed to determine the prevalence of carbapenem resistance among Acinetobacter spp. isolated from diseased dogs and cats and elucidate the underlying genetic mechanisms. Methods: In this surveillance study conducted as part of the Japanese Veterinary Antimicrobial Resistance Monitoring (JVARM) program, 139 isolates were collected from diseased companion animals across Japan (84 from dogs and 55 from cats) during 2020, 2021 and 2023. Antimicrobial susceptibility testing was performed for seven antimicrobials and carbapenem-resistant isolates (meropenem MIC ≥ 8 μg/mL) underwent whole-genome sequencing to identify resistance genes, genomic contexts, and associated mobile genetic elements. Results: Resistance rates to all tested antimicrobials were below 20%. Meropenem resistance was detected in three isolates: one from a dog and two from cats. These resistant strains were identified as A. radioresistens, A. proteolyticus, and A. johnsonii, all harboring carbapenemase genes. The A. radioresistens isolate carried chromosomal bla_OXA-23, the A. proteolyticus isolate carried bla_OXA-58, and the A. johnsonii isolate possessed a plasmid containing bla_NDM-1 and bla_OXA-58. This represents the first report of bla_NDM-1-harboring Acinetobacter isolate from companion animals in Japan. Conclusions: Carbapenem-resistant Acinetobacter spp. remain rare in companion animals in Japan; however, insertion sequence mobility may promote resistance gene dissemination. As carbapenems are not approved for veterinary use in Japan, strict antimicrobial stewardship and appropriate hygiene management are essential. Full article

Background: Recurrent vulvovaginal candidiasis (RVVC) is a chronic inflammatory disease primarily caused by Candida albicans (C. albicans). Its pathogenesis remains incompletely understood, and clinical management is challenged by recurrence and drug resistance. Ferroptosis, an iron-dependent form of programmed cell death driven by lipid peroxidation, has been implicated in various infectious and inflammatory diseases. However, its role in RVVC remains unclear, with a particular lack of evidence from clinical samples and animal experiments. Objective: This study aimed to investigate the association between RVVC and ferroptosis. First, we analyzed high-throughput sequencing data from human RVVC samples in the Gene Expression Omnibus (GEO) database to identify the expression profile of ferroptosis-related genes. Second, using an established murine model of chronic vulvovaginal candidiasis (CVVC), we validated changes in ferroptosis-related markers in vaginal tissues in vivo. Furthermore, an in vitro model of C. albicans-infected bone marrow-derived macrophages (BMDMs) was employed to explore the underlying mechanisms. This study provides experimental evidence for elucidating the pathogenesis of RVVC and exploring novel therapeutic strategies. Methods: The RVVC-related gene expression dataset GSE278036 was obtained from the GEO database. Differentially expressed genes (DEGs) were screened using the DESeq2 algorithm and intersected with ferroptosis-related genes from the FerrDb database to identify key targets. A protein–protein interaction (PPI) network was constructed using the STRING database and Cytoscape software, and hub genes were identified via the Betweenness centrality algorithm. Functional and pathway analyses, including gene set enrichment analysis (GSEA), Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and WikiPathways, were performed. Immune infiltration analysis characterized the immune microenvironment in RVVC patients. A CVVC mouse model was established in vivo, and a C. albicans-BMDMs infection model was established in vitro. The ferroptosis inhibitor ferrostatin-1 (Fer-1) was administered to investigate the pathological function and regulatory mechanisms of ferroptosis in RVVC at the molecular, cellular, and tissue levels. Results: Differential analysis identified 3132 DEGs in RVVC, which intersected with ferroptosis-related genes to yield 194 key targets. Among them, 20 hub genes were identified, including ferroptosis regulators and inflammatory factors. Functional enrichment analysis confirmed that these shared targets regulate RVVC pathology through a “ferroptosis-inflammation-immunity” multi-pathway network. Immune infiltration analysis revealed a specific immune disorder in RVVC patients characterized by “activation of the pro-inflammatory innate immune axis and suppression of the adaptive immune axis,” which was closely associated with ferroptosis-related genes. In vivo and in vitro experiments confirmed that C. albicans infection induced ferroptosis in vaginal tissues and macrophages, as manifested by lipid ROS accumulation, Fe²⁺ overload, GSH depletion, downregulation of GPX4 and SLC7A11, upregulation of ACSL4, 4-HNE, and MDA, and mitochondrial structural damage. Macrophages were identified as key target cells for ferroptosis, and their ferroptosis led to impaired antifungal function. Fer-1 treatment significantly inhibited ferroptosis, reduced vaginal histopathological damage and inflammatory cell infiltration, decreased fungal burden, downregulated abnormally elevated inflammatory factors, and restored Th1/Th2 immune balance. Furthermore, Fer-1 preserved macrophage viability and enhanced their antifungal killing capacity. Conclusions: This study provides the first evidence linking RVVC to ferroptosis through a combination of clinical data analysis and experiments, suggesting that ferroptosis is involved in its pathological process. These findings offer a new perspective for elucidating RVVC pathogenesis and developing targeted therapeutic strategies. Full article