Search Results (7,122)

Background: Oscillating hyperglycemia (glycemic variability) and vitamin D deficiency each damage the retinal microvasculature, yet their combined effect on sight-threatening proliferative diabetic retinopathy (PDR) is uncertain. Objective: To determine whether high GV and severe vitamin D deficiency independently, and additively, associate with retinal neovascularization in adults with diabetes. Materials and Methods: We conducted a cross-sectional study between January 2025 and June 2025 in 58 adults with diabetes at Constanța County Emergency Hospital, Romania. GV was classified as high (coefficient of variation > 36% or SMBG-SD > 50 mg/dL) or low. Serum 25-hydroxy-vitamin D [25(OH)D] was measured; severe deficiency < 10 ng/mL. Dilated funduscopy graded retinopathy as non-proliferative (NPDR) or proliferative (PDR). Multivariable logistic regression adjusted for HbA1c, diabetes duration, BMI, smoking, triglycerides and therapy. Results: From 58 adults (mean ± SD 59 ± 11 years), high GV characterized 29/58 participants (50%). Severe vitamin D deficiency was more frequent in the GV-high group (45% vs. 31%). PDR prevalence was 48% in GV-high and 31% in GV-low patients. After adjustment, high GV (adjusted OR 2.31, 95% CI 1.05–5.09) and severe vitamin D deficiency (OR 2.04, 95% CI 0.98–4.25) each predicted PDR. Concomitant exposure to both stressors conferred 3.9-fold higher odds of PDR (OR 3.88, 95% CI 1.35–11.1). No interaction term reached significance (p = 0.21), indicating additive effects. Conclusions: High GV and severe vitamin D deficiency independently and additively associate with PDR. Screening for both parameters may enhance risk stratification of PDR. Within adults with diabetes, high glycemic variability and severe vitamin D deficiency were each associated with higher odds of PDR after adjustment for HbA1c, diabetes duration, BMI, smoking, triglycerides, and treatment pattern; their effects appeared additive rather than multiplicative. These findings reflect associations within diabetes and do not imply that vitamin D deficiency produces retinopathy in euglycemic individuals. Full article

The article presents experimental data on the electrochemical oxidation of vanadium-bearing ore with the aim of increasing the efficiency of vanadium extraction during subsequent hydrometallurgical processing. Three different charge compositions were studied during the preliminary oxidative roasting stage, differing in the type of oxidizers used: calcined soda, sodium chloride, and their mixture in a mass ratio of 9:1. Electrochemical oxidation was carried out in a sulfuric acid medium using a membrane electrolysis cell equipped with an MK-40 type diaphragm. Experimental studies were conducted by varying key technological parameters: H₂SO₄ concentration (5–15%), solid-to-liquid phase ratio (1:2–1:5), temperature (25–85 °C), process duration (0.5–3 h), and current density (100–1000 A/m²). It was found that preliminary roasting promotes the conversion of vanadium into higher oxidation states, predominantly V⁵⁺, which significantly increases its solubility during subsequent electrochemical treatment. For the first time, the kinetic patterns of electrochemical vanadium leaching were identified, as well as the limiting mechanism of the process, associated with the formation of poorly soluble oxide films on the ore surface. Optimization of the electrochemical oxidation parameters allowed us to achieve vanadium extraction into solution up to 92%. Full article

Refrigeration has become a common practice for preserving Dendrobium officinale products. The molecular mechanisms underlying chilling stress responses, particularly those linking physiological adaptation to flavor-related metabolite changes, remain unclear. This study aimed to explore the transcriptional and metabolic changes in D. officinale leaves during cold treatment and to identify key stress-responsive metabolites underlying flavor modulation and their roles in cold adaptation. Transcriptional clustering analysis revealed distinct expression profiles under varying temperatures, indicating that chilling temperatures affect pathways related to RNA processing, oxidative stress, and secondary metabolism. Metabolomics profiling demonstrated significant metabolite shifts over time, with lipids, organic acids, and phenylpropanoids being prominently altered. Notably, flavonoids like rutin and sugars like trehalose varied in their accumulation depending on the duration of cold exposure. Proteomic analysis indicated that proteins involved in amino acid metabolism and the TCA (tricarboxylic acid) cycle were significantly impacted by prolonged chilling, with amino acids (key osmoprotectants and flavor contributors) accumulating over time, linking cold stress adaptation to sensory quality enhancement. These findings suggest that a chilling temperature primarily affects metabolic flow at different time points, which could help control the quality of D. officinale leaves during cold storage. Full article

Background and Objectives: Ixekizumab is a human monoclonal antibody targeting interleukin-17A, approved for the treatment of moderate-to-severe plaque psoriasis. Given its demonstrated efficacy and safety in clinical trials, this study aimed to evaluate the real-world drug survival of Ixekizumab and identify clinical predictors of treatment discontinuation. Materials and Methods: A retrospective, observational, hospital-based study was conducted in the Department of Dermatology at the Central University Hospital of Asturias (HUCA). Patients with moderate-to-severe plaque psoriasis who initiated treatment with Ixekizumab (Taltz^®) between 8 June 2017 and 10 October 2024, were included. Demographic data, comorbidities, age at disease onset, family history, PASI score, and previous treatments were recorded. Drug survival was assessed using Kaplan–Meier survival curves and the log-rank test. Predictors of discontinuation were analyzed using univariate and multivariate Cox proportional hazards models. Results: A total of 103 patients (55.3% women) were included. Drug survival rates were 85% at one year, 73% at two years, and 61% at four years, with a mean treatment duration of 52.5 months (95% CI: 46.01–58.99). Multivariate analysis showed that patients under the age of 65 had a significantly higher risk of treatment discontinuation (hazard ratio: 1.813; p < 0.05). The most common reason for discontinuation was secondary treatment failure (45.16%). Ixekizumab demonstrated sustained drug survival in a real-world setting, with rates falling within the mid-to-upper range reported in the literature. Older age (>65 years) was associated with greater treatment persistence, highlighting a potential influence of age on long-term therapeutic adherence. Full article

Background: Reducing critically ill patients’ exposure to antibiotics is mandatory. In randomized controlled trials, procalcitonin (PCT)-guided algorithms (i.e., antibiotic therapy [ABT] should be stopped whenever PCT is less than 0.5 µg/L or is below 80% of the peak value) reduced the duration of (ABT) more than compliance with the current guidelines. However, the interest of such stopping rules in daily practice remains debated. Thus, we carried out a real-life study addressing this issue. Results: During the study period, 112 patients with sepsis upon intensive care unit admittance were included. The median age was 66 years (56–79). Half of the patients presented with acute respiratory failure. Pneumonia was diagnosed in 78% of them, and 41% met septic shock criteria. The initial ABT was empirical in most cases, and appropriateness rate to the isolated bacteria reached 71%. A median number of four PCT measurements was achieved in both groups. The compliance rate with the PCT algorithm was 54%. The median duration of ABT was 5 (4–7) days if the PCT algorithm was followed, as compared to 7 (5–10) days otherwise (p < 0.001). This ABT stopping rule allowed a 2-day reduction in the treatment duration as compared with those recommended by the guidelines (p < 0.001). The only independent factor associated with shorter treatment duration was compliance with the PCT algorithm (OR = 0.74, 95% CI [0.62; 0.88]; p < 0.001). Regarding safety, no difference in outcome was found between the two groups. Conclusions: Complying with one PCT-based stopping rule is associated with a significant reduction in the duration of ABT in septic critically ill patients, without apparent impact on patient outcomes. Full article

The growing global demand for lithium, driven by its pivotal role in battery production, highlights the need for alternative technologies to recover this metal from low-grade and anthropogenic raw materials. This study investigates lithium extraction from aluminosilicate tailings of rare-metal production by sulfate roasting with concentrated sulfuric acid, followed by aqueous and hydrochloric acid leaching. Mineralogical analysis confirmed lithium mainly in muscovite and biotite (isomorphic substitutions) and partly as spodumene within the aluminosilicate matrix. The optimal parameters of thermochemical treatment were determined as 300 °C for 1 h at a liquid-to-solid ratio of 1:6. Subsequent aqueous leaching (90 °C, 1 h, L/S = 6:1) achieved a lithium recovery of 82.3%, while HCl proved less effective. Using response surface methodology (RSM) and a central composite design (CCD), a regression model was developed predicting up to 93.4% lithium extraction at 90 °C, a liquid-to-solid ratio of 10:1, and a leaching duration of 75 min. The calculated values showed good agreement with experimental data obtained at 90 °C, L/S = 10:1, and 30 min leaching, yielding 91.92% lithium recovery. These results confirm the efficiency of the proposed thermochemical approach and provide a scientific foundation for its further development and industrial scale-up. Full article

Background: Hyaluronic acid (HA) fillers are commonly used for midface augmentation because of their biocompatibility and reversibility. Nonetheless, discussions continue about their effectiveness and safety relative to other options. This systematic review and meta-analysis assess the effectiveness, duration, and side effects of HA fillers in midface volume restoration. Methods: Following PRISMA guidelines, a thorough search was performed on PubMed, CENTRAL, Web of Science, Scopus, and EMBASE up to March 2025. The review included randomized controlled trials (RCTs) that compared HA fillers with controls, such as placebo or alternative treatments, for midface augmentation. Results: A total of fourteen studies were included in the review, and five studies in the statistical analysis. Analysis of five RCTs involving 748 participants showed a higher and significant difference in GAIS responder rates between HA and control groups (RR = 3.27, 95% CI: 2.26–4.75, p = 0.79; I² = 95%). GAIS scores at 4, 8, and 24 weeks demonstrated no notable improvements (all p > 0.05). Adverse events were rarely reported, and there was no significant rise in moderate-to-severe adverse events associated with HA fillers (RR = 1.70, 95% CI: 0.08–34.55, p = 0.73). Conclusions: HA fillers used for midface augmentation are generally safe, they have very high midface augmentation and patient satisfaction value, but they might not provide a notable subjective aesthetic benefit over the other fillers. Clinicians need to take into account patient expectations and refine their techniques, all while recognizing the limitations of existing evidence. Future research should include objective volumetric measurements and extend follow-up durations. Full article

Background: Surgical procedures and alterations of the gastrointestinal (GI) tract increase the risk of small intestinal bacterial overgrowth (SIBO), which is associated with GI symptoms and complications that compromise postoperative recovery. However, the prevalence and clinical impact of SIBO after various upper GI surgical procedures remain poorly understood. Objective: This study aimed to evaluate the prevalence of SIBO after different types of upper GI surgery and to investigate the associated clinical factors. Methods: We conducted an observational study involving 157 patients with a history of upper GI surgery: Roux-en-Y gastric bypass (RYGB), laparoscopic single-anastomosis gastric bypass (OAGB), subtotal (STG) or total gastrectomy (TG), subtotal (SP)or total pancreatectomy (TP), cephalic duodenopancreatectomy (WR), and small bowel resection for Crohn’s disease. A glucose–hydrogen breath test was performed, and demographic, clinical, and treatment-related data were collected. Statistical analyses included t-tests, non-parametric tests, ANOVA, and correlation analyses using R software. Results: At a median follow-up of 25.7 ± 18.1 months, 31% (48/157) of patients tested positive for SIBO. The highest prevalence was observed after RYGB and OAGB (43%), followed by TG (30%), STG (29%), TP/WR (28%), and Crohn’s disease bowel resection (19%). No cases of SIBO were observed after SP. SIBO positivity was significantly associated with bloating and flatulence (p = 0.002), lactose intolerance (p = 0.047), systemic sclerosis (p = 0.042), T2D (p = 0.002), and exposure to adjuvant chemotherapy (p = 0.001) and radiotherapy (p = 0.027). In addition, the risk of SIBO increased proportionally with the duration of GI resection or exclusion (p = 0.013). Conclusions: In our study, the prevalence of SIBO after upper GI surgery was 31%, with the highest incidence (43%) observed in metabolic surgery patients. Importantly, adjuvant radio/chemotherapy was associated with an increased risk of SIBO, and extensive small bowel resection or exclusion was strongly associated with an increased risk of SIBO. Furthermore, the limitations of current diagnostic methods, which lack sufficient sensitivity and specificity, highlight the importance of early screening and standardization of diagnostic techniques to improve patient management and outcomes. Full article

Background/Objectives: Decompressive craniectomy (DC) is commonly applied to manage refractory intracranial hypertension in severe traumatic brain injury (TBI). However, its role and benefits in pediatric populations remain uncertain. Clarifying whether DC provides measurable clinical advantages in children with severe TBI may inform treatment strategies and family counseling. Methods: We conducted a retrospective, one-to-one matched cohort study at a tertiary pediatric center (2014–2023). Fifty-three children with severe TBI who underwent DC were matched with fifty-three non-DC patients based on age, Glasgow Coma Scale score, cranial CT findings, and pupillary response at admission to ensure comparable injury severity. Demographic data, clinical features, and outcomes were collected. Primary outcomes were in-hospital mortality and Pediatric Cerebral Performance Category (PCPC) scores at discharge and 3 months. Secondary outcomes included duration of mechanical ventilation, intensive care unit (ICU) stay, and total hospital stay. Results: Mortality did not differ significantly between DC and non-DC groups (17.0% vs. 26.4%, p = 0.239). DC patients had better PCPC scores at discharge (p = 0.029). At 3 months, the between-group difference was not statistically significant but showed a near-significant trend (p = 0.057). No significant differences were observed in duration of ventilation (p = 0.100), ICU stay (p = 0.348), or hospital stay (p = 0.678). Conclusions: DC may not reduce short-term mortality in pediatric severe TBI but appears to be associated with more favorable neurological outcomes at discharge. Larger, adequately powered studies with standardized monitoring and longer follow-up are needed to clarify the durability and scope of potential benefits in this population. Full article

Open reduction and internal fixation (ORIF) for mandibular condyle fractures remains a controversial and challenging issue, with the exception of basal and low-neck fractures. Currently, there is a consensus that fractures causing irreparable malocclusion or dislocation, when the fracture line runs through the base or lower neck of the condyle, require ORIF. Due to the different characteristics of fractures, various surgical approaches and their modifications are available. The use of a minimally invasive intraoral approach during endoscope-assisted procedures is considered safer for the facial nerve and provides good esthetic results without facial scarring. This study aimed to compare two surgical approaches—retromandibular and intraoral—to examine post-operative outcomes and to guide surgical decision-making in the treatment of simple fractures of the base and low-neck condylar process of the mandible. Forty-nine patients (thirteen female, thirty-six male) were analyzed: eighteen were treated with the intraoral approach, and thirty-one with the retromandibular approach. There were no statistical differences in the duration of surgery, but intraoperative blood loss was significantly lower in patients treated endoscopically compared with those treated with an extraoral approach. Post-operative facial nerve and TMJ function were comparable in both groups. The endoscope-treated patients were at a higher risk of fracture non-union, but these findings should be considered with connection with the small sample size. The intraoral approach is a valuable option for basal or low-neck fractures but demands significant surgical experience due to its technical complexity. Full article

Background/Objectives: Antimicrobial resistance (AMR) is a major global health threat, with children at higher risk due to developmental differences in drug metabolism, limited treatment options and inappropriate antibiotic use. Pediatric antimicrobial stewardship programs (ASPs) face implementation challenges, often relying on adult-based guidelines and limited pediatric-specific evidence. This study aimed to identify and prioritize the most critical areas for pediatric ASP intervention development through a structured, multi-round Delphi consensus process with experts in antimicrobial stewardship and infectious diseases. Method: A four-round modified Delphi process was conducted to identify and prioritize key pediatric ASP interventions. Experts in antimicrobial stewardship and infectious diseases were recruited through an existing clinical trial. Using an iterative survey and in-person discussions, experts provided input on priority areas, which were thematically grouped and refined across rounds. Structured feedback supported real-time refinement and consensus-building. Results: Twenty experts participated in the process, generating 25 priority items in Round 1 through open-ended responses. These were narrowed to seven key priorities through structured voting and discussion. The final items were clustered into three intersecting themes: Care Settings, Prescriptions, and Strategies. Care Settings focused on high-impact areas such as outpatient clinics and intensive care units, where misuse is common and/or care is complex. The prescriptions theme prioritized shorter durations and narrow-spectrum agents. The strategy theme highlighted the need for outcome-based metrics, improved diagnostic stewardship, and routine tracking of patient outcomes to guide and assess stewardship efforts. Conclusions: This expert consensus identified key priorities for pediatric ASPs, providing a foundation for future interventions. Findings can be used to inform policy and practice, improving the appropriate use of antimicrobials in pediatrics and combating AMR. Full article

This study investigated the effects of elevated temperature on the phenology and morphology of the early-maturing peach cultivar ‘Mihong’. The experiment was conducted from 2019 to 2024 in a temperature-gradient chamber at the National Institute of Horticultural and Herbal Science, Wanju, Korea, with four warming treatments (+2.2 °C to +5.0 °C above ambient). Higher temperatures delayed the onset of endodormancy and markedly shortened the period from endodormancy release to full bloom. Elevated temperatures also increased the LD ratio, with the proportion of fruits exceeding an LD ratio of 1.0 rising significantly with temperature. The LD ratio showed strong correlations with November mean temperature (MT11) and March maximum temperature (HT3) (r = 0.81) and was also associated with the average temperature (Temp3, r = 0.51) and duration (P3, r = −0.54) of the endodormancy release to full bloom phase. Stepwise and PLS regression identified temperatures in May, November, and March as key predictors of the LD ratio, while PCA revealed that temperature variables (Temp3, Temp5) and stage durations (P3, P4) were major contributors. These results confirm that climate warming alters the phenology and morphology of ‘Mihong’, reducing fruit quality and marketability, while providing a basis for predictive modeling and highlighting the importance of adaptive strategies such as shading or growth regulator application. Full article

Larix olgensis is a valuable timber species in northern China, typically propagated through somatic embryogenesis (SE). However, long-term subculture can lead to a loss of embryogenic potential. This study aimed to establish a simple and stable protocol for the cryopreservation and regeneration of L. olgensis embryogenic callus (EC) that preserves its SE potential and regenerative capacity. The slow-freezing method was employed for cryopreservation. A cryopreservation protocol for L. olgensis EC was developed by optimizing the preculture duration and conditions, cryoprotectant composition and thawing temperature. The results showed that optimal outcomes were achieved using a 24 h stepwise preculture on medium containing 0.2 and 0.4 mol∙L⁻¹ sucrose, followed by cryoprotectant treatment with 0.4 mol∙L⁻¹ sucrose, 2.5% (v/v) dimethyl sulfoxide (DMSO) and 10% polyethylene glycol 6000 (PEG₆₀₀₀), and thawing at 37 °C. EC cryopreserved using this protocol achieved a 100% recovery rate. Moreover, the cryopreserved recoverable EC successfully underwent SE, progressing through germination and rooting. Cryopreservation duration (storage duration in liquid nitrogen) did not affect cell viability and proliferation rate, confirming the protocol’s suitability for long-term cryopreservation of L. olgensis EC. This study provides a valuable reference for the cryopreservation and regeneration of L. olgensis EC, with potential applications for other coniferous species. It establishes a robust foundation for the large-scale propagation of conifers. Full article

The ongoing opioid epidemic in the United States highlights the need for novel analgesics with reduced risk of misuse, dependence, and adverse central nervous system effects. Suzetrigine (trade name Journavx), a first-in-class selective Nav1.8 (a sodium channel expressed in peripheral nociceptors) inhibitor, was approved by the FDA in early 2025 and marketed as the first non-opioid analgesic in over two decades. Current studies have shown that suzetrigine has potential in treating acute pain perioperatively for minimally to moderately painful ambulatory procedures. However, suzetrigine appears less potent than hydrocodone-acetaminophen in this context, and it remains unclear how effective suzetrigine is in treating more severe postoperative pain. Notably, all current studies are limited to short durations of treatment; further studies will be required to delineate suzetrigine’s long-term efficacy, safety, and addiction potential to be utilized in the management of chronic pain patients. This article provides a review of the current literature available on the use of suzetrigine in treating acute pain. Full article

Small-diameter vascular grafts often fail due to thrombosis and compliance mismatch. Decellularized plant scaffolds are a biocompatible, sustainable alternative. Leatherleaf viburnum leaves provide natural architecture and mechanical integrity suitable for tissue-engineered vessels. However, the persistence of immunogenic plant biomolecules and limited degradability remain barriers to clinical use. This study tested whether mild heat treatment improves scaffold biocompatibility without compromising mechanical performance. Decellularized leatherleaf viburnum scaffolds were treated at 30–40 °C in 5% NaOH for 15–60 min and then evaluated via tensile testing, burst pressure analysis, scanning electron microscopy, histology, and in vitro assays with white blood cells and endothelial cells. Scaffold properties were compared to those of untreated controls. Heat treatment did not significantly affect scaffold thickness but decreased fiber area fraction and diameter across all anatomical layers. Scaffolds treated at 30–35 °C for ≤30 min retained >90% of tensile strength and achieved burst pressures ≥820 mmHg, exceeding physiological arterial pressures. Heat treatment reduced surface fractal dimension while increasing entropy and lacunarity, producing a smoother but more heterogeneous microarchitecture. White blood cell viability increased up to 2.5-fold and endothelial cell seeding efficiency improved with treatment duration, with 60 min producing near-confluent monolayers. Mild alkaline heat treatment therefore improved immune compatibility and endothelialization while preserving mechanical integrity, offering a simple, scalable modification to advance plant-derived scaffolds for grafting. Full article