Search Results (21,474)

Adult deep neck infection (DNI) is a potentially life-threatening condition associated with significant morbidity and mortality. Contemporary large-scale data characterizing long-term microbial evolution and clinical outcome trends in adult DNI remain limited. This study aimed to investigate temporal changes in bacterial pathogens, treatment strategies, and clinical outcomes of adult DNI across an 18-year period. This is a retrospective multicenter cohort study using the Chang Gung Research Database (CGRD) and a de-identified nationwide database from Taiwan’s largest medical system. Hospitalized adult patients (aged ≥18 years) with DNI from 2006 to 2023 were identified and stratified into two consecutive 9-year epochs (Epoch 1: 2006–2014, n = 5512; Epoch 2: 2015–2023, n = 6551). Demographics, comorbidities, treatment modalities, disease severity, and microbiological profiles were analyzed. Bacterial isolates were evaluated at genus and species levels, with methicillin-sensitive Staphylococcus aureus (MSSA) and methicillin-resistant S. aureus (MRSA) assessed separately. Among 12,063 adult DNI patients (Epoch 1: n = 5512; Epoch 2: n = 6551), antibiotic-only treatment increased (77.3% to 83.2%) and surgical intervention decreased (22.7% to 16.9%). Descending necrotizing mediastinitis decreased markedly (2.7% to 0.7%) and in-hospital mortality declined (7.7% to 6.4%). Poly-microbial infections increased substantially (45.3% to 53.7%). Among facultative anaerobic and aerobic isolates, the Streptococcus anginosus group (SAG) emerged as a clinically important pathogen. Among anaerobes, Prevotella displaced Peptostreptococcus as the dominant genus, with Peptostreptococcus micros (Parvimonas micra) and Prevotella buccae emerging as prominent species. Over 18 years, adult DNI in Taiwan demonstrated significant improvements in clinical outcomes, with marked reductions in mediastinitis and in-hospital mortality. Concurrently, poly-microbial infections increased, and the SAG, Peptostreptococcus micros (Parvimonas micra), Prevotella, and anaerobic organisms emerged as clinically important pathogens, underscoring the need for empiric antibiotic regimens providing broad aerobic and anaerobic coverage. Although microbiological profiles vary geographically, these findings provide a contemporary evidence base to guide empiric antibiotic selection, inform surgical decision-making, and identify high-risk adult patients with DNI. Full article

The rapid adoption of large language models (LLMs) in financial services has generated a growing literature on “responsible AI” in domains such as investment analysis, credit assessment, risk management, compliance, and financial advisory systems. Unlike earlier AI systems, LLMs introduce responsibility challenges that differ in important ways from those addressed by earlier responsible AI frameworks, including hallucinations, prompt injection and manipulation, generative opacity, instruction-following failures, context sensitivity, output inconsistency, and emergent capabilities that arise only at larger model scales. While responsible AI concerns extend across AI systems more broadly, this review focuses specifically on LLMs, which since 2022 have become a major technological force reshaping financial services and have generated a distinctive body of responsibility discourse that existing frameworks are only beginning to address. However, the meaning of responsibility in this literature remains heterogeneous and inconsistently operationalized across studies. This paper provides a structured review of research on responsible LLMs in finance using a broad-to-narrow screening process across Web of Science and Scopus, reported with reference to the applicable PRISMA 2020 items . We combine a descriptive bibliometric overview with qualitative content analysis to examine the corpus. The descriptive overview covers publication trends, publication venues, disciplinary orientations, geographic distributions, and institutional affiliations, while the qualitative analysis codes the corpus on two dimensions: responsibility depth—whether responsibility is constitutive of the paper’s contribution, operative within its design, or peripheral to its framing—and responsibility mode—whether that engagement is normative, technical, evaluative, or mixed. The findings reveal a field concentrated in the Operative–Technical mode. Constitutive contributions cluster in Normative and Mixed modes, while a purely Evaluative orientation remains comparatively uncommon. Addressing these limitations requires moving beyond principle-level discourse toward institution-specific accountability mechanisms, empirical evaluation across clearly documented research and operational settings, and systematic alignment with relevant financial regulatory requirements. These efforts must address the distinctive challenges posed by LLMs, rather than only concerns inherited from the broader responsible AI literature. Full article

Transformative experiences are often described as pivotal moments of change in psychotherapy, yet relatively little is known about how such experiences are perceived within group settings. This study explored how group members and therapists describe moments of change in group psychotherapy and examined the therapeutic factors and relational processes associated with these experiences. Eight semi-structured interviews were conducted with four former group members and four licensed group therapists. Data were analyzed using reflexive thematic analysis, while descriptive counts were used to illustrate the prominence of Yalom’s therapeutic factors in participants’ accounts. All eleven of Yalom’s therapeutic factors were identified in participant narratives, with universality and cohesion emerging most frequently. Moments of change were described as emotionally significant relational experiences characterized by shared humanity, recognition, and meaning-making. Five relational processes were identified: emotional holding, risk-taking and courage, internalization of the group, therapist emotional presence, and liberation from shame. Findings suggest that moments of change emerge through the interplay of relational safety, attuned therapist presence, and courageous interpersonal engagement. The study highlights relational processes through which established therapeutic factors become experientially meaningful and contribute to psychological change within group psychotherapy and may be associated with psychological insight. Full article

Purpose: Despite the increasing use of digital platforms during health emergencies, little is known about the cognitive and structural mechanisms through which social media quality information influences preventive healthcare behaviour, particularly in low-resource settings. Drawing on the integration of the Protection Motivation Theory and Andersen’s Behavioural Model, this study examines how social media quality information shapes preventive healthcare behaviour in Sierra Leone by investigating the mediating role of risk perception and the moderating role of psychological resilience. Methods: A quantitative, cross-sectional survey approach was adopted, and data were collected from social media users in Sierra Leone, Africa, and analysed using IBM SPSS 25 and SmartPLS 4.1 to evaluate the measurement and structural models. Results: The findings disclose that SMQI significantly influences preventive behaviour both directly and indirectly via RP. Furthermore, RES positively and significantly moderates the relationship between risk perception and preventive healthcare behaviour, acting as a catalyst for action, while access to preventive resources (AcPR) serves as a critical enabling factor. Implications: This study advances health behaviour theory by integrating cognitive, psychological, and structural determinants into a cohesive model and establishes resilience as a vital boundary condition for effective crisis response. The findings offer actionable insights for policymakers and health communicators to design high-quality social media interventions that not only inform citizens but also foster the psychological resilience necessary for sustained health compliance. Full article

Abdominal aortic aneurysm (AAA) carries a rupture-related mortality exceeding 80% when untreated. Percutaneous endovascular aortic aneurysm repair (pEVAR) represents the current technical frontier, although evidence regarding its clinical and economic benefits remains heterogeneous. This narrative review of PubMed, Scopus, and Web of Science from inception to 1 August 2026 synthesises comparative data from 67 publications and four manufacturer websites to evaluate the clinical, quality-of-life, and economic outcomes of pEVAR against open femoral exposure. Current evidence suggests that pEVAR may serve as a feasible alternative to open femoral exposure, offering potential benefits regarding access-site morbidity, hospital length of stay, and early postoperative pain. While RCTs report pEVAR’s early perioperative advantages, evidence regarding long-term safety, anatomy, and costs remains predominantly observational. Additionally, pEVAR allows for locoregional anaesthesia, a strategy hypothesized to positively influence short-term outcomes in ruptured aneurysm emergencies, although prospective validation is required. However, maintaining these benefits relies heavily on overcoming the procedural learning curve and ensuring rigorous pre-procedural patient selection via computed tomography angiography to avoid severe vessel calcification and excessive depth. Available evidence suggests that in carefully selected patients, pEVAR yields an overall safety profile comparable to surgical cutdown, while potentially mitigating the risk of access-site complications. Full article

Heart failure with preserved ejection fraction (HFpEF) represents an increasingly prevalent clinical syndrome, driven by population ageing and the growing burden of cardiometabolic comorbidities, and is associated with significant morbidity and mortality. Due to its heterogeneous pathophysiology and the frequent absence of overt structural abnormalities, early diagnosis and accurate risk stratification remain challenging. In the current era of emerging disease-modifying therapies, the identification of sensitive imaging markers able to detect early myocardial dysfunction and refine patient characterization has become increasingly important. Speckle-tracking echocardiography has emerged as a valuable tool for the comprehensive evaluation of HFpEF, allowing the assessment of subclinical myocardial impairment beyond conventional parameters. Left ventricular global longitudinal strain (LV-GLS) identifies subtle systolic dysfunction despite preserved left ventricular ejection fraction (LVEF) and provides incremental diagnostic and prognostic information. Accordingly, LV-GLS has been incorporated into contemporary diagnostic algorithms and may represent a promising marker for monitoring disease progression and therapeutic response. Beyond the left ventricle (LV), left atrial (LA) strain has gained increasing relevance as a marker of atrial myopathy and elevated filling pressures. Left atrial reservoir strain (LARS) detects early atrial dysfunction before overt structural remodelling, improves the identification of HFpEF in patients with unexplained dyspnoea, and provides additional prognostic information, including prediction of atrial fibrillation and thromboembolic risk. Moreover, right ventricular free-wall longitudinal strain (RV-FWLS) allows early recognition of right ventricular involvement and has shown important prognostic implications, particularly in relation to pulmonary vascular dysfunction and exercise intolerance. Overall, a multi-chamber strain-based approach may improve HFpEF diagnosis, phenotyping, and risk stratification, supporting a transition toward a more personalized management strategy. Further prospective studies are needed to define the role of strain imaging in guiding therapeutic decisions and monitoring treatment response. Full article

Dementia with Lewy bodies (DLB) is increasingly conceptualised not merely as a disorder of neuronal death but as a primary synaptopathy in which the functional collapse of synaptic transmission and plasticity precedes, and predicts, neurodegeneration and clinical decline. Two genetic determinants dominate the heritable risk architecture of DLB: the α-synuclein gene SNCA, in which both copy-number variation and missense mutations exert dose- and conformation-dependent effects, and GBA1, encoding the lysosomal hydrolase glucocerebrosidase (GCase), the single most influential genetic risk factor for the disease. Here we synthesise evidence that these loci converge on a shared pathogenic endpoint—the impairment of activity-dependent synaptic plasticity. We argue that GBA1 loss-of-function and the resulting accumulation of glucosylceramide stabilise specific neurotoxic α-synuclein proteoforms, including soluble oligomers and self-templating conformational strains bearing defined post-translational modifications. These proteoforms are trafficked to, and enriched within, presynaptic terminals, where they disrupt SNARE-complex assembly and synaptic-vesicle dynamics, while postsynaptically they perturb NMDA and AMPA receptor trafficking, dysregulate dendritic calcium, and compromise synaptic mitochondrial bioenergetics. The net consequence is a metaplastic shift away from long-term potentiation (LTP) and toward aberrant long-term depression (LTD), a signature of synaptic failure detectable before frank pathology. We map these molecular events onto disease-relevant circuits—particularly the cholinergic basal forebrain and hippocampal–cortical and thalamocortical networks—and relate them to the defining neuropsychiatric features of DLB, including cognitive fluctuations and recurrent visual hallucinations. Finally, we evaluate emerging therapeutic strategies that target the GBA1–α-synuclein axis and that aim to restore synaptic plasticity directly. Positioning DLB within the framework of genetically determined plasticity deficits clarifies its kinship with other neuropsychiatric disorders and identifies the synapse as the most tractable node for early, disease-modifying intervention. We further examine how GBA1 allele severity and zygosity grade the phenotype, which genetic and environmental factors modify penetrance in carriers, and what distinguishes this synaptopathy from those driven by PSEN1/PSEN2, MAPT, or HTT, and we summarise the therapeutic pipeline—including enzyme augmentation and adeno-associated viral GBA1 gene therapy—that targets it. Full article

Digitization is reshaping how banks operate, yet whether it improves corporate financial performance remains unsettled. This study examines how the digital transformation that banks disclose relates to the structure of their key financial performance indicators. Using a balanced panel of 73 listed Gulf Cooperation Council (GCC) banks over 2020–2025 (438 bank–year observations), digital transformation is measured by a text-mined digital disclosure index (DDI, 0–100) constructed from annual reports and decomposed into nine themes. Bank fixed-effects regressions with Driscoll–Kraay standard errors, one-year-lagged specifications, and two-step system GMM are estimated across profitability, net interest margin, cost efficiency, credit risk and capital adequacy. Disclosed digitization more than doubled over the window, but its associations with performance are conditional rather than uniformly positive. Within banks, a higher DDI value is associated with wider net interest margins, yet also with lower profitability, higher cost-to-income ratios, modestly higher credit risk, and thinner capital buffers. This pattern is consistent with an investment or build-out phase in which the costs of digital transformation are visible before any efficiency or stability dividend and in which margins are the single offsetting benefit. The six-year window observes only this cost-bearing segment and not any later recovery, so the study documents the investment-phase drag rather than a completed cycle. The theme decomposition indicates that the margin association is closest to regulatory technology, cybersecurity, broad transformation and payments. Because the design is observational, the results are interpreted as within-bank associations rather than causal effects, and, although precisely estimated, these associations are economically modest. The study contributes a transparent theme-decomposed measure of bank digitization and evidence on its limits for corporate financial performance in an emerging-market banking region. Full article

The emergence of nanotechnology has led to a rapid increase in intentional and unintentional exposure to engineered nanoparticles (NPs), raising significant concerns over their impact on humans, animals, and ecosystems. Nanotoxicology has evolved to assess these adverse effects, but the field faces key challenges including complex physicochemical characterization, difficulties in exposure assessment, dynamic biological interactions, and distinct regulatory gaps. To address these challenges, solutions such as the standardization of testing protocols, the adoption of advanced 3D in vitro and in silico modeling, and the implementation of “safer-by-design” principles are proposed. The development of biodegradable nanomaterials (NMs) and effective risk management further emphasizes that responsible development and interdisciplinary collaboration are essential to balance technological innovation with human and environmental safety. Full article

Bronchopulmonary dysplasia (BPD) remains one of the leading chronic respiratory complications of extreme prematurity despite major advances in neonatal intensive care. Current diagnostic definitions are primarily based on respiratory support requirements and provide limited information on the biological heterogeneity and longitudinal evolution of lung injury. Lung ultrasound (LUS) is progressively reshaping the clinical approach to BPD by enabling radiation-free, bedside, and repeatable assessment of peripheral lung abnormalities throughout the neonatal course. This narrative review examines the current role of LUS in BPD, integrating its pathophysiological basis with the available evidence and distinguishing explicitly between its diagnostic, prognostic, monitoring, and treatment-guiding applications, which are supported by markedly different levels of evidence. We discuss how LUS findings reflect the major components of BPD pathophysiology, compare LUS with conventional imaging modalities, and summarize the scanning protocols, semiquantitative scoring systems, examination schedules, and patient populations that have been evaluated to date. We also review the emerging contribution of artificial intelligence to automated image analysis, standardized image acquisition, and personalized risk prediction. Most of the available evidence is prognostic rather than diagnostic: early LUS scores predict BPD subsequently defined at 36 weeks’ postmenstrual age, whereas LUS has not been validated as a diagnostic test for established BPD, and reported cutoffs remain study- and protocol-specific rather than universally applicable. Randomized evidence is confined to LUS-guided surfactant administration, where the demonstrated benefits concern the timing of treatment and the need for invasive ventilation; no trial has yet shown that LUS-guided management reduces the incidence of BPD. Current evidence supports LUS as a complementary imaging modality that extends beyond the assessment of acute neonatal respiratory disease and enables longitudinal bedside monitoring of peripheral lung aeration. Although further multicenter prospective studies are required to harmonize protocols and validate LUS-guided management strategies, the integration of standardized LUS assessment with emerging artificial intelligence technologies has the potential to establish LUS as a key component of precision respiratory care for infants at risk of BPD. Full article

Background: Chronic lower limb wounds, such as diabetic and vascular ulcers, affect up to 2% of the global population, imposing high healthcare costs and a significant risk of amputation. Although nursing care and traditional treatments are fundamental, single-use portable Negative Pressure Wound Therapy PICO 7 system, has emerged as a cost-effective alternative. The objective of this study was to evaluate the effectiveness of PICO 7, compared to the usual treatment in chronic lower limb wounds or their dehiscence in amputations. Methodology: A randomized, controlled, open-label clinical trial was conducted at the Hospital Universitario de Toledo (2024–2026). The final analyzed sample consisted of 31 patients (Intervention Group, IG: 14; Control Group, CG: 17). Both groups followed the dynamic TIME strategy to standardize wound bed preparation. Primary variables included healing rate, healing time, wound area reduction, clinical safety (infections and adverse effects), pain levels, health-related quality of life, and physical activity. Statistical analysis was performed using SPSS v.28. Results: The IG showed a higher mean percentage reduction in wound size, although the between-group difference did not reach statistical significance. No infections were recorded in the IG. Regarding quality of life and physical activity, the CG showed a significant post-intervention decline, whereas the IG remained stable. A significant negative correlation was found between final wound size and hours of sleep, suggesting that wound reduction facilitates better rest. Conclusions: The PICO 7 system appears to be a safe and feasible alternative to conventional wound care. Favorable trends in wound area reduction should be interpreted cautiously given the lack of statistically significant between-group differences. Full article

Chimeric antigen receptor T-cell therapy and bispecific T-cell engagers have transformed treatment of relapsed and refractory hematologic malignancies, achieving unprecedented response rates. However, their clinical adoption has revealed a complex spectrum of cardiovascular toxicities, differing in frequency and pattern between the two technologies. Manifestations range from common hemodynamic perturbations—hypotension and tachycardia—to severe events, including malignant arrhythmias, left ventricular dysfunction, myocardial infarction, and cardiogenic shock. These complications seem to have different pathophysiological pathways that are yet to be completely understood: on the one hand, they are frequently intertwined with cytokine release syndrome, the hallmark immune complication of T-cell-redirecting therapies, as seen with chimeric antigen receptor T-cell therapy; on the other, a substantial proportion of cardiovascular events—particularly with bispecific T-cell engagers—occur independently of cytokine release syndrome. Proposed cardiotoxic mechanisms include on-target, off-tumor antigen recognition and consequent damage; interleukin-6-driven systemic inflammation; and off-target, off-tumor antigen cross-reactivity. Effective management requires proactive baseline risk stratification, serial cardiac biomarker monitoring, and timely immunosuppressive intervention—primarily tocilizumab—to mitigate cytokine release syndrome-driven injury. Despite rapid clinical expansion, critical gaps remain: long-term cardiovascular outcomes are poorly characterized, validated surveillance protocols are lacking, and cardiovascular endpoints are rarely included in pivotal trials. This narrative review appraises the pathophysiology, clinical spectrum, and management of cardiovascular toxicities associated with these therapies, aiming to define this emerging cardio-oncology frontier, inform multidisciplinary care frameworks and propose a clinical management algorithm. Full article

Tendinopathies represent a major clinical challenge. Vasculature, neuromuscular junctions, low cellularity, and slow extracellular matrix (ECM) turnover restrict endogenous repair and predispose injured tendons to fibrosis, mechanical weakness, and reinjury. Current therapeutic strategies including rehabilitation protocols, anti-inflammatory medications, platelet-rich plasma (PRP) injections, and surgical repair primarily address symptoms or structural deficits without correcting the underlying biological limitations of tendon healing. Cell-based therapies have emerged as a promising regenerative approach aimed at restoring tissue homeostasis through modulation of angiogenesis, collagen synthesis, immune responses, and tenogenic differentiation. Mesenchymal stem cells (MSCs), adipose-derived stem cells (ADSCs), tendon-derived stem cells (TDSCs), induced pluripotent stem cells (iPSCs), differentiated tenocytes, and extracellular vesicle (EV)-based products have demonstrated the ability to enhance vascularization, promote type I collagen remodeling, suppress excessive inflammation, and stimulate tenocyte lineage commitment. These effects are mediated through paracrine signaling, growth factor secretion, and activation of key pathways, including HIF-1α, TGF-β/SMAD, NF-κB, and PI3K/Akt signaling. Despite promising preclinical data, significant translational challenges remain, including limited cell survival at the injury site, variability in cell sources and dosing, immunogenicity, risk of misdifferentiation, and lack of standardization across clinical protocols. Emerging strategies such as genetic modification, hypoxic preconditioning, scaffold-based delivery systems, and extracellular vesicle engineering aim to enhance therapeutic efficacy and reproducibility. This review synthesizes current evidence on cell-based tendon repair, critically evaluates mechanistic insights, clinical trials, and translational barriers, and outlines future directions toward biologically informed regenerative therapies. Full article

‘Wellness-at-sea’ is an integral part of the cruise holiday service bundle. Marketed within an image of experiential diversity within a safe, controlled environment, it features medical centers, spa facilities and restoration-focused itineraries. Nevertheless, epidemiologically speaking, cruise ships rank amongst the riskiest transmission environments in tourism. This perspective paper proposes a typology of wellness cruising along two axes (i.e., offer scope: themed voyages versus onboard amenities and promotion focus: borrowed credibility versus narrative ‘storyscaping’) and uses it to develop the ‘wellness-risk paradox’, a boundary case for health-tourism literature. Three testable propositions emerge: reputational risk exposure increases with the offer’s wellness centrality; narrative-based promotion is more susceptible than credibility-based promotion and a quadrant-adjusted health-assurance scheme is more effective than current inspection standards. The argument draws on the 2026 Andes hantavirus outbreak aboard the MV Hondius (three deaths among thirteen cases), the 2020 Diamond Princess outbreak, and a decade of official outbreak surveillance, reporting an increase in gastrointestinal outbreaks from 0.34 to 0.62 per million passengers between 2019 and 2025 (rate ratio 1.84, 95% CI 0.87–3.86), which reverses the pre-pandemic downward trend although annual counts remain too small for the change to reach conventional statistical significance. Sanitation-inspection compliance cannot reliably predict outbreaks, nor does it facilitate trust. Four domains of action are proposed: continuous air-quality monitoring, wastewater surveillance, behavioral risk modeling and jurisdictional coordination. Full article

Cancer-associated thrombosis (CAT) is defined as venous or arterial thrombotic events occurring in patients with active malignancy or during anticancer treatment, most commonly presenting as venous thromboembolism and representing a leading cause of morbidity and mortality in oncology. Hormone-sensitive malignancies, including breast, ovarian, and endometrial cancers, are characterized by a complex interaction among tumor biology, endocrine signaling, inflammation, endothelial dysfunction, and coagulation activation. In these malignancies, venous thromboembolism (VTE) risk is influenced not only by intrinsic tumor-related mechanisms but also by patient-specific factors and anticancer therapies, particularly endocrine treatments, chemotherapy, targeted agents, and extensive surgical procedures. Breast cancer is generally associated with an intermediate thrombotic risk, although endocrine therapy—especially tamoxifen—significantly increases VTE incidence. Ovarian cancer represents one of the most thrombogenic solid tumors because of elevated tissue factor expression, inflammatory activation, advanced-stage presentation, and aggressive multimodal treatment strategies. Endometrial cancer exhibits a strong association with obesity, metabolic syndrome, prolonged estrogen exposure, and perioperative thrombotic complications. Emerging evidence highlights the role of immune-thrombosis, extracellular vesicles, inflammatory cytokines, and sex-specific coagulation pathways in cancer-associated hypercoagulability. Current guidelines increasingly support individualized thromboprophylaxis based on tumor biology, patient-specific risk factors, and bleeding risk assessment. This review summarizes the biological mechanisms linking hormones and thrombosis in breast and gynecologic cancers, discusses current evidence regarding VTE risk factors and treatment-related thrombotic complications, and explores modern approaches to biomarkers, risk stratification, and personalized thromboprophylaxis. Full article