Search Results (1,610)

Partial breast irradiation (PBI) and omission of sentinel lymph node biopsy (SLNB) are major advances in the de-escalation of locoregional treatment for early-stage breast cancer. These strategies have evolved independently under different clinical assumptions. The randomized trials establishing PBI incorporated pathological axillary staging into patient selection, although the permitted nodal burden varied among studies, whereas contemporary trials have demonstrated that sentinel lymph node biopsy (SLNB) can be safely omitted in carefully selected patients. Consequently, radiation oncologists are increasingly encountering otherwise suitable candidates for PBI who lack pathological nodal information because SLNB has been omitted, creating an important evidence gap. This narrative review examines how pathological nodal staging became embedded within PBI eligibility criteria and whether this long-standing requirement remains justified following the introduction of SLNB omission. We discuss the biological and clinical rationale underlying current patient selection for PBI, the limitations of extrapolating evidence from whole-breast irradiation to PBI, and the potential contribution of modern imaging, tumor biology, molecular profiling, and prediction models for occult nodal disease to individualized risk assessment. Current evidence does not justify routine implementation of PBI following omission of SLNB. Pathological nodal information may be considered as one component of integrated risk assessment rather than an isolated determinant of PBI eligibility. Patients otherwise meeting contemporary radiotherapy omission criteria represent the most appropriate population for prospective evaluation of this combined de-escalation strategy. This review defines the resulting evidence gap and proposes a conceptual framework for future clinical investigation. Full article

Background: Manure-amended agricultural soil is a critical reservoir of antibiotic resistance genes (ARGs), posing escalating threats to environmental health and food safety. However, the temporal trajectories of ARG prevalence throughout the complete reproductive cycle of cash crops, and their mechanistic linkages with fertilization regimes and microbial community succession, remain inadequately understood. Methods: To bridge this knowledge gap, we conducted an in situ field experiment over the entire growth period of Chinese cabbage at a long-term manure-amended farm in Tianjin, China. Six contrasting fertilization strategies were evaluated: unfertilized control (CK1), unfertilized baseline control (CK2), traditional full-rate combined manure–chemical fertilization (TF), traditional half-rate combined manure–chemical fertilization (T1), half-dose sole manure fertilizer (T2), and half-dose sole chemical fertilizer only (T3). Results: Our results demonstrated that ARG abundance and associated mobile genetic elements (MGEs) exhibited a pronounced transient surge immediately post-fertilization, yet reverted to baseline levels by harvest, revealing a tangible resilience of the soil resistome. Notably, the optimized half-organic fertilization (T2) effectively curtailed the proliferation of manure-derived pathogenic taxa while preserving beneficial keystone phyla (e.g., Acidobacteria and Proteobacteria), indicating a trade-off between nutrient provisioning and ecological filtering. Co-occurrence network analysis further identified MB-A2-108, Saccharimonadales, and Rokubacteriales as pivotal hosts for multidrug-resistant ARGs, underscoring that microbial interspecific interactions—rather than taxonomic richness alone—are the primary drivers of resistome succession. Quantitative risk assessment confirmed that the T2 regimen reduced the composite ARG contamination index (CF_zone) by 25% relative to conventional full fertilization (TF), while maintaining comparable cabbage yields. Conclusions: Collectively, our findings advocate for precision organic fertilization as a nature-based solution that synchronizes nutrient supply with crop demand, curtails ARG propagation, and mitigates long-term agroecological risks. Full article

Healthcare-associated infections (HAIs) caused by multidrug-resistant Klebsiella spp. represent a critical and escalating global public health threat. Carbapenem-resistant Klebsiella pneumoniae (CRKP) has been designated a critical-priority pathogen by the World Health Organization, and in the 2024 WHO Bacterial Priority Pathogens List, it was the top-ranked pathogen overall. The convergence of carbapenem resistance with hypervirulence in emerging strains has further complicated therapeutic decision-making. This review provides a narrative synthesis of the evidence published between 2020 and 2025 on the prevalence, resistance mechanisms, molecular epidemiology, clinical outcomes, and therapeutic strategies for Klebsiella pneumoniae infections acquired in healthcare settings, with particular attention to the Eastern European and Romanian context. PubMed/MEDLINE, Embase, Web of Science, and the Cochrane Library were searched for relevant publications from January 2020 to June 2025, supplemented by WHO and ECDC surveillance reports. Studies were selected narratively for their relevance to the themes addressed. No new quantitative pooling was undertaken; all summary estimates reported below are cited from the published meta-analyses and surveillance reports that generated them. In the most recent global meta-analysis of hospital-acquired CRKP infection, which pooled 61 studies and 513,307 patients from 14 countries, the global prevalence of CRKP among nosocomial K. pneumoniae infections was 28.69% (95% CI: 26.53–30.86%), with pronounced regional variation from 14.29% in high-income North America to 66.04% in South Asia, and 42.05% in Western Europe. Pooled mortality among patients infected with CRKP has been estimated in a separate meta-analysis at 42.14%, compared with 21.16% among patients infected with carbapenem-susceptible strains, rising to 54.30% in bloodstream infections. Surveillance data place Romania third in Europe for carbapenem resistance among invasive K. pneumoniae isolates, at 50.30%, with a distinctive predominance of NDM plus OXA-48-like co-producers. Ceftazidime-avibactam is recommended for KPC- and OXA-48-producing strains, whereas metallo-beta-lactamase producers require aztreonam-containing combinations. CRKP in HAIs constitutes a global epidemiological emergency characterised by marked regional heterogeneity in carbapenemase distribution, high attributable mortality and rapidly evolving molecular profiles. Locally adapted surveillance, rapid molecular diagnostics, and stewardship programmes are required since empirical therapy cannot be standardised across regions. Full article

Liquid biopsy, the analysis of tumor-derived material in blood, saliva, and other body fluids, is increasingly explored for the diagnosis, surveillance, and molecular characterization of head and neck squamous cell carcinoma (HNSCC). Its performance, however, is not uniform across the disease, and the reason is fundamentally molecular. human papillomavirus (HPV)-positive oropharyngeal cancers carry viral oncogenes that are absent from the host genome and therefore provide a near ideal, tumor specific circulating marker, whereas HPV-negative tumors are driven by a heterogeneous somatic landscape that offers no single universal target. In this narrative review, we adopt a molecular perspective. We first examine the biological origin of circulating tumor DNA and of the other analytes that liquid biopsy can interrogate including circulating tumor HPV DNA, viral transcripts, microRNAs, extracellular vesicles, and methylation signatures. We then consider how analytical platforms, from droplet digital PCR to next generation and ultrasensitive whole-genome sequencing, translate these molecules into measurements. Only afterward do we discuss the clinical questions, organized by clinical objective rather than by individual study: diagnosis and early detection, prognosis and risk stratification, treatment response monitoring, minimal residual disease and surveillance, and biomarker guided de-escalation in HPV-positive disease. Twelve registered clinical trials, involving approximately 1183 patients, are presented as illustrations of these questions. We close on the biological and technical gaps that still separate promising signals from clinical practice, and on the multi analyte and dynamic strategies most likely to bridge them. At present, liquid biopsy should be regarded as a complementary tool rather than as a replacement for established clinicopathological assessment. Full article

Background: The growing awareness of breast cancer’s molecular diversity has not changed the technical foundations of surgery itself, but it has profoundly reshaped how surgeons think about surgery. Rather than molecular biology prescribing specific surgery, it is the surgeon’s interpretation of biological behavior—tumor subtype, genomic risk, treatment responsiveness—that influences surgical timing, extent, and feasibility. This is particularly important in the developing world, where mastectomy continues to be the default surgery, not always because it is required, but because biological nuance is underutilized in surgical planning. This review integrates existing evidence, guidelines, and real-world clinical experience to show how a surgeon who understands tumor biology can meaningfully expand safe breast conservation, de-escalate axillary surgery, and align operative choices with systemic therapy. In essence, molecular biology becomes a lens through which surgeons can practice more personalized, precise, and less invasive surgery, without compromising oncologic safety. Recent findings: We present evidence-based algorithms focusing on Luminal A, Luminal B, HER2-positive, and triple-negative subtypes, while discussing the nuances of multifocal and multicentric disease, metaplastic histologies, and discordant lesion management. The review addresses axillary management in the molecular era, specifying the appropriateness of sentinel lymph node biopsy, targeted axillary dissection, or completion axillary dissection, and how subtype-specific nodal responses to neoadjuvant therapy can guide de-escalation strategies. Through clinical vignettes, we exemplify how molecular integration into surgical planning can modify clinical courses, enabling oncoplastic conservation in downstaged tumors and justifying definitive resection in chemo-resistant cases. We examine the implications of germline and somatic genetic testing on surgical decision-making, particularly in relation to BRCA1/2 and PALB2 mutation carriers, alongside ethical and practical counseling considerations. Additionally, we review emerging biomarkers—such as circulating tumor DNA and immune and radiomic signatures—and propose research priorities for their incorporation into surgical trials. Conclusions: Effective implementation necessitates enhanced surgeon education, standardized assays, and multidisciplinary coordination to promote equitable access, consistent utilization of biology-driven algorithms, and rigorous quality oversight. This review furnishes breast surgeons with a pragmatic framework for translating molecular knowledge into multidisciplinary, patient-centered care pathways that optimize oncological safety, aesthetic outcomes, and overall quality of life. Full article

Background/Objectives: Bone is the third most common site of solid-tumor metastasis, and surgical management spans a wide spectrum from observation to curative en bloc resection in selected patients. 18F-FDG PET/CT has been reported to alter oncologic management in 20% to 45% of patients across diverse settings, yet its specific impact on surgical decision-making within a multidisciplinary orthopedic oncology board (MOOB) reassessment and the predictors of decision change remain undefined. Methods: We retrospectively analyzed consecutive patients with histopathologically confirmed bone metastases evaluated at a tertiary-care MOOB between February 2023 and February 2026. For each patient, the surgical plan was recorded twice: first by the orthopedic team based on available conventional imaging (radiography, computed tomography, magnetic resonance imaging) and then as the final PET/CT-informed MOOB review. This design evaluates changes in decision-making intent after PET/CT-informed multidisciplinary reassessment, rather than the isolated causal effect of PET/CT or actual surgical implementation. Surgical plans were categorized as no surgery, palliative stabilization, palliative resection, or curative-intent resection, and changes were classified as no change, escalation, de-escalation, or cancellation. Results: Among 73 patients (mean age 64.7 ± 12.1 years; 53.4% male), the most frequent primaries were lung (37.0%), breast (21.9%), and renal cell carcinoma (13.7%). Following PET/CT-informed MOOB reassessment, the intended surgical plan changed in 53.4% of cases (p < 0.001), comprising surgery cancellation (27.4%), escalation (17.8%), and de-escalation (8.2%). Patients directed to no surgery increased fourfold (6.8% to 28.8%), and curative resection emerged as a post-reassessment recommendation (0% to 10.9%). SUVmax did not predict overall decision change, but higher SUVmax was associated with cancellation/de-escalation in the directional analysis. In exploratory multivariable analysis, polymetastatic disease (OR 0.051; 95% CI 0.005 to 0.547; p = 0.014), long-bone diaphyseal location (OR 0.133; p = 0.006), and higher Eastern Cooperative Oncology Group (ECOG) performance score (OR 2.109 per point; p = 0.018) independently predicted decision change. Conclusions: PET/CT-informed MOOB reassessment was associated with substantial changes in intended surgical strategy for metastatic bone disease. The findings support careful multidisciplinary integration of metabolic imaging, metastatic burden, anatomic location, and performance status, but should be regarded as hypothesis-generating until validated prospectively with data on treatment delivery and downstream outcomes. Full article

Escalating energy costs and peak power demand charges pose significant challenges to the manufacturing sector. In response, industries are increasingly adopting on-site renewable energy sources and Battery Energy Storage Systems (BESSs). However, maximizing their economic benefit requires sophisticated control strategies that integrate energy management with production operations. This paper proposes and evaluates an integrated and adaptive rule-based coordination framework for BESS and machine-level switch-off policies in a production environment. Using discrete-event simulation, we model a four-machine manufacturing flow line powered by the grid and an on-site solar PV plant. We compare six distinct control policies, ranging from a benchmark case without storage to progressively more integrated context-aware strategies that incorporate price-aware BESS charging, dynamic peak-shaving, and adaptive machine switch-offs. The results demonstrate that integrated policies yield substantial economic benefits. The most advanced policy dynamically coordinates BESS dispatch with machine-level switch-off decisions based on electricity prices, production conditions, and energy availability, achieving the largest reduction in total energy costs and peak grid demand among the evaluated policies. This study quantifies the synergistic effects of combining supply-side (BESS) and demand-side (switch-off) strategies, providing a framework for developing resilient and cost-effective energy management systems in modern manufacturing. Full article

Cybersickness remains a barrier to sustained use of head-mounted display (HMD) virtual reality (VR) and is often evaluated as a post-exposure outcome rather than as a changing user state requiring intervention during immersion. This focused narrative review used structured searches of Google Scholar, Scopus, and Web of Science to examine evidence for sensing, state estimation, mitigation, reassessment, and adaptive control; 47 sources were included in the final synthesis. Physiological, ocular, kinematic, behavioral, and content-derived signals can support estimation of cybersickness-related outcomes, but their usefulness depends on the reference measure, temporal alignment, validation design, and operating context. Visual, locomotion, rendering, and multisensory interventions can reduce symptoms, but no strategy is consistently superior, and mitigation can impose costs to visual access, usability, or task performance. Existing architectures demonstrate connected estimation and adaptation, but evidence remains limited for prospective reassessment, de-escalation, responses to failure to improve, generalization, and safety supervision. The review organizes these findings within a framework linking dynamic user state, sensing, preprocessing, actionable state estimation, intervention selection, system adaptation, reassessment, and updated user state. Reliable closed-loop mitigation requires prospective validation of the feedback cycle, including total latency, control-error consequences, user override, limits on intervention magnitude and adjustment rate, and exposure-termination criteria. Full article

Obesity is a complex, multifactorial chronic disease characterized by excessive and/or aberrant adiposity that requires interventions beyond conventional calorie-restriction models. Current clinical guidelines converge on behavioral modification, encompassing nutritional therapy, physical activity, stress reduction, and sleep improvement, as the cornerstone of obesity management, with psychological therapy, pharmacotherapy, and bariatric procedures as adjunctive or escalating options. While traditional “one-size-fits-all” dietary approaches frequently yield suboptimal long-term outcomes, precision nutrition has emerged as a promising strategy for individualized obesity care. This review critically appraises the evidence underlying each pillar of precision nutrition: genetic profiling shows clear utility in monogenic obesity but variable benefit when diet is matched to common polygenic variants; microbiome-targeted studies reveal that the Bacillota to Bacteroidota ratio shows inconsistent associations with obesity across studies, with genus-level and functional alterations offering more reproducible targets; and metabolomic profiling of postprandial glycemic responses has progressed from foundational predictive algorithms to large-scale clinical validation. It also highlights chrono-nutrition, the alignment of food timing with individual chronotype, as an emerging pillar of personalization. Beyond dietary composition, the review addresses how personalized nutrition can mitigate the adverse effects of incretin-based pharmacotherapy and discusses how artificial intelligence can integrate multi-omics and behavioral data into real-time dietary guidance. Future clinical implementation will require overcoming challenges related to data integration, predictive accuracy, and accessibility, paving the way for more effective, evidence-based obesity management. Full article

Against a backdrop of tightening environmental regulations and escalating climate-related risks, the construction sector faces mounting pressure to improve both its sustainability performance and long-term resilience. As a market-oriented institutional tool, green finance policy has been widely identified as a pivotal lever for advancing corporate green innovation; nevertheless, its causal impact on green innovation in construction enterprises—an essential foundation for sustained industry resilience—has Iyet to be fully examined in empirical research. Capitalizing on the exogenous variation introduced by China’s Green Finance Reform and Innovation Pilot Zone (GFRIPZ) initiative, this study investigates 105 construction enterprises listed on the Chinese stock market from 2010 to 2020. Employing a Difference-in-Differences (DiD) estimation strategy, we find that the GFRIPZ initiative significantly boosts green innovation among construction enterprises. This positive association persists after a series of robustness assessments. Channel analysis identifies financing conditions as a key pathway linking the GFRIPZ initiative to green innovation. Reduced financing frictions allow construction enterprises to increase investment in environmentally oriented technological activities. Additional sub-sample analysis corroborates that the GFRIPZ policy exerts a far more salient innovation incentive effect on non-state-owned construction firms, which aligns with the stronger impetus for in-house R&D under competitive market conditions. These findings offer empirical evidence that well-designed green finance policies can serve as effective institutional enablers of green innovation, thereby contributing to the sustainable resilience of the construction sector. The findings offer actionable guidance for regulators on incorporating financial instruments into governance frameworks that support sustainable construction. Full article

Global warming poses an escalating threat to crop yield and quality, particularly for thermosensitive medicinal-edible plants such as goji berry (Lycium barbarum). Although salicylic acid (SA) is recognized for enhancing plant thermotolerance, its effects on fruit productivity and quality under summer high temperatures remain inadequately quantified. This study investigated the physiological, metabolic, and transcriptomic responses of field-grown Ningqi No. 7 (N7) goji berry to exogenous SA application under summer heat stress. SA treatment significantly increased fruit yield by 22%, while reducing leaf defoliation rate by 32%. Metabolite profiling revealed that SA elevated total soluble sugar content by 30% and flavonoid concentration by 14% but decreased total organic acid content by 16%. Transcriptomic analysis identified SA-induced differential expression of genes involved in sugar metabolism (phosphofructokinase), secondary biosynthesis (flavonoid and alkaloid related pathways), and stress responses (HSPs, E3 ubiquitin ligases, SRK2). These results demonstrate that exogenous SA enhances goji berry productivity and improves fruit taste (via increased sugar/organic acid ratio) and functional quality under summer high temperatures. Consequently, SA application thus represents a promising and cost-effective strategy for climate-resilient goji berry cultivation. Full article

As the global agri-food system faces escalating climate-related challenges, developing localized low-carbon short food supply chains (SFSCs) has become a vital strategy for sustainable agriculture. To elucidate the psychological drivers of green consumer behavior within this context, this study integrates the Stimulus–Organism–Behavior–Consequence (SOBC) framework with the Theory of Planned Behavior (TPB). The aim is to investigate the continuous purchase intentions of Taiwanese consumers for organic cocoa. Data collected via an online survey from 377 consumers with prior cocoa consumption experience were analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM). The results indicate that personal attitudes and perceived behavioral control positively drive consumption intentions, whereas subjective norms do not. This suggests that consumption behaviors rely on substantive product evaluation rather than social pressures. Additionally, green product attributes and environmental values significantly enhance TPB constructs. Importantly, consumption intentions translate positively into perceived consumer effectiveness and continuous purchase intentions. By elucidating the psychological mechanisms underlying sustainable food choices, this study highlights the value of Taiwan’s “Tree-to-Bar” model. Practically, the findings highlight potential implications for policymakers and agribusinesses regarding how environmental attributes are communicated through front-of-pack (FOP) labels that emphasize local production and low-carbon mileage. Such approaches may help make environmental information more accessible to consumers, although their effectiveness should be evaluated in future research. Full article

Background/objectives: Multidrug-resistant and extensively drug-resistant Gram-negative pathogens are a major cause of severe ocular infections, yet treatment options are increasingly compromised by escalating antibiotic resistance. Membrane-active peptides (colistin and Mel4) offer the potential to restore antibiotic susceptibility. This study investigated the efficacy of peptide- and colistin-based adjuvant strategies in enhancing the activity of conventional antibiotics. Methods: Antibacterial activity was assessed using MIC/MBC testing, checkerboard assays, time–kill kinetics, and biofilm disruption studies, supported by confocal microscopy. Toxicity was assessed using L929 fibroblasts and red blood cells. A mechanistic study was performed with a membrane permeability assay. Results: Clinical isolates of Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae showed high resistance to six antibiotic classes (up to MICs > 2048 mg/L), while polymyxin B and colistin remained active (MIC ≤ 2 mg/L). Mel4 displayed variable activity (MIC 7.8–500 mg/L). A total of 102 antibiotic–antibiotic, antibiotic–Mel4, and antibiotic–colistin combination tests were performed, of which 45 showed synergistic interactions. Combining traditional antimicrobials with either colistin or Mel4 restored antibiotic susceptibility, reducing MICs up to 2048-fold. Aminoglycoside–colistin combinations significantly lowered MICs, especially against K. pneumoniae. Time–kill assays confirmed rapid bactericidal effects (>3 log10 reduction in 3 h). The ciprofloxacin–Mel4 combination effectively disrupted biofilms (62–92%) with low toxicity and high cell viability. Membrane permeability assays showed that ciprofloxacin has limited activity, whereas both Mel4 and the ciprofloxacin–Mel4 combination showed enhanced activity across concentration gradients and over time. Conclusions: Membrane-active antimicrobials, colistin and Mel4, enhance conventional antibiotics against multidrug- and extensively drug-resistant ocular Gram-negative pathogens by restoring susceptibility, accelerating bactericidal effects, and disrupting biofilms. With low toxicity, these combinations represent promising therapeutic strategies for severe multidrug-resistant ocular infections. Full article

Management of acute coronary syndromes (ACS) in the cardiac intensive care unit (CICU) requires rapid diagnosis, timely reperfusion or invasive assessment, appropriate antithrombotic therapy, and early recognition of haemodynamic, electrical, and mechanical complications. This narrative review examines contemporary evidence across ST-segment elevation and non-ST-segment elevation presentations, with emphasis on decisions during hospitalisation and early secondary prevention. High-sensitivity cardiac troponin algorithms support accelerated assessment of suspected non-ST-segment elevation ACS, whereas next-generation assays require further implementation validation. Twelve-month dual antiplatelet therapy remains the default after ACS in patients without high bleeding risk; abbreviated regimens, de-escalation, cangrelor, and combined antiplatelet–anticoagulant treatment are selective strategies. Contemporary care also includes risk-based invasive timing, complete revascularisation in suitable haemodynamically stable patients, culprit-lesion-only initial PCI in cardiogenic shock, and individualised management of frailty and renal impairment. High-intensity statin therapy, with early ezetimibe when needed, is guideline-supported. Early PCSK9 inhibition and low-dose colchicine are selective strategies, whereas SGLT2 inhibitors and GLP-1RAs are established for specific comorbid indications. hs-cTnT Gen 6 and AI-assisted tools remain evidence-evolving, while multiomics and targeted anti-inflammatory therapies remain investigational. Clear separation of guideline-supported, selective, evidence-evolving, and investigational approaches is essential for clinically appropriate ACS care. Full article

Perioperative treatment for colorectal cancer (CRC) is undergoing a paradigm shift from uniform cytotoxic regimens toward strategies guided by tumor location, microsatellite instability (MSI)/mismatch repair (MMR) status, and recurrence risk. Four clinically relevant subgroups now shape decision-making: microsatellite stable (MSS)/proficient MMR (pMMR) colon cancer, microsatellite instability-high (MSI-H)/deficient MMR (dMMR) colon cancer, MSS/pMMR rectal cancer, and MSI-H/dMMR rectal cancer. In MSS/pMMR colon cancer, adjuvant therapy is being refined through risk-adapted treatment duration and selective use of neoadjuvant chemotherapy. In MSS/pMMR rectal cancer, total neoadjuvant therapy, selective omission of pelvic radiotherapy, and watch-and-wait strategies are redefining treatment sequencing and organ preservation. In MSI-H/dMMR colon cancer, immune checkpoint inhibitor (ICI) therapy has shown marked activity in both adjuvant and neoadjuvant settings. In MSI-H/dMMR rectal cancer, neoadjuvant ICI therapy is being explored as a non-operative organ preservation strategy. In parallel, circulating tumor DNA (ctDNA)-based minimal residual disease (MRD) assessment is emerging as a tool for postoperative escalation, de-escalation, and surveillance. Across these settings, the maturity of the evidence varies widely, ranging from established phase III standards to guideline-endorsed but still single-arm approaches and investigational strategies that require prospective validation before routine adoption. This review summarizes the current evidence and remaining challenges in biology-, site-, and risk-adapted perioperative management of CRC. Full article