Search Results (8,824)

The Lidia cattle breed is featured in several traditional popular bullfighting festivals throughout Spain, including the “Toro de Cuerda” event, in which the animals are subjected to intense physical exercise. However, the physiological impact and welfare implications of these activities remain poorly characterized. This study aimed to evaluate the stress response and muscle damage in Lidia breed bulls during roping bull celebrations through comprehensive blood analysis. Blood samples were collected from 53 adult male Lidia bulls before and after a standardized 45 min continuous running exercise during traditional roping bull events in four Spanish autonomous regions. Hematological parameters, muscle enzymes (creatine kinase, lactate dehydrogenase, lactate), and stress hormones (cortisol and ACTH) were analyzed. Significant increases (p < 0.05) were observed in leukocytes, lymphocytes, monocytes, eosinophils, neutrophils, erythrocytes, hematocrit, hemoglobin, and post-exercise platelets. Muscle enzymes showed marked elevations, with creatine kinase increasing up to 10-fold above baseline values. Stress hormones, cortisol and ACTH, also demonstrated significant increases. Despite the magnitude of these changes, all parameters remained within established reference ranges for the bovine species. This study provides the first physiological assessment of Lidia cattle during popular bullfighting celebrations, establishing baseline data for evidence-based welfare evaluation and management protocols. Full article

Background: Hip fractures represent a major clinical challenge, particularly in elderly and frail patients, where postoperative pain control must balance effective analgesia with motor preservation to facilitate early mobilization. Various regional anesthesia techniques are used in this setting, including the pericapsular nerve group (PENG) block, fascia iliaca compartment block (FICB), femoral nerve block (FNB), and quadratus lumborum block (QLB), yet optimal strategies remain debated. Objectives: To systematically review the efficacy, safety, and clinical applicability of major regional anesthesia techniques for pain management in hip fractures, including considerations of fracture type, surgical approach, and functional outcomes. Methods: A systematic literature search was conducted following PRISMA 2020 guidelines in PubMed, Scopus, Web of Science, and the virtual library of the Hospital Central de la Defensa “Gómez Ulla” up to March 2025. Inclusion criteria were RCTs, systematic reviews, and meta-analyses evaluating regional anesthesia for hip surgery in adults. Risk of bias in RCTs was assessed using RoB 2.0, and certainty of evidence was evaluated using the GRADE approach. Results: Twenty-nine studies were included, comprising RCTs, systematic reviews, and meta-analyses. PENG block demonstrated superior motor preservation and reduced opioid consumption compared to FICB and FNB, particularly in intracapsular fractures and anterior surgical approaches. FICB and combination strategies (PENG+LFCN or sciatic block) may provide broader analgesic coverage in extracapsular fractures or posterior approaches. The overall risk of bias across RCTs was predominantly low, and certainty of evidence ranged from moderate to high for key outcomes. No significant safety concerns were identified across techniques, although reporting of adverse events was inconsistent. Conclusions: PENG block appears to offer a favorable balance of analgesia and motor preservation in hip fracture surgery, particularly for intracapsular fractures. For extracapsular fractures or posterior approaches, combination strategies may enhance analgesic coverage. Selection of block technique should be tailored to fracture type, surgical approach, and patient-specific functional goals. Full article

Dose-dense chemotherapy shortens the interval between chemotherapy cycles and has shown improved outcomes in high-risk breast cancer patients. We retrospectively evaluated the efficacy and safety of dose-dense chemotherapy in 80 breast cancer patients treated at our hospital from 2020 to 2024. The regimen included epirubicin and cyclophosphamide followed by paclitaxel or docetaxel, with pegfilgrastim support. The overall treatment completion rate was 82.5%. Of the 80 patients, 55 underwent neoadjuvant chemotherapy, and the pathological complete response rate was significantly higher in triple-negative breast cancer (59.1%) compared to that in luminal-type cancer (9.1%). Common adverse events included anemia, liver dysfunction, myalgia, and peripheral neuropathy. Febrile neutropenia occurred in 8.8% of patients, with some cases linked to pegfilgrastim body pod use, particularly in individuals with low subcutaneous fat. Notably, two patients developed pneumocystis pneumonia, potentially associated with steroid administration. Despite these toxicities, most were manageable and resolved after treatment. Our findings support the efficacy of dose-dense chemotherapy, particularly in triple-negative breast cancer, while highlighting the importance of individualized supportive care and vigilance regarding hematologic and infectious complications. Full article

This comprehensive review examines the role of septoplasty in the pediatric population, emphasizing its therapeutic significance in relieving nasal obstruction and facilitating normal craniofacial growth. Despite the evident advantages of septoplasty, its application in young patients remains a subject of ongoing debate. This issue is primarily characterized by concerns regarding the still-developing immaturity of nasal cartilage, potential intraoperative and postoperative risks, and the current absence of robust data on long-term outcomes following septoplasty. Common complications such as bleeding, septal perforation, saddle nose deformity, and persistent nasal obstruction are reported in the literature; however, many studies lack long-term follow-up data on the incidence of these adverse events and revision rates, which may be higher compared to adult populations, often leading to the need for secondary surgical interventions. Strict inclusion criteria and comprehensive patient selection are paramount to maximize therapeutic success while minimizing complications. Current evidence suggests that appropriately indicated septoplasty can improve airway patency, support optimal facial development, and reduce the risk of secondary sinonasal pathology. There is a significant necessity for additional prospective, large-scale studies to establish standardized therapeutic guidelines and management strategies for this specific population, thereby ensuring effective and evidence-based pediatric otolaryngologic care. Full article

This study assesses future agricultural drought risk in the Ganjiang River Basin under climate change and land use change. A coupled analysis framework was established using the SWAT hydrological model, the CMIP6 climate models (SSP1-2.6, SSP2-4.5, SSP5-8.5), and the PLUS land use simulation model. Key methods included the Standardized Soil Moisture Index (SSMI), travel time theory for drought event identification and duration analysis, Mann–Kendall trend test, and the Pettitt change-point test to examine soil moisture dynamics from 2027 to 2100. The results indicate that the CMIP6 ensemble performs excellently in temperature simulations, with a correlation coefficient of R² = 0.89 and a root mean square error of RMSE = 1.2 °C, compared to the observational data. The MMM-Best model also performs well in precipitation simulations, with R² = 0.82 and RMSE = 15.3 mm, compared to observational data. Land use changes between 2000 and 2020 showed a decrease in forestland (−3.2%), grassland (−2.8%), and construction land (−1.5%), with an increase in water (4.8%) and unused land (2.7%). Under all emission scenarios, the SSMI values fluctuate with standard deviations of 0.85 (SSP1-2.6), 1.12 (SSP2-4.5), and 1.34 (SSP5-8.5), with the strongest drought intensity observed under SSP5-8.5 (minimum SSMI = −2.8). Drought events exhibited spatial and temporal heterogeneity across scenarios, with drought-affected areas ranging from 25% (SSP1-2.6) to 45% (SSP5-8.5) of the basin. Notably, abrupt changes in soil moisture under SSP5-8.5 occurred earlier (2045–2050) due to intensified land use change, indicating strong human influence on hydrological cycles. This study integrated the CMIP6 climate projections with high-resolution human activity data to advance drought risk assessment methods. It established a framework for assessing agricultural drought risk at the regional scale that comprehensively considers climate and human influences, providing targeted guidance for the formulation of adaptive water resource and land management strategies. Full article

Stroke is a significant global health concern characterized by the abrupt disruption of cerebral blood flow, leading to neurological impairment. Accurate and timely diagnosis—enabled by imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI)—is essential for differentiating stroke types and initiating interventions like thrombolysis, thrombectomy, or surgical management. In parallel, recent advancements in wearable technology, particularly smart clothing, offer new opportunities for stroke prevention, real-time monitoring, and rehabilitation. These garments integrate various sensors, including electrocardiogram (ECG) electrodes, electroencephalography (EEG) caps, electromyography (EMG) sensors, and motion or pressure sensors, to continuously track physiological and functional parameters. For example, ECG shirts monitor cardiac rhythm to detect atrial fibrillation, smart socks assess gait asymmetry for early mobility decline, and EEG caps provide data on neurocognitive recovery during rehabilitation. These technologies support personalized care across the stroke continuum, from early risk detection and acute event monitoring to long-term recovery. Integration with AI-driven analytics further enhances diagnostic accuracy and therapy optimization. This narrative review explores the application of smart clothing in conjunction with traditional imaging to improve stroke management and patient outcomes through a more proactive, connected, and patient-centered approach. Full article

Background: Thyroid eye disease (TED) is a rare autoimmune orbital disorder predominantly associated with Graves’ disease. It is characterized by orbital inflammation, tissue remodeling, and potential visual morbidity. Conventional therapies, particularly systemic glucocorticoids, offer only partial symptomatic relief, failing to reverse chronic structural changes such as proptosis and diplopia, and are associated with substantial adverse effects. This review aims to synthesize recent developments in understandings of TED pathogenesis and to critically evaluate emerging therapeutic strategies. Methods: A systematic literature review was conducted using MEDLINE, Embase, and international clinical trial registries focusing on pivotal clinical trials and investigational therapies targeting core molecular pathways involved in TED. Results: Current evidence suggests that TED pathogenesis is primarily driven by the autoimmune activation of orbital fibroblasts (OFs) through thyrotropin receptor (TSH-R) and insulin-like growth factor-1 receptor (IGF-1R) signaling. Teprotumumab, a monoclonal IGF-1R inhibitor and the first therapy approved by the U.S. Food and Drug Administration for TED, has demonstrated substantial clinical benefit, including improvements in proptosis, diplopia, and quality of life. However, concerns remain regarding relapse rates and treatment-associated adverse events, particularly hearing impairment. Investigational therapies, including next-generation IGF-1R inhibitors, small-molecule antagonists, TSH-R inhibitors, neonatal Fc receptor (FcRn) blockers, cytokine-targeting agents, and gene-based interventions, are under development. These novel approaches aim to address both inflammatory and fibrotic components of TED. Conclusions: Teprotumumab has changed TED management but sustained control and toxicity reduction remain challenges. Future therapies should focus on targeted, mechanism-based, personalized approaches to improve long-term outcomes and patient quality of life. Full article

This study aimed to evaluate daily patterns of hourly milking frequency (MF) in dairy cows milked with an automatic milking system (AMSs), considering the effects of season, parity order (PO), days in milk (DIM), and milk yield (MY). A retrospective longitudinal study was conducted on a commercial dairy farm in southern Brazil over one year using data from 130 Holstein cows and 94,611 milking events. MF data were analyzed using general linear models. Overall, hourly MF followed a consistent daily pattern, with peaks between 4:00 and 11:00 a.m. and between 2:00 and 6:00 p.m., regardless of season, PO, DIM, or MY category. MF was higher in primiparous (2.84/day, p = 0.0013), early-lactation (<106 DIM; 3.00/day, p < 0.0001), and high-yielding cows (≥45 L/day; 3.09/day, p < 0.0001). High-yielding cows also showed sustained milking activity into the late nighttime. Although seasonal and individual factors significantly affected MF, they had limited influence on the overall daily distribution of milkings. These results suggest stable behavioral patterns within the specific AMS management conditions observed in this study and suggest that adjusting milking permissions and feeding strategies based on cow characteristics may improve system efficiency. Full article

Sleep disorders and stroke are intricately linked through a complex, bidirectional relationship. Sleep disturbances such as obstructive sleep apnea (OSA), insomnia, and restless legs syndrome (RLS) not only increase the risk of stroke but also frequently emerge as consequences of cerebrovascular events. OSA, in particular, is associated with a two- to three-fold increased risk of incident stroke, primarily through mechanisms involving intermittent hypoxia, systemic inflammation, endothelial dysfunction, and autonomic dysregulation. Conversely, stroke can disrupt sleep architecture and trigger or exacerbate sleep disorders, including insomnia, hypersomnia, circadian rhythm disturbances, and breathing-related sleep disorders. These post-stroke sleep disturbances are common and significantly impair rehabilitation, cognitive recovery, and quality of life, yet they remain underdiagnosed and undertreated. Early identification and management of sleep disorders in stroke patients are essential to optimize recovery and reduce the risk of recurrence. Therapeutic strategies include lifestyle modifications, pharmacological treatments, medical devices such as continuous positive airway pressure (CPAP), and emerging alternatives for CPAP-intolerant individuals. Despite growing awareness, significant knowledge gaps persist, particularly regarding non-OSA sleep disorders and their impact on stroke outcomes. Improved diagnostic tools, broader screening protocols, and greater integration of sleep assessments into stroke care are urgently needed. This narrative review synthesizes current evidence on the interplay between sleep and stroke, emphasizing the importance of personalized, multidisciplinary approaches to diagnosis and treatment. Advancing research in this field holds promise for reducing the global burden of stroke and improving long-term outcomes through targeted sleep interventions. Full article

Road networks are essential for access, resource distribution, and population evacuation during natural events. These challenges are pronounced in rural areas, where network redundancy is limited and communities may have social disparities. While traditional risk management systems often focus on the physical consequences of hazard events alone, specialized literature increasingly suggests the development of a more comprehensive approach for risk assessment, where not only physical aspects associated with infrastructure, such as damage level or disruptions, but also the social and economic attributes of the affected population are considered. Consequently, this paper proposes a Vulnerability Access Index (VAI) to support road network decision-making that integrates the social vulnerability of rural communities exposed to natural events, their accessibility to nearby critical infrastructure, and physical risk. The research methodology considers (i) the Social Vulnerability Index (SVI) calculation based on socioeconomic variables, (ii) Importance Index estimation (I_imp) to evaluate access to critical infrastructure, (iii) VAI calculation combining SVI and I_imp, and (iv) application to a case study in the influence area of the Villarrica volcano in southern Chile. The results show that when incorporating social variables and accessibility, infrastructure criticality varies significantly compared to the infrastructure criticality assessment based solely on physical risk, modifying the decision-making regarding road infrastructure robustness and resilience improvements. Full article

Background and Clinical Significance: Brugada syndrome (BrS) is a rare inherited cardiac channelopathy, often associated with SCN5A loss-of-function mutations. Clinical presentations range from asymptomatic to malignant arrhythmias and sudden cardiac death. Physiological and pharmacological stressors affecting sodium channel function—such as pyrexia, certain medications, and possibly pregnancy—may unmask or exacerbate arrhythmic risk. However, there is limited information regarding pregnancy and obstetric outcomes. Obstetric management remains largely informed by isolated case reports and small case series. A literature review was conducted using OVID Medline and Embase, identifying case reports, case series, and one retrospective cohort study reporting clinical presentation, obstetric management, and outcomes in maternal BrS. A case is presented detailing coordinated multidisciplinary input, antenatal surveillance, and intrapartum and postpartum care to contribute to the growing evidence base guiding obstetric care in this complex setting. Case Presentation: A 30-year-old G2P0 woman with asymptomatic BrS (SCN5A-positive) was referred at 31 + 5 weeks’ gestation for multidisciplinary antenatal care. Regular review and collaborative planning involving cardiology, anaesthetics, maternal–fetal medicine, and obstetrics guided a plan for vaginal delivery with continuous cardiac and fetal monitoring. At 38 + 0 weeks, the woman presented with spontaneous rupture of membranes and underwent induction of labour. A normal vaginal delivery was achieved without arrhythmic events. Epidural block with ropivacaine and local anaesthesia with lignocaine were well tolerated, and 24 h postpartum monitoring revealed no abnormalities. Conclusions: This case adds to the limited but growing literature suggesting that with individualised planning and multidisciplinary care, pregnancies in women with BrS can proceed safely and without complication. Ongoing case reporting is essential to inform future guidelines and optimise maternal and fetal outcomes. Full article

Floods are among the most devastating hydrometeorological natural disasters worldwide, causing massive infrastructure and economic loss in low-lying, flood-prone developing countries like Bangladesh. Effective disaster mitigation relies on organized and detailed flood damage information to facilitate emergency evacuation, coordinate relief distribution, and formulate an effective disaster management policy. Nevertheless, the nation confronts considerable obstacles due to insufficient historical flood damage data and the underdevelopment of near-real-time (NRT) flood monitoring systems. This study addresses this issue by developing a replicable methodology for flood damage assessment and NRT monitoring systems. Using the Google Earth Engine (GEE) platform, we analyzed flood events from 2019 to 2023, integrating geospatial layers such as roads, cropland, etc. Analysis of flood events over the five-year period revealed substantial impacts, with 21.60% of the total area experiencing inundation. This flooding affected 6.92% of cropland and 4.16% of the population. Furthermore, 18.10% of the road network, spanning over 21,000 km within the study area, was also affected. This system has the potential to enhance emergency response capabilities during flood events and inform more effective disaster mitigation policies. Full article

Cutaneous and oral mucosal adverse events (AEs) are among the most common non-hematologic toxicities observed during breast cancer treatment. These complications arise across various therapeutic modalities including chemotherapy, targeted therapy, hormonal therapy, radiotherapy, and immunotherapy. Although often underrecognized compared with systemic side effects, dermatologic and mucosal toxicities can severely impact the patients’ quality of life, leading to psychosocial distress, pain, and reduced treatment adherence. In severe cases, these toxicities may necessitate dose reductions, treatment delays, or discontinuation, thereby compromising oncologic outcomes. The growing use of precision medicine and novel targeted agents has broadened the spectrum of AEs, with some therapies linked to distinct dermatologic syndromes and mucosal complications such as mucositis, xerostomia, and lichenoid reactions. Early detection, accurate classification, and timely multidisciplinary management are essential for mitigating these effects. This review provides a comprehensive synthesis of current knowledge on cutaneous and oral mucosal toxicities associated with modern breast cancer therapies. Particular attention is given to clinical presentation, underlying pathophysiology, incidence, and evidence-based prevention and management strategies. We also explore emerging approaches, including nanoparticle-based delivery systems and personalized interventions, which may reduce toxicity without compromising therapeutic efficacy. By emphasizing the integration of dermatologic and mucosal care, this review aims to support clinicians in preserving treatment adherence and enhancing the overall therapeutic experience in breast cancer patients. The novelty of this review lies in its dual focus on cutaneous and oral complications across all major therapeutic classes, including recent biologic and immunotherapeutic agents, and its emphasis on multidisciplinary, patient-centered strategies. Full article

This study presents the scientific and methodological foundation of Spain’s first national framework for the ethical management of community cat populations: the Action Plan for the Management of Community Cat Colonies (PACF), launched in 2025 under the mandate of Law 7/2023. This pioneering legislation introduces a standardized, nationwide obligation for trap–neuter–return (TNR)-based management of free-roaming cats, defined as animals living freely, territorially attached, and with limited socialization toward humans. The PACF aims to support municipalities in implementing this mandate through evidence-based strategies that integrate animal welfare, biodiversity protection, and public health objectives. Using standardized data submitted by 1128 municipalities (13.9% of Spain’s total), we estimated a baseline population of 1.81 million community cats distributed across 125,000 colonies. These data were stratified by municipal population size and applied to national census figures to generate a model-ready demographic structure. We then implemented a stochastic simulation using Vortex software to project long-term population dynamics over a 25-year horizon. The model integrated eight demographic–environmental scenarios defined by a combination of urban–rural classification and ecological reproductive potential based on photoperiod and winter temperature. Parameters included reproductive output, mortality, sterilization coverage, abandonment and adoption rates, stochastic catastrophic events, and territorial carrying capacity. Under current sterilization rates (~20%), our projections indicate that Spain’s community cat population could surpass 5 million individuals by 2050, saturating ecological and social thresholds within a decade. In contrast, a differentiated sterilization strategy aligned with territorial reproductive intensity (50% in most areas, 60–70% in high-pressure zones) achieves population stabilization by 2030 at approximately 1.5 million cats, followed by a gradual long-term decline. This scenario prioritizes feasibility while substantially reducing reproductive output, particularly in rural and high-intensity contexts. The PACF combines stratified demographic modeling with spatial sensitivity, offering a flexible framework adaptable to local conditions. It incorporates One Health principles and introduces tools for adaptive management, including digital monitoring platforms and standardized welfare protocols. While ecological impacts were not directly assessed, the proposed demographic stabilization is designed to mitigate population-driven risks to biodiversity and public health without relying on lethal control. By integrating legal mandates, stratified modeling, and realistic intervention goals, this study outlines a replicable and scalable framework for coordinated action across administrative levels. It exemplifies how national policy can be operationalized through data-driven, territorially sensitive planning tools. The findings support the strategic deployment of TNR-based programs across diverse municipal contexts, providing a model for other countries seeking to align animal welfare policy with ecological planning under a multi-level governance perspective. Full article

Adverse drug events (ADEs) significantly impact patient safety and health outcomes. Manual ADE detection from clinical narratives is time-consuming, labor-intensive, and costly. Recent advancements in large language models (LLMs), including transformer-based architectures such as Bidirectional Encoder Representations from Transformers (BERT) and Generative Pretrained Transformer (GPT) series, offer promising methods for automating ADE extraction from clinical data. These models have been applied to various aspects of pharmacovigilance and clinical decision support, demonstrating potential in extracting ADE-related information from real-world clinical data. Additionally, chatbot-assisted systems have been explored as tools in clinical management, aiding in medication adherence, patient engagement, and symptom monitoring. This narrative review synthesizes the current state of LLMs in ADE detection from a clinical perspective, organizing studies into categories such as human-facing decision support tools, immune-related ADE detection, cancer-related and non-cancer-related ADE surveillance, and personalized decision support systems. In total, 39 articles were included in this review. Across domains, LLM-driven methods have demonstrated promising performances, often outperforming traditional approaches. However, critical limitations persist, such as domain-specific variability in model performance, interpretability challenges, data quality and privacy concerns, and infrastructure requirements. By addressing these challenges, LLM-based ADE detection could enhance pharmacovigilance practices, improve patient safety outcomes, and optimize clinical workflows. Full article