Search Results (3,291)

The rise in antimicrobial resistance (AMR) among the most clinically significant bacteria presents a global threat. The coexistence of resistance mechanisms to both carbapenems and colistin is particularly concerning, as these are last-line treatments, specifically reserved for the most challenging infections caused by clinically multidrug-resistant Enterobacterales. Natural aquatic environments have become environmental reservoirs for the transmission of AMR, particularly concerning mechanisms against these two types of critically important drugs. The crucial role of environmental settings as a driving force for the spread and evolution of AMR associated with these drugs is underestimated, and scientific knowledge on this topic is limited. This review aims to fill an important gap in the scientific literature and comprehensively consolidate the available data on carbapenem- and colistin-associated AMR in the aquatic environment. This study provides a comprehensive synthesis of the current knowledge by integrating bibliographic data with a detailed genomic analysis of 278 bacterial genomes sourced from natural waters. It explores the distribution of carbapenemase and mobile colistin resistance (mcr) genes, identifying their hosts, geographical spread, and complex gene–plasmid–host associations. This review distinguishes two critical host groups for genes that provide resistance to last-resort drugs, Enterobacterales and autochthonous aquatic microbiota, highlighting both confirmed and potential interactions between them. Crucially, genomic analysis highlights the alarming co-occurrence of carbapenem and colistin resistance in single cells and on single plasmids, contributing to the spread of multidrug resistance phenotypes. These findings clearly indicate that aquatic environments are not merely passive recipients but active, evolving hubs for high-risk AMR determinants. Future research should focus on the interplay between allochthonous vectors and autochthonous microbiota to better understand the long-term stabilization of carbapenemase and mcr genes. Such efforts, combined with advanced sequencing technologies, are essential to ensure that carbapenems and colistin remain viable treatment options in clinical settings. Full article

Background: Nicotine use among the youth has been on the rise, especially with the introduction of E-cigarettes. This has sparked concerns regarding E-cigarettes and traditional cigarettes in terms of patterns, dependence, and perceptions within the youth population, which are issues this study aimed to investigate. Methods: A cross-sectional survey was conducted among university students at Ajman University, which is in the Middle East and North Africa (MENA) region. Using the Cigarette Dependence Scale (CDS-12) and Penn State Electronic Cigarette Dependence Index (PS-ECDI), dependence on both cigarettes and E-cigarettes was quantified. Results: Out of 1713 respondents, 18.9% were currently using nicotine products, including E-cigarettes (12.7%) and traditional cigarettes (5.1%). Nicotine use was significantly associated more with males than females with an odds ratio of 4.14. However, there was no difference between genders in the dependence scores. In addition, dual nicotine use and an earlier onset of nicotine consumption were associated with significantly higher dependence scores than single users and a late onset of smoking. Participants overall attributed cigarettes and E-cigarettes as equally harmful. Conclusions: Both cigarette and e-cigarette use were prevalent and associated with notable dependence. Although E-cigarettes are often promoted as cessation aids, their use in our sample did not appear to facilitate quitting and may instead sustain nicotine dependence. Targeted youth-focused cessation programs and stricter marketing and sales regulations are essential to prevent further normalization. Longitudinal studies are needed to track evolving patterns and health impacts in the MENA region. Full article

Background/Objectives: Over the last decade, the role and timing of lymph node dissection (LND) in stage III melanoma has shifted from completion LND after a positive sentinel node to a mainly therapeutic procedure for clinically evident nodal disease, driven by randomized evidence showing no survival benefit for routine completion dissection. In this evolving landscape, real-world data on postoperative morbidity—by nodal basin—and on whether complications may influence melanoma-specific survival (MSS) and disease-free survival (DFS) remain limited. We evaluated 90-day postoperative complications after cervical, axillary, and inguino–iliac–obturator LND and explored their association with survival outcomes and treatment era. Methods: We retrospectively analyzed 185 consecutive stage III melanoma patients undergoing LND at a single tertiary center (January 2004–August 2025). Postoperative morbidity was recorded up to 90 days and graded by Clavien–Dindo; given the very low rate of grade > II events, the primary endpoint was a composite of loco-regional surgical field–related complications (persistent seroma, wound dehiscence, surgical-site infection, limb lymphedema). Risk factors were assessed using logistic regression; Firth’s penalized models were applied when appropriate. MSS and DFS were estimated by Kaplan–Meier and explored with Cox models. Results: Median follow-up was 105 months. Surgical field–related complications occurred in 16.8% (31/185), and postoperative mortality was 1.0% (2/185). In multivariable analyses, inguino–iliac–obturator LND was associated with higher odds of overall complications (OR 4.03) and specifically wound dehiscence (OR 4.79) and infection (OR 7.18) versus axillary LND. MSS (n = 179) was 82% at 1 year, 55% at 5 years, and 49% at 10 years; DFS (n = 171) was 63%, 42%, and 41%, respectively. In era-based comparisons, nodal yield decreased in the post–MSLT-II period without clear separation of MSS/DFS curves; exploratory models did not show a consistent independent signal linking postoperative complications to MSS/DFS. Conclusions: In stage III melanoma, LND was associated with low major morbidity, but clinically meaningful locoregional complications persisted—most notably after inguino–iliac–obturator dissection. These data support careful patient selection and basin-tailored strategies to reduce groin morbidity within modern multidisciplinary management. Full article

We statistically examine the global distribution of free content websites (FCWs) by analyzing their hosting network scale, cloud service provider, and country-level presence, both in aggregate and across specific content categories. These measurements are contrasted with those of premium content websites (PCWs) and with general websites sampled from the Alexa top-1M. We further evaluate their security characteristics using multiple security indicators. Our findings show that FCWs and PCWs are predominantly hosted in medium-scale networks, which are strongly associated with a high concentration of malicious websites. At the cloud and country level, FCW distributions follow heavy-tailed patterns that differ from those of PCWs. Beyond static distributions, our analysis also uncovers dynamic trends, where PCWs demonstrate improving security postures over time while FCWs reveal increasing maliciousness in several categories and hosting regions. This study contributes to understanding the FCW ecosystem through comprehensive quantitative analysis. The results suggest that the harm posed by malicious FCWs can potentially be contained through effective isolation and filtering, given their concentration at the network, cloud, and country levels, and that longitudinal monitoring is essential to capture their evolving risks. Full article

As remote and hybrid work arrangements become increasingly embedded in modern professional life, understanding indoor environmental quality (IEQ) in work-from-home (WFH) settings has become critical for supporting sustainable and healthy work environments. This study assessed both subjective perceptions and objective measurements of IEQ from three different working environments of home, employer offices, and simulated standard-compliant offices. Within the home environment, household characteristics resulted in significantly different measured IEQ: larger households and pet ownership were associated with higher CO₂, VOC, and air temperature levels, while noise levels varied by childcare responsibilities and flooring type. IEQ perceptions also significantly differed: air temperature satisfaction was lower among those providing childcare, and overall environmental satisfaction varied by WFH frequency, with occasional WFH workers reporting the least satisfaction. Across the three working environments, participants were significantly more satisfied with thermal and acoustic conditions in WFH than employer offices, with simulated standard-compliant offices showing intermediate results. Notably, these perception patterns did not always align with measured environmental conditions. These findings demonstrate that both household characteristics and work context shape occupants’ IEQ perceptions, underscoring the importance of occupant-centered evaluation in advancing sustainable building design and remote work strategies. The results suggest that integrating both objective IEQ metrics and subjective experience is essential for promoting long-term environmental sustainability and occupant well-being across evolving work environments. Full article

Background: Systemic bone loss, particularly osteoporosis, and periodontal disease are highly prevalent chronic conditions that share common risk factors and biological pathways. Increasing evidence suggests a bidirectional relationship between these conditions; however, findings remain heterogeneous and evolving. Objective: This review aims to evaluate and update current evidence on the bidirectional association between systemic bone loss and periodontal disease, with emphasis on underlying mechanisms and clinical implications. Methods: A narrative review of the literature was conducted using major electronic databases, focusing on human studies evaluating the relationship between osteoporosis or systemic bone loss and periodontal disease. Relevant experimental, clinical, and epidemiological studies were included. Results: Most studies support an association between reduced bone mineral density and increased severity of periodontal disease, including greater alveolar bone loss and attachment loss. Conversely, periodontal inflammation may contribute to systemic bone remodeling through inflammatory mediators. However, variability in study design, diagnostic criteria, and confounding factors limits definitive conclusions. Conclusions: Current evidence supports a bidirectional association between systemic bone loss and periodontal disease. Greater interdisciplinary awareness is warranted, and future well-designed longitudinal studies are needed to clarify causality and inform preventive and therapeutic strategies. Full article

The Weishan rare earth element (REE) deposit, located in western Shandong, North China Block, is a typical carbonatite REE deposit and constitutes the third largest light REE resource in China. Its mineralization is closely related to the multi-stage evolution of a carbonatite magma–hydrothermal system. However, the mechanisms governing REE enrichment, migration, and precipitation remain insufficiently constrained from a mineralogical perspective, which hampers the understanding of the ore-forming processes and the establishment of predictive exploration models. Apatite is a pervasively developed REE phase in the Weishan deposit which occurs in multiple generations, and thus represents an ideal recorder of the magmatic–hydrothermal evolution. In this study, different generations of apatite hosted in carbonatite orebodies from the Weishan deposit were investigated using cathodoluminescence (CL), electron probe microanalysis (EPMA), and in situ LA-ICP-MS trace element analysis. Three types of apatite were identified. In paragenetic sequence, Ap-1 occurs as polycrystalline aggregates coexisting with calcite, is enriched in Na, Sr, and LREEs, and shows high (La/Yb)_N ratios, suggesting crystallization from an evolved carbonatite magma. Ap-2 and Ap-3 display typical replacement textures: both contain abundant dissolution pits and dissolution channels within the grains, which are filled by secondary minerals such as monazite and ancylite, and thus exhibit characteristic features of fluid-mediated dissolution–reprecipitation during the hydrothermal stage. Ap-2 is commonly associated with barite and strontianite, whereas Ap-3 is associated with pyrite and monazite and is characterized by relatively sharp grain boundaries with adjacent minerals. From Ap-1 to Ap-3, total REE contents decrease systematically, whereas Na, Sr, and P contents increase. All three apatite types lack Eu anomalies but display positive Ce anomalies. Discrimination diagrams involving LREE-Sr/Y and log(Ce)-log(Eu/Y) indicate that apatite in the Weishan REE deposit formed during the magmatic to hydrothermal evolution of a carbonatite, and that the dissolution of early magmatic apatite, followed by element remobilization and mineral reprecipitation, effectively records the progressive evolution of the ore-forming fluid. Full article

Background: Parasitic skin-related conditions represent a frequent and evolving challenge in human dermatology, as they often mimic other dermatoses, and are increasingly complicated by therapeutic resistance. With this study, we aimed to provide a practical, clinician-oriented overview of our experience, contextualising it within the current literature. Materials and Methods: We conducted a retrospective, single-centre observational study, reporting a case series of 88 patients diagnosed with parasitic or arthropod-related skin infestations at the San Raffaele Hospital Dermatology Unit (Milan) between 2019 and 2024, and integrated a concise narrative review of contemporary evidence on diagnosis, non-invasive imaging and management. For each case, we documented clinical presentation, dermoscopic or reflectance confocal microscopy (RCM) findings, and treatment response. Non-invasive tools (dermoscopy, videodermoscopy, RCM) were used when appropriate. Results: The spectrum of conditions included flea bites, bed bug bites, cutaneous larva migrans, subcutaneous dirofilariasis, Dermanyssus gallinae dermatitis, pediculosis, tick bites (including Lyme disease), myiasis, scabies, and cutaneous leishmaniasis. One case of eosinophilic dermatosis of haematologic malignancy was also considered due to its possible association with arthropod bites. Non-invasive imaging was critical in confirming suspected infestations, particularly in ambiguous cases or when invasive testing was not feasible. Several cases highlighted suspected therapeutic resistance: a paediatric pediculosis and three adult scabies cases required systemic therapy after standard regimens failed, raising concerns over putative resistance to permethrin and pyrethroids. In dirofilariasis, the persistence of filarial elements visualised by RCM justified the extension of antiparasitic therapy despite prior surgical removal. Conclusions: Our findings underline that accurate diagnosis, early intervention, and tailored treatment remain essential for the effective management of cutaneous infestations. The observed vast spectrum of isolated parasites reflects broader health and ecological dynamics, including zoonotic transmission, international mobility, and changing environmental conditions. At the same time, diagnostic delays, inappropriate treatments, and neglected parasitic diseases continue to pose significant risks. To address these challenges, clinicians should remain alert to atypical presentations, and consider a multidisciplinary approach including the consultation with parasitologists and veterinarians, as well as the incorporation of high-resolution imaging and alternative therapeutic strategies into their routine practice. Full article

Urban parks are central to public health and equity, yet less is known about how park travel distance, park “attractor” types, and time-of-day visitation rhythms co-evolved through and after the COVID-19 pandemic. Using anonymized smartphone mobility traces for public parks in Las Vegas, USA (2018–2022), we construct weekly origin–destination flows between census block groups (CBGs) and parks and link origins to socio-economic indicators. We first estimate visitor-weighted mean travel distance with a segmented time-series model that allows pandemic-related breakpoints. Results show that average park-trip distance (≈8.4 km pre-pandemic), including a substantial share of long-distance trips (≈52% of visits), contracted sharply at the onset of COVID-19, and that both travel radii and seasonal excursion peaks only partially rebounded by 2022. Next, cross-sectional OLS/WLS models (R² ≈ 0.08–0.14) indicate persistent socio-spatial disparities: CBGs with higher educational attainment and larger shares of Black and Hispanic residents are consistently associated with shorter park-trip distances, suggesting constrained recreational mobility for socially disadvantaged groups. We then identify a stable two-type park typology—local versus regional attractors—using clustering on origin diversity and long-distance share (silhouette ≈ 0.46–0.52); this typology is strongly related to visitation volume and temporal usage profiles. Finally, mixed-effects models of evening and late-night visit shares show that regional attractors sustain higher nighttime activity than local parks, even as citywide evening/late-night visitation dipped during the mid-pandemic period and only partly recovered thereafter. Overall, our findings reveal a durable post-pandemic re-scaling of park use toward more proximate, CBG-embedded patterns layered on enduring inequities in access to distant, destination-oriented parks. These insights offer actionable evidence for equitable park planning, targeted investment in high-need areas, and time-sensitive management strategies that account for daytime versus nighttime use. Full article

Intercity population flows are playing an increasingly pivotal role in shaping the spatial evolution and structural dynamics of urban networks. Drawing upon Amap Migration Data (2018–2023), this study maps China’s urban networks using social network analysis and identifies their key drivers using a temporal exponential random graph model. The findings reveal three primary insights: First, the overall network exhibits “high connectivity and strong clustering” traits. Enhanced efficiency in intercity resource allocation fosters cross-regional factor flows, resulting in multi-tiered connectivity corridors. Industrial linkages and policy interventions drive the development of a polycentric and clustered configuration. Second, the individual city network exhibits a core–periphery dynamic structure. A diamond-shaped framework dominated by hub cities in the national strategic regions directs factor flows. Development of strategic corridors enables peripheral cities to evolve into secondary hubs by leveraging structural hole advantages, reflecting the continuous interplay between network structure and geo-economic factors. Third, driving factors involve nonlinear interactions within a multi-layered system. Path dependence in topology, gradient potential from nodal attributes, spatial counterbalance between geographic decay laws and multidimensional proximity, and adaptive self-organization are collectively associated with the transition of the urban network toward a multi-tiered synergistic pattern. By revealing the dynamic interplay between network topology and multidimensional driving factors, this study deepens and advances the theoretical connotations of the “Space of Flows” theory, providing an empirical foundation for optimizing regional governance strategies and promoting high-quality coordinated development of Chinese cities. Full article

Lymph node evaluation is a central determinant of oncologic quality in the surgical management of non-small-cell lung cancer (NSCLC). Accurate assessment of hilar and mediastinal lymph nodes underpins pathologic staging, informs postoperative treatment decisions, and remains essential for prognostic stratification and assessment of resection completeness. Although international guidelines provide clear recommendations, real-world data consistently demonstrate substantial variability in lymph node staging practices, with inadequate evaluation frequently observed across institutions and surgical settings. Insufficient nodal assessment, manifested as the omission of mediastinal staging, limited station sampling, or low lymph node yield, is associated with reduced nodal upstaging, inappropriate omission of adjuvant therapy, higher recurrence rates, and inferior long-term survival. Contemporary guidance from major societies, including the National Comprehensive Cancer Network, European Society of Thoracic Surgeons, International Association for the Study of Lung Cancer, and the Commission on Cancer, has increasingly converged on a station-based definition of adequacy, emphasizing systematic evaluation of both N1 and N2 nodal stations rather than reliance on absolute node counts alone. In parallel, preoperative mediastinal staging algorithms have evolved toward routine use of endobronchial and esophageal ultrasound as first-line invasive modalities, reserving surgical mediastinoscopy for selected high-risk or inconclusive cases. Evidence from randomized trials, population-level databases, and meta-analyses indicates that thorough nodal assessment improves staging accuracy and survival, while recent data support the selective use of lobe-specific or tailored lymphadenectomy in carefully staged, low-risk early disease. Finally, emerging quality improvement interventions, including standardized specimen handling, operative checklists, and multidisciplinary feedback mechanisms, have demonstrated measurable improvements in guideline adherence and patient outcomes. This narrative review integrates contemporary evidence and guideline recommendations to outline a practical framework for implementing reliable, high-quality lymph node staging in modern lung cancer surgery. Full article

Background: Multimodal AI integration across genomics, radiomics, and pathomics is rapidly evolving in oncology, but evidence remains heterogeneous and unevenly distributed across modalities. Objective: To map empirical studies integrating two or more -omic modalities, summarize integration and validation approaches, and identify gaps informing future directions toward surgomics. Methods: We conducted a scoping review in accordance with PRISMA-ScR, searching PubMed, Ovid, Wiley Online Library, and Google Scholar for English-language studies published from January 2020 to 5 March 2025. We charted study characteristics, modalities combined, fusion strategies, AI model categories, validation approaches, and reported performance metrics as presented by the original studies. Results: From 184 records, 11 studies met inclusion criteria (n = 1078 total participants across reported studies), most focusing on radiomics–pathomics integration; fewer incorporated genomics, and tri-modal fusion was uncommon. Studies varied widely in clinical tasks, endpoints, preprocessing, and validation, limiting direct comparability. Conclusions: The mapped evidence indicates growing methodological activity in radiopathomics and cross-scale association modeling, while tri-modal pipelines and clinically deployable multimodal workflows remain underdeveloped. Surgomics is presented as a conceptual, staged roadmap informed by these gaps rather than a current clinical capability. Full article

This study aims to enhance the security of unmanned aerial vehicles (UAVs) within the Internet of Drones (IoD) ecosystem by detecting and preventing Denial-of-Service (DoS) attacks. We introduce DroneDefender, a web-based intrusion detection system (IDS) that employs machine learning (ML) techniques to identify anomalous network traffic patterns associated with DoS attacks. The system is evaluated using the CIC-IDS 2018 dataset and utilizes the Random Forest algorithm, optimized with the SMOTEENN technique to tackle dataset imbalance. Our results demonstrate that DroneDefender significantly outperforms traditional IDS solutions, achieving an impressive detection accuracy of 99.93%. Key improvements include reduced latency, enhanced scalability, and a user-friendly graphical interface for network administrators. The innovative aspect of this research lies in the development of an ML-driven, web-based IDS specifically designed for IoD environments. This system provides a reliable, adaptable, and highly accurate method for safeguarding drone operations against evolving cyber threats, thereby bolstering the security and resilience of UAV applications in critical sectors such as emergency services, delivery, and surveillance. Full article

Greece’s 2010–2018 adjustment programmes provide an insightful case of how timing of reforms, institutional frictions, and digital transformation jointly condition the outcomes of macroeconomic stabilization efforts. This review builds on programme evaluations, recent academic work, and empirical indicators to analyze the dynamics at the intersection of macroeconomic adjustment, institutional quality, and entrepreneurship, placing emphasis on productivity and the evolving role of digital governance. The paper argues that the asymmetric sequencing of fiscal consolidation, internal devaluation, institution-building, and digital modernization is consistent with deeper and more persistent output losses than initially anticipated, as complementary reforms in product markets and public administration were not yet in place. Recovery momentum was observed when administrative simplification, transparency reforms, and digital public services began to reduce transaction costs, uncertainty, and implementation frictions. In this perspective, digital governance—through initiatives such as Diavgeia, and interoperable registries—acted as an enabling complement to the effectiveness of structural reforms, supporting the shift towards a more innovation-oriented entrepreneurial ecosystem. While the evidence is associative rather than causally identified, the synthesis highlights mechanisms and transferable lessons for the design and sequencing of reform programmes in crisis and recovery contexts. Full article

Methicillin-resistant Staphylococcus aureus (MRSA) is a significant pathogen in both healthcare-associated (HA-MRSA) and community-associated (CA-MRSA) infections, posing major challenges due to its evolving antimicrobial resistance (AMR) and genetic diversity. This study investigates the prevalence, antimicrobial resistance patterns, and molecular characteristics of HA-MRSA and CA-MRSA isolates in Saudi Arabia. A retrospective analysis was conducted on 178 MRSA isolates obtained from clinical samples. MRSA identification was performed using cefoxitin disk diffusion, and antimicrobial susceptibility testing for vancomycin, linezolid, and ciprofloxacin was conducted using the BD Phoenix M50 system. Molecular characterization included SCCmec typing, spa typing, and PCR-based detection of virulence genes (pvl, tst, eta, etb, lukS, lukF). Statistical analysis was carried out using SPSS, with a significance threshold of p < 0.05. Among 1496 S. aureus isolates, 178 (11.9%) were confirmed as MRSA, with HA-MRSA (61.8%) being more prevalent than CA-MRSA (38.2%). Notably, 7.8% of HA-MRSA isolates exhibited heteroresistant vancomycin-intermediate S. aureus (hVISA). Ciprofloxacin resistance was significantly higher in HA-MRSA (85.0%) compared to CA-MRSA (38.9%). SCCmec type V was the predominant genotype (87.1%), suggesting increased infiltration of CA-MRSA strains into hospital settings. Spa typing revealed high genetic diversity, with t037 being the most common (27%). Virulence genes were detected in 6% of isolates, indicating limited dissemination of these factors. The findings highlight the increasing prevalence of MRSA, the emergence of hVISA, and shifts in clonal distribution, underscoring the need for ongoing molecular surveillance and stringent antimicrobial stewardship programs to control MRSA spread in both healthcare and community environments. Full article