Search Results (18,019)

Atherosclerosis, the leading global cause of death, is a chronic inflammatory vascular disease with higher prevalence and earlier onset in men than in women. This study aims to investigate sex differences in the atherogenic endothelial phenotype during early atherosclerosis processes by providing the first comprehensive analysis of hormone-independent responses in human umbilical vein endothelial cells (HUVECs) from opposite-sex twins. HUVECs underwent pro-inflammatory stimulation with TNF-α and supernatant from activated pro-inflammatory THP-1 cells, revealing distinct sex-specific patterns: mRNA expression of focal adhesion proteins talin-I, vinculin, FAK, and α1-actinin increased significantly only in male cells, while paxillin showed elevated mRNA and protein levels in both sexes. Male HUVECs exhibited stronger induction of cell adhesion molecule VCAM-1, pro-inflammatory cytokine IL-1β, and proangiogenic factors Flt-3L, G-CSF, and PDGF-AA, whereas IL-22 secretion was exclusively upregulated in female cells. These sex differences in levels of focal adhesion, adhesion molecules, and cytokine profiles uncover the mechanistic backgrounds of the atherogenic endothelial phenotype, independent of systemic hormones. The findings emphasize cellular sex as a critical biological variable in early atherosclerosis and vascular inflammation. Full article

Antimicrobial resistance represents a major global challenge for healthcare systems, particularly in urinary tract infections (UTIs), where empirical antibiotic therapy is frequently required. Acute pyelonephritis (AP) remains a severe condition, requiring prompt diagnosis and treatment. Local epidemiological data are essential for optimizing therapeutic strategies. The aim of this study was to analyze the pathogen distribution and antimicrobial resistance (AMR) patterns in patients with complicated AP. An observational, analytical study on community-acquired and hospital-acquired AP was conducted on patients admitted with complicated AP between January 2021 and December 2025. After applying the inclusions and exclusions criteria, 553 urinary isolates with complicated AP were analyzed to determine pathogen distribution and phenotypic AMR patterns derived from antimicrobial susceptibility testing. A total of 109 (19.7%) AMR isolates presented resistance phenotype. Resistant phenotypes were more frequently observed among male gender; age did not reach statistical significance. This study highlights the continued predominance of Escherichia coli in complicated AP while demonstrating a significant AMR burden among non-Escherichia coli pathogens, particularly Klebsiella and Pseudomonas species. These findings emphasize the importance of local epidemiological surveillance and culture-guided antibiotic therapy in the management of complicated UTIs. Full article

Objectives: Myofascial pain syndrome (MPS) is a common musculoskeletal condition, and while percutaneous needle electrolysis (PNE) and intramuscular electrical stimulation (IMES) are emerging therapies for myofascial pain syndrome and tendinopathies, their effects remain unclear. This systematic review aimed to characterize the methodological features and synthesize the evidence on the clinical improvement and adverse events rates of PNE and IMES in treating MPS and tendinopathies. Data Sources: PubMed, Scopus, Web of Science, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform, Google Scholar, and reference lists. Searches were carried out on 10 July 2025 and repeated on 16 March 2026, just before final analysis. New results found during final searches were screened for inclusion to ensure currency of the review. Methods: We selected studies based on the PICOS framework and predefined selection criteria: Population: adults with MPS or active myofascial trigger points (TrPs), or tendinopathies; Intervention: PNE or IMES; Comparator: sham procedures, other interventions, or no intervention; Outcomes: pain intensity (e.g., Visual Analogue Scale or Numeric Pain Rating Scale), pressure pain threshold (PPT), and functional measures; and Study Design: experimental studies. Studies focused exclusively on post-surgical or neuropathic pain, studies without a relevant comparator, and studies not reporting clinically meaningful outcomes were excluded. We assessed the risk of bias of included studies and performed a narrative synthesis. Results: From 737 identified records, 30 studies met the selection criteria. PNE was generally effective in reducing pain and improving function in tendinopathies and MPS, although results varied across outcomes and follow-ups. IMES showed moderate evidence for reducing pain and enhancing function, particularly cervical range of motion and PPT. However, both interventions had inconsistent clinical improvement and adverse events rates on disability indices and quality of life. Most studies had a high risk of bias due to challenges in blinding. Reported adverse events were minor and self-limiting, indicating that both therapies are generally safe when performed by trained clinicians. Conclusions: PNE and IMES may improve pain and some functional outcomes in MPS and tendinopathies; however, these findings should be interpreted cautiously because most included studies had a high risk of bias. Full article

Monitoring forest density is essential for understanding ecosystem health, wildfire risk, and post-disturbance recovery. This study proposes a robust methodology to extract forest density classes exclusively using Sentinel-2 multispectral imagery combined with vegetation indices (VIs), textural parameters, and spatial clustering metrics. The approach was applied to the northern part of Euboea Island, Greece, as a pilot area severely affected by a wildfire in August 2021. Four cloud-free Sentinel-2 images (2017–2024) were selected to capture pre- and post-fire conditions. A set of nine VIs—representing vegetation vigor, chlorophyll content, soil exposure, and canopy moisture—were calculated and statistically assessed for independence. To enhance classification accuracy, texture measures (homogeneity, correlation, and entropy) and spatial autocorrelation metrics (Moran’s I, Getis-Ord Gi) were derived for selected VIs. Supervised classification was performed using the Maximum Likelihood algorithm, yielding overall accuracies up to 89.4% and kappa coefficients above 0.85 when combining VIs with texture and spatial metrics. Results revealed a dramatic 49.3% reduction in forest cover immediately after the wildfire, with partial recovery (to 77.9% of pre-fire levels) three years later, mainly as a low-density forest. Approximately 12.1% of forest cover failed to regenerate, indicating potential long-term ecosystem degradation. The proposed approach provides a computationally efficient, high-accuracy alternative to data-fusion methods involving (Light Detection and Ranging) LiDAR or (Synthetic Aperture Radar) SAR datasets, making it suitable for operational forest monitoring and fire-risk management. Full article

Background/Objectives: Social rejection during the latency stage is a significant risk factor for children’s emotional and social development. Whereas earlier research focused primarily on individual characteristics of rejected children, contemporary perspectives emphasize peer-group processes, including norm formation, hierarchies, and social status structures. Although autonomy has been widely examined as an individual developmental construct, less attention has been given to its possible collective expression within the classroom peer group. This study aimed to explore how children understand and experience group autonomy and to clarify its role in social status and peer rejection. Methods: Twelve classroom-based focus groups were conducted with 140 fifth-grade children from five public elementary schools in Israel. Discussions were initiated using a projective narrative describing ambiguous peer exclusion. Data were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. Coding was conducted independently by two researchers and refined through iterative comparison and reflexive procedures. Results: Three themes emerged: (1) a shared longing for classroom-based group autonomy and collective decision-making; (2) group autonomy as an implicit hierarchical criterion shaping social status, whereby reduced reliance on adults and alignment with peer norms were associated with higher status, while adult dependence was linked to marginalization; and (3) an ambivalent structure of autonomy, as children valued peer independence yet expressed fear of adult punishment and responsibility. Conclusions: Findings suggest that during the latency stage autonomy shifts toward a collectively organized peer-group process. Recognizing group autonomy as a developmental dimension may deepen understanding of social status and peer rejection within classroom contexts. Full article

Land-use change contributes significantly to climate change mitigation through biophysical changes (albedo, α) and biogeochemical (greenhouse gases, GHG) emissions (here refers to methane, CH₄, and nitrous oxide, N₂O). While the impact of grassland–cropland conversion on global warming potential (GWP) is well-documented globally, research remains scarce in the saline-alkaline agropastoral transition zone (APTZ) of the western Songnen Plain, Northeast China, an ecotone uniquely characterized by soil-crusting and seasonal inundation. We conducted in situ bi-weekly measurements of N₂O and CH₄ fluxes (June–September) to acquire growing season ${\mathrm{GWP}}_{{\mathrm{N}}_2\mathrm{O}}$ and ${\mathrm{GWP}}_{{\mathrm{C}\mathrm{H}}_4}$, alongside α. The study compared an undisturbed fenced meadow (FMD) with three adjacent land-use types, clipped meadow (CMD), saline-alkaline meadow (SAL), and paddy rice field (PDY), converted from FMD from 2018 to 2022. Annual α-induced GWP (GWPΔα) was positive across all converted sites (CMD, SAL, and PDY), indicating a warming effect due to lower α compared to FMD. The PDY exhibited the highest CH₄ emission (5.04 kg CO₂ m⁻² yr⁻¹), exceeding other land uses by three orders of magnitude (p < 0.05). Conversely, N₂O emissions remained consistently minimal and stable across all sites. When integrating the net ecosystem exchange of CO₂ (NEE), the PDY functioned as a net warming source. In contrast, the warming effects of α and non-CO₂ GHGs were effectively offset by the NEE in other land uses. Machine learning identified soil water content (SWC) as the dominant predictor of α across all land uses in growing season. However, a mechanistic divergence was observed, i.e., α in low saline-alkali ecosystems (FMD, CMD and PDY) was shaped by coupled biotic and soil moisture controls, whereas in the degraded SAL ecosystem, α is almost exclusively abiotic-driven. These findings demonstrate that land-use conversion in the Songnen Plain governs complex land-surface feedbacks through distinct pathways. This study provides a quantitative framework for integrating biophysical and biogeochemical impacts to optimize land management for climate resilience in saline-alkaline agropastoral ecotones. Full article

The neuroinvasive and neurotropic character of coronaviruses is a likely reason for neurological complications which may occur during acute COVID illness and sometimes persist or newly emerge in the post-acute phase. Terminology and temporal classification remain heterogeneous. A retrospective case series was conducted in a single center (Department of Neurology, Bielański Hospital, Warsaw, Poland). Medical records from March 2020 to December 2023 were screened. Inclusion criteria: (1) confirmed SARS-CoV-2 infection (polymerase chain reaction or antigen test and radiological findings), (2) new neurological syndrome within acute, post-acute, or post-COVID interval, and (3) diagnostic documentation. Exclusion criteria: alternative established etiology fully explaining the neurological condition. Six cases were selected for detailed analysis due to diagnostic completeness as well as etiological and temporal diversity. Cases included: (1) persistent neurocognitive and sensory symptoms (post-COVID), (2) acute ischemic stroke with internal carotid artery dissection during severe COVID-19, (3) cytotoxic lesion of the corpus callosum (CLOCC) during acute COVID-19, (4) Guillain–Barré syndrome (post-acute), (5) longitudinally extensive transverse myelitis (post-acute), and (6) delayed autoimmune cerebral vasculitis (post-COVID). Neurological presentations ranged from mild persistent symptoms to fatal outcome. Neurological complications span inflammatory, vascular, and autoimmune mechanisms across distinct temporal phases of SARS-CoV-2 infection. Precise temporal classification and systematic diagnostic protocols are essential. Prospective longitudinal studies integrating biomarkers and standardized neuroimaging are required. Full article

Background/Objectives: Breast cancer remains the leading cause of cancer-related death among women worldwide. While tools such as Adjuvant Online, PREDICT, OncotypeDx and Mammoprint identify patients at higher risk of relapse who should therefore be offered chemotherapy, there are currently no tools to accurately predict response to chemotherapy, with varied response rates (regardless of subtypes, etc.) of 8–70% reported. Accurately stratifying patients based on their likelihood of benefiting from SoC chemotherapy is therefore critical to guide personalised treatment decisions. Methods: A retrospective cohort of 293 breast cancer patients treated with SoC adjuvant anthracycline-based regimen was analysed. Five biomarkers (TOP2A, PTEN, EGFR, IGF1R, and phospho-mTOR), selected for their prognostic and therapeutic relevance, were assessed using immunohistochemistry (IHC) combined with digital pathology. Results: Biomarker expression was quantified using the digital pathology platform, QuPath, with each marker, when stratified based on high/low expression, demonstrating a significant association with relapse-free survival following SoC chemotherapy in specific subtypes of breast cancer. A composite five-biomarker signature was then generated by integrating the individual biomarker scores to improve prognostic precision. Patients with a five-biomarker signature score greater than zero exhibited a significantly higher likelihood of favourable outcomes following anthracycline-based chemotherapy compared with those with a score of zero or below. Conclusions: This study establishes a novel IHC-based five-biomarker signature capable of predicting patient outcome in the context of SoC chemotherapy. As the signature relies exclusively on IHC, it is simple, cost-effective and readily integratable into routine diagnostic workflows. In addition to its prognostic value, several biomarkers within the panel are potentially actionable, offering opportunities to guide targeted therapies in patients predicted to have poor response to conventional chemotherapy. Full article

Background: Chronic heart failure (CHF) in older adults requires sustained self-management and close follow-up, yet day-to-day care is often carried out by families with support from primary healthcare nurses. In Saudi Arabia, where family caregiving is culturally normative, collaboration between nurses and patients’ families may be pivotal to effective CHF management, but remains insufficiently understood in primary healthcare contexts. Methods: A qualitative study informed by an interpretive phenomenological approach was conducted. Participants (n = 24; 12 nurses and 12 family caregivers) were recruited using purposive sampling from primary healthcare centers in Riyadh, Saudi Arabia. In-depth, semi-structured interviews were conducted in Arabic or English, audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis following Braun and Clarke’s six-phase framework. Strategies to enhance trustworthiness included member checking, peer debriefing, maintenance of an audit trail, and reflexive journaling. Results: Twenty-four participants (12 nurses and 12 family caregivers) were interviewed. Four interrelated themes were generated from both nurses’ and family caregivers’ accounts. (1) “We Are Caring Together”: Collaboration was experienced as shared responsibility for daily CHF management, grounded in trust; (2) Navigating Roles and Boundaries: Participants described unclear expectations, role overlap, and tension between professional authority and family knowledge; (3) Communication as the Engine of Collaboration: Effective partnerships depended on clear information exchange, caregiver-tailored education, and continuity of contact, while communication gaps created uncertainty and delayed support-seeking; and (4) Cultural and System Constraints Shaping Collaboration: Strong family obligation motivated caregiving but also intensified moral pressure and limited help-seeking, while time pressure and fragmented services constrained meaningful engagement and continuity across settings. Conclusions: Nurse–family collaboration in CHF management is relational, shaped by trust, role negotiation, and communication, and constrained by cultural norms and system pressures. This study contributes to the literature by demonstrating how moral obligation, hierarchical professional norms, and system fragmentation distinctively shape collaboration in the Saudi primary care context, extending existing conceptualizations derived primarily from Western individualist settings. Strengthening collaboration requires explicit role clarification, health literacy–informed caregiver education, continuity of contact, and organizational supports. Findings are limited by purposive sampling, single-city context, and exclusion of patient perspectives. Full article

Background and Clinical Significance: Left atrial myxoma is the most common benign primary cardiac tumor and is associated with embolic and hemodynamic complications. Complete surgical excision is the treatment of choice, while postoperative cardiovascular rehabilitation is essential for functional recovery. Case Presentation: We report the case of a 75-year-old woman with arterial hypertension, dyslipidemia, and chronic venous insufficiency (Clinical–Etiological–Anatomical–Pathophysiological (CEAP) class 2), and chronic hepatitis B virus (HBV) infection who underwent surgical excision of a left atrial myxoma and was subsequently admitted three weeks postoperatively for phase II cardiovascular rehabilitation. The postoperative course was complicated by transient atrial fibrillation, peripheral edema, pleural effusion, and progressive purpuric lesions of the lower limbs. Laboratory and immunological evaluation revealed positive cryoglobulins, markedly elevated rheumatoid factor (1058 UI/mL) and IgM levels (715 mg/dL), reduced complement levels (C3, C4), normocytic normochromic anemia, microscopic hematuria, and elevated ALT (156 U/L), AST (142 U/L), total bilirubin (1.4 mg/dL), and INR (1.6), suggestive of hepatic inflammatory activity. HBV status was scheduled for evaluation through Gastroenterology referral (HBV DNA viral load, serological markers: HBsAg, HBeAg, anti-HBe), as our Cardiology Rehabilitation Clinic lacks the possibility of evaluation. After systematic exclusion of alternative etiologies, secondary cryoglobulinemic vasculitis in the context of chronic HBV infection with biochemical evidence of hepatic activity was considered the most plausible diagnosis. Conclusions: This case highlights the complexity of managing elderly patients after cardiac tumor surgery, particularly in the presence of systemic comorbidities. Early recognition of extracardiac complications and an individualized, multidisciplinary strategy are essential to optimize outcomes. Full article

Land subsidence and coseismic deformation can interact in groundwater-stressed sedimentary basins, yet basin-scale identification of event-timed vertical offsets in InSAR products requires explicit control of referencing and processing effects. This study evaluates whether the 27 September 2021 Arkalochori earthquake (Mw 6.0; central Crete) produced detectable coseismic vertical offsets within the Messara Basin by applying a reproducible screening workflow to Copernicus European Ground Motion Service (EGMS) Level-3 Vertical time series, from two processing generations (EGMS 2015–2021 and EGMS 2018–2022). An event-centered step metric (stepEQ), defined as the difference between post-event and pre-event mean displacements over a fixed acquisition window, is evaluated across three fixed spatial masks (MESSARA, R15060, R8750) together with a dispersion-based precision proxy (σstep) and a cross-generation sensitivity diagnostic (ΔstepEQ). A supplementary 2 + 2 subset sensitivity analysis indicates that the adopted fixed 3 + 3 estimator is stable at the basin scale, with sensitivity concentrated mainly in threshold-adjacent cases. Results indicate that Arkalochori-related offsets are not expressed as a basin-wide step across Messara; instead, non-background responses form a spatially limited and coherent subset concentrated where the basin intersects the near-source footprint. In EGMS 2018–2022, the higher vertical offset class (C2; |stepEQ| > 40 mm) is exclusively subsidence-direction and is enriched toward the screening center (up to ~19% within the radii mask R8750 m) but remains sparse at the basin scale mask (MESSARA mask) (~1%). Step-dominated points co-locate with strongly subsiding mean vertical velocity regimes and are hosted almost entirely by post-Alpine basin deposits, indicating strong material and background-deformation conditioning of step detectability. Cross-generation comparison shows basin-scale stability of background behavior but localized near-source sensitivity, supporting use of ΔstepEQ as a Quality Control (QC) lens for threshold-adjacent interpretations. The workflow provides a transparent, transferable approach for prioritizing candidate coseismic-step locations in EGMS time series. Results are interpreted as screening-level evidence in the derived vertical signal using event timing, spatial coherence, and QC diagnostics. Full article

The Dibaya Granitic and Migmatitic Complex (DGMC), located in the Kanyiki–Kapangu sector of the Kasaï Shield (Congo–Kasaï Craton, Democratic Republic of the Congo), represents a key exposure of Neoarchean continental crust in Central Africa. Despite its geological importance, information on its petrology, geochronology, geochemistry, and structural evolution remains dispersed across historical studies. This contribution presents a structured geological synthesis based exclusively on previously published cartographic, petrographic, structural, and isotopic data. No new analytical data are introduced; rather, existing datasets are systematically compiled, critically reassessed, and integrated into a coherent tectono-thermal framework. Published Rb–Sr and U–Pb ages indicate high-grade metamorphism and widespread migmatitization at ca. 2.72 Ga, followed by granitoid emplacement at ca. 2.65 Ga. Documented mineral assemblages (garnet–biotite–plagioclase–quartz ± K-feldspar ± amphibole) and the absence of reported high-pressure index minerals support high-temperature, moderate-pressure metamorphism consistent with intracrustal reworking. Reported regional geochemical characteristics suggest high-K calc-alkaline, weakly to moderately peraluminous granitoids derived predominantly from reworking of older TTG-type crust. Structural relationships, particularly along the Malafudi corridor, demonstrate strong coupling between deformation, anatexis, and magma emplacement. Collectively, this synthesis formalizes a Neoarchean intracrustal reworking model and provides a structured analytical basis for future high-resolution petrochronological and geochemical investigations. Although no new quantitative datasets are presented, this study provides the first systematic integration of dispersed geological and isotopic information for the Dibaya Complex, establishing a transparent analytical framework for future high-resolution investigations. Full article

The concept of the 15 minutes city is increasingly present in the structure of spatial planning for large urban centers, with the main goal of improving quality of life by facilitating access to basic necessities for the population. This study aims to provide an integrated assessment of spatial accessibility for two urban centers that differ in structure and organization, with the main goal of identifying best practices that can be borrowed from one urban center to another in order to streamline sustainable spatial planning based on the strategic concept of the 15 minutes city. The entire research process is based on the development of a completely new and innovative GIS spatial analysis model that will add value to the specialized literature both through the geoinformational approach to the analysis, integration and through the exclusive use the freely available GIS databases (using the OpenStreetMap database), functionally integrated through network analysis and equations weighing the importance of accessibility needs for the population. For the analysis of pedestrian accessibility, in minutes, a total of 4826 locations were used for Cluj–Napoca and 5050 for Pecs, which were structured into 12 subclasses and five main classes (Recreational and Cultural, Public Services and Safety, Education and Health, Commercial, and Public Transport) established in accordance with the main requirements of the 15 minutes city development methodology. The integration of subclasses and accessibility classes was achieved by weighting their importance according to the responses obtained after the implementation of questionnaires to identify the working population’s perception of accessibility in their daily routine. The comparative analysis of the intermediate and final results of the proposed model leads to the establishment of directions and decision-making in the territorial planning process through the transfer of knowledge, solutions, and techniques between the two urban centers to eliminate or reduce negative hotspots and develop a more sustainable urban center in terms of accessibility and as close as possible to a 15 minutes city. Full article

Effective oral interventions for alcohol-induced metabolic stress and liver injury remain limited. Pre-absorptive gastrointestinal alcohol handling is gaining interest as a non-pharmacological strategy to reduce hepatic burden. In this study, we developed a formulation-integrated, food-compatible lyophilized recombinant whole-cell catalyst based on Escherichia coli Nissle 1917 engineered to express alcohol dehydrogenase and acetaldehyde dehydrogenase. Rather than focusing exclusively on strain-level genetic modification, the engineered cells were protected by lyophilization combined with a food-grade chitosan–alginate layer-by-layer coating, forming an artificial cell wall designed to enhance survivability during oral delivery. The formulation resisted simulated gastric acid, sodium taurocholate, and ethanol, retained enzymatic activity after storage, and demonstrated formulation stability. In alcohol-exposed mice, oral administration reduced blood ethanol and acetaldehyde levels, improved liver biochemical parameters, attenuated hepatic steatosis, and partially restored oxidative stress indicators. Integrated multi-omics analyses indicated coordinated gut-associated metabolic and inflammatory responses to alcohol and intervention, rather than a single dominant pathway. These findings provide hypothesis-generating evidence; causality remains to be established. Overall, this study demonstrates a proof-of-concept, food-compatible lyophilized recombinant whole-cell catalyst that integrates enzymatic function with formulation stability and gastrointestinal resilience, highlighting an applied, food-compatible microbial framework for exploring alcohol-related metabolic stress. Full article

Background/Objectives: Pediatric sarcomas are rare and heterogeneous malignancies for which clinical trials are essential to advance treatment and improve outcomes. However, the characteristics and trends of sarcoma clinical trials enrolling children in the United States have not been comprehensively described. This study aimed to characterize U.S.-based sarcoma clinical trials enrolling pediatric patients and to evaluate trends over time. Methods: ClinicalTrials.gov was searched for interventional sarcoma trials conducted in the United States that enrolled patients ≤ 17 years of age and were posted between 27 September 2007 and 11 January 2023. Trials were categorized as pediatric (maximum eligible age ≤ 21 years) or pediatric/adult (>21 years). Trial characteristics, including phase, intervention type, funding source, geographic scope, and reasons for early termination, were analyzed. Results: A total of 273 eligible trials were identified, of which 79% enrolled both pediatric and adult patients. Most studies were early phase (Phase 1, 2, or 1/2; 59%) and primarily evaluated drug or biologic therapies (73%). Trials involving mixed cancer types were most common (26%). The majority were multi-institutional (66%), non-industry funded (57%) and conducted exclusively in the United States (75%). Trial activations increased over time (p-value = 0.01), with a higher proportion of industry-funded studies initiated between 2016 and 2022 (p-value = 0.009). Twenty-three trials (8.4%) were terminated early, most commonly due to slow accrual (39%). Conclusions: Most sarcoma clinical trials enrolling pediatric patients continue to include both adult and pediatric populations, which may limit the development of therapies tailored to the unique biology of pediatric sarcomas. Improving outcomes will require greater emphasis on pediatric-focused research, enhanced collaboration across institutions, and increased awareness of clinical and regulatory frameworks to support the initiation of industry-funded trials. Full article