Search Results (32,636)

Given the importance of friendships and the increased risk for suicide during adolescence, potential socialization of suicidality among peers is essential to examine. Data were obtained from 93 friendship dyads (N = 186) in a community-based, longitudinal study of adolescents (Mage = 15.68, SD = 1.49, 69.9% female, 86.6% white). Adolescents’ and friends’ suicide risk and frequency of non-suicidal self-injury (NSSI) were assessed at baseline and at 3-month and 6-month follow-up assessments. Cross-lagged, Actor–Partner Interdependence Models (CL-APIM) examined socialization effects over time with the nested, dyadic data. Results indicated that direct socialization of suicide risk did not occur within the whole sample. However, socialization of suicide risk was observed for friends of adolescents with a past-year history of NSSI. The findings underscore the potential for NSSI to function as a susceptibility marker for socialization of suicide risk within adolescent friendships. Current study strengths, limitations, and clinical implications are further discussed. Full article

Objectives: To evaluate serum zonulin and CHI3L1 as indicators of intestinal permeability and disease activity in pediatric celiac disease and to explore their associations with histopathological findings and nutritional status. Methods: This prospective cross-sectional study included 131 pediatric patients with CD (aged 2–18 years) and 42 healthy controls. Patients were classified as newly diagnosed, gluten-free diet (GFD)-adherent, or GFD-nonadherent. Body mass index was calculated, and serum levels of micronutrients, zonulin, and CHI3L1 were measured using a sandwich enzyme-linked immunosorbent assay. Associations with histopathological findings, serological markers, and nutritional parameters were analyzed. Results: Age and sex distributions were similar across groups (mean age: 10.9 ± 4.27 years). Serum zonulin and CHI3L1 levels were moderately positively correlated (r = 0.525, p < 0.001). Both biomarkers showed significant positive correlations with Marsh scores and tissue transglutaminase IgA levels. Zonulin was inversely correlated with hemoglobin, serum iron, and ferritin, whereas CHI3L1 showed negative correlations with hemoglobin and folate. Parathyroid hormone levels were positively correlated with both biomarkers. Receiver operating characteristic analysis demonstrated acceptable discriminatory performance for distinguishing CD from controls (AUC: 0.713 for zonulin and 0.709 for CHI3L1). Conclusions: Serum zonulin and CHI3L1 levels are associated with disease activity and mucosal injury in pediatric CD but do not directly reflect micronutrient status. These biomarkers may complement conventional monitoring parameters by providing additional information on intestinal permeability and inflammatory activity during follow-up. Full article

Routine monitoring in racehorses requires indicators that are reproducible and practical under real training conditions. This observational study evaluated the short-term reproducibility of cardiovascular and speed indicators in French Standardbred trotters, with a particular focus on cardiac cost (CC), defined as the ratio of heart rate to speed (beats·m⁻¹). The full dataset comprised 483 sessions from 60 trotters and was used to describe age-related patterns. For reproducibility analyses, consecutive monitored sessions within the same horse were grouped into follow-up blocks when the interval between two successive sessions did not exceed 7 days. Only follow-up blocks containing at least three sessions were retained, resulting in 36 blocks, 126 sessions, and 18 horses. Each session included a warm-up, two 2000 m work blocks at increasing intensity, and recovery periods, while heart rate and speed were recorded using a Polar Team Pro system. Adjusted intraclass correlation coefficients indicated moderate reproducibility for CC during the first work block (CC B1: 0.67, 95% CI 0.48–0.78), heart rate recovery (HRR) after B1 (0.60, 0.40–0.73) and B2 (0.66, 0.47–0.78), and V150 (0.59, 0.39–0.73), whereas V180, recovery speed, and CC during B2 showed poor reproducibility. Reproducibility of CC B1 and HRR was preserved after adjustment for ambient temperature. In the full dataset, V200 increased with age, consistent with previous field-test literature. The minimal detectable change was 0.04 beats·m⁻¹ for CC B1 and 26 bpm for HRR after B1. These findings suggest that CC B1, HRR, and V150 may be useful indicators for short-term monitoring, although results should be interpreted considering the single-yard design. Full article

Background: The clinical relevance of circulating B-cell subpopulations during the early period after kidney transplantation remains incompletely understood. Methods: In this prospective single-center study, frequencies and absolute numbers of peripheral B-cell subpopulations were longitudinally assessed by flow cytometry in 71 kidney transplant recipients before transplantation (T0) and at 3 (T3), 6 (T6) and 12 months (T12) post-transplant. Associations with graft function, rejection episodes and clinical variables were explored. Results: During the first post-transplant year, relative frequencies of total and naïve B cells declined, whereas absolute counts showed modest increases. Memory B-cells expanded over time, driven by both class-switched (CSBC) and class-non-switched (CNSBC) subsets. Transitional regulatory B cells (tBregs) and plasmablasts decreased significantly, while memory regulatory B cells (mBregs) remained stable. Pre-transplant B-cell profiles did not differ between recipients experienced rejection and those with stable graft function. At T12, rejection was associated with a shift toward a memory-dominant peripheral profile, characterized by reduced naïve representation. tBregs showed modest positive associations with graft function during follow-up. Hierarchical clustering identified naïve- and memory-dominant phenotypes representing distinct post-transplant immune compositions. Conclusions: Early post-transplant peripheral B-cell landscapes are dynamic and heterogeneous. Peripheral B-cell phenotyping shows limited value as a standalone clinical monitoring tool. Full article

Context: Prosthetic rehabilitation of acquired maxillary defects with Maxillary Resection Prostheses (MRPs) remains biomechanically challenging, particularly in partially edentulous patients, where conventional clasp-retained designs often yield suboptimal retention, stability, and functional outcomes. Research Gap: The integration of telescopic crown systems with semi-precision attachments incorporating a rotational latching mechanism has not been previously described as a unified approach to optimise load distribution and prosthesis stability in maxillary defect rehabilitation. Objective: To describe and clinically evaluate a novel prosthetic design combining telescopic crowns and a semi-precision rotational latching attachment to enhance retention, stability, and functional performance of MRPs. Methodology: A 31-year-old patient with a unilateral maxillary defect following partial maxillectomy presented with an unstable interim prosthesis and impaired speech and mastication. A definitive MRP was designed using telescopic crowns on the remaining dentition to establish a controlled path of insertion and improved axial load transfer. A semi-precision attachment with a key–keyway rotational latching mechanism was incorporated into the secondary framework to engage specific undercuts while minimising lateral forces on abutment teeth. A provisional prosthesis was used for 3 months to evaluate base extension, phonetics, and functional parameters before fabrication of the definitive prosthesis. Results: Serial follow-up at 1, 3, and 6 months demonstrate consistent prosthesis stability, precise seating, and favourable retention. Marked improvements were observed in speech intelligibility, masticatory efficiency, and patient-reported comfort. Conclusions: This combined prosthetic strategy represents a novel and biomechanically optimised approach for the rehabilitation of partially edentulous maxillary defects, with promising clinical and functional outcomes. Full article

Survival rates in pediatric cancer have increased substantially over recent decades. However, children and survivors frequently experience treatment-related alterations in physical function, body composition, bone health, and metabolic regulation. Chemotherapy, glucocorticoid exposure, physical inactivity, nutritional imbalance, and inflammatory and neuroendocrine disturbances may contribute to reduced lean mass, decreased bone mineral density, sarcopenic obesity, and long-term cardiometabolic risk. This narrative review critically summarizes current evidence on multimodal exercise and nutritional interventions in pediatric oncology, with particular attention to their effects on physical function, body composition, nutritional status, and metabolic health. Literature searches were conducted in PubMed, Scopus, and Web of Science up to April 2026, combining contextual evidence with studies evaluating combined exercise and nutritional strategies. Current evidence suggests that structured and supervised exercise, particularly resistance and combined aerobic–resistance training, is feasible and safe, and may improve cardiorespiratory fitness, muscle strength, functional capacity, and body composition. Nutritional care should be individualized, prioritizing adequate protein intake, micronutrient status, periodic reassessment of energy requirements, and body composition rather than relying on BMI alone. Nevertheless, available findings remain limited by small sample sizes, heterogeneous protocols, variable supervision, inconsistent outcome assessment, and limited long-term follow-up. Integrating exercise, nutrition, and regular monitoring into pediatric oncology care may help mitigate treatment-related functional and metabolic complications. Future studies should prioritize adequately powered randomized trials, standardized intervention protocols, objective monitoring of exercise intensity, harmonized body composition and functional outcomes, and longer follow-up to define clinically applicable multimodal care models. Full article

Background: Myocardial fibrosis plays a key role in adverse remodeling after ST-segment-elevated myocardial infarction (STEMI). The effect of sodium–glucose cotransporter 2 inhibitors (SGLT2is) on myocardial fibrosis deposition among patients with STEMI undergoing primary percutaneous coronary intervention (pPCI) is unclear. Objectives: To assess the effects of SGLT2is on myocardial fibrosis among patients with STEMI undergoing pPCI. Methods: Patients with STEMI undergoing pPCI with left ventricular ejection fraction ≤ 50% were randomized to dapagliflozin 10 mg or placebo. The primary endpoint was cardiac magnetic resonance (CMR)-derived 6-month changes in remote myocardium extracellular volume (ECV) fraction from baseline. Secondary endpoints included changes in CMR-derived myocardial volumes, change in serum fibrosis biomarker levels, and adverse events. Multivariable adjustment for infarction location and diabetes status was performed as sensitivity. The study was halted prematurely due to slow recruitment. Results: Fifty-two patients underwent randomization between May 2021 and April 2024 and completed follow-up. At 6 months, dapagliflozin resulted in a non-significant reduction in ECV change compared to placebo (−0.39 [4.7] vs. 1.43 [5.7]; difference: −1.82 [−4.86; 1.23]; p-value = 0.235) while also leding to a higher degree of reduction in N-terminal pro-peptide of type III collagen (−177.0 pg/mL [416.1] vs. 3.6 pg/mL [553.8]; p-value = 0.208). No significant differences in other biomarkers or adverse events were noted in the main analysis. After adjustment, dapagliflozin was associated with increased reduction in left ventricular end-systolic volume (−4.02 mL [7.4] vs. 0.10 mL [10.1]; difference: −4.92 [−9.8; −0.1]; p-value = 0.047). Conclusions: In STEMI patients undergoing pPCI, dapagliflozin did not result in a significant reduction in ECV or biomarkers of fibrosis at 6 months. Full article

Bullous keratopathy may lead to severe corneal opacity and impaired visualization of anterior segment structures, complicating surgical qualification for endothelial keratoplasty (EK). We report the case of a 67-year-old male with pseudophakic bullous keratopathy and Fuchs endothelial dystrophy presenting with clinically complete corneal opacity and visual acuity limited to hand motion. Slit-lamp examination and anterior segment optical coherence tomography demonstrated marked epithelial remodeling with a dense plaque-like surface lesion obscuring deeper corneal structures. A staged intraoperative approach was undertaken. Following mechanical epithelial debridement, partial restoration of corneal transparency allowed for an intraoperative reassessment of stromal clarity and subsequent Descemet Stripping Automated Endothelial Keratoplasty (DSAEK). Histopathological examination demonstrated reactive epithelial thickening with associated subepithelial fibrosis consistent with chronic bullous keratopathy. Postoperatively, corneal transparency was restored and best-corrected visual acuity improved to 0.7 Snellen (0.15 logMAR), remaining stable during follow-up without graft-related complications or recurrent epithelial abnormalities. This case highlights the importance of considering epithelial contributions to apparent corneal opacity in advanced bullous keratopathy and suggests that staged intraoperative reassessment may support individualized surgical decision-making in selected patients with inconclusive preoperative evaluation. Full article

Objective: This study aimed to evaluate the clinical and radiological efficacy of percutaneous laser disc decompression (PLDD) in patients with disc-related lumbar spinal stenosis. Methods: Data from 96 patients who underwent PLDD between January 2023 and January 2025 were reviewed retrospectively. Pain intensity (visual analogue scale [VAS]), functional capacity (pain-free walking distance), patient satisfaction (global patient evaluation), and radiological canal diameter were assessed before the procedure and at 1, 3, and 6 months postoperatively. Treatment response was determined based on a ≥2-point decrease in the VAS score, which is the minimal clinically important difference (MCID) criterion. Results: A marked improvement in VAS scores was observed from the early period following PLDD, with the mean VAS score decreasing from 8.02 to 5.02 ± 1.99 at 6 months (p < 0.001). The pain-free walking distance increased from 212.7 m to 345.8 m, resulting in a significant improvement in functional capacity (p < 0.001). A significant increase in the anteroposterior diameter of the spinal canal from 7.1 ± 1.7 mm to 7.9 ± 1.8 mm (p < 0.001) was observed, corresponding to a mean increase of 0.8 mm; however, the magnitude of this radiological change was modest and should be interpreted cautiously. A moderate correlation was found between radiological expansion and VAS change (r = 0.52). At 6 months, 72.9% of patients met the MCID criterion. Although ODI improved significantly over follow-up, the mean reduction remained below commonly accepted MCID thresholds, suggesting that the functional benefit may be modest. No major complications were observed; only short-term transient radicular irritation (2.1%) was seen. Conclusions: PLDD was associated with improvements in pain control, functional capacity, and modest radiological canal enlargement in this cohort of carefully selected patients with single-level, predominantly disc-driven lumbar spinal stenosis. However, because of the retrospective design and absence of a control group, no conclusions regarding comparative effectiveness can be drawn. PLDD should therefore be viewed as a selectively applicable minimally invasive option rather than a general treatment for all forms of lumbar spinal stenosis. The observed clinical benefit was limited to the 6-month follow-up available in this cohort, and its durability beyond this period remains uncertain. Prospective and comparative studies are required to better define its long-term role and its position relative to conservative treatment and surgery. Full article

Coronavirus disease 2019 (COVID-19) has been associated with an increased long-term cardiovascular risk, potentially mediated by magnitude of the acute inflammatory response inflammation. Interleukin-6 (IL-6) and serum amyloid A (SAA) are key components of the inflammatory cascade and may serve as biomarkers of post-COVID cardiovascular vulnerability. This longitudinal observational study investigated the association between post- COVID-19 infection IL-6 and SAA levels and major cardiovascular events over a six-year follow-up period. A total of 97 individuals with documented prior SARS-CoV-2 infection were included. Circulating IL-6 and SAA concentrations were measured in the acute phase. The composite endpoint included incident arrhythmia, myocardial infarction, and all-cause mortality. Biomarker distributions were right-skewed and were therefore analyzed using non-parametric methods and penalized logistic regression models. During follow-up, 14.4% of participants experienced the composite endpoint. Individuals with adverse outcomes had significantly higher IL-6 and SAA levels compared with event-free participants. IL-6 demonstrated the strongest association with mortality, whereas SAA showed particularly robust associations with the composite endpoint, and with myocardial infarction. Both biomarkers independently predicted long-term adverse events. Circulating IL-6 and SAA concentrations measured during the acute phase of SARS-CoV-2 infection were analyzed in relation to long-term cardiovascular outcomes. These findings support the hypothesis that the magnitude of the acute inflammatory response during SARS-CoV-2 infection may be associated with long-term cardiovascular outcomes and suggest that combined assessment of IL-6 and SAA may have potential utility for hypothesis-generating prognostic signal requiring validation, pending validation in larger studies. Full article

Background: This study investigated the clinical timeline, patient monitoring behaviors, and cumulative bilateral treatment burden in patients with bilateral neovascular age-related macular degeneration. Methods: We retrospectively analyzed follow-up patterns and treatment intensity from first-eye (FE) diagnosis to second-eye (SE) conversion. Results: SE conversion occurred within a mean of 2.0 years in the FE-active group (62.5%) while the FE remained exudative, contrasting with 6.2 years in the FE-inactive group (37.5%). Upon SE conversion, the total annual intravitreal injection burden escalated 3.4-fold (p = 0.002). Notably, the FE-inactive group exhibited numerically lower annual outpatient visit counts (4.40 ± 2.71 vs. 10.29 ± 5.02; p = 0.116), which potentially widened the monitoring window. Additionally, baseline SE retinal pigment epithelium (RPE) abnormalities independently predicted progression (aOR: 19.04; p = 0.032). Conclusions: While previous literature focuses on individual eyes, our findings highlight a vigilance gap in SE detection based on FE status. Clinicians must maintain proactive surveillance for patients with baseline SE RPE abnormalities, particularly when FE stability or next-generation long-acting therapies extend clinic intervals. Due to the limited sample size, these preliminary findings warrant validation in larger prospective cohorts. Full article

We present the case of a patient who underwent transcatheter aortic valve implantation and subsequently developed an aortic pseudoaneurysm. During follow-up, the patient appeared clinically and radiologically stable, although the imaging modalities employed were not adequate to fully assess the lesion. Ten months later, a thoracoabdominal computed tomography scan performed for an unrelated reason revealed significant pseudoaneurysm growth, and the patient subsequently underwent complex aortic root surgery. Central Message: Different degrees of iatrogenic aortic annulus rupture after TAVI lead to different therapeutic approaches; once the acute phase is over it requires close follow-up with appropriate imaging techniques. Full article

Background: SGLT2 inhibitors improve outcomes in heart failure with reduced ejection fraction (HFrEF), but whether early recovery patterns after initiation differ according to HF etiology in real-world practice remains uncertain. Objective: To evaluate whether ischemic versus non-ischemic etiology is associated with different 6-month cardiac, renal, biomarker, and exploratory metabolic trajectories after early in-hospital SGLT2 inhibitor initiation in HFrEF. Materials and Methods: In this prospective single-center observational cohort (2022–2025), consecutive adults hospitalized with first-presentation acute HFrEF who initiated empagliflozin or dapagliflozin within 48 h of admission were enrolled. Patients were classified as having ischemic cardiomyopathy (ICM) or non-ischemic cardiomyopathy (NICM). The primary analytic cohort included patients with paired baseline and 6-month echocardiography. The primary outcome was change in left ventricular ejection fraction (LVEF); eGFR and NT-proBNP were secondary outcomes. Exploratory metabolic/laboratory variables were summarized descriptively using paired available-case follow-up. The study was approved by the institutional ethics committee and registered in ClinicalTrials.gov under the CaRD registry framework (NCT06090591). Results: The paired 6-month echocardiographic analytic cohort comprised 241 patients who survived to reassessment (ICM n = 90; NICM n = 151). NICM showed greater improvement in LVEF than ICM (ΔLVEF +10% [IQR 0–18] vs. +5% [IQR 0–12]; p = 0.049) and a more favorable eGFR trajectory (ΔeGFR 0.30 [IQR −5.90 to 6.60] vs. −2.70 [IQR −12.60 to 3.40] mL/min/1.73 m²; p = 0.038). NT-proBNP declined substantially in both groups, with no between-group difference in change magnitude (p = 0.845), although 6-month values remained higher in ICM (p = 0.034). However, after multivariable adjustment, ischemic etiology was no longer independently associated with 6-month LVEF or eGFR outcomes. Exploratory metabolic findings varied descriptively by etiology but should be interpreted cautiously because follow-up completeness and background treatment intensity varied across variables. Conclusions: In this real-world cohort of patients with HFrEF who initiated SGLT2 inhibitors during hospitalization, HF etiology was associated with different short-term cardiorenal recovery patterns, whereas NT-proBNP reduction was similar across groups. These findings characterize etiology-related recovery within a treated cohort rather than differential SGLT2 inhibitor efficacy and should therefore be considered as hypothesis-generating. Full article

Background: Mobile health has been increasingly integrated into tuberculosis care to support patient education, communication, and treatment engagement. However, evidence remains limited regarding whether positive engagement with mHealth is associated with knowledge, attitudes, and practices among patients with multidrug-resistant tuberculosis. This study aimed to examine the association between positive mHealth engagement and knowledge, attitude, practice, and total KAP among patients with multidrug-resistant tuberculosis, and to evaluate the psychometric properties of the engagement score used as the primary exposure variable. Methods: A cross-sectional study was conducted among patients with multidrug-resistant tuberculosis. A positive mHealth engagement score was constructed from 12 mHealth-related items after harmonizing item directionality so that higher scores indicated more favorable engagement. The 12 items reflected five behavioural domains: intensity of use, ease and acceptability of use, functional engagement (communication with providers, access to health information, and perceived benefit for disease self-management), continuity of use, and barriers to sustained engagement. The composite score was computed as the mean of the 12 standardised items, with higher values indicating more positive engagement. Internal consistency was assessed using Cronbach’s alpha and corrected item–total correlations, and structural validity was explored using principal component analysis. Adjusted linear regression models were used to examine associations between the engagement score and Knowledge, Attitude, Practice, and total KAP scores, controlling for age, sex, and occupation. Sensitivity analyses were performed after excluding a poorly performing item, and tertile analyses were used to assess dose–response patterns. Results: The positive mHealth engagement score showed good internal consistency, with a Cronbach’s alpha of 0.852. One item demonstrated poor psychometric performance, and Cronbach’s alpha increased to 0.864 after its exclusion. The data were suitable for dimensionality assessment, with a Kaiser–Meyer–Olkin value of 0.870 and a significant Bartlett’s test. Principal component analysis identified a dominant first component explaining 43.29% of the total variance. Using the refined score, higher positive mHealth engagement was significantly associated with higher Knowledge scores (β = 2.06; 95% CI: 1.28–2.85; p < 0.001), higher Attitude scores (β = 4.68; 95% CI: 3.30–6.06; p < 0.001), and higher total KAP scores (β = 6.68; 95% CI: 4.62–8.74; p < 0.001), whereas no significant association was observed for the Practice score (β = −0.07; 95% CI: −0.63 to 0.49; p = 0.804). In tertile analyses, Knowledge, Attitude, and total KAP scores increased significantly across engagement levels, while Practice scores did not. Conclusions: Positive mHealth engagement was associated with better knowledge, attitudes, and overall KAP among patients with multidrug-resistant tuberculosis, but not with practice. These findings are associative; the cross-sectional design does not permit causal conclusions. The engagement score demonstrated good reliability and acceptable structural validity and may be a useful summary measure for evaluating patient interaction with mHealth interventions in tuberculosis care. Integrated strategies combining mHealth with clinical follow-up, adherence counseling, and structural support may be needed to translate informational and attitudinal gains into practice change. Full article

Background: Elevated gamma-glutamyl transferase (GGT) is a biomarker associated with alcohol-related hepatic stress and oxidative imbalance. Although alcohol abstinence is the primary determinant of GGT normalization, adjunctive strategies may support biochemical improvement in real-world settings. Methods: This non-randomized cohort study included 197 of 1957 screened participants (10.1%), stratified according to baseline GGT into 55–99 U/L (n = 95) and ≥100 U/L (n = 102). Participants in the higher baseline subgroup underwent a multimodal intervention consisting of nutraceutical supplementation (silymarin, essential phospholipids, and a polyherbal antioxidant formulation) combined with structured psychological support aimed at promoting alcohol abstinence. The primary outcome was the change in GGT between baseline (T1) and follow-up (T2). Secondary outcomes included the proportion of participants achieving GGT reduction and the magnitude of change according to baseline severity. Clinical trial registration: ClinicalTrials.gov Identifier: NCT07603726. Results: Among participants with baseline GGT ≥ 100 U/L, GGT levels decreased from a median of 133.73 to 97.41 U/L (p < 0.001), whereas in the 55–99 U/L subgroup, median GGT changed from 67.49 to 66.51 U/L without reaching statistical significance (p = 0.072). Participants in the higher baseline subgroup demonstrated greater GGT reductions (median ΔGGT: −35.25 vs. −2.58 U/L), a higher proportion achieving GGT reduction (91.2% vs. 70.5%), and higher odds of GGT reduction at follow-up in exploratory analysis (OR = 4.32, 95% CI: 1.91–9.75). Conclusions: In this real-world cohort, reductions in GGT levels were observed, particularly among individuals with elevated baseline values (≥100 U/L) who underwent the multimodal intervention. These findings support monitoring GGT dynamics in routine clinical practice, where GGT remains a practical and accessible biomarker due to its widespread availability, low cost, and sensitivity to oxidative and alcohol-related hepatic stress. Full article