Search Results (18,925)

The small (N = 102) prospective study by Bar-Sela and colleagues at Emek Medical Center in Israel) regarding diminished efficacy of immunotherapy in the setting of cannabis use would be an important discovery which could theoretically benefit the outcomes of oncology patients if verified by independent research teams, including by basic scientists. However, if this finding was spurious, clinical practice guidelines could recommend that oncology patients receiving immunotherapies be erroneously denied an evidence-based treatment for pain and chemotherapy-induced nausea and vomiting. Our full-length manuscript identified dozens of instances of unverifiable statistical information and even errors in arithmetic in this report. More briefly, our concerns regarding this well-cited (123 times) paper are as follows: (1) non-verifiable non-parametric statistics, including some that would change the statistical inferences; (2) difficulties with determining percentages; (3) switching from two-tailed tests in the Methods to one-tailed in the Results; (4) engaging in the unusual practice of floor rounding but not reporting this in the Methods; and (5) not reporting smoking, which could be a key confound. These concerns are serious errors that undermine the validity of the results and invalidate the conclusions that can be drawn from this prospective study about cannabis and immunotherapy. Full article

Background/Objectives: Pediatric acquired brain injury (ABI) often results in persistent challenges that extend beyond motor impairments, affecting quality of life (QoL), social participation, and engagement in physical activity. Given the complexity and chronicity of these outcomes, there is a pressing need for multidimensional interventions grounded in the International Classification of Functioning, Disability and Health (ICF). Sport-based exercise interventions, when developmentally adapted and tailored to individual interests, may promote intrinsic motivation, peer connection, and sustainable engagement—factors especially relevant in pediatric ABI populations, who often experience reduced physical activity and social isolation. However, standardized, replicable protocols specifically tailored to this population remain scarce. This study presents the protocol for a randomized controlled trial evaluating the effects of a 16-week sport-based intervention on QoL, social participation, physical activity engagement, and motor functioning tailored for adolescents with pediatric ABI. Methods: Participants will be randomly assigned to an intervention group or a control group receiving usual care. The intervention consists of one weekly 60-minute session, led by trained professionals in adapted physical activity and pediatric neurorehabilitation. It combines sport-based motor skill training, cooperative games, and group activities specifically tailored to each child’s developmental level, motor abilities, and preferences. Outcomes will be assessed at baseline and following the 16-week intervention period, focusing on QoL, participation, physical activity engagement, and motor functioning. Discussion: This study introduces a structured, child-centered model that bridges clinical rehabilitation and community-based sport. By integrating motor and psychosocial targets through a group sport-based intervention, it aims to enhance recovery across ICF domains. Findings may inform interdisciplinary practice and support the development of sustainable strategies to promote long-term engagement and well-being in adolescents with ABI. Full article

This study examined the spatial and seasonal variations of trihalomethanes (THMs) and estimated the health risks associated with THM exposure in drinking water through various pathways. Water samples were collected from 14 distribution districts connected to the Ulutan Distribution System (UDS) and the Süleyman Bey Distribution System (SDS), which supply drinking water to Zonguldak Province, Türkiye. THMs were measured using the USEPA 551 method. The median total trihalomethanes (TTHMs) ranged from 41 μg/L to 71 μg/L, which is below the Turkish drinking water standard of 100 μg/L. Chloroform (TCM) was the most common trihalomethane in all distribution networks in UDS and SDS. On the other hand, pre-ozonation oxidation after chlorination in SDS disinfection caused the contribution of brominated THMs (62%) to THM formation to be higher than that of TCM (38%). The study on cancer risk reveals that ingestion (96%) poses the greatest risk of the investigated pathways, followed by dermal contact (3.95%), while inhalation has been found to have a negligible effect. The highest and lowest median TTHMs occurred during winter and summer. The findings of the study show that the distribution areas of Kozlu, Ömerli, Topçalı, and Uzunçayır, for both genders, exhibit an unacceptable cancer risk level according to the criteria established by the USEPA (˃10⁻⁴). Bromodichloromethane (BDCM) and chlorodibromomethane (DBCM) are the main contributors to cancer risk for males and females in UDS and SDS. The hazard index (HI) data indicated that the HI value remained below one for both UDS and SDS. Sensitivity analysis of THMs demonstrated that exposure frequency (EF) was the primary parameter contributing to the maximum potential impact on the total cancer risk exposure frequency (EF), followed by body weight (BW) and exposure duration (ED). Further, the results provide valuable information for health departments and water management authorities, enabling the formulation of more specific and efficient policies to minimise THM levels in drinking water distribution networks. Full article

Background/Objectives: Anosognosia for hemiplegia (AHP) is a multifaceted syndrome in which stroke survivors fail to recognize motor impairments. Although AHP has significant clinical implications, rehabilitation strategies have remained fragmented and underexplored. This systematic review aimed to critically evaluate rehabilitation interventions for AHP published between 2006 and 2025, categorize intervention types, and assess clinical outcomes to inform future research and practice. Methods: A structured search was conducted in the PubMed and PsycINFO databases on 31 March 2025, using predefined keywords related to stroke, anosognosia, and rehabilitation. The eligible studies included randomized controlled trials, case–control studies, and case studies. Following title, abstract, and full-text screening, nine studies focusing on rehabilitation interventions for AHP were selected and analyzed. Results: The interventions reviewed included sensorimotor recalibration techniques, neuromodulatory approaches, error-based cognitive training, and self-observation in video replay strategies. Interventions emphasizing motor intention monitoring, error correction, and self-observation were more consistently associated with durable improvements in motor awareness than neglect-based spatial interventions were. However, many studies were limited by small sample sizes and a lack of standardized outcome measures. Assessment methodologies vary widely, highlighting the need for multidimensional theory-driven evaluation tools. Conclusions: Effective rehabilitation for AHP requires strategies targeting disrupted self-monitoring and agency mechanisms, rather than spatial realignment alone. The video self-observation and error-based learning paradigms show particular promise. Future research should focus on controlled trials, longitudinal tracking, and the integration of individualized, mechanism-specific rehabilitation models to optimize outcomes for stroke survivors with AHP. Full article

Post-operative pancreatic fistula (POPF) is a serious yet far too common complication following distal pancreatectomy (DP), as it affects 20–30% of patients after DP. POPF raises the risk of other complications and causes delays to a patient’s oncologic care. In this review, we present the latest data on patient risk factors for developing POPF, such as obesity, smoking, young age, thick pancreas, lack of epidural anesthesia, hypoalbuminemia, and elevated drain amylase levels. Other risk factors that have been identified with irregular consistency include open surgical approach, non-malignant or neuroendocrine tumor pathology, simultaneous splenectomy, simultaneous vascular resection, and long operative time. We also review the consequences of POPF, which include hemorrhage, infection, delayed gastric emptying, re-operation, re-admission, delays in adjuvant chemotherapy initiation, reduced progression-free survival, and reduced overall survival. Finally, we present strategies that have been studied for avoiding POPF after DP, including reducing pressure at the sphincter of Oddi, the use of sealants and patches, optimizing pancreatic transection, strategies for post-operative drain placement, the use of post-operative somatostatin analogues, and pre-clinical studies of experimental devices and techniques that may inform future trials. This review informs readers on the current state of the art with regard to POPF after DP and sets the stage for future studies to improve patient outcomes. Full article

In this preliminary study, the thermoregulatory response in individuals diagnosed with Parkinson’s disease was investigated by infrared thermography. Parkinson’s disease is a complex neurodegenerative disorder primarily known for motor impairments, significantly reducing the quality of life of affected people. However, in most cases, such disease is accompanied or preceded by non-motor symptoms, including autonomic dysfunction. As in the case of neurovegetative dysautonomia, this dysfunction involves a malfunction of the autonomic nervous system, which also plays a key role in thermoregulation. In general, such conditions are not always easy to detect; a valid method could be represented by the vasomotor response of the skin to cold stimuli. In this context, infrared thermography can provide insights into the thermoregulatory patterns associated with autonomic dysfunction, representing a valuable tool for non-invasive assessment of Parkinson’s research. Early biomarkers of the disease can be obtained through changes in skin temperature, allowing for timely intervention and management. The study was conducted on a cohort of 16 subjects (8 patients with Parkinson’s disease and 8 healthy controls), who were monitored with infrared images captured from their hands, following a specific protocol established by a preliminary analysis. Experimental results revealed that thermography can detect focal points and regions exhibiting either hyper- or hypothermia across the skin surface and muscular regions. This capability allows for extracting and categorizing precise medical data, which could inform future research aimed at identifying early markers of the disease. However, as this is a preliminary observational study, no diagnostic claims are made, and further investigations on larger cohorts with controlled comorbidities are needed. Full article

Identification of temporal relations among suicide mortality and economic/political implementations provides important information for not only planning suicide prevention but also socioeconomic/psychosocial measures. This cross-sectional observation study analyzed temporal fluctuations and causalities of suicide mortalities of working-age individuals, disaggregated by age/gender/social standing (employed/unemployed), in Japan from 2009 to 2024, using government databases, by joinpoint and vector-autoregressive analyses. Suicide mortality among total and employed females decreased until the COVID-19 pandemic outbreak but sharply increased, synchronized with the pandemic outbreak, before resuming a downward trend. Among males, the decreasing trends attenuated from 2016, followed by a transient increase in 2022. Unemployed males aged 40–69 exhibited four joinpoints: 2016 (decreasing–increasing), 2018 (increasing–decreasing), 2022 (decreasing–increasing), and 2023 (increasing–stable). In contrast, suicide mortality among unemployed females aged 40–69 sharply increased in 2022 and maintained the high level. Among individuals aged 30–39, suicide mortality reversed from decreasing to increasing in 2016 (males) and 2018 (unemployed females). Economic expansion was protective for employed individuals but had no significant effect on unemployed populations. The government management instability (AENROP) index was positively associated with suicide mortality among employed and unemployed males and employed females. Unemployed females aged 30–39 were sensitive to AENROP but not economic conditions, while those aged 40–69 were largely unaffected by either. Increasing employment of individuals with psychiatric disabilities was positively associated with suicide mortality among unemployed males (30–69) and females under 40. Positive impacts of the employment rates of individuals with psychiatric disabilities and unemployment enhanced from 2016 and 2022, respectively, whereas the impacts were inconstantly affected by political rather than economic factors. Suicide mortality among unemployed individuals has emerged as a critical public health concern in Japan, with rates more than doubling among males and tripling among females in the 2020s. These findings underscore the need for integrated suicide prevention policies that address both labor market vulnerabilities and psychosocial determinants. Full article

Introduction: Osteoarthritis (OA) is a chronic degenerative joint disease with limited treatment options focused primarily on symptom management. Emerging evidence suggests that dietary interventions may influence inflammation and pain through modulation of the gut microbiome and metabolome. Methods: We conducted a 4-week open-label pilot trial evaluating the effects of an anti-inflammatory dietary intervention (ITIS diet) in 20 patients with knee OA (ClinicalTrials.gov ID: NCT05559463, registered prior to enrollment; sponsor: University of California, San Diego; responsible party: Monica Guma; study start date: 1 October 2021). The following were assessed before and after the intervention: (1) clinical outcomes; (2) gut and salivary microbiomes; and (3) salivary, stool, and plasma metabolomes. Responders were defined as patients achieving ≥30% reduction in Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain scores. Results: The ITIS diet was well-tolerated, with good adherence (66.2%) and a significant improvement in clinical outcomes, including reduced pain and improved overall health measured with the visual analog scale (VAS). Responders (n = 8) showed distinct gut microbiome and metabolome profiles compared to non-responders (n = 12). Notably, taxa within the Lachnospiraceae family exhibited dynamic, bidirectional shifts post-intervention: Anaerostipes and Limivivens were enriched among responders and negatively correlated with pain scores, while Oliverpabstia and Fusicatenibacter were depleted following dietary intervention. These taxa also showed strong correlations with anti-inflammatory metabolites, including hydroxydecanoic acid derivatives and pyridoxine. Furthermore, subsequent network analysis revealed more structured and selective microbiome–metabolome interactions in responders, specifically post-intervention. Conclusions: This pilot study shows that a short-term anti-inflammatory dietary intervention was associated with meaningful changes in the gut microbiome and metabolome. Members of the Lachnospiraceae family emerged as key taxa associated with pain reduction and anti-inflammatory metabolite production. Our findings suggest that specific microbial responses—rather than global diversity changes—may underlie dietary responsiveness in OA. Although exploratory and limited by sample size, our results support further investigation into personalized, microbiome-informed nutritional strategies for OA management. Full article

Forest disturbance is a major driver shaping the structure and function of plantation ecosystems. Current research predominantly focuses on single forest types or landscape scales. However, species-level fine-scale assessments of disturbance dynamics are still scarce. In this study, we investigated Chinese fir (Cunninghamia lanceolata), Armand pine (Pinus armandii), and Yunnan pine (Pinus yunnanensis) plantations in the mountainous eastern Yunnan Plateau. We developed a Spatial Coupling Framework of Disturbance Legacy (SC-DL) to systematically elucidate the spatial associations between contemporary species distribution patterns and historical disturbance regimes. Using the Google Earth Engine (GEE) platform, we reconstructed pixel-level disturbance trajectories by integrating long-term Landsat time series (1993–2024) and applying the LandTrendr algorithm. By fusing multi-source remote sensing features (Sentinel-1/2) with terrain factors, employing RFE, and performing a multi-model comparison, we generated 10 m-resolution species distribution maps for 2024. Spatial overlay analysis quantified the cumulative proportion of the historically disturbed area and the spatial aggregation patterns of historical disturbances within current species ranges. Key results include the following: (1) The model predicting disturbance year achieved high accuracy (R² = 0.95, RMSE = 2.02 years, MAE = 1.15 years). The total disturbed area from 1993 to 2024 was 872.7 km², exhibiting three distinct phases. (2) The random forest (RF) model outperformed other classifiers, achieving an overall accuracy (OA) of 95.17% and a Kappa coefficient (K) of 0.93. Elevation was identified as the most discriminative feature. (3) Significant spatial differentiation in disturbance types emerged: anthropogenic disturbances (e.g., logging and reforestation/afforestation) dominated (63.1% of total disturbed area), primarily concentrated within Chinese fir zones (constituting 70.2% of disturbances within this species’ range). Natural disturbances accounted for 36.9% of the total, with fire dominating within the Yunnan pine range (79.3% of natural disturbances in this zone) and drought prevailing in the Armand pine range (71.3% of natural disturbances in this zone). (4) Cumulative disturbance characteristics differed markedly among species zones: Chinese fir zones exhibited the highest cumulative proportion of disturbed area (42.6%), with strong spatial aggregation. Yunnan pine zones followed (36.5%), exhibiting disturbances linearly distributed along dry–hot valleys. Armand pine zones showed the lowest proportion (20.9%), characterized by sparse disturbances within fragmented, high-altitude habitats. These spatial patterns reflect the combined controls of topographic adaptation, management intensity, and environmental stress. Our findings establish a scientific basis for identifying disturbance-prone areas and inform the development of differentiated precision management strategies for plantations. Full article

Macadamia integrifolia, a tropical and subtropical fruit tree with significant economic and nutritional value, faces serious fungal disease problems during cultivation that severely affect yield and quality. In November 2024, leaf blight symptoms of M. integrifolia were observed in Menglian, Pu’er, Yunnan, China, with a disease incidence of 23% in the field. Initial symptoms included small spots that enlarged into circular to irregular lesions with red-brown centers and brown to black margins. Finally, the leaves turned yellow and became scorched, eventually leading to massive leaf shedding. Infected leaf samples were collected, and fungal strains were isolated, purified, and inoculated via spore suspension, followed by re-isolation. The strains were conclusively identified as Pestalotiopsis colombiensis (SWFUCB2, SWFUCB1) through an integrated approach combining DNA extraction, polymerase chain reaction (PCR), sequencing, phylogenetic reconstruction, and morphological characterization. This is the first report of P. colombiensis causing M. integrifolia leaf blight disease in China, filling a gap in research on this disease. This study provided important information for epidemiological research on this disease and the development of comprehensive leaf blight disease control strategies. Full article

Background/Objectives: The assessment of motor development in early ages is considered fundamental for the early identification of alarm signs that indicate the possibility of a child suffering from a developmental disorder. To this end, it is necessary to use reliable evaluation tools that have been specifically validated in the target population. The main aim of the current review was to examine the existing motor development assessment tools validated in Spanish populations of children aged 0–18 months. Methods: A systematic review was carried out following the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) declaration criteria, and it was registered in PROSPERO. A bibliographic search was conducted in the PubMed, Scopus, Web of Science, and Cochrane databases, using terms related to motor development, assessment tools, and validation. The COSMIN verification list was employed to evaluate the quality of the included scales, and the QUADAS-2 instrument was used to analyse the quality of the included studies. Results: A total of 7 studies were included in the review, all of which were validation studies of motor development assessment tools in Spanish populations of children aged 0–18 months. Moreover, they all show heterogeneity with respect to their characteristics, such as target population, sample size, and metric properties. Conclusions: The present systematic review provides relevant information about the characteristics and methodological quality of motor development assessment tools validated in Spanish populations. There are currently very few of these evaluation tools, as well as limitations in regard to theories that support them, their metric properties, and the methodological quality of their validation studies. Therefore, we confirm the need for validating updated motor development tools to improve the detection, prognosis, and evaluation of children with developmental disorders or at risk of suffering from them. Full article

As manufacturing and logistics-oriented supply chains continue to expand in scale and complexity, and the coupling between their physical execution layers and information–decision layers deepens, the resulting high interdependence within the system significantly increases overall fragility. Driven by key technological barriers, economies of scale, and the trend toward resource centralization, supply chains have increasingly evolved into centralized structures, with critical functions such as decision-making highly concentrated in a few focal firms. While this configuration may enhance coordination under normal conditions, it also significantly increases dependency on focal nodes. Once a focal node is disrupted, the intense task, information, and risk loads it carries cannot be effectively dispersed across the network, thereby amplifying load spillovers, coordination imbalances, and information delays, and ultimately triggering large-scale cascading failures. To capture this phenomenon, this study develops a coupled network model comprising a Physical Network and an Information and Decision Risk Network. The Physical Network incorporates a tri-load coordination mechanism that distinguishes among theoretical operational load (capacity), actual production load (production output), and actual delivery load (order fulfillment), using a load sensitivity coefficient to describe the asymmetric propagation among them. The Information and Decision Risk Network is further divided into a communication subnetwork, which represents transmission efficiency and delay, and a decision risk subnetwork, which reflects the diffusion of uncertainty and risk contagion caused by information delays. A discrete-event simulation approach is employed to evaluate system resilience under various failure modes and parametric conditions. The results reveal the following: (1) under a centralized structure, poorly allocated redundancy can worsen local imbalances and amplify disruptions; (2) the failure of a focal firm is more likely to cause a full network collapse; and (3) node failures in the Communication System Network have a greater destabilizing effect than those in the Physical Network. Full article

Background: Kigali, Rwanda’s rapidly growing capital, faces major challenges in household-level Fecal Sludge Management (FSM), with over 89% of households using pit latrines and only 48% accessing unshared sanitation. FSM services are limited, costly, and poorly executed, leading to frequent illegal dumping. Objective: This review analyzes the literature on sanitation in Kigali to identify key gaps, synergies, and recommendations for improvement. Methods: Following PRISMA 2020 guidelines, 73 relevant publications were selected from various scientific and governmental sources. Publications were included only if they were published from 2013 to 2024 and had information on sanitation in Kigali. NOS and JBI tools were utilized to assess the quality of included publications. Results: Data were categorized into four themes, (1) access to sanitation, (2) FSM services, (3) public health, and (4) sanitation governance, and analyzed using thematic, narrative, and descriptive methods. Findings reveal a dysfunctional FSM service chain, weak policy enforcement due to overlapping responsibilities, underfunding, and limited private sector participation. These issues contribute to poor sanitation, inadequate hygiene, and prevalence of diarrheal diseases and Tropical Neglected Diseases, especially among young children. Conclusions: The review recommends strengthening governance and clarifying roles, enforcing adaptable regulations, promoting public–private partnerships, and managing the full FSM service chain more effectively. Future research should focus on developing context-specific technologies and financing strategies to support sustainable FSM solutions in Kigali. Full article

Parasitic infections, such as those caused by the myxozoans Myxobolus cerebralis and Tetracapsuloides bryosalmonae, pose major threats to wild and farmed salmonids due to severe tissue damage and impairment of the host immune system. While individual infections have been studied, limited information is available on the host response during co-infection. This study investigated the transcriptomic immune response of rainbow trout (Oncorhynchus mykiss) during single and sequential co-infections with M. cerebralis and T. bryosalmonae using RNA-seq. Trout were exposed to single infections (Mc or Tb) followed by co-infections (Mc⁺ or Tb⁺). Fish were sampled at 31 days post-single infection (1 day post-co-infection). RNA from gill and caudal fin (portal of parasite entry) was sequenced, followed by differentially expressed genes (DEGs) identification and GO and KEGG enrichment. In the caudal fin, Mc⁺ (1 day after co-infection with T. bryosalomne) fish showed mild immune activation with C4B upregulation, while Tb⁺ fish exhibited a stronger response involving IFI44, ISG15, RSAD2, and TLR7 signaling. In gills, Mc⁺ fish showed moderate cytokine-related gene upregulation, while Tb⁺ (1 day after co-infection with M. cerebralis) fish displayed increased expression of humoral response genes (C3, immunoglobulin pathways) but suppression of genes involved in B cell development. These results indicate that the order of infection shapes the outcome of the host immune response, offering candidate targets at the host–pathogen interface. Full article

Traditional urbanization prioritizes economic growth but often degrades the environment, challenging SDGs 9 and 13. China’s New-Type Urbanization Policy (NTUP) balances economic expansion, energy conservation, and environmental protection. By applying the difference-in-differences (DID) method, this study examines the causal effect of NTUP on urban air quality, taking the full implementation of NTUP in 2014 and the designated pilot cities as the policy shock and treatment group, respectively. Furthermore, we explore the mediating roles of land use efficiency and innovation efficiency in this relationship. The results show the following: (1) NTUP significantly lowers urban PM2.5, robust to confounders and selection bias; (2) land use and innovation efficiency mediate this effect, verified by Sobel and Bootstrap tests; and (3) policy effectiveness varies by city level, industrial base, and economic structure. These findings highlight NTUP’s environmental benefits and inform sustainable urbanization strategies globally. Full article