Search Results (77)

Background: The Global Leadership Initiative on Malnutrition (GLIM) criteria provide a standardized approach for assessing the nutritional status of patients and demonstrate strong predictive value for the prognosis of patients with gastric cancer. However, these criteria do not incorporate indicators of adipose tissue metabolic activity, which may reflect pro-tumor microenvironmental factors. This study investigated the combined predictive value of malnutrition, defined by the GLIM criteria, and preoperative adipose tissue ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) uptake for recurrence-free survival (RFS) in patients with gastric cancer following radical surgery. Methods: A total of 105 patients were retrospectively enrolled and classified into malnourished and non-malnourished groups based on the GLIM criteria. Preoperative ¹⁸F-FDG positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) was used to measure the mean standardized uptake value (SUVmean) of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT). The predictive values of these indicators for RFS in patients with gastric cancer were assessed. Results: Multivariate survival analysis was used to identify GLIM-defined malnutrition (p = 0.020) and increased preoperative VAT SUVmean (p = 0.042) as independent risk factors for RFS. The combined analysis revealed that patients with both malnutrition and a high preoperative VAT SUVmean had the poorest RFS (HR = 18.41, p < 0.001). The predictive model integrating GLIM criteria and VAT SUVmean outperformed the GLIM criteria alone. Conclusions: This study demonstrated that combining malnutrition defined by the GLIM criteria with preoperative visceral adipose tissue ¹⁸F-FDG uptake optimizes recurrence risk stratification and exhibits superior prognostic predictive efficacy compared to using the GLIM criteria alone. This approach provides new insights into individualized prognostic assessment and intervention strategies. Full article

Viktor Frankl attributes significant importance to religion in relation to the human quest for meaning. According to Frankl, religion maintains its existence and continues offering guidance in the search for meaning irrespective of worldly conditions or developments. Since the 19th century, secularism—initially adopted particularly by Western nations but influential globally—has significantly limited the presence of religion in public life. Although the predictions of positivist scientists did not materialize and science has not “overthrown” religion, the number of religious individuals is rapidly declining in the contemporary era, while atheism is increasing. Nevertheless, research indicates that religions still serve as powerful guides in believers’ search for meaning. Moreover, globally, the most religious segments of the population tend to be the poorest and, as Frankl suggests, religion enables people to attribute meaning to their patience and endurance in the face of adversity. It is discussed by the academia that in the future world, humanity might transcend biological limitations, reaching an advanced form of existence (“trans-humanism”), and eventually even surpassing the biological form of Homo Sapiens into a digitally based life form described as the “post-human” stage. This study argues that unless humanity reaches this stage, people’s quest for meaning will continue independently of technological advancements, religions will persist in guiding these searches, and Frankl’s views will most likely remain valid. Full article

In light of the current global challenges, such as climate change, the overexploitation of natural resources, and increasing food demand, drought-tolerant forage crops present substantial potential for development in dryland regions. However, there is a notable gap in research that integrates yield improvement, nutritional quality enhancement, and resistance to pests and diseases in the production of forage crops in semi-arid areas. Therefore, selecting oat forage varieties that exhibit high yield, superior quality, and enhanced pest resistance can substantially advance the forage industry and animal husbandry in semi-arid regions. In this study, ten oat varieties, including both domestic and international cultivars, were cultivated in a semi-arid region (Weiqi town, Gansu Province) during the 2023–2024 growing season. A comprehensive analysis was performed to assess the yield, quality, and pest resistance of these varieties. All ten oat varieties successfully completed their growth cycles. Among them, Everleaf 126 exhibited a shorter plant height compared to the other varieties, measuring 103.32 cm and 115.14 cm over two years. However, its superior leaf area and tiller number led to the highest hay yields (11,819.33 kg/ha and 13,550.67 kg/ha) and seed yields (4913.20 kg/ha and 5242.33 kg/ha). Additionally, Everleaf 126 demonstrated significantly higher leaf–stem ratios (0.35 and 0.41), crude protein content (8.52% and 9.13%), and crude fat content (2.19% and 2.69%) relative to other oat varieties (p < 0.05). Furthermore, it showed the best resistance to powdery mildew (MR), red leaf disease (HR), leaf spot disease (MR), and aphids (R). The plant height of Kona was the lowest, measuring 81.22 cm and 87.16 cm, respectively, with the fewest number of tillers and the smallest leaf area. Baler II exhibited the lowest hay yield at 8770.10 kg/ha and 7898.33 kg/ha, as well as the lowest seed yield at 3409.33 kg/ha and 3323.90 kg/ha. Kona also had the lowest leaf–stem ratio (0.19 and 10.13) and crude protein content (5.74% and 6.58%), while exhibiting the highest neutral detergent fiber (NDF) and acid detergent fiber (ADF) values. Furthermore, Kona showed the poorest resistance to powdery mildew (MS) and leaf spot (MS). Finally, based on the comprehensive evaluation analysis of the membership function, in the semi-arid region, Everleaf 126 achieved the highest overall performance based upon a comprehensive evaluation, followed by Molasses and Longyan No.3. In comparison, Kona received the poorest performance. Full article

In August 2020, the World Health Assembly approved the global strategy to eliminate cervical cancer, envisioning a world where it seizes to be a public health problem. The cervical cancer elimination initiative reinforces the commitment to fulfilling the rights of adolescent girls and women by reducing both health and economic inequities in the poorest populations that have more limited access to timely and effective services. This initiative improves the quality of life of women and their families by protecting them from a disease that causes disability and preventing avoidable mortality through public health measures. This article discusses the epidemiological situation and vaccination coverage and identifies weaknesses and opportunities in Latin America and the Caribbean to propose actions to reinforce progress toward the cervical cancer elimination goal. Full article

The distributive environmental justice approach focuses on analysing the spatial patterns of environmental effects and identifying situations of inequality between different social groups. These inequalities may be related to specific impacts or be the result of accumulated benefits or harms to certain populations, the latter aspect being less investigated globally and, in particular, in Latin America. This work aims to analyse the existence of environmental injustices in the city of Montevideo (Uruguay). For this purpose, an environmental quality index (EQI) composed of five subindices is proposed: pollution, exposure to risks, health impacts, habitat quality and availability of green spaces, and their relationship with the level of poverty is evaluated through descriptive analyses and spatial regression models. The results reveal an inverse relationship between the cumulative environmental quality and poverty level, this being especially marked in the subindices of environmental pollution and habitat quality. In contrast, the availability of green spaces presents a more favourable situation for the poorest groups of the population. This study highlights the importance of analysing environmental injustices through multiple indicator-based approaches and highlights the need to incorporate these perspectives into the study of cities with high levels of segregation. Full article

This study examines the impact that International Public Sector Accounting Standards adoption might have on governance quality and corruption control in Spain, Portugal, and Italy. IPSAS was designed to globally enhance public transparency and accountability thanks to accrual accounting. However, its effectiveness in fighting corruption and steering better governance has varied across institutional contexts and implementation phases. This paper examines, using partial least squares structural equation modeling (PLS-SEM) and comparative analysis, how legal systems, political stability, and anti-corruption measures mediate the relationship. The results indicate that full IPSAS adoption, as in the case of Spain, significantly enhances governance if the institutional framework is solid and, by extension, reduces corruption. Partial adoption, such as that by Portugal, exposes moderate improvements, but Italy, still in the preparation of the process, shows the poorest result. The study identifies that the legal system, along with complementary reforms like capacity building and political stability, is a very crucial factor in enhancing the IPSAS impact. This covers the evidential gaps and provides actionable insights for policymakers, while at the same time underlining institutional strength as a key driver for IPSAS adoption, contributing to broader discussions on advancing public sector accounting reforms. Full article

Background: The incidence of melanoma is increasing globally. The estimated worldwide incidence is projected to increase from 324,635 cases in 2020 to 510,000 in 2040. In the UK, melanoma accounts for 4% of all new cases of cancer. Melanomas occurring in the skin of the head and neck represent 13% and 23% of cases in women and men, respectively. Prognostic indicators include presence of nodal or distant metastasis, ulceration, and Breslow thickness, where >4 mm thickness predicts poorest overall survival rates. Giant melanomas, a term generally applied to melanomas larger than 5–10 cm, are rare and often have a very poor prognosis. Clinical case: An 82-year-old female presented acutely with a 2–3-day history of delirium and urinary retention in February 2022. In addition, she was noted to have a large fungating growth on her forehead that obscured the bridge of the nose and had been slowly increasing in size for the past year prior to admission. She had initially presented in primary care with a small growth on her forehead but declined further investigations for fear of contracting COVID-19. She consented to having further assessment and management of the forehead mass. A shave biopsy revealed giant nodular melanoma, specifically, the largest melanoma of the face reported in the literature. Remarkably, our patient underwent a successful complete excision and skin grafting, with no evidence of recurrence or distal metastasis after 2 years of follow up. Conclusions: This case highlights the anxieties people felt about contracting COVID-19 when national guidelines recommended shielding that had resulted in further morbidity. Despite poor prognostic factors, clinically and histologically, our patient did not need any systemic anticancer therapy nor radiotherapy. She was well after 2 years follow up without any signs of recurrence. Full article

The latest satellite in the Landsat series, Landsat-9, was successfully launched on 27 September 2021, equipped with the Operational Land Imager-2 (OLI-2) sensor, continuing the legacy of OLI/Landsat-8. To evaluate the uncertainties in water surface reflectance derived from OLI-2, this study conducts a comprehensive performance assessment of six atmospheric correction (AC) methods—DSF, C2RCC, iCOR, L2gen (NIR-SWIR1), L2gen (NIR-SWIR2), and Polymer—using in-situ measurements from 14 global sites, including 13 AERONET-OC stations and 1 MOBY station, collected between 2021 and 2023. Error analysis shows that L2gen (NIR-SWIR1) (RMSE ≤ 0.0017 sr⁻¹, SA = 6.33°) and L2gen (NIR-SWIR2) (RMSE ≤ 0.0019 sr⁻¹, SA = 6.38°) provide the best results across four visible bands, demonstrating stable performance across different optical water types (OWTs) ranging from clear to turbid water. Following these are C2RCC (RMSE ≤ 0.0030 sr⁻¹, SA = 5.74°) and Polymer (RMSE ≤ 0.0027 sr⁻¹, SA = 7.76°), with DSF (RMSE ≤ 0.0058 sr⁻¹, SA = 11.33°) and iCOR (RMSE ≤ 0.0051 sr⁻¹, SA = 12.96°) showing the poorest results. By comparing the uncertainty and consistency of Landsat-9 (OLI-2) with Sentinel-2A/B (MSI) and S-NPP/NOAA20 (VIIRS), results show that OLI-2 has similar uncertainties to MSI and VIIRS in the blue, blue-green, and green bands, with RMSE differences within 0.0002 sr⁻¹. In the red band, the OLI-2 uncertainties are lower than those of MSI but higher than those of VIIRS, with an RMSE difference of about 0.0004 sr⁻¹. Overall, OLI-2 data processed using L2gen provide reliable surface reflectance and show high consistency with MSI and VIIRS, making it suitable for integrating multi-satellite observations to enhance global coastal water color monitoring. Full article

Background: Immunization saves millions of lives, and globally, vaccines have significantly contributed to reducing mortality and morbidity due to more than 20 life-threatening illnesses. However, there are considerable disparities in vaccination coverage among countries and within populations. This study evaluates the reduction in disparities in vaccination coverage across various socio-economic groups by adopting an integrated community-engagement approach combined with maternal and child health services through mobile health camps. Methods: This secondary analysis is based on a community-based demonstration project conducted between 2014 and 2016 across 146 union councils in polio high-risk districts of Sindh, Khyber Pakhtunkhwa (KP) and Baluchistan in Pakistan. The intervention involved structured community engagement and mobile health camps providing routine immunization alongside maternal and child health services. Data were collected through cross-sectional independent surveys using the WHO two-stage cluster technique at the baseline and the endline, covering over 120,000 children under 5 years old. Four key outcome indicators were analyzed: fully vaccinated children, under-immunized children, unvaccinated children, and polio zero-dose children for equity in vaccine uptake. Results: The proportion of fully vaccinated children increased in the lowest wealth quintile from 28.5% (26.7%, 30.3%) at the baseline to 51.6% (49.5%, 53.8%) at the endline. In comparison, the increase in the richest quantities was 16.2% (14.0%, 18.4%) from the baseline 56.4% (54.6%, 58.2%) to the endline 72.7% (71.1%, 74.2%). Under-vaccination dropped by 10.2% (95% CI: −11.4%, −9.1%), with the poorest quintile showing an 11.8% reduction. The gap between the highest and lowest wealth quintiles in full immunization narrowed by 6.9%, from 27.9% to 21.0% at the baseline and the endline, respectively. The prevalence of zero-dose children significantly decreased across all quintiles, with the highest reduction observed in the lowest quintile of −11.3% (−13.6%, −9.1%). The difference between the highest and lowest wealth quintiles reduced from 6.2% to 3.8%. A significant reduction in polio zero-dose children was achieved, as 13.5% (95% CI: −14.8%, −12.2%), from 29.2% (95% CI: 28.0%, 30.3%) to 15.6% (14.8%, 16.5%). Conclusions: This study shows that integrating community engagement with maternal and child health services through health camps can significantly enhance immunization coverage and reduce wealth-based disparities in high-risk, hard-to-reach areas. The approach improved coverage for zero-dose and fully vaccinated children, suggesting a potential for scaling in regions with access issues, conflict, and vaccine hesitancy. Full article

Gastric adenocarcinoma (GA) is a significant global health issue with poor prognosis, despite advancements in treatment. Although molecular classifications, such as The Cancer Genome Atlas (TCGA), provide valuable insights, their clinical utility remains limited. We performed a multi-layered functional analysis using TCGA RNA sequencing data to better define molecular subtypes and explore therapeutic implications. We reanalyzed TCGA RNA-seq data from 142 GA patients with localized disease who received adjuvant chemotherapy. Our approach included probabilistic graphical models and recurrent sparse k-means/consensus cluster algorithms for layer-based analysis. Our findings revealed survival differences among TCGA groups, with the GS subtype showing the poorest prognosis. We identified twelve functional nodes and seven biological layers, each with distinct functions. The combined molecular layer (CML) classification identified three prognostic groups that align with TCGA subtypes. CML2 (GS-like) displayed gene expression related to lipid metabolism, correlating with worse survival. Transcriptomic heterogeneity within the CIN subtype revealed clusters tied to proteolysis and lipid metabolism. We identified a subset of CIN tumors with profiles similar to MSI, termed CIN-MSI-like. Claudin-18, a key gene in proteolysis, was overexpressed across TCGA subtypes, suggesting it is a potential therapeutic target. Our study advances GA biology, enabling refined stratification and personalized treatment. Further studies are needed to translate these findings into clinical practice. Full article

Rubber is a perennial plant grown for natural rubber production, which is used in various global products. Ensuring the sustainability of rubber cultivation is crucial for smallholder farmers and economic development. Accurately predicting rubber yields is necessary to maintain price stability. Remote sensing technology is a valuable tool for collecting spatial data on a large scale. However, for smaller plots of land owned by smallholder farmers, it is necessary to process productivity estimates from high-resolution satellite data that are accurate and reliable. This study examines the impact of spatial factors on rubber yield and evaluates the technical suitability of using grouping analysis with the forest classification and regression (FCR) method. We developed a high-density variable using spatial data from rubber plots in close proximity to each other. Our approach incorporates eight environmental variables (proximity to streamlines, proximity to main river, soil drainage, slope, aspect, NDWI, NDVI, and precipitation) using an FCR model and GIS. We obtained a dataset of 1951 rubber yield locations, which we split into a training set (60%) for model development and a validation set (40%) for assessment using area under the curve (AUC) analysis. The results of the alternative FCR models indicate that Model 1 performs the best. It achieved the lowest root mean square error (RMSE) value of 19.15 kg/ha, the highest R-squared (R²) value (FCR) of 0.787, and also the highest R² (OLS) value of 0.642. The AUC scores for Model 1, Model 2, and Model 3 were 0.792, 0.764, and 0.732, respectively. Overall, Model 4 exhibited the highest performance according to the AUC scores, while Model 3 performed the poorest with the lowest AUC score. Based on these findings, it can be concluded that Model 1 is the most effective in predicting FCR compared to the other alternative models. Full article

Lassa Fever is a deadly viral haemorrhagic disease, causing annually several hundreds of deaths in West Africa. This zoonotic disease is primarily transmitted to humans by rodents of the genus Mastomys, even though other rodents reportedly carry the Lassa virus, while secondary interhuman transmission accounts for approximately 20% of cases. Although this disease has been endemic in rural zones of Nigeria, Sierra Leone, Liberfia, and Guinea for hundreds of years, it is also characterised by epidemic outbreaks in the dry season, responsible for heavy death tolls. No licensed vaccine or satisfying treatment is currently available. Disease management is hindered by the incomplete knowledge of the epidemiology and distribution of the disease, resulting from an inadequate health and surveillance system. Additional scientific constraints such as the genetic diversity of the virus and the lack of understanding of the mechanisms of immune protection complexify the development of a vaccine. The intricate socio-economic context in the affected regions, and the lack of monetary incentive for drug development, allow the disease to persist in some of West Africa’s poorest communities. The increase in the number of reported cases and in the fatality rate, the expansion of the endemic area, as well as the threat Lassa Fever represents internationally should urge the global community to work on the disease control and prevention. The disease control requires collaborative research for medical countermeasures and tailored public health policies. Lassa Fever, created by the interconnection between animals, humans, and ecosystems, and embedded in an intricate social context, should be addressed with a ‘One Health’ approach. This article provides an overview of Lassa Fever, focusing on Nigeria, and discusses the perspectives for the control of disease. Full article

People living with human immunodeficiency virus (PLWH) are a significant population globally. Research delineating our understanding of coinfections in PLWH is critical to care for those navigating infection with other pathogens. The recent COVID-19 pandemic underscored the urgent need for studying the effects of SARS-CoV-2 infections in therapy-controlled and uncontrolled immunodeficiency viral infections. This study established the utility of a feline model for the in vivo study of coinfections. Domestic cats are naturally infected with SARS-CoV-2 and Feline Immunodeficiency Virus, a lentivirus molecularly and pathogenically similar to HIV. In this study, comparisons are made between FIV-positive and FIV-negative cats inoculated with SARS-CoV-2 (B.1.617.2.) in an experimental setting. Of the FIV+ cats, three received Zidovudine (AZT) therapy in the weeks leading up to SARS-CoV-2 inoculation, and two did not. SARS-CoV-2 viral RNA was quantified, histopathologic comparisons of respiratory tissues were made, and T-cell populations were analyzed for immune phenotype shifts between groups. CD4+ T lymphocyte responses varied, with FIV+-untreated cats having the poorest CD4+ response to SARS-CoV-2 infection. While all cats had significant pulmonary inflammation, key histopathologic features of the disease differed between groups. Additionally, viral genomic analysis was performed, and results were analyzed for the presence of emerging, absent, amplified, or reduced mutations in SARS-CoV-2 viral RNA after passage through the feline model. Positive selection is noted, especially in FIV+ cats untreated with AZT, and mutations with potential relevance were identified; one FIV+-untreated cat had persistent, increasing SARS-CoV-2 RNA in plasma five days post-infection. These findings and others support the utility of the feline model for studying coinfection in people with HIV and highlight the importance of antiretroviral therapy in clearing SARS-CoV-2 coinfections to minimize transmission and emergence of mutations that may have deleterious effects. Full article

Background: The subamputation of fingers with vascular compromise presents a surgical challenge. Although tissue continuity may be considered a favourable prognostic element, in our experience, we noticed that there is not always a direct correlation between soft tissue involvement, radiographic appearance and final outcome. Methods: We included, in our study, all cases of vascular pedicle injury in which finger salvage was attempted with microsurgical revascularisation. Exclusion criteria were: integrity of both vascular pedicles, pedicle lesion without global circulatory compromise and patients treated immediately with amputation. Results: Between May 2018 and July 2023, 27 male patients with finger subamputation injuries were treated at our institution. In 11 cases of injured fingers, the only intact tissue was the flexor digitorum profundus (FDP) or flexor pollicis longus (FPL). Our global failure rate was 49%; whereas, in the subgroup of the 11 cases with continuity of the FDP or FPL, the failure rate rose to 73% and when the fingers showed flexor tendon integrity and radiographs demonstrated minimal bone damage, revascularisation failure was observed in all cases (100%). Conclusions: The results of the study show that subamputations with devascularisation, clinically presented with the combination of flexor tendon as the only element of tissue continuity and dislocation or minimal bone/articular injury, have a worse prognosis because of their trauma mechanism. We propose to add them to the Kay-Adani Classification as a subset of the poorest prognostic injuries group (III), to help surgeons to make decisions about the management of subamputation finger injuries. Full article

Breast cancer is the fifth-ranked cancer globally. Despite early diagnosis and advances in treatment, breast cancer mortality is increasing. This meta-analysis aims to examine all possible prognostic factors that improve/deteriorate breast cancer-specific survival. MEDLINE, PubMed, ScienceDirect, Ovid, and Google Scholar were systematically searched until September 16, 2023. The retrieved studies from 1995 to 2022 accumulated 1,386,663 cases from 30 countries. A total of 13 out of 22 prognostic factors were significantly associated with breast cancer-specific survival. A random-effects model provided a pooled estimate of the top five poorest prognostic factors, including Stage 4 (HR = 12.12; 95% CI: 5.70, 25.76), followed by Stage 3 (HR = 3.42, 95% CI: 2.51, 4.67), a comorbidity index ≥ 3 (HR = 3.29; 95% CI: 4.52, 7.35), the poor differentiation of cancer cell histology (HR = 2.43; 95% CI: 1.79, 3.30), and undifferentiated cancer cell histology (HR = 2.24; 95% CI: 1.66, 3.01). Other survival-reducing factors include positive nodes, age, race, HER2-receptor positivity, and overweight/obesity. The top five best prognostic factors include different types of mastectomies and breast-conserving therapies (HR = 0.56; 95% CI: 0.44, 0.70), medullary histology (HR = 0.62; 95% CI: 0.53, 0.72), higher education (HR = 0.72; 95% CI: 0.68, 0.77), and a positive estrogen receptor status (HR = 0.78; 95% CI: 0.65, 0.94). Heterogeneity was observed in most studies. Data from developing countries are still scarce. Full article