Search Results (41,209)

Background: Postoperative delirium (POD) is a common complication in geriatric patients. This prospective cohort study evaluated a possible influence of intraoperative positioning on the occurrence of POD, as intraoperative prone positioning could affect cerebral perfusion. Methods: We included 760 patients of ³60 years scheduled for elective surgery in prone or supine positions. The primary outcome was POD incidence on the first five days after surgery, assessed via 3D-Confusion Assessment Method (3-D CAM) or Confusion Assessment Method for Intensive Care Units (CAM-ICU). Preoperative assessments included the American Society of Anesthesiologists (ASA) and New York Heart Association (NYHA) classifications as well as short screenings for the cognitive (modified Montreal Cognitive Assessment (MoCA)) and self-care status of the patient. Secondary outcomes were length of hospital stay (LOS) and mortality rates. Results: Postoperative delirium rates were similar in prone and supine patients (7.6% vs. 5.5%; p = 0.31), and logistic regression analysis revealed no association of intraoperative prone positioning with POD (odds ratio 1.42 (95% CI 0.68–2.92; p = 0.342)). The overall incidence of POD was 6.1% and was associated with older age (81.5 (CI 76.2–84.8) vs. 72.0 (CI 67.0–79.0) years; p < 0.01), higher ASA and NHYA classifications, lower preoperative modified MoCA, reduced independence in self-care (p < 0.001, respectively), and longer incision-to-suture times (107.0 (CI 73.0–173.0) vs. 85.0 (CI 60.0–130.0) minutes; p < 0.01). Postoperative delirium resulted in longer LOS (14.5 (CI 9.0–27.0) vs. 7.0 (CI 4.0–9.0) days; p < 0.001), and increased mortality (13.0% vs. 1.7%; p < 0.001). Conclusions: Intraoperative prone positioning was not associated with POD in patients aged 60 years or older (OR 1.42; CI 0.68–2.92; p < 0.340), and LOS and mortality as secondary outcome parameters were also similar in patients after prone and supine surgery. Future studies assessing additional and possible confounding factors and intraoperative systemic and regional hemodynamics and oxygenation are needed to verify this result and to evaluate cerebral hypoperfusion as a possible mechanism of POD. Full article

With increasing environmental pollution and a high incidence of respiratory infections, pulmonary nodules (PN) are being detected more frequently. Although most are benign, they are often accompanied by chronic inflammation and localized fibrosis, which may predispose patients to progression toward idiopathic pulmonary fibrosis (IPF). However, the biological relationship between benign pulmonary nodules (BPNs) and IPF remains poorly understood. Therefore, this study aims to investigate the shared molecular mechanisms and identify potential biomarkers linking BPN and IPF, with the goal of elucidating the pathogenic transition from BPN to IPF. In this study, microarray data from GEO datasets were systematically analyzed to explore shared molecular mechanisms, immune infiltration characteristics, and potential early intervention strategies linking BPN and IPF. Differential expression analysis, protein–protein interaction (PPI) networks, weighted gene co-expression network analysis (WGCNA), and integrative machine learning approaches identified MME and ANKRD23 as key hub genes associated with the transition from BPN to IPF. Both genes demonstrated strong diagnostic performance, with Area Under the Curve (AUC) values exceeding 0.7, and were significantly correlated with immune cell infiltration, particularly effector memory CD8⁺ T cells. Functional enrichment and gene set enrichment analyses indicated that these genes were mainly involved in immune-related processes in BPN, while in IPF, ANKRD23 was linked to cytoskeletal organization and genomic stability, and MME was enriched in profibrotic pathways such as TGF-β signaling. The diagnostic value of these biomarkers was further validated in a bleomycin-induced IPF mouse model using quantitative polymerase chain reaction (qPCR). In addition, drug–gene interaction prediction and molecular docking analyses highlighted several naturally derived compounds with favorable binding affinity and anti-inflammatory properties, among which folic acid, curcumin, and arbutin emerged as promising candidates for safe early intervention. Collectively, these findings identify MME and ANKRD23 as potential biomarkers for early identification of BPN patients at risk of developing IPF and provide a theoretical basis for early diagnosis and targeted preventive strategies. Full article

Urban infrastructure works conducted under live traffic conditions often face a persistent gap between approved traffic management plans and their actual field implementation. This gap remains underexplored in longitudinal studies, particularly in utility projects from low- and middle-income urban contexts. This study evaluates a risk-based supervisory approach that integrates daily monitoring of the Traffic Management Plan (TMP) with a corporate risk management framework aligned with ISO 31000. The dataset includes 288 supervised workdays over 16 months (November 2023–February 2025), 99 non-conformity tickets, 96 signal-theft events (137 units), and seven traffic incidents. The analysis combines descriptive statistics, hypothesis testing, logistic regression, segmented longitudinal analysis, count models, response-time evaluation, and a composite risk index. TMP non-compliance decreased from 18.8% to 6.9% between the first and second halves of the study period ($p=0.0028$). The odds of non-compliance were significantly higher during the staff transition period in April–May 2024 (OR = 3.50; 95% CI: 1.24–9.82), while day and night shifts showed comparable rates. Monthly patterns indicate that staff instability and signal theft contributed to non-compliance levels, and ticket resolution remained slow (mean response time: 69.9 days). These findings highlight the importance of supervisory continuity, contractor stability, and timely corrective actions in improving work zone safety. Full article

Background/Objectives: Pulmonary embolism (PE) represents a major thrombotic complication in hospitalized patients with coronavirus disease 2019 (COVID-19), yet data on its incidence, clinical predictors, and short-term outcomes in actual cohorts remain heterogeneous. Methods: We conducted a retrospective observational cohort study including 395 consecutive adults hospitalized with RT-PCR-confirmed COVID-19 at a tertiary infectious diseases center between March 2020 and December 2024. Clinical, laboratory, imaging, and treatment data were extracted from electronic records, and PE was defined by computed tomography pulmonary angiography. Univariable and multivariable logistic regression analyses were used to identify independent predictors of PE in the subset of patients who underwent CTPA (n = 120), in whom PE status was definitively ascertained (47 with PE and 73 without PE). Results: Pulmonary embolism was diagnosed in 47 patients (11.9%). Patients with PE more frequently had prior venous thromboembolism (19.1% vs. 8.3%) and prolonged immobilization (61.7% vs. 23.0%), and were more often admitted to the intensive care unit (12.8% vs. 4.3%) than those without PE. Peak D-dimer levels were almost ten-fold higher in the PE group (median 5322 vs. 529.5 µg/L). In multivariable logistic regression, peak D-dimer was independently associated with PE (per log-unit increase, adjusted OR 3.9, 95% CI 2.1–7.1), and prolonged immobilization conferred a substantially higher risk of PE (adjusted OR 5.1, 95% CI 2.4–10.9). Patients with PE experienced more complex hospital courses and more frequent need for advanced therapies, although in-hospital mortality did not differ significantly between groups. Conclusions: In hospitalized COVID-19 patients, PE is frequent and closely linked to marked D-dimer elevation and acquired in-hospital risk factors, particularly prolonged immobilization. This evidence supports the use of dynamic D-dimer assessment and careful evaluation of immobilization status to improve risk stratification, guide decisions on diagnostic imaging and anticoagulation intensity, and identify patients who may benefit from closer post-discharge cardiovascular follow-up (this hypothesis requires confirmation in future prospective studies). Full article

Depression is one of the most prevalent psychiatric disorders worldwide, with a steadily increasing incidence and complex, multifactorial pathophysiology. Beyond classical neurochemical mechanisms, growing evidence points to the role of systemic low-grade inflammation and immuno-metabolic disturbances in its development. Gut microbiota dysbiosis has emerged as a key factor linking metabolic, immune, and neuroendocrine pathways, potentially exacerbating neuroinflammation and contributing to the onset and progression of depressive symptoms. Immune activation, which is a result of gut dysbiosis, may play a crucial role in the pathogenesis of immuno-metabolic depression. Thyroid dysfunction appears to be an important, yet insufficiently understood component of this network. Thyroid hormones play a crucial role in regulating metabolism, immune responses, and central nervous system function. Alterations in thyroid function, even within subclinical ranges, have been associated with mood disturbances and may share common inflammatory and metabolic pathways with depression. Furthermore, emerging data suggest that gut microbiota may influence thyroid hormone metabolism, including deiodinase activity, linking dysbiosis with thyroid axis dysregulation. Despite these insights, the integrated interactions between thyroid function, gut microbiota, metabolic syndrome, and inflammation in depression remain largely unexplored. This review explores current evidence to highlight gaps in existing research and synthesizes current knowledge, aiming to clarify mechanisms underlying immuno-metabolic depression. Understanding these relationships may provide a rationale for redefining depression as an immuno-metabolic disorder and support the development of more integrative therapeutic strategies targeting not only the brain, but also the gut-thyroid axis. Full article

Situation Awareness (SA) of operators in Cyber Security (CS) has been assumed important for effective incident response in critical infrastructure. Many previous studies have proposed tools and methods to improve SA, but there is a general lack of empirical evidence on the impact of SA on performance in this domain. In this study, we present such empirical evidence from experiments done within the domain of critical infrastructure. Eleven professional CS operators from the power sector participated in a realistic simulated network-related incident response task. SA, experience, and performance were scored for each participant. SA was measured using the Situation Awareness Global Assessment Technique (SAGAT). Statistically significant results confirmed three hypotheses: Higher SA was correlated with higher performance, and longer experience as an operator was correlated with higher performance. Additionally, higher SA is predictive of higher performance independently of longer experience. Accordingly, initial empirical evidence supporting the conjecture that cyber-SA is positively associated with performance now exists. Implications include that further CS research aimed at tool development and operator training should use recognized SA measurements as demonstrated in this study. This study thus contributes to bridging the existing knowledge gap of cyber-SA. Full article

Cryptorchidism is the most common non-lethal congenital defect of the male reproductive system in sheep, with potential economic consequences for flock management. This study investigated the incidence, testicular morphology, ultrasonographic characteristics, semen quality, and sexual behavior of bilateral cryptorchid Sarda rams. Slaughterhouse inspections of 2360 lambs showed an incidence of 0.87% cryptorchidism. Cryptorchid testes were significantly rounder and lighter than intact testes, indicating impaired development in affected animals. Ultrasonography of 15 adult bilateral cryptorchid rams showed that retained testes were markedly undersized and that the left testis was less frequently visualized. No significant association with age was detected within the studied age range. All ejaculates recovered from bilateral cryptorchid rams were azoospermic. Nevertheless, behavioral trials suggested that bilateral cryptorchid males retained sexual interest and the ability to identify estrous ewes. These findings confirm the infertility of bilateral cryptorchid Sarda rams while highlighting their preserved sexual behavior, suggesting a potential zootechnical use as teaser rams for heat detection. Repurposing cryptorchid males in this way could represent a potential alternative to surgically modified teaser rams or the use of aprons on intact rams. Full article

Introduction: Fibrinogenase and direct thrombin inhibitors (DTIs) have emerged as potential therapeutic agents for stroke, leveraging distinct mechanisms of action. However, different treatment strategies impact on the risk of stroke recurrence and in-hospital neurological progression remains inadequately characterized. Methods: We conducted a study enrolling patients with acute ischemic stroke (AIS) between 1 April 2022, and 1 July 2023. Data on demographics, comorbidities, clinical characteristics, and laboratory parameters were collected. Prognostic assessment was based on the incidence of recurrent stroke and in-hospital neurological deterioration, functional outcome (measured by the modified Rankin Scale, mRS), and neurological status (assessed by the National Institutes of Health Stroke Scale, NIHSS). Results: Among the 618 patients included in the final analysis, 187 received fibrinogenase, 127 received a DTI, and 304 served as controls. The overall stroke recurrence rate was 16.3%, with incidences of 23.0% (43/187) in the fibrinogenase group, 23.6% (30/127) in the DTI group, and 9.2% (28/304) in the control group. Neurological deterioration during admission occurred in 40 patients (6.5%), with rates of 4.3%, 12.6%, and 5.3% in the fibrinogenase, DTI, and control groups, respectively. Subgroup analysis revealed that fibrinogenase administration in patients with elevated plasma thromboproprotein (TpP) levels was associated with reduced recurrence rates and improved clinical outcomes. Discussion: Our findings preliminarily indicate that fibrinogenase and DTI therapies are more frequently employed in patients at higher risk of recurrence or progression. Specifically, fibrinogenase injection appears to suggest potential as an efficacious and well-tolerated treatment option for improving prognosis in AIS patients with elevated TpP levels. Full article

Breast cancer (BC) is the most common cancer in Kazakhstan, and a population-based breast cancer screening program was introduced in 2008, initially targeting women aged 50–60 years. It was subsequently expanded in 2018 to include women aged 40–70 years. This study evaluates the national BC screening program from its introduction in 2008 onward, focusing on program outputs, outcomes, and associated expenditures. Several administrative datasets and official sources were analyzed, including the legislative acts database, analytical reports on cancer screening programs, and cancer reporting forms. Trends in key indicators were summarized using the average annual percent change (AAPC). From the program’s inception, the absolute number of women screened increased steadily, with an AAPC of 6.23%. In contrast, the proportion of eligible women covered by screening declined over time, particularly following the expansion of the target age groups in 2018. Stage I BC detected through screening accounted for only about 50% of all stage I BC cases diagnosed nationwide, while the contribution of screening to stage II cancers was below 30%. Neither the introduction nor the subsequent expansion of the BC screening program was associated with statistically significant immediate or trend changes in national BC incidence or mortality rates. These findings may inform evidence-based discussions on potential refinements to BC screening policy and practice in Kazakhstan. Full article

Background and Objectives: Percutaneous coronary intervention (PCI) has markedly improved outcomes in coronary artery disease through the implantation of bare-metal stents (BMS) or drug-eluting stents (DES). However, in-stent restenosis (ISR) remains a significant complication, often necessitating repeat interventions. This study aimed to identify risk factors associated with ISR in patients with ST-elevation myocardial infarction (STEMI) who underwent PCI. Materials and Methods: We conducted a retrospective, non-randomized observational study of 107 STEMI patients treated with PCI between January 2016 and December 2019 who subsequently underwent clinically indicated (predominantly symptom-driven) follow-up coronary angiography within 12 months. ISR was defined as ≥50% luminal narrowing at follow-up angiography. Time-to-event analysis was performed using Cox regression models, incorporating clinical, biochemical, and angiographic variables. Results: In this selected cohort of patients undergoing follow-up angiography, ISR of any degree was identified in 87% of patients, and 52% had restenosis >70%. Advanced age, prior cardiovascular events, diabetes mellitus, chronic kidney disease, and history of stroke significantly increased the hazard of ISR. Smoking, dyslipidemia, and hypertension were prevalent in patients with severe ISR. Women presented with more severe clinical profiles (higher Killip class and troponin levels). DES showed slightly better TIMI flow than BMS, but stent type, dimensions, and number did not significantly impact restenosis risk. Thrombolytic therapy was associated with a significantly reduced ISR hazard. Mortality was 6% in patients with severe ISR. The highest restenosis incidence occurred in the LAD and RCA territories. Conclusions: ISR is a multifactorial process influenced by demographic, clinical, and procedural factors. Despite technological advances, ISR remains a prevalent issue, particularly in high-risk groups undergoing clinically indicated follow-up angiography. Secondary prevention strategies, optimized stent deployment, and targeted therapies addressing inflammation and vascular remodeling are essential to improving long-term PCI outcomes. Full article

Background/Objectives: Traumatic spinal fractures are common injuries, and a proportion of these cases require surgical stabilization using various operative systems. This study aimed to analyze the epidemiology of surgical site infections (SSIs) following exclusively trauma-related spinal surgery and to identify potential risk factors for their occurrence, as there is a lack of studies focusing on non-elective trauma-related spinal surgeries and SSI in the literature. Methods: This retrospective single-center analysis examined 710 patients with traumatic spinal injuries treated surgically between 2012 and 2022 at the Level I Trauma Center at the Department of Orthopedics and Trauma Surgery of the University Hospital Wiener Neustadt, Austria. To investigate SSI risk factors, comparative statistical analyses and logistic regression were used, with a level of statistical significance of α = 0.05. Results: In total, 28 cases (with an incidence of 3.94%) developed SSI, and these cases were characterized by a significantly higher body weight/BMI, longer operative times, and more stabilized segments and implanted hardware. They were also more likely to have undergone open surgery, laminectomy in combination with dorsal stabilization, intensive care treatment, or to present with neurological deficits or ankylosing spondylitis. SSIs occurred most frequently in the thoracolumbar and cervicothoracic junctions, and were predominantly caused by Staphylococcus epidermidis, Staphylococcus aureus, and Cutibacterium acnes. As independent risk factors, a higher BMI (OR = 1.188) and the use of cross-connectors (OR = 4.948) were identified, whereas other initially significant variables did not remain significant after adjustment. Conclusions: There are surgery-related and potentially modifiable variables and non-modifiable patient-related risk factors for the occurrence of SSI. Patients with SSIs stayed an average of 25.3 days in hospital and had a mortality rate of 17.9%. Full article

Pancreatic ductal adenocarcinoma (PDAC), which remains undetected till advanced stages of progression, is becoming a more common and aggressive PC with high mortality rates. Trending unhealthy dietary habits, sedentary life, obesity, diabetes, high body mass index (BMI), and perturbed gut microbiota, also known as dysbiosis, increase the PDAC incidences. There is an urgent need to delve into reliable and cost-effective biomarkers and strategies to diagnose and prevent the disease. Microbial remedies and dietary phytonutrients that restore gut microbial balance may be the prospective preventive measures. This article intends to recommend the hypothesis that PDAC is incepted and characterized by microbial signatures and can be managed by integrating evidenced-based complimentary approaches entailing diet, nutraceuticals, microbial interventions and life style modifications with standard therapies. The futuristic longitudinal and mechanistic studies to unravel host–microbiota and the host–microbiome interactions will allow deeper aetiologic and mechanistic insights into PDAC to evolve therapies and recommendations for better pancreatic health. Full article

Persistent post-endometrial ablation uterine bleeding indicates that no method of EA eliminates the entire endometrium, and post-EA hysteroscopy shows a distorted and scarred uterine cavity in the majority of patients. These observations raise concerns regarding presentation, assessment and stage of potential post-ablation endometrial cancer (PAEC), developing in residual endometrium pockets. To better understand these concerns, a literature search was conducted, from the introduction of EA in the 1980s through 2025, to capture reports of endometrial cancer (EC) associated with or following EA using multiple data bases, imputing search terms of EC following EA and possible combinations of first- and second-generation EA techniques associated with EC. Upon review of all publications, we identified 86 ECs associated with EA, described in 20 case reports (N = 20), four case series (N = 18), eleven cohort studies (N = 21), one registry (N = 27) and five reviews. Based on 12 relevant studies at a median follow-up of 8.5 years (range 1.9–25), 43 EC were identified in 39,795 women with a history of EA, with a summary incidence of 0.11% (range 0.0–1.59%). Although the studies and data are very heterogeneous, it appears that EA may afford a protective effect in reducing the risk of EC in the short term. The mechanistic effect is likely due to a quantitative reduction in the endometrium that can potentially become malignant, and/or due to the elimination of occult pre- or malignant endometrial elements which are vulnerable to EA. Moreover, based on 25 evaluable cases, the mode and time to presentation, the diagnostic work-up (including endometrial biopsy and hysteroscopy), and the stage of PAEC appear not to be altered by EA. Full article

Background/Objectives: Dental caries continues to represent a major oral health concern in children, particularly in uncooperative patients, where effective sealant placement is often compromised. This study evaluated the long-term clinical performance of hydrophilic (UltraSeal XT hydro) and hydrophobic (Helioseal-F) resin-based sealants in uncooperative children aged 6–9 years, assessing retention and caries incidence over 24 months. Methods: In a split-mouth, double-blinded randomized controlled trial, 34 children (104 first permanent molars) were enrolled, with 31 participants (98 teeth) completing the study. Sealants were randomly assigned to hydrophilic or hydrophobic group, with assessments at 3, 6, 12, 18, and 24 months. Results: Complete retention declined progressively in both groups, from 59.2% to 2.0% in the hydrophilic group and from 42.9% to 0% in the hydrophobic group at 24 months, with no significant intergroup differences (p = 0.719). Caries-free rates decreased from 81.6% to 49.0% in the hydrophilic group and from 75.5% to 40.8% in the hydrophobic group (p = 0.293). Children with definitely negative behavior showed significantly lower retention at 6 and 12 months (p = 0.006 and p < 0.001) compared to those with negative behavior, although differences were not significant at 24 months. Conclusions: Overall, both sealants demonstrated comparable retention and cariostatic performance, indicating that material properties alone do not determine long-term success. Further research should focus on long-term follow-up and comparative evaluation of hydrophilic sealants in cooperative and uncooperative populations to better understand how patient behavior affects sealant performance. Full article