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12 pages, 419 KiB  
Article
Predictive Value of Electrocardiographic Markers Versus Echocardiographic and Clinical Measures for Appropriate ICD Shocks in Heart Failure Patients
by Özkan Bekler, Süleyman Diren Kazan, Hazar Harbalioğlu and Onur Kaypakli
J. Clin. Med. 2025, 14(15), 5506; https://doi.org/10.3390/jcm14155506 - 5 Aug 2025
Abstract
Background: Despite the survival benefit of ICDs in patients with HFrEF, most recipients do not receive appropriate therapy during follow-up. Existing risk models based on echocardiographic and clinical parameters show limited predictive accuracy for arrhythmic events. This study aimed to assess whether ECG-derived [...] Read more.
Background: Despite the survival benefit of ICDs in patients with HFrEF, most recipients do not receive appropriate therapy during follow-up. Existing risk models based on echocardiographic and clinical parameters show limited predictive accuracy for arrhythmic events. This study aimed to assess whether ECG-derived markers outperform conventional measures in predicting appropriate ICD shocks. Methods: This retrospective observational study included 375 patients with HFrEF who underwent ICD implantation for primary prevention at least six months before study enrollment. Twelve-lead surface ECGs were analyzed for a QTc interval, Tp-e/QT ratio, frontal QRS-T angle, and maximum deflection index (MDI). Clinical, echocardiographic, and arrhythmic event data obtained from device interrogations were evaluated. Receiver operating characteristic (ROC) curve analysis and multivariate logistic regression were performed to identify independent predictors of appropriate ICD shocks. Results: Patients who experienced appropriate ICD shocks had significantly higher rates of a complete bundle branch block, digoxin use, QRS duration, QTc, Tp-e/QT ratio, frontal QRS-T angle, MDI, and right-ventricular pacing ratio. Conversely, beta-blocker use was significantly lower in this group. In multivariate analysis, independent predictors of appropriate shocks included the patient’s digoxin use (OR = 2.931, p = 0.003), beta-blocker use (OR = 0.275, p = 0.002), frontal QRS-T angle (OR = 1.009, p < 0.001), QTc interval (OR = 1.020, p < 0.001), and Tp-e/QT ratio (OR = 4.882, p = 0.050). The frontal QRS-T angle had a cutoff value of 105.5° for predicting appropriate ICD shocks (sensitivity: 73.6%, specificity: 85.2%, AUC = 0.758, p < 0.001). Conclusions: Electrocardiographic markers, particularly the frontal QRS-T angle, QTc interval, and Tp-e/QT ratio, demonstrated superior predictive power for appropriate ICD shocks compared to conventional echocardiographic and clinical measures. These easily obtainable, non-invasive ECG parameters may improve current risk stratification models and support more individualized ICD implantation strategies. Full article
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16 pages, 459 KiB  
Article
Ceftazidime–Avibactam in Critically Ill Patients: A Multicenter Observational Study
by Olivieri Silvia, Mazzanti Sara, Gelo Signorino Gabriele, Pallotta Francesco, Ficola Andrea, Canovari Benedetta, Di Muzio Vanessa, Di Prinzio Michele, Cerutti Elisabetta, Donati Abele, Giacometti Andrea, Barchiesi Francesco and Brescini Lucia
Antibiotics 2025, 14(8), 797; https://doi.org/10.3390/antibiotics14080797 (registering DOI) - 5 Aug 2025
Abstract
Ceftazidime–avibactam (CAZ-AVI) is a second-generation intravenous β-lactam/β-lactamase inhibitor combination. In recent years, substantial evidence has emerged regarding the efficacy and safety of CAZ-AVI. However, data on its use in critically ill patients remain limited. Background/Objectives: This multicenter, retrospective, observational cohort study was conducted [...] Read more.
Ceftazidime–avibactam (CAZ-AVI) is a second-generation intravenous β-lactam/β-lactamase inhibitor combination. In recent years, substantial evidence has emerged regarding the efficacy and safety of CAZ-AVI. However, data on its use in critically ill patients remain limited. Background/Objectives: This multicenter, retrospective, observational cohort study was conducted across four Intensive Care Units (ICUs) in three hospitals in the Marche region of Italy. The primary objective was to evaluate the 30-day clinical outcomes and identify risk factors associated with 30-day clinical failure—defined as death, microbiological recurrence, or persistence within 30 days after discontinuation of therapy—in critically ill patients treated with CAZ-AVI. Methods: The study included all adult critically ill patients admitted to the participating ICUs between January 2020 and September 2023 who received CAZ-AVI for at least 72 h for the treatment of a confirmed or suspected Gram-negative bacterial (GNB) infection. Results: Among the 161 patients included in the study, CAZ-AVI treatment resulted in a positive clinical outcome (i.e., clinical improvement and 30-day survival) in 58% of cases (n = 93/161), while the overall mortality rate was 24% (n = 38/161). Relapse or persistent infection occurred in a substantial proportion of patients (25%, n = 41/161). Notably, acquired resistance to CAZ-AVI was observed in 26% of these cases, likely due to suboptimal use of the drug in relation to its pharmacokinetic/pharmacodynamic (PK/PD) properties in critically ill patients. Furthermore, treatment failure was more frequent among immunosuppressed individuals, particularly liver transplant recipients. Conclusions: This study demonstrates that the mortality rate among ICU patients treated with this novel antimicrobial combination is consistent with findings from other studies involving heterogeneous populations. However, the rapid emergence of resistance underscores the need for vigilant surveillance and the implementation of robust antimicrobial stewardship strategies. Full article
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17 pages, 2225 KiB  
Article
The Persistence of Cross-Reactive Immunity to Influenza B/Yamagata Neuraminidase Despite the Disappearance of the Lineage: Structural and Serological Evidence
by Yulia Desheva, Polina Kudar, Maria Sergeeva, Pei-Fong Wong, Tamara Shvedova, Ekaterina Bazhenova, Evelyna Krylova, Maria Kurpiaeva, Ekaterina Romanovskaya-Romanko, Vera Krivitskaya, Kira Kudria, Irina Isakova-Sivak and Marina Stukova
Int. J. Mol. Sci. 2025, 26(15), 7476; https://doi.org/10.3390/ijms26157476 - 2 Aug 2025
Viewed by 184
Abstract
Influenza B viruses, divided into B/Victoria and B/Yamagata lineages, have not had B/Yamagata isolates after 2020. A study evaluated immunity to influenza B surface antigens hemagglutinin (HA) and neuraminidase (NA) in 138 patient sera from 2023 and 23 pairs of sera from 2018 [...] Read more.
Influenza B viruses, divided into B/Victoria and B/Yamagata lineages, have not had B/Yamagata isolates after 2020. A study evaluated immunity to influenza B surface antigens hemagglutinin (HA) and neuraminidase (NA) in 138 patient sera from 2023 and 23 pairs of sera from 2018 to 2019 vaccine recipients. The phylogenetic tree of the influenza B virus, based on HA and NA genes, shows that the Yamagata lineage evolves gradually, while the Victoria lineage exhibits rapid mutations with short branches. In 2023, mean levels of antibodies to HA and NA of B/Yamagata virus were higher than to B/Victoria, despite no cases of B/Yamagata lineage isolation after 2020. The titers of antibodies to NA of B/Yamagata statistically significantly differed among individuals born before and after 1988. Among patients examined in 2018–2019, neuraminidase-inhibiting (NI) antibody titers before vaccination were higher to B/Yamagata than to B/Victoria, and NI antibodies to B/Victoria and B/Yamagata positively correlated with neutralizing antibodies to B/Victoria virus before and after vaccination. Immunity to B/Yamagata virus was stronger in 2023, despite no isolation since 2020, probably due to the presence of cross-reactive antibodies from B/Victoria infections or vaccinations. Antibodies to NA of B/Victoria and B/Yamagata in 2023 correlated significantly in patients born before 1988, potentially supporting the concept of ‘antigenic sin’ phenomenon for influenza B viruses. The fact that NI antibody titers to B/Victoria and B/Yamagata correlated with neutralizing antibody titers to B/Victoria may suggest broad cross-protection. Studying influenza B virus NA antigenic properties helps understand the evolution and antigenic competition of HA and NA. Full article
(This article belongs to the Special Issue Respiratory Virus Infection)
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16 pages, 1414 KiB  
Article
Integrated Analysis of the Safety Experience in Adults with the Bivalent Respiratory Syncytial Virus Prefusion F Vaccine
by Kumar Ilangovan, David Radley, Michael Patton, Emma Shittu, Maria Maddalena Lino, Christos Goulas, Kena A. Swanson, Annaliesa S. Anderson, Alejandra Gurtman and Iona Munjal
Vaccines 2025, 13(8), 827; https://doi.org/10.3390/vaccines13080827 (registering DOI) - 1 Aug 2025
Viewed by 251
Abstract
Background/objectives: This was a post hoc analysis of safety data across the bivalent respiratory syncytial virus prefusion F (RSVpreF) vaccine clinical trial development program. Methods: Data from eight clinical trials in 46,913 immunocompetent adults who received RSVpreF or placebo were analyzed. Local reactions [...] Read more.
Background/objectives: This was a post hoc analysis of safety data across the bivalent respiratory syncytial virus prefusion F (RSVpreF) vaccine clinical trial development program. Methods: Data from eight clinical trials in 46,913 immunocompetent adults who received RSVpreF or placebo were analyzed. Local reactions and systemic events were assessed among non-pregnant ≥18-year-olds (n = 9517); adverse events (AEs) among pregnant and non-pregnant 18–59-year-olds (n = 9238); and vaccine-related AEs among non-pregnant ≥18-year-olds (n = 39,314). Post-marketing data in non-pregnant adults were considered. Results: Local reactions and systemic events were reported more frequently in RSVpreF versus placebo recipients; injection site pain was the most common local reaction (RSVpreF, 18.9%; placebo, 7.4%), and fatigue (23.5%; 18.4%) and headache (19.5%; 15.0%) were the most common systemic events. Percentages of AEs within 1 month after vaccination were similar across groups (RSVpreF, 12.8%; placebo, 13.1%); severe AEs were reported in ≤1.5% of participants. Differences in percentages of individuals reporting vaccine-related AEs between the RSVpreF and placebo groups were <0.2% for all related AEs. Serious AEs throughout the study were reported in ≤14.0% (RSVpreF, 12.6%; placebo, 14.0%). No atrial fibrillation, Guillain-Barré syndrome, or acute polyneuropathy cases were reported. The AE data from post-marketing data sources were consistent with the safety profile from the clinical trial program, with no new safety concerns. Conclusions: Integrated data demonstrated that RSVpreF was well tolerated with a favorable safety profile in non-pregnant and pregnant adults. Ongoing surveillance through real-world use and clinical trial experience continue to support the safety profile of RSVpreF. ClinicalTrials.gov: NCT03529773/NCT04071158/NCT04785612/NCT05035212/NCT05096208/NCT05842967/NCT04032093/NCT04424316. Full article
(This article belongs to the Special Issue Host Immunity and Vaccines for Respiratory Pathogens)
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14 pages, 375 KiB  
Article
Willingness to Become a Living Kidney Donor to a Stranger Among Polish Health Care Professionals Employed in a Dialysis Center: A National Cross-Sectional Study
by Paulina Kurleto, Irena Milaniak, Lucyna Tomaszek and Wioletta Mędrzycka-Dabrowska
J. Clin. Med. 2025, 14(15), 5282; https://doi.org/10.3390/jcm14155282 - 25 Jul 2025
Viewed by 339
Abstract
Background: Kidney transplantation from a living donor is considered the most beneficial form of treatment for end-stage renal failure, which, in addition to providing patients with better treatment results, significantly improves their quality of life. Understanding factors that influence the willingness to [...] Read more.
Background: Kidney transplantation from a living donor is considered the most beneficial form of treatment for end-stage renal failure, which, in addition to providing patients with better treatment results, significantly improves their quality of life. Understanding factors that influence the willingness to donate kidneys to strangers is critical in promoting and expanding the living donor pool. When considering the decision to become an altruistic kidney donor, individuals must evaluate multiple factors, including the identity of the recipient and their own perceived level of safety. This study aimed to assess the willingness of dialysis center employees to act as living kidney donors for a stranger. Methods: We conducted a cross-sectional study from February 2023 to June 2024 among dialysis specialists across Poland. The study involved 1093 people (doctors and nurses). The study used our survey questionnaire and standardized tools. Results: Nurses (vs. physicians) and those who advocated the regulation of unspecified living kidney donation in Poland, did not believe in the risk of organ trafficking, and would donate a kidney to a husband/wife or friend and accept kidney transplantation from a husband/wife were more likely to donate a kidney to a stranger. Furthermore, respondents who accepted a loved one’s decision to donate a kidney to a stranger were significantly more willing to donate a kidney to such a person themselves. Perceived self-efficacy was positively associated with the willingness to donate a kidney to a stranger. Conclusions: Less than half of healthcare professionals supported unspecific living organ donation in Poland, and nurses were more willing to donate than physicians. The factors supporting the decision generally included knowledge about organ donation and transplantation, a lack of fear of organ trafficking, and attitudes towards donation. Full article
(This article belongs to the Section Nephrology & Urology)
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24 pages, 1886 KiB  
Review
Potential Health Benefits of Dietary Tree Nut and Peanut Enrichment in Kidney Transplant Recipients—An In-Depth Narrative Review and Considerations for Future Research
by Daan Kremer, Fabian A. Vogelpohl, Yvonne van der Veen, Caecilia S. E. Doorenbos, Manuela Yepes-Calderón, Tim J. Knobbe, Adrian Post, Eva Corpeleijn, Gerjan Navis, Stefan P. Berger and Stephan J. L. Bakker
Nutrients 2025, 17(15), 2419; https://doi.org/10.3390/nu17152419 - 24 Jul 2025
Viewed by 418
Abstract
Kidney transplant recipients face a substantial burden of premature mortality and morbidity, primarily due to persistent inflammation, cardiovascular risk, and nutritional deficiencies. Traditional nutritional interventions in this population have either focused on supplementing individual nutrients—often with limited efficacy—or required comprehensive dietary overhauls that [...] Read more.
Kidney transplant recipients face a substantial burden of premature mortality and morbidity, primarily due to persistent inflammation, cardiovascular risk, and nutritional deficiencies. Traditional nutritional interventions in this population have either focused on supplementing individual nutrients—often with limited efficacy—or required comprehensive dietary overhauls that compromise patient adherence. In this narrative review, we explore the rationale for dietary nut enrichment as a feasible, multi-nutrient strategy tailored to the needs of kidney transplant recipients. Nuts, including peanuts and tree nuts with no added salt, sugar, or oil, are rich in beneficial fats, proteins, vitamins, minerals, and bioactive compounds. We summarize the multiple post-transplant challenges—including obesity, sarcopenia, dyslipidemia, hypertension, immunological dysfunction, and chronic inflammation—and discuss how nut consumption may mitigate these issues through mechanisms involving improved micro-nutrient intake (e.g., magnesium, potassium, selenium), lipid profile modulation, endothelial function, immune support, and gut microbiota health. Additionally, we highlight the scarcity of randomized controlled trials in high-risk populations such as kidney transplant recipients and make the case for studying this group as a model for investigating the clinical efficacy of nuts as a nutritional intervention. We also consider practical aspects for future clinical trials, including the choice of study population, intervention design, duration, nut type, dosage, and primary outcome measures such as systemic inflammation. Finally, potential risks such as nut allergies and oxalate or mycotoxin exposure are addressed. Altogether, this review proposes dietary nut enrichment as a promising, simple, and sustainable multi-nutrient approach to support cardiometabolic and immune health in kidney transplant recipients, warranting formal investigation in clinical trials. Full article
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15 pages, 1304 KiB  
Article
Correlates of SARS-CoV-2 Breakthrough Infections in Kidney Transplant Recipients Following a Third SARS-CoV-2 mRNA Vaccine Dose
by Miriam Viktov Thygesen, Charlotte Strandhave, Jeanette Mølgaard Kiib, Randi Berg, Malene Söth Andersen, Emma Berggren Dall, Bodil Gade Hornstrup, Hans Christian Østergaard, Frank Holden Mose, Jon Waarst Gregersen, Søren Jensen-Fangel, Jesper Nørgaard Bech, Henrik Birn, Marianne Kragh Thomsen and Rasmus Offersen
Vaccines 2025, 13(8), 777; https://doi.org/10.3390/vaccines13080777 - 22 Jul 2025
Viewed by 260
Abstract
Background: Kidney transplant recipients (KTRs) exhibit a significantly diminished immune response to Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) vaccines compared with the general population, primarily due to ongoing immunosuppressive therapy. This study evaluated the immunogenicity of a third SARS-CoV-2 mRNA vaccine dose in [...] Read more.
Background: Kidney transplant recipients (KTRs) exhibit a significantly diminished immune response to Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) vaccines compared with the general population, primarily due to ongoing immunosuppressive therapy. This study evaluated the immunogenicity of a third SARS-CoV-2 mRNA vaccine dose in KTRs and assessed the association between antibody response and protection against SARS-CoV-2 breakthrough infection. Additionally, the clinical and immunological correlates of post-vaccination SARS-CoV-2 infection were examined. Methods: A prospective cohort of 135 KTRs received a third vaccine dose approximately six months following the second dose. Plasma samples were collected at baseline (pre-vaccination), six months after the second dose, and six weeks following the third dose. Humoral responses were assessed using SARS-CoV-2-specific Immunoglobulin G (IgG) titers and virus neutralization assays against wild-type (WT) and viral strains, including multiple Omicron sub-lineages. Results: After the third vaccine dose, 74% of the KTRs had detectable SARS-CoV-2-specific IgG antibodies, compared with 48% following the second dose. The mean IgG titers increased approximately ten-fold post-booster. Despite this increase, neutralizing activity against the Omicron variants remained significantly lower than that against the WT strain. KTRs who subsequently experienced a SARS-CoV-2 breakthrough infection demonstrated reduced neutralizing antibody activity across all variants tested. Additionally, individuals receiving triple immunosuppressive therapy had a significantly higher risk of SARS-CoV-2 breakthrough infection compared with those on dual or monotherapy. A multivariate machine learning analysis identified age and neutralizing activity against WT, Delta, and Omicron BA.2 as the most robust correlates of SARS-CoV-2 breakthrough infection. Conclusions: A third SARS-CoV-2 mRNA vaccine dose significantly improves SARS-CoV-2-specific IgG levels in KTRs; however, the neutralizing response against Omicron variants remains suboptimal. Diminished neutralizing capacity and intensified immunosuppression are key determinants of SARS-CoV-2 breakthrough infection in this immunocompromised population. Full article
(This article belongs to the Section COVID-19 Vaccines and Vaccination)
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20 pages, 1153 KiB  
Article
Economic Attitudes and Financial Decisions Among Welfare Recipients: Considerations for Workforce Policy
by Jorge N. Zumaeta
J. Risk Financial Manag. 2025, 18(8), 407; https://doi.org/10.3390/jrfm18080407 - 22 Jul 2025
Viewed by 241
Abstract
This study investigates economic decision-making behaviors among welfare recipients in Miami, Florida, by leveraging well-established experimental protocols: the Guessing Game, the Prudence Measurement Task, the Risk Aversion Task, and the Stag Hunt Game. For this purpose, our study defines financial decisions as the [...] Read more.
This study investigates economic decision-making behaviors among welfare recipients in Miami, Florida, by leveraging well-established experimental protocols: the Guessing Game, the Prudence Measurement Task, the Risk Aversion Task, and the Stag Hunt Game. For this purpose, our study defines financial decisions as the underlying individual preferences that serve as validated proxies for savings behavior, debt management, job-search intensity, and participation in cooperative finance. A central objective is to compare the behavior of welfare recipients to that of undergraduate students, a cohort typically used in experimental economics research. The analysis reveals significant differences between the two groups in strategic thinking and coordination, particularly across ethnic and gender lines. Non-Hispanic/Latino participants in Miami displayed significantly higher average guesses in the Guessing Game compared to their counterparts in Tucson, indicating potential discrepancies in the depth of strategic reasoning. Additionally, female participants in Tucson exhibited higher levels of coordination in the Stag Hunt Game compared to females in Miami, suggesting variance in cooperative behavior between these groups. Despite these findings, regression models demonstrate that location, gender, and ethnicity collectively account for only a small fraction of the observed variance, as evidenced by low R2 values and substantial mean squared errors across all games. These results suggest that individual heterogeneity, rather than broad demographic variables, may be more influential in shaping economic decisions. This study underscores the complexity of generalizing findings from traditional student samples to more diverse populations, highlighting the need for further investigation into the socioeconomic factors that drive financial decision-making. Full article
(This article belongs to the Special Issue Behavioral Influences on Financial Decisions)
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26 pages, 2610 KiB  
Review
Immunosuppressants/Immunomodulators and Malignancy
by Norishige Iizuka, Yoshihiko Hoshida, Atsuko Tsujii Miyamoto, Hotaka Shigyo, Akira Nishigaichi, Gensuke Okamura and Shiro Ohshima
J. Clin. Med. 2025, 14(14), 5160; https://doi.org/10.3390/jcm14145160 - 21 Jul 2025
Viewed by 582
Abstract
Individuals with immunosuppressive conditions are at a higher risk of developing malignancies than those in the general population. Immunosuppression weakens tumor immunity, hinders the detection of pro-oncogenic cells, and activates oncogenic viruses. Malignancies arising in immunosuppressed patients tend to be aggressive, have a [...] Read more.
Individuals with immunosuppressive conditions are at a higher risk of developing malignancies than those in the general population. Immunosuppression weakens tumor immunity, hinders the detection of pro-oncogenic cells, and activates oncogenic viruses. Malignancies arising in immunosuppressed patients tend to be aggressive, have a high incidence of virus-associated cancers, and are reversible in some cases. Notably, immunosuppressive agents influence the frequency and type of malignancies, as well as their clinicopathological features. Organ transplant recipients receive long-term immunosuppressants to prevent acute rejection. Post-transplant malignancies vary depending on the type of drug administered before the onset of these diseases. Patients with rheumatoid arthritis (RA) are treated with long-term immunosuppressive medications, such as methotrexate (MTX). MTX is widely recognized as being associated with a specific type of lymphoproliferative disorder (LPD), known as MTX-associated LPD. Our recent report indicated that the clinicopathological features of rheumatoid arthritis-associated lymphoproliferative disorder (RA-LPD) also vary based on the other anti-RA agents used, such as tacrolimus and tumor necrosis factor inhibitors. Therefore, the clinicopathological characteristics of post-transplant LPD and RA-LPD evolve alongside the changes in the immunosuppressants/immunomodulators administered. Understanding the various characteristics and time trends of immunosuppressive neoplasms, particularly LPDs, in relation to different immunosuppressant/immunomodulator medications is highly valuable in clinical practice. Full article
(This article belongs to the Special Issue Rheumatoid Arthritis: Clinical Updates on Diagnosis and Treatment)
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18 pages, 647 KiB  
Article
Psychological Mechanisms of Caregiver Involvement in Caregiving for Individuals with Alzheimer’s Disease: Analysis of the Moderated Mediation Model
by Anna Sołtys and Marcin Wnuk
J. Clin. Med. 2025, 14(14), 5134; https://doi.org/10.3390/jcm14145134 - 19 Jul 2025
Viewed by 382
Abstract
Providing long-term care for a person with Alzheimer’s disease is associated with chronic stress and emotional overload. One of the key predictors of emotional burden is the amount of time devoted to caregiving, which intensifies the experienced stress. Additional risk factors include the [...] Read more.
Providing long-term care for a person with Alzheimer’s disease is associated with chronic stress and emotional overload. One of the key predictors of emotional burden is the amount of time devoted to caregiving, which intensifies the experienced stress. Additional risk factors include the stage of the illness, difficulties in the care recipient’s activities of daily living, the caregiver’s neglect of their own needs, and challenging behaviours exhibited by the person receiving care. Therefore, it is essential to identify the psychological protective resources of caregivers that can buffer the impact of stress. Background/Objectives: The objective of the study was to explore the psychological mechanisms underlying the involvement of caregivers supporting individuals with Alzheimer’s disease. A moderated mediation model was employed, in which stress indirectly affects caregiver involvement through a sense of coherence, and the strength of this relationship is moderated by the amount of time devoted to caregiving. Methods: The bootstrapping method was applied using 5000 resamples within a 95% bias-corrected confidence interval. The analysis accounted for variables such as stress levels, sense of coherence, involvement in caregiving, duration of care, education, gender, age, and stage of the illness. Results: The sense of coherence mediated the relationship between stress and involvement in caring (B = 0.0063, SE = 0.0031, 95% CI [0.0012, 0.0135]), and this indirect effect was contingent upon the amount of time devoted to helping. The relationship between sense of coherence and involvement in caring was significant at the mean level (B = 0.005, SE = 0.002, 95% CI [0.0004, 0.0101]) and became stronger at high levels of time devoted to caring (+1 SD; B = 0.009, SE = 0.003, 95% CI [0.0030, 0.0148]). These results indicate that the positive association between sense of coherence and caregiver involvement increases with the amount of time spent caring. Conclusions: The results highlight the importance of strengthening caregivers’ resilience resources—such as a sense of coherence—in preventing overload. The model may serve as a foundation for developing interventions aimed at supporting caregivers’ mental health. Full article
(This article belongs to the Special Issue Treatment Personalization in Clinical Psychology and Psychotherapy)
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20 pages, 3946 KiB  
Article
Immune Durability and Breakthrough Infections 15 Months After SARS-CoV-2 Boosters in People over 65: The IMMERSION Study
by Concepció Violán, Bibiana Quirant-Sánchez, Maria Palau-Antoja, Dolors Palacin, Edwards Pradenas, Macedonia Trigueros, Guillem Pera, Gemma Molist, Gema Fernández-Rivas, Marc Boigués, Mar Isnard, Nuria Prat, Meritxell Carmona-Cervelló, Noemi Lamonja-Vicente, Brenda Biaani León-Gómez, Eva María Martínez-Cáceres, Pere Joan Cardona, Julià Blanco, Marta Massanella and Pere Torán-Monserrat
Vaccines 2025, 13(7), 738; https://doi.org/10.3390/vaccines13070738 - 9 Jul 2025
Viewed by 542
Abstract
Background: SARS-CoV-2 booster vaccination remains essential to prevent severe COVID-19, particularly in vulnerable populations such as older adults. This study evaluated the durability and dynamics of immune responses following booster vaccination(s) in >65-year-old individuals and examined their association with protection against new [...] Read more.
Background: SARS-CoV-2 booster vaccination remains essential to prevent severe COVID-19, particularly in vulnerable populations such as older adults. This study evaluated the durability and dynamics of immune responses following booster vaccination(s) in >65-year-old individuals and examined their association with protection against new infections. Methods: Immune responses were evaluated at 3, 9, and 15 months post-booster, measuring SARS-CoV-2-specific IgG antibodies against spike [IgG(S)] and nucleocapsid [IgG(N)] proteins, neutralizing activity against the Omicron BA.2 variant, and cellular immunity. A subset of participants was tested before booster administration. Regression analyses examined the influence of clinical and immunological factors—including a bivalent fourth dose—on infection risk over time. Results: Booster vaccination significantly enhanced IgG(S) and neutralizing capacity, peaking at 3 months. Although a decline was observed by 9 months, responses remained above baseline. Individuals with prior SARS-CoV-2 infection exhibited higher IgG(S) levels and neutralizing titers, and significantly lower reinfection rates (15%), compared to uninfected individuals. A fourth vaccine dose further increased IgG(S) levels. While neutralizing capacity was not consistently enhanced by the fourth dose, recipients experienced a lower rate of new infections. Immune trajectory analyses revealed that breakthrough infections elicited strong humoral responses comparable to those seen in previously infected individuals, highlighting the role of hybrid immunity. Conclusions: In older adults, booster vaccination induces durable immune responses, with hybrid immunity offering enhanced protection. A fourth dose boosts antibody levels and reduces infection risk, supporting its use in this high-risk group. Continued monitoring is needed to determine the long-term effectiveness of boosters, particularly against emerging variants. Full article
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11 pages, 1069 KiB  
Article
Evaluation of Torquetenovirus (TTV) Particle Integrity Utilizing PMAxx™
by Giuseppe Sberna, Claudia Minosse, Cosmina Mija, Eliana Specchiarello, Pietro Giorgio Spezia, Sara Belladonna, Giulia Berno, Lavinia Fabeni, Giulia Matusali, Silvia Meschi, Daniele Focosi and Fabrizio Maggi
Int. J. Mol. Sci. 2025, 26(13), 6542; https://doi.org/10.3390/ijms26136542 - 7 Jul 2025
Viewed by 436
Abstract
Torquetenovirus (TTV) is a ubiquitous, non-pathogenic DNA virus that has been suggested as a biomarker of immune competence, with the viral load correlating with the level of immunosuppression. However, by detecting non-intact viral particles, standard PCR-based quantification may overestimate the TTV viremia. To [...] Read more.
Torquetenovirus (TTV) is a ubiquitous, non-pathogenic DNA virus that has been suggested as a biomarker of immune competence, with the viral load correlating with the level of immunosuppression. However, by detecting non-intact viral particles, standard PCR-based quantification may overestimate the TTV viremia. To improve the clinical relevance of TTV quantification, in this study, we investigated the use of PMAxx™, a virion viability dye that selectively blocks the amplification of compromised virions. Serum samples from 10 Hepatitis C Virus-positive (HCV+) individuals, 81 liver transplant recipients (LTRs), and 40 people with HIV (PWH) were treated with PMAxx™ and analyzed for TTV DNA loads by digital droplet PCR (ddPCR). Furthermore, anti-SARS-CoV-2 IgG levels and neutralizing antibody (nAbs) titers were measured post-COVID-19 vaccination. Using ddPCR, the PMAxx™ treatment significantly reduced the TTV DNA levels in all the groups (mean reduction: 0.66 Log copies/mL), indicating the abundant presence of non-intact, circulating viral genomes. However, correlations between TTV DNA and SARS-CoV-2 IgG or nAbs were weak or absent in both PMAxx™-treated and untreated samples. These findings suggest that while PMAxx™ enhanced the specificity of TTV quantification, it did not improve the predictive value of TTV viremia at assessing vaccine-induced humoral responses. Full article
(This article belongs to the Section Molecular Microbiology)
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16 pages, 214 KiB  
Article
Lived Experience of Caregivers of Lung Transplant Recipients in Korea
by Haeng-Mi Son, Kyoungok Min and Younghui Hwang
Healthcare 2025, 13(13), 1608; https://doi.org/10.3390/healthcare13131608 - 4 Jul 2025
Viewed by 319
Abstract
Background/Objectives: This study aimed to explore the underlying meaning and structure of the experiences of caregivers with lung transplant recipients using phenomenological research methods. Methods: Data were collected between February 2020 and December 2021 via in-depth individual interviews with nine caregivers of [...] Read more.
Background/Objectives: This study aimed to explore the underlying meaning and structure of the experiences of caregivers with lung transplant recipients using phenomenological research methods. Methods: Data were collected between February 2020 and December 2021 via in-depth individual interviews with nine caregivers of lung transplant recipients. The meaning of the participants’ experiences was analyzed using Colaizzi’s phenomenological analysis to ensure methodological rigor. Researchers minimized bias through reflexivity and member checking, and the study adhered to ethical standards to ensure trustworthiness. Results: Participants cared for patients who had not fully crossed the threshold of death without giving up hope for a cure. They did not avoid caregiving as a responsibility to their families but accepted it as their responsibility. The lives of the participants became increasingly immersed as they witnessed the process of the patient’s illness and gained insights into patience and gratitude through the caregiving experience. Conclusions: This study’s findings can help assess the needs of lung transplant recipients and their caregivers and guide interventions that address their reciprocal relationship. It also emphasizes the importance of ongoing education and expanded social care services to reduce caregiver stress and burden. Full article
19 pages, 695 KiB  
Article
Strengthening Active Transportation Through Small Grants
by Charles Chancellor, Trevor S. Romans, Thomas Clanton, Tiffany Rhodes and Sunwoo Park
Future Transp. 2025, 5(3), 84; https://doi.org/10.3390/futuretransp5030084 - 4 Jul 2025
Viewed by 235
Abstract
Bicycle use has been increasing in many countries for active, sustainable transportation and recreation. Bicycling can benefit an individual’s mental and physical health and contribute to a community’s well-being and desirability, and it is more environmentally sustainable than automobiles. Nonprofit organizations lead bicycle [...] Read more.
Bicycle use has been increasing in many countries for active, sustainable transportation and recreation. Bicycling can benefit an individual’s mental and physical health and contribute to a community’s well-being and desirability, and it is more environmentally sustainable than automobiles. Nonprofit organizations lead bicycle advocacy efforts in the USA, both for bicycling as recreation and as part of local transportation systems. Outride is one of the larger advocacy organizations, and it sponsors a unique grant system targeting grassroots bicycling organizations dedicated to increasing bicycling. Using the Bicycle Community Development Framework (BCDF) as a lens, this study aims to evaluate Outride’s efforts through an interpretative phenomenological approach (IPA) using semi-structured interviews to gather data regarding grant recipients’ experiences using Outride funds. Findings suggest fund recipients are increasing bicycling through programs and infrastructure development, but with more intentionality, could better support building bicycle communities. Regarding the BCDF, the recipients strongly promoted education, engineering, and equity & accessibility while fostering a sense of community, belonging, and empowerment in their participants. Full article
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25 pages, 1099 KiB  
Review
Nutritional Management of Liver Failure in the Intensive Care Unit
by Zsófia Verzár, Rudolf Kiss, Csaba Pál Bálint, Annamária Pakai and Tímea Csákvári
Medicina 2025, 61(7), 1210; https://doi.org/10.3390/medicina61071210 - 3 Jul 2025
Viewed by 601
Abstract
Liver failure, both acute and chronic, represents a complex, life-threatening condition frequently requiring intensive care unit (ICU) admission. Nutritional management is a crucial component of supportive therapy, aiming to mitigate catabolism, preserve lean body mass, and support immune and organ function. In acute [...] Read more.
Liver failure, both acute and chronic, represents a complex, life-threatening condition frequently requiring intensive care unit (ICU) admission. Nutritional management is a crucial component of supportive therapy, aiming to mitigate catabolism, preserve lean body mass, and support immune and organ function. In acute liver failure (ALF), early nutritional intervention within 24–48 h and individualized energy–protein prescriptions are essential, even in the presence of hepatic encephalopathy. Chronic liver failure (CLF) and acute-on-chronic liver failure (ACLF) are often associated with severe malnutrition, sarcopenia, and systemic inflammation, necessitating tailored nutritional strategies. Subjective Global Assessment (SGA) and Royal Free Hospital Global Assessment (RFH-GA) tools are instrumental in identifying nutritional risk. Enteral nutrition (EN) is preferred across all stages, with parenteral nutrition (PN) reserved for contraindications. Special considerations include micronutrient repletion, prevention of refeeding syndrome, and perioperative nutritional support in transplant candidates and recipients. This clinical overview summarizes current evidence and guidelines on ICU nutrition in liver failure, emphasizing a multidisciplinary approach to improve outcomes. Full article
(This article belongs to the Section Gastroenterology & Hepatology)
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