Search Results (4,433)

The tomato leafminer Tuta absoluta (Meyrick) is a devastating invasive pest that threatens tomato production worldwide. Reliance on chemical insecticides raises sustainability concerns, highlighting the need for effective biological alternatives. Combining predators with entomopathogenic nematodes (EPNs) represents a promising strategy, yet their interactions remain poorly characterized. Here, we conducted laboratory bioassays to assess the individual and joint effects of the predatory bug Arma chinensis (Fallou) and four EPN species, Steinernema carpocapsae, S. feltiae, S. riobrave, and Heterorhabditis bacteriophora, against T. absoluta larvae. Under these controlled conditions, H. bacteriophora showed the highest compatibility with A. chinensis, exhibiting the lowest virulence against the predator. Female A. chinensis exhibited strong predation on freely exposed second-instar larvae, but efficiency declined markedly against leaf-mining larvae. Heterorhabditis bacteriophora caused consistently high mortality in second instars regardless of protection. Their combined application resulted in additive mortality with significantly reduced LT₅₀ values. We also observed A. chinensis preying on nematode-infected larvae and occasional infection of the predator under confined conditions. These laboratory findings demonstrate additive effects against T. absoluta, providing preliminary evidence for stage-specific integrated biological control strategies. Full article

Cirsium arvense (L.) Scop is a perennial plant of the family Asteraceae that is mainly distributed in the temperate regions of the Northern Hemisphere. Despite being widely recognized as an invasive weed in agriculture, most of the scientific evidence shows its significant phytochemical and pharmacological importance. In the present review article, a comprehensive summary of the available literature on C. arvense’s botanical properties, phytochemical composition, biological activities, standardization potential, and future therapeutic prospects has been carefully provided. This plant has been used traditionally for the treatment of inflammation, infections, bleeding disorders, and liver-related disorders. Phytochemical investigations showed the presence of many bioactive compounds such as flavonoids, phenolic acids, triterpenes, sterols, tannins, glycosides, and volatile compounds. Among the reported biological activities, antioxidants and antimicrobial properties are the most studied activities. In addition, anticancer, antidiabetic, neuroprotective, anti-inflammatory, and antiproliferative activities have also been investigated. The environmental adaptability, rapid growth, and extensive root system of C. arvense highlight its potential for development as a sustainable medicinal and industrial crop. However, there are critical research gaps present in phytochemical standardization, toxicity assessment, pharmacokinetics, and clinical validation, warranting further comprehensive studies. Full article

Neospora caninum is a major cause of reproductive failure in cattle, responsible for epidemic abortion outbreaks that inflict annual billion-dollar losses on the global livestock industry. In water buffaloes (Bubalus bubalis), however, a phylogenetically close relative often raised in the same environments, the same parasite typically establishes a subclinical persistent infection with markedly lower rates of clinical abortion. This review inverts the traditional narrative by arguing that the key to next-generation control strategies lies in understanding the tolerant host (buffalo) rather than solely the susceptible host (cattle). By dissecting this “Neospora paradox”, we explore the molecular and immunological crosstalk that dictates pregnancy outcomes. We examine the parasite’s invasion proteins, revealed by CRISPR-Cas9 screens, and the maternal–fetal interface, where the balance between immune tolerance and parasite control determines the fate of pregnancy. We also compare N. caninum with the related zoonotic parasite Toxoplasma gondii to highlight how differential host immune recognition shapes infection outcomes. Finally, we propose that deciphering the buffalo’s successful equilibrium with N. caninum can illuminate novel pathways for vaccines and immunotherapeutic strategies, transforming the management of neosporosis worldwide. Full article

Background: Periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) is a serious complication associated with substantial morbidity and healthcare costs. Although two-stage revision arthroplasty is widely accepted as a standard treatment, debridement, antibiotics, and implant retention (DAIR) is frequently attempted as a less invasive initial strategy. However, the impact of failed DAIR on the outcomes of subsequent two-stage revision remains controversial. Methods: This retrospective cohort study included patients who underwent two-stage revision arthroplasty for PJI following TKA at a single institution between 2005 and 2019, involving 84 knees at an average follow-up of 5.1 ± 3.3 years. Outcomes were compared between patients with a history of failed DAIR (F-DAIR group, n = 23) and those who underwent direct two-stage revision without prior procedures (DTSR group, n = 61). Treatment failure rates and associated risk factors were analyzed. Results: There was no significant difference in treatment failure rates between the F-DAIR and DTSR groups (4.3% vs. 9.8%, respectively; p = 0.668). Cox regression suggested that PJI type (acute vs. chronic) and diabetes mellitus were associated with treatment failure. Conclusions: In this retrospective cohort, prior failed DAIR was not associated with a statistically significant reduction in the success of subsequent two-stage revision arthroplasty. These findings may support consideration of DAIR as an initial treatment option in carefully selected patients; however, cautious interpretation is warranted because of the retrospective design, limited sample size, baseline imbalance, and small number of failure events. Therefore, the findings should be considered hypothesis-generating rather than definitive comparative evidence. Full article

Objective: Osteosynthesis in the case of a sternal wound infection is challenging. It requires osteosynthesis systems that go beyond the usual wire techniques. In principle, there are three different systems, namely plates with locking screws, clips, and distance systems, which are the original methods used in chest wall reconstruction. The aim of this study is to assign these systems to the corresponding sternal pathologies. Patients and methods: This is a retrospective single-center analysis. Bone pathology is divided into three grades: grade I (good substance/no fractures), grade II (good substance/few transverse fractures), grade III (poor substance/substance defects/multiple transverse fractures). The individual osteosynthesis systems are assigned to the different grades accordingly. The suitability of the individual systems is analyzed in the short term and long term. Results: A total of 130 patients were included. Stable osteosynthesis was achieved in all patients. For grade I defects, 75 plates and 24 clips were used. For grade II defects, mainly plates (255) but also clips (16) were used. A distance system was used 24 times for grade III defects. One plate fractured. No other implant-related complications occurred. Discussion: If the different osteosynthesis systems are used according to the bone pathology, a stable chest wall can be restored in all patients. The individual systems have their own specific characteristics, which must be taken into account with regard to the suitability and invasiveness of the procedure. No single system is suitable for treating all sternal pathologies. Full article

The introduction of minimally invasive surgery (MIS) marked a turning point in the history of medicine, driving one of the sharpest declines in surgical mortality and morbidity ever recorded—saving millions of lives and sparing an estimated one billion patients the suffering once inherent to large-incision surgery. Within a single generation, this once highly contested surgical innovation became the global standard of care, transforming surgical practice across disciplines and on a global scale. By every measure of public health, these outcomes place modern minimally invasive and robotic-assisted surgery as among the most consequential life-saving advances in modern medical history. This review examines the clinical impact and global dissemination of MIS, tracing its evolution from Camran Nezhat’s pioneering expansion of laparoscopy beyond diagnostics to complex therapeutic procedures across surgical disciplines. Drawing on decades of evidence across gynecology, general surgery, and urology, we show that MIS is associated with substantial reductions in perioperative mortality, major complications, blood loss, infections, thromboembolic events, postoperative pain, and length of hospital stay, while maintaining oncologic equivalence and improving functional and quality-of-life outcomes. Beyond these technical advances, MIS catalyzed a broader reimagining of surgery itself, challenging long-standing norms rooted in large-incision approaches and shifting the field toward precision, organ preservation, and pathology-directed intervention. These changes were accompanied by parallel advances in multiple domains, including in imaging, intraoperative visualization technologies, surgical anatomy, instrumentation, and nerve- and organ-sparing techniques—developments that collectively established the foundation for contemporary minimally invasive and robotic-assisted surgery. Collectively, these advances have contributed to the prevention of an estimated 10–20 million surgery-related deaths that would likely have occurred under the large-incision approaches of the past. Full article

Mechanisms of arboviral neuroinvasion are still incompletely resolved, despite longstanding emphasis on the blood-brain barrier (BBB) as the principal interface for central nervous system (CNS) entry. While BBB-centered models have been highly informative, they may underrepresent the contribution of other CNS border structures, particularly the choroid plexus and the blood-cerebrospinal fluid barrier (BCSFB). Here, we re-examine the BCSFB as a relevant but unevenly supported neuroinvasion interface in arboviral encephalitis. The strongest direct evidence is currently available for Zika virus (ZIKV), for which experimental studies support infection of choroid plexus-associated cells and CNS access through the blood-CSF axis. Semliki Forest virus (SFV) provides additional direct, although still limited, support for this concept. In contrast, for West Nile virus (WNV), Japanese encephalitis virus (JEV), and tick-borne encephalitis virus (TBEV), evidence for choroid plexus involvement remains indirect or insufficiently resolved, even though neuroinvasion itself is well established. We therefore argue not for replacement of BBB-centered models, but for broader integration of the BCSFB into current frameworks of arboviral CNS invasion. This evidence-based perspective supports a hierarchical, virus-dependent view of choroid plexus involvement and highlights the need for mechanistic studies that directly test when and how this interface contributes to encephalitic disease. Full article

Streptococcus pneumoniae is a leading cause of community-acquired pneumonia, yet the immune mechanisms required for protection against invasive pulmonary infection remain inadequately understood. Using a murine model of homologous protection against invasive pneumococcal pneumonia, we explored the relative contributions of humoral and cellular immunity using adoptive serum transfer, immune cell depletion, and lung transcriptional profiling. Our findings indicated that passive transfer of immune serum provided robust protection, while neutrophil depletion significantly compromised bacterial control, highlighting that both antibodies and neutrophils are key mediators of protection. In contrast, depletion of CD4⁺ T cells or NK cells did not compromise survival. Although IL-17A has been widely implicated in host defense against pneumococcal infection, IL-17A-deficient mice remained protected, albeit with delayed clearance and reduced early antibody responses. We associate this delay with compensatory upregulation of IL-17F and increased expression of Th1-associated genes in the lungs. Together, these findings indicate that IL-17A is not essential for protection and support a model in which coordinated Th1- and Th17-related cytokine responses collectively promote neutrophil recruitment and effective antibody-mediated defense. These results highlight functional redundancy within the IL-17 cytokine axis and suggest that integrated cytokine networks, rather than individual mediators, underpin protective immunity to pneumococcal pneumonia, with implications for next-generation vaccine design. Full article

Background/Objectives: Hospital-Acquired Infections (HAI) represent one of the most frequent adverse events during care delivery, with the pediatric population (0–18 years) presenting unique vulnerabilities due to their developing immune systems, dependence on caregivers, and need for invasive devices. Despite the availability of general guidelines, existing high-level evidence is largely extrapolated from adult studies, and pediatric settings differ significantly in patient physiology and equipment size. This scoping review aims to map the key concepts, types of evidence, and research gaps related to strategies preventing HAI in pediatric patients. Methods: This scoping review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. The Population, Concept, and Context (PCC) framework will be utilized. We will include any strategy, intervention, or protocol aimed at preventing HAI. A comprehensive search will be conducted across ten major electronic databases and grey literature sources. Two independent reviewers will screen titles, abstracts, and full texts, followed by data extraction using a standardized tool to categorize the interventions and key findings. Results: The findings will synthesize diverse practices into a usable format for clinical decision-makers and identify gaps where primary pediatric research is lacking. This consolidated data aims to guide resource allocation and assist hospital infection control committees in updating pediatric safety protocols. Conclusions: This scoping review will establish a comprehensive baseline of pediatric-specific HAI prevention strategies. The findings will inform evidence-based practice, identify critical research gaps, and guide future investigations in the prevention of pediatric infections in healthcare settings. Full article

Background: Acute respiratory distress syndrome (ARDS), particularly in COVID-19–related severe respiratory failure, remains a major challenge in intensive care. Flow-controlled ventilation (FCV) may improve gas exchange by enabling precise airway pressure control; however, clinical data on its prolonged use in ARDS are limited. Methods: This single-center retrospective observational study included adult patients with moderate to severe ARDS who underwent FCV during invasive mechanical ventilation. FCV was delivered using the Evone^® ventilator with the Tritube^®. Demographic data, ventilatory settings, and arterial blood gas values were analyzed before and during 48 h of FCV and for 8 h after transition to conventional ventilation. Results: Seven patients with COVID-19–related ARDS were included. Following initiation of FCV, PaO₂ increased within the first 8 h (median increase: +24 mmHg), accompanied by a median 38% improvement in the PaO₂/FiO₂ ratio, which remained above baseline throughout follow-up. Arterial PCO₂ progressively declined, with the most pronounced reduction observed within the first 24 h (median decrease: −14 mmHg; approximately 22%). After transition back to conventional ventilation, mild deterioration in gas exchange parameters was observed; however, none returned to baseline values. All patients died during their ICU stay, mainly due to secondary infections and pulmonary embolism. Conclusions: In advanced COVID-19–related ARDS unresponsive to conventional ventilation, prolonged FCV application was technically feasible under controlled ICU conditions and associated with descriptively observed improvements in gas exchange parameters. However, late initiation of FCV did not translate into survival benefit. Prospective studies are required to define the optimal timing and patient selection for FCV. The present findings primarily support the technical feasibility and short-term physiological effects of FCV rather than clinical efficacy. Full article

Background/Objectives: Minimally invasive valve surgery via right minithoracotomy is well established for isolated aortic and mitral procedures, but its application to multivalve operations remains uncommon and clinical data are scarce. We report our initial single-center experience with minimally invasive multivalve surgery—defined as a small skin incision without rib spreading or internal mammary artery dissection—in patients with combined aortic and mitral disease. Methods: We retrospectively analyzed 10 consecutive patients who underwent minimally invasive multivalve cardiac surgery at our institution. All operations were performed through a 5–7 cm right minithoracotomy in the third or fourth intercostal space, with femoral cannulation for cardiopulmonary bypass (CPB). Nine patients underwent a double-valve procedure (aortic and mitral) and one a triple-valve procedure (aortic, mitral, and tricuspid). Operative variables, perioperative complications, and early echocardiographic outcomes were assessed. Results: The mean age of patients was 69.8 ± 5.2 years and 60% were female. Mean CPB and aortic cross-clamp times were 197.6 ± 48.3 min and 148.1 ± 34.7 min, respectively. All procedures were completed via the minimally invasive approach, with no conversion to sternotomy and no in-hospital deaths. No rethoracotomies, wound infections, or peripheral vascular complications occurred. Postoperative atrial fibrillation, observed in five patients (50%), was the most common complication. Early echocardiography showed good valve function in nine patients (90%); one had a moderate aortic paravalvular leak managed conservatively. Conclusions: In a center with established experience in single-valve minimally invasive surgery, multivalve procedures can be safely extended to a right minithoracotomy approach, with low perioperative morbidity and no early mortality despite operative times reflecting the early learning curve. Full article

Leptolegnia chapmanii is an oomycete pathogen of mosquito larvae. We investigated whether nutritional factors promoting cyst germination in vitro are associated with early infection events and instar-specific susceptibility in Aedes aegypti. Cysts of the Brazilian isolate ARSEF 12829 germinated rapidly in soybean seed extract, sunflower seed extract and minimal medium supplemented with yeast extract, whereas basal minimal medium did not promote germination. In sunflower seed extract, germination increased significantly with incubation time; in minimal medium, germination at 24 h was much higher with ≥0.2% yeast extract than with 0.1%. In third-instar larvae, a few cysts attached to the cuticle during the first 30–60 min, with no external germ tubes observed. At 3 h, melanized hyphal structures were detected in the midgut, and histological sections showed germinated and ungerminated cysts in the endoperitrophic space, with hyphae crossing the peritrophic matrix and midgut epithelium toward the hemocoel. Mortality increased with cyst concentration and exposure time and decreased with larval instar. At 3.3 × 10³ cysts/mL, final mortality reached 100% in L1–L3 and 91.2% in L4 larvae. These results link rapid cyst germination with early midgut invasion and high larvicidal activity. Full article

Background: Invasive Haemophilus influenzae type b (Hib) infection in children has become rare following the introduction of highly effective conjugate vaccines under national immunisation programmes. However, breakthrough invasive infections in fully immunised individuals can still occur. We report a case of invasive Hib infection presenting as epiglottitis and bacteraemia in a fully vaccinated 5-year-old boy in regional Queensland, Australia. Case presentation: The child, with no history of immunodeficiency, presented with a 3-day history of fever, progressive throat pain and reduced oral intake. Subsequent investigations revealed leukocytosis with left shift, markedly elevated C-reactive protein, and radiographic features consistent with epiglottitis. Blood culture grew H. influenzae type b. He was treated with intravenous cefotaxime and made a full recovery without complications. Immunological evaluation demonstrated Hib-specific IgG levels consistent with prior vaccinations, with normal immunoglobulin and lymphocyte profiles supporting the absence of immunodeficiency. Whole-genome sequencing of the isolate identified sequence type 6, a known circulating strain, and duplication of the capsule (cap-b) locus which has been associated with increased capsular polysaccharide production and reduced susceptibility to immune-mediated clearance. Conclusions: This case demonstrates that invasive Hib disease can occur in fully vaccinated, immunocompetent individuals and highlights the need for continued clinical vigilance. Pathogen-related factors, such as cap-b locus duplication, may reduce the effectiveness of the immune response. Despite this, immunisation can still confer partial protection, potentially contributing to the relatively mild clinical course. Ongoing surveillance and detailed microbiological investigation are essential to better understand and monitor vaccine breakthrough infections. Full article

Background: Healthcare-associated infections (HAIs) and antimicrobial resistance are major global public health challenges, influenced by patient clinical complexity and prescribing practices. Methods: Three-point prevalence surveys (PPSs) were conducted (P1: November 2024; P2: June 2025; P3: November 2025), involving 456 patients at the University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy. Results: The prevalence of HAIs fluctuated between 3.1% (P1) and a peak of 6.1% (P2), before decreasing to 1.9% (P3), correlating with the presence of multidrug-resistant pathogens in critical care areas. The prevalence of antibiotic use remained stable (~48%), with a decrease in carbapenem use (from 12% to 9%). A decline in ‘unknown’ McCabe scores from 24.6% to 6.8% (p < 0.001) was also observed, suggesting an improvement in completeness of prognostic data, although changes in data collection practices may also have contributed to this change. Conclusions: We showed an association between clinical severity, prolonged hospitalization, invasive device use, and infection risk in a single tertiary-care hospital, within an exploratory, cross-sectional framework. Despite high healthcare pressure, improvements were observed in antimicrobial stewardship and clinical surveillance. Future strategies should focus on optimal device management and on extending surveillance activities to medical wards with increasing patient complexity. Full article

Background: Fractures of the upper cervical spine are challenging to treat due to their proximity to critical neurovascular structures and the need for immediate, stable fixation. Open posterior fixation remains the standard but is associated with soft-tissue disruption and morbidity. Minimally invasive, navigation-assisted pedicle screw fixation represents a viable alternative for older populations, significantly reducing surgical morbidity and tissue trauma. The present study evaluates the accuracy, safety, and perioperative outcomes of minimally invasive navigated posterolateral C1–C2 fixation. Methods: We conducted a retrospective consecutive case review of 51 patients who underwent minimally invasive C1–C2 screw fixation between 2019 and 2024. All procedures were performed using intraoperative O-arm imaging and StealthStation S8 navigation. Screw placement accuracy was assessed using the Bredow modification of the Gertzbein–Robbins and Heary classifications. Perioperative data, including operative time, screw dimensions, radiation dose, complications, and hospital stay, were recorded. Results: Fifty-one patients were included in the study. A total of 212 screws were placed. According to Gertzbein–Robbins grading, 92.4% were Grade A, 6.6% were Grade B, and 1% were Grade C. According to Heary grading, 95% were Grade I and 5% were Grade III. No vertebral artery injuries, new neurological deficits, or intraoperative hardware failures occurred. The mean screw lengths were 33.2 mm (SD = 3.38 mm) (C1) and 32 mm (SD = 4.30 mm) (C2). The mean operative time was 128 min (SD = 52.95 min). The mean radiation dose was 629.16 mGy·cm² (SD = 372.2 mGy·cm²). One superficial wound infection occurred. The median postoperative NRS was 4 (IQR: 4–5). The mean hospital stay was 4.21 (SD = 3.77) days. Conclusions: Our findings demonstrate that the presented approach for C1–C2 fixation is a highly accurate and safe alternative to open posterior fixation for upper cervical fractures. Full article