Search Results (1,649)

Purpose: The present study aims to evaluate alterations in the peripapillary retinal nerve fiber layer (RNFL) thickness in pediatric patients following surgical resection of childhood-onset craniopharyngioma (CP) and to identify tumor characteristics and other factors influencing these alterations, including changes in the lesion’s location. Design: retrospective clinical cohort study. Methods: A retrospective analysis was conducted on 73 eyes from 38 patients with CP and 64 eyes from 32 age- and sex-matched healthy controls. The mean age of the CP patients was 10.3 ± 4.2 years (range 4–17), while the control group had a mean age of 10.5 ± 3.1 years (range 4–17). Optical coherence tomography (OCT) was used to assess the peripapillary RNFL thickness in the study and control groups. RNFL thickness was analyzed in the superior, inferior, and average sectors, as well as across eight optic nerve sectors. Tumor characteristics were evaluated to determine their correlation with changes in RNFL thickness in individual sectors. Results: Postoperative thickness of peripapillary RNFL in all individual sectors was significantly reduced in the CP group compared to healthy controls. Location, tumor volume, maximum tumor diameter, calcification, ventriculoperitoneal shunt, surgery technique, total resection, presence of Rosenthal fibers, and reoperation due to progression or recurrence correlated with damage to RNFL. Conclusions: CP is associated with significant reductions in RNFL thickness, indicating the tumor’s impact on optic nerve fibers. OCT is a valuable tool for monitoring visual pathway impairment and postoperative outcomes. Correlations between RNFL thickness in individual sectors and clinical parameters may offer valuable insights for diagnosis and monitoring, underlining their potential role in predicting visual outcomes. Regular RNFL evaluation should be integrated into the long-term care of CP patients to optimize visual prognosis and detect progressive or residual damage. Full article

Background/Objectives: Pulmonary typical carcinoid (TC) is a rare type of primary neuroendocrine neoplasm of the lung with indolent behavior and a good prognosis. The main treatment strategy is surgery, the extent of which is controversial given the nature of the disease. The aim of this study is to assess whether the extent of resection influences survival and recurrence in patients undergoing lung resection and lymphadenectomy for TC and to investigate negative prognostic factors for OS. Methods: A single-centre retrospective study of 15 years’ experience was conducted. Data from all patients who underwent lung resection and lymphadenectomy for TC were collected. Patients were divided into two groups: anatomical and non-anatomical resections. Perioperative and long-term oncological results were analyzed. Results: In total, 115 patients were surgically treated for TC, of whom 83 (72%) underwent anatomical resection and 32 (28%) non-anatomical resection. Univariate analyses showed that age, left lower lobe, and many comorbidities had a detrimental effect on OS, whereas on multivariate analysis, only left lower lobe location and a high Charlson–Deyo comorbidity index (CCI) were confirmed as negative prognostic factors for OS. At a median follow-up of 93 months (IQR 57-129), the OS survival curves show a slightly lower trend for non-anatomical resections (p 0.152), while no differences were found for DFS. Conclusions: The results of this study confirm that in selected patients at risk for major resections, non-anatomical resection can be used to treat TC when R0 is achievable. These data, together with evidence from the literature, highlight the importance of patient-centred care in this rare disease. Full article

Background/Objectives: Improving health outcomes for Indigenous people by strengthening the cultural safety of care is a vital challenge for the health sector. University Departments of Rural Health (UDRH), academic centres based in regional, rural, and remote (RRR) locations across Australia, are uniquely positioned to foster a culturally safe rural health workforce through training, education, and engagement with Indigenous communities. This narrative review examines the contributions of UDRHs to health workforce issues through analysis of their publications focused on Indigenous health. Methods: Research articles relating to workforce were identified from an established database of UDRH Indigenous health-related publications published 2010–2021. Results: Of 46 articles identified across the 12 years, 19 focused on developing the understanding and cultural safety skills of university students studying in a health field, including campus-based Indigenous health education and support for students undertaking rural clinical placements. Twelve articles investigated cultural safety skills and recruitment and retention of the rural health workforce. Fifteen articles focused on Indigenous people in the health workforce, examining clinical training and resources, and the enablers and barriers to retaining Indigenous students and workers. Conclusions: This analysis highlights the sustained efforts of UDRHs to improve Indigenous health through multiple areas within their influence, including curriculum design, health student training on campus, and rural placement opportunities to transform understanding of Indigenous strengths and disadvantages and rural health workforce development. A continuing effort is needed on ways UDRHs can support Indigenous health students during their studies and while on placement, how to improve cultural safety in the health workforce, and ways to better support Indigenous health professionals. Full article

Background/Objectives: Posterior inferior cerebellar artery (PICA) aneurysms are one of the most difficult cerebrovascular lesions to treat and account for 0.5–3% of all intracranial aneurysms. They have deep anatomical locations, broad-neck configurations, high perforator density, and a close association with the brainstem, which creates considerable technical challenges for either microsurgical or endovascular treatment. Despite its acceptance as the standard of care for most posterior circulation aneurysms, PICA aneurysms are often associated with flow diversion using a coil or flow diversion due to incomplete occlusions, parent vessel compromise and high rate of recurrence. This case aims to describe the utility of microsurgical clipping as a durable and definitive option demonstrating the value of tailored surgical planning, preservation of anatomy and ancillary technologies for protecting a genuine outcome in ruptured PICA aneurysms. Methods: A 66-year-old male was evaluated for an acute subarachnoid hemorrhage from a ruptured and broad-necked fusiform left PICA aneurysm at the vertebra–PICA junction. Endovascular therapy was not an option due to morphology and the center of the recurrence; therefore, a microsurgical approach was essential. A far-lateral craniotomy with a partial C1 laminectomy was carried out for proximal vascular control, with careful dissection of the perforating arteries and precise clip application for the complete exclusion of the aneurysm whilst preserving distal PICA flow. Results: Post-operative imaging demonstrated the complete obliteration of the aneurysm with unchanged cerebrovascular flow dynamics. The patient had progressive neurological recovery with no new cranial nerve deficits or ischemic complications. Long-term follow-up demonstrated stable aneurysm exclusion and full functional independence emphasizing the sustainability of microsurgical intervention in challenging PICA aneurysms. Conclusions: This case intends to highlight the current and evolving role of microsurgical practice for treating posterior circulation aneurysms, particularly at a time when endovascular alternatives are limited by anatomy and hemodynamics. Advances in artificial intelligence cerebral aneurysm rupture prediction, high-resolution vessel wall imaging, robotic-assisted microsurgery and new generation flow-modifying implants have the potential to revolutionize treatment paradigms by embedding precision medicine principles into aneurysm management. While the discipline of cerebrovascular surgery is expanding, it can be combined together with microsurgery, endovascular technologies and computational knowledge to ensure individualized, durable, and minimally invasive treatment options for high-risk PICA aneurysms. Full article

In response to the European Union’s revised Urban Wastewater Treatment Directive, which mandates enhanced monitoring and advanced treatment of micropollutants, this study was conducted. It took place within the Coastal Landscape Park (CLP), a Natura 2000 protected area in northern Poland. The focus was on the municipal wastewater treatment plant in Jastrzębia Góra, located in a region exposed to seasonal tourist pressure and discharging effluent into the Czarna Wda River. A total of 90 wastewater samples were collected during five monitoring campaigns (July, September 2021; February, May, July 2022) and analysed for 13 pharmaceuticals and personal care products (PPCPs) using ultra-high-performance liquid chromatography tandem mass spectrometry with electrospray ionisation (UHPLC-ESI-MS/MS). The monitoring included both untreated (UTWW) and treated wastewater (TWW) to assess the PPCP removal efficiency and persistence. The highest concentrations in the treated wastewater were observed for metoprolol (up to 472.9 ng/L), diclofenac (up to 3030 ng/L), trimethoprim (up to 603.6 ng/L) and carbamazepine (up to 2221 ng/L). A risk quotient (RQ) analysis identified diclofenac and LI-CBZ as priority substances for monitoring. Multivariate analyses (PCA, HCA) revealed co-occurrence patterns and seasonal trends. The results underline the need for advanced treatment solutions and targeted monitoring, especially in sensitive coastal catchments with variable micropollutant presence. Full article

The precise characterization of surface rupture zones and associated co-seismic displacement fields from large earthquakes provides critical insights into seismic rupture mechanisms, earthquake dynamics, and hazard assessments. Stereo-photogrammetric digital elevation models (DEMs), produced from high-resolution satellite stereo imagery, offer reliable global datasets that are suitable for the detailed extraction and quantification of vertical co-seismic displacements. In this study, we utilized pre- and post-event WorldView-2 stereo images of the 2024 Ms7.1 Wushi earthquake in Xinjiang to generate DEMs with a spatial resolution of 0.5 m and corresponding terrain point clouds with an average density of approximately 4 points/m². Subsequently, we applied the Iterative Closest Point (ICP) algorithm to perform differencing analysis on these datasets. Special care was taken to reduce influences from terrain changes such as vegetation growth and anthropogenic structures. Ultimately, by maintaining sufficient spatial detail, we obtained a three-dimensional co-seismic displacement field with a resolution of 15 m within grid cells measuring 30 m near the fault trace. The results indicate a clear vertical displacement distribution pattern along the causative sinistral–thrust fault, exhibiting alternating uplift and subsidence zones that follow a characteristic “high-in-center and low-at-ends” profile, along with localized peak displacement clusters. Vertical displacements range from approximately 0.2 to 1.4 m, with a maximum displacement of ~1.46 m located in the piedmont region north of the Qialemati River, near the transition between alluvial fan deposits and bedrock. Horizontal displacement components in the east-west and north-south directions are negligible, consistent with focal mechanism solutions and surface rupture observations from field investigations. The successful extraction of this high-resolution vertical displacement field validates the efficacy of satellite-based high-resolution stereo-imaging methods for overcoming the limitations of GNSS and InSAR techniques in characterizing near-field surface displacements associated with earthquake ruptures. Moreover, this dataset provides robust constraints for investigating fault-slip mechanisms within near-surface geological contexts. Full article

Background/Objectives: Violence is a significant occupational health issue for paramedics, yet underreporting limits efforts to identify and mitigate risk. Leveraging a novel, point-of-event violence reporting system, we aimed to identify characteristics of 9-1-1 calls associated with an increased risk of violence in a single paramedic service in Ontario, Canada. Methods: We retrospectively analyzed all electronic violence and patient care reports filed by paramedics in Peel Region and used logistic regression to identify call-level predictors of any violence and, more specifically, physical or sexual assault. Results: In total, 374 paramedics filed 974 violence reports, 40% of which documented an assault, corresponding to a rate of 4.18 violent encounters per 1000 9-1-1 calls. In adjusted models, the risk of violence was elevated for calls originating from non-residential locations (e.g., streets, hotels, bars), occurring during afternoon or overnight shifts, and involving young or working-age males. Presenting problems related to intoxication, mental health, or altered mental status were strongly associated with increased risk, with particularly high adjusted odds ratios for assault. Conclusions: These findings support the utility of near-miss and violence surveillance systems and highlight the need for multidisciplinary crisis response to high-risk calls, especially those involving mental health or substance use. Full article

The Paratethyan South Caspian and Mediterranean Levant basins relate to the significant hydrocarbon provinces of Eurasia. The giant hydrocarbon reserves of the SCB are well-known. Within the LB, so far, only a few commercial gas fields have been found. Both the LB and SCB contain some geological peculiarities. These basins are highly complex tectonically and structurally, requiring a careful, multi-component geological–geophysical analysis. These basins are primarily composed of oceanic crust. The oceanic crust of both the South Caspian and Levant basins formed within the complex Neotethys ocean structure. However, this crust is allochthonous in the Levant Basin (LB) and autochthonous in the South Caspian Basin (SCB). This study presents a comprehensive comparison of numerous tectonic, geodynamic, morphological, sedimentary, and geophysical aspects of these basins. The Levant Basin is located directly above the middle part of the massive, counterclockwise-rotating mantle structure and rotates accordingly in the same direction. To the north of this basin is located the critical latitude 35° of the Earth, with the vast Cyprus Bouguer gravity anomaly. The LB contains the most ancient block of oceanic crust on Earth, which is related to the Kiama paleomagnetic hyperzone. On the western boundary of the SCB, approximately 35% of the world’s mud volcanoes are located; the geological reasons for this are still unclear. The low heat flow values and thick sedimentary layers in both basins provide opportunities to discover commercial hydrocarbon deposits at great depths. The counterclockwise-rotating mantle structure creates an indirect geodynamic influence on the SCB. The lithospheric blocks situated above the eastern branch of the mantle structure trigger a north–northeastward movement of the western segment of the Iranian Plate, which exhibits a complex geometric configuration. Conversely, the movement of the Iranian Plate induced a clockwise rotation of the South Caspian Basin, which lies to the east of the plate. This geodynamic ensemble creates an unstable geodynamic situation in the region. Full article

Background/Objectives: The COVID-19 pandemic disrupted global cancer care. This study compared gastric cancer surgical outcomes before and during the pandemic in Turkey. We also aimed to analyze the impact of the pandemic and factors on survival and mortality in gastric cancer patients. Materials and Methods: This retrospective, multicenter cohort study included 324 patients from three tertiary centers in Turkey who underwent gastric cancer surgery between January 2018 and December 2022. Patients were stratified into Pre-COVID-19 (n = 150) and COVID-19 Era (n = 174) groups. Comprehensive demographic, surgical, pathological, and survival data were analyzed. To identify factors independently associated with postoperative mortality, a multivariable logistic regression model was applied. For evaluating predictors of long-term survival, multivariable Cox proportional hazards regression analysis was conducted. Results: The median time from diagnosis to surgery was comparable between groups, while the time from surgery to pathology report was significantly prolonged during the pandemic (p = 0.012). Laparoscopic surgery (p = 0.040) and near-total gastrectomy (p = 0.025) were more frequently performed in the Pre-COVID-19 group. Although survival rates between groups were similar (p = 0.964), follow-up duration was significantly shorter in the COVID-19 Era (p < 0.001). Comparison between survivor and non-survivor groups showed that several variables were significantly associated with mortality, including larger tumor size (p < 0.001), greater number of metastatic lymph nodes (p < 0.001), elevated preoperative CEA (p = 0.001), CA 19-9 (p < 0.001), poor tumor differentiation (p = 0.002), signet ring cell histology (p = 0.003), lymphovascular invasion (p < 0.001), and perineural invasion (p < 0.001). Multivariable logistic regression identified total gastrectomy (OR: 2.14), T4 tumor stage (OR: 2.93), N3 nodal status (OR: 2.87), and lymphovascular invasion (OR: 2.87) as independent predictors of postoperative mortality. Cox regression analysis revealed that combined tumor location (HR: 1.73), total gastrectomy (HR: 1.56), lymphovascular invasion (HR: 2.63), T4 tumor stage (HR: 1.93), N3 nodal status (HR: 1.71), and distant metastasis (HR: 1.74) were independently associated with decreased overall survival. Conclusions: Although gastric cancer surgery continued during the COVID-19 pandemic, some delays in pathology reporting were observed; however, these did not significantly affect the timing of adjuvant therapy or patient outcomes. Importantly, pandemic timing was not identified as an independent risk factor for mortality in multivariable logistic regression analysis, nor for survival in multivariable Cox regression analysis. Instead, tumor burden and aggressiveness—specifically advanced stage, lymphovascular invasion, and total gastrectomy—remained the primary independent determinants of poor prognosis. While pandemic-related workflow delays occurred, institutional adaptability preserved oncologic outcomes. Full article

The genus Datura L. has pharmacological activities due to its source of bioactive compounds. The effects of bioactive compounds can vary depending on species, geographical location, and environmental conditions. The purpose of this review is to summarize the most recent progress and to provide a comprehensive overview of studies concerning genetic alteration and bioactive compounds in the genus Datura, based on Scopus publications between 2015 and 2025. Throughout history, the genus Datura (Solanaceae) contains nine species of medicinal plants. A key component of elucidating the diversification process of congeneric species is identifying the factors that encourage species variation. A comparative gene family analysis provides an understanding of the evolutionary history of species by identifying common genetic/genomic mechanisms that are responsible for species responses to biotic and abiotic environments. The diverse range of bioactive compounds it contains contributes to its unique bioactivity. Datura contains tropane alkaloids (such as hyoscyamine and scopolamine), datumetine, withametelin, daturaolone, and atropine. Several compounds have been isolated and refined for use in treating various conditions as a result of recent progress in therapeutic development. Daturaolone, for example, is used to treat certain neurological disorders. In addition to providing renewed opportunities for the discovery of new compounds, these advancements also provide insights into the genetic basis for their biosynthesis. Our discussion also includes pitfalls as well as relevant publications regarding natural products and their pharmacological properties. The pace of discovery of bioactive compounds is set to accelerate dramatically shortly, owing to both careful perspectives and new developments. Full article

Smart home technology enhances the quality of life, particularly with respect to in-home care and health monitoring. While video-based methods provide accurate behavior analysis, privacy concerns drive interest in non-visual alternatives. This study proposes a Bluetooth Low Energy (BLE)-enabled indoor positioning and behavior recognition system, integrating machine learning techniques to support sustainable and privacy-preserving health monitoring. Key optimizations include: (1) a vertically mounted Data Collection Unit (DCU) for improved height positioning, (2) synchronized data collection to reduce discrepancies, (3) Kalman filtering to smooth RSSI signals, and (4) AI-based RSSI analysis for enhanced behavior recognition. Experiments in a real home environment used a smart wristband to assess BLE signal variations across different activities (standing, sitting, lying down). The results show that the proposed system reliably tracks user locations and identifies behavior patterns. This research supports elderly care, remote health monitoring, and non-invasive behavior analysis, providing a privacy-preserving solution for smart healthcare applications. Full article

The largest Eurasian rodent, the Eurasian beaver Castor fiber, is known for its amphibious lifestyle that allows it to adapt its environment to its needs. Due to its lifestyle and evolutionary history, the beaver is characterized by a distinct, unique parasitofauna. In this context, the occurrence of mites from the Demodecidae family in the Eurasian beaver was investigated. The topography of the Demodex castoris was analyzed: it was previously known from a single record from a single skin location of this host. The mite was found in large numbers in various locations in the hairy skin, including the head, trunk, and limbs. In addition, a new species associated with hairless skin, mainly around the mouth, was discovered and described: Demodex ovaportans sp. nov. The females of this species carry the egg on the dorsal side of the podosoma, which may be a form of care and a previously unknown reproductive strategy in Demodecidae. Our findings confirm that a host-specific demodecid mite species associated with the hairy skin of the entire body is a universal model in mammals. They also emphasize the uniqueness of the beaver parasitofauna, as evidenced by the host specificity and the different biology of the demodecids described in it. Full article

Background/Objective: Precise aneurysm volume measurement offers a transformative edge for risk assessment and treatment planning in clinical settings. Currently, clinical assessments rely heavily on manual review of medical imaging, a process that is time-consuming and prone to inter-observer variability. The widely accepted standard of care primarily focuses on measuring aneurysm diameter at its widest point, providing a limited perspective on aneurysm morphology and lacking efficient methods to measure aneurysm volumes. Yet, volume measurement can offer deeper insight into aneurysm progression and severity. In this study, we propose an automated approach that leverages the strengths of pre-trained neural networks and expert systems to delineate aneurysm boundaries and compute volumes on an unannotated dataset from 60 patients. The dataset includes slice-level start/end annotations for aneurysm but no pixel-wise aorta segmentations. Method: Our method utilizes a pre-trained UNet to automatically locate the aorta, employs SAM2 to track the aorta through vascular irregularities such as aneurysms down to the iliac bifurcation, and finally uses a Long Short-Term Memory (LSTM) network or expert system to identify the beginning and end points of the aneurysm within the aorta. Results: Despite no manual aorta segmentation, our approach achieves promising accuracy, predicting the aneurysm start point with an R² score of 71%, the end point with an R² score of 76%, and the volume with an R² score of 92%. Conclusions: This technique has the potential to facilitate large-scale aneurysm analysis and improve clinical decision-making by reducing dependence on annotated datasets. Full article

Introduction: Air pollution is a risk factor for a variety of cardiopulmonary diseases and is a contributing factor to cancer, diabetes, and cognitive impairment. The impact on mortality is not clearly elucidated. Objectives: The goal of this study is to determine the impact (if any) of air pollution on the 5-year mortality of patients in the American Family Cohort (AFC) dataset. Methods: The AFC dataset is derived from the American Board of Family Medicine PRIME Registry electronic health record data. It includes longitudinal information from 6.6 million unique patients from an estimated 800 primary care practices across 47 states, with 40% coming from rural areas. The Environmental Protection Agency’s Air Quality Index (AQI) measures were downloaded for the study period (2016–2022). Using the Python library pandas, the AFC and EPA datasets were merged with respect to date, time, and location. Cox Regression Models were performed on the merged dataset to determine the impact (if any) of air quality on patients’ five-year survival. In the model, AQI was handled as a time-independent (time-fixed) covariate. Results: The group with AQI > 50 had an adjusted hazard of death that was 4.02 times higher than the hazard of death in the group with AQI ≤ 50 (95% CI: 3.36, 4.82, p < 0.05). The hazard of death was 6.73 times higher in persons older than 80 years of age (95% CI: 5.47, 8.28; p < 0.05) compared to those younger than 80 years of age. Black/African American patients had a 4.27 times higher hazard of death (95%CI: 3.47, 5.26; p < 0.05) compared to other races. We also found that regional effects played a role in survival. Conclusions: Poor air quality was associated with a higher hazard of mortality, and this phenomenon was particularly pronounced in Black/African American patients and patients older than 80 years of age. Air pollution is an important social determinant of health. Public health initiatives that improve air quality are necessary to improve health outcomes. Full article

Background/Objectives: Pressure injuries (PIs), a recognized indicator of care quality, have a higher incidence in intensive care units (ICUs). Our objective was to assess whether critically ill patients identified as “unprotected” (COMHON ≥ 11) developed pressure injuries despite additional preventive measures. Methods: A historical cohort study of an adult ICU was carried out. Of the 811 patients admitted in 2022, 400 were selected. All of them were subjected to the ICU’s PI Prevention Protocol, and those with a moving average of the COMHON Index ≥ 11 were given two additional measures: a multilayer dressing on the sacrum, and anti-equinus and heel-pressure-relieving boots. Results: A total of 36 patients presented with PIs (cumulative incidence of 9%). Significant differences were observed in their mean length of stay and in their disease severity score (APACHE-II). Most of the PIs were located on the sacrum, followed by the heel. Prior to the appearance of the PIs, a sacral dressing was applied to 100% of the patients, while anti-equinus and heel-pressure-relieving boots were only applied to 58.3%. Of the 36 patients with PIs, 52.8% had a PI on the sacrum and 22.2% on the heel. Conclusions: Focusing only on those who presented with PIs, we observed that the considered measures were not effective for preventing PIs in all the patients. Not all PIs are preventable, and individual risk factors should be considered. In the future, we will analyze the individual characteristics of these patients and verify whether the Prevention Protocol was followed, in order to determine how they could have been prevented or whether they were so-called unavoidable PIs. Full article