Search Results (2,093)

Background: Endoscopic resection has become a standard curative treatment for superficial esophageal cancer. However, limited data are available regarding long-term outcomes and causes of death after curative endoscopic treatment, particularly deaths unrelated to the primary esophageal cancer. This study aimed to clarify post-treatment prognosis and to identify factors associated with mortality in patients with superficial esophageal cancer who underwent curative endoscopic resection. Methods: We conducted a multicenter cohort study in Japan to evaluate survival outcomes, causes of death, and prognostic factors in patients with superficial esophageal cancer who achieved curative resection by endoscopic treatment. Patients were stratified according to endoscopic treatment indication categories (absolute, relative, and beyond indication). Five-year overall survival and disease-specific survival were analyzed, along with risk factors for all-cause and cause-specific mortality. Results: No disease-specific deaths were observed in patients with absolute or relative indication lesions, whereas the disease-specific 5-year survival rate was 81% in patients with beyond-indication lesions. When overall mortality, including deaths from other diseases and other malignancies, was evaluated, the 5-year survival rates were 92% for absolute indication cases, 85% for relative indication cases, and 69% for beyond-indication cases. Multivariate analysis identified low body mass index (BMI) and advanced age as independent risk factors for mortality. Notably, low BMI was significantly associated with non-cancer-related death. Conclusions: Even among patients who achieve curative endoscopic treatment for superficial esophageal cancer, long-term survival is limited by deaths from other malignancies and non-cancer-related causes. Low BMI represents a clinically important prognostic factor, underscoring the need for comprehensive post-treatment surveillance and supportive care beyond cancer control. Full article

Introduction: Pre-eclampsia (PE) is a pregnancy-related hypertensive condition defined by the onset of hypertension after 20 weeks of gestation that is associated with proteinuria and maternal organ damage or uteroplacental dysfunction. It continues to be a leading cause of maternal and perinatal morbidity and mortality globally. PE is linked to systemic inflammation, endothelial dysfunction, and oxidative stress, which may compromise hepatic function. Aim: This meta-analysis assesses the impact of PE on maternal liver function by evaluating hepatic biomarkers, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and total serum bilirubin. Methods: This meta-analysis of observational studies in Epidemiology (MOOSE) involved a search of PubMed and Scopus and manual screening of studies published between 2000 and 2025. Eligible studies included cross-sectional, case–control, and cohort designs. The quality of the studies was evaluated using the Newcastle–Ottawa Scale. Statistical analysis was conducted using the online meta-analysis, Jamovi version 2.6.44, and IBM SPSS Statistics version 30, and effect estimates were reported as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Results: Forty-five studies, comprising 257,929 women 9420 with PE; 248,509 normotensive, were included. Women with PE had elevated AST, MD = 1.81 (95% CI: 1.51 to 2.10; p < 0.0001) and ALT, SMD = 1.73 (95% CI: 1.38 to 2.07; p < 0.0001); ALP, SMD = 1.43 (95% CI: 0.97 to 1.88; p < 0.0001); and total serum bilirubin (TSB), SMD = 0.62 (95% CI: 0.36 to 0.88; p < 0.0001) in comparison to normotensive controls. In the meta-regression, maternal age and quality were significant moderators, with older age and high-quality studies associated with smaller and larger effect sizes, respectively, for ALP (β = −0.720 and β = 1.444) and TSB (β = −0.304 and β = 0.761). For every 1-unit increase in body mass index, there was a significant 0.406-unit decrease in ALT effect size. Conclusions: PE is significantly associated with elevated maternal hepatic enzyme levels, indicating hepatocellular damage and impaired liver function. These findings emphasise the necessity for routine liver function monitoring in pregnant women with hypertensive disorders. Full article

In the summer of 2022, a massive toxic algal bloom of the haptophyte Prymnesium parvum devastated the Oder River in Poland and Germany. Between the end of July and the beginning of September, an estimated hundred thousand fish, mussels, and aquatic snails died. Since then, Prymnesium parvum has been established in the river network, as confirmed by monthly sampling, and there is the potential that such a catastrophe could repeat itself. Here, we report the occurrence of an apparently non-toxic bloom of the ‘golden algae’ Prymnesium parvum in May and June 2024 at comparable abundances to the ones observed during 2022, with a maximum abundance of 120,000 cell equivalents (CE)/mL in the main stem river without any associated fish deaths. Interestingly, in July 2024, local blooms in the West Oder even exceeded these abundances (160,000 CE/mL). The main-stem abundances decreased to 850–4250 CE/mL in July and 5–500 CE/mL in August. During the bloom, no mass mortalities of aquatic organisms were reported despite high abundances. Nutrients (total nitrogen TN, total phosphorus TP, N:P ratio) were inconspicuous and comparable to the disaster in 2022. To our knowledge, this is the first record of a massive Prymnesium bloom that did not result in mass fish deaths. Full article

Thoracoabdominal aortic aneurysms (TAAAs) are rare and often remain asymptomatic until rupture, leading to high morbidity and mortality. Elastin degradation, largely mediated by matrix metalloproteinases (MMPs), plays a central role in their pathogenesis. This study aimed to evaluate plasma desmosine (pDES), a specific biomarker of elastin breakdown, as a non-invasive tool for TAAA detection and risk stratification. In a prospective single-centre case–control study, 30 patients with TAAA and 30 age- and sex-matched controls were enrolled. Plasma pDES levels were quantified using liquid chromatography–tandem mass spectrometry (LC–MS/MS). Aortic wall samples from 12 patients were analysed for elastic fibre content and MMP expression by histology and western blotting. Statistical analyses included correlation testing, propensity score matching, and receiver operating characteristic (ROC) analysis. TAAA patients exhibited significantly higher pDES levels compared with controls (0.40 ± 0.31 vs. 0.22 ± 0.15 ng/mL; p < 0.001). pDES correlated positively with MMP-2 (ρ = 0.68, p = 0.02), TIMP-1 (ρ = 0.72, p = 0.01), and the proportion of elastic fibres in the aortic media (ρ = 0.61, p = 0.03). ROC analysis showed good diagnostic performance (AUC = 0.82), with a threshold of 0.27 ng/mL yielding 78.6% sensitivity and 76.7% specificity. Elevated pDES levels reflect aortic elastolytic activity and may serve as a promising biomarker for TAAA detection and risk assessment. Full article

Background: Dynapenia refers to the age-related decline in muscle strength that occurs even when muscle mass is preserved. It has become an important issue in older adults because reduced strength is strongly linked to many negative health outcomes. When dynapenia occurs together with obesity—referred to as dynapenic obesity or dynapenic abdominal obesity—the risks, including mortality, falls, and the development of multiple chronic conditions, appear to increase even further. This umbrella review aimed to bring together and summarize existing systematic reviews and meta-analyses that examined how dynapenia and its obesity-related subtypes are associated with mortality, falls, and multimorbidity among community-dwelling older adults. Methods: Following PRISMA 2020 and JBI guidelines, six major databases and search engines (PubMed, Embase, Cochrane Library, Scopus, CINAHL, and Airiti Library) were searched from their inception to October 2025. Systematic reviews and meta-analyses involving adults aged 60 years and older and reporting quantitative results on the relationships between dynapenia-related conditions and adverse health outcomes were included. The methodological quality of each review was evaluated using AMSTAR 2, and the certainty of evidence was assessed with the GRADE approach. This umbrella review followed the PRIOR framework and was reported according to PRISMA 2020. The protocol for this review was registered in PROSPERO (ID: CRD 42023415232). Results: A total of four systematic reviews and meta-analyses were included, covering more than 73,000 community-dwelling older adults. The pooled data showed that dynapenic obesity significantly increased the risk of all-cause mortality, with hazard ratios ranging from 1.50 (95% CI 1.14–1.96) to 1.73 (95% CI 1.38–2.16). Dynapenic abdominal obesity was also strongly linked to falls, with pooled estimates ranging from HR = 1.82 (95% CI 1.04–3.17) to RR = 6.91 (95% CI 5.42–8.80). For multimorbidity, older adults with dynapenia had 1.38 times higher odds of having two or more chronic diseases than those without dynapenia (OR = 1.38, 95% CI 1.10–1.72). Based on the GRADE evaluation, the certainty of evidence was moderate for mortality and falls and low for multimorbidity. Conclusions: Overall, the findings indicate that dynapenia and its obesity-related forms meaningfully increase the risks of mortality, falls, and multimorbidity among community-dwelling older adults. Importantly, these results position dynapenia not merely as a musculoskeletal condition, but as a clinically relevant marker of aging-related vulnerability. This underscores the need for early screening of muscle strength alongside obesity-related indicators, as well as the development of integrated preventive strategies that combine strength-oriented interventions with obesity management in older populations. Full article

Background: Protein–energy wasting (PEW) is a major predictor of morbidity and mortality in patients with chronic kidney disease (CKD), even before the initiation of dialysis. Its multifactorial pathogenesis includes reduced dietary intake, chronic inflammation, metabolic acidosis, hormonal disturbances, and dysbiosis of the gut microbiota. Early recognition and targeted management are crucial for preventing muscle loss, functional decline, and adverse outcomes. Methods: This narrative review summarises and integrates current evidence from the literature on nutritional and metabolic interventions to prevent and treat protein–energy wasting in patients with nondialysis chronic kidney disease. Relevant clinical trials, meta-analyses, and experimental studies published up to date were evaluated, focusing on dietary strategies, metabolic modulation, physical exercise, and gut microbiome-targeted therapies. Results: Adequate energy and protein intake remain the cornerstone of PEW management, based on available clinical and observational evidence. Individualised diets emphasising high-quality and plant-based proteins, oral nutritional supplements, and ketoanalogues can attenuate muscle wasting. Correction of metabolic acidosis and inflammation enhances protein anabolism and nitrogen balance. Physical exercise acts synergistically with dietary interventions to preserve muscle mass and function. Novel approaches—such as modulating the gut–kidney axis with pre-, pro-, and postbiotics or supplementing with short-chain fatty acids—show promise in improving metabolic and inflammatory profiles. Conclusions: The management of PEW in nondialysis CKD requires a personalised approach that integrates nutrition, physical activity, metabolic correction and microbiome modulation. Early, coordinated intervention may help to slow the progression of CKD and improve patient survival and quality of life. Full article

Background/Objectives: Malnutrition is highly prevalent in patients with acute leukemia and is frequently underrecognized at diagnosis. Traditional screening tools based on anthropometry often fail to identify early nutritional deterioration. This study aimed to evaluate the prognostic utility of a comprehensive morphofunctional assessment—including bioelectrical impedance vector analysis (BIVA), handgrip strength (HGS), and muscle ultrasound—conducted at diagnosis and after induction therapy, to evaluate the prognostic association with 12-month mortality. Methods: In this prospective cohort study, 52 adult patients with newly diagnosed acute leukemia were enrolled between November 2022 and November 2024 at two tertiary hospitals in Málaga, Spain. Nutritional status was determined using GLIM criteria. Morphofunctional assessment included BIVA-derived phase angle (PhA), HGS via dynamometry, and rectus femoris ultrasound. A second evaluation was performed prior to haematopoietic stem cell transplantation. Mortality at 12 months was the primary outcome. Logistic regression and ROC analysis were used to assess prognostic associations. Results: At baseline, 65.4% of patients were classified as malnourished. After three months, patients showed significant declines in PhA (−0.55°, p < 0.001), body cell mass (−3.15 kg, p < 0.01), skeletal muscle mass (−1.66 kg, p < 0.01), and rectus femoris cross-sectional area (−0.36 cm², p = 0.011). Baseline malnutrition (OR = 6.88; 95% CI: 1.17–40.38; p = 0.033) and PhA decline ≥ 0.90° were both independently associated with higher 12-month mortality. Conclusions: Early morphofunctional assessment using GLIM criteria, BIVA, and muscle ultrasound identifies patients at nutritional and functional risk. PhA decline during treatment was associated with higher 12-month mortality, supporting the need for early, personalized nutritional intervention in leukemia care. Full article

Background and Objectives: Autosomal dominant polycystic kidney disease (ADPKD) is a leading cause of end-stage renal disease (ESRD). Progressive renal cyst growth in ADPKD can exert mass effects, including compression of the inferior vena cava (IVC), a rare but clinically significant complication with implications for hemodynamic stability and renal outcomes. This study evaluated the prevalence of IVC compression in ADPKD and its impact on progression to ESRD, mortality, and overall survival. We aimed to provide quantitative measures to elucidate its prognostic significance. Materials and Methods: Using the TriNetX database, we conducted a retrospective cohort study of 658 ADPKD patients with IVC compression, comparing them to unmatched controls without compression. Outcomes included ESRD incidence, mortality, and survival. Kaplan–Meier curves and hazard ratios (HRs) with 95% confidence intervals (CIs) were used for analysis. Results: ESRD Risk: IVC compression was associated with a higher risk of ESRD (77.4% vs. 29.7%, RR: 2.61, 95% CI: 2.49–2.73, p < 0.001). Survival Probability: 5-year Survival was significantly reduced in patients with IVC compression (42.6%) compared to controls (61.7%) (HR: 4.00, 95% CI: 3.45–4.63, p = 0.002). Mortality: Mortality was higher in the compression group (29.2% vs. 9.1%). Combined Impact: ESRD patients with IVC compression had a lower survival rate (11.9%) than ESRD patients without compression (28.5%) (HR: 5.60, 95% CI: 5.12–6.13, p < 0.001). Conclusions: IVC compression in ADPKD is associated with significantly worse outcomes, including increased ESRD risk, higher mortality, and reduced survival. These findings underscore the importance of early diagnosis and targeted management strategies. Full article

The removal of protein-bound uremic toxins (PBUTs) from the blood of kidney failure patients with conventional dialysis is limited. However, as their harmful effects and association with morbidity and mortality in dialysis patients are increasingly recognized, PBUTs have become important therapeutic targets. In this review, PBUT removal with current state-of-the-art dialysis technologies and future perspectives are discussed. Strategies to enhance PBUT clearance include methods that interfere with PBUT–albumin binding, such as chemical displacers, high ionic strength, pH changes, or electromagnetic fields, thereby increasing the free fraction available for dialysis. While these methods have shown promise in vitro, and some also in vivo, long-term safety data are lacking. PBUT removal can also be increased by adsorption, either directly via hemoperfusion, or indirectly, e.g., via sorbents incorporated in a mixed-matrix membrane or dissolved in the dialysate. In the kidney, PBUTs are secreted in the proximal tubules; hence, a cell-based bioartificial kidney (BAK) that secretes PBUTs is proposed as an add-on to current dialysis. Yet both PBUT adsorption strategies and, in particular, BAKs face considerable challenges in upscaling and mass production at acceptable costs. In conclusion, many novel technologies are under development, all requiring further (pre)clinical testing and upscaling before these strategies can be applied in the clinic. Full article

Air pollution has been one of the major threats to public health. The study aimed to determine latent patterns of geographical distribution of health-related air pollutants across the USA and to evaluate real-world cumulative effects of these patterns on public health metrics. It was an ecological study using county-level data on the concentrations of 12 air pollutants over 20 years. Latent class analysis was used to identify the common clusters of life expectancy-associated air pollutants based on their concentration characteristics in the final counties studied (n = 699). Multivariate linear regression analyses were then applied to assess the relationship between the LCA-derived clusters and health measurements with confounding adjustment. We found that PM_2.5 mass, PM₁₀ speciation, and NONO_xNO_y (the reactive nitrogen species) were associated with life expectancy and thus were included in LCA. Among five identified clusters, the one with a more severe pollutant profile was associated with a decreasing life expectancy, an increasing mortality risk among middle-aged and elderly populations (≥45 years), and an increasing mortality rate caused by chronic respiratory conditions, cardiovascular diseases, and neoplasms. Our study brings new perspectives on real-world geographical patterns of air pollution to explain health disparities across the USA. Full article

Under the Eighth Amendment, prisons are legally mandated to provide constitutionally adequate standards of medical care to the incarcerated. But how do we make sense of a carceral structure in which the very delivery of medical care results in preventable death? This article offers a carceral case study of how prison medical care during the era of mass incarceration generates racialized mortality at the Louisiana State Penitentiary, also known as Angola Prison. By analyzing caselaw documents drawn from the docket of Lewis v. Cain, an ongoing lawsuit alleging inadequate medical care at Angola, this article seeks to address the limits of pursuing relief from prison conditions through legal interventions and reforms that are always yet to arrive. Rather than examining prison medical care and preventable death as problems to be reformed, this project aims to develop theoretical insight into how Angola Prison enacts “medical violence” against its captive population. This refers to the use of prison healthcare capacities to harm rather than affirm the lives of the incarcerated. As this case study argues, medical violence operates through organized abandonment, disregard, and carceral extraction, which together extend the life of the prison through the deaths of its captive population. Full article

The fall armyworm (FAW), Spodoptera frugiperda, poses a major threat to global maize production. Reliance on synthetic pesticides has contributed to pest resistance and environmental degradation, underscoring the need for sustainable alternatives. In this study, ethanolic extracts of neem (Azadirachta indica) and moringa (Moringa oleifera), together with maize-associated bacterial isolates, were evaluated for their biocontrol potential against fall armyworm. Gas chromatography-mass spectrometry (GC-MS) analysis for bioextract identification revealed tissue-specific chemical diversity, identifying eight key phytochemicals, including octadecanoic acid, trimethyl fluorosilane, and hexadecanoic acid in neem, and trimethyl fluorosilane, ethyl oleate, ethyl (9Z,12Z), octadecanoic acid, and benzenedicarboxylic acid in moringa extracts. Eighty-nine bacterial isolates were screened for extracellular enzyme activities (cellulase, chitinase, glucanase, and protease) and siderophore production, among which four strains, DR-55 (Bacillus subtilis), HL-7 (Bacillus cereus), HL-37 (Bacillus cereus), and DR-63 (Enterobacter sp.), exhibited >50% biocontrol efficacy under greenhouse conditions. A strong correlation (r = 0.88) was observed between in vitro antagonistic activity and greenhouse performance, validating the screening approach. Fall armyworm mortality was the highest in larvae (up to 80%), moderate in pupae (15–17%), and the lowest in adults (6–7%), respectively. Overall, plant bio-extracts and maize-associated microbial isolates represent a promising, non-hazardous strategy for sustainable fall armyworm management while preserving maize plant health. Full article

Body mass index (BMI) has shown inconsistent associations with outcomes after transcatheter aortic valve replacement (TAVR), and evidence from the Middle Eastern population is limited. This study evaluated whether BMI independently predicts early complications, mortality, or infection following TAVR in a Saudi Arabian cohort. We conducted a retrospective analysis of 197 patients who underwent TAVR between 2015 and 2024, stratified by BMI < 25, 25–29.9, and ≥30 kg/m². The primary endpoint was the in-hospital Valve Academic Research Consortium-3 (VARC-3) composite safety outcome, with secondary outcomes including individual complications, infection, length of stay, and 30-day mortality or readmission. Overall, patients had a mean age of 74.9 ± 8.8 years and 52.3% were female; in-hospital mortality was 2.0%, technical success 99%, and 30-day readmission 12.7%. BMI category was not independently associated with in-hospital complications or mortality, while advanced age ≥ 75 years (adjusted OR 2.52, p = 0.009), moderate Society of Thoracic Surgeons (STS) risk (adjusted OR 3.75, p = 0.008), and high STS risk (adjusted OR 2.26, p = 0.033) independently predicted complications. Overweight patients had higher in-hospital infection rates (14.1% vs. ~3%, p = 0.020). These findings suggest that physiologic vulnerability and operative risk, rather than BMI alone, should guide early TAVR risk assessment. Full article

Background/Objectives: Falls are a leading cause of morbidity and mortality in older adults, even among those who are physically active. This study examined the associations between skeletal muscle mass, muscle strength, and muscle power and fall risk in physically active, community-dwelling older adults. Methods: A cross-sectional analysis was conducted with 280 participants (71.9 ± 5.3 years; 75% women) enrolled in the Stay Up–Falls Prevention Project. Assessments included skeletal muscle mass (anthropometric prediction equation), handgrip strength, lower limb strength and power (Five Times Sit-to-Stand test, 5×STS), and fall history over the past 12 months. Muscle power was calculated from 5×STS performance using the equation proposed by Alcazar and colleagues. Logistic regression models and receiver operating characteristic (ROC) curve analyses were performed. Results: Overall, 26.4% of participants reported at least one fall in the previous year, with a higher prevalence among women (28.9%) than men (18.8%). Fallers showed significantly lower handgrip strength (23.1 vs. 25.4 kg, p = 0.022) and poorer lower limb strength (9.2 vs. 8.7 s, p = 0.007) compared with non-fallers. However, no significant differences were found for skeletal muscle mass or sit-to-stand–derived power. In multivariable models adjusted for age, sex, body mass index, comorbidities, and medications, lower limb strength remained the only independent variable associated with fall status (OR = 1.78, 95% CI: 1.11–2.85, p = 0.016). ROC analysis confirmed fair discriminative capacity for 5×STS performance (AUC = 0.616, p = 0.003), with an optimal cut-off of 8.62 s (sensitivity = 78.4%, specificity = 33.0%). Handgrip strength, muscle mass, and power did not show independent associations with fall status. Conclusions: These findings indicate that the 5×STS test provides a simple, cost-effective, and functional indicator for fall-risk stratification in physically active older adults. Clinicians should consider the 5×STS as a sensitive functional indicator that contributes to fall risk stratification, ideally combined with complementary assessments (e.g., balance, gait, cognition) to improve risk stratification and guide preventive interventions in ageing populations. Full article

Background: Complete rectal prolapse (RP) is a debilitating pelvic floor disorder often accompanied by obstructed defecation syndrome (ODS), fecal incontinence, and LARS-like bowel dysfunction. Laparoscopic resection rectopexy (LRR) is an established abdominal approach; however, functional outcomes after LRR with transanal specimen extraction (LRR-TSE) are incompletely defined. Aim: To evaluate short- and long-term functional outcomes—ODS, Wexner incontinence score (WIS), and LARS—in patients undergoing LRR-TSE. Methods: This single-center cohort included 53 consecutive patients who underwent LRR-TSE between January 2013 and December 2019. Variables were prospectively recorded and analyzed retrospectively. ODS, WIS, and LARS scores were assessed preoperatively and at 3, 6, and 12 months. Longitudinal changes were analyzed using repeated-measures ANOVA with Greenhouse–Geisser correction, polynomial contrasts when appropriate, and Bonferroni-adjusted pairwise comparisons. Results: ODS improved significantly over time (p < 0.001), decreasing from 12.8 ± 3.2 preoperatively to 2.4 ± 2.1, 4.2 ± 2.2, and 5.2 ± 2.9 at 3, 6, and 12 months, respectively. LARS scores declined from 18.0 ± 12.7 at 3 months to 8.8 ± 6.8 at 6 months and 3.5 ± 4.2 at 12 months (p < 0.001). WIS showed a transient increase at 3 months (8.1 ± 5.2), followed by improvement at 6 and 12 months (3.2 ± 3.7 and 2.4 ± 3.0; p < 0.001). Sex and body mass index did not affect functional trajectories (p > 0.05), whereas patients aged ≥50 years had higher postoperative LARS and WIS scores (p < 0.05). Complications occurred in 5 patients (9.43%), including one anastomotic leak with a mortality rate of 1.85%. Full-thickness recurrence occurred in 2 patients (3.77%), and 3 developed mucosal prolapse managed with Delorme’s procedure. Conclusions: LRR-TSE is a safe and feasible minimally invasive technique that improves constipation, continence, and LARS-related bowel dysfunction. Early postoperative impairment may overestimate long-term functional severity, highlighting the need for follow-up beyond 12 months. Full article