Search Results (19,472)

Chronic kidney disease (CKD) is a progressive disorder characterized by declining renal function and increased cardiovascular risk. Experimental models are essential for investigating these mechanisms, and the 5/6 nephrectomy (5/6 Nx) model is widely used to reproduce cardiorenal alterations observed in CKD. This review aims to critically evaluate how effectively the 5/6 Nx model reproduces vasoactive and redox mechanisms relevant for pharmacological testing. A narrative synthesis of experimental studies using the 5/6 Nx model in rodents was performed, focusing on vascular, inflammatory, and oxidative pathways. The 5/6 Nx model reproduces major CKD features, including hypertension, proteinuria, glomerulosclerosis, and cardiovascular remodeling. Early activation of the renin–angiotensin–aldosterone system, endothelin signaling, and sympathetic pathways contributes to vascular dysfunction. Sustained oxidative stress reduces nitric oxide bioavailability and promotes endothelial dysfunction. Dysregulation of natriuretic peptides and increased 20-HETE signaling further contribute to vascular imbalance and remodeling. These alterations occur in a well-defined temporal progression, supporting the use of this model for mechanistic and pharmacological studies. The 5/6 Nx model remains a robust and translationally informative platform for investigating CKD progression, provided that pathway-specific reproducibility and experimental variables are carefully considered. Full article

Upper tract urothelial carcinoma (UTUC) accounts for approximately 5–10% of urothelial malignancies and represents a clinically challenging disease due to its frequent presentation at advanced stages and its association with significant morbidity. Radical nephroureterectomy (RNU) with bladder cuff excision remains the standard treatment for high-risk disease; however, this approach inevitably results in loss of renal function and may significantly affect eligibility for cisplatin-based chemotherapy. In patients with imperative indications for renal preservation—including a solitary kidney, bilateral disease, or advanced chronic kidney disease—Kidney-Sparing Surgery (KSS) represents an essential therapeutic strategy. Technological advances in flexible ureteroscopy, improved visualization systems, and laser energy sources have significantly expanded the feasibility of conservative management. Ureteroscopic tumor ablation has become the cornerstone of KSS, allowing local disease control while preserving renal function. Although recurrence rates remain relatively high, repeated endoscopic treatment combined with strict surveillance protocols can achieve acceptable oncological outcomes in carefully selected patients. This narrative review summarizes the current evidence regarding conservative management of UTUC in imperative clinical situations, with particular emphasis on patient selection, endoscopic treatment modalities, laser technologies, economic implications, patient counselling, and follow-up strategies. Full article

Hydrogeochemistry is a practical and low-impact tool for mineral exploration that relies primarily on groundwater as sampling media. It is particularly valuable for blind or deeply buried deposits where surface geochemical methods are ineffective, as groundwater acts as a natural integrator of geochemical signals from depth. This study presents a PRISMA 2020-compliant systematic review of hydrogeochemical exploration practices published between 1946 and 2025, synthesizing 118 empirically screened case studies from diverse geological and climatic settings. The review evaluates the geochemical processes governing aqueous dispersion halos, including sulphide oxidation, water–rock interaction, redox controls, and physicochemical speciation, and assesses how these processes influence pathfinder behaviour and anomaly expression. Quantitative synthesis highlights consistent patterns in hydrogeochemical footprints across major mineral systems and demonstrates the effectiveness of thermodynamically informed and multivariate interpretation strategies over simple concentration-based approaches. Emerging trends identified include the growing application of non-traditional stable isotope fractionation, nanoparticle geochemistry using single-particle ICP-MS, and integration of hydrogeochemical datasets with GIS, geophysics, and machine learning-based prospectivity modelling. Unlike recent narrative reviews, this study provides a fully reproducible, structured evaluation of the global evidence base and formalizes a standardized end-to-end workflow. Full article

Background: The end of the COVID-19 public health emergency of international concern (PHEIC) in May 2023 marked a transition from disruption to recovery and rebuilding of health systems. The WHO African Region entered this period with declining routine immunization coverage, widening inequities, and fragile surveillance systems. We conducted a critical narrative synthesis of post-PHEIC recovery and the transformation of immunization systems in the region from 2023 to 2025. Methods: We thematically analyzed publicly available data from the WHO and other sources using a systems-oriented framework covering immunization coverage, equity, vaccine introductions, disease control, governance, financing, and data systems. Results: Regional coverage for most antigens was restored to 2019 pre-pandemic levels by 2024, e.g., three doses of diphtheria-tetanus-pertussis-containing vaccines at 76%. However, progress remains insufficient to meet the Immunization Agenda 2030 (IA2030) target of 90% coverage. In addition, there were 6.7 million zero-dose children in the 2024 birth cohort (6.3% higher than the 6.3 million in 2019), concentrated in a few countries. The IA2030 target is a 50% reduction in the number of zero-dose children by 2030, compared to 2019. Recovery initiatives have restored services, while accelerated introductions (e.g., malaria vaccines introduced in 20 new countries in 2024–2025) signal renewed system momentum. Yet, progress has plateaued at pre-pandemic levels, reflecting structural constraints rather than sustained transformation. Concurrently, recurrent outbreaks of measles, yellow fever, and other vaccine-preventable diseases highlight persistent immunity gaps and surveillance limitations. Structural constraints (including financing fragility, subnational inequities, and system fragmentation) continue to limit sustained progress. Conclusion: This study offers important insights that can inform immunization policymaking in the WHO African Region and beyond. Current post-PHEIC trends reflect recovery without transformation. Achieving IA2030 targets will require a shift from broad coverage expansion to precision delivery approaches that prioritize zero-dose and underserved populations. Immunization must be positioned as a central pillar of primary health care and health security systems. Full article

Neonatal infections remain a leading cause of morbidity and mortality worldwide, particularly among preterm and low-birth-weight infants and in low- and middle-income countries. This burden has intensified with the global increase in multidrug-resistant (MDR) bacteria, especially in neonatal intensive care units, where prolonged hospitalization, invasive interventions, and exposure to broad-spectrum antibiotics promote colonization, transmission, and invasive infection. In this narrative review, we explore the epidemiology and microbiological characteristics of MDR bacterial infections in newborns, alongside their associated risk factors, diagnostic challenges, treatment outcomes, and prevention strategies. Across different settings, Gram-negative pathogens, particularly Klebsiella pneumoniae, Escherichia coli, and Acinetobacter baumannii, account for a substantial proportion of severe neonatal infections, whereas methicillin-resistant Staphylococcus aureus remains important in selected units. The risk of MDR infection is driven by a complex interplay of factors, ranging from maternal and perinatal exposures to the inherent immunological vulnerability of newborns, hospital-based transmission, antibiotic selection pressure, and structural deficiencies in healthcare infrastructure. Diagnosis remains challenging because clinical presentations are nonspecific and culture-based methods are constrained by low blood volumes, prior antimicrobial exposure, and delayed turnaround times. Treatment is increasingly complicated due to resistance to standard empirical regimens, substantial regional variation in susceptibility profiles, and limited neonatal pharmacokinetic and safety data for reserve agents. Current evidence mainly supports surveillance-informed empirical therapy, susceptibility-guided treatment adjustment, antimicrobial stewardship, and strict infection prevention measures. Future progress will require neonatal-specific clinical trials, harmonized surveillance systems, stronger molecular epidemiology, and more equitable access to microbiological diagnostics and effective treatment. Full article

Background/Objectives: The objective of this study was to map and synthesize the current evidence on hemostasis in chronic and acute liver disease within the framework of Patient Blood Management (PBM). Methods: Because research in this field is heterogeneous—spanning mechanistic studies, observational data, randomized controlled trials, guidelines, and expert reviews—a scoping review was selected to comprehensively map concepts. Findings were synthesized narratively to reflect the breadth and heterogeneity of available research. Results: Hemostasis in liver disease is characterized by a fragile state of rebalanced coagulation, where parallel reductions in pro- and anticoagulant factors coexist with variable fibrinolytic disturbances and thrombocytopenia. Conventional coagulation tests (CCTs) do not accurately reflect bleeding risk, whereas viscoelastic assays and thrombomodulin-modified thrombin generation testing provide a more physiologic assessment, though with limitations. Most bleeding events arise from portal hypertension rather than coagulopathy, and the routine prophylactic correction of abnormal results of CCTs is not supported by evidence. PBM-aligned strategies—such as restrictive transfusion, targeted fibrinogen replacement, and use of thrombopoietin receptor agonists (TPO-RAs)—reduce unnecessary blood product use. Thrombosis burden is increasingly recognized in this patient population. Anticoagulation is generally safe when individualized to liver function and clinical context, however significant variability persists in clinical practice, and high-quality data remain limited for advanced disease. Conclusions: Hemostasis in liver disease reflects a dynamic and unstable equilibrium rather than a simple bleeding tendency. Diagnostic and therapeutic strategies grounded in PBM principles improve safety by avoiding unnecessary transfusion and emphasize individualized care. Despite advances in understanding rebalanced hemostasis, major gaps remain in predicting thrombotic risk, standardizing advanced coagulation testing, and defining optimal management across disease stages. Full article

Despite the rapid digitization of intangible cultural heritage (ICH), the complex mechanisms governing how users interact and co-create knowledge in digital spaces remain underexplored. Understanding the internal dynamics and engagement logic of these interactive environments is therefore essential to developing sustainable heritage knowledge ecosystems. Conceptualizing the Zhihu community as such an ecosystem, this study investigates ICH thematic structures, knowledge demands, and user participation. By employing an LLM-refined BERTopic framework, this study identified 36 core topics and mapped them onto a four-layer architecture (Cultural Resource Layer, Action Subject Layer, Social Support Layer, and External Interaction Layer) and five knowledge demand dimensions (Basic Knowledge, Cultural Experience, Professional Development, Protection and Inheritance, and Modern Application) through weighted semantic similarity and Spearman correlation analysis. The results reveal a structural configuration dominated by the External Interaction Layer. A dual-track demand mechanism was identified, comprising a professionalized ability-oriented pathway and an affective experience-driven mode. Furthermore, deep engagement was primarily catalyzed by topics that integrate technology, action, and narrative, rather than structural prominence alone. The ICH knowledge ecosystem was characterized by an outward-looking and emotion-driven orientation. This research study contributes an ecosystem framework to heritage information while providing insights for practitioners to optimize digital ICH information services through multi-dimensional semantic integration and public co-creation. Full article

Background/Objectives: Physical restraints and seclusion remain ethically contested interventions in psychiatric care, raising significant concerns regarding patient safety, dignity, and therapeutic impact. Despite growing international momentum towards restraint-reduction strategies, their use persists across the Eastern Mediterranean Region (EMR), an area that has been the subject of limited systematic attention. This review synthesises evidence on the knowledge, attitudes, and experiences of nurses and individuals with mental illness regarding these practices in EMR psychiatric settings. Methods: Following PRISMA 2020 guidelines (PROSPERO: CRD42023383751), we systematically searched nine electronic databases for studies published up to June 2023, supplemented by backward and forward citation searching. Multiple reviewers independently screened records against predefined eligibility criteria, with disagreements resolved through consensus. Methodological quality was assessed using Joanna Briggs Institute (JBI) Critical Appraisal tools, and reporting quality was evaluated using an adapted CROSS checklist; these two appraisal dimensions were conducted and reported independently. Findings were integrated through narrative synthesis. Results: From 4634 identified records, 19 studies conducted across 11 EMR countries met the inclusion criteria. Nursing knowledge deficits were identified across multiple settings, and attitudes towards restraint practices were predominantly negative. Individuals with mental illness consistently described restraint as humiliating, punitive, and physically distressing. Recurrent challenges identified across studies included inadequate staff training, chronic understaffing, and limited access to restraint-reduction alternatives. Conclusions: Substantial gaps in nursing knowledge and training persist across the EMR. The findings of this review, while derived predominantly from cross-sectional studies with convenience samples, suggest that evidence-based education programmes, standardised restraint-reduction policies, and patient-centred care frameworks warrant prioritisation to safeguard the rights, safety, and dignity of individuals with mental illness in this region. Longitudinal and experimental research is needed to confirm these directions and establish their effectiveness within EMR contexts. Full article

Background/Objectives: Financial toxicity (FT) is increasingly recognised as a critical dimension of the cancer care continuum, reflecting both objective financial burden and subjective financial distress arising from cancer-related care. Head and neck cancers (HNC) may be particularly vulnerable to FT because treatment often involves multimodal care, functional morbidity, prolonged rehabilitation, and disruption to employment. This scoping review mapped and synthesised the literature on FT in a focused subset of head and neck cancers (HNC), namely malignancies of the oral cavity, oropharynx, nasopharynx, sinonasal tract, and major and minor salivary glands. Methods: A scoping review was conducted in accordance with the methodological guidance of the Joanna Briggs Institute for scoping reviews to identify and synthesise studies addressing FT in the selected HNC subsites. Searches were undertaken in MEDLINE, Embase, Scopus, Web of Science, CINAHL, EconLit, and Global Index Medicus for English-language studies published between 1 January 2015 and 1 January 2025. The search window was restricted to this period to capture the more contemporary evolution of FT as a distinct research construct in oncology. Eligible studies included adult patients and reported patient-level FT outcomes, including direct costs, indirect costs, out-of-pocket expenditure, financial hardship, financial distress, employment disruption, or related economic strain. Findings were synthesised narratively and organised thematically. Results: Twenty-five studies published between 2015 and 2025 were included. The evidence base was dominated by cross-sectional and retrospective designs, with limited prospective follow-up and very little intervention-focused research. FT was conceptualised heterogeneously across studies, spanning direct expenditure, indirect and non-medical costs, subjective financial distress, and coping-related consequences. Questionnaire-based approaches were used in 13 studies, but only a smaller subset employed FT-specific instruments such as COST. Across the literature, FT was most commonly associated with lower income, weaker financial protection, employment disruption, rural residence in some settings, and more intensive treatment. Reported downstream associations included poorer quality of life, psychological distress, care alteration, and work-related burden, although evidence for treatment delay or survival effects was more limited and should be interpreted cautiously. Conclusions: In this focused HNC subset, FT appears multidimensional, socially patterned, and clinically relevant. However, the literature remains methodologically fragmented, with inconsistent measurement and sparse longitudinal evidence. Future work should prioritise validated and tumour-specific assessment strategies, prospective study designs, and evaluation of mitigation interventions that address both direct and indirect burden across the cancer continuum. Full article

Minimal access cardiac surgery (MACS) can mitigate the increasing risk profile of cardiac surgery patients and is associated with improved postoperative outcomes. One of the ways to manage the steep learning curve of MACS is the use of surgical simulation training. We conducted a narrative review to identify the relevant literature discussing MACS simulation training. We identified 20 studies using our search strategy. Various platforms were represented: high-fidelity (n = 8), low-fidelity (n = 6), and animal studies (n = 6). Virtual reality (VR) appeared in two wet-lab studies as an adjunct. The surgical approach was video-assisted thoracoscopic surgery (VATS) in 11 and robotic-assisted thoracoscopic surgery (RATS) in nine. The most simulated procedure was minimal access mitral valve (MV) repair (n = 16). Most studies (n = 16) evaluated the impact of simulation training on the surgical skill of participants with varying baseline MACS experience. A small proportion of included studies (n = 4) carried out only fidelity testing. While some standardised assessment tools were used, there was considerable variation in how surgical skill and fidelity were assessed. There are an increasing number of publications on MACS simulation training, with equal focus on bench and animal models. MV procedures were the most simulated, suggesting a drive towards increasing the scope of minimal access MV training. Full article

Introduction: The management of resectable non-small cell lung cancer has long relied on a relatively limited set of determinants, primarily anatomical resectability and pathological stage. Although these parameters remain central to therapeutic planning, accumulating clinical and translational evidence indicates that they do not fully explain variability in outcomes observed after lung cancer surgery. The primary aim of this review is to evaluate whether current evidence supports the need for a novel heuristic framework in resectable NSCLC. Secondary aims are to examine how host-related, clinical, and data-driven factors contribute to prognosis and treatment selection beyond conventional staging systems. Methods: This review integrates evidence from clinical studies, national registries, and translational analyses to examine how these dimensions contribute to prognosis and treatment selection. Results: Over the past two decades, advances in surgical techniques, perioperative management, systemic therapies, and large-scale clinical databases have revealed additional determinants of prognosis beyond tumor burden, including physiological reserve, nutritional condition, systemic inflammatory state, comorbidities, and socioeconomic environment. Developments in multimodal strategies and minimally invasive surgery have reshaped the therapeutic landscape. Data-driven approaches have identified clinically meaningful subgroups not captured by conventional staging systems. Conclusions: A heuristic framework integrating tumor biology, patient characteristics, and treatment context may better reflect the complexity of contemporary thoracic oncology practice. Full article

The scope of actual pro-environmental initiatives, programs, interventions, and campaigns is limited. Therefore, spillover effects from these activities to other domains of economy, the private sphere, and society are crucial to achieve a transformation of society towards sustainability. Starting from the known literature and using Google Scholar as a platform for searching additional studies, this explorative, traditional narrative review analyses behavioural spillover effects, where either one behaviour influences the likelihood of another behaviour, or an intervention shows an impact on an environmentally significant behaviour, which it did not primarily address. In the scientific literature, spillover is classified by direction (environmentally positive versus negative), involved behaviours (similar or cross-behavioural), timing (short or long term), context (e.g., work to private life), and social scope (personal, interpersonal, intra- and inter-organisational, intergroup, or international). Positive spillover can result from cognitive dissonance reduction, consistent self-perception, pro-environmental values, norms, self-identity, action-based learning, and habit formation. Negative spillover emerges through rebound effects, moral licensing, and psychological reactance. Stronger spillover is observed between similar behaviours, while cross-domain spillover is generally weaker. According to previous research, a facilitated participatory approach with strong pro-environmental orientation appears recommendable for practitioners to foster the value change required for effective and sustained positive spillover. Full article

Laparoscopic cholecystectomy is now established as the worldwide gold standard for the treatment of benign gallbladder disease. Despite technical advancements, bile duct injury (BDI) remains a major concern, especially in patients with obesity. It is well known that in patients with a Body Mass Index (BMI) ≥ 30 kg/m², identification of Calot’s triangle and the achievement of the Critical View of Safety (CVS) during laparoscopic cholecystectomy (LC) are made more challenging due to excessive visceral adiposity and concomitant hepatic steatosis reducing the workspace. Near-Infrared Fluorescence Cholangiography (NIRF-C) with Indocyanine Green (ICG) has emerged as an innovative, safe and effective technique to visualize the biliary anatomy and minimize the risk of iatrogenic BDI. However, its specific benefit in patients with obesity remains under-discussed compared to the general population. The main aim of this narrative review is to evaluate whether the intraoperative use of ICG in patients with obesity may reduce operative times and the risk of BDI. A focused review of the literature is performed on articles from 2010 to 2025 published on PubMed, Scopus and Web of Science. The application of ICG fluorescence in LC for patients with obesity represents a tangible clinical advantage, not only for anatomical identification and significant improvement of procedural efficiency, but also for the reduction in operative time. Full article

The heritagisation of cultural landscapes is often understood as a state-led administrative process. At the same time, the discursive origins and adaptive mechanisms that precede formal designation remain underexplored, especially in relation to cultural sustainability. This study examines the pre-heritagisation of Suzhou’s classical gardens during China’s modern transformation by analysing periodical discourse published between 1870 and 1948. Using a mixed-methods approach that combines quantitative content analysis and Critical Discourse Analysis (CDA), it investigates 699 historical texts from the Index to Chinese Newspapers & Periodicals database. The findings reveal a dual discursive process. On the one hand, reports portrayed the gardens as accessible, multifunctional civic spaces through narratives of public use. On the other hand, literati discourse reinforced their classical value through historical memory and aesthetic preservation. Together, these tendencies show how the gardens were materially refunctioned and symbolically re-anchored under modern conditions. Rather than directly producing later heritage designation, this process helped create the socio-cultural conditions through which the gardens acquired broader public intelligibility, cultural legitimacy, and heritage-like meanings before formal institutional recognition. Full article

This study examines how user-generated content (UGC) is incorporated and negotiated within platformized public service media (PSM) journalism, using the German content network funk as a case study. Based on a qualitative content analysis of selected formats and their social media posts, the study shows that participatory affordances offered by social media platforms (SMPs) are present but rarely foregrounded as central elements of storytelling. Instead, UGC is typically used as illustrative material or selectively embedded within editorial narratives. The analysis investigates how UGC is solicited, incorporated, and visually integrated into editorial storytelling across different formats. The findings identify three recurring patterns of UGC integration that illustrate how audience participation is negotiated within everyday editorial production: (1) illustrative UGC integration, (2) community-oriented UGC integration, and (3) minimalist UGC integration. Overall, the study highlights how platformized PSM journalism integrates UGC in ways that remain strongly editorially moderated rather than fully participatory, demonstrating how participation is enabled, constrained, and strategically applied within platform infrastructures. Full article