Search Results (2,193)

Background/Objectives: Given rising lung cancer incidence and limited data on pulmonologist-performed ultrasound-guided transthoracic core biopsy (US-TTCB), in this study, we evaluated diagnostic yield and safety for pleural or pulmonary lung masses, using Clavien–Dindo classification to standardize complication reporting. Methods: We retrospectively reviewed single-center pulmonologist-performed US-TTCB using a MEDONE biopsy gun with a 16 G/18 G Tru-Cut needle between January 2019 and December 2025. The primary endpoints were diagnostic yield, defined as specific malignant or benign histology, and complication rate. Non-diagnostic results were assessed using available clinical/imaging follow-up. Univariate analyses screened candidate correlates, and a prespecified computer tomography (CT)-completed subanalysis (n = 67) used multivariable logistic regression and receiver operating characteristic (ROC) analysis to assess CT lesion size discrimination. Results: Diagnostic yield was 84.2% (202/240); complications occurred in 12.1% (29/240), including one Clavien–Dindo Grade III event (0.4%). In the CT-completed subset (n = 67), diagnostic yield was independently associated with CT lesion size (aOR 1.03/mm, 95% CI 1.00–1.05; p = 0.022) and Chronic Obstructive Pulmonary Disease (COPD) (aOR 2.30, 95% CI 1.06–4.96; p = 0.034); CT lesion size showed an area under the curve (AUC) of 0.717 for predicting yield. Diagnostic yield remained stable over time (84.2% in first vs. second half; p = 1.00), with no association between case order and yield (OR 0.999; p = 0.64). Conclusions: US-TTCB of pleural/pulmonary masses achieved a high diagnostic yield with minimal major complications. Large CT dimension and COPD were associated with higher diagnostic success, and CT size provided fair discrimination for predicting yield; findings should be interpreted in the context of the retrospective single-center design and the restricted CT-completed subset. Full article

Background: Nuclear medicine healthcare professionals (NMHP) sustain chronic occupational exposure to iodine-131 (I-131), conferring an elevated risk of radiation-induced solid thyroid cancer. Established radiobiological prediction tools derive risk coefficients from atomic bomb survivor data but are not configured for rapid individualized risk assessment in occupational exposure settings. This study examined whether machine learning algorithms can serve as high-precision computational surrogates for excess relative risk estimation in NMHP. Aim: The study aimed to (i) develop and validate three machine learning algorithms for predicting the excess relative risk per unit absorbed dose for radiation-induced solid thyroid cancer (ERR/Gy.RST), (ii) characterize relationships between dosimetric and demographic features and predicted risk, and (iii) identify the optimal algorithm for deployment in occupational health surveillance. Methods: A dataset of 4657 observations was constructed from Life Span Study-derived ERR/Gy parameters, adapted to occupational low-dose conditions, using a dose-and-dose-rate effectiveness factor of 2.0, per ICRP Publication 103. Five features (gender, age at exposure, current age, distance from the I-131 source, and cumulative absorbed dose in the thyroid) were used to train a decision tree regressor (dtcr), a random forest regressor (rfr), and a multilayer perceptron (MLP) neural network algorithm. Results: Cumulative absorbed dose in the thyroid correlated positively with ERR/Gy.RST (r = 0.63, p < 0.01), while radiation source distance demonstrated a strong inverse association (r = −0.38, p < 0.01). The MLP algorithm achieved R² score = 0.999, MSE = 0.002, and MAE = 0.010, substantially outperforming the rfr (R² score = 0.700, MSE = 0.410, MAE = 0.295) and the dtcr (R² score = 0.510, MSE = 0.654, MAE = 0.289). Conclusions: The MLP algorithm provides a high-fidelity surrogate for established ERR/Gy.RST projection tools in the NMHP context, enabling computationally efficient, feature-integrated occupational radiation-induced thyroid cancer risk quantification. These findings suggest that machine learning-based surrogate modeling is a practical, scalable complement for occupational health practitioners and radiation protection officers to support individualized surveillance of radiation-induced thyroid cancer risk in nuclear medicine departments. Full article

Background: Type II workplace violence by patients, relatives, or visitors is an occupational health and patient-safety concern in primary care. Cranston Ridge Medical Clinic (CRMC), a single urban family medicine and walk-in primary care clinic in Calgary, Alberta, plans to implement a universal, risk-informed workplace-safety bundle that is based on observable behaviour, situational risk, and documented safety concerns rather than demographic profiling. Methods: This article describes a single-site internal quality improvement and workplace-safety evaluation protocol. The comparison is CRMC usual practice during the pre-implementation baseline period; there is no concurrent external control group. The planned evaluation will use aggregate, de-identified operational data from a 12-month pre-implementation baseline, a four-week implementation period, and 12 months of post-implementation monitoring. All clinic staff will receive workplace-safety training as part of routine implementation. No staff, patients, or visitors will be recruited as research participants, and the evaluation will not use individual-level staff survey, interview, or focus-group data. Patient/visitor information will be used only as aggregate operational monitoring data when needed to assess safety, access, patient flow, and complaints. Intervention and analysis: The bundle includes worksite analysis, staff training, a brief arrival safety screen, a response algorithm, standardized reporting, monthly safety huddles, and post-incident support. The primary metric will be the Type II workplace-violence incident rate per 1000 clinic visits. Planned analyses include run charts, pre–post rate ratios, and Poisson or negative binomial segmented regression if monthly counts are sufficient. Implementation learning will be summarized from routine training records, safety-huddle summaries, post-incident debrief themes, and other aggregate de-identified operational indicators. Expected contribution: The protocol contributes a transparent, equity-sensitive, and operationally feasible model for balancing staff safety with patient access in primary care. Full article

Background/Objectives: Despite well-documented chemical and physical hazards in healthcare settings, existing reviews of occupational reproductive risks have largely focused on single-agent risk estimation and have rarely translated occupational hygiene evidence into clinical decision-making frameworks for reproductive counseling and surveillance. This narrative review synthesizes evidence across multiple occupational exposure categories—antineoplastic agents, high-level disinfectants (HLDs), sterilants, and work-organization factors—and proposes an integrated, clinically operational framework for preconception counseling, pregnancy-sensitive risk stratification, exposure-control verification, and reproductive health surveillance among women healthcare workers. Methods: A structured narrative literature search was conducted across PubMed/MEDLINE, Scopus, Web of Science, and Embase from database inception through January 2025 and updated in March 2026. The review was guided by a Population–Exposure–Comparison–Outcome (PECO) framework and structured using Search–Appraisal–Synthesis–Analysis (SALSA) principles and the Scale for the Assessment of Narrative Review Articles (SANRA). Evidence quality was summarized using a modified hierarchy-of-evidence classification provided as a reader aid. This narrative review employed structured transparency tools but does not claim the methodological status of a systematic review. Quantitative meta-analytic pooling was not performed owing to substantial heterogeneity across study designs, exposure assessment methods, and outcome definitions; findings were synthesized narratively by exposure category. Results: The strongest and most consistent evidence was identified for occupational exposure to antineoplastic agents, which has been associated with spontaneous abortion, stillbirth, congenital abnormalities, impaired fecundability, and selected cancer-related concerns. HLDs and sterilants represent exposure categories warranting precautionary attention, with some evidence suggesting possible adverse effects on fecundability and early pregnancy maintenance; however, findings are considerably more heterogeneous, context-dependent, and reliant on self-reported exposure assessment than those for antineoplastic agents. Broader workplace factors, including shift work, prolonged working hours, physical workload, and mixed exposures, may further contribute to reproductive risk. The synthesis supports task-specific occupational history taking, exposure-control verification, and pregnancy-sensitive risk stratification. Conclusions: This review provides a multi-exposure, clinically operational framework that bridges occupational hygiene evidence with reproductive healthcare delivery, offering practical decision-support tools for clinicians managing women healthcare workers during preconception, pregnancy, and lactation. The framework includes structured occupational history-taking questions, a clinical decision pathway with evidence-tier classification, and a prevention matrix linking exposure sources to workplace controls and clinical actions. Integrating task-specific occupational history taking into routine reproductive care may improve detection of preventable workplace risks and support timely accommodation, while clinicians should calibrate recommendation strength to the underlying evidence quality for each exposure category. Full article

Chronic lung disease of prematurity (CLD) is a common complication of preterm birth with a complex pathology. Recent epidemiologic studies have identified a link between neonatal exposure to di(2-ethylhexyl) phthalate (DEHP), frequently used in medical equipment, and the development of CLD. We hypothesize that DEHP exposure in the early neonatal period contributes to lung injury in newborn rats. Newborn rat pups were raised in one of the following environments: room air (RA), RA + DEHP, hyperoxia (60% oxygen), and hyperoxia + DEHP. Ambient DEHP was inhaled at a dose of 25 mg/m³ for 6 h daily for 14 days. Lung tissue and blood samples were collected on the 14th day of life. Independent exposure to DEHP and hyperoxia resulted in thicker pulmonary septal walls, fewer alveoli, increased pulmonary polymorphonuclear leukocytes and myeloperoxidase (MPO) activity and decreased expression of CD31 on endothelial cells in lung tissue. Additionally, DEHP-exposed rats showed higher serum malondialdehyde (MDA) levels and reduced vascular endothelial growth factor (VEGF) mRNA and protein levels compared to controls. Our experiments demonstrate that inhaled DEHP, with or without hyperoxia, resulted in a similar pattern of morphological lung injury and inflammation characteristic of CLD, suggesting an association with CLD of prematurity. Full article

Background/Objectives: Antimicrobial resistance (AMR), driven by high-risk bacterial pathogens, is a major healthcare threat. This scoping review mapped artificial intelligence/machine learning (AI/ML) and computational approaches integrated with whole-genome sequencing (WGS), genomic surveillance, rapid typing, epidemiological data, or clinical metadata for early warning of AMR outbreak clones. Methods: Following PRISMA-ScR guidance and the Population–Concept–Context (PCC) framework, PubMed/MEDLINE, Scopus, and Web of Science were searched for English-language studies published between 2010 and 2026. Eligible studies addressed AI/ML or computational approaches for AMR outbreak detection, clone surveillance, transmission analysis, or infection prevention and control (IPC). Results: Thirty-eight studies were grouped into five domains: genomic surveillance; rapid typing; resistance, risk-factor, and lineage prediction; transmission reconstruction; and IPC-oriented genomic epidemiology. AI/ML supported automation, isolate prioritization, typing triage, prediction, transmission modelling, and electronic health record (EHR)-linked route identification. Conclusions: AI/ML may enhance WGS-based AMR surveillance, but validation, dataset dependence, heterogeneity, and limited IPC outcome reporting remain key gaps. Full article

Background: The prevalence of adhesive capsulitis (AC) is estimated to be 2–5% in the general population. However, the etiology of AC remains unclear. Among the various proposed factors, the precise role of cervical disease, and the severity of cervical degeneration, in the development of AC has not been fully elucidated. This study aimed to analyze the contribution of cervical disease to AC in patients with shoulder pain. Methods: A total of 409 patients who visited the Department of Rehabilitation Medicine for shoulder pain were retrospectively reviewed. The outcome variable was the presence of AC. In addition to cervical disease, other independent variables affecting AC, including sex, diabetes, obesity, dyslipidemia, thyroid disease, immobilization after surgery, rotator cuff tear, subacromial spur, and shoulder joint osteoarthritis were reviewed. To compare the two groups, an independent t-test or chi-square test was performed for continuous and categorical data. Multivariate regression analysis was used to assess the effects of independent factors on AC, adjusting for confounders. Results: Among the 409 patients, 176 (43.0%) were diagnosed with AC. Multivariate analysis demonstrated that diabetes (OR 3.03, 95% CI 1.55–5.91, p = 0.001) and cervical disease (OR 3.03, 95% CI 1.75–5.25, p < 0.001) were significantly associated with increased odds of AC. In contrast, increasing age (OR 0.95, 95% CI 0.92–0.98, p = 0.007), dyslipidemia (OR 0.55, 95% CI 0.31–0.98, p = 0.044), and postoperative immobilization (OR 0.64, 95% CI 0.41–0.99, p = 0.046) were associated with decreased odds of AC. The prevalence of AC increased with the severity of cervical degeneration. Conclusion: In patients with shoulder pain, diabetes and cervical disease were positively associated with AC, whereas age, dyslipidemia, and postoperative immobilization showed inverse associations. These findings suggest that both metabolic and cervical factors may contribute to the development of AC, highlighting the importance of considering cervical pathology in patients with shoulder pain. Full article

Erythrocyte glutathione transferase (e-GST) and oxidized human serum albumin (HSAox) were used as biomarkers to assess the environmental health of a foundry and a ceramics factory located in the Umbria region (Italy). While HSAox level indicates that no relevant oxidative stress is present in workers of either company, a distinct overexpression of e-GST, also present in non-workers residents, suggests exposure to broad environmental stressors that may be attributed to common sources. A more careful analysis of different job sectors and the effect of filtering facepieces indicates that the workers exposed to solvents show the highest e-GST expression, while different pollutants (possibly dust and/or metal fumes) seem to be present in other areas of the foundry as well as in external areas. In the ceramic company, the high e-GST activity reveals the presence of other contaminants which can be efficiently blocked by filtering facepieces and gloves together. Intriguingly, a cohort of monks (n = 14) residing in a monastery adjacent to the foundry exhibited e-GST activities significantly lower than those observed in non-worker residents, suggesting that specific lifestyle or localized environmental factors may influence exposure levels, a finding that warrants further targeted research. Full article

Achieving the EU’s climate goals by 2050 requires a rapid transition to a resource-efficient and circular economy. The electrification of transport increases the demand for rechargeable lithium-ion batteries (LiBs), where lithium–nickel–cobalt–manganese (Li-NMC) is the predominant cathode technology in the European automotive sector. Large-scale facilities for LiB production and recycling are emerging worldwide, bringing not only technical challenges but also challenges regarding healthy and safe working environments. Current knowledge on occupational exposure and health risks in the LiB industry is limited and largely based on evidence from other occupational settings. However, the LiB industry involves legacy and new combinations of metals and chemicals in novel contexts. Some of these substances have well-known adverse health effects, and combined exposure may increase their absorption and toxicity. Although processes are often highly specialised and automated, manual handling tasks remain, which put workers at risk of exposure. Important knowledge gaps remain regarding exposure levels, exposure pathways, dermal and systemic uptake, combined exposures, and potential health effects among workers. This perspective paper discusses current exposure scenarios and health risks in LiB production and recycling, identifies key knowledge gaps, and highlights future research needs to support evidence-based occupational risk management. To address several of these challenges, the GreenWorkLiB initiative applies a multidisciplinary approach combining exposure assessment, biomonitoring, and occupational medicine. The initiative investigates exposure pathways via air and skin, internal dose through biomonitoring, and potential health effects among workers in LiB production and recycling. The results can support the assessment of human health and safety within the EU’s Safe and Sustainable by Design (SSbD) framework and contribute to safe and sustainable working environments in the LiB industry. Full article

Background: Osteoporosis/osteoporotic fractures are identified in both hypercalcemic (HC-HPT) and normocalcemic variant (NC-HPT) of primary hyperparathyroidism (HPT) at various rates. Objective: Noting the need of modern society to easily assess the osteoporotic fracture risk amid the diagnosis of HPT, we aimed to address this gap by analyzing the 10-year fracture risk assessment based on traditional FRAX (Fracture Risk Assessment Tool) model in comparison to the novel algorithm (FRAXplus), according to the adjustment for the presence of HPT, as well as for the use of lumbar bone mineral density (BMD) in menopausal women with HPT versus controls (non-HPT), respectively, between HC-HPT versus NC-HPT. Methods: For each patient, the latest algorithms of FRAX and FRAXplus provided the 10-year fracture risk for major osteoporotic fractures (MOF) and for hip fracture (HF) amid a single-center, retrospective, real-life study. Results: In total, 131 subjects were included: 51.15% had HPT (64.18% of them had HC-HPT) versus age-, menopause duration-, and body mass index-matched (HPT-free) controls. As a result, 10-year fracture risk for MOF and HF was statistically significantly higher in HPT versus controls only for the calculation with femoral neck BMD. FRAXplus showed that for both estimations (MOF and HF) with introduction of lumbar BMD remained higher than controls (4.55% vs. 3.7%, p = 0.004, respectively, 1.05% vs. 0.5%, p = 0.002). In HPT group, 10-year fracture risk for MOF and HF were higher if adjustment for HPT was applied. The highest 10-year fracture risk for MOF was obtained for HPT adjustment with femoral neck BMD (5.9%) versus the estimation without using femoral neck BMD (5.25%, p = 0.001), respectively, versus the probability with adjustment for lumbar BMD (4.55%, p < 0.001). The same observation was for HF: 1.4% versus 1.2% (p = 0.028), respectively, versus 1.05% (p < 0.001). In HPT group, parathormone level positively correlated with 10-year hip fracture risk with HPT adjustment, without femoral neck BMD (r = 0.257, p = 0.049). Bone formation marker P1NP negatively correlated with 10-year fracture risk for MOF without femoral neck BMD (r = −0.416, p = 0.043), respectively, with the estimation including HPT adjustment without femoral neck BMD (r = −0.404, p = 0.05), and with the 10-year HF risk calculated without femoral neck BMD (r = −0.407, p = 0.049). Conclusions: To our best knowledge, this is the first study to address the use of FRAXplus in HPT. The similar values between FRAX-based probabilities without the use of femoral neck BMD in HPT versus non-HPT controls suggested that this traditional estimation might not be so useful in HPT population, thus the need for novel models (HPT adjustment). HPT adjustment (FRAXplus) provided a higher MOF/HF risk versus non-adjustment (FRAX). All 10-year probabilities based on FRAX and FRAXplus models showed similar values in HC-HPT versus NC-HPT, which implies that current algorithms might not make a clear distinction between HPT subtypes, yet the statistically significant results within each of these subgroups sustain the FRAXplus application regardless of the variant. Full article

Background: Early-life exposure to dichlorodiphenyltrichloroethane (DDT) may increase adult cancer risk, but evidence from Asian populations remains limited. Taiwan’s nationwide indoor residual spraying (IRS) program during the 1950s provides a unique setting to examine long-term reproductive cancer risk associated with early-life DDT exposure. Methods: We conducted an ecological study using township-level DDT IRS frequency (0–5 times) as the exposure indicator. Individuals born between 1952 and 1958 were followed from 1979 to 2022 for incident reproductive cancers based on data from the Taiwan Cancer Registry. Poisson regression models were applied to estimate relative risks associated with each additional IRS exposure. Results: A total of 109,244 reproductive cancer cases were identified. Each additional DDT spraying round was associated with increased risks of breast, ovarian, corpus uteri, prostate, testicular, and cervical cancers (RRs = 1.01–1.16). Elevated risks were observed for testicular cancer (RR = 1.16, 95% CI: 1.01–1.23) and cervical cancer (RR = 1.01, 95% CI: 1.002–1.02), for which Asian epidemiological evidence remains limited. Higher exposure levels were also associated with differences in stage at diagnosis for breast cancer among women aged ≥55 years and for corpus uteri cancer. Conclusions: Early-life DDT exposure was associated with increased risks of several reproductive cancers. These findings support the Developmental Origins of Health and Disease framework and suggest that environmental exposures during critical developmental windows may influence long-term cancer risk. However, the findings should be interpreted cautiously given the ecological study design and potential residual confounding. Full article

This study assessed physical activity (PA) levels and energy expenditure among students across various medical disciplines at Wroclaw Medical University. Data were collected in late 2024 using the International Physical Activity Questionnaire (IPAQ) long-form. Statistical analysis, including Mann–Whitney U and Kruskal–Wallis tests were used to reveal significant differences based on gender, age, and field of study. While female students generally achieved higher metabolic equivalent (MET) MET-min/week values at home and in transport, male students demonstrated significantly higher scores in total physical activity, total vigorous physical activity, and vigorous activity in free time. Gender based analysis did not reveal any statistically significant differences. Significant variations across study programs were observed only in occupational PA, same as in age-related analysis. The findings highlight sedentary risks within specific student subgroups, which may contribute to professional burnout and diminished effectiveness as future health promoters. Consequently, the study suggests that medical institutions should incorporate lifestyle medicine and health promotion strategies into their curricula to foster the long-term well-being of future healthcare professionals. Full article

Pulmonary arterial hypertension (PAH) is a fatal vascular disorder with poor prognosis. 6:2 chloro-polyfluorooctane ether sulfonate (F-53B), a persistent environmental contaminant detected in humans, is known to be vasculotoxic, yet its association with PAH remains unexplored. This study aims to elucidate the mechanisms linking F-53B exposure to PAH by integrating network toxicology, molecular docking and in vitro experiments. Potential F-53B targets were predicted using ChEMBL, PharmMapper, and TargetNet. PAH-related genes were compiled from GeneCards, Online Mendelian Inheritance in Man (OMIM), Therapeutic Target Database (TTD), and GSE254617. We identified 42 key targets of F-53B-related PAH. Functional enrichment revealed terms such as inflammatory response and extracellular matrix. Protein–protein interaction (PPI) analysis identified five hub genes: CCL2, CXCL8, CCL5, CCR2, and CCL11. Molecular docking confirmed strong binding between F-53B and these core targets, with CCR2 showing the strongest affinity (−10 kcal/mol). Molecular dynamics simulations further verified stable binding to CCR2. In vitro experiments demonstrated that F-53B activated the CCL2/CCR2 axis and induced IL-1β, TNF-α, and IL-6 in HUVECs and RAW264.7 cells. This study reveals that F-53B is linked to PAH through dysregulation of chemokine signaling networks and induction of inflammatory cytokines. These findings suggest F-53B as a potential environmental risk factor for PAH and pinpoint potential targets for intervention. Full article

Edible mushrooms are highly valued for their nutritional properties, yet their exceptional capacity to bioaccumulate heavy metals necessitates rigorous safety assessments of commercially available products. This study evaluates the concentrations of Cd, Pb, Hg, and As in 164 samples of commercial dried mushrooms to assess consumer health risks. Analysis of six species revealed that contamination levels are significantly influenced by taxonomic factors, supplier variability, and certification status. While median concentrations across most species remain within safety thresholds, Boletus edulis and Suillus spp. exhibited the highest accumulation of Cd and As, respectively. A critical finding was an incidental, extreme As concentration (369.048 mg·kg⁻¹) in Imleria badia, resulting in a Hazard Index (HI) of 63.57, far exceeding the safety limit of 1. Statistically significant differences (p < 0.01) were observed between organic and conventional products, with certified samples showing lower Hg and As levels. Although moderate consumption of most batches is safe, the high variability between producers and the presence of toxicological outliers underscore the urgent need for rigorous monitoring of harvesting areas. These findings suggest that organic certification enhances food safety and highlight the necessity for targeted nutritional guidelines. Full article

Background/Objectives: Antimicrobial resistance (AMR) represents one of the most pressing global public health challenges, with inappropriate antibiotic prescribing being a major contributor. In Hungary, general practitioners (GPs) account for over 70% of all antibiotic prescriptions, yet limited research has examined the complex relationship between patient expectations and physician prescribing behavior. This study explores general practitioners’ antibiotic prescribing practices and their perceptions of patient expectations. Methods: A cross-sectional study was conducted among 181 GPs in Hungary from March 2024 to April 2025. The sample is representative of the northeastern region of Hungary. Participants completed anonymous paper-based questionnaires assessing their self-reported professional knowledge, perceived patient expectations, prescribing behavior, and antibiotic stewardship practices. Results: Most respondents recognized antimicrobial resistance as a significant public health issue (81.7%, n = 147); however, only 52.2% (n = 94) felt capable of effectively taking action against it. While 80.6% (n = 145) reported that patients expect antibiotic prescriptions and 71.1% (n = 128) experienced conflicts over prescribing refusals at least once within the previous six months, 87.2% (n = 157) stated they do not yield to patient pressure. Concerning patterns emerged: 56.1% (n = 101) reported completing patient-initiated antibiotic courses, 36.1% (n = 65) admitted to “just-in-case” prescribing at least once within the past six months, and 38.9% (n = 70) encountered self-medication despite regulations restricting antibiotics to prescription-only use. Only 17.8% (n = 32) regularly monitored their antibiotic prescribing indicators. Physicians with multiple specialty qualifications reported less frequent patient education and more conflicts (p = 0.010). Conclusions: General practitioners demonstrate resilience despite substantial patient pressure; however, self-medication and defensive prescribing practices reveal important gaps in antimicrobial stewardship. Targeted, multifaceted interventions addressing both prescriber behavior and systemic vulnerabilities are needed to strengthen stewardship efforts. Full article