Search Results (27,221)

Background and objective: Evidence of percutaneous left atrial appendage closure (LAAC) and oral anticoagulants (OACs) in non-valvular atrial fibrillation (NVAF) patients with intermediate-to-borderline high stroke risk is scarce. We aimed to compare the efficacy and safety of these treatments in the latter clinical population. Methods: This retrospective cohort study included NVAF patients with CHA₂DS₂-VA scores of 1–2 and used 1:1 propensity score matching (184 patients per group) to compare efficacy and safety outcomes. The primary efficacy outcome was a composite of stroke, transient ischemic attacks, systemic embolism, and cardiovascular death during follow-up. Adverse safety events were categorized into peri-procedure (LAAC group) and non-procedural (both groups) events. Results: Over a mean follow-up of 48.93 ± 28.50 months, a total of 26 patients (7.07%) reached the primary composite efficacy endpoint. The LAAC group showed a significantly higher incidence of the efficacy endpoint compared to the OAC group (HR = 3.09; 95% CI 1.22–7.85; log-rank p = 0.01). Procedure-related events occurred in five LAAC patients (one contributing to primary endpoint), while non-procedural bleeding rates were similar (0.54% vs. 1.09%; p = 0.56). Subgroup analyses suggested concomitant ablation of NVAF in LAAC group did not significantly improve efficacy composite endpoints (HR = 0.47). Conclusions: In NVAF patients with intermediate-to-high stroke risk, OACs were more effective than LAAC in preventing thromboembolic events, with comparable rates of clinically relevant bleeding. Full article

Background: Cardiovascular risk models, such as the Framingham and atherosclerotic cardiovascular disease (ASCVD) calculators, have improved risk prediction but often fail to identify individuals who experience ASCVD events despite low or intermediate predicted risk. This suggests that underrecognized, non-traditional risk factors may contribute significantly to the development of atherosclerosis. Objective: This narrative review synthesizes and summarizes recent evidence on high-yield non-traditional risk factors for atherosclerosis, with a focus on clinically significant, emerging, and applicable contributors beyond conventional frameworks. This review is distinct in that it aggregates a wide array of non-traditional risk factors while also consolidating recent data on ASCVD in more vulnerable populations. Unlike the existing literature, this manuscript integrates in a single comprehensive review various domains of non-traditional atherosclerotic risk factors, including inflammatory, metabolic, behavioral, environmental, and physical pathways. An additional unique highlight in the same manuscript is the discussion of non-traditional risk factors for atherosclerosis in more vulnerable populations, specifically South Asians. We also focus on clinically actionable factors that can guide treatment decisions for clinicians. Results: Key non-traditional risk factors identified include inflammation and biomarker-based risk factors such as C-reactive protein or interleukin-6 levels, metabolic and microbial risk factors, behavioral factors such as E-cigarette use, and environmental or infectious risk factors such as air and noise pollution. We explore certain physical exam findings associated with atherosclerotic burden, such as Frank’s sign and Achilles tendon thickness. Conclusions: Atherosclerosis is a multifactorial process influenced by diverse and often overlooked factors. Integrating non-traditional risks into clinical assessment may improve early detection, guide prevention and personalize care. Future risk prediction models should incorporate molecular, behavioral, and environmental data to reflect the complex nature of cardiovascular disease. Full article

Alzheimer’s disease (AD) and related dementias (ADRD) are neurodegenerative conditions that cause gradual deterioration of cognition, memory and language in the elderly. AD has been declared as a health priority by the World Health Organization (WHO) considering its severity and unavailability of a permanent cure. Although the global AD/ADRD population is made up of many ethno-racial groups, the majority of AD studies have focused on the Caucasian population. The few AD studies conducted on minority populations in the US have found that significant AD health disparities exist, demonstrating that African Americans and Hispanics have a significantly higher prevalence of AD and related dementias, with their risk often approaching twice that of White individuals. For the past few years, epigenomic research has played an important role in understanding health disparities among diverse racial and ethnic groups. Unlike genetic studies, which focus on the DNA sequence that one is born with, epigenomics investigates how changes in gene expression due to extrinsic environmental exposures may impact disease pathophysiology. Recent epigenomic studies appear to be promising in not only understanding disease pathology but also in developing diagnostic and therapeutic tools for AD with population specificity. However, there is only a handful of studies and review articles available addressing the epigenomic applications in irradicating racial disparities in AD/ADRD. Therefore, the aim of this review is to discuss the recent findings of epigenomic studies in AD and related dementias, their contribution in irradicating racioethnic disparities and insights into the future direction of their application in precision medicine. Full article

Endocrine-disrupting chemicals (EDCs), widespread in aquatic environments, interfere with endocrine function in organisms and threaten ecosystem stability. Rotifers, critical live feed for marine fish, shrimp, and crab larvae, link EDC-induced reproductive impairment to marine ecosystem stability and aquaculture sustainability. This PRISMA-compliant review synthesizes key findings, consequences, and gaps in EDC–rotifer reproductive toxicity research. Traditional EDCs (heavy metals, per- and polyfluoroalkyl substances (PFASs), phenols, phthalate esters, polybrominated diphenyl ethers (PBDEs), and steroid hormones) and emerging EDCs (disinfection byproducts, microplastics, pharmaceutical metabolites) induce distinct reproductive harm—e.g., Hg²⁺ shows extreme toxicity (24 h LC₅₀ = 4.51 μg L⁻¹ in Brachionus plicatilis), BDE-47 damages ovaries, and microplastics cause transgenerational delays. Rotifer species and exposure duration affect sensitivity (e.g., BDE-47: 96 h LC₅₀ = 0.163 mg L⁻¹ vs. 24 h LC₅₀ > 22 mg L⁻¹ in B. plicatilis). Oxidative stress is a universal mechanism, and combined EDC exposure produces context-dependent synergistic/antagonistic effects. EDC-induced impairment reduces rotifer population density, alters structure, and propagates through food webs, threatening aquaculture and biodiversity; transgenerational toxicity (e.g., 4-nonylphenol: F₁ inhibition 28% vs. 12% in F₀) weakens resilience. This review supports EDC risk assessment, with gaps including long-term low-concentration data, transgenerational mechanisms, EDC–microbiome interactions, and emerging PFAS toxicity—priorities for future research. Full article

Traumatic brain injury (TBI) is a leading cause of critical illness and mortality in children. Transfusion of blood products, a common intervention in the management of pediatric TBI, has important implications for related principles, including trauma-induced coagulopathy, cerebral perfusion, and cerebral oxygen delivery. Knowledge gaps persist due to the limited availability of pediatric-specific data regarding blood product transfusion in TBI. In particular, there is a lack of prospective studies defining appropriate specific laboratory thresholds and transfusion targets, as well as insufficient evidence to guide the weighing of potential benefits against transfusion-related risks in this population. Although blood product transfusion in pediatric TBI has been associated with worse clinical outcomes, the underlying mechanisms and contributing factors remain poorly understood. In this review, we aimed to describe the pediatric literature on component and whole blood product transfusion in children with TBI and the pathophysiological mechanisms underlying the development of coagulopathy in this population. In addition, we incorporated available pediatric guidelines and recommendations specific to the setting of acute brain injury. Full article

Type 2 diabetes is increasingly prevalent among children and adolescents with overweight or obesity, and although lifestyle interventions remain first-line preventive strategies, long-term adherence and effectiveness are often limited. Metformin has demonstrated efficacy in delaying type 2 diabetes onset in adults at high risk, but its preventive role in pediatric populations remains unclear. This systematic review and meta-analysis aims to evaluate the effectiveness of metformin, alone or in combination with lifestyle interventions, in preventing or delaying type 2 diabetes among children and adolescents with overweight or obesity. The protocol is registered in PROSPERO (CRD42024615622), MEDLINE (PubMed), Embase, Cochrane Library, Scopus, and Web of Science and will be searched from inception to June 2025. Eligible studies include randomized controlled trials, quasi-experimental studies, and prospective cohort studies involving individuals under 18 years of age. The primary outcome is incidence of type 2 diabetes, with secondary outcomes including fasting plasma glucose, HbA1c, insulin resistance, BMI z-score, adherence, and adverse events. Where appropriate, random-effects meta-analyses will be conducted. This review will synthesize current evidence on metformin for pediatric type 2 diabetes prevention and inform future preventive strategies and clinical decision-making. Full article

Systemic Lupus Erythematosus (SLE) and primary Sjögren’s Disease (SjD) are autoimmune diseases characterized by the presence of autoantibodies that lead to damage in healthy tissues. The production of autoantibodies requires the activation and differentiation of B-lymphocytes into plasma cells. To achieve this effect, BAFF (B-lymphocyte activating factor), APRIL (A proliferation-inducing ligand), and their receptors are key factors. BAFF is a cytokine recognized by BAFF-R (BAFF receptor), which is increased and related to disease activity in both SLE and SjD patients. The H159Y mutation (rs61756766) in the gene encoding the BAFF-R, TNFRSF13C (Tumor Necrosis Factor Receptor Superfamily) has been shown in vitro to cause receptor hyperactivation via the NF-κB2 pathway. This study evaluated the frequency of this variant in a western Mexican population and its association with the risk of developing SLE and SjD. Genotypes of the TNFRSF13C H159Y (rs61756766) variant were determined by PCR-RFLP assay. sBAFF levels were measured by ELISA. The study included 300 SLE patients, 110 SjD patients, and 300 healthy subjects (HS). HS were in Hardy–Weinberg equilibrium. The data distribution was assessed using the Kolmogorov–Smirnov test. Group comparisons were conducted using the Chi-square test, Fisher’s exact test, or the Mann–Whitney U test, as appropriate. A p-value of <0.05 was considered statistically significant. In the Mexican population, allelic and genotypic distribution frequencies of the H159Y variant (rs61756766) were similar between SLE patients and HSs, while the variant was not found in SjD patients. SLE patients carrying the heterozygous CT genotype showed a trend toward higher soluble BAFF (sBAFF) levels than wild-type genotype patients. This variant does not confer risk to SLE or SjD in the Mexican population. However, the heterozygous genotype may be associated with high levels of sBAFF in SLE patients. Full article

Background/Objectives: Population aging increases the healthcare burden of chronic diseases. We aimed to characterize the sociodemographic and clinical characteristics of Aged Madrid, a cohort comprising 98.6% of the population aged 75 years and older in Madrid, Spain. Methods: Observational study with a five-year retrospective baseline period (2015–2019) to assess baseline vascular and metabolic risk. Data were taken from primary care electronic medical records, hospital discharge summaries, and pharmacy records. Results: 587,603 individuals (mean age: 84 years ± 5.8 years, 61.3% women) were analysed. Obesity affected 31.3% (more frequent in women), while type 2 diabetes occurred in 23.8% (predominantly in men). Hypertension (52.8%), dyslipidaemia (61.6%), and chronic kidney disease (21.7%) were more frequent in women. Atrial fibrillation was the leading cardiovascular condition in women (15.1%), while acute myocardial infarction predominated in men (8.2%). The most prescribed drug classes were antihypertensives (53.8%), statins (44.2%), and oral antidiabetics (26.4%). Among antihypertensives, diuretics (53.9%), ACE inhibitors (27.4%), and ARBs (25.3%) were most used, often in combinations such as diuretics + ACE inhibitors (30.1%). Diabetes treatments favoured metformin and DPP-4 inhibitors; 5.2% received insulin. Conclusions: Sex-based differences emerged in biochemical, anthropometric, and lifestyle variables. Men showed a higher prevalence of cardiovascular diseases and several cardiometabolic risk factors, while women used fewer lipid-lowering and antidiabetic agents. Diuretics were the predominant antihypertensives, and antidiabetic therapy largely followed guideline recommendations. Although 60% of statin users had no prior cardiovascular disease, and their use was concentrated mainly among individuals with major cardiometabolic risk conditions and declined with advancing age, suggesting an age- and risk-sensitive prescribing pattern rather than indiscriminate use. Full article

Background/Objectives: Sexual dysfunction (SD) and broader sexual health problems are common after neurological disorders, yet interventional evidence is fragmented across conditions and outcomes. This umbrella review mapped and appraised systematic review-level evidence on interventions targeting SD and sexual health in neurological populations and qualified conclusions using certainty of evidence. Methods: PubMed, Web of Science, Cochrane Library, Embase, PsycINFO, EBSCOhost, and Scopus were searched from inception to 27 November 2025. Two reviewers screened records, extracted data, assessed review quality with AMSTAR 2, and rated certainty across intervention–outcome pairings using a GRADE-informed approach that integrated review confidence and primary-study risk-of-bias as reported by the source reviews. Results: Twenty-six systematic reviews were included. Overall confidence was frequently limited (17/26 critically low and 6/26 low), with only a small subset rated moderate or higher. Evidence was most coherent for phosphodiesterase type 5 (PDE5) inhibitors improving erectile function in men with spinal cord injury, whereas most other interventions and outcomes were supported by low or very low certainty. Women were represented in 16/26 reviews, yet validated female sexual function outcomes were synthesized in 6/26 reviews and relationship/couple outcomes in 3/26; furthermore, 10/26 reviews restricted inclusion to men, and no review synthesized pediatric intervention trials. Conclusions: Evidence supports PDE5 inhibitors for improving erectile function in men with spinal cord injury, while evidence for other interventions and sexual health domains remains limited. Methodological limitations highlight the need for more inclusive trials, broader standardized outcomes, and longer follow-up within neurorehabilitation pathways. Full article

Scaphoideus titanus Ball, 1932 (Hemiptera: Cicadellidae), the main vector of the phytoplasma (FDp) causing Flavescence dorée, is considered a challenging problem in European vineyards. Natural insecticides permitted for S. titanus control in Italian organic viticulture are generally considered of low-to-moderate efficacy. Morever, it should be mentioned that their optimal use requires a careful approach when preparing the insecticide solutions. Synthetic insecticides used in Italian viticulture are included in only two IRAC groups, indicating potential risks for resistance. Therefore, there is a need to identify alternatives or control tools complementary to synthetic insecticides. In this study, we summarize the results obtained in five field experiments (2021–2025) using the main alternatives to synthetic insecticides (i.e., pyrethrins, kaolin, azadirachtin, Beauveria bassiana, and potassium salts of fatty acids). In all seasons, pre-insecticide application populations did not differ significantly among treatments, whereas differences emerged after insecticide applications. The overall results showed that pyrethrin-based insecticides were the most effective in reducing S. titanus nymph densities. Kaolin provided intermediate but comparatively stable levels of control across the years, whereas B. bassiana showed moderate yet highly variable efficacy. The findings obtained here can be considered in designing management strategies for S. titanus in organic viticulture that require an integrated approach combining pyrethrins with complementary, lower-impact tools to achieve effective and sustainable control over time. At the same time, natural insecticides can be incorporated into IPM strategies in conventional vineyards to prevent resistance. Full article

Background: Cardiometabolic risk (CMR), including obesity, dyslipidemia, hypertension, and impaired glucose regulation, disproportionately affects Hispanic/Latinx adults in the United States (U.S.). Although plant-forward dietary patterns are established as cardioprotective, less is known about how dietary patterns within Hispanic/Latinx subgroups relate to CMR. Methods: A narrative review was conducted of observational studies among U.S. Hispanic/Latinx adults (≥18 years) examining defined dietary patterns (a priori, a posteriori, or hybrid) in relation to CMR outcomes (e.g., BMI, waist circumference, blood pressure, glucose, lipids). Risk of bias was assessed using an adapted version of the Newcastle–Ottawa Scale. Results: Ten studies met the inclusion criteria, including Seventh-day Adventist Latinx, Puerto Rican adults, Mexican American adults, Hispanic women, and a national Hispanic cohort. Plant-forward dietary patterns were associated with lower BMI and waist circumference, lower triglycerides and fasting glucose, and higher HDL-C. In contrast, energy-dense patterns characterized by refined grains, added sugars, processed meats, fried foods, solid fats, and sugar-sweetened beverages were associated with greater adiposity, poorer lipid profiles, and higher blood pressure. Traditional rice-and-beans–based patterns observed in Puerto Rican and Mexican American groups were associated with central adiposity and higher metabolic syndrome prevalence, despite modestly higher intakes of fruits, vegetables, and fiber. Study quality ranged from good (n = 4) to very good (n = 6). Conclusions: Across Hispanic/Latinx subgroups, plant-forward dietary patterns were associated with favorable cardiometabolic profiles, whereas refined and animal-based patterns aligned with higher CMR. Given the predominance of cross-sectional evidence, these findings should be interpreted as associative rather than causal. Culturally grounded dietary counseling, along with additional longitudinal and intervention studies, is needed to support cardiometabolic health in these populations. Full article

Based on the collected mobile phone location data, this paper analyzes changes in four mobile location-based indicators and their spatiotemporal distribution characteristics before and after the earthquake, summarizing crowd movement patterns and communication behaviors after the M_S6.8 Dingri earthquake. By comparing natural neighbor interpolation and Thiessen polygon interpolation methods, we explore novel rapid assessment approaches for earthquake perception ranges, combined with actual seismic intensity maps. The results indicate an uneven distribution of population and differing dynamics in mobile phone signal activity. This reflects different behavioral patterns and the potential perceived extent of the earthquake. Within 50 km of the epicenter, all four indicators showed varying degrees of decline post-earthquake, while areas beyond 100 km exhibited short-term surges, reflecting differentiated behavioral responses based on seismic impact severity. In areas experiencing strong shaking, risk avoidance behavior predominated, while in areas where shaking was noticeable but less severe, communication behavior was more prominent. Mobile data decline zones showed high spatial correlation with intensity VIII+ regions, proving their effectiveness as rapid indicators for identifying strongly affected areas. Notably, mobile location data enabled accurate identification of strongly affected zones within 30 min post-earthquake. Full article

Background/Objectives: Frailty is a common geriatric syndrome associated with adverse outcomes such as disability, hospitalization, and mortality. This study aimed to assess the association between body mass index (BMI) trajectories over ten years and frailty among community-dwelling older adults in Brazil. Methods: This population-based longitudinal study used data from the COMO VAI? cohort, conducted with individuals aged ≥60 years in Pelotas, southern Brazil. Frailty was defined in 2024 using Fried’s phenotype, which evaluates weight loss, exhaustion, low physical activity, slowness, and weakness. BMI categories were defined as underweight (BMI < 22.0 kg/m²), eutrophy (22.0–27.0 kg/m²) and overweight (>27.0 kg/m²). BMI trajectories were identified using group-based trajectory modeling for 789 participants with data from at least two of three assessments (2014, 2019, 2024). Only trajectory groups comprising at least 5% of the sample were retained. Associations of baseline BMI and BMI trajectories with frailty were analyzed using Poisson regression with robust variance, adjusted for confounders and calf circumference. Results: Baseline underweight and overweight prevalence were 9.2% and 56.2%, respectively. Trajectory modeling identified three BMI groups: eutrophic (31.6%), overweight (56.4%), and obesity (12.0%). Obesity emerged as a distinct longitudinal trajectory rather than a baseline BMI category. Underweight did not emerge as a distinct BMI trajectory due to its low prevalence over time. Frailty prevalence in 2024 was 36.5%. Overweight trajectory participants had lower frailty prevalence after ten years (PR = 0.73; 95% CI: 0.54–0.99), while baseline underweight was associated with higher frailty ten years later (PR = 1.73; 95% CI: 1.05–2.84), consistent with the known risk of underweight and the potential protective effect observed in overweight older adults. Conclusions: Baseline underweight increased frailty risk, whereas an overweight trajectory showed a potential protective effect, consistent with the “obesity paradox” in older populations. Full article

Acute pancreatitis (AP) is an inflammatory condition with varying severity, ranging from mild self-limiting episodes to life-threatening complications. The incidence, clinical presentation, and outcomes of AP differ significantly across age groups, with elderly patients demonstrating distinct challenges. Biliary pancreatitis is more prevalent in older adults, whereas alcohol-induced AP dominates in younger populations. Elderly patients frequently present with atypical or less pronounced abdominal symptoms, which may delay diagnosis. Comorbidities such as kidney failure, cardiovascular disease, diabetes mellitus and arterial hypertension are significantly more common in the elderly and are associated with increased risk of organ dysfunction, systemic complications such as organ failure, multiple organ dysfunction syndrome (MODS), and prolonged hospitalization. The higher incidence of intensive care unit admissions and mortality is noted in the elderly, particularly in those over 80 years, in particular. Evidence on age-related differences in local pancreatic complications is inconsistent, with a possible trend toward lower rates in older adults. Early identification and individualized treatment planning are essential. Abundant fluid administration should be limited in older patients due to frequent cardiac insufficiency but should be carefully monitored due to the present or threatening renal insufficiency. Pain control with opioids may cause severe CNS complications for elderly patients. In contrast, ERCP, when indicated, is usually well tolerated in older patients. Personalized management in elderly patients is strongly recommended. Full article

Vitamin D is involved in immune regulation through effects on innate and adaptive immune responses mediated by vitamin D receptor activation within immune cells. Experimental and translational studies support its role in promoting regulatory T-cell activity, modulating Th1/Th17 responses, and influencing autoantibody production. At the population level, low serum 25-hydroxyvitamin D concentrations are consistently associated with an increased risk of autoimmune diseases, including autoimmune thyroid disorders such as Hashimoto’s thyroiditis (HT) and Graves’ disease (GD), suggesting a potential preventive association. In contrast, clinical evidence from interventional studies in patients with established disease is heterogeneous. Although vitamin D supplementation has been associated with reductions in thyroid autoantibody titers in some studies—particularly in patients with HT and baseline vitamin D deficiency—consistent effects on thyroid function, disease progression, or relapse prevention have not been demonstrated. Overall, current evidence supports vitamin D deficiency as a potentially modifiable risk marker rather than a confirmed disease-modifying therapeutic target in autoimmune thyroid diseases, highlighting the need for further studies focused on clinically meaningful outcomes. Full article