Search Results (124)

NR0B1 (DAX-1) is an orphan nuclear receptor essential for the development and regulation of the adrenal glands and gonads. Pathogenic variants in NR0B1 cause X-linked adrenal hypoplasia congenita (AHC), which typically presents with adrenal insufficiency and hypogonadotropic hypogonadism (HH) in boys. Delayed diagnosis during adolescence is uncommon but, when it occurs, can lead to preventable adrenal crisis, underscoring the need for early recognition of atypical presentations. We describe a 14-year-old boy who presented with adrenal insufficiency and delayed puberty. Genetic testing revealed a novel hemizygous in-frame duplication variant of NR0B1 (NM_000475.4:c.833_835dup p.(Leu278dup)). This variant has not been previously reported in association with X-linked AHC. The patient received hydrocortisone (10–12 mg/m²/day) and fludrocortisone (0.1 mg/day) as replacement therapy for adrenal insufficiency, along with testosterone supplementation (100–240 mg/day) to induce pubertal progression. Plasma ACTH levels gradually decreased from 10,175 pg/mL at diagnosis to 215 pg/mL during follow-up, accompanied by clinical improvement in skin pigmentation and pubertal development. This case underscores the importance of NR0B1 genetic testing in children with adrenal insufficiency and HH. Early recognition and genetic confirmation are critical for appropriate management and genetic counseling. Identification of novel variants expands the NR0B1 mutational spectrum and enhances our understanding of genotype–phenotype correlations in X-linked AHC. Full article

Conventional wastewater treatment methods typically achieve 70–90% removal efficiency for organic pollutants. However, the global wastewater crisis—with 80% of wastewater discharged untreated—demands innovative solutions to overcome persistent challenges in nutrient removal and resource recovery. This review presents the first systematic analysis of technology integration strategies for algal wastewater treatment, examining synergistic combinations of biofilm reactors, nano-enhancement, artificial intelligence, and 3D printing technologies. Individual technologies demonstrate distinct performance characteristics: algal biofilm reactors achieve 60–90% removal efficiency with biomass productivity up to 50 g/m²/day; nano-enhanced systems reach 70–99% pollutant removal; AI optimization provides 15–35% efficiency improvements with 25–35% energy reductions; and 3D-printed architectures achieve 70–90% removal efficiency. The novel integration framework reveals that technology combinations achieve 85–95% overall efficiency compared to 60–80% for individual approaches. Critical challenges include nanomaterial toxicity (silver nanoparticles effective at 10 mg/L), high costs (U.S. Dollar (USD) 50–300 per m² for 3D components, USD 1500+ per kg for nanomaterials), and limited technological maturity (TRL 4–5 for AI and 3D printing). Priority development needs include standardized evaluation metrics, comprehensive risk assessment, and economic optimization strategies. The integration framework provides technology selection guidance based on pollutant characteristics and operational constraints, while implementation strategies address regional adaptation requirements. Findings support integrated algal systems’ potential for superior treatment performance and circular economy contributions through resource recovery. Full article

Introduction: The organization of mental health care is undergoing a transformation from an institutionalized model to a community-centered model. Due to the critical specialist workforce shortage, insufficient funding, and the large number of children in crisis, its implementation presents a challenge. The aim of this study is to analyze the current situation regarding access to system-based care under contracts with the National Health Fund in various provinces in Poland. Materials and Methods: Based on an analysis of data, resources available to patients were assessed—specifically, information was obtained from the National Health Fund website entitled “NFZ Treatment Waiting Times.” From this, the waiting times for appointments in child and adolescent mental health care facilities, the availability of mental health care facilities under contracts with the National Health Fund in Poland, legal acts, and data from the Central Statistical Office were extracted. Then, an analysis of the current accessibility to child and adolescent mental health services was conducted. The inclusion criteria for data sources were as follows: accessibility—the data had to be openly available to researchers without restrictions; credibility—the data had to be verified by individual health care facilities; usefulness—the data had to accurately reflect the actual availability of services and the needs within the child and adolescent psychiatric care system. Results: There are significant differences and deviations from the average number of facilities and waiting times when comparing the 16 provinces. Notably, some of the analyzed facilities are already operating within the framework of Child and Adolescent Mental Health Centers, where the mean waiting period for inpatient care is 105 days, the mean waiting period for day-care units is 61 days, and the mean waiting period for outpatient clinics is 257 days. The number of facilities is increasing under the reform, with new level I reference centers being opened, which ensures prevention and early support is provided by a pedagogue, psychologist, and non-medical staff, providing enhanced accessibility to care without the need for a visit to a child and adolescent psychiatrist, of whom there are only 579 for the entire child population in Poland. This metric primarily refers to first-time appointments in public institutions, with notable disparities between urban and rural areas. Conclusions: The development of the reform offers hope for quicker access to mental health support for children and adolescents. With the consistent implementation of the reform and further support from non-governmental organizations, there is a high chance of building an effective community-based model with a short waiting time for help and reducing ineffective hospitalizations, among other things, in terms of costs. Full article

Background: Armed conflicts impose complex logistical and behavioral challenges on healthcare systems, particularly in managing acute conditions such as ST-elevation myocardial infarction (STEMI) and ischemic stroke. Although both diagnoses require timely intervention, their clinical pathways differ significantly. Few studies have systematically compared their management during active warfare, particularly within the warzone. Methods: This retrospective cohort study was conducted at Soroka University Medical Center (SUMC), the sole tertiary hospital in southern Israel and the main referral center for cardiovascular and neurological emergencies in the region. We included all adult patients (≥18 years) admitted with new-onset STEMI or ischemic stroke during three-month periods of wartime (October–December 2023) and matched routine periods in 2021 and 2022. Patients with in-hospital events, inter-hospital transfers, or foreign citizenship were excluded. Data on demographics, comorbidities, arrival characteristics, treatment timelines, and outcomes were extracted from electronic medical records. Categorical variables were compared using Chi-squared or Fisher’s exact test, and continuous variables using t-tests or Mann–Whitney U tests, as appropriate. Multivariable logistic and linear regression models were adjusted for age, sex, Charlson Comorbidity Index (CCI), and mode of arrival. Interaction terms assessed whether wartime modified the associations differently for STEMI and stroke. Results: A total of 410 patients were included (193 with STEMI and 217 with stroke). Patients with STEMI were significantly more likely to arrive by self-transport during the war (38, 57.6% vs. 32, 25.2%, p < 0.001) and had higher rates of late arrival beyond 12 h (19, 28.8% vs. 13, 10.2%, p = 0.002). These findings support the conclusion that patients were more prone to delayed and unstructured presentations during a crisis. In contrast, patients with stroke showed a reduction of 354 min in symptom-to-door times during the war [median 246 (30–4320 range) vs. 600 min (12–2329 range), p = 0.026]. Regression models revealed longer delays for stroke vs. STEMI in routine settings [β = 543.07 min (239.68–846.47 95% CI), p < 0.001], along with significantly lower in-hospital (OR = 0.39, 95% CI= 0.15–0.97, p = 0.05) and 30-day mortality (OR = 0.43, 95% CI= 0.19–0.94, p = 0.04). However, these differences were no longer significant during wartime. Patients with STEMI showed a trend toward lower 180-day mortality during the war (OR = 0.33, 95% CI = 0.09–0.99; p = 0.07), although this difference did not reach statistical significance. Conclusions: During wartime, patients with stroke arrived earlier and in greater numbers, while patients with STEMI showed reduced admissions and delayed, self-initiated transport. Despite these shifts, treatment timelines and short-term outcomes were maintained. These diagnosis-specific patterns highlight the importance of reinforcing EMS access for STEMI and preserving centralized protocol-based coordination for stroke during crises. Full article

Objectives. The aim of this study was to examine screen media use and the development and alteration of pre-existing mental health problems over the first year of the COVID-19 pandemic in a clinical sample of children and adolescents. Methods. A survey was conducted with over 650 parents of patients referred to child and adolescent psychiatry. Results. A worsening of the main mental health problem during the first year of the pandemic was reported more often (38%) by parents than an improvement (25%), a tendency even more pronounced for comorbid/secondary problems (worsening in 48%, improvement in 16% of cases). Girls in general, but especially between 14 and 18 years, more often showed a persistent deterioration of mental problems than boys. A negative impact of screen media use on their child’s mental health was reported most frequently by parents of a child affected by depression (50%), with acute crisis (52%), eating disorders (45%), and conduct disorder/aggression (40%). Patients with multiple/comorbid mental health problems presented significantly higher mean screen media times (5.53 h/day) than patients with a single mental problem (3.97 h/day), and their parents more frequently reported increased concerns about their child’s media use since the pandemic. Critical periods such as the lockdown or the “second wave” outbreak were characterized by higher media consumption in all patients, but with higher peaks in patients with multiple mental health problems. Conclusions. Particularly vulnerable patients, i.e., those with multiple mental problems and adolescent girls, have become more vulnerable in the course of the pandemic. From the perspective of most parents, screen media use has contributed to this development. Full article

The management of public health projects in a BANI (brittle, anxious, non-linear, incomprehensible) environment, exemplified by the ongoing war in Ukraine, presents unprecedented challenges due to fragile systems, heightened uncertainty, and complex socio-political dynamics. This study proposes an AI-driven framework to enhance the resilience and effectiveness of public health interventions under such conditions. By integrating a coupled SEIR–Infodemic–Panicdemic Model with war-specific factors, we simulate the interplay of infectious disease spread, misinformation dissemination, and panic dynamics over 1500 days in a Ukrainian city (Kharkiv). The model incorporates time-varying parameters to account for population displacement, healthcare disruptions, and periodic war events, reflecting the evolving conflict context. Sensitivity and risk–opportunity analyses reveal that disease transmission, misinformation, and infrastructure damage significantly exacerbate epidemic peaks, while AI-enabled interventions, such as fact-checking, mental health support, and infrastructure recovery, offer substantial mitigation potential. Qualitative assessments identify technical, organisational, ethical, regulatory, and military risks, alongside opportunities for predictive analytics, automation, and equitable healthcare access. Quantitative simulations demonstrate that risks, like increased displacement, can amplify infectious peaks by up to 28.3%, whereas opportunities, like enhanced fact-checking, can reduce misinformation by 18.2%. These findings provide a roadmap for leveraging AI to navigate BANI environments, offering actionable insights for public health practitioners in Ukraine and other crisis settings. The study underscores AI’s transformative role in fostering adaptive, data-driven strategies to achieve sustainable health outcomes amidst volatility and uncertainty. Full article

This study investigates Spanish-language public discourse on YouTube following the unprecedented Iberian Peninsula blackout of 28 April 2025. Leveraging comments extracted via the YouTube Data API and analyzed with the OpenAI GPT-4o-mini model, it systematically examined 76,398 comments from 360 of the most relevant videos posted on the day of the event. The analysis explored emotional responses, sentiment trends, misinformation prevalence, civic engagement, and attributions of blame within the immediate aftermath of the blackout. The results reveal a discourse dominated by negativity and anger, with 43% of comments classified as angry and an overall negative sentiment trend. Misinformation was pervasive, present in 46% of comments, with most falsehoods going unchallenged. The majority of users attributed the blackout to government or political failures rather than technical causes, reflecting a profound distrust in institutions. Notably, while one in five comments included a call to action, only a minority offered constructive solutions, focusing mainly on infrastructure and energy reform. These findings highlight the crucial role of multilingual, real-time crisis communication and the unique information needs of Spanish-speaking populations during emergencies. By illuminating how rumors, emotions, and calls for accountability manifest in digital spaces, this study contributes to the literature on crisis informatics, digital resilience, and inclusive sustainability policy. Full article

This study adopted the event study method to explore the effect of the Hualien earthquake on the performance of tourism stocks in Taiwan. This earthquake occurred on 3 April 2024 and affected Hualien and Taitung. The present study examined the short-term (10 trading days), medium-term (12 weeks), and long-term (5 months) performance of all listed tourism companies in Taiwan (overall sample) and six listed tourism companies with a branch in Hualien or Taitung (six-company sample). The results indicated that the stocks of the overall sample rebounded soon after the earthquake but declined over the long-term period. By contrast, the stocks of the six-company sample exhibited a persistent negative return immediately after the earthquake and gradually recovered in the long term. The findings of this study enhance theoretical understanding regarding the effects of a disaster on the stock market. Moreover, they serve as a reference for practical decision-making related to government risk response, investor behavior, and corporate crisis management in high-risk industries, such as tourism. Strengthening disaster preparedness and corporate branding after a disaster is critical for stabilizing market sentiment and industry resilience. Full article

Polish scholarly literature has not comprehensively analysed the image of the French Revolution of 1789–1799 in history textbooks. Similarly, 20th- and 21st-century historiography has presented no exhaustive overview of these events. This article does not claim to exhaust the subject matter. In addressing the topic of the French Revolution, the author seeks to connect with ongoing research in Poland concerning the philosophical interpretation of selected themes in Polish and world history. Moreover, given that the philosophical interpretation of these events in history education compendia has been and remains consistent with historiographical approaches, the author also extends the discussion to a broader consideration of the historiography of the French Revolution from the late 19th century to the present day. The French Revolution occupies a significant place in Polish historical education. However, while contemporary historiography increasingly associates it with crisis, injustice, and oppression, textbook narratives continue to uphold the myth of the French Revolution—favoured in Poland since the late 19th century—as a crucial event perceived as beneficial for France. Full article

We can understand Platonism as both a storehouse of resources that can be drawn upon and a living philosophy capable of helping us address the present-day environmental crisis, one of humanity’s most important and pressing challenges. Platonism appears in the collected papers here in philosophical, theological, scientific, and literary contexts, demonstrating both its versatility and its capacity. One of the aims of promoting this avenue of research is to both explore and challenge the traditional characterisations and critiques of the Platonic tradition in relation to nature and ecology. This Special Issue demonstrates how Platonism can serve as a resource for addressing the environmental crisis in a present-day context. Collectively, the wide range of contributions allow us to begin to tackle the task of showing how a Platonically orientated metaphysics can provide an integrative and sustainable framework for conceptualising nature and the place of humans within it, particularly by offering an alternative to subject-centred epistemologies. Full article

Global cacao production, primarily led by African countries, is facing a crisis, which presents growth potential for South American countries like Colombia, Peru, and Ecuador. However, a significant challenge for these countries is cadmium (Cd) contamination in cacao beans. Agroforestry systems with cacao (CAFSs) improve soil health and can remediate Cd through tree phytoextraction. Effective phytoremediation requires Cd-tolerant, high-biomass species and preferential Cd allocation to stems. This study evaluated the phytoremediation potential of four forest species (Cariniana pyriformis Miers, Terminalia superba Engl. and Diels, Swietenia macrophylla King, and Cedrela odorata L.) under cadmium (Cd) exposure. C. pyriformis exhibited hypertolerance, showing minimal biomass reduction (less than 15%, changing from 1.619 to 1.343 g plant⁻¹) under excess Cd conditions, compared to Cedrela odorata and T. superba, which showed significant biomass reductions. C. pyriformis and T. superba showed notable Cd accumulation in stems (652.99 and 635.39 mg Cd kg⁻¹), an essential feature for wood tree-mediated phytoextraction, while C. odorata allocated more Cd to leaves (35.35 mg Cd kg⁻¹). C. pyriformis maintained high photosynthesis (12.8 μmol CO₂ m⁻² s⁻¹), light use efficiency (0.086 mol CO₂ mol photons⁻¹), and an increased relative growth rate (0.575 g g⁻¹ day⁻¹) under Cd exposure. Overall, C. pyriformis demonstrated significant potential for use in phytoremediation due to its high Cd tolerance (84%), efficient allocation to stems (17%), and sustained physiological performance under Cd exposure. Conversely, C. odorata allocates Cd to leaves (16%), which can reintroduce Cd into the soil, and exhibits a low tolerance index (54%) under higher cadmium contamination. Further studies are still needed to understand the specific mechanisms of Cd accumulation in stems of promising species like C. pyriformis and T. superba. Full article

Background: Pheochromocytoma and paraganglioma are catecholamine-secreting tumors, rarely presenting with pheochromocytoma multisystem crisis (PMC), a life-threatening endocrine emergency. The severity of the condition includes a refractory cardiogenic shock and may therefore require the use of temporary mechanical circulatory support. The aim of this review is to describe the incidence of pheochromocytoma and paraganglioma crises associated with refractory cardiogenic shock, the physiopathological impact of this condition on the myocardial function, the role of temporary mechanical circulatory support (tMCS) in its management, and the outcomes of this specific population. Methods: For the purpose of this narrative review, a literature search of PubMed was conducted as of 16 November 2024. Medical Subject Headings (MeSH) terms used included extracorporeal circulation”, “Impella”, “pheochromocytoma”, “paraganglioma”, and “cardiogenic shock”, combined with Boolean “OR” and “AND”. Data from case series, retrospective studies, and systematic reviews were considered. Seven studies reporting on 45 patients who developed PMC with cardiogenic shock requiring tMCS were included. Patients were young, with a median age of 43 years (range 25–65) at presentation. Most cases presented with severe hemodynamic instability, blood pressure lability, and rapid progression to severe left ventricular dysfunction. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was the most common tMCS used to stabilize patients, initiate specific pheochromocytoma treatments, and, in some cases, provide circulatory support during emergent surgery. The median duration of VA-ECMO support was 4 days (range 1–7) and the reported mean in-hospital survival rate was 93.5%. Following VA-ECMO weaning, survivors showed full recovery of the left ventricular ejection fraction (LVEF). Conclusions: The cardiac dysfunction observed in PMC-associated cardiogenic shock may be severe and life-threatening but appears reversible. tMCS should therefore be considered in eligible cases, as a bridge to recovery, treatment, or surgery. The reported survival rates are impressively high, suggesting possibly a substantial risk of publication bias. Full article

The growing and unprecedented water crisis leads to the need to find alternative water resources, and the reuse of treated urban wastewater is an excellent approach. Accordingly, in this work, the disinfection of a secondary effluent (W) discharged from a wastewater treatment plant (WWTP) by hydrogen peroxide combined with radiation (H₂O₂+UV/visible) was studied with the aim of obtaining treated water that can be reused. Firstly, the effect of hydrogen peroxide alone, radiation per se and the combined H₂O₂+UV/Visible process in the inactivation of enterobacteria were assessed. It was found that the oxidant alone is not efficient; the maximum inactivation is achieved when the oxidant and radiation are used simultaneously. For the first time, the effect of some operational parameters, namely the hydrogen peroxide concentration (between 50 and 125 mg/L), initial pH (from 5.0 to 7.0), temperature (between 15 and 25 °C), and radiation intensity (100 to 500 W/m²), on the efficiency of the disinfection process was assessed. When the process was carried out under the best operating conditions found ([H₂O₂] = 75 mg/L, pH = 5.0, T = 25 °C, and UV/visible light with I = 500 W/m²), total enterobacteria and total heterotrophs were inactivated and the abundance of the 16S rRNA, bla_TEM, qnrS, and intl1 genes was reduced. The cultivable microorganisms grew again after 3 days of storing the treated wastewater (TW), making it impossible to reuse such effluent after storage. Therefore, the potential capacity of a diverse bacterial community present in river water to inhibit the regrowth of potentially harmful bacteria present in the urban secondary wastewater after the application of the treatment process was also evaluated. To the authors’ knowledge, this has never been studied before. For this purpose, the TW was diluted with river water (R) at a volumetric percentage of 50/50—sample R+TW. It was found that, after storage, only the total heterotrophs grew, while the abundance of the targeted genes remained practically constant. The R+TW sample after storage met the legal limits for reuse in urban and agricultural applications. The results of this study suggest that the combination of the H₂O₂+UV/visible radiation treatment with dilution of the final treated effluent with natural surface water can contribute to reducing the burden of water scarcity. Full article

Mitochondrial 3-hydroxy-3-methylglutaryl-CoA synthase deficiency (HMGCS2D) is a rare metabolic disorder that impairs the body’s ability to produce ketone bodies and regulate energy metabolism. Diagnosing HMGCS2D is challenging because patients typically remain asymptomatic unless they experience fasting or illness. Due to the absence of reliable biochemical markers, genetic testing has become the definitive method for diagnosing HMGCS2D. This study included 19 patients from 14 unrelated families diagnosed with HMGCS2D in our department between October 2018 and October 2024. The clinical presentations, biochemical findings, molecular characteristics, and management strategies were systematically summarized and analyzed. Of the 19 cases studied, 16 were symptomatic, and 3 were asymptomatic. The onset of the first acute episode occurred between 10 days and 28 months of age. Triggers for the initial crisis in the symptomatic cases included poor feeding (93.8%), vomiting (56.3%), diarrhea (25.0%), and fever (18.8%). Clinical manifestations during the first episode were lethargy/coma (81.3%), rapid breathing (68.8%), hepatomegaly (56.3%), shock (37.5%), and seizures (18.8%). The biochemical abnormalities observed included elevated plasma transaminases (100%), metabolic acidosis (75%), hypoglycemia (56.3%), and elevated plasma ammonia levels (31.3%). Additionally, low free carnitine levels were found in seven cases, elevated C2 levels were found in one case, dicarboxylic aciduria was found in two cases, and ketonuria was found in two cases. Abnormal brain MRI findings were detected in three patients. Genetic analysis revealed seven HMGCS2 gene variants across the 19 cases. Notably, a novel variant, c.407A>T (p.D136V), was identified and has not been reported in any existing databases. Two common variants, c.559+1G>A and c.1090T>A (p.F364I), were present in 11 out of 19 cases (57.9%) and 10 out of 19 cases (55.5%), respectively. The implementation of a high glucose infusion and proactive management strategies—such as preventing prolonged fasting and providing enteral carbohydrate/glucose infusion during illness—effectively reduced the rate of acute relapses following accurate diagnosis. Currently, all 19 patients are alive, with ages ranging from 5 months to 14 years, and exhibit normal physical development. To the best of our knowledge, this study represents the first reported cases of HMGCS2D in Vietnamese patients. Our findings contribute to a broader understanding of the clinical phenotype and expand the known spectrum of HMGCS2 gene variants, enhancing current knowledge of this rare metabolic disorder. Full article

Ceratonia siliqua L. (Fabaceae) is an evergreen sclerophyllous species that successfully overcomes the challenges of the Mediterranean climate. Commonly, biosynthesis of secondary metabolites is a major reaction of the plants thriving in the Mediterranean formations against temperature stress. Due to concerns about the climate crisis, we studied the impact of 6-day low (5 °C) and high (40 °C) temperature stress on young carob seedlings. In stressed plants, mainly the heat-treated, the leaves appear xeromorphic. Parameters of the physiology of the plants such as chlorophyll-a and -b, total phenolic content, and oxidative stress were measured and presented via Principal Component Analysis. Chlorophyll-a and -b contents are inferior in cold-stressed leaves while heat-stressed leaves accumulate more phenolics and experience higher oxidative stress as compared to their cold-stressed counterparts. The phytochemical profile of different extracts obtained from stressed carob leaves was identified so as to gain insight into metabolites produced under stress. Moreover, LC-HRMS/MS metabolomic workflow was utilized for the discovery of biomarkers, over- or under-regulated in stressed conditions. The antimicrobial activity of carob leaf extract fractions was assessed against six human pathogen strains and three phytopathogen bacterial strains. MeOH-H₂O and dichloromethane (DCM) extracts presented notable activity against Candida albicans and Saccharomyces cerevisiae, while DCM extracts inhibited the growth of Erwinia amylovora. We may conclude that carob tree exposure to temperature stress does not have a significant influence on secondary metabolic pathways. Full article