Search Results (148)

Ovarian endometriosis (OE) is a chronic, inflammatory gynecological disorder associated with sterility and an elevated risk of ovarian cancer. Despite its high prevalence, the complex molecular mechanisms governing OE pathogenesis remain poorly investigated. We conducted a comprehensive histopathological and molecular investigation of OE in a cohort of 188 Saudi women (88 patients with OE and 100 healthy controls) using histopathological, qRT-PCR, immunostaining, and Western blot techniques. Histopathological analysis confirmed significant stromal fibrosis and chronic inflammation in endometriotic lesions. Gene expression profiling revealed a pro-proliferative, anti-apoptotic signature, marked by the upregulation of PTTG1 and the downregulation of TNFRSF10D, CDK4, and CDKN1A. Interestingly, we identified a post-transcriptional regulatory paradox in the inflammatory response: while IL-6 mRNA was significantly upregulated, its corresponding protein level was downregulated, suggesting a novel, tightly controlled mechanism to limit excessive local inflammation. Besides the increased autophagic activity and decreased Ubiquitin mRNA levels, epigenetic dysregulation was prominent, characterized by the upregulation of DNA methyltransferase DNMT3B and the downregulation of the histone variant H3.1. These findings elucidate novel molecular pathways underlying OE pathogenesis as evidenced by a post-transcriptional paradox in IL-6 expression, and uncover key dysregulations spanning cell proliferation, apoptosis, inflammation, autophagy, and epigenetic regulation. Full article

Literature screening is a major bottleneck in systematic reviews, yet Large Language Models (LLMs) can substantially reduce workloads. However, performance varies across models and is sensitive to evaluation metrics, particularly in low-prevalence screening contexts. We validated five LLMs (GPT-4.1, Claude 3.5 Sonnet, Gemini 2.0 Flash, DeepSeek V3, and Mistral Large) against a 500-record gold-standard dataset (8 inclusions; 1.6% prevalence) using a conservative zero-shot prompt aligned with standard systematic review workflows. Performance was assessed through classification metrics (sensitivity, specificity, precision), logistic regression (GLM; Firth-penalised where separation occurred), and agreement indices (Cohen’s κ, MCC, PABAK, Gwet’s AC1). Gemini 2.0 Flash and Mistral Large showed no false negatives (1.00) but differed in specificity (0.858 vs. 0.697) and accuracy (0.860 vs. 0.702). GPT-4.1 and Claude 3.5 Sonnet performed identically (sensitivity 0.875; specificity 0.876; accuracy 0.876). In contrast, DeepSeek V3 maximised specificity (0.980) and accuracy (0.970) but demonstrated lower sensitivity (0.375). Regression analyses confirmed strong positive associations with human decisions (OR 28.9–49.5). Agreement indices revealed the expected low-prevalence artefact, with Cohen’s κ low despite high concordance while MCC, PABAK, and AC1 indicated substantially stronger agreement. Our results highlight a fundamental sensitivity-specificity trade-off, with conclusions dependent on the evaluation framework chosen. LLMs may meaningfully support title-abstract screening as decision-support tools, provided that human oversight is maintained and validation is transparent and reproducible. Full article

Implementation remains a central challenge in urban policy, yet the knowledge formats designed to bridge the gap between policy goals and on-the-ground delivery remain under-examined. This study treats 250 UN-Habitat Best Practice reports not as proof of effectiveness but as a standardized genre through which local interventions are narrated, compressed, and made portable for replication. We extract three focal sections, namely Results, Lessons Learned, and Transferability, apply systematic thematic coding with 906 open codes consolidated into axial categories, and compute co-occurrence networks using Jaccard similarity and Lift to detect thematic bundles, holes, and silos within and across sections. Three findings emerge. First, the reporting repertoire narrows progressively, as mean thematic richness declines by 28.2% from Results to Transfers while concentration increases 4.2 times, with substantive dimensions such as governance, equity, sustainability, and evidence losing prevalence to circulation-oriented themes. Second, formal bundle detection yields zero qualifying pairs across all six matrices, indicating a loosely coupled reporting grammar anchored by generic silos rather than integrated implementation packages. Third, structural holes concentrate at the pipeline’s end, where infrastructure transfer and sustainability as transferable value are the most systematically disconnected themes. These patterns reveal a portability paradox in which the reporting format achieves institutional legibility, making practices comparable within a shared vocabulary, but progressively filters out the physical, evidentiary, and context-sensitive content that operational reproduction would require. Full article

This essay examines the visual culture of what might be termed “the ecology of silver” between 1492 and 1710 in relation to colonialism on both sides of the Atlantic, with particular attention to both its shiny allure and the blind spots that that shininess produces. It focuses on three inter-related areas: depictions of Potosí, the great silver mountain in viceregal Peru; silver’s shine in European elite material culture; and the deployment of silver in celebrating the Spanish monarchy in viceregal Sicily, part of its empire within Europe. Current scholarship on early modern silver bifurcates between historical, political, and anthropological studies of silver’s extraction in the Americas and colonialism on one hand and a celebratory art historical scholarship focused on high-end European silver goods on the other. Scholars have energetically examined its extraction, the global trade in bullion, the rise of capitalism that it fed, and the wars that it fomented and paid for, but they stop short of inquiring into the ends to which silver was deployed within Europe and Asia beyond the naming of the principal ports. Meanwhile, studies of silver in Europe are overwhelmingly tightly drawn and connoisseurial, often with no reference to where the silver came from, let alone the circumstances of its extraction, transport, or even its effects. This split is due partly to a prevalent notion that silver’s value is inherent, objective, and caused by “rarity”; and it is partly due to art history’s unswerving identification with the rich and powerful. Such approaches overlook silver’s remarkable material and alchemical qualities and ignore its capacity to turn grubby profit into charismatic sparkle, which simultaneously drove the ecological and environmental damage and exonerated its profiteers. Early modern silver linked environmental destruction, colonialism, genocide, and coloniality to high culture, making it a particularly relevant topic for art historical analysis in this context. But more than that silver entwined them in complex, convulsive, and transformative ways, turning imperialism, violence and exploitation into beauty, shimmer and cultural sophistication. Hence, this essay insists on the centrality of imperial issues in the Old World as in the New, underscoring colonial dynamics within metropolitan culture while critically examining the work of seduction of art. The paradoxical quality of shine is the lens through which is seen the relation between violent coloniality and the allure and ecology of early modern silver. Full article

Background: Iron deficiency (ID) is a prevalent condition in patients with cardiovascular diseases, irrespective of anemia, associated with adverse outcomes. Its incidence and prognostic value in acute coronary syndromes (ACS) are yet to be established. Current literature on the matter is scarce, and further research is necessary to confirm a clear link between ID and possible adverse outcome prediction in this group. Aims: This study aimed to evaluate the incidence and prognostic value of ID in ACS patients, and associations between iron parameters and patients’ characteristics, comorbidities, hospitalization length, laboratory results, electrocardiographic, echocardiographic assessment, and invasive coronary angiography results. Methods: We conducted an observational prospective study enrolling 214 consecutive patients after ACS. Adverse events were defined as all-cause death or non-elective rehospitalization due to cardiovascular causes. Results: ID patients constituted 46.7% of the studied cohort. ID was associated with higher NT-proBNP on admission (p = 0.03). Higher TSAT was independently associated with lower peak troponin levels (β = −0.03, standardized β = −0.15, p = 0.03). Ferritin < 100 ng/mL was paradoxically associated with shorter in-hospital stay (p = 0.03). In multivariable analysis, ID was an independent predictor of the composite endpoint (HR 1.94 [95% CI: 1.02–3.67], p = 0.04); however, no significant differences in event-free survival have been identified between ID and non-ID groups. Conclusions: ID is a common condition in ACS patients, associated with higher values of biomarkers reflecting cardiac damage, and may constitute an important predictor of adverse events after discharge. Further, larger, preferably multicenter studies are required to establish the exact association between ID and mortality among ACS patients treated with percutaneous coronary intervention. Full article

The construction industry accounts for approximately 13% of global GDP but suffers from chronic productivity stagnation. Although artificial intelligence (AI) offers transformative potential, its adoption is constrained by three key barriers: data integrity issues (H1), socio-technical challenges (H2), and system integration problems (H3). This study investigates whether academic research attention aligns with these practitioner-identified barriers through a bibliometric analysis of 4668 publications from OpenAlex (1990–2025), applying a five-pillar analytical framework synthesized into composite scores (0–100 scale) via min-max normalization, weighted summation, and bootstrap validation. H3 achieved a nominal 15.9% prevalence rate (adjusted to ~13.0% after correcting for an 18.2% false positive rate in keyword classification), robust growth (R² = 0.654), significant overrepresentation in top-cited works (risk ratio = 1.31, p = 0.003), and received a composite score of 62/100 (confirmed). H1 (2.7%, score: 17/100) and H2 (4.6%, score: 13/100) were both rejected. The rank ordering by prevalence (H3 > H2 > H1) remains robust under all adjustment scenarios. These findings contrast notably with the RICS Global Construction Monitor (2025, n = 2200+), where practitioners most frequently reported socio-technical barriers (46%), followed by system integration (37%) and data quality (30%), yielding practitioner-to-publication ratios of 4.7:1, 5.2:1, and 1.1:1, respectively. This apparent research–practice paradox appears primarily volume-driven rather than clearly quality-driven: H1/H2 publications receive citation attention broadly comparable to the baseline, though this comparison is limited by control group heterogeneity. We call for rebalanced research agendas addressing data governance frameworks, competency development, and organizational change management. Full article

Background and Objectives: Thrombocytopenia complicates 6.6–11.6% of pregnancies. While gestational thrombocytopenia (GT) is usually benign, etiologies such as immune thrombocytopenia (ITP), preeclampsia, and HELLP syndrome require individualized management. This study aimed to characterize the etiological spectrum, maternal peripartum hematologic outcomes, blood product utilization, and mode of delivery in a tertiary-center cohort of thrombocytopenic pregnancies and to assess whether platelet count should influence delivery mode decisions. Materials and Methods: This retrospective cohort study included 137 thrombocytopenic pregnant women at a tertiary center (2010–2019), categorized by etiology and severity. Peripartum hemoglobin, hematocrit, and platelet counts were compared between delivery groups. Blood product utilization was recorded and analyzed using t-test, ANOVA, chi-square, Fisher’s exact, and Fisher–Freeman–Halton tests; binary logistic regression was used for multivariable analysis. Results: GT (43.1%) and ITP (32.1%) were the most prevalent diagnoses; cesarean delivery rate was 52.6%. Postpartum Hb was higher in the vaginal delivery group (10.24 ± 1.28 vs. 9.80 ± 1.26 g/dL; p = 0.003), while platelet counts were paradoxically lower (p = 0.039). Platelet transfusion rates did not differ significantly between delivery modes (23.1% vs. 27.8%; p = 0.621). Severe thrombocytopenia required platelet transfusion in 92.6% of cases versus 11.6% (moderate) and 0% (mild) (p < 0.001). RBC transfusion was highest in gestational hypertensive disease (41.2%) versus GT (5.1%) and ITP (2.3%) (p < 0.001). General anesthesia was used in 75% of cesarean cases. Conclusions: Delivery mode in thrombocytopenic pregnancies should be guided by obstetric indications, not platelet count alone. Although postpartum platelet counts declined more steeply after vaginal delivery, this did not increase transfusion requirements. Gestational hypertensive disorders carried the greatest hemorrhagic burden, highlighting the need for etiology-specific multidisciplinary planning. The high general anesthesia rate warrants prospective institutional audit of anesthetic decision-making protocols to determine adherence to current neuraxial anesthesia thresholds. This study is limited to maternal peripartum hematologic outcomes; neonatal outcomes were not captured and should be addressed in future prospective research. Full article

Background: The global demographic shift towards an aging population has driven a steady, exponential increase in the utilization of cardiac implantable electronic devices (CIEDs). Consequently, device-related infectious complications have emerged as a leading cause of morbidity and healthcare expenditure. Patients in their eighth decade of life—octogenarians (aged 80–90 years)—represent an exceptionally high-risk demographic due to the compounding factors of physiological frailty, immunosenescence, and complex multi-morbidity. Despite this growing demographic, their specific clinical presentations, microbiological profiles, and procedural outcomes following infection remain poorly defined in the current literature. This study aimed to comprehensively compare the clinical characteristics, pathogen distribution, and in-hospital outcomes of CIED infections in an octogenarian cohort against a younger patient population. Methods: We conducted a robust retrospective cohort analysis of 383 consecutive patients treated for confirmed CIED infections at one major tertiary referral center (Heidelberg University Hospital) between January 2002 and December 2022. The cohort was stratified by age into octogenarians (n = 76) and a younger control group (n = 307). We systematically extracted and compared data regarding baseline clinical presentation, chronic comorbidities, detailed microbiological cultures (pocket, blood, and extracted leads), and definitive in-hospital outcomes, primarily mortality and length of stay. Results: The octogenarian cohort exhibited a significantly heavier comorbidity burden, notably higher rates of coronary artery disease (51.3% vs. 29.6%, p < 0.001), systemic hypertension (55.3% vs. 38.1%, p = 0.007), and chronic obstructive pulmonary disease (7.9% vs. 1.6%, p = 0.003). Furthermore, therapeutic systemic anticoagulant use was substantially more prevalent in the elderly group (60.5% vs. 45.0%, p = 0.015). Octogenarians presented overwhelmingly with localized generator pocket infections (73.0% vs. 30.0%, p < 0.001) but paradoxically also demonstrated higher rates of systemic bacteremia and sepsis (26.3% vs. 15.0%, p = 0.019). Microbiological analysis revealed a unique pathogen profile, with Staphylococcus capitis found with significantly higher frequency in the generator pockets of the elderly cohort. Remarkably, despite possessing a higher average lead burden (2.1 vs. 1.2 leads) and extreme comorbidity profiles, octogenarians demonstrated no statistically significant differences in in-hospital mortality (3.9% vs. 4.2%, p = 1.000) or overall length of hospital stay (14.7 vs. 17.2 days, p = 0.386) when compared to the younger cohort. Conclusions: Octogenarians suffering from CIED infections display highly distinct clinical and microbiological profiles, characterized predominantly by elevated rates of localized pocket infections, specific opportunistic pathogens, and a severe underlying comorbidity burden. Crucially, our findings indicate that with the application of modern extraction and management protocols, advanced age alone does not intrinsically correlate with increased in-hospital mortality. Future prevention and perioperative management strategies tailored to this rapidly expanding demographic must heavily prioritize the mitigation of pocket-related complications, particularly considering the high prevalence of concurrent anticoagulation therapy. Full article

Background: Obesity, type 2 diabetes mellitus, and hypertension are increasingly prevalent components of metabolic syndrome and major contributors to cardiovascular disease and chronic kidney disease progression; however, in end-stage kidney disease an “obesity paradox” has been described, with higher body mass index (BMI) sometimes associated with improved survival on hemodialysis. Material and methods: This retrospective, single-center Eastern European cohort study aimed to characterize mortality and its causes around hemodialysis initiation in the contemporary era of cardiometabolic prevention and to test whether the obesity paradox persists at this high-risk transition. Adult patients initiating dialysis at the “Pius Brânzeu” Emergency Clinical Hospital (Timișoara, Romania) between January 2022 and December 2025 (n = 268; median age 66 years; 61% male; median eGFR 6.4 mL/min/1.73 m²) were analyzed using Kaplan–Meier methods and Cox regression, with comprehensive baseline clinical, laboratory, echocardiographic, medication, infection, and vascular access data; follow-up was obtained at 3, 6, 12, 24, and 36 months. Results: Late referral was common (61% < 3 months of nephrology follow-up), dialysis initiation was predominantly urgent (only 16% scheduled), and central venous catheters were the main access (81%), with substantial comorbidity burden (cardiovascular disease 71%, hypertension 90%) and frequent infections at initiation. BMI categories were non-obese (<25 kg/m², 30%), overweight (25–29.9 kg/m², 48%), and obese (≥30 kg/m², 22%); diabetes prevalence rose with BMI (32% to 58%). Unadjusted mortality did not differ by BMI (19.8%, 18.8%, 15.3%; log-rank p = 0.622), yet multivariable Cox models showed overweight status independently reduced mortality (HR 0.22 at 3 months, 0.29 at 1 year, 0.31 at 3 years vs. non-obese), whereas obesity was not protective. Early mortality was driven mainly by age ≥ 65 years, while diabetes and chronic obstructive pulmonary disease predicted later mortality; longer pre-dialysis follow-up time was strongly protective (HR per year 0.70 at 3 years), and higher intact parathyroid hormone showed an inverse association with 1-year mortality. Conclusions: These findings show a modified obesity paradox at dialysis initiation in which moderate excess weight, but not obesity, is associated with improved adjusted survival, underscoring the clinical importance of earlier nephrology engagement and individualized nutritional and risk-factor management during the pre-dialysis and early dialysis periods. Full article

(1) Background: While anticipatory anxiety is well-established in the psychological literature, the specific phenomenon of distress experienced during waiting for positive, rationally certain outcomes remains under-theorized and clinically under-recognized. (2) Methods: This paper presents a conceptual analysis and theoretical proposal introducing ‘Waiting Anxiety,’ defined as a hypothesized pattern of anticipatory distress characterized by heightened cognitive rumination, physiological arousal, and emotion regulation failure during periods of delayed resolution, specifically when the awaited outcome is positive and rationally certain (e.g., an approaching wedding, confirmed promotion, or approved visa). (3) Results: Distinct from traditional anticipatory anxiety tied to threat perception, waiting anxiety is proposed as a paradoxical form of distress that emerges despite primary outcome certainty. The construct is theoretically grounded in emotion regulation failures, temporal perception distortions, and impatience mechanisms, and is illustrated through five clinical cases. (4) Conclusions: This paper argues for waiting anxiety as a hypothesized psychological pattern warranting empirical investigation. Future psychometric, epidemiological, and neurobiological research is needed to establish its validity, prevalence, and clinical utility. If validated, integration into clinical frameworks could improve understanding of affective experience during positive life transitions. Full article

Background: Obesity is commonly seen as a condition of overnutrition; however, it is paradoxically associated with micronutrient deficiencies. These deficiencies are clinically relevant and may contribute to the progression of obesity-related comorbidities through interconnected pathways, including chronic low-grade inflammation, oxidative stress, gut dysbiosis, and impaired nutrient absorption. Objectives: This narrative review aims to summarize current evidence regarding the prevalence, underlying mechanisms, and clinical consequences of micronutrient deficiencies in individuals with obesity, with particular emphasis on their metabolic implications and potential therapeutic strategies. Results: Among individuals with obesity, iron, zinc, magnesium, calcium, vitamin D, vitamin B12, and folate are the most frequently reported deficiencies. These deficiencies arise from multiple mechanisms, including poor diet quality, increased metabolic demands, and compromised gastrointestinal absorption. In addition, obesity-related alterations in pharmacokinetics may further interfere with micronutrient distribution and bioavailability. Together, these mechanisms may lead to various clinical outcomes, such as anemia, immune, metabolic, and cardiovascular dysfunctions, along with cognitive impairment. Although several studies suggest that correcting these deficiencies may improve clinical outcomes, findings remain inconsistent, highlighting the complex and multifactorial pathophysiology underlying micronutrient imbalance in obesity. Conclusions: Micronutrient deficiencies represent frequently overlooked contributors to metabolic dysregulation in obesity. Their identification and correction should be considered a central part of the obesity management strategy. A personalized supplementation approach, based on clinical, biological, and pathophysiological characteristics, may provide a complementary support for weight-management treatments. Full article

Coronary atherosclerosis in master athletes represents a paradox: despite the well-established cardiovascular benefits of regular exercise, highly trained endurance athletes show a higher prevalence of coronary plaques than their non-athletic peers. The mechanisms behind this finding are multifactorial, involving sustained high shear stress on the vascular wall, exercise-induced inflammatory activation, altered calcium homeostasis, and interactions between genetic predisposition and sport-specific lifestyle factors. Although athletes tend to exhibit predominantly calcified—potentially more stable—plaques, recent studies highlight that mixed and non-calcified lesions are also present, particularly among lifelong endurance athletes, raising questions about their true long-term risk. Clinically, traditional risk scores often underestimate risk in this population, making multimodal assessment with tools such as coronary calcium scoring and coronary CT angiography essential. This review synthesizes the current knowledge on mechanisms, clinical implications, diagnostic strategies, and prevention of coronary atherosclerosis in athletes, while underscoring key gaps that future research must address. Full article

Procrastination is commonly conceptualized as a maladaptive self-regulatory failure associated with impaired performance and reduced control over task execution. However, recent research suggests that procrastination may also assume a functional form, referred to as active procrastination, characterized by intentional delay combined with preserved control and effectiveness. The present study aimed to examine the relationship between the level of procrastination and perceived control over academic tasks among psychology students, as well as to explore differences according to gender, study level, and mode of study. A quantitative cross-sectional pilot study was conducted using an online self-report survey administered to 300 psychology students aged 18–30 years from universities in southern Poland. An author-developed questionnaire with good internal consistency (Cronbach’s α = 0.84) was used to assess procrastination behaviors, perceived task control, and self-reported academic functioning. The results indicated a high prevalence of procrastination behaviors alongside high levels of declared task control, timely task completion, and satisfaction with task quality. Women reported significantly lower levels of procrastination than men, while no significant differences were observed with respect to study level or mode. The findings support the existence of a functional paradox of procrastination and provide evidence consistent with the concept of active procrastination, suggesting that perceived control may buffer the negative consequences of delaying academic tasks. Full article

Background: The relationship between testosterone and coronary artery disease (CAD) remains a subject of debate. Most studies suggest an inverse association—lower testosterone, higher risk. However, data from Central European populations undergoing coronary angiography are limited. Objectives: To investigate the association between serum testosterone levels and angiographically confirmed coronary artery stenosis in a Slovak population. Methods: This cross-sectional study included 129 consecutive stable patients (84 men, 45 women; mean age 64.3 ± 9.7 years) undergoing elective coronary angiography for suspected stable coronary artery disease. Significant coronary stenosis was defined as ≥50% luminal narrowing in any major epicardial vessel. Serum testosterone, lipid profile, and traditional risk factors were assessed. Univariate and multivariate logistic regression models were constructed to evaluate independent associations of coronary stenosis. Results: Coronary stenosis ≥ 50% was present in 74 patients (57.4%). Notably, patients with stenosis had significantly higher testosterone levels (6.62 ± 2.79 vs. 4.85 ± 3.50 ng/mL, p = 0.002). In univariate analysis, testosterone showed a significant association (OR 1.197 per ng/mL, OR 1.784 per SD, p = 0.003). In multivariate analysis adjusted for age, sex, diabetes mellitus, and LDL (low-density lipoprotein) cholesterol, testosterone remained independently associated (adjusted OR 2.043 per SD, 95% CI 1.221–3.420, p = 0.007), as did diabetes mellitus (OR 2.60, p = 0.032). Conclusions: Elevated serum testosterone is paradoxically associated with increased prevalence of coronary stenosis in our cohort. These findings from stable, chronic CAD patients may work fundamentally differently from what is observed in acute coronary syndromes, where stress-induced testosterone suppression may confound observed associations. Full article

Domestic cats are among the most popular companion animals worldwide, with steadily increasing ownership and life expectancy. Paradoxically, despite their high prevalence and shared environmental exposures with humans, cats remain markedly underrepresented in molecular oncology research. Cancer is a leading cause of feline mortality, and alimentary lymphoma (AL) has emerged as one of the most common feline malignancies, yet its molecular landscape remains poorly characterized. This review summarizes current knowledge on feline AL, including epidemiology, risk factors, classification schemes, diagnostic challenges, treatment outcomes, and survival, with particular emphasis on low-grade alimentary lymphoma (LGAL), the most prevalent subtype. We discuss the complex relationship between chronic inflammatory enteropathies and lymphoma, highlighting diagnostic ambiguities and the inflammatory–neoplastic continuum. Importantly, we provide a critical overview of existing genomic, transcriptomic, epigenomic, proteomic, and metabolomic studies in feline AL, revealing a striking paucity of high-throughput, multi-omics analyses based on clinical material. Recent advances in feline genome assembly and annotation offer new opportunities to address these gaps. Furthermore, we compare feline AL with its human gastrointestinal T-cell lymphoma counterparts, demonstrating substantial molecular homology across key oncogenic pathways, including JAK/STAT signaling. This comparative perspective underscores the potential of feline AL as a naturally occurring model for the human disease. We conclude that comprehensive molecular characterization of feline AL is urgently needed to improve diagnostics, prognostication, and targeted therapies, with likely translational benefits for both veterinary and human oncology. Aim: The goal of this review is to summarize the current knowledge on feline alimentary lymphoma, including its origin, risk, classification, treatment approaches, and especially molecular landscape, which still remains poorly investigated with modern high-throughput techniques. Full article