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Search Results (10,765)

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22 pages, 575 KB  
Systematic Review
Hydration Care After Stroke: A Systematic Review of International Clinical Practice Guidelines
by Colette Miller, Elizabeth Boaden, Alison S. R. Mcloughlin, Caroline L. Watkins and Stephanie P. Jones
Nutrients 2026, 18(11), 1672; https://doi.org/10.3390/nu18111672 (registering DOI) - 23 May 2026
Abstract
Background/Objectives: Hydration status at the time of stroke has been identified as a predictor of both vital and functional prognosis. Many studies have demonstrated that dehydration is associated with poorer outcomes, yet the prevalence of dehydration in those affected by stroke remains high. [...] Read more.
Background/Objectives: Hydration status at the time of stroke has been identified as a predictor of both vital and functional prognosis. Many studies have demonstrated that dehydration is associated with poorer outcomes, yet the prevalence of dehydration in those affected by stroke remains high. In this review, we systematically identify, appraise and summarise international clinical practice recommendations regarding hydration care after stroke. Methods: International clinical practice guidelines, published since 2009, were identified through a combination of searches of four online databases, searching of relevant websites and guidelines repositories, and citation tracking. Independent screening and data extraction were followed by quality appraisal using the AGREE II tool, and qualitative content analysis underpinned by a priori defined categories. Results: Thirteen clinical practice guidelines were included, from which 35 eligible recommendations were identified. Only seven (54%) guidelines were rated as high-quality (adequately addressing at least three AGREE II domains including “Rigour of development”). The majority of the 35 recommendations were intended for application to all stroke patients (23, 66%). Specific sub-populations, for whom hydration care was emphasised included people with dysphagia (8, 23%), immobile (2, 6%) and catheterised patients (1,3%), and those with cerebral oedema (1, 3%). Hydration care was most often discussed in the context of the avoidance and/or management of post-stroke complications, with only 8 (23%) recommendations specifically discussing hydration care alone. Of those eight recommendations, 3 (38%) suggested all stroke patients should have their hydration assessed, and 5 (62%) proposed methods of hydration management. Conclusions: The review demonstrates that international stroke guidelines recognise the importance of hydration care, although almost half of the guidelines are low to moderate quality and consider hydration in the context of post-stroke complications. Whilst hydration care, routine assessment and management of hydration status, is broadly endorsed, methods remain poorly defined. Further high-quality evidence is needed to support the development of standardised, evidence-based guidelines. Future guidelines should address the timing and methods of assessment, including the establishment of diagnostic thresholds to inform the interpretation of haematological results and subsequent treatment decisions. Full article
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15 pages, 518 KB  
Article
A Prospective Multi-Center Newborn Screening for Thalassemia by Comprehensive Analysis of Thalassemia Alleles (CATSA) Based on Single Molecule Real-Time Sequencing in Guangxi, China
by Aihua Xia, Hongfei Chen, Fuhua Lu, Ping Xu, Peixiao Shen, Wei Wei, Chunrong Gui, Juliang Liu, Dan Wei, Haipeng Qin, Yan Huang, Ju Long and Baoheng Gui
Int. J. Neonatal Screen. 2026, 12(2), 37; https://doi.org/10.3390/ijns12020037 - 22 May 2026
Abstract
Thalassemia is one of the most common inherited diseases in Guangxi, China. Early identification of thalassemia by neonatal screening is beneficial for effective clinical management and treatment. A total of 3671 newborns from multiple centers of Guangxi were prospectively recruited and screened for [...] Read more.
Thalassemia is one of the most common inherited diseases in Guangxi, China. Early identification of thalassemia by neonatal screening is beneficial for effective clinical management and treatment. A total of 3671 newborns from multiple centers of Guangxi were prospectively recruited and screened for thalassemia using single molecule real-time (SMRT) sequencing technology. A total of 36 types of variants of globin genes were identified, including 16 common variants and 20 rare variants in the Chinese population. In total, 956 (26.04%) newborns were identified to carry thalassemia variants, including 672 (18.31%) α-thalassemia, 228 (6.21%) β-thalassemia, 55 (1.50%) combined α/β-thalassemia and 1 (0.03%) δ-thalassemia. In addition, this study showed that the carrier rates of structural variants of α-globin genes and abnormal hemoglobin variants were 1.28% and 0.93% respectively. Phenotypically, 12 newborns with hemoglobin H disease and 2 cases with intermedia β-thalassemia were found, two of whom would be misdiagnosed by conventional genetic analysis methods. Collectively, this study characterized the complexity and diversity of thalassemia gene variants in newborns of Guangxi, and further achieved early identification of newborns with intermedia thalassemia, which facilitated precision prevention of thalassemia in this region. Also, SMRT provided a powerful tool for neonatal thalassemia screening, especially in prevalent regions. Full article
16 pages, 284 KB  
Review
Best Practice Recommendations for the Assessment, Prevention and Treatment of Vitamin D Deficiency in Türkiye: A 2026 Update in a Setting with Limited Mandatory Food Fortification
by Dilek Gogas Yavuz, Ömercan Topaloğlu, Mutlu Güneş, Alper Gürlek, Ayşe Kubat Üzüm, Zafer Pekkolay, Zeynep Cantürk, Zeliha Hekimsoy, Özen Öz Gül and Refik Tanakol
Nutrients 2026, 18(11), 1665; https://doi.org/10.3390/nu18111665 - 22 May 2026
Abstract
Background: Vitamin D deficiency is a common global health problem and remains highly prevalent in Türkiye, where limited food fortification and heterogeneous clinical practices contribute to variability in testing and supplementation strategies. Aims: To provide Türkiye-specific best practice recommendations for defining clinically relevant [...] Read more.
Background: Vitamin D deficiency is a common global health problem and remains highly prevalent in Türkiye, where limited food fortification and heterogeneous clinical practices contribute to variability in testing and supplementation strategies. Aims: To provide Türkiye-specific best practice recommendations for defining clinically relevant serum 25-hydroxyvitamin D [25(OH)D] thresholds, identifying adult risk groups for targeted testing, and recommending evidence-based prevention, treatment, and monitoring approaches while minimizing under-treatment and inappropriate high-dose use. Methods: This national expert consensus document was developed by endocrinologists from across Türkiye using a structured, modified Delphi methodology. Draft statements informed by systematic literature reviews were rated via online surveys using a 9-point Likert scale, followed by two Delphi rounds and a face-to-face consensus meeting in İstanbul in October 2025. Results: Recommendations addressed sun exposure, laboratory assessment, screening, supplementation, treatment, and follow-up. Serum 25(OH)D <20 ng/mL was defined as deficiency and <12 ng/mL as severe deficiency, with a target range of 20–50 ng/mL. Routine population-wide screening was not recommended; instead, targeted testing in high-risk adults and symptom-driven biochemical evaluation were endorsed. Empiric supplementation was recommended for selected high-risk groups, with cholecalciferol as the preferred agent. Higher individualized doses were suggested in obesity or malabsorption, while loading regimens were reserved for specific clinical indications, such as severe deficiency or certain medical conditions that impair vitamin D metabolism. Reassessment of 25(OH)D at 8–12 weeks was recommended. Conclusion: These consensus-based recommendations provide a practical, context-specific framework for assessing, preventing, treating, and monitoring vitamin D deficiency in adults in Türkiye. Full article
(This article belongs to the Section Micronutrients and Human Health)
14 pages, 491 KB  
Article
Chlorination of Clothianidin During Disinfection: Kinetics, Pathways, and Toxicity
by Fang Wei, Lei Wu, Fei Meng, Sanyan Du, Xinyuan Wu and Jun Hu
Toxics 2026, 14(6), 453; https://doi.org/10.3390/toxics14060453 - 22 May 2026
Abstract
Neonicotinoid pesticides are a typical category of emerging hazardous micropollutants, and chlorine (Cl2) is a widely used disinfectant that readily induces the chlorination of organic micropollutants. This study systematically investigated the chlorination kinetics and transformation pathways of a representative neonicotinoid pesticide [...] Read more.
Neonicotinoid pesticides are a typical category of emerging hazardous micropollutants, and chlorine (Cl2) is a widely used disinfectant that readily induces the chlorination of organic micropollutants. This study systematically investigated the chlorination kinetics and transformation pathways of a representative neonicotinoid pesticide (clothianidin, CLO) and evaluated the cytotoxicity variation via Chinese Hamster Ovary (CHO) cell assays. CLO chlorination followed second-order kinetics, with a first-order dependence on both CLO and Cl2 concentrations, and the apparent rate constant (kapp) value was measured to be 1.758 × 10−4 μM−1 h−1, at a pH of 7.0. The CLO chlorination initially accelerated and then retarded with the increase in pH. The same tendency was involved in the yield of disinfection byproducts (i.e., trihalomethanes and haloacetic acids). Dissolved organic matter was also a crucial factor inhibiting the chlorination of CLO. The reaction of CLO+ with HOCl was more prevalent than between CLO+ with ClO, wherein HOCl likely exerts electrophilic attack either after 2-nitroguanidine hydrolysis or directly at the nitrogen sites of secondary amines. Cell exposure results revealed that the chronic cytotoxicity of CLO decreased significantly after chlorination. This study helps to the mechanistic understanding of neonicotinoid transformation during water disinfection, and provides a valuable reference for the control of neonicotinoid pesticides in drinking water. Full article
14 pages, 1393 KB  
Article
Comparable Fusion Response, but Increased Inflammatory Response, with Escherichia coli-Derived Recombinant Human Bone Morphogenetic Protein-2 in Posterior Lumbar Interbody Fusion Surgery
by Mu Ha Lee, Hyun Jun Jang, Kyung Hyun Kim, Jeong-Yoon Park, Sung Uk Kuh, Dong Kyu Chin, Keun Su Kim, Jae Keun Oh and Bong Ju Moon
J. Clin. Med. 2026, 15(11), 4026; https://doi.org/10.3390/jcm15114026 - 22 May 2026
Abstract
Background/Objectives: This retrospective study aimed to evaluate the radiologic outcomes and changes in biochemical inflammatory markers following posterior lumbar interbody fusion (PLIF) with Escherichia coli-derived recombinant human bone morphogenetic protein-2 (E.BMP-2), compared with conventional autologous bone grafting. Methods: The study [...] Read more.
Background/Objectives: This retrospective study aimed to evaluate the radiologic outcomes and changes in biochemical inflammatory markers following posterior lumbar interbody fusion (PLIF) with Escherichia coli-derived recombinant human bone morphogenetic protein-2 (E.BMP-2), compared with conventional autologous bone grafting. Methods: The study included 112 patients undergoing single- or two-level PLIF for degenerative lumbar disease between 2022 and 2023, divided into E.BMP-2 (n = 50) and Control (n = 62) groups. Radiological outcomes, including Bridwell grading system and adjacent vertebral body (VB) changes, and changes in biochemical inflammatory markers—white blood cell (WBC) count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and neutrophil count—were assessed. Clinical outcomes were also evaluated. Multivariate regression and propensity-score-matched analyses, and linear mixed-effects models were applied. Results: Fusion rates were comparable between the groups (90.8% vs. 96.7%; p = 0.466); adjusted analyses showed no independent association between E.BMP-2 use and fusion outcomes. The E.BMP-2 group demonstrated a higher prevalence of adjacent VB changes (78.5% vs. 54.3%; p = 0.001), and higher postoperative inflammatory markers including CRP levels on postoperative day 7 and at 1 month, along with increased neutrophil levels on postoperative day 4 (CRP day 7: 31.7 ± 26.4 mg/L vs. 18.7 ± 14.4 mg/L, p = 0.014; CRP 1 month: 7.2 ± 13.0 mg/L vs. 2.7 ± 3.8 mg/L, p = 0.022; neutrophil count day 4: 64.4 ± 10.6% vs. 60.6 ± 8.7%, p = 0.039). However, no significant differences in clinical outcomes, as assessed by VAS scores, were observed according to adjacent VB changes or inflammatory markers. Postoperative fever and infection rates were similar between groups. Conclusions: E.BMP-2 use in PLIF demonstrated fusion rates comparable to those of autografts, without demonstrated superiority. No significant differences in clinical outcomes were identified. Further large-scale prospective studies are needed to clarify its clinical role and optimal dosing. Full article
(This article belongs to the Section Orthopedics)
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21 pages, 5444 KB  
Article
Subtype-Specific Prognosis, Recurrence Patterns, and Molecular Features in 148 Chinese Uterine Sarcomas: A Real-World Study
by Ting Huang, Xinyu Xie, Xinqiao Du, Xiuling Sun, Guo Zhang and Jianliu Wang
Cancers 2026, 18(11), 1689; https://doi.org/10.3390/cancers18111689 - 22 May 2026
Abstract
Background: Uterine sarcomas are rare, heterogeneous malignancies with distinct pathological behaviors. This study aimed to identify clinicopathological characteristics, prognostic risk factors, and potential therapeutic targets to enhance clinical management. Methods: A retrospective analysis was conducted on 148 patients with uterine sarcoma treated at [...] Read more.
Background: Uterine sarcomas are rare, heterogeneous malignancies with distinct pathological behaviors. This study aimed to identify clinicopathological characteristics, prognostic risk factors, and potential therapeutic targets to enhance clinical management. Methods: A retrospective analysis was conducted on 148 patients with uterine sarcoma treated at Peking University People’s Hospital between 1996 and 2025. Clinical outcomes, pathological subtypes, and immunohistochemical profiles were assessed. Additionally, bioinformatics analyses from RNA bulk sequencing of GEO datasets (GSE87581, GSE85383, GSE222045 and GSE64763) were performed to elucidate molecular characteristics across subtypes. Results: The most prevalent subtypes were uterine leiomyosarcoma (uLMS; 38.5%) and low-grade endometrial stromal sarcoma (LG-ESS; 29.7%). The 5-year recurrence rate was 50.5%, with frequent metastases to the pelvis and lungs. LG-ESS demonstrated the most favorable 5-year survival rate (90.3%), significantly higher than that of uLMS (61.8%) and undifferentiated uterine sarcoma (50.0%). Multivariate analysis identified histological subtype, stage, and coagulative necrosis as independent prognostic factors for overall and progression-free survival. Transcriptomic profiling revealed immunosuppression (CSF1R/CSF3R expression) in high-grade ESS, while uLMS exhibited activation of cell cycle and homologous recombination pathways. Conclusions: Histological subtype, stage, and coagulative necrosis were critical prognostic factors in uterine sarcoma. The findings suggest that vigilant pulmonary surveillance and further investigation into tailored therapeutic strategies may be warranted-including endocrine therapy for hormone-receptor-positive tumors, immunotherapy for high-grade ESS, and PARP inhibitors for uLMS. However, these hypotheses require thorough preclinical and clinical validation. Additionally, caution should be exercised to avoid overtreatment of chemotherapy in early-stage uLMS. Full article
(This article belongs to the Section Cancer Pathophysiology)
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18 pages, 2515 KB  
Article
A Vision Transformer Model with Hyperparameter Optimization for Oral Cancer Image Classification
by Chun-Tai Huang, Ying-Lei Lin, Chung-Hui Lin and Ping-Feng Pai
Electronics 2026, 15(10), 2230; https://doi.org/10.3390/electronics15102230 - 21 May 2026
Abstract
Oral cancer is a significant public health concern and is among the most common malignant tumors of the head and neck. Its incidence and mortality rates remain persistently high, especially in regions where smoking and betel nut chewing are prevalent. Due to its [...] Read more.
Oral cancer is a significant public health concern and is among the most common malignant tumors of the head and neck. Its incidence and mortality rates remain persistently high, especially in regions where smoking and betel nut chewing are prevalent. Due to its high mortality rate, early detection is crucial for improving patient outcomes. However, early symptoms of oral cancer often resemble benign oral lesions, leading to delayed diagnosis. In this study, a vision transformer (ViT) model with Optuna (ViTOPT) is employed to perform classification tasks of identifying oral cancer images. The Optuna is used to determine hyperparameters in ViT. Histological images are obtained from a publicly available dataset. Three classification tasks with histological images namely classifying oral squamous cell carcinoma (OSCC) and leukoplakia (LEUK), classifying the presence of dysplasia, and classifying OSCC and leukoplakia with or without dysplasia are performed in this study. Numerical results reveal that the proposed ViTOPT framework is able to provide satisfactory performance in oral cancer recognition. Thus, the proposed ViTOPT model is a feasible and effective alternative in identifying oral cancer. Full article
20 pages, 308 KB  
Article
Prevalence and Correlates of Mental Health Issues Among University Students in Punjab, Pakistan: Insights into Academic Performance and Psychological Well-Being
by Nauman Ali Chaudhry, Rubeena Zakar, Gulzar H. Shah, Alexander Kraemer and Bushra Shah
Healthcare 2026, 14(10), 1421; https://doi.org/10.3390/healthcare14101421 - 21 May 2026
Abstract
Background/Objectives: Mental health problems are common among university students and are more consistently associated with dissatisfaction with academic performance than with low grades alone. This study examined the prevalence and determinants of perceived stress, depressive symptoms, and low psychological well-being among university students [...] Read more.
Background/Objectives: Mental health problems are common among university students and are more consistently associated with dissatisfaction with academic performance than with low grades alone. This study examined the prevalence and determinants of perceived stress, depressive symptoms, and low psychological well-being among university students in Punjab, Pakistan, and assessed their association with academic performance. Methods: A cross-sectional survey was conducted among students aged 15 to 29 years at three public universities in Punjab, Pakistan. A total of 1308 questionnaires were completed, yielding a response rate of 91.4%. This study uses data collected in 2015 as a pre-COVID historical baseline, providing valuable insights into student mental health before the global pandemic. This temporal context offers a benchmark for future comparative studies, especially when assessing the mental health impact of COVID-19 on university students. Data were analyzed using SPSS with descriptive statistics, chi-square tests, binary logistic regression, and multinomial logistic regression. Results: The findings revealed that perceived stress and depressive symptoms were prevalent, with 54.9% of students reporting high levels of stress (mean PSS score = 27.6, SD = 8.3), and 44.2% experiencing depressive symptoms (mean M-BDI score = 33.8, SD = 16.2). Female students exhibited higher stress and depressive symptoms compared to male students. Year of study was also a factor, with second- and third-year students experiencing more stress than their final-year counterparts (p < 0.05). Financial strain was associated with poorer mental health outcomes; 62% of students who reported inadequate financial support also reported higher stress levels (p < 0.05). In contrast, students with sufficient financial resources had lower odds of experiencing stress and depressive symptoms (AOR = 0.55, p < 0.05). Additionally, students living in university or private hostels reported better psychological well-being than those living at home (AOR = 0.47, p < 0.01). Mental health issues, particularly high stress and depression, were more strongly linked with academic dissatisfaction than low grades alone, with students in the “low grades and unsatisfied” group exhibiting higher odds of mental health problems (AOR = 2.30, p < 0.05). Conclusions: Mental health problems were common among university students and were associated with poorer academic experiences, particularly dissatisfaction with academic performance. Universities should strengthen accessible mental health support through counseling services, stress-management programs, and stigma-reduction initiatives. Full article
18 pages, 694 KB  
Article
Digital-Assisted Community Pharmacy Cessation for Dual-Tobacco Users in Jordan: A Hybrid Cluster Randomized Controlled Trial
by Derar H. Abdel-Qader, Nadia Al Mazrouei, Esra’ Taybeh, Rana Ibrahim, Abdullah Albassam, Eman Massad, Alia Saleh, Sahar Jaradat and Shorouq Al-Omoush
Pharmacy 2026, 14(3), 77; https://doi.org/10.3390/pharmacy14030077 - 21 May 2026
Abstract
Tobacco use remains a major public health challenge in Jordan, where cigarette smoking and waterpipe use are both common and dual use is increasingly prevalent. Community pharmacies are highly accessible healthcare settings, yet structured smoking-cessation services remain underutilized. This study evaluated the clinical [...] Read more.
Tobacco use remains a major public health challenge in Jordan, where cigarette smoking and waterpipe use are both common and dual use is increasingly prevalent. Community pharmacies are highly accessible healthcare settings, yet structured smoking-cessation services remain underutilized. This study evaluated the clinical effectiveness and implementation of Dual-Quit Digital, a pharmacist-delivered cessation counseling program tailored to the type of tobacco used, paired with a 6-month automated WhatsApp® (Menlo Park, CA, USA) follow-up system. We conducted a pragmatic, two-arm, parallel-group, Hybrid Type 2 cluster randomized controlled trial in 16 community pharmacies in Jordan, randomized 1:1 to intervention or usual care. A total of 320 adult tobacco users were enrolled (160 per arm). The intervention combined a structured in-pharmacy pharmacist consultation, tailored behavioral support, phenotype-stratified pharmacotherapy support, and 6 months of semi-automated WhatsApp® follow-up with telepharmacy escalation for predefined red-flag responses. The control arm received usual care, consisting of opportunistic brief advice and standard over-the-counter sales without proactive follow-up. The primary outcome was biochemically verified continuous abstinence at 6 months, defined as exhaled carbon monoxide (CO) < 10 ppm and analyzed using intention-to-treat principles. Secondary outcomes included 7-day point prevalence abstinence (PPA) at 3 and 6 months, 30-day PPA at 6 months, both-product abstinence among baseline dual users, pharmacotherapy uptake and adherence, and implementation-relevant outcomes, including service reach, feasibility of recruitment, and digital engagement metrics. All 16 pharmacies were retained, and all 320 randomized participants were included in the intention-to-treat analysis. At 6 months, CO-verified continuous abstinence was achieved by 26.3% of participants in the intervention arm compared with 11.3% in the control arm (adjusted odds ratio [aOR] 2.84, 95% CI 1.55–5.18; p < 0.001). The intervention also improved 7-day PPA at 3 months (33.1% vs. 15.6%; aOR 2.68, 95% CI 1.56–4.60; p < 0.001), 7-day PPA at 6 months (30.6% vs. 14.4%; aOR 2.62, 95% CI 1.48–4.62; p = 0.001), and 30-day PPA at 6 months (28.1% vs. 11.9%; aOR 2.89, 95% CI 1.59–5.24; p < 0.001). Among baseline dual users, both-product abstinence was higher in the intervention arm (21.9% vs. 7.8%; aOR 3.30, 95% CI 1.12–9.75; p = 0.026). Pharmacotherapy initiation was more frequent in the intervention arm (72.5% vs. 28.1%; p < 0.001), as was self-reported adherence for at least 8 weeks among initiators (56.0% vs. 26.7%; p = 0.002). In the intervention arm, active patient response rates to scheduled WhatsApp® messages remained substantial, with 88.1% responding at Week 1, 73.8% at Week 4, 67.5% at Month 3, and 61.3% at Month 6; 145 red-flag triggers were captured from 62 participants, and 84.1% of escalations resulted in successful pharmacist follow-up within 48 h. The Dual-Quit Digital model significantly improved smoking-cessation outcomes compared with usual care and proved operationally feasible. These findings support integrating phenotype-stratified pharmacist counselling, pharmacotherapy support, and low-burden digital follow-up as a pragmatic cessation model for Jordan and similar settings. Full article
(This article belongs to the Section Pharmacy Practice and Practice-Based Research)
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15 pages, 558 KB  
Article
Association Between Clinical Signs and CBCT-Confirmed TMJ Involvement in Juvenile Idiopathic Arthritis: The Diagnostic Value of Facial Asymmetry and Mandibular Mobility
by Tamara Pawlaczyk-Kamieńska and Tomasz Kulczyk
Biomedicines 2026, 14(5), 1164; https://doi.org/10.3390/biomedicines14051164 - 21 May 2026
Abstract
Juvenile idiopathic arthritis (JIA) is the most common systemic chronic inflammatory connective tissue disease in children, characterized by joint inflammation lasting at least six months. Temporomandibular joint (TMJ) involvement can occur in conjunction with other joints and may often be asymptomatic in its [...] Read more.
Juvenile idiopathic arthritis (JIA) is the most common systemic chronic inflammatory connective tissue disease in children, characterized by joint inflammation lasting at least six months. Temporomandibular joint (TMJ) involvement can occur in conjunction with other joints and may often be asymptomatic in its early stages. Objective: This study aims to evaluate the relationship between clinical symptoms of the stomatognathic system and radiologically confirmed cone beam computed tomography (CBCT)-detected structural TMJ changes in children with JIA. The research hypothesis posits that specific clinical symptoms are more prevalent in patients with CBCT-confirmed structural TMJ changes. Methods: A cohort of children diagnosed with JIA was examined. Clinical symptoms, including facial asymmetry, limited mandibular movement, and joint and masticatory muscle pain upon palpation, were assessed. CBCT imaging was performed to assess osseous TMJ structural changes. Results: The frequency of orofacial clinical symptoms was assessed and compared between patients with and without radiological evidence of TMJ involvement. Children with CBCT-confirmed TMJ changes demonstrated significantly higher rates of facial asymmetry, reduced maximum mouth opening, mandibular deviation during opening, and limitations in lateral or protrusive movements compared with those without TMJ involvement. Pain-related symptoms (TMJ pain, muscle tenderness, and pain during movement) and joint sounds occurred at similar frequencies in both groups. Conclusions: Facial asymmetry, mandibular deviation during opening and reduced mandibular mobility are the clinical signs most strongly associated with structural TMJ involvement in JIA and should prompt targeted imaging. Pain-related symptoms show limited diagnostic value, highlighting the need for focused clinical assessment and future studies integrating CBCT and MRI to refine early screening protocols. Full article
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20 pages, 21568 KB  
Article
Sustained-Release Microneedles for Local Delivery of Antibacterial Peptide in Acne Therapy
by Jingyu Gao, Zhangyong Si, Mengdi Xu, Shengyu Zhang, Fan Fan, Feng Zhou and Jiantao Zhang
Polymers 2026, 18(10), 1250; https://doi.org/10.3390/polym18101250 - 21 May 2026
Abstract
Acne is a prevalent chronic inflammatory skin disorder with a high recurrence rate, in which Propionibacterium acnes (P. acnes) plays a key pathogenic role by colonizing subepidermal pilosebaceous units. The stratum corneum limits drug penetration, rendering conventional topical therapies ineffective. Herein, [...] Read more.
Acne is a prevalent chronic inflammatory skin disorder with a high recurrence rate, in which Propionibacterium acnes (P. acnes) plays a key pathogenic role by colonizing subepidermal pilosebaceous units. The stratum corneum limits drug penetration, rendering conventional topical therapies ineffective. Herein, we report a detachable sustained-release microneedle system named Bacitracin@Hyaluronic Acid–Zein Microneedle (Bac@HA-ZMN) for localized antibacterial delivery in acne therapy. This microneedle patch consists of a dissolvable HA base and zein-based indwelling microneedle tips loaded with bacitracin (Bac) against P. acnes. Mechanical testing showed an average fracture force of 1.6 N per needle tip (n = 100), sufficient for skin insertion. The needle tips enabled Bac delivery to a depth of approximately 500 μm. In vitro transdermal studies demonstrated a cumulative release of 76.1% within 96 h, significantly higher than that of the control group (14.2%). In a murine acne model, the Bac@HA-ZMN treatment group showed a significantly smaller lesion area than the control group, and the immunohistochemical positive expression areas of the inflammatory factors IL-8, MMP-2, and TNF-α were reduced to 0.79%, 4.12%, and 2.14%, respectively, which was caused by the inhibitory effect of Bac on P. acnes. These results demonstrated Bac@HA-ZMN as a promising localized, sustained antibacterial delivery platform for acne treatment. Full article
(This article belongs to the Special Issue Advances in Polymer Hydrogels for Biomedical Applications)
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11 pages, 427 KB  
Article
Multidrug-Resistant Bacterial Strains in Northern Mexico: Clinical Impact and Vitek 2-Based Characterization
by Rafael Martínez-Miranda, Fernando A. Solis-Dominguez, Aseneth Herrera-Martínez, Conrado Garcia-Gonzalez, Jonathan Isaac Arauz Cabrera, Rafael Iván Ayala Figueroa and Carlos Vidal Montiel Castañeda
Microbiol. Res. 2026, 17(5), 100; https://doi.org/10.3390/microbiolres17050100 - 21 May 2026
Abstract
Antibiotic resistance remains a major public health concern, particularly in regions with high rates of hospital- and community-acquired infections. This study aimed to quantify multidrug-resistant (MDR) bacterial strains in northern Mexico and to identify the most prevalent resistance phenotypes, the antibiotic classes with [...] Read more.
Antibiotic resistance remains a major public health concern, particularly in regions with high rates of hospital- and community-acquired infections. This study aimed to quantify multidrug-resistant (MDR) bacterial strains in northern Mexico and to identify the most prevalent resistance phenotypes, the antibiotic classes with the highest resistance and susceptibility rates, the predominant MDR species, and the specimen types yielding the greatest number of isolates. Clinically relevant strains were collected from patients with confirmed infections. Microorganism identification and antimicrobial susceptibility test-ing were performed using the Vitek 2 Compact system (bioMérieux), and the results were analyzed descriptively. Of the 1544 strains analyzed, 761 (49.29%) exhibited multidrug resistance. Escherichia coli was the most frequently isolated MDR species, followed by Pseudomonas aeruginosa. Acinetobacter baumannii showed the highest resistance rate, with 95.55% of its strains classified as MDR, whereas P. aeruginosa had the lowest MDR proportion at 30.73%. These findings underscore the urgent need for rational antibiotic use and the development of new therapeutic agents, particularly those targeting Gram-negative bacilli, to mitigate the growing threat of antimicrobial resistance in this region. Full article
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19 pages, 290 KB  
Article
Changes in Coronary Care for Acute Myocardial Infarction over the Past Two Decades (2000–2023) in Kaunas, Lithuania
by Lolita Sileikiene, Abdonas Tamosiunas, Karolina Marcinkeviciene, Daina Kranciukaite-Butylkiniene, Sarunas Augustis, Dalia Lukšienė, Jolita Kirvaitiene, Gintare Sakalyte and Ricardas Radisauskas
J. Clin. Med. 2026, 15(10), 3963; https://doi.org/10.3390/jcm15103963 - 21 May 2026
Abstract
Background/Objectives: Epidemiological studies over the first decades of the 21st century have reported a decrease in cardiovascular disease (CVD) morbidity and mortality. Changes in coronary care for acute myocardial infarction (AMI) over these years, including the COVID-19 pandemic period, have been less [...] Read more.
Background/Objectives: Epidemiological studies over the first decades of the 21st century have reported a decrease in cardiovascular disease (CVD) morbidity and mortality. Changes in coronary care for acute myocardial infarction (AMI) over these years, including the COVID-19 pandemic period, have been less studied in Eastern and Central Europe. The study aimed to assess changes in coronary care—the time of medical assistance and treatment—for AMI patients over 2000–2023 in urban Kaunas residents aged 25–64. Methods: The data source was study cases from the Kaunas Ischemic Heart Disease Registry (Registry)—Kaunas city residents aged 25–64 years included in the Registry according to MONICA project protocol evaluation methodologies. Data were analyzed by sex and age group (25–54 and 55–64 years). Descriptive statistics (chi-square and z-score values) were used to evaluate the data; the significance level was p < 0.05. A logistic regression analysis was performed to assess the odds ratios of death within 28 days across six time periods. Results: The proportion of AMI patients hospitalized up to 2 h from the onset of pain accounted for about one-fifth of all hospitalized patients in 2000–2016, while in 2017–2023, it significantly decreased. In 2017–2023, compared with 2000–2004 and 2009–2016, significantly fewer men who developed AMI were hospitalized within the first 2 h of emergency presentation (p < 0.05). Over the whole study period, fewer women with AMI were hospitalized within the first 2 h of pain as compared to men (p < 0.05). There were no significant differences in time from pain onset to hospitalization between the age groups. At the same time, from 2009 to 2012, more young AMI patients were hospitalized within the first 2 h (p < 0.05). Percutaneous coronary angioplasty (PTCA) with stenting (PCI) increased 30 times from 2000–2004 to 2020–2023. PCI has been the most available treatment for men with AMI since 2009 and stayed stable from 2013 (66.0%) until 2023 (72.1%). Women with AMI tended to get less PCI, PTCA, and coronary artery bypass grafting (CABG) than men. The pre-pandemic and COVID-19 periods did not differ in the proportions of reperfusion treatment methods used in both men and women. Thrombolysis was very rare, and since 2017, it has not been used in Kaunas because PCI has become more accessible. PCI (2000–2016) and CABG (2009–2016) were more prevalent among the 25–54-year-old AMI patients (p < 0.05). From 2017 to 2023, there were no differences between age groups in the reperfusion procedures used, nor were there differences in treatment between these groups during the pre-pandemic (2017–2019) and peri-COVID-19 pandemic (2020–2023) periods. Conclusions: In Kaunas, the treatment of patients with AMI has improved significantly over the past 20 years. The use of PCI has increased greatly, and the rate of CABG surgery stayed stable, while only every fifth patient has been admitted to the hospital in a timely manner. Men were more likely to receive PCI, and older patients were more likely to undergo CABG. Compared to the period of 2000–2004, the chance of dying within 28 days after AMI was significantly lower in 2017. Full article
(This article belongs to the Section Epidemiology & Public Health)
21 pages, 1451 KB  
Article
Gut Microbiota Changes Following Aerobic Exercise in Malnourished Octogenarians: An Assessor-Blinded Intervention Study Stratified by Nutritional Status
by Huizhi Yang, Jiahao Li, Shuangfeng Ren, Xinyu Chai, Jiali Lu, Huiping Yan and Yifan Lu
Nutrients 2026, 18(10), 1627; https://doi.org/10.3390/nu18101627 - 20 May 2026
Viewed by 187
Abstract
Background/Objectives: Global population aging is associated with a rising prevalence of malnutrition among adults aged ≥80 years. Gut dysbiosis is linked to immune decline and impaired nutrient absorption, and aerobic exercise may enhance microbial diversity. This study investigated gut microbiota changes after a [...] Read more.
Background/Objectives: Global population aging is associated with a rising prevalence of malnutrition among adults aged ≥80 years. Gut dysbiosis is linked to immune decline and impaired nutrient absorption, and aerobic exercise may enhance microbial diversity. This study investigated gut microbiota changes after a 12-week aerobic exercise intervention in octogenarians stratified by nutritional status. Methods: A total of 129 nursing home residents (≥80 years) were classified via the Mini Nutritional Assessment Short-Form (MNA-SF) into a healthy group (HG, MNA-SF ≥ 11) and a malnourished group (MG, MNA-SF < 11). Both groups underwent a 12-week brisk walking intervention (three sessions/week, 1 h/session, 40–60% heart rate reserve). Fecal samples were collected at baseline and post-intervention and were analyzed via shotgun metagenomic sequencing. Results: A total of 36 participants completed the intervention (HG = 17, MG = 19). Within-group baseline-to-post-intervention analysis showed no significant changes in alpha or beta diversity in the MG. However, post-intervention between-group comparison revealed higher microbial richness and diversity in the MG vs. the HG, with enrichment of taxa including Faecalibacterium prausnitzii and Streptococcus salivarius. Functional analysis revealed significant enhancements in metabolic pathways related to amino acid biosynthesis, protein synthesis, and quorum sensing in the MG. In contrast, the HG showed limited shifts in microbial diversity but an increase in species involved in carbohydrate metabolism. Conclusions: After 12 weeks, the malnourished group showed higher post-intervention microbial richness and diversity than the healthy group, with differences in taxonomic and predicted functional profiles. Without a non-intervention control group, the microbiota differences observed during the 12-week aerobic exercise period can only be considered observational associations, not causal. Additionally, the high dropout rate (72.1%) limits the generalizability of the findings. Clinical trial registration: The Chinese Clinical Trial Registry on 19 October 2022 (ChiCTR2200064801). Full article
(This article belongs to the Special Issue Physical Activity, Metabolic Health, and Nutritional Interventions)
18 pages, 589 KB  
Article
Interdisciplinary Study of the Clinical Phenotype of Patients with Fibrodysplasia Ossificans Progressiva (FOP) in Dental Practice: A Cross-Sectional Clinical–Statistical Analysis
by Svetlana Danshina, Andrey Sevbitov, Aglaya Kazumova, Vitaly Borisov, Anton Timoshin, Maria Kuznetsova and Alexey Dorofeev
J. Clin. Med. 2026, 15(10), 3951; https://doi.org/10.3390/jcm15103951 - 20 May 2026
Viewed by 81
Abstract
Background/Objectives: Fibrodysplasia ossificans progressiva (FOP) is an ultra-rare genetic disorder causing progressive heterotopic ossification. The dental phenotype has never been systematically characterised. We quantified dental pathologies and oral health-related quality of life across three age groups of genetically confirmed FOP patients and [...] Read more.
Background/Objectives: Fibrodysplasia ossificans progressiva (FOP) is an ultra-rare genetic disorder causing progressive heterotopic ossification. The dental phenotype has never been systematically characterised. We quantified dental pathologies and oral health-related quality of life across three age groups of genetically confirmed FOP patients and compared them with 156 matched healthy controls (2022–2025). Methods: A total of 52 FOP patients (Group I: 1–5 y, n = 14; Group II: 6–17 y, n = 21; Group III: 18–35 y, n = 17) underwent standardised dental examination (Decayed, Missing, and Filled Teeth index (DMFT), Oral Hygiene Index Simplified (OHI-S), Angle classification, temporomandibular joint (TMJ) assessment), computed tomography (CT) densitometry, sialometry, salivary crystal analysis, and Oral Health Impact Profile-14 (OHIP-14). Statistical analysis used Kruskal–Wallis, Mann–Whitney U, Benjamini–Hochberg false discovery rate (FDR) correction, and effect sizes. Results: Caries (DMFT ≥ 4) was highly prevalent across all FOP groups (82–86%) and significantly higher than in controls (84.6% vs. 38.5%, p < 0.001). Chronic stomatitis showed large age-group differences: 7.1% in Group I vs. 100% in Group III (p < 0.001); it was universal in FOP adults vs. 6.4% in controls. Enamel hypoplasia (21.4% → 58.8%) and Angle class II malocclusion (0% → 47.1%) also showed large age-group differences. Total TMJ disorders were observed in 7.1% of Group I and 100% of Group III (p < 0.001); maximal mouth opening was lower by 17.4 mm in Group III (Cohen’s d = 2.1). Salivary flow rate was 20% lower in adults (0.35 → 0.28 mL/min, p = 0.01). Calcium phosphate crystals were detected in 3/17 adults (17.6%) and showed a preliminary correlation with CT calcification grade (ρ = 0.67, p = 0.003); given the small number of crystal-positive patients, this finding should be considered hypothesis-generating. OHIP-14 total score was higher (worse) in Group III (48.9 vs. 12.4 in Group I, Cohen’s d = 1.95). Conclusions: This cross-sectional study provides a systematic characterisation of the dental phenotype in FOP across three age groups. It shows that chronic stomatitis and TMJ dysfunction become nearly universal by early adulthood, severely impairing quality of life. The correlation between salivary calcium phosphate crystals and CT calcification generates the hypothesis of a non-invasive biomarker, requiring prospective validation. The proposed clinical phenotype and minimally invasive recommendations provide a framework for safer dental management of FOP patients. Full article
(This article belongs to the Special Issue Interaction Between Systemic Diseases and Oral Diseases: 2nd Edition)
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