Search Results (3,589)

Fibromyalgia is a complex chronic disorder involving persistent widespread pain accompanied by functional limitations, cognitive impairments, and alterations in neural processing. Previous research indicates that exercise-based interventions can play a key role in alleviating symptom burden and enhancing physical performance; however, there is limited evidence regarding their impact on neurophysiological mechanisms. Creative dance, in combination with strength training, may stimulate both motor and cognitive systems, promoting brain plasticity and functional improvements. This study will analyze the effects of a six-week strength and creative dance program on physical fitness under single- and dual-task conditions in women with fibromyalgia and will explore the associated changes in brain electrical activity and autonomic modulation. Methods: This randomized controlled trial will be divided into an exercise group (n = 22) and a control group (n = 22). The 6-week supervised intervention consists of two 60-minute sessions per week, combining strength exercises and creative dance. Primary outcomes include physical fitness tests (strength, mobility, balance, and agility gait test in single-task and dual-task), fibromyalgia symptoms, and quality of life. Secondary outcomes include changes in electroencephalography, heart rate variability, physical activity level, and fear of falling. Statistical analyses will compare within- and between-group differences using non-parametric tests and effect sizes. It is hypothesized that the intervention will improve physical fitness and dual-task performance, alongside increases in brain activity power. This study may provide insights into the neurophysiological mechanisms underlying the benefits of exercise benefits in fibromyalgia. Full article

This review deals with the issue of operational coal quality control using instrumental nuclear–physical methods. The existing traditional method of coal testing, characterized by high labor intensity and low representativeness, cannot serve as a basis for operational management of mining and processing processes. Instrumental nuclear–physical methods are free from these drawbacks; they are based on various processes of interaction of gamma and neutron radiation with substances. The main modifications of instrumental methods using gamma radiation are discussed: backscattering, forward gamma scattering, gamma absorption, gamma annihilation, and natural gamma activity. Various modifications of gamma methods are related to the energy of the primary and recorded radiation, the prevalence of a particular interaction process, the depth of the method, characteristics of the test object, the measurement geometry, and the other factors. The features of gamma methods are described in the context of the tasks being solved, interfering factors (variations in the bulk density, the moisture content, and the elemental composition), and methodological approaches for increasing the sensitivity and accuracy of the coal quality assessment. The variety of modifications of neutron methods is associated with irradiation of the analyzed coal with neutrons of different energies and detection of secondary gamma radiation arising from neutron activation of elements, inelastic scattering of fast neutrons, and radiative capture of thermal neutrons by the elements composing the coal. The methodological features of neutron activation, the neutron–gamma method of inelastic scattering and radiative capture are considered in the context of elemental analysis for Al, Si, S, Ca, Fe, H, C, and O and determining the ash content of coal in general. The main trends of the instrumental quality control are highlighted and recommendations are given for their use depending on the metrological characteristics and physical and chemical properties of the control object. The gamma-albedo method with registration of X-ray fluorescence of heavy gold-forming elements is the most promising for express analysis of powder samples. To test coarse coal in large amounts, multiparameter neutron methods are needed that comprehensively utilize high-precision equipment and instrumental signals from carbon, oxygen, and major ash-forming elements. Full article

Objective: To quantify early and mid-term changes in ultrasound-detected synovitis and enthesitis after initiating guselkumab in psoriatic arthritis (PsA) and to contextualize imaging responses alongside clinical outcomes. Methods: We conducted a retrospective single-center cohort study of consecutive CASPAR-classified adults (n = 20) initiating guselkumab 100 mg (week 0/week 4, then q8w; q4w intensification per routine practice). Power Doppler ultrasound (PDUS) followed EULAR–OMERACT standards at baseline (T0), Month 3 (T3), and Month 6 (T6). The primary endpoint was within-patient change in 24-joint GLOESS. Secondary endpoints included OMERACT entheseal scores (activity-only; activity + structure), DAPSA states, PASI, and 6-month persistence. Within-patient changes were assessed using Wilcoxon signed-rank tests (two-sided). Results: All 20 patients completed T6. GLOESS decreased from T0 to T3 (mean Δ −4.05 ± 2.78; p = 0.0312) and to T6 (mean Δ −5.70 ± 4.05; p = 0.0001). Component summaries showed a numerically larger early decrease in synovial PD signal than in grayscale synovial hypertrophy (descriptive). Enthesitis scores improved: OMERACT activity-only median Δ −2.0 at T3 (p = 0.0313) and −3.5 at T6 (p = 0.016); activity + structure median Δ −1.5 at T3 (p = 0.0412) and −3.0 at T6 (p = 0.031). The estimated structural component (OMERACT-1 minus OMERACT-2) was similar across visits (descriptive), indicating improvements driven predominantly by inflammatory signal suppression rather than detectable changes in structural lesions over 6 months. Among patients with baseline PD-positive enthesitis (n = 7), PD negativity (OMERACT-2 = 0) occurred in 2/7 (28.6%) by T6. Clinical domains (DAPSA, PASI) improved in parallel, and 6-month persistence was high. Conclusions: In routine care, guselkumab was associated with a significant improvement in PD-inclusive ultrasound synovitis scores by 3 months, which deepened by 6 months, alongside an improvement in entheseal activity measures. Over 6 months, entheseal structural burden appeared stable; these findings should be considered hypothesis-generating and warrant confirmation in prospective controlled studies. Full article

Background and Objectives: Vulvo-vaginal atrophy (VVA), a prevalent condition among postmenopausal women, significantly impairs quality of life through symptoms like vaginal dryness, dyspareunia, and burning. Non-hormonal treatments, such as CO₂ laser therapy, have shown promise in managing VVA symptoms with minimal side effects. The addition of adjunctive treatments may enhance efficacy and mitigate possible adverse effects. To evaluate the combined efficacy and safety of CO₂ laser therapy and a collagen-based cream in treating VVA and to explore their potential impact on the vaginal microbiome. Materials and Methods: This was a single-center, randomized, interventional. Sixty postmenopausal women diagnosed with VVA were randomized into two groups: a control group receiving laser-only treatment and a treatment group receiving laser therapy with daily collagen-based cream application. Primary outcome measures included symptom improvement on the Visual Analog Scale (VAS) for VVA-associated symptoms. Secondary outcomes involved microbiome composition analysis. Results: Both groups showed significant symptom improvement, with the combination therapy group demonstrating superior reductions in burning, dyspareunia, and vaginal dryness (p < 0.05). Microbiome analysis revealed increased levels of beneficial species (Lactobacillus iners and Lactobacillus crispatus) and decreased pathogenic bacteria (Gardnerella vaginalis and Atopobium vaginae) in the treatment group, though these changes were not statistically significant. Mild side effects, such as burning and swelling in the first days following the treatment, were less frequent in the combination therapy group, likely due to the anti-inflammatory effects of the collagen-based cream. Conclusions: This study provides evidence supporting the use of CO₂ laser therapy with collagen-based cream as an effective and well-tolerated treatment for VVA in postmenopausal women, achieving significant symptom relief. The combined therapy approach holds potential for enhanced efficacy and reduced side effects compared to laser-only treatment, offering a promising alternative for women ineligible for hormone-based therapies. Full article

Introduction: Congenital structural anomalies of the pulmonary artery in children, encompassing defects such as pulmonary atresia (PA), pulmonary stenosis (PS), pulmonary artery hypoplasia, and tetralogy of Fallot (ToF), pose significant challenges in pediatric cardiac surgery due to impaired blood flow in pulmonary circulation. Traditional options for conventional repair—including autologous materials such as the native pericardium and synthetic materials such as artificial patches—have limitations including a lack of growth potential and vulnerability to restenosis over time. ProxiCor^® patches, based on the extracellular matrix (ECM), have emerged as biologically compatible substitutes capable of fostering tissue regeneration. The primary outcomes of this study were the safety (absence of patch-related complications such as restenosis, dilation, aneurysm, infection, or thrombosis) and feasibility (intraoperative handling and surgical success) of ProxiCor^® for pulmonary artery and right ventricular outflow tract (RVOT) reconstruction in a single-center pediatric cohort. Secondary outcomes included mortality, postoperative complications (prolonged mechanical ventilation > 72 h, need for continuous renal replacement therapy (CRRT), and intensive care unit (ICU) and hospital stay), and qualitative echocardiographic assessment of vessel patency during follow-up. Patients and methods: A retrospective analysis was conducted in 25 consecutive pediatric patients who underwent pulmonary artery or RVOT reconstruction with ProxiCor^® at the Department of Pediatric Cardiac Surgery in Poznań (Poland) between the years 2023 and 2024. Surgical techniques, clinical outcomes, and follow-up data were assessed using transthoracic echocardiography (TTE). Results: The median age was 224 (Q1–Q3: 124–362) days, and median weight was 4.2 (Q1–Q3: 2.8–8.5) kg. Procedures targeted repairs of the main pulmonary artery (MPA), right pulmonary artery (RPA), left pulmonary artery (LPA), and RVOT. Diagnoses included tetralogy of Fallot (ToF), pulmonary artery stenosis (PS), pulmonary atresia (PA), pulmonary artery hypoplasia, and anomalous left coronary artery from the pulmonary artery (ALCAPA). The mortality rate stood at 8% (2/25), stemming from multiorgan failure and hemorrhagic stroke, unrelated to the patch. Over a median observation period of 483 (Q1–Q3: 363–584) days, no patch-related complications (e.g., restenosis or dilation) arose. The median hospitalization time was 22 (Q1–Q3: 8.5–38.5) days. Conclusions: ProxiCor^® ECM patches appear to be safe and feasible for use in pulmonary artery and RVOT reconstruction, with favorable early outcomes. However, the small cohort size, lack of a control group, and limited mid- to long-term echocardiographic data preclude definitive conclusions about long-term outcomes or comparative effectiveness. Full article

Background: Superior cluneal nerve (SCN) entrapment is frequently underrecognized as a contributor to chronic Low Back Pain (cLBP) and gluteal pain. Musculoskeletal ultrasound may reveal surrogate markers indicative of a biomechanical entrapment environment. The primary objective was the prevalence of the ultrasound marker triad (Copeman Nod-ules-CN, thoracolumbar fascia-TLF thickening > 3 mm, and iliac enthesophytes. Secondary objectives included mean TLF thickness and its correlation with numeric pain rating scale (NPRS) and Douleur Neuropathique en 4 questions scores (DN4). Methods: In this single-center, cross-sectional observational pilot study, we enrolled 12 patients with cLBP (>12 weeks) localized to the SCN distribution and a healthy control group (12). Ultrasound measurements included TLF thickness in longitudinal and transverse planes, TLF convexity loss, iliac crest enthesophytes, and CN. Statistical analyses comprised Mann-Whitney U test, Fisher exact test, Spearman rank correlation, and multivariate logistic regression. Significance was set at p < 0.05. Results: The ultrasound marker triad (CN, iliac enthesophytes, and TLF thickening > 3 mm) demonstrated high diagnostic specificity: individually, CN were present in 91.7% of patients vs. 8.3% of controls (p < 0.001), iliac enthesophytes in 58.3% vs. 0% (p = 0.005), TLF thickening > 3 mm in 41.7% of patients vs. 0% of controls (p < 0.001)and TLF convexity loss in 100% vs. 75% (p = 0.03). Mean TLF thickness was significantly greater in patients—3.53 ± 0.46 mm longitudinal and 3.42 ± 0.39 mm transverse—compared with controls (2.61 ± 0.28 mm and 2.50 ± 0.32 mm; both p < 0.001). TLF thickness correlated strongly with NPRS (Spearman rho = 0.825; p = 0.001) but not with DN4. Logistic regression demonstrated that the marker triad accounted for 67% of NPRS variance (R² = 0.67). Conclusions: Ultrasound-detected fascial alterations and enthesopathic changes act as reliable surrogate markers for SCN entrapment and correlate strongly with nociceptive pain severity. The absence of correlation with neuropathic pain scores suggests a predominant fascial-muscular biomechanical mechanism rather than direct nerve damage. Incorporating this non-invasive protocol into clinical practice may enhance diagnostic precision and inform targeted rehabilitative strategies. Future multicenter, prospective studies with larger cohorts are warranted to validate these findings and establish standardized ultrasound criteria. Full article

To address the reduction in energy efficiency caused by severe signal attenuation during long-distance transmission in cognitive radio networks, this paper constructs an IRS-assisted and energy-constrained relay cognitive radio resource allocation model operating in the underlay mode. By introducing controllable reflective paths, the model enhances link quality and improves energy utilization efficiency. Our objective is to maximize the energy efficiency of secondary users while satisfying the interference constraints imposed on the primary user. To effectively solve the highly non-convex and high-dimensional optimization problem, we propose a Chaotic Spider Wasp Optimization algorithm. The algorithm employs chaotic mapping to initialize the population and enhance population diversity, and incorporates a dynamic trade-off factor to achieve an adaptive balance between hunting and nesting behaviors, thereby improving global search capability and avoiding premature convergence. In addition, the Jain fairness index is introduced to enforce fairness in the power allocation among secondary users. Simulation results demonstrate that the proposed model and optimization method significantly improve system energy efficiency and the stability of communication quality. Full article

Background/Objectives: Male infertility, including primary and secondary infertility, is significantly influenced by oxidative stress, which disrupts sperm function and fertility. Seminal plasma, a protein-rich fluid essential for sperm protection and function, represents a valuable source for identifying biomarkers through proteomic analysis. While previous studies have explored seminal plasma proteins in fertility, the specific proteomic changes associated with oxidative stress in secondary infertility remain unclear. This study aimed to characterize these alterations by analyzing seminal plasma from three groups: men with secondary infertility, fertile donors with high oxidative stress, and fertile donors without oxidative stress. Methods: Pooled semen samples from each group underwent quantitative proteomics analysis using advanced mass spectrometry, with subsequent bioinformatic analysis using tools like DAVID, STRING, and IPA for identifying differentially expressed proteins (DEPs). Results: Quantitative proteomic analysis identified 377 DEPs in secondary infertility and 523 DEPs in fertile donors with high oxidative stress compared to controls. Bioinformatic analysis revealed seven shared pathways, including acute-phase response signaling, organismal injury, cellular movement, cell-to-cell signaling, free radical scavenging, immune cell trafficking, and Hematological system development. Notably, C3 and SERPINA3 exhibited significant alterations, along with proteins involved in sperm motility, capacitation, and fertilization, suggesting their potential roles in impaired fertility. Conclusions: These findings underscore the link between oxidative stress and secondary infertility and highlight specific seminal plasma proteins as potential biomarkers and therapeutic targets for diagnosing and treating male infertility. Full article

Background/Objectives: Diabetes is major metabolic disorder and rapidly increasing public health problem globally. The greatest way to reduce diabetic complications is adequate knowledge about the condition. Hence, the primary objectives of this study were to evaluate the psychometric properties of the Simplified Diabetes Knowledge Test—Arabic version (SDKT-A) among Iraqi insulin-dependent diabetic patients. Additionally, the secondary objectives were to assess the associated independent variables and the risk of atherosclerosis and cardiovascular risk event by using atherogenic indices and lipid ratios with the SDKT-A. Methods: A cross-sectional, descriptive study was conducted in primary healthcare clinics. The SDKT was translated into Arabic using forward–backward translation, reconciliation, and pilot testing. Thereafter, psychometric properties of the SDKT-A were evaluated depending on different criteria. Atherogenic indices of Castelli risk indices I and II (CRI-I and II), triglyceride/HDL ratio, non-HDL-C ratio, atherogenic coefficient (AC), and triglyceride–total cholesterol–body weight index (TCBI) were calculated using specific formulas. Results: The SDKT-A questionnaire showed acceptable readability and validity. Cronbach’s alpha test (95% confidence interval) was 0.662 (0.59–0.73). The Pearson correlation coefficient of reliability for test–retest was found to be 0.659. The item difficulty index for most items was between 0.237 and 0.877. The point biserial correlation values ranged from 0.028 to 0.535 with Ferguson’s sigma value equal to 0.962. The content validation results showed a significant content validity ratio (CVR) value for most of the questions, ranging from 0.8 to 1. The content validity index (CVI) value for SDKT-A was found to be 0.98, which showed good agreement between experts. In addition, the exploratory factor analysis with promax rotation identified four domains for the final 20 items of the SDKT-A that explained 41.83% of the scale total variance. The mean score of the SDKT-A was 11.09 ± 3.40. The total score of the SDKT-A was positively and significantly correlated with education level (r = 0.322, p < 0.01). In addition, the total scores of the SDKT-A were negatively and significantly correlated with glycemic control, age, CRI-I, CRI-II, triglyceride/HDL ratio, AC, non-HDL-C ratio, and TCBI. Furthermore, the glycemic control (HbA1c) was positively and significantly correlated with the preventive measures factor (r = 0.175, p < 0.05), and were negatively and significantly correlated with the lifestyle and modification factor (r = −0.169, p < 0.05), diet and monitoring factor (r = −0.158, p < 0.05), and awareness factor (r = −0.149, p < 0.05). Conclusions: This study showed acceptable psychometric properties for the SDKT-A, with low levels of knowledge of diabetic disease in the sample population. Finally, comprehensive and interactive educational programs regarding lifestyle and modification, diet, and monitoring and awareness in primary healthcare centers in Iraq are warranted. Full article

Underground coal gasification (UCG) is an emerging energy technology that involves the in situ conversion of coal into syngas through controlled combustion within a subsurface excavation. The geomechanical processes associated with UCG can lead to significant overburden caving and surface subsidence, posing risks to surface infrastructure and groundwater systems. To accurately predict the size of overburden caving zones and associated surface subsidence, a prediction model was developed based on simulation results using discrete element method (DEM) numerical models. The main purpose of developing such a model is to establish a systematic and computationally efficient method for the rapid prediction of the height of overburden caving and its associated surface subsidence induced by underground excavation. The model is broadly applicable to different types of underground excavations, and UCG is used in this study as a representative application scenario to demonstrate the relevance and performance of the model. Sensitivity analysis indicates that excavation span, tensile strength, and burial depth are the primary controls on the height of the caving zone within the ranges of parameters investigated. Rock density is retained as a secondary background parameter to represent gravitational loading and its contribution to the in situ stress level. The derived model was validated using published numerical, experimental, and field measurement data, showing good agreement within practical ranges. To further demonstrate the application of the model developed, the predicted caving geometries were incorporated into finite element method (FEM) models to simulate surface subsidence under different geological conditions. The results highlight that the arch structure formed by overburden caving can help redistribute stresses and thereby reduce surface deformation. The proposed model provides a practical, parameter-driven tool to assist in underground excavation design, environmental risk evaluation, and ground stability management. Full article

Background and Objectives: Thoracic trauma usually results in high morbidity and mortality. It is the leading cause of death in patients within the first four decades of life. In this study, we aimed to identify risk factors for intensive care mortality and to evaluate factors affecting clinical outcomes and complications in patients with thoracic trauma who were treated in the intensive care unit (ICU). Materials and Methods: This was a retrospective, single-center study. Patients diagnosed with thoracic trauma and followed up in the ICU between 1 May 2023 and 1 January 2025 were included. Critically ill patients aged 18 years and older whose admission blood values were available and who had undergone radiological imaging were included in the study. Patients were grouped as Survivors or Non-survivors. The primary outcome was to determine risk factors for mortality. The secondary outcome was to evaluate factors affecting clinical outcomes and complications. The tertiary outcome was to determine the predictive value of the Injury Severity Score (ISS), Acute Physiology and Chronic Health Evaluation II (APACHE II), and Glasgow Coma Scale (GCS) for mortality. Results: A total of 104 patients (male/female ratio: 76/28) were included in the study. Twenty-four patients (23.1%) died, and eighty (76.9%) were discharged. Age in the Non-survivor group was found to be significantly higher (59.33 ± 22.21 vs. 40.50 ± 17.71; p < 0.001), and the proportion of women was also significantly higher in the Non-survivor group (p = 0.0082). Mortality was associated with advanced age, female sex, lower GCS score (p < 0.001), higher APACHE II scores (p < 0.001), and the presence of comorbid conditions (p = 0.003), including head trauma (p = 0.024) and cardiac arrest before ICU admission (p = 0.011). The Non-survivor group more frequently required mechanical ventilation (p < 0.001), vasopressor support (p < 0.001), and continuous renal replacement therapy (p < 0.001), and they developed ventilator-associated pneumonia (p < 0.001) and acute respiratory distress syndrome (p < 0.001) at higher rates. ICU length of stay was also significantly longer in the Non-survivor group (p = 0.045). The APACHE II score demonstrated the highest discriminatory performance, emerging as the strongest clinical predictor of mortality (AUC = 0.751, 95% CI: 0.630–0.872; p < 0.001). Age (OR: 1.06) and serum lactate levels (OR: 1.57) consistently emerged as strong independent predictors of mortality. The presence of head trauma significantly increased the risk of mortality, particularly in the APACHE II-adjusted model (OR: 9.08). The APACHE II–based model yielded high specificity (96.3%) and accuracy (88.5%), with good discrimination (AUC = 0.894) and the highest Nagelkerke R² (0.548). Conclusions: Factors that may shorten the length of ICU stay include infection control, early correction of acidosis, and maintenance of hemodynamic stability, which may reduce mortality. APACHE II was more closely related to overall clinical severity than the other scoring systems. Our data indicate that age-related frailty and acute physiological derangement, as best represented by the APACHE II score, are more significant determinants of survival than anatomic injury severity alone. Full article

Background/Objectives: Recurrence after curative gastrectomy for gastric cancer remains common, and treatment options are limited. In selected patients with isolated locoregional relapse, salvage re-gastrectomy may provide durable disease control. This study compared outcomes of salvage re-gastrectomy and chemotherapy for isolated locoregional recurrence. Methods: We reviewed 500 consecutive gastrectomies performed between 2010 and 2024. In total, 66 patients (12.8%) developed isolated locoregional recurrence after previous R0 resection: 25 underwent salvage re-gastrectomy, and 41 received chemotherapy. Propensity-score matching (intended 1:2) was used to balance clinical and pathologic variables, yielding 42 patients (17 surgery, 25 chemotherapy). The primary endpoint was overall survival (OS) from recurrence diagnosis; secondary endpoints included perioperative outcomes and patterns of treatment failure. Results: There were no 30-, 60-, or 90-day deaths after salvage re-gastrectomy. Overall mortality was lower in the surgical group (41.2%) compared with chemotherapy (80.0%; p = 0.010). Salvage re-gastrectomy was independently associated with better OS (HR 0.15, 95% CI 0.02–0.87, and p = 0.035). A longer disease-free interval correlated strongly with survival (ρ = 0.80 and p < 0.001). Surgical patients experienced fewer local (0% vs. 52%) and peritoneal (0% vs. 20%) recurrences. Conclusions: For carefully selected patients with late, isolated locoregional recurrence, salvage re-gastrectomy is feasible and associated with longer survival and improved local control compared with chemotherapy alone. Larger prospective studies are warranted. Full article

Background/Objectives: To examine longitudinal changes in total retinal nerve fiber layer thickness (RNFLT) as the primary outcome measure in newly diagnosed pediatric idiopathic intracranial hypertension (IIH) patients using Spectral-Domain Optical Coherence Tomography (SD-OCT) at one-year follow-up. Methods: This is a prospective observational cohort study with cross-sectional control-group comparison. We included children with clinically definite IIH (IIH group) and children without papilledema and a normal neurological exam as a control group. Optic nerve parameters, including the primary outcome measure RNFLT and secondary outcome measures such as total retinal thickness (TRT) and optic disk area (ODA), were evaluated using SD-OCT (3D OCT-2000, Topcon, Topcon Corporation, Tokyo, Japan). Evaluations took place at presentation and, for the IIH group, before lumbar puncture (LP), at 1-day post-LP and at 1-, 3-, 6-, and 12-month follow-ups. Results: A total of 44 children aged 7–17 years were recruited (IIH group: N = 19, control group: N = 25). The mean baseline RNFLT was 133.1 ± 18.5 µm and 113.1 ± 8.7 µm for the IIH and control groups (p < 0.001), respectively. The IIH group showed a significant decline in RNFLT at the third-month follow-up. Between 3-month to one-year follow-up, mean total RNFLT showed an insignificant decline of 6 µm and did not differ from the RNFLT of the control group; however, segmental analysis of RNFLT showed a significant decline in the thickness of the nasal segments. At the one-year follow-up, two children had significant thinning of RNFLT at the superior quadrant. Intracranial pressure measured in the IIH group was directly correlated with RNFLT at the superior segment. Conclusions: SD-OCT is a useful non-invasive adjunct tool for the diagnosis and follow-up of IIH in children from primary school age onward. RNFL thickening resolved in most children at 3 months from IIH diagnosis. The study is constrained by specific methodological limitations, including a small sample size and non-contemporaneous evaluation of the control group compared with the IIH group. The significance of the segmental RNFL changes observed after one year should be further investigated with regard to long-term development, if possible with a larger prospective study that also considers the ganglion cell layer to explore for permanent axonal damage to the optic nerve. Full article

Background: The efficacy of upadacitinib in patients with Crohn’s disease (CD) has been shown in pivotal randomized controlled trials. However, real-world data is needed to assess its effectiveness and safety in routine clinical care with biologic-experienced patients. This study aimed to evaluate the clinical and endoscopic efficacy, patient-reported outcomes (PROs), and safety of upadacitinib in biologic-experienced patients with CD in a real-world setting. Methods: This prospective bi-centric real-world study enrolled 28 anti-TNF-experienced patients with CD receiving upadacitinib 45 mg daily for 12 weeks (induction), followed by 30 mg daily maintenance through week 52. Primary endpoints included endoscopic response (≥50% SES-CD reduction or ≥2-point decrease from baseline for baseline SES-CD ≤ 4) and clinical remission (Harvey–Bradshaw Index [HBI] ≤ 4). Secondary endpoints included endoscopic remission, clinical response (HBI decrease ≥ 3 points), and quality of life (IBD-Disk). Statistical analysis used the Wilcoxon signed-rank test with 95% confidence intervals (CIs). Results: Median patient age was 37 years; 75% had ≥3 prior biologic failures. Clinical remission rates (HBI) were 59% (95% CI: 41–75%) at week 12, 44% (95% CI: 27–63%) at week 26, and 53% (95% CI: 29–76%) at week 52. Endoscopic response rates were 48% (95% CI: 44–52%) at week 26 and 46% (95% CI: 21–72%) at week 52. Endoscopic remission was achieved in 43% (95% CI: 40–48%) at week 26 and 27% (95% CI: 10–57%) at week 52. Clinical response (HBI) improved progressively from 65% at week 2 to 71% at week 52. Quality of life, as assessed by the IBD-Disk, showed significant improvement: Reduced Disease Burden (defined as a decrease of 70% or a CED-Disk Score of ≤15) was observed in 33% of patients at week 12 and 35% at week 52. Median SES-CD decreased from 9 points (IQR: 6–17) at baseline to 5 points (IQR: 1–12, p = 0.005) at week 52. Adverse events occurred in 11% of patients (4% lymphopenia, 7% skin disease), with no serious adverse events or deaths. Conclusions: Upadacitinib demonstrates significant clinical and endoscopic efficacy in biologic-experienced, anti-TNF-pretreated patients with CD, achieving remission rates comparable to or exceeding those of the pivotal trials despite a highly refractory population (75% with ≥3 prior biologic failures). The favorable safety profile supports upadacitinib as an important therapeutic option in sequential treatment of refractory CD. Full article

Canada is a top producer and exporter of crude oil but also has many in-land freshwater ecosystems that need protection using non-invasive remediation methods that are effective in sensitive environments. To assess the efficacy of enhanced monitored natural recovery (eMNR) as a secondary remediation strategy for freshwater oil spills, we conducted controlled spills of conventional heavy crude oil (CHV) in a freshwater lake at the IISD-Experimental Lakes Area in northwestern Ontario, Canada, in 2021. Three shoreline enclosures (5 × 10 m) were deployed on a wetland shoreline and treated with ~1.5 kg of weathered CHV. Four days later primary recovery of oil was conducted using shoreline washing followed by secondary remediation of residual oil using eMNR. Three unoiled, reference enclosures were also treated with shoreline washing but not secondary remediation. Polycyclic aromatic compounds (PAC) in water and sediment, and general water quality were monitored in the enclosures for 412 days after oiling. Total PACs in the water, mostly of 2- and 3-ring alkylated compounds, peaked three days after oiling (1188 ± 251 ng/L), declined to half of initial concentrations 8.26–11.75 days later and to near background levels by day 73. Total PACs were elevated in sediment of the oiled enclosures until day 70 likely due to sorption or settling oil but were heterogenous and influenced by pyrogenic compounds. Results from this study suggest that eMNR may be an effective remediation method following primary recovery efforts at sensitive aquatic sites where mechanical recovery is contraindicated. Full article