Search Results (31,936)

Objective: This study aimed to compare time-dependent changes in visual acuity (VA), central corneal thickness (CCT), intraocular pressure (IOP), and the structure and elasticity of ocular tissues, as measured by shear wave elastography (SWE), in the preoperative, postoperative 1st week, and 1st month periods. Methods: This prospective observational study with repeated measurements included 22 individuals aged 44–86 years who underwent trabeculectomy for medically resistant glaucoma. VA, CCT, and IOP were measured preoperatively and at 1 week and 1 month postoperatively for the study. The elastic properties of ocular tissues were evaluated using the SWE method by obtaining quantitative measurements of lens SWE (LSWE), vitreous SWE (VSWE), optic nerve head SWE (OSWE), and retrobulbar fat SWE (RSWE). The changes in the obtained structural and elasticity parameters were compared preoperatively, 1 week postoperatively, and 1 month postoperatively. Results: When anterior segment parameters were evaluated in individuals who underwent trabeculectomy, there were significant differences in VA (p = 0.001, ${\mathrm{ƞ}}_p^2$ = 0.401), CCT (p = 0.001, ${\mathrm{ƞ}}_p^2$ = 0.806), and IOP (p = 0.001, ${\mathrm{ƞ}}_p^2$ = 0.853) values (p < 0.05). There was no statistically significant difference between preoperative and postoperative measurements at 1 week and 1 month for the elasticity parameters of LSWE, VSWE, OSWE, and RSWE (p > 0.05). Conclusions: This study suggests that the biomechanical adaptation of ocular tissues may be incomplete in the early postoperative period. Non-invasive methods such as SWE can be considered a potential tool for postoperative follow-up and predicting surgical success. Full article

Benign parotid tumors are increasingly treated with parenchyma-sparing extracapsular enucleation, yet postoperative salivary collections and Frey syndrome can still generate clinically relevant morbidity; we evaluated whether a standardized intraoperative bundle combining intraparotid botulinum toxin A (BTX-A) and bovine collagen membrane interposition is associated with fewer complications than standard enucleation alone. In this retrospective comparative cohort at a tertiary Head and Neck Surgery Unit, consecutive adults undergoing extracapsular enucleation for pleomorphic adenoma or Warthin tumor (2010–2025) were allocated by institutional era-based protocol to Group A (2010–2017, standard enucleation) or Group B (2018–2025, enucleation plus intraoperative intraparotid BTX-A 50 IU and bovine collagen membrane placement over the repaired parotid fascia). Prespecified endpoints were sialocele/salivary fistula, surgical-site infection (SSI) within 30 days, and clinically recorded Frey syndrome within 6 months; effect sizes with 95% confidence intervals were reported. A total of 188 patients were analyzed (94 per group). Sialocele occurred in 20/94 (21.3%) in Group A versus 2/94 (2.1%) in Group B [Relative Risk (RR) 0.10]. SSI occurred in 14/94 (14.9%) versus 2/94 (2.1%) (RR 0.143), and clinically recorded Frey syndrome in 18/94 (19.1%) versus 4/94 (4.3%) (RR 0.222). This combined protocol was associated with lower complication rates through 6 months; prospective controlled studies with standardized Frey assessment and longer follow-up are warranted. Full article

The not-yet-forgotten pandemic restrictions related to COVID-19, which affected the religious sector in an unprecedented manner, significantly contributed to the intimisation and virtualisation of spiritual expressions. Religiosity that had previously been experienced both internally and externally, two essential dimensions of any religious act, was transformed into a predominantly private and virtual phenomenon. This transformation affected not only the ordinary liturgical life intrinsically linked to ecclesial community and sacred space, but also extraordinary forms of religiosity, including pilgrimage. Although the phenomenon of virtual pilgrimage to online chapels and shrines was known prior to the pandemic, developments in recent years have substantially increased interest in this form of devotion. Since pilgrimage to a sacred site requires both spiritual engagement and bodily participation, this study examines the possibilities and prospects of this emerging form of a traditional religious practice. The question of whether virtual pilgrimage may, in the future, constitute an independent and, in a certain sense, autonomous form of spiritual expression, or whether it represents merely a temporary phenomenon, emerges from an analysis of faith in both its bodily (external) and spiritual (internal) dimensions. Since these two dimensions are inseparable components of faith, virtual pilgrimage can be considered as a distinct phenomenon only in relation, whether close or remote, to physical pilgrimage. Nevertheless, to adequately acknowledge that virtual pilgrimage bears the characteristics of the “signs of the times”, it should be evaluated in a new, more comprehensive, and open manner. It may thus be understood as a primary spiritual phenomenon with the potential to significantly influence the pilgrim’s inner disposition and thereby substantially contribute to the attainment of the goals of pilgrimage, whether or not physical participation is possible. Full article

Objectives: Atrial fibrillation (AF), the most common sustained cardiac arrhythmia, and cardiometabolic comorbidity, have been increasingly associated with cognitive impairment and dementia. These associations, however, remain underexplored and underappreciated in middle-aged individuals with AF. This study aimed to explore the associations of early cognitive impairment with the presence of cardiometabolic comorbidities and potential associations with echocardiographic markers in middle-aged patients with and without AF. Methods: Between 2023–2024, fifty-six consecutive outpatients with a diagnosis of AF aged 45–65 years underwent clinical evaluation, transthoracic echocardiography, and comprehensive neuropsychological assessment using the Montreal Cognitive Assessment (MoCA) and the Consortium to Establish a Registry for Alzheimer’s Disease battery (CERAD). A control group of 58 age group-matched individuals without known cardiometabolic disease was included in comparative cognitive analyses. Results: Patients with AF and cardiometabolic comorbidities demonstrated early cognitive deficits, particularly in episodic memory and visuospatial functions, detectable even in individuals with normal MoCA scores, compared with the control group. However, no associations were observed between cognitive performance and conventional echocardiographic parameters in the group with AF. Conclusions: This study corroborated prior evidence of an association between cardiometabolic impairment and subtle cognitive impairment, but did not identify a specific contribution of echocardiography markers. More extensive and sensitive biomarkers of left atrial structure and function may be required to detect harmful associations with subtle cognitive impairment in middle-aged individuals. Further prospective studies, with a more balanced control for comorbidities, are warranted to clarify the clinical relevance of atrial structural remodeling in this context. Full article

Background and Objectives: Healthcare workers are at heightened risk of SARS-CoV-2 infection. Understanding the duration and protective value of vaccine-induced immunity is critical to inform booster strategies. This study investigates longitudinal dynamics of anti-SARS-CoV-2 receptor-binding domain IgG (anti-RBD IgG) antibodies and their association with infection risk among vaccinated healthcare workers. Materials and Methods: A prospective cohort study was conducted at Vilnius University Hospital Santaros Klinikos, Lithuania. A total of 1778 healthcare workers who completed a primary COVID-19 vaccination series were followed. Blood samples were collected every three months to measure anti-RBD IgG levels. Participants also received up to three booster doses. COVID-19 was identified by PCR, antigen tests, or positive anti-nucleocapsid IgG. For serologically detected cases, infection timing was assigned to the interval between study visits. Antibody dynamics were analyzed across vaccination stages, time, age groups, and circulating SARS-CoV-2 variants. Results: Anti-RBD IgG titers peaked in the first quarter after primary vaccination (mean 7904 AU/mL), declined sharply by quarters 2–3, and rose substantially after booster doses. Following the first booster, titers increased to ~12,598 AU/mL in quarter 1 and continued rising through quarter 3. The highest levels were observed after the second booster (24,456 AU/mL in Q1), followed by gradual decline. A high-titer plateau persisted from quarters 6 to 9 (~21,000 AU/mL), followed by decline in quarters 10–11 and partial rebound in Q12. Approximately 49.6% of participants experienced COVID-19 during follow-up. Antibody response patterns were similar across age groups, with only minor transient differences. Conclusions: COVID-19 booster doses significantly enhance and prolong humoral immunity in healthcare workers compared with the primary vaccination series. However, antibody waning over time emphasizes the need for timely boosters, particularly during periods of variant circulation. These findings support continued booster vaccination and monitoring of long-term immune protection, although anti-RBD IgG should be interpreted as a surrogate marker of humoral rather than overall immunity. Full article

Background: Artificial intelligence (AI) is increasingly incorporated into nutrition research and practice; however, the extent of its clinical integration and impact on health outcomes remains unclear. This systematic review evaluated how AI-based systems have been implemented in human nutritional interventions and summarized reported outcomes. Methods: PubMed, Scopus, Google Scholar, SpringerLink, JMIR, and MDPI were searched from January 2020 to March 2025 (search completed in March 2025). Randomized controlled trials and prospective or retrospective cohort studies published in English or Spanish were included if they evaluated AI-driven nutritional interventions in human populations and reported health-related outcomes. Risk of bias was assessed using RoB 2 and ROBINS-I. A qualitative synthesis was performed. Results: Sixteen studies involving 10,863 participants were included. Most were randomized controlled trials targeting metabolic disorders, particularly type 2 diabetes and obesity. Eleven studies evaluated metabolic outcomes, including HbA1c, body weight, fat mass, lipid levels, and insulin resistance indices. Six studies assessed gastrointestinal symptom severity scores, and two examined quality-of-life or patient-reported outcomes. Several trials reported short-term improvements favoring AI-supported interventions in glycemic control, weight reduction, and symptom severity. However, effects were heterogeneous and often observed within multimodal programs, limiting attribution of outcomes solely to the AI component. Conclusions: AI integration in nutrition remains in an early phase of clinical implementation. Although preliminary findings suggest potential benefits, interpretation should be cautious given methodological heterogeneity and moderate-to-high risk of bias across studies. Larger, rigorously designed investigations are required to determine sustained clinical effectiveness. Full article

The synergistic and mutually reinforcing relationship between the development of the new energy industry and comprehensive land consolidation is crucial for integrating ecologically fragile areas into the national “dual carbon” goals and supporting regional high-quality development. Based on a systematic literature review, field investigations in typical regions, and multi-case comparative analysis, this paper analyzes the challenges and opportunities for the new energy industry in ecologically fragile areas as well as the mutually reinforcing mechanisms between new energy industry development and land consolidation. On this basis, it explores pathways for comprehensive land consolidation in coordination with new energy development. Building on local practices, it further identifies five typical models. The results show the following: (1) The development of the new energy industry in ecologically fragile areas faces multiple challenges, including a fragile ecological environment, inadequate infrastructure, a mismatch between resource supply and demand, and land use conflicts. Against the backdrop of the energy transition, breakthroughs in key technologies, and the guidance of territorial spatial planning, the value of wind and solar resources in these areas are becoming increasingly prominent, offering broad prospects for the new energy industry. (2) The development of the new energy industry and comprehensive land consolidation in ecologically fragile areas are mutually reinforcing. Factors such as resource endowment, ecological constraints, new quality productive forces, and investment and financing mechanisms interact and integrate with each other, resulting in diversified synergistic pathways. (3) Based on the priorities of new energy industry development and the primary objectives of consolidation, five models are identified: Ecological Restoration-led Model, Resource Development-led Model, Industrial Collaboration-led Model, Technological Innovation-led Model and Integrated Development Model. Each model has distinct priorities and applicable scenarios. This study will provide a reference for new energy development and sustainable development in ecologically fragile areas, including desertified and Gobi desert areas, coal mining subsidence areas, and areas rich in wind, solar, and hydropower resources. Full article

Background/Objectives: Adenomyosis is a common disorder of the uterus in those of reproductive age. Robotic-assisted surgery has been adopted to address the technical challenges of adenomyomectomy. This systematic review evaluated the current evidence regarding the feasibility, safety, and clinical outcomes of robotic-assisted conservative surgery for uterine adenomyosis. Methods: A systematic review of literature was performed on five databases, from the beginning to 21 December 2025, to identify studies reporting robotic-assisted uterus-sparing surgical approaches to adenomyosis. Data were collected on patient characteristics, surgical techniques used, pre- and post-operative pain, fertility outcomes, and complications. Risk of bias was evaluated using the ROBINS-I framework. Results: A total of 514 articles were found; six studies met the inclusion criteria. Most included studies were small and retrospective. The operative time ranged from 279 to 147 min. Mean blood loss ranged between 25 and 296 mL with a low rate of conversion and perioperative complications. Dysmenorrhea improved after surgery as reflected by the post operative visual analog scale pain score and serum CA-125 level. Few reproductive data were collected about successive spontaneous pregnancies. Risk of bias was serious or moderate in all studies included. Conclusions: Robotic-assisted conservative surgery for adenomyosis may represent a feasible and safe option for women with symptomatic adenomyosis who wish preserve the uterus, with a positive impact on patients’ symptoms. Large prospective, multicenter studies with standardized protocols and long-term follow-up are needed to clarify the real impact of robotic surgery in adenomyosis management. Full article

Tuberculosis (TB) remains a major global cause of morbidity and mortality. Current tools for monitoring treatment response rely on sputum-based microscopy and culture, which are often insensitive, time-consuming, and impractical in extrapulmonary or pediatric TB and in individuals unable to produce sputum. Metabolomics has emerged as a promising approach for identifying host-derived biomarkers that reflect treatment-associated immunometabolic changes; however, the available evidence remains heterogeneous and has not been comprehensively synthesized. We conducted a comprehensive literature review of human studies evaluating metabolomic biomarkers in relation to TB treatment response or outcomes. PubMed, Scopus, and EMBASE were searched for human studies evaluating targeted or untargeted metabolomics (NMR, LC-MS, GC-MS, CE-MS) in relation to treatment response or outcomes. Two reviewers independently screened studies, extracted data, and assessed risk of bias using QUIPS and PROBAST. Findings were synthesized using a structured framework organized across treatment stages and outcomes. Of 218 records identified, 139 titles and abstracts were screened and 42 full texts assessed; 15 studies met the inclusion criteria. Recurrent treatment-associated signals involved amino acid metabolism, particularly the tryptophan–kynurenine pathway, as well as vitamin and cofactor metabolites (pyridoxate, nicotinamide, trigonelline). Plasma studies frequently reported lipid remodeling and bile acid perturbations, whereas urine studies highlighted polyamine metabolism (e.g., N¹,N¹²-diacetylspermine) and fatty acid β-oxidation markers. Common limitations included inadequate adjustment for confounders and, in prediction models, small sample sizes and limited external validation. Metabolomics reveals reproducible but heterogeneous immunometabolic changes during TB therapy. Key pathways include tryptophan–kynurenine metabolism, vitamin and cofactor metabolism, lipid remodeling, and urine polyamine pathways. Standardization and prospective multicenter validation are needed for clinical translation. Full article

Background and Aim: Anti-epidermal growth factor receptor (EGFR) therapy is commonly associated with skin toxicity, which may reflect treatment response. This study evaluated the prognostic significance of anti-EGFR-related skin toxicity in patients with RAS wild-type metastatic colorectal cancer (mCRC) receiving palliative chemotherapy. Materials and Methods: We retrospectively analyzed 256 RAS wild-type mCRC patients treated with anti-EGFR monoclonal antibodies at Erciyes University, Kayseri, Turkey (June 2011–February 2024). Survival was estimated using the Kaplan-Meier method with log-rank comparisons. A landmark analysis at 2 months was performed to address guarantee-time bias. Univariate and multivariate Cox regression analyses were used to identify independent prognostic factors. Results: The median PFS was 17 months in patients with grade ≥ 2 skin toxicity versus 8 months in those with grade < 2 skin toxicity (p < 0.001). The median OS was 32 and 21 months, respectively (p < 0.001). In the landmark-adjusted multivariate analysis, grade ≥ 2 skin toxicity was an independent prognostic factor for both PFS (HR 0.52, 95% CI 0.39–0.70, p < 0.001) and OS (HR 0.50, 95% CI 0.37–0.68, p < 0.001). Additional independent factors for OS included albumin, LDH, peritoneal metastasis, age, tumor sidedness, and BMI. The objective response rates were 53.9% and 11.3% in the grade ≥ 2 and grade < 2 groups, respectively (p < 0.001). Conclusions: Grade ≥ 2 skin toxicity was significantly associated with longer PFS, OS, and a higher response rate, and was confirmed as an independent prognostic factor in multivariate analysis. These findings suggest that skin toxicity may serve as a non-invasive marker of treatment efficacy. Prospective studies with time-dependent methodologies are needed to validate these results. Full article

Background: To evaluate the real-world safety and mid-term clinical performance of the Ankura™ AAA Stent Graft System in patients undergoing endovascular aneurysm repair (EVAR). Materials and Methods: This prospective, multicenter PMCF study analyzed 100 patients with abdominal aortic aneurysms (AAAs). Patients were monitored for a mean duration of 2.26 years. Primary endpoints included 30-day major adverse events and 24-month treatment success. Statistical evaluation of risk factors for reintervention was performed using univariate logistic regression. Results: The study cohort was predominantly male (97%), with a mean age of 72.01 years. Hypertension (90%) and smoking (89%) were the most prevalent comorbidities. Regarding the primary endpoints, the 30-day MAE rate was 2%. During the overall follow-up (mean 2.26 years), the primary patency rate was 97%, demonstrating high structural integrity and sustained patency. However, the overall freedom from reintervention rate was 74%, corresponding to a 26% reintervention requirement and a 27% incidence of endoleak. Reinterventions were almost exclusively driven by these post-procedural morphological complications; specifically, 26 of the 27 patients with endoleaks required a secondary procedure. No preoperative clinical or anatomical parameters were identified as significant independent predictors of reintervention in the univariate analysis (p > 0.05). The overall mortality rate was 12%, with 0% aneurysm-related mortality. Conclusions: Mid-term success and reintervention after EVAR with the Ankura™ system are primarily driven by postoperative morphological complications, such as endoleaks, rather than baseline patient risk profiles. These findings underscore the critical importance of rigorous, lifelong radiological surveillance regardless of preoperative anatomical challenges. Full article

Background/Objectives: Helicobacter pylori (HP) antibiotic eradication treatment in Germany is, at present, empirical according to the national guidelines. The aim of our prospective multicentre study was to implement routine susceptibility testing in daily clinical practice to facilitate resistance-oriented first-line antibiotic therapy and to collect local resistance data. Methods: From 1 January 2024 to 30 April 2025, in two German hospitals (in Bielefeld and Datteln), the patients who underwent gastroscopy and those who had biopsies for histopathology also underwent biopsies for the Helicobacter urease test (HUT). Positive HUT samples were sent for susceptibility testing: they were checked for phenotypic/cultural resistance to amoxicillin, clarithromycin, metronidazole, levofloxacin, rifampicin and tetracycline and genotypic/molecular resistance to clarithromycin and fluoroquinolones. Results: In total, in 1503 cases, both HUT and histology were performed, in which 256 (17.0%) histologies were HP-positive. We sent 311/1503 (20.7%) positive HUTs for susceptibility testing. In 120 (38.6%) of them, it was possible to culture HP, and for 118 cases, phenotypic resistance testing was performed. In 200/311 cases, PCR was also executed, with 111/200 cases being subjected to subsequent molecular resistance testing. Resistance patterns varied regionally, with metronidazole resistance observed in 3–33%, clarithromycin resistance in 16–20% and levofloxacin resistance in 13–16% cases. Conclusions: it is technically and logically feasible to perform HP antibiotic susceptibility testing via the same biopsy used for the HUT. The proposed procedures might be applied both in hospital and outpatient settings in endoscopic offices. Routine susceptibility testing is useful not only for the individual patient but also for monitoring the development of regional resistance patterns as a basis for better-targeted empiric therapy. Additionally, this approach might help to reduce the resistance dynamics at large in terms of antimicrobial stewardship. Full article

Background/Objectives: Protein-bound uremic toxins (PBUTs), particularly p-cresyl sulfate (PCS) and indoxyl sulfate (IS), are associated with cardiovascular toxicity and increased mortality. Conventional hemodialysis (HD) removes PBUTs poorly, and the efficacy of medium cut-off (MCO) dialyzer membranes remains uncertain. Furthermore, PBUT production is influenced by gut microbial metabolism and can be modified through diet. We hypothesized that MCO dialysis would provide superior clearance of PCS and IS compared with online hemodiafiltration (OL-HDF), and that combining MCO dialysis with increased dietary fiber and short-chain fatty acid (SCFA) intake would further reduce PBUT levels. Methods: In this prospective randomized trial, 62 maintenance HD patients underwent a 2-week wash-in period with high-flux HD (HF-HD) and were then randomized to MCO-HD (EXP) or OL-HDF (CON). After a 4-week intervention with the assigned dialysis modality, both groups continued with the same dialysis treatment and received an 8-week dietary intervention consisting of 19 g/day fiber and 1 g/day sodium propionate. The study concluded with a 4-week wash-out period on HF-HD. Primary outcomes were total serum PCS and IS levels measured at four timepoints. Results: Fifty-two patients completed the study. No significant changes in PCS or IS were observed after the dialysis-only intervention. PCS levels remained stable throughout the study. When the aligned dialysis regimen was combined with the dietary intervention, IS levels were significantly lower in the CON than in the EXP group (31.5 ± 10.3 vs. 42.0 ± 15.8 µmol/L; p = 0.006), with a partial rebound after wash-out in the CON group (39.6 ± 20.9 µmol/L; p = 0.003). Conclusions: While MCO-HD and OL-HDF had a similar effect on serum PCS and IS concentrations, only OL-HDF combined with the dietary intervention significantly reduced IS levels. Full article

Background and Objective: Active surveillance (AS) describes the active monitoring of men with low- to intermediate-risk prostate cancer (PCa), before active management (AM) is needed due to disease progression. A substantial proportion of patients require a transition to AM within a few years of diagnosis. Proclarix is a blood-based diagnostic test that predicts clinically significant PCa (csPCa) and the Proclarix risk score has been shown to correlate with tumor aggressiveness. This study aimed to assess whether Proclarix can predict the likelihood of transition from AS to AM and to compare it to PSA density (PSAD). Methods: We retrospectively evaluated the Proclarix risk scores in serum samples from a Danish cohort of 132 men recruited from the PerPros prostate biobank. Most participants had low- to intermediate-risk PCa and were considered eligible for AS at diagnosis. Blood samples were collected before the initial biopsies, and clinical follow-up data were available for every patient for a minimum of 3 and up to 9.5 years. The primary endpoint was the ability of the Proclarix risk score to predict the transition from AS to AM. The secondary endpoint was to assess whether Proclarix could identify patients at risk of progression to csPCa. For both endpoints, PSA density was also included in the analysis for comparison. Results: Overall, 48 of 132 men (36%) transitioned from AS to AM during follow-up. A baseline Proclarix risk score of ≥50% was associated with a 79% estimated cumulative probability of switching to AM (HR = 4.4, 95% CI: 2.3–8.3, p < 0.001), compared to the 58% (HR = 3.1, 95% CI: 1.7–5.7, p < 0.001) for PSAD At the 5-year follow-up, 82% of men with a Proclarix score ≥ 50% and 57% with PSAD ≥ 0.15 ng/mL/cm³ had progressed to AM. Additionally, 67% and 54% of men showed progression to csPCa with, respectively, Proclarix and PSAD at the confirmatory biopsy. In contrast, among men with a Proclarix score < 50%, only 28% progressed to AM and 32% to csPCa, whereas for PSAD < 0.15 ng/mL/cm³, 17% transitioned to AM and 23% progressed to csPCa. Conclusions: The Proclarix risk score may support clinical decision-making in AS by identifying patients at higher risk of progression and informing follow-up intensity. However, the results should be confirmed in a larger prospective study. Full article

Coffee is a very popular psychoactive beverage with a complex composition. Besides its stimulant effect due to caffeine, it contains several bioactive compounds with antioxidant properties and potent metabolic activity. Its clinical efficacy is fundamentally determined by the bioavailability and metabolic fate of its constituents. The bioactive components of coffee, such as polyphenols, melanoidins, phytosterols, biogenic amines, and carotenoids, have notable antioxidant, anti-inflammatory, and immunomodulatory effects. This review aims to present the main bioactive components of coffee, their biological effects, mechanisms of action, and the influence of preparation methods and individual variability on metabolic outcomes in common chronic diseases. The data are synthesized from clinical, prospective, and interventional studies to examine how processing variables and biological metabolism influence the health-promoting potential of coffee antioxidants. Brewing methods like hot filtration optimize the extraction of these antioxidants. Individual clinical outcomes are further modulated by genetic polymorphisms and gut microbiota variability, which influence the activation of the cellular Nrf2 antioxidant defense pathway. Full article