Search Results (36,796)

Bullous pemphigoid (BP) is the most common autoimmune subepidermal blistering disease, predominantly affecting elderly patients with multiple comorbidities. This multicentre retrospective cohort study aimed to characterize the clinical profile, treatment patterns, and drug-associated cases of BP in a real-world setting. The study included 156 patients newly diagnosed with BP between 2020 and 2024 in four dermatology departments in Poland. Diagnosis was based on clinical features, and immunological assessment, including direct immunofluorescence (DIF), ELISA, and BIOCHIP-based indirect immunofluorescence. The mean age at diagnosis was 75.5 ± 10.9 years, and 78.85% of patients had at least one comorbidity, most commonly arterial hypertension, type 2 diabetes mellitus, and dyslipidemia. Severe pruritus was reported in 74.14% of evaluated patients. Blisters and erosions were the predominant clinical manifestations. Topical glucocorticosteroids were the most frequently used treatment, followed by systemic glucocorticosteroids and methotrexate. New drug exposure within 6 months before disease onset was identified in 14.74% of patients and was associated with a shorter time to diagnosis. Drug-associated cases showed lower BP180 ELISA positivity, although this did not remain significant after correction for multiple testing. These findings highlight the clinical complexity of BP and the importance of medication review and direct immunofluorescence in diagnostic evaluation. Full article

Background/Objectives: Discharging patients after hospitalization for an acute exacerbation of chronic obstructive pulmonary disease (COPD) is a critical transition in care associated with a high risk of early readmission. This survey aimed to describe physician-reported discharge practices following COPD exacerbations, identify perceived gaps and organizational barriers, explore attitudes toward structured COPD discharge summaries, and use a SWOT analysis as an interpretative framework. Methods: In this cross-sectional observational survey, 100 physicians involved in COPD care were recruited from the official mailing list of the Respiratory Society of Serbia, which represents approximately 71% of the Society’s members. The survey assessed discharge procedures, multidisciplinary practices, patient education, comorbidity management, perceived causes of readmission, and barriers to structured discharge summaries. Data were analyzed descriptively and complemented with a structured SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis. Results: Most respondents worked in tertiary care settings and were involved in managing patients hospitalized for COPD exacerbations. Although 24% of physicians routinely used structured discharge summaries, 45% reported never using them. The most frequently perceived contributors to 30-day readmissions were active smoking (90%), poor treatment adherence (81%), comorbidities (77%), and incorrect inhaler technique (72%). Major barriers to implementing structured discharge summaries included the lack of standardized templates, time constraints, poor coordination across healthcare levels, and technical limitations. Willingness to implement structured discharge tools was high (mean score 8.86/10). SWOT analysis identified strong professional support for discharge standardization alongside organizational and system-level barriers to implementation. Conclusions: This exploratory survey identified important gaps between recommended and routine COPD discharge practices and highlighted organizational barriers to implementation. The findings may inform future evaluation and development of structured discharge tools in this healthcare setting. Full article

Cast iron components are indispensable in aerospace and automotive systems, yet their milling operations are severely affected by regenerative chatter, which degrades machining quality and damages equipment. Although various chatter prediction methods have been reported, the optimal interpolation strategy of full-discretization methods (FDMs) for multi-factor coupled dynamic systems remains unclear. This study proposes an enhanced FDM to fill this research gap. A dynamic milling model accounting for regenerative effects, modal coupling and process damping is established, and an improved FDM based on Lagrange interpolation is further developed. A systematic single-factor analysis is carried out to examine the performance of 1st–4th-order interpolation for state, delay and periodic terms. Counter-intuitively, convergence analysis and stability lobe diagram (SLD) verification reveal that higher-order interpolation does not guarantee better performance. The optimal orders are identified as 2nd/3rd for state terms, 3rd for delay terms and 1st for periodic terms. Accordingly, the proposed 321-FDM (3rd-order state, 2nd-order delay, 1st-order periodic) exhibits higher accuracy and computational efficiency compared with benchmark methods, namely the semi-discretization method and Hermite-based 3rd-order FDM. Milling experiments on cast iron workpieces validate the established model and the 321-FDM, and the experimental stability thresholds agree well with numerical predictions. This work presents a validated, high-performance stability prediction tool for chatter avoidance in cast iron machining. Full article

Chronic rhinosinusitis (CRS) constitutes a multicausal inflammatory disease of the nose and paranasal sinuses, often associated with olfactory dysfunction (OD), a symptom that significantly impacts patients’ quality of life. OD in CRS was traditionally thought to be related to mechanical obstruction of the olfactory cleft, but is now considered to be multifactorial, involving conductive, inflammatory, and sensorineural mechanisms as well. Type-2 inflammatory response (high interleukins IL-4, IL-5, IL-13), eosinophilia, and increased IgE are involved in epithelial damage, impaired neurogenesis, and persistent olfactory loss, especially in chronic rhinosinusitis with nasal polyps (CRSwNP). In addition, peripheral chronic inflammation may also play a role in central neural remodeling, which may potentially affect olfactory function. Objective psychophysical testing is necessary to accurately assess olfactory function because self-reports may lack reliability. Management strategies aim at reducing inflammation and restoring sinonasal ventilation. First-line therapy with intranasal corticosteroids and short courses of systemic corticosteroids may be useful for symptomatic relief. Biologic agents directed against type-2 inflammation have demonstrated significant benefits in selected cases. Functional Endoscopic Sinus Surgery (FESS) plays an important role in the treatment of refractory CRS to restore the airflow and to improve the delivery of topical drugs. Olfactory outcomes following surgery, however, are variable and often incomplete, reflecting underlying inflammation and neuroepithelial damage. Disease recurrence, especially in type-2–driven CRS, affects long-term outcomes, underscoring the necessity to incorporate surgery in an individualized, endotype-informed treatment strategy. Full article

Background/Objectives: Medication-related harm is a leading global patient safety challenge, yet patients’ lived experiences of medication safety remain underexplored in Central and Eastern European healthcare systems, where structural constraints significantly shape everyday medication use. Methods: This study provides an in-depth qualitative analysis of Hungarian patients’ online narratives, building on a prior netnographic mixed-methods study. Using grounded theory-informed principles and a patient-centred medication safety framework, we inductively analysed 5174 publicly accessible Hungarian-language comments posted on health forums and social media platforms between August 2020 and August 2023. The COM-B model was applied as a secondary lens to map findings onto modifiable behavioural determinants. Results: Access to services and communication emerged as the dominant medication safety concerns. Patients reported long waiting times, limited rural emergency services, and brief consultations leading to delayed or inadequate treatment. Communication gaps included insufficient information on medication duration, side effects, and follow-up, as well as conflicting advice from multiple sources, all of which eroded trust and prompted treatment discontinuation or reliance on informal online communities. Community pharmacists were largely absent from patients’ mental models of care, representing a significant missed opportunity given their accessibility. Less frequently mentioned were medication shortages, healthcare professional workload, and systemic safety culture. Conclusions: Clear, respectful communication and timely access to care are central to medication safety from the patient perspective. Netnography combined with a grounded theory-informed methodology offers a valuable approach for capturing authentic patient perspectives in structurally burdened healthcare systems, with findings relevant beyond the Hungarian context. Full article

Nasal alar arteriopathy (NAA) is a rare dermatologic condition in dogs characterized by ulcerative and potentially severe hemorrhagic lesions of the nasal alar fold. This condition has only previously been reported in German Shepherd Dogs. Achieving clinical remission can be challenging and typically involves a combination of surgical resection of the diseased tissue and immunosuppressive therapies. This report is the first to describe two cases of NAA in which clinical remission was initially achieved with oclacitinib alone. Both cases were presented to the Internal Medicine service with a complaint of unilateral recurrent epistaxis. The first case involved a 7-year-old German Shepherd dog. Clinical remission was first achieved with oclacitinib monotherapy. Relapse occurred following dose tapering, and remission was ultimately regained with dose reescalation of oclacitinib and the addition of cyclosporine. The second case involved a 3-year-old Poodle mix that achieved and maintained clinical remission with oclacitinib alone. These cases suggest that oclacitinib may be an effective and well-tolerated treatment option for NAA, offering an alternative to traditional systemic immunosuppressive therapies. However, additional treatment may be required in severe cases or during oclacitinib dose reduction. Further studies are needed to evaluate long-term outcomes and broader applicability. Full article

Objectives: To compare the adjunctive efficacy of a MicroRepair^® mouthwash containing an antibacterial complex (ABX), composed of cetylpyridinium chloride, magnolol, and honokiol, with 0.12% chlorhexidine (CHX) in the management of generalized plaque-induced gingivitis, assessing clinical periodontal parameters, salivary activated matrix metalloproteinase-8 (aMMP-8) levels, and patient-reported outcomes over 6 months. Methods: A randomized, controlled, parallel-group clinical trial included 40 systemically healthy adults with generalized gingivitis and was reported in accordance with CONSORT 2025 guidelines. Following professional oral hygiene according to the Guided Biofilm Therapy (GBT) protocol, participants were randomly allocated to ABX or 0.12% CHX, used twice daily for 14 days. Clinical parameters, including Full-Mouth Bleeding Score (FMBS, primary outcome), Full-Mouth Plaque Score (FMPS), Probing Pocket Depth (PPD), Clinical Attachment Level (CAL), Gingival Recession (REC), and Modified Lobene Stain Index (MLSI), were recorded at baseline, 2 weeks, 1, 3, and 6 months. Salivary aMMP-8 levels were assessed at baseline and 2 weeks. Heavy smokers were excluded, and smoking status was evaluated as a potential covariate. Non-parametric tests were applied (p < 0.05). Results: Both groups showed significant reductions in FMBS and FMPS over time (p < 0.05), with no intergroup differences for the primary outcome at any follow-up at the patient level. Patient-level analyses did not reveal consistent differences across secondary parameters. At the tooth level, lower FMPS values were observed in the trial group at 2 weeks and 1 month (p < 0.05), with earlier PPD reduction. CAL, and REC remained stable. Salivary aMMP-8 levels decreased significantly in both groups without intergroup differences. Patient-reported outcomes were comparable. Smoking status was balanced between groups and was not significantly associated with treatment allocation or the main clinical outcomes. Conclusions: No significant differences were observed between ABX and CHX for the main clinical and molecular outcomes, supporting its potential use as an adjunct in gingivitis management. Full article

Anemia represents one of the most frequent systemic complications of inflammatory bowel disease (IBD), with a consistently higher prevalence reported in patients with Crohn’s disease (CD) compared with ulcerative colitis (UC). While chronic inflammation, impaired iron absorption, and intestinal blood loss are recognized contributors, microbiome-mediated mechanisms influencing host iron availability remain insufficiently explored. Emerging evidence indicates that CD-associated dysbiosis is characterized by an increased abundance of siderophore-producing bacteria, particularly members of the Enterobacteriaceae family. Because siderophores are high-affinity iron-chelating molecules capable of competing with host iron acquisition systems and partially escaping lipocalin-2-mediated sequestration, their expansion may contribute to reduced luminal iron bioavailability. In this systematic review, we analyzed comparative microbiome studies published between 2016 and 2026 that directly evaluated microbial differences between CD and UC. CD microbiota consistently demonstrated enrichment in siderophore-associated taxa relative to UC. Based on these findings, we propose that microbiome-driven iron competition may represent an additional mechanistic contributor to the increased prevalence and persistence of anemia observed in CD. Although direct in vivo quantification of siderophore activity in IBD remains limited, the convergence of ecological, functional, and strain-level microbiome evidence supports a biologically plausible interaction between microbial iron-scavenging strategies and host iron metabolism. Full article

Background/Objectives: Numerous natural compounds have been reported to exhibit anti-virulence properties against pathogenic bacteria. Particularly, plants constitute a rich source of anti-quorum-sensing (QS) and anti-biofilm compounds with highly diverse chemical structures. Notably, several studies reported that plant-derived pentacyclic triterpenoids exert anti-biofilm activity against Pseudomonas aeruginosa without affecting bacterial viability, suggesting that this class of naturally occurring chemical compounds may represent a source of potent and clinically relevant anti-biofilm agents. Methods: To further investigate this hypothesis, we evaluated several commercially available pentacyclic triterpenoid acids of the oleanane, ursane and lupane types for their potential impact on QS mechanisms and biofilm formation in the P. aeruginosa PAO1 model strain. Results: Oleanane-type (oleanolic acid and maslinic acid), ursane-type (ursolic acid and corosolic acid) and lupane-type (betulinic acid) triterpenoids inhibited the expression of the QS-regulated lasB and rhlA genes as well as biofilm formation, without affecting bacterial growth. Among tested compounds, oleanolic and ursolic acids, at 400 µM, exhibited the strongest anti-biofilm activities, with 45% and 40% inhibition, respectively. Fluorescence microscopy revealed a marked disorganization of biofilm architectures, with bacterial communities failing to establish compact cell-to-cell attachment and confluent microcolonies. Further analyses indicated that these triterpenoid acids did not affect the expression of QS-regulator genes (lasR/I and rhlR/I), suggesting that their impact on lasB and rhlA expression and biofilm formation is independent of the las and rhl systems. Conclusions: These findings suggest that oleanane and ursane triterpenoid acids represent promising chemical backbones for the development of strategies aimed at inhibiting P. aeruginosa biofilm formation. Full article

The growth of Intelligent Transportation Systems (ITS) has made high-quality perception data from multi-sensor setups essential. Pairing millimeter-wave (mmW) radar with a monocular camera is a common way to recover three-dimensional information about the environment, but aligning the two is difficult because sparse radar point clouds and dense camera images differ sharply in how they sense a scene. The problem grows more severe in roadside infrastructure, where the high mounting elevation introduces perspective distortion that vehicle-mounted systems rarely face. This paper presents a systematic review, conducted under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, of radar-camera extrinsic calibration for fixed roadside infrastructure, organizing existing work into a taxonomy that separates traditional two-stage pipelines from recent end-to-end learning frameworks. Because methods designed specifically for roadside units remain scarce, the review also covers vehicle- and robot-mounted methods whose static-sensor formulation carries over to fixed roadside deployment. For the two-stage pipeline, the analysis covers target-based and targetless correspondence registration along with the optimization techniques and algorithmic assumptions behind parameter estimation. The end-to-end learning literature shows a clear shift toward self-supervised and fusion-based models, some of which report real-time performance. The review also compares the metrics and procedures used to quantify calibration accuracy. Progress is evident, but robustness in cluttered urban environments remains an open challenge, and the paper closes by outlining future directions, arguing that standardized roadside benchmarks are needed before scalable, targetless calibration can mature. Full article

Most delinquent behavior occurs within age-homogeneous peer groups. Using incident-level data from the National Incident-Based Reporting System (NIBRS), this study reassesses the extent to which contemporary juvenile group offending reflects peer-only networks versus cross-age collaboration. Results show that while juvenile-only groups remain the dominant pattern, approximately one-third of co-offending incidents involve adult participants. Mixed-age groups are associated with group size, offense type, and situational context, and are especially common in serious offenses such as homicide, aggravated assault, and drug crimes. Mixed-age co-offending is also associated with greater offense severity, particularly higher odds of victim physical injury. These findings have important implications for the criminal justice system’s response to juvenile crime. While most juvenile offending diversion programs currently focus on interventions that counter peer influence and reduce the time spent with peers engaging in antisocial behavior, intervention strategies that also address the facilitating role of adult co-offenders may also be necessary. Full article

Prior to this study, knowledge on the evolutionary lineage of Garra remained inadequate, as previous phylogenetic investigations were primarily based on partial gene sequences. Although several mitogenomes of Garra species have been reported, their structural organization and comprehensive genomic characteristics have not been thoroughly evaluated. In this study, Garra manipurensis, endemic to the Indo-Burma biodiversity hotspot, was identified based on its detailed morphology and meristic counts. The circular mitogenome of G. manipurensis is 16,776 bp in length and contains the canonical set of 37 genes, along with duplicated control regions separated by tRNA-Proline. The comparative assessments across Garra species indicate predominantly conserved GTG start codons, occasional alternative ATA initiation codons, and incomplete stop codons. The selection pressure examinations within Garrini taxa reveal a purifying selection across all protein-coding genes. The control region comprises four conserved sequence blocks and species-specific tandem repeats, reflecting a balance between functional constraint and lineage-dependent evolutionary dynamics. The phylogenetic inference supports the monophyly of Garra and places G. manipurensis in close affinity with Garra flavatra, which is native to the western slope of Rakhine Yoma in Myanmar and Mizoram State in northeastern India. The genetic diversity analyses revealed haplotype differentiation, with shallow intraspecific genetic distances (0.000–0.011) observed samples between two distinct drainage systems in Manipur and Mizoram, northeastern India. The observed pattern of haplotype divergence in G. manipurensis may reflect the historical or seasonal hydrological connectivity among the western-slope drainages of the Chin Hills, with the subsequent geographic isolation potentially contributing to the emergence of distinct genetic lineages. Nevertheless, the extent and evolutionary significance of this differentiation remain uncertain and warrant further investigation through expanded geographic sampling and the incorporation of additional molecular data. Collectively, these findings provide in-depth insights into the mitogenomic architecture, comparative gene arrangements, phylogenetic patterns, and matrilineal evolutionary history of G. manipurensis and other congeners, thereby improving our understanding of the systematics and genetic diversity of this important cyprinid fish lineage. Full article

Background/Objectives: Dementia and cognitive decline place increasing demands on healthcare systems, rehabilitation services, long-term care, and community-based prevention. Structured exercise training is a promising strategy for adults at risk of cognitive decline, but it remains unclear how intervention studies integrate cerebrovascular and cognitive outcomes in ways that can inform clinical translation, rehabilitation planning, and exercise prescription. Methods: This scoping review followed PRISMA-ScR guidance. PubMed/MEDLINE and Scopus were searched for peer-reviewed English-language studies published from 2010 to 2026, supplemented by reference list checking and citation chasing. Eligible studies were human intervention studies involving structured exercise training and at least one cerebrovascular, vascular, brain-related, or cognitive outcome. Studies were mapped by exercise modality, population risk profile, grouped outcome domain, and outcome-integration category. Results: Fifty-four studies were included. A central finding was the vascular cognitive integration gap: only 7 studies assessed both cerebrovascular and cognitive outcomes within the same intervention design, whereas 38 studies reported cognitive outcomes only and 9 reported cerebrovascular or vascular outcomes only. Aerobic training formed the most developed evidence cluster for direct cerebrovascular outcomes, whereas other modalities were more often represented in cognition-focused studies but less frequently included direct cerebrovascular measures. Conclusions: Current evidence is limited by a major vascular cognitive integration gap. Because most exercise intervention studies separate cerebrovascular and cognitive outcomes, the field cannot yet determine whether exercise-induced cerebrovascular adaptations correspond to cognitive improvements in the same participants. Future trials should combine cerebrovascular assessment, domain-specific cognitive testing, dose reporting, adherence monitoring, safety reporting, feasibility evaluation, and mechanistic biomarkers to support more precise exercise prescription for dementia risk mitigation and cognitive health promotion. Full article

Background: Effective root canal disinfection is essential for successful nonsurgical root canal treatment (RCT). Although sodium hypochlorite (NaOCl) remains the standard irrigant, it carries a risk of chemical tissue injury if extruded beyond the root canal system and may have limited penetration into anatomically complex regions. Underwater discharge plasma (UDP) generates reactive oxygen and nitrogen species (RONS) through high-frequency, high-voltage electrical discharge in aqueous media, and preclinical and in vitro studies have reported broad-spectrum antimicrobial activity. This study evaluated the clinical and radiographic outcomes of nonsurgical RCT performed using physiological saline-based UDP irrigation without NaOCl in a heterogeneous real-world clinical cohort. Methods: This single-center retrospective cohort study included 186 teeth from 134 patients treated with the PLAZEN RCT^® UDP device and physiological saline irrigation, without NaOCl. The median follow-up period was 16 months. Radiographic outcomes were assessed using the Periapical Index (PAI) system, and treatment success was evaluated according to prespecified Strict and Loose criteria incorporating both radiographic and clinical findings. Stratified analysis was performed according to preoperative PAI score: Group A (PAI 1–2) and Group B (PAI 3–5). UDP-related adverse events, defined as thermal tissue injury caused by discharge heat, were ascertained through retrospective review of clinical records, operative notes, and serial periapical radiographs. Results: Among the 186 treated teeth, radiographic outcomes were classified as Healed (85.5%), Healing (3.8%), and Unhealed (10.8%). Overall Strict and Loose success rates were 79.6% and 82.3%, respectively. Initial treatment showed numerically higher success rates than retreatment. In the stratified analysis, Group A showed an 84.1% success rate with 100% tooth survival, whereas Group B demonstrated Strict and Loose success rates of 68.5% and 83.3%, respectively. Exploratory multivariable analysis showed that periodontal pocket depth > 3 mm was the most consistent factor associated with lower odds of treatment success, whereas associations involving canal obliteration and higher preoperative PAI score were less stable across sensitivity analyses and should be interpreted with caution. No UDP-related adverse events were recorded during follow-up. Attrition sensitivity analyses were performed, and the outcome estimates should be interpreted with caution, given the retrospective design and substantial loss to follow-up. Conclusions: In this preliminary observational cohort, physiological saline-based UDP irrigation without NaOCl was associated with favorable observed periapical healing outcomes and no recorded UDP-related adverse events over a median follow-up of 16 months. However, loss to follow-up was substantial; when all 116 teeth lost to follow-up were classified as treatment failures, the worst-case Strict success rate decreased to 49.0%. Therefore, these findings should be interpreted as preliminary descriptive evidence of clinical feasibility rather than as evidence of comparative efficacy or definitive clinical safety. Adequately powered randomized controlled trials with concurrent NaOCl control arms and long-term follow-up are warranted to evaluate the comparative effectiveness, safety, and reproducibility of physiological saline-based UDP irrigation protocols. Full article

The present integrative umbrella review aims to provide a comprehensive overview of the evidence and practices related to mental health and career transitions in elite sport toward the implementation of service provision through digital interventions. Following PRIO guidelines, an extensive search across five databases (2015–2025) identified 52 eligible manuscripts (e.g., conceptual, review, and position studies). Data extraction focused on mental health, dual-career pathways, career transition challenges and needs, and identity-related issues among high-performance athletes. The findings revealed a strong consensus that athlete well-being is shaped by the dynamic interaction of mental health symptoms, sport-specific stressors, identity processes, and structural conditions across the athletic lifespan. Mental health vulnerabilities (e.g., anxiety, depression, disordered eating, and distress) were consistently reported, particularly during injury, deselection, and retirement. Dual-career engagement, diversified identities, and proactive career planning emerged as key protective factors, while stigma, limited literacy, and uneven access to psychological services remained persistent barriers. Five main thematic areas (Matrix 1) operationalized in ten higher-order intervention domains (e.g., Matrix 2, screening, monitoring, literacy, and others) and 14 potential online implementation strategies (Matrix 3) were identified. However, the evidence highlights fragmented implementation and a lack of scalable, cross-national tools to support athletes during and beyond their competitive careers. Therefore, a harmonized, evidence-based, multidimensional framework for the development and implementation of digital support resources has been proposed. This integrative review underscores the need for integrated, culturally sensitive, and digitally enabled support systems to promote sustainable transitions and long-term athlete well-being. Full article