Search Results (12,296)

Hypertriglyceridaemia is the third most common aetiology of acute pancreatitis and a leading cause of recurrence in specialized lipid clinics. The risk of acute pancreatitis rises steeply once triglycerides exceed approximately 10 mmol/L (≈885 mg/dL). Still, clinically meaningful risk may occur at lower levels in the presence of chylomicronaemia, metabolic stress, or pregnancy. This mini-review synthesizes contemporary evidence on epidemiology, mechanistic links between triglyceride-rich lipoproteins and pancreatic injury, and the practical distinction between secondary (acquired) and genetic drivers of severe hypertriglyceridaemia. We summarize acute management strategies aimed at rapid triglyceride reduction (including insulin-based approaches and therapeutic plasma exchange in selected scenarios) and focus on long-term prevention of recurrence through lifestyle interventions, correction of secondary contributors, and triglyceride-lowering pharmacotherapy. Finally, we discuss emerging RNA-targeted therapies against apolipoprotein C-III and angiopoietin-like 3, which are reshaping prevention strategies for familial and persistent chylomicronaemia and may reduce pancreatitis burden in the highest-risk phenotypes. Full article

Background and Objectives: Rib fractures cause intense pain, leading to respiratory complications. Standard care relies on systemic opioids, which carry significant adverse effects. The serratus anterior plane block (SAPB) has emerged as a promising regional anesthetic technique, but its efficacy remains unclear. This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to evaluate the efficacy and safety of SAPB versus standard care in patients with rib fractures. Materials and Methods: A comprehensive search of PubMed, Scopus, CENTRAL, and Web of Science was conducted for RCTs comparing SAPB to standard care in adults with rib fractures. The primary outcome was the pain score. Secondary outcomes included 24 h opioid consumption, need for rescue analgesia, and complications. Standardized mean differences (SMD) and risk ratios (RR) were pooled, using STATA SE 19.5. Results: Three RCTs involving 310 patients were included. SAPB significantly decreased pain scores at 2 h (SMD: −1.30, 95% CI [−2.39, −0.20]; p = 0.02), 6 h (SMD: −0.75, 95% CI [−1.41, −0.09]; p = 0.03), 12 h (SMD: −0.37, 95% CI [−0.68, −0.07]; p = 0.02), and 24 h (SMD: −5.67, 95% CI [−9.90, −1.43]; p = 0.01). This was associated with a significant reduction in 24 h opioid consumption (SMD: −0.45, 95% CI [−0.69, −0.21]; p < 0.001). However, no significant differences were found in the need for rescue analgesia (RR: 1.06, 95% CI [0.97, 1.16]; p = 0.18). Conclusions: SAPB provides significant short-term analgesic benefits and reduces opioid consumption in patients with acute rib fractures. While it appears safe, the current evidence is limited by a small number of trials and is insufficient to recommend SAPB as a first-line management option over standard care. Full article

Background: Proprioceptive deficits, commonly quantified as joint position sense error (JPSE), are frequently reported in musculoskeletal conditions. Articular manual therapy may influence afferent input and sensorimotor integration. This review synthesised the effects of joint mobilization and/or high-velocity low-amplitude (HVLA) thrust manipulation on quantitative proprioception outcomes in humans. Methods: PubMed, Scopus, CINAHL, and MEDLINE Complete were searched (from inception to November 2025) for randomized or sham-controlled trials assessing proprioception after eligible articular manual therapy. Searches were limited to English-language publications. Risk of bias was assessed using Risk of Bias 2 (RoB 2). Random-effects meta-analysis (Hedges’ g) was conducted when outcomes and time points were comparable; pooling was possible for only one outcome/time-point comparison. Certainty of evidence was assessed using GRADE. Results: Database searches yielded 483 records; after duplicate removal, 371 records were screened. Eighteen full-text articles were assessed for eligibility, of which 11 were excluded, resulting in seven randomized clinical trials (2018–2025; total n = 350) evaluating spinal or peripheral mobilization/manipulation. No eligible randomized or sham-controlled trials meeting the prespecified criteria were identified before 2018. In chronic mechanical neck pain, cervical thrust manipulation improved cervical JPSE versus sham with large partial eta-squared effects (η²p = 0.23–0.36). Cervical mobilization improved left rotation JPSE (4.15 → 1.65° vs. 4.01→3.74°). In patellofemoral pain, lumbopelvic manipulation produced immediate reductions in knee JPSE at 60° (6.58 → 4.48° vs. 5.91 → 6.05°). Only one outcome/time-point was suitable for meta-analysis (knee JPSE at 60° flexion in patellofemoral pain; two trials), showing no statistically significant pooled effect (Hedges’ g = −0.21, 95% CI −1.36 to 0.94; I² ≈ 83%). Remaining outcomes could not be pooled due to heterogeneity and incompatible reporting. Conclusions: Evidence from seven randomized trials indicates that articular manual therapy (mobilization and/or HVLA thrust manipulation) can improve quantitative proprioceptive outcomes immediately post-intervention, particularly JPSE in neck and patellofemoral pain; however, effects are condition- and outcome-specific, and confidence is limited by heterogeneity and the predominance of narrative synthesis with sparse poolable data. Future adequately powered trials should standardize proprioception protocols, include longer follow-up, and report data to enable robust meta-analysis. Full article

Background: Congenital anomalies are influenced by genetic and environmental factors. While interventions including folic acid supplementation have reduced neural tube defects, data on modifiable socio-demographic risk factors remain limited. Aim: This study aimed to assess variation in the prevalence of selected congenital anomalies across the United States according to socio-demographic factors. Methods: A population-based analysis was conducted using CDC-WONDER natality data from 2016 to 2023. Included anomalies were anencephaly, spina bifida, cyanotic heart disease, diaphragmatic hernia, omphalocele, gastroschisis, limb reduction, cleft lip/palate, Down syndrome, chromosomal disorders, and hypospadias. Associations with maternal age, BMI, race, tobacco use, diabetes, and fertility treatments were analyzed. Prevalence rates were calculated per 1000 live births. Relative risks (RRs) and 95% confidence intervals (CIs) were estimated. Joinpoint regression was used to assess annual percent changes (APCs), with p < 0.05 considered significant. Results: Among 3,482,944 singleton live births in 2023, the overall prevalence of the selected congenital anomalies was 3.3 per 1000. Compared to Caucasian mothers, risk was lower in Asian (RR 0.57; 95% CI: 0.52–0.63) and Black (RR 0.81; 95% CI: 0.76–0.85) infants and higher in American Indian/Alaska Native infants. Significant risk factors included pre-pregnancy diabetes (RR 2.41; 95% CI: 2.16–2.69), maternal age > 45 (RR 2.95; 95% CI: 2.36–3.69), and tobacco use (RR 1.78; 95% CI: 1.64–1.94). A significant decline in prevalence was observed from 2016 to 2023 (APC: –0.6%; 95% CI: –1.1 to –0.2; p = 0.006). Conclusions: Significant disparities and modifiable maternal risk factors were associated with the prevalence of selected congenital anomalies in the U.S. from 2016 to 2023. A modest statistically significant decline in overall prevalence was observed during the study period, supporting the importance of continued national surveillance and targeted preconception and prenatal interventions to reduce risk and address inequities. Full article

High platelet reactivity (HPR) in patients with coronary artery disease receiving P2Y12 inhibitors increases ischemic risk. Chronic kidney disease (CKD) is an established contributor to HPR during clopidogrel therapy. The objective of the study was to assess whether CKD influences platelet reactivity (PR) in patients treated with clopidogrel or ticagrelor. This double-blind, double-dummy study enrolled 106 stable patients more than one year after an acute coronary syndrome, with or without CKD. Participants were matched by age and sex and randomized to clopidogrel or ticagrelor. PR was measured using the VerifyNow™ P2Y12 assay, and HPR was defined as P2Y12 reaction units (PRU) ≥ 208. Median glomerular filtration rates were 80 mL/min/1.73 m² in non-CKD patients and 41 mL/min/1.73 m² in CKD patients (p < 0.01). Ticagrelor produced similarly low PR in both groups (36 vs. 35 PRU; p = 0.61). Clopidogrel resulted in a numerically higher PR in CKD patients (209 vs. 180 PRU; p = 0.07). The magnitude of PR reduction with ticagrelor relative to clopidogrel was greater in CKD patients (p-interaction = 0.09). HPR was markedly more common with clopidogrel, particularly in CKD (difference 37%; adjusted OR 4.42; p = 0.01). In conclusion, CKD significantly impairs clopidogrel responsiveness but does not affect ticagrelor, resulting in a greater relative advantage of ticagrelor in patients with CKD. Full article

Climate change significantly challenges efforts to maintain and improve crop production worldwide. Diversified crop rotations have emerged as a promising way to adapt cropping systems and bolster food security under changing climate conditions; however, robust empirical evidence remains limited. This study evaluates the long-term performance of diversified crop rotations under future climate scenarios in the North China Plain via an 80-year scenario analysis (2020–2100) spanning three shared socioeconomic pathways (SSPs:126, 370, 585). The calibrated and validated SWAP (Soil–Water–Atmosphere–Plant)–WOFOST (WOrld FOod STudies) model simulated water consumption and yield. Sustainability indices were employed to assess the cereal yield stability and compensation effect to yield loss caused by climate change. The study compares the conventional winter wheat–summer maize rotation (WM) with two legume-based rotations: soybean–WM (S–WM) and peanut–WM (P–WM). The results indicate that, under all three climate scenarios, the two legume-based rotations reduced annual water consumption by 7–9%, maintained system economic equivalent yields with one crop less, and improved water productivity by up to 10%. Future climate change decreased cereal yields by 9–26% across all rotations compared to historical baselines. However, the two legume-based rotations showed a significant residual effect, increasing subsequent cereal yields by 9–14% over the conventional WM under all scenarios. Consequently, the legume-based rotations provided a 25–51% yield compensation. Additionally, these rotations improved the sustainable yield index and system resilience and reduced cereal yield variance under future climate scenarios compared to the more vulnerable WM. This study demonstrates that diversified crop rotations are a viable strategy to mitigate negative climate impacts. The study provides critical insights for policy-makers, supporting crop-rotation diversification as a core component of risk-reduction strategies to mitigate future climate change impacts. Full article

Objectives: To synthesize current evidence and emerging data on systemic treatment strategies for early-stage and locally advanced human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC), with emphasis on treatment de-escalation and the integration of immunotherapy. Data Sources: We searched PubMed/MEDLINE, Scopus, and EMBASE for English-language studies published from 2010 to 2025 using terms related to HPV-positive disease, oropharyngeal carcinoma, de-escalation, chemoradiation, and immunotherapy. Review Methods: Peer-reviewed clinical trials, meta-analyses, and key translational studies addressing systemic therapy, biomarkers, and immunotherapeutic strategies in HPV-positive OPSCC were included. Emphasis was placed on phase II–III trials evaluating cisplatin-sparing regimens, cetuximab substitution, radiation dose reduction, and early-phase immunotherapy combinations. Evidence was synthesized qualitatively. Results: Cisplatin-based concurrent chemoradiation remains the standard of care for locally advanced HPV-positive OPSCC. De-intensification trials suggest that reduced-intensity regimens may be feasible in carefully selected low-risk patients; however, replacing cisplatin with cetuximab results in inferior survival. PD-1 inhibitors (e.g., pembrolizumab, nivolumab) provide durable responses in recurrent/metastatic disease and are under active evaluation in earlier stages and in combination with therapeutic vaccines, bispecific antibodies, and viral-vector platforms. Conclusions: Systemic therapy for HPV-positive OPSCC is moving toward biomarker-informed personalization. Cisplatin-based chemoradiation remains the curative backbone, while rational de-escalation and immunotherapy integration may preserve high cure rates while reducing long-term toxicity. Ongoing phase III trials will clarify which patient subsets are most suitable for de-intensified or immunotherapeutic approaches, guiding future standards of care. Full article

Background/Objectives: Cervical cancer remains a major cause of morbidity and mortality among women worldwide, marked by stark geographic and socioeconomic disparities. Preventable via HPV vaccination and screening, progress toward elimination varies widely across and within countries. This narrative review synthesizes the epidemiology, including incidence, mortality, survival, and stage distribution, as well as risk factors and the coverage/equity of HPV screening and vaccination programs. Methods: Comprehensive searches were performed in PubMed, Web of Science, Scopus, and Google Scholar (no date restrictions; English only). Included were original epidemiological studies, systematic reviews, meta-analyses, and international reports on burden, risk factors, or prevention indicators. Data were qualitatively synthesized into three themes: epidemiological patterns, risk factors, and screening/prevention programs. Results: Persistent high-risk HPV infection causes nearly all cervical cancers, predominantly HPV16/18, with regional variation in other types. Strong co-factors include HIV immunosuppression, early sexual debut, multiple partners, high parity, long-term oral contraceptive use, and smoking. Inequalities in incidence, late diagnosis, and survival are driven by socioeconomic disadvantages, low education, rural residence, and poor health system access. Screening ranges from cytology/VIA to primary HPV testing, but coverage is low and inequitable in high-burden settings. HPV vaccination has expanded yet faces major gaps in low- and middle-income countries. Conclusions: Cervical cancer burden concentrates in low-resource and marginalized populations. Global elimination demands accelerated, equitable scale-up of HPV vaccination and screening, alongside health system strengthening and barrier reduction. Full article

Industrial information systems based on web technologies (ISOWT) face escalating security challenges, particularly in critical sectors such as energy. Traditional qualitative security assessments often lack the ability to deliver actionable, real-time insights for managing complex, dynamic threats. This paper proposes a novel security index for evaluating ISOWT in industrial organizations by integrating fuzzy logic, metric-based evaluation, fuzzy Markov chains, and multi-agent systems. The proposed index quantifies deviations from an ideal “center of safety,” enabling early risk detection and proactive mitigation. The methodology is validated through two real-world case studies on Syria’s energy sector, namely the Ministry of Electricity website and Mahrukat fuel management system. Experimental results demonstrate substantial improvements, including a 45.9–58.5% increase in security index, 56.9–60.3% reduction in page load times, and 78.3–82.4% decrease in detected vulnerabilities. Comparative analysis shows that the proposed approach outperforms existing methods in terms of quantitative precision, real-time monitoring, and predictive capabilities. The proposed framework is scalable, automated, and adaptable, addressing key limitations of existing ISOWT security assessment techniques and providing a robust tool for enhancing system resilience. Its flexibility enable applicability across diverse industrial domains, contributing to advanced cybersecurity practices for critical infrastructure. Future work will focus on integrating advanced technologies, expanding the framework to additional sectors, developing adaptive fuzzy models, accounting for human factors, and improving visualization techniques to further address the evolving security challenges faced by industrial organizations. Full article

This study investigates the seismic performance of reinforced concrete flat slab buildings strengthened with conventional structural elements, including drop panels, edge beams, shear walls, and coupled shear walls. Unlike previous works that examined these elements independently, this research provides an integrated comparative evaluation of several common strengthening approaches under identical modeling and seismic loading conditions, offering clear guidance for practical design optimization. A comparative finite element analysis was conducted using ETABS v20 in accordance with ACI 318-19 and ASCE 7-22 seismic design provisions. Five ten-story building models were developed to assess key response parameters such as story displacement, inter-story drift, column axial forces, diaphragm deformation, and punching shear resistance under gravity and earthquake loading. Results reveal that models incorporating coupled shear walls achieve the greatest improved seismic performance, with up to 50% reduction in story displacement compared to other configurations, while also minimizing column over-compression and lateral drift. Drop panels alone showed a localized improvement in punching resistance, but their global impact on lateral stiffness was limited. However, the combination of drop panels and edge beams produced a synergistic effect, significantly enhancing overall stiffness and controlling drift. Coupled shear walls efficiently redirected lateral forces away from critical slab–column joints, thereby mitigating the risk of punching shear failure. These findings offer practical guidance for structural engineers seeking to optimize the seismic design of flat slab buildings, emphasizing the importance of integrated strengthening strategies in achieving both stiffness and ductility in seismic regions. The findings underline the significance of systematically evaluating conventional strengthening techniques within a unified modeling framework, offering engineers practical insights for improving the seismic behavior of flat slab buildings at the early stage of design. Full article

Trust in machine-learning models is critical for deployment by users, especially for high-risk tasks such as healthcare. Model trust involves much more than performance metrics such as accuracy, precision, or recall. It includes user readiness to allow a model to make decisions. Model trust is a multifaceted concept commonly associated with the stability of model predictions under variations in training data, noise, algorithmic parameters, and model explanations. This paper extends existing model trust concepts by introducing a novel Model Sureness measure. Some alternatively purposed Model Sureness measures have been proposed. Here, Model Sureness quantitatively measures the model accuracy stability under training data variations. For any model, this is carried out by combining the proposed Bidirectional Active Processing and Visual Knowledge Discovery. The proposed Bidirectional Active Processing method iteratively retrains a model on varied training data until a user-defined stopping criterion is met; in this work, this criterion is set to a 95% accuracy when the model is evaluated on the test data. This process further finds a minimal sufficient training dataset required for a model to satisfy this criterion. Accordingly, the proposed Model Sureness measure is defined as the ratio of the number of unnecessary cases to all cases in the training data along with variations of these ratios. Higher ratios indicate a greater Model Sureness under this measure, while trust in a model is ultimately a human decision based on multiple measures. Case studies conducted on three benchmark datasets from biology, medicine, and handwritten digit recognition demonstrate a well-preserved model accuracy with Model Sureness scores that reflect the capabilities of the evaluated models. Specifically, unnecessary case removal ranged from 20% to 80%, with an average reduction of approximately 50% of the training data. Full article

Clarifying the pathways through which public emergency response capability influences community responsibility holds positive implications for promoting public participation in community disaster prevention and mitigation efforts. Based on a large-scale community survey covering over 70 cities in China, this study obtained a sample of 1753 individuals through random sampling and employed Bootstrap methods for effect testing. Findings reveal the following: ① Public emergency response capability significantly correlates positively with sense of community responsibility, with both intrinsic cognitive emergency response capability and extrinsic skill-based emergency response capability demonstrating strong positive associations with community responsibility. ② Risk perception mediates the relationship between public emergency response capability and community responsibility, forming the associative pathway: “Enhanced public emergency response capability → Reduced risk perception → Strengthened sense of community responsibility”. ③ Community resilience moderates the “public emergency response capability → risk perception” pathway, with high-resilience communities significantly reducing public risk perception levels. Therefore, to fully leverage the role of public emergency response capability in enhancing community responsibility, efforts should focus on cultivating public risk prevention awareness, comprehensively disseminating safety and emergency knowledge, strengthening public emergency skills training, fostering a culture of neighborhood watch within communities, and optimizing public participation mechanisms for community disaster reduction. Full article

Osteoporosis (OP) is a common chronic disease that significantly increases the risk of bone fractures. Pharmacotherapy uses, among others, 17beta-estradiol (E2), which has been replaced in recent years by raloxifene hydrochloride (RLX). The need for long-term, high-dose therapy with these drugs is associated with serious adverse effects. The aim of this review is to analyze the current state of knowledge over the last 5 years (2020–2025) regarding the use of nanoparticles (NPs) in the delivery of E2 and RLX, with particular emphasis on their impact on bioavailability, pharmacokinetic profile, reduction in adverse effects, and improvement in the effectiveness of postmenopausal osteoporosis therapy. Preclinical studies show that combining E2 or RLX with various types of NPs reduces cytotoxicity, improves pharmacokinetic parameters, and enhances the therapeutic effects of drugs used in postmenopausal osteoporosis. These effects are mainly attributed to improved pharmacokinetics and controlled drug release, rather than confirmed active tissue targeting. However, these findings are based on preclinical models and require further validation in clinical studies. The analysis concludes that while NP systems significantly enhance the pharmacokinetic profile and safety of E2 and RLX in preclinical models, claims of true bone-specific targeting remain largely unsubstantiated, highlighting a key area for future research. Full article

Objective: This double-blind, parallel-group randomized controlled trial is the first to investigate the synergistic effects of interval resistance plus progressive aerobic training with fisetin supplementation on adipokines in obesity. Methods: Sixty sedentary men with obesity (BMI < 30 kg/m²) completed 12 weeks of thrice-weekly interval resistance training (eight exercises, 3 × 13 reps at 60% 1RM with 20% 1RM active rest), immediately followed by staged aerobic bouts (50–70% HRmax). Participants were randomized into the control-placebo (P), fisetin (F; 200 mg/day), training-placebo (TP), or training + fisetin (TF) groups. The primary outcomes were asprosin, MCP-1, and adiponectin; secondary outcomes included leptin and lipid profile. Data were analyzed via ANCOVA with Bonferroni post hoc tests. Results: Statistical analyses were conducted following the intention-to-treat (ITT) principle using an analysis of covariance (ANCOVA) model, which revealed extensive effects of the interventions on the participants’ anthropometric and biochemical indices. Regarding body composition, after adjusting for baseline values, a significant difference in mean body weight was observed between groups (F (3, 55) = 9.444, p < 0.001, ηp² = 0.340); Bonferroni post hoc tests confirmed that the training plus fisetin (TF), training-placebo (TP), and fisetin (F) groups all achieved significant weight loss compared to the placebo (P) group. Furthermore, body mass index (BMI) showed a significant inter-group difference (p = 0.021), with post hoc analysis revealing that only the TF group reached a statistically significant reduction compared to the placebo (p = 0.024; 95% CI [−3.760, −0.172]). In the assessment of biochemical and inflammatory variables, the interventions exerted a highly significant effect on asprosin (F (3, 55) = 36.047, p < 0.001; ηp² = 0.663) and MCP-1 (F (3, 55) = 29.570, p < 0.001; ηp² = 0.617). The findings indicated that the TF group experienced the most substantial reductions in both asprosin (−60.71%) and MCP-1 (−46.50%) levels. Regarding adipokines, significant increases in adiponectin levels were observed in the TP (29.38%) and TF (27.67%) groups (p < 0.05), whereas changes in leptin were statistically significant only in the TF group relative to the placebo (p = 0.049). The lipid profile results indicated a statistically significant difference in the TF group in improving all markers; this group achieved greater reduction compared to other groups, including reductions in LDL-C, triglycerides (TG), and total cholesterol (TC) (p < 0.001), while simultaneously showing a significant elevation in HDL-C. Post hoc analyses confirmed robust statistical differences in all lipid parameters for both the TF and TP groups compared to the placebo group (p < 0.05), whereas the placebo group experienced a deterioration in status characterized by a significant increase in LDL-C (p = 0.027) and a significant decline in HDL-C concentrations (p = 0.006). Conclusions: In conclusion, 12 weeks of combined interval resistance–aerobic training and fisetin supplementation significantly reduced pro-inflammatory adipokines and improved lipid profiles in obese men. These findings suggest that asprosin serves as a potential modulator in metabolic risk reduction; however, since direct mechanistic assays were not conducted, these implications remain hypothetical. Future research employing molecular readouts is warranted to confirm the underlying pathways involved. Full article

The present study aimed to analyze the differences in psychopathological symptomatology between men and women who participate in online gambling, as well as to explore the relationship between this symptomatology and different risk profiles. The sample consisted of 382 participants, all university students from a province in Spain, of whom 261 were men (68.3%) and 121 were women (31.7%), with a mean age of 21.8 years (SD = 3.2; range = 18–30 years). Psychopathological symptomatology was assessed using the SAS-45, while gambling risk profiles were determined using an ad hoc questionnaire. The results of the risk profiles were formed by categorizing the SOG-RA Scale scores into non-risk gambler, at-risk gambler, and pathological gambler. The results evidenced that gender and risk profile are determining factors in the manifestation of psychopathological symptoms. It was observed that women tend to internalize their emotional problems, presenting higher levels of depression, anxiety, and interpersonal sensitivity, while men exhibit a greater propensity to externalize their symptoms, manifesting hostility, paranoid ideation, and psychoticism. Furthermore, gamblers with high-risk profiles showed higher scores in both internalizing and externalizing symptoms. Significant correlations were identified between risk profile, psychopathological symptomatology, and cognitive distortions, suggesting the need for comprehensive interventions differentiated by gender. These findings provide valuable information for the design of specific treatments that address the emotional and cognitive needs of problem gamblers, contributing to improving the effectiveness of therapeutic strategies in the context of problem gambling. University gambling is an emerging public health issue with consequences that extend beyond the individual, affecting educational, social, and economic well-being. This study addresses a critical gap by delineating gender-specific psychopathological profiles across gambling risk categories, providing actionable evidence to inform campus-based screening and targeted prevention strategies. The findings underscore the necessity of integrating gender-responsive interventions and upstream measures—such as early detection within student health services and harm-reduction messaging—to effectively mitigate gambling-related harm. Full article