Search Results (216)

Tuberculosis (TB) remains a leading cause of death in Bangladesh, disproportionately affecting low socio-economic status (SES) populations. This review, guided by the WHO Social Determinants of Health framework and Rockefeller-Lancet Planetary Health Report, examined how social, economic, and ecological factors link SES to TB burden. The first literature search identified 28 articles focused on SES-TB relationships in Bangladesh. A second search through snowballing and conceptual mapping yielded 55 more papers of diverse source types and disciplines. Low-SES groups face elevated TB risk due to smoking, biomass fuel use, malnutrition, limited education, stigma, financial barriers, and hazardous housing or workplaces. These factors delay care-seeking, worsen outcomes, and fuel transmission, especially among women. High-SES groups more often face comorbidities like diabetes, which increase TB risk. Broader contextual drivers include urbanisation, weak labour protections, cultural norms, and poor governance. Recommendations include housing and labour reform, gender parity in education, and integrating private providers into TB programmes. These align with the WHO End TB Strategy, UN SDGs and Planetary Health Quadruple Aims, which expand the traditional Triple Aim for health system design by integrating environmental sustainability alongside improved patient outcomes, population health, and cost efficiency. Future research should explore trust in frontline workers, reasons for consulting informal carers, links between makeshift housing and TB, and integrating ecological determinants into existing frameworks. Full article

Background/Objectives: Bisphosphonates may influence vascular calcification and atheroma formation via farnesyl pyrophosphate synthase inhibition in the mevalonate pathway regulating bone and lipid metabolism. However, the clinical impact of NCB use on cardiovascular outcomes remains uncertain, largely due to methodological heterogeneity in prior studies. We aimed to evaluate the association between nitrogen-containing bisphosphonate (NCB) therapy and coronary artery calcium (CAC) progression, as well as the incidence of cardiovascular disease (CVD) and coronary heart disease (CHD) events. Methods: From 6814 participants in MESA Exam 1, we excluded males (insufficient male NCB users in the MESA cohort), pre-menopausal women, baseline NCB users, and users of hormone replacement therapy, raloxifene, or calcitonin. Among 166 NCB initiators and 1571 non-users with available CAC measurements, propensity score matching was performed using the available components of FRAX, namely age, race, BMI, LDL cholesterol, alcohol, smoking, and steroid use, and baseline CAC yielded 165 NCB initiators matched to 473 non-users (1:3 ratio). Linear mixed-effects models evaluated CAC progression, and Cox models analyzed incident CVD and CHD events. Results: In the overall cohort, NCB use was not significantly associated with CAC progression (annual change: −0.01 log Agatston units; 95% CI: −0.05 to 0.01). However, among participants with a baseline estimated glomerular filtration rate (eGFR) < 65 mL/min/1.73 m², NCB use was associated with attenuated CAC progression compared with non-users (−0.06 log Agatston units/year; 95% CI: −0.12 to −0.007). No significant association was observed between NCB use and incident CVD events in the overall cohort (HR: 0.90; 95% CI: 0.60−1.36) or within kidney function subgroups. Conclusions: Incident NCB use among postmenopausal women with mild or no CAC at baseline was associated with reduced CAC progression only in women with impaired kidney function. However, this association did not correspond to a decreased risk of subsequent cardiovascular events, suggesting that the observed imaging benefit may not translate into meaningful clinical association. Full article

Background/Objectives: According to the guidelines established by the European Society of Vascular Surgery (ESVS), a minimum 2 mm diameter is advised for both the radial artery (RA) and cephalic vein (CV) to perform a radio-cephalic arteriovenous fistula (RC-AVF). However, studies have suggested that larger vein diameters, over 2.5 or 3 mm, or even smaller vessel diameters, above 1.6 mm, can yield satisfactory outcomes in both the medium and long term. This study aims to analyze how preoperative vascular mapping influences the long-term RC-AVF failure, considering adherence to guidelines. Methods: This retrospective, monocentric, and observational study enrolled 110 patients with ESKD who were admitted, between 2018 and 2024, to the Vascular Surgery Department at the Emergency County Hospital of Târgu Mureș for the creation of an RC-AVF. Demographic characteristics, comorbidities, preoperative vascular mapping data, and laboratory data were meticulously collected from the hospital’s electronic databases. Patients enrolled in the current study were categorized into two groups based on their adherence to guideline recommendations. Results: Patients whose RC-AVF was created outside guideline recommendations demonstrated smaller arterial (p < 0.001) and venous (p < 0.001) diameters. Additionally, a higher percentage of these patients were on hemodialysis via CVC at the time of RC-AVF creation (p = 0.041), as well as a higher incidence of 6-week AVF maturation failure (p = 0.012) and long-term AVF failure (p = 0.016). In ROC Curve analysis, a threshold of 2.75 mm was established for the RA (AUC: 0.647, p = 0.005) and 2.52 mm for the CV (AUC: 0.677, p = 0.001). Additionally, patients whose RC-AVF procedures adhered to guideline recommendations had a significantly lower risk of long-term RC-AVF failure (HR: 0.44, p = 0.012). This association lost significance after adjusting for cardiovascular risk factors and the presence of CVC at admission (HR: 0.69, p = 0.328). After full adjustment, only the CV remained an independent predictor of long-term successful RC-AVF (HR: 0.68, p = 0.026). In contrast, RA lost significance after adjusting for cardiovascular risk factors and the presence of CVC at admission (HR: 0.71, p = 0.086). Conclusions: In conclusion, this study reveals that only the diameter of the CV is correlated with the long-term failure of RC-AVF, independent of age, gender, diabetes, hypertension, active smoking, and the presence of a CVC at the time of AVF creation. Therefore, while adhering to the threshold diameters of the AR and CV, as recommended by the ESVS guidelines, facilitates the creation of a functional RC-AVF, we assert that additional cofactors, such as demographic data, usual cardiovascular risk factors, or CVC presence, must also be considered to achieve optimal long-term AVF. Full article

Beer is the third most popular beverage in the world, and its production is distributed uniformly between the biggest continents. Considering the environmental aspects, the utilization of brewing by-products, mainly brewers’ spent grain (BSG), is essential on a global scale. The beer revolution, lasting over a few decades, significantly diversified the beer market in terms of styles, and therefore, also its by-products, which should be characterized appropriately prior to further application. Herein, the presented study investigated the unprecedented number of 22 different variants of brewers’ spent grain, yielded from the production of various beer styles, enabling their proper comparison. A comprehensive by-product characterization revealed an almost linear relationship (Pearson correlation coefficients exceeding 0.9) between the color parameters (L*, a*, browning index) of beer and generated spent grain, enabling a prediction of BSG appearance based on beer color. Applying wheat or rye malts increased the content of extractives by over 40%, reducing cellulose content by as much as 45%. Thermal treatments of malts (kilning or smoking) also reduced extractive content and limited antioxidant activity, often by over 30%. A lack of husk for wheat or rye reduced the crystallinity index of spent grain by 21–41%, while the roasting of barley efficiently decomposed the less stable compounds and maintained the cellulose crystalline structure. All the analyzed BSG samples were characterized by low volatile emissions and very limited antimicrobial activity. Therefore, their harmfulness to human health and the environment is limited, broadening their potential application range. Full article

Objective: To assess radiographic changes in the alveolar bone on the distal aspect of the second molars (2Ms) over time, while impacted third molars (ITMs) remain present across two timepoints. Methods: This retrospective observational study aimed to assess radiographic changes between two timepoints (T0 and T1). Both Orthopantomogram (OPG) and Periapical (PA) X-rays were utilized, with three measurements taken on the distal surface of 2Ms using EMAGO 6.1 software. Statistical significance was defined as a p-value < 0.05. Results: A total of 51 patients met the inclusion criteria, with a mean age of 45 years (SD ± 13). Sixty-eight second molars were assessed at baseline (T0) and follow-up (T1), with a mean interval of 20 months (SEM ± 62 days). No significant changes were found in vertical, oblique, or angular bone levels between T0 and T1. Gender significantly affected the cementoenamel junction (CEJ)–base of defect (BD) measurements (p = 0.022) and defect angles at T0 (p = 0.048), but not at the adjusted T1 (p = 0.292). Other variables, including medical history, smoking, and ITM angulation, showed no influence. Patient age was borderline significant in relation to intrabony defect angle (p = 0.047). Conclusions: Considering its limitations, this analysis does not provide evidence to support the hypothesis that prophylactic extraction of ITMs yields significant bone-sparing benefits. Furthermore, it does not establish that prolonged retention of ITMs consistently results in short-term bone alterations in adjacent 2Ms. Consequently, further research is warranted to more accurately assess the medium- to long-term implications of ITM retention on the bone levels of 2Ms. Full article

Background: Peripheral artery disease (PAD) is a major vascular condition often overlooked in prevention strategies. We aimed to evaluate the association between cardiovascular health, measured by Life’s Simple 7 (LS7), and the risk of PAD in a high-risk Mediterranean population. Methods: This prospective analysis included 7122 participants from the PREDIMED study (Prevención con Dieta Mediterránea) at high cardiovascular risk but free of cardiovascular disease at baseline. LS7 scores (0–14 points) were calculated using seven metrics: smoking status, body mass index, physical activity, blood pressure, total cholesterol, glucose metabolism, and adherence to the Mediterranean diet. Participants were categorized into inadequate (0–5), average (6–8), and optimal (9–14) cardiovascular health. Multivariable Cox regression models and Nelson–Aalen curves assessed the association between LS7 and PAD incidence over a median 4.8-year follow-up. A meta-analysis combining these results with three prior studies was also performed. Results: A total of 87 incident PAD cases were identified. Compared to participants with inadequate cardiovascular health, those with average and optimal LS7 scores exhibited significantly lower PAD risk (adjusted hazard ratio [HR] 0.37; 95% confidence interval [CI]: 0.22–0.61, and HR 0.25; 95% CI: 0.10–0.65, respectively). Each one-point increase in the LS7 score (range 0 to 14) was associated with an 22% lower PAD risk (HR 0.78; 95% CI: 0.68–0.90). The meta-analysis yielded a pooled HR of 0.81 (95% CI: 0.76–0.87), confirming consistent inverse associations across populations. Conclusions: Greater adherence to LS7 metrics is associated with a significantly reduced risk of PAD in high-risk Mediterranean individuals. Promoting LS7 adherence may represent an effective strategy for preventing both cardiovascular disease and PAD. Full article

Smoking is a major risk factor for a variety of oral diseases. In particular, smoking-induced dental stains have been shown to be more refractory than those in non-smokers. Hydroxyapatite (HAP) is a biomimetic material that has been shown to be helpful in many oral health applications; however, its efficacy in stain removal in smokers and non-smokers is uncertain. To compare the effects of HAP toothpaste on the removal/control of extrinsic tooth discoloration in smokers and non-smokers. The secondary goal was to compare smokers and non-smokers in terms of staining extent and response to HAP. A total of 100 adults (50 smokers, 50 non-smokers) who met the inclusion and exclusion criteria were invited to participate in the study. At baseline and 2 weeks after the intervention, the same examiner performed clinical observations, including measurements of anterior tooth stain using the approximal plaque index (API) and the Lobene stain index. Adverse events and any changes in general health conditions of the patients were monitored. Comparisons of indices at baseline and post-intervention yielded statistically significant differences. In non-smokers, the median API (IQR) at baseline was 32.5 (19.0, 63.0) which decreased to 16.5 (7.0, 42.0) after the intervention (p < 0.001). The median Lobene stain index (extension) at baseline and after the intervention was 0.9 (0.5, 1.3) and 0.3 (0.2, 0.7), respectively (p < 0.001). In smokers, the median API at baseline (IQR) was 46.0 (30.0, 86.0), which decreased to 23.0 (7.0, 43.0) (p < 0.001) post-intervention. Lobene stain indices were lower after intervention in all groups than at baseline (all, p < 0.001), and the magnitude of reduction was more prominent in the smoker group. This study demonstrates that 2-week use of a toothpaste containing HAP can effectively reduce extrinsic tooth stains in smokers and non-smokers. Full article

In recent years, accelerated global climate change has precipitated an increased frequency of wildfire events, with their devastating impacts on ecological systems and human populations becoming increasingly significant. Satellite remote sensing technology, leveraging its extensive spatial coverage and real-time monitoring capabilities, has emerged as a pivotal approach for wildfire early warning and comprehensive disaster assessment. To effectively detect subtle smoke signatures while minimizing background interference in remote sensing imagery, this paper introduces a novel dual-branch attention framework (CSFAttention) that synergistically integrates channel–spatial refinement with frequency spectral analysis to aggregate smoke features in remote sensing images. The channel–spatial branch implements an innovative triple-pooling strategy (incorporating average, maximum, and standard deviation pooling) across both channel and spatial dimensions to generate complementary descriptors that enhance distinct statistical properties of smoke representations. Concurrently, the frequency branch explicitly enhances high-frequency edge patterns, which are critical for distinguishing subtle textural variations characteristic of smoke plumes. The outputs from these complementary branches are fused through element-wise summation, yielding a refined feature representation that optimizes channel dependencies, spatial saliency, and spectral discriminability. The CSFAttention module is strategically integrated into the bottleneck structures of the ResNet architecture, forming a specialized deep network specifically designed for robust smoke recognition. Experimental validation on the USTC_SmokeRS dataset demonstrates that the proposed CSFResNet achieves recognition accuracy of 96.84%, surpassing existing deep networks for RS smoke recognition. Full article

Lung cancer remains the leading cause of cancer-related mortality worldwide, with early detection critical for improving survival rates, yet conventional methods like CT scans often yield high false-positive rates. This study introduces M-GNN, a graph neural network framework leveraging GraphSAGE, to enhance early lung cancer detection through metabolomics. We constructed a heterogeneous graph integrating metabolomics data from 800 plasma samples (586 cases, 214 controls) with demographic features and Human Metabolome Database annotations, employing GraphSAGE and GAT layers for inductive learning on 107 metabolites, pathways, and diseases. M-GNN achieved a test accuracy of 89% and an ROC-AUC of 0.92, with rapid convergence within 400 epochs and robust performance across ten random seeds; key predictors included age, height, choline, Valine, Betaine, and Fumaric Acid, reflecting smoking and metabolic dysregulation. This framework offers a scalable, interpretable tool for precision oncology, surpassing benchmarks by capturing complex biological interactions, though limitations like synthetic data biases and computational demands suggest future validation with real-world cohorts and optimization. M-GNN advances lung cancer screening, promising improved survival through early detection and personalized strategies. Full article

This study systematically examines the effect of the morphology of cerium oxide (CeO₂) on the flame retardancy, thermal stability, and mechanical properties of polypropylene composites with intumescent flame retardant (PP/IFR). Layer-CeO₂ (L-CeO₂) outperforms Particulate-CeO₂ (P-CeO₂) in enhancing the flame retardancy of PP/IFR composites, showing higher limiting oxygen index (LOI) and greater reductions in the total heat release rate (THR) and total smoke production (TSR). The substitution of 1% IFR with 1% L-CeO₂ significantly increased the LOI from 29.4% to 32.6%, while reducing the THR and TSR by 38.9% and 74.3%, respectively. L-CeO₂ incorporation improves thermal stability, increasing the residual char yield to 8.53% at 800 °C under air (vs. 3.87% for PP/IFR). Additionally, L-CeO₂ improved the mechanical properties of the composites, increasing tensile strength and rigidity. The synergistic flame-retardant mechanism is hypothesized to involve CeO₂ catalyzing the formation of a P-O-C crosslinked network in the carbon layer, leading to a denser carbon structure and improved flame-retardant performance in the PP/IFR composites. These findings demonstrate the efficacy of L-CeO₂ as a flame-retardant synergist, providing a foundation for developing fire-safe polymeric materials. Full article

Background: It is a well-established fact that late-life depression represents a significant public health issue, particularly in low- and middle-income countries experiencing rapid demographic aging. Although its clinical and societal impacts are well-recognized, data on the interplay between depressive symptoms and functional status in older populations remain limited for Türkiye. This study aimed to estimate the prevalence of depression among individuals aged 65 years or older, examine its associations with instrumental and basic activities of daily living, and identify key sociodemographic and behavioral correlates. Methods: In this study, data obtained from a population-based survey in 2264 clusters by the Turkish Statistical Institute (TUIK) were used, and weighted data were yielded from 6,036,396 adults aged 65 and over. Depression was measured using the Geriatric Depression Scale (GDS), categorizing participants as “not depressed”, “mildly depressed”, or “severely depressed”. Functional status was evaluated using the Lawton–Brody Instrumental Activities of Daily Living (IADL) Scale and the Katz Activities of Daily Living (ADL) Scale. Logistic regression models, adjusted for age and body mass index (BMI), were used to determine the associations of depression with functional impairment and various covariates, including gender, education, marital status, chronic disease, physical activity, smoking, and alcohol use. Results: Overall, the prevalence of depression in this cohort was 49.9% [95% CI = 48.7–51%], with 36.0% [95% CI = 34.8–37.0%] classified as mild and 13.9% [95% CI = 13.1–14.7%] as severe depression. IADL and ADL scores were negatively correlated with GDS scores (r = −0.416 and r = −0.321, respectively; p < 0.001). In logistic models, lower IADL scores were linked to higher odds of mild (OR = 0.797, 95% CI = [0.796–0.798], p < 0.001) and severe depression (OR = 0.689, 95% CI = [0.688–0.690], p < 0.001). Being semi-dependent or dependent in ADL further escalated depression risk. Female gender, lower education, single/divorced status, chronic disease, and inactivity also emerged as strong predictors. Conclusions: The findings of this study suggest that depression is highly prevalent among older adults in Türkiye, with functional impairment, unfavorable health behaviors, and sociodemographic vulnerabilities heightening risk. Integrating depression screening into geriatric care—alongside interventions to maintain functional independence—may help mitigate the burden of late-life depression in similar contexts. Full article

Background/Objectives: Lung cancer screening can reduce patient mortality. Multiple issues persist including timely management of patients with a radiologically defined indeterminate pulmonary nodule (IPN), which carries unknown pathological significance. This pilot study focused on combining demographic, clinical, radiographic, and common circulating biomarkers for their ability to aid in IPN risk of malignancy prediction. Methods: A case-control cohort consisting of 379 patients with IPNs (251 stage I lung tumors and 128 nonmalignant nodules) was used for this effort, divided into training (70%) and testing (30%) sets. Demographic variables (age, sex, race, ethnicity), radiographic information (nodule size and location), smoking pack-years, and plasma biomarker levels of CA-125, SCC, CEA, HE4, ProGRP, NSE, Cyfra 21-1, IL-6, PlGF, sFlt-1, hs-CRP, Ferritin, IgG, IgE, IgM, IgA, and Kappa and Lambda Free Light Chains were assessed for this purpose. Results: Multivariable analyses of biomarker, demographic, and radiographic variables yielded a model consisting of age, lesion size, pack-years, history of extrathoracic cancer, upper lobe location, spiculation, hs-CRP, NSE, Ferritin, and CA-125 (AUC = 0.872 in training, 0.842 in testing) with superior performance over the Mayo Score model, which consists of age, lesion size, history of smoking, history of extrathoracic cancer, upper lobe location, and spiculation (AUC = 0.816 in training, 0.787 in testing). Conclusions: In conclusion, a simple reduced algorithm consisting of biomarkers, clinical information, and demographic variables may have value for malignancy prediction of screen-detected IPNs. Upon further validation, this method stands to reduce the need for serial radiographic studies and the risks of diagnostic delay. Full article

German chamomile (Matricaria chamomilla L.) is not only considered a weed but also an important crop cultivated for the pharmaceutical industry. Chamomile seeds are positively photoblastic and must be sown on the soil surface. However, heavy rainfall can bury the seeds, resulting in uneven germination and partial yield loss. To address both agricultural and scientific aspects, we applied various light sources with different spectra ranging from 400 to 720 nm versus darkness, as well as smoke compounds formulated in smoke water (SW), to chamomile seeds. Our results indicate that a high proportion of red light within the spectrum is crucial for seed germination and seedling establishment. Fluorescent lamps were the least effective due to their high blue light content, highlighting the need to use white or red LEDs in experiments with chamomile seeds. The smoke compounds present in SW compensated for the absence of light, increasing seed germination by 20% in the dark, and their mode of action was additive to light, suggesting that they share the same signaling pathway. The effect of SW on seeds was stimulatory regardless of the light regime, suggesting that smoke formulations may act as a priming factor for chamomile seeds. Full article

Background/Objectives: Over the past 25 years, reconstructive techniques and patient management advancements have significantly improved outcomes in mangled lower extremity injuries. Functional results of limb salvage have been demonstrated to surpass those of primary amputations. Developments such as local fasciocutaneous flaps, vacuum-assisted closure, and hyperbaric oxygen therapy have enhanced the reconstructive ladder. Despite progress, the utility of the Mangled Extremity Severity Score (MESS) and Gustilo–Anderson classification remains debated, particularly in their prognostic value for limb salvage decisions. In the study, we aimed to evaluate the outcomes of optimizing mangled lower extremity reconstruction in 93 patients, focusing on their functional scores retrospectively. Methods: This retrospective study analyzed 93 patients treated for mangled lower extremities between January 2015 and October 2022. Patients were assessed for age, gender, injury location, MESSs, Gustilo–Anderson classifications, surgical methods, and functional outcomes using the Lower Extremity Functional Scale (LEFS). Surgical interventions included internal and external fixation, skin grafts, local flaps, muscle flaps, and free tissue transfer. LEFS scores were categorized into disability levels for functional evaluation. Correlations were drawn between LEFS and variables such as MESS, Gustilo–Anderson types, and nerve injuries. Results: Among the 93 patients, 16 had MESSs ≥ 7, and 77 had MESSs < 7. Reconstruction methods included local fasciocutaneous and muscle flaps (37 patients), free tissue transfer (29 patients), and skin grafting with vacuum-assisted closure (27 patients). Smoking was associated with delayed union and increased infection rates. LEFS scores were significantly lower in patients with MESSs ≥ 7, Gustilo grade 3C fractures, and tibial nerve injuries. Flap failures and a higher number of surgeries (>3) also correlated with poorer functional outcomes. The average soft tissue healing time was 18 days, and bone union time was 17 weeks. Conclusions: Lower extremity reconstruction demands precise surgical planning and execution, prioritizing functional restoration. MESSs and Gustilo–Anderson classifications provide practical frameworks but have limitations in predicting long-term functionality. Factors such as joint involvement, nerve injuries, and flap selection significantly influence outcomes. Smoking and delayed healing remain critical challenges. While free flaps are essential for complex defects, more straightforward methods yield better outcomes in suitable cases. LEFS emerged as a reliable tool. Full article

Background: Cigarette smoking has been associated with liver fibrosis in the setting of hepatitis C virus (HCV) infection but has not been studied among people with HIV (PWH) who consume alcohol. Methods: This is a cross-sectional study of PWH with heavy drinking and daily smoking in St. Petersburg, Russia. The primary independent variable was past 30-day cigarettes per day (cpd), and the secondary independent variable was pack-years at study entry. Advanced liver fibrosis was defined as FIB-4 > 3.25. Analyses were adjusted for gender, body mass index (BMI), past 30-day number of heavy drinking days, HCV and CD4 count. Results: Participants (n = 400) were two-thirds male (67.3%), young (median age 38 years), lean (median BMI 22), HCV antibody positive (84.5%) and not severely immune suppressed (median CD4 count 351). The median number of past-month cpd was 20 (IQR: 15–25), and the median pack-years was 24 (IQR: 17–31.8). The prevalence of advanced liver fibrosis was 11.3% (45/400). In the adjusted logistic regression analyses, we did not observe a significant association between cpd [middle (10.1–20 cigarettes) vs. lowest (5–10 cigarettes) category (adjusted odds ratio [aOR] (95% confidence interval [CI]): 1.06 (0.40–2.83), highest (>20.0 cigarettes) vs. lowest category aOR (95% CI): 0.65 (0.21–1.99), global p-value = 0.62]. The secondary analysis with pack-years yielded similar results [middle (20.1–30 pack-years) vs. lowest category (≤20 pack-years) aOR (95% CI): 0.81 (0.33–1.99), highest category (>30 pack-years) vs. lowest category aOR (95% CI): 0.91 (0.38–2.19); global p-value = 0.58]. Conclusions: In this Russian cohort of PWH, we did not detect an association between recent cigarette use or mean pack-years and advanced liver fibrosis. Full article