Search Results (11,971)

Introduction: Low back pain (LBP) is the leading cause of disability worldwide, with substantial variation in prevalence across regions. It is associated with a wide range of biophysical, psychological, social, and lifestyle factors, as well as comorbid conditions. Given its high impact, identifying population-level correlations of LBP is essential for informing prevention strategies. This study aimed to assess demographic, socioeconomic, lifestyle, and health-related factors associated with LBP in Hungary. Methods: A repeated cross-sectional analysis was conducted using secondary data from three waves of the European Health Interview Survey (EHIS) carried out in Hungary in 2009, 2014, and 2019. Results: The prevalence of LBP increased over the study period. Female sex, higher educational attainment, normal body mass index, non-smoking status, abstaining from alcohol, and good self-perceived health were associated with lower odds of LBP. In contrast, older age (≥65 years), unfavorable financial status, residence in socioeconomically disadvantaged regions, use of over-the-counter medications, and several chronic conditions were associated with higher odds. Conclusions: Reducing the impact of low back pain requires its integration into comprehensive public health frameworks that combine chronic disease management with consideration of socioeconomic inequalities at the population level. Full article

Wildfires release volatile phenolic compounds (VPs) that can be absorbed by grapevines, potentially resulting in “smoke taint” in wines. This has emerged as a prominent issue for the global wine industry due to negative impact on wine quality and subsequent financial losses. Since effective vineyard mitigation strategies remain limited, this study evaluated the efficacy of different materials applied to grapes to reduce the absorption of smoke marker compounds under simulated wildfire conditions. Twelve materials were applied to individual Cabernet Sauvignon clusters close to harvest. Treated vines were exposed to intentional smoke using a purpose-built tent. Grapes from treated vines, as well as smoke-exposed and non-exposed controls, were harvested at commercial maturity. The results showed a strong stratification of VPs within the tent and in the grapes. Glycosylation began within hours of smoke exposure, with significant increases in almost all glycosylated compounds within 4 hours compared to non-smoked controls. Some materials reduced VP uptake relative to untreated controls (kaolin, charcoal, and two commercial coating formulations—GM3E and GMB6), whereas others increased the absorption of smoke-derived compounds (Parka and wipe-out). These findings highlight that those protective treatments may have variable and sometimes counterproductive effects on smoke compound uptake. Full article

Background: Targeted therapies directed against oncogenic drivers have substantially improved outcomes for patients with epidermal growth factor receptor (EGFR)-mutant and anaplastic lymphoma kinase (ALK)-rearranged non-small cell lung cancer (NSCLC). Despite high initial response rates, most patients ultimately develop acquired resistance to tyrosine kinase inhibitors (TKIs), reflecting complex biological adaptations under therapeutic pressure. Methods: This narrative review synthesizes experimental, translational, and clinical studies examining how environmental and occupational respiratory exposures may influence resistance mechanisms in EGFR- and ALK-driven NSCLC. The review emphasizes exposure-associated signaling plasticity, inflammatory microenvironmental modulation, metabolic reprogramming, and pharmacokinetic alterations. Results: Recent evidence suggests that respiratory exposures, including cigarette smoke, air pollution, diesel exhaust, and occupational inhalational toxicants, can modulate oncogenic signaling networks relevant to resistance to targeted therapies. These mechanisms include aberrant EGFR activation, bypass signaling through the mesenchymal–epithelial transition receptor (MET) and SRC pathways, epithelial–mesenchymal transition (EMT), adaptive kinome remodeling, and exposure-associated inflammatory signaling, all of which may influence tumor evolution and therapeutic response. Conclusions: This review introduces a novel exposome-driven conceptual framework integrating environmental exposures with signaling plasticity and resistance evolution in oncogene-driven NSCLC. These findings support the concept that the respiratory exposome may represent an underrecognized modifier of targeted therapy response. Incorporating structured exposure assessment into precision oncology approaches may refine risk stratification and inform exposure-aware therapeutic strategies. Full article

The temperature field characteristics of highway tunnels during fire conditions are investigated in this paper. Numerical simulations coupled with reduced-scale physical model tests were conducted to analyze the thermal characteristics of the tunnel interior and lining structure under various ventilation conditions. Taking the extra-long double-tube highway tunnel as a case study, a numerical model was established using FLUENT to simulate a 100 MW fire under different longitudinal ventilation velocities. Furthermore, a reduced-scale physical model with a geometric similarity ratio of 1:2.7 was fabricated to investigate the effect of lining moisture content on the heat transfer characteristics. It is indicated by the results that high-temperature zones above 800 °C are mainly concentrated within roughly 100 m of the fire source, extending approximately 20 m upstream and 80 m downstream. As the ventilation velocity rises, the high-temperature zone adjacent to the fire source is gradually reduced, the upstream smoke backflow length is shortened, and the downstream thermal influence range is expanded. Obvious spatial variations are observed in the cross-sectional temperature distribution: relatively uniform temperatures are found near the fire source, whereas higher temperatures are observed at the crown in upstream and downstream sections, followed by the haunch and sidewalls. A pronounced thermal lag effect is observed in the lining structure, with both slower heating rates and lower peak temperatures being exhibited at larger distances from the fire source and in linings with higher moisture content. A temperature plateau at around 100 °C is detected, which is mainly attributed to latent heat absorption during moisture evaporation. A more significant temperature gradient through the lining thickness is also caused by a higher moisture content. These findings provide valuable references for tunnel fire safety design, smoke control strategies, and evacuation safety analysis. Full article

Background: Health-related behaviors often cluster during young adulthood, potentially increasing the risk of long-term adverse health outcomes. Understanding how lifestyle risk behaviors co-occur among university students is essential for developing targeted health promotion strategies. Objective: This study aimed to identify lifestyle risk profiles among university students based on the co-occurrence of smoking behavior, alcohol consumption, sedentary behavior, and body weight status. Methods: A cross-sectional study was conducted with 147 university students enrolled in a physical education and sport undergraduate program (mean age: 20.58 ± 2.94 years; 80.3% male). Physical activity and sedentary behavior were assessed using the International Physical Activity Questionnaire–Short Form (IPAQ-SF), while smoking and alcohol consumption were self-reported. Body mass index was used to classify weight status. Lifestyle risk profiles were identified using two-step cluster analysis based on regular smoking, alcohol consumption, sedentary behavior, and overweight/obesity. Differences in cluster distribution according to sex and federated athlete status were examined using chi-square tests. A two-step cluster analysis based on the Bayesian Information Criterion (BIC) and silhouette measure was used to identify lifestyle risk profiles. Results: Overall, 46.9% of participants had experimented with tobacco, 11.6% were current smokers, and 74.8% reported alcohol consumption. Participants accumulated an average of 3772.25 ± 1957.99 MET-min/week of physical activity. Three distinct lifestyle risk profiles were identified. Cluster 1 (46.9%), labeled the alcohol profile, was characterized by alcohol consumption without smoking and no prevalence of being overweight. Cluster 2 (20.4%), the multiple-risk profile, included participants who reported regular smoking, with nearly half presenting sedentary behavior and overweight/obesity. Cluster 3 (32.7%), the overweight profile, was characterized by overweight/obesity combined with alcohol consumption but no smoking. No significant differences were observed in the distribution of lifestyle profiles according to sex (p = 0.111) or federated athlete status (p = 0.087). Conclusions: Lifestyle risk behaviors cluster into distinct profiles among university students, with alcohol consumption appearing across multiple profiles and smoking concentrated in a specific high-risk group. These findings highlight the need for targeted health promotion strategies addressing multiple co-occurring behaviors within university populations. Full article

Serum gamma-glutamyltransferase (GGT) is a biomarker for cardiovascular disease, but the role of its encoding gene family in ischemic stroke (IS) is unknown. This pilot study of 1288 individuals (600 cases and 688 controls) investigated GGT1, GGT5, GGT6, and GGT7 polymorphisms using the MassARRAY-4 system. Conventional single-variant, haplotype, and diplotype analyses were complemented by Model-Based Multifactor Dimensionality Reduction (MB-MDR) with stability assessment and model prioritization. Conventional analysis identified female-specific associations for three GGT5 variants (rs8140505, rs2275984, and rs2267073; P_perm < 0.05). A common GGT5 haplotype was protective in females (P_perm = 0.02). Diplotype analysis revealed joint effects of GGT genotypes on IS risk in females (FDR < 0.05). MB-MDR uncovered complex higher-order interactions (P_perm < 0.0001): in women, 12 models represented second-order interactions between smoking and individual GGT variants. In men, 8 models centered on GGT1 rs5751909 spanning second- to fourth-order interactions with alcohol, smoking, and other GGT family members. All prioritized models passed FDR correction (q < 0.05) and achieved higher weighted composite scores. eQTL data linked these variants to regulatory networks controlling glutathione metabolism, oxidative stress, and inflammation. This study supports a novel hypothesis on the combined involvement of GGT gene family polymorphisms and pro-oxidant environmental factors in ischemic stroke predisposition, demonstrating that disease risk is shaped by sex-specific gene–environment interactions. The pronounced sexual dimorphism highlights the need for sex-specific personalized approaches: smoking cessation may be particularly impactful in women carrying GGT5 risk variants, while alcohol moderation could be prioritized in men with GGT1 risk variants. Full article

Background/Objectives: Gastric cancer (GC) remains a major health challenge in high-incidence regions like Fujian Province, China. This study aimed to identify modifiable dietary and behavioral risk factors for GC and to evaluate their combined effect using a Healthy Lifestyle Index (HLI) in a high-incidence region of China. Methods: A case–control study was conducted at a tertiary hospital from June 2023 to December 2024, including 336 newly diagnosed GC cases and 336 healthy controls from Fujian Province. A Healthy Lifestyle Index (HLI, scored 0–10) was constructed from ten dietary and behavioral factors, with participants categorized into tertiles as healthy, moderate, or unhealthy. Results: The proportions of males and females were 56.5% and 43.5%, respectively. The mean age of the case group was 56.76 ± 10.83 years, significantly higher than that of the control group (53.86 ± 11.13 years, p < 0.001). The HLI incorporated ten behavioral/dietary components: sedentary behavior, smoking, alcohol consumption, tea drinking, physical activity, pickled and processed food intake, regular eating habits, fruit intake, vegetable intake, and red meat intake. Cases showed a higher proportion of unhealthy lifestyle patterns (34.8% vs. 26.8%), whereas controls showed a higher proportion of healthy lifestyle behaviors (41.7% vs. 37.5%); however, the overall between-group distribution of HLI categories was not statistically significant (p = 0.078). The multivariate logistic regression showed that the healthy group was associated with a lower risk of developing GC compared to the unhealthy group (aOR = 0.34, 95% CI: 0.20–0.57, p < 0.001). Conclusions: A healthier combined dietary and behavioral profile may be associated with lower odds of GC in this population. However, the observed associations should be interpreted cautiously because of the case–control design, the lack of H. pylori data, and the absence of formal validation of the HLI in the Fujian population. Prospective studies with objective dietary assessment and more detailed clinical characterization are warranted. Full article

Background: Cigarette smoking exposes the human body to a complex mixture of toxic and carcinogenic compounds that can exert widespread biological effects across different organ systems. From addictive responses and consequence maladaptive neuroendocrine responses, cigarette smoke delivers a variety of reactive oxygen species, polycyclic aromatic hydrocarbons, nitrosamines, and heavy metals that collectively contribute to oxidative stress, inflammation, endothelial dysfunction, and metabolic disruption. The liver, as the primary organ responsible for xenobiotic metabolism, plays a central role in processing these harmful substances and is therefore uniquely susceptible to their effects. This narrative review will aim to provide an overview of the current evidence of cigarette smoking effects on hepatic structure and function and discuss clinical implications. Methods: This narrative review synthesizes evidence from in vitro studies, animal models, and human clinical research examining the effects of cigarette smoking on liver biology. Mechanistic pathways of injury, metabolic and vascular alterations, and clinical consequences for liver disease were considered. Results: Smoking influences hepatic function both directly—through biotransformation pathways generating reactive intermediates—and indirectly via vascular impairment, immune modulation, hormonal alterations, and changes in lipid and glucose metabolism. Emerging evidence indicates that cigarette smoking contributes to hepatic steatosis, accelerates fibrosis progression, worsens outcomes in viral and alcohol-related liver disease, and increases the risk of hepatocellular carcinoma. Conclusions: Cigarette smoking exerts multifaceted deleterious effects on the liver. Recognition of smoking as a modifiable risk factor for liver-related morbidity underscores the importance of smoking cessation in patients with or at risk for liver disease and highlights implications for research and clinical practice. Full article

Oral squamous cell carcinoma (OSCC) typically develops in individuals with established risk factors such as tobacco and alcohol use, yet an increasing number of cases occur in young non-smoking, non-drinking (NSND) patients. We report a case of oral tongue OSCC in a 33-year-old woman who is a never-smoker and never-drinker without identifiable environmental or local risk factors. The patient underwent surgical treatment followed by adjuvant radiotherapy and remains disease-free 15 months after therapy. Whole-exome sequencing (WES) revealed a pathogenic truncating TP53 mutation together with additional somatic alterations affecting genes involved in DNA repair, hypoxia adaptation, mitochondrial function, and epigenetic regulation. The heterogeneous mutational profile suggests branched tumor evolution and the involvement of non-classical tumorigenic pathways. This report contributes to the growing evidence that OSCC in young NSND patients represents a biologically distinct subgroup and demonstrates the value of comprehensive genomic profiling for improving understanding of tumor heterogeneity and potential molecular drivers in the absence of traditional carcinogenic exposures. 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

Objectives: To determine if global epicardial adipose tissue (EAT) radiomics, derived from non-contrast coronary artery calcium (CAC) scans, improves acute coronary syndrome (ACS) prediction beyond traditional risk factors (TRFs) and Agatston score (AS) in individuals without angina. Methods: We retrospectively analyzed 2020 subjects without angina who underwent CAC scans from 2016 to 2019, among whom 76 patients developed acute coronary syndrome (ACS) during a follow-up period until December 2023. One-to-one propensity score matching (PSM) based on TRFs (age, sex, BMI, smoking, diabetes, hypertension, dyslipidemia) and Agatston score ranks (ASR) created 76 ACS and 76 matched non-ACS subjects. A radiomics model was built using 5-fold cross-validation on the matched cohort and tested on the entire unmatched cohort. Statistical tests included AUC comparison. Results: PSM effectively mitigated disparities of TRFs and ASR. The radiomics model achieved AUCs of 0.91 ± 0.01 and 0.89 ± 0.03 for the training and matched test sets, respectively, and 0.89 ± 0.03 on the unmatched cohort. The radiomics score significantly improved ACS prediction over TRF and CAC models (p < 0.001) in both matched and unmatched cohorts. Conclusions: Global EAT radiomic phenotypes from conventional CAC scan improve ACS risk stratification beyond TRFs and AS in individuals without angina. In contrast to PCAT on CCTA, our simple approach appears to be suitable for large-scale applications using preventative CAC scans. Full article

Background: Trace elements function as essential micronutrients involved in oxidative balance, mitochondrial activity, and cardiovascular metabolism. Cigarette smoking represents a significant source of toxic metals and may disrupt systemic trace element homeostasis. Alterations in micronutrient and metal balance may contribute to oxidative stress, endothelial dysfunction, and myocardial remodeling, which are central mechanisms in the pathogenesis of heart failure with preserved ejection fraction (HFpEF). This study aimed to investigate whether smokers with HFpEF exhibit distinct hair trace element profiles compared with smokers without HFpEF. Methods: In this prospective pilot study, scalp hair samples were collected from adults undergoing clinical evaluation for suspected cardiovascular disease. Trace element concentrations were determined using inductively coupled plasma mass spectrometry (ICP-MS). Participants were first stratified according to smoking status and subsequently, within the smoker subgroup, according to HFpEF diagnosis based on the Heart Failure Association Pre-test assessment, Echocardiography and natriuretic peptide score (HFA-PEFF) algorithm. Differences in trace element concentrations were analyzed using appropriate statistical tests, with multiple-comparison correction using the Benjamini–Hochberg false discovery rate (FDR). Active smoking was defined as ≥10 cigarettes per day for at least 1 year, and cumulative exposure was quantified in pack-years. Results: Fifty-eight participants were included, including 27 active smokers. In unadjusted analyses, several trace elements differed between smokers with HFpEF and those without HFpEF, including vanadium, lithium, aluminum, and copper. However, after FDR correction, only copper remained significantly elevated in smokers with HFpEF (q = 0.004). Hair copper concentrations were markedly higher in the HFpEF group compared with smokers without HFpEF. These differences were observed alongside echocardiographic features consistent with diastolic dysfunction and structural cardiac remodeling. Conclusions: In this hypothesis-generating pilot study, smokers with HFpEF demonstrated elevated hair copper concentrations, suggesting disturbances in trace element and micronutrient homeostasis. Altered copper metabolism may reflect oxidative stress-related cardiometabolic remodeling associated with HFpEF. These findings raise the hypothesis that cardiometabolic phenotype, rather than smoking exposure alone, may modulate trace element homeostasis in HFpEF; however, causal relationships cannot be established. Full article

Plant-based diets are generally associated with a reduced risk of chronic diseases; however, the relationship between a vegan diet and genome integrity remains insufficiently characterized. In this cross-sectional study, we assessed primary DNA damage in peripheral blood cells of vegans and omnivores. A total of 62 apparently healthy adults were included: 31 vegans (median vegan diet duration 4.5 years) and 31 omnivores matched for sex and smoking status. DNA damage was assessed using the alkaline comet assay under standardized conditions and expressed as tail intensity (% tail DNA), tail length, tail moment, and total comet area. Tail intensity was significantly higher in vegans than in omnivores (B = 1.98; 95% CI 0.19 to 3.76; p = 0.031) after adjustment for age, physical activity, body mass index (BMI), and alcohol consumption. Within the vegan group, longer duration of adherence to a vegan diet was positively associated with tail intensity, independent of age (B = 0.23; 95% CI 0.03 to 0.43; p = 0.026). These findings suggest that adherence to a vegan diet and its duration may be associated with higher levels of primary DNA damage; however, these results should be interpreted with caution given the observational design and modest sample size. Full article

Background/Objectives: Immune aging has been associated with survival outcomes in patients with lung adenocarcinoma (LUAD), but its relevance within the tumor microenvironment (TME) remains unclear. Methods: Clinical, RNA-sequencing, and somatic mutation data from the TCGA LUAD cohort were analyzed. Immune aging score within the TME was quantified using a predefined blood-driven 121-gene immune aging signature (IAS-121), and patients were categorized into the lowest versus the highest IAS-121 tertiles. Immune cell composition in the TME was inferred using xCell. Overall survival (OS) was evaluated using Kaplan–Meier analysis, Cox proportional hazards models adjusted for age, sex, tumor stage, smoking status, and EGFR mutation status, and restricted cubic spline analysis to examine the dose–response relationship between IAS-121 and mortality risk. Sensitivity analyses comparing the highest versus lowest quartiles or higher than median versus lower than median of IAS-121 were performed. Two independent LUAD cohorts (GSE68465 and GSE50081) were employed for validation. Results: A total of 518 patients with LUAD from the TCGA cohort were analyzed. Restricted cubic spline analysis showed a linear association between IAS-121 and OS. Patients in the highest IAS-121 tertile showed significantly better survival than those in the lowest tertile in both the TCGA cohort (p < 0.001) and the external validation cohorts (p = 0.003). In multivariable-adjusted Cox models, the lowest IAS-121 tertile was associated with worse survival in TCGA (adjusted HR 1.87, 95% CI 1.20–2.92) and in the pooled external cohorts (adjusted HR 1.57, 95% CI 1.02–2.43). Subgroup analyses showed generally consistent associations across clinical strata. Tumors with higher IAS-121 exhibited lower CD8⁺ and CD4⁺ naïve T-cell enrichment but higher neutrophil infiltration. Conclusions: Immune aging within TME is associated with poorer survival in LUAD. Given this study is hypothesis-generating, further investigations integrating tissue- and blood-based measures of immune aging are warranted to clarify its clinical and biological implications. Full article

Background/Objectives: Individuals with alcohol use disorder (AUD) and tobacco use disorder (TUD) are at increased risk for severe COVID-19 outcomes. However, real-world evidence on vaccine effectiveness (VE) in these populations remains limited, particularly in low- and middle-income countries. This study aimed to evaluate the effectiveness of three or more COVID-19 vaccine doses against mortality in hospitalized patients with AUD and TUD in Brazil. Methods: This retrospective cohort study used data from the SIVEP Gripe database, a national surveillance system of hospitalized COVID-19 cases in Brazil. The study included adults aged ≥18 years with confirmed SARS-CoV 2 infection between February 2020 and June 2025. The intervention was defined as receipt of three or more vaccine doses (fully vaccinated) versus no doses (unvaccinated). Propensity score matching was performed separately for AUD and TUD cohorts. Vaccine effectiveness was estimated using McNemar’s test for paired samples, and the average treatment effect (ATE) and number needed to vaccinate (NNV) were calculated. Results: Among 2,184,723 hospitalized patients, 12,115 had AUD and 45,679 had TUD. After matching, VE against mortality was 42% (95% CI: 27.5–53.5) in the AUD group and 52.6% (95% CI: 46.5–58.1) in the TUD group, compared to 58.5% and 58.9% in their respective non-exposed counterparts. The ATE was consistent across groups (approximately −0.12), and the NNV to prevent one death was 8 (95% CI: 6–15 for AUD; 7–12 for TUD). Conclusions: Although VE was attenuated in individuals with AUD and TUD compared to the general population, the absolute benefit of vaccination remained substantial. Full article