Search Results (548)

Background/Objectives: In recent years, lipids have emerged as critical regulators of different disease processes, being involved in cancer pathogenesis, progression, and outcome. Matrix-Assisted Laser Desorption/Ionization Mass Spectrometry Imaging (MALDI-MSI) has significantly expanded the technology’s reach, enabling spatially resolved profiling of lipids directly from tissue, including formalin-fixed paraffin-embedded (FFPE) specimens. In this context, MALDI matrix selection is crucial for lipid extraction and ionization, influencing key aspects such as molecular coverage and sensitivity, especially in such specimens with already depleted lipid content. Thus, in this work, we aim to explore the feasibility of mapping lipid species in FFPE clinical samples with MALDI-MSI using 6-aza-2-thiothymine (ATT) as a matrix of choice. Methods: To do so, ATT performances were first compared to those two other matrices commonly used for lipidomic analyses, 2′,5′-dihydroxybenzoic acid (DHB) and Norharmane (NOR), on lipid standards. Results: As a proof-of-concept, we then assessed ATT’s performance for the MALDI-MSI analysis of lipids in FFPE brain sections, both in positive and negative ion modes, comparing results with those obtained from other commonly used dual-polarity matrices. In this context, ATT enabled the putative annotation of 98 lipids while maintaining a well-balanced detection of glycerophospholipids (60.2%) and sphingolipids (32.7%) in positive ion mode. It outperformed both DHB and NOR in the identification of glycolipids (3%) and fatty acids (4%). Additionally, ATT exceeded DHB in terms of total lipid count (62 vs. 21) and class diversity and demonstrated performance comparable to NOR in negative ion mode. Moreover, ATT was applied to a FFPE glioblastoma tissue microarray (TMA) evaluating the ability of this matrix to reveal biologically relevant lipid features capable of distinguishing normal brain tissue from glioblastoma regions. Conclusions: Altogether, the results presented in this work suggest that ATT is a suitable matrix for pathology imaging applications, even at higher lateral resolutions of 20 μm, not only for proteomic but also for lipidomic analysis. This could enable the use of the same matrix type for the analysis of both lipids and peptides on the same tissue section, offering a unique strategic advantage for multi-omics studies, while also supporting acquisition in both positive and negative ionization modes. Full article

Background: Social and financial services are essential for the inclusion and well-being of people with disabilities (PWDs), who often rely on family caregivers to access these systems. In Saudi Arabia, where disability inclusion is a strategic goal under Vision 2030, understanding caregiver experiences is crucial to identifying service gaps and improving accessibility. Objectives: This study aimed to explore caregivers’ perspectives on awareness, perceived barriers, and accessibility of social and financial services for PWDs in Saudi Arabia. The analysis is grounded in Andersen’s Behavioural Model of Health Service Use and the WHO’s International Classification of Functioning, Disability and Health (ICF) framework. Methods: A cross-sectional survey was conducted with 3353 caregivers of PWDs attending specialised day schools. The survey collected data on demographic characteristics, service awareness, utilisation, and perceived obstacles. Exploratory Factor Analysis (EFA) identified latent constructs, and Structural Equation Modelling (SEM) was used to test relationships between awareness, barriers, and accessibility. Results: Findings reveal that over 70% of caregivers lacked awareness of available services, and only about 3% had accessed them. Key challenges included technological barriers, complex procedures, and non-functional or unclear service provider platforms. Both User Barriers and Service Barriers were negatively associated with Awareness and Accessibility. Awareness, in turn, significantly predicted perceived Accessibility. Caregiver demographics, such as age, education, gender, and geographic location, also influenced awareness and service use. Conclusions: There is a pressing need for targeted awareness campaigns, accessible digital service platforms, and simplified service processes tailored to diverse caregiver profiles. Inclusive communication, decentralised outreach, and policy reforms are necessary to enhance service access and promote the societal inclusion of PWDs in alignment with Saudi Arabia’s Vision 2030. Full article

Background/Objectives: Artificial intelligence (AI) is rapidly emerging as a transformative force in healthcare education, including orthodontics. This systematic review and meta-analysis aimed to evaluate the integration of AI into orthodontic training programs, focusing on its effectiveness in improving diagnostic accuracy, learner engagement, and the perceived quality of AI-generated educational content. Materials and Methods: A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, and Embase through May 2025. Eligible studies involved AI-assisted educational interventions in orthodontics. A mixed-methods approach was applied, combining meta-analysis and narrative synthesis based on data availability and consistency. Results: Seven studies involving 1101 participants—including orthodontic students, clinicians, faculty, and program directors—were included. AI tools ranged from cephalometric landmarking platforms to ChatGPT-based learning modules. A fixed-effects meta-analysis using two studies yielded a pooled Global Quality Scale (GQS) score of 3.69 (95% CI: 3.58–3.80), indicating moderate perceived quality of AI-generated content (I² = 64.5%). Due to methodological heterogeneity and limited statistical reporting in most studies, a narrative synthesis was used to summarize additional outcomes. AI tools enhanced diagnostic skills, learner autonomy, and perceived satisfaction, particularly among students and junior faculty. However, barriers such as limited curricular integration, lack of training, and faculty skepticism were recurrent. Conclusions: AI technologies, especially ChatGPT and digital cephalometry tools, show promise in orthodontic education. While learners demonstrate high acceptance, full integration is hindered by institutional and perceptual challenges. Strategic curricular reforms and targeted faculty development are needed to optimize AI adoption in clinical training. Full article

Background: Digital transformation is increasingly present in modern logistics, especially in the context of sustainability and circularity pressures. The integration of technologies such as Internet of Things (IoT), Radio Frequency Identification (RFID), and automated platforms involves not only infrastructure but also a strategic vision, a flexible organizational culture, and the ability to support decisions through artificial intelligence (AI)-based systems. Methods: This study proposes an extended conceptual model using structural equation modelling (SEM) to explore the relationships between five constructs: technological change, strategic and organizational readiness, transformation environment, AI-enabled decision configuration, and operational redesign. The model was validated based on a sample of 217 active logistics specialists, coming from sectors such as road transport, retail, 3PL logistics services, and manufacturing. The participants are involved in the digitization of processes, especially in activities related to operational decisions and sustainability. Results: The findings reveal that the analysis confirms statistically significant relationships between organizational readiness, transformation environment, AI-based decision processes, and operational redesign. Conclusions: The study highlights the importance of an integrated approach in which technology, organizational culture, and advanced decision support collectively contribute to the transition to digital and circular logistics chains. Full article

Background: Induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs) hold transformative potential for cardiovascular regenerative medicine, yet their clinical application is hindered by suboptimal mitochondrial maturation and metabolic inefficiencies. This systematic review evaluates targeted strategies for optimizing mitochondrial function, integrating metabolic preconditioning, substrate selection, and pathway modulation to enhance energy production and cellular resilience. Additionally, we examine the role of extracellular matrix stiffness and mechanical stimulation in mitochondrial adaptation, given their influence on metabolism and maturation. Methods: A comprehensive analysis of recent advancements in iPSC-CM maturation was conducted, focusing on metabolic interventions that enhance mitochondrial structure and function. Studies employing metabolic preconditioning, lipid and amino acid supplementation, and modulation of key signaling pathways, including PGC-1α, AMPK, and mTOR, were reviewed. Computational modeling approaches predicting optimal metabolic shifts were assessed, alongside insights into reactive oxygen species (ROS) signaling, calcium handling, and the impact of electrical pacing on energy metabolism. Results: Evidence indicates that metabolic preconditioning with fatty acids and oxidative phosphorylation enhancers improves mitochondrial architecture, cristae density, and ATP production. Substrate manipulation fosters a shift toward adult-like metabolism, while pathway modulation refines mitochondrial biogenesis. Computational models enhance precision, predicting interventions that best align iPSC-CM metabolism with native cardiomyocytes. The synergy between metabolic and biomechanical cues offers new avenues for accelerating maturation, bridging the gap between in vitro models and functional cardiac tissues. Conclusions: Strategic metabolic optimization is essential for overcoming mitochondrial immaturity in iPSC-CMs. By integrating biochemical engineering, predictive modeling, and biomechanical conditioning, a robust framework emerges for advancing iPSC-CM applications in regenerative therapy and disease modeling. These findings pave the way for more physiologically relevant cell models, addressing key translational challenges in cardiovascular medicine. Full article

Background: This study aims to compare the logistical challenges of Home Health Care (HHC) services in Portugal and Brazil, highlighting the structural and operational differences between both systems. Methods: Guided by an abductive research approach, data were collected using a semi-structured survey with open-ended questions, applied to 13 HHC teams in Portugal and 18 in Brazil, selected based on national coordination recommendations. The data collection process was conducted in person, and responses were analyzed using descriptive statistics and qualitative content analysis. Results: The results reveal that Portugal demonstrates higher productivity, stronger territorial coverage, and a more integrated inventory management system, while Brazil presents greater multidisciplinary team integration, more flexible fleet logistics, and more advanced digital health records. Despite these strengths, both countries continue to address key logistical aspects, such as scheduling, supply distribution, and data management, largely through empirical strategies. Conclusions: This research contributes to the theoretical understanding of international HHC logistics by emphasizing strategic and systemic aspects often overlooked in operational studies. In practical terms, it offers insights for public health managers to improve resource allocation, fleet coordination, and digital integration in aging societies. Full article

Green innovation is a key driver of sustainable development, yet Chinese firms, as major innovators, still underperform in this area. While directors play a central role in corporate governance, the influence of their green backgrounds on green innovation remains underexplored. This study investigates how directors with green backgrounds impact corporate green innovation. We consider both the appointment and the power of green-background directors. At the same time, we use the manually collected data from China’s heavily polluting listed firms between 2014 and 2020. We also conduct regulatory effect and mediation effect analyses. We found the following: (1) Green-background directors significantly promote corporate green innovation. Appointing directors with environmental expertise enhances firms’ green innovation performance, and this positive effect strengthens as these directors’ power increases. (2) Mechanistically, green-background directors facilitate green innovation by raising firms’ environmental awareness and helping secure government environmental subsidies. (3) Contextual influences matter. Moderating effect tests reveal that the impact of green-background directors is strengthened in firms with diligent boards, firm size, and green investors, but weakened in regions with higher marketization levels. (4) Further analysis shows that green-background directors enhance both strategic and substantive green innovation while also ensuring the long-term continuity of green innovation efforts. Full article

Background: Since the COVID-19 pandemic, managing acute infections in symptomatic individuals, regardless of vaccination status, has been widely debated and extensively studied. Even more concerning, however, is the impact of COVID-19 on pregnant women—especially its effects on fetuses and newborns. Several studies have documented complications in both expectant mothers and their infants following infection. Methods: In our previous works, we provided scientific evidence of the bacteriophage behavior of SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2). This demonstrated that a well-defined combination of two antibiotics, amoxicillin and rifaximin, is associated with the same statistics for subjects affected by severe cases of SARS-CoV-2, regardless of vaccination status. We considered the few cases in the literature regarding the management of pregnancies infected with SARS-CoV-2, as well as previous data published in our works. In this brief case series, we present two pregnancies from the same unvaccinated mother—one prior to the COVID-19 pandemic and the other during the spread of the Omicron variant—as well as one pregnancy from a mother vaccinated against COVID-19. We describe the management of acute maternal infection using a previously published protocol that addresses the bacteriophage and toxicological mechanisms associated with SARS-CoV-2. Results: The three pregnancies are compared based on fetal growth and ultrasound findings. This report highlights that, even in unvaccinated mothers, timely and well-guided management of symptomatic COVID-19 can result in positive outcomes. In all cases, intrauterine growth remained within excellent percentiles, and the births resulted in optimal APGAR scores. Conclusions: This demonstrates that a careful and strategic approach, guided by ultrasound controls, can support healthy pregnancies during SARS-CoV-2 infection, regardless of vaccination status. Full article

Background: Since the election of Hamas in 2006, Gaza has endured eight major military conflicts, culminating in the ongoing 2023–2025 war, now surpassing 520 days. This protracted violence, compounded by a 17-year blockade, has resulted in the near-total collapse of Gaza’s health system. Over 49,000 deaths, widespread displacement, and the destruction of more than 60% of health infrastructure have overwhelmed both local capacity and international humanitarian response. Objectives: This narrative review aims to examine and synthesize the current literature (October 2023–April 2025) on the health crisis in Gaza, with a specific focus on identifying key themes and knowledge gaps relevant to rebuilding a sustainable health system. The review also seeks to outline strategic pathways for recovery in the context of ongoing conflict and systemic deprivation. Methods: Given the urgency and limitations of empirical data from conflict zones, a narrative review approach was adopted. Fifty-two sources—including peer-reviewed articles, editorials, reports, and correspondence—were selected through targeted searches using Medline and Google Scholar. The analysis was framed within a public health and political economy perspective, also taking health system building blocks into consideration. Results: The reviewed literature emphasizes emergency needs: trauma care, infectious disease control, and supply chain restoration. Innovations such as mobile clinics and telemedicine offer interim solutions. Gaps include limited attention to mental health (including that of health workers), local governance, and sustainable planning frameworks. Conclusions: Sustainable reconstruction requires a durable ceasefire; international stewardship aligned with local ownership; and a phased, equity-driven strategy emphasizing primary care, mental health, trauma management, and community engagement. Full article

Background: Addressing undernutrition and malnutrition requires a multi-pronged approach targeting different populations with appropriate interventions. Knowledge and perception (K&P) of Individuals and communities about nutrition to human health relationship/continuum is a prerequisite for addressing malnutrition in rural and mountain communities. Assessing K&P is essential for developing strategic interventions to up-scaling K&P of communities and achieving nutrition security. Homestead gardens are a proven intervention for achieving nutrition security for all family members of gardeners. Methods: This paper includes homestead gardeners from the Himalayan Mountain Region (HMR) as respondents. We developed a scale to assess the K&P of respondents, based on ratings from 20 judges. A total of 134 issues/items have been retained in the scale from macronutrients, micronutrients, minerals, and vitamins. A framework has also been developed and adopted for the study. A knowledge and perception index (KPI) has been developed based on the respondents’ responses. We have reviewed and analysed the national policy interventions for augmenting the K&P of the study community to achieve nutrition security. Results: The nutrition K&P of respondents are inadequate and far from the desirable level. Policy review and analysis indicate that the creation of K&P in the community to contribute to self and family nutrition security was previously highly neglected. Conclusions: The policy process of national, state, and county/district-level development sectors in developing countries under the HMR may take the initiative to ensure self-nutrition security by creating K&P of the community on nutrition issues. The designed scale is prudent requires testing and validation for measuring farmers’ K&P on nutrition, which may be adopted in future studies and policymaking not only nationally but also from an international perspective. Full article

Background: Airway management in patients with obstructive sleep apnea (OSA) presents unique challenges for anesthesiologists and other airway practitioners. This comprehensive review examines current evidence and clinical practices for managing difficult airways in this high-risk population. OSA is characterized by specific anatomical and physiological alterations that increase both the likelihood of encountering difficult intubation and the risk of rapid desaturation during airway manipulation. Methods: Preoperative assessment of OSA patients requires integration of traditional difficult airway evaluation with OSA-specific considerations, including severity indices, oxygen desaturation patterns, and continuous positive airway pressure dependency. Conventional direct laryngoscopy often proves inadequate in these patients, prompting the development and refinement of alternative approaches. Videolaryngoscopy has emerged as a particularly valuable technique in OSA patients, offering improved glottic visualization while maintaining physiologic positioning. Flexible endoscopic techniques, particularly awake flexible bronchoscopic intubation, remain essential for high-risk scenarios, though they require considerable expertise. Results: Recent technological innovations have produced hybrid devices combining multiple modalities to address the specific challenges presented by OSA patients. Adjunctive tools and techniques, including specialized introducers, exchange catheters, and high-flow nasal oxygen, play critical roles in extending safe apnea time and facilitating successful intubation. Professional society guidelines now incorporate OSA-specific recommendations, emphasizing thorough preparation, appropriate device selection, and comprehensive monitoring. Conclusions: Effective management ultimately requires not only appropriate technology but also systematic preparation, strategic device selection, and meticulous execution. As OSA prevalence continues to rise globally, optimizing airway management approaches for this challenging population remains a critical priority for patient safety. Full article

Background: Bulgaria carries a high burden of colorectal cancer (CRC) but, at the start of this study, lacked a nationwide organized screening program. Understanding specialist views (particularly on mail-based fecal testing) is essential for effective policy development. Objective: The objective is to assess the attitudes towards, practices of, and perceived barriers to CRC screening among Bulgarian gastroenterologists, with a focus on the feasibility of mail-based fecal occult blood testing (FOBT). Methods: A cross-sectional survey of 38 gastroenterologists examined clinical use of FOBT, screening method preferences, and perceived systemic and patient-level barriers to CRC screening. Results: Among respondents, 57.89% reported using FOBT in clinical practice, and 71.05% indicated they would undergo the test themselves and recommend it to relatives. Colonoscopy was the preferred diagnostic tool for 84.21% of participants; however, the existing literature raises concerns about its feasibility for large-scale population screening. Key systemic barriers, rated on a 5-point Likert scale, included financial constraints (mean = 3.08), inadequate infrastructure (2.89), and healthcare workforce shortages (2.71). Patient-level barriers were led by low health literacy (4.13), lack of motivation (3.95), and procedural fears (3.26). A majority (84.38%) believed that mail-based FOBT would increase screening uptake, and 57.89% supported annual distribution of test kits. Nearly all respondents (97.37%) favored initiating screening at age 50. Conclusions: This study highlights strong support among Bulgarian gastroenterologists for a national CRC screening program, with particular endorsement of mail-based FOBT. Despite acknowledged systemic and population-level barriers, the findings suggest that such an approach could increase screening coverage, promote early detection, and support the strategic rollout of Bulgaria’s emerging cancer control initiatives. Full article

Background/Objectives: Curcumin is a promising therapy for glioblastoma but is limited by poor water solubility, rapid metabolism, and low blood–brain barrier penetration. This study aimed to evaluate curcumin and six curcumin derivatives with improved activity against a glioblastoma cell line and favorable absorption, distribution, metabolism, excretion, and toxicity (ADMET) properties. Methods: Twenty-one curcumin derivatives were assessed and subjected to in vitro MTT cytotoxicity assays in SF268 glioblastoma and Vero cells. On the basis of the cytotoxicity results, six derivatives with the most favorable characteristics were selected for additional mechanistic studies, which included microtubule depolymerization, mitochondrial membrane potential (ΔΨm), and BAX activation assays. ADMET properties were determined in silico. Results: Compounds 2–4, 6, and 11 demonstrated better activity (IC₅₀: 0.59–3.97 µg/mL and SI: 3–20) than curcumin (IC₅₀: 6.3 µg/mL; SI: 2.5). Lead derivatives destabilized microtubules, induced ΔΨm collapse, and activated BAX. In silico ADMET prediction analysis revealed that compounds 4 and 6 were the most promising for oral administration from a biopharmaceutical and pharmacokinetic point of view. Conclusions: Strategic modifications were made to one or both hydroxyl groups of the aromatic rings of curcumin to increase its physicochemical stability and activity against glioblastoma cell line SF268. Compound 4, bearing fully protected aromatic domains, was identified as a prime candidate for in vivo validation and formulation development. Full article

Background/Objectives: Antimicrobial consumption (AMC) surveillance and antimicrobial stewardship (AMS) constitute effective strategies to combat the increasing antimicrobial resistance rates worldwide. Post-Soviet countries (Armenia, Azerbaijan, Belarus, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Moldova, the Russian Federation, Tajikistan, Turkmenistan, Ukraine, and Uzbekistan) implemented various elements of AMC surveillance and AMS to different extents. The limited quantity and quality of data from post-Soviet countries make it difficult to assess health system performance; therefore, this region is a blind spot in global AMR monitoring. This systematic review assesses and characterises AMC surveillance and AMS implementation in post-Soviet countries. Methods: Evidence was compiled via a search in PubMed, Google Scholar, Embase, CyberLeninka, and Scopus. The eligibility criteria included AMC surveillance- and AMS-related papers in human health within defined regions and timelines. Some literature from the official websites of international and national health organisations was included in the search. Results: As a result of the searches, screening, and critical appraisal, three peer-reviewed publications and 31 documents were selected for analysis. Eleven out of fifteen countries with updated national action plans for combating antimicrobial resistance have defined AMC surveillance and AMS as strategic objectives. All 15 examined countries submitted antimicrobial consumption data to international networks and reported the existence of approved laws and regulations on antibiotic sales. However, disparities exist in the complexity of monitoring systems and AMS implementation between high-income and low-income countries in the region. Conclusions: This review provides key insights into the existing AMC surveillance and AMS implementation in former Soviet countries. Although the approach of this review lacks quantitative comparability, it provides a comprehensive qualitative framework for national-level AMC surveillance and AMS system assessment. Full article

Background: Selecting enterprise resource planning (ERP) systems for complex port environments is a significant challenge. This study addresses a key research gap by identifying and prioritizing the critical factors for ERP selection within the strategic context of United Arab Emirates (UAE) ports, which function as vital hubs in global trade. Methods: A hybrid methodology was employed, first using the Fuzzy Delphi Method (FDM) to validate thirteen challenges with five industry experts. Subsequently, the Relative Importance Index (RII) was used to rank these challenges based on survey data from 48 UAE port professionals. Results: The analysis revealed “Cybersecurity concerns” as the highest-ranked challenge (RII = 0.896), followed by “Engagement with external stakeholders” (RII = 0.842), and both “Process optimization” and “Technical capabilities” (RII = 0.808). Notably, factors traditionally seen as critical in other sectors, such as “Organizational readiness” (RII = 0.746), were ranked significantly lower. Conclusions: The findings indicate a strategic shift in ERP selection priorities toward digital resilience and external integration rather than internal organizational factors. This research provides a sector-specific decision-support framework and offers actionable insights for port authorities, vendors, and policymakers to enhance ERP implementation in the maritime industry. Full article