Search Results (12,785)

Carbapenem-resistant Klebsiella pneumoniae (CRKP) has become one of the most serious problems confronting modern healthcare, particularly in intensive care units where patients are highly susceptible, procedures are frequent, and antibiotic exposure is often prolonged. In this review, carbapenem resistance in K. pneumoniae is presented not as a fixed feature of individual bacteria, but as a process that is constantly changing and closely interconnected. We bring together evidence showing how the spread of successful bacterial lineages, the exchange of resistance genes, and gradual genetic adjustment combine to drive both the rapid spread and the long-lasting presence of resistance. A major focus is placed on mobile genetic elements, including commonly encountered plasmid backbones, transposons, and insertion sequences that carry carbapenemase genes such as blaKPC, blaNDM, and blaOXA-48-like. These elements allow resistance genes to move easily between bacteria and across different biological environments. The human gut plays a particularly important role in this process. Its microbial community serves as a largely unseen reservoir where resistance genes can circulate and accumulate well before infection becomes clinically apparent, making prevention and control more difficult. This review also discusses the key biological factors that shape resistance levels, including carbapenemase production, changes in the bacterial cell membrane, and systems that expel antibiotics from the cell, and explains how these features work together. Advances in molecular testing have made it possible to identify resistance more quickly, supporting earlier clinical decisions and infection control measures. Even so, current tests remain limited by narrow targets and may miss low-level carriage, hidden genetic reservoirs, or newly emerging resistance patterns. Finally, we look ahead to approaches that move beyond detection alone, emphasizing the need for integrated surveillance, thoughtful antibiotic use, and coordinated system-wide strategies to lessen the impact of CRKP. Full article

Internal wall grinding of pipes constitutes a critical pretreatment procedure in the anti-corrosion repair operations of Prestressed Concrete Cylinder Pipes (PCCP). To address the limitations of low efficiency and poor safety associated with traditional manual internal wall grinding in PCCP anti-corrosion repair, this study presents the design of a support-wheel-type internal wall grinding robot for pipes. The robot’s structure comprises a walking support module and a grinding module: the walking module employs four sets of circumferentially equally spaced (90° apart) independent-support wheel groups. Through an active–passive collaborative adaptation mechanism regulated by pre-tensioned springs and lead screws, the robot can dynamically conform to the inner wall of the pipe, ensuring stable locomotion. The grinding module is connected to the walking module via a slewing bearing and is equipped with three roller-type steel brushes. During operation, the grinding module revolves around the pipe axis, while the roller brushes rotate simultaneously, generating a composite three-helix grinding trajectory. Mathematical models for the robot’s obstacle negotiation, bend traversal, and grinding motion were established, and multi-body dynamics simulations were conducted using ADAMS for verification. Additionally, a physical prototype was developed to perform basic functional tests. The results demonstrate that the robot’s motion characteristics are highly consistent with theoretical analyses, exhibiting stable and reliable operation, excellent pipe traversability, and robust driving capability, thus meeting the requirements for internal wall grinding of PCCP pipes. Full article

The brown bear (Ursus arctos) occurs across several regions of Türkiye and occasionally damages beehives near rural settlements. This study examines temporal data and the spatial arrangement of beehive damage incidents recorded in the Ilgaz district of Çankırı, Türkiye during 2023–2024. The temporal data were evaluated across lunar phases. A chi-square test showed that incidents did not distribute evenly. A higher frequency was found during the Waxing Crescent phase. Spatial intensity was mapped using Kernel Density Estimation (KDE), where bandwidth selection followed a cross-validation procedure. KDE results showed clear concentrations of incidents in the southern and southwestern parts of the district, while other areas recorded few or none. A Decision Tree (DT) classifier based on eleven environmental variables was used to identify predictors of incident presence. The DT achieved an AUC of 0.808. It identified “distance to settlement” as the primary separating variable, followed by “distance to road”, “distance to forest”, and the “Human Footprint Index”. Beehive damage followed a non-random temporal pattern across lunar phases. It clustered near settlements. Conflict timing followed both environmental conditions and human activity. The findings provide an empirical basis for reducing apiary losses and improving coexistence measures between local communities and brown bears in the Ilgaz region. Full article

Background/Objectives: Prepectoral direct-to-implant reconstruction is widely used, but implant rippling often necessitates lipofilling. This study aimed to identify preoperative and perioperative factors associated with delayed lipofilling. Methods: A retrospective cohort of consecutive patients who underwent immediate prepectoral implant reconstruction (April 2023–September 2024) was analyzed. Demographic data, BMI, smoking, comorbidities, oncologic treatments, surgical factors, and tumor location were recorded. Patients were divided according to whether delayed lipofilling was required. Univariate analysis was performed using Mann–Whitney U and Fisher’s exact tests. Results: Fifty-eight patients were included; approximately one-third required lipofilling. Patients who underwent lipofilling were younger and had lower BMI than those who did not. Tumor location was strongly associated with the outcome: upper inner quadrant tumors were consistently linked to delayed lipofilling, whereas upper outer quadrant tumors were more frequently observed in the group not requiring revision. Smoking history and planned radiotherapy showed nonsignificant trends toward higher lipofilling rates. No differences were found for diabetes or corticosteroid therapy. Conclusions: Younger age, low BMI, and tumor location, particularly in the upper inner quadrant, were key factors associated with delayed lipofilling after prepectoral reconstruction. These variables may support preoperative counseling and follow-up planning to better anticipate secondary procedures and optimize aesthetic outcomes. Full article

Soybean root rot, caused by diverse soil-borne pathogens, is a major constraint on production worldwide, with yield losses ranging from 10 to 60% under epidemic conditions. Symptomatic plants were collected from three locations in Harbin, Heilongjiang Province, China, and 23 fungal isolates were recovered using standard tissue isolation procedures. Integrated morphological characterization and rDNA-ITS sequencing identified these isolates as three Fusarium species: F. oxysporum (18 isolates, 78%), F. equiseti (3 isolates, 13%), and F. brachygibbosum (2 isolates, 9%). Pathogenicity assays following Koch’s postulates confirmed F. oxysporum as the predominant and most aggressive pathogen in this region. To identify resistance resources, 200 soybean germplasm accessions adapted to Northeast China were screened using an etiolated seedling hypocotyl inoculation method with Fusarium oxysporum isolate A3 (DSI = 68.5) as the test pathogen. Disease severity indices exhibited a continuous distribution (mean = 52.84, range = 0–100), suggesting quantitative inheritance. Accessions were classified as highly resistant (13, 6.5%), resistant (40, 20%), moderately susceptible (67, 33.5%), susceptible (43, 21.5%), or highly susceptible (37, 18.5%). To explore potential molecular mechanisms underlying resistance, RT-qPCR analysis was performed on two extreme genotypes—a highly resistant line (H9477F5, DSI = 15.3) and a highly susceptible line (HN91, DSI = 88.7) at 1, 3, and 5 days post-inoculation. The resistant line maintained consistently higher expression of positive regulators GmFER and GmSOD1, with GmFER reaching 15.89-fold induction at day 3. Conversely, expression of negative regulators GmJAZ1 and GmTAP1 remained lower in the resistant line, with susceptible plants showing 5.62-fold higher GmJAZ1 expression at day 3. These findings provide characterized pathogen isolates, resistant germplasm resources (53 accessions with HR or R classifications), and preliminary molecular insights that may inform breeding strategies for improving root rot resistance in Northeast China. Full article

The progressive degradation of surface waters should become one of the most important problems requiring an urgent solution. One of the methods developed is filtering water through loose, degraded sediments, blooms of cyanobacteria or algae, or a bed of hemp (Cannabis sativa L.) waste or hemp fibers. The conducted tests on the percolation of water samples and/or water with sediment from surface waters at sites with different ecological statuses indicate the possibility of using hemp waste for the reclamation of water reservoirs and rivers. The effect of filtration is a rapid improvement in water quality and, consequently, an improvement in the ecological status. The best result was achieved for a small freshwater reservoir with a large number of algae and loose degraded sediment. The initial turbidity value was at the limit of the device’s measurement capability, reaching 9991 NTU. After filtration through the hemp waste bed, the turbidity dropped to 42.52 NTU, a 99.57% decrease. The remaining parameters, C, TDS, and pH, were not subject to significant variability as a result of filtering. Excessive amounts of organic matter, which create a problem for surface waters, are removed. Due to the carrier (hemp waste), which is organic waste, any possible release of small amounts into the aquatic environment will not pose a threat. After applying filtration, a decision can be made on further actions regarding the water reservoir or river: Self-renewal of the reservoir or further percolation using, for example, mill gauze or cleaning the reservoir with other, non-invasive methods. After the filtering procedure, the hemp waste, enriched with organic matter and water remaining in the waste, can be used for composting or directly for soil mulching (preliminary tests have yielded positive results). A hemp waste filter effectively removes Chronomus aprilinus larvae (Chrinomidae) from water. This result indicates the possibility of removing mosquito larvae in malaria-affected areas. The use of hemp filters would reduce the amount of toxic chemicals used to reduce mosquito larvae. Improving the ecological status of surface waters by filtering contaminants with hemp waste filters can reduce the need for chemical treatment. The use of natural, biological filters enables sustainable surface water management. This is crucial in today’s rapidly increasing chemical pollution of surface waters. Full article

Studies on two-dimensional materials (such as topological insulators or transition metal dichalcogenides) have shown that they exhibit unique properties, including high charge carrier mobility and tunable bandgaps, making them attractive for next-generation electronics. Some of these materials (e.g., HfSe${}_2$) also offer thickness-dependent bandgap engineering. However, the standard device fabrication techniques often introduce processing contamination, which reduces device efficiency. In this paper, we present a modified mechanical exfoliation technique, the Reversed Structuring Procedure, which enables the fabrication of hybrid systems based on 2D microflakes with improved interface cleanness and contact quality. Hall effect measurements on Bi${}_2$Se${}_3$ and HfSe${}_2$ devices confirm enhanced electrical performance, including the decrease in the measured total resistance. We also introduce a novel Star-Shaped Electrode Structure, which allows for accurate Hall measurements and the exploration of geometric magnetoresistance effects within the same device. This dual-purpose geometry enhances the flexibility and demonstrates broader functionality of the proposed fabrication method. The presented results validate the Reversed Structuring Procedure method as a robust and versatile approach for laboratory test-platforms for electronic applications of new types of layered materials whose fabrication technology is not yet compatible with CMOS. Full article

Background: Awake carotid endarterectomy (CEA) under local anesthesia demands an optimal sedation strategy that ensures patient comfort while preserving the ability for real-time neurological assessment. Dexmedetomidine (DEX) and remifentanil (REMI) are widely used agents, but direct comparisons in this setting remain scarce. Methods: Exploratory, retrospective, single-center study of awake CEA (March–July 2019). DEX or REMI infusions were titrated to a Richmond Agitation–Sedation Scale (RASS) of −1 to −2. Outcomes were sedation failure (RASS ≥ +2 despite maximum infusion rate), bradycardia, hypotension, and neurologic events. Statistical analyses used χ² test (categorical variables) and Student’s t-test or Mann–Whitney test (continuous variables). Associations were assessed with Firth’s logistic regression (univariable and bivariate models), reporting odds ratios (OR) with 95% confidence intervals (CI_95%). Trends in the Bispectral Index (BIS), hemodynamic, and respiratory parameters were assessed using two-way repeated-measures Analysis of Variance (ANOVA). A p-value < 0.05 was considered significant. Results: Fifty-two patients were included (DEX = 25; REMI = 27). DEX group showed more frequent sedation failure (32.0% vs. 3.7%; p = 0.020), bradycardia (36.0% vs. 3.7%; p = 0.009), and hypotension (28.0% vs. 0%; p = 0.011). DEX was associated with increased risk in sedation failure (OR 8.58, CI_95% 1.70–85.81), bradycardia (OR 10.17, CI_95% 2.05–101.21), and hypotension (OR 22.30, CI_95% 2.46–2959.60); the direction of associations remained consistent in bivariate models adjusted for baseline confounders. ANOVA showed group-by-time interactions for BIS, heart rate, mean arterial pressure, and end-tidal CO₂. No intraoperative complications or adverse outcomes were observed. Conclusions: In this retrospective cohort of awake CEA, DEX was associated with higher rates of sedation failure and hemodynamic adverse events compared with REMI, without an apparent impact on procedural success. Given non-random allocation and baseline imbalances, these findings are hypothesis-generating and warrant confirmation in larger, robust, and prospective studies. Full article

Background: Primary Biliary Cholangitis (PBC) requires early diagnosis and specialized management to prevent progression to cirrhosis. This study evaluates the awareness levels of Turkish physicians from various specialties regarding the clinical features, diagnostic criteria, and current treatment protocols of PBC. Methods: A multi-regional cross-sectional survey was conducted with 269 physicians across Türkiye. Knowledge levels were assessed through a 28-item instrument covering epidemiology, diagnosis and therapy. Data distribution was non-normal (Skewness: −1.296, Kurtosis: 2.857), necessitating the use of the Kruskal–Wallis H test and Dunn–Bonferroni post hoc procedure for inter-group comparisons. Internal consistency was confirmed with a Cronbach’s alpha of 0.80. Results: The overall mean awareness score was 62.6%. Item-level analysis revealed a near-universal understanding of the non-mandatory role of liver biopsy in diagnosis (99.1%) yet identified a critical knowledge gap regarding second-line therapies, particularly the use of steroids (6.8%). Significant disparities were observed among specialties (p < 0.001). Gastroenterologists (Median: 91.07%) and gastroenterology fellows (Median: 85.71%) exhibited significantly higher proficiency compared to general practitioners (64.29%) and family medicine residents (67.86%). Internal medicine specialists outperformed primary care providers, while no significant differences were found among other subgroups after Bonferroni adjustment. Conclusions: Professional specialization is the primary determinant of PBC awareness. While core diagnostic knowledge is stable, significant gaps exist in pharmacological management among non-specialists. Targeted medical education for primary care physicians is essential to ensure timely referral and optimize patient outcomes. Full article

High-sensitivity cardiac troponin assays are susceptible to analytical interferences, including macrotroponin, an immunoglobulin-bound complex that may cause persistent, non-dynamic, and assay-dependent elevations. This paper describes the case of a 74-year-old woman with hypertension who presented with intermittent mild chest discomfort and exertional dyspnea and exhibited persistently elevated but stable cardiac troponin I concentrations over several months, in the absence of clinical, electrocardiographic, or imaging evidence of myocardial injury. Orthogonal testing revealed discordant results across different assay platforms, and polyethylene-glycol (PEG) precipitation resulted in a substantial signal reduction, confirming macrotroponin as the source of assay-dependent analytical interference. Recognizing this phenomenon is crucial to avoid misdiagnosis, unnecessary diagnostic procedures and inappropriate management in patients with isolated troponin elevation. In conclusion, this report provides evidence-based recommendations on the optimal diagnostic strategies and laboratory approaches to adopt in cases of suspected macrotroponin-mediated interference in high-sensitivity cardiac troponin assays. Full article

Conflicting data exist regarding the effect of intradetrusor BoNT/A on the incidence of urinary tract infections (UTIs) in patients with neurogenic detrusor overactivity (NDO), contrary to the increase in UTIs noted in patients with idiopathic OAB. Associations between UTIs, chronic inflammation, and bladder overactivity are acknowledged, albeit not fully understood. Chronic bladder inflammation is common in both NDO and OAB patients, and both animal and human studies suggest a beneficial effect of BoNT/A on both urinary and systemic levels of inflammatory markers. To explore whether intradetrusor BoNT/A injections affect the background for the incidence of UTIs in humans, we investigated in parallel the effect of intradetrusor BoNT/A on the incidence of UTIs and on the urine mRNA levels of urinary pathogen-detecting Toll-like receptors TLR2, TLR4, and TLR5 and of factors acting as intermediates of immune response and promoters of inflammatory reactions (IL1β, IL6, TNFα, and PGE₂). For this purpose, we recruited 22 patients with NDO-associated incontinence who received at least one bladder BoNT/A injection. Urine specimens for the study of UTIs were obtained before the procedure and at routine urodynamic follow-ups at 4–6 weeks, 6 and 12 months post-BoNT/A, and at clinical relapse, while urine specimens for the study of biomarkers were collected at the time of BoNT/A injection and at the abovementioned follow-ups thereafter. Urine specimens from 10 adult healthy volunteers with no OAB symptoms served as the control group in the biomarker study. The genes of interest in the urine were studied by RNA isolation, reverse transcription, and real-time PCR. The urine mRNAs of all biomarkers tested appeared to be upregulated in the patients’ samples compared with the controls, albeit only TLR2 and TLR5 mRNA increases were statistically significant. A progressive downregulation of TLR2, TLR5, IL1β, and IL6 urine mRNAs was noted at one and six months post-BoNT/A. TNFα and PGE₂ mRNAs showed a transient increase at one month post-BoNT/A followed by a dramatic drop at the six months’ follow-up. A similar trend for progressive decline was also noticed in the prevalence of both positive urine cultures and symptomatic UTIs in the same timepoints and additionally at 12 months post-treatment in patients who still benefited from the BoNT/A treatment. Upon clinical relapse, the mRNA levels of PGE₂, IL1β, and IL6 increased in parallel with an increase in the prevalence of UTIs, while the levels of TLRs and TNF-α did not follow the same trend. In summary, intradetrusor BoNT/A injections achieved significant decreases in the urine mRNA levels of pathogen-detecting TLRs, immune response, and inflammation mediator cytokines and PGE₂ in our cohort of patients with NDO-associated incontinence. In parallel, decreases were noted in both the incidence of symptomatic UTIs and rates of positive urine cultures. At the time of clinical relapse, the markers of inflammation and immune response, but not TLRs, were upregulated in parallel with the increased incidence of UTIs, suggesting that the studied genes PGE₂, IL1β, and IL6 could be further explored as potential biomarkers for inflammation/immune response and UTIs in the neurogenic population. Full article

Introduction: Rectal colonization by carbapenemase-producing carbapenem-resistant Enterobacterales (CP-CRE) is a risk factor for subsequent infections, which are associated with high mortality rates. Methods: A cross-sectional study was conducted. Rectal swabs were collected from 297 patients within 48 h of admission to eight high-prevalence CP-CRE hospital departments, with follow-up swabs taken weekly for up to 4 weeks. Species identification, antimicrobial susceptibility testing, and genetic detection of carbapenemases were performed. The genetic relationship among isolates was assessed using ERIC-PCR, combined with epidemiological data, to investigate subsequent infections. Results: Fecal carriage of CP-CRE was detected in 15.5% (46/297) of patients- All carbapenemases were metallo-betalactamases, with dominance of NDM-producing Klebsiella pneumoniae. NDM + VIM-producing Escherichia coli were also detected. Among carriers, 26.1% were colonized by two different CRE species, and 86.9% had a history of prior hospitalization. Molecular analysis revealed clonal expansion, suggesting outbreaks among colonized patients. Additionally, 17.4% (8/46) of colonized patients developed an infection, which was significantly associated with urinary catheter use (p = 0.040), mechanical ventilation (p = 0.044), and surgical procedures (p = 0.040). Conclusions: rectal colonization by CP-CRE in hospitalized patients is a serious epidemiological concern, with evidence of clonal spread and subsequent infection in colonized patients. NDM-producing K. pneumoniae was also predominant, detecting co-production of NDM + VIM in E. coli. These findings underscore the urgent need to implement epidemiological surveillance cultures to improve the prevention and control of CP-CRE infections in Cuban hospitals. Full article

Background: Diffuse large B cell lymphoma is an aggressive, heterogeneous yet treatable disease. Primary bone lymphoma is a lymphoma involving a single or multiple osseous sites with or without regional nodal involvement. It is exceedingly rare, representing <1% of new non-Hodgkin lymphoma cases per year. Most cases of primary bone lymphoma are diffuse large B cell lymphoma. They infrequently involve the craniofacial bones and mandible; its rarity can lead to delays in diagnosis. Case Series Presentation: Two 64-year-old male patients initially presented to local dentists with concerns of tooth pain and numbness. Both underwent extensive dental procedures including extraction and debridement, with an initial diagnosis of osteomyelitis. They were placed on long-term antibiotics. After months without improvement, further testing was pursued, including imaging and repeat biopsies. The patients were finally diagnosed with primary bone diffuse large B cell lymphoma. From the initial treatment of osteomyelitis, a median time of 8.5 months passed before diagnosis of lymphoma. Treatment with cytotoxic chemotherapy was initiated and both patients achieved remission. Conclusions: As in the two cases presented here, the initial point of entry into the medical system may be a visit to the local dentist. When patients present with periodontal complaints, it is imperative to maintain a broad differential, including lymphoma. This is especially crucial when the patient’s clinical course does not respond to initial treatment. This results in delays of diagnosis and initiation of therapy for a treatable cancer. Full article

Background: Childhood obesity represents the most common nutritional and metabolic disorder in industrialized countries and constitutes a major public health concern. In Italy, 20–25% of school-aged children are overweight and 10–14% are obese, with marked regional variability. Excess adiposity in childhood is frequently associated with hypertension, dyslipidemia, insulin resistance, and non-alcoholic fatty liver disease (NAFLD), predisposing to future cardiovascular disease (CVD). Objective: To investigate anthropometric indicators of cardiometabolic risk in 810 children and adolescents aged 7–17 years who underwent assessment for competitive sports eligibility at the Sports Medicine Unit of Modena, evaluate baseline knowledge of cardiovascular health aligned with ESC, AAP (2023), and EASO guidelines. Methods: 810 children and adolescents aged 7–17 years undergoing competitive sports eligibility assessment at the Sports Medicine Unit of Modena underwent evaluation of BMI percentile, waist circumference (WC), waist-to-height ratio (WHtR), and blood pressure. Cardiovascular knowledge and lifestyle habits were assessed via a previously used questionnaire. Anthropometric parameters, blood pressure (BP), and lifestyle-related knowledge and behaviors were assessed using standardized procedures. Overweight and obesity were defined according to WHO BMI-for-age percentiles. Elevated BP was classified based on the 2017 American Academy of Pediatrics age-, sex-, and height-specific percentiles. Statistical analyses included descriptive statistics, group comparisons, chi-square tests with effect size estimation, correlation analyses, and multivariable logistic regression models. Results: Overall, 22% of participants were overweight and 14% obese. WHtR > 0.5 was observed in 28% of the sample and was more frequent among overweight/obese children (p < 0.001). Elevated BP was detected in 12% of participants with available measurements (n = 769) and was significantly associated with excess adiposity (χ² = 7.21, p < 0.01; Cramér’s V = 0.27). In multivariable logistic regression analyses adjusted for age and sex, WHtR > 0.5 (OR 2.14, 95% CI 1.32–3.47, p = 0.002) and higher sedentary time (OR 1.41 per additional daily hour, 95% CI 1.10–1.82, p = 0.006) were independently associated with elevated BP, whereas BMI percentile lost significance when WHtR was included in the model. Lifestyle knowledge scores were significantly lower among overweight and obese participants compared with normal-weight peers (p < 0.01). Conclusions: WHtR is a sensitive early marker of cardiometabolic risk, often identifying at-risk children missed by BMI alone. Baseline cardiovascular knowledge was suboptimal. The observed gaps in cardiovascular knowledge underscore the importance of integrating anthropometric screening with structured educational interventions to promote healthy lifestyles and long-term cardiovascular prevention. Full article

Objective: This paper describes the development of a speech intelligibility test in Swiss German dialects, designed for children aged four to nine who are not yet familiar with standard German. Method: Suitable monosyllabic words and trochees in different Swiss German dialects were compiled, illustrated, and evaluated. Picture-pointing test procedures appropriate for children were developed. The selected test words and the pictures representing them were evaluated in a preliminary trial with forty-six normal-hearing children between two and nine years of age. Results: A set of 60 monosyllabic words and 40 trochees was recorded in four different Swiss German dialects as well as in standard German, resulting in a total of 500 recordings. Drawings were created to illustrate each word and found to be appropriate for children aged four years old or older. A non-adaptive and an adaptive test procedure using a weighted up–down method to measure speech reception thresholds in quiet and in noise were developed. Conclusions: A novel test to determine speech intelligibility in children in four different Swiss dialects was developed and evaluated in a pilot study. A validation study with more participants was designed to evaluate the test material and procedures. Full article