Search Results (362)

Background/Objectives: Granular swollen epithelial cells (GSECs) have been described primarily in mitochondrial cytopathies, in which they are regarded as a characteristic pathological finding that may aid in the diagnosis of mitochondrial dysfunction; however, their prevalence and clinical significance in native kidney disease remain unclear. We aimed to evaluate the prevalence, clinicopathological associations, and prognostic significance of GSECs in native kidney biopsy specimens. Methods: Among 1165 adults who underwent native kidney biopsy between 2011 and 2024, 501 patients with evaluable medullary tissue were included in this retrospective cohort study. GSECs were defined as enlarged tubular epithelial cells with conspicuous granular cytoplasm in medullary tubules, and cases were classified as GSEC-positive when at least one unequivocal GSEC was identified. Clinical and histopathological characteristics were compared between groups, and kidney outcomes were evaluated using Cox proportional hazards models. Results: The mean baseline eGFR was 60.8 ± 26.3 mL/min/1.73 m², and the median urinary protein excretion was 1.1 g/gCr. During a median follow-up of 2.3 years, 112 patients (22.3%) reached the composite kidney outcome. GSECs were identified in 18% of native kidney biopsy specimens containing evaluable medullary tissue, and were observed across a broad spectrum of kidney diseases. GSEC positivity was associated with older age and underlying pathological diagnoses but was not associated with baseline kidney function or proteinuria. Kaplan–Meier and multivariable Cox analyses revealed no significant association between GSECs and kidney prognosis. Conclusions: GSECs are not specific to kidney allografts and are observed in a subset of diverse native kidney diseases. Although associated with certain clinical characteristics, no independent association between GSECs and kidney outcomes was observed in this cohort. These findings suggest that GSECs may reflect disease-dependent biological responses to tubular epithelial stress, potentially related to metabolic or mitochondrial alterations, rather than a marker of progressive kidney injury. Full article

Background: Legionnaires’ disease (LD) is most often described as caused by a single Legionella pneumophila (Lp) serogroup (SG), typically SG1. However, mixed infections involving multiple SGs or even different Legionella species can occur within a single host. Such cases remain underrecognized and pose challenges for diagnosis, clinical management, and outbreak investigation. Case presentation: A 61-year-old woman developed acute fever, malaise, and productive cough after visiting a wellness spa in France, with radiological findings consistent with a lower respiratory tract infection. The urinary antigen test (UAT) for Lp was negative, but respiratory multiplex PCR was weakly positive. Subsequent testing at the Belgian National Reference Centre (NRC) for Legionella revealed an unexpected discordance between an in-house SG1-specific PCR and culture-based findings. Further analysis identified co-infection with two distinct Lp strains, SG1 (sequence type, ST146) and SG10 (ST1267), using a combination of direct sequence-based typing (SBT) and culture with serogrouping of multiple colonies. The patient improved rapidly after treatment with oral levofloxacin. Conclusions: Mixed Lp SG infections are likely underrecognized in routine practice, as neither UAT, commercial molecular assays, nor characterization of a single cultured isolate may adequately capture within-host strain diversity. Comprehensive diagnostic approaches combining culture with analysis of multiple colonies and molecular tests are essential for accurate case detection and source attribution. Referral to NRCs is recommended when advanced typing methods are unavailable. This first reported Belgian case illustrates the potential implications for patient management and epidemiological investigations, underscoring the need for broader diagnostic strategies. Full article

The earliest gut and nasal bacterial community profiles after birth remain incompletely characterized, particularly when both sites are examined in parallel. We aimed to characterize these profiles according to delivery mode within the first 48 h of life in a Mexican cohort. Meconium and nasal wash samples from 60 neonates (30 vaginal and 30 cesarean deliveries) were analyzed by V3–V4 16S rRNA gene amplicon sequencing on an Illumina MiSeq platform, followed by QIIME 2 processing. All 60 meconium samples yielded analyzable 16S rRNA profiles. Nasal washes yielded analyzable profiles in 10/30 vaginally delivered and 12/30 cesarean-delivered neonates (p = 0.79). No statistically significant differences in alpha diversity were detected by delivery mode in gut samples (observed ASVs, p = 0.842; Shannon index, p = 0.183; Pielou’s evenness, p = 0.121; Faith’s phylogenetic diversity, p = 0.574) or nasal samples (p = 0.356, 0.947, 0.644, and 0.114, respectively). In unadjusted PERMANOVA comparisons, gut community structure differed by delivery mode for Bray–Curtis (p = 0.001), weighted UniFrac (p = 0.021), and unweighted UniFrac (p = 0.013) distances, whereas nasal comparisons were not statistically significant. Traditional ANCOM identified Staphylococcus as the feature with the highest W statistic in cesarean-delivered neonates (W = 65). Descriptive phylum-level profiles were examined across maternal urinary tract infection, premature rupture of membranes, maternal comorbidities, maternal BMI, hours since birth, and recorded antibiotic exposure; these comparisons were not multivariable and cannot exclude residual confounding. Delivery mode was associated with differences in early gut bacterial community structure in this cohort. Nasal findings were inconclusive because only 22 washes yielded analyzable 16S rRNA profiles and the workflow was not optimized to quantify ultra-low-biomass bacterial DNA. These cross-sectional data do not establish persistence, causality, or the timing at which nasal communities become stable. Full article

Catheter-associated urinary tract infections (CAUTIs) are among the most common nosocomial infections globally and represent a significant cause of morbidity and prolonged hospital stays. There is a scarcity of molecular data regarding pathogens and virulence factors linked to CAUTIs, particularly in South Africa. This study aimed to determine the distribution and frequency of uropathogens, including polymicrobial infection patterns, isolated from catheterised patients at the Polokwane National Health Laboratory Services (NHLS), Limpopo Province, from March 2024 to March 2025, and to characterise the prevalence and co-occurrence of six virulence genes (fimH, papC, sfa, hly, cnf, and aer) among Escherichia coli isolates, the predominant uropathogen identified. Specimens from catheterised patients diagnosed with urinary tract infections at the National Health Laboratory Services in Polokwane were used. Uropathogens were isolated on agar and identified using the VITEK^® system. Polymerase chain reaction (PCR) was used for amplification of some virulence genes (fimH, papC, sfa, hly, cnf, and aer) associated with uropathogens. Confirmation of urinary tract infections revealed that Escherichia coli was the predominant uropathogen (32.8%), followed by Klebsiella pneumoniae (17.8%), Enterococcus faecalis, Enterococcus faecium (14%), and others. Among E. coli isolates, virulence gene analysis revealed fimH (79.8%) as the most prevalent, followed by aer (77.4%), sfa (41.7%), hly (27.4%), papC (26.19%), and lastly cnf (9.5%). This study demonstrates that E. coli is the leading cause of CAUTIs in our study population, exhibiting diverse virulence gene combinations that enhance adhesion and overall pathogenicity. The findings emphasise the need for routine molecular surveillance of CAUTI pathogens, reinforcement of catheter-care protocols, and targeted infection prevention strategies. Full article

Background and Objectives: Human populations show striking phenotypic disparities in traits and diseases, including responses to infectious diseases (IDs). The impact of host genetic diversity on infection susceptibility and outcomes is increasingly recognized, yet remains largely unknown in Qatar. Here, we explored the distribution of infection-related host genetic variants in Qatar. Materials and Methods: Infection-related genetic variants from the GWAS Catalog were analyzed in 6047 Qatari whole genomes from the Qatar Genome Program (QGP) and compared with populations from the 1000 Genomes Project (1000G). Results: Out of 272,610 GWAS Catalog associations, 1086 were related to ID susceptibility, resistance, severity, progression, clearance, response to treatment, or vaccination, and hence included in the subsequent analysis. A significant heterogeneity in the allelic frequencies (AFs) between Qatari (n = 6047) and the 1000G populations (n = 2504) was observed. The QGP cohort carries significantly lower AFs of most risk variants associated with susceptibility to tuberculosis, malaria, hepatitis, diarrheal disease, and shingles (up to 222-fold, p < 0.0001). Contrarily, an enrichment in the AFs of variants that increase the risk of chickenpox, plantar warts, pneumonia, urinary tract infections (UTIs), and leprosy was observed among Qatari individuals, yet with much smaller-fold differences (≤5-fold, p < 0.0001). In addition, most severity/chronicity-related variants were considerably less prevalent in the Qatari population (up to 20.5-fold). Analysis of variants associated with antibody response revealed a distinct genetic distribution, especially in Epstein–Barr virus (EBV) and Chlamydia pneumoniae infections (27.8- and 3-fold, respectively). Moreover, a variable inter-population allelic distribution was observed in SNPs related to measles, mumps, and rubella (MMR), smallpox, and hepatitis B virus (HBV) vaccine response, as well as variants linked to viral clearance, viral load, virus-induced progression to cancer, and response to treatment. Conclusions: These findings reveal substantial differences in pathogen-associated host variants in a diverse Qatari cohort and highlight the need for follow-up validation and future GWAS discovery efforts. Full article

Background/Objectives: Double-J stents (DJS) cause clinically significant lower urinary tract symptoms (LUTS) in 58–80% of patients following ureteroscopy (URS). The distal vesical coil is regarded as the primary anatomical source of trigonal irritation and detrusor instability. The single-J stent (SJS) eliminates this element while preserving the proximal renal pigtail for anti-migration anchorage. This study aimed to evaluate the safety and patient-reported symptom outcomes of a modified SJS compared with standard DJS following elective URS for ureteric stone disease. Methods: A prospective, single-arm, within-patient feasibility study was conducted in 28 adults undergoing elective URS at Austin Health, Melbourne, Australia (Human Research Ethics Committee (HREC)/25658/Austin-2025; NCT07535580). A modified SJS was fashioned from a commercially available 7Fr Bander™ ureteral diversion stent (Cook Medical, G14780) by trimming the shaft to 28 cm and affixing a 7 cm Prolene retrieval suture (Ethicon NW807) to the blunt distal end. The primary outcome was a cystoscopically confirmed SJS migration rate at removal (pre-specified feasibility threshold ≤5%). Secondary outcomes included change in Ureteral Stent Discomfort Test (USDT) total and domain scores (paired analysis, n = 24), adverse events, and patient preference. Results: The clinically significant migration rate was 0% (0/28); 27/28 stent tips were freely floating within the bladder, with one asymptomatic tip at the ureteric orifice at the scheduled removal visit. Mean total USDT score decreased from 39.92 ± 2.00 (DJS) to 30.42 ± 1.73 (SJS)—a mean absolute reduction of 9.50 points (23.8%; p < 0.001), a magnitude consistent with clinically relevant change, although a USDT-specific minimum clinically important difference has not been independently validated. All six USDT domains improved significantly (all p ≤ 0.014). No adverse events were recorded. All 28 patients (100%) reported they would choose the SJS again. Conclusions: The modified SJS demonstrated a favourable safety profile and was associated with lower patient-reported symptom scores than the preceding DJS across all USDT domains in this uncontrolled within-patient comparison. Because stent design, stone burden, and dwell time differed between the two assessment phases, these differences should be regarded as hypothesis-generating and provide a feasibility basis for a prospective randomised controlled trial evaluating the SJS following URS. Full article

Agathosma betulina (P.J. Bergius) Pillans is an aromatic medicinal shrub endemic to South Africa’s Cape Floristic Region, widely used in traditional medicine to treat urinary tract infections, gastrointestinal disorders, colds, and wounds. Despite its commercial importance, limited information is available on how different growing environments influence its phytochemical composition. This study profiled the secondary metabolite composition of A. betulina leaves collected from wild, open-field cultivation, and glasshouse-grown environments using ultra-performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry (UPLC-QTOF-MS) combined with chemometric analyses. Methanolic extracts prepared from nine samples were analysed, resulting in the confident annotation of 21 secondary metabolites (MSI Level 2), comprising phenolic acids, flavanones, flavones, and flavonol glycosides. Rutin was the predominant flavonoid, with concentrations of 194.62, 185.71, and 58.82 mg CE kg⁻¹ DW in wild, cultivated, and glasshouse-grown plants, respectively. Neochlorogenic acid accumulated predominantly in cultivated plants (51.84 mg CE kg⁻¹ DW) compared with wild plants (3.31 mg CE kg⁻¹ DW), while coumaroylquinic acid (125.93 mg CE kg⁻¹ DW) and feruloylquinic acid (30.74 mg CE kg⁻¹ DW) were most abundant under glasshouse conditions. Tricin-7-O-glucoside (62.93 mg CE kg⁻¹ DW) and isorhamnetin-3-O-glucoside (31.26 mg CE kg⁻¹ DW) also accumulated significantly in cultivated plants. Partial Least Squares Discriminant Analysis (PLS-DA) score explained 92.1% of the total variation (C1 = 63.8%; C2 = 28.3%), together with hierarchical heat map clustering and VIP, clearly separating samples according to growing environment. Wild plants exhibited the greatest metabolite diversity, cultivated plants showed intermediate metabolite profiles, and glasshouse-grown plants displayed reduced flavonoid accumulation and overall chemical diversity. These findings demonstrate that growing environment strongly influences secondary metabolite accumulation in A. betulina and provide valuable information for optimizing cultivation practices, quality control, and conservation strategies for this economically important medicinal species. Full article

Radical cystectomy (RC) with urinary diversion (UD) is the standard treatment for muscle-invasive bladder cancer. Although the ileal conduit (IC) is the most commonly performed diversion, its reliance on bowel reconstruction leads to substantial perioperative morbidity and long-term complications. Cutaneous ureterostomy (CU) has re-emerged as an attractive alternative, particularly for elderly and medically frail patients, due to its technical simplicity and avoidance of intestinal manipulation. Recent single-stoma and tubeless modifications have aimed to overcome historical limitations of CU, including stomal stenosis and long-term stent dependence. Compared with IC, modern refinements of single-stoma CU showed shorter operative times and generally shorter hospital stays, largely reflecting avoidance of bowel reconstruction. Estimated blood loss and overall intraoperative complication rates were broadly comparable between diversion types. Contemporary retrospective data on single-stoma modifications showed lower rates of stomal stenosis and improved catheter-free outcomes compared with historical data, while infectious complications and readmission rates remained similar to those of IC in most series. Renal outcomes generally remained stable, with patient factors such as baseline renal function, hydronephrosis, and stent dependence appearing to be more influential for long-term deterioration than diversion type alone. Quality of life after contemporary single-stoma CU was similar to IC, based on the available retrospective evidence. Overall, contemporary single-stoma CU represents a valuable bowel-sparing urinary diversion that may potentially reduce operative burden while maintaining acceptable functional and quality-of-life outcomes. Current retrospective evidence supports its role as a particularly attractive option for elderly and frail patients, although prospective, multicenter comparative studies with standardized outcome reporting are still needed to better define patient selection and long-term outcomes. Full article

Introduction: The optimal surgical approach for elderly bladder cancer patients remains controversial. We compared perioperative morbidity and short-term outcomes in patients aged ≥ 75 years undergoing open radical cystectomy (ORC) versus robot-assisted radical cystectomy (RARC). Methods: A retrospective, multicenter cohort study was performed including 179 patients aged ≥ 75 years, of whom 101 underwent RARC between 2021 and 2025, and 78 underwent ORC between 2016 and 2020. After 1:1 propensity score matching, 138 patients were analyzed to assess perioperative complications and short-term postoperative outcomes. Pathological outcomes, including pathological stage, tumor grade, lymph node status, and positive surgical margins, were additionally compared between groups. Propensity score matching was performed based on age, body mass index (BMI), pathological stage, comorbidities, prior chemotherapy, and type of urinary diversion. Results: Following propensity score matching, RARC was associated with longer operative time (332 vs. 247 min; p < 0.001) but resulted in significantly lower blood loss (310 vs. 743 mL; p < 0.001), reduced transfusion rates, shorter length of hospital stay (p < 0.001), and fewer overall intraoperative complications (8.7% vs. 18.8%; p = 0.04). Patients undergoing RARC also experienced lower rates of any complications (43.5% vs. 62.3%; p = 0.02) and major complications (Clavien–Dindo III–V: 11.6% vs. 27.5%; p = 0.03). Postoperative mortality was low in both groups and did not differ significantly between RARC and ORC (1.4% vs. 2.9%; p = 1.00). In multivariate analysis, surgical approach independently predicted major complications, with RARC conferring a significantly lower risk (OR 0.75; 95% CI 0.51–0.88; p = 0.04). Analysis of the learning curve showed a significant reduction in major complications over time for RARC (OR 0.68; 95% CI 0.53–0.93; p = 0.01) but not for ORC. Conclusions: RARC offers superior perioperative outcomes, including reduced blood loss, shorter hospitalization, and lower rates of major complications, without differences in short-term pathological outcomes. These data support RARC as a safe and effective option for elderly patients undergoing radical cystectomy. Full article

Objective: To systematically evaluate the impact of a school-based sodium reduction education program using mobile health (mHealth), known as EduSaltS, on salt-related knowledge, attitudes, practices (KAP) and sodium intake among adults and children during its real-world scaling-up and to examine geographic and population heterogeneity in its effects. Methods: A multi-center pragmatic pre–post study design was used. The EduSaltS program was implemented in three cities (Ganzhou in southern China, Zhenjiang in eastern China, and Qinhuangdao in northern China) between April 2022 and July 2024. Ten primary schools were selected from each city. Baseline and follow-up surveys were conducted approximately 12 months apart, aligned with the school calendar. Electronic questionnaires were used to collect baseline and post-intervention data on the primary outcome—salt-related KAP—from adults and children. In Ganzhou and Zhenjiang, 24 h urine collections were conducted to measure urinary sodium excretion. Results: A total of 721 adults and 770 children were included in the final analysis. After the intervention, the total KAP scores significantly increased in both adults and children across the three sites: by 8.7–10.0 points in adults and by 11.4–16.7 points in children (all p < 0.001). The changes in sodium intake showed significant heterogeneity. A significant decrease in urinary sodium was observed among adults in Ganzhou (−14.0 mmol/24 h, 95% CI: −26.1, −2.0, p = 0.022), corresponding to a reduction of 0.82 g in daily salt intake. No significant change was found among adults in Zhenjiang (adjusted difference: −0.7 mmol/24 h, 95% CI: −13.4 to 12.0, p = 0.912). In children, after the one-year intervention, urinary sodium excretion showed a significant increase from baseline to follow-up in both cities (Ganzhou: +12.9 mmol/24 h, p = 0.018; Zhenjiang: +14.0 mmol/24 h, p = 0.0002). Conclusions: The pre–post evaluation showed that the EduSaltS program was associated with significant improvements in salt-related knowledge across regions. Its effectiveness in reducing sodium intake, however, varied substantially by population and geographic location. The observed increase in children’s urinary sodium excretion may partly reflect normal childhood growth and the limitations of a pre–post design without a control group. Pragmatic randomized controlled trials are warranted to verify the effectiveness of such interventions in reducing sodium intake and blood pressure across diverse populations and settings. Full article

Background/Objectives: Lipid peroxidation is a relevant oxidative–inflammatory mechanism in essential hypertension and cardiovascular disease. Plasma thiobarbituric acid reactive substances (TBARS), commonly reported as malondialdehyde-equivalent values, provide an operational index of lipid peroxidation-related aldehydic reactivity, but blood-based assessment is limited by venipuncture and preanalytical handling requirements. Urine is an attractive non-invasive matrix for redox biomarker development, although whether urinary TBARS reflect plasma lipid peroxidation in hypertensive patients remains insufficiently characterized. This study aimed to evaluate whether matrix-specific normalization—total cholesterol for plasma TBARS and creatinine for urinary TBARS—reveals a measurable intra-individual relationship between these matrices in essential hypertension. Methods: In this paired observational study, plasma and urine samples were obtained from 39 treated patients with essential hypertension under standardized fasting conditions. TBARS were quantified using a colorimetric thiobarbituric acid reaction assay. Plasma TBARS were normalized to total cholesterol and expressed as TBARSp, while urinary TBARS were normalized to creatinine and expressed as TBARSu. Associations were assessed using Spearman’s rank correlation, exploratory receiver operating characteristic (ROC) analyses based on internally derived plasma TBARS percentile thresholds, and Bayesian bootstrap inference. Results: Cholesterol-normalized plasma TBARS and creatinine-normalized urinary TBARS showed a moderate-to-strong positive monotonic association (Spearman’s ρ = 0.717, p < 0.001). Bayesian bootstrap analysis supported this relationship, with a 95% credible interval of 0.57–0.83 and a Bayes factor > 300 for ρ ≥ 0.5. Urinary TBARS showed exploratory within-cohort discriminatory capacity for identifying elevated plasma TBARS using internally derived thresholds, with an AUC of 0.892 for the median-based classification. Conclusions: Creatinine-normalized urinary TBARS showed a moderate-to-strong association with cholesterol-normalized plasma TBARS in treated essential hypertension. These findings provide hypothesis-generating paired-sample evidence that urinary TBARS may serve as a low-burden, non-invasive proxy of plasma lipid peroxidation-related redox alterations. Further validation in larger and clinically diverse cohorts, ideally including more specific lipid peroxidation markers and renal-function-aware analyses, is required to define their translational and clinical utility. Full article

This study evaluated the effects of dietary non-fiber carbohydrate to neutral detergent fiber ratio (NFC/NDF) and allicin supplementation on serum electrolytes, urinary biochemical indicators, nitrogen (N) and phosphorus excretion, and fecal microbiota in beef bulls. Forty 12-month-old beef bulls were assigned to a 2 × 2 factorial design based on dietary NFC/NDF (0.75 and 1.02) and allicin supplementation (0 and 0.04% on a DM basis), resulting in four treatment groups with 10 replicates per group. Increasing dietary NFC/NDF decreased serum pH and increased the anion gap (p < 0.05). An interaction between NFC/NDF and allicin supplementation was observed for the serum concentrations of non-ionized calcium and total calcium (p < 0.05), with the highest concentrations detected in cattle fed high-NFC/NDF diets supplemented with allicin. Serum uric acid was elevated by high NFC/NDF (p < 0.05). High dietary NFC/NDF also increased urine pH (p < 0.05). Significant interactions between dietary NFC/NDF and allicin supplementation were observed for allantoin, creatinine, and urease activity (p < 0.05). High NFC/NDF increased N excretion, total N excretion, and N excretion rate (p < 0.01). Additionally, allicin supplementation reduced fecal N excretion and N excretion rate and increased the apparent total-tract digestibility of N (p < 0.05). Fecal microbiota Alpha diversity analysis showed that high NFC/NDF decreased the Chao1, observed features, and Shannon (p < 0.05). At the phylum level, high NFC/NDF increased Pseudomonadota but decreased Cyanobacteriota, and a significant interaction between NFC/NDF and allicin was observed for Spirochaetota (p < 0.05). At the genus level, high NFC/NDF reduced unclassified_UCG-010 but increased Succinivibrio, unclassified_Muribaculaceae, and Methanobrevibacter (p < 0.05). Allicin increased Rikenellaceae_RC9_gut_group abundance (p < 0.05). In conclusion, dietary NFC/NDF and allicin supplementation modulate acid–base balance, N utilization, and fecal microbial composition in beef bulls, providing a scientific basis for improving feed efficiency. Full article

Background/Objectives: Our objective is to evaluate the long-term effects of radical cystectomy and Bricker ileal conduit urinary diversion on upper urinary tract function and structure, with a specific focus on radiological and laboratory changes in renal function. Methods: A retrospective analysis was conducted of 120 patients who underwent radical cystectomy (RC) and Bricker ileal conduit urinary diversion between 2010 and 2024. Clinical, laboratory, and radiological data were assessed over a 24-month follow-up period. Renal parenchymal thickness, kidney volumes, and hydronephrosis grades were analyzed, and the relationship between interventions and renal outcomes was examined. Results: Postoperative follow-up showed a progressive decrease in renal parenchymal thickness and kidney volume, particularly in the left kidney. Hydronephrosis occurred in both renal units, with higher rates on the left side. Despite these changes, only a subset of patients required intervention, typically due to sepsis, acute renal failure, or pain. No significant deterioration in median estimated glomerular filtration rate values was observed; however, patients with interventions showed higher anteroposterior diameter/parenchymal thickness ratios, suggesting increased parenchymal damage. Conclusions: Following radical cystectomy and Bricker ileal conduit diversion, mild to moderate hydronephrosis is not uncommon and does not always necessitate intervention, especially in patients without clinical symptoms. Radiological parameters like renal parenchymal thickness and kidney volume may be valuable for monitoring renal deterioration. Careful follow-up and selective intervention are crucial in preserving renal function in this patient group. Full article

Background/Objectives: Chronic pain is increasingly conceptualized as a systemic condition characterized by central sensitization, autonomic dysregulation, and persistent neuroimmune and neuroendocrine alterations. These systemic changes have been linked to microbial dysbiosis, most prominently within the gut microbiome. In contrast, the relevance of the urinary microbiome outside primary urological disease remains poorly understood, particularly in non-urological chronic pain conditions. The objective of this study was to determine whether patients with chronic low back pain exhibit differences in urinary microbial diversity, community composition, or taxon-specific abundance compared with pain-free controls. Methods: In this age- and sex-matched case–control study, midstream urine samples were collected from ten patients with chronic low back pain and ten pain-free controls and analyzed using 16S rRNA gene sequencing (V4 region). Sequence data were processed using nf-core/ampliseq and DADA2. Alpha diversity, beta diversity, and differential abundance were assessed using depth-adjusted models, compositional and phylogenetically informed distance metrics, and ANCOM-BC2, with multiple sensitivity analyses to account for the low-biomass nature of urinary microbiome data. Results: After accounting for sequencing depth, no significant differences in alpha diversity were observed between patients and controls for any metric. Beta diversity analyses revealed no significant differences in overall community composition between groups across all distance measures, and dispersion was comparable between groups. Differential abundance analysis did not identify any bacterial taxa that differed significantly between patients and controls after correction for multiple testing. Conclusions: In this cohort, chronic low back pain was not associated with detectable alterations in the urinary microbiome. These findings suggest that, unlike the gut microbiome, urinary microbial communities may be relatively stable in the context of non-urological chronic pain, highlighting the importance of phenotype specificity and multidimensional approaches in microbiome-based pain research. Full article

Serratia marcescens has emerged as an important opportunistic pathogen in intensive care units (ICUs), where critically ill patients, invasive devices, antimicrobial exposure, and complex environmental reservoirs create favorable conditions for colonization, infection, and recurrent outbreaks. This narrative review synthesizes evidence from the past decade regarding the clinical and molecular epidemiology, environmental persistence, device-associated transmission, biofilm-mediated resistance, and infection-control strategies of S. marcescens in ICU settings. The literature was reviewed using an integrative approach informed by Ferrari’s narrative review framework, with thematic synthesis across clinical, microbiological, environmental, and genomic domains. Recent evidence indicates that ICU-associated S. marcescens infections frequently involve respiratory tract colonization, ventilator-associated pneumonia, bloodstream infection, urinary tract infection, and device-related transmission. Hospital water systems, sink drains, wet surfaces, ventilator circuits, reusable equipment, and contaminated antiseptic or liquid products may serve as persistent reservoirs, particularly when biofilm formation supports long-term survival and recurrent dissemination. At the molecular level, S. marcescens demonstrates substantial genomic diversity, intrinsic and acquired antimicrobial resistance, inducible AmpC β-lactamase activity, efflux-mediated tolerance, and plasmid-associated resistance gene transfer. This review particularly emphasizes the molecular determinants that enable S. marcescens to persist in ICU ecosystems, including AmpC-mediated β-lactam resistance, efflux-associated tolerance, quorum-sensing-regulated biofilm formation, plasmid-mediated horizontal gene transfer, and WGS-defined clonal transmission. Whole-genome sequencing, rapid molecular diagnostics, active surveillance, environmental sampling, and integrated infection-control bundles have become increasingly important for distinguishing clonal outbreaks from endemic transmission and guiding timely interventions. Emerging perspectives emphasize the need to combine antimicrobial stewardship, environmental engineering, respiratory-care auditing, anti-biofilm strategies, and AI-assisted real-time surveillance into adaptive ICU infection-control frameworks. Overall, S. marcescens should be regarded not merely as an episodic outbreak organism, but as a highly adaptable ICU-associated pathogen requiring multidisciplinary prevention strategies. Full article