Search Results (14,138)

Background: Postpartum depression and anxiety are common in the perinatal period and can adversely affect maternal functioning and infant outcomes. Self-esteem is a relevant psychosocial factor, yet evidence from Eastern Europe remains limited. Objectives: To describe self-esteem levels among postpartum Romanian women, examine correlational associations between self-esteem and postpartum depression/anxiety symptoms, and assess whether these associations persist after adjustment for sociodemographic and clinical covariates, across two maternity centers in a cross-sectional design. Methods: This cross-sectional study included 201 postpartum women recruited consecutively during their initial postpartum hospitalization from two public maternity hospitals in Western Romania (Bihor, n = 100; Timiș, n = 101) during 2024–2025. Participants completed the Rosenberg Self-Esteem Scale (RSES), Edinburgh Postnatal Depression Scale (EPDS), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7). Associations were assessed with χ² tests (categorical comparisons), Pearson correlations, and multivariable linear regression models including center and selected sociodemographic/obstetric covariates. Results: Self-esteem showed a strong inverse correlation with postpartum depressive symptoms (RSES–EPDS: r = −0.542 overall; r = −0.537 in Bihor; r = −0.552 in Timiș; all p < 0.001). Negative correlations were also observed with anxiety (RSES–GAD-7: r = −0.400; p < 0.001) and PHQ-9 depressive severity (r = −0.370; p < 0.001). Stratified analyses indicated graded symptom burden across self-esteem categories, with higher EPDS risk proportions among women with moderate/low self-esteem within each center (χ²p ≤ 0.039). In adjusted models, EPDS (B = −0.37; p < 0.001) and GAD-7 (B = −0.15; p = 0.021) remained independently associated with lower RSES, alongside study center (Timiș vs. Bihor: B = −1.08; p = 0.043) and educational attainment. Conclusions: Lower self-esteem co-occurs with postpartum depressive symptoms and, secondarily, anxiety in Romanian women. While the cross-sectional design precludes causal inference, these robust correlational associations support the potential value of self-esteem assessment for early psychosocial risk identification. Longitudinal research is needed to establish temporal relationships and evaluate whether self-esteem can prospectively predict postpartum mental health outcomes. Full article

Sports drinks are becoming increasingly popular, especially among young, physically active individuals. The influence of acidic drinks on dental restorative materials, including composites and glass ionomers, is an important concern in conservative dentistry. Acidic conditions can cause material degradation, which may reduce their longevity and clinical performance. We aimed to examine the effect of sports drink exposure on the colour stability of composite and glass ionomer materials. This systematic review was conducted based on records published from 1 January 2005 to 31 December 2024, according to the PRISMA statement guidelines, using the databases PubMed, Scopus, Web of Science, and Embase. Based on the established inclusion and exclusion criteria, 17 studies were selected for this review, of which 12 were included in a meta-analysis. The meta-analysis demonstrated a statistically significant increase in colour change (ΔE) for microhybrid composites and nanocomposites after immersion in sports drinks for one month (SMD = 3.04; 95% CI: 0.67 to 5.41, and SMD = 3.00; 95% CI: 1.08 to 4.92, respectively). No such significant differences were observed for nanohybrid materials (SMD = 1.64; p-value = 0.579). Despite the findings of this systematic review, the extent of material degradation observed in in vitro studies cannot be directly translated to clinical oral conditions, as factors such as salivary buffering capacity and variable exposure to sports drinks influence outcomes. Full article

Background: Although thrombophilia represents a major risk factor for adverse maternal outcomes, particularly in the postpartum period, methods for its systematic screening remain costly and limited. This case–control study aimed to evaluate whether routinely available hematological inflammatory indices combined with postpartum uterine ultrasonographic assessment can predict the presence of thrombophilia in peripartum women. Methods: Eighty women with previously diagnosed and treated thrombophilia undergoing cesarean section at term were prospectively enrolled and matched by age and parity with 80 control patients without thrombophilia. Hematological inflammatory markers derived from complete blood counts obtained within 24 h before delivery and the postpartum uterine ultrasonographic score were analyzed. Multivariable logistic regression was performed to identify independent predictors of thrombophilia, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Results: Impaired postpartum uterine involution—defined as a postpartum uterine ultrasonographic score ic—was significantly more frequent in thrombophilia cases than in controls (OR > 1, 95% CI excluding 1; p < 0.05). Thrombophilia patients exhibited significantly higher Neutrophil-to-Lymphocyte and Platelet Ratio and Cumulative Inflammatory Index values when compared with the controls, with both emerging as independent predictors in the multivariable model (OR > 1, 95% CI excluding 1; p < 0.05). The final model demonstrated good discriminative performance, with an overall classification accuracy of 88.6% and excellent specificity for excluding thrombophilia when the postpartum uterine ultrasonographic score was 0. Conclusions: The integration of postpartum uterine ultrasonographic assessment with simple hematological inflammatory indices provides a non-invasive, cost-effective approach for identifying women at increased risk of underlying thrombophilia in the immediate postpartum period. This strategy may support targeted thromboprophylaxis and rationalize the use of specialized thrombophilia testing. Full article

Background: Secondary hepatic dysfunction is a frequent yet often under-recognized complication in critically ill children. It commonly arises as a consequence of systemic processes—particularly sepsis, hypoperfusion, hypoxia, and multiorgan dysfunction—rather than primary hepatobiliary disease. This study aimed to determine the incidence, clinical characteristics, and prognostic significance of secondary hepatic dysfunction in a pediatric intensive care unit (PICU) cohort, and to evaluate its relationship with PRISM III and PELOD-2 scores. Methods: This retrospective study included patients hospitalized in a tertiary PICU between January 2022 and December 2024. Children with pre-existing liver disease or primary acute liver failure were excluded. Hepatic dysfunction was defined by elevations in age-adjusted biochemical markers. Demographic variables, clinical interventions, laboratory values, and outcomes were recorded. Mortality risk and prolonged PICU stay (>7 days) were analyzed in relation to hepatic dysfunction, PRISM III, and PELOD-2 scores. Results: Among 567 PICU admissions, 50 patients (8.8%) met criteria for secondary hepatic dysfunction. The cohort had a median age of 57.5 months and 66% were male. Hepatocellular injury predominated (96%), while cholestatic patterns were less common (4%). Overall mortality was 22%. Mortality was significantly associated with sepsis (p = 0.04), mechanical ventilation (p < 0.01), and inotropic support (p < 0.01). Both PRISM III and PELOD-2 scores were higher in non-survivors on day 1 and day 7 (p ≤ 0.01). ALT ≥ 2 × ULN and total bilirubin > 2 mg/dL were not independently predictive of mortality. Conclusions: Secondary hepatic dysfunction is relatively common in critically ill children and is associated with adverse clinical outcomes. Its prognostic relevance appears to extend beyond conventional severity scores, particularly with respect to morbidity-related outcomes such as prolonged PICU stay, suggesting that routine hepatic assessment may contribute to early risk stratification in the PICU setting. Full article

Sustainable service excellence in globalized industries requires organizations to develop workforce capabilities that support long-term relationship-building, cultural respect, and effective cross-cultural communication. This study examines how cultural intelligence functions as a mechanism for sustainable cross-cultural workforce development by investigating relationships among individual cultural values, cultural intelligence dimensions, and influence tactics among airline cabin crew members. Integrating Hofstede’s cultural dimensions framework, Ang and colleagues’ cultural intelligence model, and Yukl’s influence tactics taxonomy, we test a comprehensive mediation model using survey data from six hundred and sixty-three cabin crew members employed by international airlines operating in Turkey. The findings reveal that collectivism, long-term orientation, and uncertainty avoidance positively predict cultural intelligence development, creating foundations for sustainable cross-cultural competence. Cultural intelligence dimensions demonstrate differentiated effects on influence tactics, with metacognitive and behavioral cultural intelligence enhancing rational persuasion, behavioral cultural intelligence exclusively predicting relational tactics, and complex competitive mediation patterns for coercive tactics wherein motivational cultural intelligence reduces pressure-based influence while cognitive and behavioral dimensions increase strategic assertiveness. Cultural values directly influence tactics beyond cultural intelligence effects, with uncertainty avoidance most strongly predicting both rational and relational approaches that support relationship sustainability, while masculinity and power distance drive coercive tactics that may undermine long-term service relationships. These findings demonstrate that cultural intelligence functions as a multidimensional mediating mechanism with sometimes opposing effects, challenging assumptions that cross-cultural competencies uniformly produce sustainable outcomes. The research contributes to sustainable human resource management theory by illuminating how cultural socialization influences behavioral outcomes through complex psychological pathways, while offering practical guidance for aviation industry recruitment, training, and performance management systems seeking to build sustainable cross-cultural service capabilities. By revealing that certain cultural intelligence dimensions can enable both relationship-building and strategic coercion, the study highlights the importance of coupling cross-cultural skill development with ethical frameworks and motivational engagement to ensure that enhanced cultural capabilities support rather than undermine sustainable, respectful cross-cultural service relationships. Full article

Background/Objectives: Ovarian cancer (OC) remains one of the most lethal gynecological malignancies, mainly because it is frequently diagnosed at advanced stages due to nonspecific symptoms and the lack of effective screening strategies. Long non-coding RNAs (lncRNAs) have emerged as key regulators of gene expression, and accumulating evidence implicates them in OC initiation, progression, and treatment response. This review aims to comprehensively summarize the molecular mechanisms of lncRNAs in OC, examine their clinical potential as biomarkers, and discuss emerging technologies that are about to advance lncRNA research and therapeutics in OC. Methods: A comprehensive review of published studies investigating lncRNA expression, function, and clinical relevance in OC was conducted. Mechanistic insights were integrated across multiple regulatory levels, including epigenetic, transcriptional, post-transcriptional, and post-translational control. Advances in transcriptomic technologies and RNA-targeting techniques were also examined. Results: LncRNAs influence OC through diverse mechanisms, including chromatin remodeling, transcriptional regulation, RNA splicing, mRNA stability, protein modulation, competing endogenous RNA networks, and nuclear organization. Their dysregulation is linked to tumor progression, metastasis, chemoresistance, and poor patient outcomes. Numerous lncRNAs exhibit diagnostic and prognostic value, underscoring their clinical potential. Advances in long-read sequencing have improved lncRNA annotation and isoform resolution, while CRISPR-Cas13 offers a potential approach for selective RNA-targeted therapy. Conclusions: LncRNAs are critical molecules in OC development and progression, holding potential in advancing OC diagnosis, prognosis, and treatment. Continued integration of functional studies, advanced sequencing technologies, and RNA-targeting approaches can facilitate the clinical translation of lncRNAs for early OC diagnosis and management. Full article

Grounded in the dynamic capabilities framework, this study examines how entrepreneurship and technological innovation jointly shape business performance and how sustainable management conditions these effects across its economic, social, and environmental dimensions. Using survey data from 300 firms across multiple industries, we find that entrepreneurship significantly enhances both non-financial and financial performance, and that technological innovation serves as a key mediating mechanism through which entrepreneurship translates into performance outcomes. The results reveal differentiated moderating effects of sustainable management. While the economic dimension of sustainable management shows a limited moderating influence, the social and environmental dimensions significantly amplify the returns to entrepreneurship and technological innovation. By disentangling sustainable management into distinct dimensions, this study moves beyond prior research and demonstrates that sustainability functions as a contextual capability that asymmetrically conditions the returns to entrepreneurship and innovation. The findings offer actionable insights for managers and policymakers seeking to align entrepreneurial initiatives and innovation strategies with social legitimacy and environmental stewardship to achieve sustained value creation. Full article

This study investigated the efficacy of two value-added products derived from silkworm excrement—a concentrated extract (SCE, 20:1) and sodium copper chlorophyllin (SCC)—as functional feed additives for common carp. Diets supplemented with 0.5% SCE, 1.0% SCE, or 0.1% SCC were compared to a basal control. The results revealed a distinct dose-dependent effect for SCE: 0.5% SCE was safe, while 1.0% SCE impaired growth, feed efficiency, and digestive enzyme activity. Both SCE and SCC significantly enhanced lipid metabolism, reducing hepatic lipid deposition and improving serum lipid profiles, albeit through distinct molecular pathways—SCC primarily stimulated catabolism, whereas SCE comprehensively regulated both synthesis and breakdown. Furthermore, SCE demonstrated superior, multi-targeted immunomodulatory capacity by favorably regulating inflammatory cytokine expression, an effect not observed with SCC. Although both additives boosted systemic antioxidant capacity, their specific patterns of enzyme activity and gene expression differed. In conclusion, SCE offers broad-spectrum, synergistic benefits for health modulation, while SCC provides specific, stable bioactivity, highlighting the importance of selecting the appropriate additive form based on desired functional outcomes in aquaculture. Full article

Background and Hypothesis: Mortality in hemodialysis (HD) remains high and is not fully explained by traditional risk factors. Biomarkers reflecting myocardial stress and fibrosis, together with measures of vascular stiffness, may provide additional prognostic information in this population. Methods: We conducted a retrospective study evaluating 173 HD patients who were clinically stable and asymptomatic at baseline over a follow-up period of over 10 years. Patients were classified into four groups based on median baseline values of NT-proBNP and galectin-3 (4234 pg/mL and 28.1 ng/mL, respectively). Primary outcomes were all-cause mortality and major adverse cardiovascular events (MACE). Pulse wave velocity (PWV) was evaluated as an additional prognostic marker. Results: During follow-up, 76.9% of patients died. Higher NT-proBNP levels were associated with increased all-cause mortality, irrespective of galectin-3 levels, with adjusted hazard ratios of 2.58 and 1.93 compared with the reference group (p < 0.05). Age and PWV were independently associated with mortality risk, corresponding to a 4% increase in risk per year of age and a 6% increase per 1 m/s increase in PWV. MACE occurred in 26.8% of patients and did not differ significantly between biomarker-defined groups. Conclusions: In this long-term HD cohort, elevated NT-proBNP and increased arterial stiffness were independently associated with higher all-cause mortality. These findings support the complementary prognostic value of markers of cardiac stress and vascular stiffness in chronic hemodialysis patients. Full article

Background/Objectives: Acute calculous cholecystitis remains one of the most frequent surgical emergencies, ranging from mild inflammation to gangrenous forms associated with necrosis and sepsis. Early differentiation between these stages is essential for timely surgical management. This study aimed to evaluate the diagnostic and prognostic value of hematological inflammatory indices—the Aggregate Index of Systemic Inflammation (AISI), the Systemic Immune-Inflammation Index (SII), and the Systemic Inflammation Response Index (SIRI)—in predicting the gangrenous evolution of acute calculous cholecystitis. Methods: A retrospective study was conducted on 435 patients who underwent cholecystectomy between 2016 and 2024 at a tertiary care center. Patients were divided into gangrenous (n = 145) and chronic (n = 290) cholecystitis groups. Preoperative hematological parameters were used to calculate AISI, SII, and SIRI. After histopathological confirmation, patients with GC (gangrenous calculous cholecystitis) were identified, and for each case, two age- and sex-matched controls with chronic CC (calculous cholecystitis) were selected, maintaining a GC:CC ratio of 1:2. Preoperative hematological parameters were used to calculate AISI, SII, and SIRI. Results: All three indices were significantly higher in the gangrenous group (p < 0.001). Logistic regression identified SIRI as the strongest independent predictor of gangrenous cholecystitis (OR = 1.976, p < 0.001). ROC analysis demonstrated excellent discriminative capacity for all markers (AUC > 0.8), with SII achieving the highest diagnostic accuracy (AUC = 0.889, sensitivity 79.5%, specificity 86.3%). Conclusions: AISI, SII, and SIRI represent reliable, easily obtainable, and noninvasive biomarkers for assessing inflammatory severity and predicting gangrenous transformation in acute calculous cholecystitis. Their integration into preoperative evaluation could improve early risk stratification, surgical planning, and patient outcomes. Full article

Background: Combination chemotherapy using nanotechnology-based delivery is a promising approach to improve cancer treatment, but the added value of co-loaded polymeric nanocarriers has not been comprehensively appraised. This review synthesizes preclinical evidence on polymeric systems co-encapsulating antitumor agents. Methods: A narrative literature review identified 33 preclinical studies (2015–2025) employing polymer-based nanocarriers to co-load at least two antitumor drugs. Study characteristics and in vitro and in vivo outcomes were qualitatively analyzed. Results: Most studies addressed breast, lung, or ovarian cancer and used micelles or nanospheres. Co-loaded formulations consistently enhanced in vitro cytotoxicity and, in vivo, produced marked tumor growth inhibition relative to free drugs or single-loaded systems; in several reports, near-complete or complete tumor regression was achieved. Synergy was frequently suggested but not consistently quantified, more than half of the studies did not report a combination index. Most formulations showed favorable tolerability, with few reports including mild hepatic toxicity, renal, or weight-related effects. Beyond conventional drug pairs, examples of co-delivering chemotherapeutics with resistance modulators, gene therapy agents, or targeted ligands illustrated how tailored release profiles and active targeting can potentiate efficacy. Nevertheless, heterogeneity in models, dosing schedules, endpoints, and limited long-term safety data hamper cross-study comparison and translation. Conclusions: Co-loaded polymeric nanocarriers constitute a promising platform to optimize combination chemotherapy, improving preclinical antitumor efficacy with generally limited toxicity, but more standardized and mechanistically driven studies are required to support clinical development. Full article

Heavy metals (HMs) and metal-oxide nanoparticles (NPs) frequently co-occur in freshwater systems, yet their combined effects on microbial predators remain poorly understood. Here, the freshwater ciliate Coleps hirtus was used to evaluate the cytotoxicity of single and binary mixtures of HMs (Cd, Cu, Zn) and NPs (ZnO, CuO, TiO₂, SiO₂), and to characterize associated antioxidant responses. Acute toxicity was assessed after 24 h by estimating LC₂₀ and LC₅₀ values, while mixture toxicity for Cd + Zn and Cd + ZnO was analyzed using the Toxic Unit approach and the MixTOX framework. Non-enzymatic (TPC, DPPH, HRSA) and enzymatic (CAT, GST, GPx, SOD) antioxidants were quantified as sublethal biomarkers at concentrations below lethal thresholds. HMs were markedly more toxic than NPs, with a toxicity ranking of Cu > Cd >> Zn, whereas NPs followed ZnO > CuO >> TiO₂ >> SiO₂. Cd + Zn mixtures showed predominantly antagonistic or non-interactive effects, while Cd + ZnO mixtures exhibited strong synergistic toxicity with a non-linear dependence on mixture composition, as supported by MixTox modeling. Exposure to HMs and NPs induced significant and often coordinated changes in antioxidant biomarkers, with binary mixtures eliciting stronger responses than single contaminants. Together, these findings indicate that mixture composition strongly influences both toxicity outcomes and oxidative stress responses in C. hirtus. The combination of clear, mixture-dependent toxicity patterns and robust oxidative stress responses makes C. hirtus a promising bioindicator for freshwater environments impacted by HMs and NPs. Full article

Background/Objectives: Whole food, plant-based (WFPB) diets have been associated with reduced cardiovascular risk and enhanced overall health. However, nutrition education in medical training remains limited. This study evaluated an experiential WFPB intervention known as the “Plant Plunge.” Methods: A total of 64 medical student participants attended weekly one-hour nutrition seminars on campus led by a local nonprofit, received complimentary WFPB lunches, and were encouraged to eat a WFPB diet for four weeks. Semi-structured interviews explored program perceptions. Pre- and post-intervention assessments measured nutrition knowledge, and a post-program survey assessed attitudes toward the intervention. Results: We analyzed a total of 14 interviews, 25 pre- and post-intervention knowledge assessments, and 49 post-intervention surveys. Qualitative analysis identified seven major themes: (1) improved physical health outcomes; (2) increased awareness of nutrition’s role in medicine; (3) concerns about feasibility and accessibility of WFPB diets; (4) personal empowerment and behavioral change; (5) educational value of seminars; (6) social engagement and peer support; and (7) relevance to future clinical practice. Mean scores on the knowledge assessment significantly improved from 73.3% to 87.0% (p = 0.045) following the Plant Plunge. Survey responses revealed that 65% of participants agreed that they increased knowledge of food ingredients, 54% indicated increased likelihood of selecting plant-based options, and 43% agreed that finding WFPB foods was easy, with 16% disagreeing. Conclusions: The Plant Plunge improved medical students’ nutrition knowledge, dietary attitudes, and perceived readiness for lifestyle counseling while offering an experiential model of nutrition education. Short, experiential nutrition programs may serve as scalable approaches to strengthen nutrition training and support chronic disease prevention. Full article

Aim: To investigate the impact of pain on some electroencephalographic (EEG) features at term equivalent age (TEA) and, second, to assess if the proposed EEG analysis may be predictive of the neurodevelopmental outcome at 24 months corrected age. Methodology: Infants born <32 weeks of gestational age, without major brain injury, were studied with an 8-channel EEG recording at TEA. The number of skin-breaking procedures from birth to the EEG recording was collected, as well as opioid administration. The following EEG-based indexes were investigated: Brain Simmetry Index (BSI) and Circular Omega Complexity (COC). Multivariate statistical analysis was performed. Results: Seventy-seven preterm newborns were enrolled. The multivariate models showed that higher pain exposure resulted in higher BSI, lower COC μ (mean), and lower COC values related to δ waves (all p < 0.05). Fentanyl was associated with increased BSI values related to α and β waves (all p < 0.05). Morphine showed a positive effect on BSI and a negative effect on OC μ and COC on all frequency bands (all p < 0.05). COC related to δ waves was positively associated with cognitive outcomes (p = 0.034). Conclusion: Pain and opioids might impact brain dynamics in preterm infants. Quantitative multivariate EEG indexes may be helpful to characterize the neurodevelopmental outcomes. Full article

Optic neuritis (ON) has been recognized since antiquity, but its modern clinical identity emerged only in the late 19th century and was definitively shaped by the Optic Neuritis Treatment Trial (ONTT). The ONTT established the natural history, visual prognosis, association with multiple sclerosis (MS), and therapeutic response to corticosteroids, building the foundation for contemporary ON management. Subsequent discoveries—most notably aquaporin-4 IgG-associated ON (AQP4-ON), myelin oligodendrocyte glycoprotein antibody-associated ON (MOG-ON), and double-negative ON—have fundamentally transformed this paradigm, shifting ON from a seemingly uniform demyelinating syndrome to a group of biologically distinct disorders. These subtypes differ in immunopathology, clinical course, MRI features, retinal injury patterns, CSF profiles, and long-term outcomes, making early and accurate differentiation essential. MRI provides key distinctions in lesion length, orbital tissue inflammation, bilateral involvement, and chiasmal or optic tract extension. Optical coherence tomography (OCT) offers complementary structural biomarkers, including severe early ganglion cell loss in AQP4-ON, relative preservation in MOG-ON, and variable patterns in double-negative ON. CSF analysis further refines diagnosis, with oligoclonal bands strongly supporting MS-ON. Together, these modalities enable precise early stratification and timely initiation of targeted immunotherapy, which is critical for preventing irreversible visual disability. Despite major advances, significant unmet needs persist. Access to high-resolution MRI, OCT, cell-based antibody assays, and evidence-based treatments remains limited in many regions, contributing to global disparities in outcomes. The understanding of the pathogenesis of double-negative optic neuritis, the identification of reliable biomarkers of relapse and visual recovery, and the determination of standardized cut-off values for multimodal diagnostic tools—including MRI, OCT, CSF analysis, and serological assays—remain unresolved challenges. Future research must expand biomarker discovery, refine imaging criteria, and ensure equitable global access to cutting-edge diagnostic platforms and therapeutic innovations. Four decades after the ONTT, ON remains a dynamic field of investigation, with ongoing advances holding the potential to transform care for patients worldwide. Together, these advances expose a fundamental tension between historically MS-centered diagnostic frameworks and the emerging biological heterogeneity of ON, a tension that underpins the structure and critical perspective of the present review. Full article