Search Results (663)

Background/Objectives: Gestational diabetes mellitus (GDM) is one of the most common metabolic complications during pregnancy. Nutritional and diabetological education constitutes the cornerstone of treatment; however, its actual impact according to maternal knowledge levels requires further evaluation. The objectives of this study were to assess the influence of maternal dietary and lifestyle knowledge on the metabolic control of women diagnosed with GDM and to analyze the effectiveness of nutritional and diabetological education received during pregnancy in achieving favorable obstetric and perinatal outcomes. Methods: A prospective observational cohort study was conducted at a tertiary referral center in women diagnosed with GDM. Participants completed a specific questionnaire to evaluate dietary and lifestyle knowledge relevant to glycemic control. Pregnancy follow-up included anthropometric measurements, maternal biochemical parameters—including oral glucose tolerance tests—and maternal-fetal obstetric outcomes, analyzed in relation to knowledge levels and education received. Results: Results showed that women with lower nutritional knowledge exhibited higher body weight, body mass index, and glucose levels in GDM diagnostic tests. Higher knowledge levels were associated with improved metabolic control. Nutritional and diabetological education during pregnancy proved beneficial, with better maternal-fetal outcomes observed, particularly among women who received reinforced education. Conclusions: Dietary and lifestyle knowledge significantly influenced GDM metabolic control. Nutritional education before and during pregnancy is key to optimizing glycemic management and improving maternal-fetal outcomes, supporting the need for preventive and educational programs targeting women with risk factors. Full article

Professionals working in biological conservation seek to understand, manage, and restore populations of native organisms using many techniques. A common approach for this discipline is using long-term data collections to inform decision making. However, several quantitative issues complicate statistical analysis of monitoring datasets and can reduce the utility of results for conservation decision making. Integrating results from multiple analyses applied to the same dataset (i.e., approaching the same biological problem using different techniques) is one way to address concerns related to field data that violate statistical assumptions. This process allows data analysts, researchers, and managers to assemble insights based on the weight of evidence. Here we tested whether three different statistical techniques [(1) multiple logistic regression on original data, (2) multiple logistic regression on standardized data (i.e., mean of 0 and standard deviation of 1), and (3) random forest analysis] identified a similar hierarchy for selecting natural and anthropogenic habitat regressors. Our examination of how environmental variables affected Plains Minnow (Hybognathus placitus), a state-threatened fish, is relevant to other taxa and locations. We gained useful information from redundancies (i.e., agreements across analyses). New directions also emerged by addressing ambiguities (i.e., disagreements among results across analyses). When multiple analyses were integrated into one ecological story, a clearer interpretation emerged. Viewing different statistical tests as facilitators that provide mutual advantages can advance the understanding and application of statistical analyses applied to non-experimental field datasets. Full article

Coxsackievirus A16 (CVA16), a major etiological agent of hand, foot, and mouth disease, is increasingly contributing to neurological complications, with no vaccines or virus-specific antivirals currently available. To identify CVA16-restricting host factors, we investigated the role of the interferon-stimulated gene shiftless (SHFL), previously implicated in the control of other RNA viruses. Using CRISPR–Cas 9, we generated SHFL knockout rhabdomyosarcoma cells and assessed viral replication, cytopathic effects, and replication stage dynamics. We evaluated disease progression and tissue injury in neonatal mice infected with a mouse-adapted CVA16 strain. SHFL expression was strongly induced during CVA16 infection and was inducible by exogenous interferon-β treatment, and its loss markedly increased infectious virus production, accelerated early replication, and exerted severe cytopathic effects. In vivo, SHFL deficiency led to rapid weight loss, pronounced neurological signs, increased viral burden across multiple tissues, and uniform mortality, together with high viral loads and extensive pathological damage in the central nervous system, lungs, and skeletal muscle. Transcriptomic analyses revealed SHFL-dependent modulation of adhesion- and mitogen-activated protein kinase-related pathways. Overall, our results suggest SHFL as a key determinant of host resistance to CVA16, acting mainly at the post-transcriptional stage to limit viral spread and tissue injury, and highlight SHFL-linked pathways as promising host-directed antiviral targets. Full article

Obstructive sleep apnea (OSA) is a common disorder caused by recurrent upper airway obstruction during sleep, affecting individuals across the lifespan. In children, OSA commonly results from adenotonsillar hypertrophy and may resolve spontaneously or following surgical intervention. Among adolescents and adults, OSA is more frequently associated with modifiable lifestyle factors, particularly obesity. The natural history of OSA may evolve from intermittent snoring and mild disease to moderate or severe forms if left untreated, leading to reduced health-related quality of life and overall health deterioration. Early identification of OSA, especially in mild and moderate cases, allows timely interventions to improve OSA-associated indices and may prevent progression to severe disease. Continuous positive airway pressure therapy remains the treatment of choice for adults, providing effective symptom control and reducing long-term complications, although adherence rates vary. In obese patients, sustained weight reduction represents the most effective disease-modifying strategy: a ≥5% weight loss is associated with an approximately 80% reduction in progression risk, while bariatric surgery achieves remission in up to 60–65% of cases at one year. Emerging anti-obesity pharmacotherapies have also demonstrated clinically meaningful reductions in the apnea–hypopnea index. Comorbid conditions such as hypertension, type 2 diabetes, and depression exacerbate OSA severity, impair treatment response, and complicate overall disease management. This review uniquely integrates pediatric and adult longitudinal data, treatment-modified trajectories, and emerging therapeutic approaches to provide a life-course perspective on OSA natural history, highlighting opportunities for early, phenotype-directed intervention to possibly alter disease course and long-term outcomes. Full article

Background: Subtle Lisfranc injuries are low-energy, purely ligamentous lesions increasingly recognized in active patients; although screw fixation is common, Internal Brace (IB) flexible fixation is an alternative. Methods: In this multicenter retrospective study (2014–2021), 65 patients with subtle ligamentous Lisfranc injury (C1–M2 diastasis < 5 mm) underwent standard screw (SS, n = 35) or IB fixation (n = 30). Outcomes included AOFAS and VAS, standing radiographs and weight-bearing CT (WBCT) diastasis, pedobarography (4–6 months), and complications. Results: Demographics and injury mechanisms were similar. Both groups improved from preoperative status to final follow-up (p < 0.05). At 6 months, IB had higher AOFAS and lower VAS than SS (p < 0.05). Final stability was comparable: standing C1–M2 diastasis 2.54 mm (IB) vs. 2.55 mm (SS); WBCT dorsal 1.26 vs. 1.21 mm and plantar 3.58 vs. 3.42 mm (all NS). Pedobarography showed no significant side-to-side differences in either group. Complications favored IB: SS had screw breakage 11.4% (4/35), recurrent diastasis 2.9% (1/35), and early arthritis 5.7% (2/35); IB had no implant breakage, no severe recurrent diastasis, and no early arthritis. Conclusions: In this Level III study, IB fixation was associated with better 6-month clinical outcomes with similar final radiographic stability and fewer hardware-related complications versus SS. Full article

Introduction/Object: Gastrointestinal cancers are among the most common types of neoplasms and are often associated with malnutrition, which affects physical performance, treatment tolerance and prognosis. This paper aims to synthesize, through a systematic search, the evidence on the impact of nutritional interventions on nutritional status in patients with digestive cancers prone to malnutrition. Methods: A systematic search was performed in PubMed, MDPI, Web of Science and ScienceDirect, for articles published between 2009 and 2025. Overall, 14,503 records were identified, and after screening of titles, abstracts and full-text evaluation, 80 studies (cross-sectional and cohort) were included. Data extraction was performed by a single researcher, using pre-established criteria and a standardized table, and the assessment of study quality was performed qualitatively, taking into account study design, sample size, nutritional assessment methods and clarity of reporting of results. Results: Evidence suggests that individualized and early applied nutritional interventions contribute to maintaining weight and protein status, improve tolerance to oncological treatments and may positively influence patient survival. Conclusions: Nutritional therapy plays a crucial role in preventing complications and supporting the body during oncological treatment, optimizing patients’ quality of life. This review provides a clear synthesis of the current evidence and recognizes methodological limitations related to the qualitative assessment of the included studies. Full article

Both obesity and chronic kidney disease (CKD) are increasingly recognized as global epidemics. Their escalating incidence and far-reaching health implications highlight the urgent need for comprehensive prevention and management strategies. This review aims to clarify how obesity interacts with end-stage kidney disease (ESKD) and how to improve the management of obese patients receiving kidney replacement therapy. It also explores underlying mechanisms, current treatments, future directions, and ongoing controversies. By highlighting this intricate relationship, the review seeks to enhance clinical practice and promote further research toward more personalized care for this vulnerable population. Obesity is frequent in dialysis patients and creates challenges related to body composition, metabolism, and treatment. While higher body mass index (BMI) may appear to improve survival, this paradox does not offset the cardiovascular and functional risks of visceral and sarcopenic obesity. Obesity also increases post-transplant complications and can limit access to transplantation. Lifestyle changes rarely achieve lasting weight loss, whereas bariatric surgery—especially sleeve gastrectomy—can improve transplant eligibility with fewer complications. Weight-loss medications may be used before transplantation but remain insufficiently studied in ESKD. After transplantation, weight-reduction efforts should continue, with pharmacotherapy preferred over bariatric surgery. Comprehensive assessment strategies and individualized management approaches in ESKD patients are essential to optimize outcomes in this growing patient population. Full article

Obesity hypoventilation syndrome (OHS) is a severe and underrecognized respiratory disorder characterized by the coexistence of obesity, daytime hypercapnia, and sleep-disordered breathing. Although well described in adults, pediatric OHS remains poorly defined despite the rising prevalence of childhood obesity. Its pathophysiology is multifactorial, involving obesity-related mechanical constraints, impaired ventilatory control, altered chemosensitivity, and frequent overlap with obstructive sleep apnea. Clinical manifestations in children are often subtle and nonspecific, including snoring, sleep fragmentation, daytime sleepiness, and neurocognitive impairment, frequently leading to delayed diagnosis and, in some cases, acute cardiopulmonary decompensation. Management of pediatric OHS is challenging and largely extrapolated from adult data. Positive airway pressure therapy remains the cornerstone of treatment, while weight reduction is essential but difficult to achieve in pediatric populations. Pharmacological approaches such as medroxyprogesterone or acetazolamide remain experimental, with limited pediatric evidence. This review synthesizes current knowledge on pediatric OHS, focusing on epidemiology, pathophysiology, clinical presentation, diagnostic challenges, and therapeutic strategies. Increased awareness and earlier recognition are essential to prevent progression to chronic respiratory failure and long-term cardiovascular complications. Full article

Background and Objectives: Obesity has been increasing sharply worldwide and is related to diabetes, cardiovascular diseases, liver disease, and cancer. Sleeve gastrectomy is the most used surgical approach to reduce body weight and treat metabolic implications observed in patients with moderate-to-severe obesity. On the other hand, this procedure affects the musculoskeletal system, and investigating skeletal muscle is not routinely recommended for bariatric surgery. This study aimed to evaluate the psoas muscle in patients in the preoperative period of sleeve gastrectomy and six months after the procedure using abdominal computed tomography scans. Materials and Methods: This clinical, exploratory, and observational study, with a prospective longitudinal observational study design, was conducted at a single center with 31 women who underwent sleeve gastrectomy. The evaluations were performed before and after six months of the procedures. Results: Anthropometric, muscle strength, hepatic ultrasound, and psoas computerized tomography evaluations were performed. A significant reduction in body weight, body mass index, waist, neck, and calf circumference was observed. There was also a substantial reduction in right-hand strength and the area and index of the psoas muscle (but with an increase in density). Most presented a routine abdominal ultrasound. Conclusions: Our results suggest that muscle evaluation provides valuable information for clinical monitoring before and after bariatric surgery, helping to identify potential risks and guide multidisciplinary follow-up. Psoas muscle area and psoas muscle index decreased, but psoas muscle density increased, all significantly. These results indicate that conducting a muscle evaluation is helpful for patients undergoing bariatric surgery, supporting the use of the clinical approach before and after the procedure, predicting possible complications, and providing more accurate prognoses. Full article

Background/Objectives: Preterm birth remains a major cause of neonatal morbidity and mortality, particularly in multiple pregnancies and in cases of cervical shortening. While cervical cerclage is established in singleton pregnancies, its efficacy in multiple gestations remains uncertain. This study compares pregnancy and neonatal outcomes following second-trimester cerclage in singleton and multiple pregnancies with a short cervix. Methods: In this retrospective cohort study, 96 women underwent second-trimester cerclage at a tertiary perinatal center between 2020 and 2024. All had a cervical length ≤ 25 mm or prolapsed membranes without infection or premature rupture. Primary outcomes included term delivery rate, gestational age, mode of delivery, and neonatal outcomes; secondary outcomes comprised surgical complications and rehospitalization, defined as the need for renewed inpatient care due to threatened preterm labor or procedure-related complications. Results: In total, 79 singleton and 17 multiple pregnancies were analyzed. Term delivery occurred more often in singletons (54%) than multiples (18%, p = 0.006). Mean gestational age at birth was 258 ± 25 days in singletons versus 228 ± 28 days in multiples (p < 0.001). Birth weight was significantly lower in multiples (1985 g vs. 2943 g; p < 0.001), and neonatal infections were more frequent (53% vs. 26%; p = 0.008). Caesarean delivery was more common in multiples (82% vs. 33%; p < 0.001). Apart from increased postoperative contractions in multiples (24% vs. 5%; p = 0.031), complication rates and rehospitalization (27% vs. 29%; p = 0.8) were similar. Conclusions: Second-trimester cerclage is less effective in preventing preterm birth in multiple pregnancies compared to singleton pregnancies; however, it appears to be associated with a stabilizing clinical course and may facilitate outpatient management in selected high-risk cases. These findings support individualized counseling and shared decision-making, particularly in multifetal gestations. Full article

Background/Objectives: Silicosis remains a major occupational health concern worldwide and is characterized by notable clinical heterogeneity in terms of disease progression and complications. However, the underlying metabolic mechanisms contributing to this heterogeneity remain poorly understood. Methods: We conducted a case–control study involving 156 silicosis patients and 132 silica-exposed controls. The plasma samples were analyzed via untargeted metabolomics based on liquid chromatography–mass spectrometry (LC-MS/MS). To explore disease subtypes and potential biomarkers, we applied non-negative matrix factorization (NMF) clustering, weighted gene co-expression network analysis (WGCNA), and machine learning approaches. Results: A total of 860 differentially abundant metabolites, including elevated pathogen-associated compounds, were identified in silicosis patients. Unsupervised NMF clustering revealed two distinct metabolic subtypes with different clinical features. Patients in the NMF2 subgroup had a 5.3-fold greater risk of pulmonary infections (p = 0.026) than those in the NMF1 subgroup. Metabolomic analysis revealed that NMF2 was enriched in arachidonic acid and unsaturated fatty acid metabolism pathways, with prominent LysoPC accumulation, suggesting inflammation-related lipid peroxidation. In contrast, NMF1 was characterized by increased spermidine biosynthesis and urea cycle activity, along with suppressed saturated fatty acid metabolism and reduced LysoPC processing, potentially affecting membrane integrity and promoting fibrosis. A machine learning-derived dual-metabolite panel, tyrosocholic acid and PI (20:4/0:0), achieved AUC values above 0.85 for both silicosis detection and subtype classification. Conclusions: These findings highlight metabolic heterogeneity in silicosis and suggest clinically relevant subtypes, providing a foundation for improved stratification, early detection, and targeted interventions. Full article

Background: In adult patients, rocuronium shows interindividual variability related to weight, sex, and age, but paediatric data are limited. This study aimed to evaluate clinical factors influencing the duration of action of rocuronium in children. Methods: Patients aged between 0 and 18 years undergoing planned general anaesthesia were eligible. The primary objective was to compare the duration of clinical action of rocuronium after a single dose, measured until the return of TOF (Train of Four) 1, across three-group age categories. Secondary objectives explored the relationship between TOF recovery and sex, weight, height, initial body temperature, as well as the occurrence of postoperative complications related to general anaesthesia. Results: Among 96 analysed patients, no clinically relevant association was found between the duration of rocuronium action and the studied clinical factors. TOF 1 occurred at 18.1 ± 9.5 min in those aged 1 to 5 years (n = 26), 16.8 ± 14.5 min in those aged 6 to 10 years (n = 33), and 18.2 ± 13.8 min in those aged 10 to 17 years (n = 37), p = 0.626. A post hoc analysis revealed high variability in recovery times across TOF levels, both in the per-protocol population (e.g., TOF 1: 17.7 ± 12.9 min) and in patients who did not receive sugammadex. Conclusions: In paediatric patients, the duration of rocuronium action after a single dose demonstrated substantial interindividual variability, which was not explained by age, sex, weight, height, or body temperature. Full article

Constructing reusable accident-text corpora is hindered by anonymization, heterogeneous sources, and sparse labels, which complicate cross-document event linking. We propose a spatiotemporal lattice-constrained approach that encodes administrative hierarchies and temporal granularity, defines domain-informed consistency criteria, instantiates spatial/temporal relations via a subset of RCC-8 and Allen’s interval algebra, estimates anchor weights via smoothing with monotonic projection, and fuses signals using a constrained monotonic network with explicit probability calibration. An active-learning decision rule—combining maximum probability with a probability-gap criterion—supports scalable automatic labeling, and controlled augmentation leverages instruction-tuned LLMs under lattice constraints. Experiments show competitive ranking (Hit@1 = 41.51%, Hit@5 = 77.33%) and discrimination (ROC-AUC = 87.34%), with the best F1 (62.46%). The method yields the lowest calibration errors (Brier = 0.14; ECE = 1.97%), maintains performance across sources, and exhibits the smallest F1 fluctuation across thresholds (Δ = 1.7%). In deployment-oriented analyses, it auto-labels 77.7% of cases with 97.51% accuracy among high-confidence outputs while routing 22.3% to review, where the true-positive rate is 81.46%. These findings indicate that integrating structured constraints with calibrated probabilistic fusion enables accurate, auditable, and scalable event linking for accident-corpus construction. Full article

Background: Growth impairment and poor nutritional status are recognized complications of pediatric inflammatory bowel disease (IBD), yet data specific to ulcerative colitis (UC) are limited. This systematic review aims to provide an overview of current knowledge on growth, nutritional status, and body composition in children and adolescents with UC. Methods: A systematic literature search was performed up to August 2025. Studies including patients aged 5–22 years with confirmed UC were reviewed. Results related to growth, nutritional status, and body composition were narratively synthesized to summarize findings. Results: Fifteen studies with 1575 patients with UC met inclusion criteria, comprising 5 prospective, 5 cross-sectional, and 5 retrospective designs. Although the included studies were conducted in broader IBD cohorts, only UC-specific outcomes were reported. The data were limited by sample size, heterogeneity in patient characteristics, outcome definitions, and assessment methods. The majority of patients had prolonged disease with remission or mild activity. Growth failure prevalence ranged from 7% to 36%, with weight deficits being more common than height deficits. Undernutrition affected up to 25% of patients, with variability across studies. Overweight and obesity were also observed, though most studies showed no significant differences between UC patients and controls. Only five very small studies assessed body composition, reporting inconsistent findings regarding reductions in lean body mass. Conclusions: Growth impairment and poor nutritional status can occur in children and adolescents with UC. Larger, standardized, high-quality studies focused specifically on UC are needed to better characterize its impact on growth and nutritional status, including the essential integration of body composition assessment. Full article

Total hip arthroplasty (THA) is a transformative procedure for managing severe hip disorders, yet implant longevity remains a critical challenge, particularly for younger, active patients. Wear-related complications are a leading cause of revision surgery, emphasizing the need for optimized design and material performance. This systematic review aims to synthesize evidence on the wear behavior, material properties, and design parameters of hip implants with a focus on finite element analysis (FEA)-based predictive approaches. A comprehensive literature search was conducted across Scopus, PubMed, ScienceDirect, MDPI, and Cochrane databases following PRISMA guidelines. Studies published between 2010 and 2025 were included if they addressed THA biomechanics, wear analysis, or material optimization using FEA, hip simulators, or radiostereometric techniques. Key findings reveal that larger femoral heads, while reducing contact pressure, increase wear due to greater sliding distance. Gravimetric wear rates ranged from 3.15 ± 0.27 mg/Mc to 2.18 ± 0.31 mg/Mc, while linear and volumetric wear reached 0.0375 mm/Mc and 33.6 mm³/Mc, respectively. Stress analysis showed custom stems exhibited markedly lower von Mises stress (194.9 MPa) compared to standard designs (664.3 MPa), and fatigue assessments confirmed a factor of safety > 1 across profiles. Patient-specific factors, such as body weight, significantly influenced wear with a 26% increase in metal wear observed between 100 kg and 140 kg. This systematic review synthesizes current research on total hip arthroplasty, emphasizing biomechanical and material factors critical for implant longevity and patient care. It uniquely integrates FEA-based wear prediction with clinical implications, bridging computational modeling, geometry optimization, and material performance to provide actionable insights for next-generation, patient-specific hip implant design. Full article