Search Results (4,100)

Background: Perioperative hypotension is a frequent but underrecognized complication during transcatheter aortic valve implantation (TAVI). Although reduced left ventricular ejection fraction (EF) and low baseline blood pressure have been linked to hemodynamic instability, the role of metabolic comorbidities and procedural factors remains less well established. Methods: We retrospectively analyzed 123 patients who underwent transfemoral TAVI between June 2016 and June 2022. Perioperative hypotension was defined as a sustained systolic blood pressure < 90 mmHg or ≥30% reduction from baseline for at least 5 min. Clinical, laboratory, and procedural predictors were assessed using multivariate logistic regression, and model performance was evaluated by ROC curve analysis. Results: Perioperative hypotension occurred in 57% of patients. Independent predictors were diabetes mellitus (OR 2.79, 95% CI 1.03–7.56, p = 0.044), reduced EF (<50%) (OR 2.87, 95% CI 1.13–7.31, p = 0.027), lower baseline diastolic blood pressure (OR 0.935 per mmHg, 95% CI 0.893–0.978, p = 0.004), and longer procedural duration (OR 1.038 per minute, 95% CI 1.001–1.076, p = 0.044). The predictive model demonstrated good calibration and discrimination (AUC 0.844). Patients with hypotension had significantly higher in-hospital mortality (12.9% vs. 1.9%, p = 0.027) and longer ICU stay. An exploratory finding suggested less frequent use of sugammadex among hypotensive patients (11.4% vs. 32.1%, p = 0.005). Conclusions: Perioperative hypotension is common during TAVI and strongly associated with early mortality. Our study uniquely identifies diabetes mellitus as an independent predictor, alongside ventricular dysfunction, baseline blood pressure, and procedural duration. These findings suggest that careful preprocedural risk stratification, hemodynamic vigilance, and optimization of anesthetic management may improve outcomes in vulnerable patients. Full article

Wild carnivores are increasingly recognized as hosts or reservoirs of canine parvovirus (CPV), a major pathogen of dogs. To investigate CPV circulation in Central Europe, we examined 221 red foxes (Vulpes vulpes) and 53 European badgers (Meles meles) from seven Slovakian regions. Small intestines (n = 86), rectal swabs (n = 123), and feces (n = 65) were tested by real-time PCR, and positives were sequenced for the VP2 gene. Virus isolation was performed on MDCK cells. CPV was detected in 10.9% (30/274) of samples, with a prevalence of 10.9% (24/221) in foxes and 11.3% (6/53) in badgers. Phylogenetic analysis revealed co-circulation of CPV-2a, CPV-2b, and CPV-2c, with CPV-2b being prevalent (20/30, 66.7%) and CPV-2c detected in a single sample (1/30, 3.3%). CPV-2a/2b isolates clustered with European strains, while CPV-2c grouped within the “Asian” lineage. Several sequences carried “Asian-like” signatures (5G, 267Y, 324I, 370R), suggesting transboundary introduction and spillover into wildlife. Two infrequent substitutions were identified: S552I in CPV-2b and I447M in CPV-2a. Viable virus was isolated from all positives, with characteristic CPV-cytopathic effects. This study provides the first molecular and virological evidence of CPV in Central European wildlife. Our findings expand our understanding of CPV diversity in Europe, and underscore wildlife as an integral component of European ecology. Full article

Background: Since the introduction of the hepatitis B virus (HBV) vaccination program in Oman in 1990, the HBV prevalence has markedly decreased. However, hepatitis D virus (HDV) infection, which is associated with progressive liver disease in patients with chronic HBV, remains understudied in the Omani population. This study aimed to estimate HDV’s seroprevalence, characterize its virological and clinical features, and identify factors associated with anti-HDV positivity among adult Omani patients with chronic HBV infection. Methods: We conducted a multicenter cross-sectional study in 2024 at two referral hospitals and two polyclinics in Oman. Adult Omani patients with chronic HBV (HBsAg-positive for >6 months) were enrolled. Demographic, clinical, laboratory, imaging, and elastography data were collected. The total anti-HDV antibodies were tested using an ELISA; HDV RNA was tested for anti-HDV-positive or equivocal results. Liver Fibrosis was assessed non-invasively through liver stiffness measurement (LSM) using vibration-controlled transient elastography (VCTE); FibroScan^® and clinical evaluation. Ridge (penalized) logistic regression identified predictors independently associated with anti-HDV positivity. Results: Among 639 patients (59.3% male; mean age of 46.6 ± 8.8 years), 36 patients were anti-HDV-positive, resulting in an HDV seroprevalence of 5.6% (95% CI: Exact 3.98–7.71; Wilson 4.10–7.70). Only one anti-HDV-positive patient had detectable HDV RNA, which became undetectable on follow-up without HDV treatment. The anti-HDV-positive patients were more frequently female and had a higher frequency of prior blood transfusions. In a penalized multivariable analysis, blood transfusions were independently associated with anti-HDV positivity (OR of 19.94), whereas male sex was associated with lower odds of being anti-HDV-positive (OR of 0.15). All the anti-HDV-positive patients had mild fibrosis (F0–F1). Conclusions: Our study demonstrated an anti-HDV prevalence of 5.63% among adult Omani patients with chronic HBV infection, while active viremia appeared to be rare. Blood transfusions were the main identified risk factor. Given the very low HDV viremia, targeted screening of higher-risk groups may be efficient. Full article

Phenol-derived compounds are among the most hazardous organic pollutants for aquatic environments due to their relatively high aqueous solubility. Microalgae harbor metabolic pathways that enable the degradation of phenolic compounds into less toxic derivatives, highlighting their potential for the bioremediation of these contaminants. In this study, four microalgal species were evaluated for their tolerance and biodegradation capacity of a mixture of phenolic compounds which include phenol, p-cresol, and acetophenone. The results revealed that Chlorella sorokiniana and Nannochloropsis gaditana could tolerate higher concentrations of the mixture (60, 50, and 25 mg L⁻¹ of phenol, p-cresol, and acetophenone) than Chlamydomonas reinhardtii and Tetraselmis chuii (60, 30, and 20 mg L⁻¹ of phenol, p-cresol, and acetophenone). Notably, Tetraselmis chuii could biodegrade these compounds with the highest efficiency (32, 45, and 85% of initial phenol, p-cresol, and acetophenone, respectively) after 72 h of cultivation. In the absence of alternative carbon sources in the medium, Tetraselmis chuii also biodegraded 45, 60, and 51% of initial phenol, p-cresol, and acetophenone, at 72 h, highlighting its potential for bioremediation processes. Finally, the ascorbate peroxidase, catalase, and phenol hydrolase enzymatic activities of Tetraselmis chuii were studied in presence of the pollutants, showing increasing activity levels of these enzymes (123, 135, and 173% of control cultures for APX, CAT, and PH, respectively) involved in the antioxidant system and the degradation of phenolic compounds. Full article

This study examines educators’ perceptions of diversity in promotional practices within the Irish context through the lens of Gender Schema Theory (GST). Although women constitute the majority of the teaching workforce, they remain underrepresented at senior leadership levels, highlighting persistent gender disparities. Using survey data from 123 educators, this study investigates how gender shapes perceptions of the role of diversity in promotion processes. Findings indicate that women were more likely than men to perceive diversity across multiple dimensions as essential to fair and effective promotions and to enhancing leadership effectiveness. By contrast, men were more inclined to perceive current practices as already fair and inclusive and preferred to maintain the status quo. Importantly, tokenism was not strongly endorsed by either group, suggesting that diversity initiatives are broadly regarded as legitimate. The results underscore how gendered schemas influence perceptions of merit and fairness and highlight the importance of embedding transparent and inclusive structures in leadership promotion within Irish education. Full article

Background/Objectives: Despite the high complete response (CR) rate to first-line therapy, approximately one-third of patients with advanced-stage Hodgkin lymphoma (HL) eventually relapse. In up to 30–50% of cases, relapses are subclinical, i.e., initially detected only by imaging procedures. However, there is no definitive consensus on the optimal surveillance strategy for high-risk HL patients. Methods: The purpose of this cohort study is to evaluate the long-term outcome of stage II-B/IV HL patients who relapsed under routine imaging surveillance (imaging cohort) compared to those who relapsed under conventional clinical monitoring (standard cohort). Follow-up in the imaging cohort systematically included FDG-PET/CT, ultrasonography, and/or chest X-ray. At relapse, patients were treated with the same approach (salvage therapy and autologous hematopoietic stem cell transplantation [AHSCT]) in both cohorts. Results: A total of 123 high-risk HL patients were assessed at their first relapse: 80 in the imaging cohort and 43 in the standard cohort. The 2-year event-free survival (EFS) was significantly higher in the imaging cohort compared to the standard cohort (70% vs. 37.2%, respectively; p = 0.001). Similarly, the CR rate following salvage treatment was greater in the imaging cohort as compared to the standard cohort (68.8% vs. 41.9%, respectively; p < 0.004). These differences were due to the capability of routine imaging surveillance to detect disease with more limited extension (early onset of clinically silent relapses) as compared to standard clinical monitoring, which was associated with relapsed disease in a more advanced stage. Conclusions: Our findings suggest that routine imaging surveillance in patients with high-risk HL leads to improved EFS detecting relapses, which were characterized by more favorable prognostic factors (low tumor burden), thus enabling the timely administration of salvage therapy. Full article

Background/Objectives: This study aims to report and compare data from the PRO-AOSD (patient-reported outcomes adult-onset Still’s disease) survey in patients with AOSD from the perspective of patients and their treating physicians. Methods: PRO-AOSD comprised blinded patient and physician surveys. The surveys were designed to assess perceived symptoms and physical impairment. Outcomes reported here include patient demographics; physicians’ assessment of the patient’s health state; physician-reported laboratory findings; pain; disease activity; symptoms; physicians’ treatment goals; and the impact of lifestyle factors on disease improvement. Results: Adult patients with AOSD were recruited from 19 centers in Germany. A total of 124 patients were included, with 74 (59.7%) females; the mean age was 45.5 years. The mean time from first symptom to diagnosis was 2 years, and the mean time was 7 years from diagnosis to survey completion (N = 123). Of 107 patients, most (81.3%) had inactive disease defined by CRP levels. At the time of the survey, around two-thirds of patients were receiving biologic therapy, with 84.1% (69/82) reporting an improvement in symptoms. Many patients had previously received antibiotics (47.6% [n = 58] and 30.4% [n = 37], per patient and physician reports, respectively). Persistent symptoms were reported more frequently by patients than by physicians, including back pain (39.5%), fatigue and weakness (38.7%), and joint inflammation (27.4%). Physicians classified 35.5% of patients as symptom-free. Patients reported exercise as having a positive impact on symptoms (52.4%), while stress (74.2%) and sleep deprivation (62.9%) were reported to worsen symptoms. Targeting systemic manifestations, such as the absence of fever (58.1%, n = 72), was considered the most important treatment goal by physicians. Conclusions: Data from PRO-AOSD highlight distinct differences between patients’ and physicians’ interpretations of the same cases of AOSD. Prior Presentation: These data were presented at the German Congress of Rheumatology (DGRh; 30 August–2 September 2023; Leipzig, Germany). Full article

The healthcare needs of refugees and people seeking asylum are often broad and complex, with a higher burden of communicable diseases. There are limited data describing migrants’ experiences of accessing healthcare in Ireland. This cross-sectional study describes the experiences of migrants accessing healthcare services through an Irish Infectious Diseases clinic. Individuals attending the infectious diseases services in our hospital who had migrated to Ireland were included. Data were collected via a questionnaire, focusing on factors that may limit access to care, including communication, accessibility, cost, and stigmatisation. Seventy-six patients participated in this study. N = 20 (26%) of patients reported a commuting time of more than two hours to attend our clinic. N = 11 (15%) had experienced being unable to access healthcare in Ireland due to cost. Trust in healthcare providers was high (88%), and patient-reported satisfaction with communication was high (>90%). Persons living in direct provision services were more likely to report issues around privacy and less likely to have registered with a general practitioner. Accessibility and privacy were among the biggest challenges faced by migrants attending infectious diseases services at our centre, while communication and trust in healthcare providers were identified as areas of strength. Considering the burden of infectious diseases in migrant populations, and the challenges that certain migrant populations face in accessing healthcare, it is important to identify potential barriers to accessing care in order to ensure equitable, effective care. This study seeks to identify and describe the challenges that migrants face when accessing care through an Irish infectious diseases clinic. The results can help inform service provision and allocation of resources at a local level, while also identifying an area for further research regarding the barriers to accessing care faced by migrant communities in Ireland. Full article

Background/Objectives: Preclinical chest computed tomography (CT) imaging in small animals is often limited by low resolution due to scan time and dose constraints, which hinders accurate detection of subtle lesions. Traditional super-resolution (SR) metrics, such as peak signal-to-noise ratio (PSNR) and structural similarity index (SSIM), may not adequately reflect clinical interpretability. We aimed to evaluate whether deep learning-based SR models could enhance image quality and lesion detectability in rat chest CT, balancing quantitative metrics with radiologist assessment. Methods: We retrospectively analyzed 222 chest CT scans acquired from polyhexamethylene guanidine phosphate (PHMG-p) exposure studies in Sprague Dawley rats. Three SR models were implemented and compared: single-image SR (SinSR), segmentation-guided SinSR with lung cropping (SinSR3), and omni-super-resolution (OmniSR). Models were trained on rat CT data and evaluated using PSNR and SSIM. Two board-certified thoracic radiologists independently performed blinded evaluations of lesion margin clarity, nodule detectability, image noise, artifacts, and overall image quality. Results: SinSR1 achieved the highest PSNR (33.64 ± 1.30 dB), while SinSR3 showed the highest SSIM (0.72 ± 0.08). Despite lower PSNR (29.21 ± 1.46 dB), OmniSR received the highest radiologist ratings for lesion margin clarity, nodule detectability, and overall image quality (mean score 4.32 ± 0.41, κ = 0.74). Reader assessments diverged from PSNR and SSIM, highlighting the limited correlation between conventional metrics and clinical interpretability. Conclusions: Deep learning-based SR improved visualization of rat chest CT images, with OmniSR providing the most clinically interpretable results despite modest numerical scores. These findings underscore the need for reader-centered evaluation when applying SR techniques to preclinical imaging. Full article

The Ground Penetrating Radar (GPR) method can image dielectric discontinuities in subsurface structures, which cause the reflection of electromagnetic (EM) waves. These discontinuities are imaged as reflectors in GPR sections, often distorted by diffracted energy. To focus the diffracted energy within the GPR sections, migration is commonly used. The migration velocity of GPR data is a low-wavenumber attribute crucial for effective migration. Obtaining a migration velocity model, typically close to a Root Mean Square (RMS) model, from zero-offset (ZO) data requires analysis of the available diffractions, whose density and (x, t) coverage are random. Thus, the accuracy and efficiency of such a velocity model, whether for migration or interval velocity model estimation, are not guaranteed. An alternative is the multipath summation method, which involves the weighted stacking of constant velocity migrated sections. Each stacked section contributes to the final stack, weighted by a scalar value dependent on the constant velocity value used and its relation to its estimated mean velocity of the section. This method effectively focuses the GPR diffractions in the presence of low heterogeneity. However, when the EM velocity varies dramatically, 2D weights are needed. In this study, with the aid of an Artificial Intelligence (AI) algorithm that detects diffractions and uses their kinematic information, we generate a diffraction velocity model. This model is then used to assign 2D weights for the weighted multipath summation, aiming to focus the scattered energy within the GPR section. We describe this methodology and demonstrate its application in enhancing the lateral continuity of reflections. We compare it with the 1D multipath summation using simulated data and present its application on marble assessment GPR data for imaging cracks and discontinuities in the subsurface structure. Full article

Respiratory syncytial virus (RSV) remains a leading cause of pneumonia in young children in Mexico and worldwide. To investigate RSV dynamics in Mexico, we conducted a multicenter study from August 2021 to July 2023 in six hospitals across five States, analyzing respiratory samples from children under five years with pneumonia. Multiplex RT-PCR identified 203 RSV-positive cases, of which 123 were RSV-B and 80 RSV-A. Interestingly, 77% of the collected samples showed evidence of coinfection with other respiratory pathogens, with rhinovirus, Haemophilus influenzae, and Streptococcus pneumoniae being the most common. Also, RSV-B dominated in 2021–2022, whereas RSV-A prevailed in 2022–2023, mirroring trends observed in the United States. Sequences of the genes encoding G and F proteins showed that RSV-A lineages were more diverse, with A.D.1, A.D.1.8, and A.D.5.2 being frequently detected. In contrast, nearly all RSV-B sequences belonged to lineage B.D.E.1. Finally, ancestral state inference suggests repeated introductions from the USA and other North American countries, with limited evidence of sustained local circulation. These findings show different trends in RSV circulation between two consecutive seasons and the importance of genomic surveillance to monitor RSV diversity, evaluate vaccine impact, and inform public health strategies in Mexico’s evolving post-pandemic respiratory virus landscape. Full article

Background: Cisplatin (CP), a platinum-based chemotherapeutic agent, is widely used to treat cancer but causes nephrotoxicity. Riociguat, a soluble guanylate cyclase (sGC) stimulator that enhances the nitric oxide–sGC–cGMP signaling pathway, was investigated for its potential protective effects against cisplatin-induced nephrotoxicity. Materials and Methods: Rats were randomly divided into four equal groups (six rats each) and treated for nine consecutive days. The first and second groups were given oral carboxymethylcellulose 0.5% (vehicle) for 9 days, and on day 6 were injected intraperitoneally with saline or CP, respectively. The third and fourth groups were treated orally with two doses of riociguat (3 and 10 mg/kg/day) for 9 days, and received intraperitoneal injections of CP on day 6. Blood, urine, and kidney tissues were analyzed 24 h after the last treatment. Results: CP significantly elevated the markers of kidney function, including uric acid, serum creatinine, and urea. CP also caused histological kidney damage. Antioxidant markers, including catalase (CAT), glutathione reductase (GR), superoxide dismutase (SOD), and total antioxidant capacity (TAC) were significantly reduced, while inflammatory cytokines (IL-1β, IL-6, and TNF-α) and lipid peroxidation (MDA) were markedly increased. Riociguat improved kidney structure and significantly reduced kidney function markers, MDA, and inflammatory cytokines while restoring GR, TAC, SOD, and CAT activities. Conclusions: These results indicate that riociguat exerts protection of the kidneys from CP-caused kidney damage by antioxidation and anti-inflammation. Riociguat may have potential as an adjunct therapy to mitigate CP-associated nephrotoxicity. Full article

This initial exploratory study examined the perceptions of teachers and school leaders in the Republic of Ireland regarding diversity in promotions to school principalship, framed by Equity Theory, Organisational Justice Theory, and Legitimacy Theory. A mixed-methods approach was utilised within this study. Data was collected from 123 participants via an online survey comprising Likert-type statements and open-ended questions. This data was analysed using descriptive statistics and quantitative analysis for the Likert-type statements and thematic analysis was used to examine the qualitative responses, allowing for the identification of recurring patterns and themes to complement the quantitative findings. Findings indicated disparities between perceived and desired prioritisation of diversity, alongside varied perceptions of its impact on school performance and leadership. Disability, social class, and religious diversity were perceived as the least prioritised in promotion practices, while gender and cultural diversity received greater support and were more frequently linked to positive leadership outcomes. Participants reported mixed perceptions across diversity dimensions, with gender, age, and cultural diversity associated with the most positive impacts. Concerns about tokenism and the perceived undermining of merit-based promotion were widespread, reflecting the importance of fairness, transparency, and alignment with stakeholder expectations. The study underscored the need for promotion processes that are both equitable and credible, and for organisational cultures that enable diverse leaders to thrive. These findings provided a foundation for further research and policy development to foster inclusive and representative school leadership in Ireland. Full article

Tourist loyalty is vital for destination success, fostering repeat visits and positive word-of-mouth. This study explores the psychological and safety-related factors driving tourist loyalty to natural attractions in Oman, a rising destination known for its stability and safety. Using Social Cognitive Theory as a foundation, the research incorporates perceived risk and novelty seeking as key moderating variables. Data were collected via an online survey of 165 international tourists and analyzed through Partial Least Squares Structural Equation Modeling (PLS-SEM). Findings show that attachment, satisfaction, and novelty seeking significantly affect both attitudinal and behavioral loyalty. While perceived value strongly influences behavioral loyalty, its impact on attitudinal loyalty appears more complex, suggesting possible unobserved mediators. Additionally, risk perception and novelty seeking moderate the link between destination familiarity and loyalty, underscoring the role of tourists’ internal evaluations of safety and desire for new experiences. This study advances the limited literature on tourist loyalty in developing countries by integrating psychological and risk-related dimensions. It offers actionable insights for tourism planners and marketers in Oman: emphasizing the country’s safety reputation, improving satisfaction levels, and crafting experiences that blend familiarity with novelty can enhance tourist loyalty and ensure sustained competitiveness in the global tourism market. Full article

Functional bowel disorders (FBDs) are chronic gastrointestinal conditions characterized by recurrent symptoms associated with gut microbiota dysbiosis. Although accumulating evidence suggests that probiotics can improve symptoms in patients with FBD, the underlying mechanisms remain to be fully elucidated. In this randomized, double-blind, placebo-controlled clinical trial, 38 adults meeting the Rome IV diagnostic criteria of functional constipation (FC) and functional diarrhea (FD) received either a multi-strain probiotic complex or placebo for 8 weeks. Clinical outcomes were evaluated using the Irritable Bowel Syndrome Severity Scoring System (IBS-SSS), bowel habits questionnaire, and IBS Quality of Life (IBS-QoL) instrument. Fecal samples were collected at baseline and at week 8 for gut microbiota profiling via 16S rRNA gene sequencing and metabolomic analysis using gas chromatography–mass spectrometry. Probiotic supplementation significantly reduced the severity of abdominal bloating and its interference with quality of life, and improved the body image domain of the IBS-QoL. Beta diversity analysis showed significant temporal shifts in the probiotic group, while 16S rRNA sequencing revealed an increased relative abundance of Faecalibacterium prausnitzii and Blautia stercoris. Fecal metabolomic analysis further indicated elevated levels of metabolites implicated in the gut–brain axis. Multi-strain probiotic supplementation alleviated gastrointestinal symptoms and improved aspects of psychosocial well-being in adults with FBDs, potentially through modulation of the human gut microbiome. Full article