Search Results (436)

Background/Objectives: Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) using a fully covered self-expandable metal stent (FCSEMS) is an alternative to endoscopic retrograde cholangiopancreatography for biliary drainage; however, FCSEMSs may cause intrahepatic bile duct (IHD) obstruction and cholangitis. In this study, we developed an FCSEMS with multiple self-made side holes at its tip and evaluated its safety and efficacy. Methods: This retrospective study included 100 patients who underwent EUS-HGS with FCSEMS placement between April 2022 and October 2023. Fifty patients received a conventional FCSEMS, and 50 received an FCSEMS with multiple self-made side holes. Technical and clinical success, residual contrast in the IHD, recurrent biliary obstruction (RBO), and adverse events (AEs) were then evaluated. The clinical success rates were 98% and 90% for the side hole and conventional FCEMS groups, respectively. The amount of residual contrast in the IHD was lower in the side hole group (0% vs. 12%, p = 0.027). RBO incidence was significantly lower in the side hole group (8% vs. 30%, p < 0.001), with migration as the primary cause in the conventional group. Early AEs, including segmental cholangitis, occurred only in the conventional group. During reintervention, all stents were safely removed. Conclusions: The FCSEMSs with multiple side holes reduced IHD occlusion and cholangitis, improving biliary drainage and safety. Further studies are needed to confirm these findings. Full article

Coinfection with parasites and viruses can exacerbate disease transmission, outcomes and therapy. This study searched the Web of Science, PubMed, Scopus and JSTOR databases for publications on the prevalence of parasitic coinfection in people living with viruses from 1 January 2005 to 30 April 2022, and 356 studies were included and systematically reviewed. A meta-analysis was performed to assess the global prevalence of and factors potentially associated with parasitic infection (helminths and protozoa) in virus-infected people, and the infection burden was estimated. A variety of parasites (29 families, 39 genera, and 63 species) and viruses (8 kinds) were identified. The prevalence of parasitic coinfection in (all) virus-infected people was estimated to be 21.34% (95% CI 17.58–25.10, 5593 of 29,190 participants) and 34.13% (95% CI 31.32–36.94, 21,243/76,072 participants) for helminths and protozoa, respectively. Specially, in human immunodeficiency virus (HIV)-infected people, the global prevalence was 19.96% (95% CI 16.18–23.74) for helminths and 34.18% (95% CI 31.33–37.03) for protozoa, respectively. The global prevalence of protozoa was 41.79% (95% CI 15.88–67.69) in hepatitis B virus (HBV)-infected people and 17.75% (95% CI 3.54–31.95) in DENV-infected people, respectively. The global burden of parasitic infections in HIV-infected people was 7,664,640 for helminths and 13,125,120 for protozoa, respectively, and that in HBV- and dengue virus (DENV)-infected people was 137,019,428 and 629,952, respectively. The prevalence of parasitic coinfection at the family, genus, and species levels in virus- or HIV-infected people were comprehensively estimated and further analyzed by subgroups. Among the most commonly identified parasites, the five helminth genera with the highest prevalence in HIV-infected people were Schistosoma (12.46%, 95% CI 5.82–19.10), Ascaris (7.82%, 95% CI 6.15–9.49), Strongyloides (5.43%, 95% CI 4.11–6.74), Trichuris (4·82%, 95% CI 2.48–7.17) and Ancylostoma (2.79%, 95% CI 1.32–4.27), whereas the top five protozoan genera were Toxoplasma (48.85%, 95% CI 42.01–55.69), Plasmodium (34.96%, 95% CI 28.11–41.82), Cryptosporidium (14.27%, 95% CI 11.49–17.06), Entamoeba (12.33%, 95% CI 10.09–14.57) and Blastocystis (10.61%, 95% CI 6.26–14.97). The prevalence of parasitic coinfection in virus-infected people was associated with income level. The findings provide valuable global epidemiological information for informing normative guidance, improving surveillance, and developing public healthcare strategies. Full article

Background: Pancreatic ductal adenocarcinoma (PDAC) presents a challenge due to its poor prognosis. Irreversible electroporation (IRE) shows promise in improving margin clearance and increasing R0 and R1 indirect resection rates. Although IRE is believed to preserve surrounding tissues, this study aimed to assess postoperative refractory diarrhea as a severe complication and challenge the assumption of consistent tissue preservation. Methods: Patients undergoing pancreaticoduodenectomy (PD) with IRE for superior mesenteric artery (SMA) margin accentuation between May 2022 and April 2024 were included. Primary endpoints were diarrhea-related morbidity and mortality; secondary endpoints included R-status, recurrence, and metastases. IRE electrodes were initially positioned circumferentially around the SMA, but this approach was modified to hemi-circumferential placement and applied in six additional patients. Results: All five patients (median age 70, 80% female) in the initial cohort developed secretory diarrhea lasting a median of 6 months (IQR 5–6.5), with a median frequency of 5 stools/day (IQR 5–6.5). Two patients (40%) died due to diarrhea-associated cachexia. In contrast, among the six patients treated with the modified technique, patients’ diarrhea resolved within a median of 8 days (IQR 6–10) without need for opioid or advanced antidiarrheal therapy. Conclusions: Circumferential IRE for SMA margin accentuation may damage the superior mesenteric plexus and induce severe, prolonged diarrhea. Hemi-circumferential application may mitigate this risk. Larger studies are required to validate these findings and optimize the use of IRE in PD. Full article

Ozone (O₃) is a major air pollutant with significant health effects, including increased respiratory and cardiovascular mortality. While previous research has largely focused on urban areas, this study assesses the association between maximum 8 h O₃ concentrations and non-accidental mortality, including cardiovascular and respiratory mortality, in suburban and rural areas of Spain. We conducted a nationwide time-series analysis across 122 municipalities between April and September 2017 using Poisson regression models and adjusting for daily maximum temperature and provincial variability. Distributed lag models were applied to estimate the cumulative effects of ozone exposure on mortality, considering lags from 1 to 30 days. For each 10 µg/m³ increase in 8 h maximum O₃ concentration, a significant increase in all-cause mortality risk of 2.3% was observed, with a peak at lag 2. Cardiovascular mortality increased by 2.4%, also peaking at lag 2, while respiratory mortality showed the strongest association, with a 4.3% rise at lag 1. A secondary mortality risk increase was observed at lags 24–28, suggesting the potential delayed effects of O₃ exposure. These findings showed higher risk than those previously reported for urban populations and highlight the need for targeted public health interventions to mitigate the impact of ozone pollution in non-urban populations. Full article

Very rarely, the atmosphere produces a natural experiment that, if captured, has the potential to lend insight into the fundamentals of atmospheric behavior. During the North American solar eclipse on 8 April 2024, a prescribed fire on the grounds of Fort Benning produced a smoky haze in Columbus, Georgia, USA. This haze covered the Columbus State University main campus and the nearby Columbus Airport (KCSG) leading up to and during the peak of the eclipse. Automated Surface Observing Station (ASOS) and Georgia Weather Network observations were examined for the event. At the time of temperature minimum, the temperature depression at KCSG was 0.5 °C greater than at nearby ASOS stations. An “eclipse wind” was observed at KCSG but not at the nearby ASOS stations. Based on observations of steady-state air and dewpoint temperatures, together with rapid fluctuations in visibility, we propose the Subcritical Aerosol-Moisture Feedback (SAMF) mechanism, in which subtle feedbacks among particle growth, relative humidity, and scattering of radiation by aerosol-laden air may maintain steady-state thermodynamic conditions. This case study offers a unique opportunity to examine aerosol behavior under transient radiative forcing, suggesting insights into how a smoky environment enhances thermal buffering and stabilizes the boundary-layer response under rare conditions. Full article

The field of esports has been studied from different multidisciplinary perspectives, making it an emerging field with plenty of room for progress. However, it still has underdeveloped areas, such as university esports. The purpose of this study was to analyze student gamers enrolled on higher education courses in Portugal and identify their sociodemographic profile and gaming habits, as well as to assess their interest in university esports. Methodologically, we followed a quantitative–descriptive approach; data were collected between April and June 2024 using an online questionnaire and then analyzed using descriptive and inferential statistical techniques. The sample consisted of 1073 student gamers with regular gaming habits enrolled at 30 public institutions in 2023/2024. Our results show a high level of interest in university esports (n = 579, 54.0%), and the greater the involvement in gaming, the greater the interest. The male gender continues to prevail in this context (n = 770, 71.8%), and the majority play daily (n = 515, 48.0%), between 6 and 10 h a week (n = 322, 30.0%), although there are differences in the various indicators between genders. We identified the most played videogame categories (n = 8) and those that they intend to play (n = 15) in university esports. In conclusion, university esports offer a wide range of options and are played in a context favorable to gaming interest (young adult students), with enormous growth and expression within the esports phenomenon. Full article

Background: Investment decisions in stocks are one of the most complex tasks due to the uncertainty of which stocks will increase or decrease in their values. A diversified portfolio statistically reduces the risk; however, stock choice still substantially influences the profitability. Methods: This work proposes a methodology to automate investment decision recommendations with clear explanations. It utilizes generative AI, guided by prompt engineering, to interpret price predictions derived from neural networks. The methodology also includes the Artificial Intelligence Trust, Risk, and Security Management (AI TRiSM) model to provide robust security recommendations for the system. The proposed system provides long-term investment recommendations based on the financial fundamentals of companies, such as the price-to-earnings ratio (PER) and the net margin of profits over the total revenue. The proposed explainable artificial intelligence (XAI) system uses DeepSeek for describing recommendations and suggested companies, as well as several charts based on Shapley additive explanation (SHAP) values and local-interpretable model-agnostic explanations (LIMEs) for showing feature importance. Results: In the experiments, we compared the profitability of the proposed portfolios, ranging from 8 to 28 stock values, with the maximum expected price increases for 4 years in the NASDAQ-100 and S&P-500, where both bull and bear markets were, respectively, considered before and after the custom duties increases in international trade by the USA in April 2025. The proposed system achieved an average profitability of 56.62% while considering 120 different portfolio recommendations. Conclusions: A t-Student test confirmed that the difference in profitability compared to the index was statistically significant. A user study revealed that the participants agreed that the portfolio explanations were useful for trusting the system, with an average score of 6.14 in a 7-point Likert scale. Full article

The use of a conceptual model of reference and modelling of relevant processes is mandatory to correctly interpret chemical and isotopic data. Adopting these basic guidelines, we have interpretated the unprecedented increase in the H₂S_(g) concentration and the concurrent unexpected decrease in the δ³⁴S value of H₂S_(g) recorded since 2018 in the fumarolic effluents of the Bocca Grande fumarolic vent at Solfatara, Campi Flegrei caldera, in the framework of our conceptual model of the Solfatara magmatic–hydrothermal system. Assuming that the magma chamber situated at depths ≥ 8 km was filled at the end of the 1982–1984 bradyseismic crisis and no refilling episodes took place afterwards, as suggested by gas geochemistry, the concentration and the δ³⁴S value of H₂S_(g) of the Bocca Grande fumarolic effluents are controlled by closed-system degassing of the melt at depths ≥ 8 km and disproportionation of SO₂ in the deep hydrothermal reservoir (6.5–7.5 km depth) hosted in carbonate rocks where H₂S equilibrates. These processes have been active during the last 40 years, but 41.1% (±6.4%) of the sulfur initially stored in the melt (2200 mg/kg) was lost in the 4-year period of April 2018–April 2022. This marked loss of S from the melt in 2018–2022 might be due to the high solubility of sulfur in the melt, which caused its preferential separation during the late degassing stages. These findings are of utmost importance for the surveillance of the Solfatara magmatic–hydrothermal system during the ongoing bradyseismic crisis. Full article

Background: There is a lack of automatic real-time monitoring of airborne pollens in China and no validation study has been performed. Methods: Two-year continuous automatic real-time pollen monitoring (n = 437) was completed in 2023 (3 April–31 December) and 2024 (1 April–30 November) in Shanghai, China, in parallel with the standard daily pollen sampling(n = 437) using a volumetric Hirst sampler (Hirst-type trap, according to the European standard). Daily ambient particulate matter and meteorological factors were collected simultaneously. Results: Across 2023 and 2024, the daily mean pollen concentration was 7 ± 9 (mean ± standard deviation (SD)) grains/m³ by automatic monitoring and 8 ± 10 grains/m³ by the standard Hirst-type method, respectively. The spring season had higher daily pollen levels by both methods (11 ± 14 grains/m³ and 12 ± 15 grains/m³) and the daily maximum reached 106 grains/m³ and 100 grains/m³, respectively. A strong correlation was observed between the two methods by either Pearson (coefficient 0.87, p < 0.001) or Spearman’s rank correlation (coefficient 0.70, p < 0.001). Compared to the standard method, both simple (R² = 0.76) and multiple linear regression models (R₂ = 0.76) showed a relatively high goodness of fit, which remained robust using a 5-fold cross-validation approach. The multiple regression mode adjusted for five additional covariates: daily mean temperature, relative humidity, wind speed, precipitation, and PM₁₀. In the subset of samples with daily pollen concentration ≥ 10 grains/m³ (n = 98) and in the spring season (n = 145), the simple linear models remained robust and performed even better (R² = 0.71 and 0.83). Conclusions: This is the first validation study on automatic real-time pollen monitoring by volumetric concentrations in China against the international standard manual method. A reliable and feasible simple linear regression model was determined to be adequate, and days with higher pollen levels (≥10 grains/m³) and in the spring season showed better fitness. More validation studies are needed in places with different ecological and climate characteristics to promote the volumetric real-time monitoring of pollens in China. Full article

Assessing bloodmeal sources and sporozoite infection rates in mosquito vectors is essential for understanding their role in malaria transmission. This study investigated these factors in Hawassa, Southern Ethiopia—an area recently invaded by Anopheles stephensi—through adult mosquito collections conducted between January and April 2023 using BG-Pro traps, CDC Light Traps, and Prokopack Aspirators. A total of 738 female Anopheles mosquitoes were collected, including An. arabiensis (72.9%), An. pharoensis (13.4%), An. stephensi (7.5%), and An. coustani (6.2%). Human Blood Index (HBI) values were 23.3% for An. arabiensis, 43.8% for An. pharoensis, 8.3% for An. stephensi, and 25.0% for An. coustani. Plasmodium infection was detected in 8% of An. arabiensis and 4.7% of An. pharoensis, while An. stephensi and An. coustani were uninfected. The findings highlight the presence of multiple competent malaria vectors, with significant infection rates observed in both primary and secondary species, underscoring the need to include secondary vectors in control and surveillance programs. The detection of An. stephensi alongside native vectors adds complexity to malaria control efforts, reinforcing the importance of continuous monitoring to understand the changing dynamics of vector populations and their roles in transmission. Full article

Background/Objectives: Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by recurrent rashes and itching, which seriously affects the quality of life of patients and brings a heavy economic burden to society. The treat-to-target (T2T) strategy was proposed to guide optimal use of systemic therapies in patients with moderate to severe AD, and patients’ adherence is emphasized along with combined evaluation from both health providers and patients. While effective treatments for AD are available, non-adherence of treatment is common in clinical practice due to the patients’ unawareness of self-evaluation and lack of concern about the specific follow-up time points in clinics, which leads to the treatment failure and repeated relapse of AD. Methods: This project consists of three parts. First, an artificial intelligence (AI) model for diagnosis and severity grading of AD based on deep learning will be trained. Second, an AI assistant decision-making system (AIADMS) in the form of an app will be developed. Third, we design a prospective, randomized controlled trial to test the hypothesis that the AIADMS with implementation of the T2T could help control the disease progression and improve the clinical outcomes. Results: A total of 232 participants diagnosed with moderate to severe AD will be included and allocated into the app group or the control group. In the app group, participants will be assisted in using the app during the process of management and follow-up at the scheduled time points, including 2 weeks, 4 weeks, 8 weeks, 12 weeks, 6 months, and 12 months after treatment. In the control group, the diagnosis, treatment, and follow-up of participants will be carried out according to the current routine on a face-to-face basis. The primary outcome is the overall efficiency rate of treating objectives including PP-NRS, EASI, SCORAD, POEM, and DLQI at 12 weeks after treatment, which is calculated as the “Total number of participants with effective treatment of 5 treating objectives/total number of participants *100%”. Spss20.0 software will be used to analyze the data according to the principle of intent to treat. Trial Registration: The protocol was registered at the National Institutes of Health Clinical Trials Registry with the trial registration number NCT06362629 on 11 April 2024. Conclusions: This study aims to improve AD management by integrating advanced technology, patient engagement, and clinician oversight through AIADMS app to achieve treat-to-target (T2T) goals for effective and safe long-term control. Full article

Objectives: Atrial fibrillation (AF) is the most common sustained arrhythmia associated with stroke, heart failure, and increased mortality. Due to its efficacy and safety, cryoballoon ablation (CBA) is widely accepted for rhythm control; however, long-term AF recurrence remains a challenge. Continuous monitoring with implantable loop recorders (ILRs) enhanced by artificial intelligence (AI) can detect both symptomatic and asymptomatic episodes, potentially optimizing patient management. This analysis assessed the long-term effectiveness of CBA in maintaining sinus rhythm and investigated the role of ILR-guided monitoring in enhancing therapeutic decisions. Methods: Data from 91 patients with paroxysmal or persistent atrial fibrillation (AF) who underwent pulmonary vein isolation using cryoballoon ablation at four Italian centers between April 2022 and April 2024 were analyzed. All patients received an insertable loop recorder (ILR) before or during hospitalization for ablation, allowing for the continuous remote monitoring of arrhythmias. Baseline demographics, procedural details, AF occurrence, AF burden (calculated as the total duration of all AF episodes occurring within a day and categorized by episode duration), therapeutic adjustments, and the effect of artificial intelligence (AI) on data processing were evaluated. Results: The cohort’s average age was 62.4 years, with 24.2% of participants being female. Physician-confirmed AF recurrence was noted in 26.7% of patients at 12 months and 49.5% at 24 months. The device data indicated a daily AF burden of ≥6 min in 47.2% at 12 months, with 25.9% surpassing 1 h. AI algorithms decreased false-positive alerts by 21%, resulting in an estimated saving of 19 clinician hours. In patients with pre-ablation ILR data, the median AF burden significantly decreased from 7% to 0.2% (p = 0.017). ILR-guided monitoring affected treatment adjustments, leading to the discontinuation of antiarrhythmic therapy in 36 patients and redo ablations in 8. Conclusions: Continuous ILR monitoring, combined with AI-driven analysis, enables the detection of AF recurrences and burden, thereby facilitating timely therapeutic adjustments. Full article

Introduction: Flexible bronchoscopy and its new methods have revolutionized the era of the diagnosis, staging, and restaging of lung cancer. A rare late complication is post-bronchoscopy respiratory infection, but it is critical due to treatment delays, treatment cancellation, and death. The aim of this study is to identify risk factors for respiratory tract infection after bronchoscopy in patients with lung cancer. Methods: A retrospective single-center observational study of 182 hospitalized patients was conducted at U.G.H. “ATTIKON” who underwent bronchoscopy for diagnosis/staging/restaging of lung cancer from January 2022 to April 2023. Patients were divided into two groups based on whether or not they developed post-bronchoscopy respiratory infection. Results: Analyzing the data between the groups, several potential risk factors for infection were identified, including recent hospitalization for COVID-19 within the last month (OR: 6.16; p = 0.01), history of COPD (OR: 8; p = 0.03), presence of emphysema on CT scan (OR: 8; p = 0.03), endobronchial lesions causing ≥ 50% bronchial obstruction with inability to advance the bronchoscope (OR: 9.6; p < 0.01), increased white blood cell count (≥8.5 K/μL) before bronchoscopy (OR: 8; p = 0.03), and advanced stage IV non-small-cell lung cancer (OR: 9.67; p = 0.02). Conclusions: Comparing our results with previous studies on risk factors for respiratory infections after bronchoscopy, we found that recent hospitalization for SARS-CoV-2 infection was a unique finding in our study. With the increasing incidence of lung cancer worldwide and the critical role of bronchoscopy in diagnosis/staging/restaging, large multicenter studies are needed to identify these risk factors and develop strategies for early detection, treatment, and prevention. Full article

Background/Objectives: Celecoxib, a COX-2 selective nonsteroidal anti-inflammatory drug (NSAID), is widely prescribed for pain management due to its efficacy and improved gastrointestinal safety profile compared to traditional NSAIDs. Understanding prescription trends and their comparison to other NSAIDs provides valuable insight into prescribing behaviors in clinical settings. Methods: This retrospective study analyzed celecoxib prescriptions written by three pain management physicians in a single institution over a 16-month period from 1 January 2023 to 30 April 2024. Prescription data were collected and grouped into four 4-month intervals to assess temporal trends. Additionally, we compared celecoxib prescriptions to other commonly prescribed NSAIDs, including ibuprofen, meloxicam, naproxen, and diclofenac. Results: A total of 143 celecoxib prescriptions were identified during the study period, with a steady increase observed across consecutive intervals: 8 prescriptions from January–April 2023, 22 from May–August 2023, 46 from September–December 2023, and 67 from January–April 2024. In comparison, a total of 165 prescriptions were written for other NSAIDs over the same period, with 26 prescriptions from January–April 2023, 41 from May–August 2023, 45 from September–December 2023, and 53 from January–April 2024. While prescriptions for both celecoxib and other NSAIDs increased over time, the rate of celecoxib prescriptions showed a steeper rise. Conclusions: The findings demonstrate a notable increase in celecoxib prescriptions in this pain management clinic, outpacing the growth of other NSAIDs. This trend may reflect increasing provider preference for COX-2 selective inhibitors due to their favorable safety profile and efficacy. Further research is warranted to explore the underlying factors driving these prescribing patterns. Full article

Background: The cost and uptake of cancer medications dispensed as take-home treatments are not well understood. Therefore, in this study, we describe trends and the impact of SARS-CoV-2 on the utilization and cost of take-home cancer medications dispensed through the public payer system in Ontario, Canada. Methods: We conducted a repeated cross-sectional time-series analysis examining monthly and fiscal-year trends in the utilization and cost of take-home cancer medications reimbursed by the public payer between 1 April 2017 and 31 March 2021, in Ontario, Canada. Our primary outcome was per-beneficiary spending. Total public payer spending and the number of unique beneficiaries who were dispensed take-home cancer medications were reported as secondary outcomes. All outcomes were reported overall and stratified by drug class. We used autoregressive integrated moving average (ARIMA) models to assess the impact of the SARS-CoV-2 pandemic on the aforementioned trends. Results: Annual per-beneficiary spending on take-home cancer medications increased by 32.8% (from CAD 4422 in 2017/18 to CAD 6579 in 2020/21) over the study period. The rise in per-beneficiary spending was driven by the cost of medications within the small-molecule targeted therapy and immunotherapy drug classes, which accounted for three-quarters of total public payer spending on take-home cancer medications in 2020/21 despite being dispensed to less than 8% of beneficiaries. Upon the declaration of emergency for SARS-CoV-2, a short-term decline in per-beneficiary spending (CAD −179 per month; p-value < 0.01) was observed between March and June 2020. This temporary decline was driven by an increase in the number of beneficiaries (5582 per month; p-value < 0.01) receiving low-cost take-home cancer medications within the cytotoxic chemotherapy and hormonal therapy drug class without a corresponding rise in public payer spending. Conclusion: Future research should investigate barriers to the widespread uptake of take-home cancer medications during periods of public emergencies, particularly for high-cost drugs. Full article