Search Results (306)

Losing a sibling to a drug-related death can lead not only to profound grief but also to unexpected psychological growth. This mixed-method study examined such growth among siblings bereaved by a drug-related death in Norway, combining survey data from 78 participants with interviews from ten siblings. Quantitative findings showed that appreciation of life and personal strengths were the most prominent domains of growth. Regression analysis indicated that self-efficacy explained most of the variance in growth when controlling for time since death, whereas social support did not make a unique contribution. Qualitative findings added depth by revealing how growth was experienced through closer family relationships and a heightened sense of empathy toward people in vulnerable situations. These accounts suggest that growth may involve a reorientation of values and deeper relational ties, aspects that standardized measures may not fully capture. Although based on a small and relatively homogeneous sample, the integrated results point to the importance of internal coping resources and family connectedness in fostering growth after a stigmatized loss. Further research should explore these mechanisms in more diverse populations and examine how they evolve over time. Full article

Background: Neonatal and infant aortic arch reconstruction remains a high-risk cardiovascular procedure requiring effective cerebral and myocardial protection. Variability in perfusion strategies may influence early hemodynamic stability and postoperative recovery. This study aimed to evaluate the early and short-term cardiovascular outcomes of a standardized beating-heart aortic arch reconstruction strategy incorporating simultaneous antegrade selective cerebral and continuous coronary perfusion. Methods: In this retrospective single-center cohort study, 31 consecutive neonates and infants undergoing aortic arch reconstruction between November 2022 and December 2025 were analyzed. A standardized surgical protocol was applied, consisting of extensive ductal tissue resection, interdigitating posterior end-to-end anastomosis, anterior autologous pericardial patch augmentation, and moderate hypothermic antegrade selective cerebral perfusion combined with continuous coronary perfusion via innominate artery cannulation. Early postoperative outcomes and short-term echocardiographic follow-up results were assessed. Results: The cohort included 31 patients, 22.6% of whom had complex associated cardiac anomalies requiring concomitant procedures. Median cardiopulmonary bypass and aortic cross-clamp times were 119 and 64 min, respectively. There was no in-hospital mortality. Major complications were infrequent, and median intensive care unit stay was 5 days. During a median follow-up of 6.8 months, one patient (3.2%) developed recoarctation requiring reintervention. No late mortality was observed. Conclusions: A fully standardized beating-heart aortic arch reconstruction strategy incorporating simultaneous cerebral and coronary perfusion demonstrated favorable early cardiovascular and short-term outcomes, even in anatomically complex cases. Preservation of continuous coronary perfusion may be associated with improved myocardial stability and early postoperative recovery; however, these findings should be interpreted as observational and hypothesis-generating given the absence of a control group. Larger multicenter studies with longer follow-up are warranted to confirm these findings. Full article

Background: Immune checkpoint inhibitors (ICIs) have become a cornerstone in the treatment of advanced non-small cell lung cancer (NSCLC), yet substantial heterogeneity in clinical outcomes persists. Easily accessible biomarkers that can reliably stratify prognosis in real-world practice are still lacking. The Lung Immune Prognostic Index (LIPI), integrating lactate dehydrogenase (LDH) and the derived neutrophil-to-lymphocyte ratio (dNLR), has emerged as a promising candidate, yet its clinical relevance remains incompletely defined. Methods: We conducted a multicenter retrospective analysis of 211 patients with metastatic NSCLC treated with second-line nivolumab between 2017 and 2025. Patients were categorized into three groups (good, intermediate, and poor) according to their LIPI score, and the relationships between LIPI and objective response, disease control, progression-free survival (PFS), and overall survival (OS) were analyzed. Results: LIPI stratification effectively discriminated patients into prognostically distinct groups. Objective response rates were comparable across LIPI categories and did not differ significantly. In contrast, disease control declined progressively with worsening LIPI scores, reaching statistical significance (p < 0.001). Overall survival was significantly worse in patients with poor LIPI, demonstrating a clear stepwise reduction from good to poor LIPI groups (p = 0.007). Although progression-free survival showed a consistent numerical decrease across LIPI categories, this trend did not achieve statistical significance. Conclusions: In patients with metastatic NSCLC receiving second-line nivolumab in a real-world setting, LIPI reliably stratified overall survival and disease control outcomes, despite limited association with early response or progression-free survival. Its simplicity and reliance on routinely available laboratory parameters support its use as a clinically meaningful prognostic tool in everyday practice. Full article

Lorentz invariance violation (LIV) can alter the group velocity of photons by modifying their dispersion relation, manifesting as differences in the arrival times of photons with different energies. This effect can accumulate over long propagation distances, making gamma-ray bursts (GRBs) a key tool for probing Lorentz invariance violation. By analyzing spectral lag data from 360 measurements across 90 GRBs using Markov Chain Monte Carlo (MCMC) sampling, and under the assumption that all GRBs share a common intrinsic time delay function, we report a maximum a posteriori value of the energy scale of quantum gravity at linear order $E_{QG}=8.96\times {10}^{14}$ GeV, though the data are also compatible with Lorentz invariance ($E_{\mathrm{QG}}=\infty$) to within $2.8\sigma$. Furthermore, we are $95\%$ confident that $E_{QG}\ge 6.67\times {10}^{14}$ GeV. Full article

This study investigates how bio-inspired versus sustainability-focused framing influences lay evaluations of a specific bio-inspired building-technology scenario, testing the empirical validity of the so-called “biomimetic promise”. Employing a between-subjects experimental design ($N=582$), we examined assessments of a weather-responsive self-shading façade across bio-inspired, sustainable, and neutral framing conditions. We developed and validated the 12-item Perceived Bio-Inspiration Scale (PBS)—a novel standardized psychometric instrument designed to quantify lay recognition of biomimetic features across visual, intentional, and naturalistic dimensions. While results showed robust direct framing effects, we identified a significant negative spillover: emphasizing biological inspiration significantly reduced the technology’s perceived sustainability, while sustainability framing diminished its perceived bio-inspiration. These findings demonstrate, in this façade context, that laypersons evaluate bio-inspiration and sustainability as cognitively distinct and potentially competing constructs, indicating that “natural-is-better” bias is not universal across all technology domains. Consequently, merely invoking biological origins is insufficient to enhance a technology’s ecological appeal. To foster public trust, science communication should shift from abstract biological metaphors toward a performance-driven communication strategy that prioritizes the disclosure of verifiable life-cycle assessment and specific operational advantages over symbolic nature-based analogies. Full article

Background: Vandetanib and cabozantinib are the approved first-line antiangiogenic multikinase inhibitors (aaMKIs) for metastatic medullary thyroid carcinoma (MTC); however, real-world data on their comparative efficacy, optimal sequencing, and outcomes beyond the first-line setting remain limited. We report multicenter real-world outcomes from a large Turkish cohort. Methods: In this retrospective multicenter cohort study, we analyzed data from 24 oncology referral centers across Türkiye. Patients with histologically confirmed metastatic MTC who received systemic therapy between December 2011 and December 2024 were included. The primary endpoint was progression-free survival (PFS), assessed separately for first-line (PFS1) and second-line (PFS2) therapy. Overall survival (OS) and prognostic factors were evaluated using Kaplan–Meier and Cox proportional hazards analyses. Results: A total of 115 patients were included (median age 47.4 years; 63.5% male). In the first-line setting, vandetanib (47.8%) and cabozantinib (30.4%) were the most frequently used agents. Median PFS1 was 40.8 months with vandetanib and was not reached with cabozantinib; both were significantly superior to chemotherapy (median PFS1 4.9 months; log-rank p < 0.001). In the second-line setting, median PFS2 was not reached with cabozantinib and was 32.5 months with vandetanib. Sequential use of cabozantinib and vandetanib across the first two lines was associated with a median time to second progression of 114 months, compared with 39 months in patients receiving any other TKI combination (p = 0.003). Second-line use of cabozantinib or vandetanib was independently associated with improved OS (HR 0.40, 95% CI 0.16–0.98; p = 0.046). On multivariate analysis, younger age (HR 0.16, 95% CI 0.03–0.72; p = 0.017) and bone metastasis (HR 0.29, 95% CI 0.11–0.73; p = 0.009) were independent prognostic factors for OS. Conclusions: In this real-world cohort of patients with metastatic MTC, cabozantinib and vandetanib demonstrated durable efficacy across treatment lines, substantially outperforming alternative TKIs and chemotherapy. Sequential use of both approved aaMKIs was associated with prolonged disease control. These findings suggest a potential association between access to both agents and improved outcomes. They are consistent with their central role in treatment sequencing, particularly in settings with limited access to selective RET inhibitors. Given the retrospective design and small subgroup sizes, these results should be interpreted as exploratory and hypothesis-generating. Full article

Background: Breast cancer outcomes are influenced by tumor biology, stage at diagnosis, and access to timely care. Refugee populations may experience disparities in cancer outcomes despite formal access to healthcare services. Türkiye hosts the largest population of Syrian refugees globally and provides universal access to oncology care, offering a unique context to examine equity in breast cancer outcomes. Methods: We performed a retrospective cohort study of female patients diagnosed with invasive breast cancer between 2013 and 2022 at two tertiary oncology centers in Gaziantep, Türkiye. Patients were grouped as Syrian refugees or Turkish citizens based on recorded nationality. Baseline clinicopathologic features and stage at diagnosis were compared between groups. Overall survival (OS) was estimated by the Kaplan–Meier method and compared using log-rank tests. Survival analyses were performed overall and stratified by stage category (I–III vs. IV). Cox proportional hazards regression was used to evaluate the association between ethnicity and OS with adjustment for stage and molecular subtype (and other prespecified covariates as appropriate). Treatment delivery patterns (systemic therapy and radiotherapy) were descriptively compared to evaluate access after entry into care. Results: Among 499 patients (150 Syrian refugees; 349 Turkish citizens), Syrian patients were younger at diagnosis and more frequently presented with de novo metastatic disease. In the overall cohort with survival data (n = 430), unadjusted OS differed by ethnicity; however, survival differences were attenuated after stratification by stage. In stage I–III disease, OS did not significantly differ between groups, and in stage IV disease, median OS was comparable between ethnicities. In multivariable analysis adjusting for stage and molecular subtype, ethnicity was not independently associated with OS, whereas stage and molecular subtype remained prognostic. Treatment delivery patterns in both the non-metastatic and metastatic settings were broadly similar between groups. Conclusions: Within a universal healthcare system, the dominant disparity between Syrian refugees and Turkish citizens was more advanced stage at presentation. After accounting for stage and tumor biology, ethnicity itself was not independently associated with overall survival, suggesting that efforts to reduce outcome gaps should prioritize earlier diagnosis and linkage to care. Full article

Chronic alcohol consumption exacerbates kidney injury, particularly in individuals with hepatitis B virus (HBV) infection. This study investigated the protective effects of boric acid supplementation against alcohol-induced renal damage in HBV transgenic mice. HBV transgenic mice were divided into four groups: control (C), boric acid (B), alcohol (A), and alcohol + boric acid (A + B). Renal injury was evaluated using H&E, PAS, TUNEL, and desmin staining. The expression of caspase-3, cytochrome c, and APAF-1 was analyzed by qRT-PCR. Biochemical analyses included BUN, creatinine, oxidative stress markers (ROS, MDA, TOS, OSI), total antioxidant status, and antioxidant enzyme activities (SOD, CAT, GPx). Histopathological findings showed activated parietal epithelial cells in all groups, indicating renal injury. Alcohol significantly increased tubular damage, podocyte desmin expression, apoptosis, cytochrome c and APAF-1 mRNA levels, and oxidative stress markers, while reducing antioxidant enzyme activities and BUN levels compared with controls. Boric acid supplementation significantly mitigated alcohol-induced tubular injury, apoptosis, oxidative stress, and serum creatinine levels, and improved BUN values. Boric acid treatment alone also alleviated glomerular and tubular injury and reduced tubular apoptosis compared with HBV control mice. Overall, boric acid exerts renoprotective effects in HBV-transgenic mice subjected to chronic alcohol exposure by inhibiting oxidative stress, apoptosis, and podocyte injury. Full article

Background: Deep vein thrombosis (DVT) is one of the most common cardiovascular diseases and is especially prevalent in areas with environmental pollution. Bioaccumulation of toxic heavy metals may lead to deterioration of homeostasis with cellular change, endothelial dysfunction, DNA impairment and cellular signaling. The reason for this is usually the accumulation of thrombogenic toxins in the body as a result of long-term exposure or a lack of regulatory gene expression. In this study, we aimed to measure the minerals that potentially accumulate in the nail. The measurement method was laser-induced breakdown spectroscopy (LIBS), which is a form of atomic emission spectroscopy. It uses a highly energetic laser source to form a plasma of excited atoms emitting light of characteristic wavelengths. It provides accurate quantification and reveals the relationship between tissue accumulation of toxic heavy metals and DVT formation. Methods: Between January 2020 and December 2021, 100 patients diagnosed with lower-extremity deep vein thrombosis were screened in a single tertiary healthcare center. Among them, 50 patients who met the eligibility criteria and consented to participate were included in the study. An additional 50 age-matched healthy volunteers were enrolled as controls. Demographic and clinical characteristics were recorded. Nail samples were obtained from each participant, and elemental emission intensities were quantitatively analyzed using laser-induced breakdown spectroscopy (LIBS). Results: No difference in clinical characteristics was detected between the groups. While iron, calcium and silicon were found to be high in DVT patients, magnesium was found to be low. Regarding the magnesium emission, ROC analysis showed 76–90% specificity and 69–82% sensitivity, respectively. Conclusions: LIBS is a useful method because it is easy to use and can be used with a small sample. According to the results of our study, information about the pathogenesis of DVT was obtained through nail analysis. Therefore, we believe that LIBS analysis is a method that may be useful in determining the causes and predisposing factors for DVT. Full article

Background: Autologous arteriovenous fistulas (AVFs) are the preferred vascular access modality for hemodialysis due to superior durability and lower infection rates. However, long-term secondary functional patency remains a critical determinant of dialysis success and patient survival. Although sex-related differences in vascular access outcomes have been reported, their impact on long-term secondary patency remains insufficiently clarified. Objective: The primary objective of this study was to evaluate long-term gender differences in the secondary functional patency of AVFs and to determine clinical, anatomical, and procedural factors contributing to these disparities. Methods: A retrospective cohort study including 968 ESRD patients undergoing AVF creation between 2012 and 2024 was conducted. Secondary patency was analyzed using Kaplan–Meier survival curves. Multivariate logistic regression identified independent predictors. The overall primary functional patency rates were 78.9% at 1 year, 71.2% at 3 years, and 62.7% at 5 years. When stratified by gender, male patients demonstrated primary patency rates of 80.3% at 1 year, 72.8% at 3 years, and 64.5% at 5 years, whereas female patients showed slightly lower rates of 77.3% at 1 year, 69.4% at 3 years, and 60.6% at 5 years. Conclusions: Female gender, particularly in the postmenopausal period, is an independent determinant of reduced long-term secondary AVF patency. Early identification of high-risk patients and structured risk factor optimization are essential to improve vascular access durability. Full article

Background: Kyphotic deformity following osteoporotic vertebral fracture (KDOVF) often requires corrective surgery to restore sagittal alignment; however, mechanical complications, such as proximal junctional failure (PJF) and distal junctional failure (DJF), remain major concerns. Selection of the lower instrumented vertebra (LIV) plays a critical role in balancing mechanical stability and functional preservation; however, the optimal criteria for LIV selection have not been fully established. Methods: This multicenter retrospective cohort study included 52 patients who underwent corrective surgery for KDOVF, with a minimum 1-year follow-up. The patients were classified into a long-fixation group with pelvic fixation (n = 27) and a short-fixation group with lumbar LIV fixation (n = 25). Mechanical complications, radiographic parameters, patient-reported outcomes, and paraspinal muscle fatty degeneration were compared between groups. Subgroup analysis was performed within the short-fixation group to identify the factors associated with DJF. Results: The incidence of PJF was significantly higher in the long-fixation group than in the short-fixation group (37% vs. 8%, p < 0.01), whereas DJF was observed only in the short-fixation group (24%). Within the short-fixation group, patients who developed DJF demonstrated significantly greater preoperative sagittal malalignment, a lower rate of cement-augmented pedicle screw, and more advanced fatty degeneration of the paraspinal muscles. The short-fixation group also showed better postoperative lumbar function. Conclusions: LIV selection in KDOVF surgery is associated with distinct patterns of junctional mechanical complications. Short fixation may be feasible in carefully selected patients who demonstrate preserved compensatory capacity. Full article

Background/Objectives: Neurological complications remain a critical source of morbidity and mortality following pediatric cardiac surgery for congenital heart disease (CHD). While advances in surgical and perioperative care have improved survival, the incidence of postoperative neurological events and their associations with perioperative characteristics remain incompletely characterized in heterogeneous pediatric populations. This study aimed to assess the incidence of postoperative neurological complications and to examine factors associated with adverse clinical outcomes in pediatric patients undergoing cardiovascular surgery. Methods: This retrospective, single-center study included 210 pediatric patients (<18 years) who underwent open-heart or major cardiovascular surgery with cardiopulmonary bypass at Medipol University Hospital between January 2021 and January 2022. Univariable logistic regression analyses were performed to explore associations between perioperative variables, postoperative neurological complications, and in-hospital mortality. Results: Of the study population, 119 patients (56.7%) were male and 91 (43.3%) were female; 117 patients (55.7%) were younger than 2 years of age. The most common procedures included ventricular septal defect repair (18.6%) and tetralogy of Fallot repair (13.3%). Postoperative neurological complications occurred in 20 patients (9.5%). Median postoperative intubation duration and intensive care unit (ICU) stay were significantly longer among patients with neurological complications (p < 0.001). In-hospital mortality occurred in 18 patients (8.6%). Postoperative neurological complications, reoperation, prolonged intubation, extended ICU stay, and longer cardiopulmonary bypass duration were significantly associated with in-hospital mortality. Conclusions: Postoperative neurological complications were associated with prolonged ICU stay and increased in-hospital mortality. These findings emphasize the clinical importance of close neurological monitoring and perioperative strategies aimed at preserving cerebral perfusion and minimizing cardiopulmonary bypass duration in pediatric cardiac surgery. Full article

Background: Deaf and hard-of-hearing (DHH) adolescents in mainstream schools may face communication barriers and social challenges that can affect their well-being and health. However, population-based knowledge based on adolescents’ own reports—particularly including those with additional disabilities—remains limited. The aim of this study was to assess self-reported well-being, mental health complaints, somatic complaints, and perceived teacher support among DHH adolescents in Swedish mainstream schools and to compare these outcomes with those of hearing adolescents and DHH adolescents with additional disabilities. Methods: This cross-sectional study was based on data from the Swedish school survey Liv och Hälsa Ung (Life and Health of Young People). The sample comprised 5923 adolescents aged 13–18 years attending grades 7 and 9 in compulsory school and year 2 in upper-secondary school. Outcomes included well-being (WHO-5 or a single-item measure for grade 7), mental health complaints, somatic complaints, and perceived teacher support. Group differences by hearing status, additional disability, gender, and school level were examined using analysis of variance (ANOVA). Results: Hearing adolescents reported higher well-being, fewer somatic complaints, fewer mental health complaints, and higher perceived teacher support compared with DHH adolescents. DHH adolescents with additional disabilities consistently reported the poorest outcomes across all domains. For example, perceived teacher support was significantly lower among DHH adolescents with additional disabilities (M = 3.66, 95% CI [3.54–3.78]) compared with hearing adolescents (M = 4.01, 95% CI [3.99–4.03]). Across all groups, girls, particularly those with disabilities, reported poorer well-being and higher levels of somatic and mental health complaints than boys. Conclusions: The findings highlight substantial health disparities among adolescents with hearing loss in mainstream schools, especially among those with additional disabilities. Perceived teacher support emerged as an important contextual factor and may represent a key target for school-based interventions aimed at promoting well-being and mental health among DHH adolescents. Full article

Castor (Ricinus communis) is a toxic seed used to extract oil for the chemical industry, with castor meal as a by-product. A recently developed industrial method allows its detoxification, enabling its use as a protein-rich feed for ruminants. This study evaluated the safety of detoxified castor meal based on intake, digestibility, and performance of sheep fed sugarcane silage containing increasing levels of this ingredient. The detoxified castor meal, supplied by an oil extraction industry, underwent no additional detoxification treatment. Twenty-four intact male sheep were randomly assigned to diets containing 0%, 10%, 20% or 40% fresh matter castor meal in sugarcane silage. Diets were balanced with soybean meal and ground corn. After 60 days of feeding, no signs of intoxication were observed. Crude protein (CP) intake decreased from 0.157 to 0.128 kg/day (p = 0.03) and ether extract (EE) intake from 0.068 to 0.044 kg/day (p = 0.04). Crude protein digestibility declined from 754 to 473 g/kg (p < 0.01), and EE digestibility from 813 to 725 g/kg (p = 0.02). All other intake, digestibility, and performance variables were not significantly affected (p ≥ 0.05). Industrially detoxified castor meal was shown to be a safe additive in sugarcane silage up to 40% by fresh matter, with no adverse effects on sheep performance. Full article

Objective: The objective was to investigate the association between anogenital distance (AGD) and adenomyosis in reproductive-age women and to evaluate the potential of AGD as a non-invasive biomarker reflecting prenatal hormonal environment. Methods: This prospective case–control study included 40 women with adenomyosis diagnosed according to the Morphological Uterus Sonographic Assessment (MUSA) 2022 criteria and 40 age-matched healthy controls. Two AGD measurements were obtained: AGD-af (anus to posterior fourchette) and AGD-act (anus to clitoral tip). Measurements were performed by two independent observers using vernier calipers. Hormonal parameters, reliability analyses, receiver operating characteristic (ROC) curve analysis, and logistic regression were conducted. Results: Women with adenomyosis had significantly shorter AGD-af compared to controls (23.78 ± 7.20 vs. 27.88 ± 7.50 mm, p = 0.015), whereas AGD-act did not differ significantly (p = 0.574). Inter- and intra-observer reliability was excellent (intraclass correlation coefficient [ICC] = 0.87–0.93). ROC analysis revealed an area under the curve (AUC) of 0.658 (95% confidence interval [CI]: 0.55–0.76) for AGD-af (optimal cut-off = 24 mm; sensitivity: 57.5%, specificity: 67.5%). In multivariate logistic regression, AGD-af remained independently associated with adenomyosis after adjusting for age and body mass index (BMI) (adjusted odds ratio [OR] = 0.925, 95% CI = 0.866–0.989, p = 0.022). No significant difference was observed in hormonal parameters between groups. Conclusions: Women with adenomyosis exhibit a modest but significant reduction in AGD-af, suggesting a possible influence of prenatal hormonal environment in disease pathogenesis. Although its diagnostic accuracy is fair, AGD-af may serve as a complementary, non-invasive biomarker in clinical assessment of adenomyosis. Full article