Search Results (15,556)

Background: Euthanasia and physician-assisted suicide (EPAS) are highly contentious topics with significant medical, legal, and cultural implications. Previous research suggests that various sociodemographic, health, and psychosocial factors determine attitudes toward EPAS. This study set out to identify psychosocial predictors of support for EPAS. We hypothesized that perceived control, self-efficacy, and social support would each predict support for EPAS after controlling for sociodemographic and health-related variables. Methods: For this study, we recruited 446 Jewish Israeli adults who were 82.32 years of age on average (SD = 5.99; range 65–101 years). Participants completed a battery of questionnaires including a series of vignettes featuring hypothetical family members with a terminal illness (i.e., cancer, dementia, Parkinson’s disease). We performed a three-step hierarchical regression equation, controlling for demographic factors (age, gender, education, relationship status, economic status, and religiosity) as well as perceived and relative physical health. Results: As hypothesized, both self-efficacy and (the absence of) social support predicted support for EPAS; perceived control did not. Religiosity was the strongest predictor of opposition to EPAS. Fully 31% of variance in support for EPAS was predicted by this regression model. Conclusion: Support for EPAS does not appear to reflect a pervasive need for control over all aspects of life (i.e., perceived control) but a more specific need for personal autonomy (i.e., self-efficacy). Longitudinal research is required over multiple points of data collection to ascertain how change in social support affects support for EPAS in late life. Policy makers should embrace these findings when formulating end-of-life care policies, ensuring that both social support and personal autonomy are prioritized in the care of older adults. Full article

Background/Objectives: Antimicrobial resistance (AMR) is a major global health threat, with children at higher risk due to developmental differences in drug metabolism, limited treatment options and inappropriate antibiotic use. Pediatric antimicrobial stewardship programs (ASPs) face implementation challenges, often relying on adult-based guidelines and limited pediatric-specific evidence. This study aimed to identify and prioritize the most critical areas for pediatric ASP intervention development through a structured, multi-round Delphi consensus process with experts in antimicrobial stewardship and infectious diseases. Method: A four-round modified Delphi process was conducted to identify and prioritize key pediatric ASP interventions. Experts in antimicrobial stewardship and infectious diseases were recruited through an existing clinical trial. Using an iterative survey and in-person discussions, experts provided input on priority areas, which were thematically grouped and refined across rounds. Structured feedback supported real-time refinement and consensus-building. Results: Twenty experts participated in the process, generating 25 priority items in Round 1 through open-ended responses. These were narrowed to seven key priorities through structured voting and discussion. The final items were clustered into three intersecting themes: Care Settings, Prescriptions, and Strategies. Care Settings focused on high-impact areas such as outpatient clinics and intensive care units, where misuse is common and/or care is complex. The prescriptions theme prioritized shorter durations and narrow-spectrum agents. The strategy theme highlighted the need for outcome-based metrics, improved diagnostic stewardship, and routine tracking of patient outcomes to guide and assess stewardship efforts. Conclusions: This expert consensus identified key priorities for pediatric ASPs, providing a foundation for future interventions. Findings can be used to inform policy and practice, improving the appropriate use of antimicrobials in pediatrics and combating AMR. Full article

Seafood plays a key role in a healthy diet due to its high content of essential nutrients. However, its global trade and complex supply chains expose it to frequent mislabeling and food fraud. This study investigates Italian consumers’ willingness to pay (WTP) for traceable seafood products, exploring how blockchain technology (BT) can enhance transparency and economic sustainability in the fish supply chain. An online questionnaire, administered in 2022 and 2024, gathered responses from a diverse demographic, focusing on four representative seafood species: farmed sea bass, striped venus clams, giant red shrimp, and albacore tuna. Results indicate that most respondents—primarily with higher education levels—value traceability and are willing to pay a premium for certified, traceable seafood. The study models the economic feasibility of implementing BT at both national and regional levels and finds that the consumer’s WTP exceeds the additional costs incurred by adopting BT. These findings support the viability of traceability systems in improving food safety and sustainability, while reinforcing consumer trust. The results also underscore the importance of providing clear information at the point of purchase, particularly regarding species, origin, and production methods—factors critical to informed seafood choices and advancing more sustainable consumer behavior in Italy. Full article

Introduction: The risk of new or recurrent cancer in inflammatory bowel disease (IBD) patients with a history of cancer treated with immunomodulators (IMMs), including conventional immunosuppressors (ISSs), biologics or small molecules is undefined. The primary aim was to assess the frequency of new or recurrent cancer in IBD patients treated with IMMs after first cancer. The secondary aim was to evaluate risk factors for new/recurrent cancer in the same IBD population. Methods: In a retrospective multicenter study, all IBD patients using any IMM after first (index) cancer were enrolled. Inclusion criteria: Crohn’s disease (CD) or ulcerative colitis (UC), history of any cancer, detailed clinical history, and follow-up after cancer of ≥6 months. Exclusion criteria: IMM use for ≤3 months. Results: In total, 122 IBD patients (84 CD, 38 UC) treated with IMMs after first cancer were enrolled (age 59.5 [26–89] years). Index cancer included (n = [%]) genitourinary tract cancer (18 [14.8]), non-melanotic skin cancer (NMSC) (17 [13.9]), breast cancer (15 [12.3]), thyroid cancer (13 [10.7]), melanoma (14 [11.4]), colorectal cancer (CRC) (11 [9.0]), hematopoietic cancer (9 [7.4]), prostatic cancer (8 [6.6]), neuroendocrine cancer (4 [3.3]), head and neck cancer (3 [2.5]), liver cancer (3 [2.5]), endometrium cancer (2 [1.6]), lung cancer (1 [0.8]) and others (3 [2.5]). ISSs after cancer included (n = [%]) thiopurines (10 [37]), methotrexate (MTX) (14 [51.9]) and others (3 [11.1]) Biologics included (n = [%]) TNF-inhibitors (36 [32.4]), vedolizumab (60 [53.6]), ustekinumab (45 [40.2]), small molecules (9 [7.3]) and others (6 [5.4]). In a median follow-up of 8 [1–45] years after index cancer, 12/122 (9.8%) patients using IMMs after cancer developed new or recurrent cancer. No risk factors for new/recurrent cancer (i.e., age at diagnosis of cancer, smoke, gender, IBD type, IMM use, duration before or after cancer) were identified. Conclusions: In a multicenter study, ISSs or biologics after cancer were not identified as risk factors for new or recurrent cancer in IBD. However, IMMs were used after a long-term interval from index cancer. Full article

Objectives: This study aimed to investigate the diagnostic performance of imaging-based biomarkers from computed tomography (CT) and magnetic resonance imaging (MRI) for prediction of malignant and borderline malignant ovarian tumours. Methods: 195 consecutive patients with suspected primary epithelial ovarian cancer were included from the retrospective “Prognostic and Diagnostic Added Value of Medical Imaging in Staging and Treatment Planning of Gynaecological Cancer” (PRODIGYN) study. The radiological stage, according to the International Federation of Gynaecology and Obstetrics system (rFIGO), magnetic resonance imaging (MRI)-based Ovarian-Adnexal Reporting and Data System (O-RADS-MRI) score, and the mean apparent diffusion coefficient (ADC_mean) were investigated for prediction of ovarian malignancy, with histopathology as reference. The same imaging biomarkers were applied to the borderline tumour cohort (n = 33) to predict malignant/adverse features, such as micro-invasion. Results: The rFIGO stage demonstrated high accuracy for ovarian malignancy, with an area under the curve (AUC) of 0.98 (95% confidence interval (CI) = 0.97–0.99). On lesion level, the sensitivity and specificity of the O-RADS-MRI score to predict ovarian malignancy, after adjusting for correlated data structure, was 1 (CI: 0.96–1) and 0.82 (CI: 0.70–0.90), respectively. The performance of ADC_mean to predict ovarian malignancy on lesion level was moderately high, with AUC = 0.78 (95% CI 0.68, 0.88). Discrimination of adverse features in borderline tumours was not improved. Conclusions: rFIGO and O-RADS-MRI showed excellent performance and outperformed ADC_mean as predictive tools for ovarian malignancy but could not predict adverse features in borderline tumours. Full article

Background: Phelan–McDermid syndrome (PMS), caused by SHANK3 variants or 22q13.3 deletions, often includes systemic features such as gastrointestinal and hepatic abnormalities. This study highlights the overlap between PMS and metabolic-associated steatotic liver disease (MASLD), focusing on PNPLA3 variants and underscoring the need for structured metabolic monitoring. Methods: We describe a 25-year-old male with PMS due to a 22q13.33 microdeletion involving SHANK3. He exhibited developmental delay, seizures, and hypotonia. Genetic testing revealed homozygosity for the PNPLA3 p.I148M variant. Clinical, anthropometric, biochemical, imaging, and metabolic investigations were performed, including liver ultrasound and metabolic profiling of lymphoblastoid cell lines. Results: Ultrasound revealed moderate hepatic steatosis consistent with MASLD. After ursodeoxycholic acid treatment and a Mediterranean-style diet, steatosis improved to mild. Metabolic profiling demonstrated increased nicotinamide adenine dinucleotide generation under metabolic stimuli, suggesting altered energy homeostasis. Conclusions: We highlight the contribution of PNPLA3 to MASLD in PMS and support systematic hepatic monitoring. Genotype–phenotype associations in PMS may provide insights relevant to MASLD research and clinical management. Full article

Gliomas present as highly heterogeneous and aggressive central nervous system (CNS) tumors with challenging diagnosis and management. Traditional and current therapies are lacking efficacy in overcoming the complex and dynamic behavior of gliomas and the local tumor microenvironment. Emerging research highlights the significant role of innate immune receptors including Toll-like, NOD-like and RIG-like receptors, as well as cGAS-STING receptors, scavenger and C-type lectin receptors in glioma development and progression. These receptors can both impact immune modulation as well as facilitate tumor growth through interactions with tumor-associated macrophages, myeloid-derived suppressor cells and cytokine networks, contributing to immune evasion in the tumor microenvironment. Herein, we discuss the main signaling pathways induced through innate immune receptors in gliomas along with their functional properties in glioma pathology while exploring current applications to treatment. Utilizing innate immune receptors as therapeutic targets holds great promise, especially when used along with traditional chemotherapy and radiation schemes, strengthening immune responses. Future studies focusing on the deeper understanding of innate immune receptors signaling and complexity are highly required to enable novel immunoregulatory treatment schemes for gliomas. Full article

Crohn’s disease (CD) is an immune-mediated inflammatory bowel disease (IBD) with a multifactorial pathogenesis involving genetic predisposition, immune dysregulation, and environmental triggers. Dietary patterns have recently garnered growing attention for their potential benefits and risks in patients with IBD. Nutritional therapy has been established as an effective option in pediatric populations, but its role in adults remains less defined. The available studies indicate that while no single diet can be universally recommended, adherence to a Mediterranean diet is associated with multiple health benefits. Nutritional therapy appears promising in inducing clinical remission in adults with mild to moderate CD, particularly when partial enteral nutrition is combined with food-based modifications. Tailoring these strategies to cultural contexts and providing support from qualified dietitians may improve adherence, clinical outcomes, and overall quality of life. This review highlights the growing role of nutritional therapy in adult CD and its potential integration into routine management alongside conventional treatments. Full article

Starch is a promising alternative to petroleum-based polymers due to its biodegradability and renewable nature. However, its widespread use in non-food applications raises ethical concerns. Mango kernels, a major byproduct of mango processing, represent an abundant yet underutilized starch source. However, conventional starch extraction requires costly purification steps with significant environmental impact. This study explores the development of extruded biocomposites, using corn starch and mango kernel flour (MKF) as a more sustainable alternative. The influence of lignin, extractives, amylose, and amylopectin content on the material properties was assessed. MKF was obtained by removing both tegument and endocarp from the mango kernels, grinding them in a colloidal mill, and finally drying the ground kernels. The resulting flour was blended with corn starch, processed in an internal mixer, and injection-molded. The composites were characterized through mechanical testing, water absorption analysis, colorimetry, and UV absorption assays. Notably, the composite containing ~20% MKF exhibited mechanical properties comparable to commercial polyethylene (PE-PB 208), with a tensile strength of 9.53 MPa and a Young’s modulus of 241.41 MPa. Additionally, MKF enhanced UVA protection. These findings suggest that mango kernel flour can partially replace starch in the production of injection-molded biopolymers, offering a more sustainable approach to biodegradable plastic development. Full article

Autoimmune gastritis (AIG) is a chronic, organ-specific autoimmune disease characterized by progressive destruction of gastric parietal cells driven by autoreactive CD4⁺ T-cells, epithelial stress pathways, and microbial factors. Parietal cell loss results in achlorhydria, intrinsic factor deficiency, and vitamin B12 malabsorption, ultimately leading to pernicious anemia. Compensatory hypergastrinemia promotes enterochromaffin-like (ECL) cell hyperplasia and contributes to the development of type 1 gastric neuroendocrine neoplasms (gNENs). These clinical consequences are well recognized, yet the cellular and molecular mechanisms driving mucosal atrophy and neoplastic transformation remain incompletely defined. Recent advances highlight the role of endoplasmic reticulum stress, impaired autophagy, innate immune effectors, and dysbiosis in perpetuating inflammation and epithelial injury. The frequent coexistence of AIG with other autoimmune disorders further adds to its clinical complexity. Therapeutic options remain limited, spanning vitamin B12 replacement and endoscopic management to emerging targeted approaches. Netazepide, a gastrin/CCK2 receptor antagonist, is the only agent tested in clinical trials, whereas interventions targeting ER stress, autophagy, immune tolerance, or microbiome composition are still in the preclinical stage. Clarifying these mechanisms is crucial to improve biomarker development, optimize surveillance, and identify targeted therapies to prevent neoplastic transformation. Full article

The SETD6 protein lysine methyltransferase monomethylates specific lysine residues in a diverse set of substrates which contain the target lysine residue in a highly variable amino acid sequence context. To investigate the mechanism underlying this multispecificity, we analyzed SETD6 substrate recognition using AlphaFold 3 docking and peptide SPOT array methylation experiments. Structural modeling of the SETD6–E2F1 complex suggested that substrate binding alone is insufficient to restrict SETD6 activity to only one lysine residue, pointing to additional sequence readout at the target site. Methylation of mutational scanning peptide SPOT arrays derived from four different SETD6 substrates (E2F1 K117, H2A.Z K7, RELA K310, and H4 K12) revealed sequence preferences of SETD6 at positions −1, +2, and +3 relative to the target lysine. Notably, glycine or large aliphatic residues were favored at −1, isoleucine/valine at +2, and lysine at +3. These preferences, however, were sequence context dependent and variably exploited among different substrates, indicating conformational variability of the enzyme–substrate interface. Mutation of SETD6 residue L260, which forms a contact with the +2 site in the available SETD6-RELA structure, further demonstrated substrate-specific differences in recognition at the +2/+3 sites. Together, these findings reveal a versatile mode of peptide recognition in which the readout of each substrate position depends on the overall substrate peptide sequence. These findings can explain the multispecificity of SETD6 and similar mechanisms may underlie substrate selection in other protein methyltransferases. Full article

Background: This study examined changes in psychological adjustment among patients with Anorexia Nervosa (AN) and Binge Eating Disorder (BED) following a 3-week inpatient multidisciplinary (disease-tailored) rehabilitation program. Methods: twenty consecutive Italian female adults with a diagnosis of AN (mean age ± SD: 25.9 ± 9.4 years; mean Body Mass Index: BMI: kg/m²: 15.8 ± 1.61) and fifteen consecutive Italian female adults with diagnosis of BED (mean age ± SD: 43.5 ± 15.3 years; mean Body Mass Index: BMI: kg/m²: 41.1 ± 7.82) were admitted to the study. Psychological functioning and well-being were assessed pre- and post-intervention using the Strengths and Difficulties Questionnaire and the Psychological General Well-Being Index. Results: Significant improvements in emotional symptoms [F(1, 31) = 21.1973, p < 0.001, ƞ²p = 0.406] and overall psychological functioning [F(1, 31) = 10.0062, p = 0.373, ƞ²p = 0.026] were observed in both groups, with the most pronounced changes in internalizing symptoms, such as anxiety and depression. Changes in BMI were significantly associated with emotional symptoms, vitality [F(1, 31) = 4.89, p = 0.035, ƞ²p = 0.136], and total well-being scores [F(1, 31) = 6.341, p = 0.017, ƞ²p = 0.170]. By contrast, no significant changes were observed in domains such as behavioral problems, hyperactivity/inattention, and peer relationships, probably indicating the need for more prolonged and targeted, domain-specific interventions. Conclusions: A 3-week inpatient multidisciplinary program was associated with improvements in internalizing symptoms and psychological well-being in women with AN and BED. Domains such as behavioral regulation and social functioning showed limited change, indicating the need for longer and targeted psychosocial components. Full article

This research presents a novel conceptual framework for inclusive education by integrating Internet of Things (IoT)-driven real-time environmental and behavioral monitoring with adaptive teaching strategies. Unlike traditional methods, our model leverages sensor-based data collection to analyze classroom conditions, teacher mobility, and student interactions, enabling dynamic adjustments that aim to enhance engagement and inclusivity. While the framework is theoretical and has not yet undergone experimental validation, we discuss how optimizing spatial configurations, voice dynamics, and movement patterns could support student participation, particularly for learners with diverse needs. Pilot implementations and empirical testing are planned for future research. By merging data-driven insights with educators’ expertise, our approach offers a scalable vision for creating responsive, inclusive learning environments that proactively address barriers to education. Full article

Multiple myeloma is a clonal plasma cell malignancy with a highly variable range of clinical manifestations. Over recent decades, substantial progress has been made in laboratory diagnostics, which has deepened our understanding of disease biology, improved risk stratification, and informed treatment strategies. In an era of transformation and innovation, conventional laboratory methods remain essential, as cutting-edge technologies might not be immediately accessible to all laboratories. Nonetheless, even widely used laboratory methodologies present many challenges, such as variability in assay performance, interpretative criteria, and standardization. This review by the Portuguese Multiple Myeloma Group of the Portuguese Society of Hematology provides a comprehensive overview and practical appraisal of current conventional laboratory methods employed for multiple myeloma diagnosis. Full article