Search Results (68,975)

We investigated the impact of liver damage on systemic inter-organ communication in an extensive observational case–control study of 923 patients with severe obesity and biopsy-confirmed metabolic dysfunction-associated steatotic liver disease (MASLD) or metabolic dysfunction-associated steatohepatitis (MASH) undergoing bariatric surgery. Using a comprehensive panel of circulating organokines, including fibroblast growth factor (FGF) 19, FGF21, adiponectin, galectin-3, irisin, and leptin, along with choline metabolites, we characterized metabolic signaling patterns associated with liver disease severity. Compared to controls, patients with MASLD/MASH exhibited significantly lower levels of FGF19, choline, and trimethylamine, while FGF21, galectin-3, irisin, and leptin were elevated. Sex-specific alterations in leptin and adiponectin were observed in patients with severe obesity but not in controls. Network analysis revealed a complex and individualized interplay among organokines, shaped by age, sex, and anthropometric factors. Despite this complexity, a dysregulation of the FGF21–adiponectin axis was associated with more advanced liver involvement. The large cohort and comprehensive organokine profiling studied provide valuable insights into the role of the FGF21–adiponectin axis on systemic metabolic alterations in severe obesity and their potential clinical implications. Full article

Background: Aortic stenosis (AS) is a prevalent acquired heart valve disease with increasing incidence, particularly among older adults. Gender-specific differences in AS presentation, comorbidities, and outcomes remain underexplored, necessitating further investigation to optimize personalized treatment strategies. Objective: To evaluate the clinical and demographic characteristics, comorbidities, and survival outcomes of patients with AS, stratified by gender and aortic valve morphology. Methods: A retrospective analysis of 145,454 echocardiographic examinations (2009–2018) at the Federal State Budgetary Institution “V.A. Almazov National Medical Research Centre” identified 84,851 patients meeting the inclusion criteria (Vmax ≥ 2.0 m/s, age ≥ 18 years). Patients were stratified by gender and valve morphology (bicuspid aortic valve [BAV] vs. tricuspid aortic valve [TAV]). Survival was assessed in 475 pts with AS over a 16-year period (2009–2025) using Kaplan–Meier analysis. Statistical comparisons utilized STATISTICA v. 10.0, with p-values derived from P-tests. Results: Of the cohort, 4998 men and 6322 women had AS. Men with AS were older (median 64 vs. 57 years, p < 0.0001) and had higher systolic blood pressure (140 vs. 130 mmHg, p < 0.0001) than men without AS. Women with AS were also older (median 70 vs. 58 years, p < 0.0001) with higher systolic (140 vs. 130 mmHg, p < 0.0001) and diastolic blood pressure (80 vs. 80 mmHg, p < 0.0001). Men with AS had higher rates of hyperlipidemia (HLP) (26.3% vs. 10.3%, p < 0.0001), while women with AS had increased coronary artery disease (CAD) (35.7% vs. 26.4%, p < 0.0001), diabetes mellitus (DM) (13.4% vs. 10.2%, p < 0.0001), and obesity (10.9% vs. 10.2%, p = 0.06). Chronic heart failure (CHF) was more frequently reported in patients with AS, regardless of gender, compared to patients without AS (in men 53.4% vs. 41.8%, p < 0.0001; in women 54.5% vs. 37.5%, p < 0.0001). BAV was associated with higher AS prevalence (54.5% in men, 66.4% in women). Survival analysis revealed higher mortality. Over the 16-year follow-up period, the mortality rate was 21.7%. Conclusions: Mortality in a representative AS cohort reached 21.7%, underscoring the progressive nature of the disease and its long-term impact. Survival was negatively affected by age over 68.5 years, as well as the presence of aortic regurgitation (AR), increased peak aortic jet velocity, and enlarged maximum aortic diameter. Aortic valve replacement demonstrates an insignificant effect on patient survival rates. Beta-blocker therapy in patients with varying degrees of aortic AS severity has not only demonstrated its safety but has also shown a positive effect on reducing mortality (improving survival). In contrast, the combination of angiotensin II receptor blockers (ARBs) with calcium channel blockers (CCBs) is quite dangerous for patients with AS and reduces their survival. Aortic valve replacement demonstrates an insignificant effect on patient survival rates. In contrast, the absence of fibrinolytic therapy and anticoagulant treatment is associated with an improved prognosis. Conversely, the administration of antiarrhythmic agents and statins is correlated with enhanced survival outcomes, potentially attributable to their influence on coexisting comorbidities. Further research is required to delineate their precise mechanisms and contributions. These results emphasize the importance of early identification, comprehensive risk assessment, and individualized management strategies in improving outcomes for patients with AS. Full article

Background: Tularemia is a rarely identified disease in Slovenia. In summer 2024, we detected a tularemia outbreak in the Kranjsko-Sorško polje, located in North-Western part of Slovenia. Aim: To describe the epidemiological investigations and preventive measures to contain the outbreak. Methods: The patients with confirmed tularemia were interviewed. Serology and PCR was used for microbiological confirmation of tularemia and in some patients by isolation from blood or by RT-PCR. Results: The majority of confirmed tularemia cases in 2024 were infected in the geographically limited area in North-Western part of Slovenia (38/46). Tularemia was confirmed in two patients by isolation Francisella tularensis subsp. holarctica from blood or wound, in one by blood PCR, and in the others by serology. Most cases were associated with mowing or harvesting hay with intensive dusting. Twenty-eight (75.7%) out of 37 cases developed pulmonary tularemia. Sixteen cases were hospitalized. After confirming the outbreak, we alerted medical professionals in the region and the general public using the regional and national media and website of National Institute of Public Health. Conclusions: Endemic tularemia in Slovenia is associated with handling wild life and presents in ulceroglandular form. In the localized outbreak in year 2024 there was an extraordinary upsurge of pulmonary tularemia, with many of the cases initially investigated for lung cancer based on the radiology reports. Due to dry weather condition in summer 2024, excessive dusting associated with mowing the grass and handling hay resulted in inhalation of infective aerosols leading to the infection with F. tularensis. Full article

Progressive pulmonary fibrosis (PPF) is a clinical syndrome associated with worsening quality of life and increased mortality among patients with various interstitial lung diseases. This review aims to update the concepts and criteria that adequately define PPF, aiming to facilitate earlier recognition and optimize clinical management. Fibrosing interstitial lung disease (ILD-f) can progress over time despite optimal management of the underlying conditions. Current criteria for defining PPF include worsening respiratory symptoms, decline in pulmonary function tests (particularly forced vital capacity and diffusing capacity), and radiographic progression over a 1-year follow-up period. However, implementation of these criteria in clinical practice poses challenges. This review discusses the limitations of current evaluation methods and proposes future directions, including the need for validated symptom assessment tools, standardization of pulmonary function testing, and improvements in quantitative radiological evaluation methods. Full article

Multiple myeloma (MM) is a complex genetic disease characterized by the heterogeneity of tumor cells. We have measured KRAS, NRAS, and BRAF gene mutations in circulating free tumor DNA (ctDNA) from plasma, bone marrow, and plasmacytoma samples as well as their correlation with various clinical and laboratory parameters. The prospective study included 113 MM patients (74 with plasmacytoma and 39 without), treated at the National Medical Research Center for Hematology (Moscow, Russia) from 2009 to 2024. FISH was performed on CD138+ bone marrow cells for 104 patients and array-CGH for two extramedullary plasmacytoma samples. Mutation analysis on CD138+ bone marrow cells was performed for 99 patients, on ctDNA for 80 patients, and, in 26 cases, samples of plasmacytoma were also investigated. Mutations in the KRAS, NRAS, and BRAF genes either in bone marrow, ctDNA, or plasmacytoma samples were found in 50% of patients. In patients with plasmacytoma, mutations in ctDNA were found in 28% of cases versus 0% in cases without plasmacytoma (p = 0.0007). Rare “noncanonical” KRAS and NRAS gene mutations were also more frequent in ctDNA compared to the bone marrow substrate (50% versus 9%, p = 0.01). Liquid biopsy in MM, particularly identification of the KRAS, NRAS, and BRAF gene mutations in ctDNA, is a valuable instrument for prognostication. Researching the intricate mechanisms underlying extramedullary involvement, and identifying novel high-risk factors associated with the disease, is worthwhile. Full article

Background: Diabetic foot ulcers (DFUs) in patients with peripheral artery disease (PAD) are difficult to treat and associated with poor healing outcomes. Photobiomodulation therapy (PBMT) and exercise have shown individual benefits, but evidence on their combined effects is limited. Objective: To evaluate whether PBMT combined with resistance exercise improves wound healing and walking ability in patients with DFU and PAD. Methods: In this pilot randomized trial, 11 patients with DFU and PAD were allocated to either PBMT plus supervised exercise or exercise alone for 4 weeks. Outcome measures included wound size, skin temperature, and 6-min walking distance. Results: PBMT combined with exercise improved wound healing and walking capacity compared with baseline; however, no significant between-group differences were observed. A positive correlation was observed between post-PBMT plantar skin temperature and percentage of wound reduction. Conclusions: PBMT combined with resistance exercise may enhance wound healing and functional mobility in patients with DFU and PAD. Full article

Feline infectious peritonitis (FIP) is a progressive and often fatal disease caused by a virulent biotype of feline coronavirus (FCoV). Although antiviral treatments are now available, relapse and resistance remain ongoing concerns. This study investigates the therapeutic potential of P. indusiatus, a medicinal mushroom, for its antiviral and anti-inflammatory activities against FIP. The main protease (FIPV M^pro) of feline infectious peritonitis virus (FIPV) was recombinantly expressed and purified to facilitate enzyme inhibition screening. P. indusiatus exhibited the strongest FIPV M^pro inhibitory activity among the 17 mushroom extracts tested (69.2%), showing a notable level of inhibition relative to standard antiviral agents such as lopinavir and ritonavir. To assess its anti-inflammatory potential, PBMCs derived from healthy cats and FIP-associated effusions (FIP fluid) were cultured and stimulated with LPS to induce inflammation. In healthy PBMCs, P. indusiatus significantly reduced nitrite levels, with effects similar to dexamethasone. However, PBMCs from FIP fluid, already in an activated state, showed no additional response. Notably, this study is the first to successfully isolate and culture PBMCs from FIP fluid, providing a new platform for future immunological research. These findings suggest that P. indusiatus possesses both antiviral and anti-inflammatory properties, positioning it as a potential dual-action therapeutic candidate for FIP. Further investigation into cytokine signaling pathways is warranted to clarify its mechanisms of action and advance future therapeutic development. Full article

Background/Objectives: Lung cancer remains the leading cause of cancer-related mortality worldwide, with a high proportion of cases diagnosed at advanced stages. Accurate mediastinal staging is essential to guide optimal therapeutic decisions. This study aimed to evaluate the diagnostic performance of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and to develop a composite clinical–molecular score (EXPoSURE) for risk stratification. Methods: A retrospective study was performed that included 131 patients diagnosed with lung cancer between December 2023 and December 2024 at a regional oncology center in Oltenia, Romania. All patients underwent bronchoscopy and EBUS-TBNA using a standardized protocol. Clinical, pathological, and molecular data were collected to assess diagnostic yield, staging performance, and the association with molecular markers. The EXPoSURE score integrated PD-L1, p63, EGFR status, comorbidities, histological type, and TNM stage. Results: EBUS-TBNA provided a conclusive diagnosis in 91.6% of cases, with a low rebiopsy rate of 8.4% and no requirement for mediastinoscopy. Most patients (68%) were diagnosed at stage IV. PD-L1, p63, and EGFR expression showed no significant correlation with TNM stage, while the EXPoSURE score demonstrated promising stratification capability. Occupational exposure appeared to influence disease severity in some subgroups, although further validation is needed. Conclusions: EBUS-TBNA is a valuable, safe, and effective approach for minimally invasive diagnosis and mediastinal staging of lung cancer. The proposed EXPoSURE composite score may contribute to a multidimensional risk assessment, supporting more tailored management strategies and warranting prospective validation. Full article

Background: Children with cancer frequently experience pain, which may persist into survivorship. Furthermore, many undergo body composition changes throughout their disease trajectory. However, little is still known about the interplay between pain and body composition. Methods: This cross-sectional case–control study compared pain and anthropometric characteristics between 30 children with cancer (8–18 years) and 30 age- and sex-matched healthy controls and examined whether pain was associated with anthropometric characteristics and cancer diagnosis. Pain in the past two weeks, chronic pain, and pressure pain thresholds (PPTs) at the tibialis anterior and trapezius pars descendens muscles were assessed. Anthropometric measures included waist circumference, fat %, fat-free mass, muscle mass, body water %, and Body Mass Index. Results: Children with cancer had a higher prevalence of chronic pain (p = 0.011), lower PPTs at the tibialis anterior (p = 0.030), and fewer pain locations (p = 0.037). They also showed lower body water % (p = 0.020), and higher waist circumference (p = 0.012) and fat % (p = 0.026). Cancer diagnosis and lower muscle mass were associated with lower PPTs at both locations (tibialis anterior: p = 0.016, β = −0.305; p = 0.033, β = 0.267; trapezius pars descendens: p = 0.020, β = −0.286; p = 0.004, β = 0.361, respectively). Conclusions: Children with cancer differ from their healthy peers in both pain and body composition profiles. These findings underscore the need for systematic pain assessment and body composition monitoring in pediatric oncology and may help identify children at risk for heightened pain sensitivity and adverse body composition changes who could benefit from early, targeted interventions. Full article

Liver fibrosis is associated with increased rates of morbidity and mortality. At present, there are no specific treatments that can directly reverse hepatic fibrosis. The endocannabinoid system has been found to play a significant role in regulating the development and progression of liver diseases, in addition to having protective effects. In this study, we investigate the protective potential of β-Caryophyllene (BCP) against Thioacetamide (TAA)-induced liver fibrosis. Wistar rats were injected with TAA (200 mg/kg) three times per week for 8 weeks to induce liver fibrosis. They also received oral BCP before the TAA injections. AM630 (1 mg/kg) was administered to confirm the CB2 receptor-dependent effect of BCP. The BCP treatment (50 mg/kg) protected against cell injury and potentiated antioxidant defense by replenishing hepatic GSH, improving catalase activity, and inhibiting the formation of MDA. The co-administration of BCP mitigated the TAA-induced inflammatory response by decreasing the release of proinflammatory cytokines. Histological examination showed preserved cellular integrity, decreased collagen deposits with other extracellular matrix proteins, and low levels of myofibroblast activation. In addition, the BCP-treated rats demonstrated upregulated sirtuin 1 (SIRT1) expression, which had a direct inhibitory effect on hypoxia inducible factor (HIF-1α). AM630 pre-treatment inhibited all the aforementioned protective mechanisms of BCP. Based on our findings, BCP exerts protective effects in liver fibrosis, which can be attributed to its agonist action on CB2 receptors. This study provides preclinical evidence of the potential preventative benefits of BCP in liver fibrosis. Full article

Inhibitors of the tyrosine kinase Zap70 are actively searched to improve treatments of lymphoid malignancies and autoimmune diseases associated with an abnormal T-cell response. The natural product withaferin A (WFA) has been characterized as a covalent inhibitor of Zap70 capable of blocking the migration of human T-cells. By analogy, we postulated that other withanolides equipped with a thiol-reactive, α,β-unsaturated ketone may form covalent complexes with Zap70. The hypothesis was tested using a molecular modeling approach with a panel of 12 withanolides docked onto the kinase domain of Zap70. Seven natural products revealed a capability to form stable complexes with Zap70 comparable to that of WFA, including withangulatin A, 4β-hydroxywithanolide E, withaperuvin, and ixocarpalactone A. Withangulatin A surpassed all the other withanolides for its ability to engage an interaction with Zap70 kinase and to form covalent complexes via bonding to the Cys346 residue close to the enzyme active site. The physicochemical and ADMET properties of withangulatin A were analyzed via Density Functional Theory calculations and an analysis of its Fukui function descriptors. The C3 position of the enone moiety was identified as the most reactive (nucleophilic) site of the molecule. Withangulatin A revealed a satisfactory ADMET profile with no major toxicity anticipated. It represents a potential hit to guide the design of Zap70 inhibitors. Full article

The X-linked TLR7 rs179008 T allele has been associated with altered antiviral immunity. Given their shared inflammatory pathways and higher pediatric mortality rates in Brazil during the pandemic, we investigated their association with multisystem inflammatory syndrome in children (MIS-C) together with Kawasaki disease (KS) following SARS-CoV-2 infection. A cross-sectional study (2021–2022) analyzed 73 hospitalized children (<13 years) with confirmed COVID-19. Genotyping for TLR7 rs179008, TLR8 (rs3764879, rs2407992), and TLR3 rs3775291 was performed via PCR and Sanger sequencing. MIS-C/KS cases were identified using CDC criteria, with severity classified by the need for ICU care. Statistical analysis included Fisher’s exact test and relative risk (RR) calculations. Hemizygous boys carrying the TLR7 T allele had a 1.87-fold higher risk of MIS-C/KS (p = 0.007) and a 1.75-fold increased risk of severe or critical outcomes. The T allele frequency was 2.6× higher in MIS-C/KS cases versus other COVID-19 presentations. All fatalities occurred in boys (3/8 MIS-C cases) with one T-allele carrier. No associations were found for TLR8 or TLR3 variants. The TLR7 rs179008 T allele is a potential genetic risk factor for severe post-COVID-19 inflammatory syndromes in boys, likely due to impaired immune signaling. These findings highlight its utility as a biomarker for risk stratification in pediatric populations. Full article

Vector-borne diseases (VBDs) continue to pose a persistent global health challenge, disproportionately impacting low- and middle-income countries where surveillance and healthcare infrastructure are constrained. Within these countries, residents of remote island communities are particularly vulnerable to emerging VBD threats; however, they remain critically understudied. We conducted a community-based cross-sectional survey of 300 residents from Shahpori Island, Bangladesh, and Gaya Island, Malaysia, to assess knowledge, attitudes, and practices (KAP) related to VBDs. Using a structured questionnaire and mixed-effects Poisson regression modeling, we identified socio-demographic predictors of VBD-related knowledge and compared KAP outcomes across the two islands. Significant disparities were observed between the two settings: the Gaya Island residents demonstrated a higher level of awareness regarding VBDs and preventive practices compared to the Shahpori residents. Education was a strong predictor of VBD knowledge, with individuals possessing secondary education or above exhibiting significantly better knowledge (β = 0.2024, p = 0.0003). Marital status was also a significant factor, with unmarried respondents showing lower levels of knowledge (β = –0.1657, p = 0.0372). Age was positively correlated with VBD knowledge (β = 0.0051, p = 0.0119), indicating a gradual increase with age, while income, gender, occupation, and household size were not significantly associated. Despite basic awareness of VBD symptoms and transmission, detailed understanding of mosquito ecology, disease symptoms, and breeding prevention strategies was remarkably poor, especially among the Shahpori residents. Our findings highlight critical gaps in VBD-related knowledge and prevention behaviors shaped by socio-economic and educational disparities. Community-focused public health strategies including educational campaigns, establishment of health infrastructure, access to trained healthcare providers, and integrated vector control interventions are urgently needed to enhance resilience against emerging VBD threats such as drug-resistant malaria in remote island populations. Full article

Background/Objectives: African swine fever (ASF) is a disease of domestic pigs and wild boar caused by African swine fever virus (ASFV), in which infection often leads to high morbidity and mortality. Although subunit and mRNA vaccines based on protective antigens have been explored for ASFV, their protective efficacy remains insufficient for practical ASF control, highlighting the need to identify new potential antigens capable of inducing more potent and broadly protective immune responses. Previously, we found that the antibodies against the ASFV E120R protein (pE120R) could significantly inhibit virus replication in primary porcine alveolar macrophages (PAMs). However, it is not yet known whether anti-pE120R antibodies can induce antibody-dependent cellular cytotoxicity (ADCC). Methods: In this study, we analyzed the conservation and immunogenic features of pE120R and established an HEK293T cell line with stable expression of pE120R as target cells (HEK293T-pE120R). Additionally, a co-culture system comprising target cells and peripheral blood mononuclear cells (PBMCs) was established to evaluate the ability of the anti-pE120R antibodies to induce ADCC as measured by lactate dehydrogenase (LDH) release assays. Results: The results showed that pE120R is highly conserved among different ASFV genotypes and contains multiple B-cell and T-cell epitopes. Importantly, LDH release assays demonstrated that anti-pE120R antibodies triggered NK cell-mediated ADCC. Notably, ASFV replication in HEK293T-pE120R cells was not promoted. Conclusions: In summary, pE120R was associated with antibody production in a cytotoxicity assay. The ability of this antigen to induce protective immunity, if any, requires further evaluation in vivo. Full article

Background/Objectives: This retrospective observational study evaluated associations among dentition type, age, systemic conditions, and oral pathology in pediatric patients. Methods: A six-month retrospective analysis was conducted in a specialized pediatric hospital. Patients (n = 155; 0–18 years) were grouped as clinically healthy with oro-maxillofacial diseases or with systemic diseases. Data included dental/periodontal status, anomalies, gingival bleeding index, IOTN score and oral mucosal conditions. Statistical tests (chi-square, ANOVA, and correlations) were applied. Results: Chronic gingivitis was most frequently associated with primary dentition. Caries and root debris were more frequent in ages 4–6, while acute gingivitis appeared in younger children. Orthodontic treatment need increased with age, especially in mixed dentition. Periodontal diseases were most often linked to digestive pathologies. Conclusions: Oral health in children showed associations with age, dentition type, and systemic conditions. Findings highlight associations rather than causation, underscoring the importance of prevention, early monitoring, and age-appropriate interdisciplinary management. Full article