Search Results (10,827)

Mycotoxins are toxic secondary metabolites produced by fungi, frequently present in food and representing significant health hazards. Exposure occurs through the consumption of contaminated foods or animal-derived products from livestock fed with contaminated feed. This study evaluated internal exposure to twelve mycotoxins in 492 first-morning urine samples from adults, aged 18–65 years, in the Valencian Community, Spain. Samples were analysed using a “dilute-and-shoot” approach followed by UHPLC-MS/MS. Aflatoxins (AFs) were the most frequently detected, with a geometric mean (GM) of 1.17 ng/mL and a 95th percentile (P95) of 6.04 ng/mL. Alternariol (AOH), present in 63% of samples, showed high concentrations (GM: 0.98 ng/mL; P95: 4.74 ng/mL). Emerging mycotoxins such as alternariol monomethyl ether (AME), citrinin (CIT), and sterigmatocystin (STER) were also considered due to their potential health impacts. Exposure levels correlated with variables including sex, age, annual income, smoking status, and recent consumption of meat and cereals. Probable daily intakes (PDIs) were estimated from urinary concentrations to support risk assessment. Hazard Quotients (HQs), Margins of Exposure (MOEs), the Hazard Index (HI) and the total Margin of Exposure (MOET) were calculated to evaluate the risk associated with mycotoxin exposure. Findings suggest that potential health risks cannot be excluded. Full article

Objectives: This study aimed to assess the impact of traditional Korean medicine services (TKMS) on subsequent knee surgery and opioid use in patients diagnosed with knee osteoarthritis (KOA). Methods: This retrospective cohort study used National Health Insurance Review and Assessment Service claims data from 2015 to 2017 to identify patients treated for KOA (M17) in 2016. Patients with at least two Korean medicine (KM) clinic visits within 6 weeks of the initial diagnosis formed the TKMS group, while those without visits to KM clinics formed the n group. Propensity score matching (PSM) (1:1) was applied and the incidence of knee surgery and opioid use was followed up for one year. Kaplan–Meier survival curves and Cox proportional hazards models estimated time-to-event outcomes and hazard ratios (HRs). Sensitivity analyses were performed to verify the results across varied treatment windows of 4, 8, and 10 weeks. Results: After PSM, 247,168 patients were included in the analysis for each group. The TKMS group exhibited significantly lower HRs for knee surgery (HR = 0.69, 95% CI: 0.66–0.72), opioid use (HR = 0.66, 95% CI: 0.65–0.66), and their compound events (HR = 0.66, 95% CI: 0.65–0.67) compared with the Non-TKMS group. The results remained consistent across sensitivity analyses. Conclusions: Among patients with KOA, the utilization of TKMS may significantly reduce the incidence of knee surgery and opioid use. Thus, the utilization of TKMS may be associated with a reduced need for unnecessary surgical interventions and with lower reliance on high-risk medications. Full article

Optimizing organic fertilizer substitution is essential for enhancing the sustainability of agriculture and achieving a balance between crop productivity, nutritional quality, and environmental safety. Here, we conducted an 11-year field experiment to evaluate the effects of substituting 50% of mineral fertilizers with pig manure (PM) or cattle manure (CM) on the nutritional quality of wheat grain, heavy metal (HM) accumulation, and associated human health risks. The yield and protein content were highest in the mineral fertilizer (MF) treatment, and grain micronutrients (Fe, Mn, Cu, Zn) were 6.7–13.8% higher under organic substitution (PM/CM) than in the MF treatment. The Ni, Pb, and As contents were 35.4–43.0% higher in the PM treatment than in the MF treatment, which stems from the higher HM content in pig manure. Health risk assessments indicated that the Hazard Index (HI) for children exceeded 1 in the PM treatment, primarily due to As, which accounted for 69.6% of the HI. All treatments remained within safe thresholds, although As and Pb posed detectable carcinogenic health risks. The higher levels of Ni and As in pig manure likewise led to a significant increase in the health risk associated with the PM treatment compared to the MF treatment. We developed a novel Grain Quality Index (GQI) that combined nutrient and HM data, which indicated that the nutritional quality of wheat grain was similar in the CM and MF treatments. The GQI was 9.1% lower in the PM treatment than in the MF treatment. These findings suggest that the substitution of mineral fertilizer with cow manure can help achieve a balance between yield, nutrition, and safety, and more stringent regulation of HMs is required for the use of pig manure. Our findings provide actionable insights with implications for sustainable wheat production policies. Full article

Background/Objectives: Hyponatremia has been associated with mortality and hospital readmissions. Although multimorbid older patients are particularly affected, specific data on this group are lacking. Methods: A prospective cohort was used based on the OPERAM (OPtimising thERapy to prevent Avoidable hospital admissions in the Multimorbid elderly) trial, a European multicenter, cluster-randomized trial among hospitalized patients aged ≥70 years with ≥3 chronic medical conditions taking ≥5 long-term medications, with documented sodium values at admission, excluding participants with hypernatremia (>145 mmol/L). The primary outcome was all-cause 1-year mortality, and secondary outcomes were 30-day mortality and readmission at 1 year and at 30 days. We examined the association between hyponatremia and mortality in comparison to normonatremia using a mixed-effects survival model, with adjustment for age, sex, comorbidities, study intervention arm, study site and cluster; and the association between hyponatremia and readmission using competing risk models with death as the competing risk. Subgroup analyses were performed across sodium hyponatremia categories (mild 134–130 mmol/L, moderate 129–125 mmol/L, severe < 125 mmol/L). Results: Of 2008 OPERAM participants, 1968 had a sodium value at admission, and 33 were excluded due to hypernatremia. In the 1935 participants, the mean age was 79.4 years (standard deviation 6.3), 866 (44.8%) were female, the median number of comorbidities was 11 (IQR 8–16), the median number of drugs was 10 (IQR 7–13), and 401 (20.7%) had hyponatremia at admission. The multivariate-adjusted hazard ratio (HR) for 1-year mortality with hyponatremia was 1.41 (95% confidence interval [CI] 1.11–1.78, 364 deaths) and for 30-day mortality was 1.20 (95%CI 0.74–1.94, 89 deaths). The adjusted sub-HR for 1-year readmission was 0.94 (95%CI 0.79–1.11), and that for 30-day readmission was 1.1 (95%CI 0.78–1.59). There was a linear increase in 1-year mortality across hyponatremia categories (HR from 1.31 to 2.64, p for trend = 0.001). Conclusions: Hyponatremia at admission is associated with increased 1-year mortality in multimorbid older adults, with increasing risk for lower sodium values. These findings support sodium as a useful prognostic marker in this setting, while its potential independent impact on survival remains to be clarified in prospective studies. Full article

Objectives: To assess the incidence rate of anterior acute uveitis (AAU) in patients with longstanding axial spondyloarthritis (axSpA); to evaluate demographic and clinical characteristics associated with AAU development; and to determine the influence of AAU on bDMARD initiation and retention in this population. Methods: This two-timepoint cohort study analysed data from patients enrolled in the Spanish SpA registry REGISPONSER (2004–2007), who were re-evaluated 17 years later in the REGISPON-3 follow-up study (2021–2023). Information on the date of first AAU episode and bDMARD initiation was collected. Kaplan–Meier and Cox proportional hazards models were used to assess AAU incidence, predictors, and its association with time to bDMARD initiation and treatment retention. Results: A total of 299 patients with longstanding axSpA were included, of whom 33.4% experienced at least one episode of AAU, corresponding to an incidence rate of 1.15 per 100 person-years. The cumulative probability of a first episode of AAU increased with disease duration. The relative risk for developing a second episode after the first, compared to the overall risk of any episode in the total population, was 1.85 (95% CI: 1.34–2.57). In multivariable cox analysis, female sex and baseline enthesitis were independently associated with a higher risk of AAU. AAU did not significantly affect the likelihood of subsequent bDMARD initiation, with similar cumulative treatment probabilities in patients with and without AAU. Among treated patients, adalimumab was more frequently prescribed in those with a history of AAU. bDMARD retention rates at two and five years were comparable regardless of AAU status, suggesting that AAU was not associated with long-term treatment persistence. Conclusions: In patients with longstanding axSpA, the incidence of AAU increased steadily over time. However, the presence of AAU did not significantly influence bDMARD initiation or long-term retention in routine clinical practice. Full article

Background and Objectives: To evaluate the prognostic value of the Clinical–Pathologic Stage–Estrogen receptor status and Grade (CPS+EG) staging system, which combines clinical staging, pathological staging, oestrogen receptor (ER) status, and tumour grade in predicting survival outcomes in patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer receiving neoadjuvant therapy (NACT). Materials and Methods: A retrospective review was performed on 245 female breast cancer patients who received anti-HER2 therapy alongside NACT at the Medical Oncology Department of Kartal Dr Lütfi Kırdar City Hospital, University of Health Sciences, from April 2012 to June 2024. The CPS+EG score was calculated using the MD Anderson Cancer Centre neoadjuvant treatment response calculator. Patients were categorised into two groups based on their CPS+EG score < 3 and ≥3. The primary outcomes assessed were disease-free survival (DFS) and overall survival (OS). Kaplan–Meier and log-rank tests were utilised for time-to-event analysis; Cox regression was used for multivariate analysis. A significance level of ≤0.05 was considered. Results: The median age of the patient cohort was 51 years (range: 27–82 years). Among these patients, 183 (74.6%) had a CPS+EG score less than 3, while 62 (25.3%) exhibited a score of 3 or higher. The median follow-up duration was 37.6 months. The pathological complete response (pCR) rate across the entire cohort was 51.8%. Specifically, the pCR rate was 56.3% in the group with CPS+EG scores below 3, and 38.7% in those with scores of 3 or higher (p = 0.017). Patients with CPS+EG scores less than 3 demonstrated superior overall survival (OS), which reached statistical significance in univariate analysis. Multivariate analysis identified the CPS+EG score as an independent prognostic factor for both overall survival and disease-free survival (DFS), with hazard ratios of 0.048 (95% CI: 0.004–0.577, p = 0.017) and 0.35 (95% CI: 0.14–0.86, p = 0.023), respectively. Conclusions: The CPS+EG score is an independent and practical prognostic marker, particularly for overall survival, in patients with HER2-positive breast cancer who have received neoadjuvant therapy. Patients with a CPS+EG score < 3 have higher pCR rates and survival rates. When used in conjunction with pCR, it can improve risk categorisation and contribute to the individualisation of adjuvant strategies in the post-neoadjuvant period. Due to its ease of calculation and lack of additional costs, this score can be instrumental in clinical practice for identifying high-risk patients. Our findings support the integration of the CPS+EG score into routine clinical decision-making processes, although prospective validation studies are necessary. Full article

Landslides represent a recurrent hazard in tropical mountain environments, where rapid urbanization and extreme rainfall amplify disaster risk. The Sentani region of Papua, Indonesia, is highly vulnerable, as demonstrated by the catastrophic debris flows of March 2019 that caused fatalities and widespread losses. This study developed high-resolution landslide susceptibility maps for Sentani using an ensemble machine learning framework. Three base learners—Random Forest, eXtreme Gradient Boosting (XGBoost), and CatBoost—were combined through a logistic regression meta-learner. Predictor redundancy was controlled using Pearson correlation and Variance Inflation Factor/Tolerance (VIF/TOL). The landslide inventory was constructed from multitemporal satellite imagery, integrating geological, topographic, hydrological, environmental, and seismic factors. Results showed that lithology, Slope Length and Steepness Factor (LS Factor), and earthquake density consistently dominated model predictions. The ensemble achieved the most balanced predictive performance, Area Under the Curve (AUC) > 0.96, and generated susceptibility maps that aligned closely with observed landslide occurrences. SHapley Additive Explanations (SHAP) analyses provided transparent, case-specific insights into the directional influence of key factors. Collectively, the findings highlight both the robustness and interpretability of ensemble learning for landslide susceptibility mapping, offering actionable evidence to support disaster preparedness, land-use planning, and sustainable development in Papua. Full article

Background: The combined impact of impaired kidney function and subclinical myocardial injury (SCMI) on cardiovascular (CV) mortality has not been well studied. We aimed to evaluate their individual and joint associations with cardiovascular mortality. Methods: We analyzed data from 6057 participants (mean age 57.0 ± 13.0 years) in the U.S. Third National Health and Nutrition Examination Survey. Estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI equation. Electrocardiographic SCMI was defined as a cardiac infarction/injury score ≥ 10. CV mortality was determined from the National Death Index. Multivariable logistic regression assessed baseline cross-sectional associations between eGFR and SCMI. Cox proportional hazards models were used to examine the individual and combined associations of eGFR and SCMI with CV mortality. Results: At baseline, 1297 participants (21.4%) had SCMI. In multivariable logistic regression analysis, eGFR < 45 mL/min/1.73 m² (vs. ≥45) was not associated with SCMI (OR [95% CI]: 1.10 [0.84–1.45]). Over a median follow-up of 18.4 years, 690 CV deaths occurred. In separate Cox models, both SCMI (vs. no SCMI) and eGFR < 45 (vs. ≥45) were associated with increased CV mortality risk (HR [95% CI]: 1.36 [1.16–1.60] and 1.56 [1.24–1.99], respectively). Compared with participants with eGFR ≥ 45 and no SCMI, those with both eGFR < 45 and SCMI had the highest CV mortality risk (HR [95% CI]: 2.36 [1.65–3.36]), followed by eGFR < 45 alone (1.47 [1.09–1.96]) and SCMI alone (1.33 [1.11–1.58]). Conclusions: Both reduced eGFR and SCMI were independently associated with CV mortality. Their coexistence showed the highest risk, but without statistical significance compared with each alone, possibly reflecting limited power and distinct mechanisms. Full article

This study investigates occupant–seat interaction dynamics in high-speed train frontal collisions. A finite element model of a second-class double seat was developed and simulated using LS-DYNA R12.1 software with a Hybrid III dummy, applying trapezoidal and triangular acceleration pulses per European and American standards. The research analyzes the impact of front-row seatback recline angles (0°, 10°, 20°) and seatback-to-base connection stiffness (1000 N/mm to 0 N/mm) on head, neck, chest, and leg injury severity. Results show that a 10° recline provides optimal protection under fixed stiffness. When optimizing both parameters, a 0° recline with approximately 300 N/mm stiffness minimizes composite injury metrics (HIC₁₅, N_ij, CTI). However, reducing stiffness at non-zero recline angles increases neck injury risk due to tray table displacement toward the cervical region. These findings emphasize the critical importance of integrated seat design optimization for rail passenger passive safety and highlight the need to mitigate tray table hazards. Full article

Global climate change and rapid urbanization have intensified urban heat risks, particularly in cities such as Jinan that face pronounced heat-related environmental challenges. This study takes Jinan’s main urban area as a case example, integrating the Local Climate Zone (LCZ) framework with the Hazard–Exposure–Vulnerability–Adaptability (HEVA) model to develop multi-temporal heat risk maps. The results indicate the following: (1) High-risk zones are primarily concentrated in the densely built urban core, whereas low-risk areas are mostly located in peripheral green spaces, water bodies, and forested regions. (2) Heat risk shows clear diurnal patterns, peaking between noon and early afternoon and expanding outward from the city center. (3) LCZ6 (open low-rise), despite its theoretical advantage for ventilation, exhibits unexpectedly high levels of heat hazard, exposure, and vulnerability. (4) SHAP-based analysis identifies land surface temperature (LST), floor area ratio (FAR), impervious surface area ratio (ISA), housing value, building coverage ratio (BCR), and the distribution of cooling facilities as the most influential drivers of heat risk. These findings offer a scientific foundation for developing multi-scale, climate-resilient urban planning strategies in Jinan and hold significant practical value for improving urban resilience to extreme heat events. Full article

Background: Optimal energy and protein delivery during the early phase of severe trauma remains unclear. Observational studies frequently contradict the findings of randomized controlled trials, raising concerns about confounding factors. The aim of this study is to assess nutritional adequacy and daily variability in the energy gaps and its impact on outcomes using innovative statistical methods. Methods: Prospective observational study enrolled severely injured patients in the ICU at the Level 1 trauma center between October 2023 to April 2025. To describe the evolution of calorie and protein deficits during the first 10-day ICU stay, we utilized a linear mixed-effects model to estimate each patient’s individual energy gap trajectory. Results: 286 patients were analyzed. Median APACHE II and ISS score was 16.0 (12.0–20.0) and 22.0 (18.0–27.0), respectively. Mortality rate was 35.3%. Patients received 68.3% of prescribed calories and 76.8% of proteins. Admission energy deficit, rate of caloric intake, and their interaction are associated with ICU mortality. Increased day-to-day energy variability was associated with longer duration of mechanical ventilation (HR = 0.55, 95% CI: 0.31–0.99; p = 0.047). Patients who achieved better caloric (HR = 0.68, 95% CI: 0.48–0.98, p = 0.036) and protein (HR = 0.29, 95% CI: 0.09–0.96, p = 0.043) nutrition had a lower hazard of developing nosocomial infection. Conclusions: This study supports the 2023 ESPEN guidelines, showing that achieving the recommended energy and protein intake during the early phase of severe trauma is linked to lower mortality rates, shorter mechanical ventilation time, and reduced risk of nosocomial infections. Full article

Background: Proteomic profiling may improve the understanding of obesity and cardiovascular risk prediction. This study explores the use of protein-predicted scores for body mass index (PPS_BMI), body fat percentage (PPS_BFP), and waist–hip ratio (PPS_WHR) to estimate risk for major adverse cardiovascular events (MACEs). Methods: We used data from the UK Biobank with proteome profiling. PPS_BMI, PPS_BFP, and PPS_WHR were derived using the LASSO algorithm. The association between these protein scores and incident MACEs was evaluated using a competing risk model. Results: Strong to moderate correlations were observed between protein-predicted obesity phenotypes and their measured counterparts (R²: BMI = 0.78, BFP = 0.85, WHR = 0.63). Each standard deviation increment of PPS_BFP and PPS_WHR, but not PPS_BMI, was associated with greater risk of MACEs (hazard ratio [HR] 1.25, 95% CI 1.14–1.38, p < 0.0001; HR 1.15, 95% CI 1.06–1.24, p = 0.001, respectively). For predicting MACEs, compared with the PREVENT equation (C statistic 0.694), the models adjusted for only age, sex, current smoking, and protein scores showed comparable performance (C statistics 0.684–0.688). Conclusion: Protein-predicted scores of obesity showed strong independent associations and predictive performance for MACEs, suggesting they may capture additional biological risk beyond anthropometry. These scores may complement existing risk models by providing a biologically informed approach to assessing obesity-related cardiovascular risk and improving risk stratification. Full article

Cervical cancer (CC) is the fourth most common cancer among women globally, with venous thromboembolism (VTE) representing a life-threatening complication. Cancer-associated thrombosis (CAT) arises from tumor-driven activation of hemostasis, worsening prognosis. Recently, circulating microRNAs (miRNAs) have emerged as potential biomarkers for both CAT and cervical tumorigenesis. Thus, this study aimed to assess the implications of five miRNAs—miR-20a-5p, -23a-3p, -125b-5p, -145-5p, and -616-3p—in CC-related VTE context. These miRNAs were quantified by RT-qPCR in plasma from 69 CC patients before treatment. Briefly, VTE occurred in nine patients, decreasing overall survival (OS) [log-rank test, p = 0.005; hazard ratio (HR) = 4.78; 95% confidence interval (CI), 1.42–16.05]. Lower miR-20a-5p levels predicted VTE (ꭓ² test, p = 0.027) and, in subgroup analyses, they were linked to cervical squamous cell carcinoma (CSCC) and older age (ꭓ² test, p = 0.003 and p = 0.043, respectively). In VTE patients, miR-145-5p downregulation was associated with improved OS (log-rank test, p = 0.018), an effect also observed in the adenocarcinoma (ADC) subgroup (log-rank test, p = 0.039). The remaining miRNAs showed subtype-specific links to clinicopathological features and survival. These findings highlight the potential value of circulating miRNAs in thrombotic risk and prognosis assessment in CC. Full article

Background: Healthcare professionals are at significant risk of musculoskeletal injuries due to the physically demanding nature of patient-handling tasks. While various ergonomic interventions have been introduced to mitigate these risks, comprehensive methods for assessing and addressing musculoskeletal hazards remain limited. Purpose: This study presents a novel approach to evaluating musculoskeletal injury risks among healthcare workers, marking the first instance in which two motion tracking systems are used simultaneously. This dual-system setup enables a more comprehensive and dynamic analysis of worker interactions in real time. Healthcare professionals were divided into three groups to perform patient transfer tasks. Three key poses within the task, associated with peak lumbar forces, were identified and analyzed. Results: The resulting compressive forces on the participants’ lower back ranged from 581.0 N to 3589.1 N, and the Anterior–Posterior (A/P) shear forces ranged from 33.1 N to 912.3 N across the three poses. Relative differences in trunk flexion showed strong correlations with compressive and A/P shear forces at each pose, respectively. Discussion and conclusion: Strong associations were found between lumbar loads and participant’s anthropometrics. Recommendations for optimal postures and partner pairings were developed to help reduce the risk of lower back injuries during patient handling. Full article

This paper introduces a formal mathematical framework for Digital Risk Twins (DRTs) as an extension of traditional digital twin (DT) architectures, explicitly tailored to the needs of safety-critical systems. While conventional DTs enable real-time monitoring and simulation of physical assets, they often lack structured mechanisms to model stochastic failure processes; evaluate dynamic risk; or support resilient, risk-aware decision-making. The proposed DRT framework addresses these limitations by embedding probabilistic hazard modeling, reliability theory, and coherent risk measures into a modular and mathematically interpretable structure. The DT to DRT transformation is formalized as a composition of operators that project system trajectories onto risk-relevant features, compute failure intensities, and evaluate risk metrics under uncertainty. The framework supports layered integration of simulation, feature extraction, hazard dynamics, and decision-oriented evaluation, providing traceability, scalability, and explainability. Its utility is demonstrated through a case study involving an aircraft brake system, showcasing early warning detection, inspection schedule optimization, and visual risk interpretation. The results confirm that the DRT enables modular, explainable, and domain-agnostic integration of reliability logic into digital twin systems, enhancing their value in safety-critical applications. Full article