Search Results (1,902)

Implementation of molecular detection methodology of Shiga toxin-producing Escherichia coli (STEC) in Danish patients began in 1997. Since then, changes in molecular detection methods and diagnostic criteria have led to the present situation, in which almost all diarrhoeal stool specimens are examined for STEC. Whole genome sequencing (WGS) of STEC isolates referred to the national reference laboratory has increased the detailed characterisation, and revealed a large spectrum, of STEC types, including cross-over pathotypes typically associated with extraintestinal disease or traveller’s diarrhoea. Association of subtype stx2a (and stx2d) with the risk of developing haemolytic uraemic syndrome (HUS) was confirmed. These changes have resulted in an increase in the number of diagnosed STEC cases from 31 cases in 1997 to 1432 in 2023. Similar increases in Europe have also been recorded. Culture of STEC is, on the other hand, declining, which poses a challenge to the identification of multiple STEC infections and outbreaks. Syndromic (PCR) test panels have also resulted in an increase in the detection of multiple microorganisms. Double or triple infections have increased the role of clinical microbiologists in interpreting and assessing the significance of diagnostic results and have also increased the need for high-quality curation of surveillance data. Full article

Buffer zones are essential for the protection of the Outstanding Universal Value (OUV) of World Heritage properties. In China, to address the limitations of the prevailing “two-line” delineation system for architectural heritage protection, this study introduces the concept of buffer zone as a new perspective on heritage management. Focusing on the Cao Family Compound—a representative residence of Shanxi Merchants—this research situates the site within a broader cultural network to fully articulate its historical and social values. The methodology unfolds in three phases: (1) comprehensive identification of 47 spatial elements contributing to the compound’s significance, through field investigation, literature review, analysis of historical imagery and architectural drawing, and oral history interview; (2) systematic evaluation of each element’s value contribution to the compound based on six criteria across two dimensions, employing the Analytic Hierarchy Process (AHP) and Weighted Sum Method (WSM); (3) spatial visualization and hierarchical buffer zone delineation conducted via ArcGIS-based data modeling and the Natural Breaks classification method. This integrated approach establishes a holistic and structured framework that bridges architectural heritage with its setting, providing practical guidance for policymakers and conservation practitioners. Full article

Background/Objectives: Forensic dental determination plays a central role in human identification, age estimation, and trauma analysis in medico-legal contexts. Traditional approaches—including clinical examination, odontometric analysis, and radiographic comparison—remain essential but are constrained by examiner subjectivity, population variability, and reduced applicability in fragmented or degraded remains. Recent advances in cone-beam computed tomography (CBCT), three-dimensional surface scanning, intraoral imaging, and artificial intelligence (AI) offer promising opportunities to enhance accuracy, reproducibility, and integration with multidisciplinary forensic evidence. The aim of this review is to synthesize conventional and emerging approaches in forensic odontology, critically evaluate their strengths and limitations, and highlight areas requiring validation. Methods: A structured literature search was performed in PubMed, Scopus, Web of Science, and Google Scholar for studies published between 2015 and 2025. Search terms combined forensic odontology, dental identification, CBCT, 3D scanning, intraoral imaging, and AI methodologies. From 108 records identified, 81 peer-reviewed articles met eligibility criteria and were included for analysis. Results: Digital methods such as CBCT, 3D scanning, and intraoral imaging demonstrated improved diagnostic consistency compared with conventional techniques. AI-driven tools—including automated age and sex estimation, bite mark analysis, and restorative pattern recognition—showed potential to enhance objectivity and efficiency, particularly in disaster victim identification. Persistent challenges include methodological heterogeneity, limited dataset diversity, ethical concerns, and issues of legal admissibility. Conclusions: Digital and AI-based approaches should complement, not replace, the expertise of forensic odontologists. Standardization, validation across diverse populations, ethical safeguards, and supportive legal frameworks are necessary to ensure global reliability and medico-legal applicability. Full article

Postimplantation syndrome (PIS) is an early inflammatory response following endovascular stent-graft implantation (EVAR and TEVAR), defined by culture-negative fever and leukocytosis. The patient’s preoperative inflammatory status is thought to play a central role in its development. This study aimed to evaluate whether the systemic inflammatory response index (SIRI) and the eosinophil-to-lymphocyte ratio (ELR) can serve as preoperative predictors of PIS. Clinical data from 300 patients who underwent aortic endograft implantation and laboratory results obtained 24 h before the procedure, and at 24 h, 72 h, and 1 week postoperatively, were prospectively recorded. PIS was defined as culture-negative fever ≥ 37.8 °C accompanied by leukocytosis ≥ 12,000/µL. Inflammation-based indices derived from complete blood count (SIRI and ELR), along with serum C-reactive protein (CRP) and albumin levels, were compared between patients with and without PIS. Logistic regression and receiver operating characteristic (ROC) analyses were performed to identify independent predictors. PIS developed in 55 patients (18.3%). Patients with PIS were younger (70.1 ± 8.6 vs. 72.7 ± 7.3 years; p = 0.042) and had larger aneurysm diameters and greater mural thrombus thickness. Preoperatively, leukocyte count, SIRI, and CRP levels were significantly higher in patients who developed PIS, whereas ELR and albumin levels were lower. Multivariable analysis showed that a larger aneurysm diameter (OR: 1.2; 95% CI: 1.0–1.3; p = 0.003), greater mural thrombus thickness (OR: 1.3; 95% CI: 1.0–1.6; p = 0.012), EVAR procedure (OR: 3.7; 95% CI: 1.2–6.3; p = 0.033), elevated SIRI (OR: 1.9; 95% CI: 1.2–3.1; p = 0.005), and higher CRP (OR: 1.4; 95% CI: 1.1–3.2; p = 0.003) were significantly associated with PIS. In contrast, increasing age, higher ELR, and higher albumin levels were associated with a reduced risk of PIS. Simple biomarkers routinely obtained from standard laboratory tests can contribute meaningfully to the preoperative prediction and postoperative identification of PIS. Their integration into risk stratification models and confirmation against definitive diagnostic criteria will require validation in larger, multicenter studies. Full article

Arrhythmogenic cardiomyopathy (ACM; MIM #107970) is a primitive heart muscle disease characterized by progressive myocardial loss and fibrosis or fibrofatty replacement, predisposing patients to ventricular arrhythmias, sudden cardiac death, and heart failure. Despite advances in imaging and genetics, early diagnosis remains challenging due to incomplete penetrance, variable phenotypic expressivity, and the fact that fatal arrhythmic events may often occur in the early stages of the disease. In this context, the identification of reliable biomarkers could enhance diagnostic accuracy, support risk stratification, and guide clinical management. This narrative review examines the current landscape of potential and emerging biomarkers in ACM, including troponins, natriuretic peptides, inflammatory proteins, microRNAs, fibrosis-related markers, and other molecules. Several of these biomarkers have demonstrated associations with disease severity, arrhythmic burden, or structural progression, although their routine clinical utility remains limited. The increasing relevance of genetic testing and non-invasive tissue characterization—particularly through cardiac imaging techniques—should also be emphasized as part of a multimodal diagnostic strategy in which biomarkers may play a complementary role. Although no single biomarker currently meets the criteria for a standalone diagnostic application, ongoing research into multi-marker panels and novel molecular targets offers promising perspectives. In conclusion, the integration of circulating biomarkers with imaging findings, genetic data, and clinical parameters may open new avenues for improving early detection and supporting personalized therapeutic strategies in patients with suspected ACM. Full article

Objectives: This study aimed to evaluate the reproducibility of artificial intelligence (AI) in identifying cephalometric landmarks, comparing its performance with manual tracing by an experienced orthodontist. Methods: A high-quality lateral cephalogram of a 26-year-old female patient, meeting strict inclusion criteria, was selected. Eighteen cephalometric landmarks were identified using the WebCeph software (version 1500) in three experimental settings: AI tracing without image modification (AInocut), AI tracing with image modification (AI-cut), and manual tracing by an orthodontic expert. Each evaluator repeated the procedure 10 times on the same image. X and Y coordinates were recorded, and reproducibility was assessed using the coefficient of variation (CV) and centroid distance analysis. Statistical comparisons were performed using one-way ANOVA and Bonferroni post hoc tests, with significance set at p < 0.05. Results: AInocut achieved the highest reproducibility, showing the lowest mean CV values. Both AI methods demonstrated greater consistency than manual tracing, particularly for landmarks such as Menton (Me) and Pogonion (Pog). Gonion (Go) showed the highest variability across all groups. Significant differences were found for the Posterior Nasal Spine (PNS) point (p = 0.001), where AI outperformed manual tracing. Variability was generally higher along the X-axis than the Y-axis. Conclusions: AI demonstrated superior reproducibility in cephalometric landmark identification compared to manual tracing by an experienced operator. While certain points showed high consistency, others—particularly PNS and Go—remained challenging. These findings support AI as a reliable adjunct in digital cephalometry, although the use of a single radiograph limits generalizability. Broader, multi-image studies are needed to confirm clinical applicability. Full article

Background: Hypophosphatemia is a frequently underestimated metabolic disorder, yet it can be one of the first biochemical findings in primary hyperparathyroidism (PHPT). Current diagnostic and surgical criteria for PHPT do not include serum phosphate, despite its potential value as an early marker. Methods: We report the case of a 79-year-old woman with type 2 diabetes mellitus, hypertension and osteoarthritis, followed since 2015 for persistent hypophosphatemia (0.8 mg/dL) and stress fractures. Results: Initial calcium and vitamin D levels were normal, but PTH was elevated. Bone scintigraphy revealed multiple stress fractures, while ultrasound and sestamibi scan were inconclusive. Despite cholecalciferol and calcitriol supplementation, hypophosphatemia persisted. From 2023, progressive hypercalcemia developed (10.9 mg/dL), with sustained hypophosphatemia (1.7 mg/dL), persistently high PTH (121 pg/mL) and markedly elevated FGF-23 (1694 kRU/L). Renal phosphate wasting was demonstrated, with reduced tubular reabsorption. An 18F-fluorocholine PET-CT performed in 2024 identified two right parathyroid adenomas, establishing the diagnosis of PHPT. The patient was referred for parathyroidectomy. Conclusions: Hypophosphatemia may serve as a complementary biomarker in the diagnostic and therapeutic approach to PHPT, but only after other potential causes of low phosphate levels have been excluded, as illustrated in this case. Its consideration could facilitate the early identification of PHPT and improve clinical decision-making, particularly in patients who do not meet classical surgical indications. Full article

This study presents the first systematic investigation of ancient Egyptian votive animal mummy wrappings, based on the analysis of an extensive dataset encompassing specimens from various museum collections and archaeological contexts. The research addresses the long-standing neglect and fragmented understanding of the wrapping chaîne opératoire and aims to establish a consistent terminology, as the different stages of the wrapping sequence, bundle shapes, and decorative patterns have often been described vaguely. Through an interdisciplinary methodology that integrates photogrammetry, colorant identification, textile analysis, and experimental archaeology, the study explores the complexity of wrapping practices across their different stages. This approach offers new insights into the structural logic, raw material selection, and design conventions behind this production. The analysis reveals that the bundles exhibit standardized shapes and decorative patterns grounded in well-established visual criteria and manufacturing sequences. These findings demonstrate that the wrappings reflect a codified visual language and a high level of technical knowledge, deeply rooted in Egyptian tradition. The study also emphasizes its economic implications: the wrapping significantly enhanced the perceived value of the offering, becoming the primary element influencing both its material and symbolic worth. Ultimately, this work provides an interpretative framework for understanding wrapping as an essential medium of ritual sacralization for votive animal mummies, allowing the individual prayer to be effectively conveyed to the intended deity. Consequently, this research marks a significant step forward in advancing the technical, aesthetic, and ritual insight of wrapping practices, which preserve a wealth of still-overlooked information. Full article

Background: Stroke is a leading cause of seizures and epilepsy, both of which are linked to increased mortality, disability, and hospital readmissions. Early recognition and management of seizures in acute stroke are crucial for improving outcomes. Electroencephalogram (EEG) is not routinely used for post-stroke seizure monitoring and is typically initiated only after clinical suspicion arises, making bedside recognition essential. This scoping review aimed to map the existing literature on clinical methods used for identifying and observing early post-stroke seizures (EPSSs) at the bedside. Methods: We included literature involving adults with acute ischaemic stroke or primary intracerebral haemorrhage who were diagnosed or suspected of having inpatient EPSS. Searches were conducted in Medline, CINAHL, Embase, and the Cochrane Library for English-language publications up to April 2023. Eligible sources included primary research, case reports, systematic reviews, clinical guidelines, consensus statements, and expert opinion. Reference lists of included articles were also reviewed. Data were charted and synthesised to assess the scope, type, and gaps in the evidence. Results: Thirty papers met inclusion criteria: 17 research studies, six expert opinions, four case reports, and three clinical guidelines. Empirical evidence on clinical methods for seizure recognition and monitoring in acute stroke was limited. No studies evaluated the effectiveness of different approaches, and existing recommendations lacked detail and consensus. Conclusions: Accurate EPSS diagnosis is vital due to its impact on outcomes. This review highlights inconsistency in monitoring methods and a clear need for targeted research into effective clinical identification strategies in acute stroke care. Full article

Necrotizing enterocolitis (NEC) is a significant cause of morbidity and mortality for preterm infants in the neonatal intensive care unit. From the first surgical approaches for NEC in the 1970s and the development of Bell’s staging criteria, there has been a continuous medical and scientific journey towards understanding the pathophysiology, clinical progression, and treatment possibilities for this devastating disease. Basic science research has played a crucial role in understanding the pathogenesis of NEC. In vivo NEC models, which include rodents (mice, rats) and pigs, and in vitro NEC models, which utilize intestinal cell lines and organoids, have identified critical disease biomarkers, pathways in NEC pathogenesis, and novel therapeutic targets. These potential therapies have been brought into clinical trials to improve treatment options for infants with NEC. This review will provide a comprehensive assessment of research conducted over the last decade, leading to a deeper understanding of the disease’s development and progression through the use of innovative models, the identification of novel biomarkers, the development of new therapeutic approaches, and, finally, an overview of the latest clinical trials. We will conclude with a discussion of ongoing challenges and future research directions, highlighting the optimism and hope that these advancements bring to the field of neonatology and pediatric surgery. This review will serve as a reference and guide for future NEC research, with the ultimate goal of enhancing clinical outcomes and improving the quality of life for patients with NEC and their families. Full article

Tackling climate change in the public–private partnership (PPP) infrastructure sector requires radical transformation of projects to make them resilient against climate risks and free from excessive carbon emissions. Types of PPP infrastructure such as transport, power plants, hospitals, schools and residential buildings experience more than 30% of global climate change risks. Therefore, this study aims to examine the interrelationships between the climate risk management strategies in PPP infrastructure projects. The first step in conducting this research was to identify the strategies through a comprehensive literature review. The second step was data collection from 147 PPP stakeholders with a questionnaire. The third step was analysing the interrelationships between the strategies using a partial least square–structural equation model approach. The findings include green procurement, defined climate-resilient contract award criteria, the identification of climate-conscious projects and feasible contract management strategies. The results provide understanding of actionable measures to counter climate risks and they encourage PPP stakeholders to develop and promote climate-friendly strategies to mitigate climate crises in the PPP sector. The results also serve as foundational information for future studies to investigate climate change risk management strategies in PPP research. Full article

Background: Bioelectrical impedance analysis (BIA) is a widely used field technique for assessing body composition in football. However, its reliance on population-specific regression equations limits its accuracy. Objective: This scoping review aimed to map the scientific literature on BIA applications in professional and semi-professional football, highlighting uses, limitations, and research opportunities. Methods: A comprehensive search was conducted in the scientific databases PubMed, EMBASE, Web of Science, and SPORTDiscus. Identified studies involved the use of BIA in professional and semi-professional football players (≥16 years) in the context of routine training and competition. Results: From 14,624 records, 39 studies met the inclusion criteria and were included. Three main applications were identified: (1) quantitative body composition assessment, (2) qualitative/semi-quantitative analysis (e.g., bioelectrical impedance vector analysis (BIVA)), and (3) muscle health and injury monitoring. Seven specific research areas emerged, including hydration monitoring, cross-method validation of body composition analyses, development of predictive models, sport phenotype identification, tracking training adaptations, performance/load assessment via phase angle, and localized BIA for injury diagnosis and recovery. Conclusions: While quantitative BIA estimates may lack individual-level precision, raw parameter analyses may offer valuable insights into hydration, cellular integrity, and muscle injury status, yet further research is needed to fully realize these applications. Full article

Background: Demoralization, anxiety, irritability, and depression are common among hospital patients and are associated with poorer outcomes and greater healthcare burden. Early identification is essential, but simultaneous screening across multiple domains is often impractical with questionnaires. Computerized Adaptive Testing (CAT) offers a solution by tailoring item administration, reducing test length while preserving measurement precision. The aim of this study was to develop and validate FRIDA (Four-factor Rapid Interactive Diagnostic Assessment), a freely accessible, web-based CAT for rapid multidimensional screening of psychopathology in hospital patients. Methods: We analysed data from 472 medically ill in-patients at a University Hospital. Item calibration was performed using a four-factor graded response model (demoralization, anxiety, irritability, depression) in the mirt package. CAT simulations were run with 1000 virtual respondents to optimize item selection, exposure control, and stopping rules. The best configuration was applied to the real dataset. Criterion validity for demoralization was evaluated against the Diagnostic Criteria for Psychosomatic Research (DCPR). Results: The four-factor model showed good fit (CFI = 0.947, RMSEA = 0.080). Factor correlations were moderate to high, with the strongest overlap between demoralization and depression (r = 0.93). In simulations, the CAT required, on average, 7.8 items and recovered trait estimates with high accuracy (r = 0.94–0.97). In real patients, mean test length was 11 items, with accuracy of r = 0.95 across domains. FRIDA demonstrated good criterion validity for demoralization (AUC = 0.816; sensitivity 80%, specificity 67.5%). Conclusions: FRIDA is the first freely available, multidimensional CAT for rapid screening of psychopathology in hospital patients. It offers a scalable, efficient, and precise tool for integrating mental health assessment into routine hospital care. Full article

Hyperechoic vertical artifacts are an essential feature of lung ultrasound (LUS) arising from various pathological states. Those that meet the criteria for B-lines have the most significant diagnostic value and should be differentiated from other hyperechoic vertical artifacts of unspecified clinical importance. Although numerous studies have assessed the impacts of transducer type on the appearance of B-lines in human medicine, comparative studies in veterinary medicine are limited and conflicting. This study compares three transducer types for the assessment of hyperechoic vertical artifacts in dogs. We hypothesize that there is high-level reviewer agreement in the assessment of HVA image quality and characteristics, and that the image quality/characteristics differ between the three transducers. Dogs (n = 8) with HVAs and sonographic absence of lung consolidations, pleural effusion, and/or pneumothorax were enrolled. Twenty-four cine-loops (5 s) containing HVAs were retrospectively and independently reviewed by two reviewers, who were blinded to the case details but not transducer type. The reviewers assessed the cine-loops for the following: whether HVAs meet the B-line criteria, ease of counting HVAs, and overall image quality. Paired cine-loops from the same patient using different transducers were then presented for HVA quality comparison. Inter-rater concordance was determined using the Kappa coefficient, Kendall’s tau, and Pearson correlation coefficient, while characteristics were compared using chi-square and Kruskal–Wallis tests (level of significance, α = 0.05). The overall concordance of image quality was good (Pearson’s coefficient = 0.82). The PA transducer scored lower in image quality (p < 0.001), HVA blending (p = 0.014), graininess (p < 0.001), and clarity of edges (p < 0.001) when compared with the microconvex and linear transducers, and the identification of B-line criteria differed between transducers (p = 0.024). Furthermore, the PA scored lowest in the comparison of paired cine-loops regarding the image and HVA quality (p < 0.001). Although more HVAs failed to reach the far field with the linear transducer (10/16, 62.5%) compared with the microconvex (8/16, 50%) and PA (3/16, 18.5%) transducers, the linear transducer scored higher than the microconvex and PA transducers regarding its ability to count B-lines (p < 0.001). This study demonstrates that the type of transducer significantly impacts the characteristics of HVAs, with the PA transducer producing lower-quality images compared with the microconvex and linear transducers. Full article

Menopausal symptoms can substantially impair women’s quality of life, yet large-scale, population-based data from German-speaking regions are lacking. We used data of a cross-sectional online survey among 26,338 women in Germany, Austria, and Switzerland, using validated instruments such as the Menopause Rating Scale (MRS II), Insomnia Severity Index (ISI), and Alcohol Use Disorders Identification Test (AUDIT-C). Additional questions covered weight change, employment, nutrition, and physical activity. We investigated correlations and group differences using descriptive statistics and univariate tests. The average MRS score was 16.94, with 51% classified as severe discomfort and 15% as requiring treatment. Insomnia was common, with 90.3% reporting at least some degree of sleep disturbance and nearly half (48%) meeting criteria for clinical insomnia. Sleep problems were significantly associated with menopausal symptom severity. No correlations were found between MRS scores and reported nutrition and exercise. Unemployment and weight gain were significantly associated with higher symptom burdens. These findings highlight the considerable health burden faced by menopausal women in the DACH region and suggest a substantial unmet need for clinical and public health interventions. Full article