Search Results (2,970)

Background and Objectives: Diabetic foot gangrene remains a major cause of lower limb amputation, driven by vascular, neuropathic, and infectious mechanisms. Identifying predictors for amputation type is essential to optimizing outcomes and reducing disability. We aimed to analyze the burden of diabetic foot gangrene and the patients’ characteristics according to the type of surgery, minor or major amputations. Methods: We conducted a retrospective observational study including 295 diabetic patients who underwent surgery for foot lesions at a Romanian tertiary center (January 2023–December 2024). Patients were classified according to surgical outcome as minor (toe/foot-level) or major (below/above-knee) amputations. Clinical, demographic, and pathological variables were compared between groups. Statistical analysis was performed with IBM SPSS Statistics 20.0. Categorical variables were expressed as frequencies and percentages, and continuous variables as mean ± SD or median (min–max). Group comparisons used Student’s t-test, Mann–Whitney U, Chi-square, or Fisher’s exact test, and binary logistic regression was applied to calculate odds ratios (OR) with 95% confidence intervals (CI). Results: Among the patients included (mean age 64.8 ± 10.8 years; 69.2% male), 191 (64.7%) underwent minor amputations/debridement and 104 (35.3%) required major amputations. Patients with major amputations were older (66.8 ± 11.3 vs. 63.7 ± 10.4 years, p = 0.012) and less frequently male (56.7% vs. 75.9%, p = 0.001). Lesion extension to the foot or beyond strongly predicted major amputation (p < 0.001). Peripheral arterial disease was more prevalent in the major group (85.6% vs. 65.4%, OR = 3.13, 95% CI = 1.68–5.84), while neuropathy was associated with minor procedures (12.6% vs. 3.8%, p = 0.015). Anemia (70.2% vs. 56.5%, p = 0.021) and leukocytosis (68.3% vs. 49.2%, p = 0.002) were also independent predictors of major amputation. Conclusions: The study highlights the need for early detection, coordinated multidisciplinary care, and personalized assessment of diabetes burden and its complications to minimize the risk of major limb amputation. Full article

In many countries across the Western world, religion is in decline, with public secular environments increasingly outweighing family-based religious socialization. Canada and West Germany exemplify this trend, where younger generations often perceive religion as something to be justified within predominantly nonreligious peer groups. Muslims, as a religious minority, display greater resilience to secularization, yet their religiosity is also subject to transformation. Drawing on narrative family interviews spanning two to three generations, this study examines the conditions shaping religious continuity and discontinuity within Muslim families in Canada and West Germany. Focusing on second- and third-generation Muslims, we find that practicing religion with children is the most significant factor in successful transmission, especially when rituals are woven into daily life. Yet family practice alone is insufficient: embedding children in faith-based community networks and fostering open dialogue about religion prove crucial for sustaining confidence, belonging, and adaptability. Religious transmission also intersects with ethnic and cultural identity, though ethnic ties alone do not guarantee continuity. Ultimately, we observe that transmission involves transformation: parents are changing the way they approach religion, placing a greater emphasis on their children making their own choices. Muslim families, like other faith communities, shift toward more individualized and reflective forms of religiosity, negotiating their identities within secular and often critical societal contexts. Full article

Background: Hereditary spastic paraplegia (HSP) is a clinically and genetically heterogeneous group of neurodegenerative disorders characterized by progressive lower-limb spasticity and weakness. SPAST mutations are the most common cause of autosomal dominant HSP (SPG4). However, many pathogenic SPAST variants are unique and genetic data from underrepresented communities remain limited. Methods: Whole-exome sequencing (WES) was performed on the index patient with HSP. Variant annotation tools included Ensembl VEP, LOFTEE, CADD, SIFT, PolyPhen-2, MutationTaster, and SpliceAI. Variant interpretation followed ACMG/AMP guidelines. Clinical evaluation and family history supported phenotypic correlation and segregation. Results: A novel heterozygous frameshift variant in SPAST (c.339delG; p.Glu114Serfs*47) was identified. The variant was predicted to cause nonsense-mediated decay, resulting in loss of the microtubule-interacting and AAA ATPase domains of spastin. It was absent from population databases (gnomAD, TOPMed, 1000 Genomes) and public variant repositories (ClinVar, HGMD). The variant segregated with disease in two affected siblings and could be classified as likely pathogenic. Conclusions: This novel SPAST frameshift variant expands the mutational spectrum of SPG4-HSP and highlights the importance of including isolated or minority communities in genomic research to improve variant interpretation. Full article

Background: The definitions and approaches used to diagnose gestational diabetes (GD) are varied. The two-step approach recommended by the American College of Obstetricians and Gynecologists (ACOG) combines the sensitivity of a glucose challenge test (GCT) with the specificity of a 3-hour oral glucose tolerance test (OGTT). We investigated if minor modification of the two-step procedure can provide improved detection of GD by identifying a risk group of pregnant women with high risk of GD. Methods: We conducted a prospective cohort study of pregnant women enrolled early during pregnancy and followed till delivery. All participants underwent the ACOG-recommended two-step procedure for GD diagnosis. Based on GCT and OGTT results, the participants were divided into four risk groups (RGs): GCT-negative (RG0), GCT-positive but OGTT normal (RG1), single abnormal value on OGTT or raised HbA1c (RG2) and diagnosed GD (RG3). Baseline evaluation included dietary history (24 hour recall) and physical activity. A series of multivariable logistic regression analyses were conducted to estimate the odds of maternal and fetal outcomes. Results: A total of 1041 pregnant women were included in the study, of whom 16 (1.6%) were diagnosed as GD. Our two-step approach identified 48 (4.6%) women as GD, while RG2, RG1 and RG0 comprised 75 (7.2%), 218 (20.9%) and 700 (67.2%), respectively. Compared to RG0, RG2 showed a higher likelihood of antepartum complications [odds ratio and 95% confidence interval 2.38 (1.16–4.15)], any adverse outcome without [2.04 (1.17–3.55)] or with cesarean section [2.09 (1.21–3.61)] and primary cesarean section [1.68 (1.01–2.81)] after adjustment for potential confounders. RG2 was also significantly associated with pregnancy-induced hypertension, meconium-stained amniotic fluid and premature rupture of membranes. Conclusions: In the study participants, we identified a subgroup (RG2) at high risk of GD with perinatal outcomes showing profile consistent with that of GD. Full article

Background: Metabolic syndrome, a cardiovascular risk cluster, is recognized as a global health priority influenced by gene–diet interactions. The rs2794720 polymorphism has not been previously reported in relation to metabolic syndrome. This study examined the associations between dietary iron, SNP rs2794720, and metabolic syndrome in Chinese metropolitan population, with a focus on sex-specific and genotype-specific effects. Methods: A community-based cross-sectional study enrolled 2639 adults (1254 males, 1385 females) from Shanghai, China. Anthropometric measurements, laboratory analyses, and genotyping for the participants were performed. Dietary assessment utilized the 3-day 24 h dietary recall method. Metabolic syndrome was identified by the presence of at least three out of five metabolic abnormalities according to the NCEP—ATP III criteria. Results: After adjusting for confounders, in males, metabolic syndrome risk was associated with dietary iron (p = 0.002) but not with rs2794720 (p = 0.731). In females, metabolic syndrome risk was associated with rs2794720 (p = 0.014) and dietary iron (p = 0.016), with a significant interaction observed between rs2794720 and dietary iron (p = 0.047). Stratified by rs2794720, among females lacking the C allele, there was a linear trend between dietary iron and metabolic syndrome risk (p = 0.048). Compared to the reference group (lowest-intake GG homozygotes), the Q2–Q4 Ors (95% CI) were 5.31 (1.08, 39.52), 5.50 (1.16, 40.28), and 8.40 (1.80, 41.44)), while the major allele carriers did not show this trend (p = 0.704); compared to the reference group, the Q1–Q4 ORs(95% CI) were 6.13 (1.68, 39.66), 7.53 (2.06, 48.86), 8.10 (2.20, 52.60), and 7.84 (2.07, 51.70)). Conclusions: Our study first identified rs2794720 as a novel SNP associated with metabolic syndrome in Chinese females. The association between dietary iron and metabolic syndrome risk was unique to GG homozygotes (the minority), whereas CC/CG genotypes (the majority) showed no such association. Full article

Glyphosate, a widely used herbicide, is under scrutiny for its potential neurotoxic effects. This study investigated whether oral exposure to glyphosate, even at doses currently considered safe in Europe, alters the neurochemical profile of enteric nervous system (ENS) neurons in the porcine jejunum. Fifteen immature female pigs were allocated to three groups: control (C), low-dose (G50; 50 µg/kg b.w./day), and higher-dose (G500; 500 µg/kg b.w./day). Following 28 days of exposure, jejunal samples were subjected to double-labelling immunofluorescence staining for neuronal markers, including Hu C/D and PACAP, CGRP, CART, nNOS, or VAChT. Results revealed dose-dependent neurochemical alterations across all enteric plexuses, with glyphosate increasing the number of neurons expressing PACAP, CGRP, CART, and nNOS, while reducing VAChT-positive neurons. The effect of glyphosate on enteric neurons appeared largely uniform across different plexus types, with more pronounced changes at the higher dose and only minor regional variation. Overall, the findings suggest that glyphosate exposure, even within regulatory limits, may alter the neurochemical profile of enteric neurons in a broadly uniform manner, potentially reflecting responses to oxidative stress or early neurotoxic effects, as reported in previous studies. This study challenges current safety thresholds and emphasises the need to reassess regulatory guidelines, particularly in the context of chronic exposure and potential risks to vulnerable populations. Full article

In Georgia (Sakartvelo), a program promoting bilingual education in preschool institutions was formally adopted in 2020. It aligns with the objectives of the 2021–2030 State Strategy for Civic Equality and Integration Plan, which envisions a comprehensive reform of bilingual education across Georgia’s regions. Any reform requires research and evaluation to measure how effectively it is being implemented and whether the intended outcomes have been achieved. The bilingual education initiative pursues a dual objective: to preserve the native languages of minority communities while ensuring effective acquisition of the state language. This dual mandate is intrinsically linked to state language policy and constitutes a sensitive issue for local communities, parents, and preschool administrators, thereby necessitating a careful and nuanced approach. The present study analyzed the readiness of the social environment to support the implementation of bilingual education programs at the preschool level in the regions of Georgia in which ethnic minorities live side by side. Research was carried out in two ethnically diverse regions—Kvemo Kartli and Samtskhe–Javakheti. The author conducted individual and group interviews, and the elicited data were analyzed with the help of content and thematic analyses. This study examines key attributes of the ongoing preschool reform to identify factors that facilitate the effective implementation of early bilingual education initiatives. The findings highlight both commonalities and regional variations in parental attitudes toward the bilingual education reform. Full article

Background: Esophageal adenocarcinoma (EAC) and squamous cell carcinoma (ESCC) follow divergent incidence trajectories in the United States. Rising use of electronic nicotine delivery systems (ENDS) and evolving demographic risk profiles may be reshaping these trends. We aimed to characterize national incidence patterns of EAC and ESCC from 2000 through 2022—stratified by age, sex, and race/ethnicity—and to place these in the context of changing behavioral exposures. Methods: We performed a retrospective cohort study using Surveillance, Epidemiology, and End Results SEER 21 registry data (covering 48% of the U.S. population). We included first-primary, histologically confirmed EAC (ICD-O-3 codes 8140–8576) and ESCC (8050–8084) in individuals aged ≥ 15 years diagnosed between 2000 and 2022. Age-adjusted incidence rates (per 100,000 person-years; 2000 U.S. standard) and annual percent changes (APCs) were estimated via Joinpoint regression models. Results: A total of 90,290 EAC and 47,916 ESCC cases were identified. EAC incidence increased from 2.3 to 2.8 per 100,000 (APC +0.90%; 95% CI, 0.45–1.35), with the largest relative rises in ages 15–39 years (APC +1.50%) and among women (APC +2.65%). Non-Hispanic Black and American Indian/Alaska Native populations experienced the most pronounced EAC increases. Overall ESCC incidence declined (APC −0.78%; 95% CI, −1.10 to −0.46), though Asian/Pacific Islander (+3.59%) and American Indian/Alaska Native (+1.58%) groups saw rising rates. Conclusions: EAC incidence continues to climb—especially in younger adults, women, and select racial/ethnic minorities—while ESCC declines are uneven. These histology-specific patterns highlight the urgency of tailored prevention, targeted early-detection efforts, and mechanistic studies on emerging exposures such as vaping. Full article

As universities become increasingly open, campuses are no longer only places for study and daily life for students and faculty, but also essential spaces for public visits and cultural identity. Traditional perception evaluation methods that rely on manual surveys are limited by sample size and subjective bias, making it challenging to reveal differences in experiences between groups (students/visitors) and the complex relationships between spatial elements and perceptions. This study uses a comprehensive open university in China as a case study to address this. It proposes a research framework that combines street-view image semantic segmentation, perception survey scores, and interpretable machine learning with sample augmentation. First, full-sample modeling is used to identify key image semantic features influencing perception indicators (nature, culture, aesthetics), and then to compare how students and visitors differ in their perceptions and preferences across campus spaces. To overcome the imbalance in survey data caused by group–space interactions, the study applies the CTGAN method, which expands minority samples through conditional generation while preserving distribution authenticity, thereby improving the robustness and interpretability of the model. Based on this, attribution analysis with an interpretable decision tree algorithm further quantifies semantic features’ contribution, direction, and thresholds to perceptions, uncovering heterogeneity in perception mechanisms across groups. The results provide methodological support for perception evaluation of campus functional zones and offer data-driven, human-centered references for campus planning and design optimization. Full article

STEM (Science, Technology, Engineering & Mathematics) programs hold significant social and economic relevance, as the technological innovation that sustains a country’s competitiveness depends on them. This article compares research on STEM programs in Portuguese- and Spanish-speaking countries, specifically Brazil, Chile, Portugal, and Spain. More specifically, it aims to reflect on the social and economic relevance of STEM programs; vocational choices and the social stereotypes associated with these fields; the variables that influence academic success, retention, and graduation rates; and the measures implemented, either nationally or by Higher Education Institutions (HEIs), to promote access and success in these programs. We conducted qualitative research, analyzing official documents and peer-reviewed articles that describe the higher education landscape in the selected countries. Results show that in all four countries studied, there is a growing demand for STEM graduates. However, concerns remain about high dropout and failure rates, as well as the lower participation of women and students from disadvantaged socioeconomic backgrounds or ethnic minorities. Some measures have been implemented by the governments of these countries to promote greater democratization of access and academic success for these students. Nevertheless, inequalities persist, suggesting the need to increase investment in practices and policies that encourage young people, especially those from more disadvantaged groups, to engage early in STEM domains. Full article

The aim of this pilot in vitro study is to investigate the fracture strength of hybrid abutment crowns (HACs) made of a 3D-printable, tooth-colored, ceramic-reinforced composite (CRC). Based on an upper first premolar, a crown was designed, and specimens were additively fabricated from a composite material (VarseoSmile Crown plus) (N = 32). The crowns were bonded to standard abutments using a universal resin cement. Half (n = 16) of the samples were subjected to artificial aging, during which three samples suffered minor damage. All specimens were mechanically loaded at an angle of 30° to the implant axis. In addition, an FEM simulation was computed. Statistical analysis was performed at a significance level of p < 0.05. The mean fracture load without aging was 389.04 N (SD: 101.60 N). Two HACs suffered screw fracture, while the crowns itself failed in all other specimens. In the aged specimens, the mean fracture load was 391.19 N (SD: 143.30 N). The failure mode was predominantly catastrophic crown fracture. FEM analysis showed a maximum compressive stress of 39.79 MPa, a maximum tensile stress of 173.37 MPa and a shear stress of 60.29 MPa when loaded with 389 N. Within the limitations of this pilot study, the tested 3D-printed hybrid abutment crowns demonstrated fracture resistance above a clinically acceptable threshold, suggesting promising potential for clinical application. However, further investigations with larger sample sizes, control groups, and clinical follow-up are required. Full article

Background: Contemporary dermatology and cosmetology continue to explore effective strategies for normalizing the function of oily skin, where excessive sebum production and impairment of the hydrolipid barrier pose considerable therapeutic challenges. The aim of the present study was to evaluate the effects of a series of microneedling mesotherapy treatments with a sebum-regulating ampoule on selected biophysical parameters of the skin in individuals with oily skin. Methods: The study included 19 female volunteers aged 18–42 years, who underwent six treatment sessions at three-week intervals. Skin parameters were assessed at baseline, after three sessions, and after six sessions using the MPA system (Courage & Khazaka) equipped with the following probes: Corneometer (hydration), Sebumeter (sebum secretion), pH meter (surface pH), Glossymeter (skin shininess), and Tewameter (transepidermal water loss). Results: After six sessions, hydration significantly increased both in the T-zone (from 43.9 ± 8.0 to 54.0 ± 5.4 AU; +23%) and on the cheeks (from 35.9 ± 8.3 to 55.6 ± 4.8 AU; +55%) (p < 0.001). Sebum secretion decreased markedly, with values in the T-zone falling from 192.2 ± 30.6 to 127.7 ± 27.2 AU (−34%) and on the cheeks from 185.0 ± 36.2 to 114.8 ± 30.1 AU (−38%) (p < 0.001). Skin surface pH showed minor but significant modulation within the physiological range (T-zone: 6.33 ± 0.64 → 6.01 ± 0.17; cheeks: 6.14 ± 0.50 → 6.03 ± 0.17; p = 0.021). TEWL demonstrated a nonsignificant change (T-zone: 17.46 ± 11.31 → 19.09 ± 3.54 g/m²/h; cheeks: 20.89 ± 5.36 → 18.37 ± 2.95 g/m²/h; p > 0.05), while skin gloss remained stable (T-zone: 5.46 ± 1.25 → 5.60 ± 1.16 GU; cheeks: 5.29 ± 1.76 → 4.87 ± 1.20 GU; p > 0.05). Conclusions: Microneedling mesotherapy combined with a sebum-regulating ampoule significantly improved skin hydration and reduced sebum secretion, accompanied by stabilization of skin surface pH. Although changes in TEWL and gloss were not statistically significant, the overall results indicate improved skin condition and balance. Despite the absence of a control group, these findings support the potential of this combined approach as an adjunctive therapy for oily skin. Further controlled studies with larger cohorts are warranted to confirm its efficacy and long-term effects. Full article

Bias in artificial intelligence is a critical issue because these technologies increasingly influence decision-making in a wide range of areas. The recommender system field is one of them, where biases can lead to unfair or skewed outcomes. The origin usually lies in data biases coming from historical inequalities or irregular sampling. Recommendation algorithms using such data contribute to a greater or lesser extent to amplify and perpetuate those imbalances. On the other hand, different types of biases can be found in the outputs of recommender systems, and they can be evaluated by a variety of metrics specific to each of them. However, biases should not be treated independently, as they are interrelated and can potentiate or mask each other. Properly assessing the biases is crucial for ensuring fair and equitable recommendations. This work focuses on analyzing the interrelationship between different types of biases and proposes metrics designed to jointly evaluate multiple interrelated biases, with particular emphasis on those biases that tend to mask or obscure discriminatory treatment against minority or protected demographic groups, evaluated in terms of disparities in recommendation quality outcomes. This approach enables a more comprehensive assessment of algorithmic performance in terms of both fairness and predictive accuracy. Special attention is given to Graph Neural Network-based recommender systems, due to their strong performance in this application domain. Full article

Anecdotal reports have recently circulated suggesting that intramuscular injection of bacteriostatic saline (BS)—which contains benzyl alcohol (BnOH)—can reverse botulinum toxin type A (BoNTA)-induced brow ptosis. Given the well-established intracellular persistence of BoNTA’s light chain and its irreversible cleavage of SNAP-25, such rapid functional recovery challenges existing pharmacological understanding. This study employed high-resolution pharmacokinetic/pharmacodynamic (PK/PD) modelling using the AesthetiSim™ platform to systematically evaluate this hypothesis. A total of 30,000 virtual patients were randomized to receive BoNTA alone, BoNTA followed by BS injection, or BoNTA followed by normal saline (NS) at Day 7. The model incorporated BoNTA diffusion, internalization, SNAP-25 cleavage, neuromuscular output, and transient BS effects on membrane permeability and endosomal trafficking. Simulated recovery trajectories were tracked over 90 days. The primary outcome, time to 80% restoration of baseline frontalis muscle force (T₈₀), averaged 42.0 days in the BoNTA-only group and 35.5 days in the BS group (Δ = −6.5 days; p < 0.001). Only 13.9% of BS-treated patients reached the T₈₀ threshold by Day 30. Partial reactivation (T₃₀) occurred earlier with BS (21.8 ± 5.3 days vs. 27.3 ± 4.9 days), and the area under the effect curve (AUEC) was increased by 9.7%, reflecting higher overall muscle function over time. In molecular simulations, BnOH produced a minor rightward shift in the BoNTA–SNAP-25 dissociation curve, but receptor occupancy remained above 90% at therapeutic toxin concentrations, suggesting no meaningful impairment of binding affinity. A global Sobol sensitivity analysis demonstrated that the primary driver of recovery kinetics was intracellular LC degradation (49% of T₈₀ variance), while BS-modulated extracellular parameters collectively contributed less than 20%. These findings indicate that BS does not reverse the molecular action of BoNTA but may transiently influence recovery kinetics via non-receptor-mediated pathways such as increased membrane permeability or altered vesicular trafficking. The magnitude and variability of this effect do not support the notion of a true pharmacologic reversal. Instead, these results emphasize the need for mechanistic scrutiny when evaluating rapid-reversal claims, particularly those propagated through anecdotal or social media channels without supporting biological plausibility. Full article

Cardiovascular disease disproportionately affects women in the United States. CVD outcomes are closely tied to a multitude of factors including lifestyle habits and socioeconomic status which create a complex interweb of determinants of health that place certain age and racial groups at higher risk over others. Such inequities highlight the need for targeted prevention strategies to address the unique risks faced by different populations. In this study, a state-wide analysis examining the mortality rates among women aged 35 years or older in Florida from 2018 to 2023 was done in order to identify high risk groups to better inform evidence-based public heath interventions that are tailored to the population’s needs. Mortality rates were extracted from the CDC Wonder Database. Age-adjusted and crude mortality rates, per 100,000 women, were calculated and stratified by ten-year age groups, Hispanic origin, race, and major CVD subtypes based on various ICD-10 codes. From the ICD-10 113 Cause List, “The Diseases of the Heart” were the cause of the majority of the deaths; however, “Other Forms of Chronic Ischemic Heart Diseases” was the leading subtype. Crude rates for the “Ischemic Heart Diseases” decreased 110.9 per 100,000 women in 2018 to 101.5 per 100,000 women in 2023. Yet, the most common cause of CVD-related mortality remains ischemic heart disease. Across the study period, non-Hispanic women experienced more than twice the crude mortality rate of Hispanic women. Racial breakdowns showed that White women had the highest CVD mortality, followed by Black women, who had elevated rates of heart failure and heart attacks in comparison to other minority groups. Asian women had the lowest rates across all cardiovascular subtypes. These findings underscore the persistent age and racial differences in cardiovascular outcomes emphasize the urgent need for culturally informed, community-specific preventative interventions to improve cardiovascular care and reduce mortality within high-risk populations. Full article