Search Results (663)

Background: Liver cancer, either primary or metastatic, is a leading cause of cancer-related deaths and in many cases is presented in stages requiring major hepatectomy. Adequate future liver remnant (FLR) volume is essential before any major hepatectomy. Portal vein embolization (PVE) has long been the standard technique for preoperative liver hypertrophy, but liver venous deprivation (LVD) has emerged as a novel method, potentially offering faster and superior results. The aim of this study is to compare FLR hypertrophy outcomes between LVD and PVE in patients undergoing major hepatectomy for liver malignancy. Methods: A systematic literature search was conducted across PubMed, Cochrane library, and clinicaltrials.gov for studies assessing FLR volume changes after LVD or PVE in patients with primary or secondary liver tumors undergoing liver resection. Data extraction was performed independently by two reviewers. The study protocol was registered in PROSPERO and was prepared according to the PRISMA guidelines. Results: Twelve retrospective cohort studies were included in this systematic review. Liver venous deprivation consistently demonstrated superior FLR hypertrophy, with a faster and higher percentage increase compared to PVE. Time to resection was also shorter in the LVD groups in most studies. Safety outcomes were comparable, with no consistent difference in post-procedural complications or mortality. Conclusions: Liver venous deprivation may potentially be a safe and effective alternative to PVE, offering more robust and rapid FLR hypertrophy with similar morbidity and mortality rates. While current evidence supports its superiority in selected patients, future validation with larger prospective clinical trials is essential before it can be adopted as standard management of patients with insufficient FLR volume. Full article

Air pollution is a leading environmental risk that causes respiratory morbidity and mortality. The increasing availability of high-resolution environmental data and air pollution-related health cases have accelerated the use of machine learning models (ML) to estimate environmental exposure–response relationships, forecast health risks and call for the needed policy and practical interventions. Unfortunately, ML models are opaque, in a sense that, it is unclear how these models combine various data inputs to make a concise decision. Thus, limiting its trust and use in clinical matters. Explainable artificial intelligence (xAI) models offer the necessary techniques to ensure transparent and interpretable models. This systematic review explores online data repositories through the lens of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline to synthesize articles from 2020 to 2025. Various inclusion and exclusion criteria were established to narrow the search to a final selection of 92 articles, which were thoroughly reviewed by independent researchers to reduce bias in article assessment. Equally, the ROBINS-I (Risk Of Bias In Non-randomized Studies of Interventions) domain strategy was helpful in further reducing any possible risk in the article assessment and its reproducibility. The findings reveal a growing adoption of ML techniques such as random forests, XGBoost, parallel lightweight diagnosis models and deep neural networks for health risk prediction, with SHAP (SHapley Additive exPlanations) emerging as the dominant technique for these models’ interpretability. The extremely randomized tree (ERT) technique demonstrated optimal performance but lacks explainability. Moreover, the limitations of these models include generalizability, data limitations and policy translation. Conclusion: This review’s outcome suggests limited research on the integration of LIME (Local Interpretable Model-Agnostic Explanations) in the current ML model; it recommends that future research could focus on causal-xAI-ML models. Again, the use of such models in respiratory health issues may be complemented with a medical professional’s opinion. Full article

Organ transplantation significantly enhances the survival and quality of life for recipients. However, multiple dependent and independent variables can adversely affect life expectancy after transplantation. Cancer is one of the most common causes of morbidity and mortality for long-term organ transplant recipients. The incidence of cancer in transplanted tissues can be twice as high in approximately 32 distinct cancer types. Oncogenic viruses present in graft tissues may contribute to the etiology of various cancers in transplant recipients. Such oncogenic viruses include hepatitis viruses, papillomaviruses, Epstein–Barr virus, Kaposi’s sarcoma, Merkel cell virus, JC virus, BK virus, and human T-lymphotropic virus type 1, all of which have been associated with various malignancies in these patients. To mitigate this risk, a comprehensive viral screening protocol should be integrated into the transplantation process. Depending on the type of graft, diagnostic methods, control strategies, and post-transplantation care may vary considerably. To efficiently implement any strategy to inhibit viral oncogenicity, a comprehensive understanding of viral–host interactions involving oncogenic viruses within graft tissue is essential. The current view of tumor biology is that changes in the tumor microenvironment and immune signaling influence evolutionary selection pressures. Such interactions ultimately promote conditions that favor uncontrolled host–cell proliferation and malignant transformation. This review examines these viral–host interactions and their role in cancer development among transplant recipients. Full article

Background: Cardiovascular disease is a leading cause of mortality in England, with South Asians estimated to have a higher risk of CVD development compared to the general population. Harmful drinking is a key risk factor for cardiovascular disease, but little is known about drinking behaviours among South Asians, especially those aged 18–25. Objectives: The objectives of this study were (i) to investigate the knowledge of the cardiovascular effects of harmful drinking among young South Asians aged 18–25, and (ii) to explore the perceptions of young South Asians towards the role of the pharmacist in supporting individuals with alcohol-related harm. Methods: Qualitative, in depth, face-to-face, semi-structured interviews were conducted with ten young South Asians, around 30 min in length. The interviews were audio recorded, transcribed verbatim and then thematically analysed. Results: Four superordinate themes emerged: (1) Culture Clash; (2) The Great Escape; (3) Cardiovascular Confusion; and (4) The Ambiguous Pharmacist. These themes highlighted a dichotomy between the drinking behaviours among different South Asian communities, a lack of knowledge regarding the cardiovascular consequences of harmful drinking and mixed views regarding pharmacists’ role in supporting dependence. Participants acknowledged the prevalence of poor cardiovascular health among British South Asians, citing various types of dysfunction and possible causes; however, the effect of drinking specifically was not understood. Most participants would refer a young person struggling with dependence to a pharmacist and would be receptive to discussing drinking with one. However, few commented on any role outside of signposting to other services or healthcare providers. Conclusions: Greater cardiovascular health promotion is needed among South Asians, with an emphasis on the link between excess alcohol consumption and cardiovascular dysfunction. Furthermore, pharmacists must do more to promote greater awareness of the different ways in which alcohol dependence can be supported within the community to encourage young people seeking harm reduction to utilise those services as needed. Full article

Background/Objectives: A higher adherence to the Mediterranean diet (MedDiet) has been associated with a lower risk of death in different populations, but this association has been insufficiently investigated in the elderly Spanish population. In this study, we assess the association between adherence to three MedDiet indexes and all-cause, cardiovascular disease (CVD), and cancer mortality in a population aged 65 years and older in Spain. Methods: The population included 903 participants from two population-based surveys. Diet was assessed at baseline by using validated food-frequency questionnaires (FFQ). We calculated scores of adherence to the MedDiet for three indexes: alternate Mediterranean Diet Score (aMED), relative Mediterranean Diet Score (rMED) and 17-item energy-restricted Mediterranean Diet Adherence Screener (erMEDAS). Deaths were ascertained through the National Death Index of Spain and the Mortality Registry in the Valencian Region during a 12 year follow-up period. Cox regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI), adjusting for relevant confounders. Results: During the 12 years of follow-up, 403 deaths occurred: 160 due to CVD and 90 to cancer. Compared to participants in the lowest tertile of adherence to aMED, those in the highest tertile showed a 30% lower risk of all-cause mortality, HR = 0.70 (95% CI 0.51–0.96). In addition, per two-point increase in aMED, we observed a 17% lower risk of all-cause mortality, HR = 0.83 (95% CI 0.73–0.95), and a 21% lower risk of CVD mortality, HR = 0.79 (95% CI 0.64–0.99). A 9% lower risk of all-cause mortality was also observed per two-point increase in the rMED score, HR = 0.91 (95% CI 0.84–0.99). Compared to participants in the lowest tertile of adherence to rMED, those in the highest tertile showed evidence of a marginally significant, lower risk of cancer mortality, HR = 0.55 (95% CI 0.29–1.04). No association was observed between the erMEDAS index and mortality for any cause. Conclusions: High adherence to the MedDiet, as measured by aMED and rMED indexes, was associated with lower all-cause, CVD, and cancer mortality in an older Mediterranean population after 12 years of follow-up. Full article

Background/Objective: Neonatal respiratory distress syndrome (RDS) is a leading cause of morbidity and mortality in preterm infants. Interleukin-10 (IL-10) and endothelial nitric oxide synthase (eNOS, also known as NOS3) regulate inflammation and vascular tone, and genetic variants may influence the risk of RDS. To investigate the association between IL-10 rs1800872 (c.-149+1984T>G), IL-10 rs1800896 (c.-149+2474T>C), and NOS3 rs2070744 (c.-149+1691C>T), NOS3 rs1799983 (c.894T>G) variants and the risk of RDS in a Romanian cohort of preterm neonates. Methods: This case–control study included 340 preterm neonates (113 with RDS, 227 controls) born at <36 weeks of gestation. Genotyping was performed using TaqMan SNP assays. Logistic regression adjusted for gestational age and sex estimated odds ratios (ORs) and 95% confidence intervals (CIs). ROC analyses evaluated predictive performance. Results: No significant differences in genotype or allele distributions were observed between RDS and control groups for any variant. Haplotype analysis also revealed no association with RDS susceptibility or severity. NOS3:c.894T>G variant was associated with reduced risk of severe RDS after correction (adjusted p = 0.009), though survival analysis showed no significant genotype-specific effects. Epistatic genotype interaction was observed for the IL-10 T/G + T/C, present only in RDS (p = 0.0026). ROC analysis revealed a clinical prediction of RDS (AUC = 0.996), while the addition of genetic variants improved discrimination for severity (AUC = 0.865; 95% CI: 0.773–0.957) and mortality (AUC = 0.913; 95% CI: 0.791–1.000). Conclusions: IL-10 and NOS3 variants were not individually associated with overall RDS susceptibility. The observed epistatic interactions and the potential protective effect of NOS3:c.894T>G against severe forms can suggest modulatory roles in disease progression. Larger, ethnically homogeneous cohorts are needed to confirm these findings and assess their potential for informing personalized care for neonates. Full article

With the expansion of utility-scale renewable energy development worldwide, accurate estimation of bird and bat fatalities is needed for informed policy-making and appropriate formulation of mitigation strategies. Background mortality, or the mortality caused by natural as opposed to anthropogenic processes, is often identified as a positive bias, and sometimes it is identified as a substantial or even leading contributor to fatality estimates. To estimate background mortality, I compiled fatalities/ha counted during searches of turbine-free study sites reported by others over 2548 ha and myself over 2297 ha. No bat fatalities were found in any of these searches. Bird fatalities/ha averaged 0.0055. I also compared estimates of fatalities/ha before and after turbine removals from 123 rows of wind turbines in California’s Altamont Pass Wind Resource Area (APWRA). These turbine rows had been searched for fatalities over various periods during 1998–2002 and 2006–2014, and fatalities had been recorded at each row during first searches of new monitoring periods. I used the same search methods as the monitor, but my first searches covered 624 ha of plots centered around vacant turbine sites. I found 0.0194 (95% CI: 0.0035–0.0352) bird fatalities/ha, but no bat fatalities. I estimated that background mortality was 3.6% (95% CI: 0–6.2%), mortality caused by unremoved power lines and meteorological towers was 8.2% (95% CI: 0–15.8%), and mortality caused by wind turbines was 88.2% (95% CI: 78–100%). Contamination of carcasses from operable wind turbines ≥ 400 m distant from vacant turbine sites likely biased my estimate upward by 3.5-fold compared to natural mortality averaged among sites far from wind turbines. This study does not support the notion that background mortality contributes substantially to mortality estimates at renewable energy projects. 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

This study aimed to identify bacterial isolates associated with mortality events in Salmo trutta rearing farms in Spain and to assess their antibiotic resistance profiles. The analysis covered five fish farms: two with a recent history of antibiotic use and three without any antibiotic application in the six months prior to sampling. Tissue samples were collected from moribund fish displaying clinical signs such as erratic swimming, ocular hemorrhages, fin hemorrhages, and skin lesions during disease outbreaks in 2022 and 2023. The samples were analyzed using real-time PCR, amplification and sequencing of the 16S rRNA gene and the ITS-1 intergenic spacer, and MALDI-TOF mass spectrometry. A total of 19 bacterial isolates were identified, with Gram-negative bacteria, particularly Aeromonas spp., being the most prevalent. Other identified taxa included Plesiomonas sp., Hafnia alvei, Pseudomonas fulva, and Kluyvera intermedia, as well as Gram-positive species such as Carnobacterium maltaromaticum, Lactococcus sp., and Enterococcus faecium. Notably, resistant strains were found in four of the five farms, even in those that had not administered antibiotics, suggesting that environmental contamination and anthropogenic factors may significantly contribute to the spread of resistance. Environmental stressors—such as sudden increases in water temperature and high turbidity caused by suspended organic matter—appeared to precede mortality peaks. The findings highlight the role of Aeromonas spp. as a key bacteria associated with mortality events in S. trutta and underscore the multifactorial nature of antibiotic resistance in aquaculture. No florfenicol-resistant isolates were detected in the farms where it is routinely used, indicating that florfenicol remains an effective antibiotic in aquaculture. However, the continuous and systematic monitoring of its use remains essential. The detection of bacteria not traditionally associated with fish pathology in samples from diseased animals suggests the need for further studies into their pathogenic potential. Overall, this descriptive study emphasizes the importance of preventive health strategies, prudent antibiotic use, and environmental monitoring to mitigate bacterial diseases and limit the spread of antimicrobial resistance in brown trout farming. These findings align with a One Health perspective, linking aquaculture practices, ecosystem integrity, and public health. Full article

Background/Objectives: Toxoplasma gondii is a major cause of zoonotic infections in both humans and animals, resulting in significant mortality in susceptible species, such as New World primates and marsupials. Toxoplasmosis is particularly concerning in zoos and wildlife reserves, where outbreaks threaten conservation efforts for endangered species. In the absence of a commercially available vaccine against toxoplasmosis for humans and captive wild animals, current prevention strategies are limited to restricting the access of cats to enclosures, controlling rodent populations, and maintaining strict food hygiene. Recent research has shown promising results with an intranasal vaccine (VXN-Toxo) composed of maltodextrin nanoparticles conjugated with a purified, inactivated T. gondii parasite. This experimental vaccine does not pose a risk of causing disease and offers advantages such as better stability compared with live pathogen-based vaccines. Methods: This study presents a large-scale evaluation of the effect of VXN-Toxo administered to captive wildlife across 20 zoos in Europe and the Americas between 2017 and 2025. Seven hundred and eighty-four animals, representing over 58 species (including primates, marsupials, rodents, and felids), were vaccinated without any adverse events reported. Results: Retrospective mortality data from 20 participating zoological institutions revealed an overall 96.7% reduction—and, in many cases, a complete elimination—of toxoplasmosis-associated deaths post vaccination. Conclusions: These results demonstrate, for the first time, consistent and broad-spectrum protection against T. gondii of different strains in a wide array of captive wildlife species. This universal vaccine represents a promising tool for toxoplasmosis prevention in zoological collections, with significant implications for animal health and conservation strategies. Full article

Cardiovascular diseases remain the leading cause of mortality worldwide, with multiple risk factors contributing to their development. Among these, obesity and hyperhomocysteinemia have been recognized as significant contributors to endothelial dysfunction, a key early event in the pathogenesis of atherosclerosis. Our study aimed to evaluate the relationship between total homocysteine (tHcy) levels and traditional cardiovascular risk factors in overweight and obese adolescents. We enrolled 42 obese, 14 overweight, and 25 non-obese children. No significant differences in tHcy levels were observed between overweight, obese, and non-obese adolescents. Homocysteine positively correlated with age (r = 0.433, p < 0.011) and creatinine concentrations (r = 0.363, p = 0.001) in the overall group of overweight, obese, and non-obese children, as well as in the combined group of overweight and obese children (for age: r = 0.275, p = 0.025; for creatinine: r = 0.278, p = 0.025). We did not find any association between homocysteine and atherogenic lipid profile, insulin-resistance status, blood pressure, and inflammatory parameters in overweight and obese patients. Age emerged as the strongest independent predictor of homocysteine levels. The observed association with creatine suggests a potential renal contribution to homocysteine metabolism. Full article

Traumatic brain injuries (TBI) represent a leading cause of morbidity and mortality globally. Whilst clinical care has significantly improved in recent years, there is still significant scope to improve patient outcomes, particularly in relation to quality of life. However, there is a window of opportunity for clinical intervention, since most of the mortality and morbidity is associated with secondary injury processes that arise after the initial trauma. In the brain, as with any tissue, inflammation plays an important role in the response to injury. However, particularly with severe injuries, an excessive inflammatory response can have detrimental effects. Following TBI, inflammation can lead to the development of cerebral oedema and a rise in intracranial pressure. Without effective control, these processes can rapidly lead to patient deterioration. This narrative review focusses on the role of inflammation in TBI in order to examine the strategies that may help improve patient outcomes. Whilst there is clearly a relationship between the development of cerebral oedema, rising intracranial pressure (ICP), and poor patient prognosis, there are also discrepancies in terms of their impact on patient outcomes. In addition to causing a rise in ICP, this review examines in what other ways inflammation and the development of cerebral oedema may contribute to the injury process. The potential for these factors to impact upon microvascular function and reduce cerebral tissue perfusion and oxygenation is explored. In addition, the impact of TBI on glymphatic function is discussed. Following an evaluation of the potential injury processes, the scope for intervention and the development of novel therapeutic approaches is explored. Full article

Preterm labour (PTL) affects about 11% of all deliveries world-wide. It is a major cause of perinatal morbidity and mortality. Although the precise cause is unknown in about 50% of cases, infections are thought to be a major contributing factor. These infections are more common in earlier preterm deliveries. While some women with these infections will manifest the classical features of fever, tachycardia (maternal and/or fetal), leucocytosis, raised biomarkers of infections, and uterine tenderness/irritation, others will be asymptomatic. Some of the women may develop a short/dilating cervix without any obvious contractions. Identifying such women is potentially challenging. Evidence has shown that a condensation of echogenic particles just above the cervix—amniotic fluid (AF) sludge, identified by ultrasound—is a marker for microbial invasion of the amniotic cavity (MIAC) and preterm birth (PTB) in both asymptomatic and symptomatic women (including those with a short or normal cervix). Those with a short cervix with AF sludge have a significantly greater risk of progression to PTB. Treatment with antibiotics has been shown in some but not all case series to result in a resolution of the sludge and either a delay or prevention of PTB. The widely varied results from treatment could be related to the antibiotics used and the route of administration. The use of the parenteral combination of clindamycin, a cephalosporin, and metronidazole has been shown to be more effective compared to azithromycin. Here we review the literature on the relationship between the sludge and PTB and conclude (1) that the AF sludge is an ultrasound marker of MIAC and PTL and (2) that following its diagnosis, appropriate counselling should be offered and the triple antibiotic combination offered. We suggest that randomised trials should be undertaken to determine the most efficacious antibiotic combination. Full article

Background/Objectives: Noncommunicable diseases (NCDs) are the leading causes of global mortality among adults. The aim of this study was to examine the association between adherence to 24 h movement behavior guidelines and the diagnosis of NCDs. Methods: This cross-sectional study was conducted with users of the Health Academy Program in Brazil. The sample consisted of 1212 individuals (92.9% female), aged 18 years or older. Dependent variables included self-reported hypertension, diabetes, hypercholesterolemia, and cardiovascular disease based on previous medical diagnosis. Independent variables (physical activity, screen time, and sleep) were self-reported. Binary and multinomial logistic regressions were performed and adjusted for sex, age, educational level, body mass index, and marital status. Results: Participants who did not meet any of the 24 h movement behavior recommendations had higher odds of hypertension (OR: 1.35; 95% CI: 1.15–1.77), diabetes (OR: 1.07; 95% CI: 1.03–2.01), and having two (OR: 1.29; 95% CI: 1.09–2.91) or three or more NCDs (OR: 1.40; 95% CI: 1.11–2.13). Not meeting the physical activity recommendation was associated with higher odds of hypercholesterolemia (OR: 1.37; 95% CI: 1.06–1.76). In contrast, meeting the physical activity guideline alone (OR: 0.32; 95% CI: 0.11–0.85) or in combination with adequate sleep (OR: 0.32; 95% CI: 0.11–0.90) was associated with lower odds of cardiovascular disease. All of these results remained significant after adjustments for multiple comparisons. Conclusions: Not meeting any of the 24 h movement behavior guidelines, especially those related to physical activity, was associated with a higher occurrence of NCDs. Full article

Introduction: The combination of ceftazidime−avibactam (CAZ-AVI) with aztreonam (ATM) may be an option for the treatment of infections due to metallo-β-lactamases (MBLs) producing bacteria, as recommended by current guidelines. MBLs protect the pathogen from any available β-lactam/β-lactamase inhibitor (BL/BLI). Moreover, in vitro and clinical data suggest that double carbapenem therapy (DCT) may be an option for such infections. Materials and Methods: This retrospective study was conducted in two mixed intensive care units (ICUs) at the University Hospital of Larissa, Thessaly, Greece, and the General Hospital of Larissa, Thessaly, Greece, during a three-year period (2022−2024). Mechanically ventilated patients with bloodstream infection (BSI) caused by K. pneumoniae resistant to all BL/BLI combinations were studied. Patients were divided into three groups: in the first, patients were treated with CAZ-AVI + ATM; in the second, with DCT; and in the third, with antibiotics other than BL/BLIs that presented in vitro susceptibility. The primary outcome of the study was the change in Sequential Organ Failure Assessment (SOFA) score between the onset of infection and the fourth day of antibiotic treatment. Secondary outcomes were SOFA score evolution during the treatment period, total duration of mechanical ventilation (MV), ICU length of stay (LOS), and ICU mortality. Results: A total of 95 patients were recruited. Among them, 23 patients received CAZ-AVI + AZT, 22 received DCT, and 50 patients received another antibiotic regimen which was in vitro active against the pathogen. The baseline characteristics were similar. The mean (SE) overall age was 63.2 (1.3) years. Mean (SE) Acute Physiology and Chronic Health Evaluation II (APACHE II) and SOFA scores were 16.3 (0.6) and 7.6 (0.3), respectively. The Charlson Index was similar between groups. The control group presented a statistically lower SOFA score on day 4 compared to the other two groups [mean (SE) 8.9 (1) vs. 7.4 (0.9) vs. 6.4 (0.5) for CAZ-AVI + ATM, DCT and control group, respectively (p = 0.045)]. The duration of mechanical ventilation, ICU LOS, and mortality were similar between the groups (p > 0.05). Comparison between survivors and non-survivors revealed that survivors had a lower SOFA score on the day of BSI, higher PaO₂/FiO₂ ratio, higher platelet counts, and lower lactate levels (p < 0.05). Septic shock was more frequent among non-survivors (60.3%) in comparison to survivors (27%) (p = 0.0015). Independent factors for mortality were PaO₂/FiO₂ ratio and lactate levels (p < 0.05). None of the antibiotic regimens received by the patients was independently associated with survival. Conclusions: Treatment with CAZ-AVI + ATM or DCT may offer similar clinical outcomes for patients suffering from BSI caused by K. pneumoniae strains resistant to all available BL/BLIs. However, larger studies are required to confirm the findings. Full article