Search Results (2,200)

Gunshot injuries are challenging conditions because of the unique characteristics of the wounding agents producing soft tissue damage that may be compounded by the formation of an expanding temporary cavity (cavitation). Variations in ballistic performance leading to higher energy transfer by the projectile, including bullet tumbling, deformation, and fragmentation, cause increased soft tissue injury and may also lead to more extensive bone comminution compromising local blood supply. Once life-threatening injuries have been excluded or properly addressed, the emergency management of localized trauma from bullets and shotgun pellets may be complicated due to progressive tissue necrosis within the zone of injury. Additionally, the risk of infection should be tackled, especially in high energy bone injuries. War experience suggests a baseline separation between wounds with limited tissue destruction which can routinely be managed as simple penetrating injuries and those resulting from high energy transfer to the tissues involving a substantial amount of necrotic elements surrounding the wound channel which call for a more aggressive surgical approach. A further justification for such a distinction is the need for antibiotic therapy, which varies according to most studies depending on the wounding mechanism, the nature of the wound, and the extent of tissue injury. The emergency physician should also be aware of the possibility of “bizarre” bullet paths resulting in occult injuries of important anatomic structures. Full article

Background/Objectives: The optimal rate of enteral feeding advancement in preterm infants remains uncertain despite decades of clinical research. This uncertainty arises from concerns that rapid feeding progression may increase the risk of feeding intolerance and necrotizing enterocolitis (NEC), two major causes of morbidity and mortality in this population. The feeding rate may also influence intestinal oxygenation due to mesenteric hemodynamic changes during feeding. This study aimed to evaluate whether the rate of enteral feeding advancement (slow vs. rapid) affects intestinal oxygenation and its association with feeding intolerance (FI) or necrotizing enterocolitis in very low birth weight preterm infants. Methods: This prospective, randomized, two-center study included infants born at 28–32 weeks of gestation. Group 1 received slow advancement (20 mL/kg/day) and Group 2 rapid advancement (30 mL/kg/day) of enteral feeds. Splanchnic (srSO₂) and cerebral (crSO₂) oxygenation were monitored daily using the FDA-approved INVOS NIRS device during feeding periods (08:00–16:00). Monitoring was performed during minimal enteral nutrition (Phase 1), advancement phases (Phase 2), and for two days after achieving full enteral feeding (Phase 3). The splanchnic-to-cerebral oxygenation ratio (SCOR) was also calculated. Percentage changes in srSO₂ and SCOR during and after feeding were calculated from baseline (prefeeding) values and analyzed. Results: Sixty infants were enrolled. Mean gestational age and birth weight were 29.76 ± 1.33 weeks and 1375.05 ± 271.19 g, respectively. Group 2 achieved full enteral feeding significantly earlier (p = 0.001), with no other demographic differences between groups. No cases of NEC were observed. Feeding intolerance occurred in 14 infants (23.3%): 8 in Group 1 and 6 in Group 2 (p = 0.192). Both groups exhibited increased srSO₂ and SCOR during feeding; however, the between-group differences were not statistically significant (Phase 2 srSO₂ and SCOR: p = 0.07, 0.08; Phase 3 srSO₂ and SCOR: p = 0.069, 0.071). However, the percentage change from baseline in srSO₂ and SCOR during and after feeding was significantly greater in Group 2 during the advancement and full enteral feeding phases (Phase 2 srSO₂ and SCOR: p = 0.03, 0.022; Phase 3 srSO₂ and SCOR: p = 0.015, 0.048). Infants with feeding intolerance demonstrated significantly lower srSO₂ and SCOR values compared to tolerant infants, and this reduction persisted even after reaching full enteral feeding. ROC analysis suggested gestational age < 30 weeks, birth weight < 1180 g, srSO₂ < 52, and SCOR < 0.6 were associated with feeding intolerance. Conclusions: Intermittent bolus feeding increased intestinal oxygenation, with a more pronounced effect in the rapid advancement group. No difference in gastrointestinal adverse outcomes was observed between groups. Lower intestinal oxygenation was associated with feeding intolerance, and the suggested predictive criteria may help guide individualized feeding strategies. Full article

Background and Objectives: Necrotizing enterocolitis (NEC) represents a severe gastrointestinal emergency in preterm infants. The aim of this study was to identify risk factors and predictive parameters for NEC requiring surgery and to evaluate associated short-term outcomes. Materials and Methods: We conducted a retrospective study in preterm neonates diagnosed with NEC admitted to a tertiary neonatal intensive care unit (NICU) between January 2015 and May 2025. Demographic data, perinatal events, risk factors, clinical signs, imaging findings, and outcomes were analyzed, with a particular focus on surgically managed cases. Descriptive and inferential statistical methods were applied. Results: Forty-four infants met the inclusion criterion. The mean gestational age (GA) was 29.34 ± 4.3 weeks, and the mean birth weight was 1100 ± 563 g. According to Bell’s severity index, 45.5% had Bell Stage I, 36.4% Stage II, and 18.2% Stage III. Eleven patients (25%) required surgery. All surgical patients had abdominal distension, and 63.6% had bilious gastric residue. Abdominal X-ray showed pneumoperitoneum in 72.7% and pneumatosis intestinalis in 27.3% of cases. Laboratory abnormalities, including thrombocytopenia, elevated C-reactive protein (CRP) and lactate dehydrogenase (LDH), and hyponatremia (45.5%; 133 ± 6.95 mmol/L), were frequently associated with surgical NEC. A lower GA and birth weight correlated with a higher Bell stage (p = 0.0085 and p = 0.0291). Overall mortality was 29.5% (13/44); surgical mortality was 9.1% (1/11). Conclusions: In this single-center lot, low gestational age and birth weight, abdominal distension with bilious residuals, systemic inflammation, and hyponatremia were frequent among infants who required surgery. Selected infants may benefit from early surgery even without perforation, but inferences are limited by this study’s sample size and retrospective design. Prospective multi-center studies are needed to validate predictors and refine surgical timing. Full article

Background: Complicated pneumonia (CP) in children presents in various forms—including empyema, necrotizing pneumonia (NP), necrotizing pneumonia with pleural effusion (NP + PE), and parapneumonic pleural effusion (PPE)—and is associated with significant morbidity despite advances in antimicrobial therapy. This study aimed to describe and compare the clinical characteristics, laboratory findings, antibiotic use, and outcomes across different CP subtypes in hospitalized children and to assess the impact of prior antibiotic use on presentation and treatment outcomes. Methods: This retrospective observational study included 58 children admitted with CP to tertiary hospitals in Jordan. Patients were categorized into four subtypes: empyema (n = 4), NP (n = 4), NP + PE (n = 17), and PPE (n = 33). Demographic data, clinical features, laboratory results, antibiotic regimens, and clinical outcomes were analyzed. Multivariable regression was used to identify predictors of prior antibiotic use. Results: Fever and cough were the most common symptoms (96.6%). Over 40% of patients had received antibiotics prior to admission. Those pre-treated had significantly longer symptom duration (8.2 vs. 4.5 days, p < 0.001), longer hospitalization (18.2 vs. 14.6 days, p = 0.023), and more frequent chest tube insertion (66.7% vs. 35.3%, p = 0.019). Streptococcus pneumoniae was the most common organism isolated in culture-positive cases. Vancomycin-based regimens were the most frequently used treatments. Univariate regression analysis showed that patients with prior antibiotic use had significantly higher odds of longer hospitalization duration (OR = 1.11, p = 0.028) and chest tube insertion (OR = 3.67, p = 0.021). Conclusions: Complicated pneumonia in children remains a diverse and clinically significant condition. The findings demonstrate that prolonged symptom duration prior to hospitalization and certain clinical interventions were associated with prior antibiotic exposure. These results provide insight into local disease patterns and prescribing behaviors, which may help inform strategies to optimize antimicrobial stewardship and improve care pathways for affected children. Full article

The Common European ash (Fraxinus excelsior L.) is one of the main species constituting the field protection forest belts in Northeastern Bulgaria. Studies conducted in shelterbelts in Dobrich and Balchik in July 2020 and in Tutrakan and Dulovo in June–July 2022 revealed severe dieback of ash. The observed symptoms included density thinning of the crowns, dieback of branches, presence of sunken necrotic cankers, and light green to yellow foliage and premature defoliation. Parts of the shelterbelts were completely destroyed with 100% tree mortality. To determine whether the invasive Hymenoscyphus fraxineus or other pathogens are present in the ash field protective forest belts in Northeastern Bulgaria, fungal isolation was undertaken. Samples were collected from four locations: Dobrich and Balchik in June 2020, and Tutrakan and Dulovo in June–July 2022. The morphology, temperature–growth rate relationships, and pathogenicity of the two pathogenic fungal species isolated in this study—Diplodia fraxini and Diplodia seriata—were examined. Morphological and physiological studies confirm the molecular identification of the obtained plant pathogens. The Diplodia fraxini isolates (Dobrich 3, Tutrakan 2, and Dulovo 4) showed mycelial growth between 5 °C and 35 °C, with minimal growth at 5 °C (0.20–0.27 mm/day) and an optimum growth rate of 3.9–4.5 mm/day at 20–25 °C. Growth declined sharply above 30 °C, ceasing entirely at 35 °C. In contrast, D. seriata (Dulovo 5) exhibited higher growth rates, showing limited growth above 5 °C (~1 mm/day), and maximum growth of approximately 8 mm/day at 25 °C. Growth in D. seriata remained moderate up to 35 °C and ceased near 40 °C, indicating a broader temperature tolerance and higher upper thermal limit than D. fraxini. The results from the pathogenicity tests show that D. fraxini can cause necrosis on ash—both on leaves and twigs—and is likely involved in the investigated ash decline cases. Further studies of the spread and epidemiology of D. fraxini are needed in order to establish its occurrence on the territory of Bulgaria. Full article

Multidrug-resistant (MDR) Streptococcus suis (S. suis) is a zoonotic pathogen capable of infecting pigs across all age groups, leading to conditions such as meningitis, arthritis, and endocarditis. In humans, infections can result in septic arthritis, meningitis, necrotizing fasciitis, and septicemia, which may be fatal. The absence of a complete genome sequence hinders comprehensive bioinformatic studies of MDR S. suis derived from pigs. In this study, we present the whole-genome sequence of MDR S. suis serotype 2 ST01 isolated from joint fluid samples obtained from pigs. Whole-genome analysis revealed that the ST01 chromosome carries 19 antibiotic resistance genes that confer resistance to major classes of antibiotic including aminoglycosides, tetracyclines, fluoroquinolones, lincosamides, polypeptide, and nitrofurans. Additionally, it contains 15 virulence factors associated with immune modulation, bacterial adherence, and stress survival. Whole-genome analysis identified 84 horizontal gene transfer elements in ST01 (comprising 28 genomic islands, 52 transposons, and 4 prophages), alongside mutations resulting in reduced virulence (302 instances) and loss of pathogenicity (34 instances). Furthermore, 18 antibiotic targets along with 21 lethal mutations were identified as potential targets for preventing, controlling, and treating infection caused by MDR S. suis serotype 2 ST01. In vivo infection experiments demonstrated that intraperitoneal inoculation with ST01 resulted in mortality among Kunming mice, with a median lethal dose (LD₅₀) of 5.62 × 10⁹ CFU/mL. Histopathological analysis revealed varying degrees of lesions in the infected organs of the mice. This study thus provides valuable insights into strategies aimed at combating S. suis infections and their transmission within swine populations. Full article

This paper will present in vivo release profiles of Doxorubicin.HCl from halo-spun drug-loaded rubbery porous mats. For the very first time, Fluorescent Organism Bioimaging (FOBI) was used to follow drug release in a live animal model with induced tumors. A new predictive model based on apparent diffusion coefficients to simulate release profiles will also be presented and could have general applications for release profile predictions. Surprisingly, histological evaluation found that the tissue layer forming next to the drug-eluting mats had unordered morphology and only necrotic cells. This is a stunning contrast to the highly regular collagen structure next to mats without the drug, typical of an adverse foreign body type reaction. The findings suggest that this drug-eluting fiber mat can be used as a local chemotherapy approach coupled with mitigation of capsular contracture, the major complication associated with breast reconstruction following mastectomy. Full article

Rosmarinus officinalis (rosemary) is one of the most cultivated Lamiaceae species because of its medicinal, aromatic and ornamental properties. In the late summer of 2023, symptoms of desiccation were observed in a rosemary field located in southern Italy and the isolation from necrotic roots revealed three different fungal species: Ceratobasidium sp., Fusarium falciforme and Macrophomina phaseolina. All the isolates were morphologically and molecularly identified and Koch’s postulates assays were performed to establish the pathogenicity and the effect of each fungus on the disease incidence and severity. A dual plate method was used to investigate the interaction between Ceratobasidium sp., F. falciforme and M. phaseolina, mixing them in pairs and all together. Similarly, in vivo inoculations with the pathogens in combination were used to verify the role of each isolate in the interaction with the others and the contribution in plant disease expression. The results allowed to identify M. phaseolina and F. falciforme as causal agents of desiccation and root rot of rosemary, with M. phaseolina being the most aggressive between the two. Conversely, Ceratobasidium sp. behavior was influenced by the interaction with the other pathogens and the plant. Notably, this is the first report of M. phaseolina and F. falciforme on rosemary plants worldwide. This disease, caused by multiple pathogens, highlighted the crucial role of the combination of traditional in vivo assays and the use of molecular methods to achieve an accurate diagnosis. Full article

Background/Aim: Immature permanent teeth with necrotic pulps present thin dentinal walls and open apices, making them highly susceptible to cervical fractures even after apexification. This study aimed to compare stress distribution patterns produced by different coronal base materials following mineral trioxide aggregate (MTA) apexification using three-dimensional finite element analysis (FEA). Materials and Methods: A CBCT-based model of a maxillary immature incisor was reconstructed and modified to simulate six restorative scenarios: control (sound tooth), MTA + conventional glass ionomer cement (GIC), MTA + resin-modified glass ionomer cement (RMGIC), MTA + bulk-fill flowable composite, MTA + conventional composite resin, and MTA + flowable composite resin. A 100 N oblique load (45°) was applied, and von Mises stress, displacement, and periodontal ligament strain were analyzed. Inter-model comparisons were performed using one-way ANOVA with Tukey post hoc tests (p < 0.05). Results: All models exhibited maximum stress concentration in the cervical third of the root. Bulk-fill flowable composite and RMGIC generated lower cervical stress and more homogeneous distribution compared with GIC or conventional composite resin. Conventional composite resin produced the highest stress concentration due to its higher stiffness. Derived biomechanical metrics confirmed statistically significant differences between groups (p < 0.05). Conclusions: The coronal base material strongly affects the biomechanical behavior of immature incisors restored after MTA apexification. Selecting low-modulus, stress-dissipating materials such as bulk-fill flowable composites or RMGICs may minimize cervical stress and potentially reduce fracture risk. These computational findings warrant validation through in vitro and clinical studies. Full article

Introduction: Primary cutaneous CD8+ aggressive epidermotropic cytotoxic T-cell lymphoma (PCAETL) is a rare and highly aggressive subtype of cutaneous T-cell lymphoma (CTCL), accounting for less than 1% of CTCL cases. It is defined by CD8+ cytotoxic T-cell proliferation with marked epidermotropism, necrosis, and a high proliferative index. Clinically, it presents as ulcerated or necrotic lesions with rapid progression and poor response to conventional therapies. Aims: To describe a fatal case of PCAETL in a young adult female, emphasizing the diagnostic challenges, clinical progression, histopathological features, and treatment limitations. Case Presentation: A 41-year-old Venezuelan woman presented with a 10-month history of disseminated papules and nodules initially misdiagnosed as Hansen’s disease. After her arrival in Ecuador, she was re-evaluated and found to have generalized dermatosis with ulcerated nodules and tumors. Histopathological examination revealed atypical epidermotropic CD8+ T-cell infiltration with extensive necrosis. Immunohistochemistry demonstrated strong positivity for CD3, CD5, and CD8, and a Ki-67 index of 80%, confirming the diagnosis of PCAETL. The patient received methotrexate with partial response but experienced disease relapse during second-line etoposide therapy. She developed febrile neutropenia and died five months after diagnosis. Conclusions: This case highlights the rarity, diagnostic complexity, and aggressive nature of PCAETL. Early recognition and clinico-pathological correlation are essential for timely diagnosis. However, therapeutic options remain limited, and outcomes are poor despite systemic chemotherapy. Further research into targeted and personalized therapies is urgently needed to improve survival in this devastating disease. Full article

Cardiovascular diseases in dogs have diverse causes and may progress rapidly to life-threatening complications. This review outlines the relevant pathological conditions involving the cardiovascular system in dogs, especially the myocardium, including myocarditis caused by canine parvovirus (CPV-2), heartworm disease (Dirofilaria immitis), hemangiosarcoma, and polyarteritis nodosa (PAN). CPV-2 affects the myocardium of puppies during the early weeks of life, leading to necrosis, fibrosis, and congestive heart failure. Heartworm disease is caused by adult D. immitis residing mainly in the pulmonary arteries, inducing pulmonary hypertension, right ventricular overload, and vascular damage, with the severity being related to the worm burden and duration of infestation. Hemangiosarcoma is a malignant vascular tumor, most frequently originating in the spleen or right atrium, often diagnosed at an advanced stage, with widespread metastases. Polyarteritis nodosa in dogs is a necrotizing, systemic vasculitis of medium-sized arteries that may affect the coronary arteries of the heart. Its pathogenesis is still unclear, though an immune-mediated mechanism is suspected. By presenting these lesions, the review underscores the many factors that can trigger cardiovascular diseases in dogs, as well as the clinical significance and the need for further research into their pathogenesis and treatment. Full article

Pott’s Puffy Tumor (PPT) is a rare but potentially life-threatening complication of frontal sinusitis, characterized by subperiosteal abscess formation and frontal bone osteomyelitis. Although predominantly seen in adolescents, adult cases are increasingly recognized. Early diagnosis is essential to prevent severe orbital and intracranial sequelae. We present two patients with distinct clinical features: a 31-year-old female with chronic frontal sinusitis complicated by sequestrated bone extrusion through a cutaneous fistula, and a 16-year-old male with an acute presentation of subperiosteal abscess, nasal polyp-related obstruction of the osteomeatal complex (OMC), and orbital cellulitis. Both patients underwent combined surgical and medical management, including broad-spectrum intravenous antibiotics, functional endoscopic sinus surgery, and external drainage. In the adult, necrotic bone was excised, and the anterior frontal wall was reconstructed with titanium mesh to restore sinus anatomy and drainage, while in the adolescent, early abscess drainage and polyp removal ensured frontal recess patency and prevented osteomyelitis. Postoperative follow-up demonstrated complete resolution without recurrence. These cases highlight that PPT can occur in both acute and chronic settings of chronic rhinosinusitis with nasal polyps, emphasizing the importance of prompt imaging, multidisciplinary evaluation, and individualized surgical strategies to optimize outcomes and minimize life-threatening complications. Full article

Bovine colostrum stands out as a natural supplement with rich bioactive components that attract attention for its therapeutic potential in the maintenance and improvement of gastrointestinal (GI) health. The major bioactive components of bovine colostrum include immunoglobulin (Ig) (especially immunoglobulin G), lactoferrin (LF), growth Factors (IGF-I, TGF-β, EGF), oligosaccharides (OS), and bioactive peptides. These components play a role in epithelial repair, suppression of inflammation, balancing the microbiota, and enhancing the mucosal barrier. Various animal models and recent human studies show that bovine colostrum has various positive effects against gastrointestinal tract diseases such as inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), non-steroidal anti-Inflammatory drug (NSAID)-induced enteropathy, and necrotizing enterocolitis (NEC). These effects include preservation of epithelial integrity, reduction of inflammatory markers, and improvement of intestinal permeability. Studies on the tolerability and efficacy profiles of various bovine colostrum formulations for oral, oropharyngeal, and enteral administration are increasing. In this review, the multifaceted effects of bovine colostrum on the gastrointestinal tract are explained at a mechanistic level, and potential areas of study for clinical translation are presented. Bovine Colostrum stands out as a promising natural biotherapeutic agent for both preventive and therapeutic approaches. Full article

Granulosa cells (GCs) and ovarian putative stem cells (oPSCs) represent distinct but complementary populations within the mammalian ovary. While GCs have long been considered terminally differentiated and hormonally specialized, emerging evidence indicates that they retain epigenetic plasticity and, under defined conditions, can be reprogrammed into cells exhibiting pluripotent-like features. In contrast, oPSCs, including oogonial stem cells (OSCs) and very small embryonic-like stem cells (VSELs), are naturally multipotent and capable of spontaneous or inducible differentiation into neural, endothelial, and other somatic lineages. Both cell types express stemness-related markers, such as OCT4, SOX2, and c-KIT, and demonstrate potential for self-renewal and lineage conversion. Recent advances in chemical modulation of epigenetic reprogramming, particularly with agents from the family of non-specific DNA methyltransferase (DNMT) inhibitors, such as 5-azacytidine (5-azaC), highlight the feasibility of generating functional, lineage-specific derivatives of GCs or oPSCs without genetic manipulation. Not without significance is also the fact that extended/high-dose 5-azaC-mediated modulation can induce cell senescence or apoptotic/necrotic death. Therefore, dosing must be carefully titrated, which strongly supports a dose- and/or time-dependent mechanism for 5-azaC-based epigenetic modification in treated cells. This study aims to summarize the molecular and functional properties of mammalian GCs and oPSCs, emphasizing their applicability in regenerative medicine and reproductive bioengineering, with a focus on safe, patient-specific cell-based therapies. Full article

Acute myocardial infarction (MI) is a major cardiovascular event and a leading cause of mortality worldwide. Beyond the initial ischemic injury, the inflammatory and immune responses play pivotal roles in both tissue damage and subsequent healing. While the anti-inflammatory strategies targeting neutrophil-driven injury have demonstrated potential in limiting early cardiac damage, growing evidence highlights the critical role of innate immune cells beyond the acute phase. Neutrophils, traditionally associated with tissue injury, also contribute to the resolution of inflammation and initiate key repair processes. Monocytes and macrophages follow a dynamic trajectory, transitioning from pro-inflammatory to reparative states, and play essential roles in debris clearance, angiogenesis, and scar formation. In the early inflammatory phase of acute MI, immune cells such as neutrophils and monocytes are rapidly recruited and activated. While they initially amplify inflammation through the release of pro-inflammatory mediators, their subsequent transition toward anti-inflammatory and reparative phenotypes helps limit tissue damage by clearing necrotic debris from the infarcted area and contributes to the resolution of inflammation. Accumulating evidence reveals a complex crosstalk between neutrophils and macrophages post-MI, with resident macrophages being involved in neutrophil recruitment, and neutrophil-derived signals participating in monocyte recruitment and macrophage polarization, thereby coordinating the spatial and temporal phases of cardiac repair. Understanding how neutrophil-derived mediators influence macrophage responses and whether macrophage-secreted factors reciprocally modulate neutrophil behavior opens promising pathways for developing targeted therapies to limit adverse remodeling following MI. Therefore, this review aims to (i) provide an overview of the roles of neutrophils and monocytes/macrophages in the pathophysiology of myocardial infarction, (ii) explore the mechanisms of communication, particularly via neutrophil-derived secreted factors, that influence monocyte/macrophage function and impact post-MI inflammation, repair, and remodeling, and (iii) highlight the potential therapies interfering with inflammation and neutrophil/macrophage cross-talk. Full article