Search Results (5,270)

Background and Objectives: The function of the right heart and the pulmonary artery pressure have been linked to outcomes following transcatheter aortic valve replacement (TAVR). This study utilized the V1-R wave amplitude from pre-procedural electrocardiography as an indicator of pulmonary artery pressure, examining its connection to one-year mortality post-TAVR. Materials and Methods: This retrospective study, conducted at a single center, involved patients with severe symptomatic aortic valve stenosis who underwent TAVR between March 2014 and September 2023. The study analyzed patients’ pre-procedural V1-R wave amplitude on electrocardiography and systolic pulmonary artery pressure measured by transthoracic echocardiography. Patients who died within one year were classified as non-survivors; others as survivors. Results: Of the 236 patients, 56 (23.7%) died within one year of follow-up. A cut-off value of 66.5 µV for V1-R wave amplitude was associated with 66.1% sensitivity and 66.7% specificity (AUC: 0.735; 95% CI: 0.660–0.811), and 55.5 mmHg for systolic pulmonary artery pressure (sPAP) was associated with 67.9% sensitivity and 68.3% specificity (AUC: 0.708; 95% CI: 0.624–0.793) in predicting one-year mortality. The independent predictors of increased mortality included a history of cerebrovascular disease, elevated sPAP, and a high R-wave amplitude in lead V1. In contrast, statin use emerged as an independent predictor of reduced mortality. Conclusions: The V1-R wave amplitude and sPAP measured before TAVR were independent predictors of mortality following TAVR, highlighting the significance of right heart function. Full article

Acetylcholinesterase (AChE) has emerged not only as a cholinergic enzyme but also as a modulator of β-amyloid (Aβ) aggregation via its peripheral anionic site (PAS), making it a dual-purpose target in Alzheimer’s disease. While classical AChE inhibitors provide symptomatic relief, they lack efficacy against the amyloidogenic cascade. This review highlights recent advances in multifunctional AChE pharmacophores that inhibit enzymatic activity while simultaneously interfering with Aβ aggregation, oxidative stress, metal dyshomeostasis, and neuroinflammation. Particular emphasis is placed on dual-site inhibitors targeting both catalytic and peripheral domains, multi-target-directed ligands (MTDLs) acting on multiple neurodegenerative pathways, and metal-chelating hybrids that address redox-active metal ions promoting Aβ fibrillization. We also discuss enabling technologies such as AI-assisted drug design, high-resolution structural tools, and human induced pluripotent stem cell (iPSC)-derived neuronal models that support physiologically relevant validation. These insights reflect a paradigm shift towards disease-modifying therapies that bridge molecular pharmacology and pathophysiological relevance. Full article

Background and Clinical Significance: Percutaneous vertebroplasty is an effective procedure for patients with osteoporosis and fractures. However, notable side effects may occur. Cement leakage into the vascular system may be incidental, with effects ranging from asymptomatic to life-threatening conditions. The treatment of extravasation of the cement and pulmonary embolism does not have definitive guidelines and requires specific treatment for every patient, ranging from basic anticoagulation to surgical procedures. Cement embolisms without periprocedural complications—such as cardiac perforation or massive pulmonary embolism—are often stable. However, symptomatic presentations with hemodynamic instability can occur. We report a clinically significant case of symptomatic cement pulmonary embolism resulting in shock. Case Presentation: A 68-year-old female patient with osteoporosis and a history of cement vertebroplasty two weeks prior to admission for vertebral compression fracture arrived with a three-day history of left leg swelling and shortness of breath. Vital signs revealed hypotension and the lab tests showed elevated lactate and D-dimer, mild leucocystosis, normal PCT and a threefold increase in CRP. The ultrasound confirmed complete thrombosis of the left external iliac and common femoral vein. The thoraco-abdominal CT demonstrated the extravasation of the cement from vertebroplasty to the inferior vena cava, lumbar veins, coupled with multiple cement structures in the segmental lobar pulmonary arteries. The echocardiography showed preserved right ventricular function. The management included intravenous fluids, anticoagulation and norepinephrine. Conclusions: This case underlines that cement pulmonary embolism following vertebroplasty, while typically undetected, can result in significant hemodynamic compromise even in the absence of right heart failure, potentially mediated by an inflammatory response. Importantly, it highlights the possibility of delayed clinical deterioration, with instability manifesting two weeks post-procedure—distinct from the more commonly observed immediate peri-procedural complications or other stable delayed presentation. Full article

Sweetpotato is a key staple crop in tropical and subtropical regions. Its vegetative propagation makes it a persistent reservoir, facilitating the emergence and spread of complex infections. Understanding its virome is crucial for disease management and food security. We investigated the sweetpotato virome in Burkina Faso using rolling circle amplification and Oxford Nanopore sequencing. Eight symptomatic leaf samples, previously undiagnosed using conventional methods, were analysed. Bioinformatic pipelines were employed followed by phylogenetic comparisons. Two viruses known to infect sweetpotato, namely sweet potato leaf curl virus (SPLCV) and sweet potato leaf curl deltasatellite 3 (SPLCD3), were consistently detected in all samples. Additionally, pepper yellow vein Mali virus (PepYVMV), cotton leaf curl Gezira alphasatellite (CLCuGeA) and cotton leaf curl Gezira betasatellite (CLCuGeB) were identified for the first time in this crop. Phylogenetic analysis confirmed their genetic proximity to isolates from tomato, okra and pepper. Their co-occurrence with SPLCV and SPLCD3 indicates a complex viral landscape that could influence disease severity. This study highlights the underestimated role of sweetpotato as a viral reservoir, influencing virus evolution and transmission. Further studies should assess their pathogenicity, co-infection dynamics and vector-mediated transmission to improve crop productivity. Full article

Introduction: The elbow is a rare site for bone tumors, and for this reason, the literature provides little data on the epidemiology of metastatic lesions involving the distal humerus, proximal ulna, and radius. Before performing surgery of the metastatic bone, it is first necessary to consider both patients’ and metastatic lesions’ features in order to better choose the best possible treatment. This systematic review aims to collect data on elbow metastases, delineate primary tumors leading to such metastases, guide surgical treatment decisions, and evaluate reconstructive techniques and associated complications. Material and Methods: A systematic literature review was conducted in April 2024, searching the PubMed, MEDLINE, and Cochrane Library databases using specific search terms related to elbow metastases. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) was followed. Eligible studies reported at least one patient with metastatic bone disease involving the elbow region and specified the undertaken treatment. For studies reporting multiple skeletal sites, only elbow-specific data were extracted. We excluded recurrences of primary elbow tumors. The methodological quality of included studies was assessed with the modified Coleman Methodology Score (mCMS). Results: In total, 28 articles (103 patients) were included. The studies were predominantly case reports (68%), with a mean mCMS of 31. Gender was reported for only 41 patients: 71% were male and 29% female. The mean age at diagnosis of elbow metastatic lesion was 55 years old. Renal cell carcinoma was the most common primary tumor (28%), followed by breast (9%) and lung cancer (6%). The distal humerus was the most frequently affected site (85%). A surgical approach was adopted in 90% of cases, whereas 10% of patients were managed conservatively. Forty-five patients underwent wide tumor resection followed by reconstructive surgery while forty-eight patients received a surgical treatment for either pathological fractures or impending fractures. Conclusions: When treating elbow metastasis, a thorough evaluation of the patient is crucial, considering the patient’s functional status, pain management needs, and overall prognosis; all these features influence the treatment of choice. The selected treatment should aim to provide optimal functional outcomes and minimize complications. For patients with pathological or impending fractures, single or double plate fixation is typically the preferred approach. For patients with severe, symptomatic lesions unresponsive to conservative therapy, resection followed by the implantation of a modular prosthesis usually offers the best clinical and functional outcomes. Full article

This article explores an integrative framework for medical rehabilitation that combines regenerative medicine, systemic homeostasis, and microbiome modulation to optimize recovery and long-term health. Moving beyond conventional rehabilitation approaches focused on symptomatic recovery, this multidimensional paradigm emphasizes cellular repair, physiological balance, and microbial health as interdependent pillars of effective recovery. The framework leverages advancements in stem cell therapy, immune system modulation, and microbiota-targeted interventions to address both immediate functional restoration and long-term systemic resilience. By highlighting the synergistic interplay between these components, this article provides actionable insights into transforming medical rehabilitation into a proactive and holistic endeavor, paving the way for enhanced therapeutic outcomes and sustained patient well-being. Full article

Bacterial diseases of Pleurotus pulmonarius, caused by diverse pathogens and associated with a range of symptoms, reduce its commercial value and lead to substantial economic losses. While most research has focused on Pseudomonas tolaasii and its non-volatile toxin tolaasin, little is known about other bacterial pathogens and their volatile metabolites. In this study, two bacterial pathogens were isolated from symptomatic P. pulmonarius fruiting bodies in Guangxi, China, and identified as Ewingella americana and Cedecea neteri. Using headspace solid-phase microextraction coupled with gas chromatography–mass spectrometry (HS-SPME-GC-MS), we identified 16 volatile organic compounds (VOCs) produced by these two species, seven of which exhibited toxicity-inducing sunken lesions, discoloration, and inhibition of mycelial growth. Symptom severity was quantified by colorimetric analysis. Among the toxic VOCs, 2,4-di-tert-butylphenol was the most potent, inducing sunken lesions and slight discoloration at concentrations as low as 0.5 mg/mL, and causing significant inhibition of mycelial growth at 5 μg/L. The remaining VOCs also caused varying degrees of sunken lesions, yellowing or browning, and suppression of mycelial growth. This study is the first to demonstrate the pathogenic potential of VOCs produced by bacterial pathogens in P. pulmonarius, underscoring their role as important virulence factors and providing a foundation for further investigation into their mechanisms and control strategies. Full article

Fusarium wilt (Foc) TR4 was first reported in Northern Vietnam in 2018. Since then, it has rapidly spread across most northern provinces along the Red River basin banana production landscapes, impacting Cavendish (Musa AAA genome) production. The other main banana cultivars which are widely grown in this production zone are Pisang Awak (Musa ABB genome) and Pisang Mas (Musa AA genome). Field surveys were conducted in 2022/2023 across this banana production region to assess pathogen spread from Cavendish monocropping systems into adjacent smaller-scale mixed cultivar systems. Across 130 sites, a total of 210 banana pseudostem tissue samples were collected from symptomatic Cavendish, Pisang Awak and Pisang Mas plants. Foc TR4 incursions into mixed small-to-mid-sized Cavendish–Pisang Awak plantations were confirmed, and the pathogen was also recorded in Pisang Awak plantations and backyard gardens that did not contain any Cavendish mats. A screenhouse-based Foc TR4 screening trial including seven commonly cultivated Musa varieties in Northern Vietnam indicated that Pisang Awak and Pisang Mas are susceptible to the pathogen. While Pisang Awak, an important local variety, is known to be susceptible to both Foc Race 1 and TR4, recent field observations suggest a limited susceptibility of Pisang Awak to Foc TR4 in mixed cultivar plantation settings. Local farmers similarly reported observing reduced susceptibility, with several having already replanted TR4-affected Cavendish fields with Pisang Awak as part of their disease management strategy. No infections were observed on field-grown Pisang Mas plants in TR4-affected mixed banana cultivar production landscapes. These results and insights provide solutions for the revival of TR4-affected Cavendish production fields or landscapes, through the cultivation of less susceptible local cultivars. In addition, the introduction, validation and scaling of Formosana (i.e., GCTCV-218, a Cavendish somaclone with moderate resistance to Foc TR4) should be envisaged. Full article

Background/Objectives: Ureaplasma parvum (Up) is an opportunistic pathogen associated with urogenital tract infections, pregnancy complications, and reproductive system diseases. Advances in molecular diagnostics have expanded its pathogenic spectrum to include invasive conditions such as arthritis, meningitis, and pneumonia. However, the pathogenic significance of Up remains controversial. Methods: This study retrospectively analyzed nine adult cases of Up detected by metagenomic next-generation sequencing (mNGS) between 2023 and 2024. Results: Patients, aged 21 to 70 years, predominantly had underlying immunosuppressive conditions (66.7%). Infections involved the urinary system (44.4%), respiratory system (33.3%), and peritoneal cavity (22.2%). Symptomatic relief was achieved in five cases following treatment with tetracyclines, quinolones or tigecycline. Conclusions: These findings highlight Up as a potential causative agent of invasive infections, particularly in immunocompromised patients. Up has potential pathogenic significance, whether it is detected as a single pathogen or as a coexisting pathogen. Full article

Coronary anomalies, although rare, should be considered when young patients present with angina. Clinical suspicion and multi-modality imaging including coronary angiography and tomographic imaging should be pursued for symptomatic patients such as the one we are presenting with anomalous right coronary artery from the pulmonary artery. She was promptly referred for surgical intervention with re-implantation of the right coronary artery onto the aorta. Full article

Background: Since the 1990s, numerous investigations have assessed the diagnostic effectiveness—specifically sensitivity, specificity, and accuracy—of exercise stress testing (EST), stress echocardiography (SE), stress myocardial single-photon emission computed tomography (SPECT), and stress cardiac magnetic resonance imaging (CMR). However, the outcomes of these studies have often been inconsistent and inconclusive. To provide a clearer comparison, we conducted systematic reviews and meta-analyses aimed at quantitatively evaluating and comparing the aggregated diagnostic performance of these four commonly used techniques for detecting coronary artery disease (CAD). Methods: A comprehensive search of PubMed, Scopus, Embase, Cochrane Library, and Web of Science was conducted to identify cohort studies evaluating the diagnostic accuracy of EST, SE, stress myocardial SPECT, and stress CMR in symptomatic patients with suspected or confirmed CAD. The main goal was to compare their diagnostic value by pooling sensitivity and specificity results. Each study’s data were extracted in terms of true positives, false positives, true negatives, and false negatives. Results: A total of 104 studies, comprising 16,824 symptomatic individuals with either suspected or known CAD, met the inclusion criteria. The pooled sensitivities for CAD detection were 0.66 (95% CI: 0.59–0.72, p < 0.001) for EST, 0.81 (95% CI: 0.79–0.83, p < 0.001) for SE, 0.82 (95% CI: 0.78–0.85, p < 0.001) for stress myocardial SPECT, and 0.83 (95% CI: 0.81–0.85, p < 0.001) for stress CMR. Corresponding specificities were 0.61 (95% CI: 0.55–0.67, p < 0.001), 0.85 (95% CI: 0.82–0.87, p < 0.001), 0.74 (95% CI: 0.70–0.78, p < 0.001), and 0.89 (95% CI: 0.86–0.92, p < 0.001), respectively. Considerable heterogeneity was observed across the studies, as reflected by I² values ranging from 82.5% to 92.5%. Egger’s generalized test revealed statistically significant publication bias (p < 0.05 for all methods), likely due to the influence of smaller studies reporting more favorable results. Despite this, sensitivity analyses supported the overall robustness and reliability of the pooled findings. Conclusions: Among the diagnostic tools assessed, EST demonstrated the lowest accuracy for detecting obstructive CAD, whereas stress CMR exhibited the highest. Although stress myocardial SPECT showed strong sensitivity, its specificity was comparatively limited. SE emerged as the most balanced option, offering good diagnostic accuracy combined with advantages such as broad availability, cost-effectiveness, and the absence of ionizing radiation. Full article

Grapefruit (Citrus × paradisi Macfad.) is susceptible to Huanglongbing (HLB) disease, which prominently affects tree health and leads to a substantial loss of productivity. HLB-affected trees exhibit a nutritional imbalance expressed in either deficiencies or toxicities of the essential minerals required for plant growth, as well as changes in the production of plant metabolites. Hence, understanding foliar nutritional and metabolite fluctuations as HLB-elicited symptoms progress can assist growers in improving tree health management strategies. This study evaluated changes in foliar nutrient and phloem sap amino acid concentrations of HLB-affected grapefruit trees showing a mixed canopy of HLB-induced blotchy mottle and asymptomatic mature leaves. The trees used in our experiment were fruit-bearing seven-year-old grapefruit trees (cv ‘Rio Red’ on sour orange rootstock) grown in South Texas. Two types of foliage from HLB-affected trees were studied, (a) HLB-symptomatic and confirmed Candidatus Liberibacter asiaticus (CLas)-positive (IS) and (b) CLas-negative and HLB-asymptomatic (IA) mature leaves, which were compared to asymptomatic and CLas-free mature foliage from healthy trees (HY) in terms of their leaf nutrient and phloem sap amino acid contents. Hierarchical clustering based on leaf nutrient contents showed that 70% of IA samples clustered with HY samples, thus indicating that the levels of some nutrients were statistically similar in these two types of samples. The concentrations of the macronutrients N, Ca, Mg, and S and the micronutrients Mn and B were significantly reduced in HLB-symptomatic (IS) leaves, as compared to their IA and HY counterparts, which did not show statistically significant differences. Conversely, leaf Na concentration was approximately two-fold higher in leaves from HLB-affected trees (IA and IS) independent of symptom expression as compared to leaves from healthy trees. Significantly higher concentrations of glutamine and the S-containing amino acids taurine and cystathionine were observed in the IS leaves relative to the phloem sap of IA leaves from HLB-affected trees. In contrast, the phloem sap of IA (14%) and IS (41%) leaves from HLB-affected trees exhibited lower levels of γ-amino butyric acid (GABA) as compared to HY leaves. The results of this study highlight the changes in leaf nutrient and phloem sap amino acid profiles following CLas infection and HLB symptom development in grapefruit, and we discuss these results considering the strategies that growers can implement to correct the nutritional deficiencies and/or toxicities induced by this disease. Full article

Background/Objectives: The aim of this study was to investigate the natural course of a whiplash-associated disorder (WAD) in a Lithuanian population with low awareness of the condition. Methods: In this controlled observational study, 45 participants, enrolled during the acute period after motor vehicle accident, and 50 matched controls were followed up at 8 months. Clinical evaluation of WAD grades was combined with self-scored questionnaires for pain, WAD symptoms, disability, emotional state, and cognitive impairment. The Quebec Task Force Questionnaire was used to assess persistence or development of new symptoms at follow-up. Demographic and sick leave data were collected. Results: The WAD group showed a significant improvement in clinical signs and self-rated scores for pain and disability after 8 months and became largely comparable to the control group. However, only 13 out of 45 WAD participants were symptom-free at follow-up. Persistent neck pain and dizziness/unsteadiness as well as newly developed cognitive complaints were more frequent in the WAD group compared to controls, each reported by around a third of individuals. Logistic regression showed that new cognitive symptoms could be predicted by nausea/vomiting in the acute period and persisting neck pain at follow-up. None of the participants remained on sick leave at follow-up. Conclusions: In a country with low awareness of WAD, a larger proportion of individuals remain symptomatic months after acute whiplash injury but maintain their ability to work. The emergence of new cognitive complaints may suggest concomitant central nervous system involvement. Full article

Musculoskeletal shoulder pain due to rotator cuff (RC) tears is a prevalent condition that significantly impacts function and quality of life. Understanding the underlying pain mechanisms, including movement-evoked pain (MEP) and pain facilitation phenomena such as temporal summation (TS), is essential for improving targeted interventions. This cross-sectional study examined relationships among TS, pain at rest, and MEP in 85 individuals with symptomatic RC tears. Mechanical TS was assessed on the contralateral forearm using standardized mechanical stimuli, while pain at rest and MEP during active arm elevation were measured via numerical rating scales. Spearman’s correlations were performed for the overall cohort and stratified by pain duration (<3 months, acute; ≥3 months, chronic). Weak but statistically significant correlations were found between TS and MEP (r = 0.23, p = 0.02) and between pain at rest and MEP (r = 0.30, p = 0.005), whereas no correlation existed between TS and pain at rest. The logistic regression model showed limited predictive ability. These exploratory findings suggest partially overlapping but distinct pain mechanisms in RC tear patients and should be interpreted as hypothesis-generating, warranting validation in larger, prospective cohorts. Full article

Risdiplam is an orally administered small molecule that modifies the mRNA splicing of SMN2 for the treatment of spinal muscular atrophy (SMA). Its use is approved in presymptomatic patients diagnosed by neonatal screening with early and severe forms with two copies of SMN2, but we do not have real data on the evolution of oral treatment in this early phenotype of SMA. We present two cases treated at one month of life with a follow-up of 12 months and discuss their different evolutions and the causes of this. Familial adherence to treatment is important, as discontinuation can convert an early form of presymptomatic SMA to symptomatic. Molecular biomarkers such as plasma monitoring of neurofilament light chain (pNf-L) should be considered in the follow-up of early forms of SMA and may support the decision to change treatment in infants with SMA. Full article