Search Results (23,821)

Pheochromocytoma and paraganglioma (PPGL) are rare tumors derived from the adrenal medulla and extra-adrenal chromaffin cells. Diagnosis is often challenging due to the great variability in clinical presentation; the complexity of management due to the dangerous effects of catecholamine excess and the potentially malignant behavior require in-depth knowledge of the pathology and multidisciplinary management. Nowadays, diagnostic ability has certainly improved and guidelines and consensus documents for treatment and follow-up are available. A major impulse to the development of this knowledge has come from the new findings on the genetic and molecular characteristics of PPGLs. Germline mutation in susceptibility genes is detected in 40% of subjects, with a mutation frequency of 10–12% also in patients with sporadic presentation and genetic testing should be incorporated within clinical care. PPGL susceptibility genes include “old genes” associated with Neurofibromatosis type 1 (NF1 gene), Von Hippel Lindau syndrome (VHL gene) and Multiple Endocrine Neoplasia type 2 syndrome (RET gene), the family of SDHx genes (SDHA, SDHB, SDHC, SDHD, SDHAF2), and genes less frequently involved such as TMEM, MAX, and FH. Each gene has a different risk of relapse, malignancy, and other organ involvement; for mutation carriers, affected or asymptomatic, it is possible to define a tailored long-life surveillance program according to the gene involved. In addition, molecular characterization of the tumor has allowed the identification of somatic mutations in other driver genes, bringing to 70% the PPGLs for which we know the mechanisms of tumorigenesis. This has expanded the catalog of tumor driver genes, which are identifiable in up to 70% of patients Integrated genomic and transcriptomic data over the last 10 years have revealed three distinct major molecular signatures, triggered by pathogenic variants in susceptibility genes and characterized by the activation of a specific oncogenic signaling: the pseudo hypoxic, the kinase, and the Wnt signaling pathways. These molecular clusters show a different biochemical phenotype and clinical behavior; they may also represent the prerequisite for implementing customized therapy and follow-up. Full article

Background: The rise of multi-drug-resistant Gram-negative bacteria necessitates the development of new antimicrobial agents. Cefiderocol shows promising activity by exploiting bacterial iron transport systems to penetrate the outer membranes of resistant pathogens. Objectives: This study evaluates the efficacy of cefiderocol testing methods and trailing effect impact using a ComASP^® Cefiderocol panel, disk diffusion (DD), and MIC test strips (MTS) compared to iron-depleted broth microdilution (ID-BMD). Methods: A total of 131 Gram-negative strains from clinical samples was tested by commercial methods and the gold standard. Results were interpreted as per 2024 and 2023 EUCAST guidelines. Results: ID-BMD revealed high cefiderocol susceptibility among Enterobacterales and Pseudomonas aeruginosa, with one Klebsiella pneumoniae isolate being resistant. Acinetobacter baumannii exhibited higher MIC values, particularly considering trailing effects that complicated MIC readings. ComASP^® showed 97% categorical agreement (CA) and 66% essential agreement (EA) with ID-BMD for Enterobacterales but failed to detect the resistant K. pneumoniae. DD tests demonstrated variable CA (72% or 93%), and 38% or 34% of strains within the ATU according to EUCAST Breakpoint Tables v13.0 and 14.0, respectively, with major errors only. MTS for P. aeruginosa had 100% CA but 44% EA, and often underestimated MIC values. Conclusions: The study emphasizes the need for standardized criteria to address trailing effects and ATU and highlights the discrepancies between testing methods. While cefiderocol resistance remains rare, accurate susceptibility testing is crucial for its effective clinical use. The findings suggest that current commercial tests have limitations, necessitating careful interpretation and potential supplementary testing to guide appropriate antibiotic therapy. Full article

Universities, as hubs of economic, technological, and social knowledge development, have increasingly adopted metric-based strategies to guide resource management and monitor their growth. The Sustainable University World Ranking, UI GreenMetric, is widely applied for this purpose, measuring performance across six categories aligned with the United Nations Agenda 2030—Sustainable Development Goals (SDGs). This study focused on assessing information concerning the water category of this ranking, or the five water management indicators, at the School of Arts, Sciences, and Humanities of the University of São Paulo, to estimate its classification. The methodology involves assessing the current situation of the university in terms of each indicator, and classifying it according to the ranking guidelines. The information obtained is treated as evidence for posterior validation with the ranking. The findings indicate satisfactory performance in the indicators of water 1, 3, and 5. Notably, the implementation of rainwater collection and storage systems has been successful, alongside maintaining potable water parameters for consumption within the campus, as well as the use of efficient water-saving devices. Indicators 2 and 4, related to effluent treatment and water reuse, are expected to achieve higher classifications with the reactivation of the wastewater treatment system’s operation. Over the period from May 2023 to June 2024, the average daily water consumption was measured at 52.89 ± 25.23 m³ day⁻¹, with a per capita consumption rate of 10.28 L consumer agent⁻¹ day⁻¹. An anticipated 20% reduction in water consumption is expected upon the incorporation of water reuse initiatives. The use of the UI GreenMetric framework has been found strategic and useful as a diagnostic tool, facilitating the identification of areas requiring improvement and guiding efforts toward enhancing the sustainability of the institution. Full article

Background/Objectives: We investigated the effects of ultraprocessed food (UPF) consumption on metabolic disorders (e.g., adiposity, metabolic associated steatotic liver disease [MASLD], and insulin resistance) in children and adolescents with obesity to improve dietary guidelines and public health strategies. Methods: The dietary intake of 149 participants (aged 8–17 years) was assessed with food diaries. The NOVA classification system was used to classify food according to the degree of processing. Metabolic outcomes, including the fat mass index (FMI), hepatic fat percentage, and insulin resistance, were measured via dual-energy X-ray absorptiometry (DXA), magnetic resonance imaging proton density fat fraction (MRI-PDFF), and biochemical analysis, respectively. Results: Greater UPF consumption from baseline to the 6-month follow-up was significantly associated with increased insulin and decreased total cholesterol and LDL-cholesterol. UPF consumption was positively associated with the prevalence of MASLD (liver MRI-PDFF ≥ 5%; odds ratio _{T3 vs. T1} = 1.75; 95% confidence interval [CI] 1.03, 3.00), moderate-to-severe MASLD (liver MRI-PDFF ≥ 10%; OR _{T3 vs. T1} = 4.19; 95% CI 1.72, 10.22), and insulin resistance (OR _{T3 vs. T1} = 2.44; 95% CI 1.33, 4.48), after adjusting for covariates. A linear dose-response relationship was observed between UPF consumption and the odds of moderate-to-severe MASLD and insulin resistance. Conclusions: Greater UPF consumption was strongly associated with MASLD and insulin resistance in children and adolescents with obesity, underscoring the importance of reducing UPF consumption through dietary guidelines and public health interventions to mitigate the risk of obesity-related metabolic conditions in young populations. Full article

Background: Nutrition significantly impacts the outcomes of critically ill children in intensive care units (ICUs). Due to the evolving metabolic, neuroendocrine, and immunological disorders associated with severe illness or trauma, there are dynamically changing phases of energy needs requiring tailored macronutrient intake. Objectives: This study aims to assess the changing dietary needs from the acute phase through recovery, provide recommendations for implementing evidence-based strategies to ensure adequate energy and nutrient provision in pediatric ICUs, and optimize patient outcomes. Methods: A comprehensive search of the MEDLINE-PubMed database was conducted, focusing on randomized controlled trials, meta-analyses, and systematic reviews related to the nutrition of critically ill children. The study highlights recent guidelines using the GRADE approach, supplemented by relevant adult studies, current clinical practices, challenges, gaps in knowledge, and future directions for research aimed at improving nutritional interventions. Results: Early personalized, incremental enteral feeding helps mitigate the negative energy balance during the acute phase, aids organ function restoration in the stabilization phase, and supports growth during the recovery phase and beyond. Conversely, early full nutritional support, high protein doses, or isolated micronutrient administration have not demonstrated benefits due to anabolic resistance in these patients. Moreover, early parenteral nutrition during the acute phase may suppress autophagy and lead to worse outcomes. Accurate assessment of nutritional status and monitoring of daily energy and protein needs are crucial. Conclusions: Strong evidence supports the establishment of a dedicated nutritional team and the implementation of individualized nutritional protocols in the ICU to reduce morbidity and mortality in critically ill children. Full article

Despite guidelines for screening and treating perinatal mood and anxiety disorders (PMADs), systemic issues and clinician biases often result in unmet mental health needs in Black women. This study assessed the feasibility and impact of comprehensive PMAD training on obstetric healthcare providers’ attitudes, knowledge, and implicit racial biases. We conducted a feasibility study with two cohorts of healthcare providers who received either in-person or virtual training. The training focused on PMADs, implicit bias, and culturally responsive care. Participants completed pre- and post-training assessments measuring attitudes, knowledge, empathy, and implicit racial biases. Both training modalities showed trends towards improved PMAD screening attitudes and empathy, with significant increases in beliefs about treatment efficacy. Implicit bias scores approached significance, showing a shift toward fewer participants with racial preferences. However, there was an unexplained increase in preference for White over Black post training. The training improved healthcare providers’ readiness to screen for PMADs and enhanced their understanding of PMADs. However, the persistence of implicit biases highlights the need for ongoing, sustained interventions to address deeply rooted biases. Future research should incorporate continuous learning strategies and link training to healthcare outcomes for minoritized communities. Full article

Dyslipidemia is a common metabolic complication in patients undergoing peritoneal dialysis (PD) and has traditionally been viewed primarily in terms of cardiovascular risk. Current guidelines do not recommend initiating lipid-lowering therapy in dialysis patients due to insufficient evidence of its benefits on cardiovascular mortality. However, the impact of dyslipidemia in PD patients may extend beyond cardiovascular concerns, influencing PD-related outcomes such as the peritoneal ultrafiltration rate, residual kidney function, PD technique survival, and overall mortality. This review challenges the traditional perspective by discussing dyslipidemia’s potential role in PD-related complications, which may account for the observed link between dyslipidemia and increased all-cause mortality in PD patients. It explores the pathophysiology of dyslipidemia in PD, the molecular mechanisms linking dyslipidemia to peritoneal membrane dysfunction, and summarizes clinical evidence supporting this hypothesis. In addition, this paper examines the potential for therapeutic strategies to manage dyslipidemia to improve peritoneal membrane function and patient outcomes. The review calls for future research to investigate dyslipidemia as a potential contributor to peritoneal membrane dysfunction and to develop targeted interventions for PD patients. Full article

Follicular lymphoma (FL) is the most prevalent indolent B-cell lymphoma entity, often characterized by the t(14;18) BCL2-IGH translocation. The malignancy represents a clinically and biologically highly heterogeneous disease. Most patients have favorable prognoses; however, despite therapeutic advancements, the disease remains incurable, with recurrent relapses or early disease progression. Moreover, transformation to an aggressive histology, most often diffuse large-B-cell lymphoma, remains a critical event in the disease course, which is associated with poor outcomes. Understanding the individual patient’s risk of transformation remains challenging, which has motivated much research on novel biomarkers within the past four decades. This review systematically assessed the research on molecular biomarkers in FL transformation and outcome. Following the PRISMA guidelines for systemic reviews, the PubMed database was searched for English articles published from January 1984 through September 2024, yielding 6769 results. The identified publications were carefully screened and reviewed, of which 283 original papers met the inclusion criteria. The included studies focused on investigating molecular biomarkers as predictors of transformation or as prognostic markers of time-related endpoints (survival, progression, etc.). The effects of each biomarker were categorized based on their impact on prognosis or risk of transformation as none, favorable, or inferior. The biomarkers included genetic abnormalities, gene expression, microRNAs, markers of B cells/FL tumor cells, markers of the tumor microenvironment, and soluble biomarkers. This comprehensive review provides an overview of the research conducted in the past four decades, underscoring the persistent challenge in risk anticipation of FL patients. Full article

Located in northern Western Australia, the Pilbara is the highest productivity region for iron ore and other metal mining in Australia. As elsewhere, mine closure guidelines typically require post-closure landforms to be safe, stable, non-polluting and sustainable here in the long-term. I reviewed the primary literature, including international, national and state government guidelines and regional case studies for mine closure and related socio-environmental topics, to understand the key risks and management strategies needed to achieve these broad expectations for below water table (BWT) mining. Many BWT open cut mining projects will result in pit lakes in this region, many of which will be very large and will degrade in water quality with increasing salinisation over time. As an arid region, risks are dominated by alterations to hydrology and hydrogeology of largely unmodified natural waterways and freshwater aquifers. Although remote, social risks may also present, especially in terms of impacts to groundwater values. This remoteness also decreases the potential for realising practicable development of post-mining land uses for pit lakes. Explicitly considered risk-based decisions should determine closure outcomes for BWT voids, and when pit backfill to prevent pit lake formation will be warranted. However, maintaining an open pit lake or backfilling a void should also be considered against the balance of potential risks and opportunities. Full article

Over the past decade, wearable medical devices (WMDs) have become the norm for continuous health monitoring, enabling real-time vital sign analysis and preventive healthcare. These battery-powered devices face computational power, size, and energy resource constraints. Traditionally, low-power microcontrollers (MCUs) and application-specific integrated circuits (ASICs) have been used for their energy efficiency. However, the increasing demand for multi-modal sensors and artificial intelligence (AI) requires more computational power than MCUs, and rapidly evolving AI asks for more flexibility, which ASICs lack. Field-programmable gate arrays (FPGAs), which are more efficient than MCUs and more flexible than ASICs, offer a potential solution when optimized for energy consumption. By combining real-time reconfigurability with intelligent energy optimization strategies, FPGAs can provide energy-efficient solutions for handling multimodal sensors and evolving AI requirements. This paper reviews low-power strategies toward FPGA-based WMD for physiological monitoring. It examines low-power FPGA families, highlighting their potential in power-sensitive applications. Future research directions are suggested, including exploring underutilized optimizations like sleep mode, voltage scaling, partial reconfiguration, and compressed learning and investigating underexplored flash and hybrid-based FPGAs. Overall, it provides guidelines for designing energy-efficient FPGA-based WMDs. Full article

This exploratory research conducted a thematic analysis of students’ experiences and utilization of AI tools by students in educational settings. We surveyed 87 undergraduates from two different educational courses at a comprehensive university in Western Canada. Nine integral themes that represent AI’s role in student learning and key issues with respect to AI have been identified. The study yielded three critical insights: the potential of AI to expand educational access for a diverse student body, the necessity for robust ethical frameworks to govern AI, and the benefits of personalized AI-driven support. Based on the results, a model is proposed along with recommendations for an optimal learning environment, where AI facilitates meaningful learning. We argue that integrating AI tools into learning has the potential to promote inclusivity and accessibility by making learning more accessible to diverse students. We also advocate for a shift in perception among educational stakeholders towards AI, calling for de-stigmatization of its use in education. Overall, our findings suggest that academic institutions should establish clear, empirical guidelines defining student conduct with respect to what is considered appropriate AI use. Full article

Background: Alzheimer’s disease (AD) is the most common cause of dementia and cognitive decline in the elderly. Although the etiology of AD is unknow, an increase in amyloid precursor protein (APP) leads to the toxic aggregation of Aβ plaques. Several factors, such as hypertension, diabetes, dyslipidemia, smoking, hormonal changes, and metal exposure, could increase the risk of developing AD. In this review, we will examine the role of copper (Cu) in the pathophysiology of AD, as well as the mechanisms involved in neurotoxicity and cognitive decline. Methods: This review was conducted in accordance with PRISMA guidelines. We performed a comprehensive literature analysis over the last ten years on AD and Cu. Only late-onset Alzheimer’s disease was considered; only studies on elderly people of both sexes were included. Results: A total of seven articles were picked for this review, three studies focused on non-ceruloplasmin-bound Copper (non-Cp-Cu) and four on ceruloplasmin-bound Copper (Cp-Cu). The results showed higher Cu concentrations in patients compared to healthy controls. Conclusions: Elevated concentrations of Cu may contribute to the progression of AD, potentially interacting with ATP7B mutations, oxidative stress (OS), and amyloid-β plaques. Future research is needed to provide more robust evidence and better characterize the relationship between AD and Cu. Full article

Elevating Indigenous leadership in conservation science is critical for social and ecological wellbeing. However, Indigenous knowledges are frequently undermined by persistent colonial research standards. In response, calls to implement ethical guidelines that advance Indigenous research and data governance are mounting. Despite this growing movement, most environmental studies continue to follow largely colonial, extractive models, presenting a widening gap between ethical guidelines and practical applications across diverse research contexts. To address this gap, our study aims to design and evaluate a wildlife conservation research project based on the Relational Science Model, which outlines guidance for improving research relations with Indigenous Peoples. To achieve this aim, we conducted a post-survey to evaluate the project from the perspectives of the intended beneficiaries of La Bendición in southwestern Guatemala, accompanied by researcher reflections and observations. The results revealed strong agreement between community research partner experience and Relational Science Model outcomes, including relevant and innovative knowledge generation, alongside improved trust in research collaborations. Respondents also outlined several areas of improvement, including a desire for more diverse community engagement, particularly regarding youth. Overall, this study outlines pathways and recommendations for researchers, institutions, and agencies to improve relational accountability in conservation science practice, supporting Indigenous conservation governance and environmental justice. Full article

Background: The literature lacks a combined analysis of neurosurgical microvascular anastomosis training models. We performed a systematic literature search to provide an overview of the existing models and proposed a classification system based on the level of simulation and reproducibility of the microvascular anastomosis. Methods: The systematic literature search followed the PRISMA guidelines. We consulted MEDLINE, Web of Knowledge, and EMBASE independently for papers about bypass training models. Every training model was analyzed according to six tasks supposed to esteem their fidelity to the real operative setting by using a scoring system from zero to two. Finally, authors classified the models into five classes, from A to E, by summing the individual scores. Results: This study included 109 papers for analysis. Training models were grouped into synthetic tubes, ex vivo models (animal vessels, fresh human cadavers, human placentas) and in vivo simulators (live animals—rats, rabbits, pigs). By applying the proposed classification system, live animals and placentas obtained the highest scores, falling into class A (excellent simulators). Human cadavers and animal vessels (ex vivo) were categorized in class B (good simulators), followed by synthetic tubes (class C, reasonable simulators). Conclusions: The proposed classification system helps the neurosurgeon to analyze the available training models for microvascular anastomosis critically, and to choose the most appropriate one according to the skills they need to improve Full article

(1) Background: Obstetric brachial plexus palsy (OBPP) is an unpredictable and unpreventable neurological injury, caused by shoulder dystocia during birth, that affects the brachial plexus and leads to motor and sensory deficits in the child’s upper extremity. The limited literature on early therapeutic assessment of newborns with OBPP highlights a gap in specialized care that, if filled, could enhance decision-making and support timely treatment. The objective of this paper is to analyze the therapeutic intervention techniques used at an early stage and their functional impact, from the occupational therapy discipline in the treatment of the upper extremity in babies and children with OBPP. (2) Method: Systematic review design and meta-analysis. A systematic review is a comprehensive analysis of existing research on a specific topic, using rigorous methods to identify, evaluate, and synthesize studies. Meta-analysis, often part of a systematic review, combines results from multiple studies to identify overall trends and enhance reliability, providing a clearer summary of evidence. Articles that included pediatric patients (from birth to 12 years of age) with a diagnosis of OBPP were reviewed. The results of the techniques used were analyzed according to each study, with the scale or method of assessment considered by the study for the presentation of data. The articles were assessed for methodological quality using the “PEDro Validity Scale”. (3) Results: A total of 2190 articles were found, with 108 analyzed and 22 fully meeting this study’s standards. Fourteen had a quantitative design, while the others included clinical guidelines. The most statistically reliable intervention techniques were CIMT (constraint-induced movement therapy) and splinting (dynamic and static), with second-tier techniques like joint manipulation, NMES, early infant management education, and serial casting used when needed. This study focused on children from birth to eight years old, with assessment tools primarily measuring upper limb range of motion, external rotation, supination, and impairment levels, though bimanual activity assessment was less common. (4) Conclusions: The early implementation of the techniques that provide us with the most data are CIMT, splinting, NMES, and joint manipulation linked to health education for families. In second place, we have the use of TB infiltrations and serial casts, when the treatment of the previous techniques fails in some cases. Full article