Controlled donation after circulatory determination of death (cDCDD) is now a major contributor to transplant activity worldwide. However, its expansion has been complicated by inconsistent terminology, diverse clinical protocols, and ethical uncertainties. To address these challenges, the European Society for Organ Transplantation (ESOT) convened a global consensus forum involving multidisciplinary experts from various geographic regions. Four steering committees were established to address adult and pediatric donation pathways, normothermic regional perfusion, and the determination of death. Using a structured methodology, expert panels participated in two waves of surveys, complemented by an in-person consensus meeting to develop recommendations on key clinical and ethical aspects of cDCDD. This article presents the project methodology and consensus results regarding standardized terminology and definitions that are essential for successfully harmonizing international practice. Consensus was achieved on fundamental terms, including the recommended nomenclature of "donation after circulatory determination of death," definitions of clinical categories such as possible and potential donors, and key time points in donation protocols. The establishment of shared terminology provides a foundation for comparing outcomes across programs, facilitating international research collaboration, and supporting evidence-based improvements in clinical practice. This consensus represents an important step toward global convergence of donation practices while maintaining core ethical values and supporting continued technological and societal progress in the field.
Complete lung atelectasis resulting from main bronchial obstruction may arise from both benign and malignant etiologies. Diagnosis is often delayed, particularly in younger patients, leading to prolonged lung collapse and compensatory hemidiaphragmatic elevation. Pneumonectomy is traditionally considered in such cases, lung-sparing resections should be preferred, especially in young individuals. The indication for sleeve resection in the setting of long-standing complete atelectasis remains controversial. We report the clinical presentation, surgical management, and outcomes of two patients with chronic dyspnea and presented with long-standing complete right lung atelectasis secondary to right main bronchus obstruction, treated with lung parenchyma-sparing procedures. A 30-year-old woman with post-tuberculosis bronchial stenosis (treated in 2018 at the Institute of Pneumonology "Marius Nasta", Bucharest) and a 34-year-old man with a typic endobronchial carcinoid tumor (treated in 2025 at the Centre Hospitalier Monkole, Kinshasa) were included. Both patients underwent right upper sleeve lobectomy by lateral thoracotomy. They were discharged on day 6, with an uneventful short- and long-term outcomes, including rapid improvement of pulmonary function. Even in cases of prolonged complete lung atelectasis due to main bronchial obstruction, lung-sparing resection is feasible and effective. It avoids pneumonectomy and is not associated with increased perioperative or long-term complications.
The COVID-19 pandemic significantly altered the epidemiology of respiratory viral infections in children. This study aimed to compare the clinical and epidemiological characteristics of influenza and COVID-19 infections in hospitalized pediatric patients in Romania during the pandemic. We conducted a retrospective observational study at the Alessandrescu-Rusescu National Institute for Mother and Child Health in Bucharest between January 1, 2020, and November 2025. Pediatric patients (0-18 years) hospitalized with COVID-19 infection or influenza A/B type were included. Demographic data, clinical presentation, comorbidities, complications, and outcomes were analyzed. A total of 234 patients with COVID-19 and 235 patients with influenza type A/B were included. The median age in the COVID-19 group was 13.9 months with a median length of hospitalization of 4 days, while in the influenza group, the median age was 32.6 months, with a median length of stay of 5 days. Influenza virus was associated with higher risks of intensive care unit admission, longer hospitalization (P < 0.001), pneumonia (22.0% vs 6.0%, P < 0.001), and acute respiratory failure (18.3% vs 10.7%, P = 0.025). In contrast to adult populations, influenza infection was associated with a more severe clinical course than COVID-19 in hospitalized pediatric patients, despite the younger age of COVID-19 patients. These findings emphasize the importance of preventive strategies against influenza in children.
Qualitative liquid chromatography-mass spectrometry (UHPLC-MS) and NMR analysis of the diethyl ether extract of the aerial part of Eryngium dichotomum plant belonging to the Apiaceae family led to the putative identification of phenolic acids, flavonoid glycosides, triterpenoid saponins, fatty acids, and oxylipins. The tentative identification of several secondary metabolites by UHPLC-MS analysis was further confirmed by compound isolation and comprehensive spectroscopic characterization using 2D NMR and mass spectrometry, leading to the elucidation of seven compounds, a mixture of two hydroxy fatty acids, namely (Z,E)-13-hydroxyoctadeca-9,11-dienoic acid (1) and (E)-13-hydroxyoctadec-11-enoic acid (2); two C17 polyacetylenes, (E)-heptadeca-1,10-dien-4,6-diyne-3,8,9-triol (3), and falcarinol ((Z)-1,9-heptadeca-1,9-dien-4,6-diyn-3-ol) (4); glycerol monopalmitate (5) and two flavonoid glycosides, kaempferol 3-O-β-D-glucopyranosyl-(1 → 6)-O-β-D-galactopyranoside (6), and quercetin 3-O-β-D-glucopyranosyl-(1 → 6)-O-β-D-galactopyranoside (7). Furthermore, the antioxidant activity of the n-butanol and the diethyl ether extracts of the species were evaluated using the DPPH, FRAP, and ABTS assays. In addition, the anticancer activity of the major falcarinol-type polyacetylene was assessed against A375 human melanoma cells.
Preeclampsia is increasingly understood not only as a clinical syndrome of hypertension and organ dysfunction, but also as a disorder in which placental gene regulation, maternal vascular adaptation, and inflammatory signaling are shaped by abnormal epigenetic control. While several reviews have described epigenetic biomarkers in preeclampsia, the therapeutic implications of these mechanisms remain less clearly integrated. This review, therefore, focuses on the translational potential of epigenetic pathways as therapeutic entry points, with particular attention to DNA methylation, histone regulation, non-coding RNA networks, extracellular vesicle communication, and hypoxia-responsive placental signaling. Rather than treating these mechanisms solely as diagnostic signatures, the article evaluates how they may define molecular endotypes, identify pregnancies that could benefit from closer surveillance, and guide future interventions targeting upstream placental dysfunction. Potential strategies include selective modulation of DNMT and HDAC activity, microRNA inhibition or replacement, nutritional and environmental epigenetic optimization, placenta-oriented nanocarrier delivery, and pharmacogenomic stratification. The review also addresses the central barriers to translation, including tissue specificity, maternal-fetal safety, off-target epigenomic effects, ethical acceptability, long-term developmental consequences, and regulatory uncertainty. By reframing epigenetic alterations as actionable biological circuits rather than isolated biomarkers, this work provides a therapeutic and precision-medicine perspective on preeclampsia and outlines research priorities needed before epigenetic interventions can be responsibly evaluated in pregnancy.
To develop effective and equitable emission reduction policies in the European Union, it is necessary to consider not only the level of environmental inequality but also its persistence over time. Therefore, examining the stationarity properties of inequality indicators is important for determining whether such inequalities are temporary or permanent. Accordingly, this study analyzes the stationarity characteristics of ecological footprint inequality in the European Union for the period 1961-2024. Ecological footprint inequality is measured using three complementary inequality indices: the Gini coefficient, the Theil-T index, and the Atkinson index. In addition to traditional unit root tests such as ADF, PP, and KPSS, the analysis employs Fourier-based tests, structural break unit root tests, and the artificial intelligence-based ARNN-ADF test to examine the stationarity structure of the series. Furthermore, the ARFIMA model is employed as a robustness check to assess the long-memory properties of ecological footprint inequality. The findings of this study are test-dependent. Conventional unit root tests suggest level stationarity, whereas Fourier-based, structural-break and nonlinear tests provide stronger evidence of persistence. ARFIMA results further indicate a stationary long-memory process operating close to the non-stationarity boundary. These findings suggest that shocks to ecological footprint inequality are not purely transitory but tend to persist over long periods. Overall, the results highlight the need for structural and long-term policies to reduce ecological footprint inequalities across European Union countries.
In children and infants, thoracic empyema most often develops as a complication of parapneumonic pleural effusions progressing to purulent collections. With an estimated incidence of approximately 0.6% among pediatric pneumonia cases, empyema remains associated with significant morbidity. This study aimed to characterize pediatric parapneumonic empyema by analyzing clinical, biochemical, and radiological parameters and their relationship with treatment decisions and outcomes. We conducted a retrospective, single-center study including children diagnosed with parapneumonic pleural empyema and treated in the Pulmonology Department of the "Grigore Alexandrescu" Emergency Hospital for Children between January 2021 and December 2024. Only patients managed surgically-either by chest-tube drainage or video-assisted thoracic surgery (VATS)-were included. Fibrinolytic therapy was not used due to limited institutional experience, with VATS preferred in complicated cases. Patients were stratified according to initial intervention. Clinical, laboratory, and imaging data were extracted from medical records. A total of 33 patients were included, with a median age of 4 [3-8] years. The median time to initial intervention was 2 [1-5] days. Fourteen patients (42.4%) underwent primary VATS after a median of 4.5 [2-6.3] days, while 19 received initial chest-tube drainage after 1 [0-3] days, with a mean drainage duration of 21.2 ± 11.5 days. Median hospital stay for the cohort was 27 [21-38.5] days. Loculations and septations were significant predictors of hospitalization length. Drainage duration was significantly shorter in the primary VATS group compared with the chest-tube group (9.5 [7.8-12.5] vs. 19 [11-30] days; p = 0.011). Dyspnea strongly predicted selection of VATS as initial treatment (OR 18.0, 95% CI 1.86-174.21; p = 0.013). Imaging findings on thoracic ultrasound did not significantly influence the choice of initial intervention. Computed tomography, performed in 45.5% of cases, identified complications such as bronchopleural fistula, empyema necessitans, and pyopneumothorax, and was associated with prolonged hospitalization. Chest-tube drainage was the most frequent initial treatment, with escalation decisions driven primarily by clinical presentation rather than imaging or biochemical markers. Thoracic ultrasound was valuable for assessing effusion complexity but had limited prognostic utility. The lack of fibrinolytic therapy resulted in a high rate of VATS, highlighting the need for standardized, symptom-driven management algorithms integrating clinical, laboratory, and imaging data.
Patients receiving maintenance hemodialysis were highly vulnerable during the coronavirus disease 2019 pandemic because treatment continuity required repeated exposure to healthcare settings, while multiple comorbidities increased severe infection risk. Although many studies reported clinical outcomes in dialysis populations, fewer assessed hospitalization costs, particularly in Eastern Europe. This study evaluated hospitalization costs among maintenance hemodialysis patients admitted with COVID-19 during pandemic waves in Romania: Wave 1 (March-May 2020), Wave 2 (October 2020-February 2021), and Wave 3 (July-November 2021). We conducted a retrospective cohort study using linked administrative and clinical databases from a Romanian tertiary nephrology center. The source database included 126 entries. After exclusion of records lacking complete reimbursement or admission/discharge data, 84 hospitalization episodes were eligible for analysis. The dataset included the first two waves: 23 admissions in Wave 1 and 61 in Wave 2. Mean hospitalization cost increased from 6,216.51 RON in Wave 1 to 8,478.76 RON in Wave 2, while median cost increased from 3,094.44 RON to 5,281.90 RON. Mean length of stay decreased significantly from 18.39 to 11.61 days (P = 0.0047). Mean cost per hospitalization day increased significantly from 426.30 RON/day to 767.47 RON/day (P = 0.0013). Total hospitalization cost correlated positively with length of stay (Spearman's ρ = 0.50, P < 0.001). Data from Wave 3 were limited and interpreted descriptively. The second pandemic wave was associated with shorter admissions and higher daily hospitalization costs, suggesting more intensive inpatient management. These findings support prioritization of dialysis patients in future preparedness and healthcare resource planning.
Psychological distress is highly prevalent among patients with cancer, particularly during the perioperative period. Psycho-oncological interventions may improve emotional outcomes, yet their short-term effectiveness and moderating factors remain insufficiently explored. This prospective pre-post observational study without a control group included 95 women diagnosed with breast and gynecological cancers. Psychological assessments were conducted at baseline (T0) and after a perioperative psycho-oncological intervention (T1), consisting of 3-6 sessions integrating cognitive-behavioral therapy, mindfulness, narrative therapy, and guided imagery. Outcomes included anxiety (HAM-A), depression (HAM-D), post-traumatic stress symptoms (PCL), and self-esteem (RSES). Effect sizes (Cohen's d) and subgroup analyses were performed. Baseline scores indicated moderate to high levels of psychological distress. Significant improvements were observed across all psychological variables: anxiety (Δ = -7.6, d = 1.10), depression (Δ = -6.1, d = 0.98), PTSD symptoms (Δ = -8.8, d = 1.08), and self-esteem (Δ = +3.7, d = 0.85) (all P < 0.001). Clinical response rates ranged from 61% to 68%. Patients with insecure attachment showed higher baseline distress but greater improvement. Educational level, disease stage, and rural vs. urban origin influenced both baseline distress and treatment response. Short-term perioperative psycho-oncological intervention is associated with clinically significant reductions in psychological distress. Response variability suggests the need for personalized approaches based on psychological and socio-demographic profiles.
➢ Romanian orthopaedic practice has demonstrated a growing uptake of digital infrastructure, including the implementation of robotic-assisted surgical workflows and emerging applications of artificial intelligence.➢ Romania ranks among the European countries with the highest hospital bed capacity per capita, supporting the provision of sustained care for elderly patients, including those with fragility fractures and oncologic orthopaedic conditions and those undergoing complex revision surgeries.➢ The Romanian Arthroplasty Register was modernized and relaunched in 2025 as an initiative to align with other long-standing national European counterparts.
Spondylodiscitis, though rare, is a serious condition that can lead to disability or death. It may be caused by pyogenic, granulomatous (e.g., tuberculosis, brucellosis, fungal), or rarely, parasitic infections. Pain and neurological deficits typically result from bone destruction, deformity, and mass effect. Various microbiological agents have been identified in the literature, with more frequent spinal infections caused by pyogenic bacteria, such as Staphylococcus aureus, as well as by less common agents, including Mycobacterium tuberculosis and fungi, such as Candida albicans. Between February 2013 and May 2020, patients underwent posterior decompression surgery with specimen collection for microbiological analysis, transpedicular instrumental fixation, and deformity correction. Inclusion criteria were spinal pain, neurological deficit, spondylodiscitis with radiological or MRI confirmation, and positive microbiological results. Patients under 18, those requiring multiple surgeries, or those with degenerative or conservatively managed cases were excluded. Post-surgical treatment included 6 weeks of dual-antibiotic therapy for pyogenic infections, 1 year of antituberculous therapy with four drugs for the first 3 months, and 6 months of antifungal therapy, consisting of 4 weeks of intravenous treatment followed by oral therapy. Descriptive statistical methods were used in this study. Of the 67 patients, 73.13% had lumbar involvement. Thirty underwent single-level fixation; 37 had multi-level fixation. Pain scores (VAS) improved consistently at 6 weeks and 3 months post-op. All patients initially had neurological deficits, with functional improvement shown by better Oswestry Disability Index scores and Frankel grades after surgery. Surgical intervention was effective in relieving pain, correcting deformities, and improving function in spondylodiscitis. Obtaining a microbiological diagnosis during decompression is crucial for guiding targeted therapy and minimizing antibiotic resistance.
One-dimensional fibrous scaffolds with tunable bioactivity offer promise for bone tissue regeneration, yet optimal calcium phosphate phases for enhancing osteogenic performance remain underexplored. This study aimed to evaluate the impact of monetite-, brushite-, and cerium-doped phosphate deposition on electrospun nylon nanofibres functionalised via matrix-assisted pulsed laser evaporation (MAPLE). Five nylon fibre compositions were synthesised, coated with three calcium phosphate phases, and calcined at varying temperatures (500-800 °C) before laser deposition. Physicochemical properties were assessed using energy-dispersive X-ray spectroscopy (EDS), scanning electron microscopy (SEM), and fibre diameter measurements, averaging 62.1±23.8 nm. Biocompatibility assays following MC3T3 preosteoblast seeding and incubation evaluated biological performance. EDX confirmed homogeneous phase deposition; SEM showed phase- and temperature-dependent morphology, with monetite yielding uniform granular structures and cerium-doped phosphate at 800 °C forming dense aggregates. Brushite-coated fibres exhibited superior preosteoblast metabolic activity, reaching 178±2% after 48 h (p < 0.001), indicating phase-specific stimulation of bone cell growth. These phosphate-functionalised nylon fibres retain structural integrity, hierarchical porosity, and enhanced bioactivity, providing a versatile electrospinning-MAPLE platform for customisable bone grafts with clinical potential.
It is known that antimicrobial surface treatments are one of the measures that can reduce the spread of viral, bacterial or fungal infections that threaten humans' life. The excessive use of antibiotics has led to the emergence of resistant microorganisms. This study presents the potential of nanocomposites to impart durable antimicrobial properties, which can be enhanced by the use of gamma radiation, even after two months of activation. Leather surfaces finished with composite titanium dioxide nanoparticles decorated with silver, copper oxide and/or graphene oxide were investigated before, immediately after, and after 60 days of gamma irradiation treatment. The antibacterial activity against Escherichia coli ATCC 25922 and Staphylococcus aureus ATCC 6538 was found to be maintained, and even slightly increased over time compared to unirradiated leathers. Analyses of the morphology and composition of the surface of treated leathers using SEM/EDS, ATR/FTIR, as well as photo activity tests allowed the identification of structural characteristics and the modifications induced by gamma radiation activation. Evaluating the resistance properties of leathers finished with the new nanoparticle composites compared to those finished classically confirmed the quality of the applied technologies. These results provide a solution for antimicrobial treatment of medical equipment, including footwear, with potential applications in other areas such as furniture, aircraft or car upholstery, clothing and bags.
Emergency surgery for complicated colon cancer is associated with high morbidity and mortality, and selecting between primary anastomosis and stoma formation remains challenging. Systemic inflammation may influence intraoperative decisions and postoperative outcomes, but its role in emergency settings is not fully established. This retrospective study included patients undergoing emergency surgery for complicated colon cancer between October 2020 and January 2025. Patients were grouped according to surgical strategy (primary anastomosis vs. stoma formation). Preoperative inflammatory biomarkers-C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and systemic immune-inflammation index (SII)-were analyzed in relation to surgical decisions, postoperative complications, anastomotic leakage, and 30-day mortality using multivariate logistic regression and ROC curve analyses. Among 221 patients, 136 (61.5%) underwent primary anastomosis and 85 (38.5%) stoma formation. Higher CRP, NLR, and blood glucose levels were independently associated with a lower likelihood of primary anastomosis (AUC = 0.764). Postoperative complications occurred in 40.7% of patients and were independently predicted by body mass index, Charlson Comorbidity Index, serum creatinine, blood glucose, and NLR (AUC = 0.851). Anastomotic leakage was strongly associated with elevated CRP, NLR, SII, and serum creatinine, with CRP showing the highest predictive accuracy (AUC = 0.894). Elevated NLR and serum creatinine independently predicted 30-day mortality. Preoperative inflammatory biomarkers, particularly CRP and NLR, offer important prognostic value for surgical decision-making and early postoperative outcomes in emergency colon cancer surgery.
Multiparametric magnetic resonance imaging has improved risk stratification and lesion-directed sampling in suspected prostate cancer. MRI-ultrasound fusion biopsy targets MRI-visible lesions, whereas systematic biopsy provides non-targeted glandular sampling. This study aimed to compare the diagnostic yield of fusion and systematic biopsy in a single-center paired cohort and to explore biopsy-to-surgical pathology concordance in operated patients. This retrospective study included 138 men who underwent both fusion-targeted and systematic biopsy during the same diagnostic work-up. The primary endpoint was overall prostate cancer detection; secondary endpoints included clinically significant prostate cancer detection, discordance between methods, PI-RADS-stratified detection, complications, and exploratory surgical pathology findings. Clinically significant cancer was defined as a Gleason score ≥3+4 / ISUP Grade Group ≥2. Fusion biopsy detected prostate cancer in 65/138 men (47.1%) versus 56/138 (40.6%) for systematic biopsy; combined biopsy detected cancer in 72/138 (52.2%). Fusion-only detection occurred in 16 patients (11.6%) and systematic-only detection in 7 (5.1%). The paired difference for overall cancer detection did not reach statistical significance (exact McNemar P = 0.093). Clinically significant prostate cancer was detected in 37/138 men (26.8%) by fusion biopsy and 35/138 (25.4%) by systematic biopsy (P = 0.815). Detection rates increased with PI-RADS category and were highest in PI-RADS 5 lesions. Surgical pathology was available in 45 patients; upgrading occurred in 21 (46.7%) and adverse pathology in 18 (40.0%). Fusion biopsy showed a numerically higher overall detection rate, particularly in PI-RADS 5 lesions, while systematic biopsy retained complementary value. These findings support a combined targeted and systematic biopsy strategy in selected patients. Current evidence also suggests that careful antibiotic stewardship is a safe approach in the management of office-based transrectal prostate biopsy.
Graphene oxide (GO) provides a versatile platform for the development of antimicrobial and anti-adhesive materials, particularly when combined with covalently immobilized bioactive compounds but translating antibiotic activity into a stable layer without clinically relevant drug leaching remains challenging. Here, we report a covalently engineered GO-moxifloxacin (GO-MOX) composite obtained by grafting MOX onto ethylenediamine-functionalized GO via carbodiimide coupling. The successful functionalization was supported by complementary physicochemical analyses, including FTIR, NMR, Raman, XPS, TGA, SEM/EDS and XRD. TGA indicated a high MOX loading of approximately 44.75 wt%, while HPLC analysis revealed that extractable/free MOX represented only 0.0586% of the total MOX content, supporting the predominantly covalent and minimally releasing character of the material. GO-MOX showed pronounced antimicrobial activity against representative ESKAPEE pathogens, with MIC values of 7.81 μg/mL against E. coli and 62.5 μg/mL against the tested Gram-positive strains. In the antimycobacterial assay, GO-MOX markedly inhibited the growth of both drug-susceptible and rifampicin/isoniazid-resistant Mycobacterium tuberculosis strains under the tested conditions. Anti-adherence activity was observed at sub-inhibitory concentrations, with MBEC values of 1.95 μg/mL for E. coli and 7.81 μg/mL for S. aureus, suggesting interference with early bacterial attachment. Additional analyses on mature biofilms formed on titanium substrates showed that GO-based treatments, particularly GO-MOX, affected biofilm viability, promoted membrane permeabilization, and altered extracellular matrix components, including extracellular proteins, nucleic acids/eDNA-like fractions and polysaccharides. In vitro cellular assays showed that normal MRC-5 fibroblasts recovered metabolic activity to ≥80% after 72 h, whereas A549 cells displayed a concentration- and time-dependent decrease in viability. ROS generation and Caspase-3 activity further suggested that the selective antiproliferative response observed in A549 cells may be associated, at least in part, with oxidative stress-mediated apoptotic mechanisms. In silico target prediction and structural inspection of MOX-topoisomerase complexes suggested that GO-MOX may retain a MOX-related contribution involving bacterial DNA gyrase/topoisomerase IV, while GO may provide additional contact-associated interfacial effects. Overall, GO-MOX emerges as a promising antimicrobial and anti-adhesive nanoplatform with cell-selective antiproliferative effects, supporting its further investigation for the future development of biomedical antimicrobial surfaces and coatings.
Urinary tract infections (UTIs) and the widespread use of antibiotics are a growing concern in both the urological field and public health. UTIs affect both male and female patients similarly, with a higher incidence among individuals with excessive rates of stone formation. This study aimed to evaluate the main microorganisms and antimicrobial agents involved in urinary tract infections in men undergoing surgical procedures for urolithiasis over a 2-year period. We conducted a retrospective, single-center, observational study over 24 months, from January 2024 to December 2025. Criteria for inclusion consisted of male patients of at least 18 years old, at least one positive urine culture (>105 CFU/ml), a single bacterial agent, imaging-confirmed urolithiasis, and a history of surgical management of renal stone disease (FURS, URS, and/or PCNL). Cases that were conservatively managed or presented no evidence of urolithiasis, as well as female patients, were excluded from this study. A total of 543 patients underwent assessment. Differences were observed between the incidence of Gram-positive (155, 28.55%) and Gram-negative (388, 71.45%) microbial agents. The highest incidence was highlighted for Escherichia coli (32.33% of cases), followed by Enterococcus spp. (20.81%) and Klebsiella spp. (20.81%). Among the resistance rates for the main antibiotics evaluated, the highest values were observed for Levofloxacin (44.53% for Gram-negative and 55.47% for Gram-positive). This study underscores the importance of appropriate and optimized antimicrobial management, especially in patients undergoing surgery for renal stone disease, reinforcing current data.
Physical inactivity among children and adolescents has reached critical levels worldwide, with approximately 81% of school-aged youth failing to meet the World Health Organization recommendation of at least 60 min of moderate-to-vigorous physical activity per day. At the same time, screen-based sedentary behaviors have increased substantially, raising concerns about their combined impact on brain development, cognitive processes, and behavioral regulation. Although extensive research exists, evidence regarding dose-response relationships, neurobiological mechanisms, and the moderating role of screen-related behaviors remains fragmented. This scoping review aimed to systematically map the evidence linking physical activity and sedentary behavior with cognitive outcomes in children and adolescents, examine dose-response patterns, synthesize underlying neurobiological mechanisms (including brain-derived neurotrophic factor and neuroplasticity), and evaluate the moderating influence of screen time and smartphone-related behaviors. The review followed PRISMA-ScR guidelines and the Joanna Briggs Institute methodology. Six electronic databases (PubMed/MEDLINE, Scopus, Web of Science, SPORTDiscus, PsycINFO, and CINAHL) were searched for studies published between January 2000 and March 2026. Eligibility criteria were defined using the Population-Concept-Context framework. Two independent reviewers conducted screening, achieving strong inter-rater reliability (κ = 0.84). Of 2,843 records identified, 60 studies met inclusion criteria across four thematic domains: physical activity and cognitive outcomes, dose-response parameters, neurobiological mechanisms, and screen-based sedentary behavior including nomophobia. Chronic physical activity, particularly in school-based and clinical ADHD settings, was consistently associated with executive function improvements across included systematic reviews and trials. Screen time exceeding 4 h per day was associated with anxiety, depressive symptoms, and attentional deficits in observational data. Evidence on exercise-induced BDNF upregulation, contingent on structured exposure (≥3 sessions/week, ≥12 weeks), is restricted to five pediatric RCTs and warrants cautious interpretation. This scoping review maps consistent associations between physical activity and improved cognitive function in youth, mediated through neurobiological pathways that vary in strength across study designs and populations. Excessive screen exposure is associated with cognitive risk in observational data. Integrated public health frameworks addressing physical activity, screen time, and sleep represent a priority direction for future longitudinal research and policy development.
For the past 4 decades, researchers have relied on the Craig-Gordon model to estimate and simulate the deuterium and oxygen-18 isotopic fractionation effects of hydrologic processes on surface waters, soils and vegetation. In parallel, researchers focussed on the relationship between tissue free water and organically bound tritium in plants have used deuterium as an anolog for tritium in sensitive laboratory settings. In this proof-of concept investigation, plant process applications of the enhanced Craig-Gordon model are parameterized for tritium to assess the influence of a range of controls on organically bound tritium formation in plants. Simulation results identify the interplay of humidity, soil porewater tritium and tritium in air on free water and organically bound tritium formation in plant tissues. Regulatory transfer factor model simulations are compared with the enhanced Craig-Gordon simulation results, showing agreement between the two only under specific conditions. The proof-of-concept results presented here are promising in that they identify the mechanisms that can results in OBT concentrations exceeding regulatory model predictions. Although promising as a proof-of-concept, laboratory and field testing of the approach is required for verification.
To scope the current European landscape of multi-modality cardiovascular imaging practices in immune-mediated inflammatory diseases (IMIDs). An electronic (e)-survey was distributed to members of the European Association of Cardiovascular Imaging (EACVI) about imaging in cardio-rheumatology. A parallel e-survey focused on the use of coronary computed tomography (CT) for cardiovascular disease (CVD) risk stratification in IMIDs was conducted via the British Society of Cardiovascular Imaging (BSCI). Of the total 111 respondents to the EACVI survey, 92 (82.9%) were consultant-grade physicians and 68 (61.3%) worked in tertiary centres. These individuals had varied experiences in cardio-rheumatology, with limited access to dedicated cardio-rheumatology services and training opportunities. Sixty-nine (62.2%) used coronary CT to guide preventive therapies in IMID patients with borderline risk scores and cardiac symptoms, with a preference for coronary CT angiography over coronary artery calcium scoring alone in this setting. These findings about coronary CT were corroborated in the parallel survey of 54 BSCI members. When using cardiovascular magnetic resonance imaging (CMR) to detect myocardial involvement in IMIDs, 73/111 (67.6%) perceived a need for IMID-specific CMR criteria beyond the current modified Lake Louise criteria for myocarditis. In terms of nuclear imaging, timely access to 18F-fluorodeoxyglucose positron emission tomography imaging was identified as a barrier for diagnosing large-vessel vasculitis, and 61/111 (57%) of responders felt that the development of novel radionuclide tracers should be a future research priority. This European survey highlights the need for dedicated cardio-rheumatology services and specialist training, and further evidence to inform future clinical practice recommendations on multi-modality cardiovascular imaging in IMIDs.