Alcohol health warning labels are an important part of a comprehensive alcohol policy, but there is a lack of recent implementation data across Europe. This study examined the presence, content and format of health warnings across 13 European countries. Store audits were conducted across 32 stores in 23 cities. The sampled products were assessed for the presence, topic and format of health warnings. Among the 1636 investigated products, 69.7% displayed health warnings. The most common topics were pregnancy (68.0%), drink-driving (21.4%) and age restrictions (16.6%), followed by responsible drinking messages (6.9%) and health harms due to alcohol use (0.3%). About one in four (26.7%) products contained a multi-topic warning. The majority of products featured only a pictogram (62.3%), while 6.7% included both pictogram and text, and 0.7% contained text only. Lithuania, France and the Netherlands had the highest proportions of products displaying at least one warning (above 90%). Proportions were lowest in Croatia, Poland, Slovenia and Greece (under 50% of products with health warnings). Existing warnings predominantly focus on messages relevant to at-risk population groups rather than on alcohol harms affecting the general population. The current implementation largely reflects the alcohol producers' voluntary commitments, although the highest implementation is found in countries with existing legislation. There is underutilised potential to inform Europeans about the health harms of alcohol through warning labels. Stronger regulatory approaches at the EU or Member State level could improve the quality of information provided directly to consumers.
In recent years, there has been an increase in studies reporting on effective child language interventions for people with or at risk for (Developmental) Language Disorder ((D)LD). However, the translation of this evidence into practice has been impeded by under-specified intervention reporting, specifically on what the active ingredients of therapy are and how they are defined. This systematic review forms part of a larger research programme conducted by the Intervention Consensus for Language Disorder group. To identify, summarise, and synthesize how the active ingredients of oral language interventions for children with or at risk for (D)LD have been labelled, defined, described, and classified in empirical and clinical literature. This registered review (PROSPERO ID CRD42024541407) adhered to PRISMA guidelines. Search terms were included in seven electronic databases. Included literature comprised peer-reviewed oral language intervention studies (published in English, German, Portuguese, Croatian, Italian, or Finnish; between January 2019 and May 2024; and reporting on participants who were ≤ 18 years, with/at risk for (D)LD); intervention-focused taxonomies; intervention manuals (published in the last 10 years); and textbooks used to teach child language interventions in pre-registration Speech and Language Therapy/Pathology courses (identified through the Whatworks database and a social media survey, respectively). Data extraction was guided by the TIDieR checklist with additional items deemed relevant for this review. 9576 articles were identified and screened; 619 were included for full text screening; and 243 articles were included in the review. Significant reporting inconsistencies were evident, including identical labels masking different mechanisms, as well as similar mechanisms operating under different labels; conflation of discrete techniques and procedures; the application of common labels in multiple ways; the use of unfamiliar terminology to refer to familiar techniques; and the use of broad terms masking multiple active ingredients. These inconsistencies do not align with what is considered well-specified active ingredients and consequently, significantly impede intervention replication and cross study comparisons. This review highlights the need to develop consensus on (1) how active ingredients of intervention are labelled and defined so that they are consistent, precise and non-overlapping and (2) a comprehensive integrative taxonomy for ease of understanding and use, when reporting on oral language interventions for children with or at risk for (D)LD. What is already known on this subject Oral language interventions contain numerous proposed 'active ingredients', but these are reported with substantial inconsistency across studies, textbooks, and intervention manuals. In addition, different taxonomies classify similar elements in divergent ways. What this paper adds to the existing knowledge We have provided the first comprehensive analysis demonstrating the extent of inconsistency, ambiguity, and conceptual overlap in how active ingredients are labelled and described in the oral language intervention literature. There is misalignment across current taxonomies and we lack an internationally agreed framework that integrates discrete active ingredients along with dosage and contextual active support ingredients. What are the potential or actual clinical implications of this work? Without clear, shared definitions of active ingredients, clinicians cannot reliably interpret research, replicate interventions, or implement evidence-based practices with fidelity. A unified internationally agreed lexicon and taxonomy would enable clinicians to understand precisely what constitutes a given technique, how it should be delivered, and what child behaviours it is intended to influence, strengthening the quality and consistency of intervention delivery.
Increases in colorectal cancer (CRC) incidence among young adults were reported in 27 countries/territories worldwide, yet information on mortality trends is limited. Using the WHO Mortality database (1990 to 2023), we found CRC mortality rates among younger adults (25 to 49 years) increased in 18 of 49 countries (0.7-4.3%/year) during the most recent decade, decreased in 15, and were otherwise stable. Trends ranged from decreases of > 2%/year in Singapore, Belgium, and Denmark to increases of > 3%/year in Paraguay, Uruguay, Chile, and the UK. In half of the countries with increasing trends, rates in older adults (50 to 79 years) were stable (Colombia, Philippines, Croatia [women only]) or decreasing (Uruguay, the U.K., Australia, Canada, the U.S., Argentina). In the remainders-primarily in Latin America/the Caribbean-mortality rose in both groups. Increasing CRC mortality among younger adults may signal a growing future burden, reinforcing the need for etiologic investigation and heightened awareness to avert deaths through earlier detection.
Trunk muscle endurance is important for injury prevention and performance in tennis due to repetitive rotational and high-range motion loads. Normative data for youth tennis players is have not been established and the influence of body size and competitive rank on these measures remains unclear. The aim of this study was to establish age- and sex-specific reference values for trunk endurance and to examine the influence of body size and competitive success on endurance capacity. A total of 214 young tennis players (115 males, 99 females; age=14.1 ± 2.3 years) registered with the Croatian Tennis Association. Participants were stratified by national ranking into high-achieving (HA; ranked top 30) and low-achieving (LA) groups. Trunk flexor endurance was measured using the plank test, and trunk extensor endurance was measured using the Biering-Sørensen (s). Covariates included age, sex, height, and weight. In female players, HA participants demonstrated significantly better trunk extensor endurance than LA participants (F = 5.35, p = 0.023) after controlling for body size. No significant differences in endurance were found between HA and LA males (p > 0.05). Regression analysis showed that body height and weight were not significantly associated with test performance in either sex (p = 0.08-0.98). Females in the U18 category significantly outperformed males in the Biering-Sørensen test (p < 0.01). The key findings of the present study indicate that neither height nor weight are significantly correlated with the core strength and endurance of the back muscles in both male and female young tennis players. Player level significantly influences the results of the plank and Biering-Sørensen tests in females, whereas in males, differences are not statistically significant after accounting for body size. These results highlight the importance of structured trunk endurance training, particularly for female players, where core performance appears to be closely related to competitive success. Age and sex-specific normative values for these tests may assist coaches and researchers in evaluating, monitoring, and developing core strength and endurance in youth tennis populations, with potential implications for improving performance and injury prevention.
This systematic review assesses current evidence on the management of non-plaque (dental biofilm)-induced gingival diseases and conditions (NPIGDs), including (i) inflammatory and immune conditions, (ii) neoplasms and (iii) gingival pigmentations. To address the question 'How should NPIGDs affecting the gingiva be managed?' specific searches were conducted in four electronic databases to identify clinical studies evaluating the effectiveness of any intervention for NPIGDs in patients of all ages. All descriptive and analytical study designs were eligible, provided they described conditions presenting at the gingival level. Over a total of 6111 articles initially identified, 461 met inclusion criteria. Reports ranged from case reports to randomised controlled trials. Overall evidence quality was moderate to very low, reflecting highly heterogeneous literature published over the past 50 years. Treatment approaches varied substantially depending on whether the condition was primarily gingival (e.g., leukoplakia, pigmentations) or a gingival manifestation of a systemic disease (e.g., leukaemic infiltration). Potentially malignant and malignant gingival lesions required careful evaluation and biopsy for diagnosis, followed by surgical management, typically involving radical excision. Gingival pigmentations were most often managed by dentists and, generally, only when patients expressed aesthetic concerns. NPIGD management is challenging due to the heterogeneity of these conditions and often requires multidisciplinary care. Dental professionals must conduct thorough clinical assessments, identify prognostic factors, perform appropriate screening and diagnosis and select the most suitable treatment strategy-which frequently includes referral to medical or oral medicine specialists, especially for potentially malignant or malignant gingival lesions.
This paper examines how Water-Energy-Food (WEF) Nexus projects, as perceived by a European expert sample drawn primarily from academia, can help bridge the gap between academia and practice to achieve greater long-term impact. Drawing on an expert survey, particularly involving members of the EU-based NexusNet COST Action, the study aims to assess the current status of WEF+ Nexus projects (NPs), identify perceived impact dimensions, and evaluate the effectiveness of existing approaches to their design, governance, and implementation. Survey findings reveal perceived key challenges and barriers to achieving lasting project impact, including limited understanding of the Nexus approach. Predominantly academic respondents point to a perceived disconnect between research and practice, which they associate with insufficient systematic impact assessment and weak policy implementation, alongside siloed institutional structures, and resistance to change. In response, the authors propose a set of practical impact indicators and tailored recommendations for improving WEF+ NP design and implementation. These recommendations emphasize mainstreaming Nexus thinking in education and capacity building, enhancing stakeholder engagement, strengthening cross-sectoral collaboration, ensuring policy coherence, and securing sustainable financing for WEF+ initiatives. By addressing these factors, the study supports the development of more integrated and transdisciplinary solutions and calls for further refinement of impact measurement tools to better capture the real-world contributions of WEF+ NPs to sustainable development.
Adrenocortical carcinoma (ACC) in children is a rare and aggressive malignancy. Despite representing a small fraction of pediatric adrenal tumors, ACC poses distinct challenges due to its heterogeneous biological behavior, frequent hormone secretion, and the limited availability of standardized, pediatric-specific treatment protocols. Complete surgical resection remains the cornerstone of curative intent therapy, and complete adrenalectomy offers the best chance for long-term survival. Given the aggressiveness of ACC, particularly in advanced disease, adjuvant therapies are often considered to improve outcomes. The aim of this consensus meeting was to bring together international experts to develop international guidance based on the best available evidence and collective clinical experience to harmonize long-term management. A modified three-step Delphi consensus method was used to finalize the statements from an international panel of pediatric ACC experts from four continents (Europe, the Americas, and Asia, and Oceania). An electronic survey was developed by the steering committee (ENSAT Kids) and distributed to the panel. Agreement and disagreement were rated using a six-point Likert scale with the opportunity to provide structured feedback. Consensus was defined a priori as ≥75% agreement. This Delphi process yielded consensus statements for therapy guidance, comprising 12 surgical statements and 68 medical treatment statements, organized by strategy and disease stage. These statements are intended to support clinicians in delivering more consistent and standardized therapeutic strategies for pediatric ACC. Future efforts should prioritize the design and conduct of high-quality, collaborative research studies in order to provide more evidence and therapy improvements.
The emergence of high-cost therapies, particularly in oncology, rare diseases, and advanced therapy medicinal products, has increased the need for robust pharmacoeconomic evaluations to support healthcare decision-making. These innovative interventions often promise substantial clinical benefits but also pose challenges due to limited long-term data, high upfront costs, and uncertain cost-effectiveness. This narrative review critically examines key pharmacoeconomic frameworks, e.g. cost-effectiveness analysis and cost-utility analysis, and highlights their limitations in assessing such novel therapies. The role of real-world evidence, advanced modeling techniques, and patient-reported outcomes is explored, alongside the ethical and policy considerations that arise in pricing, access, and reimbursement. Recent literature and case studies involving gene and cell therapies are reviewed, illustrating the complexity of determining value under uncertainty. The paper advocates for a more flexible, transparent, and patient-centered approach to health technology assessment, integrating societal values and dynamic reassessment mechanisms. Such strategies are essential for achieving sustainable access to high-value therapies while maintaining health system efficiency and equity.
The aortic valve-sparing procedure has been performed for more than 2 decades and has proven durable results in several aortic and root phenotypes. Few studies have analyzed the impact of aortic valve regurgitation on the need for leaflet repair and outcomes after trileaflet aortic valve-sparing surgery. The aim of this study is to analyze in a large cohort the clinical and echocardiographic outcomes of trileaflet aortic valve-sparing surgery in patients with aortic root dilatation, focusing on the impact of preoperative aortic regurgitation and cusp repair. We extracted the data from the Heart Valve Society Aortic Registry (previously also known as AVIATOR). We selected patients with trileaflet aortic valves undergoing operations for aortic root dilatation (root/ascending aorta ≥45 mm) by the valve-sparing procedure. The primary outcome was the incidence of moderate or more aortic insufficiency and progression level of aortic insufficiency of at least 1 grade at follow-up. A cusp repair score was created as the cumulative sum of all leaflet repair techniques used per patients. A total of 1116 patients were included in the analysis. Mean age of patients was 53 ± 15 years, and 84% were male. The observed incidence of moderate/severe aortic insufficiency at 1, 5, and 10 years was 0.7%, 3%, and 6.8%, respectively. Both moderate or more aortic insufficiency and progression of aortic insufficiency by 1° increase significantly with time. Preoperative aortic insufficiency and the need for additional clamping sessions were independent predictors of aortic insufficiency progression, whereas the cusp repair score increases the risk of aortic insufficiency of moderate or more. In patients with trileaflet aortic valves undergoing sparing surgery, preoperative aortic insufficiency and the need of a more extensive cusp repair increase the long-term risk of aortic insufficiency. Time also impacts the recurrence of aortic insufficiency or its increase.
Roemheld (gastro-cardiac) syndrome describes cardiac symptoms precipitated by gastrointestinal pathology, typically gastric distension or hiatal hernia. Foreign body ingestion is common, but retention of long objects such as toothbrushes is rare and usually requires endoscopic removal. We present an unusual case of acute heart failure with restrictive filling pattern and markedly elevated NT-proBNP, in which cardiac symptoms resolved after extraction of two retained toothbrushes from the stomach. A 44-year-old woman was admitted for progressive dyspnoea, 6-kg weight gain, and NT-proBNP of 853 pg/mL. Echocardiography revealed restrictive diastolic dysfunction. After IV furosemide, diuresis reached 4 L in the first 24 h. Cardiac magnetic resonance showed preserved ejection fraction and no structural abnormalities; however, two foreign bodies were incidentally visualized within the stomach. Gastroscopy was performed and two toothbrushes were removed. Total diuresis reached 12 L and NT-proBNP decreased to 58 pg/mL by Day 3. Psychiatry evaluation excluded psychosis or self-harm intent; the patient denied ingestion. She reported wearing complete dentures due to early onset periodontitis at age 33. Symptoms resolved completely after extraction. This case supports that gastric retention of foreign bodies may trigger or exacerbate heart failure via gastric distension, vagal stimulation, and impaired venous return-a form of Roemheld gastro-cardiac syndrome.
p27, a cyclin-dependent kinase inhibitor, functions as a tumour suppressor in the nucleus but may acquire oncogenic properties when mislocalized to the cytoplasm. While KRAS mutations can induce p27 phosphorylation and cytoplasmic retention, the regulation and significance of p27 expression in wild-type (WT) KRAS colorectal cancer (CRC) remain unclear. This study investigated the relationship between WT KRAS status and p27 localization, as well as the potential roles of miR-221/222 expression and the CDKN1B V109G polymorphism in CRC susceptibility. Immunohistochemical analysis of 50 WT KRAS CRCs and adjacent normal tissues revealed the highest percentage of p27-positive cells in the superficial layer of normal mucosa and significantly fewer in the tumour center. WT KRAS tumours with KRAS expression showed increased p27 expression and predominant cytoplasmic localization at the invasive front, suggesting altered p27 subcellular distribution. miR-221/222 expression showed no correlation with p27 levels, and the CDKN1B V109G polymorphism was not associated with CRC risk. This study is the first to examine p27 localization in WT KRAS CRC. The observed association between WT KRAS expression and cytoplasmic p27 localization highlights a potential mechanism contributing to tumour progression through altered p27 function.
This study reports the design, synthesis, and biological evaluation of novel resveratrol-inspired thieno-benzimidazole and thieno-oxazole derivatives as potential therapeutics for Alzheimer's disease. The research is grounded in the cholinergic hypothesis, which links cognitive decline to reduced acetylcholine levels due to enzymatic degradation by acetylcholinesterase (AChE) and butyrylcholinesterase (BChE). Given the increasing relevance of BChE in later disease stages, the focus was placed on developing selective BChE inhibitors. A series of 14 compounds was synthesized using multi-step organic reactions, including Wittig reactions, Vilsmeier formylation, and cyclization strategies. Structural confirmation was achieved through NMR and mass spectrometry. The studied acetylated derivatives exhibit photochemical instability due to efficient trans-cis isomerization and subsequent secondary processes under UV irradiation, necessitating strict light protection during handling, storage, and application. Biological evaluation revealed that all compounds selectively inhibited BChE, with no significant AChE inhibition observed. Among them, carbamate-oxazole derivative 14 exhibited the highest potency (IC50 = 0.248 μM), outperforming the reference drug rivastigmine. Several other derivatives showed moderate to strong activity, with oxazole-based compounds generally outperforming benzimidazole analogs. In addition to enzyme inhibition, antioxidant activity was assessed using the DPPH and CUPRAC assays. Compound 8 exhibited the strongest radical-scavenging activity, comparable to that of Trolox. Molecular docking and dynamics simulations provided insight into binding interactions, highlighting key π-π stacking and hydrogen bonding within the BChE active site. Furthermore, in silico genotoxicity analysis indicated that the most active compounds lack mutagenic potential. Overall, the study identifies promising multifunctional candidates combining selective BChE inhibition, antioxidant properties, and favorable safety profiles, supporting their potential as lead compounds for Alzheimer's disease therapy.
Palladium disulfide (PdS2), a noble-metal transition metal dichalcogenide with an unusual puckered orthorhombic structure, is of interest for fundamental research and optoelectronic applications due to its distinctive optical properties. Despite this potential, PdS2 itself remains relatively underexplored. Here, we characterize the steady-state and ultrafast optical properties of multilayer PdS2 film using polarization-dependent Raman and second-harmonic generation microscopy, ellipsometry, and ultrafast differential reflectance. We extract the dielectric function, an indirect bandgap of 1.25 eV and confirm the 2O phase. Ultrafast measurements reveal multi-timescale dynamics, including a two-step decay (370 fs and 1.1 ps) and blueshift during photoinduced carrier relaxation, as well as coherent phonon oscillations of the Ag1 optical mode. Long-lived carrier recombination is described by a biexponential decay with time constants of 240 ps and 2 ns. These results provide insight into the ultrafast dynamics and optoelectronic properties of PdS2, and may open new possibilities for its use in photonic and optoelectronic devices.
Digital health offers opportunities for safe, equitable, and accessible care, and its integration into respiratory care is a strategic priority for the European Respiratory Society. However, sustainable implementation remains complex, and guidance for health care systems is limited. This study aimed to undertake a scoping review of the published initiatives that have implemented digital respiratory technologies into real-world routine clinical practice over the past decade, identify the technologies used, implementation strategies used, the challenges and supports they encountered, and the lessons they reported for making care more equitable, strengthening patient-professional relationships, improving the patient journey, and reducing environmental impact. Following Arksey and O'Malley's methodology, we searched ten databases (December 2013-2023 [updated April 2025 and February 2026]): MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Library, Web of Science, Scopus, IEEE Xplore, CABI Global Health, and WHO Medicus; and used key domains in the commonly used implementation frameworks such as the Consolidated Framework for Implementation Research (CFIR), Nonadaptation, Abandonment, and Challenges to the Scale-up, Spread, and Sustainability of Health and Care Technologies (NASSS), and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to categorize results and understand methodologies used. As a scoping review, we mapped the available evidence, rather than synthesizing outcomes, appraising study quality, or estimating effectiveness. To broaden coverage and strengthen interpretation, we crowdsourced additional studies and sought feedback on our preliminary findings from a network of respiratory experts across 17 countries. Overall, 24,672 studies were identified; after deduplication, 14,811 were screened; 84 studies from 31 countries were included in the final review. The digital respiratory technologies comprised apps, platforms, chatbots, and smart devices. Reported technological functionalities encompassed remote consultation, clinician monitoring, video directly observed therapy, remote rehabilitation training, self-management support, education, monitoring medication adherence, and a school-based remote clinic. CFIR, RE-AIM, and the plan-do-study-act (PDSA) cycle were the most widely used frameworks. Successful implementation used simple technologies that fitted existing workflows and avoided additional workload. Co-development and trust-building with end-users influenced motivation and adoption, while leadership, team cohesion, and communication facilitated success. Barriers included insufficient resources, poor interoperability, lack of funding and reimbursement, and limited technical support. This scoping review provides a cross-condition review of digital respiratory technologies implemented in routine clinical practice. Unlike previous disease-specific or experimental-focused reviews, our innovative approach used established implementation Theories, Models, and Frameworks (TMFs) to identify shared barriers and enablers across diverse populations and health care systems. We summarize key implementation domains in state-of-the-art digital respiratory care and identify major gaps related to health equity, patient-clinician trust, continuity of support, and environmental sustainability. These findings emphasize the value of using implementation TMFs for scaling effective, patient-centered digital respiratory care in real-world settings.
Epstein-Barr virus (EBV) has been implicated in the pathogenesis of multiple sclerosis (MS). Elevated immunoglobulin G (IgG) titers against EBV nuclear antigen 1 (EBNA1) represent the most consistent serological marker of MS risk, with levels remaining persistently elevated following disease onset. We conducted high-dimensional profiling of virus-specific antibody-associated immune features in 60 individuals with relapsing-onset MS followed over time and in 54 age- and sex-matched EBV-seropositive healthy controls. EBNA1-specific IgG in MS patients exhibited a distinct proinflammatory Fc signature, characterized by increased affinity for Fc γ receptors (FcγRs) and enhanced Fc-mediated effector functions, including antibody-dependent phagocytosis, complement activation, and natural killer cell engagement. This signature was not observed for antibodies against other common viral antigens and showed a strong association with MS. Increased FcγR binding by IgG, specific for both EBNA1 and the lytic EBV glycoprotein 350 (EBV-gp350) correlated with disease activity, defined as clinical relapse and/or presence of contrast-enhancing brain lesions (CELs). Both fragment antigen-binding and pro-inflammatory functional Fc-mediated features contribute to the association between EBNA1-specific antibody responses and MS. Fc effector functions of EBV-specific antibodies may actively participate in promoting focal disease activity in MS. ANN NEUROL 2026.
We explore how minimal neural networks can invert the renormalization group (RG) coarse-graining procedure in the two-dimensional Ising model, effectively dreaming up microscopic configurations from coarse-grained states. This task, formally impossible at the level of configurations, can be approached probabilistically, allowing machine-learning models to reconstruct scale-invariant distributions without relying on microscopic input. We demonstrate that even neural networks with as few as three trainable parameters can learn to generate critical configurations, reproducing the scaling behavior of observables such as magnetic susceptibility, heat capacity, and Binder ratios. A real-space renormalization group analysis of the generated configurations confirms that the models capture not only scale invariance but also reproduce nontrivial eigenvalues of the RG transformation. While the inversion is necessarily imperfect, these minimal models robustly reproduce the RG-relevant structure of the critical distribution. Surprisingly, we find that increasing network complexity by introducing multiple layers offers no significant benefit. These findings suggest that simple local rules, akin to those generating fractal structures, are sufficient to encode the universality of critical phenomena, creating an opportunity for efficient generative models of statistical ensembles in physics.
Histopathological placental inflammation provides objective evidence of intrauterine inflammatory exposure in preterm birth, but placental histopathology is not immediately available after delivery. We aimed to determine whether placental inflammatory pathology is associated with cord blood and postnatal inflammatory biomarkers in preterm infants. In this prospective cohort study, 87 preterm infants with birth weight < 2500 g were enrolled. Cord blood collected at birth was analyzed for procalcitonin (PCT), presepsin (P-SEP), and high-sensitivity C-reactive protein (hs-CRP). Placentas were categorized as no pathological findings, inflammatory placental pathology, or other placental pathology. Exploratory lesion-specific analyses further classified inflammatory lesions as maternal inflammatory response only (MIR-only) or fetal inflammatory response present (FIR-present). Multiple linear regression models with log-transformed outcomes were used to examine associations between inflammatory placental pathology and cord blood PCT and postnatal CRP after adjustment for perinatal covariates. Fifteen infants (17%) had inflammatory placental pathology. Cord blood PCT differed significantly between the primary placental pathology groups and was highest in infants with inflammatory placental pathology (P = 0.001), whereas cord blood P-SEP and hs-CRP did not differ significantly. Postnatal CRP was also higher in infants with inflammatory placental pathology (P = 0.004). In adjusted binary models, inflammatory placental pathology remained associated with higher cord blood PCT (adjusted fold change 2.31, 95% CI 1.50-3.55; P < 0.001) and higher postnatal CRP (adjusted fold change 4.66, 95% CI 2.23-9.76; P < 0.001). Exploratory lesion-specific analyses showed stepwise increases in cord blood PCT and postnatal CRP from no inflammatory lesion to MIR-only and the highest values in FIR-present cases (overall P = 0.003 and P = 0.002, respectively). Culture-confirmed or clinically diagnosed EOS and microbiological positivity were more frequent in infants with inflammatory placental pathology. Histopathological placental inflammation in preterm infants was associated with higher umbilical cord PCT and higher postnatal CRP. Cord blood PCT showed the most consistent association with inflammatory placental pathology, including in exploratory analyses of fetal inflammatory response lesions. These findings support the potential clinical relevance of clinically available inflammatory biomarkers in relation to placental inflammatory pathology, but larger studies are needed to confirm lesion-specific associations and clarify their clinical utility.
National income level influences the prevalence and outcomes of cardiovascular disease (CVD), with lower-income countries contributing disproportionately to the global CVD burden. Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) requires specialised equipment, increasing procedural costs. However, whether national income level contributes to disparities in managing patients with CTO remains unclear. To compare the clinical profiles, procedural settings and outcomes of patients undergoing CTO-PCI in middle-income countries (MICs) and high-income countries (HICs). This cross-sectional study included 15,329 patients who underwent CTO-PCI between 2021 and 2023. Data were obtained from the European Registry of Chronic Total Occlusions (ERCTO). Of the 24 enrolling countries, 7 were classified as MICs and 14 as HICs. Patients in HICs were older (67 ± 10 vs 61 ± 10 years; p < 0.001) and presented with greater CTO complexity (J-CTO score: 2.31 ± 1.25 vs 1.99 ± 1.17; p < 0.001). Conversely, patients in MICs were more likely to have diabetes (35% vs 29%; p < 0.001) and to be active smokers (59% vs 49%; p < 0.001). Patients in MICs had lower use of mechanical cardiac support (0.1% vs 0.8%; p < 0.001), advanced calcific plaque modification devices (1% vs 6.1%; p < 0.001), and intravascular ultrasound (14% vs 25%; p < 0.001). MICs achieved higher procedural success (89.5% vs 90.5%; p = 0.07) but higher mortality compared to HICs (0.6% vs 0.2%; p < 0.001). Among a selected population of patients undergoing CTO-PCI, notable clinical, anatomical, and procedural differences exist between MICs and HICs. These findings highlight the importance of tailoring public health strategies to optimise cardiovascular care across diverse economic settings.
Sarajevo is the most PM2.5-polluted European capital (IQAir Report, 2024); however, fine aerosol measurements' studies in the city are scarce. This study presents the results of an 8-month campaign in Sarajevo site focusing on organic aerosol (OA) and equivalent black carbon (eBC) and their respective sources. The mean PM1 campaign concentration in Sarajevo is 34.2 μg·m-3 with significantly higher contributions in winter stagnation episodes during which daily concentrations can exceed 100 μg·m-3. Furthermore, the number of daily PM1 concentrations during this 8-month campaign exceeding the EU legislation PM2.5 limit value are more than 4 times the stated maximum number of days per year. The eBC sources consist of liquid fuel (eBClf, 62%), and solid fuel (eBCsf, 38%) combustion, the latter proportion being higher than in other European sites. OA source apportionment results revealed 4 factors: hydrocarbon-like OA (HOA, 15%), two solid fuel combustion OA (SFOA1, 31%; SFOA2, 9%), and oxygenated OA (OOA, 44%). HOA and eBClf are related to traffic emissions; SFOA1, SFOA2, and eBCsf are associated with residential heating, although SFOA2 potentially reflects additional regional combustion sources; and OOA shows regional, secondary aerosol characteristics with biomass burning emissions influence. Accordingly, Sarajevo's burden from air pollution could lead to all-cause mortality on the order of 10% during its heavy-polluted episodes. Overall, the submicron aerosol in Sarajevo constitutes a hotspot of fine aerosol pollution in comparison to other European sites both in its absolute concentrations and its relative proportion of biomass burning and SO42-, making this hotspot more comparable to those observed in other global hotspots than to typical European urban backgrounds.
The present guideline updates the initial ESCD patch testing guideline, summarizing all aspects of patch testing for the diagnosis of contact allergy in patients suspected of suffering, or having been suffering, from allergic contact dermatitis or other delayed-type hypersensitivity skin and mucosal conditions. Sections with brief descriptions and discussions of different pertinent topics are followed by highlighted short practical recommendations, which have been consensualized in a Delphi process. Topics comprise, after an introduction with important definitions, materials, technique, modifications of epicutaneous testing, individual factors influencing the patch test outcome or necessitating special considerations, children, patients with occupational contact dermatitis and drug eruptions as special groups, patch testing of materials brought in by the patient, adverse effects of patch testing and the final evaluation and patient counselling based on this judgement. Finally, short reference is made to aspects of (continuing) medical education and to electronic collection of data for epidemiological surveillance.